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Methods@#Fifty-one discs were obtained from patients undergoing surgery for herniated disc. Their ages ranged from 19-65 years, and 31/51 were male. Pre-surgical T1 and T2 weighted lumbar-spine MRIs were analyzed to observe Pfirrmann grade, VEP defects, herniation type, Modic changes, and high-intensity zones (HIZ) at the affected level. Five-micron thick sections were stained with hematoxylin and eosin, Alcian blue periodic acid–Schiff stain; examined for histological degeneration scores (HDS; 0–15), inflammation (0 [absence]–3 [severe]), and presence of cartilaginous endplate (CEP). Three-micron thick sections were stained with protein-gene-product 9.5 and expression was counted/mm2. Data was analyzed, and p<0.05 was considered to indicate statistical significance. @*Results@#VEP defects, Modic changes, and HIZ were respectively observed in 30/51, 16/51, and 6/51 of the samples. CEP was observed in 26/51 samples and in 23/51 with endplate defects. Discs with adjacent VEP defects showed increased HDS (p<0.001) and inflammation (p<0.001). Discs with adjacent Modic changes also revealed increased HDS (p=0.01). Histological sections with CEP showed increased HDS (p<0.001) and inflammation (p<0.001), and nerve density was significantly positively correlated with HDS (r=0.27, p=0.02). @*Conclusions@#VEP changes can modulate degeneration and inflammation of herniated discs. Presence of these changes is highly predictive of the occurrence of CEP in herniated discs, which leads to slow resorption and persistent clinical symptoms.
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Background Although blood urea nitrogen (BUN), creatinine (Cr) and electrolytes are not the mainstay of diagnosis in acute coronary syndrome (ACS) patients but they may have a role in providing a more detailed view of the complications and mortality rates. The aim of this study was to determine the efficacy of these parameters in the diagnosis and mortality risk-assessment of patients with ACS. Methodology A total of 200 patients with ACS were recruited in this prospective study. The relationship of serum BUN, Cr and electrolytes with cardiac enzymes, Global Registry of Acute Coronary Events (GRACE) and mortality was assessed during a 6-months follow-up. Statistical test like multivariate linear regression and binary logistic regression analysis were applied. Results On multivariate linear regression analysis, serum potassium (K) (Unstandardized Coefficient B = −3.77; p = 0.04) showed significant negative association with Creatine Kinease and serum BUN (Unstandardized Coefficient B = 0.52; p = 0.001) showed significant positive association with Troponin I. The patients with GRACE > 105 had significantly higher levels of serum BUN and Cr. Receiver operating characteristic curves showed that area under curve (AUC) of BUN (0.7) was higher than AUC of Cr (0.5). Multiple adjusted model showed that patients with BUN > 32.5 mg/dl were almost 20 times more likely to be associated with mortality as compared to reference group. Conclusion In addition to cardiac enzymes, K along with BUN and Cr may serve as important aid in diagnosis of ACS. BUN and Cr may also serve as important tools in mortality-risk assessment of ACS patients.
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Background Recent studies have shown that complete blood count (CBC) parameters can effectively predict long-term mortality and re-infarction rates in acute coronary syndrome (ACS). However, the role of these parameters in predicting short term mortality has not been studied extensively. The main objective of this study was to determine whether CBC parameters can predict 30-days mortality and the incidence of major adverse cardiac event (MACE) in ACS patients. Methodology A total of 297 patients with ACS were recruited in this prospective study. The relationship of baseline white blood cell (WBC) to mean platelet volume ratio (WMR) with MACE and mortality was assessed during a 30-days follow up. The patients were divided into two groups: Group A [WMR < 1000] and Group B [WMR > 1000]. Multivariate COX regression was performed to calculate hazard ratios (HR). Results WMR had the highest area under receiver operating characteristics curve and highest discriminative ability amongst all CBC parameters in predicting mortality. Patients in Group B had a higher mortality rate (p < 0.001) than patients in Group A. WBC count (p = 0.02), platelet count (p = 0.04), WMR (p = 0.008), platelet to lymphocyte ratio (p < 0.001) and neutrophil to lymphocyte ratio (p = 0.03) were significantly higher in the MACE-positive group as compared to MACE-negative. In multivariate cox regression analysis, WMR > 1000 (HR = 2.9, 95% confidence interval 1.3–6.5, p = 0.01) was found to be strongest biochemical marker in predicting mortality. Conclusion WMR is an easily accessible and an inexpensive indicator, which may be used as a prognostic marker in patients with ACS.
