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Objective: To determine skin changes in patients of End Stage Renal Disease [ESRD] on maintenance hemodialysis [MHD] and factors affecting these changes
Study design: Cross-sectional observational study
Place and duration of study: Nephrology Department, Mayo Hospital, Lahore in collaboration with Dermatology Department, King Edward Medical University, Lahore, from October 2015 to January 2016
Methodology: Two hundred patients who were undergoing MHD for more than three months were included in the study. Patients' demographic data, laboratory reports and dialysis records were noted in a predesigned questionnaire. Skin examination was carried out by consultant dermatologist after patient's permission
Results: Among 200 patients included in study, 105 were malesand rest of them were females. Major causes of ESRD were Diabetes Mellitus [n=83, 41.5%, followed by Hypertension [n=80, 40%], Nephrolithiasis [n=15, 7.5%] and Chronic glomerulonephritis [n=5, 2.5%]. At least one cutaneous finding was present in every patient. Common skin findings observed were pigmentation [86%], xerosis [83%], pallor [79%], pruritus [69%], acquired ichthyosis [50.5%], and bacterial skin infections [18.5%]. Among them, nail manifestations were half-and-half nails [52%], onychomycosis [30.5%], onycholysis [20.5%], subungual hyperkeratosis [23.5%], and Mee's lines [7.5]. Among hair changes were sparse scalp hair [38.5%], brittle and lustreless hair [28%]. The factors contributing to skin changes were patient's age, cause of ESRD, anti HCV positivity, high urea and creatinine levels, duration and frequency of hemodialysis, hemoglobin levels, calcium phosphate product and socioeconomic status. Some skin manifestations were interrelated with each other like xerosis with pruritus [p<0.001], pruritus with bacterial infection [p<0.022], acquired Ichthyosis [p=0.008] and hair changes [p=0.035]
Conclusion: ESRD patients on hemodialysis develop various skin changes during the course of disease process, which contribute to increased morbidity. Different factors affecting skin changes were the cause of ESRD, adequacy and duration of dialysis, employment, financial status, anti HCV positivity, and metabolic factors
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Adhatoda vasica and Calotropis procera species were investigated as a resource for new diverse pharmacological agents including B complex, individual total phenolic compounds and antioxidants for curing and treatments of many infectious diseases in human through advanced analytical methods. These plants are abundant in Khyber Pukhtoon Khawa, Pakistan as well as in all over the world and famous for their unique medicinal importance. These herbaceous species are so far used for animals curing while current exploration of these species showed that these species are a precious resource of various compounds which can be employed in the formation of different drugs. The results showed that the leaf and flower extracts of Adhatoda vasica and leaf extract of Calotropis procera contained higher contents of bioactive compounds. The chemical analysis of the samples resulted in higher values of total phenolic compounds [71.32mg GAE/g], total antioxidants [651% DPPH inhibition], the enzyme catalase [4716Mug/g], ash content [16.72%] and pH values in the Calotropis procera, whereas the total carotenoids [1987mg/100g], the enzymes, superoxide dismutase [4566Mug/g] and peroxidase [1322Mug/g] were higher in leaves of Adhatoda vasica. The flower extract of the Adhatoda vasica was rich in the flavonoids [0.87mg/100g] and organic matter [89.99%] as compared to Calotropis procera. The obtained data for each parameter was interpreted by applying Complete Randomized Design [CRD] along with factorial arrangements. The mean comparison was performed using LSD test at 5% probability level. The presence of these phytochemicals may lead to the conclusion that these herbal plants have the potential for formation of new drugs and can be used as herbal medicine for treatment of different cancer and viral diseases. These compounds are also useful in the treatment of the tumor
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Objective: to determine the frequency of mucocutaneous manifestations in HIV positive patients
Methods: this descriptive cross-sectional study was conducted at the Outpatient Department of Dermatology and HIV clinic of Services Hospital, Lahore from Jun 10, 2015 to Dec 09, 2015. Total 170 HIV positive patients fulfilling inclusion / exclusion criteria], were assessed on clinical grounds and relevant investigations e.g. KOH preparations, Tzanck smear and histopathology were carried out. These patients were enrolled in the study after taking informed consent. Patient's biodata, CD4 count and mucocutaneous lesions found were recorded on a predesigned proforma
