study on the postnatal development and aging changes of the neurosecretory nuclei of the hypothalamus [supraoptic and paraventricular nuclei] in the albino rat

The hypothalamus is a distinct neurological entity concerned with a variety of regulatory processes. Recently, the prescence of variations in the level of neurosecretions wth the progress of age was reported. To study the changes in the structure of magnocellular neurons in the paraventricular and supraoptic nuclei during the period of postnatal development. Furthermore, to study the changes which occurred in the structure of these neurons in the old age had been studied. A total of 52 albino rats were used. The age groups of the animals include: one day, 10 days, 20 days, 2 months and 2 years old animals. Brains were processed to be studied with Einarson's gallocyanin-chrome alum stain, Golgi- Cox method and transmission electron microscope. In addition, the number of cells in the magnocellular part of the paraventricular and supraoptic nuclei were measured in all studied age groups and statistically analyzed. In the newly born rats, the paraventricular and supraoptic nuclei were composed of small rounded condensed cells. At the age of 10 days old rats, the paraventricular nucleus appeared to be well differentiated into ventromedial [parvocellular] and dorsolateral [magnocellular] parts. With the progress of age from 10 days up to the adult stage, the cells of the supraoptic nucleus and the magnocellular part of the paraventricular nucleus appeared to be densely stained which indicated increase in the Nissl granules. Ultrastructural study showed that the cells had abundant amount of free ribosomes, rough endoplasmic reticulum and mitochondria. The nucleus had fine dispersed chromatin. Golgi-Cox study showed marked increase in extension and branching of dendrites with the progress of age during the developmental period. Morphometric study showed significant increase in the number of cells from the new born up to the adult stage. In old aged rats, the cells of the paraventricular nucleus and the supraoptic nucleus appeared to be faintly stained. Some cells had vacuolated cytoplasm. Ultrastructural study showed marked decrease in the free ribosomes and the presence of many lipofuscin pigment in the cytoplasm of cells. The nucleus showed chromatin condensation and irregularity of the nuclear membrane. In addition, there was apparent decrease in the amount of the synaptic vesicles in the presynaptic terminals making contacts with the magnocellular neurons. Golgi-Cox study revealed marked decrease in the extension and branching of dentrites. Morphometric analysis showed significant decrease in the number of cells. This study demonstrated in the presence of structural changes in the magnocellular part of the paraventricular nucleus and supraoptic nucleus during the period of development. In old age, the presence of many degenerative changes was observed. This cytoarchitectonic analysis and morphological study could help in the explanation of the functional differences in the various ages

Microbiological surveillance of operation theatres and ICUs of a tertiary care hospital, Lahore

The aims of this work was to study the level of bacterial contamination of air, surfaces and equipment in operation theatres of a tertiary care hospital in Lahore. Settle plates method was used for air samples and swabs for surfaces and other articles. High bacteriological contamination of air and sucker machine was detected and total bacteriological counts in air samples was high. On the other hand surfaces showed less bacterial contamination. It is concluded that microbiological surveillance of operating theaters can play an important role in reducing bacterial contamination consequently peroperative infectious episodes can be reduced considerably

Meatal stenosis in circumcised males - Is it preventable?

Meatal stenosis is most commonly seen among the circumcised males. The true incidence of this post circumcision complication is not known. The most favored hypothesis regarding the etiology is ammoniacal fumes produced in the wet diapers, which cause meatitis of unprotected glans. It is treated by meatoplasty. 26 pediatric patients suffering from meatal stenosis were treated between Jan. 2003 and Dec. 2005 both inclusive [Mean age was 4.36 years and ranging 2 - 10] and mean follow up was 4 months. Patients were studied for presenting symptoms, size of meatus, perimeatal balanitis, pyuria and postoperative complications such as bleeding, infection and recurrence. They were advised postoperative dilatation with ophthalmic ointment nozzle for one month. Patients with prior history of circumcision were included in the study. The most common symptom in our study was thinning of urinary stream 17 [65.4%] cases. Other common symptoms were painful micturition in eight and bloody spotting in seven cases. Eight patients were having pin hole meatus and three cases were having pyuria. Compliance for post operative dilatation was 76.9% [20 cases]. No case of recurrence was seen. It can be concluded that meatal stenosis is related to infant circumcision. It is treated by meatoplasty with satisfactory outcome. Whether we would be able to prevent this post circumcision complication ? There is no obvious solution to this problem for the time being

Metronidazole for bacterial vaginosis - a comparison between vaginal gel and oral therapy

