Spectrum of primary salivary gland tumors with special emphasis on their management and outcome at a rural tertiary care centre

Background: Salivary gland tumors (SGT) are uncommon tumors of diverse histopathology accounting for <2% of all neoplasms. Early diagnosis differentiates between benign and malignant SGT and less extensive surgical procedure can be performed. The objective is to study the spectrum of primary SGT with special emphasis on their distribution, treatment and outcome at a rural tertiary care centre.Methods: A prospective observational study was conducted on 30 consecutive primary SGT patients attending the Departments of Surgery and Otorhinolaryngology of North Bengal Medical College and Hospital over a period of one and half years. All patients were clinically evaluated, investigated, treated accordingly and followed up during the period of study. Data was collected and compiled in Excel sheet and analysed using GraphPad Software and GraphPad QuickCalcs 2018 (San Diego, CA). A p value <0.05 was considered statistically significant.Results: Maximum patients (83.3%) were in the age range of 31-60 years. The male to female ratio was 1:4 for benign tumours and 1:1 for malignant tumours. Malignant cases were 66.67%. Involvement of parotid gland was the commonest (43.3%) and mostly presented with swelling (73.3%). Pleomorphic salivary adenoma was the commonest benign tumor (33.3%) and mucoepidermoid carcinoma was the commonest malignant tumor (16.7%). Permanent facial palsy was observed in 2 (9.5%) and recurrence in 4 patients (19%).Conclusions: SGT are rare and present in various modes. Malignant cases were singularly more in this study.

Effect of chronic restraint stress on immune status of male sprague dawley rats

To determine the effect of chronic restraint stress on immune status of Sprague Dawley rats by comparing total leukocyte count [TLC], total lymphocyte count and levels of serum immunoglobulins A, E, G and M of the rats exposed to chronic restraint stress with that of healthy control rats. Quasi-experimental study. Centre of Research in Experimental and Applied Medicine [CREAM], Army Medical College, Rawalpindi, in collaboration of National Institute of Health [NIH], Islamabad, from June 2008 to June 2009. Sixty healthy male Sprague Dawley rats were obtained from NIH. Rats were divided into two groups, each having 30 rats. The rats of group-I were not exposed to chronic restraint stress, while rats of group-II were exposed to chronic restraint stress in meshwire restrainer for 6 hours daily for 15 days. Estimation of total lymphocyte count and serum immunoglobulins [IgG, IgA, IgM and IgE] was carried out and compared between the groups. TLC, lymphocyte count and serum IgA, IgE, IgG and IgM levels were found significantly lower in rats exposed to chronic restraint stress as compared to the rats which were not exposed to stress [p < 0.001]. Chronic restraint stress compromises immune status of rats by decreasing the levels of immunoglobulins and lymphocyte count

IT IT study [the incubation time in tetanus study]

To determine the effect of incubation time on morbidity and mortality in patients with tetanus. Cross Sectional Descriptive Study This study was carried out in the Medicine Department of Saidu Hospital from Jan 2009 to Dec 2012. A total of 30 patients both males and females were included. These tetanus Patients were classified in two Groups. Group I [Short incubation period i.e. less than 7 Days] and Group II [Long incubation period i.e. seven or more than 7days]. The association of short and long incubation time with mortality and morbidity was assessed. There was no mortality in this study. While morbidity was assessed in terms of hospital stay, whether stay was more than 10 days or less than 10 days. In Group I, 17 [85%] patients had a hospital stay of more than 10 days while in Group II Only 3[30%] had a hospital stay of more than 10 days. The results were analyzed using the chi square test of independence. The p value was 0.003. We conclude that short incubation period has definitely association with morbidity which in this study was hospital stay of more than 10 days

