Role of dexamethasone in brachial plexus block

To evaluate the effect of dexamethasone added to [lignocaine] on the onset and duration of axillary brachial plexus block. Randomized controlled trial. Combined Military Hospital Rawalpindi, from September 2009 to March 2010. Patients and Methods: A total of 100 patients, who were scheduled for elective hand and forearm surgery under axillary brachial plexus block, were randomly allocated to group A in which patients received 40 ml 1.5% lidocaine with 2 ml of isotonic saline [0.9%] and group B in which patients received 40 ml 1.5% lidocaine with 2 ml of dexamethasone [8 mg]. Nerve stimulator with insulated needle for multiple stimulations technique was used to locate the brachial plexus nerves. After the injection onset of action and duration of sensory blockade of brachial plexus were recorded at 5 minutes and 15 minutes interval. Group A showed the onset of action of 21.64 +/- 2.30 min and in group B it was 15.42 +/- 1.44 min [p < 0.001]. Duration of nerve block was 115.08 +/- 10.92 min in group A and 265.42 +/- 16.56 min in group B [p < 0.001]. The addition of dexamethasone to 1.5% lignocaine solution in axillary brachial plexus block prolongs the duration of sensory blockade significantly

Gas chromatography-mass spectrometry analysis of various organic extracts of Merremia borneensis from Sabah

OBJECTIVE@#To analyse the chemical composition of different extracts of Merremia borneensis (M. borneensis) by gas chromatography-mass spectrometry (GC-MS).@*METHODS@#The dried leaves powder was extracted with methanol at room temperature by using Soxhlet extractor. Methanol crude extracts of M. borneensis were extrastel with hexane, chloroform, ethyl acetate and butanol.@*RESULTS@#Qualitative analyses of various organic crude extracts showed that majority of these are flavonoids, terpeniods, alkaloids and glycosides. Most of the identified compounds by GC-MS are biologically important. Further the M. borneensis leaf possesses certain characteristics that can be ascribed to cultivation on a domestic plantation.@*CONCLUSIONS@#The suitable extracts for respective compounds can be chosen on the basis of above GC-MS analysis. All the major compounds from different extracts are biologically active molecules. Thus the identification of a good number of compounds from various extracts M. borneensis might have some ecological significance.

In vitro total phenolics, flavonoids contents and antioxidant activity of essential oil, various organic extracts from the leaves of tropical medicinal plant Tetrastigma from Sabah

OBJECTIVE@#To detect the in vitro total phenolics, flavonoids contents and antioxidant activity of essential oil, various organic extracts from the leaves of tropical medicinal plant Tetrastigma from Sabah.@*METHODS@#The dry powder leaves of Tetrastigma were extracted with different organic solvent such as hexane, ethyl acetate, chloroform, butanol and aqueous methanol. The total phenolic and total flavonoids contents of the essential oil and various organic extracts such as hexane, ethyl acetate, chloroform, butanol and aqueous ethanol were determined by Folin - Ciocalteu method and the assayed antioxidant activity was determined in vitro models such as antioxidant capacity by radical scavenging activity using α, α-diphenyl- β-picrylhydrazyl (DPPH) method.@*RESULTS@#The total phenolic contents of the essential oil and different extracts as gallic acid equivalents were found to be highest in methanol extract (386.22 mg/g) followed by ethyl acetate (190.89 mg/g), chloroform (175.89 mg/g), hexane (173.44 mg/g), and butanol extract (131.72 mg/g) and the phenolic contents not detected in essential oil. The antioxidant capacity of the essential oil and different extracts as ascorbic acid standard was in the order of methanol extract > ethyl acetate extract >chloroform> butanol > hexane extract also the antioxidant activity was not detected in essential oil.@*CONCLUSIONS@#The findings show that the extent of antioxidant activity of the essential oil and all extracts are in accordance with the amount of phenolics present in that extract. Leaves of Tetrastigma being rich in phenolics may provide a good source of antioxidant.

