Current trends in treatment of hypertension in Karachi and cost minimization possibilities

This study finds out drug usage trends in Stage I Hypertensive Patients without any compelling indications in Karachi, deviations of current practices from evidence based antihypertensive therapeutic guidelines and looks for cost minimization opportunities. In the present study conducted during June 2012 to August 2012, two sets were used. Randomized stratified independent surveys were conducted in doctors and general population - including patients, using pretested questionnaires. Sample sizes for doctors and general population were 100 and 400 respectively. Statistical analysis was conducted on Statistical Package for Social Science [SPSS]. Financial impact was also analyzed. On the basis of patients' doctors1 feedback, Beta Blockers,and Angiotensin Converting Enzyme Inhibitors were used more frequently than other drugs. Thiazides and low-priced generics were hardly prescribed. Beta blockers were prescribed widely and considered cost effective.This trend increases cost by two to ten times. Feedbacks showed that therapeutic guidelines were not followed by the doctors practicing in the community and hospitals in Karachi. Thiazide diuretics were hardly used. Beta blockers were widely prescribed. High priced market leaders or expensive branded generics were commonly prescribed. Therefore, there are great opportunities for cost minimization by using evidence-based clinically effective and safe medicines

Ovarian cancer; the role of CA-125 as a tumor marker. An institutional based descriptive and prospective study

1]. To analyze of serum tumor marker CA-125 in patients with ovarian malignant tumors. 2]. To correlate between the serum levels of tumor marker with histological types of ovarian malignant tumors. Institution based descriptive and prospective study. Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro from January 2009 to June 2011. One hundred cases, diagnosed as ovarian malignant tumor on H and E staining were selected for study and measure serum CA-125 preoperatively and postoperatively in each case. Out of 100 cases diagnosed as on H and E stain were 33 serous cystadenocarcinoma, 24 mucinous adenocarcinoma, 10 germ cell tumors and 08 sex-cord stromal tumors. On serum analysis increased level of CA-125 was seen preoperatively in 33/33 cases of serous cystadenocarcinoma and 24/29 cases of mucinous adenocarcinoma. Serum tumor marker value was declined following appropriate therapy of the tumors. Serum tumor markers CA-125 is useful and important for the detection of ovarian tumors. It is most significant for serous cystadenocarcinoma. It may also help in prognosis and specific treatment of ovarian malignancies relating to histological type

Strong BCL2 expression in Burkitt lymphoma is not uncommon in adults.

Background: The distinction between Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL) is not always easy, so much so that the WHO 2008 Blue Book has incorporated a provisional category of "B-cell lymphoma, unclassifiable with features intermediate between DLBCL and BL." One of the immunohistochemical (IHC) markers used at times to differentiate between the two is IHC expression of BCL2, which was initially believed to be consistently negative in BL. Later it was recognized that weak BCL2 expression is still compatible with the diagnosis of BL. To verify or otherwise this current view this study was undertaken. Materials and Methods: We retrieved 39 confirmed cases of BL, in both children and adults. All these cases had typical morphology, IHC profile, and Mib-1 index that are typical of BL. All these cases were then stained with a monoclonal antibody against BCL2 oncoprotein, using 2-step Envision system. Results: Out of 39 cases, 31 cases (79.4%) were completely negative for BCL2, whereas 5 (12.8%) were weak focal positive. However, another 4 (10.2%) cases did show strong diffuse cytoplasmic staining for BCL2. Fluorescent in-Situ hybridization (FISH) for t(14:18) was optimally done on 6 out of 9 cases. All these 4 cases were from adults with 3 out of 4 arising in the parotid region. Two out of 4 cases also showed t(8:14) on FISH. Conclusions: It was concluded that contrary to the common belief, strong BCL2 IHC expression is possible in typical BL in adults and cannot be absolutely relied upon to distinguish between BL and DLBCL.

Post Dural puncture headache - a comparison of midline and paramedian approaches

The purpose of this study was to compare two approaches for dural puncture regarding post dural puncture headache [PDPH] in general population presenting for surgery under spinal anaesthesia. A comparative observational study was conducted at Sir Ganga Ram Hospital, Lahore, from March 2005 to July 2005. Twenty five patients, planned to undergo elective surgery under spinal anaesthesia, were randomly assigned to each of the two groups. Group-M received sub arachnoid block [S.A.B.] using midline approach for dural puncture whereas in Group-P paramedian approach was utilized. Both groups were observed for PDPH for three post operative days. The PDPH was much less frequent in P group compared to M Group, thus it was concluded that paramedian approach should be used frequently for dural puncture for spinal anaesthesia