Stump appendicitis single centre experience: a retrospective study

Background: Appendicectomy is the most common surgical procedure done for acute appendicitis worldwide. However, one among 50000 appendicectomy patients may present with recurrent abdominal pain, requiring hospitalization as stump appendicitis and may need completion appendicectomy. There are a few reports addressing management of stump appendicitis in the literature. Here we present our experience of laparoscopic completion appendicectomy over ten-year duration.Methods: A retrospective evaluation of records of appendicectomy from January 2008 to December 2018. All patients who had stump appendicitis as diagnosis and those who underwent completion appendicectomy were included. There were no exclusions. Details pertaining to presentation, duration of symptoms, records of previous surgery, perioperative and postoperative data was recorded, including follow-up of at least six months.Results: All 15 patients were managed by laparoscopic completion appendicectomy. Patients age range from 12 to 58 years, 12 were males and 3 female, duration of symptoms was from two to ten days, previous appendicectomy was done 4 to 84 months before, nine were diagnosed by ultrasonography of abdomen and six by CT scan, stump size ranged from 1 to 3.6 cm, mean operating time was 86.4 mins (range, 60-120 minutes). Duration of hospital stay was 3 to 5 days. There were no perioperative morbidity or mortality.Conclusions: Laparoscopic approach of completion appendicectomy is safe for management of stump appendicitis.

The Process Of Designing Special Wheel Chair For People With Physical Disabilities

@#There is a need to design and develop an affordable motorized vehicle for better mobility among physical disabilities. This study aimed is to initiate appropriate and affordable materials to develop an accessible motorized wheelchair. It includes the feasibility study of the existing used wheelchair, the system used and the characteristic of the physical disabilities symptom. Through the observation, an existing motorized wheelchair uses stainless steel as the main structure, manipulating the shelves heavy-duty accessories, electrical component, heavy-duty battery and car pulley system in which the weight accumulates approximately 100 kg. The heavyweight wheelchair cannot be folded and put inside the car. It also needs to have a special carrier to carry the wheelchair. The field research has also been conducted to evaluate the existing wheelchair system in the market with various systems used, components, and motors material used in the area of technical, usability and comfort before start to redesigning the wheelchair. The results of the study would include the background needs of the characteristic of physical disabilities. The available high-grade aluminium materials will be used to support the mobility and their relevant properties. The design will be done all the way and the specification will be used as an instrument data for the motorized vehicle. The selection of design features, documentation of design procedures and results will be used to create a P.O.C (Prove of Concept) prototype for the meant vehicle. The user will use the preliminary prototyping test and the data (result) will be used to improvise the wheelchair prototype. The second improvised prototype will undergo the second user testing in the area of reliability, stabilization of system, and ease of usage. The results expected will be observed and tested by the user to lead towards the recommendation of the motorized wheelchair design.

To Study Efficacy Of Comprehensive Diabetes Care (cdc) Management Program In Type Ii Diabetic Obese Patients: An Observational Study

Context: Diabetes mellitus (DM) contributes to a major chunk of morbidity, mortality, and healthcare cost on a global level. The prevalence of DM is rising alarmingly, worldwide and India. Comprehensive Diabetes Care (CDC) is a combination of Panchakarma and diet management. Aims: This study was conducted to evaluate the effect of CDC on Glycosylated hemoglobin (HbA1c), body mass index (BMI), body weight, abdominal girth and dependency on conventional therapy in DM Patients. Setting and Design: This observational study was conducted in July 2017, wherein the data of obese Type II DM patients (HbA1c >6.5%) who attended out-patient departments (OPDs) at Madhavbaug clinics in Maharashtra, India were identified. Materials and Methods: Data of patients who were administered CDC (60-75 minutes) with minimum 6 sittings over 90 days (± 15 days) were considered. Variables were compared between day 1 and day 90 of CDC. Results: Out of 27 patients, 22 were included for analysis, out of which 10 were males while 12 females. CDC showed significant improvement in HbA1c 1.1% (from 8.80 ± 0.93 to 6.98 ± 1.73; p<0.001), BMI by 2.66 (from 33.79 ± 3.80 to 31.13 ± 3.91, p< 0.001), weight by 6.56 kg (from 83.67 ± 11.28 to 77.11 ± 12.27, p<0.001). Abdominal girth (from 104.34 ± 9.74 to 96.97 ± 11.93; p<0.001), also showed significant reduction. Dependency on concomitant medicines was reduced, with the number of patients on no concomitant medicines increasing from 27% to 41%. Conclusion: Comprehensive Diabetes Care Management Program found to be efficacious; by reducing HbA1c, as well as reducing dependency on allopathic medications.

