Extraction and characterization of high purity chitosan by rapid and simple techniques from mud crabs taken from Abbottabad

Chitosan and chitosan based materials offer diverse applications in the field of biotechnology, nanotechnology, pharmaceuticals, environmental protection and tissue engineering due to their various biological and physicochemical properties. Major sources of chitosan are shrimps, crabs and lobsters. Properties of chitosan differ with the degree of deacetylation and the molecular weight. Researchers are investigating to produce high quality chitosan in cost effective and time efficient way which was the aim of present study. The exoskeleton of mud crabs, taken from Abbottabad, was demineralized with 2mol/dm3 H2SO4 solution for 4hour and then, deproteinized with 2mol/dm3 NaOH solution for 4hour at room temperature. Yield of crude chitin was 78% which was deacetylated with 55% NaOH solution at 110oC for 4hour to obtain chitosan. After precipitation, the yield of pure chitosan form the crab shell was 39%. The degree of deacetylation of chitosan was 92% measured by potentiometric titration and the molecular weight was 1.2×106g/mol [1200KD], determined by viscometric method. We concluded that a high quality chitosan can be produced at commercial level in Pakistan by rapid and simple techniques

Prevalence and diagnostic of head and neck cancer in Pakistan

Head and Neck [HN] cancer is the most frequently identified cancer across the globe and is considered as 8-10 % of all cancers in Southeast Asia. The social and cultural habits are the main cause of the remarkable increase in HN cancer in Pakistan. HN cancers are more prevalent in men as compared to women. The HN cancer in Pakistan is mainly attributed to discrete demographic profile, risk elements, eating patterns and family history. The foremost factors of risk are linked with cigarette smoking, alcoholic drinks and tobacco chewing like paan, gutka, etc. The actual burden of HN cancer in Pakistan is 18.74% of all new cancer cases recorded during 2004 -2014. The data is collected from HN cancer patients who are diagnosed from September 2011 till May 2012 in the Institute of Nuclear medicine and Oncology, Lahore Pakistan. In order to diagnose risk factors of HN cancer, the Logistic Regression [LR] and Linear Discriminant Analysis [LDA] are used as analytical tools. The findings of using these both tools concluded that gender, age, occupation, socioeconomic status, family history, chewing habits, smoking habit, worked in the chemical or dust place, alcohol use are main causes for HN cancer. The main aim of this study is to develop the awareness about HN cancer, its causes and early diagnosis

Transmural tracheal laceration during transhiatal esophagectomy for adenocarcinoma of esophagus

We report a case of a patient undergoing transhiatal esophagectomy for carcinoma of lower one third of esophagus, who suffered intraoperative iatrogenic transmural tear of trachea just above the carina. This life threatening condition needed costal flap repair of tracheal laceration by thoracic surgeon. Early diagnosis, team approach by surgeons and anesthetists, and in time management are key elements for the survival and uneventful recovery of the patient

Thoracic trauma: one year surgical audit at Arar Central Hospital, Saudi Arabia

Background: Thoracic trauma is increasingly encountered now a days in emergency room

Objective: To determine the pattern and management outcome of thoracic trauma patients at area central Hospital Saudi Arabia

Methodology: Study Design: Crosssectional study. Place and Duration of Study: This study was conducted on 104 patients at the ER, ICU and Surgical floor of Arar Central Hospital, Northern Border Region, Saudi Arabia from 1 January to 31 December 2015. Information consisting of patients particulars, pattern and modes of injuries and hospital stay were recorded. Complications and deaths were analyzed by database to determine the morbidity and mortality. Patients irrespective of their age and gender were included in our study. The data was entered and analyzed by using SPSS version 11

