old dietary regimen as a new lifestyle change for Gastro esophageal / reflux disease: a pilot study

Treatment of gastro esophageal reflux disease [GERD] is becoming a challenge for medical profession. Proton pump inhibitors [PPIs] are commonly recommended but many disadvantages of these drugs are being reported, particularly when used for long term. Transient lower esophageal sphincter relaxations [TLESRs] are important cause of acid reflux. Gastric distention in upper stomach is the strongest stimulus for generation of TLESRs and is aggravated by intake of food in between meals. In an earlier cases report, two meals a day with intake of only fluids in between was suggested as a remedy for GERD. Present pilot study was conducted on 20 patients with endoscopically proven reflux esophagitis [Los Angles Grade a, b or c], who followed our advice to take meal twice a day with consumption of only soft drinks [fruit juices, tea, coffee, water, etc] in between and no medication for two weeks. On 14[th] day 15 patients [75%] were free of reflux symptoms, 2 [10%] had partial improvement and 3 [15%] reported no difference. It is concluded that two meals a day with intake of only fluids in between, whenever the patient feels hungry or thirsty, is a useful dietary regimen for the management of GERD. Further investigations are needed to confirm the benefits of this physiological lifestyle change

Multinodular goiter; frequency of malignancy

The object of this study was to determine the frequency and type of thyroid carcinoma in Multi nodular goiter [MNG] after surgical resection on histopathological basis. Multi nodular goiter [MNG] is one of the common presentations of various thyroid diseases. Thyroid nodules have been reported to be found in 4% to 7% of the population on neck palpation. Although in comparison to solitary nodule, the risk of malignancy in MNG is low but certain studies are showing significant risk. This prospective, observational study was carried out in the surgical unit I of Ghulam Mohammad Mahar Medical college hospital sukkur from 2007 to 2012. 94 cases with clinical diagnosis of MNG were analyzed during this period. All the patients were admitted through opd with routine investigations plus investigations specific to thyroid including thyroid profile, thyroid scan, FNAC of dominant nodule before being subjected to surgery. All FNACs were carried out at agha khan university hospital Karachi. Histopathology of operated specimen was the main criteria for malignancy. Among the 94 cases which were included in this study, 9 [9.5%] cases containing foci of malignancy. Incidence of malignancy commonly occurs in females, papillary carcinoma is being the commonest entity. The incidence of malignancy in MNG in this study is 9.5% that is quite high. So people should be educated and encouraged to attend the thyroid clinics for proper evaluation and early diagnosis of Malignancy

Efficacy of combination of fluoxetine and cognitive behavioral therapy and fluoxetine alone for the treatment of obsessive compulsive disorder

A number of pharmacological approaches as well as psychological interventions are effective in the treatment of obsessive-compulsive disorder [OCD]. The present study was conducted to see the relative efficacy of treatment approaches. 30 diagnosed cases of OCD were taken and divided into two groups. Each group consisted of 15 patients. Group A [N=15] received Capsule Fluoxetine and Group B [N=15] received Capsule Fluoxetine and CBT [13 weekly sessions]. Twenty six participants completed the study [13 in each group]. Dhaka University Obsessive-compulsive Scale [DUOCS] was used to measure the symptom severity. Symptom scores were measured at weeks 1, 5, 9 and 13. After 13 weeks, analysis of the data was done and the means of initial DUOCS score and 13th week score were compared. In both the groups the mean score changes were highly significant [p=0.000]. Intra group analysis revealed that both the treatment approaches were highly efficacious. Inter-group analysis revealed that the response in combination group was significantly higher starting from 9th week, continuing up to 13th week. Mean symptom reduction and mean percentage reduction of symptoms were also higher in the case of combination group