Randomized controlled trial on the effect of Al-Quran recitation vs counseling on smoking intensity among Muslim men who are trying to quit smoking

Introduction: Nicotine cravings and withdrawal symptoms are associated with higher rates ofrelapse. It has been shown that combining behavioral therapy and pharmacotherapy leads to ahigher long-term abstinence rate in those who quit smoking. Al-Quran recitation has been provento reduce anxiety among athletes before tournaments and pulse and heart rates among patientsawaiting cardiac operations. As most of the patients who wish to stop smoking experience highanxietystates, we postulate that Al-Quran recitation will also able to reduce craving among smokersattempting to quit smoking.Methods: Fifty smokers from an outpatient clinic were randomly assigned to control andintervention groups. They were taught different ways of coping with smoking urges, i.e., counselingusing the 12’M’ method (control group) versus Al-Quran recitation (intervention group). Theymet for four consecutive weeks of counselling and to fill out a withdrawal scale. Carbon monoxide(CO) levels were tested at baseline and at week 4. At week 12, the number of cigarettes smoked wasmeasured again. The decrease in the number of cigarettes considered to be clinically significant forthe calculation of sample size was based on expert opinionResults: The reduction in the number of cigarettes smoked was 7 cigarettes in the counsellinggroup and 9 cigarettes in Al-Quran recitation group over 12 weeks duration. There was astatistically significant difference in the number of cigarettes smoked between the groups. Therewas also a statistically significant difference in the change in cravings between the groups at week 4(p-value= 0.005). However, the difference in the changes in CO levels between the two groups wasnot statistically significant.Conclusion: Al-Quran recitation produced a statistically significant reduction in the numberof cigarettes smoked at week 12 and a significant change in cravings at week 4 among smokersattempting to quit. Difference in smoking abstinence rates was not measured in this study.

Attitude and experiences of undergraduate dental students and interns towards research

Objective: this study was designed to evaluate the perception of students and interns toward research

Materials and Methods: the study was conducted in January 2014. Participants of the study were fourth, fifth, and 6[th] year students and interns. A questionnaire comprised thirteen questions was distributed to evaluate students' and interns' perception about the importance of research in their learning

Results: the results showed that interns and 6th year students were more interested in research as compared to their junior counterparts as they realized the importance of research in their educational growth. This was reflected by the number of interns who completed the questionnaire

Conclusion: dental students realized the importance of research in the education, but it was found that the proportion of students who did research as part of their course was very low. Students should be actively engaged in research, which can be achieved by introducing research as a compulsory component of their course

Knowledge of and attitudes towards of menstrual disorders adults in north-eastern state of Peninsular Malaysia

Introduction: In Malaysia, the prevalence of menstrual disorders among adolescents and young adults is high. However, most of them are not aware of the signs and symptoms of menstrual disorders in terms of medical issue as well as Islamic ruling. Awareness of the menstrual disorder symptoms is important so that early and appropriate treatment can be given. Objectives: The objective of the study was to compare the knowledge and attitude of premarital men and women on menstrual disorders. Methods: This was a comparative cross sectional study conducted in Kota Bharu, Kelantan. Selfadministered questionnaires were given for data collection. The questionnaires consisted of 3 parts that required information on the women’s and men’s socio-demographic data, women’s menstrual history and information in knowledge and attitude of men and women on menstrual disorders. Results: A total of 460 respondents were involved in this study with a response rate of 93.5%. The prevalence of good knowledge was higher among women compared to men with 73.2% and 26.8%, respectively. There was a significant difference on knowledge and attitude on menstrual disorders between premarital men and women.

