Outcome of Laproscopic Cholecystectomy in Acute Cholecystitis

Objective: To compare the outcome of early laparoscopic cholecystectomy in acute cholecytitis due to cholelithiasis as compared to interval cholecystectomy in terms of conversion rate, operative time and complications.Study design:  Descriptive studyPlace of study: Department of general surgery, Pakistan Atomic Energy Commission General Hospital, H-11/4 Islamabad.Duration of Study: January 2016 to June 2017.Methodology: Patients were divided into two groups. Group A had acute cholecystitis and were admitted through emergency room or surgical OPD and were operated in the same index admission on earliest possible list thus waiting time for surgery was one to four days approximately. While group B, had all elective cases, without any evidence of acute cholecystitis, mainly booked through OPD. All the patients included in both groups, were studied for initial diagnosis, duration of symptoms, duration of surgery, conversion to open cholecystectomy, per operative and post-operative complications and duration of hospital stay.Results: A total of 360 patients were operated in the hospital for cholelithiasis during the said period. Standard four ports were employed for the surgery. Group A (acute cholecystitis) had total 112 patients while group B (non-acute cholecystitis) had 248 patients. Of these 112 patients in group A, there were 77 males and 35 females.  In group B, there were 112 male and 248 female patients in group B. The mean operating time for group A was 64±13 min. whereas for group B the mean duration was 60± 12 min. The average amount of blood loss during surgery for group A was 45 ml ± 33 ml and for group B was 30ml + 20ml.Conclusion: Early laparoscopic Cholecystectomy, for acute cholecystitis is cost effective, has shorter total length of hospital stay and reduces the risk of repeat cholecystitis

Orbital aspergillus infection mimicking a tumour: A case report

A 14-year-old male presented to the neurosurgical clinic with swelling just above the right eye which had been growing slowly for the last eight years. The swelling first appeared following a non-penetrating trauma eight years ago. On examination it was a non-tender, non-erythematous, firm, round swelling causing marked proptosis and diplopia on downward gaze only. The visual acuity was intact. MRI showed an intraorbital, extraconal mass isointense on T1 and hypointense on T2 imaging. A diagnosis of orbital tumor was made. A white, friable mass consistent with meningioma was resected. However histopathology report later showed it to be an Aspergilloma. The Patient was successfully treated with anti-fungal medicine and was disease-free at one year follow-up

Orbital aspergillus infection mimicking a tumour: a case report

A 14-year-old male presented to the neurosurgical clinic with swelling just above the right eye which had been growing slowly for the last eight years. The swelling first appeared following a non-penetrating trauma eight years ago. On examination it was a non-tender, non-erythematous, firm, round swelling causing marked proptosis and diplopia on downward gaze only. The visual acuity was intact. MRI showed an intraorbital, extraconal mass isointense on T1 and hypointense on T2 imaging. A diagnosis of orbital tumor was made. A white, friable mass consistent with meningioma was resected. However histopathology report later showed it to be an Aspergilloma. The patient was successfully treated with anti-fungal medicine and was disease-free at one year follow-up

Comparison of chromogenic urinary tract infection medium with cysteine lactose electrolyte deficient media in a resource limited setting

OBJECTIVES: To compare the chromogenic UTI medium (CUM) with cysteine lactose electrolyte deficient medium (CLED) in terms of isolation of uropathogens, turnaround time and cost. METHODS: A total of 251 urine samples were selected and inoculated on both CLED and CUM, growth was observed after 24 and 48 hours of incubation. Isolates were identified by colony\u27s colour and biochemical tests. Turnaround time for identification and cost was calculated till final identification of microorganisms. RESULTS: A discrepancy in isolation was observed in seven samples with growth on CUM in 24 hours while in 48 hours on CLED. There was 100% agreement in identification by both media. Almost 50% samples were identified within 24 hours by using CUM in contrast to CLED where most samples were identified in 48 hours. Total number of reagents used and total cost for processing of a specimen including technologist and consultant time by using CUM is significantly low in comparison to CLED. CONCLUSION: CUM can replace CLED as a primary isolation media for urine culture in clinical laboratories in Pakistan as it is user friendly, facilitates early reporting and saves cost

Magnetic resonance imaging (MRI) findings in white matter disease of brain

Demyelinating and dysmyelinating white matter diseases are important components of neurological problems. Recently, Magnetic Resonance Imaging (MRI) has played a key role in diagnoses of white matter diseases. Therefore, the purpose of the current study is to evaluate the usefulness of MRI in determining the type and frequency of white matter disease. We studied 35 patients who visited the Radiology Department of the Aga Khan University Hospital (AKUH) for MRI with suspected demyelinating/dysmyelinating disorder from January 2003 to December 2005. Multiple Sclerosis (MS) (17; 48%) and leukodystrophies (10; 29%) were the most common diseases. The MRI helped identify the sites and types of the lesion precisely and thereby helped made clearer. distinction between various types of white matter diseases. The current study demonstrated the effective use of the imaging and clinical presentation for arriving at the correct diagnosis

