Hair dye poisoning: "an early intervention"

The use of hair dye has been emerging worldwide however usage of Paraphenylenediamine [PPD] in making hair dye is generally restricted to underdeveloped and developing countries. In particular, prevalence of accidental and suicidal ingestion is more in low socioeconomic areas. The spectra of hair dye toxicity is wide, however, it presents more commonly with severe angioedema of face and neck leading to respiratory failure, rhabdomyolysis complicating into acute kidney injury, myocarditis and acute liver injury. Here we present a unique case of PPD poisoning in a young female presented with laryngeal edema and marked rhabdomyolysis. Preemptive shifting to Critical care unit and elective endotracheal intubation for air way patency obviated the need of tracheostomy and precluded its related complications. Moreover, aggressive intravenous hydration prevented from renal failure despite markedly raised Creatine phospho kinase [CPK] levels

Learning habits as factors influencing academic performance in medical students

The objectives of the study were multifaceted: first, to explore the various learning habits preferred by medical students; second, to examine the predictive association between various learning habits and academic performance, third, to examine the age-wise, gender-wise, and education level-wise [i.e. pre-clinical and clinical] differences on learning habits. The sample comprised of 361 medical students of King Saud bin Abdulaziz University for Health Sciences [KSA U-HS] with an age range of 17-28 years. The results indicated that most commonly used learning habit by medical students were motivation and metacognition and self-regulation. Further, learning habits of motivation, test taking anxiety and metacognition and self- regulation are seen as significant predictors of academic performance. Moreover, age-wise and education-level wise differences are evident only on metacognition and self- regulation whereas gender-wise differences are found on information processing learning habits. It is concluded that factors of learning habits can increase the students 'performance in the examination

Q192R paraoxonase1 polymorphism is a risk factor for cataract in Pakistani population

Cataract, the lens opacity, is among major causes of blindness in Pakistani population. In recent past, oxidative stress is suggested to play crucial role in loss of transparency. Along with other antioxidants, Paraoxonase 1 [PON1] has also shown decreased activity in patients suffering from cataract. The aim of current study was to examine the possible association of PON polymorphism with predisposition of cataract formation in local population. The study was conducted on 51 cataract patients and 50 control subjects considering all ethical issues. DNA was extracted from whole blood and PON1 polymorphism was identified using tetra primer ARMS-PCR method for both positions L55M and Q192R. Tetra primer ARMS-PCR results revealed that association between L55M polymorphism and cataract was insignificant while 192R genotype PON1 frequency was higher among the people suffering from cataract [78.4%] as compared to control subjects [56%], [odds ratio=2.857, confidence interval=1.197-6.820]. Hence, R allele is likely to be a risk factor for cataract with allele frequency [82.3%] and [odds ratio=4.552, confidence interval=1.716-12.073, p-value=0.002]. PON1 Q192R polymorphism is likely to be a risk factor for cataract development in Pakistani population while PON1 L55M was not found to be associated with cataract

Effect of Tamsulosin on stent related symptoms; a prospective study

Introduction: Cystoscopic intraluminal placement of ureteral stents has become a routine practice in urology. Ureteral stents preserve urine flow from the kidney to the bladder in cases of ureteral obstruction [intrinsic or extrinsic]. In patients with obvious ureteral obstruction, the placement of a ureteral stent will restart urine transport and protect the kidney from possible risks. Ureteral stents are troublesome in some patients and causes LUTS. Study Design: Prospective randomized controlled trial. Setting: Urology Department, Sheikh Zayed Hospital Lahore. Period: Six month started from August 2015 to December 2015

Material and Methods: 100 patients who were randomly divided into two equal groups. The patients were between 18 to 50 years of age of both gender undergo retrograde double-J ureteral stent placement. Before the double-J stent will be applied, all patients completed an International Prostate Symptom Score [IPSS] questionnaire for evaluation of lower urinary tract symptoms. Patients were divided in two groups on the basis of lottery method tamsolusin group [1] and placebo group [2]. Tamsulosin group patients was given tamsulosin post operatively and placebo group was given a placebo postoperatively

Results: There were total 100 patients who were enrolled in this study with a mean age of 42.63 +/- 6.24. There were 75[75%] were male while 25[25%] were female. The mean IPSS sore at presentation was 2.47 +/- 1.43 and post treatment was 5.20 +/- 1.65. There was significant difference in IPSS score in control group with mean 5.28 +/- 1.69 versus study as mean 2.22 +/- 1.05 group, p-value= 0.010

Conclusion: There is difference in lowering of IPSS score in the patients who are given tamsolusin versus those who were retained on placebo

Cardiovascular risk score in Rheumatoid Arthritis

Objective: To determine the 10-year Cardiovascular risk score with QRISK-2 and Framingham risk calculators in Rheumatoid Arthritis and Non Rheumatoid Arthritis subjects and asses the usefulness of QRISK-2 and Framingham calculators in both groups

