Outcomes of intubation techniques in nasolacrimal duct blockage in adult age group: a comparative study based on Sindh, Pakistan population

Background: Nasolacrimal duct obstruction is listed under the heading of congenital diseases; on other hand it is also commonly present in adult age group. In population of Sindh we found these patients frequently. Through this study we revealed the surgical options for the treatment of Nasolacrimal duct obstruction in population of Sindh provenience of Pakistan. The objective of the study was to compare the outcomes of two different intubation techniques in treatment of Nasolacrimal duct obstruction between two age groups. Comparative study was conducted in the Department of Ophthalmology Al-Ibrahim Eye Hospital Karachi from May 2018 to June 2019.Methods: Total 136 numbers of patients were included on the bases of history, clinical examination and pre-operative syringing test. Non- probability convenient sampling was applied for data collection. Total 136 numbers of patients were divided into two groups on the bases of treatment and further subgroup on the bases of age ranges. Data were analyzed by SPSS version 20.0.Results: Frequency and percentage of recovery in six months in each subgroup with application of chi-square test. Frequency and percentage of post-operative complications prolong treatment and regurgitation and patency of tube in each group and subgroups.Conclusions: The results showed significant difference between the groups. Group A showed higher success rate with minimal percentage of complications and post-operative measurements in both age ranges as compare to Group B.

Prevalence of amoebiasis in a model research community and its confirmation using stool antigen elisa for Entamoeba histolytica

Entamoeba histolytica [E. histolytica] produces an invasive disease called amoebiasis, which commonly produces diarrhea with or without blood in both children and adults, leading to high morbidity and mortality. Entamoeba dispar [E. Dispar] is a noninvasive, nonpathogenic organism. Both Entamoeba histolytica and Entamoeba Dispar look alike on microscopy and therefore cannot be differentiated unless checked on ELISA, PCR or other specific method. To calculate the actual prevalence of pathogenic amoebiasis in children by comparing the stool microscopy with ELISA stool antigen i.e. gold standard. Across sectional, comparative study. Children under five years in a community village Budhni, District Peshawar. A sample of 288 children aged <5 years were randomly selected. Information's were collected on the age and gender of the children. Fresh stool specimens were examined microscopically and with stool antigen kit of ELISA for detection of Entamoeba histolytica. The specificity and sensitivity of microscopic method was calculated against ELISA. Data was analyzed using statistical computer software package SPSS version 10.0. A total of 288 stool specimens were collected and examined for Entamoeba histolytica. Out of these 36[12.5%] stools were positive for E. histolyticaon microscopy while 14[4.9%] were positive on ELISA. Out of 14 ELISA positive samples, 10 samples were also positive on microscopy while 4 were ELISA positive but microscopy negative. About 22 samples, which were positive on microscopy were negative on ELISA indicating that these samples might have been of E. Dispar which is nonpathogenic protozoa. The sensitivity and specificity of microscopic method was 71.4% and 90.5% respectively, as against stool antigen test. Actual prevalence of Entamoeba histolytica is low in the area. Stool ELISA was able to differentiate between pathogenic Entamoeba histolytica and the non-pathogenic Entamoeba dispar and thus can minimize unnecessary antiamoebic treatment in these children

Corneal approach 20 Guage vitrectomy system for the management of congenital cataract

Objective: To evaluate the efficacy and complications of 20 gauge vitrectomy via corneal approach for the management of congenital cataract

Method: We performed anterior capsular vitreorhexis, lens matter aspiration [LMA], primary posterior vitrectorhexis and anterior vitrectomy via corneal approach using 20 gauge vitrectomy system in children younger than two years of age with congenital cataract between January 2014 to December 2014. The intra and postoperative complications were observed

Results: Twenty nine eyes of 21 children were included in this study. Congenital cataract surgery using 20 gauge vitrectomy system via corneal approach did not reveal any intra operative complication. Post operatively all children were able to freely open their operated eyes. Conjunctival congestion at the incision site in four eyes and mild anterior chamber reaction in 8 eyes were seen on 1[st] day which resolved at one week follow up. Other major post operative complications such as inflammatory membrane, irregular pupil, posterior/anterior syneache and opacification of visual axis were not seen during follow up period

