ABSTRACT
Background@#Normal saline solution (NSS) has been the fluid of choice for renal transplant patients, but it can lead to hyperchloremic acidosis and hyperkalemia. This study was performed to compare the safety profile of low-chloride solutions with that of NSS in renal transplant patients. @*Methods@#We conducted a systemic review search on PubMed, Embase, and the Central Cochrane Registry. Randomized clinical trials (RCTs) and matched cohort studies involving NSS as the control arm and low-chloride solutions as an intervention arm were chosen. The standardized mean difference for continuous variables, the odds ratio (OR) for discrete variables, and a 95% confidence interval (CI) for effect sizes were used. A p-value of <0.05 was considered statistically significant. Analysis was performed using a random-effects model irrespective of heterogeneity, which was evaluated using I2 statistics. @*Results@#Nine RCTs and one cohort study with a total of 726 patients were included. After transplantation, serum potassium was significantly lower in the low-chloride group (standardized mean difference compared to NSS group, –0.38 mEq/L; 95% CI, –0.66 to –0.11; p = 0.007). Similarly, postoperative chloride was lower in the low-chloride group (–2.41 mEq/L [–3.34 to –1.48], p < 0.001). No statistically significance was observed in delayed graft function (OR, 0.98 [0.56–1.69], p = 0.93), day 3 creatinine (–0.14 mg/dL [–0.46 to 0.18], p = 0.38), or day 7 urine output (–0.08 L [–0.29 to 0.12], p = 0.43). @*Conclusion@#Use of NSS during renal transplant leads to increased incidence of hyperchloremic acidosis with subsequent hyperkalemia, but clinical significance in the form of delayed graft function or postoperative creatinine remains comparable to that of low-chloride solutions.
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Abdominal compartment syndrome [ACS] is increasingly identified in critically ill patient and its harmful effects are well documented. The disparity among the pressure, volume in abdominal cavity and its contents, results in ACS. The actual incidence of ACS is not known. However, it has been observed predominantly in patients with severe blunt and penetrating abdominal trauma, ruptured abdominal aortic aneurysms, retro- and intra-peritoneal hemorrhage, pneumoperitoneum, neoplasm, pancreatitis, ascites and multiple bone fracture. We present a case of 40-year female who underwent emergency cesarean section and developed abdominal compartment syndrome due to urinary bladder distension secondary to blockade of urinary catheter with blood clots. This is a very unusual cause of ACS
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Background and Objectives: Helicobacter pylori [H. pylori] infection is cause of several gastrointestinal diseases in humans. Virulence genes of H. pylori are associated with severity of disease and vary geographically. The aim of present study was to detect H. pylori in formalin-fixed paraffin-embedded [FFPE] tissues and further investigate prevalence of babA2, cagA, iceA1, iceA2, vacA s1/s2 and vacA m1/m2 genotypes in H. pylori from gastric cancer [GC] and gastric ulcer [GU] patients' biopsy samples
Methods: We used FFPE tissues of 35 GC and 10 GU patients' biopsy samples. Using Polymerase Chain Reaction [PCR], detection of H. pylori strain was performed by using specific primers targeting 16S rRNA and ureC encodes for phosphoglucosamine mutase genes. We have identified different virulence genes of H. pylori by PCR
Results: Of all the 45 samples tested, 20 GC and all 10 GU samples were positive for identification of H. pylori using specific genes [16S rRNA and ureC]. The prevalence of babA2 [100%] was significantly higher in GC as compared to GU [40%] samples. The rate of virulence genes vacAs1 was higher in both GU 8 [80%] and GC [100%]
Conclusions: Our study finds that vacAs1am1 and babA2 are most prominent genotypes and may play role in development of Gastric cancer
ABSTRACT
