Detection of interleukins-6 and 8 in saliva as potential biomarkers of oral pre-malignant lesion and oral carcinoma: a breakthrough in salivary diagnostics in Pakistan

Oral cancer is at rise in our population due to increasing use of areca nut [Betel nut] with or without tobacco. It is the second frequent malignant tumour for both the gender in Pakistan. This non-interventional case control study was carried out with the aim to explore saliva as diagnostic medium for detecting interleukins [IL] 6 and 8 as biomarkers of pre-malignant lesions [PML] and oral carcinoma. Total 105 subjects were recruited and were divided into three groups "A", "B" and "C" each comprising of 35 subjects. Group "A" comprised of cases with strong clinical evidence of oral PML. Group "B" constitute clinical and histologically proven OSCC and group "C" include disease free subjects as controls. Saliva from all the recruited subjects was procured by drooling method and stored at-20[degree sign]C before further process. All the collected samples were centrifuged at 4500 rpm for 15 minutes at 4[degree sign]C. Supernatant fluid was used in ELISA for detection and quantification of IL-6 and IL-8. Data was analysed by using Chi-square test and multivariate analysis was done by non-parametric test. P-value of 0.05 was taken as standard reference. Significant co-relation was found for qualitative salivary detection of IL-6 and IL-8 among the groups [P<0.001 and <0.0001 respectively]. Regarding quantitative salivary concentration of leukotrienes, no significant co-relation was found in levels of IL-6 among the groups while there was significant association of IL-8 levels between the groups [P<0.0001].On post Hoc multiple comparison, significant co-relation was found among oral PML group and controls [P=0.001] and OSCC group and control [P=<0.0001]. In conclusion salivary detection of IL-6 and IL-8 could be used as probable biomarker for early detection of oral PML and OSCC in etiologically distinct population of Pakistan

Effect of smoking on C-reactive protein levels in chronic periodontitis

The objective of the study was to compare the effect of smoking on the level of C-reactive protein [CRP] in chronic periodontal disease. The response of periodontal treatment and its effect on the level of the CRP was also observed in both groups. Hundred patients with chronic periodontitis were taken. Smoking history of the patients was assessed and accordingly, they were categorized as: Group A [smokers] and Group B [non- smokers]. Periodontal evaluation was done on every patient and blood samples were collected for noting the levels of CRP. All patients were then given treatment of chronic periodontitis by mechanical removal of calculus as well as prescription of antimicrobials and mouth rinses. Periodontal evaluation and blood samples were repeated three months after the given treatment to check the change in CRP levels. At Baseline, CRP levels of smoker group was more than non- smoker group. Three months after the given periodontal treatment, the periodontal health was significantly improved. Mean CRP level in both smoker group and non- smoker group was significantly decreased. Chronic periodontitis has significant effect on CRP levels. Chronic periodontitis may add to the inflammatory burden of an individual and this can be reverted to some extent if appropriate treatment is given. This response will not be affected by adverse effects of smoking

Salivary detection of human Papilloma virus 16 and 18 in pre-malignant and malignant lesions of oral cavity: Is it feasible in Pakistani context of Socio-Cultural Taboos?

