Ameliorative effect of hydro-methanolic extract from roots of Rauwolfia serpentina on some biochemical parameters of type 1 diabetic mice

Present work seeks to investigate the biochemical parameters in terms of hypoglycemic and hypolipidemic effects of hydro-methanolic roots extract [HyMREt] of Rauwolfia serpentina in type 1 [alloxan induced] diabetic mice. Animals were divided into seven groups, four control groups, and three were test groups [HyMREt at 50, 100, and 150mg/kg]. Each treatment was repeated for 14 days regularly in all seven respective groups and afterwards the body weights, fasting blood glucose [FBG], insulin, and serum lipid levels were determined. Total body weights of diabetic mice treated with HyMREt extract were dose dependently [p

Ethanolic seeds extract of Centratherum anthelminticum reduces oxidative stress in type 2 diabetes

This work was accomplished to assess the in-vitro antiglycation and antioxidant activities of ethanolic seeds extract of Centratherum anthelminticum [CSEt], followed by its in-vivo examination in type 2 diabetes. Overnight fasted rabbits were divided into control and diabetic groups. Rabbits in diabetic group were fed with 35% fructose solution to develop hyperglycemia that was well-monitored by glucometer. These were divided into diabetic control [distilled water 1ml/kg], positive control group [pioglitazone 15mg/kg] and two test groups [CSEt 400 and 600mg treated]. All treatments were given orally. After 14 days, rabbits were sacrificed and blood samples were used to estimate glycated haemoglobin [HbA1c] while total bilirubin [direct and indirect], uric acid, alanine aminotransferase [ALT] and creatine kinase [CK] were done in sera. In addition, antioxidant parameters viz., catalase [CAT], superoxide dismutase [SOD], reduced glutathione [GSH] and lipid peroxidation [LPO] were in liver tissues. The in-vitro studies showed good antiglycation and antioxidant potential of CSEt. Similarly, in-vivo investigation showed significant reduction in glycemia and body weights in type 2 diabetic test groups. Plus values of HbA1c, ALT, CK, uric acid and bilirubin were almost back to normal along with improvement found in efficiency of antioxidant parameters

Hypoglycemic and hypolipidemic activities of crude seeds of Centratherum anthelminticum in healthy volunteers and type 2 diabetic patients

This study first time reports the hypoglycaemic activity of crude seeds powder [CSP] of Centratherum anthelminticum in healthy and type 2 diabetic volunteers. In addition, hypolipidemic effect of same CSP was also determined in healthy volunteers. Healthy individuals were divided into control and two test groups T1 and T2 treated with 200 and 400mg of CSP. Similarly, type 2 diabetic patients were also divided into positive control [PC] treated with metformin 600mg and two test groups DT1 [CSP 400mg + metformin 600mg] and DT2 [CSP 400mg]. Each group has 6 individuals and each treatment was done orally. CSP 400mg was found more hypoglycaemic on all time intervals from 30 to 120min when oral glucose tolerance test was conducted in healthy volunteers. Both test quantities of CSP 200 and 400 mg were found successful in same healthy personsin decreasing the levels of triglycerides and total cholesterol [p<0.05], low and very low density lipoprotein cholesterols [p<0.01] and keeping the level of high density lipoprotein cholesterol as same as it was observed in control group. Similarly, CSP 400mg along with metformin and alone was also found helpful in lowering the fasting blood glucose levels in type 2 diabetic patients [DT1 and DT2] -24.99% and -20.62% respectively as compared to diabetic group only treated with metformin [PC], [p<0.01]. Therefore, CSP of C. antheminticum proves effective hypoglycaemic and hypolipidemic agent by possibly inducing glucose tolerance in healthy individuals and type 2 diabetic patients

Compliance and effectiveness of who surgical safety check list: a JPMC audit

Objective: To assess World Health Organization [WHO] Surgical Safety Checklist [SSC] compliance and its effectiveness in reducing complications and final outcome of patients

Methods: This was a prospective study done in Department of General Surgery [Ward 02], Jinnah Postgraduate Medical Centre [JPMC], Karachi. The study included Total 3638 patients who underwent surgical procedure in elective theatre in four years from November 2011 to October 2015 since the SSC was included as part of history sheets in ward. Files were checked to confirm the compliance with regards to filling the three stage checklist properly and complications were noted

Results: In 1st year, out of 840 surgical procedures, SSC was properly marked in 172 [20.4%] cases. In 2[nd] year, out of 857 surgical procedures 303 [35.3%] cases were marked which increased in 3rd year out of 935 surgical procedures 757 [80.9%] cases and in 4th year out of 932 surgical procedures 838 [89.9%] cases were marked. No significant change in site and side [left or right] complications were noted in all four years

