Aeromonas hydrophila induced necrotizing fasciitis following laparoscopic cholecystectomy

Necrotizi ng fasciit is [NF] i s a m ultifaceted disease of the muscle fascia and body tissues which demands the earliest intervention. Past reviews have documented ver y few cases of Aeromonas Hydroph ila [AH] induced N F fol lo wing abdominal surgery. AH can cause fatal NF as seen in a 72 year old female patient reported at Liaquat National Hospital &Medical College; a ter tiary care center in Karachi, Pakistan on 2nd April, 2022. She had a k nown comorbidity of hypertension and presented with the chief complaint of symptomatic gallstones for which she unde rwent Laparoscopic Cholecystectomy (LAPCHOL). She developed NF of the lower ab domen post- oper atively. Following uneventful Laparoscopic Cholecystectomy our pati ent presented to the ER two days later with severe lower abdo minal pain and overlyi ng celluliti s. Fasc io to my revealed extensive myonecrosis with necrotizing soft tissue in fe ction. Despite u ndergoing extensive surgical debr idement and broad spectr um antibi ot ic administration; the patient died in the ICU on the fifth postoperat ive day followi ng septic complications. Histopathologica l an alysis, confirmed i nflammat ion and necrosis. Culture sensitivity of the debrided tissue revealed AH. Approach should lie towards analyzing the behaviour of such microbes in high risk patients through collective case studies. This is the first clinical case showcasing such parameters e ncountered in the General Surger y Department.

Influence of omega- 3 fatty acids, soya isoflavones and their combination for abrogating carbon tetrachloride hazards in male rats

Studies have shown that carbon tetrachloride (CCl4) induces hepatic and renal damage arising from oxidative stress. The present study was undertaken to examine the effect of omega-3 fatty acids and/or soya isoflavones on CCl4 induced toxicity in male albino rat liver and kidney. For this purpose, 42 rats were divided as follows: group 1, rats serves as the control without any treatment; group 2, rats were administered a single dose of CCl4 intraperitoneally (1 mg/kg b. wt.); group 3, rats were supplemented daily with omega-300 orally (400 mg/kg b. wt.); group 4, rats were supplemented daily with pro-S orally (50 mg/kg b. wt.); group 5, rats were supplemented daily with omega-300 orally for four weeks, then after 24 hours treated with a single dose of CCl4 at the same tested doses. group 6, rats were supplemented daily with pro- S orally for four weeks, then after 24 hours treated with a single dose of CCl4 at the same tested doses; group 7, rats were supplemented daily with an oral combination of omega-300 and pro-S orally for four weeks, then after 24 hours treated with a single dose of CCl4 at the same tested doses. Results showed that CCl4 administration induces hepatic damage indicated by a significant increase in the activities of alkaline phosphatase (ALP), aspartate aminotransferase (AST) and Aalanine aminotransferase (ALT) enzymes and glucose level, with a significant increase in malondialdehyde (MDA) and nitric oxide (NO) levels and a significant decrease of reduced glutathione (GSH) level in liver tissue. Also, CCl4 toxicity induce renal damage manifested in a significant increase in serum urea, creatinine, uric acid, and oxidative stress of kidney tissue reflected by increase of MDA, NO and the decrease of GSH levels. The pre-treatment with omega-3 fatty acids and/or soya isoflavones revealed ameliorative effect against deleterious effects of CCl4 toxicity on hepatic and renal tissues and all tested parameters. Results of the current study revealed also that the pre-treatment with omega-3 fatty acids and/or soya isoflavones to rats improved liver and kidney function and produced high antioxidant activity.

Typhidot - A blessing or a menace

Objectives:

Typhoid remain an increasing problem in Third world countries like Pakistan. A reliable, easy and affordable rapid diagnostic test is a need for our clinicians, many of whom consider Typhidot to be promising. Typhidot has been used as the only tool to diagnose typhoid fever by general practitioners and consultants despite its low sensitivity and specificity causing misdiagnosis and treatment. We therefore conducted this study to evaluate the sensitivity and specificity of Typhidot in patients with fever.

