Early Outcome of Primary Repair in Colonic Injury.

The management of the colon injury remains controversial in spite of a number of divergent reports during the past decade. Previously surgeons were reluctant to do primary anastomosis but now-a-days they are doing primary repair with good results. The present study is designed to see the early outcomes of primary repair in colonic injury. This prospective observational study performed at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2013 to June 2013 with allocation of 50 patients with colonic injury who underwent laparotomy with primary repair of that injury in the department of Casualty Surgery. A primary repair was performed after freshening the edges or by resection and primary anastomosis with 3.0 round-body Vicryl by single layer extra mucosal interrupted suture. Data processed using software SPSS version 16.0. For all analytical results a p value <0.05 was considered significant. In this study the commonest site of injury were transvers colon and sigmoid colon 38.0% in each. Out of 50 respondents, 5(10.0%) developed burst abdomen, 1(2.0%) developed entero-cutaneous fistula with none had paralytic ileus or septicaemia or pelvic collection. No mortality observed. This study showed that the increasing in colon injury scale (CIS) score culminate into increasing rate of postoperative complication & post operative complications were more at left colon (24%). On basis of our findings, we recommend the primary repair is a safe and effective surgical technique for addressing the large gut injury. Unnecessary proximal diversions should be avoided. According to our experience, we believe that the policy of primary repair of colon injuries can be applied more liberally in majority of patients with high success rate.

An unusual foreign body in the urinary bladder.

In the urinary tract, foreign body is most commonly found in the urinary bladder. Most foreign bodies in the lower urinary tract are self-inserted via urethra as a result of exotic impulses, psychiatric illness, sexual curiosity, or sexual practice while intoxicated. Various types of foreign bodies have been reported such as wire, screw, fish, thermometer, or animal such as snake. Here we report a case of 22 years men who gave the history of self insertion of a large saline set both ends are cut. Diagnosis can be made by proper history taking, clinical examination, and relevant investigation. The treatment of foreign bodies is determined by their size, location, shape, and mobility. In most cases endoscopic management is appropriate but sometimes open procedure is required. Our case with an unusual foreign body admitted in general hospital Jamalpur for better management and subsequently foreign body was removed by suprapubic cystostomy.

Live worm in gallbladder: a case report.

Ascariasis, the most common helminthic infection is caused by ascaris lumbricoides. Usually the adult worm lives in the small intestine. Rarely it migrates through the papilla of vater and may enter the common bile duct. We are reporting a case of live worm in gall bladder. Presence of Ascaris lumbricoides in gallbladder is rare entity as it is difficult to reach there due to narrow and tortuous cystic duct.

Evaluation of the results of operative management of lumbar spinal canal stenosis.

Lumber spinal canal stenosis is an important cause of low back pain and it frequently presents with low backache with neurogenic claudication. Operative management of lumbar spinal canal stenosis by decompression surgery is an effective method. This prospective interventional (quasi experimental) study was performed in patient having history of characteristic clinical features like low backache with radicular pain, neurogenic claudication, signs of root compression, positive MRI findings attending in the department of Orthopaedic Surgery and Neurosurgery, Dhaka Medical College Hospital and NITOR. Dhaka, from July 2008 to June 2010. Thirty patients were evaluated among those 18(60%) were 50 years and above. Male to female ratio was roughly 9:1. About 87% of the patients had sensory deficit and 50% had neurogenic claudication. Majority (83.3%) of the patients at presentation had a suffering of 12 or >12 months. Diagnosis shows that 3.5% of patients had L4 lesion, 60% L5, 6.5% patients had L4 & L5 and 30% S1. Laminectomy was done in 43.3% of patients, laminectomy and disectomy in 30% and laminectomy, discectomy & foraminal decompression in 26.7% of patients. Relief of symptoms occurred in 25(83.5%) of patients. Over three-quarter (76.7%) of patients exhibited minimal disability and 23.3% moderate disability based on Oswestry Disability Index, while by MacNab criteria, most (80%) of patients was excellent, 10% good and another 10% fair. Repeated measure ANOVA statistics showed that mean Oswestry score decreased significantly from 54.5% at baseline to 22% at the end of 1 year (p<0.001).

Traumatic gut injury: a study of 100 cases in Mymensingh Medical College Hospital.

