Enhancing pharmaceutical potential and oral bioavailability of Allium cepa nanosuspension in male albino rats using response surface methodology

Objective: To enhance the pharmaceutical potential and oral bioavailability of quercetin contents of Allium cepa peel extract by novel nanosuspension technology. Methods: Nanoprecipitation approach was successfully used for the formulation of nanosuspension. To obtain pharmaceutical-grade nanosuspension with minimum particle size and polydispersity index, sodium lauryl sulphate was selected as a stabilizer. Important formulation parameters were statistically optimized by the response surface methodology approach. The optimized nanosuspension was subjected to stability and in vitro dissolution testing and characterized by scanning electron microscopy, atomic force microscopy, Fourier transform infrared spectroscopy, and zeta sizer. To evaluate the preeminence of nanosuspension over coarse suspension, comparative bioavailability studies were carried out in male albino rats. The pharmaceutical potential of developed nanosuspension was evaluated by antioxidant, antimicrobial, and toxicity studies. Results: The optimized nanosuspension showed an average particle size of 275.5 nm with a polydispersity index and zeta potential value of 0.415 and -48.8 mV, respectively. Atomic force microscopy revealed that the average particle size of nanosuspension was below 100 nm. The formulated nanosuspension showed better stability under refrigerated conditions. Nanosuspension showed an improved dissolution rate and a 2.14-fold greater plasma concentration of quercetin than coarse suspension. Moreover, the formulated nanosuspension exhibited enhanced antioxidant and antimicrobial potential and was non-toxic. Conclusions: Optimization of nanosuspension effectively improves the pharmaceutical potential and oral bioavailability of Allium cepa extract.

Enhancing pharmaceutical potential and oral bioavailability of Allium cepa nanosuspension in male albino rats using response surface methodology

Objective: To enhance the pharmaceutical potential and oral bioavailability of quercetin contents of Allium cepa peel extract by novel nanosuspension technology. Methods: Nanoprecipitation approach was successfully used for the formulation of nanosuspension. To obtain pharmaceutical-grade nanosuspension with minimum particle size and polydispersity index, sodium lauryl sulphate was selected as a stabilizer. Important formulation parameters were statistically optimized by the response surface methodology approach. The optimized nanosuspension was subjected to stability and in vitro dissolution testing and characterized by scanning electron microscopy, atomic force microscopy, Fourier transform infrared spectroscopy, and zeta sizer. To evaluate the preeminence of nanosuspension over coarse suspension, comparative bioavailability studies were carried out in male albino rats. The pharmaceutical potential of developed nanosuspension was evaluated by antioxidant, antimicrobial, and toxicity studies. Results: The optimized nanosuspension showed an average particle size of 275.5 nm with a polydispersity index and zeta potential value of 0.415 and -48.8 mV, respectively. Atomic force microscopy revealed that the average particle size of nanosuspension was below 100 nm. The formulated nanosuspension showed better stability under refrigerated conditions. Nanosuspension showed an improved dissolution rate and a 2.14-fold greater plasma concentration of quercetin than coarse suspension. Moreover, the formulated nanosuspension exhibited enhanced antioxidant and antimicrobial potential and was non-toxic. Conclusions: Optimization of nanosuspension effectively improves the pharmaceutical potential and oral bioavailability of Allium cepa extract.

Effect of ferric carboxymaltose in the management of postpartum iron deficiency anemia

Background: Iron deficiency is the most common cause of anemia, around the world, with postpartum hemorrhage one of the reasons. Different treatment options are available for correction of iron deficiency, ferric carboxymaltose being the most recent

Objective: To determine the effectiveness of ferric carboxymaltose in the management of iron deficiency anemia in the postpartum period

Methodology: An experimental study was conducted at Sheikh Zayed Medical College/Hospital Rahim Yar Khan. 30 female patients, with documented iron deficiency anemia within 10 days of post partum period and with no history of renal or hepatic disease, infection, anemia due to any other causes, severe anemia requiring blood transfusion and no parenteral iron therapy in last 20 days, were included in the study. All the patient were given ferric carboxymaltose 15mg/kg body weight [max 1000mg] intravenous infusion. Pre and post therapy complete blood picture including hemoglobin and serum ferritin levels were compared after 1 week. The data was entered and analyzed in SPSS version15

