Occupational zoonosis and laboratory animals-based research in Pakistan: a strategic vision for the welfare of laboratory animals

Worldwide history shows, zoonosis has resulted in number of deaths and has a negative impact on economies. Zoonosis is not only limited to the wild or domestic animals but there is also a risk of zoonosis for researchers working with the laboratory animals in research institutes/universities. In the laboratory animal facilities, exposure of zoonotic agents from laboratory animals to humans has occupational and public health importance. In addition to the public health importance, the presence of zoonotic agents and other infections also affect the quality and reproducibly of biomedical research. According to international biomedical laboratory animal-based research data, the primary laboratory animal species being used mostly are rodents especially mice. Rodents including mice are the sources of various zoonotic agents. So, working with laboratory rodents, various diseases can be transmitted to researchers, technical and managerial staff. These diseases are usually asymptomatic in laboratory animals but can cause serious illness in humans and may also affect the reproducibility and quality of research. This review article mainly focuses on common zoonotic diseases of rats and mice, their mode of transmission and prevention. Most importantly, authors in this review article, are proposing a strategic vision focusing on making legislation, councils/associations to regulate laboratory animal care and use program for laboratory animal-based research in Pakistan. This strategic vision will not only help to prevent zoonosis but also help to improve the quality and reproducibility of animal-based research

Frequency of Laryngospasm in awake Versus deep Extubation after Intranasal surgery

Objective: To compare the frequency of laryngospasm in awake versus deep extubation after intranasal surgery

Study Design: Randomized controlled trial

Place and Duration of Study: The study was carried out at Combined Military Hospital Rawalpindi which is a tertiary care hospital, after seeking permission from Hospital Ethics Committee. Study was carried out for six months, from Feb 2013 till Aug 2013

Material and Methods: Two hundred and fifty patients fulfilling the inclusion criteria were selected for this study and divided into two groups of 125 each. Patients of group A were extubated fully awake while the patients assigned to group B were extubated during deep anaesthesia. Patients were then monitored closely for 30 minutes to assess whether they developed laryngospasm or not

Results: The mean age in group-A was 23.92 +/- 5.01 years and in group-B was 24.16 +/- 5.56 years. The mean height in group-A was 169.53 +/- 4.74cm and in group-B was 170.42 +/- 4.34 cm. The mean weight in group-A was 66.18 +/- 6.31 kg and in group-B was 65.67 +/- 6.00 kg. In group-A 72 percent patients were male and 28 percent were female while in group-B 76 percent patients were male and 24 percent patients were female. In group-A 9 [7.2 percent] patients developed laryngospasm and in group B 6 [4.8 percent] patients developed laryngospasm

Conclusion: There is no difference in frequency of laryngospasm in awake versus deep extubation after intranasal surgery

Use of penile skin flap in complex anterior urethral stricture repair: our experience

Objective: To present our experience of treatment of complex anterior urethral strictures using penile skin flap

Study Design: Descriptive, case series

Place and Duration of Study: Department of urology Combined Military Hospital Malir Cantonment, Karachi and Armed Forces Institute of Urology, Rawalpindi from Jan 2012 to Feb 2014

Material and Methods: Total 18 patients with complex anterior urethral strictures and combined anterior and bulborurethral strictures were included. Patients underwent repair using Orandi or circularfacio-cutaneous penile skin flap depending upon the size and site of stricture. First dressing was changed after two days and an in dwelling silicone two way foleycatheter was kept in place for three weeks. Graft was assessed with regards to local infection, fistula formation and restricturing. Re-stricture was assessed by performing uroflowmetery at 6 months and 1 year. Ascending urethrogram was reserved for cases with less than 10 ml/sec Q max on uroflowmetery. Repair failure was considered whenthere was a need for any subsequent urethral procedure asurethral dilatation, dorsal visual internal urethrotomy, or urethroplasty

Results: Overall success rate was 83.3%. Of all the patients operated 1[5.6%] had infection with loss of flap, 3[16.7%] had urethral fistula and none had re stricture confirmed by uroflowmetery

Conclusion: In our study the excellent results of the penile skin flap both in anterior urethral strictures and combined anterior and bulbar urethral strictures are quite encouraging. It is easy to harvest and seems anatomically more logical

Prevalence of Ttype II diabetes in district Dir Lower in Pakistan

Objective: To investigate the prevalence of type II diabetes and pre-diabetes and its risk factors in the District Dir Lower Pakistan

Methods: This study was a population based cross-sectional analysis of 1650 individuals of age 20-80 years, using cluster random sampling technique. After an overnight fast, diabetes and pre-diabetes were analyzed according to the World Health Organization recommendation

