Functional outcome of transforaminal lumbar inter body fusion: an experience at a tertiary care centre

Objective: To assess functional outcome of transforaminal lumbar inter body fusion [TLIF] with specific reference to improvement in pain by visual analogue score [VAS] and Oswestry disability index [ODI]

Study Design: Quasi-experimental study

Place and Duration of Study: The study was conducted at the Department of Spine Surgery of a tertiary care hospital in Rawalpindi from May 2004 to May 2013

Material and Methods: Thirty nine patients who underwent TLIF and completed one year of follow up in our department during the study period were included in the study. Cases were evaluated clinically and radiologically preoperatively and assessed for pain with VAS and general well being with ODI. After TLIF they were reassessed at 1, 3, 6 months and 1 year for improvement in VAS and ODI. Patient satisfaction and work status after surgery was also recorded at 1 year of follow up

Results: Out of 39 cases 19[48.7%] were operated for degenerated disc disease [DDD], 11[28.2%] for spinal stenosis and 7[17.9%] for spondylolisthesis and 2[5.2%] for trauma. A total of 28[71.79%] were males and 11[28.21%] were females. Common levels operated were 12 [30.8%] at L4-5, 11 [28.2%] at L5-S1, and 12[30.8%] at L4,5-S1, 2[5.1%] at L2-4 and 1[2.6%] each at L3-4 and L3-5. At 1 year of follow up median VAS score improved significantly from 7 to 2 and median ODI improved significantly from 76 to 34. Regarding patient satisfaction 26 [66.7%] patients were satisfied, 9 [23.1%] were partially satisfied and 4 [10.2%] were not satisfied with the surgical outcome

Conclusion: TLIF is a safe and effective procedure for reducing chronic low back pain as a result of DDD, instability and spondylolisthesis

Psychosocial determinants of hypertension

Abstract: Hypertension or high blood pressure is a condition in which blood pressure in the arteries is persistently elevated. It is a serious problem in the community leading to social stagnation

Objectives: To determine the association between various psycho-social factors and hypertension. Design: Population based Case-Control study. Place and Duration: Urban Lahore. From May 2012-September 2012

Subjects and Methods: A population based case-control study with 1:1 case to control ratio was conducted. A total of 100 persons [50 cases and 50 controls] were recruited in the study. The selection was made on laid down criteria from adult population living in Urban Lahore in the vicinity of Mayo Hospital Lahore after taking due consent. Data was collected through a pretested questionnaire by a 5 membered team of MBBS students of King Edward Medical University, Lahore under direct supervision of Department of Community Medicine, KEMU. Data was collected, compiled and analyzed through SPSS version 20

Results: Overall 47% were males and 53% were females. Hypertension was found more in females, in the age group 51-65 years, who were married and in graduates. In bivariate analysis, hypertension was found significantly associated with anxiety [OR: 3.167, 95%CI: 1.398-7.174], restlessness [OR: 5.060, 95%CI: 2.150-11.910], anger [OR: 3.083, 95%CI: 1.330-2.963], and income [OR: 3.019, 95%CI: 1.315-6.929]. Whereas diet [OR:0.667, 95%CI: 0.302-1.472], sedentary lifestyle [OR: 1.000, CI: 0.454-2.203], smoking [OR: 1.976, CI: 0.612-6.380], alcohol intake [OR: 2.042, CI: 0.719-23.266], intake of tea/coffee [OR:2.125, 95%CI:0.943-4.789] and unemployment [OR:0.583,95%CI:0.177-1.925] were not found to have any association with hypertension

Conclusion: Hypertension was found significantly associated with anxiety, restlessness, anger, and income

Causes of short stature identified in children presenting at a tertiary care hospital in Multan Pakistan

To determine the frequency of common causes of short stature in children presenting to the Children's Hospital and the Institute of Child Health, Multan. This cross sectional study was done in Pediatric Endocrinology department, the Children's Hospital and the Institute of Child Health, Multan, from March to September, 2011. One hundred and sixty nine children with short stature presenting to the outpatient department meeting inclusion criteria were recruited after taking an informed consent. The detailed history, physical examination including anthropometric measurements and relevant investigations were recorded. Causes of short stature [outcome variable] were recorded on a predesigned proforma for final analysis. The common causes of short stature identified were; familial short stature [FSS] 36 cases [21.3%], hypothyroidism 29[17.2%], growth hormone deficiency [GHD] 18[10.7%], insulin dependent diabetes mellitus [IDDM] 16[9.5%] and constitutional delayed growth and maturation [CDGM] 11[6.5%] cases. This was followed by primary malnutrition 8[4.7%], celiac disease 6[3.6%], Turner syndrome 5[3%] cases and unknown syndromes 4[2.4%] followed by other rare causes. Common causes of short stature identified in this study were endocrine diseases followed by normal variant short stature [NVSS], while nonendocrine causes were the least

