Carotid Artery Stenting and Its Impact on Cognitive Function: A Prospective Observational Study / 신경중재치료의학

Purpose@#Carotid artery stenting (CAS) has evolved as a first-line therapeutic option for carotid revascularization in indicated patients for stroke prevention, but there is still a lack of data on its effect on cognitive function (CF), especially among Indian patients. To determine the effect of CAS on CF and to study the immediate and delayed complications of CAS in Indian patients. @*Materials and Methods@#This was a prospective, observational, single-center study. CF was assessed using Addenbrooke’s cognitive examination version III (ACE) before and 3 months after stenting. The demographic and clinical parameters were also assessed. A follow-up evaluation after 3 months was done to compare CF and to observe the occurrence of any complications. @*Results@#Out of 31 patients, 3 were lost to follow up. There were no immediate or delayed procedure-related complications. There was a statistically significant improvement in overall ACE score and memory before and after stenting. On subgroup analysis of those with and without strokes, there was a significant improvement in visuospatial function and mean ACE score. Those with left CAS had significant improvement in memory, visuospatial, language, and ACE scores than right CAS. @*Conclusion@#CAS was associated with significant improvement in CF in patients.

Fall-related injuries in a low-income setting: results from a pilot injury surveillance system in Rawalpindi, Pakistan

This study assessed the characteristics and emergency care outcomes of fall-related injuries in Pakistan. This study included all fall-related injury cases presenting to emergency departments [EDs] of the three teaching hospitals in Rawalpindi city from July 2007 to June 2008. Out of 62,530 injury cases, 43.4% [N = 27,109] were due to falls. Children [0-15 years] accounted for about two out of five of all fall-related injuries. Compared with women aged 16-45 years, more men of the same age group presented with fall-related injuries [50% vs. 42%]; however, compared with men aged 45 years or more, about twice as many women of the same age group presented with fall-related injuries [16% vs. 9%, P < 0.001]. For each reported death due to falls [n = 57], 43 more were admitted [n = 2443, 9%], and another 423 were discharged from the EDs [n = 24,142, 91%]. Factors associated with death or inpatient admission were: aged 0-15 years [adjusted odds ratio [aOR] = 1.35], aged 45 years or more [aOR = 1.94], male gender [aOR = 1.15], falls occurring at home [aOR = 3.38], in markets [aOR = 1.43], on work sites [aOR = 4.80], and during playing activities [aOR = 1.68]. This ED-based surveillance study indicated that fall prevention interventions in Pakistan should target children, older adult women, homes, and work sites

Concurrent splenic lymphangiomatosis and Proteus syndrome

A 37-year-old female presented with Proteus syndrome and was found to have an asymptomatic enlarged spleen. Pathology confirmed splenic lymphangiomatosis. We describe an association of these 2 disorders in the Middle Eastern population. Diagnosis and pathogenesis are discussed in this case report

Hepatitis B surface antigen carrier rate in unvaccinated and vaccinated children with thalassaemia major at Bahawal Victoria Hospital, Bahawalpur, Pakistan

Screening of blood reduces but does not eliminate the risk of hepatitis B virus [HBV] infection in multi-transfused thalassaemia patients. This study was done to evaluate efficacy of HBV vaccination on hepatitis B virus surface antigen [HBsAg] carrier rate in children with thalassaemia major receiving multiple blood transfusions. In a cohort study conducted at a hospital in Bahawalpur, Pakistan, during 2009-10, children with thalassaemia major aged < 60 months who received more than 24 blood transfusions and were HBsAg negative at the time of first blood transfusion were included. Of 196 unvaccinated children, the seropositive rate was 12.2%; while among 218 children vaccinated during the first year of life via the Pakistan Expanded Programme on Immunization, the seropositive rate was only 0,9%. The HBV vaccine was highly effective in reducing the HBsAg carrier rate in children with thalassaemia aged < 5 years

