Psychiatric Co-morbidity in Patients With Irritable Bowel Syndrome at a Tertiary Care Center in Northern India

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a chronic psycho-physiological disorder. It is considered to be the most common functional gastrointestinal disorder, and about 50–90% of IBS patients have associated psychiatric co-morbidity. We aimed to study psychiatric co-morbidities in patients with IBS visiting a tertiary care center. METHODS: This was a cross-sectional case-control study conducted over a duration of one and a half years from January 2014 to July 2015. Patients were selected from the out-patient department of gastroenterology. About 160 patients with IBS who fulfilled the inclusion criteria and who gave written informed consent were selected as study cases. The healthy attendants of cases were selected as controls. A total of 200 controls were selected. Rome-III criteria were used to diagnose IBS. For diagnosing psychiatric disorders, we used the Mini International Neuropsychiatric Interview Schedule Plus. RESULTS: Mean age of our cases and controls was 39.7 ± 11.4 and 37.7 ± 9.6 years, respectively. Females outnumbered males in our cases as well as their controls by a ratio of 2:1 approximately. Psychiatric disorders were seen in 84.4% of IBS patients as compared to 41.5% in controls. Major psychiatric disorders seen in our patients were generalized anxiety disorders (30.0%) and depression (28.0%). CONCLUSIONS: The majority of patients with IBS who present to a tertiary care center have co-morbid psychiatric disorders. We need to screen these patients for such co-morbidities and develop a holistic approach for better outcome in such cases.

Ethanolic extract of Nigella sativa protects Fe[II] induced lipid peroxidation in rat's brain, kidney and liver homogenates

The study describes the effect of ethanolic extract of Nigella sativa against Fe[II] induced lipid peroxidation. Basal and Fe[II] induced thiobarbituric acid reactive species [TBARS] production was significantly inhibited by the ethanolic extract of Nigella sativa at 25-200micro g/ml. Our data revealed that the extract has high DPPH radical scavenging activity at highest tested concentrations. The extract significantly chelated Fe[II] and scavenged hydroxyl [OH[black circle]] radical at 25-200micro g/ml concentration. The nutritional analysis was performed and carbohydrate, fats, fiber, protein, moisture and ash content were measured in the studied extract. The phytochemical analysis confirmed the presence of alkaloid, carbohydrate and sugar, glycosides, phenolic compounds, flavonoids, protein and amino acid, phytosterols, tannins, gum and mucilage. The extract also showed significant antimicrobial activities against 10 bacterial strains i.e. Salmonella typhi, Bacillus subtilis, Bacillus cereus, Klebsiella pneumonia, Escheria coli, Xanthomonas, Salmonella heidelberg, Staphylococcus aureus, Clostridium and Escheria coli [human] and 5 fungal strains i.e. Aspergillus niger, Entomola, Aspergillus flavus, Alternaria alternata and Penicillium. This study confirms the potential antioxidant and antimicrobial activities of ethanolic extract of Nigella sativa which can be considered not only as a diet supplement but can be used against a variety of free radical induced damage diseases

prospective observational study assessing the outcome of Sepsis in intensive care unit of a tertiary care hospital, Peshawar

Objective: The current study aims to explore the factors associated with outcome among patients with severe sepsis and septic shock admitted to the intensive care unit, Northwest General Hospital and Research Centre, Peshawar, Pakistan

Methods: A prospective observational study was carried out at intensive care unit of our hospital from February 2014 to October 2015. Data was collected using a structured format and statistical analysis was done using SPSS version 20®. Regression model was applied to identify the factors contributing to the outcome of severe sepsis and septic shock. P-value less than 0.05 was considered statistically significant

Results: Majority of the patients meeting the criteria of this study were male 147 [54.9%] with a mean age of 54.8. The most common source of sepsis was lung infections [42.2%] followed by urinary tract infections [18.7%], soft tissue infections [6.3%] abdominal infections [6%] and in 6.3% patients the source remained unknown. Further analysis has revealed that increase in number of days of hospitalization was observed to be slightly associated with the outcome of the treatment [1.086 [1.002 - 1.178], 0.046]. Moreover, the risk of mortality was the higher among the patients with septic shock 22.161[10.055 - 48.840], and having respiratory, kidney and central nervous system complications. Overall it is seen that septic shock alone was found responsible to cause death among 32.0% of the patients [Model 1: R2 0.32, p=0.000], and upon involvement of the organ complications the risk of mortality was observed to 42.0%

