Frequency of gastro oesophageal varices in liver cirrhosis

Background: Gastroesophageal varies can present as one of the complication of liver cirrhosis

Objective: To determine the frequency of gastro oesophagealvarices in liver cirrhosis

Methodology: This was a cross sectional study, carried out at Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan from 1st July to 31st December 2016. The cases of liver cirrhosis diagnosed on clinical suspicion and radiological findings of coarse echo texture of liver, dilated portal vein more than 1cm with or without ascites falling in child pugh class B and C were included. The cases were included of both gender with age range of 20-70 years. These cases then underwent upper GI endoscopy at same institute and were looked for gastro oesophageal varices. Data analysis was done by using SPSS version 20

Results: In this study, there were total 100 cases, out of which 64 [64%] were males and 36 [36%] were females. The mean age was 53+/-11 years. Gastric varices were seen in 14 [14%] of the cases. Gastric varices were significantly high in cases with child pugh class C where it was seen in 12 [17.14%] of cases with p= 0.04. This was also significantly high in cases that had duration of liver cirrhosis more than 5 years where it was seen in 13 [20.96%] of cases with p value of 0.001

Conclusion: Gastro oesophageal varices are not uncommon in cases of liver cirrhosis and it is significantly high in cases with duration of cirrhosis more than 5 years and child pugh class C

Efficacy of terlipressin in upper gi bleeding due to liver cirrhosis

Background: Upper Gastrointestinal bleeding [GI] bleeding can be a fatal and life threatening emergency and need emergency treatment to avoid unwanted morbidity and mortality

Objective: To determine the efficacy of Terlipressin in cases of upper GI bleeding due to liver cirrhosis

Methodology: In this case series, there were total 50 cases of upper GI bleed within last 24 hours due to liver cirrhosis of both genders, falling in the age range of 30-70 years, presenting to medical wards and emergency department. Terlipressin was injected in a dose of 1mg every 6 hour. This therapy was given for maximum of 72 hours. The efficacy was labeled as yes when there was no bleeding episode over 12 hours. Data was entered and analyzed by sing SPSS version 21

Results: In this study, there were total 50 cases out of which 35 [70%] were males and 15 [30%] females. The mean age and duration of cirrhosis were 49.45+/-6.85 years and 4.87+/-2 years respectively. The efficacy was almost equal in both genders [p= 0.95]. The efficacy was slight better in age group 30-49 years where 16 [69.56%] out of 23 cases had it [p= 0.12]. The efficacy was significantly better in Class A where 4 [80%] out of 5 cases had it as compared to Class B and C with p= 0.01

Conclusion: Terlipressin has good efficacy in treating upper GI bleed in cases with liver cirrhosis and this is significantly better in cases with Child Pugh Class A

Optimal primary surgical management of infected pseudoaneurysm in intravenous drug abusers: ligation or reconstruction?

Objective: To find out the optimal primary surgical treatment options for infected pseudoaneurysm in intravenous drug abusers. Study Design: Cross sectional descriptive study. Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital Lahore, from Jan 2010 to Jun 2015

Material and Methods: A total of 31 consecutive patients with a history of intravenous drug abuse and an infected pseudoaneurysm in the groin or elbow, presenting in emergency department; were included in this study. All patients were primarily treated with ligation of the artery, excision of infected pseudoaneurysm and debridement of necrotic tissues. Only one patient underwent additional revascularization procedure

Results: All patients who underwent ligation and excision procedures did well initially. One [3.2%] patient developed severe distal ischemia after ligation of femoral artery within first 24 hours, so extra anatomic revascularization procedure was performed. Five [16.1%] patients required revascularization procedure after 16 weeks due to disabling distal ischemia. No amputation was needed and mortality rate was zero

Conclusion: Primary ligation of the artery with excision of infected pseudoaneurysm and necrotic material was found the optimal initial management for infected pseudoaneurysm in intravenous drug addicts. Ischemic complications if develop should be treated with early or late revascularization

Dual plating osteosynthesis technique used for fixation of inter - condylar distal humerus fractures via transolecranon approach

Introduction: The dual plate osteosynthesis technique for fixation of inter-condylar distal humerus fracture is now considered an accepted treatment modality. It provides a rigid fixation of fracture fragments to enable early post-operative mobilization for good outcome

