Ghost ileostomy release down: our initial experience

Background: Many publications describe the advantages of the creation of ghost ileostomy (GI) to prevent the need for formal covering ileostomy in more than 80% of carcinoma rectum patients. However, none of the papers describes exactly how to ultimately remove the GI in these 80% of patients in whom it doesn't need formal maturation. Aim: To describe and evaluate the ghost ileostomy release down (GIRD) technique in terms of feasibility, complications, hospital stay, procedure time etc. in patients with low anterior resection/ultra-low anterior resection (LAR/uLAR) with GI for carcinoma rectum. Method: The present was a prospective cohort study of patients with restorative colorectal resections with GI for carcinoma rectum, Postoperatively the patients were studied with respect to ease and feasibility of the release down of GI and its complications. The data was collected, analyzed and inference drawn. Results: A total of 26 patients needed the GIRD and were included in the final statistical analysis of the study. The procedure was done between 7th to 16th postoperative days (POD) and was successful in all patients without the need of any additional surgical procedure. None of the patients required any local anesthetic injection or any extra analgesics. The average time taken for procedure was 5-minutes and none of the patients had any significant difficulty in GI release. There were no immediate postprocedure complications. Conclusion: The GIRD technique is a simple, safe, and quick procedure done around the 10th POD that can easily be performed by the bedside of patient without the need of any anesthesia or additional analgesics. (AU)

Culture sensitivity and antibiotic profile in urinary tract infection in children between 1-15 years

Background: The aim was to study the antibiotic resistance in children with urinary tract infection and to observe any difference between antibiotic resistance rates.Methods: It was a prospective study carried out in SKIMS Medical College Hospital, Srinagar over a period of two years from January 2017 to January 2019. The study included 210 children between 1 year and 15 years who had presented with complaints of urinary tract infection and whose urine cultures were positive for the growth of an organism. These children were analyzed in order to find the frequency of organisms grown on culture, sensitivity of organisms isolated on culture and the rates of developed resistance to the antibiotics.Results: A total of 210 patients aged were included in the study, encompassing 66 (31.4) males and 144 (68.6%) females. Out of 144 female children 108 were under 6years of age while as out of 66 male children 48 were under 6years of age. As per the growth on urine culture,' the commonest organism that grew on culture were Escherichia coli (E. coli) was observed in 156 (74.3%), enterococcus in 18 (8.57%), Proteus mirabilis in 11 (5.2%), Acinetobacter spp. in 7 (3.3%), Pseudomonas spp. 5 (2.4%), Staphylococcus aureus in 4 (1.9%), Morganella spp. in 3 (1.4%) patients. Authors found imipenem, aminoglycosides and nitrofurantoin as the most effective antibiotics for urinary tract infections in pediatric age group.Conclusions: From this study, they concluded that parenteral antibiotics to be started empirically for the treatment of UTIs in all pediatric age groups are' aminoglycosides. In contrast for outpatient management of urinary tract infections, our results suggest that nitrofurantoin should be used for children aged beyond 1 year of age due to the low rate of resistance to nitrofurantoin in patients aged over 1 year.

Clinicoepidemiological Profile of Childhood Poisoning in the Pediatric Unit of a Tertiary Care Hospital in North India

Background:This study was conducted to find out the pattern of poisoning cases among the pediatric population in Srinagar and its Northwestern suburbs and compare it with what occurs elsewhere in India. Thereby we aimed to provide practical knowledge in dealing with these pediatric patients.Methods:The hospital records of children between the ages of 0-19 years admitted to the pediatric emergency ward of SKIMS Medical College Hospital Srinagar with poisoning from July 2016 to June 2018 were evaluated.Results:A total of 154 cases of poisoning were admitted in the study period, of which 89(57%) were males and 69(43%) were females. In the 0-12 year age group the poisonings were mostly in boys(68.26%) and were accidental whereas in the 13-19 year agegroup poisonings were mostly in girls(64%) and due to suicidal attempts. Organophoshorus poisoning was the most commonly ingested poison across all age groups(44.8%) followed by rodenticides(16.23%), kerosene(13.63%) and medications(11.68%). Interventions mostly commonly done were gastric lavage, induced vomiting. Mortaliy was seen in 2 cases over 2 years(1.29%). Conclusion:Knowledge on epidemiological and clinical features ofpoisoning in children according to age groups, establishing safety standards for sale and storage of harmful chemicals, and parental education can help to decrease the burden of childhood poisoning

