Comparison of Paramedian with Midline technique of Spinal Anaesthesia in elderly

Objective: To compare the technique of paramedian with midline approach of subarachnoid block in terms of number of attempts and frequency of success rate in elderly patients undergoing elective lower body surgeries

Study Design: Randomized controlled trial

Place and Duration of Study: This study was carried out at Anaesthesia department of Combined Military Hospital Lahore. Six months from Jan 2014 to Jun 2014

Material and Methods: One hundred and seventy elderly patients were scheduled for lower body surgery, using spinal anaesthesia. They were randomized to either Midline approach [n=85] or Paramedian approach [n=85] by lottery method. The outcome measures number of attempts and success rate were noted in both groups and analyzed using SPSS version 18

Results: The successful block in first attempt was 95.3 percent in Paramedian group and 58.8 percent in Midline group. Mean number of attempts in paramedian group was 1.24 +/- 0.52 as compared to 1.95 +/- 0.97 in midline group. A p-value <0.05 was taken significant

Conclusion: The Paramedian technique was found associated with higher success rate, lesser possibility of repeated number of attempts in elderly patients as compared to Midline approach

Clinical spectrum of pediatric dermatoses at a tertiary care unit

Objective: To determine the clinical spectrum of pediatric dermatoses at a tertiary care unit

Methods: Three hundred and fifty cases aged up to 12 years, presenting to dermatology unit I, Jinnah Hospital, Lahore with skin diseases were enrolled over a period of 6 months. Detailed history and physical examination were done to diagnose the skin lesions. All the information was collected on a specially designed proforma

Results: A total of 350 children with skin diseases, 186 [53.1 percent] males and 164 [46.9 percent] females were seen. The mean age of patients in the study was 4.18+/-2.97 years. Infections and infestations were the common dermatoses seen in 158 [45.1 percent] and 105 [30 percent] children, respectively. Eczema was present in 79 [22.6 percent] patients and diseases of sweat gland in 8 [2.3 percent]

Conclusion: Infection and infestations were seen as the most common pediatric dermatoses

Exposure of dermatology postgraduate trainees to different learning resources and procedural skills in Pakistan

Objective To determine the learning resources and procedures used for dermatology postgraduate training in Pakistan

Methods Trainees from different centers accredited for dermatology postgraduate training in Pakistan were approached. A pre-designed proforma was filled by 100 dermatology trainees of FCPS, MCPS and MD programs

Results Hundred percent trainees followed Rook's Textbook of Dermatology as a major learning resource. The most commonly read journal was Journal of American Academy of Dermatology. Scientific conferences had been attended by less than 50% students. Most of the students were participating in clinical case discussions, while clinical slide sessions and histopathology sessions were not being attended by all. Most commonly learnt diagnostic procedure was fungal scraping [92%], least common was immunofluorescence [16%]. Out of various therapeutic procedures, electrocautery was being performed by 100% students while dermal fillers and botox injections by none

Conclusion There is a wide variation in exposure of dermatology residents to various learning resources and procedural skills across different teaching units of the country. The most lacking part of training highlighted in this study is the aesthetic or cosmetic aspects of dermatology

Potential of nano-emulsions as phytochemical delivery system for food preservation

Nature is a rich source of bioactive phytochemicals. These plant based compounds have rich scope as antioxidants, antimicrobial compounds and food preservatives and so for long time to be used in meat, fruits, vegetables and processed food items, either as added preservative or as coating material in various food applications, but the major limitation is their limited solubility in a food grade medium. Nano-emulsion is a best choice as a medium having vast area of application. The major advantage of nano-emulsion would be the solubility of a vast group of compounds, due to the presence of water and lipid phases. In this way, nano-emulsions can be proved to be the most suitable candidate as phytochemical delivery system for food preservation. In present article, the use of phytochemicals as potent food preservatives has been reviewed, in context of solubility of phytochemicals in nano-emulsion and applications of food grade nano-emulsions to food systems

Metal II complexes of ethambutol as good enzyme inhibitor and promising antioxidant