Methods: During the study 106 RA and 106 Non RA patients age and sex matched participants were enrolled from outpatient department. Demographic data and questions regarding other study parameters were noted. After 14 hours of fasting 5 ml of venous blood was drawn for Cholesterol and HDL levels, laboratory tests were performed on COBAS c III [ROCHE]. QRISK-2 and Framingham risk calculators were used to get individual 10-year CVD risk score

Results: In this study the mean age of RA group was [45.1 +/- 9.5] for Non RA group [43.7 +/- 8.2], with female gender as common. The mean predicted 10-year score with QRISK-2 calculator in RA group [14.2 +/- 17.1%] and Non RA group was [13.2 +/- 19.0%] with [p-value 0.122]. The 10-year score with Framingham risk score in RA group was [12.9 +/- 10.4%] and Non RA group was [8.9 +/- 8.7%] with [p-value 0.001]. In RA group QRISK-2 [24.5%] and FRS [31.1%] cases with predicted score were in higher risk category. The maximum agreement scores between both calculators was observed in both groups [Kappa=0.618 RA Group; Kappa=0.671 Non RA Group]

Conclusion: QRISK-2 calculator is more appropriate as it takes RA, ethnicity, CKD, and Atrial fibrillation as factors in risk assessment score

Single centre experience of transperitoneal radical tumour nephrectomy

Objective: To share the experience of radical nephrectomy through transperitoneal approach

Material and methods: After approval from ethical committee and the consent from patients a retrospective study vas conducted extending from January 2012 to January 2014 to identify clinical characteristics of renal ell carcinomas, staging, per operative and early post operative complications. The study included all renal cancer patients presented to Sheikh Zayed Hospital Lahore with in this specified period. Detailed history nd physical examination was performed. Haematological and radiological investigations including ibdominopelvic ultrasonography and CT scan abdomen and pelvis were performed to stage the renal umour. High resolution CT chest was performed where indicated. Radical nephrectomy performed hrough transabdominal approach and outcomes measured in terms of per-operative and early postoperative complications

Results: There were total of 50 cases. The male to female ratio was 3:2. Vlean age of patients was 52.38 [18-93] years. Most common clinical presentation was gross haematuria [66%]. The mean tumour size was 8.34 [3-24] cm. Operative findings were suggestive of tumor limited to Gerota's fascia in 40 patients [80%] and in 6 [12%] tumor was extending into renal vein or inferior vena cava. In these cases, venacavatomy had to be performed. Lymphadenectomy was performed in 2 patients [4%] who were having enlarged hilar lymph nodes. Total operative time ranged between 120 to 180 minutes. Intra-operative splenic injury was seen in 2 [4%], while aortic injury was observed in one [2%] patient. Post operatively one [2%] developed pulmonary embolism, 2 [4%] chest infection while 2 [4%] developed wound infection and 3 patients [6%] required blood transfusion. Tumour histology was clear cell in [84%], papillary transitional cell carcinoma [12%] and oncosytoma contributed 4%

Conclusion: We observed that large number of the patients presented with haematuria and most of them were male. Radical nephrectomy along-with removal of tumour thrombus is a valuable method for the treatment of renal cell carcinoma having tumour thrombus either in renal vein or inferior vena cava. Common pathological type was clear cell carcinoma

Relation of serum cotinine with passive smoking

Background: Cotinine is a major metabolite of nicotine and retains for a substantial time in different body fluids. It is considered as a passive smoke exposure marker. Studies on different biochemical markers of tobacco smoke exposure are lacking in Pakistan and serum continine levels in nonsmokers provide a comprehensive measure of passive smoking from all sources in the last two to three days

Objective: To compare the frequency of serum cotinine detection in smokers, passive smokers and never smokers

Methods: Serum cotinine was analyzed on 135 self reported smokers, never smokers and passive smokers by 17-A gas chromatograph with flame ionization detector [FID] equipped with Supelco SPB-5 fused silica capillary column attached with Class GC 10 Software. Association between the qualitative variables [cotinine present/absent] between groups [smoker, never smoker and passive smoker] was taken out using Pearson chi-square test. The mean difference for serum cotinine between the groups [smoker, never smoker and passive smoker] was evaluated by using kruskal wallis test. P-value less than 0.05 was taken as significant

Results: Serum cotinine was detectable in 72.1% of passive smokers which was a significantly higher proportion than smokers and never smokers [p< 0.001]

Conclusion: Cotinine was detectable in the serum of smokers and passive smokers. Passive smoking may contribute to increased serum cotinine levels. Large sample size may be required to establish it as a marker for environmental tobacco smoke exposure marker and for validation of smoking status

First degree hemorrhoids; efficacy of injection sclerotherapy experience in surgical department

