An Observational Study on Cutaneous Appendageal Tumours with Pilar Differentiation

Background: Cutaneous appendageal tumours belong to a diverse group of tumours with specific histo pathology.The aim of this study is to determine the pattern, age,gender and site distribution of Pilar differentiation tumours. Material & Methods: The study was conducted in the department of Pathology,Government Medical College Srinagar for a period of 18 months. It was an observational cross sectional study.Formalin fixed,paraffin embedded tissue sections were stained with hematoxylin and eosin stain for histopathological analysis. Results: A total of 112 cases of Pilar tumours were studied.108 were benign and 4 were malignant with male to female ratio of 1.07:1. The maximum number of benign cases were observed in 11 -20 years of age group and the malignant tumours age ranges from 35-45 years and the tumour usually presented in the eighth decade.Head and Neck was the most common site. Conclusion: Histopathological examination of Pilar Tumours is the gold standard to differentiate between benign and malignant tumours. It is also useful for exact categorization of cutaneous appendageal tumours.

Assessment of flatulence causing agents in Chickpea (Cicer arietinum L.) and their possible removal

Abstract Flatulence and fullness of stomach is one of the most common problem associated with chickpea primary due to presence of some oligosaccharides and phenols. In this investigation Desi and Kabuli varieties were compared for these oligosaccharides and phenolic compounds. Furthermore, the effect of different processing and cooking methods such as soaking, cooking and germination in the reduction of these antiphysiological factors were are also studies. Maximum tannic acid (0.90 ± 0.20%) was observed in Parbat and C-44 while minimum (0.60 ± 0.04%) in Karak-2. Stachyose contents ranged between 1.10 ± 0.05 (Karak-3) to 1.42 ± 0.02% (Parbat) while raffinose was 0.63 ± 0.05(Karak-3) to 0.81 ± 0.02% (Dasht). The highest tannic acid content was reduced up to 50% in C-44 by cooking of 72 hours germinated seeds. Stachyose and raffinose contents were completely removed after 72 hours germination. Present studies revealed that cooking after germination is the most effective method to reduce the anti-nutritional factors of chickpea. Individually, soaking and cooking also contributed to the loss of the same factors but to a lesser extent.

Synthesis of silver and gold nanoparticles from leaf of Litchi chinensis and its biological activities

Objective: To synthesize and isolate silver and gold nanoparticles from Litchi chinensis leaf methanolic extract, and to evaluate its comparative biological activities including muscles relaxant, analgesic, anti-inflammatory and antidiarrheal. Methods: The gold and silver nanoparticles were synthesized by dissolving methanolic extract in gold chloride and silver nitrate solution separately which were confirmed by colour change and UV-Vis spectroscopy, and pellets were collected through centrifugation. Biological activities of the extract were conducted on BALB/c mice through various standard methods and the data were subjected to One-way ANOVA. Results: The colorless gold chloride solution changed to purple soon after the addition of plant extract, demonstrating that the reaction took place and gold ions were reduced to gold nanoparticles, while colorless silver nitrate solution changed to light and dark brown that was indicative of silver nanoparticles. The muscles relaxant activity showed that silver nanoparticles were more effective than gold nanoparticles and methanolic extract in traction test. The analgesic activity showed that silver and gold nanoparticles showed highest percentage decrease in acetic acid induced writhing at the doses of 50, 100 and 150 mg/kg b.w. The highest anti-inflammatory activity was produced by gold nanoparticles followed by silver nanoparticles, while low activity was observed in methanolic leaf extract. Only the crude methanolic extract showed significant antidiarrheal activity as compared to the standard drug atropine sulphate, while antidiarrheal activities of gold and silver nanoparticles were non-significant. Conclusions: The present work concludes that isolated silver and gold nanoparticles from leaf methanolic extract shows strong muscles relaxant, analgesic and anti-inflammatory activities while crude methanolic extract possesses good antidiarrheal activity.

