Showing papers in "Annals of King Edward Medical University in 2009"
TL;DR: Among acute appendicitis, lymphoid hyperplasia was the predominant finding seen in 57.8% of cases, and all appendectomy specimen should be sent for routine histopathological examination so as not to other unusual or co-existing pathologies.
Abstract: Objective: The purpose of this study is to see the pattern of various histopathological diagnoses in appendectomy specimens. Setting: This retrospective study carried out at Isra University Hospital, Hyderabad and three main hospitals of Hyderabad over a period of two years starting from March 2006 to February 2008. Methods : Hospital records of all patients who were diagnosed as acute appendicitis and underwent appendectomy (either open or laparoscopic) were reviewed retrospectively. Patients' age, sex operative findings and histopathology reports were noted. Histopathology reports were analyzed according to the diagnosis. Results: Hospital records of 323 patients who were diagnosed as acute appendicitis and underwent appendectomy (either open or laparoscopic) were reviewed. 86.3% specimens revealed findings of acute appendicitis, 10.8% were normal, while 3% has tuberculosis, 1.5% had Meckle diverticulitis and 0.6% each of adenocarcinoma and Carcinoid tumour. Among acute appendicitis, lymphoid hyperplasia was the predominant finding seen in 57.8% of cases. Conclusion: Other than acute inflammation, routine histopathological examination of the appendix yields important clinical information like benign and malignant tumours. All appendectomy specimen should be sent for routine histopathological examination so as not to other unusual or co-existing pathologies. Key words: Appendectomy, histopathology, acute appendicitis.
17 citations
TL;DR: Acoustic neuroma was the commonest benign tumor and medulloblastoma was found to be the predominant malignant tumor in this study.
Abstract: Results: Among 62 patients, 43 (69.35%) were male and 38 (61.29%) patients were adult. The morphological distribution of the posterior cranial fossa tumors was as follows: Meningioma – 7 cases (11.2%), Schwannoma – 12 cases (19.3%), Acoustic Neuroma – 20 cases (32.25%), Medulloblastoma – 9 cases (14.5%), Pilocytic Astrocytoma – 2 cases (3.22%), high grade Astrocytoma – 3 cases (4.83%), Metastatic carcinoma – 5 cases (8.06%) and malignant round blue cell neoplasm – 4 cases (6.45%). Conclusion: Acoustic neuroma was the commonest benign tumor and medulloblastoma was found to be the predominant malignant tumor in this study. Medulloblastoma was also seen the commonest posterior cranial fossa tumor in children.
14 citations
TL;DR: Squamous cell carcinoma is the most common cancer of oral and maxillofacial region and most frequent site for squamous cell cancer is oral tongue.
Abstract: Objective : To determine the frequency and pattern of carcinomas in Oral and Maxillofacial region, in particular relation to the primary sub site and involvement of the level of lymph nodes in the neck. Study Design : Descriptive study. Place and Duration of the Study : Oral and Maxillofacial Surgery Department, King Edward Medical University/ Mayo Hospital Lahore and Institute of Nuclear Medicine and Oncology Lahore (INMOL), from 1 st October 2007 to 30 th September 2008. Patients and Methods: Inclusion criteria: patients of all age groups and gender with biopsy (incisional or excisional) proven carcinomas of the oral and maxillofacial region. Exclusion criteria: Irradiated patients and patients with metastatic carcinomas in head and neck region. Results : Squamous cell carcinoma was found in 84.28% (n = 118) patients out of 140 cases, Adenocarcinoma was 5.7% (n = 8), Basal cell carcinoma was 0.7% (n = 1), Acinic cell carcinoma was 1.4% (n = 2), Adenoid cystic carcinoma was 3.6% (n = 5), Mucoepidermoid carcinoma was 3.6% (n = 5) and Verrucous carcinoma was found in 0.7% (n = 1) patients. The levels of lymph nodes involved were as follows; level I 35.7% (n = 50), level II 24% (n = 34), level III 11.4% (n = 16), level IV 6.4% (n = 9) and level V 3.5% (n = 5) in all 140 cases. There were 10% (n = 14) cases of parotid gland tumors, 28.6% (n = 39) tongue carcinomas, 11.4% (n = 16) maxilla, 22.1% (n = 31) buccal mucosa, 15% (n = 21) mandible, 8.5% (n = 12) floor of the mouth and 4.3% (n = 6) cases of palate. Most of the patients with Squamous cell carcinoma presented with T3 and T4 which were 33.9% (n=40) and 43% (n=51) respectively. Histopathologically, SCC with well-differentiated, moderately differentiated and poorly differentiated varieties were 27.12% (n = 32), 33.9% (n = 40) and 38.98% (n = 46) respectively. Most of the SCC patients were of stage stage-III or stage IV 41.5% (n = 49) and 35.5% (n = 42) respectively. Conclusion : Squamous cell carcinoma is the most common cancer of oral and maxillofacial region and most frequent site for squamous cell carcinoma is oral tongue. Key words: Oral carcinoma, squamous cell carcinoma, precancerous lesions, TNM staging.
11 citations
TL;DR: A prospective-observational study to determine the radiological pattern of pulmonary tuberculosis in diabetes mellitus and found the typical pattern (patchy infiltration / nodular pattern with or without cavitation) involving upper zone and the atypical pattern with lower lung field involvement.
