Awareness Regarding Thalassemia in General Population of Rahim Yar Khan, Pakistan

Background: Thalassemia, an inherited blood disorder represents a significant burden for many countries across the globe and the knowledge related to this illness is very limited. The preventive practices, among people especially from developing countries. In Pakistan, Thalassemia is a serious health problem bearing 5 to 8% frequency of beta-Thalassemia gene without discrimination of ethnic groups. Objective: To assess the awareness level regarding Thalassemia in general population of Rahim Yar Khan, a district of Southern Punjab, Pakistan. Methodology: Study Design: Cross sectional study. A total of 400 adults of 18 years and above age, were selected randomly, from the households of the Rahim Yar Khan City and one Rural Union council. Out of 400 subjects, only 131, reported that they had heard the name ”Thalassemia”, hence for analysis of awareness, the data of only these 131 was used. A structured questionnaire was designed which included information on; gender, age and 24 questions about awareness of Thalassemia disease. Level of Awareness was ascertained by response of these 24 questions and was categorized as poor, average and good. The persons answering less than 12 questions correctly were considered to have poor knowledge, answers of 13-18 questions were labeled as possessing average knowledge and the persons were included in category of having good knowledge who answered more than 18 questions correctly. Data was analyzed by using SPSS 20. Results: Out of 131 study subjects , who reported to have ever heard of word Thalassemia, level of awareness about Thalassemia was found to be “Good” among 7 (5.4%) persons, 27 (20.6%) persons have an average knowledge about Thalassemia and a large number of people 97 (74%) have poor knowledge about Thalassemia disease. Conclusion: Public knowledge regarding Thalassemia was found to be poor among general population of Rahim Yar Khan, Pakistan.

Hypoglycemic and hypolipidemic effects of Lactobacillus fermentum, fruit extracts of Syzygium cumini and Momordica charantia on diabetes induced mice

A lot of treatment strategies available for diabetes but its complications are still a medical problem around the globe. It demands to find out some alternative therapeutic measures. In order to investigate the anti-diabetic potential of probiotics and natural extracts, this study was designed. Accordingly, a local source of yogurt probiotic strain Lactobacillus fermentum was isolated and characterized that showed its probiotic properties. Besides this, natural extracts of plants fruits like java plum [Syzygium cumini] and bitter gourd [M. charantia] were made. Lactobacillus fermentum and the extracts were administered individually as well as in combination to diabetes induced mice. Different parameters like body weight, blood glucose level and lipid profile including total cholesterol, HDL and LDL were analyzed before and after treatment. The results showed that Lactobacillus fermentum and natural extracts have hypoglycemic as well hypolipidemic activity against diabetic mice. This study can further investigated to screen potential compounds from these extracts to control the glucose and the lipid levels in diabetic patients

Vildagliptin ameliorates biochemical, metabolic and fatty changes associated with non alcoholic fatty liver disease

Objective: To determine the effect of Vildagliptin in non-alcoholic, fatty liver disease patients with dyslipidemia

Methods: A randomized placebo controlled trial was conducted at outpatient clinic of Medical Unit-I of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, in which fifty eight patients of NAFLD with dyslipidemia were divided in to two, case and control groups. The case group was given tablet Vildagliptin 50mg twice a day for twelve weeks and control group was given placebo in same way. Body weight, body mass index [BMI], lipid profile, liver enzymes and ultrasound finding of fatty liver were assayed before and after treatment

Results: After 12 weeks treatment of vildagliptin there was significant improvement in following parameters. Body weight and BMI decreased significantly from 88 +/- 11 to79 +/- 12 kg [p0.036] and 30 +/- 4 to 27 +/- 5 kg/m2 [p 0.005] respectively. Notable reduction in the value of TC, TG and LDL-C [TC: 252 +/- 24 to 220 +/- 20mg/dl [p 0.031]; TG: 190 +/- 24 to115 +/- 22 mg/dl [p 0.005]; LDL-C 160 +/- 15 to 145 +/- 13mg/dl [p 0.004]. HDL-C level increased significantly from 29 +/- 5to45 +/- 4 mg/dl [p 0.001].There was remarkable reduction in aminotransferases level [ALT: 78 +/- 17 to 48 +/- 14IU/L [p 0.036]. AST: 63.3 +/- 13 to41 +/- 11IU/L [p 0.002]. There was overall 65.5% improvement in fatty liver grading on ultrasound with vildagliptin while non significant effects were seen in placebo group in all of the above parameters

