ABSTRACT
Objective: The most important desideratum of a provisional crown is an adequate marginal fit that is essential for maintaining optimal periodontal health, reducing the sensitivity of freshly prepared dentin and protection of the pulp. The purpose of this in vitro study was to compare the vertical marginal accuracy of provisional crown materials using three different material systems [chemically activated PMMA powder-liquid system, light activated UDMA single paste system, and chemically activated Bis-GMA two paste auto mix system] and two different techniques [direct and indirect]
Methods: Two customized stainless steel dies, simulating prepared and unprepared tooth were used to fabricate 40 provisional crowns. Additional silicone elastomeric impression and a vacuum-formed polypropylene sheet were used as a matrix. Ten crowns, each of the three material systems used in the study [n = 10 × 3] were fabricated using the direct technique and ten crowns from chemically activated PMMA powder-liquid system [n = 10 × 1] using an indirect technique. Scanning electron microscope [SEM] was used to measure vertical marginal discrepancies at x100 magnification. The results were analyzed using descriptive statistics and comparisons between various groups were made using one way analysis of variance [ANOVA] after checking the normality of data using Shapiro Wilk's Test. Post Hoc Tukey HSD Test was used to determine the statistical difference between the means of independent group pairs
Results: The mean marginal discrepancies of Bis-GMA composite resin, UDMA composite resin, and PMMA acrylic resin using direct technique were 67.15 µm, 71.01 µm, and 84.56 µm respectively. PMMA acrylic resin showed a mean marginal discrepancy of 103.03 µm using the indirect technique
Conclusion: This study has shown that provisional crowns fabricated with Bis-GMA composite resin material [two paste auto mix system] registered the best marginal accuracy. Provisional crowns fabricated with indirect technique recorded less marginal opening than with direct technique
ABSTRACT
Leukocyte adhesion deficiency type 1 [LAD-1] is a rare autosomal recessive disorder caused by mutations in the gene that codes for CD18, the beta chain of beta-2 integrins, located on the long arm of chromosome 21. This defect results in failure of leukocyte migration to the site of infection due to the absence of surface integrins. Leukocyte adhesion deficiency should be suspected in any patient with recurrent infections, impaired wound healing, history of delayed umbilical cord separation, periodontitis, leukocytosis, recurrent soft tissue and oral infections. Diagnosis is based on the analysis of neutrophils for the surface expression of CD18, CD11a, CD11b and CD11c by flow cytometry. Here, we present a 55-day male infant with umbilical cord separation on the 10th day of life and no history of infection, who was identified with LAD-1 with low expression of CD11b. The purpose of performing LAD flow cytometric analysis in this patient was to screen him for LAD-1 as his elder brother had LAD-1 and one elder sister died undiagnosed with recurrent skin and chest infections at 8 months of age
ABSTRACT
Vancomycin-resistance among Enterococci has been escalating in recent years in many countries. Linezolid, an oxazolidinone is one of the novel drug that promised effective therapy of infections caused by vancomycin-resistant Enterococci [VRE].However, like with most of the previous antimicrobial agents, the clinical benefit of linezolid is being threatened by the emergence of resistant strains of MRSA and vancomycin resistant enterococci VRE, being reported in many countries. This study was conducted to establish linezolid susceptibility of VRE isolates by determining the in vitro activity of linezolid against vancomycin resistant Enterococci, isolated in our setup using fifty VRE isolates. The data collected from this study conclude that the vancomycin resistant Enterococci are 100% linezolid susceptible and presently there is no significant resistance against this unique oxazolidinone in our setup
ABSTRACT
Objective: To determine the frequency of urinary tract infection [UTI] in diabetes mellitus patients