Perinatal outcomes in pregnancy with asthma

Objective: To examine the relationship between asthmatic pregnancies and selected maternal and neonatal outcomes in a representative cohort. Methods: A retrospective cohort study was conducted at the Aga Khan University Hospital during the year 2004. A random selection was made of 65 asthmatic and 63 non-asthmatic singleton births. The neonatal outcomes studied were birth weight, premature birth and Apgar scores at 1 and 5 minutes. The maternal outcomes studied were number of hospital admissions, and number of documented UTI during the studied pregnancy and past history of abortions and stillbirths. Resluts: The mean age of asthmatics and nonasthmatics were 28.0 +/- 4.9 years and 27.7 +/- 3.6 years respectively. The average parity among asthmatic women was 2.97 while that in controls was 2.57 (p \u3c 0.137). Neonates born to asthmatic mothers had shorter mean gestational age with increased risk of premature birth and lower Apgar scores. Asthmatic mothers had a greater risk of abortions and low birth weight babies. They also had higher rates of UTIs and hospital admissions. Conclusion: Asthmatic pregnancies are more likely to result in abortion, premature delivery and low birth weight babies. The asthmatic pregnancies were also linked with higher rates of maternal UTI. Thcrefore a more vigilant monitoring is required in asthmatic pregnancies

Magnetic resonance spectroscopy of enhancing cerebral lesions: Analysis of 78 histopathology proven cases

Objectives: To investigate the efficacy of magnetic resonance spectroscopy in differentiating various types of neoplastic and non-neoplastic enhancing cerebral lesions.Methods: The prospective study was conducted from January 2007 to December 2009 at the Department of Radiology, Aga Khan University Hospital, Karachi. All patients with enhancing brain lesions on magnetic resonance imaging who underwent magnetic resonance spectroscopy and a biopsy with histopathological analysis were included in study. The lesions were categorised into neoplastic and non-neoplastic lesions on the basis of spectroscopy findings. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of magnetic resonance spectroscopy were calculated. Predicted probabilities were computed and comparison of median values of metabolites and their ratios was analysed using non-parametric Mann Whitney U test to differentiate between neoplastic and non-neoplastic lesions.Results: Of the 102 patients enrolled, 78 (76.5%) comprised the final study sample. There were 53 (68%) male and 25 (32%) female patients with an overall mean age of 40.21 ± 17.69 years (range: 4-76 years). The mean overall size of the lesion was 4.01 ± 1.79 cm, and 61(78%) lesions were neoplastic and 17 (22%) were non-neoplastic. The sensitivity, specificity, positive predictive value and negative predictive value and diagnostic accuracy of magnetic resonance spectroscopy in differentiating neoplastic and non-neoplastic lesions were 90.16%, 64.70%, 90.16%, 64.70% and 78.20% respectively. A cut-off value of 2.55 of Choline/N-Acetyl Aspartate ratio depicted sensitivity of 70% in differentiating the lesions.Conclusion: Magnetic resonance spectroscopy is a highly sensitive technique in addition to conventional magnetic resonance imaging in characterising and differentiating between neoplastic and non-neoplastic cerebral lesions

Prevalence of Black Quarter in Association with Patho-Morphological Alterations in Affected Tissues at Different Zones of Punjab-Pakistan

Background: Blackleg or Black Quarter (BQ) is a serious bacterial disease caused by Clostridium chauvoei. It causes edematous and gaseous changes in skeletal muscles of animals. The study was designed to find prevalence of BQ in 6 districts of Punjab, Pakistan from June 2018 to June 2019.Methods: Animals were randomly monitored, and selected in each union council regardless of age, sex and species, but lameness and hyperthermia were the selection parameters. A proforma was used to record the experimental readings of each animal. A total of 1500 swab samples from bovines (cattle and buffaloes) were processed through conventional PCR and culture sensitivity tests to examine the comparative diagnostic efficacy and suitability of the test.Results: Sensitivity and specificity of culture tests were 87.6% and 34.19% respectively, whereas PCR demonstrated 81% and 47.3% results for the said aspects, respectively. Alpha toxin gene (Ccta) was amplified at 52.2oC yielding an amplicon size of 1400 base pairs. Area wise and season wise prevalence of each animal was also determined. The prevalence of BQ in cattle was significantly higher (P 0.05) in Lahore (0%) and Nankana Sahib (8%) which belonged to the canal irrigated zones.Conclusion: There was higher prevalence of BQ in different areas of Punjab, Pakistan that show the higher risk of disease transmission. A systematic surveillance system is essential to regularly monitor the disease incidence and prevalence in these areas of Pakistan.Keywords: Black Quarter; Prevalence; Pathological; Ruminants;  Zone

Estimation of Serum Ferritin Level to Detect Iron Deficiency Anemia in Children less than 5 Years of age

Objective: To evaluate serum ferritin levels in children less than five years as screening measure for iron deficiency anemia (IDA). Subjects and Methods: A cross-sectional study was conducted at Benazir Bhutto Hospital Rawalpindi from 1st March 2010 to 31st Jan 2011. A simple random sampling technique was adopted for study proceedings. Fifty children of less than five (5) years of age were enrolled in the study. The study population included children, aged less than five presenting at pediatrics outpatient department. The children with known hematological abnormality, infection, inflammation were excluded from the study. Blood complete picture for hemoglobin and serum ferritin level estimation were the diagnostic tools used and correlated afterwards. Data were collected and entered in Statistical Package for Social Sciences (SPSS, version 16) for analysis. Descriptive statistics were calculated. Chi-square test was applied for evaluation and calculation of significance in each of the characteristics of the population at P ≤ 0.05. Results: A total of 50 children with age range of 3-60 months, were recruited for the study. The study population was categorized into three groups; Infants (3-12 months), Toddlers (13-23 months) and Preschool-age (24-60 months) groups. The mean hematocrit of the study population was 33.5 (2.8%) and the mean serum ferritin level was 52.4 ng/ml with a range value of 0.2-353.0 ng/ml. Thirty-eight (38) patients of the study population were iron-deficient, with serum ferritin levels of less than 12 ng/ml. Conclusion: Serum ferritin level is a good screening test for detection of iron deficiency in children Key words: Children less than five years, Iron deficiency anemia, Serum ferritin levels