Co-existence of thin basement membrane nephropathy with other glomerular pathologies; a single center experience

The co-existence of thin basement membrane nephropathy [TBMN] and another glomerular pathology portends a worse prognosis than TBMN alone. The purpose of our study was to investigate the prevalence of TBMN and associated glomerular pathologies at our institution. We reviewed all renal biopsies performed at Saint Louis University hospital over a 7-year period. We excluded all post transplant biopsies, and biopsies showing diabetic glomerulopathy, membranoproliferative glomerulopathy, membranous glomerulopathy, and biopsies where no electron microscopy or immunofluorescent studies were done. All other biopsies were included. A total of 634 biopsies were included in the study. The prevalence of TBMN was 47 [7.4%], of whom 17 [36.2%] had TBMN alone. In the remaining 30 [63.8%] patients TBMN was associated with other glomerular pathologies: IgAN 9 [19.1%] and FSGS 9 [19.1%]. We found significantly higher prevalence of IgAN in patients with TBMN versus all biopsies [19.1% vs. 7.7%, respectively, P = 0.002]. We found significant similarities in biopsy indications for TBMN and IgAN group. Around two thirds of the cases of TBMN were associated with other glomerular pathologies. The prevalence of IgAN, but not focal segmental glomerulosclerosis, was significantly higher in patients with TBMN as compared to the general renal biopsy specimens

Effectiveness of sodium hyaluronate eye gel in patients with dry eye disease: a multi-centre, open label, uncontrolled study

To assess the effectiveness of sodium hyaluronate Eye Gel in Dry Eye Disease [DED] patients. A Multi-center, Open-label, Uncontrolled clinical trial was conducted in different centers of Pakistan. Ten ophthalmologists conducted this study in which 250 diagnosed patients with dry eye disease were enrolled after obtaining a written informed consent. Ten patients were dropped out during the study period. All patients were assessed as per following criteria for enrolling a patient into the study: Tear Film Break - up time [TBUT]

Gabapentin for the treatment of trigeminal neuralgia

The aim of this study was to investigate the efficacy and safety of Gabapentin in the treatment of trigeminal neuralgia. Anticonvulsant drugs are regarded as useful treatment of neuropathic pain. In this study the efficacy and side effects of Gabapentin in comparison with Carbamazepine for the treatment of trigeminal neuralgia were evaluated. The study was interventional and cross over comparison. Fifty six patients with Trigeminal neuralgia were administered Gabapentin in comparison to fifty seven control group with Carbamazepine. The clinical trial comprised of two phases of 4 weeks each with three days of washout period. The final titration dose for Gabapentin was 900mg and Carbamazepine 1200mg. the efficacy of these medications was determined by visual analogue scale [VAS] and side effects were recorded through marking of profiles encountered on initiation as well as termination of each of two phase of clinical trial. The Gabapentin benefited 55% [31/56] of the patients with pain relief [p<0.05] in contrast to 50% [29/57] who obtained relief of pain from Carbamazepine as control on visual analogue scale assessment. It was concluded that Gabapentin is more effective and safer drug for the treatment of Trigeminal Neuralgia

Prevalence of chronic orofacial pain in a clinical sample

The aim of the study was to determine the prevalence of patients suffering from chronic orofacial pain but did not respond to any conventional therapy and therefore were referred to the Department of Oral Medicine, Khyber College of Dentistry, Peshawar. One hundred and eighty nine patients with overage age 39 years with persistent orofacial pain were recruited in this study. [135 females and 54 males]. The differential diagnosis was made on the basis of history, clinical examination and by applying the criteria laid down by International Association for the Diagnosis of Pain. Analysis showed the following results; Patients suffering from tempo mandibular disorders [TMD] 72[38%], trigeminal neuralgia [TN] 45 [23%], burning mouth syndrome 24[12.6%], atypical facial pain 18[9.5%] Dental pain 15[7.9%], tension type headache 6[3.17%], oro pharyngeal tumors 9[4.7%]. After diagnosis the patients showed relief from pain when appropriate treatment was provided except nine patients which were suffering from tumor

