Use of abdominal compression device in colonoscopy: a systematic review and meta-analysis

Background/Aims@#Colonoscopy for screening is associated with unpleasant experiences for patients, and abdominal compression devices have been developed to minimize these problems. However, there is a paucity of data supporting the therapeutic benefits of this strategy. This study examined the effects of using an abdominal compression device during colonoscopy on the cecal intubation time (CIT), abdominal compression, patient comfort, and postural changes. @*Methods@#We searched PubMed and Scopus (from inception to November 2021) for randomized controlled trials that assessed the effects of an abdominal compression device during colonoscopy on CIT, abdominal compression, patient comfort, and postural change. A random-effects meta-analysis was performed. Weighted mean differences (WMDs) and Mantel-Haenszel odds ratios (ORs) were calculated. @*Results@#Our pooled analysis of seven randomized controlled trials revealed that abdominal compression devices significantly reduced CIT (WMD, –0.76 [–1.49 to –0.03] minutes; p=0.04), abdominal compression (OR, 0.52; 95% confidence interval [CI], 0.28–0.94; p=0.03), and postural changes (OR, 0.46; 95% CI, 0.27–0.78; p=0.004) during colonoscopy. However, our results did not show a significant change in patient comfort (WMD, –0.48; 95% CI, –1.05 to 0.08; p=0.09) when using an abdominal compression device. @*Conclusions@#Our findings demonstrate that employing an abdominal compression device may reduce CIT, abdominal compression, and postural change but have no impact on patient comfort.

Best surgical treatment of pilonidal sinus natal cleft?

Objective: To assess the outcome of various surgical techniques applied for treatment of pilonidal sinus natal cleft

Study Design: Retrospective study. Place of Study: Zayed Military Hospital, Abu Dhabi, U.A.E. Period: Jan-2013 to Dec-2016

Methodology: Total cases operated 234, male 217 female 17, Surgical procedures performed, excision with primary closure, excision with marsupialization, excision with laying open and excision and closure with flaps. Age 14 to 49 years, median age 21 years, average BMI 33kg/m[2]

Results: Average healing time14 days, 43 days 56 days and 14 days from group one to four. Wound infection 3.4 %, bleeding 5.9 %. Recurrence rate of 12.3%. Marsupialization showed zero percent wound infection, bleeding of 4.6% and recurrence of 11.6 %

Conclusion: Excision and marsupialization is easy to perform, appears to have less complications, relatively shorter healing time and almost similar recurrence. In addition higher BMI showed higher recurrence rate

Safety of direct Trocar insertion for Laparoscopic procedures

Creation of pneumoperitoneum is first step in laparoscopic surgeries. Four basic techniques are used to create pneumoperitoneum i.e. blind veress needle [VN], direct trocar insertion [DTI], optical trocar insertion [OTI] and open method

Objective: The objective of the study is to determine the safety of direct trocar insertion for laparoscopic procedures

Setting: Department of Surgery, Allied/DHQ Hospital and Mujahid hospital Faisalabad

Duration of study: From 01-01-2013 to 31-12-2017 over a period of five years

Study design: Prospective randomized study

Methodology: A total of 1500 cases undergoing laparoscopic procedures were included in study.1470 [98 percent] patients had pneumoperitoneum established by DTI at umbilicus,25 patients by DTI at palmer's point and only 1 patient has pneumoperitoneum established by open method

Results: Out of 1500 cases, 1280 were females and 220 were males, male to female ratio was 1:5.8. The age of patients varied between 16-70 years mean age was calculated as 33.22+9.31 years. Pneumoperitoneum by DTI at umbilicus was achieved successfully in 1474[98.26 percent], while it was established by DTI at palmer's point in 25 [1.6 percent] patients. In only 1[0.06 percent] patient pneumoperitoneum was created by open method.1[0.06 percent] patient developed visceral injury,1[0.06 percent] patient developed port site hernia and 10[0.66 percent] patients developed port site infection

Conclusion: DTI is a safe and reliable technique for establishing pneumoperitoneum and should be used routinely

clinical study showing altered antioxidants profile in patients with hypertension

