Role of perioperative echocardiography in repair of incomplete shone complex: A case series

Multilevel obstruction of left-sided heart structures was originally characterized by Shone et al. The formulation of an appropriate operative strategy remains challenging and needs to be individualized for this complex subset of patients. Intraoperative transesophageal echocardiography (TEE) not only helps in delineating spatial anatomy but also reveals associated anomalies that help in decision-making regarding operative strategies for these patients. Here, we discuss five such cases of Shone's anomaly presenting at varied age group with different associated anomaly in which intraoperative TEE played a pivotal role in the management.

To determine the frequency of vitamin d deficiency in patients with chronic hepatitis c

Objective: To determine the frequency of vitamin D deficiency in patients with chronic hepatitis C [CHC]

Design: It was a Descriptive and Cross Sectional study

Place and Duration of Study: It was carried out in the Medicine Unit of Pakistan Naval Ship SHIFA, Karachi from Nov 29, 2016 to May 29, 2017

Patients and Methods: Approval was sought from Institutional Review Board before carrying out the study. Proper history, clinical examination and appropriate lab investigations were carried out. Standard techniques were used for blood sample collection. Site used for blood collection was antecubital fossa. Sterile method was used for fasting sample and about 10 ml of blood was collected from each patient

Results: A total of 289 patients were included. Strict exclusion and inclusion criteria was used for study cohort. Mean age [years] of study cohort was 34.51+8.32. There were 188 [65.1] male and 101 [34.9] female patients. Patients with CHC who were vitamin D deficient were 74 [25.6]

Conclusion: Patients of CHC had high frequency of vitamin D deficiency which suggests that further studies in the region will be conduct in our general population to know the exact statistics which will pave the way for future researchers

Frequency of complications of percutaneous nephrostomy in upper obstructive uropathy

Background: Ultrasound guided percutaneous nephrostomy may relieve the urinary tract obstruction but may have complications

Objective: To determine the frequency of complications of Ultrasound guided, percutaneous nephrostomy by seldinger technique for obstructive uropathy

Methodology: This was a descriptive cross-sectional study of 196 patients with obstructive uropathy who were treated with ultrasound guided percutaneous nephrostomy done by Seldinger's technique. The patients were followed up for 15 days for the complications like sepsis, hemorrhage, pleural effusion and displacement of catheter.Data was entered and analyzed by using SPSS version 14

Results: Sepsis occurred in 1 [0.51%], major hemorrhage in 1 [0.51%], minor hemorrhage in 3 [1.53%], pleural effusion in 1 [0.51%], displacement of PCN catheter in 11 [5.61%] and no complications occurred in 179 [91.33%] patients

Conclusion: The most common complications rate for the ultrasound guided percutaneous neprhostomy by Seldinger's technique are displacement of PCN catheter, hemorrhage and sepsis

Fite-Faraco staining in combination with multiplex polymerase chain reaction: A new approach to leprosy diagnosis.

Background: Leprosy is not always an easy disease to diagnose, and patients can remain undiagnosed for longtime, not only at the peripheral clinics but also even at places with higher medical facilities, so, there is an urgent need for rapid and definitive modalities for leprosy diagnosis. This prospective study evaluates the ability of Fite-Faraco staining (FF staining) and multiplex polymerase chain reaction (PCR) over hematoxylin and eosin staining (H and E staining) and Ziehl-Neelsen staining (ZN staining). Aims: The aim of this perspective study is to evaluate the effectiveness of FF staining in combination with multiplex PCR for the early and rapid diagnosis of leprosy than any other coexisting diagnosis tool. Methods: Patients with new skin patches or nodules with or without evidence of nerve damage were selected for the study. Punch biopsy was collected according to standard procedures. Each biopsy sample was divided into two equal parts, one half was fixed in 4% (v/v) buffered neutral formalin and then accordingly embedded in paraffin. Sections were stained by three different methods: H and E staining for histopathological examination, ZN staining, and FF staining for detection of acid-fast bacilli (AFB). And the other part was subjected for DNA extraction and PCR was carried out by the obtained DNA sample. Results: H and E staining, ZN staining, FF staining, and PCR yield 58.2%, 50.9%, 60%, and 67.7% successful diagnosis of leprosy. The true diagnostic performances for these techniques were as follows: H and E staining - sensitivity 70.6%, positive predictive value (PPV) 81.9%, negative predictive value (NPV) 53.6%. For ZN staining - sensitivity 59.9%, PPV 69%, NPV 45.7%. For FF st aining - sensitivity 74.6%, PPV 85.9%, NPV 56.7%, and for PCR - sensitivity 87.8%, PPV 95.6%, NPV 71.2%. Conclusion: The combination of FF staining and PCR was shown to provide a rapid and definitive diagnosis in the majority of leprosy suspected cases with a higher positive likelihood ratio (+LR) of 7.76 and 2.716, respectively, than H and E staining of 2.244 and ZN staining of 1.378.

