Evaluation of interleukin-33 & sST2 levels in type-2 diabetic mellitus patients with or without metabolic syndrome

Background & objectives: Diabetes mellitus (DM) is characterized by increase in blood glucose levels due to defective insulin secretion or insulin sensitivity. Interleukins (ILs) are known to play an important role in the pathogenesis of DM. The aim of this study was to investigate the serum concentration of IL-33 and its receptor soluble ST2 (sST2) in patients with diabetes and draw a correlation between their serum levels and different standard glycaemic indices of patients affected with type-2 diabetes with or without metabolic syndrome. Methods: Thirty type-2 diabetic individuals and 30 healthy controls were recruited for this study. Serum and plasma were separated by centrifugation of blood for quantitative measurement of IL-33, sST2 and other biochemical parameters. Results: It was observed that serum IL-33 levels were significantly less and sST2 levels were significantly high in type-2 diabetic individuals as compared to healthy controls. A significant correlation between the serum IL-33 concentration and fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) levels were also found. Additionally, data also elucidated that serum levels of high-density lipoprotein, low-density lipoprotein or triglyceride in type-2 diabetics did not influence the serum levels of IL-33 and sST2, thereby excluding these factors as the major drivers of changes in serum IL-33 and sST2 concentration. Interpretation & conclusions: This study demonstrated alteration in serum levels of IL-33 and sST2 in type-2 diabetic individuals. Further mechanistic studies, focusing on the progression of type-2 diabetes could elucidate the involvement of IL-33 in the cellular acquisition of insulin resistance as observed in type-2 diabetics

Irrational Use of Quinolones in Tertiary Care Hospital Karachi, Pakistan

Objective: The antimicrobial drugs especially Quinolones are the top most therapeutics class of drug prescribed in some country like Pakistan in primary and tertiary care hospitals and clinics. The objective of the study was to assess the irrational prescribing practice of quinolones in tertiary care setups of Karachi. Methodology: A prospective observational study was conducted for the period of 04 months from November 2019-February 2020, in Public and Private Sector Tertiary Care setups of Karachi. Data was collected from surgical, medical and emergency wards on the basis of World Health Organization prescribing pattern, to evaluate the prescriptions based on Culture sensitivity tests (CST), empirical, targeted, and/or prophylactic therapies. Results: Out of total 1000 patients 41.6% patients were from Public and 58.4% were from Private Sector Tertiary Care Hospital. 13.7% of the patients from Public and 24.8% from Private Sector Tertiary Hospitals were prescribed Quinolones after performing their Culture Sensitivity Test. However, 79.8% of the patients were prescribed Quinolones without Culture Sensitivity Test. 36.4% patients were prescribed with empirical therapy, 20.2% with De-Escalation therapy, while 43.4% were prescribed with prophylactic therapy of quinolones. Conclusion: Study concluded that some serious efforts are required to avoid the irrational prescribing practice and promote the rational prescribing practice of antibiotics particularly for Quinolones.

Effects of shade on guinea grass genotypes Megathyrsus maximus (Poales: Poaceae)

Introduction: Light stress is an important factor limiting the biomass yield while combining forage production with crops or forestry. Guinea grass is a widely adapted perennial fodder grass. The species exhibits high degree of variation for morphology, adaptation and biomass yield. Objective: Since there is a need in identifying shade adapted forage grasses for the expanding area under agroforestry/silvipastures, the present investigation took the task of understanding how the morphologically distinct genotypes of guinea grass respond under different shaded intensities. Methods: In the present study, forty-four genotypes related with the shade response were studied in varying shading conditions (pure sunlight, 25, 50 and 75 % shade) created artificially. Results: Based on green and dry matter yields ranking, the genotype IG 01-98 performed the best followed by genotypes IG 01-92, IG 97-5, IG 97-6 and IG 01-89 in decreasing order. Particularly, IG 01-93 was identified as the best performing under 50 % shading conditions. On the other hand, most of the top ranking genotypes performed well both under open and up to 50 % of shade. Morphologically, these genotypes were taller and possessed longer and broader leaves. Under shaded conditions (over 50 %), leaf length and width showed an increasing trend compared to open conditions. Also, chlorophyll content increased with shading intensity. Conclusions: Most of the genotypes collected from the southern Indian humid tropical environment with early flowering nature were tolerant to shade. Differential genotypic response was observed for biomass yield and yield attributes under shade. The study established appreciable variability for shade tolerance among genotypes.

