The outcome of primary percutaneous coronary intervention in patients with stent thrombosis

Background: Primary percutaneous coronary intervention (PCI) is a recommended management strategy for patients with de novo ST-segment elevation myocardial infarction (STEMI). Still, the efficacy of primary PCI in-stent thrombosis (ST) induced STEMI is unclear. The aim was to assess the clinical characteristics and the in-hospital outcomes of patients undergoing primary PCI for STEMI caused by acute, sub-acute, or late ST. Methods: A sample of hundred consecutive patients who presented with STEMI due to ST were included in this study. The angiographic evidence of a flow-limiting thrombus or total vessel occlusion (thrombolysis in myocardial infarction (TIMI) flow grade 0 to II) at the site of the previous stent implant was taken as ST. Primary PCI was performed, and all enrolled patients and in-hospital mortality were observed. Results: Male patients were 69, and the mean age was 58.9 ± 7.78 years. ST was categorized as acute in 40 patients, sub-acute in 53, and late in the remaining seven patients. Killip class III/IV was observed in 45 patients. Dissection was observed in 25, under deployment in 74, and/or malposition in 24 patients. Thrombus aspiration was performed in 97, plain old balloon angioplasty in 76, and stenting in 22 patients. Final TIMI III flow was achieved in 32 patients. During a mean hospital stay of 4.93 ± 2.46 days, the mortality rate was 27%. Conclusion: In-hospital mortality after primary PCI was observed in more than 1/4th of the patients with STEMI due to ST undergoing primary PCI

Prevalence of diabetic retinopathy in rural Pakistan: A population based cross-sectional study

Purpose: To estimate the prevalence of diabetic retinopathy (DR), an emerging cause of sight threat and blindness from a large rural population in Pakistan. Methods: This was a population?based cross?sectional study. We selected a rural district of Matiari Sindh Province in Pakistan, where we selected all the health facilities and their attached Lady Health Workers (LHWs)/Lady Health Supervisors (LHSs). These female health workers were trained to identify high?risk diabetic individuals in their catchment areas using pre?defined criteria and to refer them to the nearest health facilities for screening and testing random blood sugar (BSR). Adults of 18 years or above, male or female, were included in the study for DM and DR screening. Ophthalmic examination was conducted by the optometrists on those who had BSR level >180 mg/dl for the evidence of DR. Identified DR patients were referred to a linked tertiary?level ophthalmology institute for their free DR treatment. Results: Of the identified and referred 24,463 participants, 23,999 were tested for BSR and 2,331 (9.74%) were found to be high?risk patients (BSR >180 mg/dl) and had ophthalmic examination conducted. Of these, 563 had clinically established DR, a prevalence of 24.2% (95% CI, 22–26%). Significantly more DR patients (228, 40.5%) were found in the age group >60 years, with more among female (327, 58.1%) with DR. Conclusion: DR is highly prevalent in the Pakistani rural population. The establishment of an integrated approach within the health care system could decrease the burden of DR in Pakistan

Laparoscopic appendectomy for acute appendicitis: an observational study from a peripheral hospital with limited facilities in Kashmir, India

Background: Appendectomy is one of the most commonly performed procedures in abdominal surgery and the laparoscopic approach is gradually replacing the conventional laparotomy for acute appendicitis.Methods: A total of 108 patients with acute appendicitis who underwent laparoscopic appendectomy at JLNM Hospital Srinagar over a period of five years were evaluated in terms of feasibility and safety of the procedure at the District level hospital. It was an observational study.Results: The age of the patient ranged between 16 and 43 years, with 68 males and 40 females. Most (76.85%) of the patients had un-ruptured inflamed appendix. The mean operative time was 43 minutes with no intra-operative complications. Two patients required conversion to open surgery. Mean duration of hospital stay was 1.7 days. Eight patients had post-operative complications which were managed conservatively.Conclusions: Laparoscopic appendectomy is safe and feasible in expert hands, and can be done using low cost, readily available basic laparoscopic instruments and suture materials at hospitals with limited facilities.

