Diabetic foot ulcer; sequelae

Objective: The number of diabetic patients is increasing at a rapid rate1. Management of diabetic foot has been a challenge for medical professionals. This study was carried out to find the sequelae of diabetic foot ulcer management. Study design: Observational analytical study. Setting: Military Hospital, Combined Military Hospitals Rawalpindi and MIMC teaching Hospital, Mirpur [AJK]. Period: Sep 2009 to August 2013

Materials and methods: Total 310 patients were included in this study as outdoor and indoor cases. Out of these 184 were males and 126 were females. Age affected ranged from 20 years to 90 years. Average age was 50 years. Wagner's grading for diabetic foot ulcer was used as guideline for management

Results: Hyperglycemia was controlled in consultation with physicians in all these patients. Out of these 310patients 199 [64%] patients got their feet wounds healed on conservative management without amputation while 111[35.8%] patients had to undergo some amputation at some level

Conclusion: Diabetes mellitus, fore runner of so many diseases requires multidisciplinary approach. Well controlled diabetes mellitus, good feet hygiene, rational antibiotics in light of culture/sensitivity report and timely conservative or active surgical intervention produce good results in diabetic foot management

Antioxidant activities of different parts of Musa sapientum L. ssp. sylvestris fruit.

Musa sapientum L. ssp. sylvestris (Family: Musaceae) is a popular edible fruit. It is used by the traditional healers in the treatment of diarrhoea and dysentery. In the present study, methanolic extracts of peel (MSPE), pulp (MSPU) and seed (MSSE) of the fruit were investigated for in vitro antioxidant activity using DPPH (1,1-diphenyl-2-picrylhydrazyl) radical scavenging capacity, reducing power, CUPRAC (Cupric Reducing Antioxidant Capacity) and total antioxidant capacity. The phenolic content of the extracts were also determined. The plant extracts showed a direct concentration dependent increase in scavenging DPPH radical. MSSE showed better scavenging activity than MSPE and MSPU with an IC50 value of 54.92 μg/ml, while the standard antioxidant, ascorbic acid, showed an IC50 value of 13.75 μg/ml. The Fe3+/ferricyanide to ferrous and cupric ion reduction capacity of MSSE were better than the reference agent ascorbic acid. All three extracts showed good results in total antioxidant assay. MSSE was also found to contain good amount of phenols (244.38 mg/g of plant extract in GAE). The results of this study indicate that MSSE has strong in vitro antioxidant activity.

Antioxidant and antihyperglycemic activities of methanolic extract of Glinus oppositifolius leaves.

The present study was carried out to investigate the antioxidant and antidiabetic potential of methanolic extract of Glinus oppositifolius leaves. The antioxidant potential was examined by DPPH radical scavenging assay, nitric oxide (NO) scavenging assay, determination of total flavonoid content and total antioxidant capacity assay. Antihyperglycemic activity was studied by oral glucose tolerance test (OGTT) in normal mice and in alloxan-induced diabetic mice. In DPPH radical scavenging assay the IC50 value of the extract was found to be greater than 1000 μg/ml (ascorbic acid, IC50 = 14.45 μg/ml) while it was 269 μg/ml in nitric oxide (NO) scavenging assay (quercetin IC50 = 15.24 μg/ml). The amount of total flavonoid was 25 .46 mg/g and total antioxidant activity was 79.48 mg/g equivalent to Quercetin and Ascorbic acid respectively. A significant effect (p<0.05) on oral glucose tolerance was noted at the dose of 200 mg/kg and 400 mg/kg body weight in mice. At the same doses, the extract showed significant (p<0.05) reduction of blood glucose level in Alloxan-induced diabetic mice compared to the standard drug Metformin. Overall, the results of the present study indicate that the methanolic extract of Glinus oppositifolius leaves possess moderate antioxidant activity and significant antihyperglycemic activity.

Musa paradisiaca L. and musa sapientum L. : A phytochemical and pharmacological review.

