A glued technique of external dacryocystorhinostomy

Purpose: Fibrin glue was used for anastomosis of lacrimal sac and nasal mucosal flaps and was compared with the conventional suture technique in external dacryocystorhinostomy. Methods: A prospective interventional randomized control study in which 50 consecutive patients of primary acquired nasolacrimal duct obstruction (PANDO) were equally allocated into two groups. The case group underwent glued technique of external dacryocystorhinostomy (Ext DCR) in which fibrin glue was used for the apposition of the anterior lacrimal sac and nasal mucosal flaps. In the control group, conventional technique of Ext DCR was used to suture the flaps. Functional success was assessed by improvement in epiphora and fluorescein dye disappearance test (FDDT), whereas anatomical success was assessed by lacrimal irrigation and endoscopic view of the osteotomy site. Results: The anatomical success in both the groups was 92%, whereas the functional success was 92% in the case group and 88% in the control group. The difference in the success rates between the two groups was statistically non?significant. Conclusion: Glued technique of Ext DCR is a simple and easy alternative to suturing of the flaps. Though the final outcome was comparable in both the groups, glue can be especially useful in uncooperative cases, in cases of excessive bleeding, or in situations where the flaps are very thin or have become friable

Statins everyday versus alternate days: Is there a difference in myalgia rates?

Objective Statins are widely used drugs, known to cause myalgia, leading to high discontinuation rates. The objective of our study was to determine the frequency of myalgia in patients on everyday-dose (EDD) regimen with those on alternate-day dose (ADD) regimen. Methods This cross sectional study was conducted in a tertiary care hospital of Pakistan. A sample size of 400 patients between the age of 40–70 years, taking simvastatin 40 mg for at least 6 months or more were selected. Patients with prior musculoskeletal or neuromuscular complains, and family history of muscular disorders were excluded. Subjects were evaluated for myalgia via a self-administered questionnaire, and those complaining of myalgia were then evaluated for serum vitamin D levels. Data was analyzed through SPSS 16.0 and compared using chi square test. Results The overall prevalence of myalgia was 7% (28/400). Frequency of myalgia in patients taking simvastatin everyday (n = 20, 10%) was significantly higher compared to those taking it every alternate day (n = 8, 4%) (p = 0.02). There was no significant difference between the time of onset, nature, severity, type, or location of myalgia between the 2 groups. The most common cited triggering factor for pain was physical exercise. Of the patients experiencing myalgia, 13 (6.5%) from the EDD group and 6 (3%) from the ADD group had low levels of vitamin D. Conclusions ADD regime was better tolerated by the patients than EDD regime. Alternate day therapy, with or without vitamin D supplementation, may be used by the physicians for troublesome muscular complains.

Efficacy of serum blood urea nitrogen, creatinine and electrolytes in the diagnosis and mortality risk assessment of patients with acute coronary syndrome

Background Although blood urea nitrogen (BUN), creatinine (Cr) and electrolytes are not the mainstay of diagnosis in acute coronary syndrome (ACS) patients but they may have a role in providing a more detailed view of the complications and mortality rates. The aim of this study was to determine the efficacy of these parameters in the diagnosis and mortality risk-assessment of patients with ACS. Methodology A total of 200 patients with ACS were recruited in this prospective study. The relationship of serum BUN, Cr and electrolytes with cardiac enzymes, Global Registry of Acute Coronary Events (GRACE) and mortality was assessed during a 6-months follow-up. Statistical test like multivariate linear regression and binary logistic regression analysis were applied. Results On multivariate linear regression analysis, serum potassium (K) (Unstandardized Coefficient B = −3.77; p = 0.04) showed significant negative association with Creatine Kinease and serum BUN (Unstandardized Coefficient B = 0.52; p = 0.001) showed significant positive association with Troponin I. The patients with GRACE > 105 had significantly higher levels of serum BUN and Cr. Receiver operating characteristic curves showed that area under curve (AUC) of BUN (0.7) was higher than AUC of Cr (0.5). Multiple adjusted model showed that patients with BUN > 32.5 mg/dl were almost 20 times more likely to be associated with mortality as compared to reference group. Conclusion In addition to cardiac enzymes, K along with BUN and Cr may serve as important aid in diagnosis of ACS. BUN and Cr may also serve as important tools in mortality-risk assessment of ACS patients.

Bilateral congenital infantile hemangioma of upper eyelids.

