Emphysematous Cholecystitis With Perforation And Biliary Peritonitis

Emphysematous cholecystitis (EC), uncommon but potentially fatal sequelae of acute cholecystitis mainly seen in old-aged patients with high mortality rate, caused by secondary infection of gall bladder with gas-forming enteric organisms. Herein, we report a case of emphysematous gangrenous cholecystitis with perforation and biliary peritonitis in a 76-years-old non-diabetic lady that was successfully managed by surgical intervention coupled with medical. The report of this case highlights the risk of missing this extremely rare but potentially fatal condition once the patient presents in late-stage with concurrent complications like perforation and peritonitis. Therefore, prompt diagnosis and early surgical intervention is imperative are imperative to avoid undesired outcomes.

Anti-bio gram of the most common dietary additives [spices] against common problematic organisms

Background: In the current scenario, the greater antibiotic toxicity, increasing drug cost, and continually rising multi drug resistance are the main compelling factors for the researchers to focus on natural bioactive sources for safe and natural therapeutic agents as an alternative to allopathic antibiotic

Objectives: The main objective of the study is to investigate antimicrobial potential of most commonly used kitchen spices in an attempt to explore the natural bioactive sources for natural therapeutic agents as an alternative to synthetic antibiotics, against which there is a continuous rise in multi-drug resistant pathogens

Study design: Experimental/in vitro study conducted [from Sep, 2015 to Feb, 2016] in different departments [of School of Pharmacy, Pathology and Bio-chemistry of UM and DC], The University- of Faisalabad

Methodology: Antibiotics assay is performed by using the disc diffusion methods. Clove and Cinnamon extracts are prepared and from these sensitivity discs are prepared. Standard size inoculum is also prepared. Then by using standard disc diffusion method the zones of inhibitions produced by Clove and Cinnamon extracts are measured and recorded, and is compared with positive and negative controls

Results: Spice extracts of Clove and Cinnamon tested against test organisms revealed antimicrobial potency with diameter of zone of inhibition [13.33+/-0.33mm to 20.50+/-0.72mm] and [12.17+/-0.31mm to 15.67+/-0.49mm] respectively while positive control manifested zone of inhibition [19.33+/-0.21mm to 29.50+/-0.22mm]. Ethanol extracts prepared by soxhlet apparatus showed better results compared with extracts prepared by simple maceration process. Furthermore, overall ethanol extracts showed better results compared with the aqueous extracts. Statistical analysis: Data was analyzed by two-way analysis of variance [SPSS]

Conclusion: This study reported the presence of natural bioactive compound[s] in Clove and Cinnamon with highly significant broad spectrum antibacterial potential, even against multi drug resistant pathogens

Relationship between the family environment and childhood obesity

Objective: To determine the association of family environment with childhood obesity

Methodology: This case control study was conducted in Public and Private schools of Lahore city and was analyzed in Department of Community Medicine, Allama Iqbal Medical College Lahore from November 2015 to May 2016.Students having age 8 to 10 years studying in grade 4 and 5 were selected for this study

Results: After compiling the results, it was noted that childhood obesity was associated with parental BMI, eating between regular meals, TV viewing >4hours/day and physical activity <20min/day

Conclusion: Results of this study revealed that childhood obesity is associated with risk factors of family environment [parental BMI, eating between regular meals, TV viewing >4hours/day and physical activity <20min/day]

Anti-Microbial potential of Panacea [Nigella Sativa]

Background: In the existing scenario, increasing drug cost, toxic effects and drug resistance or the main motivating factors for researchers to exploit the natural bioactive sources for safe and natural therapeutic as an alternative to antibiotics

Objectives: The main objective of the study is to find out the antimicrobial potential, its spectrum and magnitude in N.sativa

Study Design: Experimental/in vitro study

Duration: September, 2016 - February, 2017

Settings: Different departments [of School of Pharmacy, Pathology and Bio-chemistry of UM and DC], The University of Faisalabad

Methodology: Antibiotics assay is performed by using the disc diffusion methods. N.sativa extracts are prepared and from these sensitivity discs are prepared. Standard size inoculum is also prepared. Then by using standard disc diffusion method the zones of inhibitions produced by N.sativa extracts are measured and recorded in mm and is compared with positive and negative controls

