Assessment of Panoramic Radiographic Variables as Predictors of Inferior Alveolar Nerve Injury During Third Molar Extraction

ABSTRACT Objective: To assess the role of radiological predictive markers on orthopantomogram for inferior alveolar nerve (IAN) injury related to the removal of mandibular third molar surgery and the occurrence of post-operative IAN paresthesia. Material and Methods: This prospective observational study was conducted on 60 patients (aged 17-35 years) indicated for extraction and showed one or more of the seven previously known panoramic radiographic risk signs of IAN injury. Variables such as age, sex, tooth angulation, and relationship with the inferior alveolar canal (IAC) were assessed to see their outcome on IAN injury. Data analysis is presented through tables and descriptive methods. Results: Among patients, 26 were male and 34 were female, with a mean age of 26.17 years. Out of seven radiological predictive markers, only six were found in this study, whereas one marker, viz. interruption of white line of the canal was not found. After surgical removal of the lower third molar, only two patients with radiographic signs showing the deflection of roots and darkening of roots continued with sensory deficit 5 weeks post-operatively. Conclusion: The risk of inferior alveolar nerve injury during lower third molar surgery is very low, even in patients with radiological predictive markers.

Basilar artery dolichoectasia an unusual and rare cause of secondary trigeminal neuralgia: a clinical report / Dolicoectasia da artéria basilar uma causa incomum e rara de neuralgia do trigêmeo secundária: um relato clínico

Objective: Patients with Trigeminal Neuralgia often consults a dentist for relief of their symptoms as the pain seems to be arising from teeth and allied oral structures. Basilar artery Dolichoectasia is an unusual and very rare cause of secondary Trigeminal Neuralgia as it compresses the Trigeminal nerve Root Entry Zone. Case reports: We report three cases of Trigeminal Neuralgia caused by Basilar artery Dolichoectasia compression. The corneal reflex was found absent in all three of the cases along with mild neurological deficits in one case. Multiplanar T1/T2W images through the brain disclosed an aberrant, cirsoid (S-shaped) and torturous Dolichoectasia of basilar artery offending the Trigeminal nerve Root Entry Zone. Discussion:Based on these findings we propose a protocol for general dentist for diagnosis of patients with trigeminal neuralgia and timely exclusion of secondary intracranial causes. Conclusion: General dentists and oral surgeons ought to consider this diagnosis in patients presenting with chronic facial pain especially pain mimicking neuralgia with loss of corneal reflex or other neurosensory deficit on the face along with nighttime pain episodes. Timely and accurate diagnosis and prompt referral to a concerned specialist can have an enormous impact on patient survival rate in such cases (AU)

Objetivo: Pacientes com Neuralgia do Trigêmeo frequentemente consultam um dentista para alívio de seus sintomas visto que a dor parece surgir dos dentes e estruturas orais relacionadas. A Dolicoectasia da artéria basilar é uma causa incomum e muito rara de Neuralgia do Trigêmeo secundária, pois comprime a zona de entrada da raiz do nervo trigêmeo. Relatos de casos: Relatamos três casos de Neuralgia do Trigêmeo causada por compressão por Dolicoectasia da artéria basilar. O reflexo da córnea se encontrava ausente em todos os três casos, juntamente com leves déficits neurológicos em um caso. Imagens multiplanares T1/T2W através do cérebro revelaram uma Dolicoectasia cirsóide (em forma de S) anômala e tortuosa da artéria basilar que atingiu a zona de entrada da raiz do nervo trigêmeo. Discussão: Com base nesses achados, propomos para o dentista clínico-geral um protocolo para diagnóstico de pacientes com Neuralgia do Trigêmeo e exclusão oportuna de causas intracranianas secundárias. Conclusão: Os dentistas clínicos-gerais e cirurgiões orais devem considerar este diagnóstico em pacientes que apresentam dor facial crônica, especialmente dor que mimetiza neuralgia com perda do reflexo da córnea ou outro déficit neurossensorial na face junto com episódios de dor noturna. O diagnóstico oportuno e preciso e o encaminhamento imediato a um especialista em questão podem ter um enorme impacto na taxa de sobrevida do paciente em tais casos (AU)

