Efficacy of peripheral streptomycin injection in the treatment of idiopathic trigeminal neuralgia

To evaluate the efficacy of peripheral streptomycin injection in relieving the pain of idiopathic trigerninal neuralgia. Quasi experimental study. Oral and Maxillofacial Surgery Department, Armed Forces Institute of Dentistry Rawalpindi, from 1[st] June 2006 to 31[st] December 2007. Thirty patients of idiopathic trigerninal neuralgia were selected. They received five consecutive injections of streptomycin Ig in 3 ml of 2% Lignocaine [Septodont] with 1: 100,000 adrenaline at one week interval. Follow up was carried out at one, two and six months after the last injection. Age ranged from 15-78 years [mean 44.67]. Male to female ratio was 1:1.14. Right side of the face was involved in 70% and left side in 30% cases. Mandibular division of trigeminal nerve was involved in 43.3% and maxillary division in 40% of the cases. In the rest both maxillary and mandibular divisions were involved. Pain was significantly decreased from baseline to 1 month [p < 0.001]. The level of pain was increased a bit but the increase was significant at two months [p = 0.006] and at 6 months [p = 0.020]. Best treatment modality for this devastating disease is yet to evolve. Within the confines of the study it can be stated that efficacy combined with low post treatment morbidity makes streptomycin a useful treatment option

Correlation between serum ferritin level and liver function tests in thalassemic patients receiving multiple blood transfusions.

Background: Multiple blood transfusions are the mainstay of thalassemic patients in order to combat the severe anemia. These frequent blood transfusions result in the excessive iron deposition, leading to multiple injuries to a variety of organs in the body. In response to these injuries, the levels of various enzymes are disturbed. The whole phenomena usually involve the interrelation of one parameter with some other. The present study aimed to estimate the levels of serum ferritin and hepatic enzymes and to find out any possible correlation between them in thalassemic patients receiving multiple blood transfusions. Methods: A total number of 90 thalassemic patients of both sexes ranging from 10-15 years, receiving multiple blood transfusions were included in the present study. Blood samples from all the patients were withdrawn and analyzed for the values of serum ferritin, hemoglobin and hepatic enzymes (serum alanine transaminase, serum aspartate transaminase, serum alkaline phosphatase). Pearson correlation coefficient was applied to observe correlation between serum ferritin level and hepatic enzymes. A P value of ≤0.05 was considered statistically significant. Results: The overall values of serum ferritin, and hepatic enzymes (serum Alanine Transaminase, serum Aspartate Transaminase, serum Alkaline Phosphatase) were remarkably increased than their normal values. However, hemoglobin level was considerably decreased in thalassemic patients. A weak positive insignificant correlation was observed between serum ferritin with hepatic enzymes and hemoglobin in thalassemic patients. Conclusion: Multiple blood transfusions cause iron overload in the body, which in turn, lead to increased serum ferritin levels in thalassemic patients. High levels of hepatic enzymes are somewhat correlated to serum ferritin concentration. However, the exact reason of elevated levels is still unclear. Further detailed studies should be conducted in order to identify the exact mechanism behind this and to search for the promising correlations of various parameters in thalassemic patients receiving multiple blood transfusions.

Prevalence of hepatitis b and c in oral and maxillofacial surgery reported at liaquat university hospital Hyderabad

To analyze the prevalence of hepatitis B virus [HBV] and hepatitis C virus [HCV] carriers in oral and maxillofacial patients. Experimental study. This study was carried out at Oral and Maxillofacial Surgery Department, Liaquat University Hospital Hyderabad from 1[st] September 2011 to 31[st] August 2013. Data of 520 patients who were hospitalized at Liaquat University Hospital for treatment of maxillofacial fractures. Study design was descriptive/cross sectional study. All patients were treated both under general anesthesia as well as local anesthesia, sedation. Our hospital is tertiary referral center for Sindh province. Patients who were hospitalized at Oral and Maxillofacial Surgery Department during the study period for any category of maxillofacial surgery were screened before managing. 60% were males and 40% were females with age from 15-80 years. HBV was positive 15% in patients and HCV was positive in 11% of patients. The high prevalence of HBV and HCV in maxillofacial surgical patients recommended a regular test for HBV and anti-HCV for every one patient, to prevent spread of HBV and HCV among staff, patient to patient and oral surgeon

