Role of Probiotics in Patients with Allergic Rhinitis: A Systematic Review of Systematic Reviews

Abstract Introduction Allergic rhinitis (AR) is estimated to affect up to 30% of the world population. With the rise in cases, newer treatment modalities have been explored. Probiotics have shown to reduce symptoms of AR and improve quality of life. A few systematic reviews have been published aiming to assess the role of probiotics in AR. Objectives To consolidate the recent evidence with an overview of systematic reviews by extracting data regarding subjective outcomes (from quality of life questionnaires, the Total Nasal Symptom Score, the Total Ocular Symptom Score, the Daily Total Symptom Score, the incidence of AR, and the Rhinitis Total Symptom Score) and objective outcomes (levels of antigen-specific immunoglobulin E [IgE], total IgE, interleukin 10 [IL-10], interferon gamma [IFNG], eosinophil, and the T helper 1/T helper 2 [Th1/Th2] ratio). Data Synthesis We conducted a literature search on the PubMed, EBSCO CINAHL, EBSCO Dentistry & Oral Sciences Source, and Cochrane Library up to April 14, 2020. The qualitative assessment was performed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR-2) tool. A total of 419 titles were screened, and 3 systematic reviews met our eligibility criteria. Probiotics in the treatment of AR have been shown to improve quality of life, the total nasal and ocular symptom scores, the daily total symptom scores and Th1/Th2 ratio. No difference was ascertained for rhinitis total symptom score, and the rates of antigen-specific IgE, total IgE, IL-10, INFG and eosinophil. Conclusion The present review showed that there is considerable evidence that probiotics are useful in the treatment of AR. Further randomized trials targeting the limitations of the currently-available evidence can help ascertain the usefulness of probiotics in cases of AR.

Paraplegia Following Spinal Cord Contusion from an Indirect Gunshot Injury / 대한신경손상학회지

Spinal cord injuries are debilitating and life threatening. Paraplegia due to direct traumatic gunshot injury to the spinal cord is common. The most common cause of spinal cord injury is road traffic accidents. This is followed by spinal cord injury due to a fall from a height. Most of the spinal cord injuries due to gunshot wounds occur as a result of direct traumatic effects. We present a rare case of a 49-year-old male with trauma. He developed paraplegia after a gunshot wound injury to the neck and contusion to the spinal cord, with no direct trauma. Paraplegia due to direct gunshot injury can have many different outcomes. In our case, the patient was managed conservatively, and the outcome was favorable.

Bilateral renal lymphangiectasia with ascites and pleural effusion

A 42 year male patient with complaints of dull abdominal pain and hematuria for 01 year was referred by Nephrologist for abdominal ultrasound [USG]

USG demonstrated echogenic kidneys, perinephric and renal sinus cystic fluid collections bilaterally with minimal ascites and mild right sided pleural effusion. The USG findings were confirmed by computed tomography [CT] and magnetic resonance imaging [MRI] scan and were characteristic of renal lymphangiectasia. Awareness regarding renal lymphangiectasia will result in early diagnosis and management and decreased morbidity

Aspartate aminotransferase-alanine aminotransferase ratio predicts cirrhosis in chronic hepatitis C patients

Background: Hepatitis C virus infection is on rise in Pakistan

Objective: To evaluate serum aspartate aminotransferase and alanine aminotransferase ratio [AST/ALT ratio] in predicting liver cirrhosis of chronic hepatitis C patients

Patient and Methods: Study Design: Aprospective study. Place and Duration of Study: This study was done in Gasteroenterology department at Sheikh Zayed Hospital Lahore. Duration of study was 6 months from 1[st] January to 30[th] June 2010. Total 80 patients of chronic hepatitis C confirmed by PCR were included in the study. The sera of the patients were tested for AST and ALT. Liver biopsy of each patient was performed. Histological Activity Index [HAI] of the specimens was scored on the basis of Knodell score. AST/ALT ratio was correlated with the histological stage [i.e. degree of fibrosis], and the histological grade [i.e. inflammatory activity]

