Traditional practices of the ethnoveterinary plants in the Kaghan Valley, Western Himalayas-Pakistan / Prácticas tradicionales etnoveterinarias de las plantas en el valle de Kaghan, Himalaya occidental Pakistán

Introduction: Indigenous people in a far-flung mountainous area without basic facilities, mainly rely on medicinal plants to cope with various veterinary health problems. Objective: The present study was carried out to explore the traditional knowledge of ethnoveterinary practices in Kaghan Valley, district Mansehra, Western Himalayas-Pakistan. Method: Ethnoveterinary data were collected between February to October 2014 from nine villages of the Kaghan Valley by involving 80 local people include traditional healers using a semi-structured interview. Results: A sum of 41 plant taxa of ethnoveterinary medicinal plants was documented for treating livestock ailments. Out of which, herbaceous plants were recorded with high percentage (27 species, 65.8 %). Most of the species were used to treat gastrointestinal diseases (12 taxa), followed by health improvement (7 taxa). The widely used part of plants for livestock aliments was the whole plant (9 species) followed by leaves (7 species), and preparation were paste (18 species) followed by powder with 10 species. The highest used values were recorded for Arisaema costatum (0.82), Primula denticulata (0.76), and high relative frequency citations for Berberis lyceum and Dryopteris ramosa with 0.37 each. Among the plant species Skimmia laureola, Thymus linearis and Phytolacca latbenia were among the taxa with cent fidelity level. Conclusion: The flora used in traditional remedies of the valley was found mostly endemic due to excessive utilization. Thus, further chemical investigation, better utilization and conservation of indigenous use of the reported species should be considered for future work.

Introducción: Los pueblos indígenas de zonas montañosas lejanas sin facilidades básicas dependen principalmente de las plantas medicinales para afrontar problemas de salud de tipo veterinario. Objetivo: Explorar el conocimiento tradicional en las prácticas etnoveterinarias en el valle de Kaghan, distrito de Mansehra, Himalaya occidental-Pakistán. Métodos: Se recopilaron datos etnoveterinarios mediante una entrevista semiestructurada entre febrero y octubre de 2014 en nueve aldeas del valle de Kaghan, con la participación de 80 habitantes locales, incluidos curanderos tradicionales. Resultados: Se documentó un total de 41 taxones de plantas medicinales etnoveterinarias para el tratamiento de enfermedades del ganado. Se registró un alto porcentaje de plantas herbáceas (27 especies, 65.8 %). La mayoría de las especies utilizadas han sido para tratar enfermedades gastrointestinales (12 taxones), y mejora de la salud (7 taxones). Para el tratamiento de enfermedades del ganado, lo más usual fue utilizar la planta entera (9 especies), seguida de las hojas (7 especies), con preparación en pasta (18 especies) y en polvo (10 especies). Las especies registradas con más uso fueron: Arisaema costatum (0.82), Primula denticulata (0.76) y Berberis lyceum y Dryopteris ramosa con la misma alta frecuencia relativa (0.37 cada una). Las especies Skimmia laureola, Thymus linearis y Phytolacca latbenia se reportaron entre los taxones con mayor nivel de fidelidad porcentual. Conclusión: La flora utilizada en los remedios tradicionales del valle de Kaghan fue mayoritariamente endémica. Se propone para trabajos futuros mayor investigación química, y mayor utilización y conservación en las especies de plantas reportadas por los indígenas.

