Impact of socio-demographic characteristics on sleep quality and health of insomnia patients

Background: Socio-demographic characteristics has impact on the sleep quality and health among insomnia patients

Objectives: The present research aimed to determine the effect of socio-demographic characteristics on sleep quality and health among insomnia patients

Study design, settings and duration: This cross-sectional study was carried out at Gilgit, Pakistan from February 2016 to February 2017

Patients and Methods: In the current study, data of 200 insomnia patients were collected by scales including Insomnia Severity Index, Pittsburgh Sleep Quality Index, and Health Status Questionnaire [SF-36] through purposive sampling technique. The data analysis was carried out by using SPSS [Version-22]. Independent sample t test and one way ANOVA were used to test the assumptions

Results: Results revealed that female insomnia patients had better sleep quality, t [198] = 3.21, p-value <0.01, as compared to males, while males had better overall physical and mental health t [198] = 2.69, p-value <0.05. Young adults had better sleep quality t [198] = 2.34, p-value <0.05, and physical functioning t [198] = 2.02, p-value <0.05 as compared to late adolescents. More educated insomnia patients had better sleep quality t [198] = 2.11, p-value <0.05, physical functioning t [198] = 214, p-value <0.05 and overall physical and mental health t [198] = 2.77, p-value <0.05 whereas less educated patients had better vitality level t [198] = 2.22, p-value <0.05. Moreover the results revealed that insomnia patients with rural background had better physical functioning t [198] = 2.55, p-value <0.05 whereas patients with urban background had better overall physical and mental health t [198] = 4.12, p-value <0.05

Conclusion: Socio-demographic factors, like age, gender, education and residential status, greatly influence the level of sleep quality and health among insomnia patients

Predictors of mental well-being among adults in Pakistan and Qatar: cross-cultural study on salutogenesis model of medical health

Background: The study has investigated a concept of salutogenesis model of medical health named sense of coherence in relation to well-being of adults from a cross-cultural perspective. Besides the independent effect of sense of coherence on the well-being, its effect was combined in a moderation model to investigate its interactive effect on well-being

Objectives: The study intended to examine the moderating role of extroversion and neuroticism in the relationship between sense of coherence and well-being in Pakistan and Qatar. The research also investigated mean differences in the level of sense of coherence in two cultures including Pakistan and Qatar. More clearly interaction effect of sense of coherence and personality types was investigated along with a cross-cultural comparison on sense of coherence

Subjects and Methods: Sense of Coherence Scale, Short Warwick-Edinburgh Mental Well-Being and NEO-Five Factors Inventory were administered on 250 participants from Pakistan and Qatar. The study completed in one year duration from 2015 to 2016

Results: Moderation analysis revealed that personality types moderated the relationship between sense of coherence and well-being among adult participants. Results of t-test found that adults from Qatar exhibited higher level of sense of coherence as compared to their Pakistani counterparts

Conclusion: The study has investigated a medical health model of salutogenesis from cross-cultural perspective. Finding confirmed the interactive effect of sense of coherence and personality types on the well-being of adults. Significant differences in the level of sense of coherence in two cultures contain cross-cultural importance from medical perspective

Enhanced production of Lovastatin by filamentous fungi through solid state fermentation

Lovastatin is a natural competitive inhibitor of 3-hydroxy-3-methyl glutaryl coenzyme-A [HMG-CoA] reductase and inhibits specifically rate limiting step in cholesterol biosynthesis. Further, lovastatin in comparison with synthetic drugs has no well-reported side effects. Four pure isolated filamentous fungal strains including Aspergillus niger IBL, Aspergillus terreus FFCBP-1053, Aspergillus flavus PML and Aspergillus nidulans FFCBP-014 have been cultured by solid state fermentation [SSF] using rice straw as substrate for the synthesis of lovastatin. After selecting Aspergillus terreus FFCBP-1053 as the best producer of lovastatin, various selected physical parameters including pH, temperature, inoculums size and moisture content were optimized through response surface methodology [RSM] under center composite design [CCD] for lovastatin hyper production. Maximum lovastatin production of 2070+/-91.5 was predicted by the quadratic model in the medium having moisture content 70% and pH 4.5 at 35 degree C which was verified experimentally to be 2140+/-93.25Mug/g DW of FM [microgram/gram dry weight of fermentation medium], significantly [P<0.05] high as compared to un-optimized conditions while it was noted that lovastatin production is independent on inoculum size [P>0.05] measured by spectrophotometer at 245 nm against standard. It was determined that optimized conditions for the hyper-production of lovastatin from fungal sources have a significant effect

