Incidence of Atrial Fibrillation (AF) in Patients of Acute Coronary Syndrome

Introduction: Atrial fibrillation is common among patients withcardiovascular disease and is a frequent complication of theacute coronary syndrome.Objective: In this study our main goal is to assess theincidence of AF in patients of acute coronary syndrome.Method: This retrospective observational cohort study wasdone at Dhaka medical college and hospital from December2010 to December 2011 where 100 patients (male=73,female=27) were diagnosed with of ACS and AF. All data wereentered on the Statistical Package for Social Science (SPSS)and analyzed.Results: During the study most of the patients were belong to51-60 age group (53%) and 53% patients developed atrialfibrillation after admission. Also new onset AF patient’s hospitalstay rate was higher.Conclusion: After many analyses we can said that, incidenceof new-onset AF was more common in patients presenting withACS.

Outcome of shish kabab osteotomies fixed with SIGN NAILI in osteogenesis imperfecta. our experience at Ghurki Trust Teaching Hospital, Lahore, Pakistan

Objective: To evaluate the results of shish kabab osteotomies fixed with SIGN NAIL in long bone deformities of patients suffering from osteogenesis imperfect

Methods: This study was carried out on 12 patients who presented in OPD or Emergency Department with deformities of long bones. Detailed history, examination and investigations including X-ray AP and Lateral view of involved bone were done. All these cases were treated with Shish Kabab Osteotomies and SIGN NAILunder spinal or general anaesthesia. These cases were followed up for up to average of 20 months [range 06 months -6 years ] and results of the nail were observed in terms of union, rehabilitation and complications

Results: It was found that 8 [66.7%] were male and 4 [33.3%] were females with a mean age of 14.83 +/- 5.24. 5 [41.7%] patients having age 10-15 years and 7 [58.3%] were between 16-20 years. Total 21 surgeries performed. 3[25.0%] had surgery on unilateral femur,2 [16.7%] on unilateral tibia, 3[25.0%] on both unilateral tibia and femur,3 [25.0%] had surgery on bilateral tibia and 1[13.3%] with bilateral tibia and femur. The parents of all patients had a first degree consanguineous marriage. The mean hospital stay were 4.17 +/- 1.75 days. All osteotomies sites heal within 06 months, better bone densities, 1 Having recurrence of deformity and no fracture were found. Only two patients using walkers while remaining need no support for walking

Conclusion: Sign Nail along with shish kabab osteotomies in deformities of osteogenesis imperfecta is the treatment of choice. Patient rehabilitation is early, hospitalization is short, and osteotomies site healing response is good as well as decrease risk of fracture

Indole acetic acid and ACC deaminase from endophytic bacteria improves the growth of Solarium lycopersicum

Background: Endophytic bacteria are ubiquitous in all plant species contributing in host plant's nutrient uptake and helping the host to improve its growth. Moringa peregrina which is a medicinal plant, growing in arid region of Arabia, was assessed for the presence of endophytic bacterial strains. Results: PCR amplification and sequencing of 16S rRNA of bacterial endophytes revealed the 5 endophytic bacteria, in which 2 strains were from Sphingomonas sp.; 2 strains from Bacillus sp. and 1 from Methylobacterium genus. Among the endophytic bacterial strains, a strain of Bacillus subtilis LK14 has shown significant prospects in phosphate solubilization (clearing zone of 56.71 mm after 5 d), ACC deaminase (448.3 ± 2.91 nM α-ketobutyrate mg-1 h-1) and acid phosphatase activity (8.4 ± 1.2 nM mg-1 min-1). The endophytic bacteria were also assessed for their potential to produce indole-3-acetic acid (IAA). Among isolated strains, the initial spectrophotometry analysis showed significantly higher IAA production by Bacillus subtilis LK14. The diurnal production of IAA was quantified using multiple reactions monitoring method in UPLC/MS-MS. The analysis showed that LK14 produced the highest (8.7 uM) IAA on 14th d of growth. Looking at LK14 potentials, it was applied to Solanum lycopersicum, where it significantly increased the shoot and root biomass and chlorophyll (a and b) contents as compared to control plants. Conclusion: The study concludes that using endophytic bacterial strains can be bio-prospective for plant growth promotion, which might be an ideal strategy for improving growth of crops in marginal lands.