Methodology: This was a cross sectional study, conducted from October to December 2017 at department of Microbiology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. A total of 200 samples of urine, were collected from outdoor patient department of diagnosed diabetic patients and were inoculated on a CLED agar. These cultures plates were placed in incubator at 35-37 degree C in aerobic environment. Positive cultures having growth were identified by their colony characteristics, appearance and confirmed by biochemical tests. Pure culture was obtained and inoculated on Nutrient agar plate and discs of amoxicillin clavulanic acid [20Mug: 10Mug], ciprofloxacin [5Mug], imipenem [10 Mug], piperacillin tazobactam [10Mug] and gentamicin [10Mug] were applied. Plates were examined to read the zones of inhibition according to CLSI. Data was analyzed by using SPSS Version 20
Results: Uropathogens were isolated from 200 urine samples. Escherichia coli was the most frequent isolate [52%], followed by Klebsiella species [17%], Proteus species [8%], Pseudomonas aeruginosa [6%] and Staphylococcus species[17%]. Gram positive bacteria were highly sensitive to imipenem, Sulzone [Cefoperazone/Sulbactam]. Gram negative bacteria were sensitive to imipenem, sulzone, Fosfomycin, ceftriaxone, Ciprofloxacin and resistant to amoxicillin clavulanic acid, nitrofurantoin, piprracillin tazobactam and gentamicin
Conclusion: DM patients are prone to Urinary Treat Infection and should carefully be treated after culture and sensitivity, as rational use of antibiotics make it difficult to treat. Microbial Drug Resistance against uropathogens is a major problem and this problem should be properly evaluated
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Objective: To evaluate the percutaneous dilatational tracheostomy procedure safety among the critically ill Medical ICU patients
Methodology: The study was descriptive and conducted in Medical ICU, Department of Pulmonary and Critical Care Medicine, Services Institute of Medical Sciences, Lahore, from February 2015 to May 2016. Fifty three Medical ICU patients underwent tracheostomy procedure through percutaneous dilatational technique using both Grigg's and Ciaglia's methods. Procedure was performed at bed side using local anesthesia, sedation and systemic analgesia, under bronchoscopic guidance. Patients were monitored for intraprocedural and postprocedural complications like: hemorrhage, stomal infection, injury to adjacent structures, arrhythmias, transient hypoxemia, transient hypotension, paratracheal insertion, pneumothorax, sub-cutaneous emphysema, loss of airway, accidental decannulation, tracheal ring fracture and new lung infiltrate or atelectasis
Results: A total of 53 procedures were performed. Intraprocedural complications included: Transient hypoxemia 4/53 [7.5%] and hypotension 3/53 [5.6%], hemorrhage 3/53 [5.6%] and one case of paratracheal placement. No procedure related mortality was noted. 10 patients died during the ICU stay due to the primary underlying disease and one patient died after a successful decannulation. 36 patients had uneventful decannulation. Six patients were directly discharged from ICU
Conclusion: Percutaneous dilatational tracheostomy is a safe procedure with low complications rate and suitable for critically ill ICU patients
ABSTRACT
Background and Objective: Increased neutrophil lymphocyte ratio [NLR] is a marker as well as predictor of various cardiac and non cardiac disorders. Our aim was to assess the relationship between NLR and different level of glycemic control in type 2 diabetic patients
Methods: An observational study was conducted at diabetic clinic of Sheikh Zayed Medical College/ Hospital, Rahim Yar Khan from September 2016 to February 2017 in which 330 type 2 diabetic patients were randomly divided in to three groups based upon diabetes control according to ADA criteria. Patients in group A with HbA1c /= 9 %[ worst control]. Patients were assessed in terms of complete blood count and C - reactive protein
Results: As compared to excellent control [Group A] patients with worst control [Group C]showed a high leukocyte count [p .001], high neutrophil count [P .003] and lower lymphocyte count [P 0.44] while patients in poor control [Group B]did not differ significantly. Similarly value of NLR was also significantly higher in worst control [Group C] as compared to poor control[Group B] and excellent control [Group A] diabetes [4.3+/-2.8, 2.7+/-1.0 and2.0+/-0.5[p.001]. NLR were found independent predictor of worst diabetes control [OR: 1.809, 95% CI: 1.459-2.401] along with fasting blood sugar [OR: 0.938, 95% CI: 0.995-0.982] and CRP [OR: 1.020, 95% CI: 1.003-1.028]