Knowledge and practices of nurses regarding spread of nosocomial infection ingovernment hospitals, Lahore

Introduction: Nosocomial infection, also called hospital acquired infection occur in patient who are admitted in Hospital for a long or short period of time for some therapeutic or diagnostic purposes yet patient have no evidence of infection before admission in hospital. The pathogenic organism of nosocomial infection may be bacterial, viral, contagious and parasitic those are found in the air, within utensils; may spread from one person to another person

Objectives: The objective of this study was to evaluate the knowledge and practices of nurses regarding the spread of nosocomial infection in government hospitals of Lahore

Design: A cross sectional Descriptive study was conducted in Government hospitals of Lahore, Pakistan from February 2016 to April 2016. Sample size was 240 and the response of the participants were taken through simple random sampling techniques. Data was analyzed by using SPSS version 21

Results: Most of the participants were female 231[96.3%] and 9[3.8%] were male. It is revealed that nurses have enough knowledge about spread of nosocomial infection as out of 240 participants 77 [32.1%] were agree and 69[28.8%] were strongly agree that they are fully aware of hand washing guidelines but their practices to reduce the spread of nosocomial infection were not good as 81[33.8%] were neutral and 72[30.0%] were disagree that they follow the recommended guidelines for use of alcohol based solutions or other antiseptics before and after each contact to move or during the transferring of the patients

Conclusion: Nurses had good knowledge about spread of hospital acquired infection, use of safety precautions, uses of alcohol based formulations but their practices to reduce the spread of nosocomial infection were not up to satisfactory level

Heavy metals identification and exposure at workplace environment its extent of accumulation in blood of iron and steel recycling foundry workers of Lahore, Pakistan

The determination of heavy metals in blood is an important occupational environmental toxicology screening procedure. The aim of study was to determine the concentrations of Pb, Cd, Cr and Ni in blood samples of iron and steel foundry workplace exposed workers under routine clinical laboratory conditions. The method was employed for the quantitative determination of lead, cadmium, chromium and nickel in workplace environment particulate matter blood samples from iron and steel foundry workers and in unexposed controls. The results indicate that lead, chromium and nickel levels of the exposed workers are significantly higher those of the controls. Nickel Concentration [fig/L] in high P value=0.0306 and Chromium Concentration [microg/L] in P value=0.0295in worker population as compared to controls. Lead showed highest Absorption concentration in serum from particulate matter to Serum 47.3[microg/L]. Absorption concentration of nickel in serum 16.5[microg/L] was lower than lead observed in worker's population. Absorption concentration of cadmium and chromium in serum from particulate matter -152[microg/L] observed very low. The results also show the need for immediate improvements in workplace ventilation and industrial hygiene practices

Frequency of anemia in rheumatoid arthritis patients presenting in various hospitals of Peshawar, Khyber Pakhtunkhwa

Objective: Anemia is a chronic complication of rheumatoid arthritis that is produced by a number of causes. Very little interest in research is shown in this field by researchers both nationally and internationally. The main objective of the study was to determine the frequency of anemia in rheumatoid arthritis patients

Study Design: Descriptive, cross sectional study

Place and Duration of study: This study was conducted at the Hayatabad Medical Complex [HMC], Rehman Medical Institute [RMI] and Khushal Medical Center, Peshawar, from April 2015 to March 2016

Materials and Methods: Two hundred and thirty patients with rheumatoid arthritis visiting medical outdoor clinics in different hospitals of Peshawar were enrolled from April 2015 to March 2016. Detailed history was taken and clinical examination was performed. After taking consent, diagnosis of anemia was made by performing peripheral smear tests using digital sysmex XT-4000i hematology analyzer. The identity of patients was kept confidential. The demographic informations such as name, age and gender were recorded