Conclusion: The 20-gauge vitrectomy system via corneal approach is easy to perform, is less time consuming, safe and effective for the management of congenital cataract in younger children

Effectiveness of non-mesh [shouldice] versus mesh [lichtenstein] repair in inguinal hernia

To evaluate the optimum method of repair for inguinal hernia with respect to low rate of recurrence, minimum postoperative pain and cost effectiveness. Retrospective and Comparative study. This study was conducted between 2004-2007 in the surgical department DHQ Hospital Karak from. Either 320 patients were randomly allotted to mesh or non-Mesh repair. They were followed up at the 1[st] week and then 1, 6,12,18,24 and 36[th] month. Clinical outcome that is, recurrence rate, quality of life, Post-oparative pain etc were noted. After 3 year, the recurrence rates were significantly different for the two types of repairs. The Shouldice is usually suited in primary and unilateral inguinal hernial repair in adult males. In addition, The Lichtenstein is best for bilateral and recurrent inguinal hernial repair in old patients [>60 Yrs] and in elective states of repair

Risk factors in the upper urinary tract stone disease in Peshawar and Charsadda

The present study was design to know the biochemical Risk Factors of the upper urinary Tract Stone Disease in the Peoples of Peshawar and Charsadda District. Observational Study. This study was carried out at District Head Quarter Teaching Hospital Charsadda and Naseerullah Khan Babar Memorial Teaching Hospital Kohat Road Peshawar from 12[th] August 2012 to 11[th] August 2013. One hundred subjects who were suffering from upper urinary tract stone disease were included in the study. The evidence of stone in the renal and history of spontaneous passage of stones in the urine were determined regarding Microscopic Examination. The age range of our subject was between 01 - 60 years. The mean age +/- S.D of age of stone former for men was 34.6 +/- 8.6 years and for female 30.8 +/- 6.7 in N.S.F. Family history of stone disease was found in [16%] of patients. 4% in maternal side and 12% paternal. The Serum Phosphate level was higher in S.F than N.S.F and is a risk factor for Upper Urinary Tract Stone Disease in Peshawar and Charsadda

Frequency of urinary symptoms in post menopausal women with uerovaginal prolapse

To determine the frequency of urinary symptoms in postmenopausal women with Uterovaginal Prolapse. Descriptive study. This study was conducted in Department of Obstetrics and Gynecology Unit II, Dow University of Health Sciences and Civil Hospital Karachi Pakistan from July 2006 to June 2007/ 60 [sixty] Consecutive pts were included in the study through structural Proforma from the outpatient, ward or emergency. Informed consent was obtained. A detailed history and related examinations and investigations were done. These include Urine DR, Urine C/S and Urodynamics like cystometry in selected patients. Majority of Women found have symptoms were at the age of 60 yr [36.66%] While urinary symptoms less seen at the age of 80 yr [6.66%] while Parity 6-10 was higher in Postmenopausal women to have urinary symptoms [63.33%]. The urinary symptoms found in Postmenopausal women were frequent urine passing [33.33%], Nocturia [83.33%], Retention of urine [20.0%], Dysuria [26.66%], Voiding difficulty [53.35%], Urge incontinence [20.0%] and Stress incontinence [53.33%]. Pelvic organ Prolapse and urinary symptoms like incontinence are prevalent in older women and are associated with age. Large studies are required to assess the relationship of urinary symptoms with Uterovaginal Prolapse. Because these urinary symptoms effect over quality of life of women so it is recommended to reduce genital prolapsed and associated urinary symptoms by implementing some measures such as health education of women and weight control

Proportion of urinary symptoms in pre and post-menopausal women with uterovaginal prolapse