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Background: Cases of self insertion of anorectal foreign objects and their extraction maneuvers had occasionally been stated in literature
Objective: To determine the presentation and management of self induced anorectal foreign bodies
Methodology: Retrospective data of anorectal foreign bodies from 1 March, 2010 to 30 September, 2015 was collected and analyzed in this cross sectional study. Atotal of 17 male patients presented with foreign bodies in lower gastrointestinal tract were included in this study. Information regarding detailed clinical history, digital rectal examination, proctoscopy, sigmoidoscopy, plain abdominal radiograph and surgical and nonsurgical treatments were collected and analyzed. Details of intraoperative or postoperative complications, observed mortality or morbidity and condition at discharge, were also noted and analyzed, by using SPSS version 20
Results: The mean age of 17 patients included in this multicentered retrospective analysis was 35 +/- 17 years. Anorectal pain was present in 17 [100%] patients while rectal bleeding was observed in 14[82.35%]. Only 7[41.17%] revealed history of foreign body insertion through anus for sexual gratification. Plain abdominal radiograph displayed foreign bodies in 10 patients. In 7[41.17%] patients, foreign bodies were extracted transanally. Ten [58.82%] patients experienced laparotomy for high lying objects. No major or minor postoperative complications were observed. There was no mortality. Mean hospital stay was 2.14 +/- .1.95 days
Conclusion: Anorectal foreign body can present invariably. Low threshold of suspicious is required for early recognition. Management should be planned according to type and best possible facilities availability
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Objective: To assess the diagnostic accuracy of CT scan in detecting paranasal sinus fungal infections
Study Design: Cross-sectional, observational study
Place and Duration of Study: Department of Radiology, Ziauddin University Hospital, Karachi, from April to September 2014
Methodology: Patients with clinical suspicion of fungal sinusitis were included in this study. Patients with already diagnosed or history of recurrent fungal infections were excluded. All these patients underwent CT scan examination of paranasal sinuses. Findings were recorded. Final diagnosis was based on smear analysis for fungal culture. Accuracy analysis was conducted for CT diagnosis using smear analysis as the gold standard. Kappa analysis was conducted to determine agreement
Results: Out of the 120 patients, 71 [59%] were male. The sensitivity, specificity, positive predictive value and negative predictive value of CT were 96.19%, 93.33%, 99.01%, 77.77%, respectively. The diagnostic accuracy was 95.83%. Kappa statistics showed 82% agreement beyond chance
Conclusion: CT scan is highly accurate in diagnosing and characterizing fungal infection of paranasal sinuses. It also determines the extent of disease which eventually aids in deciding the surgical approach to be used
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Objective: To study the diagnostic accuracy of Ultrasound B scan using 10 MHz linear probe in ocular trauma
Methods: A total of 61 patients with 63 ocular injuries were assessed during July 2013 to January 2014. All patients were referred to the department of Radiology from Emergency Room since adequate clinical assessment of the fundus was impossible because of the presence of opaque ocular media. Based on radiological diagnosis, the patients were provided treatment [surgical or medical]. Clinical diagnosis was confirmed during surgical procedures or clinical follow-up
Results: A total of 63 ocular injuries were examined in 61 patients. The overall sensitivity was 91.5%, Specificity was 98.87%, Positive predictive value was 87.62 and Negative predictive value was 99%
Conclusion: Ultrasound B-scan is a sensitive, non invasive and rapid way of assessing intraocular damage caused by blunt or penetrating eye injuries
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Background: Acute abdomen is a surgical emergency and sometimes portrays a challenge as its cause remains unexplained unless explored. Recently, trend of diagnostic laparoscopy in acute abdominal conditions is growing among surgeons due to its benefits of establishing diagnosis and provision of therapy with minimal invasive approach
Objective: To assess the diagnostic and therapeutic utility of laparoscopic surgery in unexplained acute abdominal conditions
Methodology: Fifty three patients, from 1st September 2014 to 30th June 2015, with unexplained acute abdominal conditions on clinical and radiological assessments were subjected to diagnostic laparoscopy. Therapeutic laparoscopic surgery was offered to all diagnosed cases. Resected specimens were directed for histopathological analysis to confirm diagnosis. All patients were followed up to 3 months. The data was entered and analysis by using SPSS version 20
