Biological screening of Elaeagnus umbellata Thunb

The bark and fruit extracts of Elaeagnus umbellata have been investigated for their antibacterial, anti-fungal, insecticidal and phytotoxic activities. The petroleum ether extracts of the plant showed significant activity against E. faecalis. The activity of dichloromethane extract was also determined significant against S. aureus. The chloroform extract indicated low activity against E. coli, K. pneumoniae, B. subtilis and S. flexenari. The ethyl acetate fraction demonstrated significant activity against K. pneumoniae while methanolic extract exhibited significant activity against E. coli. All extracts showed low phytotoxic activity. The dichloromethane extract exhibited moderate insecticidal activity while other extract indicated low activity

Low recovery rate of helicobacter pylori from positive CLO test patients suffering from dyspepsia

Helicobacter pylori are a well-known cause of gastrointestinal diseases particularly amongst patients suffering from dyspepsia. To evaluate the recovery rate of Helicobacter pylori from suspected peptic ulcer patients with dyspepsia symptom. Gastroenterology Unit, Aseer Central Hospital, Saudi Arabia. A Prospective Study. Gastroscopy and gastric biopsy were performed on 53 patients with dyspepsia from January 2012 to January 2013; all were subjected urease CLO test and culture. The CLO-positive biopsies were cultured using brain-heart infusion agar with added blood [7%], and Skirrow's supplement was used for isolating Helicobacter pylori. Inoculated plates were incubated at 37°C for 7-10 days in a microaerophilic incubation environment and examined for suspected Helicobacter pylori colonies. Helicobacter pylori cultures were confirmed by the positive urease, oxidase and rapid antigen test. Cultures of non-Helicobacter pylori bacteria were identified using few phenotypic tests then confirmed by VITEK 2 automated system. Seventeen [32.08%] Helicobacter pylori were isolated [in pure form or in mixed cultures] using Brain-Heart Infusion agar with blood and Skirrow's supplement. Nineteen [35.85%] samples revealed no growth, 5 [9.43%%] revealed the growth of Acinetobacter spp, 4 [7.55%] revealed Brucella melitensis, 2 [3.77%] revealed Pasteurella spp. and 1 [1.89%] revealed Pseudomonas aeruginosa. The recovery rate of Helicobacter pylori from CLO positive biopsies was low, 17 [32.08%], but growth of other gram negative bacilli was documented

Diabetes mellitus; prevalence in patients of chronic hepatitis C

To determine the prevalence of Diabetes mellitus in patients of hepatitis C virus infection. Prospective and observational study. Medical Wards at Combined Military Hospital Jhelum. Period: 1st November 2009 to 31st October 2010. Method: 100 cases of HCV positive on Elisa method were inducted. All cases were segregated into different states of liver disorders and were screened for Blood Sugar level, for one year. So as to observe the frequency of Diabetes Mellitus among HCV positive patients. Diabetes mellitus was considered to be present if patients were already on diabetes treatment or fasting or random blood sugar indicated diabetes mellitus according to standard criteria. One hundred patients were studied. Fifty five [55%] were males and forty five [45%] were females. The ages ranged from 15 to 71 years [Mean 44.24]. Out of these 100 patients, total of 28 [28%] had diabetes mellitus. Out of 100 patients, 82 patients had chronic hepatitis C virus infection without cirrhosis and 22 [26.4%] of these had diabetes. Twenty two patients with chronic hepatitis C, who had diabetes mellitus, twenty [90.9%] were non-insulin dependent diabetics and two [9.1%] were insulin dependent. Total of 18 patients had cirrhosis and out of these 6 patients [33.33%] had diabetes mellitus. Six patients with cirrhosis all had non-insulin dependent diabetes mellitus. Patient with chronic hepatitis C virus infection and cirrhosis secondary to hepatitis C virus infection have strong association with diabetes mellitus and great majority of them are non-insulin dependent diabetics

