Effect of raphanus sativus [radish] leaf extract on atorvastatin induced hepatotoxicity in rabbits

Objectives: To investigate hepato-protective effect of ethanolic leave extract of Raphanus sativus against atorvastatin induced hepatotoxicity in albino rabbits

Study design: Experimental study

Material and Method: This study conducted at department of Physiology and Pharmacology, University of Agriculture, Faisalabad. The ethanolic extract of Raphanus sativus was prepared for hepatoprotective effect against hepatotoxicity produced by atorvastatin

Results: The results were compared with normal and experimental control. Serum was tested for ALT, AST, Alkaline Phosphatase and Bilirubin along with histological studies. Ethanolic extract of Raphanus sativus with 100mg/kg. of body weight dosage developed some changes representing hepatotoxicity but higher doses showed an increase in toxicity as observed on histologic sections. A reduction in fibrosis and cholestasis was observed which needs further evaluation

Conclusion: Ethanolic extract of raphanus sativus did not show any amelioration in the increased enzymes level however a reduction in cholestasis was observed as represented by decreases in alkaline phosphatase levels also confirmed by histological studies

Knowledge, attitude and practice of MBBS Students regarding Hepatitis B and C: a cross sectional survey at Faisalabad medical University, Faisalabad

Background: Hepatitis is a public health problem throughout the world. The chances of job-related exposure to hepatitis among healthcare workers is a key concern, particularly among students in healthcare profession

Methods: This six months [Jan to Jun 2017] cross-sectional study was carried out at Faisalabad Medical University, Faisalabad. Total 300 MBBS students [1st to 4th year] took part in this study. Data was collected using validated self-administered questionnaire. Descriptive statistics and Chi-square tests were used to find out the association between variables in the study

Results:Of 300 medical students, 40.6 percent were males and 59.4 percent were females. Female and older students demonstrated higher knowledge regarding hepatitis B and C, route of transmission, and availability of treatment for hepatitis B and C. Among them, 58.7 percent of males and 61.4 percent females had sufficient basic knowledge about hepatitis B and C. Moreover, 54 percent males and 57 percent females had good knowledge about sources for spreading of hepatitis while 54 percent males and 62 percent females had good knowledge regarding prevention against hepatitis. From total 300 students, 156 [52 percent] were vaccinated against hepatitis B. Lack of time was the most common reason reported for not being vaccinated against hepatitis B

Conclusion: The majority of participants in this study showed sufficient knowledge concerning HBV and HCV, route of transmission and prevention

Conclusion: It was concluded that CTG coupled with fetal blood sampling for fetal pH versus carditocography alone is an accurate method for assessment of fetal condition in labour to decide the mode of delivery and neonatal outcome after birth

Silent peptic ulcer disease perforation

Objective: To determine the frequency of asymptomatic [silent] peptic ulcer disease [PUD] perforation and risk factors associated with it

Study design: Descriptive case series

Place and Duration of study: Surgical Unit 1, Ward-3 Jinnah Postgraduate Medical Centre [JPMC] Karachi, from January 2014 to December 2016

Methodology: All patients above twelve year of age operated due to peptic ulcer perforation with history of known case of PUD and asymptomatic patients with spontaneous perforation were included. Risk factors like H-pylori infection, use of NSAIDs, smoking, alcohol consumption, betel nut consumption and socioeconomic status were noted. Frequencies of asymptomatic and symptomatic PUD patients with perforations were determined and risk factors for both the groups were analyzed

Results: Total of 198 patients of acute peritonitis due to peptic ulcer perforation were operated in three year period. Among these 171 [86.34%] patients were male and 27 [13.64%] female. One hundred and fifty three [77.27%] patients had no previous history of PUD and 45 [22.73%] were known cases of PUD and partially treated. H-pylori was detected in 35/45 [77.77%] in symptomatic group and 115/153 [75.16%] in asymptomatic group. Smokers were 9/45[20%] in symptomatic group and 54/153 [35.29%] in asymptomatic group. NSAID and steroid users were 9/45 [20%] in symptomatic and 54/153 [35.29%] in asymptomatic group. Alcoholics were 18/45 [40%] in symptomatic and 27/153 [17.64%] in asymptomatic group. Betel nut was rare risk factor. All patients belonged to low socioeconomic group