Junctional epidermolysis bullosa [JEB] is a recessively inherited skin blistering disease and is caused due to abnormalities in proteins that hold layers of the skin. Herlitz JEB is the severe form and non-Herlitz JEB is the milder form. This report describes a case of congenitally affected male child aged 5 years, with skin blistering. He has mitten-like hands and soft skin blistering on hands, legs and knees. Symptoms almost disappeared at the age of 3 years but reappeared with increased severity after 6 months. Histopathological examination showed epidermal detachment with intact basal cell layer and sparse infiltrate of lymphocytes with few eosinophils in the dermis. There was no blistering on the moist lining of the mouth and digestive tract. Localized symptoms with less lethality and histopathological examination indicated the presence of non-Herlitz type of JEB. This is the first report which confirms the presence of non-Herlitz junctional epidermolysis bullosa in Pakistan
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Background and Objective: Antiplatelet drugs are frequently used after coronary artery bypass graft [CABG] surgery to prevent venous graft occlusion. The fear of bleeding complications prevents them to be given early post operatively, which is the time when antiplatelets use confers maximum benefit. Our objective was to determine the effect and influence of early aspirin therapy on fatal and nonfatal bleeding complications and blood requirements after coronary bypass surgery [CABG]
Methods: The patients who only underwent coronary artery bypass surgery for the first time in the past three years and did not have any bleeding diathesis were retrospectively analyzed from the cardiac surgery database of CPEIC Multan. The patients either received aspirin within six hours of CABG or had it given after 12 hours. The patients were analyzed for mean blood loss and number of blood units transfused. SPSS was used for statistical analysis. P value < 0.05 was considered significant
Results: Total 281 patients received aspirin within six hours while 326 patients did not. Mean blood loss in early aspirin group was 727ml as compared to 767ml in the other group [p value 0.74]. The median number of blood units transfused was 2 [p value 0.98]. Our results did not show any statistical difference in both the groups
Conclusion: Aspirin can safely be given early after CABG without the fear of bleeding complications thus conferring the advantage of increased graft patency
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Objective: To compare insulin resistance and glycemic indicators among subjects with euthyroidism and subclinical hypothyroidism
Study Design: Comparative cross-sectional study
Place and Duration of Study: Department of Pathology and Medicine, PNS Hafeez, Islamabad, in collaboration with the Department of Chemical Pathology and Endocrinology at the Armed Forces Institute of Pathology [AFIP], Rawalpindi, from December 2015 to September 2016
Methodology: Subjects referred for executive screening of apparently healthy population [without any known history of diabetes, hypertension, heart disease or other chronic ailments], were included. Subjects were grouped as euthyroidism and subclinical hypothyroidism
Results: Median [IQR] insulin resistance indices including fasting insulin and Homeostasis Model Assessment for Insulin Resistance in subjects with group-1 [n=176, 87%, Thyroid Stimulating Hormone: 0.5 - 3.5 mlU/L] and group-2 [n=26, 13%, Thyroid Stimulating Hormone: 3.51 -15 mlU/L] were 7.6 [6.70] vs. 11.4 [13.72, p=0.040] and 1.77 [1.79] vs. 2.8 [3.07, p=0.071]
The median differences for fasting plasma glucose were 5.0 [1.0] in group-1 vs. 5.0 [1.47] for Group-2 [p=0.618], and glycated hemoglobin was 5.60 [1.1] vs. 5.60 [1.7, p=0.824]. Homeostasis Model Assessment for beta sensitivity index in paradox showed slightly higher values for group-2 [median [IQR] 86.67 [92.94]] than group-1 [111.6 [189.64, p= 0.040]]
Conclusion: Measures of insulin resistance including Homeostasis Model Assessment for Insulin Resistance and fasting insulin levels were significantly different between subjects with euthyroidism and having subclinical hypothyroidism
Subject(s)
Humans , Female , Male , Adult , Middle Aged , Insulin Resistance , Blood Glucose , Cross-Sectional Studies , Glycated Hemoglobin , Euthyroid Sick Syndromes/bloodABSTRACT
Pincer nail deformity is often undertreated although it is a cause of pain and disfigurement.This may be attributed to underdiagnosis and lack of awareness of the available treatmentoptions especially surgical options. Not many centres offer surgical correction of pincer naildeformity in Malaysia. We would like to describe a surgical method of correcting this deformity.
