Thiosemicarbazone and thiazolylhydrazones of 1-indanone: as a new class of nonacidic anti-inflammatory and antiplatelet aggregation agents

This research based on the anti-inflammatory and antiplatelet aggregation properties of some new thiazolyl hydrazone derivatives of 1-indanone. In this regard a thiosemicabazone and twelve thiazolyl derivatives of 1-indanone have been synthesized. Out of these synthetic compounds seven derivatives 1-3, 6, 11-13 exhibited varying degree of anti-inflammatory action with IC50 esteems going from 5.1+/-1.3 - 78.8+/-4.6µM/mL. Compound 1 [IC50 =5.1+/-1.9µM] displayed potent result than standard ibuprofen [IC50 = 11.2+/-1.9 µM]. In antiplatelet aggregation assay, five compounds 1, 5, 6, 8 and 11 were observed to be dynamic with IC50 esteems observed in the range of 38.34-255.7+/-4.1µM, whereas, aspirin [IC50 = 30.3+/-2.6 µM] was used as standard. However, compound 11 was found to be good active for both anti-inflammatory and antiplatelet aggregation activities [IC50 = 13.9+/-4.9µg/mL] [IC50 = 38.60+/-3.1µM], respectively

Laparoscopic cholecystectomy in acute gall bladder

To look for the feasibility and results of laparoscopic cholecystectomy in acutely inflamed gall bladder, gangrenous cholecystitis and empyema gall bladder. It was a prospective observational case series. As an institutional policy early laparoscopic cholecystectomy was performed in all the patients with diagnosis of acute cholecystitis. The incidence of gangrenous cholecystitis and empyema gall bladder was noted and laparoscopic intervention was preferred in all these patients. The demographic profile, clinical records, operative details, complications and follow up details were prospectively gathered on a performa. Early laparoscopic cholecystectomy was performed in 142 patients. 103 patients had simple acute cholecystitis, 13 patients had empyema gall bladder and 26 patients had gangrenous cholecystitis. The incidence of comorbids such as diabetes mellitus, hypertension and ischemia heart diseases was 28.1%, 61.5 and 80.75 in patients with simple acute cholecystitis, empyema gall bladder and gangrenous cholecystitis respectively. Male gender was predominating in patients with complicated cholecystitis. The open conversion rate was 3.88% in simple acute cholecystitis, 15.38% in empyema gall bladder and gangrenous cholecystitis combined. There were 2 major complications in patients with simple acute cholecystitis and 2 major complications in patients with gangrenous cholecystitis. There was one mortality in a patient with simple acute cholecystitis. Laparoscopic cholecystectomy is a safe and effective option in acute gall bladder. Based on our experience we recommend an early laparoscopic gall bladder removal, provided expertise and gadgets are available

effects of CO2 pneumoperitoneum on end tidal CO[2] [ETCO[2]], arterial blood pressure and heart rate during laparoscopic cholecystectomy under general anaesthesia

To analyze the effects of CO2 pneumoperitoneum at 13 to 15 mmHg infra-abdominal pressure on end tidal CO2 [ETCO2], arterial blood pressure and heart rate during laparoscopic cholecystectomy under general anaesthesia with controlled mechanical ventilation. Prospective Descriptive Study. The study was conducted at the department of anaesthesia Fauji Foundation Hospital Rawalpindi from August 2005 to September 2006. Fifty consecutive ASA grade-1 patients, 47 females, 3 males and aged 35-65 years undergoing laparoscopic cholecystectomy were included in the study. All patients received a standardized balanced anaesthetic in which 0.7 - 1% isoflurane was used during maintenance. Ventilation was controlled and minute volume was kept at 100 ml/kg/min. Pneumoperitoneum was created with CO2 at a flow rate of 10 liter/min and 13 to 15 mmHg infra abdominal pressure was maintained during the operation. End tidal CO2 [ETCO2], heart rate and non invasive systolic, diastolic and mean arterial blood pressure was recorded immediately before infra abdominal C02 insufflation and then after 5 minutes interval during the period of CO2 pneumoperitoneum. Study period started immediately before infra-abdominal CO2 insufflation till about 60 minutes of surgical procedure. The end tidal CO2 [ETCO2] levels progressively increased to reach a plateau 36mmHg 20 minutes after the beginning of infra abdominal CO2 insufflation. The end tidal CO2 [ETCO2] levels increased to 21% of base line [from 30 to 36 mmHg] during CO2 pneumoperitoneum for laparoscopic cholecystectomy under controlled mechanical ventilation at minute volume 100 ml/kg/min. The systolic, diastolic and mean arterial blood pressure increased to 12% to 17% of the baseline during CO2 pneumoperitoneum at 13-15 mmHg infra abdominal pressure. There was no significant change in heart rate. CO2 pneumoperitoneum produces rise in end tidal CO2 [ETCO2] levels and hemodynamic alterations proportional to the increased infra abdominal pressure during laparoscopic surgery under general anaesthesia with controlled mechanical ventilation

