Bone Mineral Density in patients with Chronic low back pain

Objective: To determine mean bone mineral density in patients with chronic low back pain presenting at Armed Forces Institute of Rehabilitation Medicine Rawalpindi based on dual energy x-ray absorptiometry studies

Study Design: Cross sectional study

Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi from Apr 2015 to Mar 2016

Patients and Methods: Two hundred and forty patients having low back pain of more than 6 months duration fulfilling the inclusion criteria were included both from indoor and outdoor departments through non-probability consecutive sampling. Bone mineral density was measured at lumbar spine by dual energy x-ray absorptiometry studies by the same technical staff using the same equipment. A written informed consent was taken from each patient. Data were collected and recorded on specialized proforma by the principal investigator

Results: Spine BMD on DXA scan ranged from 0.90 to 0.98 g/cm2 with a mean of 0.95 +/- 0.02 as shown in. When stratified, the mean BMD decreased significantly with increasing age and severity of LBP; 20-30 years vs. 31-40 years [0.95 +/- 0.01 vs. 0.92 +/- 0.02; p=0.001]. However, there was no significant difference in mean BMD across genders; male vs. female [0.94 +/- 0.01 vs. 0.94 +/- 0.02; p=0.680]. Similarly there was no significant difference in mean BMD across various durations of low back pain; 7-10 vs. 11-14 months [0.94 +/- 0.03 vs. 0.93 +/- 0.01; p=0.617]

Conclusion: The mean bone mineral density at spine was found to be lower in patients with chronic low back pain. It was significantly lower in older patients and those with severe low back pain. However, it didn't change significantly with various durations of low back pain or gender

Intra-articular corticosteroids versus physiotherapy in the management of adhesive capsulitis

Objective: To compare the intra-articular corticosteroid versus physiotherapy in the management of adhesive capsulitis in terms of mean pain score. Study Design: Randomized controlled trial. Place and Duration of Study: Outpatient department, at Armed Forces Institute of Rehabilitation Medicine, from Jul 2013 to Jul 2015

Material and Methods: A total of 90 patients with adhesive capsulitis were enrolled as per inclusion criteria by non probability consecutive sampling. Forty five patients were assigned to group "A" and were given intra-articular injection of triamcinolone 40mg [2ml] and bupivacain 2ml into the shoulder joint. Group "B", having forty five patients received eight session of physiotherapy on alternate day. Outcome measure included mean pain score using visual analogue scale at six week follow-up

Results: Statistically significant improvement in pain score on visual analogue scale was found in patients with group "A", with improvement in score from 7.2 +/- 0.91 at the start of the study to 5.6 +/- 0.18 at six week follow-up [p<0.001]. Whereas no statistically significant results were obtained in patients with group "B" having pain score on visual analogue scale of 7.4 +/- 0.14 at the start of the study to 7.3 +/- 0.14 at six week follow-up [p=0.54]

Conclusion: The use of intra-articular corticosteroid injection in shoulder joint potentially offers a significantly greater clinical improvement in pain relief over the use of supervised physiotherapy in the management of patients suffering from adhesive capsulitis

Urodynamic bladder patterns in spinal cord injury patients

Objective: To determine the frequency of various neurogenic bladder patterns in patients with traumatic spinal cord injury presenting at Armed Forces Institute of Rehabilitation Medicine Rawalpindi based on urodynamic studies

Study Design: Descriptive cross sectional study

Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine [AFIRM] Rawalpindi, from Jul 2014 to Jun 2016

Material and Methods: One hundred and forty traumatic spinal cord injury patients fulfilling the inclusion criteria were included both from indoor and outdoor departments through non-probability purposive sampling. Urodynamic studies were performed using the urodynamic equipment at urodynamic laboratory. Data were collected and recorded on specialized proforma by the principal investigator

Results: Among 140 study participants detrusor overactivity was found in 100 patients out of which 76 [76%] had thoracic level of injury, 20 [20%] had cervical level and 4 [4%] had lumbar level of injury. Detrusor areflexia was the bladder pattern in 40 patients out of which 26 [65%] had thoracic level of injury, 10 [25%] had cervical level, and 4 [10%] had lumbar level of injury

