S-allyl Cysteine and Taurine revert peripheral metabolic and lipid profile in non-insulin-dependent diabetes mellitus animals: Combination vs Monotherapy

Abstract The present study was designed to evaluate the beneficial synergistic effects of S-allyl Cysteine (SAC) and Taurine (TAU) on hyperglycemia, lipid profile and renal damage markers in type 2 diabetes mellitus (T2DM) in rats. Experimental T2DM was developed by administering an intraperitoneal single dose of nicotinamide (NA; 230 mg/kg) and streptozotocin (STZ; 65 mg/ kg) in adult rats. Control and diabetic rats were treated with SAC (150 mg/kg); TAU (200 mg/ kg) or SAC and TAU (75+100 mg/kg) combination for four weeks. Measurements of traditional markers of kidney toxicity in serum, such as blood urea nitrogen (BUN), serum creatinine (Scr), and alkaline phosphatase (ALP), together with serum cholesterol/triglyceride such as serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) may yield a snapshot of renal damage and lipid profile in NA/STZ-treated rats. The variation in levels of fasting blood glucose, glycosylated hemoglobin, insulin and lipid profile was significantly augmented in SAC/TAU treatment group. The diabetic group showed elevated renal injury markers in serum, which were decreased significantly by SAC/TAU treatment. Thus the results of the experiment clearly indicate the potential of the SAC/TAU combination in improving diabetic complications.

Classical Closed Technique by Veress Needle Insertion Versus Direct Trocar Insertion in the Creation of Pneumoperitoneum in Various Laparoscopic Surgeries

Introduction: Laparoscopy has revolutionised Surgerywith its widespread acceptance as predominantly minimallyinvasive to intraabdominal surgical procedures. Creationof pneumoperitoneum is indispensable primary step ofthe procedure as it allows creation of operative field. Itcan be achieved by various techniques viz Classical openmethod as described by Hasson. The aim of the study wasto ascertain safety of direct trocar insertion in creation ofpneumoperitoneum in laparoscopic surgeries and adopt thesame as an alternative to veress technique.Material and methods: A total of 576 patients were includedin the study, Group A comprised of patients in whom wecreated pneumoperitoneum by classical veress needleinsertion and included 327 patients. Group B comprised of249 patients in whom we created pneumoperitoneum by directtrocar insertion method.Results: The mean age of patients was 47.54 years SD 11 witha male female ratio of 1:1.56. Laparoscopic cholecystectomy(52.08%) was most frequent followed by laparoscopicappendectomy (13.02%). Group A patients witnessed omentalemphysema (7.95%) as commonest complication followed bypreperitoneal insufflation(5.19%) while as the most commoncomplication in group B was omental emphysema (0.81%).Port site infection (4.28%) and subcutaneous emphysema(3.36%) predominated in group A and port site infection(1.2%) and seroma formation (1.2%) were common in groupB.Conclusion: There are many methods to createpneumoperitoneum. The closed technique modified to directtrocar insertion versus classical method by Veress werecompared in patients undergoing laparocopic proceduresat SMHS hospital for a period of one and a half year. Theresults are fascinating as the modified technique overshadowsits classical version in terms of feasibility, efficacy andconsumption of time.

Is open lateral anal sphincterotomy really a safe and satisfactory treatment option for refractory chronic anal fissures? - a prospective study

Background: Chronic anal fissure is a familiar entity in surgical outdoor departments of hospitals in our valley. The muslim women are usually reluctant to expose their anal canal related pathologies to male surgeons, letting anal fissures to reach the chronic stage. Under this background, the present study was conducted to look for the feasibility of lateral anal sphincterotomy in the management of chronic anal fissure in our patients.Methods: This prospective study was carried out over a period of 3 years in the unit 2nd of department of surgery at SMHS (Shri Maharaja Harisingh) hospital, an associated hospital of Government Medical College Srinagar. During this period, 59 patients presented to the outpatient department with typical chronic anal fissures and were included in this study.Results: Fifty-nine patients, diagnosed on clinical evaluation as chronic anal fissure were included in this study. The age varied from 19 to 58 years with mean age of 36.38±7.14 (SD= 7.14) years. There was a female predominance, with a female to male ratio of 2.1:1. Fifty-two (88.1%) patients had posterior midline fissure and 7 (11.8%) patients had an anterior anal fissure. Thirty-one patients were not satisfied with the conservative treatment and insisted for surgical management. All 31 patients were managed by open lateral anal sphincterotomy.Conclusions: Lateral anal sphincterotomy (LAS) is a safe and effective method of management for chronic refractory anal fissures. The complications are minimal and negligible.

