Correlation of Obesity and Other Factors with Presence of Extra Hepatic Disease among the Patients Presenting with Fatty Liver

Purpose: To assess the Correlation of obesity and other factors with presence of extrahepatic disease among the patients presenting with fatty liver at CMH Rawalakot, Azad Kashmir. Study design: Correlational Study. Setting: Gastroenterology department CMH//Sheikh Khalifa Bin Zayad Al Nahyan Hospital Rawalakot. Duration of study: Six months, from 01-09-2018 to 01-03-2019. Patients and methods: A prospective study was conducted on 51 patients of fatty liver diagnosed on ultrasound by consultant radiologist of own hospital. The demographic profile included age, gender, presence of obesity, triglyceride levels and total cholesterol levels. Common extra-hepatic conditions which were looked for in this study included Diabetes mellitus (DM), Hypertension (HTN), Ischemic heart disease (IHD) and Osteoarthritis (OA) which were diagnosed with the help of detailed history taking, relevant physical examination and laboratory investigations. Results: Out of 51 patients included in the final analysis 31 were male and 20 were female. Twenty-seven participants had one or more co-morbid illnesses while 24 had no such diseases at the time of study. DM was the commonest comorbid illness while OA was least reported. Twenty four patients were obese while 27 had BMI less than 30. The presence of obesity and raised total cholesterol levels had a significant relationship with presence of extra-hepatic illness among the patients presenting with fatty liver. Conclusion: Patients presenting with fatty liver have high prevalence of extrahepatic diseases. Routine screening of common illnesses should be done on all the patients who have been diagnosed as having a fatty liver. Special attention should be given to the patients who had BMI more than 30 or raised total cholesterol levels.

A Comparative Study of Laryngeal Mask Airway Lubrication with Lignocaine 2% V/S Beclamethasone 005% Cream

Postoperative sore throat (POST) is a minor complication after general anaesthesia. Many agents have been used as lubricant to reduce the incidence of POST with variable efficacy. Methods: We conducted a study to compare the incidence of POST with 0.05% betamethasone gel and 2% lignocaine jelly as a lubricant for LMA insertion in patients undergoing general anaesthesia. Sixty subjects were divided randomly into two groups. Patients in Group B (n = 30) had 2.5 ml of 0.05% of betamethasone gel while the Group L had 2.5 ml of 2% lignocaine jelly applied on the cuff of LMA. After standard induction and insertion of LMA cuff inflated to 60 cm of H2O and was maintained at the same throughout the surgery. Results: In PACU, patients were inquired about sore throat at immediate and 24 h post operative period. POST was not observed in any of the patients of Group B. In group L 13% of the patients had 1st degree and 3% had 2nd degree of sore-throat in immediate post-operative period. After 24 h 3%patients had 1st degree sore-throat and 1% patients had 2nd degree of sore-throat in Group L patients. Conclusion: We conclude that lubricating cuff of LMA with 0.05% of betamethasone gel is effective in reducing the incidence of POST.

Comparison of Two Different Technique of Interscalene Block in Orthopedic Patients Undergoing Shoulder Surgery

The traditional Interscalene brachial plexus block has a 100% incidence of diaphragmatic paralysis, resulting in a 25-30% reduction in forced vital capacity (FVC). A modified or low Interscalene block is defined as a brachial plexus nerve block below C6 but above the supraclavicular fossa. The purpose of our study was to determine if a modified Interscalene block would prevent diaphragmatic paralysis while providing an adequate pain control for patients undergoing shoulder surgery. Methods: 50 patients who were scheduled to undergo shoulder surgery were incorporated in the study. Patients were randomized to receive either a low (LI) or a traditional (TI) interscalene nerve block. Both groups received 15ml of 0.5% Bupivacaine diluted to 30ml for brachial plexus block. Post-block lung function was assessed using incentive spirometry. Results: The average decrease in lung volume in the group receiving the low-modified interscalene block was 900ml, while the decrease in the traditional group was 860ml. The decrease in lung volumes between the two groups was determined to be not significant (p= 0.525). Conclusion: Low interscalene brachial plexus blockade is often described as a technique used to prevent phrenic nerve blockade and hemi-diaphragmatic paralysis. Our study found that phrenic nerve blockade was low in LI group as compared to TI group. Postoperative pain scores, respiratory complications, need for supplemental oxygen, and delay in discharge did not occur in either group. We found that LI interscalene brachial plexus blockade not better than TI interscalene block.

