Complexation of ibuprofen with water soluble p-sulfonatocalix [4]arene: a potential candidate for drug delivery application

Complexation of ibuprofen with water soluble p-sulfonatocalix[4]arene [3] was evaluated. Both molecules exhibit a host and guest type complexation. pH, complex stoichiometry and binding constant were determined by UV-Vis and FT-IR spectroscopy. The maximum complexation of 3 with ibuprofen occurs at pH 2. Stability constant values [9.897] show that there is favorable complex formed due to vital role of p-sulfonatocalix[4]arene, while the thermodynamic parameters, i.e. [Delta]G, [Delta]H and [Delta]S have been found as -24.09 KJ/mol, 0.012 KJ/mol and 0.12 KJ/mol. K, respectively. The results show that 3 has efficiency to carry the drug at particular conditions and can be used for drug delivery as a carrier

Assessment of molybdenum breakthrough levels in molybdenum-99/technetium-99m generators: one year experience at NIMRA Jamshoro Pakistan

Technetium-99m radioisotope is the backbone of any nuclear medicine institute. This radioisotope is acquired by the elution of Molybdenum-99/Technetium-99m generator which emits 141 keV gamma ray and having 6.04 hour half-life. Occasionally the contents of Molybdenum-99 may mix up with elute, which may affect image quality and patients may receive higher doses than recommended. This study was initiated to check and evaluate the contamination of Molybdenum-99 in Molybdenum-99/Technetium-99m generators used at Nuclear Institute of Medicine and Radiotherapy [NIMRA] Jamshoro Pakistan before its administration to patients for diagnostic procedures. The Molybdenum-99 impurity in Technetium-99m elute for 50 generators was studied during the year 2012. The measurements were made using dose calibrator and a standard canister at the time of first elution of the generators. The dose calibrator displays result after executing various steps in a sequence. Due to some production process error or any mechanical fault high activity of Molybdenum-99 was recorded and removed with decrease in Technetium-99m yield. The most of eluted generators [90%] contained 10% of molybdenum breakthrough of the permissible limit [P < 0.05]. The high activity of Molybdenum-99 was recorded in only 6% of the generator and removed by using standard methods with some reduced Technetium-99m activity. The molybdenum breakthrough was according to recommended standards in most of the generators. The removal of high contents of Molybdenum-99 enabled the institute to continue routine imaging services by improved image quality and reduction in radiation dose to the patients

Anaplastic thyroid cancer: a retrospective analysis of 120 cases

Anaplastic Thyroid Cancer [ATC] is one of the most lethal malignancies with very short survival and extremely poor treatment outcome. ATC accounts for 2-5% of all thyroid cancers worldwide with an annual incidence of about 2/million. To review the natural history and treatment outcome of ATC patients treated at King Faisal Specialist Hospital and Research Centre [KFSH and RC] located at Riyadh, Saudi Arabia. Retrospective review of 120 Saudi cancer patients collected from registry data at KFSH and RC from 1976-2008. Search key words included: thyroid cancer, anaplastic, undifferentiated and not otherwise specified. Search was not restricted to particular age, gender, treatment or tumor size. Demographic information, baseline patient characteristics including date of diagnosis, type of treatment and date of death were obtained from KFSH and RC registry data and Saudi death registry. A total of 120 cases were identified at our cancer centre from 1976 to 2008. Of these total, 73 were females [60.8%] and 47 were males [39.2%]. The average age at diagnosis was 63.34 +/- 12.8 years. Thirty-four patients underwent surgery [28.3%], 52 had a palliative radiation treatment [43.3%] and only 5 had chemotherapy [4.2%]. The median survival was 53 days [0-457]. Our review proves that ATC is rapidly fatal cancer and is unresponsive to currently available therapeutic options. More research is needed to understand the tumor biology and novel treatment options

Estimation of the contribution of private providers in tuberculosis case notification and treatment outcome in Pakistan

To improve involvement of the private sector in the national tuberculosis [TB] programme in Pakistan various public-private mix projects were set up between 2004 and 2009. A retrospective analysis of data was made to study 6 different public-private mix models for TB control in Pakistan and estimate the contribution of the various private providers to TB case notification and treatment outcome. The number of TB cases notified through the private sector increased significantly from 77 cases in 2004 to 37 656 in 2009. Among the models, the nongovernmental organization model made the greatest contribution to case notification [58.3%], followed by the hospital-based model [18.9%]. Treatment success was highest for the district-led model [94.1%] and lowest for the hospital-based model [74.2%]. The private sector made an important contribution to the national data through the various public-private mix projects. Issues of sustainability and the lack of treatment supporters are discussed as reasons for lack of success of some projects