effect of low dose aspirin on bleeding in patients undergoing minor oral surgical procedures

Objective: To evaluate the safely of oral surgical procedures without stopping low dose aspirin. Study Design: Randomized controlled trial. Place and Duration of Study: Oral and Maxillofacial Surgery department, Armed Forces Institute of Dentistry, Rawalpindi, from Mar 2008 to Mar 2009

Material and Methods: Seventy patients taking aspirin 75 to 150 mg daily and requiring minor oral surgery were included. Patients were randomly divided into two groups, group A [control group] who stopped taking aspirin and group B [intervention group] in which aspirin was not stopped. Their bleeding time [BT] and platelet count were assessed before surgery. Suturing and pressure pack were used to control bleeding. Data were entered in SPSS version 10

Results: Out of 70 patients, 48 [68.57%] were male and 22 [31.43%] female. The mean age was 58.83 +/- 10.94 years. The mean bleeding time was 2.23 +/- 0.013 minutes for group A, and 2.71 +/- 0.12 minutes for group B. The difference was statistically significant [p=0.01]. Severe bleeding was noted in 2 patients from group A and 3 patients from group B, but local haemostatic measures were sufficient to control bleeding

Conclusion: The patients on low dose aspirin can safely undergo routine minor oral surgical procedures, without alteration in their regular therapeutic aspirin regimen

Role of nanodiamonds in drug delivery and stem cell therapy

Context: The use of nanotechnology in medicine and more specifically drug delivery is set to spread rapidly. Currently many substances are under investigation for drug delivery and more specifically for cancer therapy

Evidence Acquisition: Nanodiamonds [NDs] have contributed significantly in the development of highly efficient and successful drug delivery systems, and in stem cell therapy. Drug delivery through NDs is an intricate and complex process that deserves special attention to unravel underlying molecular mechanisms in order to overcome certain bottlenecks associated with it. It has already been established that NDs based drug delivery systems have excellent biocompatibility, nontoxicity, photostability and facile surface functionalization properties

Results: There is mounting evidence that suggests that such conjugated delivery systems well retain the properties of nanoparticles like small size, large surface area to volume ratio that provide greater biocatalytic activity to the attached drug in terms of selectivity, loading and stability

Conclusions: NDs based drug delivery systems may form the basis for the development of effective novel drug delivery vehicles with salient features that may facilitate their utility in fluorescence imaging, target specificity and sustained release

The effectiveness of seated combined extension-compression and transverse load traction in increasing cervical lordosis- challenging the underlying framework

Introduction: The goal of this study was to assess the effectiveness of seated combined extension- compression and transverse load (ECTL) traction as a new method for increasing a reduced lordosis of less than 30 degrees in a Malaysian population between the ages of 18 and 60 years. Possible changes in disc height were measured in accordance with the underlying theoretical framework, that suggests the anterior cervical structures would elongate due to creep over the fulcrum of the traction device. Method: This was a single centre, randomised, blinded controlled clinical trial with parallel groups, used to test the superiority of the seated combined ECTL traction together with physiotherapy exercises when compared with the same physiotherapy exercises used as a control. Fifty randomly allocated subjects who completed the forty treatments over the fourteen weeks were analysed using non-parametric tests for changes in outcomes. Results: There were no significant changes in outcomes for disc height changes seen in this study. The findings of a greater overall increase in posterior disc height changes compared with anterior disc height changes were in contrast with the proposed underlying theoretical framework for this type of ECTL traction. The greater height changes occurring in the control group were also unexpected. Conclusion: The findings in this study of the contrasting changes in disc height of greater posterior than anterior height changes, question the underlying theoretical framework as postulated for this type of traction.

