Efficacy and accuracy of focused assessment sonography for trauma [FAST] in management of isolated gastrointestinal injury due to blunt abdominal trauma

Objective: To determine the diagnostic accuracy of Focused Assessment Sonography for Trauma [FAST] in patients having isolated gastrointestinal injury due to blunt abdominal trauma

Study design, settings and duration: Prospective, interventional study was done in department of General Surgery and Diagnostic Radiology, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana from July 2012 to June 2014

Materials and Methods: All patients who came with blunt abdominal trauma underwent emergency ultrasound with FAST technique to detect free fluid/ collection in abdominal cavity as an indicator of intra-abdominal organ injury. After ultrasound examination, most patients underwent surgical laparotomy to identify the gut and solid organ injury and were managed accordingly. The surgical findings were compared with ultrasound findings to see the correlation

Results: A total of 317 patients with blunt abdominal trauma underwent emergency US with FAST technique. Out of these, 296 [93.37%] underwent exploratory laparotomy. During surgery, 52 [17.56%] patients had evidence of bowel injury with 38 [12.83%] having solid organ injury plus bowel injury and 14 [4.72%] having only bowel injury. Amongst them, FAST ultrasound showed free fluid/ collection in 28 [53.8%] patients [true positive] while it was negative in 24 [46.15%] patients [false negative]. Among these, 24 patients with negative FAST, 15 [62.5%] had both solid organ injury plus bowel injury and 09 [37.5%] had only bowel injury [False negative]

Conclusion: FAST ultrasound missed 46% bowel injury with or without other solid organ injury and is therefore not reliable in diagnostic tool for assessing isolated bowel injury due to blunt abdominal trauma

In vitro antioxidant and hepatoprotective activities of Paeonia emodi [Wall] rhizome methanol extract and its phenolic compounds rich fractions

The present study aimed to quantify the total phenolic content in Paeonia emodi rhizome methanol extract and its fractions and then evaluate the in vitro antioxidant and hepatoprotective activities of fractions rich in phenolic compounds. Maximum quantity of total phenolic content was observed in butanol [112.08 +/- 5.5 mg GAE/g dw] and chloroform fraction [107.0 +/- 3.5 mg GAE/g dw] followed by methanol extract [94.2 +/- 4.4 mg GAE/g dw], aqueous fraction [92.9 +/- 2.5 mg GAE/g dw], ethyl acetate [62.3 +/- 8.3 mg GAE/g dw] and n-hexane fraction [51.6 +/- 7.2 mg GAE/g dw]. The fractions rich in total phenolic content were evaluated for in vitro antioxidant activity based on 2, 2-diphenyl-1-picrylhydrazyl [DPPH] scavenging assay. The butanol and chloroform fraction showed significantly [P<0.05] higher radical scavenging activity with IC50 values of 6.5 and 7.05 +/- 2.5 ppm respectively. Positive correlation [R square=0.95] was observed between total phenolic content and in vitro antioxidant activity. The fractions rich in phenolic compounds were also evaluated for their hepatoprotective activity in paracetamol intoxicated mice. Five days oral administration of these fractions at a dose of 300 mg/kg body weight restored the serum ALT, AST and ALP levels of paracetamol intoxicated mice to normal level. From the results of the present research it was concluded that the butanol and chloroform fractions of P. emodi rhizome methanol extract are rich in phenolic compounds and strong antioxidant and effective in attenuation of hepatotoxicity

Corrigendum: Prevalence of Depression and Glucose Abnormality in an Urbanizing Rural Population of Bangladesh

The chronology of the authors can be changed like: Khurshid Natasha, Bishwajit Bhowmik, A. K. Azad Khan, Akhtar Hussain.

