Comparison between Urethroplasty with and without stent for Hypospadias in terms of postoperative Urethrocutaneous Fistula formation

Objective: To compare the urethroplasty with and without stent for hypospadias in terms of frequency of postoperative urethrocutaneous fistula formation

Study Design: Randomized controlled trial

Place and Duration of Study: Department of Pediatric Surgery, Pak Emirates Military Hospital Rawalpindi, from Jan 2015 to Dec 2017

Patients and Methods: A total of 260 patients with diagnosis of hypospadias were selected from outpatient department after confirming their diagnosis by taking a detailed history and performing thorough clinical examination. Patients were divided randomly into two groups, group A and group B via lottery method. In group A, urethroplasty was done by using a stent while in group B, urethroplasty was done without a stent although stent was used in this group as a template preoperatively to form a neo urethra and then removed after 24 hours. The 6-8 FR nasogastric tube was used as stent. The follow up was after 2, 6 and 12 weeks to see the fistula formation in both types of procedures. All the data was recorded on the specially designed proforma attached as annexure A. Data was analyzed using SPSS version 22

Results:The overall incidence of urethrocutaneous fistula was 21 [8 percent] out of the total study population. In group-A there were 18 [13 percent] cases who developed fistula and in group-B 3 [2 percent] cases developed fistula. There was significantly higher no of cases in group-A, who developed fistula as compared to group-B, p-value = 0.001

Conclusion: Stents are routinely used in many centres after urethroplasty for hypospadias repair leading to higher incidence of urethrocutaneous fistula. If urethroplasty is done meticulously, stentless surgery may produce fewer fistulas

Study of erythrocyte sedimentation rate and anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis

Objective: To study the erythrocyte sedimentation rate [ESR] and anti-cyclic citrullinated peptide [anti-CCP] antibodies in rheumatoid arthritis patients on disease modifying anti-rheumatic drug therapy

Study Design: Cross sectional comparative study

Place and Duration of Study: Centre for Research in Experimental and Applied Medicine [CREAM-I], Department of Biochemistry and Molecular Biology, Army Medical College, Rawalpindi in collaboration with Rheumatology Department, Military Hospital Rawalpindi, from Jan 2016 to Jun 2016

Material and Methods: Study sample was seventy in number and was divided into two groups. Group I consisted of thirty five patients suffering from rheumatoid arthritis, while group II consisted of thirty five healthy individuals who were not suffering from any chronic illness. Non probability purposive sampling was done. ESR was measured using Westergren method, while anti-CCP was estimated by enzyme-linked immune sorbent assay [ELISA]

Results: Data were analyzed using SPSS 22 version. Mean age of patients of rheumatoid arthritis was 49.69 +/- 11.5 years and that of control group was 47.4 +/- 10.4 years. Among the study population 30 [43%] individuals were males and 40 [57%] were females. In patient category, there were 10 [29%] males and 25 [71%] females. In control group 20 [57%] males and 15 [43%] females were present. Independent t-test was applied between the two variables i.e. ESR and anti-CCP, with showed significant p-value of less than 0.001

Conclusion: There was significant increase in both ESR and anti-CCP levels in rheumatoid arthritis patients on disease modifying anti-rheumatic drugs as compared with control group

Diabetic patients; study of inflammatory markers

Inflammation is the one of the major causes for development of type 2 diabetes mellitus and its complications. In this study, association between inflammation and type 2 diabetes mellitus was studied by measuring various inflammatory markers [soluble vascular cell adhesion molecules type - 1, Interleukin - 6 and C- reactive protein] between healthy and diabetic patients. A cross sectional comparative study. The study was conducted at Department of Biochemistry and Molecular Biology, Army Medical College, Rawalpindi in collaboration with Combined Military Hospital, Rawalpindi and Centre for Research in Experimental and Applied Medicine [CREAM], Army Medical College, Rawalpindi for blood sampling and biochemical assays respectively. The study was performed in 40 human subjects divided into two groups containing 20 subjects each. One group was designated as control while the other was diseased [diabetic] group. Glycemic status was measured to confirm their normal and diabetic state. Inflammatory markers were measured by Enzyme Linked Immunosorbent Assay [ELISA]. Levels of all inflammatory markers [soluble vascular cell adhesion molecules type - 1, Interleukin - 6 and C-reactive protein] were found to be raised in the experimental diabetic groups; 1991.5 +/- 201.97 ng/ml, 24.99 +/- 1.366 pg/ml and 2931 +/- 168.319 respectively compared to the control group; 570.2 +/- 16.526 ng/ml, 6.64 +/- 0.3516 pg/ml and 1806.6 +/- 183.32 respectively. Inflammatory markers were significantly elevated in patients with diabetes mellitus as compared to normal healthy control subjects