Allelic variance among ABO blood group genotypes in a population from the western region of Saudi Arabia

BACKGROUND: Characterization of the ABO blood group at the phenotype and genotype levels is clinically essential for transfusion, forensics, and population studies. This study elucidated ABO phenotypes and genotypes, and performed an evaluation of their distribution in individuals from the western region of Saudi Arabia. METHODS: One-hundred and seven samples underwent standard serological techniques for ABO blood group phenotype analysis. ABO alleles and genotypes were identified using multiplex polymerase chain reaction, and electrophoretic analysis was performed to evaluate the highly polymorphic ABO locus. RESULTS: A phenotype distribution of 37.4%, 30.8%, 24.3%, and 7.5% was found for blood groups O, A, B, and AB respectively in our study cohort. Genotype analysis identified 10 genotype combinations with the O01/O02 and A102/O02 genotypes being the most frequent with frequencies of 33.6% and 14.95%, respectively. Common genotypes such as A101/A101, A101/A102, A101/B101, B101/B101, and O01/O01 were not detected. Similarly, the rare genotypes, cis-AB01/O02, cis-AB01/O01, and cis-AB01/A102 were not found in our cohort. The most frequently observed allele was O02 (35.98%) followed by the A102 allele (17.76%). Furthermore, our findings are discussed in reference to ABO allele and genotype frequencies found in other ethnic groups. CONCLUSION: The study has a significant implication on the management of blood bank and transfusion services in Saudi Arabian patients.

Standard interferon in the treatment of. hepatitis C; response rate in genotypes 2 and 3 from an area in Azad Kashmir, towards north of Pakistan

To assess the response rate and side effect profile of combination therapy with standard interferon alpha 2a and ribavirin in patients with chronic hepatitis C, genotype 2 and 3. Observational study. This study was conducted at Saleem Medical Complex and Maryam Maternity home,Kotli, Azad Kashmir from January 2012 to December 2012. Both male and female patients above 20 years of age with chronic hepatitis C, living in district Kotli Azad Kashmir, not treated previously, were included in the study. Viral load and genotyping were determined before initiation of treatment. Therapy was given with conventional interferon alpha 2a, 3 Million international units subcutaneously on alternate days and ribavirin 400mg tablets twice daily, for 24 weeks. PCR was repeated at the end of treatment and six months later. Clinical and lab monitoring was done at regular intervals and side effect profile was recorded. Out of 150 patients, 30 [20%] were males and 120 [80%] were females. Most of the patients were between 20-50 years of age [83.99%]. End of treatment response was 82% and sustained viral response was 65.33%. Fever was the most common side effect followed by flu like symptoms. All the patients completed the treatment without any dropout. The study showed a good response rate to standard interferon plus low dose ribavirin against genotype 2 and 3, with a favorable side effect profile without any drop out, indicating that it is a suitable treatment option

Efficacy of greater auricular nerve block in eliminating pain during mandibular third molar extraction

Pain during mandibular third molar tooth surgery following conventional inferior alveolar nerve block [IANB] is quite common because of sub-optimal analgesia. A double- blind randomized controlled trial was done to evaluate the efficacy of extraoral greater auricular nerve block [GANB] as preemptive analgesia in patient undergoing surgical extraction of mandibular third molar class 2, 3 position B and C. This Study was conducted in minor oral surgical department at Armed Forces Institute of Dentistry from 6th Aug, 2012 to, 5th Feb 2014. A total of sixty patients were divided into two equal groups. Group A received conventional IANB along with GANB while group B was administered IANB only. In group A, 23[76.7%] patients experienced no pain while only 7[23.3%] patients experienced mild pain. While in group B, 6[20.0%] patients experienced no pain, 22[73.3%] experienced mild pain, 2[6.7%] patients experienced moderate pain. The difference was statistically significant [p-value0.0001].Based on this study it was concluded that perioperative pain can be eliminated by preemptive GANB analgesia in deep seated mandibular third molar extractions

Frequency of category 1 and category 2 tuberculosis in district Kotli Azad Kashmir

