Assessment of biochemical and antioxidative status in patients suffering from dengue fever / 华中科技大学学报（医学）（英德文版）

A multi-centred study was designed to collect dengue epidemiologic data from government and registered private hospitals/clinics and maintained archive of frozen specimens in bio-bank to be used for future dengue epidemic control program, and assess the epidemiology of dengue fever (DF) by evaluating biochemical and oxidative status of patients. ELISA IgM antibodies test was done to confirm DF. From August 2010 to December 2011, 101 confirmed blood samples of DF patients referred to pathology lab of Jinnah Hospital Lahore were subjected to the epidemiologic assessment by evaluating the biochemical and physiological indices and alterations of circulating antioxidants. Clinical features of DF patients and effect of fever on blood components and serum proteins of liver were recorded. The hospital stay in DF, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) showed significant difference. Significant increases in serum alanine amino transferase (ALT) (P=0.000), aspartate amino transferase (AST) (P=0.000), alkaline phosphatase (ALP) (P=0.000), malondialdehyde (MDA) along with significant decreases in total protein (TP) (P=0.000), reduced glutathione (GSH) (P=0.000), superoxide dismutase (SOD), catalase (CAT) (P=0.000), and sialic acid contents (P=0.016) were observed. A positive correlation existed between bound sialic acid levels, liver enzymes and circulating antioxidants (r=0.656, P=0.016). In the present study, alterations of circulating antioxidants in DF suggest that DF might be a metabolic response to an acute, self-limiting tropical viral infection, and a consequence of the viral inflammatory process.

Assessment of biochemical and antioxidative status in patients suffering from dengue fever / 华中科技大学学报（医学）（英德文版）

A multi-centred study was designed to collect dengue epidemiologic data from government and registered private hospitals/clinics and maintained archive of frozen specimens in bio-bank to be used for future dengue epidemic control program, and assess the epidemiology of dengue fever (DF) by evaluating biochemical and oxidative status of patients. ELISA IgM antibodies test was done to confirm DF. From August 2010 to December 2011, 101 confirmed blood samples of DF patients referred to pathology lab of Jinnah Hospital Lahore were subjected to the epidemiologic assessment by evaluating the biochemical and physiological indices and alterations of circulating antioxidants. Clinical features of DF patients and effect of fever on blood components and serum proteins of liver were recorded. The hospital stay in DF, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) showed significant difference. Significant increases in serum alanine amino transferase (ALT) (P=0.000), aspartate amino transferase (AST) (P=0.000), alkaline phosphatase (ALP) (P=0.000), malondialdehyde (MDA) along with significant decreases in total protein (TP) (P=0.000), reduced glutathione (GSH) (P=0.000), superoxide dismutase (SOD), catalase (CAT) (P=0.000), and sialic acid contents (P=0.016) were observed. A positive correlation existed between bound sialic acid levels, liver enzymes and circulating antioxidants (r=0.656, P=0.016). In the present study, alterations of circulating antioxidants in DF suggest that DF might be a metabolic response to an acute, self-limiting tropical viral infection, and a consequence of the viral inflammatory process.

Outcome of corticosteroid injection in de quervain's tenosynovitis

BACKGROUND: De Quervain's tenosynovitis is a stenosing tenosynovitis of the first dorsal compartment of the wrist. The diagnosis is made by history and physical examination. Finkelstein's test is positive in typical cases

OBJECTIVE: To assess the clinical effect of local corticosteroid injections for de Quervain's tenosynovitis

MATERIAL and METHODS: Fifty De Querven's Tenosynovitis patients were included in the study

All had a mean of 6 weeks of treatment of the condition with oral and local NSAIDs and had shown no response. The severity of tenderness on first dorsal compartment and pain felt on Finkelstein test was recorded on Visual analogue scale. A mixture of 1 ml [10mg] of triamcinolone acetonide and 1 ml of 1% lidocain hydrochloride was injected in first dorsal compartment of involved wrist. Patients were followed for clinical assessment fortnightly for 24 weeks

Outcome measure was reduction in pain and tenderness on the radial side of wrist and negative Finkelstein test subsequent to local triamcinolone acetonide injection

RESULTS: Out of 50, thirty-five patients [70%] after 1st injection were symptoms free at two weeks, fifteen patients who showed no improvement were given second injection two weeks after the first. 42 [84%] patients at four weeks, and all patients at six weeks were symptoms free and fully satisfied with the therapy. All the 50 patients were followed for 24 weeks and no recurrence was found

The adverse reaction of steroid was seen in 18/50 [36%] of patients, which were subsided in 20 weeks. There was no incidence of nerve injury, tendon rupture, or infection