Results: Accurate diagnosis was established successfully in all patients. The outcome of diagnostic laparoscopy was: uncomplicated acute appendicitis in 31[58.49%] patients, complicated acute appendicitis in 5[9.43%] patients, acute cholecystitis in 1[1.88%] patients, pancreatic necrosis in 1[1.88%] patients, mesenteric adenitis in 2[3.77%] patients, caecal mass in 2[3.77%] patients, dual pathologies in 5[9.43%] patients, and gynaecological emergencies in 6[11.32%] patients. We did not need to convert to open surgery for diagnostic or therapeutic purpose in any case. No significant intraoperative and postoperative complications were observed. All patients were discharged within 2 days after surgery except three cases. There was no mortality
Conclusion: Our initial experience showed that diagnostic laparoscopy in acute abdomen is useful in establishing diagnosis, safe to perform and achieves therapeutic goals in almost all patients
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Background: in this arena of minimally invasive surgery, surgeons have been compelled to combat the pathologies through smaller incisions to lessen the toll of surgery in terms of cosmesis
Objective: to describe the outcome of buttonhole access surgery in uncomplicated acute appendicitis
Methodology: this was a quasi experimental study, conducted over a period of four years, 1[st] January 2010 to 31[st] March 2015, we performed appendectomies among 213 thin lean cases [BMI6] through buttonhole access which were attempted through a small incision of 1.5-2cm size placed usually lower down in pelvis so could be hided easily in undergarments. Data regarding demographics, clinical features, operative time, hospital stay, postoperative additional analgesic requirements and complications if any was collected and analyzed through SPSS 20
Results: the mean BMI of the patients was 18.94 +/- 0.88 kg/m[2] and the mean Alverado score at the time of admission was 8.16 +/- 1.01. Through buttonhole access, appendectomies were successfully accomplished in 205 [96.24%] patients [mean incision length 1.887 +/- 0.156 cms]. Mean operative time was 19.69 +/- 6.21minutes. No intraoperative complication was noticed. 209 [98.12%] patients were discharged within 24 hours of operation. The only postoperative complication was small seroma which developed in only 2[0.93%] cases. No scar related complications was observed over a period of six month follow up. There was no mortality
Conclusion: buttonhole access for uncomplicated acute appendicitis is feasible and safe to perform in thin lean patients where diagnosis is sure
ABSTRACT
Background: Single incision laparoscopic appendectomy [SILA] is getting popular but is expansive due to the need of special equipment. Surgeons are thrived to develop different low cost techniques in order to decrease the cost. We herein describe an early experience of our own simplified low cost single incision laparoscopic appendectomy [SILA] technique with use of conventional laparoscopic instruments and a modified suture loop technique among patients with uncomplicated acute appendicitis [UAA]
Objective: To determine the outcome of single incision laparoscopic appendectomy by an innovative suture loop technique among patients with uncomplicated acute appendicitis
Methodology: In this Quasi experimental study we performed SILA in 25 patients of all age and both sexes by using conventional non-reticulating laparoscopic instruments, 0[degree] telescope, two 10mm ports and an innovative percutaneous suture loop [named Saad's loop] to suspend appendix for essential dissection around it. Any intraoperative or postoperative complications were noted. The patients were followed at least till 6 months after surgery
Results: We successfully completed SILA with our technique [Saad's loop] in all patients. The mean number of attempts to engage the loops was 1.76 +/- 0.93 and the mean operative time was 36.72 +/- 11.23 min. Suture loop did not cause trauma to appendix in any case. The mean VAS was 0.20 +/- 0.50. All patients were discharged within two days. No intraoperative or postoperative complications were noted over a period of six months follow up
Conclusion: Our SILA technique with conventional laparoscopic instruments is simple and cost effective in patients with UAA by the use of innovative suture loop to suspend appendix. However, further randomized controlled trials with large sample size are recommended in assessing this new technique SILA to disclose its prospective benefits
Subject(s)
Humans , Male , Female , Adult , Laparoscopy , Appendicitis , Acute Disease , Non-Randomized Controlled Trials as TopicABSTRACT
Dengue virus syndrome is an emerging global health challenge which is endemic in tropical countries like Pakistan. In recent years dengue incidences have increased considerably in different areas of Pakistan with more sever impacts on urban and peri-urban populations. This review is an effort to highlight the changing epidemiology of dengue fever, role of Government of Pakistan in disease management and control using preventive and community based approaches in the region. Moreover, there is an emphasis on application of Wolbachia as novel, inexpensive and environmentally benign candidate for control and eradication of dengue transmitting vectors.
