Polymeric emulgel carrying Cinnamomum tamala extract: promising delivery system for potential topical applications

Currently, the use of natural compounds obtained from plants tremendously increased due to their promising therapeutic properties. The aim of this study was to formulate a stable emulgel formulation loaded with Cinnamomum tamala (CT) extract. The antioxidant activity of plant extract was determined by DPPH inhibition assay. The extract was successfully loaded into an emulgels using different concentrations of carbopol-940, liquid paraffin, emulsifying agents and preservatives. Preliminary stability study was performed of 17 CT emulgel formulations at accelerated temperature of 50 °C for 2-months. Organoleptic evaluation, centrifugation, globule size, pH, electrical conductivity and rheological studies were performed for a period of 90-days at different temperature including 8, 25, 40 and 40 °C ±75% RH. The CT extract showed promising antioxidant activity of about 81%. On the other hand, the CT loaded emulgel formulation displayed high physical stability at all tested conditions of temperature and time. However, slight decrease in pH and minimum increase in conductivity was observed at 40 and 40 °C±75% RH. The rheological examination of CT emulgel indicated the flow index values of all the samples kept at different temperatures were less than 1, demonstrated non-newtonian and pseudo-plastic nature of CT emulgel. Taken together, the CT emulgel formulation has been evinced to be an excellent addition in the field of topical formulations.

Clinical, sonological and radiographic predictors of abdominal injuries after blunt abdominal trauma

There are several situations that complicate the diagnosis of abdominal injuries. Physical examination may be unreliable due to the presence of multiple trauma or changes in the levels of consciousness. This prospective observational study was done consecutive adult blunt abdominal trauma patients. Parameters from pre hospital information, physical examination, laboratory investigations, FAST, and CR were recorded for all patients. Predictors for the presence of ≥1 injuries on abdominal CT were determined. 175 patients were included, with mean ages of 32.94± 14.21 years. 145 had injuries on abdominal CT. Patients with abdominal injuries had significantly lower mean systolic BP on admission (98.79±12.8 v/s 114±7.38), lower mean GCS (11.70±2.02 vs 13.10±1.74), significantly lower levels of hematocrit (29.18±8.31 v/s 34.33±6.46 %); significant difference in presence of abdominal bruises [pvalue ≤ 0.0001,or 6.669 CI (2.42-18.47)]; abdominal tenderness [p value ≤ 0.0001, or 63.708 CI (20.171-201.218)] and guarding /rigidity[ p value ≤ 0.0001, or 5.662 CI (2.054- 15.608) ], significantly higher frequency of abnormal chest CR [p value 0.019, or: 7.886 CI (1.033- 60.202)] ; significantly higher frequency of abnormal pelvic CR [p value : 0.011; or : 8.545 ( CI: Peerzada Ziaulhaq, Mohammad Imran Wagay, Sheikh Riaz Rasool, Rouf A Wani, Naseer A Choh, Saba Banday. Clinical, sonological and radiographic predictors of abdominal injuries after blunt abdominal trauma. IAIM, 2018; 5(4): 144-152. Page 145 1.121-65.115)]; significantly higher frequency of FAST score of > 3 [ p value : ≤ 0.0001 , or 0.034 (0.005-0.256)] as compared to the group of patients with no organ injuries on CT. we observed that the predictors for injuries on CT are: Hemodynamic instability, Altered level of consciousness (GCS≤13), Decreased haematocrit levels, Abnormal physical examination of the abdomen (particularly abdominal tenderness), Fracture of the ribs ,Fracture of the pelvis and FAST score of >3.

Comparison of outcome of percutaneous nephrolithotomy in adult versus paediatric patients

Objective: To compare the outcome of percutaneous nephrolithotomy [PCNL] in terms of operative time, hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients

Study Design: Descriptive case series

Place and Duration of Study: Shifa International Hospital, Islamabad, from January 2010 to December 2013

Methodology: A retrospective analysis of 155 patients who underwent PCNL from January 2010 to December 2013. The patients were divided into 2 groups: patients aged ? 12 years were included in paedriatic group [A] while patients aged > 12 years were included in adult group [B]. The patients were analyzed for age, gender, stone size, operative time, stone clearance, hospital stay, and peroperative and postoperative complications. Data was collected by chart review on specified proforma

