Anti-avian influenza virus H[9]N[2] activity of aqueous extracts of Zingiber officinalis [Ginger] and Allium sativum [Garlic] in chick embryos

In the present study, anti-Avian influenza virus H9N2 activity of aqueous extracts [5, 10, 15, 20, 25%] of Zingiber officinalis and Allium sativum was evaluated. Embryo-toxicity was evaluated by histopathological scoring of Chorio-allantoic membrane of chick embryos. Cytotoxicity of extracts was determined by MTT assay on Vero cells. Aqueous extract of ginger had antiviral activity at 10, 15, 20 and 25% while garlic had activity at 15, 20 and 25%. Histopathological scoring of chorio-allantoic membrane for aqueous extracts [5, 10, 15, 20, 25%] of ginger [0.66+/-0.57, 1.33+/-0.57, 1.66+/-0.57, 2.66+/-0.57, 3.66+/-0.57, respectively] and garlic [1.00+/-0.00, 1.33+/-0.57, 2.00+/-0.00, 2.33+/-0.57, 3.66+/-0.57, respectively] was concentration dependant. MTT assay revealed cytotoxicity of both plants was also concentration dependent. Extracts of ginger [5, 10, 15, 20, 25%] had lower cytotoxicity [71, 59, 28, 22, 0 % cell survival, respectively] as compared to garlic [61, 36. 20, 11, 3% cell survival, respectively]. Overall results revealed that concentration of aqueous extract of ginger [10%], showing antiviral activity against H[9]N2, was less toxic to vero cells [> 50% cell survival]. It is insinuated that ginger may have anti- Avian influenza virus H9N2 potential and its active compounds needs further investigations

Hashimoto's thyroiditis: not uncommon in simple benign goiter. A review of 1102 thyroidectomies for simple benign goiter

Objective: To see the frequency of Hashimotos Thyroiditis [HT] in patients operated with the diagnosis of simple goiter

Study Design: A retrospective multicenter study

Place and duration: From 1[st] January 1999 to 31[st] March 2011 at three tertiary care hospitals

Methodology: All patients with simple benign goiter irrespective of age and sex are included in the study. Patients already diagnosed for hashimotos thyroiditis, recurrent goiter, abnormal thyroid hormone profile, diagnosed congenital thyroid pathology or non availability of postoperative histopathology were excluded from the study. Histopathology of all patients reviewed to see the frequency of hashimotos thyroiditis in patients operated for benign simple goiter

Results: Among a total of 1102 patients, 91.28% [n=1006] were female and the majority were in 5[th] decade [35.48%, n=391] of life. Histopathology review of all patients operated for benign simple goiter showed that 2.81% [n=31] were having Hashimoto's thyroiditis and majority [87.09%, n=27] were female. Hashimoto's thyroiditis were common in patients who was in the 3[rd] decade of life followed by 4[th] decade, i.e. 35.48% [n=11] and 32.26% [n=10] respectively

Conclusion: Hashimotos thyroiditis is not uncommon and due to its varied clinical presentation it should be ruled out in simple benign goiter before surgery

effectiveness of vacuum assisted wound closure [VAC] In diabetic foot

Objectives: To determine the mean healing time of vacuum assisted wound closure in diabetic foot ulcer patients

Study Design: An interventional case Series

Place and Duration: Department of General Surgery, The Royal Oldham Hospital, Oldham, U.K from 1[st] September 2012 to 30[th] March 2013

Methodology: All patients with diabetic foot ulcer of any size and duration were included in the study that fulfills inclusion criteria. Patients were subjected to VAC dressing which involved the controlled application of sub-atmospheric pressure to the local wound environment, using a sealed wound dressing connected to a vacuum pump. Patients were followed by disappearance of exudates and appearance of granulation tissue and the time of healing of wound

Results: Among 40 patients studied, 45.0% were between 41 to 50 years of age with male to female ratio was 1.6:1. The mean duration of diabetes in patients was an average of 14 +/- 5.65 years. Duration of diabetic foot was 24 +/- 6.0 and initial average wound area was 50.6 +/- 27.6cm[2]. After VAC therapy, the wound area ranged from 3.4 to 92.35 cm[2], the average area being 41.75 cm[2]. The actual reduction in wound area attained by VAC therapy varied from 3.4 to 38.6 cm[2], with an average reduction of 11.4 +/- 4.55 cm[2]. The percentage reduction in wound area ranged from 10.3% to 62.11%, with an average reduction of 27.9 +/- 13.7%. Wounds were healed after VAC therapy for an average of 21.75 +/- 10.55 [range, 14 to 40] days

Conclusion: VAC therapy is very effective and useful in the treatment of diabetic foot and ulcers and has an effective role in promotion of proliferation of granulation tissue, reduction in the wound size and healing of wound in lesser time

When a surgeon should retire?

