Effectiveness of ultrasound shear for clipless laparoscopic cholecystectomy versus conventional unipolar electrocautery in patients with cholelithiasis

Objective: to determine the efficacy of ultrasound shear in laparoscopic cholecystectomy in terms of total operative time, postoperative bile leaks, gall bladder perforation rate, and postoperative bleeding from cystic artery and collateral injury to bowel and duodenum

Study Design: comparative study

Place and Duration of Study: Mayo Hospital, Lahore, from June 2013 to May 2014

Methodology: 150 cases [75 in each group] were randomized into two groups, i.e. harmonic scalpel clipless group [HSG] versus conventional laparoscopic cholecystectomy [CLC] with electrocautery group. The above stated variables were documented. The data for age, blood loss, and drain output were positively skewed as calculated using the Shapiro-Wilk test. The histograms, Q-Q plots and box plots were analyzed for all the dependent variables. Skewed qualitative continuous data was analyzed using the Mann-Whitney U-Test

Results: operative time was significantly lower in HSG as compared to CLC. Median operative times were 30 minutes [IQR 10] versus 35 minutes [IQR 10] [p<0.001]. HSG group had perforation rate of 5/75 [6.67%] as compated to 16/75 [21.33%] in CLC [p=0.010]. Intraoperative blood loss in group A was significantly lower than in group B [p=0.001]. Postoperative median pain score was 3 [IQR 2] versus 3 [IQR 3] in HSG versus CLC, respectively

Conclusion: all the primary outcomes showed improved results in the ultrasound shear group as compared to the group for conventional electrocautery

Duodenal perforation due to ingested partial denture

Ingestion of foreign bodies including dentures can be a cause of morbidity and mortality. We report a case of poor-fit denture in an elderly male with pulmonary and musculoskeletal comorbidities, who presented as an acute abdomen. The pin attached to the denture caused perforation of first part of duodenum. The only positive finding prior to surgery was a radiopaque density in the abdominal radiograph of the patient and air under the diaphragm. It is important for all the surgeons dealing with acute care patients to be aware of different designs and constructions of dentures

Penile shaft strangulation with wrought iron metallic pipe

Penile strangulation due to any solid encircling ornament or metal is rarely reported. Venous outflow obstruction due to any constricting item around the shaft leads to venous congestion, urinary obstruction, and rarely gangrene of the penile shaft skin. We report a case presenting with penile near-strangulation due to iron-lead metallic junction pipe which was cut using a heavy electric metal cutter

study of hygienic practices in secondary level students of the Quetta City

Objective: To investigate the standards of personal hygiene in secondary level students

Study Design: Observational / descriptive / cross sectional study

Place and duration of study: This study was conducted at Government Sardar Essa Khan Girls High School, Quetta from July 2014 to December 2014

Materials and Methods: The study was conducted on grade 7[th] and 8[th] students of Government Girls High School Quetta with the help of questionnaire. Health status of students was also examined by performing physical examination

Results: Amongst the target population 40.31% students were 11 to 13 years old, 57.65% were 13-16 years old while 2.04% students belonged to the 16.1 to 19 age group. Parents of the majority of the participants were literate. Family income of 52.65% students was above Rs. 15000/month. All the students had closed sewage system and community water supply in their houses. More than 80% of students were found neat, clean and healthy according to the criteria of health score designed for this study

Conclusion: This study indicates satisfactory personal hygienic conditions amongst target students but still there was a room for improvement. However, awareness campaigns should be conducted in schools to increase understanding about good hygiene practices

Surgical and visual outcomes of retinal detachment surgery in eyes with chorio-retinal coloboma

Objective: To evaluate the anatomical and visual outcome of surgical management of retinal detachment associated with chorio-retinal coloboma

Study Design: Prospective interventional case series

Place and Duration of Study: This study was conducted at Al-Shifa Trust Eye Hospital Rawalpindi from Jan 2012 to Dec 2013

Material and Methods: Twenty one eyes [21 patients] that underwent surgery for retinal detachment associated with chorio-retinal colobomas were selected. Evaluation was done on the basis of type of intervention, final visual acuity and anatomical outcome and complications. Out of 21, 19[90.47%] eyes underwent pars plana vitrectomy with silicone oil [SO] and 2[9.52%] underwent primary scleral buckling surgery. SO was removed in 9 [47.36%] eyes at final follow up. Encircling band was placed in 12 [63.15%] eyes based on peroperative judgment of surgeon. Intra-operative lensectomy was performed in 6 [28.57%] eyes. The main outcome measures were retinal re-attachment and visual recovery. Statistical analysis was performed using "IBM statistical package for social sciences [SPSS] Statistics" [version 17.0, Chicago, Illinois, USA]. Qualitative variables were described using percentage; quantitative data were defined using mean +/- standard deviation. The pre op and post op frequency of best corrected visual acuity [BCVA] was compared using Wilcoxan Signed Ranks Test. Confidence interval was 95% [level of significance p<0.05]

