Quick diagnostic and management community acquired pneumonia at Sumbawa hospital: a case report

Pneumonia is most common cause of respiratory distress an infection of the pulmonary parenchyma. Despite being the cause of significant morbidity and mortality, it is often misdiagnosed, mistreated, and underestimated. Pneumonia historically was Typically classified as community-acquired (CAP), hospital-acquired (HAP), or ventilator-associated (VAP). A 68-year-old male was sent to the emergency department from clinic with an oxygen saturation of 86%. She has fevers with cough and generalized weakness for one week. She had been evaluated by her primary care provider on day two of illness and was started empirically on cefixime without improvement of her symptoms. The patient arrived febrile, tachycardic, tachypneic, and hypoxic on room air with right-sided crackles on exam. Lung Ultrasound of the right lower lobe demonstrates lung hepatization, a classic finding for pneumonia. In addition, a shred sign is present with both air bronchograms and focal B lines-all suggestive of poorly aerated, consolidated lung. Authors critically evaluate the evidence for the use lung ultrasound for rapid diagnostic. It is important to understand this disease, rapid diagnostic with ultrasound and when treated promptly and effectively, these patients will rapidly recovery. Good oxygenation, intravenous Antibiotic, intravenous fluids and symptomatic treatment which should be started within minutes of the patients’ arrival to emergency department.

Synthesis, characterization and antihypertensive activity of 2-phenyl substituted benzimidazoles

Hypertension is one of cardiovascular disease that is not sufficiently prevented and controlled at both hospital and community levels. Hypertension resulted in significant morbidity and mortality. The benz-imidazole ring is very important pharmacophore in modern drug discovery. The substituted benzimidazoles are the important for medicinal research. Researchers have reported that substituted Benzimidazoles are the structural isosteres of nucleotides, and easily allow them to interact with the different biopolymers, possess pharmacological activity especially antihypertensive activity. Angiotensin II Receptor Antagonists/Blockers [ARBs] compete with angiotensin II at the receptor site and block the contractile effect of angiotensin II in all vascular smooth muscles. Among all Angiotensin II Receptor Antagonists/Blockers [ARBs], Telmisartan, Milfasartan and many others have benzimidazole ring in their structure. In this study Angiotensin II Receptor Antagonists/Blockers [ARBs] have been prepared. Synthesized compounds were characterized by physical data and FTIR spectroscopic technique. Synthesized compounds studied were finally screened for their antihypertensive activity by tail cuff method of measurement of blood pressure by NIBP apparatus [None Invasive Blood Pressure] using Chart 5.0 software. The compounds synthesized were 2-[3-nitrophenyl]-1Hbenzimidazole [1a], 3-[1H benzimidazol-2-yl]aniline [1b] and 5-[1H-benzimidazol-2-yl]-2-methoxyphenol [1c]. The synthesized compounds have shown antihypertensive activity by taking Losartan as lead compound

Spontaneous bacterial peritonitis in cases with liver cirrhosis

Background: Liver cirrhosis is an irreversible liver damage and can result into various complications due to hepatocellular damage and fibrosis. Ascites and then superadded sub acute bacterial peritonitis [SBP] is not uncommon

Objective:To determine the frequency of spontaneous bacterial peritonitis in cases with liver cirrhosis

Methodology: This was a cross sectional study that was conducted at Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan from 1stMarch to 30thSeptember 2016, in which 150 cases of liver cirrhosis were selected according to clinical and laboratory investigation. SBP was labeled according to standard international criteria. Data analyses was done by SPSS version 21

Results: In this study, there were total 150 patients of liver cirrhosis out of which, 93 [62%] were males and 57 [38%] females. The mean age of the patients was 52.43+/-5.12 years. There were 84 [56%] cases in child class Pugh C and 66 [44%] in class B. SBP was seen in 45 [30%] of the cases. SBP was observed more in those with child Pugh class C where it was seen in 31 [36.90%] cases as compared to 14 [21.21%] cases in child class b with p= 0.04. SBP was also more common in those that had liver cirrhosis for more than 3 years where it was seen in 36 [37.11%] cases as compared to 9 [16.98%] that had cirrhosis for less than 3 years, with p= 0.01