Conclusions: Frequency of silent perforation was 77.27%. Major risk factors were H-pylori infection and NSAID use. Screening for H-pylori and use of antiulcer drugs can decrease the perforation of PUD

Tuberculosis of intestine

Objective: to determine the clinical spectrum and surgical outcome of gastro-intestinal tuberculosis

Study design: descriptive case series

Place and Duration of study: department of General surgery ward 3 Jinnah Postgraduate Medical Center [JPMC] Karachi, from June 2010 - July 2015

Methodology: all patients who were diagnosed as cases of gastrointestinal tuberculosis and underwent operative procedures were included. Data was collected on a structured proforma. The variables collected included age of the patients, gender, clinical presentation, surgical procedures performed and outcome

Results: a total of 100 patients were managed. There were 67 female and 33 male patients. Female to male ratio was 2:1. The minimum age was 13 year and maximum 50 year with the mean age of 32 year. Apart from the constitutional symptoms like nausea, vomiting and low grade fever, abdominal pain was the commonest presentation. Eighty-eight patients were operated. End ileostomy, limited right hemicolectomy and resection anastomosis with primary repair were the commonly performed procedures. Two patients developed enterocutaneous fistulae. Five patients presented with septic shock and died

Conclusion: intestinal TB had varied presentation. It was found more frequently in females. Fever and weight loss were common presentations. High index of suspicion must be exercised in making a diagnosis

Recurrent laryngeal nerve palsy and hypocalcemia with and without bilateral ligation of inferior thyroid artery in total thyroidectomy

Objective: To find out frequency of recurrent laryngeal nerve palsy and hypocalcemia with and without bilateral ligation of inferior thyroid artery [ITA] in total thyroidectomy

Study design: Descriptive case series

Place and duration of study: Department of General Surgery ward 3, Jinnah Postgraduate Medical Center Karachi, from April 2010 to April 2015

Methodology: All patients of non toxic multimodular goitre who had indication for surgery were included. Patients were divided in two groups. In group I patients ITA was ligated and in group II it was left alone during total thyroidectomy. Postoperatively serum calcium level was done after 24 hours, 48 hours and on Day 7. Voice changes were also noted. If hypocalcemia and voice changes recovered within 6 months then the condition was labeled as transient phenomenon. If changes persisted then it was considered permanent insult

Results: There were 100 patients of non toxic multimodular goitre in this series. Age range was from 12 year to 65 year. In each group there were 48 females and 2 males. In group I 12 [24%] patients developed transient hypocalcemia and 3 [6%] had transient recurrent laryngeal nerve palsy. In group II 10 [20%] developed hypocalcemia and 7 [14%] had recurrent laryngeal nerve palsy. All were transient in nature

Conclusion: The frequency of hypocalcemia and recurrent laryngeal palsy was less in patents with bilateral ITA ligation

Frequency of peptic ulcer perforation during fasting and without fasting

Objective: To find out the frequency of peptic ulcer perforation during fasting in the month of Ramadan with non-fasting during other months

Study design: Descriptive case series

Place and duration of study: Department of Surgery Ward-3 Jinnah Postgraduate Medical Center Karachi, from January 2005 to November 2014

Methodology: The data of 220 patients who were operated due to peptic ulcer perforation, was analylsed. Patients were divided into 2 groups. Group I [n= 139] included patients who were operated in the months other than Ramadan, while group II [n= 81] included patients who were operated during the month of Ramadan. The patients of peptic ulcer due to malignancy were excluded

Results: Of the total there were 209 male and 11 female patients. Age range was 12 year to 65 year. Most of the patients [n=178 - 85%] were between 20 year to 50 year of age. Frequency of perforation was highest in Ramadan then in Shawal month and was less in other months of the year. On average patients with peptic ulcer in Ramadan were 8.1 and in non-fasting months 1.2

Conclusion: The frequency of perforation in peptic ulcer disease was higher in Ramadan month during fasting state as compared to other months of the year

