Development of cetyl dimethicone based water-in-oil emulsion containing botanicals: Physical characteristics and stability

The aim of current research was to develop a water-in-oil emulsion containing grape seed extract for application in cosmeceuticals. Finally grinded dried grape seeds powder was extracted with hydro alcoholic mixture. Emulsions consisting of different concentrations of cetyl dimethicone [Abile EM90], the nonionic emulsifier, liquid paraffin as oily phase and water as aqueous phase were developed. Color, odor, pH, viscosity, liquefaction, phase separation, centrifugation and thermal stability of the formulated emulsions were observed at various storage temperatures i.e. 8 +/- 0.5[degree sign] C, 25 +/- 0.5[degree sign] C, 40 +/- 0.5[degree sign] C and 40[degree sign] C +/- 0.5[degree sign] C with 70% RH. The stable formulation consist of 16% mineral oil, 4% of ABIL EM 90[registered sign], 4% grape seeds extract, 1% rose oil and 75% distilled water. All the results derived from this study showed good stability over the three months study period which indicates w/o emulsion can be used as carrier of 4% grape seeds extract to enhance desired effects when applied topically

Sofa score and outcome: experience at a public sector hospital ICU

Objective: The objective was to find a cut off value of at admission SOFA score that best predicts outcome in critically ill patients admitted to ICU of public sector health care facility

Study Design: Cross-sectional, descriptive study

Place and Duration of Study: Medical ICU, Holy Family Hospital, Rawalpindi from February to April 2013

Material and Methods: One hundred and one patients were included. At admission SOFA score of each patient was noted. Data regarding age, gender, at admission SOFA score and outcome in terms of expired or improved [discharged/shifted from ICU] was sought. Receiver Operator Characteristics Curve [ROC] was drawn for SOFA score and poor outcome. Based on the coordinates of SOFA score and outcome ROC curve, best cut off value of SOFA scores with corresponding highest sensitivity and specificity was calculated. Outcome of patients above and below the cut off value was correlated employing Chi-square test

Results: Of the 101 patients, 39 [38.6%] improved and 62 [61.3%] expired. Mean initial SOFA score of patients who improved was 5.87 +/- 4.17 and who expired was 10.98 +/- 4.65. Coordinates of the curve showed that SOFA score cut off value 7.5 had best corresponding sensitivity [0.774] and specificity [0.744]

Based on this finding, patients were categorized to Group I [SOFA score <7], and Group II [SOFA score >8]. 32.6% of the Group I and 82.8% of the Group II patients expired [p-value 0.0000001]

Conclusion: Higher initial SOFA scores in critically ill patients is associated with higher mortality. Initial SOFA scores [<7 and >8] are best predictor of outcome in these patients

Incidence of retinopathy in chronic Hepatitis C patientstreated with pegylated interferon alpha 2a and ribavirin combination therapy

The objective of this study was to determine the incidence of retinopathy in chronic hepatitis C patients treated with Pegylated interferon alpha 2a and Ribavirin. This descriptive case series study was conducted in Medical Unit II of the Jinnah Hospital Lahore from September 2012 to February 2013. One hundred chronic hepatitis C patients visiting Medical Unit II outpatient department fulfilling inclusion criteria were selected for this study via non probability purposive sampling. Patients were started on pegylated interferon and ribavirin combination therapy. Subjects were subjected to dilated eye fundoscopic examination at the start of therapy and then after three months of the therapy. One hundred patients were included in this study. Out of these 100 patients 5% developed retinopathy whereas fundus examination was normal in rest of the patients. Interferon therapy can lead to retinopathy. Periodic fundoscopic examinations help in early detection and prevent progression to permanent visual loss

Dengue hemorrhagic fever: comparison of patients with primary and secondary infections

Dengue hemorrhagic fever [DHF] is considered to be associated with secondary dengue infection. This study was conducted to note frequency of primary and secondary dengue infection in DHF patients. Additionally these patients were compared in terms of age, gender, laboratory parameter, diseases severity and outcome. In this cross sectional observational study DHF patients fulfilling DHF criteria of Dengue Expert Advisory Group [DEAG] were included and divided into groups based on dengue specific IgG positivity and ratio of IgM to IgG. Group I, patients with secondary dengue infection were IgG positive or their ratio of IgM to IgG was <1.2. Group II, primary dengue infection patients were IgG negative or their ratio of IgM to IgG was >1.2. The two Groups were compared for statistically significant association in terms of age, gender, laboratory parameter [at admission hematocrit [HCT], platelet, white blood cell [WBC] counts, alanine aminotransferase [ALT] value], severity [DHF or dengue shock syndrome], and outcome [recovered or expired]. Two hundred thirty-four DHF patients were included. 66.2% was male and 33.8% female. Mean patient age was 28.8 +/- 12.4 years. Based on dengue markers results, 61.5% patients were categorized to Group I, and 38.5% to Group II. Statistically significant association between the two Groups was noted in terms of at admission platelet count, and ALT value, P value <0.05. Primary dengue infection is frequently associated with DHF. Patients with DHF caused by secondary dengue infection have lower at admission platelet counts and higher ALT value

