large infantile capillary hemangioma of the eyelid with 5 years follow-up

A five-day baby girl presented with a large mass involving the right upper and lower eyelid obstructing the visual axis completely. She was treated with intralesional triamcinolone acetonide injection under general anesthesia but no change in size of the tumor was observed. Oral beta blocker, propranolol, 1 mg/kg body weight, was given at three months. After two months, no significant change in tumor size was seen. The tumor was managed by surgical excision. There was no effect of intralesional triamcinolone acetonide and oral beta blockers. Even with surgical excision, there was recurrence of tumor

Cholesteatoma clinical outcome and complications: a study on patients with chronic ear disease

To identify the clinical behaviour and consequences of cholesteatoma and to formulate a strategy for achieving early diagnosis, appropriate management and avoidance of all the grave complications. Hospital based descriptive type of study. This study was conducted in Shahina Jamil Hospital from April 2011 to Dec 2012. 40 patients of any age and gender were included in the study. The age, gender, socio-economic status and complications like hearing loss, facial nerve paralysis, intracranial spread, labyrinthitis, mastoid fistula and ossicular chain status were recorded and analyzed. We found that 62.5% were male and 37.5% were female.75% of the patients belong to rural areas and 25% belong to urban areas. All the patients [100%] presented with ear discharge and hearing loss. Ossicles were found intact in all patients. Labyrinthitis was the most common complication [37.5%]. It was found that cholesteatoma was frequent among poor, male and young patients leading to necrosis of the ossicles in all patients. Labyrinthitis, mastoid fistula and intracranial spread were common complication

The significance of microbiopsies in cytological smears.

Background: The role of fi ne needle aspiration cytology (FNAC) in the diagnosis of malignant lesions is well documented. Conventionally obtained fi ne needle aspiration (FNA) smears frequently contain well preserved viable intact tissue fragments (microbiopsies). Aims: The present study was aimed at evaluating the microbiopsies and carrying out further cyto-histopathologic correlation in order to assess what additional information they could provide. Materials and Methods: A total of 116 FNA smears from clinically suspected malignant lesions were examined, of which 81 smears (70.0%) contained representative tissue fragments of the tumors. Histopathological details were available in 75 cases. Immunocytochemistry (ICC) was applied in selected smears as and when required. Results: Tumors in which microbiopsies aided in diagnosis chiefl y included soft tissue malignancies (12 cases), typed into malignant peripheral nerve sheath tumor, fi brosarcoma, spindle cell sarcoma and malignant melanoma; lung tumors (14 cases) classifi ed as small cell carcinoma, large cell carcinoma, squamous carcinoma and adenocarcinoma; breast tumors (08 cases), typed into ductal, medullary and lobular carcinoma; and lymph node metastasis (19 cases) from primaries in lung, larynx and thyroid. The cyto-histopathologic concordance was raised from 81.2% in the absence of microbiopsies to 93.2% in their presence. Conclusions: FNA smears containing microbiopsies are of ample help in establishing fi rm diagnosis, tumor typing, and predicting possible primary sites in metastatic tumors which were not possible by cytology alone. Hence, this technique can be utilized to enhance the diagnostic accuracy of FNAC, if put into practice in evaluation of routine cytology smears, without increasing any fi nancial burden on patients.

Frequency of hepatitis a in patients with acute hepatitis in abbottabad

To investigate the frequency of hepatitis [A] in patients with acute hepatitis. Retrospective study. This study was carried out at Shahina Jamil Teaching Hospital Abbottabad from March 2006 to February 2008. The study included all acute hepatitis patients who visited the ShahinaJamil Hospital Abbottabad. Various viral markers were used to establish the diagnosis of acute hepatitis that included anti HAV IgM, HBsAg, anti HCV and anti HEV IgM. Liver function tests were also done. A total of 125 patients with acute hepatitis visited the out patient department of S.J. Hospital Abbottabad during the study period. The specific etiologic diagnosis could be made in 88 [70.4%] patients. Hepatitis [A] was found in 33[26.4%], HBV in 19[15.2%], HCV in 6[4.8%], and HEV in 30[24.0% patients. The mean age of the patients with HAV infection was significantly younger than patients with HBV,HCV and HEV. The present study showed that hepatitis A is one of the common type of viral hepatitis and can be controlled easily with improving sanitation and water distribution and personal hygiene