Results: One hundred and twenty-nine [129] patients including 44 [34.10%] females and 85 [65.89%] males with a mean age of 45.00 +/- 1.44 years were adults. Twenty-six palrents with mean age of 9.21 +/- 5.70 years, 17 [65.4%] males and 9 [34.6%] females, were included in the paedriatic group. Mean stone size was 2.12 +/- 1.01 cm in paedriatic group compared to 2.52 +/- 0.77 cm in adult group [p = 0.023]. Mean operative time in paedriatic group was 158.8 +/- 39.63 minutes compared to 119.34 +/- 37.06 minutes in adult group [p < 0.001]. Mean hospital stay in paedriatic group was 2.76 +/- 1.14 days compared to 3.12 +/- 1.27 days in adult group [p=0.1881]. Peroperative stone clearance was in paedriatic group was 93.28 +/- 9.23% compared to 90.81 +/- 12.23% in adult groups [p = 0.331]. One patient in the adult group developed urosepsis

Conclusion: There was no significant difference in outcome of percutaneous nephrolithotomy in terms of hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients. Operative time was significantly shorter in adult cases compared to paedriatic cases

Qt interval prolongation and ventricular arrhythmias in patients with chronic heart failure

To determine the association of QTc interval prolongation with ventricular arrhythmias in patients with chronic heart failure. Descriptive study. This study was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, Pakistan from April 2013 to August 2013. Fifty three heart failure patients were monitored for 48 hours using ambulatory holter electrocardiography recorders. Digital ECG data was analyzed for QTc interval along with frequency and severity of arrhythmias. Association of prolonged QTc interval with ventricular arrhythmias and severity of arrhythmias was analyzed. Cardiac arrhythmias were observed in 79.2% patients. QT analysis revealed that 69.8% patients had prolonged QTc interval, 86.4% patients with prolonged QTc had ventricular arrhythmias. Of these 66% patients were found to have severe ventricular arrhythmias. Comparison of mean QTc interval of our study population with a reference value showed significantly higher QTc interval of our study group than the test value. Arrhythmia frequency and severity significantly increases with an increase in QTc interval in heart failure demonstrating association of prolonged QTc interval with high risk of severe ventricular arrhythmias and sudden cardiac death in chronic heart failure

Sensitivity Pattern of Staphyloccus Aureus in Surgical site Infections after Elective Surgery

To determine the sensitivity pattern of Staphylococcus au reus in surgical site infection after elective surgery. Cross sectional descriptive. January1, 2012 to May 31,2013. Patients with minor or major surgical site infection [SSI] were selected by the treating surgeons and swabs taken for culture and sensitivity testing on blood agar, chocolate agar and MacConkey's agar plates [incubated at 370C] aerobically. The suspected colonies were subjected to catalase test and later coagulase test to confirm as Staphylococcus au reus and tested for sensitivity against commonly used antibiotics. Staphylococcus au reus was isolated in 59.2% of positive cultures. The highest resistance of S.aureus was against Cefixime [95.1%] followed by Cefaclor [77.1%]. The least resistance was against Sulbactam and Cefoperazone [8.2%] followed by Sparfloxacin [11.5%] and Amikacin [16.4%]. S. au reus was variably resistant to other commonly used drugs. Staphylococcus aureus is sensitive to less commonly used drugs like combination of Sulbactan and Cefoperazone and Sparfloxacin. Resistance to commonly used drugs like Cefixime and Cefaclor exists in surgical site infection and needs appropriate measures for prevention and control

Correlation of global registry of acute coronary events [GRACE] with the angiographic severity and extent of coronary artery disease in patients with non- ST elevation acute coronary syndrome

