Experience of laparoscopic cholecystectomy during a steep learning curve at a university hospital

Cholelithiasis is the most common disease of alimentary tract affecting the adult population globally and our country in particular is no exception to it as a cause of hospitalization. Surgical removal of gall bladder is the main stay of symptomatic cholelithiasis ensuring a permanent cure. The minimally invasive technique of laparoscopic cholecystectomy has gained wide acceptance as a Gold Standard treatment ever since its introduction. The purpose of this prospective observational study was to document our experience of laparoscopic Cholecystectomy during a learning curve in a single unit of a university hospital and compare it with other available data in the literature. Total 94 patients underwent laparoscopic cholecystectomy during the learning curve from Jan 2009 to Dec 2010 in the Department of Surgery Liaquat University Hospital Jamshoro. Mean age was 42 years with females [88.29%] preponderance. Majority of the cases were operated by consultants [85.10%] within 25-60 minutes. Postoperative hospital stay was 3 days with return to work in 7 days. Only 6 [6.38%] cases were converted to open technique. Intra-peritoneal drains and Foley's catheter were kept in selected cases only. Eleven patients [11.70%] had intra-operative complications including complete transaction of CBD in only one [1.06%] male patient. Five patients [5.31%] had postoperative complications with two patients having iatrogenic duodenal injury which was not identified during surgery and pseudo cyst pancreas. Four patients [4.25%] died due to multiple organ failure. We conclude that Laparoscopic Cholecystectomy is a gold standard procedure and should be learned on virtual simulated models before starting this procedure on human patients.

Outcome of the rubber band ligation with Milligan Morgan haemorrhoidectomy

Haemorrhoids is a common anorectal disease seen in our society. Conservative management is usually adopted for 1[st] and 2[nd] degree haemorrhoids. Patients who do not respond to above management are the candidates for other modalities of treatment which includes sclerotherapy, rubber band ligation, cryosurgery and stapler gun or open haemorrhoidectomy. The purpose of study was to compare the outcome of the Rubber band ligation with Milligan Morgan haemorrhoidectomy in patients with 2[nd] and 3[rd] degree haemorrhoids. Hundred diagnosed admitted patients of uncomplicated 2[nd] and 3[rd] degree piles were treated either with rubber band ligation [RBL] or open method of Milligan Morgan [OH] for the period from January 2007 to December 2007 were included in the study. Both procedures were evaluated regarding effectiveness, safety, complications after procedures, hospital stay and return to work on a written Performa. Patients with 1[st] and 4[th] degree haemorrhoids, below the age of 12 years, bleeding diathesis, associated local anorectal conditions requiring surgery, complicated haemorrhoids, recurrent and secondary haemorrhoids were excluded from the study. Follow up of all these patients was done in OPD to assess any complication and recurrence. Data was analysed through SPSS-16.0. One hundred indoor patients with 2[nd] and 3[rd] degree haemorrhoids were treated either with rubber band ligation or open technique. Most [>90%] of the patients were males. Majority of the patients were in 30-33 years age group. Fresh bleeding [90%] and constipation [45%] were the commonest symptoms followed by prolapsed, discharge and irritation. Second degree was more common than 3[rd] degree haemorrhoids. Intensive pain was the commonest complain after both the procedures, however faecal incontinence was not reported in either group. Hospital stay was longer in open technique [70%] compare to few hours to one day in rubber band ligation group. Return to work was earlier in patients treated with rubber band ligation. Rubber band ligation is safe and effective method compare to open technique in 2[nd] and 3[rd] degree symptomatic haemorrhoids

Factors causing non-breastfeeding in children under six months of age in district Nowshera, Pakistan

In developing countries bottle feeding has emerged a big public health problem while in developed countries the trend is opposite. Prevalence of breast feeding in Pakistan is 90-98% but in some subgroups of population it is as low as 60-80%. The objectives of the study were to determine the causes of non breast feeding in children less than six months of age in district Nowshera, and assess practice of starting first breast feeding to the newborn. A cross sectional study was conducted in ten union councils of district Nowshera. A total of 305 children under six month age were selected by simple random method. Data was collected on pre-designed questionnaire and analysed by descriptive statistics. The study included 198 children from rural and 107 from urban areas. Mothers/guardians of 71.8% children were uneducated. Causes of non breast feeding included perception of mothers of having insufficient milk [45.9%], working mothers [18.4%], mothers with chronic diseases [13.1%], children with congenital or acquired diseases [17%], mothers having next pregnancy [3.61%] whose mothers have been died [0.98%] and twin babies [0.98%]. On the other hand, 61% babies started breast feeding on first day, 19% on second, 10.8% on third and 3.9% after third day while 5.2% babies got no breast feeding at all. Main causes of non-breastfeeding in less than six month age are perception of having insufficient milk, working women and twin babies