Results: Among 230 patients, with mean age of 50 years, male-female ratio was 30%[n=70] and70%[n=160] respectively. Anemia was diagnosed in 26%[n=60] patients, while 74%[n=170] patients had no anemia among the study group. Out of 60 patients with anemia, 30%[ n=18] patients were male and 70%[n=42] patients were female. Anemia association with the duration of rheumatoid arthritis was analyzed, which shows that anemia increases as duration of rheumatoid arthritis increases

Conclusion: It is concluded from the study that rheumatoid arthritis is a chronic disorder affecting multiple organs of the body and anemia is a well-known significant complication of rheumatoid arthritis as shown by the results of this study

Medicinal plants and management of diabetes mellitus: a review

Diabetes is a metabolic disorder characterized by chronic hyperglycemia and associated with dysfunction and failure of various body organs. Alarming increase in prevalence rate has made this disorder a major health problem globally. The available treatment modalities are not sufficient to combat diabetes and associated complications. A number of medicinal plants have a significant antidiabetic potential against diabetes mellitus. We have listed the use of important medicinal herbs for the treatment and management of diabetes in this review

Frequency of medical covers and diseases encountered in field by a field medical unit of Pakistan army

Objective: To determine the frequency of medical covers and diseases encountered in the field by a field medical unit of Pakistan Army

Study Design: Descriptive study

Place and Duration of Study: The Study was conducted in 61 Medical Battalion Multan, from Jan 2013 to Dec 2013

Patients and Methods: All the medical help demanded either in the form of nursing assistants [NA] or medical officers [MO] or advanced dressing station [ADS] or forward treatment centre [FTC], by a competent authority of HQ Log 2 Corps, during complete one year of 2013 [January 2013 to December 2013]

Results: A total of 90% of all medical covers were in-station and 95% of them required NA only. Ten percent of all medical covers were out-station and 98% of them required MO also. Eighty percent of the diseases faced in field were gastroenteritis, 15% upper respiratory tract infection [URTI], 5% were heat exhaustion, trauma, foot rot, arthropode/vector borne diseases

Conclusion: Prompt first aid and speedy evacuation is the essence of medical cover. Basic life support [BLS] trained nursing staff and speedy, reliable and fast ambulance is the core of medical evacuation. MO is only to be employed where distance from any other medical or surgical facility is more than 2 hours. Water source in field to be screened for coliform count under responsibility of concerned engineer detachment or packed water bottles to be provided from the supply detachments

Therapeutic Effect of Atorvastatin on kidney functions and urinary excretion of Glimepiride in healthy adult human male subjects

Glimepiride and Atorvastatin in combination are commonly employed for treating the hyperglycemia and dyslipidemia, respectively, in patients of type 2 diabetes. The present study was designed to find out the influence of Atorvastatin on urinary excretion and renal clearance of Glimepiride in healthy adult male volunteers. In each experimental subject, Glimepiride 2mg was given orally after an overnight fasting. Samples of blood and urine were taken at different specific time intervals. After a washout period of ten days, Glimepiride 2mg was co-administered with Atorvastatin 20mg orally. Post-medication, blood and urine samples were collected following the same sampling schedule as for Glimepiride alone. The samples were analyzed for Glimepiride and creatinine concentration by HPLCUV and Spectrophotometer, respectively. Mean [ +/- SE] values for blood pH 7.445 +/- 0.05 and 7.382 +/- 0.05, urine pH 4.972 +/- 0.08 and 5.08 +/- 0.10, diuresis 0.0207 +/- 0.00 and 0.0237 +/- 0.00ml/min/kg, endogenous creatinine in plasma 9.048 +/- 0.33 and 8.613 +/- 0.024 micro g/ml, endogenous creatinine in urine 512.34 +/- 18.20 and 556.72 +/- 4.60 micro g/ml, Glimepiride plasma concentration 0.16069 +/- 0.00 and 0.3227 +/- 0.01 micro g/ml, Glimepiride urine concentration 1.5994 +/- 0.03 and 0.8665 +/- 0.04 micro g/ml, renal clearance of creatinine 1.224 +/- 0.09 and 1.550 +/- 0.09ml/min/kg, renal clearance of Glimepiride 0.2064 +/- 0.01 and 0.0641 +/- 0.00ml/min/kg and clearance ratio 0.1791 +/- 0.01 and 0.0414 +/- 0.00 were observed for Glimepiride alone and its concurrent administration with Atorvastatin, respectively. Atorvastatin decreased the urinary excretion and renal clearance of Glimepiride due to which chances of hypoglycemia provokes and renal handling of Glimepiride involves back diffusion besides glomerular filtration and no influence of Atorvastatin was seen on these mechanisms