Surgical Site Infection [SSI] was noted in 59 [7.50%], 52 [6.47%], 44 [4.70%] and 20 [2.12%] cases in 1st, 2nd, 3rd and 4th year respectively. SSI in laparoscopic cholecystectomies was 41 [20.8 %], 45 [13%], 20 [5.68%] and 4 [1.12%] in 1st, 2nd, 3rd and 4th year respectively. No significant change in chest complications were noted in all four years. Mortality rate also remained same in all four years

Conclusion: WHO SSC is an effective tool in reducing in-hospital complications thus producing a favorable outcome. Realization its efficacy would improve compliance

Short term outcome of laparoscopic ventral rectopexy for rectal prolapsed

Objective: To find out the short term outcomes of effectiveness and safety of laparoscopic ventral rectopexy for rectal prolapsed

Methods: It was a descriptive case series study of 31 consecutive patients of rectal prolapse in Colorectaldivision of Ward 2, Department of General surgery, Jinnah Post Graduate Medical Center, Karachi, from November 2009 to November 2015. These patients were admitted through outpatient department with complains of something coming out of anus, constipation and per rectal bleeding. All patients were clinically examined and baseline investigations were done. All patients underwent laparoscopic repair with ventral mesh placement on rectum

Results: Among 31 patients, mean age was 45 years range [20 - 72]. While females were 14[45%] and males 17[55%]. We observed variety of presentations, including solitary rectal ulcers [n=4] and rectocele [n=3] but full thickness rectal prolapse was predominant [n=24]. All patients had laparoscopic repair with mesh placement. Average hospital stay was three days. Out of 31 patients, there was one [3.2%] recurrence

Port site minor infection in 3[9.7%] patients, while conversion to open approach was done in two [6.4%], postoperative ileus observed in two [6.4%] patients

One[3.2%] patient developed intractable back pain and mesh was removed six weeks after the operation. One[4.8%] patient complained of abdominal pain off and on postoperatively. No patient developed denovo or worsening constipation while constipation was improved in 21 patients [67%]. Sexual dysfunction such as dysperunia in females and impotence in males was not detected in follow up

Conclusions: This study provides the limited evidence that nerve sparing laparoscopic ventral rectopexy is safe and effective treatment of external and symptomatic internal rectal prolapse. It has better cosmetic and functional outcome as advantages of minimal access and comparable recurrence rate

Outcome of four years experience in laparoscopic ventral hernia repair

To find out the short term outcomes of laparoscopic ventral hernia repair [LVHR] during the last four years. It was a descriptive and prospective case series of 53 consecutive patients out of 107 at Department of General Surgery, Jinnah Post Graduate Medical Center, Unit II, Karachi, from January 2009 to December 2012. These patients were admitted through out patient department with complain of lump, pain and discomfort. Most of the patients were obese. All patients were clinically examined and baseline investigations done. Fifty three [49.5%] patients underwent laparoscopic repair with mesh placement and remaining 54 by open surgical repair. Among 53 patients, mean age was 46 years range [30 - 55]. While females were 33[62.2%] and males 20[37.7%]. We observed variety of hernias, in which midline and epigastric hernia were predominant. The commonest symptom was lump and dragging sensation. The duration of symptoms ranged between 6 months to one year. About 53 patients [49.5%] had laparoscopic repair with mesh placement. Average hospital stay was two days. Out of 53 patients, 4 [7.5%] had cellulitis at trocar site, seroma in 2[3.7%], 2[3.7%] patient complained of persistent pain postoperatively, port site minor infection was in 2[3.7%] patients, while conversion to open approach was done in 2 [3.7%], postoperative ileus was observed in one [1.8%] patients. This study provides the evidence that, laparoscopic repair with mesh placement in ventral hernia is safe and effective approach compared to open surgical procedure. It has a low complication rate, less hospital stay and low recurrence

Complex fistula-in-ano: surgical management and outcome

Objective: To assess the outcome of the surgical management of patients with complex fistula-in-ano

Study design: Case series

Place and Duration of study: Department of General surgery Jinnah Postgraduate Medical Center Ward 2 Karachi, from January 2009 to December 2012

Methodology: An analysis of patients with complex fistula-in-ano treated with different operative techniques Resultswas done. The techniques included two stage seton fistulotomy, three stage seton fistulotomy, fistulectomy with sphincter repair, drainage of supralevator abscess and colostomy. Patients were followed-up through colorectal OPD with special emphasis on postoperative bleeding, healing, recurrence and fecal incontinence

