retrospective analysis of non-HDL cholesterol: for improved cardiovascular risk assessment

Objective: To assess Non-HDL cholesterol as an indicator of Cardiovascular risk [CVR] in addition to low density lipoprotein [LDL] cholesterol

Methods: A retrospective study was conducted in the Department of Clinical Biochemistry, Indus Hospital Karachi from September 2007 to December 2012. After approval for conducting the research obtained from the Institutional Research Board a retrospective analysis of non-HDL cholesterol and LDL Cholesterol in 2115 lipid profiles was conducted, which had been analyzed on fasting serum or EDTA plasma by Randox Rx Imola and Daytona analyzers using Randox kits. Since this was a retrospective study that included all the lipid profiles presented in the lab from Sept 2007 to Dec 2012, so it did not require any sample size calculation

Results: Statistical analysis performed on data was unpaired t-test using SPSS package Version 22. Analysis of 2115 lipid profiles shows that 1389 [66%] had Triglyceride levels above 1.7mmol/l of which 642 [46%] were females and 747 [54%] were males. Regarding males, in 77 out of 747 [10%] samples there was an elevated non-HDL cholesterol [greater than 3.4mmol/l] in the presence of a normal LDL cholesterol [less than 2.6 mmol/l.]. In the other 22 out of 747 [2.9%] males, LDL-cholesterol was elevated in the presence of normal non-HDL cholesterol. In the females 66 out of 624 [10%] samples there was an elevated non-HDL cholesterol [greater than 3.4mmol/l] in the presence of a normal LDL-cholesterol [less than 2.6 mmol/l] and LDL-cholesterol was elevated in the presence of normal non-HDL cholesterol in 15 femalesout of 642 [2.3%]

Conclusion: Non-HDL cholesterol is also a necessary analysis for the true assessment of cardiac vascular risk in addition to LDL-cholesterol especially in the samples with elevated triglycerides samples. Therefore, it is recommended that non-HDL cholesterol be reported as part of lipid profile

Dynamization versus static antegrade intramedullary interlocking nail in femoral shaft fractures

Objective: to compare the primary dynamic interlocking technique with static interlocking method for femoral shaft fractures in terms of bony union

Study design: quasi experimental study

Place and Duration of study: department of Orthopaedic Surgery, Ziauddin University Hospital Karachi, from March 2012 to August 2013

Methodology: all patients with closed femoral shaft fractures were treated by closed reamed intramedullary [IM] interlocking nail. They were divided into two equal groups. Group I [Dynamization group] patients underwent primary dynamization and in Group II [Static group] patients the static nail was used. Both groups were divided into subgroups on the bases of post reduction intrafragmental gap less than or more than 3mm on x-ray.The surgical procedure and postoperative protocols were same for both the groups, with the exception of interlocking mode. The outcome was measured using Thorensen clinical criteria. Bony union, time of union, delayed union, nonunion, implant breakage and leg shortening were recorded

Results: a total of 64 patients were included, 32 in each group. Mean time of union was same in dynamic group and static group with post reduction intrafragmental fracture gap < 3mm. In the dynamic group with post reduction intrafragmental fracture gap=3mm, one case of nonunion was noted. In static group two cases of delayed union and one case of nonunion were noted in sub group with post reduction intrafragmental fracture gap=3mm

Conclusion: dynamization significantly shortened the mean time to union in femoral shaft fracture with intrafragmental gap =3mm, though it did not significantly affect the union rate of the femoral shaft fractures as compared to static close intramedullary interlocking nailing

Modified Kapandji wiring technique for unstable fractures of distal end of radius

To assess the results of modified Kapandji wiring technique in unstable Colles' fractures. Descriptive study. At Ziauddin Hospital Karachi, From September 2005 to August 2006. A total of one hundred and eighty five adult patients presented in our centre with fractures of lower third of radius during the study period. Of these only twenty eight adult patients were included who had unstable fractures of the distal end of radius. There were nine male and nineteen female patients. Average age was 51 years. Three to four Kirschner-wires were used to stabilize the fracture. According to AO classification system thirteen were type A2, nine were type A3, and six type C1 fractures. X rays revealed good anatomical reconstruction consistent with a good wrist function. There was a much shorter period of rehabilitation as compared with plaster of Paris casts. No major complication occurred with this technique. For unstable fractures of the lower end of radius, intrafocal Kapandji wiring is a safe and successful method for achieving good results. It is easy to learn and perform. The device employed has a low cost

Triglyceride profile in dyslipidemia of type 2 diabetes mellitus

To evaluate ratios of serum triglycerides and cholesterol levels which may indicate postprandial lipid handling and to assess their role as prospective markers of dyslipidaemia in type 2 diabetes mellitus. Comparative, observational study. Bismillah Taqee Hospital, Karachi from July 2002 till December 2003. The study comprised 160 subjects, including 83 known type 2 diabetics [45 males, 38 females] and 77 age-matched controls [45 males, 32 females]. Fasting blood samples were analysed for serum triglycerides and total cholesterol, using automated chemistry analyzer. HDL-C was determined by precipitation method and LDL-C and VLDL-C were estimated by Friedewalds formula. LDL/HDL ratio and TG/HDL ratios were also calculated. The mean values for male and female diabetics were compared with that for the male and female non-diabetics respectively and tested for significance by paired t-test. Serum triglycerides and VLDL were raised in both male and female diabetics. No significant differences were observed in levels of serum total cholesterol, LDL, HDL and the LDL/HDL ratio. The mean value of the TG/HDL ratio for male diabetics was higher than that for the male non-diabetics [p=0.39]. A statistically significant difference was found in the TG/HDL ratios for the female diabetics and non-diabetics [p < 0.05]. In this study, type 2 diabetics showed marked hypertriglyceridaemia and raised TG/HDL ratio. The dyslipidaemia of diabetes predisposes to development of coronary heart disease and, therefore, evaluation of the TG:HDL ratio may provide a good tool to monitor and manage the lipid abnormalities in diabetics

Leptin levels in pre and post menopausal Pakistani women

To evaluate the correlation of fasting serum leptin levels with anthropometric measurements and menopausal status, in women. The study comprised of 80 non-obese women who were divided into 2 groups as pre-menopausal [n=46] and post-menopausal [n=34].Anthropometric measurements i.e. height, weight, waist and hip circumference were measured for all the subjects and the Waist-hip Ratio [WHR] and Body Mass Index [BMI] were calculated from these measurements. A fasting venous blood sample was taken from all the subjects and serum leptin concentrations were determined by ELISA. A comparison of the mean values for BMI and WHR between the two groups showed a non significant difference. Within each group, significant associations were noted between the fasting serum leptin level and values of BMI and WHR. A comparison of the mean serum leptin concentrations between the two groups, showed a highly significant difference [p<0.001]. Our results indicate that in the non-obese women of our population, leptin levels associate with BMI and WHR and together with menopausal status seem to be important determinants of serum leptin levels

Upper extremity deep vein thrombosis

A case of deep vein thrombosis of axillary vein [Paget-Schroetter syndrome] is described in an 18 years old male. Patient presented via emergency with a one week history of pain and swelling of arm. Duplex imaging showed deep vein thrombosis of third part of left axillary vein and venae comitantes of brachial artery. Patient's condition resolved on conservative treatment