Molecular detection of mutations in isolates of multidrug resistant tuberculosis and tuberculosis suspects by multiplex allele specific PCR

For lowering prevalence of drug resistance it is necessary to diagnose TB in tuberculosis sputum suspect patients instead of TB-cultured samples which required a long time of culturing. Comparison of the results of drug resistant bacterial genes in both tuberculosis suspect sputum and multi-drug resistant DNA isolates detected by MASPCR. In the current study, the genetic mutations linked with INH, RIF as well as EMB drugs were detected by MASPCR simultaneously in MDR as well as TB suspect sputum isolates. 175/291 samples belonged to MDR and 116/291 samples belonged to tuberculosis suspect group. In all the isolates, presence of Mycobacterium tuberculosis-species [100%] was confirmed by targeting hupB gene. In MDR group, maximum prevalence of gene mutation was detected in rpoB531 [92.57%] and embB306 [97.71%] while in TB-suspect group, equal percentage [96.55%] of mutation was detected in rpoB531 and embB306 by MAS-PCR. Collectively, rpoB531 [n=274, 94.15%] and embB306 [n=283, 97.25%] mutation were observed in maximum tuberculosis cases. MAS-PCR technique yielded reliable results and showed massive Isoniazid, Rifampicin and Ethambutol drugs resistance in TB-isolates from Pakistan; hence it can be used in clinical laboratories with high burden of tuberculosis to detect drug resistance rapidly and cost effectively

Antioxidant, antibacterial and antiproliferative activities of pumpkin (cucurbit) peel and puree extracts - an in vitro study

Natural resources right from the beginning of the human civilization has paved the way to human being to combat different challenges. The big challenge was to safe the human being from diseases and shortage of food. Plants helped the man in both areas very efficiently. No doubt when plants are used as food actually we are also taking lot of compounds of medicinal values in an excellent combination which naturally reduce the risk of diseases. Extraction and purification of several medicinally important compounds also gave the way to develop pharmaceutical industry in addition to its own therapeutic effects against different lethal diseases. Pumpkin is one of the several medicinal important vegetables used in different way on the behalf of its admirable power to combat different diseases. Antioxidant and biological studies showed very important results. A good coherence was found among extraction yield [10.52 to 18.45%], total phenolics [1.13 to 6.78 mg GAE/l00g], total flavonoids [0.23 to 0.72mg CE/l00g] and antioxidant potential [-70%]. Antibacterial assays of peel and puree extracts advocated good potential to stop the growth and division of pathogenic bacteria. Further biological activity study was carried out using MDBK cancer cell line. The growth inhibitory effect on cancer cell line using MTT assay showed methanol extracts of peel and puree both remained efficient to inhibit growth [-35%] and cell division of cancer cells. Our results showed that extracts of pumpkin puree and its waste, peel, may be utilize to prepare functional food against pathogenic born diseases and most active compounds may also be extracted, concentrated and converted into tablets or suspension form for therapeutic purposes

Renal biopsy: a much needed tool in patients with Systemic Lupus Erythematosis [SLE]

Background and Objective: Systemic lupus erythematosis [SLE] is an inflammatory disorder associated with significant morbidity and mortality. Kidneys are frequently affected in SLE and various stages of lupus nephritis have been identified based on severity of the disease. Treatment varies with the staging and correct diagnosis is essential for timely intervention as it can have significant impact on morbidity and mortality.The objective of the study was to determine whether laboratory parameters of lupus nephritis [LN]; including urinalysis, serum creatinine [S. Cr] and 24 hours urine protein can accurately predict histologic staging of the disease

Methods: This retrospective study was conducted in department of Nephrology, Liaquat National Hospital Karachi from January 2012 to December 2014. Fifty one patients of SLE who underwent renal biopsy were selected. Patients, urinalysis at the time of renal biopsy, serum creatinine and 24 hours urine collection for protein were noted. All patients renal biopsy was read by the same pathologist. Patients were clinically staged based on these parameters and their histologic staging based on biopsy findings were compared, to see their correlation. Data was analyzed using SPSS version 17. Chi-square test was used to analyze categorical data and p<0.05 was considered significant. Cohen's kappa [kappa] analysis was used to examine the agreement by comparing lupus nephritis staging done by laboratory and histological ground. P value <0.05 indicates that agreement was unlikely due to chance alone

