Hunchback with “S” Shape Spine: Cadaveric Case series

Introduction: Kyphosis is a sharp posterior angulation due to localized collapse or wedging of one or more vertebrae and scoliosis is the lateral curvature of the spine. These may occur due to a congenital defect, fracture, and sometimes pathological or spinal tuberculosis. Materials and Methods: During routine cadaver dissection, four cases of kyphoscoliosis were identified. In the first case, a protrusion on the posterior surface of the trunk of the cadaver at L1 level was observed in a 60- year-old male. The lungs were collapsed and adherent with the pleura and thoracic wall. The posterior wall of the stomach was adherent to the pancreas and a depression was noted on the anterior surface of abdominal aorta. The T12 and L1 vertebrae were fused, and the spine was deviated to the left side. The anterior aspect of the body of L1 vertebrae was marginally eroded. The second case of kyphoscoliosis was from 80-year-old female cadaver. The descending and abdominal aorta had an abnormal course along the vertebral column, third and fourth cases were observed with slight protrusion and scoliosis but not much changes in the vertebral column. Results: The cause of the deformity was confirmed by pathological examination of the tissues showed inter vertebral disc degeneration with calcification and ossification and osteopenia. The underlying etiology can be tuberculosis, injuries, or infections. Conclusion: Severe kyphoscoliosis can affect wide range of systems in the body. It will affect not only the respiratory system also pressure on great vessels as a consequence of bony deformity.

Pharmaceutical care in the community pharmacies of Saudi Arabia: present status and possibilities for improvement

Pharmaceutical care can be given in all settings: The community, hospitals, long-term care, and the clinic. However, published literature indicates that there is a substantial barrier to implementing pharmaceutical care programs in community pharmacies. This review was conducted to discover gaps and limitations in pharmaceutical care services in community pharmacies in the Kingdom of Saudi Arabia [KSA]. We searched PubMed and other available scientific website databases using the following key words to retrieve the relevant articles: Community Pharmacy, Healthcare System, Pharmaceutical Care, KSA. Two authors independently screened the titles and abstracts of promising articles. They discarded irrelevant studies and retained studies, and reviews that held the promise of relevant data or information. The review revealed that only one out of the four studies conducted in KSA retrieved by the authors reported pharmaceutical care service other than dispensing. The same results were reported in other studies conducted in some developing countries. All pharmaceutical care services were reported in studies conducted in Europe. The authors came to the conclusion that in KSA, dispensing of medicines is the dominant service provided by community pharmacists and that there was very limited if not a total absence of other pharmaceutical care services

Clinicopathological spectrum of gall bladder cancer in Kashmir - an institutional study

Gallbladder cancer is a highly aggressive malignancy that usually presents at an advanced incurable stage. It is the fifth most common gastro-intestinal tumor and leads to approximately 2800 deaths in United States annually. This was a retrospective study carried out in the Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, a 650-bed super speciality hospital in Kashmir valley. We reviewed the histopathological records of all the patients who were diagnosed as carcinoma gallbladder from Dec 2009-Dec 2013. Gross findings and histopathological findings were noted from the departmental archival material and clinical records of the patients including the clinical presentation, laboratory investigations, radiological investigations, pre-operative diagnosis and intra-operative findings, were retrieved from the hospital records. We analyzed 57 cases of carcinoma gallbladder for their clinicopathological features It included 19 males and 37 females. In our study, adenocarcinomas accounted for 87.5% of total carcinomas. Incidentally, all but one patient where gall stones were found, adenocarcinomas were seen. We have 4 patients of squamous cell carcinoma. In our series we have a single case of small cell carcinoma which was positive for neuroendocrine markers. In our study, gall stones were seen only in 8 cases [14%] of the total cases

Initial Experience Using the 5MAX(TM) ACE Reperfusion Catheter in Intra-arterial Therapy for Acute Ischemic Stroke

