Extraction and characterization of high purity chitosan by rapid and simple techniques from mud crabs taken from Abbottabad

Chitosan and chitosan based materials offer diverse applications in the field of biotechnology, nanotechnology, pharmaceuticals, environmental protection and tissue engineering due to their various biological and physicochemical properties. Major sources of chitosan are shrimps, crabs and lobsters. Properties of chitosan differ with the degree of deacetylation and the molecular weight. Researchers are investigating to produce high quality chitosan in cost effective and time efficient way which was the aim of present study. The exoskeleton of mud crabs, taken from Abbottabad, was demineralized with 2mol/dm3 H2SO4 solution for 4hour and then, deproteinized with 2mol/dm3 NaOH solution for 4hour at room temperature. Yield of crude chitin was 78% which was deacetylated with 55% NaOH solution at 110oC for 4hour to obtain chitosan. After precipitation, the yield of pure chitosan form the crab shell was 39%. The degree of deacetylation of chitosan was 92% measured by potentiometric titration and the molecular weight was 1.2×106g/mol [1200KD], determined by viscometric method. We concluded that a high quality chitosan can be produced at commercial level in Pakistan by rapid and simple techniques

Tibial dyschondroplasia is closely related to suppression of expression of hypoxia-inducible factors 1α, 2α, and 3α in chickens

Tibial dyschondroplasia (TD) cases has not been reported in Tibetan chickens (TBCs), but it is commonly seen in commercial broilers characterized by lameness. The underlying mechanism remains unclear. Hypoxia-inducible factors (HIFs) are important regulators of cellular adaptation to hypoxic conditions. In this study, we investigated the role of HIF-1α,

Transperineal template-guided prostate saturation biopsies in men with suspicion of prostate cancer: a pilot study from Pakistan

Traditionally, transrectal ultrasound (TRUS)-guided biopsies are done for the diagnosis of prostatecancer (PCa) in Pakistan. The transperineal template-guided saturation biopsy (TTSB) approach hasbeen recently introduced in Pakistan and we share diagnostic yields and pathological findings ofspecimens taken for PCa diagnosis in men with elevated serum total prostate specific antigen (PSA)and negative TRUS-guided prostate biopsies. In all, 16 patients investigated at the Department ofUrology, Sindh Institute of Urology and Transplantation (SIUT), underwent TTSB. The mean ageof patients was 67.8 ± 8.8 (range: 55 - 84) years. The median PSA was 9.5 (IQR: 7.9 - 19.8) ng/ml. The duration of symptoms before biopsy ranged from 1 month to 144 months. The prostatewas enlarged with mean weight of 73.5 ± 55.5 g. Histopathology revealed PCa in 5 of 16 (31.2%)cases. The Gleason score was 6 (3+3), 7 (3+4) and 8 (4+4) in 1 case each (6.3%) and 10 (5+5) in 2cases (12.5%). At least two cores were positive in all positive cases. None of the patients requiredantibiotics post-procedure. In conclusion, the TTSB technique is a promising option for patients withelevated PSA level and negative transrectal prostate biopsies for the detection of PCa in our settin

Diabetic foot ulcer; sequelae

Objective: The number of diabetic patients is increasing at a rapid rate1. Management of diabetic foot has been a challenge for medical professionals. This study was carried out to find the sequelae of diabetic foot ulcer management. Study design: Observational analytical study. Setting: Military Hospital, Combined Military Hospitals Rawalpindi and MIMC teaching Hospital, Mirpur [AJK]. Period: Sep 2009 to August 2013

Materials and methods: Total 310 patients were included in this study as outdoor and indoor cases. Out of these 184 were males and 126 were females. Age affected ranged from 20 years to 90 years. Average age was 50 years. Wagner's grading for diabetic foot ulcer was used as guideline for management

Results: Hyperglycemia was controlled in consultation with physicians in all these patients. Out of these 310patients 199 [64%] patients got their feet wounds healed on conservative management without amputation while 111[35.8%] patients had to undergo some amputation at some level

Conclusion: Diabetes mellitus, fore runner of so many diseases requires multidisciplinary approach. Well controlled diabetes mellitus, good feet hygiene, rational antibiotics in light of culture/sensitivity report and timely conservative or active surgical intervention produce good results in diabetic foot management

