Comparison of surgical site infections between laparoscopic and open cholecystectomy

Background: This study assessed the causes of infection in cholecystectomy and compared the infection rates between the open and laparoscopic cholecystectomy

Materials and Methods: This was a retrospective cohort study, performed on all patients admitted to Shariati Hospital since February 2017 for cholecystectomy. Initially, the patients were evaluated for infection risk factors, and then surgical site infection rates in these individuals were measured. Infection was assessed at the time of patients discharge [in the first few days after surgery] and again a month later, either in clinic or by phone. Information from 81 patients was collected, and SPSS software version 24 was used to analyse the data using appropriate statistical tests. Statistical significance was defined as p value < 0.05

Results: The mean age of the participants was 45.89 +/- 13.38. The relationship between surgical site infections [SSI] and age, sex, comorbidities [diabetes, hypertension, ischemic heart disease, malignancy, chronic lung disease, and chronic kidney disease], taking corticosteroids, smoking, and the emergency or elective nature of the surgery was not significant. The mean age of the patients who underwent open cholecystectomy was higher than the laparoscopic group [p = 0.005]. Similarly, the average hospitalization period for those underwent open cholecystectomy was higher [p = 0.03]. Finally, the infection rates for open cholecystectomy were 6 times higher than laparoscopic surgeries [RR: 6.11]

Conclusion: There was no significant relationship between SSIs and the risk factors assessed in this study. However, infection rates were higher in the open cholecystectomy group. More studies on the various risk factors of infection and the differences between the laparoscopic and open surgical methods are required

The effect of a short-term pulmonary rehabilitation on exercise capacity and quality of life in patients hospitalised with acute exacerbation of chronic obstructive pulmonary disease.

Background. Recent research shows that pulmonary rehabilitation (PR) programmes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), reduced dyspnoea, improved exercise capacity, and prevented occurrence of further exacerbations. Objective. To evaluate the utility of a 3-week PR programme in patients with AECOPD. Methods. Patients admitted with AECOPD, following clinical stabilisation in the respiratroy intensive care unit (RICU), were alternately assigned to intervention (n=15); and control groups (n=15), respectively. Baseline assessment included spirometry, six-minute walk test (6MWT), symptom limited cardiopulmonary exercise test (CPET), health-related quality of life (HRQoL) assessment by generic questionnaire medical outcomes study short form (S-F 36) questionnaire and dyspnoea evaluation by Borg score. The intervention group patients were treated with usual care plus PR exercises in the form of 20 minutes each of walking, bicycle ergometry and resistance exercises, thrice-weekly for three weeks. The control group patients were treated with only the usual care. After discharge from hospital the treatment regimens were continued on alternate days on outpatient basis, for a total of three weeks. The assessment was repeated in both the groups after three weeks. Results. Nine sessions of PR exercises produced statistically significant improvement in general well-being, forced expiratory volume in the first second (FEV1), 6MWT parameters, exercise capacity, peak oxygen uptake and volume of oxygen consumption (VO2)/Watts slope on CPET in patients with AECOPD.

Practice nurses and pharmacists: a perspective on the expectation and experience of nurses for future collaboration

To explore the nurses' expectations and experience about pharmacists in private sector hospitals of Karachi, Pakistan. A cross-sectional study was conducted from June to September 2012 in five private sector hospitals of Karachi, Pakistan. A convenient sample of nurses [n=377] were enrolled in this study. Data was obtained through a previously validated questionnaire. Responses were statistically analyzed using SPSSv.17. Questionnaires were returned giving a response rate of 63.6% of which 20 were unusable [n=240]. Out of the remaining 220, 24.1% [n=53] responded that they never or rarely interacted with a pharmacist. Respondents who expect pharmacists to collaborate with nurses to solve drug related problems were 45% [n=99]. Nurses' experience of pharmacists was not substantial as only 44.5% [n=98] respondents consider pharmacists as a reliable source of clinical drug information. The role of pharmacists is not well appreciated among nurses in Pakistan. Hence, pharmacists must bridge the observed gap and use a more strategic and consistent approach to build a more positive image in line with other healthcare professionals and in providing patient-centred pharmaceutical care. This research would impress upon the pharmacists the need to redefine their role in the healthcare settings

