Clinical outcomes of surgically corrected atrial septal defects

Objective: To examine the outcomes of surgical repair of atrial septal defects in paediatric and adult patients. Methods: The retrospective study comprised data of 84 patients who had undergone surgical correction of atrial septal defect at the Aga Khan University Hospital, Karachi, between June 2006 and December 2011. All patients with isolated atrial septal defect (ostium secundum, ostium primum and sinus venosus with or without partial anomalous pulmonary venous connection) were included. Clinical and transthoracic echocardiographic data was reviewed. SPSS 17 was used for statistical analysis. Results: There were no deaths in the study population. The mean time for follow-up was 6.5±9.9 months. Most of the patients (n=80; 95.2%) were in New York Heart Association class I at follow-up, while the remaining 4(4.8%) were in New York Heart Association class II. Post-operatively, 8 (9.5%) patients developed brief episodes of arrhythmias. There were 3 (3.57%) patients who were re-admitted within 30 days; 2 (66.7%) had superficial wound infection, while 1 (33.3%) had to be re-opened because of cardiac tamponade. Conclusion: Surgical repair of atrial septal defects is a safe procedure which is associated with excellent results and low morbidity

ASSOCIATION OF POSITIVE FAMILY HISTORY WITH BREAST CANCER IN YOUNG FEMALES WITH BREAST LUMPS.

Background; Breast cancer is most frequently diagnosed cancer in females. It has a major impact on health of women. According to a World Health Organization [WHO] estimate, more than 1.2 million people are diagnosed with breast cancer worldwide every year. This study was conducted to determine the frequency of breast cancer in patients presenting with breast lumps in our population. OBJECTIVE; To determine frequency of breast cancer among young females presenting with breast lumps at a tertiary care hospital. Material and Methods; Consecutive 160 young ladies presenting with breast lumps were taken.  Young females with breast lumps were taken and diagnosed for breast cancer. All the data was entered and analyzed using SPSS-20. Results; Of these 160 study cases, 98 (61.2 %) were un-married female patients while 62 (38.8 %) were married female patients. Mean age of our study cases was 23.23 ± 3.85 years (with minimum age of our study cases was 18 years while maximum age was 32 years). Our study results have indicated that majority of our study cases i.e. 123 (76.9 %) were aged up to 25 years. Mean body mass index of our study cases was 26.23 ± 1.92 kg/m2 and obesity was present in 48 (30.0 %). Mean disease duration was 2.98 ± 2.54 months and 111 (69.4%) had duration of illness up to 3 months. Breast cancer was noted in 40 (25.0%) of our study cases. Conclusion; High frequency of breast cancer was noted in our study among young females presenting with breast lumps. Breast cancer was significantly associated with marital status, increasing age, residential status, socioeconomic status and family history of breast cancer. These findings suggest that females at every age group with breast lumps need specialized care for diagnosis and management. Keywords; Breast Cancer, Breast Lumps, Young Females. DOI: 10.7176/JMPB/54-18 Publication date: April 30th 201

Frequency of puerperal infection with meconium stained amniotic fluid.

Objective: To determine the association of meconium stained amniotic fluid with puerperal infection. Material, place and method: A Cohort Study was conducted from 1stjanuary 2018 to 30th June 2018 in department of obstetrics & gynecology, Nishtar hospital, Multan. A total of 66 women with singleton pregnancy, gestational age 37-41 weeks of any parity undergoing elective caesarean section were eligible in study. Patients with rupture of membranes for more than 6 hours on history, diabetic patients, preterm delivery and post term delivery were excluded. During elective caesarean section, after rupture of membranes women were divided in two equal groups. 33 (50%) patients with meconium stained liquor in exposed group and 33 patients (50%) with clear liquor in un-exposed group were divided. Puerperal infection was noted when temperature of 38°C and higher on any two of first ten days postpartum excluding of first 24 hours. The data was analyzed using statistical analysis program to compare proportions between these two groups. Frequency, percentage and mean ±SD were presented for variables. Chi-square test was applied to compare puerperal infection in both groups taken p ≤0.05 as significant. Results: Age range in this study was from 18 to 35 years with mean age of 28.000± 2.27 years in Exposed Group while 26.212± 3.06 years in Unexposed Group. Mean gestational age was 38.848±1.12 weeks in exposed group while 39.060±1.11 weeks in unexposed group. Puerperal infection was seen in 63.64% patients in exposed Group as compare to 12.1% in unexposed Group (p=0.005). Conclusion: Recognition of the increased risk of infection in women with meconium stained fluid improves the perinatal outcome. Keywords: Meconium stained amniotic fluid, Puerperal infection, Association, cohort study. DOI: 10.7176/JMPB/54-17 Publication date: April 30th 201

