Aluminium Phosphide Poisoning: clinical profile and outcome of patients admitted in a tertiary care hospital

Background: Acute poisoning is a significant health problem being the leading cause of morbidity and mortality all over the world. Poisoning due to ingestion of Aluminum Phosphide and Organophosphates is considered among the commonest poisons leading to fatal consequences

Objective: To study the clinical profile and outcome of the patients with [Wheat Pills] Aluminum Phosphide [ALP] poisoning brought to the District Head Quarter [DHQ] Teaching Hospital, Sahiwal

Setting and Duration: The study was carried out in DHQ Hospital Sahiwal [a tertiary care health institution attached with Sahiwal Medical College, Sahiwal, Pakistan] for the period of one year i.e. 1[st] January, 2017 to 31[st] December, 2017

Methodology: The patients above 12 years of either gender brought to the DHQ Hospital Sahiwal, with history of ingestion of [wheat pills] Aluminum phosphide; were included in study by non-probability convenient sampling. The data retrieved from the hospital record / treatment charts of the patients admitted in Accident and Emergency / Medical Units. Prior permission from the controlling authorities was also taken. The data entered in predesigned proforma for further analysis

Results: Of the total one hundred and ten patients; 94[85.45 percent] belonged to the younger age group 12-30 years while 65[59.1 percent] cases of Aluminium Phosphide poisoning were females and 45[40.9 percent] males. Similarly, females represented 30[27.27 percent] poisoning cases compared to males 16[14.54 percent] in the age stratum 12-20 years. Majority 48[43.63 percent] cases were between the age group of 21-30 years. The intake of Aluminium Phosphide with suicidal intent was found in 82[79.6 percent] cases. The frequent clinical features were Shock / Tachycardia observed in 32[29.1 percent] cases whereas 62[56.36 percent] patients couldn't survive in spite of extensive resuscitation

Conclusion: Aluminium Phosphide is frequently used poison with suicidal intent especially in the younger population. Shock / Tachycardia were the most frequent clinical presentation of the patients. Mortality rate was higher in Aluminium Phosphide poisoning in spite of resuscitative measures. No antidote is available so far whereas role of magnesium sulphate and coconut oil are controversial

Recommendations: Situation could be improved by reducing the occupational exposure, resolving the conflicts leading to self-poisoning and adequate training of the medical / paramedical staff in poisoning management at the primary, secondary and tertiary care hospitals. Proper legislation is to be done for strict control on the sale of aluminium phosphide. Further research is required to find out the effective antidote in order to reduce the mortality because of aluminium phosphide poisonin

Role of antioxidant in recurrent pregnancy losses

Objective: To compare the rate of recurrent abortion in antioxidants supplemented and non-supplemented mothers

Study Design: Randomized control trail, double blind study

Place and Duration of Study: Liaquat University Medical and Health Sciences-Jamshoro [LUMHS], Shaheed Mohtarma Benazir Bhutto Medical University Larkana [SBBMU] hospital and PMC hospital Nawabsha [2012-2014]

Material and Methods: The patients were the mothers who had aborted three consecutive losses continuously. It was multicentre hospitals based study, where cases of recurrent abortion mothers frequently reported and were available. Two techniques were used convenient and snowball to select the patients

Results: A total of 123 cases of recurrent abortion [RA] were recruited and identified for registration [Point Estimate of Incidence] among them n=67 mothers in the active arm and n=56 in placebo arm. The R.A incidence rate was 89 per 1000 mothers at risk in Placebo arm and 149 per 1000 mothers at risk in Active arm. In case of RA the mean age was 30 years in both the arms. Mothers who had suffered recurrent abortion in both arms were mostly illiterate [61%]. The mean duration of marriage in active arm was 16.7 years. Researcher found that most of mothers, 92 [75%] did not become pregnant after taking the prescribed supplementation

Conclusion: The use of antioxidants before conception and during pregnancy significantly improves the chances of live births and outcome in general

experience of trans-abdominal repair of vesico-vaginal and uretero-vaginal fistulae