A newborn female baby presented to us with horizontally oval swelling involving posterior lamella of both upper eyelids and is limited by lid margin. The swelling was bright red, nontender, firm in consistency, nonreducible, blanches on pressure, and fixed to underlying structures with no rise in temperature. The size of the swelling was 2.8 cm × 1.1 cm × 1 cm in the right upper eyelid and 2.8 cm × 1.3 cm × 1 cm in the left upper eyelid. There was total occlusion of the visual axis [Fig. 1]. Magnetic resonance imaging of both orbit shows diffusely bulky and heterogeneous altered signal intensity lesions involving the posterior lamella of upper eyelid on both sides [Fig. 2]. The patient was prescribed oral propranolol 2 mg/kg in two divided doses under the supervision of a pediatrician and responded well to the treatment within a week of the initiation of the treatment [Fig. 3] and reduce further in size within 12 weeks of the treatment with the clearing of the visual axis [Fig. 4]. Discussion Infantile hemangioma, a benign tumor of vascular endothelial cells, is the most common type of childhood tumor.[1] Infantile hemangiomas are more common in premature or low‑birth‑weight infants.[2] It usually presents at birth or is evident by 6–8 months of age. The lesion typically manifests within the first few weeks of life, grows rapidly in the 1st year during the proliferative phase then invariably and slowly regresses over the following 4–5 years during the involutional phase.[3] For the management, the long‑term use of topical 0.5% timolol maleate solution is safe and effective in treating superficial infantile hemangiomas.[4] As compared to corticosteroids, oral propranolol also represents an effective therapy for periorbital infantile hemangioma.[5]

Efficacy of intravenous tramadol in reduction of propofol induced pain

Objectives: Propofol is one of the mainly used intravenous anaesthetic used around the globe.However, it is commonly associated with intravascular pain at the time of administration. In this study, we wanted to determine the effectiveness of Tramadol in comparison to Lignocaine in reducing Propofol induced pain

Study Design: Randomized clinical trial

Study Setting: It was performed in Main Operation Theatre, AK CMH Rawalakot; over a period of seven Months from 27-09-2013 to 27-04-2014

Subjects and Methods: 100 patients, having ASA I and ASA II who had presented for elective surgery, were included in the study. Patients with psychiatric disorder or hypersensitivity to lignocaine, propofol or tramadol were excluded. They were divided into two groups of 50 each. Group A received 50 mg intravenous Tramadol, followed by 25 % of dose calculated for Propofol [2 mg/kg]. Drugs were injected into most prominent vein of hand, using 20 G cannula, at rate of 1 ml/sec. Group B received 2 ml of 2 % lignocaine, followed by Propofol in same manner. IBM SPSS version 20 was used for statistical analysis. Independent sample T-test was used for find out p value for age. Chi square was used to find out p value for gender and pain. Pain was assessed by anesthetist as per patient's facial response or complaint of pain

Results: Mean age was 31.94 +/- 17.59 and 29.86 +/- 13.58 in group- A and B respectively [P value=0.07]. Group A comprised of 33 female and 17 males, whereas Group B comprised of 30 females and 20 males [P value =0.534]. Pain was present in 7 [14%] patients in group A as compared to 11 [22%] patients in group B [P value=0.298]. Statistically the difference in regards to gender or pain was insignificant

Conclusion: The study concludes that there is no significant difference between pretreatment with tramadol or lignocaine, in relieving pain caused by propofol?

Efficacy of prophylactic intravenous administration of ondansetron for prevention of spinal anesthesia induced hypotension in elderly patients

Objective: Hypotension is the commonest side effect associated with spinal anesthesia. Multiple modalities have been tested to find adequate preventive measure. Main objective of this study is to find out the effectiveness of prophylactic administration of inj. ondansetron for prevention of spinal anesthesia induced hypotension in elderly patients

Study design: Double blind, randomized controlled trial

Place and duration of study: This study was conducted in our anesthesiology department from 01 July 2014 to 31 December 2014

Methodology: 100 patients were selected for the study using non-probability sampling technique, and divided into two groups of 50 each using random numbers table. Each patient was preloaded with ringer's lactate solution in a dose of 10 ml/kg Patients of Group A received 8 mg of ondansetron IV five minutes prior to administration of spinal anesthesia; whereas patients of Group B were injected normal saline IV. Data were collected and analyzed using IBM SPSS version 20. Chi square test was used to compare hypotension between two groups. A p-value < 0.05 was taken as significant