effect of sand storms on acute asthma in Riyadh, Saudi Arabia

Major sand storms are frequent in the Middle East. This study aims to investigate the role of air particulate matter [PM] level in acute asthma in children in Riyadh, Saudi Arabia. An aerosol spectrometer was used to evaluate PM < 10microm in diameter [PM 10] and PM < 2.5 microm in diameter [PM 2.5] concentrations in the air every 30 minutes throughout February and March 2012 in Riyadh. Data on children 2-12 years of age presenting to the emergency department of a major children's hospital with acute asthma during the same period were collected including their acute asthma severity score. The median with interquartile range [IQR] levels of PM 10 and PM 2.5 were 454 microg/m[3] [309, 864] and 108 microg/m[3] [72,192] respectively. There was no correlation between the average daily PM 10 levels and the average number of children presenting with acute asthma per day [r = -0.14, P = 0.45], their daily asthma score [r = 0.014, P = 0.94], or admission rate [r= -0.08, P = 0.65]. This was also true for average daily PM 2.5 levels. In addition, there was no difference in these variables between days with PM 10 >1000 microg/m[3], representing major sand storms, plus the following 5 days and other days with PM 10 < 1000 microg/m[3]. Sand storms, even major ones, had no significant impact on acute asthma exacerbations in children in Riyadh, Saudi Arabia. The very high levels of PM, however, deserve further studying especially of their long-term effects

Efficacy of cervical spine mobilization versus peripheral nerve slider techniques [neurodynamics] in cervicobrachial pain syndrome

The objective of this study was to compare the efficacy of cervical spine mobilization versus peripheral nerve slidertechniques [neurodynamics] incervicobrachial pain syndrome. The study design was arandomized interventional study. This study was conducted at the Armed Forces Institute of Rehabilitation Sciences [AFIRM], Rawalpindi from August 2014 to January 2015. Forty patients [n=40] were included by using purposive sampling technique. Patients of Age 30 to 60 years with Radiating neck pain, Limited ROM of neck and Pain persisting for more than 2 months, were included in study. Then randomly divided into two groups, each group contains 20 participants. One group was treated with neck mobilization and other was treated with neurodynamic treatment protocol. Pain and Active Range of Motion [AROM] was measured by Visual analog scale [VAS] and Inclinometer respectively. Neck Disability Index was also used. Patients were assessed before and after six week intervention. Data was analyzed on SPSS 20 and Independent t Test was used to compare the results of two groups. Pain was measured on VAS, the mean of Mobilization and Neurodynamics were [2.0+1.892 vs.4.8+2.397] respectively. There is significant [p<0.05] difference between two groups. There is also significant [p<0.05] difference for Range of Motion between two groups. The mean value for NDI of both groups were [14.5+7.564 vs 26.80+11.484]. It also shows better treatment is mobilization. The results of this comparison between two single interventions indicate that cervical mobilization treatment in neck pain is more useful than anneurodynamic treatment. For daily practice, we can recommend treatment according to the expert guidelines investigated

