Hypospadias with cryptorchidism presented as ambiguous genitalia and its management with surgery

Background: The incidence of hypospadias with cryptorchidism is about 6-31.6%. Current management recommendations are that undescended testis beyond three months needs surgery between 6-12 months of age. Proximal hypospadias and cryptorchidism overlap with disorders of sex development and endocrine problem. The aim of this study was to assess the outcome of surgical management of hypospadias with cryptorchidism, at selected centers in Dhaka, Bangladesh.Methods: This prospective study was conducted in the Department of Pediatric Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from January, 2018 to January, 2022. In this study, we included 70 diagnosed cases of hypospadias with cryptorchidism presented as ambiguous genitalia who underwent surgery.Results: Mean age at surgery was 4.6�4 years and majority (91.4%) were male. Associated renal anomalies were absent in 81.4% cases, symptomatic renal anomalies were present in 11% cases, severe chordee was 62.9%. Abnormal hemiscrotum was 98.6% and normal hemiscrotum was 1.4%. Hernia with cryptorchidism was present in 30 % cases. Testosterone was normal in 94.3% patients, estrogen and progesterone was elevated in 5.7% patients. After operation, male was 94.3% and female was 2.9%, chordee condition was corrected in 81.4% and urine passed through tip of penis in 84.3% patients.Conclusions: We found that surgery is simple, safe, and effective in the treatment of patients with hypospadias and cryptorchidism with satisfactory functional results, normal physical health status, improved quality of life, satisfying psychological support and probably less pain.

Association between Hemogram Parameters and Coronary Collateral Development in Subjects with Non-ST-Elevation Myocardial Infarction

SUMMARY OBJECTIVE Coronary collateral development (CCD) predicts the severity of coronary heart disease. Hemogram parameters, such as mean platelet volume (MPV), eosinophil, red cell distribution width, and platelet distribution width (PDW), are supposed novel inflammatory markers. We aimed to compare hemogram parameter values in patients presenting with non-ST-elevation myocardial infarction (NSTEMI) with adequate or inadequate CCD. METHODS A total of 177 patients with NSTEMI undergoing coronary arteriography were enrolled and divided into two groups based on the development of CCD: one group with adequate CCD (n=88) and the other with impaired CCD (n=89). RESULTS Baseline demographics and clinical risk factors were similar between the groups. Hemogram parameters were not significantly different between the two groups. However, compared to the inadequate CCD group, the median PDW was significantly higher in the adequate CCD group, 17.6 (1.4) vs. 17.8 (1.6) p=0.004. In a multivariate analysis, PDW (p=0.001, 95% CI for OR: 0.489(0,319-0,750) was found to be significantly different in the adequate CCD group compared to the inadequate CCD group. Pearson's correlation analysis revealed that PDW was significantly correlated with the Rentrop score (r=0.26, p<0.001). CONCLUSIONS We suggest that since PDW is an index that is inexpensive and easy to assess, it could serve as a marker of CCD in patients with NSTEMI.

RESUMO OBJETIVO O desenvolvimento colateral coronariano (CCD) prediz a gravidade da doença coronariana. Parâmetros de hemograma como volume plaquetário médio (VPM), eosinófilo, largura de distribuição de glóbulos vermelhos e largura de distribuição de plaquetas (PDW) são supostos novos marcadores inflamatórios. Nosso objetivo foi comparar os valores do parâmetro hemograma em pacientes com infarto do miocárdio sem supradesnivelamento do segmento ST (IAMSSST) com DCC adequado ou inadequado. MÉTODOS Um total de 177 pacientes com NSTEMI submetidos à arteriografia coronariana foram incluídos e divididos, com base no desenvolvimento de CCD, em dois grupos: grupo com CCD adequado (n = 88) e grupo com CCD alterado (n = 89). RESULTADOS Os dados demográficos e os fatores de risco clínicos basais foram semelhantes entre os grupos. Os parâmetros do hemograma não foram significativamente diferentes entre os dois grupos. Mas, em comparação com a mediana inadequada do grupo CCD, o PDW foi significativamente maior em CCD adequado de 17,6 (1,4) vs. 17,8 (1,6) p = 0,004. Na análise multivariada, PDW (p = 0,001, IC 95% para OR: 0,489 (0,319-0,750) foi significativamente diferente no grupo CCD adequado em comparação com o grupo CCD inadequado. A análise de correlação de Pearson revelou que PDW foi significativamente correlacionado com escore de aluguel (r = 0,26, p <0,001). CONCLUSÃO Sugerimos que, uma vez que a PDW é um índice barato e de fácil avaliação, pode servir como um marcador de DCC em pacientes com IAMSSST.

