Hypoglycemic and hypocholesterolemic activity of leave of few medicinal plants against steptozotocin induced hyperglycemia

Diabetes mellitus [DM] is universal of the hormonal problem and Type II diabetes is foremost obstacle. Accessible management in medicine has numerous contrary paraphernalia. Medical flora shows an essential part in managing diabetes specifically in unindustrialized nations. The present study was done on leaves of Rhazya stricta Decane, Adhatoda zeylanica, Berberis lycium Royle and Olea furrrignea, whose methanolic extracts were used to check their hypoglycemic and hypolipidemic activity by using glucometer and kit method respectively in blood of male and female albino mice Balb C. Results showed that leaves of R. stricta were best for hypoglycemia [125.34 +/- 63.79mg/dl, 107.34 +/- 18.00mg/dl, 146.00 +/- 40.36mg/dl and 178.34 +/- 17.03mg/dl], hypocholesterolemia [147.88 +/- 21.83mg/dl and 125.89 +/- 14.03mg/dl] and triglycerides [103 +/- 8.88mg/dl and 89. +/- 43.4mg/dl] in random and fasting conditions, in male and female mice respectively. All plant extract were most effective for hypoglycemia and hypocholesterolemia in female mice as compared to male mice. Moreover statistical analysis revealed that leaves of other plants were also effective but less than leaves of R. stricta. So this plant part and a combination of presently used plants can be used for further studies particularly among females by the purification of active compounds against hyperglycemia and hypercholesterolemia

Head and neck infections; secondary to dental causes; diagnosis and treatment

To analyse the risk factors responsible for different head and neck infections secondary to dental causes. DESIGN: Retrospective study. Department of ENT and Head and Neck Surgery, Allied Hospital, Punjab Medical College, Faisalabad. October 2011 to September 2014. The study consisted of 50 patients who presented with history of head and neck infections secondary to dental causes in the department of ENT and Head and Neck Surgery at Allied Hospital Faisalabad. Patients of head and neck infections of either sex ranging from 12 to 57 years of age and having history of dental infections / extractions were included in the study. Patients having head and neck infections secondary to some other cause other than dental etiology were excluded from the study. SPSS software, version 10 was used to analyse the data. Chi square test was applied to analyse the data. In our study 62% patients with head and neck infections were males while 38% patients were females. Age ranged from 12 years to 57 years with mean age 33.68 years. 96% of our patients presented with deep neck abscesses while only 02% of the patients had osteomyelitis of maxilla and further 02% of the patients presented with necrotizing fasciitis of the submandibular region. 58% of the patients had dental infections whereas 42% patients were having dental extraction as the root cause responsible for these head and neck infections. Moreover, all the patients had poor oro-dental hygiene. It was also observed that 76% of the patients, having history of dental extraction, were treated by unqualified dental practitioners without adequate aseptic conditions. Twelve patients out of fifty [24%] were found to have diabetes mellitus and one patient each was suffering from malignancy and chronic renal failure. 10 [20%] of our patients were smokers. Some of the patients [16%] were having anemia. Two patients out of fifty [04%] were suffering from pulmonary tuberculosis. All these patients were managed with adequate parentral antibiotics and surgical interventions. We had to perform an emergency tracheostomy in one patient. All the patients had good response to the management without any complication. Dental infections and dental extractions are still an important cause for potentially life threatening head and neck infections in developing countries like Pakistan. Unhygienic dental practices and lack of proper dental care facilities along with immunocompromizing conditions such as diabetes mellitus are most common risk factors for these avoidable head and neck infections. Therefore it is necessary that unhygienic dental practices as well as practices by unqualified dental practitioners should be strictly banned

Complications after post and core treatment

Rehabilitation of worn dentitions is a big challenge. To save badly damaged teeth after endodon-tic treatment, provision of post and core restoration is very effective treatment option. The aim of this study was to observe common complications associated with provision of post and core treatment for the badly damage tooth. In this study 95patients reported to Oral Diagnostic Departments ofHamdard University Dental Hospital [HUDH], Karachi and Nishtar Institute of Dentistry [NID], Multan were randomly selected. Sixty two females and thirty three males were included in this study with age range from 18-47years. After taking consent, patients were evaluated by using self designed proforma after six month from provision of post and core restorations. Statistical Package for Social Sciences [SPSS] version 16 was used for data analysis to find common complications linked with post and core restorations. The most frequent complain was gingivitis which was reported in 21 patients [22.1%] followed by loss of retention! requirement of re cementation which was found in 15 [15.7%] patients respectively