Association of patent ductus arteriosus (PDA) with prematurity and low birth weight neonates

Background: Patent ductus arteriosus (PDA) is a major morbidity encountered in preterm neonates, especially in babies less than 28 weeks gestation or 1000g. It may close spontaneously in preterm neonates; however, failure to close spontaneously in preterm neonates results in significant mortality and morbidity in them.Methods: This prospective study was conducted in a tertiary care hospital in north India over a period of one year. The study cohort consisted of preterm, newborn babies admitted in the hospital with gestational age less than 37weeks and birth weight <2500g.Results: In this study total number of patients admitted during the study were 2930. Out of these preterm low birth weight neonates were 432. Among preterm low birth weight neonates admitted, 132 neonates were excluded as per exclusion criteria. Patent ductus arteriosus was detected in 56 among the 300 neonates giving an overall incidence of patent ductus arteriosus 18.6%, the incidence of patent ductus arteriosus was 56.2% for neonates weighing less than 1000gm, 24.7% for neonates weighing between 1000-1499g, 11.6% for neonates weighing between 1500-1999g and 5.6% for the neonates weighing between 2000-2499g.Conclusions: Thus, incidence of patent ductus arteriosus was inversely proportional to gestational age and birth. Data also suggest that immaturity is the major determinant of the persistent patency of ductus arteriosus.

Assessing the efficacy of aqueous garlic extract, sodium nitrite and sodium thiosulfate against prolonged oral cyanide exposure in rabbits

This study was aimed to compare the efficacy of aqueous garlic extract, sodium nitrite [SNT], sodium thiosulfate [STS] and hydroxocobalamin against oral cyanide exposure in rabbits. For this purpose, forty two adult male rabbits were divided randomly into 7 groups of 6 animals [A-G] each. Rabbits in group A were offered feed only and served as negative control, while the rabbits in group B received feed plus potassium cyanide [KCN] at 3mg/kg orally and were kept as positive control. Animals in group C received feed, KCN and intraperitoneal injection [IP] of aqueous garlic extract at 500mg/kg. Rabbits in group D were given feed, KCN and IP injection of STS at 600mg/kg. Members in group E received feed, KCN and IP injection of both aqueous garlic extract at 500mg/kg and SNT at 20mg/kg. Animals in group F were given feed, KCN and IP injection of both STS at 600mg/kg and SNT at 20mg/kg, while the rabbits in group G received feed, KCN and IP injection of hydroxocobalamin at 300mg/kg. The treatments were given to respective groups for 40 days. The efficacy of the antidotes was measured on the basis of changes in biochemical profile of rabbits in each group. In this study, hydroxocobalamin was found to be significantly more effective cyanide [CNI] antidote than garlic, STS, SNT plus garlic extract, or SNT and STS, either alone or in combination. A combination of SNT and garlic extract was the second most effective CNI antidote. The efficacy of garlic alone was significantly higher than STS alone or in combination with SNT. The efficacy of combined SNT and STS was superior to STS alone in treating rabbits with CNI toxicity. In conclusion, aqueous garlic extract alone or in combination with STS can effectively be used against cyanide toxicity

Comparison Of T-Tube Drainage Versus Primary Closure Of Common Bile Duct After Choledochotomy In Case Of Choledocholithiasis

Choledocholithiasis is the common problem that necessitates surgical intervention. It is managed either by endoscopic sphincterotomy or surgical exploration i.e. choledochotomy. The traditional surgical management of CBD stones consists of a supra-duodenal choledocotomy and insertion of a Ttube. The role of T–tube has been challenged since Thornton and Halsted described primary duct closure after CBD exploration. This study was carried out with an aim to evaluate the feasibility and safety of primary closure as compared to T-tube drainage in choledocholithiasis cases requiring CBD exploration. 70 patients in the age group of 18-60 years presenting with common bile duct stone were included after obtaining informed and written consent with exclusion of patients with malignant conditions and CBD dilation >2.5 cm. Patients fulfilling the inclusion criteria were randomly allocated into two groups of 35 patients each: Group I (Primary repair group) and Group II (T-tube repair group).In Group I duration of hospital stay ranged from 8 to 20 days (mean 12.03±2.60 days) whereas in Group II this range was 18 to 29 days (mean 22.74±3.41 days. Statistically, the difference between two groups was significant (p<0.001).The primary closure was a feasible, safe and relatively better technique as compared to T-tube drainage. It had fewer complications and a smooth and shorter duration of hospital stay which have both economic as well as psychological implications.

