Neuroprotective potential of polydatin against motor abnormalities and dopaminergic neuronal loss in rotenone induced Parkinson model / Potencial neuroprotector de la polidatina contra las anomalías motoras y la pérdida neuronal dopaminérgica en un modelo de Parkinson inducido por la rotenona

Among the neurodegenerative disorders, Parkinson disease (PD) is ranked as second most common. The pathological hallmark is selective degeneration of the dopaminergic neurons in the nigro-striatal regions of brain with appearance of the Lewy bodies. Present study explores the neuro-protective potential of polydatin in terms of amelioration of degeneration of dopaminergic neurons in nigro-striatal regions of brain and distorted neuromotor behavior in the rotenone model of Parkinson's disease. Thirty-six male Sprague Dawley rats were divided into three groups. Group A (control), Group B (rotenone treated) and Group C (rotenone+polydatin treated). Rotenone was administrated intraperitoneally (i.p) at a dose of 3 mg/kg/body weight while polydatin was given i.p. at a dose of 50 mg/ kg/body weight for four weeks. Then, animals were sacrificed; substantia nigra (SN) & striatum isolated from brain and five micron thick sections were prepared. Cresyl violet (CV), H&E and Immuno-histochemical staining using anti-TH antibody was done. Motor behavior was assessed weekly throughout the experiment using five different methods. Rotenone treated parkinsonian animals showed deterioration of motor behavior, weight loss, loss of dopaminergic neurons and diminished immune-reactivity in the sections from the nigrostriatal regions of these animals Polydatin+rotenone treatment showed contradicting effects to parkinsonism, with amelioration in weight loss, neuro-motor behavior, dopaminergic loss and immune-reactivity against dopaminergic neurons. Present study revealed a neuro-protective potential of polydatin in animal model of PD by ameliorating the neuro-motor abnormalities and degeneration of dopaminergic neurons in nigrostriatal regions.

Entre los trastornos neurodegenerativos, la enfermedad de Parkinson (EP) se clasifica como la segunda más común. El sello patológico es la degeneración selectiva de las neuronas dopaminérgicas en las regiones nigro-estriatales del cerebro, con la aparición de los cuerpos de Lewy. El presente estudio explora el potencial de protección neuronal de la polidatina en términos de la mejora de la degeneración de las neuronas dopaminérgicas en las regiones nigro-estriatales del cerebro y el comportamiento neuromotor distorsionado en el modelo de rotenona de la enfermedad de Parkinson. Treinta y seis ratas macho Sprague Dawley se dividieron en tres grupos: Grupo A (control), Grupo B (tratado con rotenona) y Grupo C (tratamiento con rotenona + polidatina). La rotenona se administró por vía intraperitoneal (i.p.) a una dosis de 3 mg/kg/peso corporal, mientras que la polidatina se administró i.p. a una dosis de 50 mg/kg/ peso corporal durante cuatro semanas. Posteriormente, los animales fueron sacrificados. Se aislaron la substantia nigra (SN) y cuerpo estriado de los cerebros y se realizaron secciones de cinco micras de espesor. Se realizó una tinción de violeta de cresilo (CV), H&E y tinción inmunohistoquímica usando anticuerpo anti-TH. El comportamiento motriz se evaluó semanalmente durante todo el experimento utilizando cinco métodos diferentes. Los animales parkinsonianos tratados con rotenona mostraron deterioro del comportamiento motriz, pérdida de peso, pérdida de neuronas dopaminérgicas y disminución de la reactividad inmune en las secciones de las regiones nigroestriadas. El tratamiento con polidatina + rotenona mostró efectos contrarios al parkinsonismo, con mejoría en la pérdida de peso, en el comportamiento motor, en la pérdida dopaminérgica y en la reactividad inmune contra las neuronas dopaminérgicas. El presente estudio reveló un potencial de protección neuronal de la polidatina en el modelo animal de la EP al mejorar las anomalías neuro-motoras y la degeneración de las neuronas dopaminérgicas en las regiones nigroestriatales.

