Plants used against liver disorders by autochthonous practitioners of Multan, Pakistan.

The research work was commenced with an aim to document plant based drug recipes used by autochthonous practitioners against liver diseases in Multan region. The data was collected by interviews and semi-structured questionnaire from 43 traditional herbal practitioners. Recorded data was evaluated using the use value, relative frequency of citation (RFC), family importance value (FIV) and family use value (FUV). Total of 69 plant species belonging to 38 families were reported to be utilized to treat various liver disorders. The most important species regarding their use value were 3.0 for Polygonum bistorta, Citrus limon. It means that highly cited plants are more important in traditional medicines but this does not mean the plants low-citation plants by respondents are less medicinal important. It may be due to unavailability of plants in the area or lack of knowledge. Most of plant parts used were leaves due to ease of collection as compared to underground parts. One the basis family use value Asteraceae as the dominating or prominent family. These plants can be further investigated for allied pharmacological studies that will affect the socio-economical condition of the local community.

Safety of the plastibell circumcision in neonates, infants, and older children.

OBJECTIVES: The objectives of this study were to determine the safety of the Plastibell device (PD) circumcision in neonates, infants, and older children. PATIENTS AND METHODS: A prospective, descriptive study was conducted in private clinics of district Poonch and district Sudhanuti Azad Kashmir, Pakistan, during the period from November 2014 to August 2017. Research was conducted in light of guidelines set by Helsinki declaration. Healthy male babies free of any clinical signs of illness and congenital anomaly were included in the study. The babies having weight <3 kg at the time of surgery were excluded from the study. The parents/guardian were explained about the procedure and informed consent was taken. The complications that developed postoperatively were recorded. The record of all cases was analyzed retrospectively for safety outcome and complications developed in neonates, infants, and older children. RESULTS: A total of 1000 cases including 655 (65.5%) neonates, 241 (24.1%) infants, and 104 (10.4%) children between 1 and 5 years of age were selected. The PD circumcision was done in all these cases. Of these, 93.5% neonates, 89.6% infants, and 66.3% children older than 1 years of age had no complications postoperatively. The complication rate was highest among the children between 1 and 5 years of age as compared to neonates and infants. The complications such as bleeding prepuce, hematoma, and swelling prepuce were higher in infants than neonates while superficial infection and buried glans were noted more in neonates than infants. CONCLUSION: It may be inferred from our findings that Plastibell circumcision is safer if done in the 1st year of life and younger the age better is prognosis in healthy male babies.

Advantages of Selective Use of Intraluminal Shunt in Carotid Endarterectomy: A Study of 122 Cases.

Objectives: To assess the advantage of selective use of shunt in carotid endarterectomy (CEA) under local anesthesia. Materials and Methods: A total of 122 consecutive patients fulfilling international guidelines were included. Shunt was used selectively only in cases of bilateral severe carotid artery occlusive disease or in those patients who developed neurological symptoms on clamping of carotid artery. Follow up was done weekly for one month; then every month for 3 months; and then every 3 months for a year. Results: Shunt was used only in 5% (n = 6) patients. Of these, 2.5% (n = 3) patients were those who developed neurological symptoms on clamping the internal carotid and deployment of shunt resulted in complete resolution of symptoms. 2.5% (n = 3) had severe bilateral carotid stenosis and shunt was deployed. One of these patients developed stroke which was permanent. There was no mortality. The mean procedure time was 170 min in patients in whom shunt was used, when compared with 100 min in patients without shunt (P = 0.003). Conclusion: Use of shunt in carotid endarterectomy under local anesthesia as selective policy has an advantage in terms of cost effectiveness, operation time and prevention of potential complications.

CAUSES OF DELAYED PRESENTATION OF ACUTE APPENDICITIS AND ITS IMPACT ON MORBIDITY AND MORTALITY.

BACKGROUND: Acute appendicitis is one of the commonest abdominal emergencies and appendectomy. is one of the commonest emergency procedures performed all over the world. The study was done with an objective to evaluate the different causative factors for delayed presentation of appendicitis. METHODS: This cross-sectional study was carried out in the Surgical "C" unit, at Ayub Teaching Hospital, Abbottabad, Pakistan from 20th June 2013 to 19th June 2014. A total of 130 patients presented with appendicitis in OPDs or emergency department. Detailed history, general physical and systemic examination especially abdominal examination was done along with investigations. RESULTS: It was found that 23.08% of complicated appendicitis presentation is due to missed diagnosis by physicians, 30.77% is due to missed diagnosis by non-doctors, 23.08% is due to conservative management at DHQ hospitals by surgeons, and 23.08% presented late because of self-medication at home. CONCLUSION: All patients with pain Right iliac fossa, there should be suspected of appendicitis. Proper workup should be done to exclude it. If kept on conservative management then regular monitoring of vitals with laboratory investigations should be done.

Risk factors for diabetic foot ulcer.

