ABSTRACT
Objective: to assess the reliability of non-islanded distally based sural artery flap, in terms of number of flap failure [partial and major flap necrosis], number of surgeries related to the problem for which flap surgery was performed, hospital stay and return to work, for coverage of soft tissue defects of the distal one-third of leg, ankle and heel
Study Design: cohort study
Place and Duration of Study: department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore, Pakistan, from January 2003 to March 2014
Methodology: distally based sural artery flaps in 87 patients requiring coverage of distal lower lumb were studied, retrospectively. They were divided into two groups. G1 included 46 cases in which distally based sural artery flap was islanded. G2 included 41 cases in which flap was not islanded and pedicle was raised. The variables that were measured in two groups included age, gender, size and cause of defect, co-morbidities, number of surgeries, total hospital stay, return to work and flap related complications. Independent sample t-test and tests of proportions were used for comparison with significance at p < 0.05
Results: the mean age of patients was 38.4 +/- 16.2 years in G1 and 35.1 +/- 18.6 years in G2. In G1, 34 cases were traumatic, 5 caused by diabetic ulcers and another 7 cases were trophic ulcers in paraplegic patients caused by pressure sores. In G2, the cause was trauma in 32 cases, diabetic ulcers in 7 cases, trophic ulcers in 2 cases. The mean number of surgeries in G1 was 3 +/- 1 and 2 +/- 1 in G2 [p < 0.001]. The mean hospital stay in G1 was 43.1 +/- 3.6 days while 27.9 +/- 2.1days in G2 [p < 0.001]. There was epidermolysis in 21 out of 46 islanded distally based sural artery flaps [G1] and in 9 out of 41 non-islanded flaps [G2] [p=0.0203]. Partial necrosis occurred in 12 of flaps in G1 and in only 3 of G2 flaps [p=0.024]
Conclusion: distally based sural artery flap can be made more reliable and with lesser complications by raising the pedicle with skin rather than islanding the flap
ABSTRACT
Objective: To assess the Positive and Negative Symptoms Scale pattern and World Health Organization Quality of Life-BREF scale scores of patients with schizophrenia after seven years of the initial diagnosis
Study Design: A cross sectional observational study
Place and Duration of Study: Department of Psychiatry, Military Hospital Rawalpindi from Jan 2007 to Dec 2008
Material and Methods: Thirty patients who were invalided out of military service with the diagnosis of schizophrenia in 2000 and 2001 were subjected to psychometric evaluation seven years after the initial diagnosis in 2007 and 2008. They were assessed for their current symptoms and Quality of life using Positive and Negative Symptoms Scale [PANSS] and World Health Organization Quality of Life [WHOQoL-BREF] scale respectively. Both are established psychometric tools to assess the entire spectrum of schizophrenia and quality of life
Result: All patients were males. Forty three percent of the subjects had Positive and Negative Symptoms Scale [PANSS] score i.e. below cut off value of 65. Mean PANSS score of the group was 72. A score of more than 12 on World Health Organization Quality of Life-BREF [WHOQoL-BREF] scale indicating better quality of life was seen in 43 % of the patients. Factors linked with PANSS score > 65 and poor Quality of life [Qol score 4-12] were being single, unemployed, living in cities, using psychoactive substances and in initial years of military service
Conclusion: More than half of the patients with diagnosis of schizophrenia continue to show high Positive and Negative Symptoms Scale [PANSS] score and poor quality of life after seven years of initial diagnosis of schizophrenia
ABSTRACT
Nigella sativa [N. sativa], remedial usage against different diseases associated with skeleton, cardiovascular, digestive and urinary systems has a long-standing history. At present, efforts are underway to study its effects against various cancers at both the cellular and molecular levels. In this review, the role of active constituents like thymoquinone [TQ] on different types of cancer has been explored. TQ putative involvement in metastasis has been assessed by elucidating its effects on cell proliferation, adhesion, invasion and angiogenesis. Up regulation of caspase 3, Smac and down regulation of p-AKT, p65, XIAP, Bcl-2, COX-2 is also influenced by N. sativa. These findings prove a significant positive correlation between TQ concentrations and induction of apoptosis, decrease in motility and a reduction in invasion and angiogenesis in cancerous cells. However, there are still quite a few unaddressed domains, which need to be understood. One of these may include target specificity of N. sativa against cancerous tissues, mode of administration, dosage and downstream regulators in mediating these effects. In reference to earlier findings and low cost availability, N. sativa may, also, be suggested as either a suitable sole remedy for cancer or as a complementary to ongoing conventional therapy based extensive and rigorous in vivo optimization and validation