To compare the efficacy of 0.75% metronidazole vaginal gel with oral metronidazole for the treatment of bacterial vaginosis. Comparative study, conducted in the Department of Obstetrics and Gynaecology at Ghurki Trust Teaching Hospital attached with Lahore Medical and Dental College, Lahore. The total number of patients included were 290. They were divided into two groups, by random selection. Group A [150 patients] and Group B [140 patients]. 150 patients received metronidazole vaginal gel for 5 days. 98 [85%] patients were free of signs of infection. 11 [9.5%] patients showed partial response and the dose was repeated, while 6 [5.2%] patients showed no response to treatment. 140 patients received metronidazole 400 mg x BD orally for 5 days. In which 80 [77%] patients were free of discharge while 14 [13%] patients and 10 [9.6%] patients showed partial or no response respectively and it was mainly because of gastro-intestinal complaints. Vaginal metronidazole is effective for the treatment of bacterial vaginosis and is associated with better compliance and less side effects as compared to oral metronidazole

Frequency of extended spectrum beta-lactamase producing Klebsiella pneumoniae and Escherichia coli isolates

Extended spectrum beta lactamases [ESBLs] that mediate resistance to 3[rd] generation cephalosporins are now observed worldwide in all species of Enterobacteriaceae especially Klebsiella pneumoniae and Escherichia coli. ESBL producing organisms are responsible for nosocomial planned to determine the frequency of extended-spectrum beta-lactamase [ESBL] production among Klebsiella pneumoniae and Escherichia coli isolated from different clinical specimens from patients admitted to different teaching hospitals of Lahore [Services Hospital, May Hospital and Sir Ganga Ram Hospital]. It was carried out in Department of Pathology, Services Institute of Medical Sciences [SIMS], Lahore from October 2005 to August 2006. A total of 324 clinical isolates of Klebsiella pneumoniae and Escherichia coli recovered from different clinical specimens like blood, urine, sputum, pus/ wound swabs were included in this study. All isolates were screened and confirmed for extended spectrum beta lactamase [ESBL] production by Kirby-Bauer disk diffusion method on Mueller Hinton agar using NCCLS guidelines. Out of a total of 324 isolates, 184 were Klebsiella pneumoniae and 140 were Escherichia coli. Among these, 47.82% were Klebsiella pneumoniae and 38.57% Escherichia coli isolates were ESBL producer. ESBL production was the highest among isolates from blood [50%] isolates from Mayo Hospital, Lahore [56.25%]. It is concluded that there is a high frequency of ESBL production among nosocomial isolates of Klebsiella pneumoniae and Escherichia coli. These isolates being resistant to 3[rd] generation cephalosporins and many other classes of antibiotics pose a special therapeutic challenge. Therefore, these isolates should be routinely tested by ESBL production

Efficacy of fine needle aspiration [FNA] cytology in differentiating malignant and benign ovarian cysts

This study was carried out to determine the diagnostic efficacy of fine needle aspiration cytology between neoplastic and non neoplastic ovarian cysts and to verify the cytological diagnosis of aspirated fluid with histology of excised cyst. This was carried out at the Department of Obstetrics and Gynaecology, Ghurki Trust Teaching Hospital, Lahore from February 2003 to February 2005. It was an analytic study. A total number of 55 patients were included in the study. They were selected on the basis of ultrasonographic examination and having unilocular and non septate ovarian cysts. Ultrasound guided aspiration of cysts was done followed by excision. The cytology of fluid was correlated with histology of excised cyst. Follicular cysts were seen in the highest percentage followed by haemorrhagic luteal cysts, serous cyst adenomas and serous cyst adenocarcinomas. Ultrasound guided fine needle aspiration of ovarian cysts is a feasible alternative to surgery for benign cysts of the ovary

Vulval mass

Miss T, daughter of G. N., 25 years of age presented with history of swelling of the right side of the vulva for last 3 years. On examination a large growth arising from the labia majora and hanging down to just below the knee was seen. Excision of the vulval growth was done. Histopathology revealed fibroepithelial polyp

Frequency of hepatitis C in admitted patients of department of obstetrics and gynaecology, ghurki trust teaching hospital, Lahore