Conclusion: Spontaneous bacterial peritonitis is a common complication in the liver cirrhosis and it is significantly high in cases that had child pugh class C and those with duration of liver cirrhosis more than 3 years

Identification of the risk factors of the thyroid cancer by using logit model in Lahore

Thyroid Cancer is a disease, which becomes a cause of death in developing countries. The aim of this study is to investigate all the possible risk factors of thyroid cancer in Pakistan. This study was consisting of 320 individuals, including 160 cases and 160 controls. These subjects were interviewed from the INMOL hospital and Sheikh Zayed Hospital, Lahore. The information was collected regarding the characteristics like age, gender, family history of thyroid cancer, use of iodine-diet, radiation therapy, etc. Descriptive and inferential statistics were used to explore the risk factors of the thyroid cancer. Odds ratio and 95% confidence interval [CI] were computed by using logistic regression model. The result showed that the odds ratio and 95% CI for family history of cancer are 2.222 and [1.281-3.853], for use of iodine diet are 2.619 and [1.492-4.596], for acromegaly disease are 1.947 and [1.123-3.374], for oxidative stress are 6.229 and [3.473-11.172], for red meat are 2.601 and [1.421-4.762], for fast food are 3.177 and [1.745-5.785], for fried food are 2.357 and [1.268-4.382], for the use of fats are 2.531 and [1.265-5.064] and for sea food are 2.050 and [1.127-3.729], respectively. It can be concluded that oxidative stress has 6 times high risk of thyroid cancer with the odd ratio 6.229 and CI [3.473, 11.172]. Moreover, fast food, the use of iodine diet, red meat and the seafood are also increased the risk factor of thyroid cancer

Mitral valve repair in a rheumatic population: an experience at AFIC/ NIHD

Objective: To analyze the outcome of mitral valve repair in rheumatic heart disease

Study Design: Retrospective analytical

Place and Duration of Study: Armed forces institute of cardiology/National institute of heart diseases Rawalpindi from Jan 2011 to June 2013

Material and Methods: In this retrospective study of 28 patients [15 females]. The mean age was 20.2 +/- 11.2 years [range, 11 to 55 years]. The cause of mitral regurgitation was rheumatic in all patients, with no congenital myxomatous, infective or ischemic cases. About 68% patients were in New York Heart Association [NYHA] functional class III or IV. In all the cases posterior ring annuloplasty was done with flexible C- Shape rings with size ranging from 20 to 26 mm. Repairs included anterior leaflet repair with cusp shortening and resuspension [n=17], posterior leaflet repair with quardranguloplasty and transpositioning [n=6], commissuroplasty [n=2] and mixed anterior posterior leaflet repair [n=3]

Results: There was no operative mortality. Follow-up was carried out for 10 months. The trivial mitral regurgitation was found in 3 cases [10.7%]. Four [14.2 %] patients required mitral valve replacement due to valve dysfunction

Conclusion: Mitral valve repair in rheumatic patients, with current techniques, can effectively correct functional and hemodynamic abnormalities with satisfactory results

Efficacy of rifaximin in hepatic encephalopathy

Background: Chronic liver disease [CLD] leads to extensive health care burden due to various complications including hepatic encephalopathy

Objective: To determine the efficacy of Rifaxamin in hepatic encephalopathy

Methodology: This was a descriptive cases series study, which was conducted at Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan from 1[st] January to 31[st] July 2016. The cases with age 20-60 years and of either sex having chronic liver disease of both Child Pugh Class B and C presenting with acute hepatic encephalopathy of grade II or more within 1 week diagnosed according to west haven criteria were included in this study. Rifaxamin was administered at a dose of 550 mg three times a day for 1 week. Efficacy was labeled as yes when there was complete resolution of symptoms of hepatic encephalopathy with 7 days of administration of the drug. The data was analyzed by using SPSS version 21

