Adams-Oliver syndrome: a case report

Adams-Oliver syndrome is a rare disease, which presents with cutaneous, cardiac and skeletal defects. We, herein, describe a case of 1-month-old girl with aplasia cutis, cutis marmorata telangiectatica and terminal transverse limb reduction defects with a positive HCV serology. The patient is put on regular follow-up

Generalized morphea - a case report

Generalized morphea is a subtype of morphea in which widespread sclerotic plaques are seen without systemic involvement. We are reporting a case of 10-year-old boy with generalized morphea for 6 years

Frequency of nickel sensitivity in patients with shoe dermatitis

Objective To determine the frequency of positive patch tests for nickel in patients of shoe dermatitis

Methods This was a descriptive study carried out in the outpatient department of Dermatology Unit-II, Mayo Hospital, Lahore. A total of 50 patients were inducted in the study with ages 12 and above and either sex, with shoe dermatitis. The patients were tested using patch tests with the allergen nickel sulfate hexahydrate 5% in petrolatum base using the European standard series

Results Most of the patients were female i.e. 37 out of a total of 50

The mean age of patients was 31 years [14 to 65 years]. Housewives and students were most commonly affected. 18% of the patients positively tested for nickel sulfate

Conclusion Nickel sulfate hexahydrate is a frequent allergen causing shoe dermatitis

Comparison of efficacy and safety of 0.005% calcipotriol ointment versus 0.05% betamethasone dipropionate ointment versus calcipotriol plus betamethasone ointment for the treatment of vitiligo

Department of Dermatology, Unit II, King Edward Medical University/ Mayo Hospital, Lahore

Objective To compare the efficacy and safety of calcipotriol ointment versus betamethasone ointment versus calcipotriol plus betamethasone ointment in patients of vitiligo

Methods Patients with vitiligo [n=159] were randomized in three equal groups A, B and C. Group A [n=53] applied topical calcipotriol ointment, group B [n=53] applied topical betamethasone dipropionate ointment and group C [n=53] applied calcipotriol plus betamethasone ointment for a total of three months and were followed up for further 1 month. They were evaluated for improvement in pigmentation using Vitiligo Area Scoring Index [VASI] and side effects

Results Out of a total of 159 patients, females [66.7%] out-numbered male patients [33.3%]. Mean of change in VASI was 38.77 in group C, 26.23 in group B and 18.30 in group A. Overall change in VASI was highest in group C with a statistically significant p = 0.008. All the groups showed few side effects like erythema, burning, atrophy and acneiform eruption, which were not statistically significant

Conclusion All topical therapies were found to be efficacious and safe in the treatment of vitiligo. But out of these three drugs, the combination of calcipotriol and betamethasone was superior in efficacy

Gestational diabetes; sensitivity, specificity and diagnostic accuracy of glucose challenge test in diagnosis

To find sensitivity specificity and diagnostic accuracy of Glucose Challenge test in diagnosing Gestational Diabetes in Pregnant women. Due to poor socioeconomical and educational status, dietary habits and ignorance regarding pregnancy related problems probably increase the prevalence and burden of gestational diabetes mellitus [GDM] and its complications in pregnancy. Best and simple strategy to identify women with gestational diabetes is still lacking and unclear. Cross sectional study. This study was performed at Jinnah Hospital Lahore, from Nov 2005 to Dec 2006. A glucose challenge test [GCT] was performed on 500 selected pregnant women by giving 50-g glucose in water orally. A serum glucose level ?140 mg/dl after an hour was taken as positive test. To confirm GDM, 75 g glucose in 200 ml of water was given and sugar levels after 2 hrs by Glucometer, >200 mg/dl confirmed GDM. An increasing trend in age, gestational age and BMI and a significant difference regarding positive family history of diabetes and gravidity was seen in patients with GDM compared to normal pregnant. The maximum percentage of GDM 2 was noted in multigravida, between 25-29 years, BMI >28kg/m, and a gestational age of 28 weeks. The sensitivity of GCT was 80%, specificity 97.8%., and diagnostic accuracy was 96.4%. Screening is necessary to identify women with GDM. A 50-g glucose challenge test might be acceptable as a screening test for GDM as it has high sensitivity, specificity and diagnostic accuracy