Diabetes control could through platelet-to-lymphocyte ratio in hemograms / O controle diabético poderia ser predicado por Platelet para a relação de linfócitos no hemograma

SUMMARY OBJECTIVE Association between type 2 diabetes mellitus and inflammation is well-established. We aimed to study platelet-to-lymphocyte ratio (PLR), a novel inflammatory index derived from hemogram, in diabetic patients in comparison to those in healthy volunteers. METHODS Medical data of type 2 diabetics that showed up in general outpatient medical clinics of our institution between February 2017 and August 2017 were recorded and analyzed. RESULTS Median PLR of type 2 diabetic patients was significantly higher than the PLR of healthy controls (p=0.001). Moreover, PLR was significantly and positively correlated with HbA1c (p<0.001, r=0.58), fasting plasma glucose (p<0.001, r=0.49), and c-reactive protein (p=0.003, r=0.30) levels. Type 2 diabetic subjects with proteinuria had significantly higher PLR levels than that of diabetic subjects without proteinuria. CONCLUSION As an inexpensive and easy to use index, PLR may be useful in predicting the development and control levels of type 2 diabetes mellitus. However, its correlation with HbA1c needs to be validated by larger prospective studies.

RESUMO OBJETIVO A associação entre diabetes mellitus tipo 2 e inflamação está bem estabelecida. Pretendemos estudar a relação plaquetária com linfócitos (PLR), um novo índice inflamatório derivado do hemograma, em pacientes diabéticos e comparar com aqueles em voluntários saudáveis. MÉTODOS Foram registrados e analisados dados médicos de diabéticos de tipo 2 que apareceram em clínicas ambulatoriais de medicina geral de nossa instituição entre fevereiro de 2017 e agosto de 2017. RESULTADOS A PLR mediana dos pacientes com diabetes tipo 2 foi significativamente maior que a PLR de controles saudáveis (p=0,001). Além disso, a PLR foi correlacionada de forma significativa e positiva com os níveis de glicemia de jejum (p<0,001, r=0,49) e níveis de proteína c-reativa (p=0,003, r=0,30) com HbA1c (p<0,001, r=0,58). Os indivíduos diabéticos de tipo 2 com proteinúria aumentaram significativamente os níveis de PLR do que os indivíduos diabéticos sem proteinúria. CONCLUSÃO Como um índice barato e fácil de usar, a PLR pode ser útil para prever o desenvolvimento e controle do nível de diabetes mellitus tipo 2. No entanto, sua correlação com HbA1c precisa ser validada por estudos prospectivos maiores.

Serum uric acid to HDL-cholesterol ratio is a strong predictor of metabolic syndrome in type 2 diabetes mellitus