Assessment of antiphospholipid antibodies in women with recurrent miscarriage at GMMMC, Sukkur

Objective: To determine and analysis of Antiphospholipid Antibodies in women with RecurrentMiscarriage belongs to District Sukkur

Study Design:Cross-sectionals study

Place and Duration of Study: This study was conducted in the Ghulam Muhammad Mahar Medical College, Sukkur and women attending local health clinics enrolled in this study after taking their informed consent fromMay, 2012 to August2013

Materials and Methods: In this study 205 patients were taken. Patient's whole blood was collected by disposable syringes through vein puncture technique from cubital vein and maximum of 10 ml blood was taken. An aliquot of this blood [4 ml] was transferred in the EDTA containing tube. Immediately after collection plasma was separated and stored at -40 °C for the measurement of plasma Anti phospholipid and anticardiolipin antibodies level. 5 ml blood was drawn in plain tube and allowed to clot, and then serum was separated and used for blood cholesterol, HDL, LDL and Plasma lipid concentration

Results: In the current research of district Sukkur showed the highest frequency in age group of 26 to 35 years [Table 140]. In physical parameters, BMI, calories intake and maternal history of RM of patients and control subjects showed significant [p<0.05] difference. In present study the assessment of antiphospholipids antibodies [aPL] 1.95 % which were significantly different [p<0.05] than controls. Results of anticardiolipin antibodies [aCL] showed 2.43 % prevalence in patients with recurrentmiscarriage

Conclusion: The present study indicated that antiphospholipid antibodies and anticardiolipin antibodies were found an indipanded risk for recurrent miscarriage in population of Sukkur

Response: Prevalence of Depression and Glucose Abnormality in an Urbanizing Rural Population of Bangladesh (Diabetes Metab J 2015;39:218-29)

No abstract available.

Corrigendum: Increasing Prevalence of Type 2 Diabetes in a Rural Bangladeshi Population: A Population Based Study for 10 Years

The statement that the protocol was approved by the Norwegian Ethical Committee is incorrect.

Prevalence of Depression and Glucose Abnormality in an Urbanizing Rural Population of Bangladesh

BACKGROUND: Depression and glucose abnormality are increasing in Bangladesh including its rural area. This study was designed to determine the prevalence of depression in an urbanizing rural population of Bangladesh with or without glucose abnormality (including diabetes mellitus [DM], and pre-diabetes which combines impaired fasting glucose and impaired glucose tolerance pre-DM). METHODS: A total of 2,293 subjects aged > or =20 years were investigated. Sociodemographic and anthropometric details, blood pressure, fasting (fasting plasma glucose) and 2 hours after 75 g plasma glucose (2-hour plasma glucose), were studied. Montgomery-Asberg Depression Rating Scale was used to assess depression. RESULTS: The overall prevalence of DM was 7.9% and pre-DM was 8.6%. Prevalence of depression was 15.31% (n=351; 95% confidence interval [CI], 1.59 to 1.36) with mean depressive score 17.62+/-3.49. Female were more likely to have depression (17.16%). The 22.35% of male and 29.46% of female with pre-DM and 26.58% male and 36.27% female with DM had depressive symptoms. There was no significant variation in the mean age of different groups (healthy, depressed and with glucose abnormality). Depression was significantly associated with age, marital status, occupation, high physical activity, and low body mass index. The odds ratio (OR) for depression was significantly increased in patients with glucose abnormality compared with those without pre-DM (OR, 2.49; 95% CI, 1.76 to 3.51; P<0.000) and DM (OR, 3.27; 95% CI, 2.33 to 4.60; P<0.000). CONCLUSION: Prevalence of depression found alarming in our study area though lesser than previous studies and it is significantly related to glucose abnormality. The study reveals that mental health should get more focused specially along with metabolic diseases.

Comparison of intrathecal isobaric ropivacaine with hyperbaric bupavicaine for spinal anaesthesia in lower limb surgeries

Background: Spinal anesthesia, is one of the commonly applied surgical anesthesia

Objective: This study was conducted to compare the efficiency and safety of intrathecal ropivacaine with intrathecal bupivacaine for spinal anesthesia in lower limb surgeries

Material and methods: Study Design: Quasi - experimental study. Place and Duration of Study: The study was carried out at. operation theatres of Combined Military Hospital Panoaqil Cantt from 1[st] December 2013 to 30[th] June 2014. Sixty patients of age between 20 to 60 years, males and females and American Society of Anaesthesiologist physical status or, planned for lower limb surgeries were included in the study. Selected patients were divided into two groups [Group A and Group B]. Group A [n = 30] received 3 ml of isobaric ropivacaine 5mg/ ml [15 mg] and Group B [n = 30] received 3 ml of hyperbaric bupivacaine 5mg/ ml [15 mg]. Sensory block was tested with pinprick and motor block was evaluated with Bromage scale until full recovery. The primary end point was to compare the duration of sensory and motor block