Results: Among 51 patients analyzed, 37 patients were females [72.5%] and 14 patients were males [27.5%] with mean age of 32.51 + 16.91 years. In stage II, kappa [kappa] of 0.304 represented fair strength of agreement and a p value of 0.012 [p<0.05] which was statistically significant. In stage III, kappa was 0.209 indicating none to slight agreement and a p value of 0.131 [p>0.05]. In stage IV, kappa [kappa] was 0.141 [slight agreement] and p value 0.301 [p>0.05] in stage V; kappa [kappa] of 0.030 represented poor agreement and a p value of 0.828 [p>0.05]

Conclusion: Staging of lupus nephritis done on basis of laboratory findings did not correlate well with underlying histological staging. Therefore, renal biopsy is an essential tool in approach to lupus nephritis in order to provide timely and appropriate treatment to patients

Biased expression, under the control of single promoter, of human interferon alpha-2b and Escherichia coli methionine amino peptidase genes in E. coli, irrespective of their distance from the promoter

Human interferon alpha-2b and Escherichia coli methionine amino peptidase genes were cloned independently as well as bicistronically in expression plasmid pET-21a [+]. Production of human interferon alpha-2b was comparable to that of E. coli methionine amino peptidase when these genes were expressed independently in E. coli BL21-CodonPlus [DE3]-RIL. However, human interferon alpha-2b was produced in a much less amount whereas there was no difference in the production of methionine amino peptidase when the encoding genes were expressed bicistronically. It is important to note that human interferon alpha-2b was the first gene in order, after the promoter and E. coli methionine amino peptidase was the next with a linker sequence of 27 nucleotides between them

Frequency of pulmonary hypertension in hemodialysis patients

Pulmonary hypertension [PH] has been described in hemodialysis [HD] patients and has been associated with increased morbidity and mortality. Our objective was to determine the prevalence of pulmonary hypertension in patients on regular hemodialysis. This cross sectional study was conducted in Department of Nephrology, Liaquat National Hospital Karachi from April 2013 to March 2014. Eighty patients of end stage renal disease [ESRD], on maintenance hemodialysis [HD]; underwent Trans thoracic Echocardiography were selected. Systolic pulmonary arterial pressure [SPAP] was recorded. Pulmonary hypertension was defined as, pulmonary artery pressure [PAP] greater than 30 mm Hg at rest. Pulmonary hypertension was further divided into mild [PAP b/w 30-45mmHg], moderate [PAP b/w 45-65mmHg] and severe pulmonary hypertension [PAP > 65mmHg]. The effect of different vascular accesses, age, gender, dialysis vintage on the development of pulmonary hypertension was observed. Out of 80 patients, 45 patients [56%] had pulmonary hypertension [PH]; 25 [55.5%] had moderate, 13 [29%] had mild, and 7 [15.5%] patients had severe pulmonary hypertension [PH]. Pulmonary hypertension was present in 41 [60%] patients with AVF, 3 [27%] patients with tunnel cuffed catheter and 1 patient had AV bridge graft. Pulmonary hypertension was more common in females; present in 28 females [67%] and 17 males [45%], that was statistically significant [p<0.05]. Mean duration of hemodialysis in [months] of patients with PH was 20.93 +/- 12 vs. 10.29 +/- 10 in patients without PH [p<0.05]. Age had no relation to development of PH. ESRD patients on HD have strong tendency to develop PH. Our study demonstrated that PH is more common among females. Duration of hemodialysis and AV access has strong relation to the development of PH

Antioxidant and antibacterial activities of Hibiscus Rosa-sinensis Linn flower extracts

