Potassium Hydroxide (KOH) Wet Preparation for the Laboratory Diagnosis of Suppurative Corneal Ulcer.

Background: Suppurative keratitis is a common ophthalmic condition mostly caused by fungi. Apart from fungal culture, wet preparation using 10% Potassium hydroxide (KOH) for microscopic detection of fungal elements is a rapid and accurate method of laboratory diagnosis. Purpose: This prospective and cross sectional study was undertaken in order to evaluate the diagnostic sensitivity of wet preparation microscopy using KOH for detection of fungal agents from suppurative corneal ulcer patients. Methodology: Fifty six (56) consecutive clinically suspected patients of suppurative corneal ulcer attending Rajshahi Medical College Hospital (RMCH) during the period from July, 06 to June, 07 were included. Corneal swabs were taken aseptically for detection of bacteria in gram-stained smear and culture. Conventional mechanical corneal scrapings were collected under topical anesthesia and utilized for microscopic detection of fungal agents in KOH wet preparation and fungal cultures in the department of Microbiology of Rajshahi Medical College. Results: Culture yielded microbial growths in 47(83.93%) out of 56 samples of corneal ulcer that included 24 (42.86%) pure fungal growths, 14 (25.0%) pure bacterial growths and 09 (16.07%) mixed microbial growths (both bacteria and fungi). Direct microscopical examination using 10% KOH wet preparation detected 28 fungal agents out of total 33 fungal cases (combining both pure and mixed fungal growths in culture). Diagnostic sensitivity of wet preparation microscopy was found to be 84.85% by comparing its performance to fungal culture yields, which is the ‘gold standard’ for laboratory diagnosis. Conclusion: This limited study has revealed that wet preparation can be a tentative diagnosis of fungal keratitis and can be accurately relied upon for initiating prompt anti-fungal therapy and also recommended as a cost-effective method for laboratory diagnosis especially where culture facility is not available.

Factors affecting survival in patients with oesophageal atresia and tracheo-oesophageal fistula

To evaluate the various factors affecting survival in babies with oesophageal atresia and tracheo-oesophageal fistula. Descriptive study. The study was carried out at the Department of Paediatric Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences [PIMS], Islamabad from March 2004 to March 2005. All neonates with oesophageal atresia [EA] and tracheo-oesophageal fistula [TEF] during the study period were included in the study. Patients having isolated EA were excluded. A total of 80 patients were included in the study. Patients were received from the emergency department, OPD and Neonatal ICU. Diagnosis was confirmed by passing a radio opaque orogastric tube. Investigations were done to look for other associations. After stabilisation, right thoracotomy was performed, fistula was ligated and divided. An attempt was made to do a primary oesophago-oesopahgostomy. Nasogastric feeding was started on 2nd post-operative day. A contrast oesophagogram was performed on the 7th postoperative day and having ruled out leak, oral feeding was started. Out of the total, 33 [41%] survived and 47 [58%] patients died. Out of 47 deaths 20 [25%] died before surgery and 27 [34%] died after surgery. Mean follow up period was 6 months. Sixteen [20%] patients had anastomotic leak, 24 [30%] had anastomotic stricture, and 64 [80%] patients had postoperative pneumonia. We conclude that proper antenatal check ups will detect the problem early, avoid home deliveries and hence improve survival. Pneumonitis and septicaemia significantly affect survival. Availability of ICU is one of the main determinants of survival. The likely cause of high mortality rate in pre-operative patients in our series is non-availability of NICU due to limited space in our setup

One hundred and thirty seven living donor pediatric liver transplants at Riyadh Military Hospital. Results and outlook for future

To review the results of 137 living donor pediatric liver transplants performed at Riyadh Military Hospital [RMH]. Retrospective analysis of the in- and out-patient case notes was carried out. Data were collected regarding age, gender, nationality, diagnosis, type of procedure, complications and survival of the grafts and the recipients. The first 137 living donor pediatric liver transplants were performed in 113 months. The age range was 4.5 months to 14 years. Eighty-four recipients [61%] were male. One hundred and twelve children were Saudi. Left lateral segment was used as allograft in 135 cases. One child each received full left lobe and full right lobe. Six auxiliary partial orthotopic liver transplants were carried out. Familial metabolic liver disorders made the largest group of children needing transplant. The most common indications were progressive familial intrahepatic cholestasis and biliary atresia [45 cases each]. The numbers of major complications are: hepatic artery thrombosis [n=8]; portal vein thrombosis [n=3]; portal vein stenosis [n=3]; hepatic vein stenosis [n=3] and biliary strictures [n=4]. Fifteen patients died. Three further allografts have been lost. Thus, the overall patient survival rate is 89% and graft survival rate is 86.8%. Living donor liver transplantation is a viable option for children with end-stage liver disease. Metabolic liver disease is the most common indication in Saudi Arabia. The cadaveric donor supply is in shortage and living donation is a practical alternative. The incidence of complications and recipient and graft survival rates of the program at RMH are acceptable

