Prevalence of hypertriglyceridemia and risk factors of ischemic versus hemorrhagic stroke

Objective: To find the prevalence of hypertriglyceridemia in ischemic and hemorrhagic strokes and to assess the risk factors associated with them

Methodology: This cross-sectional study was conducted in Medical OPD/ Emergency, PAF Hospital Mushaf, Sargodha over a period of six months from Nov-2010 to May-2011. All patients of either gender diagnosed as having stroke, with hyper dense or hypo dense area on CT scan brain and of age more than 30 years were included in the study. Patients on anti-hyperlipidemic drugs, with previous history of stroke, having blood disorders, like hemophilia and idiopathic thrombocytopenic purpura and, on warfarin therapy were excluded from the study

Results: 203 patients were enrolled in the study. Out of these 203 patients 138[68%] were males, 65 [32%] were females.127[62.6%] stroke patients had hypertriglyceridemia. In multivariate analysis, hypertriglyceridemia was found to be the only risk factor associated with ischemic stroke adjusting for all the other variables. It was found that patients with hypertriglyceridemia had 3.24 times higher odds of having ischemic stroke [P-value=0.017]

Conclusion: Hypertriglyceridemia was found in majority of the patients with stroke. Furthermore, it was found to be an independent risk factor of ischemic stroke

Hepatitis B and C; prevalence in south Punjab population

Background: Pakistan is a developing country of 180 million people with low health and educational standards. According to the Human Development Index of the United Nations, it is ranked 146[th] out of 187 countries

Objective: To know the actual disease burden of Chronic Hepatitis Viruses B and C in Southern Punjab. Study Design: Cross-sectional, Observational study. Setting: Ibn-e-Sina Hospital and Research Centre. Period: March 2010 to February 2014

Methodology: A total of 26800 people from general population were included in the present study. Free vaccination camps were established in rural and urban union councils with the help of local politicians, in Schools, Madrassahs and Industrial units and a permanent camp was established in Ibn-e-Sina Hospital. People of all age groups and either sex were vaccinated

Results: A total of 26800 individuals were screened, [mean: 36.47 +/- 13.81]. 2090 [7.8%] tested positive for Anti-HCV. Among these 68.6% [n=1433] were males while 31.4% [n=657] were females. 616 [2.3%] tested positive for HBsAg of which 401 [65.2%] were male and 215 [34.8%] were female. 75 subjects [0.28%] were positive for both HBsAg and Anti-HCV

Conclusion:- We as a community need to be more vigilant as the disease burden of HBsAg is not decreasing in the general population and the Burden of Anti-HCV is one of the highest in the world

Hypertriglyceridemia in patients with type II diabetes Mellitus

Objective:To determine the frequency of type II diabetic patients with hypertriglyceridemia

Materials and Methods:This was a cross sectional study carried out at medical unit, PAF Hospital Mushaf, Sarghoda from 19th January 2013 to 18th July 2013. A total of 200 patients of either gender having age >30 years with type II diabetes either controlled or uncontrolled for at least 5 years were enrolled in the study. Patients on anti-hyperlipidemic drug, with history of ischemic heart disease, nephrotic syndrome, hypothyroidism and type I diabetes mellitus were excluded from the study

Results: Mean [+/-SD] age of enrolled participants was 53.25 [+/-7.5] years. 86 [43%] were males and 114 [57%] were females. Mean [+/-SD] fasting blood sugar level was 135 [+/-23.04] mg/dl and random blood sugar was 205.62 [+/-31.87] mg/dl. Mean [+/-SD] duration of diabetes was 6.69 [+/-1.87] years. Out of 200 patients of type II diabetes, 102 [51%] had hypertriglyceridemia out of which majority [63.7%] of patients had uncontrolled diabetes

Conclusions:The frequency of type II diabetic patients with hypertriglyceridemia is found to be 51% with majority having uncontrolled diabetes

Hypertensive, angiotensin converting enzyme [ACE] inhibitory and diuretic activities of the aqueous-methanol extract of ipomoea reniformis

