Comparison the effect of 3 point valgus stress knee support and lateral wedge insoles in medial compartment knee osteoarthritis

There are many opinions and controversies regard the effect of lateral wedge insoles and valgus stress Spoint knee braces in treatment of medial compartment knee osteoarthritis [OA]. In this study we compared the effect of lateral wedge insoles and 3 point knee supports in treatment of medial compartment knee OA. Sixty patients [35-65 years], with knee pain and genu varum and moderate to severe medial compartment DJD were divided into three groups. The first group received a custom molded 3 point valgus stress knee support. Lateral wedge insoles were applied for the second group and the third group served as control. All groups were followed for 9 months according to pain severity, walking distance, and radiologic changes. Pain reduced significantly in both lateral wedge and knee brace groups compared to control group with more significant reduction in the brace group. The walking distance was significantly longer only in the brace group. There was more pronounced effect of brace in patients with severe DJD in walking distance compared to moderate DJD, but not in severity of pain. Three point valgus stress knee support had more significant effect on pain reduction, walking distance and also radiologic improvement of patients with moderate to severe medial compartment DJD compared to lateral wedge insoles and could even reverse radiologic findings

Investigation of the relationship between osteoporosis and sexual satisfaction in women

As clinical observations have shown, osteoporotic women were complaining of lack of sexual satisfaction and are more prone to depression. Hence, we decided to find the statistical direct relationship between these two factors. The case group included 53 menopause women [21 with osteoporosis and 32 with osteopena] and 53 premenopausal women [37 osteoporotic, and 16 osteopenic]. In the control group, there were 53 menopause women, and 53 premenopausal women who had normal bone density. Sexual satisfaction in both groups of case and control was assessed by standard Larson's sexual satisfaction questionnaire and bone density was investigated by Dual-energy x-ray absorptiometry [DEXA], in Chamran Hospital bone mass densitometry center. The menopause women had significantly less sexual satisfaction in comparison with non-menopause ones. Osteoporotic women showed significantly less sexual satisfaction that means that the main effect of osteoporosis and menopause is significant. Osteoporotic women reported significantly less sexual satisfaction in comparison with the two groups of healthy women and osteopenic women [Scheffe test]. Osteopenic women also had less sexual satisfaction in comparison with healthy women. This study suggests that there is a relationship between bone loss and sexual satisfaction in both groups of women. Therefore, this correlation suggests the importance and necessity of quick diagnostic investigation and the management of osteoporosis in women with sexual dissatisfaction

[Synergistic effects of vitamin A and extremely low frequency electromagnetic field [50HZ] on limb bud development in balb/c mouse]

Vitamin A is involved in vertebrate morphogenesis, growth, cellular differentiation, and tissue homeostasis. Vitamin A and its metabolites are essential for adequate embryo development. Electromagnetic fields [EMFs] have been used effectively to treat some diseases, such as certain musculoskeletal and chondrogenic disorders. In the present study, we aimed to investigate the synergistic effects of EMFs and Vitamin A on limb bud development in Balb/C mice in vivo. The Balb/C mice were used as experimental model. After mating, the pregnant mice were divided randomly into 3 groups as control, sham and experimental groups. Control and experimental groups received a single dose injection of Vitamin A [15000IU/Kg] on 10.5[th] gestational day, interaperitonealy. In addition, animals in experimental group were exposed to EMFs [50 Hz /100 gauss, for 4[th] during three days]. The animals were killed on the 15.5[th] day of gestation and were submitted to caesarian section. The obtained fetuses were examined externally with an analyzed under a stereoscopic microscope and were photographed. Data were analyzed statistically by t-test and ANOVA and Ktuskal-Wallis. Morphological and histological examinations showed significant changes in limb buds as compared with sham exposed and control groups. In both fore and hind limb buds significant decrease obtained in proximo-distal [P-D] and anterior posterior [A-P] axes [P<0.05]. Chondrocytes counts revealed a significant delay in the development of chondrocytes in experimental groups as compared with sham exposed and control groups [P<0.05]. Synergistic effects of vitamin A and extremely low frequency electromagnetic field [50Hz] cause delay in development

