Comparative efficacy of prolene and prolene-vicryl composite mesh for experimental ventral hernia repair in dogs

In this study, efficacy of two hernia mesh implants viz. conventional Prolene and a novel Prolene-Vicryl composite mesh was assessed for experimental ventral hernia repair in dogs. Twelve healthy mongrel dogs were selected and randomly divided into three groups, A, Band C [n=4]. In all groups, an experimental laparotomy was performed; thereafter, the posterior rectus sheath and peritoneum were sutured together, while, a 5 × 5 cm defect was created in the rectus muscle belly and anterior rectus sheath. For sublay hernioplasty, the hernia mesh [Prolene: group A; Prolene-Vicryl composite mesh: group B], was implanted over the posterior rectus sheath. In group C [control], mesh was not implanted; instead the laparotomy incision was closed after a herniorrhaphy. Postoperative pain, mesh shrinkage and adhesion formation were assessed as short term complications. Post-operatively, pain at surgical site was significantly less [P<0.001] in group B [composite mesh]; mesh shrinkage was also significantly less in group B [21.42%, P<0.05] than in group A [Prolene mesh shrinkage: 58.18%]. Group B [composite mesh] also depicted less than 25% adhesions [Mean +/- SE: 0.75 +/- 0.50 scores, P

In vitro adhesion of oral candida dubliniensis isolates to acrylic denture surfaces following brief exposure to sub-cidal concentrations of polyenes, azoles and chlorhexidine

We aimed to investigate the effect of brief exposure to sub-cidal concentrations of nystatin, amphotericin B, ketoconazole, fluconazole and chlorhexidine gluconate on the adhesion of oral Candida dubliniensis isolates to the surface of acrylic dentures. After determining the minimum inhibitory concentration of each drug, 20 oral isolates of C. dubliniensis were exposed to sub-cidal concentrations of the drugs for 1 h. The drugs were then removed by dilution, and the adhesion of the isolates to denture acrylic strips was assessed by an in vitro adhesion assay. Compared to the controls, exposure to nystatin, amphotericin B, ketoconazole, fluconazole and chlorhexidine gluconate suppressed the ability of C. dubliniensis isolates to adhere to acrylic denture surfaces with a reduction of 74.68, 74.27, 57.31, 44.57 and 56.53% [p <0.001 for all drugs], respectively. Brief exposure to sub-cidal concentrations of anti-mycotics suppressed the adhesion of C. dubliniensis oral isolates to acrylic denture surfaces

Radiation doses from [131]I treated hyperthyroidism patients versus life style: - a survey

Radioactive iodine is widely used for the treatment of various thyroid disorders. Safety issues are often a source of worry and anxiety for the patients, their families and comforters. The patients are advised to restrict their social and work related activities. The work presented in this study describes the results of a structured survey conducted on patients visiting our hospital. The total number of patients inducted was 419. The patients were asked about their housing conditions, family set up, number of children, travelling modes and travelling time back to home. The hospital leaving exposure rates from the patients were measured and radiation doses to others were estimated. Patients residing in joint family system were 93%. The measured dose rate at one meter were 5.7, 11.0, 15.7, 18.7, 23.0 and 28.0 micro Svh-1 for the administered [131]I activity of 185, 370, 555, 740, 925 and 1100 MBq respectively. The corresponding radiation doses to others from the patient were estimated as 0.76, 1.53, 2.29, 3.06, 3.82 and 4.58 mSv. The patients using public transport were 78.04% whereas 21.96% used private transport. There were 11.93% of the patients with no children and 88.07% of the patients had children residing with them. It was observed that 1.67% of the patients had no toilets at home and 98.33% had multiple toilets available. The radiation protection advice and regulatory requirements need to be formulated keeping in view the individual patient life styles and other living conditions

Pediatric air gun shot injury

Air guns [AGs] use air or another compressed gas to propel a projectile. Different injuries may occur in children due to their body structure, which is lessresistant with thin soft tissue coverage that can be easily penetrated by an AG shot. We present 3 cases of pediatric AG shot injury. The first-case had right lumber deep tissue penetration of AG pallet without internal damage, the second-case had a complex course of pellet into the perineum, and the third-case was shot in the left shoulder. All cases were accidentally shot. The shooters were all children, and relatives of the victims. All patients were generally stable on arrival. Two cases were operated, and one received conservative management. On follow up, no complications were noted. At first sight, AGs and air rifles may appear relatively harmless, but they are potentially lethal and children should not be allowed to play with them.

