Prevalence of cutaneous leishmaniasis in the largest populated city Karachi, Pakistan / Prevalência de leishmaniose cutânea na maior cidade populosa de Karachi, Paquistão

The study was undertaken from September 2018 to April 2019 to determine the prevalence of cutaneous leishmaniasis in human beings living in six districts of Karachi. Suspected persons were screened for the disease and positive cases were identified on the basis of skin lesions and blood samples. Samples were observed by mounting their smear. A total of 207 subjects of different ages and sex groups were investigated, however, only 192 (92%) of the suspected cases were found to have the disease 64% of cases were male which were significantly high (p<0.05), than female 36%. The lesion was more frequently detected among the youth ages of 21-30 years (31%) as compared to other groups. In both sexes, legs were found to be more infected (25% male + 20% female) followed by arms (20% male + 0% female) and face (15% male +11% female). The mixed body parts had shown the lowest infections such as (4% in males + 5%) in females. In conclusion, the highest and lowest leishmaniasis infections were observed in District West (23% male + 9% female) followed by District East (15% male + 7% female), District Malir (11% male+ 4% female), District Central (7% male + 5% female), District Korangi (4% male + 7% female) and District South (4% male + 4% female) respectively.

O estudo foi realizado de setembro de 2018 a abril de 2019 para determinar a prevalência de leishmaniose tegumentar em seres humanos que vivem em seis distritos de Karachi. Pessoas suspeitas foram rastreadas para a doença e os casos positivos foram identificados com base em lesões de pele e amostras de sangue. As amostras foram observadas montando seu esfregaço. Um total de 207 indivíduos de diferentes idades e grupos sexuais foi investigado, no entanto apenas 192 (92%) dos casos suspeitos foram encontrados para ter a doença; 64% dos casos eram do sexo masculino, que foram significativamente elevados (p < 0,05), e do sexo feminino 36%. A lesão foi detectada com maior frequência entre os jovens de 21 a 30 anos (31%) em comparação com os outros grupos. Em ambos os sexos, as pernas estavam mais infectadas (25% homens + 20% mulheres), seguidas pelos braços (20% homens + 0% mulheres) e rosto (15% homens + 11% mulheres). As partes mistas do corpo mostraram as infecções mais baixas (4% homens + 5% mulheres). Em conclusão, as infecções de leishmaniose mais altas e mais baixas foram observadas no Distrito Oeste (23% homens + 9% mulheres) seguido pelo Distrito Leste (15% homens + 7% mulheres), Distrito Malir (11% homens + 4% mulheres), Distrito Central (7% homens + 5% mulheres), Distrito Korangi (4% homens + 7% mulheres) e Distrito Sul (4% homens + 4% mulheres), respectivamente.

Prevalence of cutaneous leishmaniasis in the largest populated city Karachi, Pakistan

Abstract. The study was undertaken from September 2018 to April 2019 to determine the prevalence of cutaneous leishmaniasis in human beings living in six districts of Karachi. Suspected persons were screened for the disease and positive cases were identified on the basis of skin lesions and blood samples. Samples were observed by mounting their smear. A total of 207 subjects of different ages and sex groups were investigated, however, only 192 (92%) of the suspected cases were found to have the disease 64% of cases were male which were significantly high (p 0.05), than female 36%. The lesion was more frequently detected among the youth ages of 21-30 years (31%) as compared to other groups. In both sexes, legs were found to be more infected (25% male + 20% female) followed by arms (20% male + 0% female) and face (15% male +11% female). The mixed body parts had shown the lowest infections such as (4% in males + 5%) in females. In conclusion, the highest and lowest leishmaniasis infections were observed in District West (23% male + 9% female) followed by District East (15% male + 7% female), District Malir (11% male+ 4% female), District Central (7% male + 5% female), District Korangi (4% male + 7% female) and District South (4% male + 4% female) respectively.

Resumo O estudo foi realizado de setembro de 2018 a abril de 2019 para determinar a prevalência de leishmaniose tegumentar em seres humanos que vivem em seis distritos de Karachi. Pessoas suspeitas foram rastreadas para a doença e os casos positivos foram identificados com base em lesões de pele e amostras de sangue. As amostras foram observadas montando seu esfregaço. Um total de 207 indivíduos de diferentes idades e grupos sexuais foi investigado, no entanto apenas 192 (92%) dos casos suspeitos foram encontrados para ter a doença; 64% dos casos eram do sexo masculino, que foram significativamente elevados (p 0,05), e do sexo feminino 36%. A lesão foi detectada com maior frequência entre os jovens de 21 a 30 anos (31%) em comparação com os outros grupos. Em ambos os sexos, as pernas estavam mais infectadas (25% homens + 20% mulheres), seguidas pelos braços (20% homens + 0% mulheres) e rosto (15% homens + 11% mulheres). As partes mistas do corpo mostraram as infecções mais baixas (4% homens + 5% mulheres). Em conclusão, as infecções de leishmaniose mais altas e mais baixas foram observadas no Distrito Oeste (23% homens + 9% mulheres) seguido pelo Distrito Leste (15% homens + 7% mulheres), Distrito Malir (11% homens + 4% mulheres), Distrito Central (7% homens + 5% mulheres), Distrito Korangi (4% homens + 7% mulheres) e Distrito Sul (4% homens + 4% mulheres), respectivamente.