Results: In study there were 80 cases out of which 57 [71.25%] were males and 23 [28.75%] females. The mean age was 53.23 +/- 4.81 years. There were 58 [72.50%] cases in child pugh class C and 22 [27.50%] in class Bay 37 [46.25%] has grade IV encephalopathy. Efficacy of Rifaxamin was seen in 34 [42.50%] of cases. It was significantly high in child class B where it was observed in 12 [54.55 %] cases as compared to 22 [37.93%] cases in Class C. [P= 0.01]. Efficacy was better in those with grade II hepatic encephalopathy where it was seen in 5 [62.50%] out of 8 cases followed by 16 [45.71%] out of 35 cases in grade III and 13 [35.14 %] out of 37 cases having grade IV encephalopathy. [P= 0.001]

Conclusion: Rifaxamin is being used for the treatment of hepatic encephalopathy and it has shown significant better results in Child pugh class B and grade II encephalopathy

Clinic follow-up compliance of persons with type1 diabetes in tertiary care hospital

Objective: The objective of the study was to assess the compliance with clinic follow up in people with type I diabetes mellitus and its relation with their glycemic control

Methods: Total of 97 subjects with type 1 Diabetes Mellitus were included in this cross sectional study. In addition to the scheduled follow up, the patients were telephonically called by the clinic reception to make an additional appointment. We compared the glycemic control amongst the clinic follow up compliant and non-compliant group. To data was analyzed on SPSS 18.0 version

Results: Out of 97 subjects, 48 [49.5%] were male and 49 [50.5%] were female. The mean age of subjects was 17.03 +/- 6.54 years. Mean duration of diabetes was 4.61 +/- 5.2 years. Mean hemoglobin A1C [HbA1c] was 10.59 +/- 3.09%. There was a significant difference in glycemic control of subjects who were compliant towards clinic follow up as compared to those who were non-compliant. The turn up of people with type 1 Diabetes Mellitus who were asked for an additional appointment, was only 15%

Conclusion: It was concluded that there was a strong relation between compliance towards follow up visit and the glycemic control. It was also observed that majority of the subjects with type 1 Diabetes Mellitus responded to the phone calls however did not turn up

Use of vibration anesthesia in hair restoration surgery

Objective: To compare the pain levels in supraorbital/supratrochlear nerve blocks with and without the use of vibration in patients undergoing hair restoration

Methods: The study was conducted on 20 patients undergoing 1[st] session of hair restorative surgery. The nerve block, on one side, was administered with the vibrator and on the other side without it. The vibration was started 3-5 seconds prior the insertion of the needle. The patients pain scores were recorded using the Wong-Baker Faces Pain scale [0-10]

Results: The mean age 29.7 years [range, 24-37 years]. The mean pain score with the vibrator was 2.4 [range, 1-4] whereas the mean pain score was 4.6 [3-6] without the vibrator. There were 30% smokers. The average pain score in smokers vs. non-smokers was 6.2 vs. 4.3 on the side without vibrator and it was 3.8 vs .2.0 on the side with the vibrator, respectively. None of the patients opted to undergo procedure without the vibrator for the next session

Conclusion: The use of vibration decreases the severity of pain perceived by the patients

Single-Layer vs. Double-Layer Donor Scalp Wound Closure in Strip Harvest

BACKGROUND: To know the difference between single and double-layer wound closure. METHODS: The study was conducted in ten patients undergoing first session of hair restoration surgery by ‘strip method’ under local anaesthesia. Informed consent was obtained from all the patients. The length and width of the strip were marked pre-operatively. Three points were marked, one in the midline ‘O’ and one on either side, ‘A’&‘B’ at 8 cm from ‘O’. After removing the strip, five deep, interrupted, absorbable sutures were applied on left half but not on the right half. Lower edge trichophytic closure was performed with no undermining of the skin edges. A single continuous non-absorbable sutures was used to close the skin. The stitches were removed on the 10th postoperative day. The patients were assessed at 9 months interval postoperatively. RESULTS: The mean age of the patients was 33.8 years. The average width of the strip removed was 15.1 mm. The average width of the scar on single-layer closure was 1.57 mm and 1.58 mm on the double-layer closure. The mobility of the scar was 7.9 mm on single-layer closure and 6.2 mm on double-layer closure. There was no statistical significance in the scar size and mobility of single-layer vs double-layer closure. The time of surgery was more in double-layer closure and the extra cost of the suture material. CONCLUSIONS: There was no difference in scar quality. The extra time and money was saved in single-layer closure. The mobility of the scar was also found to be better in single-layer closure.