Pattern of orthopaedic injuries in motorcycle accidents

Background: With increasing number of motor vehicles and population, trauma patients are increasing day by day. Motorcycle accidents are one of the major causes of disabilities and deaths in young males

Objectives: To determine the pattern of orthopaedic injuries and outcome of its treatment in patients presented to Allied Hospital Faisalabad after motorcycle accidents and to provide the baseline data to policy makers and other stakeholders who want to undertake necessary measures to improve road safety in the country

Study design: Descriptive cross sectional

Setting: Accident and Emergency [A and E] and orthopaedic department of Allied Hospital Faisalabad

Duration of study: January 2012 to December 2012

Method: All patients were admitted through Accident and Emergency department. The data was collected in retrospective way and was analyzed using SPSS version 17

Results: Total 1003 patients were included in this study. 859 were male [85.6%] and 144 were female [14.4%]. The patient ages ranged from 3 to 90 years with peak frequency of 21-30 years 318 [31.7%]. Businessmen290 [28.9%], employee/public workers 224 [22.3%] and students 216 [21.5%] were the majority of victims. Collision of motorcycle with vehicles was the most common mechanism of injury 31.4% and Motorcycle riders 613 [61.1%] were the usual victims. Frequency of non-helmet use was 93.4% and of head injuries along with orthopaedic injuries were 33.1%. Most common orthopaedic injury pattern in motorcycle accidents was fracture of tibia and fibula 43.4%. Mean duration of hospitalization was 9.1days

Conclusion: Road traffic accidents constitute one of most important public health problem in our society. Disabilities and deaths in motorcycle crash are increasing day by day. Preventive programs must be launched by policy makers of concerned departments and stakeholder at national level as solely a medical approach is insufficient to save precious lives of many people

Open reduction and k-wire fixation of displaced unstable lateral condyle fractures of the humerus in children

Lateral condyle fractures in children are the second most common fracture about the elbow. The problem arises in those cases which are difficult to treat by pop cast or by close reduction with percutaneous pin fixation. Late presentation is another challenge. We selected surgical treatment for such cases up to 12 weeks to evaluate our results. To study the usefulness of open reduction and K-wire fixation of displaced, unstable with or without rotation of fractures lateral condyle of the humerus in children presenting up to 12 weeks post injury Prospective. Three teaching orthopaedic units Independent Medical College / Punjab Medical College, and University Medical College Faisalabad. From January 2008 to December 2010. In this prospective study a series of 22 patients were treated using technique of open reduction and internal fixation with k-wires. The results were assessed by criteria of Agarwal et al with little modification after follow-up for 1 year. Excellent to good results were observed in all the12 patients presenting at 1-4 weeks post injury. In 5 patients presenting at 5-8 weeks, the results were excellent in one, good in 2, fair in1 and poor in one patient. In 5 patients presenting at 9-12 weeks good in 1 fair in 2 and poor in 2 patients. Open reduction and internal fixation is an effective treatment in all cases of displaced fractures of the lateral condyle of the humerus presenting up to 12 weeks post injury on the basis of low surgical complications and high union rate

Otitis media: comparison of outcome of underlay versus overlay myringoplasty

To compare the outcome of underlay versus overlay myringoplasty procedure in the management of otitis media. This comparative study was conducted at the Department of Ear, Nose, Throat, Head and Neck Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from January 2008 to December 2009. It included eighty-six patients with dry ears for at least six weeks and no focus of infection in nose, sinuses or throat were included in the study. Forty three patients underwent underlay technique while other 43 patients were operated through onlay techniques. Myringoplasty was performed in total of 86 patients. Male were 69 [80.02%] and females were 17 [19%]. Thirty-five [40.70%] of them belonged to age group of 10-25 years. Thirty [34.88%] were in the age range of 26-35 years, while 21 [24.42%] aged between 36-45 years with mean age of 27.48 +/- S.D 10.20 years. Overall success rate of graft uptake was noted in 70 [81.40%] out of 86 cases. All 86 cases were equally divided into two group's i.e. 43 patients in each group. Thirty-eight out of 43 perforated drums were treated with underlay techniques having success rate of 88.37% as compared to 32 out of 43 patients with only techniques where the graft uptake was 74.4%. Underlay technique is more successful statistically as compared to overlay technique of myringoplasty in all age groups

