Laparoscopic Cholecystectomy in Cirrhotic Patients

Laparoscopic cholecystectomy can be an effective and safe treatment for symptomatic gallbladder disease in select patients with Child-Pugh A and B cirrhosis

Cultural practices of rearing preterm infants: A qualitative study in a tertiary care hospital, Karachi, Pakistan

The research work explores the cultural practices of feeding and hygiene of preterm infants in the Pakistani context. A Qualitative descriptive-exploratory design has been used. Purposive sampling was utilized to recruit 17 mothers, who met inclusion criteria from a largest government tertiary care hospital in Karachi, Pakistan. The semi-structured interview was used to collect the data, which lasted for approximately 45-60 minutes. Thematic analysis was conducted to analyze the key findings of the study. Welcoming newborn with \u27honey\u27 and herbal remedies were reported as a common ritual among mothers. Findings revealed differences in the time period of initial bath given to the preterm, ranges from 3 days to 1 month. These custom variations of rearing preterm have its own meaning in the prescribed culture; however, these customs are the insights to explore more on its effects on infants\u27 health. This study provides useful insights into several practices of cultures, which serve as the determinants of infants\u27 nutrition and health status. It provides an insight to the health care professionals to provide quality care to preterm infants

Pathologies associated with impacted maxillary canine tooth in patients presenting at a tertiary care hospital

Background: The pathologies associated with impacted maxillary canine tooth presented as radiolucent, radiopaque and mixed radiolucent radiopaque lesions on radiographs and adenomatoid odontogenic tumor was the most common pathology associated with it followed by dentigerous cyst, odontoma and calcifying odontogenic cyst after histopathological confirmation. This study was planned to determine the frequency of pathologies associated with impacted maxillary canine tooth in patients presenting at a tertiary care hospital.Methods: This cross-sectional survey was conducted at Dental / Oral Surgery Department, Shaikh Zayed Medical College / Hospital, Rahim Yar Khan, Pakistan from January to December 2017. A total of 60 patients with clinical and radiographic diagnosis of impacted maxillary canine tooth were enrolled. Orthopantomogram and/or para nasal sinus view were considered as the standard radiograph for assessment of pathologies associated with impacted maxillary canine tooth which were confirmed by histopathological examination. Demographics and radiographic findings and histopathological confirmation of pathologies were noted.Results: Out of a total of 60 patients, 38 (63.33%) pathologies associated with impacted maxillary canine presented as radiolucent lesion, 11 (18.33%) each presented as radiopaque and mixed radiolucent radiopaque lesion. Adenomatoid odontogenic tumor (30%) was the most common pathology associated with impacted maxillary canine tooth. The other pathologies associated were dentigerous cyst (26.67%), odontoma (18.33%), calcifying odontogenic cyst (11.66%), calcifying odontogenic cyst with an odonotoma (6.66%), Odontogenic keratocyst (3.33%) and Ameloblastoma (3.33%).Conclusions: The most common pathology occurring predominantly with impacted maxillary canine tooth was adenomatoid odontogenic tumor followed by dentigerous cyst, odontoma and calcifying odontogenic cyst

The relationship between Prenatal Stress, Depression, Cortisol and Preterm Birth: A review

Preterm birth is one of the most common adverse pregnancy outcomes. Maternal risk factors such as stress and depression have been associated with preterm birth. Preterm infants are at a higher risk of poor growth and neuro developmental outcomes. The objective of this paper is to examine the relationship between maternal stress, depression, cortisol level, and preterm birth. Preterm birth is one of the most common adverse pregnancy outcomes with a global prevalence of 9.6% and one of the major contributors to infant mortality and morbidity. The association between psychosocial stress and preterm birth, although examined for more than 25 years, has not yet been fully established. A systemic review was conducted in which research studies and review articles from 1970 to 2012, published in English, focusing on human subjects, and addressing the relationship between stress, depression, cortisol and preterm birth were included in this review. The studies examining the relationship between stress, cortisol levels and preterm birth have shown inconsistent findings that may be explained by varied study designs, differences in defining and measuring stress, timing of stress measurement, sample characteristics, and study designs. The relationship between stress, cortisol levels and preterm birth may be multifactorial and complex with premature birth being the final common pathway. A longitudinal cohort study, with a large sample size and multiple measures of stress, depression, and cortisol level, as well as a measure of anxiety and other stress hormone biomarkers may add new knowledge and enhance our understanding about the contribution of psychosocial stress to preterm birth

