Rhesus and Kell phenotyping of voluntary blood donors: foundation of a donor data bank

Objective: To assess the Rhesus [Rh] and Kell [K] phenotype of voluntary blood donors and lay foundation of a data bank of voluntary blood donors

Study Design: Cross-sectional study

Place and Duration of Study: Blood Bank, The Aga Khan University Hospital, Karachi, in the year 2014

Methodology: Voluntary blood donors were inducted after taking written informed consent. Three -5cc of EDTA anticoagulated blood sample was taken to phenotype red cells for C, c, E, e, and Kell antigens using antisera. [DiaMed- Switzerland]

Results: Hundred blood donors were included in the study. ABO blood groups of the donors were: O [37%], B [31%], A [21%] and AB [11%]. Ninety-seven percent were Rh D positive while 3% were Rh D negative; 'e' antigen had the highest frequency [99%], while 'E' antigen was the least frequent [19%]. The most common probable Rh phenotype was R1R1 [[DCe/DCe] in 44 [44%]. In the Kell system, all the donors [100%] had phenotype of K-k+

Conclusion: The most common blood group was O +ve. The pattern of Rhesus antigen expression and phenotype found in this study was concordant to that reported previously from Asia. However, there was a much lower frequency of K antigen

Retrieval of gallbladder through epigastric port as compared to umbilical port after laparoscopic cholecystectomy

This comparative prospective study was conducted at the Ghulam Muhammad Mahar Medical College Hospital and Red Crescent General Hospital, Sukkur, Pakistan, for a period of two years from July 2012 to June 2014. The study included 1800 patients who underwent laparoscopic cholecystectomy for symptomatic cholethiasis. These patients were divided in to two groups. Group I included 900 patients, who underwent conventional laparoscopic cholecystectomy with the four port technique. In these patients, the gall-bladder was retrieved through umbilical port by a sterile surgical hand glove [size 6[1/2] or 7 inches] endobag. The fascial defect of 10 mm umbilical port was closed by vicryl "0" with J-shaped needle, while three 5 mm ports closed by applying steri strips. Group-II also included 900 patients. In these patients laparoscopic cholecystectomy was done by using three ports, 10 mm epigastric working port, 5 mm umbilical port for 5 mm telescope and lateral 5 mm port for assistant. The gall-bladder was retrieved through epigastric port without endobag. The results of both these techniques were collected and analyzed on SPSS version 14. The mean age of patients was 45 years. The male to female ratio was 1:3. In group-I, after laparoscopic cholecystectomy, gall-bladder was retrieved safely through 10 mm umbilical port in surgical glove endobag. In acutely inflamed cases, the gall-bladder was opened at the umbilical port site inside the endobag and decompressed before retrieval. In this group, wound infection of umbilical port occurred in 5.11% patients, port-site hernia in 3.66%, port-site bleeding in 1.33% while difficulty in retrieval of gall-bladder in acutely inflamed cases in 1.88% patients. In group-II, wound infection in epigastric port was found in 1.55% patients, port-site hernia in 0.11%, port-site bleeding in 4%, difficulty in retrieval of gall-bladder in 5.33% while leakage /perforation of gall-bladder in 4.11% patients. The serious complications like wound infection and port-site hernia are more frequently found in group-I patients as compared to group-II

Needle stick injuries among dental health care providers: a survey done at Hyderabad and Karachi

