Comparative efficacy of prolene and prolene-vicryl composite mesh for experimental ventral hernia repair in dogs

In this study, efficacy of two hernia mesh implants viz. conventional Prolene and a novel Prolene-Vicryl composite mesh was assessed for experimental ventral hernia repair in dogs. Twelve healthy mongrel dogs were selected and randomly divided into three groups, A, Band C [n=4]. In all groups, an experimental laparotomy was performed; thereafter, the posterior rectus sheath and peritoneum were sutured together, while, a 5 × 5 cm defect was created in the rectus muscle belly and anterior rectus sheath. For sublay hernioplasty, the hernia mesh [Prolene: group A; Prolene-Vicryl composite mesh: group B], was implanted over the posterior rectus sheath. In group C [control], mesh was not implanted; instead the laparotomy incision was closed after a herniorrhaphy. Postoperative pain, mesh shrinkage and adhesion formation were assessed as short term complications. Post-operatively, pain at surgical site was significantly less [P<0.001] in group B [composite mesh]; mesh shrinkage was also significantly less in group B [21.42%, P<0.05] than in group A [Prolene mesh shrinkage: 58.18%]. Group B [composite mesh] also depicted less than 25% adhesions [Mean +/- SE: 0.75 +/- 0.50 scores, P

Hematological studies in chickens infected with hydropericardium syndrome

The present research project was designed to determine the hematologiacal values in infected broiler flocks with hydropericardium syndrome from January to June, 2012 in order to adjoining areas of Hyderabad Sindh. A total of 72 containing population 96,500 broiler chicken were surveyed to observe for hematological variation during the study period. Only 30 [41.66%] flocks were found affected with Hydro pericardium syndrome. Out of these flocks, the incidence of syndrome was recorded as 5.4% during the month of January, 7.41% in February, 10.8% in March, 13% in April, 15.1 in May and 12.8% during the month of June. The hematological studies were conducted in infected broilers with hydropericardium syndrome and found increase in white blood cells [WBC] from 14.500 +/- 2.298 to 25.820 +/- 844.00 and concentration of erythrocytic sedimentation rate [ESR] from 2.340 +/- 0.89 to 3.458 +/- 0.291. Amongst leukocytic count, showed marked increase with neutrophils and relative decrease of lymphocytes from 69.360 +/- 0.152 to 55.480 +/- 2.132, monocytes 4.660 +/- 0.598 to 3.340 +/- 270, eosinophils 1.496 +/- 0.204 to 1.004 +/- 0.097 and basophils 0.878 +/- 0.55 to 0.734 +/- 0.067 in infected birds

Road traffic crashes in Ramadan: an observational study

The aim of this study was to investigate trends in road traffic crashes [RTCs] managed by an emergency service, Rescue 1122, in 2011 in Punjab, Pakistan. RTC data were collected from 35 districts of Punjab and reviewed retrospectively. Data analysis revealed that the service responded to 12 969 RTC emergencies during August 2011 [Ramadan], compared with an average of 11 573 RTCs per month from January to August 2011. The younger age group [11-27 years] was victims in 29% of RTCs; 39% were due to speeding and 43% occurred in peak rush hours [14:00-18:00] before iftar [breakfast].Results of the study showed that Rescue 1122 faced more RTCs during Ramadan compared with the preceding months. Road safety is an important public health issue in Pakistan. Although there have been great improvements in roads in the past few years, much work needs to be done to deal with mounting trends in RTCs. Public awareness, political will and stringent law enforcement are key factors

Autoimmune thrombocytopenia. Is it a different disease or different aspects of a single disease?