[ effects of mobile phone waves [940MHz] on embryonic development of hematopoiesis system in Balb/C mouse]

Today, increasing usage of microwaves generator sets such as cell phones, have been caused much worry related to their waves effects on human health. In this research, simulated waves effects of cell phones with frequency of 940MHz have been studied on hematopoiesis system of Balb/C mouse embryo. In an experimental study pregnant mice [Balb/C] were used as a laboratory model. The mice were divided into control, sham-exposed and experimental groups. The experimental groups were exposed to the waves on the 8[th] day of embryonic development for 4 or 10 days [everyday for 4 hours]. At the end of treatment period, the experimental samples, sham-exposed and control related to morphology and histology studies of hematopoiesis organs were done by light microscope. Using t-test and Mann-Whitney test, the quantitative data were analyzed. Morphologic study of embryos which were 18 days old didn't show any abnormality but the weight of experimental embryos [1.263 +/- 0.017 gr] compared with sham-exposed [1.268 +/- 0.006 gr] showed significant increase [P<0.05]. The study of tissue sections in embryos which were 12 days old didn't show significant change in tissue and cellular position of yolk sac of experimental samples as compared with control group. Also, tissue studies of embryos which were 18 days old didn't show any changes in general structure of liver, spleen, marrow bone but the number of Megakaryocytes of spleen and erythrocytes which had not nucleus in bone marrow of experimental samples showed significant increase as compared with the sham-exposed. The number of erythrocytes in liver which had not nucleus also showed significant increase as compared with the sham-exposed [P<0.05]. Waves of cell phones with frequency of 940MHz don't affect on general structure of liver, spleen, bone marrow of Balb/C embryos but it causes significant changes in the number of cells of these tissues

[ Comparison of the stretching with ethyl chloride spray and stretching after injection of the lidocaine in the treatment of the trigger points: single blind randomized clinical trial [RCT]]

Trigger points have been described as a cause of pain in clinical practice and an extremely source of musculoskeletal pain. Stretching can effectively inactive trigger points and provide symptomatic relief. This study compares muscle stretching immediately after inject of lidocaine vs. stretching with the ethyl chloride spray in the treatment of the trigger points. patients with trigger point in gluteal muscles were recruited using strict inclusion and exclusion criteria from Shiraz medical school clinics. Subjects under went 2 office visits and 2 phones follow up. In group A stretching was with spray of ethyl chloride and in group B stretching of muscle injected oone immediately after injection was done immediately after injection. Evaluation measure tools were 0-10 NRS, VAS and BPI. In respect to VAS and NRS there was statistical significance difference between both groups 1 month and 2 month after treatment. There was statistical significance difference between both groups in all measuremant aspect of BPI except [general activity and walking] one month after treatment. muscle stretching immediately after injection of lidocaine was more effective [at least up 2 month] than stretching after spray of the ethyl chloride in the symptomatic treatment of gluteal trigger points and improvement of functional activity of the patients

Peripartum hysterectomy

To find out the frequency, indication and its associated morbidity in our setup. Prospective cross-sectional observational study for the period one year [from June 2003 - May 2004] carried out in the Department of Obs / Gynae, Lahore General Hospital Lahore. During the study there were 26 cases of peripartum hysterectomy, of which 14 case were of caesarean hysterectomy, while 10 cases were following normal vaginal delivery and 2 cases followed by instrumental delivery. Uterine atony was the most common indication for peripartum hysterectomy in 12 cases [46.15%]. Uterine rupture including instrumental delivery tear was 2nd most frequent cause in 4 +2=6[23.07%] of cases. In 19.2% [5] of cases abnormal placentation was the cause. In 2[7.6%] of cases sepsis was the cause leading to secondary PPH followed by hysterectomy. A subtotal hysterectomy was carried out in 10 [38.46%] and total hysterectomy was performed in 16 [61.53%] cases. there were 4 maternal deaths. Urinary tract injuries occurred in 3[11.53%] cases, fever, chest infection and wound infection were common morbidity. Anemia was found in almost every case. Intra and post operative Blood transfusion s were given in all cases. Reloparotomy was done in one patient for continues vaginal bleeding. Despite its morbidity and mortality emergency Obstetric hysterectomy remains an essential life saving tool. Uterine atony, uterine rupture and abnormal placentation were mast common indications, reflecting under utilization of existing antenatal, family planning services. Injudicious use of oxytocin, lack of transportation facilities, poverty and delayed referral all contribute to morbidity and mortality associated with emergency Obstetric hysterectomy