To evaluate salivary detection of HPV-16 and 18 would be feasible and informative biomarker for oral pre-malignant and malignant lesion in our population. This non-interventional, case control study was carried out at department of E.N.T, Head and Neck Surgery, Dow University of Health Sciences, Dow Medical College and Civil Hospital Karachi, Pakistan between July 2011 to December 2012. Total of 105 cases were recruited. These were divided in three groups 'A', 'B' and 'C having 35 subjects each. Group'A' constitutes patients having strong clinical evidence of oral pre-malignant lesions [PML]. Group 'B' includes historically proven oral squamous cell carcinoma [OSCC] and Group 'C' comprised disease free subjects as controls. After taking informed consent, relevant clinical history was recorded on institutional approved performa. Saliva from all subjects was procured by standard 'drooling method'. Samples were stored at +4°C and later transferred to Laboratory to store at-20°C before further process. Samples werKfcentrifuged at 4500 rpm for 15 minutes at 4°C. Cell pellets sediments were used for identification of HPV-16 and 18 by real-time PCR method. Data was entered and analysed using SPSS version 16. P-value of 0.05 was taken as standard. In group 'A', HPV-16 was detected in 3 [8.6%] cases while HPV-18 was not detected in any of the subject. In group 'B', HPV-16 was detected in 07 [20%] while HPV-18 was found in 06 [17.1%] cases. Mixed HPV-16 and HPV-18 were found in 02 [5.7%] cases. In group 'C, HPV-16 was detected in 03 [8.6%] while HPV-18 was not detected in any of the subjects. Significant relationship was observed between the groups for HPV-18 detection [P= 0.002] while for HPV-16, no significant association was found [P= 0.245]. HPV infection for the causation of oral cancer cannot be fully established possibly due to small sample size. More over differences in genetic makeup, environment, indulgence in peculiar risk factor habits, sexual practices and difficult evaluation of the acquisition of viral load due to socio-cultural and religious restrictions could be the reason

Impact of untreated high blood pressure on renal function tests at initial diagnosis of hypertension

Pakistani population is at higher risk of developing hypertensive complications at a younger age, resulting from undiagnosed and untreated hypertension [HTN]. High cost of medical care is a barrier to early detection and assessment of end organ damage as well as physicians are disinclined to adopt more aggressive therapeutic management to improve blood pressure control. A cross sectional study was planned to determine the effect of high blood pressure on renal function tests in a random population aged 25-50 year, at initial diagnosis of hypertension. The study was conducted on total 276 subjects; 201selected from five general practitioners clinics in Karachi and were classified into pre hypertensive, and hypertensive stages I and II on the basis of 7th JNC report. Two BP readings were taken half an hour apart. A blood sample was drawn for measurement of serum urea, creatinine and a dipstick test was done to check protein in urine. The results were compared with 75 control, normotensive subjects. The percentage, mean and Standard deviation were computed. ANOVA was performed to compare four study groups and LSD test was applied to compare pair-wise group. Pearson's correlation was applied to find out association of renal function with stages of hypertension. The mean urea and creatinine levels were on higher normal side in HTN stages-I and II [39.91 +/- 8.51 and 1.72 +/- 0.54 in stage-I and 44.51 +/- 9.93 and 1.91 +/- 0.88 in stage-II respectively]. The frequency of proteinuria was also more in these groups, indicating declining renal function in these patients as compared to control and prehypertension groups. Subjects diagnosed with stage I and II HTN showed evidence of subclinical renal damage, along with the presence of proteinuria at the time of diagnosis

Molecular diagnosis of oral pre-malignant lesions and oral squamous cell carcinoma in saliva-a breakthrough in Pakistan