Operating room [or] utilization and efficiency; a study to find out methods for improvement

Introduction: Operating room [OR] is a key department in any institution and it runs with heavy resources. Improper running carries not only loss of revenue but it also effects patient care. Delays in operating room are deleterious and methods to decrease these delays are important not only for patient care, but to maximize operating room resource utilization

Objective: To determine the causes effecting the OR utilization and efficiency and to find out ways to overcome it. Study Design: Observational Study. Period: 15-01-2011 to 08-06-2011. Setting: King Khalid Hospital, KSA

Patients and Methods: Operating room baseline data was collected for one month and it was compared with historical data of the last six month. Operating room utilization was found to be 41% overall and 34% for elective cases [benchmark 85%]. In patient pathway, on average 17 min were required from call to ward to enter in operating room. First incision time was 11%=8-8:30, 31% = 8:30-9 and 58%= 9+. Cancelation was 9%. Various improvement projects were started including surgical list management, OR rescheduling, start on time dashboard, pre-anesthesia clinic and reinforcement of day surgery program

Results: The results showed 47% improvement in elective OR utilization and OR utilization reaching 69%. There was 76% improvement in emergency case booking and 18% improvement in pre/ post-op process time. There was 64% improvement in 1[st] cases before 9 am

Conclusion: Integrated management working can improve the working and outcome of the operating room resulting in high efficiency and best patient satisfaction

To determine the comparative values of lipid profile between ischemic and hemorrhagic stroke

Objectives: To determine the relationship of total cholesterol, HDL-C and their ratio among ischemic and hemorrhagic stroke

Study Design: An observational prospective comparative study

Place and duration: This research work was carried out from 1[st] June 2014 to 31[st] December 2014 at department of medicine Bahawal Victoria Hospital Bahawalpur

Methedology: Hundred patients between 30 to 90 years of age, who were admitted by the department of general medicine BVH Bahawalpur with first ever stroke and verified by CT scan brain, were included in the study. Patients who had history of coronary heart disease or lipid lowering drugs, neurological deficits secondary to epilepsy, infective or metastatic disorder, or pre-existing severe cognitive disorder were excluded from this study. A detailed history and physical examination details along with fasting lipid profile were collected from patient records in the hospital medical department. Mean values of quantitative data were presented as mean SD [standard deviation].Frequency percentage of total cholesterol, high density lipoproteins and triglycerides in both groups of ischemic and hemorrhagic stroke, were determined and compared using proportion test for any significant difference taking p-value of < 0.05 as significant

Results: Quantitative data of CVA, comprising [50 each of ischemic and hemorrhagic cases] was analyzed. Mean age of presentation was 56 years. In 50 ischemic patients mean total cholesterol was raised above normal reference range. It was 218.30 +/- 79mg/dl in ischemic stroke while it was 194 +/- 26.7mg/dl in hemorrhagic cases and it was highly significant at P value of < 0.001.The mean HDL concentration was 33.10 -7.33 in patients of ischemic stroke while it was 39.02-4.22 in hemorrhagic cases with p value of o.oo2 [highly significant]. Serum triglycerides levels turned out to be normal in both groups

Conclusion: Hypercholesterolemia and low HDLC was seen significantly in ischemic CVA group as compared to hemorrhagic counterpart

Prevalence of resistance to 1[st] line anti tuberculosis drugs at Rahim Yar Khan

Background: tuberculosis is an important infectious health issue and its control strongly rely upon effective treatment. The drug resistance and its pattern are important determinant of the treatment regimen, its duration and outcome

