Ambiguous genitalia: an overview of 7 years experience at the Children's Hospital and Institute of Child Health, Lahore, Pakistan

Objective: To determine the classification and etiological diagnosis of children presented with ambiguous genitalia/atypical genitalia according to the newer classification system of Disorder of Sex Development [DSD]

Methods: This observational, cross-sectional study was conducted at the Department of Pediatric Endocrinology and Diabetes at The Children's Hospital and Institute of Child Health, Lahore from January, 2007 to December; 2014. Files of all the children with ambiguous genitalia were retrospectively analyzed and relevant data was retrieved. All the information was recorded on predesigned proforma and analyzed accordingly

Results: A total of 300 cases of ambiguous genitalia classified according to the new DSD classification. 46, XX DSD were 54.3% [n=163], 46, XY DSD were 43.7% [n=131], sex chromosome DSD were 2% [n=6]. Among 46, XX DSD cases, the most common cause was congenital adrenal hyperplasia [97%, n=158]. However, in 46, XY DSD partial androgen insensitivity/5?-reductase deficiency [62%. n=81] constituted the most commonest disorder. Other causes of 46XY DSD include testosterone synthesis defect[23%], congenital adrenal hyperplasia [CAH,12%], testis regression syndrome [1.5%] and persistent mullerian duct syndrome [PMDS,1.5%]. Sex chromosome disorder constituted one case of iso-chromosome X turner syndrome, mixed gonadal dysgenesis [n=3], ovotesticular DSD/chimerism [n=2]

Conclusion: Ambiguous genitalia have varied etiologies, 46; XXDSD found being the commonest of all, showing predominance of CAH especially salt loosing type. The early detection and prompt treatment of cases of ambiguous genitalia plays a pivotal role in the management of acute life threatening condition and gender assignment

Safety of fenbendazole in common peafowl [Pavo cristatus]

The present study was undertaken to find out the safety levels of fenbendazole in common peafowl. This bird, raised on aviaries and zoos, can be severely parasitized with Ascaridia galli [enteric worms] and Syngamus trachea [gapeworm] along with other parasitic worms. Fenbendazole is a highly effective benzimidazole-class anthelmintic in animals. The objective of this work was to provide target animal safety data in young peafowl and to demonstrate reproductive safety in adult birds. During the experimental study, diets containing fenbendazole at 0, 100, 200 and 300 ppm were fed for 21 days [three times the normal treatment duration]. Data for feed consumption, feed conversion rate, and body weights were recorded for each bird in each group. Drug concentrations in different tissues of birds were determined to correlate concentrations with clinical observations, clinical pathology, and histologic findings. There were no morbidities or mortalities after study day 21. Additionally, there were no statistically significant treatment-related differences among above mentioned parameters. Analysis of fenbendazole concentrations in kidney, liver, leg/thigh, and breast muscle and skin with associated fat revealed that, even at the highest dose level used and with no feed withdrawal, fenbendazole concentrations were relatively low in these tissues. These findings indicate that fenbendazole has a relatively wide margin of safety in young peafowl and that the proposed dose of 100 ppm in the feed for 7 consecutive days is well within the margin of safety. In the reproductive safety study, five breeder peafowl farms fed fendbendazole at 100ppm for 7 days and collected data on hatching percentage of peahen eggs before and after treatment. Reproductive performance in peahen was not adversely affected

Pulmonary alveolar proteinosis: a rare cause of respiratory failure

Pulmonary Alveolar Proteinosis [PAP] is a rare syndrome in the paediatric age group and characterized by intra-alveolar accumulation of proteinaceous phospholipid-laden material called surfactant. The diagnosis is made by High Resolution Computed Tomography [HRCT] chest which shows characteristic crazy paving appearance and diagnosis confirmed by Bronchoalveolar Lavage [BAL]. We report two cases. First was a 9-month old infant who presented with respiratory distress and peripheral cyanosis since birth. He was diagnosed on High Resolution Computed Tomography [HRCT] chest as a case of pulmonary alveolar proteinosis and broncho-alveolar lavage confirmed his diagnosis. Second case was a 10-year old female child who had a history of repeated chest infections for 5 years and now presented with cough and respiratory distress for 45 days. She was also diagnosed on HRCT chest but unfortunately she died before bronchoalveolar lavage

Role of nigella sativa L. seeds against carbon tetrachloride induced liver injury in rabbit - an experimental study

