Lethal response of the dengue vectors to the plant extracts from family Anacardiaceae

Objective: To explore the larvicidal activities of different plant parts of Melanochyla fasciculiflora (. M. fasciculiflora), Gluta renghas (. G. renghas), Anacardium occidentale and Mangifera indica from family Anacardiaceae against the laboratory and field strains of dengue vectors Aedes aegypti and Aedes albopictus (. Ae. albopictus). Methods: Leaves and bark parts of study plants were collected from Taman Nageri, Bukit Pancor and Teluk Bahang National Park, Penang, Malaysia. Leaves and stem barks were separated, air dried, ground and extracted with methanol by Soxhlet apparatus. Crude extract was obtained by evaporating the extra solvent in rotary evaporator. The 4th instar larvae from laboratory and field strains were exposed to 50-1. 300 mg/L concentrations according to World Health Organization standard larval bioassay. Larval mortality was recorded after 24 h of exposure. Results: Highest larvicidal activity was exhibited by G. renghas bark extract against Ae. albopictus laboratory strain at 600 mg/L. G. renghas also showed the highest larvicidal activities for other strains as compared to other plant extracts, followed by Mangifera indica and M. fasciculiflora and Anacardium occidentale. Conclusions: Ae. albopictus has been found to be more susceptible as compare to Aedes aegypti in both laboratory and field strains in this study. G. renghas and M. fasciculiflora were tested for the first time and exhibited prompting larvicidal activities against dengue vectors. These results revealed that all the plants especially G. renghas and M. fasciculiflora have the higher larvicidal activities and can be used for the control of dengue vector as a new environment friendly, target specific and low cost phytochemical.

D - dimers assay as an adjunct to diagnosis of cerebral venous sinus thrombosis

To determine the frequency of raised D-dimer in patients of cerebral venous sinus thrombosis [CVST] at Neurology Department, Military Hospital Rawalpindi. Descriptive study. One year duration conducted in the Department of Neurology at Military Hospital Rawalpindi from 1[st] May 2010 to 1[st] May 2011. Thirty patients were selected randomly from Neurology Department, who were recently diagnosed cases of cerebral venous sinus thrombosis [CVST] on the basis of magnetic resonance imaging [MRI] and magnetic resonance venography [MRV]. D-dimer test samples were drawn and subjected to latex agglutination test. There were 22[73.33%] males and 8[26.67%] females in our study. D dimmer assay analyses revealed 90% [27 patients] as positive and 10% [3 patients] as negative. Raised D-dimer levels are highly suggestive of CVST provided other conditions are clinically excluded and they can be used as an adjunct in the diagnosis of cerebral venous thrombosis

Frequency of inter-atrial blocks in patients with ischemic stroke

To determine the frequency and association of Interatrial block in hospitalized patients with Ischemic Stroke. A case control study. Department of medicine, Military Hospital, Rawalpindi from 1st Jan 2009 to 30 December 2009. It included 64 patients, 32 cases of diagnosed ischemic stroke and 32 patients were taken as controls not suffering from ischemic stroke or ischemic heart disease. ECG findings of both selected groups were evaluated for presence or absence of interatrial block. Out of 32 ischemic stroke patients, 14 [43.85%] were found to have interatrial block on electrocardiogram [ECG]. Whereas only 6 [18.80%] controls were found to have interatrial block on ECG. Odds ratio was 1.66. Interatrial block is more frequent in ischemic stroke patients and may represent a risk factor for such stroke.

