[Evaluation of maximum levator resection in management of severe Blepharoptosis]

Objective: To study the efficacy of maximal levator resection in patients with severe ptosis with poor levator function [LF]

Patients and methods: 31 patients with severe ptosis underwent maximal levator resection.Palpebral fissure height and LF were assessed preoperatively and postoperatively. Results: All patients showed an excellent reduction in ptosis with a single intervention resulting in a clear visual axis. Palpebral fissure height improved from means [SD] 2.98 preoperatively to 7.70 postoperatively [P value <0.001], No patients underwent additional surgery because of cosmetic issues. All patients showed a marked, consistent, and lasting improvement in LF, going from mean [SD] 2.60 preoperatively to 7.82 postoperatively [P value < 0.001]

Conclusions: Maximal levator resection is an effective surgical technique in management of patients with severe ptosis with good cosmetic appearance in terms of ptosis reduction in the majority of cases and with a significant increase of the levator palpebrae superioris function

Ureteroscopic lithotripsy: a day-surgery procedure

Objective: To ascertain patient's safety and efficacy of ureterolithotripsy as a day-surgery procedure

Study Design: An interventional study

Place And Duration: At Citi Medical Center Larkana, Ghulam Mohammed Mahar Medical College and Hospital Sukkur Peoples University of Medical and Health Sciences for Women Nawabshah between Dec: 2007 to Dec: 2012

Methodology: All the patients of either sex having ureteral stone less than 1.5 cm in diameter were selected on the basis of routine clinical examination, laboratory investigation like complete blood count and biochemistry, Ultra-sound and x-rays like intravenous urography [IVU] etc for ureteral lithotripsy. The Semi-rigid UreteroscopicG.O Fr with Swiss Lithoclast lithotripter was used

Results: Our study comprises 320 selected patients. Male to female ratio was 1.6:1. Average age of patients was 30.5 year. The mean stone diameter was 1.2 cm. The stones were successfully disintegrated and completely pulverized in 95% [n=304] cases. In remaining 5%[n=16] cases, the procedure was deferred. Among them, ureteric catheter or J J stent in 3% [n=9] and 2%[n=7] cases respectively had been left. Of them, former cases were due to failure of access to stone and ureteroscope did not negotiate at all and in later cases stone was presented in upper ureter and inadvertently floated up into the kidney [P< 0.05]. The operative complications like simple mucosal injury occurred in 11%[n=35] and minor bleeding which did not cloud the field of vision occurred only in 13%[n=42] cases. The Mean operating time was 27[ranged from 22 to 55] minutes. Postoperative complications like urinary tract infection [sepsis] with fever and persisting haematuria had occurs in 5.5%[n=18] cases 9%[n=29] respectfully. The hospital stay was merely a day in all except 15% [n=47] cases who developed post-operative complications [P< 0.05]. In 03 week follow-up, residual fragments were noted only in 6%[n=19] cases. These patients were managed conservatively except 2%[n=7] cases that underwent repeat ureteral catheterization for manipulation of fragments which were jammed together, remit

Conclusion: Although, our study has documented high success rate and low morbidity with merely a day hospital stay but is dependent on many potentially modifiable and process-related factors

Determination of antibiotic resistance pattern in Escherichia coli strains isolated from animal faeces in a farm house

The present study aimed to evaluate the antibiotic resistance pattern of Escherichia coli strains isolated from animals to ascertain the levels of antibiotic resistance pervasiveness. A total of 28 E. coli strains were isolated from faecal samples and the antibiotic resistance pattern of E. coli strains was determined by means of disc diffusion assay. The resistance pattern determined for all strains was amoxicillin, streptomycin, cefepime, azteronam, amoxicillin/clavulanic acid, ciprofloxacin and ceftriaxone

About 50-75% of the strains were reported as resistant to more than five antibiotics [multidrug-resistant]. This might result in broadening of the antibiotic resistance canvas among animals and from animals to human taking the animal food products or living in close contact with them?