Results: Spice extract tested against test organisms revealed antimicrobial potency with diameter of zone of inhibition [27.17+/-0.98mm - 31.33+/-0.21mm] while positive control manifested zone of inhibition [19.33+/-0.21 - 29.17+/-0.17mm]. Ethanol extracts prepared by Soxhlet apparatus showed better results compared with extracts prepared by simple maceration process. Furthermore, overall ethanol extracts showed better results compared with the aqueous extracts

Conclusion: This study revealed the presence of natural bioactive compound[s] in N.sativa with highly significant broad spectrum antibacterial potential, even against multi resistant pathogens

randomized comparison of ultrasound guided versus blindly placed radial arterial catheters

Objective: To evaluate the effectiveness of ultrasound [US] guided radial artery cannulation as compared to the blind insertion of arterial line in intensive care unit of a tertiary care center

Methodology: One hundred patients were divided into two equal groups. In group I, arterial line was inserted using the blind palpation technique. While in group II, arterial line was inserted with the help of ultrasound guidance. The primary endpoints were time of insertion in 1st attempt, number of first successful attempts and maximum number of attempts used for insertion of arterial line. Data was analyzed by using SPSS V23. Chi-square test was used for analysis of gender and successful insertion in 1st attempt. Independent sample t-test and Mann-Whitney U-test were used to compare quantitative variables

Results: Mean baseline systolic blood pressure, mean diastolic blood pressure and mean pulse rate before surgery were also not significantly different between the groups. Arterial line was inserted in first attempt in in 88.0% patients in ultrasound guided group and in only 70.0% patients in blind palpation group [p-value 0.027]. Arterial line insertion time in 1st attempt was also significantly less in ultrasound guided group 77.68+/-7.98 seconds versus 95.46+/-15.53 seconds in blind palpation group [p-value <0.001]. We also found less number of attempts 1.16+/-0.37 in ultrasound guided group versus 1.44+0.67 in blind palpation group [p-value 0.025]

Conclusion: Ultrasound guided radial artery cannulation is associated with higher rate of successful insertion and less time is required for arterial line insertion as compared to blind palpation method

Comparison of lidocaine and a combination of lidocaine and ketorolac pretreatment on withdrawal movement induced by rocuronium injection

Introduction: Rocuronium is a widely used monoquaternary aminosteroid nondepolarizing muscle relaxant of intermediate duration with a rapid onset to achieve optimal conditions for endotracheal intubations. The injection of rocuronium bromide during induction of anesthesia has often been associated with pain-induced withdrawal movement near the site of injection. It has been hypothesized that addition of ketorolac and Lidocaine in combination as pretreatment drugs among patients undergoing general anesthesia with rocuronium injection provides a better control of withdrawal movements in comparison to patients who receive only lidocaine. The objective of this study was to compare the efficacy of pretreatment of combination of ketorolac and Lidocaine and Lidocaine alone in the frequency of withdrawal movement associated with rocuronium injection in peripheral veins during intubation

Methodology: This study was conducted on 90 patients undergoing elective surgeries under general anesthesia in operation theater complex of our hospital. Patients were randomly divided in group A and B by lottery method. Group A received 20 mg lidocaine IV prior to rocuronium. Group B received lidocaine 20 mg and ketorolac 10 mg IV. General anesthesia was administered by induction via 5 mg/kg thiopental sodium in a separate peripheral intravenous line. Withdrawal movements were observed as mild, moderate and severe, and recorded on a well-structured performa. Efficacy was defined as no withdrawal movement on injecting rocuronium

Results: The differences in age and gender of patients were not significant in both groups and these were not associated with efficacy of treatment in the groups. However ASA status of the patients was significantly associated with efficacy of treatment groups. In Group-A 27[60%] and in Group-B 36[80%] patients had no withdrawal movement while mild movement was observed in 12[26.7%] patients in Group-A, and in 7[15.6%] patients in Group-B. Moderate movement was seen in 6[13.3%] patients in Group-A, and in 2[4.4%] patients in Group-B. The number of patients who had withdrawal movement was 18[40%] vs. 9[20%] in Group-A and Group-B respectively [p = 0.0384]. The criterion of efficacy was fulfilled by 27[60%] Group-A patients, compared to 36[80%] patients in Group-B

