Effects of exercises on pregnancy related low back pain: a quasi experimental study

Objective: To evaluate the effect of therapeutic exercises on pregnancy related low back pain in a tertiary care hospital of Karachi

Material and Methods: This was a quasi-experimental study with non-probability convenience sampling technique. Study was carried out at Liaquat National Hospital Karachi. Patients were divided into two groups [Experimental and Control]. Inclusion criteria were age <30 years, 2nd and 3rd trimester, stable medical status and those who gave the informed consent. Exclusion were pregnancy induced hypertension [>140/90mmHg], Cardiac disease, diabetes mellitus, persistent vaginal bleeding, history of miscarriages, decreased foetal movement. Data was collected through assessment Modified Oswestry Low back pain disability questionnaire. SPSS version 23.0 was used to analyze the data

Results: A total of 30 samples were selected for the study. There were 15 respondents in experimental while 15 in control group. Disability levels were found to be significantly decreased after post treatment in experimental group with P-value= 0.002. It was seen that number of patients was increased from 1[6.7%] to 6[40%] in minimal disability group whereas crippled back pain group in pre-treatment group was totally shifted towards minimal or moderate pain 3[20.0%] and no case was seen in post-treatment

Conclusion: Low back pain in pregnancy can disturb daily life routine but exercise therapy and proper counselling will lead stress free life to female in gestation. After post treatment in experimental group showed decrease in pain as compare to control group who were not provided any exercise therapy. Working women in experimental group also showed decrease by crippled back pain to moderate pain after exercise. So in the end researcher suggest that physiotherapy exercises play a vital role in reducing Low Back Pelvic Pain [LBPP] during pregnancy

Raised intraocular pressure following Intravitreal Triamcinolone Acetonide in diabetic versus non-diabetic patients

Objective: To determine the frequency of an increase in intraocular pressure [IOP] after intravitreal triamcinolone acetonide [IVTA] in diabetic versus non-diabetic patients with various chorio-retinal disorders

Methods: This prospective, interventional comparative case series was conducted at Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi from May 2012 to April 2014. Two hundred thirty seven eyes of 180 patients were enrolled with 90 patients each in diabetic and non-diabetic group, requiring IVTA. IVTA 4mg/0.1ml was injected and IOP was measured at one week, one month, three months and six months in both groups of patients

Results: In diabetic group, 43 patients were male [47.8 percent] and 47 were female [52.2 percent], while in non-diabetic group, 56 [62.2 percent] patients were male and 34 [37.8 percent] were female. Mean age of patients in diabetic group was 52.21 +/- 9.6 years and in non-diabetic group was 51.13 +/- 10.75 years. The mean preoperative IOP was 13.6 +/- 2.8 mmHg and 14.1 +/- 2.4 mmHg in diabetic and non-diabetic group respectively. In diabetic group, mean [+/-SD] IOP was 16.4 +/-4.9 mmHg, 14.6 +/-3.6 mmHg, 17.6 +/- 9.7 mmHg and 15.5 +/- 7.09 mmHg at one week, one month, three months and 6 months post injection. While in non-diabetic cases, mean [+/-SD] IOP was 14.8 +/- 3.33 mmHg, 15.9 +/- 4.2 mmHg, 15.5 +/- 4.2 mmHg and 14.1 +/- 3.2 mmHg at one week, one month, three months and 6 months follow up. The raised IOP was observed in 117 eyes [49 percent] in both groups of patients, with 78 eyes [65 percent] in diabetic group and 39 eyes [33 percent] in non-diabetic group

Conclusion: After IVTA, an IOP rise was observed more in diabetics than non-diabetic patients

Prevalence of diabetic retinopathy in Pakistan: a systematic review

Objectives: Primary aim was to review the literature on the prevalence of diabetic retinopathy [DR] and Vision threatening diabetic retinopathy [VTDR] in Pakistan