Abstract: th in world ranking of diabetes mellitus prevalence. When two diseases are common, these can effect each other in terms of clinical presentation and course of the disease. In pulmonary tuberculosis with diabetes mellitus radiological pattern of may be different from patients without diabetes mellitus. Objective: To determine the radiological pattern of pulmonary tuberculosis in diabetes mellitus. Study Design: A prospective-observational study. Place of Study: The study was conducted in B.V. Hospital, Bahawalpur. Duration of Study: The study was conducted from January 2004 to December 2006. Material and Methods: One hundred and fifty patients with diabetes mellitus (both type 1 and type 2) and pulmonary tuberculosis were included in the study. Pulmonary tuberculosis was diagnosed on the basis of AFB positive sputum, history and radiological findings suggestive of pulmonary tuberculosis. Two physicians (including one chest physician) and a radiologist reviewed the chest radiographs. Those x-rays were selected in which there was no difference of opinion. Diabetic patients were either known diabetics or they were newly diagnosed based on WHO criteria. Results: A total of 150 patients were analyzed in which there was 105 were male and 45 females. The age range was 18 years to 75 years. The mean age was 49.81 and standard deviation was +12.28. Out of 150 films 69 (46%) showed the typical pattern (patchy infiltration / nodular pattern with or without cavitation) involving upper zone. While 81 (54%) pts showed the atypical pattern with lower lung field involvement. Out of 150 films, in 84 right lung was involved, in left lung about 39 and bilateral lesion found in 27 films. In 75 films x-rays showed non homogeneous opacity, cavity in 31 and homogeneous shadows in 22 and multiple shadows in 22 films. Among lower lung field involvement with pulmonary tuberculosis 50.6% were above the age of 50 years.
11 citations
TL;DR: This subject should be taught in graduation so that the doctors of future may get a significant understanding for exploring, implementing the research and make evidence based decisions.
Abstract: Back ground: The research in medicine has caused concern among both doctors and bio-statistician for many years 1 . Fundamental concepts of statistics are dire need for medical doctors. If medical doctors do not understand fully the primary concepts of Biostatistics, then the scientific conclusions they reach will be more likely to be wrong 2 . Methodology Study Design : Cross-sectional descriptive study design was used. Total number of respondents: The study was conducted at King Edward Medical University (KEMU) Lahore- Pakistan. A questionnaire was e-mailed to 332 post-graduate medical students (doctors, dentists and physiotherapist) in which only 227 responded. The questionnaire was also manually distributed to 110 medical post-graduate students. Consequently, the total number of respondents was 327 (response rate = 74%). Results: The mean age of respondents was 31 ± 0.37 years along with the S.D = 6.67 years. There were 198 (60.55%) male and 129 (39.440 female respondents. The basic knowledge of biostatistics among students was not satisfactory. The proportion of students was significant (p-value= 0.00) who were agreed that this course is useful for them and every medical institute should start regular courses on Biostatistics during M.B.B.S. Conclusion: Our medical institutes should take a daring step towards the education of Research Methodology and Biostatistics. This subject should be taught in graduation so that the doctors of future may get a significant understanding for exploring, implementing the research and make evidence based decisions. Key Words: Medical-statistics, Research Methods and Medical Research. Words Count: 238.
10 citations
TL;DR: MGSO4 was the better anticonvulsant than diazepam infusion in terms of total morbidity, the value (P < 0.05), recurrence of fits, maternal deaths, respiratory depression, and perinatal deaths.
Abstract: The anticonvulsant has key role in management of eclampsia but the choice is still controversial. Objectives: To compare the efficacy of magnesium sulfate and diazepam infusion as good anticonvulsant. Study Design The study was conducted at Obst/Gynae Unit -II, Punjab Medical College, DHQ Civil Hospital, Faisalabad from 1 st May, 2007 To 30 th December,2007. Material and Methods: There were total 3506 deliveries in 8 months among 45 cases of antenatal eclampsia were selected. The cases of postpartum eclampsia, gestational age less than 28 weeks, and dead fetuses were excluded. 25 patients were allocated Mgso 4 and 20 patients treated with Diazepam infusion regardless of prior therapy. The dosage of both was monitored clinically. Morbidity was defined in terms of maternal and fetal measures. Results: MGSO4 was the better anticonvulsant than diazepam infusion in terms of total morbidity, the value (P < 0.05), recurrence of fits (16% versus 30%), maternal deaths (Null versus 5%), respiratory depression (Null versus 10%). Mgso4 was associated with better outcomes in terms of total fetal morbidity (28% versus 90%) and perinatal deaths (4% versus 15%) than diazepam the value (P < 0.05). Fewer babies in Mgso4 group had low apgore score at 1 minute (12% versus 25%), at 5 minute (Null l% versus 10%), required less intubations (8% versus 25%) and required less admission in special care unit (4% VS 15%) than diazepam group. Key Words: Magnesium sulfate (Mgso4), Diazepam infusion, Eclampsia.
9 citations
TL;DR: The most common presenting feature of chronic suppurative otitis media with cholesteatoma was ear discharge, and most of the cases showed the ossicular erosion and incus was most commonly involved.
Abstract: Objective: The objective of the study was to detect and analyse frequency of occurrence of different types of ossicular chain defects in chronic suppurative otitis media with cholesteatoma on mastoid exploration and to identify the ossicle most commonly eroded by cholestestoma. Study Design : Analytical study Materials and Methods : A total of 75 cases of chronic suppurative otitis media with cholesteatoma with different age groups were admitted at E.N.T. Unit-1, Mayo Hospital, Lahore from July 2002 to July 2005. Each patient had essentially the work up according to the specific Performa. Results: Ninety seven percent (97%) cases showed the ossicular erosion while 3% cases showed intact ossicle i.e., all ossicle were intact. The Long process of incus was the commonest portion involved and then stapes supra-structure. Cholesteatoma was more common in the males (52%) than in the females (48%). Majority of patients i.e. 52% were in the age group of 16-30 years. It is also revealed that majority of patients belonged to poor communities living in rural or slum areas of the cities. Conclusion: The most common presenting feature of chronic suppurative otitis media with cholesteatoma was ear discharge. Most of the cases showed the ossicular erosion and incus was most commonly involved. Cholesteatoma is more common in males than in females. Cholesteatoma is more common in low socioeconomic groups. Key words: Cholesteatoma, Ossicles, Chronic suppurative otitis media with Osteitis.
