Cardiology residents’ attitudes towards clinical supervision: a multi-centered study / 한국의학교육

Purpose@#Residents’ gender, residency level, and hospital types might influence their attitudes towards clinical supervision (CS); however, reports of its impact on cardiology residency are nonexistent. We explore the effect of gender, residency level, and hospital location’s effect on Indonesian cardiology trainees’ attitudes towards CS. @*Methods@#A multi-centered, cross-sectional study was conducted. We invited 490 Indonesian cardiology residents in September– October 2019 to complete the Cardiology CS Scale. Residents’ attitudes, gender, university, and residency year were expressed using descriptive statistics. A Mann-Whitney test analyzed the gender and university location effect on residents’ attitudes. Training year and university’s impact were subjected to the Kruskal-Wallis test; a p-value of <0.05 reflected a significant result. @*Results@#A total of 388 residents agreed to participate (response rate=79.18%). Most of them were male (n=229 [59,02%]), attended universities in Java Island (n=262 [67,52%]), and were in their 2nd–3rd year of training (n=95 [24.48%], each). There were no significant differences in residents’ attitudes between genders (U [Nmale=229, Nfemale=159]=17,908.50, z=-0.27, p=0.78). Generally, their attitudes were significantly affected by the university (H(7)=47.38, p<0.01). However, the university location (located in Java Island or outside Java Island) does not affect residents’ attitude towards CS (U [NJava=262, Nnon-Java=126]=15,237.00, z=-1.23, p=0.22). In addition, the residents’ training year also affected the residents’ response (H(2)=14.278, p<0.01). @*Conclusion@#Cardiology residents’ attitudes towards CS are significantly influenced by training year and university but not gender or university location. The results might provide insightful information for further improvement of CS in cardiology training and guide further evaluation.

Delay in Diagnosis of Stomach Cancer Patients Attending a Tertiary CareHospital in Kashmir: A Hospital Based Cross Sectional Study

Introduction: cancers is associated with a favourable outcome. Stomach cancer is one of the most common cancers of gastrointestinal tract. Majority patients visit physicians in developed stages. To evaluate theObjective: reporting pattern of stomach cancer patients living in Kashmir valley in order to determine the median time of delay from the beginning of symptoms to diagnosis. Total 116 proven stomach cancer patientsMethod: were evaluated for the pattern of presentation at endoscopy laboratory of Super Speciality Hospital, Shireen Bagh Kashmir from April 2019 to September 2020. In this study, the mean age (SD) of participantsResults: was 60.22 ± (11.90) years. Majority of the participants (69.8%) were males. Cases were predominantly from the rural area (58%).Only 15.5 % of the cases were diagnosed within one month of their symptoms while as 3.4% of the cases had a total delay of more than 12 months. The study found a considerable total delay in the diagnosis of stomach cancer. The mean of the patient delay was 45.6 days. The median total delay was 20 weeks. Since stomach cancer has high mortality and morbidity rates associated, creatingConclusion: awareness among the population and training of physicians regarding timely referral of patients seems important

Objective Evidence of Inducible Ischemia in Patients with Ischaemic Heart Disease by Global Longitudinal Strain During Dobutamine Stress Echocardiography