To assess the success rate of trans-abdominal repair of vesico-Vaginal fistula. This prospective descriptive study was conducted in the Departments of Surgery, Gynaecology and Urology, Ghulam Mohammad Mahar Medical College Hospital, Sukkur, Pakistan from August 2009 to July 2012. A total 27 patients of vesicovaginal fistula [VVF] and Uretero-Vaginal fistulae were included in the study. All patients had supra-trigonal multiple or single VVF were repaired by the abdominal approach. The outcome of the procedure and post-operative complications were recorded. Thirteen patients had single Supra-trigonal, three had multiple VVF. Three had vesico-Uterine and four had uretero-vaginal fistulae. All were operated by abdominal approach successfully. Pelvic surgery [abdominal hystrectomy /LSCS] was the major cause of VVF, accounting for 66.66 %[18 Patients], while in remaining 33.33% [9 patients] the obstructed and prolonged labor were the cause. All fistulae healed successfully with minor leaking in 2 [7.4%] patients which settled spontaneously. One patient developed post-operative adhesions [small bowel obstruction] and was explored and adhesiolysis was done. Three [11.11%] patients developed post-operative wound infection and healed by dressing. Trans abdominal is an excellent approach for supra-trigonal, vesico-uterine and uretero-vaginal types of fistulae

out come of transvaginal repair in 50 cases of vesico-vaginal fistula

To see the out come of transvaginal repair of vesico-vaginal fistula. A consecutive case series study. This study was conducted in the department of Urology and Dialysis Unit Peoples Medical College Nawab Shah, from Jan 2007 to the Dec 2009. Patients were collected from the urology out patient department and the department of gynecology People's Medical College Nawab shah. Total 50 females were operated for the vesico-vaginal fistula trans-vaginally. After the admission care full history and examination were done to demonstrate the incontinence subjectively and objectively. Before surgery all subjects were diagnosed by the cystoscpic examination. All subjects were operated transvaginally. The total 50 females were operated for the vesico-vaginal fistula trans-vaginally. In 35 cases obstructed and prolonged labour and in 15 cases pelvic surgery was the cause of vesico-vaginal fistula. Cystoscopically all fifty fistulae were divided according to their site in the bladder. Supra trigonal 07, trigonal 35 and Marginal 08. All were repaired transvaginally. After two weeks catheter was removed, the leakage occurs in four [04] cases in supra-trigonal cases. In trigonal variety of vesico-vaginal fistula all thirty five [35] cases only three [03] fistulae were leaked. In third variety of vesico-vaginal fistula was marginal variety. Total eight [08] fistulae were and three [03] out of eight fistulae were leaked. We conclude that transvaginal is an excellent approach for the vesico-vaginal fistula, especially in trigonal, solitary and smaller i.e. <4cm variety of fistulae. Careful selection of the patient and the time of repair are the important mile stones for the successful out come.

Frequency of seropositivity of Hepatits C in Thalasemia major patients

Thalassemia is inherited as an autosomal recessive disorder. Children suffering from beta thalassemia major, due to various genetic defects, have deficient synthesis of beta globin chain of Hemoglobin. They need frequent blood transfusions, so they are at increased risk of transfusion transmitted infections especially HCV. To evaluate frequency of hepatitis C in thalassemia major patients. Prospective descriptive study. This study was conducted at the Thalassemia care Center Nawabshah, Sindh from 1[st] January 2011 to 31[st] December 2011. Children ages from 3 months to 14 years with Beta thalassemia major were included. Patients were scrutinized for anti HCV antibodies by third generation ELISA technique. Total of 126 patients of thalassemia major studied in this series, 59 [46.82%] were males and 67 [53.17%] females. Out of these 18 [14.26%] were hepatitis C positive. HCV infection is an important cause of viral infection among thalassemic children with a prevalence of 14.26% in our study population

use of alpha-blockers and hyoscine n-butyl bromide [HBB] for the treatment of nephrolithiasis is most effective treatment for lower uretric stones

Medical expulsion therapy has been shown to be a useful adjunct to observation in the management of ureteral stones. Alpha-1-adrenergic receptor antagonists have been studied in this role. Experimental study. This study was conducted Urology at GMMMC Hospital Sukkur from January 2008 to December 2010. In this study 480 patients were selected, with stones located in the distal tract of the ureter with stone diameters of 5 to 10mm were enrolled in the present study and were randomized into 4 equal groups. Group 1 received hyoscine N-butyl bromide [HBB], Group 2 received alfuzosin, Group 3 received doxazosin and Group 4 received teraozin. The subjects were prescribed diclofenac injection [75 mg] intramuscularly on demand for pain relief and were followed-up after two weeks with x-rays of the kidneys, ureters, bladder and urinary ultrasonography every week. The number of pain episodes, analgesic dosage and the number of days of spontaneous passage of the calculi through the ureter were also recorded. The average stone size for groups 1, 2, 3 and 4 was comparable [6.13, 5.83, 5.59 and 5.48 mm respectively]. Stone expulsion was observed in 11%, 52.9%, 62%, and 46% in groups 1, 2, 3 and 4 respectively. The average time to expulsion was 10.55 +/- 6.21 days in group 1, 738 +/- 5, 55 days in group 2, 785 +/- 5.11 days in group 3 and 7.45 +/- 5.32 days in group 4. Alpha blockers were found to be superior to HBB [p <0.05]. Medical treatment of distal ureteral calculi with alfuzosin, doxazosin and terazosin resulted in a significantly increased stone-expulsion rate and decreased expulsion time when compared with HBB, HBB seems to have a negative effect on stone-expulsion rate