Frequency of gastric varices in patients with portal hypertension based on endoscopic findings

Objective: To find out the frequency of gastric varices in patients with portal hypertension based on endoscopic findings

Study Design: Descriptive Study

Place and Duration of Study: Department of Gastroenterology, Military Hospital, Rawalpindi from Jan to Jun 2011

Material and Methods: All patients fulfilling the inclusion criteria were selected through consecutive sampling. The patients presenting with hematemesis, melena or ascites with portal hypertension on ultrasound abdomen were admitted in the hospital. The patients were first stabilized hemodynamically and then kept empty stomach for at least four hours before endoscopy. The patients were sedated with intravenous midazolam and endoscopic findings obtained were entered on the patient proforma

Results: The overall frequency of gastric varices was 11%, whereas 89% had no gastric varices

Conclusion: A large number of patients with portal hypertension have gastric varices. It is recommended that endoscopy be carried out in all patients with identified portal hypertension

Outcome of mesh envelope bone grafting for traumatic segmental bone defects

Background: Long bone defects treatment is a technically demanding procedure in orthopedic surgery and may require bone graft pieces, which are loosely applied to the bone and few pieces can spill over in the surrounding area, resulting in failure in obtaining beneficial effects. The vicryl mesh envelope around the bone graft may be a solution

Objective: To determine the role of mesh regarding bone graft containment and union in long bone defects of > 4cm

Methodology: This experimental study was conducted in orthopedic department of Lahore General Hospital, Lahore from 1[st] January 2012 to 31[st] December 2014. Total 28 cases were included in the study and randomized into two equal groups. Fourteen patients were managed with vicryl mesh [group A] while 14 patients were treated routinely without the use of vicryl mesh envelope [group B]. Data was entered and analyzed by using SPSS version 18.0

Results: The mean age of all the patients was 29.11+/-6.16 years. The mean age of patients in group A was 29.71+/-6.56 years and in group B was 28.50+/-5.92 years. There were 20 [71%] male patients and only 8 [29%] female patients presented with long bone defects. Most of the patients were managed with dynamic compression plating i.e. 20 [71.43%]. In group A, 1 [7.1%] patient developed infection and re-operation was done while in group B 6 [42.9%] patients has infection and reoperation was executed to eradicate it. The difference was significant for post-operative infection between both groups [pvalue= 0. 029]

Conclusion: This study concluded that there was significant difference between both techniques in graft containment, consolidation and graft failure. Patients managed with vicryl mesh have better outcome than without vicryl mesh

Outcome of wound coverage around ankle joint with sural artery flap

Background: Trauma is the most common cause of fractures and majority of these fractures involve the foot. So the early coverage is mandatory to prevent the complications, it is challenging to the orthopaedic, plastic and reconstructive surgeons. Sural artery reversible flap is one of the options

Objective: To determine the outcome of sural artery flap for wound coverage around ankle

Methodology: A total of 24 patients were included in this interventional study. All the patients having wound around the ankle due to any cause and of either sex presenting in emergency department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1st June 2014 to 30th April 2016 were included in this study. Outcome was measured as "Good", "Fair" and "Poor". The data was entered and analyzed by using SPSS version 16

Results: In this study 24 patient were operated, 41.66% were children and 54% were male. In 50% heel region was involved and in 25% melleolar region and 12.5% dorsum of foot and in 12.5% above ankle joint. Outcome noted was "Good" 83.3% "Fair" 8.3% and "Poor" 8.3%

Conclusion: Sural artery flap for the coverage around ankle is simple, safe and can be performed by orthopedic surgeon at any center without the requirement of special instrumentation and special test, with good outcome

Comparison of outcome of fractures of inferior pole of patella

Background: Fractures of patella are common and it constitutes about significant proportion of all skeletal injuries resulting from either direct or indirect trauma

Objective: To evaluate the outcome of inferior pole fractures of patella treated with tension band wiring and resection of avulsed fragment and re-attachment of ligament to patella

Methodology: This was an comparative study, carried out in Department of Orthopaedic surgery of Lahore General Hospital, Lahore from 16[th] June 2012 to 15[th] June 2014. A total of 20 patients were included in this study. These patients were randomly divided into two groups. In Group-A patients were treated with open reduction and internal fixation with tension band wire and in Group-B patients were treated by resection of the avulsed fragment and reattachment of the patellar ligament to the patella. Patients were followed up for surgical site infection and functional outcome at 1[st], 7[th], 15[th], day one month, three months and six months post operatively. Final outcome was assessed by using Bostman criteria. Data entry and analysis was done by using SPSS version 17

