Celiac disease; histopathological evaluation of endoscopic duodenal [D2] biopsies in patients

To find out the Modified Marsh type of celiac disease [CD] patients on histopathological examination of duodenal [D2] biopsies and to correlate it with tissue transglutaminase IgA levels. Cross sectional study. Place of Histopathology laboratory [Department of Pathology], Isra University Hospital and Asian Institute of Medical Sciences [AIMS], Hyderabad. July 2013 to December 2013. 96 patients with a history of malabsorption or atypical symptoms with clinical suspicion of CD were subjected to endoscopy. Endoscopic duodenal [D2] biopsies were taken regardless of age and gender. D2 biopsies were processed for histopathological examination under light microscopy. Out of 96 patients, 45 [46.9%] patients had moderate type of lamina propria inflammation along with highly significant p-value [0.0001].CD type 3a was observed in 34 patients [35.4%]. In this study the comparison of serological level of tissue Transglutaminase IgA [tTGA] and histological severity revealed significant correlation. All Modified Marsh types of CD with tTGA level seen in our study were highly significant [p-value 0.001]. In this study strong correlation was observed between the serological tTGA level and histological findings by Modified Marsh classification along with lamina propria inflammation of duodenal mucosa in CD patients

Effects of L-carnitine; on skeletal muscle of rabbit

L-carnitine [L-car] is a trimethylated amino acid required for the transformation of long chain free fatty acids into acylcarnitine and their subsequent transport into the mitochondrial matrix. It enhances the fatty acid oxidation for energy thus delaying the skeletal muscle fatigue. Objectives of this study were to determine effect of L-carnitine supplementation on skeletal muscle lactate after fatigue, to observe effect of L-carnitine supplementation on force of contraction in skeletal muscle and to estimate the time to onset of fatigue after L-carnitine supplementation. In control group, the rabbit sedated and soleus muscle was excised, Homogenized and centrifuged. Supernatant collected, was mixed with reagents of lactate test kit. Absorbance of light was read with the help of spectrophotometer and readings were noted. In experimental group, L-carnitine was given in a dose of 80mg / kg. The period of administration was two weeks. Soleus muscle was excised after giving the last dose of L-carnitine. Lactate level was measured by using lactate test kit [Randox®]. Readings for lactate measurement were noted after fatigue in both groups. Statistically significant results [p <0.05] were found in all three variables. Data was analyzed by applying [t] test in IBM SPSS Statistics - 20 software. L -carnitine delays the onset of fatigue of skeletal muscle. This was the stated alternative hypothesis

Diabetic control situation; a study of diabetic patients in ministry of health primary health centers of Makkah Al Mukkarahma Saudi Arabia

To determine the prevalence of controlled diabetes in registered diabetic patients with Hemoglobin A1c [HbA1c]

Effects of various excipients on tizanidine hydrochloride tablets prepared by direct compression

This study was conducted to assess the effects of various excipients in 10 different Tizanidine hydrochloride tablet dosage forms that were prepared by direct compression method [DC]

Various excipients are available for DC method; we selected those excipients that are used commonly in tablet manufacturing

The excipients used included lactose anhydrous, di-basic calcium phosphate anhydrous, starch, talc, sodium carboxy methyl cellulose, polyvinyl pyrrolidone [PVP], silicon dioxide [Aerosil], stearic acid, magnesium stearate and microcrystalline cellulose [Avicel]

These tablets were then evaluated by performing different pharmacopoeial and non-pharmacopoeial tests [i.e. diameter, hardness, thickness, weight variation, disintegration and assay]

It was observed that Formulations B, D and H of Tizanidine hydrochloride gave best results within USP specified limits for the tests employed among all the formulations whereas Formulations F and G showed poor friability, disintegration and dissolution profiles rendering starch in combination of talc and sodium carboxy- methyl cellulose unsuitable for Tizanidine hydrochloride tablet formulations

With the present approach, more studies can be designed using other active ingredients and excipients to get an optimal and cost effective product