Ethambutoldihydrogenchloride [EMB] with chemical formula C[10]H[24]N[2]O[2].2HCl is ethane-1,2-diamine in which one hydrogen attached to each of the nitrogen is substituted by a 1-hydroxybutan-2-yl group [S,S-configuration]. It is an FDA approved drug and has been used for treatment of tuberculosis since 1960's. Prolong use of EMB has a side effect of visual impairment and in literature it is related with the depletion of Zn metal from the body. As it is a good chelating agent, many metal II complexes have been synthesized with anti-tubercular activity. The purpose of this work was to synthesize metal II complexes of EMB and to evaluate their antioxidant activity along with enzyme inhibition activity [acetylcholine esterase and protease]. The metals used for complex formation were Co, Zn, Fe, Cu and Ni. IR spectral data and physical parameters supported the complex formation. The obtained results showed the synthesized complexes as notable antioxidants and enzyme inhibitors

Potent AChE enzyme inhibition activity of Zizyphus oxyphylla: a new source of antioxidant compounds

The purpose of this study was to assess the antioxidant potential and enzyme inhibition of various fractions of Zizyphus oxyphylla. The plant metabolites were extracted in methanol and partitioned with n-hexane, chloroform, ethyl acetate and n-butanol successively. Phytochemical screening showed presence of alkaloids, terpenoids and flavonoids in ethyl acetate and n-butanol fractions. The antioxidant potential and acetylcholine esterase assay of all these fractions and remaining aqueous fraction was evaluated by using reported methods. The results revealed that chloroform soluble fraction exhibited highest percent inhibition of DPPH radical as compared to other fractions. It showed 95.01 +/- 0.37% inhibition of DPPH radical at a concentration of 120microg/mL. The IC[50] of this fraction was 13.20 +/- 0.27microg/mL, relative to butylated hydroxytoluene [BHT, a reference standard], having IC[50] of 12.10 +/- 0.29microg/mL. It also showed highest total antioxidant activity i.e. 1.723 +/- 0.34 as well as highest FRAP value [339.5 +/- 0.57TEmicroM/mL] and highest total phenolic contents [142.65 +/- 1.20 GAE mg/g] as compared to the other studied fractions. The fractions were also studied for Acetylcholine esterase enzyme [AChE] enzyme inhibition activity and n-butanol soluble fraction exhibited maximum inhibition [95.5 +/- 0.13mg/mL with IC[50] =9.58 +/- 0.08mg/mL relative to galanthamine [13.26 +/- 0.73mg/mL], while n- hexane soluble fraction [165.15 +/- 0.94mg/mL] showed non-significant. We are still working to isolate pure compounds for active fractions targeting potent inhibition responsible for some activities

Efficacy of narrowband ultraviolet B phototherapy with needling in patients of vitiligo

Objective: To determine the efficacy of narrowband ultraviolet B therapy [NBUVB] with needling in patients of vitiligo

Methods: A total of 100 cases were included in this study. In each patient a patch of 15 to 5 cm diameter skin area was selected as a target lesion for the study. Needling was done on the whole patch with a disposable insulin syringe, from the pigmented margins or the islands in the vitiliginous patch. After the procedure, the whole patch was subjected to NBUVB. The repigmentation was assessed according to 5-grades scale. Results: Out of 100 patients of vitiligo, 45% males and 55 % females, treated with NBUVB with needling, 58% patients showed grade 4 response i.e. 75% or more repigmentation

Conclusion: Narrowband UVB with needling is an effective, useful and well-tolerated therapy for treatment of vitiligo

Frequency of dyslipidemia in patients with psoriasis

To determine the frequency of dyslipidaemia in psoriatic patients. A cross-sectional study was carried out in the Department of Dermatology, Jinnah hospital, Lahore for the duration of six months. A total of 120 patients suffering from psoriasis, of any severity, belonging to either sex and with age between 15-70 years were included in the study. All patients in the study were investigated for total cholesterol, triglycerides, low-density lipoproteins and high-density lipoproteins after 12-14 hours of overnight fasting. The mean age of the patients was 38.59 +/- 13.86 years. There were 78 [65%] male and 42 [35%] female patients. The mean duration of psoriasis was 5.46 +/- 4.49 years. The mean PASI score was 14.98 +/- 8.95. There were 67 [55.8%] patients having dyslipidaemia and 53 [44.2%] patients had normal lipid levels. 34 [28.3%] patients had raised total cholesterol [>200mg/dl], 32 [26.7%] raised low-density lipoprotein-cholesterol [>130 mg/dl], 44 [36.7%] hypertriglyceridemia [>150mg/dl] and 35 [29.2%] patients had reduced high-density lipoprotein-cholesterol [> 130 mg/di], 44 [36.7%] hypetriglycerideia [> 150 mg/d] and35 [29.2%] patients had reduced high-density lipoprotein-cholesterol levels [< 40 mg/dl] it is concluded from this study that patients of psoriasis have a high incidence of dyslipidaemia, as it was found in 55.8% of psoriasis patients