Objective: The purpose of study is to assess the morbidity and clinico-radiological outcome of the dual plating osteosynthesis technique used for fixation of inter-condylar distal humerus fractures [DHF] via trans-olecranon approach

Methodology: This perspective cross sectional study was carried at Department of Orthopaedic Surgery, Dow Medical College / Civil Hospital Karachi from June 2014 to March 2016. A total of 21adult patients with comminuted inter-condylar fracture of the distal humerus operated with dual plating osteosynthesis technique via trans-olecranon approach were evaluated clinically and radiologically for functional outcome based on Jupiter criteria including alignment and fracture union after a mean follow-up of 8 months. Post surgical complications were noted. Fractures were classified according to Muller et al [AO]. Patients with polytrauma, pathological fracture, open fracture and a fracture more than 2 week old were excluded from the study

Results: Out of the 21 patients, 38% were female and 62% were male. 52.3% had left elbow while 47.6% had right elbow involvement. The mean age was 31 years [range 20 - 50 years]. Mean time between injury and internal fixation was 4.8 days. The mean follow-up period was 8 months. As per AO classification, 10 cases were C1, 7 cases C2 while 4 cases were in C3. The most common cause of fracture was road traffic accident in 13 cases. All fractures achieved anatomical restoration of articular surface and were united in average 14.6 weeks. The clinical results were evaluated for functional outcome based on Jupiter criteria. According to that criterion, satisfactory results were obtained in all patients. We had no instance of postoperative deep infection and neurological complications, only Backing of olecranon K-wires were noted in 5 patients [23.8%]

Conclusions: We conclude that dual plate osteosynthesis technique is an effective procedure for fixation of inter-condylar distal humerus fracture, achieves rigid fixation and hence, early mobilization. Additionally use of olecranon osteotomy offers best fracture exposure of distal humerus. Complications were minimal and healing satisfactory

Biosynthesis, characterization and antimicrobial action of silver nanoparticles from root bark extract of Berberis lycium Royle

Various biological methods are being recognized for the fabrication of silver nanoparticles, which are used in several fields. The phytosynthesis of nanoparticles came out as a cost effective and enviro-friendly approach. When root bark extract of Berberis lycium was treated with silver ions, they reduced to silver nanoparticles, which were spherical, crystalline, size ranged from 10-100nm and capped by biomolecules. Synthesized silver nanoparticles were characterized by UV-visible spectroscopy, Scanning Electron Microscopy [SEM], Energy Dispersive X-ray Spectroscopy [EDX], Transmission Electron Microscopy [TEM], X-Ray Diffraction [XRD] and Fourier Transform Infra Red Spectroscopy [FTIR]. The plant mediated synthesized silver nanoparticles showed pronounced antimicrobial activities against both Gram negative bacteria [Escherichia coli, Klebseilla pneumoniae, Pseudomonas aeruginosa] and Gram positive bacteria [Staphylococcus aureus and Bacillus subtilis]. The plant mediated process proved to be non-toxic and low cost contender as reducing agent for synthesizing stable silver nanoparticles

Hepatitis-C virus infection among injecting drug users in Lahore, Pakistan: a cross sectional study

Objectives: To determine the prevalence and risk factors of hepatitis C virus among injecting drugs users, furthermore different genotypes of HCV infection and their effect on viral load were also found and subsequently most prevalent subtype was predicted

Methods: All samples were processed for Anti-HCV antibody detection through ELISA by using third generation ELISA Kit. The Anti-HCV positive serum samples were stored for RT-PCR to estimate the viral load and genotypes of HCV for study. Injecting drug users selected from in and around Lahore Metropolitan from July 2012 to August 2013 was included. The data analysis was completed by using SPSS version 16. A p-value of < 0.05 was considered to be significant

Results: A total of 241 Injecting drug users were enrolled and screened for Anti HCV in the study. Prevalence of HCV infection in IDUs from Lahore was found to be 36.09%. Education [p=0.000], low socioeconomic status [p=0.011], Blood transfusion [0.003], any tattoo on the body [p=0.002], use of injectable drugs with reused syringes [p=0.000] and sharing of syringes [p=0.001] in groups was significantly associated with HCV infection. Some utensils were also significantly associated with HCV status. The most common subtype of HCV genotype was 3a [n=65] followed by 2a [n=15] and 1a [n=6]

