Parasiticidal and brine shrimp cytotoxicity potential of crude methanolic extract of rind of Punica granatum Linn against round worms and tape worms

Rind of Punica granatum is traditionally used for anthelmintic purposes. The current work describes the possible anthelmintic activity of crude methanolic extract of Punica granatum [Pg. Cr] against round worms [Ascaridia galli] and the tape worms [Raillietina spiralis]. Brine shrimp cytotoxicity is also performed. Brine shrimp cytotoxic activity was tested using different concentrations [1000µg/ml, 100µg/ml and 10µg/ml] of Pg.Cr. In vitro anthelmintic activity of Pg. Cr was determined against the parasites using albendazole and piperazine citrate as st and ard anthelmintic drugs in concentration 10 mg/ml. LC50 value for Brine shrimp cytotoxicity was 189.44+/-28µg/ml. In test concentration of 40mg/ml of the Pg. Cr, Raillietina spiralis was paralyzed in 23 minutes. However, for parasiticidal activity [death of the parasite], it took less time [40 minutes] as compared to st and ard Albendazole. Time taken for death of the parasite Raillietina spiralis, in concentration 40 mg /ml, is 40 min. While st and ard drugs took more time to kill the Raillietina spiralis. Pg. Cr took 19 minutes to paralyze the Ascaridia galli at concentration 40 mg/ml whereas; it took 48 minutes for to kill the parasite Ascaridia galli. The current work confirms the traditional use of rind of Punica granatum as anthelmintic against Raillietina spiralis and Ascaridia galli. Results of brine shrimp cytotoxicity assay warrant for the isolation of cytotoxic compounds. List of abbreviation: Pg. Cr = Crude methanolic extract of Punica granatum

ORAL submucous fibrosis: comparison of different treatment modalities

Oral submucous fibrosis [OSMF] is a chronic, insidious, fibrotic disease that predominantly affects people of South-East Asian origin. The majority of patients present with an intolerance to spicy food, rigidity of lip, tongue and palate leading to varying degrees of limitation of mouth opening and tongue movement. The use ofareca nut has been strongly implicated as the principal etiological factor in the pathogenesis of OSMF which involves cytokine mediated collagen synthesis and deposition and reduced collagen degradation. Various modalities have been proposed for the management of OSMF. Aimed primarily at increasing oral opening, surgical treatments have been hampered by relapse and medical agents have yielded limited success. In this prospective comparative study we tested a hypothesis that a combination ofintralesional steroid and oral antioxidant would prove to be of maximal efficacy than either of the two agents used alone. Forty five patients with a clinical and histologic diagnosis of OSMF were randomly divided into three treatment groups of fifteen patients each. Patients in group [A] received monthly intralesional injections of methylprednisolone acetate, those in group [B] were put on daily lycopene supplements while the ones in group 'C' received monthly intralesional injections of methylprednisolone acetate and concurrently were put on daily lycopene supplements as well. Mouth opening values for patients showed an average increase of 3.46 mm, 2.46 mm and 7 mm for groups A, B and C respectively. The difference in mouth openings at the end of treatment was found to be statistically insignificant between groups A and B [p > 0.05], significant between groups A and C [p < 0.05] while it was very significant between groups B and C [p < 0.01]. We therefore conclude that the most favorable response in terms of clinical efficacy was derived from the combination ofintralesional steroid and oral antioxidant therapy in patients abstaining from areca nut habit and indulging in rigorous physiotherapy. We further suggest that this modality may be used as a frontline therapy for the pharmacologic and physiotheraputic management of oral submucous fibrosis

Predictive value of neutrophil/lymphocyte ratio in predicting complications after non st elevation myocardial infraction

A Cross sectional study conducted in Cardiology Unit, Hayatabad Medical Complex from August 2011 to February 2012. In a total of 250 patients with non ST elevation MI were enrolled in study. Neutrophil to lymphocyte ratio [NLR] was determined. Those with high NLR were followed over two week period to detect in hospital mortality; Atrial Fibrillation and ST segment Deviation. Association of cellular response with the incidence of post-MI mortality/complications was assessed by multiple logistic regression analyses. There were 250 patients comprising of 154 [61.60%] males and 96 [38.40%] females. The overall mean age was 51.57 +/- 12.5 years. The frequency of high neutrophil to lymphocyte ratio was present in 78 [31.20%] patients. The In hospital mortality and atrial fibrillation rate was in 10.26% and 11.54% cases respectively while ST segment deviation was in 57.69% patients. Patients with Non ST Segment elevation Myocardial Infarction with high Neutrophil to lymphocyte ratio, is a good predictor of In hospital mortality, atrial fibrillation and ST segment deviation. Thus a single CBC analysis may help to identify Non- STEMI patients at risk for mortality and complications.