Correlation of patterns of bone marrow infiltration and biochemical factors in non-hodgkin lymphoma

Objectives: To investigate the patterns of bone marrow involvement in in Non-Hodgkin's Lymphoma [NHL] patients and to correlate the patterns with beta2 microglobulin [beta2m] and lactate dehydrogenase 2 [LD2] levels in these patients

Methods: It was a cross sectional study which was conducted in two years at Post Graduate Medical Institute, Lahore and at Centre of Excellence in Molecular Biology [CEMB], Lahore. The study was conducted on 50 subjects irrespective of age and sex divided into two groups i.e. Group-A comprising 20 normal healthy controls while Group-B consisted of 30 patients of NHL with bone marrow infiltration. Bilateral bone marrow trephine biopsy was done to assess the patterns of bone marrow infiltration. Serum beta2m and LD2 isoenzyme levels were determined in already diagnosed 30 patients of NHL. The values were compared with 20 healthy age and sex matched controls. Correlation coefficients were determined using Pearson's Correlation Coefficient. The estimations were made prior to the institution of chemotherapy

Results: beta2m and LD2 levels were significantly [p-Value < 0.05] raised in NHL patients with disease advancement and were compared with controls. These serological markers showed negative correlation [-0.235 for beta2m and -0.133 for LD2] with the spread of disease and patterns of involvement in NHL patients

Conclusion: By observing the patterns of bone marrow involvement in NHL patients possible guidelines about prognosis and treatment protocols can be obtained as the serological markers levels correlate well with the spread of disease and patterns of involvement in NHL patients

In vitro antimicrobial, antiprotozoal activities and heavy metals toxicity of different parts of Ballota pseudodictamnus [L.] Benth

The study was done to check the antimicrobial and antiprotozoal activity of different parts of Ballota pseudodictamnus [L.] Benth. These activities were then compared with the heavy metals toxicity of different parts, which plants accumulate in different concentrations in different parts. In in-vitro antileishmanial results ethanolic extract, chloroform and ethyl acetate fractions in roots of Ballota pseudodictamnus [L.] Benth showed antileishmanial activity. The ethanol, w-butanol and ethyl acetate fraction in stem revealed inhibition of amastigote form of leishmania. The ethanolic extract, chloroform, and w-butanol fraction in leaves showed inhibition of leishmanial parasite. In heavy metals study, Chromium was above permissible value in all parts except in leaves. Nickel was above WHO limit in roots. Cadmium and lead were beyond permissible limits in entire plant parts. Results revealed that different parts of the plant have different inhibition properties. So each part of plant should be checked for antimicrobial and antiprotozoal assay separately. It is concluded that various metals accumulates with miscellaneous concentrations in different plant parts

Calcitriol-mediated Reversible Hypercalcemia in a Patient with Primary Adrenal Lymphoma

Primary adrenal lymphomas (PAL) are rare occurrences with only less than 150 cases reported in the literature. Two-thirds of these cases were reported in the last decade due to the advancements in imaging techniques and immunohistochemistry. The non-specific signs and symptoms have resulted in a delayed onset of symptoms and diagnosis of these tumors. Reports of the results of chemotherapy are not gratifying, and most patients die within one year of the diagnosis. We report a 65-year-old male with adrenal non-Hodgkin’s lymphoma (NHL), who presented with hypercalcemia and renal failure. We reviewed all adrenal NHL cases presented with hypercalcemia and attempted to comprehend its etiology and overall survival effect.

