Comparative hypoglycemic activity of different fractions of Thymus serpyllum L. in alloxan induced diabetic rabbits

The aim of present study was to evaluate and compare the hypoglycemic activity of different solvents extracts of Thymus serpyllum in rabbits. Diabetes was induced with single intravenous injection of alloxan monohydrate [150mg/kg]. Glibenclamide and acarbose were used as standard drugs. The crude powder of Thymus serpyllum [500 mg/kg b.w] significantly reduced blood glucose level in both normal and diabetic rabbits. Various extracts of Thymus serpyllum were compared for their hypoglycemic activity in diabetic rabbits. Ether and aqueous extracts significantly reduced the blood glucose level with maximum effect [p<0.001] produced by aqueous extract, which was selected for further study. Aqueous extract significantly inhibited the rise in glucose level in oral glucose tolerance test. The extract showed synergistic effect with different doses of insulin; however serum insulin level of the diabetic rabbits was not significantly increased by the extract. HbA1c level was significantly [p<0.05] reduced whereas hemoglobin level was significantly increased in three months study. Phytochemical screening of the aqueous extract showed the presence of alkaloids, flavonoids, tannins, terpinoids, reducing sugar and cardiac glycosides. It is concluded that the aqueous extract might be used alone or in combination with insulin to manage diabetes and its associated complications

Vacuum assisted closure- utilization as home based therapy in the managementof complex diabetic extremity wounds

Vacuum assisted closure is a reported technique to manage complex wounds. We have utilized this technique by using simple locally available material in the management of our patients on outpatient basis. The objective of this study is to present our experience. This study was conducted from June 2011 to June 2013 at Dow University Hospital and Aga Khan University Hospital, Karachi. There were 38 patients managed with vacuum assisted closure. Mean age was 56 +/- 7.8 years. Twenty three patients presented with necrotizing fasciitis and 15 patients with gangrene. Lower limbs were involved in majority of the patients. Debridement or amputations were done. Vacuum dressing was changed twice weekly in outpatient department. Wounds were closed secondarily if possible or covered with split thickness skin graft in another admission. All the wounds were successfully granulated at the end of vacuum therapy. Mean hospital stay was 7.5 days. Vacuum dressing was applied for a mean of 20 days. There was reduction in the size of the wound. Thirteen patients underwent secondary closure of the wound under local anesthesia, 18 patients required coverage with split thickness skin graft and 7 patients healed with secondary intention. Vacuum assisted closure appeared to be an effective method to manage complex diabetic wounds requiring sterile wound environment

Diabetes mellitus modifying factors; investigation among the inhabitants of Sargodha city, Pakistan

Diabetes mellitus is wide spread non transmissible disease but its prevalence is increasing everyday so this study was conducted with an aim to investigate the factors that are modifying diabetes mellitus among patients at DHQ [District Head Quarter] Hospital Sargodha. A prospective study was carried out by well-trained pharmacists in DHQ Sargodha, Pakistan to assess the factors modifying diabetes mellitus. Data was collected from 110 patients randomly by using convenience sampling method. A well structured questionnaire was designed to collect information from patients and entire procedure was conducted with the permission of concerned authorities of Hospital management. The factors that are considered in present study are medication, treatment, patient physician interaction and society attitude towards diabetic patients which are helpful in halting the progression of diabetes and prevention of co morbidities. The results of study disclose that 74.5% diabetic patients felt better after treatment whereas 56% diabetic patients were satisfied with the information provided by physician to them but still 70% patients were suffering from co morbidities. The survey indicated that 62.7% patients said that exercise proved to be healthy activity in improving diabetes. However 59% diabetic patients were following a proper diet plan which was helpful in modifying their diabetes. The diabetic patients must be informed about importance of regular follow-up in averting long-standing complications. Patients should be guided about importance of dietary recommendations, exercise and strict metabolic control, that can holdup or avert the series of complications allied with diabetes

