Role of pregablin in neuropathic pain

To evaluate the role of pregablin in neuropathic pain. Prospective descriptive study. This study was conducted in the department of medicine of Al-Tibri Medical College and Hospital from Jan. 2011 to Jan 2012. A prospective study conducted in a private hospital of Karachi from Jan 2011 to Jan 2012. A total 107 cases were enrolled. All patients are adult above 18 years of age. The neuropathic pain was analyzed by Leeds Assessment of Neuropathic symptoms and sign [LANSS]. The pain was assessed by numeric pain rating scale. The data was recorded on a preset performa. Primary disease was also controlled and all the patients were given pregablin 50-150mg/day for two-six weeks. The symptoms were re assess by numeric pain scale. The SPSS 16 used to analysed. Total number of patients were 107. Male were 52 while female were 55. The patients were grouped according to pathology. The most common pathology was Diabetes in 49 cases [45.79%] followed by hypertension in 35 cases [32.71%] and herpes zoster in 27 cases [25.23%]. The age ranges from 42-72 years with mean age is 56.66 +/- 16. The dose ranges from 50-150 mg per day and the duration of treatment were two- six weeks. The pregablin was superior in relieving pain and sleep in patient with diabetic neuropathy and post herpetic neuralgias. The adverse effects noted were somnolence, lethargy and ataxia. Two of the cases were stopped treatment due to somnolence. The result of adding pregablin in the treatment of a patient with neuropathic pain was very successful and it is improving the quality of life and sleep

To evaluate different features of pyogenic liver abscess

To evaluate different features of pyogenic liver abscess. Prospective descriptive study. This study was conducted in the Medical Department of Al Tibri Medical College and Hospital, Karachi from Jan 2011 to Jan 2013. Patient presented with upper abdominal pain and fever of more than two weeks duration. All patients undergone ultrasound of abdomen reported at Al Tibri Medical College and hospital were enrolled in the study. All data was recorded in a preset proforma and features like biodata, symptoms, sign, biochemical test, ultrasonographic finding, culture and sensitivity of pus were assessed. The data were analyzed on SPSS version 15. Total cases were 67. Male were 47 and female were 20. The mean age was 47 +/- 18. With range from 29 to 65 years. Male were more as compared with females. The commonest symptoms were abdominal pain in 43 cases [64%], fever was in 39 cases [58%], anorexia was in 39 cases [58%], Jaundice was in 29 cases [43%], weight loss in 24 cases [37%], raised ESR was in 42 cases [62%], raised leukocyte count was in 57 cases [86%], raised bilirubin in 46 cases [69%] ALT was raised in 27cases [40%] and alkaline phosphatase was raised in 20 cases [29%], ultrasound abdomen showing single abscess in 55 cases [83%] and multiple in 12 cases [17%], right lobe involvement in 53 cases [79%], left lobe involvement in 14 cases [21%], 37 cases [55%] were under gone therapeutic percutaneous ultrasound guided aspiration of the abscess . Culture were positive in 49 cases [73%], in which Klebsella pneumonia was the commonest organism found in 22 cases [45%], Enterococcus supp were in 11 cases [23%], E-coli were in 9 cases [18%], While the culture is negative in 18 cases [27%]. No mortality were recorded. The pyogenic liver abscess is one of the common cause of upper abdominal pain and fever of longer duration

Frequency of hepatitis D virus infection in hepatitis B surface antigen-positive liver diseases

