Omphalomesenteric duct cyst in an omphalocele: a rare association

Omphalomesenteric duct [OMD] remnants and omphalocele are not infrequently seen in paediatric patients. In most of the cases, OMD remnant in an omphalocele is a Meckel's diverticulum; however rarely there may be other lesions. A one-day old male baby underwent surgery for omphalocele. At exploration a 10 x 12 cm cyst containing gut contents was found as the content of the omphalocele, with proximal and distal ileal loops running in continuity with it. Resection of the cyst with end to end primary gut anastomosis was done. Baby also had complex associated cardiac anomalies and died few days after surgery due to sepsis

Knowledge about the management of avulsed toothamong Karachi school teachers

The objective of this study was to assess the knowledge of school teachers regarding management of avulsed tooth. The information about the management of avulsed tooth was collected through a specifically designed questionnaire. A total of 150 questionnaires were distributed among teachers of five different private schools of Karachi who were dealing with children of 6 to 12 years old. Out of 150 teachers only 100 answered the questionnaire [66%]. Majority [80%] of the teachers knew about the importance of emergency management of tooth avulsions. One third [34%] teachers answered affirmative regarding their experience with tooth avulsions. 26% said that they would replant the avulsed tooth by themselves. More than half [57%] of the teachers, preferred water as the best storage medium than normal saline. Knowledge of school teachers regarding management of avulsed tooth was unsatisfactory. It should be improved by continuous dental educational seminars in schools

[Microbial profile and antibiotics sensitivities of gram-negative rods in a neonatal intensive care unit]

Infection in neonatal intensive care unit [NICUs] causes significant morbidity and mortality worldwide. The microbial profile and antibiotic sensitivity are important contributing factors. The aim of this study is to investigate the incidence of various invasive pathogens in an NICU and to describe the antibiotic resistance patterns in Gram-negative rods isolated from NICU. Data from the microbiology laboratory at Salmaniya Medical Complex from January 2002 till December 2007 were reviewed pertaining to organisms isolated, type of samples, and antibiotic resistance pattern of Gram-negative rods [GNRs]. Data were grouped into Group 1 [2002-2004] data and Group 2 [2005-2007] data. There was no significant difference between the two groups with regard to percentage of positive culture 17.3% Group 1 and 18.6% Group 2. There was a significant increase of multi-drug resistant [MDR], Acinetobacter beurmanni and extended spectrum beta lactamase [ESBL] producing organisms. Resistance to third and fourth generation cephalosporins was alarmingly high. Our study documented increase of resistant organisms and high resistance tocephalosporin. The use of ampicillin and gentamycin as empirical therapy should be reviewed. Further surveillance studies are needed to monitor both organisms and antibiotic resistance

Vesicovaginal fistula: repair by vaginal approach

To evaluate the outcome of transvaginal repair in vesicovaginal fistula even in cases having fistulous opening high in vagina or close to ureteric orifices. This study was carried out in Departments of Urology and Gynecology Lahore General Hospital from April 2004 to Oct 2007. Detailed history was taken; physical examination and relevant investigations were carried out. In extended lithotomy position, simultaneous cystoscopy and vaginal examination were performed in all cases. After identifying the fistula and ureteric orifices, trans-vaginal repair was done in all the cases. Thirty cases of urinary incontinence for 3 months to 12 years, with age range of 18 to 49 years and their parity ranged from 1 to 6. Sixty six percent fistulas were supra-trigonal and less than 2 cm [range1-4cm]. It was seen that obstetrical causes [59.4%] overruled the gynecological ones [33.3%]. Five patients had one or more previous fistula repair attempts; while one of the females had 4 deliveries even with the fistula. First repair attempt was successful in 27 [91.1%] cases, two of the remaining three were cured in 2[nd] repair and last one was cured in third trans-vaginal attempt. None of the repair compromised the ureteric orifice. The vaginal approach avoids laparotomy, splitting of the bladder and ureter re-implantation in the cases having fistulae closed to the ureteric orifice. Patient recovery is faster with less morbidity

Pattern of homicidal deaths in Faisalabad

Homicide is a reflection of extreme aggression. Many factors influence such a behavior. Family environment, urbanization and the presence of weapons. We conducted this study on autopsies conducted at the department of forensic medicine, Punjab Medical College Faisalabad to know the dimensions of homicide in terms of age, sex, weapons involved and seasonal variation if any. The study encompasses all 188 cases of homicide reporting for autopsy at the department of forensic medicine, Punjab Medical College Faisalabad from July 2001 to June 2002. The cases were categorized on the basis of police inquest and autopsy findings. The homicide rate in Faisalabad was 8.3/100,000 population/year. The age of predilection was the third decade of life and males outnumbered females by a ratio of 3.47:1. A firearm was used in almost 50% of the cases. A surge in the summer months was noticed. Homicide rate is high in Faisalabad. Firearms are the major weapon used for committing homicide

Value of urinary gram staining in the diagnosis of urinary tract infection in catheterized patients

This study was designed to evaluate the urinary Gram stain as a screening test for the diagnosis of urinary tract infection in catheterized patients, using quantitative urine culture as gold standard. Gram staining and urine culture were carried out on urine samples from 107 catheterized patients. The sensitivity, specificity, positive predictive values and negative predictive values of the test were 73.5%, 77.7%, 76.4% and 75.0% respectively. It is concluded that due to high false negative [26.5%] and false positive [22.3%] rate, Gram staining is not reliable screening test for the diagnosis of urinary tract infections, especially in catheterized patients

Frequency of bacteriuria in relation to duration of catheterization

To correlate the incidence of bacteriuria with duration of catheterization, 600 urine sample from patients catheterized for various duration were taken. The frequency of bacteriuria was 21.50% with catheter duration of 1-3 days, 62.43% with catheter duration of 4-7 days, 75.26% with catheter duration of 8-14 days and 91.26% with catheter duration of more than 14 days. The frequency of bacteriuria in female patients was significantly higher [74.13%] than in male patients [65.19%] [P< .05] during short term catheterization [4-7 days]

Pyuria as predictor of bacteriuria in catheterized patients

Six hundred and nine urine samples were analyzed for pyuria to assess its efficacy as a predictor of bacteriuria, in catheterized patients, using different techniques of pus cells estimation. In 235 and 323 urine samples, pus cells were counted per high power field in centrifuged and uncentrifuged urine respectively, while in 51 urine samples pus cells were counted per cubic millimeter in uncentrifuged urine. All the urine samples were simultaneously cultured. Pyuria [pus cells > 10/HPF or CMM] was correlated with bacteriuria [colony count > 10[5] per ml]. The overall efficacy of pyuria as a predictor of bacteriuria was low [52.01-60.78%] and there was no significant difference among the different techniques. It was concluded that pyuria as predictor of bacteriuria is the least reliable technique to be recommended in routine clinical practice