Association of Central Corneal Thickness with Age and Serum Electrolytes in Hypertensive and Non-Hypertensive Patients

Background and Objectives: The normal Central corneal thickness (CCT) ranges about 510-520 microns. It is normally seen in clinical practice that corneas which are thicker are linked with greater intraocular pressures (IOPs). The purpose of the study was to determine the central corneal thickness and establish its relationship with age and serum electrolytes in hypertensive and non-hypertensive patients. Methodology: A total of 108 subjects were included in our cross-sectional comparative study (54 hypertensive and 54 non-hypertensive). Written informed consent was taken. We measured blood pressure with mercuric sphygmomanometer. Ultrasound pachymeter was used to measure central corneal thickness while we drew 5 ml of blood for estimation of the serum electrolytes. Data was entered and evaluated using IBM SPSS 17. Quantitative variables were presented as Mean ± SD. Pearson correlation was used to find correlation of normally distributed variables p-value ≤ 0.05 was considered to be statistically significant. Results: Central corneal thickness was statistically same in hypertensive and non-hypertensive subjects. Serum Na+ was significantly increased in hypertensive subjects while serum K+ and Cl- were significantly decreased in hypertensive subjects. No significant correlation was seen in hypertensive while weak negative correlation was observed between CCT and age in non-hypertensive patients. Weak positive correlation was observed between CCT and Na+ both in hypertensive and non-hypertensive. Significant correlation was observed in CCT and K+ in hypertensive while negative correlation was seen in non-hypertensive. Weak correlation was observed in CCT and Cl- both in hypertensive and non-hypertensive. Conclusion: Mean CCT was significantly lower in hypertension. CCT and age showed weak and positive correlation in hypertensive while weak and negative correlation in non-hypertensive. Serum electrolytes and CCT showed no significant correlation.

Clinical study of primary hyperlipidaemia and the role of Kalonji [nigella sativa] and Saboos-e-Asapghol [plantago ovata] in its management

Lipid disorders comprise the most prevalent serious disorders in industrialized nations and are a rapidly growing problem in developing nations. The growing prevalence of obesity, type 2 diabetes mellitus, hyperlipidaemia and metabolic disorders are important risk factors for atherosclerosis. To cure the hyperlipidaemia several synthetic drugs of better efficacy are being introduced in the modern system of medicine. But most of the medications induce adverse side effects. Therefore search for safe and effective lipid lowering drugs was the main motivating factor behind this study. In Unani System of Medicine many drugs [single drugs as well as compound formulations] are used for the purpose of reducing body weight and treating the obesity. Saboos-e-Asapghol [Plantago ovata] and kalonji [Nigella sativa] are among these medicines. Their efficacy has also been proved pharmacologically and documented as good hypolipidemic. A clinical study was carried out in Ajmal Khan Tibbiya College Hospital on 60 patients of primary hyperlipidaemia. The diagnosis was made on inclusion and exclusion criteria. The Unani formulation Sufoof-e-Kalonji [Nigella sativa] 2 gm and Saboos-e-Asapghol [Plantago ovata] 4 gm twice daily before meal were given for 90 days

The combination of drugs was found to be significant in lowering the lipid level and in increasing the level of serum HDL-cholesterol, in patients of primary hyperlipidaemia. Therapeutic responses were evaluated through follow up observations at 45th day interval. The results were analyzed statistically and results were encouraging

Neck webbing in a male patient A case report

In the month of November, 2013, there came a male patient with the complaints of frequent vomiting and body ache. His age was 35 years. When the patient was exposed for clinical examination, there were prominent skin folds on either side of the neck. It was our first experience to see a male person with webbing of neck. On examination, his height was 5 feet and 4 inches and was of normal intelligence. The pulse rate was 76 per minute, and blood pressure was 184/82 mm Hg. On examination of chest, no significant abnormality or deformity was observed. However, there was prominent grade III systolic murmur in the 2nd aortic area. Respiratory system was normal and on abdominal examination, no organomegally was found. The patient was asked as usual to undress for genital examination, the size of testes were smaller and firm, not compatible to his age. Right testis was higher as compared to left and hernial orifices were normal. Despite of one of his presenting complaints, no musculoskeletal deformity was observed and also no abnormal pigmentation of skin was seen

