Burr hole aspiration of brain abscess in children with cyanotic heart disease

Objective: To determine the efficacy of burr hole aspiration of brain abscess in children with cyanotic heart disease in terms of number of aspirations and residual abscess

Study Design: Experimental study

Place and Duration of Study: Department of Pediatric Neurosurgery at The Children's Hospital and The Institute of Child Health, Multan, from July 2010 to June 2014

Methodology: Pediatric patients of cyanotic heart disease with brain abscess were admitted. After taking history, clinical examination and necessary investigation, aspiration of abscess through a burr hole was performed. Data was collected through pre-designed proforma. Analysis of results was performed and comparison was made through statistical package for social sciences [SPSS-20]

Results: Total number of patients were 50 with 31 [62%] male and 19 [38%] female children. Patients' age ranged from 5-10 years with mean age of 7.44 +/-1.11 years. Single abscess in supra tentorial was commonly found in 44 [88%] patients. Multiple abscesses were present in 4 [8%] patients. Cerebellum was involved in 2 [4%] patients. Abscess was completely aspirated in single attempt in 37 [74%] patients, two attempts in 9 [18%] patients, and three attempts in 4 [8%] patients. No bacterial growth on culture was reported in 32 [64%] patients. Culture was positive in 18 [36%] patients. Postoperative hematoma developed in 2 [4%] patients. No mortality was reported in early postoperative period

Conclusion: Aspiration of brain abscess in children with cyanotic heart disease through a burr hole is safe and successful

Studies on metabolic evaluation of urinary risk factors in southern Punjab, Pakistan

Objective: The aim of the present study was to assess the metabolic abnormalities such as hypercalciuria, low urine volume, hypocitraturia, hyperoxaluria and hyperuicosuria in recurrent stone formers of southern Punjab as these abnormalities vary in different populations

Study Design: Prospective study

Place and Duration of Study: This study was conducted at the Department of Biochemisty, Bahauddin Zakarya University Multan and Nisthar Medical College Multan from December 2010 to January 2012

Materials and Methods: One hundred adult patients who were known idiopathic recurrent calcium oxalate renal stone formers [RCSF[S]] were selected from the various districts of the Southern Punjab, Pakistan. Twenty four hour urine collections were made while the subjects were on their usual diet. Samples were collected in clean polyethylene containers. Volume was measured using a graduated cylinder. Hydrochloric acid N/10 HCl [1 ml/100 ml of urine] was added to stop auto-conversion of ascorbic acid to oxalate during storage. Thymol was added as a preservative

Results: Common metabolic change found in the present work was hypercalciuria. It was found in 38 patients [38%] it was isolated in 25 cases and associated with other changes in 13 patients

Conclusion: Most of the patients were noted to have metabolic abnormalities. Hypercalciuria, low urine volume, and hypocitraturia were common metabolic defects. Hypercalciuria was the most frequent risk factor

Prostatic carcinoma; association between serum prostatic specific antigen [PSA] and gleason grade

During the past many years the availability of serum PSA as a screening marker, has encouraged its use to diagnose both prostatic cancer and its recurrence. Patients with high S/PSA are at increased risk of advanced carcinoma prostate and screening at an earlier stage would help to manage it accordingly. The aim of this study was to determine association between serum prostatic specific antigen [PSA] levels and Gleason grade in prostatic carcinoma patients. Descriptive, case series study. Department of Urology and Renal Transplantation in collaboration with Institutional laboratory of Bahawal Victoria Hospital, Bahawalpur. June 2012 to June 2014. Total 160 patients of age 50-80 years with biopsy proven prostatic carcinoma were included. Patients with h/o radiotherapy for prostatic carcinoma and anti-androgen therapy were excluded. Histological slides of each patient were reviewed by using the Gleason grading system. Gleason grade of each patient was correlated with his serum prostatic specific antigen [PSA] report which was done before surgery or biopsy. In our study, mean age was 66.89 +/- 9.28 years. Mean serum PSA was 21.41 +/- 13.67 ng/ml. Intermediate grade cancer was found in 38.75% patients followed by moderate to poorly differentiated cancer in 31.86% patients. Gleason score >/= 7 was significantly higher in patients with serum PSA >20 ng/mL than those with serum PSA

Attenuation of erythrocytic acetyl cholinesterase by paracetamol and chloroquine: evidence in an in vitro study

The present study deals with the erythrocytic acetylcholinesterase inhibitory activity of paracetamol and chloroquine in an in vitro protocol using Michaelis Menten parameters [Apparent Michaelis Constant [aKm] and Apparent Maximum Velocity [aVm]. Paracetamol showed marked inhibition of the erythrocytic acetylcholinesterase. The inhibitory values for aKm and aVm were 65.6% 51.36% respectively, which reduced with respect to control and therefore, proposed an un-competitive type of antagonism. When chloroquine was tested, it showed 45.14% inhibition for aKm which increased while 69.21% for aVm decreased with respect to control; proposed a mixed type of antagonism. In conclusion, the cholinergic intervention by paracetamol in this study suggested a new mechanism for its analgesic activity as acetylcholinesterase inhibitors have already shown both peripheral and central analgesic activity, while the cholinergic activation by chloroquine provided explanation for some of its side effects

