Discrepancy in core infarct betweennon-contrast CT and CT perfusionwhen selecting for mechanicalthrombectomy

Objective@#Mechanical thrombectomy (MT) is now an established treatment foracute ischemic stroke (AIS) with large vessel occlusion (LVO) within 6 hours. Since2018, MT is also recommended from 6-24 hours after selecting with additional multimodalimaging including perfusion imaging. We sought to investigate patients withsignificant discrepancy in core infarct between computed tomography (CT) and CTperfusion (CTP). @*Methods@#In this retrospective study, patients with AIS who were evaluated for MTusing the RAPID software (IschemaView, Redwood City, CA, USA) from February2018 to March 2019 were included. Cases with discrepancy between infarct volumeon non-contrast CT and core volume (cerebral blood flow <30%) as analyzed by RAPIDon CTP were analyzed. @*Results@#In the study period, 635 patients were evaluated for acute stroke symptoms.Non-contrast head CT was performed in 635 patients, and CTP with RAPID softwarepost processing was performed in 134 patients. Among the 134 patients, 8 (5.9%)patients had gross discrepancy in core infarct between CT and CTP, with underestimationof infarct by CTP. Evaluation of these cases shows that the likely reason forthis discrepancy is recanalization of a LVO, which then leads to erroneously normal orgross underestimate of the core infarct volume determined from CTP post processinganalysis. @*Conclusions@#Recanalization of a LVO can lead to erroneously normal or gross underestimationof the core infarct as determined by post processing software analysisof CTP data. The whole composite of hyperacute CT imaging should be examinedwhile making decisions. This caveat of perfusion imaging interpretation has not beenreported previously.

Metronidazole in acute non-perforated appendicitis

Objective: To compare the infective complication rate after open appendicectomy in patients with nonperforated appendicitis receiving cefazolin with metronizadole and cefazolin alone

Study design: Randomised controlled trial

Place and Duration of study: PAEC General Hospital Islamabad, from March 2015 to June 2016

Methodology: Patients with acute non-perforated appendicitis were divided into two groups. Group A patients received cefazolin with metronizadole and Group B received only cefazolin. A total of three doses were given, one preoperatively and two postoperatively in each group. Patients in both groups were followed up for 30 days postoperatively for any surgical site infections [SSI]

Results: A total of 242 patients were operated of whom 11 were excluded as they did not come for follow-up. There were 111 patients in group A and 120 in group B. Infection rate in group A patients was 7.21 % and in group B, 8.33%. There was no significant difference of wound infection in both the groups [p=0.427]

Conclusion: Addition of metronizadole in patients with non-perforated acute appendicitis did not reduce the rate of surgical site infection

Medicinal uses and chemistry of flavonoid contents of some common edible tropical plants

Flavonoids are wide range of phytochemical with various pharmacological effects including antioxidant, anti-inflammation, anti-platelet, anti-allergic, cytotoxicity, reduce risk for heart disease or cancer etc. These flavonoids inhibited various enzymes such as prostaglandin synthase, lypoxygenase, cyclooxygenase, and induced detoxifying enzyme systems such as glutathione S-transferase. Flavonoids have significant vitamin C sparing activity and powerful antioxidants than the traditional vitamins such as quercetin, myricetin, rutin and apigenin. In vegetables, quercetin glycosides predominate, but glycosides of kaempferol, luteolin, and apigenin are also present. Fruits exclusively contain quercetin glycosides, whereas kaempferol and myricetin glycosides are found only in trace quantities. In this article we mainly discussed on three major flavonols [kaempferol, quercetin, and myricetin] and two major flavones [luteolin and apigenin] of edible tropical plants

Subclinical hypothyroidism; frequency in chronic kidney disease patients before dialysis

Chronic kidney disease [CKD] is characterized by progressive destruction of renal mass with irreversible sclerosis and loss of nephrons.Various metabolic, hematological and endocrine abnormalities are known to occur in CKD. Subclinical hypothyroidism is an important endocrine abnormality associated with a greater cardiovascular risk, atherosclerosis and an important factor for progression of renal disease in such patients. To calculate the frequency of subclinical hypothyroidism in predialysis CKD patients. Cross sectional survey. Pathology Department Post Graduate Medical Institute, Lahore. 06 months [June 2011 to Dec 2011]. 210 patients were included in the study Serum creatinine. TSH and FT4 were measured and the relevant data was entered in predesigned proforma. 19.5% of CKD population had subclinical hypothyroidism with slightly increased preponderance in females as compared to males and also increased frequency as the stage of CKD increased. Subclinical hypothyroidism is more common in CKD population. Increased frequency of subclinical hypothyroidism was found in patients with reduced renal function not on dialysis. 19.5% of CKD population on conservative management had labortary evidence of thyroid dysfunction

