Validated spectrofluorimetric method for determination of sulpiride in commercial formulations using Hantzsch condensation reaction

A simple, sensitive, selective and cost effective spectrofluorimetric method has been established for the quantification of sulpiride after their complete alkaline hydrolysis. The method is based on the condensation of the primary amino group of alkaline hydrolytic product of sulpiride with acetyl acetone and formaldehyde in acidic medium [0.25 M HCl] to form a fluorescent product. The reaction product formed shows maximum fluorescence intensity at 483 nm after excitation at 431 nm. The different reaction conditions influencing the condensation reaction were carefully optimized and a linear range of 0.1-3.5 micro g mL[-1] with good correlation coefficient between florescent intensity and concentration of sulpiride was found at optimum parameters. The LOD and LOQ were found to be 11 and 39 ng mL[-1] respectively. The proposed method was successfully used for the quantification of sulpiride in bulk powder and commercial formulations. The effect of common pharmaceutical excipients and co-administered drug was also studied and no interferences were observed. The validity of the method was tested by analyzing sulpiride in bulk powder, and pharmaceutical formulations through recovery studies. Recoveries [%] were obtained from 98.62 to 100.24% for bulk powder, and 97.09 to 100.57% for commercial formulations. The results were validated statistically with those obtained by reference literature high performance liquid chromatographic method

Typhoid fever in paediatric patients in Quetta, Balochistan, Pakistan

To determine the seropositivity of typhoid fever in febrile pediatric patients presenting to tertiary care center. This observational study was conducted at Children Hospital Quetta [CHQ] from July 2011 to March 2012. The children with three or more days fever, no obvious focus of infection and clinically suspected of typhoid fever were screened. Sterile Blood samples were obtained from febrile patients and Widal and Typhidot [Trade Mark] tests were performed for the diagnosis of Typhoid fever in the suspected populations. Total of 2964 clinically suspected patients were screened for typhoid fever. Of these, 550 [18.6%] patients were positive serologically. The higher prevalence of the disease in hot summer season and increasing pattern of the disease was observed in summer days. The disease was higher in school age children under 5-10 years. Although non-significant association was observed on sex basis. The findings highlight the considerable burden of typhoid fever in pre-school and school-aged children. The variation in the disease pattern has also been observed under seasonal variation and different age groups, all of which need to be considered in deliberations to control the typhoid fever

Quantification of sparfloxacin in pharmaceutical dosages and biological samples

A simple and fast method for spectrophotometric determination of sparfloxacin using p-dimethylaminobenzaldehyde [DMAB] has been developed. A yellow coloured product formed from reaction between sparfloxacin and DMAB as a result of condensation reaction at room temperature. The maximum absorbance was found at 392 nm with molar absorptivity of 4.9 × 10[3] L mol[-1] cm[-1]. All parameters for the reaction, as concentration of DMBA reagent, molarity of sulphuric acid, and reaction temperature were studied. Under the conditions studied, a linear relationship between absorbance of the condensation product and concentration of sparfloxacin in the range of 2.0-80.0 microg m[E1] was found with good correlation coefficient [0.9997]. The limits of detection [LOD] and quantification [LOQ] for the proposed method were found to be 0.22 and 0.75 microg m[E1] respectively. The repeatability and accuracy [model] of the method was studied at three different concentrations of sparfloxacin and found with value of relative standard deviation less than 2.0%. The method was found selective for determination of sparfloxacin in the presence of commonly used excipients in dosage forms. The developed method was validated statistically and applied successfully to the analysis of the drug in pure form, pharmaceutical preparations, and spiked blood plasma and urine samples with good accuracy [real] and precision. The percentage recovery was found from 99.0-100.0% with relative standard deviation less than 1%. The results of the proposed method were compared statistically with the results of literature HPLC method

Significant high lipid profile in pre-hypertensive subjects as compare to stage 1 and stage 2 of hypertensive subjects