Results: Both the groups were demographically similar. Onset of sensory block at T1 [p<0.05] and the median time of onset of sensory block at T10 [p<0.05] was statistically significantly different. The time taken to achieve maximum motor blockade [group A 9.073 +/- 1.075 min, group B 5.540 +/- 0.760 min] was delayed with group A compared to group B [p<0.05]. The mean duration of analgesia [p<0.05] and the mean duration of motor blockade [p<0.05] was less in Group A as compare to Group B. Return of Bromage to zero [p<0.05] was faster in Group A as compared to group B and was statistically significant

Conclusion: Isobaric ropivacaine 0.5% [study group A] provided lesser grade of motor blockade and shorter duration of both sensory and motor blockade, for short duration lower limb surgeries where prolonged motor blockade is quite undesirable and early mobilization can be planned

Prevalence and severity of temporomandibular disorders [TMD] in undergraduate medical students using Fonseca's questionnaire

Objective was to assess the prevalence and severity of TMD in undergraduate medical students. It was a cross sectional descriptive study based on Fonseca's Questionnaire. It was conducted in four medical disciplines [Dentistry, Medicine, Pharmacy and Physical therapy] of The University of Faisalabad. All study participants were full time students and were females. Self-reported questionnaire was distributed among students and they were given detailed explanation to fill it. After collection of forms, scoring was done according to given standard method and data was entered in SPSS and statistical test of Chi-squared was applied. One hundred and thirty seven [137] students were enrolled and completed questionnaire of the study. 11[7.9%] students were observed with No TMD, 62[44.3%] with mild TMD, 62[44.3%] with moderate TMD and 5[3.6%] students with severe TMD [Fig 1]. Difference among age groups was significant [p?0.047] for three questions [Q2, Q, 5, Q10] There was no statistically significant difference regarding prevalence of TMD among all four disciplines of students. Regarding severity of TMD, it was observed that MBBS students were more in category of severe TMD as compared to other disciplines. It was concluded that the mean level of stress and TMD is almost equivalent in different disciplines of professional education with a variation in its level of severity which is 2 times more in MBBS students as compared to other students. There was no significant difference regarding prevalence of TMD in four groups of study

Prevalence and associated risk factors for syphilis in women with recurrent miscarriages

A Cross Sectional population based serological studies was conducted to determine the prevalence and associated risk factors for syphilis women with recurrent miscarriages. Patient's 5ml whole blood was collected through venepuncture technique. Data were collected by all women answered a questionnaire and by investigating blood sample VDRL test and FTA-ABS test. The study was conducted in a confidential manner and numbers were used to identify the participant. Total 256 women were included in the present study. Mean age of women was 29.4 years while range was 21 to 38 years [206/256]. Out of the 256 samples, 05 [1.9%] were positive for active syphilis. Majority belonged to low socioeconomic group, uneducated and had previous congenital anomaly. Active infection with Treponema pallidum [T.P] in women belonging to low socioeconomic level were disquieting. This is probably due to illiteracy and high proportion of unsafe sexual behavior. It is also suggestive that seropositive status is often discovered in routine serological studies during pregnancy

Analysis of syphilis and associated risk factors in pregnant women belongs to remote areas of sukkur

To determine and analysis of Syphilis and Associated Risk Factors in Pregnant Women Belongs to Remote Areas of Sukkur. Cross sectional study. This study was conducted on women belongs to peripheral areas of sukkur over a period of fifteen months, which beginning in May, 2012. Patient's 5ml whole blood was collected through venepuncture technique. Data were collected by all women answered a questionnaire and by investigating Blood Sample VDRL test and FTA-ABS test. The study was conducted in a confidential manner and numbers were used to identify the participant. Total 200 Pregnant women were included in the present study. Mean age of women was 25.4 years while range was 18 to 39 years. Out of the 200 samples, 6 [3.0%] were positive for active syphilis. Majority was belonging to low socioeconomic group of population. Active syphilis infection in pregnant women belongs to remote areas with low socioeconomic level were significantly disquieting. Alarming results of this study suggestive that seropositive status is often discovered in routine serological studies during pregnancy at health centers and efficient prolonged treatment of mother were available