To assess the frequency of hepatitis C in admitted patients of department of obstetrics and gynaecology Ghurki trust teaching hospital, Lahore. Descriptive study this study was conducted on patients admitted in obstetrics and gynaecology ward Ghurki trust teaching hospital, Lahore from 1st January 2005 to 31st December 2005. A total of 1569 patients of age between 20 to 70 years were admitted in obstetrics and gynaecology ward Ghurki trust teaching hospital, Lahore and were screened for anti-HCV antibodies by 3rd generation ELISA. All positive patients were asked about previous history of jaundice, surgery, blood transfusion, multiple injections and dental procedures. Out of 1569 patients 107 were found to be anti-HCV positive. Mean age of patients was 34.5 years. Frequency of anti-HCV was maximum [38.3%] in 31-40 years age group and in gynaecology patients [12.5%]. Previous history of multiple injections and dai handling were the most commonly associated factors. Co-existent hepatitis B and C was found in only 2 [1.8%] patients. Hepatitis C is becoming an alarmingly common problem in the area of Ghurki Trust Teaching Hospital, Lahore. Its modes of transmission need to be properly evaluated for its control and prevention

Seroprevalence of rubella IGG and IGM antibodies in infants suspected of having rubella infection

This study was conducted to assess clinical and laboratory screening for suspected congenital rubella syndrome [CRS] and to evaluate the efficacy of reporting of CRS cases at the Children's Hospital and the Institute of Child Health. A total of 100 infants suspected of having rubella infection were included in the study. Rubella titer was used as an indicator. Enzyme linked immunosorbent assay was performed to detect rubella specific IgM and IgG. The data was analyzed on infants 'birth weight, infants' clinical characteristics and laboratory evaluation. The study shows that out of 100 Infants, only three [3%] met the definition for confirmed rubella whereas thirty-four patients were positive for Rubella IgG only. Ninety-seven other children had clinical presentation that met the definition for a probable case but when they were tested for Rubella specific IgM antibodies, the tests were negative. Rubella IgG positive patients were further categorized on the basis of their age; 33 [97%] infants were of less than six months and only 1 [3%] infant was of more than six months. Average age of the patients was 2.2 months [SD +/- 1.55]. The common clinical presentations in rubella positive patients [n=3] were failure to thrive [100%], cataract [67%], patent ductus arteriosus [67%], microcephaly [67%], intracranial calcification [33%], buphthalamus [33%], and hepatosplenomegaly [67%]. With regard to hematological abnormalities in the three rubella confirmed cases, three had anemia [loon two infants had thrombocytopenia [67%], and only one infant had leucopenia [33.3%]. The relatively high rate of susceptibility indicated a risk of a rubella outbreak, and the resulting. Congenital rubella syndrome is an under-recognized public health problem in Pakistan and can be reduced by vaccinating all seronegative women. There is an urgent need for the collection of appropriate data to estimate the cost effectiveness of a potential Rubella Control Programme

Vesico vaginal fistula after interval debulking in epithelial ovarian cancer

Mrs. S.E, 45 years of age was diagnosed as a case of ovarian carcinoma and had interval debulking, following which she developed vesico-vaginal fistula. Continuous bladder drainage was done for 6 weeks and she was given post operative chemotherapy with cisplatin and gemcitabine. On her 6 weeks postoperative examination, the fistula had healed completely. She is receiving her chemotherapy cycles and is in satisfactory condition