Phytochemical study of polyphenols in perilla frutescens as an antioxidant

Perilla frutescens is an annual herb of the mint family native to East Asia. Polyphenols present in perilla have various structural varieties with large diversity of biological activities. It is direct influence the quality of perilla plant and their potential functions. Some of these products have been studied and proven to be effective source of phenolic antioxidants. The aqueous extract contains phenolic compounds such as phenolic acids, cinnamic acid derivatives, flavonoids, and lignans. Gallic acid, hydroxytyrosol [3,4-DHPEA], cinnamic acid derivatives [coumaroyl tartaric acid, caffeic acid and rosmarinic acid], flavonoids, scutellarein 7-O-diglucuronide, luteolin 7-Odiglucuronide, apigenin 7-O-diglucuronide, luteolin 7-O-glucuronide, and scutellarein 7-Oglucuronide], and anthocyanins [mainly cis-shisonin, shisonin, malonylshisonin and cyanidin 3-O-[E]-caffeoylglucoside-5-O-malonylglucoside] are present

Assessment of antibacterial, thrombolytic and cytotoxic potential of Cassia alata seed oil.

Cassia alata is a pan tropical shrub. It has been reported to have medicinal activities like laxative effect and active against ringworm, skin diseases and ulcer. The leaf extract of this plant has shown antibacterial activity. In this study, seed oil extracted from Cassia alata , was studied for Antibacterial, Thrombolytic and Cytotoxic activity by using in vitro techniques. Chloroform extract of the seed oil was tested for Antibacterial activity using disc diffusion method and that extract showed potent antibacterial activity against both Gram(+) and Gram(-) bacteria. DMSO extract of the seed oil was tested for Brine shrimp lethality bioassay using Brine shrimp nauplii. The LC50 of DMSO extract of Cassia alata seed oil was found to be 250μg/ml, indicates that the oil has moderate pharmacological action. The DMSO extract of the seed oil was also tested for in vitro thrombolytic activity. The extract showed reasonable thrombolytic activity against negative control (water).Further investigation on the plant is required to confirm their pharmacological activity and thereby utilizing them as useful medicinal plant.

Sensitivity and specificity of BerEP4 immunostaining in basal cell carcinoma cases in Asian skin

To evaluate the BerEP4 stain positive cases of basal cell carcinoma in our population [BCC]. A non-interventional descriptive study. Military Hospital and Armed Forces Institute of Pathology [AFIP] Rawalpindi from 1[st] January 2009 to 31[st] August 2009. Patients who reported to the skin department of Military Hospital Rawalpindi with clinical impression of BCC were biopsied. Only those cases which were easily diagnosed on Haematoxylin and Eosin [HandE] were included. All such sections were then subjected to BerEP4 immune marker and the intensity of staining was noted. In addition, 11 cases of straight forward squamous cell carcinoma [SCC] were also stained with BerEP4, which served as controls. The study group [BCC cases] included 17 males [59%] and 12 females [41%], who were histologically diagnosed as BCC. All such cases were subjected to BerEP4 immune staining. All the tumors showed positive staining, the intensity/staining pattern was however variable. Twenty-two out of twenty-nine cases showed diffuse [75.9%], while 7 out of 29 cases showed partial [24.2%] staining; irrespective of the histological subtype and site of tumor. All the SCCs were negative for BerEP4 staining. BerEP4 was positive in 100% of the cases. Its intensity was however variable. Nevertheless, it must be used with confidence in all difficult to diagnose cases of BCC, especially when it is difficult to differentiate from SCC

Therapeutic evaluation of a combination of Bambusa arundinacea, Calotropis gigantea, piper nigrum, Zingiber officinole, Colchicum autoummale, Asphalt and Calcined iron in gout

Gout [Niqras: derived from Anqaroos meaning greater toe] is not a single disease. The term is used to describe a number of disorders in which crystals of monosodium urate deposit on joints give rise to acute gouty arthritis of metatarso-phalangeal joint of a greater toe in 70% of patients. Several Unani single and polypharmaceutical combinations are reported in literature as being highly beneficial in gout. In this study an attempt has been made to evaluate the efficacy of a combination of drugs in gout [Niqras]. The observations and results were analysed statistically and test of significance was done by applying paired 't' test