We compared the plasma antioxidants level of normal control group with that of hypertensive patients in order to test the hypothesis "that antioxidants level has been diminished in hypertensive patients and that antioxidants are interconnected with each other making a network. The plasma and red blood cells antioxidants level of newly diagnosed hypertensive patients [[n=30], [mean age 53 years], [mean systolic BP 158 mmHg, mean diastolic BP 100 mmHg]] were compared to those of the control subjects [[n=30], [mean age 50 years], [mean systolic BP 126 mmHg, mean diastolic BP 90 mmHg]] using liquid chromatography linked with electrochemical detector [HPLC-ECD]. The data was analyzed by Minitab software at a 95% confidence interval [p?0.05] as significant. The comparison between the two groups was made applying 2-sample and paired t-test. The individual concentration of antioxidants in both plasma and red blood cells of hypertensive patients was lower in comparison with that of control group while the oxidized/ reduced ratios of these antioxidants were higher in hypertensive patients in comparison with that of control group. It is concluded that antioxidants level had been diminished in the hypertensive patients when compared with control group. The overall concentration of all antioxidants has been diminished in the oxidative stress induced pathological conditions which confirm that the studied antioxidants are working in a network. This study may be helpful for the recommendation of antioxidants intervention

Comparative pharmacokinetics of omeprazole and its metabolites in poor and extensive metabolizer Pakistani healthy volunteers and a review of different studies

This study was designed to evaluate a comparative single dose [40mg] pharmacokinetics [PK] of Omeprazole [OMP] and its two metabolites, 5-hydroxy Omeprazole [5-OH-OMP] and Omeprazole sulphone [OMP-S] in poor [PM] and extensive [EM] metabolizer Pakistani healthy adult volunteers. The frequency of CYP2C19 and CYP3A4 varies widely in different populations. The present study was conducted to evaluate the PK of OMP and its two metabolites in Pakistani population and to review different studies conducted after administration of single dose of OMP. Twenty two subjects were enrolled in this study and divided into two groups. The CYP2C19 phenotyping was evaluated by the metabolic ratio of OMP to 5-OH-OMP. It was a single dose, open label study and the blood samples from subjects were collected at different time intervals until 24 hours. The PK parameters were calculated using the PK-summit software. The metabolic ratio of area under the plasma concentration-time curve AUCOMP/5-OH-OMP was 1.86 +/- 0.572 and13.84 +/- 2.504 for EM and PM, respectively; maximum plasma concentration [Cmax] of OMP was increased by two folds for PM while the AUC? was increased by 3 folds; the Cmax and AUC? of 5-OH-OMP decreased for PM by 2 folds while there was 3 fold increase observed in the Cmax and AUC? of OMP-S. The PK of OMP and its metabolites in different populations were also discussed, and issues regarding CYP2C19 and CYP3A4 genotyping were also extensively reviewed. In EM of CYP2C19 the concentration of 5-OH-OMP is higher while that of OMP-S is lower. This study as well as reported studies reveals that in PM of CYP2C19 more drugs are available for CYP3A4 to be metabolized. A correlation between CYP2C19 EM and PM activity with CYP3A4 needs to be established

Study on quality and efficacy of commercial tylosin and doxycycline products against local isolates of mycoplasma in broilers

The present study was conducted to investigate the quality and efficacy of commercially available preparations of tylosin and doxycycline available in the local market at Peshawar for poultry. In vitro and in vivo, tests were conducted to check the quality of these antimicrobial drugs. In vitro quality control test was performed by High performance liquid chromatographic [HPLC] and micro dilution method. In vivo, efficacy of the test drugs was checked in broilers infected with Mycoplasma gallisepticum. Results of HPLC indicated that test drug-2 contains doxycycline hydrochloride within specified limits but contain high quantity of active ingredient [Tylosin tartrate 120%]. Recovery percentage of test drugs [3, 4, 5] were below the pharmacopoeial limit, which contained low quantity of tylosin tartrate [85%, 87.5%, 85%] respectively however, percent recovery of doxycycline were in the appropriate limits. All the tested drugs were effective against Mycoplasma gallisepticum and showed minimum inhibitory concentration [MIC] at 1.9micro g/ml. The in vivo result indicated that all tested drugs decreased morbidity and mortality in infected chicks. The birds treated with test drugs [3 and 5] showed mortality of 9.5%, which was slightly higher than the other test groups. The current study suggested that there are incidences of substandard drugs in Pakistan and the drug regularity authorities should take strict actions against the manufacturing companies

Role of laparoscopy in evaluation of abdominal pain

Objective: To evaluate the diagnostic efficacy of laparoscopy in ill-defined recurrent chronic abdominal pain