Conclusion: Chances of recovery were poor among the patients with septic shock. Moreover, those patients having respiratory and urinary tract infection are least likely to survive

Effect of methanolic extract of Asparagus racemosus willd. on lipopolysaccharide induced-oxidative stress in rats

Lipopolysaccharide [LPS] induced oxidative stress and impairment of normal physiological function generally categorized by increased anxiety and reduced mobility. Therefore, the present study was to find out the effect Methanolic extract of Asparagus racemosus [MEAR] in lipopolysaccharide [LPS]-induced oxidative stress in rats. LPS-induced oxidative stress in rats was measured by locomotor activity by photoactometer test, anxiety with elevated plus maze test and also studied the oxidative stress markers, nitric oxide and cytokines. The obtained data shows that LPS markedly exhausted [p<0.001] brain-reduced glutathione [GSH], superoxide dismutase [SOD] and catalase [CAT] significantly increased [p<0.001] the level of malondialdehyde [MDA], nitric oxide and the activity of cytokines in the brain. MEAR supplementation resulted in normalization of brain GSH and CAT and SOD and decreases in the levels of MDA with reduction of nitric oxide and cytokines in the brain. The action of the extract at dose of 200 mg/kg was almost similar to the standard drug, quercetin [100mg/kg, p.o.]. These present study conclude that MEAR administration significantly [P<0.05] reduced LPS- induced oxidative-stress and intensely suggest that Asparagus racemosus Willd. is a functionally newer type of cerebroprotective agent

Assessment of antiphospholipid antibodies in women with recurrent miscarriage at GMMMC, Sukkur

Objective: To determine and analysis of Antiphospholipid Antibodies in women with RecurrentMiscarriage belongs to District Sukkur

Study Design:Cross-sectionals study

Place and Duration of Study: This study was conducted in the Ghulam Muhammad Mahar Medical College, Sukkur and women attending local health clinics enrolled in this study after taking their informed consent fromMay, 2012 to August2013

Materials and Methods: In this study 205 patients were taken. Patient's whole blood was collected by disposable syringes through vein puncture technique from cubital vein and maximum of 10 ml blood was taken. An aliquot of this blood [4 ml] was transferred in the EDTA containing tube. Immediately after collection plasma was separated and stored at -40 °C for the measurement of plasma Anti phospholipid and anticardiolipin antibodies level. 5 ml blood was drawn in plain tube and allowed to clot, and then serum was separated and used for blood cholesterol, HDL, LDL and Plasma lipid concentration

Results: In the current research of district Sukkur showed the highest frequency in age group of 26 to 35 years [Table 140]. In physical parameters, BMI, calories intake and maternal history of RM of patients and control subjects showed significant [p<0.05] difference. In present study the assessment of antiphospholipids antibodies [aPL] 1.95 % which were significantly different [p<0.05] than controls. Results of anticardiolipin antibodies [aCL] showed 2.43 % prevalence in patients with recurrentmiscarriage

Conclusion: The present study indicated that antiphospholipid antibodies and anticardiolipin antibodies were found an indipanded risk for recurrent miscarriage in population of Sukkur

Analysis of syphilis and associated risk factors in pregnant women belongs to remote areas of sukkur

To determine and analysis of Syphilis and Associated Risk Factors in Pregnant Women Belongs to Remote Areas of Sukkur. Cross sectional study. This study was conducted on women belongs to peripheral areas of sukkur over a period of fifteen months, which beginning in May, 2012. Patient's 5ml whole blood was collected through venepuncture technique. Data were collected by all women answered a questionnaire and by investigating Blood Sample VDRL test and FTA-ABS test. The study was conducted in a confidential manner and numbers were used to identify the participant. Total 200 Pregnant women were included in the present study. Mean age of women was 25.4 years while range was 18 to 39 years. Out of the 200 samples, 6 [3.0%] were positive for active syphilis. Majority was belonging to low socioeconomic group of population. Active syphilis infection in pregnant women belongs to remote areas with low socioeconomic level were significantly disquieting. Alarming results of this study suggestive that seropositive status is often discovered in routine serological studies during pregnancy at health centers and efficient prolonged treatment of mother were available