Introducción: El estrés leve es un factor importante que limita el rendimiento de la biomasa al tiempo que combina laproducción forrajera con los cultivos o la silvicultura. El zacate guinea es una planta de forraje perenne ampliamente adaptada. La especie presenta un alto grado de variación en su morfología, adaptación y rendimiento de biomasa. Objetivo: Como existe la necesidad de la identificación de pastos forrajeros adaptados a la sombra para el área de expansión bajo agroforestería /silvicultura, la presente investigación se realizó para entender cómo los genotipos morfológicamente distintos al zacate guinea responden a diferentes intensidades de sombra. Métodos: Se estudiaron 44 genotipos y su respuesta a los niveles de sombra: luz solar pura y 25, 50 y 75 % de sombra (creados artificialmente). Resultados: Basado en la clasificación de rendimientos demateria verde y seca, el genotipo IG 01-98 fue el mejor, seguido de los genotipos IG 01-92, IG 97-5, IG 97-6 e IG 01-89 en orden decreciente. Por su parte, el IG 01-93 fue identificado como el de mayor rendimiento bajo el 50 % de condición de sombra. La mayoría de los genotipos de primer nivel tuvieron un buen desempeño, tanto bajo sombra abierta como al 50 %. Morfológicamente, estos genotipos fueron más altos y poseían hojas más largas y más anchas. En condiciones de sombra, de más del 50 %, la longitud y ancho de la hoja mostraron una tendencia creciente en comparación con la condición abierta. El contenido de clorofila aumentó con la intensidad de la sombra. Conclusiones: La mayoría de los genotipos recolectados al sur de la India en un ambiente tropical húmedo y tienen una floración temprana, fueron tolerantes a la sombra. Se observó una respuesta genotípica diferencial para los atributos de rendimiento y rendimiento de biomasa bajo sombra. El estudio mostró la existencia de una variabilidad apreciable para la tolerancia a la sombra entre los genotipos.

Safety and efficacy of palonosetron compared in prevention of postoperative nausea and vomiting in patients undergoing elective major surgery under general anaesthesia

Background: Post-operative nausea and vomiting continues to be a common side effect of surgery and anaesthesia, affecting the economics of medical care, as well as the degree of patients’ satisfaction, comfort and quality of life.The objective of the present study were to compare the efficacy and safety of palonosetron versus placebo for prophylaxis of early onset (within 24 hours post-surgery) and late onset (24-72 hours post-surgery) post-operative nausea or vomiting in patients undergoing elective major surgery under general anaesthesia.Methods: A prospective, randomized, parallel group, two arm, double blind placebo controlled trial was conducted on n=100 indoor patients undergoing elective major surgeries were enrolled into the present study.Results: The patients showing complete response were 32 (64%) in palonosetron group and 19 (38%) in the placebo group (p<0.05) in the 0-24 hour time interval. The patients receiving palonosetron showed higher complete response rates in the 0-24 hour and 0-72 hour time intervals. 42 patients (84%) on palonosetron and 30 (60%) on placebo showed complete control of vomiting in 0-24 hour period. Adverse events related to the drug were reported in 5 patients (10%) in palonosetron group as compared to 3 patients (6%) in placebo group.Conclusions: A single prophylactic 0.075 mg IV dose of palonosetron effectively reduced the occurrence and severity of nausea and vomiting and delayed the time to emesis and treatment failure in the early as well as the overall postoperative period of 72 hours.

