Electroconvulsive therapy [ECT] for the management of neuroleptic malignant syndrome [NMS] in adults

Objective: To determine the efficacy and safety of electroconvulsive therapy [ECT] for the management of neuroleptic malignant syndrome [NMS] in adults. Study Design: Open label, unblinded series. Place and Duration of Study: This study was carried out at the Department of Neurology, Military Hospital Rawalpindi, from Jan 2015 to Dec 2015

Material and Methods: All the patients with the diagnosis of NMS during the study period were included in the study. Consective non-probability sampling technique was used. Patients were divided into two groups; uncomplicated and complicated cases of NMS

Results: A total of nineteen patients were included in this pilot study. Out of all, thirteen [68.4%] were males and six [31.6%] were females. Mean age of the patients was 35.05 [SD 13.362] years. The drug classes causing NMS were antipsychotic medicines in 73.7% of patients and antiemetics in 26.3% of patients. Mean electroconvulsive therapy [ECT] sessions given were 6.16 [SD 2.062]. Following treatment n=16 [84.2%] patients had complete recovery while n=3 [15.3%] patients died

Conclusion: In this small, open label, unblinded study ECT appears effective and safe in treating NMS in adults. Larger randomized studies will help to confirm data emerging from this preliminary study

Percutaneous dilatational tracheostomy: a prospective analysis about the safety of procedure among ICU patients

Objective: To evaluate the percutaneous dilatational tracheostomy procedure safety among the critically ill Medical ICU patients

Methodology: The study was descriptive and conducted in Medical ICU, Department of Pulmonary and Critical Care Medicine, Services Institute of Medical Sciences, Lahore, from February 2015 to May 2016. Fifty three Medical ICU patients underwent tracheostomy procedure through percutaneous dilatational technique using both Grigg's and Ciaglia's methods. Procedure was performed at bed side using local anesthesia, sedation and systemic analgesia, under bronchoscopic guidance. Patients were monitored for intraprocedural and postprocedural complications like: hemorrhage, stomal infection, injury to adjacent structures, arrhythmias, transient hypoxemia, transient hypotension, paratracheal insertion, pneumothorax, sub-cutaneous emphysema, loss of airway, accidental decannulation, tracheal ring fracture and new lung infiltrate or atelectasis

Results: A total of 53 procedures were performed. Intraprocedural complications included: Transient hypoxemia 4/53 [7.5%] and hypotension 3/53 [5.6%], hemorrhage 3/53 [5.6%] and one case of paratracheal placement. No procedure related mortality was noted. 10 patients died during the ICU stay due to the primary underlying disease and one patient died after a successful decannulation. 36 patients had uneventful decannulation. Six patients were directly discharged from ICU

Conclusion: Percutaneous dilatational tracheostomy is a safe procedure with low complications rate and suitable for critically ill ICU patients

Role of Saha's procedure in change of movement at shoulder joint in traumatic brachial plexus injuries

Background: Brachial plexus injuries are difficult to manage situation for surgeons

Objective: To assess the effects of saha's procedure on improving the range of movement of shoulder joint with brachial plexus injury

Methodology: We conducted a quasi-experimental study of twelve patients with absent or extremely weak shoulder abduction [motor grade 2 or less] due to traumatic brachial plexus injuries [C5-C6-C7/C5-C6 deficit], who had undergone surgical reconstruction of the flail shoulder by tendon transfer [Steindler elbow flexorplasty]. The etiology of shoulder weakness in all patients was traumatic brachial plexus palsy [C5-C6-C7/C5-C6 deficit] from 1[st] January 2011 to 31[st] December 2014. Shoulder abduction improved or not improved measured in term of range of motion at shoulder joint. Age, gender, preoperative strength [rated on a 0 to 5 scale for the trapezius], previous surgery, length of follow-up, other associated operative procedures, results and complications were recorded

Results: We operated on twelve patients and average age at which patients presented was 22.83 in which only one was female. The percentage years of C5-C6 and C5-C6-C7 were 86.66% and 13.33% respectively. Average time elapsed since injury was 23 months. We followed the patients on average of about 2 years. The Average increase [change] in the abduction range was 74.10

Conclusion: Saha's procedure is good and effective procedure in improving the range of motion [Change] at shoulder joint in traumatic brachial plexus injuries [C5-C6-C7/C5-C6 deficit]