OBJECTIVES: The 5MAX ACE is a new large bore aspiration catheter available for vessel recanalization for treatment of acute ischemic stroke (AIS). We report our initial experience with its use. METHODS: A retrospective analysis of patients undergoing intra-arterial therapy for AIS using the 5MAX ACE reperfusion catheter at our institution was performed. Patient demographics, clinical characteristics and procedural data were obtained from chart review. Successful recanlization was defined as achievement of Thrombolysis in Cerebral Infarction score (TICI) 2b-3 and time to recanalization was defined as time from groin puncture to achievement of at least TICI 2b recanalization. RESULTS: The 5MAX ACE was used in 15 patients from July-October 2013. Direct aspiration was used as the primary technique in 10/15 (67%) patients. Out of these, aspiration alone was sufficient for recanalization in 3 (20%) patients. In the remaining 7 (47%) patients, additional devices were used. In 5/15 (33%) patients, combined aspiration/stentriever thrombectomy using Solitaire(TM) (3/5 patients) and Penumbra 3D Separator(TM) (2/5 patients) were used as the primary technique. Successful recanlization (TICI 2b-3) was achieved in 11/15 (73%) patients. Average time from groin puncture to successful recanalization was 46 +/- 30 minutes (range 14-98 minutes). There were no procedural complications. CONCLUSION: The 5MAX ACE is a useful recanalization tool, either by direct aspiration or combined stentriever/aspiration. It may be most advantageous with large clots in the internal carotid artery. The potential for effective and faster recanalization using this device alone or in combination may be a good topic for future study.

Risk factors of diabetic ketoacidosis; case-control study

Background: Diabetic ketoacidosis [DKA] is a life threatening complication of Diabetes Mellitus. Diabetic ketoacidosis requires early detection, prompt assessment and immediate management. For institution of preventive measures, knowledge of risk factors present in local circumstances is pre-requisite

Objective: Our study was planned to identify the various risk factors of diabetic ketoacidosis and to determine outcome of patients during these episodes

Patients and Methods: This Case-Control Study was carried out in the Department of Medicine, Bahawal Victoria Hospital, Bahawalpur, from 1st September, 2010 to 29th February, 2012. Hundred diabetic patients aged >13 years were included. Fifty consecutive patients admitted with diabetic ketoacidosis were enrolled as cases. For each case an age and sex matched control was selected. Controls were the diabetics not having ketoacidosis. Primary end points were noted i.e. [a] Patients died in emergency room or during ward stay, [b] Patients discharged alive. The statistical analysis was done using SPSS Version 16. Multivariate analysis was carried out by comparing cases and controls. Odds ratios [Ors] for each suspected risk factor were calculated. Confidence Interval [CIs] and significance of ORs was determined through Multiple Logistic Regression Analysis

Results: Our study included 100 patients, 50 cases with ketoacidosis and 50 control patients. It was noted that 54% were males in each group. Maxfmum incidence of DKA was observed in 4th decade. 90% patients with DKA were discharged alive while 10% patients died. Cases were more likely to have infections [50 percent vs 18 percent, P< 0.001], poor compliance with treatment, [44 percent vs 12 percent, P<0.001] and newly diagnosed diabetes [16 percent vs 4 percent, P <0.063] as compared with controls. Other risk factors-identified were trauma [2%], dehydration [2%], acute pancreatitis [2%], myocardial infarction [2%] and stroke [2%]. In multivariate analysis, factors associated with a significantly increased risk of DKA were, poor compliance with treatment [Odds ratio 5.762 [95 percent confidence interval, 2.079 to 15.970]], infections [Odds ratio 4.556 [95 percent confidence interval, 1.834 to 11.316]] and recent onset diabetes [Odds ratio 4.571 [95 percent confidence interval, 0.919 to 22.729]]

Conclusion: The risk for precipitation of Diabetic Ketoacidosis significantly increases due to infections, poor compliance with treatment and in patients with new onset diabetes

General practitioners' awareness and management of common psychiatric disorders: a community-based survey from Karachi, Pakistan

This study assessed the knowledge and management of common psychiatric disorders by general practitioners [GPs] in Karachi, Pakistan, Structured interviews were carried out in 2009 with 360 GPs selected by cluster random sampling. Patients with psychiatric disorders were estimated to be up to 10% of the daily caseload according to 71.8% of doctors. Two-thirds of GPs were unaware of the ICD-10 diagnostic criteria for depression and anxiety disorders. Benzodiazepines were the most recognized category of medication [75.3%] and were the most commonly used medication for all mental health conditions. Fewer GPs were familiar with selective serotonin reuptake inhibitors [35.1%] or tricyclic antidepressants [20.2%]. Lack of time and patients financial constraints were reported to be barriers to care. Most GPs [69.2%] had not received any recent medical education about mental health problems. Gaps in GPs' knowledge about the management of mental disorders have implications for the rational use of psychotropic medications in primary care