[ effect of a stretching- strengthening exercise program on decreasing pain index on workers with musculoskeletal complaints]

Musculoskeletal disorders are the leading cause of disability among people during working years which impose high expenses on the society in different aspects. this study was conducted to assess the effect of a stretching- strengthening exercise program on decreasing pain index on workers with musculoskeletal complaints. This quasi-experimental study was done on cleaning unit workers in one of the factories producing hygiene instruments in Shiraz in 2006. All the fifty four employees were considered in our study. First, all workers were evaluated by the physiatrist under complete musculoskeletal examination and pain intensity was assessed by VAS and BPI indices. After 3 months, to confirm the chronicity of symptoms, the second examination was done and then exercise program was recommended for 3 months. The collected results were analyzed by SPSS software and non-parametric Wilcoxon test. The primary mean of the VAS index was 5.00 +/- 2.27cm while after 3 months it was raised to 5.32 +/- 2.76 cm and reduced to 1.98 +/- 2.07 after doing exercise program, which is a significant decline [p<0.001]. Mean of different indices of BPI showed significant decrease after completing exercise program [p<0.001]. Doing an exercise program based on type of work, and availability of facilities in work environment is effective in decreasing musculoskeletal complaints as a primary cause of disability among workers

[ effects of exposure to simulation cell phone waves on gonads of male mouse]

The increasing users of microwave appliances such as cell phones caused an increasing interest on investigation of its adverse effects on human health and development of animals. This study is done to investigate the effects of simulating cell phone waves on gonads and sex cells of male Balb/C mouse. This is an experimental study in which with the use of generating apparatus of simulating cell phone waves, adult male mice were exposed to cell phone waves for 10 days [4 hours per day]. Then structure and ultrastructure of testes and number of sex cells were examined by light and transmission electron microscope. Data was analyzed using t and Mann Whitney testes. The results did not show any significant differences in the size and weight of testes in mice exposed to the simulating cell phone waves. Results also showed that the number of spermatogonia cells and primary spermatocytes and spermatids and sperms were significantly increased in exposed mice [p<0.05], but the number of sertoli cells were significantly decreased [p<0.05]. The study of micrographs showed changes in ultrastructure of sexual cells, such as cleft and hetrochromatined nucleus and decrease of cell organelles and vacuolization of cytoplasm. Results indicate the effect of simulating cell phone waves on number and ultrastructure of sex cell in male Balb/C mouse

[Effect of low frequency electromagnetic fields on gonads and fertility of female Balb/c mouse]

The increasing use of EMF [electromagnetic field] generating apparatus [refrigerators, computers, TV, etc] caused an increasing interest in investigations of its adverse effects on human health. This study is done to investigate the effects of EFM on Balb/c mice. This is an experimental study in which at first a ciruit generating low frequency electromagnetic field [50 Hz, 15G] was designed. Then adult virgin female mice were placed in coil and exposed to 15 gauss electromagnetic field for 4 day and 6 hour per day. Then their blood was examined to assay the level of hormones [FSH, LH, estradiol, progesterone]. Also ovary and uterus sections were studied with light and electronic microscope. Results showed that the weight and size of ovary was not significantly affected in females exposed to the low frequency electromagetic field and their offspring. Our results also showed that the number of ovary follicles were significantly affected in exposed females [p< 0.05]. Also the study of micrographs showed hetrochromatinated oocytes and follicular cells and increasing polysomes, accumulation of mitochondria and cleft mucleus. Decreasing amount of FSH, LH and 50% decrease in couplation rate was also seen as compared with the control group. Results of this study is indicator of EFM effects on gonads' structure and endocrine system and decreases fertility

