Pattern of combat casualties in war against terror among soldiers wearing body armor at CMH Peshawar

To determine the pattern of gun shot and explosive injuries in soldiers equipped with body armor and helmet. Descriptive study Combined Military Hospital Peshawar, from 1st June 2008 to 30th May 2010. All combat casualties received in 'Emergency reception' of Combined Military Hospital, Peshawar were included. Data was taken from the patient's medical charts and by personal evaluation and entered in a proforma. The variables used were age, use of helmet, cause of the injury, site of injury, Haemo-dynamic Status, conscious level, intensive care treatment duration, total hospital stay, return to work and mortality. A total of 516 combat casualties were received in 'Emergency reception' of Combined Military Hospital, Peshawar, Pakistan. All patients were males with a mean age of 31.22 +/- 7.858 years. Sixty nine percent [356] cases had injury due to splinters from Improvised Explosive Devices [IED] and 31% [160] had gunshot wounds. Seventy five percent [391] patients were haemodynamically stable while 24.2% [125] were unstable. Penetrating Extremity Injury [PEI] was the commonest injury [71.9%] followed by Penetrating Injury of Face or Neck [PNFI] in 12.0% [62], Penetrating Torso Injury [PTI] in 8.9% [46] and Penetrating Injury of Cranial Vault [PCI] in 7.2% [37]. Overall mortality was 64 [12.4%] IEDs have become the weapon of choice in gorilla warfare by the terrorists in addition to guns, bombs, and anti-personnel mines. The use of body armor has decreased the mortality but the morbidity in terms of limb injuries has increased

Influence of lead on growth and nutrient accumulation in canola (Brassica napus L.) cultivars.

Canola (Brassica napus L.) is commonly used as a hyper-accumulator for phytoextraction of heavy metals from soil and water. Like many other heavy metals, lead (Pb) contaminates soil, water and air and thus it is a great problem. This study was conducted to investigate toxic effects of Pb on growth and nutrient uptake in four canola cultivars. Each of four cultivars of canola (Con-II, Con-III, Legend and Shiralee) was subjected to four levels of Pb (0, 30, 60 and 90 mg Pb kg-1 of soil) from lead chloride [PbCl2]. Due to Pb toxicity, plant growth was adversely affected and relatively a severe reduction in root biomass (45.7%) was recorded. The Pb accumulation increased both in shoot and root, the highest being in root. The uptake of different nutrients, i.e., N, P, K, Ca, Mg, Zn, Cu and Mn was reduced (38.4, 32.8, 33.1, 49.6, 7.78, 52.0, 42.6 and 45.9%, respectively) in the shoots and that of N, Fe, Zn, and Cu in the roots (48.5, 33.2, 24.3 and 44.8%, respectively) of all canola cultivars. The root K, P, Zn and Mn and shoot P, Mg and Fe contents were less affected, the concentration of Pb, Ca and Mg in roots of all cultivars. Among canola cultivars Con-II and Con- III performed better than Legend and Shiralee in terms of growth (26.03%) and nutrient accumulation. Overall, plant growth and nutrient accumulation in the canola cultivars was hampered due to the presence of Pb.

Therapeutic effects of ciprofloxacin on the pharmacokinetics of carbamazepine in healthy adult male volunteers

