Coagulation abnormalities and their relationship with bleeding manifestations in patients with dengue-A single center observational study

Objective: To evaluate coagulation abnormalities and their relationship with bleeding manifestations among patients with dengue. Methods: This observational study was conducted on 292 adult dengue patients who were admitted to a tertiary care hospital of Western India from July 2021 to June 2022. Coagulation tests including prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer were performed. Patients were monitored for bleeding manifestations. Results: Coagulation abnormalities were reported in 42.8% of the patients. Overall, prolonged aPTT was the most common coagulation abnormality (40.8%), followed by low fibrinogen (38.7%), raised D-dimer (31.2%), raised INR (26.0%) and prolonged PT (19.2%). Bleeding manifestations were present in 19.9% patients. PT, INR, aPTT and D-dimer levels were significantly higher (P<0.01) and fibrinogen level was significantly lower (P<0.001) in patients with bleeding compared to patients without bleeding. Patients with bleeding had a significantly higher rate of all coagulation abnormalities than patients without bleeding (P<0.01). Conclusions: Patients with bleeding showed a significantly higher frequency of coagulation abnormalities compared to patients without bleeding. Patients with dengue should be assessed for coagulation abnormalities.

Modeling and Molecular Docking Studies on Alangium salvifolium (Alanginaceae) as a Target for Anti-oxidant Enzyme

Objectives: The present studies pursue at retrieve and draws the active phytocompounds structure of Alangium salvifolium and assessing its simulation anti-oxidant enzyme activities. Methods: Retrieve/draws of the compounds were carried out using chem.-sketch software. The 3-D structures of the Phytocompounds were visualized based upon the UV, NMR spectral data along with their energy simulation studies. The antioxidant and enzyme simulation activity were evaluated in-silico using the ACD labs,PyRx, RASMOL,PYMOL,Aragslab and Discovery 3.1 studio. Key Findings: Phytochemicals structure drawing of A. salvifolium resulted in the structured and recognition of four phytochemicals. The plant phytochemicals showed significant anti-oxidant enzymes activity enhancer and ROS eliminator through binding to its metal domain receptor. Conclusion: Phytochemicals were drawing from A. salvifolium. To the best of our knowledge, among these phytochemicals, were studied anti-oxidant enzymes metals binding domain to increase the ROS scavenging activity for the foremost time from mimic with molecular docking. Moreover, study of phytochemicals simulation was for the first time from this plant. The plant revealed auspicious increase the antioxidant activities virtual screening. This gives thinking to some of its pharmacological properties and suggests additional antioxidant effects, for as a scavenger as well as anti-oxidant enzyme stimulator, which have not been reported yet.

Varus distal femoral osteotomy in young adults with genu valgum and fixation with DCS

Objective: to study and analyze the surgical results of distal femoral Varus osteotomy in patients with genu-valgum

Material and Methods: between September 2006 to November 2013, 18 distal femoral oste tomies were performed on 14 patients at department of orthopedic surgery Services Hospital Lahore. After taking the history and physical examination, appropriate radiographs were taken. We did Varus femoral osteotomy by standard lateral approach and 95 angled dynamic compression screw [DCS] fixation, then followed the patient clinically and radiographically till sound healing of osteotomy was achieved

Results: this study was done on 18 knees [14 patients] with mean age 17 years [range 16 to 19 years].The mean duration of follow up was 7.9 months [range 6 to 9 months]. The tibiofemoral angle before and after operation was compared. The average tibiofemoral angle before operation was 19.24degree [14degree to 24degree] and follow up was 6.75degree [5degree to 8degree]. Mean lateral distal femoral angle [LDFA] before surgery was 7 4.85degree [67degree to 83degree] and after surgery was 86.90degree [83degree to 90degree]

Conclusions: distal femoral osteotomy wit DCS fixation through lateral approach can be reliable procedure for the treatment of valgus knee deformity. In this procedure tibiofemoral angle correction can be achieved without compromising the function of quadriceps muscle which helps in the early rehabilitation of the patient in terms of restoring the knee movements. Another advantage of lateral approach is, along with genu-valgum correction, the patella can be stabilized simultaneously

Pattern of extranodal involvement in non hodgkin's lymphoma

To study the anatomical and histomorphological pattern of extranodal non hodgkin's lymphoma [NHL]. Descriptive study. The study was carried out at oncology department combined military hospital rawalpindi during July 2012 to April 2013. All newly diagnosed patients of NHL with extranodal involvement were included in the study.They were categorized as primary extranodal or secondary extranodal lymphomas. Histological pattern and site of involvement were studied. The male to female ratio was 2.2:1 [Male 31, Female 14], and the mean age was 48.16 years[SD=13.40]. Primary extranoal involvement was seen in 55.6% of patients. Secondary extranodal involvement was seenin 44.4patients. Diffuse large B-cell lymphoma [DLBCL] was the most common type of NHL observed in both primary and secondary extranodal involvement. Gastrointestinal tract was the most common site for primary extranodal involvement and bone marrow was the most common site for secondary extranodal involvement.High freqency of primary extranodal involvement was noted in our study. DLBCL was the most common morphological type observed.Gastrointestinal tract and secondary bone marrow involvement were the most common anatomical sites for primary and secondary extranodal involvement respectively