Background: Operator dependent two-dimensional (2D) echocardiography is a noninvasive test to assess myocardial hypokinesia. Inter observer variability is more as it is subjective. Objective evidence of 2D global longitudinal strain (2D GLS) and strain rate imaging are getting popularity. Methods: This cross sectional study was done on 20 patients who came for dobutamine stress echo (DSE) in the department of cardiology of BSMMU, Dhaka from 1st February 2019 to 31st July 2019. 2D GLS was done before and just after DSE. Results: DSE findings revealed 6 patients had viable LAD, 9 had viable LCX and 6 had viable RCA, 9 had nonviable LAD, 2 had nonviable LCX and 3 had nonviable RCA territories. Difference in Post-systolic strain rate (SRps) in myocardial segments supplied by LAD at baseline peak stress in patients who had normal and nonviable LAD (-21% to. -23%, p=0.98) and (-6%to – 7%, p= 2.87) which were not significant. At peak exercise there was a trend towards greater SRps in viable territory of LAD in compared with baseline and peak stress (-1% to -16%, P = 0.05) which was significant. SRps in myocardial segments supplied by LCX at baseline and peak stress in patients who have normal and nonviable LCX (-20% to. -21%, p=0.82) and (-5%to – 5%, p=1.18) which had similar result as LAD territory. At peak exercise there was a trend towards greater SRps in viable territory of LCX compared with baseline and peak stress (-12% to -15%, P = 0.06). There was no significant difference in SRps in myocardial segments supplied by RCA at baseline and peak stress in patients who had normal and nonviable RCA (-23% to. -24%, p=1.72) and (-4%to – 5%, p=2.10). At peak exercise there was a trend towards greater SRps in viable territory of RCA compared with baseline and peak stress (-10% to -15%, P = 0.04). Conclusion: Results of subjective interpretation of DES has compared with objective evidence 2D GLS on peak stress which has similarity. It was a small study. Future large study is needed to establish these findings.

Histopathological spectrum of chronic skin ulcers in a tertiary care hospital

Background:The skin is the largest organ of the body, comprising of epidermis, dermis and hypodermis. Thus, a wide range of diseases can develop from the skin ranging from infectious diseases to malignancy, some of which may present as non-healing ulcers. Skin biopsy forms the fundamental basis for differentiation of similar looking lesions, thus helping the pathologists to make a definitive diagnosis and more so to the clinician for better management of patients. The objective was to study the histopathological spectrum of chronic non healing ulcers of skin for proper management and treatment.Methods:This was a hospital-based study which was conducted in SKIMS,Soura, a tertiary care hospital of Kashmir valley for a period of 1year extending from January 2018 to December 2018. All the patients who presented with the complaint of non-healing ulcer for more than 4 to 6 weeks were subjected to skin biopsy and histopathological examination.Results:A total of 260 biopsies were examined. Out of 260 patients 146 were males and 114 were females. Ninety out of 260cases (34.61%) and 170 (65.39%) were diagnosed as malignant and benign ulcers respectively.Diabetic ulcer was the second most common cause ofnon-healing ulcers followed by bacterial infections and tuberculosis. Squamous cell carcinoma was the most common neoplastic pathology. Conclusions: It was concluded from the study that non-healing skin ulcers can be encountered at any age in daily medical practice

Anatomical Variations of Paranasal Sinuses – A MDCT Based Study

Background: Pneumatisation of various bones around the nasal cavity results in the formation of paranasal sinuses. Varying degrees of pneumatisation result in multiple variations of paranasal sinuses some of which are important from clinical, pathological and surgical perspective. Objective: Determining the prevalence of various sinonasal anatomical variations on multi-detector computed tomography. Materials and methods: 852 patients with various symptoms of active rhinosinusitis were subjected to non-contrast enhanced CT examinations of the paranasal sinuses and nasal cavity. Multi-planar reconstructions were done in axial, coronal and sagittal plane and the reconstructed CT images were evaluated for the presence of anatomic variants of the sinonasal cavities and the prevalence of each variant was calculated. Results: Deviated nasal septum (DNS) was the most common anatomic variant of the paranasal sinuses and nasal cavity seen in 724 patients (85%), if minimal septal deviation (<1 mm) was also taken into account. The second most common variant was prominent ethmoid bulla which was present in 392 of 852 patients (46%). Dehiscent lamina papyracea (0.9%) and pneumatised crista galli (11.7%) were the least commonly seen sinonasal anatomic variants. Conclusion: Sinonasal anatomic variants are a rule rather than an exception, being present in a majority of population. These variations should be diagnosed and documented on CT examinations of paranasal sinuses to avoid any unforeseen complication during functional endoscopic sinus surgery and other skull base surgeries.

