Development of a rapid resolution HPLC method for the quantitative determination of sitagliptin in human plasma

A new high performance liquid chromatography [HPLC] method for the quantitative determination of sitagliptin in human plasma was developed and validated for pharmacokinetics study. The plasma was spiked with the internal standard [Salbutamol, IS], extracted with trichloro acetic acid. The extracted analyte was injected into a Symmetry ODS C18 column [250mm×4.5mm, 5m] and the flourometric detector was operated at 267 nm for excitation and 575 nm for emission. The mobile phase consisting of Potassium dihydrogen phosphate buffer pH [4.9]- Acetonitrile Methanol [30:50:20 v/v] at flow rate of 1.0mL/min. The method showed high specificity. Calibration curves of the peak area ratio of each analyte/IS versus sitagliptin concentration were linear in the range of 0.122-31.25 micro g/mL [r>0.989] for plasma and 0.012-25 ug/ml for QC solution[r>0.995]. The lower limit of quantification [LLOQ] was 0.122microg/mL in plasma and 0.012 in QC solution. The intraday and interday coefficient of variation was lower than 10%. The accuracy [relative recovery] at three levels was 100.95%, 101.03% and 97.79% respectively. The extraction recovery was 97.6%, 92.2% and 91.96% at the concentrations of 6.25, 25 and 100microg/mL, respectively. Short term and long term, freeze thaw stability of standard solutions and plasma samples were satisfactory. The optimized HPLC method was validated and proved to be specific, robust and accurate for determination of Sitagliptin in human plasma

Extra nasal manifestations of fungal sinusitis in children

Objectives: To portray the extra nasal features of fungal sinusitis in children in southern Punjab [Pakistan]

Study design: A retrospective descriptive study

Place and duration: Conducted at two tertiary care hospitals Ibn-e-Sina Hospital Multan, teaching hospital affiliated with Multan Med and Dental College, CMH Multan and one private ENT hospital Javeria ENT hospital Mianchanu. Period of study was three years [Jan 2010-Dec 2012]

Methodology: Thirty children with age range of 5-12 years fulfilling the diagnostic criteria of fungal sinusitis treated within 3 years [Jan 2010 - Dec 2012] were evaluated retrospectively. Nineteen patients were referred from ophthalmology and pediatric units of different hospitals located in Multan region for otorhinological opinion. Eleven patients reported directly to ENT department with nasal symptoms. Clinical presentation, radiological, laboratory and operative findings were studied

Results: Mean age determined was 10.2. Males were affected more than female and majority of them belonged to underprivileged group. Most frequent extra nasal features were epiphora, proptosis, telecanthus and headache

Conclusion: Fungal sinusitis is misjudged in children. In absence of or minimal nasal symptoms diagnosis gets delayed leading to dreadful disease with poor outcome

Occupational noise induced heraing loss

Objective: To investigate hearing threshold of industrial workers and correlate between noise exposed and unexposed groups

Study design: An observational cross sectional study

Place and duration of study: Study was conducted at medical testing and research organization located at Islamabad from January 2010 to May 2010

Methodology: 50 industrial workers [Gp A] exposed to constant high level noise were integrated in study and compared with matched control group [Gp B]. Pure tone audiometry [subjective test] was carried out to measure the hearing threshold at various frequencies

Results: Hearing loss was more prevalent in group A. A characteristic dip of hearing threshold was noted at 4000 Hz in Gp A

Conclusion: Industrial workers are at higher risk of developing Sensor-neural hearing loss [SNHL] as compared to general population. These individuals can easily be picked in early stages by audiometry and appropriate protective measures advised to prevent or interrupt the silent progress of disease

Chest pain as a presenting complaint in patients with acute myocardial infarction [AMI]

Objective: To study various characteristics of chest pain in acute myocardial infarction patients

Methodology: A total of 331 patients of AMI admitted at Cardiology unit Nishtar Hospital Multan and Chaudhry Pervez Elahi Institute of Cardiology Multan, irrespective of the age and gender, were included in this study. The study duration was one year starting from June 2011 to June 2012. Non-probability purposive sampling technique was used in this descriptive study. Informed consent to participate in this study was taken. Data were entered and analyzed using SPSS-11

Results: A total number of 331 patients with AMI were included in the study. Mean age was 54.99+/-11.25 years with minimum age 20 years and maximum age 90 years. It included 264[79.8%] male and 67[20.2%] female patients with male to female ratio of 3.9:1. Out of these 331 patients 308 [93.1%] patients reported chest pain as the presenting complaint. Remaining 23[6.9%] presented with clinical features other than chest pain. There were 127[38.4%] patients with pre-cordial chest pain, 115[34.7%] had retrosternal chest pain, 58[17.5%] were having epigastric pain. Severe chest pain was seen in 281[84.9%] patients while 26[7.9%] had only mild chest discomfort. Radiation of the pain to shoulder, neck and jaw was seen in 75 [22.7%] patients. In 42[12.7%] patients, pain radiated to both sides of chest. Another 55[16.6%] patients had pain radiation to chest, shoulder, upper arm and ulnar side of left forearm. Chest pain radiation to interscapular region along with both sides of chest was present in 10[3.0%] patients. In 11[3.3%] patients' pain radiated only to left side of chest. Pain persisting for >20 minutes was reported by 298 [90%] patients while only 10[3.1%] had pain persisting for <20 minutes