Outcome of open reduction and intramedullary kirschner-wires fixation for fracture shaft radius ulna in children

Background: There has been a trend toward operative management of pediatric Diaphyseal Forearm Fractures [DFFx]. We studied our experience with surgical management of these injuries to assess outcome and complications

Objective: The purpose of this study was to assess outcome and complications associated with open reduction and intramedullaryKirschner-wire fixation for fracture shaft radius ulna in children

Design: Prospective study

Setting: Orthopedic surgery departments of Independent Medical College, Punjab Medical College and University Medical College Faisalabad

Study Period: Between March 2009 and February 2011

Method: The study group included 32 boys and 12 girls aged 6-15 years with unstable displaced fractures shaft radius, ulna or both. Relevant history and x-rays of the forearm were taken. We followed the inclusion and exclusion criteria. All the cases were treated with open reduction and retrograde Kirchner wire fixation. The cases were followed for at least 6 months. Patients were assessed functionally and radiologically and results were graded according to the system described by Price et al as excellent, good, fair and poor

Results: This prospective study was completed on 44 patients 32 were male and 12 were female. All fractures were united in acceptable alignment. At final assessment there were 30 [68.18%] excellent, 8 [18.18%] good, 3 [06.82%] fair and 3 [06.82%] poor results. The fair or poor clinical outcome was higher in children above 10 years of age. Delayed union after IM intramedullary fixation occurred in 3 children over 10 years of age

Conclusion: This technique can provide precise fracture reduction, maintains stabilization for fracture healing, results in minimal cosmetic deformity, cost effective and facilitates easy removal of implants after treatment

Outcome of augmented external fixation of unstable distal radius fractures

Background: Well-reduced unstable distal radius fractures have the potential to undergo late displacement and/or collapse due to musculotendinous forces. To over come this there is controversy as to which is the preferred treatment - minimally invasive like external fixation or invasive like open reduction and plating

Objective: To determine the outcome of augmented external fixation of unstable distal radius fractures

Design: Prospective study

Setting: Orthopedic surgery department of Independent Medical College, Punjab Medical College and University Medical College Faisalabad

Period: Between January 2009 and December 2010

Methods: In this case series study 46 patients with unstable distal radius fractures were followed for 1 year after operation using the technique of application of common 3.5mm AO external fixator using principle of ligamentotaxis for reduction and restoring length with addition of k-wires plus bone graft if needed. All patients were evaluated according to the sum of demerit points system [Saito, 1983]

Results: There were 20 male [43.48%] and 26 females [56.52%] with mean age 48.54+16.36. According to the sum of demerit points [Saito, 1983], the latest follow-up functional end results were 'Excellent' in 45.66%, Good in 34.78%, Fair in 10.87% and Poor in 08.69%. As for the anatomical results at follow-up, the radial shortening <2mm in 37 [70.44%], from 2- 4mm in 5 patients [10.87%] and >4mm in 4[08.69%]. The average radial tilt was 22°and palmar tilt was 6°

Conclusions: The application of common 3.5mm AO external fixator with addition of k-wires is simple, cost effective, quick, minimally invasive and prevents redisplacement of fracture fragments adequately. The risk of infection is small and there is little damage to the surrounding tissues

Comparison of solid versus cannulated interlocking nail in fracture of shaft of femur in adults

Objectives: The aim of this study was to compare the outcome of solid versus cannulated interlocking nails as a method of internal fixation in closed femoral shaft fractures in adults

Study Design: Quasi Experimental

Place and Duration of Study: Orthopaedic Department Allied Hospital, Faisalabad a teaching hospital affiliated with Punjab medical college, Faisalabad. Duration of study was from Jan 2007 to Dec 2008

Patient and Methods: The study was based on sixty cases. Thirty cases were included in either group of solid and cannulated intramedullary interlocking nails. The solid interlocking nailing group was designated as group A, the cannulated as group B. The most common cases were road traffic accidents. The average hospital stay was 6 days. The follow up time was 9 months