The objective of this study was to assess the frequency of needle stick injury [NSI] among dental health care providers including dental technicians. A cross sectional survey was conducted among dental health care providers running independent dental clinics at Hyderabad and Karachi during the month of April 2013 and a total of 166 qualified dentists and 88 dental technicians were interviewed. Ninety [54.2%] out of 166 qualified dentists and 45 [51.1%] out of 88 dental technicians had been the victims of NSI at least once in preceding 12 months. 104 [62.6%] dentists knew about universal guidelines for prevention of needle stick injury, whereas only 7 [8%] technicians knew about safety guidelines. Only 67 [40.4%] dentists out of 166 and 7 [8.0%] technicians out of 88 reported about the needle stick injury to health authorities [or seniors]. Common reasons for non-reporting among qualified dentists were: 55 [33.1%] believed that there was no benefit to report, 45 [27.1%] did not know where to report and 32 [19.3%] assumed that needle was new. In the category of technicians, 52[59.1%] did not want to report. 03[3.4%] believed needles were used for first time and 5 [5.7%] believed nothing will happen. The risk of blood borne viral infections due to needle stick injury among dental health care providers, especially dental technicians is very high. Based on local studies and international guidelines, national guidelines for Pakistan should be developed by experts to minimize the chances of needle stick injury

Acid aspiration prophylaxis during anaesthesia for caesarean section: a survey among anaesthetists at Hyderabad

Pulmonary aspiration of gastric contents leading to acid aspiration syndrome [AAS] is a well recognized risk factor during general anaesthesia [GA] for Caesarean section [CS]. The cross sectional observational study was conducted during July 2008 to October 2008 at Department of Anaesthesiology and Intensive Care, Liaquat University of Medical and Health Sciences Jamshoro, Sindh, Pakistan. The objective was to assess anaesthetic practice patterns and measures to prevent aspiration of acid gastric contents in full term pregnant women undergoing anaesthesia for Caesarean section. A structured questionnaire regarding practice of anaesthesia for Caesarean section was distributed among anaesthetists working and practicing at Hyderabad. Results from the completed questionnaires were transferred to a Microsoft Excel spreadsheet and the responses represented as percentages. General anaesthesia was preferred by 75.4% anaesthetists for caesarean section, 83.6% anaesthetists used rapid sequence induction with cricoid pressure during general anaesthesia, 29.5% respondents restricted clear fluids for 2-3 hours. Antacids were used by 90% of the anaesthetists, while about 50% anaesthetists performed extubation when patients were fully awake. Recommended practice patterns and measures to prevent aspiration of acid gastric contents during anaesthesia for caesarean section are not observed by most of the anaesthetists working at Hyderabad

investigation of mechanism of vasodilator activity of 17 beta-estradiol as being geriomic or non-genomic

To determine the vasodilator activity of 17 beta-estradiol as being genomic or non-genomic. The experimental protocol was divided into three groups, In group I aorta of rat was subjected to serial dilutions of norepinephrine and a standard concentration was selected, which produced optimal vasoconstriction. In group II, tissue was challenged with serial dilutions of 17 beta-estradiol in the presence of vascconstriction induced by the standard concentration of norepinephrine. Meanwhile in group III tissue was challenged with serial dilutions of 17 beta-estradiol in presence of standard concentration of norepinephrine after pretreatment with dactinomycin, which was used to inhibit protein synthesis so that genomic mode of action could be blocked. In our study 17 beta-estradiol, after pretreatment with dactinomycin, produced vasodilator activity in the same pattern as obtained without administration of protein synthesis inhibitor in the tissue preconstricted with norepinephrine [P<0.001]. The observations demonstrate the vasodilator activity of the 17 beta-stradiol to be its non-genomic action

Efficacy and safety of intra-vesical B.C.G in superficial bladder tumor after TURGB

To determine the effectiveness, safety and side effects of intra-vesicle B.C.G immuno-therapy in superficial bladder tumor after TURGB. Observational study / Quasi-experimental. Bolan Medical College Teaching Hospital Quetta, from August, 2004 to July, 2008. Patients age ranges from 40 to 75 years.21 males and 4 females, with proven superficial bladder tumor [Ta-Tl]were included after TURGB in this study. These 25 patients underwent intra-vesicle immunotherapy [BCG.].These patients were followed up for two years and extent of improvement in presenting symptoms, recurrence of tumor, side effects and complications were noted. Out of 25 patients 23 patients [92%] received BCG immunotherapy after TURGB. Out of these 23 Patients 15 patient [65.2%] showed complete response and 6 patients [26.08%] showed partial response while remaining 2 patients [8.69%] had constant progression in disease and underwent cystectomy. It was concluded that B.C.G immunotherapy is very effective and save patients from recurrence and cystectomy