To analyze the differences in lipid profile in various categories of hypertension in our local population. Cross Sectional Study. This study was conducted at Amin Hayat Memorial Trust for diabetes and Hypertension, Lahore and Punjab Institute of Cardiology [PIC], Lahore from Dec. 2005 to May 2007. A total of 510 subjects of either sex were screened during a cross-sectional study. Biochemical assessment includes the determination of TC [Total Cholesterol], LDL-C [Low Density Lipoprotein Cholesterol], HDL-C [High Density Lipoprotein Cholesterol], and TG [Triglycerides], which were measured by using commercially available kits using Hitachi 902 photometer. vLDL and LDL-C/HDL-C ratio was calculated by using formula. Abnormal lipid profile was observed in 59% of the study population. Around 75% of prehypertensive subjects had abnormal lipid profile as compare to stage 1 and stage 2 of hypenension. Beside prevalence significant high levels of TC, LDL-L, and LDL-C/HDL-C were also observed in prehypertensive group. Females had significantly high levels of TC, HDL-C and LDL-C/HDL-C compared to males. A high prevalence of dyslipidemia was observed in all stages of hypertension; however, prehypertensive group had significant high levels of lipid profile and smoking and family history also predispose to high blood pressure

Analysis of changes in intraocular pressure with changes in body position

To find out the patterns of changes in Intraocular Pressure [IOP] with changes in body position, both in the sitting and lying position. This descriptive study was conducted at Hayatabad Medical Complex, Peshawar from October 2010 to March 2011. All the individuals who voluntarily consented were included in the study. These include individuals without any eye pathologies, glaucomatous eyes, eyes with cataract and both hospitalized and non-hospitalized individuals. While all the individuals who have any corneal pathologies, uveitis, detachment, post operative and post lasered eye were excluded from the study. All the patients were examined with slit lamp. Then Per kins' hand-held applanation tonometer was used to measure the IOP both in the sitting and lying position. The proforma was then filled and data was analyzed by using SPSS v.17. A total of 100 volunteers were included in our study while total number of eyes were two hundred. The mean age of the sample was 49 +/- 15.4 years. There were 110[55%] males and 90[45%] females. Hypertension was present in 50[25%] patients and all of them were taking ant ihyper tensive medications. Thirty five [17.5%] were diabetic and were also on medications. The mean IOP in the sitting position was 13.28 +/- 3.6 mmHg and in lying position it was 16.4 +/- 3.9 mmHg. The difference between lying and sitting position was 3.12 +/- 0.3 mmHg [p<0.001]. A postural IOP change can occur when an individual changes its position from sitting to supine position. Intraocular pressure increases in the lying position as compared to the sitting position

Frequency of headache with stress in adolescent and young adults

Objective of this study was to establish a link between stress as a cause of headache in young adults. Cross sectional study. Department of Neurology Military Hospital [MH] Rawalpindi from September 2009 to March 2010. Thirty young patients, referred for the complaints of headache to the Neurology out patient department, were included in this study. A detailed especially designed, pre tested headache questionnaire was devised which was filled for every patient individually included in the study. Twenty One [70%] of the patients in the study group did have the feeling of stress preceding the headache which sometimes persisted during the episode. Nine [30%] did not report any such feeling of stress before or during the episode. Out of the patients reporting stress 71% [15] were female patients and 29% [6] were males. These key findings suggest that stress and headaches may be related for adolescents and young adults and that this relationship may be reinforced over time. Moreover female patients were far more susceptible to this stressful stimulus as compared to the males

Percutaneous nephrolithotomy for the treatment of renal stones larger than 2.5 CM

To share our experience regarding the safety and efficacy of Percutaneous Nephrolithotomy for the treatment of renal stones of larger than 2.5 cm and to study the frequency of any postoperative complications associated with this procedure. This is a descriptive study conducted during the period from June 2007 to December 2009. Using non-probability convenient sampling, total 88 patients with renal stones of more than 2.5 cm were selected for PCNL. Data was analyzed on SPSS version 10 for windows XP. In a cohort of 88 patients [57 male and, 31 female] PCNL was performed for renal stone treatment. The mean age was 33.5 [9 - 65] years. The mean operative time was 85 [60 - 180] minutes and the mean stone size was 3.2 cm range [2.5-4.8] cm. There were 37 staghorn and 51 non staghorn stone. PCNL via a single access tract was accomplished in 86% [76/88] of procedures, with upper pole calyx in 30, middle calyx in 27 and lower pole calyx in 19 procedures, while multiple tracts were used in 14% of procedures [12/88] with 09 procedures using the upper and middle calyxes and 05 procedures using lower and middle calyxes. The stone-free rates for staghorn stone at discharge and at 3 months were 83.7% and 90.8% respectively, while for non staghorn stone the figures were 85.8% and 92.5% respectively. Postoperative complications were observed in 9% of the procedures [8/88], the commonest of which was bleeding necessitating blood transfusion in 4 patients. PCNL is safe and Effective treatment for renal calculi associated with less morbidity, shorter hospital stay and is cost effective

