Organic and Inorganic Mercury in Biological Samples of Flouresecent Lamp Industries Workers and Health Risks / 生物医学与环境科学（英文）

Objective@#The present study aims to investigate the concentrations of Hg and its aspects methyl mercury (Me-Hg) and inorganic mercury (I-Hg) in the biological samples (BSs) of fluorescent lamp industries workers (FLIWs).@*Methodology@#Different BSs including red blood cells (RBCs), plasma, urine, hair and nails were collected from the workers exposed to Hg and unexposed persons were selected as control group to measure both the T-Hg concentration as well as its species in different biological samples through quantitative analysis. Health data was collected through questionnaire survey.@*Results@#The mean concentrations of T-Hg (31.9 µg/L), Me-Hg (27.7 µg/L), and I-Hg (5.36 µg/L) in RBCs were found significantly ( < 0.001) higher among the workers ( = 40) as compared to the control group ( = 40). Similarly the mean Hg concentrations in plasma, urine, hair and nails were also significantly higher among the workers than the control group. The statistical relation between Hg concentration and demographic characteristics observed that workers experience and fish consumption has increased the Hg concentration while age, weight and smoking found no significant effect on Hg concentration in the BSs.@*Conclusion@#The study observed that the workers were highly exposed to high concentration of Hg and they are at a high health risk.

Comparative pharmacokinetics of omeprazole and its metabolites in poor and extensive metabolizer Pakistani healthy volunteers and a review of different studies

This study was designed to evaluate a comparative single dose [40mg] pharmacokinetics [PK] of Omeprazole [OMP] and its two metabolites, 5-hydroxy Omeprazole [5-OH-OMP] and Omeprazole sulphone [OMP-S] in poor [PM] and extensive [EM] metabolizer Pakistani healthy adult volunteers. The frequency of CYP2C19 and CYP3A4 varies widely in different populations. The present study was conducted to evaluate the PK of OMP and its two metabolites in Pakistani population and to review different studies conducted after administration of single dose of OMP. Twenty two subjects were enrolled in this study and divided into two groups. The CYP2C19 phenotyping was evaluated by the metabolic ratio of OMP to 5-OH-OMP. It was a single dose, open label study and the blood samples from subjects were collected at different time intervals until 24 hours. The PK parameters were calculated using the PK-summit software. The metabolic ratio of area under the plasma concentration-time curve AUCOMP/5-OH-OMP was 1.86 +/- 0.572 and13.84 +/- 2.504 for EM and PM, respectively; maximum plasma concentration [Cmax] of OMP was increased by two folds for PM while the AUC? was increased by 3 folds; the Cmax and AUC? of 5-OH-OMP decreased for PM by 2 folds while there was 3 fold increase observed in the Cmax and AUC? of OMP-S. The PK of OMP and its metabolites in different populations were also discussed, and issues regarding CYP2C19 and CYP3A4 genotyping were also extensively reviewed. In EM of CYP2C19 the concentration of 5-OH-OMP is higher while that of OMP-S is lower. This study as well as reported studies reveals that in PM of CYP2C19 more drugs are available for CYP3A4 to be metabolized. A correlation between CYP2C19 EM and PM activity with CYP3A4 needs to be established

Knowledge, attitudes and practices of lady health workers regarding family planning program in tehsil muzaffargarh

Objective: To assess the knowledge, attitudes and practices of lady health workers [LHWs] regarding implementation of family planning program in Tehsil MuzaffarGarh

Study Design: Cross sectional study

Place and Duration of Study: It was carried out from December 2015 to May 2016 involving Lady Health Workers from 10 union councils of Tehsil Muzaffar Garh including both urban and rural areas

Material and Methods: The data were collected by interviewing 307 LHWs using a structured closed ended questionnaire

The data were entered and analyzed through SPSS version 22

Results: Lady health workers [LHWs] demonstrated a good knowledge ranging from 78% to 99% of different aspects of family planning. They were poorly informed regarding pregnancy complications, breast feeding and infertility. Almost all of them 305 [99%] showed positive attitude regarding job, trainings, compatibility of family planning with religion, although were unsatisfied with their salaries and monetary incentives