Post dural puncture headache after spinal anaesthesia for caesarean section: a comparison of 25G Quincke, 27G Quincke and 27G whitacre spinal needles

To compare the frequency and severity of post dural puncture headache in obstetric patients using 25G Quincke, 27G Quincke and 27G Whitacre spinal needles. Comparative, randomized, double-blind, interventional study. Liaquat University Hospital Hyderabad from October 2005 to December 2006. 480 ASA I-II full term pregnant women, 18 to 45 years of age, scheduled for elective Caesarean section, under spinal anaesthesia, were randomized into three groups: Group I [25G Quincke spinal needle: n=168], Group II [27G Quincke spinal needle: n=160] and Group III [27G Whitacre spinal needle: n=152]. Spinal anaesthesia was performed with 1.5-2.0 ml 0.75% hyperbaric bupivacaine using 25G Quincke spinal needle [Group I], 27G Quincke spinal needle [Group II] and 27G Whitacre spinal needle [Group III] at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Frequency and severity and of postdural puncture headache [PDPH] were recorded. Data were analyzed using SPSS-11. Frequency of PDPH following the use of 25G Quincke [Group I], 27G Quincke [Group II] and 27G Whitacre [Group III] spinal needles was 8.3% [14/168], 3.8% [6/160] and 2.0% [3/152] respectively. In Group I, PDPH was mild in 5 patients, moderate in 7 patients and severe in 2 patients. In Group II, it was mild in 2, moderate in 3 and severe in 1 patient. In group III, it was mild in 2 and moderate in 1 patient. Severe PDPH did not occur in Group III. Most of the patients with PDPH developed it on first and second postoperative day. When using a 27G Whitacre spinal needle, the frequency and severity of PDPH was significantly lower than when a 25G Quincke or 27G Quincke needle was used

Frequency, pattern and etiology of nosocomial infection in intensive care unit: an experience at a tertiary care hospital

Nosocomial infection is defined as an infection which develops 48 hours after hospital admission or within 48 hours after being discharged. The objectives were to assess the frequency of nosocomial infection in patients admitted to intensive care unit [ICU] and to determine the etiological factors in such patients. It was an Observational Study and conducted in Intensive Care Unit, Liaquat University Hospital Hyderabad Sindh Pakistan from January 2008 to November 2008. All patients above 16 years of age admitted in the ICU for more than 48 hours and developed clinical evidence of infection that did not originate from patients' original diagnosis at the time of admission, were included in the study. Data was entered in a proforma and analyzed using SPSS version 10.0. During the study period, 97 out of 333 patients acquired nosocomial infection. The frequency of nosocomial infection was 29.13%. Respiratory tract infection was seen in 29 [30.1%], urinary tract infection in 38 [39.1%] and blood stream infection in 23 [23.7%] patients. Other infections we identified were skin, soft tissue, wound and gastrointestinal tract infections. Patients admitted in intensive care unit are at more risk of acquiring nosocomial infection from different sources. It is suggested that proper nursing care, sterilization and disinfection of instruments and equipment and careful handling of invasive procedures are the best tool to control these life threatening infections

