Impact of pharmacist's intervention on disease related knowledge, medication adherence, HRQoL and control of blood pressure among hypertensive patients

The present study was aimed to evaluate the effect of educational intervention provided to the patients of hypertension through pharmacist with the goal to improve knowledge about hypertension, adherence to prescribed medicines, blood pressure control and HRQoL [Health Related Quality of Life]. A total of 384 patients were assigned randomly into 2 groups including intervention and control groups each having 192 patients. Urdu versions of knowledge questionnaire regarding hypertension, medication adherence scale [MMAS-U] by Morisky and EuroQol scale [EQ-5D] were utilized. Each patient's blood pressure was measured. After educational intervention, an increase was found in mean knowledge score about hypertension [18.18 +/- 4.00], adherence score [5.89 +/- 1.90], HRQoL score [0.73 +/- 0.12] and Visual Analogue Scale [VAS] score [69.39 +/- 5.90] among the IG. The blood pressure control also improved and lower systolic [131.81 +/- 10.98 mmHg] and diastolic blood pressures [83.75 +/- 6.21 mmHg] were observed among the patients of IG. This study showed that educational programs are useful for patients in increasing patient's levels of knowledge about hypertension, improving adherence to prescribed medication and enhancing blood pressure control. This increase is in turn accountable to improve HRQoL

Efficacy of intravitreal bevacizumab combined with pan retinal photocoagulation versus panretinal photocoagulation alone in treatment of proliferative diabetic retinopathy

Objective: To compare effectiveness of pan-retinal photocoagulation alone versus panretinal photocoagulation combined with intravitreal bevacizumab on visual acuity and central macular thickness in patients presenting with proliferative diabetic retinopathy

Methods: This Randomized controlled trial was carried out at Armed Forces Institute of ophthalmology, Pakistan from Jan 2016 to Aug 2016. Seventy six eyes of 50 patients having proliferative diabetic retinopathy and diabetic macular edema were included in the study. All the patients were subjected to detailed clinical examination that included Uncorrected visual acuity [UCVA], best corrected visual acuity [BCVA], slit lamp examination of anterior and posterior segments. Optical coherence tomography [OCT] and fundus fluorescein angiography [FFA] were carried out and patients were divided in two groups [GP and GI]. Three monthly sessions of Pan retinal photocoagulation [PRP] using Pattern Scan Laser [PASCAL] alone was performed in group GP while PRP along with three monthly intravitreal bevacizumab [IVB] was performed in group GI. BCVA and CMT was recorded 04 weeks after the third PRP session in both the groups

Results: Seventy six eyes of 50 patients [38 in each group] were treated with three sessions of PRP alone and PRP with IVB in Group GP and GI respectively. Mean age of the patient in group GP was 57.47 +/- 6.08 years while that in group GI was 55.69 +/- 6.58. The magnitude of induced change in BCVA was 0.09 +/- 0.15 in GP while 0.22 + 0.04 in GI groups while mean induced change in CMT after treatment was 77.44 +/- 92.30 um and 117.50 +/- 93.82 um in group GP and GI

Conclusion: Laser PRP combined with IVB has superior visual and anatomical outcome than PRP alone in patients with combined presentation of PDR and DME

Effect of axial length on peripapillary retinal nerve fibre layer thickness measured by spectral domain optical coherence tomography

Objective: To determine the relationship between mean axial length and mean peripapillary retinal nerve fibre layer [RNFL] thickness using spectral domain optical coherence tomography [SD OCT] in healthy subjects

Study Design: Cross sectional study

Place and Duration of Study: Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi, from Dec 2014 to Aug 2015

Material and Methods: Data of 300 eyes of 300 healthy volunteers were collected at AFIO from December 2014 to August 2015 and analysed. Axial length and RNFL thickness of each volunteer was calculated using laser interferometer [IOL master] and SD OCT respectively. Eyes were divided in three groups based on axial length. Statistical analysis of the data were done using SPSS version 17.0

