Mycetoma in north-western Yemen: Clinico-epidemiological and histopathological study

Background: Mycetoma is widespread in Yemen; however, there are only a few documented reports on the entity from this geographical area. Methods: A prospective study of 184 cases of mycetoma (male 145 and female 39) from different regions of north-western Yemen was conducted between July 2000 and May 2014. Clinical profile was recorded in a standardized protocol. The diagnosis was based on clinical features, X-ray studies, examination of grains, and histopathology. Results: Eumycetoma was diagnosed in 129, caused by Madurella mycetomatis in 124, Leptosphaeria senegalensis in one and pale grain fungus in four, whereas actinomycetoma occurred in 55, caused by Streptomyces somaliensis in 29, Actinomadura madurai in nine, Actinomadura pelletieri in one, and Nocardia in sixteen. Eumycetoma cases were treated with prolonged course of antifungal drugs, mostly ketoconazole, with itraconazole being used in four patients, along with excision or debulking. Results were better when antifungal drugs were given two to three months before surgery and in those who received itraconazole. Actinomycetoma cases were initially treated with co-trimoxazole monotherapy; later streptomycin was added in 30 cases. Six patients who did not show adequate improvement and two others from the start were treated with modified Welsh regimen and with good results. Limitations: Identification of different causative agents was done by histopathology and could not be reconfirmed by culture. Conclusion: Mycetoma is widespread in north-western Yemen with a higher incidence of eumycetoma and a majority of the cases were caused by Madurella mycetomatis. Modified Welsh regimen in actinomycetoma and itraconazole with excision in eumycetoma showed the best results.

Manuka honey enhanced sensitivity of HepG2, hepatocellular carcinoma cells, for Doxorubicin and induced apoptosis through inhibition of Wnt/ß-catenin and ERK1/2

BACKGROUND: Recently, there is increasing awareness focused on the identification of naturally occurring anticancer agents derived from natural products. Manuka honey (MH) has been recognized for its biological properties as antimicrobial, antioxidant, and anticancer properties. However, its antiproliferative mechanism in hepatocellular carcinoma is not investigated. The current study focused mainly on investigating the molecular mechanism and synergistic effect of anticancer properties of MH on Doxorubicin (DOX)-mediated apoptotic cell death, using two different p53 statuses (HepG2 and Hep3B) and one non-tumorigenic immortalized liver cell line. RESULTS: MH treatment showed a proliferative inhibitory effect on tested cells in a dose-dependent manner with IC50 concentration of (6.92 ± 0.005%) and (18.62 ± 0.07%) for HepG2 and Hep3B cells, respectively, and induced dramatic morphological changes of Hep-G2 cells, which considered as characteristics feature of apoptosis induction after 48 h of treatment. Our results showed that MH or combined treatments induced higher cytotoxicity in p53-wild type, HepG2, than in p53-null, Hep3B, cells. Cytotoxicity was not observed in normal liver cells. Furthermore, the synergistic effect of MH and Dox on apoptosis was evidenced by increased annexin-V-positive cells and Sub-G1 cells in both tested cell lines with a significant increase in the percentage of Hep-G2 cells at late apoptosis as confirmed by the flow cytometric analysis. Consistently, the proteolytic activities of caspase-3 and the degradation of poly (ADP-ribose) polymerase were also higher in the combined treatment which in turn accompanied by significant inhibitory effects of pERK1/2, mTOR, S6K, oncogenic ß-catenin, and cyclin D1 after 48 h. In contrast, the MH or combined treatment-induced apoptosis was accompanied by significantly upregulated expression of proapoptotic Bax protein and down-regulated expression of anti-apoptotic Bcl-2 protein after 48 h. CONCLUSIONS: Our data showed a synergistic inhibitory effect of MH on DOX-mediated apoptotic cell death in HCC cells. To our knowledge, the present study provides the first report on the anticancer activity of MH and its combined treatment with DOX on HCC cell lines, introducing MH as a promising natural and nontoxic anticancer compound.

