Junctional epidermolysis bullosa [non-herlitz type]

Junctional epidermolysis bullosa [JEB] is a recessively inherited skin blistering disease and is caused due to abnormalities in proteins that hold layers of the skin. Herlitz JEB is the severe form and non-Herlitz JEB is the milder form. This report describes a case of congenitally affected male child aged 5 years, with skin blistering. He has mitten-like hands and soft skin blistering on hands, legs and knees. Symptoms almost disappeared at the age of 3 years but reappeared with increased severity after 6 months. Histopathological examination showed epidermal detachment with intact basal cell layer and sparse infiltrate of lymphocytes with few eosinophils in the dermis. There was no blistering on the moist lining of the mouth and digestive tract. Localized symptoms with less lethality and histopathological examination indicated the presence of non-Herlitz type of JEB. This is the first report which confirms the presence of non-Herlitz junctional epidermolysis bullosa in Pakistan

Transversus abdominis plane block offers prolonged postoperative analgesia than surgical incision infiltration by bupivacaine in cesarean section patients

Background and objective: Postoperative pain requires a well-planned analgesia regimen to ensure adequate patient comfort, satisfaction, early mobilization and also to decrease the hospital stay after anesthesia. We conducted this study to compare the transversus abdominis plane block with direct infiltration of bupivacaine into surgical incision in cesarean section to prolong the mean duration of postoperative analgesia

Methodology: This Randomized control trial was conducted in department of anesthesia, Nishtar Hospital, Multan from July 2016 to December 2016. A total of sixty patients were included in the study and randomly divided into two equal groups of 30 each; Group-T and Group-I. Group-T received TAP block with 0.3 ml/kg of 0.25% bupivacaine on each side under double pop technique, and Group-I received 0.6 ml/kg of 0.25% bupivacaine infiltration in surgical incision. Postoperatively all the patients were monitored in PACU. VAS was noted at 1/2, 1, 2, 4 and 6 h intervals. Inj tramadol 1.5 ml/kg was given as rescue analgesia when VAS score >/=4. Time to requirement of first rescue analgesia was noted. Sample size was calculated with 80% power of test, 95 % confidence interval taking mean and standard deviation of rescue analgesia in Group-T 148 +/- 46.7 and in Group-I 85.38 +/- 38.07. Data were analyzed with computer software SPSS version 23. Mean +/- SD was calculated for quantitative variables and frequency [percentage] was calculated for qualitative variables. Student t-test and chi square test were applied. P value 0.05 was considered as significant

Results: Mean VAS score at half hour in Group-T was 3.8 +/- 2.9 and in Group-I was 5.0 +/- 3.0; and mean VAS score at one hour was 4.4 +/- 3.01 in T Group and in Group-I was 5.3 +/- 3.09 respectively; at two hours 4.7 +/- 2.9 and 6.3 +/- 4.2, and at four hours was 5.2 +/- 2.9 and 5.7 +/- 2.8 in Group-T and Group-I respectively. Mean VAS score during six hours was 5.5 +/- 2.8 and 6.1 +/- 2.5 in Group-T and Group-I respectively. Mean time for 1st analgesia in Group-T was 296.3 +/- 37.1 min and in Group-I was 202.0 +/- 34.9 min, by applying t-test P= 0.000 a significant value

Conclusion: TAP block is a promising technique in alleviating postoperative pain in patients' cesarean section. The procedural simplicity of this block, along with reliable level of analgesia [T10-L1], and longer duration makes the TAP block a good option

comparative study to evaluate the chronotropic action of citalopram, fluoxetine and paroxetine on intact frog's heart

Objective: To compare the chronotropic action of citalopram, fluoxetine and paroxetine on frog heart

Study Design: Experimental animal study

Place and Duration of Study: This study was conducted at Yusra Medical and Dental College, Islamabad from October 2015 to February 2016

Materials and Methods: Stunning and pithing of the frog was done following which the heart was exposed. The apex was attached to a force transducer. Heart rate readings were recorded on Power lab. Three groups were designed. In every set of experiments basal readings [without drug] were initially recorded that served as the control and then the tissue was treated with one antidepressant. In Group I we documented the effects of citalopram. In Group II we observed the effects of fluoxetine and in Group III we noted the effect of paroxetine. Statistical analysis was done using SPSS version 22. A p value of less than or equal to 0.05 was considered statistically significant