Study to estimate the prevalence of malaria infection in Sukkur

The aim of the study to estimate the prevalence of malaria amongst the population with fever or history of fever at sukkur. Cross sectional study. This study conducted at laboratory Ghulam Mohammad Mahar Medical College Hospital Sukkur from January 2011 to December 2012. Total 1746 clinical suspected case of malaria were included in the study. Patients presenting with fever were screened, thick and thin blood films prepared on microscopic glass slide, stained with 5% Giemsa's stain. There were 344 cases below 11 years, 590 cases between 11 to 20 years.812 cases above 20 years. They were 960 males and 786 females, with male to female ratio 1.2:1 .The prevalence of plasmodium slide positivity was 7.9% [138/1746]. Among plasmodium slide positive, 60.5% [83/138] were positive for P.vivax and 39.5% [55/138] were positive for P. falciparum. Identification of malaria cases in early acute phase of disease is significant for proper curative treatment. Anti mosquito eradication measures should be taken for breeding places of vector with personal protection measures and awareness program for malaria should be initiated

Isolation of E-coli in UTI cases with malnutrition in children of distant rural area of Sukkur, Sindh

A cross-sectional study of isolation of Escherichia coli in urine culture of children and its correlation to childhood malnutrition induce microcytic hypochromic anaemia [I.D.A]. Cross Sectional Study. This study was carried out at the Biochemistry Department, GMMMC, Sukkur from 01.12.2011 to 31.05.2013. Study was carry out among the children under 05 [five] years of age. Number of children included in this study was 150. Structured questionnaire were use to obtain the required data. Laboratory investigation of blood, urine samples was performing by standard methods and anthropometric data also collected. The results showed that Escherichia coli positive children are 64.0%, 60.5% Childs has extremely low body weight, 43.6% shows stunting and 21.7% was wasting. This study showed that there is correlation between Urinary tract infection and malnutrition. So, energy yielding nutrients containing 8 - 10 essential amino acids, fates and minerals may be supplemented to less privileged patients of remote rural area of sukkur to enhance immune status

Unilateral pupillary dilatation following septoplasty: cause for concern?

We report and explain unilateral pupillary dilatation following routine septoplasty and trimming of inferior turbinates. The unilateral pupillary dilatation was caused by inadvertent instillation of sympathomimetic, [xylometazoline hydrochloride] in the eye during preparation for nasal surgery. The effect was short-lived and the patient made a full recovery. Unilateral pupillary dilatation after sinonasal surgery can be alarming due to the possibility of injury to the globe and intracranial haemorrhage but can also be explained by the mydriatic effect of the sympathomimetic nasal drops and sprays used to decongest the nose. Such possibility should be borne in mind and would help to explain and reduce the anxiety and avoid unnecessary investigations

Atrioventricular and interventricular groove and septal extension of right sinus of Valsalva aneurysm: a rare cause of complete heart block

A 26 years old male presented with vertigo and history of fall. The electrocardiogram revealed 2:1 second-degree heart block and later progression to complete heart block. Transthoracic echocardiography revealed aneurysm at the site of ascending aorta and computed tomographic scan showed an aneurysm of right sinsus of Valsalva extending into right atrioventricular and interventricular groove and causing complete heart block by compression on the conduction system. He also suffered from lymph node tuberculosis. This case report is unique because of rare presentation as complete heart block

Response: Increasing Prevalence of Type 2 Diabetes in a Rural Bangladeshi Population: A Population Based Study for 10 Years (Diabetes Metab J 2013;37:46-53)

No abstract available.

Increasing Prevalence of Type 2 Diabetes in a Rural Bangladeshi Population: A Population Based Study for 10 Years

