[Effect of weight bearing symmetry modification on balance and gait function in individuals with chronic stroke]

The aim of this study was to assess the effect of compelled weight bearing with therapeutic exercise on functional test results of balance and gait in individuals with stroke. 32 hemi-paretic patients in experimental and control groups [16 patients in each group] participated in this study. Patients in the experimental group wore shoes for 6 weeks with a lift of 6 mm thickness embedded in non-paretic side to increase weight symmetry and performed balance and gait re-education exercises for 90 minutes daily. Patients of the control group only received therapeutic exercises. Assessments were included percentage of body weight on the affected limb, gait velocity; stride length, timed up and go and Berg Balance Scale tests that were recorded in both groups before and after treatment and 3 months after the end of treatment. All variables showed significant improvement following treatment and improvement effects were maintained during follow up examinations. In the experimental group, percentage of weight bearing on the paretic limb also increased significantly in follow up. The percentage of weight bearing on the paretic limb and BBS score increased more in the experimental group than in the control group [P=0.001]. Compelled weight bearing on the paretic limb and re-education of balance and gait caused more improvement in weight symmetry and functional balance in individuals with chronic stroke

[Study the effect of "constraint-induced movement therapy" on symmetry of spatiotemporal gait parameters in hemiparetic patients]

Balance and gait disorders are common motor complications after stroke. Studies have revealed that conventional physiotherapy cannot manage these disorders efficiently, so more studies addressing causes of these complications and presenting efficient treatment protocols are crucial. Concerning the significant effect of Constraint Induced Movement Therapy on treatment of upper limbs motor impairments in hemiparetic patients, the goal of this study is to assess the effect of "Constraint Induced Movement Therapy" on symmetry of spatiotemporal gait parameters and velocity of gait in hemiparetic patients. Thirty hemiparetic patients [aged from 40 to 60 years] participated in this study. Patients were divided randomly into 2 groups. They received constraint induced movement therapy [group1] and mass practice [group 2] for 3 weeks. Experimental assessments of patients included stride velocity and symmetry of spatiotemporal gait parameters [spatial step symmetry, temporal stance symmetry, temporal swing asymmetry, overall temporal asymmetry] that were recorded and compared before and after treatment. In addition, the amount of weight bearing asymmetry was assessed via dual force platform. In both groups, stride velocity increased [p=0.03, p=0.01]. In group A, spatial step symmetry increased [p=0.02].Temporal swing asymmetry and overall temporal asymmetry decreased [p=0.01]. In group B, only temporal swing asymmetry decreased [p=0.02]. Physical therapy by "constraint induced movement therapy" can improve symmetry of spatiotemporal gait parameters efficiently through overcoming the "learned non use" phenomenon and improving the somatosensory deafferentation to motor controller centers

Pyogenic liver abscess: a five year retrospective study in slums of Karachi

Objective: to analyze the various features of pyogenic liver abscess in poorly developed slum area of Karachi

Design and settings: a retrospective study done in hospitalized diagnosed cases of pyogenic liver abscess confirmed by ultrasonography in Jinnah Medical College, Hospital Korangi Karachi from January 2004 to December 2008

Methods: all patients diagnosed as pyogenic liver abscess were reviewed for demographic status, clinical features, hematological and biochemical analysis, size of abscess, cultures of pus, management and outcome. Ameobic liver abscesses were excluded. The data were analyzed on SPSS 11.5

Results: a total of 76 patients was diagnosed as pyogenic liver abscess having 76.6% male and 22.4% female patients with mean age of 52.1 yrs. The most common symptoms and signs were upper abdominal pain in 82.6%, fever in 75%, and right hypochondrium tenderness in 43.4%, hepatomegaly in 30% and jaundice in 18.4%. Leucocytosis [71%], raised alkaline phosphatase levels [63%], raised total bilirubin levels [60.5%], ALT levels [52.6%] and low hemoglobin values [42%] patients were common abnormal laboratory findings. Ultrasongraphy showed that right lobe of the liver was involved in 85.5% patients with 84.2% patients having single abscess. Klebsiella pneumoniae 35.7% was revealed as the common pathogen from the aspirated pus of the patients. Only 9 [11.8%] patients were referred for surgical intervention and followed up there. There was no mortality noticed in this study

