Microbial and chemical analysis of illicit drugs samples confiscated from different areas of Pakistan

The microbial and chemical analysis of illicit drug samples from different areas of Pakistan i.e. Quetta, Karachi, Lahore and Islamabad was conducted in a cross-sectional study at National Institute of Health, Islamabad. The drug samples were confiscated by Anti Narcotics Force [ANF], Pakistan. Microbial analysis was done by estimating bioburden which revealed the presence of gram negative and positive bacteria's, fungus, Streptococcus, Staphylococcus species. Trypton soya agar was used for total aerobic count, MacConkey agar for gram-negative bacteria, Sabouraud dextrose agar for fungus and Vogel-Johnson agar for Streptococcus and Staphylococcus species. Colour tests were applied to identify the drug samples. Qualitative and quantitative analysis of suspected samples of Heroin, morphine, cocaine and acetic anhydride was made by employing different chromatographic techniques i.e. Thin-layer chromatography [TLC] and High-performance liquid chromatography [HPLC]. The samples were found to be adulterated with paracetamol, diazepam and Dextromethorphen. Acetic anhydride was adulterated with hydrochloric acid [HCl]. There is lack of information providing structured advice on responses to the consequences of illicit drug adulteration. Robust and rehearsed interventions and communication strategies would provide a basis for response for a wide variety of organisations. Research into the usefulness of media warnings about adulteration of illicit drugs is required

Bipolar electrofulguration with endoscopic approach in allergic hypertrophied turbinate

Background: Allergic hypertrophied turbinate, is managed by different treatment modalities, with variable outcome

Objective: To evaluate the result of bipolar electrofulguration with endoscopic approach in allergic hypertrophied turbinate

Patients and Methods: Study design: Descriptive, cross sectional study. Place: ENT department of Jaber AL - Ahmed Forces Hospital, Kuwait from 1[st] January 2008 to 31[st] December 2010. Fifty five cases of hypertrophy of Inferior turbinate were selected. Forty patients were females and 15 were males. They presented mainly with history of nasal blockage. Endoscopic bipolar diathermy was used to decrease the size of inferior turbinate. The variables included were nasal obstruction, post nasal drip, itching and sneezing. The patient were followed up on one, three and 6 month. The data was entered and analyzed by SPSS version 12

Results: Endoscopic bipolar diathermy showed good results after follow upto two six months duration. We found that 89% of the patients reported subjective improvement and 65% of the patients have objective improvement as well

Conclusion: Bipolar diathermy of inferior turbinate using zero degree endoscope is a good technique for excellent view of inferior turbinate. This procedure gives good results to the patients

exposition of medicinal preponderance of Moringa oleifera [Lank.]

Medicinal plants are believed to be a precious natural reservoir as they are assumed to have paranormal effects for the mankind. Moringa oleifera grows throughout most of the tropics and has numerous industrial and medicinal uses. This review acquaints with the consequence of fera [Moringaceae], a fast growing medicinal plant wide spread in tropical regions with height ranging from 5-10m. It has an enormous nutritional worth due to existence of vitamins and proteins. It is subsisted with many constituents. Its oil consists of oleic, tocopherols, stearic, palmitic, behenic and arachidic acid. Flavanoids and phenolics such as gallic acid, chlorogenic acid, ferulic acid, kaempferol, ellagic acid, quercetin and vanillin are present by means of leaf extract, being richest in phenolics and subsequent fruit and seed extract respectively, that are accountable for antioxidant activity of plant. Seeds have been pragmatic with active components as novel O-ethyl-4- [alpha -L-rhamnosyloxy] benzyl carbamate together with seven known compounds, 4 [alpha -Lrhamnosyloxy]-benzyl isothiocyanate, niazimicin, niazirin, beta -sitosterol, glycerol-1- [9 -octadecanoate], 3 -O- 6 -Ooleoyl- beta -D-glucopyranosyl-b-sitosterol, and beta - sitosterol- 3-X-O - beta -D-glucopyranoside, that have been discerned to inhibit EBV-EA [Epstein- Barr virus-early antigen], that is persuaded by the cancer promoter. M. oleifera leaves, gums, roots, flowers as well as kernels have been unanimously utilized for managing tissue tenderness, cardiovascular and liver maladies, normalize blood glucose and cholesterol. It has also profound antimicrobial, hypoglycemic and anti-tubercular activities

Critique of medicinal conspicuousness of Parsley [Petroselinum crispum]: a culinary herb of Mediterranean region