Relationship of sociodemographic factors with serum levels of vitamin D in a healthy population of Pakistan

Background: High prevalence of vitamin D deficiency has been reported from Pakistan. Association of sociodemographic factors with vitamin D status has received little attention in this region. Therefore, we embarked on investigating the relationship of sociodemographic factors with vitamin D levels in a healthy Pakistani population. Venous blood from 226 healthy participants [age range 19-69 years] was collected and analyzed for serum concentrations of 25[OH] vitamin D [25[OH]D] and other related biomarkers. Demographic characteristics of the study participants were collected. Vitamin D deficiency [25[OH]D levels less than 20 ng/ml] was found to be 75% in this cohort. Gender, sunlight exposure and monthly household income emerged as predictors of hypovitaminosis D. Mean serum 25[OH]D levels in the groups with monthly household income less than Pakistani Rupees [PKR] 20,000, between PKR 20,000-50,000 and above PKR 50,000 were found to be 11.0+/-7.5, 13.9+/-9.6 and16.9+/-11.7 ng/ml, respectively. Using logistic regression the odds of having vitamin D deficiency was 3.22 [95% CI, 1.65-6.28] in the group with household income less than PKR 50,000 per month compared to the group with household income more than PKR 50,000 per month when the model was adjusted for gender and exposure to sunlight. There is an association between household income and hypovitaminosis D in a healthy Pakistani population

Black Rice (Oryza sativa L., Poaceae) Extract Reduces Hippocampal Neuronal Cell Death Induced by Transient Global Cerebral Ischemia in Mice

Rice is the most commonly consumed grain in the world. Black rice has been suggested to contain various bioactive compounds including anthocyanin antioxidants. There is currently little information about the nutritional benefits of black rice on brain pathology. Here, we investigated the effects of black rice (Oryza sativa L., Poaceae) extract (BRE) on the hippocampal neuronal damage induced by ischemic insult. BRE (300 mg/kg) was orally administered to adult male C57BL/6 mice once a day for 21 days. Bilateral common carotid artery occlusion (BCCAO) was performed for 23 min on the 8th day of BRE or vehicle administration. Histological analyses conducted on the 22nd day of BRE or vehicle administration revealed that administering BRE profoundly attenuated neuronal cell death, inhibited reactive astrogliosis, and prevented loss of glutathione peroxidase expression in the hippocampus when compared to vehicle treatment. In addition, BRE considerably ameliorated BCCAO-induced memory impairment on the Morris water maze test from the 15th day to the 22nd day of BRE or vehicle administration. These results indicate that chronic administration of BRE is potentially beneficial in cerebral ischemia.

A CT scan anatomical study correlating between the retroversion of the humeral head and the orientation of the inter-tubercular sulcus

The shoulder socket is called the glenoid fossa This socket is shallow and is part of the scapula (shoulder blade) The surface of the humeral head and the inside of the fossa are covered with articular cartilage The glenohumeral joint consists of an articulation between the scapula and humerus Retroversion angle of humeral head (or retrotorsion angle, RA) is an important parameter in total shoulder arthroplasty and is one of these important reference factors which can influence the outcomes of total shoulder arthroplasty This study was undertaken to evaluate the correlation between retroversion angle of humeral head and position of intertubercular sulcus The present study is a prospective one which was conducted in the Department of Radiodiagnosis and Imaging at Government Medical College and Hospital, Srinagar The 60 dry adult humeri were analyzed by multiplanar computed tomography (CT) CT data were transferred to a workstation (Silicon Grafics; Sunnyvale, CA) for multiplanar CT-reformation The mean retroversion angle of the humeral head in relation of the transe-picondylar axis was 123 degree The mean ITS orientation was 407 degree The Pearson correlation coefficient between the retroversion of the humeral head and the ITS orientation was -037 There was an inverse correlation between the retroversion of the humeral head and the ITS orientation This variation is due to several factors, including the definition of humeral head retroversion, different methods of measurement, ranges of normal values, and accuracy of anatomic landmarks to guide determination of anatomic retroversion Humeral head retroversion is generally defined with respect to the plane of the humeral head articular surface proximally; distally, however, Yassar Shiekh, Aamir Javed Khan, Mohammad Iqbal Bhat A CT scan anatomical study correlating between the retroversion of the humeral head and the orientation of the inter-tubercular sulcus IAIM, 2018; 5(12): 96-101 Page 97 the reference axis has been debated, including the transepicondylar axis, trochlear tangent axis and forearm axis The study concludes that there is a reverse correlation between the retroversion of the humeral head and the orientation of the intertubercular sulcus

