Early detection of doxorubicin-induced cardiotoxicity and its prevention by carvedilol.

Background: The objective was to detect doxorubicin (Dox) - induced myocardial injury at early stage by quantitative estimation of cardio specific protein, cardiac troponin I (cTnI) and to explore the cardioprotective effects of carvedilol. Methods: The study design was lab-based randomized controlled in-vivo in rabbits conducted from January to August 2012. Cardiotoxicity was produced by single intravenous injection of 12 mg/kg body weight (BW) of Dox in a group of rabbits, control group was treated with normal saline only and the rabbits of third group were pre-treated with carvedilol 30 mg/kg of BW for 10 days before injecting Dox. Results: Dox induced cardiotoxicity was depicted by markedly raised serum levels of cTnI, creatine kinase-MB, lactate dehydrogenase, and Grade 3 necrosis of the heart tissue in rabbits. The pre-treatment with carvedilol resulted in improved serum levels of these biomarkers and the histological picture of heart tissue. Conclusions: Quantitative serum estimation of cTnI detects the presence of cardiotoxicity much before cardiac dysfunctions can be revealed by any other diagnostic technique. It can lead to significant economic impact in the management of cancer patients because the troponin-negative subjects can be excluded from long-term cardiac monitoring programs that involve high costs imaging techniques. The outcome of Dox chemotherapy can be made successful with the concurrent use of carvedilol.

Phytochemical and antioxidant studies of Berberis lycium

Six compounds have been isolated from methanolic and petroleum ether extracts of Berberis lyceum [Barberry]. Four out of six isolated compounds are reported for the first time from this plant. Purification of different compounds has been accomplished by conventional extraction and chromatographic techniques. The compounds have been structurally characterized by IR, Low Resolution MS, [1]H-NMR and [13]C-NMR spectroscopic techniques. All plant extracts and isolated compounds were assayed for the first time for their antioxidant activity

Laparoscopic cholecystectomy; outcome in patients with co-morbidity

To determine the frequency of bleeding, surgical site infection and common bile duct injury after laparoscopic Cholecystectomy in patients with co-morbidity. Descriptive Study. [Case series]. Department of Allied and D.H.Q hospital Faisalabad. July 2006 to December 2007. It comprised of 30 consecutive patients of cholelithiasis with co-morbidity presenting in surgical department. Patients having uncontrolled hypertension, chronic obstructive airway disease and malignancy were excluded. Detailed history and physical examination was carried out as per protocol. It was followed up by relevant investigations. All the cases underwent laparoscopic cholecstectomy. The age of the patients ranged from 23-68 y, with mean age of 40-56 y. Among these 14 cases were having D.M [46.66%], 06 patients were cirrhotic [20%], 06 patients had acute cholecystitis [20%], 02 patients were having H.T.N [6.6%] and 02 patients were > 70 years [6.6%]. All the patients were females. Out of diabetic patients undergoing laparoscopic cholecystectomy, SSI was noted in 02 [6.66%] patients. While mild postoperative bleeding was noted in 01 [16.6%] of cirrhotic patients after laparoscopic cholecystectomy.No untoward event was noted in patients with H.T.N ac, Cholecystitis and advanced age. In high risk patients undergoing laparoscopic cholecystectomy, very few complications were noted. Postoperatively, Morbidity following above procedure was quite low as compared to conventional one. Laparoscopic cholecystectomy should be the preferred option in high risk patients for better outcome

Violence against medical staff: prevalence and effects of violence against psychiatrists in Kuwait

To determine the prevalence and effects of violence against psychiatrists in Kuwait. Questionnaire-based study. Hospital for Psychological Medicine, Kuwait. All the consenting psychiatrists working in the only psychiatric hospital in the country were administered two questionnaires; a 12-item frequency-weighted questionnaire to measure the rates, frequency, and severity of violence and another 5-item, duration-weighted questionnaire to measure the effects of violence. 1] The frequency and the type of the violent incidents and 2] the after effects of violence on the victim, over the past one year. Fifty-three [69%] out of 77 psychiatrists completed and returned the questionnaires. Fifty-one [96%] psychiatrists reported having experienced one or another kind of violent incident; twenty-three [49%] experienced physical violence involving a single act of violence and another nineteen [36%] were subjected to physical violence involving multiple assaults or use of a weapon or a gun. The consequences of violence, in order of frequency, included flashbacks [53%], taking time off [41%], fearfulness [32%], and sleeplessness [26%]. The prevalence and severity of violence against psychiatrists are higher than the emergency department [ED] doctors but after-effects of violence were more severe amongst the ED doctors. Introduction of formal protocols, documentation of violent incidents, prosecution of offenders, and organizational support are some of the measures likely to help bring safety at workplace. In view of the small sample size, firm conclusions are difficult to draw

