Evaluating therapeutic potential of coriander seeds and leaves (Coriandrum sativum L.) to mitigate carbon tetrachloride-induced hepatotoxicity in rabbits

Objective:To evaluate the hepatic and renal protective potential of coriander seeds and leaves using animal feed model.Methods:Coriander seeds- and leaves-based sauces were administrated to normal (Study I) and carbon tetrachloride (2 mL/kg B.W.)-induced hepatotoxic rabbits (Study II). Hepatic and renal biomarkers like aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, superoxide dismutase and catalase were measured.Results:Coriander leaves-based sauce exerted more decline (P<0.05) in serum aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase levels in the study II as 18.32%, 19.91% and 21.24%, respectively. While, hepatic superoxide dismutase and catalase levels were raised significantly (P<0.05) in both studies. Renal parameters also depicted positive impact by the provision of developed sauces.Conclusions:Coriander seeds and leaves based sauces are effective in alleviating the hepato/renal toxicity. The hepatoprotective effect of coriander leaves is more pronounced as compared to coriander seeds.

Complications and mortality in ST-segment elevation acute myocardial infarction in diabetic and non-diabetic patients

The difference in environmental conditions along with foods in the subcontinent than other parts of the world incited this work to see how complications and outcome differ in diabetic and non-diabetic patients. 240 patients [76 diabetic and 164 non-diabetic] suffering from ST-segment Elevation acute myocardia infarction were included in the study. Complications of Acute Myocardial Infarction [AMI] and the outcome were compared between diabetics and non-diabetic patients. Different complications studied varied significantly [P<0.001] within diabetics, non-diabetics and in overall after controlling for diabetes. Complications showed similar pattern [heterogeneity test P>0.5] in diabetic and non-diabetic patients. The abnormalities including Cardiogenic shock [OR = 1.9; 95% CI=0.85-4.22], left ventricular failure [OR = 2.5], re-infarction [OR=2.2], arrhythmia [OR=2.04] and ventricular septal defect [OR=2.17] were 4.2, 21.3, 4.2 and 85.24 times higher in diabetics, respectively. However, occurrence of post myocardial angina [OR=0.38] was low in diabetics than non-diabetics. Odds of having diastolic dysfunction were 1.8 times higher in diabetic patients. The moderate and severe LV-dysfunction was 3.3 and 2.5 times higher diabetics, while mild LV-dysfunction in was 2.1 times higher in non-diabetics. Mortality due to STEMI in diabetics was 2.3 times higher than in non-diabetics. Mortality varied significantly between different age groups in non-diabetics and in overall after controlling for diabetes. In non-diabetic group, mortality was 8.4 times higher in patients those were not given streptokinase than those were given streptokinase, while in diabetic group it was 2.5 times higher in patients were not given streptokinase than those were given streptokinase. The results indicate that the diabetics have higher risk of mortality. Inferior infarction is more serious in diabetics than non-diabetics and chances of survival in streptokinase treated patients is five times in non-diabetic while it about two times in diabetics. The results suggest the importance of streptokinase treatment in patients having ST-segment Elevation Acute Myocardial Infarction

Endoscopic Sinus Surgery [ESS] verses conventional intranasal polypectomy for ethmoidal nasal polyposis

The purpose of this study was to compare conventional intranasal ethmoidectomy currently in practice with Endoscopic Sinus Surgery [ESS]. The effectiveness, complications and financial effects of both the techniques were also compared. It was a comparative study. This study was carried out at CMH Lahore from June 2002 to June 2004. 100 patients suffering from ethmoidal nasal polyposis bilaterally occluding the nostrils were included in this study. They were randomly assigned in two groups of 50 patients each. The first group was operated by intra-nasal ethmoidectomy by conventional method while the second group was operated by endoscopic sinus surgery. Post-operatively patients were seen weekly for 1 month and then at 1, 3 and 6 months. The recurrence of polyp was noted after 6 months. All complications were less in the group that underwent endoscopic sinus surgery compared to the group of intranasal ethmoidectomy. However the most significant difference was in post-operative crusting and recurrence after 6 months, where P-values were highly significant in favour of endoscopic sinus surgery. Endoscopic sinus surgery is a much superior and safe procedure compared to conventional intranasal ethmoidectomy for surgical management of nasal polyposis. There is overall decrease in complication rate especially postoperative crusting. Recurrence rate of nasal polyposis is also significantly reduced