To determine whether the GRACE risk score correlates with the angiographic extent and severity of coronary artery disease in patients with NSTE-ACS undergoing cardiac catheterization. We conducted a cross sectional descriptive study in 154 patients with NSTE-ACS admitted at AFIC-NIHD from 1[st] April to 30[th] September 2011. For each patient the GRACE risk score was calculated by using specific variables collected at admission. The extent and severity of coronary artery disease was evaluated on angiography for each patient. A total of 154 patients were included in the study. The average age of the patients was 55.81years. Majority [75%] of the patients was male and 25% were females. The mean GRACE score was 132.85. Overall 40 patients had low, 54 had intermediate, and 60 had high GRACE risk score. Among patients with low score 28 had SVCAD, 4 patients had DVCAD and none of the patients had TVCAD. In the intermediate group 24 patients had SVCAD, 18 had DVCAD and 6 had TVCAD whereas among the high GRACE risk score 4 patients had SVCAD, 24 had DVCAD and 32 had TVCAD. Regarding the severity of coronary artery disease; among the low GRACE risk score patients; 8 had subcritical and 32 had critical CAD. In the intermediate GRACE risk score subset of patients, 6 had subcritical and 48 had critical CAD and none of the patients of high GRACE risk score had subcritical CAD and all 60 patients had critical CAD. GRACE risk score is a valuable noninvasive tool in predicting the extent and severity of CAD

Culprit artery characteristics and severity of angiographic thrombus burden in primary percutaneous coronary intervention in patients presenting with ST elevation myocardial infarction

The purpose of study was to characterize culprit artery characteristics in terms of presence of thrombus burden in patients with acute myocardial infarction using prevalent parameters of thrombus estimation. Descriptive study. Adult cardiology departments of Armed Forces Institute of Cardiology / National Institute of Heart Diseases [AFIC/NIHD] from 1[st] October 2011 to 31[st] September 2012. We studied 119 patients treated with primary percutaneous coronary intervention for ST- segment myocardial infarction. Bare metal stents were used in all patients as per hospital protocol. Thrombus burden [TB] was graded [G] as GO = no thrombus, G1= possible thrombus, G2 = small [greatest dimension <, 1/2 vessel diameter [VD]], G3 = moderate [>1/2 but <2 VD], G4 large [>2 VD], G5 = unable to assess TB due to vessel occlusion. Patients with G5 were reassessed after passage of guide wire or small balloon for thrombus burden. Frequency of major adverse cardiac events [MACE]-defined as death, myocardial infarction and infarct- related artery revascularization was recorded for the pen-procedural period which was defined in our study up to 72 hours. Overall, in hospital MACE was 8.4%. Large thrombus burden is a significant predictor for mortality and MACE

Efficacy and safety of transradial approach in primary PCI for STEMI

To determine the efficacy and safety of transradial approach in primary percutanous intervention in acute ST segment elevation myocardial infarction. Descriptive study Emergency reporting [ER] department of Armed Forces Institute of Cardiology National Institute of Heart Diseases [AFIC/NIHD] from Dec 2011 to Dec 2013 Retrospective data of 354 patients had been collected through records. All the patients presented with acute myocardial infarction to emergency reporting [ER] department of Armed Forces Institute of Cardiology National Institute of Heart Diseases were included in the study. All the patients underwent primary coronary intervention through transradial route. All patients received IIB IIIA inhibitors bolus and infusion. The primary end points were procedure success and local access site hematoma and secondary end points were major bleeding requiring blood transfusion and door to balloon time. The mean age of the patient was 64 +/- 18 years, there were 251 [70.9%] males and female were 103 [29.1%]. Radial access site cannulation time was 194 +/- 22 sec and door to balloon time was 78 +/- 14 min. Procedural success was 349 [98.6%]. Forearm hematoma was noted in 4 [1.12%]. No major bleeding requiring transfusion was noted. Primary percutanous intervention [PPCI] via transradial [TRI] route in acute STEMI patients can be achieved with high success and low complications in our population. The clinical outcome is matching with local and international data

Frequency and angiographic characteristics of coronary artery ectasia in patients undergoing coronary angiograms at AFIC and NIHD

To determine the frequency and angiographic characteristics of coronary artery ectasia in the patient population of AFIC and NIHD. Descriptive Study Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi from Jan 2007 to Dec 2011. All coronary angiograms done during the period were included in the study. The reports of coronary angiograms of those patients who were diagnosed to have coronary artery ectasia were left circumflex artery reviewed to assess the distribution of ectasia in different coronary arteries. Concomitant significant coronary artery stenosis left ventricular [LV] systolic function and history of revascularization were also documented. Over the study period, a total of 41,459 patients underwent coronary angiograms. 548 [1.32%] patients were diagnosed to have coronary artery ectasia. Out of these 467 [85.21%] patients were males and 81 [14.78%] were females. Their mean age was 53.7 years. Left anterior descending [LAD] was the coronary artery, most commonly affected by ectasia followed by left circumflex artery [LCx] and Right coronary artery [RCA]. Twenty three patients also had ectasia of left main stem. Four Hundred and three [73.54%] patients also had concomitant occlusive coronary artery disease and 19.52% patients had history of coronary revascularization either by percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]. Coronary artery ectasia is not a benign disorder as it could present as acute coronary syndrome having its own morbidity and mortality