place of transvaginal color and pulsed Doppler sonography in the diagnosis of benign and malignant endometrial pathology in patients with post menopausal bleeding

Transvaginal color Doppler ultrasound [TVCDUS] may play significant role in diagnosis of endometrial pathology particulary endometrial carcinoma in women with postmenopausal bleeding [PMB]. Increasing experience in this field may help many women to overcome long waiting lists for surgery. In [65] women with postmenopausal bleeding we measured endometrial thickness [ET] [double layer] considering [8] mm as cut-off point to differentiate between benign and malignant endometrial lesions. We also looked for homogenicity, regularity of endometrium and integrity of sub endometrialhalo. [TVCDUS] was used to asses the vascularity, and vascular density of endometrium, myometrium and endometrial tumor. Resistance index [RI] and peak systolic velocity [PS] were also measured for endometrial, myometrial and uterine arteries. Correlation between [TVCDUS] and results of histopathology of endometrial specimens [24 hysterectomy and 41 D and C] was done. [ET] of [8] mm was found to be predictive for endometrial carcinoma with sensitivity of 100% and visualization rate of endometrial flow was significantly higher in case of carcinoma versus benign conditions of endometrium. Vascular density was significantly higher in case of carcinoma. [RI] of [0.42] was considered as cut-off point to differentiate between benign and malignant lesions with sensitivity of [80%]. [PI/ ] for myometrial and uterine arteries were not significantly different between cancer and benign conditions. TVCDUS has an important role in diagnosis of endometrial carcinoma especially in high risk group of women. Intra-tumoral blood flow is more sensitive marker of carcinoma than uterine blood flow. Adopting this method with increasing experience may result with considerable saving of both potential and economic costs

Herpes zoster oticus masquerading as lateral pontomedullary syndrome

Ramsay Hunt syndrome, also known as herpes zoster oticus is usually caused by reactivation of preexisting varicella zoster virus in the geniculate ganglion. Here we report a case of herpes zoster oticus masquerading as lateral pontomedullary syndrome occurring during the pre-eruptive phase of chicken pox. The case is being reported for its rare and unusual clinical presentation.

Profile of patients attending eye OPD Shahina Jamil teaching hospital Abbottabad in year 2008 / 2009

The aim of our study was to collect relevant information about patients attending out patient department [OPD] of Ophthalmology in Shahina Jamil Hospital Abbottabad in year 2008/2009. A comprehensive proforma was designed which contained all relevant information about the patients. It was completed for each patient attending eye OPD from March 2008 to February 2009. At the end of the year all record was analyzed. The total number of patients attending eye OPD from March 2008 to February 2009 was 10,000. These patients were analyzed on the basis of age, sex and demography. Patients with different diseases were also analyzed. This study gave us an idea about the demographic and other details including diagnosis of the patients attending Eye OPD. Such studies are needed to tailor our health services according to the needs of the patients and their total quality management

Biodegradation of anthraquinone dye by Aspergillus niger SA1 in self designed fluidized bed bioreactor

Biodegradation and decolorization of Drimarene blue K2-RL [anthraquinone] dye by a fungal isolate Aspergillus niger SA1 was studied in self designed lab scale bioreactor system with different solid supports. Aspergillus niger SA1, was efficiently immobilized on sand and sodium alginate beads. The immobilized cells were used in the form of fluidized bed reactor for textile dye [Drimarene blue] removal. Both the reactors were operated at room temperature and pH=5.0 in continuous flow mode with increasing concentrations of dye in simulated textile effluent. The reactors were run on fill and draw mode, with hydraulic retention times of 24-72 h. The fluidized bed bioreactor with sand as immobilizing support [FBR1] showed overall better performance as compared to fluidized bed bioreactor with sodium alginate as immobilizing support [FBR2]. The average overall color, BOD and COD removal in the FBR1 system were up to 78.29, 70.81 and 83.07% respectively, with 50 ppm initial dye concentration and HRT of 24 h. While 72.19%, 86.63% and 74.74% removal of color, BOD and COD were observed, respectively, in FBR2 with the same conditions. Reductions in BOD and COD levels along with color removal proved that decolorization and biodegradation occurred simultaneously