WHO estimates, around 80% of the especially developing world is indigent on complementary and alternative medicines which are prodigiously derived from herbal material. Parsley [Petroselinum crispum] is an important culinary herb originated from the Mediterranean region. It possesses small and dark seeds with volatile oil content. Petroselinum crispum is now planted throughout the world due to its usage in food industry, perfume manufacturing, soaps, and creams. Its main constituents subsume coumarins, furanocoumarins [bergapten, imperatori], ascorbic acid, carotenoids, flavonoids, apiole, various terpenoic compounds, phenyl propanoids, phathalides, and tocopherol. Due to these constituents, it has been annunciated to possess a number of possible medicinal emblematics including, antimicrobial, antianemic, menorrhagic, anticoagulant, antihyperlipidemic, antihepatotoxic, antihypertensive, diuretic effects, hypoglycaemic, hypouricemic, anti oxidative and estrogenic activities. In Morocco, Parsley is mostly used as an elixir to treat arterial hypertension, diabetes, cardiac and renal diseases. Antioxidant and antibacterial activities of parsley, made it propitious in food systems. Its ELI17 gene has been corroborated as a particularly fast-responding gene. There is a requisite for extensive research to avail the maximal benefits of this significant medicinal plant. The aim of this review paper is to divulge the chemical constituents of parsley that are explicitly related to substantial medicinal facets.

Comparative phytochemical, hepatoprotective and antioxidant activities of various samples of Swertia chirayita collected from various cities of Pakistan

Medicinal plants are crucial for about 80% of the world population in developing and developed countries for their primary and basic health care needs owing to better tolerability, superior compatibility with human body and having lesser side effects. The present study was conducted on various solvent extracts of three plant samples of Indian and Nepali origin Swertia Chirayita [Roxb.] Buch-ham [Chiratia] collected from various places to establish their comparative phytochemical analysis, chromatographic profile, hepatoprotective and antioxidant activities. Nepali Swertia Chirayita was found to have finest Chromatographic profile [TLC]. Phytochemical analysis revealed Alkaloids, flavonoids, saponins, ascorbic acid, glycosides, steroids and triterpenoids in all samples. Different solvent fractions of the methanolic plant extracts of Swertia chirayita were assessed for hepatoprotective activity by carbon tetrachloride-induced liver damage in rats. The grade of protection was measured by using biochemical parameters such as serum glutamate oxalate transaminase [SGOT/AST], alkaline phosphatase [ALP], serum glutamate pyruvate transaminase [SGPT/ALT] and total bilirubin. The in-vitro antioxidant activity of the extracts was also evaluated by the 1, 1-diphenyl-2-picrylhydrazyl [DPPH] free radical scavenging assay. The methanolic and aqueous extracts, at a dose of 200 mg/kg and 300 mg/kg, produced significant [P<0.05] hepatoprotection by decreasing the activities of the serum enzymes and bilirubin while there were marked scavenging of the DPPH free radicals by the fractions. Decreased observed in the biochemical parameters suggests that the plant extracts possesses hepatoprotective as well as antioxidant activities without any significant variation amongst them. These activities reside mainly in the methanolic extract of whole plant

Prevalence of allergic fungal sinusitis among patients with nasal polyps

Background: Nasal polyps are commonly seen in our routine ENT practice. Allergic Fungal Sinusitis [AFS] is also one of them

Objective: To determine the prevalence of allergic fungal sinusitis among patients with nasal polyps

Patients and Methods: This sectional study was conducted in Department of ENT, Sheikh Zayed Hospital, Rahim Yar Khan from 11[th] July, 2013 to 10[th] January 2014. This study included 84 patients with diagnosis of nasal polyps. All the patients were evaluated for the presence of allergic fungal sinusitis which was described as frequency and percentage. The data was collected in pre designed performa. The data was entered and analyzed by using SPSS version 16

Results: Allergic fungal sinusitis was detected in 9 [11%] patients. The mean age of the patients was 31 +/- 6 years, and all of the patients have, nasal obstruction, post nasal drip and sneezing

Conclusions: Allergic fungal sinusitis is seen commonly among patients with nasal polyps. So, every patient with nasal polyp should be evaluated for the presence of AFS

Audit of patients of epistaxis: treatment modalities and relation with blood groups

Background: Epistaxsis in one of the common condition faced in emergency

Objective: To evaluate the pattern of epistaxis, treatment, modalities and relation of epistaxis with blood groups