Kartagener syndrome

12 year old boy presented in ENT OPD with rhinorrhoea, nasal obstruction and chronic cough since childhood. He had hypertelorism and his nose was filled with watery and mucoid secretion with extensive nasal polyps bilaterally. Otoscopy revealed secretary otitis media confirmed on tympanometery and myringotomy. Suspicion of Kartagener syndrome came from dextrocardia and was confirmed on electron microscope that revealed missing dynin arms on quantitative estimation of cilia

Determinants of outcome of primary repair of colonic trauma

To search of parameters for the selection of the group cases of colonic injuries getting maximum benefit of primary repair. A prospective non-randomized study. Surgical Unit IV, DHQ Hospital, Faisalabad. Patients with colonic trauma due to penetrating and non-penetrating injuries. The main outcome determinants found significant were age, proper prompt treatment, severity of injury, haemodynamic status at the time of operation and gross faecal contamination. Thirty patients colonic trauma who the basis of history, clinical examination and investigations. Patients were closely observed for sign and symptoms of anastomotic leak, and intra- record of these patients was maintained on preformed proforma. All risk factors were made measurable on abdominal sepsis, wound infection. Out of 30 patients, presented to Emergency Ward during one year, underwent exploratory laparotomy. The complete 24 patients were managed by primary repair and six patients were managed by staged procedure. All the 24 patients developed no infective complications. One out of six patients of staged procedure group died on 3[rd] post-operative day due to sudden myocardial infarction and three out of six patients developed infective complications. Age, proper prompt treatment, severity of injury, haemodynamic status at the time of operation and gross faecal contamination are determinants of outcome of primary repair of colonic trauma

Blunt liver trauma: selective conservative approach

To highlight the scope of conservatism in the selective blunt liver injuries in patients who are hemodynamically stable. Prospective non-interventional descriptive study. The study was conducted in Surgical Unit-I and IV of Allied and DHQ Hospitals, PMC, Faisalabad, during three years from August 2004 to august 2007. Out of 45 patients received during this period, 28 were hemodynamically unstable and were immediately explored, the remaining 17 were enrolled in the study who were managed conservatively. After resuscitation all the patients underwent Ultrasound and then followed up with serial Hb% estimation and repeat ultrasound scanning in the High Dependency Unit of the wards. The patients were discharged on 7[th] day, if the hematology and check Ultrasound scan was normal with the advice to restrict physical activity and the regular follow-up in the OPD. Out of the 17 patients treated conservatively, 14 were male and only 3 were females.the SGPT levels were elevated in 84%. More than one liter of hemoperitoneum was detected in two cases who were given 4 units of blood and 11 of the 17 patients needed blood transfusion. There was no missed intraabdominal injury in our series. The mean length of hospital stay was 10.2 days. The two patients [11.76%] developed perihepatic abscess and were treated by subcutaneous drainage. Selective non-operative approach is a valid policy for patients with blunt liver trauma who are hemodynamically stable

Tuberculosis of the liver

A fifty years old lady underwent elective extended right hemicolectomy for a mass of ascending and transverse colon along with incision and drainage of abscess in the right lobe of liver. Histopathology turned out to be tuberculous liver abscess and tuberculous colitis. Although tuberculosis is very common in our country, but tuberculosis of liver is rare this case is one of that, showing the decreased immunity of the patient and local spread of disease. The tuberculous liver abscess is rare [1], when present is associated with focus of infection in the lungs or the GIT

Occult metastasis in carcinoma of oral cavity

To determine the frequency of occult neck node metastasis in squamous cell carcinoma of oral cavity, in particular relation to the subsite and histopathological grading, and of involvement of the level of lymph nodes in the neck in oral cavity carcinoma. Descriptive study. Pakistan Institute of Medical Sciences, Islamabad and Wah Medical College, POP Hospital, Wah Cantt. from June 2000 to August 2006. Inclusion criteria were untreated carcinoma of oral cavity, not crossing midline, having NO neck. The tumors size more than T4 were excluded. All patients had ipsilateral type III modified radical [functional] neck dissection and lymph node groups were subjected to histopathology. Occult metastasis were found in 12 out of 37 cases [32.4%]. Metastasis in tongue carcinoma was 5/14, lower afveofar ridge carcinoma metastasized in 5/18, floor of mouth carcinoma was 2/4 and buccal mucosa carcinoma was 0/1.The percentage of occult metastasis in well-differentiated carcinoma [WDSCC], moderately differentiated carcinoma [MDSCC], and poorly differentiated carcinoma [PDSCC] were 22.2, 25% and 54.6% respectively. The levels of lymph nodes involved were level I [16.7%], level II [83.3%], level III [75.5%] and level IV [16.7%]. Oral cavity is a favourable site for metastasis to lymphatics even with small tumors. Occult metastasis is so frequent even with early carcinomas that neck should be treated with primary site. It is also important to remove level IV lymph nodes along with level I, II and III