Frequency of Abdominal Tuberculosis in cases presenting with acute abdomen

Objective: To determine the frequency of abdominal tuberculosis in cases presenting with acute abdomen

Study design: This was a cross sectional study

Place of study: Department of Surgery, Sheikh Zayed Hospital. Rahim Yaar Khan

Period of study: July 2017 to December 2017

Methodology: The cases of both genders with age 15 years or more were included in this study. The diagnosis of acute abdomen was made where there was pain in abdomen of 5 or more on visual analogue scale and absolute constipation within last 24 hours with or without vomiting. The cases with any malignancy and those with end stage renal, liver or heart disease will be excluded. The cases will undergo surgery at the same institute by consultant surgeon and biopsy will be taken from the affected intestinal or omentum tissue and presence of granulomatous disease on it will reveal it as abdominal TB

Results: In the present study there were 100 cases, that presented with acute abdomen. The mean age was 39.56+/-10.23 years. Abdominal TB was detected in 25 [25 percent] of the cases. There was no significant difference in terms of gender with p= 0.78. Abdominal TB was significantly high in cases that had age group 40 or less years where it was seen in 22 [30.98 percent] cases with p value of 0.03. This was also more common that had concomitant pulmonary TB where it was seen in 6 [35.29 percent] cases; though this was not significant with p value of 0.21

Conclusion; Abdominal TB was detected in every 4th case presented with acute abdomen and it is significantly high in cases that had age group 40 year or less

Is open decortication superior to fibrinolytic therapy as a first line treatment in the management of pleural empyema?

Objective: To confirm that either Fibrinolytic therapy or open decortication which of the two is an effective First line treatment of pleural empyema

Methods: This prospective comparative study was conducted in the department of surgery Sheikh Zayed Medical College and Hospital, Rahim Yaar Khan. Seventy eight [78] patients were included in this study. There were two groups of patients; Group I [n=35] patients treated with fibrinolytic therapy, Group II [n=43] patients treated with open decortication. Data was entered and analyzed in SPSS v16. Student's t-test was used for comparison of quantitative variables. Chi-square and Fisher's Exact test were used for comparison of qualitative variables. P-value

Results: There was no significant difference in base baseline characteristics of patients of Group I and II. Incidence of comorbidities was also same between the groups. Most of the patients in Group I and II were in empyema stage III. Fluid cultures was positive in 33 [94.3%] patients in group I and 39 [90.7%] patients in group II. 30 [85.7%] was successfully treated using fibrinolytic therapy but this therapy failed in five [14.3%] patients, two of these patients expired within the hospital. There was only one [2.3%] treatment failure in open decortication Group that patient expired within the hospital [p-value 0.04]. Overall duration of hospitalization was significantly high in fibrinolytic group, this was 17.6 +/- 1.95 days versus 12.09 +/- 2.18 days in open decortication group [p-value <0.0001]. There was no significant difference regarding operative mortality within the two groups

Conclusion: Open Drainage is associated with better outcomes as compared to fibrinolytic therapy when used as a First line treatment of empyema

Role of occipito - mental view in chronic headache, is it beneficial?

Chronic Headache is one of the common visiting symptoms in outpatient department. Amongst various investigations advised by the concerned medical practioner, . X.Ray P.N.S, occipitomental view or water's view is the most common and routine investigation. It is the most commonest radiological investigation because of easy availability of radiographic equipment, low cost and even free service available in public sector Hospitals. To determine the cause of chronic headache after viewing occipitomental view [OM] for para nasal sinuses [PNS] with history of more than one month of duration and to know that this plain radiograph is beneficial for diagnosis. Observational study. Department of Radiology. Civil Hospital Karachi. This study was conducted from October 2010 - December 2010 [3 month] in the Department of Radiology, Civil Hospital Karachi. All patients with symptom of headache of more than one month duration over the age of 18 years were included with conventional radiograph. Patients of less than 18 years of age were excluded from this study. Among 50 patient, 32 [64%] were males and 18 [36%] were females. Out of 25 [50% patients who were diagnosed as sinusitis. 17 [34%] were males and 08 [16%] were females. Pansinusitis was also detected in 13 cases [26%], 07 were males [14%] and 06 were females [12%]. Maxillary sinusitis was also found as a cause of chronic headache. This may be unilateral or bilateral. 10 [20%] cases were detected as maxillary sinusitis. Amongst them 5 [10%] were male and 5 [10%]were females. 3 cases [6%] were detected as bilateral maxillary sinusitis. 2 cases [4%]. were also having mucosal thickening and edema in frontal sinuses. One of the cause of Headache is deflected nasal septum [DNS]. In this study 5 [10%] patient were diagnosed as a case of DNS. Plain film studies ofparanasal sinuses, occipitomental view is the most frequent initial / primary imaging study advised because of its comparatively low cost, frequent availability, low radiation dose and easy to perform entity.. Although, CT Scan ofparanasal sinus is preferred choice especially when Functional Endoscopic Sinus Surgery [FESS] is planned

