Anti-hyperlipidemic and anti-diabetic evaluation of ethanolic leaf extract of Catharanthus roseus alone and in combination therapy

The use of plants in disease treatment is cost effective and relatively safe. This study was designed to investigate anti-hyperlipidemic and anti-diabetic activity of ethanolic leaf extract of Catharanthus roseus alone and in combination therapy in hyperlipidemic & diabetic mice. Eight groups comprising five mice each were used. Group A was hyperlipidemic control, group B, C, D received atorvastatin (20 mg/kg), leaf extract (200 mg/kg) and leaf extract in combination with atorvastatin (200 mg/kg and 20 mg/kg) orally for 15 days. Group E was diabetic control. Group F, G, H received sitagliptin (40 mg/kg), leaf extract (200 mg/kg) and extract in combination with sitagliptin (200 mg/kg and 40 mg/kg) orally for 7 days. Blood cholesterol levels were measured at 1st, 5th, 10th and 15th day and fasting blood sugar levels were measured at 2, 12, 24, 72 and 168 hours during treatment. One-way ANOVA with tukey- kramer multiple comparison test was used. The chemical characterization of ethanolic extract of Catharanthus roseus leaves showed presence of alkaloids, saponins, tannins and flavonoids. Ethanolic extract of Catharanthus roseus has significant anti-hyperlipidemic & anti-diabetic effects (p<0.05, p<0.01) when compared with control but had not cause significantly increase in anti-hyperlipidemic effects of atorvastatin. While significantly increased the antidiabetic effect of sitagliptin (p<0.05)

Glycemic patterns and factors associated with Post-Hemodialysis Hyperglycemia among end-stage Renal Disease patients undergoing, maintenance Hemodialysis / Journal of the ASEAN Federation of Endocrine Societies

Introduction@#Chronic and post-prandial hyperglycemia are independent risk factors for diabetic complications. Glycemic patterns among hemodialysis end-stage-renal-disease (ESRD) differ as glucose metabolism changes with declining kidney function with more pronounced glycemic fluctuations. The objectives of this study are to determine glycemic patterns on hemodialysis days, the magnitude of post-hemodialysis rebound hyperglycemia (PHH) and their associated factors.@*Methodology@#148 patients on hemodialysis were analysed, 91 patients had end-stage-diabetic-renal disease (DM-ESRD), and 57 patients had end-stage-non-diabetic renal disease (NDM-ESRD). Glycemic patterns and PHH data were obtained from 11-point and 7-point self-monitoring blood glucose (SMBG) profiles on hemodialysis and non-hemodialysis days. PHH and its associated factors were analysed with logistic regression.@*Results@#Mean blood glucose on hemodialysis days was 9.33 [SD 2.7] mmol/L in DM-ESRD patients compared to 6.07 [SD 0.85] mmol/L in those with NDM-ESRD (p<0.001). PHH occurred in 70% of patients and was more pronounced in DM-ESRD compared to NDM-ESRD patients (72.5% vs 27.5%; OR 4.5). Asymptomatic hypoglycemia was observed in 18% of patients. DM-ESRD, older age, previous IHD, obesity, high HbA1c, elevated highly-sensitive CRP and low albumin were associated with PHH.@*Conclusion@#DM-ESRD patients experienced significant PHH in our cohort. Other associated factors include older age, previous IHD, obesity, high HbA1c, elevated hs-CRP and low albumin.

