Hemodialysis internal jugular vein versus subclavian vein catheters: complications, patients' comfort, tolerance and cost-effectiveness

Objective: To compare hemodialysis [HD] internal jugular vein [IJV] versus subclavian vein [SCV] catheters in terms of procedural complications, patients' comfort, tolerance and cost effectiveness

Methods: Sixty six consecutive eligible adult patients planned for hemodialysis @ 3 sessions/ week for maximum 42 days in a private hospital at Sialkot, Pakistan were documented between March 2017 and April 2018. A group, IJV or SCV catheter was allotted to alternate subjects. The catheters were inserted as per practice guidelines. Record of catheter-related complications [CRCs] was computerized. Similarly, patients' uncomfortability and expenditures on management of CRCs were recorded

Results: Of 66 cases, 62 [93.9%, 31/group] successfully completed the study. Baseline information showed male predominance [n = 47, 75.8%], age [M = 47, range 24-75 years] or catheter stay time [M = 40 days]. The rate of vein damage or artery puncture was found higher in IJV than SCV group [[13.9 vs. 6.5%] or [9.7 vs. 3.2%], respectively] during catheterization. The difference also existed in late CRCs such as bacterial infection [32.3 vs. 16.1%], or device dysfunctioning [9.7 vs. 3.2%] with an exception of mechanical kinking. All the patients of IJV or SCV group with missed [19.4 vs. 6.5%] or shortened HD sessions [22.6 vs. 12.9%] reported CRCs-based discomfort as a cause of the regularity. Moreover, the participants of IJV group consumed 69% of the total expenditures on CRCs management

Conclusion: SCV is a better site for HD catheterization as it has comparatively lesser likelihood of complications, patients' feel comfortable and it is also cost-effective.than IJV

Initial experience of high power diode laser for vaporization of prostate

Objectives: Prospective evaluation and experience of high power diode, 980nm diode laser for bladder outlet obstruction due to enlarged prostate

Methods: Total of 50 patients were included in the study. International prostate symptom score, quality of life, international index of erectile function-5, prostate specific antigen and prostate volume were compared with values at three months and six months postoperatively

Results: At the end of three months of postoperative period, the mean +/- SD international prostate symptom score decreased significantly from 20.83 +/- 3.77 to 9.23 +/- 2.79 [p=0.0001]. The mean maximal flow rate increased significantly from 8.23 +/- 2.12 to 18.56 +/- 5.09 ml per sec [p=0.0001]. Quality of life score changed considerably as compared to baseline. There was no deterioration in erectile function according to the international index of erectile function-5 short form

Conclusion: The high power diode laser provides significant improvements in International Prostate Symptom Score and the maximal flow rate with low morbidity

Screening of antibacterial activity of different brands of co-trimoxazole paediatric suspension available in the local market

Sulfonamides are the drug of choice for number of infections like pneumonia, toxoplasmosis, nocardiosis, urinary tract infections. Sulfonamides are most commonly used in combinations such as [Trimethoprim-Sulfamethoxazole] [TMP+SMZ] or co-trimoxazole. Sixty five isolates belonging to five different species, E. coli [22], S. aureus [18], Klebsiella [05], Pseudomonas [16] and Proteus [04] were used for screening antibacterial activity against different brands [A-G] of Co-trimoxazole by disc diffusion method. Brand G exhibited highest activity against E. coli with mean zone of inhibition 41mm +/-2.3 standard deviation. The antibacterial activity against other species S. aureus, Klebsiella and Pseudomonas were found as: [mean +/- standard deviation] observed as 39.73 mm +/- 10.59 mm +/- 38 mm +/- 2 and 24.93 mm +/- 5.32. However all isolates of Proteus were found resistant against different brands of co-trimoxazole

Biliary atresia with situs inversus: an experience shared

Biliary Atresia [BA] is a well-known entity and can present with multiple congenital anomalies. BA is one of the most common conditions in which pediatric liver transplant is performed. Identification of Biliary atresia with situs inversus [SI] has not been documented in Pakistan. We report two such cases. First was an eighty-day-old baby boy, icteric from day of birth. On further evaluation had dextrocardia, SI, gross hydronephrosis [HN] of left kidney and stasis at pelvi ureteric junction [PUJ]. Liver biopsy showed biliary cirrhosis secondary to extra hepatic biliary atresia [EHBA]. The second baby presented at two months of age. Ultrasound abdomen and hepatobiliary scintigraphy confirmed liver in left hypochondrium [SI] and findings suggestive of BA. Echocardiography confirmed SI with mesocardia. In this paper we have described the association of BA with SI in two patients presenting at the pediatric Gastroenterology, hepatology and nutrition unit