Comparative analysis of endoscopic full-thickness resection and surgical resection of large gastric stromal tumors (with video) / 中华消化内镜杂志

Objective:To study the safety and effectiveness of endoscopic full-thickness resection(EFR) in the treatment of large gastric stromal tumors with diameter of 5-7 cm.Methods:Data of 36 patients with large gastric stromal tumors (5-7 cm) who received EFR or surgery (including laparoscopic and open surgery) in the First Affiliated Hospital of Zhengzhou University and confirmed by postoperative histopathology from January 2017 to October 2018 were retrospectively analyzed. Patients were divided into endoscopic group (9 cases) and surgical group (27 cases) according to different resection methods. The perioperative indicators and the total incidence of complications in the two groups were compared.Results:In terms of perioperative indicators, the median operation time of the endoscopic group was significantly longer than that of the surgical group (4.0 hours VS 2.0 hours, P<0.01), and the postoperative fasting time (4.55±0.88 days VS 6.22±2.24 days, t=-2.15, P=0.03) and hospital stay (6.88±1.26 days VS 10.03±2.90 days, t=-3.13, P<0.01) were significantly shorter than those of the surgical group. The median visual analogue scores (VAS) of abdominal pain of the endoscopic group on the first postoperative day (3 VS 6, P<0.01)and the third postoperative day (1 VS 3, P<0.01) were significantly lower than those of the surgical group. The hospitalization cost was significantly less than that of the surgical group (55±14.7 thousand yuan VS 73±24.3 thousand yuan, t=-2.11, P=0.04). In term of the total incidence of complications, the endoscopic group was 11.1% (1/9), which was higher than that of the surgical group [7.4% (2/27)], but there was no statistically significant difference( P=1.00). Conclusion:EFR is safe and effective in the treatment of large gastric stromal tumors (5-7 cm), and has the advantages of less invasiveness, rapid postoperative recovery, and lower hospitalization cost. But how to shorten the operation time is an urgent problem to be solved.

Association between ABO Blood Group Phenotype and Reaction to Academic Stress in Young Medical Students

Introduction: Professional medical education needs hardwork, good physical and mental health. In previous studiesthere is no scientific consensus that a relationship existsbetween the ABO blood group and personality traits. In thiscurrent study we tried to find out association between differentblood groups and different type of stressors like physical,environmental, interpersonal and academic in young medicalstudents.Material and methods: This Descriptive Cross sectionalstudy was conducted at Rashid Latif Medical College Lahorefrom April to May 2019. A modified pre structured, valid andreliable questionnaire SSI was used to access the physical,academic, environmental, interpersonal stress, blood groupand gender of 1st year and 2nd year MBBs students. Initially220 (91 male and 129 female) were enrolled.Results: A total of 216 medical students filled in the survey outof 220 students, 126 students (n=126) were female and (n=90)were male who completed the questionnaire; the response ratewas 98.18%. Out of 216 students blood group A was 32, ABwas 42, B was 92 and O was 50. A greater variation in theresponse was observed in the physical category (St: deviation10.40), while the least variation was observed in the categoryof interpersonal (St: deviation 5.27), respondents while thevariation tends to increase in environment (St: deviation 6.78)and academic (St: deviation 7.20).Conclusion: All variables stressors like Physical, academic,environment and interpersonal are found to have negativeand insignificant relationship with dependent variable bloodgroup.

Effect of long-term exposure to sublethal concentration of imidacloprid on some biochemical and haematological parameters of Grass carp and Goldfish