Evaluation of Rosners index vs Brandt correction and Chang’s %, in the interpretation of mixing studies at varying dilutions

Background: For evaluation of unexplained prolongation of PT and PTT, mixing tests forms a great diagnostic tool. On mixing equal volume of patient plasma with normal pooled plasma, if there is correction it indicates factor deficiency and non-correction indicates inhibitors.Methods: Sysmex CS-5100 Coagulometer with Pathrombin SL APTT reagent, LA1 and LA2 reagents supplied by siemens were used. All data were expressed as Mean±SD. Statistical analysis was done using unpaired students t test. A p value of <0.05 was used to indicate statistical significance in all analyse.Results: APTT with (1:1) and (4:1) mixing study for detection of factor deficiency showed a sensitivity of 91% and 92% for RI, 88% and 90% for Changs %, and 75% for Brandt correction PNP aPTT + 5 secs respectively. For Inhibitors, RI shows a sensitivity of 79% and 89%, Changs 71 and 80% and Brandt test 50% for APTT (1:1) and (4:1) mix, respectively.Conclusions: Mixing tests forms an important diagnostic tool in differentiating factor deficiency from inhibitors especially in LAC patients. This study recommends mandatory use of mixing tests in LAC cases as also advocated by BSH, ISTH and CLSI. Rosners Index is more sensitive than changes % and Brandt correction in the interpretation of mixing studies. It can be safely concluded that RI can be used as a reference method for evaluation of mixing studies and its sensitivity is greatly increased by using PP4:1 PNP. It’s a matter of debate that whether these indices can be effective with other Analysers and reagents?

In-Vivo Study on Anxiolytic Effects of Hydroalcoholic Extract of Agaricus blazei Murill

Background: Anxiety involved panic attacks either having or not having social fear, social anxiety disorder, generalized anxiety disorder as well as separation anxiety disorder is known to be marked mental diseases. It is related to high medical cost and a significant load of disease. Agaricus blazei Murill (AbM) is a mushroom and possesses immunemodulating and antimicrobial effects both in-vivo and in-vitro and as well as it has been used to treat cancer, hepatitis, dermatitis, and hyperlipidemia traditionally. Method: In this experiment evaluation of anxiolytic effect of AbM on mice has been done by using Elevated Plus Maze test, open field test and motor co-ordination test by rotarod. Mice (Mus musculus) weighing 22-25 grams, were divided into 4 groups (n=6). Oral administration of hydro-alcoholic extract of AbM was utilized in 2 doses i.e. 136.5 mg/kg and 273 mg/kg. Group, I received vehicle (distilled water 10 ml/kg), p.o. Group II received standard (diazepam 1 mg/kg), i.p. Group III and IV orally received hydro-alcoholic extract of AbM (136.5 mg/kg and 273 mg/kg, respectively). Result: In Elevated Plus Maze test, oral administration of hydro-alcoholic extract of AbM (136.5 mg/kg and 273 mg/kg, respectively) exhibited significant (p<0.01) elevation in the percentage of number of open arm entries (48.0 ± 1.1% and 48.93 ± 2.1% respectively) and time spent in open arm (14.92 ± 1.9% and 84.17 ± 2.4%). Conclusion: Hence it is concluded that hydro-alcoholic extract of AbM can be a new therapeutic agent to treat anxiety.

A prospective observational pharmacovigilance study of adverse drug reaction monitoring in patients of tuberculosis receiving category I and II treatment regimens at tertiary care hospital