Methanol outbreak in the district of Hulu Langat, 2018

@#Introduction: A methanol outbreak occurred in the district of Hulu Langat on 16 September 2018. The Hulu Langat District Health Office received 25 notifications of a suspected methanol poisoning from Kajang and Ampang Hospital. An outbreak investigation was done to determine the source followed by a preventive and control measure. Method: Active case detection was done on cases living quarters and workplaces. Patients were interviewed, and their blood and urine samples were sent for methanol analysis. Samples of suspected alcoholic beverages were also sent for analysis. A suspected case was defined as any person presented with clinical symptoms with a history of consuming alcoholic beverages within five days before symptoms and high anion gap metabolic acidosis. A confirmed case was defined as a suspected case with positive blood and urine methanol. Results: In total, there were 25 suspected cases, of which 12 cases were confirmed. The calculated attack rate was 48%. There were six mortalities (50%) secondary to severe metabolic acidosis. The most common presenting symptom was vomiting (75%) and abdominal pain (41.7%). These cases were linked to consumption of illicitly produced alcohol. Samples of the alcoholic drinks were positive containing high level of methanol. Conclusion: The methanol outbreak in the Hulu Langat was successfully managed. Appropriate control and prevention measures were taken, including health promotion and joint enforcement activities. Steps were taken successfully through collaborations with multiple agencies and cooperation with Selangor Health Departments and the Ministry of Health. Continuous surveillance on the product of liquor, and health promotion are essential to prevent a similar outbreak from happening again in future.

A cluster randomised controlled trial on effectiveness of carbon monoxide measurement feedback among college smoker : A study protocol

@#For the last 30 years, tobacco smoking has continued to be the leading cause of premature deaths in Malaysia. Majority of the smokers in Malaysia are at the precontemplation and contemplation stages. Therefore, for the purpose of increasing smoking cessation among this group, the strategies that motivate them to quit smoking have to be reviewed.

Caesarian sections: frequency and indications at peripheral tertiary care hospital

Objective: This study was conducted to determine the frequency and indications of caesarian section [CS] at Combined Military Hospital [CMH] Abbottabad. Study Design: Descriptive cross sectional study. Place and Duration of Study: Obstetrics and Gynecology Department, CMH Abbottabad, from Sep 2016 to Mar 2017

Material and Methods: A total of 2, 340 females delivered during the study duration were enrolled in study. Medical records of all the patients were analyzed retrospectively to determine the CS rate. Patient's demographic data, obstetric history, and indications and type of CS were recorded. Data were entered, coded and analyzed in IBM SPSS Statistics 20 software. Descriptive statistics were produced

Results: Of 2340 births, 1093 [46.7%] were via CS with about 50.9% being emergency CS. Mean age of the patient who underwent CS was 26.7 years. The most frequently noted indication was previous CS [59.4%], followed by poor progression of labor [32.2%], and fetal distress [26.9%]. More than half of the women [57.7%] who underwent CS fell into Robson Group 5 i.e. were multiparous with at least one previous CS and had a single cephalic pregnancy at term

Conclusion: CS rate at our setting was comparable to rates at similar tertiary care hospitals in Pakistan. The most common indication was previous scar, the most frequently observed indication in literature

Intrauterine balloon tamponade-a novel technique to prevent and manage placental site haemorrhage

Objective: This study was conducted to determine the effectiveness of Foley catheter balloon tamponade in postpartum haemorrhage at Combined Military Hospital [CMH] Abbottabad. Study Design: Descriptive study. Place and Duration of Study: Obstetrics and Gynaecology Department CMH Abbottabad, from Sep 2016 to Mar 2017

Material and Methods: Patients who developed postpartum haemorrhage after caesarean section [CS] and were treated with intrauterine balloon tamponade [IUBT] using a Foley catheter were identified by review of medical records. Patient's demographic data, obstetric history, type of CS, cause of haemorrhage and transfusion history were extracted. Data was entered, coded and analyzed in IBM SPSS Statistics software. Descriptive statistics were produced

Results: A total of 26 patients were included with mean age of 29.2 +/- 5.23 years. More than two-thirds of the patients were multi-gravida and around three-quarters were at full term. The most frequent cause for postpartum haemorrhage [PPH] was placenta previa major. In 25 of the 26 [96.1%] patients the procedure was successful in stopping bleeding. There were no adverse effects related to the procedure

Conclusion: We found that IUBT with an inexpensive Foley catheter is likely to be effective in most cases of PPH associated with caesarean section, without causing additional adverse events

Doctor Shopping Behaviour and Its Predisposing Factors amongst Dermatology Patients / Jurnal Sains Kesihatan Malaysia

