Intraoperative Parathyroid Hormone Monitoring in the Surgical Management of Sporadic Primary Hyperparathyroidism

Intraoperative parathyroid hormone monitoring (IPM) has been shown to be a useful adjunct during parathyroidectomy to ensure operative success at many specialized medical centers worldwide. Using the Miami or “>50% intraoperative PTH drop” criterion, IPM confirms the complete excision of all hyperfunctioning parathyroid tissue before the operation is finished, and helps guide the surgeon to identify additional hyperfunctioning parathyroid glands that may necessitate further extensive neck exploration when intraoperative parathyroid hormone (PTH) levels do not drop sufficiently. The intraoperative PTH assay is also used to differentiate parathyroid from non-parathyroid tissues during operations using fine needle aspiration samples and to lateralize the side of the neck harboring the hypersecreting parathyroid through differential jugular venous sampling when preoperative localization studies are negative or equivocal. The use of IPM underscores the recognition and understanding of sporadic primary hyperparathyroidism (SPHPT) as a disease of function rather than form, where the surgeon is better equipped to treat such patients with quantitative instead of qualitative information for durable long-term operative success. There has been a significant paradigm shift over the last 2 decades from conventional to focused parathyroidectomy guided by IPM. This approach has proven to be a safe and rapid operation requiring minimal dissection performed in an ambulatory setting for the treatment of SPHPT.

Severe pneumonia requiring ICU admission: revisited

To describe the aetiology, outcome and management approach for patients with community acquired pneumonia [CAP] and hospital-acquired pneumonia [HAP] who required ICU admission and to determine the predictors of mortality. A prospective observational study of 119 consecutive patients who were admitted to the ICU with diagnoses of CAP [n = 89] or HAP [n = 30] from May 2011 until December 2012. The overall ICU and hospital mortality rates for CAP and HAP were 24.4% and 30.3%, respectively. There were no significant differences between the patients with CAP and HAP in terms of ICU mortality or the average length of hospital stay. The most commonly isolated pathogens were H1N1 [23%] and Streptococcus pneumonia [17%] in the patients with CAP and Acinetobacter baumannii [37%] in the patients with HAP. Multidrug resistant [MDR] organisms were detected in 32 [38.6%] isolates. The median time for receiving antibiotics was 2 h. Most of the patients [82%] received double antibiotic coverage. Multiple regression analysis identified septic shock [beta = 0.43, p < 0.001], acute respiratory distress syndrome [ARDS] [beta = 0.34, p = 0.003], and the pneumonia severity index [PSI] [beta = -0.36, p < 0.024] as significant predictors of mortality. The outcomes of patients with severe pneumonia who were admitted to the ICU were better than those of previous reports. Early administration of combination antibiotics was practiced with vigilance. MDR organisms and respiratory viruses were the commonly isolated pathogens. The presence of septic shock, ARDS and high PSI were independent predictors of mortality

Bioequivalence study of two oral formulations of clarithromycin in human male subjects

To assess the bioequivalence of tablets formulations of Clarithromycin 500mg each of test and reference products. A single post oral dose of each formulation was given to 14 male healthy volunteers. The study was conducted phase 1, open-label, randomized, complete two- way crossover designed with 7 days wash out period. The plasma concentration of Clarithromycin was quantified by validated microbiological assay method. The precision of the method was evaluated using calibrated 14-hydroxyClarithromycin concentration was detected semi quantitatively as equivalent of Clarithromycin /ml. The peak plasma concentrations of [3.63 +/- 0.80 ug/ml] and [-3.31 +/- 0.35 ug/ml] was attained in about 1.42 hours and 1.49 hours for both test and reference Clarithromycin tablets respectively. The mean +/- SD values for total area under the curve [AUC] were 22.07 +/- 4.90 and 20.16 +/- 2.35 h.mg/L for both test and reference tablets respectively. This study indicated that the differences in all the bioequivalence parameters for test and reference Clarithromycin formulations are statistically non-significant; hence both formulations are considered bioequivalent

Trend of repeat cesarean section after previous one LSCS at fatima memoriaijjmpitjvllahore Two years study

The cesarean section rate has been increasing both in developed and undeveloped world. The study was conducted in order to analyze factors leading to repeat cesarean section and to elaborate on [Preventable Factors] under given conditions

