Frequency of post dural puncture headache in patients undergoing elective cesarean section under spinal anesthesia with median versus paramedian approach

Objective: Post dural puncture headache [PDPH] is one of major complications of spinal anesthesia. There are two approaches to administer spinal anesthesia i.e. median and paramedian. We conducted this study to compare the frequency of PDPH after spinal anesthesia for cesarean section with median versus paramedian approach using 25 gauge pencil point needle

Methodology: This randomized controlled trial was conducted at Departments of Anesthesiology, Surgical Intensive Care and Pain Management Centre as well as Gynecology and Obstetrics, Peoples University of Medical and Health Sciences, Nawabshah, Benazirabad [Pakistan]. One hundred and twenty females underwent elective cesarean section under spinal anesthesia were enrolled. After informed written consent, the parturients were randomly divided into two equal groups by lottery method; Group A patients received spinal block with median approach and Group B patients received it with paramedian approach. All spinal blocks were performed with 25 gauge pencil point needle. The patients were asked about the presence or absence of headache through Visual Analogue Scale [VAS] in the next 72 hours

Results: In median approach [Group A], 3 patients [5%] had PDPH; whereas in paramediannapproach [Group B] only 1 patient [1.6%] had PDPH. All the patients were of younger age and low parity. They developed PDPH within 24 -48 hours which was of mild to moderate in degree on VAS and relieved by rest, plenty of fluids and simple analgesics containing caffiene in mild case. While strong analgesics and muscle relaxants were added in cases of moderate PDPH. PDPH was relieved within 2-3 days in all cases without any complication. The difference was statistically insignificant [p-value=0.30]

Conclusion: Paramedian approach is better than median approach in terms of reduction in the frequency of PDPH, though the results were statistically insignificant?

To compare the efficacy of internal sphincterotomy with topical 0.2% glyceryl trinitrate ointment after hemorrhoidectomy for pain relief

To compare the efficacy of internal sphincterotomy with topical 0.2% glyceryl trinitrate ointment after hemorrhoidectomy for pain relief. Randomized controlled trial. Department of surgery, Combined Military Hospital Rawalpindi. Individual patients undergoing hemorrhoidectomy were randomized to either undergo internal sphincterotomy [Group A] or apply 0.2% glyceryl trinitrate [Group B]. internal sphincter was divided up to dentate line through one of hemorrhoidectomy incisions. For 2[nd] group the first dose of 0.2% GTN ointment was applied at the end of hemorrhoidectomy. They were advised sitz bath 4 times daily and stool softener. Post operative pain was measured using visual analogue scale [VAS] on 1[st], 2[nd] post op day and after a week and the average score was noted. VAS of pain far last visit was compared between the groups. Post operative pain was comparatively less in group A as compared to group B [p = 0.014]. In patients undergoing hemorrhoidectomy, addition of surgical internal sphincterotomy results in lesser pain in the postoperative period as compared to those receiving topical application of 0.2% glyceryltrinitrate ointment

Role of periodontal therapy in type II diabetes mellitus

The purpose of this study was to observe a gender based effect of periodontal therapy on glycaemic control of type II diabetes mellitus. This Interventional study was conducted on one hundred four patients suffering from type II diabetes mellitus, both gender were included from twenty five to sixty five years of age. Periodontal parameters were calculated using the community periodontal index need, bleeding on probing, tooth mobility and furcation involvement. The glycaemic status was evaluated by determining glycosylated haemoglobin [HbA1c] levels at base line before non-surgical periodontal therapy and three months after receiving the treatment. All the examination and data collection were carried out by a single examiner. The data were analysed using the SPSS version 15.It was conducted that the periodontal parameters along with the reduction in the results of glycaemic parameters significantly improved [p 0.005] and more pronounced in female patients than male patients.It was concluded that the severity of the periodontal disease is the most important risk factor related to poor glycaemic control

In-vitro susceptibility of levofloxacin against different clinical isolates

Background: Levofloxacin is a broad spectrum quinolone, widely used to treat infections caused by gram negative and gram positive bacteria. Development of resistance by pathogens against different broad spectrum antibiotics is increasing and now becoming a global issue

Objectives: The aim of the study is to evaluate the current sensitivity pattern of levofloxacin against various common clinical isolates like Escherichia coli, Staphylococcus aureus. Pseudomonas aeruginosa and Klebsiellapneumoniae