@#Doctor shopping increases health economic burden and morbidities. Its prevalence and predisposing factors have to beidentified in order to formulate preventive measures. We aimed to determine the prevalence of doctor shopping, its reasonsand predisposing factors by conducting a cross sectional study of new patients at the Dermatology Clinic, UniversitiKebangsaan Malaysia Medical Centre (UKMMC). Doctor shopping was defined as having consultation with ≥3 healthcareproviders without a referral for the same illness prior to the patients’ visit to UKMMC. Reasons and contributing factorswere classified as disease, healthcare provider, logistic and cost related. Data was collected by a face to face interview.Dermatology Life Quality Index (DLQI) questionnaire determined disease impact on the patients. A total of 58 (55.8%)female and 46 (44.2%) male patients participated. Referral was patient-initiated in 51.9% while 40.4% were doctorshopping. Age, gender, ethnicity, income, occupation and type of health finance provider were not associated with thisbehaviour. About 95% doctor shopped due to disease factors: searching for a cure (95.2%), lack of improvement (88.1%),worsening disease (50.0%), dissatisfaction with treatment (31.0%), seeking other opinions (26.2%) and exploringtreatment options (26.2%). Impaired DLQI (OR 1.17; 95% CI 1.08,1.38), p 0.04, and disease related factors (OR 6.57; 95%CI 1.52, 7.72), p 0.041 were significant independent risk factors. Doctor shopping is very common among our patients.Reasons and predisposing factors are predominantly disease related. Patient education and counselling is important inmanagement of dermatological diseases to prevent doctor shopping.

Definitive management of Morbidly Adherent Placenta: analysis of maternal outcomes

Objective: To identify risk factors predisposing to morbidly adherent placenta and to study obstetric outcome in such patients

Study Design: Retrospective descriptive study

Place and Duration of Study: Department of Obstetrics and Gynaecology Military Hospital Rawalpindi, from Jan 2014 to Dec 2014

Material and Methods: A total of 54 patients with morbidly adherent placenta were studied retrospectively. Patient's data including demographic data, previous obstetric history and outcome was collected from hospital records. Data was analyzed by using SPSS version 20

Results: The incidence of morbidly adherent placenta was 4.74 per 1000 deliveries. Mean age of patients was 33.33 +/- 2.82 years with mean gestational age of 35.13 +/- 0.91 weeks. All patients had history of prior caesarean section with 4 [7.40 percent] patients having four, 32 [59.25 percent] having three, 16 [29.62 percent] having two and 2 [3.70 percent] having one previous caesarean section. Associated placenta previa was present in 43 [79.62 percent] patients. Out of 54 patients 39 [72.22 percent] had placenta accreta, 11 [20.37 percent] had placenta percreta while 4 [7.4 percent] had placenta increta. Obstetric hysterectomy was done in 51 patients while in remaining 3 uterus was preserved. Out of these three, one died as a result of septicemia while methotrexate was started in remaining two cases. However an interval hysterectomy was performed in these two cases because of massive postpartum hemorrhage

Conclusion: Previous caesarean section and placenta previa are major risk factors for morbidly adherent placenta. Patient education, antenatal diagnosis with well planned surgical intervention and anticipation of blood loss are keys to successful management

Assessing knowledge and practice among patients with diabetes at tertiary care hospital

Objective: To assess knowledge and practice among patients with type 2 diabetes and to study their demographic details

Study Design: Cross-sectional observational study

Place and Duration of Study: Outpatient department, Combined Military Hospital Abbottabad, from Oct 2016 to Mar 2017

Material and Methods: A total of 430 patients with type 2 diabetes who attended outpatient department for routine visits were included in the study after taking consent. While patients with type 1 DM, chronic illnesses like; cardiac failure, renal failure and psychiatric illness were excluded from study. All patients were selected by non probability convenient sampling technique. Data was collected by using a questionnaire and was analyzed by using SPSS software. Descriptive statistics were produced

Results: Out of 430, 232 [53.95 percent] were male while 198 [46.04 percent] were female with male to female ratio of 1.17:1. The greatest numbers of patients were in age group 60-69 years with average duration of DM 1-5 years in about 35.35 percent. Seventy seven percent of patients had positive family history of disease. About 40 percent of patients had average knowledge with mean score of 2.02 while 52.5 percent had satisfactory practice and routine follow up. Eye complications, neuropathy and nephropathy were major complications observed