Carbamazepine is a [CYP1A2 and CYP3A4 enzyme inducer] medicine which is used by epileptic patients for a long time. During the course of therapy, patients are generally caught by other diseases like urinary tract infections, upper respiratory tract infection, skin and soft tissue infection etc. To cure them, physicians commonly prescribe fluoroquinolones like Ciprofloxacin [CYP1A2 inhibitor] along with Carbamazepine [CBZ]. Interactions may result without recognition which may lead to unforeseen toxicity, untoward effects or even therapeutic failure. Therefore, studies were conducted to investigate the effect of Ciprofloxacin on the pharmacokinetics of Carbamazepine in healthy adult male volunteers. The main objective of this study was to generate new knowledge regarding CBZ and Ciprofloxacin interaction for physicians and research workers dealing with these medicines. Eight healthy adult male volunteers were selected to assess the effect of ciprofloxacin on the pharmacokinetics of Carbamazepine. After overnight fast the selected male volunteers were given CBZ orally. Blood samples were drawn at different time intervals after medication. Then the same volunteers were given CBZ along with ciprofloxacin. Blood samples were again drawn at the same time intervals as done previously. Plasma was separated from the blood samples. Concentration of CBZ in the plasma samples was determined by using HPLC technique. Results of the present study indicated that ciprofloxacin significantly increased the plasma concentration of CBZ when given concurrently to the healthy adult male volunteers. Ciprofloxacin increased C[max], AUC and t [1/2] while it decreased the CL and Vd of CBZ when administered concurrently to the adult volunteers. Change in pharmacokinetic parameters was due to slow metabolism or elimination of CBZ when given concurrently with ciprofloxacin to the adult volunteers. This is probably due to the inhibition of CYP3A4 isoenzyme by ciprofloxacin which is responsible for metabolism of CBZ. Ciprofloxacin increased the plasma concentration of CBZ so dose adjustment as well as drug monitoring of CBZ is required when both the drugs are given concurrently. The knowledge regarding interaction between ciprofloxacin and CBZ would be helpful for the pharmaceutical industries, physicians and a blessing for the patients

Lumbar Discitis; prevalence and management after lumbar disc surgery

To study the occurrence of discitis after lumber disc surgery and its management. Observational study. Department of Neurosurgery QAMC/ BVH Bahawalpur. April 2006 to May 2009. This study includes 400 patients who underwent standard laminectomy procedure for disc excision. Patients presenting with backache and leg pain were thoroughly investigated. For the confirmation of herniated disc MRI or lumber route myelography were performed. All patients underwent either fenestration, hemilaminectomy or complete laminectomy for disc excision. Patients were followed for two weeks to three years after surgery. The diagnosis of discitis was on clinical grounds but this condition was confirmed by heamatological examination i.e. ESR, complete blood count, C-reactive protein and radiological examination i.e. MRI, CT and plain X-rays. Eighteen [4.5%] patients out of four hundred patients developed dicitis after surgery. Initially all patients were managed conservatively i-e. with complete bed rest and antibiotics .Fifteen [83.33%] patients responded well to this treatment but three [16.67%] patients did not improve and were subjected to surgery. Discitis after lumber disc surgery is rare. Discitis should be considered in any patient who develops severe backacheleg pain and muscles spasms after one to four weeks of lumber disc surgery especially accompanied with fever, raised ESR and elevated C-reactive proteins. A definitive diagnosis is essential for appropriate therapy of discitis

Validity of nalidixic acid screening in fluoroquinolone-resistant typhoid salmonellae

To validate the screening of low-level fluoroquinolone resistance in typhoid salmonellae by using nalidixic acid [30mg] disk providing an acceptable zone of inhibition. Quasi-experimental study. The Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan from July 2002 to June 2003. Antimicrobial susceptibility of 225 clinical isolates of S. typhi [n=126] and S. paratyphi A [n=99] against nalidixic acid and ciprofloxacin was determined by the modified Kirby-Bauer disk diffusion and agar dilution techniques of NCCLS. The relationship between the zone sizes and the MICs of the two quinolones was plotted in the form of scattergrams and nalidixic acid MICs and zone of inhibition sizes were correlated with those of ciprofloxacin by regression analysis. One hundred and ninety-five isolates were nalidixic acid-susceptible [MIC <16 Mug/mL] and 30 were nalidixic acid-resistant [MIC >32 Mug/mL]. All the nalidixic acid-susceptible isolates had ciprofloxacin MIC of <0.064 Mug/mL. Among the nalidixic acid-resistant isolates 20 had ciprofloxacin MIC > 0.125 Mug/mL and 10 had ciprofloxacin MIC < 0.03- 0.064 Mug/mL. The diameter of inhibition zone around a 30 mg nalidixic acid disk of nalidixic acid-resistant isolates was <13 mm [range 6-16 mm, mean 10.3 mm + SD 3.5 mm], while among nalidixic acid-susceptible isolates it ranged from 14 to 30 mm [mean 23.8 mm + SD 2.2 mm]. The diameter of inhibition zone around a 5mg ciprofloxacin disk of nalidixic acidresistant isolates ranged from 26 to 35 mm [mean 29.8 mm + SD 3.1 mm], while in nalidixic acid-susceptible isolates it ranged from 32 to 42 mm [mean 36.6 mm + SD 1.9 mm]. With ciprofloxacin MIC Z WITH CARON0.125 mg/mL taken as a breakpoint, a zone of <33mm around a 5mg ciprofloxacin disk to detect low susceptibility strains had a sensitivity of 100% and a specificity of 82%. Screening for nalidixic acid resistance [inhibition zone diameter of <13 mm] in isolates with ciprofloxacin MIC Z WITH CARON 0.125 mg/mL using a 30 mg nalidixic acid disk yielded a sensitivity of 100% and a specificity of 95%. Screening for nalidixic acid resistance with a 30mg nalidixic acid disk is a reliable and cost-effective method for detection of low-level fluoroquinolone resistance in typhoid salmonellae

