Anterior technique in spinal deformity correctional surgery

The aim of this review is to classify spinal deformities, provide knowledge in correctional surgery of spinal deformities and highlight the anterior technique. PubMed and Medline database search was performed for published articles up to October 2017 related to surgical techniques for spinal deformities. Spinal deformity may be the pathology of one vertebra or may develop with pathologies of multiple vertebras, ribs or the pelvis. The spine must be analyzed in different planes before starting the treatment because it can be accompanied by multiple organ pathologies. Different surgery types can be used and anterior method is one of them, which can give better result in cases with advanced kyphosis. The therapy of serious spinal deformity is challenging and needs a careful analysis of the patient by the orthopedic surgeon, anesthesiologist, pulmonologist, and neurologist especially when neurologic deficits are existing

Frequency and pattern of congenital heart defects in a tertiary care cardiac hospital of Karachi

Objective: To determine the current frequency and pattern of distribution of congenital heart defects [CHD] at National Institute of Cardiovascular Diseases [NICVD], with the age at which initial diagnosis of CHD was made and the age at which the participant first visited the study center

Methods: This is a descriptive and prospective hospital based study conducted in the pediatric cardiology unit outpatient department of NICVD. This study included all the patients, irrespective of age, having confirmed diagnosis of CHD on the basis of echocardiographic report. The collected data was entered and analyzed by using Statistical Package for Social Sciences v 20.0

Results: Out of 1100 cases of congenital heart defects 1003 could be analyzed. There are 565 males [56.3%] and 438 females [43.6%]. Total 609 cases [60.6%] were of simple acyanotic lesions and 387 [38.6%] were complex cyanotic lesions. In simple lesions septal defects constitute 64.9% and obstructive lesions were 11.0%. Tetralogy of fallot[TOF] was the commonest CHD and cyanotic lesion accounted for 24.4% of the total 1003 cases followed by Ventricular septal defect[VSD] 21.5%, Atrial septal defect [ASD] 9.3% and Patent ductus arteriosus [PDA] 8.6%. Pulmonary stenosis[PS] was the most common obstructive lesion making 3.1% of the CHD. In 147 [14.5%] cases combination of simple defects were encountered and the commonest combination was ASD with VSD in 34 cases

Conclusion: Congenital Heart Defects are very common in our setup and early detection of CHD is increasing. Overall burden of CHD is also increasing therefore a proper population based study on a large scale is needed to estimate the prevalence accurately

Evaluation of anti-streptolysin o titers in rheumatic heart disease patients

Background: Anti-streptolysin O titer is related to rheumatic heart disease

Objective: To assess anti-streptolysin O titer in rheumatic heart disease patients at Punjab Institute of Cardiology Lahore

Methodology: It was a cross-sectional study, 130 consecutive patients of rheumatic heart disease admitted at Punjab Institute of Cardiology Lahore between 1[st] January to 31[st] December, 2014, fulfilling the inclusion and exclusion criteria were enrolled. Their laboratory findings were taken; CRP and ESR levels were measured. ASO titer was measured by latex agglutination test. ASO Titer more than 200IU/ml was taken as significant

Results: It was found that 81[62.31%] patients of rheumatic heart disease has ASO levels more than 200IU/ml and 49[37.69%] patients has ASO less than 200IU/ml. Fifty two percent study subjects were female and 60% were between 4-15 years of age

Conclusion: Majority of the patients admitted with RHD has raised level of ASOT

Typhoid fever in paediatric patients in Quetta, Balochistan, Pakistan

To determine the seropositivity of typhoid fever in febrile pediatric patients presenting to tertiary care center. This observational study was conducted at Children Hospital Quetta [CHQ] from July 2011 to March 2012. The children with three or more days fever, no obvious focus of infection and clinically suspected of typhoid fever were screened. Sterile Blood samples were obtained from febrile patients and Widal and Typhidot [Trade Mark] tests were performed for the diagnosis of Typhoid fever in the suspected populations. Total of 2964 clinically suspected patients were screened for typhoid fever. Of these, 550 [18.6%] patients were positive serologically. The higher prevalence of the disease in hot summer season and increasing pattern of the disease was observed in summer days. The disease was higher in school age children under 5-10 years. Although non-significant association was observed on sex basis. The findings highlight the considerable burden of typhoid fever in pre-school and school-aged children. The variation in the disease pattern has also been observed under seasonal variation and different age groups, all of which need to be considered in deliberations to control the typhoid fever

Relapsing fever, a rare disease in Saudi Arabia

Background: relapsing fever is an acute febrile illness caused by blood spirochetes belonging to genus borrelia. This spirochete can be acquired through the bite of an infected soft tick [Ornithodoros species] or contact with an infected louse [Pediculus humanus] and thus constituting two types of relapsing fever [RF] depending upon the responsible vector i.e. Tick borne relapsing fever [TBRF] and Louse-borne relapsing fever [LBRF]. It is characterized by recurrent cycles of pyrexia which are separated by intervals of apparent recovery. During pyrexia, organisms are found in blood. While during afebrile period, organisms hide themselves in spleen, liver and even central nervous system