Toe tourniquet syndrome

Toe tourniquet syndrome refers to external, mechanical, circumferential constriction of the toes. We report a series of 4 infants with toe tourniquet syndrome from Saudi Arabia who presented during wintertime with very similar symptoms [approximately 48 hours of inconsolable crying and irritability], similar involved region [toes], and similar constricting agent [hairs]. Immediate removal of the hair fibers was carried out in all patients, fortunately followed by fast healing with no signs of tissue necrosis. The prompt diagnosis and treatment of the condition were vital in attaining the good outcome and preventing ischemic complications

Effects of Subtherapeutic concentrations of chlorhexidine gluconate on germ tube formation of oral candida

The main objective of this study was to investigate the effect of brief exposure to subtherapeutic concentrations of chlorhexidine gluconate on germ tube formation of Candida albicans isolates obtained from smokers, diabetics, asthmatics using steroid inhalers and healthy individuals. Forty isolates of C. albicans were used in this study. All these isolates were quantified for germ tube formation without exposure to the drug and were used as the control group for data analysis. Isolates were also exposed to three subtherapeutic concentrations of chlorhexidine gluconate [0.00125, 0.0025 and 0.005%] for 30 min [limited exposure]; the antiseptic was then removed and germ tube formation of these isolates was quantified microscopically following incubation in a germ tube-inducing medium. Compared with the unexposed controls, brief exposure to all concentrations of chlorhexidine gluconate suppressed the ability of the C. albicans isolates to form germ tubes in increasing order by 13.72% [p < 0.001 to p = 0.02], 46.16% [p < 0.001] and 72.46% [p <0.001]. These findings show that brief exposure to subtherapeutic concentrations of chlorhexidine gluconate may modulate germ tube formation of C. albicans isolates, thereby suppressing their pathogenicity, and further elucidate the pharmacodynamic mechanisms by which chlorhexidine gluconate may operate in vivo

Rapid differentiation of candida dubliniensis from candida albicans by early D-xylose assimilation

To determine if D-xylose [XYL] and/or alpha-methyl-D-glucoside [MDG] assimilation can be used reliably as a rapid test to differentiate Candida dubliniensis from Candida albicans at an earlier time point such as 2 h after inoculation. Thirty isolates of C. albicans and C. dubliniensis recovered from anatomical sites and clinical specimens were used. Isolates were inoculated into the API 20C AUX yeast identification system, and incubated at 30[degree sign]C. XYL and MDG assimilations were read at 2-hour intervals beginning 2 h after the initial inoculation and up to 24 h of incubation; thereafter, results were read after 48 and 72 h. Twenty-nine [97%] C. albicans isolates had assimilated XYL at 16 h and, by 24 h, all isolates were positive for XYL assimilation. None of the C. dubliniensis isolates assimilated XYL. The MDG assimilation revealed that 24, 40, 92 and 100% of C. albicans isolates became positive after 16, 24, 48 and 72 h of incubation, respectively, whereas only 3% of C. dubliniensis isolates assimilated MDG after 72 h. The findings showed that it is possible to rapidly differentiate C. albicans from C. dubliniensis isolates using the API 20C AUX carbohydrate assimilation kits after 16 h of incubation at 30[degree sign] C based on the XYL assimilation

Prevalence of plasmid mediated bla(TEM-1) and bla(CTX-M-15) type extended spectrum beta-lactamases in patients with sepsis