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

Typhidot: a blessing or a menace

Typhoid remain an increasing problem in Third world countries like Pakistan. A reliable, easy and affordable rapid diagnostic test is a need for our clinicians, many of whom consider Typhidot to be promising. Typhidot has been used as the only tool to diagnose typhoid fever by general practitioners and consultants despite its low sensitivity and specificity causing misdiagnosis and treatment. We therefore conducted this study to evaluate the sensitivity and specificity of Typhidot in patients with fever. A retrospective analysis of a total of 145 febrile patients was done. Blood culture and Typhidot along with other relevant investigations had been performed in each case. Sensitivity, specificity and the association of Typhidot to the diagnosis was found using SPSS v16.0. Out of 145 patients, 15 [10.3%] had positive blood culture for Salmonella typhi, 7 [4.8%] had positive culture for salmonella paratyphi and 94 [64.8%] had positive culture for other organisms. Twenty nine [20%] patients had negative culture results. Forty seven [32.4%] patients had only IgM positive on Typhidot, 7 [4.8%] had both IgM and IgG positive and 91 [62.8%] had both IgM and IgG negative. Amongst the 130 patients with diseases other than typhoid, 50 [38.5%] showed a positive Typhidot result. Amongst the 15 patients with typhoid, 11 [73.3%] showed a negative Typhidot result. The sensitivity of Typhidot was found to be 26.7% and the specificity was 61.5%. The Positive Predictive Value [PPV] was 7.4% and the Negative Predictive Value [NPV] was 87.9%. Even though Typhidot is rapid, easy and affordable, its use should be discouraged due to low sensitivity and specificity and insignificant [p=0.067] association to the disease

Descriptive analysis of alleged rape/sexual assault incidents in Rawalakot, AJK

To describe the socio-demographic along with the medico-legal characteristics of rape assailants and victims reporting to a police station in Rawalakot, Azad Kashmir. Retrospective study. This study was carried out at Forensic Medicine Department, Poonch Medical College, Rawalkot Jan 2007 to April 2015. This was a retrospective cohort study in which a total of 67 cases of alleged rape victims were identified while reviewing all available police files concerning reported rapes and attempted rapes from 2007to 2015. The data was gathered on preformed questionnaires after conducting the pilot study. All information about victims and alleged offenders were extracted from the police files including socio-demographic profile of the both the accused and victim i.e age of the victim and assailant, marital status of assailant and victim, time of incident,number of accused persons and whether challan was filed or otherwise. A total of 67 cases were collected from the police records regarding the alleged rape cases. Maximum number of victims belonged to age group of 21 to 30 years and most offenders also belonged to same age group. 70.1% [n=47 of victims and 79.1% [n=53] of assailants were unmarried. In most of the cases, one offender was involved while gang rape constituted 6% [n=4] of cases. Most cases were reported between 1200-1800 Hrs followed by 0600-1200 Hrs. The total no of cases year wise are 4 in 2007, 4 in 2008, 7 in 2009, 5 in2010,13 in 2011, 5 in2012, 11 in 2013, 13 in 2014 and 5 in first 4 months of 2015

Comparison of efficacy of lignocaine anesthesia of vocal cords by [spray as you go] through a bronchoscope with lignocaine injection through the cricothyroid membrane

To assess and compare the efficacy of lignocaine anesthesia of vocal cords by [spray as you go] through a bronchoscope with lignocaine injection through the cricothyroid membrane. Quasi experimental study. This study was done in Combined Military Hospital Peshawar form May 2009 to June 2010. Thirty patients in each group were given local anesthesia to the vocal cords. With lignocaine either via intratracheal instillation through the cricothyroid membrane or through a fibreoptic bronchoscope [spray as you go]. A cough score was calculated by recording the number of coughs as the bronchoscope was advanced through the cords into the trachea. A twenty point unpleasantness score was marked by the patient 2 hours after the procedure. Cough score and unpleasantness score was compared among the two groups using SPSS version 19. Median unpleasantness score was 6 [Inter quartile range [IQR] 4-8] whereas median cough score was 2[IQR 0-3]. The difference was statistically significant among the two groups for both cough and unpleasant scores [p < 0.001 and p < 0.001 respectively]. Intratracheal injection of lignocaine is more comfortable for the patient. It induces much less cough and irritability to the patient than the [spray as you go] technique