Hypoglycemic and anti-platelet aggregatory effect of acacia modesta leaves extract on alloxan induced diabetic rats

Objectives: To compare the hypoglycemic and anti-platelet aggregation effect of Acacia modesta leaves extract and Glibenclamide on alloxan induced diabetic rats

Study Design: Experimental study

Place And Duration: This Experimental study was performed at Shifa College of Medicine and National Institute of Health [NIH], Islamabad

Methodology: Diabetes mellitus was induced in 90 out of 120 male albino rats by intraperitoneal injection of 110 mg/kg bw of alloxan and was confirmed by measuring fasting blood glucose level >200 mg/dl on 4th post-induction day. The rats were equally divided into four groups, A [normal control], B [diabetic control], C [diabetic rats treated with glibenclamide], and group D [diabetic rats treated with plant extract]. Rats of group C and D were treated with single dose of 900 micro.g/kg b.w of glibenclamide and 400 mg/kg b.w of Acacia modesta leaves extract respectively for three weeks. Blood Glucose levels were measured by glucometer, Platelet aggregation by Dia-Med and serum beta-thromboglobulin by ELIZA technique

Results: The results showed significant hypoglycemic [p<0.01] and anti-platelet aggregatory [p<0.01] effect of glybenclamide and Acacia modesta leaves extract on diabetic control rats. Within the treatment groups, the fasting blood glucose, and serum beta-thromboglobulin levels were nearly equally significant [p<0.05] in diabetic rats treated with glibenclamide and plant extract

Conclusion: Acacia modesta leaves extract has a nearly equally significant hypoglycemic and anti-platelet aggregation effect on diabetic rats as that of glybenclamide

Emergency contraception: knowledge, attitude and practices among doctors of a tertiary care hospital

In Pakistan maternal mortality rate [MMR] is very high and more than one in five women die from pregnancy related causes; solution to this is to have low fertility rate. The emergency contraceptives [ECs] can be used to prevent unwanted pregnancies. The aim of this study was to assess the knowledge, attitude and practice about ECs among doctors. Institution-based crosssectional descriptive study on knowledge, attitude and practice of ECs was conducted at Rawal Hospital from Feb to May, 2012. Data was collected using structured questionnaire and analysed using SPSS-16. Fifty-seven percent of the respondents were >30 years of age, 94% were Muslim, 81% were married and 51% were women. Ninety-seven percent had heard of ECs before, only 17% knew Intra-uterine contraceptive device [IUCD] a method of EC. Sixty-one percent responded that IUCD should be removed if patient gets pregnant [p=0.007] and according to 31% ECs were not abortifacient [p=0.045]. Regarding attitude, 55.5% of the participants supported its use [p=0.027] and agreed to its easy accessibility [p=0.004]. Thirty-eight percent responded an increased dose of birth control pills as a form of EC [p=0.008], while 40% did not agree that ECs are effective when taken before intercourse [p=0.011]. Knowledge and practice of ECs is very low among doctors but a positive attitude is there. Evidence-based knowledge to family physicians regarding emergency contraception is strongly recommended to reduce the chances of MMR

audit of laparotomies; carried out in combined military hospital Panno Aqil over three years period

To make an audit of laparotomies carried out at Combined Military Hospital Pano Aqil over a three year period. Cross sectional, retrospective study. Study was carried out at surgical department of combined military hospital Panno Aqil over a period of three years from Jan 2009 to Dec 2011. Patients with significant intra-abdominal pathology presenting as acute abdomen and who underwent laparotomy were included in study. Patients were either electively admitted via outpatient department or through Accident and Emergency [A and E] department. Patient charts and records were used to collect data. All 174 patients underwent laparotomy. In [27.6%] cases, intestinal perforation was the underlying cause; gynaecological pathology was found in [21.2%] patients. In 19.5% cases blunt and penetrating abdominal trauma was the cause of acute abdomen. Acute intestinal obstruction was found in [21.3%], tumors were found in [7.9%] and miscellaneous causes were identified in [2.3%] cases. Laparotomies carried out at Combined Military Hospital Pano Aqil fulfilled the evidence based medicine criteria

