Risk factors for scabies among male soldiers in Pakistan: case-control study

Being a preventable disease, good control of scabies can be achieved by identification of risk factors. During the 3-month period February 2006-April 2006 we carried out a case-control study on 200 patients with scabies and 200 controls to identify risk factors for scabies among male soldiers in Pakistan. We identified risk factors for the infestation using logisitic regression analysis. Itching in family/dormitory mates, infrequent bathing, infrequent changing of clothes, low education, sharing beds and being away from the barracks were identified as significant risk factors for scabies, while overcrowding, large family size and sharing of towels and hospitalisation were not

Surgical anatomy of the hepatic arteries: a prelude to living donor liver transplantation

In the setting of Liver Transplantation as a new and emerging specialty in Pakistan the need has arisen for exact descriptions of the hepatic vascularization to avoid iatrogenic vascular damage. Exact knowledge of the arterial anatomy is required to plan the best resection as well as to minimize the risks of donor morbidity. We studied variations of extrahepatic arterial anatomy in forty six patients who underwent major hepatobiliary or pancreatic resections with complete exposure and/or skeletonization of the extrahepatic arterial anatomy. The extrahepatic arterial anatomy in twelve cadaveric dissections was also studied. The commonest arterial variant seen in our series was Type 1 i.e. 91.37% . The prevalence of anatomical variants was 8.63% . Knowledge of the variation in the hepatic arterial anatomy will help us in planning and performing the safe procurement of grafts from living donors with less risk of serious ischemic complications

Identification and preservation of the external laryngeal nerve during thyroid surgery: surgical and anatomic considerations

Iatrogenic injuries of external branch of superior laryngeal nerve [EBSLN] during thyroid surgery are not uncommon due to the possibility of anatomic variations in the relationship of this nerve with superior thyroid vessels and the result may be devastating to those patients who rely on their voices professionally. The study included 2 groups. Group A was a prospective nonrandomized analytical series of all consecutive patients undergoing thyroidectomies for various conditions in Surgical Unit II, Shaikh Zayed Postgraduate Medical Complex, Lahore, Pakistan during a three years period [November 2004 - November 2007]. This group consisted of 133 patients. Male to female ratio was 1:3. Mean age was 35.22 years [range: 17-71 years]. Ninety one [68.42%] patients had bilateral dissection [total, sub-total or neartotal thyroidectomies] and 42 [31.57%] had unilateral dissection [hemithyroidectomy I lobectomy and isthumusectomy]. Thus, a total of 224 superior polar dissections were carried out. Three [3 .296 %] patients out of the 91 patients in the bilateral dissection group had asymmetrical nerves. Eighty one [60.9%] patients had benign disease, 32 [24.06%] had malignancy and 20 [15.03%] had toxic goiter. Nerve could not be identified in 42 [18.75%] polar dissections [positive identification in 182 [81.25%] polar dissections]. Three [2.25 %] patients in this study had clearly documented EBSLN injury as determined by voice changes, patient interview and IDL. In Group B, the anterior neck triangles of 19 embalmed human cadavers [i.e. 38 neck half preparations] of both sexes and variable ages with neither enlarged thyroid glands nor any other signs of abnormality in this region were dissected in the dissection halls of two medical colleges in Lahore. The course and topographical relations [especially in relation to the superior thyroid vessels, superior pole of the thyroid and the cricothyroid muscle] of the EBSLN as well as bilateral asymmetry were noted as for Group A. Nerves were classified according to classification of Cernea et al. Good knowledge of the anatomy and relations of the EBSLN with meticulous dissection and ske letonisation and individual ligation of the superior polar vessels is the key to success

Diabetic control and serum lipids in diabetics attending a Pakistani hospital

Diabetes Mellitus is more prevalent in Asians as compared to White Caucasians. Hence, it has great importance as a public health problem. There is a paucity of data about the state of lipids in this disease, from Pakistan. We studied diabetic patients attending outpatients clinic and recorded their personal characteristics, details of their disease and measured their blood glucose, lipids and glycosylated haemoglobin. Design: Case series. Setting: Patients attending outpatients department of a teaching hospital. Subjects and Seventy consecutive diabetics attending the outpatients department were enrolled in the study. Their age, sex, disease duration, body mass index [BMI]; treatment history, occupation and social class were recorded. Fasting plasma sample was collected and glucose, cholesterol [total, HDL, LDL], triglycerides and glycosylated haemoglobin [HBA] estimated. Data was analysed using SPSS statistical package. Most of the patients were non-insulin dependent [N1DDM] diabetics 90%, sedentary workers [70%] and females [66%]. Mean duration of diabetes was 6.2 years [SD 5.2]. Plasma glucose [mean 201 mg/dl], HBA [mean 7.92], triglycerides [mean 215.9 mg/dl] and total cholesterol [mean 221.4 mg/dl] were recorded. About a quarter of cases had a BMI > 28 Kg/m2 and 15% had a BMI > 30 Kg/m2. HDL and LDL cholesterol mean values were 44.1 mg/dl and 134.2 mg/dl respectively. There was good correlation between HBA and fasting plasma glucose. However, the correlation between fasting plasma glucose and various lipid parameters was poor. Conclusions: Majority of diabetics attending hospital outpatients were suffering from NIDDM. A significant proportion of them were obese. As a group they exhibited poor diabetic control and had only modest elevation of plasma lipids. The correlation between fasting plasma glucose [and HBA] and lipid levels was poor. However, there is good correlation between fasting plasma glucose and glycosylated haemoglobinm, highlighting usefulness of the latter for monitoring