Conclusion: patients with Pyogenic liver abscess can be managed with better outcome if diagnosed early with ultrasound, necessary intervention and appropriate therapy

Incidence of distal caries in mandibular second molars due to impacted third molars - a clinical and radiographic study

Occurrence of distal caries in lower second molars has been associated with impacted mandibu-lar third molars especially mesioangular impactions. Caries detection and restoration can be difficult and if it progresses, root canal treatment or extraction of the second molar may be necessary. The aim of this retrospective study was to evaluate the incidence of caries on distal aspect of mandibular second molars in patients referred for corresponding third molar assessment and to identify its association with angular position and depth of the impacted mandibular third molars based on the classification of Pell and Gregory. Two hundred impacted mandibular third molars were assessed in a total of one hundred and sixty seven patients presenting to the Department of Oral and Maxillofacial Surgery, Islamic International Dental College and Hospital from April 2011 to July 2012. These patients had age range between 18-57 [mean age of 37years] According to this study, 42.5% cases show caries on distal aspect of mandibular second molars. Incidence of caries with mesioangular impacted third molars was 51%. Majority of these mesioangular cases were level B and Class I as per Pell and Gregory Classification. Distal caries found in association with horizontal impactions was 29.10%, vertical impactions 15.2% and distoangular impactions 4.7%. No caries was found in relation to transverse impactions. It was concluded that distal caries in second molars is common, especially in cases of mesioangular mandibular third molar impactions and prophylactic removal of these impacted teeth may be considered appropriate. If such a third molar is left in situ, close monitoring is necessary

Expected survival using models of life table compared with survival of gastrointestinal tract cancer patients in north of Iran

Northern regions of Iran have been encountered to dominate malignancies of gastrointestinal [GI] tract. We came to examine the total excess mortality due to the GI cancer in Mazandaran province. Socio-demographic and clinical data of 484 patients with GI cancer collected during the years 1990-1991were available from Babol Cancer Registry. Patients were followed up for 15 years by the year 2006. Using the West Coale-Demeny life table model, a number of five life tables for men and four for women, corresponding to each birth cohort, were constructed. Observed survival was obtained using the Kaplan-Meier method and compared with the Expected survival calculated using the direct adjusted method represented by STEIN et al. The sample of subjects encompassed 66.3% men and 33.7% women with mean age 58.26 +/- 10.90, and endoscopy was the general method for cancer detection. Esophagus accounted for 74.2%, and stomach and colorectal accounted for 22.7% and 3.1% of GI cancers, respectively. Survival rate in 15 years following diagnosis was nearly 6%. Comparing patient and expected survival curves showed a significantly reduced survival for patients of each GI cancer over the whole period and especially during the first two years after diagnosis. Patients experienced reduced survival associated with the development of GI cancers. Considering individuals in a population come from different cohorts, adjustment by constructing distinct life tables for different birth cohorts is recommended. The West model is recommended as a first choice to represent mortality in countries whose registration systems are exposed to various errors

Prevalence and characterization of listeria species in domestic and industrial cheeses of Isfahan region

Listeria monocytogenes is of major concern to the food industry in general and the dairy industry in particular. Little is known about incidence of this pathogenic bacterium in dairy products in Iran. A survey was made from 23 September 2006 to 22 June 2007 for Listeria species in ninety samples of traditional and industrial cheeses, in milk and surface where the cheeses were manufactured from unpasteurized raw milk in the province of Isfahan [Iran]. Listeria murrayi, L. grayi and L. ivanovii, were detected in nine traditional cheeses and one a raw milk sample. None of the different Listeria species were isolated from the industrial cheeses and their environment. There are almost good hygienic conditions in domestic cheese manufacturing farmhouses in Isfahan area, but we should try to improve hygienic levels until we have none of the Listeria spp. in our samples