Malignant tumors; frequency at Sargodha, a single centre, retrospective study

As in most developing countries, incidence of cancer is also increasing in Pakistan. It is important that information on the frequency and epidemiology of malignant tumors be updated, as it is the basis of future health planning for the population at risk. This retrospective study was carried out to find the prevalence of various cancers in the population of Sargodha district [central Punjab, Pakistan] and to compare the regional and international studies, so as to plan and develop the oncology setup of Sargodha Medical College on a rationalized basis of disease prevalence. Data from July 2010 to June 2013 was retrieved from the department of statistics of the hospital and variables of interest were collected and analyzed using SPSS 10.0. It was observed that the most frequent cancer in our patients was breast cancer [n=172] while carcinoma of lungs was the most frequent carcinoma in male population [n=24]. However our observations were a bit different from the international studies published on the subject, the probable reason being the availability of treatment facility and easier access in the nearby districts of Faisalabad and Lahore where many patients still go directly. More over the illiterate and poorer faction of the society does not come to the hospitals for management of the disease but rather go to the quakes and faith healers to relieve them of their sufferings. It is concluded that the department of clinical oncology should arrange cancer awareness programs for the general population to avoid delays in getting consultation, as at present they report to the hospital when the disease is quite advance and surgery is often not possible. Our study also revealed a somewhat different pattern of malignancies in our community raising a need for further studies to evaluate the reasons for this changed pattern in relation to various etiological factors

Midstream urine isolates: sensitivity pattern of various antibiotics in pediatric patients

The objectives of the study was to determine different microorganisms responsible for causing urinary tract infections UTI in children and to evaluate sensitivity and resistance pattern of different antibiotics used in UTIs. Study was conducted in Children Hospital Complex [CHCM], Multan, Pakistan. Total 125 children having UTI were taken to determine the antibiotic sensitivity and resistance pattern against microorganisms causing urinary tract infections in children. The urine samples were collected in urine bottles and smears were made within 2 hours of sample collection. Urine sample was inoculated on agar media and then incubated for 24 hours. A smear was prepared on a slide form culture of microorganisms and gram testing was conducted. The microorganisms were then characterized by use of API [Analytical Profile Index] MICROBACT TM 24E of Oxoid England. The antimicrobial susceptibility testing of various antibiotics was performed by disc diffusion method. The percentage of Gram +ve bacteria causing urinary tract infections in children was 28%, Gram -ve 62.4% and Yeast 9.6%. The most prevailing species are S. aureus, S. epidermidis and E.coli. Results showed that female children are more prone to UTI than male children. Norfloxacin is effective in S. Aureus UTI while cefaclor is effective in S.epidermidis UTI. Amikacin, Norfloxacin and Cefuroxime are effective in UTI caused by E.coli

Locking Compression Plate in Musculoskeletal Oncology 'a Friend in Need'

BACKGROUND: We are presenting our experience in the use of locking compression plate (LCP) after juxta-articular oncological resections in addition to its use in pathologic fracture. METHODS: A retrospective audit of skeletal reconstruction using LCP in 25 cases of long bone tumors was performed from 2008 to 2010. Reconstruction following limb salvage surgery was done in 17 patients and internal fixation of pathological fracture was done in 8 patients. All patients were available for > 12 months of follow-up, and thus assessed for union at the resected ends. RESULTS: There were 8 males and 17 females in the study. The average age at the time of surgery was 30 years (range, 9 to 66 years). The minimum follow-up was 12 months (range, 12 to 32 months). All patients except three went on to heal successfully. Complications occurred in those three patients: wound infection in one, nonunion in another, and periprosthetic fracture in the other patient. In the remaining patients, union was achieved at an average of 6.5 months after reconstruction in curative resection and 4.75 months after fixation of pathological fractures. CONCLUSIONS: Joint sparing limb salvage surgery was made successfully possible after sekeletal reconstruction with LCP. Its use was also quite effective in pathological fractures with poor bone quality. Use of locking plates for musculoskeletal oncological reconstruction resulted in a good and predictable rate of union.

