Frequency of raised urinary trypsinogen-2 in acute pancreatitis

Objectives To determine the frequency of raised Urinary Trypsinogen-2 in diagnosed patients of acute pancreatitis

Methodology Settings Patients in emergency refer to General Surgery ward-3 Jinnah Post Graduate and Medical Centre Karachi. Duration Six months, started from 20-01-2012 to 19-07-2012. Study Design Cross sectional descriptive study. Subjects and Methods All cases of Acute Pancreatitis diagnosed by Upper Abdominal Pain, Raised Serum Amylase and/or Serum Lipase and Abdominal CT Scan findings, were included in the study. Urinary Trypsinogen-2 dipstick test was done. All patient related data including age, gender, sex and raised Urinary Trypsinogen-2 or normal, was recorded. Data analysis was done on SPSS version 10. Frequency and percentage was calculated for gender and raised trypsinogen-2. Age and gender wise stratification was done to see the effect of these variables on outcome

Results Mean age of the patients was 38.14 +/-7.42 years. The minimum age was 24 years, while the maximum age was 63 years. Raised urinary trypsinogen-2 level was present in 55 [65.5%] patients. Stratification of age group shows, that 40 [66.7%] patients in age group

Conclusion The frequency of raised Urinary Trypsinogen-2 in diagnosed patients of acute pancreatitis was found to be high

Comparative results of repair of ischemic mitral regurgitation [IMR]: conventional against trans-septal approach

Objective Ischemic mitral regurgitation is common and increases mortality, even when mild. [American Heart Association] AHA and European association have both stressed the need of mitral valve repair in patients with moderate or more regurgitation. The aim of this study was to compare the results with the conventional and right atrial trans-septal approach of mitral valve repair in Ischemic Mitral Regurgitation [IMR]

Methodology A total of 308 consecutive patients underwent mitral valve repair for IMR, between January 2012 and December 2013 at Tabba Heart Institute. Patients who had at least moderate mitral regurgitation or more mitral regurgitation underwent mitral regurgitation repair. The final decision of mitral valve repair was taken after the intra operative trans-esophageal echocardiography [TEE]

Result Total number of patients included in study was222, out of those 153 [69.9%] patients underwent conventional approach and 69 [31.1] patients underwent trans-septal approach. Total 88.2% patients got off bypass in normal sinus rhythm in conventional approach group, as compared to 82.1% in transseptal group. 11.8% and 17.9% patients got off by pass on pacing in conventional and transseptal approach respectively. 3 patients developed junctional rhythm and 5 patients developed complete heart block in post-operative period in trans-septal approach

Conclusion Right Atrial Trans-septal technique is a good alternative approach that can be used in relatively small atria. It not only provides an excellent exposure to the mitral valve, there also seems to be no associated rhythm disturbances encountered as well

Police encounters in Karachi - an autopsy based study

Background and Objective: A unique study conducted in Karachi with actual facts and figures based on autopsy findings of killings in Police encounters during last three years, also highlighting the number of killings which occurred during last three years along with age group, parts of body involved in such deaths along with areas of Karachi, so as to give an overall picture of these encounters. More over the root causes of these encounters, along with recommendations to improve the prevailing law and order situation in Karachi enabling people to per sue their daily routine without any fear or threat to life and property

Methods: The study is an autopsy based descriptive cross-sectional study conducted at Mortuaries at Civil hospital, Jinnah Postgraduate Medical Center and Abbasi-Shaheed Hospital of Karachi. The duration of study is based on three years, from 1st Jan 2011 to October 31st 2014. Records were gathered from the office of the Police Surgeon, Karachi and each post mortem report was scrutinized by the authors who are senior Forensic Experts themselves. All cases of police encounters that were brought for autopsy were included in the study while any case which was not autopsied was excluded. Aside from this custodial deaths have been excluded in the study