Methods:

A retrospective analysis of a total of 145 febrile patients was done. Blood culture and Typhidot along with other relevant investigations had been performed in each case. Sensitivity, specificity and the association of Typhidot to the diagnosis was found using SPSS v16.0.

Results:

Out of 145 patients, 15(10.3%) had positive blood culture for Salmonella typhi, 7 (4.8%) had positive culture for salmonella paratyphi and 94(64.8%) had positive culture for other organisms. Twenty nine (20%) patients had negative culture results. Forty seven (32.4%) patients had only IgM positive on Typhidot, 7(4.8%) had both IgM and IgG positive and 91(62.8%) had both IgM and IgG negative. Amongst the 130 patients with diseases other than typhoid, 50(38.5%) showed a positive Typhidot result. Amongst the 15 patients with typhoid, 11(73.3%) showed a negative Typhidot result. The sensitivity of Typhidot was found to be 26.7% and the specificity was 61.5%. The Positive Predictive Value (PPV) was 7.4% and the Negative Predictive Value (NPV) was 87.9%.

Conclusion:

Even though Typhidot is rapid, easy and affordable, its use should be discouraged due to low sensitivity and specificity and insignificant (p=0.067) association to the disease.

The role of children with congenital anomalies in generating parental depressive symptoms

BACKGROUND

Many expectant parents wish to have a normal child. Unfortunately this does not always happen and some of them may have a child with birth defects leading to detrimental psychological effects on the parents. One of the common presentations generally observed is depression. The presence of depressive symptoms amongst such parents needs to be recorded to find out its prevalence. The results of such finding can help shape future programs for the prevention and treatment in this population group. This study will therefore explore the extent of depressive symptoms amongst parents of children with congenital anomalies.

METHODS

A case control study design was chosen. Ethical Review Board gave approval for the study on December 31, 2010, and the collection of data was started on January 5, 2011. Two randomly chosen samples of 132 parents each were collected from National Institute of Child Health (NICH), Ida Rieu, and Civil Hospital Karachi (CHK) over 8 months. First group consisted of parents of children with congenital anomalies and the second group was chosen as the control group from general population. Zung scale was used to record the presence of depressive symptoms in these two populations. Mann-Whitney test was performed to compare the depression scores.

RESULTS

The scale was completed by 132 parents in both sets. The parents of children with congenital anomalies showed greater (p < 0.0001) depressive symptoms. Mothers displayed greater (p = 0.029) depressive symptoms than fathers.

CONCLUSION

The parents of children with anomalies (60.6%) had more depressive symptoms than parents of normal children (27.3%).

Effects of papaya leaves on thrombocyte counts in dengue--a case report

Dengue fever is on the rise in developing nations like India, Pakistan, Sri Lanka and Bangladesh. There is no antiviral chemotherapy or vaccine for dengue virus and management of the disease is done on supportive measures. The decline in the thrombocyte count leads to dengue haemorrhagic fever accounting for complications and mortality. Oral administration of Carica papaya leaves extract is said to have a positive impact on thrombocyte count. A 23-year-old man was administered a calculated dose for five days. Blood samples were tested for complete blood count before and after the administration of the juice. Thrombocyte count had increased from 28000/micro liter to 138000/micro liter at the end of five days. We present our experience here.

Medical students perception of their medical environment-expected versus actual perceptions--a cross sectional study

OBJECTIVE

To compare the expected (perceptions of their environment at the beginning of their 1st year) versus actual perceptions (perceptions at the end of 1st year) of 1st year students at Dow University of Health Sciences.

METHODS

The 'expected' perceptions of the students were recorded at the beginning of their 1st year (n = 411) of medical education when they entered the medical school using Dundee Ready Educational Environment Measure (DREEM). DREEM is a validated and self-administered inventory which focuses on learning, teachers, self-confidence and academic as well as social environment. The 'actual' perceptions were then recorded at the end of their first year (n = 405) of education when they had received adequate exposure of their environment. The 2 records were then compared.