Antioxidant and antibacterial potential of different solvent extracts of locally grown Hibiscus rosa-sinensis Linn was evaluated. The antioxidant activity was assessed by estimation of total flavonoids contents, total phenolic contents, DPPH free radical scavenging activity and percentage inhibition of linoleic acid oxidation capacity. Agar disc diffusion method was used to assess antibacterial potential of crude extract of H. rosa-sinensis. The yield of the crude extracts [23.21 +/- 3.67 and 18.36 +/- 2.98% in 80% methanol and ethanol solvents was calculated, respectively. Methanol and ethanol extract of H. rosa-sinensis showed total phenolics 61.45 +/- 3.23 and 59.31 +/- 4.31 mg/100g as gallic acid equivalent, total flavonoids 53.28 +/- 1.93 and 32.25 +/- 1.21 mg/100g as catechine equivalent, DPPH free radical scavenging activity 75.46 +/- 4.67 and 64.98 +/- 2.11% and inhibition of linoleic acid oxidation potential 75.8 +/- 3.22 and 61.6 +/- 2.01% respectively, was measured. Antibacterial study against three human pathogens such as staphlococus sp. Bacillus sp. and Escherichia coli showed growth inhibitory effect in the range of 12.75 +/- 1.17 to 16.75 +/- 2.10 mm. These results showed H. rosasinensis indigenous to Kallar Kahar and its allied areas bear promising medicinal values and could be used for developing herbal medicines to target oxidative stress and infectious diseases.

Novel indium-111 labeled gastrin peptide analogues [MG-CL1-4]: synthesis and quality control

Radiolabeled neuropeptides are widely investigated to diagnose and therapy of tumors. These peptides get internalization after binding with particular receptors at the surface of cells and finally move to lysosome. Internalization into tumor cells helps in mapping the infected site. Minigastrin peptide analogues [MG-CL1-4] were synthesised and labeled with 111-In radioisotope under different sets of conditions for imaging CCk-2 receptor bearing tumors. Different parameters such as temperature [80-100[degree]C], pH [4-12], incubation time [5-30 minutes] and dilution effect were investigated to get the maximum labeling yield and stability. The results indicated that MG-CL1-4 is successfully labeled with indium-111 at pH 4.5 with heating at 98[degree]C for 15 minute. At these conditions i.e. heating, pH and incubation minimum oxidized and maximum labeling yield, more than 94 %, was obtained. The labeling stability was studied by incubating the radiolabeled complex for predefined time points in PBSA and blood serum. Results show that more than 90% radiolabeled MG-CL1-4 remained intact

Pertrochanteric fracture femur; outcome of surgery in elderly subjects following a dynamic hip screw

Background: Pertrochanteric fracture is common in elderly population. The dynamic hip screw is widely accepted in the treatment of P/T fractures of the proximal femur

Objective: The purpose of this study was to assess radiological and clinical union in elderly patients after operative treatment of a pertrochanteric femoral fracture with DHS

Design: A prospective study

Setting: Orthopaedic surgery department of Independent Medical College Faisalabad

Study Period: Between July 2009 and June 2012

Method: The study group included 22 males and 51 females aged 50-95 years following pertrochanteric fracture femur either stable or unstable. Relevant history and x-rays were taken. We followed the inclusion and exclusion criteria. All patients were operated on routine operation list under image intensifier after necessary investigations and fitness for anaesthesia. All the cases were treated by closed/open reduction and a dynamic hip screw [DHS] was inserted by a standard technique. An outpatient follow-up with x-ray check-ups was carried out at one-month, 3months, 6 months and after 1 year intervals to assess union and walking ability as outcome measures

Results: 73 cases were included in study 22 males and 51 females.66 fractures [90%] healed at an average of 12 weeks postoperatively [range 8-28 weeks]. There were 4 patients [5.47%] requiring further surgical intervention. No obvious shortening of more than 1.6 cm was noted compared to the contra lateral normal limb. Our results suggest that fixation with DHS may allow a faster post-operative restoration of walking ability. Mortality upto1 year 11[15.06%].Further 6[8.22%] patients were lost to follow up