Nigella sativa fixed and essential oil improves antioxidant status through modulation of antioxidant enzymes and immunity

The onset of 21[st] century witnessed the awareness among the masses regarding the diet-health linkages. The researchers attempted to explore traditional products/plants were in the domain of pharmacy and nutrition focussing on their health benefits. In the present research intervention, we investigate the role of Nigella sativa fixed oil [NSFO] and essential oil [NSEO] in improving antioxidant status and modulation of enzymes. The National Institute of Health [NIH] provided us 30 Sprague Dawley rats that were equally placed in three groups. The groups were fed on their respective diets [56 days] two experimental diets i.e. D[2] [NSFO @ 4.0%] and D[3] [NSEO @ 0.30%] and control. The indices pertaining to antioxidant status, antioxidant enzymes, and parameters pertaining to immunity were evaluated at 4 weeks interval. The experimental diets [NSFO@ 4.0% and NSEO@ 0.30%] modulated the activities of antioxidant enzymes i.e., catalase [CAT], superoxide dismutase [SOD], glutathione transferase [GST], glutathione reductase [GR] and glutathione peroxidase [GPx], positively. Indices of antioxidant status like tocopherols and glutathione were in linear relationship with that of GPx, GR and GST [P<0.01]. Myeloperoxidase activities were in negative correlation with GST [P<0.01] but positive correlation with some other parameters. In the nutshell, the fixed and essential oil of Nigella sativa are effective in improving the indices pertaining to antioxidant status, however, the immune boosting potential needs further clarification. However, authors are of the view that there is need to explore the molecular targets of Nigella sativa fixed and essential oils. Findings from such studies would be useful to validate this instant study for health promoting potential against diabetes mellitus and cardiovascular disorders

Perioperative morbidity and mortality in 100 cases of transhiatal esophagectomy- a single surgical unit experience of Khyber teaching hospital, Peshawar

To observe the perioperative morbidity and mortality rates of 100 transhiatal esophagectomies operated for esophageal carcinoma in a surgical unit of a tertiary care hospital. Data pertaining to all patients that had undergone transhiatal esophagectomy from Feb, 2012 to Jan, 2014 were reviewed. The study group comprised 100 patients. Indication for surgery was esophageal cancer. Perioperative morbidity and mortality i.e. morbidity and mortality during the first 30 days, were studied. Two patients died during the postoperative period in hospital. The anastomotic leakage rate was zero. No dysphagia was found during one month of postoperative period. Overall survival was 98% for the first 30 days of surgery. Transhiatal esophagectomy has been common stay and a safe rather feasible procedure. Oncological therapy has its role and better results are found in centers where the procedure is frequently performed

Per oral bleeding: rare presentation of gardner-diamond syndrome

A 10-year boy presented with spontaneous episodes of oral bleeding for the last 6 months. Detailed ENT examination showed no pathology, bleeding profile was normal, endoscopy and dental examination also did not reveal any abnormality. Child abuse or malingering was also ruled out. Initially the child was managed with platelet transfusion and fresh frozen plasma and then put on follow-up treatment with antifibrinolytics, Vitamin C but the episodes became recurrent. Psychiatric evaluation revealed that child was suffering from depression. Antidepressants were prescribed by the psychiatrist that not only cured the depression with time but also the bleeding episodes which were actually related to child's depression [Gardner-Diamond syndrome or psychogenic purpura]. This is a diagnosis by exclusion where the patients bleed due to dysregulated steroid secretion secondary to stress; resulting in development of sensitization to RBC membrane, and dysregulated fibrinolytic system activity

Missed vascular injuries: presentation and outcome

Objective: To describe the different presentation, diagnostic evaluation, management and outcome of complications of missed vascular injuries. Study Design: A case series. Place and Duration of Study: Combined Military Hospital, Rawalpindi and Combined Military Hospital, Kharian Cantt, from June 2009 to June 2012

Methodology: All the patients with vascular injuries missed at the time of causative trauma who reported during this study period were included. Patients presented with acute vascular injuries and iatrogenic aneurysm at the vascular anastomosis site were excluded. All cases were evaluated with either CT or conventional angiography and managed with various open vascular surgical techniques and their results were assessed