Conclusions: LHWs have a good knowledge and positive attitude towards family planning except knowledge about infertility, pregnancy complications and breast feeding. Family planning practices are difficult in rural areas because of low literacy rate and dominance of mothers in law, which needs attention

Surge of malaria in Mianwali due to floods: perspective from a secondary care hospital

Objective: To assess the magnitude of flood related rise in the frequency of malaria, diagnosed at a secondary care hospital, during 2007-2011

Study Design: Cross sectional descriptive study

Place and Duration of Study: Pakistan Air Force hospital Mianwali, from 1[st] Jan 2007 to 31[st] Dec 2011

Patients and Methods: Monthly records of hospital laboratory patients with peripheral blood smears, positive for malarial parasites, were counted from 1[st] Jan 2007 to 31[st] Dec 2011. Frequencies of vivax and falciparum malarial cases diagnosed each year during 2007-2009 were compared with the corresponding frequencies during the year of floods i.e. 2010, and the following year i.e. 2011

Results: When compared with the mean of the annual frequencies during 2007-2009, there was a rise in the total number of malaria cases by 1.3 times in 2010; while next year, i.e. during 2011, the rise was 3.0 times. During the period 2007-2011, vivax malaria cases always peaked during the months of September each year while falciparum malaria cases had a spike in the months of November

Conclusion: Massive floods resulted in a rise in the frequency of malaria cases during flood season and as an after math during the next malarial season. Planning for prevention and control should be done accordingly. Spread of falciparum malaria following the floods demands more efforts towards halting its possible rise in Mianwali district

Frequency of retinopathy in newly diagnosed patients of type 2 Diabetes Mellitus [DM]

This study was to determine the frequency of retinopathy in newly diagnosed type-I1 Diabetics. Cross sectional descriptive study. It was conducted at Department of medicine, Military Hospital [MH], Rawalpindi from 1st Jan 2012 to 30 Jun 2012. We included 200 patients of type-I1 DM from both genders diagnosed in last 03 months from both outdoor and indoor departments in the age range of 40 to 70 years by consecutive sampling. All patients having co morbidities affecting retina were excluded. Informed written consent was taken before enrollment. Formal approval of the study was taken from hospital ethical committee. Ocular Fundoscopy was performed with WelchAllyn Ophthalmoscope [REF 11470] as per standard protocols and both eyes were elamined. The grade of DR [diabetic retinopathy] awarded as per highest changes in any of the two eyes. All tests were carried by a single person to avoid inter-observer variations. Findings of ocular fundoscopy were confirmed by ophthalmologist. All data was analyzed by using SPSS version 11. Out of 200 subjects 63.5% were male and 36.5% were female. Age ranged from 40 to 70 years with mean age of 51.05 + 6.910 years. 29 [14.5%] subjects had Diabetic retinopathy. Out of 29 patients, 24 [82.8%] had preproliferative and 5 [17.2%] had proliferative diabetic retinopathy. A significant proportion of diabetic patients have retinopathy at the time of diagnosis of their disease which is more common in males and with increasing age. It is recommended to thoroughly screen the newly diagnosed diabetics for early detection of diabetic retinopathy and its management involving early referral to eye specialist

Efficacy and patient acceptability of analgesia by intranasal diamorphine in burns patients: results of a pilot project

To objectively assess intranasal diamorphine as an analgesic adjuvant for change of dressings in burn patients. Eleven patients were recruited at a regional burns centre for this pilot study. Intranasal diamorphine at a weight-calculated dose was administered through an atomizer and patient vital signs and APVU scores were documented pre and post administration. A post-procedural satisfaction questionnaire was also completed by all patients. Eleven patients [8 males and 3 females] were recruited for this pilot project. Mean age was 34 years [19-57 years] and mean burn total body surface area [TBSA] was 8.9% [4-17%]. Procedure duration was a mean of 53.0 minutes [30-72 minutes]. Six of the patients had a past history of opiate use. The data of our small-scale study shows that it has good analgesic efficacy, rapid-onset, safety and high degree of patient satisfaction without the need for intravenous access. There were no side-effects and all patients expressed satisfaction with the analgesia given. Intranasal diamorphine provides effective analgesia for moderate to severe procedural pain and can be a safe analgesic adjuvant for change of dressings in burn patients