Salmonella typhi infection: a rare cause of endocarditis

A 21 years old male with a history of mitral valve repair for mitral regurgitation is discussed. He was presented with a history of fever and loose motions for one month and shortness of breath for 03 days. Chest radiograph and ECG was within normal limits. Total leukocyte count was elevated and antibodies to salmonella typhi were positive. Blood culture revealed Salmonella typhi growth. Echocardiography revealed small echogenic masses on mitral valve. He responded to treatment with ceftriaxone given for 4 weeks. This is a rare case where Somonella typhi was isolated from blood of a patient with echocardiographic evidence of documented mitral valve disease and endcarditis

Nosocomial uropathogens and their antibiotic sensitivity patterns in a tertiary referral teaching hospital in Rawalpindi, Pakistan

Nosocomial urinary tract infections [NUTIs] are by definition not present at admission of a patient and are acquired during hospitalisation. The objective of this study was to study the uropathogens and their antibiotic sensitivity patterns in hospital acquired urinary tract infections presenting in a teaching hospital. It was a retrospective descriptive study carried out at the Department of Pathology, Fauji Foundation Hospital, Rawalpindi, Pakistan, during the year 2009. Reports of urine culture and sensitivity performed during one year were retrospectively studied with a view to document various isolates and their antimicrobial sensitivity. Out of a total number of 1204 urine cultures submitted, 246 were found to have nosocomial urinary tract infections. Over all prevalence of nosocomial urinary tract infection in the examined reports was 20.43%. Nosocomial Urinary tract infections are common. Gram negative bacilli are most frequent uropathogens and are resistant to commonly used antibiotics. Fosfomycin followed by Gentamycin and Cefotaxime were the most effective antibiotics

Role of diagnostic laparoscopy: a study of 58 patients

To evaluate the role of diagnostic laparoscopy in undiagnosed abdominal diseases. Prospective nonrandomized descriptive study. Fauji Foundation Hospital Rawalpindi, from l[st] January 2007 till 31[st] December, 2009. All the patients of undiagnosed intermittent or chronic pain abdomen and other pathologies presenting to the department of surgery who were candidates for laparoscopy were included in the study. Total of 58 patients [42 females and 16 males] were included in the study. Appendicular pathology, abdominal tuberculosis and pelvic inflammatory disease each was found in 8 patients [13.79%] and adhesions in 6 patients [10.33%]. Other less common pathologies included undescended intraabdominal testes, endometriosis, gall bladder pathology and mesenteric lymphadenopathy. In 14 patients [24.13%] no pathology was detected. Diagnostic laparoscopy is an important diagnostic tool in the armamentarium of surgeons which can be employed for diagnosis of obscure abdominal conditions. Where appropriate therapeutic measures if indicated can be adopted at the same time

Patterns of presentation, surgical management and outcome of patients with degloving injures

To describe the patterns of degloving injuries and to identify the outcome of different management techniques in patients with degloving injuries in patients presenting at Allied and Divisional headquarters hospital, Faisalabad. Prospective case study from January, 2008 to July 2008. Surgical floor of Allied and District Headquarters [Teaching] Hospitals, Faisalabad. Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome was entered on a specially designed Proforma, compiled and analyzed by using SPSS. Between February 2008 and July 2008, a total of 50 patients were included in the study. The etiological factors were road traffic accidents in 78% [39 patients], rotatory machine accidents 16% [8 patients] and domestic trauma in the remaining 6% [3 patients]. Degloving injury more commonly occurred in the lower limb 44% [22 patients], upper limb 16% [8 patients], scalp 22% [11 patients], penoscrotal 10% [5 patients] and miscellaneous group 8% [4 patient]. Associated skeletal fracture was seen in 3 [6%] patients. With increasing road traffic accidents, there is a marked increase in patients presenting to emergency department with degloving injuries. Early recognition and well planned surgical approach is all it takes to prevent complications and salvage a limb