Methods: A search of the bibliographic databases [Medline, Pub med, and Google scholar] was conducted from 1990 to March 2017. Articles about prevalence of DR and VTDR in Pakistan were retrieved and scrutinized. The studies satisfying the inclusion/exclusion criteria were considered for detail review

Results: Forty one articles on prevalence of DR were traced out. Exclusion and inclusion criteria were met in 29 studies. In selected studies [29], pooled Prevalence of DR was found to be 28.78% with a variation of 10.6% to 91.3%. Out of 29 studies, DR was classified in 19 studies. Pooled Prevalence of VTDR in these 19 studies was found to be 28.2% [variation of 4% to 46.3%] of patient with retinopathy and 8.6% of all diabetics

Conclusion: A great variation in the values of DR and VTDR was observed in this study. Researchers suggest a community based study with uniform methodology to find out a comparable value of prevalence of DR and VTDR in all provinces of Pakistan

Perianal fistula; evaluation of the Perianal fistula by MRI: our experience

MRI is increasingly used nowadays in the evaluation and management of Perianal Fistula. To assess the role of MRI in the detection and classification of Perianal Fistula and correlation of preoperative MRI findings with the findings on surgery. Prospective study. Department of Radiology King Khalid Civilian Hospital Tabuk Kingdom of Saudi Arabia. Two years between February 2013 and February 2015. 60 patients were referred from surgical department for evaluation of Perianal fistula by MRI during the above mentioned period. MRI was performed in 48 Patients. [42 males and 6 Females] using variety of MRI sequences. Fistulas were classified according to SJUH [St James's University Hospital classification MR imaging based grading system] and MRI findings of individual MRI sequence used were correlated with operative findings. Most common fistula was Grade 1 [37.5%].In majority of the cases internal opening was found at 6 O clock position. Post intravenous contrast enhanced Axial and coronal oblique [CE FST1WFSE] Fat suppressed T1 weighted Fast spin echo and Axial and coronal Fat suppressed T2W FSE sequence [FST2WFSE] showed the highest Accuracies 98.13% and 97.06% respectively in diagnosis of anorectal fistulae. MRI should be used as a first line imaging modality in the preoperative assessment of Perianal fistula. Findings on Axial and coronal oblique CE FST1WFSE, axial and coronal oblique FST2WFSE showed the excellent agreement with the surgical findings. By using MRI as the first line imaging modality in the evaluation of Perianal Fistula one can percept best possible surgical management resulting in prevention of residual/ recurrence disease and complications such as fecal incontinence

Frequency and the related socio-demographic and clinical factors of phantom limb pain in traumatic amputees presenting at a tertiary care rehabilitation setup

Objective: To find out the frequency of phantom limb pain [PLP] in a sample of Pakistani amputee population presenting with amputation due to trauma and to investigate its relationship with different sociodemographic and clinical factors

Study Design: A cross-sectional descriptive study

Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi from August 2010 to October 2013

Material and Methods: Through non-probability purposive sampling, patients of both genders and all ages having a traumatic etiology of amputation were sampled from the outdoor amputee clinic and the indoor amputee ward. Patients having diabetes mellitus, polyneuropathy, memory loss, cognitive deficits and established history of psychiatric disorders were excluded. Through face to face semi structured interviews, information was obtained about presence of PLP, gender, location [urban or rural], ethnicity based on Pakistani provinces [Punjab, Sindh, Khyber Pakhtunkhwa, Balochistan, Azad Jammu and Kashmir], monthly income in Pakistani Rupees [PKR] [<10,000, 10,000 - <50,000 and >50,000], level of education [grade <5, grade 5 - 10, and grade >10], level of amputation and cause of trauma [fall from height, motor vehicle accident, blast injury, bullet injury or others]

Results: Out of 268 patients [mean age 28 +/- 6 years], 266 [99.3%] were male and 2 [0.7%] were female. Majority [79.1%] were rural based, Punjabis [44.8%], had a monthly income <10,000 PKR [85.4%], education from grade 5 - 10 [80.2%] and a lower limb amputation [86.9%]. The commonest cause was blast injuries [72.8%]. PLP was present in 42.5% [n=114] of the individuals and it was not significantly related to gender, living location, ethnicity based on Pakistani provinces, level of education, monthly income, cause of traumatic amputation and level of amputation