Feeding practices among the infants presenting with acute diarrhoea

To study various feeding practices in children who present with acute watery diarrhea. The objective of the study was not only to study the feeding patterns but also draw an association between different feeding patterns and acute diarrheal episodes Outdoor and indoor unit of Department of Paediatrics Jinnah Hospital affiliated with Allama lqbal Medical College Lahore. Two hundred and fifty patients with acute watery diarrhea of less then 14 days between the ages of I month to I year were included in the study. It was a case control cross sectional study. The data related to 250 patients was collected. The required information was obtained from inother/ attendant of the infant in the questionnaire. All the questionnaire were filled by the doctors. The majority of the infants with acute diarrhea were between 4 months to 1 year 195 [78%]. Forty two [17%] were exclusively breastfed while 78 [310/,] exclusively bottle-fed. Fifty five [22%] had both breast feeding as well as bottle feeding. A large number of mothers 112 [44.8%] gave the teason of insufficient milk for the baby. Majority of the infants with acute diarrhea episodes was between and 12 months when either breast milk is being replaced by bottle milk or improper weaning practices are being used. A large number of infants with acute diarrhea were either mixed fed or bottle fed. Because of increased mixed and bottle feeding there is high incidence of diarrhea in our community

Complications of acute diarrhea in malnourished children

In a developing country like Pakistan malnutrition is a serious health problem. Diarrheal diseases and malnutrition are inter-related. Hence it is worth studying not only diarrhea itself but also the incidence of acute diarrheal complications in malnourished children. A total of 150 malnourished children with acute diarrhea, 50 patients in each 1st, 2nd and 3rd degree of malnutrition were included in the study to see the frequency of complications. Their ages ranged from 1 month to 4 years. Majority of the patients [44.68%] were between 6 months and 1 year. The incidence of complications was highest in the youngest age group [1 month to 1 year]. The majority of the complications like acidosis, shock and septicemia were seen in children with 3rd degree malnutrition. Metabolic and electrolyte derangements were seen again in majority of the patients with 3rd degree malnutrition. The duration of hospital stay was directly related to the degree of malnutrition

Hexadecyl- phosphorylcholine ointment for treatment of cutaneous leishmaniasis: an animal trial

A placebo- controlled trial compared 6% hexadecyl- phosphorylcholine [HePC] and 12% benzethonium chloride ointment with placebo ointment for treatment of cutaneous leishmaniasis. Cutaneous lesions were experimentally induced by inoculation with leishmania promastigotes in 60 golden hamsters. Forty [40] animals were treated with drug and 20 with placebo ointment applied twice daily for 15 days. After treatment, all lesions were significantly reduced in size in the treatment group compared with the placebo ointment. No parasites were detected in smears from 35/ 40 of the drug- treated lesions and no relapses occurred over 120 days of observation

Re-operation after abdominal procedures lesion learnt from our two years experience