SUMMARY OBJECTIVE Metabolic syndrome (MS) is a clinical entity that associated with increased risk of type 2 Diabetes Mellitus (DM) and cardiovascular diseases. Serum uric acid levels are correlated MS criteria. We hypothesized whether a uric acid to HDL-cholesterol ratio (UHR) could predict diabetic regulation and presence of MS in type 2 diabetic subjects. METHODS Admissions of the subjects with type 2 DM to outpatient clinics of our institution were retrospectively analyzed. Study population grouped into well-controlled and poorly controlled diabetics according to the HbA1c level (cut off 7%) and further grouped into type 2 DM with and without MS according to the presence of MS. UHR of study groups compared. RESULTS A hundred diabetic subjects enrolled. Mean UHR was significantly lower in well-controlled diabetics (9.7 ± 3.7%) compared to poorly controlled subjects (14 ± 5.4%) (p<0.001). Median UHR of diabetics with MS (13 (6-29) %) was greater than that of the diabetics without MS (9 (3-16) %) (p<0.001). UHR greater than 11% has 77% sensitivity and 60% specifity in predicting worse diabetic control (AUC: 0.752, p<0.001) and a UHR greater than 10.6% has 83% sensitivity and 71% specifity in predicting MS (AUC: 0.839, p<0.001). Sensitivity and specifity of UHR in predicting MS were better than most of the sensitivities and specifities of the five criteria of MS. CONCLUSION We suggest utilization of UHR in diagnosis of MS as a novel criteria. Nevertheless, prospective studies with larger population may make a better scientific evidence in that issue.

RESUMO CONTEXTO E OBJETIVO A síndrome metabólica (SM) é uma entidade clínica associada ao aumento do risco de diabetes mellitus tipo 2 (DM) e doenças cardiovasculares. Os níveis séricos de ácido úrico estão correlacionados com os critérios estabelecidos de EM. Uma vez que DM tipo 2 e MS são distúrbios metabólicos, nós hipotetizamos se uma relação ácido úrico para HDL-colesterol (UHR) poderia predizer a regulação diabética e a presença de MS em diabéticos tipo 2. MÉTODOS As admissões dos sujeitos com DM tipo 2 aos ambulatórios de nossa instituição foram analisadas retrospectivamente. A população do estudo agrupou-se em diabéticos bem controlados e mal controlados, de acordo com o nível de HbA1c (corte de 7%) e posteriormente agrupados em DM tipo 2 com e sem EM de acordo com a presença de EM. UHR dos grupos de estudo comparados. RESULTADOS Um total de 100 indivíduos diabéticos tipo 2 inscritos no estudo. A média UHR foi significativamente menor em diabéticos bem controlados (9,7 ± 3,7%) em comparação com indivíduos com DM tipo 2 mal controlada (14 ± 5,4%) (p < 0,001). A mediana da UAR de diabéticos com EM (13 (6-29)%) foi maior que a dos diabéticos sem SM (9 (3-16)%) (p < 0,001). Um UHR maior que 11% tem 77% de sensibilidade e 60% de especificidade em predizer um pior controle diabético (AUC: 0,762, p < 0,001) e um UHR maior que 10,6% tem 83% de sensibilidade e 71% de especificidade em prever MS (AUC : 0,839, p < 0,001). A sensibilidade e especificidade de UHR em predizer MS foram melhores do que a maioria das sensibilidades e especificidades dos cinco critérios de MS. CONCLUSÃO Sugerimos a utilização da UHR no diagnóstico da SM como um novo critério. No entanto, estudos prospectivos com maior população podem fazer uma melhor evidência científica nessa questão.

Diabetic regulation of subjects with type 2 diabetes mellitus is associated with serum vitamin D levels

SUMMARY OBJECTIVE Vitamin D deficiency is not only associated with bone metabolism but also with diabetes mellitus. We aimed to study the possible association between serum vitamin D concentration and HbA1c level in patients with type 2 diabetes mellitus (T2DM) in this retrospective report. METHODS Patients with T2DM were enrolled to the study either in regulated or non-regulated T2DM groups, according to HbA1c levels. An HbA1c level of <8% was considered as relatively controlled and others were considered as poorly controlled T2DM. RESULTS Serum vitamin D levels in poorly controlled T2DM subjects (9.4 (4.9-34) ng/ml) were significantly lower than that of the relatively well regulated T2DM patients (13.5 (3.4-36) ng/ml) (p=0.03). Vitamin D was strongly and inversely correlated with HbA1c levels (r= -0.295, p=0.005). CONCLUSION Whatever the cause or result of the diabetes mellitus, it is clear that lower vitamin D is strongly associated with worse diabetic regulation in T2DM subjects. Randomized controlled larger studies, which research the relation between diabetic regulation and vitamin D status, are needed to claim whether it could be a therapeutic target in future in diabetic subjects.