LRINEC score - a reliable diagnostic tool for early diagnosis of necrotizing fasciitis

Objective: To evaluate the reliability of LRINEC [Laboratory Risk Indicator For Necrotizing Fasciitis] score for clinical diagnosis of necrotizing fasciitis [NF]

Study design: Retrospective review of records

Place and Duration of study: Department of General Surgery ward 26, Jinnah Postgraduate Medical Center [JPMC] Karachi, from December 2010 to November 2015

Methodology: The diagnosis of NF was made on the clinical grounds followed by confirmation on surgical intervention by the presence grey necrotic tissues, absence of dermal bleeding and foul smelling dish water color pus. The LRINEC score was applied. Patients were excluded from study if they were of age < 15 or >90 year and patients transferred from other hospitals after the initial treatment

Results: The LRINEC score calculated and all the patients were divided into two groups. One group with LRINEC > 6 included 27 patients while the other group with LRINEC score < 6 included 13 patients. The diagnosis of NF was confirmed on histopathology of tissue sample taken during the first debridement. Histopathology revealed that 23 out of 27 patients with LRINEC >6 and 4 out of 13 patients with LRINEC score <6 had positive histopathology for NF. LRINEC score was found to be 92.15% sensitive [CI; 95%] and 90.70% specific [CI; 95%] with positive and negative predictive value [PPV and NPV] of 95.45% and 85.33% respectively

Conclusion: The diagnostic yield of LRINEC scoring system for necrotizing fasciitis was high. It was easy to apply and cost effective

Comparative results of repair of ischemic mitral regurgitation [IMR]: conventional against trans-septal approach

Objective Ischemic mitral regurgitation is common and increases mortality, even when mild. [American Heart Association] AHA and European association have both stressed the need of mitral valve repair in patients with moderate or more regurgitation. The aim of this study was to compare the results with the conventional and right atrial trans-septal approach of mitral valve repair in Ischemic Mitral Regurgitation [IMR]

Methodology A total of 308 consecutive patients underwent mitral valve repair for IMR, between January 2012 and December 2013 at Tabba Heart Institute. Patients who had at least moderate mitral regurgitation or more mitral regurgitation underwent mitral regurgitation repair. The final decision of mitral valve repair was taken after the intra operative trans-esophageal echocardiography [TEE]

Result Total number of patients included in study was222, out of those 153 [69.9%] patients underwent conventional approach and 69 [31.1] patients underwent trans-septal approach. Total 88.2% patients got off bypass in normal sinus rhythm in conventional approach group, as compared to 82.1% in transseptal group. 11.8% and 17.9% patients got off by pass on pacing in conventional and transseptal approach respectively. 3 patients developed junctional rhythm and 5 patients developed complete heart block in post-operative period in trans-septal approach

Conclusion Right Atrial Trans-septal technique is a good alternative approach that can be used in relatively small atria. It not only provides an excellent exposure to the mitral valve, there also seems to be no associated rhythm disturbances encountered as well

Predicting severity of pancreatitis and its mortality-comparison of BISAP and Ranson scoring systems

Objective: to find out the prognostic significance of BISAP scoring system and its accuracy in predicting the severity of acute pancreatitis in comparison with Ranson criteria

Study design: cross-sectional study

Place and Duration of study: Department of General Surgery ward 26 Jinnah Postgraduate Medical Centre [JPMC] Karachi, from January 2013 to December 2014

Methodology: Patients of either gender more the 14 year of age with acute pancreatitis admitted through emergency department were included. All the patients were scored according to the Ranson criteria [at time of admission and at first 48 hours post admission] and BISAP score [in first 24 hours of admission]. Patients were categorized having mild or severe acute pancreatitis on the basis of organ failure for more than 48 hours and these patients were treated in HDU/ICU according to the standard protocol

Results: a total of 50 patients diagnosed as acute pancreatitis were admitted during the study period. The mean age of the patients was 43.48 +/- 15.75 year with the age range from 15 year to 75 year. There were 30 [60%] females and 20 [40%] males with F:M ratio of 1.5: 1. The duration of hospital stay was 2-50 days with mean of 12.15 +/- 5.85 days. Nine [18%] patients developed persistent organ failure for more than 48 hours and were classified as having severe acute pancreatitis. These patients underwent contrast CT- scan abdomen on day 3 of admission. Three of them had necrotizing pancreatitis. The frequency of severe form of acute pancreatitis stratified by the BISAP and Ranson score were both statistically significant [p < 0.001]. Three [6%] patients died during their hospital stay [mortality rate 6%]. All the three patients who died had Ranson score > 3 and BISAP score = 3 respectively