Potential risk of cross-infection by tourniquets: a need for effective control practices in Pakistan

Tourniquets used repeatedly on patients for blood sampling are a potential source of nosocomial infections. They harbor numerous microorganisms, including methicillin-resistant Stapbylocoecus aureus [MRSA]. The aim of this study was to investigate tourniquets for the presence of microorganisms and to ascertain the infection control practices of health care workers. A cross-sectional study was carried out in 2012 on 100 samples of tourniquets collected from public and private sector hospitals in Karachi, Pakistan. The samples were cultured, and pathogenic microorganisms were identified and tested for methicillin resistance. A questionnaire was administered simultaneously to 100 health care workers who had used the tourniquets. Descriptive data are represented as frequencies and percentages. Ethical considerations were taken into account. The total colonization rate was 51%, with no bacterial growth in 17/40 and 32/60 samples from public and private sector hospitals, respectively. S. aureus was isolated from 12 [42%] private sector hospital samples and 10 [43%] public sector hospital samples. Although MRSA was found in more samples from public than private sector hospitals, the difference was not statistically significant. Nevertheless, 90% of all elastic and 41% of all rubber tourniquets harbored microorganisms [P < 0.001]. Although 96% of health care workers agreed that hospital staff and fomites can transmit infection, none identified tourniquets as a potential source. When asked whether tourniquets appeared clean before use, 66% agreed, and only 25% considered that tourniquets should be washed or cleaned before use. Tourniquets are a potential reservoir and vehicle for the spread of nosocomial infections, including MRSA. Health care workers have inadequate knowledge about infection control procedures and personal hygiene for disinfecting reusable items

Gated spect myocardial perfusion scintigraphy for identifying septal perfusion artifacts in left bundle branch block

To determine the role of gated Single Photon Emission Computed Tomography [SPECT] for accurate assessment of myocardial perfusion scintigraphy [MPS] of patients with left bundle branch block [LBBB]. Analytical study. Punjab Institute of Nuclear Medicine [PINUM], Faisalabad, Pakistan, from June 2002 to April 2003. MPS data of patients with LBBB was analyzed. Resting gated SPECT MPS was performed after an injection of 740 MBq 99mTc-MIBI in 10 normal and 25 subjects with LBBB [with low probability of coronary artery disease]. Visual and quantitative analyses were done on non-gated [NG], end diastolic [ED], end systolic [ES] images. Calculations included septal to lateral wall ratio [SLR], myocardial thickening [MT=% increase in counts during systole] at end systolic phase and myocardial thickening at peak level [% peak MT]. Septal hypoperfusion was noted in 19 [76%] patients on NG images and in only 1 [4%] patient on gated SPECT ED images. On NG images of LBBB group, SLR was lower than in controls [0.68 +/- 0.07 vs. 0.87 +/- 0.05, p<0.001]. SLR of LBBB patients approached to that of control group in gated SPECT ED data [0.86 +/- 0.06 vs 0.88 +/- 0.06, p=ns]. Myocardial thickening at ES for septum was markedly lower in LBBB group than in controls [21.83% ' 10.86 vs. 66.32% ' 20.15, p<0.001]. In patients with LBBB, reduced septal thickening results in artifactual septal perfusion defects. Gating the perfusion scintigraphy and reporting perfusion status on end diastolic frames in LBBB patients can eliminate these artifacts