Ipomoea reniformis Roxb. [Convolvulaceae] is a small, weedy herb used for the management of cardiac problems in traditional systems of medicine in India and Pakistan. Objective of the present study was to investigate the hypotensive, diuretic and angiotensin converting enzyme [ACE] inhibitory activities of the aqueous-methanol [30:70] crude extract of the dried aerial parts of I, reniformis [Ir.Cr.] in rats. To record blood pressure lowering effects of the Ir.Cr, different doses of the extract were administered through jugular vein to the ketamine-diazepam anesthetized normotensive rats and blood pressure was recorded via carotid artery. ACE inhibitory activity of the extract was studied in-vitro; using hippuryl-1-histidyl-l-leucine as substrate, the product hippurate was quantified spectrophotometrically after reacting with cyanuric chloride/dioxane reagent. Effects of intraperitoneal administration of the extract on urine and urinary electrolyte excretion were also investigated in rats. The extract [Ir.Cr.] produced 21.51 +/- 3.41, 28.99 +/- 2.30, 53.34 +/- 0.88 and 61.71 +/- 3.37% fall in mean arterial blood pressure of the anesthetized rats at the doses of 0.1, 0.3, LO and 3.0 mg/Kg, respectively. Ir.Cr. was found to have serum ACE inhibitory activity, with IC[50] value of 422 +/- 21.16 ng/mL. The extract also increased urine volume and urinary Na+ excretion significantly at the doses of 30 and 50 mg/Kg in rats. The study concludes that the crude extract of Ipomoea reniformis [Ir.Cr.] has hypotensive, ACE inhibitory and diuretic activities, which provide the scientific justification for the traditional uses of the plant as cardioprotective, antihypertensive and diuretic remedy

Management of otitis media with effusion in children suffering from allergic rhinitis

Otitis media with effusion is a pathological condition of the middle ear in which sterile effusion is presented behind the non-perforated Tympanic Membrane. This prospective study was conducted during period from July 2007 to June 2011. One hundred and sixty children of age group between one to ten years were included in study. After starting the treatment for Allergic Rhinitis they were followed up at the intervals of 1, 2, 4, 12 weeks, 6 month and one year. Detailed ENT examination along with tuning fork tests, pure tone Audiometry and Tympanometry were performed on every visit. In suspected cases of having effusion we performed Myringotomy and Grommet insertion for confirmation of diagnosis and to resolve the effusion. We found that allergic rhinitis leading to upper respiratory tract infection was a prime factor as the cause for Otitis media with effusion. myringotomy and Grommet insertion causes aeration and drying of fluid

Unusual presentation of episodic inspiratory stridor "paradoxical vocal fold motion" its awareness and management

Back Ground: stridor is always terrifying entity and presentation of such patient in clinic is Dire emergency. Majority of these cases are dealt with empirical medicines like steroids and antihistamines, but sometimgs patients need surgical intervention like Tracheostomy or Endotracheal intubation to save the life. Paradoxical Vocal Fold motion is a relatively uncommon in routine Otolaryngological practice. So it can be easily confused with Bronchial Asthma or upper air way obstruction like Laryngeal oedema. Due to rare occyrrence and requirement of special diagnostic fiber optic instruments, the final diagnosis can be difficult. Management of paradoxical Vocal Fold Motion is discussed in this original article. Common mistake which is being done by many Otolaryngologists is treatment with Steroids which may worsen the disease. The aim of this study is to increase the awareness about Paradoxical Vocal Fold Motion regarding management with review of literature

Aim: aim of study is to document the etiological factors and treatment modalities of patients presenting with inspiratory stridor in Paradoxical vocal card motion

Setting and design: retrospective study in two teaching Hospitals

Material and methods: records of patients presenting with inspiratory stridor at outpatient and in emergency between 2007 and 2010 were analyzed

Results: paradoxical vocal fold motion constitutes 77% of inspiratory stridors. Male to female ratio was 1:2.4. Among the etiological factors were sinusitits, allergic Rhinitis, Gastro esophageal reflux disease, Psychogenic and exposure to irritants. Conservative treatment was sufficient in all of these cases, none of these patients required intubation or tracheostomy

