Management Options of Brain Abscess in Children with Cyanotic Heart Disease [CHD], Craniotomy vs Burr hole in a Developing Country

The aim of our study was to compare the advantages and disadvantages of burr hole and craniotomy methods in management of brain abscess in children secondary to cyanotic congenital heart disease [CHD]. The parameters used to compare these two methods were outcome of the treatment, improvement of Glasgow coma score, CT appearance of abscess andre-operation. Retrospective study was conducted over 6 year's period. A total of thirty three [33] paediatric patients were included in this descriptive study which was carried out in the Neurosurgery Department of Foundation University Medical College Rawalpindi, Pakistan from June 2003 to May 2009. Patients having the following criteria were selected for burr hole procedure: Intracranial abscess in patients of congenital heart disease, no previous surgical intervention, Patient's history and CT brain films available. Following patients were excluded from the study; postoperative, post traumatic and fungal abscess, age more than 15 years old and abscess less than 25mm Patients having low risk of anaesthesia and absence of above mentioned risk factors were selected for craniotomy and excision. Our study results showed that patients who underwent the burr hole aspiration of abscess had a decreased mortality, shorter hospital stay, significant improved progress in neurological and radiological status as compared to craniotomy and excision group. Our study results suggested that burr hole aspiration is more efficient procedure as compared to craniotomy in terms of surgical intervention and postoperative outcome in a selected group of brain abscess in patients with CHD. It is also a cost effective procedure

Cervical smear

To review cervical smear results in women of reproductive age group. Descriptive study. This study was carried out at the pathology department, Railway hospital, lslamic lnternational Medical College Trust. Rawalpindi, from Jan 2007-Dec 2010. A total of four hundred and seventy seven cervical smears were included in the study. lnclusion criteria was females of reproductive age group. Smears from postmenopausal women and those who had hysterectomy were excluded from the study. The cervical smear was taken using modified Ayres wooden spatula, or plastic spatula, to collect endocervical sample. The slides prepared were immediately fixed in 95% ethyl alcohol, and were subsequently stained by the recommended procedure of Pap staining. After staining, the slides were mounted with Canada balsam and finally reported by the cytopathologist according to the Bethesda System. Four hundred and seventy seven patients were included in the study. Most of the patients belonged to low socio economic status. The cytological examination of the smears showed inflammatory changes in 33% [n=159] cases, normal smears/ no positive finding in 25% [n= 118] cases, while reactive changes were seen in 2% [n= 10]. Dysplastic changes were seen in 2% [n= 10], while unsatisfactory/ lnadequate samples were reported in 38%[n=182] cases.

Hospital acquired infections; knowledge about it and its prevention

Nosocomial infections may be defined as the infections which develop within hospital. There are different types of microorganisms which are involved along with other agents for the spread of these infections. Knowledge about the spread and prevention of these infections is the basic step for control. Hospital staff especially the doctors should be aware about the precautions to control the spread of there infections. To assess the knowledge of doctors about hospital acquired infections and its prevention. descriptive study In surgical unit of Allied Hospital Faisalabad from 15[th] June 2006 15[th] July 2006. Study population was consisted on 71 doctors including Consultants, Medical Officers and House Officers. Data was collected with the help of questionnaires. Results showed that majority of doctors were aware about nosocomial infections [N.I] but have weak knowledge about their routes of transmission and common types of N.I. The study revealed that doctors have sufficient knowledge regarding N.I and its prevention but certain weakness were observed

Evaluation of cardiac risk by oxidative stress and inflammatory markers in diabetic patients

To evaluate the diabetic patients for cardiac risk by measuring oxidative stress and inflammatory markers in relation with glycaemic control. A total of 140 subjects were included in this case-control study, comprising of 70 diabetic patients with coronary heart disease [CHD] and an equal number, age and sex matched controls. The patients were non-alcoholic and had age >40years, BMI < 30 kg/m2 and glycated hemoglobin [HbA1c] 7-10%. Serum total cholesterol [TC] and gamma glutamyltransferase [GGT] were analyzed on selectra-E auto analyzer. Serum nitrate was measured at 540nm on ELISA. HbA1c on was analyzed by using Human kit. Serum high sensitivity C-reactive protein [hS-CRP] was analyzed on immulite 1000. Patients mean age was 51 [range 40-73] years. Diabetic patients had significantly elevated median of HbA1c [7.9 vs 4.9], hS CRP [6.0 vs 2.12], TC [5.95 vs 4.45], nitrate [19.20vs 10.70] and GGT [29.50 vs 22.50] as compared to controls [p< 0.001]. HbA1c showed a positive correlation [p <0.001] with hS-CRP [r=0.49], TC [r=0.69], nitrate [r=0.41] and GGT [r=0.30]. Oxidative stress and inflammatory markers should be used in addition to HbA1c for assessment of increased cardiac risk in un-controlled diabetic patients because of accelerated atherosclerosis due to free radical injury