Results: Sample size of 104 patients was included. Male to female ratio was 4:1. Patients age raised from 4 years to 82 years, mean age was 29.6 years. Blunt Trauma was most prevalent [72.11%], followed by Penetrating injuries [19.23%] and combined injuries [8.65%]. Extra thoracic injuries included orthopedic injuries in 35[33.65%] patients, 28[26.92%] patients has neurological injuries whereas in 23[22.11%] patients blunt abdominal trauma was noted. Most frequent injury pattern seen was Fracture Ribs 70 [67.30%] patients with underlying haemothorax in 27[25.96%]patients. Most of the patients treated either conservatively or with tube thoracostomy 53.84% and 43.27% respectively. Complications were encountered in 35 [33.65%] patients. 10 [9%]patients has Chest tube site infection whereas 7[6.73%] developed atelectasis treated successfully by Bronchoscopy. Overall 6 [5.76%] deaths were recorded during study duration

Conclusion: Thoracic injuries remain major trauma related issues in this part of country. Highest priority must be given to the chest injured patients in order to decrease the morbidity and mortality. Moreover surgical audit should be expanded to other facilities also in order to improve the health care facilities provided to patients

Laryngeal fracture caused by a lacrosse ball

Neck injuries in lacrosse are rare and mostly involve the musculoskeletal system. The lacrosse ball is a solid rubber ball of approximately 20 cm in diameter and the fastest shot recorded in professional lacrosse is over 100 mph. Despite wearing full protection, the neck remains prone to blunt trauma by this ball. A 23-year man sustained a direct blow to his left neck by a lacrosse ball during play, resulting in immediate aphonia and stridor. CT scan confirmed a left thyroid lamina fracture. The patient was treated conservatively and his airway was monitored for 24 hours. He made a full recovery. It is important that lacrosse players should be aware of this potential injury and appropriate precautions should be taken to avoid this trauma

Biodegradable synthetic polyurethane foam nasal packing after septoplasty

To determine the usefulness of biodegradable Synthetic Polyurethane Foam [SPF] nasal packing as an adjunct to day-case septoplasty. Comparative, observational case series. Aberdeen Royal Infirmary, University of Aberdeen, Scotland, UK, in the year 2011. One-hundred consecutive patients who underwent septoplasty and received SPF packing in 2010 were prospectively audited while one-hundred consecutive patients undergoing septoplasty in the year 2000 were studied retrospectively. Data collected include demographics, type of operation and duration of hospital stay. Excel and SPSS were used for data collection and analysis. In the year 2000, the average age of the patients was 40.6 years. There were 37 females and 63 males. One patient returned home the same day, 22 stayed one night, 69 spent two nights and 8 stayed more than two nights in hospital for their operation. The average length of stay was 1.84 nights. In 2010, the average age of patients was 37.86 years, with 31 patients being female and 69 male. All patients in this cohort received SPF packing postoperatively. Seventy-three patients went home the same day, 24 patients stayed one night and 3 patients spent two nights in hospital for their operation. Average length of hospital stay was 0.3 nights. Results were statistically significant [p < 0.001]. SPF was a useful nasal packing option after septoplasty and inferior turbinate surgery, which enabled the surgeons to carry out this surgery safely as a day-case procedure

Epiglottic hypoplasia: a natural model for supraglottic laryngoplasty

Non-syndromic hypoplasia of the epiglottis presenting without symptoms at middle age is an extremely rare entity. We report a 50 years female who presented with oral ulcers and incidentally was found to have an asymptomatic rudimentary epiglottis and thickened bilateral aryepiglottic folds forming an inverted funnel shaped supraglottis protecting the airway from any aspiration. This case demonstrated a functional model of natural supraglottic laryngoplasty which can be used in treating intractable aspiration, similar to the Steam boat modification of Biller's technique of supraglottic laryngoplasty. This natural example can be used to design or scrutinize the existing models of supraglottic laryngoplasty in the treatment of intractable aspiration

Unilateral pupillary dilatation following septoplasty: cause for concern?