Experience of devolution in district health system of Pakistan: Perspectives regarding needed reforms

Objective: To identify the strengths and weaknesses of the devolved district health system from the experiences of different stakeholders, and recommend direction for reforms in the existing system.Methods: Using qualitative exploratory design, the study was conducted in 3 cities of the province of Sindh in Pakistan--Karachi, Khairpur and Larkana--from January to March 2010. Nine in-depth interviews were conducted with multiple stakeholders (District Coordination Officer, Executive District Officer, Medical Superintendent, Medical officers, Health system experts) of the district health system. Interviews included questions on autonomy in decision-making at the district level and the effectiveness of the devolved health system. Data transcripts were made from the recorded tapes and notes taken during the interviews. Thematic analysis was done and the data was classified into 3 broad themes of governance, financing and factors related to resources and service delivery.Results: The main strengths identified included formation of District Health Management Team for wider inter-sectoral collaboration, creation of new posts at sub-district level for close monitoring and supervision, and greater financial autonomy to prioritise according to needs. The reported weaknesses included lack of team work, limited autonomy, lack of capacity, nepotism and poor accountability.Conclusion: While devolution has been scrapped in most parts of the country, the findings of the study provide recommendations for the delegation of further powers at sub-district and union council level, enhanced capacity and increased transparency and accountability to make the system work

Comparison of Outcome of one Versus two Drains Insertion for Seroma Formation Following Modified Radical Mastectomy in Breast Carcinoma

Objective: Comparative outcome of one versus two drains insertion for in the term of seroma formation following modified radical mastectomy in breast carcinoma. Methodology: This Prospective Interventional trial was conducted at Department of General Surgery, Liaquat University Hospital Hyderabad from February 2018 to January 2019.  Females with breast carcinoma admitted for modified radical mastectomy were included. Patients were divided into two groups.  Groups I underwent one drain placement and group II underwent two drains placement. All patients were observed to measure and record the volume of the fluid. Patients were discharged from Hospital in stable condition and after removal of drains, and followed up weekly for one month. Data was recorded on self-made proforma and analyzed by using SPSS-20. Results: Total of 80 patients were selected, 38 in group A and 42 in group B. Mean age of patients of group A was 49.08 ± 9.89 years and group B was 51.40 ± 13.59 years. , Excised Mass weight was lesser in group A as compared to group B. Mean volume of drain discharge was significantly higher in Group B 323.43 ± 158.88 ml, while it was in group A 230.29± 200.98, findings were statistically significant 0.013. Seroma formation was statistically insignificant among both groups as 8(21.1%) in group A and   10(23.8%) in group B, p-value 0.768. Conclusion: One-drain and two-drain insertion are equally effective to reduce the seroma formation after modified radical mastectomy; however, one drain insertion leads to more patient compliance and comfort with probably less morbidity and cost

Etiologies of zygomatic bone fracture at a tertiary care hospital of South Punjab, Pakistan

