Single centre experience of transperitoneal radical tumour nephrectomy

Objective: To share the experience of radical nephrectomy through transperitoneal approach

Material and methods: After approval from ethical committee and the consent from patients a retrospective study vas conducted extending from January 2012 to January 2014 to identify clinical characteristics of renal ell carcinomas, staging, per operative and early post operative complications. The study included all renal cancer patients presented to Sheikh Zayed Hospital Lahore with in this specified period. Detailed history nd physical examination was performed. Haematological and radiological investigations including ibdominopelvic ultrasonography and CT scan abdomen and pelvis were performed to stage the renal umour. High resolution CT chest was performed where indicated. Radical nephrectomy performed hrough transabdominal approach and outcomes measured in terms of per-operative and early postoperative complications

Results: There were total of 50 cases. The male to female ratio was 3:2. Vlean age of patients was 52.38 [18-93] years. Most common clinical presentation was gross haematuria [66%]. The mean tumour size was 8.34 [3-24] cm. Operative findings were suggestive of tumor limited to Gerota's fascia in 40 patients [80%] and in 6 [12%] tumor was extending into renal vein or inferior vena cava. In these cases, venacavatomy had to be performed. Lymphadenectomy was performed in 2 patients [4%] who were having enlarged hilar lymph nodes. Total operative time ranged between 120 to 180 minutes. Intra-operative splenic injury was seen in 2 [4%], while aortic injury was observed in one [2%] patient. Post operatively one [2%] developed pulmonary embolism, 2 [4%] chest infection while 2 [4%] developed wound infection and 3 patients [6%] required blood transfusion. Tumour histology was clear cell in [84%], papillary transitional cell carcinoma [12%] and oncosytoma contributed 4%

Conclusion: We observed that large number of the patients presented with haematuria and most of them were male. Radical nephrectomy along-with removal of tumour thrombus is a valuable method for the treatment of renal cell carcinoma having tumour thrombus either in renal vein or inferior vena cava. Common pathological type was clear cell carcinoma

MRI brain findings in patients with high serum prolactin levels

The purpose of the study was to find MRI findings in patients with Prolactin levels above1000mIU/L. Methodology: This Retrospective study was conducted in Radiology Department, Rehman Medical Institute,Peshawar, from December 2009 to October 2012. A total of 86 patients, aged 16-48 years with high Prolactinlevels, were screened with MRI for pituitary gland abnormalities. Only new undiagnosed patientswere considered for the study. Children and patients with known causes for hyperprolactinaemia wereexcluded.The most common abnormality on MRI was microadenoma [n=34, 39.5%] followed by macroadenoma[n=14, 16.3%]. 12[7%] cases of complete/partial empty sella syndrome were seen. Macroadenomawas more common in males [n=6 out of 14, 42.3%] while microadenoma was more common in females[n=32 out of 72, 44.4%]. Majority of Patients had an abnormal MRI finding, showing that MRI screening should berecommended for Prolactin levels above 1000mIU/L. Microadenoma was the most common abnormality,having higher incidence in female patients

Resistance and sensitivity pattern of Staphylococcus aureus; a study in lady reading hospital Peshawar

This study was done to determine the sensitivity and resistance pattern to the most common antibiotics in use. The data for this retrospective study was obtained and analysed from October 2010 to October 2011 in Lady Reading Hospital, Peshawar. Purposive sampling and univariate analysis was done. 2058 samples were cultured for sensitivity using Kirby Bauer's Diffusion technique and in a period of one year, growth of Staphylococcus aureus was obtained in 723 samples. These 723 growths were obtained from clinical isolates of pus [699], blood [16] and urine [8]. Fourteen drugs from five different classes of antibiotics were tested for sensitivity against Staphylococcus aureus. Most of the growth was obtained from pus [96.7%]. Resistance was high to all groups of antibiotics except glycopeptides. There was no case of Vancomycin Resistant Staphylococcus aureus [VRSA]. Out of 723 samples, 228 [31.5%] were Methicillin Resistant Staphylococcus aureus [MRSA]. The resistance to a representative antibiotic of each group is as follows: Ciprofloxacin [Fluor quinolone] 51.7%, Cephradine [Cephalosporin] 46.2%, Amoxicillin+Clavulanic Acid [Penicillin group] 45.6%,Imipenem+Cilastatin Sodium [Carbapenem] 42.0% and Teicoplanin [Glycopeptide] 19.8%.Resistance of Staphylococcus aureus to Teicoplanin and most of the antibiotics is high and strict guidelines are required to control unnecessary prescriptions and over the counter sale of antibiotics

