Objective: The study aims to evaluate the surgical closure of Atrial Septal Defect (ASD) and concomitant surgical procedures needed at Cardiac Care Centre. Introduction: An ASD is a hole of variable size in the atrial septum. A patent foramen ovale that is functionally closed by overlapping of limbic tissue superiorly and the valve of the fossa oval inferiorly (in response to the normal left-to-right atrial pressure gradient) is excluded. ASDs generally permit left-to-right shunting at the atrial level. Partial anomalous pulmonary venous connection (PAPVC) is a condition in which some but not all pulmonary veins connect to the right atrium or its tributaries, rather than to the left atrium. Methodology: A prospective cohort study was done at Tabba heart institute. 115 consecutive patients were reviewed and investigated. All the patients with surgical closure of ASD and concomitant surgical procedures who returned for follow-up from June 2011 to May 2016 in the study were included as population sample. Results: Total ASD repair only patients were 80 and patients who needed concomitant procedures too were 35. The size of the defect ranged from 3mm to 58mm, with a mean of 26.96±11.02mm. The relative frequencies of different ASDs were secundum 57 (80.2%), primum 4 (5.6%), and sinus venosus 10 (14.08%). Major post-operative complications by Age group and by procedure were evaluated and presented. Conclusion: It was concluded from our results that surgical repair of atrial septal defects and its variants is associated with very low morbidity in different age groups due to its excellent results.
Introduction: A 49-year-old man presented to the emergency department with complaints of 2-day history of abdominal pain without any significant nausea, vomiting, diarrhea, or constipation. He was started on doxycycline 100 mg twice daily for tooth infection 5 days ago. Physical examination showed abdominal distention and epigastric tenderness without guarding. Past medical history included, seizures, and COPD. Home medications were pantoprazole, phenobarbital, and tegretol. Labs were significant for mild leukocytosis, hemoglobin of 11, and hematocrit of 34, and metabolic profile showed normal aspartate transaminase, alanine transaminase, alkaline phosphatase, amylase, lipase, and normal lipid profile. Abdominal ultrasound did not show any gallstones, but CT abdomen with contrast showed pancreatitis with peripancreatic fluid. Doxycycline was discontinued and patient was started on intravenous fluids, pain control, and tube feedings. Patient’s symptoms have significantly improved and he was able to tolerate oral feedings. Patient was discharged after uncomplicated course and was told not to take doxycycline again. Drug-induced pancreatitis represents 1.4% of all causes of acute pancreatitis. Diagnostic criteria include: pancreatitis develops during drug therapy, other possible causes of pancreatitis should be eliminated, pancreatitis should resolve after discontinuing the suspected drug, and the reoccurrence of pancreatitis after reusing the same drug. Drug-induced pancreatitis classified into definite, highly probable, or weakly probable in correlation with mentioned criteria. Our patient developed acute pancreatitis 3 days after the administration of doxycycline and was resolved 3 days after discontinuation of the drugs. All other possible factors, such as alcohol use, gallstones, hypercalcemia, hyperlipidemia, and malignancy were eliminated by physical examination, blood tests, and imaging studies. Adverse effects of doxycycline include elevation of liver and renal function tests, nausea, vomiting, and dysphagia. Doxycycline is part of the tetracycline group of antibiotics, which is linked to few cases of acute pancreatitis. Suggested theories include intrinsic toxins versus idiosyncratic reactions. Our patient most likely suffered from acute pancreatitis due to doxycycline since other causes of pancreatitis were eliminated. Although this adverse effect is not well known, it is probably quite rare. Physicians should consider acute pancreatitis in patients who develop nausea, vomiting, and epigastric pain when taking doxycycline. If doxycycline is suspected as the causative agent, it should be discontinued and readministration should be avoided.
Upper gastrointestinal bleeding is the most common and potentially life threatening emergency. Despite great advances in the field of medicine, the optimal management of bleeding peptic ulcer with adherent clot on endoscopy is still controversial. The aim of this study is to compare the combined endoscopic and medical therapy with medical therapy alone for bleeding peptic ulcer with adherent clot (Forrest type IIB). During two-year study period, around 342 patients presented to our Tertiary care hospital with acute upper gastrointestinal bleeding. Out of these, 81 patients were noted to have adherent clot (Forrest type IIB) during endoscopy and were included in study. 40 patients received combined endoscopic and medical treatment, whereas 41 patients received medical treatment only. The base line characteristics of patients in two groups were comparable and statistically significant. Primary Outcome being recurrence of bleeding within 7 days of treatment was less in combined therapy group compared to medical therapy group (2.5% vs. 17.1%) This was statistically significant. Secondary outcome like recurrence of bleed in 30 days and need for repeat endoscopy were less in combined group compared to medical therapy group. These were statistically significant as well. Other secondary outcomes like necessity for surgery and mortality were fewer in combined group, but these were not statistically significant. In conclusion combination endoscopic therapy consisting of epinephrine injection, removal of the adherent clot, and treatment of underlying stigmata is more effective than medical therapy alone.