Assessment of knowledge and reporting of adverse drug reaction in resident doctors in a teaching hospital in North India

Background: This study was done to assess the knowledge, attitude and practices of residents towards pharmacovigilance in a teaching hospital in North India.Methods: A cross-sectional study was conducted among residents of Chintpurni Medical College and Hospital, Pathankot (CMC&H). A questionnaire containing 17 questions was distributed to 80 residents of CMC&H, Pathankot. This study was conducted over a period of 3 months from July to September, 2017.Results: 64 out of the 80 residents (80%) responded to questionnaire. Among the respondents, 6% did not know the term adverse drug reaction (ADR) and almost 18% did not witness any ADR during clinical practice. Among those who witnessed ADRs nearly 25% could not ascertain the type of ADR. Those who ascertained ADRs claimed that upto 60% suspected ADRs required short hospitalisation. 6% residents did not consider ADRs avoidable and almost 25% residents did not consider ADRs predictable. 37% residents did not report the ADRs to anyone and nearly 43% did not know whom to report the ADRs. More than 18% claimed that they were not taught about PV in undergraduate curricular practical training teaching. Up to 31% residents claimed that nobody ever discussed with them about ADR reporting during internship.Conclusions: According to this study, residents lack adequate knowledge and practice of reporting ADRs. This study suggests a greater need to create awareness amongst them to promote reporting of ADRs. This study also suggests that incorporation of Pharmacovigilance in medical curriculum will strengthen pharmacovigilance activity.

Pomegranate peel extract lessens histopathologic changes and restores antioxidant homeostasis in the hippocampus of rats with aluminium chloride-induced Alzheimer's disease

Objective: To investigate the neuroprotective efficacy of pomegranate and ellagic acid on the histopathological changes in the hippocampus of an aluminium chloride (AlCl3) induced rat model of Alzheimer's disease. Methods: Sprague Dawley rats were divided into 4 groups (n=10 each): Group I : serving as negative control; Group II, Alzheimer model, induced by administration of 17 mg/kg bw AlCl3; Group III, administered the same dose of AlCl3 with 50 mg/kg of pomegranate peel extract and Group IV : administered ellagic acid (50 mg/kg) in addition to the same dose of AlCl3. The medication given to all groups continued for 28 days. All were given the compounds by gastric gavage. Radial arm maze test, hippocampus antioxidant markers, histopathology of the dentate gyrus, and CA3 of the hippocampus were evaluated. Results: Rats treated with pomegranate peel extract exposed to radial arm maze test showed less number of errors and reduced time needed to reach the criterion. There was an increase in the levels of glutathione, catalase, and total antioxidant capacity and decreased lipid peroxidation products. Histopathological features in dentate gyrus and CA3 as apoptosis and chromatolysis of pyramidal cells and granular layer, respectively, were decreased. Alzheimer characteristic neurofibrillary tangles and senile plaques were reduced. Treatment with ellagic acid ameliorated the pathological results but to a statistically lower level. Conclusions: Pomegranate peel extract alleviates memory deficit and restores antioxidant homeostasis following degenerative changes in the hippocampus induced by aluminium chloride in rats..

Post-thoracotomy ipsilateral shoulder pain: What should be preferred to optimize it - phrenic nerve infiltration or paracetamol infusion?

Background: Post thoracotomy ipsilateral shoulder pain (PTISP) is a distressing and highly prevalent problem after thoracic surgery and has not received much attention despite the incidence as high as 85%. Objectives: To study the effect of phrenic nerve infiltration with Ropivacaine compared to paracetamol infusion on PTISP in thoracotomy patients with epidural analgesia as standard mode of incisional analgesia in both the groups. Study Design: Prospective Randomised and Double Blind Study. Methods: 126 adult patients were divided randomly into 2 groups, “Group A (Phrenic Nerve Infiltration Group) received 10 mL of 0.2% Ropivacaine close to the diaphragm into the periphrenic fat pad” and “Group B (Paracetamol Infusion Group) received 20mg/kg paracetamol infusion” 30 minutes prior to chest closure respectively. A blinded observer assessed the patients PTISP using the VAS score at 1, 4, 8, 12 and 24 hours (h) postoperatively. The time and number of any rescue analgesic medication were recorded. Results: PTISP was relieved significantly in Group A (25.4℅) as compared to Group B (61.9℅), with significantly higher mean duration of analgesia in Group A. The mean time for first rescue analgesia was significantly higher in Group A (11.1 ± 7.47 hours) than in Group B (7.40 ± 5.30 hours). The number of rescue analgesic required was less in Group A 1.6 ± 1.16 as compared to Group B 2.9 ± 1.37 (P value <0.5). Conclusions: Phrenic Nerve Infiltration significantly reduced the incidence and delayed the onset of PTISP as compared to paracetamol infusion and was not associated with any adverse effects.

