experience with mesh versus darn repair in inguinal hernias

Background and Objective: The inguinal hernia accounts for 50 percent in old age males. A Lichtenstein type of operation has now become the method of choice in most developed countries but in the developing world traditional simple suture repair is still in common practice in resource limited hospitals due to the scarcity and expensive nature of the commercial prosthetic mesh. Our objective was to compare the rates of complications in Lichtenstein repair to tension free Darn repair

Methods: Ninety two male patients from 20-60 years of age reported for direct or indirect inguinal hernia with open Mesh/Lichtenstein or darn repair in emergency or electively from January 2014 to December 2015 were enrolled in this prospective randomized control trial [RCT]. The primary end point was to compare the surgical site infection, length of hospital stay and hernia recurrence with different techniques

Results: The hospital stay was higher in patients who had Lichtenstein repair, Superficial surgical site infections in cohort A [6.5%] and cohort B [4.36%] were noted. Complications of recurrence in Group-A were [1.5%] as compared to Group-B which had a recurrence of 6.52%

Conclusion: Lichtenstein is more promising in comparison to Darn repair in terms of recurrence in inguinal hernia

Association of serum zinc level with pre eclampsia

Background: Pre eclampsia is the commonest obstetrical complication in pregnant women. The etiology of pre eclampsia has yet not been clearly understood. It has a worldwide prevalence of 2-10% of pregnancies and one of the major causes of increase in maternal and perinatal morbidity and mortality. Zinc plays an important role in the course and eventual outcome of human pregnancy and is essential for normal embryogenesis and fetal growth. Zinc deficiency in pregnancy is thought to be associated with pre-eclampsia

Objective: The aim of this study was to investigate the serum zinc level in pre-eclampsia

Patients and Methods: This Hospital based study conducted at Gynecology Department of Indus Medical Collage, Tando Muhammad Khan, Sindh from October 2015 to March 2016 with the Permission of Head of the Department and Principal of Institute. The study groups consist of 40 consecutive diagnosed cases of pre eclampsia and 40 women with normal pregnancies. The serum zinc level of the subjects under this study was determined using Atomic Absorption Spectrophotometer

Results: The results of our study showed that serum Zinc level among the pre-eclamptic and was statistically significantly low as compared to normotensive pregnant women

Conclusion: The findings of current work are statistically significant to establish that concentration of serum zinc among preeclamptic subjects is lower than in the normotensive women during pregnancy

Mean platelet volume as an indicator of glycemic control in type 2 diabetes mellitus

Objective: To study platelet counts [PC], mean platelet volume [MPV] and glycated HbA1 in type 2 Diabetes mellitus [T2DM]

Study Design: Case control study

Place and Duration of Study: This study was conducted at the Department of Medicine, Indus Medical College Hospital, Tando Muhammad Khan, Sindh from March to November 2015

Materials and Methods: A sample of 150 subjects; comprising of Group A- controls [n=50], Group B- controlled diabetics [n=50] and Group C- [n=50] uncontrolled diabetics. DM was diagnosed according to American Diabetes Association. Permission was taken from ethics review committee of institute. Only willing subjects were included after they signed consent proforma voluntarily. Blood pressure, BMI, Blood glucose, Platelet counts, MPV and HbA1c were determined Data was typed on Microsoft excel, and then pasted SPSS 22.0 sheet for statistical analysis. Chi square test, one way ANOV, post-Hoc Tukey Cramer and Pearson's association was used for analysis of data variables. All data was analyzed at Confidence interval of 95% [

Results: MPV was raised in Diabetics in particular with uncontrolled glycemic index as shown in table II. MPV showed negative correlation with platelets was found with MPV [r = -0.27, p=0.03]. MPV was positively correlated with glycated HbA1 [r = 0.78, p= 0.0001]. HbA1c as high as 14.3% was noted in uncontrolled diabetics

Conclusion: The present study reports raised Mean platelet volume in Diabetics in particular uncontrolled diabetics. MPV showed positive correlation with HbA1c and negative correlation with platelet count

Histological pattern of oral carcinoma and its association with different addictive risk factors

Objective: Objective of this study was to find out association between histopathology of oral carcinomas and addictive risk factors

