Intravenous patients controlled analgesia versus maxillary nerve block in unilateral maxillary surgery

The aim of the present study was to compare perioperative pain relief with intravenous patient controlled analgesia using morphine and maxillary nerve block in patients undergoing unilateral maxillary surgery. Sixty patients, ages between 17 and 70 years, ASA I and II, undergoing unilateral maxillary surgery [cystectomy, odontogenic tumour excision and orodental fistula repair], were recruited in the study and divided into two equal groups. In Group-A patients were administered general anesthesia plus maxillary nerve block with bupivacaine, and in Group-B patients were anesthetized with general anesthesia and morphine followed by PCA. Blood pressure, heart rate and Spo[2] were measured intraoperatively every 15 min. VAS was used postoperatively every 4 hours during first 24 hours. Satisfaction of the patient, conscious level, and complications, e.g. nausea, vomiting, itching and urine retention, were recorded in both groups. Results are presented as mean +/- standard deviation [SD]. Statistical analysis was performed with SPSS software version 16. The unpaired students t-test was used to compare the results of both groups. Complications are presented as percentage. P value <0.05 is considered significant. The hemodynamic parameters were increased in group B in comparison to group A. No significant changes in oxygen saturation during intraoperative period were observed between both groups or within groups. Regarding pain score [VAS], there were no statistically significant difference between both groups at [0] hour but difference was statistically significant between both groups after 4, 8, 12, 16, 20 and 24 hours, VAS score being more in Group B in comparison to Group A. Only 10% and 3.3% of patients inGroup A suffered from nausea and drowsiness respectively. In group B, 30%10%, 10%, 20 %and 10% of patients suffered from nausea, vomiting, Pruritus, drowsiness and urine retention respectively. This part needs to be described in a better way. Perioperative pain relief in cases of unilateral maxillary medium sized maxillary pathology removal achieved by maxillary nerve block is better than intravenous patient controlled analgesia due to hemodynamic stability, better pain control and lower side effects

[Polymorphisms of prolactin gene in a native chicken population and its association with egg production]

The induction and regulation of broodiness is of the most important role of prolactin in avian species. The promoter region of the prolactin gene is an appropriate model for studying tissue-specific and hormonally-regulated activation of gene transcription. In this study, the association between prolactin promoter region alleles and egg production in Fars native chickens was investigated. In total, 100 laying hens, randomly selected from the flock of the Breeding Center for Fars Native Chicken, were genotyped for two single nucleotide polymorphisms [C-2161G and C-2402T], one 24-bp insertion-deletion at the site -358. The observed genotypic frequencies in the C-2161G site were CC [0.437], CG [0.435] and GG [0.101]. Two alleles were found for the SNP of C-2402T with frequency of 0.34 for T and 0.66 for C. The 24-bp insertion-deletion at the site -358 was shown to be polymorph in the studied sample, with the observed genotyping frequency of 0.417 in II, 0.457 in ID and 0.126 in DD. Significant relationship was found between the SNP[s] and insertion-deletion genotypes with egg production [P<0.01]

[ frequency of AgNOR [Argyrophilic Nucleoli Organizer Region] points in differentiation between the benign prostatic hyperplasia and prostatic adenocarcinoma]

Background: while the differentiation of prostatic adenocarcinoma and benign prostatic hyperplasia [BPH] is not often a difficult task, sometimes it is not the case even for the experienced pathologists. In this study the efficacy of AgNOR staining technique for differentiating between the prostatic adenocarcinoma and BPH were evaluated

Materials and Methods: using a descriptive study 15 prostatic adenocarcinoma samples [without spot to histologic grade] and 15 BPH samples were selected and stained with AgNOR method. Specimens were taken from paraffin block in Pathology laboratory archive

Results: the average AgNOR points in BPH and prostatic adenocarcinoma were1.39 and 2.48 per cell, respectively. In BPH there were one or two points of AgNOR with specific margin but in prostatic adenocarcinoma numerous arranged AgNOR points were seen. While the number of cells in BPH with three or more AgNOR points were 4.7, in prostatic adenocarcinoma it was 41.47

Conclusion: AgNOR is a useful method to differentiate between benign prostatic hyperplasia and prostatic adenocarcinoma

