Intestinal Obstruction Changing Etiological Trends

Background: To describe clinical presentation, etiology, and management of patients presenting with intestinal obstruction. Method: From 6th September 2004 to 6 September 2005, 50 patients with provisional diagnosis of intestinal obstruction were admitted from emergency room of Rawalpindi General Hospital. All patients were initially assessed after resuscitation in emergency room. The decision, to operate or manage conservatively, was taken by a consultant. The clinical diagnosis was matched with per-operative findings and histopathology reports. Results: Of the total 50 patients, 42 were males and 8 were female. The age distribution varied from 15 years to 70 years. Mean age was 41.7 ± 13.6.Commonest symptom with which the patients presented was generalized abdominal pain. Most common sign was tachycardia, present in 49 patients. Most common etiology leading to intestinal obstruction was obstructed inguinal hernia in 22 followed by post operative adhesions in 12 patients. Conclusion: Obstructed inguinal hernia is the most common etiology of intestinal obstruction. Early diagnosis and surgical intervention is required to decrease gut ischemia leading to increased morbidity in patient

Perforated appendix! An experience of a Public teaching hospital

Introduction  The most common cause of non-traumatic acute abdominal pain as well as the most common acute abdominal condition presenting to Surgical Emergency is none other than Acute Appendicitis hence it becomes the most common entity undergoing surgery in Emergencies all over the world. The lifetime risk for someone to develop acute appendicitis is 8.6% and 6.7% for males and females respectively, with 90% found in children and young adults and 10% in patients over 60 years of age.1 Increasing age or in other words decreasing immunity does affect the incidence of perforated appendix as we see the  the perforation rate in acute appendicitis is approximately 20~30%  but as the age goes beyond 60 years it inclines to  32-72%.2 Delay in the diagnosis caused by indefinite  history and physical examination  tends to contribute to higher incidence of perforated appendix as reported by Siripong et al. In another study the risk factors that were found to be associated with perforated appendicitis were male sex, fever ≥ 38°C, anorexia, and duration of pain in the pre-admission period.3 In one of the the study pre-hospital delays were exceeding related to perforation as compared to in-hospital delays which was explainable because of a linear relationship present among the pathological grade  to hospital interval ratio , thus leading to increased risk of perforation.4 As far as the blood work was concerned , an increase in Total Leucocyte count with majority being polymorphonuclear leukocytes (PMN), and raised C-reactive protein (CRP) levels were found to be responsible for substantial increment in the  risk and gravity of complications in appendicitis. Presence of comorbid diseases didn't show any significant affect on perforation rate.5

Hospital-Based Cancer Registry

Background :. To  determine the frequency of different types of malignancies in different gender and age groups, presenting at a surgical unit. Methods:  In this observational study  cancer patients of both genders were included to determine frequencies of different malignancies that presented to a surgical unit.  All the patients with age greater than 12 years and being admitted in surgical unit 1 with the diagnosis of malignancy, were included. The variables recorded included age, sex, address, diagnosis, biopsy, date of biopsy, treatment timeline, stage at presentation, final outcome and referral to other care units. Data was entered and analyzed using the statistical package for social sciences (SPSS) software, version 22. Results: A total of 150 malignant tumours were analyzed. There were 50 (33.3%) male patients and 100 (66.7%) females. Malignant tumours of breast 67 (44.7%) and esophagus 16 (10.7%), were found to be the most common whereas malignant melanoma  (0.7%), submandibular tumours (0.7%), and parotid tumours (0.7%), were least common. The most common malignancy in males were of stomach (16.0%) and rectum (16.0%), whereas in females it was the breast malignancies (67.0%). Dividing the age distribution of the patients into 15-year bands, the peak age-category was 41-60 years (46.0%), while only 3 (2.0%) patients were above 80 years.  Conclusion: Cancer trends were found to be similar as that of other studies in Pakistan with a few differences. Data management is sub optimal. There is a dire need of integrated system of Cancer Registry

The impact of the COVID-19 pandemic on the education of medical, dental and non-medical healthcare professionals in Bangladesh : findings and connotation

