Doppler waveform study as indicator of change of portal pressure after administration of octreotide

Objective: To estimate the effect of portal pressure lowering drug 'octreotide, by observing the Doppler waveform before and after the administration of intravenous bolus of octreotide and thus to assess indirectly its efficacy to lower the portal pressure

Methods: This quassi experimental study was carried out in Medical Department in collaboration with Radiology Department of Jinnah Postgraduate Medical Center Karachi Pakistan from September 10, 2015 to February 5, 2016. Cases were selected from patients admitted in Medical Wards and those attending Medical OPD. Diagnosis of cirrhosis was confirmed by Clinical Examination and Lab and Imaging investigation in Medical Department

Doppler waveform study was done by experienced radiologist in Radiology Department before and after administration of octreotide

Doppler signals were obtained from the right hepatic vein. Waveform tracings were recorded for five seconds and categorized as 'monophasic', 'biphasic and 'triphasic'. Waveform changes from one waveform to other were noted and analyzed

Results: Significant change i.e. from 'monophasic' to 'biphasic' or 'biphasic' to 'triphasic' was seen in 56% cases while 'monophasic' to 'triphasic' was seen in 20% cases. No change was seen in 24% cases. Improvement in waveform reflects lowering of portal vein pressure

Conclusion: Non invasive Hepatic vein Doppler waveform study showed improvement in Doppler waveform after administration of octreotide in 76% cases. Doppler waveform study has the potential of becoming non invasive 'follow up tool' of choice for assessing portal pressure in patients having variceal bleed due to portal hypertension

Frequency of microalbuminuria in patients with ischemic stroke

To determine the frequency of microalbuminuria in patients with ischemic stroke. This cross-sectional study was conducted from 1[st] April 2009 to 30[th] September 2009 at Allied Hospital, Faisalabad. 195 patients of ischemic stroke, with or without diabetes mellitus and hypertension were tested for early morning urine albumin to creatinine ratio. A urinary albumin to creatinine ratio of 30 to 300 micro g/mg was considered as microalbuminuria. Out of 195 patients, microalbuminuria was present in 94 [48.2%] patients. Out of 68 diabetic patients, microalbuminuria was present in 37 [54.4%] patients while out of 127 non- diabetics, 57 [44.9%] had microalbuminuria. Out of 113 hypertensive patients, microalbuminuria was present in 56 [49.6%] while out of 82 non hypertensives, 38 [46.3%] had microalbuminuria. Among 28 patients having both diabetes mellitus and hypertension, 16 [57.1%] had microalbuminuria. Out of 42 patients without both diabetes and hypertension, 17 [40.5%] had microalbuminuria. We found high frequency of microalbuminuria in patients with ischemic stroke. Therefore, microalbuminuria could be is a useful modifiable factor, in addition to conventional risk factors, in identifying those at increased risk of ischemic stroke

Cerebral sinus thrombosis secondary to epidural anaesthesia

Cerebral venous sinus thrombosis [CVST] is an uncommon, and yet potentially fatal, condition; we present a rare case of CVST as a complication of epidural anaesthesia used for caesarean section, we review different aspects of CVST in terms of epidemiology, aetiology, investigations, and treatment, as well as most acceptable theory explaining the pathogenesis in our case report

Intramedullary interlocking nailing without image intensifier and ortho table

Interlocking nails are the gold standard treatment of fractures of shaft of long bones of lower limbs. It is also frequently performed for most of the humerus fractures. The procedure is commonly performed using an image intensifier and orthotable. These are expensive and are not readily available in peripheral/field hospitals especially in resource - poor countries. Retrospective study. Field Hospital Muzaffarabad and Combined Hospital Kharian. Sep 2007 to July 2011. 138 consecutive cases of fractures of femur, tibia and humerus shafts fixed with I/M I/L Nails in a field hospital. Reduction was achieved by open method in 87 [96.66%] cases of femur, 24 [60%] case of tibia and 5[62.5%] of humerus. There were 34 females and 100 males' ratio 1:2.94. All the cases were adults with mean age 38.2 years and range was 16-78 years. Bones fixed were femur [90] 65.21%, tibia [40] 28.21%, and humerus [8] 5.70%. Fracture line was transverse in 104 [75.3%] and communited 10 [7.2%]. Fractures were closed 112 [81.2%] and 26 [18.8%] of case. Recent fractures were 122 [88.4%] and old non united 16 [11.6%]. Mean follow up period was 06 months - range 3 months to 1 _ years. Complications were failure to achieve distal interlocking 6 cases, infection 3 cases. Union time averaged 3.5 months. It is therefore concluded that I/M I/L nailing can be done without image and traction table