Study Design: Prospective study

Place and Duration of Study: Surgical department, Military Hospital Rawalpindi, from Jul 2011 to Dec 2013

Material and Methods: A total of 102 patients who presented to surgical department with chronic recurrent abdominal pain of unknown etiology and underwent diagnostic laparoscopy were included in our study. Patients with acute onset of abdominal pain, hemodynamically unstable, pregnant or those in which diagnosis can be made by radiological techniques were excluded from our study. Patient's demographic data, clinical findings and laparoscopic findings were recorded. Finally data was analyzed by using SPSS version 21

Results: Out of 110 patients 96 were female while remaining 14 were male. The age range of the patients was 20-70 years with mean age of 50 +/- 10 years. The most common site of pain was lower abdomen while mean duration of abdominal pain was 34 weeks. Laparoscopic findings include acute recurrent appendicitis in 32 [29.09%] patients, cholecystitis with biliary sludge in 14 [12.72%], pelvic inflammatory disease in 12 [10.90%], ovarian cyst in 11[10%], adhesions in 10[9.09%], intestinal tuberculosis in 8 [7.27%], mesenteric lymphadenitis in 7 [6.36%], lymphoma in 4 [3.63%], ectopic pregnancy in 3 [2.7%], CA gallbladder in 2 [1.81%], meckels diverticulum in 2 [1.81%], endometriosis in 2 [1.81%] and crohns disease in 1 [0.9%] patients. Mean operative time was 48 min while average hospital stay was 2-3 days. No major complications were noticed

Conclusion: Laparoscopy in our clinical setup has significant role in diagnosing cases of vague abdominal pain which cannot be diagnosed by routine investigations

Serum beta 2 microglobulin and lactate dehydrogenase 2 isoenzyme as markers of bone marrow infiltration in non-Hodgkin lymphoma

Objective: To determine the levels of serum lactate dehydrogenase 2 [LD2] Isoenzyme and beta 2 microglobulin [beta 2m] in patients of non-Hodgkin's lymphoma [NHL] and to correlate these levels in NHL patients with and without bone marrow infiltration

Study Design: Cross sectional study

Place and Duration of Study: Post Graduate Medical Institute, Lahore and Centre of Excellence in Molecular Biology [CEMB], Lahore, from 2008 to 2010

Material and Methods: The study was conducted on 80 subjects irrespective of age and sex and divided into three groups i.e. group A comprising 20 normal healthy controls, group B 30 patients of NHL without bone marrow infiltration while group C consisted of 30 NHL patients with bone marrow infiltration. Serum beta 2m and LD2 isoenzyme levels were determined in the subjects and the values were compared with healthy age and sex matched controls. The estimations were made prior to the institution of chemotherapy

Results: Serum beta 2 microglobulin and LD2 levels were significantly raised in NHL patients compared with controls. There was also significant difference when the values were compared between the patients of NHL with and without bone marrow infiltration

Conclusion: The levels of beta 2m and LD2 showed positive correlation with the extent of the disease, so we conclude that non-invasive parameters are useful indicator of the extent of the disease

Correlation of patterns of bone marrow infiltration and biochemical factors in non-hodgkin lymphoma

Objectives: To investigate the patterns of bone marrow involvement in in Non-Hodgkin's Lymphoma [NHL] patients and to correlate the patterns with beta2 microglobulin [beta2m] and lactate dehydrogenase 2 [LD2] levels in these patients

Methods: It was a cross sectional study which was conducted in two years at Post Graduate Medical Institute, Lahore and at Centre of Excellence in Molecular Biology [CEMB], Lahore. The study was conducted on 50 subjects irrespective of age and sex divided into two groups i.e. Group-A comprising 20 normal healthy controls while Group-B consisted of 30 patients of NHL with bone marrow infiltration. Bilateral bone marrow trephine biopsy was done to assess the patterns of bone marrow infiltration. Serum beta2m and LD2 isoenzyme levels were determined in already diagnosed 30 patients of NHL. The values were compared with 20 healthy age and sex matched controls. Correlation coefficients were determined using Pearson's Correlation Coefficient. The estimations were made prior to the institution of chemotherapy

Results: beta2m and LD2 levels were significantly [p-Value < 0.05] raised in NHL patients with disease advancement and were compared with controls. These serological markers showed negative correlation [-0.235 for beta2m and -0.133 for LD2] with the spread of disease and patterns of involvement in NHL patients

Conclusion: By observing the patterns of bone marrow involvement in NHL patients possible guidelines about prognosis and treatment protocols can be obtained as the serological markers levels correlate well with the spread of disease and patterns of involvement in NHL patients

Comparison of oral itraconazole versus topical clotrimazole in treatment of pityriasis versicolor

Objective: To compare the efficacy of single dose of oral itraconazole 400mg with 1% topical clotrimazole in the treatment of pityriasis versicolor

Study Design: Randomized controlled trial.