association between oral lichen planus and HCV infection

The purpose of this study was to investigate the possible epidemiological relationship between Oral Lichen Planus [OLP] and Hepatitis C Virus [HCV] infection in Peshawar. This case control study was conducted on three groups of patients who were investigated for HCV infection. Group I [78 Patients clinically and histological confirmed OLP were tested for HCV infection.Group II [78 Patients] control group seeking treatment for other mucosal lesions were screened for HCV infection. Group III [1809 patients] volunteers control group consisted of healthy persons who came to Khyber college of dentistry, Peshawar for dental treatment were also screened for HCV infection. In group I, 1[1.28%] patients were found HCV positive with age range of 30-65 years. In group II, 2 [2.86%] patients were HCV positive while in group III, 56[3.09%] patients were HCV positive. The weak association between OLP and HCV infection was seen in these patients. The result was not significant in the participants P>0.05. This study suggested that no clear relationship could be established between OLP and HCV infection in Peshawar

Vitamin B12 for the treatment of recurrent aphthous stomatitis

The purpose of this study was to confirm the beneficial effects of Vitamin 12 in the treatment of Recurrent Aphthous Stomatitis. This study was conducted at the Department of Oral Medicine of Khyber College of Dentistry, Peshawar on 65 patients suffering from Recurrent Aphthous stomatitis. The patients were randomly divided in to two groups A sublingual dose of Vitamin B12 500 mcg and 1000 mcg was administered to the two groups for 6 months. There were 35 patients in Group-I who were given l000mcg Vitamin B 12 sublingually while in Group-II, 30 patients were given 500 mcg Vitamin B 12 sublingually for 6 months at bed time. The parameter has been recorded in each group on monthly basis for 6 months. The level, duration of pain, the number of outbreak and the size of ulcer was considerably reduced in patients who were treated with Vitamin B 12 l000mcg irrespective of blood Vitamin 12 level as compared to patients taking 500 mcg Vitamin B 12. There was no Recurrent Aphthous stomatitis in Group-I at the end of 6 months while in Group-II there was 30% relief. Thus Vitamin B 12 1 000 mcg sublingually in the treatment of Recurrent Aphthous ulceration is a safe, effective, inexpensive and low risk treatment regardless of serum Vitamin B 12 level in the blood

Treatment of oral lichen planus with topical tacrolimus and triamcinolone acetonide ointment - a comparative study

The aim of the study was to compare the efficacy and safety of topical Tacrolimus ointment with that of Triamcinolone Acetonide ointment on patients suffering from oral lichen planus. A total of sixty patients [53 females and 07 males, means age 48 years; 30 patients per groups] were treated with Tacrolimus, a calcineurin inhibitor immunosuppresor drug and Triamcinolone acetonide for three months in a randomized clinical trial. Thirty patients [group 1] were treated with topical Tacrolimus [0.1%, 0.003%] ointment four times daily and thirty patients [group II] were treated with Triamcinolone Acetonide 0.1% ointment four times daily. The clinical effects were graded after 1, 2, and 3 months of treatment. Visual analogue scale 0-10 was used to access the severity of pain before and after treatment. In group 1, Sixteen patients showed healed lesion, 10 showed improvement and 4 showed no improvement. In group II, 5 were healed, 9 patients showed 50% improvement and 16 showed no improvement. No side effects of these drugs were reported in these patients. Topical tacrolimus ointment induced a better initial therapeutic response than Triamcinolone acetonide ointment. However, relapse occured in 12 cases within 6-8 weeks of the cessation of the therapy

Public health problems in low and high socio economic areas of Karachi, Pakistan

Despite many media campaigns by government and private sectors highlighting, water and sanitation treatment plans and policies, the public health problems are still common in different socioeconomic areas. The objective of our study was to explore the major public health problems prevailing in two different socioeconomic areas. The objective of our study was to explore the major public health problems prevailing in two different socio economic areas in Karachi, Pakistan. A cross sectional survey was conducted from January 1, 2008, to June 15, 2008. Convenience sampling was used to select the EVACUE housing situated and model village. From each house selected, interviews were conducted based on one participant per house. The main outcome variables were measure of different qualities of drinking water safety, taste, etc. Problems of waste and sanitation included disposal of solid waste and leakage of drainage system in the area. The results found water quality to be good with safe drinking water and less residents complained in EVACUEE as compared to Model. Health problems of drinking water and sanitation were more prevalent in low socio economic areas as compared to higher socio economic area