Results: Total number of encounter deaths autopsied during the period of study are 260, with 135[51.92%] autopsied at JPMC, 95[36.54%] at Abbasi Shaheed Hospital and 30[11.54%] at Civil Hospital Mortuary. Identity of deceased was known in 108 cases [41.54%] and 152[58.46%] remained unidentified. Majority of cases were between 25-30 years [n=135, 51.92%], next in order of frequency were 31-35 years [n=46, 17.69%] and least in 36 and above years [n=37, 14.23%]. On autopsy the pattern of frequency of body parts involved is ; bullet injuries in chest and abdomen in 110 cases [42.31%], only chest in 74 cases [28.46%], head in 17 cases [6.54%] and abdomen in 25 cases[9.62%].District wise Malir was venue of most of the encounter deaths 115[44.23%], followed by District South with 44 [16.92%] deaths, District East with 35[13.46]. A comparison between 2013 and 2014, showed that the frequency of Police encounters has increased from 19.23% i.e. from 50 deaths in 2013 to 57.69% i.e.150 deaths in 2014, up to October 31[st] 2014

Conclusion: The word life has not been defined in the Constitution of Islamic Republic of Pakistan, but it does not mean nor can it be restricted only to vegetative or animal life or mere existence from conception to death. Life includes all such amenities and facilities which a person born in a free country is entitled to enjoy with dignity, legally and constitutionally. So it is the duty of the state to provide safety to public. Although it is a good attempt to clean the city from notorious elements in the city of Karachi, but the main thing is that law enforcing agencies carry it without political discrimination and in cases of police encounters the action should be justified to rule out extra judicial killings. Speedy trial of those apprehended in courts of law and protection to witnesses will be of great help

Analysis of physiological [PAO[2], pulse and blood pressure] changes during modified ECT under general anaesthesia

To study the changes in physiological parameters ie PAO[2], pulse and blood pressure changes during ECT under GA. Quasi-experimental study. Department of Psychiatry and Department of Anaesthesiology, Combined Military Hospital Abbottabad from Sep 2009 to Feb 2010. A total of 50 patients with depression were given four separate ECT sessions each. All patients were anaesthetized using propofol 180-200 mg I/V and suxamethonium 50 mg ie 0.75-1 mg per kg I/V without atropine. They were stratified according to physiological changes including PAO[2], pulse and blood pressure at 1, 2 and 5 min after ECT. Oxygen saturation was measured using a pulse oximeter, which measures saturations in the range of 65-100%. Age range was 19-65 years; mean 46 years [SD +/- 13]. Mean diastolic BP before ECT was 84.72 that decreased post ECT ie 78.02 and 77.46 and 74.44 at interval of 1, 2 and 5 minute respectively. Post-ECT pulse and PAO[2] behaved similarly. Post ECT systolic BP decreased at land 5 minutes. Pulse rate decreased after ECT. ECT under propofol is one of the most effective and safe modality of treatment for psychiatric patients under the supervision of qualified psychiatrists and anaesthesiologists and it gives more stable hemodynamic changes

killing of women without weapon: 5 year medico-legal study of rape cases in Karachi

Background: Rape is amongst the most prevalent sexual assault against women in Pakistan.1i These bullets when fired damage the physical, psychological, social, and economical well being of the victim, culminating often into problems culminating in a myriad of social, psychological and medical problems

Objective: To analyze the various medico legal parameters and dimensions of alleged rape cases in metropolis of Karachi and present this analysis in relation to the demographic parameters of the alleged cases

Methods: A descriptive and cross sectional study on a total of 1210 cases of alleged sexual assault, that were reported from January 1, 2007 till December 31, 2011, at the three authorized medico legal centers of Karachi: Jinnah Post Graduate Medical Center, Abbasi Shaheed Hospital and Civil Hospital Karachi

Results: Amongst the total of 1210 cases, majority involved unmarried females [n=898; 74.21%], whereas married cases were 312[25.79%]. On an average 20% of the cases were reported per year [n=292], with peak incidence in 2011 when the percentage rose to 21.65%[n=262] and the minimum being at 17.27%[n=209] in year 2007. Most cases were reported 0-6th day post incident with the percentage being 35.70%.[n=432]. The cases in which examination was carried out between 1 week to 1 month after incident were 64.29%[n=778]. The negative cases came out to be 62.56%[n=757] and positive cases came out to be 37.43%[n=453], on the bases of clinical findings [i.e. tears local injuries] and laboratory investigations. Sexual assault is more common, in the age group of 15-20 years [n=586; 48.42%]