Results: Mean age of all 20 patients was 34.20 +/- 12.13 years. Although both treatment groups had statistically same rate of surgical site infection from 1[st] day till 15[th] day post operatively. From 1[st] month till 6[th] months follow up time period none of the patients had surgical site infection in both treatment groups. At 1[st] month and 6[th] month post operatively in Group-B outcome was statistically better as compared to Group-A patients. But at 2[nd] month outcome of patients was statistically same in both treatment groups

Conclusion: Resection of the avulsed fragment and reattachment of the patellar ligament to the patella had good outcome according to the Bostman criteria as compared to open reduction and internal fixation with tension band wire

Frequency of urinary tract infections and causative agents in different age groups in both genders in a tertiary care hospital

Objective: To determine the frequency of urinary tract infections and their causative agents in different age groups in both genders

Materials and Methods: All urine samples received from February 2013 to October 2013 for culture and sensitivity in Baqai Laboratory [a subsidiary of Baqai University Hospital, Nazimabad, Karachi] were processed. Urine samples showing pyuria were inoculated on Cysteine Lactose Electrolyte Deficient [CLED] medium and blood agar and incubated at 37 degree C for 24 hours.Samples showing 10[5] organisms were considered to have significant bacteriuria. Organisms were identified by standard biochemical procedures

Results: Out of 633 samples inoculated, 40% [253] showed significant bacteriuria. Incidence of isolated uropathogens was E.coli [70%], Enterobacter species [9%], Enterococcus species [7.5%], Psudomonas species [5%], Klebsiella species [4%],Acinetobacter species [3.2%], Salmonella species [0.8%], Staph. aureus [less than 1%] and Candida [less than 1%]. Genderwise distribution of patients: Male 36%, Female 64%. Predominent number of female patients was in reproductive age group while greater frequency in males was seen in patients above 55 years of age

Conclusion: There is higher frequency of urinary infections in females in reproductive age groups and more men with urinary infections were aged above 55. E.coli is the prominent causative organism

Pattern of rubber bullet injuries in the lower limbs: A report from Kashmir / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Rubber bullets are considered a non-lethal method of crowd control and are being used over the world. However the literature regarding the pattern and management of these injuries is scarce for the forensic pathologist as well as for the traumatologist. The objective of this report was to add our experience to the existing literature.</p><p><b>METHODS</b>From June 2008 to August 2010 the Government Hospital for Bone and Joint Surgery Barzulla and the Department of Orthopaedics, SKIMS Medical College/Hospital Bemina Srinagar received 28 patients for management of their orthopaedic injuries caused by rubber bullets. We documented all injuries and also recorded the management issues and complications that we encountered.</p><p><b>RESULTS</b>All patients weremales with an age range of 11e32 years and were civilians who had been hit by rubber bullets fired by the police and the paramilitary forces. Among them, 19 patients had injuries of the lower limbs and 9 patients had injuries of the upper limbs. All patients were received within 6 h of being shot.</p><p><b>CONCLUSION</b>Our findings suggest that these weapons are capable of causing significant injuries including fractures and it is important for the surgeon to be well versed with the management of such injuries especially in areas of unrest. The report is also supportive of the opinion that these weapons are lethal and should hence be reclassified.</p>

Attitude, behavioural improvement and preferences; in medical students as they move up to the next higher class

Present study endeavoured to assess medical student's ethical behaviour, preferences and improvements one year later. Cross-sectional, questionnaire-based. Liaquat University of Medical and Health Sciences Jamshoro. Sindh. Pakistan. October 2013 - Jan 2014. First year [FY] and second year [SY] MBBS students [n = 122 each year] of both genders, were randomly selected and a questionnaire administered. Fifty six percent male and 40% female students of FY marked proxy attendance; 72% males and 65% female would mark proxy attendance if given a chance. Percentages increased in SY. Significant co-relation existed between gender and proxy attendance [p = 0.01]; self-financed or hostlers showed no association with marking proxy attendance. Sense of responsibility in females and courteous behavior in both genders improved in SY. Teacher's behaviour affected student's conduct; and improvement in understanding English was noted in both genders in both years, however, the small% of students finding English as a barrier were prone to mark proxy attendance [p = 0.05]. Males preferred physiology whereas female preferred anatomy in both years. In FY, subject of choice was anatomy, substituted for Physiology in SY. Majority students preferred chalk and black board vs. multimedia based teaching. Cheating behaviour and sense of responsibility, but civilised behaviour, did not improve after one year education