Clinical spectrum and risk factors of stroke - a study of 80 patients

To determine the clinical presentation and frequency of hypertension, diabetes mellitus, hyperlipidaemia, ischaemic heart disease, obesity, and other disorders which have a role in pathogenesis of stroke in patients belonging North Punjab. Descriptive Study. Medicine Department of Combined Military Hospital Jhelum from September 2009 to September 2010. Patients with features of stroke confirmed by CT scan brain were enrolled. Brain imaging showing abnormality e.g. brain tumour, meningitis, multiple sclerosis and metabolic derangements that could explain focal neurologic deficit were the exclusion parameters. The clinical presentation and frequency of hypertension, diabetes mellitus, hyperlipidaemia, ischaemic heart disease, obesity, smoking, atrial fibrillation and past history of TIA /stroke among males and females were evaluated. A total of 80 consecutive patients with ischemic and hemorrhagic stroke were included in this study. There were 53 males and 27 female patients with male to female ratio of 1.9:1. The age of patients ranged from 50 to 80 years. [Mean-63.75 years]. Out of 80 patients, 42 [52.5%] had ischemic stroke and 35 [43.75%] had haemorrhagic stroke, 3 [3.75%] patients had subarachnoid haemmorrhage Sixty [75%] patients presented with right hemiparesis/hemiplegia, 17[21.25%] patients with left hemiparesis/hemiplegia, 12 [15%] were unable to speak properly, 24 [30%] patients had headache, 17[21.25%] patients developed coma, 08 [10%] had fits and 13 [16.25%] patients had vomiting. Hypertension was found in 51 [63.75%] patients, smoking in 35%, diabetes mellitus in 33.75%, hyperlipidaemia in 31.25%, ischaemic artery disease in 15%, obesity in 23.75%, past history of TIA /stroke in 15% and atrial fibrillation in 6.25%.Frequency of hypertension, diabetes mellitus, hyperlipidaemia, ischaemic heart disease, and smoking was high in stroke patients. These can be modified by proper health education. This can have a great impact on the morbidity and mortality of stroke.

Frequency of hepatitis B and hepatitis C in multi-transfused beta thalassemia major patients

To determine the frequency of hepatitis B and C virus infection among children with beta thalassemia major registered at Military Hospital Rawalpindi. Descriptive Study. The study was carried out at Military Hospital Rawalpindi, from 1st September 2008 to 31st August 2009. Children attending Thalassemia Centre Military Hospital Rawalpindi for regular blood transfusion were registered. They belonged to different ethnic groups and came from different parts of the country. Their demographic data was recorded, detailed history taken and physical examination was carried out. Their serum samples were tested for hepatitis B surface antigen and anti HCV antibody assay with third generation commercial ELISA method. During the study, 141 patients of beta thalassemia major were screened. Out of them 50 patients [35.5%, 95% confidence interval 27.8-43.5] were found hepatitis C virus antibody positive and 1 patient [0.7%] hepatitis B surface antigen positive. One patient [0.7%] had both hepatitis B and C virus infection. Mean age of hepatitis C infected patients was 10.4+3.85years [range 2-16 years]. Mean age of uninfected patients was 6.1+ 3.59 years. [p value 0.000]. In addition, the results indicate that higher prevalence of anti-HCV was significantly associated with longer duration of transfusion [p value <0.003]. In spite of the fact that screened blood is used for transfusions, still a large number of patients have been found infected with hepatitis C. Therefore more accurate techniques are required for screening of blood to prevent transfusion associated transmission

Dual thyroid ectopy in an old woman

Very few cases with dual thyroid ectopy and a normally located thyroid gland have been reported. A 65 years old woman presented with hemoptysis and mild dysphagia 5 years after thyroidectomy. On direct laryngoscopy a supraglotic mass was detected and removed; which on histopathology turned to be an ectopic thyroid tissue. On barium swallow lateral view of the neck demonstrated a mass between trachea and esophagus at C4-6 level. CT scan confirmed a high attenuation, mass posterior to trachea in sub-cricoid area. Suspecting another ectopic thyroid here, Technetium-99 scans were done, while on thyroxine and 4 weeks without it: earlier was inconclusive but the later confirmed another ectopic thyroid in thyroid bed on left side with a tail on right. The diagnosis was dual ectopic thyroid tissue in supraglottic area and the thyroid area [laterally and to the left] extending between trachea and esophagus at C4-6 level producing difficulty in breathing and mild dysphagia. This was a case of dual ectopic thyroid. It emphasizes that thyroid scan should be routinely performed in all thyroid cases and all the suspicious areas studied