Frequency of common modifiable risk factors in patients with myocardial damage undergoing single vessel coronary angioplasty

To determine the frequency of common modifiable risk factors in patients with myocardial damage undergoing single vessel coronary angioplasty. Descriptive study. Armed forces Institute of Cardiology / National institute of Heart Disease Rawalpindi from June 2012 to Nov 2013. Hundred patients undergoing elective single vessel percutaneous coronary angioplasty were evaluated with creatinine kinase and creatinine kinase MB levels before, after 8 hours and 24 hours following coronary angioplasty. The detailed performa was filled from each patient covering the necessary variables. Out of 100 patients 22% had raised creatinine kinase at 8 hours and 43% had raised creatinirie kinase after 24 hours following coronary angioplasty. Whereas 19% patients and 38% patients had raised creatinine kinase MB levels at 8 hours and 24 hours following the procedure respectively. No patient had rise of creatinine kinase or creatinine kinase MB more than 3 times of normal limits in the study. Among patients with raised CK-MB highest frequency was of diabetes mellitus, raised LDL levels, smoking and hypertension. Patients with raised CK-MB levels after 1[st] day of coronary angiography had diabetes mellitus [84%], raised LDL levels [79%], smoking [68%] and hypertension [58%]

Heart rate variability from 24 hours versus 72 hours holter monitoring in patients with mitral valve prolapse

To compare recorded heart rate variability from 24 hours with that recorded from 72 hours holter monitoring in patients with mitral valve prolapse. Cross sectional study. Department of Clinical Cardiac Electrophysiology Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi from May 2007 to March 2008. Patients from 15 to 38 years of age with confirmed diagnosis of mitral valve prolapse on 2 dimensional echocardiography were included. Patients with acute myocardial infarction [MI], Ischemic heart disease, diabetes mellitus or hypertension were excluded. Total 37 patients were included in the study through non-probability consecutive sampling. All these patients underwent 72 hours holter monitoring using Reynolds medical holter monitors 'life card CF'. Statistical time domain measures of heart rate variability i.e. standard deviation of all NN intervals [SDNN], standard deviation of the averages of NN intervals [SDANN] and square root of the mean of the squares of differences between adjacent NN intervals [RMSSD]. Mean values of SDNN, SDANN and RMSSD from 24 hours holter monitoring were 141.62 ms, 125.16 ms and 28.40 ms whereas those recorded from 48 hours of holter monitoring were 136.94 ms, 122.37 ms and 26.46 ms respectively. Difference between none of the variables from the two recordings was significant. Heart rate variability remains the same irrespectively of the length of holter monitoring

Management of patients with acute myocardial infarction complicated by ventricular septal rupture - AFIC study

The aim of this study was to report management; peri-procedural and short term results of patients hospitalized with acute myocardial infarction [MI]complicated by ventricular septal rupture [VSR] considered high risk or unfit for surgical repair at AFIC-NIHD. Quasi experimental study Adult and paediatric cardiology departments of Armed Forces Institute of Cardiology / National Institute of Heart Diseases [AFIC/NIHD] from 1[st] January 2012 to 31[st] August 2013. We included 12 patients with post myocardial infarction VSR with mean age of 59 years [41-85 years], who underwent elective transcatheter closure. The entry criteria for trans-catheter closure after initial medical stabilization was 1] patients with ventricular septal rupture up to 20 mm size with significant left to right shunting [Qp/Qs >1.5] 2] defect anatomy and location thought to be suitable for device closure or otherwise considered high risk or unfit for surgical closure. The time from the onset of infarction to the index procedure ranged between 4 to 20 days [mean 10.83 days]. There were ten patients in acute phase [2 weeks or less] and two presented in sub-acute phase [> 2 weeks]. Ten patients were in NYHA class III and one each in class II and IV. A successful device implantation occurred in all patients except in one in whom second attempt failed. The defect size ranged 4-18 mm [mean 9.25 mm] and the devices ranging from 8-22 mm [mean 13.3 mm] were implanted. The procedure time ranged from 90-140 min [mean 105 min]. In all patients Qp/Qs was more than 2 and decreased to less than two after the procedure. Six surviving patients are in NYHA class II and doing well. One patient died one hour after the procedure whereas one patient died twelve hour after the closure because of re-infarction. One patient developed another VSR leak 3 days after the procedure and device closure was attempted again but the device could not be deployed. He subsequently died awaiting surgery. Primary trans-catheter closure of post-infarction ventricular septal rupture may be an alternative to surgery in patients with suitable anatomy and high risk or unfit for surgery