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at Dental OPD, Liaquat University Medical Hospital and department of Pathology LUMHS Jamshoro/ Hyderabad from 2015 to 2016

Materials and Methods: Total 60 patients were included in the study having oral carcinomas. Careful clinical assessment following by complete medical history along with clinical examination was carried out. All the addictive cases were selected. All the information of various parameters like age, gender of patient, relevant clinical history, tobacco habit, other addictive associated risk factor, and microscopic histopathological findings of tissue specimen were carried out. All the addictive risk factor's association was noted with types of oral carcinoma

Results: Out of these 60 patients, maximum number of patients i.e. 29 [48.33%] were from > 50 years of age group. Majority of patients 35[58.33%] were illiterate while only 6[10%] were graduate. Majority of patients 21[35%] had carcinoma in buccal mucosa. Majority of the cases 46.66% multiple addictive habits, while only tobacco chewing, betal nut/manpuri, gutka, naswar and tobacco smoking habits were found with percentage of 8.34%, 10%, 8.34%, 6.66% and 20% respectively. According to histopathological findings squamous cell carcinoma was the most common in 85% of the cases, following by verrucous carcinoma in 6.67%, Micro-invasive SCC was only in 1 patient and other non-squamous cell carcinomas were found in 6.67% of the cases.On the association between histological findings and addictive risk factors no significant difference was found between squamous cell carcinoma and addictive risk factors p value 0.112, while VC, MISCC and other non-squamous cell carcinoma were significantly associated with patients having multiple addictive habits p value 0.02

Conclusion: We concluded that multiple mix addictions of tobacco chewing and smoking, gutka, naswar andbetal nuts are significantly associated with oral carcinomaand potentially increases the chances of oral malignancy in certain pre malignant conditions

Role of proton pump inhibitors in chronic cough

To see the effectiveness of Proton Pump Inhibitors in patients with chronic cough at Liaquat UniversityHospital. Observational study. This study was conducted at ENT Department, Liaquat University Hospital, Jamshoro/Hyderabad from November 2010 to October 2011. Irrespective of age and gender 109 cases were recorded with history of chronic cough. After getting a detailed History all the cases were examined thoroughly for any pathology in Nose, Nasopharynx,Sinuses, Throat and Larynx in ENT department and then Sent to Physician to find or exclude the pathology in chest and Gastro intestinal tract. Required investigations were carried out in selected cases. All the cases after diagnosis were selected for PPI treatment for 30 days. Patient's response to the treatment was recorded. All the data regarding sign symptoms, clinical diagnosis, duration of cough and response of the cases to PPI treatment was entered on Performa for analysis. 109 cases were chosen in present study with chronic cough, majority of the cases 55 [50.45%] were found with age group of 41-60 years. Female were found in the big percentage 63 [57.79%], as compare to male 46 [42.20%], mostly 86[78.89%] cases had duration of cough under VIII weeks. 39 [35.77%] cases were noted with feeling of lump in throat and this was commonest symptom. 57 [52.29%] patients were found with complete response, 35 [32.11%] patients were noted with partial response and continued for some more days, while 17 [15.59%] patients had not respond to PPI treatment and those were advised some other investigations and treatment. PPI having prime role in cases of chronic cough. PPI can easily be given on Clinical ground even without more investigations

To detect the fungal infection in the patients with nasal polyps

To determine the prevalence of fungal infection in the patients having nasal polyps at Liaquat University Hospital, Hyderabad. Observational and prospective study. This study was conducted in the Department of the ENT of Liaquat University Hospital, Jamshoro/Hyderabad from March 2012 to August 2012. Total 50 had selected. All the cases with nasal polyp, both genders and above 18 years of the age were integrated. Routine lab investigations had completed. Radiological examination including the X-ray of paranasal sinuses and CT scan had done to diagnosis sinuses, bony erosion, orbital and intracranial extension. Surgical procedure had done according to the need of the patient. After surgery all the samples separated in 2 places under sterile process. One for histopathology and 2[nd] in the normal saline had sent for fungal Culture of specimen. Total 50 cases were selected in the study after diagnosis of nasal polyp, mean age of the cases was mean +SD=36.05+7.21 years, male had found in the majority 31[62.0%]. Nasal obstruction was the most common 42 [84.0%] in the clinical presentation. Majority of the cases 26.0% were under went surgical procedure of nasal polypectomy. After done histopathology frequently diagnosis found as Inflammatory polyp 43 [86.0%], while08 [16.0%] cases were found with fungal infection and 42 [84.0%] were without fungal infection after culture test. In conclusion fungal infection is found most common in the cases having nasal polyps