Osteoarthritis among women in Bahrain: a public health audit

This study aims to train students on public health survey; correlate risk factors of osteoarthritis and to identify modifiable risk factors. Osteoarthritis survey was carried out among 420 Bahraini women, above 40 years of age, diagnosed of osteoarthritis, attending ministry of health facilities. Most cases in the study were from the age group of 50- 59 years with a mean age of 57. Osteoarthritis: of major joints alone was 74%; of generalized was 21% and of small joints of hands and feet alone was 5%. Within major osteoarthritis: 48% were knees alone; 51% were knee and hip and 2% were hip alone. Combinations of co-morbidities were found among 43%. History of diagnosed: diabetes in 10%, hypertension among 13% and hypercholesterolemia in 5% of cases. Half of the cases in the study were obese and 30% were overweight. Osteoarthritis of the Knee and the combination of the osteoarthritis of knee and hip was highest among obese followed by overweight cases. Menopause was found among 68%of patients. Patients on medication accounted for 85% and 75% were on Physiotherapy. Half of the sample had family history of osteoarthritis. While over 90% were less educated with odds ratio for being housewives at 3.085. The multivariate analysis of ordinal regression returned pseudo R2 of 30% for the model with the following significant variables: age, BMI, menopause status, exercise, chronic morbidities and family history of osteoarthritis. Overall, the proportion of major osteoarthritis of the weight bearing joints is very high. The modifiable risk factors identified from this study are sedentary lifestyle, obesity and overweight, as well as chronic morbidities

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

[ biological aspects of the gold fish Carassius auratus [L. 1758] in the Euphrates river, middle of Iraq]

Some biological aspects of the gold fish Carassius auratus [L. 1758] were studied in the Euphrates river near Al-Mussaib Power Station in the middle of Iraq, during the period of September 2002 to December 2003 .A total of 301 specimens were collected, with total length ranged between 6.2 to 25.5 cm and total weight between 10 to 175 gm. The b value obtained from length-weight relationship was volued 2.89. The age of fishes ranged from 1 to 4 years. From Von Bertalanffy growth pattern, Linfinity was 27.9 cm and K was 0.36. The highest mean of highet values of natural mortality rate coincides with the gonad weights at cold and warm months. The present study recorded increased values in the total length on the account of the weight of male as compared with female. Thus, the gold fish reached an optimum length in short time, although, there is increasing in the natural mortality rate of fishes increased and the gonads, were developed two months earlier compared with the same fish species in natural environment. This can be due to the thermal effluents effect of Al-Mussaib power station

Two years review of facial fractures at a tertiary care hospital in Islamabad, Pakistan

Objective: To present the experience of characteristics and management of facial fractures in a tertiary care Hospital in Islamabad, Pakistan

Methods: Study was conducted in the department of Plastic Surgery at Pakistan Institute of Medical Sciences, Islamabad, Pakistan from January 2002 to December 2003. Only adult patients of either sex were included who presented with facial fractures. Patients below 12 years of age and those having only facial lacerations were excluded. In all cases, plain X-rays, OPG [Orthopantomogram], Water's view and CT scan [in more severe cases] were obtained. Majority of the patients was operated on routine operation days [Monday to Saturday]. All other fractures were managed by Open Reduction Internal Fixation [ORIF] via intra-oral approach [gingivobuccal incision]. Only those fractures were approached from the external wound when the wound lied on the line of fracture

Results: Total 133 fractures were noted in 96 patients. Most of the patients were males [76%] with a male to female ratio of 3.1:1. Mean age of the patients was 36.5 years [range 13 - 79 years]. The commonest cause was road traffic accident [53.1%] followed by assault [21.9%]. Mandible was the commonest facial bone to be involved [59.4%]. Various associated injuries were also noted in these patients with facial lacerations [29.9%] being the most common. Various treatment modalities were employed including Maxillo-Mandibular Fixation [n=37], lag screws [n=21], microplates [n=23]. The most frequent complication was pain and or lower lip paraesthesia

Conclusion: Patients with these injuries must undergo early interventions including reduction and stabilization of fractures. Moreover, ORIF should also be undertaken wherever possible not through an external approach but the intraoral approach