9 citations
TL;DR: Nulliparity and more age at first live birth was associated with increased breast cancer risk and breastfeeding was not protective against breast cancer.
Abstract: Results: Breast cancer patients and control subjects did not differ regarding age (p = 0.9), early menarche (OR for menarche at < 12 years vs. ≥ 12 = 1.6, 95% CI = 0.6 — 4.3), and late menopause (OR for menopause at ≥ 50 vs. < 50 = 1.0, 95% CI = 0.5 — 2.0). History of breast cancer in 1 st degree relatives did not increase breast cancer risk (OR = 1.0, 95% CI = 0.5 — 2.1). Nulliparous women had significantly higher risk than parous women (OR = 4.7, 95% CI = 1.9 — 11.0). Women with younger age at first live birth (< 30 years) had less breast cancer risk as compared to women with ≥ 30 years of age at first live birth (OR = 0.2, 95% CI = 0.1 — 0.5). Breastfeeding had no effect on the risk of breast cancer in parous women. Conclusion: Nulliparity and more age at first live birth was associated with increased breast cancer risk. Breastfeeding was not protective against breast cancer.
8 citations
TL;DR: The histological pattern is aimed to see the frequency and pattern of malignancy in goiter and STN in both sexes so that recommendations can be made for management.
Abstract: Introduction Thyroid nodules are among the commonly encountered surgical specimens in histopathology laboratory. Thyroid nodules can be solitary or multiple. Carcinoma of thyroid is uncommon accounting for only 1% of all human tumors. Annual incidence of thyroid cancer is 0.5 to 10:100,000 person’s world wide. The prevalence of carcinoma is lower in multinodular goiter (MNG) than in solitary thyroid nodule (STN) (2). Malignancy is seen in only 0 to 11% of patients with MNG and is usually an incidental finding in thyroidectomy specimens, and in 3 to 33% of patients with STN. Clinical assessment based on physical examination of thyroid nodule helps to distinguish cases having high risk of malignancy. Iodine uptake thyroid scan, ultrasonography of the gland and fine needle aspiration cytology (FNAC) can also play a significant role in establishing the preoperative diagnosis of malignancy, but FNAC is the modality of choice. One shortcoming of FNAC in MNG is false negative result because the needle may not go into the nodule on which the test needs to be done. However, its role in solitary nodule is well established. Help of ultrasound guidance for FNAC can be taken if the cell yield is poor on aspiration. STN is the most common indication for surgical resection as prevalence of malignancy is more in solitary nodules. However, the solitary nodules should be cold on thyroid scan because hot nodules are less likely to be malignant. Malignancy in thyroid is mostly seen in hypo functioning cold nodules which do not take up iodine. Men develop thyroid nodules less frequently than women. Another fact is that frequency of malignancy in STN is more common in men than in women. Solitary cold nodules in men should be thoroughly investigated. Malignant nodules need to be treated surgically whereas benign nodules can be managed conservatively. Thyroid malignancy does not cause hypo or hyperthyroidism. Patients with thyroid malignancy usually reveal normal thyroid function tests. This study is aimed to see the histological pattern and ascertain the frequency and pattern of malignancy in goiter and STN in both sexes so that recommendations can be made for management.
8 citations
TL;DR: Results: Two hundred and fifty consecutive patients having tight rheumatic mitral stenosis were studied and spontaneous echo contrast was visualized more frequently on TEE as compared to TTE in both the groups p<0.001.
Abstract: Results: Two hundred and fifty consecutive patients having tight rheumatic mitral stenosis were studied. The mean age of the study population was 26.9 ± 7.5 years. There were more female 128 (51.2%) patients than males 122 (48.8%). Atrial fibrillation (AF) was present less frequently in the study as 33 (13.2%) patients had AF as compared to 217 (86.8%) patients having sinus rhythm. AF was more significantly associated with thrombus formation with 23 (60.5%) patients having thrombus as compared to 15 (39.5%) patients in sinus rhythm having thrombus p < 0.0001. Thrombus in LA was more commonly visualized on TEE as compared to TTE (X 2 =242.3, p=0.0001) and was mostly detected in left atrial appendage (X 2 =211.2, p=0.0001). Spontaneous echo contrast was visualized more frequently on TEE as compared to TTE in both the groups p<0.001.
7 citations
TL;DR: In the study sample type 2 diabetes mellitus is associated with significantly thinner thighs and calves than nondiabetes whereas central adiposity is prevalent in both diabetics and non-diabetics.
Abstract: Discussion: Our focus is on how the biometric measurements of diabetics differ from non-diabetics in the South Asian population. The significant inverse relationship between thigh and calf circumference and high blood glucose level can be used as an observational clinical screening tool to quickly identify patients with poorly controlled blood sugar in a typical out-patient setting. Further study is required to determine whether these biometric changes are due to the diabetes itself; or whether having a certain body shape predisposes to diabetes mellitus; and also whether these changes can be reversed with good glycemic control. Conclusion: In our study sample type 2 diabetes mellitus is associated with significantly thinner thighs and calves than nondiabetes whereas central adiposity is prevalent in both diabetics and non-diabetics.
TL;DR: Overwhelming majority of children suffering from acute bronchiolitis was less than one year of age, and main presenting features of acute bronChiolitis were respiratory distress, nasal flaring and wheezing.