Klippel-trenaunay syndrome: a rare cause of intermittent lower gastrointestinal bleeding

Klippel-Trenaunay syndrome is a rare non-hereditary congenital abnormality characterized by a clinical triad of soft tissue hypertrophy of extremity, varicosities and cutaneous hemangiomas or lymphongioma. Bleeding per rectum is an uncommon but potentially serious complication. We herein report a case admitted to the gastroenterology ward Postgraduate Medical Institute, Lady Reading Hospital Peshawar, with intermittent haematocezia and symptomatic iron deficiency anemia. The patient did not seek any help for gastrointestinal bleeding until his admission to our unit. He was also having gigantism of his right leg and port wine angiomatous spots on his buttocks and leg. The literature on the evaluation and management on this case is reviewed

A case of cellulitis of the hands caused by a predatory bird attack

Many species have been drastically affected by rapid urbanization. Harris's hawks from their natural habitat of open spaces and a supply of rodents, lizards and other small prey have been forced to change their natural environment adapting to living in open spaces in sub- and peri-urban areas. Specific areas include playgrounds, parks and school courtyards. The migration of this predatory species into these areas poses a risk to individuals, and especially the children are often attacked by claws, talons and beaks intentionally or as collateral damage while attacking rodent prey. In addition, the diverse micro-organisms harbored in the beaks and talons can result in wound infections, presenting a challenge to clinical management. Here we would like to present a case of an 80-year-old man with cellulitis of both hands after sustaining minor injuries from the talons of a Harris's hawk and review the management options. We would also like to draw attention to the matter that, even though previously a rarity, more cases of injuries caused by birds of prey may be seen in hospital settings.

Preparation and in-vitro in-vivo evaluation of sustained release matrix diclofenac sodium tablets using PVP-k90 and natural gums

Conventional dosage form is nowadays mostly replaced by sustained release formulation in order to increase drug efficacy and patient compliance. The sustained release properties of the PVP K90 alone and in combination with guar gum, xanthan gum and gum tragacanth were evaluated using diclofenac sodium [100 mg/tablet] as a model drug. Tablets were processed using wet granulation method and evaluated for sustained drug release properties. The drug release from the formulations was studied in relationship with Commercially available Diclofenac Sodium SR, used as a reference tablets and results were expressed as similarity [f1] and differential factor [f2]. The tablets prepared using PVP K90 160 mg/tablet sustained the release of diclofenac sodium for 12 hours. Formulations where the PVP K90 was partially replaced with different gums also sustained the release of drug for 12 hours. The release of the drug from these formulations mainly followed Higuchi model and super case-II and Non-Fickian diffusion. The in-vivo drug release was studied in healthy human volunteers using non-blinded cross over, two period design using Diclofenac Sodium SR Tablets as a reference drug. The relative bioavailability of the formulation containing PVP K90 and gum tragacanth was 0.91. The studies showed that the use of the PVP K90 in combination with gum tragacanth both in-vitro and in-vivo sustained the release of the drug

Management of foreign bodies in the upper gastrointestinal tract with flexible endoscope

To evaluate the management of foreign bodies in the upper Gastrointestinal tract in a tertiary care hospital in Peshawar. In this descriptive study, conducted at Gastroenterology Department Hayatabad Medical Complex Peshawar from May 2002 to May 2009, a total of 40 consecutive patients presenting with history of foreign body ingestion were included. Radiological survey was made before endoscopy in all the patients. Flexible endoscope, esophageal over tube and other accessories were used for removal of the foreign bodies. Female to male ratio was 1.5:1. The mean age of the sample was 19.92 +/- 23.5. Dysphagia [n=18, 45%] was the most common symptom in the esophageal foreign bodies followed by retrosternal pain or discomfort [n=11, 27.5%]. The most common foreign body was coin ingestion [n=24, 60%]. Meat bolus and bone chip impaction was present in 9 [22.7%] patients. The success rate in case of esophageal foreign bodies was 93.75%. While in the case of gastric foreign bodies, it was 100%. There was a small perforation which occurred in only one patient with esophageal foreign body which was managed conservatively. In the case of gastric foreign bodies, no procedure related complications occurred. Flexible endoscopy was a safe and effective technique for the management of foreign bodies in the upper gastrointestinal tract in our study