Conclusion: Increased NLR level is associated with elevated HbA1c and poor glycemic control in patients of type 2 diabetes mellitus. It can be used as a disease monitoring tool during the follow up of diabetic patients
ABSTRACT
Background: Pseudomonas aeruginosa is an important pathogen isolated from various clinical samples. It continues to cause complication in nosocomial infections
Objective: To determine the prevalence and antibiotics resistance pattern of P.aeruginosa isolated from a clinical samples at a tertiary care hospital
Methodology: This was a cross sectional study. A total of hundred clinical samples comprising urine, pus, blood and wound swabs were collected from ICU and burn unit, surgical ward, medical ward and OPD of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. These samples were cultured on MacConkey and Blood agar. Urine was cultured on CLED agar. Plates were aerobically incubated at 35-37 [degree sign]C. Positive cultures were identified by culture characteristics and biochemical reactions. Antimicrobial resistance of all isolated bacteria was done by the disk diffusion testing. Pure culture was obtained then inoculated on Nutrient agar plate using disks of amoxicillin: clavulanic acid, ceftazidime, ciprofloxacin, amikacin, imipenem, piperacillin tazobactam and gentacin. After 24 hrs incubation plates were examined to read the inhibition zones
Results: From these samples Pseudomonas aeruginosa was isolated from urine [17%], pus [26%], blood [9%] and wound swab [48%]. Pseudomonas aeruginosa showed resistance against Piperacillin Tazobactam [99%], Amoxicillin Clavulanic Acid 91%, Tigecycline 89%, Amikacin 83% and Ceftazidime 79%
Conclusion: Our Study showed that P. Aeruginosa, is the common microorganisms isolated resistance pattern is against common antibiotics. To cope with antimicrobial resistance against critically ill patients with pseudomonas infections it is necessary to follow firm antibiotic policies and SOPs while implementation of surveillance programmes for MDR bacteria and infection control and prevention procedures are needed
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Objective: to observe the diagnostic yield of conventional TBNA with EBUS-TBNA for right paratracheal and subcarinal nodes
Study Design: Observational / descriptive study
Place and Duration of study: This Study was conducted in Pulmonology Department of Services Institute of Medical Sciences [SIMS] Lahore from January 2013 to March 2015 after approval from ethical review committee
Materials and Methods: We prospectively enrolled patients with right Mediastinal and sub carinal lymph nodes for bronchoscopy and TBNA. Patients of both gender with significant [>1.5 cm] subcarinal and right paratracheal nodes or mass lesions were included in the study. All patients had conventional TBNA done with Smooth shot needle no.19 F via video bronchoscope under light sedation. Adequacy of the sample and definitive diagnosis either by Histopathology or cytology was noted
Results: Sixty patients including 27 male [45%] and 33 [55%] female had TBNA for Subcarinal or paratracheal nodes or mass lesions. Mean age was 50.31 + 14.3. Fifty four [90%] patients had the diagnosis on histopathology, cytology or tissue culture while 6 [10%] patients had non-diagnostic/inadequate samples. Leading diagnosis was Sarcoidosis 24 [44.4%] followed by NSCCA 11[20.3%], Tuberculosis 10 [18.5%], SCCA 7 [12.9%], and Endocrine Tumor 2 [3.7%]. Minor hemorrhage 6 [10 %] was managed by topical adrenaline
Conclusion: Conventional TBNA is useful easily available, cheap and safe diagnostic tool in patients with Sub- carinal and right Para-tracheal lymph nodes/mass lesions of >1.5 cm size
ABSTRACT