Tetralogy of Fallot with absent pulmonary valve syndrome; appropriate surgical strategies

Abstract OBJECTIVE: To evaluate patients presenting with Tetralogy of Fallot with absent pulmonary valve syndrome to a tertiary care hospital and their surgical management. METHODS: The retrospective study was conducted at Congenital Cardiac Services, Aga Khan University Hospital, Karachi, Pakistan, and comprised data of Tetralogy of Fallot patients between April 2007 and June 2012. Data was analysed together with follow-up echocardiography. Variables assessed included demographics, imaging, operative technique, complications, post-operative recovery and follow-up echocardiography. SPSS 17 was used for statistical analysis. RESULTS: Of the 204 patients, 6 (3%) had undergone surgical correction for Tetralogy of Fallot with absent pulmonary valve syndrome. All 6(100%) patients underwent complete repair. Median age for surgery was 8.5 years (range: 0.5-29 years). Of the different surgical strategies used, Contegra and Bioprosthetic valve placement had satisfactory outcome with minimal gradient at Right Ventricular Outflow Tract, good ventricular function and mild valvular regurgitation. One (16.6%) patient with Trans Annular Patch developed post-operative Right Ventricle Outflow Tract gradient of 80mmHg with moderate pulmonary regurgitation. One (16.6%) patient with monocusp valve developed free pulmonary regurgitation at 6 months. The other 4(66.6%) patients are currently free from any complications or re-intervention. CONCLUSIONS: Early surgery is preferred in symptomatic patients. The repair depends upon achieving integrity of pulmonary circulation which is best achieved by using right ventricle to pulmonary artery conduit or inserting a pulmonary valve

From tradition to simulation: An experience of team training on management of shoulder dystocia

Objective: To determine if simulation-based team training improves the management of shoulder dystocia compared to traditionally taught obstetrical emergencies. Methods: The prospective mixed-method study was conducted at the Centre for Innovation in Medical Education at the Aga Khan University, Karachi, from June to August 2018, and comprised doctors and nurses having up to five years of labour and delivery experience. The subjects were divided into two equal groups which were further subdivided into four equal teams. Group 1 was taught to manage shoulder dystocia using traditional lectures and hands-on pelvic models, while group 2 was trained in a simulated environment with a simulated scenario of shoulder dystocia. After two weeks, the performance of both teams were assessed and compared. Data was analysed using SPSS 19. A focus group discussion was subsequently conducted on the quality of the simulation experience.Results: Of the 32 subjects, 16(50%) each were doctors and nurses. They were divided into groups having 16(50%) members each, and each group had 4 teams having 4(25%) subjects. The overall mean age of the sample was 31.9±2.8 years (range: 28-38 years). The mean score for performance on technical and communication task of group 2 was 10.25±1.258 compared to 5.7±2.500 in group 1 (p=0.028). Focus group participants agreed that training in a simulated environment was far superior than being traditionally taught.Conclusions: Simulation-based team training in shoulder dystocia management was associated with better feedback than traditional-style teaching

First steps towards a landslide inventory map of the Central Karakoram National Park

The northeastern part of Pakistan is known to be a region of extremes, where the highest reliefs and the longest glaciers of the world may be found. In this environment, through the multidisciplinary Social, Economic and Environmental Development (SEED) Project the knowledge of the sustainable exploitation possibilities of the Central Karakoram National Park area (CKNP) will be improved. One of this project's objectives is the analysis of the geological hazards giving as output a landslide inventory and a susceptibility map, utilizable as functional tools for a future sustainable territorial planning. The Bagrot Valley, chosen as test site, was partially field surveyed and part of the landslide-prone areas preliminarily identified through DEM analysis, GIS techniques and Analytical Hierarchy Process (AHP) methodology, were later validated on the field. ASTER DEM was used as the basis of morphometric analysis

Characters Association Analysis in Safflower (Carthamus tinctorius L.)