Turnover intentions and political influence behavior: a test of "fight-or-flight" responses to organizational injustice

We examined the role of organizational frustration as a linking mechanism between the perception of organizational injustice and fight [political influence behavior]/ flight [turnover intentions] responses. The participants were 201 middle-level managers drawn from manufacturing and logistics companies in northern Malaysia. Data were collected by means of a printed questionnaire. Whereas all the three components of injustice-procedural, distributive, and interactional-had significant positive impact on turnover intentions and political influence behavior, only procedural injustice and distributive injustice had such impact on frustration. Interestingly, organizational frustration played a partial mediating role in the relationship of distributive and procedural injustice with turnover intentions and political influence behavior. Implications of the findings for those in managerial roles and directions for future research are suggested

Frequency and visual outcome of anterior segment involvement in accidental ocular trauma in children

To analyze the frequency and visual outcome of anterior segment involvement in accidental ocular trauma in children. This descriptive case series was conducted in the Department of Ophthalmology Lady Reading Hospital, Peshawar from 15th June 2007 to 15th October 2008 on 200 cases of anterior segment involvement in children during accidental ocular trauma. Patients were admitted through casualty or Outpatient Department. After detailed history, systemic examination and complete ocular examination was done including visual acuity, slit lamp examination and examination under anesthesia when necessary. In this study, male children constituted 74.5% [149] and females 25.5% [51] of the total. Children between ages of 6-10 years are more vulnerable [42%]. Injury caused by blunt object was seen in 64.05% [129] of children and mostly it was due to stone in 21.50% [71]. The commonest place of injury was indoors in 38.50% [77], followed by playgrounds in 28.00% [56] and on streets and roads in 21.5% [43]. The visual acuity on arrival was PL+ ve in [35.5%] and open globe injury was observed in 36.0%. At the end of two months 13.5% eyes were phthisical. Blunt ocular trauma is a common ocular trauma in children with males more vulnerable. School going children are more at risk. Blunt trauma especially because of stone is the main culprit with devastating visual results

Synthesis, characterization and biological activity of some 1, 3, 4-thiadiazol derivatives

Thiadiazoles are their derivatives exhibit a wide variety of pharmacological activities such as Antibacterial and anti-inflammatory. In the present study we have synthesized derivatives some 2,5 substituted 1,3,4-thiadiazoles. The structures of these synthesized compounds were confirmed by IR, NMR, and MASS spectra data. These compounds were evaluated for varies biological activities such as antibacterial and anti-inflammatory activity

Neurofibromatosis with bilateral renal artery stenosis and end stage renal disease: case report

Neurofibromatosis type 1 [NF-1] is an autosomal dominant, hereditary, neurocutaneous syndrome that may, primarily or secondarily, affect different organs or systems of the body including the cardiovascular system. The most common vascular abnormality in patients with NF-1 is renal artery stenosis. Here we report the case of a middle-aged gentleman who presented at Sultan Qaboos University Hospital, Oman, with end stage renal disease and severe hypertension and was diagnosed to have NF-1 with bilateral renal artery stenosis. He was started on renal replacement therapy