OBJECTIVE@#To characterize the bacterial pathogens in patients having gram negative septicaemia. Further, to evaluate the antimicrobial resistance and underlying molecular mechanisms in these strains.@*METHODS@#A total number of 70 cases of gram negative sepsis were included in this prospective, open labeled, observational study. Standard methods for isolation and identification of bacteria were used. Antimicrobial susceptibility and ESBL testing was performed by the standard disc diffusion method. PCR amplification was performed to identify bla(CTX-M), bla(SHV) and bla(TEM) type ESBLs. Conjugation experiments were performed to show resistant marker transfer.@*RESULTS@#The most prevalent isolates Escherichia coli (E. coli) 58.6%, Klebsiella Spp. 32.9% and Pseudomonas 8.6%, were resistant to most of the antimicrobials including cefazolin, ceftriaxone, cefuroxime, ampicillin and co-trimoxazole but sensitive to imipenem and meropenem. ESBL and MBL production was seen 7.3% and 12.2% of E. coli isolates respectively. Three isoaltes were found to have bla(CTX-M-15) and two of them also showed bla(TEM-1) type enxyme. Whereas, none of them showed bla(SHV). Conjugation experiments using J-53 cells confirmed these resistant markers as plasmid mediated.@*CONCLUSIONS@#This work highlights the molecular epidemiology of escalating antimicrobial resistance and likely switch over of bla(CTX-M-15) type extended spectrum beta-lactamases by bla(TEM) type ESBLs in India. Further, the antimicrobial resistance by horizontal gene transfer was predominant among Enterobacteraceae in the community setting.

Prevalence of Candida dubliniensis among oral Candida isolates in patients attending the Kuwait University Dental Clinic

The aim of this study was to determine the oral candidal carriage of patients seeking dental treatment at the Kuwait University Dental Clinic and to ascertain the Candida species composition among them. 370 oral rinse samples were collected from patients. The germ tube test, CHROMagar Candida medium and VITEK 2 yeast identification system were used for species identification. C. dubliniensis isolates were confirmed by the production of rough colonies with hyphal fringes and chlamydospores on simplified sunflower seed agar. Of the 370 samples investigated, 160 [43.24%] showed Candida in culture. The isolation of Candida was significantly higher in individuals who were smokers or were under medication for either diabetics or asthma [99 [62%]] compared to healthy individuals [61 [38%]]. Of the 210 samples which did not yield Candida, 131 [62.38%] were healthy and 79 [37.62%] were associated with smoking or with usage of drugs for aforementioned conditions. Species isolated were C. albicans [102 [63.7%]], C. dubliniensis [23[14.3%]], C. krusei [13 [8.1%]], C. tropicalis [12 [7.5%]] and C. glabrata [10 [6.2%]].Candida species were more prevalent in patients having predisposing factors implicated in oral candidosis, such as in smokers, diabetic patients and asthmatic patients using inhalation steroids. C. albicans was the most prevalent species isolated, followed by C. dubliniensis

Extrathyroidal uptake from thyroid carcinoma on [99m]Tc-pertechnetate scintigraphy

Three cases of imaging with 99mTc-pertechnetate [[99m]TcO[4]] and unusual positive lymph node uptake in the neck are reported hereby. Two cases were later diagnosed to be well-differentiated thyroid carcinoma, [DTC] with nodal metastasis. The third was a confirmed case of carcinoma thyroid that had presented with mass in the neck soon after surgery, being prepared for ablative dose of radioactive iodine [131]I. All three were young females under 40 years of age. These 3 cases signify that extra thyroidal areas of uptake on a routine thyroid scan with [99m]TcO[4] can some time be due to thyroid carcinoma with regional metastases. Foci of metastasis in patients with DTC may be incidentlly detected with [99m]TcO[4] scan. Multinodular goiter with palpable lymph node should always be investigated for exclusion of malignancy. The patients underwent near total thyroidectomy and radical neck dissection; histopathology confirmed the scan findings

Irrigation free transurethral resection of prostate [TURP]