Diagnostic yield of lymphocyte rich exudative pleural effusion

To determine the diagnostic yield of lymphocytic rich Pleural effusion in patients with pleural exudates. Observational study. This study was carried out in the Medicine department of Saidu hospital from Jan 2011 to December 2012. Fifty [50] patients with pleural exudates were included. Effusions were classified as transudates or exudates on the basis of Light's criteria. Exudates were further classified as lymphocyte rich or non lymphocyte rich. Lymphocyte rich effusion is one in which [60%] or more than [60%] of the cells are lymphocytes. [80%] of the pleural effusions were lymphocyte rich and [95%] of these effusions were Tuberculous. On the other hand [20%] of the Exudates were non lymphocyte rich and only [5%] of these exudates were tuberculous. The p value was 0.000 [Chi squared=x[2]28.1, df=1]. We conclude that tuberculosis is the commonest cause of lymphocyte rich pleural exudates

PMF [pulmonary massive fibrosis] and the exposure period to the respirable coal dust

To determine the association between pulmonary massive fibrosis and duration of dust exposure in patients with coal worker pneumoconiosis. A cross sectional descriptive study. This study was carried out in the Medicine department of Saidu Teaching Hospital Saidu Sharif swat from Jan 2007 to Dec 2011. One hundred and twenty [120] patients suffering from coal worker pneumoconiosis were included. They were either already diagnosed patients of coal worker pneumoconiosis or newly diagnosed symptomatic patients. Forty four[36.6%] had simple coal worker pneumoconiosis, Forty six [38.3%] had complicated coal worker pneumoconiosis and thirty [25%] had PMF, in which twenty patients[66.6%] had exposure of more than twenty years. The results were analysed using the chisquaretest with a p value of 0.00000472.There is clear association between PMF and exposure period to the respirable coal dust. We conclude that prolonged period of exposure has association with the development of PMF

Pattern of dyslipidemia in adult diabetic subjects in the community hospital of district Swat

The incidence of diabetes is growing at dramatic rates around the word and its complications are associated with significant health and financial burdens, warranting strong and comprehensive prevention efforts. The objective of the present study was to evaluate the pattern of dyslipidemia in the adult diabetic patients in Saidu Teaching Hospital, Saidu Sharif, Swat. The study comprised of 100 subjects, 50 subjects with diabetes and 50 [non-diabetic] controls. The serum Cholesterol, Triglycerides, High-density Lipoprotein-Cholesterol [HDL-C] and Low-density Lipoprotein-Cholesterol [LDL-C], blood sugar [random and fasting], blood pressure [systolic and diastolic] of Diabetic subjects were compared with Control subjects. Diabetic subjects had high mean value of Triglycerides and LDL-C [but statistically nonsignificant], low level of HDL-C [statistically highly significant] and high blood pressure as compared to Control subjects. Dyslipidemia is a potent predictor of cardiovascular morbidity and mortality in diabetic patients

Seroprevalence of HBsAg and anti-HCV in general healthy population of Swat district with frequency of different HCV genotypes

The main purpose of this study was to find out the seroprevalence of HBsAg and anti HCV in apparently healthy population of district Swat. The other objective was to find out the different types of genotype prevalent in this part of the country. This is a descriptive, observational study which is community based and was conducted by the Hepatology section of Medical Department, Saidu Teaching Hospital, Saidu Sharif from May 2007 to August 2008. Screening camps were held in all the four sectors to which the district was arbitrarily divided. Sera were checked by 3rd generation Elisa technique for HBsAg and anti HCV antibody. Positive cases for anti HCV were recalled in batches and the blood samples taken for HCV RNA testing by PCR and Genotyping. Data was available on a total of 4680 healthy men and women. There were 2870 male and 1810 female participants. We found 3871 [82.7%] subjects Negative. One hundred sixty four [3.5%] were positive for HBsAg and 645[13.8%] were positive for anti-HCV antibodies. Only 15 volunteers [0.3%] were infected with both HBV and HCV. Two hundred twenty cases, who were positive for HCV RNA BY PCR testing were checked for genotyping. One hundred nine [49.5%] cases had genotype 3a, 74[33.7%] cases were having genotype 3b, 19 cases [8.7%] had mixed, 10 cases [4.5%] had Ib and eight cases[3.6%] were untypeble. In district Swat of NWFP, prevalence of hepatitis B surface antigenmia is 3.5% and anti Hepatitis C antibody is 13.8% with a combined prevalence of 17.3%. Genotype three is the commonest genotype [83%] prevalent in this area and six months combination antiviral therapy can be undertaken without checking for genotype in routine

