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

Synthesis, antibacterial and antifungal possession of amino acids containing sulfonamide moieties

Sulfonamides were developed by the simple reaction of amino acid with p-toluenesulfonyl chloride and structures of the new products [2a, 2b and 2c] were confirmed by elemental and spectral analysis [FT-IR, [1]HNMR and[13]CNMR]. In vitro, developed compounds were screened for their antibacterial and antifungal activities against two sensitive bacteria belonging to both gram positive and gram-negative types and two fungi. The synthesized sulfonamides [2a, 2b, 2c] exhibited excellent antifungal activities against the tested fungi. Among the tested compounds 2a and 2b have marked activity against E. coli with zone of inhibition [mm] 22.3+/-0.11and 20.2+/-0.26 [MIC: 12.5[micro]g/mL, 12.5[micro]g/mL] and S. aureus with zone of inhibition [mm] 20.2+/-0.26 and 23.2+/-0.55 [MIC: 12.5[micro]g/mL, 6.25[micro]g/mL]. Compound 2c is moderately efficient towards E. coli [zone of inhibition [mm] 14.2+/-0.64, MIC: 100[micro]g/mL] and no activity against S. aureus

Incidence of beta-thalassemia carriers in Muzaffarabad, Azad Kashmir

Objective: To determine the frequency of beta-thalassemia carriers in healthy population from Muzaffarabad Azad Kashmir

Methods: In this cross sectional population based study, people from Muzaffarabad were motivated to get themselves tested for beta thalassemia trait. People found healthy on basis of a questionnaire and clinical examination were included in the study. Complete blood counts and peripheral smear review were performed on EDTA samples. Hemoglobin [Hb] electrophoresis was performed. Subjects with mean corpuscular volume [MCV], <76 fl, and/or mean corpuscular Hb [MCH], < 27 pg were subjected to hemoglobin A2 [HbA2] level estimation by elution method. Hemoglobin A2 of more than 3.5% was considered diagnostic for beta-thalassemia trait. Azad Kashmir is a territory with considerable ethnic heterogeneity. This is basically a tribal society with a high proposition of consanguineous marriages. We created awareness among the general population

Results: Found that gene is present in almost all tribes studied

Conclusion: Using strict criteria for healthy population, we conclude that incidence of thalassemia trait is 5.6 % in our study population. beta -thalassemia trait is present in almost all ethnic groups. To control thalassemia major, screening program for thalassemia carriers must be initiated in the area

Synthesis, antimicrobial and antifungal possessions of tramadol esters: In vitro studies

Tramadol esters were prepared by refluxing equimolar concentration of tramadol with leucine and asparagine separately with methanol, sulphuric acid and phthalic anhydride for 10 hours and temperature was maintained at 75[degree]C. After refluxing, the colour of sample solutions were changed from colorless to yellow, blank solution was prepared in the same way as the sample solution except the Tramadol. Both the products and blank were neutralized with sodium carbonate and excess of sodium bicarbonate was precipitated as sodium sulphate, which was washed with acetone. The structures of both the products were confirmed with spectral data [FT-IR, [1]HNMR and [13]CNMR]. Antimicrobial and anti-fungal property of derivative of analgesic tramadol drug was tested with one fungus and three sensitive bacteria belonging to both gram positive and gram-negative types. Esterified product of tramadol with leucine and asparagine showed moderate activity against Escherichia coif and Tricophyton rubrum. Both the products showed marked activity against Staphylococcus aureus and found no activity against Salmonella spp

Improved limit of detection and quantitation development and validation procedure for quantification of zinc in Insulin by atomic absorption spectrometry

