Frequency Of Stone Clearance After Transurethral Fragmentation Of Large Urinary Bladder Calculi Using Pneumatic Swiss Lithoclast.

BACKGROUND: Vesical calculi refer to stones in the urinary bladder. The causes of bladder stones include bladder outlet obstruction, neurogenic voiding dysfunction, infection, or foreign bodies. Very rarely, these vesical calculi may reach very large sizes and the largest dimension can sometimes reach 13 centimetres. METHODS: This descriptive cross-sectional study was conducted from 1ST May 2019 to 31st October, 2019 at Institute of Kidney Diseases, Urology Department, Hayatabad Peshawar. 164 patients with vesical stone were included in study. Ultrasound-KUB was used for diagnosis of vesical stone and after informed consent, and they underwent transurethral nephroscopic lithotripsy via the pneumatic Swiss Lithoclast. RESULTS: Frequency of stone clearance was 96.34%. No statistically significant association of stone clearance was observed with age, gender, number of stones or max dimension of largest stone in the bladder (p>0.05). CONCLUSIONS: Transurethral nephroscopic pneumatic lithotripsy via pneumatic Swiss Lithoclast is safe and effective procedure for treatment of large vesical stones. However, this being the first such study in adults, more data is needed to confirm these findings.

Pattern Of Breast Cancer: Experience At Ayub Teaching Hospital, Abbottabad.

BACKGROUND: Breast cancer is the most common malignancy found in females all over the world and the second leading cause of cancer death in European countries. The purpose of this study was to find out the pattern of disease presentation in our region where a proper tumour registry system is lacking. METHODS: This descriptive study was carried out in the Department of Surgery, Ayub Teaching Hospital Abbottabad, from July 2021 to June 2022. All female patients with biopsy-proven breast cancer were included in the study: benign lumps, refused to enrol, and those who were lost to follow-up were excluded. RESULTS: A total of 87 patients with carcinoma breast were included: 92 % (n=80) had invasive ductal carcinoma. Axillary lymph nodes were involved in 88.5% (n=77), 75.8% of the tumours, (n=66), were Grade 2, 34.5% (n=30) were in the 40-49 years age group, and 30 % (n=27) of the disease was categorized as Stage III or IV. In 55 % (n=48), the tumour was on the right side and in 39% (n=34), the upper outer quadrant was involved. Most of the patients, 90.8% (n=79), were married and had used contraceptive measures. Only 19.5% of patients (n=17), had a history of nipple discharge and 56% (n=49) had a positive family history: 71% (n=62) had nipple retraction, and 54% (n=47), proved to be ER PR positive. CONCLUSIONS: Our patients presented late: axilla was commonly involved and a third had advanced disease. Screening and community awareness programs may help in early detection. Hormone use for contraception needs to be weighed carefully. Better data collection may help in designing screening and care programs.

Frequency Of Hyperuricemia In Subjects With Unstable Angina/Myocardial Infarction And Their Prognosis.

BACKGROUND: Inhibition of nitric oxide synthesis and stimulation of smooth muscle proliferation by increased serum levels of uric acid play an important role in accelerated atherogenesis in the vessels of patients with hyperuricemia. The objective of the study was to determine the frequency of hyperuricemia in patients with acute coronary syndrome and their in-hospital outcomes. METHODS: This cross-sectional study was conducted in the cardiology department of Ayub Teaching Hospital, Abbottabad from 1st September, 2018 to 28th February, 2019. A total of 199 patients diagnosed with acute coronary syndrome (ACS) were enrolled in this study using non-probability consecutive sampling. Diagnosis of ACS was made on history, electrocardiogram (ECG) findings and on the presence of elevated cardiac biomarkers. Serum uric acid was checked within 24 hours of presentation and patients were grouped into hyperuricemic and normouricemic groups according to uric acid levels. Next in-hospital outcomes were compared between the two groups by comparing the presence or absence of complications. The data was collected on a structured proforma and was analyzed statistically by using SPSS version 16. RESULTS: Out of 199 patients, 146 (73.37%) were male and 53 (26.63%) were female. The mean age of the study participants was 57.99 ± 6.07 years with a range of 48-68 years. Hyperuricemia was diagnosed in 50 (25.13%) study participants. Among complications, 15 patients (7.94%) had cardiogenic shock, 27 (13.57%) had heart failure, 10 (5.03%) had cardiac arrhythmias, 16 (8.04%) had conduction defects and hyperuricemia was diagnosed in 50 (25.13%) patients. Cardiogenic shock was more common in patients with hyperuricemia (p < 0.05). CONCLUSIONS: Hyperuricemia is associated with a number of significant adverse outcomes for patients with an acute coronary event. Regular screening / monitoring of serum uric acid level in general population can prevent the direct and indirect morbidity associated with hyperuricemia.

Frequency Of Elevated Troponin T In Patients Of Hronic Renal Failure Without Clinically Suspected Acute Myocardial Infarction.