Self-reported anxiety of dental procedures among dental students and its relation to gender and level of education

Objectives: The study aimed to identify the dental procedures that elicit the highest level of anxiety by various dental procedures and to determine the correlation of anxiety with students' gender and varying perceptions of anxiety across years of dental education

Methods: This cross-sectional study was conducted at Sardar Begum Dental College, Peshawar, Pakistan during June 2014. The Corah's Dental Anxiety Scale [DAS] was distributed to all students. This instrument had 26 items examining the anxiety levels experienced for different dental procedures. Options ranging from 1 to 4 were provided for every item, where 1 represented low anxiety and 4 represented the highest anxiety

Results: The overall response rate was 67.3% [n = 101; 64 females and 37 males]. Among the top five dental procedures eliciting the highest anxiety levels, females were found to be more anxious than males for all procedures [fear of injection/needle, root canal treatment, extraction, and application of cold air] except the need for further treatment. Pre-clinical students [1[st] and 2[nd] year] were found to be more anxious than clinical students [3[rd] and 4[th] year]. Significant differences [p < 0.05] were found for three procedures: rubber dam placement, inability to stop dentist, and impression taking. Clinical students reported high anxiety for the latter, and pre-clinical students reported higher anxiety for the former two procedures

Conclusions: Higher anxiety levels were reported by females and pre-clinical students than their respective counterparts. Educational sessions and graded exposure therapy at an initial stage of dental educational training may decrease the anxiety associated with dental procedures

Prime reasons for premature discontinuation of antituberculous therapy: at Mayo hospital, Lahore, Pakistan

The objective of this study was to determine the reasons of premature discontinuation of antituberculous therapy. This was a descriptive cross-sectional study that was carried out on 200 diagnosed patients of pulmonary tuberculosis at the Department of Chest Medicine, Mayo Hospital Lahore. The study showed that among the 200 patients, 44 discontinued anti-tuberculous therapy for various reasons. Poverty, feeling of being cured, use of alternative medicine and local remedies were the most common reasons for discontinuation of anti-tuberculous therapy

Management of ascites due to gastrointestinal malignancy

Ascites is the pathological accumulation of fluid within the abdominal cavity. The most common cancers associated with ascites are adenocarcinomas of the ovary, breast, colon, stomach and pancreas. Symptoms include abdominal distension, nausea, vomiting, early satiety, dyspnea, lower extremity edema, weight gain and reduce mobility. There are many potential lymphatics, portal vein thrombosis, elevated portal venous pressure from cirrhosis, congestive heart failure, constrictive pericarditis, nephritic syndrome and peritoneal infections. Depending on the clinical presentation and expected survival, a diagnostic evaluation is usually indicated as it will impact both prognosis and the treatment approach. Key tests include serum albumin and protein and a simultaneous diagnostic paracentesis, checking ascetic fluid, WBCs, albumin, protein and cytology. Median survival after diagnosis of malignant ascites is in the range of 1 to 4 months; survival is apt to be longer for ovarian and breast cancers if systemic anti-cancer treatments are available

Correlations in survivin expression with the expression of p53 and bcl-2 in invasive ductal carcinoma of the breast.

This work studied the correlations between survivin, bcl-2 and p53 in infiltrating ductal carcinoma of the breast. A total number of 382 cases were collected from 3 hospitals in northeastern Malaysia. Survivin, bcl-2 and p53 were detected by immunohistochemistry on samples prepared from tissue blocks. Significant correlations were found between tumor histological grades and tumor size and lymph node involvement. Highly significant statistical correlations (p<0.001) were found in expression of the markers under study. It is concluded that such significant correlations may imply that the alterations in the expression take place in a concerted fashion, implying that many of these cases may share common abnormalities.

