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Biomedical subjects

Jamshed Akhtar

Publications and source records attributed to Jamshed Akhtar.

13 recordsLinked to original sources
PubMed2006

Corticosteroids therapy in the management of infantile cutaneous hemangiomas.

OBJECTIVE: To determine the effectiveness of systemic and intra-lesional corticosteroids, in the management of infantile cutaneous hemangiomas and to compare the results with untreated lesions. DESIGN: Randomized controlled trial. PLACE AND DURATION OF STUDY: Surgical Unit B of National Institute of Child Health, Karachi, from January 2001 to January 2003. PATIENTS AND METHODS: A total of 75 cases with cutaneous hemangiomas were included in the study. Three groups of 25 patients each were made by allocating first patient to control group, every second patient to oral steroid group and every third patient to intra-lesional steroid group. In control group, patients were managed conservatively with repeated hospital visits in order to note down changes occurring in the lesion. In oral steroid group, tablet prednisolone was given at a dose of 2mg/kg/day on alternate days. The dose was gradually tapered over a period of 8 weeks. In intra-lesional steroid group, injection triamcinolone was given at a dose of 1 to 5 mg/kg, with a maximum dose of 30mg. Six injections of triamcinolone in monthly intervals were given. Outcome measures noted were the change in size before and after treatment, duration of proliferative phase, change in morphology and complications. RESULTS: In the control group,76% lesions showed little or no change, 5.8% had less than 50% reduction and 20% lesions showed actual increase in size. In oral steroid group, 32% lesions showed greater than 50% reduction in size, 44% lesions had less than 50% reduction and 24% lesions had little or no change. In intra-lesional steroid group, 44% lesions showed greater than 50% reduction in size, 32% lesions showed less than 50% reduction and 24% lesions had little or no change. Morphology change in terms of color change, surface bosselation and soft consistency was found in 88% lesions of oral steroid group, 92% in intra-lesional steroid group and 16% in observation group. Complication rate was 16% in observation group, 20% in oral steroid group and 24% in intra-lesional steroid group. CONCLUSION: Hemangiomas when left untreated behave in an unpredictable manner. Low dose steroids whether given orally or intra-lesionally, showed remarkable reduction in size with minimal side effects.

Female↗
PubMed2006

Complications / problems of colostomy in infants and children.

OBJECTIVE: To determine the frequency of complications/problems occurring with construction of colostomy in infants and children. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Surgical Unit B, National Institute of Child Health, Karachi, from September 2001 to March 2003. PATIENTS AND METHODS: All the patients admitted in the unit who required colostomy as part of their management were included in the study. The patients who were operated upon previously or operated elsewhere and referred after having colostomy, were excluded. Problems associated with colostomy construction like skin excoriation and chronic blood loss were also recorded. Chi-square test of proportion was used to determine the p-value. RESULTS: There were 121 patients. Most of the patients were operated due to anorectal malformations (n=71) and Hirschsprung's disease (41). Complications/problems related to colostomy occurred in 67.7% patients. The most common problem was skin excoriation. Second in rating was chronic blood loss from stoma. Prolapse of stoma was more common in transverse loop colostomies. Divided colostomies had higher number of complications as compared to loop colostomies, similarly, transverse colostomies had high number of complications but in both the cases difference was not statistically significant. Four (3.3%) patients died. CONCLUSION: Construction of colostomy in paediatric patients carries high frequency of complications/problems and requires careful technique. The role of stoma care clinic and enterostomal therapist can be instrumental in preventing problems associated with colostomy.

Anal Canal↗
PubMed2006

Complications of inguinal hernia surgery in children.

OBJECTIVE: To determine the postoperative complications of elective inguinal hernia surgery in children DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Surgical Unit B, National Institute of Child Health, Karachi, from February 2004 to November 2005. PATIENTS AND METHODS: Children with inguinal hernia, admitted electively through surgical outpatient, were included. Patients operated earlier and presenting with complications were excluded. Patients with concomitant diseases, regarded as predisposing factors for hernia development, were also excluded. Physical examination and relevant investigations (hemoglobin level and ultrasound of scrotum) were performed. Inguinal hernia was repaired electively by Rehbein procedure. Patients were followed at day 7, 1 month, 3 months and 9 months to note the postoperative complications of the surgery. Ultrasound was repeated at 6 and 9 months postoperatively for the size of testes. RESULTS: A total of 223 patients with inguinal hernia were included in the study. Age ranged from 8 days to 12 years. There were 188 males with 75 patients under 1 year of age. The longest follow-up was upto 9 months in 133 patients. The complications of scrotal edema occurred in 6 (2.97%), haematoma in 1(0.49%), wound infection in 2 (0.99%) and 5 events of recurrence of hernia in 4 patients. All appeared within 3 months of follow-up. Four recurrent hernia were operated. In all cases intact sac was found. No patient developed decrease in size of testes nor ascent of testes was noted at follow-up. CONCLUSION: in this series, there were minimal complications observed in relation to inguinal hernia surgery.

Child↗
PubMed2006

Correlation of the size of undescended testis with its locations in vatrious age groups.

