Triggers of blood transfusion in percutaneous nephrolithotomy

To determine the triggers of blood transfusion in patients undergoing percutaneous nephrolithotomy [PCNL]. Observational study. The Aga Khan University Hospital, Karachi, From 1988 to 2007. The percutaneous surgery database was retrospectively reviewed to identify patients with postoperative haemorrhage and need for blood transfusion. Blood loss was estimated by the postoperative drop in haemoglobin factored by the quality of any blood transfusion. Various patients and procedure-related factors were assessed for association with total blood loss of blood transfusion requirement using stepwise univariate, forward multivariate regression analysis. A total of 326 procedures were performed in 316 patients. Two hundred and thirty two procedures were included in the study. There were 167 males and 65 females. The mean age was 41 +/- 14 years. The mean haemoglobin drop was 1.68 +/- 1.3 gm/dL. The overall blood transfusion rate was 14.2%. Stepwise multivariate regression analysis showed that female gender [p= 0.003], staghorn stone [p= 0.023], stone fragmentation with ultrasound [p= 0.054] and chronic renal failure [p= 0.001] were significantly predictive of the need for blood transfusion. Chronic renal failure, female gender, presence of staghorn calculi and stone fragmentation using ultrasonic device were predictive of blood transfusion in this cohort of patients

Bacteriological spectrum of clinical specimens from cases of nosocomial infections in paediatric ICU

To assess bacteriological spectrum, of isolates from cases of nosocomial infections in pediatric ICU. subjective study that was carried out from November 2009 to September 2010, on two hundred samples which were taken from patients in pediatric ICU, tertiary care hospital who were clinically suspected of having nosocomial infection and processed for the diagnosis and isolation of the infective organisms in the Department of Microbiology, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Centre [JPMC], Total 200 samples were collected. Out of these 143 samples showed positive results. 138 were of bacterial growth while 5 samples were positive for fungus. Among these 61 were positive for septicemia, 44 positive for UTI and 17 samples were positive for respiratory tract related disease, while 21 positive for miscellaneous samples. This study presents a general overview of nosocomial pathogens in Pediatric ICUS and emphasizes the importance of timely clinical and bacteriological monitoring among children especially in patients in critically ill situation

Surgical management of CSOM in a Tertiary Medical Centre

To determine the surgical outcome of chronic suppurative otitis media [CSOM] in term of anatomical and functional results. This study was conducted in the department of E.N.T. Abbasi Shaheed Hospital, Karachi, over a period of one year from Jan 2002 to Jan 2003. 50 consecutive patients were included in this study presented with chronic suppurative otitis media. All cases were enrolled in previously prepared performa which include pertinent clinical history and examination, results of related investigations, surgical findings, surgical techniques adopted and final out come. Total 50 patients were included in this study, of which 23 were male and 27 female with the ages from 2 years to 53 years. Surgical techniques included the intact canal tympanoplasty in 15[30%] patients and canal wall down tympanoplasty in 20[40%] patients. In the canal wall down technique, cavity problems were observed in 3 [8.5%] patients. Graft takes were good in 33 [94%] patients and functional results in term of gain in hearing were observed in 31 [88.5%] cases. CSOM may associate in some farm of irreversible sequelae or pathological condition of the middle ear. It is the disease of low socioeconomic group. The infection may be mixed and polymicrobial, however complications are rare because of the invention of effective antimicrobial agents. Anatomical and functional results were good in our series and this is due to good pre-operative assessment, use of proper surgical techniques and long term follow up

Surgical ligation of scrotal varicocele for male factor infertility is a valid option of treatment

To evaluate the role of surgical ligation of scrotal varicocele for treatment of male factor infertility. We studied 60 patients who presented with infertility and were also found to have scrotal varicocele. Patients with other probable causes contributing to infertility were excluded. Diagnosis was made by clinical examination and scrotal ultrasonography. All the patients underwent either laparoscopic varicocelectomy or open retroperitoneal high ligation of the testicular veins. Operative time and hospital stay was recorded. All patients were evaluated for postoperative improvement of semen parameters and development of any postoperative complication. The results were analyzed by commercially available software. During the study period 5 patients were lost to follow up and were excluded. The rest of patients [n=55] were young, with age ranging from 20 - 35 years [Mean age 27.8 years, SD + 4.38]. All patients had unilateral left sided varicocele; two patients [3.6%] had grade I varicocele, 21 patients [38.2%] had grade II varicocele and 32 patients [58.2%] had grade III varicocele. Statistically significant improvement in sperm density [p value < 0.05], sperm activity [p value < 0.05] and sperm morphology [p value < 0.05] was observed after the surgical ligation. The mean operative time was 54.88 minutes [SD + 13]. The mean hospital stay in laparoscopic procedure was 33.4 [SD + 15.3]. Minor complications were noted in 13 patients and included superficial wound infection in 3 patients, 6 patients exhibited testicular pain and persistence of varicocele in 4 patients. Surgical ligation of scrotal varicocele is a safe and effective mode of treatment of male factor infertility in selected population

Metanephric adenoma: a rare benign renal tumor

Metanephric adenoma is a rare benign renal tumour. We are reporting one histologically proven such case in a 23 year old male from Afghanistan. He presented with severe right flank pain since 3 weeks. Nephrectomy was done and histopathology was consistent with the diagnosis of metanephric adenoma. This novel renal mass has been reported to have benign clinical course despite its symptomatic presentation and large tumour size. There is no distinguishing radiological feature with can differentiate it from malignant tumours. So far, a uniformly benign clinical course has been associated with Metanephric adenoma, but given its relatively recent identification and rarity and the lack of clinical, radiographic, or cytologic means to establish a definite diagnosis, Metanephric adenoma remains primarily a pathologic diagnosis

Tat mediates transcriptional activation of HIV-1 gene in vitro.

Gene expression of human immunodeficiency virus (HIV-1) is greatly enhanced by a viral transactivator, the Tat protein, which interacts with R region sequences of the HIV-1 long terminal repeat (LTR). There is no direct evidence to indicate transcriptional activation of HIV-1 by Tat. Using an in vitro transcription system, we demonstrate that an established mouse cell line, which constitutively expresses Tat protein, selectively stimulates the steady state levels of the transcripts directed from the long terminal repeat (LTR) sequences of HIV-1. The gel binding retardation assays further demonstrate a stable activated complex, formed due to direct binding of Tat to DNA elements of the HIV-1 LTR. These data implicate transcription as the site of Tat action in trans-activation and could play an essential role in human immunodeficiency virus replication, similar to the nuclear trans-activators of other viruses.