An assessment of the quality and content of information on diverticulitis on the internet.

AIM: Although commonly the first port of call for medical information, the internet provides unregulated information of variable quality. We aimed to evaluate commonly accessed web-based patient information on diverticulitis using validated and novel scoring systems. METHODS: The top internet search engines (Google/Bing/Yahoo) were queried using the keyword 'diverticulitis.' The first 20 websites from each were graded using the DISCERN and Journal of the American Medical Association (JAMA) benchmark criteria. A novel diverticulitis-specific score was devised and applied. RESULTS: Thirty-six unique websites were identified. The mean total DISCERN score for all websites was 39.92 ± 12.44 (range = 18-62). No website achieved the maximum DISCERN score of 75. The mean JAMA and diverticulitis scores were 2.5 ± 1.08 (maximum possible score = 4) and 11.08 ± 4.17 (19 points possible) respectively. Fourteen (35.9%) and 20 (51.2%) did not provide the date of last update and authorship respectively. Thirty-three (84.6%) mentioned surgery as a treatment option; however, the majority (69.7%) did not describe the surgery or the possibility of a stoma. All except two described disease symptoms. Only ten (25.64%) provided information on when to seek further medical advice or help. CONCLUSION: Web-based information on diverticulitis is of variable content and quality. The majority of top websites describe disease symptoms and aetiology; however, information to prompt seeking medical attention if required, descriptions of surgical procedures and the possibility of stoma creation are poorly described in the majority of websites. These findings should be highlighted to patients utilising the internet to obtain information on diverticulitis.

Ascitic Fluid Culture in Cirrhotic Patients with Spontaneous Bacterial Peritonitis.

OBJECTIVE: To determine the frequency and compare the culture yield of bacterial isolation by conventional and blood culture BACTEC bottle techniques in cirrhotic patients with spontaneous bacterial peritonitis (SBP). STUDY DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: Pathology Department, Bannu Medical College, Bannu, KPK, from January 2012 to December 2013. METHODOLOGY: Paracentesis of 20 ml of ascitic fluid tapped from cirrhotic patients with SBPwas carried out by a single technologist. The analysis included differential leukocyte count (DLC), while 5 ml each of the fluid was inoculated into conventional culture media and BACTEC blood culture bottle. All the data were analysed on (SPSS) version 16 to determine frequencies with percentages and mean values with standard deviation. Chi-square test was used for comparing the yield of conventional and blood culture bottle methods. P-value was considered significant if < 0.05. RESULTS: In 105 cases of ascitic fluid analyses, 27 (25.72%) had positive ascitic fluid culture whereas 78 (74.28%) had negative ascitic fluid culture. Ascitic fluid culture was positive in 6 cases by conventional culture media and in 27 cases by BACTEC culture bottle media (p < 0.001). Bacterial isolation was obtained by both culture methods in 6 cases (p < 0.001). CONCLUSION: Direct bedside inoculation of ascitic fluid by BACTEC culture bottle method has better yield as compared to conventional culture method.

Seminal volume in the investigation of male infertility.

OBJECTIVE: To determine the seminal volume among infertile males and the frequency distribution of hypospermic and hyperspermic patients in infertile males. STUDY DESIGN: Cross-sectional observational study. PLACE AND DURATION OF STUDY: Department of Reproductive Physiology/Health, Public Health Laboratories Division, National Institute of Health, Islamabad, from 2002 to 2009. METHODOLOGY: Semen examinations of infertile male were carried out according to the standardized method of the World Health Organization. Seminal volume of 2-6 ml were considered normal, while volumes less than 2 ml and higher than 6 ml were considered hypospermic and hyperspermic respectively. RESULTS: Out of 1521 patients, 355 were hypospermic (23.34%), 1046 were normospermic (68.78%) while 120 were hyperspermic (7.88%). In the hypospermic cases, 57 out of 355 (16.05%) had a volume of less than 1 ml. Of those 57 patients, 34 were found to be azoospermic, 12 were asthenozoospermic, one each were terato- and polyzoospermic, while 6 had normal counts. Among the hyperspermic patients (n=120), 3 were azoospermic, 24 were oligozoospermic and 19 cases (15.84%) had count within the normal range, while 1 patient was polyzoospermic. Significant differences (p < 0.05) were observed among azoospermic, oligoasthenozoospermic and teratozoospermic groups when comparing hypo and hyperspermic patients. CONCLUSION: Seminal volume is an important parameter for assessment of infertility investigation and its abnormalities constitute a valuable index of problems with the male partner, even if the count and motility are well within the acceptable limits.

