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Biomedical subjects

K Butt

Publications and source records attributed to K Butt.

At least 19 recordsLinked to original sources
PubMed2006

Urologic complications in renal transplant recipients by donor type.

BACKGROUND AND PURPOSE: Reduced donor morbidity has been established after laparoscopic donor nephrectomy compared with open harvest, but differences in recipient outcomes remain less obvious. We compared the urologic complications in patients receiving kidneys procured by cadaveric, open, and laparoscopic harvest. PATIENTS AND METHODS: A retrospective study of all the kidney transplantations performed between January 1998 and December 2003 was undertaken to extract 100 consecutive patients in each group. All urologic complications were obtained and grouped by the type of donor procurement. RESULTS: Overall, 48 of the 276 transplant patients (17%) had urologic complications: 14% of the cadaveric-donor recipients, 20% of the open-donor recipients, and 18% of the laparoscopic-donor recipients. There were no ureteral complications in the laparoscopic group. CONCLUSIONS: Laparoscopically procured donor kidneys were associated with significantly fewer recipient ureteral complications than open cadaver or live-donor procurement.

Adolescent↗
PubMed2004

Prescription and dispensing practices in public sector health facilities in Pakistan: survey report.

OBJECTIVES: To gather information on existing prescription practices, dispensing practices and patient satisfaction in government health services of the NWFP, Baluchistan and Punjab province. METHODS: A cross sectional study design was used for this purpose. Ten health care facilities were selected from each province keeping appropriate representation from first level health facilities, district health facilities and tertiary care hospital. Analysis of selected indicators was carried out on the basis of provinces, health facilities, gender and different age groups. RESULTS: Documentation of 914 responses was completed from three provinces. Almost equal distribution of encounters was maintained representing different health facilities. Forty seven percent of encounters involved children under 15 years of age. Female patients comprised of 56% and the mean age of the entire sample was 26 years. The mean dispensing time was only 38 seconds, the mean consultation time was 1.79 minutes and the average number of drugs per prescription turned out to be 2.7 out of which only 1.6 drugs were being dispensed from the facility. More than half of the prescriptions contained antibiotics and 15% of patients were prescribed with injectables. Only half of the patients expressed satisfaction with their visit to health facility. CONCLUSIONS: Like many other developing countries, prescription and dispensing practices are not satisfactory in public sector health facilities of Pakistan. Appropriate and workable solutions need to be developed and implemented in the country to improve systems. Regular audits and qualitative studies should become part of the effort.

Adolescent↗
PubMed1998

A masked randomized comparison of oral and vaginal administration of misoprostol for labor induction.

OBJECTIVE: To test the null hypothesis that administering misoprostol orally or vaginally will result in no difference in time to vaginal birth, and to determine whether different frequencies of tachysystole and hyperstimulation are associated with route of administration. METHODS: Two hundred six women after 37 completed weeks' gestation who presented with an indication for induction were randomly assigned to receive misoprostol (50 microg) either orally or vaginally every 4 hours as needed to induce labor. Placebo use and allocation concealment accomplished blinding until data analysis was completed. Sample size was calculated to allow a two-tailed alpha of .05 and power (1-beta) of 80%. All fetal heart rate and uterine activity graphs were classified according to Curtis' criteria before induction groups were unmasked. RESULTS: Analysis involved 104 women in the oral group and 102 in the vaginal group. The mean time (+/-standard deviation) to vaginal birth with oral misoprostol was 1072 (+/-593) minutes compared with 846 (+/-385) minutes with the vaginal protocol (P=.004). There were no significant differences in cesarean rate, epidural use, or neonatal outcomes. More frequent tachysystole for 20 minutes (P < .01) and hyperstimulation (P < .04) were observed with vaginal misoprostol. No neonatal asphyxia occurred in either group. CONCLUSION: Misoprostol effectively induces labor, given orally or vaginally. There is a shorter interval to vaginal birth with vaginal application; however, the more frequent occurrence of fetal heart rate graph abnormalities in this group suggests that, until the optimal dosing interval for vaginal use is determined, the preferred route of misoprostol administration might be oral.

Abortifacient Agents, Nonsteroidal↗
PubMed1998

Band ligation vs endoscopic sclerotherapy in esophageal varices: a prospective randomized comparison.

OBJECTIVE: A prospective randomized trial was conducted to compare efficacy, safety and complications of band ligation (BL) with sclerotherapy (Scl). METHODS: Patients with esophageal variceal bleeding were randomized into two study groups. BL (group A) was done in 28 patients whereas 30 patients (group B) had Scl. After initial treatment, follow-up sessions were repeated by the same method every two weeks till obliteration or reduction to grade 1. Subsequent sessions of endoscopy were done every three months, same procedure was repeated for recurrence of varices and for any episode of rebleeding. RESULTS: Initial control of bleeding by Scl was achieved in 22 of 28 patients (78%) and in 23 of 24 patients (96%) with BL. Eradication of varices was significantly better achieved in BL group, with less treatment sessions required in Group A as compared with group B 2 +/- 1.2 vs 5 +/- 2.5, P < 0.001). Major complications (3% vs 16%, P < 0.05) as well as mortality (11% vs 21%, P > 0.05) was higher in group B. CONCLUSION: Band ligation was more effective mode of treatment and was associated with lesser early mortality and complications as compared with sclerotherapy.

Endoscopy↗
PubMed1991

Excessive follicular recruitment and growth in mothers of spontaneous dizygotic twins.