audit of Acute Pain Service in Central, Saudi Arbia

A retrospective analysis of acute pain service [APS] was performed to look at the epidural and patient-controlled analgesia [PCA] with respect to their indications, duration and quality of pain control, dosage regimen and common side effects. This study was conducted in the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia. All APS monitoring forms, from the year 1994 to 2003 were collected. Every tenth PCA and epidural form was then randomly taken out and reviewed. From each sample form information concerning operation, analgesic modality [epidural or PCA], its duration, side effects and non-steroidal anti-inflammatory drug [NSAID] use was collected. Postoperative pain and sedation were monitored as 0=none, 1=mild, 2=moderate and 3=severe. For the first 24 hour of APS period, information was also gathered concerning duration of each pain score, highest pain score, sedation score and lowest respiratory rate. Informations of PCA [incremental dose, lock-out interval, back ground infusion, number of hours PCA not activated and total morphine consumed] and epidural infusion [concentration of mixture of local anesthetic with opioid and its volume consumed during first 24 hours] were also collected. A total of 10002 patients aged 16-74 years received APS; one third of them receiving epidural and two thirds receiving PCA. Eighty-five% of patients received APS after cesarean section and 7.8% received APS after abdominal hysterectomy. Acute pain service served 77% of total APS patients for 24-48 hours. The average duration of APS was 44.2 hours. For the first 24 hours, PCA and epidural was compared for severity and duration of pain. A pain score of zero was found for a longer period [average 19.6 hours] with epidural whilst; a pain score of 1 and 2 was observed for a longer period [average 11.4 and 4.0] with PCA. The mean highest pain score was 0.7 for epidural and 1.7 for PCA. Patients having no postoperative pain included 35.7% of the epidural analgesia group and 0.5% of the PCA group. The highest sedation score of one was found more often in the epidural group and a score of 2 was found more often in the PCA group. No case was documented where the respiratory rate was <12/minute. Most [51%] PCA patients were prescribed an incremental dose of 1.5mg of morphine with a lock-out interval of 10 minutes. Basal morphine infusion was used in 96% of PCA patients. Patient-controlled analgesia was not activated for the mean period of 13.2 hours in the first 24 hours postoperative period. Average total amount of morphine consumed by patients was 76.8 mg during the average total duration of 42.9 hours of PCA. Amongst patients who received epidural analgesia, 93.6% received the mixture of fentanyl [4 microgram/ml] and Bupivacaine [0.03%]. On average, 194 mls of epidural infusion was used in the first 24 postoperative hours. Overall, 35% of patients received NSAIDs along with APS and 12.6% of patients developed complications during APS. Complications were recorded in 25.6% of epidural patients and 4.4% of PCA patients. The most common complication was pruritis. In the past decade, APS has provided a safe and efficient service to over 10 thousand postoperative obstetric and gynecology patients. Epidural analgesia as compared to PCA provided superior analgesia but caused more frequent minor side effects. More resources are required to provide good quality APS to all eligible postoperative patients for the desirable period

Efficacy of epidural of clonidine in relieving pain after thoracotomy: study some hemodynamic, respiratory function and urodynamic changes

Thoracotomy is an operation of considerable risk, causing severe postoperative pain, and therefore creates a great need for postoperative analgesia. Our study aimed to compare between epidural morphine and clonidine as regard postoperative pain relief, hemodynamic, respiratory and urodynamic effects. In the current study, twenty adult patients scheduled to perform lobectomy through a posterolateral thoracotomy were enrolled. They were divided into two equal groups according to the analgesic drug used. Morphine Group [MG]: patients received a bolus dose of morphine 0.05 mg/kg diluted in 10 cc. saline injected through thoracic epidural catheter before induction of anesthesia, followed by continuous infusion of 0.5 mg/hour diluted in 10 cc saline. Clonidine Group [CG]: patients received a bolus dose of clonidine 10 micro g/kg diluted in 10 cc saline injected through thoracic epidural catheter before induction of anesthesia, followed by continuous infusion of 2 micro g/kg/hour in 10 cc saline. Our results showed that both epidural morphine and clonidine were effective for postoperative pain relief, but the quality of pain relief was better in morphine group. Both were associated with stable hemodynamic variables and improved postoperative pulmonary functions except for bradyapnea in morphine group. As regard urodynamic study, there were significant criteria for urinary retention in morphine group, whereas, there were significant criteria for increased frequency and urgency for micturation in clonidine group. Both epidural morphine and clonidine are efficient in relieving post-thoracotomy pain, but the quality of pain relief in morphine group is superior to clonidine. Also, both agents cause hemodynamic stability except clonidine was associated sometimes with bradycardia. They improved postoperative pulmonary functions due to pain relief, but morphine was sometimes associated with bradyapnea. Epidural morphine was associated with a 50% incidence of urine retention, whereas clonidine was associated with a 60% increase in frequency ad urgency of urination

Comparison between single dose versus seven days metronidazole therapy in treatment of trichomonas vaginalis vaginitis

Comparison between single dose use of metronidazole versus seven days therapy in the treatment of trichomonas vaginalis infection. Design and Setting: A one year study from September 2002 to August 2003 conducted at Ghurki Trust Teaching Hospital attached with Lahore Medical and Dental College, Lahore. The total number of patients included are 109. Main Outcome Measure: Comparative treatment results of single dose versus 7 days therapy of metronidazole in treatment of trichomonas vaginalis. 54 patients received metronidazole for 7 days. 51[94.44%] were free of infection. 3 did not respond to treatment and were retreated in the same way. 55 patients received 3 gm single dose treatment. 53% [96.36%] were free of infection while 3 patients required repeat treatment. Conclusions: Single dose treatment is an acceptable option with few side effects and better compliance