Relationship of heart rate with hypertension in adult population of Mingora city, District Swat

The aim of this study was to evaluate the relationship of heart rate with hypertension in adult population of Mingora city, district Swat. The study comprised of 100 subjects, 34 control, 33 obese and 33 hypertensive. Weight, height, body mass index, heart rate, and blood pressure of hypertensive subjects were compared with obese subjects and control subjects. Hypertensive subjects had faster heart rate than obese normotensive subjects, which in turn had higher value than control subjects. Faster resting heart rate is a potent predictor of cardiovascular morbidity and mortality

Thrombotic thrombocytopenic purpura, at a tertiary care centre in lahore, Pakistan

Thrombotic thrombocytopenic purpura is a syndrome, characterized by microangiopathic hae-molytic anaemia, thrombocytopaenia, neurological symptoms, renal disease and fever. Commonly considered rare, but actually it is one of the most under diagnosed disorders. This study was aimed at evaluating the clinical features, course, prognostic factors and treatment outcome in 17 patients diagnosed as having thrombotic thrombocytopaenic purpura [TTP]. It was a cross-sectional descriptive study at Shaikh Zayed Hospital Lahore. This study includes patients diagnosed as having TTP by the department of haematology from January 2005 to December 2007. Eight of 17 patients were treated with plasma exchange. Six of these 8 patients survived. Plasma infusions were performed in 9 patiejits, 5 of them recovered. Overall 65% patients recovered and mortality was 35%

Diagnostic outcome of patients presenting with severe thunderclap headache at saidu teaching hospital

To find out the frequency of patients attending Casualty department of a Teaching Hospital with sudden severe thunderclap headache, their diagnostic out-come and follow up. The study was conducted in Casualty and Medical, Departments of Saidu Teaching Hospital, Saidu Sharif, from January 2006 to December 2006. Out of 22,000 patients with different Medical problems attended Casualty department during study period of which 128 cases had acute severe thunderclap headache. Age range was 15 to 80 years with mean age of 46 +/- 10 years. Seventy eight patients [61%] were female and fifty [39%] were male. Protocol included proper clinical examination, basic laboratory investigations, admission to the General medical ward / Intensive care unit for observation, treatment and follow-up. CT scan of brain and or lumber puncture was performed in all the studied patients. The in-hospital follow up period was from two to fourteen days. The patients were reviewed one month later after discharge from hospital. Out of 120 patients twenty cases [15.6%] had Subarachnoid haemorrhage [SAH] seven patients [5.4%] had Cerebral infarction, five patients [3.9%] had an Intracerebral Haematoma. Five patients [3.9%] had aseptic meningitis. Two cases [1.5%] were reported as cerebral edema. One case [0.8%] had venous sinus thrombosis. As there was no specific finding on investigations and follow up of 88 cases [69%]: these were labeled as idiopathic thunder-clap headache. Past history of not more than three similar episodes was present in 33 cases [25.78%]. Out of these 33 cases, thirty belonged to the benign group of 88; other three cases had organic causes. Clinical diagnosis of Migraine was made in 37 cases out of these 88 cases. Attack of severe thunderclap headache is not an un-common emergency. Attack due to Subarachnoid haemorrhage [SAH] or other serious underlying disease cannot be distinguished from non specific headaches on clinical grounds alone. It is recommended that all such patients be hospitalized and investigated properly with CT scan and or lumbar puncture to distinguish between benign and organic headaches