Conclusion: Detrusor overactivity was the commonest neurogenic bladder pattern among the traumatic spinal cord injury patients

Frequency of celiac disease in children with iron deficiency anemia at the children hospital and the institute of child health Multan

Objective: To determinethefrequency of celiac disease in patients presenting with iron deficiency anemia"

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at Department of Pediatric Gastroenterology, Children's Hospital and the Institute of Child Health; Multan lasted from December 2014 to October 2015

Materials and Methods: Total one hundred patients were enrolled after fulfilling criteria. Non Probability consecutive sampling technique was used for sample collection. Patients were included in study fulfilling age one year to 14 years of both gender and diagnosed as iron deficiency anemia on serum ferittin level less than 15ng/ml. Results: One hundred patients with iron deficiency anemia were enrolled in this study. The mean age of patientswas 4.48 +/- 2.733. Fifty three[53%] male and forty seven [47%] were female. There was a significant difference between groups 1 and 2 in term of gender [p<0.05]. The frequency of celiac disease was 21% in children with iron deficiencyanemia

Conclusion: Screening of celiac disease should be done as a routine investigation in children with iron-deficiency anemia

Doppler ultrasound for assessment of pulsatility index variation of middle cerebral artery in intrauterine growth retardation

To assess variation of pulsatility index of middle cerebral artery [MCA-PI] in intrauterine growth retardation [IUGR]. Descriptive study. Hospital Lahore, from March 2006 to September 2006. A total 100 patients with IUGR in third trimester were selected. Ultrasound estimation of fetal weight [using fetal biometry] below 10[th] percentile for that gestational age was labeled as IUGR. MCA-PI value of less than 0.751 was labeled as abnormal. Abnormal values of PI-MCA were found in 79% of IUGR cases while 21% had normal values. PI-MCA is a sensitive modality of assessing IUGR

Primary duodenal Burkitt lymphoma in a paediatric patient, presenting as a protein-losing enteropathy

Lymphomas of gastrointestinal system are usually of non-Hodgkin's type. Primary Burkitt lymphoma involving the duodenum is very rare in paediatric population. It may present as protein losing enteropathy in adults which may lead to generalized edema, however in paediatric population these cases are associated with colicky or persistant abdominal pain, weight loss, fever, gut bleeding or obstruction. We report a case of a young male child with primary duodenal Burkitt Lymphoma presenting as protein losing enteropathy

Diagnostic usefulness of anti-tissue transglutaminase in celiac disease: correlation with intestinal mucosal biopsy

To describe the clinical value of Anti-tTG [IgA, IgG] in the diagnostic work-up of celiac disease patients. Children with clinical suspicion of celiac disease, presenting in Gastroenterology and Hepatology out patient department, Children's Hospital and The Institute of Child Health, Multan were recruited. It was a descriptive case series, study was conducted from Jan 2007 to Jan 2009, blood samples for Anti-tTGs [IgG, IgA] and duodenal biopsies for histological analysis were taken. Data was analyzed for descriptive analysis. Sixty patients with symptoms suggestive of celiac disease were submitted for Anti-tTGs [IgG, IgA] and duodenal biopsy, 46 patients had histological changes according to the Marsh criteria and 49 had raised Anti-tTGs. A total of 54 patients who had one or both the tests positive, were considered for final analysis. 41 patients showed histological changes of celiac disease on duodenal biopsy and raised Anti-tTGs, 5 patients with histological changes of celiac disease had Anti-tTGs levels within normal limits. Five patients with raised Anti-tTGs levels had nonspecific inflammatory changes [not consistent with celiac disease] and 3 patients with raised Anti-tTGs levels had normal histology of intestinal mucosa. Anti-tTGs [IgA, IgG] is very valuable screening marker in the diagnostic work-up of celiac disease, specially in selecting the patients for duodenal biopsies