Effect of landfill leachate on the stream water quality

The influence of leachate from open solid waste dumping near Salhad stream [Abbottabad, Pakistan] was investigated to quantify the variations of water quality during August 2007 to April 2008. Samples were collected from five different sites located along the Salhad stream. Two sites were located before the mixing of solid waste leachate with the surface water. One sampling site was of leachate and other two chemical parameters like pH, water temperature, electrical conductivity [EC], total dissolved solids [TDS], Biological oxygen demand [BOD], chemical oxygen demand [COD] and dissolved oxygen [DO]. Microbiological analysis was done by using Membrane filter technique. The results of various parameters determined strongly suggested that landfill leachate had severe deleterious impact on the water quality of Salhad stream. The parameters exceeding the allowable limits of WHO, EC and National Environmental Quality Standards included pH, TDS, BOD, COD, total bacterial counts and total coliform counts. Heavy metals like Pb, Cd and Cu were released from the leachate into the Salhad stream which might affect the sustainability of the aquatic life. Integrated, multi-sector approaches are required to deal with the contamination problem and sustainable management of the Salhad stream water

Road traffic injuries in Rawalpindi city, Pakistan

Data on road traffic accident [RTA] injuries and their outcome are scarce in Pakistan. This study assessed patterns of RTA injuries reported in Rawalpindi city using standard surveillance methods. All RTA injury patients presenting to emergency departments of 3 tertiary care facilities from July 2007 to June 2008 were included. RTA injuries [n=19 828] accounted for 31.7% of all injuries. Among children aged 0-14 years females suffered twice as many RTA injuries as males [21.3% versus 11.4%], whereas this trend reversed for the age group 15-24 years [41.9% versus 21.7%]. One-fifth of injuries were either fractures or concussion. Severity and outcome of injuries were worse for the age group 45 years and older. For every road traffic death in Rawalpindi city, 29 more people were hospitalized and 177 more received emergency department care. These results suggest the need for better RTA injury surveillance to identify preventive and control measures for the increasingly high road disease burden in this city

Knowledge, attitudes and practices of barbers about hepatitis B and C transmission in Hyderabad, Pakistan

Hepatitis B and C virus [HBV/HCV] infections are serious global health problems. Shaving by barbers has been identified as the key risk factor for spread of HBV. We conducted a cross-sectional survey of barbers in Hyderabad city, Pakistan in 2007 to establish their knowledge and attitudes to the risk of HBV and HCV transmission and their working patterns. Observations showed that 96.2% washed razors with antiseptic after each client and 95.7% used a new blade with new clients. However, knowledge about the diseases and modes of transmission were poor and only 36.6% knew that hepatitis can be transmitted via shaving instruments. Only 3.2% of 186 barbers were vaccinated against HBV. Strategies are needed for raising awareness and regulations of barbers' practices

Role of modified triple test scoring system for evaluation of palpable breast masses in women under age 40

This prospective analytical clinical study was carried out to determine if a modification of the triple test score in which ultrasonography is substituted for mammography could be developed to rapidly and accurately assess breast mass in women under 40 years of age. Total hundred women were included in this study. Women younger than 40 years with palpable masses were evaluated utilizing modified triple test scoring. Surgical oncologist performed physical examination radiologist performed ultrasonography and cytopathologist did FNAC. All the patients were below age 40; about 50% were between 25-29 years. The youngest patients were of 20 years of age. Seventy-five patients were married and 25 were unmarried. Eleven% of the patients gave history of breast cancer in one of their family members. All the patients have a breast lump; most of the patients found their lumps incidentally while palpating them; however 38% of the patients had associated pain. Weight loss and anorexia was present in 3[3%] cases. Most of the patients 53[53%] presented with breast problem of less than three month duration, 26[26%] presented with complaints of 4-6 months duration while 21[21%] having duration of complaints more than 6 months. Fifty-five cases [55%] of breast lump were found on left side as compared to right 45[45%]. We thus conclude that to minimize delay and, therefore, reduce anxiety in majority of patients presenting to hospital and to avoid unnecessary out patient follow up and open biopsy, a policy of modified triple assessment [where ultrasonography is substituted for mammography especially female under the age of 40 years] with immediate reporting to provide a "one stop" diagnostic service proved highly beneficial for patients. The triple test score thus modified and named as modified triple test score [MTTS]

Gastric ulcer healing effects of Nigella sativa; a comparative experimental study with cimetidine