We report and explain unilateral pupillary dilatation following routine septoplasty and trimming of inferior turbinates. The unilateral pupillary dilatation was caused by inadvertent instillation of sympathomimetic, [xylometazoline hydrochloride] in the eye during preparation for nasal surgery. The effect was short-lived and the patient made a full recovery. Unilateral pupillary dilatation after sinonasal surgery can be alarming due to the possibility of injury to the globe and intracranial haemorrhage but can also be explained by the mydriatic effect of the sympathomimetic nasal drops and sprays used to decongest the nose. Such possibility should be borne in mind and would help to explain and reduce the anxiety and avoid unnecessary investigations

Severe hypo-osmotic hyponatraemia due to chylous leak following radical neck dissection

Chylous leak is a documented complication of radical neck dissection with well recognised morbidities, including wound breakdown, hypovolaemia and hypoalbuminaemia. Other less well-documented electrolyte imbalances can also ensue. We aim to raise awareness about hypo-osmotic hyponatraemia as a potentially fatal, commonly overlooked complication of high-output chylous leaks. Following identification of his hyponatraemia, this patient underwent successful management in the intensive therapy unit, followed by surgical repair of his chylous leak. Hypo-osmotic hyponatraemia as a complication of chylous leak is not well documented, is likely to be overlooked when present, and is potentially life-threatening. It should be sought after in any patient with a high-output chylous leak following neck dissection

Copper and cadmium levels in hairs and nails; an indicator of heavy metal pollution

Heavy metals ingested or inhaled can affect liver, Brain, Bone and lungs. Raised copper and cadmium levels have been seen in ischemic heart disease. A level of trace elements varies in blood among population. In this study Copper and Cadmium levels were determined in hairs and nails; easy to sample and store. Purpose of this study is to find out relationships with heavy metals pollution and try to develop as a screening test. Such work is not yet done in our population. 86 male subjects and 20 controls [male] were selected for determination of Cu and Cad concentrations in hairs and nails. Medical history was noted. 3-4 fingernails and 1 tbsp of hair cut from the nape of neck close to root were obtained. Samples were analyzed by atomic absorption spectrophotometer. Highly significant [p< 0.001] raised copper levels were seen in hairs and nails of subjects [110.79 +/- 26.01 and 99.34 +/- 7.81microg/ gm respectively] compared with control [80.76 +/- 7.81and 77.65 +/- 2.48]. Similarly significantly [p< 0.001] raised Cadmium levels were found in subjects [hairs 143.57 +/- 62.03and nails 104.71 +/- 74.52] compared with control [89.20 +/- 12.98 and 77.54 +/- 12.32]. Highly significant [p< 0.001] raised values of Cd and Cu indicate that hairs and nails concentration may indicate heavy metals pollution and it can be easy sampling test for screening of pollution about heavy metal exposure

Coblation adenotonsillectomy in children

To determine re-admission rate for post-tonsillectomy pain; the primary and secondary post-tonsillectomy bleeding rate; the percentage requiring control of post-tonsillectomy bleeding in children undergoing coblation tonsillectomy. A descriptive study. Royal Hospital for Sick Children [Yorkhill Hospital] between 2004 and 2006. All patients who underwent tonsillectomy with or without adenoidectomy by coblation technique. Patients were identified from operation theatre log book and electronic data base of theatre activity. The hospital case notes were reviewed retrospectively to collect data, regarding demographics, indication and type of surgery, grade of operating surgeon, duration of hospital stay, re-attendance and re-admission, and management of complications. A total of 106 children; males [n = 53, 50%], females [n = 53, 50%] with a mean age 6.3 years underwent surgery using coblation technique. Thirty-one percent had a tonsillectomy while 69% underwent an adenotonsillectomy. Of these, 48% had history of recurrent tonsillitis, 43% had obstructive sleep apnoea and 9% suffered predominantly from obstructive symptoms. Eighty-two percent of patients were discharged on the first postoperative day. Only one patient had primary bleeding requiring re-operation. After discharge, 7 patients [6.7%] were re-admitted with secondary bleeding, 3 [2.8%] of whom were taken back to theatre to control the bleeding under general anaesthesia. Coblation tonsillectomy is a useful technique in having a low primary and secondary bleeding rates in children undergoing tonsillectomy and adenotonsillectomy

Amyloidosis of the nasopharynx: an unexpected cause of unilateral middle ear effusion

