Successful anesthetic management of patient with stiff person syndrome

We herein describe the successful anesthetic management of a patient with stiff person syndrome undergoing right total hip replacement under spinal anesthesia. We also describe the problems associated with general anesthesia. The advantage of using regional anesthesia in these patients is the avoidance of muscle relaxants. The use of general anesthesia carries the risk of hypotonia in stiff person syndrome postoperatively due to enhancement of gamma aminobutyric acid [GABA] action on synaptic transmission by drugs that have a gamma GABA agonistic action

Comparison of phenylephrine and ephedrine for treating hypotension after spinal anesthesia for cesarean section: a Randomized double-blind clinical trial

Background and objectives: Hypotension following spinal anesthesia [SA] for cesarean delivery can have important consequences for parturient and may affect neonatal outcome. The objective of this study was to compare intravenous bolus doses of phenylephrine and ephedrine to treat hypotension after SA for cesarean section and the effect of vasopressors on fetal outcome in terms of Apgar score. Methodology: Two hundred parturient fulfilling inclusion criteria were r and omly allocated into two groups of hundred each. Lumbar puncture was done in sitting position and 10 mg, 0.5% hyperbaric bupivacaine was given intra-thecally to every patient. All patients were placed supine with 15 degree left lateral tilt position. If hypotension occurred after SA [systolic blood pressure less than 90 mm Hg or decrease in systolic blood pressure more than 20% of base line whichever is lower] was treated with either 100µg phenylephrine in Group A or6 mg ephedrine in Group B boluses given intravenously. Results: Single intravenous bolus dose of phenylephrine 100 µg was effective in treating hypotension in 92% parturient while ephedrine 6mg remained effective in 78% parturient, which was statistically significant [p= 0.0009]. There was no difference in the mean Apgar scores [p = 0.76] at 1 minute and [p = 0.09] at 5 min between the two groups. Incidence of bradycardia [heart rate < 50 beats/mints.] was significantly higher in Group A as compared to Group B [p=0.038]. Conclusion: Intravenous bolus dose of phenylephrine 100 µg and ephedrine 6mg were both effective in treating hypotension after SA for elective cesarean section. Mean Apgar scores of the neonates at 1 and 5 min were comparable between the two groups. Key words: Spinal anesthesia, cesarean section, hypotension, ephedrine and phenylephrine Citation: Siddiqui AS, Salim B, Siddiqui SZ. Comparison of phenylephrine and ephedrine for treating hypotension after spinal anesthesia for cesarean section: A R and omized double-blind clinical trial. Anaesth Pain and Intensive Care 2015;19[1]:44-49

Quantitative analysis of biomarker rutin in different species of genus Ficus by validated NP and RP-HPTLC methods

Biomarker rutin was analyzed in methanol extracts of leaves of five different species of genus Ficus [Ficus carica, Ficus nitida, Ficus ingens, Ficus palmata and Ficus vasta] by NP-HPTLC [Method I] and RP- HPTLC methods [Method II]. The development and validation for method I was carried out with silica gel 60F[254] plates using EA: GAA: FA: H[2]O [10:1:1:2.5, v/v/v/v] as developing system. Method II was carried out on silica gel 60F[254] RP-18 plates using mobile phase ACN: H[2]O [4:6 v/v]. Both analyses were scanned at 305 nm and were found to give well resolved peak of rutin at Rf 0.28 +/- 0.01 and 0.68 +/- 0.03 for Method I and Method II, respectively. The percentage of rutin was found to be 0.51% and 0.66% in F. ingens, 0.24% and 0.54% in F. palmata and 0.14% and 0.17% in F. vasta by Method I and Method II, respectively. Method II [RP-HPTLC] was found to be more accurate, precise and sensitive than Method I. Method II can be used as an important tool for standardization and quality control of bulk drugs and in-process formulations of rutin

Evaluation of thermo sensitivity of curcumin and quantification of ferulic acid and vanillin as degradation products by a validated HPTLC method

Charismatic therapeutic potential of curcumin in biological research have triggered an interest to explore the thermal degradation pattern of curcumin, formation of ferulic acid and vanillin as degraded metabolites at different temperatures in methanol and corn oil. The results revealed 47% w/w loss of curcumin along with formation of 17% w/w vanillin and 9% w/w ferulic acid at boiling temperature of methanol while oil samples show 38.9% w/w loss of curcumin but not confirming the formation of ferulic acid and vanillin. Findings of this study revealed that formation of vanillin in methanol starts around 50[degree]C and its concentration goes on increasing up to 70[degree]C and then further degraded at boiling temperature of methanol. Formation of ferulic acid begins around 60[degree]C and initially increases with rise of temperature and then decreases approaching boiling point of methanol. Vanillin as well as ferulic acid was absent in corn oil samples though degradation of curcumin was observed by reduction in peak area of curcumin. The present study was done by applying a validated high-performance thin-layer chromatography method. The method involved glass-backed HPTLC plates precoated with silica gel 60F254 as the stationary phase and toluene: ethyl acetate: methanol [8:1:1, v/v/v] as mobile phase