Helicobacter Pylori Sequential Eradication Therapy: Clarithromycin based Therapy Versus Levofloxacin based Therapy. Study from Kashmir Valley

Introduction: Various regimens have been used for H-pylorieradication. Sequential therapy is an alternative to classicaltriple therapy. This study was designed for evaluatingthe efficacy of levofloxacin based sequential therapyvs clarithromycin based sequential therapy in H-pylorieradication.Material and methods: It is a randomized clinical trial. Twohundred H. Pylori infected patients diagnosed by rapid ureasetest (RUT) on UGI endoscopy were randomly divided intotwo groups A and B. Group B Levofloxacin based sequentialregimen and group A clarithromycin based sequential regimen.H-pylori eradication status was evaluated with rapid ureasetest on UGI endoscopy 6 weeks after completion of sequentialtherapy.Results: As per protocol, eradication rates for group B and Awere 86% and 81% respectively. Eradication rate for H-pyloriis greater with levofloxacin based sequential therapy ascompared to that of clarithromycin based sequential therapybut it is not statistically significant p >0.05.Conclusion: Levofloxacin based sequential therapy has highereradication rate than clarithromycin based sequential therapy.Although not statistically significant in our study, levofloxacinbased sequential therapy could be better alternative forthe treatment of H-pylori in areas with high clarithromycinresistance.

Micro-health insurance in dentistry: the road less travelled

Oral health is indeed a challenge for the urban poor. Majority of the patients spend from their pocket, which aggravates their financial condition. It is paramount for the government and the healthcare industry to adopt a value-based approach to redress the oral health lapses for the underserved population. Micro health insurance (MHI) can have a game changing effect on the oral healthcare space too, if concerned stakeholders build the right partner network. Aim of the study was to discuss the principal features, basic structure, and functioning of a few MHI schemes, and presents a hypothetical model of MHI which can be implemented in dentistry. Literature search was conducted in two main databases, pubmed and cochrane, using key phrases such as “community based health insurance,” “micro health insurance,” micro or community based health insurance,” and “health insurance and financial protection”. Articles published in last ten years with full texts were considered. 23 schemes were eligible for the systematic review. Our analysis shows that MHI, in the majority of cases, contributes to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, household borrowings and poverty. However, the studies did not affirm oral health benefits. The importance of oral healthcare in India is superficial. Focus on oral healthcare can be achieved only if the impending cost due to out of pocket payments can be supplanted with a more affordable and dynamic payment model. With MHI extended to oral healthcare, India can certainly achieve its SDG goal. It’s time to look beyond.

Three minutes propofol after sevoflurane anesthesia to prevent emergence agitation following inguinal hernia repair in children: a randomized controlled trial / 대한마취과학회지

BACKGROUND: Emergence agitation (EA) is a common problem after sevoflurane anesthesia among children. There have been mixed results with control of EA using propofol 1 mg/kg bolus following sevoflurane anesthesia. An infusion of 3 mg/kg of propofol over 3 min following sevoflurane anesthesia has been found to be promising in children undergoing magnetic resonance imaging scans. However, no studies have been conducted during surgical procedures. We aimed to examine the efficacy of transition to propofol for 3 min after cessation of sevoflurane anesthesia in children undergoing inguinal hernia repair. METHODS: In this prospective randomized controlled trial, 64 children aged 1–12 years, scheduled for inguinal hernia repair, were randomized to receive either propofol 3 mg/kg over 3 min (propofol group) or no propofol (control group), after the cessation of sevoflurane anesthesia. EA was assessed using the Paediatric Emergence Anesthesia Delirium (PAED) scale and the Watcha scale. Emergence time and the duration of post-anesthesia care unit (PACU) stay were also recorded. RESULTS: The incidence of ED was lower in the propofol group on both the PAED (81.3% vs. 15.6%, P < 0.001) and the Watcha (78.1% vs. 15.6%, P < 0.001) scales. The mean emergence time was 6.37 minutes longer in the propofol group with no significant difference in PACU times. CONCLUSIONS: Transition to propofol 3 mg/kg over 3 min following sevoflurane anesthesia reduces the incidence of EA and improves the quality of emergence. Although emergence times were longer, the duration of stay in the PACU was similar with propofol use.