To compare the proportion of urinary symptoms in pre and postmenopausal women with Uterovaginal prolapse. Comparative Study. The study was carried out at the Department of Obstetrics and Gynecology Unit II, Dow University of Health Sciences and Civil Hospital Karachi from July 2005 to January 2006. Sixty consecutive patients [30 premenopausal and 30 postmenopausal] were included in the study through structured Proforma from the out patient ward or emergency. Informed consent was obtained. A detailed history and related examinations and investigations were done. These include urine DR, Urine C/S and Urodynamic like Cystometry in selected patients. In this study the difference of urinary symptoms in pre and postmenopausal women of Uterovaginal prolapse were statistically found insignificant like frequency of urine [26.7% versus 33.3%], Urgency [20% vs 26.7%], Nocturia [26.7% vs 13.3%], Dysuria [40% vs 26.7%], Voiding problems [40% vs 46.7%] Urge incontinence [40%vs 20%]. Stress incontinence was slightly higher in postmenopausal group than premenopausal [53.3%vs 46.7%] but this difference was found insignificant, while parity status between these two groups had significant difference like parity 2-5 was higher in pre-menopause group than postmenopause [66.7% vs 36.7%] and parity 6-10 was higher in postmenopause group than pre-menopause [63.3% vs 26.7%]. Significant difference in parity was found between pre and post-menopausal women with Uterovaginal prolapse but the difference of urinary symptoms in pre and postmenopausal group was found significant. Uterovaginal prolapse associated with different urinary symptoms especially incontinence and voiding problems. These urinary symptoms effect over quality of life of women. This warrants greater attention for Gynecological health needs in our country by safe family planning practices

Validity of pleural fluid protein in differentiating tuberculouse from malignant pleural effusion

Validity of pleural fluid protein in differentiating tuberculouse from malignant pleural effusion keeping histopathology as gold standard. Cross sectional study. This study was conducted in the Pulmonology department post graduate medical institute, Lady Reading Hospital Peshawar, Khyber Pakhtunkhwa [KPK] Pakistan from March 2009 to March 2010. One hundred and seventy nine patients having clinical suspicion of pulmonary tuberculouse and malignancy and fulfilling the inclusion criteria were subjected to Abrams needle biopsy, plural tissue was examined by histopathology. Biopsy in order to know the significant difference of pleural fluid protein level between tuberculous and malignant pleural effusion, histopathology finding and protein concentration were determined their frequency and percentage. Among total number of 179 patients one hundred and fourteen [63.69%] were male and sixty five [36.32%] were female. The age limit from 15-80 years, the result shows that 60.9% were tuberculous and 39.9% were malignant pleuraleffusion, among these malignant 20 [11.2%] showed primary and 50 [27.9%] secondary malignancy. Tuberculous PE was more common in younger age group while malignant PE in older age group, 32 number of patients falling in category A, 59 in category B, and 88 in category C.A protein level in belonging to category C, there was statistically significant difference between tuberculous and malignant PE, tuberculous PE have high concentration of protein than malignant PE, The category [A] have malignant PE. Plural fluid total protein level determination and differentiating is a valuable tool in reaching to the diagnosis of suspectedtuberculouse from malignant pleural effusion provided it is used in addition to the adequate clinical scenario

Shouldice Versus Bassini's Procedures for Inguinal Hernial Repair

Objective: To evaluate the optimum surgical technique for inguinal hernia repair, Shouldice or Bassini's. Study Design: Retrospective comparative study. Place and Duration of Study: This study was conducted between 2004 to 2006 in the surgical ward DHQ Hospital Karak. 200 patients with unilateral and primary inguinal hernia were randomly allotted to either Shouldice or Bassini's repair. The cases were collected either as emergencies or electively. Materials and Methods: All the patients had primary and unilateral inguinal hernia. They were operated electilively or as emergencies. Patients were randomly allotted to either Shouldice or Bassini's repair. The Shouldice was performed with 210 prolene in four layers while the bassini's repair was done with prolene 0 or 1. Results: The patients operated for inguinal hernia were followed for up to 5 years. The shouldice repair was found associated with a lowest recurrence rate of 3% and the Bassini's repair with 5.7%. The difference remains statistically significant [P<0.001]. Conclusion: The Shouldice repair for inguinal hernia was associated with a recurrence rate of less than 1% in the Shouldice clinic at TOR ONTO

role of fiberoptic bronchoscopy in the diagnosis of unsuspected pulmonary disease presenting with hemoptysis