Pakistan human resources for health assessment, 2009

Pakistan faces a human resources for health [HRH] crisis. A cross-sectional survey was conducted to overview frontline health workers. A total of 750 health facilities were surveyed across Pakistan. The median estimate of public sector health care workers in the district health system in Pakistan is 417 288, including 46 153 doctors and 41 032 nurses. Another estimated 20 000 doctors work in public sector tertiary care hospitals across the country. A total of 3549 health care workers were interviewed regarding job satisfaction and work environment. The private sector had better work environment scores compared with the public sector. Policy dimensions showed an absence of robust policies in practice. The public sector is inadequately staffed and job satisfaction and work environment need improvement. HRH crisis countries should share experiences, and developmental partners should support them in overcoming the HRH crisis

Severe acute maternal morbidity and intensive care in a public sector university hospital of Pakistan

The study was planned to review the case series of pregnant women requiring intensive care due to severe acute maternal morbidity in the public sector university hospital, in order to identify failures and priorities in maternal health care provision in Pakistan. A retrospective case series study was performed of critically ill obstetrics patients admitted to general intensive care unit of Liaquat University Hospital Hyderabad, Pakistan, from January 1[12] to 31[12] December 2006. Data included demographics, disease responsible for critical illness, complications that prompted ICU admissions, intervention required, length of ICU stay and the resulting foeto-maternal mortality and morbidity. Over the study period, 30 obstetric patients were transferred to general ICU, representing 1.34% of 2224 deliveries. Seventy three% of women belonged to rural areas, 96% were un-booked while history of surgical intervention was present in 87% of cases. Hypertensive disorders of pregnancy [50%] and sepsis [17%] were the two main obstetrical conditions responsible for maternal illness. Respiratory failure [57%] and haemodynamic instability [40%] were the major indications for ICU transfer. Mechanical ventilatory support was the commonest intervention required in the ICU followed by the ionotropic support [33%].The foetal mortality rate was 43%, while maternal mortality rate was 33%. Maternal morbidity and mortality can be reduced by meticulous adaptation of safe motherhood initiative, provision of separate ICU services for critically ill obstetrical patients and early assessment and aggressive intervention through a team approach involving obstetricians, intensivists and anaesthetists

[Success rate of retreated teeth with periapical lesions: a clinical and radiographic evaluation]

As for other dental treatments, root canal therapy may lead to failure. Correction of these conditions will be faced with problems and complexities, particulary if any periapical lesion is peresent. The aim of this study was to evaluate the success rate of retreament in teeth with apical lesions. In this descriptive study 60 teeth with failed root canal therapy which had been retreated by an endodontist were reevaluated clinically and radiographically between 6 to 12 monthis after retreatment. Clinical examinations were performed by a clinician and comparison with the primary symptoms, recorded in patiants file, was obtained. Periapical radiographs were prepared by parallel technique and E speed film with the same proccessing conditions. Periapicel lesion size was evaluated and comparison was made before and 6-12 month after retreament, using photoshop software [version7] .The data were analyzed by chi-square test and agreemental tables. Statistically, there was no correlation between variables and success rate. The success and failure percentage of retreatment was 81.7% and 5%, respectively and 13.3% of cases were uncertain. The most success rate was observed in group of 31-40 years old [95%], keeping in mind that most patients were in this age group. The least success was in group over 50 years old. According to this study, the high success rate could be expected in retreatment of teeth with periapical lesion