To assess the safety and feasibility of irrigation free TURP in our routine practice. This study was carried out at Department of Urology, Karachi Medical and Dental College and Abbasi Shaheed Hospital, from March 2009 to February 2010. In this interventional study our inclusion criteria was benign disease and prostate weight up to 70 grams. Patients having more than two systemic medical illness like Diabetes, Hypertension [HTN], Ischemic heart disease [IHD], Cerebro-vascular accident [CVA] and Parkinsonism, were excluded from study. Patients remains on anti coagulant medications, patients with present or persistent urinary tract infections were also excluded. Patients who had surgical trauma, incidentally invent urethral stricture and vesical stones were also excluded. All cases were operated by one qualified, experienced surgeon. The decision of irrigation free TURP was taken on the basis of satisfactory hemostasis and good peri operative blood pressure control. Irrigation free TURP was ordered in post operative notes and such cases were closely observed for next 24 hours. After initial advice of irrigation free group if the patient needed irrigation because of haematuria, different patient's and operative variables were reviewed. There were total 50 patients aged 52-84 years with prostate weight ranging from 35 to 70 grams. Mean weight of prostate was 50.12 grams. Our 27% patients were hypertensive, 20% were diabetic and 17% patients had two comorbid conditions. Out of 50 patients 39 that is 78% cases remained irrigation free and followed the routine post operative course and were discharged. Patients who developed haematuria and had irrigation were 22%, seven had about two liters irrigation fluid over 6 hours and 4 patients had larger amount of fluid for 24 hours. In those patients who needed irrigation, seventy six percent were hypertensive, forty two percent were diabetic and twenty percent had two comorbid conditions. History of urinary infection was positive in ninety percent cases. Size of prostate and duration of surgery had no major impact on post operative period in this study. Seventy percent of the patients who needed irrigation had low blood pressure during surgery and became hypertensive in post operative phase. Post TURP Irrigation is an important step that helps in avoiding clot retention in early post operative phase. It increases the work load and treatment cost. In selected patients who have moderate gland, no major co morbidities and no infection, irrigation free TURP can be practised under close observation

comparison of the antifungal activity of herbal toothpastes against other brands of toothpastes on clinical isolates of candida albicans and candida dubliniensis

To evaluate the anti-Candida activity on Candida albicans and Candida dubliniensis species of 2 herbal and 7 other brands of toothpastes commonly used in Kuwait. Antifungal activity was determined by agar diffusion test on 65 isolates of C. albicans and 21 isolates of C. dubliniensis for each toothpaste. A uniform quantity of toothpaste was filled into wells punched into Sabouraud dextrose agar medium plates inoculated with the test isolates, incubated at 37°C; inhibition zone diameters were read after 24 h. The mean inhibition zone diameters ranged between 12 and 23 mm for C. albicans and between 12 and 27 mm for C. dubliniensis. A herbal toothpaste brand manufactured in the Middle Eastern region [United Arab Emirates] consisting of many herbal ingredients compared to other brands was found to be the most active [p < 0.001] against both Candida species tested, which also demonstrated higher inhibitory activity against C. dubliniensis isolates compared to C. albicans. The herbal toothpaste brand presented significant anticandidal activity over conventional toothpastes and may be useful in reducing the pathogenic potential of Candida species

Creating synergies for health systems strengthening through partnerships in Pakistan - a case study of the national eye health programme

Blindness and visual impairment are major causes of noncommunicable diseases in Pakistan. Two national population-based blindness surveys conducted in 1988 and 2002-04 demonstrated a reduction in prevalence of blindness from 1.78% to 0.9% with a significant drop in cataract blindness as a result of accelerated nationwide interventions and eye care integration in primary health care. In addition, between 2006 and 2008r 88 facilities were upgraded as a result of the national eye health programme. These measures resulted in a 279% increase in eye outpatient attendances and a 375% increase in eye surgeries performed. Investment in human resources development and policy change contributed significantly to the sustainability of the programme. Key challenges facing the programme include aligning national eye health strategies with health system strengthening informed through health systems research. This gaper attempts to document this extraordinary success