Conclusion: Results of this study showed that combination of intravenous lidocaine and ketorolac prior to rocuronium injection is more effective that lidocaine alone for preventing withdrawal movements for general anesthesia

Comparison of effects of propofol and isosorbide dinitrate during rewarming on cardiopulmonary bypass

Objectives: Comparison of effects of propofol and isosorbide dinitrate during rewarming on cardiopulmonary bypass in patients undergoing coronary artery bypasses grafting

Methods: it was randomized prospective clinical trial. One hundred and twenty patient [120] undergoing CABG surgery were included in this study. Group-1 [Study group, n=60]: in which only propofol infusion used during rewarming and Group-ll [control Group, n=60] in which isosorbide dinitrate and propofol infusion combination was used during rewarming. The data was entered and analyzed through SPSS Version 19

Independent sample T-test and chi-square test were used for data analysis. P value of < 0.05 was taken as significant

Results: Mean arterial pressures during rewarming were 63.41 +/- 3.61 mmHg in propofol group versus 60.80 +/- 4.86 mmHg in control group [p-value 0.001]. Core temperature on weaning from cardiopulmonary bypass was 37.11 +/- 0.49 °C in propofol group and 37.00 +/- 0.18 °C in control group. After drop in core temperature was little more in propofol group [1.02 +/- 0.36 °C] versus 0.96 +/- 0.37 °C in control group but this difference was not statistically significant [p-value 0.41]. Mean Ventilation time after surgery in propofol group was 4.65 +/- 0.65 hours versus 5.03 +/- 0.81 hours in control group [p-value 0.006]

Conclusion: Propofol alone is capable of fulfilling the requirements of adequate rewarming during Cardiopulmonary bypass and can produce more hemodynamic stability and early post-operative recovery

Continuous low tidal volume ventilation during cardiopulmonary bypass reduces the risk of pulmonary dysfunction

Objective: Pulmonary dysfunction is considered to be the most important complication after open heart surgery. Different maneuvers like intermittent or continuous positive pressure ventilation, low tidal volume ventilation and different vital capacity maneuvers have been used for reducing the incidence of pulmonary dysfunction after cardiac surgery. In this study we evaluated the effects of low tidal volume ventilation versus no-ventilation during cardiopulmonary bypass [CPB] in patients undergoing conventional CABG surgery

Methodology: This randomized clinical trial was conducted in a tertiary care cardiac hospital. One hundred patients who were planned to undergo conventional CABG surgery were divided into two groups by using draw randomization procedure. In Group A patients [ventilation group] ventilation was continued at low tidal volume of 3 ml/kg, respiration rate of 12 breaths/min and PEEP of 5 cmH[2]O. In Group B patients [non-ventilation group] ventilation was arrested during CPB. For data analysis Statistical Package for Social Sciences [SPSS] V17 was used. Parametric variables were compared using unpaired t-test and non-parametric variables were compared using o[2]-test

Results: The mean patient's age in this study was 57.70 +/- 8.57 years in ventilated group and 54.5 +/- 8.33 years in non-ventilated group. PaO[2]/FiO[2] ratio and alveolar-arterial oxygen tension gradient immediately after intubation was same in groups. But PaO[2]/FiO[2] was significantly high in ventilated group after one hours of CPB and even after four hours of CPB [p < 0.001 and 0.002 respectively]. Alveolar arterial oxygen tension [A-a O[2]] gradient after 1 hour and four hours of CPB was significantly low in Ventilated group [p < 0.001 and 0.001 respectively]. Total Mechanical ventilation time was also significantly shorter in ventilated group 5.19 +/- 1.96 hours versus 6.42 +/- 2.60 hours in non-ventilated group [p 0.009]. On 4th post-operative day, incidence of atelectasis was significantly low 20% in ventilated group versus 38% in non-ventilated group [p = 0.04]

Conclusion: Continuous low tidal volume ventilation is associated with better oxygenation after surgery and reduced risk of post-op pulmonary complications during cardiopulmonary bypass in patients undergoing conventional coronary artery bypass graft surgery