Results: Significant increase in both hemoglobin and serum ferritin levels was noted in patients with mean rise being 2.4g/dl and 338.3 ng/ml in hemoglobin and serum ferritin levels, respectively. Mild rash and fever were the only adverse events noted, in only one patient, each

Conclusion: Ferric carboxymaltose appears to be a very effective drug for the treatment of iron deficiency anemia both in terms of rise in hematological indices and low adverse event profile

Risk factors for postoperative complications after thyroidectomy in simple multinodular goiter

Background: Postoperative complications after thyroidectomy are problematic for patients and surgeons. The postoperative outcome of thyroidectomies is related to risk factors concerning the patient, the thyroid disease and the surgeon

Objective: To analyze the risk factors for postoperative complications after thyroidectomy in patients of simple multinodular goiter

Methodology: A prospective study was conducted in Surgical unit of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan on 114 patients diagnosed and surgically treated for simple multi nodular goitre [MNG] between 1[st] July 2012 and 30 June[th] 2014 meeting the following criteria: bilateral MNG; operation by surgeons with experience in endocrine surgery; no associated parathyroid pathology; no initial thoracic approach; and minimum follow-up of 6 months. Age, sex, time of evolution of symptoms, thyroid weight, recurrent goiter and type of surgery [total thyroidectomy or near total thyroidectomy] were analyzed as risk factors for complications. Data was analyzed using SPSS version 16.0. P-values < 0.05 were considered statistically significant

Results: During the study period 114 thyroidectomies were performed. There were 20 [17.5%] males and 94 females [82.5%] with age of 48.5 +/- 13.6 years. Male to female ratio was 1:4.7. Total thyroidectomy performed in 57[50%] patients and near total thyroidectomy was also performed in 57[50%] patients. Total complications occurred was 29 [25.43%] in 114 patients. Transient hypoparathyroidism was the major complication seen in 17 [14.9%] patients and permanent hypoparathyroidism was seen in 3[2.6%] patients. 3[2.6%] patients suffered from transient recurrent laryngeal nerve palsy [RNLP] and 2 [1.8%] patients suffered from permanent RNLP. Hematoma formation was present in 3[2.6%] patients and wound infection was present in 1[0.9%].There was significant association of transient hypoparathyroidism with duration of goiter [p-value=.016], presence of compressive symptoms [p-value= 0.000] and type of surgery [p-value=.017]. Permanent hypoparathyroidism was significantly associated with recurrence of goiter [p-value=.02]. Permanent RNLP was significantly associated with compressive symptoms [p-value=.007]. There was no significant between hematoma formation and risk factors. So duration of goiter, presence of compressive symptoms, weight of thyroid gland, type of surgery and recurrence were the significant risk factors for complications in patients of simple MNG

Conclusion: In conclusion duration of goiter, presence of compressive symptoms, recurrence of goiter and surgical resection are significant factors for post thyroidectomy complications. By performing early surgery and total thyroidectomy complications rate can be reduced

Dengue fever its diagnosis, treatment, prevention andcontrol

Background: Dengue virus has emerged as a majorpublic health problem worldwide in the recentdecades. The incidence of this infection has increasedin tropics and subtropics including Pakistan. It is onethe most common and perhaps the most dangerousviral disease transmitted by mosquitoes. Currentepidemic of dengue fever of 2011 in Pakistan hashighlighted the lack of direction and neglect of thisdevastating disease. Now it is of fundamentalimportance to implement public health measures andalso to improve management of Dengue HemorrhagicFever and Dengue shock syndrome in our hospitals

Objectives: The objectives of this review article areto;1. Describe the epidemiology, virology, riskfactors,clinical features, diagnosis andmanagement of dengue fever.2. Determine the complications of dengue fever.3. Find out different modalities for prevention andcontrol of dengue fever.4. Provide awareness to the public about thisdisease and to dispel undue fears

Conclusion: Fever is the symptom present in almostall patients .Bleeding leads to serious complicationsin dengue fever. No effective vaccine or antiviralagents are available to treat dengue infection at themoment

Prognosis and Control: Attempts tocontrol dengue vector [mosquitoes] and effectivevaccine remain the important preventive measures