Effect of long dose exposure of Podophyllum hexandrum methanol extract on antioxidant defense system and body and organ weight changes of albino rats

Objective: The present study was undertaken to investigate the effect of long dose administration of methanol rhizome extract of Podophyllum hexandrum and hydrogen peroxide on lipid peroxidation of erythrocytes, antioxidant enzyme status of rat liver, kidney, lung and brain tissue and body weight and organ weight changes of albino rats. Methods: The body and organ weight was monitored with digital scale balance and lipid peroxidation of RBC ghost membrane was monitored by measuring malonaldehyde (MDA). Antioxidant enzymes were assayed by standard procedures. Results: Our study showed that administration of H2O2 (0.1%) in drinking water of the rats for 25 weeks increased the malondialdehyde levels in erythrocytes of all the rats. However, rats receiving Podophyllum hexandrum extract and α- tocopherol had lower MDA levels in a dose dependent manner, which indicates decreased lipid peroxidation in these rats. Our results also showed decrease in the activity of glutathione reductase, glutathione-S-transferase and reduced glutathione levels in different organs of H2O2 treated rats. Rats receiving methanolic extract of Podophyllum hexandrum at the concentration of 5, 10 and 15mg% for 25 weeks increased the activity of glutathione reductase, glutathione-S-transferase and glutathione levels in different organs of the rats indicates the protective effect of the plant in combating oxidative stress undergone by the rats. No significant variation (P< 0.05) in the organ weights between the control and the treated groups was observed after 25 weeks of treatment. Conclusions: In conclusion, this study presents strong evidence of the nontoxic effect of the methanol extract of Podophyllumhexandrum. The findings also demonstrate that Podophyllum hexandrum methanol extract increased the levels of antioxidant enzymes and decreased lipid peroxidation in albino rats and explained the extensive utilization of the plant in traditional medicine.

Predictors of intestinal parasitosis in school children of Kashmir : A prospective study.

Objectives: To identify the factors associated with intestinal parasitosis in rural and urban school children of Kashmir. Methods: Single fresh stool samples from rural and urban school children in three age groups: a)5 to < 8 years ,b) 8 to <11 years and c)11-14 years were taken .Various demographic characteristics considered were source of drinking water, type of toilet used and social classes as per the Kuppuswamy social scale. Personal hygiene was assessed by the visiting physician based on length of nails, hair and frequency of bathing. Stool samples were analyzed for detection of motile forms of E. histolytica and microscopic examination under low power detected eggs of intestinal helminths. Concentration methods were used if egg count was low. Results: 274 stool samples from rural school children and 240 samples were taken from urban school children respectively. 214 (46.7%) students had stool tests positive for parasitosis. Ascariasis was the most prevalent parasitosis ( 28%) followed by Giardiasis ( 7%) , Trichuriasis( 5%) and Taeniasis( 4%). There was higher prevalence of parasitosis among rural orphanage children compared to urban orphanage students (76% vs. 48% p <0.05). Highest prevalence of 70% was seen in the age group 8-11years. Students using river/stream water had higher rates of parasitosis compared to those who were using tap water. 202 students were found to have poor personal hygiene and parasitosis was higher in them compared to students with good personal hygiene (p<0.05). Conclusion: Poor environmental sanitation, personal hygiene, type of toilet and water used were associated with recurrent intestinal infestation besides socio economic status. Regular deworming programmes need to be adopted at school level especially in 8-11 years old children to check the surge of intestinal parasites and their subsequent morbidities.