Conclusion: Rape as sexual assault is still a major concern in our region. Most of the cases reported were however not proved to be positive; Reasons being many, especially when the victim report their cases late or the nature of cases being such [as in rape after abduction] that relevant physical findings were rendered useless to provide evidence. There is a need to provide safeguards to such victims so that they may seek legal and medical attention sooner, and measures to provide social security to such sufferers so that their physical and mental health can be restored in due time

Nosocomial tracheobronchitis in mechanically ventilated patients: frequency, aetiology and outcomes

The aim of this study was to determine the frequency, etiology, microbiological sensitivity and outcomes of nosocomial tracheobronchitis [NTB] in mechanically ventilated patients admitted in surgical intensive care unit. A prospective observational study was conducted in the Surgical Intensive Care Unit [ICU], Department of Anaesthesiology, Civil Hospital Karachi from April 2009 to April 2010. All the patients on mechanical ventilator for more than 48 hours in the ICU were evaluated according to the criteria for the diagnosis of nosocomial tracheobronchitis [NTB]. Outcomes of the patients were measured in terms of development of nosocomial pneumonia after NTB, length of ICU stay, duration of mechanical ventilation and mortality in the ICU. Two hundred and eighteen patients were evaluated for this study. Nosocomial tracheobronchitis was diagnosed in 72 patients. The frequency of NTB was 33%. Sixteen types of organisms were identified, 61.23% cases were poly-microbial, while in the remaining 39.7% cases single organism was isolated. The most common organism was gram negative Acinetobacter spp [51%], followed by Klebsiella spp [29%] and Pseudomonas aeruginosa [16.6%]. Escherichia coli and other gram negative rods were 13.8 % and 11.4%, respectively. There were 4.16 % cases of MRSA isolated in patients who had positive cultures for gram negative organ-isms [poly-microbial]. Ceftriaxone was given in 44% cases as empirical therapy and continued in 33% cases after microbial sensitivity and replaced in 11% cases after culture sensitivity to Cefiperazone + salbactum and in 14% cases cefiperazone was given in combination therapy. Imipenem was used in 28.5% of patients. Quinolones were used in 19% contaminated cases of gut surgeries. Nosocomial tracheobronchitis was significantly associated with increased length of ICU stay and longer duration of mechanical ventilation in our patients when compared to those patients who did not develop NTB [p<0.001]. Moreover, out of 72 patients, 11 developed subsequent nosocomial pneumonia. There was no statistically significant difference noted in mortality rates among patients with NTB and without NTB [43% vs. 41%]. The mortality was related to concomitant comorbitidies, primary cause and surgical outcomes. Nosocomial tracheobronchitis is a common infection in mechanically ventilated patients that significantly affects the development of pneumonia and length of ICU stay for the patients. This study was an insight to the state of NTB in an ICU setup. The higher frequency of NTB demands such studies to set protocols in every intensive care unit

Two forgotten induction agents; etomidate versus thiopental sodium with rocuronium for rapid sequence induction

To assess the effect on intubating conditions and haemodynamic response on intubation of two different induction agents etomidate and thiopental sodium with rocuronium during rapid sequence induction. This prospective quasi experimentalstudy was conducted in Department Of Anaesthesia, SICU and Pain Management, Dow Medical College, Civil Hospital Karachi and Abbasi Shaheed Hospital Karachi Medical and Dental College over a period of one year. Total 120 American Society of Anaesthesiologists [ASA] physical class I and II, adult patients of either gender, aged between 18 to 60 years, undergoing elective surgery were allocated randomly into two equal groups to receive either intravenous thiopental sodium [Group NTR] or etomidate[Group NER] for rapid sequence induction. Group NER was given nalbuphine 0.1 mg/kg, induction agent etomidate 3 mg/kg with muscle relaxant rocuronium 1.0 mg/kg while in group NTR induction agent thiopental sodium was given in the dose of 4 mg/kg with nalbuphine and rocuronium in the same doses. After sixty seconds, laryngoscopy was done. Intubating condition was assessed using the criteria of Cooper and colleagues: ease of intubation, condition of vocal cords and response to intubation. Cardiovascular response on intubation in terms of systolic and diastolic blood pressure and heart rate was evaluated at 0,1, 3 and 5 minutes. Demographic data were comparable between the groups. Intubating conditions which were assessed in terms of ease of laryngoscopy, condition of vocal cords at intubation and intubation response coughing, bucking and diaphragmatic movement were significantly better in the group NER [p<0.05]. Similarly, arterial blood pressure remained close to base line in NER group but there was significant fall in both systolic and diastolic blood pressure in group NTR. However, there was no significant difference in change in the heart rate in the groups. Etomidate-rocuronium is better than thiopental-rocuronium in terms of intubating conditions and haemodynamic stability during rapid sequence induction in non-septic surgical patients in emergency department