CT guided percutaneous drainage of pancreatic abscess

Objective: to determine the outcome of CT guided percutaneous drainage of pancreatic abscess

Study design: descriptive case series

Place and Duration of study: department of General Surgery Unit I, Jinnah Postgraduate Medical Centre Karachi, from October 2011 to October 2015

Methodology: all patients with acute pancreatitis who developed pancreatic abscess which was diagnosed on clinical grounds and with CT scan abdomen underwent CT guided percutaneous drainage. Following aspiration fluid sent for culture and sensitivity and drain was placed in the abscess cavity. CT scan was repeated and if no residual collection found with clinical improvement of symptoms, patients were discharged. Patients who did not improve up to 40 days or clinically deteriorated and developed complications like sepsis or pancreatic fistula formation, underwent surgical intervention. Data was collected on specially designed performa

Results: five Hundred and fifty eight patients of acute pancreatitis were admitted during the study period and among them 25 [4.48%] patients developed pancreatic abscess. Four [16%] patients were male and 21 [84%] female. Mean age was 45 +/- 10 year. Twenty [80%] patients were cured with percutaneous drainage in 20 - 40 days and five [20%] developed complications for which open surgical intervention was done. One [4%] developed pancreatic fistula and one [4%] patient died. Three patients improved with surgical intervention

Conclusion: CT guided percutaneous drainage is minimally invasive and effective surgical treatment for pancreatic abscess

Morbidity and mortality in acute pancreatitis

Objective: to determine the morbidity, mortality and causes of acute pancreatitis in patients presenting to a tertiary care hospital

Study design: descriptive case series

Place and Duration of study: department of Surgery Ward 3 Jinnah Postgraduate Medical Centre Karachi, from October 2013 to October 2015

Methodology: patients diagnosed as having acute pancreatitis were included in the study. Laboratory and radiological investigation were carried out. Local, systemic complications, mortality and causes of acute pancreatitis were noted. Patients were followed up to 3 months to record the late complication of acute pancreatitis

Results: a total of 220 patients of acute pancreatitis were included. Average age of patients was 43 year. There were 150 [68.18%] female and 70 [31.82%] male patients. Of the total 176 [80%] patients had acute mild pancreatitis, 24 [10.90%] acute moderate pancreatitis and 20 [9.10%] acute severe pancreatitis. Overall mortality was 3.64% [n=8]. Mortality in acute moderate pancreatitis was 8.33% and in acute severe pancreatitis 30%. Local and systemic complications occurred in 18.33% patients. This included ARDS [20%], pleural effusion [20%], hypocalcaemia [20%], shock [18.8%], neurological [13.63%] and renal failure [13.63%]. In 85% cases cause of acute pancreatitis was cholelithiasis

Conclusions: overall mortality in acute pancreatitis was 3.64. It was more in cases of acute severe pancreatitis. The major cause of acute pancreatitis was cholelithiasis

In vitro larvicidal potential against Anopheles stephensi and antioxidative enzyme activities of Ginkgo biloba, Stevia rebaudiana and Parthenium hysterophorous

OBJECTIVE@#To investigate in vitro larvicidal and antioxidant enzymes potential of the medicinal plants Ginkgo biloba (G. biloba), Stevia rebaudiana (S. rebaudiana) and Parthenium hysterophorous (P. hysterophorous) against Anopheles stephensi (An. stephensi) 4th instars larvae.@*METHODS@#For evaluation of larvicidal potential, the ethanolic, methanolic and dichloromethane leaves extracts of three different plants were used in dose-dependent experiments in two media, while the antioxidant enzymes activities were investigated using four different methods viz., superoxide dismutase, peroxidase, ascorbate and catalase.@*RESULTS@#An. stephensi has developed resistance to various synthetic insecticides, making its control increasingly difficult. The comparative performance of ethanolic extracts (65%-90%) was found better than the methanolic extract (70%-87%) and dichloromethane extract (60%-70%). Among the three plants extracts tested in two media, S. rebaudiana exhibited higher larvicidal activity with LC(50) (24 h) in methanolic extract than P. hysterophorous and G. biloba. G. biloba and P. hysterophorous exhibited the strongest antioxidative enzymes activity and S. rebaudiana were less active and no significant difference was observed.@*CONCLUSIONS@#These three plants exhibit larvicidal potential and can be further used for vector control alternative to synthetic insecticide due to eco-friendly and diseases control, furthermore these plant species have potent antioxidative enzyme activities, therefore, making them strong natural candidate particularly for diseases which are caused due to free radicals.