BACKGROUND: Cardiac Troponins are established markers of myocardial injury; however, they may be elevated in chronic renal failure (CRF) patients even in absence of acute myocardial infarction. The objective of the study was to determine the frequency of elevated Troponin T in patients of chronic renal failure without clinically suspected acute myocardial infarction. METHODS: This cross-sectional study was conducted at Medical B Unit of Ayub Teaching Hospital, Abbottabad from 16th December 2013 to 16th June 2014. A sample of 117 patients of chronic renal failure was included in the study without any gender discrimination. The patients were defined as known chronic renal failure when renal failure was reported in their past medical history and by estimation of glomerular filtration rate (GFR). Those patients who had raised Troponin T due to any other reason like acute myocardial ischemia (chest pain, electrocardiographic changes and greater than 20% elevation in Troponin T from baseline), sepsis, heart failure and those who were receiving cardiotoxic chemotherapy were excluded. The subjects were enrolled by non-probability consecutive sampling. Results were analysed by SPSS 16.0. RESULTS: Out of 117 participants, 72 (61.5%) were males and 45 (38.5%) were females. The mean age of the study participants was 52.08±14.21 years. Elevated Troponin T was found in 45 (38.5%) of the patients. There is statistically significant association between the stage of CRF and elevated levels of Troponin T. Statistically significant negative correlation (r=-0.213,p=0.021) was found between the Glomerular Filtration Rate and serum levels of Troponin T. CONCLUSIONS: A high proportion of CRF patients have elevated Troponin T and the rise is significantly associated with the stage of chronic renal failure.

ARE WE TELLING THE DIABETIC PATIENTS ADEQUATELY ABOUT FOOT CARE?.

BACKGROUND: Diabetes mellitus affects more than 285 million people worldwide. The prevalenceis expected to rise to 439 million by the year 2030. Diabetic foot ulcers precede 84% of non-traumatic amputations in diabetics. One lower limb is lost every 30 seconds around the worldbecause of diabetic foot ulceration. Apart from being lengthy, the treatment of diabetic foot is alsovery expensive. There is very limited emphasis on foot care in diabetic patients. Even indeveloped countries patients feel that they do not have adequate knowledge about foot care. Thisstudy was conducted to find out how much information is imparted by doctors to diabetic patientsabout foot care. METHODS: This cross-sectional study was conducted in admitted patients of theDepartment of Medicine, DHQ Hospital, Abbottabad from May 2014 to June 2015. One hundredand thirt-nine diabetic patients more than 25 years of age were included by non-probability consecutive sampling. RESULTS: The mean age was 57.17 (±11.1) years. 35.3% of patients weremale and 64.7% were female. The mean duration of diabetes in patients was 8.3 (±6) years. Only36.7% of patients said that their doctor told them about foot care. Less than 40% of patients knewthat they should daily inspect their feet, wash them with gentle warm water, and dry themafterwards. Only 25.2% of the participants knew how to manage corns or calluses on feet. 66.5%of patients knew that they should not walk bare foot. Overall, 63% of our patients had less than50% knowledge of the 11 points regarding foot care that the investigators asked them. CONCLUSION: Diabetic foot problems are the one of the costliest, most disabling and dishearteningcomplication of diabetes mellitus. Doctors are not properly telling diabetic patients about footcare. There is a deficiency of knowledge among the diabetic patients regarding foot care.

Comparison Of Efficacy Of 10% Potassium Hydroxide Solution Versus Cryotherapy In Treatment Of Molluscum Contagiosum.

BACKGROUND:: Different topical therapies are being used for treating molluscum contagiosum. Potassium hydroxide in varying solution strengths with irritant reaction on the skin can help in eliminating the infection. It is cheap, easily available, can be easily applied at home, with good safety profile and cost effectiveness. This study was conducted to compare the efficacy of 10% potassium hydroxide solution versus cryotherapy in treating molluscum contagiosum. METHODOLOGY: This study was a Randomized control trial conducted in the Department of dermatology, Military hospital Rawalpindi. Study included 120 randomly selected patients with molluscum contagiosum divided equally into two groups. Group A were treated with 10% potassium hydroxide aqueous solution applied daily to the lesions twice daily for 6 weeks while Group B received weekly cryotherapy with liquid nitrogen. The status of lesions was documented weekly for 6 weeks. RESULTS: Of the 120 patients enrolled, 67 (55.8%) were male and 53 (44.2%) were female. Mean age of patients was 20.53(±8.17) years. At base line Molluscum contagiosum lesion ranged from minimum of 2 lesions to maximum of 26 lesions with a mean of 8.95 (SD ±4.45) lesions. Of 120 patients, complete clearance was observed in 98(81.6%) of patients, 48(80%) patients had lesion clearance in Group A and 50 (83.3%) patients had lesion clearance was observed in Group B. No statistical significance was observed in the lesion clearance between the two groups (p-0.63). CONCLUSIONS: The efficacy of 10% potassium hydroxide solution and cryotherapy is statistically same over 6 weeks of treatment. Thus less expensive, easily available and cosmetically more acceptable potassium hydroxide solution can be used instead of cryotherapy in treating molluscum contagiosum.