To determine the frequency of HDV among hepatitis B surface antigen [HBsAg]-positive liver disorders. An observational cross-sectional study. Medical Unit I, Chandka Medical College Hospital, Larkana, from July 2003 to June 2008. Adult patients with HBs liver related disorders were evaluated for the presence of delta antibodies using commercially available ELISA kits. Descriptive statistcs were used for describing data. Proportions of anti D antibodies between gender and age were compared using chi-square test with significance at p < 0.05. Of the 774 cases, 438 were males [60.4%] and 336 were females [39.6%]. The mean age was 36.5 +/- 14.39 for males and 34.03 +/- 13.16 years for females ranging from 15 to 60 years. Anti-HDV was positive in 183 patients [23.6%].The frequency of HDV was not significantly different between the gender groups [p=0.718]. HDV infection was markedly higher in chronic than acute liver disorders. The HBV/HDV co-infection is frequent in the studied area. Therefore, practitioners and health care managers should be made aware of the risk of dual infection with HBV and HDV

Specialty choices of medical students and house officers in Karachi, Pakistan

Understanding patterns of career choices in medicine is important for educators and policy-makers to plan the supply of specialists. This study analysed the career choices made by medical students and house officers in 2 private and 2 public medical schools in Karachi, Pakistan. An anonymous, self-administered questionnaire was completed by 850 students. Internal medicine, paediatrics, general surgery and obstetrics and gynaecology were the 4 highest ranked specialties, with internal medicine ranked top as both the 1st and 2nd choice. Internal medicine was the 1st choice for significantly more students in public than private medical colleges [22.2% versus 14.9%]. Students from private medical institutions chose a wider range of specialties than those from publicly-funded colleges. A high proportion of medical students and graduates in Karachi favour the same medical specialties, which may lead to saturation in those areas of specialization

Trends of utilizing medication, recommended by evidence based guidelines, for myocardial infarction, in a tertiary care hospital, "too far but not too dark"

Background: acute myocardial infarction [MI] is a major health problem with a substantial mortality and morbidity. Numerous guidelines have been established that should be followed in the management of acute MI

Objective: to determine whether the current practice in managing patients admitted with acute MI in a tertiary care hospital is evidence based compliant

Patients and Methods: this retrospective study was based on the record of the patients with diagnosis ofMI admittedbetween January to June 2007, at Sheikh Zayed Hospital, Rahim Yar Khan, who fulfilled the predefined criteria

Results: Total number of cases were 58, mean age of the study subjects was 47+ 8.65 years, with age range of 16 to 95 years. It was observed that 81% of study subjects were male. Half of the patients belonged to lower income group; Laborer and house wives were 3 1 % and 19% respectively. Sixteen percent of patients were hypertensive and diabetic. 19 % were smoker and 5% had family history of coronary artery disease. Anterior and inferior wall MI were reported in 64% and 32% of the patients, respectively. Injection Streptokinase [SK] was given to 52% of the patients. Aspirin, clopidogril and nitrates were given to all patients, whereas 34 % and 36% were prescribed Beta blocker [BB] and statins, respectively. Angiotensin converting enzyme inhibitor [ACEI] was given in 43% patients

Conclusion: SK, the only means of acute revascularization was given in only 52% patients mainly due to delayed presentation. Use ofAspirin is an unbeatable target and given to all patients. Use of BB and statins in < 40% and ACEI in<50% is not optimal. However, these trends of cardiac medication in a tertiary care hospital with limited provision, reflects the diffusion of light of evidence based medicine into darkness of periphery

Physico-chemical standardisation of market sample of zufa khushk [agastache urticifolia]

In Unani system of medicine Zufa Khushk is in medicinal use since ancient times. There is controversy in botanical identity in between the two plants of same family [Labiatae]. Commonly available Zufa Khushk in north Indian market is botanically identified as Agastache urticifolia [Benth] Kuntze [Giant Hyssopus] but it has been described by some latest authors of Unani literature as Hyssopus officinalis [Common Hyssopus] and standardization of its flower has also been carried out by them. Keeping in view the necessity to provide pure and genuine drug to the patients for better efficiency of the prescribed drug, standardization of the sample drug has been carried out and revealed that actual botanical source of Zufa Khushk is Agastache urticifolia of Labiatae. It has also been studied that in spite of its aromatic nature, the market sample of Zufa Khushk was free from volatile oil

retrospective study of central nervous system shunt infections diagnosed during 3 year period