Comparative study of inverting sutureline versus over and over continuous suturing in hypospadias repair

Hypospadias is one of the most common congenital anomalies of the male newborns affecting 1 in 300. Urethral meatus lies ectopically on the ventral surface of penis proximal to its normal position. There is defective development of urethral spongiosum and ventral prepuce. Various degrees of chordee may be associated. Objective of the study was to study the incidence of urethrocutaneous fistula formation after hypospadias repair employing two different suturing techniques. This Prospective Randomised Descriptive Clinical Trial was conducted in Department of Surgery, Fauji Foundation Hospital, Rawalpindi and Basharat Hospital, Rawalpindi, during a period of five years from January 2005 till December, 2009. A prospective study of 100 patients of glanular/penile hypospadias requiring repair was completed from January, 2005 till December, 2009. Fifty of these patients had urethral tube reconstruction using conventional over and over continuous suturing technique [Group-1]. In another group of fifty patients continuous inverting sutures [Connel technique] commonly used in intestinal anastomosis was employed [Group-2]. Polyglycolic acid sutures 4/0 to 6/0 as appropriate were used for all the repairs in both the groups by the same surgeon. Six [12%] urethrocutaneous fistulas formed in the Group-1 of fifty patients with over and over continuous suturing as compared to 4 [8%] in Group- II with equal number of patients where inverting suture technique was used. Inverting sutures reduce the incidence of urethrocutaneous fistula formation in hypospadias repair

Prevalence of malignancy in goitre-a review of 718 thyroidectomies

Thyroid malignancies are a heterogeneous group of tumours which show considerable variability in biological behaviour, histological appearances and response to therapy. Thyroid cancer is uncommon and represents only 1% of all malignancies. Objective was to determine the prevalence of malignancy in patients presenting with goitre. This prospective, observational study was conducted at Department of Surgery, Fauji Foundation Hospital, Rawalpindi from January 1999 to December 2008. All patients requiring surgery for goitre were included in the study. Postoperatively histopathologies of specimens were evaluated in all patients. 718 patients were operated and post operative histopathology specimens were reviewed. 2.92% of patients were found to have malignancy. Prevalence of papillary and follicular carcinoma was 33.33% each. Anaplastic carcinoma was found in 23.81% of patients followed by Hurthle cell carcinoma in 9.53% of patients. All postoperative thyroid specimens should be subjected to histopathology. Prevalence of follicular carcinoma and anaplastic carcinoma is relatively higher in our country due to high incidence of iodine deficiency goitre

Chest radiographic findings in bronchogenic carcinoma in Pakistani population

To observe the common radiographic findings in histologically confirmed cases of bronchogenic carcinoma. This descriptive study comprised of 35 consecutive histopathologically / cytological confirmed cases of bronchogenic carcinoma that were admitted from January 2000 to April 2003 in Bahawal Victoria hospital Bahawalpur. Plain chest radiographs were obtained in all cases. Two radiologists blinded to the cell types were asked to interpret the radiographs. Hilar mass was the major manifestation in 62.8% cases. Chest radiographs showed 7 different types of lesions in four cell varieties in 35 cases, these included hilar mass in 62% cases of squamous cell carcinoma. Cavitation and rib erosion were found exclusively in squamous cell type carcinoma. In small cell carcinomas, hilar involvement was present in 83.3% cases. Half of large cell carcinomas and one case of adenocarcinoma presented with a peripheral mass. Hilar mass was seen in 50% cases with adenocarcinoma. Wide mediastinum was seen only in cases with small cell carcinoma. The chest radiograph findings in brochogenic carcinoma has more or less a standard patterns which can help the physician in better suspicion and diagnosis

Rupture splenic artery aneurysm

We present a case of ruptured splenic artery aneurysm in 18 years old unmarried girl who presented with severe upper abdominal pain and sudden collapse. Ultrasound abdomen showed free fluid and ultrasound guided needle aspiration confirmed haemoperitoneum. On laparotomy, a 3cm saccular aneurysm of the middle of the splenic artery was noted. With prompt and urgent management the patient survived