The profile and outcome of children admitted in paediatric intensive care unit of a public hospital in Karachi

Objective: To determine the profile and outcome of children admitted in paediatric intensive care unit of a public hospital in Karachi

Study Design: Descriptive / Observational study

Place and Duration of Study: This study was conducted at PIGU of Civil Hospital Karachi from July 2013 to June 2014

Materials and Methods: Data of the admitted patients was collected from the file records. It included demographic profile, admitting diagnosis, length of stay and outcome. Descriptive statistics were applied to describe the results

Results: Overall 243 children were admitted in PICU during the study period. Among which 133 were admitted in 1[st] half and 110 during the later half of the year. 126 [51.85%] were male, whereas 117 were female. According to the age group, 91 [37.44%] were under 1 year where as 152 [62%] were more than 1 year among which 92 were between 1-5 years of age. Majority, 160 [67%] were admitted through emergency. Duration of stay in the hospital was varied, and 176 [72.42%] patients stayed for more than 24 hours, of these, 60 stayed for 3- 5 days. Upon admission, 83 [34.15%] needed ventilatory support. 16 [6.58%] children needed fluid boluses for resuscitation, whereas inotropic support was required by 49 [20.16%] children. Most of the cases i.e. 68 [27.98%] had respiratory illness as reason for admission. CNS diseases were present in 44 [18%] patients followed by sepsis/infection in 35 [14.40%] cases and Cardiovascular diseases in 22 [9%] cases. Out of total admission, 174 [1.60%] were shifted to the ward. Mortality was recorded in 59 [4%] cases, among which 40 occurred during 1[st] half of year and 19 during later half of the year, resulting in mortality of 30% in 1[st] half and 17% in 2[nd] half, respectively. Out of 59 expiries, 24 [40%] died within 1[st] 24 hours due to poor status at admission. Sepsis was the most common cause seen in 42 [71%] of non survivors. 7 cases were referred to other specialized centers for further management after initial stabilization, whereas 3 cases left against medical advice

Conclusion: Respiratory system, central nervous system and infectious disease/sepsis were the commonest reasons for admission. PICU showed improved working in later half of year after its beginning

Comparison of gonial angle determination from cephalograms and orthopantomogram of patients under orthodontic treatment

Objective:To compare and find out the possible application of OPG for gonial angle and compare it with cephalogram in Orthodontic patients of a Public Sector Dental Institute

Materials and Methods:In this descriptive retrospective study lateral cephalograms and OPG of 103 patients, 27 males and 76 females were analyzed. The gonial angle was determined in panoramic radiographs by two tangents drawn from the condyle's posterior borders and right and left ramus and inferior border of the mandible. Landmarks in the cephalogram were identified and spotted. Cephalometric protractor and calipers were used to mark and measure the angles. Angles and other parameters were rechecked to counter any missed measurement

Results: In lateral cephalograms the mean value of gonial angle was 121.77 degree and in panoramic radiographs 122.18 degree. In females,the difference among the mean gonial angle in both radiographs was 1.20 and in males 1.224 while difference among the two genders was 0.02 degree. As P > 0.05 for all the variables stated above, these differences were not significant

Conclusion: OPG may be considered to evaluate the gonial angle as correctly as a lateral cephalogram because in the values of gonial angles measured in both radiographs there was non- significant difference. The plus point in OPG is that it is more accurate in evaluating patient's gonial angles without any overlaid images

Seroprevalence rate of poliovirus antibodies among the healthy and protein energy malnutrition children

To study the association between Protein energy malnutrition and polio-specific immunoglobulin G antibodies production among children in Gadap Town Karachi, Pakistan. Comparative cross sectional survey conducted at fixed EPI center and Pediatric OPD of a tertiary care hospital Karachi. Children were selected by convenient sampling method during the period from 17 March to 17 May 2013. It was ensured that they must have received more than seven oral polio vaccine doses as eligibility criteria for the study. A total of 170 blood samples were collected and tested for the presence of polio-specific IgG antibodies using Poliomyelitis IgG ELISA Test Kit produced. Statistically significant relation was found between PEM and IgG antibodies production OR [P = 0.000]. Overall Seroprevalence rate among the study population was 98.8%, PEM group 97.6% and healthy group 100%. The study demonstrated that there is a need to focus on the protein energy malnutrition among the children as an immunization strategy for the 100% seroprevalence rate in all population against polio in Pakistan