Conclusion: Vildagliptin exhibited beneficial effects in non-alcoholic fatty liver disease, Nondiabetic patients with dyslipidemia

Isolation and purification of heparin from bovine pancreas by different methods

Background: Different methods of heparin extraction are being used

Objective: To compare heparin extraction from bovine pancreas by using three different methods including method of Charles and Scott, Max and Volpi

Methodology: Design: Comparative Study. Setting: The University of Lahore with three month's duration starting from 1[st] July 2013. Fresh twenty samples of bovine pancreas samples were collected from the slaughterhouse of Lahore Pakistan and immediately placed in the ice buckets. The isolated heparin samples were separated into two species, slow moving and fast moving heparin by agarose gel electrophoresis. The anticoagulant activity of heparin samples was determined by using assay of Mitali et al [1982]

Results: The percentage yield of heparin extracted by Volpi method was significantly higher [P<0.001] i.e. 0.446% with the anticoagulant activity of 19 IU/ mg for bovine pancreas

Conclusion: Heparins are important in the field of medicine and pharmaceuticals. The results of our study showed that heparin isolated by the method of Volpi was significantly higher for bovine pancreas

Diagnostic accuracy of Magnetic Resonance Imaging in assessment of Meniscal and ACL tear: correlation with arthroscopy

To determine the diagnostic accuracy of magnetic resonance imaging [MRI] in injuries related to anterior cruciate ligament and menisci and compare its effectiveness with that of arthroscopy. This retrospective cross-sectional study was conducted in the department of Radiology and Medical Imaging of Dallah Hospital, Riyadh, Kingdom of Saudi Arabia from September 2012 to March 2014. Fifty four patients [including 30 men and 24 women] with internal derangement of knee referred from the orthopedic consulting clinics underwent MR imaging followed by arthroscopic evaluation. The presence of meniscal and ligamentous abnormality on the imaging was documented by two trained radiologist. Findings were later compared with arthroscopic findings. The sensitivity, specificity and accuracy of MR imaging for menisci and ACL injury were calculated: 100% sensitivity, 88.4% specificity, 90% positive predictive value, 100% negative predictive value, and 94.4% accuracy were noted for medial meniscal injury. Similarly, MR had sensitivity of 85.7%, specificity of 95%, positive predictive value of 85.7%, negative predictive value of 95%, and accuracy of 92.5% for lateral meniscal injuries. Likewise, anterior cruciate ligament had 91.6% sensitivity, 95.2% specificity, 84.6% positive predictive value, 97.5% negative predictive value, and 94.4% accuracy. MRI is extremely helpful in identifying meniscal and anterior cruciate ligaments tears. MR imaging has high negative predictive value making it better choice as screening tool compared to diagnostic arthroscopic evaluation in most patients with soft tissue trauma to knee

Laboratory surveillance of malaria at District Bahawalpur Punjab, Pakistan

Background: In Pakistan malaria is prevalent in different parts of all the four provinces. The estimated number of annual malaria cases in Pakistan is 1.5 million. The climate of Pakistan is conducive for malarial transmission

Objective: The present study was planned to determine the laboratory surveillance of malaria in Bahawalpur District over a period of five years

Patients and Methods: The present descriptive study was conducted on malarial epidemiology in Bhawalpur region over a period of 5 years from 2007 to 2011. The study was conducted by collecting data from those health facilities where malaria screening was done routinely. Thick and thin smears were taken by the trained personal on glass slides and stained by Giemsa technique. They were then examined microscopically for the diagnosis and specification of malarial parasite. Doubtful samples were sent to consultant haematologists at tertiary level health facilities for confirmation

Results: Annual parasite index was highest in 2007 i.e. 0.091. Slide positivity rate was highest [0.21] in 2007 and dropped [0.01] in 2010. Annual Blood Examination Rate was also highest [4.28] in 2007