We wished to establish the frequency, regularity and laterality of multiple ovulation in mothers of dizygotic (DZ) twins and controls. Subjects had regular menses and were not using oral contraceptives. Ovarian ultrasound scans were taken over a number of cycles in 21 mothers of DZ twins and 18 controls (including 13 mothers of monozygotic [MZ] twins). Multiple large follicles (greater than or equal to 12 mm diameter) were seen significantly more frequently in mothers of DZ twins (13/21 mothers, 24/77 cycles, average +/- SE follicles/cycle 1.34 +/- 0.11) than controls (2/18 mothers, 3/31 cycles, average 1.10 +/- 0.08). Both ipsilateral and contralateral multiple follicles were observed. In one case a mother of DZ twins showed multiple large follicles in 7 out of 10 cycles in which she was scanned, including both ipsi- and contralateral patterns of occurrence.

Adult↗
PubMed1991

Renal transplantation from elderly living donors.

A worldwide shortage of cadaveric donors has led to the increased utilization of elderly living donors, with controversial results. In an attempt to assess the effect of donor age on graft survival and subsequent renal function, we analyzed our clinical results in 276 consecutive recipients of living related renal transplants spanning both the cyclosporine and the azathioprine eras, of whom a total of 44 recipients received kidneys from donors over 55 years old. All recipients were otherwise similar in age, race, haplotype mismatch, number of retransplants, and number of pretransplant transfusions, apart from an increased number of diabetics among the CsA-treated recipients of elderly kidneys (38% vs. 14%). The cumulative patient and graft survival rates at 1 and 5 years were independent of donor age whether CsA or AZA was utilized. Nor was the incidence of rejection or infection significantly different in the older donor group when compared with the younger cohort. Short-term and intermediate-term renal function, as assessed by serum creatinine, was however poorer but stable in the older donor group when compared with the younger one. The mean serum creatinine levels at 1 year in the CsA- and AZA-treated recipients of kidneys from older donors were 2.4 and 2.0 mg/dl, respectively, compared with 1.6 and 1.4 mg/dl, respectively, when the donor age was less than 55 years (P less than 0.001). Since renal function at the end of the first posttransplant year is considered a determinant of long-term graft survival, this is a cause for concern, but in view of the universal shortage of organs and the negligible morbidity to donors, renal transplantation from elderly living donors remains an acceptable practice.

Age Factors↗
PubMed1990

HLA-identical renal transplants: impact of cyclosporine on intermediate-term survival and renal function.

Seventy-two and 34 consecutive HLA-identical sibling renal transplant recipients were treated with azathioprine/prednisone (AZA; follow-up, 5.0 years) and cyclosporine/prednisone (CSA; mean follow-up, 2.9 years), respectively. Both groups were similar in age, sex, race, and number of transplants, but there were more diabetics in the CSA group (34% v 8%). Actual patient survival at 1 year and actuarial patient survival at 5 years were 100% and 96%, respectively in the CSA group compared with an actual patient survival of 91% and 82% at 1 and 5 years, respectively, in the AZA group. Actual graft survival at 1 year improved from 85% in the AZA group to 97% in the CSA-treated recipients (P less than 0.05). Mean serum creatinine at 5 years remained stable in the AZA group at a mean of 123 mumol/L (1.4 mg/dL) compared with a progressive increase in this parameter to a mean of 212 mumol/L (2.4 mg/dL) after the same time interval in the CSA patients. Furthermore, the slopes of the serum creatinine against time were significantly different between the two groups (P less than 0.01). Mean daily CSA dose averaged 4 mg/kg 12 months following transplantation, with a decrease to 2.4 mg/kg by the fifth year. Causes of death in the AZA group were cardiovascular (eight), sepsis (three), cancer (one); and in the CSA group, Kaposi's sarcoma (one). Causes of graft failure in the AZA group were immunological (six), sepsis (three), technical (two), recurrence of disease (one), and patient death with a functioning graft (five). Technical (one), noncompliance (two), recurrence of disease (one), and patient death with a functioning kidney (one) caused graft failure in the CSA group. No difference in posttransplantation serum cholesterol or incidence of new onset diabetes was observed between the two groups, but hypertension was significantly more frequent (51% v 21%, P less than 0.01) when CSA was used. In conclusion, intermediate-term results of CSA-treated HLA-identical transplant recipients showed improved patient and graft survival with less complications apart from hypertension. However, the slow, but relentless, increase in serum creatinine in the CSA-treated patients compared with those treated with AZA is of concern.

Actuarial Analysis↗
PubMed1988

Pharmacokinetics of sufentanil in patients undergoing renal transplantation.

Renal failure and chronic haemodialysis are often associated with alterations in fluid status and plasma proteins. These changes, in turn, may result in pharmacokinetic alterations in affected patients. The purpose of this study was to investigate the pharmacokinetics of sufentanil in chronic renal failure patients undergoing kidney transplantation. Ten male patients were studied. Following induction of anaesthesia each patient received sufentanil 2.0 micrograms.kg-1 IV with subsequent serial plasma sampling for drug measurement from one to 360 minutes. A biexponential equation provided the best fit of the sufentanil concentration data with mean +/- SEM distribution (alpha) and elimination (beta) half-lives of 2.9 +/- 1.3 and 176 +/- 87 minutes, respectively. The mean Vc and Vd beta values were 0.15 +/- 0.05 L.kg-1 and 0.85 +/- 0.16 L.kg-1, respectively; plasma drug clearance was 11.5 +/- 3.7 ml.kg-1.min-1. Mean values for K10, K12 and K21 were 0.15 +/- 0.06.min-1, 0.4 +/- 0.14.min-1 and 0.1 +/- 0.04.min-1, respectively. With the exception of Vd beta, these pharmacokinetic values are similar to those reported in previous studies in general surgical, elderly and burn patients. The Vd beta values observed in this study may have resulted from alterations in drug distribution or elimination following revascularization of the implanted kidneys. Nevertheless, it appears that modification of sufentanil doses is unnecessary in chronic renal failure patients undergoing renal transplantation.

Adult↗