CONCLUSION: We conclude that one or two local steroid injections in the first dorsal compartment leads to significant improvement in patients with de Quervain's tenosynovitis

Outcome of partial nail plate and matrix removal [winograd technique] for ingrown toe nail

INTRODUCTION: Ingrown toe nails are one of the common and painful condition of foot. The most common presentation is distal lateral ingrowing. When the conservative treatment fails, problem is recurrent or if the lesion is more severe, surgical treatment is advised. Surgical treatment consists of partial or complete nail excision in combination or without partial matricectomy

This study highlights the results of surgical intervention with Winograd technique

MATERIAL AND METHODS: The study was conducted at Liaquat university hospital and a private practice setup between January 2010 and July 2011.The inclusion criteria was adult patients of either sex with ingrown toe nail in stage two and three involving big toe. A total of 70 patients were enrolled in the study. Sixty five patients with 65 toes were finally registered for follow up. Winograd surgical technique was used for excising lateral 20% to 25% of the ingrown nail with matrix removal. Primary outcome measures were, well healed wound, pain free toe, and no recurrence. Secondary outcome measures were post operative infection and recurrence within one year after surgery

RESULTS: Thirty [46.15%] patients were male and 35[53.85%] female. Their mean age was 27.30 years [range 20 to 45 years]. The mean follow up period was 9.46 Months. Twenty five patients [38.46%] were in stage II and 40[61.54%] were in stage III. Fifty eight patients [89.23%] recovered uneventfully with no postoperative complications. There mean recovery time was, 13.62 days. Early postoperative complications were seen in seven [ 10.76%] patients. Two had swelling and 5 patients [7.69%] develop postoperative infection. These seven patients with infection and swelling recovered in the mean time of 20.71days, whereas all recovered in the mean time of 14.38 days. Recurrence was seen in 4.61% within a mean period of 5 months. With chi square test only 3 cases had recurrence and 62 behave satisfactory with p value of P<0.0001. All the Ten patients [15.38%] who develop complications belong to Heifetz stage III at the time of surgery

Sixty two out of 65 patients [92.30%] were satisfied with the treatment

CONCLUSION: The Winograd technique of partial nail plate and matrix removal is inexpensive, effective, safe and easy to perform. The procedure has low recurrence rate. The postoperative complications are more common in patients presenting with Heifetz stage III disease

Frozen shoulder: role of single intra-articular corticosteroid injection and home exercise programme

Objective: To observe the affects of intra-articular steroid injection followed by simple home exercise programme in patients with primary frozen shoulder phase I and phase II

Material and Methods: Eighty five patients with idiopathic [primary] frozen shoulder, clinical phase I and II with unilateral involvement with minimum duration of six months were selected for the study. The solution injected contained 5cc of 1% lidocaine HCl [xylocain] and 2cc [80 mg] methyl prednisolone acetate [depomedrol]. All patients were injected once. The glenohumeral joint was injected via posterior approach. The site of entry was same as used for traditional posterior portal for arthroscopy of shoulder. After the inra-articular injection, patients were advised to perform range of movements exercise within the limits of pain daily for ten minutes. Systemic documentation of shoulder function was made before the treatment and six months after the intra-articular injection by obtaining simple shoulder test [SST]

Results: All the 15 patients in clinical phase I recovered in the mean time of seven weeks. [Range 3 weeks to 3 months]. Fifty out of seventy patients in clinical phase II recovered in the mean time of 4 months. [Range 3 weeks to 6 months] Twenty patients did not meet the recovery criteria within six months after injection

Conclusion: In patients with frozen shoulder, single intra-articular injection of corticosteroid combined with simple home exercise program is effective in improving shoulder pain and disability

Investigation and comparison of colon specificity of novel polymer khaya gum with guar gum

To investigate the colon specificity of novel natural polymer khaya gum and compare with guar gum. Release profile of tablets was carried out in presence and absence of rat cecal contents. The fast disintegrating core tablets of budesonide, were initially prepared by direct compression technique. Later, these tablets were coated with khaya gum or guar gum. After suitable pre compression and post compression evaluation, these tablets were further coated using Eudragit L-100 by dip coating technique. X-ray images were taken to investigate the movement, location and the integrity of the tablets in different parts of gastro intestinal tract in rabbits. The release profiles revealed that khaya gum or guar gum, when used as compression coating, protected the drug from being released in the upper parts of the gastro intestinal tract to some extent but the enteric coated formulations completely protected the drug from being released in the upper parts of the gastro intestinal tract, and released the drug in the colon by bacterial degradation of gums. It was found that both the polysaccharide polymers exhibited different release profiles in presence and absence of rat cecal contents. However, further enteric coat helped in targeting the drug to colon very effectively. Better dissolution models revealed the colon specificity of polysaccharides and alone can not be used either for targeting the drug to the colon or for sustaining or controlling the release of drug