Background: First line Anti-TB therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol / streptomycin is very effective. However, major adverse reactions to antituberculous drugs can cause significant morbidity and mortality. One of the main reasons for non?adherence to anti?TB therapy (ATT) is ADRs, even under DOTS. Present study was carried out in tertiary care hospital. The objective of the study was to evaluate types and frequency of ADRs in intensive and continuation phase of category I and II Anti-TB medication.Methods: A prospective observational study conducted in Department of TB- Chest and Medicine, Govt. Medical College, Aurangabad, Maharashtra, India. All the TB patients reporting at DOTS Center of institute were enrolled and monitored for ADRs. The causality and severity of the reactions were determined using Naranjo algorithm and Hartwig questionnaire.Results: Total, n = 241 tuberculosis patients on DOTS therapy were enrolled for the study. Out of 241 patients, 17 were dropouts so 224 patients assessed for ADRs. 127 (56.69%) developed adverse drug reactions. The higher numbers of ADRs were observed in age group 31-40 yrs followed by 21-30 yrs, ADRs were more common in men. Pulmonary TB (73.66%) cases were more common than extra pulmonary TB. Majority of adverse drug reactions were Gastrointestinal (GI) problems (30.92%), followed by Liver dysfunction and Hepatotoxicity (20.39%) and skin problems (17.10%). The causality of ADRs, in majority cases were found to be Probable (56.57%). Around 19 patients require treatment interruption and most of the patients were managed with supportive medication without removing anti tubercular drug from regimen.Conclusions: ADRs are major limiting factor for completion of drug therapy under RNTCP and occurrence of drug resistance which requires attention of all health care professionals.

A Retrospective Study To Determine Thyroid Dysfunction In Patients With Diabetes Mellitus At Kalaburagi, Karnataka, India

Background- There is a complex interrelationship in the co-existence of thyroid dysfunction among diabetic patients and may be related to the growth of cardiovascular diseases and other complications of long-term metabolic imbalances. The prevalence of thyroid dysfunction varies from 10 to 24% among diabetic patients. Objective- To determine the prevalence of thyroid dysfunction among the patients with diabetes mellitus in a tertiary care hospital at Kalaburagi, India. Methods- This retrospective study was conducted during June 2018 analysing the records of diabetes patients attending to the diabetes OPD, Department of General Medicine in the past one year and their association with thyroid dysfunction was studied. Results- Atotal number of 200 diabetes mellitus Type I and Type II patients were included in the study. Out of 200patients, 27 (22.5 %) had thyroid dysfunction and remaining 93 patients had normal thyroid function. Out of 27 thyroid dysfunction patients, 8 (6.6%) had clinical hypothyroidism, 17 (14.1%) had subclinical hypothyroidism and 2 (1.6%) diabetics had hyperthyroidism. Conclusions: Thyroid is common among type 2 diabetic patients, especially in females. It is most commonly secondary to autoimmune thyroid disease. Microvascular complications are commonly observed in this group of patients with dual endocrinal disorder treating physicians should routinely screen thyroid in patients with diabetes mellitus to prevent complications.

Environmental health effects associated with recycling of sewage for potable purposes: a literature review

This literature review has been drafted to explore and emphasise the potential environmental health risks and benefits of recycling wastewater especially in areas affected by prolonged drought. With limited water resources, recycled treated sewage water can be used to augment the fresh water supply. This review will provide an understanding of the importance of water recycling and the environmental impacts recycling can have on the environment. A comparison is also provided to understand the environmental effects of untreated sewage on the environment and the potential benefits associated with the recycling. Public health aspect is also elaborated to highlight whether recycled treated sewage is a viable option to be considered for the use as potable water. Literature suggests that recycled treated water has a purifying effect on the environment and can be used for potable and non-potable purposes.

In Vivo Study on Laxative Effect of Prunus amygdalus Oil

Objective: In this study, we assessed the laxative effects of Prunus amygdalus oil (PAO) in constipation model of mice. Method: The animals were divided into 6 groups and Prunus amygdalus oil was orally administered in two dose-strengths (3.0 ml/kg/day and 6.0 ml/kg/day) in mice. Group one was administered with Lactulose (30 ml/kg/day) as standard. Understandings of the possible mechanism of laxative action 2 groups of animals were pretreated with atropine (10 ml/kg/day) that moderately inhibit the laxative activity of Prunus amygdalus oil. Results: Results of our study revealed that treatment of PAO was effective in increasing the fecal number and fecal weight and this increase was very close to standard drug Lactulose, which indicate the laxative activity of oil. Those groups of animals which were previously administered with atropine partially inhibit the laxative activity of Prunus amygdalus oil, specifying that laxative action is mainly facilitated through muscarinic receptors activation and indicated the occurrence of Acetylcholine like component. Conclusion: Our study results revealed the laxative activity of PAO mediated mainly with the cholinergic pathway. This study provides a basis for beneficial use of Prunus amygdalus oil in constipation.