Thyroid synovial sarcoma: a case report

Sarcomas are rare tumors account for about 1% of cancers in adult. Soft tissue sarcomas are the most common one. Synovial sarcoma's incident is about 10% of all sarcomas and most commonly rise from para-articular regions in young adults. Based on our knowledge there have been only two reports of thyroid synovial sarcoma in medical literature. We report a 44-year old woman presented with a rapid growing neck mass. The pathology report revealed sarcoma and the immunohistochemistry [IHC] was compatible with synovial sarcoma. It could be understood that synovial sarcoma can be found in various tissues even if there is no synovial cells

comparative study of cardioprotective effect of three anesthetic agents by measuring serum level of troponin-T after coronary artery bypass grafting

Cardiac surgery is associated with some degree of myocardial injury. Preconditioning first described in 1986 was pharmacologic and non- pharmacologic. Among the long list of anesthetic drugs, isoflurane as an inhaling agent along with midazolam and propofol as injectable substances have been documented to confer some preconditioning effects on myocardium. In this study cardiac Troponin T [cTnT] ,as a reliable marker, was used for evaluating myocardial injury. This prospective double blind study was comprised of 60 patients scheduled for CABG and were randomly assigned into three groups who received infusion of propofol or midazolam or isoflorane. Surgical procedures and anesthetics were similar for 3 groups. cTnT measured preoperatively and at 12, 24 and 36hr after arrival in ICU. There were no statistically significant differences in mean cTnT levels between three groups in the preoperative period and 12-24 hours after arrival in ICU. However, mean cTnT in 3 groups at 36 hours after arrival in ICU were different [P< 0.013] and cTnT level was significantly higher in midazolam group [P<0.001] and lowest in isoflurane group [P=0.002]. There were significant differences on cTnT levels between anesthetic groups of isofluran, midazolam and propofol at 36 hr after surgery. Preconditioning effect of isoflurane was higher than the other two groups

Effect of crude extract of Bombyx mori coccoons in hyperlipidemia and atherosclerosis.

The silkworm is the larva or caterpillar of the domesticated silkmoth, Bombyx mori and being a primary producer of silk is an economically important insect. These days the silk is emerging as a resource for solving a broad range of biological problems. The silk (Abresham) is popularly known as Abresham muqriz (muqriz means cut) in Unani medicine. Its cocoons are extensively used as an ingredient of various Unani formulations like Khameer-E- Abresham Sada, Khameere Abresham Hakeem Arshad Wala, Khameere Abresham Ood Mastagi Wala etc. and are used to treat many cardiac and nervous disorders. The hypolipidemic activity of this drug, along with Nepata Hindostana (Badranjboya) and Terminalia Arjuna (Arjan) has been documented. But action of extract of Bombyx mori cocoons as a single drug is not documented. That's why; it was decided to study its effect on hyperlipidemia and atherosclerosis. The Male New Zealand White rabbits all of 1.5kgs were selected for the study. After stabilization period (2 weeks) the rabbits were divided into 3 groups (Group I - Control, Group II Lesion Control and Group III treated with extract of Bombyx mori silk cocoon). Hyperlipidemia and atherosclerosis were induced with 1% cholesterol diet. After induction of hyperlipidemia and atherosclerosis for twelve weeks, Group III rabbits were treated with Bombyx mori for 6 weeks (45 days). A significant decrease in hyperlipidemia was seen within 4 weeks of treatment. Histopathologically, the atherosclerotic plaques showed reduction in size. The third group showed a significant increase in the body weight and also an increase in the HDL cholesterol levels. The study concludes that extract of Bombyx mori cocoons has a significant effect on hypercholesterolemia and atherosclerosis probably because of its antioxidant and hypolipidemic effect.

Genetic markers for idiopathic scoliosis on chromosome 19p 13.3 among Saudi Arabian girls: A pilot study.