Percutaneous transmitral commissurotomy [PTMC]; procedural success and immediate results, a tertiary care hospital experience from developing country

Background: Mitral stenosis is one of the grave consequences of rheumatic heart disease. Balloon valvuloplasty for stenosed mitral and pulmonary valves has been practiced with good results in the world. Since Inoue et al. introduced balloon valvuloplasty in 1982, percutaneous transmitral commissurotomy [PTMC] has become the treatment of choice for mitral stenosis replacing surgical commissurotomy and mitral valve replacement in many cases

Objective: The aim of this study was to audit the procedural success, in hospital outcome in patients undergoing percutaneous trans-mitral balloon commissurotomy [PTMC] in our set up. Study Design: Observational cross sectional study. Place and Duration: The study was conducted at Faisalabad Institute of Cardiology Faisalabad from March 2011 to December 2013

Materials and Methods: Total one hundred and twenty four patients underwent percutaneous transmitral commissurotomy from March 2011 to December 2013. Any patient of age >/= 10 years with mitral stenosis who fulfills the inclusion and exclusion criteria for PTMC was enrolled in this study. A full history particularly, age, sex, occupation, address, symptoms regarding their referral for medical checkup was noted. Detailed clinical examination especially relevant cardiovascular examination of all the patients was done. ECG of every patient was done. Baseline routine investigations including blood complete with ESR, electrolytes, CRP, LFT, RFT was done in each case. A baseline echocardiography was performed in all patients. Mitral valve area was calculated by planimetry and by pressure half time method. Severity of mitral stenosis was graded as: very sever stenosis [valve area <1cm[2]], severe [valve area 1- 1.5 cm [2]] moderate [valve area 1.5- 2 cm[2]] and mild [valve area > 2.0 cm[2]]. To exclude any clot in LA and LA appendage Transesophageal echocardiography [TEE] was performed. In Cath Lab pre and post PTMC invasive hemodynamics including LA, RA, RV, left ventricular end-diastolic pressure [LVEDP], and transmitral pressure gradient [PG] was calculated. Those patients who have echo contrast on echocardiography were given 5000 IU heparin IV after septal puncture. Antibiotic prophylaxis was initiated in all patients thereafter. The procedure was performed under local anesthesia, if needed moderate sedation was given with midazolam. The procedure was ended when either at least one commissure was splitted, adequate increase in mitral valve area or increase in degree of MR or decrease in mean LA pressure to ½ of pre PTMC value or decrease in mitral valve gradient was observed. After 24-48 hours patient was discharged and before discharge transthorasic echo was done to measure all the parameters as pre PTMC along with any echo finding of pericardial effusion

Results: Total 124 patients were studied, 92[74.2%] were female and 32[25.8%] were male showing a female predominance. The mean age was 27.29 +/- 9.3. Most of the patients 58[46.8%] were in age group 21-30 years. 87[70.16%] patients were in atrial fibrillation and 37[29.83%] had sinus rhythm. The procedure was successful in 118[95.16%] patients. 2[1.6%] patients need urgent MVR due to severe MR and 1 [0.8%] died during procedure. Most of the patients 85[68.55%] were in NYHA class III. After PTMC, ASD was present in 13[10.5%] patients. After PTMC moderate MR was seen in 2[1.6%] and severe MR was observed in 4[2.173%] patients. Most of the patients 115[92.7%] before PTMC were in severe pulmonary hypertension and after PTMC most of the patients 91[73.4%] were in mild pulmonary hypertension. Pre PTMC mean MVA [cm[2]] was 0.684 +/- 0.1226 and post PTMC it was 1.533 +/- 0.281 cm[2]. Mean MVPG pre PTMC was 26.178 +/- 5.94 mmHg and post PTMC it was 7.62 +/- 5.007 mmHg with significant p value 0.0001. Mean LA pressure before procedure was 29.68 +/- 8.137 mmHg and post PTMC it was 12.28 +/- 6.99 and p value was 0.0001. 10 patients had special problems, 3 had previous H/O PTMC, 3 were pregnant lady, one has kyphoscoliosis, one had large IAS aneurysm, one had H/O CVA and one patient was suffering from renal cell carcinoma