A simple and expeditious analytical method for determination of zinc in human insulin isophane suspension by flame atomic absorption spectrophotometer [FAAS] was validated. The method was carried out on atomic absorption spectrometer with 0.4nm b and width, 1.0 filter factor on deuterium [D2] background correction. The integration time was set at 3.0 second with 5.0mA lamp current. The parameters of method validation showed adequate linearity, efficiency and relative st and ard deviation values were between 0.64%-1.69% [n=7], 1.31%-1.58% [n=10] for repeatability and intermediate precision respectively. The limit of detection 0.0032µg/mL, 0.0173µg/mL, 0.0231µg/mL and limit of quantitation 0.0107µg/mL, 0.0578µg/mL, 0.0694µg/mL based on signal to noise [SN], calibration curve method [CCM] and fortification of blank [FB] were obtained respectively. The percentages of recovery for low, medium and high spiked concentration levels of zinc in human insulin were 99.38+/-0.04 to 100.3+/-0.03, 98.45+/-0.38 to 100.3+/-0.07 and 99.42+/-0.03 to 99.42+/-0.08 respectively. With the use of this method, five samples from each vial of human insulin isophane suspension were analyzed and the zinc content was determined. The zinc content were 22.1+/-0.025µg/mL and 24.3+/-0.028 µg/mL which compliance the British Pharmacopoeia st and ard.

Assessment of hindrances in offering prayers in catheterised patients

To determine the difficulties which hinder the Muslim patients with urinary catheters in offering regular prayers and help then solve those difficulties. A descriptive study. The study was conducted in the department of Urology Foundation University Medical College and Fauji foundation Hospital Rawalpindi from July 2008 to December 2009. Muslim ambulant and mentally alert patients between the age 20 to 70 having a urinary catheter [urethral or suprapubic] were included in the study. 500 volunteer patients from both genders fulfilling the inclusion criterion were included in the study. Patients were given a questionnaire and asked about their regularity regarding offering of prayers before the insertion of urinary catheter and any change in that aspect after the catheter was placed. They were asked to mention the hindrance faced by them in offering their regular prayers after they got the urinary catheter. Before insertion of the urinary catheter 39.2% patients were offering their prayers regularly, while after having been catheterized only 0.4% patients remained regular in their prayers. 30% mentioned about the urinary leakage alongside the catheter as a hindrance to prayers. 28% said they did not know how to perform Wudhu [washing of arms up to elbows, face and feet, and touching the hair on the front of the head with water] while they had a catheter inserted. 12% described urethral pain as a hindrance to offer prayers. Remaining 29.6% gave no reason for abandoning regular prayers. However, all the patients wished they could pray. Those patients were guided. Patients complaining of pain due to catheter were treated. Those who could give no reason were counseled. A positive approach on the part of the patients was observed after these measures. Muslim patients having a urinary catheter can offer regular prayers. Urinary catheter is not a hindrance to prayers. Patients need to be counseled accordingly

Child laborers; abuse is universal at Rawalpindi

In Pakistan there are about 3.3 Million unprotected child laborers. They are constantly exposed to all kinds of dangers and abuse intimidating the future of the country. These child laborers are without the basic necessities of life including food, shelter, schooling and healthcare services, which has devastating effects on our socio-economic fabric. It is quite imperative to comprehend and unveil the perilous picture of the working conditions of child laborers and the abuse inflicted upon them at such an impressionable age. Cross sectional study. Rawalpindi city including workshops, shops and streets of Rawalpindi. January 2008-Dec 2008. Objective: To assess the presence of any Verbal, Physical and Sexual abuse among the child laborers at Rawalpindi city. Out of the total sample of 700 study subjects 315 [45%] of the Child laborers reported being abused whereas 385 [55%] reported no abuse. Out of the fraction which reported to be abused the break up is as follows. 214 [67.9%] reported verbal abuse, 75 [23.8%] reported Physical abuse and 25 [7.9%] reported sexual abuse. This study concluded that the child laborers are open to the elements of the adversities that come along with their work environment. The government should be urged to take necessary steps to trim down the abuse against child laborers and its frightening effects on their families, society and nation at large by constituting strict laws and ensuring their speedy implementation

Women beliefs and practices regarding food during pregnancy- a hospital based study

The aim of the study was to assess the existing beliefs and practices regarding food during pregnancy. Cross-sectional study. The present study was conducted in Antenatal Clinic, Department of Gynecology and Obstetrics at Holy Family Hospital, Rawalpindi. This study was conducted in four months time from September 1[st] to December 31[st], 2008. Sample size was 189 pregnant females who were attending the Antenatal Clinic, Department of Gynecology and Obstetrics at Holy Family Hospital, Rawalpindi. This was calculated by computer software called Raosoft- a sample size calculator by keeping confidence level 95%, margin of error 5%, and response rate 86%. Simple Convenience Sampling technique was used. 89% believed that there is an effect of food on pregnancy and 11% did not. Despite of high literacy rate [93%] there are certain strong food beliefs regarding pregnancy which have been practiced by pregnant ladies, which were effecting their food intake like hot, cold, badi and having difficult labour. All available resources for creating awareness among the masses regarding the importance of diet during pregnancy should be used properly by using all means of communication [especially mass media]