High altitude headache - an etiological based study

To determine the various causes of headache in patients evacuated from high altitude. Descriptive study An observational hospital based study carried out on 50 soldiers evacuated from Northern Areas to Military Hospital Rawalpindi between Sep 2009 to Mar 2010 for evaluation of headache as their major complaint. Necessary investigations including neuroimaging were carried out in coordination with Department of Neurology, Military Hospital and an appropriate diagnosis was made in each case. The data was analyzed accordingly. A total of 50 patients were analyzed .They were all males and the mean age was 25 years. 52% patients had Acute Mountain Sickness, 12% hypertension, 10% High altitude cerebral edema, 8% Tension type headaches, 6% Dural venous sinus thrombosis, 6% migraine, 2% encephalitis, 2% were of Subarachnoid hemorrhage and 2% patients Hydrocephalus. Acute mountain sickness and high altitude cerebral edema accounts for a significant number of patients with high altitude headache

Frequency of axonal variants of guillain-barre syndrome in Pakistan

To determine the frequency of axonal variants in our patients of Guillain-Barre Syndrome. Descriptive study. Department of Neurology, Military Hospital, Rawalpindi and Armed Forces Institute of Rehabilitation Medicine [AFIRM] from 01 Jan 2009 to 30 Jul 2010. Forty adult patients meeting the National Institute of Neurological Disorders and Stroke criteria for Guillain-Barre Syndrome [GBS] were consecutively enrolled in the study. Patient's data, detailed history, examination and electrophysiological studies were carried out and recorded on predesigned proforma. All patients were examined and reviewed by Consultant Physicians and neurologists. Electromyography and Nerve conduction study testing was done by experienced electro-physiologists. Axonal variants of Guillain-Barre Syndrome constituted 16[40%] in our study. The variants of Guillain-Barre syndrome were acute inflammatory polyradiculoneuropathy [AIDP] in 24[60%] patients followed by acute motor axonal neuropathy [AMAN] in 12[30%] and acute motor sensory axonal neuropathy [AMSAN] in 4[10%] patients. We report a high frequency of the axonal variants of Guillain-Barre Syndrome in Pakistan

Treatment options for Guillain-Barre syndrome [GBS] - a comparative assessment of treatment efficacy between intravenous immune globulin [IVIG] with plasmaphoresis

To compare the therapeutic efficacy of Intravenous immune globulin [IVIG] with Plasma exchange [plasmaphoresis] in patients of Acute Inflammatory Demyelinating Polyneuropathy i.e. Guillain-Barre syndrome [GBS]. Randomized Controlled Trial [RCT]. The study was of 12 months duration conducted at Department of Medicine, Neurology Unit of Military Hospital Rawalpindi from Jun 2008 to Jun 2009. 60 Patients of GBS were randomly assigned to two treatment groups. Group A received Intravenous immune globulin [IVIG] and Group B Plasma Exchange. Patient's functional status according to London scale grade was assessed at the time of admission and at 02 and 04 weeks after giving treatment. Improvement in mean London scale Grades in each group was calculated at different weeks from baseline and then both groups were compared to each other. In each group there was significant improvement [P-value< 0.001] from baseline-2weeks and baseline-4 weeks. But when compared to each other both the groups had comparable improvement [p-value> 0.05]. Both IVIG and Plasma Exchange have equal therapeutic efficacy in the treatment of patients of GBS

comparison of pioglitazone with metformin in management of type 2 diabetes mellitus

To compare hypoglycemic effect of Pioglitazone and Metformin in type 2 Diabetes Mellitus. Quasi experimental study. Department of Medicine, Military Hospital Rawalpindi Cantt from 11-01-2007 to 12-08-2007. Sixty patients of type 2 diabetes mellitus from outdoor department were selected. On arrival at OPD each patient was examined thoroughly. Therapeutic option was allocated to the patients simply by using a table of random numbers and dividing them in two equal groups. Informed written consent was obtained. Each patient was followed on monthly subsequent visits [six in total] and his HbA1c, fasting and random blood glucose were recorded carefully. All the data thus obtained was processed and analyzed using SPSS version 10.0. Mean and SD were calculated for age, BMI, fasting blood glucose, random blood glucose and HbA1c levels. Mean drop of all three parameters were compared among two groups. At the end of six months, it was revealed that fasting and random [2 hours postprandial] blood glucose dropped more in Pioglitazone group; P=0.000 and 0.02 respectively. While almost comparable effect was observed in HbA1c [P=0.2]. Pioglitazone has significantly better hypoglycemic effect than Metformin in type 2 diabetes mellitus at the end of six months therapy