The objective of the study are to audit our experience of the management of cases presenting with operative complications requiring acute re operation and to identify the factors resulting in the first operation failure requiring re-exploration. A prospective observational/analytical study. Acute re-operative abdominal surgery during two years period 2002-2003 in surgical Unit 1 Allied hospital, Fiasalabd. All the cases which were re-explored after abdominal surgery admitted in surgical unit 1, Allied hospital, Faisalabad are included in the study. The cases fall in three categories, trauma cases [29] 33.71%, non trauma emergency cases [32] 37.25 and elective surgery cases [25] 29.1%. The incidence of our own unit cases subjected to re-operation is 21.9% [24]. The presenting pathologies after first operation are in 6 groups; Gastrointestinal fistulas [38 cases] 41.8%, bowel obstruction [7 cases] 8.15%, abdominal abscesses [12 cases] 13.9%, bleeding [18 cases] 20.9%, miscellaneous [biliary and G.U.] [8 cases] 9.35, abdominal wound dehiscence and evisceration [3 cases] 3.6%. Total of 136 complications are in 70 cases. Mortality of 7 cases [8.14] is shared by the semi-trained surgeons, Medical officer operators [6 cases] and the trainee surgeons [1 case]. Incidence of mortality in elective surgery cases is 4% in trauma cases 10.34%, non trauma emergency cases 9.4%. Intensive resuscitation including nutritional support, team of senior consultants doing the re-operation, intra-operative and post operative monitoring are the hallmarks of the management. Training and retraining [continuous medical education] of surgeons and regionalization of trauma cases are recommended. The facilities for less invasive procedures blessed with low morbidity and very low mortality will shrink this list of re-operations

Feeding practices among the infants presenting with acute diarrhoea

To study various feeding practices in children who present with acute watery diarrhea. The objective of the study was not only to study the feeding patterns but also draw an association between different feeding patterns and acute diarrheal episodes. Outdoor and indoor unit of Department of Paediatrics Jinnah Hospital affiliated with Allama Iqbal Medical College Lahore. Two hundred and fifty patients with acute watery diarrhea of less then 14 days between the ages of 1 month to 1 year were included in the study. It was a case control cross sectional study. The data related to 250 patients was collected. The required information was obtained from mother/ attendant of the infant in the questionnaire. All the questionnaire were filled by the doctors. The majority of the infants with acute diarrhea were between 4 months to 1 year 195 [78%]. Forty two [17%] were exclusively breastfed while 78 [31%] exclusively bottle-fed. Fifty five [22%] had both breast feeding as well as bottle feeding. A large number of mothers 112 [44.8%] gave the reason of insufficient milk for the baby. Majority of the infants with acute diarrhea episodes were between 8 and 12 months when either breast milk is being replaced by bottle milk or improper weaning practices are being used. A large number of infants with acute diarrhea were either mixed fed or bottle fed. Because of increased mixed and bottle feeding there is high incidence of diarrhea in our community

Managment of post burn contracture of neck

It is a prospective analytical study. 43 patients admitted during JAN 2001 to DEC 2002 who presented with severe functional [25 patients] of cosmetic impairment [27 patients]. We selected 4 different options to manage the patients. [1] Release of/or excision + thigh grafts [2] Release of/or excision + wolfm [3]Thick therish + local flap [4] Musculocutaneous flap. Out of 43 patients 27 were females and 16 were male and the age varies from 4-45 years. Out of 28 patients a [1] 25 given satisfactory and excellent results, and 5 out of Six patients a [2] and 4 out of 5 with [3] gave excellent results. To evaluate the outcome of different options for the management of PBNC we are presenting our 2 years experience of PBNC Neck in 43 patients from January 2001 to December 2002 who were admitted through surgical outdoor of Teaching Hospitals of PMC, Faisalabad. In our set up most of the patients presented with severe functional [25 patients] and cosmetic impairments [27 patients out of 43] because of late presentation, delayed treatment, poverty and lack of proper medical facilities. We selected 4 different options to manage these patients accordingly i.e. [1] release or and excision of contracture and thick split skin graft, [2] release or and excision of contracture and full thickness skin graft, [3] thick split skin graft and local flap, [4] musculocutaneous flap, giving satisfactory to excellent results in 25 out of 28 patients, 5 out of 6 patients and 4 out of 5 patients respectively. Thick split skin grafting after release or/and excision of contracture with strict advice of wearing cervical neck collar remained our mainstay of treatment because it was one of the best practical options to deal with severe PBC Neck while other options being reserved for difficult and recurrent cases. Thick split skin grafting is an easy, cost effective, reliable and compliant to the patient. Furthermore thick split skin grafting is a simple procedure whi ch may be carried out by any general surgeon with reserve for referred for the difficult cases