RESUMO CONTEXTO E OBJETIVO A deficiência de vitamina D não é apenas associada ao metabolismo ósseo, mas também ao diabetes mellitus. Procurou-se estudar a possível associação entre os níveis de concentração do soro de vitamina D e de HbA1c em pacientes com diabetes mellitus tipo 2 neste relatório retrospectivo. MÉTODOS Os pacientes com diabetes mellitus tipo 2 foram inscritos no estudo em regulada ou não regulada de acordo com os grupos de níveis de HbA1c DM2. HbA1c nível de <8% caracterizava DM2 controlada e HbA1c > 8% DM2 descontrolada. RESULTADOS Os níveis de vitamina D no soro em indivíduos com DM2 mal regulados (9,4 (4,9 a 34) ng/ml) foram significativamente menores do que o do bem regulado em doentes DM2 (13,5 (3,4-36) ng/ml) (p = 0,03). A vitamina D foi forte e inversamente correlacionada com os níveis de HbA1c (p = 0,005). CONCLUSÃO Seja qual for a causa ou o resultado do diabetes mellitus, é claro que níveis baixos de vitamina D são fortemente associados com pior regulação em indivíduos diabéticos com DM2. Maiores estudos randomizados e controlados que pesquisam a relação entre o status de vitamina D e a regulação em diabéticos são necessários para molusco se é, no futuro, poderia ser um alvo terapêutico em indivíduos diabéticos.

Aspartic acid racemization with correlation to age: a forensic perspective

Objective: To estimate age through aspartic acid racemization of human dentin for forensic analysis, and to calculate the margin of error between chronological age and estimated age by racemization method

Study Design: Cross-sectional comparative study

Place and Duration of Study: Dental Outpatients' Department, Ziauddin Hospital, Karachi, from 2011 to 2014

Methodology: Patients from dental orthodontics department were selected. Verbal expressed consent was taken from the participants. Preliminary data was entered in a specially designed performa having name, chronological age, gender, socio-economic status. L and D ratio of aspartic acid were quantified in dentin for each tooth by High-Pressure Liquid Chromatography technique. Results of 100 samples with known age were used during study to estimate co-efficient of racemization. Regression equation was derived by plotting 85 samples of known age and KR as independent and dependent variables and least square equation was derived - Age = -4.391 +347.396 [co-efficient of racemization]

Results: The estimated co-efficient of determination was 0.74, meaning thereby that the regression equation was 74% correct for estimating age. The calculated correlation between chronological age and co-efficient of racemization was 0.834, which is interpreted as a very strong and positive correlation. The co-efficient of racemization increased with the age. The mean chronological age [38.44 +/- 13.22] years were statistically similar to the mean calibrated age [37.52 +/- 12.36] years. The median of actual and calibrated age was found to be 3.4 with inter-quantile value of 13. No statistically significant difference was observed among gender [p=0.837], or socioeconomic status [p=0.35]

Conclusion: Racemization of human dentin could be used as one of the reliable method for estimating age. HPLC is a reliable technique to estimate the co-efficient of racemization because it is highly reproducible, cost-effective and convenient. However, the procedure should be optimized and standardized within all laboratories for quality assurance

Docking and ADME/T analysis of silibinin as a potential inhibitor of EGFR kinase for ovarian cancer therapy.

Epidermal Growth Factor Receptor (EGFR) is mostly deregulated and over expressed in ovarian cancer, which is directly linked with STAT3 activation that leads to the accumulation of anti-apoptotoc events and thus, platinum drug resistance occurs. Regarding this, increasing of platinum drug sensitivity by targeting EGFR receptor along with platinum drugs is one of the major strategies in ovarian cancer treatment. In this context, using molecular simulation studies, the present study described the structural and functional properties of silibinin as a potential inhibitor of EGFR tyrosine kinase, and also its metabolic profile had been investigated by SOM prognosis. According to the results, silibinin have shown the significant binding energy by interacting with important residues in the active site. Again, it also processed medium absorption profile with no Fe accessibility. Furthermore, the study is also useful for further clinical based studies and also for the validation of toxicological and pharmacokinetic study.