Conclusion: The overall level of knowledge and practice concerning diabetes is average. This highlights the importance of awareness campaign and patient counseling to improve their knowledge regarding diabetes. There should be continuous process of evaluation to improve patient care and also health care delivery system

Role of laparoscopy in evaluation of abdominal pain

Objective: To evaluate the diagnostic efficacy of laparoscopy in ill-defined recurrent chronic abdominal pain

Study Design: Prospective study

Place and Duration of Study: Surgical department, Military Hospital Rawalpindi, from Jul 2011 to Dec 2013

Material and Methods: A total of 102 patients who presented to surgical department with chronic recurrent abdominal pain of unknown etiology and underwent diagnostic laparoscopy were included in our study. Patients with acute onset of abdominal pain, hemodynamically unstable, pregnant or those in which diagnosis can be made by radiological techniques were excluded from our study. Patient's demographic data, clinical findings and laparoscopic findings were recorded. Finally data was analyzed by using SPSS version 21

Results: Out of 110 patients 96 were female while remaining 14 were male. The age range of the patients was 20-70 years with mean age of 50 +/- 10 years. The most common site of pain was lower abdomen while mean duration of abdominal pain was 34 weeks. Laparoscopic findings include acute recurrent appendicitis in 32 [29.09%] patients, cholecystitis with biliary sludge in 14 [12.72%], pelvic inflammatory disease in 12 [10.90%], ovarian cyst in 11[10%], adhesions in 10[9.09%], intestinal tuberculosis in 8 [7.27%], mesenteric lymphadenitis in 7 [6.36%], lymphoma in 4 [3.63%], ectopic pregnancy in 3 [2.7%], CA gallbladder in 2 [1.81%], meckels diverticulum in 2 [1.81%], endometriosis in 2 [1.81%] and crohns disease in 1 [0.9%] patients. Mean operative time was 48 min while average hospital stay was 2-3 days. No major complications were noticed

Conclusion: Laparoscopy in our clinical setup has significant role in diagnosing cases of vague abdominal pain which cannot be diagnosed by routine investigations

Outcome in patients undergoing endoscopic lumbar discectomy for prolapsed para spinal intervertebral disc

Background: Backache is second most common problem presenting to the primary healthcare providers. Lumbar discectomy has been revolutionized from open conventional discectomy to endoscopic removal. Endoscopic procedures are proving their superiority regarding good outcome, less wound site pain and shorter hospital stay, in Neurosurgery as well. Micro discectomy and Endoscopic discectomy is used only in few centres in Pakistan. This study aimed to share our experience of early surgical outcome endoscopic lumbar discectomy in terms postoperative pain improvement and duration of hospital stay

Methods: This prospective study was carried out at Neurosurgery Department, Jinnah Hospital, Lahore from Jan 2014 to Jan 2016. During this period, 35 patients of both sexes, aging between 20 and 60 years, with symptoms and signs of lumbago with sciatica were enrolled. Data was collected on a questionnaire after informed verbal and written consent

Results: A total of 35 patients were operated including 10 males and 25 females. Their age ranged from 20 to 60 years with mean age 33.14+/-8 years. Majority [32, 91%] of the patients had left side prolapsed paracentral disc, and remaining [3, 9%] had right sided prolapsed disc. Regarding the level of disc 19 [54%] patients had L4- 5 while 15 [43%] had L5-S1 and remaining one [2.9%] patients had L3-4 level. The post-op wound site visual analogue score was 1.57+/-1.1. Twenty-five patients had VAS of 1 [71.4%]. Minimum hospital stay was 1 day in 16 [45.75%] patients and maximum was 4 days in 3 [8.6%] patients. Mean hospital stay was 1.83+/-0.95 days. The only complication encountered was iatrogenic dural tear seen in one patient but with no CSF leak from wound site. No surgical site infections were reported at follow-ups