Cardiovascular risk score in Rheumatoid Arthritis

Objective: To determine the 10-year Cardiovascular risk score with QRISK-2 and Framingham risk calculators in Rheumatoid Arthritis and Non Rheumatoid Arthritis subjects and asses the usefulness of QRISK-2 and Framingham calculators in both groups

Methods: During the study 106 RA and 106 Non RA patients age and sex matched participants were enrolled from outpatient department. Demographic data and questions regarding other study parameters were noted. After 14 hours of fasting 5 ml of venous blood was drawn for Cholesterol and HDL levels, laboratory tests were performed on COBAS c III [ROCHE]. QRISK-2 and Framingham risk calculators were used to get individual 10-year CVD risk score

Results: In this study the mean age of RA group was [45.1 +/- 9.5] for Non RA group [43.7 +/- 8.2], with female gender as common. The mean predicted 10-year score with QRISK-2 calculator in RA group [14.2 +/- 17.1%] and Non RA group was [13.2 +/- 19.0%] with [p-value 0.122]. The 10-year score with Framingham risk score in RA group was [12.9 +/- 10.4%] and Non RA group was [8.9 +/- 8.7%] with [p-value 0.001]. In RA group QRISK-2 [24.5%] and FRS [31.1%] cases with predicted score were in higher risk category. The maximum agreement scores between both calculators was observed in both groups [Kappa=0.618 RA Group; Kappa=0.671 Non RA Group]

Conclusion: QRISK-2 calculator is more appropriate as it takes RA, ethnicity, CKD, and Atrial fibrillation as factors in risk assessment score

Pattern of maxillofacial trauma; a five years study of 3360 cases

Objectives: to determine the pattern of maxillofacial injuries in the local population

Study Design: retrospective clinical and epidemiologic study

Period: January 2009 to December 2013

Setting: tertiary care hospital

Methods: 3360 patients reported for maxillofacial injuries. A number of parameters, including age, gender, facial bone fractures, laceration on face, injury of trigeminal and facial nerve branches, sensory and motor deficit in relation to soft tissue trauma and bone fracture, were evaluated

Results: males were dominant and male to female ratio was 6.3:1. Patients of 3[rd] decade were more and constitute 63.2%. Road traffic accident was the common etiological factor [78%]. Mandible fracture was dominant and it was present in 1591 patients [47.7%]. Soft tissue laceration frequency was high in cheek region and was 13.7%. Sensory deficit [Trigeminal nerve injury] was present in 1167 patients [34.7%]. Motor deficit [Facial nerve injury] was present in 249 patients [6.83%]. Nerve injuries in relation to mandible fracture were common

Conclusion: road traffic accident was the most common etiological factor and mandible fracture was common. Trigeminal nerve injuries were common and frequency of nerve injuries was high in relation to mandible fracture

Seasonal variation in stroke in a teaching hospital of Khyber Pakhtunkhwa

Objective: to determine seasonal variation in the occurrence of stroke and its subtypes [ischemic stroke and hemorrhagic stroke] during summer and winter and to observe the frequency of common risk factors for stroke

Methodology: the present descriptive study was conducted in the Department of Medicine, MTI Lady Reading Hospital Peshawar, Khyber Pakhtunkhwa, Pakistan, over a period of one year from 1st January 2014 to 31st December 2014. A total of 321 patients of any age and either gender were included. The diagnosis was established based on history, clinical examination and supplemented by CT scan of brain

Results: in winter 58.56% of patients and in summer 41.48% of patients were presented. Ischemic stroke was present in 66.04% patients while hemorrhagic stroke in 33.95% patients. Males had more strokes as compared to females [60.75% Vs. 39.25%]. In males highest number of strokes was found in 60-69 age groups whereas in females it was in 50-59 age groups. In winter the strokes increased in all age groups comparative to summer. Hypertension [34.26%] was the highest risk factor for stroke

Conclusion: stroke showed seasonal variation. Winter season was associated with increased frequency of stroke and its subtype of hemorrhagic stroke. There was variation of gender, season and stroke types in different age groups. Hypertension was found to be the highest risk factor

Age and gender specific stroke risk factors in a teaching hospital in Khyber Pakhtunkhwa