Development and bioevaluation of [99m] Tc[CO][3]-labeled [1-azido-1- deoxy-beta -D-glucopyranoside] complex as a potential tumor-seeking agent

The 1,2,3-triazole-containing [1-azido-1-deoxy-beta -D-glucopyranoside] complex was synthesized using click chemistry approach and evaluated its potential as a tumor-seeking agent. In the present study, [99m] Tc-tricarbonyl labeled [1-azido-1-deoxy-beta -D-glucopyranoside] radiotracer [[99m] Tc[CO][3]-BM], [where BM stands for biomolecule, e.g., [1- azido-1-deoxy-beta -D- glucopyranoside]] was synthesized via click chemistry approach and then labeled with technetium- 99m through isolink kit. Radio labeled drug was tested for radiochemical purity and in vitro stability by chromatographic techniques. Normal distribution and tumoral uptake were studied in Swiss Webster mice. Radiochemical purity results show 97.9 +/- 1.5% labeling and its in vitro stability were studied at room temperature up to 5h. The radio labeled drug exhibited 73.6 +/- 1.1% binding with blood proteins. Normal distribution of drug shows prominent uptake in brain while in case of tumor-bearing mice, the uptake was maximum in tumor tissue and negligible amount was shown in brain. The biodistribution was further compared with 2-fluoro-2-deoxy glucose [[18]F-FDG], which was used as a positive control. The data indicate that [99m] Tc-tricarbonyl labeled [1-azido-1-deoxy-beta -D- glucopyranoside] radiotracer might be a feasible candidate with reasonable potential for tumor diagnosis

Level of vitamin d in Orthopaedic Trauma among adult patients

Background: The evidence on level of vitamin D in trauma patients is scarce in the developing countries

Objective: To determine the levels of vitamin D in trauma patients above 18 years of age

Methodology: This was a cross sectional study conducted on patients admitted in the Orthopedic department of Sheikh Zayed Medical College /Hospital, Rahim Yar Khan, patients included in this study were 340. The duration of study was 21st July to 16th March 2016. Vitamin D level were measured by using vitamin D kits [Roche]. Patients less than 18 years were not included in the study. Data was analyzed by using SPSS version 16

Results: A total of 340 patients admitted in orthopedic department were included in this study. Overall 92.6% patients have deficient or insufficient level of vitamin D. Most of the patients [68.8%] were less than 45 years of age. Majority of the patients were male [71.8%]. Most of the patients [72.4%] were not smokers. Majority belonged to rural areas [56%], and have no history of steroid intake

Conclusion: This study confirmed that majority of the trauma patients were vitamin D deficient or insufficient. This highlights that trauma surgeons should consider vitamin D in the armamentarium of orthopaedic treatment

Outcome of wound coverage around ankle joint with sural artery flap

Background: Trauma is the most common cause of fractures and majority of these fractures involve the foot. So the early coverage is mandatory to prevent the complications, it is challenging to the orthopaedic, plastic and reconstructive surgeons. Sural artery reversible flap is one of the options

Objective: To determine the outcome of sural artery flap for wound coverage around ankle

Methodology: A total of 24 patients were included in this interventional study. All the patients having wound around the ankle due to any cause and of either sex presenting in emergency department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1st June 2014 to 30th April 2016 were included in this study. Outcome was measured as "Good", "Fair" and "Poor". The data was entered and analyzed by using SPSS version 16

Results: In this study 24 patient were operated, 41.66% were children and 54% were male. In 50% heel region was involved and in 25% melleolar region and 12.5% dorsum of foot and in 12.5% above ankle joint. Outcome noted was "Good" 83.3% "Fair" 8.3% and "Poor" 8.3%

Conclusion: Sural artery flap for the coverage around ankle is simple, safe and can be performed by orthopedic surgeon at any center without the requirement of special instrumentation and special test, with good outcome

Unilateral Meniere's disease; intra tympanic injection of low dose gentamicin in the treatment

ABSTRACT: Meniere's disease is chronic progressive disease with unclear idiopathic etiology and symptomatic improvements with treatment

Objectives: To analyze the efficacy of low dose intratympanic injection of gentamicin for vertigo control in unilateral Meniere's disease. Study Design: Quasi experimental study. Settings: Department of ENT, PIMS, NESCOM and IMDC Islamabad