Conclusion: Endoscopic Lumbar discectomy is a safe procedure with short hospital stay

Outcome and Predictors for Smoking Cessation in a Quit Smoking Clinic

Smoking is one of the addiction problems that needs an effective intervention. Smoking cessation studies have shown the promising result, but the central issue was to prevent relapse. A retrospective cohort study was conducted at Quit Smoking Clinic in Klinik Kesihatan Tanglin, Kuala Lumpur to determine the outcome and predictors of smoking cessation. A cohort of 770 smokers attended the clinic between the year 2008 and 2015 was selected through simple random sampling. Smokers were defined as current smokers while smoking abstinence is defined as cessation for more than 6 months and relapse as any smoking episode even a puff since the quit date. The majority were Malays, Muslims and had at least secondary education. The mean age of smoking initiation was 17.6 years old. The majority of the respondent smokes between 11 to 20 sticks per day and had a higher nicotine dependence score (43.0%). The smoking cessation outcome was good with 52.5% of the respondent abstained from smoking at 6 months. The predictors for smoking cessation were numbered of the quit attempt (1 to 10 times) (AOR = 1.582, 95% CI = 1.012-2.472) and pharmacotherapy (aOR = 0.711, 95% CI=0.511-0.989). More frequent follow-up was essential during the first 6 month period to enhance not only medication compliance but also a motivational aspect to smokers to maintain cessation. Emphasis should also be made for smokers who make first quit attempt.

Pattern of facial gunshot and blast injuries amongst law enforcing forces

Objective: To assesses the pattern of maxillofacial gunshot and blast injuries amongst law enforcing forces personnel

Study Design: Descriptive Study

Place and Duration of Study: Combined Military Hospital Lahore from Jan 2010 to Dec 2010

Materials and Methods: This prospective study evaluated 52 patients from Jan 2010 to Dec 2010 at Combined Military Hospital [CMH], Kohat Pakistan. All patients in this study were males as fighting corps of law enforcing forces comprises only male soldiers and officers. Patients aged from 18 to 50 years with mean age 29.12 years +/- 8.56 years

They were assessed for presence of gunshot and ballistic injuries by clinical examination and evaluation of necessary radiographic investigations

Results: Nineteen patients out of total 52 patients had no other injury which accounts for about 36.9%. In maxillofacial area upper third of face was most frequent site to receive gunshot and ballistic injuries as 10 patients received injuries to upper face which measures about 19.2%. Along with maxillofacial area upper limbs were most common site affected as 14 patients received injuries to upper limbs which is 26.9% of all patients

Conclusion: Gunshot wounds present a great challenge to oral and maxillofacial surgeons and a multidimensional team approach is required to rehabilitate the victims of gunshot injuries

Effect of calcium hypochlorite and chloramine on blood biochemistry and sodium pentobarbital induced sleeping time in mice

Disinfectants are chemical agents used to eradicate, deactivate or kill microorganisms. Chemical disinfectants especially chlorine compound are extensively used for water sanitization. Among these calcium hypochlorite and chloramines are commonly used now a day. Large number of chemical compounds, drugs and endogenous substances are metabolized by hepatic enzymes known as cytochrome P450 enzyme system. Many chemicals are capable of enzyme induction. Enzyme induction may change the metabolism of other drugs and endogenous substances which may alter the plasma concentration of these chemicals. To evaluate the enzyme inducing ability of calcium hypochlorite and chloramine, sleeping time induced by sodium pentobarbital was noted in mice. Normal saline was taken as negative control. Rifampicin, chloramphenicol and grapefruit juice were taken as positive control group. On completion of dosing after 4 weeks, alteration in sleep induction and recovery times was noted and compared. Histological evaluation of liver was observed. Asignificant decrease in sleeping time was observed in calcium hypochlorite and chloramine treated groups. Both calcium hypochlorite and chloramine caused a significant change in liver enzymes and in the values of complete blood count.In histological evaluation both caused fat deposition in the hepatocytes. It was concluded from the study that both calcium hypochlorite and chloramine were hepatic microsomal enzyme inducer