In silico analysis of indole-3-carbinol and its metabolite DIM as EGFR tyrosine kinase inhibitors in platinum resistant ovarian cancer vis a vis ADME/T property analysis.

Epidermal Growth Factor Receptor (EGFR) is one of the four members of the Human Epidermal Receptor (HER) family, which is deregulated and over expressed in platinum resistant ovarian cancer. Thus, targeting EGFR receptor along with platinum drugs is one of the major strategies to increase the platinum drug sensitivity. That‟s why, in this study, we aimed to investigate the inhibitory activity and binding site analysis of indole-3-carbinol and its active metabolite 3,3'-diindolylmethane by using molecular simulation studies, also metabolic profile had been investigated by SOM prediction. The 3,3'-diindolylmethane showed significant inhibitory activity and binding energy comparing to indole-3-carbinol, also it processed lower toxicity and will undergo aromatic hydroxylation due its high intrinsic activity and Fe accessibility. Though our research study supports previous reports of EGFR inhibition, further in vivo study is necessary for validation of toxicological and pharmacokinetic study. However, the current work tries to address most of the variables in the dynamic drug design process by In silico study in order to boost the potentiality of the selected molecule to serve as good leads in terms of optimum pharmacokinetic and toxicological attributes.

Evolution of selective COX-2 inhibitor from Alangium salvifolium: an in silico approach.

Pain and inflammation are linked with a number of pathological conditions. Several studies are in progress worldwide to find natural healing agents with better safety profile. Our current study was aimed to evaluate Alangium salvifolium (family: Alangeaceae) derived analgesic compounds for therapeutic drug discovery by computational approach. Literature based studies were used to explore the compounds of A. salvifolium. Ligands were prepared by following the appropriate procedures and finally in silico molecular docking analysis performed by GOLD 4.2. After post docking analysis, salviifosides A of Alangium salvifolium was found to have interaction on COX-2 protein by obtaining highest fitness score 50.64 and molecular interaction suggests that it could be a potent anti-inflammatory compound and it may be worth for further clinical trials.

Recovery of Schistosoma haematobium ovum from Labeo rohita: first report from Pakistan

Schistosomiasis, also known as bilharzia, is a parasitic disease caused by trematodes from the genus Schistosoma that can infect humans and animals. S. mansoni, S. japonicum, and S. mekongi all causes intestinal schistosomiasis except S. haematobium that causes urinary schistosomiasis. It is only specie which effects urinary system, it can affect liver, heart, lungs also but very rarely. Schistosoma haematobium is endemic to over 50 countries in Africa and the Middle East and Western Asia and may be fatal in HIV positive people. A number of reports from the African countries like Nigeria have been reported. A few cases are reported 9but in Pakistan it has never been reported before in native people. It is first time reported in Pakistan in the intestine of Rahu (Labeo rohita). The purpose of this study is to elaborate the approach of zoonotic agent by various other routes including the commonly available fish

Morphology and incidence of atherosclerotic lesions in subclavian arteries - a human autopsy study

To assess different morphological categories of atherosclerotic lesions and their incidence in relation to age and sex in our population. Prospective descriptive observational study. This study was conducted at Mortuary of King Edward Medical University Lahore and Department of Pathology Allama Iqbal Medical College Lahore and completed in one and a half year from. A total of 30 human autopsies were carried out at random. The age range was between 8 and 85 years. Right and Left subclavian arteries were taken out from dead bodies. They were opened lengthwise. One to four areas of tissue were taken from each artery in all cases. Section were prepared from paraffin blocks. They were stain with Haematoxylin and Eosin stain. Special stains were also performed to differentiate all the components of atherosclerotic lesions. The fibrolipid plaques were seen in l3 cases in the right subclavian artery and I3 cases in left subclavian artery. The complicated lesions were seen in 8 cases in the right subclavian artery and 9 cases in the left subclavian artery. 6 of these 8 cases showed ulceration in the right subclavian artery and 2 showed intimal vascularization and haemorrhage alongwith thrombus formation. In the left subclavian artery the ulceration was seen in 7 cases and intimal vascularization and haemorrhage in 2 cases along with thrombus formation. The calcified lesions were present in 7 cases in the right subclavian artery and 8 cases in the left subclavian artery. The morphological changes in media and elastics were seen in 7 cases in right subclavian artery and 8 cases in left subclavian artery. In this study different atherosclerotic lesions are categorized and their relation to age and sex is appreciated in our population. This study is although is preliminary but gives basic and useful data about the incidence of ischemic changes in upper limbs due to raised atherosclerotic lesions in subclavian arteries