Effects of thirty minutes regular brisk walk on blood pressure in hypertensive subjects

Objective: The present prospective study was conducted to observe the physiological effects of brisk walk on the systemic blood pressure in hypertensive subjects

Study Design: Observational study

Place and Duration of Study: This study was conducted at Outpatient Department, NICVD-Jinnah Postgraduate Medical Center [JPMC] / Physiology department, BMSI, Karachi from December 2001 to May 2002

Materials and Methods: A sample of 30 diagnosed cases of mild uncomplicated systemic hypertension and 30 healthy controls were selected as per study criteria. Aerobic exercise was explained as of doing regular briskwalking of 30 minutes on alternate days for 60 days. Systolic blood pressure [SBP], diastolic BP [DBP], heart rate [HR] and respiratory rate [RR] were checked at baseline and after 60 days of aerobic exercise. Consent of subjects and approval of ethics committee of institute was observed. Data was analyzed on the SPSS 10.0. Continuous and categoricaldata wasanalyzedbystudent`st-testand Chisquaretestrespectivelyas95%confidenceinterval

Results: Baseline systolic BP, diastolic BP, HR and RR were raised in hypertensive subjects compared to controls [p=0.001]. After 60 days aerobic exercise, the systolic BP, diastolic BP, HR and RR were reduced in hypertensive subjects compared to controls [p >0.05]

Conclusion: The present study concludes that the aerobic exercise improves Systolic blood pressure [SBP], diastolic BP [DBP], heart rate [HR] and respiratory rate [RR] in hypertensive subjects

Effects of aerobic exercise on lipid profile in patients with type 2 diabetes[NIDDM]

Objectives: This study was undertaken to observe the effects of aerobic exercise on lipid profile in newly diagnosed type 2 diabetic patients

Study Design: Observational study

Place and Duration of Study: This study was conducted at Physiology Department, JPMC Karachi from December 2001 to May 2002

Materials and Methods: 30 adult male subjects with uncomplicated type 2 diabetes were selected from diabetic clinic of JPMC, Karachi. 30 apparently healthy adult male subjects were selected from friends, students and staff members of BMSI, as control. The subjects belonging to diabetic groups were then briefed about exercise protocol, which consisted of a regular brisk walk of 30 minutes on alternate days per week for 60 days

Results: Base line Values of mean HDL-cholesterol serum cholesterol, serum total triglycerides, LDL-cholesterol, and mean fasting blood glucose were significantly different in diabetic group as compared to control group [P<0.001] After aerobic exercise, all the parameters except HDL-C were significantly decreased while HDL-C was significantly increased as compared to the pre-exercise values

Conclusion: Regular aerobic exercises improve blood glucose, TAG, LDLc and cholesterol and increases the HDLc in type 2 diabetic subjects has been concluded by the present study

Hypoglycemia; patients with liver cirrhosis

To determine the frequency and severity of hypoglycemia in patients with liver cirrhosis. Cross sectional case series study. Six months. Liaquat University Hospital Hyderabad. All the patients of liver cirrhosis, of >12 years of age and of either gender were evaluated for hypoglycemia by assessing the glycemic status through random or fasting blood glucose level. The severity of liver cirrhosis was identified according to the Child-Pugh classification whereas the severity of hypoglycemia was grouped in mild, moderate and severe categories. The data was entered and saved in SPSS and frequency and percentage was calculated for hypoglycemia in patients with liver cirrhosis. The stratification was done for age, gender, hypoglycemia and severity of the disease and hypoglycemia. The chi-square test was applied between categorical variables at 95% confidence interval and p -value