Abstract: Background: Bronchiolitis is an acute inflammatory obstruction of small airways in children that occurs in first two years of life and is characterized by fever, rhinitis, cough, tachypnea, expiratory wheeze and increased respiratory effort. Objective: To study epidemiological and clinical features in children with acute bronchiolitis. Study design: Descriptive study. Setting: Department of Paediatrics, King Edward Medical University/ Mayo Hospital, Lahore. Duration: Six months (October 2006 to March 2007). Subjects and Methods: After consent from parents, one hundred and seven children of age between 2months to 2years with the first episode consistent with clinical case definition of bronchiolitis were included by using convenient sampling. Results: A total of 107 children were included. Mean age was 11.3 ± 5 months. Male to female ratio was 1.3. Mean weight 9.3 ± 2.2 kg, mean head circumference 44.1 ± 2.7 cm, and mean length was 71.6 ± 7.5 cm. Forty eight percent children were bottle fed and 38% were breast fed. Thirty eight percent children had family history of acute respiratory tract illness while 14% children had family history of allergy. Among total of 107 children, 91% had respiratory distress at the time of pre-sentation, 76% had nasal flaring, 72% wheezing, 64% had fever, 41% retractions and 32% had decreased feeding. Conclusion: Overwhelming majority of children suffering from acute bronchiolitis was less than one year of age. There was male predominance. Most of the children were bottle fed. Main presenting features of acute bronchiolitis were respiratory distress, nasal flaring and wheezing. Key words: Bronchiolitis, respiratory tract infection, wheezing.
TL;DR: The use of single dose preoperative cefurexime prophylaxis was as effective as multidose regimes for preventing serious infectious morbidity among patients in this prospective study of elective obstetric and gynecologic surgeries.
Abstract: Objective: To evaluate the effectiveness of single dose prophylaxis in elective obstetric and gynecologic surgeries. Study Design: Descriptive study. Place and Duration of Study: Department of obstetric and Gynae, Sharif Medical and Dental College/Hospital Lahore from January 2006 to August 2008. Patients and Method: A prospective study comprising of 305 patients undergoing elective obst and Gynecologic surgery during a period of 3 years at department of obstetric and Gynae, Sharif Medical and Dental College/Hospital Lahore. All patients received 1.5 gm parental cefurexime at the time of induction of anesthesia. Hospital and post discharge surveillance for presence of surgical site wound infection was done. Results: In this study, Total 305 patients were enrolled, 249 were obstetric and 56 were gynecologic patients. No intra-operative surgical complication was observed with 54.91mins mean surgical duration. Febrile morbidity was seen in 91 patients (30%) and only 10 patients were developed infectious morbidity irrespective of Hb level. The mean duration of hospital stay was 3.56 days. Conclusion: The use of single dose preoperative cefurexime prophylaxis was as effective as multidose regimes for preventing serious infectious morbidity among our patients. It's the maintenance of standard sterilization techniques of operation room which counts not the nutritional status or Hb level for the prevention of surgical site wound infection. Shortening the duration of antibiotic prophylaxis also helps in reduction of medical costs. Key Words: Antibiotic prophylaxis, cefurexime, gynecologic surgery, surgical site, wound infection.
TL;DR: Referring high risk pregnancies to tertiary care hospitals is not enough because these centers and neonatal units have their own limitations so more attention should be paid to prevention.
Abstract: To determine the selected antenatal and perinatal risk factors (weight, sex, gestational age, maternal age, parity, mode of delivery, place of delivery, age at arrival and stage of hypoxic ischemic encephalopathy) for adverse outcome in babies with birth asphyxia, at Sir Ganga Ram Hospital, Lahore. This was an observational study conducted in a prospective manner in the neonatology unit of the department of Paediatrics, Fatima Jinnah Medical College/Sir Ganga Ram Hospital, Lahore, over a period of six months from 1 st August, 2007 to 31 st Jan. 2008. This study included 144 consecutive asphyxiated neonates who were admitted in our neonatal unit and fulfilled the inclusion criteria. Detailed maternal information, physical examination and progress of the babies were noted regularly till the time of death or discharge and entered into a specified proforma. Babies were categorized into different stages of HIE (Hypoxic Ischemic Encephalopathy) according to Sarnat and Sarnat staging. On the basis of outcome, they were divided into two groups, group one who survived and were discharged with stable vital signs and group two, who died. Effect of risk factors on both groups were compared and results were expressed as (P 2.5 kg and fifty one (35.4%) 1.5-2.5 kg. 15 (10.4%) babies of birth asphyxia did not suffer HIE, 53(36.8%) had stage I, 46 (32.0%) stage II and 30 (20.8%) stage III HIE. 86 (59.7%) of the babies were discharged successfully and 58 (40.3%) died. Variables (risk factors) found significantly affecting adverse outcome were late arrival and severe birth asphyxia. Conclusion: Referring high risk pregnancies to tertiary care hospitals is not enough because these centers and neonatal units have their own limitations so more attention should be paid to prevention. Key words: Birth Asphyxia, Hypoxic Ischemic Encephalopathy, Adverse outcome.
TL;DR: There is a need to create awareness about determinants and transmission of Hepatitis B and C in the authors' com-munity and both active and passive immunization should be available to the professions at risk.