Methods: A total of one hundred and ten samples were collected from different pathological laboratories of Karachi, Pakistan. The above mentioned pathogens were isolated from blood, stool/urine, sputum, skin samples

Results: Results show least resistance of levofloxacin against Ecoli [27.5%], and P.aeruginosa [27%], while S.aureus possessed highest resistance [45%]

Conclusion: Study concluded levofloxacin still possesses excellent anti-microbial activity against common pathogens. Routine monitoring and surveillance is further required to ensure effective treatment regimens to community

Partial edentulism based on Kennedy's classification

The aim of this study is to investigate the distribution of the partial edentulism in general population according to Kennedy's classification. Cross Sectional Study This study was conducted Isra Dental College OPD in Hyderabad from Feb 2010 to July 2011. This is a cross sectional study carried out on 395, subjects, both males and females and belonging to age groups 35-50 years, completed during the period of one and half year. All patients' personal history was taken regarding their age and socioeconomic condition. Partial edentulism was recorded by visually examining the study sample. The results include the visual examination of 395 individual in which majority were males 246 [62%], mostly belonging to the poor class, 231 [59%] and in early forties 181[46%]. There is high prevalence of Kennedy's class IV, 128[32%] among sample then followed by Kennedys Class I 92[23.3%], II 76[19.2%] and III 50[12.7%]. The association between partial edentulism according to Kennedy's classification with socio- demographic profiles of the sample is statistically significant [68, 17%; p=0.04]. In our study there is significant difference between gender and partial edentulism as more male patients visit the dental clinic for partial denture belongs to low income status and in 41-45 years age group

comparative study of trans urethral resection versus trans urethral incision for small size obstructing prostate

To compare the results of transurethral resection of prostate [TURP] with transurethral incision of prostate [TUIP] for small size obstructing prostate. Comparative study. Department of Urology, Peoples University of Medical and Health Sciences for women Hospital Nawabshah, from 2008 to 2010. Patients were divided in TURP and TUIP groups with fifty patients in each. Patients of any age with small size [thirty grams or less] prostate needing surgical intervention were included. TURP was done with conventional technique. In TUIP two deep incisions were made at 5 and 7'O clock positions of the bladder neck using Collings knife. Pre-per and postoperative variables were observed and recorded. All patients were followed up to six months post operatively. A total of 100 patients were included in the study. Mean operative time was 12.4 minutes in TUIP and 22.6 minutes in TURP. Retrograde ejaculation and blood transfusions were less in TUIP than TURP. The improvement in maximum flow rate improved in both the groups. TUIP is as effective as TURP in achieving maximum flow rate but TUIP was superior in terms of shorter operative time, less retrograde ejaculation and less need of blood transfusion

Quantitative status of heavy metals in soils of Quetta irrigated by sewage water

In soils of different areas of Quetta city, irrigated by sewage water, the highest concentration of heavy metals was found to be as follows: lead [1.38 ppm], copper [0.86 ppm], chromium [0.036 ppm], cadmium [0.29 ppm], iron [10.50 ppm], nickel [0.74 ppm], zinc [19.45 ppm] and arsenic [0.001 ppm] on average basis. The sewage water contained lead [53.26 ppb], copper [22.5 ppb], chromium [1.33 ppb], cadmium [0.53 ppb], iron [127.7 ppb], nickel [51.14 ppb], manganese [17.08 ppb], zinc [31.38 ppb] and arsenic [0.011 ppb]. At each site the concentration of heavy metals and sewage water showed positive relationship