Frequency of HBV surface antigen and anti-HCV in healthy voluntary blood donors in swat district

To find out the seroprevalence of HBsAg and anti HCV among the healthy voluntary blood donors in the District of Swat, N.W.EP. This cross sectional survey study was conducted at blood transfusion services unit, Saidu Group of Teaching Hospital, Saidu Sharif, Swat. All voluntary healthy blood donors attending the above services from January 2003 to December 2005 were screened for HBsAg and anti HCV by Acon test device. A total of 41613 persons were screened during this study period. Out of them, 1392 [3.34%] persons were found positive for either HBsAg or Anti HCV antibodies. Out of 41613 individuals, 464 [1.11%] were positive for HBsAg and 938 [2.23%] were positive for anti HCV antibodies. Seroprevalence of HBsAg and anti HCV in healthy voluntary blood donors in Swat District is relatively low as compared to the prevalence in overall general population of Pakistan. All blood donors should be routinely screened and young healthy non-paid donors should be encouraged to donate blood for blood banks

Treatment of chronic hepatitis C infection in Swat district based upon the national guidelines

The objective of this study was to determine the efficacy of combination Interferon and Ribavirin therapy with frequency of side effects in the treatment of chronic Hepatitis C Naive patients in Swat District according to the guidelines laid down by Pakistan Society of Hepatology. This is an uncontrolled, open, perspective and observational study, carried out in the Medical Unit of Saidu Teaching hospital, Saidu Sharif Swat, from January 2003 to February 2006, 117 consecutive patients fulfilling the inclusion criteria were enrolled for the study at the central registry. They were given treatment as per protocol for 24 weeks. Patients were reviewed and investigated six months after stopping treatment. Total of 104 patients completed the study. Treatment had to be discontinued in five cases [4.67%] due to sever adverse drug reactions. Serum ALT normalized in 65 patients after 12 weeks, in 26 cases during 16th- to 24" week, and remained high in 13 cases [Biochemical response of 87.50%]. Negative HCV by PCR was observed in 93 cases[89.42] towards the end of treatment:[Virological response and ETR of 89.42%] Six months after stopping treatment, the PCR test remained negative in 47 [71.21%] cases out of the 66 cases tested.[SVR=71.21%] Based upon the current National guidelines the combination of Interferon and Ribavrin therapy produced ETR of 89.42% and SVR of 71.21% in patients of Swat district and adjoining areas. The side effects of this specific therapy were common but tolerable and manageable

Immunoglobulin E screening of serum and lacrimal fluid: a new dimension in the management of chronic conjunctivitis

The purpose of present study is to differentiate between allergic and environment related chronic conjunctivitis on the basis of the measurement of Immunoglobulin E levels in tears and serum. Forty specimens of tear and serum from drivers were sent for Immunoglobulin E assay. Samples were divided clinically into two categories. Group A included twenty four samples [60%] who were clinically chronic conjunctivitis [chronic conjunctivitis is defined here as conjunctival inflammation of period greater than a year, remissions and relapses, with no obvious cause/ophthalmic disease and patient on or off topical treatment] and group B included sixteen samples [40%], of clinically normal [normal having no ocular symptoms] [control]. Length of service as driver, hours of daytime driving, primary ocular symptom, history of atopy or allergy, tear film break up time [BUT] were emphasized at history and ophthalmic examination. None of the subjects had clinically obvious cause of conjunctivitis. The group-A [patients] were randomly treated with fluoromethalone and artificial tears. The patients were required to record the subjective improvement. Tear Immunoglobulin E values were normal [1-2ku/L] in both A and B groups. Serum Immunoglobulin E was elevated significantly in twenty samples [84%] in group A [clinically chronic conjunctivitis] whereas, it was elevated in six samples [38%] in group B [clinically normal group]. Serum Immunoglobulin E levels were normal in 16% and 62% of group A and B respectively. The recovery was significant with fluoromethalone use at 4 weeks as compared to that of artificial tears but at 8 weeks and 12 weeks, there was no significant difference between artificial tears group and fluoromethalone group. Serum Immunoglobulin E and tear Immunoglobulin E levels can be used to investigate the cases of chronic conjunctivitis as normalcy of tear Immunoglobulin E reasonably excludes local allergy. This enables the clinician to resort to tear replacement therapy rather thanprescribing steroids with accompanying side effects. However, there is no correlation of serum Immunoglobulin E with tear Immunoglobulin E