Microbial spectrum of cardiac implantable electronic device infections - a tertiary cardiac center experience

The objective of the study was to determine the microbiological spectrum of cardiac implantable electronic device [CIED] infections. Case series Armed Forces Institute of Cardiology / National Institute of Heart Diseases AFIC/NIHD from January 2011 to Nov 2013. A total of 15 pus samples from patients with possible CIED infection out of 814 patients with implantable CIEDs were processed. Thirteen patients with positive cultures out of fifteen were included in the study. Clinical evidence of CIED infection included signs of inflammation and purulent drainage. A CIED infection was microbiologically confirmed based on culture yield. Blood cultures were carried out in all patients with suspected CIED infection along with trans-oesophageal echocardiography [TOE], wherever clinically indicated to exclude bacteremia and lead endocarditis. Sixty nine percent of patients with culture proven CIED infection were females and 31% were males. The mean age of patients was 61 years [range 53-70 years]. Devices included 11 PPMs, 1 ICD and 1 CRT. The most frequent organisms were gram-positive [77% of isolates]; with Coagulase-negative Staphylococci [CoNS] predominating in particular Methicillin Resistant Staphylococcus epidermidis [MRSE] in 46.4% cases followed by Methicillin Sensitive Staphylococcus epidermidis [MSSE] in 15%. Non tuberculous Mycobacterium fortuitium was isolated from pus in two patients; with PPM and ICD implants respectively. MRSA was isolated in only 01 PPM infection with evidence of lead endocarditis on TOE. Pseudomonas species was isolated from pus in one patient with CRT implant. CIED infections are more often caused by Staphylococci predominantly CoNS, although atypical Mycobacteria can be implicated

Procedural outcome of primary PCI inst-segment elevation myocardial infarction at Afic and Nihd Rawalpindi - Pakistan

To determine the procedural outcome of primary percutaneous coronary interventions [PCI] in ST segment elevation myocardial infarction. A quasi-experimental study. Armed Forces Institute of Cardiology and National Institute of Heart Diseases, a tertiary care cardiac institute from November 2011 to September 2013. Total 228 patients who underwent primary percutaneous intervention [primary PCI] were included in this study. A pre designed performa was prospectively filled which included demographic and procedural variables. Procedural success and in hospital mortality were recorded. The mean age was 59 +/- 10.88 years. There were 205 [89.9%] males, 80 [35.1%] patients were found to be diabetic, 47 [20.6%] hypertensive, and 90 [39.5%] patients were smokers. Family history of ischemic heart disease was positive in 51 [22.4] patients. Anterior, inferior and lateral myocardial infarction were present in 137 [60.1%], 90 [39.5%] and 1 [0.4%] patients respectively. The Median time from the onset of symptoms to the arrival in the hospital was 122.5 +/- 142.57 and median door to balloon time was 60 +/- 22.88 min. Left anterior descending [LAD] was the commonest infarct related artery accounting for culprit artery in 138 [60.5%] followed by right coronary artery [RCA] and left circumflex artery [LCX] in 72 [31.6%] and 18 [7.9%] cases respectively. Procedural success was achieved in 222 [97.4%] patients. Six [2.6%] patients died in the hospital. High success rate with low mortality rates can be achieved in our set up. However more studies and long term follow up is required to validate our results

Role of aspiration thrombectomy in primary PCI for STEMI - myth or reality?

