Effectiveness of Early Versus Late Dressing Removal in Contaminated and Clean Surgical Wounds

Aim: This study was conducted to assess the effectiveness of early versus late dressing removal in contaminated and clean surgical wounds. Study design: A Prospective non-randomized study. Place and duration: In the Surgical Unit of AllamaIqbal Teaching Hospital, Sialkot from March 2018 to March 2019. Method: Sixty patients age eighteen or above (planned surgery and emergency surgery) were enrolled in the study, admitted in hospital and operated. All surgical wounds met the criteria of contaminated and clean surgical wounds. Thirty patients were included in each group with early and late dressing removal. In the early removal group, within 48 hours, the surgical dressing was removed and in the late group 48 hours after surgical intervention. The incidence of deep and superficial surgical site (SSI) infection was studied in these two groups. Additional subordinate factors such as dehiscence of wound incidence and secondary suturing were too assessed. Results: Thirty patients were included in each group with early and late dressing removal for final scrutiny. The occurrence of superficial surgical sight infection was lower expressively in the early dressing removal group. The time required for full recovery (days) (8.60-10.70; p=0.734) was shorter considerably in the early dressing removal group. In the early dressing removal group, there was the significantly shorter postoperative hospital stay (days) (10.50 vs. 15.0; p ≤ 0.001). Conclusion: Early dressing removal considerably decreases the superficial SSIs incidence in contaminated and clean surgical wounds. It also considerably decreases the time of full wound healing and facilitates short hospital stay as compared to late dressing removal.

Results of Primary Closure and Excision of Pilonidal Sinus Disease

Objective: The aim of this analysis was to determine the results of excision and primary closure of pilonidal sinus disease. Study Design: A Prospective Study. Place and Duration: In the Surgical department of PIMS Hospital Islamabad for the one-year duration from May 2018 to May 2019. Methodology: Eighty cases were included for excision with primary closure. Individuals having recurrent pilonidal sinus disease and with acute pilonidal sinus, abscess were excluded from the analysis. All subjects were operated in prone position under general anaesthesia. To clean the sinus tract; Methylene blue dye was injected. Postoperative complications and recurrence were recorded. All patients were followed at the outpatient department for three months and then every three months. Results: Eighty patients who met the criteria of inclusion were underwent surgery. 68 were male of the 80 patients, the female was 12, and 34 years was the mean age. Six days was the mean hospital stay and three weeks was the average duration when patients return to their work. From 80 patients; 10 (12.5%) had wound infection and 3 from them had minor wound infection. The seroma formation was noted in 5 (6.25%) which was aspirated. Only 6 patients had a recurrence, representing a 7.5% overall recurrence rate. Conclusion: It is concluded that pilonidal sinus disease primary closure and excision are related to early wound healing, short hospital stay, reduced chance of recurrence and rapid return to work.

Molecular epidemiology of β-thalassemia in Pakistan: Far reaching implications.

Background: β -Thalassaemia, an autosomal recessive hemoglobinopathy, is one of the commonest genetically transmitted disorders throughout the world. Collective measures including carrier identification, genetic counseling and prenatal diagnosis are required for preventing β-thalassemia. Aim: To achieve this objective, Identification of the spectrum of genetic mutations, especially for various ethnic backgrounds in Pakistan. Therefore, we designed a cross sectional prospective study to identify the frequency of various gene mutations in different ethnic groups of Pakistan. Materials and Methods: Over a 5-year period, DNA from 648 blood samples {including specimens of chorionic villus sampling (CVS)} were analyzed for the twelve most common β-thalassemia mutations found in the Pakistani population by a Multiplex amplification refractory mutation system (ARMS). Each sample was analyzed for the mutation as well as the normal gene, appropriate with negative and positive controls, and reagent blanks. Results: Out of 648 samples mutations were identified in 640 (98.75%) samples by multiplex ARMS. 8 common β-thalassemia mutations were identified in 8 different ethnic groups accounting for 93.9% of the β-thalasemia alleles. Conclusions: Based on the outcome of this study a cost effective proposal is formulated for detection of β-thalassemia mutations.

Effect of aspirin on the developing teeth of neonates / Efecto de la aspirina en el desarrollo de los dientes de neonatos

The objective of the present study was to evaluate the effect of aspirin (Acetyl Salicylic Acid) on the developing teeth of the fetus while the mothers were treated through out the pregnancy. Aspirin is a widely used analgesic and antipyretic drug used for symptomatic treatment. However, recent animal studies have indicated a potent teratogenicity of Acetyl Salicylic Acid. Its easy availability without prescription has been associated with high possibility of misuse, especially in the developing world. An experimental control study was carried out where female rabbits being treated with aspirin were taken as mammalian model, and their offspring were used to evaluate the developmental defects in teeth. Quantitative analysis of minerals in three types of the sample teeth, was done using scanning electron microscope and energy dispersive X-ray spectroscopy (SEM-EDX). Calcium was the most affected mineral and incisors and mandibular molars were found to be the most affected teeth. Voluminous variations were observed in the mineral contents of samples from the treated and control group, however, significant results could not be achieved. A larger sample size could possibly be needed to produce more conclusive results.

