Role of pipelle versus dilatation and curettage in tissue diagnosis abnormal uterine bleeding

Background: Menstrual irregularities and abnormal heavy menstruation account for up to 26-35% of women attending Gynecological outpatient Department. Abnormal Uterine Bleeding (AUB), it is more common at extremes of age endometrial hyperplasia occurs in 5-10% of patients with post-menopausal bleeding out of which atypical hyperplasia has 26-32 % risk of having malignancy in future. Therefore, endometrial sampling for histopathology is important in the assessment of abnormal uterine bleeding is mandatory. Our study was conductive to know the effectiveness of pipelle type devices, versus Dilatation and curettage in obtaining quality endometrial tissue for histopathological examination.Methods: The study was undertaken in Department of obstetrics and gynaecology along with department of Pathology at Rajarshi Chhatrapati Shahu Maharaj, government medical college, Kolhapur after getting approval from the Hospital Committee on Clinical Research and Ethical Committee of the institution, during the period from October 2016 to March 2017 (six months). Total number of subjects included in study is Hundred after taking into consideration of inclusion and exclusion criteria.Results: The ease of doing procedure was much easier as compared to D&C and the Tissue sample obtained for histopathological examination were as par D&C. It was concluded that histopathology report was available in 92 of the 100 pipelle samples and 93 of 100 D&C samples. It was also, observed that increased endometrial thickness was not always associated with adequate tissue diagnosis.Conclusions: Pipelle is simple, affordable, patient friendly can be easily performed with minimal training, which can be performed in Outpatient Gynaecological Department. The diagnostic value and positive predictive value of Pipelle is at par with conventional D&C. So, pipelle can be recommended for all perimenopausal patients with AUB to rule out various, premalignant and malignant conditions of the endometrium.

Early Stoma Closure in Patients with Temporary Intestinal Stoma’s- A Hospital Based Study

Background: Intestinal stoma formation is beneficial in patients who cannot sustain prolonged surgery due to poor general condition, hemodynamic instability or other co-morbid conditions. Stoma formation decreases mortality and morbidity in such patients. However, stoma formation itself is associated with complications like skin irritation, prolapse, retraction, electrolytes loss etc. Early closure of temporary stomas will reduce patient’s physical and psychological discomfort. Aim: - To study the feasibility and advantages/ disadvantages of early closure of temporary intestinal stomas i.e. within 3 weeks. Design and Place:-This is a prospective observational study which was conducted over one year (2011 to 2012) on thirty (31) patients with temporary stomas for various etiology admitted in Department of surgery, Government medical college, Jammu. Methods: Patients with temporary stoma for various reasons were subjected to early stoma closure i.e. within three weeks (21 days) after confirming distal patency. Merits and complications of early stoma closure were noted. Results: Out of 31 patients, early stoma closure was done in 30 patients. Intra-operatively one (3.33%) patient was found to have pus collections, so stoma closure was not done. Wound infection in 5(16.6%) patients, Paralytic Ileus in 2(6.66%) patients and wound dehiscence in 1(3.33%) patient were the noted complications, all of which were managed conservatively. One patient (3.33%) had post stoma closure intestinal obstruction for which re-laparotomy was done and stoma recreated. Conclusion: Early closure of temporary stoma offers improved quality of life to the patient with no significant post operative complications.

Left-sided appendicitis in a 14-year girl with midgut malrotation

We present a case of 14-year girl with left-sided acute appendicitis who presented with lower abdominal pain. Midgut malrotation occurs at a rate of 1 in 500 live births. The condition is incidentally diagnosed during various radiological investigations done for other purposes. However, such patients may present with conditions like acute appendicitis, which poses a diagnostic dilemma if a high index of suspicion is not kept. The purpose of this case report is to increase awareness in the emergency physicians and young surgeons of this rare presentation; and the importance of radiological investigations in the diagnosis of left-sided appendicitis, to decrease morbidity and mortality