Conclusion: The study reveals that IDUs with reused syringes status and sharing of syringes in group had more chances to get HCV infection. The viral load in IDUs infected with different subtypes of genotype was significantly associated

Analysis of insect toxicity and repellent activity of phytochemicals from [Skimmia laureola, Nair] against [Black garden ant, Lasius niger] of Pakistan

A study was conducted to evaluate the toxicity and repellency of essential oils from root, stem and leaves of Nazar panra, Skimmia laureola [DC.] Zucc. Ex Walp. of family [Sapindales: Rutaceae] ver. Nair of Pakistan. The oils were tested at three concentrations i.e. 1, 5 and 10Black garden ant, Lasius niger L. [Hymenoptera: Formicidae] of Pakistan were selected and exposed to essential oils at room temperature. All essential oils showed Insecticidal activity with LC50=10.15, while dose dependant effect was significant with R2=0.98. It can be concluded that the three Essential oils in this study have both Insecticidal as well as repellent effect

Patency of autologous reverse great saphenous vein versus polytetrafluroethylene in below knee femoro popliteal bypass grafting

Objective: to compare the patency rates of autologous saphenous vein and expanded polytetrafluroethylene graft in femoropopliteal below knee bypass grafting in patients with peripheral vascular disease

Study design: comparative study

Place and Duration of Study: department of Vascular Surgery Combined Military Hospital Lahore, from January 2011 to January 2013

Methodology: patients with disabling intermittent claudication, rest pain, impending gangrene were included. All patient had duplex scan of the affected limb to assess the velocity of the blood flow in infrainguinal vessels as well as. CTA from infra-renal aorta onwards distally. At operation popliteal artery was assessed for patency and runoff. Great saphenous vein was also assessed for diameter [at least 4mm was labeled as suitable]. In non-suitable cases PTFE was used

Results: a total of 200 bypasses were performed in 190 patients. Of these, 102 [51%] patients had reverse saphenous vein bypass [RSVB] graft and 98 [49%] received expanded polytetrafluroethylene [e-PTFE] graft. Common indications of operation were intermittent claudication in 101 [50.5%] and rest pain in 70 [35%] patients. At 3 year post surgery seven [3.7%] patients were lost to follow-up and 36 [19%] died. Primary patency rate for e-PTFE graft was 62.9% while it was 86.4% for RSVB graft [p =0.032]. The secondary patency rate in e-PTFE graft was 64.1% and in RSVB graft 85.1% [P = 0.034]

Conclusion: saphenous vein graft had a superior patency rates at all intervals of time and it needed lesser redo operations when compared with e-PTFE graft

Abdominal aortic aneurysm rupture masquerading as intestinal obstruction - a rare presentation

We describe a case of a 70 year old man who presented with large bowel obstruction but the physical examination deterred initial diagnosis and raised suspicion of ruptured abdominal aortic aneurysm [AAA]. Subsequent investigations confirmed ruptured AAA. An immediate open surgical repair was performed and patient made a successful recovery. Ruptured AAA masquerade numerous diagnoses including large bowel obstruction; clinicians should anticipate and treat this challenging entity timely

Background: Among vascular diseases, AAA approximately affects 2% of the western population1. AAA is characterized by a dilatation of the localized segment of aorta more than 1.5 times than its normal calibre. Rupture of AAA is the most life threatening surgical emergency with an overall mortality ranging from 32% to 90%2. At present, there is significant scarcity of literature regarding aortic disease in Pakistan. We report a first ever successful surgical repair of a ruptured AAA with a confounding clinical presentation of large bowel obstruction in Pakistan

Role of operative lumbar sympathectomy in patients with critical lower limb ischemia not amenable to vascular reconstructive surgery

Objective: To assess the effectiveness of operative lumbar sympathectomy [LS] in patients with unreconstructable lower limb peripheral vascular disease

Study design: Cross sectional study

Place and Duration of study: Department of Vascular Surgery Combined Military Hospital [CMH] Lahore, from May 2012 to May 2015