El objetivo del estudio fue evaluar el efecto de la aspirina (ácido acetilsalicílico) sobre el desarrollo de los dientes en fetos de conejos, cuyas madres fueron tratadas durante toda la gestación. La aspirina es un fármaco ampliamente utilizado como analgésico y antipirético para el tratamiento sintomático. Sin embargo, estudios recientes en animales han indicado una teratogenicidad potente por parte del ácido acetilsalicílico. Su fácil disponibilidad, sin la necesidad de receta médica, se ha asociado con una alta posibilidad de su mal uso, especialmente en el mundo desarrollado. Se diseñó un estudio de control experimental, donde conejos hembras fueron tratadas con aspirina, tomándose como modelo de mamíferos, y sus crías fueron utilizadoa para evaluar los defectos en el desarrollo de los dientes. Se realizó el análisis cuantitativo de tres tipos de minerales en los dientes de la muestra mediante microscopio electrónico de barrido y espectroscopía de rayos X por dispersión de energía (SEM-EDX). El calcio fue el mineral más afectado y los incisivos y molares inferiores fueron como los dientes más afectados. Grandes variaciones se observaron en el contenido mineral de las muestras de los grupos tratado y control, sin embargo, no se lograron resultados significativos. Un tamaño de muestra más sería necesario para producir resultados más concluyentes.

Does the existing traditional undergraduate Anatomy curriculum satisfy the senior medical students.

Interns at the end of their clinical year and medical students at the end of their final year were asked to evaluate the anatomy curriculum they had experienced in their undergraduate preclinical years. Most of the respondents found that the gross anatomy taught to them was adequate but the vast majority expressed that clinical anatomy, imaging anatomy and surface and living anatomy were inadequate. Both interns and medical students ranked anatomy courses and integrated clinical topics as the keystone for their clinical training and felt the need of a clinically oriented anatomy curriculum, case studies and participation of clinical faculty members in teaching during the pre-clinical years. Retrospective evaluations at the end of internships and the undergraduate years are helpful “evidence” to be considered when reforming the anatomy curriculum, and in particular when developing a clinical core course in anatomy. The results of such surveys should be taken into consideration when discussing modifications to the anatomy curriculum.

Altered liver morphology and enzymes in streptozotocin induced diabetic rats / Morfología y enzimas del hígado alteradas en ratas con diabetes inducida por estreptozotocina

This study was undertaken to evaluate the relationship and effects of diabetes on liver morphology, architecture and function. The hepatic effects of diabetes were evaluated in vivo using streptozotocin (STZ)-induced diabetic rats as an experimental model. The degree of hepatic dysfunction was measured by using biochemical parameters like serum transaminases (ALT and AST), alkaline phosphatase (ALP)and pseudocholinesterase (PChE) while the histopathological studies were carried out to support the enzymic Parameters. The aim of the study was to investigate the association between diabetic hepatic complications and liver enzyme alterations. This study was performed in the Department of Anatomy; Institute of Pharmaceutical Sciences and Institute of Diabetology and endocrinology of Baqai Medical University, Karachi. Diabetes was induced by a single dose of STZ (45 mg/kg, b.w.) given intraperitoneally in sodium citrate buffer at pH 4.5. Eighty albino rats were divided into five groups: control (A) and STZ treated (B, C, D, and E) which were sacrificed 2, 4, 6 and 8 weeks post treatment respectively. Histopathological examination of liver showed accumulation of lipid droplets, lymphocytic infiltration, increased fibrous content, dilatation and congestion of portal vessels and proliferation of bile ducts. Increased levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), ALP and PChE were observed in the liver. It seems that the diabetic complications in the liver like hepatocyte destruction etc. are likely to be due to alterations in enzyme levels.

Este estudio se realizó para evaluar la relación y los efectos de la diabetes sobre la morfología, arquitectura y la función del hígado. Los efectos hepáticos de la diabetes se evaluaron in vivo utilizando estreptozotocina (STZ) para inducir diabetes en ratas como un modelo experimental. El grado de disfunción hepática se midió mediante el uso de parámetros bioquímicos, como las transaminasas séricas (ALT y AST), fosfatasa alcalina (ALP) y pseudocolinesterasa (PChE), mientras que los estudios histopatológicos se llevaron a cabo para apoyar los parámetros enzimáticos. El objetivo del estudio fue investigar la asociación entre las complicaciones hepáticas diabéticas y la alteración de enzimas hepáticas. Este estudio se realizó en el Departamento de Anatomía, Instituto de Ciencias Farmacéuticas y el Instituto de Diabetología y Endocrinología de la Baqai Medical University, Karachi. La diabetes fue inducida por una dosis única de STZ (45 mg/kg de peso corporal) administrada por vía intraperitoneal en tampón citrato de sodio a pH 4,5. Ochenta ratas albinas se dividieron en cinco grupos: control (A) y tratados con STZ (B, C, D y E), las que se sacrificaron a las 2, 4, 6 y 8 semanas después del tratamiento. El examen histopatológico de hígado mostró acumulación de gotitas de lípidos, infiltración linfocítica, aumento del contenido de fibras, dilatación y congestión de los vasos portales, y la proliferación de conductos biliares. Aumento de los niveles de aspartato aminotransferasa (AST), alanina aminotransferasa (ALT), ALP y PChE fueron observados en el hígado. Parece que las complicaciones de la diabetes en el hígado como la destrucción de los hepatocitos etc., son probablemente debido a alteraciones en los niveles de las enzimas.