Retinopathy risk factors among diabetics in a tertiary care military hospital

To determine the frequency and risk factors for severity of retinopathy in diabetic patients referred to a tertiary military hospital. Cross-sectional study. Armed Forces Institute of Ophthalmology, Rawalpindi from Jun 2008 to Dec 2009. Diabetic patients aged 40 to 79, referred for suspected diabetic retinopathy [DR] on fundoscopy from medical outpatient clinic of Military Hospital Rawalpindi were randomly included in the study. Participants underwent a standardized interview and examination Retinopathy was assessed through dilated pupils, and graded into absent retinopathy, mild to moderate, or advanced. Presence of clinically significant macular edema [CSME] was also recorded. To evaluate the simultaneous effect of significant risk factors on the different stages of DR, multivariate regression analysis was carried out. Out of five hundred and ten patients, DR was confirmed in 63% cases with advanced retinopathy in 21.3%. In univariate analysis, duration of diabetes, fasting blood glucose, and presence of oedema were significantly associated with retinopathy [P<0.005] On multivariate analysis, however, only duration of diabetes [Odds Ratio 6.15 for 5 to 10 years and 38.29 for more than 10 years] and macular oedema [OR 6.617 95% CI 3.95-11.07] remained significant. CSME was present in 173 [33%] patients and its frequency increased with the severity of DR [P<0.001]. The frequency of DR among military personnel and their dependants was high with strong association to duration of diabetes. This underscores the importance of regular retinal detect DR in the early stages and timely intervention to prevent diabetes related blindness

Frequency of ocular manifestations of chronic graft versus host disease

With the advancement of techniques for haematopoietic cell transplantation, the number of transplant survivors is increasing rapidly and so are the chances of chronic graft versus host disease [cGVHD]. The ocular manifestations of this disease have not been explored in our local population. This study was conducted to determine the frequency of ocular complications in cases of cGVHD following successful bone marrow transplantation. Twelve diagnosed cases of cGVHD were evaluated from June 2008 to March 2009 and there ocular manifestations were noted especially the ocular surface disorders, using double staining method with fluorescein and rose-bengal. Nine patients [75%] were having dry eyes, 7 [58.3%] with mebomian glands dysfunction, 4 [33%] with acute conjunctivitis, 2 [16.7%] with bilateral lacrimal canalicular occlusion, and 1 [8.3%] each of bilateral posterior subcapsular cataract, unilateral sterile corneal epithelial defect, anterior uveitis, retinal haemorrhages and disc oedema. The higher frequency of dry eyes along with other ocular manifestations in patients of cGVHD suggests the need of close ophthalmic monitoring in all such cases

Intralenticular foreign body with a clear lens

Intraocular foreign bodies [IOFBs] are not uncommon in patients of penetrating ocular trauma but intralenticular foreign bodies are rarely seen. Penetrating ocular injuries are observed more commonly in young men. Intralenticular foreign bodies cause visually significant cataract in almost all cases. We report here a case of a young soldier with intralenticular foreign body of about 1.5 mm in size sparing the visual axis and only causing focal cataractous changes. The foreign body remained innocuous for about 3 months of follow-up not causing any progressive cataract, glaucoma or uveitis. The foreign body was removed, lens aspiration was done and posterior chamber intraocular lens was implanted, as patient could not be followed on long-term basis. The vision was restored to normally within 2 months

Spontaneous resolution of direct carotid cavernous fistula

Proptosis due to carotid cavernous fistula is rare sequelae of head injury. We report a case of post-traumatic, direct high flow carotid cavernous fistula that resolved spontaneously 06 weeks after carotid angiography. It however, resulted in loss of vision due to delay in early treatment. In the cases of post-traumatic proptosis, carotid cavernous fistula should be kept in mind

Use of botulinum A toxin [BOTOX] in different types of facial dystonia

This study was carried out in the Eye Departments of Combined Military Hospital, Kharian and Military Hospital, Rawalpindi, from January 2007 to August 2008. To determine the effects of botulinum A toxin [Botox] injection in different types of facial dystonia. A total of 23 botulinum A toxin [Botox] injections were given in 13 patients including 7 males and 6 females. Patients were followed up at 1 week, 6 weeks and 6 months after the injection. The indications were essential blepharospasm in 4 [30.77%] cases and hemifacial spasms in 9 [69.23%] cases. Age ranged from 28 to 60 years [mean 41 +/- 12 years]. Four patients were given injections three times and 2 patients were injected twice. Onset of action of botulinum A toxin [Botox] was variable, starting on the same day in 3 patients while in the rest of patients it started on the next day. Mean duration of action was 12.77 weeks +/- 4.68 [range 6-23 weeks]. Dystonia improved in all the cases. Temporary slight facial paresis and lagophthalmos occurred in 3 [23%] cases while ptosis occurred in 2 [15.4%] cases. Two patients [15%] had mild ocular irritation and conjunctival congestion after injection, which settled with topical mild steroid [fluorometholone]. Botulinum A toxin [Botox] is useful treatment for different types of facial dystonia

