Dealing a neonate with CHARGE syndrome: Anaesthesia perspective of perioperative care

CHARGE syndrome is a condition that can disturb numerous areas of human body. As an abbreviation CHARGE stands for: coloboma, heart defects, atresia choanae, and retardation of growth, genital, and ear abnormalities. The configuration of malformations differs among individuals with this disorder, and the various health issues can be life-threatening during infancy and childhood. Affected individuals typically have several main features or a combination of major and minor appearances. Here we are presenting a case report of a neonate with CHARGE syndrome who underwent successful repair of choanal atresia under general anaesthesia with invasive monitoring

Oral ephedrine is useful to wean patients off long term parenteral vasopressors after cervical spinal cord injury

Traumatic spinal cord injury [SCI] in young adults not only increases the risk of mortality but more commonly it complicates with life-long disability. Cervical SCI patients are particularly susceptible and sensitive to phases of cardiovascular instability and respiratory failure directly consequential from their injuries. Furthermore, long term vasopressor requirement is not uncommon though weaning from parenteral vasopressor is a challenge. We document a case of the use of oral ephedrine, which we used to wean our patient from parenteral vasopressors. Oral ephedrine can be an appropriate option to get rid of long term use of infusion of vasopressor

Effects of L-carnitine; on skeletal muscle of rabbit

L-carnitine [L-car] is a trimethylated amino acid required for the transformation of long chain free fatty acids into acylcarnitine and their subsequent transport into the mitochondrial matrix. It enhances the fatty acid oxidation for energy thus delaying the skeletal muscle fatigue. Objectives of this study were to determine effect of L-carnitine supplementation on skeletal muscle lactate after fatigue, to observe effect of L-carnitine supplementation on force of contraction in skeletal muscle and to estimate the time to onset of fatigue after L-carnitine supplementation. In control group, the rabbit sedated and soleus muscle was excised, Homogenized and centrifuged. Supernatant collected, was mixed with reagents of lactate test kit. Absorbance of light was read with the help of spectrophotometer and readings were noted. In experimental group, L-carnitine was given in a dose of 80mg / kg. The period of administration was two weeks. Soleus muscle was excised after giving the last dose of L-carnitine. Lactate level was measured by using lactate test kit [Randox®]. Readings for lactate measurement were noted after fatigue in both groups. Statistically significant results [p <0.05] were found in all three variables. Data was analyzed by applying [t] test in IBM SPSS Statistics - 20 software. L -carnitine delays the onset of fatigue of skeletal muscle. This was the stated alternative hypothesis

Chronic idiopathic urticaria; suggested/hypothetical role of elevated serum TSH in pathogenesis of chronic idiopathic urticaria

Urticaria is a condition in which itchy red bumps or wheals appear on the skin unexpectedly. There are two main types ,acute condition which last for up to six weeks while chronic idiopathic urticaria [CIU] last for more than six weeks. There are multiple factors in causation of chronic idiopathic urticaria [CIU] and therefore association with elevated thyroid stimulating hormone [TSH] was evaluated in this study. Prospective case control. Department of Physiology Dow University of Health Sciences Karachi. December 2004 to January 2006. A total number of ninety subjects/patients were enrolled. They were divided in three groups having 30 subjects/ patients in each group. Group A consist of diagnosed cases of chronic urticaria. Group B consist of diagnosed cases of hypothyroidism and group C consist of age and sex matched healthy subjects. In all selected patients/subjects, serum antithyroid autoantibodies and thyroid profile [serum TSH, T3 and T4], complete blood count, IgE levels, ESR were done. All patients were selected from dermatology and medical units of civil hospital, Agha Khan Hospital, JPMC and community health clinics in Karachi. Out of 90 patients, 47[78%] were found to have chronic urticaria compared to control. Out of 47 patients, serum TSH [thyroid stimulating hormone] was found to be elevated in 20[42.6%] patients with or without hypothyroidism compared to control group.[P <0.001] Statistically significant association was found between elevated serum TSH and chronic urticaria symptoms

Iron deficiency anemia: scenario of pregnant women living at an altitude of >5000 feet in district abbottabad

To estimate the frequency of iron deficiency anemia in a sample of population of pregnant women residing permanently at high altitude of > 5000 feet in different areas of district Abbottabad. Cross sectional Study. Northern Institute of Medical Sciences Abbottabad: From 17 August 2009 to 15 June 2010. This study was carried out on hundred pregnant women residing permanently at an altitude of > 5000 feet above sea level in district Abbottabad. The age range was fixed to 15-45 [child bearing age] years. Suspected study participants having anemia were tested for iron status by serum ferritin test. Pregnant women having both anemia and iron deficiency were labeled as patients of Iron deficiency anemia. Results: The age range was 15-41 years with a mean of+/ - SD of 28.13 + / - 6.61. All women were of low and middle socioeconomic class with 74% illiteracy. 60% of women had birth spacing of two or less than two years. 64% of pregnant women had three children. Anemia was detected in 74% [X[2] =9.42 p > 0.05], iron deficiency in 66% [X[2] = 14.76 p <0.01] and iron deficiency anemia in 60% [X[2] = 13.56 p < 0.01]. High altitude resident pregnant women remain at high risk of developing iron deficiency anemia because of illiteracy, poverty and ignorance. With adequate nutrition and health education the problem can be addressed effectively

Supportive Scientific Investigations on Usefulness of Honey [Asl Khalis]

The use of honey [Asl Khalis] in the treatment of external and internal ailments must be much older than the history of medicine itself. According to Unani medicine, it is used as nutritive agent and therapeutically has antibacterial, anti-inflammatory, detergent, deobstruent, lithotryptic and wound healing properties. Honey consists of glucose, fructose, water, maltose, trisaccharides and other carbohydrates, sucrose, mineral, proteins, vitamins and enzymes. An attempt has been made here to review the scientific evidences regarding usefulness of Honey [Asl Khalis] as a drug used in Unani medicine.