Results: the age ranged between 16 and 60 with a mean of 41.9 +/- 8.2 years. There were 113 [66.5%] male patients and 57 [33.5%] female patients. Mucocutaneous manifestations were found in 143 out of 170 [84.1%] patients
Conclusion: a high prevalence of dermatological lesions in HIV infected patients was seen in the present study. Most common mucocutaneous manifestation was viral infections followed by bacterial and fungal infections
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Objective: to determine association between psoriasis and dyslipidemia
Methods: this cross-sectional study was done at Dermatology Department, Lahore General Hospital, Lahore. Non-probability convenient sampling 106 cases and 106 age-and gender-matched controls] were included in this research. Blood samples from both cases and controls were taken after fasting of 12 hours. Informed consent was taken in order to determine the level of their lipid profile. SPSS 21 version was utilized to evaluate the collected data
Results: the mean age of cases and controls in current study was 31.74 +/- 5.27 and 31.24 +/- 5.29 years, respectively. In cases there were 51 [48.1%] female and 55[51.9%] male patients while in control group, there were 68 [64.1%] males and 38 [35.9%] females. There was significant association of cases and dyslipidemia and there were 54 times more chances of having dyslipidemia for cases. The overall logistic model showed that there were 219.633 times more chances of dyslipidemia for cases, moreover, raised triglyceride and low HDL had significant association with cases while age and gender have no significant role
Conclusion: dyslipidemia is positively associated with psoriasis regardless of age, gender and severity of disease. As dyslipidemia is a major risk factor for microvascular complications and proved risk factor for cardiovascular disease, we must include serum fasting lipid profile as a routine investigation in psoriatic patients and early screening must be ensured to minimize the risk of cardio vascular diseases
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Objective: To compare the efficacy of topical hydroquinone 2% and oral tranexamic acid 500mg daily in patients of melisma
Methods: A total of 140 patients [70 patients in each group] were enrolled, who were randomly divided into 2 groups. Group A was treated with topical hydroquinone 2% and group B was given oral tranexamic acid 500mg daily. Follow-up was carried out at the end of 2[nd], 4[th] and 8[th] week to compare reduction in MASI score at last follow-up
Results: The mean age of patients was 29.67 +/- 6.38 years with an age range of 15 to 45 years. There were 28 [20%] male and 112 [80%] female patients. Majority i.e. 120 [85.7%] cases were married and 20 [14.3%] were unmarried. The age of onset was 15-25 years in 67 [47.9%] patients, 26-35 years in 52 [37.14%] and 36-45 years in 21[15%] patients. Both groups showed a decline in MASI score; however, the results were significantly greater in group B [oral tranexamic acid]. At final follow-up, the mean percentage reduction was higher in group B [77.97+/-8.37] as compared to group A [67.02+/-8.42], p < 0.001. Adverse effects like erythema, burning, allergic contact dermatitis and pigmentation were noticed in the first group. One [1.4%] patient developed nausea and vomiting and diarrhea with oral tranexamic acid
Conclusion: Oral tranexamic acid 500 mg had a better response when compared with topical hydroquinone 2% cream and better safety profile. It might be considered as a future treatment option
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Trichoepithelioma is a benign adnexal tumour arising from hair matrix cells. It can be sporadic, familial or a component of other genetic diseases. We report a 40-year-old female who presented with disseminated papulonodular lesions on the face only which were confirmed histopathologically as trichoepithelioma. Her daughter also had trichoepithelioma in the nasolabial folds. They had no other systemic features and were concerned the cosmetic disfigurement imparted by the disease
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Objective: To document the results of using simple technique of Firlit procedure with modified circumcision for treatment of glanular hypospadias. Study Design: Descriptive case series. Place and Duration of Study: Department of Urology, Shifa International Hospital, Islamabad, from January 2011 till May 2017
Methodology: The subjects included pediatric patients who underwent repair of glanular hypospadias by using modified circumcision and Firlit procedure. Patients were analyzed for operative time, age, hospital stay, and peroperative and postoperative complications. Chart review was done for collection of data on specified proforma
Results: There were 73 patients with mean age of 1.81 +/- 0.92 years. Children were discharged on the same day. None of them needed catheterization and dressing. Temporary dressing was used for mild bleeding immediate post op in 13 [17.80%] cases only. Postoperative complication such as urinary retention, fever, severe pain, or urinary tract infection were not seen in children. Meatal stenosis was not seen on a 2-24 months' follow-up. Satisfactory urine stream and good cosmesis was noted by the parents