Frequency of dementia in Parkinson's disease

To assess the frequency of dementia in Parkinson's disease. Study Design:Descriptive study Place and Duration:The study was performed inBolan Medical Complex Hospital, Quetta during Dec 2009 to Jun 2011 [One and half year]. Patients and Methods The purpose of this study was to assess the frequency of dementia in Parkinson's disease. The outdoor patients presented with features of Parkinson's disease were evaluated by using 'UKPDBB' [United Kingdom Parkinson Disease Brain Bank] diagnostic criteria,disease severity assessed by [Hoehn and Yahr scale] and later on they will be assessed for dementia by using 'Mini-Mental Examination'. The exclusion criteria were history of repeated stroke, encephalitis, drug induced Parkinson's disease, drug addiction and brain tumour. The data was collected on structured questionnaire. For descriptive purpose patients were divided into two groups, Parkinson disease [PD] and Parkinson disease with dementia [PDD]. The data was analyzed by SPSS version 17.0. The frequency distribution in number and percentage was calculated.ResultsiThere were 35 patients who presented with the clinical features of Parkinson disease. The features of dementia were found in 6 patients [17%], while 29 patients [83%] remained non-demented. Among demented patients 6 [100%] of Parkinson disease, there were five male [83.3%], while one patient [16.7%] was female.The entire demented patients had started symptoms after the 6th decade.. Regarding functional disability PD group had Hoehn and Yahr score of < 3, while PDD group had > 3. Positive primitive reflexes common in both groups 4 out of 6 in PDD group, while 15 out of 29 in PD group. Mild cognitive impairment was found in 4 [11.4%] patients, not fulfilling the criteria of dementia Dementia in PD was not quite high in our study. Most of the patients had cognitive impairment during their 6th or 7Jh decade of life

effectiveness of botulinum toxin in the management of benign essential blepharospasm and hemifacial spasm

To determine the effectiveness of Botulinum toxin in the treatment of Benign Essential Blepharospasm [BEB] and Hemifacial spasm [NFS] at a tertiary care hospital. Neurology Department, Bolan Medical Complex Hospital, Quetta. 30 months from 15 March 2010 to August 2012. Quasi experimental study. All patients referred to neurophysiology laboratory for Botox [BTX] injection were enrolled in the study after taking written consent. Botox injection 1.25 units was used for BEB and 3.0 units used for HFS given in the laboratory. Patients were observed for any immediate complications and then followed at two weeks for start of improvement and side effects and then at one, three and six months for duration of lasting improvement and any side effects. In this hospital based study we enrolled 30 patients with the diagnosis of BEB and HFS. The average age of the patients was 52.47 +/- 11.59. Out of 30 patients 57% were male and 43% were female with 1.3:1 male to female ratio. Blepharospasm was observed in 53.3% patients and hemifacial spasm was observed in 46.7% patients. In 50% of patients the onset of improvement was within 4-7 days. 93.4% of patients had improvement at the end of one month and 80% patients had improvement at 3 months follow up. Total duration of benefit lasted for up to 4-5 months in 46.6% of patients, 30% patients had benefit lasting for more than 5 months. 16.7% patients noticed benefit for up to 3 months and only 6.7% patients had benefit of only 2 months. Side effects such as Ptosis, diplopia, photophobia, redness of eyes, dry eyes and facial weakness occurred in 23% of patients in first week and up to one month while only 6.7% patients continued to have side effects at 3 months. This is the first study of its kind in our local population. This study concludes that the BTX is highly effective in the management of BEB and HFS and it is well tolerated

Gingivitis and dental caries status among the school going children of Jamshoro city

The purpose of the study is to assess the gingivitis and dental caries status among school going children of Jamshoro city. Descriptive Study This study was conducted at the out patients department of Liaquat University Hospital Jamshoro during the year Jan 2010 to Oct 2011 A descriptive study was conducted among 700 school going children. The general information and the information regarding oral hygiene practice and dental visits were obtained. The gingivitis of the subjects was assessed by using Loe and Silness Gingival Index. The dental caries status was assessed by using International Caries Detection and Assessment System. Out of 700 school children, n=270 [38.57%] were boys and reaiming n=430 [61.42%] were girls, the age distribution was done in three groups and in group one total children were n=101 [14.42%], in group two n=187 [26.71%] and in group three n=432 [58.85%] children, Gingival Index according to Loe and Silness in grade zero were n=322 [46.00%] children, grade one n=165 [23.57%] children, grade two n=143 [20.42%] children and in grade three n=70 [7%] children, Dental Caries Status of school children in relation with age group was in age group one n=199 [28.42%] children, in age group two n=175 [25%] children and in age group three n=115 [16.42%] children. The results of this study indicate that there is a moderate prevalence of gingivitis and dental caries among school going children of Jamshoro city. We the dental care providers, oral hygienist, parents and teachers trying to motivate the school going childrens for to improving the oral health of the oral cavity so that they can prevent themselves from common problems of the oral cavity