Subclinical rickets

The study on sub clinical rickets is unique in the sense that it has not been preplanned conducted anywhere especially in Pakistan. The objective of present study was to explore the prevalence, gender and geographical distribution of sub clinical rickets and their related factors among school students. Out of total participants, 189[90%] students were finally included in the study from rural, urban and suburban high schools of Hazara Division, KPK. The age of boys and girls students was 11 years to 16 years. Anthropometrics data along with daily intakes of meal and availability of sun shine was noted on record form. Sub clinical cases were diagnosed with abnormal biochemical findings without physical indications of rickets. Sub clinical rickets was found in 51[27%] students, out of which 15[8%] were boys and 36[19%] girls. Geographically, 26 cases of sub clinical rickets were from rural schools, 16 of urban and 09 found in suburban school. All sub clinical cases had serum level of sunshine vitamin D in between >/= 18nmol/l to

Subclinical nutritional rickets among adolescents in kaghan valley

To determine the occurrence of subclinical rickets and its causing factors among adolescent students of schools in Kaghan Valley, Pakistan. Observation cross-sectional study. Department of Biochemistry and Health Sciences, Hazara University, Mansehra, Ayub Medical College and Teaching Hospital, Abbottabad, from March to April 2012. Sixty seven students [34 boys and 33 girls] age between 11 - 16 years included in the study from different schools of Kaghan Valley, Pakistan. Characteristic, serum biochemical and nutritional status were measured for all the participants. On the basis of biochemical finding the boys and girls students were divided in to two groups, normal subjects and subclinical rickets [absent symptoms with altered biochemistry]. Twenty six participants, 19 [73%] girls and 07 [27%] boys had biochemical abnormality but no clinical signs and symptoms of rickets. Low vitamin D and high alkaline phosphatase level were observed in 26 [100%], 21 [81%], low calcium in 17 [65%] and low phosphorus 7 [27%] subjects with subclinical rickets. None had high parathormone level above normal range. Nutritional intake of calcium, phosphorus and vitamin D was found less than the recommended daily intake in all the participants. Subclinical rickets is common problem among adolescent students especially in girls which is due to low nutritional intakes and avoidance of sunshine due to environmental and traditional impacts

Aetiology and types of neonatal seizures presenting at ayub teaching hospital Abbottabad

Neonatal seizures [NS] affect approximately 1% of neonates. Clonic, tonic, myoclonic and subtle seizures are the common types. Birth asphyxia, sepsis, metabolic derangements, intracranial bleed, kernicterus, tetanus and 5[th] day fits are the common aetiologies. This study was planned to evaluate the types and causes of neonatal seizures. It was a descriptive case series conducted at Ayub Teaching Hospital, Abbottabad from 12[th] December 2006 to 25[th] September 2007 on eonates having seizures. Serum chemistry, blood counts, cerebrospinal fluid examination and cranial ultrasound were done in all patients. Blood culture, renal and liver function tests, computerised tomography scan, metabolic and septic screening was done in selected patients. Descriptive statistics were applied for analysis. Tonic clonic seizure was the commonest type [28%] followed by multi-focal clonic, and focal tonic seizures [25% each]. Birth asphyxia was found to be the main aetiology [46%].Tonic clonic seizure was the commonest type and birth asphyxia the main aetiology identified in the majority of neonatal seizures.

Iron deficiency anemia: scenario of pregnant women living at an altitude of >5000 feet in district abbottabad

To estimate the frequency of iron deficiency anemia in a sample of population of pregnant women residing permanently at high altitude of > 5000 feet in different areas of district Abbottabad. Cross sectional Study. Northern Institute of Medical Sciences Abbottabad: From 17 August 2009 to 15 June 2010. This study was carried out on hundred pregnant women residing permanently at an altitude of > 5000 feet above sea level in district Abbottabad. The age range was fixed to 15-45 [child bearing age] years. Suspected study participants having anemia were tested for iron status by serum ferritin test. Pregnant women having both anemia and iron deficiency were labeled as patients of Iron deficiency anemia. Results: The age range was 15-41 years with a mean of+/ - SD of 28.13 + / - 6.61. All women were of low and middle socioeconomic class with 74% illiteracy. 60% of women had birth spacing of two or less than two years. 64% of pregnant women had three children. Anemia was detected in 74% [X[2] =9.42 p > 0.05], iron deficiency in 66% [X[2] = 14.76 p <0.01] and iron deficiency anemia in 60% [X[2] = 13.56 p < 0.01]. High altitude resident pregnant women remain at high risk of developing iron deficiency anemia because of illiteracy, poverty and ignorance. With adequate nutrition and health education the problem can be addressed effectively