During the present research, C. idella and C. auratus fish were exposed to 2-ppm concentration of imidacloprid for 28 and 24 days, respectively, and the effect on biochemical and haematological parameters was investigated. During the study of biochemical parameters, there occurred significant increase [P<0.05] in the serum levels of ALT and creatinine of imidacloprid exposed groups of both species of fish. The level of serum albumin of imidacloprid exposed groups of both fish species was significantly lower as compared to control group [P<0.05]. Serum globulin level in imidacloprid exposed group of C. idella was insignificantly lower as compared to control group, however the serum globulin level of C. auratus was significantly lower than the control group [P < 0.05]. The level of total proteins in serum of imidacloprid exposed groups of both fish species was insignificantly lower as compared to control groups [P> 0.05]. During the study of haematological parameters, TLC of C. idella was insignificantly [P>0.05] higher than control group but the TLC of C. auratus was significantly [P<0.05] higher than control. There was also observed increasing trend in the percentage of neutrophils and lymphocytes of imidacloprid exposed group of each fish species. The platelets count of imidacloprid exposed group of each fish species was significantly [P<0.05] lower than control group. The haemoglobin concentration of imidacloprid exposed group of C. idella was significantly lower than control group [P<0.05]. In case of C. auratus, the haemoglobin level of imidacloprid exposed group was insignificantly lower than control group [P>0.05]. From the finding of the present research it was concluded that 28 days exposure of C. idella and 24 days exposure of C. auratus to 2 ppm concentration of imidacloprid does not cause mortality however the exposure causes alteration in the normal level of biochemical and haematological parameters

Phenotypic manifestation of congenital transverse amputation of autopod in Pakistani subjects

Terminal transverse deficiency of forearm is a very rare limb malformation. Most of the cases have traumatic etiology and congenital presentation is less common. A series of six individuals with transverse deficiency through the hands is presented in this communication. The cases were congenital, morphologically similar and showed loss of four fingers, most often postaxial. The affected arm was reduced in size compared to the contralateral limb and there was distortion of palmer creases. All cases were sporadic and nonsyndromic in nature. The characteristics of these cases were concordant with the symbrachydactyly type III or monodactylous type, when classified according to the scheme proposed by Blauth and Gekeler [1973]. The malformation resulted in permanent quality-of-life impairment in these subjects and warrant prosthetic management. Detailed physical and phenotypic features of the patients have been presented

Controlled release matrix tablets of glipizide: influence of different grades of ethocel and Co-excipient on drug release

The aim of the current study was to formulate and evaluate glipizide controlled release matrix tablets by means of different grades of polymer Ethoceland different co-excipients in order to evaluate their effect on drug release profiles during in vitro dissolution studies. Type II diabetes mellitus is usually treated with Glipizide. Glipizide belongs to sulfonylurea group. Gastric disturbance and severe hypoglycemia has been observed after taking glipizide orally. To overcome these problems, controlled release matrices were developed using different grades of ethyl cellulose polymer with a drug-polymer ratio of 1: 3by the direct compression method. The effect on drug release of partial replacement of lactose by different co-excipients, HPMC K100M, starch and CMC, were also studied. Diameter, thickness, hardness, friability, weight variations, drug contents of formulations were tested, these properties were within prescribed limits. Co-excipients and polymer containing formulations were compared to the without co-excipients and polymer containing formulations with respect to their release profile. After a 24-hour release study, ethyl cellulose polymer containing formulation exhibited prolonged release for 5-16 hours; however the polymer Ethocel standard FP 7 Premium without co-excipient containing formulation exhibited controlled release for 24 hours. Incompatibility was investigated between drugs, co-excipient DSC and polymer study was performed and any type of interaction was not found. Different kinetic models were used to study the release mechanism. An enhanced release rate was observed in case of excipients containing formulations

Genotyping of High Risk Human Papillomavirus (HPV) Among Cervical Precancer and Cancer Patients.