Methodology: A total of 117 LS were performed in 105 patients fulfilling the inclusion criteria. The indications for operation were rest pain only in 61 [52.1%], rest pain with trophic changes in 24 [20.5%] and distal gangrene in 32 [27.3%] patients. Duplex scan was done and ankle brachial pressure index [ABPI] was measured preoperatively. Patients were assessed for pain using Visual Analog Scale [VAS] and improvement in trophic changes. All patients were followed up for one year documenting improvement of pain, healing of trophic lesions and / or amputations

Results: At 6 weeks postoperatively, 85 [72.6%] patients became pain free [p = 0.008], and at one year follow up 60 [51.2%] patients remained pain free [p = 0.002] when compared with preoperative pain scores. Pain improvement was more in patients with ABPI of 0.3 or more. The limb salvage rate was 67.6%. Thirty-eight [32.4%] patients end up in amputations. There was no mortality in this series

Conclusions: LS has a role in the management of ischemic symptoms and limb salvage in patients not amenable to vascular reconstruction. Preoperative ABPI has prognostic value in postoperative outcome, with clinical improvement if it is more than 0.3. Smoking was a negative predictive factor in our series

Pediatric forearm fractures; functional outcome managed with intramedullary rush nails - experience in a tertiary care hospital

Unstable forearm both bones fracture in children more than 10 years of age are difficult to manage with cast and surgical intervention is required. To determine the functional outcome of patients with unstable forearm fractures managed with intramedullary rush nail. This study was conducted at Department of Orthopedics, Civil Hospital Karachi from July 2011 to August 2013. All the patients with age in between 10 to 15 years, with close radius ulna unstable fracture presenting within 7 days of trauma or fall were included in the study. All the fractures were stabilized with intramedullary rush nails. Functional outcome was assessed at 12 weeks. There were 79 patients included in the study. Mean age was 13.17+/-2 years. There were 52 male patients [65.8%] and 27 females [34.2%]. There were 24 patients with history of road traffic accident, 29 patients with fall and 26 patients with blunt injury. Acceptable outcome was found in 64 [81%] patients and observed more in male children [p=0.001] and children above 13 years of age [p=0.027]. Union was achieved in all the patients. Six patients had pin site irritation and 2 had superficial infection. Intramedullary fixation with rush nail in unstable forearm fractures in the children appeared to be an effective method of fixation and provided acceptable outcome in 64 [81%] patients

Patient's influx at outpatient medical laboratory [OPML]; Forecasting of patient's influx at Mayo hospital, Lahore using arima model

Uni-variate time series data analysis has been reported in medical literature for prediction the patients volume, emergency overcrowding, stay length in hospital on surgical procedure and bed occupancy in hospital wards, patients influx or patients arrival, moreover to estimate the cost of hospital stay or any medical or surgical procedure. The present study was designed to fit an appropriate uni-variate ARIMA model [Box-Jenkin methodology] to forecast the patient's incoming at OPML, Mayo Hospital, Lahore. Mayo Hospital Lahore, September 2009 to December 2013 were used for fitting the best model. Time series data of male, female and peads patients coming/reporting in OPML, OPD. The appropriate model for male and female data was found as ARIMA [1, 0, 1] and for peads as ARIMA [1, 1, 1] after residuals diagnostic checks. The estimated number of male patients for Month of January2014 is 632 whereas the actual incoming of male patients in the month of January, 2014 was 649, which shows that the estimated model has ability to forecast the number of incoming patients accurately. It is now concluded that the fitted ARIMA model can be used to forecast the patients incoming to OPD Medical Laboratory for future planning and management

Comparison of marginal breakdown in bonded and conventional amalgam restoration

Aim of the study was to assess the fracture resistance of bonded and non bonded amalgam filling. Amalgam is the material of choice for posterior restorations because of its strength, longevity as compared to other materials. In spite of all these advantages of being cost effective, ease of manipula-tion, its inability to bond to tooth structure is a major problem. This makes an amalgam restoration to undergo micro leakage and subsequently secondary caries, marginal ditching and failure of resto-ration occurs. Scientific research has concluded that marginal breakdown is the factor which leads ultimately to the fracture of entire restoration. To improve the mechanical retention and ultimately the marginal breakdown and fracture resistance a new bonding amalgam has been introduced. The bonded amalgam needs to be evaluated and compared with conventional amalgam in respect of marginal integrity. It was concluded that there was no difference in marginal break down of conventional and bonded amalgam fillings and it was suggested that their use in traditional amalgam cavity preparations should not be recommended until proven clinical benefits have been demonstrated