Need for chest tube after video assisted thoracoscopic [VATS] lung biopsy

To observe the effects of early removal of chest tube drain after video assisted thoracoscopic [VATS] lung biopsy. We prospectively evaluated the removal of chest tube drain at six hours or 24 hours after the VATS-lung biopsy in fifty consecutive patients with no evidence of air leak after the lung biopsy. Our results show that removal of chest tube drain at 6 hours was not associated with complications such pneumothorax, atelectasis or pleural effusion as compared to the 24 hours removal of the drain[p>0.05]. Early removal of chest tube drain is safe in patients where air leak has been documented to be absent. Since it was a non-randomized evaluation, further randomized study in our population is needed to confirm these findings

Thyroid status and urinary iodine levels in women of endemic goiter area

To determine the thyroid function tests and urinary iodine levels in women belonging to goiter endemic area. Descriptive study conducted in women of goiter endemic area in Saggian Lahore. Saggian Lahore is a goiter endemic area. A total of 293 women between the ages of 18-45 years residing in the area were clinically screened for goiter. Of them 73 women having goiter were recruited for the study. Information regarding demographic profile clinical presentation and physical examination of the goiter was recorded on a questionnaire. The goiter size was graded according to WHO, UNICEF and the International Council for the Control of Iodine Deficiency Disorder. About 5ml of blood sample was drawn from each women and run for thyroid function tests i.e. T3 T4 and TSH using Elisa kits [Human scientific Co. Germany]. Urinary iodine was checked by chemical method. Mean age of 73 women was 28.5 years. Marital status showed that 48[65.7%] were married and 25[34.3%] were unmarried. Visible diffuse goiter was seen in 56[77%] cases. Pressure symptoms as cough and shortness of breath was seen in 30[41%] and 31[42.5%] women respectively. Among the 73 women 24.6% [18 cases] took treatment for goiter. Adverse pregnancy outcome secondary to goiter was seen in 58% [28 cases] out of 48 married women. Thyroid function tests result showed that 72% [53 cases] were euthyroid, 18% [13 cases] were hypothyroid, and 10% [7 cases] were hyperthyroid. Urinary iodine levels showed that 99% women were iodine deficient. Thyroid functions do not indicate iodine deficiency in all cases of goiter, therefore, Urinary iodine levels need be estimated while investigating goiter cases. Policy message: Iodine deficiency should be diagnosed and treated on priority basis

Three port versus four port laparoscopic cholecystectomy

Objective: The objective of this study is to compare the outcome of three vs four port laparoscopic cholecystectomy and detect safety of three port laparoscopic cholecystectomy [LC] as routine procedure

Study Design: Simple comparative study

Setting: One year starting from June 2010 to May 2011. Sample size: 100 patients

Methods: All patients were divided into two groups. Group A: three port laparoscopic cholecystectomy was done. Group B: Conventional four port laparoscopic cholecystectomy was done. Outcome is determined in terms of postoperative pain [determined by visual pain scale] and complications [bleeding, infection, bile duct injury]

Results: 35 patients in Group A had low pain score and 15 were high pain score. In group B, 24 had low pain score and 26 high pain score. In group A only 10 patient needed nalbuphine as compared to 35 patient in group B. Both groups have almost same operating time [48.5min A and 48min B]. Hospital stay is same [48h]. Complications like port site bleeding [2 patient in A and 4 in B], wound infection [2 in A and 3 patients in B], abdominal pain [3 in group A and 4 in group B] of three port laparoscopic cholecystectomy are comparable with four port cholecystectomy. No patient in both groups suffered bile duct injury

Conclusion: The three-port technique is as safe as the standard four-port for LC. The main advantages of the three-port technique are that it is less painful, safe, less chances of wound infection and leaves fewer scars

Rabies: a highly fatal but preventable disease

Rabies is a highly infectious viral disease of central nervous system caused by rabies Lyssa virus type-1. It is also known as hydrophobia and is transmitted to human being mostly by the rabid carnivorous animals

Objectives: 1-To understand the pathogenesis of the disease rabies and be able to manage this problem most effectively. 2- To be able to avoid preventable deadly complication of this disease. 3- To give awareness about right treatment and remove wrong concepts among the public about this highly fatal disease