Drug utilization study of antihypertensive drugs used in the treatment of second and third trimester of pregnancy in tertiary care hospital

Background: Hypertensive disorders are major cause of the perinatal and maternal mortality and morbidity worldwide. Aim of study was to evaluate current trend of antihypertensive drugs and to assess frequency and distribution of antihypertensive drugs in pregnancy.Methods: A retrospective observational study was conducted in a tertiary care hospital for period of six months in collaboration with department of obstetrics and gynaecology. Patients data recorded in case report form and analysed to study prescription pattern and related information.Results: Total of 104 cases were enrolled in this study. Prescribed antihypertensive drugs in pregnancy were Labetalol, Nifedipine, MgSO4 and furosemide. Most commonly prescribed drug was labetalol. In this study, Gestational hypertension was most common diagnosis in hypertensive disorder. Majority of drug prescribed from category C and A. In present study, Single drug therapy was most commonly prescribed for hypertension in pregnancy was 64.42% whereas multiple drug therapy was 35.57%. Most common maternal complication was anaemia i.e. 54.05% followed by placental abruption in 24.3%. Neonatal outcome was low birth weight i.e.36% followed by preterm birth i.e.24%.Conclusions: Labetalol found to be most common prescribed drug. Single drug therapy prescription was high as compared to multiple drug therapy prescription in hypertensive disorders in pregnancy. Gestational hypertension was most common cause of hypertensive disorder. Anaemia was found to be most common maternal complication encountered in hypertensive disorders in pregnancy. Most common adverse neonatal outcome was low birth weight.

A prospective observational pharmacovigilance study of adverse drug reaction monitoring in patients of MDR-TB at tertiary care hospital

Background: The emergence of drug resistant mycobacteria has become a significant public health problem world over creating an obstacle to effective TB control. ADRs are common in patients of MDR-TB on DOTs-Plus drug regimen. Present study was carried out in tertiary care hospital. Identification of types and frequency of adverse drug reactions in Intensive and continuation phase of MDR-TB Patients.Methods: It was a prospective observational study conducted in Department of TB- Chest and Medicine, Govt. Medical College, Aurangabad, Maharashtra, India. All the MDR-TB patients admitted at the directly observed treatment, short course plus (DOTS plus) Center at Medical College Hospital were enrolled and were monitored for ADRs. The causality and severity of the reactions were determined using Naranjo algorithm and Hartwig questionnaire, respectively.Results: A total of 121 tuberculosis patients of MDR-TB on DOTS therapy were enrolled for the study. Out of 121 patients, 13 were dropouts, 6 died, 7 defaulted so 108 patients assessed for ADRs, 48 patients developed 61 (56.48%) adverse drug reactions. The higher numbers of ADRs were observed in age group 31-40yrs followed by 21-30yrs which were more common in men. Majority of adverse drug reactions were Gastrointestinal (GI) problems 32 (52.45%), followed by Ototoxicity 7 (11.48%) and Psychiatric Manifestations 6 (9.84%) and skin problems 3 (4.92%). On evaluation of the causality of ADRs, majority were found to be Possible (59.02%). The severity assessment showed that most of the patients ADRs were of moderate level (50.82%).Some patients required treatment withdrawal and replacement with other drug and most of the patients were managed with supportive medication without removing anti-tubercular drug from their treatment regimen.Conclusions: ADRs are major factor limiting completion of drug therapy under RNTCP and occurrence of drug resistance which requires attention of all health care professionals.