Solitary Eosinophilic Granuloma of Frontal Bone: A Rare Entity.

Histiocytosis is a term applied to a group of rare disorders of the reticuloendothelial system. Langerhan cell histiocytosis (LCH) is characterized by the clonal proliferation of a special type of cell, the Langerhans cell. These are dendritic antigen-presenting cells that are normally distributed in many organs. LCH is presents as one of three clinicopathologic entities: acute disseminated Langerhan cell histiocytosis (Letterer- Siwe syndrome), unifocal eosinophilic granuloma, or multifocal eosinophilic granuloma. Unifocal lesions usually affect the skeletal system and may be asymptomatic, may cause pain and tenderness and in some instances, pathological fractures. This disorder is relatively indolent and may regress spontaneously or needs local excision or irradiation. We present a case of solitary eosinophilic granuloma of frontal bone.

Assessment of male reproductive health by conventional method of semen analysis

Data available over the past twenty years reveal that in approximately 30% of cases of infertility, pathology is found in man alone, and in another 20% both man and woman are abnormal. Therefore, the male factor is at least partly responsible in about 50% of infertile couples. The longer a couple remains sub fertile, the worse is their chance for an effective cure. This study was planned to analyse the complete semen picture of infertile men for assigning the specific cause to male infertility related to concentration, motility and morphology and to know the distribution and pattern of male infertility in the various subclasses in Pakistani population. It was a prospective descriptive analytical study conducted at Department of Reproductive Physiology/ Health, Public Health Divisions, National Institute of Health [NIH], Islamabad. One thousand five hundred twenty-one [1,521] infertile male patients, and 97 proven fathers, taken as a control. Conventional semen analysis was performed on all samples. Out of 1,521 infertile men, 13.3% were azoospermic, 23.2% oligozoospermic, 0.9% polyzoospermic, 14.5% normozoospermic, 35.2% asthenozoospermic 10.5% oligoasthenozoospermic and 2.4% teratozoospermic. Sperm concentration and active motility of proven fathers, was significantly higher [p<0.05] than the normal concentration group. Least liquefaction time was recorded in case of polyzoospermic subjects, and highest for azoospermic cases. Although, the liquefaction time of azoospermic and oligozoospermic subjects varied non-significantly [p>0.05] with the proven fathers. Normal forms were significantly higher [p<0.05] among the proven fathers and polyzoospermic cases, in comparison with the other groups. Head defects were more in teratozoospermic group, followed by oligoasthenozoospermic and oligozoospermic patients. Neck defects were more profound in oligoasthenozoospermic and oligozoospermic patients, while, tail defect showed significant increase in teratozoospermic and asthenozoospermic cases only. Head and neck defect varied significantly [p<0.05] with proven fathers in all groups, while tail defect varied significantly [p<0.05] in oligozoospermic, asthenozoospermic and teratozoospermic groups only when compared with proven fathers. Complete semen analysis which provides important information about the quality and quantity of the sperm, should be performed before reaching a final conclusion

Common trend of antibiotics usage in a tertiary care hospital of Peshawar, Pakistan

Antibiotics are used to eradicate the pre- and postoperative infections in surgical procedures and in all others medical cases. However, inappropriate and indiscriminate use of antimicrobial agents can potentially have a number of problems. The emergence of antimicrobial resistant bacteria, an increased number of patients experiencing adverse drug events, and increased drug-related cost have been documented. The objective of the study was to determine the trend of use of antibiotics and hospitalisation of patients in various units of a tertiary care hospital, to investigate practice variation of antimicrobial agents within the hospital, and to identify and document any opportunity for its improvement. A questionnaire containing relevant information about the study was prepared. Patients' age, sex, diagnosis, duration of hospital stay and type of antibiotic used were recorded and analysed, with particular reference to antibiotic group and disease pattern, in 3 different treatment areas of Hayatabad Medical Complex [HMC], Peshawar, Pakistan, from July 2006 to June 2007. During the period under report, a total of 519 patients were studied for their disease and the type of antibiotics used. The leading type of antibiotics reported were 3rd generation antibiotic used on 147 [28.33%] patients in the 3 units collectively, 1[st] generation 127 [24.47%], and penicillin 99 [19.08%], while macrolides were the least used. The available resources are needed to be effectively utilised, to minimise the hospital stay due to rational use of antibiotics, and to minimise burden of antibiotics on poor patients