To investigate the protective effect of Nigella sativa against carbon tetrachloride [CCl[4]] induced liver injury in adult male Rabbit model. Experimental/Analytical study. This study was carried out at the Animal House, Isra University from May, 2012 to October 2012. Thirty male Rabbits were selected according to inclusion and exclusion criteria and studied. Animals were divided into three groups Carbon tetrachloride was used to induce liver injury. N. sativa seeds were administered in experimental group. Blood samples were collected from peripheral veins. Sera were used liver enzyme detection. The animals were sacrificed by over-dose of Ketamine and liver was removed for histological study. The data was analyzed on SPSS version 16.0 for Windows release [Chicago, IL, USA]. A p-value of

Teratogenic effects of different concentrations of retinoic acid on chick embryonic heart cells cultured in vitro

To detect the possible teratogenic effects of various concentrations of retinoic acid [RA], in chick cardiac cells cultured in micromass culture. Experimental study. This study was carried out at the University of Nottingham, UK on chick embryonic hearts for a period of six months from Jan. 2010 to June 2010. Embryonic hearts were dissected from 5 day old white leghorn chick embryos to produce a cardiac cell suspension in DMEM culture medium. Cells were either exposed to culture medium or vehicle only or to different concentrations of retinoic acid ranging from1 micro M to 100 micro M. End points for cellular differentiation were observational scores at 24, 48 and 144 h following explantation. Cell viability was established with resazurin and kenacid blue assays. Statistical analysis of the results was via one way ANOVA and Kruskal Wallis tests and P value < 0.05 was considered significant. Retinoic acid significantly reduced cellular differentiation at and above 1 micro M [P value < 0.05], at concentrations 50 micro M and above no single focus was observed to be beating. The resazurin assay for viability showed decreasing viability of cardiac cells with increasing concentrations of retinoic acid. Same trend was observed with kenacid blue assay which determined the overall protein content. However the cells exposed to only culture medium or vehicle did not show significant differences in terms of viability, protein content and beating ability. The potential of retinoic acid as teratogen is proved in this in vitro study and it is recommended that the pregnant ladies should avoid the use of these drugs during early developmental period

Traumatic duodenal injuries, surgical management

Objectives: The purpose of this study is to share our surgical experience of duodenal injuries management and to evaluate outcome of different surgical procedures

Study Design: case series

Place and Duration of Study: Surgical emergency Allied hospital Faisalabad from 01 June 2012 to 31 may 2014

Methods: All patients with traumatic duodenal injuries were included. Data included patient's profile, date of admission, mechanism of injury, grade of duodenal injury, type of procedure, and outcome

Results: Total number of cases in period under study was 29. There were 26 [89.7%] male and 3 [10.3%] female and mean age of 27.8 years. 62% cases were due to blunt abdominal trauma commonly road traffic accident and 38% penetrating injuries predominantly firearm injuries. Second part of duodenum was found to be the most commonly injured site in 55.17% case and grade II injuries accounted for 65.52% of total injuries. The most common operative procedure performed was Primary repair. Postoperatively 10.34% cases developed duodenal fistula, and the overall morbidity was found to be 34.48% and mortality 31%

Conclusion: It is concluded that blunt trauma abdomen is common cause of duodenal injury in our setup. Most injuries can be managed by primary repair. Early diagnosis and surgical intervention is most important factor for good results

Relation of breast cancer with parity and breastfeeding

Objective: The purpose of this study was to evaluate the relationship of breast cancer with parity and breastfeeding in local settings since no such studies have been carried out previously. The results of such study can provide data for comparison from other parts of country and international research

Study Design: Observational study

Place and Duration: Department of Surgery Allied Hospital Faisalabad between October 2013 and October 2014

Methods: A sample of 500 breast cancer patients diagnosed clinically and histopathologically was included in the study after informed consent. Patients were interviewed using a questionnaire. We observed the variables of age, parity, menstrual history and months of breastfeeding for each child. Analysis was done using SPSS version 12. 0

Results: In present study, 500 patients of breast cancer were included with age ranging from 28 years to 80 years. Most common age group was 40 to 50 years. 91.8% females with breast cancer were multiparous and all 91.8% females gave history of breastfeeding their children. 48% of the females breastfed for more than 5 years, 40% of them for 1to5 years and 3.8% of them for less than 1 year. Only 8.2% females who were either unmarried or had no issues did not breastfeed at all