Results: Mean age of study population was 23.16 +/- 3.73 years. Mean axial length was 24.40 +/- 1.50 millimetres [mm]. Mean of average peripapillary RNFL thickness was 128.87 +/- 9.94 micrometres [micro m]. Mean peripapillary RNFL thickness of superior, inferior, nasal and temporal quadrant was 158.27 +/- 11.04 micro m, 152.92 +/- 14.54 micro m, 103.85 +/- 5.01 micro m and 100.45 +/- 11.59 micro m respectively. Mean RNFL thickness, as well as RNFL thicknesses of each quadrant was also significantly different between hypermetropic, emmetropic and myopic eyes [p-value<0.001]. There was also a strong negative correlation between axial length and peripapillary retinal nerve fibre layer thickness [r= -0.964, p-value<0.001]

Conclusion: Variation in axial length significantly affects the measurement of RNFL thickness and must be counted for, while diagnosing glaucoma on basis of thinning of RNFL

Efficacy and safety of optic nerve sheath fenestration in patients with raised intracranial pressure

Objective: To evaluate the efficacy and safety of Optic Nerve Sheath Fenestration [ONSF] in patients with raised intracranial pressure [ICP]

Methods: This Quasi Experimental Study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi from July 2013 to July 2015.Thirty one eyes of 18 patients who underwent ONSF for raised ICP were followed up for one year to ascertain efficacy and safety of ONSF procedure

Results: Thirteen [72.22%] patients underwent ONSF bilaterally, while five [27.78%] underwent unilateral ONSF. Best corrected visual acuity [BCVA] improved in 24 [77.4%], remained stable in four [12.9%] and deteriorated in three [9.7%] patients. Papilledema improved in 27 [87.1%] while remained stable in four [12.9%] according to Frisenscale of Papilledema. Change in BCVA and papilledema from pre-operative values was statistically significant [p<0.001]. There was significant negative correlation [r= -0.434, p=.017] between duration of symptoms before presentation and improvement in BCVA. Common complications were a tonic pupil, subconjunctival haemorrhage, chemosis, weakness of recti and diplopia

Conclusion: ONSF is an effective procedure with statistically significant improvement in BCVA and reduction in severity of papilledema

Spectrum of combat ocular injuries in Pakistani troops

Objective: To analyze the demography, characteristics, visual and anatomical outcomes of combat ocular injuries sustained by Pakistani troops

Study Design: Case series

Place and Duration of Study: Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi, from January 2010 to June 2014

Material and Methods: Data of 156 eyes of 120 war wounded patients treated at AFIO from 2010 - 2014 was retrieved and analysed. Record of each patient was evaluated and demographic data, mode and type of injury, initial and final visual acuity [VA], associated globe injuries, concomitant non-ocular injuries, type of surgical procedures and complications were endorsed on a pre-devised proforma. Injuries were classified according to the Birmingham Eye Trauma Terminology [BETT]. Statistical analysis of the data was done using SPSS version 13.0

Results: Mean age of study population was 28.33 +/- 7.70 years. Improvised explosive device [IED] blast was the most common mode injury occurring in 51 [42.5%] of casualties. Forty eight [30.76%] eyes sustained closed globe injuries while 108 [69.23%] eyes had open globe injuries. Thirty one [19.87%] eyes were initially managed conservatively, while primary corneo scleral repairs were done in 77 [49.35%] eyes. Overall, final visual outcome was significantly better in closed globe injuries as compared to open globe injuries with 26 [54.16%] eyes with closed globe injury achieving final VA of >/= 6/12 as compared to 10 [9.25%] eyes with open globe injuries

Conclusion: Closed globe combat ocular injuries have better visual outcome as compared to open globe injuries

Rate and reasons of conversion of laparoscopic cholecystectomy to open cholecystectomy? A prospective analysis of 450 consecutive laparoscopic cholecystectomies