Results: The prevalence of diabetes and prediabetes was 11.1% and 16.0%, respectively. Type II diabetes was found 11.0% in female and 11.2% in male subjects. Stepwise multiple logistic regression showed that growing age, positive family history, body mass index [obesity], hypertension, exercise [less physical activates], education, monthly income, are statistically significant risk factors with type II diabetes

Conclusion: Our results suggest that type II diabetes has become a main health problem in District Dir Lower and better strategies are required to handle this problem

Complications of percutaneous nephrolithotomy single center experience of 103 cases

Objective: To present our complications of percutaneous nephrolithotomy [PCNL] during initial one year using modified Calvien system

Study Design: Observational prospective cohort

Place and Duration of Study: Armed Forces Institute of Urology [AFIU] Rawalpindi from 1[st] January 2014 to 31[st] December 2014

Material and Methods: The study was conducted at AFIU, Rawalpindi from 1[st] January 2014 to 31[st] August 2014. All of the consecutive 103 patients who underwent PCNL were included. Single-stage PCNL was performed in all the cases under general anesthesia. Pneumatic and ultrasound probes [alone or in combination] were used to fragment the calculi. Stone fragments were removed using graspers. A 16 Fr Foley catheter was used as nehrostomy tube. It was clamped on the first postoperative day. Foley catheter and ureteric stent was removed one day later. Intravenous antibiotics were given during admission period, i.e. 3-5 days. The complications were classified according to modified Clavien system. The data was analysed using the Statistical Package for the Social Sciences [SPSS] version 16

Results: Sixty nine [67%] patients were males and thirty four [33%] were females. Their ages ranged from 7 years to 81 years with mean age 41.7 +/- 16.34 years. PCNL was performed on right side in 48 [46.6%] cases while 55 [53.4%] underwent PCNL on left side. Overall complication rate was 21.35%. Grade 1 complications in 7.7%, grade 2 in 7.8%, grade 3a in 2.8% and grade 4a complications in 2.9% were seen

Conclusion: PCNL is associated with low incidence of major complications even in the hands of beginners when carefully performed

Development of Maize Haploid Inducer Lines and Doubled Haploid Lines in Pakistan.

The work on maize doubled haploid development has started at the Maize Research Station, Ayub Agricultural Research Institute, Faisalabad, Pakistan during 2010 in collaboration with University of Agriculture Faisalabad, Pakistan. The aim of current study was to develop locally adopted maize haploid inducer lines utilizing cheap and easy source of Stock6 and indeterminate gametophyte mutant ig1 gene lines imported from Maize genetic Coop Stock Centre. The lines were later utilized to produce doubled haploid inbred lines. The environmental conditions of Faisalabad are extreme in nature. In spring crop during pollination period temperature may reach up to 45°C. Therefore, locally adopted haploid inducers are needed. Best performing local inbred lines were screened having branched heavy tassel, bold seed, good pollen shedding ability and vigor. These lines were utilized as female donor parent while imported lines as recurrent pollen parent in back cross breeding program until BC4 generation. These lines were selfed twice until BC4F2 and evaluated for haploid induction rate (HIR). Lines with high HIR were further intercrossed to achieve maximum transgressive segregation. Mass selection for the adaptation traits was exercised for individual F2 plants followed by ear-to-row plantation of selected progeny. Four best haploid inducer lines with HIR up to 5% having very good tassel size, height and heat stress tolerance were selected in 2014. Haploid seeds collected in different induction crosses until 2012, were used for colchicine doubling treatment. The doubling percentage of the haploid plants was very low 0.15% and out of 1000 treated seedling 15 survived and only 5 reached up to maturity, where only one D0 cob was harvested. This was successfully selfed and was grown in three different locations for next two seasons and there was no segregation in the successive generations. Developing countries that cannot afford costly haploid inducer lines can work on Stock6 and other cheap sources available free of cost and can develop their own haploid inducer lines well adapted to their own climatic conditions.

