Psychosocial assessment of pulmonary functions: a comparative study held on students of 1st and 4th year MBBS at SIMS Lahore

Objectives: To see the pulmonary functions in students of 1st year and 4th year MBBS, SIMS and to compare them with each other considering the Environmental and stress related factors affecting Pulmonary functions on both groups

Methods: 30 students from each 1st and 4th year were taken from Services Institute of Medical Sciences Lahore. Consent in written was taken, participants were questioned and spirometery tests were performed. Data was analyzed using SPSS version 20

Result: Age and BMI of both groups were comparable. The mean values of FEV1 was better in 4th year students [3.2830 +/- 0.7677 V/S 3.2357 +/- 0.8223] and it was not statistically significant [p =0.819]. Values of FVC and FEV1 were better among 4th year students who exercise daily with values of 4.2323 +/- 0.5078 and 4.2343 +/- 0.3070 respectively than those of 1st year students have values of FVC and FEV1 as 4.0057 +/- 0.5022 and 3.7629 + 0.5268. The difference is statistically significant [p= 0.043 and 0.028 respectively]. The mean values of Forced Volume Capacity and Forced Expiratory Volume 1 of students residing in hostels were better in 4th year students [4.0171 +/- 0.8698 and 3.4129 +/- 0.9089 respectively] but it was not statically significant

Conclusion: Pulmonary functions were slightly better in 4th year students. It was due to their resistance to cope up with the environment, stress related to studies and better life styles regarding exercise and less numbers of smokers

Post BCG vaccination lymphadenitis with or without supporation, what is the optimum management

The Bacille-Calmette-Guerin [BCG], a living attenuated vaccine with characteristic residual virulence, has been used to prevent tuberculosis since 1921. The world health organization [WHO] has recommended BCG Vaccination as a part of the global expanded program for immunization [EPI] in developing countries. Lymphadenitis with or without suppuration is the most common complication of this vaccination. Retrospective Study. This study was conducted in Nishtar Hospital, Multan Pakistan and King Faisal Hospital Taif, KSA between May 2009 to June 2012. All patients referred to pediatric surgical service in a period of three years were retrospectively studied for optimum management. Our all 28 patients underwent surgical management and were advised antituberculous treatment but only 6 [21.4%] were compliant with medical treatment. All patients recovered after surgery with or without antituberculous treatment. Optimum treatment for post BCG lymphadenitis who are unresponsive to medical treatment is surgery. Post operative antituberculous treatment seems to be unnecessary

Hepatitis B surface antigen carrier rate in unvaccinated and vaccinated children with thalassaemia major at Bahawal Victoria Hospital, Bahawalpur, Pakistan

Screening of blood reduces but does not eliminate the risk of hepatitis B virus [HBV] infection in multi-transfused thalassaemia patients. This study was done to evaluate efficacy of HBV vaccination on hepatitis B virus surface antigen [HBsAg] carrier rate in children with thalassaemia major receiving multiple blood transfusions. In a cohort study conducted at a hospital in Bahawalpur, Pakistan, during 2009-10, children with thalassaemia major aged < 60 months who received more than 24 blood transfusions and were HBsAg negative at the time of first blood transfusion were included. Of 196 unvaccinated children, the seropositive rate was 12.2%; while among 218 children vaccinated during the first year of life via the Pakistan Expanded Programme on Immunization, the seropositive rate was only 0,9%. The HBV vaccine was highly effective in reducing the HBsAg carrier rate in children with thalassaemia aged < 5 years

Epidemiology and outcome in patients of diabetic foot

The aim of study was detailed analysis of the presentation of diabetic foot ulcers, characteristics and predictors of outcome [incidence of amputation in neuropathic, ischemic, neuro ischemic] in patients presenting with diabetic foot at our hospital. This prospective analytic study was conducted from January 2009-August 2010 at POF Hospital Wah Cantt. Diabetic patients who presented with foot ulcers were enrolled in this study. Demographics of patients along with ulcer size, type, site and Grade according to Wagner Classification were recorded. Wounds were managed with daily dressings, nursing care and de-sloughing of necrotic tissue along with appropriate antibiotic cover. Patients were followed over period until wound healed completely or a lower limb amputation performed, the outcome noted and patient was deemed to have completed study. One hundred and fifteen patients with mean age 55.46 +/- 8.23 years, both male and female were included in this study. Out of 115 patients 111 patients had Type-II diabetes while only 4 presented with Type-I. Mean Duration of diabetes was 14.61 +/- 2.17 years. With respect to underlying causes 18.3% foot ulcers were ischemic, 22.6% were neuropathic and 59% were neuro-ischemic. Median ulcer size was 74% of ulcer classified as Wagner grade-II and III while 24% were of Grade-V. Lower limb amputation were performed in 25% of patients whereas limb salvage achieved in 75% of patients with wounds healed [median healing time 5 [3-10 weeks]. Preservation of the limb function without endangering the patient must be a goal of treating diabetic foot. Once foot amputation is successful, rehabilitation with orthotic or prosthetic devices may allow years of a functional extremity along with preventive measures like cessation of smoking, daily foot hygiene and foot inspection