Materials and Methods: Gentamicin was used intra tympanically in this multicentre study of 75 patients over a period of 8.5 years between 1[st] January 2005 to 30[th] June 2013 in definite Meniere's disease according to the 1995 Document of American academy of otolaryngology- Head and Neck Surgery [AAO-HNS].All these centers followed same criteria and procedures. Single dose of 1 ml Gentamicin solution 40 mg/ml was instilled in the middle ear through the grommet under microscope and followed up for 3 months and two years. The staging of disease [hearing thresholds] the degree of disability [frequency of attacks per month] and the functional level were assessed before and after treatment

Results: Among 75 patients, 41 were female and 34 were males between age ranges of 25 to 70 years. Most of the patients in the study had stage 2 [23/75] and stage 3 [41/75] Meniere's disease. About 68[91%] patients were having good control of vertigo at the end of two year of intratympanic gentamicin without any loss of hearing

Conclusion: A single Low dose intratympanic gentamicin is effective in controlling vertigo in patients with Meniere's disease with no further deterioration in hearing for at least two years follow up

Sarcasm of quality and efficiency: an evaluation of inpatient bed utilization in services hospital Lahore Pakistan

Objective: to determine inpatient bed utilization in the Pediatrics Ward of Services Hospital, Lahore as average daily census and Bed Occupancy Rate

Methods: a cross sectional study was conducted in the Pediatrics Medicine Ward of Services Hospital Lahore which is a tertiary care hospital attached with Services Institute of Medical Sciences Lahore, Pakistan. A 'midnight census' was conducted by 4th year MBBS, Medical Students for the children admitted from 6 to 12 May, 2015. The data for inpatient service utilization was analyzed for estimation of average daily census and bed occupancy rate

Results: the average daily census was 69 patients per day and the Bed Occupancy Rate was found to be 137.7%. This rate was higher than 100% that shows the over-utilization of beds leading to quality compromise for the provided services

Conclusion: high bed occupancy rate indicates a scarcity of beds in the Pediatric Ward which highlights a disparity between the supply and demands of pediatric medical services. A change in policy and increase in number of beds would help provision of quality health services to the children

Nephrotoxic effects of omeprazole on renal vasculature of albino wister rats by histopathological study

Objective: To evaluate the nephrotoxicity of increasing doses of omeprazole on the renal blood vessels by the use of an animal model

Study design: Randomized control trial

Materials and Methods: A total of 45 albino wister rats were procured from the Veterinary University Lahore. The animals were randomly divided into three groups, a control group [n=15] that was given distilled water, 2nd group [n=15] was given omeprazole per oral at a dose of 0.3mg/Kg BD and the 3rd group [n=15] was feed with omeprazole at a dose of 0.6 mg/Kg BD. None of the rats died during the study. The animals were sacrificed after 6 weeks of drug administration and the kidneys were dissected out. Histopathology was done to evaluate the slides under the light microscope for glomerular congestion and atrophy, and congestion of blood vessels and haemorrhage in the interstitium. Judgment standards set were either absence or presence of these parameters

Results: None of the rats in the control group [n=15] showed any evidence of injury to the kidneys. While in group 2 [n=15] who were given 0.3mg/Kg 60% [n=9] showed glomerular congestion [P value < 0.0001] while glomerular atrophy was noted in 13.33% [n=2]. [P< 0.0001]. Group 3 were given 0.6mg/Kg equivalent to dose of 40mg omeprazole BD of 70 Kg of human. This group showed glomerular congestion in 86.67% [n=13] [P< 0.0001] while glomerular atrophy was noted in 26.67% [n=4]. [P< 0.0001].Histopathology of the interstitium also showed an increasing tendency of injury as the dose of the omeprazole is increased. In group 2 The injury to interstitium was observed in 33.33 % [n=5] [P= P< 0.0001] while in group 3 it was observed in 53.33% [n= 8][P= P< 0.0001]

Conclusion: It was observed that omeprazole has toxic effects in the blood vessels of the kidney as shown by the glomerular congestion and atrophy along with the hemorrhage and congestion of the renal interstitium. The incidence of these toxic effects increases as the dose of the drug is increased