To estimate the frequency of Category 1 and 2 Tuberculosis in area of research. Cross sectional study. This study was a conducted in District Kotli Azad Kashmir from January 2009 to December 2009. This study was conducted with a population of 750,000. Data was collected from all the eight national TB centres in the District Kotli. It included every patient registered there with the diagnosis of tuberculosis including pulmonary and extra pulmonary tuberculosis and sputum smear positive and negative patients. They were classified as category 1 and category 2 according to the standard definitions. Results were given in tabulated form. From a total of 752 patients, 579 [76.99%] were pulmonary and 173 [23%] were extra pulmonary. In pulmonary TB cases, 259 [44.78%] were sputum smear positive [235 [90.73%] of them were category 1 and 24 [9.24%] were category 2]. In 320 [55.26%] sputum smear negative patients, 300 [93.75%] were category 1 and 20 [6.25%] were category 2. All of the extra pulmonary TB cases were category 1 [100%]. As a whole 708 [94.15%] were category 1 and 44 [5.85%] were category 2. In our study frequency of category 2 patients was found to be relatively low. It indicates that the problem of drug resistant tuberculosis is probably low in the area. It also shows the effectiveness of local TB control programme

Prevalence of tuberculosis in Kotli, Azad Kashmir

Tuberculosis is highly prevalent in Pakistan. It is a contagious disease and causes a lot of morbidity and mortality. Its treatment is costly especially for poor countries like Pakistan. But fortunately it is a preventable disease. Objective of this study was to analyse various epidemiological features of tuberculosis in District Kotli, a remote area of Northern Pakistan. This cross sectional study was conducted in District Kotli, Azad Kashmir from January to December 2009. Data was collected from eight national TB centres of District Kotli. It included all the diagnosed cases of tuberculosis, registered there during the study period. Various epidemiological aspects of these patients were analysed. Total number patients registered during the study period were 752. Of these 579 [76.99%] were pulmonary and 173 [23%] were extra-pulmonary tuberculosis [EPT]. Total prevalence of tuberculosis was found to be 100.27 per 100,000. Prevalence of pulmonary TB was 77.2 while that of EPT was 23.07 per 100,000. There were 405 males [53.85%] and 347 females [46.14%]. Most patients were 61-75 years of age [220, 29.25%]. Overall 417 [55.44%] were 46-75 years. Housewives were affected most frequently [324, 43.08%]. Labourers were also commonly involved [40.82%]. All cause mortality was 29 [3.85%]. Mortality due to tuberculosis was 11 [1.04%]. Among pulmonary tuberculosis, 259 [44.78%] were sputum smear positive and 320 [55.26%] were sputum smear negative. In EPT, most frequent was pleural effusion [74, 42%] and least frequent was skin involvement [3, 1.73%]. Prevalence of tuberculosis in Kotli was lower than the overall prevalence in Pakistan. Male to female ratio was lower than that generally observed in Southeast Asia. It was more common in middle to old age population. Frequency was higher in housewives and labourers. Very significant proportion of pulmonary TB was sputum smear positive. Among EPT, pleural effusion was the most common mode of presentation

Frequency of hepatitis C in asymptomatic patients in district headquarters hospital kotli, azad kashmir

Background: Hepatitis C is a common problem in developing world. It can affect a large number of asymptomatic people in whom it may cause serious complications in long run. Moreover, these asymptomatic infected people pose a serious risk for the transmission of infection to healthy population. Objective of this study was to estimate the frequency of Hepatitis C in asymptomatic adult patients attending medical OPD of District Headquarters Hospital Kotli, Azad Kashmir, and to assess the risk factors associated with its transmission. Methods: This was a cross-sectional study that included asymptomatic patients of both genders, aged 15–80 years, attending medical OPD of District Headquarter Hospital Kotli, Azad Kashmir from January to December, 2008. They attended the OPD for problems other than Hepatitis and most of them presented with vague complaints like generalised body aches, tiredness and dyspeptic symptoms. They were randomly tested for Hepatitis C virus [HCV] antibodies by Immunochromatographic kit method. Positive samples for Hepatitis C antibodies were confirmed by third generation ELISA. Those who were confirmed were assessed for the risk factors associated with HCV transmission. Results: The study included 9, 564 patients. Out of them 4, 230 [44.22%] were males and 5, 334 [55.77%] were females. A total of 611 [6.38%] cases were positive fo HCV; 257 [6.08%] were males, and 354 [6.64%] were females. Highest frequency [36%] was found between 21 and 30 years of age, and 60.54% positive patients were 21–40 years old. Blood transfusion was the most common [34.36%] risk factor followed by history of dental procedures [24.54%]. In 27.16% no risk factor could be detected. Conclusion: Frequency of Hepatitis C is quite high in our population. Rate is higher in young adults. It is needed to adopt organised preventive strategies to overcome this problem. Blood transfusion is still the most significant risk factor followed by dental and surgical procedures. Health related procedure