Quantification of glycyrrhizin in anti-stress herbal formulations by validate HPTLC method: a rational paradigm towards quality control of herbals

In the present study an analytical method of high-performance thin-layer chromatography [HPTLC] has been developed for quantification of glycyrrhizin for marketed antistress liquorice root capsules [LRC] and herbal tea [HT]. Chromatography was performed by using mobile phase ethyl acetate [EA]: glacial acetic acid [GAA]: Methanol [MeOH]: water [H2O] in proportion of 6:2:2:1, v/v/v/v. The developed plate was scanned and quantified densitometrically at absorption maxima 254nm. The method was validated for various analytical parameters viz. precision, accuracy, recovery, robustness, specificity, detection and quantification limits. The developed system was found to give compact spot for glycyrrhizin [Rf = 0.33 +/- 0.001]. The linearity relationship was described by the equation Y=6.841X+ 70.428. The limit of detection [34 ng band-1], limit of quantification [101ng band-1], recovery [99.4-99.8%], and precision [

Effect of some plants' extracts used in Sudanese folkloric medicines on carrageenan-induced inflammation

Investigations for anti-inflammatory potential and categorization of Sudanese medicinal plants according to their potency. Anti-inflammatory effect of plants' extracts of 17 genera were studied using the carrageenan induced inflammation in rats' paws. The plant extracts were obtained using methanol and dichloromethane as solvent and administered intra peritoneally at the concentration of 2g/kg body weight. The results obtained in this experiment strongly support and validate the traditional uses of these Sudanese medicinal plants to treat various inflammatory diseases. 63.9% of plants extracts showed marked inhibition of inflammation induced by carrageenan [78.3% out of this percentage represented by methanolic extract], 27.8% showed no activity and 8.3% enhanced the carrageenan induced inflammation. The anti-inflammatory effect of many of these plants has not been reported previously, yet they have been extensively used in Sudanese folkloric medicine. The result of this study justify the traditional medicinal use of the evaluated plants species in treating inflammatory disorders and helped in categorizing the investigated plants into most useful, moderately useful and least useful category for inflammatory diseases. Out of the 17 investigated plant species 05 belongs to most useful and 06 belongs to moderately useful category. However, toxicity studies are required to prove the safety of these plant materials

Antioxidant potential of Rumex vesicarius L.: In vitro approach

Objective: To assess in-vitro antioxidant activity of different fraction and perform high performance thin layer chromatography fingerprint analysis of most active fraction of Rumex vesicarius L. (R. vesicarius). Methods: In the present study, acetone, ethyl acetate, n-butanol, and methanol extracts of R. vesicarius were evaluated for radical scavenging activity by studying the inhibition of the level of lipid peroxidation induced by Fe(

Antioxidant potential of Rumex vesicarius L.: in vitro approach

<p><b>OBJECTIVE</b>To assess in-vitro antioxidant activity of different fraction and perform high performance thin layer chromatography fingerprint analysis of most active fraction of Rumex vesicarius L. (R. vesicarius).</p><p><b>METHODS</b>In the present study, acetone, ethyl acetate, n-butanol, and methanol extracts of R. vesicarius were evaluated for radical scavenging activity by studying the inhibition of the level of lipid peroxidation induced by Fe(++)/ascorbate, DNA sugar damage, scavenging of hydrogen peroxide, diphenylphosphine DPPH radical scavenging activity, total phenolic content, total flavonoids content and total proanthocyanidin. High performance thin layer chromatography finger print profiling of R. vesicarius L. was also done.</p><p><b>RESULTS</b>Lipid peroxidation induced by the iron/ascorbate system, hydrogen peroxide, diphenylphosphine and DNA sugar damage were inhibited by the addition of different extract of R. vesicarius. Among them, methanolic extract showed maximum efficacy. The methanolic extract showed the highest total phenolic, total flavonoids and total proanthocyanidin contents.</p><p><b>CONCLUSIONS</b>The results suggest that the extracts can be a vital source of phytochemical antioxidants.</p>