Gene expression profiling in women with breast cancer in a Saudi population

To generate consensus gene expression profiles of invasive breast tumors from a small cohort of Saudi females, and to explore the possibility that they may be broadly conserved between Caucasian and Middle Eastern populations. This study was performed at King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia, from January 2005 to January 2007. Gene expression profiles were generated from 38 invasive breast tumors, and 8 tumor adjacent tissues [TATs] using BD Atlas cDNA expression arrays containing 1176 genes. Results were confirmed by reverse transcriptase polymerase chain reaction, and analyzed by 2-dimensional unsupervised hierarchical clustering. The analysis identified 48 differentially expressed genes in tumors from which 25 are already reported by various western studies. Forty-three of these genes were also differentially expressed in TATs. The same data set has been able to distinguish between tumors and the TATs, interestingly by using only 4 of the differentially expressed genes. Moreover, we were able to group the patients according to prognosis to an extent by hierarchical clustering. Our results indicate that expression profiles between Saudi females with breast cancer and the Caucasian population are conserved to some extent, and can be used to classify patients according to prognostic groups. We also suggest 3 differentially-expressed genes [IGHG3, CDK6, and RPS9] in tumors may have a novel role in breast cancer. In addition, the role of TATs is much more essential in breast cancer, and needs to be explored thoroughly

Gene expression profiles of the flbroblasts from breast tumors and normal tissue compared with the tumor expression profiles

The study was designed to examine whether the gene expression profiles of fibroblast cell lines, established from the tumor and the normal tissue from the same breast, exhibit any similarities with the profiles of the original tissues. Fibroblast cell lines were established from invasive ductal carcinoma [IDC] and ductal carcinoma in situ [DCIS] of the breast and the adjacent normal tissues. Isolated total RNA from the cell lines and tissues were used to prepare labeled cDNA which was hybridized to Becton Dickinson Atlas TM microarrays for obtaining profiles of expressed genes. The profiles of tumors and cell lines were compared. This study was carried out at King Faisal specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia, during 2004 and 2005. Alterations of expression of most of the genes in the tissues were not detectable in the cell lines. The expression of a lower number of genes was altered in DCIS compared with that in IDC tumors. Although the fibroblasts discharge important functions, their gene expression profiles do not represent the breast tissue to the extent that any prognostic decisions could be made

Surgical management of pericardial diseases

Tuberculosis and purulent pericarditis are the most common causes of pericardial effusion and constriction. Chronic constrictive pericarditis is a chronic inflammatory process that involves both fibrous and serous layers of the pericardium and leads to pericardial thickening and compression of the ventricles. The resultant impairment in diastolic filling reduces cardiac function. Pericardiectomy remains the treatment of choice for chronic constriction. A review of 72 cases at department of Cardiothoracic Surgery, Lady Reading Hospital is presented. There was a mortality of 12% and a morbidity of 20%. Forty seven of the 72 cases were tuberculous. The surgical excision of pericardium remains the only available curative treatment for constrictive pericarditis, while open pericardial drainage is required for cardiac tamponade resulting from pericardial effusion

Oesophageal dilatation as palliation for irresectable carcinoma oesophagus

The primary therapeutic goals in patients with advanced oesophageal malignancy are the re-introduction of an enteral diet and early discharge. The endoscopic dilation has been proposed as an alternative technique for palliation in patients not suitable for surgery. To review our experience with oesophageal dilation for the palliation of malignant oesphageal obstruction. A retrospective review was conducted of the notes of all patients who underwent palliative oesophageal dilation in our unit. 100 patients [age range 30-90years] underwent oesophageal dilation for malignant oesophageal obstruction 48% of patients had obstruction at lower one third of esophagus. Median survival was 6 weeks [range 1week to 03 months]. Successful dilation was possible in 70% of cases. During follow up 20% returned to solid diet, 50% required a soft diet and 30% were unable to tolerate any enteral nutrition. The use of oesophageal dilation achieves, good palliation allowing earl y discharge from hospital, re-introduction of an enteral diet

experience of burn injueies

To study the demographical data of burn patients. This study was carried out in department of Plastic Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from January 2002 to December 2003. Only admitted patients of either sex of age more than 12 years were included. Total 77 males and 65 females fulfilled the criteria. The mean age in males was 32.2 years and 24.4 years in females. Male to female ratio was 1: 1.18 respectively. Burns were common during winter season [42.2%] In 6% patients, suicidal burns were noted. 15% patients were homicidal cases. 79% patients had the burns accidentally. Stove burst [22%] was the major mechanism in females whereas in males, 18% had the direct flame injury. Kitchen [27%] was the commonest place in females. Housewives [35%] were most frequently affected. More married males [39%] were burnt as compared to 18% of the unmarried females. Inhalational injury was present in 23% patients. Males had average burns of 27.4% TBSA and females had 39.5% TBSA involvement. 18% of the deaths were among the males and 16% in females. Prevention is always the rule to be safe from burns but once it occurs, immediate and proper care should be given with aggressive treatment to minimize the post burn problems

