Quantitative determination of creatinine from serum of prostate cancer patients by N-doped porous carbon antimony (Sb/NPC) nanoparticles.

Creatinine is an indicator of hindrance in urination and renal insufficiency. Creatinine levels are the marker of the late stages of prostate cancer. Early and sensitive detection of creatinine can reduce deaths associated with prostate cancer. In this work, nitrogen-doped porous carbon antimony (Sb/NPC) nanoparticles are fabricated to be employed as a non-enzymatic biosensor. Sb/NPC has promising redox activity and is synthesized by a two-step reaction using low-cost precursors. Electrochemical sensing by Sb/NPC is conducted for standard creatinine solutions on a three-electrodes system. Cyclic voltammetry, amperometry, and electrochemical impedance spectroscopy are used to sense creatinine. LOD and LOQ of the Sb/NPC modified electrode are 0.74 µM and 2.4 µM, respectively. This electrode system analyzes creatinine in the serum of prostate cancer patients who have elevated PSA levels. More than 90% creatinine is recovered from a spiked serum sample of a prostate cancer patient. A direct relation is observed between PSA levels and creatinine levels in prostate cancer. The developed cyclic voltammetric setup detects trace concentrations of creatinine in serum.

Leiomyomatosis peritonealis disseminata: An exceptional case.

Leiomyomatosis peritonealis disseminata is a rare clinical disorder characterised by proliferation of smooth muscles spread all over the peritoneal cavity. History and examination do not help in establishing a proper diagnosis, which is possible only by histopathology. Although LPD is a benign disease which regresses spontaneously, it may degenerate to malignancy, so proper follow up is mandatory. A 38-year-old lady presented with lower abdominal pain on 27th day of her menstrual cycle. Due to suspicion of ovarian cyst accident, laparotomy was performed during which innumerable nodules were found scattered all over the peritoneal cavity. Histopathology revealed leiomyomatosis peritonealis disseminata. The patient was followed up for two years without any treatment and she remained asymptomatic.

Intraperitoneal Bupivacaine as Post-laparoscopic Cholecystectomy Analgesia.

OBJECTIVE: To assess the efficacy of large volumes of diluted intraperitoneal bupivacaine in post-laparoscopic cholecystectomy analgesia. STUDY DESIGN: A randomised controlled trial. PLACE AND DURATION OF STUDY: Department of General Surgery, Nishtar Hospital, Multan, from August 2018 to June, 2019. METHODOLOGY: Two equal groups with 55 patients each were formed. Normal saline 500 ml in group A, and mixture of 20 ml 0.5% bupivacaine in 480 ml normal saline in group B, was used to irrigate peritoneal cavity. Final outcome of the study was the comparison of pain-free duration. Postoperatively, numerical rating scale (NRS) score at various intervals and total analgesics requirement within 24 hours after the procedure were included in the secondary outcomes. Student's t-test was applied on continuous data and Pearson's Chi-square test on nominal variables. P >0.05 was considered of no statistical significance. RESULTS: Both groups were comparable for age, weight, gender, duration of surgery. Postoperative analgesia duration was 0.99 ± 0.51 hours in group A and 16.53 ±2.65 hours in group-B (p<0.001). On average, 124.80 ±26.68 mg and 31.00 ±14.98 mg tramadol was given to group A and B patients, respectively (p<0.001). There was statistically significant difference in NRS score at 30 minutes, 1, 3, 6 and 12 hours postoperatively (p<0.05). NRS score at ETT extubation and at 24 hours was statistically not different (p >0.05). CONCLUSION: Large volume of diluted bupivacaine when injected intraperitoneally during laparoscopic cholecystectomy provides prolonged time pain relief.

Role of honey in wound dressing in diabetic foot ulcer.

BACKGROUND: Honey has antibacterial and antimicrobial properties. This study was conducted to evaluate the efficacy and role of honey as local wound dressing agent in the management of diabetic foot and its effect on rate of amputation. METHOD: This prospective observational study was done in the general surgery department, Al- Noor Specialist hospital, Holly Makkah, KSA from 1st March, 2007 to 31st May, 2008 (15 months). This study includes 172 patients of either gender, above 18 years of age, belonging to different nationalities admitted to A1- Noor specialist hospital, Holly Makkah, KSA. RESULTS: A total of 172 patients with male to female ratio 1.54:1 were admitted from 1st March, 2007 to 31st May, 2008 with complicated and non-healing diabetic foot ulcers. Out of these 172 patients, 135 (78.48%) were Saudi and 37 (21.52%) were non Saudi residents with ratio of 3.6:1. After admission and resuscitation, all the patients under went early surgical debridement and dressing with the thick layer of honey locally available. Wounds became healthy within 7-35 days. Three patients (1.75%) underwent big toe amputation and 2 (1.16%) patients under.went below knee amputations. Twenty (11.6%) patients under went split skin grafting to cover the wound while in other patients wound healed by secondary intention. CONCLUSION: Use of honey significantly reduced rate of amputation and improve wound healing when used for wound dressing in chronic diabetic foot ulcers.

Role of ultrasonography in early diagnosis of infantile hypertrophic pyloric stenosis.

BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of gastric outlet obstruction in infants. This study was conducted to identify the accuracy of ultrasonography in the diagnosis of infantile Hypertrophic pyloric Stenosis. METHODS: This cross-sectional descriptive study was conducted in Department of Paediatric Surgery, Children Hospital Complex & the Institute of Child Health, Multan during two year period from 1st July, 2010 to 30t of June, 2012. Fifty patients <8 weeks of age who presented with complaints of non-bilious vomiting were included in the study. Abdominal ultrasound was performed in all the cases. On ultrasonography pyloric canal length, diameter and pyloric muscle wall thickness was measured. Open surgery was performed as per indications and after informed consent. The pre-operative findings were compared with ultrasongraphic findings. Study variable were male to female ratio, percentage of - cases in which pyloric mass was palpable. We also compare the duration of onset of symptorms with pyloric canal length, diameter and muscle thickness. RESULTS: In this study, out of 50 patients, 46 (92%) were male and 4 (8%) were females. Gastric peristalsis was visible in 100% patients and mass was palpable in 14 (28%) patients. Pyloric canal length was more than standard in 98% cases; canal diameter was more than the standard in 87% cases and pyloric muscle thickness in 60% of cases. Ultrasonographic findings remained 98% accurate in this study. CONCLUSION: Ultrasonography is an investigation of choice for early diagnosis of IHPS before significant fluid and electrolyte imbalance occur. It is cost effective, harmless, freely available and easier to perform. Pyloric canal length and diameter are more specific for the diagnosis of IHPS than pyloric muscle thickness.

Single versus 3-dose antibiotic prophylaxis in clean and clean contaminated operations.

BACKGROUND: Infection is a great problem in surgery and is encountered by all surgeons by nature of their craft; they invariably impair the first line of host defence. Bacteria may enter the wound during or after the operation and may be of endogenous or exogenous origin. The objective of this study was to determine the effectiveness of preoperative antibiotic prophylaxis in reduction of postoperative wound infection in clean and clean contaminated procedures and to compare the cost of antibiotic prophylaxis in both groups. METHOD: This was a prospective study done on patients in General Surgery Department, Al-Noor Specialist Hospital, Holly Makkah, Saudi Arabia from 1st April 2006 to 30th March 2007. Total 400 patients were divided into 2 groups of 200 patients each: Group-A received single dose antibiotic prophylaxis, and Group-B received 3 doses of antibiotic therapy. Only clean and clean contaminated procedures were included and results were compared. RESULTS: In Group A, clean procedures (Group-Al) were 110, and clean contaminated (Group-A2) were 90 patients. In clean procedure, rate of infection was 5 out of 110 (4.54%) and in clean contaminated procedures it was 3 out of 90 (3.33%). In Group B, in clean procedures (Group-B1), rate of infection was 7 out of 90 (7.77%), while in clean contaminated procedures (Group-B2) it was 9 out of 110 (8.18%) patients. Over all wound infection rate after single dose antibiotic prophylaxis was 4% in both procedures and 8% after 3-dose antibiotic therapy. CONCLUSION: Single dose antibiotic prophylaxis is as effective as 3-dose therapy in clean and clean contaminated procedures to prevent wound infection and is cost-effective.

Prevalence of necrotizing fasciitis during Ramadan and Hajj 1427-H.

BACKGROUND: Necrotizing Fasciitis is a rare progressive disease which results in significant rate of mortality and morbidity if there is any delay in diagnosis and treatment. Objectives of this Prospective observational study were to share our experience of dealing necrotizing fasciitis in terms of different presentations, diagnosis, treatment and outcome during Ramadan and Hajj. It was conducted in the Department of General Surgery, Al-Noor Specialist Hospital, Holly Makkah, KSA during Ramadan and Hajj period from 1-8-1427 to 30-1-1428. METHODS: Total 35 patients > 12 years of age, irrespective of the gender belonging to different nationalities admitted to Al-Noor specialist hospital, Makkah, KSA were included in this study to evaluate the different causative factors, presentations, response to medical/surgical treatment and outcome. RESULTS: Total 35 patients with male to female ratio of 6:1 were admitted during Ramadan and Hajj period from 1-8-1427 to 30-1-1428 (six months) with the features of necrotizing Fasciitis. Out of these 35 patients, 23 (65.7%) were Hajji and 12 (34.28%) were residents (Both Saudi and non Saudi) with a ratio of 2:1. Major co-morbid factors were old age, diabetes mellitus, hypertension and renal failure. Among systemic manifestations, 4 (11.42%) developed septic shock and admitted to ICU, 4 (11.42%) needed ventilator support for respiratory failure, and 5 (14.28%) patients developed Myocardial infarction. After resuscitation, 33 patients under went aggressive surgical debridement and two patients died before surgery. Microbiology revealed, 15 (42.85%) Streptococcus Group-A infection, 13 (8.51%) Polymicrobial and 4 (11.42%) MRSA. Diagnosis was conformed by histopathology. Mortality rate was 11.5%. CONCLUSION: Better outcome in necrotizing fasciitis depends upon early presentation, prompt diagnosis and aggressive surgical debridement. There was strong correlation between severity of necrotizing fasciitis and co morbid factors, general condition at presentation, systemic toxicity and raised WBC count.

Spontaneous cholecystocutaneous fistula.

We report a case of cholecystocutaneous fistula in a 90 years old female as a complication of gallstone disease. Patient presented with necrotizing fasciitis of anterior abdominal wall and cholecystocutaneous fistula. She was bedridden for the last 3 years due to cerebral vascular accident. She was a known case of chronic cholecystitis and 2 years back common bile duct stenting was done, in Jeddah, for obstructive jaundice but cholecystectomy was not done because patient was not fit for surgery.