Sexual dysfunction and sperms abnormalities in individuals suffering from diabetes mellitus

This paper aims to put light on sexual dysfunction [disorder] and sperms abnormalities in individuals suffering from diabetes mellitus and also to reveal the relationship of sexual dysfunction with diabetes mellitus, both type-1 and type-2, in diabetic patients. This paper also describes and enlightens the complications developed in such individuals who are first diabetic and then become vulnerable to sexual dysfunction

Courvoisier's law revisited

According to Courvoisier's law; if gallbladder is palpable in a jaundiced patient, it is unlikely to be due to gallstones, because stones would have given rise to chronic inflammation and subsequently fibrosis of gallbladder therefore, rendering it incapable of dilatation. Conversely, the causes other than stone [principally tumours], would result in the distension of gallbladder, felt on abdominal palpation. However, in Courvoisier study of 109 cases of dilatation of gallbladder, 17 were due to impacted stones. Therefore, Courvoisier concluded that dilatation of gallbladder was rare with stones obstructing the common bile duct. Despite this fact it is always assumed that the palpable gallbladder is due to malignancy [pancreatic or periampullary etc.]. Here, we report a rare case of palpable gallbladder in a jaundiced patient due to multiple cholelithiasis and a large choledocholithiasis causing obstruction of CBD

Sonographic fetal biometry charts for a Pakistani cohort

This study aimed to develop growth centiles at different gestational weeks for fetal biparietal diameter, abdominal circumference, femur length and head circumference in a Pakistani cohort. Data were collected at a tertiary referral hospital from pregnant women at gestational ages 13-40 weeks referred for obstetric ultrasound as a part of routine antenatal care. A total of 1599 fetal sonographic biometric measurements were collected after screening for the inclusion criteria. For each measurement, separate regression models were derived to estimate the mean, standard deviation and reference percentiles at each week of gestational age for this cohort. The best fitting model for each variable was selected. These charts will help radiologists and clinicians in predicting dates of delivery, assessing fetal growth and identifying intrauterine fetal insufficiency in the Pakistani population

Determination of trace metals abnormalities in patients with vivax malaria

In the present study, blood serum level of metals were determined in malarial patients and compared with those in the normal subjects without complication using Atomic Absorption Spectrometer. For the determination of these metals twelve intravenous blood samples each from referred malarial patients and a group of normal subjects were collected and immediately centrifuged to obtain the supernatant liquid, serum of both the groups for analysis. The blood serum levels of copper in malarial patients determined to be 2.6917 ppm, which is higher as compared to that found 2.045 in normal subjects. Whereas the blood serum levels of iron, magnesium, and zinc found 2.0708 ppm, 12.2467 ppm and 4.9017 ppm respectively in malarial patients, who are lower than those, are determined in the blood serum of normal subjects. Blood serum levels of iron, magnesium, and zinc in normal subjects found 3.950 ppm, 19.4892 ppm, and 5.242 ppm respectively. In this study the metal content of copper, iron, magnesium and zinc in vary in malarial patients as compared those in the normal subjects. It may suggest that the decreased levels of iron, magnesium, and zinc can be maintained by giving as supplement of these metals in therapy

Increasing frequency of Anti-HCV seropositivity in a cross-section of people in Karachi, Pakistan

To determine the current frequency of circulating anti-HCV antibody in a cross section of subjects in Karachi, Pakistan and compare it with previous observations. A total of 35,191 individuals of both sexes presenting at a private diagnostic lab and its branches in Karachi city were screened for Anti-HCV antibody during a two year period ending Dec 2010. Positive tests were detected using EVOLIS automated 4th generation analyzer and confirmed with COBAS e411 random access solid phase chemiluminescent enzyme immunoassay. Also, a retrospective scrutiny of 37,391 subjects tested in the same lab during 2002-07 suggested 5.9% anti-HCV seropositivity, and was considered for comparison. Anti-HCV antibodies were detected in 3170 [9.01%] of those assessed. The youngest positive subject was a 5-day-old male neonate, the eldest an 82-year-old male. The majority of carriers [48.0%] were aged 30-49 years and 53.1% of those tested positive in Karachi, Pakistan were female. Carrier rate of anti-HCV antibody was 5.9% during 2002-07 recorded in the same lab. HCV antibody frequency in our Karachi subjects have steadily increased from 5.9% in 2002-07 to 9.01% in 2009-10, encouraging awareness and enquiry of reasons for the increasing reach of a significant virus