Comparison of single with double layer intestinal anastomosis

OBJECTIVES: To compare management outcome of single layer interrupted extramucosal intestinal anastomosis with double layer conventional method of intestinal anastomosis

DESIGN: Comparative study

MATERIAL AND METHODS: This prospective comparative study was conducted in Surgical Unit-II of Benazir Bhutto Hospital, Rawalpindi over a period of two years from Jan 2007 to Dec 2008. Adult patients undergoing elective or emergency small and large gut anastomosis were included. Esophageal, gastric and biliary anastomosis were excluded. Sixty patients were divided in two groups of 30 patients each. In Group-A single layer interrupted extra-mucosal anastomosis was done and in Group-B double layer anastomosis

Main outcome measures were to compare duration of procedure, post-operative leakage and post operative duration of hospital stay

RESULTS: Anastomotic leakage occurred in two [6.6%] patients of group A and in one [3.3%] patient of group B [p=0.55]

Mean of time taken for anastomosis was 18.30 min in group A and 25.87 min in group B [p=0.001]

Mean of duration of post operative hospital stay was 6 days in group A and 5.87 days in group B [p=0.8]

CONCLUSION: Single layer extramucosal intestinal anastomosis is equally safe and can be performed in shorter time than the double layer intestinal anastomosis

Gallbladder carcinoma; frequency in patients under going cholecystectomy for chronic cholecystitis

Chronic Cholecystitis is one of the commonest diseases presenting in surgical department and is subjected to cholecystectomy each time. Asuspicious gall bladder on ultrasound initiates further investigations to rule out carcinoma of gall bladder yet some times a benign looking gall bladder on ultrasound turns out to be carcinoma of gall bladder on histopathology. Descriptive study. District Head Quarters Hospital, Sargodha, from September 2007 to March 2009. 200 patients who underwent both open and Laparoscopic cholecystectomy for cholelithiasis were subjected to this study. All relevant data was documented on a standardized data form. Patients were between the ages of 28-74. Patients already diagnosed as Gallbladder Carcinoma, empyema gall bladder, mucocele and gall bladder polyp were excluded from the study. Gall bladders removed after each surgery ware sent to laboratory for histopathological evaluation. A total of 200 cases were studied [161 females, 39 males; M: F ratio 1:4]. The mean age was 45 years [range 28-74 years]. The most common presenting complaint was pain right hypochondrium with nausea and vomiting [85%].The average operating time was 50 minutes in case of open cholecystectomy and 1 hour in laparoscopic cholecystectomy. Complications included biliary leak in 2 patients [1%], Wound Infection in 3 patients [1.5%] and death in one case [0.5%]. The overall rate of complications was 3%. There were a total of 5 patients of laparoscopic cholecystectomy who required extension of the incision, for Carcinoma Gallbladder. Carcinoma of gall bladder is a very aggressive malignancy and usually presents at a very advance stage as its symptoms mostly are marked by symptoms of cholecystitis. Detection of gall bladder carcinoma is very difficult in early stages on ultrasound. Any findings in ultrasound suggesting malignancy should be confirmed on further investigations like CT scan .Carcinoma of Gall bladder is not very common in cases of cholecystectomy for chronic Cholecystitis but once found should be dealt with extreme precision following established operating protocols