Conclusions: The outcome of this study suggests that PTMC is a safe procedure in experienced hand with good success rate and optimal results even in patients with special problems like pregnancy, previous CVA and redo cases

Thyroid disorders; and cardiovascular risks

Thyroid hormones have many effects on cardiovascular function, and deficiency or excess of thyroid hormones can result in cardiac dysfunction. Abnormalities of the cardiovascular system are often identified during examination of hyperthyroid and hypothyroid patients

Objective: The aim of this study was to address the effects of thyroid hormones on the cardiovascular system and the clinical relevance of the cardiovascular response to thyroid dysfunction

Study Design: Cross sectional study

Setting: The study was conducted at Allied Hospital / Punjab Medical College Faisalabad and PINUM Hospital Faisalabad

Period: October 2014 to August 2015

Materials and Methods: Total 100 patients with thyroid disease [Hypo/hyperthyroidism] were enrolled in the study. Any patient age >/=20 years, that had documented history of thyroid disease [Hypothyroidism or hyperthyroidism] or on medications for thyroid disorder was recruited in this study

Results: Total 100 consecutive patients with abnormal thyroid function tests who fulfill the inclusion and exclusion criteria were enrolled in the study. Mean age was 47.9 +/- 23.20 years. 16% were male and 84% were female. Majority of the patients 37[37%] were in age group 51 - 60 years. 53% were suffering from overt hyperthyroidism and 31% were suffering from hypothyroidism. Subclinical hyperthyroidism and hypothyroidism was present in 7% and 9% patients respectively. Goiter was present in 24% patients. Atrial fibrillation was observed in 34% hyperthyroid patients. Overall 23% were diabetics and 25% had H/O hypertension. Dyslipidemia was present in 20% hyperthyroid and 25% hypothyroid patients. Echocardiography was performed in 19% patients. 7% patients undergone thyroid surgery. Overall 11% patients were suffering from CCF. Pulmonary hypertension was observed in 17% hyperthyroid and 35.48% hypothyroid patients. MeanFT4 in hypothyroid patients was 1.16 +/- 022 ng/dl. Mean TSH was 10.92 +/- 21.09 [microIU/ml] in hypothyroid and 0.19 +/- 0.14 [microIU/ml] in hyperthyroid patients

Conclusions: The outcome of this study suggests that patients with untreated overt / subclinical thyroid dysfunction are at increased risk of cardiovascular complications

effect of prenatal administration of valproic acid on the survivability and day of hatching of chick embryo

To assess the effects of prenatal administration of valproic acid on the survivability and day of hatching of chick embryo in comparison with age-matched controls. The experimental study was conducted at the Department of Anatomy, Regional Centre of College of Physicians and Surgeons Pakistan, Islamabad, from February 2010 to February 2011. Fertilised chicken eggs were divided into two groups, labelled as experimental group-A and control group-B. Group-A eggs were injected with valproic acid, incubated and hatched. Group-B eggs underwent sham treatment using normal saline. The fully hatched chicks were then evaluated for the day of hatching and survivability, on hatching or on day 22 of incubation whichever was earlier. Outcome was statistically compared with the controls using SPSS 10. The two groups had 30 eggs each. In Group-A 23[76.66%] chicks hatched out, while there were 7[23.33%] dead chicks. In Group-B, 28[93.33%] chicks hatched out and 2[6.66%] were dead. Chicken embryos exposed to valproic acid in ovo showed increased mortality [p<0.001] and delayed hatching [p<0.001]. Prenatal exposure of chick embryos to valproic acid decreased embryo survival and also delayed hatching compared to age-matched controls

Atrial and ventricular septal changes in ethanol vapour exposed chick embryos

To study the effects of ethanol vapour exposure on development of atrial and ventricular septa of chick embryo. The experimental study was conducted at the College of Physicians and Surgeons, Islamabad, from 2006 to 2007. The experimental and control groups were further divided into three subgroups based on the day of sacrifice. The experimental group was exposed to ethanol vapours produced in a specially-designed vapour chamber and then compared with age-matched controls. There were 90 eggs in each of the two groups. The development of inter-ventricular septum completed at day 7 of development in chick embryo. Ethanol vapour exposure produced a small discontinuity at day 10 of development in a chick embryo which may be labelled as ventricular septal defect since ventricular development is completed by day7. Interatrial septum formed till day 7 with small perforations which persisted till hatching. Ethanol vapour exposure may lead to ventricular septal defect

developmental gross morphology of pancreas in chick embryo after prenatal administration of valproic acid