Injection sclerotherapy of bleeding gastric varices using absolute alcohol

To evaluate the effectiveness of absolute alcohol injection in the management of bleeding gastric varices. This descriptive study was conducted in the department of Gastroenterology, Hayatabad Medical Complex Peshawar from September 2006 to September 2009. Twenty Seven patients with portal hypertension fulfilling the inclusion criteria and consenting were included in the study. Endoscopy was arranged within 12 hours of admission to the hospital. The gastric varices were injected with 5-10 ml of absolute alcohol depending upon the size of the varices. Both intravariceal and paravariceal techniques were used. Subsequent endoscopy sessions were arranged at 2 weeks intervals. The outcomes assessed were variceal eradication, rebleed and death. Findings were noted and entered into a structured proforma. Data was analyzed using SPSSv.10. Fifteen [55.56%] patients were male and 12 [44.44%] were female with a mean age of 47.52 +/- 15.09 years. Twenty one [77.78%] patients had cirrhosis due to chronic hepatitis C, 4 [14.81%] were HBV related while 2 [7.40%] had alcoholic liver disease. Majority [70.73%] had child's class C followed by B and A [18.51% and 11.11% respectively]. Variceal eradication was achieved in 19[70.37%] patients. Three were lost to follow up while 5 died due to uncontrolled bleeding. Post sclerotheraphy ulceration was the most common complication [64%] followed by pyrexia [28%], Retrosternal/epigastric pain [16%] and dysphagia [8%]. Sclerotherapy with absolute alcohol may be effective in achieving hemostasis in bleeding gastric varices but with exceptionally high rate of complications

Hepatotoxicity of ATT

To determine the frequency of hepatotoxicity with standard ATT. Descriptive. Department of Medicine, Combined Military Hospital Lahore. Feb 2007 to April 2008. 250 patients aged 18 years or greater having pulmonary TB were selected through non-probability convenience sampling technique. All patients were given four drugs for two months indoors, followed by two drugs for four months in outdoor. Symptoms suggestive of hepatotoxicity were enquired from the patients regularly. Serum bilirubin and ALT were measured on monthly basis and finally on completion of therapy. Hepatotoxicity was defined as a five fold rise in serum ALT. In patients developing hepatotoxicity, treatment was modified accordingly. This study was done on 189 male and 61 female patients [total: 250]. Hepatotoxicity developed in 13 [5.2%] patients, mostly during the initial phase of treatment [84.6% incidence during the first month]. Risk factors included: age [4 out of 156 young patients and 9 out of 94 older patients; p: 0.016] and nutritional status [8 malnourished patients and 5 well nourished patients; p: 0.031]. Hepatotoxicity was not related to the gender [9 males and 4 females; p: 0.585] or the results of baseline sputum smears [7 out of 102 smear positive cases and six out of 148 smear negative cases; p: 0.064]. Hepatotoxicity with ATT is fairly common, especially in the elderly, malnourished patients and during the initial phase of treatment