Results: The isolated heart tissue sample was exposed to 0.5ml of drug. Citalopram at a concentration of 1.54mM reduced the heart rate from 30 to 19 beats/min. Fluoxetine at a concentration 1.6mM brought down the heart rate from 23 to 20 beats/min. Whereas, paroxetine at a concentration of 1.3mM increased the heart rate from 21 to 23 beats/min

Conclusion: Citalopram out of the three chosen drugs caused the most marked reduction n in heart rate. Fluoxetine caused a subtle reduction in heart rate. Paroxetine on the other hand caused a mild increase in heart rate

Health issues and wellbeing; working children in carpet industry in Punjab, Pakistan

Children are perceived as the future of any country. With this in mind, child labor does nothing but destroy the future of the children. Carpet weaving is destructive for children because children often sit in odd positions for extensive hours, inhaling dust and working in inadequate lighting situations, all these aspects are hazardous to the wellbeing of children. Child carpet weavers have to face occupational damages and diseases. To identify the factors contributing to child labor and effects of work-related health issues on the wellbeing of carpet weavers. Cross sectional survey. Punjab province. A sample of 320 carpet child workers of age group 8-17 years was interviewed. A well-structured questionnaire was constructed to collect the data. The SPSS/PC + 20.0 Statistical Package for Social Sciences were used for analyzing the data. The study found that majority of the respondents was facing the problem of body aches, backbone problem, eye strain and general exhaustion and cuts and wounds. The significant relationship was observed between work-related illness [type of illness] and the personal wellbeing of carpet working children. It was strongly suggested that comprehensive strategy consisting of macro as well as micro policies is to be commenced to control, reduce and eradicate. The ill effects related to carpet weaving. The participation of children in carpet weaving industry should be stopped or at least immunizad present. The carpet workers immediately need concentrated efforts not only to solve their work-related issues, but also to make them productive adult in their own wellbeing as well as in the welfares of society

comparison of single versus multimodel analgesia in ablative maxillofacial surgical procedures

Objectives of this study was to evaluate the analgesic effect of single vs multimodal analgesics in postoperative pain in ablative maxillofacial surgery and to investigate whether prophylactic treatment with multimodal nociceptive blockade will delay the onset of postoperative pain, decrease analgesic requirement, speed recovery time and facilitate early discharge in this surgical group. This experimental comparative study was conducted in Maxillofacial Operation Theatre of Nishter Institute of Dentistry, Multan during the period from August 2013 to Feb 2014 equal groups of 30 each using non probability convenience sampling technique. In Group A patients an intramuscular injection of Ketorolac 0.5mg/kg was given 45 min before induction of anaesthesia preoperatively. In group B patients intramuscular injection of 0.5mg/kg ketorolac + 2mg/kg body weight of Tramadol [IM] was given 45 min before induction of anaesthesia preoperatively + local infiltratration of 0.5% injection bupivacaine was done 10 min before giving incision. In Group A patients, 17 patients [56.6%] had mild pain, 6 patients [20%] had moderate, 5 patients [16%] had severe and 2 patients [6.66%] had no pain. While in group B who received multimodal analgesia, the degree of postoperative pain was greater than in the group A in which 15 patients [50%] had mild pain, 2 patients [6%] had moderate pain and 13 patients [43.3%] had no pain. In group B, no patient suffered from severe pain. It was concluded that multimodal analgesia showed greater advantage over single analgesia in patients undergoing ablative maxillofacial surgical procedures

Intraocular pressure; incidence of steroid induced rise in local population of normal, V.K.C and C.S.G patients