Diabetic hand; management

A case series study held at surgical unit 1. BV Hospital Bahawalpur. Study was conducted from June 2006 to May 2009, to evaluate various aspects of diabetic hand and to establish a protocol to manage it. All diabetic patients presented with hand infection to the unit during this time were included in the study but patients having classical diabetic hand syndrome were excluded. Total 48 patients were admitted during the period under review. Male to female ratio was 2:1 and age was ranged from 31 to 48 years. Data was collected on Performa and shifted to computer program SPSS version 12. All patients were manual workers or house wives and 40 patients gave history of minor trauma to the digits during work. All patients were either undiagnosed [16 patients] or had uncontrolled diabetes. Most of them delayed seeking advice for their trauma and infection of hand properly. During treatment, 30 patients [62.5%] required amputation of one or more digits of the dominant hand including amputation of thumb in 19. Only 4 patients [8.33%] ended up in amputation of hand, whereas, no patient required amputation of forearm. No mortality was seen during study period. It was concluded that diabetic hand involves persons in active life period relatively in younger age group. Undiagnosed or uncontrolled diabetes is major contributory factor. Health education, early diagnosis and prompt treatment in specialized units may be helpful

Comparative study between intranasal antrstomy and antral lavage an experience at CMCH Larkana

To compare the results of intranasal asntrostomy and antral lavage in maxillary sinusitis. This randomized control study was conducted in the department of ENT Chandka Medical College Hospital Larkana during the period from December 2004 to 2007. The overall study of 150 cases was conducted. Out of 150 cases 92 [61.31%] were male and 58 [38.71%] were female and the male / female ratio was 1.6:1. Symptomatology was dominated by PND 95% purulent rhinorrhea 70% headache 52% and nasal obstruction 25%. The overall result of 150 patients x-ray showing mucosal theckining 89 [59.3%] hazzy / opaque sinus 40 [26.6%] and fluid level 14 [9.4%] three times antral lavage was done in all 100 patients. Out of 100 patients 33 got no benefit and underwent for intranasal asntrostomy along with selected 50 patients. Every patient was followed up for 2 weeks. Antral lavage showed 67% benefit and 33% patients got no benefit while intranasal antrstomy followed up patients got 90% benefit and 10% got no benefit This study shows that results of intranal antrstomy is better than antral lavage

Comparative study between intranasal antrostomy and antral lavage

This study was conducted to carry out comparison between intranasal antrostomy and antral lavage and comparison of gross appearance of sinus mucosa and any pus/secretion during operation and pre-operative radiological findings. To establish the following facts: i] Improve the aeration and draining of maxillary sinus to prevent the complications of maxillary sinusitis. ii] Gross appearance of sinus mucosa and any pus/secretion in patients not responding to conservative management, Prospective study. This study was conduded in the departments of ENT, Chandka Medical College Hospital, Larkana and Civil Hospital, Karachi from Dec 2004 to Dec 2007. Total no of 150 cases were selected in this study with non febrile, acute, sub-acute and chronic maxillary sinusitis, divided into two groups. First group was treated with antral lavage under general anaesthesia. The second group was treated by intra nasal antrostomy under general anaesthesia. The comparison data between 1st and 2nd and between 2nd and 3rd lavage nearly the same with minor degree of improvement. Most of the patients undergoing for intra nasal antrostomy [including 33 patients who were not responding to antral lavage] were relieved from their symptoms by this procedure

Haemorrhoidectomy: open versus closed technique

To compare open haemorrhoidectomy technique with closed one in terms of wound healing time and complications. A comparative clinical trial. Department of Surgery Bahawal Victoria Hospital Bahawalpur, from June 2006 to June 2008. Patients of 3rd and fourth degree haemorrhoid [n-60] were selected for this study. They were divided into two groups. Group A [n-30] was treated by open haemorrhoidectomy [Milligan Morgan technique] and group B [n-30] was treated by closed haemorrhoidectomy [Ferguson technique]. Postoperatively patients were evaluated for wound healing time and complications. The age of the patient ranged from 18 years to 73 years. The wound healing time was little over 2 weeks in group B while it was just above 4 [1/2] weeks in group A with p value of less than 0.05. After 24 hours the mean VAS in group A was 4.76 +/- 1.4 while it was 3.93 +/- 1.68 in group B and the p value was 0.046 which was significant The best results were obtained with closed haemorrhoidectomy technique as there was less post operative pain, rapid wound healing and less post operative bleeding with this approach. Closed haemorrhoidectomy is treatment of choice for 3[rd] and 4[th] degree haemorrhoids