To determine the effects of prenatal administration of valproic acid on the developmental gross morphology of pancreas in chick embryo. Experimental study. Anatomy Department, Regional Centre, College of Physicians and Surgeons, Islamabad, from February 2010 to February 2011. An experimental group-A and control group-B, comprised of 30 eggs each. Freshly laid fertilized chicken eggs of experimental group were injected with valproic acid, incubated and hatched. Eggs of control group underwent sham treatment using normal saline. The chicks were sacrificed on hatching or day 22 of incubation, whichever was earlier. The pancreata of only alive chicks of both groups were dissected out, and evaluated for gross morphology in terms of length and weight by statistically comparing with control ones. Then pancreata were stained with aldehyde fuchsin and orange-G stain to study other obvious histological effects, if any. Chicken embryos exposed to valproic acid in ovo, showed significant decrease in length and weight of pancreata. The mean of length [cm] of pancreata in group-A was 2.208 +/- 0.166, and group-B was 2.300 +/- 0.102 [p=0.008]. The mean of weight [g] of pancreata in group-A was 0.032 +/- 0.009, and group-B was 0.048 +/- 0.005 [p=0.001]. Valproic acid exposure showed retarding effect on the gross development of pancreas as depicted by decrease in the length and weight of pancreata

Efficacy of mitomycin C in reducing recurrence of anterior urethral stricture after internal optical urethrotomy

PURPOSE: To determine the efficacy of mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy (IOU). MATERIALS AND METHODS: This was a randomized controlled trial conducted in the Department of Urology at the Institute of Kidney Diseases Peshawar from March 2011 to December 2013. A total of 151 patients who completed the study were divided into two groups by the lottery method. Group A (cases) comprised 78 patients in whom mitomycin C 0.1% was injected submucosally in the stricture after conventional IOU. Group B (controls) comprised 73 patients in whom IOU only was performed. Self-clean intermittent catheterization was not offered in either group. All patients were regularly followed up for 18 months. Recurrence was diagnosed by use of retrograde urethrogram in all patients and flexible urethroscopy in selected cases. Data were collected on a structured pro forma sheet and were analyzed by SPSS. RESULTS: The mean age of the patients in group A was 37.31+/-10.1 years and that in group B was 40.1+/-11.4 years. Recurrence of urethral stricture was recorded in 11 patients (14.1%) in group A and in 27 patients (36.9%) in group B (p=0.002). The mitomycin group also showed a delay in recurrence compared with the control group (p=0.002). CONCLUSIONS: Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C was found to be highly effective in preventing the recurrence of urethral stricture after IOU.

Risk factors of chronic subdural hematoma recurrence after burr hole surgery

Background: Chronic subdural hematoma [CSDH], a common type of intracranial hemorrhage and one of the most common clinical entities encountered in daily neurosurgical practice tends to occur in elderly patients

Objective: To determine the frequency and risk factors of chronic subdural hematoma recurrence after burr holes surgery

Patients and Methods: This descriptive cross sectional study was conducted in neurosurgery department Nishtar Hospital Multan from 1[st] January 2013 to 31[st] December 2013. All the patients diagnosed as CSDH, confirmed on computed tomography [CT] and treated by hematoma evacuation and drainage through cranial bur hole during the study duration were included in the study. Routine computed tomography [CT] was performed in all the patients, the day after the surgery, one week after the surgery, two months after the surgery and all the patients were followed up to three months after the surgery. Preoperative and postoperative CT findings were compared to calculate the recurrence rate. Data was entered and analyzed by using SPSS version 17. P-value = 0.05 was considered significant

Results: There were 72.64% male and 27.36% female patients. 78.31% patients were = 70 years age and 21.69% below 70 years. CT demonstrated CSDH as hypo dense to cerebral parenchyma in 49.05%, isodense in 29.24% and hyperdense in 21.71%. Recurrence of chronic subdural hematoma after the bur holes craniotomy was observed in 10.8% [12] patients. Major risk factors identified for recurrence were age = 70 years and re-expansion of the brain after the surgery

