Percutaneous nephrostomy for the relief of upper urinary tract obstruction: an experience with 200 cases

To assess the role of Percutaneous Nephrostomy in upper obstructive uropathy. This was a descriptive study, conducted at Department of Urology, Lady Reading Hospital and Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar from January 2006 to December 2008 on 200 patients of upper obstructive uropathy undergoing Percutaneous Nephrostomy. Fluoroscopy and Ultrasonography were used as guiding tools for accurate puncture of the renal tract. The patients were kept in the ward and their renal function tests were checked daily. All the data was collected on a structured proforma and analysis was done on SPSSv 10. A total of 200 Percutaneous Nephrostomy were attempted in 200 patients. The mean age of the sample was 41.6 +/- 12.68 years. Male to female ratio was 2.3:1. The causes included Stone disease in 104 [52%], Pyonephrosis in 52 [26%], Malignancy in 20 [10%], Renal tract tuberculosis in 12 [6%], Obstetrical trauma in 8 [4%] and Ureteric Injury due to Fire Arm in 4 [2%] patients. It was successful in 192 patients, while there was a failure in 8 cases [4%]. Considerable relief in terms of symptoms and renal biochemistry was observed with in a week. The mean blood urea level of 265 mg/dl before PCN dropped to 37 mg/dl and mean serum creatinine of 10.5 mg/dl dropped to 1.2 mg/dl respectively in all patients except 12 who were declared to have End Stage Renal Disease [ESRD]. Percutaneous Nephrostomy improves the patient's condition both in terms of urinary output and renal parameters

Effect of race, gender and age on thyroid and thyroid stimulating hormone levels in north west frontier province, Pakistan

Thyroid is one of the ductless endocrine gland, which is located immediately below the larynx on either side of and anterior to the trachea. The principal hormones of thyroid gland are thyroxine [T[4]] and triiodothyronine [T[3]]. The current study was carried out to investigate the impact of race, gender and area on the levels of Thyroxine [T[4]], Triiodothyronine [T[3]] and Thyroid Stimulating Hormone [TSH] in normal healthy individuals. Serum levels of T[4], T[3] and TSH in 498 normal healthy individuals belonging to different districts of North West Frontier Province, Pakistan, were examined. Serum T[4] and T[3] were analysed by Radio Immuno Assay [RIA] method whereas TSH was estimated by Immunoradiometric assay [IRMA] method. Levels of T[4], T[3] and TSH ranged from 53 to 167 eta mol/L, 0.6 to 3.1 eta mol/L and 0.3-4.8 micro IU/L respectively. The levels of these hormones show significant change from the reference values that are used in clinical laboratories as well as in Institute of Radiotherapy and Nuclear Medicine [IRNUM], Peshawar, Pakistan. It is concluded that the age, gender, race and area, all have an appreciable effect on the levels T[4], T[3] and TSH

Pattern of lipid profile in type-2 diabetes mellitus patients

To know the pattern of lipid profile in obese and non-obese type-2 diabetes mellitus patients as compared to a control group One hundred [50 obese and 50 non-obese] diagnosed patients having diabetes mellitus minimum for the last three years were randomly selected from the outdoor patient department of medicine, Khyber teaching hospital, Peshawar during the year 2002. Obesity was taken as body mass index of more than 25 kg/m[2]. One hundred healthy individuals were selected from among the staff of Khyber medical college, Khyber College of Dentistry, and Khyber Teaching Hospital, Peshawar to constitute the control group. They had no history of any chronic illness. Subjects suffering from cardiovascular diseases, kidney disorder and hepatic disorders were excluded from the study. Fasting serum triglyceride, total cholesterol, HDL-C, LDL-C, and VLDL-C were determined by enzymatic calorimetric method and calculated by using Friedewald [1972] formula. The levels of serum triglycerides [170.15 +/- 10.3 mg/dl vs 159.01 +/- 10.11mg/dl], total cholesterol, [191.61 +/- 18.61 mg/dl vs 182.61 +/- 17.6 mg/dl], LDL-C [113.12 +/- 11.01mg/dl vs 102.69 +/- 11.17 mg/dl] and VLDL-C [34.03 +/- 2.03 mg/dl vs. 31.80 +/- 0.2mg/dl] were higher in diabetic patients as compared to the control group, while HDL-C [43.39 +/- 6.41 mg/dl vs. 57.69 +/- 7.06 mg/dl] was lower as compared to the control group. Dyslipidemia is a significant finding in type-2 diabetes mellitus patients