Serum electrolyte derangements in patients with traumatic brain injury

Electrolyte derangements are common sequel of traumatic brain injury. Use of intravenous fluids, diuretics, syndrome of inappropriate ADH secretion and cerebral salt washing are some of the factors responsible for this. Proper in time detection followed by appropriate treatment not only improves neurological status but also decrease morbidity and mortality. This study was conducted to know serum derangements of different electrolytes in patients with traumatic brain injury. This cross-sectional study was conducted in Pakistan Institute of Medical Sciences, Islamabad, Pakistan from Feb 2009 to Feb 2010. All adult patients with traumatic brain injury who presented to Neurosurgical department with severe head injury [GCS <8] and who need monitoring in high dependency unit, were included in this study. Initially twice daily serum electrolyte monitoring for one week then once daily for remaining period of hospital stay was carried out. All samples were sent to Pathology department of Pakistan Institute of Medical Sciences, Islamabad. Patients who need corrective measures for imbalance had repetition of sampling after giving appropriate therapy. Statistical analysis was performed on SPSS-16. Total 215 patients presented with severe head injury that were managed in high dependency unit. Out of which 127 [59.1%] were male and 88 [40.9%] were females. Most of them were adults between 21-40 years of age [21.4%; 24.7%]. Sodium was the main electrolyte that underwent change and out of which hyper-natremia was major abnormality that occurred in 140 [65.1%] of patients. This is followed by hypo-kalemia that occurred in 79 [36.7%] of patients. Serum calcium and magnesium levels show little derangements. Electrolyte imbalance following traumatic head injury is an important cause to look for in patient monitoring. Sodium is the chief electrolytes of concern. Serum potassium and calcium levels also under goes notable changes

Frequency of HBs Ag and anti-HCV in trauma patients

This study was carried out to determine the frequency of Hepatitis B and C Viral infection in patients undergoing emergency surgical operations after trauma, and to evaluate the associated risk factors. Descriptive Study. This study was conducted at General Surgical, Orthopaedic and Paediatric Surgery Department of Ghulam Muhammad Mahar Medical College Hospital Sukkur from May-2011 to April-2012. All the patients who were admitted in the Surgical and orthopaedic department for emergency surgical operations followed by trauma were included in the study. The patients were screened for HBsAg and Anti-HCV using immunochromatography [ICT] method. Those who were weak positive by ICT were further confirmed by Enzyme Linked Immunosorbent Assay [ELISA]. 592 patients were admitted in Surgical and orthopaedic department during a period of last one year for emergency operations after trauma and were screened for HBsAg and Anti-HCV. Out of these 592 patients 472 [79.7%] were males and 120 [20.27%] were females. Mean age of these patients was 40 years. After screening, 33 [5.57%] patients were found HBsAg positive and 117 [19.76%] were Anti-HCV positive, while 09 [1.5%] were positive for both. Hepatitis-B was found in 21 [2.3%] males and 12 [1.3%] females, while Hepatitis-C was predominantly found in 68 [7.44%] males and 49 [5.36%] female patients. Parenteral injections by Quacks, previous surgery, blood transfusion and shaving by barbers were found to be the risk factors. High frequency of HBs Ag and Anti-HCV was found in trauma patients undergoing emergency surgery. Our message is that "Prevention is better than cure". So it is essential to prevent the spread of Hepatitis B and C by screening every patient before surgery and counseling of patients

Treatment outcome of enteric fever in children at tertiary care hospital Sukkur Pakistan

Enteric fever [Typhoid fever] is widely recognized as a major public health problem in developing countries. To evaluate the treatment outcome of enteric fever in children. Retrospective descriptive study. This study was conducted at the Paediatric department, Ghulam Muhammad Mahar Medical College Hospital Sukkur from January 2009 to December 2011. This was a retrospective study, included all patients of enteric fever, of both sex and age ranged from 6m to 13 years. All enteric patients were confirmed by serological test Typhidot IgM or IgM and IgG positive. The data was collected from case record for demography and treatment outcome. A total of 360 patients were diagnosed to have enteric fever during this period. Mean age of presentation was 6.47 years and 166 [46.12%] patients were <5 years whereas 194 [53.88%] were > 5 years of age. Male: Female ratio was 2:1. Serological test typhidot IgM was positive in 290 [80.5%] and both [IgM + IgG] were positive in 70 [19.45%] of cases. Raised ALT was seen in 90[25%] of cases. Complications were seen in 52 [14.4%] of cases, hepatitis 10 [2.77%], hepatic abscess 3 [0.83%] intestinal hemorrhage 8 [2.22%], peritonitis 4 [1.11%] intestinal perforation 4 [1.11%], cholecystitis 6 [1.66%], paralytic ileus 3 [0.83%] enteric encephalopathy 3 [0.83%], meningitis 1 [0.27%]. Two patients expired [0.55%], one was enteric encephalopathy and other intestinal perforation with peritonitis. enteric fever remains a major cause of morbidity and mortality in our part of country. Major complications found in our cases were hepatitis, hepatic abscess, intestinal hemorrhage, intestinal perforation, peritonitis, cholecystitis, enteric encephalopathy, meningitis, osteomyelitis, septic arthritis