The clinical findings prompted us to diagnose the patient as a case of Noonan syndrome which is a counter part of Turner's syndrome in females. We asked the patient to get admitted so that the detailed clinical examination and necessary investigation including karyotyping be carried out. However, the patient left against medical advice and did not report to OPD for further discussion and councelling

Observation based clinical study of idiopathic urticaria and role of time tested Unani formulation Safoof-e-Musakkin and Safoof-e-Kabidi in patients attending skin OPD

Urticaria is a dermal presentation of vascular reaction characterized by wheal with itching, stinging or pricking sensations. There is usually no confusion in making diagnosis due to clear-cut clinical presentation. In this study variable presentation of Urticaria in various cross section of population and without any age and gender biased were subjected for the study. The cases were randomly selected for single blind clinical study and observation based analysis was made after giving the dosage of Unani formulation prescribed in routine Unani OPD for last 40 years in Ajmal Khan Tibbiya College and Hospital without any apparent known or reported side effect. The data were analyzed and projected to draw the conclusion

History of ophthalmic surgery and contributions of Unani scholars

Ophthalmological diseases mainly cataract has its own history from the treatment point of view. Hippocrates the Father of Medicine himself treated cataract by depressed or couched method, since in his time the same methodology was adopted by other Greek scholars. When Tib reached into the land of Arabia the system derived other techniques and instruments for the management of cataract. Surgeons of the Arab land and renowned Unani scholars such as Galen, Albucasis [Zahravi], Isa bin Kahhal, Ibn Al-Haitham and Avenzoar [Ibn Zohr]. They operated and managed the cataract cases and were known as renowned Ophthalmologists of their times. Later on these pioneer works were transmitted as well as translated by French scholars and other Europeans. They modernized such works and finally transmitted through their hands. Despite having rich literature rendered by Unani scholars and works done by Unani and Arab scholars, the knowledge has been transferred and unfortunately we are the follower in todays scenario

Diversity of presentations in decompensated chronic liver disease due to HCV

Background: An estimated 170 million people worldwide suffer from HCV infection. Chronic hepatitis C virus [HCV] infection is often a clinically silent infection presenting many years after with complications related to decompensation, so

Objective: To emphasize the role of early detection and intervention in preventing complications of HCV related chronic liver disease

Materials And Methods: Newly diagnosed decompensated chronic liver disease [CLD] due to HCV infection presenting to respective hospitals during 2010

Study design: observational multicentre study

Results: Out of 340 new cases of decompensated chronic liver disease due to hepatitis C virus. 190 [56%] were females and 150 [54%] were male. In terms of presentation, patients were having overlapping symptoms and signs like ascites, jaundice, upper GI bleed and encephalopathy. 220 [64.7%] had clinical ascites, 70 [20.5%] had spontaneous bacterial peritonitis, 130[38.2%] had altered conscious level and150 [44.1%] had upper GI bleed. It was inferred from history that 170[50%] patients with Hepatitis C were detected while being investigated for complaints other than liver disease. Other presentations included jaundice in 10[2.9%] 50 [14.7%] with previous upper GI bleed, 80 [23.5%] with CLD, 10 [2.9%] with epigastric discomfort and 20 [5.8%] had altered conscious level. 235 [69.1%] with Child's Score B and 105[30.4%] with Child's Score C

Conclusion: Majority of patients become aware only when complications set in. Early detection and interventions should be stressed because the available treatment options for the complications are beyond the reach of majority of patients and don't have a permanent solution