Place and Duration of Study: Dermatology department, Military Hospital Rawalpindi, from Jun 2015 to Dec 2015

Material and Methods: A total of 60 patients of pityriasis versicolor fulfilling the inclusion criteria were selected from dermatology OPD after written informed consent and approval from the hospital ethical committee

Patients were divided into two treatment groups using random numbers table. Group A received single dose of itraconazole capsule [400mg] and group B received 1% clotrimazole cream twice daily application for 2 weeks

Patient evaluation included detailed history, clinical examination and direct microscopy of skin scrapings for fungal hyphae at the baseline, at the end of 2[nd] and 6[th] week of treatment. Efficacy of treatment was assessed on the basis of clinical and mycological cure

Results: At the end of 2 weeks of treatment, clinical cure was seen in 23 [76.6%] and 29 [96.6%] patients [p=0.05] and mycological cure in 20 [66%] and 26 [86.6%] patients in group A and B respectively [p=0.06]. At follow up [end of 6 week] 21 [70%] and 28 [93.3%] patients were cured clinically [p=0.02] while 18 [60%] and 27 [90%] patients were cured mycologically [p=0.007] in group A and B respectively

Conclusion: Topical clotrimazole [1%] was found more effective than single dose of oral itraconazole in the treatment of pityriasis versicolor

Laparoscopic Sleeve Gastrectomy for Morbid Obesity: UAE Tertiary Care Hospital Initial Experience.

Aim: To study efficacy of Laparoscopic Sleeve Gastrectomy (LSG) for morbid obesity as a measure of weight reduction over a period of one year from May 2011 – 2012. Materials and Methods: Morbidly obese patients (n=109) referred from clinics with primary problem of obesity and consequent co-morbidities underwent the procedure LSG during a period of one year. The data included; demographics, weight of patients/BMI, Comorbid conditions, preoperative work up, indications for surgery, length of hospital stay, duration of surgery, postoperative complication and reduction of weight at 3 weeks, 3, 6 and 12 months. Results: Out of 109 patients, 94 (86%) are below 40 years of age, reflecting high prevalence of obesity in the younger population in UAE. As per gender, 67 (61.5%) are female and 42 (38.5%) male. Preoperatively, mean weight is 121±16 kg; 68 (62.4%) patients have BMI 40-50 kg/m2 and 41 (37.6%) of 35-40 kg/m2, 12 (11%) patients are diabetics (DM), 9 (8.3%) hypertensive (HTN), 12 (11%) have symptoms of Gastritis, 3 (2.8%) have shown Clo test +ve., 7 (6.4%) complaining Knee Joint pain, 3 (2.8%) with Backache, 2 (1.8%) patients are diagnosed cases of gastroesophageal reflux disease (GERD), though 58 (53.2%) have no comorbidities. Among those 107 (98.2%) patients are referred to dietitian. All patients underwent laparoscopic sleeve gastrectomy (LSG). Postoperatively, 104 (95.4%) patients were without any complication. 1 (0.9%) patient has bleeding while 4 (3.7%) has minor issues (nausea, vomiting) and there was no leak in this group of patients. On follow up, there was a significant weight loss and improvement of comorbidities: At 3 weeks post op, the mean weight was 113±16 kg, at 3 months 103±13 kg, at 6 months 92±12 kg and at 1 year 82±10 kg. Complete resolution of Diabetes Mellitus (DM) observed in 7 (58.33%) out of 12 patients and improvement in 5 (41.55%). Complete resolution of hypertension (HTN) in 5 (55.55) and improvement in 4 (44.44). Gastritis completely resolved in 10 (83.33) and improved in 2 (16.66). The patients who had knee joint pain and backache, all improved. Conclusion: LSG has clearly proven its efficacy for morbid obesity in term of weight reduction and consequent co-morbidities. It’s gaining popular in community being an acceptable and safe procedure.

