Effect of bupivacaine with and without intra peritoneal instillation on postoperative visceral pain after laparoscopic cholecystectomy

Background: Laparoscopic Cholecystectomy is the treatment of choice for symptomatic gallstones disease. Open cholecystectomy results mainly in parietal pain while laparoscopic cholecystectomy causes visceral pain

Objective: To compare post-operative visceral pain at 24 hours in patients undergoing laparoscopic cholecystectomy with and without intra peritoneal instillation of bupivacaine

Methodology: Setting: Surgical Unit II, Sheikh Zayed Medical College/Hospital Rahim Yar Khan. Duration of Study: 1 July to 31 December 2015. Study design: Randomized controlled trial [RCT]. A total of 60 patients having symptomatic gallstones disease were included in this study. Patients were randomly divided into two groups. Thirty patients in group Awere treated with bupivacaine 0.5 % instillation. For the patients in group B, the dose was not instilled in the gall bladder fossa and right and left sub diaphragmatic spaces. Postoperative pain was assessed up to 24hours after surgery using Visual Analogue Scale [VAS]. The data was entered and analyzed by using SPSS version 16

Results: The mean age of the patients was 35 +/- 8 years in group A, and 37 +/- 8 years in Group B. Post operative pain at 24 hours was significantly low in group A than in group B [33.3% vs. 70%; p=0.004]

Conclusion: Intraperitoneal bupivacaine instillation after laparoscopic cholecystectomy reduces pain in the initial postoperative period. It is easy to administer with no adverse effects and may become a routine practice for this procedure

Heart failure clinical outcomes in hyponatremic versus normonatremic patients

To compare the outcome in heart failure patients between normonatremic and hyponatremic cases in the short term. A cross-sectional study focusing on descriptive statistics at the Department of Cardiology, Lady Reading Hospital Peshawar was performed from 9th August 2011, till 29th April, 2012. Both male and female patients aged 14 years and above admitted diagnosed with heart failure were enrolled and data observed. Those having serum sodium of ?135mmol/L were defined as hyponatremic. All the patients were managed according to guidelines. All patients were followed during their hospital stay. Patients who survived were discharged on standard HF medications and followed till the end of third month for 3 month mortality and re-admissions for heart failure. Total study population was 241. Mean age was 59.2 +/- 14.9 [18- 100] years. Female patients were 51% [123]. Mean serum sodium was 136 +/- 5.1mmol/L [116-151]. Hyponatremia was present in 35.3% [85] patients. Overall three month follow up mortality was 14.7%, while it was significantly higher in hyponatremic group 22.7% compared to normonatremic patients 10.7% [P=0.02]. Being followed for a period of 3 months 25% patients were readmitted to hospital with heart failure decompensation. Hyponatremic group had readmission rate of 26.7% compared with 24% in normonatremic patients [p=0.74]. Hyponatremia in patients diagnosed with heart failure possess a significant over all risk to a higher mortality as compared to those that are normonatremic. Re-admissions for heart failure are equally common in hyponatremic and normonatremic patients

Effect of socioeconomic status, education level and type of denture on denture hygiene knowledge and practices of denture wearers

The objective of this cross-sectional survey was to assess the knowledge level of complete and partial denture wearers regarding denture hygiene measures and practices, and to find any association of knowledge level with socioeconomic status, education and type of denture. Eighty five denture wearers were interviewed through a self-designed close-ended questionnaire including nine relevant questions that were to be answered as "No" or "Yes". Final score was determined numerically, rang-ing from 9 upto 18, which was used to devise five groups of knowledge level: extremely poor [score of 9-10], relatively poor [score of 11-12], moderate [score of 13-14], relatively good [score of 15-16], and extremely good [score of 17-18]. Results showed that the knowledge grade of the study participants was non-significant for socioeconomic status [P value 0.55] but highly significant for education level [P value 0.001] and type of denture [P value 0.014]. It was concluded that knowledge and practices of the patients regarding denture hygiene was related to their educational status [more literate participants had better knowledge] and also to the type of denture being worn [complete denture patients had relatively better knowledge than the partial denture patients]

profile of atopic dermatitis in out patient department of dermatology Isra university hospital