Superficial bladder tumor; effectiveness of single dose perioperative mitomycin-c instillation in reducing recurrence

Bladder cancer is the second most common urologic cancer. Approximately 90% are transitional cell carcinoma among which superficial bladder cancer constitutes about 50-70%. It is usually treated by transurethral resection with adjuvant intravesical instillations of chemotherapy or immunotherapy. Primary problems in superficial bladder cancers are its tendency to recur, about 50-80%, following surgical ablation alone, with progression to muscle invasive disease in 20-25% cases. Intravesical chemotherapy appears to have major impact on decreasing chances of recurrence of superficial bladder cancer. To determine the efficacy of single dose perioperative intravesical mitomycin C in reducing recurrence of superficial bladder tumor. Comparative study. Department of Urology Shaikh Zayed Hospital Lahore. One year.13-04-2009 to 13-04-2010. Patients were divided into two groups randomly by using random numbers i.e. 40 patients in group A and 40 patients in group B. Group A [40 patients] of bladder tumor received post TURBT single dose Mitomycin-C 40 mg/40ml N/Saline intravesically and Group B [40 patients] was control group i.e. TURBT alone without Mitomycin-C. The recurrence at first year follow up in both groups were showed a significant difference [p<0.05] as shown in Table No V: There were only 10% recurrence in Group A i.e. patients who had intravesical Mitomycin -C as compared to 55% recurrence in Group B, who did not received postoperative intravesical Mitomycin-C. It is concluded that one perioperative [within 6 hours of TURBT] intravesical instillation of chemotherapy significantly decreases the risk of recurrence after TURBT in patients with stage Ta T1, single and multiple papillary bladder cancer in low risk as well as high risk tumors. One immediate instillation after TUR reduces the recurrence

Standard antituberculosis drug induced hepatotoxicity: Do the risk factors matter?

Objective: To determine the frequency of hepatotoxicity with standard antituberculosis drug therapy and its risk factors

Method: This prospective cohort study was conducted at Muhammad Medical College Hospital, Mirpurkhas and Liaquat University Hospital Jamshoro, from July 2007 to August 2008. A total of 350 cases of active pulmonary tuberculosis with normal pretreatment liver function test [LFT] were selected through probability sampling. Patients were started first line antituberculosis drug therapy [ATT]. The liver function derangement was monitored. If any hepatotoxicity noticed, the time duration for toxicity occurrence and time taken for normalization of LFT were recorded. ATT was altered as needed, with exclusion of toxic drug. Data were collected on proforma and analyzed by using SPSS version 10.0

Results: ATT induced hepatotoxicity developed in 91 [26%] patients with minor, moderate and severe alanine transaminase [ALT] rise noted in 48 [52.75%], 40 [43.95%] and 3 [3.3%] cases respectively. Hepatotoxicity for individual drugs were noted as; Isoniazid [INH] 53 [58.24%], rifampicin 32 [35.16%] and pyrazinamide [PZA] 6 [6.59%] [p=0.01]. Malnutrition, low albumin, acetaminophen, female sex, older age and low serum cholesterol were noted as the risk factors [p=0.05]

Conclusion: Hepatotoxicity occurs significantly with anti-TB drugs, usually reversible and rarely fulminant. It is more frequent in patients with malnutrition, low albumin, acetaminophen, female sex, older age and low serum cholesterol

Primary chiasmal sarcoid granuloma masquerading as glioma of the optic chiasm

A 37-year-old woman presented with a 6 months history of headaches and memory impairment. Examination showed no neurological deficit with normal vision. MRI scans showed an enlarged optic chiasm. There was no dural or leptomeningeal enhancement or hydrocephalus. Open biopsy of the suprasellar mass showed non-caseating chronic granulomatous inflammation compatible with sarcoidosis. Systemic features of sarcoid were absent. Patient showed marked improvement on steroid therapy

Frequency of hepatitis C and D super infection in patients with hepatitis B related complex liver disorders

