Introduction: Biliary tract diseases comprise the most frequently occurring pathology in the abdomen, among which cholelithiasis affects 10-15% of the population. Early laparoscopic cholecystectomy, performed within 72 hours 2) Interval laparoscopic cholecystectomy, performed within 72 hours to 6 weeks 3) Delayed laparoscopic cholecystectomy in which patients are treated with antibiotics and given date of surgery within 6-8 weeks according to international criteria. Objective: To find out the variability between hot, urgent, and delayed laparoscopic cholecystectomy in terms of clinical complications and to find out the readmission rate, the persistence of symptoms, and the safety of the procedure. Materials and Methods: This is a retrospective study carried out in the Surgical Unit ll, Holy Family Hospital, Rawalpindi from January 2018 to March 2018. All adult male and female patients presenting with acute cholecystitis and pancreatitis were included in the study. Results: Total number of patients included in our study is 82. Most of the patients were female 80.5% with a mean age of 44 years. Most of the patients were categorized under delayed laparoscopic cholecystectomy 93.9%, 6.1% underwent interval/urgent cholecystectomy, and 1.2% early/hot cholecystectomy. Diagnosis in the study showed acute cholecystitis in 79.3% of patients, pancreatitis in 7.3%, empyema /gangrene of gallbladder in 6.1% mucocele in 6.1%, and choledocholithiasis in 1.2% of patients. Hence we figured out that performing early cholecystectomy leads to lesser complications. Conclusion: Early laparoscopic cholecystectomy was found out to be a safe and cost-effective procedure. There is an increased incidence of readmission and complications with delayed laparoscopic cholecystectomy. We suggest that measures must be taken in Pakistan to follow international guidelines in health practices to improve patient care.
Liquid crystal (LC) materials exhibit interesting electro-optic switching and molecular ordering properties. Furthermore, the addition of chemically compatible active emitters such as core-shell quantum dots (QD) in a LC medium allows optical as well as dielectric tuning in an anisotropic, reconfigurable ordered medium. Order in a nematic LC phase is characterized by an orientational order parameter. In this work, we demonstrate the use of patterned substrates to generate arrays of integer topological defects in a nematic LC medium doped with cadmium selenide (core) cadmium sulfide (shell) core–shell QDs. We demonstrate the formation of metastable air-pillar-induced integer topological defects (TDs) in relatively thinner 9 μm LC sandwich cells, and the formation of field-induced TDs in thicker (25 μm) cells. Simultaneously, the self-assembly of core-shell QDs into square arrays on the patterned substrates is discussed, highlighting potential electro-optic device applications. The surfactant hexadecyltrimethylammonium bromide (CTAB) is found to play a significant role in LC TD formation as well as QD spatial organization at the optimized concentration. Self-assembly and ordering of single- and multi-component LCs within structured devices is a highly relevant problem for modern optoelectronic devices. This work opens new possibilities for classical as well as quantum light sources which require spatially ordered optical emitters in a reconfigurable dielectric medium at a micron-scale.
Objective: To determine the frequency of nerve bundle hypertrophy in aganglionic segments in relation to the site of biopsy, along with the assessment of value of Calretinin immunostaining in the diagnosis of suspected cases of Hirschsprung disease. Study Design: Cross Sectional study. Setting: Department of Pathology, Pakistan Institute of Medical Sciences (PIMS) Islamabad. Period: September 2018 to March 2019. Material & Methods: After routine tissue processing colonic biopsies were examined for presence of ganglion cells and hypertrophic nerve presence or absence. Diagnosis of Hirschsprung disease was based on the absence of ganglion cells in submucosal and myenteric plexus, the presence or absence of hypertrophic nerves (more than 4 nerves >30 µm thick/×200 field or more than 2 nerves >40 µm thick/×200 field) was also noted in all cases of Hirschsprung disease (aganglionic segments). Calretinin immunostaining was applied to all the cases and controls and findings were recorded as positive or negative staining. Statistical Analysis: Data was analyzed using SPSS version 23. Qualitative data was calculated as frequencies and percentages. Pearson Chi square test was used to establish the association of nerve bundle hypertrophy with the site of biopsy. Results: Total biopsies were 60; 30 each from ganglionic and aganglionic segments. Calretinin sensitivity in our study was 90%, specificity 83.3%. In 30 cases of aganglionosis hypertrophic nerves were present in 13(21.7%) and they were absent in 17 (28.3%). No significant association (p value= 0.447) was seen in nerve bundle hypertrophy and site of biopsy. Conclusion: Calretinin immunohistochemistry can be used as a reliable ancillary technique in the diagnosis of HD. Aganglionosis may not always be associated with submucosal nerve hypertrophy which alone should not be used as a criteria for HD diagnosis but instead adjunct methods like Calretinin immunostaining must be utilized to confirm presence or absence of ganglion cells. There is no association of nerve hypertrophy with site of biopsy.
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