Introduction: Human papillomavirus (HPV) is a DNA virus which has tropism for epithelial cells, is the major etiological factor for development of cervical precancerous and cancerous lesions. Nearly 100 diff erent types of HPV have been characterized and thereare a large number of other types. HPV infection is one of the most common causes of sexually transmitted disease in both men and women worldwide. It is associated with a variety of clinical conditions that range from innocuous lesions to cancer. Genital HPV types are divided into high and low-risk types, according to the oncogenic potential. Molecular and epidemiologic studies have solidifi ed the association between high risk HPV types (especially HPV-16 and HPV-18) and cervical squamous cell carcinoma. HPV infection is often transient and self-limiting but infection may persists and progress to high grade lesions and cancer. In addition to persistent high-risk HPV infection, other viral factors such as high viral loads, HPV variants, infections with multiple high-risk HPV types and genetic predisposition contribute to the development of cervical cancer. Th e aim of the present study was to detect HPV DNA and identify high risk HPV genotype among women having cervical intraepithelial neoplasia and carcinoma and to evaluate potential effi cacy of prophylactic HPV vaccine. Methods: Cervical swab from histopathologically diagnosed CIN (n=51) and carcinoma (n=39) patients were taken and high risk HPV DNA was detected by HC II assay. Polymerase Chain Reaction was used to identify high risk HPV genotype. Result: HPV DNA was detected in 41 (45.56%) patients by HC II assay. HPV type 16 was detected in 27 (81.82%) followed by type 18 in 3 (9.09%) and type 45 in 2 (6.06%) cases of cervical carcinoma. Among precancerous cases, only type 16 was detected. Conclusion: Knowledge based on HPV prevalence and genotype could be used to predict the effi cacy of cost eff ective prophylactic vaccine, introduction of newer generation vaccine and management of cervical carcinoma.

Descriptive epidemiology of hereditary musculoskeletal: and limb defects in the isolated population of Chitral, North-West Pakistan

Musculoskeletal and limb defects [MLDs] are the major categories in hereditary anomalies and are a significant source of the disabilities. This study aimed at elucidating the nature and pattern of MLDs prevalent in Chitral district, which is an isolated population in the North-West of Pakistan. A cross-sectional epidemiological study was conducted in Chitral and subjects/families with MLDs were ascertained from public places, hospitals and door-to-door visits. The phenotypic manifestations, expressivity, sporadic/familial presentations, isolated/syndromic nature, inheritance pattern, and socio- demographic attributes, of MLDs were observed. A total of 153 independent subjects/families with certain types of MLDs were recruited. The MLDs were classified into 9 major and 22 minor entities. In this cohort, polydactyly was observed to be overwhelmingly common [71%], followed by syndactyly and absence limb deformities. The majority of the cases [78%] had sporadic nature, 93% anomalies had isolated presentations; upper limbs were more commonly affected than the lower limbs; and unilateral cases were twice in ratio than bilateral. The majority of the malformations had milder phenotypes, however, 17% of the MLDs were severe in nature and resulted in certain types of disability, compromising the normal life of the subject. This research witnesses a distinctive pattern of MLDs in Chitral, which has not been reported for any other population of Pakistan so far. Further studies are required to observe the molecular etiologies of these malformations and to offer rapid diagnosis and genetic counseling

Pattern of different types of cerebral stroke in Faisalabad

Objective: To determine the frequency of different types of stroke in patients with cerebral stroke presenting in DHQ hospital Faisalabad

Study Design: Cross Sectional Descriptive Study

Setting: Study was conducted in Medical Unit IV DHQ Hospital Faisalabad between 01-06-2014 to 30-11-2014

Materials and Methods: 100 patients both male and female of ages more than 16 years admitted with acute stroke with in and after 24 hours of stroke and patients having infarction, hemorrhage and subarachnoid hemorrhage as a cause of stroke diagnosed on Computerized Tomography [CT] scan of the brain were included in the study. After Informed Consent, data collection was carried out after taking history, performing clinical examination and doing investigations. Data was analyzed by using Chi-Square test at 5% level of significance. Statistical analysis was carried out with the use of SPSS Version 21 for Windows. In this study, frequencies of major categories of stroke were found out in relation to different age groups and sex. Hypertension and association between frequencies of various categories of stroke and Diabetes Mellitus, Hypertension and association between frequencies of Diabetes various categories of stroke and irregularly treated Hypertension and Diabetes Mellitus were found out