To determine the frequency of super infection of hepatitis C and D in patients with hepatitis B related complex liver disorders and the distribution of HBV genotypes in these patients. Descriptive study. The Gastroenterology Unit of PMRC in JPMC, Karachi, from July 2006 to June 2007. All patients registered for HBV associated infections were selected. Blood was drawn from 180 patients who fulfilled the inclusion criteria. Those with an incomplete test profile were excluded. All clinical conditions were investigated through liver function tests, coagulation profile, and findings at abdominal ultrasonography, upper gastrointestinal endoscopy and liver biopsy. Liver cirrhosis and hepatocellular carcinoma [HCC] were diagnosed either on the basis of histology, or on a combination of radiological, endoscopic and laboratory data. Hepatitis B virus DNA was extracted from serum, and subjected to a nested PCR using the type specific primers for HBV genotype. Descriptive statistics were used for frequency and mean determination. The 129 patients finally selected for statistical analysis included 108 [84%] males and 21 [16%] females. The age ranged from 6- 68 years [mean=31.5 +/- 12.39 years]. There were 70 [54.2%] patients of non-cirrhotic, chronic hepatitis [CLD], 38 [29.4%] carriers, 12 [9.3%] cirrhotics and 9 [6.9%] HCC patients. Among the 129 patients, 45 [34.9%] were positive for double infection with HDV. These included 35 CLD cases, 7 cirrhotic and 3 carriers, 4 [3.1%] patients were positive for double infection with HCV including one with CLD, 2 with cirrhosis and one with HCC. Triple infection with HBV/HDV/HCV was present in 4 [3.1%] patients who had CLD. Approximately 59% [n=76] patients were not coinfected, though 9 had developed HCC. The genotype distribution of HBV was observed as D in 98 [76%] patients, A in 24 [18.6%], and AD mix in 7 [5.4%]. Genotypes B, C, E or F were not found. Accordingly, genotype D strains were the predominant strains among all categories. The frequency of super infection of hepatitis C and D was found to be highest in HBV cirrhosis patients compared to patients having chronic liver disease [non-cirrhotics] and carriers. Genotype D of hepatitis B virus was found dominant in all hepatitis B related complex liver disorders

Carotid body tumor: MRI appearance

A 52-year-old male presented with a painless swelling of the right side of the neck of four months duration. The clinical examination was unremarkable except for the swelling. On deep palpation pulsations were felt. Patient was referred to radiology department for ultrasonography neck on grey scale imaging there was an echogenic mass at the level of carotid bifurcation on Doppler study there was blood flow within the mass associated with displacement of the internal carotid artery due to pressure effect. Carotid body tumor was suspected and patient underwent for CT and MRI for confirmation

Neck swelling in children: an unusual presentation

Neck swelling in the children's has always been a diagnostic challenge for radiologists. A 3 year boy presented in the surgical outdoor with a painless lateral neck mass and was referred to our department for USG neck. On USG ectopic thymus was suspected. MRI was advised to confirm the ultrasound finding .MRI confirmed our ultrasound diagnosis by typical appearance of thymic tissue using different sequences. Information about this anatomic variant and of its variable clinical presentation is essential and it should be included in the differential diagnosis of neck masses, especially in children

First Successful autologous chondrocyte implantation in Pakistan

Osteochondritis dissecans entails a hyaline cartilage defect of the articular surface causing pain and functional restriction in young adults, sometimes resulting in early degenerative arthritis. Conventional treatment methods such as abrasion chondroplasty and mosaicplasty have limitations in terms of quality of the resultant cartilage and donor site morbidity. A more recent technique, autologous chondrocyte implantation [ACI] results in hyaline cartilage formation and gives good long-term outcome, but requires a high-level cell culture facility and two surgical procedures. The patient was a young female with knee pain, intermittent locking and feeling of "joint mouse". MRI scan and arthroscopy showed a 2x2 cm full thickness osteochondral defect in the medial femoral condyle. A free fragment of articular cartilage was found, which was extracted arthroscopically, and chondrocytes were cultured from it in the Juma laboratory. Subsequently, patient underwent surgery whereby the chondrocytes were injected under a periosteal patch sewn over the defect. Over six months, patient's symptoms completely resolved and she returned to full function. A repeat arthroscopy after one year revealed complete filling of the previous defect with normal appearing cartilage indicating success of the procedure. This technology can be utilized for treating patients with a variety of conditions affecting hyaline cartilage of joints

Effects of summer and winter on blood picture among young adults

To find out the effects of summer and winter seasons. The blood pictures of 252 healthy students were studied in the last week of June, 2006 and the last week of January, 2007. Total leucocyte, absolute neutrophil, absolute lymphocyte and red blood cell counts and hamemoglobin concentration were highly significantly [P < 0.001] higher in the summer than in the winter. Packed cell volume was also significantly [P < 0.01] higher in the summer. Mean corpuscular volume [MCV] mean corpuscular haemoglobin [MCH], mean corpuscular haemoglobin concentration [MCHC] and platelet count showed a non-significant [P > 0.05] difference between the two seasons. It is concluded that there are significant seasonal variations in the blood picture of healthy young adults

