Diversity of the Anisoptera & Zygoptera (Odonata: Insecta) of Swat, Pakistan / Diversidade de Anisoptera e Zygoptera (Odonata: Insecta) de Swat, Paquistão

Odonates are important biological control agents for the control of insect pests and insect disease vectors of medical and veterinary importance. The present study was conducted to evaluate the odonate fauna of Swat, Pakistan from March to October 2019. A total of 200 specimens of odonates were collected from diverse habitats. The collected specimens of the order Odonata belonged to 5 families, three families of suborder Anisoptera namely Libellulidae, Gomphidae and Aeshnidae while two families of suborder Zygoptera (Chlorocyphidae and Coenagrionidae). The specimens were categorized into 12 genera and 22 species. Libellulidae was the dominant family (n = 138) accounting for 69% of the odonate fauna. Orthetrum was the dominant genus (n = 73) of suborder Anisoptera accounting for 36.5% of the odonate fauna. The least dominant genera were Anax, Paragomphus and Rhyothemis (n = 5 each) accounting each for 2.5% of the odonate fauna. In Zygoptera, the dominant genus was Ceriagrion (12.5%) and the least dominant genus was Ischnura (6%). Pantala flavescens (Fabricius, 1798) was the most abundant odonate species in the study area recorded from all surveyed habitats. Shannon Diversity Index (H) was 2.988 and Simpson Diversity Index (D) was 0.95 for the collected odonate fauna. The highest abundance of Odonata was recorded in August, September and May while no odonate species were recorded in January, February, November and December. Lotic water bodies were the most suitable habitats with abundant odonate fauna. Anax immaculifrons (Rambur, 1842) was the largest sized odonate species having a wingspan of 53.2±1.63 mm and body length of 56.3 ± 0.4 mm. The present study shows the status of odonate fauna of Swat, Pakistan in diverse habitats and seasonsonal variation throughout the year. Further work is recommended to bridge the gaps in the existing literature.

Odonatos são importantes agentes de controle biológico para o controle de insetos-praga e vetores de doenças de insetos de importância médica e veterinária. O presente estudo foi conduzido para avaliar a fauna de odonatos de Swat, Paquistão, de março a outubro de 2019. Um total de 200 espécimes de odonatos foi coletado em diversos habitats. Os espécimes coletados da ordem Odonata pertenciam a cinco famílias, três famílias da subordem Anisoptera, a saber, Libellulidae, Gomphidae e Aeshnidae, enquanto duas famílias eram da subordem Zygoptera (Chlorocyphidae e Coenagrionidae). Os espécimes foram classificados em 12 gêneros e 22 espécies. Libellulidae foi a família dominante (n = 138), respondendo por 69% da fauna de odonatos. Orthetrum foi o gênero dominante (n = 73) da subordem Anisoptera, responsável por 36,5% da fauna de odonatos. Os gêneros menos dominantes foram Anax, Paragomphus e Rhyothemis (n = 5 cada), representando cada um 2,5% da fauna de odonatos. Em Zygoptera, o gênero dominante foi Ceriagrion (12,5%), e o gênero menos dominante foi Ischnura (6%). Pantala flavescens (Fabricius, 1798) foi a espécie de odonato mais abundante na área de estudo, registrada em todos os habitats pesquisados. O Índice de Diversidade de Shannon (H) foi de 2,988, e o Índice de Diversidade de Simpson (D) foi de 0,95 para a fauna de odonatos coletados. A maior abundância de Odonata foi registrada em agosto, setembro e maio, enquanto nenhuma espécie de Odonata foi registrada em janeiro, fevereiro, novembro e dezembro. Corpos d’água lóticos foram os habitats mais adequados, com abundante fauna de odonatos. Anax imaculifrons (Rambur, 1842) foi a espécie de odonato de maior tamanho, com envergadura de 53,2 ± 1,63 mm e comprimento do corpo de 56,3 ± 0,4 mm. O presente estudo mostrou o status da fauna de odonatos de Swat, Paquistão, em diversos habitats e variação sazonal ao longo do ano. Recomenda-se trabalho adicional para preencher as lacunas na literatura existente.