Pterygium; comparison of results excision through bare sclera technique with and without intraoperative Mitomycin C application

To study the results of primary pterygium excision through bare sclera technique with and without intraoperative Mitomycin C use. This was an experimental study with randomised controlled trial. This study was conducted at Eye A unit, Khyber Teaching Hospital, Peshawar from May, 2007 to April,2009. One hundred patients with primary pterygium were selected from ophthalmology Deptt. OPD at Khyber Teaching Hospital, Peshawar. Detailed history was taken. Complete ocular examination done and those fulfilling inclusion criteria were included in the study. Anesthesia used was topical proparacaine 0.5% and local infiltration of 2% lignocaine. Mitomycine C [MMC] 0.02% [0.2mg/ml] was applied through a cotton swab at the bare part of the sclera for five minutes in 50 of these patients. Patients were followed up till three months. In bare sclera technique without MMC, recurrence rate was 70% [35 patients] while in MMC group, it was 16% [08 patients].There was one punctuate epithelial keratitis in MMC group and two cases of conjuntival granuloma one in each group. Pterygium excision through simple bare sclera technique had significantly high recurrence rate as compared to intraoperative use of MMC

Comparison of outcome in reamed versus unreamed nailing in the treatment of tibial diaphysial fracture

Background: Tibial diaphysial fractures are among the notorious fractures as far as management is concerned

Objective: To compare the outcome [union] between reamed and unreamed nailing in transverse tibial diaphysial fractures

Patients and Methods: Study Design: Experimental study. Setting: Department of Orthopaedic Surgery, Bahawal Victoria Hospital Bahawalpur. Study Duration: 8 months from 1[st] January 2009 to 31[st] August 2009. Study subjects: 210 patients were divided into two groups A and B. Group A patients were managed by reamed interlocking nail tibia and group B patients by unreamed interlocking nail tibia. Follow up was done up to 3 months and outcome in terms of union was compared between two groups. 15 patients in each group were lost to followup so data analysis was done on 180 patients. Union was achieved in 80% of patients in group A while 70% in group B. Our study suggests that reamed interlocking nail tibia is better treatment option than unreamed interlocking nail tibia

Initial experience of high power diode laser for vaporization of prostate

Objectives: Prospective evaluation and experience of high power diode, 980nm diode laser for bladder outlet obstruction due to enlarged prostate

Methods: Total of 50 patients were included in the study. International prostate symptom score, quality of life, international index of erectile function-5, prostate specific antigen and prostate volume were compared with values at three months and six months postoperatively

Results: At the end of three months of postoperative period, the mean +/- SD international prostate symptom score decreased significantly from 20.83 +/- 3.77 to 9.23 +/- 2.79 [p=0.0001]. The mean maximal flow rate increased significantly from 8.23 +/- 2.12 to 18.56 +/- 5.09 ml per sec [p=0.0001]. Quality of life score changed considerably as compared to baseline. There was no deterioration in erectile function according to the international index of erectile function-5 short form

Conclusion: The high power diode laser provides significant improvements in International Prostate Symptom Score and the maximal flow rate with low morbidity

Evaluation of union of neglected femoral neck fractures treated with free fibular graft

To evaluate the frequency of union of neglected femoral neck fractures treated with free fibular graft. Descriptive case series. Department of Orthopedics Bahawal Victoria Hospital Bahawalpur, from April 2009 to January 2010. Patients of neglected femoral neck fracture [one month postinjury] were included in the study. They were operated and internal fixation was done with concellous screws and free fibular graft placed. They were followed till the evidence of radiological union. Out of 55 patients there were 40 males and 15 females. Ages ranged from 20 year to 50 year. The duration of injury was from 4 weeks to 6 months. Fifty patients achieved complete union while five patients developed non-union with complaint of pain. There was no wound infection and hardware failure. Fracture reduction and internal fixation with use of free fibular graft and concellous screws for neglected femoral neck fractures is the treatment of choice

Effects of Ramadan fasting and physical activity on glucose levels and serum lipid profile among type 2 diabetic patients

To assess the effect of fasting and physical activity on blood pressure, fasting glucose, cholesterol, triglyceride, high density and low density lipoproteins among diabetic type 2 patients. Seventy five patients who had three visits [last ten days of Shabann [visit 1], Ramadan [visit 2] and Shawwal [visit 3]] were included in the study. Physical measurements, clinical measurements and 12 hours fasting blood sample were taken, along with an interview for demographic information and physical activity on each visit. The samples were analyzed for 1] Glucose, 2] Cholesterol, 3] Triglyceride, 4] Uric Acid, 5] HDL-C, and 6] LDL-C. The mean weight of the patients decreased significantly from 71.43 kg to 69.41 kg from visit 1 to visit 2. Mean systolic blood pressure also decreased significantly from 124.25 mm/Hg to 119.86 mm/Hg while. Mean triglyceride level decreased from 239.095mg/L to 207.07 mg/L from visit 1 to visit 2 and it kept decreasing to 159.25 mg/L till third visit. Mean LDL value increased from 104.12 mg/L to 112.64 mg/L from visit one to visit two and then further increased to 119.0 mg/L on the third visit. Ramadan fasting is safe for diabetes type II patients and is associated with weight loss and improvement in the overall diabetic control. Furthermore, the physical activities could reduce the body weight, waist measurement, systolic blood pressure, triglyceride and HDL