Conclusion: It is concluded that the Dynamic Hip Screw is safe, suitable and reliable fixation

Pre dialysis care and types of vascular access employed in incident hemodialysis patients: a study from Pakistan

To determine frequency of different vascular access use in Incident hemodialysis [HD] patients and determine whether predialysis care in terms of timely advice for vascular access placement was better in the hands of nephrologist. A cross sectional study was conducted. Data was collected on the type of access used for first HD, including temporary Central venous catheters [CVC], permanent CVC [Permacath], arteriovenous fistula [AVF], or arteriovenous graft [AVG]. In addition, information was also gathered if patients were aware of their renal disease and was followed by other physicians or nephrologist. A total of 120 patients were enrolled in the study, 80% required CVC as their first access for HD [96/120 patients] out of which 74.2% were dialyzed through temporary catheter and 5.8% through Permacath. About 20% of patients were dialyzed through mature Arteriovenous [AV] access. Majority [95.8%] of patients were being followed by any health care provider. 68% of them were aware of their renal disease. About 55.8% were referred to nephrologist and 40% were followed by other physicians. About 83.5% of patients followed by nephrologist were advised AV access prior to commencing HD, compared to only 10.4% followed by other physicians [p < 0.05]. 24/61 [39.3%] patients that were advised AV access by both groups had timely made AV access and underwent HD by it. Very high incidence of temporary HD catheter was used in Incident HD patients. Moreover, pre dialysis care in terms of placement of AV access prior to initiating HD is better in the hands of nephrologist and patients should be timely referred to nephrologist especially when they have Stage 4 chronic kidney disease [CKD]

Standardization of micropropagation techniques for Aloe vera: a pharmaceutically important plant

Aloe vera [Syn Aloe barbadensis Mill.], a medicinal plant, has a great potential in cosmetic and drug industry due to presence of more than 200 bioactive compounds. Natural propagation of Aloe vera, by means of suckers, is very slow and insufficient to meet the increasing demand of pharmaceutical and cosmetic industries. Shoot tip was used as an explant for in vitro regeneration of Aloe vera. Explants were disinfested with the use of 0.1% mercuric chloride and 0.5% sodium hypochlorite, and washed thoroughly with autoclaved distilled water. Solid MS medium was used with addition of different concentrations of 6-benzyl aminopurine and Alpha -naphthalene acitic acid. After 7 weeks of inoculation, greatest number of shoots [11.18] and highest shoot length [12.15cm] were found in MS medium supplemented with 0.5 mg 1[-1] 6-benzylaminopurine [BAP] along with same concentration of Alpha -naphthalene acitic acid [NAA]. Best rooting [84.67%] was found in medium supplemented with 1.5 mg 1[-1] of indole butyric acid [IBA]. The rooted explants were then gradually acclimatized and shifted to green house

Outcome of dynamic compression plate for displaced diaphyseal fractures of the radius and ulna in adults

Background: In adults displacement, angulation, rotation and comminution may be quite marked and closed reduction is often difficult or impossible to achieve. Even if an acceptable position can be obtained, and a cast successfully applied, late slipping of the fracture is extremely common and difficult to treat with severe loss of function

Objective: To assess the fracture union and functional outcome of patients treated with stable internal fixation and early mobilization

Study Design: Prospective study

Setting: Orthopaedic surgery departments of Independent Medical College and Punjab Medical College Faisalabad

Study Period: Between January 2010 and December 2011

Method: The study group included 32 males and 14 females aged 14-60 years with unstable displaced fractures shaft radius, ulna or both. Relevant history and x-rays of the forearm were taken. We followed the inclusion and exclusion criteria. All the cases were treated with open reduction and internal fixation with 3.5mm small fragment dynamic compression plate and screws. The cases were followed for at least 6 months. Patients were assessed functionally and radiologically and results were graded according to the system described by F.M. Marek et al [1961] as excellent, good, fair and poor