Objective: to determine the frequency and pattern of drug resistance among 1[st] line anti tuberculosis treatment

Methodology: it was a cross sectional study carried on 100 cases of smear positive TB. This study was conducted from 1[st] January 2010 to 30 June 2011. Detailed demographic data and history of ATT was taken and their sputa were sent for drug susceptibility testing on LJ media. The cases with drug resistance and no previous history of ATT were labeled as primary while those with previous history of ATT were labeled as secondary resistant cases. The data was entered and analyzed by using SPSS version 15

Results: out of 100 patients enrolled, drug susceptibility report was available for 87 isolates as sputum failed to grow any organism in 13 patients. Out of these 87 cases, 48 [55.17%] were males and 39 [44.83%] females with age range of 9-91 years. Seventeen out of 87 patients [19.5%] had previous history of ATT. Out of 87 isolate, 62 [71.26%] were sensitive to all 1[st] line drugs [R, H, E, Z, S] while 25 [28.74%] were resistant to one or more drugs. Primary resistance was seen in 17 [24%] out of 70 cases in contrast to secondary in 8 [47%] out 17. The difference between primary and secondary resistance among various drugs was statistically significant for isoniazid [p value 0.003] and pyrazinamide [p value 0.036] while the difference to streptomycin, ethambutol and rifampicin was insignificant with p values of 0.20, 0.35 and 0.09 respectively. There was no case of primary MDR-TB and 5.9% of secondary MDR-TB. None of the sociodemographic parameter was significantly associated with drug resistance

Conclusion: resistance to 1[st] line anti-tuberculosis drugs at Rahim Yar Khan is still common. There are good number of patients in which this resistance pattern compromise the currently recommended regimens. However, larger surveillance studies are needed to strengthen this evidence

Susceptibility pattern of 2[nd] line anti tuberculosis drugs at Rahim Yar Khan

Background: Pakistan has a high burden of drug resistant TB. Effective management of these cases needs the inclusion of 2[nd] line anti-tuberculosis drugs. A comprehensive knowledge of susceptibility pattern to these drugs is mandatory to formulate the best possible regimen

Objective: to determine the susceptibility pattern of 2[nd] line anti tuberculosis drugs

Methodology: this cross sectional study was carried out at Department of Pulmonology, Sheikh Zayed Medical College / Hospital, Rahim Yar Khan on smear positive cases of PTB. This study was conducted from 1[st] March 2010 to 30[th] April 2011. A total of 64 smear positive tuberculosis patients of any age and sex regardless of previous treatment with 1[st] line ATT and no history of prior exposure to 2[nd] line ATT were included. Sociodemographic data like age, sex, marital status and income were recorded. Early morning sputum samples were cultured on LJ medium at a reference lab. Drug susceptibility testing [DST] was done for ethionamide, amikacin, kanamycin, capreomycin and ofloxacin to determine the presence of resistance. The data was analyzed on SPSS version 15

Results: in this study, out of total 64 cases, 36 [56.25%] were males and 28 [43.75%] females with age range of 9 to 76 years. Thirteen cases [20.31%] had previous exposure to 1[st] line ATT. Twelve [18.8%] were resistant to one or more drugs. Resistance was highest for ofloxacin [14.1%] followed by ethionamide [6.3%], capreomycin [3.1%], amikacin [1.6%] and kanamycin [1.6%]. Sociodemographic characteristics also did not show any statistically significant association with drug resistance

Conclusion: there is high frequency of resistance to ofloxacin and ethionamide. To avoid addition of further resistance, DST should be available as early as possible by conventional methods or by rapid genotypic methods at the start of treatment

Effect of thymectomy on drug requirement of myasthenia gravis patients

Objective: to determine the effect of thymectomy on the drug requirement of myasthenia gravis

Methods: forty patients of myasthenia gravis admitted in Neurology Department Mayo Hospital Lahore were registered. After recording their demographic profile and confirmation of their diagnosis of myasthenia gravis, they were subjected to thymectomy. Their dosages of drugs before thymectomy were recorded and were compared with dosage requirements at 18-30 months post thymectomy