Three minutes propofol after sevoflurane anesthesia to prevent emergence agitation following inguinal hernia repair in children: a randomized controlled trial / 대한마취과학회지

BACKGROUND@#Emergence agitation (EA) is a common problem after sevoflurane anesthesia among children. There have been mixed results with control of EA using propofol 1 mg/kg bolus following sevoflurane anesthesia. An infusion of 3 mg/kg of propofol over 3 min following sevoflurane anesthesia has been found to be promising in children undergoing magnetic resonance imaging scans. However, no studies have been conducted during surgical procedures. We aimed to examine the efficacy of transition to propofol for 3 min after cessation of sevoflurane anesthesia in children undergoing inguinal hernia repair.@*METHODS@#In this prospective randomized controlled trial, 64 children aged 1–12 years, scheduled for inguinal hernia repair, were randomized to receive either propofol 3 mg/kg over 3 min (propofol group) or no propofol (control group), after the cessation of sevoflurane anesthesia. EA was assessed using the Paediatric Emergence Anesthesia Delirium (PAED) scale and the Watcha scale. Emergence time and the duration of post-anesthesia care unit (PACU) stay were also recorded.@*RESULTS@#The incidence of ED was lower in the propofol group on both the PAED (81.3% vs. 15.6%, P < 0.001) and the Watcha (78.1% vs. 15.6%, P < 0.001) scales. The mean emergence time was 6.37 minutes longer in the propofol group with no significant difference in PACU times.@*CONCLUSIONS@#Transition to propofol 3 mg/kg over 3 min following sevoflurane anesthesia reduces the incidence of EA and improves the quality of emergence. Although emergence times were longer, the duration of stay in the PACU was similar with propofol use.

Clinical profile of stroke in Kashmir

Stroke is a major health problem in the world ranking among the top three causes of death, after heart disease and cancer in developed countries. We prospectively studied one hundred patients of acute cerebrovascular accident who presented to accident and emergency department. Definite diagnosis was done by cranial imaging. This was conducted last year in our hospital which is a tertiary care hospital in Kashmir valley catering a population of 7 million. We documented hemorrhagic stroke in 79 patients (79%) while 21 patients (21%) had occlusive stroke which is in contrast with most of the studies done earlier (most western studies). Risk factors viz., hypertension, smoking were contributing to the high incidence of stroke. Majority of the patients presented in the 5th to 7th decade, consistent with other studies. Majority of the patients presented during awake phase and presented with maximum neurodeficit at onset. Majority of the patients had hemiplegia (paresis) 71%. Basal ganglia was the major site of bleed 49.4%. Dietary habits, extremes of climate and decreased physical activity predispose to high incidence of strokes.

Habit-breaking methods employed by mothers of children with nonnutritive sucking habits resident in suburban Nigeria

Parents are often concerned about their children's nonnutritive sucking (NNS) habits and may institute mechanisms to try to break them. Aim: The study identified various methods instituted by mothers resident in a suburban Nigeria to break NNS habits of children, reasons for wanting to break the habit, and the association between instituted methods and sociodemographic profile of the mothers. Materials and Methods: The data of 129 mothers of children aged 4 years to 12 years who had NNS habits at the time of conducting a household survey were analyzed. Statistical Analysis: Tests of associations were conducted to determine the association between maternal age and level of education and methods employed to break child's NNS habits. Results: Eighty-four mothers (65.1%) made efforts to break the habit. Habit persisting to older age was the main concern. The most common method employed for breaking habits was punishing the child (54.8%).Only 7 (20.0%) mothers who were concerned about NNS habit(s) sought professional advice. A greater though insignificant percentage of mothers in the 25–34 years age group (57.2%; P = 0.48) and those with secondary school level of education (56.0%; P = 0.12) made efforts to break their children's NNS habits. Conclusions: The majority of mothers were concerned about their children's NNS habits. However, very few concerned mothers sought professional advice. Efforts need to be made to improve the public awareness about the availability of professional services for managing NNS habits and potential impact of employing nonprofessional methods to break habits.