Cutaneous manifestations of chronic renal failure

Objective: To determine the frequency of cutaneous lesions in patients of chronic renal failure [CRF]

Methods: 350 patients of CRF regardless of gender and cause, fulfilling inclusion criteria were enrolled from all the four medical units, nephrology unit and renal dialysis unit of Jinnah Hospital, Lahore. An informed consent was taken. Detailed examination and required investigations for cutaneous manifestations were carried out, noted and entered in a structured proforma

Results: Out of 350 patients evaluated, 100% had skin changes. 186 [53%] patients were males and 164 [47%] were females. The most prevalent finding was xerosis present in 309 [88.3%] patients followed by pruritus in 271 [77.4%] patients. Among nail changes, half-and-half nails were present in 267 [76.3%] and among mucosal changes, xerostomia was present in 290 [82.9%] patients

Conclusion: Chronic renal failure is associated with complex array of cutaneous manifestations caused either by disease or treatment. The commonest are xerosis, pruritus, half-and-half nails and xerostomia

Alcohol-induced Hyperlipidemia Is Ameliorated by Orally Administered DWP208, a Sodium Succinate Form of ZYM201

DWP208 is a sodium succinate form of ZYM-201 which is a triterpenoid glycoside isolated from Sanguisorba officinalis, a medicinal plant prescribed for various diseases, such as duodenal ulcers and bleeding in East Asian counties. We demonstrated that this compound is able to normalize the altered lipid metabolism induced by hyperglycemia and a high fat diet. In this study, we determined whether hyperlipidemic conditions induced with chronically treated alcohol can also be restored by DWP208. Similar to our previous results, orally administered DWP208 (1 to 10 mg/kg) also ameliorated the hyperlipidemia that was induced by alcohol. This compound reversed the alcohol-induced hyperlipidemia including (i) up-regulated hyperlipidemic parameters such as low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), atherosclerotic index (AI), triglyceride, and total cholesterol, and (ii) down-regulated hyperlipidemic parameters such as absolute body weight, superoxide dismutase (SOD) activity, and high-density lipoprotein (HDL) in serum and liver. According to our data, the ameliorative activity of DWP208 is due to its indirect anti-oxidative activity as a result of which lipid peroxide and hydroxyl radical levels were reduced and the activity of SOD was enhanced. Therefore, our data strongly suggest that DWP208 can be used as a remedy against alcohol-induced hyperlipidemia.

Herpes zoster in children

To study the epidemiology and clinical features of childhood herpes zoster. The study was carried out from March 2008 till February 2012. Forty two cases of herpes zoster in children less than 12 years of age were enrolled from the outpatient departments of Lahore General Hospital and Jinnah Hospital Lahore. Patients were subjected to detailed history, physical examination and relevant investigations. Out of 42 patients with herpes zoster, 57.1% were males and 42.9% were females. The mean age was 8 years with an age range of 18 days to 12 years. In most patients a single dermatome was involved [69%] and thoracic dermatome was involved in the majority [40.4%]. The most common symptom was pruritus in 52%, followed by pain in 12%. A positive history of previous exposure to varicella was present in 31% patients only, and out of these 61% were exposed before the age of two years. Six patients gave history of chickenpox in mother during pregnancy. Majority of patients i.e. 83.3% showed no evidence of immunosuppression on history, examination and investigations. Three patients were anti-HCV positive [7.1%], two [4.6%] had tuberculosis, one [2.3%] patient was taking steroids and one [2.3%] was diagnosed as leukemia. Most of the children with herpes zoster had no obvious evidence of immunosuppression. History of previous exposure to varicella was found in only 31% with majority being exposed below two years of age. Herpes zoster is a relatively mild disease in children with pruritus being the main symptom in 52% and pain occurred in only 12% of cases.

