Distal Duodenal Stricture Secondary to Mesenteric Fibromatosis (Intra-Abdominal Desmoid Tumor) of the Jejunum.

Introduction: Mesenteric fibromatosis (intra-abdominal desmoid tumor) is rare, with only a few cases reported in the literature. Clinical symptoms range from asymptomatic, nausea, early satiety, abdominal pain, and gastrointestinal bleeding. Although histologically benign, such a tumor may become locally invasive, and aggressive forms contribute to significant morbidity and mortality. Case Presentation: We report the case of a 52-year-old West African male with a 1-year history of intermittent hematochezia and intermittent bloating. Colonoscopy revealed a 4-mm rectal polyp and internal hemorrhoids. Esophagogastroduodenoscopy revealed a severe duodenal stricture 4-5 cm distal to the ampulla. Further work-up with contrast-enhanced computed tomography of the abdomen and pelvis revealed a 5.0 × 3.7 × 4.3-cm mass within the mesentery, encasing the distal portion of the duodenum. Exploratory laparotomy was performed, and the mass was excised from the jejunum. Histopathology findings and immunohistochemical analysis revealed the diagnosis to be mesenteric fibromatosis (desmoid tumor), positive for nuclear ß-catenin and SMA, and negative expression of STAT6, desmin, caldesmon, pan-cytokeratin, or c-KIT. The Ki67 index is <1%. Conclusion: This case report highlights the diagnostic challenges of mesenteric fibromatosis due to its nonspecific clinical presentation. Recognizing uncommon presentations of mesenteric fibromatosis and risk factors aids in early diagnosis, management, and treatment. Importantly, this also aids in the prevention of complications such as intestinal obstruction, bowel ischemia, and fistula formation.

The Patterns of Impacted Third Molars and Their Associated Pathologies: A Retrospective Observational Study of 704 Patients.

Background: The study aims to investigate parameters in patients attending Fujairah Dental Center, including assessing the prevalence of impacted teeth, determining the frequency of associated pathological conditions, and evaluating the patterns and angulations of impacted third molars. Methods: It is a retrospective descriptive study of the panoramic radiographs of patients who attended Fujairah Dental Center for dental care between January 2011 and December 2017. The minimum age for inclusion was 17 years. Clinical records were used to obtain the demographic details of patients, such as age, gender, nationality, medical history, and smoking history. Seven hundred and four panoramic radiographs and clinical records of patients were analyzed. The age range was between 17 and 112 years old, with a mean age of 34 years (S.D 13.5). Results: Of the 704 panoramic radiographs evaluated, 236 (33.6%) X-rays showed teeth impaction with a total of 562 impacted teeth in the upper and lower jaws. Five hundred and twenty-five (93.4%) were impacted third molars, and 37 (6.5%) teeth were other kinds of impacted teeth. Females showed a higher frequency of impacted teeth (62.6%) compared to males (37.4%). The highest prevalence of impacted teeth was found in the 17-25 year age group (61%), and the prevalence declined with advancing age. Impacted third molars were more likely to occur in the mandible (57.3%) than in the maxilla (42.7%). Most of the impacted third molars were in the mesioangular position, followed by the vertical position. The evaluation of the depth of impacted third molars demonstrated that level C impaction was the most frequently seen, followed by level B impaction. Impacted third-molar teeth often presented with two roots (60.7%), followed by a single root (31.3%). An evaluation of the relationship between lower third molars and the inferior dental canal (IDC) revealed that the most frequently observed relation was interrupted (61.5%), followed by a distant relation to the ID canal, and 13% were superimposed. The most common morphological pattern of roots of the impacted third molars was either straight-type or curved and dilacerated roots (5.7%). Additionally, the most noticed pathological conditions associated with impacted teeth were carious second molars adjacent to impacted third molars (42%), which was more likely to be seen in the 17-25-year age group, with females having a higher prevalence than males.

Bilateral adrenal histoplasmosis presenting as adrenal mass mimicking malignancy in an immunocompetent patient.