Assessment of determinants of decrease in tendency for breast feeding in Mothers Visiting Services Hospital Lahore

Objective: assesment of the determinants of decrease in tendency for breast feeding among mothers visiting Gynae and Peads OPD of Services Hospital Lahore

Material and Methods: this was a cross sectional, descriptive study, carried out at Services Hospital, Lahore. Study duration was 3 months from June 2014 to August 2014. Study population included all mothers before menopause in Gynae and Paeds OPD of Services Hospital Lahore. A predesigned structured questionnaire was used to collect data from mothers. Data was entered, cleaned and analyzed using SPSS version 16. Consent was obtained on the form beforehand

Results: breastfeeding practices were more in the mothers who had knowledge about benefits of breastfeeding. The percentage of women having knowledge of benefits had increased tendency to start breastfeed their child within 30 minutes of birth and to continue it for 2 years. Mothers who had breastfeeding as a family tradition were provided with more suitable environment which led to increased tendency for breast feeding. On contrary the mothers who we're not provided with a suitable environment and did not have breastfeeding as family tradition had decreased tendency to breast feed their children. Mothers who were in good health condition had increased tendency to breastfed their children. Breast feeding practice in women who did not consider breastfeeding as old fashion and did not think breast feeding to affect their figure was more than the mothers who preferred top feeding as a fashion. The breastfeeding practice in women who had a good health status i.e. did not have systemic disease ,breast abnormality and felt healthy after breast feeding is more than the mothers who had poor health status

Conclusion: from the results it was concluded that lack of knowledge about benefits of breastfeeding, misconceptions about taboos regarding breastfeeding affecting figure and is an old fashioned practice, poor health status of mothers, increased work load on the part of mothers and lack of suitable environment to breastfeed led to decrease in tendency for breastfeeding

Maternal risk factors in preterm neonates

To study the frequency of maternal risk factors in preterm birth. Descriptive - Cross sectional study. This study was carried at Hamdard University Hospital, Karachi from January 2013 to December 2013. All preterm neonates were examined at Hamdard University Hospital. Mothers who delivered neonates before 37 weeks of gestation and their suspected maternal risk factors contributing to preterm labor were registered on a pre-designed proforma. Keeping prevalence of 14.9%[1], bound of error 5%, confidence interval 95%, the calculated sample size is 195. There was Non-probability consecutive sampling. Mothers who delivered live born babies in Hamdard hospital Karachi before 37 weeks of gestation. Babies were born after 37 weeks of gestation and still birth. During the study period, 195 mothers who delivered preterm neonates were included. Out of 195 patients, anemia was found as most common risk factor for preterm delivery in 50.8% mothers, followed by history of previous abortion and premature rupture of membrane with 23.0% and 13.8% respectively. History of previous preterm delivery, pre-eclampsia and antepartum hemorrhage were the least reported risk factors at 4.1% each in our study. Prematurity is still a major problem in Pakistan. Early detection of the most common maternal risk factors as: nutritional status of women [BMI], previous abortions, previous preterm births will reduce the prematurity rate, medical cost and suffering of the parents

Demographic features of tuberculosis lymphadenitis patients

Background: Tuberculosis is an infectious disease, having high morbidity and mortality

Objective: This study was conducted to determine the demographic features of tuberculous lymphadenitis

Material and Methods: This cross-sectional study was carried out at Amir Clinical Laboratories Chiniot from 1[st] February, 2013 to 15[th] April, 2014. All of the 127 patients who presented with the complaint of cough, fever and clinical finding of cervical lymph node enlargement were included in this study. They were diagnosed having tuberculosis with the help of clinical examination and laboratory investigations. They were managed according to the standard protocol. FNAC was performed. The cases of tuberculous lymphadenitis were evaluated according to the age and gender groups. The data was entered and analyzed by using SPSS version11

Results: A total of 127 patients having cough, fever and enlarged lymph node were included and it was found that 85 [67%] were having Tuberculosis Lymphadenitis on FNAC. It was found that 29[34%] belonged to < Rs.10000 monthly income, 43[51%] belonged to Rs.11000- 20000 monthly and 13[15%] belonged to

Conclusion: The frequency of tuberculous lymphadenitis is more in age group of 1- 10 years and 11-20 years. In each group the frequency of males being affected is relatively more