To study the profile of atopic dermatitis in patients presenting at outpatient department of Dermatology of Isra University Hospital, Hyderabad. Observational study. This study was carried out at the Department of Dermatology, Isra UniversityHospital, Hyderabad from April 2012 to April 2014. A sample of 100 patients of atopic dermatitis was selected through non probability purposive sampling as per inclusion and exclusion criteria. Atopic dermatitis was diagnosed on the basis of patient history and clinical presentation and clinical findings. The findings were collected on a predesigned structured proforma. Written informed consent was taken from the willing participants. Ethical approval was taken from the institute. Data was analyzed on SPSS 21.0 [IBM, incorporation, USA]. Categorical variables were analyzed using chi square. P-value of statistical significance was taken at

Prevalence of skin diseases in patients presenting at the out patient department of Isra university hospital hyderabad: a clinical survey

The present study was conducted to investigate the prevalence of skin diseases in patients reporting at the Out Patient Department of Isra University Hospital Hyderabad. Cross sectional study. This study was carried out at Out Patient Department of Isra University Hospital Hyderabad from April 2006 - April 2014. A total of 2067 patients [1096 males and 971 females] were examined initially. Patients were selected through non probability purposive sampling as per inclusion and exclusion criteria. Because of limited time and workforce, only six dermatoses of main interest were recorded. Patients were examined by consultant dermatologist. Written informed consent was taken from the willing participants. Ethical approval was taken from the institute. Data was analyzed on SPSS 21.0 [IBM, incorporation, USA]. Categorical variables were analyzed using chi square. P-value of statistical significance was taken at

Frequancy of hyponatremia and in hospital clinical outcomes in these patients hospitalized for heart failure

To determine the frequency of hyponatremia and in-hospital clinical outcomes in hyponatremic patients hospitalized for heart failure.This was a descriptive study conducted in department of cardiology, Lady Reading Hospital, Peshawar. Both male and female patients aged 14 years and above admitted with heart failure fulfilling the inclusion criteria, were included in the study. Patients were subjected to detailed history and clinical examination. Admission Serum sodium was measured in all patients. All the patients were managed according to guidelines. All patients were followed for in hospital mortality and length of hospital stay [LOHS].The total number of patients was 241. Mean age was 59.2 +/- 14.9 [range 18-100] years. Females were 123 [51%] patients. Mean serum sodium was 136 +/- 5.1mmol/L. Hyponatremia [serum sodium

Influence of literacy level on pretreatment expectations of patients seeking removable dentures

The objective of this study was to find out any association between pretreatment expectations of prosthodontic patients with their literacy level. For this, a cross-sectional survey was carried out on 100 new patients requiring complete or partial dentures. A self-designed close-ended questionnaire, based on nine relevant questions was used. Patients were required to answer as "Yes" or "No." Afterwards, a numeric calculation was done to derive a final score that ranged from 9 upto 18. This final score was used to categorize the expectations of the patients into five groups i.e. very low [score of 9-10], relatively low [score of 11-12], moderate [score of 13-14], relatively high [score of 15-16], and very high [score of 17-18]. Overall, only 3 [3.0%] patients had the ideal very low expectations and both belonged to the literate groups. In contrast, very high expectations were seen in 10 [10.0%] illiterate patients only. Chi-square test revealed significant association of pretreatment expectations with literacy level [P<0.001]. It was concluded that patient expectations from removable dentures were highly influenced by their literacy status

slit-skin smear an alternate to histopathology in the diagnosis of cutaneous leishmaniasis?

