Radiological mean age of fusion of medial end of the clavicle: a parameter of age

Objective: To determine the mean age of fusion of medial end of clavicle by radiography

Study Design: Cross-sectional study

Place and Duration of Study: Departments of Forensic Medicine, Dow Medical College and Ziauddin University, Karachi, from June 2010 to May 2011

Methodology: The subjects for this study were selected from various government colleges of Karachi. The subjects were analyzed for age and further confirmation was done by interviews where birth records and other physical parameters of age were also assessed. X-rays chest PA view was taken focusing on the medial end of clavicle; and were examined by a consultant radiologist and complete fusion of the medial end was noted. P-value less than 0.05 was considered significant

Results: The mean age of fusion of medial end of the clavicle was found to be 21 +/- 1.43 years. Significant difference was observed in male to female age of fusion 21.14 +/- 1.41 years versus 20.65 +/- 1.94 years [p > 0.05]. Similarly, statistically significant differences were observed between lower to middle income class and higher income class of all society. No difference was observed among various ethnic groups

Conclusion: Socio-economic factors, such as diet and nutrition, directly affect bone growth and hence bones' age. The results of fusion of the medial end of the clavicle are not affected by ethnicity; however, it is significantly affected by gender. More studies should be conducted in various parts of the country to make a natural standard in setting up uniform criteria for assessing age at or above 21 years

Comparison and correlation of hepatic and hematological parameters in patient with plasmodium vivax and plasmodium falciparum

Objectives: To compare and correlate hepatic and hematological parameters in patients with Vivax and Falciparum Malaria

Study design: A retrospective comparative study

Place and duration: The study was conducted the Department of Biochemistry, Basic Medical Sciences Institute with collaboration of National Institute of Child Health and malaria control program counter at Jinnah Postgraduate Medical Center Karachi during 1st August 2005 to 31st December 2006

Methodology: The study included 120 consecutive patients. All patients were between 1 to 10 years of age. They were divided equally into two groups, Plasmodium vivax malaria [Group A] and Plasmodium falciparum malaria [Group B]. Those patients having a history of icterus, taking hepatotoxic drugs or had evidence of hepatic dysfunction were excluded from the study. Liver function tests and hematological parameters performed

Results: All patients had fever, chills with rigors and body aches. On evaluation an increasing tendency of jaundice and hepatosplenomegaly along with statistically significant value [p<0.05] in serum bilirubin, alanine transaminase [ALT], hemoglobin, bleeding time [BT] and prothrombin time [PT] was found in patients with Falciparum as compared to vivax malaria. In Group A, serum bilirubin has negative correlation with hemoglobin but positive with PT. PT has negative correlation with ALT but positive with aspartate transaminase [AST]. Platelet has negative correlation with ALT but positive with alkaline phosphatase [ALP]. In Group B, hemoglobin has negative correlation with bilirubin, ALT and AST but positive with ALP; serum AST, and ALT were negatively correlated with, platelet and PT but positive with bleeding and clotting time. Platelets have significant coefficient correlation [0.524] regarding total protein and clotting time shows significant coefficient correlation [0.606] with alanine transaminase shown in table- 111

Conclusions: Liver function test and hematological parameters should be performed in patients with diagnosed Plasmodium Falciparum Malarial infection to prevent complication

Technology for treatment and recycling of wastewater of automobile service stations

A prototype treatment plant was fabricated and tested at varied hydraulic retention times for settling the suspended/settleable matter and skimming out oil and grease at laboratory plants of 40 L and 56 L. The results showed that 99.7% of oil and grease and almost all total suspended solids were removed and sparkling clear water was obtained, reusable for washing vehicles