CT guided renal biopsy: Safety and efficacy, a study in Pakistan

Percutaneous renal biopsy [PRB] of native kidney with automated spring loaded device is performed with various techniques to improve efficacy and safety .This study was performed to evaluate[1] the safety and efficacy of PRB performed under CT guidance[2] time to develop complications to see whether this procedure can be performed as outpatient[3] diagnostic yield of the specimen. The study was conducted at the Department of Nephrology of Dr. Ziauddin Hospital, on all patients admitted for renal biopsy between 1[st] January 2009 to 31[st] December 2011. PRB was performed on native kidneys by experienced nephrologist under CT guidance with a 18 guage automated spring loaded biopsy gun. Patients were included if they fulfilled the inclusion criteria. All patients were observed for 24 hours post biopsy for major complications like gross hematuria, drop in hemoglobin requiring transfusion, or requiring surgical or radiological intervention and minor complications like transient hematuria, spontaneously resolving perinephric hematoma and their timing of development. In addition, information was gathered regarding diagnostic yield of the specimen. 100 consecutive biopsies were performed. There were no major complications in 98% of the biopsies. 2% patients developed gross hematuria and significant hematoma with a drop in hemoglobin that required blood transfusion. 2% of patients developed minor complications. 100% of the specimen had adequate tissue for making the diagnosis. All major complications developed within 12 hours of procedure. The minor complication occurred at 18 hrs. PRB under CT guidance is a safe and effective procedure; however recommendations can not be made to perform it on outpatient basis

Comparison of oral versus injectable vitamin-D for the treatment of nutritional vitamin-D deficiency rickets

To assess the safety and acceptability of a single dose of vitamin-D versus the efficacy of injectable Vitamin-D versus oral vitamin-D. Case control. It was carried out at the Department of Paediatrics, Kharadar General Hospital, Karachi, from August 2003 to April 2004. Children of the age of 6 months to 3 years with clinical, biochemical and radiological evidence of vitamin-D deficiency rickets were included. The history, clinical examination, complete blood picture, serum calcium. Phosphorus, alkaline phosphatase and X-ray of wrist joint were done. The children were divided into two groups A and B. Group A was given oral vitamin-D and group B was given intramuscular injection of vitamin-D on the first day and then they were followed for two more visits at 30 and 90 days with clinical, biochemical and radiological examinations to assess the outcome. There were 50 confirmed cases of rickets in each group. The mean age was 10.9 +/- 5.1 months and 14.7 +/- 8.1 months in group A and B respectively. In these children, clinical features were weakness, difficulty in walking, frontal bossing, ribcage deformity and widening of wrist were seen. After one dose of vitamin-D [cholecalciferol], there was appreciable gain of weight and height and raised levels of alkaline phosphatase became normal during follow-up. Radiological florid rickets and non-florid rickets in both groups healed clinically during follow-up period. Oral and injectable forms of vitamin-D [cholecalciferol] were effective but injectable form was shown to be statistically significant. There were no undesirable side effects and both forms of treatment were well-tolerated

