Salvadora persica; anti-inflammatory activity in rats

To evaluate anti-inflammatory activity of Salvadora persicain rats. The anti-inflammatory activity of Salvadora persica was assessed in 63 albino rats of both sexes, weighing 400 gm. They were divided into three groups, A [control], B [crude drug], C [standard drug] with twenty one animals. Each group was divided into three subgroups with seven animals. Groups B and C were given crude drug and aspirin diluted in one ml of distilled water once daily orally, in doses of 300, 500, and 700 mg/kg body weight respectively, prior to induction of edema and Group A was given same volume of saline. Inflammation was induced in hind paw of rat by sub-planter injection of 0.1ml of 1% carrageenan. Paw volume was measured in terms of milliliters using plethysmometer, immediately before injection and then hourly up to 5 hours and mean was calculated. The inhibition of edema was calculated for each subgroup with respect to control group. After carrageenan injection mean paw volume of control group was 5.43 ml, while that of drug treated subgroup was 4.32 ml and standard group was 4.49 ml at the dose of 700 mg/kg body weight. Comparison of crude drug with the control was found to be statistically significant only at 700 mg/kg and was comparable with the standard drug aspirin. Salvadora persica has shown anti-inflammatory activity by decreasing the paw volume of carageenan induced edema

effect of hydro alcoholic extract of Juglans regia leaves in streptozotocin-nicotinamide induced diabetic rats

Phytotherapy has been achieved to maintain glycemic control in patients with diabetes mellitus. The present study was conducted to evaluate the antihyperglycemic properties of the Juglans regia leaf extract in streptozotocinnicotinamide induced diabetic rats. Nicotinamide was injected intraperitonealy [i.p.] 15 min before the injection of Streptozotocin [i.p.]. One week after induction of diabetes, oral treatment started with extract of Juglans regia and Metformin and continued for 4 weeks. Fasting blood sugar, body weight, serum lipids and insulin level were measured in different groups. A significant reduction of glucose, HbA1c, total cholesterol and serum triglycerides were detected after 4 weeks in rats treated with Juglans regia leaves compared to the control groups. Thus, Juglans regia extract treatment showed potential hypoglycemic and hypolipidemic effects in type 2 diabetic rats

Laparoscopic versus inguinal [Ivanissevich] varicocelectomy

To compare the postsurgical outcome of laparoscopic and open inguinal varicocelectomy. Quasi-experimental study. Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2003 to June 2007. One hundred seven patients underwent either open inguinal or laparoscopic varicocelectomy. Diagnosis was made by clinical examination and color Doppler scan in doubtful cases. Pre-operative semen analysis was done in all patients. Operative time, postoperative analgesic requirement in number of tablets, hospital stay in days, improvement in semen parameters in subfertile subjects, pain on visual analog score, and postoperative complications were recorded and compared between the two groups. There were 50 patients in each group, with age ranging from 12-50 years [26.9 +/- 7.67 in open inguinal and 26.2 +/- 7.08 in laparoscopic group]. Average operative time was 34.8 +/- 7.89 minutes for open inguinal and 43.8 +/- 8.95 minutes for laparoscopic group. The analgesic requirement was 16.3 +/- 1.58 tablets in the open inguinal and 11.3 +/- 2.23 in the laparoscopic group. Postoperative pain was significantly less in the laparoscopic group. There was statistically significant [p < 0.001] improvement in sperm count as well as motility in both groups irrespective of procedure. The open inguinal [Ivanissevich] procedure and laparoscopic varicocelectomy had almost equivalent postoperative outcomes regarding improvement in semen parameters and postoperative complications. Open inguinal procedure had a shorter operating time while laparoscopic varicocelectomy had the advantage of less analgesic requirement and short hospital stay. On the whole, open inguinal [loupe magnified] varicocelectomy is an effective procedure where availability and costs of laparoscopic instruments are barriers

Comparison of propofol and sevoflurane for laryngeal mask airway insertion [LMA] in adults