Conclusion: In our local settings, multiparity and breastfeeding do not alter the risk of breast cancer and thus other risk factors must be studied

Evaluation of chick in ovo culture as screening method for detection of teratogens

Congenital malformations are the leading cause of neonatal mortality and morbidity. Out of all birth defects, congenital abnormalities of the heart are at the top. There are many etiological factors responsible for such defects. Environmental agents or teratogens are the factors which could be detected by certain screening methods and may be controlled at an early stage to minimize the chance of mortality. This study was conducted to detect the efficacy of inovo culture system as screening system for teratogenecity testing. Experimental study. This study was conducted at the Department of Anatomy, Isra University Hyderabad for a period of six months. White Leghorn Chicken eggs were incubated for 3 days and after 3 days eggs were injected with ethanol 10% and 20%, PBS, neutral red dye and some were left untouched. The eggs were again incubated back until day 9. On day 9 the embryos were taken out and examined for gross malformations. The hearts were then fixed and processed for H and E staining and examined under microscope. The results showed that addition of alcohol [ethanol] to chicken eggs produced many gross malformations and examination of hearts under microscope also showed malformed hearts. However other chemicals used did not show any malformations. This study confirmed the teratogenecity of ethanol in chick embryos and can be used as an alternative method for screening of teratogens and toxins

Effect of Nigella sativa extract oil on granulation tissue in cutaneous wound: an experimental study in a rabbit model

The present study aims to observe the effect of Nigella Sativa [NS] oil extract on the granulation tissue formation on induced cutaneous wounds in a rabbit model. Experimental study. This study was conducted at the Department of Anatomy, Isra University Hyderabad from May to October, 2012. Twenty male adult Wistar rabbits were studied according to inclusion and exclusion criteria. The rabbits were divided into two groups; Group I. [n=10] skin wounds were treated with 1% pyodine daily and Group II. [n=10] Nigella sativa extract oil was applied on inflicted cutaneous wounds. The animals were sacrificed by over-dose of Ketamine and Xylazil as per protocol and skin wound area was excised. The tissue samples were fixed in marked containers, containing 10% formaldehyde as preservative. The tissue samples were embedded in paraffin, cut into 5 um thick sections and stained with Hematoxylin-Eosin and Masson`s trichrome and examined for histological findings. The data was analyzed on SPSS version 17.0 [Chicago, IL, USA]. The continous variables were analyzed by independent sample t-test. The p-value was taken at

Ethanol induced developmental defects can be prevented with supplementation of vitamin E

Alcohol exposure during intrauterine life produces spectrum of disorders collectively termed as fetal alcohol syndrome. Apart from craniofacial and brain defects this syndrome produces various cardiac abnormalities such as atrial and ventricular septal defects, teratology of Fallot, transposition of the great arteries, truncus arteriosus. The mechanisms behind these ethanol-induced deficits are unknown. This study was conducted to detect the preventive role of lipid soluble vitamin E in ethanol induced heart malformations in chick embryos cultured in ovo. Experimental study. This study was conducted at the in the school of Biomedical Sciences, University of Nottingham, UK for a period of 6 months. White Leghorn chicken eggs were incubated for 3 days in 37 Degree °C with relative humidity of 100%. Eggs were microinjected with 100 micro l of either PBS, vitamin E 200 micro M, SOD 2 micro M, 20% ethanol in PBS, or ethanol plus vitamin E and ethanol plus SOD dissolved in PBS. On day 9 eggs were cracked and examined in terms of their viability. The viable embryos were examined for growth retardation by measuring crown rump length, and any malformations or gross abnormalities observed including limb deformities, facial defects, heart defects and brain vesicle development. Ethanol-induced alterations occurred in craniofacial development, vitelline circulation, crown rump length, facial abnormalities, brain development, which were prevented by addition of vitamin E and superoxide dismutase. These results show that exposure of the chick embryos to ethanol during development result in structural changes in the heart that mimic malformations that occur in patients with fetal alcohol syndrome [FAS]. These findings may be prevented with addition of vitamin E

Study of pharmacokinetics and comparative bioavailability of nefopam 30 mg tablets in twelve fasting healthy Pakistani male young subjects: single-dose, randomized, two-period, two-treatment and two-way cross-over design