To evaluate the association between autoimmune thrombocytopenia with other autoimmune disorders, to show if they are different autoimmune diseases or one disease with different presentations at the same time, and to study the effect of treatment on platelet count in different thyroid condition. In this retrospective study, we included 141 patients with thrombocytopenic purpura. The result of thyroid function test, thyroid autoantibodies, Coombs' reactivity, anti-nuclear antibody, and double-stranded DNA were analyzed. This study was conducted in the Clinical Hematology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia between June 2003 and August 2010. There were 51 [36.2%] patients with laboratory evidence of autoimmune disease, 13 [9.2%] with hypothyroidism, and 6 [4.3%] with hyperthyroidism. In addition, 5 [3.5%] patients showed laboratory evidence of Evan syndrome and 3 [2.1%] patients had isolated positive thyroid antibodies. There was non-significant difference [p=0.61] in platelets count after one month of treatment of patients with different thyroid condition. Immune thrombocytopenia is associated with evidence of different autoimmune disease or a combination of them, which may appear at presentation or during the course of disease giving evidence that they are different manifestations of a single disease. Screening patients for antithyroid antibodies would identify a patient at risk of developing overt thyroid disease. These patients may be further screened with a thyroid-stimulating hormone assay to detect subclinical thyroid disease

Estimation of insulin resistance in non-diabetic normotensive Saudi adults by QUICKI, HOMA-IR and modified QUICKI: a comparative study

Identification of insulin resistance [IR] in the general population is important for developing strategies to reduce the prevalence of non-insulin-dependent diabetes mellitus [NIDDM]. We used the original and a modified version of the Quantitative Insulin Sensitivity Check Index [QUICKI, M-QUICKI], and the Homeostasis Model Assessment of Insulin Resistance [HOMA-IR] to divide non-diabetic normotensive adults into high-[HIR] and low-insulin-resistant [LIR] subgroups to investigate similarities and differences in their characteristics. Three hundred fifty-seven healthy adults aged 18-50 years were recruited randomly from health centers in Jeddah in a cross-sectional study design. Anthropometric and demographic information was taken. Insulin, glucose, lipid profile and free fatty acid were determined in fasting blood samples. M-QUICKI, HOMA-IR and QUICKI were calculated. Reported cut-off points were used to identify HIR subjects, who were then matched for age and sex to others in the study population, resulting in 3 HIR and 3 LIR subgroups. Two hundred nine subjects satisfied the selection criteria. M-QUICKI correlated significantly [P=.01] with HOMA-IR and QUICKI values. Increased adiposity was the common characteristic of the three HIR subgroups. HIR subgroups identified using M-QUICKI [97 subjects] and HOMA [25 subjects], but not QUICKI [135 subjects], had statistically different biochemical characteristics compared to corresponding LIR sub-groups. Adiposity, but not sex, is a risk factor for IR in the studied population. Further studies are needed to choose the most appropriate index for detecting IR in community-based surveys

Comparison of preoperative computerized tomography scan imaging of temporal bone with the intra-operative findings in patients undergoing mastoidectomy

To compare the consistency rates of pre- and intra-operative radiological findings in patients with chronic suppurative otitis media CSOM. In a cross-sectional study, 80 patients with CSOM underwent pre-operative CT scanning and we compared the results with intra-operative clinical findings during mastoidectomy from 2000-2004 in the Otology Department, Amiralmomenin Hospital of Guilan Medical University, Rasht, Iran. Sensitivity, specificity, positive and negative predictive value of CT scan in tympanic and mastoid cholesteatoma, ossicular chain erosion, tegmen tympani erosion, dehiscence of facial canal, lateral semicircular canal LSCC fistula were assessed. Then, correlation between radiological findings and intra-operative findings were calculated. The mean age of the patients was 27.9 +/- 16.3 years. Mostly were males n = 57 [71.3%]. Correlation of preoperative radiological images with intra-operative clinical findings were moderate to good on tympanic cholesteatoma, mastoid cholesteatoma and ossicular chain erosion, but weak and insignificant in cases of tegmen tympani erosion, facial canal dehiscence and LSCC fistulae. Preoperative CT scan may be helpful in decision-making for surgery in cases of cholesteatoma and ossicular erosion. Despite of limitations radiological scanning is a useful adjunct to management of CSOM

Salivary anti-Helicobacter pylori positivity among endoscopy patients with chronic liver disease

In this study, endoscopy patients with and without chronic liver disease [CLD] were examined and tested for Helicobacter pylori infection by detecting the presence of serum and salivary anti-H. pylori antibody. The validity of these measures was compared with Campylobacter-like organism analysis [gold standard] performed on patients requiring gastric biopsy. Among 114 patients with CLD and 50 without, the commonest endoscopy diagnosis was gastritis [27.2%]. Salivary H. pylori positivity was significantly associated with older age. Salivary anti-H. pylori antibody positivity showed low sensitivity [36.6%] and high specificity [75.8%] in CLD patients