Comparison of maternal complication in elective Vs. Emergency caesarean section

To compare the maternal complication in elective vs emergency caesarean section. Prospective study. Department of Obstetrics and Gynaecology, Lahore General Hospital, The study was conducted from August 2004 to August 2005. During this period all women underwent elective or emergency caesarean section included. A total of 920 caesarean sections were performed, 770 were emergency and 150 were elective. Intraoperative and postoperative complications were 76, 70 in emergency and 6 in elective group. Postoperative complications were 120, 110 in emergency and 10 in elective cases. In emergency caesarean section maternal mortality and morbidity is high

evaluate and compare the effects of first generation anti-histamine [chlorpheniramine maleate] and second generation anti-histamine [Cetirizine dihydrochloride] on isolated trachea of rabbit

Histamine is generally considered as the principal mediator of the acute inflammatory process and the allergic and anaphylactic reaction in both the upper and lower respiratory airways. Chlorpheniramine maleate is a stable, most potent, .first generation antihistamine. It is clinical efficacy in the treatment of IgE mediated histamine disorders is well established. Cetirizine dihydrochloride is a potent, non-sedative HI receptor antagonist, belongs to second generation antihistamines. It is highly effective and safe drug for treating seasonal and perennial allergic rhinitis amid urticaria. Also used in chronic idiopathic urticaria and atopic dermatitis. The purpose of study was to evaluate the antagonostic effects of chlorpheniramine maleate and cetirizine dihydrochloride on histamine induced contractions in isolated trachea of rabbit and to compare the effects of first generation anti-histamine [chlorpheniramine maleate] and second generation anti-histamin [cetirizine dihydrochloride] on isolated trachea of rabbit. In this study twenty-four experiments were performed on isolated trachea of rabbit, in the presence of selected standard concentration of histamine dihydrochloride antagonistic effects of various concentrations of chlorpheniramine male-ate [10e-18 to 10e-3 gm/ml] and cetirizine dihydrochloride from concentrations to 10-3 gml ml were recorded by Polygraph Model 7B in terms of rate and amplitude. Chlorphenimmine maleate showed non-significant antagonistic effect from concentrations 10e-18 to 10e-9 gm/ml in case of rate and 10e-18 to 10e-8 gm/ml in case of amplitude. Significant response showed from concentrations 10e-8 to 10e-3 gm/ml in care of rate [P<0.001] and 10e-7 to 10e-3, gm/ml in case of amplitude [P<0.001] while, cetirizine showed non-significant response front concentrations to, gm/ml in case of rate and 10e-18 to 10e-12 gm/ml in case of amplitude. Significant response observed from concentrations 10e-12 to 10e-3 gm/ml in case of rate [P<0.001] and 10e-11 to 10e-3 gm/ml in case of amplitude [P<0.001]. It was concluded that chlorpheniramine maleate antagonized thetukl tisatnmd mine induced contractions 80.65% at concentration la, gm/ml in case of amplitude 11.35% at concentration 10e-3 gm/ml in case of rate and cetirizine dihydrochloride 82.69% in case of amplitude and 12.33% in case of rate

Surgical management of simple vesicovaginal fistulae

Vesicovaginal fistula is a fairly common occurrence in our country because of poor availability of obstetric care. The purpose of this study is to review our results in the surgical management of VVF.Design: Prospective study. Place and duration of the study: The study was conducted in the department of urology, Federal Government Services Hospital [F.G.S.H.]; Islamabad, from February 2002 to January 2004. Patients and Eleven patients were operated for vesicovaginal fistulae. Transvaginal repair was done in 8 [72.7%] patients while transabdominal repair was adopted in 3 [27.3%] patients only. Inclusion criteria: All patients presented with vesicovaginal fistulae only. Exclusion criteria: All patients presented with genitourinary fistulae other than VVFs. The majority of fistulae [10 [90.9%]] were caused by ischaemic necrosis of bladder and vaginal walls resulting from obstructed labour. One [9.1x] patient developed VVF after hysterectomy due to some gynaecological problem. Surgical repair proved to be successful through transabdominal route in all 3 [100%] cases of VVFs while in 6 [75x] of 8 [100%] cases through transvaginal route. To describe an overall result, 9 [81.8%] vesicovaginal fistulae were successfully repaired at first attempt. Vesicovaginal fistulae can be best managed following basic surgical principles like adequate exposure, identification of structures, wide mobilization, tension free closure, good haemostasis and uninterrupted bladder drainage