Unusual oropharyngeal foreign body

We present an unusual case of foreign body [sewing needle] in a young man, who swallowed it with bolus of food. It penetrated through soft palate into parapharyngeal space, detected with image intensifier and removed successfully. Postoperative course remained uneventful

Bacteriology of [CSOM] tubotympanic disease and antimicrobials

Chronic suppurative otitis media is the inflammation of middle ear by pus producing organisms characterized by discharge and conductive deafness, and is still prevalent around the world. To study the prevalent bacterial pathogens and antimicrobial sensitivity pattern of these isolates. Study of CSOM [tubotympanic diseased] patients at out patient ENT clinic and Microbiology department Sh. Zayed Hospital Lahore. Selection of 100 tubotympanic disease cases from CSOM patients for Bacterial culture and sensitivity. Among Gram positive Staphylococcus aureus represented 34.3% while among gram negative Pseudomonas aeruginosa represented 24.4% and Proteus species were 11.7% of the total isolates. Antimicrobial susceptibility to ciprofloxacin was observed in 92.9% of total isolates followed by sparfloxacin in 92.4%. Septran was the least effective antimicrobial with a sensitivity of only 20.1%. Staphylococcus aureus, Pseudomonas aeruginosa and Proteus species continue to be the major infecting pathogens

Comparison of isolates using conventional sterile swab and nichrome wire loop in chronic suppurative otitis media cases

In chronic suppurative otitis media aerobic Gram positive, Gram negative and anaerobes are found. Middle ear specimen for bacterial culture can be obtained by using sterile swabs and nichrome wire loop separately. To study difference in isolation of bacterial pathogens in cases of CSOM using sterile swabs and nichrome wire loop to obtain middle ear specimen and find a simple, safe, and effective method of collecting middle ear specimen. Study of 100 tubotympanic cases from CSOM patients and collection of ear discharge samples with conventional sterile swabs and Nichorme wire loop separately. Selection of 100 tubotympanic cases from CSOM patients on the basis of history, clinical features, microscopic examination of tympanic membrane by E.N.T. consultant and processing of ear swabs for bacterial culture isolation. The ear discharge sampled with nichrome wire loop [n=100] and conventional sterile swab [n=100] yielded 208 and 221 isolates respectively. Staphylococcus aureus represented 36.5% and 34.3% Pseudomonas aeruginosa 25.9% and 24.4% proteus species 12.5% and 11.7% of the total isolates obtained. Bacterial isolates from ear samples taken with conventional sterile swab were found to be identical to those with nichrome wire loop. Conventional sterile swab is a simple, safe, cheap and effective method of collecting middle ear specimen

Relationship between total cystic area of ovaries and acanthosis nigricans in polycystic ovarian syndrome

To correlate the total area of Acanthosis Nigricans with total cystic area of ovaries in women with polycystic ovaries. Thirty young females with polycystic ovaries were selected and in them total cystic area and total area of Acanthosis Nigricans was measured. Mean total cystic area was 92.0 [SD 35.12] and mean total area of Acanthosis Nigricans was 224.46 [SD 234.90]. The relationship between total cystic area [TCA] and total area of Acanthosis Nigricans [TAAN] was statistically significant with p of 0.007. There is a significant correlation between total cystic area and total area of Acanthosis Nigricans in subjects with PCOS. So Acanthosis Nigricans could be a useful cutaneous marker for PCOS and the extensiveness of the cysts presents