To assess the incidence of steroid induced rise in intra-ocular pressure in different group of patients. The study was conducted in the department of ophthalmology Akhtar Saeed Trust Teaching Hospital of Akhtar Saeed Medical and Dental College Lahore and Continental Medical College Lahore from Jan 2009 to Oct 2010. Three groups were formulated in which group A comprised of normal population with no ocular disease, group B included patients with vernal keratoconjunctivitis while group C comprised of chronic simple glaucoma patients with controlled intraocular pressure. Dexamethasone 0.1% eye drops were used four times daily for four weeks and patients were evaluated weekly in terms of IOP monitoring after which they were labeled as either low or non-responders, moderate responders or high responders. In group A 40% of the patients showed rise in IOP, group B showed 95% rise in IOP and the response in group C cases was 100%. Topical steroids result in significant rise in IOP therefore careful monitoring should be done in all patients on corticosteroids

Hair tourniquet syndrome

To find out the causes and sites involved of hair tourniquet syndrome in our setup. This descriptive study was conducted in Surgical units of Agency Headquarter Hospital, Landikotal and Govt. City Hospital, Peshawar from 2007-2011. Fifty consecutive cases of hair tourniquet syndrome of both sexes were included. Data was collected on a pre designed proforma regarding the patient's age, sex, family background, socio-economic status and possible causes of this unique entity by interviewing the parents, relatives, spiritual healers, paramedical staff and quacks. Site involved was determined by clinical examinations in the OPD, ward and in operation theatre under sedation. Data was analyzed using SPSS version 16. Out of 50, 38 [76%] were male and 12 [24%] were female. In 30 [60%] patients, glans penis were involved, while other parts involved were digits [hand and foot] in 12%, skin tags in 11 [22%], umbilical hernia in 2 [4%], meningocele in 1 [2%]. In 28 [56%] cases, no cause was found, especially in infants. Other causes were for the management of nocturia in 12%, amputation of skin tags in 10% and post circumcision bleeding, spiritual healing and jealousy each in 6% patients. Human hair was found in cases of infants and children while in adults animal hair was used. Outcome of Unnoticed and missed hair coils around skin appendages can be devastating in shape of strangulation and amputation whether the cause is known or not

Outcome and cost comparison of laparoscopic transabdominal preperitoneal hernia repair versus open Lichtenstein technique

To compare the outcome and cost of laparoscopic inguinal hernia repair versus open repair. This was a randomized controlled study conducted on 100 patients from January 2011 till April 2012, in Surgical 'A' unit, Lady Reading Hospital, Peshawar. A total of 100 patients were randomized and were allocated into two groups i.e. open repair [Lichenstein procedure] and laparoscopic repair [Trans-abdominal pre-peritoneal mesh repair, TAPP] group using lottery method. Type of hernia, type of procedure done, total cost of surgery, duration of hospital stay, post operative pain rating by visual analogue score and post operative complications were assessed. Significant difference was observed between the two groups in relation to the perioperative complications. Mean operative time was short in open repair 55.40 +/- 10.73 minutes compared to TAPP 87.10 +/- 11.60 minutes but the mean length of hospital stay was less in TAPP [2.78 +/- 0.64 days] compared to open [3.5 +/- 0.67 days]. Regarding postoperative complication urinary retention was 22% and 10%, wound discharge was 20% and 08%, recurrence was observed in 12% and 06% in open repair and TAPP respectively. The difference was statistically insignificant. Laparoscopic repair showed significantly less post operative surgical pain compared to open repair. This trial showed no statistical difference between the open and laparoscopic procedures regarding post operative complications but laparoscopic repair showed statistically lower post surgical operative pain and hospital stay with greater operative time and cost. This study supports the use of the laparoscopic repair techniques for the treatment of inguinal hernia

Subculture on Islam agar: rapid and reliable method to detect group b streptococci colonization status

Background: Various methods have been used to detect the colonization status of near term pregnant females but there is lack of consensus on the most appropriate method. In this study we have evaluated three different techniques in terms of their reliability and easiness to perform

Objective: The objective of our study was to determine the validity of 3 laboratory methods namely direct culture on selective blood agar, direct culture on Islam agar and subculture after enrichment with Lim broth on Islam agar in diagnosis of group B streptococcus [Streptococcus agalactiae] [GBS] in near term pregnant females

Materials and Methods: This prospective study was conducted at microbiology section of department of the Pathology, King Edward Medical University and outpatient department of Lady Atchison and Lady Willington Hospital, Lahore. 200 near term, pregnant women of all ages between 35 to 37 weeks of gestation were included in the study. Swabs from the vaginal introitus were subjected to analysis by culture on 4 medias and sensitivity and specificity were calculated for each media against the gold standard