Health seeking behavior of the people; knowledge, attitudes and practices [KAP] study of the people of urban slum areas of Karachi

The aims and objectives were, to know about the approach of people towards seeking medical advice with different options of healers, to observe thinking, feeling and various actions of people including level of self medication, and to know perception of people regarding various practices done by the healers. People living in urban slum areas of Karachi. Cross sectional Karachi. July to October 2008. Subjects and It was Knowledge, attitudes and practices [KAP] study carried out on a sample of 300 permanent household members aged>/=16 years of middle and poor class living in urban slum areas of Karachi. The mean age of the study participants was 38.27 with standard deviation of 17.57. 182 [61%] were male while 118[39%] were female. Out of 300 study participants [n=300] 260 [86.6%] consult allopathic healers including 169 [56.33%] MBBS general practitioners and 91 [30.3%] non qualified or quacks,25 [8.3%] consult homeopaths, 11 [3.6%] Hakims, and only 4 [1.33%]consult faith healers [P<0.05].148 [49.33%], participants belong to middle class group, while 152 [50.66%] were from poor class. 50% study participants do self medication at home prior to consultation for heath. Health seeking behavior is a complex phenomenon in developing countries like Pakistan where poverty overrides all other factors in decision of selecting a healer. It is recommended that people should be educated in choosing a healer which should be a qualified one

Typhoid and non-typhoid ileal perforation: surgical experience of 50 cases

The objective of the study was, to find out the frequency of typhoid and non typhoid ileal perforation, to observe the association of various epidemiological factors in causation of disease and to note surgical, clinical, and laboratory findings along with mortality. A comparative descriptive study. The study was conducted in the department of surgery Civil Hospital Karachi from June 1997 to August 1998. fifty consecutive patients of non-traumatic ileal perforation managed surgically were observed by making two groups of typhoid and non typhoid ileal perforation. Out of 50 [n=50] 32 [Group - A] patients [26 male and 6 female] had typhoid while 18 [Group - B] patients [15 male and 3 female] had non-typhoid ileal perforation. There were 41 [82%] male and 09 [18%] female. In-group A age range was 16-50 years and a mean of +/- SD of 25 +/- 10 while in group B age range was 12- 60 years and a mean of +/- SD of 26 +/- 11.65. In group A 90.6% while in group B 100% patients had a single perforation. Wound infection was the most common complication. Mortality was 6.25% and 5.5% in group A and B respectively. There was no significant association [P<0.05] of gender, seasonal and living conditions. Surgical cum Epidemiological findings point out to the need of distinguish between different types of non traumatic ileal perforation, and having check on the related causative factors leading to their occurrences

Utility of bad [aegle marmelos linn.] in unani medicine

Bael [Aegle marmelos] is an important medicinal plant used in Unani System of medicine, which is cultivated throughout India. It is popularized for having antidiarrhoeal and antidysenteric activity. The present paper is an attempt to summarize the pharmacological actions and medicinal uses of the BaeI plant mentioned in Unani medical literature as well as in currently reported studies

Inverted Meckel's diverticulum causing intussusception in an adult

Adult intussusception is rare, making-up only about 1% of the causes of bowel obstruction intussusception, secondary to an inverted Meckel's diverticulum, is also a rare occurrence. Chronic abdominal pain, lower gastrointestinal bleeding, and recurrent obstructive symptoms may lead to an unnecessary delay in diagnosis. This case report describes a rare cause of adult intestinal intussusception due to inverted Meckel's diverticulum. Intussusception was diagnosed on emergency ultrasound of the patient, who was successfully managed with surgery

Influence of anthropometric measures on age related cataract

To evaluate the Influence of Anthropometric measures on age related cataract. A cross-sectional study on local male population. This study was conducted in department of physiology basic medical science institute Jinnah post Graduate Medical Institute. [BMSI, JPMC] in collaboration with ophthalmology Department of JPMC and Physiology Department Dow Medical College Karachi. After selection of subjects by consecutive sampling, a prescribed proforma was filled. A complete eye examination was performed and the subjects were asked to attend the laboratory, after 12 hour fasting samples were collected. Serums were stored for analysis. Blood pressure was measured by mercury sphygmomanometer. Weight, Height, Body Mass Index, Waist Circumference, Hip circumference and Waist/Hip Ratio were recorded. Subjects were divided in to four groups. Group-A =Normotensive, Normoglycaemic with Cataract [as Control] Group-B=Hypertensive with Cataract Group-C=Diabetics with Cataract Group-D=Hypertensive, Diabetics with Cataract. This study revealed that age related Cataract is influenced by Anthropometric measures. In our population age related cataract is inversely influenced by body mass index in contrast to the developed countries

Ambiguity in the nomenclature of medicinal plants used in Unani medicine

Due to ambiguity in the names of Unani Medicinal Plants, overlapping of data may occur in chemical or pharmacological informations where the botanical identity of market sample of crude drug taken up for research is not ascertained. The authentication of botanical source of plant material taken up for medicinal use is also necessary to maintain efficacy of the unani drugs. The botanical identity of many such controversial plants is yet to be resolved. In the present communication, an attempt has been made to compile a list of such plants which are known in the literature or sold in Indian markets by different names and vis-c-vis