ABSTRACT
Dengue virus syndrome is an emerging global health challenge which is endemic in tropical countries like Pakistan. In recent years dengue incidences have increased considerably in different areas of Pakistan with more sever impacts on urban and peri-urban populations. This review is an effort to highlight the changing epidemiology of dengue fever, role of Government of Pakistan in disease management and control using preventive and community based approaches in the region. Moreover, there is an emphasis on application of Wolbachia as novel, inexpensive and environmentally benign candidate for control and eradication of dengue transmitting vectors.
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Introduction: urinary tract infections are common in women of developing countries which results in substantial morbidity and health care cost. The Urogenital fistula is frequently related to gynecological conditions
Material and Methods: this is a prospective study was carried out in the Department of Nephrology, Abbasi Shaheed Hospital from March 2011 to May 2014. 79 patients with urogenital fistula, irrespective of cause of the fistula, with ages between 18-60 years were included in this study. Patients were referred to nephrology clinic. A detail medical history was taken from each patient for episodes of urinary tract infection and the treatment given during the last six months. Patients were educated how to collect midstream morning urine sample. Urine sample were taken from all symptomatic and asymptomatic patients for culture examination and send to laboratory within an hour
Results: we have found that out of 72 patients studied for UTI, 89 percent of the studied patients had culture proven UTI. Recurrent UTI is very common in patients with uro-genital fistulas and 72 percent of patients experienced an average of 03 episodes of symptomatic UTIs during last six months. Relapses are more frequent than re-infections. Culture proven but asymptomatic infections were seen in 39 percent of patients. Mean infectious episodes rate during last six months was 3. 73 percent of the observed episodes were symptomatic, while asymptomatic bacteriuria was seen in 27 percent of patients. The most frequent Bacteria is E. coli followed by Pseudomonas aerugenosa and Enterobacter species. These were the most common pathogen isolated which are highly resistant to Amoxicillin, Cotrimoxazole, Fluoroquinolones and Cephalosporins. We found that the isolated pathogens are mostly sensitive to Piperacillin- Tazobactam and Carbepenem groups of Drugs
Conclusion: we concluded that Urogenital fistula in developing countries are most regularly linked to Gynecological surgery whereas in developing countries, complicated childbirth is the most common cause. Recurrent infections are more frequent in patients with urogenital fistula and mostly represent relapse rather than re-infection. Relapsing infection warrants extensive evaluation of urinary tract and extended period of antimicrobial therapy with appropriate antibiotics
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Present study endeavoured to assess medical student's ethical behaviour, preferences and improvements one year later. Cross-sectional, questionnaire-based. Liaquat University of Medical and Health Sciences Jamshoro. Sindh. Pakistan. October 2013 - Jan 2014. First year [FY] and second year [SY] MBBS students [n = 122 each year] of both genders, were randomly selected and a questionnaire administered. Fifty six percent male and 40% female students of FY marked proxy attendance; 72% males and 65% female would mark proxy attendance if given a chance. Percentages increased in SY. Significant co-relation existed between gender and proxy attendance [p = 0.01]; self-financed or hostlers showed no association with marking proxy attendance. Sense of responsibility in females and courteous behavior in both genders improved in SY. Teacher's behaviour affected student's conduct; and improvement in understanding English was noted in both genders in both years, however, the small% of students finding English as a barrier were prone to mark proxy attendance [p = 0.05]. Males preferred physiology whereas female preferred anatomy in both years. In FY, subject of choice was anatomy, substituted for Physiology in SY. Majority students preferred chalk and black board vs. multimedia based teaching. Cheating behaviour and sense of responsibility, but civilised behaviour, did not improve after one year education
