Intussusceptions in adults: Clinical features and operative procedures

Objective: To determine the clinical presentation and treatment outcomes of adult patients with intussusceptions. Study Design: Case series. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 1988 to December 2008. Methodology: Medical records of patients with diagnosis of intussusceptions in adults (above 15 years of age) from January 1988 to December 2008 were retrieved through ICD 9 coding system. Patients with complete records were included in the study and those with incomplete medical record or under 30 days follow-up were excluded. Data was analyzed on SPSS version 16. The treatment outcomes were hospital stay, 30 days-morbidity, mortality and recurrence of intussusceptions during follow-up period. Results: The mean age of the 19 patients was 37 years with male predominance. Most patients presented with acute bowel obstruction. In 14 patients, small bowel were involved. CT scan diagnosed intussusception in 10 out of 12 patients. Benign lead point were found in 80% cases. Eighteen patients were treated surgically. Fourteen (70%) patients underwent resection with primary anastomosis while in 4 patients only reduction was done. In resection group, 11 patients had resection after reduction and in 3 patients only resection was done. There was no recurrence in resection group. One recurrence was noticed in the reduction group and one patient died of advanced gastrointestinal malignancy in the nonoperative group. Conclusion: Intussusception is a rare cause of acute intestinal obstruction in adult population. CT scan is a promising diagnostic tool to establish pre-operative diagnosis. Early surgical resection could achieve optimal outcome. Small bowel intussusception could be reduced before resection if there is no doubt about bowel viability. In most of the patients the lead point could be benign disease

Non-traumatic right hepatic artery pseudoaneurysm: An unusual cause of hemobilia and obstructive jaundice

Most hepatic artery pseudoaneurysms (HAPA) are post traumatic, and non-traumatic pseudoaneurysm is rarely reported. It is a potentially life threatening vascular disorder and difficult to diagnose before rupture. Early diagnosis and prompt nonoperative intervention of this lesion could be life saving. The authors report the case of a patient with hemobilia caused by ruptured right hepatic artery pseudoaneurysm and subsequently developed right hepatic duct stricture, which has not been reported previously. This patient was successfully treated with endovascular stent graft of pseudoaneurysm and endoscopic stenting of right hepatic duct stricture

Mealtime difficulty in older people with dementia

Aim: To evaluate the evidence published in systematic reviews on the effectiveness of interventions aimed at alleviating mealtime difficulties in older people with dementia. Background: Older people with dementia gradually lose their self-care abilities as the condition of dementia progresses and this includes the ability to eat independently. There is a large body of research into this phenomenon, including into the effectiveness of interventions to alleviate the problems which arise. Recently there have also been several systematic reviews with different conclusions about the effectiveness of these interventions

Rectal carcinoma under 40 years of age: seven-year post-treatment follow-up at a tertiary care hospital in Pakistan

Objectives: To determine epidemiological characteristics, clinical presentation, histopathological features, and long-term follow-up of patients below 40 years of age with carcinoma rectum.Methods: The retrospective case series comprised all patients presenting with histopathological diagnosis of carcinoma rectum with age 15-40 years at the Aga Khan University Hospital between January 1994 and December 2004. Details regarding patient demographics, pre-operative assessment, management and tumour grade and stage were obtained from a prospectively maintained database. Continuous and categorical variables in the data were analysed.Results: Of the 23 patients in the study, 14 (60.89%) were male and 9 (39.13%) were female. Mean age of the subjects was 31+/- 5 years. Overall, 22 (95.6%) patients presented with rectal bleeding and 12 (52%) had altered bowel habit. The most common site for the tumour was lower rectum (n=20; 87%) and 13 (56.5%) required abdominoperineal resection. Local recurrence rate was 13% (n=3) and distant metastasis occurred in 2 (8.6%) patients during the seven year follow-up. Two (8.6%) patients died, and both had distant metastasis.CONCLUSION: Carcinoma rectum is uncommon but an important malignancy in patients aged below 40 years. The clinician should have a high index of suspicion in young patients presenting with bleeding per rectum, altered bowel habit and weight-loss

Renewable energy governance in India: challenges and prospects for achieving the 2022 energy goals

India has set colossal renewable energy (RE) targets (achieving 175GW of renewable energy capacity by 2022) which need a clear strategy roadmap, integrated planning and a whole-of-system approach. However, the loopholes in institutional mechanisms are bound to hinder the process of policy formulation and implementation for the aspired quantum leap. This paper is an attempt to observe governance of renewable energy in India while exploring the issues and challenges that have been stalling the process of clean energy uptake. The paper finds that despite the comprehensive policy and regulatory frameworks, the large disconnect between the central policies and regional needs has created barriers for deployment of renewable technologies. The paper emphasizes the provision for clean energy financial support to be made available to the states for addressing the disparities between RE potential and the development cost, and planning for better grid management systems. The RE targets also demand an intensive capital market development and innovative financial support mechanisms and products. While aligning itself with the clean energy goals, India needs to focus significantly on the energy needs of the rural population which has been grappling with electricity cuts and brownouts. For regions with limited or no electricity supply, the government should aggressively promote the ideas of off-grid solar power and micro grids. The paper also recommends the possibilities for private sector investments, rural entrepreneurship and public- private ventures for filling in the gaps, and thus harnessing the potential of RE-rich states