To compare the effects of Porpofol and Sevoflurane in Laryngeal Mask Airway insertion. This study was quasi experimental was carried out in the Department of Anesthesiology, Surgical Intensive Care and Pain Management, Dow Medical College and Civil Hospital Karachi, Dow University of Health Sciences. The duration of the study was six months. In this study 60 patients schedule for elective surgery were enrolled which were divided into two groups. The average age of the patients was 25.1 +/- 10.6 years [95% CI; 23.7-29.0]. Out of 60 patients, 28 [46.6%] were males and 32 [53.3%] were females with 1:0.8 male to female ratio. Gender difference was not statistically significant between the groups [Chi-Square= 0.601; P=0.44]. The average age, weight and LMA insertion time were not statistically significant between groups. Induction time was significant between groups. Induction time was significantly higher in porpofol group [B] than in the sevoflurane group [A]. Condition of LMA insertion of 24 [80%] patients were excellent [score = 18] and 6 [20%] patients were satisfactory [Score between 16 to 17] in group A while condition of LMA insertion of 28 [93.3%] were excellent and 2 [6.7%] were satisfactory in group B. This study concludes that porpofol is a better anesthetic agent for insertion of LMA as compared to sevoflurane by using loss of eye lash reflex as the end point for induction

Varicocelectomy high ligation versus low ligation

To find out the outcome of two modalities in management of varicocele comparing high ligation [Paloma's procedure] and low ligation [Ivanissivich's procedure] This observational descriptive study was carried out in Surgical units of People's Medical College Hospital Nawabshah on 60 patients, belonging to age group of 15 to 36 years from January 2002 to December 2006. Patients with varicocele were divided in two groups of treatment modality equally. Group I comprising 30 patients for high ligation whereas 30 patients were kept in Group II for low ligation. Follow up was carried out for two years but response was poor. Varicocele had been observed on left side in most of the cases [95%]. Three cases [5%] presented in Grade-I, 21 [35%] in Grade-II and 36 [60%] in Grade-III varicoceles. Oligospermia was detected in 15% of cases. Group I patients were apprehensive regarding disappearance of dilatation and hanging veins postoperatively seen in 70% of cases whereas disappearance of veins were seen in 93.34% in Group II patients. Complications like haematoma and hydrocele are seen in Group II patients as compared to Group I. Wound infection and recurrence remained almost the same in both groups. High ligation was better tolerated with less complication but did require more counseling regarding disappearance of dilated veins. Paloma's procedure also does not disturb the normal anatomy of inguinal canal

audit of informed consent in surgical patients at a university hospital

To obtain informed consent is considered an integral part of modern clinical practice. It works as a safeguard of patient's rights and minimizes the chances of legal action against the physician in case of any complication arising from the proposed therapy. Objective was to evaluate the practice of informed consent in patients undergoing surgery in a University hospital. A survey was conducted at different surgical departments of a university hospital during December 2007 to March 2008. Participants were selected from patients over the age of 18 years who had undergone elective or emergency surgery. All interviews were based on structured questionnaire. The patients were asked if an informed consent was taken or not before the surgery. They were also inquired if they were given information about the diagnosis, the surgical procedure planned and risks associated with it. The patients were also asked if they were informed about the types of anaesthesia proposed. A total of 106 patients were randomly selected for this study. In 8.5% cases, no consent was taken. Only 38% of the surveyed patients acknowledged that they actually understood the information imparted to them. 66% patients were informed about the type of anaesthesia proposed but none was given any hint about complications of anaesthesia. 11% patients actually signed the consent forms themselves. The quality of existing informed consent process in a university hospital is less than ideal. There is a great need to educate the doctors and healthcare regarding the importance of patient's autonomy and their right to the information about their medical condition and the proposed surgical procedures to ensure their participation in the decision making regarding their treatment

Laparoscopic cholecystectomy in the elderly patients. An experience at Liaquat University Hospital Jamshoro

Advancing age with its associated co-morbidities increases the likelihood of postoperative complications as well as conversion rate during laparoscopic cholecystectomy. Recent studies have also questioned efficacy of this procedure in geriatric patients. The present study assesses the safety and applicability of laparoscopic cholecystectomy in geriatric patients. The objective of the present study was to asses safety and applicability of laparoscopic cholecystectomy in the elderly patients of 65 years and above. This is a prospective analysis of 173 patients, over 65 years of age, who underwent laparoscopic cholecystectomy from December 2002 to November 2006 at Liaquat University Hospital, Jamshoro. Patients presenting with complicated and uncomplicated gallstone disease were included in the study population and all of them were operated laparoscopically. The data included demographic details, co-morbidities, underlying biliary pathology, indications for surgery, operative and postoperative complications, morbidity and mortality, and hospital stay. The statistical analysis of the data performed on SPSS version 10. Laparoscopic cholecystectomy undertaken in 173 elderly patients with a mean age of 69.72 years, out of whom 52 [30.05%] were males and 121 [69.94%] were females. Co-morbid conditions were identified in 53.17% [n=92] patients and included hypertension in 38 patients [21.96%], Diabetes Mellitus in 23 patients [13.29%], COPD in 19 [10.98%] patients, Coronary artery disease in 9 [5.20%] and cardiac arrhythmias in 3 [1.73%] patients. Indications for surgery included simple biliary colic in majority of patients [69.94%] and complicated stone disease in 52 [30.05%] subjects. There were 37 [21.38%] emergency laparoscopic cholecystectomies and 136 [78.61%] patients were operated electively. Mean operative time was 100 minutes with a SD 29.03. Fourteen [8.09%] patients required conversion to OC [Open Cholecystectomy] due to various reasons. Mean hospital stay was 6.28 days. Overall 23 [13.29%] patients developed postoperative complications. One patient died of acute MI on 2nd postoperative day. There is no undue risk in laparoscopic cholecystectomy in the elderly population and the procedure can be regarded as safe as in patients below 65 years of age