Otolaryngologic manifestations of gastroesophageal reflux disease

To determine frequency of endoscopic oesophagitis in the patients who complain the chronic laryngopharyngeal disorders in the absence of typical gastroesophageal Reflux Disease [GERD] symptoms. Descriptive study The study was carried out in the department of E.N.T at Nawabshah Medical Centre, Nawabshah over the period of two years [2004 to 2006]. One hundred patients of either sex and in the age group between 25-79 years with symptoms of chronic laryngopharyngeal disorders were selected for study. All patients had physical examination of upper aero digestive tract. Direct laryngoscopy was done to evaluate the status of larynx, however rigid esophagoscopy was done to evaluate the status of esophageal mucosa and biopsies from lower part of esophagus were taken in all patients. Eighty percent of patients with symptoms of chronic laryrigopharyngitis were also suffering from microscopic Oesophagitis. Among the 80% patients 87.5% were having non-erosive oesophagitis while 12.5% were having erosive oesophagitis. In significant number of patients with chronic upper respiratory symptoms resistant to the treatment, there was co existing gastroesophageal disease which could be the cause of the symptoms

Common bile duct pathologies at Nawabshah

To determine the causes, prentation, management and outcome of Common Bile Duct [CBD] pathologies. Descriptive analytical study from January 1995 to December 2006. Surgical Unit-I, Nawabshah Medical College and Hospital, Nawabsheh. All patients who presented with CBD pathologies. Data of all the patients with CBD pathologies was collected and entered on a proforma, including their complaints, positive examination findings, investigation, diagnosis, procedure performed and its outcome. During the study period 45 patients presented with CBD pathology. Amongst them 14 were males and the rest females [31], with a mean age of 36.7 years. Around 67% patients had choledocholithiasis as the commonest cause. Exploration of the CBD with T-tube insertion was the commonest procedure, performed in 69% patients. About 4% patients had retained stones and 20% developed wound infection. Mean hospital stay was 13 days. Most common pathology involving the CBD was secondary stones; 95% patients had associated gall stones also

Role of verapamil in acute opioid abstinence syndrome

To determine the effectiveness of calcium channel blocker, verapamil in the treatment of acute opioid withdrawal syndrome in patients with chronic dependence on opioid. A clinical study. The study was conducted at Psychological Medicine ward, Civil Hospital Karachi from January 1998 to April 1998. A total of twenty [20] patients were admitted for ten [10] days in hospital. No treatment was given during the first two days of admission after abrupt termination of opioid to observe the acute opioid withdrawal signs and symptoms. Then the verapamil was given orally to each patient in a 40mg dose thrice daily from day 3 to day 10 of admission. The intensity of signs and symptoms was recorded by using subjective and objective opiate withdrawal questionnaire. Urine analysis for opioids was done on day 1, 5 and 10 of admission. Verapamil significantly decreased the intensity of signs and symptoms of acute opioid withdrawal from day 4 to day 10 of admission. Urine analyses for opioids were positive on day 1 while zero on day 10. Verapamil was found to be safe and effective for the treatment of signs and symptoms of acute opioid withdrawal in in-door patients without any significant side effect

comparative study of kinetic parameters of alprazolam in hepatic and renal insufficient patients

To compare the kinetic parameters of Alprazolam in both hepatic and renal insufficient patients. Jinnah Postgradute Medical Institute, Karachi. Blood samples were collected from three groups of the patients after giving tablet Alprazolam [0.25 mg B.D] for 21 days. These samples were then analyzed for kinetic parameters i.e. Plasma half life, clearance, plasma concentration and volume of distribution. The parameters included plasma concentration of Alprazolam, clearance [cl], serum alkaline phosphate, serum bilirubin and serum glutamate pyruvate transaminase. Patients were divided into three groups i.e. 1] control, 2] suffering from renal insufficiency, 3] suffering from hepatic insufficiency. On day seven and day twenty one, in the same group [both renal], plasma conc. and t 1/2 increased while Vd and cl decreased. On the other hand in the same group [both hepatic], on day 7 and 21, plasma conc. and t 1/2 increased while Vd and cI decreased. When comparative study done on day 7 and 21 in opposite groups [renal vs hepatic], plasma conc., Vd and t 1/2 increased while cI decreased. In hepatic insufficiency, the doses of Alprazolam [benzodiazepines] should be reduced but in renal insufficiency doses should be reduced in only severe forms of renal dysfunction