Religiosity and Addiction Among Medical Students

The present study was aimed at exploring the relationship between the role of religiosity and drug addiction among medical students. In the present study the drug addicted medical students were compared to non-addicts on measures of adolescent alcohol and drug use and demographic information. Participants of the study consisted of two hundred (N=200) male and female students with the age range of 18-29, including one hundred addicts (n=100) and one hundred (n=100) non addict medical students. Convenient sampling and snowball technique was used for collecting the data from medical students of Khyber Pakhtunkhwa, Pakistan. Responses from the different medical students were analyzed. The finding of the research indicated that those students who offered their prayers on regular basis were less likely to be prone to drug addiction as compared to those who did not offer prayers regularly

Renewable energy governance in India: challenges and prospects for achieving the 2022 energy goals

India has set colossal renewable energy (RE) targets (achieving 175GW of renewable energy capacity by 2022) which need a clear strategy roadmap, integrated planning and a whole-of-system approach. However, the loopholes in institutional mechanisms are bound to hinder the process of policy formulation and implementation for the aspired quantum leap. This paper is an attempt to observe governance of renewable energy in India while exploring the issues and challenges that have been stalling the process of clean energy uptake. The paper finds that despite the comprehensive policy and regulatory frameworks, the large disconnect between the central policies and regional needs has created barriers for deployment of renewable technologies. The paper emphasizes the provision for clean energy financial support to be made available to the states for addressing the disparities between RE potential and the development cost, and planning for better grid management systems. The RE targets also demand an intensive capital market development and innovative financial support mechanisms and products. While aligning itself with the clean energy goals, India needs to focus significantly on the energy needs of the rural population which has been grappling with electricity cuts and brownouts. For regions with limited or no electricity supply, the government should aggressively promote the ideas of off-grid solar power and micro grids. The paper also recommends the possibilities for private sector investments, rural entrepreneurship and public- private ventures for filling in the gaps, and thus harnessing the potential of RE-rich states

Renewable energy governance in India: challenges and prospects for achieving the 2022 energy goals

India has set colossal renewable energy (RE) targets (achieving 175GW of renewable energy capacity by 2022) which need a clear strategy roadmap, integrated planning and a whole-of-system approach. However, the loopholes in institutional mechanisms are bound to hinder the process of policy formulation and implementation for the aspired quantum leap. This paper is an attempt to observe governance of renewable energy in India while exploring the issues and challenges that have been stalling the process of clean energy uptake. The paper finds that despite the comprehensive policy and regulatory frameworks, the large disconnect between the central policies and regional needs has created barriers for deployment of renewable technologies. The paper emphasizes the provision for clean energy financial support to be made available to the states for addressing the disparities between RE potential and the development cost, and planning for better grid management systems. The RE targets also demand an intensive capital market development and innovative financial support mechanisms and products. While aligning itself with the clean energy goals, India needs to focus significantly on the energy needs of the rural population which has been grappling with electricity cuts and brownouts. For regions with limited or no electricity supply, the government should aggressively promote the ideas of off-grid solar power and micro grids. The paper also recommends the possibilities for private sector investments, rural entrepreneurship and public- private ventures for filling in the gaps, and thus harnessing the potential of RE-rich states

Morbidity of colostomy reversal

Abstract OBJECTIVE: To determine morbidity after colostomy reversal at a tertiary care hospital. METHODS: The retrospective case series was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients aged 15 years or more who underwent colostomy reversal from January 2003 to December 2011. Data was collected regarding demographics, procedure dates, indication, as well as type and location of colostomy. Details of colostomy reversal, including pre-operative, intra-operative and post-operative variables were recorded. RESULTS: The mean age of the 96 patients was 40±16 years; 72(75%) of them being males. The most frequent indications for fashioning of colostomy were bowel perforation in 53 (55.2%) and malignancy in 9(9.3%) patients. Intra-operative complications occurred in 5(5.2%) with bowel perforation in 3(3.1%) and bleeding in 2(2%) patients. Overall, 40(41.6%) patients had post-operative local complications; the most common being wound infection in 19(19.8%) followed by incisional hernia 15(15.6%). Patients who experienced post-operative complications had significantly longer hospital stay compared to those without complications (9±2.8 vs. 7±2.4days; p=0.038). CONCLUSIONS: Colostomy reversal was associated with non-negligible morbidity. The most common complications were wound infection and incisional hernia

Seeing COVID-19 through a Health care professional’s eye

Background: The world is in a state of war. The health care professionals are the front line soldiers who are fighting this war against COVID-19. The modification in human behavior to a specific stimulus (say the Corona epidemic) is the single most important determinant of the fate of that stimulus.  On 26th February 2020, Pakistan reported its first corona positive cases. Till Mid-March, the number raised to a significantly critical level. As the outbreak was unexpected in Pakistan, the situation created chaos and panic among the public as well as among health care workers. The current study analyzed COVID-19 thorough a healthcare professional's eye. There has been no previous study according to the PubMed database. Using the keywords, "Coronavirus, Health care professionals, Pakistan, COVID-19", for any sort of previous cases reported or literature reported relating to coronavirus, our team could not find any article, case report or publication of any sort. So this study is the first from Pakistan Methods: In this cross-sectional study, a self-administrated online questionnaire was circulated through emails and social media to the whole country. The questionnaire comprised of assessing knowledge about the cause and symptoms of COVID-19. A total of 146 responses were scrutinized to include in the survey, in the time period of 1 week (March 23-30, 2020). The participants belonged to private and government institutions from all provinces of Pakistan. Results: The mean values of all items depicted that all health care professionals were well aware of the knowledge, symptoms and transmissibility of COVID-19. Conclusion:  The study concluded that the healthcare professionals were fully aware of the transmission of COVID-19 and its symptoms. However, it is recommended that the government should provide full support to health care professionals, who are at the front line. &nbsp