Comparison of serum lipid profile in ishaemic and haemorrhagic stroke

To compare serum lipid profile between patients of ischaemic and haemorrhagic strokes. Cross sectional, comparative study. Military Hospital, Rawalpindi, from August 2004 to February 2005. Patients with diagnosis of stroke comprising 100 consecutive patients each of ischaemic and haemorrhagic strokes were included in the study while patients on lipid lowering therapy were excluded from study. To determine the subtype of stroke, clinical examination followed by CT scan of brain was done. A serum sample after 8 hours of overnight fasting was taken on the next day of admission for both groups of patients. Total serum cholesterol, triglycerides, LDL-cholesterol, VLDL-cholesterol and HDL-cholesterol was determined, using enzymatic colorimetric method. Statistical analysis was done by comparison of lipid profile in two subgroups, using proportion test for any significant difference. The mean age at presentation of patients with stroke was 64.2 +/- 12 years with a male to female ratio of 3.6:1. In 100 ischaemic stroke patients, raised serum total cholesterol was seen in 42, triglyceride in 04, LDL-cholesterol in 05 and VLDL-cholesterol in 07 patients. Serum HDL- cholesterol was below the normal reference in 31 cases. On the other hand, serum total cholesterol and triglycerides was raised in 05 patients each, LDL-cholesterol in 09 and VLDL-cholesterol in 03 patients of haemorrhagic stroke. Serum HDL-cholesterol was below normal in 04 patients of haemorrhagic stroke. On comparison, there were significantly greater number of patients with raised srum cholesterol and low HDL-cholesterol in ischaemic stroke than haemorrhagic stroke [p < 0.05]. No statistical significance was found on comparing serum values of ischaemic and haemorrhagic stroke for triglycerides, LDL-cholesterol and VLDL-cholesterol. Ischaemic stroke patients had high serum total cholesterol and lower HDL-cholesterol levels as compared to haemorrhagic stroke. High risk patients of stroke may be screened using srum lipid profile and further studies are suggested to evaluate the effect of lipid lowering therapy in terms of morbidity and mortality in ischaemic stroke patients

Helicobacter pylori infection in patients with dyspeptic symptoms having normal endoscopy

To find out the frequency of Helicobacter pylori infection in the local population presenting with dyspeptic symptoms but having normal upper gastrointestinal endoscopic findings. This descriptive study was carried out in gastroenterology department of Military Hospital Rawalpindi. The study was conducted in the department of gastro intestinal of Military Hospital Rawalpindi from November 2004 to September 2005. Hundred cases of dyspepsia having normal upper gastrointestinal endoscopy were taken as study population. Although the gold standard for presence or absence of Helicobacter pylori infection is culture but in this study the diagnostic method used was histopathology of gastric antrum. The male and female ratio was 2:1. Majority of the patients were either 40 years of age or less, mean age being 40.52 [sd +/- 13.22]. The chief symptoms were pain epigastrium [46%] and upper abdominal discomfort [27%]. Helicobacter pylori gastritis was found in 51% of cases. We conclude that Helicobacter pylori infection is quite common in dyspeptic patients apparently having normal endoscopic gastric mucosal findings. Eradication therapy should be instituted in positive cases to avoid its long-term complications

Anti vascular endothelial growth factor [bevacizumab] in central retinal vein occlusion: an interventional case series