Primary intraosseous solid carcinoma of the mandible: a case report and review of literature

A primary intraosseous carcinoma [PIOC] arising de-novo is an extremely rare tumour that is limited to the jaws. The majority of the reported cases of PIOC have their origin from the odontogenic cysts, those arising de-novo are rarely illustrated. The definite diagnosis of PIOC is often difficult as the lesion must be differentiated from other primary and metastatic squamous cell carcinomas of jaws. We report an uncommon case of PIOC arising de-novo in a 25 years old man. The clinical, radiological and histological features are described. This infrequent lesion should be considered in the differential diagnosis of any jaw radiolucency

Pleural empyema in children: prolonged clinical course

Objective: To assess the hypothesis that empyema thoracis is a problem which is often not optimally treated and to analyze evolving experience in clinical presentation, management and outcome in thoracic empyema

Design: Prospective observational descriptive study

Place and Duration of study: Department of Pediatric Medicine of Children's Hospital and the ICH Lahore from February 2008 to October 2008

Patients and Methods: Out of these 50 children 29 [58%] were males and 21 [42%] were females. Age range was from 06 months to 14 years. The mean duration of illness prior to hospital admission was 18 days. Ultrasonography was utilized in the diagnosis of all patients. Chest CT scan was done in 16 [32%] patients. Pleural fluid culture was positive in only 6 [12%] patients. Staph aureus was the predominating organism 4 [8%]. All patients were treated with intra venous antibiotics and tube thoracostomy. Antituberculous medication was given to 6 [12%] of patients. 29 [58%] patients developed complications in the form of localized collection 12[24%], septations 8 [16%], bronchopleural fistula 7 [14%], pneumothorax 1 [2%] and hydropneumothorax 1 [2%]. 12 [24%] patients were shifted to surgery department for decortication. In this study, duration of illness before visiting hospital was significantly associated with complications [p=0.04]

Conclusion: Empyema associated with community-acquired pneumonia is an important cause of morbidity in children. Para pneumonic effusion should be treated aggressively by physicians. Early drainage and proper antibiotics are recommended to prevent progression to late stage and serious complications, which in turn subjects the patient to a major surgery

Clavicle fractures; incidence a two years study

To emphasize upon the frequency of fractures of clavicle due to indirect blunt trauma caused by road traffic accidents and falls from heights and their sequalae. Observational descriptive study. Combined Military Hospital Bannu during a period of two years from June 2003 to May 2005. Patients included in the study were the trauma patients brought to Combined Military Hospital Bannu during a civil -military conflict in tribal areas of North and South Waziristan. Patients had sustained multiple injuries mostly due to road traffic accidents in hilly terrain, falls from heights and combat scuffles. Out of these trauma victims, 746 patients fractures of the clavicle were grouped, analyzed, treated with standard treatment methods and patients were followed up for the varying periods of time. Out of 746 patients treated at our hospital, 84 were having fracture of clavicle [10.8%]. 53 patients [63.1%] with clavicle fracture had fracture involving middle third of the clavicle, 20 patients [23.8%] had fracture of lateral third, and 11 patients [13.1%] had fractures involving medial third of the clavicle. Clavicle is a bone which is at risk of fracture in cases of indirect blunt trauma because the first human reaction in any violence or assault is to protect oneself by using the upper limbs. Its peculiar development and anatomical shape makes it vulnerable to fracture in most physical insults. However, it usually unites by conservative methods and even considerable non-union does not significantly affect function