Foreign body in oesophagus; role of parents in prevention

To study the attitude of parents about the coins given to their children, especially about their knowledge of coins that these may become F.B. in oesophagus and can cause an unexpected problem. A questionnaire- based survey presented to parents of the children admitted in ENT ward having coin trapped in their oesophagus. ENT Department Bahawal Victoria Hospital, Bahawalpur from July 2004 to June 2005. Parents of the children, who were admitted in ENT ward B.V.H, Bahawalpur, were interviewed using a questionnaire proforma focusing especially about the knowledge of parents about coins as a possibility of F Body. Ethical requirements including the administration of written informed consent and provision of confidentiality were ensured. SPSS computer software was used for data management. In our study 84 out of 100 patients were less then 7 years age. Sixty two were male and 38 were female children. Seventy four of the children we re from rural areas. Most of the parents were illiterate and of poor social class. Fifty nine had history less then 1 days and 28 had 1-3 days. Eighty eight patients were operated with one day. Most of the parents [54%] were anxious and worried Thirty five were ashamed while 11% were not bothered. Most of parents pointed out risk factors as easy availability of coin [78%], easy access of coin for children [56%], bad habit of children to put every object in mouth [42%] and lack of knowledge of parents about the risk of coin as foreign body in esophagus [88%]. Future commitments of the parents were noted as follows: restriction of coin for children [60%] education of children [32%] and 8% of parents did not bother about care of children for this. Recommended Suggestion by parents were these Govt. Should ban [92%], role of press and newspaper [62%], role of T.V and radio. [74%], role of health workers to educate people [88%]. In our setup, most of the parents are illiterate and unaware of the risk t hat the coin can become a foreign body in esophagus in children. They can be awarded and educated via media like press, television and radio and compaign by health workers. Incidence of these emergency cases can be reduced by these measures to negligible level

Renal artery stenosis in patients with peripheral vascular disease in Kuwait

The aim of this study was to identify the incidence of atherosclerotic renal artery stenosis [RAS] in patients with peripheral vascular disease [PVD] and its relation to any known risk factors. This prospective study was conducted on 212 patients who were subjected to peripheral angiography for symptoms of PVD over a 3-year period from 1995 to 1998 at the Mubarak AI-Kabeer Hospital, Kuwait. Angiograph-ic evidence of atherosclerotic disease and its severity was recorded in renal, abdominal aorta, iliac, femoral, popliteal and below-knee arteries. In addition, a detailed search of identifiable risk factors was done using history, clinical examination and laboratory studies. The incidence of significant atherosclerotic RAS [more than 50% diameter stenosis] in patients with PVD was 15/212 [7.07%] with no significant difference in ratio between males and females [p = 0.3] compared to that of PVD alone. Patients with common iliac and femoral artery lesions had a high incidence of RAS [93.3 and 86.7%, respectively] with more than 80% probability in RAS patients with involvement of these vessels. There was significant renal impairment [p < 0.005], as assessed byserum creatinine levels, in patients with RAS compared to those who did not have it. There was a high incidence of smoking in patients with RAS [p = 0.02], and smoking was the only risk factor identified in these subjects. Patients with iliac or femoral atherosclerotic disease have a high probability of associated RAS. Presence of renal impairment in patients with PVD is highly indicative of RAS. Smoking is the only identified risk factor for RAS in association with PVD in our population

Hemolytic uraemic syndrome associated with pregnancy

Hemolytic uraemic syndrome [HUS] and thrombotic thrombocytopenic purpura [TTP] are described as acute syndromes with multisystem abnormalities and pentad of thrombocytopenia, microangiopathic hemolysis, neurological symptoms, renal impairment and fever. Both diseases were believed to form a continuum of the same disease, but recently it was found, that they were having a different pathophysiology, as TTP patients have a deficiency in von wilbrand factor [vWF] cleavage protease. When renal involvement is severe with little or no neurological manifestation, this microangiopathy is termed as haemolytic-uraemic syndrome. If the hemolytic uraemic syndrome is not associated with diarrhoea, it is called D-negative or atypical HUS. This subdivision is ofetiological and prognostic importance. TTP-HUS is associated with high maternal and fetal morbidity and mortality. Treatment of these syndromes differs from syndrome of hemolysis with elevated liver enzymes [HELLP syndrome] and acute fatty liver of pregnancy hence accurate diagnosis is important for optimal therapy. Plasma transfusion and plasmapheresis have revolutionized management of TTP and HUS by increasing survival 80% to 90%. Here we are reporting a case of D-negative hemolytic uraemic syndrome associated with pregnancy causing in-trauterine fetal death. Diagnosis made on clinical and he-matological findings, successfully treated by plasmapheresis with residual maternal renal impairment. We are presenting this case, as it is rare disorder associated with high mortality and morbidity, to increase awareness about disease, its diagnosis and management