Awareness regarding implant supported dental prosthesis; a survey in tertiary care set up

Objective: This research was aimed to assess the awareness and attitude regarding implant-retained prosthesis as the most advanced option for tooth replacement amongst residents of Karachi visiting tertiary care centre

Methodology: This cross-sectional survey was conducted in the department of Prosthodontics at Bahria University Dental Hospital, Karachi. Undertaking the demographic characteristics of patients, the objective was to determine the awareness and attitude toward implant supported prosthesis

Results: Amongst 380 responses retrieved, 9.8% of respondents were aware about the dental implant treatment. While correlating awareness with demographics features, awareness statistically increased with educational level [p= 0.00] and occupational category[p=0.01] of the participants. The friends and relative s[40.5%] were the main source of information regarding dental implant treatment modality. 54.1% were unwilling to undergo treatment with dental implant whereas high cost [55.2%]was the major limiting factor for implant treatment. 64.9% demanded dental insurance for getting the treatment. 45.9% had no knowledge regarding maintenance of implant supported prosthesis .73.0% had no idea regarding longevity of dental implant where as 86.5% were unaware of it's impact on systemic health

Conclusion: The overall awareness regarding implant supported prosthesis was found to be minimal. This underlines the need of efforts and measures that should be made to raise the awareness and thus alter attitude towards dental implant therapy. Expensive rates [55.2%] was found to be the major limiting factor that should be relieved in the form of health insurance policies, especially in the developing countries like ours

Multi-parametric 3-Tesla MRI evaluation of prostate in cases with negative prostatic biopsy with raised PSA levels – A tertiary care hospital study

The incidence of prostate cancer has been gradually increasing in the world. Checking the serum prostate-specific antigen (PSA) level and a digital rectal examination (DRE) are the gold standards for prostate cancer screening. Prostate gland is divided into four zones, the peripheral zone (PZ), transitional zone and central zone and anterior nonglandular fibromuscular stroma. Prostate is divided into minimum 16 and optionally 27 regions of interest as per European consensus meeting. Until recently, most professionals have been skeptical that magnetic resonance imaging (MRI) could be used on a widespread basis to diagnose or stage prostate cancer with any degree of reliability, and therefore help with making treatment decisions. The aim of the present study was to study diagnostic value of mpMRI of prostate in cases of raised PSA but with negative biopsy. The present study was carried out in the post graduate department of Radiodiagnosis and imaging Govt. Medical College Srinagar over a period of one year from May 2016 to April 2017. All patients with negative prostatic biopsy were evaluated on Siemens 3 tesla MRI scanner. All patients underwent initial T1W scanning to look for any evidence of hemorrhage and patients having hemorrhage due to previous biopsy were also excluded from study or their study was deferred until hemorrhagic artifacts disappear. After proper case selection patients were subjected to detail Multiparametric MRI (mpMRI) for prostate 6-8 weeks period was given from previous biopsy time to MRI study and cases with hemorrhage on T1 weighted sequence were either excluded from study or their study was deferred till resolution of Aijaz Ahmad Hakeem, Irshad Mohiuddin, Tanvir Iqbal. Multi-parametric 3-Tesla MRI evaluation of prostate in cases with negative prostatic biopsy with raised PSA levels - A tertiary care hospital study. IAIM, 2018; 5(6): 5-13. Page 6 haemorrhage. The conclusion of the present study was that Mp-MRI prior to repeat biopsies can improve the detection rate of clinically significant PCa and allow for a more accuracy in prostate disease diagnosis.

