VAAFT: video assisted anal fistula treatment; bringing revolution in fistula treatment

To share our findings that the new treatment modality Video Assisted Anal Fistula Treatment [VAAFT] is a better alternate to the conventional treatments of Fistula in Ano in our setup with minor changes in the initial method described by Meinero. Karl Storz Video equipment including Meinero Fistuloscope was used. Key steps are visualization of the fistula tract, correct localization of the internal fistula opening under direct vision and endoscopic treatment of the fistula. This is followed by an operative phase of fulguration of the fistula tract using glycine solution mixed with manitol, curetting the tract with curette and fistula brush. Internal opening is closed with a Vicryl 1 suture. Total of 40 patients were operated using VAAFT from October 2013 to March 2014. Three were re-operated. The other 37 cases were followed up at 6 weeks, 3 months and 6 months. Primary healing took place in 20 [50%] cases at 6 weeks. In the remaining 17 [42.5%] cases, minor discharge occurred with itching which resolved till the next visit at 8 weeks and 12 weeks. As the main aim in treating fistula is proper identification of the internal opening, excision of the tract and sparing the sphincter function, VAAFT achieves all aims with additional benefits of patients' satisfaction and negligible scaring

Prevalence of hepatitis-D virus infection in hepatitis B surface antigen-positive children in southern Punjab

Hepatitis D virus [[HDV] is a defective RNA Virus dependent on Hepatitis B virus [HBV] infection for its replication and expression. It is known that co-existent infection with HDV tends to aggravate the course of HBV-associated liver disease. This study was carried out to determine the sero- prevalence of HDV among Hepatitis B Surface antigen [HBSAg] Positive children visiting the Nishtar Medical Centre Jampur [Rajanpur]. Experimental study. This study was carried out at Nishtar Medical Centre Jampur [Rajanpur] from December2010 to September 2012. 280 children, out of them 175 were male and 105 were female, having HBSAg Positive and visited the Clinic during the above-said period were included in the study. Effective Preventive measures are the need of hour and Pakistan may be considered as area of highest Prevalence around the globe [JPMA59:434,2009]. Some serious steps should be carried out to lower down the Prevalence rate of Hepatitis B in Southern Punjab

Results of distraction compression and compression distraction in segmental defects of tibia with the use of Ilizarov's external fixator

To compare the results of distraction-compression and compression-distraction in segmental loss of tibia by Ilizarov extent fixator and to see the functional end results of each procedure. Comparative study. This study was carried out in the Department of Orthopaedic, Nishtar Hospital, Multan from April 2008 to March 2010. A total of 30 cases were included in the study. Gap non-union in tibia is a frequently encountered problem in open tibial injuries. Their treatment have been unsatisfactory until the introduction of distraction histeogenesis by Ilizarov, before the end results were often amputation. Gap non-union of up to 5 cm can be managed by initial compression, later on the LLD is addressed and distraction histeognesis whereas gap of >5 cm are amicably managed by segment transport i.e. distraction and later compression between the transported segment to other end of the fracture. Both methods are excellent if the limitations and principles are followed. Our recommendations are gaps of < 5 cm to be managed and compression-distraction of gaps of >5 cm to be managed with distraction compression mode of treatment

Comparison of adynmic external fixator with dynamic external fixator in the management of the comminuted fractures of distal radius in the patients between 40-45 years age

To compare the treatment outcome of comminuted intra-articular fractures distal radius with adynamic external fixator and dynamic external fixator in patients of 40-65 years of age. Experimental Study. This study was carried out in the Department of Orthopaedic, Nishtar Hospital, Multan from Jan 2010 to December 2011. This experimental study was carried out in the Department of Orthopaedic, Nishtar Hospital, Multan. A total of 60 patients in both groups were included in the study. Out of the 60 patients, 43 [71.7%] were male and 17 [28.3%] were female with the right hand 35 [58.3%] and left hand 25 [41.7%]. It is concluded that dynamic external fixator is a better method of treatment for the comminuted fractures of the distal radius than adynamic external fixator because it allows early motion of tendons, muscles and adjacent joints and later, of the wrist itself while reduction and especially radial length were maintained in bridging external fixation

Spontaneous bacterial peritonitis; microbiological analysis of ascitic fluid in patients with complicated liver cirrhosis