Comparison of intercanine and intermolar width between cleft lip palate and normal class I occlusion group

Objective: To determine the mean difference of arch dimensions [both intercanine and intermolar width] between cleft lip palate and normal class I occlusion group

Study Design: Cross-sectional analytic study

Place and Duration of Study: Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, [Dow University of Health Sciences [DUHS]], Karachi, from March 2012 to April 2013

Methodology: Group 1 consisted of 32 subjects with complete repaired, non-syndromic unilateral and bilateral cleft lip palate. Group 2 consisted of 32 subjects with normal facial morphology and class I occlusion. Exclusion criteria were cleft lip palate subjects with systemic diseases, any arch expansion procedure, incomplete repaired palate, open fistulas, developmental or acquired craniofacial muscular deformities, autoimmune conditions, syndromes, endocrine abnormalities, neurological problems, or previous history of orthodontic treatment and signs and symptoms of temporomandibular disorders, history of trauma, impacted or missing teeth, periodontally involved teeth, subdivision molar classification, skeletal base II and III with molar class I. The transverse width [intercanine and intermolar width] of dental casts was measured with the help of digital caliper. The intercanine width was measured between cusp tips of the canine while the intermolar width distance was measured between mesiobuccal cusp tips of first molars, and buccal grooves of the mandibular first molars in both cleft lip palate and normal class I occlusion group, respectively

Results: There were 64 subjects with mean 14.7 +/- 6.8 years in the cleft palate and 14.7 +/- 6.3 years in the normal group. There was statistically significant differences found between intercanine and intermolar width in maxillary arch [p < 0.001]. In mandibular arch, only intercanine width has showed significant difference [p < 0.001] between cleft and normal occlusion class I group

Conclusion: Maxillary and mandibular intercanine width was found to be significantly reduced in cleft lip palate group [both unilateral and bilateral] as compared to normal class I occlusion group

Thyroid disorders; and cardiovascular risks

Thyroid hormones have many effects on cardiovascular function, and deficiency or excess of thyroid hormones can result in cardiac dysfunction. Abnormalities of the cardiovascular system are often identified during examination of hyperthyroid and hypothyroid patients

Objective: The aim of this study was to address the effects of thyroid hormones on the cardiovascular system and the clinical relevance of the cardiovascular response to thyroid dysfunction

Study Design: Cross sectional study

Setting: The study was conducted at Allied Hospital / Punjab Medical College Faisalabad and PINUM Hospital Faisalabad

Period: October 2014 to August 2015

Materials and Methods: Total 100 patients with thyroid disease [Hypo/hyperthyroidism] were enrolled in the study. Any patient age >/=20 years, that had documented history of thyroid disease [Hypothyroidism or hyperthyroidism] or on medications for thyroid disorder was recruited in this study

Results: Total 100 consecutive patients with abnormal thyroid function tests who fulfill the inclusion and exclusion criteria were enrolled in the study. Mean age was 47.9 +/- 23.20 years. 16% were male and 84% were female. Majority of the patients 37[37%] were in age group 51 - 60 years. 53% were suffering from overt hyperthyroidism and 31% were suffering from hypothyroidism. Subclinical hyperthyroidism and hypothyroidism was present in 7% and 9% patients respectively. Goiter was present in 24% patients. Atrial fibrillation was observed in 34% hyperthyroid patients. Overall 23% were diabetics and 25% had H/O hypertension. Dyslipidemia was present in 20% hyperthyroid and 25% hypothyroid patients. Echocardiography was performed in 19% patients. 7% patients undergone thyroid surgery. Overall 11% patients were suffering from CCF. Pulmonary hypertension was observed in 17% hyperthyroid and 35.48% hypothyroid patients. MeanFT4 in hypothyroid patients was 1.16 +/- 022 ng/dl. Mean TSH was 10.92 +/- 21.09 [microIU/ml] in hypothyroid and 0.19 +/- 0.14 [microIU/ml] in hyperthyroid patients