Glucose 6- Phosphate dehydrogenase deficiency associated with neonatal jaundice

Glucose-6 Phosphate Dehydrogenase [G-6PD] deficiency is the commonest enzymopathy in human beings. It is transmitted as X-linked recessive disorder. Acute hemolytic crisis is the most common presentation of G-6PD deficiency, but in neonatal period it usually presents as jaundice. To find out the proportion of G-6PD deficiency cases in patients with neonatal pathological hyperbilirubinemia and study the clinical course of disease. The study was conducted at the neonatal unit of The Children's Hospital and Institute of Child Health, Lahore from January 2000 - April 2001. One hundred jaundiced neonates with unconjugated hyperbilirubinemia in pathologic range [peak serum bilirubin more than 12 mg/dl in full term and more than 15 mg/dl in preterm neonates] were included. Screening for G-6PD deficiency was done by dye decolorization test, which is semi quantitative, visual colorimetric assay. Out of 100 study cases, 62% were male and 38% were female. 10% of the cases were found to be G-6PD deficient; all were male. One case of G-6PD deficiency developed jaundice during first 24 hrs of life, 8 cases between 1 -7 days and one case after 7 days of life. Peak serum bilirubin levels in neonates with G-6PD deficiency were < 20 mg/dl in 2 cases, 20-30 mg/dl in 6 cases and >30 mg/dl in 2 cases. Evidence of hemolysis [reticulocyte count >5% and Hb% <12.5 gm%] was present in two neonates. In the G-6PD deficiency group, 40% of the cases underwent exchange transfusion compared to 26.6% of cases in the G-6PD normal group. One neonate with G-6PD deficiency had kernicterus at admission. Two neonates with G-6PD deficiency died, due to culture proven sepsis. G-6PD assay should be included in all jaundiced neonates with unexplained neonatal unconjugated pathological hyperbilirubinemia. G-6PD deficiency associated neonatal jaundice is not only hemolytic in origin, but is also related to the impairment of hepatic bilirubin conjugation and excretion

Brain abscess; clinical presentation

A study of 50 cases of brain abscess is presented, emphasis being on clinical presentation and early diagnosis. A comparison is made with other studies and recommendations are made for early diagnosis

Microvascular decompression for trigeminal neuralgia

A study of ten cases of microvascular decompression for trigeminal Neuralgia carried out at Bahawal Victoria Hospital, Bahawalpur is presented. Results are compared with other similar series and conclusions drawn

Transcutaneous bilirubinometry: clinical application

Simultaneous estimations of serum and transcutaneous bilirubin were done in 105 healthy, full term, jaundiced newborns. A good correlation was found between the transcutaneous and serum bilirubin values with coefficient of correlation 0.774. The observed sensitivity was 90%, specificity 78% and positive predictive value 64% at mean serum bilirubin concentration of 9.92 mg/dl. Two action levels at transcutaneous bilirubin values 15 and 18 were also generated that correlated with low and high serum bilirubin values; they can therefore be used for screening of jaundiced full term babies. This study indicates that the transcutaneous bilirubin meter is useful for screening of jaundiced neonates