Vascular endothelial growth factor plays major role in ocular angiogenesis and retinal edema production and is a step forward in the management of ocular neovascularization and retinal edematous pathologies. To determine the efficacy and safety of intra-vitreal Avastin [Bevacizumab] in cases having central retinal vein occlusion. A prospective interventional study. This study was done at Said Anwar Medical Centre, Dabgari Gardens, Peshawar from June, 2007 to September, 2009. All patients with central retinal occlusion occurring in the past 3 months and seen between the study period were included in the study. Diagnosis of central retinal vein occlusion was made clinically by slit lamp biomicroscopy with 78D examination Patients who had received any treatment for and eyes which already had developed Anterior Segment Neovascularization, Neovascularization elsewhere or Neovascularization on disc at presentation were excluded. Dose of 0.05 ml [1.25mg] of Avastin [Bevacizumab] was used as intra vitreal injection every month for 3 months in cases that presented within a month of occlusion and less injections were given in dose presenting later. Follow-up was done at 30th, 60[th], 90[th] and 120[th] day after the onset of disease. Visual outcome was defined as Snellen's or LogMar Best Corrected Visual Acuity at final follow up, of 120[th] day, compared to the visual acuity at presentation. Data were analyzed by SPSS version 17. Total of 17 eyes of 17 patients were included in this study. Eleven [64.7%] patients were males while 6 [35.3%] were females. Total of 40 intra-vitreal injections of Avastin were given to patients with a mean of 2.35 injections per eye. Good visual outcome was achieved in 10 [58.8%]] eyes, while 7[41.2%] had stable visual outcome. Mean initial Best Corrected Visual Acuity [LogMar] in all 17 eyes was 1.79 [SD +/- 0.87] which significantly improved to a mean of 1.18 [SD+0.77] at final follow up. Mean improvement in Best Corrected Visual Acuity [LogMar] after paired sample test in all patients at final follow up on day 120 was 0.61[SD+0.84]. Retinal hemorrhages and macular edema decreased clinically on examination on consecutive follow up visits. No eye developed neovascularization elsewhere, neovascularization on the disc, neovascularization, retinal tears, retinal.detachment, lens trauma, endophthalmitis or anterior chamber activity. Bevacizumab [Avastin] is an effective and safe treatment option for central retinal vein occlusion affected eyes and resulted in improvement in visual acuity. It reduced macular edema and prevented ocular neovascularization at least for short term

Evaluation of AST/ALT ratio as a marker of liver fibrosis and cirrhosis in patients with chronic hepatitis C

To assess the relation between serum AST/ALT ratio [AAR] and hepatic fibrosis and cirrhosis associated with chronic hepatitis C. A cross sectional study. The study was conducted in the department of medicine Military Hospital Rawalpindi from Sep 2004 - Feb 2005. Fifty diagnosed patients of chronic hepatitis C were selected whose liver biopsy was performed as a workup plan fro treatment. Serum AST/ALT ratio [AAR] was determined and degree of liver fibrosis noted on histopathology, using Knodell scoring system. ANOVA was applied to study the difference in AAR in different stages of liver fibrosis. The mean AAR was found to be higher with each increasing stage of liver fibrosis. The mean AAR in cirrhotics [1.34] was significantly higher compared to noncirrhotics [0.77], p<0.001. AAR >/= 1 had 100% sensitivity and negative predictive value in distinguishing cirrhotic from non-cirrhotic patients with 87% specificity and 45% positive predictive value. There is only a modest relation between AAR and early hepatic fibrosis [stages 1-3] in patients with chronic hepatitis C, while AAR is significantly higher in patients with advanced fibrosis/ cirrhosis

Optic neuritis: a three years retrospective study

The aim of our study was to review our clinical experience with optic neuritis. A retrospective review of the medical records of patients admitted for optic neuritis from January 2000 through December 2002, in Ophthalmology Department of Lady Reading Hospital, Peshawar was undertaken. Out of 28 cases of optic neuritis, 10 [35.7%] were male whereas 18 [64.3%] were female. The mean age was 31.25 years. Eight [28.6%] cases had bilateral and 20 [71.4%] cases had unilateral optic neuritis. Nine [25%] eyes had retrobulbar neuritis, 24 [66.66%] eyes had papillitis and three [8.33%] eyes had neuroretinitis. Visual acuity [VA] at presentation was between no perception of light-hand movement in 11 [30.55%] eyes, counting finger-6/60 in 18 [50%] eyes, 6/36-6/18 in five [13.88%] eyes and between 6/12-6/6 in two [5.55%] eyes. Patients had mean follow-up of 39.67 days. Final unaided VA of eyes with optic neuritis was between no perception of light-hand movement in 5 [13.88%] eyes, counting finger-6/60 in 9 [25%] eyes, 6/36-6/18 in 4 [11.11%] eyes and between 6/12-6/6 in 18 [50%] eyes. Two [5.55%] cases had recurrence of optic neuritis during study period. Young females are more affected then males. Majority cases were unilateral. Presentation is slightly late with marked impairment of vision. Papillitis is common clinical type of presentation. Fifty percent of patients regain good vision [6/6 6/12]