Salivary gland tumours: a tertiary care hospital experience

To study demographic, clinical and histopathological features of salivary gland tumours in a tertiary care hospital. Prospective cross sectional study. This study was carried out in the Department of ENT, Head and Neck surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from June 2010 to May 2014. This prospective cross sectional study of 4 years was carried out in the Department of ENT, Head and Neck surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar. All the patients qualifying inclusion criteria were evaluated in terms of detailed history, thorough examination and relevant investigation. After performing required surgery specimen was examined for histopathology. In this study 123 patients were included with mean +/- SD age of 40 +/- 5.1 years [age range 7–76 years]. Males were 81 and females were 42 with male: female ratio of 1.9:1. Most of the patients presented in 4th decade [28.45%, 35]. Lump was the commonest clinical feature lasting for 1-5 years [66.66%, 82]. Among the tumours 77.23% were benign while 22.76% were malignant. Benign tumours were commonly noticed in parotid gland [53.65%]. Pleomorphic adenoma was the commonest benign tumour [65.04%, n-80], affecting parotid gland in 52.03%. Mucoepidermoid carcinoma is the commonest malignant tumour [12.19%] predominantly found in minor salivary gland of palate [6.50%]. Salivary gland tumours predominantly affecting middle aged male population. Benign tumours are the commonly occurring salivary gland tumours. Pleomorphic adenoma is commonly occurring benign tumour affecting predominantly parotid gland while mucoepidermoid carcinoma is the commonest malignant tumour of salivary glands

Microbiology of bile in symptomatic uncomplicated gallstone disease

To determine the microbiology of the bile culture and antimicrobial susceptibility in patients with symptomatic gallstone disease in our setup. A descriptive study. Surgical Department Combined Military Hospital [CMH] Kharian from Oct, 2010 to Jun, 2011. A total of 106 patients underwent cholecystectomy due to symptomatic gallstones and their bile was cultured for aerobic and anaerobic bacteria and culture sensitivity was performed. Data was analysed by using statistical package for social sciences [SPSS] version 13. Bile culture was negative in 81 patients [76.4%] and was positive in only 25 patients [23.6%]. Escheria Coli was the most common cultured organism in 10 [40%] patients, Klebsiella in 5 [20%] patients, Pseudomonas in 5 [20%] patients, Proteus in 2 [8%] patients, Staphlococcus aureus in 2 [8%] patients and mixed organisms were cultured in 1 patient [4%]. Cefoperazone with sulbactum and Amikacin were the most effective prophylactic antibiotics. Bile in majority of patients with symtomatic uncomplicated gallstone disease is sterile. E. coli is the most commonly cultured organism and cefoperazone with sulbactum and amikacin are the most appropriate antibiotics in our setup

Variable arterial supply of motor areas of human brain

To study the arterial supply of motor areas of human brain regarding its variable source due to its significance in neurosurgical practice and angiography. It is prospective descriptive study on cadaveric human brains. This study was conducted on different cadaveric brains collected from anatomy and Forensic Departments of various teaching institutes during July2007-July2008. A total 100 brains were collected, skull cap was cut by electric saw meinges were saved, Skull cap was removed. Brain was removed through epidural space without any injury to blood vessels. After putting one week in 10 % formaline jar, dura was removed and branula No.24 was passed into each anterior and middle cerebral arteries separately at different times. Blue Indian ink was injected into anterior cerebral artery after ligating anterior communicating Artery. After injection branula was removed and ligature applied to the artery so that dye may not escape. Now branula was passed into middle cerebral Artery and the red Indian ink was injected so that contrasting colours clearly demarcate the blood vessels supplying the motor areas of brain. Arteries supplying from functional areas were divided in two groups A and B. Group A include primary motor cortex and group B include motor speed area or Broca's area. Each of this group is further subdivided into three sub groups A1, A2, A3 and B1, B2, B3. Sub group Al and Bl include area supplied by single artery, Sub group A2 and B2 include area supplied by multiple arteries whereas subgroup 3 include variant arteries supplying that area. Results were statistically evaluated. Sign test was used to test for presence of variant artery in each area and it was statistically significant. In group A out of 100 cases no case fell in such group A1, 96 cases [96%] fell in such group A2, where middle cerebral Artery and anterior cerebral Artery supplying the area . The frontal branches of middle cerebral artery two to three in number and anterior parietal branch of middle cerebral Artery supply 80% of area while one to two branches of frontopolar Artery, branch of anterior cerebral Artery supply 1.0 to 1.5 cm strip on supero medial surface of motor area. The anterior cerebral Artery supply the leg area and middle cerebral Artery the face trunk and upper limb area. In sub group A3, 4 cases [4%] accessory middle cerebral Artery appeared as variant Artery. In group B out of 100 cases 90 cases [90%] fell in sub group B1. 9 cases [9%] fell in sub group B2 where middle cerebral Artery through frontal branch and accessory middle cerebral Artery supply the area 1 case [1%] fell in such group B3. Where anterior temporal branch of inferior trank of middle cerebral Artery supply the area as variant Artery. 19 cases out of 100 [19%] showed variations among these 4 cases [4%] showed variations in arterial supply of primary motor cortex and 1 case [1%] showed variations in the arterial supply of motor speech area. Collateral vessels may modify the effects of cerebral ischaemia. anatomical variations of the cerebral arteries are of immense importance in surgery , angiography and all non-invasive procedures to help in interpretation of cranial angiogram. The major variations include duplication segmental duplication, aplasia, hypoplasia and fenestration of the vessels