We report a case of a 78-year-old immunocompetent man who presented with worsening fatigue and lethargy for one month. He had also been complaining of cough and SOB for two months which had been attributed to his underlying COPD and possible pneumonia. CT showed bilateral pleural effusions, ground-glass opacities, cirrhosis, splenomegaly and bilateral adrenal masses which was highly suspicious for malignancy. After pheochromocytoma was ruled out, EUS-FNA guided biopsy was performed on the left adrenal gland. Histology was positive for yeast cells, with fungal staining (PAS) revealing narrow-based budding compatible with Histoplasma. The patient was treated with amphotericin and itraconazole. Our case is unique as he presented with hepatosplenomegaly, which is reported in less than a quarter of cases. Although typically a diagnosis in immunocompromised patients, a high index of clinical suspicion is required to diagnose disseminated histoplasmosis in an immunocompetent patient. The gold standard for diagnosis is fungal tissue culture. However results may take up to weeks. EUS-FNA guided biopsy of adrenal glands can aid in early definitive diagnosis and management.

Evaluation of risk factors for unanticipated hospital admission following ambulatory surgery - An observational study.

Context: Unanticipated admissions following ambulatory surgery significantly affect hospital admission and operation room flow. Most of the factors responsible for unanticipated admission following ambulatory surgery were preventable. It is, therefore, crucial to improve patient selection criteria and to identify the risk factors for unanticipated admission during preoperative period. These unanticipated admissions have now been considered as quality care indicator and a target to improve healthcare costs. Aims: To assess the reasons and risk factors for unanticipated hospital admission after ambulatory surgery. Settings and Design: Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia. Methods and Materials: In this case-control study, cases who were re-admitted within 48 hours following ambulatory surgery were included. The convenience sampling was used to identify controls. Data including patients' demographics, type of anesthesia and surgery, any intraoperative or postoperative complications, etc., were extracted. Statistical Analysis Used: Descriptive statistics is used to summarize the study variables. Mean and standard deviation were used for quantitative variables. Percentage and frequencies were used for qualitative variables. Univariate and multivariate logistic regressions were used to assess risk factors for unanticipated hospital admission after ambulatory surgery. Results: There were 153 cases and 147 controls in this study. The study found postoperative pain as the most common reason for re-admission after ambulatory surgery followed by bleeding, fever, and asthma exacerbation. Multivariate logistic regression showed age, BMI more than 40, and presence of respiratory disease as risk factors (P < 0.05). Conclusions: Age, high BMI more than 40, and presence of respiratory disease increase the risk of unanticipated hospital admission after ambulatory surgery.

Diagnostic accuracy of the Patient Health Questionnaire 2 (PHQ-2) in Qatar's primary care settings.

This cross-sectional study was designed to establish diagnostic accuracy of the Patient Health Questionnaire 2 in Qatar's primary care population. The data required for the study were anonymously extracted from Qatar's primary care electronic medical record system. The sensitivity, specificity, predictive values, negative values and optimal cut-off points were calculated for the tool. A total of 6921 individuals met the study's inclusion criteria. The diagnostic accuracy of cut-off values was calculated for scores 1-6. Based on the Youden's index (0.58), a score of 2 was identified as the most optimal cut-off. It offers a sensitivity of 88.73% and specificity of 69.31%. Further studies should aim to confirm the results using alternative study designs and to report them in accordance to population characteristics both in Qatar and internationally.

An Integrated Deep Learning and Belief Rule Base Intelligent System to Predict Survival of COVID-19 Patient under Uncertainty.

The novel Coronavirus-induced disease COVID-19 is the biggest threat to human health at the present time, and due to the transmission ability of this virus via its conveyor, it is spreading rapidly in almost every corner of the globe. The unification of medical and IT experts is required to bring this outbreak under control. In this research, an integration of both data and knowledge-driven approaches in a single framework is proposed to assess the survival probability of a COVID-19 patient. Several neural networks pre-trained models: Xception, InceptionResNetV2, and VGG Net, are trained on X-ray images of COVID-19 patients to distinguish between critical and non-critical patients. This prediction result, along with eight other significant risk factors associated with COVID-19 patients, is analyzed with a knowledge-driven belief rule-based expert system which forms a probability of survival for that particular patient. The reliability of the proposed integrated system has been tested by using real patient data and compared with expert opinion, where the performance of the system is found promising.

Coexisting Cirrhosis Worsens Inpatient Outcomes in Patients With Infective Endocarditis: A Cross-Sectional Analysis of the National Inpatient Sample 2013-2014.