Posterior reversible encephalopathy syndrome [PRES]

Posterior reversible encephalopathy syndrome [PRES] is a clinicoradiologic entity. Neurotoxicity with characteristic watershed CT/MR imaging features characterize this condition. This case report describes PRES syndrome in a 35-year-old patient admitted with eclampsia. On the first postpartum day; she developed severe headache, generalized tonic-clonic seizures and visual symptoms including transient visual loss. MRI scan of the brain showed symmetric areas of hyperintense signal on T2-weighted images in the occipital lobes bilaterally. Patient improved symptomatically. Repeat MRI of the brain 4 months after initial admission showed resolution of the previous abnormalities

Bronchial atresia with partial anomalous pulmonary venous return

Bronchial atresia and anomalous superior pulmonary venous return into the left brachiocephalic vein are unusual anomalies. We present a young asymptomatic man in whom these two distinct anomalies were co-existingly found on routine medical examination. Patient was diagnosed as a case of congenital bronchial atresia with partial anomalous pulmonary venous return based on the evidence of special features on X-ray chest film, characteristic contrast enhanced 16-slice CT chest findings, lack of symptoms and no change on fallow-up X-ray chest films

Thrombocytopenia; frequency and degree in patients with falciparum malaria

Malaria is usually associated with reduction in blood cell counts and mild to moderate thrombocytopenia is a common feature of falciparum infection. This study has been conducted to find out frequency and degree of thrombocytopenia in patients suffering from falciparum malaria at a tertiary care hospital of Abbottabad. It was a descriptive case-control study being carried out at Ayub teaching hospital and Northern institute of Medical Sciences [NIMS] Abbottabad over a period of ten months. All patients with acute febrile illness without localizing signs were considered for study. A total 250 patients having falciparum malaria diagnosed by peripheral blood film examination have been studied. Complete blood counts were performed by Automated Beckman Coulter Analyzer. Blood films were examined by clinical pathologist for plasmodium falciparum via light microscopy using oil-immersion lens. Out of 250 patients, 155 [62%] were females and 95[38%] males with M: F ratio of 1:1.5. Mean age was 36 +/- 1.2 years [range 17-58 years]. Out of 250, 175[70%] had thrombocytopenia [p<0.05] while 75 [30%] had normal platelet counts. Thus mild, moderate and severe thrombocytopenia had been observed in 121[48.4%], 41[16.4%] and 13[5.2%] respectively [p<0.05]. Fever appeared to be most common symptom observed in all patients [100%] followed by vomiting and nausea [88%]. Anemia was the commonest sign present [80%] during our study. We discovered high frequency of mild thrombocytopenia in falciparum malaria. Therefore, thrombocytopenia can be supportive in diagnosis of plasmodium falciparum infection

Health seeking behavior of the people; knowledge, attitudes and practices [KAP] study of the people of urban slum areas of Karachi

The aims and objectives were, to know about the approach of people towards seeking medical advice with different options of healers, to observe thinking, feeling and various actions of people including level of self medication, and to know perception of people regarding various practices done by the healers. People living in urban slum areas of Karachi. Cross sectional Karachi. July to October 2008. Subjects and It was Knowledge, attitudes and practices [KAP] study carried out on a sample of 300 permanent household members aged>/=16 years of middle and poor class living in urban slum areas of Karachi. The mean age of the study participants was 38.27 with standard deviation of 17.57. 182 [61%] were male while 118[39%] were female. Out of 300 study participants [n=300] 260 [86.6%] consult allopathic healers including 169 [56.33%] MBBS general practitioners and 91 [30.3%] non qualified or quacks,25 [8.3%] consult homeopaths, 11 [3.6%] Hakims, and only 4 [1.33%]consult faith healers [P<0.05].148 [49.33%], participants belong to middle class group, while 152 [50.66%] were from poor class. 50% study participants do self medication at home prior to consultation for heath. Health seeking behavior is a complex phenomenon in developing countries like Pakistan where poverty overrides all other factors in decision of selecting a healer. It is recommended that people should be educated in choosing a healer which should be a qualified one