To determine age and gender specific stroke risk factors in a teaching hospital in Khyber Pakhtunkhwa. A hospital based descriptive study was performed in medical units of Lady Reading Hospital, Peshawar, from July 2011 to March 2012. A total of 100 patients of 18 years and above and of both genders were included. Study patients with first-ever acute stroke were divided into three groups; Group A young adult [<40 years], Group B, middle-aged [40-60 years], and Group C elderly [>60 years]. In these 03 groups, stroke risk factors were compared. Patients were assessed for hypertension, ischemic heart disease, hyperlipidemia, atrial fibrillation, diabetes mellitus and smoking. SPSS version 18.0 was used for statistical analysis. A sample of 100 patients was taken comprising 68% males and 32% females. Study patients had a mean age of 63.44 +/- 13.849. There were 08 patients in Group A, 29 in Group B, and 63 patients in Group C. Overall, hy-pertension was found in [62%], followed by smoking [47%], coronary artery disease [33%], diabetes mellitus [28%], hyperlipidemia [24%] and atrial fibrillation [21%]. Pattern of distribution of stroke risk factors is age and gender specific. Majority were found to have hypertension. Hypertension, diabetes mellitus, atrial fibrillation and hyperlipidemia differ significantly among the 03 age groups. Smoking was significantly different in males and females

Frequency of thyroid dysfunction during TFT in interferon and ribavirin therapy in patients with chronic hepatitis C

Objective: To determine the frequency of thyroid dysfunction among patients of chronic hepatitis C [HCV] infection receiving combination of interferon-alpha and ribavirin therapy

Study Design: Cross-sectional study

Place and Duration of Study: Department of Medicine, PNS Shifa Naval Hospital Karachi, from September 2012 to March 2013 over a period of six months

Patients and Methods: In this study, 170 diagnosed patients of chronic HCV [confirmed by anti-HCV and HCV RNA-positive] presenting to medical OPD with normal thyroid functions were recruited. All patients fulfilled inclusion and exclusion criteria. They were prescribed IFN-alpha 2b [3 million units subcutaneously 3 days a week] and oral preparation of antiviral drug ribavirin [800 to 1200 mg daily in divided doses according to weight]. At the end of 12 weeks of combination antiviral therapy, their thyroid profile was worked up. Serum TSH, free T4 and T3 levels were determined by chemiluminescence technique in chemical pathology lab of the hospital. Statistical analysis was done on SPSS 17

Results: Out of 170 patients, 83 [48.82%] were females and 87 [51.18%] were males with the age ranging from 22-46 years [mean +/- SD: 33.86 +/- 5.32]. After 12 weeks of antiviral therapy, thyroid functions were normal in 156/170 [91.76%] patients, whereas in 14/170 [8.24%] cases thyroid dysfunction was observed. Out of those patients having thyroid dysfunction, 10/14 [71.42%] were hypothyroid whereas 4/14 [28.58%] had hyperthyroidism

Conclusion: Managing patients of chronic HCV with combination antiviral therapy comprising IFN-alpha 2b and ribavirin can cause thyroid dysfunction. These patients should be monitored before and during treatment to avoid complications and poor compliance

Ashphyxial deaths: a retrospective study conducted at tertiary care hospital of Sindh

Objective: To study frequency of patterns and manners of asphyxial deaths autopsied at LiaquatUniversity Hospital

Study Design: Retrospective study

Place and Duration of Study: This study was conducted at the Department of Forensic Medicine and Office of Police Surgeon-Medico legal section, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad from January 2010 to December2014

Materials and Methods: Medicolegal files of autopsy were studied retrospectively. 135 files were finalized after scrutiny of 2033 autopsies. Causes, types and patterns of asphyxia were noted. Essential data was noted in a pre-designed proforma for study purpose. Data variables were analyzed on Microsoft excel and Statistix8.1 using appropriate statistical tests. P value of

Results: One hundred and thirty five cases of asphyxial deaths [out of 2033 autopsies] were studied. Age [mean +/- SD] was noted as 49.7 +/- 8.9 years. Of 135 cases, 65.9% [n=89] were male and 34.07% [n=46] were female [X[2]=112.5 p=0.0001]. 28.1% and 8.14% of cases showed ligature and manual strangulation respectively. Hanging, drowning, traumatic asphyxia and throttling were noted in 42.21%, 12.59%, 5.18% and 3.7% respectively. Suicidal deaths in 29.6%, homicidal in 57.03% and accidental asphyxial deaths were observed in 13.33%

Conclusion: Homicidal and suicidal deaths of hanging and strangulation seemed to be the major contributing causes of asphyxial deaths