Infertility. A clinical approach

Infertility was, is and will be a serious problem for married couples. This review paper is intended to focus on clinical, social, and psychological problems in infertility. Infertility is a clinical problem which denotes the inability of a couple to give birth to child after a year of marriage. There exist a number of possible factors of male infertility, these are pathological infertility, physiological, genetically, and sexually transmitted infections. Attempt has been made to uncover the ignorance among the masses, who turn to pirs and mazars for a cure, and lack of will among medical professionals to find a scientific solution which has further aggravated the issue

Two cases of ambigious genitalia

The term "Ambiguous genitalia" applies to confusing appearance of the external genitalia. Sex assignment becomes essential for the parent's peace of mind, and in turn depends on anatomy and functional endocrinology rather than karyotype. Two cases with all different genetic sex, gonadal sex and phenotypic sex are described. First case is that of congenital adrenal hyperplasia [CAH] in a month old baby whose genotype was female with laboratory investigations exposing her diagnosis. She is doing well with oral hydrocortisone and fludrocortisone. Second case is that of probable 5-alpha reductase deficiency who would probably need future surgery

Frequency of gall bladder carcinoma in patients undergoing surgery for cholelithiasis

To determine the frequency of gall bladder carcinoma in patients undergoing surgery for cholelithiasis at Isra University Hospital, Hyderabad, Singh- Pakistan. This was a descriptive study, conducted from April 2006 to March 2008 at Isra University Hospital Hyderabad, Pakistan. This study included 200 cases of cholelithiasis who underwent cholecystectomy at out Hospital. Patients belonged to both sexes having cholelithiasis, diagnosed on the basis of clinical grounds and supported by ultrasonography. A uniform procedure of history taking, physical examination, investigations and treatment was adopted for all the patients, and data were recorded on the pre-designed proforma. Of 200 cases that were operated for gall bladder stone disease, eight were found to have carcinoma of gall bladder i.e. frequency was 4%. The age ranged from 35 to 70 years, with mean 50[ +/- 5.3] in females and 56[ +/- 2] in males. Male to female ratio was 1:3. On ultrasound, only three [37.50%] patients with advanced disease had a pre-operative clue of carcinoma. The frequency of gall bladder carcinoma in our population seems much higher than Western populations. Females are more affected than males by this problem. Ultrasonography can miss malignant lesions; therefore every gall bladder specimen should be subjected to histopathology. While in unsuspected cases undergoing laparoscopic cholecystectomy, gentle handling of the gall bladder is critical to avoid port site implantation caused by spillage of bile

Recurrent abdominal pain in children

To determine the causes of recurrent abdominal pain [RAP] in children and suggest general management guidelines. It is a descriptive observational study conducted from August 2000 to July 2003.One hundred fifty two children of 2- 15-Years age with recurrent abdominal pain were enrolled in this study. A pre-designed proforma was filled and investigations like Complete Blood Count [CBC], urine and fresh stool analysis was performed in all cases. Patients presenting with upper abdominal pain with or without dyspeptic symptoms were evaluated for H. Pylon by serology. Helicobacter pylon antibody serology [value >50 i.u Elisa method] positive patients were offered endoscopy examination and endoscopic antral biopsies were done. Other tests like x-ray chest and or abdomen, barium meal study, ultrasonography of abdomen, EEG examination and tuberculin test were done as indicated. Patients were followed at 2-week interval for three months and specific treatment prescribed as per etiology identified. Out of 152 children, a female to male ratio was 2:1, age range was 2-15 years and mean age was 8.9 years. Mean duration of symptoms was 16 months. Patients presented with epigastric localization of pain 65%, 25% presented with 'whole' abdominal pain while 5% patients presented with pain in loins and 5% had pain in tower abdomen. Protozoal infections which included giardiasis and amoebiasis [33%] were the commonest association followed by Helicobacter pylon [31%]. Endoscopy was performed in 15 cases; biopsy was positive for H.Pylori in all [100%] cases. Thirteen percent had worms in addition to giardia and entamoeba histolytica and 10% had gastro-esophageal reflux. Among other causes urinary tract infection was 5%, constipation was 3% a peptic ulcer diseases was 02%. Abdominal epilepsy, abdominal migraine, cholilithiasis, ovarian cyst, ulcerative colitis and gastnic-trichobizoar all were less than 1%. Recurrent abdominal pain is frequent and challenging pediatric problem. High index of suspicion and careful thorough clinical evaluation supported by stepwise laboratory work-up according to it's clinical presentation and consideration of common treatable causes will be a cost effective approach. Balanced diet with higher fiber content, environmental cleanliness, better quality of water and good personal hygiene practices can reduce common infections with causative factors