Conclusions: The outcome of this study suggests that patients with untreated overt / subclinical thyroid dysfunction are at increased risk of cardiovascular complications

OCT determined macular thickness in diabetic retinopathy and relation to colour vision deficiency patterns.

Background: Diabetic retinopathy is the most common cause of blindness in industrialised nations and the incidence of diabetes is expected to rise over the next 10 years. Early treatment of proliferative diabetic retinopathy and diabetic maculopathy improves visual outcome and with effective screening, blindness could be reduced. Patients suffering from diabetes mellitus show alterations in their colour perception. Colour vision testing provides a sensitive, non-invasive method to assess macular damage in diabetic retinopathy and any deterioration in colour vision often precedes changes in other clinical measures such as visual acuity and morphological changes. Optical coherence tomography (OCT) provides cross-sectional images of the retina, information concerning internal retinal structure as well as reproducible measurements of retinal thickness. Aims & Objective: This study was intended to examine the relationship between macular thickness on OCT (Optical coherence tomography) and colour vision deficiency patterns in diabetics. Material and Methods: A total of 100 patients with established diabetic retinopathy visiting hospital were examined and a detailed history of diabetes, duration and inability to differentiate colours was taken. Retinal examination for evidence of diabetic retinopathy and colour vision patterns on Ishihara colour vision chart were noted. OCT was performed on these patients. Results: 21% (21 out of 100) of patients under study showed a gross deficiency of red green pattern of colour blindness. The colour vision deficiency increased with increasing macular thickness. Macula thickness on OCT in subjects varied from 188 to 462 microns. The average macular thickness of patients with total colour vision deficiency was 290 microns that with red green was 274 micron and those without any colour vision deficiency was 228. Prevalence of colour vision deficiency increased with duration of diabetes and severity of retinopathy. Conclusion: Higher prevalence of red green colour blindness was observed in patients of diabetes with macular oedema. Impaired colour vision was more in patients with macular thickness above 228 micron.

Practice patterns of diabetic retinopathy referral among doctors in a tertiary hospital.

Background: There were 31.7 million diabetics in India in year 2000 with a projection to reach 79.4 million by year 2030. We must identify and treat high-risk persons before severe loss of vision occurs. We doctors of all specialities have to strive together to create awareness of the importance of routine eye evaluation for all diabetics as this blindness is largely irreversible once set in. Visual impairment as a result of Diabetic Retinopathy (DR) has a significant impact on patients’ quality of life. In communities in which intensive retinopathy screening programmes have been implemented, rates of vision loss have decreased. There is a need to increase the awareness among doctors of all specialities on the importance of retinal examination by ophthalmologists even in well controlled diabetics. Aims & Objective: A survey to assess the practice patterns among doctors about diabetic retinopathy referral, its complications, treatment modalities and the knowledge about timing of referral to ophthalmologists. Material and Methods: Questionnaires consisting of 16 questions pertaining to general awareness, clinical manifestations, complications and treatment was given to doctors in two sections A and B. Answers were analysed and tabulated. Results: 36 doctors of various specialities participated in the survey. 19.4% of doctors felt there was no need to refer all diabetics routinely for fundus examination. 80.6% (29 of 36) of doctors were regularly referring all diabetics to ophthalmologist, where as 19% did not. 86.1% of the participants felt there was no need to worry about retinopathy if blood sugar levels were controlled. Amongst the participants 75% were well aware of DR, its presentation, complications and 88.9% about its treatment. Conclusion: Diabetic retinopathy still is not well understood among general doctors and non-ophthalmologists. It is therefore advisable to educate consultants about the severity of the problem and need for early referral to prevent complications. General Practitioners can be educated about the timing to seek expert opinion for treatment.

