Outcome Analysis of Colostomy Closure in Different Pediatric Surgical Conditions: A Pediatric Tertiary Care Hospital Study in Bangladesh

Background: A Colostomy is a revocable surgical procedure an incision in the anterior abdominal wall and suturing it into place in which a stoma is formed by drawing the healthy end of the large intestine or colon through. This opening, in conjunction with the attached stoma appliance, provides an alternative channel for feces to leave the body. Due to anatomical defects frequently referred for closure colostomy, colostomies are often used in cases of imperforate anus and other conditions. The neonatal & children who are unable to pass feces normally and safely. pediatrics colostomy. Some neonates require emergency surgery on their tummy in the first few months of life. It is most commonly due to being born prematurely and developing a bowel problem or a blockage of the bowel. As part of this surgery, the ends of the bowel may be brought to the skin surface to divert stool into a bag called a colostomy. Intended to be temporary with reversal, later on, the stoma allows time for the bowel to rest and recover. Aim of the study: To find out the outcome analysis of colostomy closure in different pediatric surgical conditions and were reviewed to look for complications following closure colostomy.Material & Methods:This prospective was conducted in the department of Pediatrics Surgery Bangladesh Shishu Hospital & Institute, Dhaka, and Lubana General Hospital & Cardiac Center, Dhaka, Bangladesh from July 2014 to June 2021. A total of 86 patients who underwent colostomy closure were enrolled in this prospective study as the study population. Data including age, gender, surgical conditions, complications of the patients and oral feeding, and bowel preparation were all collected from the patients’ parents or hospital admission files.Results:Out of 86 cases included the age range from 8 months-10 years. There were 37(43.0%) females and 49(57.0%) males and there were more difficulties with Anorectal malformation (43.02%) than with Hirschsprung disease (40.7%). There was no record of using Necrotizing Enterocolitis, in surgical patients. The risk of wound infection and leakage was greater than any other consequence in the patients. The illness known as colostomy was predominantly encountered in men. No morbidity was recorded in this study. Conclusions:Proper stoma care, the use of well-fitting colostomy bags, and early colostomy closure enhance the prognosis. Prior to surgery, encourage thorough mechanical bowel preparation and antibiotic use. The key to a successful colostomy closure for anti-surgical diseases is appropriate IV feeding after surgery.

Clinical profiling of stroke

Background: Stroke is the second leading cause of death worldwide. Defined by the WHO as 'Rapidly developing clinical signs of focal or global disturbance of cerebral function with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than vascular origin'. It is a major complication of hypertension

Objectives: To evaluate the personal and clinical characteristics of stroke patients

Setting: Salmaniya Medical Complex, Bahrain

Design: A Retrospective Cross-Sectional Study. I

Method: All patients diagnosed and admitted between 1 January 2010 and 31 December 2010 were included. One hundred eighty-three patients were included in the study

Personal and clinical data were documented. Data was entered and analyzed using SPSS program version 17

Result: Ischemic stroke was the most common, 115 [62.8%]

The majority of patients were males, 129 [70.5%]

The most notable outcome is the rehabilitated patients, 74 [40.4%]

One hundred sixty-six [90.7%] patients did not suffer confusion, whereas 84 [45.9%] had impaired speech and 77 [42.1%] had right-sided numbness and weakness

Conclusion: The most common type of stroke was the ischemic stroke, 115 [62.8%]

The most common symptom was weakness, 147 [80.3%]

The most common risk factor was hypertension, 136 [74.3%] and the most common outcome was rehabilitation, 74 [40.4%]

clinical experience of patients with heat stroke at Karachi during a devastating heat wave in 2015

Objectives: To review the clinical presentations, management and outcomes of heat stroke patients presented to Hamdard University Hospital, Karachi in summer 2015

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the Hamdard University Hospital [Taj Medical Complex], Karachi from 15[th] to 30[th] June 2015

Methods: A retrospective analysis of database of 51 patients presented with high grade fever [>1040F] and altered sensorium was performed. All data were transferred to proforma which included patient's demographic features [name, age and sex], clinical and laboratory parameters, treatment given, duration of hospital stay, outcomes [death or alive] and reasons of mortality. The SPSS version 19 was used for statistical analyses

Results: Majority of the patients [63%] were between 61-80 years of age group with mean +/- SD age was 69.24 +/- 11.28 years. Males were affected more than females [60.7% vs. 39.3% respectively]. Out of 51, 41 [80.4%] had co-morbidities and were on regular medications. The mean +/- SD Glasgow Coma Scale at the time of presentation was 10.29 +/- 4.33. The major laboratory derangements were hyponatremia [68.6%], elevated blood urea [52.9%], serum creatinine [41.2%] and alanine transferase [15.6%]. Standard treatment strategies were provided to all patients. Out of 51, 19 [37.3%] patients were expired as a result of multi-organ failure, shock, arrhythmias and rhabdomyolysis

Conclusion: Heat stroke is common in older males especially those who had co-morbidities. It carries a significant mortality due to multiorgan failure and shock

Amoebic liver abscess: Role for intervention?