Ventriculoperitoneal [VP] shunts are used for intracranial pressure management and temporary cerebrospinal fluid [CSF] drainage. Infection of the central nervous system is a major cause of morbidity and mortality in patients with CSF shunts. To evaluate the clinical features, pathogens and outcomes of patients with CSF shunt infection collected over 3 years. The study was carried out in Paediatric Surgical Ward, Nishtar Hospital, Multan during the period from August 2005 to August 2008. The patients with shunt infections were evaluated using age, sex, causes of shunt infection, prognosis, clinical infection features and clinical outcome. The most common causes of etiology of hydrocephalus in shunt infected patients were congenital hydrocephalus myelomeningeocele [32%]. The commonest causative micro-organism identified was staphylococcus [S] aureus, followed by acinetobacter spp. And S. epidermidis. Timely usage of appropriate antibiotics, according to the antimicrobial susceptibility testing and the removal of the shunt apparatus is essential for successful treatment

Correlation of plasma endothelin-1 levels with pulmonary hypertension after inhaled nitric oxide therapy

Variable response to inhaled nitric oxide [iNO] therapy in patients with mitral stenosis [MS] having pulmonary hypertension [PH] has been documented in early studies. The objectives of this study were to measure plasma Endothelin-1 [ET-1] levels in those patients and to correlate them with pulmonary vascular indices after iNO therapy. It was Quesi-experimental study. Thirty patients with mitral or mixed mitral and aortic valve disease with severe pulmonary hypertension and vascular indices and cardiac output were recorded. After the surgery, 10-20 ppm iNO was administered for 1 hour and all the parameters were again recorded. Patients were grouped into responders and non responders on the basis of% reduction in Pulmonary Vascular Resistance [PVR] after iNO therapy. Plasma ET-1 levels were measured in both groups by ELISA before and after the iNO therapy. Paired sample t-test was used to compare mean values for significance. The correlations between variables were then calculated by using Pearson's coefficient. The plasma ET-1 levels were very high in all patients. They reduce in responders after iNO therapy; non-responders paradoxically showed significant increase in the levels of ET-1 after iNO therapy. Moreover, a positive correlation was observed in plasma ET-1 levels and post operative levels of PVR. The correlation of changes in PVR and plasma ET-1 is a key mediator of poor response in PH secondary to MS, after iNO therapy

Children with acute viral hepatitis: a one year study at Shaikh Zayed Hospital, Lahore

Objectives: To study the clinical spectrum, outcome and etiological agents of acute viral hepatitis in admitted patients at Paediatric Department Shaikh Zaycd hospital, Lahore. Setting: Paediatric Department Shaikh Zayed hospital, Lahore

Duration: One Year from November 2004-0ctober 2005. Study design: Retrospective Descriptive study. Inclusion criteria: I. Age between 1-15 years; 2. All patients admitted with acute viral hepatitis in the Paediatric department. Exclusion criteria: 1. Children with drug induced hepatitis; 2. Children with chronic liver disease; 3. Children with obstructive jaundice

Results: A total of 69 patients out of 2391 admitted patients were included during that period out of them 43[62%] were males and 26 [38%] were females. In our study jaundice was the presenting complaint in 52[75%] patients, followed by vomiting in 48[69%], fever in 42[60%], dark colour urine in 30 [43%], anorexia in 25 [36%], abdominal pain in 24 [35%], yellow colour stool in 7[10%] and irritability in 2 [3%] patients. 13 patients had a positive family history of hepatitis out of them 3[4.3%] had Hepatitis A virus [HAY], 7[10%] Hepatitis B virus [HBY], and 3 [4.3%] had Hepatitis C virus [HCY]. History of blood transfusion was found in 7[10%] patients while it was negative in remaining 62[90%]. Only 2[2.8%] patients were vaccinated against HAY and 9 [13%] against HBY. Icterus was present in 52[75%], 65[94%] had tenderness in the right hypochondrium, hepatomegaly in 57 [83%] and splenomegaly in 7% and one patient was drowsy at the time of admission. All the patients were screened against HAY, HBY, HCY, HOV and HEY in a serial wise approach. Out of them 50[72%] patients were HAY IgM positive, 4[5.7%] HbsAg positive, 2[2.8%] had anti-HCY, 2[2.8%] had HEY lgM and 1[1.4%] had HDY+HbsAg. In 10 [14%] patients no viral marker was detected out of these five viruses. Out of 69 patients 4[5.7%] developed hepatic encephalopathy. Out of these 2 pts. expired and 2 survived. A total of 67[97%] were discharged and 2 [3%] expired