Serum homocysteine as a risk factor in diabetic with colour vision deficiency and for developing retinopathy.

Background: Diabetic retinopathy causes vascular complications of retina causing blindness. Macular edema is the crucial cause of visual impairment and may occur at any stage of diabetic retinopathy. Patients suffering from diabetes mellitus can show alterations in their colour perception. Colour vision testing provides a sensitive method to assess macular damage. Deterioration in colour vision often precedes changes in other clinical measures such as visual acuity and morphological changes. Elevated homocysteine levels play a causative role in inducing vascular endothelial cell damage and causing retinopathy in diabetics. Aims & Objective: This observational study was intended to examine if serum homocysteine is a risk factor for developing colour vision defects in diabetes and worsening of retinopathy. Material and Methods: A total of 92 patients with established diabetic retinopathy and having colour vision defects visiting hospital were examined and a detailed history of duration of diabetes was taken. Retinal examination for evidence of diabetic retinopathy and colour vision patterns on Ishihara colour vision chart were noted. OCT was performed on these patients. Results: 92 of patients with diabetic retinopathy under study had a gross colour vision deficiency. The average macular thickness on OCT of patients with total colour vision deficiency was 279 microns. Prevalence of colour vision deficiency increased with duration of diabetes and severity of retinopathy. The average serum homocysteine level in these patients was 21.98 μM/L which was above the normal range. Serum homocysteine levels ranged from 11.0 μM/L to 30.2 among males and 11.1to 41.0 in females. Conclusion: Higher prevalence of colour blindness was observed in patients of diabetes with macular oedema and high circulating serum homocysteine levels. Impaired colour vision was more in patients with average macular thickness of 228 micron and raised homocysteine levels thus suggesting it could be a possible risk factor.

Is declotting a better procedure than Redo MVR for stuck mitral valve?

To evaluate and compare the outcome of declotting versus Redo Mitral Valve replacement for stuck mitral valve in the early postoperative period. Retrospective interventional study. Armed Forces Institute of Cardiology and National Institute of Heart Diseases [AFICNIHD] Rawalpindi from 1[st] Jan, 2010 to 31[st] Oct, 2013. A total of 36 patients were selected. Group A [n = 28] underwent declotting and group B [n = 08] were treated by redo mitral valve replacement [MYR]. Diagnosis of prosthetic valve obstruction was made on the basis of history, clinical examination, echocardiography and fluoroscopy. All patients were operated under general anesthesia and cardiopulmonary bypass [CBP]. Total clamp and CPB time were recorded. Post operatively, patients were evaluated with daily progress parameter. The hemodynamic status, isotropic support, ventilation time, intensive care ward and total hospital stay were also recorded for comparison. Two-dimensional echocardiography was done before extubation and at discharge. Mortality rate was also compared in the two groups. No statistical difference was found on the basis of gender, age, interval between initial mitral valve replacement [MVR] and redo operation or decloting, anticoagulation status, New York Heart Association NYHA] functional class, international normalized ratio [INR] level, trans thoracic echocardiography and luoroscopy. The mean CBP time and cross clamp time was significantly less in group A than group B. Similarly mean ventilation time in group A was significantly less than in group B. The mean ITC stay was and mean hospital stay was not statistically significant. The mortality rate in group A and B was 7.14% and 50% respectively which was statistically significant. Prosthetic valve thrombosis is a life threatening complication after mechanical mitral valve replacement with high mortality without timely and effective surgical intervention. Declotting, being a less aggressive surgical technique is recommended because of better outcome in terms of morbidity and mortality in the early post-operative period