This study was done to find out the mode of presentations, management options and the factors which dictate the out-come of the patients with traumatic gut injury. It has been carried out in the department of Surgery, Mymensingh Medical College Hospital in 100 patients with traumatic gut injury from January 2009 to December 2010. Most of the patients were within 21-30 years (47%) and male patients were the predominant group (90%). In this study penetrating injury was more common (57%) than non-penetrating (43%) injury as a cause of gut injury. Stab (64.91%) was the main mechanism of penetrating abdominal trauma; while road traffic (58.14%) was the main mechanism of non-penetrating abdominal trauma. Diagnosis was made on clinical presentation, physical examination and some investigations. Abdominal pain (98%) was the chief complain and chief sign was abdominal tenderness (98%) and absent bowel sound (91%). Small gut injury was present in 71% patients, 20% patients had large gut injury and 9% had both gut injury. In small gut, jejunum (49.29%) was the most vulnerable portion and right sided colon (55%) was the most affected portion in large gut trauma. Spectrum of injury in small gut included single perforation (63%), multiple perforations (23%), laceration (11%) and devascularization (3%) injury. Primary repair in 60.87%, resection & anastomosis in 27.54% and resection anastomosis with proximal diversion in 11.59% patients were done in small gut injury. Injuries in the large gut were classified into three categories according to Flint Colon Injury Severity Scoring. Highest incidence was in Grade I (60%) category, second in Grade II (35%) and Grade III (5%) was the third one. Simple primary repair in 40%, primary repair or resection anastomosis with proximal diversion in 30%, loop ileostomy in 20% and Hartman's procedure in 10% were done in patients of large gut injury. Resection anastomosis with proximal diversion was performed in patients of both small and large gut injury. Outcome of management was quiet acceptable with 47% of patients having uneventful recovery. Delayed presentation, delayed definitive management, haemodynamically unstable patient, site and number of injuries in the gut were the crucial factor for the overall 44% morbidities of this series. Morbidity rate was 9%. More than half of the patients (56.04%) discharged from the hospital within 10 days. Only a few patients could be followed up for a few months after surgery, who reported to have a satisfactory outcome with no morbidity.

Molecular detection of Anaplasma in apparently healthy Cholistan breed of cattle from the Bahawalpur district, Pakistan.

The present study was designed to report the prevalence of Anaplasma sp. in blood samples of Cholistan breed of cattle from Bahawalpur District and to determine the risk factors associated with the prevalence of this parasite. A total of 148 blood samples were randomly collected from apparently healthy cattle. On the sampling sites, data on the characteristics of the animals (species, gender, age) were collected through questionnaires. 47 blood samples (31.8% of total) produced the 577 base pairs DNA fragment specific for 16S rRNA gene of Anaplasma sp. by PCR amplification. Out of 47 Anaplasma sp. positive PCR products, 9 were found to be Anaplasma marginale by restriction with BssNa1 and 9 were confirmed to be Anaplasma phagocytophilum (A. phagocytophilum) as they amplified 550 bp fragment from the amplified MSP 2 gene of this species. Risk factor analysis indicated that the presence of parasite was not limited to a particular sex or age group of the infected animals. Comparison of hematological profile revealed that Anaplasma sp. positive cattle had significantly reduced levels of mean corpuscular volume (P=0.02) and eosinophils (P=0.02) than in parasite negative animals. While studied serum biochemical profile remain unaffected when compared between the two groups.

"Race related illness in Vietnamese refugees".

The author worked for six weeks in September 1982, as a Medical Practitioner and Psychiatrist at the first Asylum Centre Puerto-Princessa, Palawan, Philippines. This paper relates relevant aspects of Mental Health needs of Vietnamese refugees related to racism, aftermath of war, leaving home-land without preparation, perilous escape, prolonged stay in cramped refugee camps, and move on to unsettled, unsure future in another country with alien culture and environment. Changes of life situation, loss of business, property or occupation, loss of loved ones, separation from friends, disruption of family relationships are related to racism and persecution elements in 'Boat People'. The most frequent psychiatric illnesses among the refugees are: depression, anxiety state, psychosomatic disease and psychosis. A special mental health project is needed to train health workers, provide service and consultation and to organising research activities. On the preventive aspects, primary prevention may be achieved by less stress on rapid assimilation and the reduced likelihood of discrimination, hostility and prejudice. Secondary prevention consists of early detection of the disease and early initiation of treatment and tertiary prevention consists of the elimination or reduction of residual disability after an illness.

Resolution of pathological identification between mother and son following rhinoplasty.

The case here described shows that severe psychological disturbance can be caused by identification between mother and son, resulting in preoccupation with a part of the body, which in the opinion of those outside the relationship, shows no gross abnormality. Similar delusional beliefs to those held by the mother were induced in the son, when he reached the age at which these beliefs occurred in the mother, in whom they were incompletely resolved. Plastic surgery, in the absence of gross deformity, brought relief of the distress caused by this type of psychopathology. Relief occurred in the conflicts of both mother and son, even though operation was on the latter, only.