The question that when a surgeon should retire has been the subject under discussion since long. In the present era, medical education, knowledge, training, and technology are evolving at a rapid pace. At the other end, age causes decline in physical and cognitive performance. So the older a surgeon is, the more likely that he is remote from his initial education and training in his specialty. Research also proves that the senior surgeons are hesitant to plan for their retirement. So far there is no definitive study matching surgical outcomes to surgeons' age. The author believes that work done in related domains can provide a better understanding of physician aging and cognition issues, and thus can suggest more effective strategies towards continuous professional development and lifelong learning in medicine

comparison of post operative pain and hospital stay between Liechtenstein's repair and Laparoscopic Transabdominal Preperitoneal [TAPP] repair of inguinal hernia: a randomized controlled trial

To compare the open Lichtenstein repair and laparoscopic mesh repair for direct inguinal hernias in terms of immediate post operative pain and length of hospital stay. This randomized control trial was conducted at Benazir Bhutto Hospital Rawalpindi from January 2009 to June 2010. All patients presenting in the surgical OPD with direct inguinal hernia, ASA l/ll, were randomly divided in two equal groups. Group-1, patients underwent Lichtenstein's repair and Group-11 had hernioplasty by laparoscopic method [TAPP]. Post operative pain intensity assessed by VAS and hospital stay measured in hours. A total 60 patients of direct inguinal hernia were studied. The mean age was 61.48 +/- 7. The range of postoperative pain experienced was 5.55 as per VAS among all patients. In group-1 [open hernioplasty] majority of patients [53.33%, n=16] experience severe type of pain where as in group-li, moderate seventy of pain was reported by large number of patients [63.34%, n=19]. The mean post operative pain intensity as per VAS was 6.23 in group-l and 4.43 in group-ll patients. The mean length of hospital stay was slightly less [35.10 hrs] in group-l as compared to group-ll [38.70 hrs]. There is definitely less post operative pain after laparoscopic repair but hospital stay is same in both the procedures but laparoscopic procedure does increase the cost

Pattern and mortality of burns injuries in children

To see the type of burns, pattern of burn injuries, burning agent, place of injury and total body surface area involved in children. Descriptive study. This study was carried out at Burn Unit, Social Security Hospital, Islamabad from. January 2006 to March 2014. Children below 16 years of age reporting to causality department with burns were included in the study. Among 112 patients, 17.85% and 16.96% were from 5 - 6 and 3 - 4 year of age respectively. Flame injuries were commonest [41.07%], followed by hot liquids [31.25%] and electric burns [16.07%]. Majority [74.11%] of burn injuries sustained at home. 39.28% and 20.54% sustained less then 10% and 11-20% of burns respectively. Only 8.04% and 5.36% sustained burns between 21-30% and 31-40% respectively. No mortality was observed in patients having less than 40% of burns and 100% mortality among patients having more than 80% burns. Burn injuries from hot liquid are common in less than 6 years of age and flame burns above 10 years of age while playing with burning shopping bags and working in kitchen. As most of these injuries are avoidable, intensive educational programmes are needed to increase public awareness regarding burn dangers and to teach them how to take proper preventive and safety measures at home

12 year study of medico-legal aspect of burns in females

Objective: To assess medico-legal aspects, risk groups, types and severity of burns in female patients coming to the tertiary care hospital

Study design: A descriptive study

Place and Duration of Study: Burns Unit Fauji Foundation Hospital Rawalpindi, from April 1997 to March 2009

Methodology: All female patients above 15 year of age reported with burn injuries were evaluated regarding their demographic details, nature and severity of burns. Circumstances leading to burn injuries and other important factors leading to homicidal or suicidal burns were also evaluated

Results: Rate of homicidal burns and suicidal burns was 16.54% and 4.32% respectively among 139 patients studied. Among these homicidal and suicidal burns, majority of females [51.08%]were less than 25 year of age, 86.21% from rural areas and 86.66% belonged to lower socio-economic group. Majority [51.72%] of them were married and 65.52% living with their in-laws at the time of incident. Flame burns [89.66%] were commonest and kerosene oil stove burst was the main cause of injuries in 89.66% cases. Most women [51.72%] were having disputes with in-laws. Among these, 48.27% female sustained 81- 90% of the total body surface area burn. Assault was done by in-laws in 34.49% patients and by husband in 20.49% patients respectively. Majority of these females [75.86%] were brought to the hospital by other relatives and 72% were brought to the hospital after 48 hours of the incident