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Objective: To determine the different demographic parameters, associated morbidity and mortality of measles cases admitted in a paediatric unit of a teaching hospital
Study Design: Descriptive cross sectional study
Place and Duration of Study: Pediatrics department Combined Military Hospital Kharian from October 2012- September 2013
Material and Methods: All patients admitted with diagnosis of measles according to World Health Organization [WHO] definition of clinical measles up to 12 years of age were included. Detailed history and clinical examination was done. Required information regarding study parameter was collected on a pre designed proforma. Different complications in relation to age, vaccination and nutritional status were assessed. Statistical data was analyzed by SPSS version 17
Results: Among total 68 patients, 48[70.58%] were male and 20 [29.41%] female. Mean age was 21.26 [ +/- 26.95] months. Thirty four [50%] patients were between 6-8 [completed] months of age, 3 [4.41%] less than 6 months whilst 5[7.35%] were aged between 5-12 years. Partially and unvaccinated patients were 19.11% and 88.88% respectively. Thirty [44.11%] cases were well nourished and 38 [55.88%] malnourished. Pneumonia [41.66%] was the commonest complication followed by diarrhea [37.5%], oral lesions [29.16%], otitis media [10.41%], eye changes, encephalitis, myocarditis and hepatitis [each 4.16%]. Mortality was 1.47%. Complications were more common in malnourished than well nourished patients [p-value <0.05] and in unvaccinated than vaccinated children [p-value <0.05]
Conclusion: Majority of patients was less than 9 months age. Pneumonia was the commonest complication and only cause of death. Complications were more common among unvaccinated and malnourished children
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Objective: To describe hospital waste management plan in our setting for primary to tertiary hospitals and to make it environmental friendly with respect staff safety
Study Design: Observational / cross sectional study
Place and Duration of Study: This study was carried out at Bahawal Victoria Hospital, Bahawalpur from May to August 2015
Materials and Methods: This study carried out as an assignment for the course of Environmental and Occupational Health point of view. Data has been collected from the staff of the BV Hospital and the Quaid-e-Azam Medical College, Bahawalpur as our study subjects. The purpose of this paper is to outline the hospital waste management plan in our setting from primary to tertiary hospitals in a comprehensive way to put forward suggestions for further improvement
Results: Among the hospital staff particularly doctors were not aware of any hospital waste management protocol/plan. Similarly nobody form the hospital staff recalled any training program or such activity to be performed in their respective wards or departments since ever. Just the concerned nursing staff had sort of interaction with the sanitary workers and the sweepers engage in their routine hospital cleaning process supervised by the sanitary inspectors. As such no health facilities had properly implemented any hospital waste management plan in accordance to expected standard and practices; just routine maintenance of the hospital cleanliness is being carried out and the wastes were collected and moved to the point of transportation or being transported direct to its disposal point
Conclusion: There is need to develop Hospital Waste Management policy and plan for institutions along with its allocation of appropriate funds. Hosp Waste disposal standard operating procedures in a way that such model can be implemented anywhere by little modification as per need assessment basis in all of our healthcare settings
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A simple eco-friendly method has been developed for detection of hydroxyzine dihydrochloride in pure and pharmaceutical dosage forms. Both conventional system and microwave assisted procedures are used for the development of color. The blue coloured complex is measured spectrophotometrically at 750nm. Peak shift in FT-IR spectra also indicated the formation of complex
The reaction obeys Beer's law over the concentration range of 50-250ng/ml of hydroxyzine dihydrochloride
The precision value [infra-day and inter-day RSD] for the drug is not greater than 0.79% and recoveries were found to be in range of 99.01-99.99%
The designed method is applicable for periodic determination of hydroxyzine dihydrochloride in pure and pharmaceutical dosage forms
ABSTRACT
Objective: To compare wall motion score at 6weeks in patients with short and normal deceleration time on day 1 after acute MI
Study Design: Cohort study
Setting: Cardiology Department Sheikh Zayed Hospital Lahore
Sample Size: 100 patients
Sample Technique: Non probability convenient sampling
Data Collection Procedure: In my study I evaluated 100 patients with acute MI on day 1 and at six weeks post MI. All patients were treated with streptokinase and heparin. Echocardiography was performed using Vivid I ultrasound machine [GE medical system]. Patients were divided in two equal groups depending on deceleration time, group A [DT <150 ms] and group B [DT >150 ms] on day 1 post MI .Their wall motion score ,left ventricular volumes and ejection fraction were compared at base line and at six weeks
Results: Patients with short DT showed higher wall motion score [29 +/- 3 vs 20 +/- 2.5] higher left ventricular volumes [LVEDV 98 +/- 21 vs 77 +/- 8, LVESV 64 +/- 13 vs 38 +/- 6 ] and lower ejection fraction [37 +/- 5 vs 50 +/- 4] at base line. Also, at 6 weeks, patients with short DT showed less improvement in wall motion score [27 +/- 2 vs 17 +/- 6] and ejection fraction [39 +/- 5 vs 53 +/- 5] compared to patients with normal deceleration time
Conclusion: Patients with short deceleration time have larger infarcts[high WMS], poorer left ventricular systolic function and are at higher risk of ventricular remodeling compared to patients with normal deceleration time. DT measured post MI is a reliable and noninvasive short term predictor of outcome after MI
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Objective: To elucidate the pattern of inheritance and determine the relative magnitude of various genetic effects for maturity and flowering attributes in subtropical maize. Methods:Four white grain maize inbred lines from flint group of corn, two with late maturity and two with early maturity, were used. These contrasting inbred lines were crossed to form four crosses. Six generations (P1, P2, F1, F2, BC1, and BC2) were developed for each individual cross. These were evaluated in triplicate trial for two consecutive years. Results: Both dominance gene action and epistatic interaction played major role in governing inheritance of days to pollen shedding, 50% silking, anthesis silking interval and maturity. Conclusions: Preponderance of dominance gene action for these traits indicated their usefulness in hybrid programs of subtropical maize.