Hypoglycemia; experience in diabetics

Hypoglycemic symptoms are a very common experience for diabetics ranging from an innocent increased appetite to dreadful unconsciousness. This study was designed to assess the patient's awareness about the symptoms, experience of individual symptoms and their ability to recognize and to respond accordingly. All diabetic patients were assessed for the awareness of different symptoms of hypoglycemia, their experience of individual symptoms in last six months and ability of the patient and family members to recognize and to respond accordingly to these symptoms on a prescribed proforma with the help of trained staff. We had 1260 new cases of DM during the study period with valid diagnosis and taking either sulphonylurea or Insulin who were enrolled in the study. 280 patients had no idea of the symptoms. 564 patients knew no more than three symptoms. Palpitation and sweating were the most commonly known 80% and experienced 65% symptoms. Hunger and epigastric discomfort were the next best known 73% and experienced 58% symptoms. Loss of consciousness was the next in the list in terms of knowledge 52% and experience 23%. Coldness of body 28%, severe weakness 24%, blurred vision 12%, abnormal behavior 12% and altered consciousness 6% were the next in the list of experience. Early morning headache, night terror and frequent awakening were the least known 3% and recognized1% symptoms. Abnormal behavior and altered consciousness were not known to any patient as a symptom. Of those who knew or experienced the symptoms, eating anything available was the most common response, only 35% responded by eating rapidly available food items like sugar, honey, candies, beverages, fruit juice or jams. 3% of patients even resorted to taking diet colas initially and only later took other food after waiting for some time. In the event of patient getting unconscious, 80% of the times attendants did not consider hypoglycemia initially at home at first such experience. Patient must be properly educated about these symptoms before prescribing these agents and shall be repeatedly evaluated at each visit. Failing to recognize early and mild symptoms may lead to a terrifying experience

Metabolic syndrome frequency in patients presenting with acute myocardial infarction

To determine the frequency of metabolic syndrome in patients presenting with acute myocardial infarction [MI]. Cross -sectional, observational, multi center study. Allied Hospital Faisalabad from 01-01-2009 to 30-06-2010. Any patient fulfilling the criteria of acute myocardial infarction were admitted and enrolled in the study during the study period. Demographic details, history and clinical examination of the patients were recorded on prescribed performa after securing an informed consent. Blood Pressure was recorded in lying posture from right arm and waist circumference measured at umbilical level in lying position. Blood sample was collected in fasting state for estimation of plasma glucose, serum HDL-cholesterol and serum triglycerides levels. Out of 690 patients, 420[60.86%] were male and 270[39.14%] were females with average age 55.90 +/- 10.19. 40% males and 44% females had metabolic syndrome and incidence increased with age. Waist circumference was increased in 46.85% participants followed by increased fasting blood sugar [42%] levels. Frequency of metabolic syndrome was high among the patients with acute myocardial infarction. It supports the potential for preventive efforts in persons with high risk for acute myocardial infarction

Therapeutic evaluation of a unani formulation in the management of seborrhoeic dermatitis

Apart from advancement in diagnosis and management of skin diseases, several problems are still having no radical cure in dermatology and seborrhoeic dermatitis is one of them. In Unani medicine, management of several diseases are described in accordance with its fundamental principle of Mijaz and Akhlat, and have very promising effect on such diseases. Musaffiyat are in fact the key tools for almost every skin disorder. Several Unani formulations are being used since ancient times without any known side effects. As our study is based on modern approach of diagnosis and management, the result may be considered as more promising

Carotid body tumor: MRI appearance

A 52-year-old male presented with a painless swelling of the right side of the neck of four months duration. The clinical examination was unremarkable except for the swelling. On deep palpation pulsations were felt. Patient was referred to radiology department for ultrasonography neck on grey scale imaging there was an echogenic mass at the level of carotid bifurcation on Doppler study there was blood flow within the mass associated with displacement of the internal carotid artery due to pressure effect. Carotid body tumor was suspected and patient underwent for CT and MRI for confirmation

Neck swelling in children: an unusual presentation

Neck swelling in the children's has always been a diagnostic challenge for radiologists. A 3 year boy presented in the surgical outdoor with a painless lateral neck mass and was referred to our department for USG neck. On USG ectopic thymus was suspected. MRI was advised to confirm the ultrasound finding .MRI confirmed our ultrasound diagnosis by typical appearance of thymic tissue using different sequences. Information about this anatomic variant and of its variable clinical presentation is essential and it should be included in the differential diagnosis of neck masses, especially in children

Therapeutic evaluation of a combination of Bambusa arundinacea, Calotropis gigantea, piper nigrum, Zingiber officinole, Colchicum autoummale, Asphalt and Calcined iron in gout