Conclusion: Our findings showed that annual blood examination rate, slide positivity rate and annual parasite index continued to drop during the study period

comparative study on mothers in relation to antenatal counseling and other factors affecting their breastfeeding practices

Objectives: To determine the effect of various factors on breastfeeding practices of mothers between counseled and not counseled group

Study design: Descriptive cross-sectional study

Place and duration of study: Maternity ward Fauji Foundation Hospital Rawalpindi, from May to November 2009

Methodology: 100 mothers practicing breastfeeding were included in the study and were divided into two groups of 50 mothers each on the basis of their antenatal counseling status. Data regarding breastfeeding was collected by using a pre-tested structured questionnaire after taking informed consent from all the participants

Results: Most of the counseled mothers were antenataly booked [98%] [as compare to the not counseled mothers [44%] and the difference was found significant P<0.001. The mothers in the counseled group who complained of insufficient milk [16%] was less than the not counseled group [40%], and a significant difference was found between two groups P<0.008. Most mothers of the counseled group observed the advice of no extra water during lactation as compared to the not counseled mothers with a significant difference of P<0.001between the two groups

Conclusion: It is concluded from this study that antenatal counseling helps in motivating the mothers for breastfeeding. But it needs to be addressed further and clinicians need to emphasize the importance of breastfeeding during antenatal check ups

Antimicrobial and clinical profile of uropathogens isolated at a tertiary care level laboratory

Background: Urinary tract infection is common in all age groups. It is more common in females, immunocompromised patients and those who have been catheterized or had some other invasive procedure of urinary tract. Gram negative and gram positive microorganisms are responsible for UTI. Sensitivity of uropathogens to antimicrobial drugs has changed over the past many years

Objective: The present study was planned to determine the common uropathogens, their antimicrobial sensitivity and clinical profile at a tertiary level health facility

Material and Methods: In this cross sectional study, urine samples of two hundred symptomatic patients were studied and the underlying pathogens were identified by appropriate methods. The present study was conducted from 1st May, 2009 to 31st May, 2012 in Ayub Teaching Hospital, Abbottabad. This study was conducted from 1st May, 2009 to 31st May, 2012, in Ayub Teaching Hospital, Abbottabad. Subsequently their sensitivity to antibiotics was determined by the recommended method. The data was entered and analyzed in SPSS 15

Results: Female patients were more than males. Increased frequency and dysuria were observed in all patients. E.coli was the commonest pathogen identified, followed by Klebsiella, Staphylococcus and Pseudomonas species. E.coli was sensitive to aminoglycosides, carbapenum and quinolones in decreasing order of frequency. Klebseilla and pseudomonas are sensitive to nor floxacin, whereas, Staphylococcus are sensitive to quinolones

Conclusion: E.coli remains the most common uropathogen. Antimicrobial sensitivity of uropathogens showed a changing pattern

Diffusion weighted MR imaging of ring enhancing brain lesions

To evaluate the role of diffusion weighted imaging in differentiating the cause of ring enhancing brain lesions. Analytical, descriptive study. Department of Radiology, The Aga Khan University Hospital, Karachi, from March 2007 to July 2011. Diffusion weighted imaging [DWI] was performed on 37 patients having ring enhancing lesions on their post-contrast brain MRI scans. These lesions were characterized into neoplastic and abscess cavity on the basis of diffusion restriction. Correlation of all these findings was done with histopathology obtained in all these patients. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of DWI were calculated. Comparisons of mean ADC values of abscess and neoplastic lesions were also done using t-test. DWI had a sensitivity of 94.73%, specificity of 94.44%, positive predictive value of 94.73%, and negative predictive value of 94.44% and diagnostic accuracy of 94.5% in differentiating brain abscess from neoplastic brain lesions. Mean ADC value in central cavity and wall of neoplastic lesions and brain abscesses were calculated with significant p-value of 0.001 and 0.025 respectively. Diffusion weighted imaging is non-invasive method with high sensitivity and specificity which can help in differentiation of ring enhancing neoplastic lesions and brain abscesses. This modality should be read in conjunction with conventional imaging