Management of TB in the private sector in Khartoum, Sudan: quality and impact on TB control

Sudan has a large and growing private health sector. No survey was done in Sudan to show the extent of the use of private health care services by the population. Also precise data on tuberculosis [TB] diagnosis and treatment in the private sector are not available. A facility-based cross-sectional survey was carried out during February 2007 - June 2007 in Khartoum state, whereby consented private physicians working in the all private clinics [n=110] were interviewed. This study showed that a large private sector exist in the country and deliver care to TB patients and reported the non-adherence of this sector to National Tuberculosis Program [NTP] guidelines. 59.1% of the interviewed physicians correctly mentioned the TB treatment regimens, only 8 [12.3%] physicians that reported management of TB patients actually prescribed these regimens to their patients. Similarly, only 10 [15.4%] physicians required sputum smear examination for TB diagnosis. A considerable proportion of cases is inadequately managed by the private sector and is not notified to NTP. The information delivered by this study can be used to develop a workable Public-private mix [PPM] model with the private sector

Comparative study between the effects of clevidipine and nitroglycerine in patients with pulmonary hypertension undergoing mitral valve replacement

Pulmonary hypertension [PHT] is commonly found in patients undergoing mitral valve replacement [MVR]. Various pharmacologic agents have been used to decrease the pulmonary artery pressure in pulmonary hypertensive patients. Clevidipine is a third-generation IV dihydropyridine calcium channel blocker, specific arterial dilator, with rapid onset and offset. The aim of the present study was to compare between the effects of clevidipine and nitroglycerine on pulmonary and systemic hemodynamics as well as pulmonary oxygenation. Thirty patients with PHT scheduled for elective MVR were enrolled in this study and randomly allocated into 2 groups. Patients received either nitroglycerin infusion at 0.25-10 microg/kg/min [NTG group] or clevidipine infusion at 0.4-8 microg/kg/min [CLV group]. Pulmonary and systemic hemodynamic parameters as well as oxygenation data were measured after induction of anesthesia, after weaning from CPB before the start of the study medication, and after 30 minutes, 2 hours, and 4 hours from the start of the study medication. The incidence of postoperative atrial fibrillation and total ICU and hospital length of stays were also recorded. The mean pulmonary artery pressure [MPAP], pulmonary vascular resistance [PVR], pulmonary capillary wedge pressure [PCWP], mean arterial blood pressure [MAP], and systemic vascular resistance [SVR] were significantly lower in the CLV group compared to the NTG group. In both groups, these parameters were significantly lower at 30 min, 2 hours, and 4 hours after drug administration compared to pre-drug administration values. There was no statistical significant change in the heart rate [HR] in the CLV group, however, it was significantly increased at 30 min, 2 hours, and 4 hours after drug administration compared to pre-drug administration values in the NTG group. The cardiac index [Cl] was significantly increased at 30 min, 2 hours, and 4 hours after drug administration compared to pre-drug administration values in CLV group and was statistically higher than NTG group. There was a non significant decrease in the PaO[2]/Fi0[2] and no significant change in PaCO[2] and SvO[2] at 30 min, 2 hours, and 4 hours after drug administration compared to pre-drug administration values in both groups with no statistical difference between the two groups. Clevidipine is a valuable alternative to nitroglycerine in the treatment of PHT in patients undergoing MVR as it showed better pulmonary and systemic hemodynamic profiles and did not worsen pulmonar] oxygenation