To evaluate salivary detection of interleukin 6 and 8 and high risk HPV-16 and 18 are informative biomarkers of Oral Pre-malignant Lesion [PML] and Oral Squamous Cell Carcinoma [OSCC] in our population. July 2011 to December 2012. Total 105 cases were included. The subjects were divided in three groups 'A', 'B' and 'C' having 35 participants each. Group 'A' comprised of patients having strong clinical evidence of oral PML. Group 'B' constitutes histologically proven OSCC and Group 'C' includes disease free subjects as controls. Relevant clinical history was recorded after informed consent on institutional approved performa. Saliva was collected as per standard drooling method'. Samples were stored at +4oC and later transferred to Dow Diagnostic, Research and Reference Laboratory to store it at -20oC before further process. Samples were subjected to centrifugation at 4500 rpm for 15 minutes at 4oC. Supernatant fluid phase was used in ELISA for detection and quantification of IL6 and IL8. . Cell pellets were used for identification of high risk HPV-16 and 18 by real-time PCR. Data was entered and analyzed on SPSS version 16. P-value of 0.05 was taken as standard reference. In group 'A', IL6 was not detected in almost all the subjects except one case. IL8 was detected in 26/35 [74.3%] subjects and not detected in 09 [25.7%] cases. In group 'B', IL6 was detected in 13 [37.1%] cases and in 22 [62.9%] cases, it cannot be detected. IL8 was detected in 33 [94.3%] and it was not detected in 02 [5.7%] subjects. It is observed that IL8 is consistently found raised in group 'A' and 'B'. In group 'C', IL6 was not detected in any of the subject while IL8 was detected in 10[28.6%] cases. Significant association was found for qualitative salivary detection of IL6 and IL8 between the groups [P= < 0.0001 and < 0.0001 respectively]. Regarding quantitative salivary concentration of IL6 and IL8, no significant co-relation was found in salivary levels of IL6 between the groups while there was significant association of salivary IL8 levels between the groups [P= <0.0001]. On post Hoc multiple comparison, significant co-relation was found in IL8 levels between oral PML group and controls [P=0.001] and OSCC group and controls [P= <0.0001]. In group 'A', HPV-16 was detected in salivary samples of 3 [8.6%] cases while HPV-18 was not detected. In group 'B', HPV-16 was detected in the salivary samples of 07 [20%] cases while HPV-18 was detected in 06 [17.1%] cases. Mixed HPV-16 and HPV-18 were found in 02 [5.7%] cases. In group 'C', HPV-16 was detected in 03[8.6%] cases while HPV-18 was not detected in any of the subjects. Significant relationship was observed between the groups for salivary HPV-18 detection [P= 0.002] while for detection of HPV-16, no significant association was found [P= 0.245]. Salivary concentration of IL6 and IL8 in oral PML and oral cancer are useful biomarkers in our population. Detection of HPV infection for the causation of oral cancer cannot be fully established possibly due to small sample size. More over different genetic makeup, environmental and geographic differences, indulgence in peculiar risk factor habits and different sexual practices compared to west due to socio-cultural and religious restrictions could be the reason

Influence of anthropometric measurements on abnormal gonadotropin secretion in women with polycystic ovary syndrome

To evaluate the influence of anthropometric measurements on abnormal gonadotropin secretion in patients with polycystic ovary syndrome [PCOS]. Cross-sectional study. The Institute of Basic Medical Sciences [IBMS], DUHS in collaboration with Gynae/infertility clinics of the Civil Hospital and Lady Dufferin Hospital, Karachi, from October 2010 to February 2011. One hundred and sixty three oligomenorrhic PCOS women of reproductive age [18 - 40 years] fulfilling the revised Rotterdam 2003 criteria were studied. The data recorded on a prescribed proforma included current age, age at menarche, menstrual irregularities, presence of hirsuitism, acne, infertility, familial nature, blood pressure, BMI and waisthip ratio. Blood samples for gonadotropin assay were taken randomly on day 6th to 30th of menstrual cycle, in a gel tube. Hormonal assay was performed using chemiluminescent immunoassay. Kruskul Wallis test was used to assess the influence of BMI levels on LH:FSH values. The mean weight was 66.14 +/- 11.02 kg and mean BMI was 27.03 +/- 4.42 kg/m2. There was no significant difference in mean LH/FSH ratio [p=.575] among BMI groups. However, there was a positive correlation between BMI and LH:FSH ratio [p=0.04, r=0.155]. There was high frequency of obesity [69%] in women with PCOS. Although no significant difference was found between mean LH:FSH ratio among different BMI groups levels but significant correlation between BMI levels and LH: FSH suggested that there was positive relation between BMI and LH: FSH