Musa paradisiaca L. and Musa sapientum L. (Musaceae) are mainly grown in the tropical and subtropical countries and are widely used for its nutritional values all over the world. The fruits as well as the other parts of the plant are used to treat different diseases in human in traditional medicine. This review presents the scientific information on the traditional uses, phytochemistry and pharmacology of these two species. Both M. paradisiaca and M. sapientum are traditionally used in diarrhoea, dysentery, intestinal lesions in ulcerative colitis, diabetes, sprue, uremia, nephritis, gout, hypertension and cardiac disease. This review reports the phytochemicals isolated and identified from fruit pulp, peel, seeds and flowers. A comprehensive assessment of the biological activities of different extracts is included and possible mechanisms and phytochemicals involved have been correlated.

Multi drug resistance tuberculosis: pattern seen in last 13 years

Drug resistance in tuberculosis is a serious problem throughout the world especially, after the emergence of multi drug resistant TB strains. To estimate drug resistance in TB patients and compare it with previous studies to see the changing trends. The PMRC Research Centre receives sputum samples from all the leading hospitals of Lahore. This retrospective analysis was done from 1996 to 2008 on the multi drug resistant TB strains that were seen during these years. Five first lines tuberculosis drugs were tested on Lowenstein Jensen medium using standard proportion method. A total of 2661 confirmed isolates of Mycobacterium tuberculosis were seen over the past 13 years. Of the total, 2182 were pulmonary and 479 were extra pulmonary specimens. The patients comprised of those with and without history of previous treatment. These specimens were subjected to drug susceptibility testing. Almost half of the patient had some resistance; multiple drug resistance were seen in 12.3% and 23.0% cases without and with history of previous treatment respectively. overall resistance to rifampicin was 26.4%, isoniazid 24.1% streptomycin 21.6% ethambutol 13.4% and pyrazinamide 28.4% respectively. Statistically significant difference was seen between primary and acquired resistance. When compared with the reports from previous studies from the same area, there was a trend a gradual increase of drug resistance. Resistance to anti tuberculosis drugs in high. TB Control Program should start "DOTS Plus" schemes for which drug susceptibility testing facilities should be available for correctly managing the patients

Lingual tuberculosis

Tuberculosis is a common disease in developing countries like Pakistan. Although it can involve almost any region of the body, some presentations are still very rare. This is a case report of a 36 years old male with tuberculous lesion on the tongue presenting as a lump. Patient also had disseminated disease. There are very few cases reported of this rare presentation across the globe

Prevalence of hepatitis C, hepatitis B and human immunodeficiency virus infection among blood donors at Fatimid center Multan

To find out the prevalence of Hepatitis C, Hepatitis B and HIV infection among blood donors at Fatimid Center, Multan., determine whether the laboratory methods to be used for the detection of HBV, HCV and HIV infection and disseminate the findings of the study for the constitution of proper screening programme at blood transfusion centers. This cross-sectional study was designed to know the screening pattern of Hepatitis B, Hepatitis C and human immunodeficiency virus in blood donors at Fatimid Center Multan during the period from November 2001 to December 2001. Hepatitis C, Hepatitis B and HIV infection is commonly transmitted via blood, blood products and unsafe sex from one person to another in the community. 1014 blood donors were screened for Hepatitis B, Hepatitis C and HIV antigen. 79 were found reactive for HBV, 37 reactive for HCV and HIV reactive was found none. The recipients of Hepatitis C and Hepatitis B reactive blood are 20 times more likely to have evidence of post transfusion Hepatitis C and Hepatitis B infection than recipient of Hepatitis C and Hepatitis B non reactive blood. This study was carried out with the objectives to see prevalence of Hepatitis C, Hepatitis B and HIV infection in blood donors, Hepatitis B Hepatitis C and HIV infection association with parentraI therapies, etc. Blood donors record for HBV, HCV and HIV was collected from blood bank of Fatimid Center Multan. Among 79 Hepatitis B reactive blood donors 30 [37.97%] had history of previous blood transfusion, 7 [8.86%] had parentral therapy, 2 [2.53%] had history of drug addiction, 2 [2.53%] had history of sexual contact while 37 Hepatitis C reactive blood donors 5 [13.51%] had history of previous blood transfusion and 20 [54.05%] had history of parentral therapy. None had history drug addiction, 9 [24.32%] had history of sexual contact. Luckily no HIV infection reactive case was found. The results of the present study underline the dire need to have a national comprehensive plan with multidisciplinary approach for HBV, HCV, HIV prevention is the community. It is suggested that blood and blood products should be screened for HCV, HBV, HIV infection before transfusion and use of disposable syringes, other sterilized instruments during hospital stay and use of disposable razors at barbers shop must be kept in mind