Clinical and ultrasound correlation in first trimester abortion

To compare the diagnostic accuracy of clinical and ultrasound evaluation in first trimester abortions and assess the impact of ultrasound on patient management. Non-interventional comparative study conducted on 100 patients, selected on simple random basis from Gynae Outpatient Department. Department of Obstetrics and Gynaecology, Allama Iqbal Medical College and Jinnah Hospital, Lahore Materials and All the patients with symptoms of first trimester abortion were evaluated clinically and by ultrasound to formulate a diagnostic and management plan. Both Modalities were compared for diagnostic accuracy, positive and negative correlation in different types of abortions. 34% of the patients were at 10 weeks of gestation, 28% were unsure of dates, 17% were at 11 weeks of gestation, 13% of the patients were at 9 weeks of gestation, 5% were at 6 weeks while 3% were at 7 weeks of gestation. Clinical diagnosis was made in 42% of cases; in 39% definite diagnosis was possible with combined clinical and ultrasound evaluation while in 19% no diagnosis was established with either modality In 89% of the cases the diagnosis was made on single ultrasound scan, while 11% required a repeat scan. Correlation between two modalities was present in 81% of the cases. Positive correlation was obtained in 59% and negative correlation was seen in 22%. The correlation was not possible in 19% of cases. Ultrasonography is an essential tool in diagnosis of early pregnancy failures especially where clinical evaluation is inconclusive

Vaginal birth after caesarean section [VBAC]

Aims and To find out the rate of vaginal delivery after one caesarean section Study Design: Non-interventional, descriptive study Study Setting: Department of Obstetrics and Gynaecology, Allama Iqbal Medical College and Jinnah Hospital, Lahore. Materials and A trial of vaginal delivery was carried out on 100 patients with previous one caesarean section. Selection criteria were subjects with normal pregnancy, adequate maternal pelvic dimensions vertex presentation and spontaneous onset of labour with previous one uncomplicated LSCS. Patients with classical caesarean section, medical complications, multiple pregnancy, IUGR, placenta previa and extensive myomectomy were excluded from the study. Informed consent was taken from all patients; trail of scar was given with vigilance. Maternal and fetal monitoring was carried out with facility of operation theatre, anaesthesia and paediatrician. Majority of patients was between 20-24 years of age. 58% of the patients were primipara. Successful vaginal delivery was achieved in 72% and rate of repeat section was 28%. Leading indications for repeat section were failure to progress, [50%], fetal distress [28.5%] and scar tenderness [21.43%]. No maternal and fetal mortality occurred. Trial of scar after one LSCS should be encouraged with vigilant monitoring provided no obstetric contraindication exists

Modified Giemsa staining for rapid diagnosis of malaria infection

To develop and evaluate a rapid method for the diagnosis of malaria infection by microscopy of stained blood films. Subjects and Blood specimens were collected from randomly selected confirmed malaria cases [n = 75] and suspected malaria cases [n = 175]. The microscopy was done on each set of blood films stained by modified and the standard Giemsa staining methods. All the 75 previously diagnosed malaria cases were confirmed by the microscopy of blood films stained by both methods. Forty-nine [28%] of the 175 cases suspected for malaria infection showed malarial parasites on microscopy of blood films stained by both methods. However, due to homogeneous staining and clearer background of the blood films it was possible to determine the parasite species in 65% of the cases on microscopy of the thick films stained with the modified method compared to only 20% with the standard method. Further, the turnaround time for reporting the microscopy test result was 15-20 and 45-50 min with modified and standard staining methods, respectively. Our data showed that performance of the modified staining method in detecting malarial parasites was comparable to that of the standard staining method. Moreover, the modified staining method was rapid, easy to use, and reliable