IgA nephropathy - its seasonal variation and clinico pathological profile in local patients

To study the frequency of IgA nephropathy in relation to seasonal variation and its clinico-pathological profile at Military Hospital Rawalpindi. A descriptive study. Military Hospital, Rawalpindi, Pakistan from Jan 2010 to Mar 2012. The study was conducted at Military Hospital Rawalpindi on 289 consecutive renal biopsy specimens. Ultrasound

Polio vaccination; knowledge, attitude, and practice in district Abbottabad, Khyber Pakhtunkhwa, Pakistan

To assess knowledge, attitude and practice [KAP] about poliomyelitis [polio] vaccination in District Abbottabad, province Khyber Pakhtunkhwa [KPK], Pakistan, to identify reasons of failure of polio vaccination/ eradication campaign and to make recommendations in the light of the study. District Abbottabad, province KPK, Pakistan including both urban and rural areas. Three months from 1st June to 31st August 2012. This cross-sectional descriptive explorative study was conducted in District Abbottabad, of province KPK, Pakistan. A structured questionnaire was submitted to people in the urban and rural population using convenient sampling. Out of 200, only 142 questionnaires were filled by interviewing parents and guardians of the children followed by focused group discussions with the community heads and the parents of the children. Majority [61.78%] of respondents were of low income category with the mean age of 31 years. Amongst those [75%] were earning Rs.7,000-12,000 per month. Literacy rate was low with 45.77%. Out of which 40.67% fathers and 59.33% mothers were illiterate. Therefore a few respondents were aware about the mode of transmission of polio. Majority [80%] said that polio could be prevented by polio drops and about 86% said that this vaccine had no side effects. About 45% respondents refused to cooperate with polio teams, and 28% respondents believed, that Abbottabad Operation had bad effect on anti-polio campaign. Regarding the use of boiled drinking water, 95.8% respondents knew that it was good for health. While only 4.20% were using boiled water for drinking. Advice of the health professionals [69.71%] and other family members [7.74%] was respected in making health care decisions, therefore it was an opportunity for the government to involve these persons as well as media men in conveying message to the community to achieve ultimate goal of polio free Pakistan. Unawareness among the population of District Abbottabad, especially the knowledge about the disease, mode of transmission and its prevention are the most deficient areas. Secondly misconceptions about the nature of polio drops, and religious misinterpretations in masses, created by general public and religious leaders, are the major obstacles in the real success of vaccination campaign

Rota virus diarrhea in hospitalized children

To determine the frequency and clinical features of Rota virus diarrhea in children presenting in a tertiary care hospital. A cross-sectional, observational study. National Institute of Child Health, Karachi, from January to June 2007. A total of three hundred children of either gender aged 1 month to 5 years, who presented with diarrhea of < 7 days as a primary illness were enrolled. Children with bloody diarrhea or nosocomial gastroenteritis acquired during hospitalization for other disease were not included. Detection of Rota virus in stool was done by enzyme linked immunoassay. Out of 300 children, 188 [63%] tested positive and 112 [37%] tested negative for Rota virus. Positive Rota virus cases in 7 - 12 months of age was [n = 34, 18.08%]. Overall, 151 [80.3%] children with Rota virus were less than 3 years old. 182 [60.7%] had fever, 118 [39.3%] had vomiting and 156 [82.9%] children had both fever and vomiting. This study shows that Rota virus is a common organism causing diarrhea in children less than 3 years of age. There is a need to incorporate Rota virus vaccine in the national EPI program to decrease the disease burden as highlighted in this study

Reasons and patterns of tooth extraction in a tertiary care hospital- a cross sectional prospective survey

OBJECTIVES: The aim of this study was to find the reasons of tooth extraction in permanent dentition and to identify the patterns of tooth extraction among karachiates

MATERIAL AND METHODS: This study was carried out in the department of oral and maxillofacial surgery [OMFS], in tertiary care hospitals of Karachi from October 2013 to March 2014. In this cross sectional study total 6251 patients were selected through non-probability convenience sampling and data was collected by trained clinician using predesigned questionnaire after informed verbal consent. The reasons and pattern of tooth loss was recorded and data was computed on SPSS. Version 19.00