Antithrombin levels in healthy Pakistani males

To determine the antigenic concentration and percent functional activity of antithrombin in healthy Pakistani males. Over a period of one year, 50 healthy male volunteers divided into two age groups were tested for antithrombin levels by radial immunodiffusion[RID], at the Departments of Pathology King Edward Medical College and Postgraduate Medical Institute, Lahore. None of them were suffering from any acute or chronic disease, nor were taking any medications. Plasma samples were used to determine the antigenic and derived percent activity from NOR-Partigen* plates supplied by Dade Behring. The younger group of healthy male volunteers [n=25], mean age 23.5 years showed a higher antithrombin concentration 46.7mg/dl or 155% functional activity: while the older volunteers [n=25], with mean age 44.0 years, showed 42.4 mg/dl concentration or 142% functional activity. The p value was insignificant between the groups [p> 0.05]. The younger healthy individuals in our population show higher antithrombin concentration and functional activity, which tends to decrease insignificantly with age

Spectrum of ocular surface squamous neoplasia

To describe the pattern of ocular surface squamous neoplasia [OSSN], clinical presentations, the risk factors and treatment options. An observational case series. Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, from April 2003 till August 2006. The study included 36 eyes of 35 patients with biopsy-proven ocular surface neoplasia. The details of patients regarding age, gender, laterally and risk factors were entered into a specially-designed proforma. Each patient was also assessed blomtcroscoplcally for type and complications of ocular surface neoplasia. The frequency of OSSN was 0.37 among admitted hospital patients. Among 36 cases of OSSN, squamous cell carcinoma of the conjunctiva was the most common type of OSSN seen in 63.9%, followed by carcinoma in situ of conjunctiva in 25% and carcinoma in situ of cornea in 11.1%. Male patients outnumbered female [65.7% vs 34.3%] with 71.42% of patients above 60 years of age. The risk factors identified were: old age, ultraviolet B exposure and xeroderma pigmentosa. Treatment consisted of local resection with or without adjuvant therapy in 61.1%, exenteration in 30.5%, enucleation in 5.5% and chemo/radiotherapy in 2.7%. Intraocular invasion was seen in 5.5% and orbital spread in 30.5%. The frequency of OSSN was 0.37% among admitted patients. Identification of exact etiological factors will enable to formulate strategies that are likely to decrease the incidence of this disease and the associated morbidity and mortality

Neurofibromatosis type II: a rare neurocutaneous syndrome

Neurocutaneous syndromes are heterogeneous group of disorders with abnormalities of central as well as peripheral nervous system. Neurofibromatosis type II [NF-II] is an autosomal dominant neurocutaneous syndrome rarely diagnosed in pediatric population. Diagnosis is based on clinical history and radioimmaging. We present a 14 years old boy with headache and decreased hearing, who turned to be a case of neurofibromatosis type II

Demography of patients with periocular dermoid cysts

To study the demographics of patients admitted in the hospital with histologically proven periocular dermoid cysts. A retrospective descriptive case series. Department of Ophthalmology Khyber Institute of Ophthalmic Medical Science, Hayatabad Medical Complex, Peshawar from July, 2004 to March, 2007. Clinical characteristics of patients with dermoid cysts admitted to the hospital were retrieved from patient charts. A note was made of its frequency, age, gender and laterality. Other features like site, size, depth, histology and presenting features were also looked for. Patient's age at the time of surgery was also noted. The frequency of dermoid cysts was 40.8% amongst orbital cases. Majority [65.7%] were females and 73.6% patients were below 15 years of age. The disease was right sided in 55.2%. Majority were superficial dermoids [71.0%] followed by conjunctival dermoids [15.7%] and deep dermoids [13.1%]. The most frequent clinical finding was a mass in 84.2%. Most patients [44.7%] were below 10 years at the time of surgery. The disease is more common in females and children. Superficial dermoids are more frequent. Presentation is usually with a subcutaneous mass and treatment of choice is surgical excision

Sonographic evaluation of the triangular cord sign in the diagnosis of biliary atresia, confirmed with needle liver biopsy