Abdominal tuberculosis;Still the great mimicker

To study the different clinical presentations, operative and postoperative course of abdominal tuberculosis. Case series study. Surgical units, Bahawal Vicotria Hospital, Bahawalpur. May 01, 2005 to April 30, 2007. This was a prospective type of case series study. A selection criterion of patients was that all patients of either sex and age being diagnosed as case of abdominal tuberculosis. The clinical record of the patient's data, symptoms and signs, biopsy report, biochemical and radiological report, treatment [surgery and chemotherapy] given and a follow-up. Total 96 patients presented with abdominal tuberculosis, 60[62.5%] were male and 36[37.5%] were female. Peritonitis was present in 48[50%] patients, intestinal obstruction[acute and sub-acute] was present in 32[33.33%] patients, mass right iliac fossa was present in 14[14.58%] patients and 2[2.08%] patient presented with mass in the epigastrium. 28[29.16%] patients has concurrent pulmonary tuberculosis. Two patients expired so mortality rate was 2.08%. The control of TB has been a challenging problem because the natural history of the disease and its varying pattern in which it manifests is in different groups

Role of distant flaps in soft tissue defects of the hand

To evaluate the role of different distant [groin, hypogastric] flaps in soft tissue defects of the hand. Design and Observational case series from Jan. 2002 to Jan. 2005.Bahawal Victoria Hospital, Bahawalpur.32 patients, 28 males and four females with large skin defects on hand due to agricultural machine injury 16], road traffic accidents [8], blast injuries [6] and electric burns [2].In 18 cases groin flap while in 14 cases hypogastric flaps were employed to cover the defects. Results: Two flaps were lost completely, partial flap loss occured in one, marginal necrosis in three, while infection was noted in one case.Distal flaps are useful for the coverage of the soft tissue defects of the hand when applied with proper. indications

Management of the anal fissure: a comparison between lateral internal sphincterotomy with manual dilatation of anus

Design: It was a comparative study of randomly selected sample of 50 patients

Purpose: To compare the results of lateral internal sphincterotomy with manual dilatation of anus under general anaesthesia in the management of fissure in ano in terms of [Relief of symptoms, Post operative complications]

Place and Duration of study: Patients presented to Surgical unit, Bahawal Victoria Hospital, Bahawalpur from 15-02-2002 to 14-02-2004

Material and methods: This was a prospective type of comparative study. The patients of fissure in ano were randomly divided into two groups. Group A patients were treated by lateral sphincterotomy and Group B patients were treated by manual dilatation of anus under anesthesia. Follow up protocol was also maintained. Patients were examined and evaluated according to the comparison criteria which were [Relief of symptoms, Complications developed, Recurrence and Healing of fissure]

Result: Out of these 50 patients, 32 were male and were female. In Group-A, 92% of patients were completely cured, 4% of patients developed retention of urine while 4% of patients developed post-operative bleeding. The success rate was 92%. In Group-B, success rate was 72% out of remaining 8% developed incontinence of flatus, 8% developed incontinence of faeces, 4% developed retention of urine while haematoma was observed in 4% of cases.The data was analysed with [SPSS] on computer, Standard Error of Difference Between Two Proportions was applied. Chi square test was applied and P value found to be 0.04 which is less than 0.05 [Statistically insignificant]

Conclusion: On the basis of this study, it was concluded that the results of Lateral Internal Sphincterotomy in the management of anal fissure is safer and more effective than manual dilatation of anus under anaesthesia

Split thickness skin grafting; change of 1[st] dressing of donor area

Objectives: 1] To compare the result of early [7[th] day] with late [14[th]] dressing. 2] To establish protocol for the change of 1[st] dressing of donor area after STSG Design: A comparative [case control] study. Setting: Surgical unit B V Hospital Bahawalpur. Period: From 2001 to 2003

Material and Methods: All the patients who under went STSG due to any reason were included in the study. Patients were divided into two randomized groups. In one group dressing of donor area was changed at 7[th] postoperative day while in other group, 1[st] dressing was changed on 14[th] postoperative day. The two groups were compared in speed of healing; postoperative pain, cosmetic result and patients satisfaction