MRI in Cerebellopontine angle and internal auditory canal lesions

Background: A large variety of inflammatory and neoplastic lesions are known to occur within internal auditory canal and cerebellopontine angle Imaging techniques are now available to guide the search for the underlying cause of most patient complaints The advent of MRI has revolutionized the medical diagnostic imaging because it allowed tissue characterization of many lesions High resolution MRI scan is highly sensitive in detecting lesions of internal auditory canal and cerebellopontine angle More recently, diffusion imaging is playing a substantial role in evaluation of CPA masses High ADC values of solid vestibular schwannomas were in conformity with increased diffusion rates, indicating the presence of increased amounts of extracellular water (a relatively loose tissue in tumor matrix) This study was undertaken with purpose to present MRI findings in cases of CPA and IAC lesions and to assess the impact of MRI on the diagnosis management and follow up, after treatment, of these lesions with an attempt to compare MRI findings with operative and H/P findings in the cases where surgery was done Materials and methods: The present study was conducted in Post Graduate Department of Radiodiagnosis, Government Medical College, Srinagar on patients presenting with otoneurological signs and symptoms suggestive of CP angle and IAC lesions referred for MR imaging by various departments of GMC Hospital Srinagar during the one year period of study Results: Majority of lesions found in this study were tumors (33 lesions), next common in our series were inflammatory lesions and vascular lesions (4 each case) Among all lesions and tumors most common MR diagnosis in our study was acoustic neuroma 20 of 41 lesions (4878%) and 20of 33 tumors (6060%) respectively Next common among tumors was meningiomas 3 out of 33 cases (909%) Conclusion: The results of the present study concluded that, MRI has particular advantages over CT for study of internal auditory canal and cerebellopontine lesions because it is non-ionizing Aijaz Ahmad Hakeem, Irshad Mohiuddin MRI in Cerebellopontine angle and internal auditory canal lesions IAIM, 2018; 5(12): 40-50 Page 41 investigation, better soft tissue contrast and resolution, multiplanar capability permits more reliable distinction of lesions, better identification of structures involved by lesions, tissue characterization of lesions and absence of beam hardening artifacts makes MR imaging superior ion evaluating the lesions in CP angle and IAC The radiological features of various lesions are often sufficiently distinctive to permit a specific diagnosis to be made MR imaging due to its multiplanar capability helps in knowing the exact site and extent of these lesions MRI shows inflammatory and vascular lesions with exquisite detail and is better for detection of such lesions as compared to CT MRI allows a confident perspective pathologic diagnosis to be made (Using FSE T2 weighted images, diffusion imaging, SE images, thin section post gadolinium scans) and this predictive value far exceeded the CT

Cardiovascular disease incidence and risk factor patterns among Omanis with type 2 diabetes: a retrospective cohort study

Objectives: Cardiovascular disease [CVD] represents the leading cause of morbidity and mortality among patients with type 2 diabetes mellitus [T2DM]. Its incidence and risk factor patterns vary widely across different diabetic populations. This study aims to assess the incidence and risk factor patterns of CVD events among Omanis with T2DM

Methods: A sample of 2 039 patients with T2DM from a primary care setting, who were free of CVD at beseline [2009-2010] were involved in a retrospective cohort study. Socio-demographic data and traditional risk factor assessments at the baseline were retrieved from medical records, after which the first CVD outcomes [coronary heart disease, stroke, and peripheral arterial disease] were traced from the baseline to December 2015, with a median follow-up period of 5.6 years

Results: The overall cumulative incidence of CVD was 9.4% with an incidence density of 17.6 per 1000 person-years. Prevalence of poor glycemic control, hypertension, obesity, dyslipidemia, albuminuria, and current smoking were 40.0%, 56.3%, 39.0%, 77.3%, 18.7%, and 7.8%, respectively. The univariate survival analysis showed a significant association between CVD and the following factors: age, diabetes duration, body mass index, glycemic control, hypertension, total serum cholesterol, and albuminuria

Conclusions: This study revealed high incidence of CVD and high prevalence of its traditional risk factors among Omanis with T2DM. In addition, compared to global studies, important differences in the prevalence of some risk factors and their patterns in the univariate association with the cardiovascular outcome have been observed

Carpal tunnel syndrome and other entrapment neuropathies

Entrapment neuropathy is the result of pressure on a peripheral nerve as it passes through a narrow canal that is bounded by stiff tissues. In spite of their ubiquitous nature, they are underdiagnosed, underreported, and sometimes not properly managed, especially in developing countries. Entrapment neuropathies are of various types, but the most common type is carpal tunnel syndrome. Mechanisms involved in the pathophysiology of entrapment neuropathies include mechanical compression and nerve ischemia. A clear understanding of the various types and the underlying mechanisms of entrapment neuropathies are invaluable in the decision-making process involved in the management of every patient with the condition

