Antihyperglycemic and antidyslipidemic effect of calotropis flowers in experimental diabetic rats

Background: Diabetes mellitus is a growing menace and the cost of treatment and debilitation is high especially in poor societies. Hyperglycemia in diabetes is associated with deranged lipid profile. Various parts of plants and herbs have been indigenously used around the world for treatment of diabetes mellitus. Root, bark, leaves and latex of Calotropis procerahave been experimentally studied for their antidiabetic effect. This study was undertaken to explore the antidiabetic and antidyslipidemic effect of the flowers of Calotropis procera

Methods: Diabetes was induced by streptozotocin. Calotropis procera flowers aqueous extract [CFEX] was given orally in doses of 10,20,30,40 and 50 mg/kg body weight. Serum levels of total cholesterol, triglycerides, HDL and LDL were measured at the beginning of experiment and at intervals of 1 day, 1 week, 2 weeks and 3 weeks and compared with those in positive controls treated with glibenclamide and untreated negative control animals

Results: Weight loss in CFEX-treated animals was not significantly different from positive control group. Decrease in serum glucose levels, comparable to positive controls, was observed in animals treated with CFEX 20,30,40 and 50 mg/kg body weight. The TC, TG and LDL significantly decreased while a significant increase in HDL was seen

Conclusion: Calotropis procera flowers extract has shown antihyperglycemic and antidyslipidemic effects in experimental diabetic rats and may have the potential of a potent antidiabetic agent

Investigation of antiparkinsonian effect of Aloe vera on haloperidol induced experimental animal model.

Background: Aloe vera (Family: Liliaceae) has been used for the treatment of diabetes, skin disorders and as an anti-inflammatory agent. There is increased concern about the side effects of conventional medicine in the treatment of Parkinson’s disease (PD). As A.vera has found to have antioxidative property, it may be a safer alternative. Methods: Parkinson’s disease was induced by administering haloperidol (1 mg/kg i.p. daily x 1 week).The mice of either sex were divided into 06 groups (n =12). 1 st day group mice were given distilled water (orally), 2nd group were administered haloperidol (20 mg/kg i.p.).The 3rd, 4th and 5th groups were administered A.vera (100, 200, and 400 mg/kg/day, orally) respectively, along with haloperidol. Group 6- received Levodopa (30mg/kg, i.p,) along with haloperidol. To evaluate anti-Parkinson effect, hanging wire test, tardive dyskinesia test and hole board test were performed on the1st day and 8th day. One way ANOVA was used to detect statistical significance followed by post-hoc Tukey test. Results: A.vera (200 and 400 mg/kg, p.o.) was found to increase the hanging time significantly (p <0.001) in hanging wire test and significantly decreased (p <0.001) the Vacuous Chewing Movements (VCMS) in tardive dyskinesia test as compared to haloperidol group. A.vera (200 and 400 mg/kg, p.o.) was found to significantly increase (p <0.001) the number of dips and no. of line crossings in hole board test when compared to haloperidol group. Conclusion: The results of the present study conclusively showed that A.vera has beneficial effect in haloperidol induced experimental model of Parkinson’s disease.

Cranial measurements; estimation of stature from cranial measurements

Human body exhibits regular age, sex and race dependent proportions amongst its various segments relative to its height. Knowledge of the cranial morphometry is important from clinical and forensic view point. The stature of a person being genetically predetermined is an inherent characteristic, the estimation of which is considered to be important assessment in identification of human remains. Norms of regression formulae for calculation of height are required for different populations. To document norms for cranial dimensions and present linear regression formulae for stature prediction in adult male and female population of Southern Punjab. The study was conducted at the Multan Medical and Dental College, Multan and took about fourteen months to complete. The study was conducted on 672 adult individuals [430 males and 242 females] from in and around the city of Multan in Punjab. Measurements of the head including maximum cranial length [glabella-inion length], maximum cranial breadth [maximum bi-parietal diameter] and maximum auricular head height were taken. Results were expressed as mean +/- SD. Height was measured in standing anatomical position. Correlation coefficient of Pearson was used to find the relationship between various cranial dimensions using which the linear regression formulae to predict the stature were derived. The mean height of the study population was found to be significantly different between genders. The males appeared to be considerably taller than females. The mean cranial length, cranial breadth and auricular head height the measurements were larger significantly in the males as compared to females. Pearson's correlation coefficient between stature and cranial measurements was found to be highly positive for both sexes. Linear regression formulae to predict the stature from the cranial dimensions were derived. The study is conducted to document norms for cranial dimensions and it presented gender specific linear regression models for stature prediction in adult South Punjab population