Vitamin e deficiency in south asian population and the therapeutic use of alpha-tocopherol [vitamin e] for correction of anemia

Mild to moderate vitamin E deficiency because of inadequate consumption of vitamin E-rich foods and intestinal fat malabsorption is common in growing children, women of reproductive age and elderly South Asian population. Severe vitamin E deficiency may lead to peripheral and motor neurodegenerative diseases [e.g ataxia and motor skeletal myopathy], impaired immune response and free radical-induced hemolytic anemias. Vitamin E insufficiency and/or deficiency status in the general Pakistani population has not been sufficiently investigated. Moreover, there are challenges in determining vitamin E status in apparently healthy humans due to variations in their age, sources of consumed vitamin E and plasma lipid levels. Oxidative stress-induced reactive oxygen species have been shown to cause ineffective erythropoiesis and enhanced lysis of erythrocytes in some of the experimental animals and humans. Several studies on patients with various types of inherited hemolytic anemias, chronic renal disease, premature low birth infants and apparently healthy humans have shown that vitamin E might be therapeutically effective in the prevention and/ or treatment of anemia in these subjects

Lack of association of statin use with vitamin D levels in a hospital based population of type 2 diabetes mellitus patients

Objective: To investigate the relationship of statins [drug given to reduce serum levels of LDL-cholesterol] on vitamin D levels of Pakistani type 2 diabetes mellitus [DM] patients in a hospital in Karachi

Methods: In a cross-sectional survey, 312 consecutive patients with type 2 DM [219 males and 93 females, age 22-70 years] were recruited with informed consent. A questionnaire was administered to find out whether they were statin users or non-users. Serum was analyzed for concentrations of 25[OH] vitamin D [25[OH]D] and other related biomarkers such as serum cholesterol, triglycerides, HDL-cholesterol, LDLcholesterol, phosphate and calcium using kit methods. Multiple Linear Regression was used to evaluate association of statin use with serum levels of vitamin D while adjusting for related covariates including duration of statin use, duration of type 2 DM and smoking

Results: Mean concentrations of serum cholesterol, and LDL-cholesterol were lower among statin users compared to statin non-users [P < 0.01], while HDL-cholesterol levels were higher [P<0.01]. No relationship was observed between statin use and serum levels of vitamin D [P=0.768], when adjusted for age, gender, BMI, duration of type 2 DM, smoking, serum cholesterol and LDL-cholesterol. The adjusted regression coefficient [beta] and standard error [SE[beta]] for statin use duration were 0.012 [0.042], when serum levels of vitamin D was taken as an outcome

Conclusion: Lack of association was found between statin use and vitamin D levels in a hospital-based population of Pakistani patients with type 2 DM

Organism causing ventilator-associated pneumonia in children presenting at tertiary care hospital, Karachi

Objective: To determine the prevalence of organism causing ventilator associated pneumonia [VAP] in children presenting at Tertiary Care Hospital, Karachi. Study Design: A cross-sectional descriptive study. Place and Duration of Study: The study has been conducted at MICU of Zia Uddin Hospital Karachi, from Aug 2015 to Jul 2016

Material and Methods: Patients required mechanical ventilation were included in the study from the age range of 6 months to 15 years. Information for the assessment was retrieved from the hospital databases with hospital's ethical approval and consent from patients' parents or guardians