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To determine the sensitivity pattern of the isolates under study against commonly used antimicrobials. The study was carried out at the Department of Microbiology, University of Health Sciences Lahore. Two hundred Clinical isolates [n=200] of Enterobacteriaceae were collected from various tertiary care hospitals of Lahore. The isolates were identified by their morphology and cultural characteristics. API 20E was used for their biochemical profile. Kirby-Bauer disk diffusion method was employed for their susceptibility according to CLSI 2009 guidelines. Modified Hodge Test was used for testing carbapenemase production. Further confirmation was done using EDTA disk potentiation method. Susceptibility pattern of two hundred isolates showed multidrug resistance pattern. All the isolates showed least resistance to Imipenem and Meropenem [0.5%] followed by Amikacin [24%] and Tetracycline [61%]. Only one strain of K. pneumoniae was found to be resistant to carbapenems and it was confirmed to be carbapenemase producer by Modified Hodge Test, and metallo [3-lactamase producer by EDTA disk potentiation method. Carbapenemase has intruded local isolates of K. pnuemoniae. It can result in outbreak of carbapenem resistant strains as it can spread through vertical as well as horizontal transmission. The carbapenem resistant isolates must be contained in order to prevent its further spread among other members of Enterobacteriaceae and other bacteria
Subject(s)
beta-Lactamases , Enterobacteriaceae/drug effects , Enterobacteriaceae/enzymology , Carbapenems/pharmacology , Drug Resistance, Multiple , Sensitivity and Specificity , Cultural Characteristics , Edetic AcidABSTRACT
The objective of this study was to compare the efficacy of rubber band ligation versus injection scierotherapy in second degree haemorrhoids. This randomized control study has been conducted at Surgical O.P.D Nishtar Hospital Multan from 3rd April 2008 to 3[rd] October 2008. The study included 70 patients divided randomly in two equal groups. Patients in group A were subjected to injection sclerotherapy while patients in group B were treated with rubber band ligation. The patients were followed up at two weeks after the treatment and history regarding bleeding and pain was taken and proctoscopy was done to see pile core sclerosis. No patient was below 20 years of age in each category. Males were affected more than females. Only 31.43% of patients complained of mild pain after RBL while 60% of the patients had no pain at all. 91.43% and 88.57% of patients were free from the cardinal symptoms of bleeding and prolapse respectively, after RBL, at the end of 2 weeks of follow up 62.86% and 65.71% of patients were free from the cardinal symptoms of bleeding and prolapse while 34.29% of patients complained of mild pain after injection scierotherapy at 2 weeks. Rubber band ligation showed better results and good efficacy as compared to injection scierotherapy and should be considered as a procedure of choice for outpatient treatment of second degree haemorrhoids
Subject(s)
Humans , Male , Female , Hemorrhoids/classification , Sclerotherapy , Ligation , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
Patients with an abdominal stab wound presenting with shock, peritonitis or eviscerarion are usually subjected to early laparotomy, although very few studies have been done to validate the criteria. To validate that early laparotomy for stab wounds is compulsory or other diagnostic methods may be helpful to prevent unnecessary laparotomy in certain cases. The study was carried out in surgical unit-1, Nishtar Hospital, Multan during the period from January 2003 to June 2008. A total of 110 patients with stab wounds of the anterior abdomen, flank or lower chest were evaluated for their accuracy in predicting the presence of significant abdominal organ injury. Overall, 47 patients had a significant abdominal injury [42.7%]. The signs of peritoneal penetration including omental evisceration, air under the diaphragm or free fluid in the abdomen were not the independent predictors of significant injury. Signs of major internal haemorrhage or generalized peritonitis are reliable criteria by themselves for early laparotomy. Peritoneal penetration is a poor indicator of significant organ injury and warrants direct organ specific evaluation, such as computed tomography or laproscopy, to identify, patients who can safely be treated without operation