Weaning practices in urban and rural areas of Pakistan

Weaning practices varies in different communities and affected by beliefs. Family feeding order, attitudes towards weaning nutrition, geography, economic status, climate etc. Detailed knowledge of above factors is essential to improve the child nutrition. The growth of an infant and a young child is almost totally dependent on the nutrition he is getting. Improper feeding practices and poor nutrition of a young child can lead to ill health and malnutrition. It is essential to explore the knowledge, customs, beliefs and their effects to overcome malnurition and growth retardation. It is also necessary to know about the knowledge, attitude and practices relating to weaning in different communities and factor influencing these. The study is conducted on mothers of children at the age of weaning from both unban and rural origin. Simple random sampling technique is adopted for the study purpose. A questionnaire prepared to evaluate knowledge, beliefs, customs, and dietary habits relating to weaning and effect of economy, demography, literacy etc. on the believes, customs and practices. After collection of data, analysis done to draw conclusions. The study shows that 65% children are weaned at the age of 4 to 6 months in urban population while 50% in rural areas. In both population middle class weaned their children early, education also improved the situation. Weaning before the age of 3 months existed to some extent in both populations. Mixed feeding prevalent in both communities. Trend towards introduction of processed foods is more in both populations, food fads and to boos are also present, but more prevalent in rural areas, due to these high energy and protein foods are usually prohibited for a young child. In urban areas, children of working mothers also affected due to improper look after by the servants and relatives. The study shows that many children in both rural and urban population do not receive the right food to eat in their early childhood. This is resulted in growth retardation, and ill health in most children. This is true more in rural areas as compared to urban areas, but there are no significant differences in both populations, Predisposing factors include low income of the family, illiteracy, delayed weaning, late introduction of high-energy foods, protein and other nutrients for infant growth. In case the weaning foods are introduced to the infant at the right age, their frequency is less than required number of feeds per day

Non-occupational lead exposure and hypertension in Pakistani adults / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Hypertension is one of the most prevalent diseases in the developed and developing countries. Based on the long historical association and the provocative findings of blood pressure effects at low level of lead exposure a study was carried out to determine if an association existed between low blood lead concentration and hypertension. In this study the effects of low-level exposure to lead on blood pressure were examined among 244 adults using atomic absorption spectrometer. For quality assurance purpose certified reference materials i.e., Animal blood A-13, Bovine liver 1577 and cotton cellulose V-9 from IAEA (International Atomic Energy Agency) and NIST (National Institute of Standard Technology) were analyzed under identical experimental conditions. The mean age of hypertensive adults was 52 years (range 43 - 66). The mean values of systolic and diastolic blood pressure were (209+/-11.7) (range 170 - 250) and (117+/-3.9) (range 105 - 140) mmHg respectively. Blood lead concentration ranged from 78 - 201 microg/L with a mean of 139 microg/L and 165 - 497 microg/L with a mean of 255 microg/L in normal and hypertensive adults respectively. Increase in systolic blood pressure was significantly predictive with increase in blood lead levels. Body mass index (BMI) and lipid profile including total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol and triglyceride correlated with blood pressure.

A study of the pattern of head injury in District Aligarh. U.P.. India.

Trauma as a general rule carries medicolegal implication. Head injury adds complexity to the problem as it adversely affects the complete evaluation of trauma until some time has elapsed after a particular injury. The often ill-defined clinical manifestation, the impact of claim settlements, and malingering further add to the problem of fair decision.

Metanephric adenoma: a rare benign renal tumor

Metanephric adenoma is a rare benign renal tumour. We are reporting one histologically proven such case in a 23 year old male from Afghanistan. He presented with severe right flank pain since 3 weeks. Nephrectomy was done and histopathology was consistent with the diagnosis of metanephric adenoma. This novel renal mass has been reported to have benign clinical course despite its symptomatic presentation and large tumour size. There is no distinguishing radiological feature with can differentiate it from malignant tumours. So far, a uniformly benign clinical course has been associated with Metanephric adenoma, but given its relatively recent identification and rarity and the lack of clinical, radiographic, or cytologic means to establish a definite diagnosis, Metanephric adenoma remains primarily a pathologic diagnosis

Hearing loss and diabetes in a United Arab Emirates population: a prospective controlled study