Selecting the appropriate electrode placement site for pulp tester on first premolar teeth

To find out the appropriate electrode placement site for electric pulp tester on first premolar teeth of both arches. This was an experimental study performed at Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro from October 2010 to March 2011. Forty volunteers with first premolar teeth free of restorations and caries were recruited. First premolar from each quadrant was selected, and rubber dam was applied without clamps. Three sites on each crown were tested twice with an electric pulp tester, and lowest threshold responses were recorded. Data were analyzed with ANOVA variable test. The lowest response for both [maxillary and mandibular] teeth was found on the tip of buccal cusp. Other sites showed an increase in level from the tip of buccal cusp, middle 1/3 of buccal surface and cervical 1/3 of buccal surface. No statistically significant difference was found in the responses of male and female subjects. It was concluded that the appropriate electrode placement site for pulp tester on first premolar teeth is the tip of buccal cusp

Dental resin-based composites: a transition from macrofilled to nanofilled

The invention of dental resin based-composites [RBCs] has provided a broad range of materials for the restoration of load-bearing posterior teeth with excellent clinical results and adequate longevity. A variety of RBCs, namely "microhybrid", "nanohybrid" and "nanofilled" have been marketed with bold claims of a technological advancement. Although "microhybrid", "nanohybrid" and "nanofilled" RBCs have exhibited a degree of clinical and experimental success compared with their predecessors, however, it is difficult to justify which RBC is superior as a result of slight variations in filler size and associated interchangeable mechanical and physical properties of RBCs. The objective of the current review article is to highlight the development of various filler particles of dental RBCs and resultant variation in mechanical and physical properties which may ultimately provide directions for future research on the RBCs

Culture and sensitivity pattern in patients with external ventricular drain infection

Background: External ventricular [EVD] is a life saving procedure and involves insertion of a catheter in ventricular space to drain cerebrospinal fluid [CSF]. Our objective of this study was to determine the culture and sensitivity [C/S] pattern in patients with EVD infection. Methods: This cross sectional study was conducted in Department of Neurosurgery, Pakistan Institute of Medical Sciences [PIMS], Islamabad from December 1, 2008 to January 31, 2010. All admitted patients who had acute hydrocephalus, underwent EVD insertion after excluding meningitis and ventriculitis by physical examination and per operative CSF sampling. The EVD was done at right Kocher's point. Prophylactic third generation antibiotic [Ceftriaxone] was started and continued till EVD was in place. C/S was sent to PIMS laboratory on first documented fever and or change of CSF color or when plan was to replace EVD with Ventriculo-peritoneal shunt [VP]. Once infection was there CSF was sent for C/S initially and routine examination [R/E] daily. Antibiotics were changed according to C/S report and continued till they were needed. Infection rate was also estimated. Results: Among 76 patients 41 [53.9%] were male and 35 [46.1%] were females. Most were adults and were between 31 to 40 years of age. Mean duration of EVD was 11.41 days. Overall infection rate was 11.8%. Among causative organisms Staphylococcus Aureus [44.4%] was most common followed by Acenitobacter and Enterobacter and commonly used prophylactic antibiotic [Ceftriaxone] had considerable resistance. Conclusion: EVD is a simple and life saving procedure. Most common organisms causing infection are Staphylococcus Aureus followed by Acenitobacter. Conventional used antibiotic Ceftriaxone has considerable resistance. Keywords: External Ventricular Drain, organisms, antibiotics