Surgical management of colonic volvulus during same hospital admission

To study the local patient profile, diagnostic methods, and treatment outcome in patients with large bowel volvulus to recommend a management plan. A retrospective study of patients record with a final diagnosis of large bowel volvulus treated at King Saud Medical Complex, Riyadh, Saudi Arabia between January 2000 and December 2007 were performed for patient demography, clinical presentations, co-morbidity, diagnostic methods, anatomical types, management, and outcome. Forty-two patients with large bowel volvulus were reviewed. They represented 8.5% of all intestinal obstructions treated. Most had sigmoid volvulus [83%], were less than 60 years of age, and were male. Recognized risk factors were present in 12 [29%] patients. Diagnosis was suspected on plain abdominal x-ray in 28 patients [69%], although the characteristic signs of omega and coffee bean were seen in only 16 patients. Eight patients required emergency surgery. Endoscopic decompression was successful in 34 patients, followed by a definitive surgery in 24 patients. Seven patients refused surgery; 3 of them were readmitted with recurrence and were operated. Three patients were unfit for surgery. There were 3 deaths. Large bowel volvulus is uncommon in this area. Abdominal distension with pain, constipation, and characteristic gas pattern in plain x-ray can help diagnose most cases. Decompression can be achieved in most patients with sigmoid volvulus, followed by surgery during the same hospital admission. Transverse colon and cecal volvulus usually need emergency surgery

Hepatitis C virus genotypes in Bahawalpur

This study was conducted at Medical Unit-II Bahawal Victoria Hospital / Quaid-e-Azam Medical College Bahawalpur from May 1st, 2005 to December 31st 2005. The objective of this study was to determine hepatitis C virus [HCV] genotypes in Bahawalpur, Pakistan. In consecutive 105 anti-HCV [ELISA-3] positive patients, complete history and physical examination was performed. Liver function tests, complete blood counts and platelet count, blood sugar fasting and 2 hours after breakfast, prothrombin time, serum albumin, serum globulin and abdominal ultrasound were carried out in all the patients. Tru cut biopsy was performed on 17 patients. We studied HCV RNA in all these patients by Nested PCR method. HCV RNA was detected in 98 patients and genotyping assay was done by genotype specific PCR. Among total of 105 anti-HCV positive patients, HCV-RNA was detected in 98 patients. Out of these 98 patients there were 57 [58.2%] males and 41 [42.8%] females. Their age range was 18-75 years. The age 18-29 years 26 [26.5%], 3o-39 years 35 [35.7%] and 40-75 37 [37.8%], while to [10.2%] patients were diabetics and 34 [34.7%] patients were obese. Liver cirrhosis was present in to [10.2%] patients. Forty two [43.9%] patients were symptomatic while 56 [57.1%] were asymptomatic. Out of 98 patients 11 [11.2%] were un type-able and 87 [88.8%] were typeable. 70/98 [71.4%] were genotype 3; 10/98 [10.2%] were genotype 1; 03/98 [3.1%] were genotype 2; 03/98 [3.1%] were mixed genotype 2 and 3; 01/98 0%] were mixed genotype 3a and 3b. Genotype 3 is the most common HCV virus in our area which shows that both virological and biochemical response will be better. Because HCV genotype 3 is more frequent among the drug users which points towards unsafe injection practices in our area