Fascial slings: a new adjunct to Brachiobasilic Fistula Elevation fascial slings

Objective: To introduce a new technique of fascial slings created from fascia over biceps muscle as an adjunct to Brachiobasilic fistula elevation contributing in the ease of cannulation and position of arm for both nursing staff and the patient

Study Design: Retrospective study

Place and Duration of Study: This study was carried out in Combined Military Hospital Rawalpindi, form Jan 2016 to Apr 2017

Patients and Methods: The demographic and outcome data of the patients, who underwent Brachiobasilic Elevation using fascial slings, were collected and analyzed retrospectively

Results: A total of 89 [60 males, mean age 44.2 +/- 14 years and 29 females mean age 42.6 +/- 12 years] patients underwent brachiobasilic fistula elevation. The distance of fistula vein from skin incision at mid arm was found to be consistent from the per op measurement till the last assessment at 6 months. In our study it was 5 +/- 0.7 cm. Slinged vein was found to be easy to cannulate in first prick as per dialysis nursing staff. Fistula maturation rate was 91 Percent. A total of eight [9 Percent] fistulae were never put on dialysis because of thrombosis. The mean maturation time was 40 +/- 14 days. Fifteen [16 Percent] patients had arm edema, and twelve [13 Percent] had infections. Patients had similar ease of arm position as of brachiocephalic AVF during dialysis

Conclusion: Considering the consistent post op distance of fistula vein from scar site, ease of cannulation for the dialysis staff and comfort of arm position for the patient during dialysis after fascial slings it is concluded that fascial slings are good adjunct to basilic vein elevation technique

Accuracy of Ca-125 concentration as predictor of peritoneal dissemination of colo-rectal carcinoma

Objective: To determine the association of CA-125 levels with the peritoneal dissemination among the patients of colo-rectal carcinoma at a tertiary care surgical oncology unit of Pakistan

Study Design: Observational study

Place and Duration of Study: Department of Surgical Oncology, Combined Military Hospital Rawalpindi. Duration of ten months, from Jan 2018 to Oct 2018

Patients and Methods: A total of 83 cases of colorectal carcinoma were included in the study, which were diagnosed by consultant oncologist after relevant histological and radiological investigations. Peritoneal dissemination was confirmed during the surgery. CA-125 levels were assessed before the surgery and cut off of 35U/mL was used. Relationship of age, gender, raised CA-125, tumor metastasis and tumor differentiation was assessed with the presence of peritoneal dissemination among the patients suffering from colo-rectal cancer

Results: Fifty nine patients were males and 24 were females. Mean age of the patients was 51.17 [+/-3.395]. Out of 83 patients of colo-rectal cancer, 37.3 percent showed the presence of peritoneal dissemination while 62.7 percent had no peritoneal dissemination at the time of surgery. Forty one patients had raised levels of CA-125 while 42 had levels within the normal range. After applying the logistic regression we found that raised levels of CA-125 and metastatic illness had significant association with the presence of peritoneal dissemination among the patients of colo-rectal cancer

Conclusion: CA-125 concentration emerged as a strong predictor of peritoneal dissemination of colo-rectal cancer in our study analysis. Routine checking of levels of this marker among the patients of Colon cancer may help in early recognition of the advancement of disease and help the surgical oncologists to manage it in a more effective way

Evaluation of Genetic Diversity amongthe Pakistani Wheat (Triticumaestivum L.) Lines through Random Molecular Markers

