Fructose; is it an ideal sweetening agent?

To study and compare the effects of fructose and galactose on, blood glucose, insulin, HbA[1c] and lipids and anthropometric measurements. Ninety, healthy adult male rats of Sprague-Dawley strain. Experimental study. Department of Biochemistry and Molecular Biology, A.M.C, Rawalpindi, in collaboration with N.I.H, Islamabad. Twelve months. Rats weighing 180-350 grams were selected by random sampling and were divided into three groups, 30 each. Group I was given standard diet, Group II was given high fructose diet [HFD], i.e., 1.5gms/Kg body weight/day of fructose, along with standard diet for two weeks and Group III was given high galactose diet, i.e., 0.83gms/Kg body weight/day, along with standard diet for two weeks. There was a significant increase in height of galactose group while fructose group has significant weight loss; BMI decreased in both but more in former. The blood levels of cholesterol, HDL-c, LDL-c, TG, and insulin were significantly higher in fructose group than in galactose group. There was no significant difference between blood glucose and HbA[1c] among these groups yet their higher levels indicate the chances of developing insulin resistance. Fructose due to its less hyperglycaemic effects should not be used in diet and must not be prescribed in diabetes, as in the long run it can lead to obesity, hypertension and cardiovascular risk. Non-significant effects of galactose on above parameters [except lipoproteins], does not mean that it can be used as an alternative to fructose and this area needs exploration

Exercise tolerance test [ETT] or myocardial perfusion scan [MPS] -what to choose in patients of ischaemic heart disease [IHD]?

To evaluate the validity of exercise tolerance test [ETT] with treadmill exercise in the diagnosis and follow-up of ischaemic heart disease [IHD], taking myocardial perfusion scan [MPS] as standard. Retrospective, validation study. Nuclear Medical Centre [NMC] Armed Forces Institute of Pathology [AFIP], Rawalpindi, Pakistan, from 1 January to 31 December 2009. One hundred and nineteen patients [88 males, 31 females], referred for MPS; were selected through non-probability, consecutive sampling. Patients of all ages and gender, fit to undertake treadmill exercise, were included. Patients with contraindications to ETT, like unstable angina, conduction abnormalities, etc., or those who had taken a beta blocker within the preceding 24 hours, were excluded. ETT through treadmill exercise was done, followed by MPS with single photon emission computed tomography [SPECT] technique, using Thallium-201 or Technetium-99 m 2-methoxy-isobutyl-isonitrile [MIBI]. ETT was interpreted as positive or negative for ischaemia, with borderline changes considered positive. MPS was interpreted as positive or negative for ischaemia. Validity of ETT was evaluated in terms of sensitivity [Sn], specificity [Sp], and positive and negative predictive value [PPV and NPV], taking MPS as standard. Sensitivity of ETT was found to be 77.5% and specificity was 43.6%. PPV was 73.8% and NPV was 48.6%. Out of a total [n] of 119 patients, true positive [TP] cases were 62, true negative [TN] 17, false positive [FP] 22 and false negative [FN] 18. ETT is an acceptably sensitive but non-specific test for evaluating myocardial ischaemia, with adequate PPV but low NPV, when validating it against MPS. Replacing the MPS with ETT, in the diagnosis and follow-up of IHD, is thus, not prudent. ETT can be useful as a screening test

Serum prostate specific antigen [PSA];In normal subjects and patients of benign prostatic hyperplasia and carcinoma prostate

To study correlation between age-linked serum prostate specific antigen [PSA] levels in normal subjects and patients of benign prostatic hyperplasia [BPH] and carcinoma prostate [CaP]. OPDs. Case-control study. SIUT; Karachi Six months. 250 subjects were enrolled for the study and 93 were finally selected [31 each, representing the normal, BPH and CaP groups]. Subjects 40 years of age and above were included and those with any urinary tract disorder orthose under treatment with 5-alpha-reductase inhibitors were excluded. Each group was divided into four sub-groups of ages 40-49, 50 - 59, 60 - 69 and 70 and above years. AxSYM total PSA [tPSA] assay_ was used tor serum PSA estimation. Values were expressed as mean and standard error of mean and Fischer's test, students' t test and correlation coefficient were used to determine significance and for comparison of data. There was a no significant difference in PSA levels in all age groups when normals were compared with BPH cases. PSA levels were significant in normal as compared to CaP cases and BPH as compared to CaR. No significant correlation between age-linked serum PSA levels in normal subjects and patients of BPH and CaP could be established. The study, however, found atrend of declining PSA levels at the age of 70 years and above

Effect of post-myocardial infarction streptokinase [SK] therapy, on myocardial viability - evaluation with thallium- 201 single photon emission computed tomography [TL-201 SPECT]

