Extracorporeal shockwave lithotripsy; which parameter determines the outcome: calculus radiodensity or calculus size

To evaluate the effect of urinary calculi attenuation values from non enhanced computed tomography [stone radiodensity] and stone size in determining the outcome of treatment by ESWL. Descriptive case series study. Department of Diagnostic Radiology, Lahore General Hospital Lahore, in collaboration with the Department of Urology, Lahore General Hospital Lahore. Study was carried out over a period of six months from January 2012 to July 2012. Seventy patients with solitary renal calculus of 05 mm - 20 mm size were evaluated for calculus attenuation values in Hounsfield Units on non enhanced computed tomography. Patients were being grouped according to calculus attenuation values as: 1] less than 500 HU [soft] 2] 500-1000 HU [medium] 3] more than 1000 HU [Hard]. Patients were also distributed in three groups according to stone size as: 1] 5-10 mm 2] 11-15 mm 3] 16-20 mm. Patients were being subsequently treated with ESWL. During each ESWL session 3000 shockwaves were given. Stone clearance was documented by USG within three month after start of treatment. Out of 70 patients stones were cleared in 84.3% [n=59] patients. According to the stone density, the rate of stone clearance was 100% [n=19] in group 1, 88.9% [n=27] in group 2 and 66.7% [n=24] in group 3. Regarding the stone size, stones were cleared in 88.9% [n=9] in group 1, 77.4% [n=31] and 90% [n=30] in group 3. The best outcome was in patients with stone diameter of 16-20 mm and a density of < 500 HU. The worst outcome was in patients with stone diameter of 11-15 mm and a density of >1000 HU. The attenuation value of stone has a greater impact on ESWL outcome than the stone size. Further these attenuation values of urinary tract stones before ESWL helps in determining the treatment outcome and in planning alternative treatment in patients with likelihood of poor outcome from ESWL

Antifungalactivity of cedrus deodara root oil against various fungal isolates

Antifungal activity of Cedrus deodara root oil against Aspergillus niger, Aspergillus flavus, Fusarium solani, Fusarium oxysporum, Rhizoctonia solani and Macrophomina phaseolina has been investigated using disc diffusion and well method. The maximum zone of inhibition of 6 mm was noted for Rhizoctonia solani for oil concentrations of 160 and 170 microg/disc while only 5 mm for 100, 120 and 140 microg/disc, respectively by disc diffusion method. No significant response has been observed against Fusarium solani, Fusarium oxysporum, Macrophomina phaseolona, Aspergillus niger and Aspergillus flavus. However, Aspergillus flavus showed maximum zone of inhibition of 8 mm for 210 microg and 7 mm for the concentration of 190 microg using well method where as the oil did not show any response against Aspergillus niger using well method

Risk factors associated with childhood asthma among children aged 1-12 years in Rawalpindi

To explore various risk factors associated with childhood asthma in Rawalpindi garrison and city among children 1-12 years old. Case Control study. Pediatric departments of Military Hospital [MH] and Combined Military Hospital [CMH] Rawalpindi from 1st Aug to 30th Nov 2009. A total of 128 children with diagnosis of asthma presenting in outpatient and indoor pediatric departments of MH and CMH Rawalpindi between ages of 1-12 years were included. Age, gender and socioeconomically matched 112 children without diagnosis of asthma were included as controls. A predesigned questionnaire containing various factors associated with childhood asthma was filled by the researcher by detailed interview with either of parents. Data was analyzed by SPSS version 15 and chi-square test was applied to determine significance. p value <0.005 was considered significant. Out of 15 risk factors studied 8 were found significantly associated with childhood asthma. Significant factors were education of any of the parents more than matric, history of fever at least three times in last year, use of antibiotics, history of hay fever, raised IgE levels, exposure to passive smoking, living in urban areas and family history of asthma [p value<0.005]. Non significant factors were mode of delivery, exclusive breast feeding for more than 3 months, partial breastfeeding for more than 6 months, history of eczema, atopy, history of viral respiratory infections in infancy and less than three number of rooms at home. Male preponderance was noted amongst cases. Education of parents, fever, antibiotics, hay fever, raised IgE levels, exposure to passive smoking, living in urban areas and family history of asthma proved to be significant factors which are similar to those reported in other studies. However, difference was found in other factors. Recognition of these factors can help to optimize management of asthma in children in this area

Gall bladder carcinoma with krukenburg tumour a case report

To determine the mechanism and pattern of animal related injuries in the troops deployed in field. A hospital based observational study. Main Dressing Station Kotli Azad Kashmir from Jan 2004 to Jan 2006 An observational hospital based study was carried out on all the patients who reported to the Main Dressing Station [MDS] between Jan 2004 to Jan 2006. The data was collected by using hospital information system. A performa was developed after review of literature which included necessary information related to patient's age, sex, type of injury and species of animal involved. The information collected was analyzed in detail. Laskin and Donhoue1 classification was used to classify wounds. A total of 48 patients were reviewed. These were all males and the mean age was 25 years. Thirty three [69%] patients had soft tissue injuries, 7 [15%] had fractures, 5 [10%] had head injury and 3 [6%] had abdominal injury. Mule kick injuries occurred in 37[77%] patients, dog bite in 7[15%] cases and donkey bite in 4[8%] cases. Troops deployed in the field are exposed to the hazard of animal related injuries which can be fatal at times. The complex nature of these injuries entails early and appropriate management in order to achieve satisfactory outcome and prevent complications. Prevention strategies include proper animal handling techniques based upon animal behavior and the appropriate use of well designed confinement facilities