Conclusions: Most of the women were less than 25 year of age. Majority were from the rural area and were from lower socioeconomic group. Flame burns due to kerosene oil was the commonest type

killing of women without weapon: 5 year medico-legal study of rape cases in Karachi

Background: Rape is amongst the most prevalent sexual assault against women in Pakistan.1i These bullets when fired damage the physical, psychological, social, and economical well being of the victim, culminating often into problems culminating in a myriad of social, psychological and medical problems

Objective: To analyze the various medico legal parameters and dimensions of alleged rape cases in metropolis of Karachi and present this analysis in relation to the demographic parameters of the alleged cases

Methods: A descriptive and cross sectional study on a total of 1210 cases of alleged sexual assault, that were reported from January 1, 2007 till December 31, 2011, at the three authorized medico legal centers of Karachi: Jinnah Post Graduate Medical Center, Abbasi Shaheed Hospital and Civil Hospital Karachi

Results: Amongst the total of 1210 cases, majority involved unmarried females [n=898; 74.21%], whereas married cases were 312[25.79%]. On an average 20% of the cases were reported per year [n=292], with peak incidence in 2011 when the percentage rose to 21.65%[n=262] and the minimum being at 17.27%[n=209] in year 2007. Most cases were reported 0-6th day post incident with the percentage being 35.70%.[n=432]. The cases in which examination was carried out between 1 week to 1 month after incident were 64.29%[n=778]. The negative cases came out to be 62.56%[n=757] and positive cases came out to be 37.43%[n=453], on the bases of clinical findings [i.e. tears local injuries] and laboratory investigations. Sexual assault is more common, in the age group of 15-20 years [n=586; 48.42%]

Conclusion: Rape as sexual assault is still a major concern in our region. Most of the cases reported were however not proved to be positive; Reasons being many, especially when the victim report their cases late or the nature of cases being such [as in rape after abduction] that relevant physical findings were rendered useless to provide evidence. There is a need to provide safeguards to such victims so that they may seek legal and medical attention sooner, and measures to provide social security to such sufferers so that their physical and mental health can be restored in due time

Regional variation and clinical manifestations of acute dengue infection observed at a tertiary care hospital of district Rawalpindi

Objectives: To assess the regional variation and clinical manifestations of acute dengue infection amongst the patients who presented to a tertiary care hospital of Rawalpindi

Study design: A Descriptive study

Place and duration: Study was carried out at Microbiology Department of Holy Family Hospital, Rawalpindi Medical College, Rawalpindi, from 1st August 2010 to 30th March 2011

Methodology: A simple random sampling technique was adopted for all the suspected cases of acute dengue, admitted in the dengue ward of Holy Family Hospital, Rawalpindi. Their blood samples were taken and analyzed by ELISA test for the detection of antidengue antibodies [IgM]

Results: A total of 30.2% [n=104] patients were diagnosed positive by ELISA test. The frequency of dengue fever [DF] in males was 68.2% [n=71] and in females it was 31.7% [n=33]. The incidence of dengue fever was high in Rawalpindi [30.2%] and Chakwaal [30.1%]. The most common clinical manifestations were high grade continuous fever [>10[degree]F] seen in 88.4% [n=92], followed by retro-orbital headache 65.3% [n=68], epigastric pain 65.3% [n=68], arthralgias 63.4% [n=66] and myalgias 50% [n=52]

Conclusion: The incidence of Dengue fever is high in Rawalpindi and Chakwaal. The most common clinical manifestations of acute DF include high grade continuous fever along with retro-orbital headache, epigastric pain, myalgias and arthralgias

Assessment methods in medical education: a review

Good assessment is a major challenge in medical education. One of the major obstacle to a comprehensive assessment is the lack of familiarity on the part of medical educators about proper selection and effective use of different assessment methods. This primer [review] gives an overview of the basic ideas and vocabulary that one should understand in order to evaluate the quality of any assessment tool designed for the purpose of evaluating the undergraduates, postgraduates or other medical professionals. Applicability and effectiveness of different assessment tools are described along with their limitations and advantages. In addition, assessment methods currently in use are reviewed with attention to their psychometric strength and weaknesses. The data was collected from cross sectional studies, review articles, books on medical education and from guidelines for assessment between 1956 to 2013. Websites and other online resources of medline, NCBI and medscape were used to extract the data