To evaluate management and outcome of Iatrogenic Common Bile Duct injury after cholecystectomy. Descriptive study. Isra University Hospital Hyderabad during the period of April 2013 to April 2014. All patients presented with CBD injury after cholecystectomy included while CBD tumor and CBD stone and trauma were excluded from study. Total of sixteen patients with CBD injury were admitted from outside the hospital in surgical ward in Isra University hospital either through OPD or Emergency Room or Endoscopy Suite depending on the mode of presentation and failure of ERCP if performed according to the need and clinical presentation. All patients were resuscitated and investigated thoroughly and the procedure whether ERCP, or reconstructive surgery or conservative treatment performed based on patient's clinical presentation and mode of injury and is recorded in the preset approved Performa from relative hospital's ethical review committee and the data compiled in SPSS version 10. All 16 patients; 4[25%] male and 12[75%] females admitted from outside the hospital in two year period. Presented in variable time interval12 [75%] patients admitted in 1 month, 3[18.8%] in 6 monthsand 1[6.3%] in 12 months. Jaundice was the main presenting symptom. Patients were resuscitated and optimized for invasive procedure i.e. ERCP and reconstructive surgery. Six patients were treated with ERCP successfully and 9 underwent reconstructive surgery and 1with some biliary drainage responded to simple conservative treatment. Operative success rate was 75% with 25% mortality which was related to the presence of peritonitis, development of multiorgan failure and late repair of bile duct injury. Although CBD injury is one of the most devastating complication but its early diagnosis and prompt treatment can prevent patient's life with subsequent few or no complication even after its reconstructive surgery. Training must be emphasized to find the all possible ways of recognizing biliary tract anatomy during surgery and possess skills to overwhelm the primary and leading cause of bile duct injury i.e. the visual misperception
ABSTRACT
Objective: To assess the efficacy of Sequential Organ Failure Assessment score [SOFA] as a determinant of outcome in critically ill medical patients
Study Design: Prospective observational cohort study
Place and Duration of Study: This study was conducted at Medical ICU of Civil Hospital Karachi from June 2014 to December 2014
Materials and Methods: The study was conducted on 152 patients admitted in the Medical ICU. The SOFA score was calculated on admission and thereafter daily until ICU discharge or death. The primary outcome measure was ICU mortality. The initial SOFA score, the SOFA scores at 48 and 72 hours, the mean and highest SOFA scores and the trend of SOFA score during the initial 48 hours were correlated with mortality
Results: The overall ICU mortality rate was 35.5 % [n=54]. Patients with an initial SOFA score of /= 10 had a mortality rate of 88.2 %. The SOFA scores at 48 and 72 hours also showed significant association with mortality. The mortality rates of patients having a score of /=10 at 48 and 72 hours were 91.3% and 93.8% respectively. A sharp rise in mortality was seen when the Highest SOFA score during the entire ICU stay exceeded 7. Patients having a mean SOFA score of greater than 5 had a mortality rate of 66.7% regardless of length of stay. Univariate Logistic Regression Analysis revealed that the Highest SOFA score had closest correlation with mortality followed by Mean SOFA score, SOFA at 48hours, and SOFA at 72 hours. The biggest area under the receiver operating characteristic curve [AUROCC] was seen for the Highest SOFA score followed by SOFA at 72 hours, Mean SOFA score and SOFA at 48hours. Analysis of the changes in SOFA score during the first 48 hours depicted a mortality rate of 54.9% when the score increased, 27.6% when the score decreased and 23.3% when it did not change
Conclusion: The serial evaluation of SOFA score proved to be a convenient and efficient tool to predict mortality in the critically ill ICU patients
ABSTRACT
To determine the frequency of low mid upper arm circumference [MUAC] of children with acute malnutrition. This study was conducted in the department of paediatrics at Liaquat University Hospital Hyderabad from 01-06-2012 to 30-11-2012. All the children with features of malnutrition, of either gender were recruited and evaluated for their mid upper arm circumference which was measured through plastic measuring tape. During six month study period, total 135 children with acute malnutrition were studied for their mid upper arm circumference [MUAC], of which 95[70%] were males and 40[30%] were females. The mean age +/- SD of overall population was 30.24 +/- 10.57 