Liver abscess complicates intestinal amoebiasis in 3-10% of the cases. Presented here is an interesting case of amoebic liver abscess which was diagnosed using ultrasound abdomen and CT scan showing compression of the right kidney. The patient was not responding to maximal medical management with intravenous Ceftriaxone and Metronidazole, underwent therapeutic and diagnostic aspiration of "anchovy sauce pus" and had relief of his symptoms of fever and abdominal pain after 6 days of admission. With this case we would like to highlight the use of therapeutic radiological intervention for the treatment of liver abscess and also discuss the indications, complications and role for the same in clinical practice

Validated spectrofluorimetric method for the determination of atorvastatin in pharmaceutical preparations / 药物分析学报

A rapid,sensitive and simple spectrofluorimetric method was developed for the estimation of atorvastatin.In this method,the native fluorescence characteristics of atorvastatin have been studied in both acidic and basic media.High sensitivity was obtained with 5％ acetic acid at 389 nm using 276 nm for excitation.Regression analysis showed a good correlation coefficient (r=0.9995) between fluorescence intensity and concentration over the range of 1.5-4 μg/mL with detection limit of 0.012 μg/mL.The proposed method was successfully applied to the analysis of atorvastatin in pure and pharmaceutical dosage forms with average recovery of 100.29±0.47％.The results were compared favorably with those of the reported method.

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

Health seeking behavior of the people; knowledge, attitudes and practices [KAP] study of the people of urban slum areas of Karachi

The aims and objectives were, to know about the approach of people towards seeking medical advice with different options of healers, to observe thinking, feeling and various actions of people including level of self medication, and to know perception of people regarding various practices done by the healers. People living in urban slum areas of Karachi. Cross sectional Karachi. July to October 2008. Subjects and It was Knowledge, attitudes and practices [KAP] study carried out on a sample of 300 permanent household members aged>/=16 years of middle and poor class living in urban slum areas of Karachi. The mean age of the study participants was 38.27 with standard deviation of 17.57. 182 [61%] were male while 118[39%] were female. Out of 300 study participants [n=300] 260 [86.6%] consult allopathic healers including 169 [56.33%] MBBS general practitioners and 91 [30.3%] non qualified or quacks,25 [8.3%] consult homeopaths, 11 [3.6%] Hakims, and only 4 [1.33%]consult faith healers [P<0.05].148 [49.33%], participants belong to middle class group, while 152 [50.66%] were from poor class. 50% study participants do self medication at home prior to consultation for heath. Health seeking behavior is a complex phenomenon in developing countries like Pakistan where poverty overrides all other factors in decision of selecting a healer. It is recommended that people should be educated in choosing a healer which should be a qualified one

Penile fracture: role of early surgical intervention on postoperative outcome

Fracture of penis is relatively uncommon but grave urological emergency, which needs urgent surgical intervention to achieve good postoperative outcome

Objective: To determine the outcome of early surgical repair in patients presenting with fracture of penis

Patients and Methods: This retrospective study comprises 13 patients with fracture of penis, presenting in emergency of Services Hospital, Lahore from 2000-2007. Diagnosis was made clinically. No radiological investigation was carried out. All patients had primary suturing of the tunica tear and were followed up for 2-6 months postoperatively

Results: Mean time interval between accident and arrival to hospital was recorded. Eight patients [61.5%] had fracture due to sexual intercourse. Three patients [23.08%] bending of penis. Masturbation and fall on to an erect penis each accounted for 1 [7.70%] of the total cases. There were no significant complications except necrosis of penile skin in one patient. Erectile function was preserved in all patients postoperatively

Conclusion: Early surgical intervention for penile fracture has good postoperative outcome with acceptable complication rate. Early diagnosis and surgical repair are instrumental in ensuring good outcome and minimal complications