Results: On gold standard media 32 cases were found to be positive for GBS. The prevalence was 16%. The calculated sensitivity and specificity for different techniques were; Blood agar [93.3%, 98%], Islam Agar [93.3%, 98%] and LIM enriched Islam Agar [100%, 100%]

Conclusion: Subculture on Islam Agar after LIM enrichment is superior to other techniques in terms of its performance and cost related issues

Treatment outcomes of reconstruction with iliac bone graft and rib graft in patients with mandibular defects

Iliac bone graft can be used to reconstruct alveolar defects or bone defects under 5 cm. Rib grafts have proven ideal for condylar reconstruction. Objective of this study was to assess the functional and aesthetic outcomes and post operative complications of the reconstructive method. In this study iliac bone alone or combined with rib graft was used for reconstruction of mandibular defects. Sampling technique was non probability purposive. This study was conducted in the Department of oral and maxillofacial surgery, Nishter Institute of Dentistry, Multan from March 2010 to march 2012. A total of 15 patients of hemimandibulectomy were reconstructed by iliac bone alone or combined with rib bone graft. In 3 cases iliac bone was combined with rib bone graft. There were 6 [40%] male and 9[60%] females. Mean age was 23.86+2.69y [range 20 -30y]. There were no significant post operative complications. Reconstruction with iliac bone graft combined with rib graft is an excellent method of reconstruction in patients with mandibular defects

Safety of ultrasonic dissection versus conventional electrocautery dissection during laproscopic cholecystectomy in terms of gall bladder perforation

To compare the safety of ultrasonic and electrocautery method of dissection in terms of gallbladder perforation. This randomized controlled trial included 128 patients, which were divided into two groups, ultrasonic dissection [A] and electrocautery dissection [B]. GB perforation [if any] was noted intraoperatively, and all the data was recorded on a structured questionnaire. Data was analyzed using SPSS. The incidence of GB perforation was significantly lower in ultrasonic dissection [10.9%] than electrocautery methods of dissection [29.7%], hence the safety of ultrasonic dissection in terms of gallbladder perforation, was significantly higher than electrocautery dissection [89.1% vs. 70.3% p-value=0.007]. Ultrasonic dissection is safer modality of dissection in terms of gall bladder perforation and its use should be encouraged as routine method of dissection during LC

Safety of single layer continuous extra mucosal gut anastomosis in emergency

To evaluate the safety and complications of a single layer continuous extra mucosal gut anastomosis in emergency. This descriptive study was conducted in emergency department of Lady Reading Hospital Peshawar over a period of ten months from September 2007 to July 2008. Study comprised of fifty consecutive patients after fulfilling the inclusion and exclusion criteria. The safety of anastomosis technique was analysed by postoperative complications of morbidity and mortility. Among 50 patients 80% were male and 20% were female, mainly young adults. Patients with anastomotic leakage were 8%. The rate of wound infection was 34%. Mean hospital stay was 7.22 days. Mortality was 8% due to septicemia and hypovolemic shock. Single layer continuous extra mucosal anastomosis is safe and with less anastomosis-related morbidity and mortality

Frequency of urethrocutaneous fistula following snodgrass hypospadias repair in children

To determine the frequency of urethrocutaneous fistula over a period of three months following snodgrass hypospadias repair for the treatment of distal penile hypospadias in children. This descriptive study was conducted in the pediatric surgery unit, Lady Reading Hospital, Peshawar over a period of eight months from June 2009 to February 2010. Patients with distal penilehypospadia without chordee between 2 and 14 years were included and patients were excluded who had previous repair for hypospadias. All those patients fulfilling the inclusion and exclusion criteria whose parents gave informed consent after explanation of the whole protocol were admitted through outpatient department for the said procedure and data was analyzed. A total of 52 patients were included in the study. All patients were in the range of 2 to 10 years and underwent Snodgrass Tubularized Incised Plate [TIP] urethroplasty for hypospadias repair. The overall rate of urethrocutaneous fistula was 9.6% [5 out of 52 patients]. Mean operative time noted in minutes was 57.52 minutes. No major morbidity or mortality was noted in this study. TIP urethroplasty is simple, single stage operation in the management of hypospadias and has good functional and low complication rate