Conclusion: treatment. Rabies can be managed effectively with various modalities like wound management, vaccination and use of Rabies immune-globulins [RIG] as active and passive immunization according to the category of the exposure

Prognosis and outcome: With tissue or cell cultured vaccine the results are good while nerve tissue vaccines have too many disadvantages and are of uncertain efficacy. Failure to use RIG in category iii bite is often a reason for failure of therapy

Prevalence of dyslipidemia in patients with type-2 diabetes mellitus

The dyslipidaemia associated with type-2 diabetes is associated with raised plasma triglycerides, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol and very low-density lipoprotein cholesterol levels and is a risk factor of cardiovascular disease. To assess the lipid abnormalities in patients with type-2 diabetes. A cohort study carried out at Diabetic Clinic of PMRC Research Centre, FJMC, Lahore, Pakistan. Eight years case records of type-2 diabetic patients seen at the research centre from 1999-2006 were reviewed. The research centre is a specialized centre for diagnosing and treating diabetes mellitus. All the patients were recruited for their follow up check up and laboratory investigations for dislipidemia. Adult treatment panel III guidelines for dyslipidaemia were followed. A 12 hours fasting blood sample was collected from each patient for serum total cholesterol, triglycerides, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and glucose as well as glycosylated hemoglobin [HbA1c] by using standard methods at Biochemistry laboratory of the research centre. LDL-C/ HDL-C ratios, Very low-density lipoprotein cholesterol [VLDL-C] and body mass index was calculated after anthropometery body mass index [BMI] >/= 25 was considered as overweight while >/= 30 obese. HbA1c<6.1 was considered as poor glycemic control. Data was analyzed by using statistical software SPSS-15. a total of 1200 type-2 diabetes were seen in 8 years. There was poor glycemic control, in 87.5% subjects judged on blood HbA1c levels. These patients had higher total cholesterol, LDL-C and low HDL-C levels in blood. The percentage of patients with high, borderline and near optimal risk LDL-C was 62.7, 26.9 and 10.4% respectively, while HDL-C >40mg/dl were seen in 67%. Raised VLDL-C [above 40 mg/dl] was seen in 32.9% cases. The group with high LDL and VLDL is at risk of developing cardiovascular disease. Hypertriglyceridaemia was found in 55% and hypercholesterolaemia in 45.4% cases. Obesity as indicated by body mass index was found in 53.7% patients. Statistically significant association of hypercholesterolemia, hypertriglyceridemia, hypo HDL cholesterolemia and VLDL-C was found with advancing age while only hypertriglyceridemia and VLDL-C showed a positive association with duration of diabetes. A significant association of hyperglycemia [raised HbA1c] was seen with hypertriglyceridemia and high LDL-C along with high body mass index i.e. obesity. Hypertriglyceridemia, high LDL-C and VLDL-C, low HDL-C levels and obesity were the pattern of dyslipidemia found in our diabetic population

Role of adjuvant topical oxygen therapy [Topox] versus conventional methods in the management of non- healing infected wounds

Objectives: To compare the role of adjuvant topical oxygen therapy versus conventional methods in the management of non-healing infected wounds

Study Design: Simple comparative study

Setting: The study was carried out in one year duration from January 2010 to December 2010 in Surgical unit-1 Allied Hospital Faisalabad

Sample Size: 60 patients

Methods: Total of 60 patients was divided into two groups. In one group [A] topical oxygen therapy was given along with conventional measures for management of wound. In second group [B] only conventional methods were used for wounds

Results: 60 cases included in this study,30 in group A and 30 in group B. From patients of group A, 16[53.3%] showed clinical improvement in first week and 25[83.3%] showed clinical improvement in second week. While in group B 5[17%] and 11[36.7%] showed clinical improvement in first and second week respectively.5[17%] patients in group A developed granulation tissue in first week and 19[63%] in second week. While in group B 2 [7%] developed granulation tissue in first week and 8[27%] in second week. From group A 10[33.3%] and 24[80%] patients showed complete wound healing in second and third months respectively. In group B 3[10%] patients showed complete wound healing in two months and 12[40%] in three months.1[3.3%]patient in group A deteriorated in first week and 2[7%] in second week.8[27%]patients from group B deteriorated in first week and 4[13.3]in second week