Cardiovascular risk factors in Saudi Arabian and non-Saudi Arabian diabetic patients in Saudi Arabia

To determine frequency of cardiovascular risk factors in Saudi and non-Saudi diabetics, we studied patients attending King Abdulaziz University Hospital for follow-up in the period January 1997 to December 2001. Cardiovascular risk factors, including hypertension, hyperlipidaemia, obesity and smoking, were studied as well as degree of blood glucose control. Of 1122 patients in the study, 48% were Saudis and 52% non-Saudis. No statistically significant difference was found for prevalence of cardiovascular risk factors between the two groups. Correlation of each of the risk factors to patient's age showed significant correlation to hypertension and smoking

Sub-optimal postpr and ial blood glucose level in diabetics attending the outpatient clinic of a University Hospital

To determine the frequency of diabetic patients who attained the optimal postpr and ial blood glucose level. Cross-sectional study of type-2 diabetic patients being followed at the medical outpatient clinic of King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from January 1999 to December 2001. Patients were classified according to postpr and ial blood glucose level into 3-categories; group-1 [<9mmol/l], group-2 [9.1-10 mmol/1], group-3 [>10 mmol/1]. Other data such as age, sex, duration of diabetes, presence of hypertension, hyperlipidemia, smoking, obesity, ischemic heart disease was recorded as well as mortality. Results; A total of 443 patients were studied with mean age of 55 years and equal male to female ratio. The mean 2-hour Postpr and ial blood glucose level was 14 mmol/1. The majority of patients were in group-3 [71%], while group-1 was 22% and group-2 was 7%. Patients with high 2-hour postpr and ial blood glucose [group-3] have a higher prevalence of hypertension [120/315 [38%] versus 31/97 [32%] p=0.01], hyperlipidemia [72/315 [23%] versus 13/97 [13%] p=0.02], obesity [79/315 [25%] versus 18/97 [19%] p=0.04], ischemic heart disease [72/315 [23%] versus 16/97 [17%] p=0.04] and mortality [35/315 [11%] versus 8/97 [8%] p=0.06] compared to those with controlled level [group-1]. A low frequency of diabetics attained the optimal 2-hour postpr and ial blood glucose level. Action should be taken on this crucial issue for the optimal management of diabetes

case of Rifampicin induced pseudomembraneous colitis

We report a case pf pseudomembranous colitis that developed in a patient with tuberculous abdominal lymphadenopathy during treatment with rifampicin. The patient had delayed presentation [3 months] after the start of rifampicin. She had one relapse after 2 months that was successfully treated, and she finished her antituberculosis therapy without any further relapses. Awareness of this serious complication of rifampicin therapy should be encountered

Dyslipidemia and type-2 diabetics

To determine the frequency of type-2 diabetics who have target lipoprotein blood levels and to study these levels in patients with ischemic heart disease and cardiovascular disease risk factors. Retrospective analytical study of hyperlipidemic type-2 diabetics between January 2000 and January 2001 was undertaken. King AbdulAziz University Hospital. We studied hyperlipdemic type-2 diabetics who were on regular follow up to the medical outpatient clinic of King Abdulaziz University Hospital from January 2000 to January 2001. The mean lipoprotein levels, duration of hyperlipidemia and it's treatment, duration of diabetes, it's treatment and degree of blood glucose control, presence of hypertension, ischemic heart disease, and smoking were recorded. A total of 202 patients were studied with mean age of 60 years and equal male to female ratio. The mean duration of diabetes was 10 years and it was 7 years for hyperlipidemia. The mean level of LDL was 3.15 mmol/l and it was 1.0 mmol/l and 2.47 mmol/l for LDL and TG respectively. Only 31% of patients had LDL<2.6 mmol/l, 28% had IIDL >1.1 mmol/l and 37% had TG <1.7 mmol/l. No significant difference was found in the frequency of target level of LDL in patients with IHD and those without; 26% versus 34% [0.4]. Similarly, no difference was found in those with hypertension, obesity, and patients with family history of hID compared to those without these risk factors; 30%, 26%, 16% versus 34%, 36%, 33% [p 0.2,0.1,0.4 respectively]. Males were found to have a higher frequency of target LDL level compared to females; 38% versus 25% [p 0.04]. A low frequency of type-2 diabetics has target levels of lipoproteins and this was also evident in diabetics with IHD and CVD risk factors

Is hypertension common in hosptalized type 2 diabetic patients?