Methods: one hundred and thirteen patients presenting with high grade fever were studied for disease pattern. They underwent routine and special investigations for meningitis, malaria, dengue, enteric fever, HBV, HCV and HIV on quality control maintained analyzers by standard methods

Results: all the 113 patients after diagnosis were classified as enteric fever [41], malaria [37], meningitis [20], dengue fever [14] and a patient of relapsing fever i.e. Borrelia recurrentis. This patient was brought in unconscious state, looked jaundiced, dehydrated, had hepatosplenomegaly. His CBC showed WBC 10. 7X1 0A9/L, Hb 10.5g/dl, Platelet count 35x10"9/1. Giemsa stained blood film showed multiple number of spiral shaped organisms- borrelia recurrentis. He had signs of splenic rupture; he underwent splenectomy. Histopathology of spleen for spirochetes confirmed spiral shaped organisms [borrelia recurrentis]

Conclusions: there is very little information about borrelia infection in Saudi Arabia. The prevalence or incidence in Saudi Arabia is unknown. Its apparent rarity may be due to under diagnosis and under reporting. A high index of suspicion in appropriate clinical situations will lead to its early recognition and treatment

audit of fibreoptic bronchoscopy service at KRL Hospital Islamabad

Fibreoptic bronchoscopy is an important diagnostic and therapeutic tool for a wide spectrum of thoracic disorders in interventional pulmonology. The British Thoracic Society published comprehensive guidelines in 2001 on the use of fibreoptic bronchoscopy. The purpose of this audit was to evaluate the performance of our bronchoscopy service in the light of these guidelines with a view to identify areas for further improvement. In this prospective audit a series of 50 consecutive bronchoscopies performed at KRL Hospital Islamabad was studied. For each examination we recorded patient demographics, indication of the procedure, radiological information, pre-procedure evaluation by the pulmonologist, the bronchoscopic appearance and histopathological and microbiological findings, where indicated, and any untoward events associated with the procedure. The mean age was 48.8yrs [SD +/- 17.9] with male predominance [M 78%, F 22%].The main indication of the procedure was sampling of bronchial washings for microbiological assessment [n=25; 50%], followed by evaluation of suspected malignancy[n=15; 30%], hemoptysis [n=9; 18%] and persistent cough [n=1; 2%]. Chest X-rays were abnormal in majority of patients [n=46; 92%] and radiological appearance of pulmonary mass lesion was seen in 24% [n=11] of abnormal CXRs. Thirty percent [n=15] of bronchoscopies were abnormal with 93% diagnostic yield of specimens obtained for histopathological assessment. A low diagnostic yield of 24% was observed in cases of specimens collected for microbiological assessment. No major procedure related complications were observed during or after the procedures. Fibreoptic bronchoscopy is a safe procedure provided all basic precautions are taken. The procedure should be considered in all patients with a mass lesion on CXR. Although thehistopathological diagnostic yield was well above the recommended standard in cases of endoscopically visible malignancy but a low diagnostic microbiological yield was observed especiallyin cases being evaluated for tuberculosis. The latter may be attributed to less selective study population and sub-optimal microbiological service. Hence the audit was useful in identifying an area for furtherimprovement. In a developing country, like Pakistan, gender bias is rampant even when it comes to access the healthcare facilities

Effect of a compound recipe [medical plants] on serum insulin levels of alloxan induced diabetic rabbits

The present study was planned to observe the hypoglycaemic effect of the 'Compound recipe' a combination of traditional medicinal plants in normal and alloxan induced diabetes mellitus. This study was performed to study the possible role of indigenous medicinal plants in the regeneration of pancreatic beta-cells and in treatment of insulin dependent diabetes mellitus. The 'Compound recipe' was administered daily in doses of 400-mg/kg body weight to normal and alloxan induced diabetic rabbits for a period of 4 months. The blood glucose and serum insulin levels were estimated before and 1,2,3 and 4 months after the administration of the extract. The extract exerted a significant [p>0.05] hypoglycemic effect in alloxan diabetic rabbits. The hypoglycemic effect was not significant [p>0.05] in normal rabbits. The extract exerted a significant [p<0.05] increase in insulin levels in alloxan diabetic rabbits. The effect on insulin levels was not significant [p>0.05] in normal rabbits. The doses used did not show acute toxicity or result in behavioral changes. From this study it may be conclude that the Compound recipe causes an increase in serum insulin levels in alloxan induced diabetic rabbits possibly due to regeneration of pancreatic beta cells