Assessment of the level of trace element zinc in seminal plasma of males and evaluation of its role in male infertility.

BACKGROUND: Male infertility is a serious problem all over the world. Nutritional deficiency of trace element Zinc (Zn) may play a role in male infertility as Zn plays an important role not only in normal testicular development, but also in spermatogenesis and sperm motility. Deficiency of Zn is associated with hypogonadism and insufficient development of secondary sex characteristics. OBJECTIVE: The present study was designed to analyze the level of seminal Zn among different groups of infertile patients and to correlate it with sperm concentration, active, sluggish and immotile fractions of seminal parameters, with an objective to establish the role of Zn in male infertility. SETTING AND DESIGN: The present study was carried out in five- years period from 2004 to 2009. It was a descriptive analytical study with non probability sampling. MATERIALS AND METHODS: Semen examination of the patients was carried out according to the standardized method of the World Health Organization. Semen Zn was estimated by color 5 Br. PAPS method. STATISTICAL ANALYSIS: All statistical analyses were performed by using SPSS (Version 14.0 for windows) software, by applying student's t-test. RESULTS: The result showed that seminal Zn was 702.92±10.60, 598.48±12.95, 617.54±9.55, 542.29±22.75, 710.36±7.87, 712.06±7.96, 789.36±21.33, and 762.06±8.99 mg/dl in azoospermic, oligozoospermic, asthenozoospermic, oligoasthenozoospermic, teratozoospermic, normozoospermic, polyzoospermic, and proven fathers group, respectively. CONCLUSIONS: Decreased concentration of seminal Zn do affect the sperm count, while increased level of seminal plasma Zn causes decreased sperm motility; so, it is suggested that administration of Zn should be very carefully monitored in such patients having low sperm count but normal sperm motility, as adequate seminal Zn is required for normal sperm function.

Assessment of male reproductive health by conventional method of semen analysis.

BACKGROUND: Data available over the past twenty years reveal that in approximately 30% of cases of infertility, pathology is found in man alone, and in another 20% both man and woman are abnormal. Therefore, the male factor is at least partly responsible in about 50% of infertile couples. The longer a couple remains sub fertile, the worse is their chance for an effective cure. This study was planned to analyse the complete semen picture of infertile men for assigning the specific cause to male infertility related to concentration, motility and morphology and to know the distribution and pattern of male infertility in the various subclasses in Pakistani population. METHODS: It was a prospective descriptive analytical study conducted at Department of Reproductive Physiology/Health, Public Health Divisions, National Institute of Health (NIH), Islamabad. One thousand five hundred twenty-one (1,521) infertile male patients, and 97 proven fathers, taken as a control. Conventional semen analysis was performed on all samples. RESULTS: Out of 1,521 infertile men, 13.3% were azoospermic, 23.2% oligozoospermic, 0.9% polyzoospermic, 14.5% normozoospermic, 35.2% asthenozoospermic 10.5% oligoasthenozoospermic and 2.4% teratozoospermic. Sperm concentration and active motility of proven fathers, was significantly higher (p<0.05) than the normal concentration group. Least liquefaction time was recorded in case of polyzoospermic subjects, and highest for azoospermic cases. Although, the liquefaction time of azoospermic and oligozoospermic subjects varied non-significantly (p>0.05) with the proven fathers. Normal forms were significantly higher (p<0.05) among the proven fathers and polyzoospermic cases, in comparison with the other groups. Head defects were more in teratozoospermic group, followed by oligoasthenozoospermic and oligozoospermic patients. Neck defects were more profound in oligoasthenozoospermic and oligozoospermic patients, while, tail defect showed significant increase in teratozoospermic and asthenozoospermic cases only. Head and neck defect varied significantly (p<0.05) with proven fathers in all groups, while tail defect varied significantly (p<0.05) in oligozoospermic, asthenozoospermic and teratozoospermic groups only when compared with proven fathers. CONCLUSIONS: Complete semen analysis which provides important information about the quality and quantity of the sperm, should be performed before reaching a final conclusion.

Rising prevalence of Hepatitis B and C and risk factors at District Headquarter Teaching Hospital Bannu, Khyber-Pakhtunkhwa.