To evaluate the effect of post-myocardial infarction Streptokinase therapy on myocardial viability, employing Thallium-201 single photon emission computed tomography [TL-201 SPECT]. Retrospective, experimental study. The Nuclear Cardiology Department, Armed forces Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi, from 1[st] April 2009 to 31[st] October 2009. Male patients, who had suffered from acute myocardial infarction [AMI], in an area supplied by the left anterior descending [LAD] artery, had infarct-related electrocardiogram [ECG] changes and received or did not receive Streptokinase therapy, were included. Those with a normal ECG, or history of revascularization, or non-ST elevation MI, or more than on MIs, were excluded. The patients were divided into groups 1 [who received Streptokinase] and 2 [who did not receive Streptokinase]. Each group contained 42 patients and all underwent scintigraphic viability study through intravenous injection of 3.0 mCi [123 MBq] of TL-201, followed by rest-redistribution SPECT imaging on a dual head, dedicated cardiac gamma camera system [Philips Cardio MD [registered sign]]. Emory's cardiac toolbox [registered sign] and AutoQUANT [registered sign] were used for data processing and quantitative estimation of viable myocardium. Empirical scores from 0 to 2 were assigned to each of the scans, in the order of increasing viability, and these were compared across the two groups. Group 1 contained 42 patients [age range = 38 to 80 years, mean = 53.98 +/- 11.26 years], in whom empirical viability scoring was done. Score 0 was seen in 2 patients, score 1 was seen in 15 patients and score 2 was seen in 25 patients from this group. Group 2 also contained 42 patients [age range = 38 to 80 years, mean = 56.71 +/- 9.05 years], in whom viability score of 0 was seen in 3 patients, score 1 was seen in 11 patients and score 2 was seen in 28 patients from this group. Age difference between the two groups was statistically insignificant [p = 0.223]. The myocardial viability results analysed by 3 x 2 contingency table applying chi- square [X[2]] test also showed no significant difference between groups 1 and 2 [p= 0.611]. This study did not find any significant difference in myocardial viability - post- myocardial infarction - in patients who received or did not receive Streptokinase therapy

Assessment of cerebral perfusion in chronic tobacco users through spect [single photon emission computed tomography] using tc-99m hmpao [metastable technetium-99 labelled hexa-methyl propylene amine oxime]

To determine an association between chronic tobacco use and changes in cerebral perfusion through semi-quantitative scintigraphic assessment employing metastable Technetium-99 labelled hexa-methyl propylene amine oxime single photon emission computed tomography [Tc-99m HMPAO SPECT]. Design: Case-control study. Place and duration of study: The study was conducted at the Department of Medical Sciences, Pakistan Institute of Engineering and Applied Sciences [PIEAS], Nilore, Islamabad, from Oct 2001 to May 2002. Regional cerebral perfusion in 48 chronic tobacco users was evaluated, utilising a normal database created by HMPAO brain scans of 20 non-tobacco users. Subjects were classified into chronic tobacco users and non-tobacco users through the use of the smoking index [SI]. [Smoking Index = Number of years of tobacco use x Number of cigarettes smoked per day]. SI value of 100 was taken as the cut-off value. Regions of interest [ROIs] were declared hypoperfused or hyperperfused if their percentage perfusion values relative to the average perfusion per pixel of the whole slice under evaluation did not fall within + 2 standard deviation [SD] of the mean regional perfusion in the corresponding ROI, in the normal control group. Result: Chronic tobacco users showed 164 hypoperfused ROIs [6.57%] and 138 hyperperfused ROIs [5.53%] out of 2496 ROIs assessed, whereas the normal controls showed only 15 hypoperfused [1.44%] and 27 hyperperfused [2.60%] ROIs out of 1040 ROIs assessed [P < 0.001]. Cerebral perfusion in chronic tobacco users was found to be significantly decreased compared to the non-tobacco users

Subarachnoid haemorrhage; evaluation by CT scanning

25 patients of Subarachnoid Haemorrhage between the ages of 39 to 70 years were studied over a period of 3 years [Jan, 1998 to Dec, 2001] out of which 92% patients had classical Subarachnoid Haemorrhage on CT and 8% did not show any definite SAH. CT scan is quite helpful in Subarachnoid Haemorrhage diagnosis and there after the proper management of the disease.

Colour doppler ultrasound; A useful diagnostic tool for venous imaging

The incidence and prevalence of venous thrombosis can only be estimated as most episodes go undetected clinically. Venous Thromboembolism [VTE] is a major source of emboli in 95% cases of pulmonary embolism [P.E], which in tuner is one of the leading causes of death in patients dying undetected. This study was carried out in the Department of Radiology and Ultrasound at Allied Hospital, PMC Faisalabad for a period of 8 months and total number of cases are 100. The objective was to evaluate the case of VTE and their squealae by using Colour Doppler studies. The result was that colour doppler sonography and colour enhanced technique has improved the sensitivity of blood flow detection