Conclusion: It is concluded that recurrence of chronic subdural hematoma after burr holes evacuation is directly related with age and re-expansion of the brain after surgery

Safety and technical success of percutaneous left main coronary artery stenting

Critical stenosis of left main coronary artery [LMCA] has always remained a challenge for interventional cardiologists. Conventionally Coronary Artery Bypass Grafting [CABG] is done for these patients but recently Percutaneous Coronary Intervention [PCI] is also being tried more frequently, but data of PCI is scarce in this regard. Our objective was to determine the safety and technical success rate of percutaneous left main coronary artery stenting. This was 12 month follow up study conducted at Pakistan Institute of Medical Sciences [PIMS], Islamabad from 11th Jan 2012 to 11th Jan 2013. All symptomatic patients who underwent coronary angiogram at PIMS and were found to have either isolated LMCA disease or coexisting osteal Left Anterior Descending [LAD] artery disease were potentially eligible for the study. Patients who had previous surgical treatment for coronary artery disease and those with renal dysfunction requiring dialysis were excluded. Patients were counselled in detail regarding the pros and cons of PCI versus CABG. Those who opted for PCI were included in the study. All these patients were treated with percutaneous left main coronary artery stenting with or without osteal LAD stenting. Seventy two patients had LMCA disease during angiogram. Fifteen patients opted for CABG. Four patients did not meet the inclusion criteria, whereas 53 patients were finally enrolled. Mean age of patients were 55.45 +/- 10.275 years. Twenty nine patients were with acute coronary syndrome and 22 presented with unstable angina. PCI with stenting was technically successful in all patients. One patient died three months after PCI, there was no other mortality. Our study showed that Percutaneous Coronary Intervention [PCI] to LMS has good technical success rate; the safety of the procedure is also acceptable

Comparison of Airtraq and Macintosh laryngoscopes for elective intubation in patients without predicted difficult airway

Objective: to compare conventional Macintosh laryngoscope with Airtraq for elective tracheal Intubation

Material and Methods: a in this randomized control trial conducted during Jan-June 2013. 50 ASA I andII patients without predicted difficult airway included in each group. Main outcomes were intubation time and intubation success rate, number of attempts, airway injury, and number of optimization maneuvers, glottic view and failure of intubation

Results: airtraq has significantly less intubation time, number of optimization maneuvers required and better glottic view [p<0.005] as compared to Macintosh laryngoscope

Conclusion: during elective intubation, Airtraq has better laryngoscopic view and shorter intubation time as compared to Macintosh laryngoscope

Etiology and postnatal management of prenatal hydronephrosis: a study of two teaching hospitals of Khyber Pakhtunkhwa

Background: Hydronephrosis is the most common abnormal finding in the urinary tract during prenatal ultrasonography screening. It is important to differentiate between obstructive and physiologic hydronephrosis because obstructive pathology may lead to recurrent urinary tract infection and end stage renal disease

Objectives: To determine the aetiology of prenatal hydronephrosis and see its outcome following treatment at two teaching hospitals of Khyber Pukhtoon Khawa. Study type, settings and duration: This descriptive retrospective study was conducted in Department of Paediatrics in Kuwait Teaching Hospital, Peshawar and Department of Urology in Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar from January 2008 till December 2010

Patients and Methods: A total of 64 neonates were included in the study with a mean follow up of 14.5 months. Data of antenatal ultrasound, postnatal ultrasound, clinical features, urea, creatinine, voiding cysto-urethrogram, renal scan and operative and non operative information was collected on structured Proforma and was analyzed on SPSS version 17

Results: Out of 64 neonates, 39 were males and 28 females. Ultrasonography showed unilateral hydronephrosis in 52 patients and bilateral in 12. Based upon prenatal ultrasonography using Antrerio posterior diameter, 37 patients had mild hydronephrosis, 14 had moderate and 13 had severe hydronephrosis. Etiologically 44 patients had physiologic hydronephrosis, 11 pelvi-ureteric junction obstruction, 5 vesicouretric reflux and 4 posterior urethral valves. Surgery was performed in 15 patients which included open pyeloplasty in 11, vesicostomy followed by posterior valve fulguration in 4 patients. All patients vesicouretric reflux were treated medically. The severity of prenatal hydronephrosis was significantly associated with need for definitive urological surgery [p <0.005]. Ancillary procedures like percutaneous nephrostomy were inserted in 7 patients