Results: Mean age of Group A was 64.16 +/- 8.47 years, whereas that of Group B was 62.58 +/- 8.99 [p value= 0.39]. Mean weight of Group A was 72.64 + 5.82 kg, whereas that of Group B was 70.66 + 5.96 kg [p = value p- 0.295]. Hypotension was present in 23 [46%] patients in Group A, where as it was present in 34 [68%] patients in Group B [p value= 0.026]. Bradycardia was recorded in 3[06%] vs. 11 [22%] patients in Group A and B respectively [p=0.021]

Conclusion: We conclude that intravenous administration of 8 mg of ondansetron, 5 minutes prior to subarachnoid block, is effective in decreasing frequency of hypotension and bradycardia in elderly patients

Use of neostigmine in black mamba snake bite: a case report

Snake bite is quite common in most of the countries of the world, especially tropics and subtropical areas. The snake venom is usually one of the two types; neurotoxins and hemotoxins or hemolysins. The management of snake bite consists of supportive treatment and anti-snake venom serum. The patients suffering from respiratory problems due to muscular paralysis will require mechanical ventilatory support. We present a case of a victim of black mamba bite, which is one of the most dreaded snakes in Africa. His recovery was slow and marred with coagulation profile derangement. Finally we started neostigmine and atropine and witnessed a dramatic improvement in his muscle power. He rapidly improved and was discharged with complete recovery

Role of prophylactic ondansetron for prevention of spinal anaesthesia induced hypotension in lower segment caesarean section

Objective: To determine the efficacy of prophylactic administration of intravenous Ondansetron for prevention of spinal anaesthesia induced hypotension in lower segment caesarean section

Study Design: Double blinded randomized controlled trial

Place and Duration of Study: It was conducted in Anesthesiology department, CMH Rawalakot; from 3 Mar to 4 Jun 2014

Material and Methods: One hundred patients were selected for this study, and randomly divided in two groups of 50 each, using random numbers table. Both groups were preloaded with Ringer's lactate at dose of 10ml/kg. Group A received 04 mg of IV ondansetron 5 min prior to spinal anaesthesia, whereas Group B received normal saline 05 minutes before administration of Spinal Anaesthesia

Results: Average age of Group A was 28.62 +/- 4.64 years, whereas that of Group B was 27.88 +/- 3.98 [p-value= 0.394]. Average weight of Group A was 70.30 +/- 6.25 kg, whereas that of Group B was 70.74 +/- 6.17 kg [p-value= 0.724]. Hypotension was noted in 21 patients in group A [42%], whereas it was observed in 34 Patients in Group B [68%] [p-value= 0.009]. Bradycardia was noted in 9 patients in Group A [18%] and 19 patients in Group B [p=0.026]

Conclusion: Intravenous administration of 04 mg of intravenous ondansetron, 05 minutes prior to subarachnoid block, is effective in decreasing frequency of hypotension

Cost‑effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery.

Context: Cost‑effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery. Aims: To compare the cost effectiveness of phacoemulsification (PE) versus manual small‑incision cataract surgery (MSICS). Settings and Design: Prospective randomized controlled trial. Tertiary care hospital setting. Subjects and Methods: A total of 52 consenting patients with age‑related cataracts, were prospectively recruited, and block randomized to PE or MSICS group. Preoperative and postoperative LogMAR visual acuity (VA), visual function‑14 (VF‑14) score and their quality‑adjusted life years (QALYs) were obtained, and the change in their values calculated. These were divided by the total cost incurred in the surgery to calculate and compare the cost effectiveness and cost utility. Surgery duration was also compared. Statistical Analysis Used: Two group comparison with Student’s t‑test. Significance set at P < 0.05; 95% confidence interval (CI) quoted where appropriate. Results: Both the MSICS and PE groups achieved comparative outcomes in terms of change (difference in mean [95% CI]) in LogMAR VA (0.03 [−0.05−0.11]), VF‑14 score (7.92 [−1.03−16.86]) and QALYs (1.14 [−0.89−3.16]). However, with significantly lower costs (INR 3228 [2700–3756]), MSICS was more cost effective, with superior cost utility value. MSICS was also significantly quicker (10.58 min [6.85–14.30]) than PE. Conclusions: MSICS provides comparable visual and QALY improvement, yet takes less time, and is significantly more cost‑effective, compared with PE. Greater push and penetration of MSICS, by the government, is justifiably warranted in our country.