The objective of the study was to determine the outcome of thrombus aspiration in Primary coronary intervention [PCI] for ST elevation myocardial infarction [STEMI]. Case Series The study was carried out in Armed Forces Institute of Cardiology - National Institute of Heart Diseases [AFIC-NIHD] over a period of twelve months from January 2013 to December 2013. Data of 30 patients who underwent aspiration thrombectomy during primary PCI for STEMI by the transradial approach was collected. Inclusion criteria were chest pain suggestive of myocardial ischemia lasting longer than 30 min accompanied by ST- segment elevation or new left bundle branch block on the ECG within 12 h of symptom onset. Patients with previous CABG, cardiogenic shock or requiring TPM placement were excluded from this study. A 6F sheath was placed inside the radial artery, and cardiac catheterization was performed. Angiographic and electrocardiographic signs of myocardial reperfusion were assessed. Study endpoints included TIMI III flow and ST-segment resolution at the end of the procedure. Mean age of the patients was 52 years [range 37-77 yrs] and 63% [n= 19] were males and 37% [n=11] were females. The right radial artery was used in 90% of cases. Thrombus aspiration catheter used was 6 F Thrombuster II [70%] and Hunter [30%].There was significant improvement in markers of myocardial reperfusion with achievement of ST-segment resolution and TIMI 3 flow in 28 patients [93%]. No case of vascular complications such as major access site bleeding, vascular perforation, radial artery occlusion, forearm ischemia, compartment syndrome or MACE was observed. Thrombus aspiration [TA] is applicable in the majority of patients undergoing primary PCI for myocardial infarction with ST-segment elevation, and it improves early markers of myocardial reperfusion

Spectrum of pathologies in cases of intestinal obstruction and perforation based on histopathological examination of resected intestine - Report from a third world country

Cases presenting with intestinal perforation and obstruction constitute a substantial work load on our surgical service. Etiologies vary in underdeveloped and developed countries. Histopathological examination of resected intestine is expected to provide the definite evidence of the underlying etiology- guiding a better health care planning for preventive measures. Our objective was to study the spectrum of histopathological findings in resected intestines from cases of intestinal obstruction and perforation in our local population to document the underlying etiology. A total of 120 cases of intestinal resection were included. Detailed gross and microscopic examination with routine stains was performed. Definite evidence of any specific etiology on the basis of morphology was documented. A total of 95 cases with clinical/radiological diagnosis of obstruction [79.2%] and 25 of intestinal, perforation [20.8%] were included. Tuberculous enteritis was the commonest etiology [n=41; 43.1%] in cases of intestinal obstruction followed by malignant tumours [n=30; 31.5%]. Ischemic infarct/gangrene, post op illeal adhesions, polyps and ulcerative colitis followed. In cases of perforation, Typhoid enteritis [n=15; 60%], was the commonest pathology followed by idiopathic perforation [n=5; 20%], tuberculous enteritis [n=3;12%], carcinoma [4%] and ulcerative coliti [4%]. In developing countries infective etiology remains a dominant cause of intestinal obstruction and perforation. Its presentation in younger age leading to intestinal resection demands effective preventive measures in this part of the world to prevent morbidity and mortality

Complications of Diode Laser in Endourological Procedures in Co-morbid Patients

To determine safety of diode laser by studying post operative complications after endourological procedures in co-morbid patients. A descriptive study. Shalamar hospital, Lahore from June 2009 to June 2012. We studied post-operative complications [up to 3 months] in 3 groups [prostatic obstruction, bladder growths ,urethral strictures] of total180 patients with ASA III and IV. We assessed hematuria, UTI, abdominal pain, suprapubic discomfort, urinary retention, dysuria, incomplete procedure, cardiac or respiratory compromise, fluid overload, mortality, catheterization times and mean postoperative hospital stay In prostate group, mean age was 70.8 +/- 8.6 years and follow-up period was 3 months. Complications were: mild transient haematuria in 65 [100%], creamy urine in 50 [77%], urinary tract infection in 25 [38.4%], dysuria in 16 [24.6%], retreatment required in 06 [9.2%], suprapubic discomfort in 3 [4.5%], TURP syndrome in 1 [1.5%] and significant hemorrhage requiring blood transfusion in 1 [1.5%],. In urethral strictures, the complications were: microscopic hematuria in 80 [100%], urinary tract infection in 52 [65%] suprapubic discomfort in 9 [11.2%], dysuria in 6 [7.4%] mild transient hematuria in 5 [6.2%]. In bladder growths, the complications were: mild transient haematuria in 30 [85.7%], creamy urine in 19 [54.2%], suprapubic discomfort in 18 [51.4%], dysuria in 9 [25.7%], urinary UTI in 8 [22.8%], ablation performed in two sittings in 1 [2.8%]. No mortality in any group. Diode laser is a safe and useful modality in patients with co-morbidities [ASA III and IV]