Interval tonsillectomies; comparison of per and post operative complications in patients undergoing early and delayed after peritonsillar abscess

Peritonsillar abscess is a common clinical problem faced by otorhinolaryngologist all over the world. There are different schools of thoughts regarding tonsillectomy after peritonsillar abscess due to its expected complications. This comparative study was conducted to know about frequency of complications in each of the techniques. To compare per and post operative complications in patients undergoing early and delayed interval tonsillectomy after peritonsillar abscess. This was randomized control trial. Department of ENT, Head and Neck surgery, PGMI/HMC, Peshawar. From Jan 2012 to Dec 2013. After taking detailed history, thorough examination, relevant investigations and informed written consent peritonsillar abscess was drained and then interval tonsillectomy was performed. The complications were noted on predesigned proforma. Chi square test was used to compare the complications in both the groups while keeping P < 0.05 as significant. Out of 60 patients males were 38 and females were 22 with male to female ratio of 1.31:1. Average age was 24.7 years + 7.63 SD with a range of 13-45 year in Group-A, while Group B has average age of 23.97 year + 7.07 SD with a range of 13-46 years. Findings of per-operative and post operative hemorrhage showed that there was insignificant difference in both the groups [P=0.601]. However pain and hospital stay in both the groups was significantly different with P value of 0.004 and 0.000 respectively. Early interval tonsillectomy is an easy and safe procedure for peritonsillar abscess

Aetiology of optic atrophy

Objective: to investigate the patients of opt c atrophy to find the cause

Material and Methods: this descriptive study was conducted at department of neurology, Mayo Hospital Lahore and department of medicine, Wapda Teaching Hospital, Lahore. Patients of all ages and both sexes with optic atrophy were included. Patients of pure eye diseases like glaucoma and those having any contraindication to essential investigations were excluded. First 118 patients were studied. After history and physical examination some initial and predetermined tests were performed on all patients. Further advance investigations were performed to reach the diagnosis on case to case basis. All the data obtained was processed for the results

Results: out of these 118 patients, 75 [63.56%] were male and 43 [36.44%] were female. Mean age was 43.97 +/- 17.54 years [range 3 to 71 years]. Causes of optic atrophy included, Tumours in 29 [24.58%], demyelinating diseases in 19 [16.10%], infections in 18 [15.25%], methanol toxicity in 11 [9.32%] and ischemic optic neuropathies in 9 [7 .63%] patients. Hydrocephalus and hereditary optic neuropathies, each in 4 [3.39%] patients while non-neoplastic compressive lesions, drugs and trauma, each in 3 [2.54 %] patients caused optic atrophy. Nine patients had rare causes while six patients remained undiagnosed

Conclusion: tumours, demyelinating diseases, infections, methanol toxicity and ischemic optic neuropathies were the frequent causes of optic atrophy. Methanol toxicity is more common in our society as compared to the rest of the world

Association of smoking and low serum bilirubin antioxidant concentrations

Objectives: The objective of this study was to identify the association between cigarette smoking and serum bilirubin antioxidant concentrations

Study Design: A descriptive cross sectional study

Place And Duration: Study was conducted at the Department of Biochemistry at Sheikh Zayed hospital Lahore over a period of one year from January 2012 to December 2012

Methodology: The sample size was sixty with an equal distribution of healthy and control group. Thirty were known smokers and thirty were healthy controls. Thirty smokers who had been smoking for at least five pack years [20 cigarettes per day for one year is equal to one pack year] were included after ruling out coronary artery disease by Exercise Tolerance Test. Same no. of healthy control subjects were selected from general population with no history of smoking, CAD, Diabetes and hypertension

Results:The results of the study have shown that smoking decreases the serum bilirubin concentrations. The mean value of serum bilirubin in 50%[n=30] smokers was 0.59 + 0.034. While in control group 50%[n=30], it was 0.85 + 0.057

Conclusion: From the results, it was concluded that cigarette smoking lowers the bilirubin antioxidant concentration

Association of serum bilirubin concentration with risk of coronary artery disease

Objectives: Objective of this study was to assess the serum bilirubin concentration [within the reference range] as a marker for coronary artery disease [CAD]

Study Design: It was a descriptive cross sectional study and simple random sampling technique was adopted for the proceedings

