Safety of conscious sedation in patients undergoing endoscopic retrograde cholangio pancreatography

Objective: to assess the safety of conscious sedation in patients undergoing endoscopic retrograde cholangio pancreaticography [ERCP]

Study Design: an observational study

Place and Duration of Study: department of Gastroenterology, Liaquat National Hospital, Karachi, from April 2010 to April 2015

Methodology: all patients underwent ERCP procedure under midazolam and/or nalbuphine were included. Safety was assessed by monitoring the hemodynamics and complications during procedure till discharge from hospital. SPSS version 20 was used for descriptive analysis

Results: a total of 550 procedures were enrolled for the study. The mean age of the patients was 50.85 +/- 15.66 years. There were 197 [35.8%] males. Out of 550 procedures, only 2 [0.4%] reported complications. The study reports a success rate of 531 [96.5%] procedures who underwent ERCP with conscious sedation. Only 19 [3.5%] cases could not be completed successfully under conscious sedation and were converted to general aneasthesia

Conclusion: the present study shows that ERCP technique is safe under conscious sedation as it delivers balanced tranquillity

Comparative study of chromium toxicity with hypertension and end stage renal failure cases

Objective: To assess the association between hypertension and chronic renal failure with lethal effects of chromium on the beginning of the Chronic Kidney disease

Study Design: A prospective cross sectional study

Place and Duration of Study: Jinnah post graduate medical centre and Kidney centre Karachi during December 2012 to December 2013

Materials and Methods: The present study was conducted on a total of 150 patients [age > 40 years] divided into three groups. Patients in Group I included 50 patients with hypertension whereas Group II included 50 patients with hypertension associated with chronic renal failure [CRF] and Group III consisted of 50 healthy controls

Results: Results showed that levels of fasting blood sugar and HbA1c in both group I and group II weresignificantly higher as compared to controls. The levels of serum urea [132.0 +/- 28.2] and creatinine [7.8 +/- 1.38] in group II patients were significantly high as compared to group I and group III patients. The Creatinine clearance [55.1 +/- 9.61] in group II patients were significantly less as compared to group I and group III patients. Serum chromium levels were significantly high in group II patients[59.6 +/- 6.73]as compared togroup I andcontrols

Conclusion: Serum chromium level has significant correlation with glycemic index in both group I and group II patients compared to controls, while correlation with renal failure was significant only in group II patients

Pattern of utilization of dental services in public teaching hospital of Karachi

Objective: To describe the configuration of consumption of Facilities offered by the Public Teaching Hospital in Karachi

Study Design: Cross-sectional study

Place and Duration of Study: This study was conducted at the OPD of Dr. IshratulIbad Institute of Oral Health Sciences, Karachi from December, 2011 to June, 2012

Materials and Methods: The preformed questionnaire was distributed in the OPD. A total of 579 patients attending the OPD of the Public Teaching Dental Hospital Dr. IshratulIbad Institute of Oral Health Sciences

Results: Our study demonstrated that mean were in the age group 20 -39 yrs. 56.5%, while slightly more than 30 per cent were between the ages 40 -59 yrs. About 11.9%of the subjects were over 60 years old. However, no significant difference was found between the age groups and the gender [p>O.05]

Conclusion: Our study concluded that application of facilities in the people is poor. The mainstream of the people for dental approach were for the treatment of severe symptoms rather than for preventive measures. Motivation and proper awareness are required to use existing services

Effects of lactobacillus [acidophilus] on cutaneous wound repair with respect to neutrophil count in comparison with steroid

Objective: To evaluate the effects of lactobacillus [acidophilus] in repairing of wound with respect to neutrophil count in comparison with steroid therapy

Study Design: Experimental study

Place and Duration of Study: This study was conducted in the Department of Anatomy of Al-Tibri Medical College Isra University Karachi Campus from June 2014 to October 2014

Materials and Methods: Randomly selected Wistar albino rats were taken and their weight was between 100 -150 gms. The rats were divided in three groups on the basis of topical application. Group I was treated with topical normal saline, Group II with topical lactobacillus[acidophilus], and Group III topical Steroid were applied once daily].Each group is further divided into four sub groups according to the day of sampling like group Ia[day 03], group Ib[day 07], group Ic[day 14] and group Id [day 21]. Samples were taken on day 3,7,14 and 21 from each group and tissues were processed and stained to observe the neutrophil count that showed rapid healing processes. Data was analyzed on SPSS version 21 by applying ANOVA and post hoc tukey'stest