Metabolic syndrome; gamma glutamyltransferase in patients

To determine the role of gamma glutamyltransferase as a biochemical marker for the diagnosis of metabolic syndrome. Cross sectional descriptive study. One year. Department of Medicine, Liaquat University Hospital Hyderabad / Jamshoro. All the patients with metabolic syndrome visited at OPD / admitted in the ward were further evaluated for serum gamma-glutamyltransferase level. The data was analyzed in SPSS 16 and the frequency and percentage was calculated. During one year study period, total one hundred patients [23 males and 77 were females] with metabolic syndrome were recruited and study for gamma glutamyl transferase level. The mean age +/-SD for overall population was 56.84+/-6.52 whereas it was 48.92+/-5.82 and 58.61+/-7.73 in male and female population respectively. The mean +/- SD of systolic and diastolic blood pressure [mmHg], triglycerides [mg/dl], high density lipoprotein pressure [mg/dl] and fasting blood sugar [mg/dl] in overall population was 161.20 +/- 16.74 and 95.60 +/- 8.34, 176.38 +/- 11.93, 29.44 +/- 2.90 and 108.42+/- 6.25. The mean gamma glutamyl transferase level in overall population was 86.75+/-7.74 while it was 84.83+/-5.32 and 89.52+/-6.84 in male and female population respectively. The gamma-glutamyltransferase was raised in 75 patients of which 13 were males and 62 were females [p=0.02] and majority of patients were 50-59 year age group [p <0.01]. It is concluded that GGT is a good diagnostic tool in metabolic syndrome with statistical significant results

Liver cirrhosis; frequency and severity of hyponatremia in patients

Liver cirrhosis results from prolonged, widespread but patchy hepato-cellular necrosis due to various reasons. To determine the frequency and severity of hyponatremia in patients with liver cirrhosis. Descriptive case series study. Six months. Liaquat University Hospital Hyderabad. The cirrhotic subjects were assessed for hyponatremia and its severity. The data was analyzed in SPSS 16 and the frequency and percentage was calculated for hyponatremia and statistically p -value

Liver cirrhosis; frequency and severity of thrombocytopenia in patients

To determine the frequency and severity of thrombocytopenia in patients with liver cirrhosis. Cross sectional study. 01-03-2013 to 31-08- 2013. Liaquat University Hospital, Hyderabad. The cirrhotic patients were assessed for thrombocytopenia and its severity. The data was analyzed in SPSS version 11.00 and frequency and percentage was computed. The chi-square test was applied and p -value

Vivax malaria; frequency, severity of thrombocytopenia and variation in red cell distribution width [RDW]

To determine the frequency and severity of thrombocytopenia and to evaluate the variation of red cell distribution width [RDW] in patients with acute vivax malaria. Cross sectional descriptive case series study. Six months. Liaquat University Hospital. All the patients with acute vivax malaria were evaluated for thrombocytopenia its severity and RDW. The data was analyzed in SPSS 10 and the frequency and percentage was calculated. Total 126 patients with acute vivax malaria were recruited, of which 88 were males and 38 were females. The mean age +/- SD for male and female subjects was 44.76 +/- 6.83 and 40.83 +/- 7.42. The common features observed were fever 31%, rigor 15% and combined features 14% [p=0.05]. The thrombocytopenia was identified in 86 patients of which 65 were males and 21 were females [p=0.04]. The increased RDW was observed in 75 patients of which 57 were males and 18 were females [p=0.05]. The bleeding was detected in 56 and dyspnea and heart failure was found in 30 thrombocytopenic subjects [p=0.02]. Regarding outcome 82 subjects were recovered while the 04 patients were expired [p=0.05]. Regarding severity of thrombocytopenia majority 48.8% were in moderate category with male predominance [p=0.02]. The thrombocytopenia and increased RDW was observed in patients with acute vivax malaria

