Frequency of primary hyperaldosteronism in young hypertensives in a tertiary care setting of Rawalpindi

Objective: To determine the frequency of primary hyperaldosteronism in young hypertensives in hospital settings of Rawalpindi

Study Design: Cross-sectional study

Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from June 2016 to May 2017

Methodology: Two hundred and fifty patients with hypertension [blood pressure of more than 140/90 mm Hg] of both genders, with age between 17-40 years were recruited in the study. Patients on anti-hypertensive medications, renal function derangement, pregnant females and those labelled with secondary hypertension were excluded. Blood samples were taken for the analyses of plasma renin, aldosterone, electrolytes, and blood gases. Parametric quantitative variables were presented as mean + SD

Results: Eight cases, out of a total 80 subjects fulfilling the inclusion criteria, were diagnosed with primary hyperaldosteronism and 72 with essential hypertension. Mean age of patients having primary hyperaldosteronism was 29.25 +7.1 years. The mean diastolic blood pressure of all patients was 90.3 +6.5 mm of Hg, while mean systolic blood pressure was 142.7 +10.5 mm of Hg

Conclusion: Frequency of primary hyperaldosteronism was found to be 10%, emphasising on the fact that it is not very uncommon in young hypertensives

determination of medians of biochemical maternal serum markers in healthy women giving birth to normal babies

Objective: To determine median values of biochemical maternal serum markers during second trimester maternal screening to rule out chromosomal anomaly, Down syndrome. Study Design: Cross sectional study. Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology [AFIP], from Nov 2016 to May 2017

Patients and Methods: Non-probability consecutive sampling technique was used. All healthy pregnant women with single pregnancy were included. As non-parametric statistics was used, the sample size was collected to be 155. Blood sample for serum human chorionic gonadotropin [HCG] was analyzed on random access immulite 2000, alpha-fetoprotein [AFP] was analyzed on ADVIA Centaur, unconjugated estriol [uE3] and Inhibin A measured by Enzyme-Linked Immunosorbent Assay [ELISA] method by PR 4100 Micro plate Reader

Results: Total 155 women were enrolled in this study. Mean maternal age was 33.46 +/- 2.35 years and mean maternal body weight was 54.98 +/- 2.88 kg. Median value of quadruple markers, calculated from 15-18[th] week of gestation, was used for calculation of multiple of median [MoM] for screening of trisomy 21 in this gestational age. Median values at 15 week of gestation: hCG 36650 mIU/ml, AFP 23.3 IU/ml, uE3 3.5 nmol/l, Inh A 198 ng/l, at 16 week of gestation: hCG 29050 mIU/ml, AFP 35.4 IU/ml, uE3 4.1 nmol/l, Inhibin-A 179 ng/l; at 17 week of gestation: hCG 28450 mIU/ml, AFP 36.0 IU/ml, uE3 6.7 nmol/l, Inhibin-A 175 ng/l and at 18 week of gestation: HCG 25200 mIU/ml, AFP 38.2 IU/ml, uE3 8.2 nmol/l, Inhibin-A 190 ng/l

Conclusion: In this study we were able to get median values of quadruple markers for regional population, which will be used in future to calculate MoM for the screening purpose of Down syndrome. It will help to rule out Down syndrome by non-invasive test and at early stage of pregnancy

Association of metabolic syndrome with atypical antipsychotic drug [olanzapine] short term versus long term use

Objective: To determine the association of metabolic syndrome with atypical antipsychotic drug [olanzapine] short term versus long term use

Study Design: Case control study

Place and Duration of Study: Chemical pathology department Army Medical College Rawalpindi, from Nov 2014 to Oct 2015

Material and Methods: The study was carried out on 240 subjects, 120 cases and 120 controls. For the purpose of the study cases were divided into four groups A, B, C and D according to the duration of drug use. Group A patients included those who the last the drug olanzapine for the last three months. Group B patients included those who were using the drug olanzapine for the last six months. Group C and D included those who were using the drug for last 1 year and more than one year [2-5 years] respectively. By employing non probability convenience sampling technique the data was collected from patients having the diagnosis of psychosis as per DSM IV modified criteria through a proforma and fasting blood samples were drawn. These samples were tested for fasting serum lipid profile and fasting plasma glucose. The data obtained were analyzed using SPSS version 21. For quantitative data Mean and SD were calculated. For qualitative data frequency and percentages were calculated. Qualitative data was compared using chi square test whereas quantitative data was compared using independent sample t-test