Neonatal cholestasis continues to present a diagnostic challenge for pediatric surgeons. Various diagnostic protocols are available, often involving invasive procedures which are generally not available in the district general hospitals. The objective of this study is to evaluate the role of Triangular Cord sign [TC sign] on ultrasound for the prompt and easy diagnosis of biliary atresia in infants. A prospective study was planned. Patients with positive TC sign underwent needle liver biopsy for confirmation. Infants with neonatal cholestasis were referred from the gastroenterology department. Abdominal ultrasound was performed with 3-6MHz convex and 6-10MHz linear transducers on Core Vision, Toshiba by a single paediatric radiologist and results were correlated with needle biopsy of the liver interpreted by the histopathologist. Thirty nine Infants with cholestatic jaundice underwent ultrasound and biopsy. Twenty patients were diagnosed on ultrasound as biliary atresia on the basis of positive triangular cord sign and 18 of them were confirmed on biopsy

Assessment of socio demographic risk factors involved in coronary artery disease seen in patients presenting in coronary outdoor

The aim of the study is to assess the sociodemographic risk factor involved in Coronary Artery Disease seen in patients presenting in Coronary outdoor. A Case-Control study. The study was conducted between July 1[st] to July 28, 2004 in Lahore. It was a community based survey conducted on coronary outdoor departments in Lahore. Multistage followed by systematic random sampling methodology was used. 30 known patients of CHD were selected as cases along with inclusion of 30 healthy people as controls for the assessment of sociodemographic risk factors of CHD. The final result shows that there is a significant risk for persons over 50[OR:3, CI:0.93-94], male sex [OR:2.28, CI:0.71-7.3], smokers [OR:11.6 CI:2.95-49.00], sedentary life style [OR:6 CI0.82-8.89], persons having transport problems [OR:2. CI0.62-6.51], high cholesterol diet [OR:2.2 CI0.71-7.46], positive family history of CHD [OR:13.75,CI3.40-60.40] and underlying diseases like diabetes and hypertension [OR:4.75,CI0.40-16.74]. The study reveals an area that needs attention. The overall risk profile in our community showed increased risk of CHD in male sex, age over 50, high cholesterol diet, smoking. sedentary life style. positive family history of CHD and stressful conditions

Incidence and outcome of severe Hyponatremia in children and young adults. A single institution experience

Our two main objectives are to assess the incidence and the outcome of severe hyponatremia in young hospitalized patients. We retrospectively reviewed the incidence and outcome of severe hyponatremiac [Na <125 mmol/l] in-patients less than 18 years of age, admitted as consecutive admissions during one calender year. Psuedohyponatremia and artifactual hyponatremia were excluded. Patients' demographics, clinical features, laboratory, treatment and outcomes were recorded. Of 3561 admissions of patients less than 18 years of age, 20 developed severe hyponatremia. Nausea, vomiting, irritability, clouded sensorium and seizures were the most common symptoms and signs. Underlying central nervous system disease, pneumonia and malignancy were major co-morbid conditions. The initial volume status was determined as hypervolemia [n=7], hypovolemia [n=7] and euvolemia [n=6]. Iatrogenic [diuretics 5 and hypotonic fluids 7] hyponatremia accounted for 60% of all cases. Mortality was 20%. Patients receiving intravenous hypotonic fluids should be closely monitored for the development of hyponatremia. The common etiology of hyponatremia in our studied cohort of patients is iatrogenic

Risk of malaria transmission through blood transfusion and its detection by serological method