Diversity of the Anisoptera & Zygoptera (Odonata: Insecta) of Swat, Pakistan

Abstract Odonates are important biological control agents for the control of insect pests and insect disease vectors of medical and veterinary importance. The present study was conducted to evaluate the odonate fauna of Swat, Pakistan from March to October 2019. A total of 200 specimens of odonates were collected from diverse habitats. The collected specimens of the order Odonata belonged to 5 families, three families of suborder Anisoptera namely Libellulidae, Gomphidae and Aeshnidae while two families of suborder Zygoptera (Chlorocyphidae and Coenagrionidae). The specimens were categorized into 12 genera and 22 species. Libellulidae was the dominant family (n = 138) accounting for 69% of the odonate fauna. Orthetrum was the dominant genus (n = 73) of suborder Anisoptera accounting for 36.5% of the odonate fauna. The least dominant genera were Anax, Paragomphus and Rhyothemis (n = 5 each) accounting each for 2.5% of the odonate fauna. In Zygoptera, the dominant genus was Ceriagrion (12.5%) and the least dominant genus was Ischnura (6%). Pantala flavescens (Fabricius, 1798) was the most abundant odonate species in the study area recorded from all surveyed habitats. Shannon Diversity Index (H) was 2.988 and Simpson Diversity Index (D) was 0.95 for the collected odonate fauna. The highest abundance of Odonata was recorded in August, September and May while no odonate species were recorded in January, February, November and December. Lotic water bodies were the most suitable habitats with abundant odonate fauna. Anax immaculifrons (Rambur, 1842) was the largest sized odonate species having a wingspan of 53.2±1.63 mm and body length of 56.3 ± 0.4 mm. The present study shows the status of odonate fauna of Swat, Pakistan in diverse habitats and seasonsonal variation throughout the year. Further work is recommended to bridge the gaps in the existing literature.

Resumo Odonatos são importantes agentes de controle biológico para o controle de insetos-praga e vetores de doenças de insetos de importância médica e veterinária. O presente estudo foi conduzido para avaliar a fauna de odonatos de Swat, Paquistão, de março a outubro de 2019. Um total de 200 espécimes de odonatos foi coletado em diversos habitats. Os espécimes coletados da ordem Odonata pertenciam a cinco famílias, três famílias da subordem Anisoptera, a saber, Libellulidae, Gomphidae e Aeshnidae, enquanto duas famílias eram da subordem Zygoptera (Chlorocyphidae e Coenagrionidae). Os espécimes foram classificados em 12 gêneros e 22 espécies. Libellulidae foi a família dominante (n = 138), respondendo por 69% da fauna de odonatos. Orthetrum foi o gênero dominante (n = 73) da subordem Anisoptera, responsável por 36,5% da fauna de odonatos. Os gêneros menos dominantes foram Anax, Paragomphus e Rhyothemis (n = 5 cada), representando cada um 2,5% da fauna de odonatos. Em Zygoptera, o gênero dominante foi Ceriagrion (12,5%), e o gênero menos dominante foi Ischnura (6%). Pantala flavescens (Fabricius, 1798) foi a espécie de odonato mais abundante na área de estudo, registrada em todos os habitats pesquisados. O Índice de Diversidade de Shannon (H) foi de 2,988, e o Índice de Diversidade de Simpson (D) foi de 0,95 para a fauna de odonatos coletados. A maior abundância de Odonata foi registrada em agosto, setembro e maio, enquanto nenhuma espécie de Odonata foi registrada em janeiro, fevereiro, novembro e dezembro. Corpos dágua lóticos foram os habitats mais adequados, com abundante fauna de odonatos. Anax imaculifrons (Rambur, 1842) foi a espécie de odonato de maior tamanho, com envergadura de 53,2 ± 1,63 mm e comprimento do corpo de 56,3 ± 0,4 mm. O presente estudo mostrou o status da fauna de odonatos de Swat, Paquistão, em diversos habitats e variação sazonal ao longo do ano. Recomenda-se trabalho adicional para preencher as lacunas na literatura existente.

Diversity of the Anisoptera & Zygoptera (Odonata: Insecta) of Swat, Pakistan / Diversidade de Anisoptera e Zygoptera (Odonata: Insecta) de Swat, Paquistão