Role of abrasives in dentistry

A dental abrasive is an important part of dental services. This specialty deals with the finishing and polishing of dental appliances like complete dentures, removable partial dentures, crown and bridges and the direct dental restorative materials. Effective finishing and polishing of direct or indirect dental restorations may not only responsible for good aesthetics but also provide healthy oral environment and the longevity of the restorative material. This review is based on latest technology and the material used in dentistry which provides an overview of basic principles based on dental abrasives. The overall aim is to provide the awareness and broader knowledge of the principles and tools available to produce an optimal surface finishing and Polishing in dental restoratives techniques

ACNE: history, reality and legends

Acne is a common problem in adolescents and young adults. Acne and its associated problems with selfesteem and social inhibition represent a figurative "rite of passage" for as many as 80 percent of adolescents and young adults. Because having acne can have a major impact on a teenager's quality of life, importune the patients how they feel about their acne and what expectations they have from treatment at baseline provides a foundation for assessing improvement during the course of therapy. Understanding this relationship can help clinicians develop strategies to improve treatment compliance. Patient education is essential. Edification about acne, its pathogenesis and probable effect, over and above prerequisites for ongoing management, is necessary. Generally, held viewpoints surrounding acne need to be logically conversed with both the patient and their family. The patient is well served by physicians who dispel the myths surrounding acne and provide accurate information about how acne develops. Drinking soda or eating chocolate does not cause acne, nor is acne the result of being unclean, and it canot be whashed or scrubbed away. Patients need to be counsel that acne may appear to worsen in the early weeks of therapy, but tolerance strategies will lessen the potential irritation. Instructions about the application of medications and general skin care [eg, using only the hands for facial washing; using a mild synthetic cleanser] should be provided to all patients starting acne treatment

An autopsy study of sudden cardiac death

To determine the cause of sudden cardiac death and observe the morphological changes in the heart after death. A cross sectional survey of 66 cases was carried out at Armed Forces Institute of Pathology [AFIP] Rawalpindi from 1992 to 1994. A detailed autopsy including external and internal postmortem examination was done. Representative sections were taken for histopathological examination and some viscera were sent to Chemical Examiner at Lahore for chemical analysis. All the cases were male with age range from 21 to 58 years. These cases died within 60 minutes with or without onset of symptoms. Fifty two cases revealed mild to severe atherosclerosis. Coronary occlusion with thrombosis was seen in 37 cases whereas 9 cases showed critical narrowing without evidence of thrombosis. Five showed both symmetric and asymmetric hypertrophy. Changes in conduction system of the heart were seen in 4 individuals. Myocarditis was noted in 2 cases only. The cause of death could not be determined in 3 cases. Majority of the cases died of coronary atherosclerosis whereas 17% cases revealed hypertrophic cardiomyopathy, changes in conduction system and myocarditis and 4% cases were undetermined. A detailed and thorough postmortem examination is mandatory to ascertain the cause of sudden cardiac death

Castleman disease presenting as obstructive jaundice

A 48-year-old Saudi male was admitted with features of obstructive jaundice. Endoscopic retrograde cholangiopancreatography showed stricture in distal common bile duct CBD. Computed tomography scan revealed lymphadenopathy along CBD and in porta hepatis. Cholangiocarcinoma, lymphoma or metastatic deposits were suspected but no definite preoperative diagnosis could be established. Laparotomy disclosed lymph node enlargement in porta hepatis and along the CBD and lesser curvature of the stomach. Triple bypass procedure was performed to relieve the obstruction. Pathological examination of the lymph nodes showed Castleman disease of hyaline vascular type

Laparoscopic cholecystectomy for acute cholecytitis. Can preoperative factors predict conversion?