Induction characteristics of two different concentrations of propofol in children undergoing eye surgeries

To compare the induction characteristics of two different concentrations of propofol [i.e. 1% and 2%] in children undergoing eye surgeries. This cross-sectional comparative study was conducted at LV Prasad Eye Institute Hyderabad India. Hundred consecutlve patients of American soclety of Anaesthesiologist [ASA] status I and II coming for elective eye surgeries were enrolled in the study. Patients were divided into two groups of 50 each. Group A were given propofol 1% while patients in Group B were given propofol 2% for induction of anaesthesia and were maintained with 1% isoflurane and 60% nitrous oxide in oxygen. Induction characteristics were assessed and compared in two groups. Student's t test and chi- square test were applied. Loss of consciousness was more rapid with propofol 2% compared with propofol 1% [40s Vs 48s; P = 0.02]. Pain on injection occurred in 5 patients [10%] and 10 patients [20%], P = 0.09 after propofol 1% and 2% respectively. Spontaneous movements during induction occurred in 8 patients [16%] and 12 patients [24%, P=0.18]. Satisfactory intubation was done in 40 patients [80%] and 45 patients [90%, P=0.19], while spasm just after intubation was noticed in 1 patient [2%] and 3 patients [6%] receiving propofol 1% and 2% respectively. Hemodynamic changes were not different in the two groups. Propofol 1% and propofol 2% are equally effective and safe for induction of anaesthesia in children undergoing eye surgeries

Stress hyperglycemia and mortality in patients with acute ischemic stroke

The objective of the study was to compare mortality and morbidity in patients of acute ischemic stroke presenting with and without stress hyperglycemia. A high proportion of patients suffering an acute stress such as stroke or myocardial infarction may develop hyperglycemia, even in the absence of a preexisting diagnosis of diabetes. This study was carried out in neurology units of Military Hospital Rawalpindi, and in Combined Military Hospital Rawalpindi, both are tertiary referral hospitals. The duration of study was from 1st March to 25th August, 2004. In the hyperglycemic group, out of 50 patients, 22 [44%] died within 04 weeks of stroke. In the control group, 10 [20%] out of 50 patients expired. The study showed a statistically significant relative risk of 2.2 in case of hyperglycemics as compared to normoglycemics. In the study group, mortality rate was higher in males, 14 [63%] out of 22 as compared to females of 8 [36.36%]. Even in survivors, functional outcome at 01 month was worse in the hyperglycemic group. Patients with stress hyperglycemia were 0.4 times less likely to improve as compared to normoglycemics. In non-diabetic patients suffering from an ischemic stroke, moderately elevated glucose levels were associated with a more than 2-fold higher risk of short-term mortality compared with lower glucose levels. Even in survivors, stress hyperglycemia was associated with a poor functional outcome after acute ischemic strokes

Peritoneal biopsy; its role in exudate ascites

The objective of this study was to access the role of peritoneal biopsy in patients with exudative ascities. 30 patients with exudative ascities were studied at Military Hospital Rawalpindi and Combined Military Hospital Rawalpindi .In all patients peritoneal biopsy was done by open method. Biopsy was suggestive in 16 patients .In 9 patients it showed chronic granulomatous inflammation and in 7 patients it was suggestive of abdominal malignancy, in rest of the patients it was nonspecific .In the last group of patients four patients were given a trail of ATT to which they responded. The condition was more common in females [71.4%], and tuberculosis involved women in childbearing age while malignancy mostly in 6th and seventh decade.100% patients presented with abdominal distention and only 30% with abdominal pain. Other symptoms were loss of appetite, shortness of breath, easy fatiguability and fever .We conclude that peritoneal biopsy is a safe and reliable method of diagnosis for patients with exudative ascities and should be done in every case if the patient's condition permits. Although in very sick patients a trial of ATT can be given and should be continued