RESULTS

The total expected DREEM score was 118/200 and the total actual DREEM score was 113/200. The expected domain (Students' perceptions of learning, students' perceptions of teachers, students' academic self-perceptions, students' perceptions of atmosphere, and students' social self-perceptions) scores were 28/48, 26/44, 20/32, 28/48, and 16/28. The actual domain scores were 27/48, 23/44, 19/32, 27/48, 16/28. However both the actual and expected scoring displayed satisfactory environment for learning. Significant differences (p < 0.0001) were found in the two samples.

CONCLUSION

In general the results displayed that the students perceived the environment positively but the significant difference found in the two samples, demonstrated that their expectations were not met.

Hepatitis patients lost to follow-up at a liver centre in a tertiary care hospital of Karachi, Pakistan--a cross-sectional descriptive study

OBJECTIVE

To investigate the causes for loss-to-follow-up of hepatitis patients at a liver centre of a tertiary care hospital.

METHODS

A representative sample of 165 patients who were lost to follow-up during 2009 to 2010 was chosen and a cross-sectional descriptive study was performed. All hepatitis patients included were screened for antibody to hepatitis C virus (HCV Ab) and hepatitis B virus surface antigen (HbsAg), and were tested through polymerase chain reaction (PCR) and genotyping. Laboratory investigations, ultrasounds, personal habits, visits to hakeems and use of other alternative medications, occupations and income per month, education, and other basic information was also recorded. Those who did not return for follow-up were contacted and inquired about their reasons for loss-to-follow-up. Based on this data, the patients were categorised into four different groups according to reasons of loss to follow up: non-compliance, alternative medication, monetary issue and poor prognosis.

RESULTS

The entire sample size of 165 patients who were lost to follow-up was included in the study. 14 (8.5%) patients were hepatitis B virus (HBV) positive. Of these patients, 1 (7.1%) was lost due to alternative medication and the rest (n=13; 92.9%) were lost to follow-up due to non-compliance. Amongst the 151 (91.5%) hepatitis C virus (HCV) positive patients, 2 (1.3%) were lost due to monetary issues, 17 (11.3%) were lost due to alternative medication, 4 (2.6%) were lost due to poor prognosis and 128 (84.8%) were lost due to non-compliance.

CONCLUSION

This study shows that most patients were lost to follow-up due to non-compliance. It is important for physicians to design better counselling programmes to make the patient compliant enough to go through the complete treatment.

Crude cellulase from oil palm empty fruit bunch by Trichoderma asperellum UPM1 and Aspergillus fumigatus UPM2 for fermentable sugars production

Cellulase is an enzyme that converts the polymer structure of polysaccharides into fermentable sugars. The high market demand for this enzyme together with the variety of applications in the industry has brought the research on cellulase into focus. In this study, crude cellulase was produced from oil palm empty fruit bunch (OPEFB) pretreated with 2% NaOH with autoclave, which was composed of 59.7% cellulose, 21.6% hemicellulose, and 12.3% lignin using Trichoderma asperellum UPM1 and Aspergillus fumigatus UPM2. Approximately 0.8 U/ml of FPase, 24.7 U/ml of CMCase and 5.0 U/ml of β-glucosidase were produced by T. asperellum UPM1 at a temperature of 35 °C and at an initial pH of 7.0. A 1.7 U/ml of FPase, 24.2 U/ml of CMCase, and 1.1 U/ml of β-glucosidase were produced by A. fumigatus UPM2 at a temperature of 45 °C and at initial pH of 6.0. The crude cellulase was best produced at 1% of substrate concentration for both T. asperellum UPM1 and A. fumigatus UPM2. The hydrolysis percentage of pretreated OPEFB using 5% of crude cellulase concentration from T. asperellum UPM1 and A. fumigatus UPM2 were 3.33% and 19.11%, with the reducing sugars concentration of 1.47 and 8.63 g/l, respectively.