Frequency of organic pathologies in patients with irritable bowel syndrome

To evaluate Irritable bowel syndrome [IBS] labeled patients, meeting symptom based criteria of IBS, for organic pathologies. This descriptive study was carried out in Gastroenterology Department, Hayat Abad Medial Complex, Peshawar, during the period from March 2003 to March 2005. A total of 85 consecutive patients were included in the study, who were labeled as IBS by the General Practioners. All of them were meeting symptom based criteria [ROME II] for IBS. Informed consent was taken. Patients with alarm signs including dysphagia, rectal bleeding, anemia, weight loss, family history of colon cancer, were excluded from the study. Detailed history and physical examination was done. Laboratory evaluation, which included complete blood count, erythrocyte sedimentation rate[ESR], blood urea, serum creatinine, serum electrolytes, liver function tests, thyroid function tests, and stool examination for ova, parasites and culture when indicated, was done. Patients underwent Upper G I Endoscopy, Ultrasound of the abdomen, Flexible sigmoidosopy and/or Full length colonoscopy as indicated. Other investigations like small gut biopsy, celiac serology and biopsy from the large gut were done as needed. Out of the 85 patients, 68 [80%] were males and 17 [20%] were females. Abdominal pain was the most common, present in 65 [76%] patients out of 85 patients. All these patients had mixed type of IBS symptoms, having both diarrhea and Constipation. Laboratory investigations were normal in almost all patients except in 5 [5.8%] patients, who were having evidence of hypochromic microcytic anemia. All these five patients were having mixed pattern IBS. Three [3.5%] were males and their celiac serology and small gut biopsy showed evidence of celiac sprue. Ten [12%] of patients were having cysts of Amoeba in their stools routine examination but there were no trophozytes found. Another 15 [17%] patients were having non significant hemorrhoids on lower GI endoscopy. 17 [20%] of patients were having antral gastritis on EGD, but the biopsy showed non specific gastritis. Irritable bowel syndrome can be diagnosed clinically, using ROME II criteria and a few inexpensive and non invasive tests. In patients with IBS-D and IBS-M routine serological screening for celiac sprue may be a cost effective strategy

Prevalence and B-lactamase producing bacterial isolates in a teaching hospital in Peshawar, Pakistan: a four year study

Prevalence of microorganisms was studies in clinical samples of various body fluids [n=12259], collected from patients at Post graduate Medical Institute Hayatabad Medical Complex [PGMI, HMC] Peshawar. Only 34.90% of samples exhibited growth, 36.25% of these isolates were Gram positive and 63.75% were Gram negative bacteria. E. coli was the most prevalent organism [39.45%] followed by S. aureus [32.23%], Proteus spp. [9.23%], Pseudomonas spp. [6.54%], Streptococuss spp. [3.51%], Acinetobacter spp. [2.66%], Citrobacter spp. [2.8%], Providencia spp. [2.2%] and miscellaneous bacteria [1.38%]. The growth of bacteria was high in pus samples [44.03%] followed by urine [38.21%], high vaginal swab [HVS] [8.58%], cerebrospinal fluid [CSF] [1.96%], blood [3.39%] and miscellaneous samples [3.83%]. E. coli and S. aureus were the most prevalent organism in urine [56.57%] and pus samples [44.02%], respectively. The frequency of E. coli [61.76%] was high in samples collected from female patients and percentage of the infections caused by the S. aureus in male and female patients was 47.9 and 52.1, respectively. During the study period, frequency of the E. coli was high during April to October and the prevalence of S. aureus was very common during March to October. Consistent but insignificant increase in the beta-lactamase producing S. aureus and E. coli was observed throughout the period of the study. However, increase in the beta-lactamase producing S. aureus and E. coli was above 80%. The prevalence of extended spectrum beta- lactamase [ESBL] in E. coli was increased from 13.85% in year 2000 to 22.66% in year 2003. The increasing in prevalence of microorganism, particularly of beta-lactamase producing E. coli and S. aureus and ESLB is alarming situation. Various measured like prescribing and patient compliance are required to control the increase in the prevalence of microorganism

Prevalence and resistance pattern of Pseudomonas aeruginosa against various antibiotics