comparative study of percutaneous suprapubic cystolitholapaxy versus open cystolithotomy in children

To compare the outcome of percutaneous suprapubic cystolitholapaxy with open cystolithotomy in children. Comparative study. Department of Urology and Surgery, Peoples Medical College Hospital Nawabshah, from 2004 to 2007. Hundred patients [87 boys and 13 girls], from 1 to 10 years of age were enrolled in the study. The size of stones ranged from 8mm to 25mm. Patients were divided in two equal groups A and B. Group A submitted for percutaneous suprapubic cystolitholapaxy and group B for open cystolithotomy. The procedure was done under spinal and caudal anesthesia with intravenous sedation. To compare the outcome of percutaneous suprapubic cystolitholapaxy with open cystolithotomy Postoperative complications noted in group A patients included transient hematuria in 2 cases [p 0.495]. Operative time in group A was 10 to 15 minutes while in group B it was 25 to 40 minutes [p 0.0005]. Urinary leakage [n=2 - p 0.495] and wound infection [n=3 - p 0.242] were observed in group B. Duration of catheter placement was 2-3 days in group A, while 5 to 7 days in group B [p 0.0005]. Hospital stay of group A was 2-3 days while 5-7 days in group B [p 0.0005]. All patients became stone free. Percutaneous suprapubic cystolitholapaxy is an efficient, safe, minimally invasive and cost effective method

Early and delayed management of penile injuries

Trauma literature regarding management of penile trauma affecting all age groups in the face of coexisting life-threatening injuries is underdeveloped. Furthermore it had potential for significant complications including infection, incontinence, erectile dysfunction and infertility. presuming these facts we intend to assess the efficacy, safety, and complications of penile injuries and its proper management in our setup. Thirty patients of penile injuries having age of 4-64 years were selected from department of urology services hospital, Lahore. Patients having genital tumors or injured due to radiation and bums were excluded from study. Demographic details, brief clinical history and thorough local and systemic examination were carried out in these patients. Each subject was investigated for blood complete picture, urinalysis, and radiographic studies. Taken as a whole two third of our study population result shows fine outcome. Following the result of early and delayed management of cases, significant number of patients shows excellent outcome as compared to patients who were presented late in hospital. early presented patients to hospital shows promising outcome with reduced risk of long term sequelae as compared to patients presented late

Duckett urethropusty: technique in the management of distal hypospadias

To assess the efficacy, safety and complication of Duckett urethroplasty technique in the management of distal hypospadias. Prospective study. At Urology Department, Services Hospital Lahore and larkana. From 1 998 to 2007. Fifty patients of distal hypospadias were selected from the Urology Departmental services hospital lahore and larkana for duckett urethroplasty technique. Age of the patients ranged from 5 to 22 years. The mean age was 1 0 years, forty [80%] patients belonged to urban areas while 10 [20%] were of rural areas.AII the patients presented with dystopia of external urethral meatus and chordee [ventral curvature]. 25 [50%] presented wih misdirected stream, spraying of urine 3 [5%] and narrow stream 3[5%]. The subcoronal type of distal hypospadias was commonly seen in our study. Forty [80%] patients had subcoronal and 10 [20%] distal penile urethral opening. All the patients were had distal type of hypospadias associated with chordee. Following duckett technique 32 [64%] patients had good result and 10[20%] patients have fair result while 8[1 6%] were decleared as a failed cases. There is still no operative procedure.which can be labelled as ideal operation for hypospadias.however duckett technique have lower success rate but statistically insignificant as compared to other procedures