relationship between sleep and cognitive functioning in adult people

The purpose of the current study is to find out if subjective sleep complaints will have less cognitive functioning in older people [50 years and above]. Sleep was assessed with the subscale Sleep Problems of the Symptoms Checklist-90 [Arrendell and Ettema 1986]. Cognitive performance was measured with the Mini Mental Status Examination [Folstein, et al 1975] which is used as a dependent variable. Subjective complaints would be negatively associated with cognitive performance, since in elder people biological sleep is likely to be related with cognitive changes. A group of 12 people were given the task of collecting data through purposeful sampling techniques. Sample size of 120 participants was assessed. Each member of the group collected data from 10 subjects. Pearson Correlation Moment was applied for data analysis. In older persons the coefficient of falling asleep difficulty was -0.05 [p=0.33] and for waking up too early the coefficient was -0.13 [p=0.012] while for restless sleep coefficient was calculated as -0.09 [p=0.094]. The assumption was verified that sleep problems negatively associated with cognitive functioning

Effect of exercise training program in post-CRET post-CABG patients with normal and subnormal ejection fraction [EF > 50% or < 50%] after coronary artery bypass grafting surgery

The aim of the present study is to compare the effect of exercise training program in post-Cardiac Rehabilitation Exercise Training [CRET], post-CABG patients with normal and subnormal ejection fraction [EF >50% or <50%] who have undergoing coronary artery bypass grafting [CABG] surgery. The study was conducted on 100 cardiac patients of both sexes [age: 57-65 years] who after CABG surgery, were referred to the department of Physiotherapy and Rehabilitation between 2008 and 2010 at Liaquat National Hospital and Medical College, Karachi. The patients undertook exercise training program [using treadmill, Recumbent Bike], keeping in view the Borg's scale of perceived exertion, for 6 weeks. Heart Rate [HR] and Blood Pressure [BP] were measured and compared in post CABG Patients with EF [>50% or <50%] at the start and end of the exercise training program. Statistical formulae were applied to analyze the improvement in cardiac functional indicators. Exercise significantly restores the values of HR and BP [systolic] in post CABGT Patients with EF [>50% or <50%] from the baseline to the last session of the training program. There appeared significant improvement in cardiac function four to six weeks of treadmill exercise training program. After CABG all patients showed similar improvement in cardiac function with exercise training program. The exercise training program is beneficial for improving exercise capacity linked with recovery cardiac function in Pakistani CABG patients

Diabetes mellitus type 2 as a major risk factor of developing Alzheimer-s disease in Pakistani population

Diabetes mellitus type-2 [DMT2] could increase the risk of Alzheimers disease [AD] specifically related dementia, through several biological pathways, but the relationship between DM and the development of AD remains uncertain. The aim of the present study was to explore the status of diabetes as one of the major risk factors of cognitive decline and dementia in AD and to compare the risk of developing AD among subjects with and without DM. The baseline examination was conducted from January 2008 to October 2010 on 611 subjects of both sexes who were above 50 years of age, to detect the prevalent cases of dementia. The Mini-Mental State Examination [MMSE] was done on all of these subjects. At each follow-up, random blood glucose levels were determined; all participants underwent a comprehensive clinical examination The study shows that risk of dementia increases with age, duration of diabetes and relevant conditions e.g. obesity. The risk of Dementia increases with duration of diabetes and the chi-square tests verify the claim. The calculated chi-square test statistics value was found to be 130.26 with degrees of freedom 9, corresponding p-value is [<0.005]. It was also found that obese diabetics had higher risk of developing AD, as well as those having borderline diabetes were also at the higher risk. The present study revealed that DMT2 is one of the major risk factors that would increase the risk of AD; but along with other factors like obesity, lifestyle and aging, it can lead to AD and related pathological conditions in individuals markedly characterized by dementia and cognitive decline

Prevalence of elevated luteinizing hormone [LH]/follicle stimulating hormone [FSH] ratio in polycystic ovary syndrome [PCOS] women among local population