Plastibell device circumcision versus bone cutter technique in terms of operative outcomes and parent's satisfaction

Objective: To compare the rate of complications of Plastibell and bone cutter circumcision technique and recognition of top worries and satisfaction rate in the mind of parents before and after the procedure of Plastibell device [PD] circumcision in infants less than 6 months of age

Methods: It was a descriptive prospective study conducted at department of surgery Sheikh Zayed Hospital, Rahim Yar Khan. Two hundred parents of infants of less than six months of age were recruited for this study. Infants were divided into two equal groups. Group I included Plastibell circumcision technique and Group II included Bone Cutter Circumcision technique. Data was analyzed using SPSS Version 17. Independent sample t-test and chi-square test was used to compare quantitative and qualitative variables respectively. P-value <0.05 was taken as significant difference

Results: Total number of two hundred infants were included in this study. Most common worries of parents about Plastibell Device circumcision were; fear of fever [42.0%]. Fear of pain and bleeding [66.0%]. Plastibell Device method was associated with less operation time and bleeding as compared to bone cutter method [P-value <0.0001 and <0.0001 respectively]. Incidence of complications other than bleeding and infection was 3.0% in bone cutter method and 1.0% in Plastibell device method. Pain score was significantly less in plastibell device group [p-value <0.0001]. Post-operatively, 98% parents showed complete procedural satisfaction in Plastibell group versus 87% parents in bone cutter one month after surgery [P-value 0.003]. About 4% parents in bone cutter method group showed cosmetic displeasure versus only 1% parents in plastibell device group

Conclusion: The study concluded that Plastibell Device circumcision is a safer technique for circumcision and is associated with highest level of parent's satisfaction

Level of vitamin d in Orthopaedic Trauma among adult patients

Background: The evidence on level of vitamin D in trauma patients is scarce in the developing countries

Objective: To determine the levels of vitamin D in trauma patients above 18 years of age

Methodology: This was a cross sectional study conducted on patients admitted in the Orthopedic department of Sheikh Zayed Medical College /Hospital, Rahim Yar Khan, patients included in this study were 340. The duration of study was 21st July to 16th March 2016. Vitamin D level were measured by using vitamin D kits [Roche]. Patients less than 18 years were not included in the study. Data was analyzed by using SPSS version 16

Results: A total of 340 patients admitted in orthopedic department were included in this study. Overall 92.6% patients have deficient or insufficient level of vitamin D. Most of the patients [68.8%] were less than 45 years of age. Majority of the patients were male [71.8%]. Most of the patients [72.4%] were not smokers. Majority belonged to rural areas [56%], and have no history of steroid intake

Conclusion: This study confirmed that majority of the trauma patients were vitamin D deficient or insufficient. This highlights that trauma surgeons should consider vitamin D in the armamentarium of orthopaedic treatment

Outcome of wound coverage around ankle joint with sural artery flap

Background: Trauma is the most common cause of fractures and majority of these fractures involve the foot. So the early coverage is mandatory to prevent the complications, it is challenging to the orthopaedic, plastic and reconstructive surgeons. Sural artery reversible flap is one of the options

Objective: To determine the outcome of sural artery flap for wound coverage around ankle

Methodology: A total of 24 patients were included in this interventional study. All the patients having wound around the ankle due to any cause and of either sex presenting in emergency department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1st June 2014 to 30th April 2016 were included in this study. Outcome was measured as "Good", "Fair" and "Poor". The data was entered and analyzed by using SPSS version 16

Results: In this study 24 patient were operated, 41.66% were children and 54% were male. In 50% heel region was involved and in 25% melleolar region and 12.5% dorsum of foot and in 12.5% above ankle joint. Outcome noted was "Good" 83.3% "Fair" 8.3% and "Poor" 8.3%

Conclusion: Sural artery flap for the coverage around ankle is simple, safe and can be performed by orthopedic surgeon at any center without the requirement of special instrumentation and special test, with good outcome

Variation in pharmacokinetics of omeprazole and its metabolites by gender and CYP2C19 genotype in Pakistani male and female subjects