Pharmacognostical evaluation of ricinus communis leaves

Ricinus communis is a common medicinal plant in Ayurveda and Unani systems of medicine, used in several parts of the country for its various medicinal properties. The present work attempts to summarize the pharmacognostical characters of the leaves. HPTLC, histological colour reactions and fluorescence analysis were also carried out

Patterns of argyrophilic nucleolar organiser regions in pleural and peritoneal effusions

To evaluate AgNOR size and dispersion as alternate methods to AgNOR counts in order to differentiate malignant from non-malignant effusions. Comparative study. Department of Pathology, Postgraduate Medical Institute, Lahore, from January 2003 to June 2004. A total of 240 samples of pleural and peritoneal effusions were centrifuged, deposits smeared on slides and stained with H and E and AgNOR stain. The diagnosis of malignancy or otherwise was made on H and E staining. AgNOR counts, variation in size and dispersion of AgNOR dots in smears were graded and compared in malignant and non-malignant effusions. Mean AgNOR counts of 11.47 +/- 3.60 and 11.04 +/- 3.89 in malignant pleural and peritoneal effusions, respectively, were significantly [p<0.0001] greater as compared with counts of 3.36 +/- 0.69 and 3.35 +/- 0.66 in non-malignant effusions. AgNOR size and dispersion were of higher grade in significantly greater proportion of malignant as compared with non-malignant effusions [p<0.0001]. Typing of AgNOR size and dispersion was found to be an easy and reproducible alternative to traditional AgNOR counts for differentiating malignant from non-malignant effusions. These parameters should be correlated with already established but expensive techniques of AgNOR area and size imaging by electron microscopy and flow cytometry, as an economical alternative

Comparative susceptibilities of Escherichia coli to ceftriaxone alone and in combination with sulbactam

The study was conducted to observe the effect of ceftriaxone alone and in combination with sulbactam against Escherichia coli. Forty Isolates of -lactamase producing Escherichia coli were collected in the microbiology laboratory Khyber Medical College, Peshawar. These were cultured and their sensitivity tests were done both with and without adding sulbactam in ceftriaxone using specially prepared antibiotic disks. NCCL zone diameter criteria was used. The disks containing the combination of ceftriaxone and sulbactam produced larger zones of inhibitions than those containing only ceftriaxone. This showed that the bacteria which had become resistant to ceftriaxone can once again become sensitive to ceftriaxone, if the inhibitor sulbactam is added

Pattern and frequency of various utrine tumours: a retrospective study over a period of 26 months

This is a retrospective study to find out the frequency of various uterine tumours. It includes hystrectomy specimens, tumour excisions and endometrial curettings which were sent to Department of Pathology, Allama Iqbal Medical College, Lahore and author's laboratory during a period from January 2001 to March 2003. A total of 471 cases are analysed. Leiomyomas were seen in 369 patients [78.34%] and endometrial polyps in 49 cases [10.41%]. Malignant tumours were found less frequently with adenocarcinoma in 23 patients [4.88%] followed by leiomyosarcoma in 8 patients [1.70%], Endometrial stromal tumours in 7 patients [1.49%], Choriocarcinoma in 6 patients [1.27%] and Mixed Mullarian tumours in three patients [0.64%]. NonHodgkin's Lymphoma was seen in one patient [0.21%] while in five patients [1.06%], metastatic tumours were found. Three were squamous cell carcinomas, two from cervix and one from lung while two were invasive ductal carcinomas coming from breasts. It is concluded that in the uterus benign tumours and tumour like conditions are more common with leiomyomas as the most common uterine neoplasms whereas malignant tumours are less common and endometrial adenocarcinoma being the most common uterine malignant tumour

Effect of ficus relegiosa on blood glucose and total lipid levels of normal and alloxan diabetic rabbits

The present study was planned to observe the hypoglycemic effect of the 'Ficus relegiosa', a traditional medicinal plant. This study was performed to study the possible role of indigenous medicinal plants in the treatment of Diabetes mellitus [type-2] Normal rabbits were divided into 5 groups [1-5] of six animals each. Group 1 served as control and received 15 ml of water only. Group 2 received tolbutamide 500-mg/Kg body weight. Group 3-5 received the extract of Ficus relegiosa dissolved in 15ml of water in doses of 200 mg/Kg, 250 mg/Kg and 300mg/Kg body weight respectively. The diabetic rabbits were also divided in 5 groups on the same pattern. The blood glucose and total lipid levels were estimated before and 1,2, 3 and 4 hours after the administration of the extract. The extract exerted a significant [P< 0.05] hypoglycemic effect in normal rabbits, which was however short lived. The hypoglycemic effect was not significant [P> 0.05] in alloxan treated rabbits. The extract had no significant effect [P> 0.05] on total lipid levels in normal as well as in alloxan-treated diabetic rabbits. The doses used did not show acute toxicity or result in behavioral changes. From this study it may be concluded that the extract acts by initiating the release of insulin by pancreatic beta cells of normal rabbits