Association of lipoprotein [a] with lipid disorders in offspring of patients with premature myocardial infarction

To investigate the association of Lipoprotein[a] with lipid disorders in offspring of patients with premature myocardial infarction. The study was carried out in Saidu Teaching Hospital and Biochemistiy Department of Saidu Medical College, Swat, from May to July 2007. Sixty children and youngsters were included. Thirty cases were those with fathers having myocardial infarction before the age of 55 years and thirty children matched for age, gender, dietary and smoking habits without a family history of coronary artery disease served as controls. Total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol and Lipoprotein[a] were measured in children of both the groups. The serum level of Lipoprotein[a] was significantly higher in the cases as compared to controls proving a strong association between altered lipid levels and high lipoprotein[a] in the blood. Lipid disorders are common in offspring of patients with premature myocardial infarction and there is a strong association between altered lipid levels and high lipoprotein[a] in the blood of these persons

Complications of MVD for trigeminal neuralgia

This standard approach describes the decompression of offending vessels at the root entry zone of 5th cranial nerve. We have operated upon 25 patients with different age group. C.T. Scan of all patients was normal except two. One had CP angle tumor and other had right epidermoid cyst. The aim of study was to evaluate the outcome and complication in one year follow up

Electrophysiological pattern of neuropapathy in Guillain-Barre syndrome

Guillain Barre Syndrome is an acute immune mediated polyneuropathy. We conducted a prospective study in Neurology Department, Mayo Hospital, Lahore to evaluate different electrophysiological patterns in Guillain Barre Syndrome. A total of 25 cases were registered over the period of one year and nerve conduction and electromyography was done on each patient. The break down of different patterns of neuropathy was 36% demylinated, 12% axonal and 52% of mixed variety having both demylinating and axonal components. From our study we conclude that pattern of neuropathy in GBS is nearly same as reported in most European and local studies except Chinese endemic cases where axonal form is more frequent

Outcome of MVD for trigeminal neuralgia

This article depicts the general outcome of patients suffering from trigeminal neuralgia and Microvascular decompression was done. We have discussed the surgical technique, number of patients in different age group, offending vessels/other lesion and division involved in number of cases. The patients were treated surgically and clinically re-examined for 6 months postoperatively. The effect of surgical treatment was good

Jelly belly test

A technique is described as how to appreciate urethral obstruction prior to attempt at catheterization to avoid injury to urethra. In this technique anesthetic jelly is administered through external urinary meatus, which leads to distension of distal urethra in case of obstruction

Clonal spread of multi-drug resistant klebsiella pneumoniae isolates in a large teaching hospital in the U.K

To study hospital-wide dissemination of Extended Spectrum Beta-Lactamase [ESBL] producing Klebsiella pneumonaie strains in a University Teaching Hospital in the West Midlands region of the UK. Material and ESBL producing Klebsiella pneumonaie strains were isolated from patients admitted to the study hospital during a two months period. Two Klebsiella pneumonaie NCTC strains, 10896 and 9633 were used as controls. Biotyping profiles were determined by using API 20E system [APIBioMerieux, France] as per manufacturer's instructions. Initial susceptibility testing of the isolates was performed by the BSAC disc diffusion method on IsoSensitest agar [ISA; Oxoid, Basingstoke, UK]. ESBL producing isolates were further tested by the BSAC broth dilution method using MIC breakpoint susceptibility tests. Isolates were grown for 24 hours at 37 oC in 5 ml of Brain Heart infusion [BHI; Oxoid, Basingstoke, UK]. Restriction digestion of chromosomal DNA and Pulsed-field gel electrophoresis [PFGE] were carried out. The sixteen clinical isolates from the study hospital clustered into two API biotype profiles. Their antibiogram profile was similar except that eight isolates were resistant to ciprofloxacin in addition to other antibiotics tested. There was no apparent correlation between the API profile and antibiogram among these patients. Of the sixteen ESBL producing Klebsiella pneumoniae isolates from the study hospital, 9 were from urinary samples, 5 isolates were from sputum, and the remaining two strains were from blood cultures. For the 20 clinical isolates and two control strains examined, 6 Xba 1 restriction patterns were observed. The 16 clinical isolates from our hospital produced identical DNA profile. These were designated as type A. The four unrelated isolates from a different hospital produced two DNA types designated as type B and type C. The two control strains produced fragment patterns different to each other and to the remainder of the isolates. These were designated as type E and type F. This study emphasizes the need for continued surveillance of ESBL producing enterobacteriacae. This will be helpful in monitoring antimicrobial resistance, and to guide intervention to minimize its occurrence

protective effects of vitamin E versus vitamin C against cisplatin ototoxicity in guinea pigs [histological and audiological study]