RESULTS: According to the result analysis on SPSS version 19.0, the male to female percentage was 43.25% and 56.74% respectively and the highest number of extractions was observed at the age of 50 years i.e. 6.24%.The percentage of reasons of extraction of teeth in our population is as follows, the grossly carious teeth are 51.8%, Periodontal problem 19.2%, Impaction 2.9%, RCT failure 2.8%, Economics 0.9%, Root caries 6.8%, Orthodontics 2.9%, Prosthodontics 0.1%, Fracture 1.3% , Malopposed 0.7%, Supernumerary teeth 0.9%, tooth In the fracture line 0.1%, Aesthetics, Pathological fracture, Preradiation 0.0%

CONCLUSION: It was concluded from the above study that dental caries, is the most common reason for tooth loss followed by periodontal disease and first molar is the commonest tooth extracted

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

Emerging human health pertinent to modern agriculture. Critical review

In developing countries week and dispersed link has been shown between agriculture and human diseases. In this regard present review was conducted and revealed several examples that there exist strong link between agriculture and diseases. Review categorized the major disease into zoonotic, vector borne and food associated. Zoonotic diseases were found to be transmitted by the livestock. Some of these diseases are also associates with vectors that were found to be transmitted by the agriculture. Mosquito is the major vector transferring malaria, cholera and skin diseases. Agricultural intensification is the major source of their climate change through increased emission of green house gases. Agricultural intensification, ecological disturbance and inadequate agricultural managements are the dominant reason revealed. Rate of future agricultural diseases such as zoonotic diseases emergence or reemergence will be closely linked to the evolution of the agriculture-environment nexus. Meanwhile, the available research is not enough to address these issues. Agriculture sector is for peace and sustainability and to strengthen this sustainability there is dire need of Convergence is needed between integrated pest management strategies and integrated vector management strategies to help farmers improve their agricultural practices while minimizing environmental risks to health. In addition, further research by the medical scientists and agricultural scientists is needed to explore the epidemiology of various diseases caused by the agricultural activities through promotion of vector

Persistent junctional reciprocating tachycardia [PJRT]

Persistent Junctional reciprocating tachycardia [PJRT] is an arrhythmia mostly seen in infants and children, but is reported in the older age group as well. It is an easy diagnosis with [awareness of the mind]. Once confirmed by electro-physiological study, the management is simplified. Radiofrequency ablation of the accessory pathway gives complete cure in almost all cases, especially so, for those with the persistent form. The tachycardia when untreated could induce the so called Tachycardia Induced Cardiomyopathy [TIC] which is reversible. We report the case of a 64-year-old lady with spontaneously relapsing and remitting PJRT which remained undiagnosed. Ultimately, a complete cure was achieved with the help of electro-physiology study and radiofrequency ablation

Changing haematological parameters in dengue viral infections

Dengue Fever is the most common arboviral disease in the world, and presents cyclically in tropical and subtropical regions of the world. The four serotypes of dengue virus, 1, 2, 3, and 4, form an antigenic subgroup of the flaviviruses [Group B arboviruses]. Transmission to humans of any of these serotypes initiates a spectrum of host responses, from in apparent to severe and sometimes lethal infections. Complete Blood count [CBC] is an important part of the diagnostic workup of patients. Comparison of various finding in CBC including peripheral smear can help the physician in better management of the patient. This cross sectional study was carried out on a series of suspected patients of Dengue viral infection reporting in Ittefaq Hospital [Trust]. All were investigated for serological markers of acute infection. Out of 341 acute cases 166 [48.7%] were confirmed by IgM against Dengue virus. IgG anti-dengue was used on 200 suspected re-infected patients. Seventy-one [39.5%] were positive and 118 [59%] were negative. Among 245 confirmed dengue fever patients 43 [17.6%] were considered having dengue hemorrhagic fever on the basis of lab and clinical findings. Raised haematocrit, Leukopenia with relative Lymphocytosis and presence atypical lymphocytes along with plasmacytoid cells was consistent finding at presentation in both the patterns of disease, i.e., Dengue Haemorrhagic fever [DHF] and Dengue fever [DF]. Changes in relative percentage of cells appear with improvement in the symptoms and recovery from the disease. These findings indicate that in the course of the disease, there are major shifts within cellular component of blood.