Duration : Two years [January 2007 to December 2008]

Methods: This study was conducted in Obstetric and Gynaecology Department of Fatima Memorial Hospital from January 2007 to December 2008. A total of 119 patients with history of previous one lower segment cesarean section [LSCS] who underwent repeat lower segment cesarean section [LSCS] were analyzed and included in the study

Results: Out of 119 CASES, 75 [63%] were elective and 44 [37%] were emergency Lower segment cesarean section [LSCS]

Analysis of shake flask experiments results conducted on residues from hydrometallurgical processes

Hydrometallurgical facilities processing sulfide based ores produce waste residues in the form of sludges that contain concentrations of metals, as well as metal sulfides. As a part of the waste characterization and risk assessment process, a statistical design of experiment was used to assess the significant factors and interactions in the residue leaching process. Two shake flask experiments, a 24 factorial design and 23 central composite design were employed to evaluate the effect of mixing time, test pH, solid/liquid ratio and residue type on acidity, alkalinity, sulfate and metal concentration and pH of the resulting filtered leachate. The results indicate that the variable tested mixing time and solid/liquid ratio most strongly affect metal concentration in the filtrate from waste residue samples tested over a moderate test pH range. When tests were conducted over a longer test period and at lower test pH values, test pH and residue type were dominant factors contributing to residue filtrate metal concentration

Homocysteine in gestational diabetes and normal pregnancy plus effects of folic acid

The aim of study was to assess serum homocysteine and its relation with serum folate, vit B12 and lipid profiles in gestational diabetes mellitus and comparison with normal pregnant women as well as effect of different doses of folic acid on Homocysteine [Hcy] and pregnancy outcome. In a biphasic study first prospective controlled study 80 pregnant women were chosen at 24-28 weeks of gestation. In case group pregnant women with gestational diabetes mellitus and control group who had normal Oral Glucose Tolerance test [GTT] results. Levels of fasting glucose, homocysteine, vit B12, and folic acid, uric acid, total cholesterol, triglyceride, LDL, HDL, were measured. In phase II study a randomized clinical trial was done with diabetic women 15 with 1mg folic acid and 15 with 5 mg folic acid for six weeks and then above variables and pregnancy outcome was evaluated. The mean levels of homocysteine in Gestational Diabetes Mellitus [GDM] group were significantly higher but folic acid and vit B12 were significantly lower. Hcy levels were decreased in both groups after six weeks folic acid but decrease in Hcy for group 5mg was significantly more than 1mg group. Homocysteine levels were higher in GDM than normal pregnancy. High dose folic acid can reduce Hcy levels more than low dose and it may be a safe, simple, inexpensive intervention that prevents major pregnancy complications

Comparison of CT scan and colour flow doppler ultrasound in detecting venous tumour thrombous in renal cell carcinoma

Renal cell carcinoma has marked tendency to spread into renal vein, inferior vena cava and right side of heart. Extension of tumour thrombus into these veins will alter the surgical approach. We have compared the CT scan with Colour flow Doppler ultrasound in detecting venous tumour thrombus in renal vein and inferior vena cava. This cross-sectional study included 30 adult patients presenting with renal tumour. Patients of either gender were included in the study. Non probability convenience sampling was used. All patients underwent colour flow Doppler ultrasound and CT scan with contrast to asses the renal vein and inferior vena cava. The results were confirmed by intra operative findings and histopathology. The data was analyzed using SPSS version 12. Out of 30 patients, 20 [66%] were males and 10 [34%] female. The tumour was predominantly on the right side [60%], as was renal venous tumour thrombus [44%]. Inferior vena cava was involved in 4 cases predominantly due to right sided tumours. The sensitivity of Doppler ultrasound in detecting renal venous tumour thrombus [88% on right and 100% on left side] was higher than CT scan [63% on right and 60% on left side]. Doppler ultrasound was also superior to CT scan in detecting vena caval thrombus. The overall sensitivity of Doppler sonography was higher than CT scan in detecting tumour extension into renal veins and inferior vena cava. Therefore, it can be used as a complementary tool in equivocal cases

Risk Factors of hepatitis B and C transmission in patients coming to a hepatology out patients clinic