Head injury and its consequences - a one year study in Karachi

Head injuries are a major cause of mortality or disability among the youth of the nation. This study was conducted to determine the causes of head injuries in Karachi and its implications on individuals. Prospective observational Study. This study was performed at the Emergency department of Jinnah Post Graduate Medical Centre [JPMC], Karachi from January 2013 to December 2013. The study included 1,59,600 cases of head injury [expired or alive] brought to the emergency department of JPMC. Major Head injuries accounted for 42% of the total injury cases. Majority of the head injury cases belonged to the male segment of the society [73%] with ages ranging from 20 years - 39 years [54%]. The leading cause of head injury was found to be Road traffic accidents [RTA] [43%]. While analysing the outcomes of head injuries, it was found that the death rate for head injuries was 40%. This encompasses the patients that expired during or after treatment as well as the dead brought to the hospital. The mortality rate due to head injuries is escalating day by day. Road traffic accidents account for majority of these cases. Steps need to be taken to control fatal head injuries by adopting effective preventive measures like traffic control and management, rapid response to accidents, effective and efficient handling of cases in hospital emergencies

Epidemiology and mortality of burns in Karachi

Despite being a serious hazard the causal factors and outcomes of burn injuries in Karachi remain an under researched area. The purpose of our study was to analyse the epidemiology and mortality of burn injury cases in Karachi in order to create awareness at mass level. Prospective Observational Study. This study was carried out from October 30[th], 2013 to April 30[th], 2014 in the Burns Centre, Civil Hospital Karachi. The study encompassed all the burn injury cases [expired or alive] reported to the Civil Hospital during the six months of the study period. The demographic information, cause and level of injury of all the reported cases were documented. 784 cases of thermal injuries were reported. Out of these, 441[56.25%] were males and 343[43.75%] were females. Most of the burn victims [60%] belonged to the age group of 15 - 44 years. Out of 784 cases, 565 cases [72%] were of serious dermo-epidermal and deep burns. The overall burn mortality rate was found to be 55.9%. This included burn victims who were brought dead or expired during treatment. Maximum burns were a result of fire/flame [48.1%]. The mortality rate of burn injuries in Karachi is alarming as compared to the international statistics. Fire incidents are the main cause of these injuries. Fatal burns can be prevented if necessary precautions are taken

Frequently isolated bacteria and their culture and sensitivity pattern in a medical ICU

Empirical antibiotic therapy in seriously ill patients requires careful selection of antibiotics. This study was planned to determine the pattern of bacterial infections and culture sensitivities in patients admitted to a medical intensive care unit [ICU]. Patients with positive bacterial cultures from specimens of blood, urine, endo-tracheal tube, suction catheter, and tracheal aspirates were included. Data regarding microbial isolates and their culture sensitivities was collected. Escherichia coli [E. coli], Pseudomonas aerogenosa [PA], Klebsiella pneumonea [KP], Staphylococcus aureus [SA] and methicillin resistant Staphylococcus aureus [MRSA] were the most frequently isolated bacteria. E coli showed 100% sensitivity to sulbactam potentiated sulfoperazone, and meropenam. PA were sensitive to gentamycin, imepenam, and sparfloxacin in > 70% cases. All KP isolates were sensitive to amikacin, imepenam and sparfloxacin. SA were 100% sensitive to amikacin. MRSA were 100% sensitive to vancomycine and linezolid. Based on these results, sulbactam potentiated cefoperazone in combination with amikacin seems the best empirical antibiotic regimen. Imipenam usage can be an alternative

Indigenous health perception and practices of the Punjab: an anthropological reflection