Objective: To assess the rate and causes of conversion of laparoscopic to open cholecystectomy [OC] in 450 patients who underwent laparoscopic cholecystectomy [LC] by the same surgeon in tertiary care teaching hospitals

Study Design: Descriptive study

Place and Duration of Study: The study was conducted initially at Pakistan Navalship [PNS] Shifa, Karachi and later at Combined Military Hospital, Lahore from November 2009 to June 2013

Material and Methods: All the patients of both genders and of any age group, undergoing LC for gall bladder pathology whether acute or chronic, acalculous or calculous were included in this study by convenient sampling. The exclusion criteria were choledocholithiasis, malignancy, and patients who willingly opted for open cholecystectomy. All the patients were operated by the same experienced laparoscopic surgeon. The number and sizes of the ports varied from patient to patient and was on the choice of the operating surgeon. A detailed proforma was filled which included the demographic data of the patients, indications for cholecystectomy, histories of previous abdominal surgery, their comorbidities [if any], operating time, intraoperative findings, complications, post-operative hospital stay and rate and reasons for conversion to open cholecystectomy [if required]

Results: Out of 450 consecutive patients for whom LC was attempted by a single surgeon, 7 patients [1.6%] were converted to OC. There were 380 female and 70 male patients [F: M ratio 5.4:1]. Their mean age was 44.6 +/- 13.5 years, ranging from 9-82 years. All patients who required conversion to OC were females. The mean operating time was 38.9 +/- 16.2 minutes [range 15-120 minutes]. The reasons for conversion included cystic artery bleeding2, liver bed bleeding1, common hepatic duct injury1, cholecystoduodenal fistula1, severe adhesions caused by tissue inflammation and fibrosis of Calot's triangle1 and cystic duct avulsion1

Conclusion: The overall rate of conversion to OC was 1.6%. Laparoscopic cholecystectomy is a safe procedure with very little chances of conversion to open even in acute cases, when performed by an experienced surgeon

Comparison of open cholecystectomy with laparoscopic cholecystectomy using latest variables of pulmonary functions as parameters

To compare open cholecystectomy with laparoscopic cholecystectomy using latest variables of pulmonary functions as parameters. Randomized controlled trial. Department of Surgery, CMH Rawalpindi from May 2010 to Nov 2010. Patients with symptomatic cholelithiasis subjected to elective cholecystectomy were studied. The patients were divided into two groups. Open Cholecystectomy was performed on patients in group I, and laparoscopic cholecystectomy was performed in patients in group 11. Respiratory function tests were performed preoperatively and on the morning of the 1st post-operative day. Preoperative pulmonary function tests were normal and did not differ significantly between the two groups. After operation a significant reduction in the FEVl [Forced Expiratory Volume in first second], FEV6 [Forced expiratory volume in first six seconds] and their ratio FEVl/FEV6 occurred after both open and laparoscopic cholecystectomy. However, mean reductions in FEV1, FEV6 and FEVl/FEV6 in the laparoscopic cholecystectomy group were significantly [p <0.05] less as compared with those after open cholecystectomy. Laparoscopic cholecystectomy causes less impairment of lung function than cholecystectomy performed through a subcostal incision

Types, management and complications of trachiobronchial foreign bodies

To determine the types, management and complications of tracheohronchial foreign bodies. cross sectional study. This study was conducted at ENT Department of Nishiar Hospital Multan from January 2010 to December 2011. 150 patients underwent rigid bronchoscopy under general anesthesia after routine investigations and x-rays chest where feasible. A total ISO patients underwent bronchoscopy for diagnostic as well as therapeutic purposes. Most common foreign bodies were peanuts [40.66%], beetle nuts [18.669/o] and whistles [18.66?/o]. In 137 [91.33%] patients, foreign bodies were removed on bronchoscopy at first attempt. 10 [6.67%] cases were diagnostic and only 2 [1.33%] cases were subjected to open surgical removal. One [0.67%] of the patients died in ICU after removal of foreign body. Early diagnosis and timely management of foreign bodies with bronchoscopy saves patients life and avoids complications. Younger children should not be offered peanuts, whistles or toys that can be inhaled