Introduction Cirrhosis is known to be an important prognostic factor in determining morbidity and mortality in preoperative cardiac risk assessment for cardiac surgery. Data is limited on outcomes in patients with infective endocarditis (IE) and comorbid liver cirrhosis. The objective of our study is to evaluate the clinical outcomes in patients suffering from IE both with and without underlying liver cirrhosis as well as to determine rates of in-hospital mortality and factors that contribute to this outcome. Hypothesis Liver cirrhosis worsens clinical outcomes in patients with IE. Materials and methods Patients with a principal diagnosis of IE with and without liver cirrhosis were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically the National Inpatient Sample for the years 2013 and 2014 using International Classification of Diseases, Ninth Revision (ICD-9) codes. Results During 2013 and 2014, a total of 17,952 patients were admitted with a diagnosis of IE, out of whom 780 had concurrent liver cirrhosis. There was increased in-hospital mortality [15.6% vs 10.2%, aOR = 1.57 (1.27-1.93)], acute kidney injury [41.4% vs 32.6%, aOR = 1.45 (1.24-1.69)], and hematologic complications [32.1 vs 14.7%, aOR = 2.87 (2.44-3.37)] in patients with IE with liver cirrhosis when compared to patients with IE without liver cirrhosis. Patients having IE without liver cirrhosis underwent an increased number of interventions, i.e. aortic (7.2 vs 3.7%, aOR = 0.51 (0.34-0.76)) and mitral (4.9% vs 3.4%, aOR = 0.39 (0.23-0.69)) valvular replacements as compared to those with liver cirrhosis, which may explain the increased mortality seen in patients with liver cirrhosis. Conclusion Liver cirrhosis is an important prognostic risk factor for in-hospital mortality in patients with IE. The coagulopathic state in addition to increased rates of bleeding complications and renal dysfunction make these patients poor surgical candidates thus contributing to higher mortality. Further research into the individual risk factors contributing to the increased mortality rates in patients with IE and cirrhosis is required.

Extensive Circumferential Heterotopic Ossification Discovered at the Base of a Loop Ileostomy.

Heterotopic ossification is a rare phenomenon defined by the formation of bone within nonossifying soft tissues. A rare variant of heterotopic ossification is heterotopic mesenteric ossification (HMO), in which there is involvement of the mesentery and surrounding intra-abdominal structures. There are only four previously reported cases of HMO involving an ileostomy. We present a case of HMO affecting an ileostomy which was discovered during elective stoma reversal in a 52-year-old male who required fecal diversion following perineal necrotizing fasciitis.

Hepatitis C virus and its genotypes in chronic liver disease patients from Meghalaya, Northeast India.

BACKGROUND AND OBJECTIVES: Hepatitis C virus (HCV) is an important cause of chronic liver disease (CLD). Although Northeast India is believed to be a HCV hotspot, the proportion of HCV infection and the distribution of HCV genotypes in CLD cases from the region are not known. The objectives of the study were to determine the proportion of HCV infection in newly diagnosed CLD patients from Meghalaya, Northeast India, and further investigate the HCV genotype distribution in those patients. MATERIALS AND METHODS: The aetiology of CLD was evaluated in 196 newly diagnosed patients, recruited consecutively over a period of 1 year in a medical college hospital from Meghalaya. Those positive for HCV infection were genotyped, and the mode of transmission of the virus was investigated. RESULTS: A considerable proportion (43 patients, 21.9%) of CLD patients were positive for HCV (95% confidence interval [CI]: 16.7%-28.2%). Other leading causes of CLD were alcohol (36.32%) and hepatitis B virus infection (39.3%). Genotype 3 was the most prevalent (48.7%, 95% CI: 33.9%-63.8%), followed by genotype 6 (30.8%, 95% CI: 18.6%-46.6%) and genotype 1 (20.5%, 95% CI: 10.8%-35.5%). The frequency of genotype 6 was remarkably higher than in the other regions of India. Injecting drug use appeared to be the most common mode (28 patients) of acquiring HCV. This was true irrespective of the genotype. CONCLUSIONS: The presence of HCV in newly diagnosed CLD cases from Meghalaya was considerable. The genotype distribution of HCV was distinct from the other regions of India.

The birth prevalence, severity, and temporal trends of congenital heart disease in the middle-income country: A population-based study.