BACKGROUND: To observe changes in the prevalence of type 2 diabetes mellitus (DM) and impaired fasting glucose (IFG) and its associated risk factors in a rural Bangladeshi population over a 10-year period. METHODS: Three cross-sectional studies were undertaken in a rural community (aged > or =20 years) in 1999, 2004, and 2009. Structured questionnaires including sociodemographic parameters, anthropometric measurements, blood pressure, and blood glucose values were recorded. DM and IFG were diagnosed using 1999 World Health Organization criteria. RESULTS: Age standardized prevalence of DM increased significantly (P<0.001) from 1999 to 2009 (2.3%, 6.8%, and 7.9% in 1999, 2004, and 2009, respectively). The prevalence of IFG increased significantly (P=0.011) from 4.6% to 5.8% between 1999 and 2004 but then decreased from 5.8% to 5.3% during 2004 to 2009. Significant linear trends were shown in both sexes for general and central obesity as indicated by body mass index, waist circumference, and waist hip ratio (WHR). Increasing age and systolic blood pressure were significant risk factors for DM in all three studies. WHR for males was also significantly associated with the risk of DM in all three studies. WHR for females was only significantly associated with DM in 2009. CONCLUSION: A significant rise in the prevalence of DM was observed in this population over 10 years. This increase was seen in both sexes, and in all age groups. A significant increase in the prevalence of the associated risk factors of general and central obesity was observed in both sexes.

Frequency of low serum magnesium level in diabetic and non-diabetic patients compared with other risk factors of cardiovascular diseases

To assess the frequency of serum magnesium level in heart failure patients with and without diabetes mellitus. Cross Sectional Study. This study was conducted at Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Centre [JPMC], Karachi, in collaboration of National Institute of Cardiovascular Diseases [NICVD] Karachi, from April 2003 to December 2003. A sample size of 45 was drawn through convenient sampling, between the age group of 35-65 years. Serum magnesium, glucose levels were estimated, using Kit method, data was analyzed on the SPSS 11 for statistical significance. Out of 45 cases of heart failure, 15 were diabetic with low level of serum magnesium [1.67mg/dl] as compared to 30 non-diabetics with significantly high level of serum magnesium [1.75mg/dl]. This study concluded, in heart failure patient with diabetes mellitus had low serum magnesium level and was at increased risk of complications related to magnesium

Prevalence of Type 2 Diabetes and Impaired Glucose Regulation with Associated Cardiometabolic Risk Factors and Depression in an Urbanizing Rural Community in Bangladesh: A Population-Based Cross-Sectional Study

BACKGROUND: To determine the prevalence of type 2 diabetes (T2DM) and impaired glucose regulation (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT]) in an urbanizing rural population of Bangladesh and associated cardiometabolic risk indicators and depression. METHODS: A total of 2,293 subjects aged > or =20 years in an urbanizing rural Bangladeshi community were investigated. Socio-demographic and anthropometric details, blood pressure, fasting plasma glucose (FPG), 2 hours after 75 g plasma glucose (2hPG), glycosylated hemoglobin, fasting serum insulin and lipid profiles were studied. Presence of depressive symptoms using Montogomery-Asberg Depression Rating Scale was also assessed. RESULTS: The prevalence of IFG, IGT, IFG+IGT, and T2DM were 3.4%, 4.0%, 1.2%, and 7.9%, respectively. The prevalence of T2DM and impaired glucose regulation differed between males and females, but, both increased with age in both sexes. FPG and 2hPG had positive correlation. Employing logistic regression, it was found that increased age, waist to hip ratio, systolic blood pressure, total cholesterol, triglycerides, and depression were independent risk indicators for diabetes. Both insulin resistance and beta-cell deficiency were significantly related for causation of diabetes. Among the study population, 26.2% had general obesity, 39.8% central obesity, 15.5% hypertension, 28.7% dyslipidemia, 17.6% family history of diabetes, and 15.3% had depression. Physical inactivity and smoking habits were significantly higher in male. CONCLUSION: Rising prevalence of diabetes and impaired glucose regulation in this urbanizing rural population exist as a significant but hidden public health problem. Depression and other cardiometabolic risk indicators including obesity, hypertension, and dyslipdemia were also prevalent in this population.

Amyloidosis of the nasopharynx: an unexpected cause of unilateral middle ear effusion

Amyloidosis is an idiopathic disease that is characterized by the extracellular deposition of fibrillar proteins. The disease can be categorized as primary or secondary where deposits occur in conjunction with chronic diseases such as rheumatoid arthritis or tuberculosis. The deposits can be localized or systemically distributed. It can mimic, and also be associated with underlying malignancy. Primary amyloidosis is a rare cause of a nasopharyngeal lesion, and less so of a secondary middle ear effusion. Its association with underlying chronic and malignant disease must not be over-looked if serious complications are to be avoided. It is, therefore, important to consider this as a differential diagnosis in such patients