Frequency of endoscopic gastric neoplasms in five years at JPMC

Gastric cancer is among the most common malignancies in Pakistan. The aim of our study are i] to document different histological types of gastric malignancies as per age and sex ii] discuss its possible association in patients who underwent endoscopy and iii] compare our data with local and abroad studies. Retrospective study. This study was conducted in the Department of Pathology, Basic Medical Science Institute, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from 1[st] January 2003 to 31 December 2007. A total of 740 cases of gastric endoscopic biopsies were received for histopathological evaluation at the Department of Pathology, Basic Medical Science Institute, JPMC, Karachi. Out of these cases, a total of 70 gastric neoplasms were separated, analyzed and classified according to the WHO classification system and their relative frequencies were recorded. Gastric adenocarcinoma was the commonest neoplasm with male predominance in 5th to 7[th] decade of life, account for 88.57% [62/70] of all gastric neoplasms. Gastric lymphoma was the second common with 8.57%[06/70] and gastric carcinoid was least common with 1.43%[1/70] of all gastric neoplasms. This study highlights that adenocarcinoma is the most common gastric malignancy seen in most high risk group includes elderly males followed by lymphoma with no gender difference. So we advise regular endoscopic biopsies surveillance at least in high risk age group for the early detection of cancer

Wound infections and culture sensitivity pattern in pediatric burn patients

To identify common organisms causing burn infection and their antimicrobial sensitivity pattern. A retrospective study of sixty patients with burn wound infection was carried out at burn unit of Khyber Teaching Hospital Peshawar from September 2006 to August 2007. Children who received burn injuries with signs and symptoms of septicemia were included in this study. Age, sex, percentage of burn wound and etiology of burn wounds was recorded. Culture and sensitivity tests were performed from burn wounds of those patients who were having fever and other features of septicemia by tissue culture of all patients[from infective sites] and their results were noted. Out of sixty patients, fourty were male and twenty were female pediatric burn patients. The most frequent organism isolated was staphylococcus aureus [25%], followed by pseudomonas [21.6%]. Other organisms included mix pseudomonas and staphylococcus aureus [23.5%], E-coli [13%], proteus [3%], Klebsiella [3%]. All these organisms were resistant to most routine antibiotics. This study highlights that staphylococcus aureus [25%] and pseudomonas [21.6%] are the most common organisms and cefoperazone/sulbactam and imipenem/cilastatin are the most effective empirical therapy in our setup

Fogarty balloon catheter ablation of posterior urethral valves in neonates

Neonates with posterior urethral valves in developing countries, where costly endoscopic instruments are usually not available, are a special problem. The objective of this study was to evaluate the efficacy of fogarty balloon catheter ablation of posterior urethral valves as an alternative to endoscopic valve fulgaration. From January 2006 to December 2006, we received 07 neonates with Posterior Urethral Valves which were subjected to this technique. Their age range was between 5-26 days, while the weight range varied between 2.5 Kg to 3.5 Kg. Valves were ablated by using size 6F Fogarty catheter in the main operation theater under general anesthesia. Technique was successful in all the 7 neonates which was evident by a good stream of urine. Two patients had Grade III, while two patients had Grade IV vesicoureterric reflux before ablation. In patients with Grade IV reflux, reflux downgraded to Grade III on MCUG done 3 months after ablation. Patients with Grade III reflux were lost to follow up. Ablation of posterior urethral valves with Fogarty balloon catheter in neonates is simple, economical and effective way to treat these patients. Endoscopic valve fulgaration in neonates is hazardous and this technique is a good alternative, especially in developing countries

Pattern of epiphyseal union at knee in the children and young adults of Peshawar

Objectives of the study were to: 1. Determine the age of epiphyseal union at distal end of femur and proximal end of tibia and fibula in the children and young adults of Peshawar. 2. Compare the pattern of epiphyseal union at knee among males and females. Non-interventional descriptive. Department of Forensic Medicine, Khyber Medical College Peshawar. In the study 120 healthy, young volunteer students of both sexes and original residents of NWFP were included. Males were 15-19 years and females were 13-17 years of age. Age was certified by means of birth record, school certificates and interview with the parents. Radiographs of right knee were taken using conventional x-rays apparatus. Non-probability purposive sampling technique was used. Radiological findings regarding epiphyseal union were classified as follow; a. Stage of non-union b. Stage of partial union c. Stage of complete Union Data was compiled and significance of results was evaluated through statistical analysis of the data using Chi-square and t-test. In males average age of epiphyseal union of femur, tibia and fibula is 16.5, 17 and 17.5 years respectively. In comparison, in females epiphyseal union of femur and tibia takes place at the age of 14 years while that of fibula at the age of 15 years. Epiphyseal union is 2.5 to 3 years earlier in females as compared to males. Epiphyseal union occurs earlier in Pakistan than in European countries. Europeans norms and standards of skeletal growth used for age estimation are not valid for Pakistani children. Further studies on pattern of epiphyseal union must be conducted to develop local reference standard that may be used for age estimation