Prevalence of cutaneous leishmaniasis in the largest populated city Karachi, Pakistan.

The study was undertaken from September 2018 to April 2019 to determine the prevalence of cutaneous leishmaniasis in human beings living in six districts of Karachi. Suspected persons were screened for the disease and positive cases were identified on the basis of skin lesions and blood samples. Samples were observed by mounting their smear. A total of 207 subjects of different ages and sex groups were investigated, however, only 192 (92%) of the suspected cases were found to have the disease 64% of cases were male which were significantly high (p 0.05), than female 36%. The lesion was more frequently detected among the youth ages of 21-30 years (31%) as compared to other groups. In both sexes, legs were found to be more infected (25% male + 20% female) followed by arms (20% male + 0% female) and face (15% male +11% female). The mixed body parts had shown the lowest infections such as (4% in males + 5%) in females. In conclusion, the highest and lowest leishmaniasis infections were observed in District West (23% male + 9% female) followed by District East (15% male + 7% female), District Malir (11% male+ 4% female), District Central (7% male + 5% female), District Korangi (4% male + 7% female) and District South (4% male + 4% female) respectively.

Comparing the endothelialisation of extracellular matrix bioscaffolds with coated synthetic vascular graft materials.

INTRODUCTION: Existing synthetic vascular grafts have unacceptably high failure rates when replacing below knee arteries. In vitro endothelialisation is a technique, which has been shown to enhance the patency rates of below knee vascular grafts. Synthetic materials are however poor cellular substrates and must be combined with coatings to promote cellular growth and attachment. The most common coating clinically is fibrin-coated ePTFE. The aim of our study was to compare the endothelialisation of fibrin-coated ePTFE with novel extracellular matrix (ECM) biomaterials that we hypothesise will provide a superior substrate for cell growth. METHODS: Human endothelial cells were cultured on ECM scaffolds and fibrin-coated ePTFE. Uncoated Dacron and ePTFE acted as controls. The cells were examined for viability, phenotype, adhesion and proliferation. Cell morphology was accessed using scanning electron microscopy. RESULTS: Cells remained viable and produced von Willebrand factor on all substrates tested. ECM scaffolds and fibrin-modified ePTFE achieved statistically higher attachment efficiency when compared to both uncoated synthetic graft materials (p ≤ 0.001). At 90 min 80 ± 3.6% of cells had attached to the ECM scaffold compared to Dacron (30 ± 4.5%, n = 3) and ePTFE (33 ± 2.5%, n = 3). There was no difference in adhesion rates between ECM scaffolds and fibrin-coated ePTFE (p = 1.00). Endothelial cells proliferated fastest on ECM scaffolds when compared to all other materials tested (p < 0.001) and reached confluency on day seven. CONCLUSION: ECM bioscaffolds offer an improved substrate for promoting rapid endothelialisation compared to fibrin-coated ePTFE by combining firm cellular anchorage and superior cell expansion.

Successful Treatment of Acute on Chronic Mesenteric Ischaemia by Common Iliac to Inferior Mesenteric Artery Bypass.

Chronic mesenteric ischaemia is a rare and potentially fatal condition most commonly due to atherosclerotic stenosis or occlusion of two or more mesenteric arteries. Multivessel revascularisation of both primary mesenteric vessels, the celiac artery and superior mesenteric artery (SMA), is the current mainstay of treatment; however, in a certain cohort of patients, revascularisation one or both vessels may not be possible. Arteries may be technically unreconstructable or the patient may be surgically unfit for the prolonged aortic cross clamping times required. Here we present a case involving a 72-year-old woman with acute on chronic mesenteric ischaemia. She was a high risk surgical patient with severe unreconstructable stenotic disease of the SMA and celiac arteries. She was successfully treated with single vessel revascularisation of the inferior mesenteric artery (IMA) via a common iliac to IMA reversed vein bypass. At two-year follow-up, the graft remains patent and the patient continues to be symptom-free and is maintaining her weight.