Quantitative morphometric study of the chorionic villi in hypertensive mothers

Background: Several studies have reported that mothers with pregnancy induced hypertension or those suffering from hypertensive disorders have abnormalities in histological features of the placenta. The fetus connection with the mother is through chorionic villi. Besides several other histological features changes in the chorionic villi have also been reported. This lead to the reduced supply of the necessary nutritional elements for the fetus

The aim of the Study: The principal objective of this study was to evaluate morphometric changes in the placenta of expecting mothers have hypertensive disorders of pregnancy and women without any symptoms of hypertension. As the placenta is capillary-rich region and any physiological change can adversely affect the fetal health

Patients and Methods: In this study, a total of 84 expecting mothers were recruited. Among these 42 have hypertensive symptoms before pregnancy whereas the other 42 have their blood pressure in normal ranges. Among the 42 hypertensive women, only 13 met the study inclusion criteria,i.e., blood pressure in the range of 140/90 mmHg in the 30th week of the pregnancy. The quantitative morphometric parameters included shape and size of the placenta, damage to the blood vessels mainly in the chorionic villi and an overall number of blood vessels

Results: A comparative evaluation of placenta from the hypertensive and normotensive expecting mothers showed that blood vessels area in the hypertensive mothers was significantly reduced when compared to normotensive mothers, same holds from the blood vessels in the perimeter areas. These findings have important implications as far as the fetal development among hypertensive mothers is concerned

Conclusions: Higher blood pressure associated changes in the placenta are manifested in the form of several histological and morphological changes mainly in the chorionic villi structures involved in fulfilling nutritional requirements of the fetus

Retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of renal stones greater than 2 cm

Background: Stone size is a key factor in the determination of the success of treatment modalities. Recently, there has been a great advancement in technology for minimally invasive management of urinary stones such as percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and retrograde internal Surgery

Aim of the Study: to assess and compare the efficacy of retrograde intrarenal surgery [RIRS] in the treatment of kidney stones greater than 2 cm versus percutaneous nephrolithotomy [PCNL]

Patients and methods: A retrospective analysis was carried out for a total of 118 patients, of which 46 patients underwent RIRS while 72 patients underwent PCNL between May 2013 and May 2017

Results: The mean duration of operation was 96.39 +/- 41.11 min in the RIRS group and 69.51 +/- 19.3 min in the PCNL group [p<0.001]. Hospital stay was significantly shorter in the RIRS group [1.32 +/- 0.6 vs. 4.19 +/- 1.9 days] in the RIRS and PCNL groups respectively [p<0.001]. Stone-free rates after one session were 67.4% and 90.3% of the RIRS and PCNL groups, respectively. Blood transfusions were required in two patients in the PCNL group. Complication rates were generally higher in the PCNL group

Conclusion: The present study concluded that RIRS can be a successful substitute to PCNL in the treatment of kidney stones with a diameter of 2-4 cm particularly in patients with comorbidities

Assessment of knowledge toward complications of diabetic septic foot among diabetics patients in Saudi Arabia

Background: diabetic foot ulcer is a major health problem around the world with a high morbidity and mortality rates. The good knowledge and practice pattern could decrease the diabetic foot ulcer complications

Objectives: this study aimed to evaluate knowledge of the diabetic patients regarding the complications of diabetic foot ulcer in Saudi Arabia [KSA]

Patients and Methods: this is a cross sectional community based study conducted from March 2017 to July 2017 among 920 diabetic patients. The subjects were interviewed in the shopping malls, pharmacies and coffee shops and asked to fill out a pre-tested questionnaire about the knowledge of complications

Results: the duration of diabetes was more than 10 years among 65% of them. About 40.9% of subjects were using oral hypoglycemic agents, 57.8% were using insulin for management of diabetes. The most common diabetic complication was retinopathy, while the most common foot ulcer complication was foot numbness and stiffness. The level of knowledge was good among most of subjects [77%], while 23% had insufficient knowledge regarding the diabetic foot ulcer. The good awareness was significantly associated with higher educational levels

Conclusion: the level of awareness about complications of diabetic foot was sufficient among most of Saudi subjects. But, there was an urgent need for raising the awareness and identifying the risk factors, educating the patients through increasing the patients and doctors relationship. The knowledge alone was not sufficient for assessing the practice pattern thus major studies must be conducted to assess the knowledge, attitude and practice pattern among Saudi subjects