OBJECTIVES: There is limited data on congenital heart disease (CHD) from the lower- and middle-income country. We aim to study the epidemiology of CHD with the specific objective to estimate the birth prevalence, severity, and its trend over time. DESIGN: A population-based study with data retrieved from the Pediatric Cardiology Clinical Information System, a clinical registry of acquired and congenital heart disease for children. SETTING: State of Johor, Malaysia. PATIENTS: All children (0-12 years of age) born in the state of Johor between January 2006 and December 2015. INTERVENTION: None. OUTCOME MEASURE: The birth prevalence, severity, and temporal trend over time. RESULTS: There were 531,904 live births during the study period with 3557 new cases of CHD detected. Therefore, the birth prevalence of CHD was 6.7 per 1000 live births (LB) (95% confidence interval [CI]: 6.5-6.9). Of these, 38% were severe, 15% moderate, and 47% mild lesions. Hence, the birth prevalence of mild, moderate, and severe CHD was 3.2 (95% CI: 3.0-3.3), 0.9 (95% CI: 0.9- 1.1), and 2.6 (95% CI: 2.4-2.7) per 1000 LB, respectively. There was a significant increase in the birth prevalence of CHD, from 5.1/1000 LB in 2006 to 7.8/1000 LB in 2015 (P < .0001) due to increase in detection of both mild (1.9/1000 LB in 2006 to 3.9/1000 LB in 2015, P < .001) and severe CHD (1.8/1000 LB in 2005 to 2.9/1000 LB in 2015, P < .001). CONCLUSIONS: The birth prevalence of CHD was 6.7 per 1000 live births, and two in five were severe and significantly associated with syndrome and extracardiac defect. There was a significant increase in the detection of severe lesions in recent years leading to more burden to resources that are already limited in the middle-income country. Therefore, strategic and comprehensive pediatric and congenital heart surgery program is required.

Survival and Associated Risk Factors for Mortality Among Infants with Critical Congenital Heart Disease in a Developing Country.

Critical congenital heart disease (CCHD) is associated with significant morbidity and mortality. However, data on survival of CCHD and the risk factors associated with its mortality are limited. This study examined CCHD survival and the risk factors for CCHD mortality. Using a retrospective cohort study of infants born with CCHD from 2006 to 2015, survival over 10 years was estimated using Kaplan-Meier analysis, and the risk factors for mortality were analyzed using multivariate Cox proportional hazards regression. A total of 491 CCHD cases were included in the study, with an overall mortality rate of 34.8% (95% confidence interval [CI] 30.6-39.2). The intervention/surgical mortality rate was 9.8% ≤ 30 days and 11.5% > 30 days after surgery, and 17% died before surgery or intervention. The median age at death was 2.7 months [first quartile: 1 month, third quartile: 7.3 months]. The CCHD survival rate was 90.4% (95% CI 89-91.8%) at 1 month, 69.3% (95% CI 67.2-71.4%) at 1 year, 63.4% (95% CI 61.1-65.7%) at 5 years, and 61.4% (95% CI 58.9-63.9%) at 10 years. Weight of < 2 kg at diagnosis, associated syndromes, poor pre-operative condition, and non-duct-dependent CCHD were independent risk factors for poor survival, with hazard ratios of 2.61, 2.10, 2.22, and 1.70, respectively. CCHD is associated with a high mortality rate. Low weight, poor pre-operative condition, associated syndromes, and non-duct-dependent CCHD are significant risk factors affecting the survival of infants with CCHD.

Tuberculosis-Related Diabetes: Is It Reversible after Complete Treatment?

Individuals with newly diagnosed tuberculosis (TB) were screened for diabetes (DM) with fasting plasma glucose (FPG) in Pakistan. A significant decrease in FPG was observed when TB was treated. Of those with newly diagnosed DM, 46% and 62% no longer had hyperglycemia after 3 and 6 months, respectively. Individuals with known DM also showed a significant decrease in fasting plasma levels when treated for TB, but after 3 months none had normoglycemia, and after 6 months 9.2% were normoglycemic. Thus, TB-related DM may abate when the stress terminates, as is the case in gestational DM. However, because stress hyperglycemia may be associated with subsequent risk of developing DM, follow-up is recommended.

High prevalence of diabetes and anthropometric heterogeneity among tuberculosis patients in Pakistan.

BACKGROUND: In Pakistan, the prevalence of diabetes (DM) among adults is 6.9% and expected to double by 2040. DM may facilitate transmission and halter the elimination of tuberculosis (TB). We aimed to determine the prevalence of DM among patients with TB in Pakistan, and to investigate anthropometric biochemical and haemodynamic associations between TB patients with and without DM. METHODS: We conducted a cross-sectional study at Gulab Devi Chest Hospital in Lahore, Punjab. A total of 3027 newly diagnosed smear-positive TB patients ≥25 years of age were screened for DM by HbA1c regardless of previous DM history. RESULTS: The prevalence of screen-detected DM and known DM among the TB participants was 13.5% and 26.1%, respectively, resulting in a combined DM prevalence of 39.6%. Most participants were male (64.4%). Using bivariate analyses, participants with DM were significantly older (49.8 vs. 40.6 years) with higher haemoglobin (men, 12.1 vs. 11.8 g/dl, women 11.5 vs. 10.7 g/dl), body mass index (21.0 vs. 17.6 kg/m2 ) and waist-hip ratio (men, 0.87 vs. 0.81, women, 0.87 vs. 0.79) (all P < 0.05) than participants without DM. Stratifying by screen-detected and known DM, these differences remained significant when using multivariate analysis. CONCLUSION: We report a high prevalence of DM among patients with TB who may be anthropometrically and biochemically distinct from TB patients without DM, and this heterogeneity further transcends the different DM groups.