Anthropology is the most intimate humanistic explanation of human diversity as regards various small and large scales societies of the world. Anthropology aims to provide modern human civilization with understandable accounts of how human diversity that are not rooted in racial discrimination rather to bring us an opportunity to seek underlying rationalities and intellects associated with various historical, environmental, ecological, geographical, demographical, social, political and cultural compartmentalization and assortments. To help health personnel to understand the local mind about the health and eudaemonia as perceived and practiced by the rural population. Observational [exploratory] study. This study was conducted in the Union Council of Sacha Soda in the Tehsil and district of Sheikhupura district of the Punjab province from January 2011 to December 2011. This study was based upon an intensive field works for three years in a Punjabi village Sacha Soda of Sheikhupura district on indigenous health paradigms. It is an anthropological reflection of an indigenous healthy dichotomy to which the researchers have termed "Sehat-Tandarusti" existing and prevailing in the rural Punjab. Punctuality in taking dinner [95.3%], washing hands before taking food [92.9%], mild walk after food [82.1%] and chewing sugar cane and maze as exercise of teeth [77.9%] were the most common good eating habits. Majority of the villagers were going into beds earlier [95%] and a high percent were getting up early [75%]. Their first preference in case of illness was seeking help from Faith healers [86.1%] and the herbalists [88.9%]. There is a need to adopt the indigenous health perspective on Sehat [Eudaemonia] in order to promote the social awareness and effectively mobilize the populations towards better hygienic education and raising social responsibility among populations to contribute in making their livelihoods health friendly. The reinstating of the traditional health seeking system of practices can help the local populations to seek medical advices at local level as well as removing a threat from already overburdened urban health facilities

Clinicopathological analysis of odontogenic cysts in a selected Pakistani population

The cysts of the jaw are broadly classified as odontogenic and non-odontogenic. The odontogenic cysts are pathological fluid filled cavities lined by odontogenic epithelium and further sub-classified as inflammatory and developmental. The objective was to determine the types, frequency, distribution, and demographic characteristics of odontogenic cysts in our setup. This 8 years retrospective study [from January 2003 to December 2010] was conducted at Histopathology department of Armed Forces Institute of Pathology, Rawalpindi [Pakistan]. The histopathology record of odontogenic cysts were reviewed for age, gender, site, associated tooth and histopathological diagnosis. The data was analysed by using SPSS soft ware package version 17. The data revealed that periapical, dentigerous and odontogenic keratocysts were the most commonly reported odontogenic cysts which reported in the age range of 4 to 72 years [mean 29.09 +/- 13.53 years]. Amongst them 67.7% were males and 32.3% females with peak incidence in the 2[nd] and 3[rd] decades. The association of age and teeth with different type of cysts was statistically significant while gender association was insignificant although having predilection for males. None of the case of odontogenic keratocyst was found in deciduous teeth. The statistically significant association of different types of Odontogenic cysts with the age, site, teeth and male prevalence reveals that demographic knowledge can be helpful in early diagnosis and their prompt treatment

Clinicopathalogical analysis of benign salivary gland tumours: a study of 242 cases at AFlP Rawalpindi [Pakistan]

Objective: to analyze the clinicopathological aspects of benign salivary gland tumors. Materials and Methods: This descriptive case series study was carried out from Jan 2003 to Dec 2009 at Armed Forces Institute of Pathology Rawalpindi, [Pakistan]. All cases of benign salivary gland tumors were reviewed and their diagnoses were reconfirmed. The data regarding all the major and minor salivary gland tumor was analyzed using computer soft ware program SPSS [version 17]. The descriptive statistics and frequency was calculated for type of tumors, age, gender, site and size. Association of these parameters with the type of tumor was calculated by using chi square test. Results: the most common histological tumor type found was pleomorphic adenoma, followed by Myoepithelioma. All these cases presented between 12 and 85 years of age [mean 39.7 +- 16.91] mostly in the 3rd and 4th decades of life with 48.7% males and 51.3% females respectively. The most frequent site involved by these tumors were parotid gland [66.5%]. Submandibular gland, minor salivary glands of palate and lip were the other sites involved, but none of the tumor was found in sublingual gland. The tumor size ranged between 0.4 to 18 cm with maximum variation in Pleomorphic adenoma and myoepithelioma. Conclusion: benign salivary gland neoplasm are more common than their malignant counterparts. They occur mostly in 3rd and 4th decade. Parotid gland is the most common site and pleomorphic adenoma remains the most common bengin salivary gland neoplasm followed by myoepithelioma.