HLA Frequencies in Pakistani Population in comparison with Caucasian, oriental and Negroid population

The main objective of the study was to determine HLA-A, B, and DR frequencies in Pakistani population and their comparison with HLA frequencies reported for caucasian, oriental and negroid population. Material and methods: Five thousand prospective donors/recipients of renal/bone marrow transplant who had undergone HLA typing were included in the study. All subjects were of pure Pakistani origin. They included 1245 recipients [996 males, 249 females] and 3755 donors [2740 males, 1015 females]. The HLA antigens were tested with two stage NIH micro-lymphocytotoxicity assay by using Terasaki plates. Separated T and B lymphocytes were used for class I and Class II antigens detection. Relative antigen frequencies were determined and used to calculate the gene frequencies. The HLA class I antigens A2, A11, A24[9], A1, A26[10], A3, A28, A33[19], B51[5], B35, B8, B57[17], B60[40], B44[12], B7, B61[40] were the most commonly detected antigens for the HLA class I A and B subclasses. In case of HLA-DR, DR3, DR11[5], DR7, DR15[2] were the most frequently found antigens. These antigen frequencies were compared with the antigen frequencies reported for the Caucasians, Orientals and Negroid population. Comparison of common frequencies with other populations indicates that Pakistani population is nearer to Caucasians and Orientals

beta thalassaemia imported from the mediterranean to the subcontinent?

The study was conducted to determine the source of beta thalassaemia mutations in Pakistan with the help of tracing the HLA antigens and common mutations. A total of one hundred and fifty five subjects [n=155] were included in the study. It included fifty-four patients of thalassaemia major [n=54] and their one hundred and one [n=101] siblings. HLA typing by lymphocytotoxicity method was performed for HLA class I antigens. Retrospective analysis was carried out for common beta thalassaemia associated mutations. The most frequent HLA class I frequencies and beta thalassaemia mutations were compared with different populations of the world to establish genetic ancestry of our patients. Our analyses showed that HLA B35 was present in our thalassaemics in the highest frequency. The antigen frequency [af] of HLA-B35 was 0.37 in thalassaemics while it was 0.21 in normal population [p=0.004]. The af of HLA-B35 was 0.24 in siblings of thalassaemics [p=0.06] versus normal population. However, increased expression of HLA B35 has not been reported in a number of the thalassaemic populations studied for HLA antigen. The combined HLA class I frequencies for our population have the closest match with those found in Caucasian population of the Mediterranean region. The study of the mutations for beta thalassaemia shows the mutation Fr 8/9 [G+] to be present in the highest frequency in areas of northern Pakistan. The HLA and mutation analysis show a trend for this mutation to be Asian-Indian in origin. The other common beta thalassaemia mutation that is prevalent in Southern region of Pakistan is IVS-l-5 substantiated by HLA and mutation analysis studies. It is probably of Arabic decent, as it occurs along the seashore of old trade route extending from Yemen to Philippines. There is evidence that beta thalassaemia mutations arose denovo spontaneously in Pakistan and India and then spread within pedigrees. However there is a chance that IVI-l-5 mutation may have been imported from Arabic Peninsula. It will be interesting to study HLA frequencies / RFLPs of Sindhi and Baluch populations and compare them with seashore areas enroute