Awareness and attitudes of people with diabetes regarding their disease in Hyderabad and Adjoining areas

Diabetes Mellitus [DM] is a chronic disease, associated with high degree of morbidity and mortality. Together with the advances in management of DM, and the widespread availability of treatment, patient's education and awareness about the disease is equally important for the optimum management of the disease. Hence, this study was designed to explore the prevailing attitudes and awareness of diabetic patients in and around Hyderabad - Sindh. A cross sectional survey. Interviews were made regarding attitude, awareness and education about the disease. Percentage scores were then compared separately among the gender [2 groups: male and female], age of the patients [3 groups; group 1, 18-30 years, group II, 31-50 years and group III 51-80 years], and time since the diagnosis of DM [3 groups; group A, less than 6 months, group B, 6.1 month to 3 years, and group C 3.1 years and more]. Total 127 patients were interviewed including 88[69.3%] men and 39[30.7%] women. Among these, 51.7% men and 51% women had a positive attitude while 55.4% of men and 38.8% women had adequate awareness. Also, 68.8% men and 62.8% women were adequately educated. A positive attitude was observed in 4.8%, 46.8% and 46.1% respectively in group I, II and III patients respectively. Corresponding figures for awareness were 49.6%, 55.1%, 44.4% and for education 63.2%, 69.4% and 65.1%. Regarding relationship to the chronicity of the disease, a positive attitude was observed in 53.8% of group A patients, 47.7% and 41.4% amongst group B and C patients respectively. Corresponding figures for awareness and education were 41.1%, 49.1% and 56.2% and 57.8%, 64.2% and 7.7% and 57.8% respectively. Adequate awareness and education about diabetes is lacking. Some aspects of diabetes education need more emphasis. Diabetes education should be tailored according to the individual patient understanding

Incidence of circulating antinuclear antibodies in cancer patients.

The following study was conducted to know the incidence of antinuclear antibody [ANA] in various types of cancers in different age groups of both sexes. Results revealed that an overall level of ANA in female is higher than males. This study also showed that out of 50 only 20 cancer patients had raised level of ANA. Whereas in control group only one was positive for antinuclear antibody. Of these 20 positive cases, 4 were having very high titer of ANA, 13 showed high titer and 3 samples were moderately high titer of ANA. The high prevalence of autoantibodies found in aged cancer subjects could be attributed to several cellular and humoral immunological aberrations, which occur with the aging process. The results of this study confirm the earlier observation of necrosis of tumour tissue could be an important contributing factor for production of autoantibodies.

Relation of body mass index with lipid profile and blood pressure in young healthy students at Ziauddin medical university

This study was conducted to assess serum lipids in healthy young subjects in relation with their BMI. Students of Ziauddin Medical University were assessed for anthropometric measures, blood pressure and lipid profile at the time of their admission for MBBS program. Out of 426 students all parameters were available for 301 students and they were selected for analysis in this study. Mean serum cholesterol in 301students was 149.3 +/- 31.3 mg/dl, mean LDL-C was 91.3 mg/dl +/- 27.7, mean HDL-C was 40.0 mg/dl +/- 42.2, mean triglycerides were 89.9 mg/dl +/- 42.2, mean systolic blood pressure was 113.1 mmHg +/- 13.5 and mean diastolic blood pressure was 74.0 mmHg +/- 8.1. The mean BMI of students was 21.6 Kg/m2 +/- 4.2. Among 301 students, 88 were underweight, 175 were normal and 38 were overweight according to their BMI. We found no significant difference in mean serum cholesterol and LDL-C while there were significant difference in mean serum HDL-C, triglycerides, systolic and diastolic blood pressure among the three BMI groups. In our study, there are high numbers of at-risk individuals. Therefore, strategies should be designed for weight reduction in children and adults to prevent cardiovascular disease

Comparison of troponin T and enzyme levels in acute myocardial infarction and skeletal muscle injury

The objective of this study was to compare the levels of troponin T and enzymes levels in myocardial infarction and skeletal muscle injury. This study was carried out at Basic Medical Sciences Institute, JPMC Karachi, Pakistan. Ninety subjects were selected. Thirty controls, thirty patients suffering from myocardial infarction and thirty suffering from skeletal muscle injury were selected from National Institute of Cardiovascular Diseases. Creatine kinase, aspartate amino-transferase, lactate dehydrogenase and Troponin T were determined by kit methods. Troponin T level rises significantly [p<0.01] in patients suffering from myocardial infarction. Creatine kinase [CK], CKMB, aspartate aminotransferase and lactate dehydrogenase levels rises significantly [p<0.01] in both groups compared with controls. Troponin T is an early indicator of myocardial infarction and is superior to CKMB in diagnosis of myocardial injury. There is no increase in troponin T levels in skeletal muscle injury