Pancytopenia: megaloblastic anemia is still the commonest cause

To find out the frequency of the different causes of Pancytopenia and also to specifically detect the percentage of vitamin B12 deficieny amongst these patients. It is a prospective study carried out in Medical Unit I [Ward 5] of Jinnah Postgraduate Medical Centre Karachi from March to August 2007. A total of 88 patients were included after a detailed history and examinations the information was recorded on Proforma. Findings of aspiration and trephine biopsies were interpreted in the light of history, clinical examination and peripheral blood findings. Out of 88 patients suffering from Pancytopenia, a large number [40.90%] were diagnosed as Megaloblastic Anemia, out of which 77.77% had vitamin B12 deficiency. Aplastic anemia was found in 28 [31.88%] patients followed by other less common causes. Megaloblastic anemia was found in largest number of patients who were found to have Pancytopenia on initial investigations and majority of such patients were found to be deficient in Vitamin B

usefulness of inter-renal resistive index difference in diagnosing acute unilateral ureteric obstruction due to calculus

To evaluate the usefulness of inter-renal resistive index difference in diagnosis of acute unilateral ureteric obstruction due to calculus. Case Control Study was conducted in Department of Radiology, Combined Military Hospital Lahore, from August 2005 to February 2006. Sixty patients were divided in two groups of 30 each group I, 30 patients with unilateral acute ureteric colic due to ureteric calculus; and group II, 30 patients having no symptoms and with a normal ultrasound [as controls]. Interlobar arteries were examined by Colour Doppler ultrasound in upper, mid and lower renal pole with a two to five millimetre sample volume to calculate average resistive index. Inter-renal resistive index difference [deltaRI] was then calculated. Statistically significant difference was observed in the inter-renal resistive index difference [deltaRI] measurements with mean value in the case group of 0.09 compared to 0.021 in controls. Average intrarenal resistive index measurement in the obstructed kidney was .69 compared to 0.58-0.59 in the control group. Measurement of inter-renal resistive index difference in patients with ureteric colic improves diagnostic accuracy of ultrasound in distinguishing between obstructive and non-obstructive dilatation

Malarial hepatopathy in falciparum malaria

To evaluate the clinical, biochemical and sonographic changes in patients with falciparum malaria and jaundice. A case series. This study was conducted at Medical Unit-1 [Ward 5], Jinnah Postgraduate Medical Centre, Karachi, from January 2006 to November 2007. A total of 62 adult patients, regardless of age and gender, with peripheral blood film evidence of falciparum malaria, who had jaundice, were included. Any patient with evidence of infection with Plasmodium vivax or other causes of liver disease [e.g. viral hepatitis, cirrhosis, portal hypertension, amoebic liver abscess, unexplained hepatomegaly, ascites, history of alcoholism, taking hepatotoxic drugs, past history of jaundice] was excluded on the basis of history, relevant clinical examination and investigations. Age of the patients ranged from 13-48 years [mean 26.04 +/- 8.33]. All patients were febrile and icteric, with pallor in 67.7%, hepatomegaly in 30.6%, splenomegaly in 70.9% and impaired consciousness in 20%. Serum bilirubin levels ranged from 3 to 24 mg%. Thirty two [51.6%] had serum bilirubin 3-6 mg%, 20 [32.2%] had 6-10 mg% and 10 [16.1%] had >10 mg%. ALT levels ranged from 20-870 IU/L and AST levels 24-1210 IU/L respectively. INR ranged from 1-1.3. Twenty eight patients [45%] had predominantly conjugated or mixed hyperbilirubinemia and serum transaminases were more than three times normal. Ultrasonography revealed hepatomegaly with decreased echogenicity in 22 [35.4%], splenomegaly in 48 [77.4%] and both hepatomegaly and splenomegaly in 16 [25.8%]. Gallbladder wall thickness was increased in 5 [8.06%] patients. There was no evidence of biliary dilatation. A significant percentage of patients having falciparum malaria with jaundice fulfill the criteria for malarial hepatopathy. It should be considered in patients presenting with acute febrile illness with jaundice so that specific treatment can be given

Nutritional iron deficiency in women of child bearing age- what to do?