Conclusion: in predicting the frequency of severity and mortality in patients with acute pancreatitis the BISAP scoring system is equally effective as Ranson scoring system

Skeletonized versus pedicled internal mammary harvest: relationship of pain towards technique

Objective purpose of this study is to compare skeletonized versus pedicled internal mammary harvest

Introduction one of the commonly used procedures for multi-vessel and left main coronary artery disease is Coronary Artery Bypass Grafting [CABG with fewer and recurrent complication i.e. Post procedure pain that is an outcome of mechanical, thermal or ischemic injury to the inter-costal nerves during Internal Thoracic Artery [ITA] harvesting

Methodology this study is being done to examine whether skeletonized or pedicle harvesting results in lesser occurrence and intensity of post-CABG pain with aim to identify which one is the better of the two techniques that can be used in future for patients planned with CABG. 63 consecutive patients were recruited at Tabba Heart Institute who underwent median sternotomy for CABG with Internal Thoracic Artery harvest was included. Group A went harvesting through skeletonization whereas patients in group B underwent harvesting by Pedicle ITA. This initial screening was done with the help of pre designed questionnaire. The data statistically analyzed by SPSS

Results the results of study concluded that skeletonization of ITA does not reduce post coronary artery bypass graft surgery pain at the end of one month intervals. It is suggested that that skeletonized ITA is only beneficial when bilateral ITA are used

Conclusion it was concluded that skeletonization of ITA does not reduce post coronary artery bypass graft surgery pain at the end of one month intervals. We suggest that that skeletonized ITA is only beneficial when bilateral ITA has been used

Surgical closure of ASD's and concomitant procedures needed in adults: a 3 year cardiac centre experience

Objective the study aims to evaluate the surgical closure of Atrial Septal Defect [ASD] and concomitant surgical procedures needed at Cardiac Care Centre

Introduction an ASD is a hole of variable size in the atrial septum. A patent foramen ovale that is functionally closed by overlapping of limbic tissue superiorly and the valve of the fossa oval inferiorly [in response to the normal left-to-right atrial pressure gradient] is excluded. ASDs generally permit left-to-right shunting at the atrial level. Partial anomalous pulmonary venous connection [PAPVC] is a condition in which some but not all pulmonary veins connect to the right atrium or its tributaries, rather than to the left atrium

Methodology a prospective cohort study was done at Tabba heart institute. 115 consecutive patients were reviewed and investigated. All the patients with surgical closure of ASD and concomitant surgical procedures who returned for follow-up from June 2011 to May 2016 in the study were included as population sample

Results total ASD repair only patients were 80 and patients who needed concomitant procedures too were 35. The size of the defect ranged from 3mm to 58mm, with a mean of 26.96+/-11.02mm. The relative frequencies of different ASDs were secundum 57 [80.2%], primum 4 [5.6%], and sinus venosus 10 [14.08%]. Major post-operative complications by Age group and by procedure were evaluated and presented

Conclusion it was concluded from our results that surgical repair of atrial septal defects and its variants is associated with very low morbidity in different age groups due to its excellent results

Rapidly progressive effusive constrictive pericarditis caused by methicillin sensitive staphylococcus aureus [MSSA]

Effusive-constnctive pericarditis is a clinical syndrome characterized by concurrent pericardial effusion and pericardial constriction, where constrictive hemodynamics are persistent after effusion is drained. It may present at any point along the clinical course, from the occurrence of an effusion to the development of chronic pericardial constriction. We refer an unusual case of effusive constrictive pericarditis developing rapidly within days, following purulent pericarditis secondary to chest trauma