study on Acute Myocardial Infarction with special reference to age, sex, type of infarct and associated risk factors

To study the frequency of acute myocardial infarction [AMI] and its types in patients admitted in CCU of Divisional Headquarter Hospital [DHQ], Faisalabad Institute of Cardiology [FIC] Faisalabad and to investigate associated risk factors. It was an observational hospital based study conducted at Cardiac Care Centre, DHQ Hospital Faisalabad and FIC from 30th March 2009 to 30th June 2009. One hundred patients were included in the study at both centers. A Performa was filled with tabulated questions and information was recorded. The data was analyzed on SPSS version 13. It revealed statistically significant difference by patient's age and sex. AMI was higher in males [CI = 75 - 91%] than females [CI = 9 - 25%]. Types of infarction including inferior and anteroseptal were observed in significantly higher number of patients, while extensive anterior, non-STEMI and lateral infarction was observed in significantly less number of patients. Results showed significant association [P<0.05] of fat sources in diet with types of AMI. Hypertension [CI = 36-56], smoking [CI = 30-50], family history of IHD [CI = 26-45] were stronger risk factors than others and 19% patients admitted with AMI had Diabetes Mellitus. AMI was significantly higher in patients between 40 and 50 years of age. Age and sex and fat sources in the diet showed significant association with AMI, while family history of IHD, hypertension and smoking were other stronger risk factors

Assessment of Thrombolytic & Cytotoxic Activity of Herbal Preparations Originated from Botanical Source of Bangladesh.

An in vitro thrombolytic model was used to check the clot lysis effect of four herbal extracts viz., Honey, Nigella sativa, Capsicum frutescens, Brassica oleracea, combination of Honey & Nigella sativa and Honey & Capsicum frutescens along with Streptokinase as a positive control and water as a negative control. And also brine shrimp lethality bio-assay was done using brine shrimp Nauplii and 5% of DMSO as a solvent for the ethanol extracts of Nigella sativa & Capsicum frutescens and Honey. Using an in vitro thrombolytic model, Honey, Nigella sativa, Capsicum frutescens, Brassica oleracea, combination of Honey & Nigella sativa and Honey & Capsicum frutescens showed 26.82%, 47.13%, 57.40%, 62.44%, 56.58% and 44.54% clot lysis effect respectively. From our study we found that Brassica oleracea, Capsicum frutescens, and combination of Honey & Nigella sativa showed significant % of clot lysis effect with reference to Streptokinase. Again from in vitro brine shrimp lethality bio-assay, we found that the LC50 of Honey, Capsicum frutescens & Nigella sativa were 129.62 μg/ml, 83.33 μg/ml & 45.45 μg/ml respectively.

Etiology and the role of proctosigmoidoscopy in patients with acute bloody diarrheas