Postobturation pain after single visit endodontics in teeth with pulpal necrosis

Whether root canal treatment [RCT] is performed in single or in multiple sessions, infection control and elimination or reducing postobturation pain is a key factor for the success of RCT. Single visit RCT is now being considered as a good alternative to multiple visit RCT. The objective of this study was to assess the frequeney of post-obturation pain after single visit root canal treatment in teeth wilh pulpal necrosis along with the effect of age, gender and arch on pain severity after single visit endodontes. A total of 70 pulpally necrosed teeth of patients requiring RCT were treated at Operative Department of Altanmsh Institute of Dental Medicine, Karachi; from July 2008 to Feb 2009. 7 patients did not return for followup, therefore 63 patients were included in the study. The study design was Interventional Quasi experimental. Pre and Postobturation pain was recorded according to verbal rating scale before RCT, after 1[st] day, one week and after one month. Data was analyzed using the Chi-square test. Preoperative pain was observed in 57% of patients. While at first day follow up, postoperative pain was observed in 58% of patients, After seventh day pain existed in 14% [p=0.0001] of patients, after one month 8% [p=0.0001] patients remained painful. There was significant difference in severity of post-obturation pain in 16 to 35 year age group as compared to 36 to 40 year age group. Severity of pain significantly decreased in 16 to 25 and 26 to 35 age group at 1[st], 7[th] and 1 month recall [p=0.001]. Male gender in contrast to female gender had a significantly reduced severity of pain 1st month post operatively [p=0.001]. Severity of pain was significantly decreased in maxillary teeth as compared to madibular arch [pre vs. 1 days p=0.006] and [1st day vs. 1st month; p=0.0001]. The lack of post-obturation pain was found to be positivity co-related with single visit endodontics in age group of 16-35 years, male gender and maxillary teeth

Oral lichen planus: a clinical study

To evaluate the clinical characteristics, predisposing/aggravating factors and malignant potential of oral lichen planus [OLP]. Case series. Department of Dermatology and Oral Pathology, Liaquat University Hospital, Hyderabad, from January 2006 to November 2007. Patients of either gender aged above 12 years, fulfilling the diagnostic criteria for OLP were enrolled for study. Patients not willing to participate or suspected to have drug-induced lichenoid reactions were excluded. History regarding the onset and duration, symptoms, addictions was elicited followed by oral, cutaneous and systemic examination. Biopsy was taken when the diagnosis was doubtful or malignancy was suspected. The data were analyzed using SPSS software version 11.0 for frequency and percentage. A total of 95 patients [40 male and 55 female], aged between 17 and 62 years were enrolled. Diabetes [n=05] and hypertension [n=04] were the accompanying comorbidities. Family history was positive in 3 patients only. Reticular form was the most common clinical type seen in 52 [54.7%], followed by erosive in 31[32.6%] and atrophic/erythematous types in 12 [12.6%] patients. The disease caused pain, burning and other symptoms in 72 [75.7%] patients. Buccal mucosa was the chief site of involvement [n=31]. Other sites involved were tongue [n=20], lips [n=28], palate [n=9] and floor of mouth [n=03]. Stress, spicy foods and poor oral hygiene aggravated disease in most [n=77] of the patients. OLP is a chronic disease with diverse clinical manifestations and multiple site involvement. Associated pigmentation of surrounding mucosa was unique finding of this study. Long-term follow up is needed to assess the malignant potential. Stress was the most important factor aggravating the disease

Efficacy of thrombolytic therapy in preserving left ventricular function following acute myocardial infarction

This study is a prospective study to determine the value of thrombolytic agents in restoring patency in the infarct related artery and its consequent effect on left ventricular function. At total of 48 patients were investigated, all presenting with symptoms of chest pain. Clinical, electrocardiography and echocardiographic criteria were used to document myocardial infarction. 2-D and M-mode echocardiography was used to detect abnormalities of contraction and relaxation of myocardium. Two group of patients were formed giving thrombolytic and non thrombolytic therapy. Echocardiography was done on admission, discharge and three weeks after discharge from hospital. Patients in both group were evaluated for clinical signs of left ventricular dysfunction according to Killip criteria. The study showed a better left ventricular function in group receiving thrombolytic therapy. Patients who could not be given thrombolytic therapy showed deteriorating left ventricular function which progressed even after one week. It is concluded that addition of thrombolytic therapy definitely improves left ventricular function by restoring patency of infarct related artery, and thereby improving perfusion of ischemic myocardium

Two dimensional echocardiography in acute myocardial infarction

100 Patients with first episode of acute myocardial infarction were examined. 9 patients were excluded from study because of poor echgenicity and the study consisted of 91 patients [53 anterior, 31 inferior, 6 posterior and 1 lateral]. Diagnostic admission electrocardiograph was possible in 31 [69 percent] of anterior and 14 [46 percent] of inferior infarcts. 6 patients of posterior and one of lateral wall infarct had the first electrocardiograph within normal limits. Adequate 2 dimensional echocardiography was possible in 91 patients, 71 [79 percent] had the typical wall motion abnormalities. 45 [84 percent] of anterior, 22 [70 percent] of inferior, 4 [60 percent] of posterior and one [50 percent] patient of lateral wall infarct had the diagnostic segmental dysfunction suggestive of myocardial infarction