Results: Results compared the neutrophil count of Lactobacillus group with steroid group and control group.Mean +/- SD of numbers of Neutrophils / x400 in group IIa was20.500 +/- 0.577, in group IIb11.250 +/- 1.258, in group IIc5.7500 +/- .0.5000, group IId3.7500 +/- 0.9574and in groupIawas54.25 +/- 2.872, group Ib41.250 +/- 2.629, group Ic23.500 +/- 3.000 and group Id18.750 +/- 0.957. The significant value was in group IIa and group Ia[P<0.000], group IIb and group Ib[P<0.000], group IIc and group Ic[P<0.000] and group IId and group Id [P<0.000]. Mean +/- SD of numbers of Neutrophils / x400 in groups IIa was 20.500 +/- 0.577, in group IIb 11.250 +/- 1.258, in group IIc 5.7500 +/- .0.5000, group IId 3.7500 +/- 0.9574 and group IIIa was54.500 +/- 1.290, group IIIb 42.000 +/- 1.414,group IIIc32.000 +/- 0.8165 and group IIId28.750 +/- 1.258. The significant value was in group IIa and group IIIa[P<1.000], group IIb and group IIIb[P<0.002], group IIc and group IIIc[P<0.000] and group IId and group IIId[P<0.000]

Conclusion: Lactobacillus showed potent anti-inflammatory effect against both therapeutic groups

Neglected monteggia fracture: experience in eleven patients

To evaluate surgical options in the treatment of missed monteggia fracture dislocation. Case series Place and Duration of the Study: CMH Rawalpindi from May 2007 to August 2009. We have presented our surgical experience in 11 patients who reported to CMH Rwp from May 2007 to August 2009. They were treated by close reduction or surgically depending upon the patient age and delay. Boyd's approach was used for open reduction of the radial head in some cases. Postoperatively they were evaluated by Kim's elbow performance score Patients were all boys. Those below 12 years of age were included in the study. Excellent to good results were observed in those who were treated by open reduction of ulnar fracture by callus trimming with indirect reduction of radial head via interosseous membrane traction. Single forearm bone fracture should be treated as fracture dislocation until proved by adequate radiological survey and clinical examination

Comparison of shoulder function, radial nerve palsy and infection after nailing versus plating in humeral shaft fractures

To compare shoulder function, radial nerve palsy and infection after interlocking nailing with plating of fractures of shaft of humerus during 30 weeks of follow-up. Experimental study. Orthopaedic Wards of Combined Military Hospital, Rawalpindi, from November 2006 to November 2008. Two groups of 30 patients each were inducted. Group A [n=30] was treated with intramedullary interlocking nailing while Group B [n=30] underwent plating with dynamic compression plate [DCP]. Shoulder function using ASES score, radial nerve palsy and infection were observed for 30 weeks. In group A, 11 patients had severe or moderate shoulder dysfunction [ASES score below 39], out of whom 8 [72%] were above 50 years. This age related disability was significant [p=0.003]. Transient palsy was observed in 3 patients [10%] and mild wound infection in 2 [6%], which was not associated with age or open fracture. In group B, only 1 patient had severe shoulder dysfunction, the difference was statistically significant between the two groups [p=0.001], especially in patients above 50 years of age. There was no statistical difference in infection and palsy rates between the two groups. Although nailing and plating are effective treatments for fractures of shaft of humerus, ante-grade nailing may not be suitable in elderly patients, as it can cause significant shoulder dysfunction

Hepatic duct strictures: presentation and management

A prospective study was conducted in Combined Military Hospital Rawalpindi from January 1998 to December 2000[about 3 years]. A total of 11 patients with radiologically proven strictures of hepatic ducts were included in the study. All the cases were thoroughly investigated by history, physical examination, liver function tests [LFT's], Ultrasound abdomen, Percutaneous Transhepatic Cholangiography[PTC], Endoscopic Retrograde Cholangio-Pancreatography[ERCP] and Computerised Tomography [CT]scan. Out of 11 cases, 8 [72.72%]were male and 3 [27.27%]female with male to female ratio of 2.7:1. The age ranged from 33 years to 66 years with a mean age of 48 years. There were 8[72.72%] cases of benign stricture and 3[27.27%] with malignant pathology. Of the benign strictures, 4 were Type-I, 3 type -11 and 1 Type-III[Bismuth classification] while among malignant strictures 2 were Type-II and 1 Type-I [Klatskin's classification]. The jaundice was the main presenting symptom except in 1 case. Seven patients had abdominal pain, 5 had fever, 2 presented with weight loss and pruritis and mass was palpable in only one case Surgical bypass[hepatico-jejunostomy] was done in 9 cases, 1 with malignant pathology and 8 with benign strictures including redo surgery in two of the later group. Two patients found unfit to undergo surgery or because of advanced malignancy, were subjected to Percutaneous transhepatic biliary drainage[PTBD]. Patients follow- up post-operativly varied from 3 months to 2 years. Outcome of surgical bypass compared favorably with the other studies on this subject