Abstract Odonates are important biological control agents for the control of insect pests and insect disease vectors of medical and veterinary importance. The present study was conducted to evaluate the odonate fauna of Swat, Pakistan from March to October 2019. A total of 200 specimens of odonates were collected from diverse habitats. The collected specimens of the order Odonata belonged to 5 families, three families of suborder Anisoptera namely Libellulidae, Gomphidae and Aeshnidae while two families of suborder Zygoptera (Chlorocyphidae and Coenagrionidae). The specimens were categorized into 12 genera and 22 species. Libellulidae was the dominant family (n = 138) accounting for 69% of the odonate fauna. Orthetrum was the dominant genus (n = 73) of suborder Anisoptera accounting for 36.5% of the odonate fauna. The least dominant genera were Anax, Paragomphus and Rhyothemis (n = 5 each) accounting each for 2.5% of the odonate fauna. In Zygoptera, the dominant genus was Ceriagrion (12.5%) and the least dominant genus was Ischnura (6%). Pantala flavescens (Fabricius, 1798) was the most abundant odonate species in the study area recorded from all surveyed habitats. Shannon Diversity Index (H) was 2.988 and Simpson Diversity Index (D) was 0.95 for the collected odonate fauna. The highest abundance of Odonata was recorded in August, September and May while no odonate species were recorded in January, February, November and December. Lotic water bodies were the most suitable habitats with abundant odonate fauna. Anax immaculifrons (Rambur, 1842) was the largest sized odonate species having a wingspan of 53.2±1.63 mm and body length of 56.3 ± 0.4 mm. The present study shows the status of odonate fauna of Swat, Pakistan in diverse habitats and seasonsonal variation throughout the year. Further work is recommended to bridge the gaps in the existing literature.

Resumo Odonatos são importantes agentes de controle biológico para o controle de insetos-praga e vetores de doenças de insetos de importância médica e veterinária. O presente estudo foi conduzido para avaliar a fauna de odonatos de Swat, Paquistão, de março a outubro de 2019. Um total de 200 espécimes de odonatos foi coletado em diversos habitats. Os espécimes coletados da ordem Odonata pertenciam a cinco famílias, três famílias da subordem Anisoptera, a saber, Libellulidae, Gomphidae e Aeshnidae, enquanto duas famílias eram da subordem Zygoptera (Chlorocyphidae e Coenagrionidae). Os espécimes foram classificados em 12 gêneros e 22 espécies. Libellulidae foi a família dominante (n = 138), respondendo por 69% da fauna de odonatos. Orthetrum foi o gênero dominante (n = 73) da subordem Anisoptera, responsável por 36,5% da fauna de odonatos. Os gêneros menos dominantes foram Anax, Paragomphus e Rhyothemis (n = 5 cada), representando cada um 2,5% da fauna de odonatos. Em Zygoptera, o gênero dominante foi Ceriagrion (12,5%), e o gênero menos dominante foi Ischnura (6%). Pantala flavescens (Fabricius, 1798) foi a espécie de odonato mais abundante na área de estudo, registrada em todos os habitats pesquisados. O Índice de Diversidade de Shannon (H) foi de 2,988, e o Índice de Diversidade de Simpson (D) foi de 0,95 para a fauna de odonatos coletados. A maior abundância de Odonata foi registrada em agosto, setembro e maio, enquanto nenhuma espécie de Odonata foi registrada em janeiro, fevereiro, novembro e dezembro. Corpos d'água lóticos foram os habitats mais adequados, com abundante fauna de odonatos. Anax imaculifrons (Rambur, 1842) foi a espécie de odonato de maior tamanho, com envergadura de 53,2 ± 1,63 mm e comprimento do corpo de 56,3 ± 0,4 mm. O presente estudo mostrou o status da fauna de odonatos de Swat, Paquistão, em diversos habitats e variação sazonal ao longo do ano. Recomenda-se trabalho adicional para preencher as lacunas na literatura existente.

Fulminating herpes simplex hepatitis

ABSTRACT Herpes simplex virus (HSV) is a rare cause of acute hepatitis in patients with chronic immunosuppression, including Crohn's disease. HSV hepatitis has the propensity to cause acute liver failure and death. The presenting signs and symptoms can be nonspecific, thereby causing the diagnosis to go overlooked with inadequate management, leading to a high mortality rate. We report a case of a 31-year-old male on chronic prednisone treatment for Crohn's disease who unexpectedly died. Subsequently, an autopsy showed HSV hepatitis as the cause of death. Thus, although a rare complication, HSV hepatitis should always be kept in mind as a fatal complication in patients with acute hepatitis and chronic immunosuppression.