To assess the frequency of elevated LH/FSH ratio>l in women with polycystic ovary syndrome among local population. Cross-sectional study. This cross sectional study was carried out at two tertiary care hospitals in Karachi during October 2010 to Feb 2011. A total of 163 PCOS women of reproductive age [18-40years] fulfilling revised Rotterdam 2003 criteria were studied. The data recorded on a prescribed proforma include current age, age at menarche, menstrual irregularities, presence of hirsuitism, acne, infertility, familial nature, blood pressure, BMI, waist to hip ratio. Blood sample for gonadotropin assay were taken in random state on specific dates of menstrual cycle [day 6[th] to day 30[th]] in gel tube. Hormonal assay were performed using chemiluminescent immunoassay. Mean age of presentation of PCOS subjects was 24.88 +/- 5.35 years. Menstrual irregularities [99%] were the commonest presentation followed by acne [88%], hirsuitism [71%] and infertility [62%]. A high frequency [>71%] of elevated LH/FSH >1 ratio was observed among local population. The present study concludes that elevated LH/FSH ratio>l is a characteristic finding of Pakistani population of PCOS [present in = 71% of patients] and with proper sampling dates can be used as diagnostic tool for establishing the diagnosis of PCOS

Perception and preferences of undergraduate medical students regarding the use of contemporary teaching aids at Dow International Medical College, Karachi

In this study, perception and preferences of the medical students' studying at Dow International Medical College have been described about the use of different teaching aids. Cross sectional survey was conducted on a stratified random sample of 200 undergraduate medical students during the month of October 2010 at Dow International Medical College, Karachi, Pakistan. 80% of the students responded to the questions asked. Over all 40% of the students chose powerpoint presentations as a reliable mode of teaching and favoured it as interesting and interactive teaching aid over problem based learning [28.8%], audio visual aid [18.6%] and white board [12%]. They believe that powerpoint provides a better learning experience as compared to other teaching tools. Projectors as a teaching tool was rejected by the students. This article serves as a source of valuable information for the faculty members. Students have chosen powerpoint presentations as the best teaching aid and have preferred the integration of different teaching tools for better understanding. Teachers will be able to use this information to develops better understanding about the subject matter among students by considering their learning style preferences. It will also facilitate them in developing interest and active participation of students in the classroom

Level of C-reactive protein in periodontal patients before and after treatment in a teaching hospital selected population

To determine the change in C-reactive protein [CRP] levels in subjects after treatment of chronic periodontitis. 100 patients, aged 30 to 50 years, having chronic periodontitis with a periodontal index [PI] of 6 and 8 were selected from low socioeconomic class. The patients completed a structured questionnaire that included data regarding oral and general health habits. They received treatment for chronic periodontitis and PI was reassessed after 3months.CRPlevelswere similarly measured at baseline and 3months after treatment. The mean PI of all subjects was 7.3 +/- 0.96 and 4.53 +/- 1.93 before and after treatment, respectively. Similarly, the mean CRP level [in mg/L] was 6.34 +/- 2.29 and 5.62 +/- 2.01 before and after treatment, respectively. CRP levels were higher in males as compared to females, at baseline than after treatment. However, both groups responded equally to treatment [P < 0.0005]. CRP levels were also higher in older age groups [> 40 years], both at baseline and after treatment. The CRP levels accompanied the severity of periodontal infection, and decreased significantly after improvement of periodontal health following the treatment