Patients and Methods: This retrospective the study was conducted at department of Ear, Nose, Throat, Head and Neck Surgery, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1[st] January to 31[st] December 2010. Patients with spontaneous severe epistaxis who require hospitalization for control were included in this study and those who were with obvious cause like trauma, rhinolith, foreign bodies, granulomatous condition, tumours, blood dyscrasia and age below one year were excluded from this study. Data regarding age, gender, mode of presentation, under lying cause, blood groups and treatment modalities of consecutive 160 admitted cases of epistaxis was collected and analyzed by manual method and with the help of SPSS version 19. Sixty patients were excluded from this study because of blood dyscrasia, granulumatous disease and tumours. Trauma was not included in this study. To determine the association of blood grouping with opistaxsis 100 controls were also included in the study

Results: Hypertension above 50 years was the most common cause. It was more common in male patients [72%] as compared to in female. Sixty patients [60%] were above 50 years, twenty [20%] patients were in between [30 to 49] years, nine patients [9%] were in between [10 to 29] years and seven patients [7%] were in between [01 to 09] years of age. Hypertension was observed in sixty [60%] patients, chronic rhino sinusitis in twenty [20%]. Eighty five patients [85%] were managed by anterior nasal pack and in fifteen patients [15%] posterior nasal packing was done. Blood group [O] distribution was present in [47%], while in control group it was 38%

Conclusion: In adult admitted patients, hypertension was the major cause when trauma, granulomatous disease and blood dyscrasia was excluded. Anterior nasal packing is still valuable in control of epistaxis. Patients with blood group O was found in majority of patients of epistaxis

audit of the emergency tracheostomies in a tertiary care hospital

Background: Emergency tracheostomy remains a vital life saving procedure in advanced upper airway obstructive pathologies and in various other clinical settings where urgent alternative air passage is needed. Ingestions of hair dye powder containing PPD for self harm purpose or accidentally, is emerging as its new indication especially in young female patients

Objective: To evaluate the demographic and etiological factors underlying emergency tracheostomies in consecutive one hundred patients presenting in a tertiary care hospital

Subjects and Methods: In this case descriptive study, records of one hundred consecutive cases of emergency tracheostomies were collected and analyzed from demographic and etiologically point of view, from 1[st] January, 2012 to 30[th] September, 2013 manually as well as by using SSPS version 17

Results: Etiologically we found thirty five [35%] cases of severe respiratory distress due to kala pathar ingestion, thirty [30%] cases due to advanced laryngopharyngeal growths, twenty one[21%] due to trauma of head neck region or for assisting ventilation, four [4%] due to foreign bodies in laryngotracheal region, four[4%] cases were due to acute pharyngolaryngeal edema due to corrosive in take, four[4%] cases were due to post thyroidectomy bilateral abductor paralysis, one [1%] case was due to laryngomalacia and one [1%] case was due to acute epiglottitis male to female ratio was 1 to 1.5

Conclusion: Upper air way obstruction secondary to kala pathar ingestion is emerging as a new indication for emergency tracheostomy secondly, late presentation of upper airodigestive tract tumors, along with head neck trauma, remains a dominant indication for emergency tracheostomy

Appraisal of multifarious brands of Cephradine for their in vitro antibacterial activity against varied microorganisms

The astounding and exceptional growth of generic pharmaceutical Industry in Pakistan has raised certain questions for drug regulatory authorities contemplating their efficacy and quality. The current study focuses on assessing the in-vitro antimicrobial activity of 24 brands of Cephradine 500mg capsules against 4 different strains by employing standardized methods. Disk diffusion method was performed on all brands to look into the susceptibility and resistance patterns. Standard disk of 5 micro g Cephradine powder were used during evaluation. The zones of inhibitions were ranged from 24-40mm against S. aureus, 24-40mm against E. coli, 20-25mm against K. pneumonia and 19-23mm P. mirabilis. On the basis of mean value, the multinational brands were found to have better zone of inhibitions and were better than local Pharmaceutical companies but ANOVA cooperative study showed that all brands of Cephradine showed similar comparable results. Further investigations by employing MIC method, quality of raw material with special emphasis on the shelf-life, excepients and method of manufacturing will be needed to obtain more authenticated results. The price of National and Multinational brands ranges from Rs.156.00-212.00 for 10 capsules. It is concluded that Public health is at risk because of noticeable growing widespread curse of the manufacture and trade of sub-standard or below par pharmaceuticals. The pecuniary accountability of management of pharmaceutical agents is additionally apparent. The results of the study need to be made public to boost the confidence of medical profession about the quality of locally manufactured pharmaceuticals. It will succor the foreign exchange being incurred on the trade in of medicines