Detection of carbapenemase enzymes and genes among carbapenem-resistant Enterobacteriaceae isolates in Suez Canal University Hospitals in Ismailia ,Egypt

Background: Carbapenem antibiotics are important therapeutic agents in the health care setting, they are frequently used as an empiric therapy for life-threatening infections as well as infections with multi-drug-resistant gram-negative bacilli. Carbapenemase-producing Carbapenem-Resistant Enterobacteriaceae (CRE) are a significant public health challenge worldwide. The detection of carbapenemases productions in CRE strains is performed by phenotypic and genotypic methods. The phenotypic methods target carbapenemases production but provide no guidance regarding the specific carbapenemases types, while the genotypic diagnosis has the benefit of determining the exact mechanism conferring carbapenems resistance.Aim: Improvement of the antibiotic policy and infection control strategies in Suez Canal University Hospitals in Ismailia; through adequate detection of carbapenem resistance in the hospitals.Methods: All the CRE isolates were tested by the phenotypic methods (mCIM & eCIM) test to detect carbapenemases production, and screened by the conventional PCR for the presence of five carbapenemase genes, namely blaKPC, blaIMI, blaVIM, blaNDM, blaOXA-48 Results: The study showed that (53/155) 34.1% of the Enterobacteriaceae isolates were carbapenems resistant. Carbapenemases activity was detected in (36/53) 67.9% of the examined CRE isolates using mCIM test (20/36)37.8 % showed Metallo-carbapenemases and (16/36) 30.2% showed Serine- carbapenemases by eCIM test. 60.4% (32/53) were sensitive to colistin. While by PCR all the isolates (100%) harbor one or more carbapenemases genes. (51/53) 96.2% were proved to harbor blaOXA-48 gene, (47/53) 88.7% were proved to harbor blaNDM gene, (28/53) 52.8%, were proved to harbor blaVIM,gene, the percentage of blaIMI, blaKPC isolation was (17/53) 32.1%, (4/53)7.5% respectively.Conclusion: High frequencies of carbapenemase genes among CRE isolates

Outcome of End-to-End Anastomotic Urethroplasty in Patients having Stricture Urethra

Objective: To see the results of end-to-end anastomosis and stricture excision after spatulation in patients with blind urethral stricture. Study Design: A prospective study. Place and Duration: In the Department of Urology PAEC General Hospital, Islamabad for the 3-year duration from February 2016 to January 2019. Methods: Total 20 male patients over the age of 16 years having blind stricture of membranous or bulbar urethra ≤ 2 cm were selected for the study. We excluded patients with stricture greater than 2 cm, patients with neurogenic bladder stricture and patients with malignant strictures. About 2.5 years was the mean follow-up time and one year was the minimum follow-up time. Results: About 20 patients with stricture of the urethra with 20-44 years were managed. The results were good in 14 (70%) patients, moderate in 4 patients (20%) and urethroplasty failed in 2 (10%) patients. Overall 90% was the success rate. Conclusion: Anastomosis urethroplasty has better results in patients with blind stricture of the membranous or bulbar urethra.

Effect of SGLT in Type 2 Diabetes and Gastric Bypass Surgery - A Narrative Review

Body fat is regulated by a complex neuroendocrine system,making it difficult to maintain weight loss achieved via caloricrestriction. Bariatric surgery produces greater weight lossand weight loss that is more durable than caloric restriction,and therefore is currently the most effective therapy forobesity. Sodium-glucose-co-transporter inhibitors areglucose lowering drugs that reduces plasma glucose levelsby inhibiting glucose and sodium reabsorption in the kidneys,resulting in glycosuria.Sleeve gastrectomy is one such bariatric surgical procedurethat involves the creation of a reduced stomach lumen alongthe lesser curvature of the stomach through the removal ofgastric tissues along the greater curvature from the fundusto the antrum. Stomach capacity is typically reduced 80%or more, and the intestine remains intact. This procedureproduces dramatic weight loss in humans and in rodents. Infact, recent reports indicate that its efficacy is close to that ofthe more common Roux-en Y gastric bypass.There are many diverse factors on which operative mortalityof bariatric surgery depends such as facility related, surgeonrelated, followed by patient and procedure-related. Tominimize operative mortality, specific factors were consideredfor the specific patients. As a result, to treat type 2 diabetes inassociation with obesity, slightly obese patients or overweightpatients were treated with conventional bariatric proceduresworldwide. For the management of morbidity obese diabeticpatients, there is no single or standard procedure

Adult Stature Reconstruction From Cephalo-facial Dimension In Indian Females

Aim: To identify the Stature from the cephalo-facial dimension (facial height) in Indian females.Materials and Methods: A stadiometer was used to measure the stature, and the facial height was taken byutilizing a vernier caliper, in 43 female medical students. To know about the significance and correlation, thedata were analysed statistically.Results: Mean stature and the mean facial height were found to be 158.93±11.06 cm and 10.39±0.83 cm respectively.P value was less than 0.001 and Pearson’s coefficient obtained was 0.93. Hence, there is found to be a significantpositive correlation between stature and facial height in Indian females.Conclusion: Estimation of stature from the facial height could be performed where only unknown head and faceare brought for anthropometric examinations.