Spectrum of bone lesions at Pakistan institute of medical sciences

To study demographic details of bone lesions diagnosed at Pakistan Institute of Medical Sciences [PIMS], Islamabad. A retrospective analysis of histopathology reports of 222 patients diagnosed to have various types of bone lesion, in the department of pathology at Pakistan Institute of Medical Sciences, Islamabad during a period of five years [July 2005- June 2010] was conducted. These biopsies were evaluated on hematoxylin and eosin [H and E] stained sections from paraffin embedded tissue blocks, Special stains performed whenever required. Pyogenic osteomyelitis comprised 43.6% of all bone pathologies, followed by granulomatous most probably tuberculous osteomyelitis in 7.6%. Chronic osteomyelitis was more commonly observed in 20-30 years of age group and males were affected more as compared to females. The commonest age group for benign lesion was 11-20 years. Primary malignant tumors were noted it 4.9% cases and metastatic tumors were seen in 14.4%. The commonest age group for metastatic tumors was more than 50 years of age. Males were affected more as compared to females in overall bone lesions. Femur was the commonest site in primary bone lesions. Jaw bones and scalp were more commonly involved metastatic tumors. Metastatic tumors were more common than primary malignancies. Scalp and mandible involvement was seen in metastatic tumors and bones of lower limbs were more commonly involved in primary bone lesions. Males were more commonly affected than females in this study.

Microcephaly: tracing the evolutionary lineage of ASPM gene

Microcephaly, in the form of congenital autosomal recessive disorder [MCPH], is characterized by the reduced occipital frontal head circumference >3 standard deviation of otherwise normal population of matching age and sex. The disease is primarily associated with mild to severe mental retardation. Earlier studies have unravelled that among Pakistani population, mutations in ASPM gene is strongly associated in MCPH. In the present study, we have explored the ancestral root of this disease and the process involved in its evolution using tools of bioinformatics. Experimental Methods: cDNA gene and protein sequences of ASPM gene were retrieved from NCBI database and subjected to the non-redundant BLAST. Consensus phylogenetic tree was developed after multiple sequence alignment and bootstrapping of the protein sequences of ASPM gene from different mammals using Neighbour Joining method, selecting non mammals as an out group. Comparisons of the gene synteny and exon and intron patterns of ASPM gene were also undertaken to investigate chromosomal changes during the course of human evolution. Different statistical evolutionary models namely, Codon Based Z test and Maximum Composite Likelihood Estimate were used in order to estimate the nature of nucleotide substitution and the type of selection pressure the gene has undergone. Phylogenetic tree based on ASPM gene clearly segregated all non mammalian members as an out group. Mammalian in group holds the established evolutionary lineage, based on morpho-genetic attributes of mammalian evolution, segregating monotremes at the beginning followed by the members of rodentia and finally radiation of the primates including humans. Orientation of the ASPM gene remains conserved between human and chimpanzee, however, it was found reversed along with two flanking genes, a zinc finger binding domain 41 and coagulation factor XIII, which suggest relatively recent event of gene inversion. Some earlier and, in comparison, more intricate chromosomal changes have also been detected among the lower order of mammals. Aligning ASPM gene exons with the primates and lower order mammals indicates transitional bias of mutation over transversion [R value= 1.563]. Holistically, codon based Z test revealed positive selection pressure on of ASPM gene from rodentia to primates. Briefly, the studies highlights the evolutionary events of ASPM gene in mammals especially primates including humans. Further studies in connection to correlating the cranial cavity size and ancestral gene sequences and in depth sequence comparison would be more insightful in this regard and studies in this connection are ongoing and will be reported shortly

Transabdominal repair of vesicovaginal fistula: an experience of 27 cases

To review the causes of vesicovaginal fistula and outcome of its repair through transabdominal approach. This is a descriptive cross sectional study which was conducted in Surgical "D" unit, Khyber Teaching Hospital Peshawar from January 2004 to December 2009. The record of all cases of vesicovaginal fistula that had undergone transabdominal repair was reviewed. Complex vesicovaginal fistula cases were excluded. Operative findings and procedure's details were obtained from operation notes. Post-operative follow up findings after one week, three weeks, forty days and three months were noted for every case. A total of 27 cases had undergone transabdominal repair for vesicovaginal fistula with age ranging from 26 to 63 years. Twenty two cases developed vesicovaginal fistula as a result of obstructed labour and five as a result of Gynaecological surgery [post-hysterectomy]. Mean post-operative hospital stay was seven days. Failure of repair was seen in one case only. Five cases were lost during follow up. Eight [29.63%] cases developed urinary tract infection, and two [7.40%] cases developed transient urinary stress incontinence. This study suggests that obstetrical trauma is the commonest cause for developing vesicovaginal fistula and the transabdominal approach gives satisfactory results in its repair