Emergency laparoscopic cholecystectomy in acute cholecystitis

To study the presentation and outcome of cases operated for Gynecomazia. A retrospective study spread over four years i.e. June 2002 to May 2006. Different hospitals of Karachi including Civil Hospital. 46 males who were admitted for surgery of Gynecomazia. All patients included in this study were evaluated in detail clinically and by appropriate investigations. They were counselled about the condition, and operated via a peri-areolar or sub-mammary incision, and the outcome noted in terms of healing and complications. Out of the 46 cases, majority [71.74%] presented in the age group 11-20 years with peak incidence around 16 years of age. The main symptom was breast enlargement, though pain or discomfort was also seen in 12 [26.1%] patients. The size of the breasts varied between 4-8 cms, and 34 [73.9%] cases were bilateral. Surgery was done for macromastia in 7, long standing gynecomazia in 11 and cosmetic reasons in 28 cases. Wound infection and hypertrophic scar formation constituted the few complications noted. Gynecomazia is the commonest condition affecting male breasts. In majority of the cases counselling and observation is all that is required for management, as they subside spontaneously or on medication. Surgery is indicated in those cases that do not subside or on patient demand

Etiology, presentation and managment outcome of pneumothorax

This study was carried to determine etiology, presentation, complications and management outcomes of pneumothorax in patients presenting at two hospitals in NWFP province of Pakistan. Pneumothorax patients reporting at the chest unit of Post Graduate Medical Institute, Lady Reading Hospital, Peshawar, and Pulmonology unit of Ayub Teaching Hospital, Abbottabad from 1999 to 2002 were included in the study. Patients of all ages were included. They were admitted and followed up to the full recovery/late complications. A total of 146 pneumothorax patients reported during this period. Majority of the patients were diagnosed to have pneumothorax due to pulmonary tuberculosis making about 36.30%] of the total cases. Second most common cause was primary spontaneous pneumothorax [19.86%]. Bacterial infections were also sizeable at 16.43%. Other causes included COPD, Asthma, latrogenic, Interstitial lung disease, tuberous sclerosis and bronchiectasis. It was concluded from this study that pulmonary tuberculosis is the commonest cause of pneumothorax in our setup

Ischiopagus tripus conjoined twins: a case report

Conjoined twins are one of the rarest congenital anomalies. We present a case of Ischiopagus tripus conjoined twins. The twins were fused at abdomen and pelvis, having two well formed lower limbs and one abnormal lower limb. There was only a single fused pelvis and only one set of well formed male external genitalia and absent anal opening. Anoplasty was done for imperforate anus and later on surgical separation attempted

Hypospadias repair: a five year experience

Ninety cases of hypospadias were operated in the Department of Paediatric Surgery, Chandka Medical College, Larkana, from January 1993 to December 1997. The most common age group was between 1-5 years [63.3%] and the most common variety of hypospadias was penile [68.8%]. Chordee was present in 76 patients [84.5%] and other associated anomalies were present in 8 patients [9%]. Family history of hypospadias was present in 3 patients [3.3%]. Patients without chordee were selected for single stage repair and those with chordee were selected for two stage Byar's method of repair. Chordee was corrected in 76 cases, out of which 37 patients are waiting for urethroplasty. Urethroplasty has been done in 53 patients; single stage urethroplasty in 16 patients and two stage Byar's urethroplasty in 37 patients. Overall complication rate of urethroplasty was 36%. Fistula was the most common complication [28.3%]. Byar's method of hypospadias repair was found most satisfactory and adaptable to all degrees of hypospadias