Conclusion: There is considerable overlap in chest pain of cardiac as well as non cardiac causes. However, vigilant evaluation of characteristics of chest pain in history taking may help to overcome this dilemma. Severe and prolonged precordial chest pain in a male patient between the age of 41-70 years, with pain radiation to left shoulder, neck and jaw is highly suggestive of AMI

Intramuscular ceftriaxone as single dose treatment of acute otitis media

To evaluate single dose intramuscular ceftriaxone as an option for the treatment of acute otitis media [AOM]. To compare efficacy of single dose intramuscular ceftriaxone to 10 days treatment with amoxicillin-clavulanate combination. Prospective, randomized, double blind control study. Combined Military Hospital Muzaffarabad, Azad Kashmir, over a period of 02 years from October 2006 to September 2008. A total of 148 freshly diagnosed cases of AOM between ages 03months to 6 years were recruited and divided randomly into two equal groups of 74 each using random numbers table. Group I was administered oral amoxicillin-clavulanate in a dose of 45mg/kg/day in three divided doses along with single intramuscular shot of placebo. Group II was given a single shot of intramuscular ceftriaxone in a dose of 50mg/kg along with placebo syrup thrice a day for 10 days. Patients were reassessed at day 03 and 11. Ninety four point five percent of patients responded to amoxicillin-clavulanate whereas 95.9% responded to single dose IM ceftriaxone. No significant difference was noted between the two types of treatments in term of disease outcome. Single dose intramuscular ceftriaxone can be another option for the treatment of AOM especially in children/parents with poor compliance

Reduced mouth opening following tonsillectomy in children: myth or reality

To evaluate whether tonsillectomy in children leads to subsequent reduction in mouth opening. Cohort study. Department of ENT/Head and Neck Surgery, Combined Military Hospital, Peshawar, from October 2005 to December 2006. A total of 42 children undergoing tonsillectomy [Group A = requiring insertion of a mouth gag] and 44 patients undergoing myringotomy or septoplasty [Group B = control group] were included in this cohort double blind study. Patients having pre-operative temporomandibular joint [TMJ] dysfunction, undergoing any other surgery in addition to tonsillectomy e.g. adenotonsillectomy, aged under 4 or above 15 years, and patients lost to follow-up were excluded. Painless, maximum interincisal distance [MID] was measured pre-operatively with a Vernier Calliper. Because of the inconsistency of mouth opening in children, three readings per individual were taken and the maximum recorded. Patients were followed up at 1, 2, 4, 12 and 26 weeks postoperatively in the ENT OPD and respective MID readings recorded. After a transient reduction in mouth opening, at the 26th week follow-up, 100% patients had reverted to their pre-operative MID measurements. Reduced mouth opening in children, after tonsillectomy is a transient finding returning to normal by about the 26th postoperative week

Post-tonsillectomy pain and bupivacaine, an intra individual design study

To compare whether an individual could appreciate the pain relief, if any, in either one of his/her tonsillar fossa topically suffused with a local anaesthetic [bupivacaine]. Randomized controlled trial. Department of ENT/Head and Neck Surgery, Combined Military Hospital, Peshawar, from January to June 2007. Forty-six patients of either gender, aged 10-42 years undergoing tonsillectomy for recurrent tonsillitis were enrolled for this study. At the end of surgery, having secured haemostasis, one tonsillar fossa was randomly packed with a gauze piece soaked in 3 ml of 0.5% bupivacaine for 5 minutes, while the other was not. Effects of postoperative analgesia were assessed using visual analogue scale [VAS] up to 8 hours. Majority of the patients [85%, n=39] failed to experience an appreciable pain relief on the side of local anaesthetic [bupivacaine] application [p=0.006]. Topical application of local anaesthetic [bupivacaine] confers no appreciable pain control in post-tonsillectomy patients

Efficacy of rifampicin in eradication of carrier state of staphylococcus aureus in anterior nares with recurrent furunculosis