Effects of handpiece speed on the performance of undergraduate dental students in preclinical training

Low-speed high-torque handpieces are popular for the pre-clinical training of dental students. However, in clinical practice, high-speed air turbine handpieces are commonly used. This dissimilarity creates a gap between pre-clinical and clinical training skills. The current study sought to evaluate the effects of the use of high-speed and low-speed handpieces by dental students during their pre-clinical training. Twenty-one undergraduate dental students at the College of Dentistry of Taibah University participated in this study. Each student was asked to prepare class I cavities using high-speed air turbine and lowspeed/ high-torque handpieces. The time required for cavity preparation was recorded by the authors. The prepared cavities were evaluated for quality and skill using a six-point scale. The data were statistically analysed with paired t and Mann Whitney tests. There was no significant difference in cavity preparation time between the low-speed and high-speed handpieces [538.29 and 483.76 s, respectively]. The evaluations of the cavities revealed no difference in the quality of preparations between the low- and high-speed handpieces. Additionally, no significant difference in the surface roughness of the preparations was observed. The type of handpiece did not influence the learning capabilities of the undergraduate dental students in the preparation of preparing class I cavities. This study did not observe any significant differences between the cavities that were prepared by our students using either high-speed or low-speed handpieces

Outcome of tissue sparing conservative surgery in blast injuries to limbs

Background: Blast injuries are common in countries affected by conflict

Objective: To evaluate the outcome of conservative surgical intervention in the blast injuries of limbs in civilian population

Methodology: Study Design: Cross sectional study. Place and Duration of Study: Department of Orthopedic Surgery, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1[st] September 2011 to 31[st] March 2013. Fifty patients suffering from blast injuries to upper and lower extremities in civilian population regardless of age and sex were enrolled. Those patients who already had been treated after injury at some other centers were excluded from the study. Only clinical evaluation was used to check the vascular status and viability of the remaining attached tissues. Patients were operated either under general or regional anesthesia. Repeated debridement's followed by skin coverage in the form of split thickness skin graft or rotational flaps were the treatment option for soft tissues and exposed bone respectively. Post operative antibiotics were given for a period of one week at least. Rehabilitation exercises were continued up to six months after discharge from the hospital. The data was entered and analyzed by using SPSS version 15

Results: Mean age of the victims in this study was 22 years. Twenty nine patients had some sort of traumatic amputation at presentation resulting from original injury. Original injuries occurred were as follows; loss of limb below knee 7[14%], loss of limb at ankle region 05[10%], mid foot amputations 08[16%], and hemi foot amputation in 05[10%]. In upper limb injuries pattern was as follows; 01[2%] mid palmer amputation, 02[4%] two fingers amputation, and 04[8%] had soft tissue involvement of hand. Infection rate was 22% in patients who did not have wound dressing by the primary physician while it was 10% in patients who had wound dressing by primary physician before presenting to this institution, the collective infection rate was 32%

Conclusion: Conservative wound debridement, early skin coverage, preserving maximum soft tissues and bone results in functionally and cosmetically better limb in blast injuries

Short term outcome of clubfoot correction by Ponseti method

Background: Congenital Talipes Equino Varus [CTEV] is a common complex congenital deformity of the foot. Treatment still continues to challenge the skills of the pediatric orthopedic surgeon as it has a notorious tendency to relapse, irrespective of whether the foot is treated by conservative or operative means

Objective: To evaluate the short term outcome of Ponseti method of serial manipulation and casting in Congenital Talipes Equino Varus [CTEV] in children up to 6 months of age