Comparison of hyoid bone position among cleft lip palate and normal subjects

To compare the hyoid bone position between cleft lip/palate and normal patients. Cross-sectional analytical study. Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences [DIEKIOHS], Dow University of Health Sciences [DUHS], Karachi, from March 2012 to February 2013. The sample for this study consisted of total 68 subjects among which Group 1 consisted of 34 nonsyndromic cleft lip and palate [both unilateral and bilateral] and Group 2 included 34 subjects with normal facial morphology. Both groups included males and females with mean age 14.3 +/- 0.1 year. Analysis was done on lateral cephalometric radiographs of patients including angulations taken as Hp-Mp, Hp-Ol, Hp-Sn, Cvt-Evt, Opt-Cvt, Nke, Sn-Vert, Cvt-Vert, Sn-Vert and linear distance of hyoid bone measured as C3-H, C3-RGN, and H-RGN. Statistically significant differences [p < 0.001] in C3-H, C3-Rgn, H-Rgn, and Sn-Cvt were found between cleft lip/palate group and normal group. Hyoid bone is located anteriorly and caudally in cleft lip and palate group

Toxic epidermal necrolysis in a patient receiving concurrent phenytoin and whole brain and thoracic radiotherapy

Toxic epidermal necrolysis [TEN] is a severe drug induced type IV hypersensitivity syndrome that can be caused by anticonvulsant drugs, especially the aromatic anticonvulsants such as phenytoin. Most patients with brain metastasis receive whole brain radiotherapy along with anti-edema measures and anticonvulsants either as prophylactic or for symptom control; phenytoin being the most commonly used drug. In a subset of patients, cranial irradiation may act as a precipitating factor along with anticonvulsants for the development of TEN. We report a 54-year-old patient with metastatic non-small cell lung cancer treated with palliative whole brain and mediastinal radiotherapy with concurrent phenytoin-developing TEN, which started within the radiation portals with subsequent generalization. Though a rare, but serious complication, avoidance of the use of phenytoin concurrent with radiotherapy, replacing phenytoin with newer anticonvulsants, early recognition, aggressive management and awareness of this possible complication has been implied upon in this report

Tennis elbow: role of local steroid injection

Tennis elbow is a condition, characterised by pain and tenderness over the lateral epicondyle of the humerus, and pain on resisted dorsiflexion of the wrist, middle finger, or both. The aim of this randomised controlled trial was to investigate the short term efficacy of local steroid injection compared with oral and topical NSAIDs. Sixty patients [45 male and 15 female] were included in the study. The mean age was 42 years for men and 40 years for women. They were placed in group A and B [30 cases each]. Group A received local steroid injection [triamcinolone 20 mg mixed with lignocaine 2% 1 cc] and topical NSAID cream application [diclofenac diethylammonium] twice a day, tab. diclofenac sodium 50 mg twice a day for 3 weeks. Group B received tab diclofenac 50 mg twice a day and, topical NSAID cream application twice a day for 3 weeks. Assessment of patients was made 3 times; first at the start of the study, 2[nd] time after 6 weeks, and 3[rd] time after 12 weeks. A blinded assessor rated the elbow complaints of the patients at resisted dorsiflexion of wrist using VAS [0=no severity, 1-3 mild, 4-6 moderate, 7-9 sever, 10=maximum severity]. At six weeks, 22 [73.33%] patient in group A had no pain as compared to 7 [23.33%] patients in group B who were pain free [p<0.0001, chi-square=38.75]. At 12 weeks 27 [90%] patients in group A were pain free compared to group B in which 7 [23.33%] patients were pain free [p<0.0001, chi-square=27.56]. In patients with tennis elbow, the use of local steroid injection in combination with topical and oral NSAIDs is superior to the use of combination of topical and oral NSAIDs. Better results with combination therapy using local steroid injection may be limited to the short term.