HBV and HCV are common health problems in developing countries like Pakistan, sharing the same mode of transmission. The purpose is to determine the prevalence of HBV and HCV, and its risk factors in Bannu. A cross sectional descriptive study was conducted in medical units of DHQTH, Bannu, from January, 2004 till December, 2008. A total of 25944 patients comprising 13953 males (53.7%) and 11991 females (46.3%) all above the age of 15 years, were screened for HBV and HCV by rapid method and confirmed by ELISA technique. Out of those, 1352 (5.2%) patients were found positive either for HBV or HCV, 502 (1.93%) patients for HBV, whereas 850 (3.27%) patients for HCV. Non of the patients were found positive for both HBV and HCV. Nine hundred and five (67.0%) were males and 447, (33.0%) were females. Average age was 35-55 years. Keeping in mind the above mentioned results, the most important goal to be achieved is to increase the literacy rate and awareness among people about HBV and HCV so that it endeminity could be controlled.

Common trend of antibiotics usage in a tertiary care hospital of Peshawar, Pakistan.

BACKGROUND: Antibiotics are used to eradicate the pre- and postoperative infections in surgical procedures and in all others medical cases. However, inappropriate and indiscriminate use of antimicrobial agents can potentially have a number of problems. The emergence of antimicrobial resistant bacteria, an increased number of patients experiencing adverse drug events, and increased drug-related cost have been documented. The objective of the study was to determine the trend of use of antibiotics and hospitalisation of patients in various units of a tertiary care hospital, to investigate practice variation of antimicrobial agents within the hospital, and to identify and document any opportunity for its improvement. METHODS: A questionnaire containing relevant information about the study was prepared. Patients' age, sex, diagnosis, duration of hospital stay and type of antibiotic used were recorded and analysed, with particular reference to antibiotic group and disease pattern, in 3 different treatment areas of Hayatabad Medical Complex (HMC), Peshawar, Pakistan, from July 2006 to June 2007. RESULTS: During the period under report, a total of 519 patients were studied for their disease and the type of antibiotics used. The leading type of antibiotics reported were 3rd generation antibiotic used on 147 (28.33%) patients in the 3 units collectively, 1st generation 127 (24.47%), and penicillin 99 (19.08%), while macrolides were the least used. CONCLUSION: The available resources are needed to be effectively utilised, to minimise the hospital stay due to rational use of antibiotics, and to minimise burden of antibiotics on poor patients.

Relationship between blood groups and male infertility.

BACKGROUND: Blood is man's complete and unchangeable identity. The ABO and Rh groups are recognised as major and clinically significant blood groups. Blood group antigens are not only important in relation to blood transfusion and organ transplantation, but also have been utilised in genetic research, anthropology and tracing ancestral relation of humans. The objective the present study is to examine the blood group antigens in infertile men for assessing the relationship to male infertility and to know the frequency of various blood groups among infertile males in our population. METHOD: A total of 1,521 patients along with 460 proven fathers as controls were recruited for the present study from both rural and urban areas of Pakistan and referred to Department of Reproductive Physiology/Health, Public Health Divisions, NIH, Islamabad, during 2002 to 2006. Blood grouping (ABO) and Rhesus factors (Rh) was done by the antigen antibody agglutination test. RESULTS: Overall distribution of blood groups in the studied population of 1,521 subjects was 35.50%, 28.27%, 26.89% and 9.34% for blood groups O, B, A and AB respectively. The ratio of control to patient was 1:3.3. CONCLUSIONS: The present preliminary study revealed that in our population the prevalence of male infertility in blood group O is invariably higher than in all other ABO blood groups, showing a strong relationship between blood group O and male infertility.

Bilateral protrusion of femoral head into the pelvis in neglected osteomalacia.

Osteomalacia is a metabolic bone disease in a mature individual, caused by lack of vitamin D or its active metabolites, on account of a number of factors. Osteomalacia is common in females and in countries with less sun shine. It typically presents with body aches, weakness, alongwith signs of bone tenderness and proximal myopathy. Diagnosis is made on the basis of clinical presentation and investigations; serum calcium, phosphorus, serum alkaline phosphates, 24 hour urine for calcium and phosphorus and skeletal radiology.

Trend of blood groups and Rh factor in the twin cities of Rawalpindi and Islamabad.