Tuberous sclerosis with bilateral angiomyolipomas

A case of a 30-year-old female with tuberous sclerosis, a genetic, rare, variably expressed disease is described in the present case report. Clinical symptoms were unexplained fever, pain in lumber areas and gross hematuria. Computed tomography scan of the abdomen revealed enlarged, heterogeneous kidneys, with low density tumors corresponding to angiomyolipomas. Computed tomography scan of the chest showed bilateral, diffuse, small thin-walled cysts in the lungs characteristic for pulmonary lymphangioleiomyomatosis. CT scan of the brain revealed subependymal calcifications. These three diagnostic features are rarely exhibited in a single patient. Bilateral renal angiomyolipomas and pulmonary lymphangioleiomyomatosis are some presentations of tuberous sclerosis and the coexistence of both conditions may cause devastating morbidity and 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

Antioxidant level in normal and dialyzed patients using frap method

To examine the serum antioxidant levels like vit-C, vit-E and glutathione in patients with renal diseases who were subjected to dialysis and to evaluate the antioxidant by FRAP method. To find out the involvement of free radicals in pathogenesis of renal disease. Fifty patients with high levels of creatinine and urea level were included in the study of dialysis. A difference of antioxidant level of vit-C, vit-E and glutathione was observed. The study therefore suggests the importance of assessing these marker oxidative stress antioxidant capacities in renal disease during dialysis

Scurvy; radiological diagnosis

Hypervitaminosis and hypovitaminosis occur in children in our country mainly due to socioeconomic reasons. Most common being the rickets due to vitamin D deficiency, however scurvy is also not uncommon and radiological changes suggestive of scurvy are occasionally seen. Three cases of scurvy are presented here, between one and three years of age, showing typical radiological changes especially in knees. Good history, physical examination and quality X-rays are essential for making diagnosis of scurvy

Deafness and depression

Late diagnosis, late intervention, inconsistent follow-ups, inadequate maintenance of hearing aids and not so good outcome is something nobody amongst service providers in the field of ENT, audiology and also psychiatry wishes to come across. The fact that many factors, elements, people and physicians are involved in the equation of service provision and results / outcome, therefore, it is very difficult to predict or contemplate what one does will bring good results. The element of myth, physicians dealing with deafness rarely getting help from psychiatrists and psychologists. The age at diagnosis is one of the key element in this process. It marks the beginning of a long term process and is therefore considered a parameter of concern. With a view to determine seriously how we take the hearing problem. This study was conducted at Lahore Medical and Dental College, Ghurki Trust Teaching Hospital. The objective was to find the mean age of diagnosis, type and amount of deafness, associated problems with emphasis on related psychiatric problems in particular the element of depression. In a total of 200 patients between the ages of 10 years and 80 years over a period of five years from Jan 2003 to Jan 2008 were evaluated and investigated. They represent the major ethnic group of central Punjab. Every patient underwent a detailed clinical examination, any depressive or psychiatric symptoms and relevant audiological investigations. The cause of hearing loss could be found in 82% cases. Main causes were infections [31%], trauma [19%], presbyacusis [8%] and genetic [5%]. The cause of hearing loss could not be established in 18% cases. It was higher in males [58%] than females but noticeably higher in uneducated muslim patients. Late diagnosis was also related to financial background, family size and accessibility to the health facility. In conclusion the findings of the study are a cause for concern because the element of psychiatric disturbances was very high [60%] and it raises the questions about the importance the patients with hearing problems. It is also to be pointful out that and how little importance clinicians give to associated psychiatric disturbance, in particular depressive episodes

Study of various epidemiological and metabolic criteria in diabetic children and adolescence attending pediatric outpatient clinic of NIDE