A prospective study on various clinical isolates from patients admitted from various parts of NWFP and Afghanistan at Post Graduate Medical Institute [PGMI] Hayatabad Medical Complex, Peshawar was conducted from January 2000 to December 2004 to ascertain the prevalence and antimicrobial susceptibility of Pseudomonas aeruginosa infections. Among 4709 positive isolates, 314 [6.67%] were Pseudomonas aeruginosa. The highest rate of infection due to Pseudomonas aeruginosa was observed in orthopedic ward [24.61%] and OPD [20%], in other wards the infection was between 13% to 1.5%. Gender-wise prevalence showed 61.78% male and 38.22% females were infected by Pseudomonas aeruginosa. The highest percentage of Pseudomonas aeruginosa isolates were observed in pus [57.64%] and urine [24.2%] samples. Maximum Pseudomonas aeruginosa isolates were found between March to August and the highest percentage 13.846% was observed in June. Using the disc diffusion method, the resistance patterns of 314 isolates against 14 antimicrobial agents were determined. The highest resistance was observed against ampicillin [>/= 98.4%], ampicillin/ sulbactam [85.3%], co-amoxiclave [83.8%] and ofloxacin [68.4%] and least resistance was observed against amikacin [24%]. Similarly the MIC for ampicillin [4 to >2048 micro g/ml], ampicillin/sulbactam [1 to 2048 micro g/ml] and co-amoxiclave [1 to > 2048 micro g/ml] against clinical isolates of Pseudomonas aeruginosa was also high. High resistance of Pseudomonas aeruginosa against various commonly used antibiotics showed the alarming situation. The control of drug resistant Pseudomonas aeruginosa required rational prescribing and proper use of antibiotics

Biliary leakage following cholecystectomy and its outcome

To find out the causes and outcome of management in cases of bile leakage following cholecystectomy. Prospective descriptive study from April 2005 to December 2006. Surgical Unit five of Civil Hospital, Karachi. A total of 140 patients who were operated for symptomatic gall stones. Detailed information regarding the patients was collected. Initially due to non-availability of ERCP as well as high cost in the private sector, all patients with biliary leakage underwent open surgery. Later on all patients underwent ERCP due to its availability in the unit; operative intervention was only undertaken when the ERCP was not therapeutic or failed. Ultrasound studies were done in patients who were suspected to have bile collections but no discharge from the drains or the operative wounds. Out of 140 patients, two patients were noticed to have biliary leakage during surgery and 10 post-operatively. The former cases underwent repair on the spot, while in the latter group five underwent re-exploration and four ERCP; one patient expired without intervention and another from the re-exploration group. In three patients ERCP was successful and sphincterotomy with stenting was done while in one patient there was failure of cannulation, resulting in open exploration

Causes of severe upper gastrointestinal bleeding on the basis of endoscopic findings

To describe the common causes of severe upper gastrointestinal [GI] bleeding in a tertiary care teaching hospital. This study was carried out in Gastroenterology Department Postgraduate Medical Institute, Hayatabad Medical Complex Peshawar from 1st September 2003 to 31st July 2005. Study was conducted on all patients who presented with severe upper GI bleeding. The patients were first stabilized hemodynamically and were kept empty stomach for at least 6-12 hours before procedure. Upper GI endoscopy was performed and the endoscopic findings were recorded. Out of 350 patients included in the study, 200 [57%] were males and 150 [43%] were females. The age ranged from 14 years to 75 years. Variceal bleed was the most common cause in 45.7% [n=160] cases followed by peptic ulcer in 31.4% [n=110] cases. Gastroesophageal reflex disease was noted in 10% [n=35], carcinoma of the stomach in 5.7% [n=20] of the cases and Mallory-Weiss tears in 4% [n=14] cases. Out of 160 patients with varices, 62.5% [n=100] were having esophageal varices. Out of 110 peptic ulcer cases, 63.6% [n=70] were having duodenal ulcer and 26.4% [n=29] were having NSAID induced peptic erosions. Variceal bleeding secondary to portal hypertension and peptic ulcer diseases are the most common causes of upper G I bleeding in our setup

Partial Anodontia

A severe case of partial anodontia male aged, 24 is reported with the complaint of speech and masticatory function prevailing with difficulties. He has been successfully and conservatively treated with full upper and lower overlay dentures. Aesthetics, speech and masticatory function have been improved with no deterioration in oral health