The protective effects of both vitamin E and C against cisplatin induced ototoxicity were assessed histologically and audiogically. This was done by quantifying the extent of cochlear damage with the light microscope, scanning electron microscope and with measurement of the Distortion Product Otoacoustic Emissions [DPOAEs]. Twenty-five adult male guinea pigs were used in this study. They were divided into control group, cisplatin group that was injected 8 mg/kg cisplatin intra-peritoneally [i.p.], vitamin E group that was injected 500 mg/kg of vitamin E i.p.30 mm prior to cisplatin injection, and vitamin C group which was given 200 mg/kg of vitamin C i.p. 30 min before cisplatin administration. When administered alone, cisplatin induced loss and vacuolation of outer hair cells [OHCs] as seen by LM examination. Scanning EM revealed fusion, disarrangement and loss of some stereocilia in the remaining OHCs especially in the basal turn. In contrast, inner hair cells resisted cisplatin ototoxicity. Audiological assessment demonstrated reduction in DPOAEs amplitudes and S/N values in all frequencies. Both vitamin E and C reduced cisplatin ototoxicity, with better protection achieved by vitamin C administration. Scanning EM examination showed that OHCs were similar to the control configuration after vitamin C administration while after protection with vitamin E, OHCs of the third row showed fusion and absorption of the stereocilia in some parts. In addition, both DPOAEs amplitudes and S/N ratio were near the control values up to 4 KHz. However, above 4 KHz both vitamins failed to achieve the full protection, with vitamin C showing better performance in these high frequencies. We conclude that both vitamins had protective effects against cisplatin induced ototoxicity, with vitamin C inducing more protection in the used regimen

Incidence of road traffic accidents in Hazara division

Road traffic accidents are also one of the commonest causes of mortality and morbidity in both developed as well as in under developed countries. This study was designed to see the "Incidence of Road Traffic Accidents in Hazara Division ". Method: Three years [1998 to 2000] road traffic accidental data of five districts of Hazara Division [Haripur, Abbottabad,Mansehra, Batagram and Kohistan] was collected from S.S.P. office, Abbottabad. The incidence of road traffic accidents was greater in three districts [Haripur, Abbottabad and Mansehra] as compared to two districts [Batagram and Kohistan]. Conclusion The rate of road traffic accidents was proportional to traffic load on the roads along with other causative factors

Trend of cigarette smoking among the college students, medical students and doctors

Smoking trend is increasing in both developed as well as under-developed countries. The students of high school, colleges, even medical colleges, disease healers and teachers of preventive/community medicine were also found to be engaged in smoking. Therefore this survey was designed for students and doctors of Abbotabad and Rawalpindi. 700 students and 100 doctors were randomly selected from high schools, colleges, Medical Colleges of Abbottabad and Rawalpindi. A smoking survey questionnaire was designed and filled on individual interview. The percentage of students of schools and colleges engaged in smoking was high as compared to medical students and doctors. There was no girl student found to be engaged in smoking. The trend of cigarette smoking is much higher in students of schools and colleges as compared to medical students and doctors which is an alarming situation for health, life and economy of the nations. Therefore the campaign should be moved to prevent this trend especially in the young generation and literate population

Evaluation of serum angiotensin converting enzyme [SACE] as a diagnostic marker for pulmonary embolism