ABSTRACT
Introduction: Renal stones have been one of the most commonly encountered diagnosis in patients visiting Urology clinics and Extra-Corporeal Shock Wave Lithotripsy [ESWL] has been an effective method for management of renal stones of certain size [Up to 2.5 cm]
Objective: To determine the complication rates in patients undergoing ESWL to look for safety level of the procedure. Duration And Setting: Study was conducted From December 2015-March 2016 in Kidney Center, DHQ Hospital, Faisalabad
Methodology: First 225 patients undergoing ESWL at Kidney Center, DHQ Hospital, Faisalabad were included in the study and they were observed for short term complications as post procedure pain, hematuria, fever and ureteric obstruction
Results: 225 patients included in the study. Among them 132 [58.7%] were male, 93 [41.3%] were female. Average age of patient was 38.2 years with minimum range as 5 years and maximum as 75 years. Stone size ranged from 7mm to 2.5cm with average size as 1.541cm. Fragmentation was observed in 218 [96.9 %] patients in first two sessions while no fragmentation was observed in 7 [3.1%] patients after two sessions. Out of 225, 37[16.4%] patients developed pain, 19 [8.4%] observed hematuria, 7 [3.11%] have fever and 6 [2.66%] developed ureteric obstruction. Only 3 patients developed two complications simultaneously. No statistical association was found for development of complication after ESWL in our study
Conclusion: Inference drawn from the statistics clearly showed that ESWL is still a very safe and effective modality for renal stone management
ABSTRACT
Objectives: To determine the significance of indwelling time for bacterial colonization of DJ stents by measuring the frequency of bacterial colonization in such stents after endoscopic Urological surgery. Place And Duration: Study was done from September 2014 to November 2015 [15 months] in Department of Urology and Kidney Transplantation, Allied Hospital, Faisalabad
Methodology: 68 patient were included in the study who undergone Percutaneous nephrolithotomy [PCNL] and Ureterorenoscopy [URS] for renal and ureteric stones respectively with DJ stenting. Sterile nature of urine was assured in pre-operative circumstances and patients with active urinary tract infection were excluded from the study. Urinary cultures were performed at 2-4 weeks, 5[th] week and more than 6[th] week of indwelling time and lower end of DJ stent cultures were also performed after removal
Results: 68 patients were included in the study with mean age 48.5 years [20-77 years age limits]. Among 68, 38 were male patients and 30 were female. Percutaneous nephrolithotomy [n = 5] and ureterorenoscopy [n =63] were the procedures after which DJ stenting was performed. Out of 68, 36 patients undergone right sided stenting and 32 patients undergone left side ureteric stenting. Urine culture was positive in 1 [1.47%] case and DJ stent cultures were positive for bacterial colonization in 4 [5.8%] cases. We do not found any statistical association between stent culture analysis and variables like gender, age of patient, or laterality. However we find statistical significance between stent indwelling time and colonization as evident by the results that the rate of colonization was 2.7% when indwelling time was less than 4 weeks, 4% colonization when indwelling time was 5 weeks as compared to 28.5% colonization when indwelling time was more than 6 weeks
Conclusion: These results showed that colonization rates increases when indwelling time increases especially when indwelling time exceeds 6 weeks. This study also refers to the fact that DJ stents can be kept safely for maximum duration of 6 weeks and indwelling time greater than 6 weeks will be associated with complication of urinary tract infection. Moreover this study also showed that one may find an infected colonized stents even if urine culture is negative for any growth
ABSTRACT
Background: Penile carcinoma is an uncommon condition, accounting for less than 1% of all male cancers. It typically presents as a superficial lesion involving the Glans and Penile Shaft. Risk factors for penile carcinoma include phimosis, human papilloma virus infection and tobacco smoking. The spread of the tumor to the loco-regional lymph nodes is the most relevant prognostic factor
Case Presentation: The current case report is about a 65 years old male who presented with non-healing ulcer involving glans and shaft of penis for two months. Examination of Perineum revealed an ulcer of size about 3 cm in length involving glans and distal penile shaft, with eaten up most of glans surface. Wedge biopsy histopathology report showed moderately differentiated Squamous cell carcinoma of the penis involving sub-epithelial tissue with lympho-vascular invasion and involvement of corpora cavernosa. CT-Scan abdomen with IV contrast showed no evidence of metastasis or lymphadenopathy. So partial penectomy was planned and carried out subsequently