Knowledge of dentists about epilepsy and their attitude toward the dental treatment of epileptic patients: a survey of dentists in Peshawar - Pakistan

The relationship of epilepsy with society, knowledge of people, attitude, and how may it affect the access of people with epilepsy to dental care. A questionnaire that explored facts about the knowledge, attitude and willingness to provide dental care to people with epilepsy was delivered to 129 dentists personally in the city of Peshawar [KPK], Pakistan. Of the 129 respondents, 10.9% were general dentists. Knowledge was patchy about the epidemiology, causes, treatment and recognition of epilepsy. 44% of dentists did not think that they could safely treat patient of epilepsy in their offices. Lack of knowledge and negative attitude towards epilepsy may affect the access to dental care for people with epilepsy

Clinical crown length, width and the width/length ratio in the maxillary anterior region in a sample of Mardan population

The objective of this study was to determine clinical crowns length, width and width/length ratios of the maxillary anterior teeth and to determine standard of ideal tooth dimensions. Crown length, width and width/length ratio was measured of 100 casts of patients. All of the 6 maxillary anterior teeth present, anatomically whole, without restorations that altered their dimensions, from which good diagnostic casts could be obtained, and where the anatomic elements were well defined were included in the study. The data were analyzed by using SPSS 20.0 version. Mean and standard deviation were calculated for numerical variables like age, tooth width, length and width/length ratio. Pearson correlation test was applied for symmetry of teeth sizes between left and right of arch. The sample composed of 50% males and 50% females with gender ratio 1: 1. The mean age was 23 +/- 2.3 years. The mean crown length was 10.22 mm for right central incisor, 7.96 mm for right lateral incisor and 8.88 mm right canine. The left side teeth crown width was close to right side. The mean crown width was 7.99 mm for right central incisor, 7.96 mm for right lateral incisor and 8.28 mm right canine. The left side teeth crown length was nearly equal to right side crown width. The mean crown width/length ratio was 0.91 for right central incisor, 0.72 for right lateral incisor and 0.71 right canines. The left side teeth crown width/length was nearly equal to right side crown width. Interclass correlation was almost perfect and statistically significant. The tooth dimension showed less variation [low standard deviation value] for crown length, width, and width/length ratio; so it will help the clinician in restorative procedures

Chronic experimental diabetes mellitus; quantitative changes in dorsal root ganglion cells

Background: multiple factors operate in the development of diabetic neuropathy. Sensory neurons are not protected by blood-brain or blood-nerve barrier; also the dorsal root ganglion cells [DRG] have a higher metabolic requirement than the nerve trunks. Oxygen level at the dorsal root ganglions also appears to be lower. All these physiological characteristics suggest that DRG may be particularly susceptible to damage in prolonged diabetic conditions

Objectives: to observe the quantitative cellular changes in dorsal root ganglion cells in rats with prolonged experimental diabetes

Study Design: an experimental study

Setting: Department of Human Anatomy, Faculty of Medicine, Umm al Qura University, Makkah, Saudi Arabia

Period: fifteen months to complete

Material and methods: observations were made on six control and six streptozotocin-treated male Sprague-Dawley rats after 12 months of diabetes. Cell count was done on silver-stained paraffin sections. DRG cells were arbitrarily grouped as large A-type and small B-type. Statistical examination of the cell count was done using a two-tailed t-test. Values were considered significant at P