Attitude of Pakistani doctors towards euthanasia and assisted suicide

To determine the attitude of junior and senior Pakistani physicians towards euthanasia and assisted suicide. A descriptive study. The study was carried out at Shifa International Hospital Islamabad in 2006 [January to November]. Shifa International Hospital Islamabad is a 500 bed tertiary care hospital with 400 resident staff and 140 specialists. An anonymous enclosed questionnaire on the respondent's opinion of euthanasia / assisted suicide was distributed to the doctors who were requested to rate according to degree of agreement, willingness to participate in these practices, and safeguard or restrictions needed if the practices were legalized. The total response rate was 66% and male to female ratio was 7:1. Most of the respondents were Muslims and had familiarity with the subject. Seventy seven percent believe that the practice of euthanasia and assisted suicide was not ethically justified, while 9% were in its favor. Pakistani doctors oppose euthanasia and assisted suicide

Treatment of acute lumbago; low dose diclofenac sodium with vitamin-B complex compared with diclofenac alone

To determine whether concomitant use of vitamins B1, B6, B12 along with low dose of diclofenac sodium causes quicker pain relief in patients of acute lumbago compared with diclofenac sodium alone. A randomized clinical trial. Surgical Department of C M H Attock. From September 2004 to August 2005. A total of 50 patients were selected for the study. The patients complaints were of acute lumbago of less than 3 days duration with severe impairments of movements. The age group of patients was between 20 and 65 years. The patients were randomly assigned into two groups. Group I was prescribed tablet diclofenac sodium 25mg along with vitamin B-complex containing combination of 100mg thiamine nitrate [B1], 100mg pyridoxine hydrochloride [B6], and 200mcg cyanocobalmine [B12] three times a day. Group II patients were prescribed 25mg of tablet diclofenac sodium alone. Improvement in the intensity of pain at rest and during movements [as assessed by the patients] was noted in accordance to visual analogue scale 1 to 10. The effectiveness of diclofenac sodium in combination with vitamin-B complex with diclofenac sodium alone was judged on the basis of extent of pain relief after 7 days of treatment. A total of 25 patients were treated with combination of diclofenac sodium and vitamin-B complex [Group I] and 25 were treated with diclofenac sodium alone [Group II]. As far as the extent of pain relief in first 7 days is considered, 22 patients [88%] belonging to group I and 10 patients [12%] belonging to group II had an excellent pain relief and were able to carry on with their normal routine activities. Remaining 3 patients in group I were completely relieved of pain in next 3 days while 15 patients in group II had to complete another 10 days for complete cure. To test the statistical significance of the result chi-square test was applied and the result showed that patients of Group I responded significantly well to the treatment as compared to those in Group II. Using the parameters of pain relief and movements of vertebral column, the combination of diclofenac sodium and vitamin-B complex was found to be more effective mode of treatment as the duration of treatment and the dosage of diclofenac sodium was less and also relief of pain was more rapid

C-reactive protein and acute coronary syndrome: Comparison of conservative and interventional management

Inflammation plays a key rote in the initiation and progression of atherosclerosis, the most common cause of acute coronary syndrome. C-reactive protein [CRP] that enhances plaque inflammation is synthesized six hours after myocardial infarction. High sensitivity C-reactive protein was measured by Immunoturbiditory method in 50 healthy controls and 100 patients of acute coronary syndrome on conservative or interventional management. Serum C-reactive protein levels [mg/L +/- SEM] at the time of admission were significantly raised in patients of acute coronary syndrome [11.90 +/- 2.30] as compared to controls [2.30 +/- 0.18] and further increased progressively during 24 hours of follow up period. C-reactive protein levels also increased significantly in patients who underwent interventional management [115.90 +/- 7.73] as compared to those who were on conservative management [22.28 +/- 5.54]. Serum C-reactive protein levels were found to be significantly raised in patients with acute coronary syndrome as compared to controls. In addition, patients undergoing interventional management had higher C-reactive protein levels, post intervention, as compared to those on conservative management