Petroleum hydrocarbon pollution after the Tasman spirit oil spill of coastal/deep sea sediment along the clifton beach Karachi, Pakistan

An oil tanker, Tasman Spirit, carrying 67000 tons crude oil, got damaged near the Clifton Beach of Karachi, Pakistan and approx. 31,000 ton oil spilled into the sea. The distribution of aliphatic and aromatic hydrocarbons was determined in deep sea and surface sediment collected at 12 stations along the Clifton beach of Karachi, following the oil spill. Sampling was performed during 2003-2006, starting just after the accident of the oil tanker. Concentrations of PAHs [116 parent components] and aliphatics were in the range of 0.09-560 ng/kg dw and 0.12-685 |ug/kg dw, respectively, since the date of accident and after bioremedial measures. The highest concentrations were found within the radius of 50 km around the site, the area most heavily impacted by the spill, whereas at the stations, away from the ship, the concentrations were in the lower range without alkylated compounds. Addition of increasing amounts of ship fuel oil [taken from a Pakistani ship] to a representative sediment sample showed that measurable concentration of the Tasman Spirit oil was > 1 g/kg of sediment. The toxicity of selected samples of surface sediment from the coastal area near oil spill showed higher PAH concentrations; the average number of dead fauna was 90-95% within 3 days of oil spill which gradually decreased with the time

Dengue fever; clinico-pathologic correlations and their association with poor outcome

One of the major health hazards that has erupted in Pakistan within the recent past years and has caused loss of life of many young people is Dengue Fever. Main objective was to find clinico-pathologic parameters which are essentially associated with complications and contribute to the adverse outcome. This prospective study was conducted on 106 seropositive cases of dengue fever. Patients were taken from Abbasi Shaheed Hospital, Karachi from June 2008 to March 2009. The most common 3 hematological abnormalities were thrombocytopenia and leucopenia. Platelets count below 50 x 10 / microL was seen in [78%] cases and 49% 3 patients had total white cell count below 4 x10 /microL. Partial thromboplastin time was significantly prolonged in [26%] cases whereas prothrombin time was normal in all patients. Liver enzymes both Aspartate Aminotransferase [AST] and Alanine Amino-transferase were significantly elevated in [60%] patients. Blood urea nitrogen [BUN] and creatinine was deranged in [23%] patients. Fever was the most common clinical presentation [86% of the patients]. Hematological parameters [low platelet count, low total leucocytes count, prolonged APTT and raised hematocrit] and biochemical parameters [raised aminotransferases, blood urea nitrogen] have strong association with the complications of dengue fever and hence are associated with the poor outcome of disease

Etiological determinants of congenital pelviureteric junction obstruction

Congenital ureteropelvic junction obstruction is an important and treatable cause of neonatal hydronephrosis. It may be due to congenital absence of nerves leading to adynamic segment causing functional obstruction. It may also be due to defective muscular arrangement and replacement of muscles by fibrosis leading to anatomical obstruction or it may be caused by extrinsic compression by aberrant lower polar vessel. The aim of the present study is to define the etiological determinants of congenital PUJ obstruction

Objectives: To study the macroscopic abnormalities of congenital PUJ obstruction and correlating theses abnormalities with the microscopic and immunohistological findings

Material and Methods: It was a cross sectional observational study and patients presenting to outpatients department, irrespective of age and sex, with the diagnosis of PUJ obstruction and needing surgery were included in the study. Anderson Hynes Pyeloplasty was done in all cases and resected portion of redundant pelvis and narrow segment was submitted for histopathological and immunohistological examination