Results: The mean AST/ALT ratio in 40 cirrhotic patients [1.64 +/- 0.46; p < 0.001]. A ratio = 1 has 96.38% specificity and 93.73% positive predictive value in distinguishing cirrhotic from noncirrhotic patients with 88.26% sensitivity and 94.84% negative predictive value. The ratio correlated positively with histological stage but not with the grade. Two patients out of 17 cirrhotic patients [12%] have no clinical or biochemical features suggestive of chronic liver disease except for an AST/ALT ratio more than one

Conclusion: It is concluded that AST/ALT ratio = 1 is highly specific for the presence of cirrhosis in patients with chronic hepatitis C. This ratio reflects the fibrosis stage in these patients. This ratio may be considered as a marker of fibrosis in patients with chronic hepatitis C

Frequency of axonal variants of guillain-barre syndrome in Pakistan

To determine the frequency of axonal variants in our patients of Guillain-Barre Syndrome. Descriptive study. Department of Neurology, Military Hospital, Rawalpindi and Armed Forces Institute of Rehabilitation Medicine [AFIRM] from 01 Jan 2009 to 30 Jul 2010. Forty adult patients meeting the National Institute of Neurological Disorders and Stroke criteria for Guillain-Barre Syndrome [GBS] were consecutively enrolled in the study. Patient's data, detailed history, examination and electrophysiological studies were carried out and recorded on predesigned proforma. All patients were examined and reviewed by Consultant Physicians and neurologists. Electromyography and Nerve conduction study testing was done by experienced electro-physiologists. Axonal variants of Guillain-Barre Syndrome constituted 16[40%] in our study. The variants of Guillain-Barre syndrome were acute inflammatory polyradiculoneuropathy [AIDP] in 24[60%] patients followed by acute motor axonal neuropathy [AMAN] in 12[30%] and acute motor sensory axonal neuropathy [AMSAN] in 4[10%] patients. We report a high frequency of the axonal variants of Guillain-Barre Syndrome in Pakistan

Pattern, of cancer; among the patients of the allied hospital

To detect the types of cancer. Retrospective cross sectional survey. Department of Clinical Oncology [Liaqat Ward] Allied Hospital Faisalabad. From January, 1st 2005 to December, 31st 2005. The data was obtained from the hospital record and then was tabulated with respect of age, sex, and the type of cancer. This survey includes the patients who presented in the department of oncology with one type of cancer or other. A total of 1087 patients met inclusion criteria for this survey. There were 526 [48.2419%] male and 557 [51.2419%] female patients, and 594 [54.65%] Urban and 493 [45.35%] Rural patients. Out of the total 1087 patients, 201 patients [18.4219%] presented with breast cancer, 60 patients [5.579%] presented with squamous cell carcinoma of the face and 58 patients [5.335%] were found to be suffering from brain tumor

Frequency, awareness, treatment and control of hypertension in bank employees of Bahawalpur City

The study was designed to determine the frequency, awareness, treatment and control of high blood pressure among the bank employees of Bahawalpur City. It was an observational, cross-sectional study, carried out by the Department of Cardiology, BVH, Bahawalpur. The study was done from 1[st] December 2006 to 22[nd] September 2007. A sample of 188 bank employees working in different banks was taken by convenience sampling technique. Bankers of all ages and both sexes were included and those absent at the time of visits and temporary trainees were excluded. The subjects were interviewed and examined according to Equipment, Condition of patient and Techniques [ECT] recommendations as laid down by US JNC 7[th] report. The data was collected on a questionnaire and was analyzed manually. Frequency of hypertension in bank employees was 40.96%. Almost half [51.94] of the hypertensives were aware of their disease and the other half were screened during this study. Out of 40 diagnosed patients of HTN, only 23 [57.5%] were taking anti-hypertensive therapy and among those, only 14 [60.87%] were having adequate control of their blood pressure. Hypertension was found to be more frequent among males as compared to females. Other associated risk factors were advancing age, BMI >27, family history of hypertension, tobacco smoking and lack of physical exercise. The study shows a high frequency, low awareness, bad treatment compliance and improvable control of hypertension among the bank employees of Bahawalpur City