To find out the usefulness of Bronchoscopy Tehcnique in the diagnosis of unsuspected pulmonary disease presenting with Hamoptysis. Case serious study. This study was carried out at the pulmonology Unit of Postgraduate Medical institute Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa from 15-04-2011 to 15-04-2012. Two hundred and fifty male smoker patients with age limit of 40-70 years presenting with hemoptysis having clinical suspension of unsuspected pulmonary disease and fulfilling the inclusion criteria underwent bronchoscopy. The bronchoscopic finding and demographic information were determined regarding their frequencies and percentage. Frequency distribution of pulmonary Tuberculosis 94.59% in age range 40-50 years and 5.4% in 51-60 years. bronchietasis 88.3% 50-60 years and 11.6% in 61-70 years. Chronic Bronchitis with respect to age range of 27.58% in the age range 40-50 years 72.43% in age 51-60 years. Branchoscopy Techniques is a very useful for the determination of unsuspected cases of pulmonary diseases

Significance of hypercholesterolemia in hypthyroid patients

Lipid and lipoprotein is influenced by thyroid hormone. Global distribution thyroid disease is very common in Indo- Pak. Hypercholesterolemia is common finding in hypothyroid patients. This study was conducted to know the prevalence of thyroid dysfunction and its relationship with dyslipidemia. Cross Sectional Study. The study was conducted at the Department of Pathology Jinnah Medical College Warsak Road Peshawar for the period from December 2012 to May 2013. 300 patients suspicious of thyroid element were included in study group. 100 healthy control subjects with no history of any thyroid and other chronic illness were included in control group, serum FT4, TSH and total cholesterol was estimated by Elisa and colorimetric method respectively and Results were analyzed by applying "student T test" and Chi-square". Out of 300 sera tested 78 [260] had thyroid dysfunction Hypothyroid patients serum showed significantly raised cholesterol level, however no significant association between total cholesterol and raised thyroxin level observed. Hypercholesterolemia was noted significantly in hypothyroid patients indicating need for monitoring the cholesterol level in thyroid dysfunction to avoid the risk of development of cardiovascular disease

Frequency of bronchogenic carcinoma in smoker patients with hemoptysis undergoing fiberoptic bronchoscopy

To know the frequency of bronchogenic carcinoma in smoker patients presenting with hemoptysis using fiberoptic bronchoscopy technique. Description case series study. This study was carried out at the pulmonology unit of Postgraduate Medical Institute Lady Reading Hospital Peshawar, KPK from 18/09/2007 to 18/09/2008. Two hundred and fifty smoker patients presenting with hemoptysis, having clinical suspicion of bronchogenic carcinoma and fulfilling the inclusions criteria underwent fiberoptic bronchoscopy. The bronchoscopic findings and other demographic information were determined regarding their frequencies and percentage. Fifty Nine point Two Percent [59.2%] patients were found to have pulmonary tuberculosis, seventeen Point Two Percent [17.2%] were diagnosed to have bronchiectasis, 11.6% chronic bronchitis, 5.2% with bronchogenic carcinoma and 6.8% remained with undertermined cause. Pulmonary tuberculosis is a major cause of hemoptysis in relatively younger smokers but the bronchogenic carcinoma is a major cause of hemoptysis in smokers of old age group

Evaluation of efficacy and biochemical effects of amlodipine / atorvastatin with essential hypertension

An adequate blood pressure is a treatment of hypertension and it is the risk of cardiovascular morbidity and mortality so proper therapy is essential. Combination therapy of amlodipine plus atorvastatin improved vascular compliance, an indicator of structural and functional vascular changes, and the beneficial effect on small arteries appeared to be more than additive. This study aimed to evaluate the efficacy and biochemical effects of once-daily optimized Amlodpine/Atorvastatin 5/10 mg [F-6] versus placebo. placebo-controlled, comparative study. This study conducted in the Department of Biochemistry, University of Karachi from July 2010 to January 2011. This was multicenter, randomized, placebo-controlled, comparative study. Patients were selected from different hospitals of Orangi Town Karachi and samples were analyzed in the department of Biochemistry, University of Karachi. Patients were randomized to receive optimized Amlodpine/Atorvastatin 5/10 mg [F-6] once daily and Placebo once daily for 8 weeks. The efficacy and biochemical effects variables were change from baseline at the end of study which was evaluated. In the patients treated with optimized Amlodipine /Atorvastatin 5/10mg tablets' [F-6] alone, blood pressure reduction was lower, although significant, reaching values of 136.9 +/- 10.7 / 88.2 +/- 6.3 mmHg [p < 0.05 versus Placebo] by the end of eight weeks of treatment. Thus, the drug regimens used may be considered neutral as regards glucose and significantly reduce LDL-Cholesterol. Due to the high antihypertensive efficacy and hypolipidemic and no biochemical effects of the optimized Amlodipine/Atorvastatin 5/10 mg [F-6] it is an excellent option for the treatment of hypertension and hyperlipidemia patients, with a high potential to reduce cardiovascular risks