Relationship between spiritual wellness and quality of life among university students

The present study was sought to examine the relationship between spiritual wellness, quality of life and its dimensions including physical, psychological, social, environmental, and perception of quality and health. Spiritual Wellness Inventory [Ingersoll, 1998] and World Health Organization Quality of Life Questionnaire [Power, 2003] was used to collect the data. Sample of the present study consisted of college and university students [N=313]. Purposive continent sampling technique was used to collect the information. The hypotheses were supported in the present study. Results of the Pearson correlation indicate that spiritual weliness has significant positive correlation with quality of life and its dimensions including physical, psychological, social, environmental quality of life, and perception about quality and health. They present study is pretty insightful in understanding the association of spiritual wellness with the quality of life and its different aspects

Papillary thyroid carcinoma with tuberculous cervical lymphadenopathy mimicking metastasis

To determine the frequency of tuberculous cervical lymphadenopathy mimicking metastasis from papillary thyroid cancer. Case series. Surgical Unit-I, Ward-3 of Jinnah Postgraduate Medical Centre, Karachi, from March 2005 to March 2010. All patients above 12 years of age of either gender diagnosed on investigations as papillary thyroid cancer [PTC] were included in the study. Ultrasound and fine needle aspiration cytology [FNAC], neck of solitary thyroid nodules [STN] and cervical lymph nodes were done. Total thyroidectomy and excision biopsy of cervical lymph nodes was performed, histopathological results were recorded and patients were managed accordingly. A total of 55 patients had PTC and 25 had cervical lymphadenopathy. Eighteen patients of PTC with cervical lymphadenopathy were diagnosed after investigations as cases of tuberculous cervical lymphadenopathy [TCL] initially considered as metastasis from PTC; 5 patients had metastasis from PTC. Two patients proved to be of reactive hyperplasia which initially showed tuberculous cervical lymphadenopathy on FNAC. So 80% patients of cervical lymphadenopathy with PTC were due to benign disease and 20% had metastasis in lymph node due to PTC. PTC with cervical lymphadenopathy due to co-existent tuberculosis is common. Metastasis from PTC in lymph nodes were less common than tuberculous lymphodenitis in this study. Tuberculosis should be considered before deciding for neck dissection in cases of PTC

Carcinoma thyroid in multi and uninodular goiter

To determine the frequency and profile of carcinoma in multi-nodular goiter and solitary thyroid nodule. Case series. Surgical Unit-I, Ward-3 of Jinnah Postgraduate Medical Center, Karachi, from January 1999 to January 2009. Cases with solitary thyroid nodules and multi-nodular goiter were included. Patients under 12 years of age, cystic benign lesion in solitary thyroid nodules or those multi-nodular goiters, which were not causing pressure symptoms, cosmetic problems or sign of malignancy were excluded. In solitary thyroid nodule, hemithyroidectomy was done and if histopathology examination revealed carcinoma thyroid then completion thyroidectomyw as done. In multi-nodular goiter sub-total thyroidectomy done. Results were described as frequency percentages and mean. Out of 379 patients of multi-nodular goiter only one patient was found to be papillary carcinoma [0.25%]. In 220 patients of solitary thyroid nodules, 93 patients were diagnosed as carcinoma of thyroid [42.27%]. Others diagnosed in solitary thyrid nodule were thyroid adenoma, colloid goiter, thyroiditis and multi-nodular goiter. The frequency of papillary carcinoma in 65.95% occurring females of 12-30 years of age and being multifocal in 6.45% follicular carcinoma in 23.49%, medullary carcinoma in 7.44%, analplastic carcinoma in 2.12% and lymphoma in 1.01%. Female were predominantly involved and papillary carcinoma was common in 12-30 years of age [7.63%] and follicular was common in 30-40 years of age [68.18%. 6.45% of papillary carcinoma was found to be multifocal in nature. Frequency of carcinoma of thyroid is very high in solitary thyroid nodule [42.27%], but markedly low in multi-nodular goiter. Papillary carcinoma is the most common variety, most of in younger female