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Objective of this study was to determine the frequency of anxiety levels among orthodontic patients using Norman Corah's Dental Anxiety Scale, [DAS] and its correlation with gender, age and education of patient. It was a cross sectional study. The study was carried out at Orthodontics Department, Armed Forces Institute of Dentistry [AFID], Rawalpindi from October 2014 to January 2015. A self-reported assessment scale developed by N. Corah, Dental Anxiety Scale [DAS] was used in the study. It was used in the form of a questionnaire containing data on gender, age, education. A total of 350 questionnaires were distributed among consented participants and finally valid 233 questionnaires were recruited in the study. Out of 233 patients, 69 [30%] were male and 164 [70%] were females. 46% participants had mild anxiety score, whereas only 4% participants experienced severe anxiety. With higher education level of patient lesser anxiety score was reported in this study [p= 0.015]. Results showed that patients with higher education were significantly less dentally anxious [p<0.01] about orthodontic treatments than patients with lesser education. Demographic characteristics such as gender and age of the patient had statistically no significant effect on DAS
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Background: Usually breast cancer presents as palpable mass. Suspicion of cancer is increased when nipple discharge is also present along with palpable masses. Triple assessment i.e. clinical, radiological examination and biopsy is done to detect malignancy. However, this is expansive, operator dependent and is not readily available
Objective: To determine the sensitivity, specificity and diagnostic accuracy of positive malignant cell cytology of blood stained nipple discharge among patient with palpable breast mass for detection of breast carcinoma
Methodology: This cross- sectional study was conducted at Sir Ganga Ram Hospital, Lahore, from 1[st] July, 2011 to 31[st] July, 2013 and included 100 patients who presented with blood stained nipple discharge along with palpable breast mass. All the patients had cytology of nipple discharge which was labeled as positive [if malignant cells were found]. Diagnosis was confirmed on histopathology of surgically removed breast lump [modified radical mastectomy for positive cases and wide local excision for negative cases]. The data was entered and analyzed by using SPSS version 20
Results: Cytology of nipple discharge was positive among 30 [30%] and negative in 70 [70%] patients. Histopathology of patients with positive cytology confirmed intraductal carcinoma in all cases [100%]. Sensitivity, specificity and diagnostic accuracy of cytological examination of blood stained nipple discharge was 100% each
Conclusion: Positive cytology for malignant cells in blood stained nipple discharge among patients with palpable breast masses is highly accurate and is suggestive of malignancy in almost all the cases
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Objective: The main objective of the present study was to find out visual outcome of Low Vision Devices among patients suffering from different diseases causing reduced visual acuity in the area of Dera Ghazi Khan, Southern Punjab, Pakistan
Setting: Ophthalmology Department, Dera Ghazi Khan which is a tertiary care hospital
Period: 10[th] February, 2014 to 31[st] December, 2014
Material and Methods: Patients [n=55] presented for their low vision assessment included two groups age wise as patients equal or more than 18 years age [n=22] and patients less than 18 years [n=33]. LOG MAR VA charts, contrast sensitivity test, visual fields through arc perimeters, color vision with color pencils hue 16 test along with objective and subjective refractions were applied. All the data were entered and analyzed using SPSS version 16.00
Results: Patients [n=55] aged 7-90 years presented for their low vision assessment had mean age 23.73+ 2.9 years. The patients were divided into two age groups. First group was 22 [40%] patients equal or more than 18 years age and second consisted of 33[60%] patients less than 18 years age group. Among the patients examined, 40 [72.7%] were males and 15 [27.3%] were females. Our study results revealed that the low vision devices provision was associated with a statistically significant improvement in both near and distance visual acuities and with patients' fulfillment
Conclusion: There was a significant improvement in far and near visual acuity of the patients suffering from a multiplicity of blindness caused diseases by which patients are able to improve their quality of life and able to do their tasks without getting help from others
