role of allopurinol and angiotensin receptor blockers in serum uric acid reduction in gouty and hypertensive patients

To evaluate the effect of Allopurinol in combination with angiotensin receptor blockers on hyperuricemia in gouty and hypertensive patients. Randomized, open label, prospective, comparative trial. This study was conducted in the Department of Pharmacology and Therapeutics; BMSI/JPMC, Karachi from April 2010 to November 2010. 80 hypertensive and hyperuricemic patients were enrolled from OPD and medical wards and were divided into two groups. Group DR-1[40 Patients] were given allopurinol 300mg plus candisartan 8mg daily and group DR-2 [40 patients] were given allopurinol 200mg Plus Losartan 50mg, daily four 4 months. 6 patients were unable to continue the follow-up 3 patients in each group. DR-1 combination therapy decreased serum uric acid level from 8.92 +/- 0.19mg/dl at day 0 to 5.33 +/- 0.11 mg/dl at day120. DR-2 group also showed a significant reduction in serum uric acid level from 9.14 +/- 0.19mg/dl at day 0 to 4.74 +/- 0.09mg/dl at day 120 [p<0.001]. When effects were compared in both treatment groups, the effect of group 2 regimens on serum uric acid level was more marked due to Losartan combination which also have uricosuric effects than in group 1 regimen, with average percentage decrease in serum uric acid - 40.35% in group DR-1 and -48.24% in group DR-2. The allopurinol 200mg and Losartan 50mg is more effective than allopurinol 300mg+ candesartan 8mg, to decrease serum uric acid level and group DR-2 drugs combination useful in those hyperuricemic patients who cannot tolerate high doses of uric acid lowering drugschromatogram obtained indicated the quantity of pesticide residues. Milk samples and serum samples were analyzed using HPLC technique. Pesticides such as malathion, permethrin, deltamethrin and Polytrin-C were detected in different concentrations. The levels were significantly higher than the maximum residual limit. It is concluded that the presence of pesticides in the human body is a major concern in the development of various ailments because of possible immunotoxic, mutagenic and carcinogenic potential of pesticides

Role of polymorphonuclear leukocyte in diabetic foot

To study the etiopathogenesis of foot injuries in patients of uncontrolled diabetes mellitus. Retrospective study of tissue samples received from diabetic patients clinically diagnosed as gangrene. This study was conducted in the Department of Ophthalmology, JPMC, Karachi from July 2009 to June 2011. 150 cases of uncontrolled diabetes mellitus with wounds of foot were included. 150 cases of known diabetics with peripheral neuropathy and history of loss of sensation were subjected to follow up of 2 years follow up was done on the cases. As a first step blood sugar was brought under control and broad spectrum antibiotic was given. Wound debriment was done in all cases. The specimens were subjected to H/E and Gram's staining. In H/E, liquifactive necrosis, polymorphonuclear leukocyte, mononuclear cell infiltrate, few lymphocyte plasma cells and fibroblasts were seen. New blood capillaries were few or absent. both gram positive and gram negative organisms were isolated. 79% were gram positive and 21% were gram negative. Hyperglycemia causes relative anoxia in the micro environment of the tissue due to damage of peripheral neurons. Lack of adequate circulation leads to ischemia, which is super added by infection of the subcutaneous tissue. The resultant effect is liquifactive necrosis and complete lysis of tissue. Removal of such putrefied tissue is mandatory to stop further damage to the tissue

Value of D-dimers assay in diagnosis of pulmonnary Embolism

To determine the value of D-Dimers assay in the diagnosis of Pulmonary Embolism [PE] at Armed Forces Institute of Pathology, Rawalpindi, Pakistan from January to November 2000. Forty three consecutive patients clinically suspected of suffering from pulmonary embolism and referred to Armed Forces Institute of Pathology for Ventilation-Perfusion scan of lungs were inducted in the study. A detailed history was taken and clinical examination was performed. All patients were then subjected to Perfusion and/or Ventilation scan, which was taken as the standard for the diagnosis of PE. Blood samples were collected from all patients in trisodium citrate. Platelet poor plasma obtained from the samples was tested for D-Dimers semi-quantitatively using latex agglutination method. Out of 43 patients 14[32.6%] had completely normal ventilation-perfusion scan hence the diagnosis of PE was excluded. In 6 [13.9%] patients the results were considered indeterminate. Abnormalities suggestive of pulmonary embolism were detected in 23 [53.5%] patients. D-Dimers were less than the cut off value of 500 ng/ml in 19 [44.2%] patients, whereas in 24 [55.8%] the levels were more than 500 ng/ml. When compared with the results of ventilation-perfusion scan the sensitivity of D-Dimers was 91.3% and specificity was 100%. Positive predictive value of the test was 100% whereas negative predictive value was 87.5%. D-Dimers assay combined with high clinical evidence is a cost effective, readily available test which can safely exclude the diagnosis of pulmonary embolism in majority of the cases