Distal hypospadias; Barcat-Redman urethroplasty

To assess the efficacy, safety and complication of Barcat-Redman urethroplasty technique in the management of distal hypospadias. Prospective study was completed at Urology Department, Services Hospital Lahore and Larkana from 1998 to 2007. Fifty patients of distal hypospadias were selected from the Urology Department of Services Hospital Lahore and Larkana for Barcat-Redman urethroplasty technique. Age of the patients range from 5 to 25 years. The mean age was 11 years. Forty [80%] patients belonged to urban areas while 10 [20%] were of rural areas. All the patients presented with dystopia of external urethral meatus and chordee [ventral curvature] while 25 [50%] presented with misdirected stream, 3 [5%] spraying of urine and 3 [5%] narrow stream. The subcoronal type of distal hypospadias was commonly seen in our study. Forty [80%] patients had subcoronal and 10 [20%] distal penile urethral opening. Following barcat-redman technique 35 [70%] patients had good result and 8 [16%] patients were declared as fair result while 4 [14%] declared failure. The overall morbidity rate was 30% while hospital stay was 3 days. Barcat-Redman urethroplasty technique is simple, less time consuming and has success rate for the management of Distal hypospadias

Breast carcinoma in Karachi. Clinical and pathological features

To evaluate the clinical presentation and morphological features of carcinoma Breast. A retrospective analysis of 50 patients that presented with Ca Breast over a period of three years in the surgical department of Lyari General Hospital and Civil Hospital Karachi. Most of the patients were in the 5th and 6th decade of life. The mean age at diagnosis was 48 years. The most common presentation was lump in the breast, out of which 12 were in left breast and 38 in the right breast. Location of lump indescending order; 18 in upper outer quadrant, 8 in outer lower quadrant, 5 in areolar reglon 3 in inner upper quadrant, 4 in inner lower quadrant, 10 patients presented with concomitant axillary lymphadenopathy, 2 with skin infiltration and distant metastatis. FNAC and Mammography correlated with H/P in 93% of cases. The most common tumor was infiltrating ductal carcinoma 81%. Tumor size was > 2 cm in 75% of cases. The number of cases with> 3 lymph node metastasis was significantly higher 70% in tumors of >2cm size. In Pakistani females breast carcinoma occurs at a younger age group. Due to unawareness, they are of large size at the time of presentation and show more frequent lymph node metastasis. Infiltrating ductal Ca is the most common type of tumor with predominance of high grade lesion

Cryptorchidism in adults

To evaluate the causes of late presentation in our population Cases presenting with cryptorchidism above the age of 14 years from January 2000 to December 2004, that got operated at surgical unit V and Lyari General Hospital were studied. Twenty six patients operated in the above mentioned institutes were included in the study. All male patients with of age 14 years or above with empty scrotum admitted in surgical wards through All patients with retractile testes were excluded from the study. Patients were admitted after proper diagnosis and clinical examination i.e either swelling or empty scrotum. In impalpable testes apart from base line investigation i.e U/S abdomen was also done. In case of bilateral undescended testes hormonal assay of HCG, FSH and LH were also carried out. 16 patients[57%] of the patients didn't present due to ignorance. 8 patients[29%] had consulted a rural practioners or quack; and were not guided further, other 4 patients[14%] did not present due to shyness. Three patients with bilateral cryptorchidism had infertility. This present study revealed that many treating rural practioners, quacks and paramedics were equally responsible for the late presentation of the patients. There is a need for thorough physical examination following birth by attending obstetrician, pediatrician and other practicing physicians. An advice for early corrective surgery will go a long way in reducing the complications due to late presentation

Sultamicillin in the treatment of upper respiratory tract infections

Forty nine patients, aged 12 years and above, were included in an open non-comparative trial to evaluate the efficacy and safety of sultamicillin in RTI including acute otitis media, acute tonsillitis, acute sinusitis and acute pharyngitis. Each patient received oral sultamicillin, a beta-lactamase inhibitor antibiotic 375mg twice a day in tablet form for 7-12 days. At the end of the study, 47 [96%] paients were clinically cured or improved with bacteria eradicated in 80% of patients, culture-positive at pre-treatment. Signs and symptoms of infection were rapidly resolved particularly temperature which came to normal in 80% of patients on day 3 of the treatment Side effects seen in four patients were mild and did not warrant discontinuation of treatment. Results indicate that sultamicillin is worth-while addition to existing range of oral antibiotics and has the promise to be considered as the antibiotic of choice in upper respiratory tract infections