Perception of adolescent females about viral hepatitis in urban and rural Sindh

To assess perception regarding viral hepatitis among adolescent college girls and to evaluate the frequency of vaccination against hepatitis B of urban [Karachi] and rural [District Kambar Shadad Kot] Sindh. A cross sectional study using cluster sampling technique was conducted in five randomly selected intermediate colleges of Karachi and four of district Kambar Shadadkot during January 2008-February 2009. A total number of 500 adolescent college girls of age group 16-19 years were included in the study; 350 from urban and 150 from rural Sindh. A questionnaire was filled comprising of general information regarding viral hepatitis such as; type of hepatitis, mode of transmission, methods of prevention and status of vaccination etc. Respondents were interviewed after a written informed consent and confidentiality was assured. Data was analyzed using SPSS software package. Total respondents were 500; 350 from urban [Karachi] and 150 from rural [district Kambar Shadadkot] Sindh. Knowledge regarding various types of hepatitis was known to only 4% urban and 7% respondents from rural setup, while 54% from Karachi and 30% from interior Sindh had awareness that hepatitis B and C are infectious diseases. Seventy three percent of urban respondents knew that hepatitis B can develop cirrhosis and lead to liver cancer and 51% from rural population had the acquaintance. Immunization against HBV was recognized by 53% respondents of urban population but despite acquaintance only 28% were found vaccinated and the reason cited for non immunization was lack of awareness and cost of vaccine. Only 16% girls were found vaccinated from rural Sindh. Poor knowledge about hepatitis and vaccination against it amongst adolescents is still alarming and strategies need to be developed by the relevant authorities for creating awareness and to vaccinate them

Cirrhosis of liver: etiological factors, complications and prognosis

Objective: To determine the etiological factors, complication[s] and prognosis of patients suffering from liver cirrhosis in our setup. Design: Cross-sectional study. Setting: Medical and surgical departments of Liaquat University Hospital Hyderabad/ Jamshoro, Sindh - Pakistan, from April 2005 to April 2007

Methods: Patients having an evidence of cirrhosis of liver on ultrasound examination of abdomen were enrolled. All those patients who were not confirmed to be cirrhotic, excluded from this study. All cases were studied to determine the etiological factors, complications and prognosis of disease. All data were recorded on a proforma. Patients with acute variceal hemorrhage were referred to surgical department for endoscopic sclerotherapy or variceal band ligation

Results: Total 100 patients were studied, 67[67%] males and 33[33%] females. Their mean age was 53.09 with SD= 8.85814 years. Majority of patients, 52[52%] had HCV infection, 16[16%] had HBV infection, 16[16%] had HBV and HCV co-infection, 08[08%] had alcohol abuse, 01[01%] had primary biliary cirrhosis, 02[02%] had Wilson's disease and no etiological factors were recorded in 05[05%] patients. Ascites was present in 59[59%] cases, portal hypertension in 42[42%], esophageal varices in 29[29%], spontaneous bacterial peritonitis in 29[29%], acute variceal hemorrhage in 27[27%], hepatic encephalopathy in different grades in 24[[24%], hepatorenal syndrome in 09[09%] and hepatocellular carcinoma in 07[07%] patients. All patients with acute variceal episode[s] were adequately and timely treated in surgical department. When cirrhotic patients were grouped into child-Pugh's classification, 37[37%] were in class 'A' category, 37[37%] in class 'B' category, and 26[26%] in class 'C' category

Conclusion: HCV infection is the major risk factor for cirrhosis in our setup. Ascites was the commonest complication. Patients with child-Pugh's class 'A' cirrhosis had significantly longer survival than patients with child-Pugh's class 'B' and 'C'. A multidisciplinary approach for prevention and control of ever increasing HCV infection must be adopted and to make the public awareness through the mass media about its drastic complications, and possible modes of its transmission

Severe acute maternal morbidity and intensive care in a public sector university hospital of Pakistan