Various Risk Factors in Stroke Patients at Military Hospital Rawalpindi

To determine the frequency of various risk factors of stroke. A descriptive study. Military Hospital Rawalpindi, from January 2011 to January 2012. Three hundred diagnosed patients with stroke were probed into for different risk factors, based on history, clinical examination and laboratory methods. Nineteen percent were female and eighty one percent were male patients. The mean age of the patients was 59 years. Minimum age was 38 years and maximum age was 90 years in the patients under study. Physical inactivity was the most common risk factor [78%] followed by hypertension [72%], obesity [67%], type 2 diabetes mellitus [42%], smoking [42%] etc. Physical inactivity is the most common risk factor followed by hypertension which contribute to the pathology of stroke

Diabetes mellitus prediction; Serum lipids, ALT and fasting blood glucose: using serum lipids and ALT

The rapid change in lifestyles and dietary has led to a pandemic of diabetes mellitus. The diagnosis of diabetes mellitus sometimes requires 2 hr OGTT sampling. Recent evidence has shown that there are lipid related abnormalities associated with diabetes mellitus, so a consideration comes in fortheir utilization as a marker to support diabetes mellitus. [1] To correlate serum total cholesterol, triglycerides and ALT with fasting blood glucose [2]. To predict diagnosis of diabetes mellitus using above serum markers. Cross-sectional analysis, descriptive study. This study was carried out between Mar-2010 to Jan-2011 at the department of pathology, PNS RAHAT in collaboration with PNS SHIFA. A total of 251 subjects were screened for presence of glucose dysregulation. Based upon the results of fasting blood glucose, subjects were grouped as having normal glucose tolerance [NGT], impaired fasting glucose [IFG], and newly diagnosed diabetes mellitus [NDDM]. A comparison of lipids including triglycerides, total cholesterol and alanine aminotransferase [ALT] were made in the above groups to measure the differences between the above mentioned three groups. ALT, triglyceride and total cholesterol were correlated with results of fasting blood glucose through pearson's correlation. Later the performance of different cut-offs of triglycerides, total cholesterol and two mathematical models [[Factor-l=FBG [mmol/L] + triglycerides [mmol/L]] and [Factor-ll=FBG [mmol/L] + triglycerides [mmol/L] + total cholesterol [mmol/L]]] were evaluated for detecting diabetes mellitus against the gold standard 2 hr OGTT in 71 subjects. The results of triglycerides, total cholesterol and serum ALT between the three groups were as: [[Triglycerides: NGT =1.91, IFG =2, 10, NDDM= 2.75, p=0.003] [total cholesterol: NGT=5.03, IFG=5.19, NDDM=5.74, p=0.056] [ALT:NGT=28.47, IFG=27.95, NDDM=25.78, p=0.846]]. Most correlation was found between serum triglycerides and fasting blood glucose [r2=0.235, p<0.001]; while serum total cholesterol and ALT showed lesser correlations [[total cholesterol:r2= 0.172, P=0.007], [ALT:r2= 0.010, p= 0.877]]. While triglycerides demonstrated superiority in terms of sensitivity to total cholesterol for detection of diabetes mellitus, the factors incorporating lipids and glucose had the highest overall diagnostic efficiency. Triglycerides and total cholesterol levels rise from normoglycemic individuals to subjects having impaired fasting glucose and newly diagnosed diabetics. The inclusion of triglycerides and total cholesterol for diagnosis of diabetes mellitus improves the chances of for detection of diabetes mellitus

Status of glycemic control in patients of type 2 diabetes mellitus

To determine the status of glycemic control in patients of type 2 diabetes mellitus. Cross sectional descriptive study. Medical out-patient/ in -patient departments at Military Hospital Rawalpindi from January 2011 to December 2012. Six hundred and fifty patients of type 2 DM fulfilling the required criteria were included in the study. Glycemic control of these patients was determined by estimation of blood glucose [fasting and random] and glycosylated haemoglobin [HbA1c]. The patients were grouped in three categories good, fair and poor diabetic control having their HbA1c values of being 6-7%, 7.1-8% and more than 8.1% respectively. Statistical package for social sciences [SPSS] version 15 was used for analysis. Out of 650 patients 377 [58%] had poor glycemic control with mean HbA1c of 9.5% +/- 0.95, 78 [12%] patients had fair control of glycemic control with mean HbA1c of 7.8 +/- 0.25, and 195 [30%] patients had good glycemic control with mean HbA1c of 6.4 +/- 0.17. Majority of patients had poor control of their glycemic status which is an important indicator and predictor of both micro and macrovascular complications

