Preparation, characterization and antibacterial activity of ZnO nanoparticles on broad spectrum of microorganisms.

Nano particles have received increased attention regarding their potential utility in biomedicine. In this study, we have investigated the antibacterial activity of ZnO nano particles with various particle sizes. ZnO nano particles were synthesized by conventional precipitation method using zinc sulphate and sodium hydroxide as precursors followed by the calcinations of precipitates at 350 °C for 6 h (sample A) and 550 °C for 2 h (sample B). The products were characterized by X-ray diffraction (XRD) analysis and morphology of the particles was evaluated by Scanning Electron Microscopy (SEM). Antibacterial activities against four different microorganisms were evaluated by determining the minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and zones of inhibitions using different concentrations of ZnO nanoparticles. The antibacterial activity was directly proportional to the concentration and inversely proportional to the particle size in all the microorganisms; moreover Gram positive bacteria were generally more affected than Gram negative bacteria. The stability of ZnO nanoparticles combined with potent antibacterial properties favours their application as antibacterials against broad spectrum of microorganisms.

Outcomes in High Perianal Fistula Repair Using Video-Assisted Anal Fistula Treatment Compared With Seton Use: A Randomized Controlled Trial.

Background Anal fistula, or fistula-in-ano, is a chronic abnormal communication between the epithelialized surface of the anal canal and the perianal skin. Video-assisted anal fistula treatment (VAAFT) is a novel, minimally invasive, and sphincter-saving alternative to traditional seton use. This study aimed to determine the short-term and long-term outcomes of VAAFT compared with seton treatment. Material and methods This randomized control trial was conducted at the Department of Surgery, Services Hospital, Lahore, from August 2014 to July 2020. Patients were randomly assigned to either the VAAFT group or the seton group, and postoperative outcomes were assessed for up to three years. Results The study included 80 patients (64 men and 16 women) with a mean age of 39.1 ± 11.2 years. The most common type of fistula was a transsphincteric fistula (n=36, 45%). The mean duration of surgery was significantly longer in the VAAFT group (78.6 minutes) compared with the seton group (36.97 minutes; p=0.000). The mean pain score was significantly higher in the VAAFT group (4.22) compared to the seton group (2.82, p=0.000). The mean time to return to work was shorter in the VAAFT group (7.4 days) than in the seton group (9.2 days, p=0.000). The mean healing time was significantly shorter for patients treated with VAAFT (5.75 weeks) than for those treated with a seton (9.7 weeks; p=0.000). Fistula recurrence after one, two, or three years was not significantly different between groups, and neither group had incidences of anal incontinence. Conclusions VAAFT is associated with earlier healing time and earlier return to work than the traditional seton technique, with no significant difference in fistula recurrence. VAAFT is minimally invasive and, when used in patients where indicated, allows for a prompter return to routine life for the patients, which is an optimal outcome for both patients and physicians.

Role of Laparoscopy in Diagnosing and Treating Acute Nonspecific Abdominal Pain.

Background Nonspecific abdominal pain (NSAP) is a pain for which no immediate cause is evident on acute admission and does not necessitate emergency surgical intervention. NSAP is a frequent reason for presentation in the emergency department (ED). Laparoscopy is a well-established technique that allows a surgeon to visualize the abdominal cavity after insufflation through a few small incision ports. Despite the increasing availability of laparoscopic investigation, the availability of a laparoscope in the ED settings in Pakistan is low due to the expense and maintenance needs of the system. Objective This study aimed to evaluate the role of laparoscopy in diagnosing the cause of acute NSAP and its role in treating the pathology of disease in patients presenting to the emergency department (ED) of Services Hospital, which is a government sector hospital in Lahore, Pakistan. Materials and methods This study was conducted in Services Hospital Lahore, Pakistan, from January 1, 2016 to December 31, 2019. The study included patients aged 12 to 70 years of either sex who presented to the ED with abdominal pain for whom no diagnosis could be achieved on clinical assessment, laboratory findings, and radiological findings (x-ray abdomen, ultrasonography, and computed tomography scan). All study participants underwent diagnostic laparoscopy under general anesthesia. Patients were monitored weekly via follow-up postoperatively for the first month and then monthly for 12 months. All study data were recorded on a predesigned proforma. The data were analyzed using IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Results A total of 122 patients diagnosed with acute NSAP were enrolled in our study (mean age, 46.4 ± 20.3 years). The study population consisted of 52 male patients (42.6%) and 70 female patients (57.4%). Our study participants had a mean body mass index of 24.2 ± 3.3 kg/m2. The most common ED presentation was lower abdominal pain. One hundred sixteen patients (95.1%) had positive findings on laparoscopy, while six patients (4.9%) had no identified pathology on laparoscopy. The most frequent pathology was appendicular in origin, followed by pelvic inflammatory disease. Surgical management of patients through laparoscopy was performed in 97 patients (79.5%). Conversion to laparotomy was done in 12 patients (9.8%). Definite diagnosis was established in 118 patients (96.7%). Port site infection occurred in four patients (3.3%), chest infection in five patients (4.1%), deep venous thrombosis in one patient (0.8%), and anastomotic leakage in one (0.8%) patient. Four patients (3.3%) developed recurrence of symptoms. Conclusions This study explored the role of laparoscopy in diagnosing and treating patients presenting to the ED with acute NSAP. According to our results, laparoscopy is a safe and effective method for diagnosing and treating acute NSAP with low postoperative morbidity and potentially decreased risk of postoperative complications. Physicians should consider laparoscopy as a first-line invasive investigation for patients presenting with undiagnosed acute abdominal pain.