Pattern of maxillofacial injuries in the earthquake victims

To observe the pattern of Maxillofacial injuries in Earthquake victims and to discuss their management. Descriptive Study. This study was conducted at the Maxillofacial Surgery Department, Armed Forces Institute of Dentistry [AFID], Rawalpindi over a period of six months following the 8[th] October, 2005 Earthquake. 176 patients who sustained maxillofacial injuries during the earthquake were included in this study. The pattern of maxillofacial injuries and their management was documented. Out of the 176 patients, 141 [80.11%] had fractures of the maxillofacial bones. The remaining 35 [19.89%] patients sustained minor maxillofacial injuries e.g. soft tissue injuries, dentoalveolar fractures and temporomandibular joint arthritis / dislocation. Isolated mandibular fractures were seen in 64 [36.4%] patients. Fifty-seven [32.4%] patients had multiple fractures of the facial bones. Zygomatic bone was fractured in 18 [10.2%] patients whereas 02 [1.1%] patients had isolated fracture of the maxilla. Fifty-nine [41.8%] patients were treated by closed reduction and IMF, 55 [39%] patients by open reduction and transosseous wire fixation in addition to IMF and 27 [19.1%] cases by open reduction and miniplate osteosynthesis. Postoperative complications were noticed in 18 [10.2%] of the patients. Multiple fractures of the facial bones were far more common than the routine trauma cases. The magnitude of the disaster dictated simple and timesaving conventional methods of management in majority of the cases

Exertional dyspnea in patients with diabetes mellitus: evaluation by myocardial perfusion scintigraphy

Coronary Artery disease is a major cause of morbidity and mortality in patients with diabetes mellitus. They have high incidence of silent ischemia as pain perception is blunt in such patients. As a result many of them present with atypical symptoms like exertional dyspnea, instead of classical chest pain as their chief presenting complaint. We evaluated incidence of myocardial perfusion scintigraphic [MPS] evidence of coronary artery disease [CAD] in patients with type II diabetes mellitus without known CAD presenting with exertional dyspnea as chief presenting complaint. We conducted stress-redistribution SPECT MPS with intravenous injection of 93-130 MBq [2.5-3.5 mCi] 201T1-thallous chloride in 290 subjects with type II diabetes mellitus having exertional dyspnea [SOB] as study group [151 male and 139 female, age range 20 to 76 years]. 138 asymptomatic subjects with type II diabetes mellitus also underwent same procedure as control group [56 male and 82 female, age range 29 to 65 years]. Upon the bases of clinical history, study groups were further divided into three categories, Esob=exertional SOB [n=54], AcpD= atypical chest pain with dyspnea [n=114] and TcpD=typical chest pain with dyspnea [n=122]. We conducted visual analysis on reconstructed tomographic slices. CAD was present in 34.78% control [ischemia 23.91%, myocardial infarction 10.87%] and in 66.9% study group subjects [ischemia 49.31%, myocardial infarction 17.87%]. Incidence of CAD was high in Esob group than control [48.15% vs. 34.78%], AcpD group than Esob [64.91% vs. 48.15%] and TcpD group than AcpD [77.05% vs. 64.91%]. Stress induced ischemia [SII] was more frequent in Esob group than control [37.04% vs. 23.91%] and AcpD group than Esob [50% vs. 37.04%]. However, its occurrence was almost similar in TcpD and AcpD groups [54.1% vs. 50%]. Observed frequency of myocardial infarction was almost same in control [10.87%] and Esob [11.11%] group. Incidence of myocardial infarction was higher in AcpD group than control [14.91% vs. 10.87%] and TcpD group than AcpD [22.95% vs. 14.91%]. Our study concludes that incidence of myocardial ischemia and infarction is quite high in patients with type-II diabetes mellitus presenting with exertional dyspnea. Presence of chest pain further increases the likelihood of CAD in these patients. We should perform MPS in all patients with type II diabetes mellitus who present with exertional dyspnea, even if they have no chest pain