Etiology of short stature in children

To determine the causes of short stature in children with special emphasis on growth hormone deficiency. Case series. Department of Paediatrics, Military Hospital, Rawalpindi and Combined Military Hospital, Multan from September 2004 to January 2007. Two hundred and fourteen children [140 boys and 74 girls], ranging from 02 to 15 years presenting with short stature were studied. Height and weight were plotted on appropriate growth charts and centiles determined. Relevant hematological and biochemical investigations including thyroid profile were done. Bone age was determined in all cases. Growth hormone axis was investigated after excluding other causes. Karyotyping was done in selected cases. Data was analyzed by SPSS 10.0 by descriptive statistics. Mean values were compared using t-test. In this study, the five most common etiological factors in order of frequency were Constitutional Growth Delay [CGD], Familial Short Stature [FSS], malnutrition, coeliac disease and Growth Hormone Deficiency [GHD]. In 37.4% of patients, the study revealed normal variants of growth - CGD, FSS or combination of both, 46.7% cases had non-endocrinological and 15.9% had endocrinological etiology. CGD [22.1%] in males and FSS [27%] in females were the most common etiology. GHD was found in 6.1% children and it comprised 38.2% of all endocrinological causes. Children with height falling below 0.4[th] centile were more likely to have a pathological short stature [79.2%] compared to 39.3% whose height was below 3rd centile but above 0.4[th] centile [p<0.05]. CGD and FSS are most common causes of short stature in boys and girls respectively, whereas, GHD is a relatively uncommon etiology

Local variations in the frequency and pattern of dermatoses in amputees in earthquake affected areas

To study the regional variations in the frequency and pattern of dermatoses in amputees in earthquake affected areas. District headquarter hospitals, Mansehra and Abbottabad. All patients with amputations and associated skin disease belonging to any age groups and gender were enrolled for the study. Three visits were made to the research areas. The first visit was for publicizing the time and venue of camps. In the second visit all patients presenting with any major or minor amputation acquired after the earthquake were enrolled in the study. A detailed history was taken and physical examination carried out by a qualified dermatologist. The presence or absence of amputation related dermatoses were specifically recorded and treated. At the third visit all the patients who were managed at the last visit were re-evaluated and assessed in relation to the guidelines provided to them. A total of 210 amputees [159 males and 51 females] volunteered for the study and were enrolled. Their ages ranged from 2 years to 85 years. A total of 210 cases 54 [25.7%] persons had skin lesions including ulcers [n=15], contact dermatitis [10 M, 4 F], adherent scars [6 M, 5 F], abrasions [5 M, 4 F], folliculitis [2 M], inclusion cyst [1 M], hypopigmentation [IF] and hyperpigmentation [IF]. Of the total 54 lesions, 31 lesions were seen in lower and 23 lesions were seen in the upper limb. Ulcers were the most common findings followed by allergic contact dermatitis is another significant problem. Measures should be taken to avoid unnecessary trauma and all patients with dermatitis on the residual limb should be patch tested to determine the cause

Leigh disease-a rare mitochondrial neurometabolic disorder

Clinical presentation of Leigh's disease can be highly variable. We present here this case which presented with quite bizarre neurological symptoms and signs in early infancy and was suspected on the basis of CT scan findings which was further supported by high serum lactic acid levels

Pharmacognostic studies on roots of Operculina turpethum Linn

Adulteration of drug is a huge problem when using herbal drugs in disease condition and utilization of herbal drugs in such condition is not free from doubt. In this paper we have presented the methods of standardization [macro and microscopic features, fluorescence characteristics under UV light and quantitative analysis on the basis of colour reactions] of Operculina turpethum Linn, root to establish the quality and purity of this valuable and popular remedy which is beneficial in a variety of disorders

Nalbuphine versus propofol: as an adjunct to locoregional anaesthesia for cataract surgery in elderly patients

This study was carried out at ophthalmology Dept Military Hospital, Rawalpindi from Jan 2004 to May 2004. This comparative experimental type of study was done to compare nalbuphine with propofol in order to find out suitable I/V supplementation to locoregional block for cataract surgery. Nalbuphine or propofol in subhypnotic dosage to facilitate local periorbicular block were given to 140 elderly patients at convenience sampling divided into two groups for cataract surgery. Effects of both drugs were compared clinically. Any complications observed during peri and postoperative period were noted. Propofol was found better than nalbuphine in terms of patient comfort, anxiety alleviation, acceptance of Local injection and analgesia during injection [P<0.05]. Very low incidence of postoperative nausea was an additional advantage. It was therefore concluded that propofol could be used in subhypnotic dosage in conjunction with Locoregional block during cataract surgery