Subculture on islam agar: rapid and reliable method to detect group b streptococci colonization status

Background: Various methods have been used to detect the colonization status of near term pregnant females but there is lack of consensus on the most appropriate method. In this study we have evaluated three different techniques in terms of their reliability and easiness to perform

Objective: The objective of our study was to determine the validity of 3 laboratory methods namely direct culture on selective blood agar, direct culture on Islam agar and subculture after enrichment with Lim broth on Islam agar in diagnosis of group B streptococcus [Streptococcus agalactiae] [GBS] in near term pregnant females

Materials and Methods: This prospective study was conducted at microbiology section of department of the Pathology, King Edward Medical University and outpatient department of Lady Atchison and Lady Willington Hospital, Lahore. 200 near term, pregnant women of all ages between 35 to 37 weeks of gestation were included in the study. Swabs from the vaginal introitus were subjected to analysis by culture on 4 medias and sensitivity and specificity were calculated for each media against the gold standard

Results: On gold standard media 32 cases were found to be positive for GBS. The prevalence was 16 %. The calculated sensitivity and specificity for different techniques were; Blood agar [93.3%, 98%], Islam Agar [93.3%, 98%] and LIM enriched Islam Agar [100%, 100%]

Conclusion: Subculture on Islam Agar after LIM enrichment is superior to other techniques in terms of its performance and cost related issues

Primary alveolar proteinosis

A 35 years old man presented with primary pulmonary alveolar proteinosis who was admitted to chest unit of ATH through casualty department. Before he came to our ward he was treated with different antibiotics including anti-tuberculosis drugs for a month at least. But his symptoms did not improve rather his dyspnoea got worse. He was misdiagnosed till histopathology revealed that he has pulmonary alveolar proteinosis. With this background we briefly review clinical features, diagnosis and treatment of this rare disease.

Determination of in vitro antidiabetic effects of Zingiber officinale Roscoe

Aqueous extracts of Zingiber officinale rhizomes were studied to evaluate their antidiabetic effects on protein glycation and on the diffusion of glucose in vitro in the present study. Zingiber officinale rhizome aqueous extract were examined at concentrations of 5, 10, 20 and 40 g/L. The antidiabetic effects were found to be dose-dependent. Antidiabetic potential of Zingiber officinale was mainly through inhibition of the glucose diffusion and to a limited extent by reducing the glycation. However, further studies are needed to determine in vitro effects of therapeutic potential by restraining postprandial glucose absorptions and plasma protein glycations in diabetic subjects.

Extratos aquosos de rizomas Zingiber officinale foram estudados para avaliar os seus efeitos antidiabéticos em glicação de proteínas e sobre a difusão de glicose in vitro, no presente estudo. Extratos aquosos de Zingiber officinale foram examinados nas concentrações de 5, 10, 20 e 40 g extrato de planta/L. Os efeitos antidiabéticos observados eram dependentes da dose. O potencial antidiabético de Zingiber officinale se verificou, principalmente, através da inibição da difusão de glicose e, em menor extensão, através da redução da glicação. Estudos adicionais são necessários para elucidar se efeitos in vitro representam potencial terapêutico, restringindo a absorção de glicose pós-prandial e a glicação de proteínas plasmáticas em indivíduos diabéticos.