Prevalence of hepatitis C, hepatitis B and human immunodeficiency virus infection among blood donors at Fatimid center Multan

To find out the prevalence of Hepatitis C, Hepatitis B and HIV infection among blood donors at Fatimid Center, Multan., determine whether the laboratory methods to be used for the detection of HBV, HCV and HIV infection and disseminate the findings of the study for the constitution of proper screening programme at blood transfusion centers. This cross-sectional study was designed to know the screening pattern of Hepatitis B, Hepatitis C and human immunodeficiency virus in blood donors at Fatimid Center Multan during the period from November 2001 to December 2001. Hepatitis C, Hepatitis B and HIV infection is commonly transmitted via blood, blood products and unsafe sex from one person to another in the community. 1014 blood donors were screened for Hepatitis B, Hepatitis C and HIV antigen. 79 were found reactive for HBV, 37 reactive for HCV and HIV reactive was found none. The recipients of Hepatitis C and Hepatitis B reactive blood are 20 times more likely to have evidence of post transfusion Hepatitis C and Hepatitis B infection than recipient of Hepatitis C and Hepatitis B non reactive blood. This study was carried out with the objectives to see prevalence of Hepatitis C, Hepatitis B and HIV infection in blood donors, Hepatitis B Hepatitis C and HIV infection association with parentraI therapies, etc. Blood donors record for HBV, HCV and HIV was collected from blood bank of Fatimid Center Multan. Among 79 Hepatitis B reactive blood donors 30 [37.97%] had history of previous blood transfusion, 7 [8.86%] had parentral therapy, 2 [2.53%] had history of drug addiction, 2 [2.53%] had history of sexual contact while 37 Hepatitis C reactive blood donors 5 [13.51%] had history of previous blood transfusion and 20 [54.05%] had history of parentral therapy. None had history drug addiction, 9 [24.32%] had history of sexual contact. Luckily no HIV infection reactive case was found. The results of the present study underline the dire need to have a national comprehensive plan with multidisciplinary approach for HBV, HCV, HIV prevention is the community. It is suggested that blood and blood products should be screened for HCV, HBV, HIV infection before transfusion and use of disposable syringes, other sterilized instruments during hospital stay and use of disposable razors at barbers shop must be kept in mind

Weaning practices in urban and rural areas of Pakistan

Weaning practices varies in different communities and affected by beliefs. Family feeding order, attitudes towards weaning nutrition, geography, economic status, climate etc. Detailed knowledge of above factors is essential to improve the child nutrition. The growth of an infant and a young child is almost totally dependent on the nutrition he is getting. Improper feeding practices and poor nutrition of a young child can lead to ill health and malnutrition. It is essential to explore the knowledge, customs, beliefs and their effects to overcome malnurition and growth retardation. It is also necessary to know about the knowledge, attitude and practices relating to weaning in different communities and factor influencing these. The study is conducted on mothers of children at the age of weaning from both unban and rural origin. Simple random sampling technique is adopted for the study purpose. A questionnaire prepared to evaluate knowledge, beliefs, customs, and dietary habits relating to weaning and effect of economy, demography, literacy etc. on the believes, customs and practices. After collection of data, analysis done to draw conclusions. The study shows that 65% children are weaned at the age of 4 to 6 months in urban population while 50% in rural areas. In both population middle class weaned their children early, education also improved the situation. Weaning before the age of 3 months existed to some extent in both populations. Mixed feeding prevalent in both communities. Trend towards introduction of processed foods is more in both populations, food fads and to boos are also present, but more prevalent in rural areas, due to these high energy and protein foods are usually prohibited for a young child. In urban areas, children of working mothers also affected due to improper look after by the servants and relatives. The study shows that many children in both rural and urban population do not receive the right food to eat in their early childhood. This is resulted in growth retardation, and ill health in most children. This is true more in rural areas as compared to urban areas, but there are no significant differences in both populations, Predisposing factors include low income of the family, illiteracy, delayed weaning, late introduction of high-energy foods, protein and other nutrients for infant growth. In case the weaning foods are introduced to the infant at the right age, their frequency is less than required number of feeds per day

Hallervorden-spatz syndrome magnetic resonance image [MRI] appearance

25 years male presented to the medical outdoor with signs and symptoms of extra pyramidal dysfunction and abnormal body movements and reflexes. Initial diagnosis was Wilson disease. Patient was referred to MRI department for brain MRI. On MRI images there were typical findings of hallervordon - spatz syndrome