Histological study of muscle injuries to observe the effects of environmental pollutants on its recovery and regeneration

Humans are exposed to environmental pollution, food contamination and Cigarette smoking. Environmental pollution in addition to its effects on different systems of body, it also effect on recovery and regeneration of muscular injuries. In this study under different environments the recovery period and regeneration of muscular injuries will be studied on the basis of muscle histology. Experimental study. This study was conducted in Animal room of Anatomy Department, Postgraduate Medical Institute, Lahore from May 2011 to December 2011. Study was carried out on total [100] animals. Control group comprises 28 animals exposed to [i] [Blunt trauma], [ii] Incisional injury., [iii] thermal injury and [iv] chemical injury. Whereas other nine groups of animals following initiation of injury were exposed to heavy metal pollutants and non-heavy metal pollutants by orally, parentally or inhalation. Delayed wound healing was observed, because major factors limiting the ability of skeletal muscles to regenerate after trauma or diseases were a viable population of satellites cells, re-innervation and re-vascularization. The experimental group animals became more lethargic, inactive, death rate was more. Death occurred earlier in group [6] and 8 as compared to rest of groups [P < 0.01]. Injured muscle initially showed increase in circumference and then followed by resuming its normal size in two weeks, time interval. In control group wound healing occurred in normal time whereas those exposed to metallic and non-metallic environmental pollutants showed weight reduction and delayed wound heating

Flaxseed - a miraculous defense against some critical maladies

Presence of omega-3, omega-6 rich oil, alpha-linoleic acid, dietary fibers, secoisolariciresinol diglucoside, protein and minerals in flaxseed constitute a very strong basis for the utilization of flaxseed in various food preparations as a curative agent. An extensive body of literature illustrates that flaxseed has gained a significant position in the domain of nutritional sciences owing to its pivotal role as an antioxidant agent. The review discusses at length, numerous health benefits of flaxseed typically focusing its preventive role against cardiovascular diseases, cancer, diabetes and enhancement of spatial memory. Massive increase .in the size of population with a special emphasize to the developing countries, there is an urge for exploration of the alternative dietary resources that can meet the dietary and nutritional needs of forthcoming generations. With respect to its remarkable nutritional importance, the review in question enables researchers engaged in nutritional sciences to further investigate the therapeutic value of flaxseed functional components and their dietary application in various food products and availability in processed foods as well as in the human cell line

Efficacy of topical clotrimazole in treatment of otomycosis

Otomycosis is a common condition affecting external ear and ears with chronic suppurative otitis media, and has a tendency for recurrence. Objective of this study was to determine the efficacy of topical clotrimazole in the treatment of otomycosis. This descriptive study was conducted at the outpatient department of ENT, Ayub Teaching Hospital Abbottabad, from Jul 2012 to Dec 2012. A total of 101 patients were included in this study. The results were compared and analysed regarding age, gender, presenting complaints and efficacy of clotrimazole. A total of 101 patients of otomycosis were included in the study. Male to female ratio was 0.71:1. Patients of 15 years and above were included in the study. Adults were more affected by otomycosis than the younger age group. The efficacy of clotrimazole in treatment of otomycosis was observed in 89 [94.12%] while in 12 [5.88%] patients no efficacy was seen. Age and gender have no role in efficacy of Clotrimazole in treatment of Otomycosis. Topical clotrimazole is effective in the treatment of Otomycosis

Phytochemical, antimicrobial, insecticidal and brine shrimp lethality bioassay of the crude methanolic extract of ajuga parviflora benth