Environmental and nutritional parameters controlling the biosynthesis of thermostable alkaline protease [TAP] from Bacillus sterrothurmophilos, S-WN 1616 B isolated from Wady El - Natroon lakes in Egypt

A special study was undertaken concerning the productivity of thermo- alkaline protease[s] [TAP] by the proteolytic thermoalkalophilic Bacillus stearothermophilus S-WN1616B isolated from Wady El-Natroon in Egypt. Optimal parameters controlling TAP productivity were inoculum size [0.23x109 CFU/ml], incubation period [30 days], incubation temperature [55C], pH [10-10.2] and NaCl 3%. Although L-threonine, Ca-nitrate, gelatin, peptone pantothenic acid and Zn++ enhanced [TAP] formation while added separately to gelatin-production medium, yet their elimination in addition to the absence of all ingredients of medium gave evidence that only gelatin in tap water stimulated the highest yield of [TAP] under other optimal specified conditions. Data emphasized the inducing role of gelatin on TAP-biosynthesis at relatively high temperature and pH value

Bacteriological quality of drinking water in punjab: evaluation of H2s strip test

OBJECTIVE: To assess bacteriological quality of drinking water in Punjab and to evaluate usefulness of H2S strip test in comparison with multiple tube test. METHOD: Samples of water were tested using H2S strips and multiple tube test. Maximum bacterial contamination was observed in water from domestic pumps [95.83%]. Followed by tap water in rural areas of Punjab [91.30%] and tap water in Lahore [42.85%]. Bacterial contamination was significantly higher [p < 0.001] in rural areas as compared to urban areas. Comparison of results of testing water samples by H2S strip test and multiple tube test revealed that H2S strip is 87.24% sensitive and 100% specific for detection of bacterial contamination with a positive predictive value of 100%. It was also observed that 100% water samples negative for total coliforms were also negative by H2S strip method. Moreover, with increase in number of total coliforms in the water samples, positivity by H2S strip method also increased [samples with more than 10 total coliforms/100 ml were 100% positive by H2S strip method]. Therefore, H2S strip test can be used as alternative to multiple tube test for detection of bacterial contamination of water supplies. It is concluded that bacterial contamination of water is a significant problem in Punjab. It can be improved by regular monitoring of water supplies. For this purpose use of H2S strip test is advocated at house hold level

Chronic viral hepatitis: factors influencing response to alpha interferon

Viral hepatitis is a cause of considerable morbidity and mortality, both from acute infection and its chronic sequelae. Hepatitis B virus [HBV], hepatitis D virus [HDV] and hepatitis C virus [HCV] are the most important in terms of causing major morbidity and mortality throughout the world. According to the World Health Organization [WHO] estimates, 2.000 million people have been infected by HBV worldwide. About 5% of all HBsAg carriers are estimated to be infected with HDV. Although not as prevalent as HBV infection in terms of worldwide figures, HCV more often results in chronic hepatitis [40 - 60% of post transfusion hepatitis patients], progressing to cirrhosis in 20% of cases and sometimes to hepatocellular carcinoma. Recently, a new flavivirus hepatitis G virus [HGV] has been identified as an uncommon cause of post transfusion hepatitis, which has infected 1.5% of blood donors

Early detection of nephrotoxic effects due to low-dose exposure of cadmium among cigarette smokers

The effects of low-level exposure to cadmium due to cigarette smoking on renal function were judged by the estimation of urinary levels of total proteins, cadmium, alpha-1-microglobulin [alpha1 M] and glutathione S-transferase [GST] activity among 50 males [38 smokers and 12 control. non-smokers]. Elevated urinary cadmium levels [2.408-28.160; 9.31 +/- 7.1 micro g cd/gm urine creatinine] were observed among the majority of smokers [24 cases, 63.16%] and these levels showed a positive correlation with age and smoking index. Furthermore, urine total proteins [115.18-652.14, 242.89 +/- 121.88 mg Protein/gm urine creatinine] were increased suggesting glomerular involvement among 20 cases [52.63%] of smokers. In addition, urinary alpha1 M levels [14.645-86.053; 34.05 +/- 16.83 mg alpha1 M /gm urine creatinine] and urinary GST activity [0.0-0.008; 0.00015 +/- 0.0002 micro mol/min/100 micro1/gm urine creatinine] were elevated among 18 [47.37%] and 20 [52.63%] cages of smokers respectively. Since urinary alpha1 M and GST originate from renal proximal tubules, the data of the present investigation could reflect early low-level cadmium exposure nephrotoxic effect on both the glomeruli and tubules