Mandibular third molar angulation in extraction and non extraction orthodontic cases

Background: The purpose of this study is to determine the angulation of mandibular third molar in orthodontic cases which are planned for extraction and non extraction. Methods: This is a cross-sectional descriptive study in which pre-treatment panoramic radiographs of 49 patients, age range 11–26 years were taken from the OPD of Department of Orthodontics, Dr. Ishrat- ul -Ebad Khan Institute of Oral and Health Sciences [DIKIOHS], Dow University of Health Sciences. The angles between the long axis of the second and third molars were measured. Descriptive statistics were applied. Mann-Whitney U-test was used for intergroup comparison extraction and non extraction cases. Results: This study consists of 49 patients with mean age of 17.94 years. Over all result concluded that mandibular third molar angulations were from 8–94° in extraction cases and 10–73° in non extraction cases. However, the pre-treatment 3rd molar angulation differences in extraction and non extraction cases were statistically insignificant with p-value >0.05. Conclusions: This study evaluates third molar angulations in pre-treatment cases, the differences in angulation were like other morphological differences but changes in angulation after treatment may or may not be related to extractions

Comparison of epidural and spinal anaesthesia for total abdominal hysterectomy

Objectives: to compare the time of onset, adequacy of surgical analgesia and motor blockade with epidural anaesthesia versus spinal anaesthesia for hysterectomy. To compare the frequency of hypotension and need for switching to general anaesthesia with spinal versus epidural anaesthesia for hysterectomy

Material and Methods: one hundred patients with ASA I or II undergoing hysterectomy were included in the study. Fifty patients underwent surgical procedure under epidural [E] and fifty under spinal [S] anaesthesia. Both groups were monitored for onset and quality of surgical analgesia, degree of motor blockade, frequency of hypotension and need for conversion to general anaesthesia

Results: the time of onset of surgical analgesia was significantly shorter in spinal group compared with epidural group [9.12+2.56 vs 21.7+3.59 minutes, p<0.001]. The quality of surgical analgesia was not significantly different in both groups. The degree of motor blockage was significantly more pronounced in the spinal group [mean modified Broomage scores 1.08 vs 2.10 p<0.01]. The frequency of hypotension was more in the spinal group [8 vs. 2 patients p<0.05]. The need to convert to general anaesthesia was more common in spinal compared to epidural group [8 vs. 1 patient p<0.05]

Conclusion: spinal anaesthesia for hysterectomy is associated with quicker onset of action, better motor blockade. However, both techniques allow adequate level of surgical analgesia which is not significantly different with spinal or epidural anaesthesia. Frequency of hypotension and need for conversion to general anaesthesia is more common with spinal compared with epidural anaesthesia for hysterectomy

Periodontal status of first molars during orthodontic treatment

The most important aetiological factor of periodontal disease is plaque deposition around gingival margin. The aim of the study was to investigate the negative changes in periodontal health [increase in pocket depth] of first molars in fixed orthodontic treatment and to discuss the available options to avoid it. Group A [6 month of treatment] comprised of 45 patients, compared to Group B [12 month of treatment] comprised of 45 patients. Initial pocket depth of first molars checked before placement of molar bands in both groups of patients, then for Group A patients pocket depth evaluated after 6 month of treatment and for Group B patients pocket depth evaluated after 12 month of treatment period. In patients with 6 months of treatment the pocket depth of molars mostly falls between 1.5 and 2.0 mm. In some severe cases it exceeded 3 mm. In patients at 12 months of treatment pocket depth was greater than 6 month group and it mostly fell in the range of 2.0-2.5 mm. Increase in pocket depth showed that plaque deposition leads to periodontal destruction around molar bands. Patient motivation to maintain oral hygiene and regular scaling will minimise hazardous effects

Dual source multislice computed tomography for pulmonary embolism: initial experience at AFIC/NIHD Rawalpindi

