N-Cyclo­hexyl-4-meth­yl-N-propyl­benzene­sulfonamide

The title compound, C16H25NO2S, is a sulfonamide derivative with the substitution of propyl and cyclo­hexyl groups at the N atom. The least-squares plane through all six C atoms of the cyclo­hexyl ring forms a dihedral angle of 58.88 (12)° with the toluene ring. No hydrogen-bonding inter­actions are present in the crystal structure

Choosing between endoscopic or microscopic removal of third ventricle colloid cysts

Colloid cysts are benign lesions, found in the anterior part of the roof of the third ventricle. A PubMED search of literature was performed to identify the evidence on different treatment options and surgical approaches for removal of colloid cysts. Evidence on endoscopic versus microsurgical resection of colloid cysts showed that microsurgical approach had significantly higher rates of gross total resection, lower recurrence rate and lower re-operation rate. No significant difference with respect to the mortality rate or the need for a shunt was found between the two groups. However, the overall morbidity rate was lower for the endoscopic group.

Indications And Outcomes In Neonates Requiring Mechanical Ventilation In Level III Neonatal Intensive Care Unit, Wah Cantt, Pakistan

Objective: This study was carried out in resource-restricted settings receiving patients predominantly from middle- or lower-income classes, to highlight the indications, outcomes, and multiple factors affecting the outcome of mechanical ventilation in neonates.Materials and Methods: A retrospective study was conducted in level 3 NICU. Neonates ventilated from January 2018 to July 2021 were included in this study. Primary disease as an indication of ventilation along with outcomes in comparison to various parameters (clinical and laboratory) was listed as predictors of mortality. Thrombocytopenia was defined as platelet count<150,000/ μl and thrombocytopenia present was recorded as positive and negative for normal platelet count. C Reactive Protein levels of > 6 mg/dl were taken as positive.Results: A total of 320 ventilated neonates were included in the study. Among them 65.6% were males and 41.3% survived. Respiratory distress syndrome (RDS ) (28.7%), Hypoxic Ischaemic Encephalopathy (HIE) (26.6%), and Neonatal sepsis (NNS) (14.1%) were the three most indications for ventilation. The disease-specific outcome shows mortality was 64.4% in NNS, 64% in RDS, and 56.4% in HIE. Out of the total enrolled babies for the study, 62.1% were received outdoors and 37.8 % were indoors 74.4% of babies with HIE were received outdoors. Low birth weight, prematurity, mode of admission, first CRP at the time of presentation, thrombocytopenia, and duration of ventilation were portending factors of mortality Conclusion: Prematurity associated with RDS, HIE and NNS were the major indications for ventilation. Outdoor babies have poor survival due to late referrals and late presentations. Thrombocytopenia and early sepsis were found to be bad prognostic factors

Factors ssociated with complicated appendicitis: view from a low-middle income country

Introduction Factors associated with complicated appendicitis have been inconsistently identified. Moreover, studies are lacking from low and low-middle countries where access to surgical care is limited. Our objective was to identify factors predicting complicated appendicitis as diagnosed intraoperatively in a low-middle income country hospital. Methodology Retrospective case-control study of patients who underwent laparoscopic appendectomy from 01/2008 to 12/2015 was completed. Based on intraoperative diagnosis of complicated appendicitis, patients were divided into two groups; those with complicated appendicitis (CA) and those who had non-complicated appendicitis (NCA). CT scans were further reviewed to identify presence of appendicolith. Result Of the 442 patients included, 88 (20%) patients were in the CA group while 354 (80%) patients were in the NCA group. Patients in the CA group were older [CA vs. NCA: 34.6 ± 14 vs. 30.4 ± 11.5; p-value \u3c 0.001], had symptoms for longer duration [CA vs. NCA: 2 ± 1.2 vs. 1.5 ± 0.8; p-value: 0.001] and had a greater proportion of patients with appendicoliths [CA vs. NCA: 37 (42%) vs. 84 (23.7%); p-value: 0.001]. On multivariable regression analysis, patients with complicated appendicitis had greater odds of having appendicoliths (OR: 2.4, 95% CI: 1.4-4.07; p-value \u3c 0.001) and symptoms for a longer duration (OR: 1.57, 95% CI: 1.25-1.97; p-value \u3c 0.001). Conclusion Patients with complicated appendicitis had greater odds of having appendicoliths and symptoms for a longer duration. Further studies are warranted in low and low-middle income countries to gauge the impact delay in presentation and intervention has on appendicitis and its outcomes

Comparison of Slow versus Rapid Feeding Regimen in Preterm Neonates in the reduction of hospital stay