Results: Our research found the frequency of Infarctive stroke, Intracerebral bleed and Sub-arachnoid hemorrhage as 62%, 28% and 10% respectively. Correlation of gender with major categories of stroke was found to be statistically significant. Peak age range for cerebral infarction was found to be 51-60 years accounting for 22 cases [i.e. 35.48% of all cerebral infarction cases], peak age range for intracerebral bleed was also 61-70 accounting for 12 cases [i.e. 42.86% of all intracerebral bleed patients] and peak age range for Sub-arachnoid hemorrhage was 41-50 accounting for 4[40%] cases. Infarctive stroke was also found in the lowest age range i.e. 21-30 accounting for 3 cases. Patients with uncontrolled Hypertension and Diabetes Mellitus were found to be at more risk of developing cerebral stroke

Conclusion: Infarctive Stroke is more common in our study as compared to hemorrhagic Stroke. Proper awareness and treatment about the major risk factors of stroke such as hypertension and diabetes mellitus can help to reduce the episodes of stroke in population. Patients need proper education about modifiable risk factors for cerebral stroke

Climatic factors influencing dengue cases in Dhaka city: a model for dengue prediction.

Background & objectives: Transmission of dengue virus depends on the presence of Aedes mosquito. Mosquito generation and development is known to be influenced by the climate. This study was carried out to examine whether the climatic factors data can be used to predict yearly dengue cases of Dhaka city, Bangladesh. Methods: Monthly reported dengue cases and climate data for the years 2000–2008 were obtained from the Directorate General of Health Services (DGHS) and Meteorological Department of Dhaka, Bangladesh, respectively. Data for the period 2000 to 2007 were used for development of a model through multiple linear regressions. Retrospective validation of the model was done with 2001, 2003, 2005 and 2008 data. Log transformation of the dependent variable was done to normalize data for linear regression. Average monthly humidity, rainfall, minimum and maximum temperature were used as independent variables and number of dengue cases reported monthly was used as dependent variable. Accuracy of the model for predicting outbreak was assessed through receiver operative characteristics (ROC) curve. Results: Climatic factors, i.e. rainfall, maximum temperature and relative humidity were significantly correlated with monthly reported dengue cases. The model incorporating climatic data of two-lag month explained 61 per cent of variation in number of reported dengue cases and this model was found to predict dengue outbreak (≥ 200 cases) with considerable accuracy [area under ROC curve = 0.89, 95%CI = (0.89-0.98)]. Interpretation & conclusions: Our results showed that the climate had a major effect on the occurrence of dengue infection in Dhaka city. Though the prediction model had some limitations in predicting the monthly number of dengue cases, it could forecast possible outbreak two months in advance with considerable accuracy.

Efficacy of arthemether-lamefuntrine in Malaria

Objective: To determine the efficacy ofArthemether-Lamefuntrine [AL] in patients withmalaria

Study Design: Quasi-experimental study

Place and Duration of study: Study was conductedin Medical Unit DHQ Hospital Sargodha andMedical Unit V, DHQ Hospital Faisalabad from 1stJanuary 2011 to 30 June 2011

Subjects andMethods: 129 adult patients both male and femalediagnosed to have malaria both on clinical andlaboratory examination were included in the study.Patients were given AL [20/120] 2 tablets 12 hourlyfor three days. An adequate clinical andparasitological response [ACPR] was defined asabsence of fever and parasitaemia [negative slide forMalarial parasite] by day 45 after end of treatment

Results: Out of 129 patients adequate response[ACPR] was seen in 122 patients with efficacy of94.6%

Conclusion: AL is an important andeffective treatment option for treatment of patientswith malaria

pharmacoeconomic study in two tertiary care hospitals in Abbottabad

Pharmacoeconomics has been defined as: the description and analysis of the cost of drug therapy to health care systems and society. Aim was to observe the Medication Therapy on the basis of Phamacoeconomics Analysis and to save the economic resources. This Descriptive Cross sectional study was conducted at Ayub Teaching Hospital and Combined Military Hospital, Abbottabad, from May-August 2011. The case histories of 100 patients were scrutinized thoroughly specially with reference to socioeconomic history, Clinical laboratory tests, Medication history and treatment at hospital and discharge medications. After their collection, these case histories were analyzed with respect to Phamacoeconomics and compared with the world literature. A total of 100 patients were studied. Pharmacoeconomic analysis shows that in 49 Patients' medications were according to international standards while in 51 patients' medications prescribed were irrational. Mutual interaction between physician, surgeon, other healthcare professionals, and clinical pharmacist is necessary to assure rational medication therapy and positive response to therapy of each patient.