Abstract: Objective : To find out the determinants of transmission of hepatitis B and C in patients admitted in medical wards and to assess the knowledge and practices of the patient regarding transmission of hepatitis B and C infection. Design: A case-control study. Place and Duration of the Study: In Gastroenterology ward Medical Unit 1 Punjab Medical College and Allied Hospital Faisalabad and Plastic Surgery Ward, KEMU, Lahore. Duration of the study is one year and started in May 2006. Patients and Methods: Patients of hepatitis B and C admitted in Gastroenterology ward Medical unit 1 were interviewed and data was collected using a structured proforma. The study controls were selected who were negative for Hepatitis B and C on ELIZA method and were admitted in same ward. At 95% confidence interval the sample size was calculated as 230, 115 cases and 115 controls. Statistical analysis was done using SPSS version 13. Results : Total number of the patients that participated in the study was 230 i.e., 55 with Hepatitis B, 60 with Hepatitis C and 115 in control group. The determinant of transmission of Hepatitis B found statistically significant included age, socioe-conomic status, occupations like health care workers, barbers, business owners with frequent travels, sex workers and sani-tary workers, reuse of syringes, surgical and dental procedures, cesarean section in females, accidents and blood loss, paren-teral drugs and drips, I/V drug abuse, ear and nose piercing, tattooing, getting shave and hair cut from barbers, sharing of tooth brush, contact and family history of hepatitis, extra marital sex, lack of knowledge about transmission of Hepatitis, and non-practicing of active and passive immunization. The variables found statistically significant in Hepatitis C infection inclu-ded reuse of the syringes, blood transfusions, surgical and dental procedures, accidents and blood loss, parenteral drugs and drips, I/V drug abuse, getting shave and hair cut from barbers, sharing of razors, contact and family history of hepatitis. The knowledge and practices regarding spread of Hepatitis B and C were poor. Conclusion: There is a need to create awareness about determinants and transmission of Hepatitis B and C in our com-munity. The professions at risk should be investigated for Hepatitis periodically and both active and passive immunization should be available to them. The vaccination against Hepatitis B should be strongly recommended for high risk groups. Proper screening of the blood products, sterilization of surgical instruments and universal precautions against the spread of infection should be implemented Key Words: Determinants, Hepatitis B, Hepatitis C, transmission.
TL;DR: Sialic Acids have been found to be significantly associated with the development of DM 8 and are especially increased in patients with NIDDM patients, and a highly significant correlation was found with SSA levels.
Abstract: Sialic Acid (SA) is a class of important glycemic derivatives that contain 9 carbon atoms. 1 N-acetyl neuraminic acid (NANA) is the principal SA found in human tissues. 2 SA is a generic term for a family of acetylated derivatives of neuraminic acid and is an essential component of glycoproteins and glycolipids. 3 In this study, the relationship between Serum Sialic Acid (SSA) and Non-Insulin Dependant Diabetes Millitus (NIDDM) patients was investigated. One hundred (100) subjects, 32 males and 68 females, were included in the study. They were divided into two groups according to presence or absence of Non-Insulin Dependant Diabetes Mellitus (NIDDM). Group-A was having 24 subjects without Diabetes Mellitus (DM) as a control; whereas, Group-B comprised of 76 patients with NIDDM. Sialic Acid (SA), Glucose, Lipids (Triacylglycerols and Total Cholesterol) levels were measured in serum. While, Glycated Hemoglobin (HbA1C) level was assayed in whole blood. Here we found a highly significant correlation between NIDDM patients and SSA as, NIDDM Patients had higher levels of SSA 2.37 ± 0.42 mmol/L as compared to the control group i.e. 1.48 ± 0.27 mmoI/L where p < 0.05 as well as Triacylglycerols and Total Cholesterol had highly significant correlation with NIDDM. Introduction Sialic Acid (SA) is either Nor O-acyl derivative of neuralminic acid 2 – an aldol condensation product of mannosamine and pyruvic acid. 3 Whereas Neuraminic acid it self is not found naturally. 4 They act as cofactors of many cell surface receptors e.g. insulin receptors, 5 and are positively associated with most of the serum acute phase reactants. 6,7 The levels of SSA are increased in several pathologic conditions such as inflammation and malignancy. 7 Sialic Acids (SAs) have been found to be significantly associated with the development of DM 8 and are especially increased in patients with NIDDM. 9 In this study, SSA levels in normal subjects were compared specifically with NIDDM patients only. Whereas in our other study before, an extra increase in TSSA levels were observed in diabetic patients in general (having no specification of whether Insulin Dependent or Non Insulin Dependent Diabetes Mellitus) with retinopathy as compared to those without retinopathy, 10 and in another study elevated SSA levels were also correlated with blood pressure as well as with retinopathy in NIDDM patients. 11 Research Design and Methods This study included 100 subjects, 32 males and 68 females. Diabetic patients were defined as those who had known diabetes (onset of DM after 40 years of age), and those with fasting blood glucose value exceeding 7.8 mmol/L on two different occasions – according to World Health Organization (WHO) criteria. 12 The subjects were divided into two groups: Group-A was having 24 normal subjects (10 males and 14 females) without diabetes as a control; whereas, Group-B comprised of 76 patients (22 males and 54 females) with NIDDM. According to WHO 1985 recommendations following standardized protocols; 12 all Group-A subjects underwent oral glucose tolerance test (OGTT) to exclude the presence of impaired glucose tolerance (IGT). After over night fasting, a venous blood sample for glucose, lipids and serum sialic acid estimations were made in plain tube; and another aliquot of whole blood sample for HbAlC was collected in lithium heparin tube by venipuncture of anticubital vein from every individual. Serum was obtained by centrifugation of plain tubes. Glucose, Triacylglycerol (TAG) and Total Cholesterol were determined in serum using kits of Randox Laboratories Ltd., by following methods and procedures of the manufacturer;; 3 SSA was estimated using Ehrlich's method as given by Shamberger; 14 and HbAlC was measured in whole blood by using an enzyme immunoassay. 15 Results Characteristics of the subjects (number, sex, age and duration of NIDDM) in Groups A (Normal subjects) and B (NIDDM patients) are shown in Table-1. These groups were comparable according to mean age in years ± SD (57.5 ± 15.5 vs. 56.5 ± 13.5) where, p value – non significant and mean duration in years of NIDDM ± SD 13.5 ± 6.5 (p value – non significant). Thus the results showed that, SSA has insignificant relationship with age as well as duration of NIDDM. In group-B (NIDDM patients) serum levels of Triacylglycerols and Total Cholesterol were higher as compared to control subjects (p <0.05); also, the NIDDM patients whether males or females had higher levels of SSA (2.37 ± 0.42 mmol/L) in comparison with controls (1.48 ± 0.27 mmol/L) with p <0.05 (p value – highly significant), as shown in Table 2. Discussion Our experimental data show, the increase of SSA concentration in NIDDM patients as compared to normal control M. USMAN K., 1 MANSOOR A., 2 SHABKHEZ R. et al ANNALS VOL 15. NO. 3 JUL. SEPT. 2009 153 Table 1: Comparison between control subjects (Group-A) and NIDDM patients (Group-B) on the basis of sex, age and duration of diabetes is given where p > 0.05. Characteristic Group-A (Control) Group-B (NIDDM
TL;DR: Due to the increasing resistance developed by microorganisms against the antibiotics, it may be suggested that the use of allicin along with antibiotics may overcome this resistance.