comparison of efficacy of single topical permethrin and oral ivermectin in the treatment of scabies

Scabies is a common health problem worldwide. Among available topical treatment modalities, 5% permethrin is the most effective scabicide with few side effects. Ivermectin is the only oral scabicide available. It is effective, inexpensive and easy to administer with no known drug interactions and limited side effects. To compare the efficacy of topical permethrin and oral ivermectin in treatment of scabies. In this quasi-experimental study, a total of 120 patients of scabies were enrolled and randomly divided in 2 groups of 60 each. Topical 5% permethrin whole body application for 10-12 hours and oral ivermectin as 200 micro g/kg were used in groups A and B, respectively. In both groups, history, examination and microscopy were carried out at day 0, 7 and day 14. Response to treatment was judged on following parameters: decrease in severity of pruritus, nonappearance of new lesions and absence of burrows. Each parameter was scored and sum total of individual scores was used to determine the efficacy. Mean age in group A [permethrin] was 29.45 +/- 9.72 years and in group B [ivermectin] was 31.45 +/- 12.78 years. In both groups, 66.7% patients showed complete cure. There is no significant difference regarding efficacy of topical permethrin and oral ivermectin when used in treatment of scabies

Cutaneous manifestations in patients of dengue fever

To observe the spectrum of cutaneous changes in patients of dengue fever. The study was carried out from April 2010 till October 2011. Three hundred cases of dengue fever were enrolled from the outpatient and inpatient departments of Jinnah Hospital, Lahore. Patients meeting the inclusion criteria were subjected to detailed history, physical examination and relevant investigations. The data was recorded on a pro forma and later analyzed. Out of 300 patients with dengue fever, 67.3% were males and 32.7% were females. The mean age was 35 years with an age range of 2 to 80 years. Cutaneous manifestations were present in 65% of patients. Commonest skin manifestation was pruritus which was present in 69.2% patients. This was followed by burning of extremities which was present in 64.6% patients. A skin rash was present in 42.9% patients. This rash was macular in 31.7% and papular in 11.2% patients. A petechial eruption was seen in 20% patients, while ecchymosis was seen in 13.8% patients. Mucosal involvement was seen in 40.66% patients. Skin manifestations are a common feature of dengue fever and were seen in 65% of our patients

Scabies; safety of permethrin and ivermectin

Scabies is a common health problem worldwide. Most treatment modalities available are topical. Among them 5% Permethrin is the most effective scabicide with few side effects. Limiting factors are its high cost, cumbersome application and emerging resistance. Ivermectin is the only oral scabicide available. It is effective, inexpensive and easy to use drug with no known drug interactions and limited side effects. To compare the safety of topical Permethrin and oral Ivermectin in treatment of scabies. Quasiexperimental study. Setting: Department of dermatology Jinnah Hospital, Lahore. Subjects: 120 patients were enrolled and were randomly divided in 2 groups of 60 each.-12-02-07 to 31-01-08. Non funded study [As ivermectin was not available in Pakistan during the study period, it was imported from India as tablet Ivecop 12 mg]. Topical Permethrin and oral Ivermectin were used in groups A and B respectively. Patients were examined and certain investigations were carried out before dug administration, and at day 7 and day 14 to evaluate the safety of both drugs on the basis of appearing of side effects and change in baseline investigations. In both groups, equal number of patients experienced side effects [n=15]. In group A, side effects observed were burning [n=8], contact dermatitis [n=4] and stinging [n=3]. In group B, we observed muscular pain [n=5], nausea [n=5], headache [n=2] and others [n=3]. Significant rise of hepatic enzymes was noticed in only 1 patient of group B which improved on next follow up. We found no statistically significant difference regarding safety of use between permethrin and ivermectin