Gout [Niqras: derived from Anqaroos meaning greater toe] is not a single disease. The term is used to describe a number of disorders in which crystals of monosodium urate deposit on joints give rise to acute gouty arthritis of metatarso-phalangeal joint of a greater toe in 70% of patients. Several Unani single and polypharmaceutical combinations are reported in literature as being highly beneficial in gout. In this study an attempt has been made to evaluate the efficacy of a combination of drugs in gout [Niqras]. The observations and results were analysed statistically and test of significance was done by applying paired 't' test

Prevalence of hepatitis C, hepatitis B and human immunodeficiency virus infection among blood donors at Fatimid center Multan

To find out the prevalence of Hepatitis C, Hepatitis B and HIV infection among blood donors at Fatimid Center, Multan., determine whether the laboratory methods to be used for the detection of HBV, HCV and HIV infection and disseminate the findings of the study for the constitution of proper screening programme at blood transfusion centers. This cross-sectional study was designed to know the screening pattern of Hepatitis B, Hepatitis C and human immunodeficiency virus in blood donors at Fatimid Center Multan during the period from November 2001 to December 2001. Hepatitis C, Hepatitis B and HIV infection is commonly transmitted via blood, blood products and unsafe sex from one person to another in the community. 1014 blood donors were screened for Hepatitis B, Hepatitis C and HIV antigen. 79 were found reactive for HBV, 37 reactive for HCV and HIV reactive was found none. The recipients of Hepatitis C and Hepatitis B reactive blood are 20 times more likely to have evidence of post transfusion Hepatitis C and Hepatitis B infection than recipient of Hepatitis C and Hepatitis B non reactive blood. This study was carried out with the objectives to see prevalence of Hepatitis C, Hepatitis B and HIV infection in blood donors, Hepatitis B Hepatitis C and HIV infection association with parentraI therapies, etc. Blood donors record for HBV, HCV and HIV was collected from blood bank of Fatimid Center Multan. Among 79 Hepatitis B reactive blood donors 30 [37.97%] had history of previous blood transfusion, 7 [8.86%] had parentral therapy, 2 [2.53%] had history of drug addiction, 2 [2.53%] had history of sexual contact while 37 Hepatitis C reactive blood donors 5 [13.51%] had history of previous blood transfusion and 20 [54.05%] had history of parentral therapy. None had history drug addiction, 9 [24.32%] had history of sexual contact. Luckily no HIV infection reactive case was found. The results of the present study underline the dire need to have a national comprehensive plan with multidisciplinary approach for HBV, HCV, HIV prevention is the community. It is suggested that blood and blood products should be screened for HCV, HBV, HIV infection before transfusion and use of disposable syringes, other sterilized instruments during hospital stay and use of disposable razors at barbers shop must be kept in mind

Weaning practices in urban and rural areas of Pakistan

Weaning practices varies in different communities and affected by beliefs. Family feeding order, attitudes towards weaning nutrition, geography, economic status, climate etc. Detailed knowledge of above factors is essential to improve the child nutrition. The growth of an infant and a young child is almost totally dependent on the nutrition he is getting. Improper feeding practices and poor nutrition of a young child can lead to ill health and malnutrition. It is essential to explore the knowledge, customs, beliefs and their effects to overcome malnurition and growth retardation. It is also necessary to know about the knowledge, attitude and practices relating to weaning in different communities and factor influencing these. The study is conducted on mothers of children at the age of weaning from both unban and rural origin. Simple random sampling technique is adopted for the study purpose. A questionnaire prepared to evaluate knowledge, beliefs, customs, and dietary habits relating to weaning and effect of economy, demography, literacy etc. on the believes, customs and practices. After collection of data, analysis done to draw conclusions. The study shows that 65% children are weaned at the age of 4 to 6 months in urban population while 50% in rural areas. In both population middle class weaned their children early, education also improved the situation. Weaning before the age of 3 months existed to some extent in both populations. Mixed feeding prevalent in both communities. Trend towards introduction of processed foods is more in both populations, food fads and to boos are also present, but more prevalent in rural areas, due to these high energy and protein foods are usually prohibited for a young child. In urban areas, children of working mothers also affected due to improper look after by the servants and relatives. The study shows that many children in both rural and urban population do not receive the right food to eat in their early childhood. This is resulted in growth retardation, and ill health in most children. This is true more in rural areas as compared to urban areas, but there are no significant differences in both populations, Predisposing factors include low income of the family, illiteracy, delayed weaning, late introduction of high-energy foods, protein and other nutrients for infant growth. In case the weaning foods are introduced to the infant at the right age, their frequency is less than required number of feeds per day