Secretory otitis media in adults

The otitis media with effusion is not very rare in adults. This study was carried out to find etiology and assess different modes of treatment of secretory otitis media in adults. It was a reterospective study carried out at Allied Hospital Faisalabad from Jan 1998 to Dec 2002. Total 20 patients 13 male [65 percent] and 7 females [35 percent] between 20 to 60 years of age. The mean age was 30 years. In 15 patients [75 percent] glue ear was bilateral and in 5 patients [25 percent] it was unilateral. Tympanometery was performed in all the 20 patients which showed type-B tympanogram in all subjects [100 percent]. The most common etiological factor was upper respiratory tract infection [61 percent]. The most common presenting symptom was conductive deafness [90 percent]. The most common sign was immobile tympanic membrane [77 percent]. The severity of the hearing loss in majority of the cases was moderate [60 percent]. The treatment modalities used in majority of patients were antibiotic [35 percent] followed by grommet insertion [30 percent]. The otitis media with effusion in adults must be properly investigated to rule out any grave pathology in nasopharynx and treated properly to avoid further complications of otitis media with effusion such as adhesions, perforation etc

Long-stay psychiatric patients in Kuwait: assessment of their needs

Over the recent times, proclaimed cost effectiveness and favorable response from patients' perspective has resulted in a major shift from hospital to community care, especially for long-stay psychiatric patients. Our study was aimed at defining all the long stay psychiatric patients in Kuwait and assessing their dependency needs so as to make tentative suggestions for their rehabilitation. Information was obtained from case-notes and interviews with the patients and the charge-nurses. Two scales devised for the purpose of the study were used to estimate both the medical and the daily living needs of the patients. Out of a total of 150, more than half had been in hospital for more than five years and just under 4/5ths of them were schizophrenic. Just under 2/3rd s of the patients retained the abilities to wash, dress and undress, and control bowels; and about 3/4ths had not required any medical consultation during the previous month. Conclusions: About 2/3rd s of the patients can be discharged into the community. This would require ten community homes, each accommodating eight to ten patients. The possible number of patients requiring rehabilitation, however, may be much higher. It is estimated that for every long-stay patient in the hospital there are five similar patients in the community, living with and being cared for by their families. In order to accommodate long-stay patients living with and being cared for by their families, another 130 hospital beds and 180 places in the community would be needed

Chronic suppurative otitis Media: treatment with topical quinolone

Chronic suppurative otitis media is a common disease in low socio-economic group with high morbidity. DESIGN OF STUDY: Prospective study. To find out the efficacy of topical quinolones in chronic suppurative otitis media. SETITING: Department of ENT and Head and Neck surgery at Allied Hospital [PMC] Faisalabad. PERIOD: Jan 1998 to Sep 1999. PATIENTS AND METHODS: 100 patients were included in the study. Ears swabs were taken for culture sensitivity and those sensitive to chibromin were treated by topical preparation. Treatment was considered successful if a dry ear was achieved after two weeks treatment. Dry ear was obtained in more than 74% of the patients. CONCLUSIONS: Topical treatment is logical where site of infection if fairly easily accessible and high antibiotic concentration achieved at the site of infection could prevent emergence of resistant strains

Management of pleomorphic adenoma of salivary glands

By far the most common benign neoplasm of salivary origin is the pleomorphic adenoma. It is often poorly capsulated and has bosselated surface hence more chances of recurrence after excision

Objectives: to find out the recurrence rate after superficial or total conservative parotidectomy and in case of minor salivary tumours, wide surgical excision

Design of study: prospective study

Setting: Department of ENT Allied/DHQ Hospital Faisalabad

Period: apr 1994 to Dec 1998

Material and methods: 25 cases of benign salivary swellings [22 male and 3 females] were selected after confirming FNAC report to be pleomorphic adenoma. These patients were subjected to surgical excision of the tumour by superficial/total conservative parotidectomy or excision with healthy cuff of tissue

Results: only one patient having tumour spillage during excision has recurrence in scar incision during five years follow up

Conclusions: it seems reasonable to advocate superficial parotidectomy for benign pleomorphic adenoma of parotid and excision with a wide cuff of healthy tissue in case of minor salivary gland adenoma and to avoid capsular rupture at all costs