Injury patterns from road traffic accidents

To report the pattern of injuries from high speed road traffic accidents [RTA] in the Southern Region of Saudi Arabia. In this prospective criteria based one year study; data was collected upon arrival of patients to the accident and emergency department. The patients were grouped into two, with fractures [Group-1] and without [Group-2]. A total of 1513 patients were included, 628 in Group-1 and 885 in Group-2. There were 1356 male and 157 female patients in total. Majority were in the younger age group, drivers and front seat passengers. Fewer were using restrains and more reported driving with high speeds in group-1 compared to group-2. Most accidents occurred during 12:00 hrs to 24:00 hrs in both groups. Although most of the causative factors of Road traffic accidents in this region of Saudi Arabia are similar to the rest of the world; some remain unique to the region

Surgical site infection in lumbar surgeries, pre and postoperative antibiotics and length of stay: a case study

Postoperative wound infection also called as surgical site infection [SSI], is a troublesome complications of lumbar spine surgeries and they can be associated with serious morbidities, mortalities and increase resource utilization. With the improvement in diagnostic modalities, proper surgical techniques, antibiotic therapy and postoperative care, infectious complications can result in various compromises afterwards. The objective was to study the relation of surgical site infection in clean lumbar surgeries with the doses of antibiotics. This retrospective study was conducted at Shifa International Hospital, from January 2006 to March 2008. Hundred post operated cases of lumber disc prolapse, lumber stenosis or both studied retrospectively by tracing their operated data from hospital record section for the development of surgical site infection [SSI]. The patients were divided into three groups depending upon whether they received single, three or more than three doses of antibiotics respectively. Complete data analyses and cross tabulation done with SPSS version 16. Of 100 cases, only 6% had superficial surgical site infection; only 1 case with co morbidity of hypertension was detected. Twenty-one cases had single dose of antibiotic [Group-I], 59 cases had 3 doses [Group II] and 20 cases received multiple doses [Group III]. There was no infection in Group-I. Only one patient in Group-II and 5 patients in Group III developed superficial SSI. While 4 in Group-II, 3 in Group-III, and none of Group-I had >6 days length of stay [LOS]. The dose of antibiotic directly correlates with the surgical site infection in clean lumbar surgeries. When compared with multiple doses of antibiotics a single preoperative shot of antibiotic is equally effective for patients with SSI

Legionella in clinical specimens and hospital water supply facilities: molecular detection and genotyping of the isolates

To evaluate genus- and species-specific polymerase chain reactions [PCRs] for the detection of the genus Legionella and the species Legionella pneumophila in clinical specimens and hospital water supplies, and to establish a simple and reproducible random amplification of polymorphic DNA [RAPD]-PCR technique for genotyping of Legionella. A total of 70 respiratory tract specimens [bronchoalveolar lavage: n = 46; endotracheal secretions: n = 9; sputum: n = 15] from patients with atypical pneumonia, and 283 environmental samples [water: 20; swabs: 263] collected from water storage and supply facilities of the Mubarak Al-Kabeer Hospital, Kuwait, were tested by culture and genus-specific PCR for the detection of Legionella. The L pneumophila isolates were subsequently typed by serology and RAPD-PCR using serotype-specific sera and arbitrary primers, respectively. Of the 70 clinical samples, culture yielded 2 [2.9%] whereas genus-specific PCR detected Legionella in 20 [28.6%] samples. The 2 culture-positive specimens were also positive for L.-pneumophila-specific PCR. Testing of swab and water samples by culture and genus-specific PCR yielded 61 [21.6%] and 67 [23.7%] positive samples, respectively. All of the 61 culture-positive samples were also positive by genus-specific PCR and 45 of them were positive for L.-pneumophila-specific PCR. Serological typing of 43 L pneumophila isolates showed that 8 of these belonged to serotype 1 and 35 to serotype 3; however, RAPD-PCR analyses demonstrated polymorphisms among the isolates of both serotypes. A higher association between PCR and culture was observed for the environmental samples than for the clinical samples. The application of genus- and species-specific PCRs and RAPD is useful in the detection and typing of Legionella in clinical and environmental samples