Diagnostic accuracy of fine needle aspiration cytology in hepatic tumours

To determine the diagnostic accuracy of fine-needle aspiration cytology [FNAC] in liver masses to isolate malignant from benign tumours and hepatocellular carcinoma [HCC] from metastatic tumours. Cross-sectional, observational. Department of Histopathology, Combined Military Hospital, Peshawar, from June 2004 to June 2005. All the patients with liver masses confirmed by ultrasonography, irrespective of age and gender, were included. Patients with inflammatory lesions were excluded from the study. Selected patients underwent fine-needle aspiration under ultrasound guidance followed by needle biopsy. The cytological slides were stained by haematoxylin and eosin [H and E] stain, while Papanicolaous stain was employed in selective cases. Needle biopsy fragments were fixed in formalin followed by paraffin embedding and staining with H and E stain. Sensitivity and specificity of FNAC in the diagnosis of liver masses was determined using histological diagnosis on liver biopsy as gold standard. There were one hundred subjects. The mean age at presentation was 55 +/- 12 years with male to female ratio of 1.7:1. Cytological diagnosis in 19 cases was benign/non-neoplastic and 81 was malignant. Out of the latter, 49 [60.49%] were HCC and 32 [39.51%] were metastatic tumours on cytology. The overall sensitivity, specificity and accuracy of FNAC in the diagnosis of malignant lesions was 95.2%, 100% and 96% respectively using histological diagnosis on liver biopsy as gold standard. Sensitivity of FNAC to differentiate HCC from metastatic tumours in liver was 96% while specificity was 100% having a diagnostic accuracy of 97.5%. The discrepancy in cyto-histological comparison was mainly seen in well-differentiated and poorly-differentiated HCCs. FNAC of the liver masses is a simple, safe, accurate, economical screening test without significant morbidity that can be used to identify the vast majority of hepatic neoplasms of primary or metastatic nature with high sensitivity, specificity and diagnostic accuracy

Morbidity and mortality in breast conservation surgery in early carcinoma breast

To study the mortality and morbidity after breast conservation surgery [BCS] in patients with early breast cancer and comparison with local and international literature. An Interventional descriptive study. Place and Fauji Foundation Hospital, Rawalpindi from Jan 2002 to Dec 2003. Thirty diagnosed cases of early breast cancer in clinical stage I and II were included. Patients with solitary lump with size up to 4 cm in biggest diameter, 5 cm with large sized breasts and patients with lump in one breast were included. Patients with multicentric diseases, lump larger than 4 cm in size in greatest dimension, lump situated beneath areola, lumps fixed to skin or deeper structures were excluded. There were 2 [6.67%]cases of seroma formation and 1 [3.33%] case of wound infection, 8 [26.67%]patients suffered persistent painful shoulder movements and arm pain, 4 [13.33%] patients suffered breast disfigurement. 3 [10%] cases of loco-regional recurrence. 1 [3.33%] patient underwent mastectomy and 2 [6.66%] patients underwent further local excision,. Percentage of ductal carcinoma in post-menopausal women was also high. There was no mortality. Breast conservation surgery is equally effective as mastectomy in the treatment of early breast cancer as there is no statistically significant difference in disease-free survival and overall survival

retrospective analysis of road traffic accidents in Khoula Hospital, Muscat -A national Trauma Centre

A retrospective study was conducted to determine the morbidity and mortality among road traffic accident patients reported to Accident and Emergency Department, Khoula Hospital, Muscat, Sultanate of Oman. Analysis of medical records done from January 1998 to December 1999 and review of 4669 road traffic accident patients revealed that most were males [64%], adults [84%] and nationals [79%]. This study shows that the majority of road traffic accidents occurred during weekends [46%] and those accidents were more frequent in the afternoon between 2pm to 10pm [45%]. Most common injuries seen were soft tissue injuries [40%] followed by head injuries [20%]. 12% of the total admissions in Khoula Hospital were accident victims. Out of the total road traffic accident victims, 48% got admitted to the hospital with the maximum admissions to the orthopedic ward [37%]. Mortality among those patients was 3.2% and most of patients who died were adults [83%], males [79%] and nationals [89%]. Major cause of death was head injury [67%]