Clinical spectrum of cirrhosis liver a study of 167 cases

The present study was designed to find out the aetiological pattern, presentation and to assess the severity of liver disease in patients of cirrhosis at time of presentation. A descriptive study. The study was conducted in the medical department of CMH Peshawar from January 2007 to June 2008. This study was conducted in the Medical Department of Combined military hospital Nowshera and Combined military hospital Peshawar. Cirrhotic patients were admitted to Medical ward and necessary investigations were done. Serum was tested for Hepatitis B surface antigen [HBsAg] and antibodies against Hepatitis C virus [anti HCV] by ELISA method. Where negative, serum was tested for HBcAb [IgM as well as Total], Anti Nuclear antibody, Anti Smooth muscle antibody, Liver Kidney microsomal antibodies, serum Ferritin level, Transferrin saturation and serum ceruloplasmin level. Liver biopsy was done in selective cases. Ninety- eight patients [58.6%] were male and sixty-nine [41.3%] were female. Out of 167 patients, 113 [67.6%] were found infected with HCV, 30 [17.9%] with HBV. In 18 patients [10.7%] all serological and metabolic profile was negative. Major presentations of Cirrhosis were coagulopathy [88%], Ascites [53.9%], Anaemia [45.2%] and Jaundice [35.95%]. 66 patients [39.5%] were in class A of Child-Pugh scoring system, 59 patients [35.3%] in class B and 42 patients [25%] in class C respectively. Cirrhosis liver due to HCV is more common than HBV in this region. Males are affected more than females. Majority of patients are in Child-Pugh class A and B at presentation. Internal Medicine

Etiology of short stature in children

To determine the causes of short stature in children with special emphasis on growth hormone deficiency. Case series. Department of Paediatrics, Military Hospital, Rawalpindi and Combined Military Hospital, Multan from September 2004 to January 2007. Two hundred and fourteen children [140 boys and 74 girls], ranging from 02 to 15 years presenting with short stature were studied. Height and weight were plotted on appropriate growth charts and centiles determined. Relevant hematological and biochemical investigations including thyroid profile were done. Bone age was determined in all cases. Growth hormone axis was investigated after excluding other causes. Karyotyping was done in selected cases. Data was analyzed by SPSS 10.0 by descriptive statistics. Mean values were compared using t-test. In this study, the five most common etiological factors in order of frequency were Constitutional Growth Delay [CGD], Familial Short Stature [FSS], malnutrition, coeliac disease and Growth Hormone Deficiency [GHD]. In 37.4% of patients, the study revealed normal variants of growth - CGD, FSS or combination of both, 46.7% cases had non-endocrinological and 15.9% had endocrinological etiology. CGD [22.1%] in males and FSS [27%] in females were the most common etiology. GHD was found in 6.1% children and it comprised 38.2% of all endocrinological causes. Children with height falling below 0.4[th] centile were more likely to have a pathological short stature [79.2%] compared to 39.3% whose height was below 3rd centile but above 0.4[th] centile [p<0.05]. CGD and FSS are most common causes of short stature in boys and girls respectively, whereas, GHD is a relatively uncommon etiology

Response of recombinant human growth hormone in isolated growth hormone deficiency

To observe the response of growth hormone in isolated growth hormone deficiency. Moreover the response was compared when treatment was initiated earlier or later in childhood. Quasi experimental study. The study was conducted in the department of paediatrics, Military Hospital Rawalpindi, from January 2001 to January 2006. Thirty children [19 boys, 11 girls] with isolated growth hormone deficiency, aged 3-17 years [mean 7.2 +/- 3.4] were identified. Their mean growth velocity was 1.8 cm/year [SD 0.6]. They were treated with intramuscular injections of recombinant human growth hormone [rhGHT] [0.1 U/ kg] 06 times a week for first three years of treatment. After three years of rhGHT the mean height gain was 33.5 cms [SD 8]. Mean height gain in 1st year was 15.5 cms [SD 4], in second year 10.4 cms [SD 2.8], in third year 7.6 cms [SD 2.0]. Mean total height gain was 40.6 cms [SD 4.2] when treatment was started before the age 06 years was 28.8 cms [SD 7.2] when treatment was started after the age 06 years [p < 0.05]. This study clearly demonstrates that children with isolated growth hormone deficiency treated with intramuscular rhGH resulted in increase in growth velocity but was more pronounced when started early [before age six years]

Mode of presentation and short term response to treatment in cases of congenital adrenal hyperplasia [CAH] detected over a period of one year at Military Hospital Rawalpindi