Prevalence of cleft lip and palate in cousin marriages

Birth defects are one of the leading causes of paediatric disability and mortality in developing as well as developed countries. The purpose of this study is to report our 3 months experience regarding the prevalence of cleft lip and palate in cousin marriages. A retrospective review of 50 patients who presented with cleft lip or cleft lip/palate during 3 months, from 9th March to 8th June, 2005 was carried out. Among the risk factors cousin marriages is a most frequent risk factor. Cleft lip is more common than cleft lip/palate and cleft lip alone is a different entity than cleft lip and palate combined

Role of deliberate creation of control enterocutaneous fistula in patients of abdominal tuberculosis with perforation of small bowel and matted small intestine

To study the results after forming the controlled enterocutaneous fistula in the patient of abdominal tuberculosis with matted and perforated small bowel. Design, place and duration of study This study based on therapeutic trial and conducted in one and half years from january1999 to june2001 at Mayo Hospital, Lahore. All these 20 patients either operated in emergency or on elective list were malnourished, toxic and their operative findings were almost the same, these patients had extensively matted, friable and perforated gut. In these patients it was technically not possible to perform some definite procedure like right haemecolectomy or ileostomy with out increasing the morbidity or mortality. Under these circumstances, minimal surgical procedure which can be life saving is to oppose the anterior abdominal wall to the perforation and thus create a controlled enterocutaneous fistula. In 11 patients fistula closed on its own and in eight patients fistula remained patient and needed re-exploration and repair. This new method of treatment has yielded excellent results. We were able to cure the disease with no mortality. It is recommended that in cases of TB peritonitis with perforation and matted gut making of a controlled enterocutaneous fistula saves the life of the patient

Management of acute pancreatitis: an experience at Mayo hospital, Lahore

This is a retrospective as well as prospective study of 46 patients with acute pancreaitis who were managed in North Surgical Unit of Mayo Hospital, Lahore. This study was carried out with special emphasis on need of surgical treatment and its outcome. No age group or sex was found immune to this disease. It was more common in 3rd to 4th decade of life and female sex. The commonest etiology is gall stones [54%] followed by alcohol [8%] and idiopathic [15%]. Pain epigastrium is a constant symptom. Judicious use of serum amylase urinary amylase and ultrasonography can help in early diagnosis of the acute pancreatitis. Complications are best diagnosed on CT scan. Majority of patients were treated successfully by conservative measures [44%] but developed complications which carried high morbidity and mortality. Surgical treatment of associated gall stones has prevented recurrent attacks of acute pancreatitis. Hence cholecystectomy for associated gall stones is recommended during same admission for mild to moderate pancretitis after resolution of symptoms

Does routine home visiting improve the return rate and outcome of DOTS patients who delay treatment?

Over a period of 6 months the effect of home visits on compliance with directly observed therapy, short course [DOTS], was studied on 480 new smear-positive tuberculosis patients who had delayed collecting their drugs on one occasion. Patients registered at 15 tuberculosis treatment centers in Baghdad, Iraq, were randomized to an intervention group [receiving home visits from trained personnel] or a control group. Home visits were highly effective in improving the return to treatment of patients who were late for treatment [231/240, 96.3%]. The intervention group showed a higher treatment success rate [94.2% versus 76.7%], lower default rate [0.8% versus 10.0%] and higher smear conversion rate after the end of treatment [92.9% versus 75.0%] than controls. Home visiting by trained personnel significantly improves patient compliance with DOTS

case of bilateral agenesis of the femur

Bilateral femoral agenesis is a rare anomaly. To the best of our knowledge, only three cases of simple congenital anomaly and three cases associated with femoral facial syndrome have been reported. Here, we describe a simple form of bilateral femoral agenesis observed in one of the 2 dead fetuses delivered after termination of a 24-week twin pregnancy of a normal mother. Post-mortem x-ray examination confirmed the agenesis of both femurs and also left fibula