Use of noninvasive positive pressure ventilation during pregnancy: case series

Mechanical ventilation is commonly required in critically ill pregnant patients, requiring ICU admission, with higher morbidity and mortality related to airway management. Alternatively, noninvasive positive pressure ventilation [NIPPV] is increasingly used to treat nonpregnant patients. Pregnancy has been a contraindication to its use. We would like to report a case series of successful use of NIPPV in pregnancy. NIPPV is increasingly used to treat hypoxemic respiratory failure. It has rarely been used during pregnancy. On the other hand, acute respiratory failure [ARF] remains a leading cause of ICU admission in obstetric patients. The use of NIPPV in managing ARF in pregnant patients was not investigated. We report the outcome of treatment with NIPPV of four sickle cell disease pregnant patients with ARF caused by acute chest syndrome. Median APACHE II score for the four cases was 27. Intubation was avoided in all cases. None had aspiration. Mean duration of NIPPV was 40 h with ICU discharge after a mean of 4 days

Study on child labour in automobile workshops of Peshawar, Pakistan

To determine the characteristics of children working in car workshops in Peshawar, a descriptive survey was conducted from June to November 2005 of 200 boys [6-15 years] randomly selected from 32 workshops. A questionnaire was used to collect socioeconomic and work-related data. The majority of the boys had no or little education, had started work before the age of 10 years and earned < 700 rupees/month. Most of their fathers had little education and were in poorly paid jobs, unemployed or deceased. About 40% of the boys were engaged in mechanical work. Watery eyes [31%], chronic cough [29%] and diarrhoea [22%] were the commonest symptoms reported by the boys and 38% had had a major injury

Preventive and curative effects of calendula-officinal's leaves extract on acetaminophen-induced hepatotoxicity

To asses the hepatoprotective potential of leaves of Calendula officinalis against experimentally produced liver damage in animals using acetaminophen as model hepatotoxin. This study was conducted at Department of Pharmacy, University of Peshawar. Preliminary experiments were performed in mice to estimate the protective effect of plant material against lethal dose of acetaminophen [1gm/kg]. Acute toxicity of plant material up to a dose of 3 gm was assessed in mice to note any behavioural changes and mortality. Hepatic damage in rats was induced by oral acetaminophen [640 mg/kg]. The effect of methanolic extract of leaves of Calendula officinalis was investigated against acetaminophen-induced hepatic damage in 30 male, albino rats. Acetaminophen produced 100% mortality at a dose of 1 gm/kg in mice, while pretreatment of mice with Calendula officinalis [l.0 gm/kg] reduced the death to 30%. Pretreatment of rats with leaves extract [500 mg/kg orally, four doses at 12 hours interval] prevented [p<0.05] the acetaminophen [640 mg/kg] induced rise in serum transaminase [GOT GPT], serum bilirubin and serum alkaline phosphatase. Post treatment with three successive doses of leaves extract [500 mg/kg, 6 hourly] restricted the hepatic damage induced by acetaminophen [P<0.05]. These results indicate that the crude extract of Calendula officinalis leaves exhibits hepatoprotective action

Study of cryoglobulinemia in patients with chronic hepatitis C viral infection

Hepatitis C virus [HCV] is involved in an increasing number of non hepatic diseases. Mixed cryoglobulinemia [MC] is considered a lymphoproliferative disorder. It is characterized by arthralgia, generalized weakness, purpura and organ involvement such as membranoproliferative glomerulonephritis, peripheral neuropathy, vasculitis and chronic liver diseases. Cryoglobulinemia is quite frequent in chronic HCV infection and especially when appropriate techniques of cryoglobulin detection are applied. Its frequency is usually higher in older male cirrhotic patients and who have a longer duration of HCV infection. The term essential mixed cryoglobulinemia [EMC] has been used to describe the syndrome with no evidence of underlying disease. Chronic HCV infection is the main cause [90%] of EMC type II and III with or without clinical or biochemical evidence of liver damage. In addition, HCV was described as a lymphotropic virus and may play a direct role in the development of low grade non-Hodgkin's lymphoma which is usually associated with EMC. Aiming to estimate cryoglobulins in patients with CHC viral infection to identify the possible correlation between cryoglobulinemia and CHC viral infection, we conducted this study on 40 patients with CHC viral infection. Another group of 10 normal persons was considered a control group. Among our patients, there were 32.5% positive patients for cryoglobulinemia, those patients had increased incidence of cirrhosis and low C4. We suggested that EMC associated with HCV infection should no longer be referred to as essential but rather as hepatitis C associated with MC. In addition, every patient with chronic HCV infection may have MC, so that serum cryoglobulins and complement components must be evaluated repeatedly during the course of chronic HCV infection for avoiding their complications