Results: This prospective study was completed on 46 patients 32 were male and 14 were female. All fractures were united in acceptable alignment. At final assessment excellent results were obtained in 31 [67.39%], good results in 8 [17.39%], fair in 4[08.69%] and poor in 3[06.53%] of the cases. Poor clinical out come was high in neglected and mishandled cases. There was no implant breakage or failure or fracture adjacent to 3.5 mm small fragment DCP

Conclusion: Dynamic compression plate is an excellent fixation for displaced diaphyseal fractures of the forearm bones in adults

CT guided renal biopsy: Safety and efficacy, a study in Pakistan

Percutaneous renal biopsy [PRB] of native kidney with automated spring loaded device is performed with various techniques to improve efficacy and safety .This study was performed to evaluate[1] the safety and efficacy of PRB performed under CT guidance[2] time to develop complications to see whether this procedure can be performed as outpatient[3] diagnostic yield of the specimen. The study was conducted at the Department of Nephrology of Dr. Ziauddin Hospital, on all patients admitted for renal biopsy between 1[st] January 2009 to 31[st] December 2011. PRB was performed on native kidneys by experienced nephrologist under CT guidance with a 18 guage automated spring loaded biopsy gun. Patients were included if they fulfilled the inclusion criteria. All patients were observed for 24 hours post biopsy for major complications like gross hematuria, drop in hemoglobin requiring transfusion, or requiring surgical or radiological intervention and minor complications like transient hematuria, spontaneously resolving perinephric hematoma and their timing of development. In addition, information was gathered regarding diagnostic yield of the specimen. 100 consecutive biopsies were performed. There were no major complications in 98% of the biopsies. 2% patients developed gross hematuria and significant hematoma with a drop in hemoglobin that required blood transfusion. 2% of patients developed minor complications. 100% of the specimen had adequate tissue for making the diagnosis. All major complications developed within 12 hours of procedure. The minor complication occurred at 18 hrs. PRB under CT guidance is a safe and effective procedure; however recommendations can not be made to perform it on outpatient basis

Glomerular filtration rate rather than serum creatinine should be used for recognizing patients at risk for development of contrast induced nephropathy

Serum Creatinine [SCr], widely used for renal function assessment is not an accurate measurement. SCr can be within normal range even when there is substantial nephropathy. The objective was to observe the incidence of contrast induced nephropathy [CIN] with normal SCr and low glomerular filtration rate [GFR]. This was a cross-sectional, observational study involving patients undergoing coronary angioplasty. During a period of 6 months, 64 patients having SCr ? 1.4mg/dl and a GFR of < 80ml/min were selected who underwent elective coronary angioplasty. SCr was measured again after 48 hours of the procedure. CIN was defined as a > 25% increase in SCr from the preprocedure level. For statistical analysis, SPSS version 10 was used to calculate one way Anova was used for comparing variables between CIN and No-CIN groups, while paired t-test was applied for comparison between pre and post procedure SCr. Out of 64 patients, CIN was seen in 14 patients [21.8%]. After the procedure, significant difference was seen in the mean creatinine levels [p < 0.001]. The before and after experiment creatinine values also showed a significant difference [p < 0.05]. SCr along with calculated GFR should be used to assess patients for underlying renal insufficiency undergoing contrast procedures like coronary angioplasty. Patients with low GFR and normal SCr have a significant risk of developing CIN. Identifying such patients before hand can help us decrease the overall incidence of CIN by administering timely prophylactic measures

Oculocutaneous albinism associated with axenfeld's anomaly: three case reports

Oculocutaneous albinism and anterior mesodermal dysgenesis are well-known heritable conditions, but their occurrence in association has only been rarely reported. We present cases of three siblings of a family with identical presentation suggesting that this association may be more than just a coincidence. This association is worth noting, as this could be one of the causes of ocular morbidity and poor vision in oculocutaneous albinism

Assessment of Renal insufficiency in patients with normal serum creatinine levels undergoing angiography