Accentuating the prodigious significance of Eclipta alba - an inestimable medicinal plant

Eclipta alba is a small branched perennial herb, which has been used as a traditional medicine in different countries mainly in tropical and subtropical regions of the world. The plant E. alba plays a significant role in the ayurvedic, traditional and unani systems of medicine. It is popularly known as "Bhringaraj". The herb has been known for its medicinal value and has been used as an analgesic, antimytotoxic, antihepatotoxic, antibacterial, antioxidant, antihaemorrhagic, antihyperglycemic and immunomodulatory and also recognized as a reincarnated plant. Broad range of chemical constituents have been detached from E. alba including coumestans, alkaloids, thiopenes, flavonoids, polyacetylenes, triterpenes and their glycosides. Pharmacological activities have been seen in the metabolites and extracts of this plant. Therefore this herb produces robust curative lead compounds, which would be propitious for humanity. The purpose of this review recapitulates all data related to E. alba considering its prodigious medicinal importance

Real time and accelerated stability studies of tetanus toxoid manufactured in public sector facilities of Pakistan

Tetanus is an acute illness represented by comprehensive increased inflexibility and spastic spasms of skeletal muscles. The poor quality tetanus toxoid vaccine can raise the prevalence of neonatal tetanus. WHO has taken numerous steps to assist national regulatory authorities and vaccine manufacturers to ensure its quality and efficacy. It has formulated international principles for stability evaluation of each vaccine, which are available in the form of recommendations and guidelines. The aim of present study was to ensure the stability of tetanus vaccines produced by National Institute of Health, Islamabad, Pakistan by employing standardized methods to ensure constancy of tetanus toxoid at elevated temperature, if during storage/transportation cold chain may not be maintained in hot weather. A total of three batches filled during full-scale production were tested. All Stability studies determination were performed on final products stored at 2-8 Degree C and elevated temperatures in conformance with the ICH Guideline of Stability Testing of Biological Products. These studies gave comparison between real time shelf-life stability and accelerated stability studies. The findings indicate long-term thermo stability and prove that this tetanus vaccine can remain efficient under setting of routine use when suggested measures for storage and handling are followed in true spirit

Preparation and characterization of chloramphenicol niosomes and comparison with chloramphnicol eye drops [0.5%w/v] in experimental conjunctivitis in albino rabbits

Niosomes has gained tremendous popularity as ultimate drug carrier. Lot of research work is being carried out on preparation of niosomes for ophthalmic use having no significant effect on vision and its sustained release pattern. Chloramphenicol niosomes were prepared using two different ratios of cholesterol, drug and surfactant, termed as EIN-1, EIN-2 by ether injection method and their entrapment efficiency, particle size. The in vitro drug release pattern was observed for ten hours. The EIN-2 showed 90% entrapment and released 81% of entrapped drug after 10 hours. Zeta potential and viscosity were determined and in vivo comparison was made with Chloramphenicol eye drops where it exhibited Cmax of 15 microg/ml. Stability studies were done to determine shelf life. MIC of selected strain of S. aureus was also determined. EIN 2 niosomal suspension was compared with Chloramphenicol eye drops in experimental conjunctivitis in albino rabbits. In vitro studies are encouraging as niosomes released about 75% of total entrapped drug by EIN-1 and 81% of total entrapped drug by EIN-2. In vivo study shows that niosomes released the drug in eye in acceptable range and showed a sustained release pattern without affecting the vision. Niosomes were found ultimate ophthalmic drug carriers capable to release drug in sustained and determined pattern

Knowledge, attitude and practices about needle stick injuries in healthcare workers

To assess knowledge, attitude and practices about needle stick Injuries in health care workers. Hospital based study carried out at Pakistan Institute of Medical Sciences, Islamabad, from August 2010 to November 2010. A self administered 19 items questionnaire was prepared which contained information about needle stick injuries, its awareness, frequency of injury and the protocols that were followed after an injury had occurred. These questionnaires were given to 500 health care workers working in different wards and theaters of the hospital after obtaining their informed written consent. The health care workers included doctors, nurses and paramedical staff of Pakistan Institute of Medical Sciences, Islamabad. The data was entered and analyzed using SPSS version 15. A total of 500 health care workers filled the questionnaire and returned it. Out of these 416[83.2%] reported ever experiencing needle stick injuries in their professional life. Health care workers working in Emergency department were most frequently affected [65%] followed by those working in different wards [27%] and operation theatre [8%]. Most [93.6%] workers had knowledge about needle stick injuries and only 6.4% were not aware of it. Needle stick injury occurred from a brand new [unused] syringe in 51.2% cases, while in 32.8% cases, the needle caused an injury after it had been used for an injection. In 5% cases, injury occurred with blood stained needles. The commonest reasons for needle injury in stick injuries were heavy work load [36.8%] followed by hasty work [33.6%] and needle recapping [18.6%]. About 66% health care workers were already vaccinated against hepatitis B. Only 13% workers followed universal guidelines of needle stick injuries and no case was reported to hospital authorities. Health care workers had inadequate knowledge about the risk associated with needle stick injuries and do not follow standard preventive measures. A standard protocol regarding the training and compliance to follow preventive measures should be followed in all health care institutions

