Fistula in ANO; presentation and postoperative outcome of the different surgical procedures in low type

This study was planned to find out the clinical presentation and postoperative outcome of different surgical procedure in low type in low fistula in Ano. Prospective observational study. Study was conducted in teaching hospital setting at LUMHS Jamshoro, Zia ud Din Teaching Hospital Karachi and DHQ JMC Teaching Hospital Charsadda. Liaquat University in Surgical Unit-1 Jamshoro from May 2010 to June 2012. One seventy cases of low type fistula in Ano with single external opening, irrespective of age and sex admitted in surgical unit-l, were examined. Mean age was 37 years, patient's rages from [15-60 years]. Patients having high type fistula in ano identified pre and per operatively excluded from the study. A detailed history physical examination including local examination of anorectum focusing on the level of internal opening. Investigation like fistulogram done in selected case. Fistulectomy and fistulotomy performed in all these cases and patient followed up minimum upto the 6 months time. Maximum Number of cases were seen in 3rd,4th, decade of life 50 [29.6%] and 64 [37%] respectively. Mean age was 37 ranges from 15 to 60 years. Out of 172 patients 142 [85.7%] male and 24 [14.3%] female. Male to female ratio was 6.1:1. Majority of patients one forty two [82%] presented with discharge. Discharge along with swelling in 132 [76.7%]. Hundred twelve [65%] underwent fistulectomy, 38 [22%] of the patients got fistulotomy and [12%] of patients underwent fistulectomy along with haemorrhoidectomy and fissurectomy. A total of 72 [41.4%] patients experience different post operative, surgical and anesthetic complications. Conclusions: Incidence of low type fistula in ano is higher in 3rd and 4th decade of life. The disease was found more common in male, discharge, pain, itching are common symptoms of low type fistula in ano. In low type fistula in ano fistulotomy is safe procedure. Post operative complications can be prevented by careful treatment efforts

Efficacy evaluation of pharmaceutical optimized ramipril 1.25mg [F-4] with essential hypertension

Hypertension is one of the strongest modifiable risk factors for cardiovascular and kidney disease and has been identified as the leading risk factor for mortality. ACE inhibitors or angiotensin converting enzyme inhibitors reduce peripheral vascular resistance via blockage of the angiotensin converting enzyme. This action reduces the myocardial oxygen consumption. This study aimed to evaluate the efficacy of once-daily optimized Ramipril 1.25 mg [F-4] versus placebo. Placebo-controlled, comparative study. This study was conducted in the department of Biochemistry, University of Karachi from January 2010 to June 2010. This was multicenter, randomized, placebo-controlled, comparative study. Patients were selected from different hospitals of Orangi Town Karachi and study was conducted in the department of Biochemistry, University of Karachi. Patients were randomized to receive optimized Ramipril 1.25 mg [F-4] once daily and Placebo once daily for 8 weeks. The efficacy variable was change from baseline at the end of study which was evaluated. The patients treated with optimized Ramipril 1.25 mg tablet [F-4] alone, blood pressure reduction was lower, although significant; reaching values of 139.9 +/- 11.3 / 89.9 +/- 5.5 mmHg [p < 0.05 versus Placebo] by the end of eight weeks of treatment. The results of this study demonstrated that the optimized Ramipril 1.25 mg [F-4] has a high antihypertensive efficacy and achieve desired blood pressure for eight weeks

Effects of monteleukast in mild to moderate asthmatics using fixed dose combination inhalers

A randomized open label phase IV, non comparative trial according to GCP guidelines was conducted at the Dept. of Pulmonology, Jinnah postgraduate Medical Centre, Karachi between Dec 2001 - March 2002, to evaluate the efficacy of Montelukast [Singulair 10 mg 1x0.D] on 80 patients with mild to moderate asthma [FEV1 60-80% of predicted value], who were not well controlled on their Pre-trial therapy of combination Inhalers[Salbutamol + Beclomethasone] and to assess the reduction in usage frequency of fixed combination inhalers in these patients.Prior to randomization, all the patients had their Inhaler technique checked and were provided with Volumhalers if they were not using it previously. Patients who were not taking inhalers properly were excluded from study. Total duration of trial was 30 days with follow up after every 10 days. The results showed that at the end of 30 days 82% had occasional wheezes [no wheeze or having wheeze less than once a week], 79% had breathlessness less then one week or not at all.] 73% did not have nocturnal symptoms at end of trial while 72% patients. On day 30 were either not using fixed combination at all or were occasional users. The results concluded that patients with mild to moderate persistent asthma can be controlled with oral Montelukast resulting in marked reduction in usage of combination inhalers

Upper extremity deep vein thrombosis

A case of deep vein thrombosis of axillary vein [Paget-Schroetter syndrome] is described in an 18 years old male. Patient presented via emergency with a one week history of pain and swelling of arm. Duplex imaging showed deep vein thrombosis of third part of left axillary vein and venae comitantes of brachial artery. Patient's condition resolved on conservative treatment