To report on the prevalence and implications of hypertension in hospitalized type 2 diabetic patients at King Abdulaziz University Hospital. Relevant data was retrieved from the medical charts of type 2 diabetic patients admitted to the medical unit of King Abdulaziz University Hospital in the period between January 1998 and September 1999. Patients' age, sex, body mass index, presence of hypertension and hyperlipidemia, degree of glycemic control, reason for admission, duration of hospital stay and mortality were recorded. A total of 427 patients were studied, 46% of whom were hypertensive. Hypertensive diabetics tend to be older, more likely to have a higher body mass index and hyperlipidemia, to develop cardiovascular complications and renal failure, to stay longer in hospital and to have higher mortality compared to normotensive diabetics. Hypertension is common in diabetics, early treatment of which is important to prevent cardiovascular complications, to minimize the progression of microvascular complications and to decrease mortality

Urinary tract infection

To determine the clinical characteristics, risk factors, causative organisms and antimicrobial susceptibility in diabetics and non-diabetics admitted to King Abdulaziz University Hospital Medical Unit to decide on the use of empiric antimicrobial therapy. Significant bacteriuria from the Medical Unit of King Abdulaziz University Hospital from January 1999 to August 1999 were included in the study. Medical records were reviewed and the patients were divided into 2 groups according to the presence or absence of diabetes. The following information was recorded, patients' age, sex, type of infection [community or hospital acquired], presence of dysuria, urinary catheter, intensive care unit admission, duration of hospital stay, type of organism isolated and their antimicrobial susceptibility. A total of 182 specimens were studied, 58 [32%] were diabetics. Mean age of diabetics was 64 years versus 54 years in non-diabetics and the male:female ratio was 1:1.6 versus 1:1.1 [p0.001, 0.03]. Urinary catheters were present in 12/58 [20%] diabetics and 31/124 [25%] non-diabetics, intensive care unit admission was in 23/58 [40%] versus 38/124 [31%], and duration of hospital stay was 43 days versus 38 days [p0.6, 0.1, 0.4]. Escherichia coli was isolated in 9/50 [18%] hospital acquired infections and 4/8 [50%] community acquired infections in diabetics versus 26/106 [25%] and 8/18 [47%] in non diabetics. Pseudomonas species were isolated in 16/50 [32%] and 1/8 [13%] in diabetics and 22/106 [21%] and 0/18 in non-diabetics. Escherichia coli and pseudomonas in both groups showed resistance to ampicillin and sensitivity to aminoglycoside and ciprofloxacin. Diabetics were older with high female ratio compared to non-diabetics. Escherichia coli is the most common isolate in community and hospital acquired infections in non-diabetics, while Escherichia coli was common in community acquired infection and pseudomonas was the predominant isolate in hospital acquired infection in diabetics. Aminoglycoside and ciprofloxacin can be used empirically to treat both types of infection in diabetics and non-diabetics

Clinical profile of stroke: the experience at King Abdulaziz University Hospital

To determine the pattern and risk factors of stroke in Saudi nationals and non-Saudis, at King Abdulaziz University Hospital [KAUH], in the western province of Saudi Arabia. All cases of stroke admitted to KAUH in the period between January 1995 and December 1999 were studied. Demographic data of the patients, stroke types, risk factors and mortality were reported. Of the 103 patients studied, 56% were Saudis and 44% non-Saudis with male predominance and mean ages of 66 and 62 years respectively. In Saudis, the stroke types were 74% ischemic, 10% hemorrhagic and 16% unspecifi ed, whereas in non-Saudis, the fi gures were respectively 62%, 29% and 9%. The frequency of stroke increased steadily with age in Saudis but dropped after the sixth decade in non-Saudis. There was no signifi cant difference between the Saudis and the non-Saudis in the occurrence of risk factors for stroke or in mortality. The pattern and risk factors of cases of stroke treated at KAUH are similar to those reported from other regions of Saudi Arabia and other parts of the world