To study the pharmacokinetics and comparative bioavailability of Nefopam tablets [Acupan[R]]. Experimentation of this study was based on a single-dose, two-sequence, cross-over randomized design using 12 fasting healthy Pakistani male young subjects. This validated LC/MS method was applied to a pharmacokinetic and bioavailability study in 12 fasting healthy Pakistani male subjects from the blood samples taken up to 24 h after an oral dose of one tablet of 30 mg nefopam in a double-blind, randomized, cross-over design. The mean maximum plasma concentration [C[max]] for the reference formulation was 60.71 +/- 2.36 ng/ml [ +/- SEM] and for test formulation 60.46 +/- 1.30 ng/ml [ +/- SEM]. The mean time to reach maximum plasma concentration [T[max]] values of reference and test formulations was 1.63 +/- 0.13 h [ +/- SEM] and 1.83 +/- 0.07 h [ +/- SEM], respectively. The mean +/- SEM values of AUC[0-infinity] for the reference and test formulations were 293.01 +/- 16.09 ngúh/ml and 307.53 +/- 8.99 ngúh/ml, respectively. The results showed that both formulations possessed almost the same relative bioavailability and pharmacokinetic parameters

Haemorrhoidectomy

Haemorrhoids are among the commonest surgical problems of anorectal region. Chronic constipation, straining, at defecation or micturation is the main predisposing factors but exact aetiopathogenesis remain unclear. Most patients in the initial stages are treated with conservative or minimally invasive approaches. However haemorrhoidectomy has proven long-term efficacy in the treatment of third degree haemorrhoids. There is still controversy whether open or closed haemorrhoidectomy is treatment of choice. Haemorrhoidectomy whether open or closed is associated with postoperative complications. This study was carried out to compare postoperative complications of both procedures to improve the management of haemorrhoids. To compare postoperative complications in open and closed haemorrhodectomy. Quasi- experimental. Surgical unit-1, Allied Hospital Faisalabad. One year [20/06/o6 to 20/06/07]. 100 cases [50 cases in each]. Convenience sampling. Patients with 3[rd] degree haemorrhoids. * Complicated third degree haemorrhoids. * Patients with other causes of bleeding per rectum. * Patients having associated medical problems. * Patients not willing for surgery. Out of 100 patients 7 had severe postoperative pain, 5 from open and 2 from close group.50 patients had moderate pain, 30 from open and 20 from closed group.8 patients, 5 from open and 3 from closed group got urinary retention. 2 patients both from open group had anal stricture. Closed haemorrhoidectomy is more advantageous with respect to less postoperative pain

Acute poisoning in children: etiological agents, risk factors and outcomes

A total of 70 patients were thus included. The patients were followed till discharge. A Proforma was filled and results were analyzed on SPSS version 10 of computer programme. All consecutive patients of poisoning who visited the Emergency Ward during the study period fulfilling inclusion criteria were enrolled. The mean age was 2.89 years with range of 6 months to 10 years. Male to female ratio was 1.5:1. Kerosene was the commonest agent accounting for 50% of all cases, followed by pharmaceutical products [14.3%] and chemicals [12.9%]. Storage of Kerosene in empty bottles of beverages and lack of proper storage of drugs were the commonest risk factors identified. Oral ingestion was the most common route of intoxication. Most of the patients [84.3%] were discharged without any sequelae. Overall mortality was 5.7%. Conclusion most of toxic substances to which children were exposed were those stored in eatable containers i.e. kerosene oil. Minority of children with accidental poisoning developed serious toxicity. Parents can prevent many of these accidents by identifying, adequately storing and locking away toxic material

Current practice of doctors regarding the diagnosis and use of antibiotics in enteric fever in children: knowledge, attitude and practice

The objectives were to know current practice and knowledge of doctors regarding the diagnosis and use of antibiotics in Enteric Fever in children. The study was conducted in Lahore-city. It was a descriptive, epidemiological study. 150 doctors participated in the study. 51% were MBBS, 33% were postgraduate trainees and 16% had postgraduate degrees. Ciprofloxacin was prescribed as first choice by 51% and second choice by 37.8%. Ofloxacin was advised as first line by 21% doctors and injection Ceftriaxone by 18.6%. Chloramphenicol was advised by 8% doctors. Only 67.3% doctors prescribed the antibiotics for recommended duration. 62% doctors did not know the dosage in children. Second line antibiotics are used irrationally and those are prescribed for less than recommended duration, which leads to multi-drug resistance and relapse of fever