ABSTRACT The presence of geneticdiversity is of great importance in improving wheat traits and developing strategies for optimal conservation of germplasm. Genetic diversity was assessed among common wheat cultivars using RAPD (Random Amplified Polymorphic DNA) markers at the Center of Agriculture, Biochemistry and Biotechnology (CABB), University of Agriculture, Faisalabad. RAPD primers were used among 14 Pakistani wheat cultivars, to screen the progenies and for the identification of the genes of interest. The polymorphic information content (PIC), was measured as the percentage of polymorphic fragments for all primers. A total of 583 bands(84% polymorphic) in all 14 wheat cultivars was amplified and discriminated all the wheat genotypes. The number of fragments amplified per primer ranged from 35 to 69 with an average of 48.52 fragments per primer averagely was observed. Population structure analysis anddandrogram showed distinct clustering among different wheat genotypes. Millat-11, Punjab-11, PBW-222 generated the maximum level of polymorphism, standing alone in the cluster while others are scatteredin different group.As a result, genetically numerous progenies are known, increasing the quality of sorts collections by broadening the genetic base of wheat cultivars. This study additionally indicates that RAPD markers allow quicker response and provide high throughputprocedure of accessions from a variety assortment to assess genetic diversity among wheat genotypes.

Pain relief in neuropathic pain-a comparison between 0.5% bupivacaine and 0.5% bupivacaine streptomycin combination

Objective: To compare the effectiveness of a combination of streptomycin and bupivacaine for the management of neuropathic pain against bupivacaine alone

Study Design: A randomized controlled double blinded trial

Place and Duration of Study: Pain clinic Combined Military Hospital [CMH] Rawalpindi, CMH Nowshera, Dermatology Dept. Military Hospital [MH] Rawalpindi, Department of Medicine, Surgery CMH Nowshera Feb 2009 to Feb 2010

Material and Methods: Fifty patients with post herpetic neuralgia [PHN], 10 patients with trigeminal neuralgia and 20 patients with nerve entrapment pain were included in the study. For each type of neuropathic pain, the patients were randomly divided into two groups. Group [B] received nerve blocks using 0.5% bupivacaine and group [BS] received nerve blocks using 0.5% bupivacaine and streptomycin Igm combination. A series of four nerve blocks on alternate days were given. VAS [Visual Analogue Scale] was recorded at four, eight and twelve weeks after the last nerve block. Mean baseline VAS and at 12 weeks post treatment in groups B and BS were compared for pain relief and the mean VAS at 12 week post treatment in both the groups was compared for the difference in pain relief between the two groups. Students't test was used for statistical analysis utilizing SPSS 10 versions

Results: Post herpetic neuralgia - group [B]: at 12 weeks, mean VAS was 5.75 in gp [B] and 2.26 in gp [BS] respectively. Nerve entrapment pain- group [B] at 12 weeks, mean VAS was 6.62 whereas in group [BS] VAS was 1.33. Trigeminal neuralgia-group [B] At 12 weeks mean VAS was 7.0. gp [BS] mean VAS was 1. Pain relief achieved was excellent

Conclusion: Streptomycin and bupivacaine combination is an effective modality to manage neuropathic pain. The pain relief achieved by streptomycin-bupivacaine combination is superior to that achieved with bupivacaine alone

Rationalization of routine crossmatched blood arrangement for caesarean deliveries and analysis of risk factors requiring blood transfusion

Objective: To assess the incidence of blood transfusions required in Caesarean section [CS] and evaluate the rationale of routinely arranging cross matched blood for every patient

Study Design: A chart review retrospective descriptive study

Place and Duration of Study: This study was conducted at the Anesthesia Department of Combined Military Hospital [CMH], Lahore, from June 2011 to May 2013

Patients and Methods: In this retrospective study we reviewed all singleton CS performed using data from blood bank registry and all CS patient's charts obtained from the Records Department of the hospital. Clinical variables including demographic characteristics, estimated blood loss, indications for CS, preoperative haemoglobin and indications for transfusion were gathered. Patients transfused with blood had their medical records reviewed by two reviewers to confirm accuracy and identify risk factors for haemorrhage

Results: A total of 6250 caesareans deliveries were performed over the study period. Out of these 381 patients were transfused [6.09%]. Blood typing and screening was done for 3260 cases [52%] and blood was arranged for 2320 [37%]. Among blood receiving patients 250 patients [65.62%] were emergencies. Ninety eight patients [25.72%] were primigravida. Indications for transfusion mentioned in the charts were preoperative anaemia [18.37%], repeat caesarean sections [39.37%], placenta previa [6.56%], severe preeclampsia [17.06%], failed progress in labor and other rare causes [18.37%]