Non-malignant lesions; clinico-pathological profile of nasal cavity and paranasal sinuses

The presence of a mass in the nasal cavity and paranasal sinuses may seem to be simple problem, but it is very difficult to differentiate clinically from potentially malignant tumors. To evaluate the clinical presentation and histopathological features of the non malignant lesions of nasal cavity and paranasal sinuses. Prospective descriptive study. Study was carried out in departments of Paediatrics and ENT at Ghulam Muhammad Mahar Medical College Hospital Sukkur from Jan 2009 to Dec 2012. The study included all cases of nonmalignant masses of nasal cavity and paranasal sinuses, those attended the Paediatric and ENT department and underwent the surgical intervention. One hundred twenty non-malignant cases were enrolled for this study. A separate pro-forma was filled to record the cases biodata, history, clinical examination, investigations and histopathological diagnosis. All histopathologically proven malignant masses were excluded from the study. Out of 120 cases 78 [65%] were males and 42 [35%] were females, with M:F ratio of 1.8:1. The age of presentation ranged from 8 years to 70 years and mean age was 26.3years. Sinonasal masses were found to be bilateral in 20 cases [16.67%], right sided in 65 [54.17%] and left sided in 35 [29.16%] cases. The main presenting symptoms were nasal blockage 110 [91.66%], nasal discharge 102 [85%], sneezing 60 [50%], hypoinsomnia 36 [30%], epistaxis 24 [20%], headache 20 [18.33%] and mouth breathing 18 [15%] cases. Polyp was the most common lesion in 86 [71.66%] cases observed in this study. The common histopathological diagnosis was simple inflammatory nasal polyp in 48 [40%], allergic nasal polyps 30 [25%] and fibroepithelial polyp in 8 [6.7%], inverted papilloma in 12 [10%], angiofibroma 6 [5%], capillary hemangioma 4 [3.34%] and rhinosporidiosis 4 [3.34%] cases. Sinonasal masses have various differential diagnoses and are still thought to be simple problem in our society. There is a need for early recognition and referral to ENT surgeon and need histopathological examination of every mass to confirm the diagnosis

Correction of facial asymmetry associated with unilateral hypoplastic mandible with monobloc distraction osteogenesis in adult

Facial asymmetrey can be corrected by bimaxillay orthognathic surgery and distraction osteogenesis. We report a case of facial asymmetry which was corrected using monobloc distraction osteogenesis. A monobloc was created using an osteosynthesis fixation device from the zygomatic buttress to the mandible, LeFort I osteotomy was combined with mandiular angle osteotomy and the bloc was distracted using uni-directional distractor

Intraoperative findings during canal wall down mastoidectomy in chronic suppurative otitis media at a tertiary care hospital, Sukkur, Pakistan