Place And Duration: The study was conducted in the Department of Biochemistry and Cardiology at Sheikh Zayed hospital Lahore over a period of one year

Methodology: Thirty known patients of CAD diagnosed by angiography were selected. Same numbers of healthy controls were selected

Results: The results have shown that there was a significant difference in serum bilirubin levels of both groups, when compared statistically

Conclusion: The study suggests an inverse association between serum bilirubin concentration [within the reference range] and risk of CAD and it can be used as a marker to assess predisposition towards ischemic heart disease

Evaluation of risk factors for perforation in acute appendicitis

To determine the risk factors contributing to the chance of perforation in acute appendicitis. Prospective study. This Study was conducted at Allied Hospital Faisalabad from October 2011 to February 2013. All of the 200 patients who were admitted with the clinical diagnosis of acute appendicitis were included in this study. They were managed according to the standard protocol. Appendecectomy was performed. The cases of perforated appendix were evaluated. it was found that 27 of these 200 patients had perforated appendix with the frequency of 13.5 %. 37.03 % patients were in the age group of 56-70 years with the males being 74%. The percentage of the patients who presented with the delay of 72 hours was 62%. The complication of appendicular perforation in cases of acute appendicitis depends upon delay in presentation to the hospital. Male gender and late age factors also contribute to the increased frequency

Increased risk of preterm Labour in younger pregnant females

To determine the risk of preterm birth in anemic pregnant females. Retrospective study. This study was conducted at the Department of Gynecology and Obstetrics, National Hospital Sargodha from January 201 1 to March 2012. A retrospective study was done on 220 women who attended the Gynecology and Obstetrics Department of National Hospital Sargodha for antenatal evaluation. Record of all the patients was examined. Among these 220 pregnant women, 84 were admitted with the complaint of preterm labor. The admitted patients were assessed according to ACOG criteria. They were managed according to the standard protocol. Their Hb level was determined. Gestational age was calculated and preterm pregnancy was confirmed by scan. There were 84 women who admitted with the complaint of preterm labor. Out of these, 31[36.9%] were in true labor and delivered. Rest of them was in threatened labor and managed accordingly. Among these women who were admitted with preterm labor, 46 were anemic. Associated maternal risk factors and pregnancy complication were also determined. It is concluded from this study that preterm labor associated with preterm birth is more prevalent in anemic pregnant females

Increased risk of preterm labour in younger pregnant females

To determine the risk of preterm birth in younger pregnant females. Retrospective study. This study was carried out at the Obst. and Gynae National Hospital Sargodha from September 2011 to December 2011. All of the 76 women who were admitted with preterm labor were included in the study. They were assessed according to ACOG criteria. The admitted patients were managed according to the standard protocol. Gestational age was calculated and preterm pregnancy was confirmed by scan. Associated maternal risk factors and pregnancy complications were also evaluated. There were 76 women who admitted with the complaint of preterm labor. Out of these, 29 [38%] were in true labor and delivered. Rest of them was in threatened labor and managed accordingly. 69.7 % of the women who delivered as preterm were in the age group of 15 -25 years. Associated maternal risk factors and pregnancy complication were also determined. It is concluded from this study that preterm labor associated with preterm birth is more prevalent in younger pregnant females

Development of [99m]Tc-5-fluorouracil as a potential tumor diagnostic agent

5-Fluorouracil is a well know drug for chemotherapy of various types of cancer. In the present study, we radiolabeled 5-fluorouracil with 99mTc for a diagnostic study of cancer. After successful labeling of the drug we performed an animal study to evaluate the potential of this radiopharmaceutical as a tumor diagnostic agent. The results showed 98.1 +/- 1.2 % labeling efficacy of 5-fluorouracil with [99m]Tc. The in vitro stability of the radiolabeled drug at room temperature at 4 hr of post-labeling was >96.5 +/- 0.4 %. The binding of the radiolabeled drug with plasma proteins was 66.6 +/- 3%. Partition coefficient results showed that this drug is hydrophilic in nature. Biodistribution study in rabbit models displayed faint uptake in liver. Both kidney and bladder were prominent as excretory route of the labeled drug. Bioevaluation was performed in Swiss Webster mice having naturally developed tumor. Mice were dissected, uptake of drug in various organs was studied and results showed prominent uptake in liver and tumor. Tumor was further investigated by histopathological study