Iron deficiency is the most common aetiology of anaemia worldwide and has several risk factors. Although iron deficiency anaemia [IDA] can occur at any age, women from reproductive age group are particularly vulnerable to develop IDA due to increased nutritional demand during pregnancy. Objective was to determine the frequency and nutritional risk factor of iron deficiency anaemia in women of child bearing age. This descriptive, cross sectional study was conducted from October 2005 to March 2006 at the Department of Medicine, Ward-5, and out-patients department of Jinnah Postgraduate Medical Centre, Karachi. Two hundred non-pregnant females of child bearing age were included in the study; 100 with no previous pregnancy and remaining 100 with at least one prior history of pregnancy. All the relevant information, i.e., demographic and socioeconomic was collected through a questionnaire. Two hundred patients with signs and symptoms of anaemia were recruited. Out of them 89 patients were found to be having iron deficiency anaemia in various age groups. Results also showed that dietary habit of patients was one of the causative factors leading to iron deficiency anaemia. To overcome iron deficiency anaemia a thorough and comprehensive strategy is required, i.e., educating the subjects to consume food rich in iron, community based program, monitoring severely anaemic cases and their treatment

value of second look transurethral resection in the evaluation and management of patients with bladder tumors

The role of a routine second transurethral resection in evaluating and management of patients with bladder tumor is defined. From January 2004 to October 2006, 100 patients with new or recurrent bladder tumors underwent repeat transurethral resection within 4-6 weeks after the initial resection, and the results, including the presence of residual tumor and tumor stage, were compared. Of 100 cases, 28 [28%] had no tumor and 72[72%] had residual tumor on repeat TUR. Out of 64 cases with superficial [Ta, Tis, T1] bladder tumors, 20[31%] had residual non-invasive tumor and 13 [20%] were upstaged to muscle invasive tumor. Among 36 patients with a muscle invasive tumor, 10[28%] had no residual tumor on re-TURBT. Results of second resection had changed treatment option in 39 patients [39%] from the initial treatment recommendation which was given after the first TUR. Many patients with bladder tumor have residual tumor present after an initial TUR. Routine repeat resection is advised to control noninvasive tumors and to detect residual tumor invasion

Management practices of childhood diarrhea

To elicit management practices of childhood diarrhea in this region. A cross-sectional survey. This study was carried out in CDDU-CHC [Control of Diarrheal Disease Unit Children Hospital Complex] Multan, over a period of nine months [March-Nov 2005]. Five hundred and twenty patients [age group 2 months-5 years] presenting with diarrhea and dehydration at CDDU-CHC Multan, were randomly selected. Management practices; use of medicines and intravenous fluids, preparation and use of ORS and other home made rehydration solutions, feeding practices during diarrheal attack were determined. Interviewing each mother, a pre-designed questionnaire was filled. Most of the families belonged to a poor socio-economic class; only 18.3% mothers could read and write. Mean duration of diarrheal attack was 4.1 days. Most of the mothers [95%] used allopathic medicine but only 49% from qualified doctors. Mothers [78%] knew about ORT [Oral Rehydration Therapy], but preparation and use of ORS and home available solutions was not appropriate in most of the cases. A large number of mothers withheld semisolid foods during diarrheal attack. ORT and adequate feeding during and after diarrhea are keys to the successful management of diarrhea. With regard to the management practices, there is a great need to improve awareness among mothers and caretakers about continuation of breast-feeding and/or semisolids during diarrheal attack, hand washing practices, preparation and use of ORS and avoiding antidiarrheal drugs

Types of brain tumors in hazara division and northern areas of Pakistan

Background: Early diagnosis and management of brain tumors is important to reduce morbidity and mortality. The objective of this study was to calculate frequency of different types of brain tumors in patients operated and managed at Ayub Teaching Hospital, Abbottabad

Methods: This study was carried out at Neurosurgical Department of Ayub Teaching hospital, Abbottabad from September 1999 to October 2003. Records of patients who consented for surgery after CT scan evidence of brain tumors, which were proved on biopsy later on, were included in the study. The tissue biopsy was taken by open craniotomy or by computerized stereotactic method. Pattern of different brain tumors was studied during this period

Results: Our study revealed predominantly tumors arising from neuroepithelium [49.2%] while tumors arising from meninges were relatively low [23.3%]. Nerve sheath tumors [4.2%], germ cell tumors, mal-developmental origin [2.5%], blood vessel tumors [5.8%] and miscellaneous tumors [6.6%] were found relatively in a very low frequency

Conclusion: Evaluation of brain tumor frequency will help in future management plan that may be in the form of open craniotomy, stereo tactic radiosurgery, whole brain radiotherapy or gamma knife surgery