Relationship between histone modification and seizures in rat brain

To see the effect of progesterone on GABA transporter-1 and glutamate transporter-2 expression in the cerebral contex of developing rats after recurrent seizures. Quasit experimental study. This study was carried out in Experimental laboratory at Pediatrics Department, Xiangya 2[nd] Hospital, Central South University Changsha Human P.R. China, from September 2011 to April 2011. This experiment included 90 PN-7d the SD rats, Flurothyl to cause convulsions in group and progesterone in the intervention group, one died, died of status epilepticus, a mortality rate of 2.2% in each group were randomly selected eight test SD rats [72] for the analysis of experimental results. Flurothyl induced seizures stopped after the group of SD rats had no spontaneous seizures is the emergence of limb movement disorder and abnormal reactions. The cerebral cortex GAT-1 immunohistochemistry AOD changes in the control group, PN-13D [ARS-1d], the PN-15d [ARS-3d] and PN-19d Service [ARS-7d], the convulsions rats cerebral cortex GAT-1 immunohistochemistry AOD expression than the control group was significantly higher [P<0.01]; progesterone in the intervention group, the GAT-1 immunohistochemistry AOD than the convulsions were significantly lower [P<0.01] difference between the groups is not significant. The cerebral cortex GAT-1 protein expression was significantly higher and progesterone in the intervention group [P<0.01]; progesterone at each time point after the intervention of the GAT-1 expression levels than the control groups was significantly increased statistically significant [P<0.01]. Changes of expression of the GLT-1 protein in the rat cerebral cortex in the control group, the PN-13d, PN-15d and PN 19d cerebral cortex of the GLT-1 protein expression was no significant difference [F= 1, 852, P= 0.182]. In conclusion, Progesterone through its participation in regulation of neonatal recurrent seizures caused by an imbalance in the brain cerebral cortex, GAT-1, GLT-1 expression, the maintance of the central nervous system excitation-inhibition of the balance of the system, which play an anticonvulsant effect

Frequency of low birth weight in primigravida reported PUMHS hospital Nawabshah

To determine the frequency of low birth weight in primigravida reported at PMC Hospital Nawabshah. Descriptive case series study. Departments of Gynaecology and Obstetrics and paeds medicine, at Peoples University of Medical and Health Sciences Nawabshah, from Jan 2011 to the Dec 2011. this study consisted of 319 pregnant women at 16 weeks of gestational age with singleton pregnancy reporting to the Antenatal Clinic, Obstetrics and Gynaecology Department were selected. Weight was measured by using weight machine throughout antenatal checkups. Weight and height was measured by same person rechecked. Their pregnancies were followed to assess the low birth weight. The neonatologist evaluated the babies. All primigravida women in the reproductive age group between >18 to <35 years with singleton pregnancy, normal fetal lie, and Height 5 feet or more were included. Exclusion criteria were patients associated with uterine anomalies [like uterine polyp, uterine septae, submucosal fibroid], smoking, short stature, other medical disorder like diabetes, hypertension, thyroid disorders, epilepsy and asthma. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. 319 patients included in this study. There was a wide variation in age was noted. The youngest patient was 18 years old and the oldest patient was 35 years old. The mean age was 21.21 + 4.22 years and peak age group for presentation of primigravida in our study is 26 to 30 years. clinical asses the fetal weight and observed 42 [13.16%] cases were <3.5kg weight while remaining 277[86.83%] cases were 2.5 to 4 kg weight. In conclusion, we observed in our study that low body weight of primigravida mother is associated with low birth weight babies

Follicular dendritic cell sarcoma of the neck with pulmonary metastases

We present a case of follicular dendritic cell sarcoma in a 48 years old Saudi female who reported with slowly progressive right sided extranodal neck mass associated with pulmonary metastasis. Clinical examination, histopathologic features including distinct immunostains combine together to make the rare diagnosis of follicular dendritic cell sarcoma. This entity is often misdiagnosed due to non-consideration in differential diagnosis of sarcoma. It carries a significant potential for regional as well as distant spread and hence categorized as intermediate risk malignancy. Clinical, histopathological and immunohistochemical aspects and therapeutic options of this unusual case are discussed