Introduction: In preterm babies delay in the achievement of full feeds causes prolonged hospital stay. This study will help in the nutritional management of preterm babies which will shorten the hospital stay and reduce the economic burdens on parents. Objective: To compare the mean duration of hospital stay of preterm neonates with two different feeding protocols(slow feeding regimen versus rapid feeding regimen). Materials and Methods: This study was conducted in the neonatal unit at Izzat Ali Shah Hospital from October 2019 to March 2020 through a randomized controlled trial. A total of 102 (51 in each group) were randomized to slow feeding (Group A) and Rapid feeding(Group B). Depending on the birth weight and gestational age, a certain amount of breast milk was initiated, with increments of 15-20 mL/kg/day in the slow feeding group & 25-30 ml/kg/day in the rapid feeding group. Feeding was stopped temporarily in case of any sign of feeding intolerance, suspected necrotizing enterocolitis, recurrent apnoeic episodes, and neonatal seizures. The total target feed was 180 ml/kg per day. Infants were continued in the study until discharged from the hospital.   Results: Our study shows that the mean gestational agein Group A (Slow feeding) was 34 weeks with SD ± 2.68 while the mean gestational agein Group B (Rapid feeding) was 35 weeks with SD ± 1.98. In Group A (Slow feeding) 55% neonates were male while 45% neonates were female. Whereas in Group B (Rapid feeding) 57% neonates were male while 43% neonates were female. In Group A (Slow feeding) mean hospital stay was 22 days with SD ± 7.02. In Group B (Rapid feeding) mean hospital stay was 13 days with SD ± 3.72.  Conclusion: Our study concludes that mean hospital stay in the rapid advancement of feeds was shorter as compared to the slow feeding of preterm neonates

Intra-abdominal Hypertension and Abdominal Compartment Syndrome in patients undergoing emergency laparotomy

Objective: The objectives of the Prospective observational study were to identify the frequency of abdominal compartment syndrome and intraabdominal hypertension in patients undergoing emergency laparotomy for trauma and peritonitis and to determine the impact of raised intraabdominal pressure on the overall morbidity and mortality. Materials and Methods: The study was conducted in the department of surgery Benazir Bhutto Hospital Rawalpindi. From June 2013 to May 2014 a total of 50 patients undergoing emergency laparotomy were included. IAP was measured preoperatively then postoperatively at 0, 6, 24 hours, and the findings were recorded on a specially designed preform. The patients having higher IAP were further evaluated up to 72 hours. All vitals, urine output, oxygen saturation, serum urea, creatinine were noted. The main outcomes were duration of hospital stay, the occurrence of burst abdomen, and mortality. Results: At the preoperative level the incidence of IAH was 86%. The mortality association with IAH at 6 hours postoperatively was quite significant (P<0.029). The incidence of postoperative ACS was 5% among the total patients and it was 15.6% in trauma patients. No significant association was found between IAP and occurrence of burst abdomen at any level (P values 0.4, 0.26, 0.53, 0.58 at intervals preoperatively, 0, 6, 24 hours postoperative respectively.  Conclusion: Intraabdominal pressure is an important factor that predicts the mortality of patients undergoing emergency laparotomy. It should be carefully monitored and managed accordingly to avoid the detrimental effects on virtually all organ systems. Abdominal decompression in significantly elevated intraabdominal pressure reverts the physiological derangement of Intrabdominal hypertension

Post-operative seizure control in patients with glioblastoma

While the median survival in patients with glioblastoma has not improved significantly over the past decade, aggressive attempts have been made on palliation and improving quality of life in these patients. A confluence of two debilitating pathologies which massively distorts the normal day-to-day functioning of the patients who experience it, seizures in glioblastoma patients portends a poor prognosis. There exists a paucity of reported seizure outcomes after glioblastoma treatment in neurosurgical literature. Herein we present a review examining post-operative seizure control in patients with glioblastoma

The Outcome of Unreamed Interlocking Nail for the Management of Open Fractures of Tibial Shaft: An Observational Case Series

Objective: This observational case series was designed to see of early debridement and unreamed interlocking nail have emerged as a better modality in the management of open fractures of the shaft of the tibia.Materials and Methods: This descriptive case series study was conducted at the Department of orthopedics, Wah general Hospital Rawalpindi for a period of 6 months. Through non-probability purposive sampling, 60 cases of open fracture of the tibia were included. Unreamed interlocking nail was inserted in all the sixty patients and each nail was statically locked with one screw proximally and one screw distally. Patients were followed regularly i.e on the 1st then 10th, 20th, 30th post-operative day then monthly for 9 months in OPD, and data for union and infection were recorded. Results: The mean age for all patients was 32.82 ± 8.87years. There were 49 (81.7%) male and 11 (18.3%) female patients involved in this study. There were 27 (45%) patients who presented with Gustilo Anderson type I fracture, 23 (38.3%) had Gustilo Anderson type II and 10 (16.7%) had Gustilo Anderson type IIIA. We observed that there were 17 (28.3%) patients who had a transverse fracture, 22 (36.7%) had an oblique fracture, 8 (13.3%) had a spiral fracture and 13 (21.7%) had comminuted fracture. Union occurred within 5 months in 50 (83.3%) patients, 9 (15 %) showed delayed union while 1 (1.7%) patient had non-union after a course of follow-up. Infection was also observed in follow-up in only 8 (13.3%) cases while 52 (86.7%) cases did not show any sign of infection. Conclusion: Unreamed interlocking nailing is quite enough to manage the patients presenting with an open tibial fracture in terms of a higher union rate with low infection and non-union rate