Results: The mean number of operations per eye were 1.57 +/- 0.74; mean follow-up was 13.1 months [range 12-18]. The retina remained attached in 18 eyes [85.71%] at final follow-up. The post op BCVA improved significantly as compared to pre op BCVA [p< 0.01]. Mean pre op BCVA was counting fingers [CF] and mean post op value of BCVA was 3/60

Conclusion: Pars plana vitrectomy along with silicon oil tamponade for retinal detachment related to choroiretinal coloboma improves the long-term anatomical outcome however no significant improvement in visual acuity was observed

Changes in macular thickness and visual acuity after intravitreal bevacizumab injfection in patients with retinal vein occlusion

To evaluate the effect of singel Intravitreal Bevacizumab [Avastin] injection on visual acuity [VA] and central retinal thickness [CRT] in patients with macular edema secondary to branch retinal vein occlusion [BRVO] or central retinal vein occlusion [CRVO]. Prospective, non-randomized, interventional case series. This study was conducted at Al-Shifa Trust Eye Hospital Rawalpindi from March 2012 to February 2013. Twenty three patients with macular edema attributable to vein occlusion received intravitreal injection of Bevacizumab 1.25 mg. Nine patients had central retinal vein occlusion [CRVO] and 14 patients had branch retinal vein occlusion [BRVO]. Complete ophthalmic examination including best corrected visual acuity [BCVA] and optical coherence tomography [OCT] was done at base line and follow up visits. At base line mean visual acuity was Log MAR 0.73 and showed improvement to mean Log MAR 0.39 at 12 weeks after intravitreal Bevacizumab [IVB] injection. Mean CRT was 527 micro m at baseline that decreased to 274 micro m after 12 weeks of IVB treatment. Intravitreal Bevacizumab appears to result in significant short term improvement of VA and macular edema secondary to vein occlusion

Delay in diagnosis and treatment of benign paroxysmal positional vertigo in current practice

More than 50% of the patients with peripheral vestibular disorders are suffering from Benign Paroxysmal Positional Vertigo [BPPV]. Diagnosis is established by positive Dix-Halpike test and/or roll test. Objective of this study was to analyse the delay in diagnosis and treatment of BPPV in current practice and to suggest measures to avoid this delay. One hundred and fifty two consecutive patients who were diagnosed and treated for BPPV in ENT department CMH Rawalpindi from Jan 2009 to Sep 2011 were selected for this study. All these patients were interviewed in detail regarding duration of vertigo, associated symptoms, visits to hospitals, investigations, treatment taken, cost of treatment and last or referral diagnosis before coming to our department. Out of 458 patients who presented with vertigo, 152 [33.2%] fulfilled the diagnostic criteria of BPPV. Male to female ratio was 1:1.17. Age range was 13-80 years and mean age 58.2 +/- 12.6. Posterior canal was affected in 96.7% and lateral canal in only 3.3%. Average duration between onset of first symptoms and diagnostic positional test was 19 months. One hundred and thirty eight patients have been visiting to general practitioners, various specialists, Homeopaths and Hakeems. Only 21% patients had visited to ENT specialists. 15.2% patients were already labelled correct diagnosis mostly by ENT specialists but Halpike test was done only in 8 patients and Epley's manoeuvre was tried in only four patients. 16.4% patients had undergone costly investigations like CT scan and MRI. Average cost on treatment before final diagnosis was Rs. 13,500 per patient. Particle repositioning procedure was successful in 84% patients in first attempt and 96% in two attempts. Though BPPV is a common and easily treatable condition, its diagnosis and treatment is delayed because of lack of awareness of this condition among doctors and patients. Clear understanding of the patho-physiology, diagnostic positional tests and canalith repositioning manoeuvre should be achieved through lectures and demonstrations

Outcome of laser photocoagulation in chronic and recurrent central serous chorioretinopathy

