Gastroprotective potential and mechanisms of action of Hedera nepalensis

Abstract Hedera nepalensis (H. nepalensis) , belonging to the family Araliaceae, is a medicinal plant traditionally used to treat stomach problems. The current study investigated the gastroprotective potential and the mechanism of action of H. nepalensis in diclofenac-and ethanol-induced ulcer models. Anti-oxidant and lipid peroxidation inhibitory prospects of H. nepalensis were checked out by free radical scavenging assay and UV spectrophotometer respectively. Effect of H. nepalensis on the pH, gastric total acidity of gastric juice and protective effects of H. nepalensis against ulcer models have been examined. Histopathological studies have been carried out. The aqueous methanol extract of H. nepalensis (100 µg/mL) showed anti-oxidant (83.55%) and lipid peroxidation inhibitory (70.88%) potential at 1000 µg/mL; the extract had no buffer potential. The extract (400 mg/kg) significantly (81.12% and 63.46%) showed gastroprotective effect in diclofenac and ethanol-induced rat ulcer models respectively. Histopathological studies confirmed the biochemical findings. FTIR analysis showed the presence of carboxylic acid, alkanes, conjugated alkanes, aldehydes and alkyl-aryl ethers. Gallic acid, M-coumaric acid and quercetin were found by HPLC analysis. H. nepalensis exhibited significant protection against diclofenac and ethanol induced gastric damage by anti-oxidant and lipid peroxidation suppression effects suggesting potential broad utility in treatment of diseases characterized with gastric damage.

Prepubertal and postpubertal vitiligo: a multivariate comparative study in 375 patients

Abstract: Background: The onset of vitiligo during childhood is common. Limited data exist that compare the clinical associations of prepubertal and postpubertal vitiligo in Arabs. Objective: To compare the clinical profile of pre and postpubertal onset vitiligo. Methods: A cross-sectional observational study was conducted. The Vitiligo European Task Force questionnaire was completed for each patient. Results: A total of 375 patients were included; 199 had postpubertal vitiligo (>12 years), and 176 had prepubertal onset vitiligo (<12years). There were more females in the prepubertal group (49%) than in the postpubertal group (29%), p-value <0.001. The prepubertal group has had more involvement than the postpubertal group (45% vs 30%, p=0.004). Only 8 cases of segmental vitiligo were observed; five were observed in the prepubertal group of patients. Female gender (OR=2.3; 95% CI:1.5, 3.5), presence of halo nevus (OR=2.2; 95% CI:1.1, 4.4) and face involvement (OR=1.9; 95% CI:1.2, 2.9) were positively associated with prepubertal vitiligo. Stress, as an onset factor, was positively associated (OR=0.51; 95% CI:0.3, 0.8) with postpubertal onset vitiligo. Study limitations: A possible selection bias toward more severe vitiligo cases can be a limitation, because the study was conducted in a clinic specialized in vitiligo. Moreover, a likelihood of false recall bias cannot be excluded. Conclusions: Our data present clinical evidence that vitiligo behaves mostly the same way in the prepubertal group as in the postpubertal group. However, female over-representation, more face involvement and more halo nevi were observed in prepubertal vitiligo, while stress was more prevalent as an aggravating factor in postpubertal vitiligo patients.

Multivariate Analysis of Factors Associated with the Koebner Phenomenon in Vitiligo: An Observational Study of 381 Patients

BACKGROUND: The Koebner phenomenon (KP) is a common entity observed in dermatological disorders. The reported incidence of KP in vitiligo varies widely. Although the KP is frequently observed in patients with viltiligo, the associated factors with KP has not been established yet. OBJECTIVE: The aim is to estimate the prevalence of KP in vitiligo patients and to investigate the associated factors with KP among vitiligo characteristics. METHODS: A cross-sectional observational study was conducted using 381 vitiligo patients. Demographic and clinical information was obtained via the completion of Vitiligo European Task Force (VETF) questionnaires. Patients with positive history of KP were extracted from this vitiligo database. Multivariate analysis was performed to assess associations with KP. RESULTS: The median age of cases was 24 years (range, 0.6~76). In total, 237 of the patients were male (62.2%). Vitiligo vulgaris was the most common type observed (152/381, 39.9%). Seventy-two percent (274/381) patients did not exhibit KP, whereas 28.1% (107/381) of patients exhibited this condition. Multivariable analysis showed the following to be independent factors with KP in patients with vitiligo: the progressive disease (odds ratio [OR], 1.82; 95% confidence interval [95% CI], 1.17~2.92; p=0.041), disease duration longer than 5 years (OR, 1.92; 95% CI, 1.22~2.11; p=0.003), and body surface area more than 2% (OR, 2.20; 95% CI, 1.26~3.24; p<0.001). CONCLUSION: Our results suggest that KP may be used to evaluate disease activity and investigate different associations between the clinical profile and course of vitiligo. Further studies are needed to predict the relationship between KP and responsiveness to therapy.