Frequency of headache with stress in adolescent and young adults

Objective of this study was to establish a link between stress as a cause of headache in young adults. Cross sectional study. Department of Neurology Military Hospital [MH] Rawalpindi from September 2009 to March 2010. Thirty young patients, referred for the complaints of headache to the Neurology out patient department, were included in this study. A detailed especially designed, pre tested headache questionnaire was devised which was filled for every patient individually included in the study. Twenty One [70%] of the patients in the study group did have the feeling of stress preceding the headache which sometimes persisted during the episode. Nine [30%] did not report any such feeling of stress before or during the episode. Out of the patients reporting stress 71% [15] were female patients and 29% [6] were males. These key findings suggest that stress and headaches may be related for adolescents and young adults and that this relationship may be reinforced over time. Moreover female patients were far more susceptible to this stressful stimulus as compared to the males

Comparative efficacy of amlodipine and hydrochlorthiazide-amiloride in cases of mild essential hypertension in outdoor patients at combined Military Hospital Multan

To compare antihypertensive effect of fixed dose combination Hydrochlorothiazide-Amiloride and Amlodipine in patients of mild essential hypertension. Randomized controlled trial [RTC]. Department of Medicine Combined Military Hospital Multan Cantt from 29 January 2007 to 29 June 2007. After fulfilling the inclusion criteria of mild essential hypertension, defined as per recommendations of Seventh Joint National Committee [JNC 7] for treatment of Hypertension as stage 1 hypertension, systolic blood pressure [SBP] >/= 140-159-mmHg and Diastolic blood pressure[DBP] >/= 90-99-mmHg, 100 patients were randomized into two study groups using a table of random numbers. Group 1 received tab amlodipine [5 mg] and Group 2 received tab hydrochlorothiazide-amiloride [25 mg-2.5mg]. Informed written consent was taken. The patients were followed on subsequent visits [6 in total] for five months and systolic and diastolic blood pressure was recorded carefully. All the data thus obtained were processed and analyzed using SPSS version 10.0. Mean and standard deviation [SD] were calculated for age, diastolic and systolic blood pressure. In group 1 the drop in mean SBP between first and last visit was 15.42 mm Hg. In group 2 the drop in mean SBP between first and last visit was 18.34 mm Hg. In group 1, the drop in mean DBP between first and last visit was 10.08 mm Hg. In group 2 the drop in mean DBP between first and last visit was 14.65 mmHg. Mean drop in SBP of both the groups were compared with each other and found to be significantly different [P=0.003]. Similarly mean drop in DBP of both the groups were compared with each other and found to be significant statistically [P=0.001]. Hydrochlorothiazide-Amiloride had significantly better antihypertensive effect than Amlodipine in patients of mild essential hypertension at the end of five months therapy

effects of exposure to crude oil on the health of workers involved in clean up operation

An oil tanker carrying crude oil was grounded near Karachi coastline. This observational non-interventional study was carried out to study the effect on health of workers who were involved in the clean-up operation. First fifty consecutive naval personnel who came in close contact with the spilled crude oil in the sea were evaluated. Their symptoms, physical signs and lung function tests were recorded before and then on daily basis for 2 weeks. All the 50 subjects had developed symptoms. The most frequent symptom was redness of eyes [60%] followed by headache [52%], nausea [50%], throat irritation [48%], dry cough [10%], tightness in the chest [8%], blurring of vision [8%] and other minor symptoms [18%]. None of the subjects was asked to stop the work because of the severity of toxic symptoms. Reversible obstructive airway disease was seen in only 4 subjects, all of them had dry cough before exposure. The data suggests that exposure to volatile products of crude oil leads to development of neurological, respiratory and eye symptoms. Mild reversible obstructive airway disease may only manifest in few individuals who already had respiratory symptoms before exposure