Results: Congenital PUJ obstruction was more common in males with a male to female ratio of 2:1 and it was common on left side in 55.55% cases. Presentation was in wide age range patients [2-40 years]. In 33.33% patients it was structural abnormality where we were unable to pass feeding tube and in 66.66% patients it was functional abnormality where it was distensible PUJ. Predominantly circular muscle arrangement was seen in 15[57.69%] cases. Varying degree of replacement of muscle fibers with fibrous tissue was seen in all cases and total replacement in those where kidney was nonfunctional due to PUJ obstruction. Nerves were present in 5/26 [19.23%] cases. In 4/5 [80%] cases of crossing vessels, nerves were present

Conclusion: Most cases of congenital PUJ obstruction are due to functional obstruction but anatomical obstruction also has a significant contribution [33.33%].Predominant circular muscle arrangement is the abnormality leading to impaired peristalsis. Absence of nerves leading to functional obstruction is the major defect in congenital PUJ obstruction. Crossing vessel is the real cause of PUJ obstruction mechanically compressing the PUJ in vascular tangle cases

Asymptomatic coronary artery disease in type-2 diabetes

To select a subgroup of type-2 diabetics with two additional prespecified risk factors to see that whether there is any benefit of screening such patients. Five hundred twenty six patients were sent for treadmill stress test or thallium scan. Those who had abnormal results were advised coronary angiography. The angiographically proven CAD was correlated with various risk factors to find the relationship between the disease and variables. Two hundred thirty five [48%] patients had abnormal results and among them 158 [67%] underwent coronary angiography. Among these 21% had evidence of CAD. Coronary artery bypass grafting [CABG] was performed in 35[33%] patients, catheter based intervention [PCI] in 44[40%] patients and 30[27%] patients were not suitable for intervention. Duration of diabetes, smoking, diabetic retinopathy, albuminuria, and peripheral vascular disease were significant predictor of asymptomatic CAD. This study has demonstrated strong relationship between risk factors and asymptomatic CAD in type2 diabetics

Prophylactic antibiotic in cardiac surgery - does duration of prophylaxis effect the outcome?

To evaluate that duration of prophylactic antibiotics in patients undergoing open-heart surgery have an impact on deep sternal infection. [Mediastinitis]. Cross sectional comparative study on patient undergoing open-heart surgery. This study was conducted at cardiac surgery department, Mayo Hospital Lahore. It included patients operated from May 2005 to July 2006. Duration of study was 14 months. Total of 200 patients undergoing open-heart surgery were included in the study. We compared 100 patients, receiving less than 48 hours of prophylactic antibiotics [Group A] with another 100 patients, receiving more than 48 hours of prophylactic antibiotics [Group B]. The endpoint of study was development of mediastinitis requiring sternal rewiring. Ten patients were rewired for sternal dehiscence [5%]. Test of proportion was applied and it was concluded that there is no difference in proportion of infection in the two groups. [p value of 0.05]. Conclusions: The results provide evidence that there is no need to continue antibiotic prophylaxis for more than 48 hours in patients undergoing open-heart surgery

Infective endocarditis and dentistry

Infective endocarditis is the infection of endothelium of heart and vessels. It is an uncommon condition associated with substantial mortality and morbidity. It is a common belief that it could possibly be prevented by appropriate use of antibiotic prophylaxis. The objective of this review is to provide the background knowledge of infective endocarditis in terms of etiology, pathogenesis, clinical features, diagnostic strategies and preventive aspects. The extensive search of Medline from 1986 to January 2007 was performed. There were almost 100 articles which were relevant to the subject and were chosen to extract the possible information. There has been considerable controversy in the past as to what sort of dental procedures are to be blamed and which group of patients should receive prophylactic antibiotics. The guidelines have frequently been revised and two main guidelines namely of American Heart Association [AHA] and of British Society of Antimicrobial Chemotherapy [BSAC] are currently being practiced. For a dentist these guidelines are often confusing and cumbersome. This article is aimed at relieving the undue anxiety of a dentist when he comes across with a patient predisposed to infective endocarditis and to create a better understanding between dentist, patient and cardiologist