Nigella sativa seeds have been in use as a natural remedy for over 4000 years in various parts of the world. These seeds are reported to benefit almost every system of the body; the present study was conducted to see the healing effects of Nigella Sativa in experimentally produced gastric ulcers with comparison to Cimetidine. It was an experimental study on 40 albino rats, performed in animal house of Postgraduate Medical Institute, Lahore. The animals were given Aspirin [0.2 gm/kg body weight] to produce ulcers. Four animals were killed after 2 weeks to confirm gastric ulcers by histopathology. The remaining animals [36] were equally divided in two groups and the 3 subgroups according to time schedule [2-6 weeks] for the treatment with Nigella Sativa [30 mg/kg body weight] and Cimetidine [15 mg/kg body weight]. Rats were anaesthetised and sacrificed at the end of experimental periods and the stomachs were removed, rinsed in lukewarm distilled water. Gross and microscopic examinations were performed to evaluate the results. On gross examination of stomach, 14/18 [78%] albino rats of group "A" [taking Nigella Sativa] did not reveal any abnormality due to complete response to Nigella sativa as compared to 17/18 [94%] of group "B" [taking Cimetidine]. On microscopic examination of stomach, 13/18 [72%] albino rats of group "A" [taking Nigella Sativa] revealed complete recovery as compared to 16/18 [89%] of group "B" [taking Cimetidine]. We concluded that Nigella sativa is equally effective in healing of gastric ulcer as is Cimitidine therefore we suggest the use of the N-sativa in the therapy of gastric ulcer disease in routine practice

Frequency of ABO and RH blood groups in major ethnic groups and casts of Pakistan

To find out the frequency of ABO and RhD phenotypes in different ethnic groups and casts of Pakistan. Design: cross sectional descriptive study. Place and duration of Study: Combined Military Hospital Attock Punjab Pakistan from 1St Jan 2003 to 31 11 Dec 2003. Material and All healthy young adults reporting for recruitment in Armed Forces. Cast and sub cast were recorded. ABO grouping and Rhesus typing was done by slide method. Eight thousand three hundred seventy five young adults were screened. ABO blood group distribution in Arains was: A 25.6%, B 40.5%, AB 9.2%, O 24.7%. Awans: A 22%, B 31.7%, AB 9.9%, O 36.5%. Rajputs: A 23%, B 33.2%, AB 8.8%, O 35.1%. Misc Punjabi sub casts: A 23.6%, B 33.2%, AB 7.5%, O 35.7%. Balochs: A 23.3%, B 27.9%, AB 7.8%, O 40.9%. Sindhis: A 24.9%, B 31.8%, AB 6.9%, O 36.5%. Kashmiris: A 23.7%, B 32.5%, AB 10.2%, O 33.6%. Pathans: A 24.3%, B 31.4%, AB 8.9%, O 35.4% Rh-D negative [n=749] blood group in Araeens 8.3%, Awans 10.4%, Rajputs 8.5%, Misc Punjabi sub casts 8.8%, Balochs 7.8%, Sindhis 8.7%, Kashmiris 10.9% and Pathans 7.7%. There is no statistically significant difference of ABO and Rh-D distribution among various ethnic groups, O is the most common blood group except in Arains where B is the most common and O is less common

Parotid gland sarcoidosis with renal failure

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. Although any organ can be involved in sarcoidosis, significant renal involvement is rare, mostly due to nephrocalcinosis. Renal impalrment in the absence of nephrocalcinosis is uncommon and is usually due to glomerulonephritis or granulomatous pathology in the interstitium. Bilateral parotid swelling with renal impairment, as a presenting feature of sarcoidosis, as in this case, has never been reported before

Ivor Lowis esophagectomy: experience at Jinnah hospital, Lahore

Although different approaches have been used for surgical resection of esophageal cancer, the Ivor Lewis approach is the standard technique at most centers for resection of the diseased middle and lower third esophagus. This procedure has historically been associated with significant morbidity and mortality. However, modern literature suggests that Ivor Lewis esophagectomy can be performed with an acceptable complication rate and mortality. Patients and methods: We conducted a case series of thirteen consecutive patients who underwent an Ivor Lewis esophagectomy at Jinnah Hospital Lahore from January, 2001 to December, 2002. The objective was to examine the morbidity, mortality and short-term outcome of this surgical procedure. The mean age of the patients was 45.9 years +/- 18.3 years [median: 44.5 years; range: 22 to 78 years]. 7 patients were men and 6 patients were women. 6 patients [46.2%] were operated for benign corrosive esophageal strictures whereas seven patients [63.8%] had esophageal cancer. The median age of the patients with benign strictures was 28 years [range: 20 - 35 years]. The median age of the cancer patients was 58 years [range: 54-70 years]. Of these patients, one had Stage I cancer [9.29%], two had Stage II a [28.57%], two had Stage II b [28.57%], and two had Stage III disease [28.57%]. Five patients [71.42%] had adenocarcinoma and two [28.57%] had squamous cell carcinoma. Seven patients [53.8%] had one or more co-morbid conditions, including diabetes, hypertension, cardiovascular disease and chronic obstructive pulmonary disease. Four patients [30.77%] had history of smoking. The mean operative time was 270 minutes +/- 31 minutes. The mean operative blood loss was 1500 ml +/- 102 ml. The median ICU stay was one day [range: I to 7 days]. The median hospital stay was 19 days [range: 15 to 38 days]. Eight patients [61.54%] developed post-operative complications. Most of these complications were medical [60%] rather than surgical [40%]. Respiratory complications were the commonest [30.77%]. Of the surgical complications, the most common was the development of an anastomotic leak [23.08%]. All of these were managed conservatively and none proved fatal. There were two mortalities on post operative days 7 and 8, due to ARDS and multi-organ failure respectively. The operative mortality was 15.39%.Ivor Lewis esophagectomy represents a major physiological and surgical insult. However, careful patient selection, perioperative monitoring and early aggressive treatment of complications can significantly reduce morbidity and mortality