Altered kidney morphology and enzymes in streptozotocin induced diabetic rats / Morfología y enzimas renales alteradas en ratas con diabetes inducida por estreptozotocin

We studied the effects of streptozotocin (STZ)-induced diabetes on kidney morphology, anatomy, architecture and on the activities of aminotransferases (AST and ALT), alkaline phosphatase (ALP) and pseudocholinesterase (PChE) in albino rats. The aim of the study was to investigate the association between diabetic kidney complications and kidney enzyme alterations. This study was performed in the Department of Anatomy and Institute of Pharmaceutical Sciences, Baqai Medical University, Karachi and Pathology department of College of Physicians & Surgeons (CPSP) Pakistan in 2007-08. Diabetes was induced by a single dose of STZ (45 mg/kg, b.w.) given intraperitoneally in sodium citrate buffer at pH 4.5. Eighty (80) albino rats were divided into five groups: control (A) and STZ treated (B, C, D, and E) which were sacrificed 2, 4, 6 and 8 weeks post treatment respectively. Histopathology of kidney showed lesions similar to human glomerulosclerosis, glomerular membrane thickening, arteriolar hyalinization and tubular necrosis. Increased levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and pseudocholinesterase (PChE) were observed in the kidney. It seems that the diabetic complications in the kidney are likely to be associated with alterations in enzyme levels.

Se estudiaron los efectos de la diabetes inducida por estreptozotocin (STZ) sobre la morfología, anatomía, arquitectura y sobre las actividades de aminotransferasas (ALT y AST), fosfatasa alcalina (ALP) y pseudocolinesterasa (PChE) en los riñones de ratas albinas. El objetivo del estudio fue investigar la asociación entre las complicaciones renales diabéticas y la alteración de las enzimas renales. Este estudio se realizó en el Departamento de Anatomía y el Instituto de Ciencias Farmacéuticas, Universidad de Medicina Baqai, Karachi y el departamento de Patología de Colegio de Médicos y Cirujanos (CPSP) Pakistán entre el 2007-2008. La diabetes fue inducida por una dosis única de STZ (45 mg / kg de peso corporal) administrada por vía intraperitoneal en tampón de citrato de sodio a pH 4.5. Ochenta (80) ratas albinas fueron divididas en cinco grupos: control (A) y STZ tratados (B, C, D y E), que se sacrificaron a las 2, 4, 6 y 8 semanas después del tratamiento, respectivamente. La histopatología del riñón mostró lesiones similares a la glomeruloesclerosis en humanos, engrosamiento de la membrana glomerular, hialinización arteriolar y necrosis tubular. Aumento de los niveles de aspartato aminotransferasa (AST), alanina aminotransferasa (ALT), fosfatasa alcalina (ALP) y pseudocolinesterasa (PChE) fueron observados en el riñón. Parece que las complicaciones de la diabetes en el riñón están directamente asociadas con alteraciones en los niveles de las enzimas.

Does the existing traditional undergraduate Anatomy curriculum satisfy the senior medical students? A retrospective evaluation / O currículo tradicional de Anatomia é satisfatório para os estudantes do último ano de medicina? Uma avaliação retrospectiva

Objetivo: Apresentar os resultados de um estudo sobre opiniões e conhecimento de residentes de primeiro ano e estudantes de medicina sobre o Currículo de Anatomia e suas sugestões para organizar um curso de bases clínicas em anatomia. Métodos: Residentes de primeiro ano, ao final de seu ano clínico, e estudantes de medicina ao final de seu ano de graduação foram solicitados a avaliar o Currículo de Anatomia que tiveram nos anos pré-clínicos. Resultados: A maioria dos respondentes avaliou o ensino geral de anatomia adequado, mas a grande maioria considerou os cursos de anatomia clínica, anatomia de imagem e anatomia de superfície e viva muito curtos. Os residentes de primeiro ano e estudantes classificaram os cursos de anatomia e temas clínicos integrados como essenciais para seu treinamento clínico e sentiram a necessidade de um curso de anatomia orientado para a clínica, com estudos de casos e participação de docentes de clínica nos anos de ciclo básico. Conclusões: Avaliações retrospectivas ao final do primeiro ano de residência e no último ano de graduação são ?evidências? úteis a serem consideradas na reforma do currículo de anatomia, especialmente para desenvolver um Curso de Bases Clínicas em anatomia. Os resultados de tais estudos devem ser levados em conta ao se discutirem as modificações do currículo de anatomia.