To see the possible risk factors for the transmission of hepatitis B and C in patients suffering from hepatitis B and C. Hepatitis B and C patients coming to a public sector hepatology centre and a private clinic. All patients suffering from hepatitis B and C of all ages and both gender were included in the questionnaire based study following a verbal consent form all participants. The data was collected over 1 year by 1 doctor at both the OPD and the private clinic. Data on 497 cases was collected, of the total cases 199 were suffering from chronic hepatitis B [HBV] and 298 from hepatitis C [HCV]. Males were more infected with chronic liver disease but hepatitis B was more prevalent in males. Majority of HBV [55.8%] and HCV [49.3%] cases were between 25-44 years age group and 40% HBV and 35% HCV cases were educated up to the secondary level. In 9% HBV and 10% HCV cases the father was also suffering from liver disease and 15% HBV and 13% HCV cases had a death of a family member due to liver disease. Risk factors like injections for various ailments was seen in 189 cases [95%] suffering from HBV and 286 [96%] from HCV, similarly past history of surgery and dental treatment and blood transfusion was significantly more in HCV, when compared with HBV. Though both HBV and HCV are blood born diseases but interfamilial spread of these viruses needs to interpreted with caution as it appears that the virus is coming from the community to the house hold members and the possible sources are treating physicians using a reused syringe, a dentist and barbers

Clinical pattern of cirrhotic ascities in the state of Qatar

Ascites is a common important feature of chronic liver disease and to determine the extent, causes, clinical presentation and nature of cirrhotic ascites in Qatar a descriptive, prospective study was made of 48 males and 14 females with cirrhotic ascites and a mean age of 56.2 "12.6 years admitted to the Medical Department, Hamad General Hospital between January 2004 and January 2005. Twenty six were Qatari, the remainder being of various nationalities. The most common cause of cirrhotic ascites was chronic alcoholism, found in 29 [46.8%] patients. Uncomplicated liver cirrhosis was found in 40 [64.5%] patients, complicated liver cirrhosis in 22 [35.5%] patients. At admission, encephalopathy, GI bleeding, and fever were found to be significantly associated with complicated cirrhotic ascites. Results of the study suggest that cirrhotic ascites is common in the State of Qatar with the most common causes being chronic alcoholism followed by chronic viral hepatitis C and B. It is suggested that efforts are needed to prevent and treat these two conditions

Determination of induced effect of pesticide chlopyrifos [organophosphate] on skin of Euphlyctis cyanophlyctis

Investigations were carried out on the effects of pesticide Chlorpyrifos [organophosphate] on skin of adult frogs of Euphlyctis cyanoplyctis. The effects of pesticide were observed on frog's skin during 90 days after the treatment. Study of skin cells was carried out by sectioning of fixed tissue by Paraffin Section Technique. The results obtained in the long-term experiment showed that under the effects of chlorpyrifos sections examined reveal skin covered fibrocollagenous tissue exhibiting areas of necrosis and aggregate of mild chronic inflammation, pigment containing basal keratinocytes were identified in epidermis. Variable size measured fibers with degenerated and regenerative changes also noted. A few fiber stain internalization took place in collection of chronic and non stapile inflammatory cells along with tissue necrosis. Chronic granulomatous inflamation is not identified. However, histolytic collision has been found. No evidence of malignancy was observed

Rupture of sinus of valsalva presenting with acute left ventricular failure

Rupture sinus of Valsalva is a relatively rare condition. We report a case of ruptured sinus of valsalva presenting as acute left ventricular failure. The patient underwent successful repair of ruptured sinus of valsulva with closure of fistula. During Ventriculotomy the defect was repaired using Teflon butterrressed 5/0 prolene interrupted sutures. After dramatic relief of symptoms patient was discharged on sixth postoperative day