Estrogen receptor beta gene polymorphism and endometrial inadequacy

To correlate four estrogen receptor beta polymorphisms to endometrial thickness. 24 patients with consistently thin endometrium, in natural and stimulated cycles undergoing controlled ovarian hyper stimulation for ICSI for various indications and 50 control subjects with normal endometrium undergoing COH for ICSI for male factor infertility. Sonographic evaluation of endometrium, PCR on peripheral blood leucocytes using specific primers to detect the determined four polymorphisms, as well as hormone values in COH cycles and ICSI outcome, are recorded. The deletion polymorphism was not found in either groups. The second polymorphism [P846] was significantly more commonly detected in cases of normal endometrium [50% versus 8% in cases with thin endometrium]. The third polymorphism [P1082] was not found in control group and only one case [4%] with thin endometrium and this was not significant. The last silent polymorphism [P1421] was found in 8% of cases and surprisingly all subjects of control group and this was statistically highly significant. The presence of certain ER beta polymorphisms correlate with good endometrial thickness

Ultrasound-guided core biopsy kidneys in infants and children: Kuwait experience

Ultrasound-guided core renal biopsies were performed in children to describe the accuracy of this technique and compare it with the other techniques. Forty-six children, aged 9 months to 13 years, were biopsied with 14 G and 18 G Tru-cut needles, using a real-time ultrasound sector scanner. Adequate biopsy samples were obtained from 88.2 and 86.9% of the biopsy procedures with 14 G and 18 G Tru-cut needles, respectively. No major complications were encountered. Minor complications were also minimal and seen in only 3 of our patients who were managed conservatively. Ultrasound-guided Tru-cut renal biopsy is a safe and efficient method for performing renal biopsies in pediatric patients. The use of small needles [18 G] would reduce the complication rate while allowing retrieval of sufficient tissue for histological diagnosis

Spinal extradural hydatid cyst

Objective and Importance: Hydatid disease of the bones is uncommon. Spinal hydatid disease presenting with compressive neuropathy is very rare. This case is presented for the rarity of this condition. Clinical Presentation: An adult male patient with previously treated hydatid cyst of the liver presented with symptoms of spinal nerve root compression. MRI of the spine revealed an extradural cyst which was treated with surgical excision. Patients with a known history of hydatidosis should be suspected of spinal hydatid when presenting with symptoms or signs of cord or nerve root compression

Low dose, short term, triple therapy for helicobacter pylori associated peptic ulcer

To confirm the efficacy and tolerability of a new, low-dose, short-term triple therapy, 31 endoscopically diagnosed cases of peptic ulcer who were helicobacter pylori positive by brush cytology and urease test were inducted into the study. These patients were given lansoprazole 30 mg once a day, clarithromycin 250 mg twice a day and tinidazole 500 mg twice a day for one week only. Endoscopy, urease test and methylene blue test for helicobacter pylori were repeated four weeks after stopping the therapy. Ulcer healed in all the patients while helicobacter was eradicated in 90.3% of patients

Discrimination between sets of visually similar Urdu and English phonemes through lipreading by normal subjects in the absence of auditory stimulation

With due awareness of the limitations of lipreading as an alternate but popularly used means of communication by the deaf, the study primarily focused on determining the amount and extent of relative difficulty/confusion experienced in "recognizing" and "discriminating" [through lipreading] between phonemes having various combinations of vowels and consonants. The findings revealed that [i] Vowel phonemes were better recognized than Consonant phonemes, [ii] words with First Consonant Varying were better recognized and discriminated than those with Last Consonant Varying. However within the Middle Vowel Varying category the words were best recognized discriminated

Compliance of anti-rabic vaccination at anti-rabic centre, Mayo hospital

One hundred and sixteen cases were enrolled for antirabic vaccination, by random sampling, with a male: female ratio of 4.3:1. 76.12% of patients reported within 48 hours of the bite. Whereas 63.79% of patients complied with a complete course of vaccination, 36.2% of them left vaccination incomplete. 78.26% presented with a single wound, and 21.74% had multiple wounds. As compared with some of the previous studies, we have observed that thee is a general improvement in the awareness about the prophylaxis for this grave health problem, rabies