Traditionally the treatment of Ist, 2nd and 3rd degree haemorrhoids is conservative management with fibre rich diet and better defecation discipline. If symptoms prevail then there are a wide range of treatment modalities. To evaluate the efficacy of injection Sclerotherapy for First degree haemorrhoids using 5% Phenol in Almond oil. This case series study was conducted on 83 patients with first degree piles in Surgical-C unit, Department of Surgery, Khyber Teaching Hospital Peshawar from 01/09/2010 till 01/03/2011. After Informed consent, injection Sclerotherapy with 1-2ml of 5% Phenol in Almond oil was injected in the sub mucosal plane of each pile case above the dentate line. Patients were reviewed at 3 weeks interval for bleeding per rectum for effectiveness of the procedure. A total of 83 patients with first degree haemorrhoids included in the study out of which 62 [74.7%] were male and 21 [25.03%] were female with M: F=2.99:1. Average age 41.1 years+0.1 SD with range 20-60 years. Efficacy was observed in 68 [81.83%] patients where 15 [18.07%] patients showed no results. Injection sclerotherapy is simple, convenient and effective outdoor procedure for first degree haemorrhoids

Effect of drugs; baehavior of mice measured by modified hole board head-dipping exploratory test parameter

The aim of this study was to determine head-dipping exploratory test parameter as a measure of strong modulating effect on brain and behavior. It was an observational animal study. University of Karachi. Period: Jan 2004 to July 2006. In this present study, drugs used reserpine, nux- vomica; anacardium and chlorpromazine were wide range of pharmacological actions. We evaluate the effectiveness of these drugs as agents with modulating effect on brain and behavior accessed by head dipping parameter. In this study, 25 mice were included belonging to both sexes. The study animals were divided into five groups of five animals each. Four groups were given drugs and one group was kept as control. Mice [20-35g] of either sex were used in this study. One group was kept as control for drugs. Mice were kept under room temperature. Tap-water was allowed ad-Lihitum.30 minutes after giving drugs, animals were observed for 10 minutes with two minutes of interval. Tablet crushed in 10ml of water, 1 cc was given. Screening method used was head dipping. Strychnos Nux-Vomica when used in a dose of 0.07mg has strong action on cholinergic system, CNS activity and frequent head dipping [39.8 +/- 28.8] was observed. Rauwolfia serpentine is an active alkaloid particularly present in reserpine [62.2 +/- 43.4] no significant head dipping effect was observed. Anacardium [37.2 +/- 28.6] and Chlorpromazine [39.4 +/- 32.4], show decrease effects. Keeping in view, the medicinal importance of these herbs, our present study was designed to screen these drugs for CNS activity on albino mice

Frequency of wound infection in clean orthopaedic surgery using single dose antibiotic prophylaxis

Wound infection is the disastrous complication after clean orthopaedic surgery. Role of prophylactic single dose parenteral antibiotic is still controversial in prevention of this morbidity. Frequency of wound infection in patients underwent open reduction and internal fixation of long bone clean orthopaedic fracture using single dose antibiotic prophylaxis. case series study. This study was conducted at the Department of Orthopaedic Unit 1, Civil Hospital, Karachi from 11[th] August 2010 to 10[th] February 2011. A total of 231 patients having long bone clean orthopaedic fracture were selected. Patients diagnosed as clean orthopaedic cases and determination of fractures on X-ray with intact skin over fractures were included in the study. Patients with open fracture having co-morbidities already on antibiotics were excluded from the study. Open reduction and internal fixation was carried out using single prophylactic dose of injection cepharadine [2 grams]. Wound infection was assess on 5[th] postoperative day according to Southampton wound grading system. There were 191 males and 40 females with mean age 36.70 years. Out of 231 patients, 213 had no infection while 18 cases had wound infection on 5[th] postoperative day. The use of single dose prophylactic antibiotic prophylaxis is effective in preventing wound infection after management of clean long bones orthop

Clinical and radiological behaviour of sporadic odontogenic keratocyst: a study

Odontogenic Keratocyst [OKC] is the most aggressive of the jaw cysts because of their greater tendency to recur. They are relatively common developmental cysts of the jaws. The present study [A descriptive case series] is about the clinical, features i.e. age, sex, site distribution and radiological features of sporadic odontogenic keratocyst. The present study was performed on 30 biopsy confirmed > cases over a period of 5 years. This cystic lesion is common in males [63%] as compared to females [37%]. The most common age group is the third [36.6%] and second decade [30%] of life, the most common site according to the present study was the posterior mandible i.e., the body and ramus of the mandible [40%], followed by the anterior mandible crossing the midline [20%] Anterior and posterior maxilla is not frequently involved by this cyst. Only in 9.9% of the cases the upper jaw was involved. Swelling has been the most common chief complaint i.e. [61. 702%]. In 16. 6% of patients, Odontogenic keratocyst was a chance radiographic finding. Radiologically most of the cysts were multilocular radiolucencies [83%]