Frequency of hepatitis B and C seropositivity in prisoners

This study was conducted on prisoners of Central Jail, Bahawalpur and on blood donors at Blood Bank Bahawal Victoria Hospital [BVD], Bahawalpur from Ist August 2005 to 30th November 2005. The intension was to study the seroprevalence of hepatitis B and C in prisoners and to note risk factor if any predisposing to the infection. All the prisoners of central jail Bahawalpur present during the study period, aged more than 18 years of either sex were included as the study group and a comparative group was blood donors presenting to blood bank BVH, Bahawalpur during this period. All the cases in study group [2086] as well as control group [9714] were screened for hepatitis B [HBs Ag] and hepatitis C [anti-HCV] infection detected on serum by One Step Test Device. All the positive cases were confirmed by Enzyme Linked Immunosorbant Assay. After an explanation, verbal consent was taken and a questionnaire was filled before taking samples from all the study group cases. On the basis of screening, prisoners were de vided into seropositive group and sero-negative group. The different variable applied on both the groups were age, sex, occupation, residence, marital status, self shaving / by barber, family history of [H/o] jaundice, H/o blood trans-fusion, operation, tattooing and body piercing, drug abuse, same sex/ extramarital sex and hepatitis B vaccination status. Total prisoners screened were 2086. Out of them 2072 were males [99.3%]. Mean age was 34 years. Total seropositive cases were 249 [11.9%] While during the same period seropositivity in blood donors [control group] was 5.9%. Seropositivity of HBV was 5.6% in study group and 3.1% in control group [p<0.001], HCV was 6.3% Vs 2.8% [p<0.001], statistically very significant difference. Risk factors analysis among prisoners revealed that drug abuse was significantly associated with seropositivity [27% Vs 12%, p value <0.001]. Among drug abusers, very high percentage of intravenous drug users was positive [89.2%, 25 out of 28]. Prisoners shaved by barber were also a t higher risk than self shaving [p value <0.001]. H/o operation [p<0.02] and rural origin [p<0.02] were other significant risk factors. Other risk factors evaluated were not statistically significant. Seroprevalence of hepatitis, both B and C is more in prison inmate than healthy blood donors. Main risk factor in them i is drug abuse, especially intravenous. Other significant risk factor is shaving by barber. There s a need to make some strategy to reduce the risk factors

Exhumation; a tool to establish cause of death

Exhumation is disinterment of the dead body that has already been buried. From January 2004 to December 2005, Thirty-Five cases were exhumed and subsequently autopsied in the rural and urban areas of Sindh by the Standing Medical Board of District Hyderabad for establishing the cause of death. The results revealed that out of the total thirty-five cases, [60%] twenty-one were subjected to autopsy examination first time on exhumation [Primary] whereas the remaining [40%] fourteen were re-examination cases [Secondary]. The cause of death was established in [66%] fourteen of the primary examination cases and [24%] five of the secondary examination cases. Male/ Female ratio was 2:51:1 and the maximum number [62.8%] were in between 21-40 years of age. Rural population [77%] is more frequently involved than urban population [23%]

Frequency of hepatitis C infection in diabetes mellitus

The study was conducted at diabetic clinic B.V. Hospital/Q.A.M.C Bahawalpur from December 1st, 2004 to March 15th, 2005. Diabetes mellitus and hepatitis C infections are common and emerging problems of the society. Either diabetes mellitus is common in chronic hepatitis C patients as reported initially by Ellison and co-workers or hepatitis C infection is more frequent in diabetes mellitus. We want to study the frequency of hepatitis c infection in diabetes mellitus. To study the frequency of hepatitis C infection in diabetic patients and to note any risk factors of diabetic patients predisposing to hepatitis C infection. A cross-sectionalObservational-descriptive analytic study. A total of 250 consecutive diabetic patients of either sex were compared with 6574 blood donors for hepatitis c infection. They were evaluated for hepatitis C infection by using Enzyme Linked Immunosorbant Assay [ELISA-3] which is an anti-HCV anti body test. On basis of this test, the patients were divided into two groups, anti-HCV +ve and anti-HCV -ye. Different variables of these patients were studied and compared in these two groups Variables studied were as follows:- Age, Sex, BMI, Mode of therapy area of their residence[rural or urban] Duration of diabetes mellitus, Blood pressure, Nephropathy and Control of diabetes mellitus. Among a total of 250 patients, 120 [48%] were male and 130 [52%] were female. Two hundred and forty-four [97.6%] patients were of type-II DM and 06 [2.4%] patients were of type-I DM. 22 [8.8%] patients were on insulin therapy while 228 [91.2%] were on oral hypoglycemic agents. Anti-HCV test was positive in 69 [27.6%] diabetic patients as compared to blood donors 41 [0.62%]. In anti-HCV positive group, longer duration of diabetic mellitus [15yrs 15.94%], poor control of diabetic mellitus[87%], insulin therapy[17.39%] hypertension[91.3%] and nephropathy[94.2%] were the significant vari ables while BMI, age, sex and whether they were belonging to either rural or urban area were not significant in both the groups. Hepatitis C infection is common in diabetic patients as compared to control group [27.6% vs 0.62%]. Out of diabetic patients HCV infection is more common with longer duration of diabetic mellitus, poor control of diabetic mellitus, hypertension, nephropathy and insulin therapy