Spontaneous bacterial peritonitis is a serious event in patients with liver cirrhosis and associated with significant morbidity and mortality. Most common causative organisms of SBP are E.coli, streptococcus pneumonia and klebsiella. Liver cirrhosis has multifactorial etiology and the most common causes in our country are hepatitis C and hepatitis B. [1] To observe the culture and sensitivity pattern of ascitic fluid in patients with liver cirrhosis. [2] To examine the resistance against various antibiotics. 6 months. Study was conducted in department of Gastroenterology Hepatology in collaboration with department of microbiology of Sheikh Zayed Hospital, Lahore. Sample size; 80 patients of liver cirrhosis with ascites. Sampling technique, Non probability purposive technique was adopted. Sample selection; By Inclusion and Exclusion criteria. Data collection procedure; Eighty patients with liver cirrhosis and ascites diagnosed on the basis of history, examination and ultrasound findings. After detailed history examination and full aseptic measures at least 10 ml of ascitic fluid in 20ml syringe with 16G needle was drawn in blood culture bottle at bed side and was sent to microbiology laboratory for culture and sensitivity and record of resistance and sensitivity against various antibiotics used to treat SBP. Data analysis procedure; Data was analyzed by SPSS version 10.Quantitative variables and were recorded as mean+S.D and qualitative variables, were recorded as frequencies and percentages. Out of 80 patients with suspected SBP 38[47.5%] were culture positive while 42[52.5%] were culture negative. Among these 14[36.84%] showed gram positive growth and 20[52.63%] gram negative growth while 4[10.52%] showed anaerobes. Most of the organisms were resistant to ceftazidim, cefoperazone and augmentin while sensitive to levofloxacin, ceftriaxone, cefotaxime and ciprofloxacin. Highest resistance was against ceoftazidim which was 36[95%] followed by cefoperazone 35[92%]. Spontaneous bacterial peritonitis is devastating complication of liver cirrhosis and ascites and is a leading cause of disability and death in patients with chronic liver disease. Early diagnosis and treatment with proper antibiotics and dosage are necessary for better outcome

Effect of oxidative stress created by free radicals on human serum proteins in patients with diabetes mellitus and myocardial infarction

Oxidative Modification of Blood Serum Proteins due to free radical stress has been studies in 65 patients Diabetes Mellitus [DM] and Myocardial Infarction [MI]. It has been shown that both DM and MI patients have increased level of Oxidatively Modified Human Serum Proteins [OMHSP] as compared to healthy persons. Diabetic patients had a significantly higher level and slower dynamic of OMHSP that non-diabetic patients did during 14 days after the onset of Acute MI. The data suggest that oxidative modification of proteins may be a possible factor contributing to the poorer outcome of MI in diabetic patients. The study was conducted in Cardiology and Medical units of Allama Iqbal Medical College /Jinnah Hospital Lahore during 2001-2002

Stress levels in medical residents of a teaching university in the province of Sindh, Pakistan: its effects on the quality of life of residents

Stress and stress-related illnesses are common in medical residents. If remain unattended, these illnesses might have serious repercussions affecting the quality of patient health care and physician's well-being. In this study, we evaluated the stress levels of medical residents in a teaching university [Liaquat University of Medical and Health Sciences, LUMHS] and compared them with those observed in postgraduate students pursuing M. Phil or Ph. D. degrees in basic sciences [University of Sindh]. We used Perceived stress Scale of Cohen et al and wellbeing Scale of Kaplan et al for the measurement of stress. A total of 100 questionnaires [50 per group] were given out. The recovery rate was 73%. Our data on Perceived Stress Scale indicated that there was statistically significant differences between the two groups [p=0.006], indicating that the medical residents were facing higher levels of stress as compared to postgraduates in basic sciences. However, we failed to detect male to female differences in either group. Similarly, there were significant differences on well-being Scale between the two groups [p=0.002]. Our results confirmed the previous findings that medical residents experience higher levels of stress. However, we did not observe any significant differences between and female residents. When under stress, the respondents tend to neglect the normal activities of life, became reclusive and had self-doubts. The later may have some serious consequences on patient health care

Open fracture of the tibial shaft, results of management with external fixator followed by casting or nailing