Conclusion: Although squamous cell carcinoma of the penis a rare disease, mainly affecting the elderly population but all the penile ulcers not responding to medial therapy must be evaluated for malignancy. Most of these cases remain neglected because of inadequate evaluation and investigation by the local doctors which leads to late presentation. Due to these circumstances the patients have already metastatic disease at presentation. So, it is required to educate local doctors as well as general population to create proper awareness of this disease
ABSTRACT
To determine the outcome and devise a protocol for emergency management of cut injuries in Flexor Zone 5 of hands. Descriptive study. Department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore, Pakistan, from January 2009 to March 2013. All patients above 12 years of age with single sharp cut injuries in Flexor Zone 5, with no skeletal injuries, presenting within 12 hours in emergency were included with follow-up of 6 months, with active range of motion evaluated by Strickland's adjusted formula. Power of opponens pollicis and adductor muscles was evaluated from P0-4. Nerve repair results were evaluated serially by advancing Tinnel's sign, electrophysiological studies and sensory perception scored from S0-4 compared to the normal opposite upper limb. The study group comprised of 31 patients [M: F = 2.4: 1]. Average age was 27 years ranging from 17 - 53 years. In 25 [80%] cases, injury was accidental, in 3 [10%] homicidal and in 3 [10%] injury was suicidal. Four most commonly involved structures included Flexor carpi ulnaris, ulnar artery, ulnar nerve and Flexor digitorum superficialis. Median nerve and radial artery were involved in 10 cases each, while ulnar artery and ulnar nerve were involved in 14 cases each. Longtendons were involved in most cases with greater involvement of medial tendons. None of the patients required re-exploration for ischaemia of distal limb while doppler showed 22 out of 24 vascular anastomosis remained patent. Recovery of long-tendons was good and recovery after nerve repair was comparable in both median and ulnar nerves. Early and technically proper evaluation, exploration and repair of Zone 5 Flexor tendon injuries results in good functional and technical outcome
Subject(s)
Humans , Male , Female , Ulnar Nerve/injuries , Emergency Medical Services , Lacerations/surgery , Radial Nerve/injuries , Treatment Outcome , Ulnar Artery/injuries , Ulnar Artery/surgery , Wounds, Penetrating/surgery , Wrist/blood supply , Wrist/innervationABSTRACT
To assess psychological, social and occupational functioning of patients after seven years of diagnosis of schizophrenia using Global Assessment of Functioning [GAF] scale [DSM-IV Axis-V]. A cross sectional study. Department of Psychiatry, Military Hospital Rawalpindi from October 2007 to October 2008. This study included 30 patients who were retired military personnel invalided out of service with diagnosis of Schizophrenia between 1[st] Jan 2000 to 31[st] Dec 2001. After recording demographic data, patients underwent psychometric evaluation seven years after the diagnosis in 2007 and 2008 respectively for assessment of their psychological, social and occupational functioning using Global Assessment of Functioning [GAF] Scale [DSM - IV Axis V]. All subjects were male. Majority of the patients i.e. 14 [46.7%] patients had mild to moderate symptoms of the disease [GAF score 41 - 80]. Those having high income, employed and living in cities were associated with better global functioning. Schizophrenia continues to be a chronic disabling severe mental illness with deterioration in all aspects of functioning of patients
ABSTRACT
Medicine is entering a new era for treating diseases and will enable physicians to treat the cause of a disease rather than the symptoms. Gene therapy is a promising treatment option for a number of diseases but the technique is still under investigation to make sure that it will be safe and effective. In the future, this technique may allow physicians to treat a disorder by inserting a gene to a patient's cells instead of using drugs or surgery. One of the major hurdles to successful gene therapy of genetic and acquired diseases is the ability to introduce a foreign gene efficiently into the tissue of interest. Numerous viral and non-viral [synthetic] methods for gene delivery have been developed. This review highlights the use of viral vectors for gene therapy such as adenoviruses, adeno-associated viruses, retroviruses, herpes simplex viruses, poxviruses and baculoviruses
ABSTRACT