To find out the etiology of acute bloody diarrheas in patients admitted to a tertiary care hospital. This descriptive study was conducted in the department of medicine, Lady Reading hospital from 2005 to 2008. A total of 50 patients were studied, comprising of 35 males and 15 females. Mean age of the sample was 32.66 +/- 15.4 years]. Patients who presented with acute bloody diarrhea of between 3-30 days duration were studied. Patients who had history of recurrent bloody diarrhea were also included. Patients below 12 years, severely dehydrated and seriously ill were excluded. All patients underwent fibreoptic proctosigmoidoscopy and rectal biopsy. Amebic colitis was confirmed on stool examination for Trophozoites of Entameoba histolytica, typical proctosigmoidoscopic findings and response to anti-amebic drugs. Thirty-two patients [64%] were having new onset bloody diarrhea, while 18 patients [36%] were giving history of recurrent bloody diarrhea. All patients had evidence of Procto-colitis on fibreoptic sigmoidoscopy. The most common conditions were ulcerative colitis in 25 [50%], bacterial dysentery in 15 [30%] and Amebic proctocolitis in 7 [14%]. Findings on proctosigmoidoscopy were mucosal hyperemia [50%], bleeding points [38%], ulcers [44%], pus [20%], pseudo polyps [4%] and mass [4%]. Fibreoptic Proctosigmoidoscopy is a simple and easier procedure to diagnose different causes of acute bloody diarrhea and should be considered in all cases except in seriously ill and dehydrated patients. The common causes of acute bloody diarrhea in our community are bacterial proctocolitis, amebiasis and ulcerative colitis

Prevalence of type-II diabetes mellitus and diabetic retinopathy: the Gaddap study

To determine the frequency of type-II Diabetes mellitus [DM] in the endogenous population of Gaddap town and also to evaluate the status of Diabetic retinopathy [DR] in this group. Descriptive study. Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from January 2006 till December 2008. This community based study of subjects of either gender was carried out in the Gaddap town. Three primary eye care centres were established in the existing primary health care [PHC] facilities, to screen the target Population aged 30 years and above, and who met other inclusion criteria for DM and DR respectively. Patients requiring intervention were managed accordingly. Data was entered and analyzed using Microsoft Visual Basic 6 and Microsoft Access. Out of the cohort of 19211 subjects, 1677 patients were found Diabetic, giving the prevalence of DM in Gaddap town at 8.73%, with 1258 [6.55%] known and 419 [2.18%] newly diagnosed cases. DR was seen in 460 [27.43%] of the Diabetic cases with 126 [7.51%] patients requiring urgent intervention for vision threatening complications. The result validates the importance of early screening of DR in people suffering from DM for possible management and prevention of sight threatening complications in the early stage of the disease and advocates the inclusion of primary eye care as a part of PHC system

Contribution of EDRF and EDHF to restoration of endothelial function following dietary restrictions in hypercholesterolemic rats.

The mechanisms underlying the impairment of endothelium-mediated vasorelaxation induced by dietary hypercholesterolemia and the mechanisms of restoration of endothelial function following reintroduction of low cholesterol diet were evaluated. Feeding rats with high cholesterol diet induced hypercholesterolemia and high blood pressure. This was associated with reduced vasorelaxation in response to acetylcholine, isoproterenol, and adenosine. At the same time, exaggerated contractile responses to serotonin and phenylephrine were observed. Reintroduction of a normal diet to cholesterol fed rats resulted in significant normalization of blood pressure, serum lipid profile, relaxation and contractile responses. The contributions of endothelial derived relaxing factors (EDRF), endothelial derived contractile factors (EDCFs)/prostanoids, and endothelial derived hyperpoalrising factor (EDHF) to the vasorelaxation in each group of animals were assessed. EDCFs constricting activity was increased in both cholesterol fed groups as compared to the control group. EDRF and EDHF were found to be the primary factors involved in the regulation of endothelium-mediated responsiveness. In control animals, EDRF was responsible for 70-90% of relaxation, depending on the agonist used. In cholesterol fed animals, EDRF was significantly reduced while EDHF was maintained or enhanced showing that EDHF had a significant role in maintaining the endothelial responses. Importantly, the restoration of vasorelaxation following reintroduction of normal diet was mediated not only by improvement of EDRF-dependent relaxation, but also to a significant extent by a further increase in EDHF-mediated relaxation. Taken together, the data showed that EDRF was attenuated during hypercholesterolemia and dietary interventions with low fat content restored these responses. However, EDHF-mediated responses were not reduced by hypercholesterolemia and subsequently improved their function after application of low cholesterol diet. The results implicate EDHF-mediated relaxation is also an important mechanism for restoration of endothelial function upon application of dietary restrictions for reduction of serum cholesterol level.