Comparison of frequency of recurrence following aspiration and injection of steroid versus surgical excision in the treatment of wrist ganglion

To compare the frequency of recurrence following aspiration and injection of steroid versus surgical excision in the treatment of wrist ganglion. Randomized controlled trial. General surgical department, Combined Military Hospital, Rawalpindi, Pakistan, from Jan 2010 to Dec 2010. Sixty patients of clinically diagnosed wrist ganglia were randomized into groups A and 'B' with 30 patients in each group. After approval by the hospital ethical committee, patients in group 'A' were subjected to aspiration and injection of methyl-prednisolone acetate 40 mg/ml and those in group 'B' underwent surgical excision of the ganglion. Patients were explained the procedure they were subjected to and they were also counselled about the risk of recurrence after a particular procedure and after that informed written consent was obtained from them. Patients were followed up at intervals of 2 weeks, 6 weeks, 3 months and 6 months after the procedure to look for recurrence in both groups. On follow up at 6 months, 12 [40%] patients in group A while only 2 [6.66%] patients in group B had recurrence of the ganglion. No complications were noted. This difference was found to be statistically significant [p = 0.0023]. Recurrence of wrist ganglion is considerably less in patients treated with surgical excision and should be preferred over aspiration and steroid injection

Age and sex distribution and types of foreign body esophagus - mode of presentation, risk factors involved, management and complications

To find out the age and sex distribution, type of foreign bodies, their mode of presentation, site of impaction, risk factors involved. Experimental study. This study was carried out in the ENT Department, Nishtar Hospital, Multan from January 2012 to December 2012. A total of 100 cases presented with history of FB ingestion were included. Male patients with FB ingestion were 67% and female were 33%. Male to female ratio was 2:1. Patient's age ranges from 6 months to 70 years. Most of the patients were below the age of 10 years. Majority of the patients belonged to lower socio-economic group and also from the rural areas. In total review of nature of foreign body, regardless of age, coin was the commonest F.B [76%]. In the present study rigid oesophagoscopy was done for removal of all F.B. When diagnosis is delayed, or presentation is late, complication rate increases. Do not let foreign body to pass down spontaneously after 24 hour, after that it should be urgently removed under GA without further delay

Caudal analgesia in children; comparison between bupivacaine and bupivacaine plus tramadol

Caudal analgesia with bupivacaine is used commonly for pain relief in children and extradural administration of tramadol seems to be a safe method of analgesia. The aim of the study was to compare the analgesic efficacy of caudal bupivacaine and bupivacaine and tramadol mixture for postoperative analgesia and to observe for the side effects. Department of Anesthesia and Intensive Care Unit, Bahawal Victoria Hospital, Bahawalpur. 01-12-2010 to 30-11-2011. Eighty children, aged between 2 to 12 years of age undergoing infra umbilical surgeries were selected for this randomized, controlled trial. They were randomly divided into two groups A and B. Group A [n = 40] received 0.5 ml/kg of 0.25% bupivacaine and Group B [n = 40] received 0.5 ml/kg of 0.25% bupivacaine with 1 mg/kg of tramadol as a single shot caudal block. In the postoperative period, duration of analgesia, pain score, nausea, vomiting and side effects were noted and analyzed. Patients in both groups were comparable for age and weight. It was observed that the mean duration of analgesia in group A patients was 6.23+0.68 hours while in group B, it was 9.33+0.72 hours [p<0.05]. Nausea and vomiting was present in 20% [n=8] patients in group A, while in group B, 27.5% [n=11] had nausea and vomiting in the post operative period [p<0.05]. None of the patients in both the groups had complications like motor weakness, urinary retention in the postoperative period. The addition of tramadol to bupivacaine in the caudal analgesic technique provides longer analgesia and lesser need for rescue analgesia in the postoperative period compared to bupivacaine alone