Methodology: A descriptive case series study was carried from 16[th] February to 15[th] August 2012 in the department of orthopaedic surgery, Sheikh Zayed Medical College/Hospital Rahim Yar Khan. A total of 200 feet were included in this study. The first cast application corrects the cavus deformity by aligning the forefoot with the hind foot, supinating the forefoot to bring it in line with the heel, and elevating the first metatarsal. One week after application, the first cast was removed, and after about 2-3 minutes of manipulation, the next toe-to-groin cast was applied. Manipulation and casting continued weekly for the next 5 to 6 weeks

Results: Mean age of patients was 3.9 +/- 1.7 months. Ninety one patients [62.3%] were male while remaining 55 patients [37.7%] were female. Left foot deformity was seen in 48 [33%] patients, right foot deformity was found in 34 [23%] patients and 64 [44%] patients were suffering from bilateral deformity. Percutaneous tenotomy of Tendo-Achilles was performed in 167 patients [83.5%]. Out of 200 feet, correction was achieved in 177 feet [88.5%] with zero Pirani score

Conclusion: Ponseti's method is simple, easy to learn, effective and reproducible method for correction of Congenital Talipes Equino Varus [CTEV] deformity in children

Comparison between metformin and insulin in treatment of gestational diabetes mellitus and effect on neonatal hypoglycaemia

To compare the efficacy of metformin in the treatment of gestational diabetes mellitus [GDM] with insulin and to compare the frequency of hypoglycaemia in neonates of the mothers treated with metformin and insulin. Randomized control trial to compare the efficacy of metformin with insulin in the treatment of GDM. Outpatient department and labour ward of Obstetric and Gynaecology department of Benazir Bhutto Hospital Rawalpindi from August 2012 to January 2013. A total of 110 pregnant ladies with GDM diagnosed after 20 weeks of gestation were included and divided into group A and group B with 55 patients in each group. Group A patients were treated with insulin and group B with metformin. Plasma fasting glucose and two hours postprandial glucose levels were determined on weekly basis for four weeks after starting the treatment to determine the efficacy of insulin and metformin. At birth plasma glucose levels of all the neonates were carried out two hourly, and more frequently depending upon the requirement, during first 24 hours in both the groups to determine neonatal hypoglycaemia. Fasting plasma glucose in group A and B were calculated as 5.96 +/- 0.58 and 5.76 +/- 0.46 mmol/L respectively [p=0.280], while two hours post-prandial plasma glucose levels were 7.34 +/- 0.48 and 7.28 +/- 0.58 mmol/L respectively [p=0.650]. Efficacy in group A was 78.18% and in group B was 70.91% [p=0.381] while frequency of neonatal hypoglycaemia was calculated as 61.54% in group A and 41% in group B [p=0.113]. The efficacy of metformin in treatment of gestational diabetes mellitus is similar as with insulin and the frequency of hypoglycemia in neonates of the mother treated with metformin and insulin is also similar

Esthetic and function evaluation after treatment with removable dentures by patients, lay persons, dentists in a dental school of Pakistan

The purpose of this study was to evaluate the impact of treatment on oral health related-quality of life and to estimate facial appearance change after the construction of removable dentures by patients, lay persons and dentists. In this cross-sectional study,a total of 100 patients restored with removable dentures were included. A specific questionnaire for patients based on oral health impact profile [OHIP-14]1 was used to collect information on oral health related quality of life. For esthetic evaluation patients were given options of [not at all satisfied, not very satisfied, neutral, somewhat satisfied and very satisfied] of their appearance, after the insertion of dentures. Additionally patients profile pictures were arranged randomly and in pair form; were shown to lay persons and dentists and they had to answer the following question: [Do you judge this face as unpleasant, barely pleasant and very pleasant]. After rehabilitation with removable dentures all patients showed significant improvement, higher level of satisfaction and improve esthetics. The lay persons and dentists remarked the same. Removable dentures may have a positive impact on oral health related quality of life and patient considered their post-treatment facial appearance better than before treatment and both lay persons and dentists agree with this evaluation

Correlation between innercanthal distance and the mesiodistal width of the maxillary central incisors

Objective: To establish whether a correlation exists between the innercanthal width and maxillary central incisors

Study Design: A Descriptive cross sectional study

Place and Duration: Department of Prosthodontics, Dr Ishrat ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences Karachi and from 15th October 2012 to 25th March 2014