Lockdown measures in response to the COVID-19 pandemic had an appreciable impact on the education of all medical, dental, and non-medical healthcare professional (HCP) students. These included the closure of universities necessitating a rapid move to e-learning and new approaches to practical’s. However initially, there was a lack of knowledge and expertise regarding e-learning approaches and the affordability of internet bundles and equipment. We initially con-ducted two pilot studies to assess such current challenges, replaced by a two-stage approach including a full investigation involving 32 private and public universities during the early stages of the pandemic followed by a later study assessing the current environment brought about by the forced changes. Top challenges at the start of the pandemic included a lack of familiarity with e-learning approaches, cost of the internet, lack of IT equipment and the quality of the classes. Universities offered support to staff and students to a varying degree to address identified challenges. Since then, e-learning approaches have widened the possibilities for teaching and learning at convenient times. However, challenges remain. In conclusion, there were considerable challenges at the start of them pandemic. Several key issues have been addressed with hybrid learning here to stay. Remaining challenges include a lack of ICT equipment. However, new innovations will continue

Plane Waves on Rotating Microstretch Elastic Solid with Temperature Dependent Elastic Properties

Plane waves propagating in generalized thermoelastic half space rotating with specific angular frequency has been investigated. The appropriate model of the problem in context of Green and Naghdi theory is generated, while modulus of elasticity is taken as a linear function of reference temperature. An exact approach of normal mode analysis method is implemented to obtain the expression for the displacement components, stresses and temperature distribution functions. The variations of the considered variables against the vertical distance are illustrated graphically and a comparison is made for results predicted by both the theories in presence and absence of rotation effect we have also encountered the effect because of temperature involved in elastic parameters

Cholecystectomy- Diagnostic Stratification on the Basis of Age and Sex

Background: To study the histopathological specimen of gall bladder inflammation and to correlate the pattern of inflammation with age and sex and to detect undiagnosed carcinoma of gall bladder.Method:-In this descriptive study patients undergoing laparoscopic cholecystectomy for symptomatic gall stones were included. Laparoscopic cholecystectomy was performed in all cases but had to be converted to open procedure in cases where anatomical distortion and dense adhesions prevented any further progress. Specimens were evaluated grossly and microscopic study was done.Results: Over a period of two and half years, three hundred patients with symptomatic gallstones were admitted for cholecystectomy. There were 237 females (79%) and 63 males (21%) with a male to female ratio of 1:7.9. The age ranged from 21 to 80 years(mean age=41.5 ± 5.3 years). Chronic cholecystitis was the commonest diagnosis. Adenocarcinoma was found in one patient, more than 70 years of age . Extensive gallbladder inflammation in the form of necrotizing or gangrenous cholecystitis was recorded in a significant number of male patients 5 (83.3%)compared to one female patient(16.7%). Commonest age group for chronic cholecystitis was 41-50 years age group. For acute on chronic cholecystitis, 51-60 years age group was commonest .Conclusion:-Chronic cholecystitis is the commonest presentation. Supparative cholecystitis more common in females whereas gangrenous gall bladder was detected more in males

Impacts of Climate Change on the Water Availability, Seasonality and Extremes in the Upper Indus Basin (UIB)

Gefördert durch den Publikationsfonds der Universität Kasse

On Forgotten Topological Indices of Some Dendrimers Structure

A series of previously conducted experiments pertaining to various chemicals and drugs uncover a natural linkage between the molecular structures and the bio-medical and pharmacological characteristics. The forgotten topological index computed for the molecular structures of various chemical compounds and drugs has proven significant in medical and pharmaceutical fields by predicting biological features of new chemical compounds and drugs. A topological index can be considered as the transformation of chemical structure into a real number. Dendrimers are highly-branched star-shaped macromolecules with nanometer-scale dimensions. Dendrimers are defined by three components: a central core, an interior dendritic structure (the branches), and an exterior surface with functional surface groups. In this paper, we determine forgotten topological indices of poly(propyl) ether imine, porphyrin, and zinc–porphyrin dendrimers