effect of olive-pomace oil on different blood parameters in streptozotocin induced diabetic rats

To determine the effects of olive-pomace oil on glycemic status and lipid profile in diabetes. Study Design: Randomized controlled trial. Department of Biochemistry, Army Medical College, Rawalpindi in collaboration with Centre for Research in Experimental and Applied Medicine, Army Medical College, Rawalpindi and National Institute of Health, Islamabad from March 2010 to June 2011. Seventy male albino rats of Sprague-Dawley strain were randomly divided into two groups of 35 rats, each. Rats were rendered diabetic by injecting streptozotocin. Group 1 and group 2 were given normal rodent diet and olive pomace oil supplemented diet respectively for 6 weeks. At the end of the experiment fasting blood glucose and lipid profile were measured for comparison. There was significant increase in high density lipoprotein and significant decrease of blood glucose, total cholesterol and low density lipoprotein of group II rats when compared with group I [control]. Olive pomace oil can significantly improve fasting blood glucose and lipid profile in diabetic rats

Accuracy of the upper lip bite test; modified Mallampati classification in predicting difficult endotracheal intubation

To compare the accuracy of Upper lip bite test with modified Mallampati classification for predicting the difficult laryngoscopic intubation. Cross sectional Study. The study was carried out at Department of Anaesthesiology, Intensive Care and Pain management, Combined Military hospital, Rawalpindi from September 2008 to August 2009. Four hundred patients undergoing elective surgery meeting the inclusion/exclusion criteria were enrolled after written informed consent. The airways of the patients were evaluated by using the modified Mallampati classification [MMP] and the Upper lip bite test [ULBT]. MMP class 3 or 4 and ULBT class 3 were considered as indicators of difficult intubation. The laryngeal view was graded by Cormack and Lehane classification [Gold standard]. Grade 1 or 2 was considered to represent easy intubation and grade 3 or 4 to represent difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated for both the tests separately by using the 2x2 table. ULBT had a higher accuracy of 94%, specificity of 99.2% and positive predictive value 70% compared to MMP accuracy of 82.7%, specificity of 84.4% and positive predictive value of 22.7%. The diagnostic accuracy of the Upper lip bite test was more than the modified Mallampati classification. We suggest that it be compared with the other prevailing tests as well which are often used to assess difficult intubations

D - dimers assay as an adjunct to diagnosis of cerebral venous sinus thrombosis

To determine the frequency of raised D-dimer in patients of cerebral venous sinus thrombosis [CVST] at Neurology Department, Military Hospital Rawalpindi. Descriptive study. One year duration conducted in the Department of Neurology at Military Hospital Rawalpindi from 1[st] May 2010 to 1[st] May 2011. Thirty patients were selected randomly from Neurology Department, who were recently diagnosed cases of cerebral venous sinus thrombosis [CVST] on the basis of magnetic resonance imaging [MRI] and magnetic resonance venography [MRV]. D-dimer test samples were drawn and subjected to latex agglutination test. There were 22[73.33%] males and 8[26.67%] females in our study. D dimmer assay analyses revealed 90% [27 patients] as positive and 10% [3 patients] as negative. Raised D-dimer levels are highly suggestive of CVST provided other conditions are clinically excluded and they can be used as an adjunct in the diagnosis of cerebral venous thrombosis