Comparison of propacetamol with pethidine for postoperative pain relief

The purpose of this study was to evaluate the analgesic effect of a single bolus I.V dose of propacetamol given before induction of anaesthesia and compare this effect with that of I.V pethidine also given before induction. Another objective was to study the opioid sparing effect of cetamol by using in combination with pethidine, after surgical incision had been made. Sixty adult patients of ASA I or II status were included and divided into three groups. Group A received propacetamol 2gm intravenously just before induction, in group B IV bolus dose of pethidine 0.75 mg/kg was given just before induction and group C received combination of pethidine 0.4mg/kg and propacetamol 2gm intravenously 10 minutes after the incision. After awakening from anaesthesia patients were observed for sixty minutes in recovery for pain assessment by the pain scales and the pain scores by VAS and NRS were analysed statistically by using student's t test and Mann-Whitney test. Pain scores by verbal response scale were analysed by Chi square test. p<0.05 was considered significant. No statistical difference was seen among the groups regarding their post-operative pain scores [p-VAS>0.3, NRS>0.2]. The patients who received combination of pethidine and propacetamol required longer time [p<0.05] for supplementary analgesia than the patients who were given propacetamol alone. Propacetamol 2 gm given IV before induction had no advantage over pethidine. Significant benefit of pre-emptive analgesia was not evident in first 60 min after recovery from anaesthesia

Functional outcome of ischemic stroke in diabetics

Objective was to determine whether the outcome of ischemic stroke is different or not in diabetics than nondiabetics. Prospective observational. analytical study Study place and Duration; It was conducted in medical unit-2 Bahawal Victoria Hospital, affiliated with Quaid-e-Azam Medical College Bahawalpur from October I, 2004 to September 30. 2005. 132 patients of ischemic stroke, confirmed by CT scan, were enrolled during one year study period. The patients of hemorrhagic stroke, TlA, focal deficits of non-vascular origin and infratentorial lesions were excluded. Patients were devided into two groups; diabetics and nondiabetics and were studied regarding their in hospital outcome according to the modified Rankin Scale. The variables applied were age, sex, hypertension and type of infarct [lacunar/cerebral]. Out of 132 ischemic stroke patients 36 [27%] were diabetics and 96 were nondiabetics. Hjipertension was present in 83 [62%]. Overall mortality wa s 11.3%. Mortality was significantly more frequent in diabetics than nondiabetics [16.6% Vs 9.3% p<0.05]. Disability was also more frequent in diabetics [25% Vs 13.5% p<0.05]. In diabetic group good recovery [8.8% Vs 12.5%] as well as partial recovery [50% Vs 64.5%] was less frequent. Patients <40 years were few in number with good recovery in both diabetics as well as nondiabetics. Diabetics of 40-60 years were found to have significantly high number of deaths [15.3% Vs 7% p<0.05] and disability [15.3% Vs 10.7% p<0.05] than non-diabetics. Similar pattern was seen in patients >60 years. Increasing age was found to be associated with poor outcome in both the groups but poorer in diabetics. Sex did not discriminate the poor outcome in diabetics. The presence of hypertension worsened the out come in both the groups but more in the diabetic group both in term of mortality [20.8% Vs 11.8% p<0.05] as well as disability [33.3% Vs 15.2% p<0.05]. Lacunar infarct was found in few patient with good prognosis while cere bral infarct was associated with poor prognosis and put the diabetics at higher risk in term of mortality [17.6% Vs 9.8% p<0.05] as well as disability [26.4% Vs 14.2% p<0.05]. Diabetes Mellitus is associated with poor outcome of ischemic stroke patients both in terms of mortality and morbidity during acute hospitalization. Hypertension. increasing age and large infarct size further worsens the outcome