Pattern of intestinal obstruction in infants and children

To find out causes of intestinal obstruction in infants and children and their relation to age and sex distribution. This descriptive study was conducted at Peadiatric Surgery departments of Peoples University of Medical and Health Science for women Hospital Nawab Shah and Liaquat University of Medical and Health Sciences Hospital Jamshoro, from January 2010 to December 2010. All infants and children presenting with symptoms and signs of intestinal obstruction, and patients having advanced appendicitis with intestinal obstruction, were included in this study. Surgical intervention was carried out, where indicated, otherwise patients were managed conservatively. Patients were divided into two groups: Infants were enlisted in group A, while toddlers and older children were put together in group B. Data was analyzed by using SPSS version 10 for percentage and frequencies Total 67 patients were included in the study. Among these 44 were Males and 23 Females with M: F ratio of 1.9:1. There were 24 patients in group A, among these, 15[62.5%] cases had intussusception, while other conditions, namely incarcerated inguinal hernia, colonic web, post operative adhesions, ileal web and inflammatory bands constituted 37.5% cases of bowel obstruction. In group B there were 43 patients. These included, post operative adhesions in 6[13.95%] patients, while tuberculosis of intestine in 5[11.63%], Meckel's diverticulum with band 5[11.63%], perforated appendix in 5[11.63%], intussusception in 3[6.97%], Volvulus of small intestine in 3[6.97%] and Inflammatory bands and adhesions in 3[6.97%] patients. Malrotation, Hirschsprung's disease, Trichobezoar and faecal impaction each one occurred in 2[4.65%] patients. Ovarain teratoma, lymphoma, caecal Volvulus, duodenal web and duplication of colon of each one of these conditions occurred in one [0.43%] patient each. Resection of gut and anastomosis was carried out in 18[26.86%] patients [8 from group A and 10 from B]. Two patients from group B died. Pattern of intestinal obstruction varies at different age groups in terms of etiology as well as in relative incidence. Intussusception was the commonest cause in group A, while post operative adhesion had predominance in group B. Outcome depends upon the underlying condition and associated morbidity

Frequency of depression in chronic Hepatitis C naive patients

To determine frequency of depression in chronic hepatitis C na‹ve patients before interferon therapy using CES-D questionnaire. Patients testing positive antibodies to HCV by EIA of more than 6 months duration and who have not taken interferon therapy previously were included after taking informed consent. Patients who had co-infections such as hepatitis B and D virus or human immunodeficiency virus, or patients with other coexisting chronic liver disease like primary biliary cirrhosis, chronic autoimmune hepatitis and Wilson disease were excluded from study. Urdu version of CES-D a self-reporting questionnaire in public domain was administered. A score of >/= 10 was taken consistent with depression. Ninety-six patients were included and 59.4% were depressed. These included 57.9% males and 42.1% females. Highest frequency was seen in under-graduates and positive correlation was seen with duration of hepatitis C infection. This study showed that 59.4% of patients with hepatitis C have depression before initiation of therapy and this should be evaluated and treated if necessary before starting interferon therapy

Reasons for conversion from laparoscopic to open cholecystectomy

To determine the frequency and reasons of conversion of laparoscopic cholecystectomy [LC] to open cholecystectomy [OC]. This prospective study was carried out in the Surgical unit III, Peoples Medical College Hospital from April 2006 to October 2009 male and female] were included in the study, all were evaluated fully preoperatively in respect to disease and general fitness of the patient for surgery and counseled regarding possibility of conversion from LC to OC. 6 patients [8.8%] were converted to open procedure. Obscure anatomy of Calot's triangle, bleeding and bile duct injury were common reasons of conversion. Even in difficult cases LC is a safe procedure with low incidence of conversion and complications in hands of experienced laparoscopic surgeon, where as junior surgeons being in learning curve are less confident and skillful, so are prone to more complications. Therefore they are advised to convert to open procedure earlier according to the criteria laid down, before complication occurs

Frequency of acute hepatitis C after needle stick injury and its treatment outcome

To determine the frequency of acute HCV infection after needle stick injury and its treatment outcome. Patients with HCV positive needle stick injury and reporting within 72 hours of incident were selected. Co-infections with HBV, HDV, HIV, hematological disorders and depression were excluded. Anti-HCV was done at presentation and those testing positive were excluded. HCV RNA was done after two weeks or anti-HCV after six weeks of incident. Those testing positive were kept under observation for 16 weeks for spontaneous resolution. After this period HCV RNA and Genotype were done and therapy with Peg-interferon was started. Rapid, early and sustained virological responses were checked. Two hundred eight patients with HCV positive needle stick injury were selected, 10 [4.8%] developed acute HCV infection out of them one [10%] had spontaneous recovery during the observation period of 16 weeks. seven [77.8%] achieved rapid virological response and eight [88.9%] achieved sustained virological response. Acute HCV is an uncommon disease to diagnose; it has favorable response to therapy if initiated early after a strict surveillance of patients for 8-16 weeks