Results: in the control group of animals the mean total number was 15856.33 +/- 552.538 while in the diabetic animals it was 11836.666 +/- 583.177; the reduction in the number of cells was significant. The number of A-type and B-type cells and their percentages in the control group and the diabetic group of animals were 2753.833 +/- 257.683 [17.36%], 13102.5 +/- 443.092 [82.63%] and 1202.833 +/- 87.082 [10.16%], 10633.833 +/- 517.900 [89.83%] respectively. The differences in the number of A-type and B-type of cells when compared between control and diabetic groups of animals were statistically highly significant

Conclusion: selective cells damage to DRG cells may be the harbinger of diabetic neuropathy in experimentally induced diabetic rats

Quadriceps Tendon and Patellar Ligament; a morphometric study

Background: Anterior cruciate ligament [ACL] is commonly injured especially in sportsmen. Autografts using tissue from various sources including the quadriceps tendon and patellar ligament are popular but still controversial due to varying degree of success. The morphological characteristics of the quadriceps tendon and the patellar ligament are of prime importance for this purpose

Objectives: This cadaveric study was undertaken to evaluate the morphometric characteristics of the quadriceps tendon and patellar ligament as an autograft for ACL reconstructive surgery

Study design: Qualitative cadaveric study

Material and Methods: The morphometric observations of the quadriceps tendon and patellar ligament on 36 [18 male and 18 female] adult formalin fixed cadavers were recorded by dissection. The observations included the length, breadth and thickness of the quadriceps tendon and the patellar ligament and were recorded on both sides separately in the male and female subjects. The data were tabulated, compared and statistically analyzed

Results: There was no significant difference in measurements on the right and left sides both in the male and in the female specimens. However the length and width of the quadriceps tendon was more in the males as compared to the females. The patellar ligament was significantly longer in the male specimens as was its width. Thickness of the patellar ligament, however, was not significantly different in the two genders

Conclusion: Both the quadriceps tendon and the patellar ligament are safe and convenient sources of autograft tissue for reconstruction of the ACL

cephalometric study in Southern Punjab

Background: Morphological characteristics of various races and population groups usually appear in geographical knots and clusters. Standardized cephalometricrecords are immensely valuable for clinical and forensic purposes.In spite of its clinical significance no data is available about the cephalic indices and prevalence of cephalic phenotypes in Southern Punjab

Objectives: This study was undertaken to record baseline cephalometric data, cephalic indices and craniotypes

Study design: A cross-sectional population study

Place and duration of study: The study was carried out at the Multan Medical and Dental College, Multan and took about fourteen months to complete

Material and methods: The study was conducted on 672 adult individuals [430 males and 242 females] from in and around the city of Multan in Southern Punjab. Linear measurements of the head including maximum cranial length [glabella-inion length], maximum cranial breadth [maximum bi-parietal diameter] and maximum auricular head height were recorded using a digital spreading caliper. Results of measurements were expressed as mean +/- SD. Comparison of the mean values and various proportions between sexes was performed. The horizontal, vertical and transverse cranial indices were calculated using these measurements. Craniotyping was based on the ranges in various cephalic indices

Results: Differences regarding the mean of cranial length, cranial breadth and height were significantly larger in males as compared to females [P<0.001]. The mean vertical, horizontal and transverse cephalic indices in the males and females were 79.13 +/- 5.56, 78.31 +/- 5.19, 103 +/- 7.78 and 78.32 +/- 6.40, 78.32 +/- 4.67, 100 +/- 8.67 respectively.Most of the samples depicted craniotypes as mesocephalic and dolichocephalic both in the males and the females

Conclusion: The study provides baseline cephalometric data from a population of Southern Punjab that may have its potential in clinical application and future research

Low resolution susceptibility mapping in the estimation of iron content in deep grey matter of brain at 3 tesla