Management of deviated nasal septum by septoplasty

This is a prospective study for the management of deviated nasal septum by septoplasty. Fifty patients in age group 4-40 years were selected for this study. There were 34 male 68% and 10 females 32%. All cases had deviated nasal septum with or without external cartilaginous deformity of nose. Major etiological factor causing deviated nasal septum was idiopathic or developmental in our study. After thorough preoperative and peroperative assessment all patients were operated upon by septplasty under general anesthesia at Shaikh Zayed Hospital Lahore. The success rate in 50 patients was evaluated with minimum follow up period of 8 weeks. The present study showed improvement in nasal obstruction 84%, post nasal drip 73%, headache 70% hyposomia in 58% and external nasal deformity of nose with deviated nasal septum 83% by septoplasty. The results were obtained by comparing the pre and post operative complaints with rhino logical examination. Regarding post operative complications septal adhesions were noted in 8 p atients [16%] septal perforation [1%] secondary hemorrhage in 2 patients [4%] and 6 patients had residual deviated nasal septum [12%]. From this study it was concluded that conservation at the septal frame work rather than resection is much better as it gives lesser complications, allows concomitant rhinoplasty or revision surgery and conservative surgery can be safely performed in children without fear of poor development of midface. The objective of this study was to assess the results and complications of the septoplasty

Treatment of allergic rhinitis by 25% silver nitrate cauterization

A series of 50 patients were closely assessed prospectively to determine the effectiveness, untoward effects and patient acceptance of new method of treatment of allergic rhinitis by 25% silvernitrate application. Age range was 14-45 years except one who was 55 years old. This study describes the technique, uses and results obtained following the application of 25% silvernitrate on the inferior turbinate in patients with allergic rhinitis. Each patient was evaluated regularly which based on both subjective response and clinical examination. We selected only patients having complain of nasal obstruction [92%], rhinorrhoea [82%] and sneezing [88%]. Silvernitrate 25% was used after topical anaesthesia 4% xylocaine with adrenaline and three applications were used after interval of one week. Successful relief was obtained with improvement in nasal obstruction [86%] sneezing [84%] and rhinorrhoea [68%]. Regarding complications no major complication were noted except, mild to moderate pain, nasal congestion and inc reased rhinorrhoea and all were temporary for one or two days and relieved by taking analgesics. In this study we found in follow up 4 patients still had nasal obstruction [8%], 7 patients with rhinorrhoea [14%] and sneezing in 2 patients [4%]. This new method was found to be simple, easy and effective. It is based on the astringent effect of local application of silvernitrate solution

Rhinocerebral mucormycosis - an uncommon but deadly disease

Mucormycosis is caused by fungi of the order Mucorales and is one of the most rapidly fatal fungal infections known to man. Rhinocerebral mucormycosis is the most common type and its extension to the orbit and brain is quite usual. Location of mucormycosis on the palate is a rare and late occurrence. Rhinocerebral mucormycosis is an invasive fungal infection initiated in the paranasal sinuses that frequently progresses to orbital and brain involvement. If recognized early, involvement is limited to the nasal cavity and paranasal sinuses. Diabetics in poor control are at greatest risk, however, any immunocompromised individual may be infected. We present here two cases of mucormycosis with different presentation and outcome. By presenting these case reports we would like to point out that mucormycosis should be included in the differential diagnosis of hard palate ulcers and orbital cellulitis. They also illustrate the clinical course of this unusual, but potentially fatal, fungal infection. Taxonomy, clinical presentation, diagnosis, and management of mucormycosis of the paranasal sinuses are reviewed in detail

Efficacy of prophylactic ciprofloxacin in the prevention of spontaneous bacterial peritonitis

To assess the efficacy of giving prophylactic ciprofloxacin for the prevention of spontaneous bacterial peritonitis [SBP] in cirrhotics. A prospective study of eighty [80] patients suffering from liver cirrhosis with ascites. Medical Unit-III, Services Hospital, Postgraduate Medical Institute, Lahore, Pakistan. Main Outcome Measures: Whether or not spontaneous bacterial peritonitis develops during a follow-up of one year. From the ciprofloxacin group, seven patients [17%] developed spontaneous bacterial peritonitis while in the control group, sixteen patients [40%] developed spontaneous bacterial peritonitis during follow-up of one year [p = 0.048]. At one year follow-up, the probability of recurrence was 28% in the ciprofloxacin group and 78% in the control group. These results indicate thatlong-term selective intestinal decontamination with ciprofloxacin is effective and safe in preventing spontaneous bacterial peritonitis recurrence