Visual outcome and complications in Ab-externo scleral fixation IOL in aphakia in pediatric age group

To assess the visual outcome and complications in patients after Ab-externo scleral fixation of intraocular lens in pediatric age group [15 years or less]. This quasi experimental study was conducted at Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from January 2012 to December 2012. All cases included were worked up according to the protocol. All patients underwent Ab-externo scleral fixation of IOL under general anesthesia. Patients were followed up at 1stday, 1[st] week, 1[st] month, 2[nd] month and 3[rd] month. Complete eye examination including best-corrected visual acuity and complications were noted on each visit. Thirty patients were included in the study, with mean age of 8.6 years [ +/- 3.93569]. Most of the patients, 20 [66.7%], had visual acuities of 6/18 or better. No complication was seen in 18 [60%] of the patients intra operatively while soft eye was observed in 7 [23.3%] of the patients. Another complication noted was vitreous hemorrhage, which was seen in 5 [16.7%] patients. Most common post-operative complication was Uveitis followed by astigmatism. Lens dislocation and iris abnormalities were seen in only one patient. Most of the patients showed significant visual improvement after surgery. Ab-externo scleral fixation of an IOL was found to be safe and showed favorable postoperative results with fewer complications

To study biochemical effects of optimized product Ramipril 1.25 mg tablet with essential hypertension

Hypertension is one of the strongest modifiable risk factors for cardiovascular and kidney disease and has been identified as the leading risk factor for mortality. The reduction of blood pressure lower than 130/85 mmHg provides additional benefits regarding both protection of organs and cardiovascular mortality. Angiotensin converting enzyme inhibitors have been shown to block the activation of the renin-angiotensin system in the plasma as well as in the vascular wall. The objective of this double-blind, comparative study evaluating the biochemical effects of optimized Ramipril 1.25 mg tablet as monotherapy in adult patient with essential hypertension. Double-blind, comparative study. This study was conducted at the Department of Biochemistry, University of Karachi from January 2011 to August 2011. This was multicenter randomized, double-blind, comparative study. Patients were randomized to receive Ramipril [1.25 mg] once daily for 8 weeks and at the end of study biochemical evaluation was done. In the patients treated with optimized Ramipril 1.25 mg tablets showed antihypertensive property. No significant variations of blood glucose and different parameters of lipid profile were observed during the eight weeks of treatment. We can suggest that the high antihypertensive efficacy, good tolerability and no biochemical effects of the optimized Ramipril 1.25 mg [F-4] it is an excellent option for the treatment of hypertension in a wide range of hypertensive patients, with a high potential to reduce cardiovascular risks

Biochemical evaluation of Amlodipne/Ramipril in combination with essential hypertension

The reduction of blood pressure lower than 130/85 mmHg provides additional benefits regarding both protection of organs and cardiovascular mortality. Amlodipine is a calcium channel-blocking agent with vasodilator activity and Ramipril is ACE inhibitor. The objective of this double-blind, comparative study evaluating the biochemical effects of Amlodipine 5 mg and Ramipril 1.25 mg in combination and as monotherapy in adult patient with essential hypertension, double-blind, comparative study. This study was conducted at the department of Biochemistry, University of Karachi from December 2010 to September 2011. This was multicenter randomized, double-blind, comparative study. Patients were randomized to receive Amlodopine [5 mg] once daily, Ramipril [1.25 mg] once daily and combination of amlodipine 5 mg with Ramipril 1.25 mg once daily for 8 weeks and at the end of study biochemical evaluation was done. In the patients treated with combination of Amlodipine 5 mg and Ramipril 1.25 mg tablets showed synergetic effect and no significant biochemical effects. We can suggest that good tolerability and no biochemical and hematological effects of combination of Amlodipine 5 mg and Ramipril 1.25 mg to formulate in a single dosage forms [tablet] because it is an excellent option for the treatment of hypertension in a wide range of hypertensive patients, with a high potential to reduce cardiovascular risks