Conclusion: Transfusion risk in patients undergoing routine CS is low. Factors indicating risk for transfusion include preoperative anaemia, repeat caesareans, severe preeclampsia, obstructed labor and placenta previa. In the absence of these risk factors routine arrangement of the blood does not enhance patient care

Formulation design and characterization of a non-ionic surfactant based vesicular system for the sustained delivery of a new chondroprotective agent

Diacerein is used for symptomatic relief and cartilage regeneration in osteoarthritis. Due to gastrointestinal side effects, poor aqueous solubility and low bioavailability, its clinical usage has been restricted. The objective of the present study was to enhance its dissolution profile and to attain sustained release by designing a novel delivery system based on niosomes. Five niosomal formulations (F1-F5) with non-ionic surfactant (sorbitan monostearate) and cholesterol in varying ratios of 5:5, 6:4, 7:3, 8:2 and 9:1 were developed by the reverse-phase evaporation technique. The size and polydispersivity index (PDI) were found in the range of 0.608 µm to 1.010 µm and 0.409 to 0.781, respectively. Scanning electron microscopy (SEM) of the selected formulation (F3) revealed spherical vesicles, and 79.8% entrapment was achieved with F3 (7:3). Dissolution studies using the dialysis method showed sustained release behaviour for all formulations. The optimized surfactant-to-cholesterol concentration (7:3) in formulation F3sustained the drug-release time (T50%) up to 10 hours. Kinetic modelling exhibited a zero-order release (R2=0.9834) and the release exponent 'n' of the Korsmayer-Peppas model (n=0.90) confirmed non-fickian and anomalous release. The results of this study suggest that diacerein can be successfully entrapped into niosomes using sorbitan monostearate and that these niosomes have the potential to deliver diacerein efficiently at the absorption site.

A diacereína é usada para o alívio sintomático e para a regeneração da cartilagem na osteoartrite. Devido aos efeitos adversos gastrointestinais, baixa solubilidade aquosa e biodisponibilidade, o seu uso clínico tem sido restrito. O objetivo do presente estudo foi melhorar o perfil de dissolução deste fármaco e obter liberação prolongada através do planejamento de um novo sistema de liberação designado de niossoma. Cinco formulações distintas de niossomas (F1 a F5) contendo tensoativos não iônicos (monoestearato de sorbitano) e colesterol, em diferentes proporções, de 5:5, 6:4, 7:3, 8:2 e 9:1, foram desenvolvidas através da técnica de evaporacão de fase reversa. Os tamanhos e índices de polidispersibilidade (PDI) obtidos variam entre 0,608 e 1,01 µm e entre 0,409 e 0,7781, respectivamente. Imagens de microscopia electrônica de varrimento (SEM) da formulação selecionada (F3) revelaram vesículas esféricas. Obteve-se encapsulação de 79,8% com a formulação F3 (7:3). Estudos de dissolução usando o método de diálise demonstraram padrão de liberacão prolongada para todas as formulações. A proporção de tensoativo e colesterol (7:3) na formulacão F3 prolongou o tempo de liberação do fármaco (T50%) até 10 horas. Estudos de modelação cinética demonstraram ordem de liberacão zero (R2=0,9834) e o expoente de liberação "n" do modelo de Korsmayer-Peppas (n=0.90) confirmou a liberação não-fickiana e anômala. Os resultados deste estudo sugerem que a diacereína pode ser encapsulada com sucesso no interior de niossomas, utilizando monostearato de sorbitano, o qual tem potencial para liberar, eficientemente, a diacereína no local de absorção.