Primary actinomycosis of the abdominal wall

Primary actinomycosis of the abdominal wall is a rare clinical entity. Only 7 adequately described cases have been reported in the English literature. We report a case of isolated abdominal wall actinomycosis involving the left lower quadrant of the abdominal wall in a 32-year-old diabetic male. The diagnosis was confirmed by histopathological examination. Surgical drainage of the abscess followed by long-term administration of penicillin resulted in cure. The clinicopathological spectrum of actinomycosis is reviewed and isolated involvement of the abdominal wall is characterized in light of the knowledge acquired from the available literature on this rare clinical presentation. The significance of obtaining tissues for culture and histopathology in all inflammatory lesions is emphasized

Necrotizing fasciitis. Role of early surgical intervention

To evaluate our experience of management of necrotizing fasciitis [NF] particularly the role of early and aggressive surgical intervention. This is a retrospective review of the cases affected by this disease and managed at Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia, during 5 calendar years from 1996 through to 2000 [1416-1420 A.H]. The preoperative and operative data was collected, and postoperative morbidity and mortality were analyzed. A total of 25 cases of NF were treated during the 5-year period, 18 were males and 7 female. The majority of patients had perianal suppuration as the primary lesion, followed by groin area in drug addicts and only 2 cases were primarily in the upper limbs. Diabetes and drug addiction were the main predisposing factors. All but 3 infections were polymicrobial, with streptococci and acinobacter being the most frequent organisms. The mainstay of treatment depends on a high index of suspicion, aggressive early and repeated debridements and adequate antibiotic coverage. The overall mortality was 24% but the drastic reduction in mortality was observed with early surgical intervention. The results highlight the role of early diagnosis; prompt and aggressive surgical debridements are critical for improved survival

Comparison of retrobulbar anesthesia and intracameral anesthesia using preservative free bupivacine hydrochloride 0.5 % in phacoemulsification with posterior chamber intraocular lens implantation

To compare the retrobulbar anesthesia and intracameral anesthesia using preservative-free bupivacaine hydrochloride 0.5% in terms of effectiveness, complications and comfort to the patient during phacoemulsification with posterior chamber intraocular lens implantation. This was a hospital based comparative study of two methods of anesthesia, conducted at LRBT Free Eye and Cancer Hospital, Lahore from January to July 2000. Study included 200 patients with uncomplicated age-related cataract, equally divided in two groups on simple random basis. Group A [100 patients] received the retrobulbar anesthesia and Group B [100 patients] received the intracameral anesthesia with bupivacaine hydrochloride 0.5% for phacoemulsification with posterior chamber intraocular lens implantation. Outcome measures like pain, visual acuity, intraocular pressure and anterior chamber reaction were compared. On day 1, 79% of the patients in group A and 82% patients in group B had unaided visual acuity ranging between 6/6-6/18. On day 7, this was 88% in group A and 89% group B. On day 1, 99% in group A and 98% in group B had <1+ cells in the anterior chamber while on day 7 this increased up to 100%. On day 1, 97% in group A and 98% group B had intraocular pressure less than 20 mmHg. On day 7, it increased up to 100% in both groups. 97% patients in group A and 96% patients in group B had painless surgery. Results were analysed using computer software SPSS version 10.0. Results showed no significant statistical difference between two groups in terms of pain, visual acuity, intraocular pressure, anterior chamber reaction and patient comfort. In the hands of expert surgeons and in selected patients, intracameral anesthesia with preservative-free bupivacaine hydrochloride 0.5% is a safe and effective technique of ocular anesthesia for phacoemulsification with posterior chamber intraocular lens implantation

Congenital hematometrocolpos in a circumcised girl. an anomaly superimposed by cultural mutilating practices

A rare case associated with congenital hematometrocolpos in a circumcised 13 years old Somalian girl is presented. Emphasis on proper history is highlighted. Mutilation caused by bad cultural practice of female circumcision which is although not a problem in Pakistan, is brought into notice for those who may be unaware of perineal appearance of a circumcised female and stitched over vagina