Results: Twenty eight patients with missed vascular injury underwent various vascular repairs. Age of patients ranged from 16 to 78 years [mean = 33.7 +/- 15.4 years]. Male to female ratio was 6:1. Twelve [42.8%] patients presented with pseudoaneurysm alone, 10 [35.7%] with traumatic arteriovenous fistulae, 4 [14.3%] with post-traumatic thrombosis and occlusion and 2 [7.1%] with pseudoaneurysm and hemorrhage. Penetrating injuries were the commonest cause in 19 [67.8%]. The time interval between injury and presentation in hospital ranged from 2 to 1300 weeks [mean 228 weeks]. Lower limb vessels were affected in 20 [71.4%], the upper limb in 5 [17.8%] and neck vessels in 3 [10.7%]. Superficial femoral artery was the most frequently involved artery in 9 [32.1%] cases. Interposition reverse autogenous saphenous vein graft was most common type of repair in all types of missed vascular injuries. One [3.5%] patient had amputation after secondary hemorrhage

Conclusion: Low velocity penetrating trauma was the common cause of missed vascular injury. Pseudoaneurysm was the most common presentation

The genus Crataegus: chemical and pharmacological perspectives

Traditional drugs have become a subject of world importance, with both medicinal and economical implications. A regular and widespread use of herbs throughout the world has increased serious concerns over their quality, safety and efficacy. Thus, a proper scientific evidence or assessment has become the criteria for acceptance of traditional health claims. Plants of the genus Crataegus, Rosaceae, are widely distributed and have long been used in folk medicine for the treatment of various ailments such as heart (cardiovascular disorders), central nervous system, immune system, eyes, reproductive system, liver, kidney etc. It also exhibits wide range of cytotoxic, gastroprotective, anti-inflammatory, anti-HIV and antimicrobial activities. Phytochemicals like oligomeric procyanidins, flavonoids, triterpenes, polysaccharides, catecholamines have been identified in the genus and many of these have been evaluated for biological activities. This review presents comprehensive information on the chemistry and pharmacology of the genus together with the traditional uses of many of its plants. In addition, this review discusses the clinical trials and regulatory status of various Crataegus plants along with the scope for future research in this aspect.

Supplementation of Nigella sativa fixed and essential oil mediates potassium bromate induced oxidative stress and multiple organ toxicity

The plants and their functional ingredients hold potential to cure various maladies and number of plants hold therapeutic potential. The present research was designed study the health promoting potential of black cumin [Nigella sativa] fixed oil [BCFO] and essential oil [BCEO] against oxidative stress with special reference to multiple organ toxicity. For the purpose, thirty rats [Strain: Sprague Dawley] were procured and divided into three groups [10 rats/group]. The groups were fed on their respective diets i.e. D[1] [control], D[2] [BCFO @ 4.0%] and D[3] [BCEO @ 0.30%] for a period of 56 days. Mild oxidative stress was induced with the help of potassium bromate injection @ 45 mg/Kg body weight. Furthermore, the levels of cardiac and liver enzymes were assayed. The results indicated that oxidative stress increased the activities of cardiac and liver enzymes. However, supplementation of BCFO and BCEO was effective in reducing the abnormal values of enzymes. Elevated levels of lactate dehydrogenase [LDH], CPK and CPKMB were reduced from 456 to 231, 176 to 122 and 45 to 36 mg/dL, respectively. Similarly, liver enzymes were also reduced. However, the results revealed that BCEO supplementation @ 0.30% is more effectual in ameliorating the multiple organ toxicity in oxidative stressed animal modelling. In the nutshell, it can be assumed that black cumin essential oil is more effective in reducing the extent of potassium bromate induced multiple organ toxicity [cardiac and liver enzymes imbalance] that will ultimately helpful in reducing the extent of myocardial and liver necrosis

importance of socio-economic status and sex on the prevalence of human pediculosis in government schools children in Lahore, Pakistan

The present project was designed to study the effect of age, sex and socio-economic status on the prevalence of Pediculosis [Pediculus capitis]. A survey was conducted among 1-5 class children of five public sector schools located in Lahore, where most of the students belonged to middle and low income classes. After obtaining ethical clearance from the parents, school principals and students, 500 children of age >/= 7 years were examined both macroscopically and microscopically on first come first basis up to 100 children from each school. Of 500 children [n=122 boys; n=378 girls], overall 387 [77.40%] while in girls 323 [85.45%] and in boys 64 [52.46%] were positive for Pediculosis. A higher prevalence was recorded in children of

Malignant solid pseudopapillary tumor of pancreas causing sinistral portal hypertension.