Endovenous radiofrequency ablation: no value in short-term duplex ultrasound follow-up.

INTRODUCTION: Endogenous radiofrequency ablation (RFA) is a proven treatment for varicose veins that has equal efficacy to surgical stripping. It offers the benefit of reduced post operative pain and wound infection and quicker return to work. AIM: To carry out a clinical audit of patients undergoing RFA to monitor outcomes, complication rates, follow-up sclerotherapy and to assess the need for post-operative duplex scan. METHODS: A retrospective analysis was performed of 174 procedures carried out from January 2011 to March 2012. Patients were pre-assessed with history, physical exam and duplex ultrasound. They were followed up at 3 months with same. CEAP classification was applied to check for post-operative improvement. RESULTS: 174 procedures, including 165 great saphenous vein and 9 short saphenous vein ablations were carried out on 154 patients. The duplex occlusion rate at 3 months was 99 %. 141 patients (81 %) showed a reduction in CEAP score with average CEAP decreasing from 2.37 to 0.96. Overall the complication rate was low at 7 %. Paraesthesia was the most common complication with 7 cases (4 %). There were no DVTs. 45.4 % of patients went on to have follow-up sclerotherapy for venous flares. CONCLUSION: RFA is a safe and effective treatment for varicose veins. There is no benefit in performing routine short term follow-up duplex scan due to the high occlusion rates.

Initial experience of double-layer tension free reconstruction of abdominal wall defects with porcine acellular dermal collagen implant and polypropylene mesh.

INTRODUCTION AND AIM: Various techniques have been proposed for the repair of abdominal wall defects (AWD) with varying rates of success. Despite the development of new materials and modifications of surgical technique, no single approach has emerged as the optimum way to close large AWD. We report a method for repairing large incisional and recurrent abdominal wall hernias using a double-mesh technique. The defect is closed using an underlay biological implant and an onlay synthetic mesh, which is 'quilted' to the underlying abdominal wall and biological implant. The current study reports our initial experience with this approach in ten consecutive patients operated on for large AWD. METHODS: In this prospective observational study the following data were collected: age, gender, previous surgery, co-morbidities, situation and size of the defect, antibiotic therapy, hospital stay, postoperative complications and bacteriology in case of infection. The patients were reviewed at 1, 3 and 6 months, and 1-year postsurgery. RESULTS: Overall all ten AWD of ≥ 75 cm(2) were reconstructed successfully using the quilting technique. Median age of patients was 61 years (range 47-73 years); male:female ratio was 3:2 and median weight was 107.5 kg. Two patients developed a wound infection and were treated successfully with antibiotics. At median follow-up of 15.5 months (range 6-29 months) there was no case of recurrence. CONCLUSION: The use of double-layer of porcine acellular dermal collagen implant and polypropylene mesh in reconstruction of AWD can be considered a safe and effective treatment. The early short-term results are encouraging with few complications.

Venous drainage, a simple method to prevent the systemic consequences of ischaemia-reperfusion injury in acute lower limb ischaemia.

BACKGROUND: Ischaemia-reperfusion injury (I-R injury) is a recognised and potentially fatal complication following revascularisation of an ischaemic limb. Prevention of reperfusion injury is the focus of much research, but effective drug regimens have yet to be established into clinical practice. CASE REPORT: Here we present a man with prolonged, severe lower limb ischaemia, successfully treated with a novel surgical technique for preventing I-R injury. Prior to revascularisation, the common femoral vein was cannulated and the harmful venous effluent was drained. The patient made an excellent recovery, the limb was salvaged and no systemic complications were encountered.

Diagnostic accuracy of hand-held Doppler in the management of acute scrotal pain.

We evaluate the reliability of hand-held Doppler (HHD) in the management of acute scrotal pain of 24 h or less duration. Between October 2003 and December 2004, patients presenting with acute scrotal pain were enrolled in this prospective study. After clinical examination, all patients had a HHD assessment. Presence or absence of Doppler arterial signals and its intensity were recorded. A blinded assessor corroborated HHD findings with the clinical, ultrasound, operative findings and final diagnosis. Primary outcome measured were sensitivity and specificity of HHD in the diagnosis of testicular torsion. Twenty-five patients presented during the study period with acute scrotal pain. The final diagnosis was testicular torsion in nine, epididymitis in 13, twisted cyst of Morgagni in two and Henoch-Schoenlein purpura in one patient. The HHD predicted all patients of testicular torsion correctly, preoperatively. HHD is a reliable diagnostic tool in the management of patients with acute scrotal pain.