Apoptosis in oral diagnostics: an overview

Apoptosis describes the molecular and morphological processes leading to controlled cellular self destruction. In recent years, it has been investigated for its biological significance in numerous physiological processes including embryogenesis, differentiation, proliferation /homeostasis and in the regulation of immune system. Its dysfunction and deregulation seems responsible for variety of pathological conditions e.g immune deficiency, autoimmune diseases, neuro-degenerative diseases and cancer. This communication updates molecular understanding of this natural phenomenon and its application in oral diagnostics. The present concept of signaling pathways for initiation of apoptotic characteristic changes is illustrated and the role of certain apoptotic genes identified so far is discussed. Abnormality of apoptosis and apoptotic regulatory genes during oral carcinogenesis. though conflictory, is presented. Further, clinical potential for monitoring reactions to chemo-radiotherapy is evaluated from human and animal studies and their usage as physiological markers for oral preneoplasia and squamous cell carcinoma is analyzed. On the basis of oral cytology the application of new physical and molecular methodological techniques is outlined e.g cytophotometry, DNA cytometry in relation to molecular studies and their diagnostic and prognostic implications. Understanding of molecular mechanisms provides development of newer therapeutic approaches in disease management and in future biomedical research. This overview updates molecular understanding of this natural phenomenon as its applications seem to have potential for managing common diseases in future

Anthropometric and metabolic indicators in hypertensive patients

To determine the relationship between anthropometric variables with blood glucose and lipid concentrations in different stages of hypertension and evaluate the risk factors involved in progression of pre-hypertension stage in to clinical hypertension stage-1. Case-control study. National Institute of Cardiovascular Disease and General Practitioner's Clinics, Karachi, from 2005 to 2007. The study was conducted on 276 participants aged 25-65 years and classified into four categories of control, prehypertension [pre-HTN], hypertension [HTN] stage I and II, according to 7th JNC report. Anthropometric measurements and blood chemistry were obtained. The relationship between obesity indices [Body Mass Index [BMI], Waist Circumference [WC], Waist Hip Ratio [WHpR], Waist Height Ratio [WHtR], Basal Metabolic Rate [BMR] and Cardiovascular Disease [CVD] risk factors [blood pressure, serum lipids and glucose levels]] were investigated. The analysis of variance and test of Pearson's coefficient correlation were applied to assess relationship of all the variables. The mean WHR had significant correlation with both systolic and diastolic BP in all groups of HTN, as well as with blood glucose level in control and pre-HTN groups. BMI was positively correlated with cholesterol [r=0.29] and triglyceride [r=0.25] in HTN stage-1. Impaired and high blood glucose levels were found in pre-HTN group; all lipid parameters except triglycerides were higher in HTN stage I. WHR was positively and independently related to occurrence of arterial hypertension. Elevated levels of WHR, BMI, fasting blood glucose, total cholesterol and triglycerides were responsible for progression of pre-HTN stage in to HTN stage-1

Changes in blood pressure, BMI and ECG patterns in women using low-dose contraceptives

To determine the cardiovascular risk factors in users of second generation contraceptives by recording changes in body mass index, blood pressure and electrocardiogram. Cross-sectional study. The National Institute of Fertility Research Centers at Jinnah Postgraduate Medical Center and PIB Maternity Home Karachi, from July 1997 to 1999. Sixty four women volunteered for this study [age range 20-35 years], belonging to low-income group with similar socio-cultural background. The Body Mass Index [BMI] was calculated by measuring height and weight of the subjects; systolic and diastolic blood pressure and ECG recording by standard method. The group means, standard deviations and coefficient correlation for interrelationship among variables in respective groups of subjects were calculated using relevant statistical method and software program. There was no significant difference between BMI of two types of contraceptive users as compared to non users; but BMI was significantly correlated with both systolic and diastolic blood pressures in injectable users as compared to controls. ECG alterations frequently observed in contraceptive users [40%] as compared to controls were normal findings. It was observed that women aged < 30 years and using contraceptives for more than three years had a tendency to gain weight and developed a mild increase in systolic and diastolic blood pressures

effects of brushing habits and salivary pH on caries status of first year dental students at a private Dental College in Karachi