To assess the intraoperative findings during canal wall down mastoidectomy in patients for unsafe type of chronic suppurative otitis media [CSOM]. This prospective interventional study was carried out at Department of ENT and Pediatrics of Ghulam Muhammad Mahar Medical College Hospital, Sukkur, Pakistan from June 2009 to June 2011. Eighty patients who were 5-55 years of age, of both genders, with CSOM who underwent canal wall down mastoidectomy were included in the study. The operative findings like extent of cholesteatoma, granulation tissue in different location in middle ear cleft and ossicular chain condition and otogenic complication were identified. Females were affected more than males [n=48; 60%]. Granulation tissue was found in 50 [62.5%] of cases, while cholesteatoma in 30 [37.5%] cases. The extent of disease was attic in 4 [5%], attic and middle ear 30 [37.5%], attic and antrum 16 [20%] and attic, antrum and middle ear 30 [37%] patients. In majority of the cases there were involvement of more than one ossicle; among the most affected single ossicle malleus was found necrosed in 50 [62.5%], and absent in 6 [7.5%] cases, incus was found necrosed in 42 [52.5%], and stapes was found necrosed in 20 [25%] of cases. The primary disease found in our patients undergoing canal wall down mastoidectomy was granulation. Less common were cholesteatoma and multi-ossicular

Protective role of taurine on tomaxifen-induced liver damage in rats: a morphological study

To study the protective role of taurine in tamoxifen-induced hepatic steatosis in albino rats. Prospectve experimental study. Department of Anatomy, Khyber Medical College, Peshawar, from July 2011 to November 2011. Four groups of female albino rats, each containing 8 animals, were treated for 21 days as follows: Group A served control, Group B treated with tamoxifen, Group C treated with tamoxifen plus taurine, Group D treated with taurine alone. The animals were weighed at the start and end of treatment and then sacrificed under ether anaesthesia. The livers were fixed in 10% formalin and embedded in paraffin. H and E stained 4 micro thick sections were examined microscopically. There was significant decrease in the body weights of groups B and C as compared groups A and D. Significant increase in the body weights of group C rats in comparison with group B was noted. Histologically the livers of group B animals showed generalized microvesicular and macrovesicular steatosis, with no evidence of hepatocyte necrosis. In group C the fatty change was much less pronounced as compared to group B. The study data suggest that taurine supplementation can reverse / attenuate the hepatic steatosis caused by tamoxifen treatment for 21 days, in albino rats

Arterial blood pH low ph as predictor of prognosis

Arterial blood gas analysis is the most commonly performed investigation in intensive care unit[ICU] as the changes in acid-base balance are common in critically ill patients. Changes in pH are directly related to severity of disease. Keeping in view our clinical experience and literature search, we assume that patients whose pH is less than 7 at any time in the course of disease carries poor prognosis. Quasi experimental study. ICUs of Combined Military Hospital Rawalpindi and Combined Military Hospital Multan. From 1st Jan 2006 to 6th Aug 2007 and 7th Aug 2007 to 31st May 2010 respectively. All the patients having pH less than 7 at any time in the course of disease were considered and patient having otherwise fair state of health before recent insult were included. Moribund terminally ill patient were excluded. All the thirty patients needed intubation and ventilation except one who remained conscious despite having pH. 6.95. Twenty two patients [73.4%] died and eight patients [26.6%] survived. All patients who survived were diabetic except one having tracheal stenosis. All patients who died were non diabetic. Only one non diabetic patient was among the survivor. Survival among diabetic patient as group was 100%[7/7]. Patients having pH below 7 at any time in the course of disease carry poor prognosis especially if they are non diabetic. Diabetic has best prognosis. However it is a small study of thirty cases only, further multi centre studies are needed to demonstrate the co-relation of pH with prognosis prediction

Association of ABO blood groups with diabetes mellitus

So far no studies have been performed in Malaysia to look at association of diabetes mellitus [DM] with blood groups. We studied the association of ABO blood groups with DM type 2. It was a case control study conducted at Kepala Batas Hospital Batas, Penang, Malaysia in the year 2009, involving 70 patients with DM type 2 and 140 healthy controls. Ethical approval was obtained from Universiti Sains Malaysia. Blood samples were collected from the patients after consent. Samples were tested for ABO blood groups using ID-Card gel method. Chi-square test results showed that there was an association between the ABO blood groups and DM type 2. It was found that A and O blood groups were negatively associated with DM type 2 [P<0.05] with higher percentage of A and O groups individuals were non-diabetic. No significant association was noted between DM type 2 and blood groups B [P=0.423] and AB [P=0.095]. It was also noted that B blood group was distributed with highest percentage among patients with DM type 2 [53.71%] compared to controls [22.52%], but no statistical significance achieved. The results obtained suggest that there was a negative association between ABO blood groups A and O with DM type 2, with A and O group having less chances of diabetes. Large studies in other ethnic groups are needed to confirm these results