Gastroprotective effects of cuscuta reflexa on aspirininduced peptic ulcer

Background: Gastroprotective effects of cuscuta reflexa may be considered as alterative to many currently used anti peptic ulcer drugs

Objective: To explore the in-vivo gastroprotective activity and antiulcer potential of crude extract of the indigenous medicinal plant, Cuscuta reflexa, belonging to the plant family 'Convolvulace

Methodology: This experimental study was conducted from 1[st] March to 1[st] July 2015 at faculty of pharmacy and alternative medicine, Islamia Universty Bahawalpur. The antiulcer activity of Cuscuta reflexa [Cs.Cr] was investigated in aspirin-induced ulcer models. Wistar Albino rats were divided into six groups, each consisting of six animals. Control and intoxicated groups received normal saline at the dose of 8 ml/kg, standard group received Cimetidine [100 mg/kg] and the test groups received three different doses [30, 100 and 300 mg/kg] of Cs.Cr oraly individually for seven days, with subsequent administration of aspirin [200 mg/kg oraly] for two consecutive days. At the end of the experimental period, rats were anaesthetized and sacrificed. The stomach was removed and incised to collect the gastric juice for determination of pH and acidity. The stomach from each group was evaluated for ulcer index and percent protection. Afterwards, stomachs were weighed and samples preserved in 10% formalin for histopathological studies. Acute toxicity studies were also performed in mice. The extract [Cs.Cr] was also analyzed phytochemically for the presence of various secondary metabolites

Results: Oral administration of the crude extract of Cuscuta reflexa [Cs.Cr] exhibited dose-dependent [30-300 mg/kg] significant protection [p<0.05] in the Aspirin-induced peptic ulcerated animals. The extract, Cs.Cr, was found to be safe up to the dose of 10 g/kg in mice. Phytochemical analysis showed the presence of several metabolites like glycosides, flavonoids, saponins, terpenes and tannins in the crude extract of the plant

Conclusion: The results of the study clearly showed that Cs.Cr possesses gastroprotective potential and caused the reversal of peptic ulceration which justify the traditional use of the plant in several gastric ailments like hyperacidity, gastro-esophageal reflux disease and ulcer. However, further investigations are needed to explore the exact mechanism[s] responsible for protective effects of the plant

Analysis of physiological [PAO[2], pulse and blood pressure] changes during modified ECT under general anaesthesia

To study the changes in physiological parameters ie PAO[2], pulse and blood pressure changes during ECT under GA. Quasi-experimental study. Department of Psychiatry and Department of Anaesthesiology, Combined Military Hospital Abbottabad from Sep 2009 to Feb 2010. A total of 50 patients with depression were given four separate ECT sessions each. All patients were anaesthetized using propofol 180-200 mg I/V and suxamethonium 50 mg ie 0.75-1 mg per kg I/V without atropine. They were stratified according to physiological changes including PAO[2], pulse and blood pressure at 1, 2 and 5 min after ECT. Oxygen saturation was measured using a pulse oximeter, which measures saturations in the range of 65-100%. Age range was 19-65 years; mean 46 years [SD +/- 13]. Mean diastolic BP before ECT was 84.72 that decreased post ECT ie 78.02 and 77.46 and 74.44 at interval of 1, 2 and 5 minute respectively. Post-ECT pulse and PAO[2] behaved similarly. Post ECT systolic BP decreased at land 5 minutes. Pulse rate decreased after ECT. ECT under propofol is one of the most effective and safe modality of treatment for psychiatric patients under the supervision of qualified psychiatrists and anaesthesiologists and it gives more stable hemodynamic changes

Ocular complications of dengue fever

Dengue fever is an endemic disease in the tropics and subtropics and has become a health threat worldwide in recent years. Dengue-related ocular complications are increasingly being reported from countries in South-East Asia. The authors report the first documented case of a patient with dengue fever who developed central retinal artery occlusion in addition to many other eye complications such as severe ptosis and complete internal and external ophthalmoplegia during her convalescent phase. The disease was confirmed by specific serological tests. Despite treatment, severe visual impairment occurred in this case.