Prevention of postoperative nausea and vamiting by ondansetron, In children undergoing strabismus surgery

To evaluate the antiemetic effect of ondansetron in controlling postoperative nausea and vomiting in children undergoing strabismus surgery. It was a randomized placebo controlled, double blind study of 100 children between 5-15 years of age with American Society of Anaesthesiologists [ASA] status I and II undergoing strabismus surgery under general anaesthesia.. Patients were divided into two groups of 50 each. One group was given normal saline while the other received 75ug/kg1 of ondansetron pre operatively. Children were monitored for the number of emetic episodes, and the need for a rescue antiemetic. There was significantly high P< 0.05 frequency of vomiting 30 patients 60% in group receiving normal saline when compared to ondansetron group 15 patients 30%. The incidence of early vomiting [0-4 hour] and the need for rescue antiemetic were also very low in patients receiving ondansetron when compared with the saline group. Ondansetron was found to an effective drug in preventing nausea and vomiting postoperatively in children undergoing strabismus surgery

Ocular emergencies

To describe clinical data about ocular emergencies [OE] and their management. Design: Descriptive study. Place and Duration of Study: This study was conducted from 1st January, 2000 to 31st December, 2002 at the Department of Ophthalmology, Khyber institute of Ophthalmic Medical Sciences, Lady Reading Hospital, Peshawar. Material and A comprehensive analysis of the computer record available for admitted ocular emergencies was undertaken in terms of gender, age, etiology, procedure performed and hospital stay. Ocular emergencies [1961] were 18.49% of total admissions. Male to female ratio was 2:1. Non-traumatic ocular emergencies were 1058 [53.95%] with male to female ratio of 1.47:1. In the non-traumatic ocular emergencies, majority [67.2%] were 40 years or above. Traumatic ocular emergencies were 925 [47.16%] with male to female ratio of 2.77:1. Majority [83.78%] of traumatic ocular emergencies were below 40 years and 562 [60.75%] below 20 years of age. Only 150 [16.21%] cases were 40 years and above. Corneal ulcers [44.51%] and glaucoma [24.38%] were the most common non-traumatic ocular emergencies, whereas, open globe injuries [73.4%] were leading the traumatic ocular emergencies. Total surgical procedures performed were 1382 [13.7% of total major ophthalmic surgery]. Average stay in hospital was 5.5 days. Ocular emergencies predominantly affected the males in this series. Trauma related OE are almost as common as non-traumatic. Majority of OE need surgical intervention and the average hospital stay is longer than routine admissions

Intracranial hypertension: a three year experience at military hospital, Rawalpindi

Idiopathic intracranial hypertension is a syndrome associated with multiple clinical conditions and is an important mimicker of cerebral venous thrombosis. Given the difference in prognosis of these two conditions they should be differentiated. This study was carried out in indoor and outdoor patients from 1998 to 2000 in Military hospital Rawalpindi. All patients who presented with headache and papilloedema were evaluated further as per protocol after informed consent. Out of 40 registered patients, 12 [30%] were male and 28 [70%] female. The age range was 18 to 45 years, mean was 27.28 + 6.64 years. On neuroimaging 16 [40%] patients found to be suffering from dural sinus thrombosis and all patients had a normal CT scan. Among 16 patients with dural sinus thrombosis 1 [6.3%] patient had protein C deficiency, 2 [12.5%] had pregnancy, 1 [6.3%] had postpartum haemoohage, 1 [6.3%] had puerperal sepsis, 5 [31.3%] were evaluated from high altitude, 1 [6.3%] had ear infection, 1 [6.3%] had factor V Leiden, 1 [6.3%] had antiphospholipid antibody syndrome and in the remaining 3 [18.75%] no etiology was found. In patients with isolated raised intracranial pressure a high index of suspicion should be kept for cerebral venous thrombosis as an underlying etiology especially when it occurs with the background of a hypercoaguable state