Management of soft tissue defects of hand with local [posterior interosseous] flaps

Observational case series study. To evaluate the role of Local Flaps in the management of the soft tissue injuries of hand. Study was conducted at BV Hospital, Bahawalpur from June 2002 to May 2003. In this study, we selected cases in which direct skin closure was not possible due to large defect or skin grafting was contraindicated for example in cases where bones and tendons were exposed, or in certain conditions where some secondary procedures may have to be carried out like tendon repair, tendon grafting nerve repair or fixation of fracture. Patients with severely crushed, non-salvageable hands, manageable with primary suturing and skin grafts and Patients with peripheral vascular disease, Elderly diabetic and Patients medically unfit for anesthesia. A total of 10 patients were treated between June 2002 and May 2003. There were 8 males and 2 females [male to female ratio 4:1]. Mean age of the patients was 26.26 years with range between 10 and 60 years. Most common cause of skin defects was agriculture machine injury [6 cases] followed by roadside accidents [2 cases], blast injury [I cases], and electric burn [1 cases]. In 7 patients there was an uneventful recovery. One flap was lost completely, partial flap loss occurred in one case, marginal necrosis and infection noted in one case. Local [posterior interosseous island] flaps are useful for coverage of the skin defects over the hand when applied with proper indications

Serum folate levels in end stage renal disease patients

This study was aimed to measure serum folate levels in patients of end stage renal disease [ESRD] on regular haemodialysis and compared with normal healthy individuals. It is a comparative study. Department of Pathology, Shaikh Zayed Hospital, Lahore. One hundred subjects were selected and divided into two groups. Group A include fifty patients of end stage renal disease on regular haemodialysis and group B include fifty normal healthy individuals as control. Two ml of blood was drawn by venepuncture, one ml for complete blood examination and one ml for serum folate level. A significant decrease in folate level was observed in end stage renal disease patients on regular haemodialysis as compared to control group. By measuring serum folate level in patients on regular haemodialysis we can manage anaemia due to folate deficiency

Induced polarization in humid limestone in the radio frequency range and lower

Experimental investigations in the laboratory led to a better understanding of the fundamental relationship between rock properties and electrical characteristics. Some fundamental relationships and mechanisms are represented for a quantitative interpretation of the induced polarization data of limestone rock samples, when subjected to humid atmosphere. An equivalent circuit is assumed to identify the diffusion ZD, reaction and adsorption impedances. Limestone rock samples are studied at a frequency range of 102 - 107 Hz and at atmospheric relative humidities between 18%-50%. Abnormal high dielectric Constant and abnormal behavior of the conductivities for the studied samples are observed which are ascribed to electrochemical kinetics

Surgery for pleuropulmonary tuberculosis

The purpose of our study was to analyze current indications for surgery in pleuropulmonary tuberculosis [TB]. We present our experience with TB patients presenting with indications for surgery between 1998 and 2003. Material and The indications for surgical intervention included 220 cases of empyema, mediastinal lymphadenopathy 48 cases, hemoptysis 25 cases, destroyed lung 24 cases, undiagnosed pleural effusion 24 cases, bronchiectasis 18 cases, cavitary lesion with MDRTB 13 cases and pulmonary aspergilloma 10 cases. Thirteen patients with multidrug-resistant tuberculosis required surgical intervention, although 26 were treated with second line drugs during this period. The techniques utilized included decortication in 152 cases, lobectomy in 62 cases, rib resection for pleural drainage in 50 cases, anterior mediastinotomy in 48 cases, pneumonectomy in 28 cases, open pleural biopsy in 24 cases, and thoracoplasty in 18 cases. In 12 patients [3.1%], two procedures were performed, and in one case, 3 procedures. In 65 cases [17%] there were complications, of which persistent air leakage after decortication and pulmonary resection was the most frequent [n=26]. There was a mortality rate of 2.8% [11 cases]. Conclusions: In our experience, surgery in the treatment of TB is indicated to resolve sequalae or complications, since cases of simple or multidrug-resistant TB can be managed pharmacologically. The morbidity and mortality rates in our series were acceptable