Relationship of anxiety and depression to quality of life in patients with cancer

Cancers are known to be grave disorders affecting patients and their families both physically and emotionally. The present study was planned to determine anxiety and depression in cancer patients and their relationship with quality of life. A total of 205 cancer patients from the wards of Oncology department, Combined Military Hospital [CMH], Rawalpindi were included in the study. The study population included the patients with various malignancies. The Hospital anxiety and depression scale [HADS] and EORTC-QLQ-C30 with a written consent was obtained from all the patients. Basic demographic data including age, marital status, treatment and diagnosis were collected from all the participants in a properly designed questionnaire. In total 205 cancer patients were studied. The mean age of patients was 41.04 years [SD=16.04 years]. Majority of patients were males [76.6%] and married [79%]. Mostly patients were getting chemotherapy [62.4%]. Various malignancies included Leukemias [27.3%], Gl malignancies [12.2%], Lymphomas [10.2%], Sarcoma [6.8%], Breast tumors [5.9%] and others were 37.6%. Overall 89.8% of cancer patients were found to have anxiety and depression A significant negative correlation was observed among anxiety, depression and quality of life with [r= -0.46 and r= -0.47] respectively. Poor quality of life was observed in those who have higher psychological distress. Psycho social stress and expensive treatment of cancer leads to psychological distress and it reduces patient's physical, social and emotional functioning. Psychotherapeutic treatment along with medication should be implemented as the best way to help cancer patients to cope up their distress and to improve their quality of life.

Short term effects of rosuvastatin on plasma concentration of high sensitivity c-reactive protein in patients with chronic stable angina

To determine the short term effects of rosuvastatin on elevated base line high-sensitivity C-reactive protein [hs-CRP] in patients with chronic stable angina. This Quasi-experimental comparative study was conducted in Cardiology department, Lady Reading Hospital Peshawar, between March 2010 and February, 2011. We selected 44 consecutive patients age 40 years or above, of any gender having hs-CRP levels >/= 1.2mg/l with chronic stable angina. Base line levels of hs-CRP, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and creatine phosphokinase [CPK] were measured in fasting status. These patients were treated with rosuvastatin 20 mg once daily at night and followed up for one month. Using SPSS version 16 data was analyzed. Mean age was 53 +/- 7.2 and 50% were females. Following treatment with rosuvastatin 20mg for one month the mean hs-CRP levels reduced from 4.08 +/- 2.56 to 2.72 +/- 2.40 [95%CI, 0.41 to 2.29, p=0.006]. Similarly mean total cholesterol levels decreased from 185.88 +/- 37.62 to 147.45 +/- 38.35, [p=0.0001]. LDL cholesterol decreased from 118.34 +/- 31.31 to 86.63 +/- 35.72 [p= 0.0001]. But mean HDL cholesterol had no significant increase from baseline levels i.e. from 32.18 +/- 9.93 to 33.95 +/- 7.65 [p=0.174]. TGs levels reduced from 240.11 +/- 123.66 to 197.43 +/- 88.24 [p=0.008]. Mean CPK levels did not differ significantly from base line at follow up, from 101.43 +/- 58.63 to 96.22 +/- 55.10 [p=0.646]. Short term treatment with rosuvastatin significantly decreases elevated hs-CRP levels in patients with chronic stable angina

Comparison of in-out and overnight catheterization in post operative urinary retention

To determine better modality of management of post operative urinary retention comparing in-out with overnight catheterization. Randomized controlled trail. Combined Military Hospital, Lahore, tertiary care hospital from July 2007 to June 2008. Sixty patients of postoperative urinary retention were recruited in the study in strict compliance with the inclusion and exclusion criteria. Informed verbal consent was taken. Patients were randomized using random number table into two equal groups. Group A was subjected to in-out catheterization modality. Group B was subjected to overnight catheterization modality. Procedure was carried out in complete privacy. Need to recatheterize the patient was assessed and then he was recatheterized accordingly. Frequency of recatheterization was calculated for each group. Frequency of recatheterization was significantly higher in group A as compared to group B [p=0.022]. Overnight catheterization is a better method for dealing with post operative urinary retention as compared to in-out catheterization

Frequency and severity of neutropenia in diffuse large beta-cell non Hodgkin's lymphoma after first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolone

Chemotherapy used for malignant diseases may produce severe neutropenia in first cycle which may compel for dose modification and early termination of therapy. This descriptive cross sectional study was planned to see the frequency and severity of neutropenia after first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolon in patients of diffuse large B-cell non Hodgkin's lymphoma presenting at Oncology Department Combined Military Hospital Rawalpindi from August 2009 to July 2010. Thirty patients of diffuse large B-cell non Hodgkin's lymphoma diagnosed on lymph node biopsy presenting for the first time at Oncology Department Combined Military Hospital Rawalpindi were included. They were admitted in the ward and evaluated with history, physical examination and staging investigations. Patients were then planned for first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, and vincristine with prednisolon. After the first cycle of chemotherapy they were monitored for expected neutropenia in the ward. The neutrophil counts were repeated on days 7 and 10 following chemotherapy. Neutropenia was graded as defined in the operational definition and all the data was entered on a specially designed data card. As much as 3.3% of patients suffered from grade IV neutropenia [absolute neutrophil count of <0.5x10[9]/L], 3.3% had grade III neutropenia [absolute neutrophil count of 0.5x10[9]/L- 0.9x10[9]/L], 6.6% had Grade II neutropenia [absolute neutrophil count 1.0x10[9]/L-1.4x10[9]/L and 10% had Grade I neutropenia [absolute neutrophil count 1.5x10[9]/L-1.9x10[9]/L. Overall 23.2% suffered from neutropenia of all grades post 1st cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolon in diffuse large B-cell non Hodgkin's lymphoma. Further studies are required to find the risk factors to predict this complication in our population

Frequency of bone marrow involvement in Hodgkin's lymphoma on first presentation

To determine the frequency of bone marrow involvement in patients of Hodgkin's lymphoma on first presentation at oncology department. Case series. The Oncology Department, Combined Military Hospital, Rawalpindi, from April 2006 to February 2007. Thirty five patients of Hodgkin's lymphoma diagnosed on lymph node biopsy presenting for the first time at Oncology Department, Combined Military Hospital, Rawalpindi were included. They were admitted in the ward and evaluated with history, physical examination and staging investigations. Bone marrow trephine biopsy was performed in all patients. Descriptive statistics were used to analyze data. On clinical and radiological evaluation, 8 patients [22.9%] had clinical stage [CS], 12 [34.3%] had CS II, 9 [25.7%] had CS III and 6 [17.1%] had CS IV. The microscopic appearance in bone marrow trephine examination showed lymphoma infiltrates in 6 [17.14%] patients and chronic disorder in 29 [82.85%] patients. Among patients with bone marrow infiltration, one had CS II disease, three had CS III disease and two had CS IV disease. One patient had bone marrow infiltration as the only manifestation of disease. Bone marrow involvement was seen in patients with Hodgkin's lymphoma clinical stage II or higher

Giant multiple intra-abdominal hydatid cysts

Hydatid disease is endemic in the cattle grazing areas. It is a parasitic infection caused by the Echinoccocus Granulosus. Dogs are the definitive host and humans get infected either by contact with the definitive host or by consuming hydatid ova contaminated vegetables. A 42 yr old lady presented with shortness of breath on exertion, orthopnea and progressively increasing abdominal distention. She had past history of hydatid disease and had progressively increasing abdominal distention three laparatomies and a right thoracotomy, in the past five years. On physical examination, she had a distended, non-tender abdomen. Her routine laboratory investigations were normal. Echinococcus antibody titres were 1:64 [Normal 1:32]. Computed Tomography [CT] scan revealed multiple, well defined cysts throughout the abdomen. Laparotmy and right thoracotomy was planned. Patient refused to undergo any further surgical procedure. She was discharged from the clinic with a prescription of Albendazole 400 mg twice a day for an indefinite period. Symptomatic or large cysts should be surgically treated. In cases suspected of having peritoneal spillage, antihelminthic drugs should be administered. In addition, small asymptomatic cysts, some daughter cysts, and peritoneal secondary cysts and splenic cysts may also be effectively treated with Albendazole

Association of social class in HBsAg and hepatocellular carcinoma

To find out the social class difference in relation to frequency of HBsAg and hepatocellular carcinoma in our population: Design: An analytical study. Place and Duration of Study: This study was conducted in Oncology Department, Services Hospital, Lahore from December 1997 to December 2000. Subjects and The HBsAg positive voluntary and apparently healthy blood donors were grouped into three, based on 'monthly income. Lower socioeconomic group had monthly income less than 3,000 Pakistani rupees, middle socioeconomic group had monthly income between 3,000-10,000 rupees and upper socioeconomic group had income of more than 10,000 Pakistani rupees. On the same pattern patients suffering from hepatocellular carcinoma coming for treatment were also grouped. During this period, 1000 blood donors were screened for HBsAg and 95 biopsy proven liver cancer cases were treated. Medical and demographic data of all subjects were recorded. HBsAg test was performed by immuno-chromatographic technique using Daina Screen HBsAg kit manufactured by Dainabot Co. Ltd, Tokyo, Japan. Patients from lower and middle social class had higher percentage [80% and 75%] of hepatocellular carcinoma as compared to higher social class [66.6%]. In the healthy asymptomatic blood donors lower social class had higher [13.76%] HBsAg positivity as compared to middle social class [11.25%] and higher social class [8.06%]. Preventive measures should be taken in identifying and reducing factors predisposing high frequency of these conditions