Twenty genotypes of safflower was evaluated to study the genotypic and phenotypic correlation coefficients and path effects of yield related traits on grain yield during rabi cropping season 2011-12 at Barani Agricultural Research Institute, Chakwal, Pakistan. Grain yield (kg/ha) correlated significantly and positively with plant height, boll diameter, number of grains per boll, 1000 grain weight and days to maturity. Thus these characters are the key yield contributing attributes to be given selection pressure for improving yield. The result of path analysis showed highest and positive direct effect of number of grains per boll followed by 1000 grain weight and plant height on grain yield (kg/ha). Key words: Genotypic correlations, phenotypic correlation, path analysis, safflowe

Contegra valved conduit in the paediatric population: an exciting prospect for right ventricle to pulmonary artery reconstruction; experience and outcomes at Aga Khan University

Objective: The focus of this study is to share the experience and outcomes of Contegra graft implantation in the paediatric and adult population in Pakistan. Methods: Between May 2007 and July 2011, 16 patients, underwent implantation of a Contegra valved conduit. All operations were performed through a median sternotomy with cardiopulmonary bypass. Indications included: Pulmonary atresia with ventricular septal defect (n=11), Tetralogy of Fallot with absent Pulmonary Valve (PV) syndrome (n=2), double outlet right ventricle, transposition of great arteries and pulmonary stenosis (n=1), isolated aortic valve disease (n=1) and a pseudo-aneurysm with infective endocarditis (n=1).Conduit sizes varied between 16-22 mm. Results: The three in hospital deaths were unrelated to the Contegra valved conduit. One patient was lost to follow up. Of the 12 survivors, 10 are currently free from re-operation or complications related to the conduit while one needed distal pulmonary artery dilatation owing to critical stenosis and another had severe Valvular regurgitation. Echocardiographic evaluation of the Contegra valved conduit demonstrated no haemodynamically significant valve regurgitation in 10 patients. Conclusion: In this small review of 16 operations using the Contegra valved conduit for Right Venticular Outflow Tract (RVOT) reconstruction in the paediatric population, we observed good post operative results concerning conduit function. The Contegra conduit provides an excellent substitute to the homograft with satisfactory early and mid-term results though long term results are awaited in Pakista

Study of anti-diabetic, beta-carotene-bleaching inhibiting and iron chelating properties of Carissa opaca root extracts

Degenerative diseases diabetes and oxidative stress constitute a major health concern worldwide. Medicinal plants are expected to provide effective and affordable remedies. The present research explored antidiabetic and antioxidant potential of extracts of Carissa opaca roots. Methanolic extract (ME) was prepared through maceration. Its fractions were obtained, sequentially, in hexane, chloroform, ethyl acetate and n-butanol. An aqueous decoction (AD) of the finely ground roots was obtained by boiling in distilled water. The leftover biomass with methanol was boiled in water to obtain biomass aqueous decoction (BAD). The extracts and fractions showed considerable porcine pancreatic α-amylase inhibitory activity with IC50 in the range of 5.38-7.12 mg/mL while acarbose had 0.31 mg/mL. The iron chelating activity in terms of EC50 was 0.2939, 0.3429, 0.1876, and 0.1099 mg/mL for AD, BAD, ME, and EDTA, respectively. The EC50 of beta-carotene bleaching activity for AD, BAD, ME, and standard BHA were 4.10, 4.71, 3.48, and 2.79 mg/mL, respectively. The total phenolic content (TPC) and total flavonoid content (TFC) of AD and BAD were also considerable. In general, ethyl acetate fraction proved to be the most potent. Thus, the C. opaca roots had excellent antioxidant activity while having moderate α-amylase inhibitory potential