Results: Prevalence of VAP had been high among males and the children belonging to agerange of 6 months to 4 years. Out of 83 patients, Pseudomonas aeruginosa [38.6%], E. coli [30.1%], Staphylococcus aureus [9.6%], Klebsiella [9.6%], Streptococcus [7.2%] and Acinobacter [4.8%] with VAP

Conclusion: The need for preventive measures and treatment options to avoid the bacterial colonization in the patients undergoing mechanical ventilation

Association of Vitamin D deficiency and VDBP gene polymorphism with the risk of AMI in a Pakistani population

Objective: To investigate the relationship of vitamin D deficiency and risk of AMI in a Pakistani population, and to find out any association between vitamin D binding protein [VDBP] genotypes and risk of AMI in this population

Methods: In a comparative cross-sectional study, 246 patients [age: 20-70 years; 171 males and 75 females] with first AMI were enrolled with informed consent. Similarly, 345 healthy adults [230 males and 115 females] were enrolled as controls. Their fasting serum samples were analyzed for 25 [OH] vitamin D, lipids and other biomarkers using kit methods, while DNA was analyzed for VDBP genotypes using PCR-RFLP based methods. Chi-squared test and logistic regression were used for association of vitamin D deficiency and VDBP genotypes with AMI

Results: Mean serum concentration of 25[OH] vitamin D was significantly lower in AMI patients compared to healthy subjects [p=0.015] and percent vitamin D deficiency was higher in AMI patients compared to healthy subjects [p=0.003]. VDBP IF-IF genotype was positively associated with the risk of AMI in subject above 45 years after adjusting for potential confounders [OR = 9.86; 95% CI=1.16 to 83.43]

Conclusion: Vitamin D deficiency and VDBP IF-IF genotype are associated with AMI in Pakistani adults

Liraglutide in diabetes mellitus: more facts and findings

Liraglutide exert favorable effects on most of the diabetes associated cardiovascular [CV] risk factors and this study was designed to further explore the benefits of liraglutide by observing its effect on plasma sialic acid [PSA] in diabetic rats. A total of 30 streptozotocin induced [50mg/Kg; i. p] diabetic rats were randomized into vehicle treated [1 ml/Kg s.c, twice daily] group I, liraglutide treated groups II and III [30 micro g/Kg and 150 micro g/Kg, twice daily respectively] and studied for 6 weeks. Liraglutide treated groups showed significant reductions in fructosamine levels [p

Frequency of different causes of painful swollen leg in patients referred for sonographic examination at a teaching hospital

Objective: To determine the frequency of different causes of painful swollen leg in patients referred for sonographic examination at a teaching hospital

Methodology: This was a descriptive study, carried out at the Department of Radiology, Lady Reading Hospital, Peshawar from April 2015 to September 2015. A total of 241 consecutive patients presenting with painful swollen lower limb from 23 to 85 years of age of both sexes referred to Department of Radiology for ultrasound were included in the study. Each of these patients underwent sonographic examination. Toshiba Nemio 20 Color/ Power Dop-pler ultrasound machine having 7.5 MHz linear probe were used

Results: Out of 241 patients, 33.2% were male and 66.8% were female. Mean age of the patients was 58.09 years. The causes of painful swollen leg were DVT 51.9%, intramuscular abscess 12%, cellulitis 9.5% and ruptured baker's cyst in 8.7% of patients

Conclusion: Deep vein thrombosis is the commonest cause of painful swollen leg in our population

Tracheostomy complications in admitted IDPs patients in a teaching hospital of Bannu

Objectives: The main objectives of this study were to evaluate the complications of tracheostomy in IDPs patients who were admitted in DHQ teaching hospital Bannu and further the study of complications in relation with tracheostomy types, age and tracheostomy tubes types

Study Design: Observational / analytic / cross sectional study

Place and Duration of Study: The study was conducted at the ENT Unit, DHQ Teaching Hospital, Bannu from April 2015 to December 2015

Materials and Methods: 60 patients undergoing tracheostomy, having an age group of 3 to 65 and fulfilling inclusion and exclusion criteria were selected. Elective and emergency tracheostomy was included in the study period. "Open surgical technique" was done. Metallic and portex cuffed rubber tubes ware used. To record any possible complication, a pre-designed proforma was used