Gene therapy: recent advances, future directions and concerns

There is now convincing experimental evidence which suggests that gene therapy, a procedure to correct inherited disorders by molecular techniques, may become a clinical reality in the near future. The modes of gene delivery to appropriate target cells and tissues are now more specific. Of the viral and nonviral methods of gene transfer, adenovirus based vectors have produced the best clinical results. Successful gene therapy trials which have recently taken place on some selected genetic disorders, indicate that the somatic gene manipulation as shown by the long-term stable expression of the transferred genes, will be more practical and a safer approach for the time being. This is compared to germ-line therapy which involves insertion of gene into gamete forming cells in such a way that the disorders in the offspring would also be corrected. Despite all this optimism there are still many difficulties to overcome, particularly the isolation of genes and their regulatory function. Ethical and religious considerations of gene therapy are also very important as both irrational and rational fears are associated with deliberate genetic manipulation. These will dissipate eventually, once reasonable success in gene manipulation is achieved

effect of Ramadan fasting on patients with chronic disorders from Bahrain

This pilot study was conducted to assess the effect of fasting on patients with chronic disorders during the month of Ramadan 1415 Hrs. Fifteen patients, 13 Bahraini, 2 non-Bahraini, 7 males and 8 females, whose mean ages were 57.2 +/- 11.5 years were randomly selected for the study. Among these were 5 patients [3 M, 2F] with hypertension; 8 [4M, 4F] with NIDDM and 2 [1M, IF] had both hypertension as well as diabetes. All the patients were taking regular medicines for their illnesses, and 6 out of 15 were smokers. Initial physical examination such as body weight, blood pressure, pulse rate and laboratory measurements such as fasting blood glucose level were done at the beginning of Ramadan, then at 2 and 4 weeks intervals. Analysis of the data showed that systolic and diastolic blood pressure, pulse as well as body weight showed a decreasing pattern while fasting blood glucose levels kept on fluctuating. However no statistical significant differences were observed between the pre and post fasting values. A conspicuous increase in the fasting blood glucose levels was observed at the end of second week of fasting [p = 0.0703, marginally significant] in diabetics [Table III]. This could be either due to poor compliance of medications or body's metabolic adjustment in the initial phase. These glucose levels later on decreased but were still higher than the initial values seen at the beginning of Ramadan but again not significantly different [p = 0.3589]

Low mean corpuscular volume: a useful diagnostic hematological parameter for detection of alpha-thalassemia at birth

Regional variations in the incidence of alpha -thalassaemia have been reported from Saudi Arabia. In a recent study, we observed that approximately 6-7% of the Saudi Arabia National Guard [SANG] newborn population had very low mean corpuscular volume [MCV] [100 fI]. The restriction analyses data showed that 28 of 31 [90%] with low MCV [

Hematological profile of Saudi newborns

Normal haematological values for Saudi newborns are lacking and the reference values used in most Saudi hospitals are primarily of Western origin. A study was designed to determine the haematological parameters, namely white blood count, red blood count, haemoglobin, haematocrit, mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration, platelet count, red cell distribution width and reticulocyte count in a large group of Saudi neonates delivered at King Fahad National Guard Hospital, Riyadh during the period of 1988-89. To establish normal values, haematological analyses were performed on 2433 [1202 M; 1231 F] clinically normal consecutive Saudi newborns who had a gestational age ranging from 37 to 42 weeks, normal apgar score and birthweight, mean cell volume >/= 100 fl, normal haemoglobin electrophoretic pattern, without G6PD deficiency, hyperbilirubinaemia and ABO incompatibility. Analysis of the data showed no statistically significant difference between the male and female haematological values [p<0.2] and so a single reference value can be used for both sexes. It was further observed that Saudi newborns usually had higher levels of fetal haemoglobin at birth when compared with other ethnic groups and its production decreases in normal infants during gestational age maturation of the newborns. The blood group and Rh[D] status of Saudi newborns were as follows: A -25. 9%, B=19.7%, O = 50.0%, AB = 4.4%, Rh[D] +ve = 91 .6% and Rh[D] - ve = 8.4%. These observations provide detailed haematolgoical parameters at birth and can serve as reference values for Saudi newborns which are not presently available