The effect of different initial densities of nematode (Meloidogyne javanica) on the build-up of Pasteuria penetrans population / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Pasteuria penetrans will build-up faster where there is a high initial nematode density and can suppress root-knot nematode populations in the roots of tomato plants. The effect of different initial densities of nematode (Meloidogyne javanica) (150, 750, 1500, 3000) and P. penetrans infected females (F1, F3) densities (F0=control and AC=absolute control without nematode or P. penetrans inoculum) on the build-up of Pasteuria population was investigated over four crop cycles. Two major points of interest were highlighted. First, that within a confined soil volume, densities of P. penetrans can increase >100 times within 2 or 3 crop cycles. Second, from a relatively small amount of spore inoculum, infection of the host is very high. There were more infected females in the higher P. penetrans doses. The root growth data confirms the greater number of females in the controls particularly at the higher inoculum densities in the third and fourth crops. P. penetrans generally caused the fresh root weights to be higher than those in the control. P. penetrans has shown greater reduction of egg masses per plant at most densities. The effects of different initial densities of M. javanica and P. penetrans on the development of the pest and parasite populations were monitored. And no attempt was made to return the P. penetrans spores to the pots after each crop so the build-up in actual numbers of infected females and spores under natural conditions may be underestimated.

Comparison of gated blood pool ventriculography with echocardiography and contrast ventriculography for left ventricular ejection fraction determination in post myocardial infarction patients

Obective: We compared the efficacy of gated blood pool [GBP] ventriculography with echocardiography and contrast ventriculography for measurement of left ventricular ejection fraction [LVEF] in patients with myocardial infarction. Gated blood pool ventriculography [invivo technique] and echocardiography were performed in 30 patients at least after 24 hours but within 48 hours of contrast ventriculography. Echocardiographic methods included: [1] Subjective [visual] estimation of LVEF from 2 dimensional [2D] echocardiography. [2] 2D directed M-mode [Cubed method] echocardiography. Single plane cine ventriculographic ejection fractions were calculated using Dot calibration method. The comparison of GBP ventriculographic LVEF with contrast ventriculographic LVEF and 2D echo estimated LVEF revealed no significant difference in their mean ejection fraction [44.04 +/- 11.93 vs 48.46 +/- 12.78% p = NS] and [44.04 +/- 11.93 vs 47.38 +/- 13.06%, p= NS] respectively, while comparison of GBP LVEF with 2D directed M-mode [cubed method] echocardiography revealed highly significant difference in their mean EF [44.04 +/- 11.93 vs 61.7 +/- 15.65%, p < 0.01]. GBP LVEF has statistically significant correlation with contrast ventriculographic [r = 0.86] and 2D echo estimated [r = 0.77] LVEF, while has poor correlation [r = 0.57] with cubed formula from 2D echo. GBP ventriculography can be utilized accurately for determination of ejection fraction in post myocardial infarction patients for diagnostic and prognostic evaluation

Comparison of myocardial perfusion imaging studies with technetium 99' tetrofosmin and coronary angiography findings in non-diabetic and diabetic patients of ischemic heart disease

The main objective of this study was to compare the results of myocardial perfusion imaging studies with Tc99' tetrofosmin and coronary angiography finding in non-diabetic and diabetic patients of ischemic heart disease. This study compared the results of Single Photon Emission Computed Tomographic [SPECT] imaging with technetium-99m tetrofosmin with those of coronary angiography findings in non-diabetic and diabetic patients of ischemic heart disease. Total 35 patients were included in this study and divided in to two groups, the diabetic group and non-diabetic group. Out of 35 patients 18 were were non-diabetics and 17 were diabetics. All the patients underwent stress/rest imaging with technetium tetrofosmin and coronary angiopgraphy. SPECT images were divided in to five segments per patients and >= 70% occlusion of coronary artery were considered to be significant. In comparison with nondiabetic from diabetics, the diabetics have significant number of reversible ischemia in anterior wall [p=0.023] although the angiography findings showed no significant difference in the severity of disease in left anterior descending coronary artery that is the main coronary artery to supply the anterior wall. This shows that due to diffuse disease in diabetics the severity of disease could not be assessed correctly by coronary angiography because due to diffuse nature of disease there is a lack of normal lumen for comparison. Therefore in diabetics myocardial perfusion imaging is more informative as compared to non-diabetics