To evaluate the outcome of laser photocoagulation in recurrent and chronic non resolving Central Serous Chorioretinopathy [CSCR]. In this interventional case series 9 eyes of 9 patients with recurrent or chronic CSCR underwent focal laser photocoagulation. Best corrected visual acuity [BCVA], Fluorescein Angiography [FA], Optical Coherence Tomography [OCT] were performed prior to treatment as baseline workup while BCVA and OCT were reassessed at 1 week, 1 month and three months after treatment. One month after treatment, CSCR in 5 [55.55%] eyes was completely resolved, 3 [33.33%] eyes showed partial resolution of sub-retinal fluid [SRF] while in 1 [11.11%] eye SRF did not resolve at all. However after 3 months residual SRF in 2 [22.22%] eyes resolved completely while the status of other 2 [22.22%] eyes remained same. The treatment of chronic or recurrent CSCR with laser photocoagulation may result in prompt resolution of sub-retinal fluid which can be associated with rapidly improved vision. Although this case series is limited in follow up and number of patients, the encouraging results and lack of visually significant complications suggests need for further evaluation

Knowledge, attitude and practice for breast cancer risk factors and screening modalities in staff nurses of ayub teaching hospital abbottabad

Background: Breast cancer is the commonest cancer modality in female worldwide. Avoiding the risk factors can reduce its incidence and adhering to screening and early detection can reduce its mortality. A sufficient knowledge regarding the risk factors and screening modalities is therefore essential. We assessed the knowledge level about these parameters in our staff nurses. Methods: A self-administered questionnaire survey was performed. Knowledge regarding the risk factors and screening modalities were categorised into good, fair, poor and very poor categories. Results: Knowledge regarding most of the factors was found to be fair. A few things were termed as good knowledge like role of breast-feeding in protecting against breast cancer. Practice regarding the screening modalities was not satisfactory. Only a few nurses had good knowledge of the risk factors and screening modalities. Practice of the Screening modalities was also poor. Conclusion: There is a need to improve the nursing curriculum, training at the workplace and motivate them for screening practices. They should be encouraged to talk to their patients and their female attendants about prevention and early detection of breast cancer. Keywords: Breast cancer, BSE, knowledge

Mono therapy versus double therapy versus triple therapy in the treatment of diabetic macular edema

To compare the efficacy of macular laser photocoagulation [MPC] alone or MPC with intravitreal Bevacizumab or MPC with both intravitreal bevacizumab and intravitreal triamcinolone as primary treatment of Diabetic macular edema [DME]. A randomized clinical trial. Fifty eyes of 30 patients with clinically significant DME and no previous treatment were enrolled. The eyes were randomly assigned to one of three treatments groups. In Group-1, 20 eyes underwent focal or modified grid laser, In group-2, 15 eyes received 1.25 mg / 0.05ml of intravitreal bevacizumab [IVB] followed by MPC while in group-3, 15 eyes received 1.25 mg / 0.05ml of IVB and 2 mg / 0.05ml of intravitreal triamcinolone [IVT] followed by MPC. At 12 weeks after treatment, average improvement of visual acuity in group-1 was 1.0 line, in group-2 was 1.5 lines and in group-3 was 2.0 lines. Average central macular thickness reduction was significantly more [p=0.001] in group-3 [354 +/- 110 [micro]m] than in group- 1 [1 67 +/- 57 [micro]m] and group- 2 [278 +/- 76 [micro]m]. Up to 12 weeks triple therapy group showed better visual outcome than the other two groups where as the average reduction in central macular thickness was also more in triple therapy group. Further clinical trials with longer follow-up are required to evaluate the long-term visual outcomes and complication profiles after this treatment

Cytomorphological spectrum of neurosurgical lesions by crush smears cytology

To study the cyto-pathological appearance of intraoperative crush smears of neurosurgical biopsies after subsequent comparison with paraffin sections. Place and duration of study: The study was conducted at Armed Forces Institute of Pathology, Rawalpindi, for one year from February 2002 to February 2003. One hundred, neurosurgical biopsies were received for intraoperative consultation over a period of one year. Clinical information like age, gender, history, and CT scan or MRI findings were recorded. Crush smears were prepared, fixed in 95% alcohol and stained with rapid haematoxylin and eosin stains. Diagnosis was categorised into inflammatory, benign and malignant tumours considering the cyto-pathological features. Remaining tissue was fixed overnight in 10% formalin for histological sections. Permanent Haematoxylin and Eosin [H and E] sections were used as the "gold standard" for comparison. Out of 100 neurosurgical biopsies, crush smears of 94 were considered suitable for interpretation. The smears were categorised as, 8 inflammatory, 41 benign and 41 malignant tumours. Four cases were labelled as inconclusive. Eighty four of the crush smears diagnosis agreed with the histological diagnosis, cyto-morphology of the lesions on crush smear is discussed. Crush smears are useful in the intraoperative diagnosis of space occupying lesions of central nervous system as majority of the cases have typical diagnostic yield and cyto-morphology. We found crush smear cytology highly reliable, rapid and inexpensive mode of intraoperative diagnosis