Molecular genetics in neurology

Genetically determined diseases with neurological manifestations constitute a big public health problem in many communities including Saudi Arabia. As a result of advances in molecular genetics, the bases of several neurological diseases have now been deciphered. A whole series of genes of neurologic interest have been cloned and sequenced. The analysis of human DNA using recombinant technology is fast becoming an integral part of the diagnosis of number of neurological disorders. It is expected that new methods of mapping the human genome will provide us with a valuable approach in elucidating molecular pathology of these conditions and preventing them. This review presents recent advances in molecular neurogenetics and molecular techniques used for gene analysis as a prelude to possible gene therapy

two-year clinical study of marginal deterioration and microleakage of gallium alloy restoration

A two-year clinical study was done on 100 patients to study marginal deterioration and microleakage of an experimental gallium alloy and two commercially available amalgam alloys. The amalgam alloys represented conventional low copper [Amalcap] and high copper [Tytin] alloys. The marginal quality was studied on class 2 lower molars of 40 patients with total number 120 cases, while microleakage was studied on class 4 premolars of 60 patients [buccaly and lingually] to be extracted for orthodontic treatment [total 120 restoration]. Each of the studied properties were tested in 1-hour, 1-month, 1-year and 2 year periods. Marginal quality was tested by two methods: Direct observation and ranking photographs. Three evaluators evaluated each case and the average results were taken, while microleakage was studied by immersing the extracted tooth in methylene blue dye and scoring the degree of dye penetration seen in photographs. The teeth were extracted in the different 4 periods tested. The observed results showed that, gallium alloy showed superior marginal quality and superior marginal seal in all the tested periods. The ranking order of marginal quality was: Gallium alloy the best, Tytin the second and the worst was Amalcap. Microleakage observed was highest with Amalcap, then Tytin and the least was galium alloy. Aging played an important role in both microleakage and marginal deterioration. Strengths properties, creep, dimensional changes and corrosion greatly affected both studied properties. Marginal deterioration increased microleakage

Mid tarsorraphy, an effective and practical procedure to cure indolent corneal ulear in Pakistan

Study conducted at Rawalpindi Medical College associated hospitals from 1987-1993. Mid tarsorraphy had been tried in 80 patients of indolent corneal ulcers and found to be more effective, cheaper and feasible procedure. Its usefulness to cure indolent corneal ulcers has been compared with medical specific treatment, use of issue glues and lubricants, patching, bandage soft contact lenses, chemicals cauterization and mechanical scrapping of diseased tissue and conjuctival flaps. Rationale of the procedure has also been discussed

Vitamin A deficiency xerophthalmia in Pakistan

A study of Vitamin 'A' Deficiency Xerophthalmia, during the period between 1983 and 1987, performed at hospitals attached to Rawalpindi Medical College [R.G.H. and H.F.H.] is presented. The findings are compared with two previous reports from J.P.M.C, Karachi, during 1969-70 and 1980-81. It was observed that in northern areas [Present Study] xeropthalmia was very rare, as compared to Karachi. Vitamin A Deficiency Xeropthalmia is no more a public health problem in Pakistan

Erythrocytic glucose-6-phosphate dehydrogenase deficiency and anaemia

This study demonstrates that glucose-6-phosphate dehydrogenase [G6PD] activity in anaemic patients is significantly increased compared with that in normal blood donors. There are inverse correlations between G6PD levels and several haematological indices. These correlations are difficult to explain as the reticulocyte counts in our anaemic patients were not greatly increased. A likely reason for these results is an effect of red cell age that is not properly reflected in the reticulocyte counts, and some unidentified factors affecting erythropoeisis may be responsible for the increased production of G6PD in these anaemic patients

Erythrocytic genetic disorders in the newborn population of the Saudi Arabian national guard

A cord blood screening programme initiated at King Fahad National Guard Hospital, Riyadh, revealed that the incidence of the commonly prevalent red cell genetic disorders was low in our newborn population. Approximately 5% had a-thalassaemia, 1% sickle cell disease and there was an overall incidence of 2.2% for severe G6PD deficiency. One-quarter of the G6PD deficient newborns were females, a significant finding in a condition known to have an X-linked mode of inheritance. This finding suggests that screening for this enzymopathy should include both sexes. In addition marked anisopoikilocytosis was detected on routine examination of cord blood films of four newborns. The clinical findings and the morphologic features of the parents' erythrocytes in two of them were highly suggestive of the genetic erythrocytic membrane defect, pyropoikilocytosis