Methanolic extract of medicinal herb Ajuga parviflora Benth. was evaluated for phytochemical screening [the plant extract showed the presence of aromatic compounds, carbohydrates, glycosides, tannins, alkaloids, polyphenols, quinines and dions, aminophenols, steroids/sterols, flavonoids and terpenoids], antimicrobial activities against various strains of bacteria and fungi by using disc diffusion method and insecticidal activities against red flour beetle [Tribolium castaneum], wheat weevil [Sitophilis granaries] and their larvae. The crude extract showed anti-bacterial activity against all strains with a maximum zone of inhibition of 12mm diameter against Citrobacter and Pseudomonas aurogenosa. Standard drugs Ampicillin, Gentamicin and Amoxicillin were used in parallel. The crude extract did not show antifungal activity against the tested strains of fungi even at high doses. The crude methanolic extract was also used for insecticidal activity against the two types of insects and their larva. The extract showed no significant mortality in the tested strains. For brine shrimp lethality bioassay different concentrations 10, 100 and 1000ug/ml of the medicinal herb A. parviflora methanolic extract were used. After 24 hrs the percent mortality and LD[50] value was calculated through probit analysis. The LD[50] value of extract was 321.42microg/ml while that of standard drug cyclophosphamide was 16.09ug/ml

Endoscopic disectomy: learning curve and outcome evaluation

Background: Minimally invasive techniques for Lumbar disc surgery are becoming common. It is therefore essential that we assess their learning curve and evaluate their results before their across the board application to lumbar disc herniation surgery

Objective: This prospective study was conducted to evaluate steepness of learning curve and outcome of Endoscopic disectomy

Study Design: This is a prospective study carried out at PNS Shifa, which is a tertiary care hospital, from Jan 2011 to Jan 2013

Patient Interventions: Forty three patients underwent Endoscopic disectomy for a single level herniated disc using an interlaminar approach; all procedures were performed under general anesthesia. All patients were followed prospectively. Endoscopic system used in this study consisted of tubular dilators and an endoscope with xenon light source and HD image system from Karl Storz co. Germany

Outcome measures: Outcomes were assessed by analyzing the video of the procedure to pinpoint the areas where maximum time was spent and thus devising ways to cut down the operating time. Patient outcome was measured by using Oswestry disability index and Macnab criteria

Results: 43 patients [29 males, 14 females] underwent Endoscopic disectomy for prolapsed lumbar intervertebral disc. Mean operating time was 70 minutes. The mean operation time for the first and last 10 cases was 140 and 58 minutes, respectively. The procedures affecting a prolonged operation time were evaluated. The time required for surgery reduced considerably after 12 cases. Follow up ranged from 3 to 15 months with a mean follow up of 10.8 months. Thirty five patients had an excellent outcome while five had a good outcome. Three patients had a poor outcome and underwent open disectomy. Five patients early in the study had to be converted to open disectomy due to technical difficulties. These cases were excluded from the study

Conclusions: Endoscopic disectomy is clinically effective and reliable. The learning curve, however, is steep. It requires at least 10-15 cases before surgeon can achieve command of the procedure

Hepatitis C; association of interferon-ribavirin therapy with hearing loss

The objective of this study was to determine association of Interferon-Ribavarin therapy with hearing loss in patients suffering from Hepatitis 'C'. Quasi-experimental study. Otolaryngology Department Combined Military Hospital Rawalpindi from 09 June 2006 to 08 June 2007. Consenting sixty patients of Hepatitis C divided into two equal groups of 30 each, [group A receiving Interferon-Ribavarin therapy and group B, not receiving it] during the study period fitting the inclusion criteria were selected. Pure Tone Audiometery including both air and bone conduction performed as base line data at commencement of therapy and then at the end of therapy [after six months]. Patients were sampled by Convenience [non-probability] technique. The number of patients who were found to have defined hearing loss was 06 [20%] in Group A [n=30] and 05 [16.67%] in Group B [n=30]. Chi Square test was applied which showed a p-value of 0.739 which is highly insignificant. Interferon-Ribavarin Therapy does not have a significant association with hearing loss in patients of Hepatitis 'C