Eradication of H. Pylori by quadruple or triple therapy.a comparative study

Quadruple therapy appears to be more effective than standard therapy in management of patients with helicobacter pylori infection. No data is available on the relative efficacy of triple and quadruple drug regimens from Pakistan. Consecutive patients with peptic ulcer and H. pylori infection were randomized to receive omeprazole 20 mg twice daily along with either amoxycilline [500 mg four times daily] and clarithromycin [500 mg twice daily] [Group A] or tri-protassium dicitrate hismuthate [120 mg four times daily], metronidazole [400 mg thrice daily] and tetracycline [500 mg 4 times daily] [Group B] for 10 days. Presence H. Pylori infection was looked for using an fecal antigen test before treatment and 30 days after completion of treatment. 17 of 21 patients in Group A and 16 of 23 in Group B had eradication of infection [80.9 and 69.56% respectively by protocol analysis]. Side effects occurred in 2 [1%] and 4[2%] patients in Group A and B, respectively. Discontinuation of drug was not required in any patient. Quadruple therapy for initial therapy of H. Pylori infection does not offer any advantage over standard triple therapy

Siriraj score as a tool for clinical diagnosis of stroke

Siriraj stroke score is a diagnostic tool to differentiated ischemic from haemorrhagic shock. This study was carried out to access SSS accuracy as compared to CT scan. This study was carried out in the Department of Medicine and Neurology of Mayo Hospital, Lahore. Thirty two patients were included in the study who had stroke SSS was applied as well as CT scan was done. Out of them 6% were misdiagnosed. Overall predictive accuracy was 87.5%. Siriraj stroke score is not 100% accurate. CT scan should be advised before starting definitive stroke therapy

Aetiology of exudative pleural effusion in district D. I. Khan

Pleural effusion is commonly seen in the clinical practice. A larger number of diseases can cause it. Its causes are variable in different communities. Transudative effusions pose little diagnostic difficulty as compared to the exudative ones. In this study we investigated the aetiology of exudative pleural effusion in adult patients in our setup. It is a cross-sectional study. From January 1st to June 30 th, 2002 we studied adult patients presenting to Medical unit DHQ Teaching Hospital D. I. Khan, Pakistan, having a pleural effusion confirmed by chest radiographs. Patients having clinical and/or laboratory evidence of transudative pleural effusion were excluded from the study. A detailed history and through clinical examination was recorded. Routine investigations were performed. Thoracocentesis and pleural fluid analysis were performed in all patients. Pleural biopsy was taken in patients with exudative pleural effusion. Other investigations were performed according to the clinical indication. Fifty patients with pleural effusion were studied. Out of these, 22 had exudative pleural effusion. Further investigations revealed that 15/22 [68.18%] had tuberculosis, 3/22 [13.63%] had neoplasia, 2/22 [9.09%] had amoebic infection, 1/22 [4.54%] had para-pneumonia and 1/22 [4.54%] had ampyema thoracic. We conclude that of the exudative pleural effusion in this region is mainly due to tuberculosis. Neoplasia is the second common cause in adult population. Amoebiasis should be considered in right sided pleural effusions

Ultrasound screening of at risk infants optimizes conservative management and can reduce the rate of surgery in developmental dyspalsia of Hip

To determine the usefulness of ultrasound screening of only at risk infants in the management of developmental dysplasia of hip [D.D.H.]. All live births, [9310], were examined by a neonatologist within 24 hours of birth. The infants with unstable hips on clinical examination, clicking hips, family history, breech presentation [vaginal delivery and caesarean sections] and those with concurrent congenital deformity were then seen in the D.D.H. clinic, within 3 weeks of birth .The infants were classified according to the ultrasound appearance of their hips. Graf's typing was used and formed the basis for conservative and surgical management. There were 218 Grade I, normal babies. There were 89 dysplastic hips in 83 patients. 51 Grade II, 23 Grade III and 15 Grade IV dysplasias. During the study of 23 months of study only 3 hips, all with an initial type 1V ultrasound appearance were unresponsive to conservative measures and required open surgery. Ultrasound screening of babies at risk and those with unstable hips on clinical examination optimizes conservative management and can reduce the rate of open surgical intervention in D.D.H