Anti-HCV antibody positivity of various sections of Pakistani patients

To determine the anti-HCV antibody status of various sections of the Pakistani population and patients as reported in various Pakistani studies. A meta-analysis. Department of Medicine, Rawalpindi Medical College and Allied Hospitals, Rawalpindi, from July 2007 to July 2008. Data pertaining to anti-HCV antibody status of various sections of the Pakistani population and patients was collected from studies published till July 2008. To note anti-HCV antibody status, 15 groups of subjects like liver disease patients, general blood donors, adult screening, and community prevalence etc. were identified. The frequency of total and anti-HCV antibody positive subjects of each group was noted. Chi[2] was used as test of significance for comparison wherever appropriate. Data from 183 studies was collected; 1004391 subjects anti-HCV antibody status was retrieved. 4.27% [n=42982] of these were anti-HCV antibody positive. Major bulk of patients with liver disease [56.9%], 2.71% of general and 10.39% of professional blood donors groups were positive, [p < 0.05]. Positivity in community and adult screening was 11.52 and 6.29% respectively. According to the studies in consideration; 2.71% of Pakistani general blood donors and major bulk of liver disease patients are anti-HCV positive. Community based anti-HCV positivity is 11.52%

Weaning; knowledge and practices

To evaluate the awareness and practices regarding weaning in lactating mothers of infants. A cross sectional descriptive study. At pediatrics OPD in Ghurki Trust Teaching Hopsital, Lahore. From October to December 2007. A non probability convenience sampling was done to collect data from 50 mothers who were attending out patient department along with their infants on a pre-formed questionnaire. After gathering, data was analyzed and presented in the form of tables and graphs. In the present study, 66% mothers were in the age group of 20-29 years, all were house wives, 34% were matriculate and 72% lived in joint family system Mean age of weaning was 4-6 months in more than 64% of the sample. Among the women interviewed, 44% used home-made weaning diets, 30% used mixture of homemade and commercially prepared diets, while 16% used only commercially prepared diets. Breast feeding was continued during and after weaning, by 64% of respondents along with weaning diets. Mothers need to be educated about the importance of weaning, the recommended age of weaning and about the types of weaning food. This can be achieved by using lady health workers and lady health visitors and the mass media. Importance of breast feeding with weaning diet should be emphasized upon

Methicillin resistant staphylococcus aureus prevalence amongst community versus hospital acquired skin and soft tissue infections

Methicillin resistant Staphylococcus aureus [MRSA] is becoming increasingly prevalent, not only in the hospital acquired but also the community acquired infections. Skin and soft tissues are a few of the important targets for this pathogen. A study was conducted at the departments of surgery, dermatology and pathology, Combined Military Hospital, Gujranwala Cantt to know the prevalence of MRSA amongst community vs. hospital acquired skin and soft tissue infections [SSTIs]. A total of 216 community acquired and 48 hospital acquired SSTIs were included in the study. The pus swabs/pus specimens collected from all the cases were processed for routine cultures. Isolates were identified as Staphylococcus aureus and resistance to methicillin was detected using standard techniques. Staphylococcus aureus was isolated in 64.35% of the community acquired and 72.91% of the hospital acquired SSTIs. Prevalence of MRSA amongst community acquired SSTIs was 26.6% while in the hospital acquired SSTIs was 68.57%. The study indicates quite a high prevalence of MRSA amongst community acquired and a very high prevalence in hospital acquired SSTIs. Further large scale studies are required to monitor the prevalence and spread of MRSA amongst SSTIs

Extracorporeal shock wave lithotripsy

To determine the outcome of patients undergoing extracorporeal shock wave lithotripsy [ESWL] for treatment of upper urinary tract calculi [renal and ureteric], and to note role of double-J [DJ] stents in these patients. A cross-sectional analytical study. Department of Urology, Rawalpindi General Hospital, Rawalpindi, from February 1999 to July 2001. Record of patients who underwent ESWL for renal and ureteric stones was retrieved and analyzed using statistical program, SPSS version-10 and Epi-Info 2000. In some patients pre-ESWL DJ stents were placed because of various reasons like solitary kidney, large stone volume etc. Patients were divided in two groups, Group I, in whom DJ stents were not placed, and Group II, in whom DJ stents were placed. ESWL was performed in each subject in standard way employing piezoelectric lithotripter E.D.A.P. LT 02X. Patients were evaluated for stone clearance fortnightly with X-ray or ultrasound. Four hundred and thirty-two patients, 68.8% male and 31.2% female, underwent ESWL. Mean age of patients was 37.7 ' 13.1 years. Majority of patients [78.47%, n=339] had renal, while rest had ureteric stones. Group I and II included 408 [94.4%] and 24 [5.6%] patients respectively. Renal stones were present in 78% [n=318] of Group I and 87.5% [n=21] of Group II patients. Mean size of stones in Group I and II patients was 10.91 ' 4.6, and 10.4 ' 4.7mm. Stone clearance was 96.3% and 100% in Group I and Group II patients respectively. Significantly more ESWL sessions were required for stone clearance in Group II [p-value 0.03]; in addition Group II patients had significantly more complications [p-value 0.01]. ESWL is an effective procedure. Pre-ESWL stenting is associated with increased numbers of ESWL sessions and more complications