Relationship of blood group AYE with ischemic heart disease

To see the relationship between blood group AYE and ischemic heart disease. This was a case control study done at Armed Forces Institute of Cardiology [AFIC]/ National Institute of Heart Diseases [NIHD] from 1[st] July 2001 to 30[th] June 2003. Blood groups of all patients undergoing bypass surgery were recorded. The controls were the blood groups of all angiography negative cases from the same institute for the same period. Total of 1196 cases and 1196 controls were selected on 1:1 ratio. Out of 1196 cases, 519 [43.4%] were of AYE phenotype blood group [486 Aye positive and 33 Aye Negative], 369[30.8%] were BEE, 251[21.98%] were OOO, 57 [4.76%] were AB phenotype blood group. On computing the strength of association of blood group with the IHD, it was found that persons having blood group AYE have 3.34 times more chances of developing IHD than other blood groups. The difference was highly significant [P < 0.0001]. Out of 1196 controls, 223 [18.67%] were of blood group AYE [201 Aye positive and 22 Aye Negative], 468 [39.19%] were of blood group BEE, 432 [36.18%] were of Blood Group OOO, and 72 [6.03%] were of blood group AB. Being an important risk factor it is recommended that Blood Group AYE should be included in Non modifiable risk factors of ischemic heart disease

Hospital waste management in a tertiary care army hospital

This direct observational descriptive study was carried out in a tertiary care army hospital from 5th December 2003 to 19th December 2003 to assess its prevailing practices of health care waste management and to estimate hospital waste generated per bed per day. Presently the waste is being segregated and collected in different colour coded receptacles only at the nursing stations and carried in open unhygienic trolleys. The sanitary workers were not using protective devices while handling waste in the hospital. The waste generation was calculated by placing coloured receptacles in selected zones and constant observation for seven days each as mentioned above. Results showed that total waste generation was about 3.434 kg/bed/day [out of which 0.309 kg was infectious, 0.103 kg sharps and 3.022 kg non- infectious] and that final disposal of infectious and non-infectious waste was getting mixed-up while loading in the municipality carriage system. The awareness of sanitary workers regarding colour coding was fair but not up to the mark and they were also unaware of potential hazards of health care waste while handling it. Eighty one percent of sanitary workers were vaccinated against tetanus and typhoid but none of the 86 workers were vaccinated against Hepatitis B. Two single chambered, brick made, gas fired so called [incinerators] with enormously low temperature are being used for burning which are emitting smoke and obnoxious gases directly into the atmosphere, affecting the health of the people and environment. Liquid waste is thrown down the municipal sewerage system without any prior treatment, which is adding up to the water pollution. The study concluded that although some basic steps have been taken towards the effective waste management but still there is a long way to go. Several recommendations have been made to stream line the waste segregation, collection, transportation and final disposal along with the improvement in the awareness of sanitary workers about the potential hazards of health care waste and to get 100% vaccination against tetanus, typhoid and hepatitis B. In the end it is also recommended that national guidelines on hospital waste management must be practically implemented without any further delay

Wandering Spleen

Wandering spleen is a rare clinical entity, characterized by splenic hypermobility that results from elongation or maldevelopment of its suspensary ligaments. The wandering spleen is in constant danger of torsion and infarction. This condition poses a great diagnostic challenge due oto lack of awareness and paucity of symptoms. Among adults, it usually occurs in females of childbearing age, the children below ten years of age are other sufferers. The clinical presentation may be acute or chronic, such as asymptomatic abdominal mass, an acute abdomen, or, most commonly, a mass associated with vague abdominal symptoms. Computed tomography and duplex ultrasonography are best diagnostic modalities. The traditional conservative approach carries high risk of infarction leading to splenectomy and postsplenectomy sepsis. Splenopexy is the treatment of choice for all noninfarcted wandering spleens. Splenectomy should only be performed when there is no evidence of splenic blood flow after detorsion of the spleen. The present study, reviews the presentation, course, diagnostic modalities and management options of wandering spleen

Abdominal wound closure: a prospective randomized trial of polypropylene and polydioxanone

Results of a prospective study on 164 patients, comparing the polydioxanone [PDS[R]] and polypropylene [Prolene [R]] in laparotomy wound closure; over a 30 month period are presented. All types of laparotomy wounds were considered for evaluation. Patients were analyzed for early and late wound related complications. Overall wound infection was 11%. Whereas no significant difference between two sutures was noticed for the early postoperative complications, persistent wound pain, palpable knots, and suture sinuses were significantly less with less with PDS in continued follow up [mean 24.5 months]. With the comparable safety in early postoperative period and significantly lower incidence of delayed complications, PDS can be regarded as near-to-ideal suture material for closing all types of laparotomy wounds