Methodology: One hundred and seventy five dentate individuals with intact maxillary anterior teeth were investigated. The innercanthal space was calculated among the inner canthal angles utilizing computer software. The mean dimension of the two central incisors was determined extra orally at their widest dimension. Teeth measurement and inner canthal distance association in respect to gender was evaluated by paired t test. Pearson correlation coefficients test was premeditated to establish any association amongst innercanthal space and central incisors width, significance was set at a = 0.05

Results: The mean value for male and female subjects was 33.24 +/- 3.4 mm and 34.90 +/- 3.8 mm correspondingly. The mean width of maxillary central incisors for male and female subjects was recorded 15.84 +/- 1.4 mm and 15.92 +/- 1.3 mm. The value [P = 0.000] for both estimations were significant. The Pearson correlation coefficient were positive [r = 0.202] and highly significant [P = 0 .008] between innercanthal dimension and the maxillary central incisors. The results indicated that innercanthal ratio ratio of 1:0.462 may be used to calculate the combined width of maxillary central incisor teeth

Conclusion: Mean of maxillary central incisor width and inner canthal distance were higher in females significantly. The results proposed that innercanthal distance is a good prognostic factor for determining the maxillary central incisors mesiodistal width

Salivary urea: a marker for chronic renal disease

Background: Salivary urea, correlates well with serum urea, can be utilized as a low-cost, easily accessible and noninvasive diagnostic tool for screening patients in early stages of kidney disease, especially for developing countries with limited resources. Saliva for diagnostic purpose, is inexpensive, non-invasive, easy to collect, use, store and transport, contain high amount of disease biomarkers and shows efficient and reliable results

Objective: To asses and prove the salivary diagnostics as reliable alternate to serum in renal diseases.

Methods: A cross-sectional validation study of 1 year duration from June 2012 to June 2013 was conducted. Non-probability consecutive sampling technique was employed on the patients attending the Nephrology OPD or those who were admitted to Jinnah Postgraduate Medical Centre Karachi

Results: Significant correlation [.00] was found between the levels of serum and salivary urea and creatinine. A slight increase in the level of serum urea and creatinine results in a significant increase in the level of salivary urea and creatinine. Almost 63.2% and 64.6% of changes in serum urea and creatinine can be explained by the changes in salivary urea and creatinine levels respectively

Conclusion: Saliva can be developed as a diagnostic fluid that is an alternative to blood. It is non invasive, less expensive and collection procedure does not require technicians. The use of salivary assay for diagnostics of chronic renal failure [urea and creatinine] can be established as a cost effective test for developing countries

study of the spectrum of homicide in rawalakot, AJ and K

Objective: To find out the incidence of homicide, age and gender distribution of victims, type of weapons used and the most frequently targeted regions of body in victims of homicide in Rawalakot, Azad Kashmir, AJ and K

Study Design: Retrospective study

Place and Duration of Study: This study was conducted at SKBZH/CMH Rawalakot, AJ and K from Jan 2012 toMay 2015

Materials and Methods: Performa was designed for retrospective cohort study. The study was conducted in the mortuary SKBZH/CMH Rawalakot. Consent was implied and relevant information was gathered from the available record. Out of all the cases autopsied during this three and a half year period, 66 were homicidal in nature. Rest of the cases were excluded

Results: Male to female ratio was 5.6:1.Maximum number of victims belonged to 21-40yrs agegroup. Singleinjury was present in 85% [n= 56] cases while 15% [n=10] cases had multiple injuries. The most common region of the body targeted was chest 31.8%[n=21] followed by limbs, head and neck and abdomen .The most common tool used to kill was firearm in 75.8% [n=50] cases followed by sharp edged weapon in 18.2% [n=12] cases and others [including RTA, electrocution etc.] in 6.1%[n=4]cases

Prosthodontic rehabilitation of maxillectomy patients with hollow bulb obturator clinical series

Prosthodontic Rehabilitation of maxillectomy defects is one of the complex treatment modalities practiced. Maxillectomy is performed for surgical treatment of congenital and acquired diseases and it is the most common of maxillofacial defects which need to be successfully rehabilitated to restore morphology, masticatory function, swallowing and speech. Prosthodontic rehabilitation of these defects is commonly done with an obturator prosthesis. Effective obturation of maxillectomy defect is a difficult task for the maxillofacial Prosthodontists. Multidisciplinary treatment planning is essential to achieve adequate function and retention for the prosthesis. The present clinical series describes the steps in fabrication of hollow bulb obturator prosthesis utilizing anatomical and mechanical means of gaining retention