Acute appendicitis mimics pelvic disease clinically in women of reproductive age

To analyze the clinical behaviour of acute appendicitis and pelvic disease in the women of reproductive age with special reference to ruptured right ovarian cyst/ectopic pregnancy. Study Observational. West Surgical Ward, Mayo Hospital Lahore. Duration: January-June 2006. All the women >12 years of age with the physical signs of acute appendicitis were included in the study. Age ranged from 13-44 years with the mean of 21 [median 18] years. Anorexia and shifting of pain were hallmark of acute appendicitis while sudden severe localized pain in right iliac fossa and tachycardia without fever were more specific to ruptured ovarian cyst/ectopic pregnancy. Tenderness and rebound tenderness were common with varying in intensity in each of the two diseases. Appendicectomy was done in all patients by making Gridiron incision in 150[75%], muscle cutting in 31[15.5%] and Lanz's incision in 19[9.5%] patients. Retrocaecal appendix was found in 150[75%] and pelvic in 42[21%] patients. Ruptured right ovarian cyst was present in 11[5.5%], ruptured right ectopic pregnancy in 6[3%] and ovulation bleeding in 4[2%] patients. Morbidity observed in the study was 9.5% with no mortality. In the context of limited available medical imaging modalities, detailed history and good clinical performance are the main diagnostic tools with no increase in the rate of negative appendicectomy in developing countries

Urological injuries

To find out the mechanism of injury and urological organ involved. Prospective study. two years [from 1996 to 1998] West Surgical Ward Mayo Hospital Lahore. A total numbers of 30 patients were included in the study. All the patients above the age of 12 years having injury to kidney, ureters, bladder, and combination were included. Penetrating injuries due to firearms were the dominant cause i.e. in kidneys and ureters [100%] and in urinary bladder [50%]. Kidney was the most common urological organ injured [56.66%] followed by the ureters [20%] and Urinary bladder [13.33%]. Urological injuries account for 10% of abdomen injuries. The vast majority are penetrating injuries due to firearms. The injuries may better be prevented than treated by strict maintenance of law and order

Role of barium enema preceding colostomy closure in trauma patients is limited and challangeable

The prospective study comprising 50 cases was conducted in West Surgical Ward, Mayo Hospital, Lahore from January 2000 to December 2001. Majority of the patients 45[90%] were male and 5[10%] patients were female. Cause of colostomy in 28[56%] patients was firearm, stab injury in 13[26%], blunt trauma in 4[8%], rectal impalement in 3[6%] and iatrogenic injuries in 2[4%] patients. Barium enema preceding colostomy closure was advised in all patients with 98%[49 patients] negative results and 2%[1 patient] false positive results which were found negative o n further evaluation by proctoscopy/sigmoidoscopy. Gut was prepared pre-operatively by both chemical and mechanical methods. Colostomy closure was performed in 43[86%] and resection and end t o end anastomosis in 7[14%] patients. Skin was left open in all cases. Post-operative complications observed in the series were interloop abscesses in 1[2%], anastomosis narrowing in 1[2%] and urinary tract infection in 1[2%] patient. All complications were managed according to their own protocol and priority. No mortality was recorded in the study

Acute appendicitis - incidence of perforated appendicitis

The prospective study was carried out in West Surgical Ward, Mayo Hospital, Lahore during the year 2003 consisting of 200 patients. There was slight preponderance of males 102[51%] to females 98[49%]. Age ranged from 13-75 years with the mean of 28.2 years. Appendicectomy was done in all patients by making gridiron incision in 165[82.5%], muscle cutting in 15[7.5%], Lanz`s incision in 16[8%] and right Para-median in 4[2%] patients. Regarding position of the appendix, retroceacal was the most common, found in 160[80%] and pelvic position in 31[15.5%] patients. Perforated appendix was delivered in 10[5%] patients with male to female ratio 4:1. Postoperative complications observed in the series were wound infection in 11[5.5%], prolonged ileus in 2[1%] and gastritis in 2[1%] patients. All the complications were managed according to their own protocol. No mortality was recorded in the series