Management of facial gunshot wounds

To determine pattern and presentation in terms of site of injury, airway, associated injuries; and management of facial gunshot wounds. Case series. Oral Surgery Department, Armed Forces Institute of Dentistry, Rawalpindi, between January 2001 and December 2008. All patients with gunshot wounds of the face managed at the Oral Surgery Department during the study period were included by convenient sampling method. Patients were treated by a multidisciplinary team of maxillofacial surgeon, otorhinolaryngologist and plastic surgeon. Descriptive statistics were used to determine frequencies and mean+SD for qualitative and quantitative variables respectively. A total of 38 patients with gunshot wounds to the face were identified. Age ranged from 15 to 42 years with mean of 28+4.98 years. There were 32 [84%] males and 06 [16%] females. Twenty two [57%] patients required airway management. The most frequent site involved was mandible in 25 [65%] patients while midface was involved in 13 [35%] patients. Open reduction and internal fixation [ORIF] was performed in 17 [44%] patients, while 21 [56%] patients were managed conservatively. Out of 38 patients, 15 [39%] patients had some complications; trismus, sinusitis and infection being the most frequent [10.5% each]. Facial gunshot wounds frequently involve mandible with more likely requirement of establishment of emergency airway and open reduction and internal fixation [ORIF]. Early management of gunshot wounds results in better psychosocial profile, aesthetics, reduced hospital stay and early return to function

Frequency of hepatitis B in asymptomatic patients of district headquarter hospital Kotli, Azad Kashmir

Hepatitis B is prevalent throughout the world including Pakistan. A large proportion of patients suffering from Hepatitis B may be asymptomatic and can transmit the disease to healthy population. Objectives of this study were to estimate the frequency of Hepatitis B in asymptomatic adult population coming to District Headquarter Hospital Kotli, Azad Kashmir and to determine the risk factors associated with its transmission. This was a cross-sectional study extending from January to December 2008. Subjects were randomly selected from those who attended the medial OPD of DHQ Hospital Kotli, Azad Kashmir for non-Hepatitis related problems. Both males and females between the ages of 15-80 years were included in the study. Blood samples taken from selected subjects were analysed for Hepatitis B surface antigen [HBsAg] by Immunochromatographic kit methods [ICT]. Hepatitis B positive samples were further confirmed by third generation ELIZA. The patients thus confirmed were interrogated for different risk factors associated with transmission of Hepatitis B. A total of 9,564 patients were analysed. Out of them 4230 [44.22%] were males and 5334 [55.77%] were females. Overall 141 [1.47%] patients were positive for HBSAg, 71 [1.68%] males and 70 [1.31%] females. Patients between 21-30 years of age were most commonly effected [35.46%, n=50]. Blood transfusion was the most common risk factor [24.82%, n=35] associated with Hepatitis B transmission followed by dental procedures [14.18%, n=20]. Frequency of Hepatitis B in asymptomatic people in this study was quite high. Blood transfusions and dental procedures were the most common risk factors associated with the transmission of Hepatitis B

Management of cleft lip and palate: an appraisal of 50 cases managed in oral and maxillofacial surgery department, armed forces institute of dentistry, Rawalpindi, Pakistan

From Jan 2006 to Dec 2007 a total of 50 patients of congenital cleft lip and palate were managed in oral and maxillofacial surgical department of Armed Forces Institute of dentistry [AFID], Rawalpindi. Cleft of the lip was repaired with functional repair technique, and cleft in the palate was repaired using intra velor veloplasty. Cleft lip and palate is a congenital anomaly which requires a coordinated care of the patient involving multiple disciplines of medicine and dentistry. Unfortunately the incidence of clefts is on a rise in developing countries due to lack of awareness and improper handling of pregnancy by the mother. Lack of resources on the part of both, i.e., patients and the medical professionals is not helping the cause. Although a comprehensive care of the cleft patients is far from a reality in the subcontinent, we are reporting the cleft lip and palate cases which have been treated in coordination with different specialties accessible at the Armed Forces Institute of Dentistry [AFID], Rawalpindi. In this study, we highlight the demographics, clinical features and surgical management of cleft lip and palate