Results: There was statistically no significant difference in fasting plasma glucose between group A and B and their controls whereas in group C and D these levels were significantly high as compared to controls. Triglyceride levels were significantly higher and HDL cholesterol levels were significantly lower in all four groups as compared to controls. Comparison of qualitative data which included waist circumference and blood pressure showed statistically no significant rise for group A whereas waist circumference showed insignificant rise and blood pressure showed statistically significant rise for group B. On the other hand both waist circumference and blood pressure were significantly higher for group C and D as compared to controls. Overall study revealed a graded increase in components of metabolic syndrome with duration of olanzapine use. Out of thirty patients in each group two patients in group A, 5 in group B, 7 in group C and 10 patients in group D developed metabolic syndrome as per NCEP ATP III modified criteria

Conclusion: Development of metabolic syndrome is strongly associated with long term use of atypical antipsychotic drug olanzapine

Frequency and antibiogram of isolates from surgical units of a tertiary care hospital in Quetta

Objective: To determine the frequency and antibiogram of the isolates from infected patients in surgical units of a tertiary care hospital

Study Design: Cross-sectional, descriptive study

Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Quetta, from March to October 2015

Methodology: Clinical samples from the surgical units received in Department of Microbiology for culture and sensitivity were analyzed by Gram stain, culture and biochemical tests for identification of the isolates; and the antibiotic susceptibility was determined by modified Kirby Bauer disc diffusion method. Data was analyzed by Statistical Package for Social Sciences [SPSS] version 19

Results: The commonest isolate was Acinetobacter baumannii [22%] followed by Escherichia coli [20%], Pseudomonas spp. [15%] and Methicillin-resistant Staphylococcus aureus [MRSA] [11%]. Acinetobacter baumannii showed highest susceptibility to doxycycline [41%], Enterobacteriaceae to meropenem [96%], Pseudomonas spp. to polymyxin-B [100%] and Gram positive bacteria to linezolid [100%]. Seventy-two percent of the isolates were found to be multi-drug resistant

Conclusion: There was a high infection rate in surgical patients with Acinetobacter baumannii, Eschericia coli, Pseudomonas spp. and MRSA being the commonest isolates. Acinetobacter baumannii showed highest susceptibility to doxycycline, Enetrobacteriaceae to meropenem, Pseudomonas spp. to polymyxin-B and Gram positive bacteria to linezolid

simple and rapid approach to evaluate the in vitro in vivo role of release controlling agent ethyl cellulose ether derivative polymer

Diclofenac sodium [DCL-Na] conventional oral tablets exhibit serious side effects when given for a longer period leading to noncompliance. Controlled release matrix tablets of diclofenac sodium were formulated using simple blending [F-1], solvent evaporation [F-2] and co-precipitation techniques [F-3]. Ethocel[R] Standard 7 FP Premium Polymer [15%] was used as a release controlling agent. Drug release study was conducted in 7.4 pH phosphate buffer solutions as dissolution medium in vitro. Pharmacokinetic parameters were evaluated using albino rabbits. Solvent evaporation technique was found to be the best release controlling technique thereby prolonging the release rate up to 24 hours. Accelerated stability studies of the optimized test formulation [F-2] did not show any significant change [p<0.05] in the physicochemical characteristics and release rate when stored for six months. A simple and rapid method was developed for DCL-Na active moiety using HPLC-UV at 276nm. The optimized test tablets [F-2] significantly [p<0.05] exhibited peaks plasma concentration [C[max]=237.66 +/- 1.98] and extended the peak time [t[max]=4.63 +/- 0.24]. Good in-vitro in vivo correlation was found [R[2] =0.9883] against drug absorption and drug release. The study showed that once-daily controlled release matrix tablets of DCL-Na were successfully developed using Ethocel[R] Standard 7 FP Premium

Formulation and in vitro evaluation of clotrimazole gel containing almond oil and tween 80 as penetration enhancer for topical application

Achieving a desirable percutaneous absorption of drug molecule is a major concern in formulating dermal and transdermal products. The use of penetration enhancers could provide a successful mean for this purpose. The aim of this study was to develop Clotrimazole gel and to evaluate the effect of almond oil and tween 80 [in different concentrations], on the permeation of drug through rabbit skin in vitro. In order to investigate the effect of penetration enhancers used in this study on the permeation of Clotrimazole through sections of excised rabbit skin, Franz diffusion cell was employed. Sample solution was withdrawn at specific time interval up to 24 h. Significant difference in permeation among the eight formulations was seen in the study. The permeation profile of various formulations also showed that the added enhancers in individual batches affected the permeation of the drug. Drug permeation increased with increased concentration of Tween 80 and decreased concentration of almond oil. Furthermore, almond oil combined with tween 80 showed synergistic effect. The clotrimazole gels were successfully formulated and could be beneficial for topical use