Clinicohistological pattern of ovarian tumours in Peshawar region

Ovarian tumours are one of the major health problems confronting the general practitioners in general and gynaecologists in particular. Ovarian tumours may either be asymptomatic, found on the routine ultrasound examination or symptoms may be vague till the patient has an acute emergency like torsion or rupture of a benign cyst. The worst is late presentation of a malignant ovarian tumour. There is marked variation in the presentation of the tumour as well as in histological types. This study was undertaken to analyse modes of presentation and various histopathological patterns of ovarian tumours. This study was conducted from 1st January, 2002 to 31[st] December, 2002, in Gynaecology 'A' Unit, Lady Reading Hospital [LRH] Peshawar. After admitting patients with ovarian tumours a detailed case history was taken followed by thorough clinical examination. All the relevant details were recorded using the questionnaire. Patients were investigated after performing various surgical procedures; the specimens of ovarian tumours were subjected to Histopathological examination in the histopathology section, Lady Reading Hospital, Peshawar. Amongst the total numbers of 5732 gynaecological admissions during study period the total numbers of ovarian tumours were sixty-eight. Out of which benign ovarian tumours were 61 [89.71%] and malignant ovarian tumours were 7 [10.29%]. There were no tumours with borderline malignancy. The commonest histological pattern observed in the study was epithelial tumours [76.5%] including both benign and malignant tumours. The commonest benign tumour was serous cyst adenoma [24%] followed by mature cystic teratoma [18%]. Common malignant ovarian tumours were granulosa cell tumours and Endometriod carcinoma [each 28.5%]. Epithelial tumours are the commonest variety of ovarian tumours followed by Germ cell tumours. The histological type of ovarian tumour correlates with the prognosis of the tumour

Significance and cost effectiveness of pre-operative routine laboratory investigations in young healthy patients undergoing elective ear, nose and throat surgery

Pre-operative preparation is an important component of surgical workup. Adequate clinical assessment to determine fitness for anaesthesia and surgery and to outrule possibilities of existing disease or risk factors against the procedure would suffice in elective surgery on healthy young patients. Still routine investigations are carried out following a protocol, that does not offer added benefit and is not cost effective. We evaluated one hundred and fifty young healthy patients planned for elective surgery, to compare adequate clinical assessment with results of routine investigations in such patients, in terms of significance and cost effectiveness. Significant co-relation was demonstrated between clinical assessment and routine investigations. Only 03 abnormal results were reported following 600 laboratory investigations on 150 patients. Thorough clinical assessment is mandatory for successful outcome of surgery. There is significant co-relation with routine investigations in elective Ear, Nose and Throat [ENT] surgery. Investigations should be restricted to where indicated by clinical assessment. Such policy will significantly reduce the costs and workload, thereby improving quality of health care system

Hairy cell leukemia: a case report

We report a case of a middle aged male diagnosed as Hairy cell leukemia. Clinicohematologic features were fever, weight loss, splenomegaly, anemia and thrombocytopenia. Bone marrow and spleen were infilterated by Hairy cells. An unusual feature was high TLC with large number of Hairy cells resembling superficially Hairy cell Variant. But the Flow cytometric analysis confirmed that immunophenotype was that of classic Hairy cell leukemia. Patient responded to Cladarabine therapy and had an uneventful recovery

Cigarette smoking survey of citizens of Mansehra

When a cigarette is smoked, about one-half of the smoke generated is side stream smoke. This form of smoke contains essentially all of the same carcinogenic [cancer causing] and toxic agents that have been identified in the mainstream smoke inhaled by the smoker, but at greater levels. As smoking from different sources is pollution and injurious to health, so we planned to carry out cigarette smoking survey of citizens of different localities of Mansehra. The study was carried out on 2100 subjects residing in different localities of Mansehra. A specifically designed questionaire was filled individually. Out of the study population 850 [40.48%] were found to be indulged in cigarette smoking. The study suggested that smokers should avoid smoking for the sake of their health

Relationship between disease activity indices and colonoscopic findings in ulcerative colitis

Ulcerative colitis previously thought to be a western disease has a world wide distribution with increasing incidence even in Pakistan. The clinical presentation is highly variable and is characterized by periods of symptomatic flare-ups and remissions. This study was designed to seek relationship between disease activity indices and colonoscopic findings in ulcerative colitis including extent, macroscopic and microscopic grade of disease. This is a review article

Pituitary tumors: clinical presentation

Seventeen patients with pituitary tumors presented in a 2 year period of study. Clinical, ophthalmological and endocrinological evaluation of all these patients was done along with histopathological examination. All the cases were macroadenomas. There was slight male predominance. These tumors mainly presented in the third and fourth decades of life. Fortyseven% were nonfunctioning and presented with headache, visual deterioration and visual field defects. Fiftythree% were functioning adenomas and they presented with endocrinopathies as the main feature. Majority were prolactinomas, other being growth hormone adenomas