Abdominal cocoon [sclerosing encapsulating peritonitis]: a rare cause of intestinal obstruction

A 24 years old lady presented with classical history of acute intestinal obstruction. There was a background history of chronic abdomen for 9 years. There was asymmetrical abdominal distension. On laparotomy, the entire small intestine was cocooned and enclosed in a yellowish white thick fibrotic membrane resulting in obstruction of the small intestine. When the membrane was carefully peeled off the small intestine, the underlying small gut was found to be absolutely healthy. The histopathology report was consistent with non-specific dense fibrosis. Based on these findings, a diagnosis of abdominal cocoon or sclerosing encapsulating peritonitis was made which is an extremely rare cause of small bowel obstruction

Amniotic membrane transplantation in primary pterygium compared with bare sclera technique

To compare the excision of primary pterygium by bare sclera technique and excision combined with amniotic membrane transplantation [AMT]. An experimental study. Eye Department, Military Hospital, Rawalpindi, presently known as Armed Forces Institute of Ophthalmology, Rawalpindi, from May 2007 to July 2008. A pilot study of 70 patients was conducted. Patients were divided in two groups. In group I, pterygium excision was done by bare sclera technique while in group II, AMT was done after excision. Patients were followed for 6 months. Proportion of recurrence of pterygium was noted in each group and compared with chi-square test with significance at p < 0.05. Number of patients who presented with recurrence of pterygium in group-I were 12 [37.5%] and in group-II were 4 [12.9%]. Chi-square tests showed that there was a statistically significant difference in frequency of recurrence between the two groups [p = 0.025]. AMT after excision of pterygium appeared to be safe and effective way of treating primary pterygium as compared to bare sclera technique due to lesser recurrence at 6 months

Comparison of effects of tramadol and ketorolac in intravenous regional anesthesia

Background: Intravenous regional anesthesia, is easy to administer, reliable method for short procedures, however, adjuncts are needed to improve its efficacy

Objective: To compare the effects of adding tramodol and ketorolac as adjunct to the lignocaine in intravenous regional anesthesia [IVRA], on intra-operative and postoperative pain

Material and Method: A prospective, randomized study was carried out on total of 90 patients who were undergoing upper limb surgery. The patients were divided into three groups as follows: group A received lignocaine 0.5% with tramodol 50 mg, group B was administered lignocaine 0.5% with Ketorolac 30mg, while group C received lignocaine 0.5% only as control. Intra-operatively and post operatively the patient's pain score was evaluated using visual analogue scale [VAS]. All the patients were compared for the time to first analgesic. The groups were also compared for the total number of analgesics required in the first twenty-four hours

Results: A total of 90 patients were included in this study. The mean age of patients in group A [Lignocaine 0.5% 40ml + Tramadol] was 52 +/- 7 years while in group B [Lignocaine 0.5% 40ml + Ketorolac], it was 53 +/- 6 years and in Group C [Lignocaine 0.5% 40ml], 50 +/- 5 years.Tramadol in lignocaine was found to be significantly better [p<0.05] compared to ketorolac in lignocaine and lignocaine alone for intra operative and post operative pain. The patients in tramadol group required significantly less number of analgesics in the first twenty four hours as compared to the other two groups

Conclusion: We conclude that as adjunct tramadol is significantly better as compared to ketorolac and lignocaine alone for intravenous regional anesthesia, with respect to operative, post operative analgesia, time to first analgesic and total analgesics in twenty-four hours

Comparison of laparoscopic versus open appendectomy

Background: Acute appendicitis is the most frequent condition leading to emergency abdominal surgery. Open appendectomy [OA] has been the gold standard for the treatment for acute appendicitis for more than a century. Although it is safe, the incidence of post operative complications is 10% to 20%, with 0.3% overall mortality. Patients undergoing laparoscopic Appendectomy [LA] have less postoperative pain, less impairment of vital functions, and they resume usual activities more rapidly