Mucocele of the appendix: an unusual cause of disturbed bowel habits

There are many causes of disturbed bowel habits. In this rare case of mucocele of appendix, patient presented with disturbed bowel habits of increased frequency, urgency and semisolid stool. Ultrasound of abdomen revealed fusiform cyst just below umbilicus. Differential diagnoses included mesenteric cyst, duplication cyst and mucocele of appendix. Coronal and saggital reformats of CT abdomen confirmed its origin from ceacum. Its tip was in contact with sigmoid colon. Surgical resection was carried out and histopathology revealed mucinous cyst adenoma

Typhoid and non-typhoid ileal perforation: surgical experience of 50 cases

The objective of the study was, to find out the frequency of typhoid and non typhoid ileal perforation, to observe the association of various epidemiological factors in causation of disease and to note surgical, clinical, and laboratory findings along with mortality. A comparative descriptive study. The study was conducted in the department of surgery Civil Hospital Karachi from June 1997 to August 1998. fifty consecutive patients of non-traumatic ileal perforation managed surgically were observed by making two groups of typhoid and non typhoid ileal perforation. Out of 50 [n=50] 32 [Group - A] patients [26 male and 6 female] had typhoid while 18 [Group - B] patients [15 male and 3 female] had non-typhoid ileal perforation. There were 41 [82%] male and 09 [18%] female. In-group A age range was 16-50 years and a mean of +/- SD of 25 +/- 10 while in group B age range was 12- 60 years and a mean of +/- SD of 26 +/- 11.65. In group A 90.6% while in group B 100% patients had a single perforation. Wound infection was the most common complication. Mortality was 6.25% and 5.5% in group A and B respectively. There was no significant association [P<0.05] of gender, seasonal and living conditions. Surgical cum Epidemiological findings point out to the need of distinguish between different types of non traumatic ileal perforation, and having check on the related causative factors leading to their occurrences

Prevalence of obesity in school children of Hazara division

Limited data is available in Pakistan regarding prevalence of obesity in school going children. The objective of this study was to find out obesity prevalence in school going children in Hazara division. It was descriptive study. Data of 3200 students was collected over six month period, from Hazara Division. Four schools were selected in each district two for boys and two for females. District Kohistan was excluded from study as female education is not permitted beyond primary education. Children 5-14 year age group were included in the study. Initial 20 students of each class were selected for study. Anthropometric data [weight, height] for each student was collected and entered on Performa structured for this purpose. BMI was calculated and values were compared with standard BMI charts of National Health Centre for health statistics. Prevalence of obesity was 4.78%. Out of 3,200 children enrolled 153 [4.78%] were obese. Male to female ratio was 1:1.2. The prevalence of obesity was high in private school students than government schools [66.66% and 33%]. The prevalence was high in both sexes in 12-14 years and 6-7 years age groups [49% and 20.26%]. Prevalence of obesity in present study is similar to the results from developing countries in the region but prevalence is lower than developed countries. Problem of obesity also exists in developing countries and there is need to create awareness about obesity and related complications

Frequency and clinical presentation of UTI among children of Hazara division, Pakistan

Urinary tract infection is common in children and result in permanent renal damage and end stage renal failure in significant number of patients. It is imperative to diagnose urinary tract infection early and to treat adequately. We carried out this study to look into frequency and clinical profile of UTI in children admitted in our unit. Three hundred and seventy five patients with UTI, diagnosed by urine culture with age from 0-15 years admitted in pediatric unit during 2003-2006 were included in study. Urine sample for culture was collected by midstream clean catch, urine collecting bag and Suprapubic methods depending upon the age of patient. A proforma was used to record clinical presentation and laboratory findings of these patients. Frequency of Urinary tract infections among children examined by urine culture was 375 out of 1000 [37.5%] out of which 36 [9.6%] were male and 339 [90.4%] were females. Almost half of them 48.5% were less than 3 years old. About 60% of patients belong to Kohistan and Batagram districts and failure to thrive was common presenting feature [56.6%] in patients of these two districts. Fever was common clinical presentation 91% followed by Dysuria [65%] and failure to thrive [40%]. Frequency and clinical profile of urinary tract infection in children in Hazara Division is not significantly different from that of developing and developed countries

