Growth patterns of monosodium urate monohydrate (gouty and urinary) crystals in gel: An in vitro study

Monosodium urate monohydrate crystals are deposited in peripheral joints causing gout and elicit an intense localized inflammatory attack whereas in collecting ducts and medullary interstitium as a urinary calculi which causes dysuria, nausea and hematuria. The purpose of present study is to observe possible growth patterns of monosodium urate monohydrate crystals. The crystals were grown in test tubes by single diffusion gel technique and were observed at 7[th], 14[th], 21[st], 28[th] and 40[th] day. Needle and spherulite type crystals were observed at 14[th] day, while arboresque, crystal sheaves, densely branched, dumbbell, mushroom type spherulites, plumose and hexagonal prismatic crystals were observed for the first time. After 40[th] day complete spherulites were observed with their aggregates. The crystals were characterized by Scanning Electron Microscopy, Energy-Dispersive X-ray and Fourier Transform Infra Red spectroscopies. The pattern of MSUM will be helpful to determine the role of different natural products in the modulation, inhibition or promotion of these crystals by affecting the shape, size, transparency, approximate number and total mass of growing crystals. In case of inhibition or modulation it will be helpful for evaluation the prophylactic management whereas the promotion of the crystal will give an idea about the risk factors of gout and kidney stones

Emergency Room High Index of Suspicion in Apparently Innocent Wounds Can Encounter Missed Tendon Injuries.

Introduction: Limb injuries by sharp objects commonly result in tendon or neurovascular damage. The aim of this study is (1) to determine the incidence of significant neurological, musculotendinous or vascular injury; (2) to explore the cause of such wounds; (3) to determine the incidence of missed injuries; and (4) to assess the prognosis of neurological, vascular and musculotendinous injuries. Methods: Fifty eight adult patients were evaluated in the Emergency Department of our institution for incised wounds sustained to upper and lower extremities. Major trauma with obvious musculotendinous, vascular and neurological injuries was excluded. An injury was characterized as being missed if a patient had received inappropriate treatment or had returned due to persistent symptoms despite being examined, treated and discharged. Only wounds of less than 24 hours duration were included. Non-accidental injuries were excluded. Results: Fifty one (89%) patients sustained upper extremity wounds while only seven (11%) sustained injuries to the lower limb. Neurovascular and tendon injuries occurred exclusively in the upper limb. Twenty one (36%) patients sustained tendon, nerve and/or vascular injuries (41.2%). Glass injury was found to be the most common cause (41.3%) followed by Knife injuries (15.5%). Fifteen patients were offered an admission to hospital by the Trauma service for definitive treatment. Four of these patients signed DAMA (Discharge against Medical Advice). Six patients did not warrant admission and were discharged from the Emergency Department following appropriate treatment. Thirty seven patients were treated by Emergency Physicians and subsequently discharged. A missed tendon injury was reported in one patient (1.7%). Conclusion: A thorough clinical examination and accurate injury documentation in the Emergency Department is fundamental in recognizing tendon injuries.

Use of buccal fat pad for reconstruction of intraoral defects

The aim of this prospective trial is to assess the utility of Buccal Fat Pad for closure of small and medium sized defect following excision of intra-oral lesions. Thirty five cases with intraoral lesions including thirty one cases of Squamous Cell carcinoma and four cases of severe dysplasia, recruited from the outpatient service of the department of ENT-Head and Neck Surgery, Jinnah Postgraduate Medical Centre, Karachi from 2005 till 2007. All these lesions were limited to buccal mucosa. Most these patients were males [28 males and 7 females] with ages ranging from 24 to 70 years. The buccal fat pad filled wound in all the patients showed complete epithelialization within three weeks, except for two cases who had partial dehiscence of the flap. These too were healed spontaneously without any need of secondary suturing. Five patients had some degree of restricted mouth opening but this limitation improved on mouth opening exercises with wooden tongue spatulas. We believe that Buccal fat pad flap is a simple, reliable, and convenient flap, with least of complication and donor site morbidity and should be employed in filling the small and medium size defect of oral mucosa

Herbal treatment for cardiovascular disease the evidence based therapy

More than 2000 plants have been listed in the Traditional [Herbal/Alternative] systems of medicine and some of these are providing comprehensive relief to the people suffering from cardio-vascular diseases, specially [hyperlipidemia] and [ischemic heart disease]. WHO reports indicate that around eighty percent of the global population still relies on botanical drugs and several herbal medicines have advanced to clinical use in modern times. Based on these findings, present review is written to identify the [Pharmacology and Cardio-vascular Application] of four commonly used plants in Pakistan. These include, Crataegus oxycantha, Inula racemosa, Terminalia arjuna and Commiphora mukul The selection of the plants in the present study is primarily based on their chemistry and pharmacological properties including toxicology reported in various research articles and reviews. Some very interesting findings have been observed and thus recorded and reported in this review

Flexible nasopharyngo-laryngoscopy in comparison with direct laryngoscopy

Flexible nasopharyngo-laryngoscopy is a valuable tool in the diagnosis of nasopharyngeal, laryngeal and hypopharyngeal pathologies. Previously, the same pathologies were detected by doing examination under general anaesthesia which requires admission and theatre involvement in a busy hospital like Jinnah Post Graduate Medical Centre, this results in delay of the procedure and put extra burden on already constraint resources. This study was conducted to determine the accuracy of flexible pharyngolaryngoscopy in recording the site and extent of abnormality in outpatient clinic notes when compared to the findings at direct laryngoscopy. This study was conducted at ENT department, Jinnah Postgraduate Medical Centre from 1[st] January 2006 to 31[st] December 2007. Prospective study. 148 patients included in this study were selected with the complains of hoarseness, dysphagia, odynophagia, difficulty in breathing and neck nodes. Flexible nasopharyngo-laryngoscopy done in all cases than patients were admitted in ENT department had undergone direct laryngoscopy under general anaesthesia. The findings of both procedures were compared. Accuracy was found to be 87% when the readings of flexible endoscopy were matched with that of direct laryngoscopy