Abstract: Background: This study was designed to observe the antibacterial activity of allicin in combination with antibacterials, ciprofloxacin, enoxacin, vancomycin and clarithromycin against microorganisms pseudomonas aureginosa and staph aureus. Study Design: It is an analytical study. Materials and methods: Allicin was extracted from garlic with ethanol and chloroform. It was isolated by filteration technique using 15 mm Hg of pressure. Antibiotic discs were taken and micro-organisms were obtained from pathology lab FJMC LHR, Antibacterial activity of allicin was observed in combination with antibiotics. Results: It was found from the study that there is strong synergistic effect of allicin in combination with ciprofloxacin and enoxacin against pseudomonas aureginosa. Allicin also showed synergistic antibacterial effect with vancomycin and clari-thromycin against staph aureus. Conclusion: Due to the increasing resistance developed by microorganisms against the antibiotics, it may be suggested that the use of allicin along with antibiotics may overcome this resistance. Key words; Allicin, ciprofloxacin, enoxacin, vancomycin, clarithromycin, antibacterial activity.
TL;DR: Considering the possibility of complications, both minor as well as major, following this interventional procedure, it is recommended that clinical impression and sonographic findings should be combined before proceeding on to uterine evacuation and if findings are equivocal on any of these, a waiting period of 24 to 48 hours may be observed and patient reviewed before operative procedure.
Abstract: Objective : To assess the accuracy of ultrasonography for the detection of retained products of conception in post partum and post abortal patients with Trans abdominal sonography using conventional medium frequency probes. Material and methods : Out of 289 patients referred by the Gynaecology Department with strong clinical suspicion of RPOC on clinical examination, 179 patients had D&C after sonographic evidence favouring RPOC. Sonographic criteria used for RPOC were echogenic, echopenic or mixed echogenecity uterine cavity mass with anteroposterior dimension equal to or exceeding 10 mm. We did not take into account the D&C carried out on clinical suspicion as this study was not designed for that and we wanted to know the sensitivity of Ultrasonography alone for detection of RPOC. For statistical analysis patients were divided into three groups depending on the antero posterior measurement of endometrial mass. Group I, endometrial mass thickness 10-12 mm, Group II, endometrial mass measurement 13-15 mm, Group III, anteroposterior endometrial mass thickness of 16-20 mm and Group IV with endometrial mass thickness of 21 mm onwards. Extracted material was sent for histopathology. Record of sonographic findings was matched with retrieved histopathology reports and sensitivity of sonography for the detection of RPOC was calculated. Results: 134 patients were found to have RPOC. This constituted 75% overall accuracy. Remaining 45 patients, wrongly labeled as having RPOC on sonographic evaluation, were mostly within first week of delivery or induced abortion. Blood clots and necrotic material closely mimicked RPOC in these patients but could not be differentiated from residual trophobla-stic tissue, chorionic villi or fetal parts even by experienced radiologist. Sensitivity of sonography was noted to be alarmingly low in Group I and II patients (31% aggregate) whereas in Group III and IV it approached 81% and 95% respectively. Conclusion: 75% sensitivity for detection of RPOC led to 25% patients undergoing unnecessary D&C. Considering the possibility of complications, both minor as well as major, following this interventional procedure, it is recommended that clinical impression as well as sonographic findings should be combined before proceeding on to uterine evacuation and if findings are equivocal on any of these, a waiting period of 24 to 48 hours may be observed and patient reviewed before operative procedure. This protocol should be given very serious consideration in patient with endometrial mass thickness of 15 mm or less.
TL;DR: This study compared the incidence of post transpolant hypertension, acute tubular necrosis, acute rejection, vascular and urological complications, mean creatinine level at 1 and 5 years post transplant and patient and graft survival.
Abstract: Patients and Methods: Between January, 1990 and June 2008, 1250 live donor kidney transplants were included in the study. Among the 1250 kidney transplants, there were 930 males and 320 females. We divided the study population in two groups according to their vascular reconstruction: Group A: 1130 grafts with a single artery. Group B: 120 grafts with multiple arteries. Intracorporeal in situ anatomotic techniques were used for 100 grafts with multiple arteries, while ex-vivo anastomotic techniques were used for 20 patients. We compared the incidence of post transpolant hypertension, acute tubular necrosis, acute rejection, vascular and urological complications, mean creatinine level at 1 and 5 years post transplant and patient and graft survival.
TL;DR: Almost all patients having severe deficiency were symptomatic 262 (99.2%) and majority of patients with severe deficiency are symptomatic.
Abstract: (20%) had mild deficiency and 264 (66%) had severe deficiency, where as 3 (0.75%) were having toxic levels. The frequency of major symptoms was Generalized body weakness 360 (90%), Bone and joint pains 88 (22%), Diabetes 64 (16%), history of Pathological fracture/falls 45 (11.25%), Depression/anxiety 240 (60%), Blood pressure 132 (33%), Hair loss 8 (02%), Shortness of Breath 60 (15%), Ch. Diarrhea 40 (10%), Weight loss 40 (10%), Fever 20 (5%). Almost all patients having severe deficiency were symptomatic 262 (99.2%). Conclusion: Pakistani Urban, Well feed population is grossly deficient of vitamin D and majority of patients with severe deficiency are symptomatic.