Results: thymectomy was done in 34 out of 40 patients. Five patients out of total 40 lost follow up and one was referred to oncology. 34 patients remained for follow up, 30 thymectomized and 4 nonthymectomized. The results indicate a marked reduction in average doses of pyridostigmine [90mg vs 270mg; p<0.001 ], steroids [7.5mg vs 38mg] and azathioprine [100mg vs 118mg] at 18- 30 months after thymectomy as compared to before thymectomy. At 18-30 months of follow up, thymectomized patients were using considerably lesser dosages of pyridostigmine [90mg vs 200mg], steroids [7.5mg vs 30mg] and azathioprine [100mg vs 125mg] as compared to non thymectomized patients

Conclusion: the intra-articular NSAIDs injection is a more effective treatment option compared to intra-articular steroid injection for the management of adhesive capsulitis of the shoulder

Smoking among patients attending chest department Bahawal Victoria Hospital, Bahawalpur

Objectives: Objectives of Our Study were to know the frequency of smokers attending the chest outpatient department and chest ward and determine the reasons of smoking

Study Design: Cross Sectional Study

Place and Duration of Study: This study was conducted at Chest Ward and Chest OPD of BV Hospital Bahawalpur from 18[th] May to 5[th] June 2016

Materials and Methods: Sample of 100 patients were taken by using non-probability sampling technique. Patients of all ages and both sexes were included and Unwilling patients were not included. It was descriptive cross sectional epidemiological study. Data Collection Procedure: The data was collected by means of a preformed questionnaire. The Patients were interviewed by the researchers themselves. Data was analyzed by SPSS 20 and frequencies were calculated and presented in the form of Tables

Results: In the study it was found that the frequency of smokers attending the chest outdoor and chest O.P.D was 59%. This study showed that 30% of smokers had been smoking for more than 30 years while almost 7% were smoker for more than 40 years. This study showed that 20.3 % of smokers started smoking to relieve depression, 28% due to peer pressure another 19% for fashion, 12 % for copying elders and 21% gave other reasons

Conclusion: It was concluded that smoking was quite prevalent in the patients attending the chest OPD and chest ward. Efforts should be made at community level as well as individual level to control and prevent smoking

Temporal Peaks Restoration: A New Innovation

There are several methods for restoring the temporal peaks. The most important point is the variable density and angulation of the hair, which ultimately give a soft and natural look. The current technique produces zones of variable density and helps to restore naturalness.

Gender difference in components of metabolic syndrome among patients of Type 2 diabetes

Diabetes mellitus, hypertension, obesity and dyslipidemia are the integral components that constitute metabolic syndrome. It has emerged as cause of substantial mortality with gender difference. To compare the gender characteristics of metabolic syndrome in subjects of type 2 diabetes mellitus. This observational comparative prospective study was conducted in medical ward of BVH Bahawalpur over period of 6 month from January 2014 to June 2014. Sample size of 100 diagnosed cases of type 2 diabetics [comprising equal number of males and females] were collected. As defined by WHO and IDF, variables of metabolic syndrome studied were BMI, hypertension, hyperglycemia and hyperlipidemia. The lipid values were interpreted in normal or high risk category by applying NCEP ATPIII criterion. Fasting sample were collected for sugar and lipid profile. Anthropometric, demographic and biochemical data was tabulated. Continuous and categorical variables were displayed as mean +/- standard deviation and percentage respectively. Student 't' test was use to assess the difference for the lipid profile at 5% significance level. Female patients were found to be overweight, hypertensive and had uncontrolled hyperglycemia as compared to male subjects. Their systolic blood pressure was 150 +/- 25.75 and diastolic was 90 +/- 17mm/hg. The mean blood glucose concentration was 246.64 +/- 105mg/dl. In age group 35-44 years, the mean triglycerides and cholesterol levels in females were 184.54 +/- 42.05 and 192.5 +/- 34mg/dl respectively. HDL-C was 33.2 +/- 5.19mg/dl. In females with age group of 45-54 years, the mean concentration of triglycerides, total cholesterol and HDL-C were 217.75 +/- 77.6mg/dl, 190.95 +/- 14.4mg/dl and 31.75 +/- 3.8mg/dl respectively, and all were in high risk category when compared to cut off values determined by NCEP/ADA. While in females of age group 55-64 years, the values of TGs, total cholesterol and HDL-C were 204 +/- 154.11mg/dl, 200.09 +/- 47.8 mg/dl and 33.4 +/- 4.6mg/dl respectively and again all these values were significantly raised. Female genders were affected in all respects. They had higher BMI, hypertension, hyperglycemia and hyperlipidemia as compared to male counterparts