Results: Total 31 patients [13 in group A and 18 in group -B] were included in study, 22 were male and 9 were female. Ages between 4 to 65 years with an average of 32.2 years. Diseases causing morbidity were burn [7 patients], Diabetes [5 patients] infection [12 patients], Cutaneous malignancies and others miscellaneous causes [7 patients]. Postoperative result have shown that in group- B [case] ] there was a maximum healing [16 out of 18 patients] as compared to group -A [control]. [5 out of 13 patients]. In group B only in 1 patient healing was delayed beyond 2 weeks and in one patient there was some degree of infection. In case of group A in 6 out of 13 patients healing was delayed beyond two week and in 2 patients there was infection of the wound. Many patients were not happy with cosmetic results as the donor area showed varying degree of hyperemia, scaring and discoloration, yet results were found to be more satisfactory and acceptable in group -B. Patient's satisfaction was good in case of group -B [13 out of 18 patients] as compared to group -A [7 out of 13 patients ]. Postoperative pain was a common problem in both groups

Conclusions: Healing is improved, speedy and well tolerated in case the 1[st] dressing is changed on 14[th] day

Retained sponge after abdominal surgery

To study the cause and clinical presentation along with clinical course [coperative and postoperative] of retained abdominal sponge. Design: Observational case series. Place and Duration of Study: Surgical Department, Bahawal Victoria Hospital, Bahawalpur, from April 1, 2000 to August 31, 2002. Materials and The study included 12 patients. All the patients, who presented to surgical department during the stated period with retained abdominal sponge postoperatively, were included in the study. Retained abdominal foreign bodies, other than the surgical sponge, were excluded. A total of 12 patients presented with retained abdominal sponge. Out of these, 33.33% were males and 66.66% females. Modes of presentation were intestinal obstruction, 58.33%, discharging sinus, 41.67%, intraabdominal abscess,16.67%, peritonitis, 16.67% and mass abdomen, 8.33%. One death followed despite provision of due care. Retained surgical sponge is a potentially lethal condition and all preventive measures should be taken to avoid this condition

Mondor's disease of breast

A case of Mondor's disease of breast in a 32 years old lady is described. She presented with painful vertical subcutaneous cords under her left breast. On scintimammography a suspicious nodule in her breast was detected, which revealed to be benign epithelial lesion on FNAC. With reassurance and placebo, the disease resolved spontaneously within two months

Emergency haemorrhoidectomy for acute strangulated haemorrhoids

A prospective study was conducted on 20 patients with acute strangulated haemorrhoids, from Jan. 1994 to Dec. 1996, to study the results of emergency haemorrhoidectomy. Diagnosis was made on history and physical examination. All patients underwent the standard technique of dissection, ligation and excision of the primary haemorrhoids. Two patients had reactionary haemorrhage while one developed anal stenosis which responded to repeated dilatations. It is concluded that emergency haemorrhoidectomy is a safe and effective treatment for acute strangulated haemorrhoids

Testicular tumours; clinical and histological patterns in Bahawalpur

[1] To study the clinical presentation of testicular tumours. [2] To study the histological pattern of testicular tumours in Bahawalpur. DESIGN: A prospective study. SETTING: Bahawal Victoria Hospital Bahawalpur. PATIENTS: Fifteen consecutive patients of testicular tumours. METHODS: Presenting symptoms and findings of clinical examination were recorded. Abdominal ultrasonography and chest x-rays were performed in all the patients. Skeletal radiographs were taken in one patient presenting with back pain and paraplegia. Staging was done. Inguinal orchiectomy was performed and histology was done in all cases. 40% patients presented with primary testicular neoplasms. While 60% presented with clinical picture due to secondary deposits. Histologic pattern was 33.33% Seminoma, 6.67% Lymphoma, 6.67%. Teratoma, 13.34% Embryonal carcinoma, 6.67% Yolk sac tumour and 33.33% Teratocarcinoma. Patients with testicular tumours mostly presented with the clinical picture of their secondary deposits and were in advanced stage. Seminoma and teratocarcinoma were the commonest histological types

Inguinal hernia repair under local infiltration anaeshesia

Inguinal hernia is common. Surgery is the only satisfactory treatment. General/ spinal anaesthesia are not free from complications and need prolonged hospital stay. Patients and methods: Sixty inguinal hernia patients 10 years to > 60 years of age were operated under 0.5% lignocaine with 1:400,000 adrenaline infiltration. Adequate analgesia was obtained during the operation and in early post operative period. Average hospital stay was 44 hours and average cost was Rs. 360 only. Inguinal hernia repair under local infiltration anaesthesia is safe and economical