Through service learning to provide social justice

In Pakistan there are 3.3 Million child laborers without healthcare services and educational opportunities, which affect our social fabric. We report how structured 'Service Experience' helped broaden medical students understanding of social justice. To produce health professionals who are ready to work for a cause without voracity. A Cross sectional survey through a focal group discussion. Do opportunities for structured Service Learning help modify student's perception of their role as doctors in society? Foundation University Medical College, Islamabad. Fifteen months, from January 2008-April 2009. Fifteen students interviewed 700 child laborers using a piloted interview form during a fifteen months period. Focus group discussions were held with these students to discuss their experiences. Qualitative analysis of the discussion is reported. Students empathized that children worked on a contractual basis averaging $1 per 10 hours with no meals. Parents encouraged them to earn money and they felt more satisfied pleasing them. Children didn't attend school because of the school quality and fear of abuse. "Our exposure to child labor had been limited; this has taken us to the core of the issue. We now feel responsible as a physician and a leader to ensure 'security of children in every respect' as part of their health." "We will avoid employing children at our homes and will council parents, trying to be role models for others." "As future leaders we will propose measures including establishment of free quality educational systems with paid vocational tracks." Service learning will inculcate empathy for the oppressed groups of the community and also develop a social and civic responsibility in medical students

Contraceptives knowledge and practices in district Rawalpindi: a hospital based study

To assess the knowledge and practices of contraception and reasons for non utilization of family planning services at Rawalpindi, Pakistan. A cross sectional survey. Fauji Foundation Hospital Rawalpindi from January 2007 to September 2007. This study was designed to investigate contraceptive knowledge and practice in Pakistani women attending a tertiary care hospital. A sample of 200 married women of reproductive age were interviewed to record their age, educational status, relatives practicing contraception, knowledge about contraceptive methods, source of the information and family support for contraception. Simple convenience sampling technique was used in this study. Close ended questionnaire was used to record the information. Subjects [99%] of study population were aware of currently available contraceptives and among them [48%] were practicing these methods. Educated females were [71%] and 93% practiced contraception while [29%] were uneducated and among them [47%] practiced contraception. [51%] of Females were supported by their families for practicing contraception. Source of information for [53%] was health service providers and for [39%] female was mass media. Most of [67%] female relatives also practiced contraception .Only [3%] of the subject's did not practice because of fear of Allah and [32%] had some other reasons. Level of Knowledge in study population was high but there was a huge gap of practice of contraception. Reasons for not practicing was not religious rather it was social pressure

Laparoscopic ureterolithotomy: an experience of 15 cases

To review our experience of laparoscopic ureterolithotomy and revisit its indications in the current era of minimally invasive urologic surgery. A descriptive study. The study was conducted at the department of Urology, Foundation University Medical College and Fauji Foundation Hospital, Rawalpindi from January 2007 to December 2009. We performed laparoscopic ureterolithotomies on fifteen patients for large [1.5-2.5 cm], impacted upper and middle ureteric calculi. In 10 patients laparoscopic ureterolithotomy was adopted as a primary procedure, four patients had stones resistant to Extracorporeal Shockwave Lithotripsy [ESWL], while one patient had failed ureterorenoscopy [URS]. An extraperitoneal approach was selected in all the patients. There were 11 patients with upper ureteric calculi and four with midureteric calculi, the procedure was successful in 14 cases. One patient required conversion to open ureterolithotomy. The average operating time was 50 minutes. The average hospital stay was 2.5 days. There was no major complication. One patient had persistent drain for four days. IVU at three months follow-up was normal in all cases. Laparoscopic ureterolithotomy in selected cases is a good minimally invasive procedure. Large, impacted, hard calculi which are resistant to ESWL and difficult to fragment endoscopically without flexible ureteroscopes and holmium laser can be managed by this technique