To compare the frequency of detection of Staphylococcus aureus carrier state in anterior nares of the patients suffering from recurrent furunculosis with the normal population and to determine the efficacy of rifampicin in eradication of the carrier state. Quasi-experimental study. Skin Department of Combined Military Hospital, Peshawar and Multan, from March 2004 to December 2005. Patients and The study consisted of 80 individuals. They were placed in two groups. Group I comprised of 40 patients suffering from recurrent furuncles and group II included 40 healthy adults, kept as controls. Nasal swab was taken from the individuals belonging to both the groups, when they first reported to skin OPD. The patients who were suffering from furuncles were treated with co-amoxiclav 375 or 625 mg three times a day. The patients in whom S. aureus carrier state was detected were again divided into two groups. Group 1 was prescribed rifampicin 450-600 mg daily [depending on the body weight] for 10 days, while the group 2 was not offered any treatment. After this course, a second nasal swab was taken and submitted for cultures. Among the 40 patients belonging to group I, S. aureus carrier state was detected in 23 [57.5%], while in group II the carrier state was found in 8 [20%] individuals [p <0.001]. Among the 13 patients who received rifampicin, 10 got cured of carrier state, while in 3 patients nasal swab was still positive after a course of rifampicin. In 10 patients, who were not offered any treatment, the nasal swabs remained positive [p<0.001]. These patients were followed-up in skin OPD for another 3 months, and did not develop any recurrence of the infection. Nasal swab for detection of S. aureus carrier state should be done in all patients of recurrent furunculosis. If the nasal swab culture is positive, then as the infection gets cured, the patients should receive a course of rifampicin for 10 days. This may eradicate the carrier state in majority of cases and prevent the recurrence of the infection

Vesicovaginal Fistulae: Etiology and Management At Allied Hospital, Faisalabad

To determine the etiological factors responsible for Vesico-Vaginal Fistulae [VVF] and review our experience of their management.: Retrospective descriptional study conducted over a period of six years. Department of Urology, Allied Hospital and Punjab Medical College, Faisalabad.All patients who presented with Vesicovaginal Fistula.The record of 120 patients who presented with VVF over the past six years were reviewed and analyzed. Intra-venous urography [IVU], cystourethroscopy and vaginoscopy were performed to evaluate each pcitient. VVF were repaired by vaginal and abdominal approaches, using flaps where required. The outcome of the procedures and their post-operative complications were observed and recorded.Out of the 120 patients who presented with VVF, prolonged / obstructed labour was found to be the cause in 82 [68.33%] patients, and pelvic surgery in 36 [30%] patients. VVF was repaired by the vaginal approach in 42 [39.25%] patients with a success rate of 85.71%, whereas the abdominal approach was used in 67 [62.61%] patients with a success rate of 94%.Obstructed / prolonged labour is the major cause of VVF in the third world countries like Pakistan. Low literacy rate, poverty and deficient obstetrical facilities are mainly responsible for them. However, with improved surgical techniques and skills, they are now better managed in our country. Steps should be taken by the government and NGOs to provide proper obstetrical facilities to the women of rural areas

Comparative study of internal anal sphincterotomy and anal dilatation in acute anal fissure

A cohort, comparative, non randomized study between lateral internal sphincterotomy [LIS] and manual dilatation of anus [MDA] was carried out for acute anal fissure at Combined Military Hospital [CMH] Lahore. The study included 46 patients divided into two groups. Group A underwent LIS and Group B MDA over a period of one and a half year. Patients who were diagnosed as a case of acute anal fissure on history, clinical examination and per rectal examination were included in the study. Most of the patients were army soldiers and their families admitted in CMH Lahore. Both procedures were carried out under general anesthesia. Chronic anal fissure patients were not included in the study. A proforma was devised to record patient's particulars, history, and clinical examination, per rectal findings, operative methods, post operative recovery and complications. Sigmoidoscopy was performed per operatively to rule out any secondary cause of anal fissure. Follow up time was 6 months. Recurrence rate and prolapse of haemorrhoids was in 1 [2.17 percent] in group B while no recurrence in group A. Most of complications were minor and resolved spontaneously. Reoperations included one haemorrhoidectomy and one LIS who had recurrence after MDA. Pain relief was within first 24 hours in both groups. Average time to return to work was 7 days in group A while 11 days in group B. Our experience by this prospective comparative study strongly suggests that subcutaneous lateral internal sphincterotomy under general anesthesia is the most effective method of management for acute anal fissure regarding post operative complications, loss of work hours and pain relief

Cystectomy and urterosigmoidostomy; treatment of carcinoma urinary bladder

Objective: To audit experience of cystectomy and ureterosigmoidostomy as treatment of carcinoma bladder. [2] To assess the complications of ureterosigmoidostomy. [3] To assess the quality of life after the procedure. Design: Prospective. Setting: Department of Urology Allied Hospital Faisalabad. Period: December 2000 to January 2004

Material and Methods: Twenty two cases were included in the study. All patients had muscle invasive transitional cell carcinoma, demonstrated histopathologically by TUR biopsies. CT abdomen and pelvis and sphincter assessment was performed besides other routine investigations. All patents were treated by cystectomy and ureterosigmoidostomy Prophylactic alkalinization of urine was done by Na citrate tablets

Results: All patients presented with total painless haematuria. 19 patients were male and 03 females. Age ranged from 38-75 years. 18 [82%] had T2 and 04 [18%] had T3, transitional cell carcinoma. Two patients had rectal injury. One repaired Primarily and 2[nd] patient was managed by colostomy and delayed repair. Immediate post-operative complications were urine leak wound [13.6%], wound infections in 8 patients [36%], pyelonephritis in 04 patients [18%]. No patients suffered metabolic acidosis. 03 [13%] patients expired

Conclusion: We consider that cystectomy and ureterosigmoidostomy is the right option for patients with localized carcinoma urinary bladder