Comparative evaluation of efficiency of HbA1C, fasting & post prandial blood glucose levels, in the diagnosis of type-2 diabetes mellitus and its prognostic outcome.

Background: HbA1C a marker of chronic hyperglycemia, is associated with diabetes and its complications and has been recommended as a diagnostic test. It is an indicator of average blood glucose concentration over the period of 2-3 months. The main objective of this study was to compare the efficiency of HbA1C, fasting & post prandial blood glucose levels, in the diagnosis of type- 2 diabetes mellitus. Methods: This study was conducted in a tertiary care referral hospital. Total 500 subjects included. Results: The study and control group were almost of the similar ages. FBS & 2 hour PP of control groups are 95.5 ± 9.8 & 168.45 ± 22.8 (mg/dl) respectively & that of type 2DM is 198.5 ± 25.6 & 295.8 ± 32.6 respectively. The HbA1C % of all the 30 cases of DR & all the cases with micro-albuminuria was >7.5%. Conclusions: HbA1C can be used effectively for the diagnosis of type 2 DM & it can be used for predicting the complications of type 2 DM. It shows a direct & linear correlation with the diabetic retinopathy and micro-albuminuria. It is very safe to say that HbA1C is better parameter than FBS & 2 hour PP BS level in diagnosing & predicting the complications of diabetes.

Evaluation of bone marrow aspirate in paediatric patients with pancytopenia: a 2 years study.

Background: Pancytopenia is an important clinico-hematological entity, characterized by a triad of Anemia, leucopenia and thrombocytopenia. It’s not a disease entity itself but a manifestation of many serious and life-threatening diseases. The criteria for defining Pancytopenia is Hemoglobin (HGB) <9 g/dL; total leukocyte count (TLC) <4,000 / μL or absolute neutrophil count (ANC) is < 1.5x 109/ L; platelet count, <100 x 109/ L. The main objective of this study is to classify pancytopenic cases on etiological basis. Methods: A total of 750 bone marrow smears of pancytopenic patients were studied. Results: It comprised of 72 % boys & 28 % girls with the highest number of cases < 5 years of age (64%).The maximum number of cases were of ALL and Aplastic anemias. Conclusions: CBC, clinical findings and PBS provides valuable information in the workup of pancytopenic patients and help in planning additional investigations on bone marrow samples. Bone marrow evaluation is a valuable diagnostic procedure which may confirm the diagnosis of suspected cytopenias. So the take home message is a) pediatric leukemias unlike adults, usually presents with pancytopenia b) CBC+ PBS + BMA with flow cytometry can help in diagnosing majority of pancytopenias.

Evaluation of performance of various histological grading systems of soft tissue sarcomas and the prognosis (metastatic risk and survival rate).

Background: Histologic grade represents the most important prognostic factor for all soft tissue sarcomas and it is strongly associated with the advent of metastasis and patients survival. The main objective of this study is to test individual grading system with metastatic risk and patients survival rate (prognosis). Methods: Soft tissue sarcomas (250) were graded by FNCLCC, NCI & Mhyre Jensens grading system. Special stains & immunohistochemistry were employed whenever necessary. Results: FNCLCC system shows Grade 1 = 50 (20%), Grade 2 = 75 (30%) & Grade 3 = 125 (50%). NCI (Costa et al.) showed Grade 1 = 70 (28%) Grade 2 = 85 (34%) & Grade 3 = 95 (38%). Myhre Jensen showed Grade 1 = 84 (33%), Grade 98 (39%) & Grade 3 = 68 (27%). Undoubtedly, FNCLCC system is the best of all grading systems which is very well supported by statistical analysis in this study. Conclusions: FNCLCC grading system of soft tissue sarcomas is the best documented and tested system. This present study strongly recommends FNCLCC grading system of soft tissue sarcomas to be internationally accepted because the grading system has well defined criteria & so least possible chances of interobserver variability. The present study & few other previous studies highly recommend the mandatory use of FNCLCC grading system in histopathology report format.

Platelet indices- evaluation of their diagnostic role in pediatric thrombocytopenias (one year study).