Results: Out of total 123 patients with different types of anal fistulae there were 58 [47.1%] complex and 65 [52.8%] low anal fistulae. There were 105 [85.3%] males and 18 [14.6%] females. Out of 58 complex fistulae, 28 [48.2%] patients had inter-sphincteric, 12 [20.6%] transsphincteric, 10 [17.2%] suprasphincteric, 06 [10.3%] extrasphincteric and 02 [3.4%] horseshoe fistulae. Forty-one [70.6%] patients were treated with two-stage seton fistulotomy technique, 5 [8.6%] with three stage seton fistulotomy, 11 [18.9%] with fistulectomy with sphincter repair, and in 01 [1.7%] patient colostomy was made. Overall complication rate in two stage seton fistulotmy was 9.7% and 18.1% in fistulectomy with sphincter repair

Conclusion: Complex fistulae may be successfully treated by various techniques, but the two-stage seton fistulotomy technique was an effective method for this type of fistula

Role of orally administered Gastrografin in small bowel obstruction after unsuccessful conservative treatment

Orally administered gastrografin is a hyperosmolar water soluble contrast medium. It is commonly used for the diagnosis of small bowel obstruction but it also has a therapeutic role in small bowel obstruction [SBO]. The purpose of this study was to determine the diagnostic and therapeutic role of gastrografin in cases of small bowel obstruction who didn't respond to conservative treatment. This retrospective study was carried out from Jan 2004 to Oct 2009, in which 110 patients with diagnosis [clinical and radiological] SBO were included. An initial trial of conservative treatment was given after excluding the bowel ischemia. Every patient was observed for twenty four hours to assess the response to conservative treatment. After 24hours non-responding patients were given 100 ml of gastrografin through Ryle's tube and transit of contrast was followed by repeated abdominal radiographs taken at 4,8,12 and 24 hours after administration of gastrografin. In partially obstructed patients in whom contrast appeared in large bowel no further intervention was performed. Laparotomy was performed in remaining patients in whom gastrografin failed to reach the large bowel within 24 hours. From Jan 2004 to Oct 2009, 110 patients [men =62 and women = 48] with small bowel obstruction were included in the study. The mean age of our patients was 34.1 years [15 - 40 years]. In 22% [25] patients had bowel strangulation and they were operated soon after admission. Non operative treatment was continued in 10% [12] of patients who responded to the conservative treatment in first 24hrs. Twenty eight [25%] patients had history of single surgery while 10 [9%] of patients had history of more than one operation in the past. Gastrografin was given to 73 patients who didn't respond to conservative treatment in 24hrs. Thirty four percent [25 out of 73] patients were operated for complete obstruction after gastrografin administeration. Forty five [61%] patients had partial obstruction after gastrografin administration and complete resolution of obstruction occurred in all of them except three patients who were operated for persistent obstruction. We found 92% reduction in the operative rate after gastrografin administration. No complications were noted with the use of gastrografin. After unsuccessful routine conservative treatment gastrografin can be used safely and it can reduce the operative rate. In this study out of 73 patients who were administered gastrographin, obstruction was completely resolved in 42 patients [57.5%]. It also helps in predicting the need for surgery thus it shortens not only hospital stay but also reduces the potential morbidity of late surgery due to prolong and unsuccessful non operative treatment.

Audit of splenectomy at Jinnah postgraduate medical centre, Karachi

Objective: Splenectomy is often performed in patients with heamatalogical diseases or trauma who are at high risk of complications. Our aim is to perform an audit on splenectomy in order to determine the reasons for the operation, its complication and compliance with the recent recommendations for post-splenectomy patients at Jinnah Postgraduate Medical Centre. Design: It is a Descriptive study conducted in surgical ward 2 at Jinnah Postgraduate Medical Centre from June 2003 to June 2008. Methods: A retrospective review of hospital records of surgical ward 2 of consecutive splenectomy patients with a mean follow up of 12 months. Results: Fifty-five patients underwent splenectomy in 6 years duration. The mean age was 26.7 years. The indication for splenectomy was mainly heamatological diseases and trauma. Vaccination was done in 83.6% patients. Twelve patients had postsplenectomy complications, although there were no cases of OPSI. Mean hospital stay was 6.4 days. Conclusion: We still lack compliance with the standard guidelines for post-splenectomy patients. There is space for an improvement of the vaccination rate and prophylactic antibiotic. Patients should be counselled for the risk of OPSI and should have a splenectomised card for prompt treatment. There is need for careful documentation of this important health risk and counselling of patients in the discharge summaries