BACKGROUND AND OBJECTIVE: Genetic locus linked to chromosome 19p for Adolescent idiopathic scoliosis (AIS) has been described. This study was carried out with the aim to find any significant linkage or association between three microsatellite markers (D19S216, D19S894, and DS1034) of chromosome 19p13.3 in Saudi Arabian girls with AIS. MATERIALS AND METHODS: In eleven unrelated Saudi Arabian girls who were treated for AIS with Cobb angle of ≥30 degrees and in 10 unrelated healthy individuals, linkage analysis was performed using parametric and nonparametric methods by use of GENEHUNTER version 2.1. Multipoint linkage analysis was used in specifying an autosomal dominant trait with a gene frequency of 0.01 and an estimated penetrance of 80% at the genotype and the allele level. Fisher's exact test was used in the analysis of contingency tables for the D19S216, D19S894, and DS1034 markers. RESULTS: The analysis between the patient group and healthy girls showed that at genotypic level there was no significant association of the markers and scoliosis D19S216 (P = 0.21), D19S894 (P = 0.37), and DS1034 (P = 0.25). Whereas, at the allele level, there was statistically significant association between the marker DS1034 (P = 0.008) and no significant association with the other two markers D19S216 (P = 0.25) and D19S894 (P = 0.17). CONCLUSIONS: Our study shows that at genotypic level none of the markers reported earlier were associated with scoliosis but at allele level, marker DS1034 was significantly associated with patients with AIS. This allele marker on chromosome 19p appears important in the etiology of AIS.

Case report of a perforated appendix in the sac of inguinal hernia [Amyand's Hernia]

This case is a rare aspect of inguinal hernia. The patient was admitted with a 10-day pain of right groin and a past history of an inguinal hernia which was irreducible at the time of admission. In the operating room, the hernia sac was opened which included a perforated and gangrenous appendix that is called Amy and' s hernia. The patient underwent appendectomy and herniorrhaphy at the same operation

Cancer chemotherapy-induced osteoporosis: How common is it among Saudi Arabian cancer survivors.

Objective: This study was done to assess the prevalence of cancer chemotherapy-induced osteoporosis among survivors of cancer in Saudi Arabia. Material and Methods: Patients who received chemotherapy due to malignant disease attending oncology and orthopedic clinics between June 1, 2006 and November 30, 2006, were the subjects. Age, sex, type of malignancy, last chemotherapy cycle and body mass index (BMI) of patients were entered in the database. Complete blood picture, serum calcium, phosphorous, renal function and liver function tests were done. Bone mineral density measurement of the hip and spine was done using Dual-Energy X-ray Absorptiometry. Results: We analyzed the data of 71 patients with an average age of 49.29 ± 8.24 years. Of these, 19 (25.8%) were osteoporotic and 33.87% were found to be osteopenic according to the BMD of the lumbar spine, 17 (22.6%) found to be osteoporotic and 29% found to be osteopenic per the BMD of the hip area. Patients whose BMD was normal had received their last chemotherapy cycle 48.68 ± 27.35 months earlier (P = 0.01). Osteopenia and osteoporosis were more common in patients in the age group of ≤50 years (65.6%) versus 56.4% in patients of ≥51 years (P = 0.001). Patients who received the last cycle of chemotherapy of less than 2 years were significantly more osteoporotic (81.5%-18.5%, P < 0.0001). Conclusions: Our study indicates a high prevalence of osteopenia and osteoporosis in patients who were younger than ≤50 years and who had received cancer chemotherapy. Second, bone loss continued for more than 2 years from the last cycle of chemotherapy.

Secondary osteoporosis due to sickle cell anemia: Do sex steroids play a role?

Background : The exact cause of osteoporosis in patients with sickle cell disease (SCD) is not known, and various hypotheses have been put forward. Aim: To assess the effect of sex steroids on bone mass in SCD patients. Settings and Design: In King Fahd Hospital of the university, Alkhobar, Saudi Arabia, a cross-sectional study was carried out. Materials and Methods : All patients known to suffer from SCD attending the hospital between August 2006 and August 2007 were subjects of the study. Blood was extracted for serum level of androgens, gonadotropins, thyroid stimulating hormone (TSH), calcium, phosphorus, and alkaline phosphatase. Measurement of bone mineral density (BMD) of hip and spine was done using dual-energy X-ray absorptiometry (DEXA). All tests were performed using SPSS (Statistical Package for Social Sciences), version 14.0, Chicago, Illinois, with P value of < 0.05 being statistically significant with confidence interval (CI) of 95%. Results : One hundred three consecutive patients with an average age of 27.83 years were studied. Forty-five were males; and 58, females. Low bone mass (osteoporotic/osteopenic) was found in 62.2% of the patients in the male group and 67.06% in the female group. In males, testosterone level was not significant between different groups, but total estradiol levels were significantly lower in the osteopenic and osteoporotic patients (P < 0.003 and < 0.01 respectively). In female patients, estradiol and testosterone levels were lower in osteoporotic patients in comparison to non-osteoporotic patients (P = 0.05 and 0.001). Conclusions : Our study indicates that sex steroids play a major role in the development of osteopenia and osteoporosis in patients with SCD.