To compare the results of management by secondary intramedullary nailing and POP casting in stable open tibial fractures of Gustilo-IIIA of winquist type-I and II and to assess which is the better mode of treatment after removal of fixator, whether POP casting or intramedullary nailing in our hospital our setup and resources in terms of union and likelihood of complications like malunion, non-union and infection. This randomized cohort study was conducted in the Department of Orthopaedic, Nishtar Hospital, Multan during the period from April 2005 to December 2006. A total of 50 patients were included in the study. The age range was 20-40 years. The patients included were who had fracture of Gustilo type-IIIA open fractures of winquist criteria-I and II. Out of 50 patients, 37 [74%] were injured as road traffic accident, 3 [6%] patients sustained fire arm injury, 2 [4%] patients injured on domestic accident with fall of wall on their body. Out of 50 patients, 12 [24%] had age from 11-20 years, 14 [28%] from 21-30 years, 18 [36%] from 31-40 years and 6 [12%] patients had 41-48 years. While considering the major complications in present study, it was found that these are less marked in secondary nail group as compared to secondary casting group. Wound infection developed in 9 [36%] cases and non-union occurred in 1 [4%] cases of secondary nailing. While in secondary casting group wound infection developed in 8 [32%] cases and non-union occurred in 2 [5%] cases. It is concluded that both methods can be used for the treatment of open type-IIIA tibial diaphyseal fractures

Intracapsular fracture neck of femur

To evaluate these methods of treatment, in search of providing patients a better quality of life. This prospective study was carried out on fifty patients of displaced femoral neck fractures admitted in Orthopaedic Department, Nishtar Hospital, Multan during period November 1991 to December 1993. Fifty non-pathological displaced femoral neck fracture in patients above forty years were treated either with Austin Moore hemiarthroplasty or internal fixation with DHS, Cancellous screws or Moor's pins. Weight-bearing was allowed after two weeks in hemianhroplasty group and after 6 weeks in internal fixation group. After two -years follow up, there was no significant difference in mortality in two groups. Early [Technical] complications were more with internal fixation. [25% compared to 6.6% with Moore hemiarthroplasty]. Reoperation rate within the first year was significantly high for internal fixation i.e. 45% compared with 6.6%. It was concluded that endoprosthetic replacement in displaced femoral neck fractures in elderly patients is a reliable treatment method for selected indications, and gives good short to medium term functional results when employed with careful preoperative technique and proper postoperative care and rehabilitation

Free radical oxidation of blood proteins in patients with diabetes mellitus and myocardial infarction

Oxidative Modification of Blood Proteins [OMBP] has been studied in 65 patients with Diabetes. Mellitus [DM] and Myocardial Infarction [MI]. It has been shown that both DM and MI patients have increased levels of OMBP as compared to healthy persons. Diabetic patients had significantly higher levels and slower dynamics of OMBP than non-diabetic patients did during 14 days after onset of Acute MI. These data suggest that Oxidative Modification of proteins is a possible factor contributing to the poorer outcome of MI in diabetic patients

audit of patients satisfaction after adult day - case surgery at Ayub teaching hospital, Abbottabad

Day-case surgery has become an important component in the provision of surgical care in the Western countries. This study was done to introduce the concept of day-case surgery and assess the patients' satisfaction after day case general surgery in our set up with vast rural communities lacking medical facilities and no day-case surgery units in the hospitals. All those patients suitable for day-case surgery and who accepted day-case surgery for general surgical procedures in General Surgical 'A' unit of Ayub Teaching Hospital, Abbottabad were interviewed after the operation on follow up visits. Questions were asked about their satisfaction with day-case surgery. If they were not satisfied, the reasons for dissatisfaction were noted. Direct admissions and re-admissions after day-case surgery were recorded. Any complications in the postoperative period were also noted. The patient's preference for a similar procedure as day-case in future was also recorded. There were 122 patients in this study. 60[49%] were operated under general anesthesia and 62[51%] under local anesthesia. Fourty Nine [40%] patients were satisfied while 73[60%] were not satisfied with day-case surgery. Six [5%] patients were admitted directly after day-case surgery while 7[5.7%] patients were admitted after discharge. Complications occurred in 41[33.6%] patients at home. Wound complications and pain were the most common morbidity encountered by the patients. Twenty eight [23%] patients contacted a hospital or a doctor in the early postoperative period. Sixty two [51%] patients would prefer operation as in-patient while 74 [60.6%] would prefer an overnight stay after the operation next time. Conclusions: Patients satisfaction with day-case surgery in Ayub Teaching Hospital is not high. Short-stay surgery would be more appropriate in our set up