To assess the risk of transmission of malaria through blood transfusion, and compare efficacy of testing by immunochromatographic[ICT] devices vis a vis peripheral blood film [PBF]. Design: 300 blood samples were tested divided into three equal groups of healthy volunteers, voluntary non-remunerated blood donors and patients suffering from malaria. Testing was carried out by a serological screening method, together with observation of peripheral blood films. Setting: Samples were collected from different sites and tested at the Institute of Haematology and Blood Transfusion Service, Punjab. Subjects: One hundred blood donors were selected from persons donating blood at the Institute or on mobile sessions. An equal number of healthy controls were students and staff of different colleges and the Institute. Samples of 100 patients of pyrexia and diagnosed clinically as suffering from malaria were collected from multiple clinics, laboratories and hospitals in Lahore. Main outcome measures: Assessment of the risk of transmission of malaria through blood and blood products and the comparison of serological testing for malaria with conventional peripheral blood film detection. Amongst healthy blood donors we did not find even a single case of malaria and there was no report of persistent post transfusion pyrexia. We are unable to comment on species frequency in blood donors. However, amongst known patients of malaria we found a higher frequency of Plasmodium vivax[P.v] as compared to Plasmodium falciparum[P.f]. Testing by serological method, helped us to diagnose 5% of our patients who were missed by peripheral blood films. Between properly selected voluntary non-remunerated blood donors the incidence of malaria transmission is zero and the blood is safe for transfusion. Serological testing shows good correlation with peripheral blood film detection. In fact, it can detect the disease even when film detection has been unsuccessful. If proper donor selection criteria are observed there is little risk of transmitting malaria through transfusion. However, as the donor pool in the Service is not necessarily totally that of voluntary non-remunerated donors and substantive numbers of replacement/first time, occasionally uneducated/unaware donors, are being bled, screening for malaria will not be totally unrewarding

Safe blood begins with safe donors

To identify the safest group of blood donors demographically with regard to risk of transmission of diseases in order to develop effective recruitment and retention strategies. Design: Demographic data and the results of screening for HIV, HBV l3 HCV in three different groups of blood donors have been analysed to identify the safest group of blood donors. All donors were subjected to medical interview and examination to exclude any donor who responded in the affirmative for any recognized risk factors or was considered unfit to donate blood as per national standards and guidelines. Additional data regarding educational and socio-economic status was also obtained and analysed. Subjects: Initially 703 donors registered to donate blood. None responded in the affirmative for any of the risk factors. 65 [9.25%] were deferred for different reasons and 638 donors were bled from the following three groups: 1] Healthy college going first time volunteers, 2] Healthy factory workers also first time volunteers and 3] Healthy voluntary non-remunerated donors [VNRD] who had donated at least twice in the calendar year at a hospital based blood bank. Setting: Blood from groups 1 and 2 were collected on mobile bleeding sessions, while data for group 3 was obtained from two busy teaching hospital blood banks. Testing for HIV, HBV, and HCV were carried out by rapid serological screening methods. All initially reactive donors were confirmed on EIA at the laboratories of the Institute of Haematology and Blood Transfusion Service, Punjab. All false positive, initially reactive, donors were excluded from the study. Main Outcome Measures: Identification of safest blood donor group. We found that generally younger people in our society posed a lesser risk to transmission of diseases as blood donors. The frequency of HCV positivity is alarmingly high amongst the poor in our society. Even amongst repeat donors the incidence of infectious disease markers are considerable. If appropriately motivated, women are equally poised to donate blood altruistically. Conclusions: There is a need to target younger people in recruitment and retention programmes for blood donations. Incentives like free hepatitis B vaccination should be given to preserve the existing repeat donor pool. Donor deferral registers need to be created and placed for easy reference at all blood banks. Due to the high risk of HCV transmission through blood obtained from the less fortunate class in our society, large scale HCV screening of the general population should be started and epidemiological studies undertaken to identify causes of such high frequency in order to curtail impending catastrophe

Doppler tissue imaging: a new approach to myocardial assessment in infants of diabetic mothers and correlation to maternal diabetic controls

