Comparison of vaginal culture and pap smear in the diagnosis of bacterial vaginosis

Background: Amongst the myriad of physiological and pathological conditions presenting as vaginal discharge, bacterial vaginosis is the most frequently encountered complaint in women of child bearing age, all over the world. It involves the replacement of normally predominant hydrogen-peroxide producing lactobacilli, by an overgrowth of anaerobic bacteria. We want to examine the diagnostic efficacy of Pap-Smear and vaginal culture in the diagnosis of bacterial vaginosis, while Amsel's clinical criteria is used as the gold standard

Methods: It was a descriptive study expanding over a period of 5 months, from January 2013 to May 2013, enrolling 150 patients, from the outpatient's department of lady reading hospital and Hayatabad medical complex, Peshawar. All patients who complained of vaginal discharge were eligible for study. Patients using antibiotics, vaginal suppositories as well as those who were pregnant were excluded from the study. All patients were subjected to simultaneous testing for Amsel's criteria, vaginal culture, and Pap-staining. Sensitivity, specificity, positive predictive value and negative predictive values were calculated for vaginal culture and Pap smear, with amsel's criteria being the gold standard

Results: Sensitivity, specificity, positive and negative predictive values for culture was determined as 75%, 92.1%, 64.3% and 95.1%. Pap smear was found to be 62.5% sensitive, 93.7% specific, positive and negative predictive values being 65.2% and 92.9% respectively

Conclusion: Out of these two tests, vaginal culture was labeled as the more sensitive test for the diagnosis of bacterial vaginosis

Evaluation of hepatotoxic and nephrotoxic effects of piroxicam sulfonated derivatives

Background: Pain management requires new pharmacotherapy with good efficacy and less side effects. Piroxicam is used routinely in clinical practice but it is associated with side effects. To minimize the chances of adverse effects, sulfonated piroxicam derivatives [SPD] have been introduced. We sought to find hepatotoxic and nephrotoxic effects of SPD in Albino rats

Methods: An experimental study on SPD was carried out at the Institute of Basic Medical Sciences, Khyber Medical University, Peshawar. Healthy 24 albino rats were divided into 5 groups. One control group and four experimental groups [compound I and II, each with a dose of 10mg/kg and 20mg/kg] received treatment for 7 days. Liver function tests [LFTs], renal function tests [RFTs] and histology of liver and kidney specimens was performed after culling rats. The difference between median values of samples was assessed using Kruskal-Wallis test with post-hoc [for LFTs and RFTs]. SPSS-21 was used for all statistical analysis and p?0.05 was considered statistically significant

Results: The alanine aminotransferase [ALT] values were significantly high in the 20 mg/Kg group than control for both compounds [p=0.03, p=0.001 respectively]. The aspartate aminotransferase [AST] values were significantly high in the 10 mg/Kg and 20 mg/Kg group than control for compounds II [p=0.01, p=0.0001 respectively]. The alkaline phosphatase [ALP] values were significantly high in the 20 mg/Kg group than control for compounds II [p=0.002]. The blood urea values were significantly high in the 20 mg/Kg group than control for compounds II [p=0.008]. The mean final score of liver injury in all experimental groups [mean range 5-7] was less suggesting that the damage in liver was less pronounced. Renal injury was more pronounced in the 20 mg/Kg dose for both compound I and compound II [mean score 7] compared to 10 mg/Kg dose [mean score 4]

Conclusion: Piroxicam sulfonated derivatives can cause focal changes in liver and kidney which might be reversible. The changes are less pronounced for compound I with a low dose

Evaluation of neurobehavioral effect of citrullus lanatus juice on albino mice

Objective: To observe the effect of Citrullus lanatus var. lanatus on albino mice model of anxiety and depression

Methodology: This experimental study was done in the Pharmacology department of Karachi University for a period of 02 months from 5th February-9th April 2016. Watermelon [Citrullus lanatus var. lanatus] was used. Animals were randomly assigned into 4 groups A, B, C and D [n=10]. Group A was control [normal saline]. Group B was treated with Citrullus lanatus juice in a dose of 3 ml/kg, Group C was given 6 ml/kg of juice. Two drugs [Diazepam and Fluxetin] were used as standard and given to group D animals. All doses were administered orally. Level of anxiety and depression among animals was tested by light/dark box test and forced swim test. Data was analyzed statistically

Results: Animals treated with Citrullus lanatus juice showed marked reduction in anxiety which was evident from results of light/dark box test while forced swim test revealed no effect on depression