Amyloidosis is an idiopathic disease that is characterized by the extracellular deposition of fibrillar proteins. The disease can be categorized as primary or secondary where deposits occur in conjunction with chronic diseases such as rheumatoid arthritis or tuberculosis. The deposits can be localized or systemically distributed. It can mimic, and also be associated with underlying malignancy. Primary amyloidosis is a rare cause of a nasopharyngeal lesion, and less so of a secondary middle ear effusion. Its association with underlying chronic and malignant disease must not be over-looked if serious complications are to be avoided. It is, therefore, important to consider this as a differential diagnosis in such patients

Tuberculosis with secondary vasculitis presenting as a nasal septal perforation

A 45 years old man with tuberculosis [TB] and secondary vasculitis presented with perforation of the nasal septum, involving skin and cranial nerves. Vasculitis is a recognized, tough rare complication of tuberculosis and has not been previously described in the literature as a cause of nasal septal perforation. It presents a diagnostic dilemma. The diagnostic challenges of this case are outlined, and the clinical implications are discussed

Transanal small bowel evisceration following digital reduction of a chronically prolapsing rectum

Evisceration of the small bowel through a rectal perforation is rare. This is the case of a 66 year-old female presenting to the Accident and Emergency Department with transanal evisceration of her small bowel resulting from attempted digital reduction and subsequent tear of her chronically prolapsing rectum. Reduction of the prolapsed small bowel and primary repair of the rectal tear were carried out at laparotomy. The management of this case is discussed

Optimal dose of prophylactic intravenous ephedrine for spinal-induced hypotension during cesarean section

The objective of this study was to compare the efficacy of 10, 15, and 20mg bolus doses of prophylactic IV ephedrine for prevention of maternal hypotension associated with spinal anesthesia for cesarean section. A prospective, quasi experimental study. The study was conducted at Department of Anesthesiology and Intensive Care, Shalamar Hospital Lahore [Pakistan], and was completed in six months period from January to June 2008. Ninety parturients of ASA grade I and II, receiving spinal anesthesia for elective C-section were included in this study. They were randomly divided into three groups. Group-I received lOmg, Group-II 15mg, and Group-Ill 20mg prophylactic IV ephedrine immediately after administration of spinal anesthesia. Intra operative hemodynamic changes were recorded and the data were analyzed. Incidence of hypotension was significantly higher in Group-I parturients receiving a lOmg prophylactic dose of ephedrine than in Group-II and Group-Ill parturients receiving 15mg or 20mg of ephedrine respectively [53.3% versus 13.3% and 3.3% respectively]. There was however, a significantly higher incidence of reactive hypertension in Group-II parturients [46.7%]. 15mg bolus dose of prophylactic IV ephedrine can effectively prevent spinal induced maternal hypotension during cesarean section without adverse effects like reactive hypertension

Contralateral limb weakness after intrathecal chemical neurolysis for cancer pain

The treatment of cancer pain encompasses both pharmacological and interventional techniques. In certain situations, patients may have intractable pain despite use of optimal doses of oral or parenteral analgesics. Interventional procedures, like intrathecal chemical neurolysis [ICN], play an important role in the management of such intractable cancer pains. The goal is to achieve segmental block that is purely sensory, without causing any motor weakness in the patient. Potential problems related to ICN include inadequate pain control with the progression of tumour size, short duration of effect, lower limb weakness on the ipsilateral side and rectal or bladder sphincter dysfunction. We present a case report in which the patient developed unexpected weakness of contralateral limb after ICN for management of cancer pain

Call-fleming syndrome: an extraordinary complication of tonsillectomy

A 36 years old woman underwent tonsillectomy for recurrent tonsillitis. At about one week in the postoperative period, she developed sudden onset severe [[thunderclap]], recurrent headaches and focal neurological signs including visual disturbances, ataxia and myoclonic jerks. Serial imaging with MRI, MRA and CT angiography revealed reversible white matter focal edema and segmental cerebral vasoconstriction. A diagnosis of Call-Fleming syndrome was made based on her symptoms and imaging findings, and she was started on nimodipine. She made a slow recovery but still has slight unilateral foot drop even 12 months since the initial event. This is the first case of Call-Fleming syndrome occurring following an ENT procedure