Comparison of Outcome of Percutaneous Nephrolithotomy in Adult Versus Paediatric Patients.

OBJECTIVE: To compare the outcome of percutaneous nephrolithotomy (PCNL) in terms of operative time, hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients. STUDY DESIGN: Descriptive case series. PLACE AND DURATION OF STUDY: Shifa International Hospital, Islamabad, from January 2010 to December 2013. METHODOLOGY: Aretrospective analysis of 155 patients who underwent PCNL from January 2010 to December 2013. The patients were divided into 2 groups: patients aged ≤12 years were included in paedriatic group (A) while patients aged > 12 years were included in adult group (B). The patients were analyzed for age, gender, stone size, operative time, stone clearance, hospital stay, and peroperative and postoperative complications. Data was collected by chart review on specified proforma. RESULTS: One hundred and twenty-nine (129) patients including 44 (34.10%) females and 85 (65.89%) males with a mean age of 45.00 ±1.44 years were adults. Twenty-six palrents with mean age of 9.21 ±5.70 years, 17 (65.4%) males and 9 (34.6%) females, were included in the paedriatic group. Mean stone size was 2.12 ±1.01 cm in paedriatic group compared to 2.52 ±0.77 cm in adult group (p = 0.023). Mean operative time in paedriatic group was 158.8 ±39.63 minutes compared to 119.34 ±37.06 minutes in adult group (p < 0.001). Mean hospital stay in paedriatic group was 2.76 ±1.14 days compared to 3.12 ±1.27 days in adult group (p=0.1881). Peroperative stone clearance was in paedriatic group was 93.28 ±9.23% compared to 90.81 ±12.23% in adult groups (p = 0.331). One patient in the adult group developed urosepsis. CONCLUSION: There was no significant difference in outcome of percutaneous nephrolithotomy in terms of hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients. Operative time was significantly shorter in adult cases compared to paedriatic cases.

Efficacy of ondansetron alone and ondansetron plus dexamethasone in preventing nausea and vomiting after middle ear surgery.

BACKGROUND: Post-operative nausea and vomiting is one of the most frequently occurring side effects affecting one third of the cases. Objective of the study was to compare the efficacy of ondansetron alone and ondansetron plus dexamethasone in preventing postoperative nausea and vomiting after middle ear surgery. METHODS: This randomized controlled trial was conducted at the Anaesthesia and ENT departments of Ayub Medical College, Abbottabad from January-June 2012. Forty American Society of Anaesthesiologists (ASA) I and 2 physical status patients undergoing middle ear surgery were divided into two groups by blocked randomization. Patients in group-1 (n = 20) received ondansetron 4 mg while group-II (n = 20) received ondansetron 4 mg with dexamethasone 8 mg just before start of operation. The whole postoperative period of 24 hours was divided into two phases, early 0-6 hours and late phase 6-24 hour. RESULTS: Nausea score and its frequency was significantly higher in Group-I (p < 0.05). Vomiting and its frequency were found more in group-I patients. In Group-II, the nausea score was significantly less (p < 0.01) at 6 and 24 hours after surgery. The total incidence of vomiting was reduced from 28% in group-1 to 6% in group-II. Rescue antiemetic requirement was significantly less (p < 0.01) in group-II. CONCLUSION: Prophylaxis with a combination of ondansetron and dexamethasone decreased the incidence of nausea and vomiting after middle ear surgery.

Satisfactory outcomes with usage of extended criteria donor (ECD) kidneys in re-transplant recipients.