month while the mean age of male children was 32.88 +/- 11.76 and the female child was 31.62 +/- 10.97 months. Regarding the MUAC, was low in 93[68.9%] children with acute malnutrition. The mean age +/- SD of child with low MUAC was 28.99 +/- 12.52 while the mean +/- age of male and female child with low MUAC was 27.63 +/- 10.73 and 29.85 +/- 11.64 respectively. The mean MUAC in children of acute malnutrition with low MUAC was 8.85 +/- 3.93 while it was 8.66 +/- 3.96 and 8.93 +/- 3.31 in male and female child with low MUAC respectively. The present study suggested that MUAC is appropriate and good tool for identifying severe malnutrition in children
ABSTRACT
This study was conducted to evaluate the role of beta carotene on histomorphology of rat kidneys in subacute Acetaminophen [APAP]-induced renal damage. Lab based randomized control trial. The study was carried out in the department of Anatomy Army Medical College, I Rawalpindi; in collaboration with National Institute of Health [NIH], Islamabad for one week in June 2009. Sixty young adult [4-6 weeks old] Sprague-Dawley rats of both sexes weighing 180-240 g were randomized into three groups. Experimental group A was treated with 700 mg/kg body weight subacute APAP orally once daily for 7'consecutive days. Experimental group B was administered beta carotene 30 mg/kg body weight once daily one hour before 700 mg/kg body weight subacute APAP once daily for 7 consecutive days. Control group C animals were fed NIH laboratory diet. Kidney specimens were collected 24 hours after the last dose. Five micron thick sections of kidney were stained with H and E for histomorphological study. Frequencies and percentages were calculated to describe the variables p values less than 0.05 was considered statistically significant. Microscopic examination in experimental group A demonstrated tubular necrosis of level 2 [35% animals] and level 3 [65% animals]. Mild vacuolar degeneration was also observed in 90% of the experimental group A animals. In experimental group B, there was statistically significant difference p-value < 0.001 in levels of renal tubular necrosis [15% animals] and grades of vacuolar degeneration [5% animals] as compared to experimental group A. Findings in experimental group B were not significantly different from that of control group C. Beta carotene has protective role on histomorphology of kidneys in subacute APAP-induced renal damage in rats
ABSTRACT
Background: metabolic derangements in type 2 diabetes mellitus [T2DM] are likely to affect skeletal muscle contractile functions adversely. Levo-carnitine improves muscle contractile functions in healthy humans and rats and corrects metabolic derangements in T2DM. Therefore, it is likely to improve muscle contractile functions in T2DM as well. This study was designed to determine the effect of levo-carnitine on serum levo-carnitine levels, oxidative stress and contractile parameters of fast muscle in T2DM
Methods: ninety Sprague-Dawley rats were randomly divided into three equal groups. Healthy rats served as the controls, while T2DM was induced in diabetic and carnitine groups. The carnitine group was administered levo-carnitine 200 mg/kg/day intraperitoneally for 6 days. At 28[th] day, extensor digitorum longus muscles were removed and their functions were assessed using iWorx data acquisition unit [AHK/214]. Blood obtained by intra-cardiac sampling at 28[th] day was used for estimation of serum malondialdehyde [MDA] and levo-carnitine levels
Results: maximum isometric twitch tension, time-topeak twitch tension and time-to-relax to 50% of the peak twitch tension were not significantly different amongst the groups. Carnitine group showed significant improvement in maximum fused tetanic tension, maximum fused tetanic tension after fatigue protocol and recovery from fatigue after 5 minutes of rest period compared to the diabetic group. Serum MDA levels were reduced, while serum levo-carnitine levels were elevated significantly in carnitine group as compared to the diabetic group
Conclusion: levo-carnitine supplementation increases serum levo-carnitine levels which decreases oxidative stress. This action improves contractile force but delays fatigue in fast muscles of diabetic rats. Iran. Biomed. J. 17 [1]: 29-35, 2013
ABSTRACT