Bilirubin Pigments in the first Meconium of newborn infants

To determine the pattern of excretion of total bilirubin IXa and IXb in the first meconium of newborn infants. First two newborns of varying gestational age were selected every week through random sampling from the neonatal unit. Of the 41 newborn infants selected 8 expired before meconium passage, hence the results are from 33 newborns. Meconium was collected and stored at -20°C, protected by aluminium foil. Samples were defrosted, vortex mixed with equal amount of dimethyl-sulfoxide, centrifuged, and analyzed by HPLC. Unconjugated Bilirubin-IXa and -IXb were identified and quantitative estimation of Bilirubin-IXa done. Bilirubin-IXb was greater than 50% of the total, in the first meconium of the newborn. Amount of bilirubin excreted in meconium was 29.2 - 90.8 mg [0.051 - 0.155 mmol] per sample of meconium passed. Amount was 9.7 mg/ Kg of body weight in term newborn and 12 mg / kg in preterm.The amount of bilirubin -IXb decreases and bilirubin-IXa increases with increasing gestational age. Newborns with birth asphyxia [BA] had significantly greater quantity of bilirubin in meconium, compared to infants without BA [JPMA 55:188;2005].

Late in-stent restenosis in a patient with drug-eluting stent

Drug coated stents have reduced the incidence of in-stent restenosis with coronary intervention. whether this effect is long lasting or just delaying the process is not clear. We report here a case of late in-stent restenosis with Raoamycin drug eluting stent.

Spontaneous multivessel coronary artery dissection associated with elevated homocysteine levels

A case of spontaneous multi-vessel coronary artery dissection in a young man, with markedly elevated serum homocysteine levels, is reported. The effects of elevated homocysteine levels on arterial endothelial function and possible plaque rupture leading to coronary dissection and acute coronary syndrome and / or sudden cardiac death are also discussed

Clinical and echocardiographic characteristics of patients with significant pericardial effusion requiring pericardiocentesis

Clinical and echocardiographic features of significant pericardial effusion [PE] have been reported from the west. Currently there is lack of published data from this part of the world, we reviewed all consecutive cases of significant PE requiring echocardiographic assisted pericardiocentesis to analyze the clinical and echocardiographic features of these patients. Forty four consecutive patients who underwent echocardiography assisted pericardiocentesis at the Aga Khan University Hospital [AKUH] between January 1988 and May 2001 are included in this review. Most common presenting symptoms were dyspnea [89%] and fever [36%]. Elevated JVP and pulsus paradoxus were documented in 59% and 41% of patients respectively. Sinus tachycardia [75%] and low voltage [34%] were the most common ECG findings. Malignancy [45-51%] and tuberculosis [27%] were among the most frequent causes of PE. One patient died during echocardiography-assisted pericardiocentesis. Majority of the pregnant females delivering at Aga Khan University Hospital were aware of epidural analgesia for labour. However, only a small proportion are availing this service, due to fears and misconceptions [JPMA 55:63;2005]. The symptoms and physical findings of haemodynamically significant PE are frequently nonspecific. Transthoracic echocardiography is the gold standard for rapid and confirmatory diagnosis of PE and cardiac tamponade. The most common cause of PE was malignancy followed by tuberculosis. Pericardiocentesis under echocardiographic guidance is a safe and effective treatment for significant PE

Acute myocardial infarction in a young patient

Myocardial infarction [MI] is considered to be the disease of the fifth and sixth decade as seen in the West but an earlier age incidence is not infrequently encountered in the South Asian population. However, occurrence of MI in the teen-age still remains a rare happening. We are reporting a case of a teenager, who suffered a myocardial infarction with cardiogenic shock and pulmonary edema on two separate occasions with ECG and biochemical evidence of myocardial infarction. An exercise stress test done in between the two episodes was negative at a workload of 13.5 METs. A coronary angiogram done after the second event revealed normal coronary arteries and a preserved left ventricular systolic and segmental function. Except for low HDL [high density lipoprotein] and mildly raised homocysteine levels, the patient did not have other conventional or novel risk factors for coronary artery disease

Problems created by conesetters and their management

A retrospective study was carried out in the Orthopaedic Unit of Peoples Medical College, Nawabshah to analyse the incidence and complications created by bonesetters and their management. Out of 744 patients analysed, 213 [28%] were admitted after treatment by bonesetters, females being predominant. The cases treated included 101[57%] simple fractures and 11[6%] compound fractures. Commonest complication seen was gross distal swelling [32%] among traumatic patients and chronic osteomyelitis [43%] among nontraumatic patients. It is concluded that the incidence of cases treated by bonesetters in the rural areas of Sindh is quite high