Utilization of genes encoding osmoprotectants in transgenic plants for enhanced abiotic stress tolerance

Global agriculture in the context of growing and expanding populations is under huge pressure to provide increased food, feed, and fiber. The recent phenomenon of climate change has further added fuel to the fire. It has been practically established now that the global temperature has been on the increase with associated fluctuations in annual rainfall regimes, and the resultant drought and flood events and increasing soil and water salinization. These challenges would be met with the introduction and utilization of new technologies coupled with conventional approaches. In recent years, transgenic technology has been proved very effective in terms of production of improved varieties of crop plants, resistant to biotic stresses. The abiotic stresses such as salt and drought are more complex traits, controlled by many genes. Transgenic plant development for these stresses has utilized many single genes. However, much emphasis has been placed on genes catalyzing the biosynthetic pathways of osmoprotectants. This review focuses on the current status of research on osmoprotectant genes and their role in abiotic stress tolerance in transgenic plants.

Situs ambiguous in an adult with congenital cardiovascular and musculoskeletal defect

Situs ambiguous [SA] is an abnormality in which the thoracic and abdominal organs are not clearly lateralized. Situs ambiguous with polysplenia is usually associated with complex cardiovascular abnormalities and rarely found among adults due to high mortality at younger age. We are reporting a rare cluster of Situs ambiguous with polysplenia [left isomerism] in an adult with congenital hand deformity and cardiovascular pathology, who presented with ascites and decompensated congestive cardiac failure due to dilated cardiomyopathy. He had congenital agenesis of left hand fingers and hypoplastic left thumb. Electrocardiogram and imaging findings were consistent with dextrocardia, Situs inversus and features of left isomerism. Echocardiography showed severe biventricular failure with prominent coronary sinus. Such a combination of musculoskeletal and cardiovascular pathologies was not reported in the literature. His coronary arteries were normal. He had successful single chamber Implantable Cadioverter Defibrillator [ICD] insertion

Heart failure clinical outcomes in hyponatremic versus normonatremic patients

To compare the outcome in heart failure patients between normonatremic and hyponatremic cases in the short term. A cross-sectional study focusing on descriptive statistics at the Department of Cardiology, Lady Reading Hospital Peshawar was performed from 9th August 2011, till 29th April, 2012. Both male and female patients aged 14 years and above admitted diagnosed with heart failure were enrolled and data observed. Those having serum sodium of ?135mmol/L were defined as hyponatremic. All the patients were managed according to guidelines. All patients were followed during their hospital stay. Patients who survived were discharged on standard HF medications and followed till the end of third month for 3 month mortality and re-admissions for heart failure. Total study population was 241. Mean age was 59.2 +/- 14.9 [18- 100] years. Female patients were 51% [123]. Mean serum sodium was 136 +/- 5.1mmol/L [116-151]. Hyponatremia was present in 35.3% [85] patients. Overall three month follow up mortality was 14.7%, while it was significantly higher in hyponatremic group 22.7% compared to normonatremic patients 10.7% [P=0.02]. Being followed for a period of 3 months 25% patients were readmitted to hospital with heart failure decompensation. Hyponatremic group had readmission rate of 26.7% compared with 24% in normonatremic patients [p=0.74]. Hyponatremia in patients diagnosed with heart failure possess a significant over all risk to a higher mortality as compared to those that are normonatremic. Re-admissions for heart failure are equally common in hyponatremic and normonatremic patients