Neuroprotective effect ofBacopa monnieri against morphine-induced histopathological changes in the cerebellum of rats

Opioid addiction is associated with oxidative cell injury in neuronal cells. In this study, Bacopa monnieri [L.], a reputed nootropic plant, was evaluated against morphine-induced histopathological changes in the cerebellum of rats. B. monnieri methanolic extract [mBME] [40 mg/kg, p.o] and ascorbic acid [50 mg/kg, i.p] were administered two hours before morphine [20 mg/kg, i.p] for 14 and 21 days. The in vitro antioxidant activity of mBME was determined by 2,2-diphenyl-1-picrylhydrazyl [DPPH] free-radical scavenging assay. Morphine produced vacuolization of basket and stellate cells and reduced the size of Purkinje cells in the cerebellum after 14 days. However, treatment for 21 days was associated with severe shrinkage of Purkinje cells with loss of their characteristic flask-shaped appearance as well as degeneration of basket, stellate and granule cells. Pretreatment with mBME and ascorbic acid for 14 and 21 days attenuated the morphine-induced histopathological changes in the cerebellum. The EC50 for the DPPH free-radical scavenging assay of mBME [39.06 [microg/mL] as compared to ascorbic acid [30.25 microg/mL] and BHT [34.34 microg/mL] revealed that mBME strongly scavenged the free-radicals and thus possessed an efficient antioxidant propensity. These results concluded that B. monnieri having strong antioxidant activity exerted a protective effect against morphine-induced cerebellar toxicity

Prognostic Significance of ACE and PAI-1 Genes Polymorphisms with Diabetic Retinopathy and Diabetic Non-Retinopathy in Type 2 Diabetes.

Background: ACE a renin-angiotensin system that regulates blood pressure, balance of fluids and salts in body and PAI-1 is a serine protease inhibitor, which inhibits tissue plasminogen activator andurokinase.They are thought to play an important role in pathophysiology of kidney disease in diabetes. Aim: In our present study, we studied the association of altered ACE-gene and PAI-1 gene with diabetic retinopathy (DR) and NDR in 592 samples consisted of (cohort I; 196 DR patients, cohort II; 200 diabetic nonretinopathy (DNR) and cohort III, 196 respective controls. Methods: For genotyping of ACE-gene and PAI-1 gene, genomic DNA was isolated and purified which was then amplified by PCR, and thePCR products analyzedwere by Agarose gel electrophoresis. Results: In first part, the ACE genotype and allele frequency distribution was studied. For ACE gene polymorphism, the genotype and allele frequency distribution were analyzed in DR subjects and respective controls. The results indicated that there is no statistically significant difference between DR males and females compared to respective controls. The results were significantly high between genotype frequencies of DR and DNR in males. The recessive model was found to be significantly associated with the DR male subjects (OR=0.45 [95% CI=0.20-0.99], p<0.05), whereas in females these are non-significant as compared to respective controls individuals. In second part of study, the disease status analysis of ACE gene on basis of DR stages (NPDR and PDR) was observed. The χ2 analysis indicated that results are significantly different between NPDR and respective controls (χ2=8.75, p=0.01) .And in third part of present study, disease status analysis for PAI-1 gene on the basis of DR stages (NPDR and PDR) was studied, which indicated statistically nonsignificance. The χ2 analysis values for DNR and NPDR and for DNR and PDR was (χ2=0.48, p>0.05)(χ2 =2.00, p>0.05) respectively, Conclusion: Our present study suggests that changes in genetic polymorphisms of ACE-gene and PAI-1 gene in DR, DNR and T2D Patients are risk factors, which may serve as useful prognostic markers.