Relationship between blood groups and male infertility

Blood is man's complete and unchangeable identity. The ABO and Rh groups are recognised as major and clinically significant blood groups. Blood group antigens are not only important in relation to blood transfusion and organ transplantation, but also have been utilised in genetic research, anthropology and tracing ancestral relation of humans. The objective the present study is to examine the blood group antigens in infertile men for assessing the relationship to male infertility and to know the frequency of various blood groups among infertile males in our population. A total of 1,521 patients along with 460 proven fathers as controls were recruited for the present study from both rural and urban areas of Pakistan and referred to Department of Reproductive Physiology/Health, Public Health Divisions, NIH, Islamabad, during 2002 to 2006. Blood grouping [ABO] and Rhesus factors [Rh] was done by the antigen antibody agglutination test. Overall distribution of blood groups in the studied population of 1,521 subjects was 35.50%, 28.27%, 26.89% and 9.34% for blood groups O, B, A and AB respectively. The ratio of control to patient was 1:3.3. The present preliminary study revealed that in our population the prevalence of male infertility in blood group O is invariably higher than in all other ABO blood groups, showing a strong relationship between blood group O and male infertility

Gray scale and doppler ultra-sound in the diagnosis of painless scrotal masses

To determine the role of gray scale and Doppler Ultrasound in the diagnosis of painless scrotal masses. It was a descriptive study conducted at Department of radiology, Dow University of Health Science [DUHS] and Civil Hospital Karachi [CHK] from June 2006 to June 2007. Adult patients with painless scrotal mass referred for ultrasound examination, were included in the study. All subjects were scanned with 11 MHz linear transducer on NEMIO 17 scanner in supine position and erect posture as and when needed. Gray scale ultrasound was first conducted to determine the size, location and echogenecity of the lesion. Doppler ultrasound was done to assess and document the blood flow, spectrum, and velocity of flow and indices in the epididymis, as well as in the lesion. Accuracy of Doppler scan was determined against histopathology of the respected specimen in case of tumors and against surgical findings in the benign lesions. The average age of the patients was 38.51 +/- 9.4 years. The most common scrotal mass was hydrocele [n=24, 34.29%] followed by varicocele [n=13, 18. 57%], testicular tumors [n= 12, 17.14%], spermatocele [n 11, 15.71%] and epididymal cyst [n=10, 14.29%]. Out of 12 testicular tumors, there were 05 cases of seminoma [41.7%], 02 of cases of embryonal cell carcinomas [16.7%], two epidermoid cysts [16.7%] and 01 [8.3%] each of teratoma, choriocarcinoma with metastasis and testicular lymphoma Sensitivity and positive predictive value of the ultrasound were 66.7% and 100%. Gray scale ultrasound in combination with Doppler ultra sound is a good imaging technique in patients presenting with painless scrotal masses. Benign masses are more accurately diagnosed than tumors that require histopathology for exact tissue characterization

Effect of race, gender and age on thyroid and thyroid stimulating hormone levels in north west frontier province, Pakistan

Thyroid is one of the ductless endocrine gland, which is located immediately below the larynx on either side of and anterior to the trachea. The principal hormones of thyroid gland are thyroxine [T[4]] and triiodothyronine [T[3]]. The current study was carried out to investigate the impact of race, gender and area on the levels of Thyroxine [T[4]], Triiodothyronine [T[3]] and Thyroid Stimulating Hormone [TSH] in normal healthy individuals. Serum levels of T[4], T[3] and TSH in 498 normal healthy individuals belonging to different districts of North West Frontier Province, Pakistan, were examined. Serum T[4] and T[3] were analysed by Radio Immuno Assay [RIA] method whereas TSH was estimated by Immunoradiometric assay [IRMA] method. Levels of T[4], T[3] and TSH ranged from 53 to 167 eta mol/L, 0.6 to 3.1 eta mol/L and 0.3-4.8 micro IU/L respectively. The levels of these hormones show significant change from the reference values that are used in clinical laboratories as well as in Institute of Radiotherapy and Nuclear Medicine [IRNUM], Peshawar, Pakistan. It is concluded that the age, gender, race and area, all have an appreciable effect on the levels T[4], T[3] and TSH

study of the etiology and management of post partum haemorrhage, at Nishtar medical college and hospital, Multan