Analysis of homicidal deaths in Peshawar, Pakistan

Homicide is one of the oldest crimes in human civilization. For every person who dies as a result of homicide, many more are injured. A study of the patterns of homicide in a society is one of the first steps in developing strategies to prevent it. This study was conducted at the department of Forensic Medicine Khyber Medical College, Peshawar, to know the patterns of homicide, taking it as the first step in the prevention of this crime. This study includes 520 cases of homicide out of the total of 662 medico-legal autopsies conducted at Khyber Medical College, Peshawar, during the year 2002. The cases have been labeled as homicide on the basis of autopsy and police inquest. The homicide rate for Peshawar during the period under study was 22.9/100,000. Males constituted 86.15% of the victims. 32% of the victims were in their third decade of life. Firearms were the causative agent in 86% of the cases. Chest was the primarily targeted area of the body. The highest number of homicides occurred in the month of November. The homicide rate is alarmingly high in Peshawar as is the use of firearms. This is something that should be seriously looked at by the policy makers

Psychiatric morbidity among housemaids in Kuwait. a. prevalence of psychiatric disorders in the hospitalized group of housemaids

Objectives: To determine the first hospital admission rates and the nature of psychiatric disorders among housemaids and compare them with the Kuwaiti female patients

Subjects and Methods: Based on the International Classification of Diseases [10[th] revision; ICD-10] symptom checklist, a semi-structured interview was administered to all the housemaids and the Kuwaiti female patients hospitalized during the 2-year study period

Results: The hospital admission rates were 1.86 times higher in housemaids than in the Kuwaiti female patients and the nature of psychiatric disorders was also different in the two groups. The stress-related disorders were more common among housemaids while schizophrenia was the commonest disorder among Kuwaiti patients. Duration of hospital stay was significantly shorter for housemaids, and four fifths of them were repatriated on mental health grounds

Conclusions: The psychiatric morbidity is higher among housemaids than Kuwaiti females and a substantial number of them are prematurely repatriated on health grounds. Further studies are needed to explore the possible pre-immigration risk, and post-immigration precipitating factors, to prevent this 'expatriate failure'

Suicidal deaths; Assessment in Peshawar

To find out the incidence of suicide, the gender and age groups involved, the methods used for committing the act and to note seasonal trends if any. Data source: Cases brought for autopsy at the department of forensic medicine, Khyber Medical College, Peshawar. Non- interventional descriptive. Department of forensic medicine, Khyber Medical College, Peshawar. Period: January 1991 to December 2000. Materials and All 39 cases of deaths labeled as suicide on the basis of autopsy findings, police inquest and interview with relatives of the victim were selected from the autopsies. The cases were grouped on the basis of age, sex, method of suicide used, region of the body involved and the seasonal distribution of the cases. The rate of suicide in Peshawar is 0.21 per 100,000 per year. Males were the predominant victims with a male to female ratio of 2.9:1. The age most prone to suicide was 20-29 years followed by 10-19 years. The primary method used for suicide in both sexes was by firearm followed by hanging. The head was the region of the body used for suicide in 59.37% of firearm victims followed by the chest and the abdomen. Two peaks were noted in the months of September and March. The incidence of suicide in Peshawar is amongst the lowest in the world

Unnatural female deaths Peshawar

The aim of the study was to know the extent of violent deaths among females in Peshawar, the most vulnerable age group, weapons of infliction and the mode of death. Design: Non interventional [descriptive] type study. Place and Duration of Study: This study was conducted from 1st January, 2001 to 31st December, 2001 in the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar. Subjects and Out of 679 deaths, presented for autopsy at the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar 89 were females. These were grouped according to age, mode of death and weapons of infliction. Females formed 13% of all the autopsies done in Peshawar. The age group most commonly involved was 21-40 years [50.56%]. Firearms were the predominant weapons of infliction [70.78%] and the intent was mostly homicidal [77.52%]. Fatal violence against women is uncommon in Peshawar. Suicide is rare. Young women are mostly killed by firearms