Antibiotic sensitivity pattern of Salmonella serotypes in patients with enteric fever in a teaching hospital

To determine the sensitivity of salmonella serotypes to antibiotics in patients with enteric fever. This descriptive study was carried out in medical units of Lady Reading Hospital Peshawar from January 2008 to December 2011. Patients were included by consecutive sampling technique. Blood samples were collected from patients with clinically suspected enteric fever and were sent to hospital laboratory for culture and sensitivity[C/S]. Salmonella colonies were identified using standard biochemical tests including fermentation of glucose, negative urease reaction, lysine decarboxylase, negative indole test, H2S production, and fermentation of dulcitol. Serological confirmation tests included polyvalent antisera for flagellar and somatic antigens. Antibiotic susceptibility was checked by Kirby- Bauer disc diffusion method for 22 antibiotics. Blood cultures of 106[61%] patients out of 173 patients were positive for salmonella species. Salmonella Typhi was found in 54.7% while salmonella paratyphi A in 32.1% and B in 13.2%. The sensitivity of salmonella species for ceftriaxone and ceftazidime was found to be 100%, followed by imipenem[98.1%] and meropenem [96.2%]. The sensitivity of drugs like amoxicillin, chloramphenicol and co-trimaxazolewere 2.8%, 12.3% and 22.6% respectively. Regarding quinolones, most sensitive was moxifloxacin49.1%, followed by ciprofloxacin 48.1%. Salmonella typhi was fully sensitive to meropenum, ceftriaxoneand cetazidime while paratyphi A or B was fully sensitive to ceftriaxone, ceftazidime and imipenem. The sensitivity of salmonella species was very low to the first line agents such as amoxicillin, chloramphenicol and co-trimaxazole. Salmonella species were fully sensitive to third generation cephalosporins such as ceftriaxone and ceftazidime

Effect of pioglitazone on lipid profile in type 2 diabetic patients

To determine the effect of pioglitazone on lipid profile in type 2 diabetic patients treated and followed up for three months after initiation of therapy. This hospital based quasi-experimental study was conducted in the medical B unit, Lady Reading Hospital Peshawar from July 2008 to June 2009. A total of 161 patients with type 2 diabetes mellitus were included in this study using convenient [non-probability] sampling. Clinical and laboratory evaluation of all the patients were done to note the change in lipid profile after the use of 30 mg pioglitazone. Continuous variables such as age and lipid profile [triglycerides; Low Density Lipoprotien [LDL]; High Density Lipoprotien [HDL]; cholesterol] at baseline and after 3 months time were expressed as mean +/- S.D. Paired sample t-test was used to analyze the mean difference in pre-post lab investigation by SPSS version15. Out of the 161 patients, 79 [49.1%] were males and 82 [50.9%] were females. The mean age of the sample was 51.2 +/- 11.33 years. Triglycerides decreased from 219.2 +/- 34.4 to 189.2 +/- 33.7 mg/dl with a mean difference of 29.9 mg/dl [p<0.001]. Total cholesterol changed from 201.4 +/- 29.8 to 203.2 +/- 28.9 mg/dl with a mean difference of 1.8mg/dl [p<0.001]. LDL changed from 153.7 +/- 21.1 to 154.7 +/- 20.7 mg/dl with a mean difference of 0.9 mg/dl [p<0.001]. HDL increased from 37.2 +/- 2.9 to 41.5 +/- 3.1 mg/dl with a mean difference of 4.3 mg/dl [p<0.001]. Pioglitazone was found to have beneficial effects on lipid profile. It significantly reduced the levels of triglycerides and increased levels of HDL cholesterol in patients with Type 2 diabetes

Effectiveness and safety of narrowband ultraviolet b therapy in chronic plaque psoriasis