presentation of carcinoma of larynx at civil hospital Karachi

To determine the frequency of different presenting clinical features and the most common stage of presentation in patients of laryngeal carcinoma. Descriptive study. This study was conducted at ENT department, Dow University of Health Sciences and Civil Hospital Karachi, from April 2006 to March 2007. All the patients of biopsy proven laryngeal carcinoma of any age and sex were included in the study. Demographic data, presenting complain like change in voice, difficulty in breathing, difficulty in swallowing, pain, smoked and unsmoked tobacco use, clinical examination findings, DL findings, neck examination with respect to levels of lymph nodes involvement, presence or absence of metastasis recorded in performed proforma. Histopathological reports and findings of imaging studies like X-ray chest, CT scan, and ultrasound abdomen [if needed], stage of carcinoma larynx were also recorded on proforma. In this study out of 34 cases, 32 [94.1%] were males and only 2 [5.88%] were females. Mean age was 55.23 years [SD +/- 12.09]. Most common symptom was hoarseness in 32 [94.1%] cases, 27 [79.4%] presented at advanced stage [stage III and IV] while commonest site was glottic region 50%. This study concluded that the most common stage of laryngeal carcinoma patients in our setup was late stage and commonest presenting symptom was hoarseness while commonest site was glottic region

Pattern of encephaloceles: a case series

Encephalocele is the protrusion of the cranial contents beyond the normal confines of the skull through a defect in the calvarium and is far less common than spinal dysraphism. The exact world wide frequency is not known. A substantial proportion of children especially those born with a large encephaloceles are physically and intellectually disabled. Our objective of this descriptive case series was to determine the patterns and surgical outcomes in various types of encephalocele in our setting. The study was carried at Department of Neurosurgery, Liaquat University Hospital, Jamshoro, Sindh, Pakistan during year 2005 to 2007. Patients with encephalocele [occipital, Scincipital, parietal] admitted during year 2005 to 2007 were evaluated for their clinical features. Complete base line investigations were performed including ultrasound, CT scan and MRI of brain. Other congenital anomalies were also noted in record. Written consent was taken. Operative and postoperative records were maintained. Statistical analysis was done by SPSS method. 25 children with encephalocele were selected during the years 2005-2007. Out of these 19 [76%] were male and 6 [24%] female. Age range was 06 days to 2 years. Most common type of encephalocele was occipital 20 [80%]. All patients underwent surgery. Out of 25 only one patient was died. Postoperative follow up showed uneventful results. Most common type of encephalocele is occipital in our set up. Contents of the sac of encephaloceles are dysplastic brain tissue and there is no harm to sacrifice it

Xeroderma pigmentosa - squamous cell carcinoma lip

A 10 Years old female patient of xeroderma pigmentosa [XP] presented with an oval shaped swelling on left upper lip for 2 months. Excisional biopsy was done and histopathology revealed moderately differentiated Squamous cell carcinoma. We report this case as Xeroderma pigmentosa with squamous cell carcinoma is rarely seen in ENT practice

Complicação vascular de osteocondroma: relato de caso / Vascular complication of osteochondroma: case report

Osteocondromas ou exostose são os tumores benignos mais comuns do tecido ósseo . Eles surgem durante o período de crescimento e, raramente, são responsáveis por complicações vasculares. No presente relato, reportamos um caso de paciente com osteocondroma no membro inferior e complicação vascular provocada pela compressão da artéria poplítea. O paciente apresentava queixas de dor em membro inferior direito quando foi investigado com angiografia e radiografia, que identificaram a lesão vascular e a tumoração óssea. Os tratamentos cirúrgicos simultâneos de ambas as lesões foram realizados com boa evolução pós-operatória.