Conclusion: The Firlit technique for the repair of glanular hypospadias was simple and satisfactory in terms of urine stream and cosmesis with minimal complications
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Objective: To compare the outcome of percutaneous nephrolithotomy [PCNL] in terms of operative time, hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients
Study Design: Descriptive case series
Place and Duration of Study: Shifa International Hospital, Islamabad, from January 2010 to December 2013
Methodology: A retrospective analysis of 155 patients who underwent PCNL from January 2010 to December 2013. The patients were divided into 2 groups: patients aged ? 12 years were included in paedriatic group [A] while patients aged > 12 years were included in adult group [B]. The patients were analyzed for age, gender, stone size, operative time, stone clearance, hospital stay, and peroperative and postoperative complications. Data was collected by chart review on specified proforma
Results: One hundred and twenty-nine [129] patients including 44 [34.10%] females and 85 [65.89%] males with a mean age of 45.00 +/- 1.44 years were adults. Twenty-six palrents with mean age of 9.21 +/- 5.70 years, 17 [65.4%] males and 9 [34.6%] females, were included in the paedriatic group. Mean stone size was 2.12 +/- 1.01 cm in paedriatic group compared to 2.52 +/- 0.77 cm in adult group [p = 0.023]. Mean operative time in paedriatic group was 158.8 +/- 39.63 minutes compared to 119.34 +/- 37.06 minutes in adult group [p < 0.001]. Mean hospital stay in paedriatic group was 2.76 +/- 1.14 days compared to 3.12 +/- 1.27 days in adult group [p=0.1881]. Peroperative stone clearance was in paedriatic group was 93.28 +/- 9.23% compared to 90.81 +/- 12.23% in adult groups [p = 0.331]. One patient in the adult group developed urosepsis
Conclusion: There was no significant difference in outcome of percutaneous nephrolithotomy in terms of hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients. Operative time was significantly shorter in adult cases compared to paedriatic cases
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Objective: To study the comparative effects of aqueous Neem leaf extract with N-Acetylcysteine on the basis of liver enzymes [AST, ALT, ALP] and histopathological changes in paracetamol induced liver damage
Study Design: Experimental / Interventional comparative study
Place and Duration of Study: This study was conducted at the Pharmacology Department, Al-Tibri Medical College, Karachi from January 2015 to June 2015
Materials and Methods: Total sixty [60] albino rats of either gender were equally divided into four [04] respective groups. Each group comprised of 15 animals. Animals of group A were considered as un-treated or control group. In group B animals were treated with a single dose 2mg/kg b/w of paracetamol orally. Group C animals with neem extract 500mg/kg b/w orally for 15 days along with oral administration of 2mg/kg b/w paracetamol. In group D, animals were treated with same dose of paracetamol and 140mg/kg b/w of N-Acetylcysteine intraperitoneal for 06 days
Results: The results showed that the liver enzymes were markedly increased in paracetamol treated group of animals, but decreased when animals were treated with Neem and N-Acetylcesteine. The mean serum level of enzymes such as AST, ALT and ALP were found to be more i.e, 110.8, 40.00 and 444.33 respectively but the mean level decreased in the animals of group C such as 29.133, 20.00 and 240.33. However, liver enzymes were also reduced in group D but their levels were relatively lesser than animals of group C. Regarding histopathological review, the tissue sections showed necrotic hepatocytes, congestion in blood vessels in paracetamol treated group of animals. However, the changes were found significantly reversed in group C and group D, but marked changes were seen in animals of group C as compared to N-Acetylcysteine treated group of animals
Conclusion: Paracetamol is a hepatotoxic drug causing histomorphological damage in liver along with alteration in the level of Liver enzymes. Azadirachta indica leaves have given better results compared to N-Acetylcysteine, on the basis of significant differences in biochemical parameters
