The role of computed tomography for identifying mechanical bowel obstruction in a Pakistani population

Objective: To retrospectively review our experience of CT scan in cases with a final diagnosis of surgically confirmed mechanical bowel obstruction. Methods: It is a retrospective analytical study, done from 2003 to 2008. All adult patients having undergone laparotomy in addition to a preoperative abdominal CT scan over a 5 year period were identified through the medical records and their case notes reviewed. Taking surgery to be the gold standard for diagnosing mechanical bowel obstruction, we compared results of the CT with operative findings to determine the sensitivity, specificity, positive and negative predictive values of CT scans. The data was analyzed using SPSS version 16.0. Results: A total of 271 patient records were reviewed. The mean age was 46 +/- 19 years and (64%) were men. Mechanical intestinal obstruction was found in 104 patients on laparotomy and CT scan had diagnosed 97 of these. The sensitivity and specificity was 93% respectively. CT scanning correctly identified the cause of the obstruction in 72 (74%) cases. The common reasons for bowel obstruction identified by surgery were adhesions 29 (40%), neoplasm 12 (17 %) and hernias 7 (10%). Conclusion: CT scans are reliable at diagnosing intestinal obstruction with a high sensitivity and specificity but they are not as accurate at defining the etiology of the obstruction

Microbial profiling and risk factors assessment for Otitis Media and Otitis Externa

Background: Otitis media and otitis externa are common otological manifestations in all generations especially in children. There is lack of accurate identification of the causative agent and thus poor diagnosis for such infections. Therefore, it leads to permanent anatomical disabilities including poor speech and defects in balancing and hearing. The study was conducted to isolate, characterize and identify the microbes causing otitis media and otitis externa. Methods: A total of 250 patients having otitis media and otitis externa were enrolled in the study from March 2011 to October 2011. All patients were examined through clinical examination and detailed history was collected. Pus samples from the discharging ears were plated on MacConkey’s, Chocolate and Blood agar for 24 to 48 hours. Isolates were identified on the basis of morphology, staining reactions and various biochemical tests. Results: In this study, only 6% cases yielded no growth, 14% yielded mixed cultures while 80% cases yielded pure cultures. The presumptive diagnosis for ear swabbing was otitis media (76%) and otitis externa (24%). The most common bacterial isolates obtained were Staphylococcus aureus (43.3%) followed byPseudomonas aeruginosa (25%) in the diagnosed cases of otitis media. While for the cases of otitis externa,Pseudomonas aeruginosa was the predominant organism with 52.2%. Infection of otitis media was most common among children and the persons having low socioeconomic conditions. Conclusion: Pseudomonas aeruginosa was identified as the principal pathogen followed by Staphylococcus aureus. To circumvent the painful effects of acute and chronic ear infections, an accurate microbial profiling may play pivotal role

Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review

Background: Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade.Methods: A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria.Results: Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia.Conclusion: We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries. Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review

Comparative study to access coagulation abnormalities in breast cancer

Background: Coagulation abnormalities such as thrombosis and disseminated intravascular coagulation (DIC) are the major factors that play a major role in breast cancer. In this study, coagulation abnormalities were assessed in breast cancer patients to help the clinician in early detection of DIC and management of patients at different stages of breast cancer.Methods: 75 patients were enrolled in the study, 50 were from case group (breast cancer patients) and 25 were selected as control group subjects used to compare the results. All of these subjects undergone, General Hematological analysis i.e. differential leukocyte count hemoglobin, platelets count and total leukocyte count were performed on each of the samples collected from the subjects and Specific Hematological analysis i.e. Activated Partial Thromboplastin Time (APTT), Fibrinogen Assay, Prothrombin Time (PT), D-Dimer Detection and Fibrin Degradation Products (FDPs).Results: PT was found to be comparable in patients with breast cancer when compared with controls. Difference between control group (II) and subjects with breast cancer (I) was non-significant, fibrinogen level was found to be significantly increased (p < 0.01) in patients with different stages of breast cancer when compared with controls. FDPs were found to be significantly increased (p< 0.01) in patients of breast cancer when compared with control group. These increased levels of FDPs may be due to enhanced fibrinolysis. D-Dimers were also found to be significantly increased (p < 0.01) in patients with breast cancer when compared with controls.Conclusion: Patients with breast cancer were associated with compensated DIC state including normal PT and APTT level but increased fibrinogen and platelets count as compared to the controls. Detection of D-Dimers offers a differential analysis over other laboratory tests for DIC

Household and personal air pollution exposure measurements from 120 communities in eight countries: Results from the PURE-AIR study

Background: Approximately 2·8 billion people are exposed to household air pollution from cooking with polluting fuels. Few monitoring studies have systematically measured health-damaging air pollutant (ie, fine particulate matter [PM2·5] and black carbon) concentrations from a wide range of cooking fuels across diverse populations. This multinational study aimed to assess the magnitude of kitchen concentrations and personal exposures to PM2·5 and black carbon in rural communities with a wide range of cooking environments.Methods: As part of the Prospective Urban and Rural Epidemiological (PURE) cohort, the PURE-AIR study was done in 120 rural communities in eight countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Data were collected from 2541 households and from 998 individuals (442 men and 556 women). Gravimetric (or filter-based) 48 h kitchen and personal PM2·5 measurements were collected. Light absorbance (10-5m-1) of the PM2·5 filters, a proxy for black carbon concentrations, was calculated via an image-based reflectance method. Surveys of household characteristics and cooking patterns were collected before and after the 48 h monitoring period.Findings: Monitoring of household air pollution for the PURE-AIR study was done from June, 2017, to September, 2019. A mean PM2·5 kitchen concentration gradient emerged across primary cooking fuels: gas (45 μg/m3 [95% CI 43-48]), electricity (53 μg/m3 [47-60]), coal (68 μg/m3 [61-77]), charcoal (92 μg/m3 [58-146]), agricultural or crop waste (106 μg/m3 [91-125]), wood (109 μg/m3 [102-118]), animal dung (224 μg/m3 [197-254]), and shrubs or grass (276 μg/m3 [223-342]). Among households cooking primarily with wood, average PM2·5 concentrations varied ten-fold (range: 40-380 μg/m3). Fuel stacking was prevalent (981 [39%] of 2541 households); using wood as a primary cooking fuel with clean secondary cooking fuels (eg, gas) was associated with 50% lower PM2·5 and black carbon concentrations than using only wood as a primary cooking fuel. Similar average PM2·5 personal exposures between women (67 μg/m3 [95% CI 62-72]) and men (62 [58-67]) were observed. Nearly equivalent average personal exposure to kitchen exposure ratios were observed for PM2·5 (0·79 [95% 0·71-0·88] for men and 0·82 [0·74-0·91] for women) and black carbon (0·64 [0·45-0·92] for men and 0·68 [0·46-1·02] for women).Interpretation: Using clean primary fuels substantially lowers kitchen PM2·5 concentrations. Importantly, average kitchen and personal PM2·5 measurements for all primary fuel types exceeded WHO\u27s Interim Target-1 (35 μg/m3 annual average), highlighting the need for comprehensive pollution mitigation strategies.Funding: Canadian Institutes for Health Research, National Institutes of Health