Management of congenital nasolacrimal duct obstruction with massaging and probing without general anesthesia

Management of congenital nasolarcimal duct obstruction with massaging and probing without general anesthesia. Retrospective as well as prospective study. This study was carried out in the out patients department of DHQ teaching hospital charsadda for the period of nine months between 2010 and 2011. Total number of children/infants was fifty. All suspected patients were carefully examined and divided into two groups. Statistically analysis was done by student's "t" table. When results were summed up and test parameters were separated it was seen that the success rate with sample massaging and use of topical antibiotic was 90% at the end of nine months. Five infants improved with single probing. Infantile epiphora due to nasolacrimal duct obstruction generally cured with auto canalization/ massaging with topical antibiotics at the age of 5 months. The 2[nd] thing in this study that we can use topical anesthetic agent instead of exposing the infant to the hazard and the complication of general anesthesia

Serum magnesium and hypertension

Despite advances in the prevention and treatment of hypertension over the past decade, hypertension remains an important public health challenge. Recent efforts to reduce the prevalence of hypertension have been focused on non-pharmacologic means, specifically diet. An increased intake of magnesium has been shown in some but not all studies to reduce blood pressure in patients with hypertension. Decreased Serum magnesium levels are associated with development of hypertension. This study was planned to investigate relation of serum magnesium with blood pressure in patients with mild uncomplicated hypertension. Study was conducted at LUMHS hospital Jamshoro and DHQ hospital charsadda for the period of six months. Fifty known cases of uncomplicated mild hypertensive patients were selected, same number of healthy controls were also examined. When results were summed up and test parameters were compared, it was seen that no significant differences were found in serum magnesium levels among both groups, when compared statistically. Finally we conclude that no relation of magnesium with hypertension was observed. Much more work on wide scale population may be needed to clarify the idea

Serum and urinary inorganic phosphate in stone formers and non stone formers at Peshawar

Geographical variation in the rates of kidney stones has been observed for many years. Pakistan is situated in stone belt. Calculus diseases is endemic in Pakistan, perhaps the incidence in Pakistan is highest in the world. To evaluate etiology and biochemical risk factors [inorganic Phosphate] in the Peshawar. The study was carried out at Leady Reading Hospital, Hayatabad Medical Complex, Peshawar for the period of nine months. Study was conducted at LRH and Hayatabad Hospitals of Peshawar for the period of nine months. Two hundred patients and same number of controls were selected. The mean value of mean inorganic phosphate in non stone formers were less than that of stone formers. The mean of urinary inorganic phosphate excretion in stone formers was greater than that of non-stone formers. We conclude that inorganic phosphate is an independent risk factor for renal stone formation

Mechanism of incorporation of newly synthesized myosin alkali light chain into myofibril

The present work was designed to study the incorporation of newly synthesized myosin alkali light chain [MLC] molecules into myofibris. cDNA of fast skeletal muscle type of MLC tagged with green fluorescence protein [LC3f-GFP] was transfected into cultured chicken cardiomyocytes, and the assembly of expressed LC3f-GFP was observed in living cells under a fluorescence microscope equipped with a cooled CCD camera. At 14-16 hours after transfection, LC3f-GFP was diffusely distributed in the cytoplasm of cardiomyocytes. In some cells, however, intense fluorescence spots of LC3f-GFP were found along myofibrils with a periodically of 1.2 micro m. Confocal microscopy of such cells, stained with rhodamine-labeled phalloidin, revealed the fluorescence spots of LC3f-GFP localized at both ends of A-bond. When these cells were further incubated, LC3f-GFP came to be localized at all levels of the A-bands by 26 hours after transfection. These results indicate that myosin filaments are not replaced with newly synthesized myosin molecules at once along their length, but molecules in filaments are replaced individually from their ends