Spectrum of gynecological malignancies at Jamshoro

Objective: To describe the frequency and spectrum of different types of gynecological malignancies. Study Design: An observational study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences, Jamshoro, from January 2014 to December 2015

Methodology: All patients with gynecological malignancies, admitted at the study place, whether previously diagnosed or need to establish the diagnosis on the basis of EUA, biopsy, staging and for surgery during the study period were included. All patients with benign gynecologic masses were excluded. Studied variables were age, marital status, parity, education, socioeconomic status, clinical presentation, clinical diagnosis, tumor site and surgical procedure. The diagnosis and type of malignancy was confirmed on the histopathology report of the specimen taken

Results: There were a total of 65 patients [6.39%] with gynaecological malignancies. The median age was 15 years [46.26%]. Ninety-four percent were married. Seventy-one percent had a poor socioeconomic status. Cervical cancer was most common as seen in 27 [41.5%] followed by ovarian malignancy in 21 [32.3%] of cases, uterine caners in nine [13.8%], vaginal cancer in six [9.2%], and vulval cancer in three [4.6%] of cases. The common histopathological type of cervical cancer was moderately differentiated squamous cell carcinoma [n=19, 29.2%], papillary serous cyst adenocarcinoma in ovarian [n=13, 20.0%], and squamous cell carcinoma in vagina and vulva. There was no case of primary fallopian tube malignancy

Conclusion: Gynecological malignancies are common in younger age group. The need is to strengthen screening practices, making it easy and cost-effective for all the general and at risk population, so that early detection and treatment can be possible to control the female genital tract cancers

lenalidomide induced toxic epidermal necrolysis and del [5q]: co-occurrence of rarities

Primary myelofibrosis [PMF] is a clonal, BCR-ABL1 negative myeloproliferative neoplasm characterised by splenomegaly, leukoerythroblastic peripheral blood picture and bone marrow fibrosis. Different cytogentic abnormalities are documented in PMF which have impact on clinical outcome and overall survival. Del 5q31 is documented in only 0.8% of PMF patients and is associated with poor outcome and increased risk of progression to acute leukemia. Anemia with del 5q responds frequently to lenalidomide treatment. We are reporting case of a middle-aged male who presented with constitutional symptoms, myelofibrosis; and calreticulin type 2 mutation was present. His cytogenetics showed del 5q positivity. He was started on lenalidomide but developed toxic epidermal necrolysis, resultantly lenalidomide was stopped. Skin eruptions are a known entity in patients with lenalidomide therapy; but to date, there is no reported case of lenalidomide induced toxic epidermal necrolysis [TEN] in patients with myelofibrosis

Medical school dermatology curriculum - are our graduates adequately prepared and aligned to community needs?

Background: There is paucity of research based information regarding the dermatology learning needs and their fulfilment in primary care physicians

Objective: To determine skin diseases burden in the community AND adequacy of preparedness of Primary Care Physicians to deal with skin diseases

Methodology: This was a cross sectional study conducted from 1[st] January 2015 to 31[st] December 2016 at Dermatology Outpatient Department of Sheikh Zayed Medical College/Hospital [SZMC/H], Rahim Yar Khan, for burden of skin diseases and feedback from Primary Care Physicians of both SZMC/H and Primary Health Care setups [BHUs and RHCs] of District Rahim Yar Khan regarding adequacy of their preparedness to deal with skin disease patients. Records from a tertiary care teaching hospital was sought from OPD to assess skin disease burden and Primary Care Physicians from tertiary care hospital and BHU and RHC of district were surveyed regarding content AND teaching adequacy of undergraduates through their dermatology curriculum. Data was entered and analyzed by using SPSS version 20

Results: A total of 356 doctors participated in this study. Of these 233 [65.4%] were males. It was found that 10% of patients attending OPD in Sheikh Zayed Hospital [A tertiary care teaching hospital] suffered from skin disease. Frequencies of "Common skin diseases" in the community were; eczema 12.9%, scabies 10.8%, fungal infection 9%, bacterial infection 8% and acne 7%. Of all participants, 274 [77%] reported that <10% of their patients suffered from skin disease and only 30 [8.4%] of them were fully confident while treating skin disease patients and only 36 [10.1%] reported that most of their patients were cured. It was noted that 145 [40.7%] participants could name only 1-3 of the common skin diseases in the community, 182 [51.1%] named 4-6 while only 12[3.4%] could name 7 or more and 17[4.8%] had no knowledge of even a single common skin disease in the community. Only 92[25.8%] participants rated that their undergraduate training was adequate while 264[74.2%] rated it to be inadequate