Wandering in adult psychiatric patients: clinical and sociodemographic correlates

This study was conducted to define the wandering and various factors associated with it in patients admitted to an acute psychiatry unit. Descriptive study. The study was conducted at the in patients of psychiatry department, Lady Reading Hospital between March 1998 and June 1998. All the patients admitted to psychiatry unit in the period were selected by convenient sampling. They were screened with the help of questionnaire during the course of their psychiatric illness for the wandering behaviour. Wandering was operationally defined for the purpose of the study. Those patients who had one or more episode of wandering were further evaluated to assess their socio demographic and clinical characteristics with the help of a structured interview eliciting the information about precipitants, duration and experience of the wandering. From 240 screened patients a total of 32 patients fulfilled the inclusion criteria, 22 were male and 10 female. 43.74% were living with their parents and40.62% with siblings and 15.62% with other relatives. In 22 [86%] patients relapse of psychiatric illness precipitated the wandering while in 9 patients [28%] conflict with the family members precipitated wandering. The underlying psychiatric disorders were schizophrenia [32%] followed by major depression [22%] and manic episode [15%]. wandering was more common in younger population. Schizophrenia, brief psychosis, depressive illness and dissociative disorders were the common psychiatric disorders associated with the condition. The common preceding factor of wandering behavior was relapse of psychiatric illness

Analysis of medico legal autopsies at Faisalabad

To collect and publish scientific information regarding different variables of MEDICO LEGAL autopsy to be used by health and law enforcement agencies for future planning. Data source: Cases autopsied at the department of forensic medicine, Punjab medical college, Faisalabad. Non-interventional descriptive Setting Department of forensic medicine, Punjab medical college, Faisalabad. Period: July 2001 to June 2002. Material and method: Study includes 236 cases of MEDICO LEGAL autopsy including both sexes. After legal formalities and examination of the clothes, a detailed external and internal examination of the dead body was conducted. Specimens were sent for further examinations where necessary. Findings were tabulated and analyzed. Majority of the victims [52.5%] was between the age of 20-39 years. Male cases outnumbered the female cases. Firearm was the most common causative agent in MEDICO LEGAL deaths. Homicide was the dominant manner of death. Maximum number of injuries was inflicted on the chest. A peak in MEDICO LEGAL deaths was noted in extreme summer. Homicide as a dominant manner in MEDICO LEGAL deaths and firearm being the commonest weapon of offence are eye openers. Strict legislation regarding holding of firearm weapons and justice without delay are the major steps which can help in improving the situation

Suicidal deaths; Assessment in Peshawar

To find out the incidence of suicide, the gender and age groups involved, the methods used for committing the act and to note seasonal trends if any. Data source: Cases brought for autopsy at the department of forensic medicine, Khyber Medical College, Peshawar. Non- interventional descriptive. Department of forensic medicine, Khyber Medical College, Peshawar. Period: January 1991 to December 2000. Materials and All 39 cases of deaths labeled as suicide on the basis of autopsy findings, police inquest and interview with relatives of the victim were selected from the autopsies. The cases were grouped on the basis of age, sex, method of suicide used, region of the body involved and the seasonal distribution of the cases. The rate of suicide in Peshawar is 0.21 per 100,000 per year. Males were the predominant victims with a male to female ratio of 2.9:1. The age most prone to suicide was 20-29 years followed by 10-19 years. The primary method used for suicide in both sexes was by firearm followed by hanging. The head was the region of the body used for suicide in 59.37% of firearm victims followed by the chest and the abdomen. Two peaks were noted in the months of September and March. The incidence of suicide in Peshawar is amongst the lowest in the world