Relationship between silica dust exposure and chronic obstructive pulmonary disease in workers of dust generating industries of district Peshawar

Chronic Obstructive Pulmonary Disease is a common cause of morbidity worldwide. This study was conducted to assess the relationship between silica dust inhalation and COPD among workers of dust generating industries. This cross sectional study was conducted in three main industrial regions of Peshawar i.e. Industrial Estate Hayatabad, Industrial area Ring Road and Industries of Warsak Road Peshawar. A preformed questionnaire was used to interview 160 workers, 40 each from stone-grinding, ceramics, pottery and brick industries respectively. Only workers having worked for more than five years were selected through convenient sampling. A total of 160 workers were interviewed out of which 56[35%] were symptomatic while 104[65%] were asymptomatic. Among symptomatic ones, 20[19.8%] were in 20-40years age group and 36[61%] in 41-60 years age group. In regard to exposure status, 7[26%] were symptomatic in those exposed for 5-10 years, 29[31.5%] amongst those exposed for 11-15 years and 20[49%] in those exposed for 15-20 years. With respect to working hours, none was symptomatic in those who had worked for 6 hours or less while 56[40%] were symptomatic in those who had worked for 8 or more hours. Among 128 smokers, 48[37.5%] were symptomatic and amongst 32 non-smokers 8[25%] were symptomatic. Amongst the symptomatic cases symptoms appeared within 5-10 years in 7[12.5%] of the cases, within 10-15 years in 29[51.8%] of the cases and within 15-20 years in 20[35.7%] of the cases. The major symptoms reported were cough in 56[100%] of the cases, dyspnea in 48[85.7%] and wheezing in 49[87.5%] of the symptomatic cases. The study revealed that majority of respondents who were exposed to silica dust for ten years or more, had respiratory problems. The severity of the problems was directly proportional to the duration of exposure to silica dust, density of dust [maximum in stone crushing], hours of daily exposure and other contributory factors like tobacco smoking and increasing age

Complications of laparoscopic cholecystectomy: a learning curve

The objective of the study was to find out the rate of complications of laparoscopic cholecystectomy being performed by trainees under supervision. Case Series. Place and Duration: Study was conducted in Surgical unit-1 [ward-3] of JPMC Karachi from November 2001 to November 2005. All the patients above twelve years of age of both sexes were admitted for laparoscopic cholecystectomy after evaluation in the outpatients department who were diagnosed as cases of chronic cholecystitis with cholelithiasis. A total of 620 patients were included in the study. Biliary complications were 0.16% and non biliary 0.8%. Vascular injury, diaphragmatic injury and pneumothorax did not occur in our study. Complications of laparoscopic cholecystectomy in the hands of trainees can be minimized by adhering to the principles of good laparoscopic surgery

Causes of intestinal obstruction: a study of 257 patients

To find out the common causes of intestinal obstruction in our practice. Design: Descriptive study. Place and Duration: The study was conducted in Surgical Unit-I, Ward-3 of Jinnah Postgraduate Medical Centre, Karachi, Pakistan between February, 2000 to January, 2004. Patient And In this study we included only those patients of intestinal obstruction who underwent exploratory laparotomy. Total of 257 patients of intestinal obstruction were diagnosed on the basis of clinical history, examination, radiological findings and investigations. After resuscitation exploratory laparotomy was performed to confirm the diagnosis and relieve the obstruction. The most common cause of intestinal obstruction was tuberculosis, 38.13% followed by obstructed/strangulated hernia 26.84%, post-operative adhesions 17.12%, large gut malignancy 10.09%, volvulus 6.22% and small gut malignancy 0.77%. The causes of intestinal obstruction are variable in different parts of world. Tuberculosis is one of the leading cause of intestinal obstruction in Pakistan