Urological complications of intrauterine contraceptive device

To elucidate the urological complications of Intrauterine contraceptive device [IUCD]. This study was conducted in Fauji Foundation Hospital Rawalpindi to elucidate. The urological complications of IUCD presenting to Urology department from January 2002 to December 2006. During this period 12 ladies having IUCDs presented with lower urinary tract symptoms [LUTS]. After thorough work up, 6 patients were managed surgically and the remaining 6 were managed conservatively. In all cases the IUCDs were inserted by paramedics. Out of six cases managed surgically, 3 patients had developed complete intravesical migration of device with stone formation. While in two other patients there was partial migration of the IUCD and stone formation over the migrated component of the device. One patient had simultaneously two IUCDs, one in uterus and another in bladder. We successfully performed cystolitholapaxy and retrieved four IUCDs in these patients endoscopically. A large vesical stone and the entombed IUCD in one of our patients were also removed endoscopically. The patient who presented with two IUCDs also got the vesical IUCD removed endoscopically. In remaining six cases, the IUCDs were in proper location and the cause of LUTS in these patients was urinary tract infection. These patients were successfully managed conservatively. Insertion of IUCD necessitates regular follow-up to confirm its correct position. Migration of an IUCD warrants prompt removal, even in asymptomatic patients. Cases presenting with UTI with undisplaced IUCD should be managed with appropriate antimicrobial therapy

Usefulness of crush smears in intraopertive consultation of neurosurrgical biopsies

To evaluate accuracy of intraoperative crush smears diagnosis of neurosurgical biopsies. Cross-sectional study. The Armed Forces Institute of Pathology, Rawalpindi, from February 2002 to February 2003. One hundred, neurosurgical biopsies were received for intraoperative consultation over a period of one year. Clinical information regarding age, gender, history, and CT scan or MRI findings were recorded. Crush smears were prepared, fixed in 95% alcohol and stained with rapid haemotoxylin and eosin [H and E] stains. Diagnosis was categorized into inflammatory, benign and malignant tumours. Remaining tissue was fixed overnight in 10% formalin for histological sections. Permanent H and E sections were used as the gold standard. The average time required for intraoperative cytological diagnosis was 8 minutes. Out of 100 neurosurgical biopsies, crush smears of 94 were considered suitable for interpretation. There were 8 inflammatory, 41 benign and 41 malignant tumours, including 4 inconclusive. Eightyfour of the crush smears diagnosis agreed with the histological diagnosis. Overall diagnostic accuracy of crush smears was 93.3%. Diagnosis of inflammatory, benign and malignant tumours showed specificity of 98.7%, 96% and 94%, and a sensitivity of 70%, 97.5% and 95% respectively. Crush smears are useful in the intraoperative diagnosis of space occupying lesions of central nervous system. The crush smears cytology was found highly reliable, rapid and inexpensive mode of intraoperative diagnosis

Early surgical management of appendicular mass

To determine the results of early surgical management of appendicular lump. Quasi experimental. Bolan Medical Complex Hospital Quetta, from January 2002 to January 2005. Eighty patients of appendicular mass were operated for early surgical management. All the patients operated. The choice of incision depended upon the operating surgeon. Pus collected was measured and send for culture and sensitivity. Duration of operation was measured. Primary wound closure was the aim. Complications noted and ward stay was noted for every case. Out of four hundred patients of acute appendicitis, eighty patients were having appendicular mass. There were 56 males and 24 females patients between 14 to 60 years of age. Male to female ratio was 2.33:1. Gridiron incision made in 68.75 percent, Rutherford Morrison incision in 18.75 percent, right lower Para median incision and lower midline incision made in 25 percent of the patients. Pus collection was found amounting between 20-60 ml. Lump was dissected with extra care. Operation time was between 50-100 minutes. Primary closure of the wound was done in all patients. Wound infection occurred in 18.75 percent of the patients. Most of the patients [82.5 percent] stayed for 4-7 days postoperatively, 11.25 percent patients stayed for 7-10 days and 6.25 percent patients stayed for 14 days due to wound infection. The results of early surgical management of appendicular mass showed benefits in terms of single admission in hospital, less time consuming and lower cost of treatment

Comparison of latanoprost with timolol in lowering intraocular pressure in patients with primary open angle glaucoma