TL;DR: Main outcome measures were induction-initiaton of labour interval, induction-delivery interval, maternal complications during induction, mode of delivery, fetal outcome and total hospital stay.
Abstract: Patients and Methods: Fifty primigravidae with prelabour rupture of membranes at term having Bishop score < 5 or 5 were randomized into 2 groups to undergo induction of labour with either oxytocin or prostaglandin E2 vaginal pessary. Main outcome measures were induction-initiaton of labour interval, induction-delivery interval, maternal complications during induction, mode of delivery, fetal outcome and total hospital stay.
TL;DR: Microalbuminuria (MA) has implications on the development of CHD and it is emerging as a new risk factor of this disease, which may have an association with coronary heart disease.
Abstract: Background: Coronary heart disease (CHD) is the most prevalent and important cause of death in developed nations. The incidence of this disease has also increased in our country during the last few years. This occurs due to atherosclerotic narrowing of coronary arteries, mainly because of hypercholesterolemia, hypertension, diabetes mellitus, physical inactivity and cigarette smoking. CHD manifests as stable angina (SA), unstable angina (UA) and myocardial infarction (MI). Inspite of the curtailment of these traditional risk factors the disease has not been eliminated from the globe so far. Recent research in the developed countries is focusing now to identify new biomarkers associated with CHD. Microalbuminuria (MA) has implications on the development of CHD and it is emerging as a new risk factor of this disease. Objectives: To compare the levels of microalbuminuria in CHD patients and control individuals with aim to evaluate its association with CHD. Study Design: A case control analytical study conducted at Army Medical College and Armed Forces Institute of Cardiology Rawalpindi. Material and Methods: Thirty controls (groups A) and fifty CHD patients (group B) included in this study were non diabetic and non hypertensive. Microalbuminuria was determined by immunoturbedimeteric method. Serum glucose, choles-terol, triacylglycerol and urea were measured by enzymatic method. Serum creatinine was measured by kinetic colorimeteric method. Results: Microalbuminuria, cholesterol and triacylglycerol of group B were compared with group A. A significanct diffe-rence was found with p value < 0.05. Conclusion: Microalbuminuria may have an association with coronary heart disease. Key Words: Coronary heart disease (CHD), stable angina (SA), unstable angina (UA), myocardial infarction (MI), Micro-albuminuria (MA)
TL;DR: If fracture remains untreated for 3 weeks or more it is designated as neglected fracture because internal fixation alone has a high frequency of failure rate in such cases order to achieve union of fracture internal fixation has to combine with some type of bone graft or Osteotmy.
Abstract: Introduction Femoral neck fractures in young adults have always presented a difficult problem with high rate of non union either operated or not operated (neglected) cases. From practical point of view if fracture remains untreated for 3 weeks or more it is designated as neglected fracture because internal fixation alone has a high frequency of failure rate in such cases order to achieve union of fracture internal fixation has to combine with some type of bone graft or Osteotmy.
TL;DR: The study reveals some flaws in HIV/AIDS risk behaviour preventions programs, as more access to channels of sources didn’t predict low risk Behaviour and serious efforts are required in awareness campaigns by considering specific needs of injecting drug users.
Abstract: Objectives: The present study is aimed to investigate patterns of HIV/AIDS risk behaviour practices (sexual and syringe sharing) among injecting drug users by addressing; 1. Factors effecting acquisition of risk behaviour knowledge, and 2. Demographic and psychosocial characteristics influencing practice of risk behaviour knowledge. Design: This is a cross sectional study, patients admitted for treatment and rehabilitation from injecting drug abuse, were interviewed and statistical testing was conducted using SPSS 10.1 to identify critical factors of risk behaviour practices. Material and Method: 149 male injecting drug users were included in the present study; females were excluded due to insignificant representation. Patients were interviewed on a self-developed structured questionnaire for demographic and psychosocial characteristics and another structured questionnaire was used to obtain level of risk behaviour knowledge and frequency of risk behaviour practices. Place and Duration: The study was conducted at Model Drug Abuse Control Center (MDACC), a subdivision of Department of Psychiatry and Behavioural Sciences, Bahawal Victoria Hospital, Bahawalpur, a teaching hospital affiliated with Quaid-e-Azam Medical College. Results and Discussion: Present study investigated HIV/AIDS risk behaviour practices in injecting drug users. Results showed that only two sources of knowledge Television and Print Media significantly influenced acquisition of risk behaviour knowledge (p=0.05). Among demographic characteristics, of IDUs and their access to sources of knowledge, only socioeconomic status (p=0.01) and education (p=0.001) were associated with access to sources of knowledge. Finally, the study concerns with differences in demographic characteristics and their association to risk behaviour practices. Post Hoc analysis of demographic characteristics showed that only middle level of education predicted low syringe sharing risk behaviours with (Mean difference = -1.19, P =0.03). Sexual risk behaviour was predicted by marital status and Living status. Patients living alone showed higher levels of risk behaviour practices than patients living with parents (Mean difference = 1.61, P = 0.001) and patients living with family (Mean difference = 1.31, P =0.02). In addition, high frequency of injections predicted higher levels of risk behaviour practices. Conclusion: The study reveals some flaws in HIV/AIDS risk behaviour preventions programs, as more access to channels of sources didn’t predict low risk Behaviour. Serious efforts are required in awareness campaigns by considering specific needs of injecting drug users.
TL;DR: BNP measurements in the blood, is a new technique to diagnose heart failure and the clinical sensitivity and specificity of BNP (by ELISA) was although lower than echocardiography but it can be a good alternative for echokardiography.