Alianza mundial en pro del personal sanitario: aumentando el impulso para el desarrollo de personal de la salud / Global health workforce alliance: increasing the momentum for health workforce development

La Alianza en Pro del Personal Sanitario fue lanzada en el año 2006 para brindar una plataforma conjunta a los gobiernos, a las asociaciones de desarrollo, las agencias internacionales, las organizaciones de la sociedad civil, academia, el sector privado, las asociaciones profesionales y otros actores interesados, para trabajar juntos a fin de enfrentar la crisis global de los recursos humanos en salud. Cinco años después, la visión y el mandato de la Alianza aún son válidos. A pesar de los avances, como el ubicar a personal de la salud en el ruedo internacional de la política de salud, el aumento del conocimiento, las herramientas disponibles y las señales alentadoras de compromisos de muchos países, los cuellos de botella de la fuerza laboral de la salud siguen impidiendo a muchos sistemas de salud entregar servicios de salud esenciales y de calidad. América Latina no está libre de estos desafíos. En el 2010 el Segundo Foro Mundial sobre Recursos Humanos para la Salud permitió revisar el progreso, identificar brechas persistentes, alcanzar un consenso sobre soluciones y renovar el impulso para el compromiso de las inversiones y actuaciones urgentemente requeridas.

The Global Health Workforce Alliance was launched in 2006 to provide a joint platform for governments, development partners, international agencies, civil society organizations, academia, private sector, professional associations, and other stakeholders to work together to address a global crisis in human resources for health. Five years later the vision and mandate of the Alliance still remain valid. Despite advances in bringing the health workforce to the fore in international health policy arenas, more available knowledge and tools, and encouraging signs of commitments from many countries, health workforce bottlenecks continue to prevent many health systems from delivering essential and quality health services. Latin America is not spared from the challenges. The 2010 Second Global Forum on Human Resources for Health provided an opportunity to review progress, identify persisting gaps, reach consensus on solutions, and renew the momentum for and commitment to acutely needed investment and actions.

Pattern of somatic symptoms in anxiety and depression

To determine the pattern of somatic symptoms in anxiety and depressive disorders. Cross Sectional Comparative study. Department of Psychiatry Military Hospital Rawalpindi. From May to November 2002. Patients were divided in Group I of anxiety and group II of depression. Fifty patients considered in each group by convenience sampling. The organic basis of their symptoms was ruled out. The patterns of their somatic symptoms and other information like educational and economic status were recorded on Semi Structured Proforma. The patient's diagnosis was made on schedule based ICD-10 research criteria. The severity of anxiety and depression was assessed by using HARS and HDRS respectively. The pattern of somatic symptoms in both groups was then analyzed by the urdu version of Bradford Somatic Inventory. Patterns of somatic complaints were then analyzed by chi square test. Out of 100 patients we placed 50 each in group I [anxiety] and group II [Depression]. Males were higher in depression whereas females were higher in anxiety disorder group. P-value for headache was 0.017 while in rest of the somatic symptoms it was insignificant ranging from 0.4 to 1. We found that the patterns of somatic symptoms are present in both the groups of anxiety and depression like symptoms related to musculoskeletal and gastrointestinal system were commonly observed in cases of depression whereas symptoms related to autonomic nervous system and cardiovascular system is more significantly somatized in patients of anxiety. A larger sample is required for further studies to get better results