Results: The study comprised 42 males and 18 females. The mean age of the patients was 30 years[SD+18.20]. Elective tracheostomy was done in 10% while emergency tracheostomy was done in rest of the 90% patients. Metallic tubes were used in 20% and portex cuffed rubber tubes in 80% of the patients. The recorded complication rate was 40% overall. There was an 18% immediate, 11% intermediate and 11% late complications. Complication rate was somewhat elevated in early age. Bleeding was commonest complication [20%] among all followed by emphysema, dysphagia and aspiration [4% each]. Complication rate of emergency tracheostomy was higher than elective one. Similarly, complication rate with portex cuffed rubber tubes was greater than metallic tubes

Conclusion: Rate of complication in emergency tracheostomy was higher than elective tracheostomy where as in elder patients; it was lower than in younger patients. Similarly, complication rate was greater with portex cuffed rubber tubes. From the study, it is concluded that post op care can minimize the chances of post tracheostomy complications

Frequency of peptic ulcer perforation during fasting and without fasting

Objective: To find out the frequency of peptic ulcer perforation during fasting in the month of Ramadan with non-fasting during other months

Study design: Descriptive case series

Place and duration of study: Department of Surgery Ward-3 Jinnah Postgraduate Medical Center Karachi, from January 2005 to November 2014

Methodology: The data of 220 patients who were operated due to peptic ulcer perforation, was analylsed. Patients were divided into 2 groups. Group I [n= 139] included patients who were operated in the months other than Ramadan, while group II [n= 81] included patients who were operated during the month of Ramadan. The patients of peptic ulcer due to malignancy were excluded

Results: Of the total there were 209 male and 11 female patients. Age range was 12 year to 65 year. Most of the patients [n=178 - 85%] were between 20 year to 50 year of age. Frequency of perforation was highest in Ramadan then in Shawal month and was less in other months of the year. On average patients with peptic ulcer in Ramadan were 8.1 and in non-fasting months 1.2

Conclusion: The frequency of perforation in peptic ulcer disease was higher in Ramadan month during fasting state as compared to other months of the year

In vitro biological activity of decoction of Joshanda

Joshanda is a polyherbal product, commonly practicing in inflammation of upper respiratory tract as tea. The present study was conducted to find out its antimicrobial, phytotoxic, leishmanicidal and cytotoxic activities. The decoction of the product showed profound activity against Gram positive tested pathogens especially S. aureus 36.5 mm zone of inhibition at 8.0 micro g/ml. However, it was inactive against C. albicans. Closed correlation was observed between two methods in terms of results. It had potent phytotoxic activity [75%]. However, it was devoid of any activity leishmanicidal and cytotoxic activity. Phytochemical studies of Joshanda showed the presence of various pharmacologically active groups

Cellular and genomic toxicity produced by UV light in Chinese hamster ovary cells

UVB and UVC toxicity was detected in Chinese Hamster Ovary [CHO] cell lines AA8, UV5 and XEM2 [a V79-derived cell line expressing rat P 450 1A1]. Unlike FICZ-HPLC assay that showed induction of CYP1A1 enzyme activity after 20 minutes and 2 hour UVC exposure, the EROD assay showed no difference in cytochrome P450 1A1 [CYP1A1] activity after exposure to different doses of UVB and UVC light. Different cytotoxic and mutagenic effect of photo lesions induced by UVC and UVB light was investigated with the DRAG and HPRT assays, comparing the wild type cell line AA8 and the Nucleotide Excision Repair [NER] deficient cell line UV5. DRAG assay showed a significant difference in UV induced cytotoxicity between UVC and UVB reflecting the larger energy and toxic effect of UVC along with significant difference in UV induced toxicity between AA8 and UV5 cell lines. This was further validated through the HPRT assay, which also showed a significant difference in UVC [5 J/m[2]] induced mutagenic effect between these cell lines. In addition, HPRT assay showed the mutagenic effect of photosensitizer, acetophenone. These results show that UVB and UVC generate serious damage through photo products on DNA, and might induce the metabolic activity of CYP1A1