Conclusions: Jaundice was the main presenting complaint followed by vomiting with significant recovery and Hepatitis A was the· most common cause of acute viral hepatitis in children admitted in hospital

Window procedure versus turco procedure for treatment of talipes equino varus

To compare the results of Window procedure and Turco procedure [extended postero-medical release] for the treatment of Congenital Tilopes Equino Varus [CTEV]. Comparative study conducted from 1st June to 30th May 2005. Orthodopaedic unit II, Dow University of Health Sciences and Civil Hospital, Karachi. Sixty patients with mild to moderate CTEV according to the two groups i.e. W-Group [n=30] who underwent the Window procedure and T-Group [n=30] who were operated by the Turco technique. Amongst the 60 patients, 37 [61.75] were male and 23 [38,3%] female, with ages varying from 6-18 months. The average age was 9.5 months in W-Group and 9.6 months in the T-Group. The mean operating times was 12-16 minutes in the W-Group, while it was 40-45 minutes in the T-Group. Complications were seen in 13 cases in the T-Group and only two cases in the W-Group, while recurrence occurred in four cases in the Truco and only one case in the Window Group. Good results were seen in 905 of the W-Group and 60% of the t-Group. We conclude that the Window and Turco procedures are comparable operations for CTEV. However, Window procedure is better due to fewer complications, shorter operating time, lesser blood loss, decreased recurrence rate, less fibrosis and less stiffness of the ankle and knee joints

Comparison of transvaginal sonography and saline contrast sonohysterography in women with abnormal uterine bleeding: correlation with hysteroscopy and histopathology

Transvaginal ultrasound is used conventionally as initial investigation of patients with abnormal uterine bleeding but saline contrast sonohysterography is a better technique to reliably distinguish focal from diffuse endometrial lesions. This study was performed to compare the ability of transvaginal ultrasonography and saline infusion sonohysterography as initial modality for the diagnosis of endometrial abnormalities in women with abnormal uterine bleeding. In prospective study, 100 women with abnormal uterine bleeding were submitted to sequential examination by transvaginal ultrasound, and sonohysterography. The presence of focal endometrial lesions and the type of lesion [endometrial hyperplasia, polyp, submucous myoma, or malignancy] were noted. Predictive values were calculated by correlating the results with final diagnosis reached by hysteroscopy and endometrial biopsy. The sonohysterography had 92.9% sensitivity and 89.7% specificity compared to 71.4% sensitivity and 67.7% specificity achieved by transvaginal sonography. There was 91% agreement between saline contrast sonohysterography and hysteroscopy as compared to 69% for TVS [p= 0.002]. The diagnostic performance of sonohysterography for 3 main endometrial abnormalities [i.e. endometrial hyperplasia, polyps and submucous myoma] was better than transvaginal reached to 100% as compared to TVS [61.55 and 97.7% respectively]. Our results have substantiated that sonohysterography is a better tool than transvaginal sonography for the assessment of endometrial intra-cavity lesions. By providing accurate differentiation between focal and diffuse endometrial lesions, it can help in decision making regarding selection of cases for hysteroscopy and directed biopsy. We recommend that saline contrast sonohysterography should be used as an initial investigation in cases of abdominal uterine bleeding