Infant feeding; beliefs and practices of mothers

To evaluate the infant feeding beliefs and practices of methods in our setup. A cross-sectional study. Fauji Foundation Hospital, Rawalpindi. From Jan 2007 to September 2007. 336 mothers of infants attending Fauji, Foundation Hospital were interviewed by using pre-tested questionnaire. Data was collected for Mothers beliefs and practices regarding infant feeding. Descriptive statistics like percentage, mean and range were obtained by using SPSS version 11. 366 mothers from rural and urban areas attending hospitals were interviewed. 63.9% mothers believed that breast milk should be given as first feed. Pre-lacteal feeds were given to 56% of infants. Major source of information for giving pre-lacteal feeds was relatives. At birth, 43.7% mothers discarded clostrum considering it harmful and useless for baby. Frequency of breast feeding was high initially at birth but decline rapidly by early supplementation with bottle feeding. Inadequate weaning in terms of timing, quality and quantity was observed. Cultural beliefs and taboos like hot and cold food influenced 61.5% of mothers due to which they restricted important food items. A targeted health education campaign should stress the main advantages of breast feeding. Messages should stress on protective benefits of clostrum and encourage mothers to start breast feeding immediately after birth. Potentially hazardous practices including pre lacteal feeding should be discarded. Local cultural and traditional practices and beliefs regarding different food items should be identified. This help to improve the food intake of infants by strengthening the useful beliefs and discontinuing harmful ones

Assessment of knowledge and practice of contraceptives in females of reproductive age group at a tertiary care hospital

To assess the knowledge and practice of contraceptives in females of reproductive age group. Cross sectional descriptive. OPD of Fauji Foundation Hospital from February 2008 - September 2008. 339 females of age b/w of 15-49 years attending OPD of Fauji Foundation Hospital were included in study. A structured questionnaire was used to collect data. Eighty eight percent of the females in our study sample were familiar with one or more methods of contraception [72.7% were familiar with combined oral contraceptive pill [COCP], 60.7% were aware of intra uterine contraceptive device [IUCD] and 76% knew about condoms] whereas 12% showed ignorance. 64.4% of the study population was contraceptive users and 35.4% were not using any method of contraception. Regarding preferred method of contraception 34.6% of females said they are using COCP, about 21.8% females said their tubes had been liagated whereas 26.9% and 16.7% were using IUCD and condoms respectively. Almost 46% of our study population said that contraceptive method they were using was suggested by their husbands, 44% said by health professional. Only 10% of the study population were using a method of their own choice. The present study concludes that there is a gap between knowledge [88%] and use [64.6%] of contraceptives among females of reproductive age group. Another important inference drawn from the study is that men should be made equal targets of such programs in Pakistan since 46% females in our study population were using method of contraceptive suggested by their husband

Frequency of helmet use among motorcycle riders in Rawalpindi

To find the frequency of helmet use as a safety tool and to investigate how many of the motorcyclists are aware of the beneficial effects of using a helmet. A cross sectional study. In Community Medicine Department of Foundation University Medical College, Rawalpindi from March 2007 to September 2007. A total of 1000 questionnaires were randomly distributed among motorcyclists during visits to Lalkurti, Saddar and Karchi chowk in Rawalpindi. Inclusion criteria included those motor bike rider volunteering to participate in the study. 44 responses were invalid and the total valid responses were therefore 956. No incentive was offered for participation in the study and no individual follow- up was possible. From a total sample size of 956 riders 541 were putting on a helmet and 415 were without the helmet. The frequency of helmet use was therefore 56.6% and that the use non user is 43.4%. A bog majority i.e 80.7% of the respondent s left that use of helmet while riding a motorbike should be mandatory while only 19.3% left that it should be the discretion of the riders. 57.6% of the riders left that in case of pillion riding both the riders should put on the helmet while 42.4% did not support the idea. The study implies that we need to enact and enforce policy intervention for mandatory use of helmet, effective traffic law enforcement and imparting awareness among our masses especially the younger generation to reduce Road Traffic Accidents. Print and electronic media should be utilize extensively to disseminate basic traffic knowledge at all levels of the society

Acute epiglottitis

A case of acute epiglottitis is presented here. The patient was in severe respiratory distress. He was intubated and managed in general ICU. He made good recovery. ICU management and special consideration of this disease are discussed