OBJECTIVE: To determine the prevalence of different blood groups and Rh factors in a random population sample from urban and rural areas of Rawalpindi and Islamabad region of Pakistan. METHODS: Blood group and Rh factor determination was carried out by the antigen-antibody agglutination test from October 2003 to October 2004, and encompassed 2518 subjects. RESULTS: The percentages of various groups among male and female subjects, respectively, were recorded as 27.01% and 24.02% (for blood group A), 33.75% and 32.87% (for blood group B), 8.93% and 11.20% (for blood group AB) and 30.31% and 31.91% (for blood group O). The Rh positive and negative distribution in the studied population was 92.45% and 7.55% respectively. CONCLUSION: The determination of the frequency of blood groups in the region would not only help in blood transfusion services, but also eliminate the risk of erythroblastosis foetalis in the neonates.

Comparison of percutaneous pinning with casting in supracondylar humeral fractures in children.

BACKGROUND: In Children Supracondylar fracture of humerus is one of the most common fractures in first decade of life. There are various treatment modalities for this fracture i.e. Close reduction and casting, open reduction and internal fixation, skeletal traction and Percutaneous Pinning. This study was conducted to know the outcome of Percutaneous Pinning in the management of displaced supracondylar humeral fracture in children and to compare the results with close reduction and castings and published literature. METHODS: This descriptive study was conducted in Orthopaedic department of Ayub Teaching Hospital Abbottabad and Lady Reading Hospital, Peshawar from January 2002 till December 2003 on 40 children. Patients included were of either gender with age range from 3 to 12 years with displaced supracondylar fracture presenting within 72 hours of injury. Two treatment modalities were studied for comparison. Cross k-wires fixation through each humeral condyle was done after closed reduction of fracture under image intensifier in general anesthesia. Casting/Backslab was applied after reduction of fracture without image intensifier under anesthesia or analgesia. Out come measures were according to Flynn criteria that are functional and cosmetic factor which is based on loss of elbow motion and carrying angle in degrees respectively. RESULTS: Cross percutaneous pinning gave excellent results in 13 (65%), good outcome in 4 (20%) and poor outcome in 3 (15%) patients. While patients treated with close reduction and casting showed excellent results in 4 patients (20%), good in 8 patients (40%), fair in 2 patients (10%) and poor in 6 patients (30%). CONCLUSION: Closed reduction and cross percutaneous pinning for displaced supracondylar humerus fractures in children is safe, cost and time effective method and gives stable fixation with excellent outcome as compared to close reduction and casting.

Outcome of plating, bone grafting and shortening of non-union humeral diaphyseal fracture.

BACKGROUND: Humeral diaphyseal fracture usually heals with closed methods but when non union develops then it needs surgical intervention in the form of plating and bone grafting, intramedulary nailing (open or closed simple or interlocking nails) and external fixators (circular or one plane fixator). In our unit we treated non union humeral diaphyseal fracture with plating and bone grafting and shortening of fracture ends up to 4 to 5 cm when needed. METHODS: This study was conducted at Orthopaedic Department of Ayub Teaching Hospital Abbottabad from January 2002 till December 2003. We included 15 cases with atrophic non-union in 9 (60%) and hypertrophic non-union in 6 (40%) patients. All atrophic non-union were treated with plating, bone shortening by transverse osteotomy and bone grafting, while hypertrophic non-union were treated with decortications of non-union ends and fixation with compression plates, with bone grafting in old age. Follow up measures were based on clinical (range of joints motion) and radiological (healing) findings. Follow up was done for up to 6 months. RESULTS: Out of 15 patients the age range was 20-80 years, 12 (80%) were male and 03 (20%) female. Right humerus involved in 5 (33.33%) while left humerus in 10 (66.66%) patients. In 9 (60%) patients with atrophic non union bone shortening by transverse cut osteotomy was done while in remaining patients with hypertrophic non-union plating was done in 2 (13.33%) cases and plating with bone grafting in 4 (26.66%) patients. Union was achieved in all patients after 16 to 20 weeks of surgery. In one patient (6.66%) of 75 years age with hypertrophic non-union implant was loosened after 03 months of surgery. At that time healing (Union) was evident on X-rays and humeral brace was applied for further 03 months. Two patients (13.33%) got neuropraxia of radial nerve which resolved with in 3 months time. 02 patients (13.33%) developed shoulder stiffness which resolved after exercise. CONCLUSION: In Non Union of Humerus shortening by transverse osteotomy & rigid fixation with plates give excellent results in selected cases.