Metabolic syndrome; serum ferritin level in patients

To determine the frequency of raised serum ferritin level in patients with metabolic syndrome. Case series study. Liaquat University Hospital Hyderabad. All the patients with metabolic syndrome for >/= 01 year duration, >/=20 years of age and of either sex were recruited and entered in the study. The metabolic syndrome was detected according to the NCEP-ATP III protocol. After confirmation of metabolic syndrome, the 2cc venous blood sample was taken in a sterilize 5cc disposable syringe, labeled it and sent to laboratory for evaluation of serum ferritin levels. The data was analyzed in SPSS 16 and the frequency and percentage was calculated. Total one hundred patients with metabolic syndrome were evaluated for serum ferritin level during the study period. The mean +/- SD for age of patients with metabolic syndrome was 52.73 +/- 7.83 while the mean age +/- SD of patient with raised ferritin level was 50.23 +/- 8.21. The majority patients were 30-49 age group with female predominance [p<0.01] and exist four component of metabolic syndrome. The ferritin was raised in 60 patients with female predominance [p<0.04]. The mean +/- SD of raised ferritin level in male and female population was 350.10 +/- 19.38 and 270.34 +/- 34.39 [p<0.01]. The raised serum ferritin level was identified [60%] with female predominance in patients of metabolic syndrome

Assessing of oxidative stress related parameters in diabetes mellitus type 2: cause excessive damaging to DNA and enhanced homocysteine in diabetic patients

Oxidative stress and reactive oxygen species [ROS] have been documented subsist to the pathogenesis of many diseases including diabetes mellitus. The strength of both parameters could be estimated by measuring oxidative stress marker thiobarbituric acid reactive substances [TBARS], its related parameters and the antioxidants glutathione peroxidase and superoxide dismutase [SOD] in plasma of DM patients. Lipid peroxidation was measured as TBARS and presented as malondialdehyde, total cholesterol [TC], low-density lipoprotein [LDL], triglyceride [Tg], the antioxidants [vitamin A [beta-carotene], vitamin E, vitamin C, glutathione peroxidase [GPx] and superoxide dismutase] levels. The results showed that these parameters, commonly, were declined appreciably in diabetic individuals as compared to the healthy individuals. In most cases, age and gender were appeared to involve in having greater values of diabetes marker. Further, increased level of lipid peroxidation and random behaviour of antioxidant potential also associated with Diabetes. For that reason these biomarkers might be of great important to diagnosis DNA damages of diabetic patients

Human brain; physiological alterations occurring underlying process of aging

Aging is an irreversible and universal phenomenon of every living organism's life. Many recent studies provide evidences that is strictly related to decline in cognitive function impairment but along with various causes behind these abnormal changes, change in brain !unction and structure is one of the most important factors are being widely used to study the hypothesis that the deficits in and temporal order memory are closely related. Increase in age causes reduction in memory processing tasks, which involve information storage and processing. In other explanation it is mentioned that frontal activity, differences underlying aging is associated with recruitment of brain areas and neural circuit efficiency reduction. In case of young subjects increase in activity mean shorter reaction time but in older subjects results are opposite

Pulmonary tuberculosis; cardiac manifestations

To determine the cardiac manifestations in patients with pulmonary tuberculosis. Case series study. Jan 2014 to June 2014. Liaquat University Hospital Hyderabad. All the patients presented with shortness of breath, cough with sputum, fever, haemoptysis, anorexia and weight loss were recruited and then the subjects with early morning sputum positive for acid fast bacilli and radiological lesions suggestive of pulmonary tuberculosis, of ?20 years of age and either gender were enrolled and entered in the study. The data was analyzed in SPSS 16 and the frequency and percentage was calculated. Total one hundred patients with pulmonary tuberculosis were evaluated for cardiac manifestation during six months study period. The mean +/- SD for age of patients with pulmonary tuberculosis was 45.21 +/- 8.95. The mean age +/- SD of patient with cardiac manifestations was 48.95 +/- 5.53. The majority of the subjects were in 30-49 years age group with male predominance [p<0.01]. The electrocardiographic findings were observed in 72/100 [72%] patients whereas echocardiographic changes were observed in 50/72 [69.4%] patients with pulmonary tuberculosis. The common ECG findings identified were tachycardia 30.5%, P-pulmonale 12.5% and PR prolonged in 9.7% patients with tuberculosis whereas the common echocardiographic findings noticed were pericardial effusion 42% and multiple abnormalities in 24% subjects with tuberculosis. The sinus tachycardia, cor-pulmonale and low voltage QRS complexes were predominant abnormalities on electrocardiograph whereas pericardial effusion was the common abnormality on echocardiography in patients with pulmonary tuberculosis