Whipple Procedure: A Five-Year Clinical Experience in Tertiary Care Center.

INTRODUCTION: Whipple procedure is one of the major surgeries performed in tertiary care centers. Once considered a high mortality procedure is now being practicing with mortality declining to less than 5%. This study describes our five-year experience of the Whipple procedure in terms of preoperative, operative, and postoperative parameters of patients undergoing surgery in a local tertiary care setting. MATERIAL AND METHODS: This was a non-randomized interventional study that was conducted at the Surgical Department of Services Hospital Lahore from January 2014 to December 2018. A total of 57 Whipple procedures were performed during this period. Demographic data, presenting symptoms, physical signs, past medical history, preoperative stenting details, intra-operative duration of surgery, postoperative course and complications, pathology, and causes of postoperative death were collected on a pre-designed questionnaire. Data were entered and analyzed by using SPSS 22 (IBM Corp., Armonk, USA). RESULTS: Out of 57 patients, 19 were females and 38 were males. The mean age of patients was 53±05 years. The most common presenting symptom was jaundice 39 (68.4%), followed by abdominal pain 32 (56.1%). The mean size of the tumor on CT-scan was 2.8±1.4 cm, the mean operation time was 315±38.3 min, mean blood loss during surgery was 500±130 ml, and mean hospital stay was 10±6 days. The major postoperative complication was the pancreatic fistula (12%). Twenty-one out of 39 patients presented with jaundice had undergone preoperative biliary stenting by endoscopic retrograde biliary stenting. The most common histological diagnosis was adenocarcinoma of pancreas 19 (33.3%). Out of 57 patients, nine (15.8%) patients expired in the first 30 days and the most frequent cause of mortality was septic shock. CONCLUSION: In this study, the most common presentation of patients undergoing Whipple procedure was obstructive jaundice, the most frequent operative complication was pancreatic fistula, and the most prevalent histopathology was carcinoma of the pancreas. Perioperative parameters such as mean operative time, mean blood loss during surgery, and mean length of hospital stay were comparable with other studies. However, mortality in this study was slightly higher. It can be concluded that with meticulous surgical technique, securing hemostasis strictly and standard critical care postoperatively can decrease morbidity and mortality after the Whipple procedure.

Antibacterial, Structural and Optical Characterization of Mechano-Chemically Prepared ZnO Nanoparticles.

Structural investigations, optical properties and antibacterial performance of the pure Zinc Oxide (ZnO) nanoparticles (NPs) synthesized by mechano-chemical method are presented. The morphology, dimensions and crystallinity of the ZnO NPs were controlled by tweaking the mechanical agitation of the mixture and subsequent thermal treatment. ZnO nanoparticles in small (< 20 nm) dimensions with spherical morphology and narrow size distribution were successfully obtained after treating the mechano-chemically prepared samples at 250°C. However, higher temperature treatments produced larger particles. TEM, XRD and UV-Vis spectroscopy results suggested crystalline and phase pure ZnO. The NPs demonstrated promising antibacterial activity against Gram negative foodborne and waterborne bacterial pathogens i.e. Enteropathogenic E. coli (EPEC), Campylobacter jejuni and Vibrio cholerae as well as Gram positive methicillin resistant Staphylococcus aureus (MRSA), thus potential for medical applications. Scanning electron microscopy and survival assay indicated that most probably ZnO nanoparticles cause changes in cellular morphology which eventually causes bacterial cell death.

An Unusual Cause of Right Iliac Fossa Pain: Caecal Diverticulum Perforation.

Caecal diverticulum perforation is a rare condition. It mimics acute appendicitis and is seldom suspected pre-operatively. Commonly it is discovered during exploration. Ultrasonography and computed tomography are helpful in the diagnosis of the condition. There is controversy regarding the surgical treatment. We are presenting the case of a 44-year male who underwent exploration for suspected acute appendicitis but was found to have a perforated solitary caecal diverticulum. Patient underwent diverticulectomy and made an uneventful recovery.