Worm infestation in children of Skardu

To determine the frequency of parasitic infestation among children of district Skardu. Cross-sectional study. Combined Military Hospital, Skardu, from September 2010 to January 2011. Two hundred and fifty children of 1-15 years of age. were selected from out patient department through non probability convenience sampling. Demographic information included gender, hygienic condition, source of drinking water, defecation site and maternal education. This information was recorded on a questionnaire. Parents were interviewed, while stool samples of children were collected for examination of ova and cysts. Ova and cysts of various parasites were found in 192[76.8%] children. Intestinal helminths were more frequent 167[87%] than protozoa 25[13%]. Mixed infestation seen in 24[12.5%] cases and single parasite was seen in 168[87.5%] cases. Water from streams, use of traditional defecation sites, poor personal hygiene, illiteracy of mothers and rural living proved to be significant risk factors in predicting the intestinal helminth infection [p<0.05]. Parasitic infestation is very common in children belonging to Skardu region. Ascaris lumbricoides was the most common helminth infestation found compared to protozoa. Poor hygiene, use of stream water, rural living, and low level of maternal education have appeared as major contributors towards parasitic infestation.

Bronchiolitis with montelukast; to determine improvement in symptoms in 02 months to 02 years old children

To assess the efficacy of montelukast in children with bronchiolitis. Experimental-Preventive. Pediatrics department Allied/DHQ hospital affiliated with Punjab Medical College, Faisalabad, from 1[st] Nov 2007 to 30[th] April 2008. One hundred children of bronchiolitis were studied in two equal groups, group A and group B. To group A montelukast along with symptomatic treatment was given. Group B was given only symptomatic treatment. The criteria of treatment efficacy was taken as number of symptoms free days and nights, bronchiodilator rescue therapy, duration of hospital stay and complications like worsening of symptoms, ventilatory support and side effects of drug therapy. Symptoms free days were increased in group A as compare to group B [P value = 0.000] whereas duration of symptoms free nights were significant numerically but not statistically. There was a significant reduction in exacerbations [P = 0.046] and use of rescue therapy [beta 2-agonist] in group A. Leukotriene receptor antagonist [LRTA] reduced the duration and severity of lung symptoms in children with Bronchiolitis

Unusual presentation of episodic inspiratory stridor "paradoxical vocal fold motion" its awareness and management

Back Ground: stridor is always terrifying entity and presentation of such patient in clinic is Dire emergency. Majority of these cases are dealt with empirical medicines like steroids and antihistamines, but sometimgs patients need surgical intervention like Tracheostomy or Endotracheal intubation to save the life. Paradoxical Vocal Fold motion is a relatively uncommon in routine Otolaryngological practice. So it can be easily confused with Bronchial Asthma or upper air way obstruction like Laryngeal oedema. Due to rare occyrrence and requirement of special diagnostic fiber optic instruments, the final diagnosis can be difficult. Management of paradoxical Vocal Fold Motion is discussed in this original article. Common mistake which is being done by many Otolaryngologists is treatment with Steroids which may worsen the disease. The aim of this study is to increase the awareness about Paradoxical Vocal Fold Motion regarding management with review of literature

Aim: aim of study is to document the etiological factors and treatment modalities of patients presenting with inspiratory stridor in Paradoxical vocal card motion

Setting and design: retrospective study in two teaching Hospitals

Material and methods: records of patients presenting with inspiratory stridor at outpatient and in emergency between 2007 and 2010 were analyzed