Delayed presentation of traumatic ventricular septal defect and mitral leaflet perforation

A case of intracardiac stabbing is reported. The victim sustained injuries disproportionate to his initial presentation. These included a ventricular septal defect and mitral valve leaflet perforation. The need for immediate referral to a cardiothoracic unit and the importance of the use of echocardiography is stressed. This enables the safest and most appropriate management of potentially lethal injuries.

An unusual cause of ventricular tachycardia

Inflammatory pseudotumour (IP) of the heart is an extremely uncommon and potentially fatal lesion which presents a challenging diagnosis even for the experienced pathologist, cardiologist and cardiac surgeon. This spindle cell tumour is known to be present in virtually every anatomical region but, in adults, has only previously been found in the heart at postmortem. We report the case of a 27-year-old man who presented with ventricular tachyarrhythmias and a right ventricular mass which was subsequently shown to be an IP.

Recurrent respiratory papillomatosis: a study of 24 cases

24 cases of recurrent respiratory papillomatosis (RRP) in children were treated by surgical removal with cup forceps and followed up for variable periods between 1990-95. Most of the patients required multiple operations due to recurrence. No anaesthetic death or complication was recorded. Voice changes of different degrees were noted. Four patients has glottic web formation. The findings suggest that recurrence of RRP is very common & needs multiple session of surgery. For children with persistent and progressive voice change/cry, the necessity of precise & comprehensive endoscopic examination of the upper aerodigestive tract under general anesthesia (GA) is emphasized.

A clinical comparative study between crystalloid and blood-based St Thomas' hospital cardioplegic solution

OBJECTIVE

Myocardial protection with blood cardioplegia during cardiac surgery is increasingly preferred, but few studies have compared the protective effects of crystalloid cardioplegia to the same solution with blood as the only variable. This clinical study compared the protective effects of crystalloid or blood-based St. Thomas' Hospital cardioplegic solution No. 1.

METHODS

Fifty higher risk patients undergoing elective coronary artery bypass surgery, with an ejection fraction less than 40%, were randomly allocated to receive cold (4 degrees C) intermittent crystalloid St. Thomas' No. 1 cardioplegia (n = 25), or a similar blood-based solution (n = 25) with a haematocrit of 10-12%. We determined (1) peri-operative and post-operative arrhythmias, (2) left and right ventricular function (24 h) using the thermodilution technique, (3) left ventricular high-energy phosphate content sampled before ischaemia, the end of ischaemia and the end of bypass.

RESULTS

Pre-operative haemodynamic data, aortic cross-clamp and bypass times were similar in both groups of patients; there was no mortality. At the end of ischaemia there were no differences in ATP content between groups but creatine phosphate was maintained at a significantly (P < 0.007) higher level in the blood-based St. Thomas' cardioplegia group than the crystalloid St. Thomas' cardioplegia group (20+/-2 (SE) vs. 13+/-1 micromol/g dry wt, respectively). Return to spontaneous sinus rhythm was significantly (P = 0.002) increased in the blood-based St. Thomas' cardioplegia group (96%) compared to the crystalloid St. Thomas' cardioplegia group (60%). Early post-operative ventricular dysfunction occurred in both groups, but normal LV function (stroke work index) recovered significantly (P = 0.043) more rapidly (by 2 h) in the blood-based St. Thomas' cardioplegia group of patients.

CONCLUSIONS

In a higher risk (EF < 40%) group of patients undergoing elective cardiac surgery, addition of blood to an established crystalloid cardioplegic solution significantly enhanced myocardial protection by reducing arrhythmias, improving rate of recovery of function and maintaining myocardial high-energy phosphate content during ischaemia.

A comparison of prescription medication use by nursing home and homebound dental patients

The elderly consume a disproportionate number of prescription medications dispensed in the United States. Although medication use among nursing home residents has been documented, little information is available regarding the medication use of homebound elderly. This study compared the medication use of nursing home and homebound patients treated by a mobile dental homecare program. A total of 338 dental records were reviewed, identifying the number and type of medications used. In addition, medications with xerostomic potential were identified.