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Head and Neck [HN] cancer is the most frequently identified cancer across the globe and is considered as 8-10 % of all cancers in Southeast Asia. The social and cultural habits are the main cause of the remarkable increase in HN cancer in Pakistan. HN cancers are more prevalent in men as compared to women. The HN cancer in Pakistan is mainly attributed to discrete demographic profile, risk elements, eating patterns and family history. The foremost factors of risk are linked with cigarette smoking, alcoholic drinks and tobacco chewing like paan, gutka, etc. The actual burden of HN cancer in Pakistan is 18.74% of all new cancer cases recorded during 2004 -2014. The data is collected from HN cancer patients who are diagnosed from September 2011 till May 2012 in the Institute of Nuclear medicine and Oncology, Lahore Pakistan. In order to diagnose risk factors of HN cancer, the Logistic Regression [LR] and Linear Discriminant Analysis [LDA] are used as analytical tools. The findings of using these both tools concluded that gender, age, occupation, socioeconomic status, family history, chewing habits, smoking habit, worked in the chemical or dust place, alcohol use are main causes for HN cancer. The main aim of this study is to develop the awareness about HN cancer, its causes and early diagnosis
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Objective: To determine a difference in the stone-free-rate among different renal locations in children after extracorporeal shockwave lithotripsy [ESWL]
Study Design: A descriptive study
Place and Duration of Study: Urology Department, Shifa International Hospital, Islamabad, Pakistan, from January 2007 to June 2015
Methodology: The study included children who underwent ESWL, divided into three groups based on location of stones in kidney as group A [lower pole stones], group B [upper and mid pole stones] and group C [renal pelvis stone], respectively. ESWL was done by standard technique using Storz Modulith SLX lithotripter 3rd generation. Data was collected by chart review. SPSS version 16 was used for data analysis
Results: Among 76 children with mean age of 7.55 +/- 4.16 years, 55 [72.4%] were males whereas 21 [27.6%] were females. Mean stone size was 1.08 +/- 0.59 cm. There were 34, 17 and 25 cases in groups A, B and C, respectively. Post-ESWL stone-free-rate was 47% in lower pole stones, 70.58% in upper and mid pole stones, and 68% in renal pelvis stones. Hematuria was seen in one patient from each group, sepsis in two patients from each of the mid pole/upper pole and lower pole group, while Steinstrasse in one patient from each group
Conclusion: ESWL is a safe and effective way of treating renal stones in all poles in pediatric population
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Objective: To determine the outcomes of pediatric patients who underwent ureteroscopic removal of ureteric stones in terms of stone free rates and complications
Study Design: Descriptive case series
Place and Duration of Study: Urology Department at Shifa International Hospital, Islamabad, from January 2012 to December 2014
Methodology: A retrospective analysis of 37 patients, who underwent ureteroscopy for the treatment of ureteral calculi at the study centre, was conducted. Data regarding mean stone size, stone location, stone clearance and complications was recorded on specified proforma. Data was analysed on SPSS version 16
Results: Thirty-seven children with mean age of 8.36 +/- 5.17 years were included. Twenty-five [67.6%] patients were male, whereas 12 [32.4%] patients were female. Mean stone size was 10.01 +/- 6.24 mm. Location-wise 25 [67.56%] patients had upper ureteric stones, 5 [13.5%] patients had mid ureteric stones and 7[18.9%] patients had distal ureteric stones. Twenty two [59.5%] children underwent one procedure, while 15 [40.5%] children underwent relook ureteroscopies. Second relook ureteroscopy was done in 13/25 [52%] patients, 1/5 [20%] patient and 1/7 [14.28%] patient in upper, mid and lower ureteric stones, respectively. Overall stone clearance rate was 35/37 [94.59%] after first procedure. Mean operative time was 52.54 +/- 12.39 minutes. Urosepsis was seen in 2 patients. No major complications were seen. After the second URS procedure, stone free rate was 100%
Conclusion: Ureteroscopy is a safe and effective procedure in children in terms of stone free rate and complications
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Objective To evaluate the efficacy of intralesional 5-fluorouracil alone in comparison with the combination of intralesional triamcinolone acetonide and 5-fluorouracil in treatment of small keloids
Methods Sixty patients who fulfilled the inclusion and exclusion criteria were recruited. Patients were randomly divided into two groups. In group A, intralesional 5-fluorouracil 50 mg/ml was used. In group B, combination of triamcinolone acetonide 40mg/dl [0.lml] and 5-fluorouracil 50mg/ml [0.9ml] was used, on monthly basis for 6 months. Patients were assessed for efficacy, after 6 months of the treatment
Results Efficacy was achieved in 32 cases in which 10 [33.3%] cases were from 5-FU group and 22 [73.3%] were from 5-FU+steroid group, which was statistically significant [p=0.002.]
Conclusion In the treatment of small keloids the combination of 5-FU + steroid has better efficacy in comparison with 5-FU alone