Evaluation of twenty four new Gossypium hirsutum strains for growth, yield, fibre quality and CICuV ressistance under environment of Punjab, Pakistan

Twenty four new strains were tested for their yield, quality and Leaf Curl Virus [ClCuV] resistance. NIAB-111/S, NIAB-98 and NIAB-999 were significantly high fruit bearing varieties at 90 days completing 59.54, 48.26 and 46.00% fruiting respectively. Seed cotton yield of VH-142 was highest with 5417 kgha-1 and 52 per plant boll bearing, DNH-57 and NIAB-999 remained second and third with 5234 and 5095 kg ha-1 seed cotton yield, respectively. BH-160 and CRIS-467 were found to be second and third highest boll bearing varieties with 50.97 and 40.20 per plant average bolls respectively. Plant height in CRIS-467, MNH-642 and SLH-224 was significantly higher in comparison to other varieties.NIAB-98, CIM-499 and CIM-506 were found short stature varieties in comparison with other but out of these NIAB-98 and CIM-506 were in high yielding position and CIM-499 was found medium yielder variety. GOT% of MNH-642 remained highest having value of 45.00%. While GOT%. of NIBGE-1, CRIS-168 and CRIS-467 was at lowest position with 35.73, 35.89 and 36.62% respectively. NIAB-111, CIM-499 and BH-160 were at first position in terms of fibre fineness with micronaire values 3.98, 4.00 and 4.07 micro g/inch having fibre length 28.53, 31.38 and 30.23 mm respectively. Out of 26 varieties, 16 varieties resulted maturity index in the range of 85.03% and 90.30% with highest maturity index in case of NIBGE-1 [i.e. 90.30%] followed by NIAB-999 and MNH-642 with 89.55 and 85.5% respectively.CRIS-168, CRIS-468 and CRIS-467 were found viral susceptible

Pulmonary alveolar microlithiasis - a case report

Pulmonary alveolar microlithiasis [PAM] is a rare entity, which mimics miliary mottling on chest X-rays, and on this basis, most of the cases are initially treated as tuberculosis. It involves both sexes at any age. Familial as well as sporadic cases are seen and familial form is thought to be autosomal recessive. It has no specific treatment and only symptomatic treatment is given. In Pakistan, no case of PAM is so far reported. We came across one such case, which is reported and available literature is reviewed

Pattern of injuries in trauma patients presenting in accident and emergency department of Jinnah Hospital, Lahore

To observe the pattern of injuries in patients involved in different kinds of trauma presenting to the Accident and Emergency Department of Jinnah Hospital Lahore. A prospective descriptive epidemiological study. Accident and emergency department of Jinnah Hospital Lahore. From 1st April 2005 to 30th September 2005. The study included patients presenting with different kinds of trauma to the emergency department of Jinnah Hospital, Lahore. They were further categorized into trauma of different regions of the body i.e. upper limb, lower limb, abdomen, head and neck, thorax and perineum. Then frequency of different types of trauma was determined. During this period [1st April2005 to 30th September 2005], 111'413 patients presented in accident and emergency department and 4680 patients had traumatic injury. 1404 patients [30%] had blunt trauma, 134[2.86%] had penetrating firearms injury, 2433[51.99%] had penetrating sharp injury an d 709 patients [15.15%] had crush injury. Most patients got upper limb, lower limb, head and neck and abdominal injuries, in that order. Most patients received multiple injuries. 3340 patients [71.36%] got only minor surgery like stitching under local anaesthesia and 468 patients [10%] had no surgery at all. 872 patients [18.63%] underwent some kind of major surgical procedure like amputation, exploratory laparotomy, or stitching under GA etc. Trauma is a leading cause of morbidity and mortality among all age groups. Most of the trauma victims receiving minor injuries can be treated at primary heath care centers. This can decrease the load of tertiary care hospitals. Maximum impact in reducing the burden of trauma must come from injury prevention strategies