Conclusion: PLP was found in 42.5% of our sample of Pakistani traumatic amputees. The frequency was not related to gender, monthly income, ethnicity based on provinces, education, rural or urban based living and etiology or level of amputation

Delayed referral of lower limb amputees for rehabilitation; an audit study

To determine the causes of delayed referral of lower limb amputees for rehabilitation. Study Design: Descriptive study. Armed Forces Institute of Rehabilitation Medicine Rawalpindi, from April 2012 to July 2012. Thirty two patient cases of lower limb amputation were included. They were referred cases to AFIRM from operational areas and CMHs all over Pakistan for provision of prosthesis and rehabilitation. A total of 32 lower limb amputees7 male patients with mean age 29 years were included in the study. Transtibial level was the most common amputation 19[57.6%]. Improvised Explosive Device [IED] was the most common mode of injury 19[57.6%]. 34.37% patients were delayed due to leave granted to them at local set ups before referral to AFIRM for rehabilitation. Delayed referral for rehabiltation has poor impact on rehabilitation of an amputee

Impact of pesticides of renal function tests in collaboration with liver function tests among workers of pesticide formulation and packing plants in Pakistan

Objective: to evaluate the impact of pesticides on renal function tests in collaboration with liver function tests among workers of pesticide formulation and packing plants in Pakistan

Material and Methods: one hundred workers, 20-50 years of age, working at different pesticide formulation and packing units for at least one year were included in this study. One hundred healthy age and sex matched industrial workers were taken as controls. Renal function tests i.e. blood urea nitrogen, serum creatinine and liver function tests i.e. alkaline phosphatase, alanine transaminase, aspartate transaminase, gamma glut amyl transferase, total bilirubin, and direct bilirubin, were performed. Screening for hepatitis Band C virus was also done to confirm that all the samples included in current study were negative for Hepatitis Band C virus

Results: in current study, mean blood urea nitrogen value for 100 control subjects was 8.37 mg/di while that of 100 pesticide industrial workers was 12. 70 mg/di. Mean serum creatinine value of 100 controls was 0.65 mg/di and that of patient population were 0.98 mg/di. These results revealed that all the hundred pesticide industrial workers had normal blood urea nitrogen and serum creatinine levels but on the higher side as compared to control subjects. P value was significantly high. The results of liver function tests in serum samples of control subjects were within normal range. Liver function tests of 80 pesticides industrial workers out of 100 were within normal range whereas 20 workers had abnormally raised levels

Conclusion: pesticide exposure among workers of pesticide plants might cause liver toxicity

Impact of pesticides on liver enzymes in workers of pesticide formulation and packing plants in Pakistan

To evaluate the impact of pesticides on Gamma Glutamyl Transferase [GTT], Alkaline Phosphatase [ALP], Alanine Transaminase [ALT] and Aspartate Transaminase [AST] in workers of pesticide formulation and packing plants in Pakistan. One hundred workers in the age group of 20-50 years working at different pesticide formulation and packing units for at least one year were included in this study. One hundred healthy workers from other than pesticides industry, with no history of exposure to pesticides and matching age, sex and social status were taken as controls.Biochemical tests for GGT, ALP, ALT, and AST, were carried out employing Chemistry Auto analyzer. In current study, serum of one hundred control subjects indicated mean GGT value 37.19+8.07U/L. Mean GGT value for one hundred pesticide industrial workers was found to be 30.08_10.63U/L. These results revealed that all the hundred pesticide industrial workers had normal GGT levels, but on the lower side as compared to control subjects. P value was significant. Data of hundred pesticides industrial workers was taken and it was found that ALP, ALT, AST of eighty workers was within the normal range whereas the remaining twenty workers had raised level of ALP, ALT, and AST. Data of the control group showed that ALP, ALT, and ASTof all one hundred workers were within the normal range. All Pesticide industrial workers had normal GGT levels. High or upper normal levels of ALP, ALT, and AST were observed in serum of pesticide industrial workers