Neurofibromatosis-1 with intraventricular haemorrhage and pectus excavatum

This case report describes the occurrence of intraventricular haemorrhage in a teenage boy, who was later found to have neurofibromatosis-1, cerebral vascular disease and pectus excavatum

comparative study of somatotypes in different Mizaj-e-insani

Greco-Arab system of medicine is based on fundamentals postulated by Hippocrates [460-377 B.C.]. Besides other concepts, the humoural and temperamental [mizaj] theories are the back-bone of this system and a very important base-line of Tibb is the concept of Mizaj-e-Insani [human temperament] which revolves around the diagnosis and treatment modalities as well as specific constitution of an individual. But as modern mind always seeks for more information which can only be provided by research on modern lines with the support of methods which were not available to the ancients. Therefore a comparative study was conducted between different somatotypes and Mizaje Insani at Aligarh city of Uttar Pradesh, India. Subjects were adults of age 19-25 years. Human mizaj was assessed on the basis of proforma developed to reveal Ajnase Ashra [ten parameters] as given in Unani literature, whereas somatotypes were assessed on Carter and Heath ratings. Two Types of Mizaj were selected for study i.e. Damvi and Balghami and their morphology was compared with different somatotypes. Significant difference was found between Damvi and Balghami [Mizaj] of their endomorph and slightly insignificant was documented between Damvi and Balghami and it was found that that majority of Damvi were mesomorphs where as majority of Balghami were endomorphs, which is consistent with the concept of Unani System of Medicine i.e. people of Damvi mizaj are more muscular and robust whereas Balghami mizaj people have more fat deposition

comparison of disease caused by Shigella and Campylobacter species: 24 months community based surveillance in 4 slums of Karachi, Pakistan

Despite the efforts of the international community diarrheal diseases still pose a major threat to children in children less than five years of age. Bacterial diarrhea has also emerged as a public health concern due to the proliferation of drug resistant species in many parts of the world. There is a paucity of population-based data about the incidence of shigellosis and Campylobacter infections in Pakistan. We report country specific results for Shigella diarrhea that were derived from a multicenter study conducted in six Asian countries. Disease surveillance was conducted over a 24 month period in urban slums of Karachi, Pakistan, a city with a population of 59,584. Cases were detected through passive detection in study treatment centers. Stool specimens or rectal swabs were collected from all consenting patients. Between January 2002 and December 2003 10,540 enteric infection cases were detected. The incidence rate of treated diarrhea in children under 5 was 488/1000/year. In children, 5 years and older, the diarrhea rate was 22/1000/year. 576 [7%] Campylobacter isolates were detected. The pre-dominant Campylobacter species was C. jenuni with an increase of 29/1000 year in children under 5 years. Shigella species were isolated from 394 of 8032 children under 5 years of age. Shigella flexneri was the dominant species [10/1000/year in children under 5 years] followed by Shigella sonnei [3.9/1000/year], Shigella boydii [2.0/1000/year] and Shigella dysenteriae [1.3/1000/year]. Shigellosis and Campylobacter infection rates peaked during the second year of life. The incidence rate of shigellosis increased in old age but such a trend was not observed in Campylobacter infections. Of 394 shigellosis patients 123 [31%] presented with dysentery in contrast to only 54 [9%] of 576 patients with Campylobacter infections [p < 0.001]. Both Campylobacter infections and shigellosis are common in community settings of Pakistan but shigellosis presented more frequently with abdominal pain and dysentery than Campylobacter infections indicating that shigellosis may be a more severe illness than Campylobacter infections. Due to the increased and disease severity, drug resistant shigella have become a significant health problem; moreover it is a disease of poor and impoverished people who do not have the access to standard water and sanitary conditions, health care services or optimal treatment. In the face of these facts it is empirically important to develop a low cost effective vaccine that can protect these populations for a longer duration