Prevalence of Hepatitis C infection; general patients attending various hospitals of Lahore, Pakistan: a cross sectional study

Objectives: The aim of the current study was to estimate the seroprevalence and risk factors investigation associated with hepatitis C virus [HCV] infection in general patients attending various public and private hospitals of Lahore metropolitan

Study Design: Cross sectional study

Setting: Out Patient Departments [OPDs] of public hospitals, comprising of Mayo Hospital, Sir Ganga Ram Hospital, Services Hospital, Jinnah Hospital and Lahore General Hospital of Lahore

Period: 2012

Material and Methods: A total of 904 patients from outpatient departments of five public and two private hospitals were enrolled during 2012. Blood samples were collected to evaluate their anti-HCV status using 3rd generation ELISA. To find out the risk factors associated with HCV infection, the data was collected on a pretested and validated questionnaire

Results: The seroprevalence was estimated to be 14.6%. Mean age of reactive and non-reactive general patients was significantly associated [P=0.012] with anti- HCV status. Marital status [OR=2.042], socioeconomic status, blood donation [OR=2.15], prescription by doctor or non-doctor [OR=2.664], route of drug administration, relatives having hepatitis and towel sharing [OR=1.987] were significantly associated [P<0.05] risk factors for HCV infection

Conclusion: The study reveals a higher prevalence of HCV infection in general patients of Lahore due to poor socioeconomic status, treatment by quacks, excessive use of injectable drugs, house hold contacts with hepatitis patients and lack of awareness about the HCV transmission

Carotid endarterectomy under local anaesthesia is safe and effective in high risk elderly patients

Objective: to assess the safety and effectiveness of carotid endarterectomy [CEA] under local anaesthesia [LA] in high risk elderly patients

Study design: descriptive case series

Place and Duration of study: department of Vascular Surgery Combined Military Hospital Lahore, from January 2011 to January 2015

Methodology: patients with 70% or more stenosis of internal carotid artery in asymptomatic patients while 50% or more in patients with symptomatic carotid artery disease on duplex scanning were included. They underwent endarterectomy under local anaesthesia. The indication of surgery, hospital stay, complications and mortality were noted

Results: a total of 126 CEA in 112 patients [96 males and 16 females] were performed under LA. Four [3.1%] cases were converted to general anaesthesia [GA]. Shunt was used selectively in 6 [4.7%] cases with bilateral severe carotid artery occlusive disease. Perioperative transient ischaemic attack occurred in 3 [2.3%] patients and permanent neurological deficit in one [0.8%] patient. There was no mortality in this series. The postoperative complications included haematoma formation in 4 [3.1%], bleeding in 3 [2.3%], temporary dropping of lower lip in 1 [0.8%] and pseudoaneurysm formation in 1 [0.8%] patient. Hospital stay ranged from 24 to 96 hours. Mean stay in patients who had CEA under LA was 28 hours while it was 52 hours in those who needed conversion to GA

Conclusion: carotid endarterectomy under local anaesthesia is safe and effective procedure in elderly and high risk patients

Prevalence and risk factors of HIV in Faisalabad, Pakistan - a retrospective study

Although the magnitude of HIV in Pakistan has been well documented, but no record of HIV prevalence in Faisalabad region exists. A retrospective study was carried out at Sexually Transmitted Infections [STIs] clinic, District Headquarter [DHQ] hospital, Faisalabad, Pakistan to find out the prevalence of HIV and related risk factors. Between March, 2010 and December, 2012, a total of 31040 subjects were either interviewed or their medical records were reviewed. From those recruited by convenient sampling method, written informed consent was obtained and informed about the study protocol. Blood serum was tested for antibodies to HIV-1 and HIV-2 [Enzyme-linked immunosorbent assay, Western Blot]. On the whole, Anti-HIV was demonstrated in 173 [0.557%] of the respondents. This gives an overall HIV prevalence of 557 per 100,000.Averaged age of the patients was 49.5 years [range: 30-45] with 85.55% male. Majority of the patients were urban dwellers [87.28%], divorced or widowed [46.82%] and uneducated [50.28%]. A large proportion [78%] of the patients was injection drug users. Compared to blood donation/transfusion and sexual interactions, injection drug use was the major potential risk factor for HIV infection. Most important finding was higher HIV prevalence in Faisalabad region as compared to the previous assessments at the national level. This reflects an alarming situation necessitating contextual preventive interventions. Precarious practices such as injection drug abuse, blood donation/transfusion needs to be amended and extramarital sexual contacts should be avoided