Uterine rupture: an audit to analyze management options, maternal and fetal outcome

Study Design: An analysis of 14 cases of ruptured uterus was done during January 2003 to December 2003 in Obstetrics and Gynae Department of Lahore General Hospital, Lahore. The purpose of this Audit was to analyse the different management options, maternal and fetal outcome in uterine rupture. Material and Total no of births in 2003 was 4840. Total number of ruptured uterus found to be 14 [2.9%/1000] deliveries. Among these incomplete rupture were 3 [21.4%] and complete rupture were 11 [78.4%]. Regarding the common sites of uterine rupture lower uterine segment interior surface = 11 [78.4%]. Lower uterine segment posterior surface = 2 [14.2%] and upper uterine segment rupture was = 1 [7.14%]. The most common cause of uterine rupture was found to be multiparity and injudicious use of oxytocin by TBA in 5 cases. [35.7%] and previous uterine surgery in 5 cases [35.7%]. 2 cases [14.21] were due to cephalopelvic disproportion due to hydrocephalus and 2 [14.2%] cases were of malpresentation [transverse lie] mostly handled at home by TBAs. Hysterectomy, total or sub total was done in 7 cases [50%]. Repair of uterus was done in 5 cases [35.7%], in 2-cases [14.2%]. Bladder repair alongwith uterine repair was done. In two cases [14.2%] of scar dehiscence, repeat cesarean section was done. The maternal mortality was found to be zero, while intrauterine death were 10[71.4%] and alive babies were 4 [28.5%] high perinatal mortality of 71% were found. Ruptured uterus is avoidable catastrophe by proper education, training of patients and TBA's and by providing effective family planning services, transportation, diagnostic facilities and by reducing the unnecessary caesarean section

Frequency of placenta praevia with previous caesarean section

Two hundred Cases of Previous Caesarean Sections were Studied. 130 were associated with Placenta previa. The aim of Study was to evaluate the frequency of Placenta previa with Previous Caesarean Section. Out of 130 Patients 73% were Symptomatic and 27% were asymptomatic. The most Common ante-natal Complications were anemia 40% and repeated Warning haemorrhages 64%. Out of 130 Patients 35 Patients had Previous one Caesarean Section 27%, 80 Patient had Previous two Caesarean Section 61.5% and 15 Patients had Previous three Caesarean Section 11.5%

Mirizzi syndrome management

The aim of this study was to assess the clinical presentation and management of Mirizzi syndrome. Descriptive study. During 2 year at Ittefaq Hospital Lahore 10 patients came with Mirizzi syndrome by chance. All patients presented with upper abdominal pain, jaundice and palpable gallbladder. ERCP was inconclusive in 5 patients preoperatively. Rest of 5 patients undergo surgery and on table cholangiogram was performed. All the patients undergo surgery after pre-operative work up. ERCP in 5 patients and peroperative cholangiogram in 5 patients was inconclusive. Nine patients had type-I Mirizzi syndrome and 1 patient had type-II Mirizzi syndrome. Simple cholecystectomy was performed in 9 patients but in 1 patient [type-II] after cholecystectomy T-tube was placed in common bile duct. Postoperatively T-tbe was removed after T-tube cholangiogram. Mirizzi syndrome is a uncommon presentation of gallstone. Its diagnosis is confirmed on cholangiog raphy and can be treated surgically safely

Complications of multiple gestation

A Total of selected 50 Patients with Multiple Pregnancy were Studied. The aim of the study was to see the complications of multiple gestation. It was concluded from the results that most common complication is Preterm labour [54%] anemia [38%] Pregnancy induced hypertension [32%] Preterm Premature rupture of membranes [12%] and antepartum haemmorhge in [6%]. Fetal Complications were prematurity and low birth weight