Otomycosis; a clinicomycological study and efficacy of tincture mertheolate in it's treatment

To determine the efficacy of tincture mertheolate in otomycosis. An experimental study. Department of ENT Aliama Iqbal Medical College/ Jinnah Hospital, Lahore. From Dec. 2007 to April 2008. A total of 60 patients of symptomatic otomycosis were investigated prospectively. Aural swabs were collected on first, 7[th] and 14[th] day and examined, by direct microscopy of external auditory canal and culture for fungi. Of these 60 patients found to be having pure fungal infection were taken up for mycological and therapeutic study. Fungi belonging to Aspergiilus were isolated in 57 [95%] patients of which Aspergillus niger was the commonest isolated in 34[56.6%] patients followed by Aspergillus flavus in 21[35%] and Aspergillus fumigates in 2[3.33]. Candida species in 2 [3.3%] and Mucor in 1 [1.6%] of patients. The patients were of all age groups but majority were between 21 and 30 years and the male to female ratio was equal. No patient had fungal infection elsewhere in the body. The patients were called for regular follow-up for three weeks. In 30 cases tincture mertheolate was applied as topical antifungal agent after cleaning the external auditory canal, in 17 patient's clotrimazole and in rest of the 13 patients miconazole was used. On 7[th] day, only 8 [13.3%] patients grew fungi in culture. They became symptom free on 14[th] day and no fungal material could be seen on otoscopy, direct microscopy or culture. Tincture mertheolate was found to be most effective in these patients

Role of L-carnitine in congestive cardiac failure

To determine the effect of L- Carnitine on functional and echocardiographic parameters of patients with congestive cardiac failure [CCF]. This double-blinded placebo control trial was conducted on 100 cases of CCF at cardiology outdoor department from March 2006 to May 2006. Subjects were randomized into group A [n=50] receiving 1 gm L-Carnitine and group B [n=50] receiving placebo. Baseline and at three months follow-up clinical and echocardiographic data of subjects was recorded. In L-Carnitine vs. placebo, 6 minutes walk was 400 +/- 87 m vs. 360 +/- 85 m [p = 0.04], NYHA class II and III improved [p= 0.7, p=0.3 respectively] LVED dimension showed no significant improvement [5.8 +/- 0.7 cm vs. 5.7 +/- 0.7 cm, p= 0.69], and FS improved [18.37 +/- 3.4 vs.19.90 +/- 6.7, p= 0.03]. The 6 minutes walk and FS improved in ischemic vs. Congestive cardiomyopathy [412 +/- 74 vs. 374 +/- 108 meters, p= 0.3], [19.2 +/- 50% vs.15.9 +/- 3.6%, p=0.03]. In ischemic cardiomyopathy 6 minutes walk improved [p= 0.001] LVED dimension increased [p=0.24], FS improved [p= 0.50] and NYHA class II [p=0.001], and III [p=0.02] improved. In congestive cardiomyopathy 6 minutes walk improved from baseline [p=0.13], FS showed no improvement [p=0.23], LVED dimension was not affected significantly [p= 0.65]. NYHA class improved [p=0.05]. L- carnitine is beneficial in the treatment of congestive cardiac failure. It is more effective in ischemic as compared to congestive cardiomyopathy

Myringoplasty; use of autologous temporalis fascia versus autologous tragal perichondrium

To compare the results of "take" of grafts of tragal perichondrium and temporalis fascia using underlay and overlay techniques. SETTING: Mayo Hospital ENT Department Lahore. DESIGN: Retrospective study. PERIOD: Oct 1992 to Mar 1996. PATIENTS AND METHODS: Total 112 patients, 60 Male and 52 Female. Graft "take" rate was 80% with temporalis fascia and 88% with tragal perichondrium. Whichever method of myringoplasty is used, results using tragal perichondrium are much superior than temporalis fascia