Low rates of diabetic patients reaching good control targets

A cross-sectional study was conducted of 404 diabetic patients attending King Abdulaziz University Hospital medical clinic from June 1998 to January 2000 in order to determine their rates of reaching target levels for blood glucose, blood pressure, serum lipids and body mass index. Greatest difficulty was found in reaching target levels for low-density lipoprotein and glycated haemoglobin. Target levels for blood pressure were harder to achieve for Saudis than non-Saudis. Significantly fewer females reached target levels for blood glucose, body mass index, low-density lipoprotein or all targets than males [both Saudi and non-Saudi]. Efforts are needed to improve compliance to diet and drug regimens and to identify and treat risk factors in each patient

Secondary prevention measures after acute myocardial infraction: Comparison between diabetics and non-diabetics at a Saudi teaching hospital

To compare between the use of secondary prevention measures after acute myocardial infarction in diabetic and non-diabetic patients who were admitted to the King Abdulaziz University Hospital. Method: All patients admitted with a definitive diagnosis of acute myocardial infarction between January 1995 and December 1999 were studied. Patients' age, sex, body mass index, development of heart failure, peak serum creatinine phosphokinase, duration of hospital stay, use of aspirin, beta-blockers or angiotensin-converting enzyme [ACE] inhibitors on discharge and outcome were reported. A total of 184 patients were studied, 53% were diabetics and 47% non-diabetics. The mean age for diabetics was 56 years with a male:female ratio of 3.9:1, while for non-diabetics it was 53 years with a male:female ratio of 7.7:1 [p = 0.05, p = 0.09, respectively]. Diabetic patients had a higher incidence of heart failure compared to non-diabetics, 57 versus 43% [p = 0.05], and had a longer hospital stay, 12 versus 10 days [p = 0.03]. Aspirin was used by 97% of the diabetics and 94% of the non-diabetics [p = 0.4], while beta-blockers were used by 43 and 44% [p = 0.9] and ACE inhibitors by 67 and 51% [p = 0.03], respectively. There is no difference in the use of aspirin and beta-blockers between diabetic and non-diabetic patients. ACE inhibitors were used more by diabetics. There is underutilization of beta-blockers by diabetics and non-diabetics. Physicians should be encouraged to use beta-blockers as secondary prevention measures after acute myocardial infarction as they have substantial benefits and are of generally low treatment cost

Subclinical diabetic neuropathy a common complication in Saudi Diabetics

To determine the prevalence of sub clinical diabetic neuropathy in Saudi diabetics and the risk factors associated with symptomatic diabetic neuropathy. A prospective study of Saudi diabetics attending King Abdulaziz University Hospital out patient clinic from January 1998 until April 1999. Detailed information of each patients' age, sex, body mass index, type and duration of diabetes mellitus, mode of treatment, degree of blood glucose control, presence of hypertension, hyperlipidemia, smoking, family history of diabetes mellitus and hypertension were recorded. Patients were assessed for diabetic neuropathy using the Michigan Neuropathy Program. Patients who were asymptomatic and scored less than 2 on simple clinical examination were referred to a neurologist for a complete neurological examination and nerve conduction studies. A total of 237 patients were studied with a mean age of 54.19 years and mean duration of diabetes 10.6 years. Symptomatic diabetic neuropathy was present in 132 [56%] patients while subclinical neuropathy was present in 58 [57%] of asymptomatic patients. Old age, type II diabetes with long duration, poor control and smoking were risk factors associated with symptomatic diabetic neuropathy [p<0.001, p=0.09, p<0.001, p=0.04, p=0.08]. Subclinical diabetic neuropathy is common. Early diagnosis is important for possible prevention of late neuropathic complications [foot ulcers and infections]. Prolonged poorly controlled diabetes mellitus, old age and smoking are risk factors for symptomatic diabetic neuropathy. Meticulous blood glucose control is important for nerve function protection. Researches are urgently needed for satisfactory therapy