To determine the effectiveness and safety of narrow band ultraviolet B in chronic plaque Psoriasis. This descriptive case series study was carried out at skin unit Lady Reading Hospital Peshawar from June 2009 to Dec 2010. Sixty patients suffering from chronic plaque psoriasis, between the ages of 12 and 70 years were included in the study. Minimum erythema dose was determined in every patient according to skin types [1-6]. All the patients were exposed to narrow band ultraviolet B. At zero, fourth, eighth weeks and sixteen weeks, Psoriasis Area Severity Index [PASI] was determined and decision was made to increase or decrease the dose according to response of patient. Out of sixty patients fifty eight patients showed response showing effectiveness of 97.1%. Two patients showed poor response. Four patients suffered from moderate erythema itching and vesicles. Narrowband ultraviolet B is a safe and effective therapy for chronic plaque psoriasis but long term follow up is needed to determine its carcinogenic effects

Second-opinion histopathology - a study of 142 cases at armed forces institute of pathology [AFIP], Rawalpindi, Pakistan

To assess the histopathological diagnosis made on the cases sent for second opinion to the Department of Histopathology. A descriptive study. Department of Histopathology AFIP, Rawalpindi, Pakistan from July 2010 to April 2011. During the study period, 142 cases were received for second opinion by the department. The demographical details of the patients were entered in a profroma. After initially seeing the H and slides, immunohistochemical and special stains were applied where required. The initial diagnosis and review diagnosis were then analysed. During the study period, 142 cases were analysed, 81 were male and 61 female patients. There was wide age range, from 2 months to 90 years. Out of the total 22 [15.5%] were reviewed for benign conditions and 120 [84.5%] were malignant. Majority of cases were from lymphoreticular system. In 72 [50.7%] cases diagnosis was changed on review out of which 9 were benign conditions and rest malignant. Out of the 63 malignant 27 cases and 3 out of 9 benign cases, were those where change in diagnosis was such that it changed the treatment pattern. In 12 cases the review diagnosis was changed from benign to malignant and vice versa. Getting second opinion on surgical biopsy material is very important part of treatment, particularly in our set up, where all the laboratories are not fully equipped.

Role of immunohistochemistry [IHC] in diagnosis of ovarian malignancies - is there any change from before?

Ovarian malignancies account for about 3% of all cancers in women. After the development of immunohistochemishy, it is now considered an essential part in diagnosing malignant ovarian tumours, including metastatic tumours. To compare between the frequencies, histological patterns and histogenesis of malignant ovarian tumours before and after the advent of immunohistochemistry. This descriptive cross sectional study was conducted at department of histopathology, Armed Forces Institute of Pathology [AFIP] Rawalpindi from 1[st] Jan 2010 to 10[th] Dec 2011. A total of 128 cases of malignant ovarian tumours were included. After gross and histological examination, a panel of immunohistochemistry markers was applied and tumours were classified according to WHO classification. Most frequent malignant tumours were surface epithelial tumours [54.8%] followed by metastatic tumours [12.7%]. Frequency of metastatic tumours was higher in our study as compared to other studies. Immunohistochemistry plays an important role in correct diagnosis of malignant ovarian tumours and also in identifying metastatic tumours.

Anti-cyclic citrullinated peptide antibodies as a tool in diffrentiating patients with rheumatoid arthritis from patients with chronic hepatitis C infection-associated polyarticular involvement

To assess the utility of anti-cyclic citrullinated peptide [anti-CCP] antibodies in distinguishing between patients with rheumatoid arthritis [RA] and patients with polyarticular involvement associated with chronic hepatitis C virus [HCV] infection. All the patients enrolled in this study were examined in the outpatient department of medicine unit at Lady Reading Hospital Peshawar from February to December 2010. Serum anti-CCP antibodies and rheumatoid factor [RF] were evaluated in 29 patients with RA, 13 patients with chronic HCV infection a associated with articular involvement and 35 patients with chronic HCV infection without any joint involvement. Anti-CCP antibodies were detected in18 of 29 [62.1%] patients with RA, 7 of 13[53.8%] patients having HCV with RA like arthropathy but not in a single patient with chronic HCV infection with no articular involvement. Conversely, RF was detected in 25 of 29 [86.2%] patients with RA, 9 of 13 [69.2%] patients with HCV-related RA like arthropathy and 8 of 31 [22.9%] patients with HCV infection without joint involvement. This concludes that anti-CCP antibodies can be useful in discriminating patients with RA from patients with HCV-associated arthropathy