To determine the frequency of patients with underlying renal insufficiency having normal serum creatinine level proceeding for coronary angiography. A total of 693 patients from September 2009 to February 2010 undergoing diagnostic coronary angiography at the National Institute of Cardiovascular Diseases [NICVD] with normal serum creatinine

Prevalence of H. pylori

Acid peptic disease is a world wide problem among all the age groups and both sexes. Duodenal ulcer is common as compared to gastric ulcer. Its prevalence being 4:1 in USA and UK and 5:1 in Pakistan. Etiology of peptic ulcer is almost certainly multi-factorial. Basic paradigm for ulcer disease is the imbalance between the digestive activity of acid and pepsin and the protective mechanism in place to resist mucosal digestion. Over the past few years a new line of thought has been evolved after isolating spiral campylobacter like organism from antral biopsy specimens. H pylori is now considered to be an important if not the only causative agent of gastritis and peptic ulcer disease. The dictum; No acid - No ulcer summarized the pathogenesis of peptic ulcer disease but new dictum seems to be; No H. pylori -No ulcer, as over 90% of Duodenal ulcer and 70% of Gastric ulcer patients are infected by H. Pylori. Aim of the study was to evaluate the prevalence of H. pylori among duodenal ulcer patients at Faisalabad District and its suburbs. Descriptive Study. From Mar 2008 to Oct 2008. 50 patients [40 males, 10 females] belonging to Faisalabad District and surrounding areas with upper gastrointestinal symptoms of acid peptic disease and endoscopy proved duodenal ulcer were subjected to gastric antral mucosal biopsies for evaluation of the H. Pylori status with the help of unease test and histological examination of biopsy specimen. Epigastric pain was the most frequent symptom 90%. [46 out of 50 patients]. 92% showed evidence of H. pylori infection. Maximum incidence of H. pylori was recorded in age group IV [46-55 years]. Maximum number of patients was skilled workers [35 out of 50] 70%. 80% of the patients belonged to lower and middle class. Percentage of H. pylori positivity was 89.1% and 84.34%. Acceptance of contributory role and high prevalence rate of H. pylori instigates us for addition of antimicrobial treatment to the conventional treatment with H2 Blockers and PPls which is cost effective and alter the course of the disease

Perception of acne patients regarding its pathogenesis and treatment

Background: acne vulgaris is the most common skin disease treated by dermatologists. Misconceptions about acne, regarding its causes, treatment options and their possible outcome are widespread

Objectives: the objective ofthis study was; to evaluate the knowledge and perception of acne patients regarding their understanding of acne pathogenesis, treatment options, and expectations

Patients and methods: this descriptive study was conducted in dermatology clinic, outpatient department of Sheikh Zayed Medical College /Hospital, from 1st January to 15th april,2010 and a total of 105 consecutive study subjects, who were diagnosed with acne were included. An informed verbal consent was ensured from every study subject

Results: the mean age of the patients was 18.8 +/- 2.7 years. Majority of the patients [87%] were females and unmarried [83 %]. 74% had education level matric and above. 48.6% belonged to urban areas, 30.4% to rural areas and 21% to urban slums. 67% of the patients of acne in our study reported that they felt frequently worried about their acne. 55 % of the study subjects had duration of acne less than three months, 41 % had duration between 3 to 12 months and 4% had duration more than one year. When asked about causes of acne, 35% related it with poor skin hygienic conditions, 19% to dietary factors, 13% to blocked skin pores, 10.5 % to inheritance factors, 7.6% to stress, 6.7% related to infection by germs. Regarding dietary aggravating factors; 38 % linked to oily food items, 14 % with tea, 13.3% with milk products. 17 % perceived that acne is not a curable disease. 41 % of the patients had no opinion about mode oftreatment. 67% ofthe patients expected the duration ofacne treatment may beup to 3 months

Conclusion: there is a need for accessible, accurate, community-based education on the natural history of acne, its pathogenesis, risk of sequelae, the effectiveness and expected duration of treatment, and the importance of prompt medical attention