Congenital adrenal hyperplasia [CAH] is an autosomal recessive condition which not infrequently presents with life threatening emergencies. Awareness of physicians regarding these presentations is a prerequisite for a prompt diagnosis and life saving treatment. In view of the prevalence of the condition as reported from tertiary care centres within the country and other parts of the globe, we carried out a study in the department of paediatric medicine at the Military Hospital Rawalpindi to determine the modes of presentation of congenital adrenal hyperplasia [CAH] and to observe the short term response to treatment. The study extended over a period of one year from Aug 2003 to July 2004. All children presenting with vomiting, dehydration, shock, failure to thrive and ambiguous genitalia were examined and investigated thoroughly. The mainstay of the diagnosis was a raised level of serum 170HP in a child with suggestive clinical features. A total of 30 children were fournd to have CAH during the study period. The major clinical features a presentation were vomiting 8[26.7%], ambiguous genitalia 7[23.3%], vomiting and ambiguous genitalia 10[33.3%], shock 4[13.3%] and failure to thrive 1[3.3%]. All the patients were followed up after initiation of treatment and response was observed. The study highlights the importance of common clinical symptoms life vomiting being the presenting features of CAH and the effectiveness of replacement therapy in ameliorating life threatening emergencies due to this condition

Prevalence of anti hepatitis C antibodies and hepatitis B surface antigen in healthy blood donors in Baltistan

To determine the prevalence Hepatitis C and Hepatitis B in healthy blood donors in Baltistan. A descriptive study. All the healthy donors between 20-45 years of age visiting DHQ hospital Skardu were screened for Anti HCV and HBs Antigen. Eight Hundred and fifty donors were including in the study. The overall percentage of Anti HCV was 1.1% and HBs Ag was 8.4%. The percentage rate of Hepatitis B quite high in Baltistan, whereas HCV positivity in rather low in this areas

Neonatal cholestasis Syndrome: an experience at Army medical college and Military Hospital Rawalpindi

To find the causes of neonatal cholestasis in our set up and to see the role of liver biopsy in differentiating neonatal hepatitis from biliary atresia. Design: A cross sectional survey. Place and duration of study: Histopathology department of Army Medical College and Military Hospital Rawalpindi from January 2000 to December 2004. Patients and A total of 62 cases were studied with age range of 1.5 months to 5 years. The subjects selected for biopsy were children with persistent jaundice and hepatosplenomegaly. The biopsy was taken with the help of Surecut needle under the cover of diluted intravenous Ketamine. The fixed tissues were processed under standard conditions. Result: Majority of the patients [62.90%] were of biliary atresia followed by neonatal hepatitis [27.42%]. Paucity of bile ductules was seen in 3 cases while three patients were of indeterminate etiology. Cirrhosis of liver was noted in 10 patients; six because of biliary atresia and two cases each of alpha-1 antitrypsin deficiency and galactosemia. Amongst neonatal hepatitis cases most of the patients were idiopathic in nature [58.82%]. In our set up, biliary atresia is an important and main cause of neonatal cholestasis and liver biopsy is a valuable diagnostic tool in differentiating biliary atresia from neonatal hepatitis

Clinicohaematological features of iron deficiency anaemia in children between 1-5 years of age

To study the clinicohaematological features of iron deficiency anaemia in children between 1-5 years of age. Children between 1-5 years of age suffering from iron deficiency anaemia were included in this study. Personal and family data was obtained for each child. Height and weight were recorded and degree of malnutrition determined as per modified Gomez classification. Samples for blood counts were taken in K[3]EDTA and complete blood counts were performed. Differential leucocyte count and RBC morphology was done by visual reviewing of slides. Ferritin was measured for each patient. Cut off value for defining anaemia was set at 11 g/dl as per WHO criteria. SPSS computer software was used for mean and SD calculations. Different clinical features were cross tabulated with measured Hb levels to evaluate their correlation. Chi-Square test was used to see the significant level. A total of 191 patients were studied with mean age of 1.9 [SD 0.89] years. Male to female ratio was 2:1. Overall, 121[63.3%] children had varying degrees of malnutrition. Mean Hb was 8.2 g/dl [SD 1.3]. Majority of the patients [62.3%] had Hb between 6.1-8 g/dl. Sixty patients had Hb>8 g/dl while 12 had Hb

Diagnostic value of C-reactive protein and haematological parameters in neonatal sepsis