Management of intestinal stoma

To detect the various complications in all types of intestinal stomas and various operative and non-operative strategies applied in the management of these complications. All four units of Surgical Department including Accident and Emergency department, Nishtar Hospital, Multan. Six months. 100 patients. These 100 patients included in the study were admitted through the OPD and emergency department. Data of patients was recorded on a pre-designed proforma, which was later on used for analysis. Various types of complications were noted. The commonest age group for ileostomies and caecostomies was 13-20 years and for colostomies was 21-30 years. There were 10 female and 40 male patients in total. Labourers were the commonest to have a stoma. This was also true for ileostomies and colostomies; whereas students were the most common to have caecostomies. Nine cases of ileostomy, 6 cases of caecostomy and 35 cases of colostomy were studied. About 10 [20%] colostomies were made in transverse colon, 5 [10%] in descending colon and 20 [40%] in sigmoid colon. Eight [16%] colostomies were the only permanent stomas in this study. There were 3 [60%] tube caecostomies and 2 [40%] formal caecostomies. There were 6 [66.7%] loop ileostomies and 3 [33.3%] end ileostomies. The implementation of proper surgical techniques reduces the chances of local stoma complications

Open and mini cholecystectomy [comparative study]

Cholelithiasis is the most common biliary pathology. Patients complain of recurrent attacks of epigastric or right hypochondrial pain, often radiating to the right side of back, associated with nausea and vomiting. To compare the 2 procedures i.e. conventional and mini cholecystectomy regarding postoperative pain, hospital stay and cosmetics. The study was carried out in Nishtar Hospital, Multan from May 2006 to June 2007. A total of 60 cases [30 cases underwent conventional cholecystectomy and other 30 cases underwent mini cholecystectomy]. Out of 60 patients, 18 [30%] were of < 40 years, 18 [30%] between 41-50 years and remaining 24 [40%] were of > 50 years. 48 [80%] patients were female while 12 [20%] were male. Among 30 patients of conventional cholecystectomy average hospital stay was 6.5 days while among 30 patients of mini-cholecystectomy average hospital stay was 3.3 days. Among 30 patients of conventional cholecystectomy severe postoperative pain was found in 18 [60%], moderate postoperative pain in 9 [30%] while mild postoperative pain in 3 [10%] of patients. In remaining 30 patients of mini-cholecystectomy severe postoperative pain was found in 12 [40%], moderate postoperative pain in 6 [20%] while mild postoperative pain in 12 [40%] of patients. Among 30 patients undergoing conventional cholecystectomy, all the patients developed bad looking scar while in remaining 30 patients undergoing mini-cholecystectomy, all patients developed good looking scar. Mini-cholecystectomy is associated with less patients discomfort and decreased incidence of postoperative complications, short hospital stay, good cosmetic results. Mini-cholecystectomy also has the advantage that it neither requires expensive new equipment nor the acquisition of novel skills by the surgeon

Duration between perforation and operation affecting the prognosis duodenal ulcer perforation

To describe the effect of perforation-operation interval on the prognosis of perforated duodenal ulcer. This descriptive study was conducted in surgical units of Nishtar Hospital, Multan during the period of two year from January 2004 to December 2005. There were 100 patients in study. All patients were divided into three groups according to perforation operation interval. In 58% of patients surgery was performed after 24 hours. Overall mortality of 16% in 50 patients was observed who underwent surgery. Mortality occurred only in group-B and C. Increased interval between perforation and operation increases stay in hospital. Number of complications in patients presenting with delay were much more than in patients presenting early. Morbidity rises with delay. Patients with perforated duodenal ulcers should he operated on as soon as possible. Simple closure of perforation is simple and safe with relativity low mortality and short stay in hospital