Characteristic features of 50 NAFLD patients

Objective: To note characteristic features of patients with nonalcoholic fatty liver disease [NAFLD] diagnosed on ultrasound basis

Design: Descriptive

Place and duration of study DHQ Teaching Hospital, Rawalpindi, from January to June 2003

Materials and Methods: Fifty NAFLD patients diagnosed on ultrasonographic findings were inducted consecutively. Patients with conditions associated with secondary NAFLD were excluded. Clinical and laboratory evaluation of each patient was done to note presence or absence of obesity, hepatomegaly, cholesterol and triglyceride levels, and diabetes mellitus. Obtained data was analyzed using statistical program, SPSS version 10

Results: Of the 50, 54% were female and 46% male. Mean patient age was 42.78 +/- 12.29 years. 66% patients were obese, 56% had hepatomegaly, 28% had elevated cholesterol, 72% had hypertriglycedemia, and 44% were diabetic. All of these features except for hypercholesterolemia were common in females

Conclusion: Obesity, hepatomegaly, diabetes, and hypertriglycedemia are characteristic features of our NAFLD patients that are more common in females

12 years audit of upper gastrointestinal endoscopic procedures

Evaluation of upper gastrointestinal [GI] endoscopy in terms of indications, diagnostic efficacy, and diseases diagnosed. Design: Retrospective, observational case series. Place and Duration of Study: DHQ Teaching Hospital, Rawalpindi, from March 1990 to December 2001. Subjects and Patients who underwent upper GI endoscopy in 12 years were included. Upper GI endoscopies were performed according to standard protocol. Endoscopic diagnoses were based on widely accepted criteria. Of the 8481 patients, 4935 [58.2%] were female and 3546 [41.8%] male. Mean patient age was 40.5 years. Dyspepsia [42.6%], upper GI bleed [32.8%], and evaluation of chronic liver disease [10.2%] were common indications of the procedure. An endoscopic diagnosis was possible in 82.6% patients. Varices, gastritis, duodenitis, and combined lesions were common endoscopic diagnosis. Gastritis and duodenitis were most frequent causes of upper GI bleed. We noted more gastric ulcers compared to duodenal ulcers. Females had significantly more normal endoscopies, p-value= 0.02. Upper GI endoscopy is an effective procedure. Dyspepsia evaluation is commonest indication for upper GI endoscopy in our patients. Etiology of upper GI bleed, and incidence of duodenal ulcer compared to gastric ulcer in our patients are different than described in literature. Females have significantly more normal endoscopies

Endoscopic retrograde cholangiopancreatographic evaluation of patients with obstructive jaundice

To evaluate the role of endoscopic retrograde cholangiopancreatography [ERCP] in patients with obstructive jaundice. Design: A retrospective, observational study. Place and Duration of Study: The study was carried out at Valley Clinic, Rawalpindi, from January 1999 to January 2002. Subjects and Two-hundred and twenty-six patients, who underwent ERCP for evaluation of obstructive jaundice were included. ERCP in each case was performed with standard technique and the findings were recorded. Therapeutic procedures like sphincterotomy, Dormia extraction for stone, and stent placements were performed whenever indicated. Of the 226 patients, 117 [51.8%] were males, and 109 [48.2%] females, their mean age being 51.8 ' 16.6 years. Common bile and pancreatic ducts were visualized in 81.8% and 68.1% patients respectively. Growth/masses and stones were commonest causes of obstructive jaundice. Choledocholithias was common in males, while biliary channel related growth/masses were common in females [p-value = 0.03]. Common bile duct stone clearance rate was 88%, stenting was highly successful in patients with growth and strictures. ERCP related complications were noted in 11 [4.8%] patients. ERCP is an important diagnostic and therapeutic modality for evaluation of patients with obstructive jaundice. Growth/masses and stones are common causes of obstructive jaundice which can be diagnosed and treated with ERCP