Mandibular fractures of maxillofacial skeleton- the epidemiology and management; a two years experience in a tertiary care hospital

Background: The incidence of maxillofacial skeleton fractures is rising sharply world wide, the main contributors being road side accidents, interpersonal violence and falls from heights. If not treated properly, such fractures may lead to life long functional and structural disability

Objective: This study was planned to determine demographics, clinical features, patterns of mandibular bone fractures, management, postoperative evaluation and regulatory aspects of causes of such fractures

Patients and methods: This was a descriptive study, based on data of 150 consecutive patients of facial skeleton fractures, from January 2008 to December 2009. Variables examined included demographic and clinical features, patterns of mandibular bone fractures and results of open and closed reduction of isolated mandibular fractures using surgical stainless steel wires. Patients were followed up for one year

Results: There were 135 [90%] male and 15 [10%] females, age ranged from 5-70 years [mean age was 25 years]. Most common causes were motor bike accidents [57%], and falls from different heights [16%]. Nasal bone was the most commonly fractured bone, seen in 112 [75%] patients, followed by mandible fractures in 80 patients. In s62, selected cases of mandibular fractures postoperative complication rate was higher in closed reduction than in open reduction cases with internal fixation [ORIF]

Conclusion: Long-term collection of epidemiological data regarding maxillofacial skeleton and management aspects of mandibular fractures are important for the evaluation of existing preventive measures and useful in the development of new methods of injury prevention and treatment

Glycemic status, income, self-monitoring, compliance, education and pattern of pharmacotherapy in 100 patients of type 2 diabetes mellitus

To assess the glycemic status, income, self-monitoring, compliance, education and pattern of pharmacotherapy in 100 type 2 diabetes mellitus patients. Material and This descriptive observational study was carried out at Medical A Unit, Khyber Teaching Hospital Peshawar. A total of 100 type 2 diabetic patients were included through non-probability sampling. Glycosylated hemoglobin of each patient was determined and questions were asked about income, self-monitoring of glycemic status, education and compliance of the patients. Majority of the patients [78%] had poorly controlled diabetic mellitus. Most of the patients [42%] were poor and their monthly income was less than 5000 rupees. Only 57% of the patients monitored their blood sugar once a month. No patient was using glycosylated hemoglobin for assessment of his or her glycemic status. Majority of the patients [82%] were illiterate. Oral hypoglycemic agents were used by 81% of the patients. Most of the patients had poorly controlled diabetes mellitus. Majority of the patients were poor and illiterate and there was poor self-monitoring. Most of the patients were using oral hypoglycemic drugs

MRSA Septic Polyarthritis: a case report and review of literature

A 45-year-old male patient with history of hypertension and diabetes mellitus was admitted to the hospital because of increasing erythema and swelling of left elbow, bilateral wrist, right knee and right ankle joints of two weeks duration. He had undergone amputation of his left big toe two months prior to presentation, which was complicated by wound infection and poor healing. He had been treated with multiple courses of empiric oral and intravenous antibiotics to control the local infection. On examination, the patient's temperature was 102 F, pulse rate was 90 beats per minute, and blood pressure was 160/90 mm Hg and respiratory rate 20 per minute. There was significant tenderness, swelling and erythema of both wrists. Left knee and ankle appeared markedly swollen and tender with severe limitation of movement. Left big toe wound looked infected with purulent drainage. Synovial fluid aspirate from right wrist and knee showed numerous pus cells and gram-positive cocci on Gram stain. The culture grew S. aureus resistant to methicillin but sensitive to vancomycin, teicoplanin, chloramphenicol and fusidic acid. Three consecutive blood cultures also grew colonies of S. aureus. Therefore the diagnosis of MRSA septic polyathritis was made