Effect of hypothyroidism on lipid profile in asymptomatic newly diagnosed patients

Hypothyroidism is a very common endocrine problem. It can be either overt or subclinical. Subclinical hypothyroidism predisposes to overt hypothyroidism. Hypothyroidism leads to hypercholesterolaemia because of reduced activity of lipoprotein lipase and thus increases the cardiovascular risk. The objective of this study was carried out to find the lipid profile in hypothyroid patients in asymptomatic previously undiagnosed cases and to correlate different components of lipid profile with TSH and ft[4]. This is a case control study consisting of 82 hypothyroid patients with age and gender matched controls selected through convenient sampling from Chemical Pathology Department, Army Medical College, Rawalpindi and National University of Sciences and Technology [NUST], Islamabad between May and October 2012. Data were recorded using specially designed pro forma and analysis was carried out on SPSS 17. Among the 82 hypothyroid patients, 62 were females while 20 were males. Mean age of patients was 40.6 +/- 11.7 years. Hypothyroid patients showed a dyslipidaemic picture and all the components namely total cholesterol, triglycerides, low density lipoprotein and high density lipoprotein were significantly raised when compared with the controls. TSH showed significant positive correlation [p value] with total cholesterol, low density lipoprotein and high density lipoprotein. Hypothyroid patients show a dyslipidaemic picture, thus increasing the risk for cardiovascular complications. A hypothyroid patient must be screened for lipid abnormalities, while in case of unexplained hyperlipidemia, thyroid screening must be performed

Various modes of fatalities and pattern of fatal injuries in the field

To determine various modes of fatalities and pattern of fatal injuries in the field. Descriptive study. The study was carried out at the Combined Military Hospital Bannu, the base hospital of Waziristan FATA from January 2005 to October 2009. All the soldiers brought in dead from operational area to CMH Bannu were included in the study. After entry of their personal data in admission and discharge book the detailed examination was carried out. Only percentages are presented for confidentiality purpose. However details may be provided by the author on requests routed through the authorities concerned. Gunshot wounds [33.51%], bomb blast [30.16%], mine blast [18.99%] and rocket blast [7.82%] were the common modes of fatality. Multiple injuries [two or more than two] were found on 63%, head injuries on 18%, chest injuries on 13% and abdominal injuries on 6% of all the fatal cases. Maximum numbers of fatal cases were received in the year 2005 [37.65%].Most common mode of fatal injuries was gunshot wound followed by bomb blast and mine blast. Multiple injuries were the most common fatal injuries followed by head and chest injuries. There is a need for preparedness at all levels to reduce the mortality.

Effect of olive oil on transdermal penetration of flurbiprofen from topical gel as enhancer

The present study was conducted to formulate and evaluate flurbiprofen transdermal gel. A standard calibration curve was constructed to obtain a regression line equation to be used for finding out the concentration of drug in samples. Olive oil was used as penetration enhancer and was added in different concentrations to some selected formulations to see its enhancement effect on in vitro drug release profiles. The prepared gels were evaluated for several physico-chemical parameters to justify their suitability for topical use. The in vitro drug release studies were carried out by using Franz cell diffusion apparatus across both synthetic membrane and excised albino rabbit skin. In order to investigate the drug release mechanism a kinetic approach was made by employing Korsmeyer kinetic model to the in vitro drug release profiles of flurbiprofen. The flurbiprofen topical gels were successfully prepared and could be beneficial for topical use

Comparison of closed and open methods of pneumoperitonium in laparoscopic cholecystectomy

Pneumoperitonium is the first step in laparoscopic surgery including cholecystectomy. Two commonly used methods to create pneumoperitonium are closed and open technique. Both have advantages and disadvantages. The current study was designed to compare these two techniques in terms of safety and time required to complete the procedure. This was a randomized controlled prospective study conducted at Department of Surgery, Ayub Hospital Complex Abbottabad, from 1[st] June 2007 to 31[st] May 2008. Randomization was done into two groups randomly using sealed envelopes containing the questionnaire. Seventy envelopes were kept in the cupboard, containing 35 proformas for group A and 35 for group B. An envelope was randomly fetched and opened upon selection of the patient after taking the informed consent. Pneumoperitonium was created by closed technique in group A, and by open technique in group B. Time required for successful pneumoperitonium was calculated in each group. Failure to induce pneumoperitonium was determined for each technique. Time required to close the wounds at completion, total operating time and injuries sustained during induction of pneumoperitonium were compared in both techniques. Out of the total 70 patients included in study, 35 were in group A and 35 in group B. Mean time required for successful pneumo'peritonium was 9.17 minutes in group A and 8.11 minutes in group B. Total operating time ranged from 55 minutes to 130 minutes in group A and from 45 minutes to 110 minutes in group B. Mean of total operating time was 78.34 and 67 minutes in group A and B respectively. Mean time needed to close the wound was 9.88 minutes in group A and 4.97 minutes in group B. Failure of technique was noted in three patients in group A while no failure was experienced in group B. In two cases in group A minor complications during creation of pneumoperitonium were observed while in group B no complication occurred. No patient died in the study. We concluded from this study that open technique of pneumoperitonium was, less time consuming and safer than the closed technique