To evaluate efficacy of latanoprost as compared to timolol in lowering intraocular pressure [IOP] in patients with primary open angle glaucoma [POAG]. Comparative study. A total number of 40 patients included in this study at the department of ophthalmology Nishtar Hospital Multan, out of which 20 patients received latanoprost eye drops once daily and 20 patients received timolol eye drops twice daily. There were two groups each comprising of 20 eyes. Effect of intraocular pressure was studied by using Timolol in group I and Latanoprost in group II. Timolol was prescribed twice daily as one drop in the morning and one drop in the evening, while Latanoprost was prescribed once daily as one drop in the evening. At the end of study with six months follow-up, the mean reduction in IOP from base line was 5.63 mm Hg [22.56%] in patients receiving Timolol and 7.88 mm Hg [30.13%] in patients receiving Latanoprost Latanoprost 0.005% is an effective ocular hypotensive agent than Timolol 0.5% in lowering IOP in primary open angle glaucoma

Variations in ocular pressure during menstrual cycle

The present study investigated whether a correlation between days of the menstrual cycle and variations in intraocular pressure exists or not. The number of days since the beginning of last menses was recorded along with intraocular pressure for 1,459 women. Measurements were taken by Goldmann applanation tonometer. The differences among various days of menstrual cycle were statistically insignificant. The highest mean IOP occurred between 20th and 22nd day and the second peak from 13th to 15th days of the cycle. The lowest mean IOP was found from 16th to 19th days of the cycle. This study concludes that intraocular pressure varies with the various days of the menstrual cycle, but fluctuations are statistically insignificant and cannot affect the diagnoses of glaucoma

Magnitude of decrease in intraocular pressure depends upon intensity of exercise

The present study was planned to investigate the relationship between the magnitude of intraocular pressure (IOP) reduction after short-duration exercise and the intensity, duration and quantity of exercise in healthy subjects. Twenty-five healthy, sedentary male of the same age group, performed exercises at the levels of 80%, 60%, and 40% maximum heart rate (HRmax) for 15 minutes, 80% HRmax for 7.5 minutes, 60% HRmax for 10 minutes, and 40% HRmax for 30 minutes. IOP was measured with the Goldmann applanation tonometer. The IOP reduction at 5 minutes after 15 minutes of exercising at 80% HRmax, 60% HRmax, and 40% HRmax were 4.7 +/- 0.9, 3.5 +/- 0.7, and 0.9 +/- 0.4 mmHg, respectively. At five minutes, after exercising 7.5 minutes at 80% HRmax, 10 minutes at 60% HRmax, and 30 minutes at 40% HRmax, IOP reduced by 4.5 +/- 0.7, 3.3 +/- 0.9, and 2.9 +/- 1.1 mmHg, respectively. This study concludes that intensity of exercise seems responsible for the magnitude of the initial IOP decrease after short-term exercise. Furthermore, it seems that other factors such as duration of exercise or quantity of exercise, blood pressures, body mass index are not related to the amount of the initial fall in IOP.

Effect of seasons upon intraocular pressure in healthy population of China

Studies have been shown that intraocular pressure (IOP) shows a seasonal variation, but amount of change differs from study to study. The variability in their results may be due to negligence of factors that can affect IOP. Due to differences in environmental conditions of China than other countries, we investigated seasonal variations in IOP of 103 healthy male Chinese of Shanghai. IOP was measured each month over the course of fourteen months with the Goldmann applanation tonometer. The average intraocular pressures in the winter months were higher than those in the spring, summer, and autumn months. The IOP difference between winter and summer months was found to be 1.4 +/- 0.7 mmHg.This study confirms that season influences IOP. As compared to other nations, effect of seasons on IOP seems to be somewhat less pronounced in Chinese. The possible mechanisms, responsible for the seasonal variation of intraocular pressure, are also postulated.

Age and intraocular pressure: how are they correlated?

The relationship between intraocular pressure and age in not fully understood. Intraocualr pressure may increase or decrease with age. Study was planned to determine the effect of aging on intraocular pressure of an apparently healthy population of Karachi. Depending upon age, 8036 subjects were divided into seven groups. All were examined according to standard protocols. Measurements were taken by Goldmann applanation tonometer, after a complete rest for atleast 15 minutes and always first in the right eye. Mean intraocular pressure increases progressively with age until 60 years. When one age group is compared with its preceding, the increase is non-significant until 40 years but highly significant [P<0.001] in the age groups of 41-50 and 51-60 years. The data shows non-significant decrease in the age group of 61-70 but an increase in the age group of above 70 years. This study supports the conclusion that as age increases, intraocular pressure also increases, with an average of 0.28 mmHg per decade. Knowledge of the normal range of intraocular pressure in various age groups will help glaucoma screeners