The main objectives of present study were to determine the incidence and to identify the various etiological factors of primary post partum hemorrhage [PPH] at Nishtar Hospital Multan. We also aimed to review various management options for better outcome and to compare the results with international literature. Descriptive study. The study was conducted at the department of obstetric and gynaecology, Nishtar Medical College from October 2000 to September 2001. The study included all the cases presented with primary admitted at Nishtar Hospital Multan either delivered at Nishtar hospital Multan or outside. All the patients who suffered from PPH were thoroughly interviewed and examined according to the study protocol. A total of 3000 cases admitted in Nishtar Hospital Multan during the study period. Out of these 2100 [70%] were vaginal deliveries and 900 deliveries were caesarean section out of these 117 [3.9%] patients developed PPH. Among the etiological factors most common were; uterine atony 48%, and retained placenta 34%. Most successful management strategy was early use of uterotonic agents [68%]. Despite good antenatal care, better health services, early detection of problem, availability of new pharmacological agents and introduction of different surgical options, PPH is still, a major complication of third stage of labour responsible for a high maternal morbidity and mortality

Pattern of anterolateral cervical lymph nodes involvement in papillary thyroid carcinoma

To determine the pattern of metastatic involvement of anterolateral cervical lymph nodes in papillary thyroid carcinoma. Retrospective, descriptive study. Department of Surgery, Khyber Teaching Hospital, Peshawar, from July 1998 to July 2005. The clinical and pathological record of 38 patients who underwent neck surgery for cervical metastasis from papillary thyroid carcinoma was reviewed. Neck dissections were done and 85 lymph nodes were taken. Forty lymph nodes were histologically positive and were classified in 3 groups based on dissection procedure. The neck level [levels I-V] of the positive nodes of all the 3 groups was identified. The mean age of patients was 32+2.5 years. The positive nodes in neck level III were the most involved followed by level II, IV, V and then I. Modified neck dissection should be adopted for papillary thyroid carcinoma. Papillary thyroid carcinoma usually involves the neck level II, III and IV with the level III being the most frequently involved

Inherited dyslipidaemic disorders contributing to coronary heart disease

Lipoprotein [a] [Lp [a]] is an established independent risk factor for premature myocardial infarction [MI]/coronary artery disease [CAD]. The study was conducted to determine the value of Lp [a] in prediction of CAD or MI in the offspring at risk. A total of 160 subjects were investigated. Serum Lp [a] was measured by ELISA, serum total cholesterol, triglycerides [TG] and HDL-Cholesterol by enzymatic colorimetric methods using standard kits. Differences in levels of total Lp [a] and cholesterol were observed between patients and controls. Both Lp [a] [16.23 +/- 1.95 mg/dL] and cholesterol [175.00 +/- 7.60 mg/dL] of group A [patients] were higher than the corresponding controls. However an opposite trend in results was noted for serum HDL-Cholesterol in patients vs. controls. Persons found to have elevated levels of Lp [a] should focus on controlling the known modifiable risk factor for heart disease, especially smoking, hypercholesterolemia, obesity, hypertension and sedentary life style

Development of 19-plex Y STR system and polymorphism studies in Pakistani population / 药物分析学报

For the development of 19-plex Y STR system and polymorphism studies in locl ethnic populations sixteen markers of non-recombining regions (NRY) of Y chromosome, which show high power of discrimination among individuals, were selected in this study. Blood samples (600) were e.ollected from the males of three most common castes of Pakistani population (Arnin, Awan and Rajput) with different parent lineages. Three markers (DYS385a/b, DYS389Ⅰ/Ⅱ and YCAⅡa/b) among 16 Y STRs are double-targeted regions of the Y chromosome and thus provide two polymorphie peaks for each respective primer set. These 16 Y-STRs were developed into Megaplex system for simultaneous amplification of all markers within the population. The overall power of discrimination observed in focused populations was 60.5%, 66.5% and 55% in Rajput, Awan and Arain casts respectively. This discrimination power will be helpful in haman identification for forensic casework studies including sexual assaults and paternity testing.