Delayed primary closure of contaminated abdominal wounds: a new technique

Wound infection is a common complication after surgery for abdominal sepsis. This is more common in the patients where grossly contaminated abdominal wounds are closed primarily. OBJECTIVE: 1] To assess the efficacy of primary and delayed primary closure in prevention of postoperative wound infection of contaminated wounds. 2] To compare the morbidity with two methods of wound closure. DESIGN: Comparative study PERIOD: July 1994 to June 1997. PATIENTS AND METHODS: Total 81 patients were operated having localized or generalized bacterial peritonitis during a period of 3 years at Islamia Trust Hospital Chiniot. 43 were male and 38 were female. 29[35.81%] patients had primary closure. 52 [64.119%] patients had delayed primary closure with subcutaneous proline. All patients were given appropriate peri-operative antibiotic cover. RESULTS AND COCLUSIONS: 16[55.17%] patients with primary closure had wound infection and only 8 [15.38%] patients with delayed primary closure required secondary closure so; 1. There was significant reduction in wound infection after delayed primary closure of grossly contaminated wounds with subcutaneous proline stitch. 2. It is easy, economical and cosmetically superior to the primary closure and other methods of delayed closure. 3. It reduces the hospitalization and so cuts down the morbidity

Role of nasal splints; prevention of postoperative nasal adhesions and associated morbidity

250 patients were included in a prospective, controlled clinical trial to find out the effectiveness of intranasal splints in prevention of postoperative nasal adhesions. One group[125] had insertion of splints while the other group [125] did not. Associated morbidity was also assessed. The incidence of formation of nasal adhesions was 2% in splinted group as compared to 11.9% in the non-splinted group [p<0.05].The patients who had multiple procedures were a higher risk of developing adhesions. The mean pain scores at pack removal and on 7th postoperative day were significantly high in splinted patients [p<0.001].The rate of Vestibulitis was 12% in splinted patients as compared to 2.55% in non-splinted patients. The complications such as septal perforation, ulceration and posterior dislocation of splint were not significant. It is concluded that splints should be used in carefully selected high risk patients

Quilting of mucoperichondrial flaps following septoplasty, an alternative to nasal packing

To find out a simple and effective method to stop haemorrhage and prevent haematoma formation after nasal septal surgery. DESIGN: prospective clinical trial. SETTING: Bahawal Victoria Hospital ENT department. PERIOD: Two years during 1993 - 1994 inclusive. SUBJECTS: 80 patients with deflected nasal septam admitted for surgery [70 males and 10 females] Male: female ratio 7:1. METHOD: Quilting of the mucoperichondrial flaps. None of the patients had either haemorrhage or haematoma. The surgical technique is simple, safe and effective

Role of reparil in controlling post-tonsillectomy pain

OBJECTIVE: Prospective controlled double blind study. SETTING: Bahawal Victoria Hospital Bahawalpur. PERIOD: Mar 1995 to Dec 1995. SUBJECTS: 48 patients [21 male and 27 Female] admitted for tonsillectomy. Age ranged from 14 years to 21 years. METHODS: Group A [24 patients] was given Reparil 5 mg intravenously before operation and 12 hours after operation. Group B [24 patients] was given 5 ml of normal saline at the same timings. All patients in both the groups received 400 mg. Brufen orally 8 hourly. The rescue analgesia was given in the form of intramuscular pethidine. The pain was assessed by visual analogue scale at 6,12, 18 and 24 hours after the operation. Food intake was also assessed at similarly timings. The rescue analgesia consumed in 24 hours was noted. The number of patients experiencing moderate to severe pain is significantly less in group A as compared to group B [P<0.05]. Similarly food intake was also better in group A [P<0.001]. The amount of Pethidine consumed as rescue analgesia in first 24 hours was more than double in group B as compared to group A patients. Reparil has helped to reduce post-tonsillectomy pain

Epidemiology and management of Epistaxis in the Punjab

640 patients suffering from epistaxis has been analysed. Of thee patients 60% were male and 40% female. 86% were aged between 11-40 years. The occurrence of epistaxis was greatest during the summer and winter months. Accidental trauma turned out to be the commonest [28%] cause of nose bleeding, followed by inflammatory causes [17% and idiopathic [14.5%]. In active nose bleeding anterior nasal packing was effective in 261 cases; chemical cautery in 78 cases and electrocoagulation in 65 cases; post nasal packing [Foley's catheter] in 48 cases and nosepinching in 56 cases. Arterial ligation had to be undertaken only in 2 cases. The aetiological factors and management are discussed

unusual presentation of retained surgical sponge

A 49 years old lady presented with acute intestinal obstruction after one year of abdominal hysterectomy. On explorative laparotomy, a surgical sponge was found in the lumen of the small gut. The sponge was left behind in the peritoneal cavity during previous surgery and latter on eroded into the lumen of small bowel causing obstruction