Carcinoma of prostate in clinically benign enlarged gland

Carcinoma of the prostate is one of the common tumours of old age in men. This cross sectional study was conducted to detect carcinoma of prostate in clinically benign enlarged gland and to evaluate the efficacy of Digital rectal Examination in detection of prostatic cancer in patients presented at Khyber Teaching Hospital, Peshawar from July 1998 to July 1999. Patients presenting with lower urinary tract symptoms over the age of 50 years were evaluated on English version of International Prostate Symptoms Score [IPSS], clinically examined and post-voiding residual urine determined on abdominal sonography. The selection criteria were; Severe IPSS, absence of signs of malignancy on Digital Rectal Examination [DRE] and post-voiding residual urine more than 100 ml. Thus a total 100 patients were selected for further study. Four ml blood was taken to assess Prostate Specific Antigen [PSA] level pre-operatively. All these patients underwent either transvesical prostatectomy or transurethral resection of prostate [TURP] and enucleated prostatic tissues were sent to histopathology. Eighty-five percent patients had PSA level up to 10 [eta]g/ml. PSA level of 15 [15%] patients were above 10n gm/ml out of which 13 [13%] patients were having PSA in range of 11-12 [eta]g/ml and two [2%] had PSA level between 20-25 [eta]g/ml. Histopathology report of 2% patients turned out as adenocarcinoma of the prostate. Out of 100 patients who were having clinically benign DRE findings, 2 turned out as Carcinoma of the prostate histologically

Seroprevalence of hepatitis B and C in young adults seeking recruitment in Armed Forces

Hepatitis B virus [HBV] and hepatitis C virus [HCV] are the commonest causes of chronic liver disease all over the world including Pakistan. According to the Pakistan Armed Forces policy, all the military recruits are now screened for the Hepatitis B surface antigen [HBsAg] and antibodies to Hepatitis C virus [Anti-HCV] before induction. Previous studies have shown a wide variation in the results regarding the prevalence of HBV and HCV infections. We analysed sera of 15550 young adults seeking recruitment in Armed forces for the presence of HBsAg and Anti-HCV. Sera of healthy adult individuals who presented for medical evaluation as prerecruitment criteria in the Punjab Regiment Centre, Mardan, were tested for presence of hepatitis B surface antigen [HBsAg] and anti-hepatitis C virus [Anti-HCV] by rapid method. Positive cases were confirmed by ELISA technique from Armed Forces Institute of Pathology [AFIP] Rawalpindi. A total of 15550 individuals were examined. Out of these, 504 [3.24%] individuals had positive HBsAg whereas 574 [3.69%] were positive for anti-HCV. Hepatitis B surface antigen and anti-HCV both were found in 49 [0.31%] individuals. This study which evaluated predominantly healthy young male population, showed a high seroprevalence of anti-HCV than Hepatitis B surface antigen. Although there is downward trend in prevalence of hepatitis B, there is considerable threat of HBV and HCV to our younger population and there is a genuine need for strict adherence to preventive measures

Coronary heart disease risk factors in male-type androgenetic alopecia

Hyperandrogenaemia and androgenetic alopecia has some association with increased risk of coronary heart disease. Conflicting data has since been reported with regards to levels of biochemical markers of coronary heart disease risk factors in androgenetic alopecia. A case control study was planned to evaluate biochemical markers of coronary heart disease in hyperandrogenaemia of males and androgenetic alopecia. Patients of androgenetic alopecia [n=22] were men with fronto-occipital baldness, aged 20-30 years. Healthy controls [n=20] were age-matched males without alopecia. The individuals with clinical evidence of any systemic or localised scalp disease were excluded. Levels of fibrinogen, glucose, Insulin, uric acid, total cholesterol, LDL-cholesterol and HDL-cholesterol were measured. The levels of total cholesterol, LDL-cholesterol, insulin, glucose, and uric acid in patients of androgenetic alopecia when compared with normal controls were raised significantly. Fibrinogen levels were raised while HDL-Cholesterol was lower in patients than controls but the difference was not significant statistically. The results support the hypothesis that androgenetic alopecia in males is associated with increased risk of coronary heart disease