To determine how effective is slit-skin smear as a diagnostic test in comparison with the histopathology. This was a validation study, carried out in Combined Military Hospital [CMH] Kohat from 1st September 2011 to 30th June 2012. The study population was the patients who were clinically diagnosed as cutaneous leishmaniasis. Slit-skin smears were performed in all and a biopsy was sent for histopathology. The results were analyzed by cross tabs and chi square test. A total of 50 patients were included. They were all adult males. Leishman-Donovan [LD] bodies were seen in histopathology slides in 31 patients [62%] and were not detected in 19 patients [38%]. The slit-smear showed LD bodies in 18 smears [36%] and negative in 32 smears [64%] [p=0.048]. Histopathology is statistically superior investigation than slit-skin smear in the diagnosis of cutaneous leishmaniasis

Effect of thiamine on glycemic control in induced diabetic rat model

To evaluate the effect of high dose thiamine on postprandial blood glucose [PPBG] and hemoglobin A 1C levels in induced diabetic albino rat model. Experimental/Analytical study. Animal House, Isra University Hyderabad from March to October 2013. Forty adult albino rats were divided into four groups; Group I. Controls receiving normal diet, Group II. Controls receiving thiamine fortified diet, Group III. Diabetics receiving normal diet and Group IV. Diabetics receiving thiamine fortified diet. Diabetes mellitus was induced using Streptozocin. Thiamine was given at a dose of 1.6 g/kg body weight. Venous blood samples were drawn from animal's tail with a small bore cannula before and after 12 weeks of experimentation. The PPBG levels and Glycosylated HbA [HbA1c] were measured. The data was converted into database and analyzed on SPSS version 21.0 by ANOVA and Tukey-Kramer's test. A p-value of

Pentoxifylline protects against carbon tetrachloride induced liver injury in adult male wistar rat model

To investigate the protective effect of Pentoxifylline [PTX] in carbon tetrachloride [CC1[4]] induced liver injury in adult male Wistar rat model. Experimental/Analytical study. Animal House, Isra University Hyderabad from May to December 2012. Forty five adult male Wistar rats were divided into three groups; Group A. controls received 0.9% isotonic saline, Group B. received CC1[4] orally [I.9mg/kg] mixed in olive oil, and Group C. received the PTX+ CC1[4]. Blood samples were collected for liver biochemical assays. The animals were sacrificed, liver tissue, after fixation in 4% formaldehyde, was embedded in paraffin. Tissue sections of 5micro thickness were subjected to haematoxylin and eosin staining and were assessed by light microscopy. The data was analyzed on SPSS 21.0 using one-way ANOVA, Tukey-Cramer and Chi-square tests. A p-value of

Comparison of patient's satisfaction level with complete dentures fabricated by neutral zone technique and conventional technique

The objective of the study was to compare the satisfaction level of edentulous patients provided with complete dentures that were fabricated by either the neutral zone technique or the conventional technique. For this a quasi experimental comparative study [Phase 2 trial] was carried out at Department of Prosthodontics, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan from September 2006 to February 2008. Sixty edentulous patients were included in the study and randomly placed into two groups. Complete dentures were fabricated for these patients; by the neutral zone technique for Group A and by the conventional technique for Group B. The satisfaction level of patients was assessed after six months of denture insertion with the help of a questionnaire. In Group A, 8 were highly satisfied, 19 fairly satisfied and 3 poorly satisfied while in Group B, 3 were highly satisfied, 16 fairly satisfied and 11 poorly satisfied. Chi-square test revealed a significance of 0.03 [P < 0.05] regarding comparison of patient's satisfaction level in both the study groups. It was concluded that dentures fabricated by neutral zone technique were more stable and functionally better than conventional dentures

Influence of gender and age on pretreatment expectations of prosthodontic patients requiring removable dentures

The objective was to assess the pretreatment level of expectations of prosthodontic patients from removable prostheses and to establish any relationship of these expectations with their gender and age. For this, a cross-sectional survey was carried out on 108 patients by using a self-designed close-ended questionnaire including five main questions that were to be answered as yes [2 points] or no [1 point]. Final score, derived through numeric calculation, was used to categorize the expectations as either low [score of 5-6], moderate [score of 7-8] or high [score of 9-10]. Expectations were low [realistic] for only 15 [13.9%] patients and remained very high [unrealistic] for 51 [47.2%] patients, including 30 females and 27 middle aged patients. Chi-square test revealed significance for gender [P=0.001] and the age groups devised [P=0.035]. It was concluded that both gender and age of the patients may have strong correlation with their pretreatment expectations, which were unrealistically very high among the females and middle aged patients