Anorectal malformations experience at Mayo hospital, Lahore

During the past 3 years, 513 patients were admitted with anorectal malformations at the Department of Paediatric Surgery, Mayo Hospital, Lahore. Out of these, 213 [41.52%] below the age of 3 days. Male to female ratio for high variety was 5: 1 but for low variety it was equal. High anomaly was seen in 290 patients and low variety in 223 patients, the latter being treated either with dilatation, cutback or anal transposition. A total of 84 posterior sagittal anorectoplasties were performed without any mortality. Associated congenital anomalies occurred in 15.20%. Various aspects of the disease are presented

Hepatotoxic effects of hexavalent chromium in rat: a histological study

This study was conducted with a view towards investigating histological changes produced by hexavalent chromium and to assess the extent of damage done. Design: Study involving 60 rats, randomly divided into two groups A and B each having 30 animals. Group B animals subdivided into 3 subgroups each having 10 animals, were injected with Na2Cr207 solution for 2, 4 and 8 weeks and sacrificed. Group A animals were injected an equal volume of distilled water for same time periods and then sacrificed. Setting: Animal house, PGMI, Lahore. Sixty male Sprague Dawley rats. Age 6-8 weeks. Mean weight 161 +/- 13 gms. Main outcome measures: Assessment of chromium induced histological changes in liver at low toxic doses and establishment of its correlation with advance in treatment. Chromium toxicity exhibited as decreased growth rate, increased relative tissue weight index [RTWI], thickened liver capsule, dilated central vein, congested hepatic microvasculature, hepatocellular necrosis and activation of macrophage system. Chromium coduced hepatotoxicity accentuated with advance in treatment Chromium administration leads to hepatotoxicity which progresses with continued metalaministration. Thus hepatic dysfunction is a potential hazard to people employed and living close to industries utilizing chromium

Comparison of nebulised salbutamol and intravenous aminophylline infusion in the treatment of acute bronchospasm

We conducted a study on 59 patients presenting to the Emergency Department of Mayo Hospital Lahore, with acute bronchospasm. Fifty-four of them successfully completed it. They were randomly allocated one of the following three forms of treatment for 8 hours: Salbutamol 2mg nebulised 4 hourly; continuous i.v. Aminophylline infusion or Salbutamol 1mg nebulised 4 hourly. 2mg Salbutamol nebulised with oxygen 4 hourly was judged to be the most effective form of treatment at 4 and 8 hours. It gave the most favourable improvement in pulse rate [p=0.004], paradox [p=0.009], respiratory rate [p=0.036], peak expiratory flow rate [p=0.006] and subjective score [p=0.003] at 8 hours. Favourable, though not statistically significant improvement occurred in blood pressure [systolic and diastolic], cyanosis and use of accessory muscles. Improvement in parameters was more marked after 8 hours than 4 hours of the study. Nausea, vomiting, abdominal pain, arrhythmias, vertigo, sweating and headache were more frequent [though not statistically significant] in the Aminophylline group. Greater frequency of palpitation, tremor, myalgia and cramps [not statistically significant] were reported in those receiving Salbutamol 2mg 4 hourly by nebulisation

study of hypertension and Diabetes mellitus in a medical camp in middle class urban Pakistani community

Three hundred sixty-three individuals were examined in an open invitation survey of a middle class urban population attending a medical camp. Forty% were known diabetics and nearly 30% were known to be hypertensive. Of those who answered no to suffering from diabetes 5.5% were found to be diabetic. The corresponding figure for undiagnosed hypertensives was l8%. Both the known hypertensives and diabetics had unsatisfactory control in over 50% of cases. The diabetics [known and freshly diagnosed] were more likely to suffer from abdominal obesity [p <0.001] and a body mass index more than 30 [p=0.048]. Diabetics also had a greater chance of disease among siblings [p<0.00 1]. Hypertensive subjects were more likely to be obese [p=0.001] and had a bigger waist [p<0.001]. They also had a more frequent history of hypertension in the family [p<0.001]. Obese subject [body mass index > 30] had higher systolic [p=0.026], diastolic [p=0.008] and mean [p=0.008] blood pressure; the relationship between diabetes and hypertension could not be shown at a level of p=0.05