Role of newspapers in health policy making in Punjab

This paper looks at the role of newspapers in health policy making in Punjab, the largest province of Pakistan in terms of population, with nearly 56% of the country's entire population. For the inclusive progress of socio-economic facet of the general public, government should give top priority to the investment in the health sector. Health is the second biggest public sector when it comes to physical infrastructure and human capital in Punjab. Health sector of Punjab is faced with numerous anomalies and the government has been undertaking reforms with intervals. Announcement of health policy is an important initiation for government's plan for the advancement of health sector, in this regard how the media and in case of this study, newspapers, impact health policy making. Newspapers provide a channel which is used by the policy makers to make promises and deliver intentions. Public's Feedback is an essential part of this process and is under investigation in this study. Newspapers can set the direction for public's welfare by covering a specific matter and overlooking the other. With regard to this function of the newspapers this research endeavors to discover the role newspapers in health policy making by adopting the technique of content analysis of four sampled newspapers for the period of six months

Coverage and causes of non immunization in national immunization days for polio; a consumer and provider perspective study in Peshawar

Polio is a viral disease that may cause paralysis and infant death. Despite ongoing efforts, polio has not been eradicated from Pakistan. The purpose of this survey is to estimate the coverage of polio vaccine during National Immunization Days and to determine the factors associated with lack of immunization. A Cross-sectional survey was conducted in Peshawar, Pakistan, from 1[st] June to 9[th] June 2010. Confidence level of 95% and confidence interval of 4 was used to derive the sample size [for a population more than 20,000]. Parents of 600 children under 5 years were asked about immunization during NIDs of January - May 2010 [5 NIDs]. Questions regarding demographics, income, education, occupation, accessibility to health centers and frequency of visits from health workers was inquired. Knowledge and views on immunization were also asked. 40 health personnel involved in immunization were also interviewed and they were asked about hurdles faced in immunization. 83.7% children were vaccinated in all National Immunization Days, while 94.7% had at least, taken polio vaccine once. 5.3% had not taken polio vaccine during National immunization Days of 2010. Main reasons for not vaccinating were; Vaccinator absent/not visiting home/vaccine not available [63.36%], no awareness [17.4%], Child ill [5.8%], family problem/mother busy [3.3%] and wrong ideas/sterility [3.3%]. Many health personnel [32.5%] considered lack of awareness among people and low accessibility to vaccine as the main hurdles in immunization, besides the poor salaries and incentives. Polio vaccination during National Immunization Days 2010 was a partial success because some pockets of poor children and afghan refugees were poorly vaccinated. In order to eradicate polio, they must be vaccinated

Percutaneous nephrolithotomy; randomized comparison of large bore, small bore and tubeless

We compared postoperative outcome of conventional large bore percutaneous nephrolithotomy [PCNL] with small bore and tubeless percutaneous ephrolithotomy [PCNL]. prospective randomized trial. August 2008-2009 Setting: Shaikh Zayed Hospital Lahore. The study included 90 patients randomized in three groups. Group. 1 included 30 patients who underwent conventional PCNL with large bore 16 fr nephrostomy tube, Group2 included 30 patients, PCNL with small bore 10 fr nephrostomy tube, and Group3 included 30 patients who had tubeless PCNL. Comparison was made in the terms of analgesia requirement, fever, duration of urinary leak and hospital stay. In Group 1 analgesia requirement ranged from 40-70mg mean 50mg, in Group II, it was 30-60mg with mean 47.3mg while in Group III, The requirement of analgesia was 10-50mg with mean 21.1mg, p<0.005. Hospital stay was between 4 to 7days, mean 5.7days in group I while in group II, stay was between 3 to 5 days, mean 4.3days and in group III, it was between 1 to 4 days, mean 3.17days, p<0.005. Twelve patients had fever in group I, In group II, eleven patients while in group III, five patients developed fever, p<0.005. Leakage of urine from site of wound in group I was observed between 0 to 5 days while in group II leakage was between 0 to 4 days, and the leakage period reduced in group III from 0 to 2 days p<0.005. Tubeless PCNL is associated with the least postoperative pain, urinary leakage, fever and hospital stay, it's a good option after an uncomplicated percutaneous renal procedure

Coverage and causes of missed Haemophilus influenzae type B vaccination in urban and rural areas of Peshawar

Haemophilus influenza type b [Hib] is a major cause of morbidity and mortality in Pakistan. Hib vaccine was introduced in 2009 in EPI programme. The purpose of this study was to find out the coverage and factors associated with non-immunization of Hib in urban and rural areas of Peshawar. Data was collected through random sampling in Peshawar University, Peshawar Saddar, Hashtnagri, Naway Kalay and Pawaka from 9th to 19th of June 2010. A questionnaire was used to interview parents of 600 children aged 1 year and below about demographics, Hib vaccination status, reasons for missed vaccination and views on immunization. Pearson's Chi-square test was used for statistical testing, and p<0.05 was considered significant. Completely vaccinated children were 64.2%, 25% not vaccinated at all, and 11% were incompletely vaccinated. The reasons for not vaccinating were lack of awareness [26%], family problem/mother busy [18%], centre too far [16.9%], wrong ideas [12.2%], fear of reaction [5.4%], child illness [8.1%] and miscellaneous causes [13.7%]. Low Hib vaccination coverage in Peshawar is mainly due to low awareness among people, poor economic conditions and illiteracy