Effectiveness and safety of vaginal misoprostol for induction of labour in unfavourable cervix in 3[rd] Trimester

The use of prostaglandin preparations with or without oxytocin infusion, is widely recognized and accepted as a standard method of induction of labour. It has been shown to reduce induction time and the risk of failed induction. The objective of this quasiexperimental observational study was to determine the effectiveness and safety of Misoprostol administered vaginally for induction of labour to achieve vaginal delivery. This study was conducted from October 2004 to October 2007. The study was conducted at Shaheena Jamil Teaching Hospital, Frontier Medical College, Abbottabad and Women and Children Hospital Abbottabad. A total of 6299 obstetric patients were received for delivery and 946 patients had to undergo induction of labour. Primary outcome measures were to address clinical effectiveness [delivery within 24-hours] and safety [uterine hyper-stimulation, Caesarean Section and serious Maternal Morbidity]. Secondary outcome measures included neonatal outcome. Out of 946 cases, successful vaginal deliveries were achieved in 843 [89.1%] cases. Time interval between induction and delivery was 4-24 hours. Oxytocin was required in 107 [12%] patients. Caesarean Section had to be done in 103 [10.8%] cases. The indications for Caesarean Section were foetal distress in 42 [40%], occipito-posterior position in 8 [7.7%], abruptioplacentae 2 [1.9%], cord around the neck 9 [7%], uterine hyperstimulation 6 [5.8%] and failure to progress in 20 [19%] cases. Admission to NICU was 28 [3.3%] and Neonatal deaths were 5 [0.5%]. Postpartum Haemorrhage [PPH] was observed in 22 [2.3%] patients. There was no case of rupture uterus. Vaginal Misoprostol appears to be safe and effective for cervical ripening in third Trimester. It helps vaginal delivery within 24 hours, does not increase incidence of Caesarean Section and has no adverse effect on foetal outcome. It could also be used in circumstances where extensive monitoring techniques are not available though close observation and vigilance is mandatory

Frequency of peptic ulcer in patients having decompensated cirrhosis of liver

Hepatitis B and C are spreading like an endemic disease in developing countries like Pakistan, due to many reasons. The late diagnosis of HCV and HBV infection has resulted in increased number of patients with decompensated liver disease. One of the common complications of cirrhosis is upper GI bleed caused by peptic ulceration in UK. Local data shows peptic ulceration was the second commonest of the lesions causing upper GI bleed after esophageal varices. Present study was conducted to determine the frequency of peptic ulcer in patients having decompensated cirrhosis of liver presenting with upper GI bleed, also to emphasize the importance of primary prophylaxis with proton pump inhibitors for prevention of peptic ulcer in these patients. Descriptive study. MU-III Allied Hospital Faisalabad. Hundred consecutive patients having decompensated cirrhosis of liver were selected according to pre designed proforma and endoscopy was performed to determine the site of bleeding, from Jun to November 2007. This study showed peptic ulcer as the second most important cause of upper GI bleed [34%] after esophegeal varices [57%], also decompensate cirrhotics have increased incidence of peptic ulceration [34%] as compared to general population [8.3%]. Also significant relationship between source of upper GI bleed and serum albumin level in patients having decompensated cirrhosis of liver. [P value = .019] was found. There is definitely an increased frequency of bleeding peptic ulcer in patients having decompensated liver cirrhosis as compared to general population necessitating the need of primary prophylaxis of peptic ulcer with proton pump inhibitor in decompensated cirrhotics

Organophosphorus compound poisoning; epidemiology and management [atropinization vs pralidoxime] a descriptive analysis, in allied hospital Faisalabad

1] To have an overview of epidemiological factors. 2] To determine the outcome of victims. Mil-III Allied Hospital Faisalabad, from June 2007 to Dec 2008, 484 consecutive patients who were admitted, from June 2007 to December 2008, in Medical unit III with history of having organophosphorus poisoning were analyzed for the epidemiological factors, time to arrive in the hospital, conscious level, mode of poisoning [homicidal, suicidal or accidental] treatment given and outcome. The results of the study showed that age 14-30 years is the major group involved in poisoning 87.9% as compared to ages 31-45years [10.5%] and age more then 45 years [12%], also age group 14-30 years is having more suicidal tendencies as well as accidental poisoning and these tendencies decrease with increasing age [p=0.000]. Male victims are more as compared to female victims [52.9% vs. 46.7%] in the study group. Suicidal tendencies as well as homicidal poisoning is more in female [n= 127 and 44, respectively] while accidental poisoning is more in male population [n=106], [p=0.001]. Urban population is more at risk of poisoning in all three, homicidal, suicidal and accidental, as compared to the rural population [p=0.018]. Importantly study showed that outcome of the poisoning from organophosphorus is directly proportional to the interval between poisoning and presentation in emergency ward [p= 0.000], conscious level of the victim [p=0.000] and does not depend upon the mode of management [oxime or atropine] [p=0.026]. Younger urban population have increased tendency of poisoning with a dominance of female population. Rapidity of treatment, time to arrival to hospital and conscious level at presentation are the factors deciding outcome of a given patient rather than the mode of treatment [oximes and atropine both are equally effective]