BACKGROUND: The use of extended criteria donor (ECD) kidneys have increased substantially and the benefit recognized in certain populations. Our institution has maintained a policy of aggressively utilizing ECD kidneys, even among those who have failed a previous transplant. Previous reports on the benefit of ECD in re-transplants have shown equivocal outcomes. We sought to determine if our experience would support or refute this finding. MATERIAL AND METHODS: This is a retrospective study of 19 ECD re-transplants between 2002 and 2010. We compared 1 and 3 year outcomes with 95 patients with standard criteria donor (SCD) re-transplant and 169 patients with first time transplant using ECD kidneys. Outcomes and demographics were evaluated including delayed graft function (DGF), HTN, DM, cold ischemia time (CIT), BMI, donor age and prior allograft nephrectomies using a Cox Proportional Hazard model. We compared patient and graft survival using the log rank test. RESULTS: Patient survival were similar among the first time ECD and ECD re-transplant groups at 1 year (p=0.9547) and at 3 years (p=0.8287). Graft survival was also similar between first time ECD and ECD re-transplant groups at 1 year (p=0.4781) and at 3 years (p=0.8519). As expected, SCD re-transplant had better outcomes than the other groups. CONCLUSIONS: 1 and 3 years graft and patient survival among first time ECD transplants and ECD re-transplants are similar. As the list of patients on dialysis is ever growing, it may be prudent to aggressively explore the utility of using ECD kidneys in re-transplant patients.

Non-attendance to the paediatric clinics in a Malaysian tertiary hospital: a sizeable problem and identification of an efficacious intervention.

AIM: To determine the rate, causes and risk factors of non-attendance to the paediatric clinic in a tertiary hospital in Malaysia and to determine the efficacy of one telephone call to confirm a new appointment. METHODS: For all non-attending patients, during a 2-month period, a pro forma was filled up based on patients' records. During a phone call, additional questions were asked, and a new appointment was offered. RESULTS: Of 1563 patients who had an appointment, 497 (31.8%) were non-attendees. Weather conditions, the sub-specialty and timing (morning or afternoon) had a significant effect on non-attendance. Forgetfulness was the main cause. Only 160 patients could be successfully contacted. Among the contactable patients, 55 already had an appointment, and 10 had reasons not to get a new appointment. Of the 95 remaining patients, 73 (76.8%) attended the new appointment. CONCLUSION: The non-attendance rate was high. One telephone call had a reasonable efficacy for the contactable patients, but because a high number of patients were not contactable, overall effectiveness was poor.

Experience of extracorporeal shockwave lithotripsy for kidney and upper ureteric stones by electromagnetic lithotriptor.

BACKGROUND: Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive treatment of urinary stones which breaks them, by using externally applied, focused, high intensity acoustic pulse, into smaller pieces so that they can pass easily through ureter. Shock wave generation, focusing, coupling and stone localisation by fluoroscope or ultrasound are the basic components of ESWL. ESWL has some complications and is contraindicated in certain situations. The aim of this study was to evaluate the effectiveness and safety of ESWL in kidney and upper ureteric stones by Electromagnetic Lithotriptor. METHODS: All adult patients with renal and upper ureteric stones having a diameter of up to 1 Cm were included in the study. Basic evaluation such as history, examination, ultrasound and excretory urography were performed. Electromagnetic lithotripsy was done and data were collected on a printed proforma from 1st January 2008 to 30th March 2009 in Institute of Kidney Diseases, Peshawar. RESULTS: Out of a total of 625 patients 463 were male and 162 were female; 67.36% of patients were having renal stones, 23.84% upper ureteric and 8.8% both renal and ureteric stones. Complications noted were renal colic in 9.76%, haematuria in 3.2%, steinstrasse in 2.72%, and fever in 1.12% of patients. The stone free rate was 89% and 7% of patients were having stone fragments <4 mm. ESWL failed in 4% of patients. CONCLUSION: ESWL is a safe and effective way of treating kidney and upper ureteric stones.

Nifedipine versus terbutaline for tocolysis in external cephalic version.

OBJECTIVE: To study the efficacy of nifedipine compared with terbutaline as a tocolytic agent in external cephalic version (ECV). METHODS: A prospective, randomized, comparative trial was carried out in a tertiary hospital. Women with singleton term breech pregnancies were randomized for nifedipine (group A) and terbutaline (group B) tocolysis for ECV in an outpatient setting. The efficacy, side effects, and complications were analyzed and compared. RESULTS: A total of 86 women were recruited with 43 women in each group. The overall success rate was 48.8% and this reduced the rate of cesarean delivery for breech presentation by 32.5% in our center. ECV was successful in 39.5% of women in group A and 58.1% in group B. Fewer side effects were experienced by the women in group A compared with group B, although this was not significant. CONCLUSION: Nifedipine can be used as an alternative for tocolysis in ECV when there are maternal contraindications to beta-sympathomimetics.