Emerging drug - resistance and guidelines for treatment of malaria

The increasing prevalence of multi-resistant Plasmodium falciparum malaria worldwide is a serious public health threat to the global control of malaria, especially in poor countries like Pakistan. In many countries choloroquine-resistance is a huge problem, accounting for more than 90% of malaria cases. In Pakistan, resistance to choloroquine is on the rise and reported in up to 16-62% of Plasmodium falciparum. Four to 25% of Plasmodium falciparum is also reported to be resistant to sulfadoxine-pyrimethamine and several cases of delayed parasite clearance have been observed in patients with Plasmodium falciparum malaria treated with quinine. In this article we have introduced the concept of Artemisinin-based Combination Therapy [ACT] and emphasize the use of empiric combination therapy for all patients with Plasmodium falciparum malaria to prevent development of drug resistance and to obtain additive and synergistic killing of narasite

Clinical effect of pesticide residues on total bilirubin levels in farm workers fr.om gadap area, Pakistan

Persons from fourteen different fruit and vegetable farms stations were examined for the presence of pesticide residues in their blood samples. The effect of residues on total bilirubin was studied. A significant difference between total bilirubin at different timings and at different stations was noted. Almost all the persons from different stations showed elevated levels of bilirubin. The exposure to different pesticides for prolonged period of time has affected the normal functioning of different organ systems such as liver, kidney and lungs and thus produced possible characteristic clinical effects

External genitalia injuries, a study of aetiological factors and management options

This study includes 35 patients, more than 12 years of age, with external genitalia injuries. They presented in the emergency Department of the Sir Ganga Ram Hospital, Lahore, during last 4 years [2000-2004]. Our main aim was to highlight the fact that most of these injuries are caused by rotating belt or wheel of a machine and are potentially preventable if proper precautionary measures are taken. Another aim was to discuss different management options. It has been concluded that rotating belt or wheel of a machine is the most common cause of these injuries, especially if someone is wearing loose traditional clothes

Incidence of negative appendice, our experience of 100 patients at Sir Ganga Ram Hospital, Lahore

Despite recent advances in diagnostic medicine, the diagnosis of Acute Appendicitis is still doubtful in a number of cases. Majority of the Clinicians rely on their clinical examination, strengthened by the laboratory tests. This study was done to see the incidence of negative appendicectomy in Patients, who presented in surgical emergency with pain in Rt. Iliac fossa. These patients were assessed and evaluated by clinical examination as well as with the help of Modified Alvarado Scoring system and surgery was decided accordingly. To see the incidence of Negative appendicectomies at Sir Ganga Ram Hospital, Lahore and comparing the rate with the rate of other international Studies. It was a prospective clinical and Pathological study, consisting of 100 patients, presenting in the Sir Ganga Ram Hospital Lahore, with history of right iliac fossa pain. One hundred patients were included in the study, and diagnosis of acute appendicitis was bas ed on Clinical Examination and Modified Alvarado Score. The patients selected for this study were of all age groups and both sexes. Out of hundred, 56 patients were operated after being assessed by clinical Examination and Modified Alvarado Scoring System. The incidence of negative appendicitis was about 7% in male, 20% in female and about-10% in children. Over all the rate of negative appendicectomies was 15%, which is with in lower limit of the other international studies

Complications associated with splenectomy in thalassemia

The study aims at investigating the complications associated with splenectomy in thalassemic patients It was a prospective clinical study. Sixty Splenectomies were preformed electively after pre-operative preparation in Sir Ganga Ram Hospital, Lahore during the year Jan 2003 to Sep 2005. Complications were categorized into per-operative, early post-operative and late complications. The frequency of per-operative complications was 3%, early post-operative complications were 10% and late complications were 1.6%. The rate of complications has decreased markedly as the patients are well prepared and improved post operative carp has also reduced the post-operative complications. With good perioperative management, splenectomy in children with massive splenomegaly is both safe and effective