importance of socio-economic status and sex on the prevalence of human pediculosis in government schools children in Lahore, Pakistan

The present project was designed to study the effect of age, sex and socio-economic status on the prevalence of Pediculosis [Pediculus capitis]. A survey was conducted among 1-5 class children of five public sector schools located in Lahore, where most of the students belonged to middle and low income classes. After obtaining ethical clearance from the parents, school principals and students, 500 children of age >/= 7 years were examined both macroscopically and microscopically on first come first basis up to 100 children from each school. Of 500 children [n=122 boys; n=378 girls], overall 387 [77.40%] while in girls 323 [85.45%] and in boys 64 [52.46%] were positive for Pediculosis. A higher prevalence was recorded in children of

Comparison of haemodynamic changes following tracheal intubation by using laryngoscope with intubating laryngeal mask airway

To compare haemodynamic changes following tracheal intubation using direct laryngoscopic technique with intubating laryngeal mask airway technique. Randomized control trail [RCT]. Military Hospital Rawalpindi from Jan 2008 to Dec 2008. After approval by the hospital ethics committee, 100 patients admitted for elective surgery from OPDs were randomly distributed equally in groups I and II for either direct laryngoscopy or laryngeal mask airway intubation respectively, as a part of general anaesthesia. A uniform protocol of general anaesthesia was followed. Heart rate and mean blood pressure were recorded before and at 1, 3 and 5 minutes after intubation. It was observed that increase in mean arterial blood pressure and heart rate at 1 and 3 minute was significant in patients intubated with laryngoscope as compared to patients intubated with Intubating laryngeal mask airway [ILMA]. Intubation with ILMA produces less haemodynamic response as compared to direct laryngoscopy

Spectrum of mandibular fractures presented at abbasi Shaheed Hospital, Karachi

Careless high speed driving and increasing violent attacks in the Karachi had increased the burden of maxillofacial trauma proportionally. The objectives of the study were to: Enlist the various causes of Mandibular fractures in patients coming to the Department of Oral and Maxillofacial Surgery, Abbasi Shaheed Hospital and to describe the various sites of Mandibular fracture. The descriptive, cross sectional study on the patients fulfilling the inclusion criteria. They were asked for the parameters which includes age, gender, etiology of fracture, and site of fracture using a questionnaire. Statistical analysis of continuous and categorical variables was conducted using SPSS version 16.00. Male preponderance with male: female ratio of 2.4: 1, 71.1% males and 28.9% females, mean age of the patient was 28.2 years 12.7. The most common cause of injury was recorded as Road traffic accident [RTA] 65.6% and the most common site of fracture was Parasymphysis [24.1%]. This study clearly demonstrates the most common cause of Mandibular fractures was RTA and the most common site was the Parasymphysis in our population

Oral aspects and complications in type 2 diabetes mellitus - a study

Type 2 diabetes mellitus comprises an array of dysfunctions resulting in several soft tissue abnormalities in the oral cavity. These include gingivitis periodontitis, salivary dysfunction, taste dysfunction, oral fungal and bacterial infections, geographic tongue, benign migratory glossitis, fissured tongue, traumatic ulcer, lichen planus, angular cheilitis, delayed mucosal healing, dental root caries, tooth loss, mucosal neurosensory disorders, and oral mucosal lesions. This article aims to determine the frequency of different oral manifestations and complications in patients of Type 2 Diabetes Mellitus. This will not only increase the awareness of oral manifestations and complications of diabetes mellitus but also help in expediting the research on the subject. It was a descriptive study and was carried out at the Operative Dentistry Department of Armed Forces Institute of Dentistry from January 2010 to January 2011. 200 patients fulfilling the inclusion criteria [diagnosed cases of type 2 diabetes mellitus of >35 years of age] were included in the study. 70 [35%] were female and 130 [65%] were male patients. The frequency of different oral manifestations and complications seen in these patients in descending order were; gingivitis [45%], periodontitis [36%], dental root caries [22%], taste dysfunction [7%], neurosensory dysesthesias [5%], xerostomia [4%] and oral candidiasis [2%]. It was concluded that diabetic patients are more prone to get oral complications so health education, timely diagnosis and effective treatment should be carried out to prevent these complications