This study aims to answer a question of whether hearing loss is associated with diabetes in a UAE population in Fujairah. Strict exclusion criteria were applied to eliminate other causes of hearing loss that may interfere with assessment. Thirty-nine patients were included in the study. These were compared to 39 normal controls who were age, sex and race matched on a 1:1 basis. The two groups were balanced as far as possible regarding social class. All subjects underwent an ENT examination and had a pure tone audiogram performed. The mean hearing thresholds were calculated for both groups at various speech frequencies [500-4000 Hz]. Statistical analysis using non-pairedt-test revealed no significant difference between cases and controls regarding mean hearing thresholds. We conclude from our study that hearing loss may be associated with diabetes in the population studied in Fujairah

Blunt, external laryngeal trauma, clinincal analysis and management, experience at combined military hospital, Rawalpindi

18 cases of external laryngeal trauma are being analyzed retrospectively. Main etiological factors were road traffic accidents 11 cases [61.11%] accidental strangulation 3 cases [16.66%], blunt trauma due to fall 1 case [5.5%] during fight 2 cases [11.11%] and suiccidal attempt 1 case [5.55%]. Most of the patients presented with hoarseness or aphonia 8 cases [44.44%], pain and tenderness of neck 6 cases [33.33%], odynophagia 6 cases [33.33%] and swelling of the neck one case [5.55%]. After careful history, meticulous examination and detailed investigations patients were grouped according to clinical findings. Group one had 4 patients having supraglottic swelling, edema, ore stenosis occurs as a squalal of lalpferl trauma ad occurs after sometime, not immediatily after trauma hamatoma [22.22%], group two had six patients having supraglottic stenosis [33.33%] group three had subglottic stenosis. Number of patients was again 6 [33.33%]. Group four had two patients having subglottic stenosis and tracheal stenosis [11.11%]. Treatment was varied depending upon the severity of the injuries. Fourpatients [22.22%] were managed by tracheostomy and conservative measures i.e., voice rest, humidification and bed rest. Fourpatients [22.22%] underwent laryngotracheal reconstruction with hyoid descent, three patients [16.66%] had suprahyoid release, resection and reanastomosis of stenotic segment. Two patients [11.11%] had laser ablation, two patients [11.11%] had laser ablation and serial dilations and one patient [5.55%] had laryngotracheal reconstruction with hyoid descent and augmentation with septal cartilage. Three patients [16.66%] underwent more than one operation. Fifteen patients out of eighteen [83.33%] recovered un-eventfully having stable air way, voice capable of verbal communication, decannulation and swallowing without aspiration, two patients [11.11%] are still not decannulated and are declared unsuccessful, one patient [5.55%] has got left vocal cord paralysis. A delay in early detection of external laryngeal trauma may precipitate life threatening airway compromise later on, therefore prompt and accurate diagnosis should immediately be followed by skillful air way management

Moxonidine-in mild to moderate systemic hypertension

We have recently concluded a nation wide post marketing study on efficacy and safety of Moxonidine in mild to moderate hypertensives. In all 97 patients were enrolled and out of these 87 completed a 12 weeks trial. There was an average drop of 12.9 mmHg in the DBP and 16.5 mmHg in SBP. 80% patient required a daily dose of 0.2 - 0.4 mg of Moxonidine for control of their BP In 84% of the patients completing the trial the BP changed from moderate to mild or normal or from mild toonormal. The drug was well tolerated, only 2.3% having adverse effects. We conclude that the drug studied is an effective alternate for the control of hypertension

Towards the control and cure of colorectal cancer

Colorectal cancer is the second most common visceral cancer in adult Americans. Progress in medical science has not altered mortality from colorectal cancer. Prevalence of colorectal cancer in Pakistani population is not known, but it is being detected with increasing frequency

Endoscopic therapy of colonic volvolus

Endoscopic therapy for colonic volvulus is an important and valuable advancement in the management of this disorder. It can be easily performed successfully in the majority of cases. In sigmoid volvulus, it stabilizes a patients for elective surgery with a significant reduction in the mortality. Early diagnosis and management are mandatory. In cases of cecal volvulus there has not been enough experience to make definite recommendations but endoscopic decompression and correction of the twist are worthwhile procedures in an effort to stabilize a patients for elective surgery later