Outcome of mesh repair for incisional hernia

To determine the results of incisional hernia repair with prosthetic mesh. It is a retrospective descriptive study, conducted at Surgical "D" ward Khyber Teaching Hospital, Peshawar from January, 2002 to October, 2006. A total of 121 patients were included in this study. Those patients with incisional hernia, who were repaired with mesh and completed the minimum of 9 months of follow up, were included. Patients who were clinically diagnosed to have incisional hernia were admitted and after necessary preparation, were operated and defect in the abdominal wall was closed by a synthetic mesh. During the early post operative and follow up period, patients were looked for complications like seroma, infection, chronic discharging sinus formation and recurrence. Out of 121 patients, 73 were female and 48 were male. In most of the patients the incisional hernia resulted from emergency procedures. In 35 [28.9%] patients, there was post operative seroma formation, 17 [14%] patients had wound infection. one [0.8%] patient developed subcutaneous heamatoma due to unidentified bleeding which later on required evacuation under general anesthesia. Eight [6.6%] developed recurrence of hernia out of which some patients were treated by repeat Mesh repair. In 12 [9.9%] patients there was mild to moderate skin margin necrosis and in these cases debridement was a proof of successful treatment. Partial wound dehiscence was found in 3.3% of patients. Incisional hernia is more common in midline laparotomy wounds specially performed in emergency conditions and onlay mesh repair procedure has high acceptable outcomes

Assessment of elbow function after stable fixation of AO type C fractures of the distal humerus in adults

Thirty five patients AO Type C fractures of the distal humerus reporting to Orthopedic Department were studied over a period of three years from January 2000 to March 2003. Close fractures and Gustilo Grade I and II fractures were included in the study. Age ranged from fifteen years to sixty years. all the patients were operated under general anaesthesia. A comparison b/w transolecranon approach [1] and Shahane and Stanley approach [2] was done. At a follow-up of six months the results using the Jupiter's modification of Cassebaum's rating system[3]. According to it thirteen results were rated excellent, eleven good, six fair and five poor. Complications included tourniquet palsy, infection, stiff elbow and prominent hardware

Pneumatic lithotripsy for the treatment of ureteric calculi

Transureteral lithotripsy has emerged as a popular and standard treatment modality for the management of ureteric calculi. It can be used very effectively to treat ureteric calculi at all locations. In this study, fifty consecutive cases of ureteric calculi treated by ureteroscopy and pneumatic intracorporeal [Lithoclast] lithotripsy have been reviewed. The overall success rate was 92%. With the advent of and continuous refinements in minimally invasive techniques, open surgery is becoming a story of past in the management of ureteric calculi. The success rate for ureteroscopic stone retrieval depends upon the stone size, location and experience of the ureteroscopist. In our experience, ureteroscopic lithotripsy has been found to be a safe, effective and expeditious means of clearing ureteric calculi at all levels. It is tolerated well by the patient, associated with very low morbidity and recommended as a procedure of choice for all ureteric calculi

Skin coverage of the lower leg by fasciocutaneous island flaps

Fourteen cases presenting to our unit with skin loss over the lower 1/3rd of leg including the ankle and heel are presented. The skin loss was the result of roadside accident or was due to diabetic ulcers. Coverage of the wounds was done with fasciocutaneous island flaps based on the perforators of anterior tibial artery, posterior tibial artery peroneal artery and medial plantar artery. These patients would have ended up either in amputation or referral to other specialized units increasing financial cost and mental trauma. There was male predominance [71%] and most of the injuries were the result of roadside accidents [92%]. All the wounds except those resulting from diabetes mellitus were labelled as Open Grade IIIB according to the Gustilo classification of open fractures. The wounds were debrided within twelve hours of injury [10 patients]. The fractures were stabilized with either external fixator or were internally fixed [one case]. Three wounds [21%] were covered with flaps based on the perforators of anterior tibial A., eight wounds [57%] posterior tibial artery perforators and one each on rural A., peroneal A perforators and medial plantar artery. There was superficial necrosis in two patients and deep necrosis occurred in one patient for whom split thickness grafting was done. The results have been encouraging and we are now using fasciocutaneous island flaps for coverage in the area of lower leg, ankle and heel regularly due to the excellent results and easy technique