Effects of sperm parameters on the outcomes of intarcytoplasmic sperm injection: a retrospective study from Lahore Pakistan

Background: Semen analysis is the basic step when investigating sub fertility disorders related to male genital tract. Valuable clinical information can be obtained from Semen analysis report about the spermatogenesis and functional capabilities of spermatozoa

Objective: To determine the fertilization rate and pregnancy outcomes among intracytoplasmic sperm injection patients and its association with sperm parameters

Methodology: This retrospective analytical study was carried out at Lahore Institute of Fertility and Endocrinology, Lahore. Male partners of 272 couples were included in the study as they came for evaluation for assisted reproduction in between 1st July and 31st December 2014. Before samples were collected these males were asked to remain abstinent for 3 days. Specimens were collected by masturbation, and in cases of azoospermia it was retrieved by Percutaneous Epididymal Sperm Aspiration [PESA] or Testicular Sperm Apiration [TESA]. Semen analysis was performed according to the methods and standards outlined by the World Health Organization [WHO]. Oocytes were aspirated after 35-36 hours approximately, by ultrasound-guided transvaginal retrieval. About 4-5 hours after the aspiration of oocyte, in the IVF cycles, they were inseminated. After 18 to 20 hours all oocytes were examined for pronuclei followed by cleavage assessment within 24 hours. Embryos were examined and best embryos two or three were transferred into the uterine cavity on the 3rd day

Results: Fertilization did occurred in 182 [95.8%] patients with normal sperm count, in 30 [90.9%] with subnormal sperm count and in 43 [87.8%] with Azoospermia. Fertilization did occur in 209 [95.4%] patients with normal sperm morphology, in 12 [92.3%] with subnormal sperm morphology and in 34 [85.0%] with Azoospermia. Fertilization did occur in 160 [98.2%] patients with normal sperm motility, in 59 [88.1%] with subnormal sperm motility and in 36 [85.7%] in the Azoospermia group

Conclusion: Sperm motility and morphology abnormality affected fertilization in intracytoplasimic sperm injection. Though value of semen analysis is limited but gives direction to the investigation. Mere semen examination is not at all sufficient to make definitive diagnosis. It is not at all predictive about the functional abilities of the sperms. There is a need for adding an andrology component to the training of the gynecologists

Nutritional assessment and antioxidant analysis of 22 date palm (Phoenix dactylifera) varieties growing in Sultanate of Oman

Objective: To assess the nutritional values and antioxidant analysis of 22 varieties of date palm (Phoenix dactylifera) fruit collected from various regions of the Sultanate of Oman. Methods: Nutritional parameters including moisture, fats, fiber, proteins, carbohydrates, and energy value were determined using standard methods of Association of Official Analytical Chemists. The antioxidant activity was screened for their free radical scavenging properties using ascorbic acid as a standard antioxidant. Free radical scavenging activity was evaluated using 1,1-diphenyl-2-picrylhydrazyl free radical. Results: The results of the date fruits (dried/tamar stage) revealed significantly higher moisture (15%-21%), dry matter (78%-86%), ash content (1.0%-2.0%), fiber (1.0%-2.5%), fat (0.1%-0.7%), protein (1.8%-3.8%), nitrogen (0.25%-0.55%), carbohydrates (74.5%-82.4%), and energy values (307-345.5 kcal/100 g). The antioxidant activity ranged between 40% and 86% depending upon the type of date and location. Overall, Khalas, Fardh and Khasab have significantly higher nutritional attributes; however, other varieties such as Barshi, Qush LuLu, Handal, and Khunaizi also have comparable nutritional values. The cluster analysis further evidenced the correlation of proximate parameters in different locations. Moreover, the nutritional and antioxidant attributes of similar date varieties collected from different locations were slightly varied. Conclusions: The present finding helps in understanding the nutritional significance of different date varieties in Oman while the lesser known varieties can be improved through sustainable horticultural practices as a valuable product. The study further reveals that the consumption of these dates' fruits would exert several beneficial effects by virtue of their antioxidant activity.

Nutritional assessment and antioxidant analysis of 22 date palm (Phoenix dactylifera) varieties growing in Sultanate of Oman

OBJECTIVE@#To assess the nutritional values and antioxidant analysis of 22 varieties of date palm (Phoenix dactylifera) fruit collected from various regions of the Sultanate of Oman.@*METHODS@#Nutritional parameters including moisture, fats, fiber, proteins, carbohydrates, and energy value were determined using standard methods of Association of Official Analytical Chemists. The antioxidant activity was screened for their free radical scavenging properties using ascorbic acid as a standard antioxidant. Free radical scavenging activity was evaluated using 1,1-diphenyl-2-picrylhydrazyl free radical.@*RESULTS@#The results of the date fruits (dried/tamar stage) revealed significantly higher moisture (15%-21%), dry matter (78%-86%), ash content (1.0%-2.0%), fiber (1.0%-2.5%), fat (0.1%-0.7%), protein (1.8%-3.8%), nitrogen (0.25%-0.55%), carbohydrates (74.5%-82.4%), and energy values (307-345.5 kcal/100 g). The antioxidant activity ranged between 40% and 86% depending upon the type of date and location. Overall, Khalas, Fardh and Khasab have significantly higher nutritional attributes; however, other varieties such as Barshi, Qush LuLu, Handal, and Khunaizi also have comparable nutritional values. The cluster analysis further evidenced the correlation of proximate parameters in different locations. Moreover, the nutritional and antioxidant attributes of similar date varieties collected from different locations were slightly varied.@*CONCLUSIONS@#The present finding helps in understanding the nutritional significance of different date varieties in Oman while the lesser known varieties can be improved through sustainable horticultural practices as a valuable product. The study further reveals that the consumption of these dates' fruits would exert several beneficial effects by virtue of their antioxidant activity.