OBJECTIVE: To assess the correlation of the size of undescended testis with its location in children of various age groups, per-operatively. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Surgical Unit B, National Institute of Child Health, Karachi from February 2004 - November 2005. PATIENTS AND METHODS: Children presenting with undescended testis at surgical outpatient were recruited. Physical examination and relevant investigations (haemoglobin, ultrasound for location and size of testes) were performed. Patients were divided randomly into three age groups, group I (8 months - 2.5 years), group II (2.6 - 8 years), group III (8.1-13 years). At orchiopexy location and size of undescended testis were noted. Patients were further sub-divided into groups according to peroperative location of undescended testis, group A (intra-abdominal), group B (intra-canalicular), group C (distal to superficial inguinal ring - pubic). Where no testis was found, a separate group D was assigned. The size of undescended testis at different locations in various age groups was compared with reference to normal descended testicular size in the respective age group, for statistical significance. ANOVA test was used for intergroup comparison for the size of undescended testis and Student t- test was applied for comparison with reference to normal values of the size of testis. RESULTS: A total of 102 patients with undescended testis were included in the study. The total number of 107 testicular units were assessed. Group I had 28, group II, 41 and group III, 38 testes. There were 24 intra-abdominal, 68 intra-canalicular and 12 pubic in location. In 3 cases, no testis was found at exploration. We found no statistically significant difference amongst groups (p-value=0.090) between the size of the undescended testis at different peroperative locations. The size of undescended testis grew with the age as undescended testis of larger size were found in older age group as compared to younger age group. By applying Student t-test, we did not find statistically significant difference in relation to the size of undescended testis in various age groups in comparison to the reference of mean volume of normally descended testis in the respective age groups. CONCLUSION: Pre-pubertal size of undescended testis does not differ significantly from that of normal reference value of descended testis in relation to age and location. The ultimate size of the testis can only be assessed after puberty whether it is a normally descended or undescended testis.

Adolescent↗
PubMed2005

Congenital pyloric atresia: isolated and associated with aplasia cutis congenita.

Two cases of congenital pyloric atresia (CPA) are, hereby, reported. One was suspected on antenatal ultrasound and turned out to be an isolated anomaly. Other patient had a rare association of aplasia cutis congenita with congenital pyloric atresia. The lesions of aplasia cutis congenita were multiple while congenital pyloric atresia was of type II. The patient with an isolated lesion survived following surgery while the other baby died of sepsis in postoperative period.

Adult↗
PubMed2005

Sirenomelia (Mermaid baby).

Sirenomelia is a rare anomaly that rarely occurs as an isolated lesion. Several theories have been proposed regarding the etiopathogenesis. In this communication, we report a case of sirenomelia. Our patient was referred to hospital at the age of four hours. On examination, fusion of both lower limbs with hook shaped appendage, attached distally, absent genitalia and absent anal orifice was found. Spine was deficient in sacral region. Upper torso looked normal. Baby also had frothing from mouth. Abdomen was non-distended. Feeding tube no.10 was tried to pass through mouth, which got obstructed at the level of upper esophagus that suggested oesophageal atresia. The skeletogram revealed absence of pelvic bones, sacral agenesis, absent fibulae and fracture of both femora. The patient died at the age of 12 hours.

Abnormalities, Multiple↗
PubMed2005

Crimean-Congo haemorrhagic fever: An alert for health care workers.

Recently we have come across sudden increase in cases of haemorrhagic fever. This has led to lot of speculations especially with regard to its spread. Crimean-Congo haemorrhagic fever is one condition about which awareness among health care workers is important. This is discussed in this article.

Hemorrhagic Fever, Crimean↗
PubMed2003

Non-operative management of intestinal obstruction due to ascaris lumbricoides.

OBJECTIVE: To compare, evaluate and analyze three different non-operative modalities of treatment of intestinal obstruction due to ascaris lumbricoides. DESIGN: A non-randomized, cohort and comparative study. PLACE AND DURATION OF STUDY: Department of Pediatric Surgery, National Institute of Child Health, Karachi from March 2001 to October 2002. PATIENTS AND METHODS: A total of 45 patients with the diagnosis of intestinal obstruction due to ascaris lumbricoides were included in the study. They were divided in 3 groups of 15 patients each. Group I patients were given I/V fluids only, group II patients were given hyoscinbutylbromide in infusion and group III patients were given hypertonic saline enema. The outcome of all groups was compared in terms of improvement in obstruction and hospital stay. The data was analyzed by SPSS 11.0 by using ANOVA and HSD Tuckey test for multiple comparisons. RESULTS: The non-operative treatment was successful in all of the patients. In group III improvement of intestinal obstruction occurred in 1.6 +/- 1.11 days (p value=0.001), whereas it was 2.6 +/-1.11 days in group II and 3.4 +/-1.35 days in group I. The mean hospital stay in group III was 4 +/-1.69 days (p value=0.003), whereas it was 6.27 +/- 2.31 days in group II and 5.87 +/-1.25 days in group I. CONCLUSION: We recommend that hypertonic saline enema is a better non-operative treatment modality of intestinal obstruction, due to ascaris lumbricoides, in patients who do not have peritonitis. It is associated with early improvement of obstruction coupled with reduced hospital stay.

Analysis of Variance↗