Free radial artery as an alternate conduit in CABG

This study was under taken to explore the potential of the Free Radial Graft as a safe efficient and suitable alternative conduit in coronary artery bypass grafting incase of in availability of the more established conduits like the IMA and Great Saphenous Vein graft especially in redo surgery. This prospective randomized single center trial was conducted on three groups of patients under going CABG. The study was conducted from 1st January 1999 to December 2002.The first group A [n=15 with mean age of 47.05'8.35years] Radial artery was used for grafting in Right and Left sided grafts except the LAD. In the second group B [n=15 with a mean age of 54.80'11.14 years] Great Saphenous Vein was used for grafting in Right and Left sided grafts except the LAD. In the third group C [n=20 with a mean age of 55.93' 11.14 years] IMA was only grafted to LAD. Proximal ends of both the GSV and the Radial Artery were anastomosed to the Aorta. All patients were male. Follow up was done in these patien ts both by non invasive and invasive methods such as ETT, Thallium scan, Angiography. Comparison was mainly done between the Radial artery and the Great Saphenous Vein taking as granted that the IMA g the best graft for the LAD in all cases. IMA was always applied to LAD in all patients in the three groups. In group [A] Radial Artery was grafted to RCA in 5 [33.3%] pts. Diagonal in 4 [26.7%]pts. Obtuse Marginal 12[80%] pts. And PDA 3 [20%] pts. In group [B] Great Saphenous Vein was grafted to RCA in 6[40%]pts. Circumflex 1[6.7%]pts. Diagonals 2 [13.3%] pts. Obtuse marginals 6 [40%] pts. And on PDA 4[20%] pts. All patients were regularly followed up for 18 months to 24 months. Post operative angina was reported in 2 [13.3%]pts. in group A and 5[33.3%] pts. In group B [p=0549]. ETT was done in all these pts. Was positive in 1[6.7%] in group A and 2 [13.3%] in group B [p=0.309]. Thallium scan was done in all the study population and was found positive in 4 [26.7%] in group A and 5 [33.3%] in group B Patients[p=0.265]. Coronary angiograms were done on 10 patients out of each group. In group A the grafts were patent in 9 patients [90%]. In the group B the grafts were found patent in 8 [86%] patients.[p=0.543]. Moderate Graft stenosis was found in 01 patient in group B and none in group A [p=0.35]. Totally blocked grafts were found in 01 patients in each group [p=1.00]. On the basis of this study early results suggest that Radial Artery graft is a suitable, safe, and potentially effective alternative in CABG patients. Early graft patency in patients receiving RADIAL ARTERY grafts is comparable to those receiving Saphenous Vein grafts, It may prove an excellent alternative for those who do not have the traditional conduits available due to any reason. However this short follow up period is not sufficient to come to a firmly conclusive result. A long term study with graft angiography is required to prove the efficacy of this conduit for future use

Optimization of cultural conditions of penicillium griseofuhvum for the production of penicillin griseofulvin

The present study is mainly concerned with the production of Penicillin griseofulvum by Penicillium griseofulvum NRRL 2300 in Shake Flask Technique. The production of antibiatic was carried out in cotton wool plugged 250 ml flasks. 24 hours old, vegetative inoculum was developed in conical. flasks, containing 100 ml of basal medium. Fermentation, for antibiotic synthesis was carried out for 312 hours at 2S degree C. Effects of different nitrogen and carbon sources for the formation of antibiotic were evaluated. Maximum production of antibiotic was observed in the presence of corn steep liquor, which was used as a source of nitrogen. Maximum production of penicillin griseofulvin was also observed in the presence of sucrose as a source of carbon; whereas it was decreased in the presence of other carbon sources like lactose and glucose. Other conditions such as temperature and pH were also optimized for the production of griseofulvin

Minimally invasive open heart surgery an experience at nicvd

Objective: This study was done to show that open heart surgical procedures can be done through a small sternal incision. Design: This was a single center prospective study. Place and Duration of study: Department of cardiac surgery, National Institute of Cardiovascular Diseases, Karachi. The study was completed in two years i-e Jan 1998 to Dec 1999

Subjects and Methods: A total of 40 patients underwent open heart surgery via minimally invasive approach through a lower median sternotomy. Of these 22 patients had ASD Closures, 8 underwent CABG Surgery and 10 patients had MVR procedure. The approach was via a small incision 8-1 0cm in length from xiphoid upwards and asymetrical lower median sternotomy upto the 2[nd] 1. C. S. deviated from midline on to the right side

Results: 22 patients had ASD Closure of these 21 patients had secundum defects while 1 had sinus venosus defect. In IHD group 2 patients had single vessel disease and 6 patients had 2 vessel disease [LAD and RCA]. 10 patient had MVR of these 5 patient had MR while 5 had mixed lesions. These patients had less postoperative pain. Early mobilization was achieved. No incidence of sternal dehiscence was noted. The scar was cosmetically much better than the conventional sternotomy scar and was completely hidden under the shirt