Microbial keratitis

To find out the incidence of microbial keratitis in patients with red eyes. randomized prospective study. 07 months ranging from 1st Jun 2001 to 31st Dec 2001. Eye Department, Military Hospital, Rawalpindi. Out of 857 patients with red eye 32 cases were found to have Microbial Keratitis [3%]. Preventive aspects of ocular infection should be taught to the people, like, proper washing of eyes, wearing of protective glasses. Patients coming with ophthalmic problems, i.e., red eye, photophobia, irritation and watering to the general practitioner should be referred as soon as possible to the ophthalmology department

Surgical management of genitourinary fistula

To determine the commonest cause of genitourinary fistulae and evaluate the experience of the surgical management. The study was carried out at the Urology Department, Jinnah Postgraduate Medical Centre [JPMC], Karachi. Twenty two patients were operated including 14 of Vesicovaginal Fistula [VVF], and 8 of Ureterovaginal Fistula [UVF]. In one patient of VVF fistula was extending up to proximal urethra. Out of 14 VVF cases, 9 patients underwent transvaginal repairs, 1 extraperitoneal transvesical repair and 1 transperitoneal repair. Three urinary diversions including 1 Mitrofanoff and 2 ileal conduits were also made. Ureteroneocystostomy was done in cases of UVF with adjuvant procedures in 3 cases including Psoas Hitch in 1 and Boari's flap in 2 patients. The mean age was 35 [range 21-50] years. VVF due to obstetric causes was seen in 71.4% patients while 28.6% developed VVF secondary to gynaecological procedures. Majority of [91%] VVF were repaired successfully in the first attempt in patients subjected to the procedure [78.6% cases of VVF]. There was only one recurrence in transvaginal repair, which was successfully treated with extraperitoneal transvesical approach in second attempt, thus augmenting the success rate to 100%. However 3 [21.4%] cases of VVF required urinary diversion as there was complete loss of sphincter mechanism in one case, in which fistula was extending up to the urethra, and in two cases of complex VVF with complete loss of posterior bladder wall surrounded by extensive scarring. All cases of UVF were successfully treated with ureteroneocystostomy alone or with adjuvant procedure in 37.5% cases. Uncomplicated VVF can be successful repaired transvaginally by refreshing the fistulous edges without excising it. Transabdominal route should be reserved for complicated VVF. Ureteroneocystostomy with antireflux mechanism with or without adjuvant procedure is the treatment of choice for UVF resulting from complete transaction or ligation of ureter

Fine needle aspiration biopsy of soft tissue tumours

To determine the usefulness, limitations and diagnostic accuracy of fine needle aspiration biopsy [FNAB] in soft tissue tumours. Design: Cross-sectional analytical [comparative] study. Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi. Materials and A total of 78 soft tissue tumours were subjected to FNAB from May 2000 to April 2002. Adequate aspirate was obtained in 69 patients. The smears were stained with Haematoxylin and Eosin [H and E] and May-Grunwald-Giemsa [MGG] stains. FNAB smears were put into three categories i.e. benign, borderline or malignant. A definite diagnosis was also given where possible. Tissue biopsies were received in 38 of these patients. Routine H and E staining was done in each case alongwith special stains and immunohistochemistry where required. Out of 69 tumours, 30 were categorised as benign, 9 as intermediate and 30 as malignant. Lipomas were the most common benign tumour while small round blue cell tumours constituting 7 cases [23%] were the commonest malignancy. FNAB-histological correlation showed all tumours reported as benign on FNAB to be confirmed as such. There was only one false positive diagnosis on FNAB. All cases placed in intermediate category were found to be malignant on histopathology. Considering intermediate cases alternatively as benign and malignant revealed sensitivity of 80.6% and 100%, specificity of 85.7% and 85.7% and accuracy of 81.6% and 97.4% respectively. Majority of soft tissue tumours can be categorized on FNAB with high degree of accuracy. The tumours placed in intermediate category should be subjected to biopsy or excision as it is more likely that they turn out to be malignant