Inflammatory pseudotumour of urinary bladder

A young patient with gross haematuria was evaluated radiologically which revealed a solid mass measuring 7x7 cm in the urinary bladder. Cystoscopy showed a big solid mass at bladder dome. Biopsy was taken endoscopically. Histologically it turned out to be inflammatory pseudotumour. Later partial cystectomy was done with 1 cm healthy margins. Repeat biopsy confirmed the findings of previous histopathological examination

Surgical management of carcinoma of caecum

To study the various aspects of caecal carcinoma as age, sex, clinical presentation and diagnosis. This retrospective study was conducted in Surgical Units of Nishtar Hospital, Multan during the period from January 1997 to December 2000. A total of 60 patients were included in the study. There were 45 cases of males and only 15 cases of females. Male to female ratio was 4:1. The age range was 30-80 years. Most of the patients were between the ages 45-65 years. The youngest patient was 30 years old and the oldest patient was 80 years old. Both were males. The average age was 55 years. Mass in RIF was found in 42 patients, acute appendicitis was seen in 6 patients and intestinal obstruction was present in 12 cases. Right hemicolectomy with primary ileo-transverse anastomosis was done in 42 cases. Surgery is the mainstay in the treatment of carcinoma of caecum. Thus right hemicolectomy with primary ileo-transverse anastomosis is a safe procedure in fit patients even in emergency

Frequency of hepatitis-B and C viruses in healthy blood donors at Fatmid foundation, Multan

Viral hepatitis is a major public health problem throughout the world. Viruses which can lead to viral hepatitis are hepatitis-A virus [HAV], hepatitis-B virus [HBV], hepatitis-C virus [HCV], hepatitis-D virus [delta antigen], hepatitis-C virus [HEV] and hepatitis -G virus [HGV]. To see the frequency of hepatitis-B abd C in healthy blood donors at Fatimid Foundation, Multan. Fatimid Foundation, Multan. Fresh blood specimens were collected from the donors for processing. After clotting of blood, serum was separated by centrifugation for 20 minutes initially at 3500 rpm. Serum was then transfused into second tube and centrifuged again at 10,000 rpm for 20 minutes to remove the most of the medium weight interfering substances. Method used for screening of hepatitis-B and C was IMX or Ax sym, MEIA technology Abbott, USA. Out of these 16906 were males and 512 females. Age of male subjects was in the range of 16-45 years; age of female subjects was in the range of 18-40 years. HBsAg was positive in 891 males and 10 females. Anti-HCV was detected in 601 males and 11 females. Increasing trend of hepatitis-B and C points that more studies should be conducted and mode of spread must be studied deeply so that preventive measures may be started from the root levels. Special preventive measures must be told to these healthy carriers who are potentially dangerous for others. People should be encouraged to use disposable syringes

Evaluation of cardiac denervation in patients with long-standing diabetes

Evaluation of cardiac autonomic dysfunction in long-standing diabetics, comparing patients treated with insulin and oral hypoglycemic agents. Design: Observational and comparative study between two treatment groups. Place and Duration of Study: At Department of Medicine, Pakistan Institute of Medical Sciences, Islamabad, for 6 months. Subjects and Fifty diabetic patients of about 10 years illness were studied. Patients were divided into two groups, Group I [13 males, 12 females; mean age 33.08 years] included those who received insulin, and Group II patients [12 males, 13 females; mean age 54.68 years] who received oral hypoglycemic agents for their diabetic illness. Evaluation of cardiac denervation in both the groups was done in terms of presence of resting tachycardia, loss of sinus arrhythmia and abnormalities of Valsalva response. At least some form of cardiac denervation was present in 62% of total subjects. 48% of Group I and 76% of Group II patients. Asignificantly high number of patients treated with oral hypoglycemic agents had evidence of cardiac denervation when compared with patients who were treated with insulin [p < 0.05]. Cardiac denervation is common in long-standing diabetics specifically in those treated with oral hypoglycemic agents