Hidradenitis suppurativa complicated with secondary lymphedema and lymphangioma of the scrotum

Hidradenitis suppurativa is a chronic relapsing inflammatory skin condition affecting the apocrine sweat glands. Among the complications of this rare condition are local lymphedema and lymphangioma. A case of scrotal lymphedema and lymphangioma following chronic hidradenitis suppurativa in the genital area is described. Excisional skin biopsy was compatible with secondary lymphangioma. A resection of the scrotal mass was performed with reconstruction of the scrotum, penis and perineum

Frequency of different causes of upper gastrointestinal bleeding using endoscopic procedure at a tertiary care hospital

To assess the outcome of early endoscopy in terms of frequency of different causes of upper gastrointestinal bleeding at a tertiary care hospital. Cross sectional descriptive study. Outpatients / indoor patients, Department of Medicine Military Hospital Rawalpindi from 1[st] Jan 2010 to 30[th] June 2010. Study was carried out in department of medicine Military Hospital Rawalpindi. Two hundred and forty four after cosen. Patients of upper gastrointestinal bleeding fulfilling the inclusion criteria were included in the study. Haemodynamically stable patients were kept empty stomach for at least 6-8 hours before procedure. A detailed history and thorough physical examination was carried out. Protocols for endoscopic examination were followed. Mandatory baseline investigations were obtained. Endoscopic findings were documented on a proforma. p value of less than 0.05 was considered statistically significant. There were 174 males [71.3%] and 70 females [28.7%]. The age of the patients ranged from 15 years to 75 years, mean age was 52.23 years [SD = 14.78]. The most common cause of upper GI bleed was varices in 176 [72.1%] patients; followed by gastric ulcer in 24 [9.8%] patients. Other causes in order of decreasing frequency included gastritis 16[6.55%], duodenal ulcer 14[5.73%], esophagitis 6[2.45%], Mallory Weiss tear 2[0.81%] and miscellaneous 6[2.45%]. Esophageal varices is the most common cause of upper GI bleed in our set up reflecting high prevalence of liver cirrhosis secondary to chronic HBV and HCV infection

Frequency of inter-atrial blocks in patients with ischemic stroke

To determine the frequency and association of Interatrial block in hospitalized patients with Ischemic Stroke. A case control study. Department of medicine, Military Hospital, Rawalpindi from 1st Jan 2009 to 30 December 2009. It included 64 patients, 32 cases of diagnosed ischemic stroke and 32 patients were taken as controls not suffering from ischemic stroke or ischemic heart disease. ECG findings of both selected groups were evaluated for presence or absence of interatrial block. Out of 32 ischemic stroke patients, 14 [43.85%] were found to have interatrial block on electrocardiogram [ECG]. Whereas only 6 [18.80%] controls were found to have interatrial block on ECG. Odds ratio was 1.66. Interatrial block is more frequent in ischemic stroke patients and may represent a risk factor for such stroke.

Ductal variations in the Calot's triangle seen on laparoscopic cholecystectomy

To describe the frequency and pattern of ductal variations seen in the Calot's triangle on laparoscopic cholecystectomy. Descriptive study. This study was conducted in the Surgical Unit 1, Fauji Foundation Hospital, Rawalpindi from December 13, 20008 to February 22, 2011. 200 patients with a diagnosis of biliary colic, cholelithiasis, acute cholecystitis, empyema gall bladder and mucocele gall bladder were included in this study. Patients with age less than 15 years were excluded. Careful dissection of the Calot's triangle was carried out. The anatomical variations of the cystic duct and other anomalous variations in the region were noted and data analyzed on SPSS 10. The age range was 19 to 88 years with a mean of 48 years. The majority [88%] of the patients presented with a clinical diagnosis of biliary colic. The cystic duct was of normal size in 88%, short in 7%, and long in 5% of the cases. The cystic duct terminated laterally into the common hepatic duct in 94% of the cases, anteriorly into the common hepatic duct in 5% and posteriorly into the common hepatic duct in 1% of the cases. Each Calot's triangle differs from the other. Ductal variations are the hallmark of this region and their knowledge is mandatory for a safe laparoscopic cholecystectomy