Abstract: Objective : Evaluation of serum Brain Natriuretic Peptide levels as screening test in the diagnosis of left ventricular failure or congestive heart failure Material and methods: This cross-sectional survey was conducted at the Department of Medicine, Nishtar Hospital and Ch Parvez Ellahi Institute of Cardiology Multan from Feb 2006 to August 2006. A total of 50 patients were studied. Sampling was performed by non probability convenient type sampling technique. Results : Out of the 50 patients, 47(94%) patients had ejection fraction of less than 45% and were diagnosed as cardiac failure, as confirmed by echocardiography. Among these cases BNP levels were found to be elevated in 36(72%) patients, whereas in 11 (22%) cases, BNP levels were falsely negative. Only 3 patients (6%) in whom initial clinical diagnosis was heart failure, were later found to have negative echocardiography (EF > 45%). Two patients (4%) with negative echocardio-graphy (EF > 45%), had the BNP levels also negative i.e. below the cut-off point, whereas BNP was falsely positive in 1 patient Sensitivity and specificity of BNP (by ELISA) was found to be 80% and 66% respectively and accuracy was 80%. Conclusion : BNP measurements in the blood, is a new technique to diagnose heart failure. The clinical sensitivity and specificity of BNP (by ELISA) was although lower than echocardiography but it can be a good alternative for echocar-diography. Key words: Heart failure, B-type natriuretic peptide, Left ventricular failure, Echocardiography.
TL;DR: Misoprostol is a drug which should be effective, cheap, safe, does not need refrigeration and that can be easily administered by untrained staff to control postpartum hemorrhage at primary health care setting in underdeveloped countries where majority of maternal deaths due to PPH occur.
Abstract: Background: In this modern era of 21st century, postpartum hemorrhage is still the leading cause of maternal mortality in poor countries. In 70% cases, the cause is uterine atony. For centuries a therapy was needed which should be effective, cheap, safe, does not need refrigeration and that can be easily administered by untrained staff to control postpartum hemorrhage at primary health care setting in underdeveloped countries where majority of maternal deaths due to PPH occur. Misoprostol is one drug that might fulfill these requirements.
TL;DR: Ethinyl estradiol adversely affects rat testes even in low doses but its negative effects persist till the age of 9 weeks with high dose and testes showed signs of atrophy and on exposure to low dose the effects were reversed.
Abstract: Introduction: This study was performed to analyze the effects of neonatal exposure of rat testes to synthetic estrogen, ethinyl estradiol. Aims: This study was carried out to assess the role of environmental estrogen on the rat testes. Material and Methods: 63 male neonatal rats were divided into 3 groups: Group A was control group while B and C were given subcutaneous injections of ethinyl estradiol in a dose of 0.37 mg/kg and 0.037 mg/kg body weight respectively on alternate days in the first two weeks of the neonatal period. The animals were sacrificed at the age of 2, 6 and 9 weeks and morphological aspects of effects studied. Results: Mean body weight increased significantly at 6 and 9 weeks in the group given 0.37 mg/kg and 0.037 mg/kg of ethinyl estradiol due to its anabolic effect. However there was a significant reduction in the weight of testes with reduced vas-cularity on prolong exposure to high dose. Conclusion: Ethinyl estradiol adversely affects rat testes even in low doses. Although it was not given after 14 days but its negative effects persist till the age of 9 weeks with high dose and testes showed signs of atrophy. On exposure to low dose the effects were reversed. Key words: Testes, Environmental estrogen, infertility.
TL;DR: Women who developed premature coronary artery disease had significant prevalence of majority of conventional risk factors than their male counterparts and more likely to present with angina than myocardial infarction, however distribution and severity of coronary arteries disease was similar between the two sexes.
Abstract: Introduction : Coronary artery disease has emerged as one of the leading causes of premature mortality and morbidity in South Asians. In contrast to males, younger women are ignored due to prevailed social trends. Better characterization of disease presentation in this group will help us in formulating adequate management policies. Objectives: To study clinical features, risk factors and angiographic findings in female patients with premature Ischemic heart disease comparing with men of similar age. Study design : It was Interventional:Quasi experimental study. Setting : Punjab Institute of Cardiology Lahore. Duration : From 19 th of January 2002 till 27 th of September 2003. Subjects and methods: 100 female patients and 100 male patients age 50 or below were studied, who were referred for coronary angiography. Patients with previous coronary angiogram or revascularization were excluded. Data was collected over prescribed proforma and results analyzed. Results : Prevalence of significant risk factors in women compared with men were hypertension, (50% vs 28%; P<0.01), hyperlipidemia (62% vs 26%; P<0.01) diabetes mellitus (46% vs 8%; P<0.01), sedentary life style (44% vs 24%; P<0.01) and obesity (58% vs 22%; P<0.01). Majority of women (84% vs 54%; P<0.01) presented with angina compared with men. No significant difference was noted in distribution of coronary artery disease between two sexes. Conclusion : Women who developed premature coronary artery disease had significant prevalence of majority of conventional risk factors than their male counterparts and more likely to present with angina than myocardial infarction. However distribution and severity of coronary artery disease was similar between the two sexes. Key words : Females coronary disease chest pain risk factors coronary angiography
TL;DR: Results: Frequency of induced abortion was 5% of total deliveries, and 93.7% of the cases were illiterate and belonged to low socioeconomic class.
Abstract: Results: Frequency of induced abortion was 5% of total deliveries. 93.7% of the cases were illiterate and belonged to low socioeconomic class. 43.7% cases were managed by TBAs, 25% by LHVs and 31.2% by doctors. Reasons for non use of contraception included failure of method (37.5%), husband dislike (25%), fear of side effects (12.5%), lack of access (6.25%), lack of awareness (6.25%) and misconceptions (6.2%). Contraception failure was more common in cases with condom use (50%), followed by withdrawal method (33.3%) and IUCDs (16.7%). In 87.5% cases, both partners were involved in decision making.