Conclusion: Citrullus lanatus contains important natural anti-oxidants like lycopene and vitamin C which prevent injury to vital organs like liver, heart and brain from toxic effects of reactive oxygen species. Arginine in Citrullus juice is also precursor of neurotransmitters like Y -Aminobutyric acid [GABA] and glutamate. These results showed that Citrullus because of its components like arginine played an important role in maintaining normal neurological function and ameliorated anxiety and depression

Cardiac arrhythmias and left ventricular hypertrophy in systemic hypertension

Hypertensive left ventricular hypertrophy [LVH] is associated with increased risk of arrhythmias and mortality. Objective was to investigate the prevalence of cardiac arrhythmias and LVH in systemic hypertension. In all subjects blood pressure was measured, electrocardiography and echocardiography was done. Holter monitoring and exercise test perform in certain cases. There were 500 hypertensive patients, 156 [31.2%] men and 344 [69%] women >30 years of age in the study. Among them 177 [35.4%] were diabetic, 224 [45%] were dyslipidemia, 188 [37.6%] were smokers, and 14 [3%] had homocysteinemia. Duration of hypertension [HTN] was >/= 2 years]. Mean systolic BP [SBP] was 180 +/- 20 mm Hg and diastolic BP [DBP] was 95 +/- 12 in male and female patients. Left ventricular mass index [LVMI] was 119.2 +/- 30 gm/m2 in male while 103 +/- 22 gm/m2 in female patients. Palpitation was seen in 126 [25%] male and 299 [59.8%] female patients. Atrial fibrillation was noted in 108 [21.6%] male and 125 [25%] female patients, 30 [6%] male and 82 [16.4%] female patients had atrial flutter. Ventricular tachycardia was noted in 37 [7.4%] male and 59 [11.8%] female patients. Holter monitoring showed significant premature ventricular contractions [PVC'S] in 109 [21.8%] male and 128 [25.69%] female patients while Holter showed atrial arrhythmias [APC'S] in 89 [17.8%] males and 119 [23.8%] females. Angiography findings diagnosed coronary artery disease in 119 [23.8%] with CAD male and 225 [45%] without CAD while 47 [9.4%] females presented with CAD and 109 [21.8%] without CAD. A significant association has been demonstrated between hypertension and arrhythmias. Diastolic dysfunction of the left ventricle, left atrial size and function, as well as LVH have been suggested as the underlying risk factors for supraventricular, ventricular arrhythmias and sudden death in hypertensives with LVH

Door to needle time of streptokinase and ST segment resolution assessing the efficacy of reperfusion therapy at Karachi Institute of Heart Diseases

Early start of treatment including coronary revascularisation has been recognised as crucial variable in the outcome of acute ST-segment Elevation Myocardial Infarction [STEMI]. Objectives of the study were to determine the magnitude of ST-segment resolution after thrombolytic therapy predicts short- and long-term outcomes in patients with an Acute Myocardial Infarction [AMI]. The duration of quasi experimental study was 3 years, from July 2006 to June 2009, conducted at Karachi Institute of Heart Diseases. Total 1,023 patients of STEMI treated with streptokinase [SK] were enrolled in the study. Of the total 1023, 689 [67.3%] patients were males and 334 [32.6%] were females. Six hundred and twenty-nine [61.5%] were successfully resolved after thrombolytic therapy while in 395 [38.5%] patients ST-segment could not resolve into 3 conventional ST-segment resolution categories at 60 minute and 90 minute after thrombolysis. Three hundred and twelve [30%] and 444 [43.4%] with complete resolution, 344 [33.62%] and 325 [31.76%] with partial resolution, 367 [35.8%] and 491 [19.29%] were with no resolution at 60 and 90 minutes respectively. Shock, congestive heart failure, and recurrent angina and ischemia occurred more often in patients with partial or no ST resolution as compare to complete resolution

Percutaneous coronary intervention of osteal lesions in newly established tertiary care cardiac hospital

To assess the outcome of percutanious Angioplasty in patients with osteal lesions in Coronary artery Diseases. This is a retrospective analysis of all coronary angiograms performed at the catheterization laboratory of Karachi Institute of Heart Diseases [KIHD], a tertiary referral center in Karachi, Pakistan, between the periods August 2006 to August 2008. Fifty patients were enrolled which included thirty-five men and fifteen women and all were >40 years of age. Each patient had a single target osteal lesion: twenty nine patients underwent PCI for ostial LAD lesion [among them twenty males and nine females], six had ostial LCX [five males and one female], and fifteen patients had osteal RCA stenosis [10-male patients and 5- female patients]. After high-pressure balloon dilatation residual stenosis was reduced. Twelve patients were treated with bare metal stents [BMS] while thirty eight with drug eluting stents [DES]. In all cases the procedure was successful without any pre and post procedural complications. A key issue in the treatment of an osteal lesion is to assure that the stent is inserted proximal enough to fully cover the osteal junction. Improvements in technique, equipment, adjunctive drug therapy and better understanding of the procedure have remarkably changed the practice of interventional cardiology