The types of gene delivery systems are not restricted to viral vectors but can also be the simple administration of the gene itself. The use of viral vectors for gene delivery has some risks regarding the safety of the patient whereas non-viral vectors are considered to be more safe but so far are less effective in vivo. Non-viral gene delivery system includes both physical and chemical approaches that are gaining popularity for a variety of gene-mediated therapies in humans. From the beginning of naked DNA induction directly into the cells, a number of other physical techniques have also been introduced. So far these methods have employed pressure, large volumes, electricity, ultrasound, laser, mangatic force, etc. for the transfer and expression of gene to the target site and some of them are found to be quite efficient. This review highlights the major physical methods used for the delivery of genes in living organisms
ABSTRACT
The antibiotic resistance in microorganisms is a worldwide problem that results due to chemotherapy of microbial diseases. The appearance of gradual resistance shows that a single antibiotic loses its effectiveness with the laps of time against microorganisms. Bacteria: may develop resistance intrinsically or acquire it either vertically or horizontally. This review highlights the mechanisms involved in the resistance development-of bacterial species against different classes of widely used antibiotics
ABSTRACT
The resin based filling materials were introduced in dentistry at the end of the 1940s. Poor color stability, low stiffness, lack of adhesion to tooth structure were the major drawback of this class of restorative material. Polymerization shrinkage is one of the challenges wh1th needs improvement of this material to many methods were developed. Light curing units which were the major breakthrough and the energy efficiency of the different light sources have also been discussed
ABSTRACT
Pharmaceutical care is a necessary element of health care system and is provided for the direct benefit of the patient. Community pharmacists are considered the professionals of choice in this area as they are in direct contact with a large number of populations. In order to properly implement the concept of pharmaceutical care, it is necessary to first fulfill the legal requirements as those are directly related to the sales of drugs. The current scenario of pharmacies / medical stores in terms of legal aspects was investigated by carrying out a field survey. A questionnaire was prepared and distributed to 250 local pharmacies and medical stores at various locations of Karachi. The questionnaire contained some basic information in terms of the presence of pharmacist, qualification of non-pharmacist, presence of a valid license, availability of compounding facility in the pharmacy, whether the selling of non-OTC drugs is on prescription or without prescription, storage facility of drugs, disposal of expired drugs and awareness of drug act, 1976 and related rules. Out of 250 visited medical stores and pharmacies, 160 participated in the survey, whose results are summarized in the study
ABSTRACT
Botulinum toxin is one of the most potent bacterial toxins known and its effectiveness in the treatment of some pain syndromes is well documented. However, the efficacy of some of its indications is still in the process of being confirmed. Botulinum toxin, a neurotoxin with high affinity for cholinergic synapses, blocks the release of acetylcholine by nerve endings without interfering with neuronal conduction of electrical signals or synthesis and storage of acetylcholine. It has been proven that botulinum toxin can selectively weaken painful muscles, interrupting the spasm-pain cycle. In cosmetics, a small dose of botulinum toxin can be used to prevent formation of wrinkles by paralyzing facial muscles. Botulinum toxin has been categorized into seven types, of which type-A preparations are currently the most widely used. In addition to the clinical and cosmetic uses of botulinum toxin, a number of adverse reactions have also been reported; therefore, it should be used with caution
ABSTRACT
To determine the histopathological pattern of endometrial curetting in cases of abnormal uterine bleeding in our setup. Descriptive study. Department of Pathology Peoples Medical College Nawabshah. January 1999 to December 2008. Endometrial curettage of 1209 cases presenting with abnormal uterine bleeding ranging from age groups 20 to over 60 years were studied. The patients were subdivided in to groups according to age and pattern of bleeding. The histopathological diagnosis was made and results were tabulated. 502 [41 .5%]presented with menorrhagia, [32%] with inter menstrual bleeding, 121 [10%] patients with polymenorrhoea and 61 [5.1%] with post menopausal bleeding. The various histological diagnoses included proliferative phase, cystic hyperplasia, adenomatous hyperplasia, endometritis, polyps and endometrial carcinoma. Diagnostic curettage provides help in definite diagnosis and proper treatment and is of importance in postmenopausal bleeding. Endometrial hyperplasia is the commonest lesion in patients with dysfunctional uterine bleeding
Subject(s)
Humans , Female , Uterine Hemorrhage/etiology , Curettage , Endometrium/pathologyABSTRACT