Depression in cancer patients attending outpatients department of tertiary care hospitals of Karachi

To find out the frequency of depression and associated socio demographic factors in cancer patients of Karachi. A descriptive cross sectional study was conducted during July-August 2013. Through convenient sampling method, one hundred diagnosed cancer patients were selected from outpatient department [OPD] of a private and a public sector teaching hospital. Patients of both gender, 18 years of age and above and who were diagnosed with cancer at least one month before the interview were included. Depression was assessed by Patient Health Questionnaire [PHQ-9]. The questionnaire includes all nine criteria for diagnosis of cancer as described by Diagnostic and Statisical Manual of Mental Disorders IV [DSM-IV]. Data was analyzed by SPSS version 20. Chi square test was applied for categorical data at a significance level of p<.05. Mean age of participants was 45.46 +/- 13.8 SD years [range: 18 - 85 years]. Fifty three percent were males; Seventy eight percent were currently married. Mean income was 13262 +/- 9107 SD Pakistani rupees [range: 4500 - 45,000 Rs]. Seventy four percent patients were permanent residents of Karachi. In females breast cancer while in males oral cavity cancer were the leading type of cancers. Sixty five percent patients had current depression ranging from mild to severe. Seventy percent patients had financial problems in terms of treatment cost. Chemotherapy, fatigue and financial problems were positively associated with depression [p<0.05]. Frequency of depression in cancer patients is very high. Majority of the patients were married and had financial constraints in terms of treatment cost

Intravenous urogram as a first line investigation in comparison with ultrasound

The objective of was to evaluate the usefulness and efficacy of intravenous urogram in patients with urinary tract pathology detected on ultrasound and X-ray KUB. The duration of the study was from September 2007 to August 2009 and a total of 250 patients were included in this cross-sectional study by non probability purposive sampling technique. Ultrasound scans and intravenous urograms were conducted by/under direct supervision of consultant radiologist. Out of 254 patients, four were unable to complete the intravenous urogram due to reaction to the contrast medium; hence a total of 250 patients were included in the final study. There were 66 male and 184 female patients. Calculi [renal, ureteric and vesical] were seen in 139 patients, pefviureteric Junction obstruction in 9, double collecting system and/or ureter in 6, neurogenic bladder in 13, horseshoe/pancake kidney in 2, ectopic kidney in 1, ureterocele in 2, cystocele in 1 and bladder mass in 7 patients. In 14 patients, the tests conducted were inconclusive and further investigations were advised. 28 patients had no detectable urinary tract pathology on any of the diagnostic modality. Intravenous urogram should not be performed routinely as a first line investigation in every patient presenting with flank pain. However, in congenital anomalies, intravenous urograms are needed and should be performed after a preliminary ultrasound

Giant goiter: not uncommon in endemic areas of Pakistan. a 10 years experience

Objectives: To determine the prevalence of giant goiter and morbidity after surgery and to compare the data with the national and international literature

Study Design: A prospective, observational study

Place And Duration: Department of Surgery, Fauji Foundation Hospital, Rawalpindi from May 1999 to April 2008

Methodology: All patients with giant multinodular goiter [Grade IV] were operated and prevalence of compilations was recorded meticulously, and data compared with national and international literature

Results: A total of 744 patients operated and majority were female 94.89% [n=706] from 5[th] decade of life i.e. 35.75% [n=266]. Giant multinodular goiter [Grade IV] found in 26.08% [n=194]. Among them, 96.90% [n=188] were euthyroid. Near total thyroidectomy was done in 59.79% [n=116] patients, total thyroidectomy in 28.86% [n=56] and subtotal thyroidectomy in 11.35% [n=22] patients. Transient hypocalcaemia was the commonest complication observed, in 8.24% [n=16] patients followed by seroma formation- 7.21%, [n=14]. Permanent hopoparathyroidism-2.66%, [n=4], Permanent recurrent laryngeal nerve injury-1.03%, [n=2], transient recurrent laryngeal nerve palsy-4.63%, [n=9], postoperative bleeding-1.03%, [n=2] and wound infection noticed in 2.57% [n=5] patients

Conclusion: Giant goiter is not uncommon in our setup, with expected high postoperative complications so surgery should be done by experienced hands in the centers where all facilities are available. Public awareness should be created by health authorities and organizations regarding prevention and early treatment

Mucocele appendix - case report and literature review

Mucocele appendix is a rare pathology involving appendix. We are reporting a 36 years old female operated with the provisional diagnosis of acute appendicitis but per operative findings shows mucocele appendix. Literature review is also presented along with this case report