Functional Outcome of Paediatric Diaphyseal Fractures of Femur Treated with Closed Reduction and Multiple K Wire Fixation.

Background: Diaphyseal fracture of the femur in children is one of the common causes of paediatric morbidity. These fractures in children above the age of five years, depending upon the fracture personality, can usually be managed satisfactorily using different intramedullary implants, including Kirchner wires, Rush nail, as well as extramedullary implants using various combinations of plates and screws. Each of these methods of fracture fixation has its own merits and demerits. The current study is aimed at assessing the efficacy of internal fixation of these fractures using closed reduction and percutaneous ‘K’ wire fixation. Methods: Twenty six (n=26) children with a mean age of 7.2 years (range 5-14 years) were treated using closed reduction and multiple percutaneous K wire fixation under image intensifier. The minimum follow up period was twelve months. The final clinical and radiological assessment of patient was done at the end of one year. Three patients (n=3) were lost to final follow-up and were excluded from the final statistical calculations. Results: Twenty one fractures (n=21) united at an average time interval of 4.1 months (range 3- 6.5 months). Two patients had delayed union and one had malunion. Superficial wound infections were seen in two (8.7%) patients. Impingement of bent k wires was felt by another two (8.7%) patients. Stiffness of the knee joint was seen in three patients (13%) during follow-up. Out of three (n=3) patients with knee stiffness two responded well to vigorous physiotherapy programme, while one (n=1) patient had limited knee range of motion even at the final follow-up. Malunion was seen in one (n=1) patient. Conclusion: Closed reduction and percutaneous K wire fixation is a safe, economical, technically non-demanding and highly efficacious technique for the treatment of paediatric femoral diaphyseal fractures.

Outcome of Discectomy by Fenestration Technique in Prolapsed Lumbar Intervertebral Disc.

Background: Prolapsed disc is the major cause of low backache with radiculopathy. Many different techniques, from extensive laminectomy to minimal invasive endoscopic surgeries have been described with aim to minimize the possibility of damage to other structures. Methods: Twenty patients with clinical symptoms and signs prolapsed disc having radiological confirmation by MRI were subjected to disc excision by fenestration technique. Results: The follow-up analysis as per Modified Mac Nab’s Criteria showed excellent results in 15 patients, good in 4 patients and fair in 1. Conclusion: Discectomy by fenestration offers sufficient and adequate exposure for lumbar disc excision. Advantages over conventional discectomy are smaller incision, lesser morbidity, shorter convalescence, early return to work and comparable overall results. It can even be performed in peripheral centers where recent microscopic and endoscopic facilities are not available.

Chromosomal aberration and micronucleus studies of two topoisomerase (II) targeting anthracyclines.

Anthracycline antibiotics are widely used in cancer chemotherapy. Doxorubicin and Idarubicin, topoisomerase-targeting anthracyclines, were examined for their effect on chromosomal aberration and micronucleus induction in cultured human lymphocytes employing lymphocyte transformation test and cytokinesis-blocked micronucleus (CBMN) assay. A statistically significant dose-dependent increase in micronucleus frequency (p < 0.001) in binucleated cells was seen as well as a significant increase in chromosomal aberration frequency was also observed for both the drugs. A variety of aberrations were scored including terminal deletions, breaks, gaps, exchanges, fragment formation, ends rejoining, interstitial deletions etc. Nuclear division index was also calculated and showed a cell cycle delay towards higher doses. A number of necrotic and apoptotic cells were also observed at higher concentrations. This confirms the two drugs to be clastogenic and aneugenic.