Goal-directed fluid therapy based on noninvasive cardiac output monitor reduces postoperative complications in elderly patients after gastrointestinal surgery: a randomized controlled trial

Objective: To observe the pre-Ramadan health seeking behavior, fasting trends, eating pattern and, sleep cycle in pregnant women

Methods: It is a cross-sectional observational study, from July to September 2017, conducted at Tertiary Care Hospital in Karachi. The tool used for data collection was interviewer based closed ended questionnaire, 279 pregnant women who fasted during Ramadan were included in the study

Results: One to ten days of fasting was observed by 85.7% [198] of women. About 72.4% [202] never consulted any doctor for pre-Ramadan advice regarding fasting in pregnancy. Pregnant women 81.7% [228] believed that fasting would not cause any harm to their unborn child, while 42.7% [119] of family members feared about the health of mother and unborn child. Seventy four percent [208] of respondents had a reduced sleep cycle of about 3-4 hours. The food items consumed at Sehri and Iftar were rich in carbohydrates and fats

Conclusions: Pre-Ramadan medical consultation regarding safety of fasting during pregnancy should be structured and customized for women and their families. Gaps in knowledge identified in this study may help healthcare professionals to address these issues

NSAIDs ameliorate cognitive and motor impairment in a model of parkinsonism induced by chlorpromazine

Parkinson's disease [PD] is a long-lasting neurodegenerative brain disease. It is characterized by a gradual decline in motor and non motor symptoms especially postural instability, tremors and memory impairment with localized loss of neurons mainly in the Substantia nigra. In the current research we evaluated the effects of Non-steroidal anti inflammatory drugs [NSAIDs] on motor coordination and memory in chlorpromazine [CPZ] induced Parkinson's experimental model. Intraperitoneal [i.p.] injection of CPZ [3 mg/kg] was given to all rats for 21 days to induce Parkinson like symptoms; ibuprofen [40mg/kg/day] and celecoxib [20mg/kg] were administered 30 minutes after CPZ injection. Behavioral parameters like Catalepsy, muscle strength [wire hanging test], locomotor activity [open field test] were observed. Moreover, its effect on memory was explored by the use of water maze and passive avoidance test. Our results showed CPZ significantly induced motor fluctuation and cognitive impairment in a period of 21 days. Celecoxib and ibuprofen significantly improved cataleptic scores [P<0.01], locomotion and muscular coordination in open field [P<0.01] and in wire hanging test [P<0.01]. Significant improvement in memory was observed with celecoxib [P<0.01] and ibuprofen [P<0.05] in water maze test as well as in passive avoidance test. Therefore, the present study showed neuroprotective and memory enhancing effect of ibuprofen and celecoxib against CPZ induced Parkinson's model

Attenuation of methylphenidate-induced tolerance on cognition by buspirone co-administration

Methylphenidate as a psycho stimulant drug has been prescribed in neuropsychiatric disorders to increase cognition and attention therefore is a medication of choice for attention-deficit/hyperactivity disorder however long-term administration of central nervous system stimulant produces tolerance on cognitive behavior. Previously it has been shown that long-term psychostimulant administration increases somatodendritic5HT-[IA] receptors effectiveness. Repeated buspirone administration attenuates 5-HT[IA] soma to dendritic receptors effectiveness. This study was designed to determine that buspirone co-administration may reduce methylphenidate-induced tolerance on cognitive behavior. Cognitive effects were compared by using water maze and passive avoidance test weekly after long-term administration of methylphenidate, buspirone and their co-administration. Methylphenidate at a dose of 2.0mg/kg/day in rats initially improve memory but after long-term treatment produce tolerance on cognitive behavior this effect is more pronounce in case of spatial working memory of water maze test than passive avoidance learning memory. However oral buspirone co-administration at a dose of 10mg/kg/day prevents methylphenidate-induce tolerance on cognition. It is suggested that buspirone may oppose methylphenidate-induced cognitive tolerance by reducing the sensitivity of 5-HT1A soma to dendritic receptors. These findings may help to extend future therapeutics in ADHD

risk factors and immediate complications of septic induced abortion

Objective: To identify the risk factors and immediate complications of Septic induced abortion

Study design: A descriptive study

Place and duration: Department of Obstetrics and Gynecology, Unit 1 civil Hospital Karachi, affiliated with Dow University of Health Sciences from 1st August 2006 to 15th March 2008

Methodology: The patients who were admitted with history of induced abortion were interviewed in privacy and after getting informed verbal consent, Age, marital status, parity, Socio-economic status, reasons for inducing abortion, status of abortionist and method for inducing abortion were entered in specified proforma. Then severity of complications management given to patient and their prognosis were noted

Results: Total of 50 women admitted with history of induced abortion during study period. Induced abortion was common in 21-30 years age group 62% [n= 31], married 94% [n=47], grand multiparous 40% [n=20] and lower middle class 56% [n= 28]. Most of women 48% [n= 24] did not have history of abortion in past and 54% [n= 27] of women terminated their pregnancies at gestational age of 6-10 weeks. 40% [n= 20] of women reported the reason of abortion was that they cannot afford further child followed by failure of contraception in 28% [n= 14]. In 40% [n= 20] of cases abortion was conducted by Dais and instrumentation 68% [n= 34] was the most commonly used method. Most common post abortal complication encountered during this study was hemorrhage in 66% [n= 33], sepsis in 54% [n=27], visceral injuries 24% [n= 12]. For the management D and E was the most commonly 68% [n= 34] performed procedure, followed by peritoneal lavage [16%, n=8], uterine repair [10%, n=5]