Application of hematological indices for the differential diagnosis of beta thalassemia trait and iron deficiency anemia

Objective: To apply various hematological indices for the differential diagnosis of Beta-Thalassemia trait [Beta-TT] and iron deficiency anemia [IDA]

Methodology: This retrospective descriptive study was conducted at Dar-ul-Sehat Hospital, Gulistan -e- Johar, Karachi. We retrospectively analyzed complete blood count [CBC] of 2480 patients, who came to the OPD for various problems during the year 2014 from January to December so as to identify hypochromic microcytic patients. Mentzer's index [MI], Shine and Lal index [S and L index] and Ehsani's formula were applied on the CBC report of identified microcytic hypochromic patients

Results: It was found that among a total of 2840 patients, 385 [13.55%] patients were suffering from hypochromic microcytic anemia identified on their CBC report. These included 44 males [6.74%], 300 females [33.33%] and 41 [14.48%] children. Application of Mentzer's index [MI], Shine and Lal index [S and L index] and Ehsani's formula screened the hypochromic microcytic patients into patients suffering from ß-Thalassemia trait and Iron deficiency Anemia

Conclusion: Application of hematological indices can be taken as the most useful method fordifferentiating Beta-TT from IDA by simply considering CBC report

Frequency of raised C - reactive protein in the diagnosis of clinically suspected neonatal sepsis

Introduction: Despite increasing knowledge of pathophysiology and modern therapeutic approaches, the mortality and morbidity associated with Neonatal sepsis remains alarmingly high. Its clinical features are non-specific and can be confused with many other diseases. This study is done to find out some rapid and reliable diagnostic tool in early detection of neonatal sepsis, thereby allowing prompt management and treatment of suspected cases

Objective: To determine the frequency of raised C - reactive protein in the diagnosis of suspected neonatal sepsis. Study design: Cross sectional survey. Setting: neonatal unit of pediatric medicine department of Chaudhry Rehmat Ali Memorial Trust Hospital Lahore, Pakistan. Duration of study: Six months from 01-10-2012 to 31-03-2013. Sample size: The calculated sample size is 140 cases. Sampling technique: Non probability purposive sampling. Data collection procedure: Data was collected by taking the history and physical examination of cases admitted in neonatal unit. C reactive protein was checked at bedside through quick read commercially available kits. Data was analyzed through SPSS version 12 and entered in Proforma

Results: Majority of neonates in our study population; 66 among 84[79.4%] with early onset sepsis [with in first 3 days of life] and 48 among 56 [85.7%] with late onset sepsis [4 to 28 days] has raised C reactive level for i - e >/=6 mg%

Conclusion: CRP is a readily available, inexpensive, reliable and highly sensitive marker in detection of neonatal sepsis

Health hazards of electronic media devices in children

Use of electronic devices among children is common and is increasing day by day. Exposure to electronic devices such as television, computer and cell phones is documented to be associated with lot of adverse health effects. The problems encountered in children are sleep difficulties, bad dietary habits, lower physical activity, obesity, appearance of psychological symptoms including depression, lack of social interaction etc. Parents need to be counseled regarding adverse health effects and limiting the screen time of their children to these electronic devices

Total hip arthroplasty for childhood fused hip

The conversion of a painless fused hip of a long standing duration to a mobile hip is usually not demanded due to a number of per-operative problems, iatrogenic complications and a high demanding procedure. The conversion is, however, required when a patient develops chronic back pain or a painful pseudoarthrosis of the hip. Conversion due to pseudoarthrosis in a recent fracture through femoral neck of previously fused painless hip has never been reported. We are reporting this unique indication for conversion

Intra vaginal wooden foreign body causing multiple internal fistulae and bladder stone in a 12 years girl

Vaginal foreign bodies in girls may be accidental, self-inflicted or secondary to child abuse. These may causes a number of complications like Infections, abscess formation, intestinal perforation, vaginal discharge and internal fistulae. We are presenting a case of a 13 years old girl who presented with a supra-pubic mass and dysuria. X-ray showed a radio-opaque shadow in pelvis. The child was admitted in medical ward with the diagnosis of bladder stone and UTI. She was pouring frank pus from the vagina. On rectal digital examination a hard foreign body was felt in the rectum. Investigations revealed that she had a large pelvic collection, a sharp wooden Foreign Body [FB] extending from the rectum through the vagina in to the urinary bladder forming a bladder stone. Patient also developed recto-vaginal and vesico-vaginal fistulae. Foreign body was removed along with the bladder stone, pelvic abscess drained and colostomy was performed. Later repair of vesico-vaginal fistula were performed, recto-vaginal fistula closed spontaneously and colostomy closed. Patient became fully continent for urine and feces after completion of surgical procedures. A careful history from the child revealed that she had inserted the foreign body herself as a self-exploring practice

The role of perioperative warming in surgery: a systematic review / O papel do aquecimento perioperatório em cirurgia: uma revisão sistemática