Pharmacokinetics [PK] variation of drugs in males and females may affect therapeutic effectiveness and safety. In current study the PK differences for omeprazole and its metabolites5-hydroxy-omeprazole and omeprazole-sulphone were evaluated in males and females. The current study also considered PK comparison of Pakistani subjects using the CYP2C19 genotype as variable. A single oral dose [40mg omeprazole], open-labeland, non-controlled clinical trial was arranged. Samples were quantified using reversed phase HPLC-UV method. CYP2C19 genotype of subjects was determined by tetra primer polymerization chain reaction [PCR] assay. There was a significant increase in Cmax [from 2 to 2.9microg/ml, p=0.004], [from 6.67 to 8.74microg-hr/ml, p=0.05] and elimination half-life [from 1.05 to 2.1 hr, p=0.0001] of omeprazole in females compared with males. Cmax and of 5-hydroxy-omeprazole [0.0248 and 0.0001, respectively] and omeprazole-sulphone [0.0001 and 0.001, respectively] was significantly higher in females than males when compared at 95 onfidence interval. The Cmax and AUC of omeprazole showed a significant raise [p=0.01 and 0.04, respectively] in Homz PMs [Homozygous Poor Metabolizers] compared with Homz EMs [Homozygous Extensive Metabolizers] and Htrz PMs [Heterozygous Poor Metabolizers] while Cmax and AUC of 5-hydroxy-omeprazolewas significantly higher [p=0.01 and 0.04, respectively] in Homz EMs compared with Homz PMs and HtrzPMs. AUC of omeprazole was significantly higher in females while its elimination also took longer compared with males. AUC of omeprazole was significantly higher in Homz PMs indicating that CYP2C19 displayed genetically deficient metabolism in its homozygous state

Diabetic foot ulcer; sequelae

Objective: The number of diabetic patients is increasing at a rapid rate1. Management of diabetic foot has been a challenge for medical professionals. This study was carried out to find the sequelae of diabetic foot ulcer management. Study design: Observational analytical study. Setting: Military Hospital, Combined Military Hospitals Rawalpindi and MIMC teaching Hospital, Mirpur [AJK]. Period: Sep 2009 to August 2013

Materials and methods: Total 310 patients were included in this study as outdoor and indoor cases. Out of these 184 were males and 126 were females. Age affected ranged from 20 years to 90 years. Average age was 50 years. Wagner's grading for diabetic foot ulcer was used as guideline for management

Results: Hyperglycemia was controlled in consultation with physicians in all these patients. Out of these 310patients 199 [64%] patients got their feet wounds healed on conservative management without amputation while 111[35.8%] patients had to undergo some amputation at some level

Conclusion: Diabetes mellitus, fore runner of so many diseases requires multidisciplinary approach. Well controlled diabetes mellitus, good feet hygiene, rational antibiotics in light of culture/sensitivity report and timely conservative or active surgical intervention produce good results in diabetic foot management

Bile duct injuries and outcomes: a retrospective medical record review

Objective: To report on our experience of cholecystectomy associated bile duct injuries and observe factors influencing outcomes

Study Design: Simple descriptive study

Place and Duration of Study: Surgical unit IV, Military Hospital [MH] Rawalpindi, over a period of seven years from 01-01-2005 to 1-12-2012

Material and Methods: Eighty eight patients who underwent repair of bile duct injuries during this period were included in this study. Patients referred from class 'W and 'C' hospitals to our institute were also included

Results: Fifteen immediate repairs [0-72 hours] post cholecystectomy, forty eight intermediate repairs [72hrs-6wks] and twenty five late repairs [> 6 wks] were performed [table-1]. Short term morbidity was higher in patients with upper biliary tract injury [p=.04].The most common long-term complication was biliary stricture, which occurred in 28 patients [31.8%]. Patients with bile duct injuries [BDIs] repaired in intermediate period were more prone to develop stricture of biliary tree than those repaired in immediate or late period [p=.03] [table 3]. Long term morbidity was also higher in patients who presented with bile contamination of peritoneum [p=.03] and had sustained complex biliary tract injuries [E4/E5] [p=.03].The overall morbidity and mortality rate was 31% and 3% respectively

Conclusion: We observed that complex hilar injury, presence of intra-abdominal bile and timing of BDI repair is an important predictor of long-term outcome. Injuries repaired in early [0-72hrs] or late period [>6wks] were less likely to develop biliary stricture as compared to injuries repaired in intermediate period [72hrs-6wks]. Moreover complex hilar injuries and intra-abdominal bile at presentation increases the possibility for development of late biliary stricture

Comparison of 1000-centistoke versus 5000-centistoke silicone oil in complex retinal detachment surgery

Objective: To compare the efficacy and complications of using 1000-centistoke versus 5000-centistoke silicone oil for complex retinal detachment repair