Extrarenal nephroblastoma (Wilms' tumor) is very rare with to date just 34 cases described. Two such cases out of a total of 61 patients with WT presenting to a single institution over a 10-year period are presented. Both children, a boy aged three years and a girl aged four years, both presented with an abdominal mass which had crossed the midline. Ultrasonography and contrast studies in the two patients revealed retroperitoneal tumors distinct from kidneys, but unilateral hydronephrosis was noted in both patients. Primary surgical excision was performed and both patients grouped as stage III favorable histology. Postoperative treatment included chemotherapy and radiotherapy as per UKCCSG protocols. The patients are clinically well with no evidence of disease 7 years and 20 months respectively from diagnosis. An individualized approach to treatment of extrarenal WT is advocated.
To be granted a product license, a vaccine must present adequate quality, safety and efficacy. Studies on these criteria often utilize target species in a laboratory setting. Vaccines that had been proven effective during laboratory analysis may not present the same features when sold on a large scale, after encountering field conditions, and furthermore, can even produce complications. Measures are already in place to detect adverse reactions as reported by veterinarians to manufacturers, so that vaccines under suspicion of failing can be identified and investigated. The present review article describes the main problems, specifically adverse reactions and lack of efficacy, that have been encountered following release of vaccines for general use.
The study proposes that teacher commitment to students is positively related to student's social development. Furthermore, the study suggests that gender moderates the relationship between teacher commitment and students' social development, such that the relationship was stronger for females than males. The study employed a questionnaire to collect cross-sectional data from 459 data from SSE/SST teachers and 10th grade students from high schools in Punjab, Pakistan. Analyzing data using structural equation modeling in Amos 24 revealed that all the hypothesized relationships were supported. The study found a significant relationship between teacher commitment to students and positive social development, suggesting that teacher commitment can help students positively enhance their social development. Furthermore, the study found that the relationship between teacher commitment to students and students' social development was significant for female students and insignificant for male students. The study contributes to the literature on teacher commitment and students' social development and offers novel practical insights.
This methodological study addresses a critical gap in the research landscape by exploring the influence of nursing education on the attributes of nursing students in Pakistan. Despite existing studies in countries such as Iran, Egypt, and Finland, satisfactory research on this topic remains elusive. The study aims to develop and validate an instrument tailored for the Pakistani context, specifically focusing on the power of nursing education and its capacity to shape nursing students' attributes. A questionnaire-based approach was employed to gather data, focusing on the extent to which nursing education influences the attributes of student nurses. The analysis of the data revealed encouraging findings regarding the impact of nursing education on various attributes. Notably, improvements were observed in areas such as professional communication, fluidity, and the integration of human values and professional excellence into nursing practice. This study sheds light on the nuanced concept of the power of nursing education from the perspective of nursing professionals. The findings underscore the complexity inherent in this concept, emphasizing its significance within the context of the nursing profession's ethos of compassion, ethics, and care. Importantly, the study highlights the notion of professional influence through nursing education as a valuable concept, vital for fostering the professional growth and development of nursing students. Crucially, the results demonstrate that nursing education plays a pivotal role in enhancing nursing students' professional knowledge and overall development, thereby positively impacting their attributes. By equipping students with the necessary skills and knowledge, nursing education cultivates professionalism and establishes a strong foundation for future nursing practice. This study contributes to the international discourse on nursing education and underscores the importance of tailored research initiatives to understand its impact on nursing students' attributes across diverse cultural and contextual settings.
Background: Peripheral arterial disease (PAD) is known to be strongly linked to major adverse limb events, ultimately leading to an increased risk of limb-threatening conditions. We developed a predictive model using five identified biomarkers to predict major adverse limb events, limb loss, diabetic (DM) foot ulcers, and vascular intervention in patients with underlying PAD and DM over 2 years. Methods: A single-center prospective case control study with was conducted with 2 years’ follow up. In the discovery phase the cohort was randomly split into a 70:30 ratio, and proteins with a higher mean level of expression in the DM PAD group compared to the DM non-PAD group were identified. Next, a random forest model was trained using (1) clinical characteristics, (2) a five-protein panel, and (3) clinical characteristics combined with the five-protein panel. Demographic data were analyzed by independent t-test and chi-square test. The importance of predictive features was calculated using the variable importance (gain) score. The model was used and assessed for its ability to diagnose PAD, predict limb loss, predict major adverse limb events (MALEs), predict diabetic foot ulcers, and predict the need for vascular surgery. The model was evaluated using area under the receiver operating characteristic curve and net reclassification index. Results: The cohort of 392 patients was matched for age, sex, and comorbidities. Five proteins were identified (TNFa: tumor necrosis factor alpha, BMP-10: bone morphogenic protein 10, CCL15/MIP1 delta: chemokine (c-c motif) ligand 15/macrophage inflammatory protein 1 delta, MMP-10: matrix metalloprotease 10, and HTRA2/Omi: HTRA2, also known as Omi) as having a significantly higher level of expression in the DM PAD group. HTRA/Omi had the highest contribution to the model’s ability to diagnose PAD in diabetic patients. Model performance was best when combined with clinical characteristics to predict limb loss (AUROC 0.86, 0.76, 0.80), foot ulcer (AUROC 0.87, 0.82, 0.67), MALE (AUROC 0.81, 0.78, 0.67), and the need for vascular surgery (AUROC 0.82, 0.81, 0.61). Conclusions: In this study, we describe a biomarker panel that can be used in combination with clinical characteristics to create an accurate prediction model for diagnosis and prognostication of PAD in the setting of DM.
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