Clinical profile and management of pyogenic liver abscesses in a tertiary care hospital

Background: Pyogenic Liver abscesses are potentially life threatening if left untreated. They pose a major Diagnostic and therapeutic challenge to modern world. Interventional radiology is becoming standard of care for liver Abscesses.Methods: All patients of pyogenic liver abscess admitted to Government Medical College and hospital Jammu, J and K, India from October 2018 to November 2019 were prospectively studied. Demographics, presentation, lab reports and management strategies were evaluated.Results: Total of 60 patients of pyogenic liver abscesses were studied with 81.7% males. Alcohol was found to be most common risk factor with 55% of patients being alcoholic. Right lobe of liver was involved in 66.7% of patients. Segment VI and VII were involved in 50% of patients. The most common clinical symptom was right upper quadrant pain (98.3%), followed by fever (91.7%). The most common clinical sign was right upper quadrant tenderness (91.7%). Percutaneous drainage with catheter placement was the most common and successful modality of management associated with least hospital stay.Conclusions: Pyogenic liver abscess is a rare but serious problem. Early diagnosis and treatment are necessary to avoid mortality. Percutaneous drainage along with I.V antibiotics is the best form of management

EPIDEMIOLOGICAL INVESTIGATIONS OF A PESTE DES PETITS RUMINANTS (PPR) OUTBREAK IN AFGHAN SHEEP IN PAKISTAN

Epidemiological and virological investigations were carried out during an outbreak of Peste des petits ruminants (PPR) in Afghan (Bulkhi) sheep in Pakistan. The overall morbidity, mortality and case fatality rates were 41.0, 1.2 and 3.0%, respectively. The epidemic curve was plotted and the values for basic reproductive number (R0) and herd immunity threshold (HIT) for the affected flock were estimated to be 6.85 and 85.4%, respectively. The morbid material analysis by immuno-capture ELISA (Ic-ELISA) and haemagglutination assay (HA) revealed the presence of PPR virus. The PPR virus was isolated and identified through cytopathic effects, Ic-ELISA and transmission electron microscopy (TEM)

Clinical study of neoplastic thyroid swellings

The prospective study of 108 patients of thyroid malignancy were studied with regard to surgical management in SKIMS, Srinagar. Thyroidmalignancy constituted 0.12%of total hospital admissions. It was seenmainly in patients belonging to rural areas (66.67%).The commonest observed thyroidmalignancywas papillary carcinoma (48.15%), followed by follicular carcinoma (37.04%), anaplastic carcinoma (7.41%), medullary carcinoma (5.55%) and malignant lymphoma (1.85%). Femaleswere affectedmore commonlywith a female tomale ration of 3.1:1.Patients ranged in age from 8 years to 70 years. Maximum number of cases with papillary carcinoma (34.62%), follicular carcinoma (40%) and anaplastic carcinoma (66.67%) presented in 4th, 5th and 6th decades of life respectivelywith a mean age of 34.85 years, 42.40 years and 61.25 years for papillary, follicular and anaplastic carcinoma respectively. Swelling in front of neckwas themost common (96.29%) presenting symptom, followed by hoarseness of voice. The majority of patients were having hard swellings with nodular surfaces and the swelling were free.No patient had retrosternal extension of thyroid swelling. 18.51% of patients had clinically palpable lymph nodes. Fine needle aspiration cytology was an important adjuvant to pre-operative diagnosis having sensitivity of 92.59%and specificity of 100%.Thyroid scan detected cold nodule/nodules inmaximumnumber (90.74%) of patients. Indirect laryngoscopy detected vocal cord palsy in 14.81% patients pre-operatively. Total thyroidectomy was performed in maximum (83.33%) number of patients followed by near total thyroidectomy. The main post-operative complications were hypoparathyroidism (12.96%) and recurrent laryngeal nerve palsy (11.11%). Anaplastic carcinoma was found a rapidlygrowing tumour,with a limited surgical scope.Department of General Surgery SKIMS, Soura, Srinagar (India

Study of early post -operative atrial fibrillation after valvular heart surgery.

Objectives: 1) To study the incidence and timing of development of atrial fibrillation after valvular replacement surgery; 2) To know various risk factors for development of this Arrhythmia. Material and Methods: 80 patients of either sex, with rheumatic valvular heart disease undergoing Mitral Valve, Aortic Valve and both Mitral and Aortic Valve replacement with normal preoperative sinus rhythm, operated under cardiopulmonary bypass by standard technique were observed by continuous ECG monitoring (DATA SCOPE SPECTRUM USA) to note the incidence and timing of development of atrial fibrillation. Age, sex, systemic and pulmonary hypertension, preoperative history of intermittent atrial fibrillation, preoperative left atrial and left ventricular systolic and diastolic dimensions, left ventricular ejection fractions and duration of aortic cross clamp were studied as risk factors in patients who developed Atrial fibrillation. Results: 28 patients (35%) developed atrial fibrillation in the post operative period. In majority of cases 13 (46.42%) it occurred between 24- 48 hours post operatively. 7% (14.28%) had more than one episode. It was benign and self-limiting in majority of patients. Age more than 55 years, systemic hypertension, left atrial size more than 50mm, history of pre operative intermittent atrial fibrillation, left ventricular ejection fraction below 35%, duration of aortic cross clamp > 50 minutes were significant risk factors, (P<0.01). Conclusion: Atrial fibrillation develops in significant number of patients post operatively after valvular replacement surgery. In majority of the patients it is benign and self limiting