Accuracy of surgeon - performed abdominal utrasound for gallstones

Gallstone disease is common in Pakistan. It is primarily diagnosed by ultrasonography, which is traditionally done by radiologists. If surgeons could perform ultrasonography, it would enable early diagnosis in one-stop clinic. This study was done to evaluate the accuracy of surgeon-performed abdominal ultrasonography to detect gallstones. This study was carried out at Surgical A and Surgical C units of Ayub Teaching Hospital, Abbottabad from July. 2000 to December, 2002. One hundred fourty two patients with signs and symptoms of gallstone disease who had ultrasonography performed by a surgeon, trained in ultrasonography were exclusively studied. These patients were referred for further scanning by the radiologists who were unaware of the surgeons interpretation. The results of surgeon and radiologist performed ultrasonography were compared. The interpretation of surgeon-performed ultrasonography was correct in 100 patients and incorrect in 42 patients. There were 100 True Positive. 41 True Negative, One False Negative and Zero False Positive scans yielding 99%, Sensitivity, 100% Specificity and 99.3% Accuracy. Sensitivity of surgeonperformed ultrasonography in detecting gallstones compared to operative findings was 100%,. Conclusions: Abdominal ultrasonography performed by an ultrasonography trained surgeon can detect gallstones as accurately as by a radiologist

Unusual presentation of hydronephrosis, case report

A 15 year old boy having gross abdominal distension of long duration, presented with sudden deterioration of the general condition He was initially diagnosed as a case of gross ascites but investigations proved it to be a case of unusual presentation of right sided hydronephrosis secondary to pelviureteric junction obstruction. The patient was operated and right ided nephrectomy was performed

Hypomagnesemia; a risk factor for chronic vascular complications in diabetes mellitus

A comparative study was carried out in 60 total diabetic patients with chronic vascular complications including, 20 having cardiovascular complications, 20 with retinopathy, 20 with peripheral neuropathy and 60 total diabetic patients without complications to find out any correlation of serum magnesium level with the diabetic state and any significant association with specific complications. Serum magnesium as found to be significantly decreased [P<0.001] and this correlates inversely with serum glucose, urine magnesium, urine sugar and glycosylated haemoglobin [HbA1c] which are to be significantly increased in all the groups of diabetic patients with complications where as no significant change in serum insulin was seen among the diabetics with and without complications. Serum level of triglycerides, LDL cholesterol remained significantly higher [P<0.001] whereas HDL cholesterol shared significantly [P<0.001] lower in all diabetic patients with complications while total cholesterol shared significant increase [P<0.01] in only patients having cardiovascular complications. A significant increase [P<0.01] in the level of uric acid in retinopathy and peripheral neuropathy and a non significant level in cardiovascular complications group whereas serum albumin is entirely non significant in diabetic patients with complication as compared to diabetic without complications

study of denaturation of human serum albumin

Differential Temperature-Perturbation Spectroscopy shows that the denaturation of Human Serum Albumin [HSA] produces despiralization of the molecule with simultaneous accessibility of tyrosyl residues. The quantity of tyrosyl residues increases with parallel decrease in alpha helics which is determined by the Optical Rotation Dispersion [ORD] in the range of 300-600 nm. On the basis of primary structure of albumin, the orientation of alpha helics along the polypeptide chain has been calculated. It has been shown that the 50% of tyrosyl residues are placed at the ends of the proposed helics. This explains the correlated data obtained with the help of ORD and Differential Perturbation Spectroscopy

Quality control of pharmaceuticals by high-performance liquid chromatography

High-performance liquid chromatography of sixteen commonly used drugs and vitamins have been studied. Two different reverse-phase columns have been evaluated for the chromatography of drugs and related compounds. Where as non-polar and slightly polar compounds were retained quite strongly, the columns exhibited little selectivity for polar and ionic compounds. However, the retention behavior of such compounds could be favourably influenced by variation of pH, ionic strength and organic content of the eluent. In general it was observed that the reverse-phase column is applicable to a wide range of drugs both for quality control of drugs and in situ studies