Onset of chilblains in relation with weather conditions

Chilblains or perniosis is a moderately severe form of cold injury, localized to peripheral parts of the body, which occurs after exposure to non-freezing temperatures and damp conditions. Although inter-individual variations exist with respect to susceptibility to develop chilblains, no study has been carried out in this region to determine the role of different weather conditions either alone or in combination, in predisposing the susceptible individuals to chilblains. The objective of this study was to determine the relationship between weather conditions and onset of chilblains at a moderately cold weather station. This study was conducted at the Department of Dermatology, Combined Military Hospital, Abbottabad, from Dec 2004 to Mar 2005. All patients fulfilling the clinical criteria for diagnosis of chilblains were included in the study. These patients were interviewed and examined thoroughly. A specially designed proforma was filled for each patient separately. Meteorological department was contacted for record of weather conditions. Onset of chilblains in each patient was related with weather conditions of that particular month. Computer programme SPSS 10 was used for statistical analysis. Out of 111 patients, 67 [60.4%] were males and 44 [39.6%] were females. Eighty nine [80.2%], 90 [81.1%] and 90 [81.1%] patients had onset in relation with lower temperature [<10 °C], relatively low atmospheric pressure [<1500 kpa] and higher relative humidity [>60%] respectively. There was statistically significant relationship of weather conditions with onset of chilblains when different groups, i.e., elderly and young, males and females, locals and non locals, outdoor workers and those remaining inside most of the time and those having disease of longer or shorter duration were compared. The cold weather conditions that can be endured by humans depend on combination of the duration and the extent of the exposure, in addition to physiological adaptive changes. However, susceptibility to chilblains increases when ambient temperature is less than 10°C and relative humidity is more than 60%. Elderly, females, outdoor workers and those having chronic or recurrent episodes of chilblains are less tolerant to cold weather and develop the disease under lesser ambient cold

Spontaneous bacterial peritonitis

To evaluate the prevalence, diagnostic criteria and microbial spectrum of spontaneous bacterial peritonitis [SBP] and its variants in cirrhotic patients with ascites. A hospital based prospective study carried out in cirrhotic patients with ascites. The study was conducted in the Department of Medicine Military Hospital Rawalpindi during October 2000 to March 2002. One hundred and eighty consecutive patients of cirrhotic liver between the ages of 20-65 years presenting with ascites reporting to outdoor patient department of Military Hospital Rawalpindi were included in the study. The diagnosis of cirrhosis was made on history, clinical examination and the ultrasonographic findings. These patients were subjected to ascites fluid tap and the patients were divided into SBP and non-SBP groups in the light of results of ascitic fluid routine examination and culture. The SBP group was further categorized into culture positive SBP, culture ne gative neutrocytic ascites [CNNA] and bacterascites [BA] on the basis of culture results and total leukocyte count, absolute polymorphonuclear leukocyte count per cubic mm of ascitic fluid. The study included 144 males and 36 females having cirrhosis with ascites. The mean age of these patients was 52.32 +/- 7.87 years. On the basis of routine examination and culture of tapped ascitic fluid from these cases 57 of 180[31.66%] patients were diagnosed to have SBP or its variants, In addition to classic SBP in 18[31.58%] patients, its variants namely culture negative neutrocytic ascites and bacterascites were detected in 37[64.92%] and two [3.5%] cases respectively. E. coli was the most frequently cultured organism. It was isolated in 12 cases of SBP [60%]. In 4 cases [20%] Klebsiella was cultured whereas Proteus mirabilus and Streptococcus were reported in two cases [10%] each. This study indicates that spontaneous bacterial peritonitis is common and potentially fatal complication in cirrhotic patients with ascites. E. coli is the most frequent offending organism

Small bowel volvulus leading to gangrene and short bowel syndrome

A young man was operated for acute abdomen. Laparotomy revealed small bowel diverticulosis with very short mesentery leading to volvulus of near total small bowel. Resection and end to end anastomosis was performed. Patient ended up with short bowel syndrome

Role of serodiagnosis in cutaneous leishmaniasis

Cutaneous leishmaniasis caused by different species of Leishmania parasite, is endemic in various regions of Pakistan. It is probably the second most prevalent vector-borne disease in the country [after malaria]. Diagnosis is mostly made by its clinical presentation, especially in the endemic areas. Sometimes it is aided by slit skin smear examination, histopathological study and parasite culture. Considering the fact that serology has made significant advances in diagnosing various parasitological diseases, this study was carried out to evaluate the role of serological techniques in diagnosis of cutaneous leishmaniasis. Three serological tests i.e. enzyme-linked immunosorbent assay, immunofluorescent antibody test, indirect hemagglutination test were done in 57 clinically diagnosed cases of cutaneous leishmaniasis. Positive results were seen in 62.4%, 52% and 52% with ELISA, IFAT. and IHA tests respectively. Serological tests can be used as a supporting and screening investigation hut not to make the final diagnosis