Is breast cancer in younger women a more aggressive variant? a comparative study

Breast cancer is the commonest malignancy in women in the world. About 5% of all breast cancer patients are 35 years old or younger. Current literature suggests that breast cancer in these younger women may be different in etiology, clinical features and outcome from the disease seen in older women. We included all breast cancer patients who underwent surgical treatment at Surgical Unit IV, Jinnah hospital, Lahore from December, 1998 to December, 2003. All patients who left against medical advice or were lost to follow up before completing treatment at our hospital wee excluded. The patients were divided into two groups by age. Those who were 35 years old or younger were placed in group 1 [88 patients] and those older than 35 years were placed in group 11[54 patients], which served as the control group. We compared the clinical presentation, the risk factor profile, and the grade and the stage of the tumor at presentation in younger women and their older controls. The mean age in group I was 29.38 years +/- 3.68 years. While the mean age in group II was 44.41 years +/- 7.64 years. The commonest mode of presentation in both groups was a painless lump. [93.2% in group I and 66.67% in group II; p value < 0.001]. The distribution of classical risk factors was similar in the two groups. These included family history [12.5% in group I and 11.1% in group II], nulliparity [7.95% in group I and 7.4% in group II], and oral contraceptives use[14.77% in group I and 12.96% in group II]. Younger patients presented with a greater number of poorly differentiated [Grade III] tumors compared to the older patients. [73.76% vs.24.07%; p value <0.001]. They also presented more frequently with hormone insensitive tumors [79.55% in group I vs. 24.52% in group II; p value < 0.001]. Mammography was positive more often in older women compared to the younger ones [97.44% vs.41.38%; p value < 0.001]. Ultrasound was done in 67.05% of the younger women and 27.78% in the older women. It was suggestive of malignancy in 89.83% of the younger women and 86.67% of the older ones. Modified radical mastectomy was done in 75% of the younger patients [Group I] and 61.11% of the older patients [Group II]. Radical mastectomy was done in 19.32% of group I patients and 27.78% of group II patients. Older women underwent breast conservation treatment more often than the younger women [11.11% vs. 5.68%; p value < 0.05] Adjuvant chemotherapy was given more often to younger women [73.86% in group I vs. 9.26% in group II; p value < 0.0001]. On the other hand, older patients received hormonal therapy more often that the younger ones [74.07% vs. 20.45%; p value < 0.001]. Younger patients also received adjuvant radiotherapy more frequently than their older counterparts [84.32% vs. 49.26; p value <0.05]. We conclude that women with breast cancer who are 35 years old or younger have more aggressive tumors than the older patients i.e. they present at a higher stage with poorly differentiated tumors that are frequently hormone insensitive

Profile of medicolegal cases at Jinnah hospital, Lahore

1] To physically equip accident / emergency department of Jinnah Hospital for the management of medico legal cases on scientific grounds 2] To Study the age group and the type of weapon involved 3] To create awareness amongst the social workers, law enforcement agencies and medical personnel about the management of such cases. 4] To suggest appropriate measures to reduce the incidence of these emergencies. Two hundred and fifteen cases of medicolegal nature were collected. These cases visited the Accident /Emergency Department of Jinnah Hospital Lahore during the first six months of the year 2000 [January to June]. A specialized proforma was designed to record the age, sex, and type of weapon inflicting injuries. Out of these 213 cases 182 [85.44%] were male and 31 [14.56%] were female. Majority of the patients were within the age groups of 11-30 year of age [62.91%]. 92 [43.19%] patients were injured because of the blunt weapon, 57 [26.76%] because of the firearms, 38 [17.85%] suffered injuries in road traffic accidents, 23 [10.80%] because of sharp edged weapons and 3[1.40%] patients because of the bums