Tuberculosis of the breast: a cytomorphological study of nine cases

To determine the role of FNAC with histological confirmation in the diagnosis of tuberculous mastitis, and to highlights its importance by determination of frequency, clinical history, clinical presentation and laboratory investigations in our setup. A retrospective case series from Jan. 1997 to Dec. 2006. Department of Pathology, Nawabshah Medical College, Nawabshah. Nine patients with mammary tuberculosis. The data was collected from patients files and other record, and the results tabulated. All were married multiparous women, aged 18-42 years, belonging to poor socio-economical class. One was pregnant, while three were lactating mothers. Associated pulmonary tuberculosis was present in three cases. Previous history of tuberculosis was present in one case, though five patients had a family history of tuberculosis. Lump in the breast, with or without ulceration/ abscess/ discharging sinus was the clinical presentation of all the cases, as was low grade fever and pain. All patients had anemia and weight loss, though axillary lymphadenopathy was seen in five cases. ESR was raised in all the cases and the Mantoux test was positive. The glutaraldehyde test was positive, though it was performed in three cases only. AFB were seen in one case only. The diagnosis was made on FNAC by the presence of chronic granulomatous inflammation having caseating epithelioid granulomas and Langhan's type of giant cells. The cytological diagnosis was confirmed by histopathologicaI findings of excisional biopsy specimen in all the cases. The present study highlights the importance of tuberculous mastitis; its frequency being 2.3% in breast diseases. FNAC is an important initial diagnostic tool in patients having tuberculous mastitis, specially in the rural areas. It is safe, rapid, simple, cost effective and accurate, the accuracy being 100%

Gleason grading of carcinoma prostate at Nawabshah medical college / Hospital

To evaluate the Gleason Score and pathological grading of patients with Carcinoma of the Prostate amongst prostatectomy specimen. A retrospective study from January 1996 to December 2005. Nawabshah Medical College Hospital, Nawabshah. A total 4595 patients who underwent prostatectomy. Detailed data of the patients was retrieved from the case sheets, ward records and the Pathology Department by manual search, and analyzed. Amongst the total 595 cases, the age range was 50-90 years with a mean age 465.08 years. Out of the 595 prostatectomy specimen submitted during the study period, 46 [7.73%] had adenocarcinoma. According to the Gleason Score 18 [39.13%] cases had well differentiated [Score 2-4], 24 [52.17%] had moderately differentiated [Score 5-7] and four [8.69%] cases had poorly differentiated [Score8-10] adenocarcinoma. Gleason Score is a universally accepted prognostic indicator of Carcinoma Prostate. Pathologists must report consistently for the better management of the condition

Correlation of age with histopathological type of testicular tumors

The aim of the study was to find out the frequency and histopathologic type of various testicular tumors in correlation with age of the patients in our setup. It was a retrospective, descriptive study carried out at the Department of Pathology, Peoples Medical College, Nawabshah, Pakistan. All testicular tumors diagnosed from January 1991 to December 2005 were included in the study. The clinical data and surgical pathology reports with haematoxylin and eosin stained slides were obtained from the record. All the cases were reviewed and results tabulated. The patients were divided into six age groups and the tumors classified according to the pathological classification of testicular tumors. During this period 73 cases of testicular tumors were diagnosed in the department. All cases were diagnosed as germ cell tumors [100%]; consisting of 57 [78.1%] cases of single histologic type and 16 [21.9%] cases of mixed germ cell tumors. Most of the cases presented in the 3[rd] and 4[th] decades. Seminoma was found to be the commonest tumor in 27 [37%] cases, embryonal carcinoma in 29 [27.4%] cases, teratocarcinoma in 11 [15.1%] cases, yolk sac tumor and teratoma each in 5 [6.8%] cases, embryonal carcinoma with seminoma in 3 [4.1%] cases and teratoma with seminoma in 2 [2.8%] cases. In this study the ages of the patients and the frequency and histopathological findings in testicular tumors, with few exceptions are similar to other studies from different parts of the world, confirming the worldwide similarity of these parameters