Characteristics of female patients visiting for assisted reproductive technology in a private clinic in Lahore, Pakistan

Background: Infertility has social, psychological and physical effect on couples

Objective: To describe the characteristics of women attending a private clinic for assisted reproductive technology

Subjects and Methods: The infertile couples who came to Lahore Institute of Fertility and Endocrinology [LIFE] from 1[st] January to 31[st] December, 2013 for infertility work up, were included in the study. The sampling technique used in this study was non probability, convenient, and time based, as the study design was cross sectional. Sample size was 534 patients of assisted reproductive technology.[ART]. A questionnaire was used for the data collection. This questionnaire included information on woman's demographics, obstetric and infertility history, radiology and hormone investigation. SPSS version 20 was used for the data analysis

Results: Patients with age less than 35 years were 398 [74%], between 36-39 were 103 [19%] and more than 40 years were 33[6%]. Follicle stimulating hormone [FSH] was less than 9 l U/ ml in 418 [78%] between 9-11 l U/ ml in 83[15%] and greater than 11 l U/ ml in 33[6%]. Patients having regular menstrual cycle were 498 [93%]. Patients having parity were 118 [22%] who had delivered a child. Body mass index [BMI] was less than 25 in 163[30%], between 25-30 in 219[41%], greater than 30 in 152 [28%].As with the female factors, no causes were found in 254 [47%], tubal cause in 120 [22%], PCO in 68 [12%], endometriosis in 13[2%], un-explained causes were found in 79[5%]. Count of antral follicles was 6-8 per ovary in 369 [69%], 3-5 per ovary was 129 [24%], 0-2 per ovary was 36[7%]. Primary infertility was seen in 350 [65%] patients, secondary infertility in 178 [33%], unexplained infertility in 6[1%]. Regarding duration of infertility, in 113[21%] patients it was 2 or less than 2 years, 118 [22%] was 4 years, in 49 [9%] was 5 years, in 87 [16%] was 7 years, in 82 [15%] was 10 years, in 85 [16%] was greater than 10 years

Conclusion: Importance of recognition of infertility as a health issue will not only remove treatment barriers but also improve the health seeking behaviors of the infertile couple. Health education about fertility will ease the social taboos and improve the delivery of health services to infertile couples. Age, FSH, menstrual regularity, parity, BMI, female factor, antral follicles, type of infertility, duration of infertility may have a predictive value forecasting the success of the outcome of IVF. Further research is needed on these lines

Laparoscopic colorectal surgery; district general hospital experience

The aim of this study was to assess the outcome of laparoscopic colorectal procedures performed in a district general hospital within 5 years period and to compare it with patients who had an open procedure during the same period. Data were collected retrospectively from patient's case notes retrieved from hospital medical records. One hundred consecutive cases of laparoscopic colonic resection including both benign and malignant diseases between 2005 and 2010 were analysed for perioperative and long term outcome and were compared with consecutive one hundred cases of open colectomies. Overall conversion rate was 6% for laparoscopic group. The mean major complication rates in laparoscopic group were 5% [3% in open group] and minor complications occurred in 18% [28% in open group]. There was no mortality in either group. The overall morbidity rate was 23% in laparoscopic group as compared to 31% in open colectomy group. In 64 cases, curative laparoscopic resections were performed for colorectal malignancy while 72 patients had resections for cancer in open group. The mean lymph node harvest in laparoscopic group was 13.2 nodes as compared to 12.4 in open group; no port-site recurrence was documented at a mean follow-up of 26 months. Average duration of surgery was 180 minutes as compared to 140 minutes in open group. Mean postoperative hospital stay was reduced from 13 days to 7 days. [Open Vs. Lap]. There was no statistically significant difference in major complication rates and mortality. Laparoscopic colorectal surgery is safe and feasible in elective colorectal cases and reduces the hospital stay without any added morbidity

Developmental severe macroglossia. management and surgical treatment of a difficult case