Young patient with sub-acute bacterial endocarditis presenting with embolic phenomena

Subacute Bacterial Endocarditis presents a diagnostic challenge even in this day and age due to a variety of manifestations which can be difficult to spot in the early stages where the disease can be treated effectively. This report focuses on the neural and cutaneous manifestations of the disease in a single patient. It stresses the need to suspect endocarditis in young children who present with manifestations of stroke, transient ischemic attacks or peripheral vascular lesions. Delay in treatment is a major cause of mortality in this population and only a high index of suspicion can lead to an early life saving diagnosis and treatment

Pharmacological Investigation of Cassia Sopheral Linn. Var. Purperea, Roxb

Ethanol extract of seed of Cassia sophera, Linn. var. purpurea, Roxb. was studied for some pharmacological activities in rats. Eddy's hot plate and Analgesiometer tests were used to asses antinociceptive activity of Cassia sophera. Pentobarbitone narcosis potentiation test was used to evaluate hypnotic and sedative effect, while anticonvulsant activity was evaluated by Maximum electroshock-induced seizure test and Pentylenetetrazol induced seizure test. Test drug [440 mg/kg] produced significant analgesia, potentiated the pentobarbitone induced sleeping time and exhibited anticonvulsant effect against hind limb tonic extension phase of maximum electroshockinduced seizure test and seizures induced by pentylenetetrazol. The preliminary screening of seed extract of Cassia sophera, Linn. var. purpurea, Roxb. exhibited analgesic, anticonvulsant effects and potentiated pentobarbitone sleeping time. The ethanol extract of seed of Cassia sophera, Linn. var. purpurea, Roxb. deserve further investigation for elucidation of the mechanisms of action

Incidence of ischemic heart disease in patients with non insulin dependent diabetes mellitus

Objective: To find out the incidence of IHD in patient with NIDDM. To study the pattern of clinical presentation of IHD in diabetic patient. To create awareness in the population that IHD is more prevalent in diabetic patient. Design

Prospectus Study Setting: Allied Hospital Faisalabad: Period: Apr 2003 to Sep 2003

Material and Methods: One hundred with previously diagnosed none insulin dependent diabetes mellitus [NIDDM] investigations of duration of their illness were studies. Among 100 patients, 78 were male and 22 were female

Results: Among the 100 patients studied, 17 had evidence of IHD and out these 5 [29.5%] were male and 12 [70.5%] were female. Amongst the patient having IHD, 5 [29.5%] had typical symptoms of angina with or with out ECG change consistent with IHD. Another 6 [35%] had atypical symptoms of IHD with ECG changes. Typical changes of IHD was found in 6 patients

Conclusion: The incidence of IHD is higher in diabetic patient as compare to general population. The presentation of IHD is often atypical in diabetic patients

Upper GIT bleeding; prevalence of peptic ulcer

Objective: To find out the prevalence of peptic ulcer in patients with upper GIT bleed Design: Cross-sectional study. Setting: Department of Gastroenterology of Allied Hospital Faisalabad Period: 1[st] Nov 2001 to 15[th] Apr 2002

Material and Methods: This study was conducted on 100 patients with history of hematemesis or melena of either sex and between 13-70 years of age, presenting in or referred to gastroenterology unit of Allied Hospital Faisalabad

Results: 63 patients were male and 37 were female. Male to female ratio were 2:1 approximately. Out of these 100 patients 27 had peptic ulcer with overall incidence of 27% and 49 had bleeding from esophageal varices i.e. overall incidence of 18%

Conclusions: From this study it was concluded that prevalence of peptic ulcer in patients of upper GIT bleed was far less than those found to have esophageal varices