The study included 30 newborn infants born to diabetic mothers in the Obstetrics Department and admitted to the Neonatal Care Unit in Tanta University Hospital. Their gestational age ranged from 31-40 weeks [mean 37.7 +/- 2.13] and birth weight 2.5-5.7 kg [mean 3.61 +/- 0.7 kg]. Ten healthy newborn infants of matched gestational age and sex, born to non-diabetic mothers were included as controls. The aims of the present study were: 1] to define cardiac morphology particularly septal hypertrophy with conventional echocardiography, 2] to use Doppler Tissue Imaging [TDI] echocardiography to detect early cardiomyopathic changes in infants of diabetic mothers, 3] to correlate these data to the parameters of glycemic control of maternal diabetes and 4] to follow up cases with affected myocardium so that their prognosis is determined. Full history and thorough clinical evaluation were done. Laboratory investigations included: cord blood glucose, cord blood insulin, cord blood C-peptide and fetal glycosylated hemoglobin [Hb F1c] as well as maternal glycosylated hemoglobin [Hb A1c]. Cardiac evaluation was done using conventional M-mode, 2-D, and Doppler transmitral flow velocities as well as by TDI to assess cardiac diastolic function. Septal myocardial hypertrophy was detected in 46.66% of the studied cases. Diastolic dysfunction was found in 33.3% by conventional transmitral Doppler flow studies and in 66.6% by TDI. None of the detected myocardial abnormalities were significantly correlated to parameters of maternal diabetes control such as maternal Hb A1c, cord blood insulin, cord blood C-peptide or cord blood Hb F1c. In cases of myocardial hypertrophy or diastolic dysfunction echo-Doppler and DTI studies were repeated till disappearance of myocardial abnormalities. Macrosomia was detected in 20% of the studied cases and did not correlate significantly to maternal diabetes control parameters nor to the myocardial abnormalities. There was no sign of outflow tract obstruction or myocardial systolic dysfunction in any of our studied cases, and myocardial hypertrophy or diastolic dysfunction resolved within 6 months of follow up. We conclude that macrosomia and non-obstructive cardiomyopathy are transient phenomena that still occur in IDM irrespective to the metabolic control of maternal glycemia and it is possible that other factors contribute to such manifestations. The new technique TDI could detect more cases of myocardial diastolic dysfunction in IDM than conventional echo Doppler method and it could be used for early detection and follow up of myocardial abnormalities in IDM

Transfusion transmitted HIV and HBV infections in Punjab, Pakistan

To assess the prevalence and risk of transfusion transmitted HIV and HBV infections in Punjab. The retrospective sero epidemiological data of the Institute of Haematology and Blood Transfusion Service, Punjab from 1996-2000 was analysed with regard to: a] Number of donors bled, b] Percentage of screening coverage, c] Percentage prevalence of HIV and HBV, d] Probability of receiving an infective unit P[R], probability of transmitting infection P[I] and spreading index evaluation and e] Cost assessment. The data was obtained regularly from 71 field units established in the government hospitals throughout the Province of Punjab from 1996- 2000. A total of 1176284 directed first time or replacement blood donors as well as voluntary non-remunerated blood donors who donated blood at these blood banks or at mobile sessions have been included in this study. Assessment of prevalence of HIV and HBV in blood donors and risk estimation. The screening coverage on the average has been 77.42% for HIV and 86.84% for HBV. The prevalence of HIV is 0.001% and of HBV is 2.259%. The probability of receiving an infective unit P[R] per 10000 donations is 0.023 for HIV and 29.72 for HBV. The probability of transmitting infection P[I] per 10000 donations is 0.021 for HIV and 26.75 for HBV The spreading index for both viral infections combined is 26.75 per 10000 donations. The cost of collecting and screening a single unit is Rs.350, while the cost of preventing the transfusion of a single infective unit is Rs.17836. Efforts should be made to extend 100% screening coverage, with development of altruistic voluntary non-remunerated blood donor registries, donor deferral registries and donor counseling service. There is a need to move away from hospital based blood donation system to a community-based system which would mean moving to a central and regional service concept in blood transfusion. An independent external QA programme or monitoring system is needed. The target should be to decrease prevalence to a minimum to ensure blood safety