Results: In group A we have union time within 3 months in 26[86.66%] patients, delayed union in 3[10%] patients and non union in one patient[3.33°%].Three patients in group B[10%] went into non union, one due to deep infection, one due to implant failure and breakage of nail and one with no apparent cause. Regarding infection we had superficial infection in one patient of group A and two patients of group B which was corrected with appropriate antibiotics. No case of deep infection occurred in group A but one in group B which went into non union. Regarding implant failure, we had no implant failure in group A and four cases of implant failure in group B with one nail breakage, two distal locking screw breakage and one proximal locking screw breakage

Conclusion: The most common cause of femoral shaft fractures is road traffic accident with male adult population affected the most. There was no statistical difference in union and infection in both groups. [p value >0.05].There was significant difference in implant failure in both groups with no patient in group A and four in group B [p value <0.05]. So solid interlocking nail is stronger than cannulated one

Laryngeal amyloidosis: a rare cause of hoarseness

To evaluate the presentation and management of laryngeal amyloidosis, a cause of hoarseness. This descriptive study was conducted at Postgraduate Medical Institute Hayatabad Medical Complex, Peshawar over a period of 12 years from Jan, 1996 till Dec 2007 During this period 292 patients admitted with hoarseness at ENT Department HMC, Peshawar were managed. Out of these 21 patients suspicious of laryngeal amyloidosis were included in the study. The presenting complaints were hoarsensess, sorethroat and dyspnea on exertion. All patients were of male sex with age ranged from 45-65. Surgical treatment was given to all cases. Amyloidosis can involve the larynx presenting with hoarseness. Patient should be evaluated for systemic diseases. Site, size and extent of disease can be evaluated with axial C.T scan and the different treatment option decided accordingly

Results of non anatomical fixation of unstable pertrochanteric fracture femur

To evaluate the results of union in unstable pertrochanteric fracture of femur in nonanatomical reduction and fixation. A descriptive study conducted at Department of Orthopaedic surgery Bahawal Victoria Hospital Bahawalpur. In the present study, we had 30 patients with unstable intertrochanteric fractures of either sex. Patients were treated by nonanatomic reduction, either by Dimon Houghsten or Sarmiento osteotomy depending upon fracture geometry, and fixed by dynamic hip screw. Out of thirty patients, 21[70%] were male and 9 [30%] were female. The average age of male patients was 74.9 years and that of female was 61.2 years. We included patients with Jensen's type IV fractures having osteoporotic grade of four to six according to Singh's index. Patients were followed up for minimum period of 20 weeks and evaluated for radiological union and functional outcome using Sikorski and Barrington's pain and mobility scale. Out of thirty patients, only 25 completed the follow up. Four patients had limb length discrepancy. 88% of the patients had excellent to good functional outcome. Anatomical reduction must be tried in all cases. However, to avoid the complications of implant failure and loss of reduction with varus union in unstable fractures, non anatomical reduction should be considered

Role of microlaryngoscopy in the management of laryngeal lesions

1. To evaluate the role of microlaryngoscopy in the management of various laryngeal pathologies. 2. to enlist the various laryngeal lesions causing hoarseness and their presentation. Descriptive study. This study was conducted in ENT, Head and Neck Surgery department, Hayatabad Medical Complex, Peshawar from 1[st] September 2000 to 31st December 2002. A series of 70 patients of laryngeal pathologies were included in this study. A thorough history was taken and clinical examination performed, only relevant laboratory investigations were done. CT scan /MRI was done in selected cases for extension of the lesion like carcinoma to nearby structures so that later if the lesion requires endolaryngeal microsurgical intervention, appropriate and precise excision of the lesion be carried out. Microlaryngoscopy was performed in all cases and for diagnostic purposes biopsy was taken for histopathology. 32.85% of the patients with vocal cord nodules, 17.14% with vocal cord polyps and 4.2% with Reinke's edema were treated with microlaryngoscopy. Laser was used along with microlaryngoscopy for laryngeal papillomas in 11.42% and laryngeal granulomas in 2.8%. Microlaryngoscopy was helpful not only in the diagnosis of small vocal lesions but also in the surgical management of these lesions with good post operative functional results. Microlaryngoscopy plays an important role in the diagnosis of a variety of laryngeal lesions especially in all cases that are examined on indirect laryngoscopy, where diagnosis is not clear or needs biopsy for histopathology, Moreover it has got both diagnostic and therapeutic role in laryngeal pathologies. Therefore the facility and expertise should be provided so that an early diagnosis can be made and late untoward complications can be avoided