Frequency of mucocutaneous manifestations in HIV positive Pakistani patients

Mucocutaneous manifestations are commonly observed in HIV patients. These range from various opportunistic infections, inflammatory dermatoses to neoplasms and drug reactions. To observe the nature and frequency of mucocutaneous manifestations in patients of HIV, with or without antiretroviral therapy and their correlation with CD4 cell counts. The duration of study was one year, starting from July 2009 to July 2010. The patients were enrolled from the HIV clinic and inpatient departments of Jinnah Hospital Lahore. Patients meeting the inclusion and exclusion criteria were subjected to a detailed history and clinical examination. Investigations were carried out where required. Treatment profile was also noted. The data was recorded on a pro forma and was analyzed later. A total of sixty two patients were enrolled in the study. There were 49 [79%] males and 13 [21%] females. The age range was 4 to 58 years. Cutaneous manifestations were seen in 51 [82%] patients. The most common cutaneous findings were fungal infections seen in 33.87% patients, followed by viral infections [29.03%], xerosis [22.58%] and bacterial infections [12.9%]. Less common manifestations were photosensitivity, scabies and hyperpigmentation. CD4 cell count was found to be more than 455xl0[9]/ in 22 patients while it was less than 455xl0[9]/in 40 patients. Skin manifestations were found in 19 [86.36%] patients with a high count and in 33 [82.5%] patients with a low count. Cutaneous manifestations are commonly seen in patients of HIV infection

Cornelia de Lange syndrome - a cause of hypertrichosis in children: case report and review of literature

Cornelia de Lange syndrome is a rare developmental disorder characterized by hypertrichosis, low intelligence, delayed milestones and skeletal and dental abnormalities. Gastroesophageal dysfunction, ophthalmologic, cardiac and genitourinary anomalies, learning difficulties, and mental retardation may be present in severe cases. We report a case of this syndrome who presented for laser treatment for the problem of hypertrichosis, and on examination other features of the syndrome were noted

Werner syndrome: a case report and review of literature

Werner's syndrome is a rare inherited disorder characterized by short stature, sclerosed skin, cataract and premature aging of the face. The disease involves multiple systems of the body and some of the abnormalities may cause life threatening complications such as myocardial infarction and malignancy. We report a case of this rare disorder

case of Kindler syndrome with florid scarbies

Kindler syndrome is a rare autosomal recessive disorder characterized by congenital blistering and photosensitivity combined with progressive poikiloderma and cutaneous atrophy. The genetic defect has been localized to chromosome 20 and the syndrome results due to mutations in the KIND 1 gene. We report the case of a 12-year-old boy with classical features of blistering since infancy, progressive poikiloderma, photosensitivity and characteristic atrophic cigarette paper-like appearance of the skin. In addition he had florid scabies with quite a few burrows on palms and in finger webs and numerous popular and pustular lesions on trunk and genitalia

Preparation of new formulations of balm as a remedy of flu and their efficacy

Influenza, called the flu, is an acute, highly contagious infection of the respiratory tract, which commonly occurs in children or adults of any age mostly in the winter. In the present study three new formulations of petroleum jelly and essential oils based balm were prepared for the treatment of flu and their efficacy was studied on different age group people i.e. infants, adults, and old age. Results showed that the prepared balms not only gave relief from headache, fever, cough etc., but also they reduced the intensity of viral infection

Cutaneous manifestations in 1000 Pakistani newborns

Cutaneous manifestations are commonly seen in neonates. Benign dermatoses in newborns must be distinguished from more serious, life threatening disorders with cutaneous manifestations. To determine the frequency of various dermatoses i.e. physiological and pathological among newborns up to 96 hours of age. 1000 full-term neonates were enrolled from labour rooms and pediatric nursery of Jinnah hospital, Lahore and were evaluated for cutaneous manifestations. All the relevant data regarding history, clinical examination and investigations were recorded and analyzed. Out of 1000 neonates, there were 469 boys and 531 girls. Their mean age was 72 hours [6-96 hrs]. Cutaneous manifestations were present in 94% of babies and 82.5% babies had more than one manifestation. The most common dermatoses were Mongolian spots [63.2%], Epstein pearls [47.8%], sebaceous hyperplasia [44.8%], miliaria [12.8%], hypertrichosis [12%], erythema toxicum neonatorum [12%], salmon patch [12%] and impetigo [11.4%]. Uncommon manifestations included desquamation 8.5%, omphalitis 8% and birth trauma [7.7%]. Rare dermatoses were hemangiomas [3.5%], cafe-au-lait macules [2.6%], congenital melanocytic nevus [2.4%], acne neonatorum [0.9%], preauricular skin tag [0.4%], cutis marmorata telangiectatica congenita and collodion baby in [0.1%] each. Cutancous manifestations one are frequent in newborns