Borate ions are found to have an important role in analytical and kinetic studies both for the purpose of maintaining pH and as a catalyst in the chemical degradation of a number of drugs such as atropine, benzylpenicillin, carbenicillin, cefotaxime, cephradine, hydrocortisone, indomethacin, oxytetracycline, phenylbutazone, minocycline, 5A-flurouracil, methacoline, octastatin etc. They have also been reported to exert a stabilizing effect on certain drugs including chloramphenicol, epinephrine, riboflavin, I i-methyldopa, ethyl glucuronide, ribose and glucose. Borate buffer is widely used in ophthalmic formulations for the maintenance of pH and adjustment. Boric acid is involved in the catalysis of a number of reactions of biological importance including the L-arabinose isomerase catalyzed isomerization of D-galactose to D-tagatose in the presence of boric acid
ABSTRACT
For the past nine decades, research on different aspects on vitamin A [retinol] including nutrition, biochemistry, molecular and cell biology, physiology, toxicology, medical therapy and public health is being conducted all over the world. Vitamin A is an essential micronutrient for all vertebrates. It is required for normal vision, reproduction, embryonic development, cell and tissue differentiation, and immune function in animals and humans. Many aspects of the transport and metabolism of vitamin A, as well as its functions, are well conserved among species. On the other hand, deficiency of vitamin A is also known to be associated with different specific disease conditions such as xerophthalmia, which is manifested as night blindness and corneal abnormalities, softening of the cornea [keratomalacia] and ulceration leading to irreversible blindness along with increased susceptibility to infections and abnormalities in reproduction. Research evidence suggests that diet supplemented with butter, fish, oils, milk and meat could be used as a better source to overcome vitamin A deficiency leading to a healthy life
ABSTRACT
Vitamin E [a-tocopherol] is now well accepted as nature's most effective lipid-soluble, chain breaking antioxidant, protecting cell membranes from peroxidative damage. Free-radical mediated pathology has been implicated in the development of degenerative diseases and conditions. Vitamin E has a protective role in preventing or minimizing free-radical damage associated with specific diseases and processes, including cancer, aging, circulatory conditions, arthritis, cataract, pollution and strenuous exercise. Research evidence suggests that an adequate intake of vitamin E can provide protection from the increasing high free-radical concentrations caused by air pollutants and current lifestyle patterns. Topical application of a combination of vitamin E and C has been suggested as a protective measure against UV-induced skin damage
ABSTRACT
Vitamin C [ascorbic acid] is a water-soluble vitamin that is necessary for the prevention and cure of the deficiency disease scurvy. It plays an important role as redox cofactor and catalyst in a broad array of biochemical reactions and processes. The redox behavior of ascorbic acid is the basis of most of the analytical methods used for its determination. The various methods developed for the determination of ascorbic acid in biological samples and food materials include spectrophotometric methods, fluorimetric methods, mass spectrometric methods, chromatographic methods and enzymatic methods. The high-performance liquid chromatographic methods using different detection systems are highly specific and sensitive for the determination of ascorbic acid and related compounds such as dehydroascorbic and isoascorbic acid in biological samples
ABSTRACT
To asses the frequency of HER-2/neu Oncoprotein over expression in invasive ductal breast cancer and correlate it with various prognostic parameters. Comparitive cross-sectional study was carriedout at department of pathology Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. Seventy two [72] formalin fixed paraffin embedded blocks of diagnosed invasive ductal carcinoma were retrieved and 5 m.m thick sections were cut and stained with H and E for the review of diagnosis and grading. The immunohistochemical staining was done on 4m.m thick sections by using Polyclonal rabbit anti HER-2 ZYMED USA, and ZYMED 2nd generation LAB-SA immunodetection system, to see the HER-/neu over expression. Section containing > 50% of tumor cells exhibiting intense circumferential cell membrane staining scored as positive. Thirty one [31%] positive over expression was observed. A statistically significant result [P<.05] was found between HER-2/neu over-expression and lymph node status and size of tumor. Oncoprotein HER-2/neu over expression is directly related to the lymph node status and size of the tumor. These patients may benefit from a more aggressive therapy like Herceptin and can also be used as a prognostic marker in the follow up of these patients