To determine if preoperative clinical, laboratory and radiology data can predict conversion of laparoscopic cholecystectomy for acute cholecystitis to open procedure. Retrospective analysis of 44 laparoscopic cholecystectomies were performed for acute cholecystitis between August 2000 and July 2002 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. Data related to age and sex of patients, maximum body temperature, white blood cell count, gallbladder wall thickness on ultrasonography and timing of surgery from onset of symptoms were collected. The procedure was converted from laparoscopic to open cholecystectomy in 10 patients [23%]. Conversion rate was significantly high [33% versus zero; p=0.01] if the gallbladder wall was thickened. Conversion rate was significantly low [zero versus 32%: p=0.01] if the procedure was performed within 48 hours from the onset of symptoms. The data related to age, sex, white blood cell count and body temperature did not reliably predict conversion of laparoscopic cholecystectomy for acute cholecystitis to open procedure. There was no mortality or major morbidity. Laparoscopic cholecystectomy is a safe modality of treatment for acute cholecystitis. Factors associated with increased conversion rate are thickened gallbladder wall on ultrasonography and delay in surgery for more than 48 hours from the onset of symptoms

Intestinal obstruction due to mesenteric panniculitis

This report describes a case of mesenteric panniculitis in a 40-year-old male who presented with features of intestinal obstruction. Computed tomography scan showed a mass in the mesentery of small bowel. Resection of mass with associated small bowel and anastomosis resulted in complete recovery of the patient

Successful revascularization of severely damaged lower limb in a three years old child

Reimplantation and revascularization surgery is essential component of all trauma centres in the developed countries. In children revascularization can only be performed using special microsurgical techniques. We are presenting a case of a three years old female child who was referred to us from another hospital with history of trauma to the right leg by falling of a steel object. It resulted in fracture of tibia and fibula near the knee joint with division of major vessels and loss of circulation to the limb. Successful revascularization using an autologous long saphenous vein graft resulted in full recovery and function of the limb

Splenic cyst - a rare entity

Splenic cyst is a rare condition and is usually asymptomatic unless very large in size. We are reporting a case of large splenic cyst in an 11 year old girl who presented with a 3-month history of left upper quadrant pain and abdominal distension. Total splencctomy was performed due to the involvement of the splenic blood vessels and minimal residual splenic pulp

Child bearing practices among khetrans of Balochistan

Balochistan is the largest province of Pakistan in terms of area. The population mainly includes Balochand Pathan ethnic groups. Among Balochis, Khetrans are one of the affluent tribe. They enjoy political power at the provincial and national levels. Their major settlements are in the district Barkhan and according to one estimate, their population is about one hundred thousand persons which gives them a prominent place among other Baloch tribes of the province. The concept of child hood is socially defined and culturally constructed. Every culture defines the meaning and extent of childhood and the concept includes all the beliefs and practices around children.The phenomenon of childhood does not exist in isolation. Rather, it is closely associated with the social,economic, and political institutions. The perceptions of childhood have very complex implication for the overall health status and development potentials of the well society. The enhanced understanding of childhood among the Khetrans would enable individuals and organizations to plan their activities in proper perspective

Subclassification of hepatitis B virus carriers

Hepatitis B virus [HBV] carriers are sub-categorised as [supercarriers] and [ordinary carriers] according to their HBeAg/anti-Hbe status. This subcategorization helps in the determination of grade of infectivity, viral activity, as well as therapeutic considerations in these cases. Between January 1990 and December 1993, 405 HBV carriers were evaluated for their serum [e] antigen/antibody status and out of these 129 [32%] and 246 [61%] cases were found to be HBeAg and anti-HBe positive respectively, whereas 30 [7%] carriers were doubly negative. There were no age or sex-related differences in the two groups. In conclusion, nearly one third of our HBV carriers were HBeAg positive "supercarriers" with a potentioal of high grade of infectivity. The finding is important regarding the active/passive prophylaxis of the off springs of HBeAg positive mothers

Management of an ancurysmal bone cyst

Aneurysmal bone cyst is a rare, non-neoplastic, expansile bony lesion that mainly affects children and young adults. It may cause diagnostic confusion with a bone tumor. These cysts are frequently treated surgically, but recurrence is very common and surgery is hazardous, especially when the lesion is adjacent to the growth plate. A case report of an aneurysmal bone cyst in an 11 year old child is presented with serial radiographic changes and discussion on its management