To study the prophylactic effects of High Dose Magnesium Sulphate on Cardiac Arrhythmias, Cardiogenic shock and associated mortality in Cases of Aluminum Phosphide Poisoning. Seventy One patients of wheat pill poisoning were randomly selected. Thirty seven were given high dose of Magnesium Sulphate [study group] and 34 were given low dose of magnesium sulphate [control group] through intravenous route along with other supportive measures. Patients were observed for cardiac arrhythmias and mortality in both groups. Study end point was safe discharge from the hospital or death. The mean age of the sample was 25.27 +/- 7.48 years. Frequency of cardiac arrhythmias was 40.54%[n=15] in study group versus 55.88% [n=19] in the control group. Average length of stay and frequency of cardiogenic shock was slightly lower in the study group, i.e., 1.42 +/- 0.65 days while it was 1.78 +/- 1.38 days for the control group. Overall, mortality in both the groups was 66.20% [n=47], which remained almost equal in both groups or slightly favored study group with 64.86% [n=24] in the study and 67.65% [n=23] in the control group. High dose magnesium sulphate administration was found to be helpful for cardiac arrhythmia and shock but mortality remained unchanged
Subject(s)
Humans , Female , Male , Magnesium Sulfate , Arrhythmias, Cardiac/drug therapy , Arrhythmias, Cardiac/prevention & control , Phosphines , CardiotoxinsABSTRACT
Pain is experienced by people suffering from spinal cord injury leading to disability and affecting the person's functional ability, independence, psychological well - being, ability to return to work and quality of life. Pain management in these patients is notoriously difficult due to multiple factors and varied mechanism leading to pain. Only few treatments have been assessed in randomized, controlled trials and management is based on different case reports. We are reporting our experience of managing 2 patients with neuropathic pain following traumatic spinal cord injury. Both the patients were refractory to conventional pain medications but there was significant reduction in pain following lignocaine infusion in the first patient and with ketamine in the second patient
ABSTRACT
In the past 30 years the rate of caesarean section [C/S] has steadily increased from 5% to more than 20% for many avoidable and unavoidable indications. The objective of this study was to compare maternal morbidity and determine its cause in elective and emergency caesarean section. It was a cross-sectional comparative study conducted in Civil Hospital Karachi at Obs/Gyn Unit III. All mothers admitted through OPD or emergency during the study period, of any age or parity undergoing C/S were recruited in the study. Patients having previous myomectomy, hysterotomy or classical C/S were excluded from the study. Patients undergoing emergency C/S were placed in group A, and those delivered by elective C/S were included in group B. Study variables were general and obstetric parameters and complications observed intra-operatively. Any postoperative complications were recorded from recovery room till patient was discharged from the ward. There were 50 patients in each group. In group A, 11 [22%] were booked and 33 [66%] were referred cases. In group B, 48 [96%] were booked. The mean age in both groups was 28 years. In both groups, multigravida compared to primigravida were 78% vs 22% in group A, and 92% vs 8% in group B. Indication for C/S was previous C/S in 10 [20%] patients in group A, and 39 [78%] patients in group B, placenta previa, chorioamionitis, obstructed labour [6, 12% each]; pregnancy induced hypertension and eclampsia in 5 [10%] cases in group A only. Intra-operative complications in group A were 48 [96%] vs 15 [30%] in group B [p=0.000]. Postoperative morbidity in group A was 50 [100%] and 26 [52%] in group B [p=0.000]. Intra-operative complication was haemorrhage in 46 [92%] cases in group A and 11 [22%] in group B. Anaesthetic complications were 40 [80%]; prolonged intubation 25 [50%], aspiration of gastric contents 8 [16%], and difficult intubation 7 [14%] in group A. Ten [20%] cases had anaesthetic complications in group B. Commonest postoperative complication in both groups was anaemia in 41 [82%] and 11 [22%] cases respectively. Maternal morbidity is significantly higher in emergency C/S. Haemorrhage is a frequent complication in C/S, emergency or elective.