Randomized, blinded trial comparing enoxparin with unfractionated heparin in patients undergoing contemporary percutaneous coronary intervention

This study was designed to examine a unique and low dose use of intravenous enoxaparin in elective percutaneous coronary intervention [PCI] that would be applicable to an unselected population regardless of age, weight, and renal function. There is limited experience in anticoagulation using intravenous low-molecular-weight heparin in PCI. A total of 100 consecutive patients undergoing elective PCI were treated with a single IV bolus of enoxaparin [0.5mg/kg] in group A of patients [n=50] or with unfractionated heparin in group B of patients [n=50]. Sheaths were removed immediately after the procedure in patients treated with enoxaparin and some hours later in those treated with unfractionated heparin. In group A, ACT was 124.6 +/- 9.3 before PCI and 149.2 +/- 17.1 after that [P<0.05]. In group B, one patient [2.9%] developed groin hematoma. No deaths, MI, or urgent target vessel revascularization were reported. Low- dose [0.5 mg/kg] IV enoxaparin allows a target level of anticoagulation in patients undergoing PCI, appears to be safe and effective, allows immediate sheath removal, and does not require dose adjustment

Variant of Vohwinkel's syndrome.

A 28-year-old female born to consanguineous parents, presented with progressive palmoplantar keratoderma since the age of six months and a constricting band on right fourth finger of one year duration. There was history of similar complaints being present in two other family members. Associated clinical findings included starfish-shaped cornified plaques on knuckles, resorption of distal phalanges and keratotic plaques on elbows, groins and knees. The patient was mentally sound and had normal audiometry. Biopsy from hyperkeratotic plaque showed hyperkeratosis, parakeratosis, increased granular layer and papillomatosis. Gene mapping for loricrin mutation was found to be negative.

NeuroSPECT demonstrates increased cortical function in alzheimer’s disease patients for at least two years after omental transposition neurosurgery

Se ha comunicado mejoría clínica después del implante quirúrgico de Omento (delantal de los epiplones) en el cerebro en varias condiciones neurológicas que incluyen Infarto cerebral, Encefalitis, Transecciones de la médula espinal y enfermedad de Alzheimer's. La explicación fisiopatológica de estas mejorías no es conocida pero puede relacionarse con la presencia de Células Madres y factores de crecimiento en el Omento que tendrían efectos sobre la angiogénesis, neurogénesis y sobrevida neuronal. El presente trabajo describe los cambios en la actividad cerebral en dos pacientes con diagnóstico de Enfermedad de Alzheimer's confirmado por biopsia, cuya evolución clínica había entrado a una fase de rápida progresión antes del trasplante de Omento. Los pacientes fueron evaluados psicométricamente mediante la escala de clínica de severidad demencial , desde el punto de vista cognitivo el MMSE examination y Neurospect sequencial con HMPAO medido durante 22 y 42 meses respectivamente. La severidad de la demencia mejoró durante dos o más años, mientras la actividad cortical en áreas bajo, adyacente y contralateral al Omento implantado aumentó en una o dos desviaciones standard sobre los niveles pre-operativos del paciente (el máximo aumento fue un 21 por ciento, cuatro desviaciones standard). En el paciente con menor severidad de demencia se observó a los 22 meses post-trasplante que el cingulado posterior demostraba un aumento de perfusión de 20 por ciento comparado con el nivel pre-operativo. Esto es notable si consideramos que el Omento no tenía un contacto directo con la corteza cingulada posterior que se ve envuelta en las fases iniciales de la Enfermedad de Alzheimer's (Braak y Braak etapas 3-4). Estos hallazgos justifican investigación respecto de los mecanismos por los cuales el Omento puede mejorar la actividad cerebral cortical y las funciones clínicas durante dos o más años en la enfermedad de Alzheimer's.