ABSTRACT
A 60-year-old man with chronic obstructive pulmonary disease and a heavy smoker and drinker presented to the emergency department with left-sided thoracoabdominal pain after falling down the stairs. Initial clinical findings were left-sided chest tenderness with no clinical evidence of subcutaneous emphysema. Twenty-four hours later the patient's respiratory distress increased-repeat chest X-ray showed a left gastrothorax indicative of a ruptured left hemi diaphragm. Diagnostic laparoscopy in the supine position via an umbilical port confirmed the presence of the stomach, spleen and splenic flexure of the colon in the left chest. Laparoscopic reduction of the stomach and colon was performed, but a small upper midline incision was required to reduce the spleen without injury. The diaphragmatic tear was repaired by direct open suture. The patient required a brief period of postoperative ventilation via a tracheostomy. The patient remained well at a 3-month follow-up visit.
Subject(s)
Hernia, Diaphragmatic, Traumatic/surgery , Laparoscopy , Hernia, Diaphragmatic, Traumatic/diagnosis , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
OBJECTIVE: To compare quantitative Bronchoscopic Bronchoalveolar Lavage (B-BAL) cultures with blind nasogastric tube bronchoalveolar lavage (N-BAL) cultures in the diagnosis of Ventilator Associated Pneumonia (VAP). STUDY DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: The study was conducted in Medical ICU and Chest ICU at Liaquat National Hospital (LNH), Karachi, from January till August, 2007. METHODOLOGY: Patients admitted in ICU with clinical suspicion of VAP, fulfilling inclusion criteria viz. fever, leukocytosis, new or worsening infiltrate in chest radiograph or purulent secretions were included. Exclusion criteria were deranged coagulopathy, extreme ventilatory and oxygenation demands and tracheal obstruction. All patients had N-BAL using 16 fr Nasogastric tube (NG) without lubrication followed by B-BAL. Samples collected were submitted to the laboratory for quantitative cultures and sensitivities. Results were documented on predesigned proforma. RESULTS: Fifty four patients underwent paired B-BAL and N-BAL sampling. The N-BAL sensitivity and specificity for N-BAL were 87.87% and 85.71% respectively and p-value was <0.001. N-BAL showed sensitivity of 87.87%, specificity of 75.71%, positive predictive value of 89.65%, negative predictive value of 77.77% and p<0.001, which was statistically significant. Significant differences in time required for sample collection and cost of both procedures were also observed. CONCLUSION: The results favour the use of blind NG tube bronchoalveolar lavage quantitative cultures as it is simple, safe, cost-effective and minimally invasive method of diagnosing VAP.
Subject(s)
Bronchoalveolar Lavage Fluid/microbiology , Bronchoalveolar Lavage/methods , Bronchoscopy , Cross Infection/diagnosis , Intubation, Gastrointestinal , Pneumonia, Ventilator-Associated/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Cross Infection/epidemiology , Cross Infection/microbiology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pakistan/epidemiology , Pneumonia, Ventilator-Associated/epidemiology , Pneumonia, Ventilator-Associated/microbiology , Sensitivity and Specificity , Young AdultABSTRACT
The case report of a young male with Endocarditis caused by Moraxella lacunata is presented. Although a well recognized cause of keratitis, conjunctivitis, and sinusitis; very few cases of endocarditis by this rare pathogen are reported in literature. Patient showed a prompt response when empirical therapy was de-escalated to penicillin, after receiving culture and sensitivity report from Microbiology department.
Subject(s)
Endocarditis, Bacterial/drug therapy , Moraxellaceae Infections/drug therapy , Penicillins/therapeutic use , Adult , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/therapeutic use , Ceftriaxone/therapeutic use , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/microbiology , Gentamicins/therapeutic use , Humans , Male , Meropenem , Metronidazole/therapeutic use , Moraxellaceae Infections/microbiology , Protein Synthesis Inhibitors/therapeutic use , Thienamycins/therapeutic use , Vancomycin/therapeutic useABSTRACT
A point survey of malaria in Karachi revealed a concentration of malaria cases in the periurban perimeter and marginal areas where immigrating groups, including Afghan refugees and Biharis from Bangladesh are concentrated. Populations of Anopheles stephensi, Karachi's main vector, were low, and were feeding chiefly on buffaloes which are also concentrated along the periurban perimeter. Maintenance of malaria transmission in periurban zones may depend on immigration of susceptibles, bovid hosts which help maintain zoophilic vector populations, and mosquito breeding sites in water tanks or buffalo hoofprints. The vector's switch to man-biting behaviour may occur either due to a 'spillover' effect from buffalo corrals to surrounding houses, or when buffaloes become less available for biting. Four types of chromosome inversions were found in the Karachi An. stephensi; as this species is not a vector in similar habitats in Lahore and Pondicherry where such inversions are not prevalent, it is likely that its status as a vector is related to chromosomal polymorphism influencing behaviour.