unusual foreign body in the urinary bladder

Foreign body in urinary bladder being unusual in clinical setting presents as a diagnostic dilemma with vague history. Bladder calculi are uncommon in adults and usually result either from obstruction or foreign bodies. The present case report describes a young girl presenting with cysticism. Investigations revealed a bladder calculus encrusted on trans-urethrally inserted abortion stick in the urinary bladder that warranted surgery. Endoscopic manipulation was successful. Postoperative period was uneventful

To study the feeding pattern and response to drugs in infants with [infantile colic]

This study was conducted at the department of child health of Khyber teaching hospital Peshawar, from Jan 1[st] to Dec 31[st], 2oo4. Sixty patients with infantile colic were selected for the study after taking a detailed history and thorough examination, to rule out specific organic causes of excessive crying. They were divided into two groups on the basis of drugs given [semithicone and herbal drug]. Results were tabulated, compared with different studies and the following conclusions were made. A] Infantile colic occurs commonly from two weeks to 5 months of age. B] Infantile colic seems to be less common in breast fed as compared to bottle fed infants. C] Drugs have very little role in the treatment of infantile colic

Vesico-vaginal fistula experience of surgical repair at Larkana

To assess the causes of Vesico-vaginal fistula and evaluate the results of surgical repair ot'Vesico-vaginal fistula A retrospective study was conducted in Ch and ka Medical College Hospital and Larkan Medical Centre from March 1999 to February 2005. Forty patients of Vesico-vaginal fistula resulting from causes other than malignancies and radiations were included in the study. Majority of the patients had fistula secondary to an obstetrical cause. Of the total 32 patients were repaired trans-vaginally. Prolonged labour was the major cause of Vesico-vaginal fistula [80%]. Thirty two [80%] patients were operated trans vaginally and 8 trans-abdominally. Success rate was 85.8% for the transvaginal approach in the first instance. Stress urinary incontinence was noted in 2 patients while 1 patient with transabdominal approach developed recurrence. In developing countries the major cause of Vesico-vaginal fistula is obstructed labour which can be repaired trans. vaginally in majority of cases under skilled surgeon

Outcome analysis of transvesical prostatectomy in our setting

To evaluate the outcome of suprapubic transvesical prostatectomy in our setting. Prospective and descriptive audit from July 2002 to July 2005. Department of Surgery, Peoples Medical College Hospital, Nawabshah. A total of 120 patients with lower urinary tract obstruction due to benign prostatic hyperplasia [BPH]. The details of all the above mentioned patients were recorded and the data analyzed for age, presentation, accompanying problems, blood transfusion, hospital stay, complications and mortality. The age range of the patients was from 50-90 years, mean age being 64.73 years. The indications for surgery were retention of urine in 64 [53.33%] cases, prostatism in 53 [44.17%] and haematuria in three [2.5%] cases. Associated problems were seen in 73 [60.83%] patients, including bladder stones in 19 [15.83%], inguinal hernia in 15 [12 .5%], haemorrhoids and renal stones in four [3.33%] each, and medical problems in 30 [25%] patients. The average operation time was 67.5 minutes and 51 patients needed blood transfusion [1-3 units]. Complications were seen in 49 [40.83%] cases including haemorrhage and urinary tract infection in eight [6.67%], clot retention in six [5%], wound sepsis in seven [5.83%], and transient incontinence and suprapubic urinary leakage in five [4.17%] cases each. The post-operative mortality was in 1.67% [two cases]. Transvesical prostatectomy [TVP] performed under spinal anesthesia is a safe and effective way of managing BPH. Its success has a durable effect and is a satisfactory modality in situations where facilities for transurethral resection of prostate [TURP] are not available