Vascular variations in the calot's traingle seen on laparoscopic cholecystectomy

To describe the frequency and pattern of vascular variations seen in the Calot's triangle on laparoscopic cholecystectomy. Descriptive study. From December, 2008 to February, 2011. Surgical Unit 1, Fauji Foundation Hospital, Rawalpindi. Two hundred patients with a diagnosis of biliary colic, cholelithiasis, acute cholecystitis, empyema gall bladder and mucocele gall bladder were included. Patients with age less than 15 years were excluded. Careful dissection of the Calot's triangle was carried out. The anatomical variations of the cystic artery and other anomalous variations in the region were noted and data analyzed on SPSS 10. The age range was 19 to 88 years with a mean of 48 years. The majority [88%] of the patients presented with a clinical diagnosis of biliary colic. The cystic artery was single in 91%, branched in 6% and absent in 3% cases. The cystic artery was supero-medial to the cystic duct in 88%, anterior in 6%, and posterior in 3% of the cases. Other arterial variations included Calot's arteries [2%], Moynihan's Hump [3%] and gall bladder arterial supply from liver bed [3%]. Each Calot's triangle differs from the other. Vascular variations are the hallmark of this region and their knowledge is mandatory for a safe laparoscopic cholecystectomy

Control of cystic artery in laparoscopic cholecystectomy: to clip or to use monopolar electrocautery

The purpose of this study was to compare monopolar electrocautery with clip application for securing hemostasis of cystic artery in patients undergoing laparoscopic cholecystectomy. A comparative study was performed on data collected during a 6-years period [2005-2011] from 600 patients who underwent laparoscopic cholecystectomy. In 306 cases assigned to group 1, the cystic artery was clipped while in 294 cases assigned to group 2, the cystic artery was coagulated with monopolar electrocautery. In group 1, the cystic artery was single in 91%, branched in 6% and absent in 3% cases while in group 2, the cystic artery was single in all cases. The cystic artery was of normal size in 82%, short in 7%, long in 8% and absent in 3% cases in group 1 while in group 2, it was normal in size in 88%, short in 3% and long in 9% cases. The cystic artery was originating from the right hepatic artery in 97% cases and from the superior mesenteric artery in 3% cases in group 1. In group 2, the cystic artery was originating from the right hepatic artery in 97% cases and not visualized in 3% cases. In group 1, only 3 patients had an intra-operative hemorrhage while in group 2, 3 of the patients had bleeding. The post operative recovery was also similar in both groups with 83% and 81% patients going home on the next day. There was no difference in the outcome of patients whether clips or monopolar electrocautery was used for hemostasis of cystic artery in laparoscopic cholecystectomy

Efficacy of terbinafine vs. griseofulvin in tinea capitis in the Northern areas of Pakistan

Since longtime griseofulvin has been in use to treat tinea capitis. However due to its decreasing efficacy, higher doses and side effects a search is going on to find out a better treatment. alternative. Terbinafine is one such therapeutic option. To compare the efficacy and safety of terbinafine and griseofulvin in tinea capitis in Northern Areas of Pakistan. Children 3 to 12 year-old who were clinically diagnosed for tinea capitis and confirmed by potassium hydroxide microscopy were included in the study. One group was treated with terbinafine at a dose of 62.5mg for children weighing less than 20kg and 125mg for those weighing 20-40kg and other group with griseofulvin at a dose of 15mg/kg body weight. Both groups were treated for a period of 4 weeks. Visits were scheduled at baseline and week 2, 4 and 6 for evaluation of efficacy and safety monitoring. Efficacy was evaluated on the basis of clinical improvement and mycological cure. Terbinafine showed comparatively higher clinical cure in our patients as compared to griseofulvin at week 2 [35% vs. 22%], week 4 [50% vs. 38%] and week 6 [70% vs. 55%] [p<0.05]. Similarly, mycologic cure with terbinafine was better than griseofulvin at week 2 [30% vs. 20%], week 4 [45% vs. 35%] and week 6 [60% vs. 50%] [p<0.05]. Trichophyton tonsurans was the most common organism isolated. There were no major side effects except nausea and abdominal pain in either group. Terbinafine is more effective than griseofulvin in treating tinea capitis in our part of the world