Role of fine needle aspiration cytology in the diagnosis of focal liver lesions

Fine Needle Aspiration [FNAC] of focal liver lesions was carried out at Allama Iqbal Medical College / Jinnah Hospital, Lahore and author's lab. in 108 patients between January 2000 to August 2002 to evaluate the role of FNAC in diagnosis of focal liver lesions and to find out different patholigies which present as focal liver. Out of these 108 patients, most of them [87.96%] were above the age of 40 with male preponderance [55.55%]. Morphologically, malignant lesions were more common [74.08%] with hepatocellular carcinoma[HCC] as the most common malignancy [42.59%] followed by metastatic malignancies [23.15%], undifferentiated malignancies [5.55%] and Non-Hodgkin's Lymphoma in 3[2.78%] patients while in two patients [1.85%] only normal hepatocytes were aspirated. In 13 [12.04%] patients aspirates were inadequate for any morphological evaluation. It is concluded that FNAC is a useful technique in evaluating the liver masses. However there are some difficulties which can be overcome by more experience in aspiration and better coordination between radiologist, pathologist and clinicians

Adult albino rats; study of motor units innervated by tibial nerve

The average number and size of motor units were assessed by investigating the components of motor units supplied by Tibial Nerve in adult albino rats. The motor neurons forming the Tibial Nerve localized by HRP technique extended from the caudal part of L3 to S 1 segments of the spinal cord. The motoneurons forming the Tibial Nerve [TN] which are distributed mainly in the Posterolateral and Post-Posterolateral groups with few of them are also distributed in the central groups. The average somal diameter of motoneurons ranged between 12 and 63 m. The motor end-plates on skeletal myofibers of muscles supplied by Tibial Nerve were localized by using bromo-indigo and urea-silver technique. The total of 826 motor units with the size of 137 of the muscles innervated by Tibial Nerve have been observed in the present study

Pressure necrosis of articular cartilage; types of connective tissue fibers involved in its repair

OBJECTIVE: The hypothesis that was evolved in the present study was to investigate the repair of damaged articular cartilage by connective tissue fibers other than collagen fibers. Setting: Anatomy Department. Period: Seven Weeks. At the end of sixth week of immobilization reticular fibers were seen invading the collagenous scar in the floor of ulcer. The obtained result indicates that it is not only the collagen fibers, which fill the gap, but reticular fibers are also involved in the repair of articular cartilage by fibrosis

Effect of Allium Cepa on blood Glucose levels of normal and Alloxan treated Diabetic rabbits

The aquous solution of dried powder of the Allium cepa was administered in doses of 100, 150 and 200 mg/kg body weight to normal and alloxan treated diabetic rabbits. The blood glucose levels were estimated before and 2,4,6 and 8 hours after the administration of the solution. The solution exerted a significant [P< 0.05] hypoglycaemic effect in both normal and diabetic rabbits. In normal rabbits, oral administration of 150 and 200 mg/kg doses caused decrease in blood glucose levels at 2,4,6 and 8 hours, while maximum decrease was at 6 hours. In the alloxan treated diabetic rabbits, 200 mg/kg dose only could produce significant decrease at 4,6 and 8 hours while maximum decrease was at 6 hours. The doses used did not show acute toxicity or behavioral changes. It may be concluded that the plant contains one or more hypolglycaemic principles which can reduce the blood glucose in normal rabbits and in those with alloxan induced diabetes

Pharmacological screening of some indigenous plants for anti-diabetic activity

This study deals with the effects of alcoholic extracts of seven indigenous plants on blood glucose levels of normal and alloxan-diabetic rabbits. The blood glucose levels were estimated before and 2,4,6 and 8 hours after the administration of a single 500 mg / kg oral dose. The extracts of six plants had no significant [P> 0.1] hypoglycaemic effect in normal as well as alloxan-diabetic rabbits. The extract of one plant i.e. Momordica Charantia, however, exerted a significant [P < 0.05] hypoglycaemic effect in both normal and alloxan diabetic rabbits. From this study this may be concluded that Momordica charantia can be effective in the control of diabetes mellitus

Anti-diabetic activity of indigenous plants

This study deals with the effects of alcoholic extracts of ten indigenous plants on blood glucose levels of normal and alloxan diabetic rabbits. The blood glucose levels were estimated before and 2, 4, 6 and 8 hours after the administration of a single oral dose [500mg/kg] of extract. The extracts of nine plants did not produce any significant hypoglycemic effect in normal or alloxan treated diabetic rabbits. However, the extract of one plant, Cuminum cyminum exerted a significant hypoglycemia effect [P < 0.05] in both normal and alloxan diabetic rabbits. From this study it may be concluded that Cuminum cyminum can be effective in the control of diabetes mellitus