Retrospective analysis of cases of acute endophthalmitis after surgery

To find out the prevalence and visual outcome of acute endophthalmitis after cataract surgery. Retrospective. 1[st] January 2001 to 31st December 2009. Wah Medical College, P.O.F. Hospital Wah Cantt, Rawalpindi. Fifty cases of acute endophthalmitis who had undergone treatment. Each case of acute endophthalmitis was evaluated in terms of presentation, detailed examination, treatment and outcome. Microbiological culture of the vitreous aspirates was also done to identify the causative organism. The analysis was also meant to identify the prognostic factors of visual outcome of these cases. Fifty patients presented with acute endophthalmitis out of the fifteen thousand cataract surgeries performed during the 9 year period. The incidence of endophthalmitis was 0.33% [95% CI]. A vitreous biopsy with intravitreal injection of antibiotics was done in all the cases presenting with acute endophthalmitis. Decreased visual acuity [90%] and pain [75%] were the main presenting features in these cases. There were 36 [72%] culture positive cases, with staphylococci [50%] being the most common organism found. Vitreous biopsy yielded positive results in 36 [72%] patients while negative results with no microbial growth was found in 14[28%] patients. There were 20 [40%] growths of coagulase negative staphylococci, 5 [10%] growths of streptococci, 8 [16%] growths of coagulase positive staphylococci, and 3 [6%] of gram negative organisms. The final visual outcome was recorded after one month. 8 [16%] patients achieved 6/12 or better, 26 [52%] patients achieved moderately good visual acuity 6/60 to 6/12, while 16 [32%] patients achieved poor visual acuity of less than 6/60. Of the latter group who had poor visual acuity, 2 [4%] patients had only perception of light while 1 [2%] patient had no perception of light and 1 [2%] patient had blind and painful eye who had to undergo evisceration. 6 [16%] patients achieved 6/12 or better visual acuity. The incidence of endophthalmitis is consistent with other studies. Laboratory diagnosis of the vitreous aspirates helps in the treatment. Achieving a good visual outcome is possible with treatment of the cases of acute endophthalmitis

Cerebral blood flow patterns using single photon emission computed tomography in patients with dissociative disorders and healthy controls

To compare the cerebral blood flow [CBF] changes in patients diagnosed to have Dissociative Disorder with healthy controls. Cross Sectional Comparative study. The study was done in the Department of Psychiatry Military Hospital Rawalpindi in collaboration with Nuclear Medical Centre [NMC] Armed Forces Institute of Pathology [AFIP], a tertiary care centre of Pakistan Armed Forces from Dec 2004 to May 2005. This cross sectional comparative study was done at Dept of Psychiatry Military Hospital Rawalpindi in collaboration with nuclear Medical Centre [NMC], at Armed Forces Institute of Pathology [AFIP] which is a tertiary referral center. A sample of 30 patients diagnosed as having Dissociative Disorder was compared with 10 controls for brain perfusion changes using TC-99m HMPAO [Hexamethyl-propylene-amine-oxime] Tc-99m. In group 1 perfusion changes were observed in 27 [90%] cases whereas unremarkable and insignificant changes were noted in 3 [10%] cases but no perfusion were noted in controls [P< 0.001] In patients who were suffering from different types of dissociative disorder marked cerebral hypoperfusion was observed in frontal, frontomotor, orbitofrontal and temporal regions whereas hyperperfusion was noted in frontal and orbitofrontal areas in few cases. Cerebral blood flow changes in the fronto parietal brain are associated with symptomotology in dissociative disorders

Global hospital bed utilization crisis. a different approach

To test the effect of improved physician availability on hospital bed utilization. A prospective cohort study was conducted from 1 st January 2009 to 31 st March 2009 in the Division of Internal Medicine [DIM], King Abul-Aziz Medical City [KAMC], Riyadh, Kingdom of Saudi Arabia. Two clinical teaching units [CTU]were compared head-to-head. Each CTU has 3 consultants. The CTU-control provides standard care, while the CTU-intervention was designed to provide better physician-consultant availability. Three outcomes were evaluated: patient outsourcing to another hospital, patient discharge during weekends, and overall admissions. Statistical analysis was carried out by electronic statistics calculator from the Center for Evidence-Based Medicine. Three hundred and thirty-four patients were evaluated for admission at the Emergency Room by both CTU's. One hundred and eighty- three patients were seen by the CTU-control, 6 patients were outsourced, and 177 were admitted. One hundred fifty-one patients were seen by the CTU-intervention: 39 of them were outsourced, and 112 were admitted. Forty-eight weekend patient discharges occurred during this period of time: 21 by CTU-control, and 27 by CTU-intervention. Analysis for odds ratio in both the rate of outsourcing, and weekend discharges, showed statistical significance in favor of the intervention group. The continuous availability of a physician-consultant for patient admission evaluation, outsourcing, or discharge during regular weekdays and weekends at DIM, KAMC proved to have a positive impact on bed utilization