The study was planned to review the case series of pregnant women requiring intensive care due to severe acute maternal morbidity in the public sector university hospital, in order to identify failures and priorities in maternal health care provision in Pakistan. A retrospective case series study was performed of critically ill obstetrics patients admitted to general intensive care unit of Liaquat University Hospital Hyderabad, Pakistan, from January 1[12] to 31[12] December 2006. Data included demographics, disease responsible for critical illness, complications that prompted ICU admissions, intervention required, length of ICU stay and the resulting foeto-maternal mortality and morbidity. Over the study period, 30 obstetric patients were transferred to general ICU, representing 1.34% of 2224 deliveries. Seventy three% of women belonged to rural areas, 96% were un-booked while history of surgical intervention was present in 87% of cases. Hypertensive disorders of pregnancy [50%] and sepsis [17%] were the two main obstetrical conditions responsible for maternal illness. Respiratory failure [57%] and haemodynamic instability [40%] were the major indications for ICU transfer. Mechanical ventilatory support was the commonest intervention required in the ICU followed by the ionotropic support [33%].The foetal mortality rate was 43%, while maternal mortality rate was 33%. Maternal morbidity and mortality can be reduced by meticulous adaptation of safe motherhood initiative, provision of separate ICU services for critically ill obstetrical patients and early assessment and aggressive intervention through a team approach involving obstetricians, intensivists and anaesthetists

Blood transfusion is associated with increase resource utilization and bacterial infection

To observe the association of blood transfusion and clinical outcome in cardiac surgery patients. Forty patients underwent cardiac surgery during a period of two months in a single institution. Coronary artery bypass surgery [CABG] was performed in 21 [52.5%] patients, Mitral valve replacement [MVR] in 15 [37.5%] patients, aortic valve replacement [AVR] in 2 [5%] patients and Atrial septal defect [ASD] was closed in 2 [5%] patients. The mean age of the patients were 41.7 +/- 18 years, 80% were male. Twenty five [62.5%] patients required blood transfusion. Transfusion group showed chest wound infection [7.5%], pulmonary oedema [12.5%] and shortness of breath [10%]. Total leukocyte count and platelets count were significantly lower in transfusion group. We conclude that blood transfusion is associated with increased rate of infection and pulmonary oedema, with high cost and resource utilization. Blood transfusion should be used with appropriate caution

Nosocomial infections and development of antibiotic resistance in hospitals global issue

Nosocomial infections and antibiotics go shoulder to shoulder and where there are infections, there are always antibiotics. Hmergencc of antibiotic resistance in hospitals is global issue. This paper aims to alert the health policy makers, medical staff, microbiologisls and other experts to consider more clearly the serious threat of nosocomial infections. This is for the consideration of Pakistan Ministry of Health to become actively involved in the development of a structured and coherent approach to the problem. The approach should focus on formation and implementation of a set of objectives, responsibilities, structures, surveillance system, and technical guideline of medical personnel pertaining to nosocomial infections. There is an urgent need to consider 'active management' of antibiotic usage

Intelocking versus kuntscher nails in the management of femoral shaft fractures

To compare the outcome of Femoral shaft fractures managed with Interlocking and Kuntscher intramedullary nails, in terms of healing time, full weight bearing and post-operative complications. Prospective, quasi-experimental study from March 1999 to May 2002. Orthopaedics Unit I, Civil Hospital, Karachi. A total of 200 cases of Femoral shall fractures. Half [100] the cases of Femoral shaft fractures were treated with Kuntscher intramedullary nails and the other half [100] with Interlocking nails, the cases being assigned randomly. The detailed data of the patients was recorded, computed and analyzed using Chi-square test and Students t-test. The main parameters compared included fracture healing time, full weight bearing time and post-operative complications. There was no significant difference between the two groups in terms of demographic data, fracture type and associated co-morbidities. The average operating time was 110 +/- 25 minutes for the Interlocking nail and 80 +/- 15.8 mins for the K-nail. All patients of K-nail group needed blood transfusion, while only 17 patients of interlocking group needed blood transfusion. The fill weight bearing time was significantly shorter [p < 0.005] in cases of Interlocking nail. Out of 200 fractures 182 [91%] healed with in six months while 18 [9%] did not. The latter included 6 [3%] cases treated with Interlocking nails and 12 [6%] with Kuntscher nails, p < 0.005. Interlocking intramedullary nailing is better than Kuntscher nailing in every respect

Progressive familial intrahepatic cholestasis

A case of progressive familial intrahepatic cholestasis [PFIC] is described in a 7 years old girl who presented with pruritis and progressive jaundice alongwith failure to thrive. Laboratory indicated PFIC type 1 or 2 along with cirrhosis. Patient is responding to supportive therapy while liver transplantation is being awaited