The objective of this study is to determine the effect of low resolution in the estimation of iron content in deep grey matter of brain using quantitative susceptibility mapping. Six females with mean age 43.16, S.D= 20, age range [23-66] and 13 males with mean age 28.92 + 8.14 were scanned with 3D SWI sequence at 3 Tesla [Trio-Seimens, Erlangen, Germany]. The caudate nucleus, red nucleus, globus pallidus, putamen, white matter, thalamus and substantia nigra of brain were drawn manually based on their anatomical locations in Signal Processing in Nuclear Magnetic Resonance [SPIN]. Magnitude and phase images of high resolution [HR] [0.5x0.5x2 mm[3]] were processed in SPIN using collapsing parameter to generate the low resolution [LR] [1x1x2 mm[3]] susceptibility mapping. Data was analyzed using paired t-test. A strong linear correlation [R[2]=0.99, p /= 0.05 at HR, R[2]=0.66, p >/= 0.05 at LR]. The slope of the above linear correlation was consistent with the equivalent susceptibility trend at low and high resolution QSM. Linear correlation between susceptibility and iron content at HR and LR has demonstrated that low resolution QSM holds the consistency of susceptibility and does not affect the estimation of iron content in deep grey matter of brain

Diabetic macular edema; role of intravitreal bevacizumab in treating clinically significant diabetic macular edema

To evaluate the effect of Intravitreal Bevacuzimab on Best Corrected Visual Acuity in patients with clinically significant diabetic macular edema. A prospective uncontrolled interventional case series in which 42 eyes of 31 consecutive diabetic patients with clinically significant macular edema and no significant comorbid ocular association presenting in the outpatients department of Holy Family Hospital and EYE SURGERY clinic, Rawalpindi Pakistan and opting for the treatment from 1st September 2013 to 31st January 2014 were given an intravitreal injection of Bevacizumab. BCVA was documented prior to and four weeks after the injection. Main outcome measure was changes in BCVA. Out of the 31 patients included in the study 14[45.16%] were male and 17 [54.83%] female. Average age was 56.1 +/- 7.6. All 31 patients [42 eyes] came for follow up and their BCVA recorded. 41 [97.61%] eyes showed an improvement of one or more line on Snellen's chart at 4 weeks. 14 [33.33%] eyes showed an improvement of one line, 19 [45.23%] eyes an improvement of two lines, 6 [14.28%] eyes three lines and just 2 [4.76%] eyes had an improvement of four lines on Snellen's chart at 4 weeks. Only 1[2.38%] eye remained same with no worsening. On log MAR conversion scale for Snellen's letters the BCVA improved from 0.76 +/- 0.27 to 0.47 +/- 0.27 [p< 0.001]. No significant complications were observed in any of the eyes. The use of intravitreal Bevacizumab [1.25mg/0.05ml] is a safe and effective moe of treatment for clinically significant diabetic macular edema

Clinical manifestations of Goldenhar syndrome

Goldenhar syndrome is a congenital disorder with diverse clinical presentation. This case series describes various clinical manifestations of Goldenhar Syndrome. 11 patients at least two of the described features of Goldenhar syndrome were randomly included in the study to form a case series. Clinical data of all these subjects was documented, described in percentages and analyzed. Out of the 11 patients studied, 6 were females and 5 males. Mean age was 7.3 years [ranging from 1 year to 23 years]. 7 [63.6%] patients had a limbal dermoid, 6 [54.5%] patient had mandibular hypoplasia, whereas only 3 [27.3%] presented with hemifacial microsomia. Spinal defects and polydactyly were present in [36.4%] patients each. There was one patient [9%] who had both microphthalmia and lid coloboma in addition to limbal dermoid. Similarly, renal defect [atrophic kidney], cleft upper lip and palate and CNS defect [7th nerve palsy] were present in one patient [9%] each. None of our patients had either cardiac or GIT defect. In our study we were able to document the variable manifestations of Goldenhar syndrome with their frequencies. This knowledge base will help us in planning treatment and assistance strategies or these patients

Prevalence of metallo- beta-lactamase NDM-1-producing multi-drug resistant bacteria at two Pakistani hospitals and implications for public health