Antimicrobial activities of Aerva javanica and Paeonia emodi plants

Aerva javanica and Paeonia emodi plants extracts were studied for antibacterial activity against Escherichia coli [NCTC 10418], Klebsiella pneumoniae [ATCC 700603], Pseudomonas aeruginosa, Staphylococcus aureus, Salmonella typhi, Staphylococcus epidermidis [NCTC 11047] and Methicillin Resistant Staphylococcus Aureus [MRSA] [NCTC 13143] and antifungal activity against Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger and Fusarium solani. Extracts were obtained by using methanol, n-hexane, chloroform, ethyl acetate and aqueous fraction. The extracts of Paeonia emodi and Aerva javanica showed significant antibacterial activity but only Salmonella typhi was resistant to Aerva javanica. Moreover, the antifungal activity of Aerva javanica was very poor but the fractions of Paeonia emodi showed sufficient inhibition against fungal strains

Spinal anaesthesia in paediatric patients undergoing surgery of sub umbilical region of the body

Background: The use of spinal anaesthesia in infants and children requiring surgeries of sub umbilical region is gaining considerable popularity worldwide. But in our setups in South Asia, this technique has not gained popularity yet. The objective of this prospective study was to evaluate the haemodynamic and respiratory safety of spinal anaesthesia in infants and children. Methods: In our study, 66 paediatric patients of age ranging from 6 months to 10 years of either sex, ASA I and II, undergoing surgeries of sub umbilical regions were included. Spinal anaesthesia was administered with Quincke 25 gauge needles at L3–L4 and L4–L5 space in the lateral decubitus position after premedication. Mean Arterial Blood Pressure [MAP], Heart rate, Spo2, duration of surgery and attempts of spinal block were the data recorded. Results: Out of the 66 patients, intra-operative Mean Arterial Blood Pressure [MAP] was normal in 65 [98.5%] of the patients. Heart rate was increased in 57 [86.4%] patients, intra operatively. Pulse oximetery was normal during surgery in all the children. Duration of surgery was less than one hour in 48 [72.7%] patients and it was between 1–2 hours in 18 [27.3%] of the patients. Feasibility in the form of attempts was first in 37 patients and second in 29 patients. Conclusion: The ease of performance and the safety regarding cardio- respiratory functions makes spinal anaesthesia as an alternative to general anaesthesia in infants and children undergoing surgeries of sub umbilical regions. Keywords: spinal anaesthesia, infants, sub umbilical, surgery, haemodynamics

Correlation of operative findings with pre-operative clinical signs and analysis of x-rays in patients with airway foreign bodies

Foreign body aspiration is one of the commonly encountered emergencies in ENT and still it remains a significant cause of mortality and morbidity. However with the development of modern endoscopic techniques and controlled anaesthesia, most foreign bodies can be removed safely with a bronchoscope. This study was carried out at Department of ENT, Head and Neck Surgery, Ayub Medical College, Abbottabad from 1[st] Jan 2003 to 30[th] June 2005. Total 81 patients were registered in the study. Two patients, in whom the foreign body could not be removed, were excluded from the study. The most consistent finding was decreased air entry on chest auscultation on the side of impacted foreign body which was present in 72 [91.1%] patients. The second most consistent finding was audible wheeze on the side of impacted foreign body found in 42 [53.2%] patients. The most common finding on Chest X-ray was emphysema found in 19 [61.3%] patient, followed by atelactasis in 9 [28%] patients while 3 [9.7%] patients had normal Chest x-ray. The pre-operative clinical signs in patient with aspirated foreign body give an idea about the site of foreign body in an airway. Although chest x-ray gives an idea about the pathological changes in respiratory tract it has little impact in the management of a patient with aspirated foreign body