Study to estimate the prevalence of malaria infection in Sukkur

The aim of the study to estimate the prevalence of malaria amongst the population with fever or history of fever at sukkur. Cross sectional study. This study conducted at laboratory Ghulam Mohammad Mahar Medical College Hospital Sukkur from January 2011 to December 2012. Total 1746 clinical suspected case of malaria were included in the study. Patients presenting with fever were screened, thick and thin blood films prepared on microscopic glass slide, stained with 5% Giemsa's stain. There were 344 cases below 11 years, 590 cases between 11 to 20 years.812 cases above 20 years. They were 960 males and 786 females, with male to female ratio 1.2:1 .The prevalence of plasmodium slide positivity was 7.9% [138/1746]. Among plasmodium slide positive, 60.5% [83/138] were positive for P.vivax and 39.5% [55/138] were positive for P. falciparum. Identification of malaria cases in early acute phase of disease is significant for proper curative treatment. Anti mosquito eradication measures should be taken for breeding places of vector with personal protection measures and awareness program for malaria should be initiated

Development of HPLC method by UV-VIS detection for the quantification of phenolic acids in different Ocimum sanctum Linn. Extracts

A simple and rapid chromatographic method has been developed for the simultaneous determination of five phenolic acids including Gallic acid, Chloroganic acid, Syringic acid, Benzoic acid and Vanillic acid by HPLC with UV-VIS detector

These Phenolic acids were separated by analytical column Intersil ODS-3 CIS, a gradient elution system of ACN and acidified water solution with Iml/min flow rate and quantified in a total run of 30 minutes at 2lOnm wavelength. In the quantitative analysis of these compounds showed good regression [0.995-0.999]

The limit of detection [LOD] and limit of quantification [LOQ] of these compounds were in the range of 0.15-0.46 and 0.42-2.47 Hg/ml. The average recoveries were between 95.8-103.1% and their RSD values were less than 3.34%. By the proposed method Gallic acid, Chloroganic acid and Syringic acid were found and quantified in Methanolic, Ethanolic and Acetonic extract of Ocimum sanctum Linn, leaves. While the two other phenolic acids benzoic acid and vanillic acid was not found in the extracts of Ocimum sanctum Linn, leaves

Prevalence and associated risk factors for syphilis in women with recurrent miscarriages

A Cross Sectional population based serological studies was conducted to determine the prevalence and associated risk factors for syphilis women with recurrent miscarriages. Patient's 5ml whole blood was collected through venepuncture technique. Data were collected by all women answered a questionnaire and by investigating blood sample VDRL test and FTA-ABS test. The study was conducted in a confidential manner and numbers were used to identify the participant. Total 256 women were included in the present study. Mean age of women was 29.4 years while range was 21 to 38 years [206/256]. Out of the 256 samples, 05 [1.9%] were positive for active syphilis. Majority belonged to low socioeconomic group, uneducated and had previous congenital anomaly. Active infection with Treponema pallidum [T.P] in women belonging to low socioeconomic level were disquieting. This is probably due to illiteracy and high proportion of unsafe sexual behavior. It is also suggestive that seropositive status is often discovered in routine serological studies during pregnancy

Isolation of E-coli in UTI cases with malnutrition in children of distant rural area of Sukkur, Sindh

A cross-sectional study of isolation of Escherichia coli in urine culture of children and its correlation to childhood malnutrition induce microcytic hypochromic anaemia [I.D.A]. Cross Sectional Study. This study was carried out at the Biochemistry Department, GMMMC, Sukkur from 01.12.2011 to 31.05.2013. Study was carry out among the children under 05 [five] years of age. Number of children included in this study was 150. Structured questionnaire were use to obtain the required data. Laboratory investigation of blood, urine samples was performing by standard methods and anthropometric data also collected. The results showed that Escherichia coli positive children are 64.0%, 60.5% Childs has extremely low body weight, 43.6% shows stunting and 21.7% was wasting. This study showed that there is correlation between Urinary tract infection and malnutrition. So, energy yielding nutrients containing 8 - 10 essential amino acids, fates and minerals may be supplemented to less privileged patients of remote rural area of sukkur to enhance immune status