One week eradication therapy for helicobacter pylori

1. To determine the efficacy of one week treatment in the cure of Helicobacter Pylori [H pylori] infection using triple regimen including Clarithromycin, Amoxicillin, and a Proton Pump Inhibitor [PPI]. 2. To identify the differences, if any, in response to treatment between patients from Pakistan and the rest of the world. Patients with endoscopically proven peptic ulcer disease and H pylori infection confirmed by urease test were given PPI based triple therapy for one week and then PPI was continued for another week. After two weeks, endoscopy and urease test was repeated to assess H pylori eradication. There were 32 patients [20 male, 12 female, mean age 38.9 years] included in the study. All had endoscopically proven peptic ulcer at initial diagnosis and all were positive for H pylori infection. On repeat endoscopy two weeks later, 27 patients [84.3%] showed complete ulcer healing and PPI was stopped, whereas 5 patients showed signs of partial healing. In the latter, PPI was continued for another week, and on repeat endoscopy at end of therapy, all ulcers showed complete healing. Urease test was repeated in all patients at second endoscopy and was negative in 28 patients [87.5%]. We conclude that one week of triple therapy followed by PPI for one week is sufficient for eradication of H Pylorl

comparison of clinical diagnosis and serological diagnosis in an epidemic of Crimean-Congo haemorrhagic fever

Crimean Congo Haemorrhagic Fever [CCHF] is life-threatening disease caused by Nairovirus of genus Bunyavirus caused by tick bite of Hayalomma species or by direct contact of the blood/sera of the patient and animals suffering from this disease. Epidemics have been occurring in Balochistan province of Pakistan and neighbouring Afghanistan and Iran from time to time with high mortality. Aim: In the absence of facilities for detection of serological markers of CCHF [IgM and IgG antibodies and PCR for viral RNA], a study was designed to diagnose and treat cases of CCHF reporting to a specialist unit hospital situated at Quetta, Pakistan. The aim was to compare the clinical features, complications and outcome of both groups of patients; one detecting the disease clinically only and the other depending upon serological tests for the diagnosis. Thirty-four patients having fever of less than two weeks of duration with features of bleeding from the skin and various orifices were included in this study from June 2001 to September 2001 after hospitalization. Index case and some of the consecutive cases were subjected to detection of serological markers. Rest of the cases were diagnosed on clinical grounds and baseline laboratory investigations only. Difference in both the groups was noted carefully. All the patients were given Ribavirin and blood products as and when required. Statistically there was no obvious difference in clinical manifestations [fever, body aches, purpuric spots, ecchymosis, epistaxis, gum bleed etc.] and laboratory findings [blood picture, serum ALT, serum urea and electrolytes, PT, APTT, etc]. There was also no difference in mortality of the two groups studied. In an on ongoing outbreak of CCHF, history, clinical findings and supportive baseline laboratory investigations may be sufficient for early detection and treatment of CCHF cases. However for documentation of start of epidemic, serological markers should be done. Therefore facilities for detection of viral markers of CCHF should be available at centers like Quetta

Palynological studies of some problematical medicinal plants of Pakistan

Morphology of pollen grains of each species is based on specimens selected at random. Proposed characters i.e. grain, shape of pollen grain, equatorial view, polar view, equatorial diameter [E], polar diameter [P], P/E ratio, length of colpus, exine surface, exine thickness, number of spines between colpi in each species were recorded for comparison. At species level, micro-morphological differences and distribution of surface pattern, shape and size of pollen have been found to exist. The pollen grains are consistently echinate, trizonocolporate. This study demonstrates the potential of pollen studies in distinguishing some taxonomic groups in the Asteraceae. The present research project is confined to the palynological studies of some of the problematical medicinal plants of Pakistan. Sixteen different genera: acacia, Agrimonia, Allium, Anthemis, Asparagus, Berberis, Centella, Colchicum, Cotula, Delphinium, Gentiana, Lactuca, Matricaria, Nigella, Phyllenthus, Viola have been examined in this study. Matricaria chamomilla, Anthemis nobilis, and Cotula aurea have been differentiated with the help of palynology. The palynological studies of Lactuca dissecta [with white flowers] and Lactuca dissecta [with purple flowers] showed many characteristic differences

Comparison of plasma protein concentration and haematological parameters in type-1 and type-2 diabetics of short and long duration

Diabetes mellitus is the most common metabolic disorders, characterized primarily by relative or absolute insufficiency of insulin secretion and concomitant insensitivity or resistant to the metabolic action of insulin on target tissues leading to metabolic derangement. These metabolic derangements are translated into alteration in blood constituents, thus affecting the characteristic of blood. The purpose of this study was to evaluate hematological and biochemical parameters in blood of diabetics of short and long term duration. Hematocrit, ESR, serum sugar, fibrinogen, total serum protein, albumin, and globulin were determined in shortand long-term type-1 and type-2 diabetics, and in healthy control subjects. Hematocrit, ESR, serum sugar, fibrinogen, total serum protein, and albumin concentration of both short- and long-term type-1 diabetics were significantly greater than those of the non-diabetics controls. There were no significant differences between short- term type-2 diabetics and the controls in the parameters like hematocrit, ESR, fibrinogen and globulin. However, hematocrit, ESR, serum glucose, fibrinogen, total serum protein, and albumin of long-term type-2 diabetics were significantly elevated above those of the controls. Based on the reported association of these parameters with diabetic complications, our results suggest that there could be an earlier development of complications in type-1 than in type-2 diabetics