Conclusion: Open heart surgery is possible through a minimally invasive procedure. The advantages of the procedure are less trauma, less postoperative pain, reduced risk of infection. Patient recovery is quick and excellent cosmetic result

Chemical analysis of stones in layers- A study of 102 stones at Mayo hospital, Lahore

The chemical composition of 102 urinary stones was determined in layers ['Three or two] by means of a Merckognost reagent kit by Merck, Germany. Out of 102 Calculi, 22 [21.5%] were pure stones i-e Calcium oxalates[19.8%] and uric acid[1.9%] and 80 [78.4%] were a mixture of two or more compounds.Calcium oxalate was the commonest constituent of pure as well as mixed stones

Early versus delayed laparoscopic cholecystectomy for the treatment of acute cholecystitis

Patients with a preoperative diagnosis of acute cholecystitis were prospectively allocated to treatment with early laparoscopic cholecystectomy within 24 hs of randomization or initial conservative treatment followed by delayed laparoscopic cholecystectomy 6-8 weeks later. There were 31 patients in the early group and 27 in the delayed group. There were no significant difference in conversion rate[early 19.4 percent versus delayed 22 percent], postoperative analgesic requirement [2 versus 1 dose]. Intra and postoperative complications. However, the early group has significantly longer operating time [112.5 versus 96.4 min, P=0.03] and shorter total hospital stay [3.7 versus 2.2 days, P<0.001]. The incidence of bacterial complications being markedly low, especially in the early group.These results indicate early laparoscopic cholecystectomy is safe and feasible for acute cholecystitis with the additional benefit of shorter total hospital stay and avoid the problems of failed conservative treatment and delayed surgery

Strengths and limitations of abgar scor: a critical appraisal

A cross sectional study was undertaken on 200 normally delivered newborns at Lady Aitchison hospital Lahore from august to december 1998. Apgar scores were recorded using the current virginia apgar scoring system at 1 and 5 minute interval. the newborns with scores 0-5 at 5 minutes were considered at higher risk for developing respiratory or neurological complications. our study showed significant difference [p<0.05] in scores of full term average birth weight [3 kg] and preterm low birth weight newborns [< 2 kg]. the 5 minutes scores were improved AS compared To 1 minute in 97% cases. More studies are recommended by increasing the apgar scoring time to 10 minutes in order to enhance the predictive value of this score for respiratory or neurological disabilities

Care of children needing special services

One hundred and twenty parents of handicapped children were requested to participate in a study regarding their opinions of health care provider's understanding of their children's needs and parent-care provider interrelationship. Only thirty five of them [23%] accepted the offer. Twenty five% of the participants potential. Ninety eight% parents thought that the physicians should share information with parents no matter how serious and emotionally upsetting. Ninety five% of the parents considered that their child's physician understood their needs.Parents in this study were generally satisfied with care being provided to their children. Nevertheless the results suggests the goals that could lead to unproved interaction among the parents, care providers and special children and also to enhance the interest of these parents for providing better care to their special children

saftey of laparoscopic cholecystectomy for cholelithiasis in sickle cell disease

As surgery in sickle cell patients is associated with high morbidity, this study aimed to establish the safety of minimally invasive surgery in this high-risk group. The study included 41 sickle cell patients underwent laparoscopic cholecystectomy [LC] for cholelithiasis, three patients had asymptomatic gallstones and preoperative gastroscopy and endoscopic retrograde cholangiography were performed in nine and eight patients, respectively. Twenty-six patients were given simple transfusions, while three received partial exchange transfusions. The mean operative time was 10 minutes and the conversion rate was 4.8%. There were 14.6% postoperative complications, the majority of which were respiratory and wound related and the median hospital stay was 2.5 days. Laparoscopic cholecystectomy is safe in patients with sickle cell hemoglobinopathy who are particularly at risk of developing pigmented gallstones. Therefore, the use of minimally invasive surgery is encouraged in any sickle cell patient undergoing operative intervention with the advantages of short postoperative analgesia requirement, shorter hospitalization and remarkable reductions in perioperative morbidity