Tooth shade perceptibility of undergraduate students, house surgeons and postgraduate residents

The objective of the study was to assess the shade perception abilities of undergraduate students in comparison to house surgeons and postgraduate residents on the basis of their clinical experience and technical education and training received on tooth shade selection. For this, a cross-sectional comparative study was carried out on a sample of 80 subjects, equally divided into two groups: Group I included undergraduate students and Group II included graduates doing house job or postgraduate training. All subjects were randomly divided into two further groups: the ET-group, which received proper education and training in shade selection; the non-ET-group, which did not receive such education. A shade selection exercise was devised using two Vitapan Classical shade guides. The number of correct matches established the participant's score, which was used in data analysis through the Chi-square test. Only 10 participants scored the maximum of 4 points including 2 students of Group I [2.5%] and 8 postgraduate residents of Group II [10.0%]. All of them belonged to the ET-group, which was a significant finding [P<0.05]. It was concluded that clinical experience and technical education and training received enables the observer to perform better at shade selection

Scientific and artistic principles of tooth shade selection: a review

Modern dentistry is facing growing demands for esthetic tooth-colored restorations, whether in composite, porcelain or acrylic systems. This makes shade selection, on the chair-side and its accurate formulation in the laboratory, the key determinant to the overall success of these restorations. The process of shade selection itself is based on scientific, artistic and physiological principles, which should be properly understood to avoid any shade mismatches and consequent remakes. Hence, the aim of this article was to review the basic principles involved in the shade selection process and present them in an easy-to-understand manner. For this, an electronic search was carried out in PubMed and PakMedinet databases and journal websites, supplemented by a hand search of the published literature and standard textbooks of Prosthodontics to gather all relevant information. It is hoped that this article shall provide useful knowledge to the dental community on the science behind the art of successful shade selections

Escitalopram in the treatment of obsessive-compulsive disorder: a double blind placebo controlled trial

The tolerability and efficacy for patients with obsessive-compulsive disorder [OCD] in a large, sample on Escitalopram was studied. A total of 100 adults with a confirmed diagnosis of OCD were included. The percentage of patients with an adequate drug trial, defined as 42 days of continuous treatment with a serotonin- reuptake inhibitor or placebo at dosages at or above established minimal effective dosages. Ninety-six percent of the adults who were newly diagnosed with OCD in the index year had an adequate trial of medication after their first visit for OCD. By the second half of 42 days the patient who were responding to the treatment were randomly allocated to two groups. One group received the same drug and other group was given placebo. The results were complied at the end of three months of each patient treatment. No additional psychotherapy was offered to these patients during this time period. Despite the typically chronic course of OCD, many patients with OCD responded to the Esciatolpram at the dosage of twenty milligram per day

Relationship of age, gender and skin tone to shades of permanent maxillary central incisors

The objective of this study was to correlate shades of teeth to skin color according to age and gender. The study sample comprised 200 patients ranging in age from 16 to 55 years, divided into four age groups of 50 each. Shade of middle third of labial surface of maxillary central incisor was recorded visually with the help of Vitapan 3D-Master shade guide under standardized lighting. Color of back of the hands was recorded with the help of Ideal Balance Quick Stick makeup shades, and divided into three skin tone groups. The paired samples T-test was applied at 95% confidence interval. Our results revealed a significant association [P<0.001] when either age or gender was correlated with shades of teeth and color of the skin. It was concluded that both tooth shade and skin color were strongly related with each other and with the age and gender of the patients. This information can be used effectively for fabrication of more life-like dentures

Birth order, family size and its association with conversion disorders

To find out the association of family size and birth order in patients suffering from conversion disorder, and to observe its correlation with pattern of conversion symptoms and co morbid anxiety and depressive symptoms. This was a hospital based, descriptive, cross sectional study. The study was conducted in the Department of Psychiatry, Services hospital, Lahore from August 2003 to January 2004. One hundred patients, suffering from conversion disorder diagnosed on the basis of DSM-IV criteria were assessed for symptom pattern. A semi-structured interview was used to collect details of family size and birth order. Anxiety and Depressive symptoms were evaluated by using Hospital Anxiety and Depression Scale [HADS]. The majority of the patients were having 4-6 siblings. A strong correlation was found between the larger sized family and the middle born patients with the pattern of the conversion symptoms as well as with the anxiety and depressive symptoms. The patients with a diagnosis of conversion disorder need to be managed for, not only the psychological aspects but also the social issues like family size and stresses associated with it