Intrathecal isobaric versus hyperbaric bupivacaine for elective Caesarean section

To compare the results of isobaric bupivacaine [0.5%] with hyperbaric bupivacaine [0.75%] in cases of elective Caesarean Section, in respect of time to sensory analgesia, highest level of sensory block, haemodynamic effects, and complications. Interventional, experimental study from March 2003 to March 2004. Department of Anaesthesiology and Surgical Intensive Care Unit, Dow University of Health Sciences and Civil Hospital, Karachi. Sixty pregnant patients scheduled for elective Caesarean Section. The patients were randomly assigned to receive either 0.5% isobaric bupivacaine [Group-1B] or 0.75% hyperbaric bupivacaine [Group-HB] via intrathecal route. The time of onset of block, highest level of sensory block, cardio-respiratory data, duration of analgesia and complications were recorded during surgery. Results: The time taken to reach T4 sensory analgesia in Group-IB was 6 +/- 6.43 minutes as compared to 6.93 +/- .7.8 minutes in Group-HB, while the highest sensory level achieved in Group-IB was TI and in Group-HB T2. The lowest systolic blood pressure recorded in Group-IB was 83.27 +/- 12.69 mmHg and in Group-HB 114.33 + 13.83 mm Hg, the difference being significant [p < 0.05]. There was a higher incidence of complications in Group-IB as compared to Group-HB like high spinal analgesia, vomiting and discomfort. Intrathecal block showed a greater reduction in the systolic blood pressure, and associated complications, with Isobaric Bupivacaine as compared to Hyperbaric Bupivacaine

Diabetes mellitus from antiquity to present scenario and contribution of Greco-Arab physicians

Diabetes is known since the age of antiquity. The first description that resembles the features of the disease is found in scroll of Ebers papyrus [1550 BC]. Buqrat [460 BC], the father of Unani medicine did not specifically mentioned Diabetes in his writings, but there are accounts in the buqrat's writings that are consistant with the sign and symptoms of the disease. From the 9th to 11th Century AD, Arabic medicine was at its peak, during this period the Arab physicians translated the works of Greek physicians mainly Buqrat and Jalinoos and enriched them with the knowledge of that era. Ibn Sina a renowned physician of this era described the disease in his book Al-Qanoon and mentioned gangrene and collapse of sexual function as a complication of the disease. No progress was made till the 16th Century AD when Paracelsus reported that Diabetes was due to deposition of salt in the kidneys. After Paracelsus many scientist contribute their views to the development Diabetes, but scientific advances in the 19th and 20th centuries led to the discovery of insulin, which was the turning point in the management of diabetes mellitus. This led to an explosion of multidirectional research into the role of insulin in regulating metabolism and survival. In the present paper historical aspect of Diabetes and contribution of Greco-Arab physicians will be discussed

Gender comparison of coronary risk factors and clinical presentation in young pakistani patients with coronary artery lesions

This cross-sectional study was designed to compare the gender prevalence of coronary risk factors and clinical presentation in young Pakistani patients with coronary artery lesions for defining high risk groups. A series of 120 consecutive patients [60 females/60 males] 50 years or less of age, with significant coronary artery lesions, were compared in different clinical subsets and coronary risk factors at National Institute of Cardiovascular Diseases, Karachi. The mean age of female patients was 45 +/- 5.8 years and male patients 44 +/- 5.9 years. On gender comparison: Significantly higher percentage of females presented with unstable angina and functional class III while males presented with post myocardial infarction angina, stable angina and functional class II. Diabetes mellitus was more common in females while smoking and dyslipidemia in males. Females with unstable angina had higher percentage of single vessel disease and isolated left circumflex disease while males presented with post myocardial infarction angina and greater percentage of right coronary artery lesion. Single and double vessel disease was significantly high in diabetic females compared to diabetic males. In males high serum cholesterol were associated with single vessel disease. Triple vessel disease was more common in hypertensive females and in males with family history of coronary artery disease. Within diabetics, multi-vessel disease was more common than single vessel disease. Single vessel disease was higher in non-diabetics. However, non-diabetic males had higher percentage of both single and double vessel disease has a trend for proximal lesions. Diabetes mellitus increases possibility of multi-vessel disease in both genders. Hypertension in females while high serum cholesterol and family history of coronary artery disease in males had significantly higher percentage of multi-vessel disease compared with their gender counterpart. Smoking was not a risk factor in females in the study population