Biological Screening of a Novel Nickel (II) Tyrosine Complex

A newly synthesized Nickel (II) tyrosine complex was screened as potential antimicrobial agent against a number of medically important bacteria (Bacillus subtilis, Streptococcus beta-haemolytica, Escherichia coli, Shigella dysenterae) and fungi (Aspergillus fumigatus, Candida albicans, Aspergillus niger, Aspergillus flavus, Penicillium sp.) strains. were used for antifungal activity. The antimicrobial activity was evaluated using the Agar Disc method. Moreover, the minimum inhibitory concentration of the complexes was determined against the same pathogenic bacteria and the values were found between 4~64 microg ml(-1). Brine shrimp bioassay was carried out for cytotoxicity measurements of the complexes. The LC50 values were calculated after probit transformation of the resulting mortality data and found to be 6 microg ml(-1).

Importance and scope of aromatic drugs in unani medicine

Popularity of Aromatherapy has attracted worldwide attention. Unani system of medicine with its speciality in use of aromatic drugs may also contribute to Aromatherapy debate effectively. It is in this context that a review of Aromatic drugs of Unani medicine is being presented here to cause awareness about the aromatic drugs of authentic utility employed in Unani medicine

Use of metered dose inhalers; Patient's fears and objections, errors in their techniques. A reflection of poor patient education in asthmatics

Inhalational bronchodilators and anti-inflammatory therapy is the ideal treatment for asthmatics. Successful management depends on active and continuous interaction between the clinician and a well-educated patient. Detailed interview of patients were carried out to determine the patients' fears about MDI and the errors in technique were recorded. This would highlight the common deficiencies in the management in our own socioeconomic setup. Any patient with a diagnosis of Bronchial Asthma was assessed for the competency of diagnosis. A specially trained nurse interviewed the eligible patients on a prescribed performa who were using MDI to determine their fears and objections on its use. They were asked to demonstrate their technique of MDI use and errors were noted. The physician checked all the information and confirmed that technique has been corrected and the fears addressed, Patients below the age of 16 or over the age of 60 were excluded. Seriously sick patients and patients of COPD were excluded. Asthmatics presently not using MDI were excluded. Study was carried out from January to December 2003. 192 patients were enrolled during one-year period, from January to December 2003, in this study. There were 112 males and 80 females 46% of patients rejected MDI considering it as the last resort, 54% perceived it as costly, for 58% it was a complicated way to use medicine, 54% considered it in-effective, 50% feared life long dependency, 54% disliked it as MDI would incite cough, 29% objected on the oral thrush and 13% on dysphonia associated with them and for 21% it was socially un-acceptable to use MDI in public. When inhalation technique for MDI was checked, all checked for empty canister by shaking. 92% could find out if the demo canister was empty. All removed the cap properly. 92% shaked the MDI before use while 8% failed to do so. 79% used it in proper upside-down position. Hand-Lung co-ordination was proper in only 29% of patients. 49% held their breath for adequate time. 38% made proper slow exhalation. 38% performed actuation with open mouth and 63% with mouth closed on MDI mouthpiece. 33% swallowed the drug after actuation, leakage from mouth was seen in 29% and leakage of fumes from nose was seen in 54% of patients. Multiple actuations were done by 50% of patients. Bronchial Asthma is a common clinical disorder requiring long-term treatment. Inhalational delivery systems like MDI are the ideal mode of therapy. Use of MDI is stigmatized, partly contributed by patients' dissatisfaction from results due to improper technique and partly attributed to the social inhibitions attached to its use. We defined, addressed and made effort to correct their technique. More emphasis on different aspects of patient education is the only way to improve our standard of Asthma care