Objective: To compare the outcomes of laparoscopic and open appendectomy in the treatment of acute appendicitis with regard to hospital stay, length of operation, return to normal activity and post operative pain

Patients and Methods: This experimental study was conducted at Department of Surgery, Bahawal Victoria Hospital from 1[st] November, 2011 to 30[th] June, 2012. A total of 112 patients with similar characteristics of appendicitis were selected. Patients of acute appendicitis were divided into two groups A and B comprising of 56 patients each. Open appendectomy was performed in group A and laparoscopic in group B. Sampling technique was purposive non probability sampling. Demographics, length of operation, post operative pain, hospital stay and return to normal activity were documented. Statistical Analysis was done with SPSS v 13

Results: A total of 56 patients were allocated to LA group while another 56 patients to OA group. There were no significant difference between the two groups with respect to mean age. Mean operative time was longer in LA than in OA group [P value: 0.028]. Post operative pain was less in LA group, resulting in less use of analgesics; Hospital stay was shorter in LA group [p value <0.001]. Return to normal activity was earlier in LA group [p value: 0.008]

Conclusion: Laproscopic appendectomy has advantage over open appendectomy, in terms of its ability of lower post operative pain and reduced hospital stay. It is concluded that in clinical settings where laparoscopic surgical expertise and equipment are available and affordable, LA seems to be an effective and safe alternative to OA

Retinopathy risk factors among diabetics in a tertiary care military hospital

To determine the frequency and risk factors for severity of retinopathy in diabetic patients referred to a tertiary military hospital. Cross-sectional study. Armed Forces Institute of Ophthalmology, Rawalpindi from Jun 2008 to Dec 2009. Diabetic patients aged 40 to 79, referred for suspected diabetic retinopathy [DR] on fundoscopy from medical outpatient clinic of Military Hospital Rawalpindi were randomly included in the study. Participants underwent a standardized interview and examination Retinopathy was assessed through dilated pupils, and graded into absent retinopathy, mild to moderate, or advanced. Presence of clinically significant macular edema [CSME] was also recorded. To evaluate the simultaneous effect of significant risk factors on the different stages of DR, multivariate regression analysis was carried out. Out of five hundred and ten patients, DR was confirmed in 63% cases with advanced retinopathy in 21.3%. In univariate analysis, duration of diabetes, fasting blood glucose, and presence of oedema were significantly associated with retinopathy [P<0.005] On multivariate analysis, however, only duration of diabetes [Odds Ratio 6.15 for 5 to 10 years and 38.29 for more than 10 years] and macular oedema [OR 6.617 95% CI 3.95-11.07] remained significant. CSME was present in 173 [33%] patients and its frequency increased with the severity of DR [P<0.001]. The frequency of DR among military personnel and their dependants was high with strong association to duration of diabetes. This underscores the importance of regular retinal detect DR in the early stages and timely intervention to prevent diabetes related blindness

Assessment of metered dose inhaler technique in patients with chronic lung disease at government hospitals of Rawalpindi

Metered dose inhalers [MDIs] are an affective modality of treatment for fast relief from asthma flare-ups and other symptoms, and are often used by asthmatic athletes. It has got lots of benefits and some drawbacks depending on usage technique. With proper technique and training drawbacks can be minimised. The objective of this study was to assess the metered dose inhaler technique in patients with chronic lung disease at government hospitals of Rawalpindi. A cross-sectional study was conducted in three government hospitals of Rawalpindi. The inhalation technique was assessed in six steps. Clear evidence showed that only 24% patient could perform all the steps correctly. Percentages of people that followed individual steps properly were: preparation [87.5%], exhalation [53.85%], lip closure [68.27%], inhalation [56.73%], breath-holding [27.88%] and puff interval [36.54%]. This study showed that a number of patients in government hospitals of Rawalpindi were unable to use metered-dose-inhaler properly and therefore indicates the need to make people aware of this technique either by counselling or arranging seminars