The rapid spread of metallo- Beta-lactamase producing clinical pathogens is a matter of great concern and with the addition of NDM-1 it poses more threat for public health as NDM-1 positive isolates show resistance to most of the antibiotics. The current study was carried out to determine the prevalence of extended-spectrum Beta-lactamases [ESBLs] and metallo- Beta-lactamases [MBLs], particularly NDM-1 in clinical multi-drug resistant isolates from two tertiary care hospitals in Pakistan. A total of 356 clinical isolates were included in the study where 301 isolates were collected from the Pakistan Institute of Medical Sciences [PIMS], Islamabad and 55 were collected from the Mayo Hospital Lahore. The isolates were screened for ESBLs and MBLs production by phenotypic method and PCR was performed to detect the presence of blaVIM, blaIMP and blaNDM-1 genes. Out of 356 clinical isolates, 160 showed carbapenem resistance. Of these 160 isolates, 131 displayed MBLs production as accessed by combined disk method. In MBLs producing organisms, PCR amplification confirmed 31 [23.6%] isolates harboring blaNDM-1 gene, 33 [25.1%] isolates having blaVIM gene and 2 [1.5%] isolates displaying blaIMP gene. Plasmid profile analysis of NDM-1 positive organisms showed variable number of plasmids which were stable during serial passages in antibiotic free media. The prevalence of ESBL producing organisms was recorded to be 87.5%. The results show a high level of NDM-1 positive organisms from variety of samples at both hospitals, implicating the spread of MBL genes in clinical isolates

Retrospective analysis of cases of acute endophthalmitis after surgery

To find out the prevalence and visual outcome of acute endophthalmitis after cataract surgery. Retrospective. 1[st] January 2001 to 31st December 2009. Wah Medical College, P.O.F. Hospital Wah Cantt, Rawalpindi. Fifty cases of acute endophthalmitis who had undergone treatment. Each case of acute endophthalmitis was evaluated in terms of presentation, detailed examination, treatment and outcome. Microbiological culture of the vitreous aspirates was also done to identify the causative organism. The analysis was also meant to identify the prognostic factors of visual outcome of these cases. Fifty patients presented with acute endophthalmitis out of the fifteen thousand cataract surgeries performed during the 9 year period. The incidence of endophthalmitis was 0.33% [95% CI]. A vitreous biopsy with intravitreal injection of antibiotics was done in all the cases presenting with acute endophthalmitis. Decreased visual acuity [90%] and pain [75%] were the main presenting features in these cases. There were 36 [72%] culture positive cases, with staphylococci [50%] being the most common organism found. Vitreous biopsy yielded positive results in 36 [72%] patients while negative results with no microbial growth was found in 14[28%] patients. There were 20 [40%] growths of coagulase negative staphylococci, 5 [10%] growths of streptococci, 8 [16%] growths of coagulase positive staphylococci, and 3 [6%] of gram negative organisms. The final visual outcome was recorded after one month. 8 [16%] patients achieved 6/12 or better, 26 [52%] patients achieved moderately good visual acuity 6/60 to 6/12, while 16 [32%] patients achieved poor visual acuity of less than 6/60. Of the latter group who had poor visual acuity, 2 [4%] patients had only perception of light while 1 [2%] patient had no perception of light and 1 [2%] patient had blind and painful eye who had to undergo evisceration. 6 [16%] patients achieved 6/12 or better visual acuity. The incidence of endophthalmitis is consistent with other studies. Laboratory diagnosis of the vitreous aspirates helps in the treatment. Achieving a good visual outcome is possible with treatment of the cases of acute endophthalmitis

Frequency of various neonatal complications in infants born to diabetic mothers - a hospital base study

To determine the frequency of various complications occurring in infants of diabetic mothers. This descriptive study was conducted in the neonatal unit and obstetric units of Lady Reading Hospital, Peshawar from January to July 2010. Forty two consecutive cases of infants of diabetic mothers were enrolled in the study. Maternal history especially obstetric history and history regarding diabetes mellitus was obtained and complete neonatal examination was performed. The physical findings and anthropometric measurements were recorded into a printed Proforma. Serum glucose, serum calcium, hematocrit and echocardiography was performed in all enrolled babies. Out of 42 diabetic mothers, gestation diabetes was seen in 71.4% while pre-conceptional diabetes was seen in 28.5%. The male Infants of Diabetic Mothers in this study were 69%. Infant of Diabetic Mothers delivered by C-section were 45%. Macrosomia 40.4% [n=42] was found to be the most common complication followed by hypoglycaemia 23.8%. The mortality rate in our study was 4.7% [n=2]. This study confirms the high occurrence of complications in newborns, born to diabetic mothers. Large for gestational age and hypoglycemia were the commonest complications