Frequency of pain associated with ultrasound guided percutaneous liver biopsy

To determine the frequency of pain associated with ultrasound guided percutaneous trucut needle liver biopsy. This prospective descriptive study was conducted in Radiology Department, Lady Reading Hospital Peshawar over a period of six months from April 2009 to October 2009. Cases were referred from wards as well as OPD. Patients of ages between 14 and 75 years [48.42+9.91], having diffuse or focal hepatic solid lesion [s] seen on ultrasound abdomen, were included and patients with pregnancy, moderate to marked ascites, abnormal PT and/or APTT even after correction, thrombocytopenia, coagulopathy and those using anticoagulants were excluded from the study. After informed written consent, procedure was done and data analyzed. Out of 52 procedures, pain occurred in 42 [80.8%] cases. Mild to moderate pain occurred in 41 [78.8%] cases whereas severe pain was observed in 1 patient [1.9%]. Frequency of pain was more in females [14/15=93.4%] than males [28/37=75.7%]. Frequency of pain was more in subcostal [18/21=85.8%] than intercostal [24/31=77.4%] approach. 27 of 33 [81.8%] patients with focal solid hepatic lesion and 15 of 19 [78.9%] patients with diffuse hepatic disease reported pain. Percutaneous ultrasound-guided liver biopsy is associated with low frequency of severe pain. This study shows that females report pain more frequently than males. The incidence of biopsy associated pain is more in patients who are addicted to narcotics

Various surgical options for emergency management of sigmoid volvulus

The objective of this study was to compare the outcome of various surgical options for the emergency surgical management of sigmoid volvulus. This comparative study was conducted in emergency department of postgraduate medical institute Lady Reading Hospital, Peshawar over a period of one year from February 2007 to January 2008. Study comprised of hundred cases to have sigmoid volvulus on clinical and radiological grounds operated in casualty department with various surgical options and outcomes of these procedures were determined postoperatively. Out of 100 cases, 79% were males and 21% females. Majority 51% patients were in the age range of 41-60 years, 36% patients were in age group of 61-80 years. Resection and Hartman's procedure was performed in 52% cases, resection with primary anastomosis with covering colostomy in 18% cases, resection and primary anastomosis in 15% cases, and resection with double barrel colostomy [Paul Mikulicz] in 15% cases. Wound infection/ dehiscence occurred in 21% cases, intra-abdominal abscess in 9% cases, anastomosis leakage in 6% cases. Colostomy complications included bleeding in 7% cases, retraction in 7% patients, prolapse in 4% cases. Resection and Hartmann procedure was performed in majority of patients. Wound infection/dehiscence, intra-abdominal abscess, anastomosis leakage were common postoperative complications with various frequencies

early closure of stoma warranted in the management of temporary loop ileostomy?

To assess the outcome of closure of temporary loop ileostomies by comparing frequency of post operative complication. This was an experimental study conducted at the surgical A unit of Lady Reading Hospital between Jan 2005 and Dec 2009. All patients who were primarily operated and ended up with temporary loop ileostomy were admitted via the out-patient department. Consecutively allocated into group A whose stomae were closed at 8 weeks and group B whose stomae closed at 4 weeks. Postoperative complications including wound infection, anastamotic leak, dehiscence etc. were recorded and statistical analysis done using version 13.0 SPSS for windows. Group A included 155 patients and Group B 156 patient with male predominance in both groups [p=0.869]. The mean age in both groups was similar 33.6 years and 32.7 years respectively. Anastamotic leak rate and wound dehiscence was lower in early closure group but p value was insignificant. The frequency of wound infection was higher in the early stoma closure group [p=0.001]. The mean hospital stay was similar. Apart from wound infection the frequency of complication following early closure [4 weeks] of temporary loop stoma is similar to delayed closure. Thus delayed closure of stomae should be abandoned

DMFT of 12-15 years old rural area students of south Punjab - Pakistan

Dental caries is an age old problem of the human beings which needs elimination. Advances in the world have caused different effects to this problem. Surveys are conducted to evaluate the extant of this disease and the possible causative factors, periodically in different areas. Present study was conducted to evaluate the DMFT of 12-15 years old population in a rural area of south Punjab- Pakistan. About 950 students [male and female] 12-15 years old from Six rural area school of Muzaffargarh District were included in the study. Examination was made in day light with a mirror and probe. Entries were made in a printed proforma. An overall DMFT of 2.09 was observed for the 922 subjects. DMFT increased with age. It was more in females [2.22] and less in male [2.01] and the children from better socio economic status had less scores [1.94] as compared to poor [2.24]. More meals were associated with less caries while more intermeal snacks caused increase in caries, Brushing habits could not be correlated to DMFT. Rural population needs Oral Hygiene education. Better oral hygiene measures, less frequency of intermeal snacks and prophylactic measures may help reduce the caries