Observation of different computed tomography findings in patients suffering from pulmonary embolism. All patients who underwent computed tomography for pulmonary embolism and had positive findings of pulmonary embolism, were included in the study. Armed Forces Institute of Cardiology/ National Institute of Heart Disease, between April 2009 and October 2010. Patients on mechanical ventilation were excluded from the study. CT pulmonary angiograms were obtained with 64 slice dual source computed tomography [DSCT] machine [Somatom definition] from Siemens. Before scanning breath holding was taught. A craniocaudal acquisition was obtained with a collimation of 64 x 0.6 mm and a pitch of 1.2-1.4. Total number of patients included in the study were 34 with mean age 50 years. The mean of Score by Miller was 10 +/- 5.532 and the mean percentage obstruction by method of Miller was 62.5%. The mean of Score by Qanadli was 19.62 +/- 12.32 and the mean percentage obstruction by method of Qanadli was 49.04%. The mean of Score by Mastora was 54.53 +/- 33.27 and the mean percentage obstruction by method of Mastora was 35.18%. Calculated mean and SD of right ventricular [RV] diameters was 44 +/- 7.75mm, left ventricular [LV] diameter was 32 +/- 8.06mm, RV/LV ratio was 1.508 +/- 0.58 mm, main pulmonary artery [PA] luminal diameter was 29 +/- 4.16mm, ascending aorta size was 32.46 +/- 5.14mm, PA/Aorta ratio was 0.913 +/- 0.188mm, Azygos Vein diameter was 11.14 +/- 1.88mm and superior vena cava [SVC] diameter [at azygos arch] was 18.93 +/- 3.37 mm. Correlation between methods was generally significant. Reflux of contrast injection was noted in 24 out of 34 patients, leftward bowing of inter-ventricular septum was observed in 21 patients, pleural effusion was noted in 10 patients and pericardial effusion was seen in only 3 patients. CT pulmonary angiography has emerged as a reliable non invasive tool for not only confirmation of diagnosis of pulmonary embolism in short time but also gives valuable information about prognosis of these critically ill patients. Further it can provide accurate follow up of thrombolytic therapy and can help plan an interventional strategy

Circadian periodicity in the onset of acute ST segment elevation

To analyze the influence of diabetes mellitus on circadian rhythm affecting the onset of acute ST elevation myocardial infarction. Observational study. February to August 2010. Faisalabad Institute of Cardiology, Faisalabad. Three hundred and seven consecutive patients who fulfilled the inclusion and exclusion criteria and presented with first MI were studied. All patients were divided into four groups according to the 6:00 hours interval of the day [Circadian rhythm]. Group I comprised of patients presenting with onset of symptoms between 0-6 hours, Group II 6:01 to 12:00 hours, Group III 12:01 to 18:00 hours and Group IV 18:01 to 24:00 hours. Data was analyzed for variations within groups. Two peaks of onset of symptoms were observed, first between 0-6 hours 144 [33.9%] patients and the second between 6:01 to 12:00 hours 87 [28.3%] and a non significant association was observed in time of onset of acute myocardial infarction P = 0.082. The trough was evening time 12:01 to 18:00 hours where only 63 [20.5%] patients had acute myocardial infarction. Mean age of study population was 56 +/- 12.7 years. Mean age was similar in all the four groups P = 0.155. There were 228 [74.3%] males, 79 [25.5%] females. The circadian morning peak of MI symptom onset was attenuated in patients with diabetes as Group IV consisted of higher number 24 [37.5%] of diabetics followed by group I 23 [34.7%]. Overall group II had the maximum number of hypertensive patients 41 [47.1%] as compared to other groups. Obesity was observed in 55 [18%] with similar number of patients in all groups P = 0.492. Majority of patients 117 [38.1%] presented between 4-8 hours after the onset of symptoms. Overall 170 [55.4%] patients had anterior wall myocardial infarction followed by inferior wall myocardial infarction in 82 [26.7%] patients. Our study demonstrates that the circadian morning peak of MI symptom onset was attenuated in patients with diabetes, suggesting a role of autonomic dysfunction. Inconsistency in observation of such an effect in patients with diabetes in the past may well have been due to differences in the duration of diabetes

Effects of papaverine and sodium nitroprusside solution as topical vasodilators for internal mammary artery