Urological complications in ureteric stenting live related renal transplantation

To determine the frequency and types of post-transplant urological complications in live-related kidney transplantation with reference to the impact of JJ ureteric stent. Case series. Shaikh Zayed Postgraduate Medical Institute and National Institute of Kidney Diseases, Lahore, from June 2006 to July 2010. Consecutive renal transplantations, donors being alive were relatives, reterospectively reviewed. All patients underwent extravesical ureteroneocystostomy and all, except one were stented. From the retrieved clinical records, the frequency and types of various minor and major urological complications and their management was studied. All the complications were managed according to standard guidelines. The overall incidence of urological complications among transplant recipients was 11.9%, observed in 12 patients. The complications were urinary leakage in 2 [2%] and clot retention, ureterovesical junction obstruction and wound infection in one [1%] patient each. Urinary tract infection was observed in 7 [6.9%] patients. Urinary tract infection was the most common urologic complication in the studied cases. The technique of stented extravesical ureteronecystostomy had a low rate of urological complications in this series. Other factors which may reduce the urological complications are preserving adventitia, fat and blood supply of ureter by delicate dissection during donor nephrectomy and prevent kinking and twisting of ureter are important factors in reducing the post-transplant urological complications

In hospital outcome of patients undergoing coronary endarterectomy: comparison between off-pump vs on pump CABG

Due to advancement of non-surgical methods of coronary revascularization the patients referred for surgery have extensive and complex coronary anatomy. Patients with diffuse atheromatous coronary artery disease required coronary artery reconstruction or coronary endarterectomy [CE]. Coronary endarterectomy on beating heart needs skill and better surgical technique. Coronary endarterectomy along with coronary artery bypass grafting [CABG] done on beating heart is compared with coronary endarterectomy done by using conventional CABG technique. Seven hundred and ninety five consecutive patients underwent CABG from January 2006 to March 2007 in a prospective randomized trial at cardiac surgery department, Punjab Institute of Cardiology, Lahore; out of these 115 patients underwent coronary endarterectomy [CE] and were included in this study. Coronary artery bypass grafting was performed in 115 patients. Seventy two [62.6%] were in group A on-pump and 43 [37.39%] were in group B off-pump. Mean age in group A was 55.68 +/- 1.06 and 52.63 +/- 1.40 in group B. Sixty six male and 6 female were included in group A, 40 male and 3 female patients were in group B. In-hospital mortality among patients undergoing CABG was 5.6% in on-pump group and 2.3% in offpump group [p=0.649], the duration of post-operative mechanical ventilation in on-pump was 6.78 +/- 9.34 hours and 5 +/- 4.0 hours in off-pump group [p=0.060], 66.7% patients in on-pump and 58.1% patients in off-pump group required blood transfusions, Intra-aortic balloon pump [IABP] was required in 5.6% of the patients in on-pump group. Other factors included, smoking 26.4% in on-pump and 41.9% in offpump group [p=0.01], Intensive care unit [ICU] stay was statistically significant 4 +/- 3 in on-pump group and 4 +/- 2 in off-pump group [p=0.02], and drain in on-pump group was 455 +/- 208 ml and 540 +/- 370 ml in off-pump group [p=0.01]. Coronary endarterectomy [CE] has higher post-operative morbidity and mortality but the post-operative outcome after the procedure on either technique is comparable and CE is feasible on off-pump technique as well

Vacuum assisted closure of laparostomy wounds a novel technique

Management of a laparostomy wound is contentious. Specific pathologies like severe intraabdominal sepsis, trauma requiring damage control, abdominal compartment syndrome, staged abdominal repair and other complex abdominal pathologies can be managed with a novel technique of Vacuum Assisted Closure dressing. This device applies sub-atmospheric pressure that leads to reduced bowel wall edema, bacterial count and inflammatory burden found in open abdominal wounds. This leads to a reduced need for frequent dressing changes, maintaining intact skin and improvement in fluid management. Controlled clinical studies are needed to establish the safety and effectiveness of this treatment strategy. We present our experience with this technique suggesting it to be safe and effective. A brief outline of the working of Vacuum Assisted Closure dressing is also presented