Clinical outcome in measles patients hospitalized with complications

Measles is a highly communicable viral illness and is common cause of childhood mortality and morbidity. Keeping in view the high prevalence of measles in the developing world, we carried out this study to look into the complicated measles cases and clinical outcome in patients admitted in children ward of Ayub Teaching Hospital. Detailed history and physical examination of all the hospitalized patients with complication of measles were recorded in a proforma. Immunization and nutritional status of each admitted patient was assessed and the clinical outcome of measles was compared with demographic profile. One hundred thirty six hospitalized patients with complications of measles were studied. There was 60.3% male and 57.3% of patients were vaccinated against measles. Malnourished patients were 71.35% and had longer hospital stay [>5 days]. Pneumonia [39.7%] and diarrhoea [38.2%] were the commonest complications. Seven children died and encephalitis [57.1%] was the commonest cause of death. The most common complications of measles are pneumonia and diarrhoea with dehydration requiring admission. Malnutrition results in more complications and longer hospital stay. Mortality is significantly associated with encephalitis

Frequency of dyslipidaemia in type 2 diabetes mellitus in patients of Hazara division

Diabetes mellitus increases the risk of atherosclerotic vascular disease because of associated dyslipidaemia. Many studies advocate aggressive management of lipid disorders in Type 2 Diabetes to decrease these complications. This study was carried out to know the frequency of dyslipidaemia in our patients and also to determine that whether patients with good glycaemic control [HbA1c /= 8%] emphasizing the importance of good glycaemic control. However none of our patients had a low HDL-Cholesterol as found in some other studies. Hypertriglyceridaemia along with impaired LDL-Cholesterol is present in majority of our patients. Good glycaemic control does affect the lipid profile in Type 2 Diabetes mellitus. However to provide the benefits of lipid lowering therapy to our patients, as confirmed in many studies, we need more awareness and placebo controlled double blind studies

Mushroom poisoning in children: clinical presentation and outcome

A variable clinical picture characterizes mushroom poisoning. The Amatoxin, the main toxic component of these fungi, are responsible for gastrointestinal symptoms as well as hepatic and renal failure. As acute gastroenteritis is extremely common in our set up, so every patient presenting with these symptoms is treated as gastroenteritis of viral aetiology. The authors present the clinical picture of the phalloid syndrome, its treatment and immediate outcome. All children age less than 16 years admitted in Saidu Hospital Swat from January to December 2006 with mushroom poisoning were included in the study. Patients with doubtful history or with associated illness were not included. The diagnosis was based on the clinical picture of the patient, history and the laboratory data. In addition to maintenance of fluid and electrolyte balance and treating sepsis, oral Silymarin and intravenous penicillin was started. Liver function tests, renal functions tests, serum electrolytes and coagulation profile was done in all the patients. The severity of poisoning was graded according to hepatic transaminase elevations and prolongation of prothrombin time. Of the 18 patients, fifteen were above five years of age. Female were twice in number. Fifteen patients developed hepatic failure and three patients developed renal failure. Thirteen patients expired. To start timely management, Mushroom poisoning should be considered in the differential diagnosis in patients presenting with food poisoning particularly coming in groups. Delay in diagnosis is associated with high mortality

Status epilepticus: aetiology and outcome in children

Convulsing Status Epilepticus [CSE] is a common paediatric emergency especially under 24 months age group. Present study was done to know causes of Status Epilepticus [SE] and outcome during admission and at the time of discharge. A descriptive study in children 2 months to 15 years of age, admitted in Department of Paediatrics, Ayub Medical College, Abbottabad with first status epilepticus, was done to evaluate aetiology, complications and immediate outcome after relevant history, examination, laboratory tests. All information was recorded on Performa designed especially for this purpose. Study was conducted over 2 year period from November 2005 to November 2007. Total number of children admitted with SE was 125. Majority of SE episodes were related to acute febrile illnesses. Acute viral encephalitis was the common cause of SE especially in children younger than 24 months followed by febrile convulsions. Fifteen [12%] patients expired while neurological complications secondary to brain injury developed in 10[8%] cases. Mean seizure duration was 4.92 +/- 9.18 hours in children with normal outcome, 5.93 +/- 5.76 hours in children who died, and 12.85 +/- 12.91 hours in children with abnormal neurological outcome at discharge [p > 0.05]. Correlation between age and duration of seizure was not significant [p > 0.05]. SE is a common paediatric emergency associated with high mortality and morbidity. In young children SE is commonly associated with acute viral encephalitis. Antiviral treatment should be started earlier in this group of young children after history, examination, laboratory tests along with appropriate management of SE