Background: Thrombocytopenias can be categorised into hypoproliferative (group I) & hyperdestructive types (group II) based on their etiology. Platelet indices (MPV, PDW, P-LCR, platelet-crit) can be used to differentiate this type of thrombocytopenias & these are simple, cost-effective, noninvasive & reliable. The main objective of this study was to evaluate the efficiency of platelet indices to differentiate hypoproductive type from hyperdestructive thrombocytopenias. Methods: Automated Hematology Analyzer Sysmex XT-2000i used to assess platelet indices. 100 Cases of thrombocytopenia & age adjusted (similar age group) controls with normal CBC & peripheral blood smears were included in the study. The gender was not taken into account as the ranges of platelet indices are almost the same for boys & girls of similar age groups. Results: The platelet indices of group I was platelet count = (51.8 ± 31.6) x103/mm, MPV = (8.5 ± 1.27) fl, PDW = (14.10 ± 1.15) fl, P-LCR = (31.90 ± 3.46)%. The platelet indices of group II was platelet count = (39.6 ± 32.7) x103/mm, MPV = (11.6 ± 2.25) fl, PDW = (15.16 ± 1.36) fl, P-LCR = (34.30 ± 2.2)%. Comparative analysis of MPV, PDW & P-LCR of group I and group II showed p value <0.05 proving it to be statistically significant. Conclusions: The combined interpretation of MPV, PDW & P-LCR by automated cell counters can be very useful parameters in differentiating thrombocytopenias due to various etiologies. Platelet indices showed inverse relationship with platelet count as they are increased in hyperdestructive type & shows linear relationship in hypoproliferative type. MPV, PDW & P-LCR can be precisely used to differentiate hyperdestructive type (ITP) from hypoproliferative type (acute leukemias, aplastic anemias). Platelet-crit & platelet large cell ratio are less sensitive parameters to differentiate these thrombocytopenias.

Psychiatric morbidity in married females living away from their spouses attending the psychiatry clinic in a tertiary care, teaching hospital.

Background: In India economic problems like dowry and related issues play a major role in the problems of marriage and separation The aim of the present study is to assess the psychological impact on married females who living away from their spouses, and comparison of the psychiatric morbidity with the married women who are living with their spouses. Methods: A total of 35 subjects were included in the study. Intake proforma was specially designed for study and the questions were divided into 4 subscales (somatic complaints anxiety/insomnia social dysfunction and severe depression). Results: The study clearly revealed that the occupational separation has a significant negative impact on the marital quality of the women spouses of men working abroad or living away. Comparison with the marital quality of the control group, the group does not have the separation; the study group differs significantly in marital quality. The factors such as social support from family and friends, the stay of the study group with parents or in-laws, and duration of pre-separation, the study proved that there is no significant difference exists on the marital quality of the study group based on these factors. Conclusions: The numbers of females who were separated from their spouses are more likely to have psychiatric illnesses due the additional work load of looking after the children and managing the household activities. The study also found that the females staying with their parents after the separation from their spouses were less likely to have a severe psychiatric morbidity as they felt comfortable due the cooperation from their parents.

Chediak Higashi Syndrome masquerading as acute leukemia / storage disorder - A rare case report.