Type 1 diabetes mellitus is one of the greatest challenges in public health and one of the most frequent chronic diseases in the pediatric age. The aim of this study was to study the epidemiological and metabolic criteria of 398 diabetic children who attended the outpatient pediatric clinic with determination of beta cell function of theses patients. Study of the age of onset of diabetes, sex distribution, residency, with other epidemiological factors among diabetic patients, attended the outpatient clinic of NIDE during year 2008, who accepted to participate in this study. All patients were subjected to full history taking, thorough clinical examination and full laboratory investigations including: CBC, liver enzymes, s. creatinine, lipid profile, including total cholesterol LDL-cholesterol, HDL-cholesterol and triglycerides, fasting c-peptide, Glycated HbA1c, and estimation of microalbuminuria. There was positive correlations between: Age [mean = 10.34 +/- 12.7 y.] and BMI [mean = 27.79 +/- 8.66 kg/m2], systolic B.P. [105.23 + 6.86 mmHg.] and total cholesterol [mean = 175.74 +/- 38.09 mg/dl] and systolic B.P. and triglycerides [mean = 83.88 +/- 47.46 mg/dl], and a highly positive correlations as regarding age [mean = 10.34 +/- 12.7 y.] and glycated HbA1c [mean = 9.79 +/- 2.38%]. There were no significant difference between diabetic group with c-peptide < 1 ng/ml and group with preserved beta cell function with c-peptide> 1 ng/ml as regards: Glycated HbA1c, s. cholesterol, s. cholesterol LDL, microalbuminuria, BMI and age. While there was a positive statistical difference between both groups as regards s. triglycerides [mean=75.27+31.17mg/ dl and 102.27+49.6 mg/dl]. There was no significant difference as regarding sex distribution as the female percentage was 51% while male represented 49%. The family history of diabetes was positive in 6.7% as regards father, 5.2% as regards mother, 4% as regards siblings. The study of beta cell function was done through estimation of fasting c-peptide levels. 93.7% were with fasting c-peptide level < 1 ng/ml, while 6.3% were preserved beta cell function as fasting c-peptide levels were > 1 ng/ml. Only 34.8% of the patients were doing continues home blood glucose monitoring with glucose sensors, 25.8% were doing the monitoring only with visual strips, while 39.4% of the diabetic children did not doing any home blood glucose monitoring. The glycated HbA1c was <7% in 31%, 7-8% in 22%, > 8-9% in 14% and >9% in 33%. The study of BMI of the patients showed that 56% were not overweight, [BMI <25], 27% started to be overweight, [BMI 25-30], 14% were obese, [BMI 30-<40] while 3% only were with severe obesity [BMI >40]. According to the definition of metabolic syndrome criteria, the study of the metabolic criteria of the study group showed that 112, [28.1%] patients were with positive one metabolic criteria, 56 patients, [14%] with 2 positive metabolic criteria and 36 patients, [9%] with 3 positive metabolic criteria. So, in addition to the presence of hyperglycemia, 23% of the young diabetic patients fulfilled the criteria of metabolic syndrome

Lymphocele incidence following renal transplantation our experience in sims/services hospital Lahore

To determine the incidence of lymphocele in patients who under went renal transplantation, as well as potential factors responsible or associated to its development. All records of 25 patients who were operated for renal transplant in SIMS/SHL between March 2006 to December 2007 were reviewed for lymphocele. The surgical technique was the standard one. All lymphatic vessels were either ligated or diathermized. Baseline post operative ultrasound after one week done or whenever indicated for lymphocele. 10% povidone iodine instilated in case of lymphocele. Patients were followed for an average of six months with history, physical examination and ultrasound on each visit. 25 patients [20 male and 5 female] have received renal allograft from live donors. There was 1[4%] instance of lymphocele; encountered at two weeks after renal transplantation. Careful ligation of lymphatic vessels both during graft preparation and during implantation can significantly contribute to reducing incidence of lymphocele following renal transplantation. Instillation of 10% povidone iodine in the lymphpcele can cure and prevent its recurrence

Clinical outcome of modified thiersch duplay urethroplasty for proximal hypospadias

To report the functional results, complications and cosmesis by using Thiersch Duplay urethroplasty repair for hypospadias. Between years 2006 to 2007, 30 patients underwent repair of proximal hypospadias [penoscrotal] with chordee. Two stage repair was performed in all cases. 1[st] stage consisted of chordee correction by excising fibrous cord between ectopic meatus and corona along with incision of glans. The grafting of the dorsal hood skin was made on ventral aspect of tunica albuginea. In second stage repair U shaped incision was made around hypospadiac meatus and a ventral skin flap was dissected superficially to allow tubularization around a suitable size silicon Foley catheter [5 -8 Fr in children, 10-12 Fr adolescence and 14-16 Fr in adults] without tension. The Thiersch Duplay tube was constructed using 5/0 vicryl. A subcutaneous fascial layer was closed over tube to support neourthra. The Foley catheter was left for 10-12 days. Age range was 3-25 years with mean +/- SD of 12.7 +/- 5.09. Total hospital stay was 10-12 days with mean +/- SD of 11.9 +/- SD 0.85. Twenty five patients [80.2%] could void on standing and had a good caliber straight single stream of urine in forward direction. The cosmetic appearance of a natural vertical slit glanular meatus situated at the normal position on the glans achieved in twenty five patients. Period of follow up was 4-8 month mean with mean +/- SD of 6 +/- 1.43. Main complications seen were urethrocutaneous fistulae in three [9.9%], meatal stenosis in three [9.9%], hematoma in one [3.3%], complete disruption in one [3.3%] infection in two [6.6%] and painful bladder spasm in two [6.6%]. These seen in five [16.5%] patients. Staged urethroplasty for proximal hypospadias results in a normal penis with good functional, minimum complications and excellent cosmesis, with short hospital stay

Presence of admitting team in emergency department, does it make a difference?