Breast cancer; evaluation of risk factors in our local population an institutional based descriptive and prospective study

Evaluation and distribution of established etiological risk factors in patients of breast cancer in our local population. Institution based non-interventional descriptive and prospective study Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro from January 2009 to December 2011. One hundred and two cases of breast cancer diagnosed on HE staining were selected for the study. More than 50% were in 4th and 5th Decades of life. 94% were married and 06% were un-married. 65% were in pre-menopausal group and 35% in post-menopause group. 93% had positive history of breast feeding. None of them had ever taken oral contraceptive. Smoking history was present only in 9.80% cases. 27% cases had family history of breast cancer in first degree relative and 13% in 2nd degree relatives. Majority [66.66%] were belongs to lower middle socioeconomic class. Surprisingly in this study marital status, parity, and breast feeding not proved as protective factors against breast cancer

Frequency of asymptomatic spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites

To determine the frequency of asymptomatic spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites. Descriptive study. The study was conducted at indoor and outpatient departments of Medicine, Military Hospital, Rawalpindi, Pakistan from 29[th] February 2008 to 28th August 2008. One hundred and ninety five patients of liver cirrhosis with ascites were selected. To standardize the study; patients of both genders over 18 years of age, diagnosed with liver cirrhosis and ascites were included in the study after obtaining their informed consent. Patients with abdominal tenderness and fever, hepatic encephalopathy, intra-abdominal surgically treatable cause, with any co-morbid disease [hypertension and diabetes mellitus] or refusing to give consent were excluded from the study. Strict inclusion/exclusion criteria were observed to control the confounding variables. Diagnosis of spontaneous bacterial peritonitis was based on increased ascitic fluid absolute polymorphonuclear leukocyte [PMN] count [> 250 cells / mm[3]] and/or positive bacterial culture. Out of 195 patients, 10 patients [5%] had neutrocytic ascites [absolute neutrophil count > 250 cell/mm[3]]. Out of these 195 patients, three patients [1.5%] were found to have positive ascitic fluid culture. In our study the frequency of asymptomatic spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites turned out to be 5% which is low. Therefore, analysis of ascitic fluid through diagnostic paracentesis should be reserved for inpatient or outpatient with clinically apparent new onset ascities or in cirrhotic patients with ascities whose general condition deteriorates

Frequency of different causes of upper gastrointestinal bleeding using endoscopic procedure at a tertiary care hospital

To assess the outcome of early endoscopy in terms of frequency of different causes of upper gastrointestinal bleeding at a tertiary care hospital. Cross sectional descriptive study. Outpatients / indoor patients, Department of Medicine Military Hospital Rawalpindi from 1[st] Jan 2010 to 30[th] June 2010. Study was carried out in department of medicine Military Hospital Rawalpindi. Two hundred and forty four after cosen. Patients of upper gastrointestinal bleeding fulfilling the inclusion criteria were included in the study. Haemodynamically stable patients were kept empty stomach for at least 6-8 hours before procedure. A detailed history and thorough physical examination was carried out. Protocols for endoscopic examination were followed. Mandatory baseline investigations were obtained. Endoscopic findings were documented on a proforma. p value of less than 0.05 was considered statistically significant. There were 174 males [71.3%] and 70 females [28.7%]. The age of the patients ranged from 15 years to 75 years, mean age was 52.23 years [SD = 14.78]. The most common cause of upper GI bleed was varices in 176 [72.1%] patients; followed by gastric ulcer in 24 [9.8%] patients. Other causes in order of decreasing frequency included gastritis 16[6.55%], duodenal ulcer 14[5.73%], esophagitis 6[2.45%], Mallory Weiss tear 2[0.81%] and miscellaneous 6[2.45%]. Esophageal varices is the most common cause of upper GI bleed in our set up reflecting high prevalence of liver cirrhosis secondary to chronic HBV and HCV infection