Pattern of intestinal obstruction in infants and children

To find out causes of intestinal obstruction in infants and children and their relation to age and sex distribution. This descriptive study was conducted at Peadiatric Surgery departments of Peoples University of Medical and Health Science for women Hospital Nawab Shah and Liaquat University of Medical and Health Sciences Hospital Jamshoro, from January 2010 to December 2010. All infants and children presenting with symptoms and signs of intestinal obstruction, and patients having advanced appendicitis with intestinal obstruction, were included in this study. Surgical intervention was carried out, where indicated, otherwise patients were managed conservatively. Patients were divided into two groups: Infants were enlisted in group A, while toddlers and older children were put together in group B. Data was analyzed by using SPSS version 10 for percentage and frequencies Total 67 patients were included in the study. Among these 44 were Males and 23 Females with M: F ratio of 1.9:1. There were 24 patients in group A, among these, 15[62.5%] cases had intussusception, while other conditions, namely incarcerated inguinal hernia, colonic web, post operative adhesions, ileal web and inflammatory bands constituted 37.5% cases of bowel obstruction. In group B there were 43 patients. These included, post operative adhesions in 6[13.95%] patients, while tuberculosis of intestine in 5[11.63%], Meckel's diverticulum with band 5[11.63%], perforated appendix in 5[11.63%], intussusception in 3[6.97%], Volvulus of small intestine in 3[6.97%] and Inflammatory bands and adhesions in 3[6.97%] patients. Malrotation, Hirschsprung's disease, Trichobezoar and faecal impaction each one occurred in 2[4.65%] patients. Ovarain teratoma, lymphoma, caecal Volvulus, duodenal web and duplication of colon of each one of these conditions occurred in one [0.43%] patient each. Resection of gut and anastomosis was carried out in 18[26.86%] patients [8 from group A and 10 from B]. Two patients from group B died. Pattern of intestinal obstruction varies at different age groups in terms of etiology as well as in relative incidence. Intussusception was the commonest cause in group A, while post operative adhesion had predominance in group B. Outcome depends upon the underlying condition and associated morbidity

Role of pre-operative assessment on the results of rhinoplasty in terms of patient satisfaction

The objectives of the study was to find out the importance of preoperative psychological assessment of patients in rhinoplasty and significance of excluding patients with psychiatric disorders, particularly Body dysmorphic disorder [BDD], on the overall results of surgery in terms of patient satisfaction. Randomized control trails [RCT]. This study was carried out at ENT out patients department [OPD], PNS Shifa and CMH Okara from January 2004 to Dec 2007. Patients complaining of nasal deformity with or without nasal obstruction were included in the study. A total of 85 [47 females and 38 males] patients were selected. After detailed history, examination and counseling 45 patients were selected by simple random method for psychological assessment and 40 patients not to have psychological assessment. The psychiatrist used DSM-IV TR criteria for psychological assessment and diagnosed 08 patients to be suffering from BDD and did not clear them for cosmetic surgery. Thirty seven patients being cleared for rhinoplasty [group A] and 40 patients [group B] not having psychological assessment, a total of 77 patients [42 females and 35 males] were offered cosmetic rhinoplasty. Patients were followed up for 01 year to check whether they were satisfied or not with postoperative results. The statistical data in the two groups was separately analyzed. Then by applying chi-square test the association in both the groups was calculated. Postoperatively 36/37 patients in group A were satisfied with their postoperative appearance and 32/40 patients in group B were satisfied. Chi-square test revealed the probability of <0.005, which is significant. Preoperative psychological assessment of patients has a significant role in patients undergoing cosmetic rhinoplasty as far as postoperative appearance is concerned

Outcome of endoscopic third ventriculostomy in hydrocephalus

To elucidate the outcome of endoscopic third ventriculostomy [ETV] in patients with hydrocephalus. Descriptive case series. Neurosurgery Department Peoples Medical College Nawabshah, from 1[st] January 2009 to 31[st] December 2009. Patients aged more than 2 years with hydrocephalus were included. Endoscope used with free hand technique and third ventriculostomy performed with Fogarty balloon. Success was defined with clinical improvement and radiological reduction in ventricular size. The study population consisted 19 patients with male preponderance 12 [63.15%] males and 7 [36.84%] females. Age ranged from 3 years to 55 years with mean age 20.8 years. Shunt conversion was done in 5 patients [26.31%]. The most common indication was tuberculous meningitis. Success rate was 68.41% [13 cases]. ETV is an alternative and effective method of treating hydrocephalus in patients with normal ventricular anatomy and thin membrane at the third ventricular floor. Patients with thick membrane and tuberculous meningitis and obscure anatomy had high failure rate

Colostomy in children: indications and complications

To determine the indication and frequency of complications occurring with construction of colostomy in children. This descriptive study was conducted at Paediatric Surgery department of PMC Hospital and at Mumtaz Medical Center [Pvt.] Nawab Shah, from April 2008 to December 2009. All patients who required colostomy as the part of management were included in this study. The patients who were operated upon previously or elsewhere and were referred after having colostomy, were excluded. In all patients loop colostomy was performed. Complications after colostomy construction were noted on a proforma. Thirty- seven colostomies were created in 36 patients. Sigmoid loop colostomies were 51.35%, Right and left transverse colostomies in 24.32% each. All patients were operated due to congenital anomalies. Twenty-eight patients had anorectal malformation and 8 Hirschsprung's disease. Common Complications related to stoma were excoriation of skin 58.82% and prolapse of stoma [50%]. Anaemia due to chronic blood loss was seen in 53.33% of patients. Transverse loop colostomy had higher number of complications / problems as compared with sigmoid loop colostomy. Five [13.88%] patients died [Three because of septicaemiae, one because of high grade fever at home, and one died on 2nd of PSARP, the cause could not be ascertained. Construction of colostomy in paediatric patients carries high frequency of complications and requires careful technique. A sigmoid loop colostomy is an ideal as it has minimal complications. Stoma care clinic and enterostomal therapist can be helpful in educating families for stoma care and to decrease the incidence of complications