Chediak higashi Syndrome (CHS) is a rare autosomal recessive multisystem disorder with a defect in granule morphogenesis with giant lysosomes in leucocyte and other cells. CHS is a rare disease, approximately 200 cases have been reported so far. It was described in detail by Chediak in 1952 and Higashi in 1954. 1½ year old male child presented with multiple hypopigment patches on lower extremities, light colored hair, Hepatosplenomegaly and generalised Lymphadenopathy. PBS shows giant prominent liliac to purple granules in neutrophils, band forms, few lymphocytes and monocytes. Bone marrow is hypercellular showing giant prominent gray blue to purple heterogeneous granules often multiple seen in many myeloid precursors, Neutrophils, few lymphocytes and monocytes. Occasional lymphocytes shows single giant liliac inclusions. Erythropoiesis, myeloid series and Megakaryocytes are mildly increased. Hemophagocytosis noted. CHS is characterised by partial oculocutaneous albinism, frequent fatal bacterial infections, bleeding diathesis and peripheral + Cranial nerve palsies. This disorder further culminates into accelerated phase (Lymphoproliferative Syndrome) progressing into pancytopenia. CHS is due to single gene mutation in LYST (CHS) gene localized to 1q chromosome. The diagnostic hallmark of CHS is presence of giant purple to blue violet inclusions in leucocytes. In this study granules are more prominent in Bone marrow than in PBS correlating well with previous studies. Approximately 85% of the cases, of CHS culminates into Accelerated phase showing Lymphohistiocytic infiltration progressing to pancytopenia and death due to infection. The very rare nature of this disease and its grave prognosis merits its reporting.

Evaluation of the Tuberculosis Surveillance System in District Hyderabad, Province Sindh-Pakistan, 2012.

Aims: To identify strengthens and weaknesses of Tuberculosis (TB) surveillance system of District Hyderabad and suggest recommendations for improvement. Study Design: Descriptive evaluative study Place and Duration of Study: This research work was conducted in Provincial directorate of health, district health offices, and TB sentinel sites of District Hyderabad, between February and March, 2012. Methodology: A total of 26 stakeholders were identified by using purposive sampling technique based on their involvement in and relevance to the TB surveillance system. Data was collected by review of medical records and stakeholder interviews by using “Centers of Disease Control (CDCs) Updated Guidelines for the Evaluation of Surveillance Systems. Attributes were rated as good, fair and poor on the basis of obtained score. Results: System was good in simplicity and flexibility due to simple case definition and adaptation of new changes. Presence of laboratory component and 90% completeness of forms led to good rank in data quality. The system covered limited (n=12) health facilities which caused fair representativeness. The staff was highly motivated to provide accurate, consistent and complete information and suggested good acceptability of system. Due to quarterly reporting, timeliness was poor and led to delays in outbreak identification and mitigation responses. Sensitivity and positive predictive value were 26% and 56.8% respectively. The system was fair in stability as supported by ministry of health with multinational donors. Conclusion: The TB Surveillance system was satisfactory in all attributes except representativeness, sensitivity, and timeliness. Increased establishment of sentinel sites at public and private health facilities and added frequency in reporting time were recommended.

Diabetic patients; clinical profile with endstage renal disease on haemodialysis

To study the clinical profile of diabetic patients on haemodialysis with a view to identify common clinical features and the trend of compliance with treatment and follow up. Haemodialysis unit Fatima Memorial Hospital, Lahore, from January to August 2011. Method: Data collected from all patients above 14 years of age through medical history, record, examination and fundoscopy. Out of total 76 patients on haemodialysis 50[65.7%] had DM and of these 42[84%] also had hypertension. Among diabetics 28 [56%] were male and 22 [44%] female. Mean age was 56.68 +/- 9.09. Among these 15[30%] were illiterate and 27 [54%] belonged to lower social class. Ever smokers were 18[36%]. Mean duration of diabetes since diagnosis was 10.9 +/- 5.99. Mean duration of hypertension 8.28 +/- 8.07, Duration of onset of dialysis 6 months to 8 years with mean 2.16 +/- 1.47. Retinopathy was found in 29[58%], 18[36%] had diabetic and 11[22%] had hypertensive changes. Both fasting and random blood sugar levels were monitored by 28 [56%]. None had regular follow up with HbA1c levels or urine for protienuria prior to onset of haemodialysis. Compliance with dietary advice and treatment claimed by 24[48%] and 36[72%] respectively. History of intake of Hakeem and homeopathic medications was found in 16[32%] and 10[20%] respectively. 65.7% of ESRD were diabetics. Majority were in 6th decade of life. Retinopathy was present in 58%. Low trend was observed towards compliance with treatment and follow up