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.

To evaluate comparative values of HDL cholesterol among male and female patients of type 2 diabetes

Objectives: To assess and compare the HDL Cholesterol among male and female type 2 diabetics and to look for the blood pressure and glycemic stats between both genders

Study design: An observational comparative prospective study

Place and duration: The study was conducted in Medical Unit-2 of Bahawalpur Victoria Hospital over a period of 6 months from June 2012 to December 2012

Methodology: A sample size of hundred diagnosed cases of type 2 diabetes was collected. Those who had hyperlipidaemia due to secondary causes like nephrotic syndrome, hypothyroidism and drugs were excluded. Fasting blood samples were collected for sugar and lipid profile. All collected data was analyzed through software SPSS version 10

Results: Female patients were found to be overweight and hypertensive and they had uncontrolled hyperglycemia as well. The mean values of lipoprotein were deranged in females as compared to males. By applying NCEP ATP III criterion, lipid level were classified into different risk categories. In female patient the mean concentrations of HDL-C was 32+2.4mg/dL [T-Value = -23.57 very highly significant] and was in high risk category while LDL-C was 191+31.81mg/dL [T-Value = -2.01 significant] and was in borderline risk. LDL: HDL ratio was 6.0 and significantly raised. Triglycerides were within normal range. In male patients the mean concentration of LDL was borderline risk 174+41mg/dL [T-Value = 13.2] while HDL-C was 40mg / dL [T-Value = -6.53], both in borderline category. LDL: HDL ratio was also in acceptable range in males. Triglycerides values turned out to be within normal range in both gender

Conclusion: HDL cholesterol was frequently reduced and was in high risk category in female diabetic patients as compared to male counterparts and LDL values were borderline. Hence they are at more risk of complications as they were hypertensive and had more uncontrolled hyperglycemia as well

Management of digital flexion contractures

Objectives: To present the experience of management of the digital flexion contractures

Study design: An intervenional study

Place and duration: The study was conducted in a private setup from January 2006 to December 2008

Methodology: All the patients presenting with digital flexion contractures of hand were included and patients with fixed digital joint deformity and contractures of less than three months duration were excluded from the study. The contractures were released and skin graft/flap was harvested. In majority of the cases, the digits were kept straight with K-wire. The dressing was changed on 8th postoperative days and k-wire was removed after 3 weeks and active/passive movements were advised. In case of flaps, careful monitoring was ensured. A POP splint was advised for next 3 months along with the physiotherapy. Any complication encountered was also noted and managed accordingly

Results: in a total of 56 patients, majority of the patients were males [64.3%]. Mean age was 24.8 years in males and 19.8 years in females. More than half of the patients had postburn flexion contractures [55.4%] followed by post traumatic [37.5%] and post infective [7.1%]. The duration of the deformity ranged from 3 months to 31 months [mean= 15.0 months]. About 16% of the patients belonged to age group below 10 years. Majority of the patients had involvement of right hand [53.6%] and 66.1% of the patients had single digit involvement whereas 33.9% had two or more digits involvement. Different operative modalities were undertaken including Z-plasties, skin grafts and flap coverage. No flap loss was seen during the study. Five patients underwent flap surgery whereas the remaining 16 patients developed sensations in the skin grafted area

Conclusion: Early treatment of contractures with skin graft or flap results in the improvement of finger mobility