Comparison between delayed-absorbable polydioxanone and non-absorbable [prolene] suture material in abdominal wound closure

The objective of this study was to compare Polydioxanone [PDS] and Prolene suture material for abdominal fascial closure regarding morbidity in terms of post-operative wound complications. Cohort comparative ramdomized study. Dept of surgery Combined Military Hospital Rawalpindi from January 2002 to December 2003. A series of 100 patients presenting in the General Surgical OPD and requiring midline laparotomy were studied. In group "A" all the midline abdominal wounds were closed with Prolene 1 and in group "B" PDS 1 was used. In both the groups the data was collected, based on post-operative wound complications including post-operative wound pain, wound infection, wound dehiscence, suture sinus formation, stitch granuloma and incisional hernia. All the post-operative wound complications were then compared between the two groups. Our results show that the post-operative wound infection, wound dehiscence, suture sinus formation, stitch granuloma and chronic wound pain were significantly lower with PDS 1 as compared to Prolene 1, without any significant increase in incisional hernia formation. Slowly absorbable suture material [PDS] appears to be superior than non-absorbable suture material [Prolene] in midline abdominal fascial closure

Typhoid Fever; clinical experience with levofloxacin, its efficacy and safety

To find out the efficacy and safety of Levofloxacin in patients suffering from typhoid fever. Non-comparative and prospective study. Medical Units of Allied and DHQ Hospital [PMC] Faisalabad. From May 2002 to July 2004. All suspected febrile patients were examined and provisionally diagnosed to have typhoid fever were admitted for the purpose of study till they were satisfactorily discharged. This clinical study was conducted on 70 patients of Enteric Fever. Fifty-two patients were male and 18 were female. The mean age for male patients in the study sample was 37.58 +/- 8.13 while the mean age of females was 21.92 +/- 4.73 years. Fever as a symptom was present in all 70 [100%] of the patients. Anorexia was there in 61 [85.5%] patients and abdominal pain in 49 [70%] patients. Twenty-seven [38.5%] patients had constipation along with other features. Diarrhea was present in 6 [8.5%] patients. Relative bradycardia was present in 20 [28.5%] patients. Hepa tomegaly was there in 31[44.3%] and Splenomegaly in 24 [34.3%]. Elevated liver enzymes were found in 29 [41.4%] of the patients and blood cultures positive for Salmonella typhi was seen in 19 [27.1%] patients. Widal test was positive at dilution of 1:160 in almost all of the cases and at 1:320 dilution in 18% of cases in current study. The success rate of Levofloxacin in our study was 100% in the form of settlement of fever and other symptoms and signs. The side effects were seen in 17 [24.2%] patients. In conclusion levofloxacin is effective in treatment of typhoid fever and its use in this indication is safe

Early complications of laparoscopic cholecystectomy for calculous cholecystitis

Gallstones are the most common cause of hospitalization and most common elective procedure being carried out in hospitals. Although laparoscopic cholecystectomy is not as popular in Pakistan as in the west, because people have misconception of its complications. Therefore the present study was conducted to assess the early complications of laparoscopic cholecystectomy for calculus cholecystitis. This study was conducted at CMH Rawalpindi from January 2003 to July 2003. A total 100 patients with calculus disease were admitted. This comprised of 88 [88%] females, 12 [12%] males, age ranges from 21 to 60 yrs with mean age of 45 yrs. Patients were assessed per-operatively and post-operatively followed at 01 week, 01 month and 03 months for complications. The overall incidence of complications was 12% with major complication seen in only 4% cases. There was no mortality in our series. It is concluded that Laparoscopic cholecystectomy is safe with less post-operative morbidity and mortality