Results: paradoxical vocal fold motion constitutes 77% of inspiratory stridors. Male to female ratio was 1:2.4. Among the etiological factors were sinusitits, allergic Rhinitis, Gastro esophageal reflux disease, Psychogenic and exposure to irritants. Conservative treatment was sufficient in all of these cases, none of these patients required intubation or tracheostomy

Relationship of life style choices on body fat mass in young adults

Healthy diets and regular, adequate physical activity are major factors in the promotion and maintenance of good health throughout entire life course. Accumulation of fat occurs whenever energy consumed by food and drinks exceeds that which can be utilised by an individual's metabolism and physical activity. The objective of this study was to estimate the effect of lifestyle characteristics of a representative segment of medical students in terms of fast food preferences and participation in physical activity with respect to Body Mass Index [BMI]. This cross-sectional study was carried out in Physiology Department, Bahria University Medical and Dental College, Karachi on 192 students of 1[st] and 2[nd] year MBBS. Body Mass index of students was calculated. They were classified into 4 groups with BMI /= 25 respectively. A life style questionnaire, based on preferences for healthy/unhealthy food, dietary habits and participation in physical activity was filled. Most of medical students [65%] had BMI less than 23. It was because of selection of healthy dietary pattern with nutritious food [p<0.09] and participation in outdoor games [p<0.03]. Males who had high BMI showed a tendency to daily intake of fast food [p<0.03]. Walking in both the sexes had a positive impact in maintaining normal BMI [p= Males<0.04, females<0.001]. Obesity can be prevented by innovative approaches, easiest of which is to promote active life styles with intake of healthy diet and involvement in physical activity

Cutaneous vascular anomalies pattern in neonates and infants

To analyze the patterns of cutaneous vascular anomalies in neonates and infants. To identify the complications arising in various vascular lesions. A descriptive hospital based observational study. Dermatology and pediatric department of DHQ and Allied Hospital PMC, Faisalabad From 1 Feb 2005 to 31 January 2006. 72 consecutive newborns and infants of either sex having any vascular anomaly on cutaneous areas were included in the study. The information regarding size, site, type of lesions, sex of patients, with family history and any complication were recorded on a proforma prepared for this study. Out of 72 infants 25 were male [35%] and 47[65%] were females. Family history was present in 12 cases [17%]. The commonly involved sites were head and neck 45 [62.5%], trunk 18[25%] and upper limb 9[12.5%]. In 59 children [82%] it was single and in 13[18%] the lesions were multiple. The complications observed were ulceration in 13[18%], infection in 8[11%], haemorrhage in 3[4%] and visual impairment in 4[5%], while 56[78%] had no complications

Frequency of helicobacter pylori in patients presented with perforated peptic ulcer

To study the frequency of H-pylori infection in patients with perforated peptic ulcer disease [Duodenal and Gastric]. During the study period a total of 85 patients were admitted with acute perforated peptic ulcer to surgical "C" unit Lady Reading Hospital, Peshawar from June 2004 to December 2005. They were operated and post operatively blood sample was taken for identification of antibodies against H-pylori by ELISA method. All patients irrespective of gender and age who were operated for perforated peptic ulcer were included in the study. Patient who gave history of intake of H2 receptor antagonist and Proton Pump Inhibitors up to six weeks prior to their presentation were excluded. Out of 85 patients studied and analyzed for antibodies against H-pylori, 77 [90.59%] were male and 8[9.41%] were female. Age ranged from 30-75 years. ELISA showed that 56.46% [n=48] were positive while 43.54% [n=37] were negative for antibodies against H-pylori. 87% [n=54] patients gave history of chronic dyspepsia. 47 of these were positive for H-pylori. All patients were treated with eradication therapy which consisted of clarithromycin, metronidazole and omeprazole. Six weeks after initial surgery blood samples were analysed for H-Pylori and were found to be negative. Patients who present with perforated peptic ulcer and gave history of chronic dyspepsia should be given eradication therapy post-operatively in order to reduce the incidence of recurrence