Body composition analysis to determine gender specific physical fitness equations in a cohort of Saudi population

To determine an association between body composition analysis and physical fitness in the Saudi population and derive gender specific physical fitness equations. A total of 530 healthy Saudi adults aged 15-72 years [mean 37.16 +/- 14.12 years] were enrolled in this study. Body composition analysis was assessed by bioelectrical impedance analysis [BIA], with a commercially available body analyzer according to standard protocols. Different body composition parameters, such as age, height, BSA [body surface area], obesity degree, body mass index [BMI], body fat mass [BFM] and percent body fat [% BF] contents were significantly different in males and females except weight which was non-significant [p=0.649]. There was significant positive or negative correlation among different body composition parameters except weight with age in males and weight with age, height and BSA in females. In males, all the body composition characteristics contributed to the fitness score except BMI and BFM, while in females, the most significant effect was contributed by weight and BFM. Female body composition characteristics were strongly related to fitness score compared to males [R2 = 93.8% vs R2 = 78.5%]. Different body composition parameters like BFM and%BF played an important role in determining physical fitness of healthy male individuals instead of BMI, weight and BSA, while in females weight was the best predictor of physical fitness

Frequency of eclampsia and maternal complications in a tertiary care facility of Peshawar

Eclampsia is a potentially fatal disorder of pregnancy and an important cause of maternal mortality throughout the world. To find out the frequency of eclampsia and its maternal complications in a public sector hospital. This prospective descriptive study was performed in the gynaecology unit "A" of Lady Reading hospital Peshawar. The study included all patients who presented with eclampsia to this unit in one year. The diagnosis was based on convulsions, hypertension and albuminuria. The list of complications included visual, cerebrovascular, cardiovascular, pulmonary, renal, haemostatic and hepatic. Obstetrical and minor complications were not recorded. During the study period a total of 3090 patients were delivered in the unit with 96 cases being diagnosed as eclamptics [3.1%]. Complications were seen in 46[48%] patients. Of 96 cases 11[11.5%] died. Most of the patients who died had more than one complication. Eclampsia is a serious threat to pregnant females and needs to be picked earlier and treated promptly

Repair of inguinal hernia under local anaesthesia

Inguinal hernias are being increasingly operated under local anaesthesia nowadays. In this study efficacy, safety and cost effectiveness of Inguinal Hernia repair under local anaesthesia was evaluated. This was a prospective study of 80 patients of Inguinal hernia who presented in Surgical out patient department of Pakistan Institute of Medical Sciences [PIMS], Islamabad. Study was conducted over a period of one and a half year i.e. from 01-01-2000 to 31-08- 2001. All patients were operated under local anaesthesia. Xylocaine 1% with adrenaline 1:200,000 was used. In some cases Bupivacaine 0.25% was also used. Both direct and indirect hernias were operated and repair technique was used at random, either Bassini, shouldice or Lichtenstein. The local anaesthetic infiltration was successful in most of patients and it was a wonderful experience both for the patients and surgeon. When we analyzed the results, it was noted that 75% patients were discharged on the day of operation. Incidence of complication was very low and none of the patients reported with recurrence on regular follow ups till to date. As hernia repair under local anaesthesia is very cost effective, so it can be very successful in our circumstances where burden of operation lists is very much and financial resources are minimal. Inguinal hernias should be operated on day case basis under local anaesthesia routinely

Accuracy of alvarado score system in diagnosis of acute appendicitis

The aim of the study was to find out the accuracy of Alvarado score system in the diagnosis of acute appendicitis in adults. Cross sectional comparative study [validation study]. Study was done at surgical department, Nishtar Hospital Multan from 28-05-2006 to 27-11-2006. The study included 60 patients. They were prospectively evaluated on admission, using the Alvarado score to determine whether or not they had acute appendicitis. Fifty patients [83.3%] had appendicectomies of which 10 patients [20%] had normal appendices on histopathology examination. Overall Alvarado system showed a sensitivity of 79.06%, a specificity of 35.29% and accuracy was 66.67%. Positive predictive value [PPV] and Negative predictive value [NPV] were 75.56% and 40% while for male. PPV was 81.48% and NPV was 37.5% and for female, PPV was 66.67% and NPV was 42.86%. For males, the sensitivity was 81.48%, specificity 37.5% and an accuracy of 71.42%. Alvarado system may be sufficiently used as an adjuvant clinical assessment for diagnosis of acute appendicitis, however, clinical assessment of the surgeon still, remain the mainstay for diagnosis of acute appendicitis

Screening for intra-uterine growth retardation

Ante-natal diagnosis of IUGR is usually difficult and inaccurate. Fifty two cases were studied to evaluate the foetus with IUGR. Sixteen were lost to follow up and the remaining 36 cases were studied until term. Both procedures were used simultaneously. By using SFH measurement 10 [27%] cases were detected as having IUGR, while at birth 9 [25%] infants were found to growth retard. This gave the procedure sensitivity and specificity of 90% and 96% respectively. By using ultrasound abdominal circumference measurement 13 cases were detected having IUGR giving sensitivity and specificity of 69% and 85% respectively. This small study significies the importance of measurement as screening test for identification of IUGR