Subject(s)
Humans , Abdominal Injuries/surgery , Laparotomy , Peritonitis , OmentumABSTRACT
Hepatitis B and C viruses [HBV and HCV] are hepatotropic viruses causing viral hepatitis, chronic liver disease and hepatocellular carcinoma. Modes of infection are more or less similar. HBV is vaccine preventable while HCV is not. They are prevalent in different parts of the world including Pakistan. The rate of prevalence varies from region to region and among different population segments. The present study was planned to see the prevalence of HBV and HVC among health care workers in various hospitals of Abbottabad. The study was conducted at the District Headquarter Teaching Hospital Abbottabad over a period of one year on 125 health care workers of different categories and either sex. Brief history was taken from each individual and physical examination was performed. Blood samples were taken for HBV and HC serology. Positive sera were confirmed by 3rd generation ELISA. As much as 8% individuals were positive for HBV or HCV. HBV alone was seen in 3 out of 10 [30%] individuals. HCV alone was also found in 3 out of 10 [30%] individuals. HBV and HCV co-infection was seen in 4 out of 10 [40%] individuals. Dental procedures, needle prick and surgical procedures were found the common risk factors. Blood transfusion was known in 2 out of 10 [20%] individuals. Family history of hepatitis was not positive in any individual. Results of the present study differ from those of the previous studies conducted on health care workers in Pakistan
Subject(s)
Humans , Male , Female , Hepatitis C/epidemiology , Hepacivirus , Hepatitis B virus , Seroepidemiologic Studies , Health Personnel , Hepatitis, Viral, Human , Carcinoma, Hepatocellular , Prevalence , Serology , Enzyme-Linked Immunosorbent Assay , Risk FactorsABSTRACT
Thirty-eight soldiers with a few hours history of vomiting and loose motions were admitted at Pak Fd Level II hospital, United Nations Mission in Liberia, on 3rd May 2004. The illness started with vomiting which was followed by diarrhea. Seven had severe dehydration on admission. The stools were initially loose but became blood mixed in about 12 hours. The patients were managed with IV fluids and injectable antibiotics. In the next 48 hours, the frequency of stools decreased and the colour of stools changed to green. On culture, predominant growth of Pseudomonas aeruginosa was obtained from majority of the stool specimens. The isolate was sensitive to ciprofloxacin, the antibiotic being used for treatment of the cases. The patients became completely asymptomatic in next 3-5 days. On investigation it was found that all the individuals had taken their lunch about 5-6 hours back. They had taken 'langer' cooked food of 'daal' and 'chapatti'. The samples of left over food and water were collected for cultures. A similar isolate of Pseudomonas aeruginosa was found in the water consumed. The water was being brought from a nearby lake for washingtbathing purpose and was accidentally consumed for drinking on that day
Subject(s)
Humans , Gastroenteritis/microbiology , Pseudomonas aeruginosa/pathology , Disease Outbreaks , Military Personnel , Nausea , Vomiting , Diarrhea , FeverSubject(s)
Humans , Male , Female , HIV-1 , HIV-2 , Acquired Immunodeficiency Syndrome , Visitors to Patients , HospitalsABSTRACT
To study the frequency of: [1] Verrucous carcinoma in malignant laryngeal tumours [2] Lymph node metastasis in patients with laryngeal verrucous carcinoma. Descriptive study. Purposive type. Department of ENT and head and neck surgery, Pakistan institute of medical sciences, Islamabad. Period of study extended from 1St January 2001 to 31st December 2003. Frequency of verrucous carcinoma was evaluated among One hundred and twenty, [120] cases of malignant laryngeal tumours presented and primarily diagnosed in our ENT department. Cases of verrucous carcinoma were also evaluated for presence or absence of lymph node metastasis. Frequency of verrucous carcinoma in malignant laryngeal tumours was 2.5%. None of these patients had palpable lymph nodes at the time of presentation. Verrucous carcinoma in our population is relatively uncommon disease. Lymph node involvement is rare even with advanced t umours