E. coli Resistance to Ciprofloxacin and Common Associated Factors.

OBJECTIVE: To determine the frequency of E. coli resistance to ciprofloxacin and common factors leading to it among patients presenting with urinary tract infection. STUDY DESIGN: Descriptive cross-sectional study. PLACE AND DURATION OF STUDY: Department of Medicine, Ayub Teaching Hospital, Abbottabad, from December 2011 to June 2012. METHODOLOGY: A total of 166 patients, > 18 years of age of both gender, who presented with features of UTI and had urine culture positive for E.coli were included in the study. The urine samples were further tested for ciprofloxacin resistance and the patients were further checked for the common factors leading to E.coli resistance to ciprofloxacin. RESULTS: Among 166 patients, 41 were male and 125 were female patients. Sixty-six (39.8%) E. coli isolates showed ciprofloxacin resistance. Male gender (p-value 0.001), previous history of recurrent UTI (p = 0.008, OR = 2.37), history of prior use of ciprofloxacin (p = 0.018, OR = 2.16) and history of catheterization (p = 0.005, OR = 4.80) were independent risk factors found in this study for the development of ciprofloxacin resistant UTIs. CONCLUSION: Ciprofloxacin resistance rates of E.coli were high at over 39.8%. The risk factors that affected the ciprofloxacin resistance rates of E.coli were prior use of ciprofloxacin, recurrent UTI, previous catheterization and male gender. Ciprofloxacin should be prescribed cautiously in patients with these risk factors and urine culture and sensitivity test should be performed for optimal treatment.

Kikuchi's Disease: A Rare Cause of Fever of Unknown Origin.

Kikuchi Fujimoto Disease (KFD) or histiocytic necrotizing lymphadenitis can present with unexplained fever and lymphadenopathy. It is often mistaken for more serious conditions like malignant lymphoma or tuberculosis. First case was described by Kikuchi in Japan, very few cases have been reported in Pakistan. A middle aged female presented with fever and body aches for one month. She was investigated extensively for pyrexia of unknown origin, all of which came out to be normal except a raised ESR. Anti-tuberculous drugs were started on clinical suspicion, with no improvement after a month. Later, a detailed physical examination revealed cervical lymphadenopathy. One of the lymph nodes was excised and biopsied. The histopathology suggested Kikuchi's disease. Oral Prednisolone was started showing improvement. Her fever subsided and lymph nodes disappeared at the follow-up visit. No relapse was encountered in the subsequent visits.

HYPERCHOLESTEROLEMIA IN PATIENTS OF ISCHEMIC STROKE.

BACKGROUND: Stroke is a common neurological disease that results in significant mortality and morbidity globally. Several risk factors have been identified for stroke among which hyperlipidaemia is one of the modifiable risk factors. Recent clinical trials have shown a reduction in ischemic stroke for patients taking lipid lowering medications. Therefore, the aim of this study was to find out the frequency of hypercholesterolemia in patients of ischemic stroke in Hazara region. METHODS: This cross sectional study was carried out in the Medical Department of Ayub Teaching Hospital, Abbottabad. Ninety patients of stroke confirmed as ischemic by CT scan brain were enrolled in the study after informed consent. The frequency of hypercholesterolemia in patients was recorded. RESULTS: There were 55 (61.1%) males. The mean age of patients was 64.4±11.5 years. The mean serum cholesterol in all patients was 4.16±1.1 mmol/l. The mean serum cholesterol of male patients was 4.3±1.2 mmol/l and 4.0±10.9 mmol/l in the case of females. CONCLUSIONS: Hypercholesterolemia could not be established as a major risk factor for stroke in our setup through this study that allude to the fact that other risk factors might be contributing more to the incidence of cerebrovascular accident in our population.

Diagnosis and treatment of Hodgkin's lymphoma: at times a challenge.

Hodgkin's lymphoma has been traditionally defined as a hematopoietic neoplasm composed of diagnostic Reed-Sternberg cells. More than 70% of the cases involve cervical or supraclavicular lymph nodes. Isolated sub-diaphragmatic lymphadenopathy or organ involvement is rare. We present the case of Hodgkin's lymphoma in a 51 years old female, who presented with obstructive jaundice and lymphadenopathy, empirically treated previously as a case of tuberculosis. Chemotherapy with modified ABVD protocol was given with dose modification according to LFT's. Her liver functions returned to normal levels after the first cycle. The main purpose of reporting the case is to stress definitive diagnosis of the disease before initiating treatment and the modified chemotherapy regimen used in this infrequent presentation of the disease.