Ureteric injuries in gynaecological surgery: an experience of 19 cases

To review the ureteric injuries resulting from gynaecological surgery presenting to Fauji Foundation Hospital Rawalpindi and discuss their management. A retrospective descriptive study. The study was conducted at the department of Urology Foundation University Medical College and Fauji Foundation Hospital Rawalpindi during July 2004 to June 2009. The present study was conducted at the department of Urology Foundation University Medical College and Fauji Foundation Hospital Rawalpindi during July 2004 to June 2009. Case files of all those patients who were managed during this period in our hospital for ureteric injury sustained in a gynaecological procedure were perussued in detail. It was found out whether the ureteric injury occurred in Fauji Foundation Hospital Rawalpindi or the patient sustained such injury in a peripheral hospital and was referred here for management. Information was obtained regarding the patients' age, type of gynaecological surgery, level and type of ureteric trauma and the time of its recognition. In case of those patients referred from peripheral hospitals the mode of presentation was found out from the available data. The investigations performed and the treatment offered was thoroughly reviewed for all these cases presenting with ureteric injury. A total of 19 patients of ureteric injury afflicted during hysterectomy were managed during this period in our hospital. The patients1 age ranged from 34 to 55 years [mean age: 42.5 years]. 14 patients sustained ureteric injury during abdominal hysterectomy for fibroids. Five cases had ureteric injury while undergoing a radical hysterectomy. Seven patients had previous caesarian section. 17 patients had the ureteric injury involving the last five cm of the ureter while in two patients the ureter was injured approximately 10 cm from the ureterovesical junction. Four ureteric injuries occurred during abdominal hysterectomy at Fauji Foundation Hospital Rawalpindi. These four injuries were recognized by the gynaecologist during the procedure and were managed by the urologist by ureteroureteric anastomosis over a stent [two cases] and by ureteric reimplant over a stent [two cases]. Fifteen cases were referred to us from peripheral hospitals. In these patients the period from occurrence of ureteric injury to presentation at Fauji Foundation Hospital Rawalpindi ranged from two weeks to seven months [mean: 2.5 months]. Eleven of these patients had severed ureter and presented with constant urinary leakage from the vagina in addition to normal voiding. Three ladies had a flank pain and tenderness on the affected side and one lady who came from a peripheral hospital had swinging pyrexia, unilateral flank pain and tenderness. These four cases had unilateral ligation of the ureter and did not have any urinary leakage. After open surgical exploration and ureteric reimplant all these fifteen cases had uneventful recovery. Ureteric injuries are not uncommon in gynaecological surgery. Every effort should be made to avoid this complication. Injuries recognized during gyaenecological surgery should be managed without delay while cases coming late require thorough evaluation and surgical management

Biochemical characterization and some biological properties of the phosphodiesterase I purified from Agistrodon bilineatus venom.

The venom phosphodiesterase I (PDE-I, EC 3.1.4.1) is useful in the elucidation of the structure and nucleotide sequence of nucleic acids. In the present study, PDE-I was purified from Agistrodon bilineatus venom by preparative native-PAGE. A single protein band was observed in analytical native-PAGE. The enzyme also gave a single band in SDS-PAGE with a molecular mass of 140 kDa. The position of the band was not altered in the presence of β-mercaptoethanol, suggesting the protein did not contain subunits. The enzyme was free from 5’-nucleotidase and alkaline phosphatase activities. It showed a broad optimum pH range (9.0-11.0), whereas the optimum temperature was found to be 600C, with activity decreasing at >650C. Energy of activation (Ea) was calculated to be 0.31. The PDE-I was a glycoprotein having 14% of carbohydrate content. The Vmax, Km, Kcat and Ksp values of the enzyme were 3.85 μM/min/mg, 8.3 × 10-3 M, 23s-1 and 46.4 M-1 Min-1 respectively. Cysteine caused a non-competitive inhibition with a Ki 6.3 × 10−3 M (IC50 of 1.6 mM), whereas ADP caused a competitive inhibition having Ki 0.8 × 10−3 M (IC50 5.4 mM). Glutathione, o-phenanthroline, zinc and EDTA inhibited the enzyme activity, whereas Mg2+ slightly potentiated the activity. The enzyme hydrolyzed thymidine 5’-monophosphate p-nitro-phenyl ester most readily (10-fold), while 3’-5’-cAMP was least readily hydrolyzed substrate. The enzyme up to 4.0 mg/Kg i.p was not lethal in mice. It exhibited an anticoagulant effect, and increased the normal clotting time of normal citrated human plasma, whereas the crude venom showed strong coagulant effect. The above results showed that the A. bilineatus PDE-I was very similar to that isolated from other snake venoms. The purification procedure described here is simple, rapid and reproducible and may prove useful to isolate pure protein for investigation into the contribution of this enzyme to the biological activities of A. bilineatus venom and PDE-I insight, in general.