Maternal factors associated with intrauterine growth restriction

Intrauterine growth restriction is a major neonatal health issue. Maternal factors have been found to have greater impact on IUGR. Studying these factors can help in reducing the mortality and morbidity associated with IUGR. This Case-control study was conducted at the department of Paediatrics Post-graduate medical institute Lady Reading Hospital Peshawar from March 2008-April 2009. Small-for-gestational age [SGA, i.e., IUGR cases and n=200] live born babies were compared with appropriate-for-gestational age [AGA, i.e., controls and n=200] babies. Information regarding socio-demographics of mothers, gestational age and birth weight of baby, maternal clinical characteristics, and medical and obstetric complications during pregnancy was recorded on a predesigned proforma. Data analysis was done through SPSS-16. To find the maternal factors associated with the intrauterine growth restriction, multivariable logistic regression was used. We also did two different sets of logistic regression analysis for Symmetric and Asymmetric SGA babies as Cases. After adjusting for other variables in the multivariable model we found that the mothers of IUGR babies were of younger age [OR=0.8, CI=0.7-0.9], were poor [OR=2.5, CI=1.4-4.4] and underweight [OR=3.5, CI=1.1-5.7] and had anaemia [OR=2.7, CI=1.3-5.4] in the index pregnancy, and had history of Previous IUGR birth [OR=9.7, CI=3.3-18.3] and placenta previa [OR=3.2, CI=1.1-6.6]. There was an interaction between pregnancy induced hypertension and parity of mother with a primary-para mother with pregnancy induced hypertension [PIH] having an increased risk for IUGR babies [OR=10.1, CI=1.0-23.2]. The studied factors need special attention in hospital based settings in order to improve the perinatal outcome in IUGR babies

Pattern and frequency of acute poisoning in children

To determine different agents involved in acute poisoning in children, determine time interval between ingestion of agent and report at the hospital and document its hospital outcome. This was descriptive case series study conducted at the Department of Paediatrics [Emergency and General Wards], Khyber Teaching Hospital, Peshawar from Jan 2007 to July 2007. A total of hundred patients with history of acute poisoning were subjected to detailed history and examination regarding different aetiological agents, time interval between ingestion of agent and report at hospital and hospital outcome. Majority of patients were below six years of age, 69% were male while 31% were female. Pharmaceutical agents and kerosene oil poisoning were the leading cause constituting 29% each followed by opiate and organophosphorus constituting 17% and 15% respectively. Fifty three percent of cases belonged to urban while forty seven percent belonged to rural area. Forty percent of cases were brought to the hospital within first hour; followed by 38% and 22% in 1-6 and more than 6 hours respectively. Ninety four percent of patients were discharged with almost complete recovery while six percent expired during hospital stay. Acute poisoning is an important paediatric medical emergency and has got an important effect on morbidity and mortality in this age group. Toddlers are the most prone group in children to acute poisoning. Kerosene oil, drugs, organophosphorus and opiate are the common aetiological agents of poisoning in children. Hospital outcome is poor in patients with corrosives poisoning

Screening extended families for a genetic X-linked disorder, glucose 6 phosphate dehydrogenase deficiency