Conclusion: Incidence and associated complication of illegally induced abortion can be reduced through effection family planning services by improving women's educational and social status, mass health education and legal sanction against back door abortions and early recognition of complication and referral to hospital can reduce the mortality significantly

Assessment of lipid lowering effects of vitamin E

Aim of this study was to determine the role of antioxidant vitamin E in lowering the serum cholesterol and triglyceride levels. This study was conducted in the department of Pharmacology, Faculty of Pharmacy, University of Karachi, Karachi. Duration of study was 42 days froml-03-2008 to 11-4-2008. Male 20 rabbits were equally divided into 2 groups, group A was served as control and the group B was vitamin E treated. All the animals were maintained on cholesterol rich diet for a period of 30 days in order to induce hypercholesterolemia. After induction of hypercholesterolemia the group B was given vitamin E in a dose of 8.57mg/kg/day while the control group A was maintained on distilled water only for a period of 42 days. At the end of 42 days the blood samples were collected from marginal ear vein of rabbits and were analyzed to determine the levels of cholesterol and triglycerides. The results showed that there was decrease in the level of cholesterol but the level of triglyceride was reduced much significantly by administration of vitamin E. It has been reported earlier that vitamin E has potential to decrease levels of cholesterol and triglycerides. It can be concluded that vitamin E use can reduce the level of cholesterol and triglyceride in hypercholesterolemia and may prove to be beneficial

Ruptured ovarian teratoma presenting as peritonitis

A 55-year-old lady reported to the surgical OPD with clinical findings of acute peritonitis. Emergency laparotomy was performed. The peritoneal cavity was full of purulent material, however, the gut was normal. An 8 x 6 cm thick walled cyst was found in the left ovary with a minute perforation and purulent fluid coming out of it. Thorough peritoneal lavage along with left oophorectomy was performed. The postoperative recovery was smooth. Histopathology confirmed benign cystic teratoma of ovary

Acute acalculous perforated cholecystitis

A case of acute acalculous perforated cholecystitis with acute generalized peritonitis in a middle aged cachectic man, presenting late in a moribund condition, is reported. He underwent emergency laparotomy [subtotal cholecystectomy], went into multi-organ failure and was managed accordingly. The patient recovered in about 2 weeks and was followed-up regularly

Combined urethrolithotomy with vesicolithotomy in an 18-months old boy

We present a case of 18 months old male child who reported with acute urinary retention. He had a urethral calculus along with a vesical calculus. He was subjected to combined external urethrotomy and open vesicolithotomy in one sitting. The patient made a smooth post operative recovery and was followed up for 6 months

Retroperitoneal masses: different clinical scenarios

We present two cases of retroperitoneal masses with different presentations and outcomes. The first case was a 22 years old primigravida lady who underwent emergency caesarean section for preterm premature rupture of membranes with breach. On the operating table, a large retroperitoneal mass was identified and the biopsy confirmed Burkitt's lymphoma. Post operative chemotherapy did not have a favourable result and the patient had a fatal outcome. The other case was a 15 years old boy who had a progressively increasing retroperitoneal mass. Exploratory laparotomy revealed a hard, fixed, unresectable tumour extending into the mesentery of the small gut, biopsies were taken which showed tuberculosis. Post operative antituberculosis treatment had a marked response and the tumour disappeared after 6 months

Pierre Robin sequence as birth asphyxia in a new born

A new born baby boy presented with birth asphyxia and respiratory distress. He went into cardiac arrest twice but was resuscitated. On detailed evaluation, he had low set ears and micrognathia with glossoptosis consistent with features of Pierre Robin sequence. Episodes of apnoea disappeared, on nursing, the baby in prone position and later on tongue-lip retention suture were applied. Prompt diagnosis and efficient airway management by following the principles of airway resuscitation can save the lives of such babies without specialized care

Cholecysto-hydatid cyst fistula

We present a case of recurrent hydatid cyst liver in a 32-year-old female. Previous surgery was performed 8 years ago elsewhere. Pre-operative assessment at presentation revealed a 110 x 105 mm hydatid cyst in the right lobe of the liver. On exploration, a 5 mm fistulous communication was found between the hydatid cyst and the gallbladder. Patient was subjected to endocystectomy [partial cystectomy], cholecystectomy and closure of the fistula followed by obliteration of the cavity with omentum. Postoperative recovery was uneventful

Male Pseudohermaphroditism

An unusual case of a 40-year-old infertile male is presented. On examination he had cryptorchidism with other normal secondary sexual characters. Ultrasonography and computerized tomography raised the suspicion of tumour in the right abdominal testis. On exploration, a uterus with cervix, fallopian tubes and abdominal testes were detected. This was confirmed histopathologically. Chromosomal analysis revealed 46XY