Obsessive compulsive symptoms as co-morbidity among schizophrenics

Background: Co-morbidity with obsessive-compulsive symptoms is often misdiagnosed or even neglected by psychiatrists. It has been suggested that obsessive-compulsive co morbidity leads to a poorer clinical course, lower levels of functioning, and longer periods of hospitalization compared with schizophrenics who are not obsessive-compulsives. Present study aims to address the issue by exploring the co-morbidity of obsessive compulsive symptoms in schizophrenia and to see their relationship in clinical setting

Methods: The study was conducted at Department of Psychiatry, Services Institute of Medical Sciences and Services hospital, Lahore from September 2003 to May 2004. One hundred and eighty patients with schizophrenia diagnosed on the basis of DSM-IV were included in the study. Positive and Negative Syndrome Scale for Schizophrenia [PANSS] was administered to assess the severity of the positive and negative symptoms. Same patients were evaluated for obsessions and compulsions using Padua Inventory [Pl]

Results: Sample of the patients having schizophrenia co-morbidity with obsessive compulsive symptoms was having mean age of 32 years. Among them, 45.6 % were males, 54.6 % were females and 78 [43.3 %] patients with schizophrenia were having Obsessive Compulsive symptoms. Results show that Obsessive Compulsive symptoms were significantly co morbid with schizophrenia. The correlation was significant for positive and general psychopathology symptoms, whereas, no significant relationship was found for negative symptoms

Conclusion: Obsessive Compulsive symptoms significantly co morbid in patients suffering from schizophrenia with positive symptoms

Anxiety and depressive symptoms in patients with conversion disorder

To determine symptom pattern of conversion disorder and its association with co-existent anxiety and depressive symptoms. Descriptive, cross-sectional study. The study was conducted in the Department of Psychiatry, Services Hospital, Lahore from August 2003 to January 2004. One hundred patients, suffering from conversion disorder, diagnosed on the basis of DSM-IV criteria, were assessed for severity of anxiety and depressive symptoms by using hospital anxiety and depression scale [HADS]. A semi-structured interview was used for demographic details. Anxiety was seen to be present in 35% of cases, depression in 29% and 31% of the patients had both anxiety and depressive symptoms. Overall co-morbidity of anxiety and depressive symptoms in conversion disorder was high i.e. 95% and only 5% of the patients were without any co-morbid anxiety and depressive symptoms. A significant association was found between depressive and sensory symptoms [p=<0.05] in patients with conversion disorders. The patients with a diagnosis of conversion disorder need to be managed for anxiety and depressive symptoms appropriately for better outcome

Management of fistula-in-ano; a common clinical problem

Study design A prospective study of 54 patients [age ranging from 18-54 years] operated for perianal fistula. Place: First Surgical Unit Nishtar Hospital Multan. Duration: January 2000 to July 2001. To determine the incidence of low or high anal fistula, recurrence rate following surgery and effect of surgery as well as effect of previous procedures on the incontinence. Material and methods: The fifty four patients [54] were subdivided into two groups' i.e. low and high anal fistulae and were operated by laying open technique [fistulotomy] for low fistulae and by two-stage fistulotomy, seton "cut-through technique and Re-routing of the tract for high fistulae. Patients were followed to see the incidence of recurrence, effect of surgery on continence as well as effect of previous surgery on continence. Overall recurrence was only 4.44% for low fistulae and 11.11% for high fistula in-ano. Minor incontinence was observed only following surgery for high variety. No such complication occurred in low variety. Low fistulae can be laid open with minimal loss of sphincter muscle but as for as the high variety is concerned it is safer to place a seton or stage the procedure