Screening for dengue virus infection at GMMMC hospital, Sukkur

Dengue is a severe arthropod borne viral disease characterized by fever, headache, retro - orbital pain, maculopapular rash, and thrombocytopenia. Disease is transmitted from one human to another by bite of infected Aedes aegypti mosquito. Disease now a days occurs in more than 100 countries worldwide. Study designed for screening suspected or probable cases to detect specific antibodies response in early stage of disease. Cross sectional study. This study was conducted at Ghulam Muhammad Mahar Medical College Hospital, Sukkur from October, 2010 to October, 2012. Patients presenting with fever, bleeding tendencies, maculopapular rash or fever with thrombocytopenia were screened as per WHO criteria for suspected dengue infection. Blood was collected after 4 - 5 days of onset of illness. The serologic test was performed by using rapid immunochromatographic assay detection of anti dengue immunoglobulin M [IgM] antibodies. 162 cases were screened for dengue infection. 16 [9.9%] patients were positive with anti-dengue IgM. 12 patients were male and 04 were female. Platelets count was observed below 100 x 10[3] cmm[3] in patients with dengue infection. Identification of dengue virus infection in early acute phase of disease is significant for morbidity and mortality screening of suspected cases and anti-mosquito eradication measures should be taken for breading sites of vector, mass education, and awareness programs may be initiated

Helicobacter pylori infection in patients with calcular cholecystitis: a hospital based study

Helicobacter pylori, a gram negative bacillus has been recognised as a public health problem and approximately half of the world population has H. pylori infection causes chronic gastritis, peptic ulcer disease and gastric malignancies. Objective of this study was to determine the frequency of H. pylori infection in patients of chronic calcular cholecystitis. This cross-sectional descriptive study was conducted at Liaquat University Hospital, Hyderabad, Pakistan from April 2010 to September 2010. All patients with history of gallstone presented with acute abdominal pain, dyspepsia, bloating and epigastric discomfort and diagnosed as calcular cholecystitis were further evaluated for the detection of H. pylori by serology and histopathology. Frequency and percentage of H. pylori infection in patients with calcular cholecystitis was calculated. Total 100 patients of cholelithiasis underwent laparoscopic cholecystectomy were recruited. The pain in upper right part of the abdomen was observed in all 100 patients, fever in 75%, nausea and vomiting in 68%, loss of appetite in 45%, feeling of tiredness or weakness in 22%, headache in 38%, chills in 52%, backache in 58%, pain under the right shoulder in 45%, heartburn in 67%, belching in 54%, indigestion in 80%, dyspepsia in 90%, bloating in 88%, and epigastric discomfort in 85% patients. Eighty-two percent patients had family history of gallstones. The mean age of overall study population was 48.72 +/- 8.78 years and mean age of H. pylori infected calcular cholecystitis patients was 47.98 +/- 5.43 years in male and 48.76 +/- 6.68 years in females. The H. pylori infection was identified in 55% patients with calcular cholecystitis, of which 32.7% were males and 67.3% were females [p=0.03, statistically significant]. Majority of females [60%] had >/= 40 U/ml antibody titre [p=0.917, non-significant]. A possible relationship was identified between Helicobacter pylori and calcular cholecystitis

Reduction of aflatoxin B[1] contamination in Pakistani wheat varieties by physical methods

In the study of effect of physical treatments, such as washing and heating, on the AFB[1] contaminated wheat varieties, it was observed that the reduction of AFB[1] was directly proportional to washing time in all the varieties. The concentration of AFB[1] was reduced more by heating than washing. The level of AFB[1] in dried wheat decreased to more than 50% and 90% by heating in oven at 150 and 200 [degree sign] C, respectively. However, the reduction of AFB[1] in wet wheat in which water [10%] was intentionally added was higher on heating at 100 [degree sign] C for 30 min than that in the dried wheat

Microbial assessment of un-bottled synthetic juices sold in Peshawar

Un-bottled synthetic juices are sold by street venders and hawkers raising the concern about their safety. To examine the quality of un-bottled synthetic beverages from different locations of Peshawar city using standard techniques. A total of 56 samples of un-bottled synthetic juices were collected from 8 different locations of Peshawar city and analyzed for Total Plate Count, Total Coliform Bacteria, Total Fecal Coliform bacteria, E. coli, Yeast and Mould. In all localities, the street vended un-bottled synthetic juices were found hygienically of poor quality as all had high total plate count which ranged from 2 x 102 to 5 x 107 and total coliform bacteria ranged from < 0.3 to >110 MPN/ml. Total Fecal Coliform ranged from < 0.3 to 110 MPN/ml. The presence of E. coli contamination was found in [25] 44% samples, while all the analyzed samples were contaminated with yeasts and moulds. All un-bottled synthetic juices sold on roadside were highly contaminated with disease causing microorganisms. Periodic monitoring of street beverages should be carried out to make them safe for consumption