Conclusion: This study concluded that primary care physician were not adequately prepared for managing common skin diseases during their undergraduate training. Appropriate exposure and adequate teaching in dermatology throughout undergraduate medical curriculum is essential because skin presentations manifest throughout all aspects of medicine, and most often dermatological problems are dealt with exclusively by non-dermatologists

Haematological parameters in different African populations: an experience from united nations level 3 hospital

Objective: To evaluate hematological parameters in African population to estimate normal reference intervals for these tests

Study Design: Cross sectional observational study

Place and Duration of Study: Department of Pathology, United Nations level 3 hospital, Nyala, Darfur from 1st Mar to 30th Dec 2014

Material and Methods: There were 396 healthy African male and female volunteers selected between 18-65 years of age, belonging to different countries. Fresh whole blood was used to measure haemoglobin [Hb] concentration, haematocrit [Hct], total red blood cell [TRBC] count, mean corpuscular volume [MCV], mean corpuscular haemoglobin [MCH], mean corpuscular haemoglobin concentration [MCHC], platelet count, total leucocyte count [TLC] and differential white blood cells count. Data were analysed using SPSS version 19

Results: Mean Hb of study group was 13.81 +/- 1.99 g/dl. Mean TLC was 5.50 +/- 1.96 x 103/ul. Mean lymphocyte count was 2.58 +/- 0.95. Mean platelet count was 234 +/- 92 x103 /ul. Mean values for Hb Concentration, TRBC, Hct Ratio, MCV, MCH and MCHC were all higher for African Males than Females; this difference was statistically significant [p<0.05]

Conclusion: This multi-national African population based study confirms the variations in haematological parameters previously described in single nation African studies. The commonly observed variations in normal adults are low RBC indices, relative neutropenia and lymphocytosis

Antibiotics and over the counter medication use and its correlates among Arab pregnant women visitinga tertiary care hospital in Riyadh, Saudi Arabia

Background and Objective: The use of over the counter medications [OTCMs] is a common practice globally. OTCMs are of special concern among pregnant women as they pose risk to the mother and fetus. The objective was to assess the use of OTCMs by pregnant woman, and factors associated with it

Methods: A cross-sectional study, using a structured self-administrated questionnaire was conducted at the obstetric and antenatal clinics at King Khalid University hospital, Riyadh. 354 pregnant women were surveyed

Result: About 32% of the study participants used OTCMs without prescription at least once during their last pregnancy. The most commonly used OTCM was Paracetamol [22%]. Pharmacists were the main source of knowledge [53%] for the participants. Correct knowledge regarding the drugs was associated with the usage of OTCM drug

Conclusion: Use of OTCMs and antibiotics during pregnancy is a common practice among Saudi pregnant women. General awareness regarding OTCMs use during pregnancy without prescription needs to be raised in the community. Pharmacists and media can help in providing accurate knowledge

Opioid-free anesthesia using continuous dexmedetomidine and lidocaine infusions in spine surgery / 대한마취과학회지

No abstract available.

effect of adding body mass index [BMI] and neck circumference to Epworth sleepiness scale [ESS] for diagnosing obstructive sleep apnea hypopnea syndrome in sleep clinics

Objective: To study the effect of adding body mass index and neck circumference to Epworth Sleepiness Scale [ESS] for diagnosing obstructive sleep apnea hypopnea syndrome in sleep clinics

Study Design: Cross sectional validation study

Place and Duration of Study: Department of Pulmonology, Military Hospital Rawalpindi from 1st July 2013 to 01 September 2014

Material and Methods: The ESS and ESS plus body mass index [BMI] and neck circumference [NC] data was evaluated for 150 patients hospitalized in our hospital for polysomnographic evaluation of obstructive sleep apnea. Overnight polysomnography [PSG] was done for all patients and was considered the gold standard for diagnosis of OSA. ESS Scoring, BMI and NC data was done using pre-designated questionnaire. All the data was analyzed using SPSS version 19