Conclusion: Use of TOPOX along with conventional method is more safe and effective in the management of nonhealing infected wound than conventional methods alone

Determinants of delayed presentation in breast cancer

To find out the factors which influence delayed presentation of breast cancer. A prospective study. The study was conducted in the department of surgery at Allied Hospital Faisalabad for a period of one year from 01-11- 2008 to 30-11-2009. With an informed consent, study was conducted on 75 patients of breast cancer who presented late in Allied Hospital Faisalabad for their treatment. Diagnosis of breast cancer in all the patients was established by tissue biopsy. Every patient was interviewed on a structured questionnaire to find out the determinants of delayed presentation from the date of first symptom recognition to the start of treatment. Extent of delayed presentation in our study ranged from 3 to 18 months with mean duration of 8 months. Patient delay showed a major influence on delayed presentation and its determinants were painless lump breast, negative family history of breast cancer, negative history of benign breast disease, increasing age above 40 years, lack of awareness about breast cancer, poor economic class, psychosocial and cultural beliefs, rural background, number of siblings 4 or above, lack of female doctors and illiteracy. Pre-hospital system delay showed a minor attribution to delayed presentation and it was associated with delayed or non-referral to consultants, mal-treatment by health care providers other than breast surgeons, false negative/misinterpretation of mammograms and false negative results of fine needle aspiration cytology. Locally advanced breast cancer [LABC/Stage III] was found in 62.7% patients, while, 12% patients had metastatic breast cancer [MBC/Stage IV]. Rest of the 25.33% patients had early breast cancer [EBC/stage I and II]. Delay of more than 6 months was found in 48 [64%] patients and out of them 60% had advance stage, while only 4% patients were observed in stage II [EBC]. Delay of 3 to 6 months was noted in 27 [36%] patients and among them 3 [4%], 13 [17.3%] and 11[14.7%] patients had stages I, II and III respectively. Delayed presentation of breast cancer is mainly attributed to patient delay rather than the system delay and longerd elays in presentation adversely influence the stage of breast cancer

Thyroidectomy with safe vocal cord functions

To compare the prevalence of vocal cord dysfunctions due to recurrent laryngeal nerve [RLN] injuries in thyroidectomy with and without identification of RLN. A prospective comparative study. The study was conducted in the Department of Surgery, Allied Hospital Faisalabad from October 1[st], 2008 to September 30[th], 2009. With an informed and explained consent, the study was conducted on two groups of patients who had thyroidectomy for the treatment of primary goitre. Patients were distributed on alternate basis irrespective the type of goitre into groups A and B for [thyroidectomy with identification of RLN] and [thyroidectomy with out identification of RLN] respectively. Patients of both groups were compared for the prevalence of post- operative vocal cord dysfunctions in association with recurrent laryngeal nerve injuries. Groups A and B had 52 and 53 patients respectively. Post-thyroidectomy vocal cord functions were remained safe in all the patients of group A. However, 3 [5.66%] patients of group B showed altered vocal cord functions in post operative follow up. Prevalence of RLN injuries in Group A and B remained 0% and 3 [2.97%] respectively. Out of three RLN injuries in group B, 2[1.98%] were transient and 1[0.99%] was permanent. Preservation of vocal cords functions and recurrent laryngeal nerves in thyroidectomy is more likely with the exposure and identification of RLN up to larynx