Antibacterial effect of nsaids on clinical isolates of urinary tract infection and diabetic foot infection

Non Steroidal Anti-inflammatory Drugs [NSAIDS] are a group of chemically dissimilar agents that have primary effect of inhibition of prostaglandin's synthesis. Aspirin [Acetyl Salicylic Acid] is used as an analgesic, anti pyretic, anti-inflammatory agent and also have an anticoagulant effect. Tylenol [acetaminophen] is used as pain reliever. The objective of this study was to determine the effect of Aspirin and Tylenol against clinical isolates of urinary tract infection [UTI] and diabetic foot infections. A total of 100 clinical isolates were analyzed. Out of these 50 were urine samples from diabetic patients with UTI and 50 pus samples from diabetic foot infection. Bacteriological study was done by inoculating urine samples on Cysteine Lactose Electrolyte deficient [CLED] media. Pus samples were inoculated on Blood agar and MacConkey's agar. Identification was done by colony characteristics, gram staining and standard biochemical tests and Quick Test Strip [QTS-20] DESTO Laboratories, Karachi. Antibacterial effect of Aspirin and Tylenol were tested against 100 clinical isolates by Replica plate method, Agar well diffusion method and tube dilution method. Concentrations of Aspirin and Tylenol [10 micro g, 50 micro g, 100 micro g, 500 micro g, 1000 micro g] were made in Muller Hinton media. Bacteria isolated from urine samples were Escherichia coli 30%, Staphyloccus aureus 20%, Entrococcus faecalis 10%, S.saprophyticus l0%, Proteus spp 6%, Pseudomonas spp.6%, S. pyogenes 6%, S. agalactiae 6%, S.epidermidis 4%, and Klebsiella spp. 2%. Bacteria isolated from pus samples were S aureus 30%, Pseudomonas aeruginosa 18%, S.epidermidis 14%, Klebsiellapneumonia 12%, Proteus mirabilis 12%, E. coli 10%, P.vulgaris 4%. Aspirin was effective at 100-500 ug concentration against all isolates. Tylenol has marked effect on pathogens at 100 micro g concentration. Aspirin and Tylenol along with analgesic, anti-pyretic, anti-inflammatory properties also have marked anti bacterial effect on isolates from UTI and Diabetic foot infections and inhibits the growth of both gram negative and gram positive bacteria, and both can be used synergistically with antibiotics for effective treatment

Effect of diabetes on ocular lens thickness

To determine the effect of hyperglycemia on thickness of crystalline lens of eye in diabetic population and its comparison with non-diabetics of same age group. Cross sectional observational study. The study was conducted at Railway General Hospital, Rawalpindi. A total 112 patients over a period of six months were included in study. Ocular lens thickness was measured in 56 diabetic patients and 56 non-diabetic controls by using A-scan biometry. Parameters like duration of diabetes and type of medication were recorded. 112 patients were divided into two groups. In diabetic group [56 patients], most of the patients i.e. [42%] had BSR more than 200 mg/dl. Out of 56 controls, most of the subjects i.e. 54%] had BSR between 70-90mg/dl. Thickness of crystalline lens was in the range of 4.00-6.21 mm with mean of 5.10mm in diabetics and in range of 4.00-4.50mm with mean of 4.16mm in non-diabetic controls. Thickness of crystalline lens was increased in patients who had diabetes for at least 10 years as compared to normal controls