Assessment of severity of cirrhosis in hospitalized patients

Background: To assess the severity of cirrhosis at the time of presentation to hospital and to seek association between sociocultural, demographic and geographic variables and severity of chronic liver disease

Materials and Methods: One hundred consecutive cases of cirrhosis of liver admitted in Nishtar Hospital, Multan were included in this study. After history, physical examination and relevant investigations, patients were segregated into Child grade A, B and C depending upon the severity of liver disease

Results: Among 100 cases studied, 48 were male and 52 female; the mean age was 47 years [range 20 to 80 years]. Majority of the patients were from low socio economic group. Out of 100 cases 72% were from rural areas and 28% were from urban areas. It was found that most of the patients [92%] presented to hospital when their liver disease was advanced [46 patients of Child grade B and 46 patients of Child grade C] while only 8 patients had mild liver disease [Child Grade A]. Rural population had more severe disease at the time of presentation as compared to urban population. Poor and middle socioeconomic group had more severe and advanced chronic liver disease as compared to rich class [p=0.0306]. It was found that female had more severe disease at the time of presentation [P=0.0346]. Frequency of cirrhosis was found to be more above 40 years of age

Conclusion: Results of this study indicated that cases of cirrhosis of liver are referred to tertiary care units when their disease is advanced with serious complications. Moreover there is a significant association between geographic and socioeconomic status of the patients and severity of cirrhosis. It is recommended that health care personnel should be properly trained for health education and early recognition and referral of the patients of chronic liver disease to tertiary care units. This will prevent complications and with help to decrease the morbidity and mortality

Salivary count of Streptococcus mutans in caries prediction

The purposes of this study were to give the characteristics of Streptococcus mutans isolated from saliva, and the salivary level of S. mutans and its relationships with dental caries. Dental caries is a common infectious disease worldwide. The aetiology of the disease is multifactorial, life habits and streptococcus mutans infection being the most imporatent factors. Paraffin stimulated saliva was taken from 40 subjects of three age groups in sterilized glass tubes. The saliva sample was serially diluted on GSTB agar plates. The plates were incubated anaerobically at 37 °C for 48 hours in candle extinction jars. S. mutans were identified on the basis of morphologic and biochemical characteristics. Viable cell count of S. mutans [CPU I ml] was also done on GSTB agar plates. S. mutans were found in all samples in significant percentage. The results indicated that subjects that had dental caries harboured high level of S. mutans 10[6]> CPU I ml. In age group III, the percentage of subjects with high level of S.mutans and dental caries was found to be higher as compared to age group I and age group II.

effect of commercially available local brand of toothpastes against oral bacteria

The objective of the study was to find the antimicrobial effect of local brands of toothpastes containing different active ingredients, against aerobic and anaerobic oral flora and Streptococcus mutans; the causative agent of dental caries and dental plaque. The efficacy of eight locally formulated dentifrices was checked against aerobic and anaerobic oral bacteria of 30 subjects. Sterilized swabs were applied on the subject's teeth and inhibitory zones against these bacteria were measured by agar diffusion method. The magnitude and duration of Streptococcus mutans percentage reduction was evaluated against 1:100 and 1:1000 w/v dilutions of six dentifrices containing different active ingredients. The Streptococcus mutans were treated with selected dentifrices for 0,5,10,15,30,60 and 120 minutes. The CPU was done using spread plate method. Triclosan containing toothpastes showed maximum inhibitory zones against aerobic and anaerobic oral bacteria followed by fluoridated, whitening and herbal dentifrices. The maximum percentage reduction of S. mutans was shown by triclosan containing toothpastes followed by fluoridated and herbal dentifrices. All dentifrices showed antibacterial activity against aerobic and anaerobic oral bacteria, maximum being that of triclosan containing toothpastes. The longest and largest reduction of S. mutans was shown by triclosan containing dentifrices