Prevalence Of Peptic Ulcer In Patients Of Liver Cirrhosis Presenting With Upper Gi Bleed

BACKGROUND:  Although major cause of upper GI bleed in patients of liver cirrhosis is variceal bleed. However a significant proportion also presents with non-variceal bleeding (NVB). AIM: The aim of study is to determine the frequency of peptic ulcers in patients of liver cirrhosis presenting with upper GI bleed. METHODS: This descriptive cross sectional study was conducted in Gastroenterology section of medicine department at Benazir Bhutto Hospital from April 2017 to December 2018 . 672 patients of liver cirrhosis presenting with upper GI bleed were enrolled in study through non probability consecutive sampling. Upper GI endoscopy of all patients was performed by consultant Gastroenterologist and findings were documented on standardized Performa. RESULTS: 672 patients were included in study with mean age of 54.68 ±11.15. Among these 370 (55.1%) were males and 302 (44.9%) were females. 92 patients (13.1%) had peptic ulcer as cause of upper GI bleed. 112 patients (16.6%) had both peptic ulcer and variceal bleed as cause of Upper GI Bleed and endoscopic findings of remaining 468 patients (69.6 %) showed varices (oesophageal + gastric) as prime source of bleeding. CONCLUSIONS: In this study, peptic ulcer accounted for 13.1 % of all cases of UGI bleeding. Keywords: Peptic Ulcer, Variceal bleeding, Upper GI bleed, Cirrhosis

Bronchogenic Cyst in a 13 month Old Child

Background Persistent cough ,stridor and respiratory distress are most common symptoms encountered by paediatrician in their daily practices.Although bronchogenic cyst is rare cause of persistent cough but should always be kept in differential diagnosis of respiratory sypmptoms nonresponding to antibiotics and bronchodilators. Case presentation 13 month old baby had history of frequent visits at hospital and treated as case of pneumonia and hyperreactive airway disease.Chest X-ray revealed cystic mass in mediastinum with CT chest confirmed bronchogenic cyst for which patient underwent surgical excision.Histopathology report revealed bronchogenic cyst .After surgical excision patient got stable with stridor got settled. Conclusion Case is being reported to create awareness related to bronchogenic cyst as cause of persistent cough and respiratory distres

Bronchogenic Cyst in a 13 month Old Child

Background Persistent cough ,stridor and respiratory distress are most common symptoms encountered by paediatrician in their daily practices.Although bronchogenic cyst is rare cause of persistent cough but should always be kept in differential diagnosis of respiratory sypmptoms nonresponding to antibiotics and bronchodilators. Case presentation 13 month old baby had history of frequent visits at hospital and treated as case of pneumonia and hyperreactive airway disease.Chest X-ray revealed cystic mass in mediastinum with CT chest confirmed bronchogenic cyst for which patient underwent surgical excision.Histopathology report revealed bronchogenic cyst .After surgical excision patient got stable with stridor got settled. Conclusion Case is being reported to create awareness related to bronchogenic cyst as cause of persistent cough and respiratory distres

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Comparing efficacy of Rifaximin plus Lactulose vs. Lactulose alone in treating Hepatic Encephalopathy

Background: Hepatic Encephalopathy is a syndrome observed in patients with liver cirrhosis. Various treatment modalities are in use for treatment of Porto Systemic Encephalopathy (PSE). Our study aimed to compare the efficacy of Rifaximin plus Lactulose vs.Lactulose alone in treating Hepatic Encephalopathy in local population. Materials & Methods: The study was conducted at a tertiary care hospital recruiting decompensated chronic liver disease(DCLD) patients with PSE. Using simple random sampling, patients were divided in two groups (A & B). Patients in group A received Lactulose plus Rifaximin while group B received Lactulose alone. Efficacy of treatment was assessed as return of the conscious level to pre-encephalopathy state as per clinical examination within 1 week after  start of the treatment. Results: A total of 124 patients were included in the study with each group (A & B) containing 62 patients. Frequency and percentage of efficacy among group A (Rifaximin plus Lactulose) verses group B (Lactulose alone) in treating Hepatic encephalopathy was 45 (72.6%) and 32 (51.6%) respectively. Conclusion: The study concluded that there is a significant difference in proportions of patients showing complete recovery from Hepatic encephalopathy treated with Lactulose plus Rifaximin as compared to Lactulose alone

Candida-Candida and Candida-Staphylococcus species interactions in in-vitro dual-species biofilms

Objective: In present study, interaction between different Candida species and also their interaction with Staphylococcus species were investigated in mono and dual-species biofilm model. Methods: Resistant and weak biofilms former Candida(C. albicans, C. glabrata, C. krusi) and Staphylococcus species (S. aureus, S. epidermidis, S. saprophyticus) alongwith ATCC isolates were used in mono and different dual-species combinations for estimation of biofilms by crystal violet (CV) biofilm biomass assay and XTT reduction assay. Aspartyl proteinase activity of Candida species was also measured in these developed biofilms. Results: CV assay showed increased in biofilm biomass after 48 h of incubation in developed mono and dual-species biofilms. XTT reduction assay showed overall decreasing trend in metabolic rate in biofilms after 48 h of incubation. All three Candida species with each other in dual-species in-vitro biofilms showed antagonistic behaviour. Biofilm biomass production was raised for C. albicans and C. glabrata dual-specie biofilm with allStaphylococcus species except with clinical isolate of S. aureus and in C. glabrata-S. epidermidis dual-specie biofilm. ATCC and clinical isolate of Candida showed markedly decrease aspartyle proteinase activity when co-cultured withStaphylococcuscompared to when it was cultured alone.&nbsp

Bayesian Analysis and Reliability Estimation of Generalized Probability Distributions

This edited volume entitled “Bayesian Estimation and Reliability Estimation of Generalized Probability Distributions” is being published for the benefit of researchers and academicians. It contains ten different chapters covering a wide range of topics both in applied mathematics and statistics. The proofs of various theorems and examples have been given with minute details. During the preparation of the manuscript of this book, the editor has incorporated the fruitful academic suggestions provided by Dr. Peer Bilal Ahmad, Dr. Sheikh Parvaiz Ahmad, Dr. J. A. Reshi, Dr. Tanveer Ahmad Tarray, Dr. Kowsar Fatima, Dr. Ahmadur Rahman, Dr. Showkat Ahmad Lone, Mudasir Sofi, Uzma Jan, Aaliya Syed, and Dr. Humaira Sultan. It is expected to have good popularity due to its usefulness among its readers and users