Complications of laparoscopic cholecystectomy: a learning curve

The objective of the study was to find out the rate of complications of laparoscopic cholecystectomy being performed by trainees under supervision. Case Series. Place and Duration: Study was conducted in Surgical unit-1 [ward-3] of JPMC Karachi from November 2001 to November 2005. All the patients above twelve years of age of both sexes were admitted for laparoscopic cholecystectomy after evaluation in the outpatients department who were diagnosed as cases of chronic cholecystitis with cholelithiasis. A total of 620 patients were included in the study. Biliary complications were 0.16% and non biliary 0.8%. Vascular injury, diaphragmatic injury and pneumothorax did not occur in our study. Complications of laparoscopic cholecystectomy in the hands of trainees can be minimized by adhering to the principles of good laparoscopic surgery

Atrial fibrillation post cardiac surgery: incidence, predisposing factors and prognostic implications

Background and Objectives: atrial fibrillation [AF] is the most common arrhythmia occurring post cardiac surgery and is associated with significant morbidity, increased overall hospital stay and cost. Anecdotal observations suggest very low incidence in Pakistani patients undergoing cardiac surgery particularly coronary artery bypass graft surgery [CABG]. The objective of this study was to assess the prevalence, morbidity and mortality of post cardiac surgery AF

Methods: a prospective study of 201 consecutive patients undergoing cardiac surgery at a tertiary care center. Clinical characteristics and perioperative data was collected and analyzed. Patients were followed for presence or absence of atrial fibrillation till hospital discharge

Results: the overall incidence of AF post cardiac surgery was 6.9%. AF occurred in 9 of 187 patients undergoing CABG alone, 3 of 12 patients undergoing valve replacement and 2 of 2 undergoing combined procedures. Increased left atrial [LA] size had significant association with post cardiac surgery AF [p = 0.01] as did the use of dopamine and epinephrine post operatively [p = 0.03 and 0.002 respectively]. In addition, significant association was also noted for valvular surgery [p = <0.001]. Multiple logistic regression analysis revealed that increased LA size [odds ratio 0.08, 95% CI 0.008-0.99, p = 0.04] was the only independent predictor of post cardiac surgery AF with borderline significance for concomitant valvular surgery [odds ratio 0.89, 95% CI 0.79-0.99, p = 0.05]. Mean hospital stay was significantly longer and overall cost was significantly higher in patients who developed AF [p = <0.001] in addition to higher overall mortality [p =0.025]

Conclusions: the incidence of AF post cardiac surgery was quite low in this study cohort. The occurrence of atrial fibrillation, albeit for short duration, was associated with higher all-cause mortality, significantly longer hospital stay and higher overall cost

Massive chylopericardium and chylothorax following cardiothoracic surgery

Chylopericardium is a rare complication of cardiothoracic surgery, associated with significant morbidity and mortality. The presentation may be insidious in isolated chylopericardium. Early diagnosis and appropriate treatment are essential. Simultaneous chylopericardium and chylothorax postcardiac surgery has been very infrequently reported. A case of a young patient is, hereby reported, who developed simultaneous massive chylopericardium and chylothorax, after aortic valve replacement and atrial septal defect [ASD] closure, leading to significant hemodynamic compromise and prolonged hospitalization. Surgical exploration led to the correct diagnosis and a favorable outcome

Tonsillectomy-control of haemorrhage silk ligation v/s bipolar diathermy

Control of haemorrhage during and after tonsillectomy, has always been the prime concern factor for the oto-laryngologist to minimize the morbidity and mortality since antiquity. Various techniques have been in practice for this purpose during tonsillectomy. We have used bipolar diathermy and silk sutures to control the bleeding and securing haemostasis in different cases. This is a prospective study of 120 cases of tonsillectomy conducted at ENT department, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh from January 2003 to December 2003. It is concluded that although less time is consumed when using bipolar diathermy to achieve haemostasis during tonsillectomy but however the ligation of bleeding point using silk sutures was more effective for less post operative hemorrhages

Small intestinal obstruction caused by a low vacuum suction drain, a case report

A low pressure suction drain [Abdovac] used following a right hemicolectomy resulted in small bowel obstruction by sucking the seromuscular layer into its side holes, kinking the bowel and preventing removal of the drain. Insufflation of air through the drain in combination with gentle traction is suggested for the adherent low vacuum suction drains