Infections in chlidren with nephrotic syndrome

To determine the different types of infections in nephrotic children and their association with the activity of disease. Design: A descriptive study. Place and Duration of Study: It was carried out at National Institute of Child Health [NICH], Karachi from August 1995-July 1996. Patients and All children with nephrotic syndrome who had various infections during the study period were evaluated for the activity of disease and type of infections. Out of 62 children with nephrotic syndrome having infections, 45 [72.58%] were boys and 17 [27.42%] girls in a ratio of 2.5:1. Out of them 53 [85.45%] were known nephrotics and 36 [58%] of them were on steroid therapy. Nine were new cases and had not received steroids. A total of 74 episodes of infections were observed in 62 children. Acute respiratory infections [ARI] and skin infections were the most common [29.27% and 27.02% respectively] followed by diarrhoea [13.51%], UTI [12.5%] and peritonitis [10.81%]. Two patients had pulmonary tuberculosis and 3 patients had more than one infection [cellulitis, peritonitis and pneumonia]. All children with cellulitis and peritonitis were in active disease, whereas more than 80% of patients with ARI, diarrhoea and UTI were having either relapse or had recent onset of disease. The study showed that ARI, cellulitis and diarrhoea were most common infections followed by UTI and peritonitis. Majority of the infections [>78%] were associated with active disease

Disposition kinetics of amoxicilliln from urinary excretion data in normal human volunteers in Pakistan

To investigate the disposition kinetics of amoxicillin trihydrate by urinary excretion data following oral administration in normal human volunteers. Design Addressed: Evaluation of disposition kinetics of amoxicillin in local environment using urine data. Urine samples are easy to collect as compared with the blood samples and, therefore, urine data is helpful for the evaluation of disposition kinetics of drugs. Setting: Faculty of Veterinary Sciences, Agriculture University, Faisalabad-Pakistan and Department of Pharmacy, Islamia University, Bahawalpur-Pakistan. Subjects/The study was undertaken in seven normal human volunteers. Urine samples were collected over 12 hours following drug administration and analyzed for the drug by the disc diffusion method using Sarcina lutea as a test organism. The data was analyzed for computation of pharmacokinetic parameters by standard methods. A maximum amount of 29.2 +/- 3.0 mg of amoxicillin was excreted at four hours and 17.0 +/- 1.3 mg at 12 hours. The total amoxicillin cumulative amount excreted and% cumulative at the 12th hour was concluded to be 183.4 +/- 2.6 and 73.3 +/- 1.0%, respectively. Elimination rate constant of 0.60 +/- 0.03 hr and 1.18 +/- 0.05 hours in normal volunteers was observed in this study. Conclusions: Similarities and differences were both observed when the present findings were compared with the cited results. The urine data may be used as an alternative to the blood data for the estimation of pharmacokinetics of drugs

Abdominal tuberculosis: a varied presentation

Abdominal Tuberculosis presents to the general surgeon in one of the three forms: 1, intestinal obstruction 2, tuberculous peritonitis 3, abdominal mass. In this report, patients presenting with intestinal obstruction [Acute or sub acute], over a two year period at the Department of General Surgery, Shaikh Zayed Hospital, Lahore, 30 cases were found to have intestinal tuberculosis out of a total 100 cases studied. All patients were diagnosed on exploration with hisopathological evidence of tuberculosis and/or demonstration of A.F.B. in the lesion. The mean age was 34.9 years, male to female ratio 2: 1. 86% of the patients had primary intestinal tuberculosis whereas 14% were considered to be suffering from secondary intestinal tuberculosis. Majority of the patients [66%], had single multiple strictures involving the triminal ileum and ileocaecal region, 20% of the patients were found to have mass in the ileocaecal region and perforation was seen in 14% of the cases. Primary resection of the tuberculous lesion was carried out in 28 patients. Stricturoplasty was performed in the remaining 2 patients. Hospital mortality was zero and major post operative complications were noted in 8% of the cases. The patients received standard anti-tuberculosis treatment for a period of 12 months, follow up record was available on only 26 patients. All 26 patients had completed the anti-tuberculosis medication without any ill effects. No patient had presented with recurrent problem of obstruction