Background: Fracture of the zygomatic bone is a frequent maxillofacial trauma, due to its distinction which influences it to bear the brunt of facial trauma but its pattern seems to vary geographically. This study was planned to find out etiologies of zygomatic bone fracture at a tertiary care hospital of South Punjab, Pakistan.Methods: This descriptive observational study was conducted at The Department of Oral and Dental Surgery, Shaikh zayed Medical College Hospital Rahim Yar Khan, Pakistan, from July December 2017. A total of 114 patients with isolated tripod zygomatic bone fracture were enrolled. Demographic characteristics of the patients along with etiologies of zygomatic bone fracture were recorded.Results: Out of a total of 114 patients having zygomatic bone fractures, there were 85 (74.6%) male. Majority of the patients, 58 (50.9%) were aged between 21 to 30 years, 78 (68.4%) belonged to rural areas, 42 (36.8%) laborers while socio-economic class of 66 (57.9%) patients was recorded to be middle income. Road traffic accidents were the commonest, seen among 48 (42.1%) patients followed by inter-personal violence and falls, noted among 26 (22.8%) and 17 (14.9%) patients respectively.Conclusions: Zygomatic bone fractures were most commonly seen among male gender and young age groups. Road traffic accidents and inter-personal violence were the most commonly noted etiologies in the present study

Endogenous, very small embryonic-like stem cells: Critical review, therapeutic potential and a look ahead

© The Author 2016. BACKGROUND: Both pluripotent very small embryonic-like stem cells (VSELs) and induced pluripotent stem (iPS) cells were reported in 2006. In 2012, a Nobel Prize was awarded for iPS technology whereas even today the very existence of VSELs is not well accepted. The underlying reason is that VSELs exist in low numbers, remain dormant under homeostatic conditions, are very small in size and do not pellet down at 250-280g. The VSELs maintain life-long tissue homeostasis, serve as a backup pool for adult stem cells and are mobilized under stress conditions. An imbalance in VSELs function (uncontrolled proliferation) may result in cancer. SEARCH METHODS: The electronic database \u27Medline/Pubmed\u27 was systematically searched with the subject heading term \u27very small embryonic-like stem cells\u27. OBJECTIVE AND RATIONALE: The most primitive stem cells that undergo asymmetric cell divisions to self-renew and give rise to progenitors still remain elusive in the hematopoietic system and testes, while the presence of stem cells in ovary is still being debated. We propose to review the available literature on VSELs, the methods of their isolation and characterization, their ontogeny, how they compare with embryonic stem (ES) cells, primordial germ cells (PGCs) and iPS cells, and their role in maintaining tissue homeostasis. The review includes a look ahead on how VSELs will result in paradigm shifts in basic reproductive biology. OUTCOMES: Adult tissue-specific stem cells including hematopoietic, spermatogonial, ovarian and mesenchymal stem cells have good proliferation potential and are indeed committed progenitors (with cytoplasmic OCT-4), which arise by asymmetric cell divisions of pluripotent VSELs (with nuclear OCT-4). VSELs are the most primitive stem cells and postulated to be an overlapping population with the PGCs. Rather than migrating only to the gonads, PGCs migrate and survive in various adult body organs throughout life as VSELs. VSELs express both pluripotent and PGC-specific markers and are epigenetically and developmentally more mature compared with ES cells obtained from the inner cell mass of a blastocyst-stage embryo. As a result, VSELs readily differentiate into three embryonic germ layers and spontaneously give rise to both sperm and oocytes in vitro. Like PGCs, VSELs do not divide readily in culture, nor produce teratoma or integrate in the developing embryo. But this property of being relatively quiescent allows endogenous VSELs to survive various kinds of toxic insults. VSELs that survive oncotherapy can be targeted to induce endogenous regeneration of non-functional gonads. Transplanting healthy niche (mesenchymal) cells have resulted in improved gonadal function and live births. WIDER IMPLICATIONS: Being quiescent, VSELs possibly do not accumulate genomic (nuclear or mitochondrial) mutations and thus may be ideal endogenous, pluripotent stem cell candidates for regenerative and reproductive medicine. The presence of VSELs in adult gonads and the fact that they survive oncotherapy may obviate the need to bank gonadal tissue for fertility preservation prior to oncotherapy. VSELs and their ability to undergo spermatogenesis/neo-oogenesis in the presence of a healthy niche will help identify newer strategies toward fertility restoration in cancer survivors, delaying menopause and also enabling aged mothers to have better quality eggs