Solid pseudopapillary tumor (SPT) of the pancreas is a rare benign or low-grade malignant epithelial tumor that occurs mainly in young females in second to fourth decades of life. Pathologic and imaging findings include a well-defined, encapsulated pancreatic mass with cystic and solid components with evidence of hemorrhage. We report a 23-year-old female who presented with upper abdominal pain of long duration and epigastric mass on palpation. Multidetector-row CT (MDCT) demonstrated a large well-defined heterogeneous attenuation mass, containing hyperdense areas of hemorrhage mixed with solid enhancing and cystic non-enhancing areas, arising from the pancreatic body and tail. Splenic vein thrombosis was present with dilated splenoportal collateral vessels between splenic hilum and portal/superior mesenteric veins, with dilated vessels seen in the gastric wall, with patent portal vein, compatible with sinistral portal hypertension. Typical imaging features and age and sex of the patient suggested a diagnosis of SPT of pancreas complicated by segmental portal hypertension due to splenic vein thrombosis. Histopathology of the biopsy material was confirmatory.

In vitro larvicidal potential against Anopheles stephensi and antioxidative enzyme activities of Ginkgo biloba, Stevia rebaudiana and Parthenium hysterophorous

OBJECTIVE@#To investigate in vitro larvicidal and antioxidant enzymes potential of the medicinal plants Ginkgo biloba (G. biloba), Stevia rebaudiana (S. rebaudiana) and Parthenium hysterophorous (P. hysterophorous) against Anopheles stephensi (An. stephensi) 4th instars larvae.@*METHODS@#For evaluation of larvicidal potential, the ethanolic, methanolic and dichloromethane leaves extracts of three different plants were used in dose-dependent experiments in two media, while the antioxidant enzymes activities were investigated using four different methods viz., superoxide dismutase, peroxidase, ascorbate and catalase.@*RESULTS@#An. stephensi has developed resistance to various synthetic insecticides, making its control increasingly difficult. The comparative performance of ethanolic extracts (65%-90%) was found better than the methanolic extract (70%-87%) and dichloromethane extract (60%-70%). Among the three plants extracts tested in two media, S. rebaudiana exhibited higher larvicidal activity with LC(50) (24 h) in methanolic extract than P. hysterophorous and G. biloba. G. biloba and P. hysterophorous exhibited the strongest antioxidative enzymes activity and S. rebaudiana were less active and no significant difference was observed.@*CONCLUSIONS@#These three plants exhibit larvicidal potential and can be further used for vector control alternative to synthetic insecticide due to eco-friendly and diseases control, furthermore these plant species have potent antioxidative enzyme activities, therefore, making them strong natural candidate particularly for diseases which are caused due to free radicals.

Dengue fever treatment with Carica papaya leaves extracts

The main objective of the current study is to investigate the potential of Carica papaya leaves extracts against Dengue fever in 45 year old patient bitten by carrier mosquitoes. For the treatment of Dengue fever the extract was prepared in water. 25 mL of aqueous extract of C. papaya leaves was administered to patient infected with Dengue fever twice daily i.e. morning and evening for five consecutive days. Before the extract administration the blood samples from patient were analyzed. Platelets count (PLT), White Blood Cells (WBC) and Neutrophils (NEUT) decreased from 176×10(3)/µL, 8.10×10(3)/µL, 84.0% to 55×10(3)/µL, 3.7×10(3)/µL and 46.0%. Subsequently, the blood samples were rechecked after the administration of leaves extract. It was observed that the PLT count increased from 55×10(3)/µL to 168×10(3)/µL, WBC from 3.7×10(3)/µL to 7.7×10(3)/µL and NEUT from 46.0% to 78.3%. From the patient feelings and blood reports it showed that Carica papaya leaves aqueous extract exhibited potential activity against Dengue fever. Furthermore, the different parts of this valuable specie can be further used as a strong natural candidate against viral diseases.

Small intestinal obstruction caused by a phytobezoar: a case report

Phytobezoar is a concretion formed in the stomach or intestine and composed chiefly of undigested compacted vegetable or fruit fibers. A case of Phytobezoar causing acute small intestinal obstruction in absence of prior gastric surgery or other predisposing factors is presented. The patient was managed surgically i.e., enterotomy