The Emergency Department [ED] Admitting Team was established on the 1st of September 2005 to attend patients admitted to Hamad General Hospital [HGH]. The team followed 1,065 patients for 3 months [September, October and November 2005].The study reports the change noticed during the period, on admission-disposition duration. The majority of patients were males [75%] and non-Qatari [72%], with medical cases more common than surgical cases. For the medical cases, chest infection was the leading cause of admission followed by coronary artery disease, while orthopedic cases followed by acute appendicitis were the main surgical causes of admission. The admitting team was able to cancel 10% of cases as most of them improved while pending admission. In addition, the admitting team facilitated admission of many patients to Intensive Care Units or to Operation rooms. The results were reviewed and the presence of the admitting team in ED was found to be beneficial

relationship of body weight to altitude in preschool children of southwestern Saudi Arabia

To determine the average weight and height and the prevalence of overweight or obesity and thinness in preschool children of the Southwestern highlands of the Kingdom of Saudi Arabia and compare them with their counterparts living at lower altitudes. A cross-sectional study of 559 preschool children aged 12-71 months born and living permanently at high altitude, and 463 preschool children of comparable age born and living permanently at low altitude. For each child at high and low altitude, age was recorded and weight and height were measured. Weight for height Z-score with WHO standards was used for an assessment of normal weight, overweight or obesity and thinness. The highland preschool children were found to be significantly heavier and taller than their counterparts living at low altitude, 92.1% of all highland preschool children and 67.6% of lowland preschool children were found to have normal weight [p < 0.0001], Overweight or obesity was insignificantly greater among preschool children of the highlands [2.3%] compared to the preschool children of the low lying areas [0.9%] [p<0.7]. Thinness was significantly more prevalent among preschool children of the lowlands [31.5%] than preschool children of the highlands [5.5%] [p< 0.0001]. At both high and low altitude, there were no significant differences in the prevalence of overweight or obesity and thinness between boys and girls. The findings of this study indicate that thinness is a major nutritional problem among lowland preschool children. This may be attributed to the prevailing tropical environmental conditions on the health of children at low altitude

Open fracture of the tibial shaft, results of management with external fixator followed by casting or nailing

To compare the results of management by secondary intramedullary nailing and POP casting in stable open tibial fractures of Gustilo-IIIA of winquist type-I and II and to assess which is the better mode of treatment after removal of fixator, whether POP casting or intramedullary nailing in our hospital our setup and resources in terms of union and likelihood of complications like malunion, non-union and infection. This randomized cohort study was conducted in the Department of Orthopaedic, Nishtar Hospital, Multan during the period from April 2005 to December 2006. A total of 50 patients were included in the study. The age range was 20-40 years. The patients included were who had fracture of Gustilo type-IIIA open fractures of winquist criteria-I and II. Out of 50 patients, 37 [74%] were injured as road traffic accident, 3 [6%] patients sustained fire arm injury, 2 [4%] patients injured on domestic accident with fall of wall on their body. Out of 50 patients, 12 [24%] had age from 11-20 years, 14 [28%] from 21-30 years, 18 [36%] from 31-40 years and 6 [12%] patients had 41-48 years. While considering the major complications in present study, it was found that these are less marked in secondary nail group as compared to secondary casting group. Wound infection developed in 9 [36%] cases and non-union occurred in 1 [4%] cases of secondary nailing. While in secondary casting group wound infection developed in 8 [32%] cases and non-union occurred in 2 [5%] cases. It is concluded that both methods can be used for the treatment of open type-IIIA tibial diaphyseal fractures

Types of haemoglobin in patients attending Khartoum Teaching Hospital - Sudan

Abnormal haemoglobins lead to significant morbidity and mortality. This is a prospective study, evaluating types of haemoglobin and haematological parameters in blood samples of 631 Sudanese patients. Participants were patients who attended different departments in Khartoum Teaching Hospital in the period from March 2005 through July 2005. Electrophoresis was used to determine the type of haemoglobin. 585 cases have normal haemoglobin [Hb A]. Mean red cell indices were: Hbl 1.5 g/dl, PCV 34.9%, MCV 85.4 fl, MCH 32.1pg, MCHC 33.2 g/dl, RDW 37 fl and WBC 7013 /cm3. 46 [7.3%] patients had abnormal Hb. The frequency of Hb types were AA: 92.7%, AS: 4.9%, SS: 0.8%, AC: 0.5% and AF: 0.5%.The presence of abnormal haemoglobin such as haemoglobin S is not unexpected because we live in the centre of an affected area. The study showed low haematological parameters due to various causes including poor nutrition as well as infections and haemolytic processes