Clinical presentation of non-HIV Kaposi sarcoma

Kaposi Sarcoma [KS] is a rare entity. In the north west of Pakistan and Aghanistan, we mostly come across non-HIV related Kaposi sarcoma as Human Immunedeficiency Virus [HIV]. Infections are rare in this part of the world. Here, we present a case of a non-auto Immunedeficiency Disease [AIDS] related KS. A 45-year-old male, Afghan patient presented to our oncology outpatient's unit with multiple subcutaneous nodules. The sites of involvement were the periorbital region, retro-auricular region, forearms, legs, chest and back. Oral mucosa was spared at the nodules. The patient had no visceromegaly at the time of presentation. A biopsy specimen from the retro-auricular region revealed a KS with dermal lymphatic involvement. His serum was negative for the common types of viral infections including Human Immunodeficiency Virus [HIV] on routine serology. His total B-lymphocytes [CD 19+], total T-lymphocyte [CD3+], total CD4+ lymphocyte [CD3+, CD4+] and total CD8+ [CD3+, CD8+] counts were all normal or borderline high. The patient was under treatment with 3 weekly chemotherapeutic regimens of Adriamycin, Bleomycin, Vincristine [ABV] keeping in view socioeconomical constrains, logistical difficulties in getting proper medical care and side effects of other options like radiotherapy for extended surface areas

Cancrum oris

Cancrum oris [noma] is an orofacial gangrene, which causes progressive and mutilating destruction of the infected tissues. The disease mainly occurs in children having malnutrition, poor oral hygiene and debilitating illness. It is well-documented in literature. In the international statistical classification of WHO, it is mentioned as necrotizing ulcerative stomatitis of children. Noma has disappeared from industrialized countries since the 20[th] century, but still common in third world countries especially in Africa

comparison of open vesicolithotomy and cystolitholapaxy

To compare Vesicolithotomy with Transurethral optical cystolitholapaxy. Comparative Observational study. Study was conducted at Department of Surgery, Fauji Foundation Hospital Rawalpindi, from October 2002 to April 2005. Study comprises of 40 patients, which were divided into two equal groups of twenty each. All patients having stones less than 30 mm in size were included. Group-I patients were treated with open vesicolithotomy and Group-II patients with transurethral optical cystolitholapaxy. All 40 patients were between age of 16 -76 years [mean age 52 years and 54.5 years in Group-I and II respectively] and female to male ratio were 1:2.3. Average hospital stay was long [7.33 days] in Group-I. 2.5% patients had UTI postoperatively in both groups and transient haematuria [5%], urethral trauma [5%] and recurrent stone formation [5%] was noted in Group-II patients. Transurethral optical cystolitholapaxy is a better way of managing Vesical stones because it is minimally invasive with short hospital stay. Complications noticed with this procedure are minor and can be reduced by experienced surgeon

Rupture splenic artery aneurysm

We present a case of ruptured splenic artery aneurysm in 18 years old unmarried girl who presented with severe upper abdominal pain and sudden collapse. Ultrasound abdomen showed free fluid and ultrasound guided needle aspiration confirmed haemoperitoneum. On laparotomy, a 3cm saccular aneurysm of the middle of the splenic artery was noted. With prompt and urgent management the patient survived