Analgesic and antitussive activities on methanol extract of Vigna trilobata[L] Verdc

The crude methanol extract of Vigna trilobata [Fabaceae] was evaluated for its analgesic and anti-tussive activity. Analgesic effect was determined by tail flick method and anti-tussive effect was evaluated by inducing cough with sulfur dioxide. It exhibited significant analgesic and anti-tussive activities as compared to control and standard drugs

Hepatocellular carcinoma versus other carcinomas of liver: distinguishing features

To find out the helpful cytological features distinguishing between hepatocellular carcinoma [HCC] with other carcinomas of liver Fine Needle Aspiration Cytology [FNAC] cases were selected in 35 patients on whom a diagnosis was rendered either of hepatocellular carcinoma or other carcinoma involving liver. The aspirates were examined for slide background, cellularity and specific cytoplasmic and nuclear features in both sets. There were 20 cases of hepatocellular carcinoma [HCC] and 12 cases of other carcinoma involving liver. Six out of twelve In the current study we examined 12 cytological criteria out of which six were found to be of considerable help in distinguishing hepatocellular carcinoma [HCC] from other carcinoma involving liver. The hepatocellular carcinomas characteristically had central nuclei, discohesive cells, high cellularity and naked nuclei while hyperchromatic nuclei, eccentric nuclei and nuclear cytoplasmic ratio of >75% were the prominent features of other carcinoma involving liver. On the other hand coarse chromatin, nuclear molding and chromatin clearing of nuclei showed no significant difference in distinguishing hepatocellular carcinoma from other primary and metastatic carcinoma of the liver. Fine needle aspiration cytology [FNAC] of the liver is a very useful diagnostic modality to identify the vast majority of neoplasms of primary or metastatic nature. Meticulous attention to the nuclear features is vital in distinguishing hepatocellular carcinoma [HCC] from other carcinomas of liver

Histopathological features of endometrial carcinoma

To evaluate and compare the histopathological features of endometrial carcinoma among women of various age groups. Descriptive study. The study was conducted at The Aga Khan University Hospital, Histopathology Department, from January 2001-December 2003 All cases of endometrial carcinoma who underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy were included. Median age was 55 years. Bleeding per vaginum was the commonest feature and endometrioid adenocarcinoma was the commonest histological type. Tumor involved < and > half of the myometrium in nearly half of the patients each. Vascular invasion, endocervical invasion and adnexal involvement were evident in a small number of cases. Amongst the 86 patients majority were well differentiated [grade-1] and stage-1, on FIGO staging. Patients [<40 years] had endometrioid type of endometrial carcinoma, grade-1, and FIGO stage-1. In 85% tumor was invading to < half of myometrium. Significant difference was seen among the 40-49 and >50 years age groups in grade and depth of myometrial invasion. As 76% were grade-1, 80% had myometrial invasion < half in patients <50 years, while 43.6% were grade-I and 41.8% had myometrial invasion >half in patients >50 years. Patients with endometrial carcinoma presented in early stage [stage-1] and tumor well differentiated [grade- 1]. In patients of more than 50 years of age even with stage-1, an increased frequency of deep myometrial invasion and less differentiated tumors, adnexal involvement, endocervical invasion, positive peritoneal cytology, vascular invasion and lymph nodes metastasis found

Validity of frozen section in the diagnosis of of breast lumps: 5 years experience at the Aga Khan University Hospital

To determine the accuracy of frozen section in the diagnosis of breast lump. Frozen section diagnosis given in consecutive breast biopsies performed in 5 years in our laboratory was evaluated against the final pathology report of permanent sections. The Aga Khan University Hospital Lab receives more than 400 cases per year for frozen section. Three hundred and nineteen consecutive frozen sections of breast lumps examined from 1999-2003 were considered for analysis. Age of patients ranged between 22 and 90 years [mean age 49 years]. In 316 cases [99%] there was no difference between the frozen section diagnosis and the final diagnosis. Three cases [0.94%] were incorrect; 2 cases [0.62%] were false positive. One case was false negative [0.31%]. In 7 cases [2.19%], frozen section diagnosis was deferred to permanent sections. Frozen section diagnostic accuracy was 99%. Sensitivity and specificity was 99.3% and 93% respectively. Positive predictive value and negative predictive values of frozen section were 96.6% and 99.3% respectively. High accuracy of the frozen-section diagnosis in the breast lumps was confirmed in our study