Study of environmental risk factors for pulmonary tuberculosis in Peshawar

To assess the environmental risk factors for pulmonary tuberculosis in Peshawar. Study Cross sectional observational study. Medical department, Khyber Teaching Hospital [KTH], Peshawar. From August 2004 to November 2005. A total of 156 patients, 87 males and 69 females, with clinical diagnosis of the disease, confirmed on sputum smear microscopy were selected. Relevant information was recorded with the help of a pre-designed questionnaire, prepared in accordance with the objectives of the study. The age range of the patients was from 8 years to 86 years with an average age of 47.5 years. A total of 102[65.38%] patients had positive family history of the disease. Eighty-four [53.84%] patients were from social class, with income less than 5000/month. Pulmonary tuberculosis was recorded in 142 [91.02%] patients. Eight patients had developed tuberculosis meningitis and six patients had developed TB of bones [Potts disease]. Reactivation of tuberculosis was recorded in 29[21.79%] patients. The main risk factors observed in the respondents were positive family history of the disease, housing conditions, over crowding, joint families, poverty and ignoring DOTS strategy for treatment

Correlation of macroscopic assesment in acute appendicitis with histopathology findings

To assess the observational accuracy for gross appendicular morphology at surgery by comparing it with the microscopic examination results, in order to develop clinical guidelines for improving this assessment especially with the emerging role of diagnostic laparoscopy.Retrospective, descriptive study over a period of one year.Ward 26 of Jinnah Postgraduate Medical Centre, Karachi. All patients admitted with the diagnosis of Acute Appendicitis and were operated upon. Macroscopic assessment of the appendices at operation were divided in four grades. Appendectomies were performed in all the patients and the specimens sent for histopathological examination. The reports were then compared with the gross description.The observational accuracy was 89% as compared to histopathological accuracy which was 96% amongst the total 358 patients suspected of acute appendicitis on clinical grounds. The clinical examination was false positive in 3.6% cases.Careful clinical examination is reliable; observational description of the surgeons can be improved by grading the pathological appearances of the appendix

Acute cholecystitis: immediate versus interval cholecystectomy

To compare the outcome of acute cholecystitis treated by early surgery with acute cholecystitis treated initially by conservative management and later on surgery after 6 weeks. Material and This prospective, comparative study was conducted in the surgical B unit PGMI, L.R.H Peshawar from June 1997 to-June1998. A total of 100 cases of acute cholecystitis were selected and divided into two groups. Half of the cases were selected for conservative treatment and half were treated with immediate surgery i.e. the next available list. of the two protocols were compared. Chi Square and student-t test was applied and level of significance was checked. Out of 100 cases, 50 were treated conservatively [Group B] and 50 were given the option of early surgery [Group A]. The results showed that patients of group "A" benefited more as regards early definitive treatment, less hospital stay and comparatively decreased cost of treatment. The patients of group [B] had to suffer two hospital admissions, frequent visits to hospital, double expenses and were on a constant risk of developing complications during their wait for surgery. There was no postoperative mortality and complications were few. It is concluded that patients received with acute cholecystitis at any time during the first 02 weeks should be treated by surgery as soon as possible

Association of serum uric acid with type II diabetes mellitus

Objective: to find out the association of serum uric acid with type- II diabetes mellitus and to compare the level of serum uric acid between obese and non-obese type-I1 diabetics

Material and Methods: fifty obese and fifty non-obese diabetic patients were included in the study one hundred non-diabetic subjects were selected as control group. The results were analyzed by t-test for serum uric acid, glucose and lipid profile

Results: the mean level of serum uric acid in obese type-II diabetic patients was 6.07 mg/dl as compared to 5.01 mg/dl in the control group. The difference was significant statistically

Conclusion: hyperuricemia is significantly associated with type-II diabetes mellitus and can increase the morbidity and mortality from diabetes if not managed in time

Effect of 90 decibel noise of 4000 hertz on blood pressure in young adults

Almost every individual dislikes excessive and unnecessary noise. Noise exerts various adverse psychological and physiological effects, on human body including a rise in blood pressure. 117 volunteer medical students, aged 18-23 years were exposed to 90 decibel noise of 4000 hertz for 10 minutes, produced by audiometer in a sound-proof room. Blood pressure was recorded every three minutes. Blood pressure increased during exposure to noise. Average rise in systolic blood pressure was 2.462 +/- 0.532 mm Hg and average rise in diastolic blood pressure was 3.064 +/- 1.047mm Hg. Blood pressure came to resting value within two minutes after stopping exposure to noise in more than 50% of the subjects. Systolic and diastolic blood pressure increases due to noise exposure

Salmonella spondylitis. A case report

Salmonella infection is common in the tropics, but osteomyelitis of the spine due to salmonella is rare. We are reporting a case of 23 years old house wife, who presented with fever and backache and was subsequently diagnosed to have salmonella spondylitis