Synchronous and Metachronous Malignant tumours expect the un-expected

To evaluate occurrence of synchronous and metachronous malignant tumours, to find tumour types, age group, and relationship to treatment received. Previously diagnosed 1 st primary tumour cases experiencing a synchronous or metachronous tumour, seen at AOI from February 2003 to August 2009 [78 months] were included. The cases were analyzed for morphology/histology of 1st primary tumour, age and gender of patient, treatment received for first tumour, time interval between the 1st and 2nd primary tumour, morphology/histology of second tumour, and the treatment conferred for 2nd tumour. The 2nd synchronous and metachronous tumours were 46/4025 [1.14%], in 18 males and 28 females [M:F 1:1.6]. The age range was 16-75 years [median 43 years]. The follow up time was 24-150 months. The time to 2nd primary tumour was 2-132 months. The 1st primary tumours were breast, ovary, GIT and urinary bladder. The patients received surgery, radiotherapy, chemotherapy, and hormonal therapy alone or as multi-modality treatment for the 1st tumours. The frequent 2nd tumours were breast, ovary and Gastro Intestinal tumours. It is imperative that patients with a primary malignant tumour should be thoroughly, closely, and regularly followed. Genetic counseling, risk estimation, cancer screening and chemoprevention must be emphasized. Every subsequent occurring tumour should be biopsied. The effect of 1st tumour on the 2nd or vice versa are still not fully understood and need exploration. The 2nd primary tumour is usually more aggressive, treatment resistant, and metastasizes early requiring a more aggressive treatment strategy

Peripheral arteriovenous malformations

Arteriovenous malformation [AVM] is an anomaly characterized by abnormal vascular communications between arteries and veins in the different organs of the body. It may be congenital or acquired. Microsurgical resection, endovascular embolization and radiosurgery [irradiation] are the three effective modes of treatment currently available. However, no objective criteria have been established for which mode[s] of treatment should be selected for individual patients with AVMs

spectrum of disease in lower gastrointestinal tract: endoscopic biopsy findings

To evaluate the morphological spectrum of colonic disease and its clinical presentation in our patients from hospitals in and around Rawalpindi / Islamabad. Design: A retrospective data based study. Place and Duration of Study: Pathology Department of Army Medical College, Rawalpindi. Material and The colonic mucosal biopsies of 1268 patients received during the period of 1980-1995 were studied by routine histopathology methods. A higher frequency of colonic disease in males with a male to female ratio of 2.6:1 and an age range of 1.25 months to 80 years was observed. The clinical presentations mostly seen were bleeding per rectum [32.71%], mass abdomen [23.86%], diarrheal episodes [18.62%], constipation [13.38%] and bloody diarrhea [3.02%]. The major radiological diagnosis available in 71 cases was ulcerative colitis [32.39%], colonic growth [21.12%] and polyps [11.26%]. On endoscopy the most frequently suspected lesions were polyps [34.70%], colonic growth [29.16%], ulcerative colitis [11.66%] and nonspecific findings [9.23%], while 11.23% cases showed unremarkable mucosa. The histopathology revealed mostly nonspecific colitis [25.23%], followed by polyps [24.13%], colonic cancer [17.11%], ulcerative colitis [11.19%] and colonic aganglionosis [6.54%]. A small number of cases of amoebic, eosinophilic and collagenous colitis and Crohn's disease was also seen. A number of biopsies [6.30%] were unremarkable histologically. Anorectosigmoid was the most commonly involved site than rest of the colon with a ratio of 2.43:1 and therefore most lesions were within the reach of rectosigmoidoscope

Radiological evaluation of obstructive jaundice

A study involving 125 patients of obstructive jaundice was conducted in Combined Military Hospital and Military Hospital Rawalpindi. The study group predominantly consisted of female patients between 40 and 60 years. Ultrasonography and endoscopic retrograde cholangiopancreatography [ERCP] were the commonest radiological investigations used. Ultrasonography [USG] was performed in 100% patients. It successfully differentiated obstructive from non-obstructive jaundice. ERCP was perfomed in 100 patients [80%]- It was helpful in permitting direct, non-surgical imaging of pancreatic and bilary ducts. It proved to be useful diagnostic tool as it provided gastroduodenoscopy, cholangiography and pancreatography with a single examination. Percutaneous transhepatic cholangiography [PTC] was helpful in assessing the presence, site and cause of obstruction