Clinical spectrum of spinal muscular atrophy

To evaluate the clinical pattern, frequency of occurrence and diagnostic approach to spinal muscular atrophy [SMA]. It was a descriptive study comprising 30 patients of different ages and both sexes having lower motor neuron signs compatible with different varieties of SMA, with electrophysiological evidence of anterior horn cell disease, and absence of sensory symptoms and upper motor neuron signs. Different varieties were screened during this study. Though most of the varieties were found, not all varieties were captured during the study period. SMA type III was the most common variety. Overall male to female ratio was 4:1. Family history was positive in only a quarter of cases. Limb weakness and wasting were the most common symptoms with more frequent proximal weakness than distal; and generalized weakness was the least common. Best diagnostic tool was electromyography [EMG] as apposed to muscle biopsy which can be reserved for cases with uncertain diagnosis. CPK was a highly non specific marker but helped to differentiate SMA from primary muscle disease at times. Many varieties of SMA are prevalent in our region and can be diagnosed with conventional techniques, EMG being the most sensitive and less invasive tool in the absence of molecular genetic testing

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

Thyrotoxicosis induced by metastatic gestational choriocarcinoma

We report our experience of dealing with a case of metastatic gestational choriocarcinoma with secondaries in the lungs, causing thyrotoxicosis and iron deficiency anaemia due to excessive bleeding per vaginum. The patient was managed successfully with methotrexate

Acute appendicitis masquerading as strangulated para-umbilical hernia

A case of 35 year old male who presented with cellulitis of the skin overlying a previously diagnosed incarcerated para-umbilical hernia. Initially it was thought to have resulted from vigorous scratching but the changed clinical picture of the patient, while under observation, necessitated the revision of the diagnosis to strangulated para-umbilical hernia is reported. On exploration an acutely inflamed appendix along with some omentum was found to be the content of the hernia and responsible for the cellulitis. Such a mode of presentation of appendicitis has not been reported previously

Malaria trends in general practice in Karachi, Pakistan

Malaria has been a common protozoal disease since times prehistoric. It has regained global importance after the emergence of drug-resistant strains of plasmodia and resistance of mosquitoes to commonly used insecticides. This study was done to assess the magnitude of malaria as a cause of febrile illness in Karachi and trends of malaria treatment in general practice. The malarial parasite was found present in peripheral blood of 456 out of 50.000 febrile patients [0.91%] and plasmodium falciparum was the predominant species [52%]. Trends in general practice regarding treatment of malaria are inappropriate and need to be brought in line and practiced according to the recommendations of W.H.O. Pharmaceutical drug promotion pressures must not be allowed to influence the principles and practice of scientific medical care in clinical practice

Blood parameters and smoking pattern in Peshawar colleges

A survey of cigarette smoking was carried out between September, 1993 and February, 1994. Out of 1983 students, 445 were smokers, 41 ex-smokers and 1497 non-smokers. Smoking was common in the College of Technology and least common in Islamia College. Fathers and brothers of most of the smokers were also smokers and 43% of the smokers expressed their views that they smoked to reduce personal tension. Majority of the students were not smoking and most of the ex-smokers had quitted smoking due to its adverse effects on health. The concentration of blood parameters in smokers increased gradually and hence showed correlation with the number of cigarettes smoked per day

Total cholesterol and high density lipoprotein cholesterol in myocardial infarction patients and controls

Total Cholesterol [TC] and high density lipoprotein Cholesterol [HDL-C] was measured in a group of Myocardial Infarction patients and controls The mean TC was 206 +/- 4.49 SEM in the patient group and 209.7 +/- 3.54 SEM in the control group. In patients less than 40 years of age there was a statistical difference between the TC of the two groups at the.01 level the values being 225 and 207.5; also there was a difference in the HDL-C values but it did not reach statistical significance. Lipoproteins may not be a major contributory factor to coronary artery disease in our population or may be operative at a lower level