Role of ultrasound in early detection of cirrhosis liver

To determine the accuracy of three ultrasonographic signs that are liver surface nodularity, caudate lobe hypertrophy and hepatic vein flow pattern on Doppler ultrasound in detecting severe liver fibrosis in chronic liver disease. Validation study. Department of Radiology PNS Shifa, Karachi. Duration of the study was 6 months, September 2005 to March 2006. This study included 50 patients of both sexes from 30 - 60 years of age who presented with chronic liver disease in Department of Radiology PNS Shifa, Karachi. TOSHIBA [NEMIO 20] Doppler Ultrasound Machine with 3.5 and 5MHz probes was used to look for liver surface nodularity, caudate lobe hypertrophy and pattern of hepatic vein flow. After performing ultrasound, patients were sent for liver biopsy to compare the results with histopathological findings taken as gold standard. On ultrasound the sensitivity, specificty, positive predictive value, negative predictive value and accuracy were highest for liver surface nodularity in detecting severe liver fibrosis. Ultrasound determination of liver surface nodularity is a significantly accurate method for identifying severe liver fibrosis or cirrhosis

Per-operative findings of blocked ventriculoperitoneal shunt: a study of 72 cases

Most patients with hydrocephalus are treated with ventriculo-peritoneal [VP] shunt placement; however, malfunction is common and is usually caused by mechanical failure. The aim of this study was to evaluate the per-operative findings accompanying presumed VP shunt malfunction. This is a descriptive study of 72 patients operated for shunt malfunction in the Department of Neurosurgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from January to December 2008. Presenting symptoms and signs, clinical shunt function, operative findings and outcome were recorded. Common presenting features were vomiting, irritability and general toxic look of patients. Male to female ratio was 3:1. Upper end block was observed in 39 patients while lower end and reservoir block was noted in 13 and 2 patients respectively. Choroids plexus was found in 29.2% of cases with upper end block, shunt revision was performed in most of cases [80.6%]. The importance of clinical features cannot be overlooked in a patient with shunt malfunction. Upper end block due to choroids plexus is common operative finding

Extracorporeal shockwave lithotripsy; impact of diuresis on the clearance of lower pole renal calculi

Treatment of renal stone is always a challenge. High incidence of recurrence of renal stone compels the treating physician to opt for minimally invasive treatment. With the advent of extra corporeal shock wave lithotripsy the treatment has been completely revolutionized. The treatment of lower polar stone is always tiring, and usually involves multiple modalities, the low lie of the stone, difficult clearance, narrow infundibulum, and higher incidence of regrowth make it difficult to treat. We assessed the role of diuretic in the clearance of lower polar stone after shock wave lithotrispsy, [SWL]. 60 patients were selected from both sexes and divide them in two equal groups, with age 20-75 Y for group 1, and 5-72 Y for group II. Stone size from 5- 20mm were included in our study. The patients underwent ESWL. The group I was offered inj Frusemide 20 mg intravenously after shock wave lithotripsy, while patients in group II were kept as control. The stone clearance in group I was 73.3, and 60% in group II. Which is quite significant. The use of diuresis after ESWL significantly increases the clearance rate for lower polar stones

Accuracy of ultrasonography in detection of severe liver fibrosis/cirrhosis in chronic liver disease

To determine the accuracy of three ultrasonographic [US] signs; liver surface nodularity, caudate lobe hypertrophy and hepatic vein flow pattern on Doppler ultrasound, in detecting severe liver fibrosis in chronic liver disease. Descriptive study. Department of Diagnostic Radiology, PNS Shifa Karachi. Duration of the study was 6 months -SEPTEMBER 2005 TO MARCH 2006. The study included 50 patients of both sexes [20-60 yrs], presenting with chronic liver disease to department of Ultrasound. TOSHIBA [NEMIO- 20] Doppler Ultrasound Machine with Doppler 3.5 and 5.0MHz probes was used to look for liver surface nodularity, caudate lobe hypertrophy and pattern of hepatic vein flow. After performing US, liver biopsy on these patients was performed under US guidance and sent for histopathology findings; taken as gold standard. On US, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were highest for liver surface nodularity in detecting severe liver fibrosis. However, the above-mentioned values were relatively higher when the three ultrasound signs were collectively considered; compared to single US sign. US determination of liver surface nodularity is a significantly accurate method for identifying severe liver fibrosis or cirrhosis. The accuracy of ultrasound further increases when hepatic vein flow pattern and caudate lobe hypertrophy are also taken into account