Study Design: Case series

Place and Duration of Study: LRBT Tertiary Eye Hospital, Karachi, from January 2007 to June 2013

Methodology: Eighty-five eyes [85 patients] presenting with superior rhegmatogenous retinal detachments associated with PVR grades B and C [involving not more than 3 clock hours] were randomized to either 1000 centistokes [n=44] or 5000 centistokes [n=41] silicone oil group. All patients underwent 23-gauge pars plana vitrectomy surgery with silicone oil intraocular tamponade. Patient data was analysed at 18 months post-operatively. IBM SPSS 21 was used for data analysis

Results: There were 52 male and 33 female patients aged between 22 and 70 years [45.2 +/- 16.2]. After the first surgery, successful reattachment of the retina was achieved in 67 eyes [78.8%]; of which 35 eyes were in 1000-centistoke and 32 eyes in 5000-centistoke groups. Mean pre-operative Best Corrected Visual Acuity [BCVA] was 1.63 +/- 0.54 which was improved to a mean post-operative BCVA of 1.46 +/- 0.78 [1.42 +/- 0.74 in 1000-centistoke group; 1.49 +/- 0.78 in 5000 centistoke group]. The 1000-centistoke group had a significantly higher frequency of oil emulsification which necessitated early removal of silicone oil. There were 66 eyes [77%] with at least one complication [34 eyes in 1000-centistoke group; 32 eyes in 5000-centistoke group] including cataract, corneal abnormalities, raised IOP, hypotony, vitreous haemorrhage and retinal redetachment

Conclusion: Although visual and anatomical outcomes were comparable between the two groups, the 1000-centistoke silicone oil group developed early oil emulsification necessitating its early removal

Framingham risk score in impaired glucose tolerant population: a sub analysis of diabetes prevention and awareness program of Pakistan

Objective: To assess the 10-year risk of coronary artery disease [CAD] in subjects with impaired glucose tolerance [IGT] using Framingham risk score

Methods:Data for this study was collected from Diabetes Prevention and Awareness Program. Primary prevention team visited different primary health care centers, factories, service organizations and offices within Karachi, Pakistan. IGT was diagnosed according to World Health Organization criteria after taking informed consent. Information regarding social-demography, dietary habits and physical activities were obtained by a designed questionnaire on one-to-one based interview. Framingham risk score [FRS] was used to assess risk of developing CAD

Results:A total of 315 subjects with IGT were recruited for the study. Mean age of subjects was 44.1 +/- 9.8 years and mean BMI was 27.3 +/- 5.0 kg/m[2]. Overall, 31.4% of the participants were at risk of having CAD. Males were 6.4 times and hypertensive subjects were 2.44 times more likely to have CAD in next 10 years

Conclusion:According to the findings of the study, male and hypertensive IGT subjects were more likely to develop CAD in next 10 years. Community based awareness programs are needed to educate people regarding healthy lifestyle in order to reduce the risk of IGT and CAD

Effect of bupivacaine with and without intra peritoneal instillation on postoperative visceral pain after laparoscopic cholecystectomy

Background: Laparoscopic Cholecystectomy is the treatment of choice for symptomatic gallstones disease. Open cholecystectomy results mainly in parietal pain while laparoscopic cholecystectomy causes visceral pain

Objective: To compare post-operative visceral pain at 24 hours in patients undergoing laparoscopic cholecystectomy with and without intra peritoneal instillation of bupivacaine

Methodology: Setting: Surgical Unit II, Sheikh Zayed Medical College/Hospital Rahim Yar Khan. Duration of Study: 1 July to 31 December 2015. Study design: Randomized controlled trial [RCT]. A total of 60 patients having symptomatic gallstones disease were included in this study. Patients were randomly divided into two groups. Thirty patients in group Awere treated with bupivacaine 0.5 % instillation. For the patients in group B, the dose was not instilled in the gall bladder fossa and right and left sub diaphragmatic spaces. Postoperative pain was assessed up to 24hours after surgery using Visual Analogue Scale [VAS]. The data was entered and analyzed by using SPSS version 16

Results: The mean age of the patients was 35 +/- 8 years in group A, and 37 +/- 8 years in Group B. Post operative pain at 24 hours was significantly low in group A than in group B [33.3% vs. 70%; p=0.004]

Conclusion: Intraperitoneal bupivacaine instillation after laparoscopic cholecystectomy reduces pain in the initial postoperative period. It is easy to administer with no adverse effects and may become a routine practice for this procedure