Bilateral lacrimal bicanalicular obstruction in chronic graft versus host disease

Bone Marrow transplantation has been increasingly used for the treatments of various blood cancers for last two decades. As a complication, a variable number of patients develop Chronic Graft Verses Host Disease [cGVHD] six to eight months later. Ocular involvement occurs in 60 to 80% of patients with cGVHD. Though dry eye sensation is the most common ocular symptom of cGVHD we report here a case of excessive watering due to bilateral lacrimal bicanalicular obstruction secondary to ocular involvement in cGVHD along with onset of dry eye features

Efficacy of pre-operative injection Mitomycin-C in prevention of pterygium recurrence

To determine the recurrence rate of pterygium with four weeks preoperative injection mitomycin-C using bare sclera technique. An interventional case series. This ongoing study was started in November 2005 at eye department of combined military hospital Kharian, Pakistan. Ninety one eyes of 87 patients have been so far enrolled in the study. Cases between 20 to 50 years of age, of either sex, with primary and recurrent pterygia were included. The subjects were first given 0.1 ml injection mitomycin-C 0.15 mg/ml into the body of pterygium. Four weeks later, pterygium surgery was performed using bare-sclera technique. The subjects are being followed up for at least one year to detect any recurrence. Out of 91 cases, 16 [17.58%] cases have been followed up for 12 months, 19 [20.87%] for 9 months, 21 [23.07%] for 6 months, 17 [18.68%] for 3 months and 18 [19.78%] for less than 3 months. Recurrence has not been encountered in any of these cases so far. Initial results show that pterygium surgery with pre-operative injection mitomycin-C appears to be an effective form of treatment for prevention of pterygium recurrence. Further follow up and multi-centric studies are required for final conclusion

Deoxypyridinoline [DPD], a marker of bone resorption which predicts osteoporosis

With the improvements in medical facilities, the life expectancy of ladies has crossed fifty years in Pakistan. Because of this, problems related to menopause and senility is increasing. A cross-sectional study was conducted to determine the incidence of osteoporosis in Pakistani postmenopausal women residing at Rawalpindi. This was done by estimation of deoxypyridinoline [DPD], a marker of bone resorption, for its potential for early diagnosis; so that the patients are benefited by early treatment before the disease is severe and crippling. Seventy postmenopausal women having intact ovaries were selected randomly from the general public in the locality. Control group consisted of thirty healthy premenopausal women. The mean urinary DPD level in premenopausal ladies i.e. Controls was [5.8 nmol/mmol of creatinine], while in postmenopausal women the mean DPD level was significantly higher [27.4 nmol / mmol of creatinine]. The very high loser ladies [Urinary DPD level > 30 nmol / mmol of creatinine] were regarded to have osteoporosis. X-ray of the wrist remained a poor diagnostic marker as it was positive in only 15% of postmenopausal subjects. The frequency of osteoporosis was 13.5% in ladies between 50-59 years, while in ladies between 60 - 69 years the frequency was 78% and 100% in ladies over 70 years. These figures are quite alarming

Hyperhomocysteinemia as a risk factor for ischemic heart disease

To determine association of hyperhomocysteinemia with myocardial infarction and conventional risk factors for ischemic heart disease. Design: A non-interventional comparative case control study. Place and Duration of Study: The study was conducted at the department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi and Armed Forces Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi from January 2001 to June 2001. Patients and A total of 100 hospitalized patients having myocardial infarction [MI] were randomly selected comprising 85 males and 15 females. The average age of the patients was 53 +/- 4.5 years. A similar number of age and gender-matched healthy controls were also selected. The demographic details, history and clinical examination of both patients and controls were recorded and their blood was collected in fasting state for estimation of serum total cholesterol, plasma glucose and serum total homocysteine. Serum total homocysteine level in controls was significantly lower [10.8 +/- 4.1 mmol/L] as compared to patients [18.0 +/- 5.9 mmol/L] [p < 0.0001]. Smoking showed statistically significant association with hyperhomocysteinemic patients [p = 0.04]. Ischemic heart disease was associated with moderate hyperhomocysteinemia in our patients and it was also associated with smoking