Laparoscopic colonic surgery: early experience

The paper reports early experience with laparoscopic colonic surgery in relation to indications, tumour size, operative time, duration of analgesic requirement postopera-tively, return of bowel activity, postoperative complications and mortality. A multicentre case series study at Jinnah Postgraduate Medical Centre, Orthopedic and Medial Institute, SIUT and South City Hospital between February 2007 and February 2010. Clinical and operative records of all laparoscopic-assisted colonic procedures performed between February 2007 and February 2010 were studied. 80 laparoscopic-assisted colonic surgeries were performed during this period. There were 74 cases of carcinoma, 5 cases of tuberculosis and 1 case of polyp. Laparoscopic-assisted procedures included right hemicolectomy in 54 cases, left hemicolectomy in 15 cases, sigmoid colectomy in 6 cases, segmental resection of splenic flexure in 2 cases, transverse colostomy in 3 cases. Eight cases were converted to open surgery; six because of locally advanced disease, one because of bleeding and one because of failure to localize the tumour. Mean operative time was 150 minutes. The mean tumour size was 6cm. Mean duration for analgesic requirement was 2.5 days. Mean time to return of bowel activity was 2.7 days with a mean hospital stay of 5 days. Intraoperative traction injury to the small bowel was encountered in 1 patient. Postoperatively 2 patients had local wound infection and 2 patients developed pulmonary infection. Laparoscopic-assisted colonic procedures are associated with a smaller wound, quicker return of bowel activity, reduced consumption of analgesics, a shorter hospital stay and low rates of pulmonary infection. Laparoscopic colonic surgery is feasible and a logical progression towards acquisition of advanced laparoscopic skills with good results

Rubber band ligation of symptomatic internal haemorrhoids; result of 450 cases

To assess the outcome of rubber band ligation of 2[nd] and 3[rd] degree haemorrhoids in terms of relief of symptoms. Case series. Colorectal clinic, Department of General Surgery, Jinnah Post Graduate Medical Center Karachi, from January 2001 to May 2008. All Patients with 2nd and 3rd degree haemorrhoids were included in this study. Data related to the age, gender etc, were recorded. Patients were counseled regarding prospects of success of the procedure. Short and long term outcome data were recorded for success of treatment. A total of 450 patients underwent rubber band ligation. There were 337 males [74.88%] and 113 females [25.11%] with male to female ratio of 3:1. Age of the patients ranged from 20-80 years. Male with 2nd degree haemorrhoids were 297 [66%] and females were 203 [22.88%]. Successful results were achieved in 86.22%. Rubber band ligation is a safe, effective and economical procedure for treating 2nd and 3rd degree haemorrhoids on out patient basis

Post-cholecystectomy biliary injuries: diagnosis and management

To evaluate the management strategies following Bile Duct Injuries. Retrospective and prospective analysis from July 2002 to Oct. 2005. Surgical Ward-2, Jinnah Postgraduate Medical Centre, Karachi. All patients who were admitted with Iatrogenic Biliary injuries. The patients were clarked and their clinical features noted. After appropriate preparations they were treated on the basis of Bismuth Classification. A total of 21 patients presented with Iatrogenic Biliary injuries over a period of three years. There were 15 females and six males with a median age of 40 years. Fourteen patients had laparoscopic cholecystectomy while seven had open cholecystectomy. Six cases belonged to our unit while 15 were referred from other institutes. Sixteen patients presented with biliary leak, out of which two resolved, two had ultrasound guided aspiration and two ERCP stenting done, while 10 underwent peritoneal lavage with drain placement. One patient from lavage group required ERCP stenting while one patient that underwent stenting initially developed stricture and had to undergo Roux-en-Y hepaticojejunostomy. Five patients had biliary stricture at presentation, three were Bismuth Type I, one was Type III and one Type IV. These patients were treated with Roux-en-Y hepaticojejunostomy. Two had to undergo re-exploration, one needed lavage and the other revision hepaticojejunostomy. Three patients expired in the early postoperative period. Strategies need to be developed for dealing with bile duct injuries, with a view to reduce morbidity and mortality as early recognition and timely management improves the outcome of these patients