Parasitic infestation in children of district Vehari: an underdeveloped area of Pakistan

To determine parasitic infestation among children of rural and urban areas of district Vehari. Children Complex Hospital, at District Headquarter Hospital Vehari and PMRC Research Center, Nishtar Medical College, Multan, Pakistan. A cross-sectional study was done in 2006 where 500 children aged 1-10 years presenting with anaemia and malnutrition were studied. Demographic information included residential area [rural/urban], gender, socio-economic status, hygienic conditions, source of drinking water were recorded on a questionnaire. Parents were interviewed, while stool and blood samples of children were collected for parasites and to determine anemia. Parasites were found in 140[28%] children and anemia in 236[47%]. Prevalence of protozoa 102 [20.4%] was greater than intestinal helminthes 38 [7.6%]. The most common protozoa was Entamoeba histolytica 101 [20.2%] and in nematodes, Hymenolepis nana was seen in 28 [5.6%], Ancylostoma duodenale [hook worm] in 5 [1%], Ascaris lumbricoides [round worm] in 3 [0.6%] and Taenia saginata [tape worm] in 2 [0.4%]. Diarrhoea was seen in 254 [50.8%] cases, constipation in 191 [38.2%], abdominal pain in 245 [49%], anorexia in 181 [36.2%] and abdominal distension in 86 [17.2%] children. Rural children were significantly more infected with parasites, 81 cases [32.27%] compared with urban children 59 cases [23.69%] [p<0.05] and same was for poor children 81 [34.9%] compared with middle income 57[21.8%] [p<0.05]. Infected cases with poor hygienic conditions [77 cases 35.2%] were more infected than those with satisfactory 62 [24.4%] and good hygiene 1[3.7%]. Worm infestation was common 84[35.9%] in those using drinking water from hand pumps compared to those obtaining drinking water from government water supply 47[23.9%] and water filtration plant 9[13.%], a significant difference in infection due to poor quality drinking water was observed[p<0.05]. Worm infestation and anemia were inter related and 85 [60.7%] children with anaemia had parasites against 55 [39.3%] who were not anaemic [p<0.05]. Poor sanitation, hygiene and source of drinking water have appeared as major contributors towards parasitic infestation. Ent.histolytica was the most common protozoal infection found compared to helminths. Use of clean drinking water and good hygienic practices should be instituted throughout the country

autopsy study of asphyxial deaths

The study includes autopsy examination of 132 cases of asphyxial deaths, brought by the police at Department of Forensic Medicine, K.E.M.U., Lahore during the year 2002, 2003 and 2004. The study revealed that the female to male ratio was 2:3 and individuals in the third decade of life are maximally involved. The ligature was a single loop in 77.7% of the cases and multiple in 22.3% of the cases. The most frequent non-specific asphyxial signs were congestion [72.7% of the cases] and petecheal haemorrhages [78%] cases. The hyoid bone was fractured in 22.7% cases. The associated injuries found were, physical and sexual in nature in 65% of the cases examined

Hemolytic uremic syndrome with systemic lupus erythematosus

Hemolytic-uremic syndrome [HUS] as an initial presentation of systemic lupus erythematosus [SLE] is a rare finding. We report a 25-year-old female patient who presented to our hospital with complaint of fever, joint pain, anasarca, hematuria and nose bleed. Her diagnostic workup revealed renal failure, microangiopathic hemolytic anemia and thrombocytopenia due to SLE with HUS. The patient initially responded well to treatment with steroids, plasmapheresis with cryosupernatant and cyclophosphamide but finally succumbed to enterococcus septicemia

Bilateral treponema periostitis

Symmetrical exuberant periostitis is a rare disease caused, by variety of infectious and non-infectious causes. Treponematosis is one of the rare causes of this condition. We report a patient who presented with left arm swelling, secondary to onion peel periostitis of the humerus, which was caused by Treponema species