Anterior cervical reconstruction using titanium mesh cages

Surgical management of cervical lesions with reconstruction procedures has remarkably expanded the options available in the last decade. Anterior cervical corpectomy with titanium mesh reconstruction is one of the effective method of cervical spine reconstruction. We studied 17 consecutive cases in who corpectomy and decompression was performed. Fusion with titanium mesh cages filled with local bone pieces were placed inside the cage. Clinical status improved in 13 patients whereas in 3 it remained unchanged, based on Nurick's classification. At 3 months follow up, 13 [76.4%] patients reported successful arm pain relief and 12 [70.5%] with neck pain relief with visual analog score below five. Complications included cage in kyphosis, radiculopathy, cage subsidence and wound infection. Outcome after cervical fusion procedures with a titanium mesh cage lead to early and good stability of the cervical spine, excellent neurological improvement, low risk of complication and rare need for endogenous bone graft harvest avoiding donor site morbidity, less postoperative pain and decreased hospital stay and cost

Tuberous sclerosis

Tuberous Sclerosis is an autosomal dominant disorder. It occurs with frequency of 1:5800-30000. It present as cutaneous and systemic manifestations. We report here a case of Tuberous sclerosis in a 10 month old infant who presented with infantile spasms and ash leaf lesions. Treatment with steroids showed good response

Diagnostic value of fine needle aspiration cytology [FNAC] in cervical lymphadenopathy

The aim of this study was to evaluate the diagnostic value of fine needle aspiration cytology [FNAC] in head and neck lymph nodes and in differentiating malignant from benign diseases. This prospective study was conducted in the ENT Department of PGMI HMC and LRH Peshawar from 1st April 2003 to 30th March 2004. A total of 42 patients were studied. After thorough history and examination, FNA biopsy was obtained with the help of experienced cytopathologist using 21G needle and the results compared with final histopathological diagnosis. FNAC findings in this series were metastatic [42.85%], tuberculosis adenitis [26.19%], reactive hyperplasia [16.66%], lymphoproliferative disorder [9.52%] and lymphoma [4.76%]. In terms of differentiating malignant from non-malignant lesions; diagnostic accuracy, sensitivity, speciflcity, positive predictive value and negative predictive value of FNAC were 95.23%, 95.83%, 94.44%, 95.85% and 94.44% respectively. FNAC has been found to be a useful diagnostic tool in the evaluation of patients presenting with neck nodes and should be considered before performing open biopsy

Reliability of diagnosis and asthma knowledge, attitudes and perception [KAP] in rural population of NWFP, Pakistan

Beliefs and attitudes have been proposed as partial explanations for low adherence to medical therapy and the consequent high morbidity from asthma. Out of a database of Rural Health Center in Northern Pakistan, one hundred and seventy three self reported asthmatics were interviewed; 75% of whom were diagnosed by doctors and 25% self diagnosed. The participants' mean age was 39.4'18 years; 59% were females. Thirty seven percent were housewives, 18% farmers, 15% students whereas 40% were unemployed. The mean duration of illness was seventy two months [range 1 to 480 months]. Monthly income of 79% of the participants was less than Rs.5000.00. On assessment, the diagnosis of asthma was confirmed by experts in 143 [83%] cases, mean FEV1 76.6'28.4% predicted; whereas 30 [17%] patients with mean FEV1 48.6'23.1% predicted, were found to be suffering from COPD on the basis of history, examination, spirometry, reversibility testing and response to treatment. The KAP results showed the following perceptions among the asthma patients: Asthma can be cured [50%]; Asthma requires life long medication [54%]; Asthma can not be cured [27%]; My children will also suffer from asthma [26%]; Asthma is fatal disease [53%] and Asthma is contagious disease [50%]. KAP of asthma patients in rural communities regarding asthma is low and majority of the patients have poorly controlled asthma. Self reported asthma should be confirmed by trained health professionals