OBJECTIVE: The objective of this review was to systematically analyze the trials on the effectiveness of perioperative warming in surgical patients. METHODS: A systematic review of the literature was undertaken. Clinical trials on perioperative warming were selected according to specific criteria and analyzed to generate summative data expressed as standardized mean difference (SMD). RESULTS: Twenty-five studies encompassing 3,599 patients in various surgical disciplines were retrieved from the electronic databases. Nineteen randomized trials on 1785 patients qualified for this review. The no-warming group developed statistically significant hypothermia. In the fixed effect model, the warming group had significantly less pain and lower incidence of wound infection, compared with the no-warming group. In the random effect model, the warming group was also associated with lower risk of post-anesthetic shivering. Both in the random and the fixed effect models, the warming group was associated with significantly less blood loss. However, there was significant heterogeneity among the trials. CONCLUSION: Perioperative warming of surgical patients is effective in reducing postoperative wound pain, wound infection and shivering. Systemic warming of the surgical patient is also associated with less perioperative blood loss through preventing hypothermia-induced coagulopathy. Perioperative warming may be given routinely to all patients of various surgical disciplines in order to counteract the consequences of hypothermia.

OBJETIVO: O objetivo desta revisão é analisar sistematicamente os ensaios sobre a eficácia do aquecimento perioperatório em pacientes cirúrgicos. MÉTODOS: Uma revisão sistemática da literatura foi realizada. Ensaios clínicos sobre aquecimento perioperatório foram selecionados segundo critérios específicos e analisados para gerar dados sumativo expresso na diferença média padronizada (standardized mean difference, SMD). RESULTADOS: Vinte e cinco estudos englobando 3.599 pacientes de várias disciplinas de cirurgia foram obtidos a partir de bases de dados eletrônicas. Dezenove ensaios aleatórios em 1.785 pacientes qualificados para esta revisão. Nenhum grupo de aquecimento desenvolveu estatisticamente significativa hipotermia. No modelo de efeito fixo, grupo de aquecimento tiveram significativamente menos dor e menor incidência de infecção na ferida quando comparado com o grupo de não-aquecimento. No modelo de efeito aleatório, grupo de aquecimento também foi associado a um menor risco de tremores pós-anestesia. Em ambos os modelos de efeitos fixos e aleatórios, o aquecimento foi significativamente associado com menor perda de sangue. No entanto, houve significativa heterogeneidade entre os ensaios. CONCLUSÃO: O aquecimento perioperatório de pacientes cirúrgicos é eficaz na redução da dor pós-operatória ferida, infecção ferida, e tremores. O aquecimento sistêmico do paciente cirúrgico também está associado com menor perda de sangue no perioperatório prevenindo hipotermia e induzindo coagulopatia. O aquecimento perioperatório pode ser administrado rotineiramente a todos os pacientes cirúrgicos de diversas disciplinas, a fim de neutralizar as consequências da hipotermia.

Surgical Management of Blunt Abdominal Trauma

To evaluate and compare the usefulness and limitations of diagnostic peritoneal lavage and ultrasonography in patients with blunt abdominal trauma. The study was conducted Nishtar Hospital, Multan on 100 cases presented with BAT having equivocal abdominal findings during one year i.e. March 2005 to February 2006. It was a prospective comparative study. Main age group involved in accidents and BAT was between 40 to 60 years Male to female ration was 5:1 Liver was main organ injured in most cases of BAT. It was observed that DPL was 100% sensitive and 91.3% specific while USG of abdomen was 88.9% sensitive and 100% specific. DPL. is more sensitive while abdominal USG is more specific. Both are complementary to each other

Disseminação de células tumorais induzida pelo pneumoperitônio nos portais das operações laparoscópicas e na parede abdominal: modelo experimental em hamster / Effects of pneumoperitoneum pressure on the dissemination of tumor cells and tumor recurrence at the port site and midline incisions: experimental model in hamster

Racional - Existe muita controvérsia científica quanto ao poder da pressão pelo pneumoperitônio na disseminação de células tumorais, quer para os portais de acesso nas operações laparoscópicas, quer na do próprio peritônio parietal e/ou visceral. Objetivo - Avaliar a relação entre contaminação do trocarte com células tumorais, aerolização de células tumorais, e implante tumoral em feridas da parede abdominal com o aumento da pressão intra-abdominal durante uma intervenção cirúrgica por via laparoscópica. Material e Método - Sessenta hamsters foram submetidos à laparotomia com posicionamento de dois trocártes de 5 mm no abdomen, seguidos da instilação de células de adenocarcinoma humano na cavidade abdominal. Os animais foram divididos em 3 grupos, de acordo com o nível de pressão intra-abdominal: 10,5 e 0 mmHg. O gaz intra-abdominal era liberado da cavidade abdominal através de um filtro localizado no trocarte direito para identificação de células tumorais aerolizadas. Os trocártes, após o término da operação, eram lavados em solução salina, para identificação de células tumorais. Os animais foram sacrificados após 15 dias, realizando-se estudo histopatológico das feridas abdominais. Resultados - A elevação da pressão intra-abdominal aumentou significativamente a contaminação instrumental e o implante tumoral nas feridas abdominais. O nível de pressão intra-abdominal não teve efeito no número de células tumorais aerolizadas. Conclusão - O aumento da pressão do processo perioperatório aumenta a implantação de células tumorais. Abordagem laparoscópica com baixa pressão intra-abdominal diminui a possibilidade de implantes tumorais.