Results: Age ranged from 18-74 years with mean age of the study group 53 [ +/- 12.1 SD] years. Out of study population 87 [58%] were males and 63 [42%] females. In study population 80 [55.3%] patients had ESS >10. while 102 patients had ESS>10 with BMI > 35 kg/m2 and NC>40 cm. Using an AHI >/= 5 for OSA, 136 patients [90.6%] had OSA. Sensitivity of ESS > 10 for OSA was 55.15% but increased to 72.79% when BMI > 35 kg/m2 and NC > 40 cm was added to patients with ESS > 10. Similarly specificity and predictive values of study population for diagnosing OSA also increased after adding BMI and NC to ESS

Conclusions: In this study adding body mass index [BMI] and NC to ESS score significantly increased the sensitivity and specificity and positive predictive value for diagnosis of OSA

Efficacy of terbinafine versus itraconazole in treatment of tinea capitis

Background: tinea capitis is an important skin infection in children. Terbinafine has been used as preferred drug but increasing number of resistance and side effect profile suggests search to find another drug with better efficacy and safety

Objective: to compare the efficacy and safety of terbinafine and Itraconazole in tenia capitis

Methodology: it was a randomized control trial on 120 cases of tenia capitis diagnosed on the basis of five clinical signs and symptoms [erythema, desquamation/scaling, papules, pustules and pruritis] which were rated on four point scale [0-absent, 1-mild, 2-moderate, 3-severe] summed as total signs and symptoms score [TSSS] and a positive KOH microscopy and were divided into two equal groups A and B. Group A was treated with terbinafine at a dose of 62.5 mg for children less than 20 kg, 125 mg for 20-40 kg and 250 mg for above 40 kg. Group B was treated with Itraconazole and dosage was as follows; 10-19 kg 50 mg/day, 20-40 kg 100mg/ day, more than 40 kg 200 mg/day. This study was carried out from 1[st] January to 30[th] June 2016, at department of Dermatology, Sheikh Zayed Hospital, Rahim Yar Khan. These cases were then followed at weeks 02, 04, 06 and 08 and assessed on the basis of KOH microscopy and TSSS score. Negative microscopy and zero TSSS were labeled as cured and parents were also asked about any side effect and tolerability. The data was entered and analyzed by using SPSS version 16

Results: there were 60 cases in each group. Group A has 29 males and 31 females while Group B has 34 males and 26 females. Cure was seen significantly higher in Group B where it was in 86.67% as compared to Group A with 68.33%. [p value 0.01]. There was again significant difference seen when they were compared in terms of cure time where 58.34% of cases in group B were cured by 6 weeks as compared to 40% in Group A. [P value 0.03]. There was no significant difference in terms of side effect profile [p= 0.45] while it was again significantly better in terms of tolerability with Itraconazole [p= 0.02]

Conclusion: intraconazole has better care and safety profile as compared to terbinafine in treatment of Tenia Capitis

Prophylactic rectal nsaids in the prevention of post-ercp pancreatitis

Objective: To evaluate the effectiveness of rectal non-steroidal anti-inflammatory drugs [NSAIDs] using diclofenac in preventing pancreatitis following ERCP

Methodology: It was a randomized, double blinded, placebo controlled study carried out at Surgical Unit-l, Holy Family Hospital, Rawalpindi from May 2013 to April 2014. A total of 108 patients were included and randomly assigned in each of study and placebo groups. Group I patients received 100 mg of diclofenac per rectally while group II patients received a glycerine suppository per rectally [placebo] before the start of ERCP. Post ERCP pancreatitis [PEP] was diagnosed by clinical evaluation and raised serum amylase levels after four hours of the procedure in both groups [study vs control]

Results: Out of 108 patients 32 were males and 76 were females. Mean age was 46.09 +/- 12.31 in group I, while it was 42.93 +/- 14.69 in Group II. Mean serum amylase level, 4 hours after ERCP, was 184.70 +/- 36.34 in the diclofenac group, while it was 388.20 +/- 57.27 IU/L in the control group. Thirty one patients were diagnosed with Post ERCP pancreatitis, out of which nine patients belonged to the study group and twenty two were of the control group [P = 0.000]

Conclusion: Per-rectal administration of diclofenac suppository prior to ERCP results in significant reduction in the frequency of ERCP induced pancreatitis

Frequency of hbv infection and its risk factors in asymptomatic military personnels

Objective: To determine the frequency of silent Hepatitis B virus [HBV] infection, its symptoms and risk factors in apparently healthy military personnel of Pakistan Army