Presentations of Meckel's diverticulum at Khyber teaching hospital Peshawar

This study was conducted with an objective to observe various presentations of Meckel's Diverticulum in our setting and compare it with other national and international studies. It was a retrospective analysis of hospital record carried out at the department of paediatric surgery Khyber Teaching Hospital, Peshawar. A total of 63 patients meeting the inclusion criteria were included in the study who had presented to our unit with signs and symptoms of Meckel's Diverticulum and who were diagnosed either by investigations or at surgery. All the patients were explored and resection and anastomosis performed. We did not do H. Pylori culture. Patients with bleeding per rectum were investigated by Meckel's scan. Analysis of the results was done by SPSS version 10. Majority of our patients presented with obstruction [82.5%] in contrast to the Western studies [around 40%] while only 4.7% presented with bleeding per rectum again in contrast to the Western countries [38'56%]. There appears to be a geographical and/or racial difference in the presentation of Meckel's diverticulum

Unnatural female deaths Peshawar

The aim of the study was to know the extent of violent deaths among females in Peshawar, the most vulnerable age group, weapons of infliction and the mode of death. Design: Non interventional [descriptive] type study. Place and Duration of Study: This study was conducted from 1st January, 2001 to 31st December, 2001 in the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar. Subjects and Out of 679 deaths, presented for autopsy at the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar 89 were females. These were grouped according to age, mode of death and weapons of infliction. Females formed 13% of all the autopsies done in Peshawar. The age group most commonly involved was 21-40 years [50.56%]. Firearms were the predominant weapons of infliction [70.78%] and the intent was mostly homicidal [77.52%]. Fatal violence against women is uncommon in Peshawar. Suicide is rare. Young women are mostly killed by firearms

Five years audit for presence of toxic agents / Drug of abuse at autopsy

To know the frequency of fatal poisoning in Peshawar regarding the toxic agents mostly involved and yearwise percentage. To know the age group and the gender that is most vulnerable to fatal poisoning. Design: Non-interventional [descriptive] type. Place and Duration of Study: This study was conducted over a period of five years [1997'2001] at Forensic Medicine Department, Khyber Medical College, Peshawar. Methodology: The study included 3508 autopsies conducted at Khyber Medical College, Peshawar. Out of these, 52 cases were those caused by fatal poisoning. These were analyzed according to age, gender and the toxic agent involved. t-test was applied as the test of significance. Poisoning was the cause of death in 1.48% of the total autopsies conducted during the five years. Males were more involved than the females, 90.38%. Suicidal poisoning was present in 17.30% of the total cases and accidental poisoning was found in 80.72% cases, while homicidal cases were 1.29% only. Diacetylmorphine [heroin] was the most commonly involved agent, 65.38%, of the total cases. The incidence of poisoning was more during the third and fourth decades of life. Diacetylmorphine [heroin] was the main causative agent involved in young males due to accidental over- dosage. Accidental and suicidal deaths should not be considered as inevitable. More elaborative studies are required in this area of recent research to adopt appropriate and adequate measures to save precious lives

role of radionuclide imaging and computerized axial tomography to reveal equivocal fractures in medicolegal practice

Four hundred sixty-six medicolegal cases were re-examined during the period of 3-years from 1998 to 2000 for correctness or otherwise of the challenged medicolegal certificates issued by the first examining medicolegal officer, and referred by the Health Authorities. Out of 466 cases, 190 [40.77%] cases were decided. 15 [7.89%] cases which were initially wrongly interpreted by the concerned medicolegal officer regarding the presence of nondisplaced fractures, were reviewed by the panel of experts, and keeping in view the persistent pain following trauma where the conservative radiograph failed to reveal fracture, specialized techniques in radiology i.e., Computerized Axial Tomography and Radionuclide Imaging, were utilized which showed 100% result by revealing fractures