Conclusion: Physiological hydronephrosis and vesicouretric reflux can be successfully treated with medical treatment. However, obstructive pathology requires surgical correction

Nutritional assessment and antioxidant analysis of 22 date palm (Phoenix dactylifera) varieties growing in Sultanate of Oman

OBJECTIVE@#To assess the nutritional values and antioxidant analysis of 22 varieties of date palm (Phoenix dactylifera) fruit collected from various regions of the Sultanate of Oman.@*METHODS@#Nutritional parameters including moisture, fats, fiber, proteins, carbohydrates, and energy value were determined using standard methods of Association of Official Analytical Chemists. The antioxidant activity was screened for their free radical scavenging properties using ascorbic acid as a standard antioxidant. Free radical scavenging activity was evaluated using 1,1-diphenyl-2-picrylhydrazyl free radical.@*RESULTS@#The results of the date fruits (dried/tamar stage) revealed significantly higher moisture (15%-21%), dry matter (78%-86%), ash content (1.0%-2.0%), fiber (1.0%-2.5%), fat (0.1%-0.7%), protein (1.8%-3.8%), nitrogen (0.25%-0.55%), carbohydrates (74.5%-82.4%), and energy values (307-345.5 kcal/100 g). The antioxidant activity ranged between 40% and 86% depending upon the type of date and location. Overall, Khalas, Fardh and Khasab have significantly higher nutritional attributes; however, other varieties such as Barshi, Qush LuLu, Handal, and Khunaizi also have comparable nutritional values. The cluster analysis further evidenced the correlation of proximate parameters in different locations. Moreover, the nutritional and antioxidant attributes of similar date varieties collected from different locations were slightly varied.@*CONCLUSIONS@#The present finding helps in understanding the nutritional significance of different date varieties in Oman while the lesser known varieties can be improved through sustainable horticultural practices as a valuable product. The study further reveals that the consumption of these dates' fruits would exert several beneficial effects by virtue of their antioxidant activity.

Analgesic effects of crude extracts and fractions of Omani frankincense obtained from traditional medicinal plant Boswellia sacra on animal models

OBJECTIVE@#To investigate the analgesic effect of Boswellia sacra (B. sacra), which could support the Omani traditional uses of frankincense for muscle, stomach, and arthritis pain.@*METHODS@#The crude extract, the essential oils and various sub-fractions of the crude methanol extract (each 300 mg/kg of the body weight of the animal) obtained from the resin of B. sacra were administered orally, and were evaluated for their analgesic activities by using two well known models of pain in mice, viz. acetic acid induced writhing test and formalin induced pain test in mice.@*RESULTS@#Of 13 samples, almost all of them were effective at an orally administered dose of 300 mg/kg of the body weight. The acetic acid induced writhes were inhibited in all the three phases with comparable values to the standard drug aspirin (300 mg/kg of body weight) with inhibition of 67.6% in phase I, 66.8% in phase II, and 37.9% in phase III. At the same time, all the tested samples were found effective in both the early and the late phases of formalin test. In formalin test, most of the tested samples showed more inhibitory effects as compared to the standard drug aspirin (300 mg/kg of body weight), which showed 36.2% and 29.6% inhibition in early and late phases respectively. Among the tested samples, the most significant inhibition was produced by Shabi frankincense oil (57.5% in early phase, and 55.6% in late phase). Interestingly, the extracts showed comparable percentage of inhibition to the oil and found in the following order: 60% chloroform/n-hexane sub-fraction (55.3% in early phase, and 66.7% in late phase), and 70% chloroform/n-hexane sub-fraction (59.6% in early phase, and 63.0% in late phase).@*CONCLUSIONS@#The present study provided the scientific justification about the analgesic properties of the essential oils, extract, and various sub-fractions obtained from the resin of B. sacra, thus validating its use in traditional folk medicines and other products; and hence supporting the development in the analgesic properties of bioactive natural substances.