ABSTRACT
To assess the knowledge and practices of contraception and reasons for non utilization of family planning services at Rawalpindi, Pakistan. A cross sectional survey. Fauji Foundation Hospital Rawalpindi from January 2007 to September 2007. This study was designed to investigate contraceptive knowledge and practice in Pakistani women attending a tertiary care hospital. A sample of 200 married women of reproductive age were interviewed to record their age, educational status, relatives practicing contraception, knowledge about contraceptive methods, source of the information and family support for contraception. Simple convenience sampling technique was used in this study. Close ended questionnaire was used to record the information. Subjects [99%] of study population were aware of currently available contraceptives and among them [48%] were practicing these methods. Educated females were [71%] and 93% practiced contraception while [29%] were uneducated and among them [47%] practiced contraception. [51%] of Females were supported by their families for practicing contraception. Source of information for [53%] was health service providers and for [39%] female was mass media. Most of [67%] female relatives also practiced contraception .Only [3%] of the subject's did not practice because of fear of Allah and [32%] had some other reasons. Level of Knowledge in study population was high but there was a huge gap of practice of contraception. Reasons for not practicing was not religious rather it was social pressure
Subject(s)
Humans , Female , Health Knowledge, Attitudes, Practice , Cross-Sectional Studies , Surveys and Questionnaires , ContraceptionABSTRACT
The objective of the study was, to find out the frequency of typhoid and non typhoid ileal perforation, to observe the association of various epidemiological factors in causation of disease and to note surgical, clinical, and laboratory findings along with mortality. A comparative descriptive study. The study was conducted in the department of surgery Civil Hospital Karachi from June 1997 to August 1998. fifty consecutive patients of non-traumatic ileal perforation managed surgically were observed by making two groups of typhoid and non typhoid ileal perforation. Out of 50 [n=50] 32 [Group - A] patients [26 male and 6 female] had typhoid while 18 [Group - B] patients [15 male and 3 female] had non-typhoid ileal perforation. There were 41 [82%] male and 09 [18%] female. In-group A age range was 16-50 years and a mean of +/- SD of 25 +/- 10 while in group B age range was 12- 60 years and a mean of +/- SD of 26 +/- 11.65. In group A 90.6% while in group B 100% patients had a single perforation. Wound infection was the most common complication. Mortality was 6.25% and 5.5% in group A and B respectively. There was no significant association [P<0.05] of gender, seasonal and living conditions. Surgical cum Epidemiological findings point out to the need of distinguish between different types of non traumatic ileal perforation, and having check on the related causative factors leading to their occurrences
Subject(s)
Humans , Male , Female , Ileal Diseases , Typhoid Fever , Intestinal Perforation/surgeryABSTRACT
To ascertain the efficacy of transurethral Ureteroscopy [URS] and Pneumatic Lithoclasty for the management of ureteral stones. This retrospective study was conducted from December 2005 to December 2009 at the Department of Urology and Renal Transplantation, Allied Hospital/Punjab Medical College, Faisalabad and Hospitals in Private sector. Patients with stones of different sizes and at different levels in the ureter were included in the study. Patients of less than 12 years of age and also patients with ureteric stones more than 3 cm were not included in the study.Such stones were managed by open Ureterolithotomy. A total number of 540 patients with ureteric calculi were included in the study. Cause of ureteric obstruction was stones in all cases. Among these 450 patients, 209 [38.6%] patients presented with lower ureteric stones, 266 [49.20%] patients presented with stones in the mid ureter, 65 [12.2%] patients presented with stones in the upper ureter. Bilateral ureteric calculi were present in 95 [17.5%] cases. Out of 540 cases 57 [10.62%] patients presented with anuria and they were initially treated by Percutaneous Nephrostomy PCN to relieve the obstruction followed by URS and Lithoclasty. Overall, ureteric stones at different levels and of different sizes were treated successfully in 480 [89.0%] patients and in remaining 60 [11.0%] patients stones could not be broken. Stones were successfully fragmented and cleared in the 198 [94.73%] of 209 patients with stones in the lower ureter, in 253 [95.11%] of 266 patients with stones in the mid ureter and in 29 [44.61%] of 65 patients with stones in the upper part of ureter. Stones were successfully fragmented in 347 [98.21%] out of 354, 92 [85.18%] out of 108 and 41 [52.56%] out of 78 patients with stone sizes of <1 cm, 1-2 cm and 2-3 cm respectively. DJ stents were inserted in 426 [78.81%] cases. Procedure was not successful in 60 [11.0%] patients. Stones were migrated up in to renal pelvis in 31 [5.73%] patients, stone fragmentation failure was in 13 [2.40%] patients, failure of URS insertion up to stone was in 6 [1.10%] patients and ureteric avulsion was in 1 [0.18%]. Transurethral rigid Ureteroscopy is still an acceptable procedure in the treatment of ureteric calculi of different sizes at different levels and it can be used safely with very good results in expert hands