To study the effect of brushing habits and salivary pH on caries status of dental students. A secondary aim was to promote awareness among the students regarding their oral health. A total of 90 first year dental students, [aged 18 to 21 years] belonging to middle/high socioeconomic class were questioned regarding their toothbrushing and eating habits and later subjected to estimation of salivary pH and oral examination. The subjects were divided into controls and diseased [carious] categories, the later further subdivided into three groups according to their DMFT indices. [expressed as mean+SD] The overall DMFT index was 1.71 and that in groups A, B and C was 1.75 +/- 0.59, 5.16 +/- 0.81 and 8.22 +/- 0.83 respectively. Brushing frequency decreased from 1.89 +/- 0.55 in controls to 1.50 +/- 0.54 in group B, but increased to 1.88 +/- 0.59 in group C. Likewise, the periodontal status was healthiest in group C. The salivary pH of controls was 7.29 +/- 0.47 and progressively fell to 6.55 +/- 0.39 in group C. Marginal differences were seen in the dietary pattern of controls and diseased subjects. Tooth brushing and salivary pH had a direct relation with dental caries; however, further studies are needed to emphasize the importance of salivary pH as a meaningful indicator of current or upcoming oral health problems

Influence of steroid hormones in women with mild catamenial Epilepsy

In view of considerable differences of opinion regarding the reproductive steroid hormonal pathogenesis in catamenial epilepsy, hormonal analysis of estrogen and progesterone in catamenial epileptics for a precise correlation is of significant importance. Clinical, neurological and physiological assessments, and radioimmunoassay of plasma estradiol-17b and progesterone a day prior to the onset of menstruation were carried out in noncatamenial and mild catamenial epileptics having multiple frequency tonic-clonic [primary and secondary generalized] seizures. Highly significant rise [p > 0.0001] of estradiol-17b was obtained for catamenial epileptics compared to normal subjects as well as noncatamenial epileptics [p > 0.02]. However, nonsignificant fluctuations of progesterone were found for both catamenial and noncatamenial epileptics against normal subjects as well as catamenial versus noncatamenial epileptics. The present report suggests that estradiol have a precise role in the mild premenstrual exacerbation of seizures. However, no significant change in progesterone levels might have been due to mild exacerbation of seizures in these patients. Furthermore, we suggest the importance of how we collect and categorize the data and which pathophysiologic process/ clinicobiological mechanism is involved in patients with catamenial epilepsy. Contradictory results in literature may be related to differential levels of excitation/inhibition equilibrium during various cycle phases. More precise studies including the determination of the blood levels of antiepileptic drugs, however, are required

Fibrinogen titer and glycemic status in women using contraceptives

To assess the coagulation and glycemic status in Pakistani women using contraceptives. Design: The study was conducted prospectively on 70 women and compared with 10 age-matched controls. Place and Duration of Study: The study was conducted at Karachi. Period of study was 18 month. Subjects and Eighty women aged between 20-45 years selected from low socioeconomic class and poor family background were categorized in control [n=10] and oral and injectable contraceptive users [n=70]. The contraceptives used were tablet Lofemenal, injection Norigest and Norplant implant. Their blood was tested for fibrinogen titer and random blood glucose. There was no appreciable difference either in fibrinogen titer or plasma glucose levels in injectable users as compared to controls, but increased incidence of high fibrinogen titer and borderline blood glucose was observed in oral contraceptive users 25% and 20% respectively. It was concluded that long-term use of oral contraceptives [> 3 years] might increase the thrombotic tendency and elevate the plasma glucose levels especially in women above 30 years of age

Reflux oesophagitis: a comparison of treatment with normal and slow release metoclopramide preparations

Twenty four patients with reflux oesophagitis were recruited into a crossover study of normal release metocloparmide [Maxolon tablets 10 mg three times a day] and slow release metocloparmide [Digestine capsules 40 mg equivalent to 16 mg metoclopramide HCI-once daily]. Both treatment regimens were found to be effective in the relief of reflux symptoms. The incidence of side effects was similar in both groups. Slow release was preferred by more patients. It is concluded that normal release metoclopramide given 10 mg three daily and slow release metoclopramide given 16 mg once daily are equally effective and both are well tolerated; however the slow release preparation has the advantage of smaller dose and once daily administration