Total thyroidectomy in benign multinodular goitre

Total thyroidectomy is the standard surgical procedure for thyroid malignancy. Many surgeons do not perform total thyroidectomy in cases of Benign Multinodular Goitre [BMNG] owing to the fear of recurrent laryngeal nerve [RLN] damage and postoperative risk of hypoparathyroidism. Long term thyroxin therapy with its side effects is an additional factor. We conducted this study to assess total thyroidectomy as a safe option for managing BMNG. Surgical Unit-I and Surgical Unit-Ill, Allied Hospital, a tertiary care hospital affiliated with Punjab Medical College, Faisalabad. Duration of study was two years from January 2008 to January 2010. A total number of 196 consecutive patients undergoing total thyroidectomy [TT] for BMNG were included in this study. Patients with thyroid malignancy or suspicion of malignancy were excluded. Preoperative assessment included baseline biochemical workup and thyroid function tests. Preoperative serum calcium and indirect laryngoscopy [IDL] was performed in all the patients. Postoperative assessment included serum calcium estimation after 24 hrs and 07 days of TT. IDL was considered in any patient with suspected RLN palsy. Drain output was recorded at 24 hrs after TT. Total number of 196 patients were included with 49 male and 147 female [male to female ratio of 1:3]. Age ranged from 14-60 yrs [mean:37 yrs]. One thirty six patients undergoing TT had non-toxic MNG while 60 patients had toxic MNG controlled on antithyroid drugs. Drain output ranged from 10-100 ml in 24 hrs. No patient developed permanent RLN palsy. Seven patients [3.5%] had temporary unilateral RLN palsy. Fifty six patients [28.5%] developed temporary hypocalcemia. None of the patients developed permanent hypocalcemia. Two patients developed seroma formation which was aspirated with wide bored needle. Two patients got superficial wound infection which recovered with oral antibiotics. Postoperative hemorrhage requiring re-exploration did not occur in any patient. Postoperative stay ranged from 2-4 days. Most of the patients were discharged 48 hrs after surgery. There was no postoperative mortality. Total Thyroidectomy is a safe method for treating Benign Multinodular Goitre in experienced hands with low postoperative complications and morbidity

Role of fine needle aspiration cytology for neoplastic evaluation of nodular goitre

To see the accuracy of fine needle aspiration cytology [FNAC] for neoplastic lesions in nodular goitre. A prospective comparative analytic study. The study was conducted in Pathology Department, Punjab Medical College Faisalabad in association with the Department of surgery, Allied Hospital Faisalabad from September 1[st], 2008 to May 31[st], 2010. With an informed and explained consent, the study was conducted on 117 patients of primary euthyroid nodular goitre who underwent thyroid surgery. Preoperative diagnosis in all the patients was established by fine needle aspiration cytology and thyroid function tests. After thyroid surgery, excised tissue was sent for histopathology to confirm the diagnosis. Cytological diagnosis was compared with histological diagnosis to see the accuracy of fine needle aspiration cytology for neoplastic lesions. Among the 117 patients, FNAC showed neoplastic and non-neoplastic lesions in 27 and 90 patients respectively. While, histological diagnosis revealed neoplastic lesions in 24 patients and non-neoplastic lesions in 93 patients. Sensitivity, specificity and accuracy of FNAC for neoplastic lesions in nodular goitre remained 79.17%, 91.4% and 88.89% respectively. Fine needle aspiration cytology plays a pivotal role in pre-operative differentiation between the neoplastic and non-neoplastic lesions of nodular goiter

Operative management of unstable thoracolumbar burst fractures

Operative management of unstable burst vertebral fractures is challenging and debatable. This study of such cases was conducted at the Aga Khan Hospital, Karachi from January 1998 to April 2003. All surgically managed spine injuries were reviewed form case notes and operative records. Clinical outcome was assessed by Hanover spine score and correction of kyphosis was measured for radiological assessment. The results were analyzed by Wolcoxon sign rank test for two related samples and p-value < 0.05 was considered significant. Ten patients were identified by inclusion criteria. There was statistically significant difference between mean pre-and postoperative Hanover spine score [p = 0.008]. Likewise, there was significant difference between mean immediate postoperative and final follow-up kyphosis, [p = 0.006]. Critical assessment of neurologic and structural extent of injury, proper pre-operative planning and surgical expertise can optimize the outcome of patients

Role of alanine transaminase as an indicator of non alcoholic fatty liver patients with type-2 diabetes mellitus