Antioxidant and antibacterial activities of Hibiscus Rosa-sinensis Linn flower extracts

Antioxidant and antibacterial potential of different solvent extracts of locally grown Hibiscus rosa-sinensis Linn was evaluated. The antioxidant activity was assessed by estimation of total flavonoids contents, total phenolic contents, DPPH free radical scavenging activity and percentage inhibition of linoleic acid oxidation capacity. Agar disc diffusion method was used to assess antibacterial potential of crude extract of H. rosa-sinensis. The yield of the crude extracts [23.21 +/- 3.67 and 18.36 +/- 2.98% in 80% methanol and ethanol solvents was calculated, respectively. Methanol and ethanol extract of H. rosa-sinensis showed total phenolics 61.45 +/- 3.23 and 59.31 +/- 4.31 mg/100g as gallic acid equivalent, total flavonoids 53.28 +/- 1.93 and 32.25 +/- 1.21 mg/100g as catechine equivalent, DPPH free radical scavenging activity 75.46 +/- 4.67 and 64.98 +/- 2.11% and inhibition of linoleic acid oxidation potential 75.8 +/- 3.22 and 61.6 +/- 2.01% respectively, was measured. Antibacterial study against three human pathogens such as staphlococus sp. Bacillus sp. and Escherichia coli showed growth inhibitory effect in the range of 12.75 +/- 1.17 to 16.75 +/- 2.10 mm. These results showed H. rosasinensis indigenous to Kallar Kahar and its allied areas bear promising medicinal values and could be used for developing herbal medicines to target oxidative stress and infectious diseases.

Sebaceous carcinoma with apocrine differentiation: A rare entity with aggressive behavior.

Sebaceous carcinomas are rare neoplasms but have aggressive behavior. Although they can be found anywhere in the body ocular region is the most common site which comprises 75% of all cases of sebaceous carcinomas. Due to their rarity, varied histopathological features, and diverse clinical presentation, their diagnosis is often delayed, sometimes by a year. They are divided on the basis of histological differentiation into well and poorly differentiated. Apocrine differentiation is a still rarer fi nding and only two cases have been reported in the literature so far. We report a case of sebaceous carcinoma with apocrine differentiation in a 60-year-old male who presented with a painless swelling in right upper eyelid for 2 months which was gradually progressive. Computed tomography (CT) scan was performed and a provisional diagnosis of hemangioma was made. The mass was excised and histopathological examination revealed it to be sebaceous carcinoma. However, there were areas with decapitation secretions and granular eosinophilic cytoplasm. These were positive for cytokeratin (CK) 7 and CK 19 which confi rmed their apocrine nature. Therefore, a fi nal diagnosis of sebaceous carcinoma with apocrine differentiation was made. Thus, it can be concluded that ocular sebaceous carcinomas with apocrine differentiation are extremely rare and have signifi cant clinical importance since they can mimic a benign lesion and the nature of surgical intervention and follow up is more aggressive than that of simple sebaceous carcinoma alone.

Comparative Spectroscopic determination of Heavy Metals Profile of kidney Patients before and after Dialysis and Healthy voluntaries.

Present study was conducted to quantify and compare the levels of heavy metals in plasma sample of kidney patient before and after dialysis belonging to different areas of Sargodha region. In this study, the level of copper, zinc, cadmium, iron, manganese, lead, chromium and cobalt in plasma sample of Kidney patients has been investigated using atomic absorption spectrophotometer. Heavy metal profile in both normal and diseased subject was determined using dialysis time period and age factor parameters. The mean value of Zn and Fe was found lower in kidney patient as compared to normal subject and reverse was found in case of Pb, Mn, Co and Cr. The heavy metals composition in male patients were found somewhat higher but non-significantly (P>0.05). Age factor revealed that those patients whose age was >30 years have greater values of metals as compared to <30 years patients. Similarly, the patient on dialysis with <2 years have low concentration of metals as compared to >2 years.