Molecular detection of Anaplasma in apparently healthy Cholistan breed of cattle from the Bahawalpur district, Pakistan

The present study was designed to report the prevalence of Anaplasma sp. in blood samples of Cholistan breed of cattle from Bahawalpur District and to determine the risk factors associated with the prevalence of this parasite. A total of 148 blood samples were randomly collected from apparently healthy cattle. On the sampling sites, data on the characteristics of the animals (species, gender, age) were collected through questionnaires. 47 blood samples (31.8% of total) produced the 577 base pairs DNA fragment specific for 16S rRNA gene of Anaplasma sp. by PCR amplification. Out of 47 Anaplasma sp. positive PCR products, 9 were found to be Anaplasma marginale by restriction with BssNa1 and 9 were confirmed to be Anaplasma phagocytophilum (A. phagocytophilum) as they amplified 550 bp fragment from the amplified MSP 2 gene of this species. Risk factor analysis indicated that the presence of parasite was not limited to a particular sex or age group of the infected animals. Comparison of hematological profile revealed that Anaplasma sp. positive cattle had significantly reduced levels of mean corpuscular volume (P=0.02) and eosinophils (P=0.02) than in parasite negative animals. While studied serum biochemical profile remain unaffected when compared between the two groups.

Major ion and heavy metal chemistry of Pachin river (Itanagar) - levels and sources.

The Pachin river is an upland tributary of the Brahmaputra river, originating in the foot-hills of the lesser Himalayas. A systematic study of major ions and heavy metals in the surface water of the river was carried out at peak, intermediate and low flow conditions during an one-year interval to assess the relative contributions from weathering and pollution. The major ion chemistry indicates that silicate weathering and precipitation are the major contributing factors to the river's chemical composition. The Pachin river is characterized by a low overall conductivity, even during times of evaporative concentrations during low flow. This corresponds to the fact that the catchment area is still relatively pristine, i.e., well forested and without significant industry. However, heavy metal patterns clearly reflect source input from agricultural activity and urban development. The levels of Fe and Co were amongst the highest of any rivers of the Indian sub-continent, while these and Cr, Mn, Cu and Se each exceeded the world average value. These results clearly indicate that rivers draining pristine areas can be significantly modified by human activities, and consequently, these must be monitored to ensure that useable water supplies meet the prescribed safety standards.

Variability in physico-chemical parameters of Pachin river (Itanagar).

The concentration of water quality parameters in river and heavy metals in the bed sediment were measured for Pachin River for the three major flow periods. The pH, temperature (degree C), conducity (microS cm-1), DO, COD, NH3, PO4, total hardeness and alkalinity (mg/L) were found in the range of 12 to 22, 6.90 to 7.69, 25 to 211, 5.0 to 12.5, 10-115, 1.2 to 12.0, 0.05 to 0.62, 14 to 45, and 12 to 35, respectively. The heavy metals as Zn and Se showed an enrichment of 1 to 25, and 5 to 120, with concentration (microgram/g) range of 8 to 385 and 0.5 to 6.0, for the respective metal, in the labile fraction of the bed sediment. The variability in the physico-chemical parameters for different flow periods may be assigned to dilution of river water by direct runoff, human activities and organic load. The correlation study of physico-chemical parameters shows that their source of entering the river system is the same whether it may be a natural or anthropogenic or both.

Affective disorder in Asian immigrants.

Socio-cultural factors play a contributory role in presentation and symptomatology of affective illness. Cultural shock, communication barriers, fear of loss of racial identity, different child rearing attitudes and dietary restrictions may all contribute towards the manifestation of reactive depression. An understanding of the immigrant's background will greatly help the therapist in management of his patient.

Influence of experience and nationality on assessment and outcome of parasuicide.

In Sheffield 544 consecutive cases of attempted suicide (parasuicide) were seen at 2 large hospitals over a 12-month period, and allocated in sequence to the junior and senior psychiatric staff, of British and foreign origin. During the follow-up period of 12 months, 31 patients had a further episode of parasuicide and 5 patients committed suicide. The outcome (as measured by repeat parasuicide or suicide) was not significantly affected by the country of origin of the psychiatrist, nor his length of training in psychiatry.

Lack of correlation between diarrhea and weight loss in HIV-positive outpatients in Houston, Texas.

To determine the prevalence of diarrhea and weight loss among human immunodeficiency virus (HIV)-positive patients, we reviewed the records of all patients attending the Harris County HIV Clinic during a 4-month time period. Diarrhea was considered persistent if it had been present for > 14 days or on two or more consecutive clinic visits. Weight loss was defined as moderate (5-10% reduction in weight) or severe (> 10% reduction) when the present weight was compared with the weight found at the initial clinic visit. Records were reviewed for 1,370 patients, of whom 12.2% complained of diarrhea (7.7% acute and 4.5% persistent). Diarrhea was more common among patients with a history of male-to-male sexual contact than in patients with other HIV risk factors (p < 0.003 for acute and p < 0.006 for persistent). The mean CD4 cell count was not significantly different in patients with or without persistent diarrhea (176 versus 212) or acute diarrhea (215 versus 212). Weight loss was reported in 25.2% of subjects (12.8% moderate and 12.4% severe). It did not correlate with CD4 count. Persistent diarrhea also was not associated with weight loss. Acute and persistent diarrhea were common among ambulatory HIV-positive patients, particularly in homosexual men. We did not identify a correlation among diarrhea, weight loss, and CD4 count. Thus, factors other than chronic diarrhea and immunosuppression appear to be responsible for weight loss in HIV-infected patients.