Temperament [Mizaj] and blood groups of donors and recipients and their importance in blood transfusion

Blood groups are checked before transfusion to avoid agglutination caused due to the interaction of agglutinogen present in the red cells [khilt-e-dam] of donor and agglutinin present in the plasma of recipient or vice versa. On the basis of agglutinogens present in the red cells, human beings are divided into groups, A, B, AB and O. Unani medical science is based on the concept of four Akhlat [Humours] which remain intermixed in the blood as their name suggests. Each dominating humour in the blood constitutes a particular temperament and accordingly all individuals are divided into four humoural temperaments, sanguine, phlegmatic, choleric and melancholic. Concluded, blood of all persons are not similar but differ according to temperaments. Observations revealed that in several recipients even after transfusion of compatible blood, jaundice occurred due to haemolysis. This is indicative of incompatibility of temperament of recipient and donor. In this paper it is emphasised that besides blood groups, temperaments of donors and recipients must also be checked before transfusion and be similar, to avoid ill-effects

Acute myocardial infarction: In hospital mortality of consecutive 275 parents

OBJECTIVE: To highlight the mortality in various groups of acute myocardial infarction. DESIGN: Retrospective study. SETTING: Coronary care Unit DHQ Hospital Faisalabad. PERIOD: January 1995 to December 1995. PATIENTS AND METHODS: Total number of patients were 275, males 223, Female 52. Mean age was 54.85 +/- 13.57 years, mean age of males was 53.52 +/- 13.61 and for females 60.55 +/- 11.91 years. Presented with typical chest pain of Ischaemic heart disease for more than 30 minutes. Diagnosed by history, physical examination, 12 lead electrocardiography and rise of cardiac enzymes. From the 275 patients, 102 were from inferior wall, 109 from anteroseptal and 64 were from extensive anterior wall myocardial infarction. Forty two [15%] patients expired during hospital stay, 13[12.74%], 14[12.80%] and 15[23.40%] patients expired from inferior, anteroseptal and extensive anterior wall myocardial infarction respectively. CONCLUSIONS: Mortality associated with acute anteroseptal MI and extensive anterior wall myocardial infarction was significantly higher, so these patients be monitored and managed more aggressively

Complications of the AO external fixator in open type III tibial fractures

Thirty one cases were included in this prospective experimental study to pick up the pit falls of A.O tubular external fixator application in type-III open tibial fractures in the department of Orthopaedics, Mayo hospital, Lahore during 1993-1994. Out of these 9 [28.8%] had type III-A, 21 [67.2%] had type III-B and only 1 [4%] had type III-C open fractures. 53.8% of the cases presented within six hours of the injury, 26.4% within 24 hours and the remaining 19.8% cases presented late. Biplaner unilateral fixator was applied in 19 cases [61.6%], uniplaner unilateral double bar in 11 cases [35.2%] and uniplaner unilateral single bar fixator in 1 [3.2%] case. Duration of application of external fixation ranged from 9 days to 10 months [average 3 months]. The patients were explained about the possible complications of external fixation and asked them to report before their routine follow up visit if any complication arises. We had 43 minor and 33 major complications among which some were inherent to the severity of the injury and not solely due to the application of external fixator. Minor complications in descending order of frequency were pin tract infection [41.6%], malalignment [28.8%], pin loosening [19.2%], transient ankle joint stiffness [16%], acute localized osteoporosis and algodystrophy [9.6%], oedema [6.4%], malunion [6.4%], wrong placement of pins [6.4%] and pin bending [3.2%]. Major complications in descending order of frequency were wound infection [35.2%], delayed union [32%], non union [9.8%], amputations [6.4%]. Other major complications were vascular injury, secondary cellulitis, chronic osteomylitis, foot drop, compartment syndrome, shortening and mortality 3.2% each