To test an alternative approach to population based program for identifying Glucose 6 Phosphate Dehydrogenase [G6PD] deficient Individuals in Pakistan where consanguineous marriage is common. This study was conducted at Armed Forces Institute of Pathology Rawalpindi and Pathology Department Government Lady Reading Hospital Peshawar. Five large families from Northern Pakistan, 03 with an index case of G6PD deficiency, 02 without such history [control] were screened for G6PD deficiency. All apparently healthy members of the families, both male and female of all ages, of the last three generations were included in the study. A commercial qualitative screening kit from Sigma Chemical Co. Ltd England was used for screening the individuals for G6PD deficiency. In the control families, no individual with G6PD deficiency was found among 101 individuals tested out of 159 living members. In the 03 families with an index case of G6PD deficiency 155 were tested out of 229 family member and 52 [33.5%] were found G6PD deficient. While in population screening out of 800 apparently healthy adult male subjects screened for G6PD deficiency, 47 [5.9%] were found glucose 6 phosphate dehydrogenase deficient. Testing extended families is feasible and highly cost effective way of screening for X- linked genetic disorder like Glucose 6 Phosphate Dehydrogenase deficiency in communities in which consanguineous marriage is common

Pattern of hematological diseases in hospitalized pediatric patients based on bone marrow examination

The objective of this study was to look into various diagnoses of hematological lesions on bone marrow examination in our pediatric age group of patients. This study was conducted in the Pediatric A Unit and Department of Hematology Postgraduate Medical Institute [PGMI] Lady Reading Hospital, Peshawar from 01st Jan 2007 to 31st Dec 2007. Children admitted with pallor, bleeding, lymphadenopathy or visceromegaly having abnormal smear results were included in this study. The data was statistically analyzed by SPSS version 10. One hundred and ninety-eight cases were included in the study. The age range was from 06 months to 14 years with a mean age of 5.35 years and standard deviation of +/- 3.69. Majority [4 7.5%] of these children were in the age range of 1 to 5 years with male to female ratio of 1.53. The commonest disorder was aplastic anemia present in 40 [20.2%] of the cases followed by idiopathic thrombocytopenic purpura [ITP] [15.7%], megaloblastic anemia [14.6%] and iron deficiency anemia [7.6%]. Acute leukemia was the predominant malignant disorder present in 11.6% of the cases. There were also few cases of histiocytosis and bone marrow secondaries. Visceral leishmaniasis, anemia of chronic disorders, haemolytic anemia, myeloid hyperplasia, hypersplenism, congenital dyserythropoietic anemia, malaria and Gaucher disease were the other non-malignant hematological disorders found in this study. Aplastic anemia, idiopathic thrombocytopenic purpura, megaloblastic anemia and leukemia are the commonest hematological disorders in our set up

Typhoid enteric perforation: Prognostic factors an experience with 76 patients

In spite of the world wide improvement iii public awareness of hygiene and good sanitation there are still some parts of the world where the number of typhoid enteric perforation is rising day by day. Typhoid enteric perforation if on one hand is a cause of increased morbidity and mortality for the patients, on the other hand it is becoming a common surgical problem for the surgeon. A retrospective study of 76 patients of typhoid enteric perforation was carried out with the aim to evaluate the factors contributing to the increasing incidence and delayed diagnosis of the disease. More specifically the various surgical procedures used for the treatment of typhoid enteric perforation and its results were evaluated. All the 76 patients were admitted in the Surgical 'C' Unit of Khyber Teaching Hospital from January 1991 to Dec 1994. The highest incidence was found in the second decade of life [36.84%]. Male to female ratio was 2.1. The common presenting symptoms were fever [100%] followed by pain abdomen [76.31%]. The Widal test was positive only in 71 patients while gas under the diaphragm was found in l5 cases. At Laparotomy 74 patients [97.36%] were found to have ileal perforation as compared to jejunal perforation in 2 cases. Faecal peritonitis was observed in 5=1 [59.21%]. In 59 patients primary closure of the perforation was performed. While in 11 patients exteriorization of perforation as temporary ileostomy was performed. 12 patients out of 59 with primary closure of the perforation reperforated and added to considerable postoperative morbidity and mortality. On the other hand 11 patients with the primary exteriorization of perforation as temporary ileostomy did very well. The overall mortality rate was [22.35%]. Early diagnosis and primary exteriorization of the perforation as temporary ileostomy can decrease morbidity and mortality considerably