Safety of short stay hospitalization in reversal of loop ileostomy

Study Design: Prospective, randomized

Place:Surgical-3 Jinnah Hospital/ Allama Iqbal MedicalCollege, Lahore

Duration: Two years,January2009-December 2011

Methods: Patientsbetween 10-50 years, waiting for ileal stomareversal were re-investigated and were prepared onout door basis. Admissions were done one daybefore operation of stoma reversal. All operationswere undertaken on elective lists by the same gradeof surgeons. Patients were randomly allocated oneof the two groups. Each group consisted of 60patients. Group-1 patients were allowed to take clearliquids 4 hours after surgery and fluid diet wasgiven on first postoperative day and weredischarged from hospital 24 hours after operation.Patients of group-2 were kept NPO for 4 days withnasogatric tube in situ. Clear fluids were allowed on4th postoperative day. Fluid diet was permitted on 5thpostoperative day and were discharged fromhospital on 6-7th postoperative day

Inclusioncriteria: Loop ileostomy

Exclusion criteria: Endileostomy, Extremes of age

Results: Sample size ofthe research was 120 patients with random divisionin two groups. Group-1 consisted of 60 patientsundergoing protocol of short stay hospitalizationwhereas 60 patients of group-2 were managed withconventional method of intravenous fluid and nil bymouth for 4-5 day. The demographic characteristicsof group-1 and group-2 were similar. Theindications of constructing of ileostomy wereabdominal tuberculosis, typhoid perforation,obstetrical trauma, firearm injury, iatrogenicintestinal injury during adhenolysis and strangulatedhernia with gangrenous intestine. The indicationswere almost identical in both groups. Majority ofpatients of group-1[70%] were able to go home onfirst postoperative day with total hospital stay of 2days. In group-2, 66.6% of the total patients hadhospital stay of 8 days with p value of .674 [p=.674]which is insignificant statistically. Similarly thestatistics of postoperative complications weresimilar with p value of .805 [p=.805] which is againnot significant

Conclusion: Short stayhospitalization is safe and feasible in majority of thepatients undergoing ileostomy reversal

relationship between the clinical manifestations and the presence of anti cyclic citrullinated peptide antibodies in very early rheumatoid arthritis

To establish whether the clinical presentation of anti-cyclic citrullinated peptide [Anti-CCP] antibodies and negative disease are distinct at the earliest clinically apparent phase of disease. Patients were seen in outpatient department of Lady Reading Hospital Peshawar from February 2009 to February 2011. Participants were included in the current study if they presented within 3 months of symptom onset and fulfilled 1987 ACR criteria for [RA] in the beginning or at some point during an 18 month follow-up. Data were collected on demographic variables and joint symptoms [tender and swollen joint counts]. C- reactive protein [CRP], erythrocyte sedimentation rate [ESR], rheumatoid factor and Anti-CCP antibodies status were measured. 110 patients were included [57 were Anti-CCP antibodies positive]. The Anti-CCP antibodies positive and negative groups were comparable in terms of demographic variables, inflammatory markers,tender and swollen joint counts and 1987 ACR classification criteria. Rheumatoid arthritis factor was detected more in Anti-CCP antibodies positive patients as compared with Anti-CCP antibodies negative patients. [83.3% vs. 35.8%]. There was no significant difference in the pattern of joint involvement, except for an increased prevalence of knee joint swelling in Anti-CCP antibodies positive patients [56.1% vs.17.5%]. Patients with and without Anti-CCP antibodies present in a similar way, even within three months of clinically apparent disease that eventually develops into Rheumatoid arthritis

Sternum: a useful but forgotten site for bone marrow aspiration

This study was carried out to evaluate the usefulness of sternal puncture for bone marrow examination when posterior superior iliac spine was not approachable. Case series. The study was carried out from Sep 2008 till Feb 2009 at Haematology Department, Army Medical College /Military Hospital Rawalpindi. Sternal puncture was performed on 12 patients where PSIS/ASIS were not accessible due to patients condition/ disease. The diagnosis was possible in all the patients and the reports were intimated within a few hours of carrying out the procedure. Indications for sternal puncture were non accessibility of PSIS/ASIS due to obesity, bed sores, anasarca, skin lesions and patients on ventilators. No complications were seen. Sternum is as good as other sites of bone marrow examination especially in critically ill patients who cannot undergo conventional bone marrow aspiration