This study was carried out to see the role of Alanine transaminase [ALT] as an indicator of Non Alcoholic Fatty liver disease [NAFLD] in patients having Type-2 Diabetes Mellitus. This was a descriptive study carried out al PMRC FJMC Lahore. A total of 63 diabetic cases that were diagnosed on ultrasonography as nonalcoholic fatty liver were recruited in this study. Demographic profile of the patients were recorded and all were subjected to lab investigation which included random blood glucose, serum triglycerides and liver function tests including viral marker of the hepatitis. Fatty liver was more prevalent in female patients 47 out of 63 [74.6%] and is more common above 40 years of age, median age being 46 years. The duration of disease was prolonged with median of 6 years. It is seen that 28/63 [44.5%] were hypertensive, 31% had hyperlipidemia and 9.5% were having ischemic heart disease. Majority of patients 28 out of 63 [44.5%] had hepatomegaly. The liver enzymes results showed that 12 of the 63 [19%] were positive for hepatitis B and C and had ALT level raised with mean of 63.00 +/- 40.66. While, among the other 51 patients without hepatitis B and C ALT level were within normal range in 36 [71%] of the cases. While in rest of 29%%15 out of 51 they were only mildly elevated. Thus showing that ALT has no role as an indicator of fatty liver. Alanine transaminase is not an indicator of NAFLD and mild elevation can be due to the metabolic disturbances in type-2 diabetic patients. It is therefore, suggested that ultrasound graph is a good tool to detect the NAFLD in its early stage

Comparative study between intranasal antrstomy and antral lavage an experience at CMCH Larkana

To compare the results of intranasal asntrostomy and antral lavage in maxillary sinusitis. This randomized control study was conducted in the department of ENT Chandka Medical College Hospital Larkana during the period from December 2004 to 2007. The overall study of 150 cases was conducted. Out of 150 cases 92 [61.31%] were male and 58 [38.71%] were female and the male / female ratio was 1.6:1. Symptomatology was dominated by PND 95% purulent rhinorrhea 70% headache 52% and nasal obstruction 25%. The overall result of 150 patients x-ray showing mucosal theckining 89 [59.3%] hazzy / opaque sinus 40 [26.6%] and fluid level 14 [9.4%] three times antral lavage was done in all 100 patients. Out of 100 patients 33 got no benefit and underwent for intranasal asntrostomy along with selected 50 patients. Every patient was followed up for 2 weeks. Antral lavage showed 67% benefit and 33% patients got no benefit while intranasal antrstomy followed up patients got 90% benefit and 10% got no benefit This study shows that results of intranal antrstomy is better than antral lavage

Pattern of genitourinary tuberculosis in patients with pulmonary tuberculosis

Tuberculosis is an ancient disease. It is responsible for causing a major health problem in developing countries. Genitourinary tuberculosis is the second most common form of extra pulmonary tuberculosis after lymph node involvement. This study was carried out to determine the pattern of genitourinary tuberculosis in patients with active pulmonary tuberculosis. It is a cross sectional descriptive study. Carried out in the Urology Department of Jinnah Hospital and T.B outdoor of Gulab Devi Hospital, Lahore during the period Oct, 2002 to Oct, 2004. Two hundred patients with pulmonary tuberculosis, 117 males and 83 females, ranging from 17 to 80 years of age [mean 37.9 years] were included in the study. Hundred patients were freshly diagnosed cases [group-1] and the remaining hundred patients were already diagnosed cases of pulmonary tuberculosis and had received antituberculous treatment [ATT] for at least three months [group-2]. Diagnosis of pulmonary tuberculosis was based on positive sputum smear for acid fast bacilli [AFB] by Ziehl Neelsen [ZN] staining technique. Twenty four hours urine was collected from each patient. Each specimen was examined for the presence of mycobacterium tuberculosis by ZN staining and culture on Lowenstein Jensen [LJ] medium. Positive for one or both of these procedures was taken as positive for genitourinary tuberculosis. Biopsy of urogenital tract was carried out and histopathological examination was done in patients with positive bacilluria and having urinary symptoms. Genitourinary organs of 9 patients in group-1 and 18 patients in group-2 were found involved for genitourinary tuberculosis. Among 9 patients in group-1, the urinary bladder and kidney involvement were highest 3 [33.3%] followed by epididymis 2 [22.2%] and Ureter 1 [11.1%]. Among the 18 patients in group-2, urinary bladder involvement was highest 9 [50%] followed by kidney 5 [27.8%], epididymis 3 [16.7%] and testis 1 [5.5%], Genitourinary organ involvement in patients already on antituberculous treatment is more common as compared to freshly diagnosed cases. Urinary bladder involvement is highest in both groups

Pyloric duplication cyst: a rare congenital anomaly

Pyloric duplication cyst is one of the rarest congenital anomalies. We present such a case in a boy of 6-1/2 years old who was treated by us successfully. The theories of its embryogenesis, mode of presentations, diagnosis and treatment are discussed