Presented an extremely rare case of developmental Macroglassia in a female child with significant functional and cosmetic symptoms. The condition was worsening progressively despite persistent conservative treatment necessitating surgical management. Severe macroglassia is a rare condition, usually presents as an enlarged tongue causing not only the functional symptoms like airway, speech or dietary difficulties but also presents cosmetic and social issues. Such lesions are rare but well documented in the medical literature. Our case is a female patient who was asymptomatic by birth and thereafter, but started to have progressive increase in her tongue size at the age of two, with obstructive symptoms. The patient was initially treated by conservative therapy and other alternative minimally invasive modalities of treatment. After no significant improvement over a period of almost two years, the size kept on increasing and ultimately the massive size, the cosmetic and social stress necessitates the surgical option. The macroglossia was treated successfully by surgical excision relieving all the symptoms. Different aetiologies of the condition have been mentioned in the medical literature. The treatment depends on the diagnosis, the size, the location of the tongue involved and the symptoms caused by them. If the tongue is massively enlarged and the conservative treatment fails, the surgical excision is one of the best recommended treatment options

Benign Prostatic Hyperplsia: mode of presentation and postoperative outcome

To find out various modes of benign prostate hyperplasia [BPH] presentation in our region and their relation to postoperative failure to void after transurethral resection of prostate [TURP]. A study was conducted at Urology Department, Sandeman Teaching Hospital Quetta and Akram Hospital [Private] Quetta from January 2000 to December 2003. All BPH patients in whom the primary mode of presentation was accurately determined and later on underwent TURP were included in the study. Four modes of presentation were defined: [1] lower urinary tract symptoms [LUTS], [2] acute retention, [3] chronic retention and [4] and acute on chronic retention. After relevant investigations all these patients underwent TURP. Postoperatively catheter was removed when the urine was clear, usually within 48 hours of operation. Patients failing to void were recatheterized and given a second trial without catheter [TWOC] at third day of recatheterization. Resumption of spontaneous voiding on either the first or second TWOC was defined as "successful TWOC". Failure to void on second TWOC was defined as "failure to void" and was managed by a six week period of catheterization, followed by an additional TWOC. Statistical analysis was used to see any significant relation of failure to void postoperatively to mode of presentation of BPH, age of the patients and weight of the resected prostatic tissues. A total of 345 BPH patients were included in the study. Of these 270 [78.3%] patients presented with urinary retention and 75 [21.7%] with lower urinary tract symptoms [LUTS]. Patients who presented with retention were acute retention 129 [37.4%], chronic retention 81[23.5%] and acute on chronic retention 60 [17.4%]. The proportion of men failing to void after TURP was significantly higher [P <0.05] in those with [I] acute retention as compared to LUTS [ii] chronic retention compared to acute retention and [iii] acute on chronic retention as compared to acute retention. The proportion of men failing to void postoperatively was highly significant [P <0.005] in those with retention of any type as compared to LUTS. Age of the patients and weight of the resected prostatic tissues were found not significant factors in relation to failure to void postoperatively. BPH patients in our region present very late, most of them [>78%] with complication of urinary retention. Mode of presentation of BPH greatly influences the postoperative outcome of this disease. Patients presenting with complications of chronic and acute on chronic retention have less favourable results regarding postoperative voiding after TURP. Moreover age of the patient and weight of the prostate are not significant factors in relation to failure to void postoperatively

Vesicovaginal fistula; surgical management

Objective: To present the efficacy and complications of vesicovaginal fistulae repair in our setting

Place and Duration of the Study: Surgical unit-III, Bolan Medical Complex Hospital, Akram Hospital Zarghoon Road, Quetta and Uhad Charity Hospital Quetta from April 1999 to March 2003

Patients and Methods: A total of 32 patients of vesicovaginal fistulae resulting from causes other than malignancies and pelvic radiations were included in the study. Patients were divided in to two groups on the basis of the site of the fistula and the method of repair. Group-I comprised of 18 patients who had type-II and low type-I fistulae and were operated by vaginal approach while group-II consisted of 14 patients who had type-III and high type-I fistulae and were operated by abdominal approach. Patients of both groups were discharged to go home after 5-7 days postoperatively. Postoperative follow up was carried out at out door on weekly basis for two months

Results: The cause of vesico-vaginal fistulae was obstetrical in 28 [87.5%] and gynaecological [hysterectomy] in 4 [12.5%] patients. Trans-vaginal repair of fistula was successful in 16 [88.9%] patients at first operation while in abdominal approach the cure rate was 100%. However preoperative bleeding requiring blood transfusion occurred in 5 [35.7%] patients of group-II. Another one patient in this group developed wound infection. Dysuria/urinary frequency and hematuria persisted for few days postoperatively in some patients of both groups. Urinary stress incontinence was present postoperatively in 5 [27.7%] and 3 [21.4%] patients of group-I and group-II respectively but it subsided in two months time in all except 2 [11.1%] patients of group-I

Conclusion: Birth trauma is still a major cause of vesicovaginal fistula in our region. Improvement in health services and socio-cultural status can help to reduce the incidence of this demoralizing injury. Once occurred VVF, can successfully be repaired by strictly adhering to principles of; a tension free repair, adequate blood supply, prevention of infection and adequate postoperative bladder drainage