Frequency of chemotherapy induced neutropenia in patients of non hodgkin's lymphoma

The aim of the study is to see the frequency and severity of neutropenia after first or subsequent cycles of chemotherapy in patients of Non Hodgkin's lymphoma [NHL]. Descriptive cross sectional study. This study was carried in the Radiotherpay and Oncology Department, Bolan Medical Complex Hospital, Quetta, from March 2010 to February 2012, Forty two patients of different types of NHL diagnosed on lymph node biopsy presenting for the first time at Radiotherapy and Oncology Department in collaboration with Haematology Section [Pathology Deptt:], Bolan Medical Complex Hospital. Quetta, were included. They were admitted in the ward and evaluated with history, physical examination and for staging investigations. Patients were then planned for chemotherapy comprising cyclophosphamide, doxorubicin, and vincristine with prednisolon [CHOP] and with rituximab [R CHOP]. After the first cycle of chemotherapy they were monitored for expected neutropenia in the ward. The neutrophil counts were repeated on days 7 and 10 following chemotherapy. Neutropenia was graded as defined in the operational definition and all the data were entered on a designed data sheet. Forty two patients of NHL were included in this study, of which 34 patients received CHOP, and 08 patients R-CHOP, from March, 2010 to February, 2012. According to WHO classification, 24[57.1%] patients were of Diffuse large B-cell lymphoma [DLBCL], 08[19.0%] were follicular lymphoma [FL] and 04[9.5%] patients were Mantle cell lymphoma [MCL] and remaining 06[1430] are other types of NHL's. 2[4.7%] of patients suffered from grage IV neutropenia [absolute neutrophil count of <0.5 x 10[9]7L], 3[7.1%] had grade III Neutropenia [absolute: Neutrophil count of 0.5 x 10[9]L-0.9 x 10[9]/L], 3[71%] had Grade II neutropenia [absolute netrophil count 1.5 x 10[9] /L-1.4 x 10[9]/L] and 5[11.9%] had Grad I neutropenia [absolute netrophil count 1.5 x 10[9]/L-1.900/L]. Other risk factors noted, i.e., cardiac, Liver and Renal comorbidities in 3[7.1%], 5[11.9%] and 4[9.5%] of patients respectively. Overall 30.8% of patients of NHL's suffered from neutropenia of all grades post first cycle of chemotherapy comprising CHOP and R-CHOP

Comparison of single dose with multiple dose antibiotic prophylaxis with cefuroxime in open cholecystectomy

To compare single dose with multiple dose antibiotic prophylaxis with Cefuroxime in open cholecystectomy in terms of post operative surgical site infection, hospital stay and cost effectiveness. Study Design: Quasi experimental study. The study was conducted in the Surgical Unit of Punjab Employees Social Security Institution Islamabad and Ahmed Hospital Rawalpindi Teaching Hospitals of IMDC Islamabad, from 1st August 2010 to 30th September 2011. A total of one hundred and ten patients requiring elective open cholecystectomy were included. Patients with acute cholecystitis, jaundice, diabetes, malignancy, choledocholithiasis and co morbidity were excluded. Patients were divided in to two groups, 55 patients in each group, Group A received only single dose of Cefuroxime and Group B received multiple doses [six]. In this study, 97 [88%] patients were females and 13 [12%] were males. The mean age was 40.69 years. In Group A, 4 [5.5%] patients, and in Group B, 7 [12.7%] patients developed surgical site infection. Mean hospital stay in Group A was 2.18 days and in Group B 2.43 days. Cost of antibiotics in Group A was six times less than Group B. There is no difference in single dose and multiple doses prophylaxis with Cefuroxime in low risk patients for elective open cholecystectomy in terms of post operative surgical site infection and hospital stay however single dose is more cost effective