BACKGROUND: Diabetic foot is one of the common complications of diabetes mellitus. Many risk factors are involved in its causation. This study was conducted to determine risk factors responsible for foot ulcer in diabetic patients. METHODS: A total of 196 consecutive patients with diabetic foot were included in the study. Detailed history, clinical findings and investigations were recorded. Lesions were graded according to Wagner's classification, and appropriate medical and/or surgical treatment was carried out. Patients who did not consent to participate in the study had established gangrene of the foot, or had any medical co-morbidity especially chronic heart failure and chronic renal failure which could influence these risk factors were excluded from the study. Data were collected on a special proforma for analysis. RESULTS: Out of 196 patients 80.1% were male. One hundred and forty-six (74.48%) patients were in the range of 40-70) years. Right foot was more commonly involved (65.3%). 91.3% patients had diabetes of more than 5 years duration. No treatment had been received by 47.4% patients while 41.3% were on oral anti-diabetics; 11.2% patients were on insulin. All patients had type 2 diabetes mellitus. Neuropathy was present in 51% patients, 62.8% had absent or diminished peripheral pulses, 43.4% had poorly controlled diabetes. According to the Wagner classification 30.6% patients had grade 1, 26.5% had grade 2, and 42.9% had grade 3 diabetic foot. Evidence of infection was seen in 85.7% patients: staphylococcus aureus was isolated in 43.4% patients. Osteomyelitis was present in 42.9% patients. Surgical intervention was performed in 85.7% patients. Direct relation was found between the duration of diabetes, sugar control, peripheral neuropathy, peripheral arterial disease. grade of diabetic foot, evidence of osteomyelitis, intervention and the outcome of the disease. CONCLUSION: Neuropathy, peripheral arterial disease, duration of diseases and undlerlying osteomylitis are the major risk factors and need to addressed while educating patients.

Aetiological factors in mechanical intestinal obstruction.

BACKGROUND: Intestinal obstruction occurs when the normal flow of intestinal contents is interrupted. The most frequent causes of intestinal obstruction are postoperative adhesions and hernias, which cause extrinsic compression of the intestine. Less frequently, tumours or strictures of the bowel can cause intrinsic blockage. Objective of the study was to find out the various aetiological factors of mechanical intestinal obstruction and to evaluate the morbidity and mortality in adult patients presenting to Surgical 'A' unit of Ayub teaching hospital with mechanical intestinal obstruction. METHODS: This cross-sectional study was conducted from March 2009 to September, 2009. All patients presenting with intestinal obstruction and were above the age of 12 years were included in the study. Patients with non-mechanical obstruction were excluded from the study and those who responded to conservative measures were also excluded. RESULTS: A total of 36 patients with age ranging from 12 to 80 years (Mean age 37.72 +/- 19.74 years) and male to female ratio of 1.77:1, were treated for mechanical intestinal obstruction. The most common cause for mechanical intestinal obstruction was adhesions (36.1%). Intestinal tuberculosis was the second most common cause (19.4%), while hernias and sigmoid volvulus affected 13.9% patients each. Malignancies were found in 5.6% cases. CONCLUSION: Adhesions and Tuberculosis are the leading causes of mechanical intestinal obstruction in Pakistan. Although some patients can be treated conservatively, a substantial portion requires immediate surgical intervention.

Empyema thoracis: management outcome.

BACKGROUND: Empyema thoracis results from postpneumonic effusion of bacterial origin or trauma. If untreated it may convert to fibro-purulent or an organising stage. METHODS: This study was conducted at cardiothoracic unit of Ayub Teaching Hospital Abbottabad from Jan 2008 to Aug 2009. Patients with diagnosis of empyema thoracic were studied. Their clinical features and investigations were recorded on a proforma. Antibiotics alone, aspiration, chest intubation, rib resection or decortication were performed where required. RESULTS: Out of 71 patients, males were 58 (81.69%) and females were 13 (18.3%). Majority of the patients (24, 33.8%), were below 20 years of age. Most of the patients (59, 83.09%), were from the poor socioeconomic class. Forty-one (57.76%) patients were smokers, 12 (16.9%) were diabetic, and 39 (54.92%) were hypertensive. Cough was the most common complain (62, 87.32%). Forty (56.33%) had more than 50% involvement of hemi thorax. In 44 (61.97%) cases, cause was tuberculosis. Fifty-one (71.83%) patients were treated with tube thoracostomy and 13 (18.3%) required decortication. CONCLUSION: Empyema thoracis commonly affects males. Apart from clinical assessment, x-ray chest is an important and simple investigation to detect empyema thoracic. Mostly tube drainage cures the diseases but in case of failure other options are also available.

Management of thoracic trauma: experience at Ayub Teaching Hospital, Abbottabad.

BACKGROUND: The incidence of thoracic trauma has rapidly increased in this century of high speed vehicles, violence and various other disasters. It has been observed that chest intubation was required in more than 75% of patients. METHODS: This prospective study was performed in cardiothoracic surgery unit of Ayub Teaching Hospital Abbottabad from Jun 2007 to Dec 2007. A total of 114 consecutive patients with chest trauma were included in the study, their patterns of injuries classified, treatment strategies and outcome were recorded on a proforma. RESULTS: Out of 114 patients with chest trauma, 76 (66.65%) were having penetrating and 38 (33.33%) had blunt trauma. Haemothorax was detected in 67 (58.77%), Pneumothorax in 23 (20.17%), rib fracture in 11 (15.02%) and diaphragmatic injuries in 4 (3.5%) cases. Overall complication rate was 14%. Wound infection was present in 8 (7.01%) and empyema in 4 (3.5%). Mortality was 2.6%. CONCLUSION: Penetrating chest injuries were more common than blunt injuries and chest intubation with resuscitation was adequate in most of the patients.