Clinico-morphological pattern of bone lesions in children

The present study was performed to find the spectrum of bone diseases in children and to correlate with age, sex, and site of origin. This was a retrospective study and consists of 95 cases of hone biopsies which were diagnosed in the Department of Pathology at the Institute of Child Health and Children's Hospital, Lahore during a period of six years [Jan 2003-Dec 2008]. These biopsies were evaluated on haematoxylin and eosin stained sections from paraffin embedded tissue blocks. Special stains were performed whenever required. Pyogenic osteomyelitis [OM] accounted for 35.78% of all bone pathologies followed by tuberculous osteomyelitis in 22.10%. Osteosarcoma [OS] was the most frequent [primary tumour of bone followed by Ewing's sarcoma [ES]. One case of metastatic bone tumour was also recorded. Osteochondroma, osteoma, aneurysmal bone cyst, fibro-osseous dysplasia, chondroma and simple bone cyst were also found in children. The bone tumours are relatively more prevalent in males

Effects of hormonal contraception on serum lipid profile and lipoprotein [LP [a]]

To evaluate the cardiovascular risk factor in Pakistani females, using oral and injectable contraceptives by determining lipid profile and lipoproten [a]. This study was carried out prospectively on 60 women aged between 20-45 years and compared with 30 aged matched controls conducted at Dept of Biochemistry and Molecular Biology, Army Medical College Rawalpindi and various family planning clinics of Rawalpindi and Wah Cantt. Hormonal users were mostly un-educated and controls were taken from different medical colleges and hospitals. They were educated and some of the controls were also from low socioeconomic group and un-educated. Oral contraceptive users [OC; n=30] and injectable users [IC; n=30]. They were using oral tablet lofenienal and injectables depopfovera for more than 1 year. Controls were not using any form of contraceptives. Fasting blood samples were analyzed for serum total cholesterol, triglycerides, HDL-C and LDL-C and Lp [a]. Lipid parameters were estimated by enzymatic colorimetric method and Lp [a] was analyzed by immunoterbidimetric method. The women using OCP shows significant difference in BMI [p<0.01] as compared to control. Similarly injectable users also showed significant difference in DM1 [p<0.001] as compared to control. SBP shows a significant difference in both groups A and B as compared to control [p<0.05] but DBP was higher in injectable users only [p<0.05] and group A was higher than group C but difference was not significant. The level of HDL-C is decreased significantly [P<0.05] in groups A and B as compared to control. Lipoprctein [a] in both groups A and B showed higher levels than control [p<0.0001]. It is suggested therefore that women using hormonal contraceptives are prone to develop atherosclerosis and coronary artery disease earlier as compared to women not using contraceptives

Gall bladder carcinoma with krukenburg tumour a case report

To determine the mechanism and pattern of animal related injuries in the troops deployed in field. A hospital based observational study. Main Dressing Station Kotli Azad Kashmir from Jan 2004 to Jan 2006 An observational hospital based study was carried out on all the patients who reported to the Main Dressing Station [MDS] between Jan 2004 to Jan 2006. The data was collected by using hospital information system. A performa was developed after review of literature which included necessary information related to patient's age, sex, type of injury and species of animal involved. The information collected was analyzed in detail. Laskin and Donhoue1 classification was used to classify wounds. A total of 48 patients were reviewed. These were all males and the mean age was 25 years. Thirty three [69%] patients had soft tissue injuries, 7 [15%] had fractures, 5 [10%] had head injury and 3 [6%] had abdominal injury. Mule kick injuries occurred in 37[77%] patients, dog bite in 7[15%] cases and donkey bite in 4[8%] cases. Troops deployed in the field are exposed to the hazard of animal related injuries which can be fatal at times. The complex nature of these injuries entails early and appropriate management in order to achieve satisfactory outcome and prevent complications. Prevention strategies include proper animal handling techniques based upon animal behavior and the appropriate use of well designed confinement facilities