To analyse various parameters of sepsis screen singly and in combination to formulate a guideline for the diagnosis of neonatal sepsis. Design: A cross-sectional analytical study. Place and Duration of Study: The neonatal intensive care unit at the Paediatric Department, Military Hospital, Rawalpindi, over a period of seven months from 1st June to 31st December 2003. Subjects and One hundred neonates having clinical features of sepsis and 100 normal asymptomatic neonates were evaluated with a set of investigations. C-reactive protein [CRP], erythrocyte sedimentation rate, total leukocyte count, absolute neutrophil count [ANC], immature neutrophils to total neutrophil count ratio [I/T ratio], thrombocytopenia, degenerative changes in the neutrophils and gastric aspirate cytology [GAC] for polymorphs were used for diagnosis of neonatal sepsis. CRP was positive in 24/28 [85.7%] of group-A [proven sepsis] and 58/72 [80.5%] of group-B [probable sepsis] and had a specificity of 95%. ANC was the second most sensitive test having sensitivity of 71.4% for group- A and 63.9% for group-B and 88% specificity. For group-A, sensitivity of GAC for polymorphs and platelet count was 71.4% and 64.3% respectively. The sensitivity, specificity and predictive values [PV] of the individual tests and different tests combination was also calculated for group-A and B. A set of investigations including CRP, TLC, ANC, thrombocytopenia, cytoplasmic vacuolization in the neutrophils and GAC for polymorphs are highly sensitive in detection of culture negative cases of neonatal sepsis. Moreover, a combination of three tests enhances the sensitivity of these tests

Brucellosis: Haemorrhagic pleural effusion. A case report

To describe haemorrhagic pleural effusion as a rare complication of brucellosis that finally needed lung decortication. Clinical Presentation and Intervention: A 37-year-old female presented with a 1-week history of fever, dry cough and pleuritic chest pain. Physical examination showed signs of right pleural effusion and hepatosplenomegaly. Complete blood count showed pancytopenia, white blood cells 2.9/mm3, haemoglobin 10 g/dl, platelets 131/mm3. Chest X-ray confirmed a moderate right pleural effusion, that was found to be exudative biochemically. Culture of pleural fluid and blood grew Brucella species. Fever subsided with Brucella chemotherapy, but pleural effusion persisted. Computed tomographic [CT] chest scan showed a large loculated pleural effusion, which failed to resolve despite repeated aspirations under CT guidance. Fluid was always found to be haemorrhagic. Finally, lung decortication was done with successful outcome. This case showed that brucellosis can cause haemorrhagic pleural effusion that needs lung decortication

review of gastrointestinal manifestations of brucellosis

Brucellosis is hyperendemic in the Kingdom of Saudi Arabia [KSA] with more than 8,000 cases reported each year to the public health authorities. The disease can affect almost any organ system in the body including the gastrointestinal system. In some instances, gastrointestinal manifestations may be the only presenting features of the disease. These range from milder complaints like diarrhea, vomiting to more serious complications like involvement of the liver, the spleen and the gallbladder to rarely life-threatening complications like colitis, pancreatitis, peritonitis and intestinal obstruction. Recognition of this type of presentation of brucellosis is important because early diagnosis and treatment usually result in complete recovery without complications

Comparison of response between food supplemented with powdered iron in syrup form for iron deficiency anemia

To evaluate and compare the response between food supplemented with iron in powdered and iron in syrup forms for the treatment of iron deficiency anemia in children aged 1-5 years. Design: Quasi-experimental study. Place and Duration of Study: This study was conducted at Combined Military Hospital, Multan, from January 2000 to December 2000. Patients and Consecutive 200 cases of iron deficiency anemia, aged 1-5 years, were included in the study. Diagnosis was based on history, physical examination, complete blood counts [CBC] and serum ferritin levels. The patients were randomized to receive either iron in syrup form [Group A] or equivalent doses of iron powder sprinkled over food [Group B]. The patients were followed up with hemoglobin estimation [Hb] and reticulocyte response at 2 weeks, 4 weeks and 6 weeks. CBC and serum ferritin were repeated at 6 weeks. Over half [51%] of the patients were between 1-2 years of age. One hundred thirty-two were males and 68 females. Most of the patients belonged to poor socioeconomic class. The iron in powder form was better tolerated than iron syrup as this group witnessed fewer episodes of gastrointestinal disturbances. The rise in mean Hb level after 6 weeks of treatment in group A and B was 1.6 g/dl and 1.9 g/dl respectively. Hemoglobin rise in group B was more than group A but this was statistically non-significant [p > 0.05]. There was small but significant [p < 0.05] rise in serum ferritin in both the groups. There was no significant difference between the two groups for response to the two forms of iron administration. The powdered form of iron is a cost-effective and better tolerated method of iron administration in children and can be considered as an alternate option for the treatment of iron deficiency anemia in children