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Host Modulation Therapy [HMT] is a treatment concept that reduces tissue destruction and stabilizes or even regenerates inflammatory tissue by modifying host response factors. It has been used for treating osteoporosis and arthritis for several decades. However, its use in dentistry has only been recently reported. The objective of this article is to present a review of the various literatures available on HMT and also its role as adjunct therapy in periodontics. For identifying studies for this review, a PUBMED search was carried out in 2013 for all articles published till December 2012. The search was restricted to English language publications only. Longitudinal prospective and retrospective studies were included in the search. The key words used were: Host Modulation Therapy; Sub antimicrobial dose doxycycline and Non-Surgical Periodontal Therapy. The main outcomes sought were host modulation therapeutics in periodontics. Exclusion criteria included cross sectional studies, short case series as well as studies with short follow-up periods. There is a paucity of literature on HMT in periodontics although the only drug approved by United States Food and Drug Administration [FDA] is a subantimicrobial dose of doxycycline [SDD] with highly predictable results as a host modulating agent in periodontal diseases and also an effective adjunctive therapy in various diseases of periodontium. However, more randomized controlled trials are needed to obtain clinical guidelines on the usage of other host modulating agents as adjunct as well as definite therapy for periodontal diseases. SDD is an effective adjunct therapy when used in dosage of 20mg twice daily for minimum 3 months duration in various periodontal diseases with predictable clinical outcomes. It is also recommended that future clinical research on anti cytokine drugs, chemically modified tetracycline and other HMT agents should be conducted so that new drugs are available with highly predictable results
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The objective of this study was to analyze and document the presentation of liver trauma and associated injuries. Present study was conducted from January 2010 to December 2011 at Jinnah Postgraduate Center, Karachi, Pakistan. Oral and written consent was obtained from the participants before the start of the study. Inclusion criteria included all patients, aged more than 13 years with hepatic trauma admitted in the wards. The patients with co existing chronic hepatic diseases were excluded. This study comprised of 61 participants, among those [95%] were males and [5%] were females. The mean age of the participants was 31.4. The mean age for female participants was 28.3 while for male was 31.6. Amongst the patients with hepatic trauma, 67.2% had road traffic accidents [RTA] as the cause of their liver injury followed by firearm injury in 19.7%of the cases, physical assault in 9.8% and stab wound in 3.3% of the patients. Investigations done on the patients were ultrasound and C.T scan. In this study 60.7% patients were diagnosed on abdominal ultrasound and 14.8% were found to have hepatic trauma on the abdominal C.T scan. In all the patients with hepatic injury 50.8% had associated injuries. The most common associated injury was chest complications which was present in 10 [16.4%, C.I: 3.7-39.7] patients followed by gut perforation which was present in 11.4% patients. Other common injuries included forearm fracture which was present in 09.8%patients, spleen injury was found in 8.1% and diaphragm injury in 4.9% patients. In Pakistan Road traffic accident is one of the most frequent causes of Hepatic injury and middle aged men are at the highest risk of hepatic trauma
ABSTRACT
Bone is a remarkable connective tissue that possesses the quality to undergo the process of remodeling to maintain its mass and structure depending on mechanical loading, however not all bones are subjected to mechanical loading yet they don't show disuse osteoporosis. In oral biology, tooth removal leads to alveolar bone resorption due to reduced mechanical load [like limb bone], however basal bone does not resorb so quickly on disuse despite the fact that there is less mechanical load on it [like calvaria]. So in this respect, mandible display features of both the limb bone and calvaria. Therefore the aim was to compare the amino acids composition of mandible with ulna and calvaria and the objective was to compare the bone samples with collagen standard. The commercial collagen type I from the rat tail tendon [sigma Aldrich, UK] was used as a reference to be compared with the bone samples. These samples were subjected to carbon-13 NMR spectroscopy. Results showed that the carbon-13 spectra of ulna and calvaria were almost similar, while mandibular spectra showed the most distinct results. Carbon-13 NMR study showed increased proline content in calvaria then ulna. However mandible showed greater hydroxyproline content and lower glycine content than other spectra. Furthermore, an important finding was the presence of additional amino acids particularly aspartate, leucine and isoleucine in mandible, and glutamate, phenylalanine and methionine in other bone spectra, that might suggests non-collagenous proteins in bone. Additional work is required using new techniques in the NMR that can separate collagenous proteins from the non-collagenous proteins to further explore the complex dynamics of bone