To compare the effects of topical sodium nitroprusside [SNP] and papaverine solutions to treat left internal mammary artery spasm. Randomized Control Trial [RCT]. AFIC / NIHD Rawalpindi from Jan 2009 to March 2009. Fifty consecutive patients undergoing elective coronary artery bypass graft surgery [CABG] were randomly assigned to two groups: group N [n=25, Sodium Nitroprusside solution], and group P [n=25, Papaverine]. In each patient, pedicled left internal mammary artery was harvested, five minutes after heparin administration, left internal mammary artery was divided distally; flow per minute was calculated after measuring the free flow for over 15 seconds; this is named [Flow 1.]Then, the pedicled left internal mammary artery was sprayed with the randomized solution, and covered with the test solution soaked sponge. The second flow measurement [Flow 2] was done before commencing cardiopulmonary bypass. A third flow measurement [Flow 3] was recorded just before left internal mammary artery to left anterior descending coronary artery anastomosis, while the patient was on cardio pulmonary bypass. Analysis of variance was applied to detect differences among groups; paired-sample t test was used for left internal mammary artery topical free flow in both groups. Mean left internal mammary artery free flows were as follows: group N, flowl=32.72 +/- 27.67 ml/min, versus group P flowl=23.44 +/- 15.16 ml/min [p<0.148], group N flow2=63.92 +/- 33.40 ml/min versus group P flow2=38.88 +/- 24.54 ml/min [p<0.004], and group N flow3=62.44 +/- 38.38 ml/min versus group P flow3=49.52 +/- 30.29 ml/min [p <.170]. Topical free flow difference amongst the two groups was statistically significant in the flow2 [p< 0.004]; whereas topical mean free flow difference was statistically significant when the groups were individually compared group N flowl:flow2, flow 1: flow 3and flow 2: flow 3 group N [p<.000, .000, .846] and group P [p<.001, .000, .001] respectively. Sodium nitroprusside [SNP] and papaverine solutions are able to treat vascular spasm and increase the flow of left internal mammary artery, when they are used topically. However sodium nitroprusside allows early and better relief of vascular spasm

Dermatoglyphic pattern study

Objectives: This dermatoglyphic study was focused on to evaluate bilateral dermatoglyphic dimorphism, gender dermatoglyphics dimorphism, pattern occurrence and difference from mean pattern occurrence

Study Design and Method: It was conducted at PMC Faisalabad, 152 students of 2nd year MBBS [session2009-2010] took part as subjects. Data was obtained with use of ink pad. Patterns were recorded, classified, statistically analyzed and discussed

Results and Conclusion: Arithmetic mean, percentage and mode of data were calculated. Analysis showed that loop pattern has the highest frequency [51.1%] followed by whorl pattern [36.8%]. Arch pattern is the rarest pattern [7.8%]. There is more predominance of arch and loop pattern than average values in this study

Haemorrhoidectomy: open versus closed technique

To compare open haemorrhoidectomy technique with closed one in terms of wound healing time and complications. A comparative clinical trial. Department of Surgery Bahawal Victoria Hospital Bahawalpur, from June 2006 to June 2008. Patients of 3rd and fourth degree haemorrhoid [n-60] were selected for this study. They were divided into two groups. Group A [n-30] was treated by open haemorrhoidectomy [Milligan Morgan technique] and group B [n-30] was treated by closed haemorrhoidectomy [Ferguson technique]. Postoperatively patients were evaluated for wound healing time and complications. The age of the patient ranged from 18 years to 73 years. The wound healing time was little over 2 weeks in group B while it was just above 4 [1/2] weeks in group A with p value of less than 0.05. After 24 hours the mean VAS in group A was 4.76 +/- 1.4 while it was 3.93 +/- 1.68 in group B and the p value was 0.046 which was significant The best results were obtained with closed haemorrhoidectomy technique as there was less post operative pain, rapid wound healing and less post operative bleeding with this approach. Closed haemorrhoidectomy is treatment of choice for 3[rd] and 4[th] degree haemorrhoids