Firearm injuries - a study of 110 cases

It is a perspective study of 110 cases of firearm injuries presenting at accident and emergency department Jinnah Hospital Lahore. The medicolegal services or provided by the department of forensic Medicine and Toxicology, Allama Iqbal Medical College, Lahore. Consecutive 110 cases of firearm injuries were recruited in the study presenting in the Accident and Emergency Department of Jinnah Hospital Lahore during period October 1998 to September 2000. Out of the total of 110 cases, 100 cases were males [91%]. And 10 were female [9%]. The age ranged from 0 to above 60 years. The maximum numbers 42 [38%] were found between 21 to 30 years. Rifled weapon was used in 96 cases [87.3%] and non rifled weapon [shot gun] in 14 [12.7%] near distance fire was in 23 [21%] and for distance fire in [79%]. Body parts involved were also analyzed i.e. head face neck, chest abdomen and limbs. The gravity of situation reemphasized and suggestions made to the relevant authorities for better, healthy and peaceful society

Vaginal birth after caesarean section [VBAC]

Aims and To find out the rate of vaginal delivery after one caesarean section Study Design: Non-interventional, descriptive study Study Setting: Department of Obstetrics and Gynaecology, Allama Iqbal Medical College and Jinnah Hospital, Lahore. Materials and A trial of vaginal delivery was carried out on 100 patients with previous one caesarean section. Selection criteria were subjects with normal pregnancy, adequate maternal pelvic dimensions vertex presentation and spontaneous onset of labour with previous one uncomplicated LSCS. Patients with classical caesarean section, medical complications, multiple pregnancy, IUGR, placenta previa and extensive myomectomy were excluded from the study. Informed consent was taken from all patients; trail of scar was given with vigilance. Maternal and fetal monitoring was carried out with facility of operation theatre, anaesthesia and paediatrician. Majority of patients was between 20-24 years of age. 58% of the patients were primipara. Successful vaginal delivery was achieved in 72% and rate of repeat section was 28%. Leading indications for repeat section were failure to progress, [50%], fetal distress [28.5%] and scar tenderness [21.43%]. No maternal and fetal mortality occurred. Trial of scar after one LSCS should be encouraged with vigilant monitoring provided no obstetric contraindication exists

Candida albicans myocardial abscess

A case report of an 88 years old male is presented who had past medical history of aortic valve replacement twice, first in 1984 and second in 1998, acute congestive heart failure with aortic insufficiency due to bioprosthetic degeneration and aortic root dilation and aortic dissection [status-post aortic root repair and ascending aorta replacement with Hemashield aortograft in 1998], infrarenal 4.8 cm abdominal aortic aneurysm, myocardial infarction in 1999, peripheral vascular disease, hemicolectomy due to colonic polyps, benign prostatic hyperplasia, status post transurethral prostatectomy in 1990, chronic renal insufficiency, and rheumatic fever. He was transferred from a nursing home to the acute care in July 1999 with a history of fever, 101.7oF, lethargy, mild confusion, shortness of breath and chest pain. On physical examination, the patient was found to have distended neck veins, a III/VI systolic ejection murmur at the left 2nd intercostals space and a diastolic murmur at the apical region, and bibasilar crackles on respiratory examination. The chest radiograph revealed right middle lobe infiltrates and prominent bronchial markings and cardiomegaly with an unfolding aorta. Electrocardiograph showed atrial fibrillation, left axis deviation, and an old septal infarct. On initial laboratory work-up, the patient had a total leukocyte count of 12.4 t/cu mm, [polymorphs 81.4%, lymphocytes 8.2%, monocytes 10.3%], with a platelet count of 94 t/cu mm and normal cardiac enzymes. The initial blood urea nitrogen, creatinine and electrolytes were within normal range. Vancomycin, Rifampin and Gentamicin were started empirically. On third day of hospitalization, transthoracic and transesophageal echocardiography were done which did not show any vegetation or myocardial abscess. Two blood samples were drawn for cultures and were found to be positive for Candida albicans. Continued