A number of supportive laboratory tests such as ECG, Chest x-ray, ABGs, SLDH, SGOT, S. Bilirubin and D-dimer with variable sensitivity and specificity are available to facilitate the clinical diagnosis of acute Pulmonary Embolism [PE]. Serum Angiotensin Converting Enzyme [SACE] which is produced mainly by the pulmonary vascular endothelial cells, is found altered during a variety of diffuse lung diseases. This study was designed to evaluate the validity of SACE level as a marker for hypoxic damage to the pulmonary endothelium in PE. Design: A prospective study carried out on forty patients with high clinical suspicion of PE. Besides routine diagnostic tests mentioned above all of them had Ventilation Perfusion isotope [V/Q] scans [as a diagnostic test] and SACE level checked. Setting: Shaikh Zayed Hospital Lahore. Results. Among forty consecutive patients with age range 25-59 years [mean: 42 Yr], twenty six patients [65%] with abnormal scans reported as High Probability' were included in group-A [True Positive], whereas 14[35%] patients having Low-Probability [Suspected] or Normal scan were included in group-B, Low SACE level [<28iu/L] was found in 19/26 [sensitivity of 73%] in Group-A [Positive Predictive Value: 47%] and 9/14 [sensitivity of 64%] in Group-B, whereas mean levels for both groups were 34.55 and 54.84 respectively. Rise in LDH was pronounced in Group-A. Only chest X-ray and ECGs were found to be more sensitive for group-A than group-B. Changes in ABGs [Type-1 Resp. Failure] had low sensitivity. Among clinically suspected cases of PE, fall in SACE level can be used as a sensitive and reliable diagnostic marker as more than 75% of the enzyme is produced in the lungs compared with other enzymes which have extra-pulmonary source

Bleeding Meckel's diverticulum - A known but rare entity: a case report

Meckel's diverticulum is a remnant of embryonic omphalomesenteric duct In 20-30 percent of the cases ectopic tissue is present, which may be either gastric or pancreatic. Mostly it is asymptomatic but may be associated with symptoms of bleeding due to ulcer formation, perforation, intestinal obstruction or discharge from the umbilicus. We are reporting a case of Meckel's diverticulum with bleeding diagnosed on the basis of positive radio-isotope scan

Erectile dysfunction: the need for a scientific approach to this taboo topic

Erectile dysfunction is a problem that needs to be explored. This is an illness that has always been under discussed. Our study was carried in Mayo Hospital on 1252 patients. Out of these 434 [34.6%], were found to have some degree of erectile dysfunction. 114/434 [26.22%] did not seek medical advice. 192/434 [44.2%] went to quacks and 128/434 [29.4%] consulted doctors. 37.3% of patients with erectile dysfunction had diabetes mellitus as concomitant disease. 12.4% patients had hypertension while 6.9% and 3.9% patients had ischemic heart disease and tuberculosis respectively. These results emphasize the need that this disorder should be dealt scientifically. People and doctors should be made more aware of the recent advances in medical management of erectile dysfunction so that more people can seek a qualified medical advice and may benefit from the treatment. This article addresses the diagnosis of erectile dysfunction and identifies diagnostic tests that can be used by primary care physicians to determine the patients most at risk and the treatments most suited to meet the patients and their partners goal for therapy

Bifid tongue: a case report

A case of complete bifid tongue is presented along with a short discussion

Familiar Juvenile adenomatous polyposis: a rare entity-case report with emphasis on the mode of treatment

Juvenile and adenomatous polyps occurring simultaneously in the large bowel is a very rare entity and its mode of treatment is similar to familial adenomatous polyposis coli. In our case we performed a total proctocolectomy with an ileostomy, a procedure which is not a first choice in familial adenomatous polyposis coli

Untreatable monocular blindness in pakistani eye patients

To determine the incidence of untreatable [at least by means currently available in Pakistan] monocular blindness in our hospital-based population, we examined 1,710 consective patients admitted to the Department of Ophthamology, Lady Reading Hospital, Postgraduate Medical Institute, Peshawar from September 17, 1990 to January 1991. Seven percent [235] of the patients had monocular blindness with visual acuity of 3/60 [10/200] or less in the affected eye. Out of these 235 patients, visual loss in 94 [40%] was due to trauma, in 51 [21.7%] due to corneal opacification from various corneal diseases, in 41 [71.4%] due to end-stage glaucoma [33 with primary glaucoma and eight with secondary glaucoma], in 15 [6.3%] from postoperative infection following cataract surgery, in 14 [5.9%] due to optic atrophy, and in the remainder 20 [8.5%] due to miscellanous causes, including retinoblastoma [four cases], retinal detachment [three cases], panophthalmitis [two cases], spontaneous rupture of an anterior staphyloma [two cases], basal cell carcinoma of eyelid invading the orbit [two cases], squamous cell carcinoma of conjunctiva involving globe [two cases], microphthamos, proptosis complications, explusive choroidal hemorrhage during cataract extraction, myopic degeneration, and diabetic retinopathy [one case each]. That only one patient had visual loss due to diabetic retinopathy is interesting. The overall incidence of monocular blindness in Pakistan can be significantly reduced by adequate and timely preventive and therapeutic measures against ocular trauma and corneal disease, the two leading causes of blindness. The recent heavy influx of the Afghan refugees of Russian aggression of their country might increased the incidence of trauma in our area. [Pakistan Journal of Ophthalmology 8:3-5, January, 1992]