ABSTRACT
Purpose@#Laparoscopic approach to colonic tumor requires skill set and resources to be established as routine standard of care in most centers around the world. It presents particular challenge in country like Pakistan due to economic constrain and lack of teaching and training opportunities available for surgeons to be trained to deliver such service. The aim of this study is to look into changing practice of our institution from conventional approach of open to laparoscopic surgery for right colon cancer. @*Methods@#Consecutive patients between January 2010 to December 2018 who presented to Shaukat Khanum Memorial Cancer Hospital and Research Centre with diagnosis of right colon (cecum, ascending and transverse colon) adenocarcinoma and underwent surgical resections were included in this study. @*Results@#A total of 230 patients with adenocarcinoma of the right colon underwent curative resections during the study period. Of these, 141 patients (61.3%) underwent laparoscopic surgery while open resection was performed in 89 patients (38.7%). Five-year disease-free survival (DFS) of patients with American Joint Committee on Cancer (AJCC) stage III (80.9% vs. 54.8%, P = 0.021) was significantly better if these patients underwent laparoscopic surgery while a trend toward better DFS (96.7% vs. 84.1%, P = 0.111) was also observed in AJCC stage II patients, although this difference was not significant. @*Conclusion@#This study demonstrates the adoption of a laparoscopic approach for right colon cancer over 10 years. With a standardized approach and using the principle of oncological surgery, we incorporated this in our minimally invasive surgery practice at our institution.
ABSTRACT
Poor adherence with medicine declines the clinical outcome of pharmacotherapy. It may carry serious sequelae especially in case of antihypertensive drugs like cerebrovascular accident [CVA]. This study has been planned to find the association of poor adherence with anti-hypertensive with CVA in diabetic and non- diabetic patients. One hundred CVA patients who were admitted through Emergency in Abbasi Shaheed hospital, a tertiary care hospital in Karachi, were recruited from Jun 2013 till Dec 2013. The criteria of inclusion was, diagnosed case of CVA, with primary hypertension, availability of patient's therapeutic record, consent of the patient or legal successor/heir. The criteria of exclusion was, secondary hypertension, newly diagnosed primary hypertensive patients and complete adherence with medication. Morisky medication adherence scale was applied. Therapeutic record was accessed. The mean age was 62.15 years with 3:1 male to female ratio. Adherence to medicine was graded <6. Patients with hypertension were 41 and with diabetes and hypertension were 59. Majority of patients were on monotherapy as compared to polytherapy [62% versus 38%].The mode of therapy was significantly different [P<0.05] in the two groups. ACE Inhibitors, Calcium Channel Blockers, Beta Blockers and other agents were used by 45.16%, 35.48%, 16.12% and 03.24% patients respectively. The aforementioned drugs were used by 57.14%, 33.33% and 09.52% respectively in 21 patients who were on antihypertensive and oral hypoglycemic agents. A statistical significant difference [P<0.05] was seen in the case of ACE Inhibitors. Similarly they were used by 42.10%, 39.47% and 18.42% in 38 patients respectively, who were on antihypertensive and insulin. No statistical significant difference [P>0.05] was seen in any combination [p>0.05]. Thus it is concluded that poor adherence with ACE inhibitors may be a risk factor of CVA in diabetic patients using oral hypoglycemic agents
ABSTRACT
Antibiotics not only support to alleviate the infections but also facilitate to avert the multiplication of microbes. Due to the irrational use of antibiotics, the resistance of antibiotics has been augmented which results may increase in morbidity and mortality with the span of time. World renowned regulatory bodies like Food and Drug Administration [FDA], Center of Disease Control and Prevention [CDC], and World Health Organization [WHO] vigorously advocate the surveillance of the resistance of antibiotics. During the present study by Kirby-Bauer disk diffusion method 141 clinical isolates of Staphylococcus aureus [n=47, 33.34%], Escherichia coli [n=54, 38.3%], Proteus species [n=26, 18.4%], and Klebsiella pneumoniae [n=14, 9.92%] are evaluated against cefepime and cefpirome which comes of fourth generation cephalosporin. It has been found that cefpirome has better bactericidal activity than cefepime against E. coli and K. pneumoniae while cefepime has been possessed better antibacterial activity against S. aureus and Proteus species which were isolated from respiratory tract infections, blood stream infection, intra-abdominal and urinary tract infections, and skin and soft tissue infections. K. pneumoniae, E. coli, Proteus species, and S. aureuswere 34.8%, 26.3%, 11.3%, and 37.7% resistance against cefepime respectively. S. aureus, E. coli, K. pneumoniae, Proteus species has shown 41.4%, 21.7%, 17.6%, and 8.9% resistance against cefpirome correspondingly.
ABSTRACT
Background: Chronic obstructive pulmonary disease [COPD] has boon one of the main causes of mortality worldwide. The impact of COPD has been increasing socio-economically over time to make COPD an alarming condition for health associated professionals due to the severity of prevalence and its expensive treatment. Due to COPD, patients not only suffer from the illness as the financial costs associated with it
Objective: To determine the prevalence and the medication of COPD
Methods: The medical records of patients suffering from COPD were collected from different tertiary care hospitals in Karachi from June 2011 to May 2012 comprising of middle adulthood to mature aged patients
Results: Out of 1260 patients 174 [13.60 %] were suffered from COPD. Nearly all the patients of COPD were associated with co-morbidity like diabetes mellitus, hypertension, urinary tract infections, renal failure, pneumonia, cardiovascular diseases, and other diseases. Ant-allergy, oxygen supply, intravenous and oral montilukast, atrovent and other nebulizers, cough syrups, inhalers, antibiotics, and other treatment were used for the treatment of COPD as directed by the world renowned guidelines for COPD
Conclusion: The prevalence of COPD is high and is detected through a standalone pulmonary function test [PFT] e.g Spirometry, or in conjugation with a clinical examination. In most oases the guidelines provide by the British Thoracic Society, Americans Thoracic Society, and European Respiratory Society are used to treat COPD