Study Design: Descriptive cross sectional study

Place and Duration of Study: Department of medicine, Combined Military Hospital Okara from Oct 2012 to Mar 2013

Material and Methods: A total of 6236 healthy troops with age ranging from 18 to 57 years without previous or present history of HBV infection were selected by consecutive sampling from Okara Garrison. Blood samples were subjected to rapid screening of HBV infection using immunochrom atographic [ICT] kits [Intec production, Inc] with sensitivity and specificity of 99.8% and 95 % respectively. All positive cases were confirmed by 4th generation ELISA and PCR for HBV DNA were also sent. All infected cases were given a questionnaire about different risk factors of HBV infection. Finally variables were defined qualitatively and quantitatively and frequency, percentage, mean [SD] were calculated. All the data was analyzed using SPSS version 19

Results: Age ranged from 18-57 years with mean age of the study group 27 [ +/- 7.2] years. Mean age among those with HBs Ag positive was 32 [ +/- 7.3] years. Frequency of HBV infection was 2.03% [127 participants out of 6236] whereas PCR for HBV DNA was positive in 51 out of 127 [40.1%]. Most common symptom was anorexia in 16 patients [12.6%] followed by fatigue and fever in 15 patients [11.8%] each. While 42 patients [33.1%] were asymptomatic. Dental procedures was found to be most frequent risk factor [25.9%] followed by previous history of surgery [21.2%]

Conclusion: Although pre induction screening of HBV infection is carried out in Pak Army still its prevalence is matched with that of general Pakistani population. Soldiers' education and immediate vaccination is recommended at time of induction to stop the spread of this dreadful disease in Pak army

Effect of pioglitazone on serum high density lipoprotein [HDL] levels of type-2 diabetics

Objective: To study effect of Pioglitazone on serum high density lipoprotein levels in patients with type 2 diabetes mellitus

Study Design: Single blind randomized controlled trial

Place and Duration of Study: Department of medicine, Combined Military Hospital Multan from 1[st] Feb 2011 to 30[th] July 2012

Material and Methods: A total of 276 already diagnosed patients of diabetes mellitus type 2 between age of 30-80 years, presenting to the outpatient department of Combined Military Hospital Multan were selected. Type 2 diabetic patients were allocated group A or B using random allocation. Base line blood sugar fasting [BSF], glycosylated hemoglobin [HbAlc], high density lipoprotein [HDL] levels were taken. Group A was treated with Pioglitazone along with other hypoglycemic agents while group B was treated with only hypoglycemic agents and multivitamin tablets were added as placebo.After 12 weeks of treatment, serum HDL levels were measured to analyze effect of pioglitazone on serum HDL levels

Results: Pioglitazone group showed significant improvement in the serum HDL levels from baseline HDL 46.38 + 6.44mmol/L to 49.80+ 5.86 mmol/L after 12 weeks of therapy, [p = 0.001]

Conclusion: Pioglitazone when used in combination with other oral hypoglycemic agents has a beneficial effect on the serum HDL levels of the diabetics

Frequency of medical complications in hospitalized stroke patients at Bahawal Victoria Hospital, Bahawalpur

Objective: To find out the frequency and nature of medical complications in hospitalized patients admitted to Bahawal Victoria Hospital, Bahawalpur with acute stroke

Study Design: Cross-sectional Study

Place and Duration of Study: This study was conducted at the Department of Medicine, Bahawal Victoria Hospital and Quaid-e-Azam Medical College, Bahawalpur from July 2015 to September 2015

Materials and Methods: 98 patients who fulfill the inclusion criteria and gave informed consent were enlisted in the study. These patients were regularly observed for any post stroke medical complications after the clinical evaluation and CT scan plain brain until they were discharged from the hospital

Results: The mean age of the patients was 57.15 +/- 15.42. Most of the patients suffering from stroke were female [68.4 %] and belonged from rural population [73.5 %]. Most of them were suffering from ischemic stroke [66.3 %]. Specified medical complications included: Recurrent Stroke [29.6 %], Epileptic seizures [12. 2 %], Urinary tract infections [30. 6 %], respiratory tract infections [31. 6 %], bed sores [15.3 %], shoulder pain [10.2 %], depression [53.1 %], falls [13.3 %], Venous Thromboembolism [7.1 %]. A total of 14 patients [14.28 %] died during the hospital stay due to severe disease

Conclusion: This study established the post stroke medical complications mainly the pressure sores, pain and infection. As a complication, depression was also identified among the stroke patients. The disability and mortality can be minimized by early identification and treatment of these likely avertable complications