Nitroglycerine ointment for anal fissure

To determine long term effectiveness of glyceryl trinitrate [GTN] for treatment of anal fissure and to find out its side effects. This study was done on patients who presented with symptoms of anal fissure in colorectal clinic surgical ward 2 JPMC. Total 498 patients were included out of which 237 had acute anal fissure while 261 patients had chronic fissure. All patients received 8 weeks treatment with 0.2% GTN ointment three times daily applied over perianal area. Those patients who developed side effects i.e. headache were offered treatment with 2% diltiazem. After 8 weeks treatment 228 patients of acute anal fissure had complete healing and 9 patients had partial response. In chronic anal fissure, 229 patients completely healed after 8 weeks of treatment while 32 patients were advised further 4 weeks treatment of GTN due to partial healing and out of them 22 patients had complete healing. Thirteen patients had to undergo lateral sphincterotomy. Five patients complained of headache that settled after shifting to treatment with diltiazem ointment. Ten patients developed recurrence of symptoms. GTN proved to be good first line treatment for most of patients with anal fissure. Small group of patients experience recurrence of symptoms and most of them respond to prolong duration of treatment

audit of the management of acute pancreatitis in a general surgical ward

To assess the results of the management of Acute Pancreatitis. Retrospective descriptive study from Jan. 2003 to Dec. 2005. Setting: Surgical Ward-2, Jinnah Postgraduate Medical Centre, Karachi. 62 patients with the diagnosis of Acute Pancreatitis. The demographic variables, cause and outcome of the cases were observed and recorded. Out of the total 62 patients, 37 had cholelithiasis; other causes were alcoholism, abdominal trauma, worms, instrumentation [ERCP] and drugs. All patients were classified according to APACHE-II scoring system into acute oedematous pancreatitis, severe acute pancreatitis and acute necrotizing pancreatitis. Forty eight patients developed complications including ARDS, anuria, hypotension, paralytic ileus and pseudocyst formation. Four cases died due to multiorgan failure. Current recommended principles in the management of Acute Pancreatitis are based on identification of patients having severe disease and the group at risk for the development of complications. APACHE-II is a helpful scoring system and CT scan is an effective diagnostic tool in difficult cases

variant of Bouveret's syndrome

Bouveret`s syndrome is gastric outlet obstruction caused by impaction of a large gall stone in the duodenal bulb, through a cholecystoduodenal fistula. In this case, which is a variant of Bouveret's syndrome, a 58 years old lady presented with right upper quadrant abdominal pain and vomiting. Investigations, including MRCP, revealed a large stone impacted in the duodenal bulb and another one at the duodenojejunal junction causing dilatation of the stomach and the duodenum. She underwent laparotomy with cholecystectomy, closure of cholecystoduodenal fistula and an enterotomy to remove the stone impacted at the duedenojejunal junction

experience of total mesorectal excision in surgery for rectal cancer

To evaluate the results following total mesorectal excision in rectal cancers. Place and Duration of Study: Surgical Ward 2, Jinnah Postgraduate Medical Centre [JPMC], Karachi. From January 2003 to December 2005. Fifty consecutive patients with histological diagnosis of rectal cancer were included in this study. In all cases tumor staging was carried out with ultrasound [US] and CT scan. Carcino-embryonic antigen [CEA] level was also done. They underwent surgery in the form of abdomino-perineal resection [APR], low anterior resection, ultra low anterior resection and Hartmans procedure. Total mesorectal excision [TME] was done in 42 patients and their postoperative morbidity and mortality were recorded. Out of 50 patients 6 were irresectable. These patients had evidence of disseminated disease on US and CT scan. Forty two were resectable. Age range was 14-60 years. Thirty patients were between 20-40 years. Male to female ratio was 4:1. Thirty three patients had tumor at anorectal junction, four patients had tumor at 7 cm from anal verge, in five the tumor was not palpable as it was in the mid rectum. APR was carried out in thirty-three patients, low anterior resection in the four, ultra low anterior resection in four, with covering ileostomy in all cases of low and ultra low anterior resection. One patient had Hartmans procedure. In 42 patients curative surgery was done. With limited follow up over a period of two years one patient who had APR developed local recurrence. Total mesorectal excision in rectal cancer surgery is known to give less postoperative morbidity and good local disease control. Appropriate training in total mesorectal excision should be given to surgeons under training in order to achieve standard surgical outcome

Antifertility activity in medicinal herbs

Antifertility activity pertaining to two varieties [White and Red] of Abrus precatorius Linn, has been investigated which indicates significant fertility control. This activity has been demonstrated in the seeds as well as in an oil extracted from those seeds. The drug induced typical changes in Oestrus cycle which in these proven fertile Vistar rats, consisted predominantly of an Oestrus phase; maintained continuously long after the administration of the drug and thus rendering these animals infertile for longer durations. Furthermore, an inhibition of ovulation due to an interference in the release of gonadotrophins from the pituitary, as a possible mechanism of action, has been suggested