Laparoscopic cholecystectomy: a clinical practice audit

To evaluate laparoscopic cholecystectomy by a clinical practice audit at Military Hospital, Rawalpindi. Prospective study. Surgical department Military Hospital from Jul 2011-Dec 2013. A total of 1020 patients who underwent laparoscopic cholecystectomy for acute or chronic cholecystitis and gallstone panereatitis were included in our study while those who had previously undergone abdominal surgeries, those with high risk for general anesthesia, immunocompromised patients, with age greater than 70 years and having comorbidities like cardiac insufficiency, severe asthma, chronic liver disease with ascites and compromised renal functions were excluded from the study. Patients' demographic data, operative time, intra-operative findings, intra-operative difficulties, post-operative complications, conversion rate to open cholecystectomy and post-operative recovery time were recorded. Data was analyzed by using SPSS version 21. Out of 1020 patients 907 were females while 113 were males with male to female ratio of 1:8.02. Age range was 20-70 with mean age of 50 k 10.456 years, 447% patients presented with the clinical features of acute cholecystitis, 540 [52.94%] with chronic cholecystitis and 23 [2.28%] with acute panaeatitis. Mean 1 operative time was 20 minutes in asymptomatic patients, while 40 minutes in acute cholecystitis and 35 minutes in chronic gallstone disease. Gall bladder perforation, bleeding from cystic artery and bile spillage were mostly encountered per-operative difficulties. Only 37 [3.6%] patients were converted to open cholecystectomy. Post-operative complications occur in only 122 [12%] patients. 938 [92%] patients were discharged within 48 hours. of surgery. Laparoscopic cholecystectomy in our setup has comparable results to the data available from other surgical facilities around the world and it has become a gold standard technique for the treatment of non-complicated gallstone disease

Prediction of 10-year risk of hard coronary events among Saudi adults based on prevalence of heart disease risk factors

Cardiovascular disease is becoming the lead cause of mortality and morbidity worldwide, and developing countries are the main contributors to this trend. Saudi Arabia, which is considered a rapidly developing country, faces progressive urbanization and the adoption of a westernized lifestyle, factors which contribute to the rising burden of cardiovascular disease. Our study evaluates the prevalence of coronary risk factors and predicts hard coronary artery events over 10 years in an urban Saudi cohort. A cross-sectional observational study was conducted on a Saudi population. The study involved Saudi subjects aged more than 20 years without a history of coronary heart disease. Demographic variables and hard coronary events [HCE] risk factors were measured. Each subject's 10-year HCE risk was estimated by means of the Framingham Risk Score [FRS]. A total of 4932 subjects [2215 men and 2717 women] were examined, the majority [85%] of whom were less than 40 years old. The risk of developing HCE within the next 10 years was low in 92.6% of subjects, intermediate in 3.2% and high in 4.1%. On considering diabetes as coronary heart disease [CHD] risk-equivalent, 26% of subjects were at high risk for hard coronary events in 10 years. The HCE risk progressively increased with age and was higher in men. Our study, the first to estimate the 10-year risk of HCE among adults in an emerging country, deter-mined that a significant proportion of a younger aged population is at risk for the development of hard coronary events. Public awareness programs to control risk factors are warranted

Spectrum of diseases in acute intestinal obstruction

To determine the etiological spectrum of acute intestinal obstruction in our clinical setup Military Hospital Rawalpindi. Descriptive study. Surgical department of Military Hospital, Rawalpindi from Jul 2012 to Jul 2013, over a period of about 1 year. A total of 120 patients with acute mechanical intestinal obstruction who underwent laparotomy were included in our study while those with non-mechanical intestinal obstruction like history of trauma and paralytic ileus were excluded from the study. All the patients were selected by non-probability purposive sampling technique. Emergency laparotomy was done and operative findings were recorded. A total of 120 patients with mechanical intestinal obstruction were included in this study out of which 93 [69.17%] were female and remaining 27 [30.83%] were males. Male to female ratio was 1:2.24. Age range of patients was 22-85 years. Out of 120 patients operated for acute intestinal obstruction post-op adhesions were found in 37 [30.83%] patients followed by intestinal tuberculosis in 23 [19.17%] patients, obstructed inguinal hernias in 13 [10.83%], gut malignancies in 15 [12.5%], Meckel's diverticulum with bands in 7 [5.83%], volvulus in 7 [5.83%], perforated appendix in 6 [5%], intussusception in 2 [1.7%], inflammatory bands in 5 [4.17%], trichobezoar and faecal impaction in 2 [1.7%] while in 3 [2.5%] patients no definite cause was found. Post-op adhesions are the commonest cause of mechanical intestinal obstruction in our setup followed by intestinal tuberculosis as second most common clinical pattern of presentation