Left ventricular ejection fraction [LVEF] determination in post myocardial infarction patients. A comparison of gated blood pool [GBP] ventriculography and contrast ventriculography

To compare the efficacy of gated blood pool versus contrast ventriculography [Gold standard] for determination of ejection fraction in post myocardial infarction patients. Patients and Gated blood pool imaging [BPI] was performed by gated blood pool radionuclide ventriculography or MUGA in 30 patients within 48 hours after single plane [RAO-30] contrast ventriculography. Statistical analysis was done by student "t-test" [unpaired] and by Pearson's correlation co-efficient. Result: There was no significance difference in their mean ejection fraction [44.04 +/- 11.93 Vs 48.46 ' 12.78%, P = NS] and has statistically significant correlation [r=0.86, P=0.171] GBP ventriculography can therefore be utilized accurately for determination of ejection fraction for prognostic and diagnostic evaluation of post myocardial infarction patients

Correlation of technetium 99 M tetrofosmin perfusion imaging with coronary angiography in patients with known or suspected coronary artery disease

This study correlated the results of Single Photon Emission Computed Tomographic [SPECT] imaging with technetium-99m tetrofosmin with those of coronary angiography in patients with known or suspected coronary artery disease. Total 65 patients were included in this study and divided in to two groups, the study group and the control group. 35 patients included in study group and 30 patients in control group. All the patients underwent stress/ rest imaging with technetium tetrofosmin and coronary angiography. SPECT images were divided in to five segments per patient and > 70% occlusion of coronary arteries were considered to be significant. 95 perfusion defects were noted and 70 coronary arteries were involved in diseased process. Left anterior descending artery [LAD] was involved in 70% of cases and right coronary artery [RCA] in 66%. In Tc. Tetrofosmin study the fixed defect was more common in left ventricular apex and reversible ischemia and mixed defect in inferior wall. Regarding sensitivity RCA 87%, LAD 85% and circumflex 70% and specificity 93% in circumflex, 83% in RCA and 75% in LAD and the p-value is <0.01

Incidence of carcinoma of gallbladder discovered on routine histopathology after cholecystectomy for cholelithiasis

This is a retrospective study of 148 patients, seeking for incidence of carcinoma of gallbladder in patients admitted with cholelithiasis in Surgical unit-3, Civil Hospital Karachi, form January 1999 to 2001, all of whom underwent cholecystecomy. Out of 148 patients, 120 [81%] were females [mean age 40 years], 14 [9.4%] were males [mean age 56 years]. The commonest clinical presentation was of upper abdominal pain [93%], followed by flatulent dyspepsia [65%], nausea and vomiting [25%], and palpable gallbladder [17%], jaundice [14%]. Live function tests were altered in 21% of cases, with raised alkaline phospatase in 17%. Utraonography of abdomen was done in all the patients, which showed choleithiasis in 100% of cases, increased wall thickness [7%], irregularity in the wall [4%], CBD dilatation with or without stones in 16% of cases. Laparoscopic Cholecystectomy was done in 72 patients and open cholecystectomy was done in 65 patients. 16 patients had CBD exploration. 08 patients were suspected of carcinoma gallbladder per-operatively. Cholecystectomy plus wedge resection of liver was done in 05 patients and the other 03 suspected cases had simple cholecystectomy. Histopathology of all the above patients revealed inflammatory changes in 138 patients [93%], 10 patients [7%] were diagnosed as stage-I carcinoma of gallbladder on histopathology. Of these 06 came bock for follow up, and no further surgical intervention was offered and treatment was expectant and symptomatic. The incidence of carcinoma discovered on routine histopathology after cholecystectomy for choleithiasis with chollecystitis was 7%

Effect of menopause on serum calcium phosphorus and alkaline phosphatase in relation to urinary calcium, phosphorus and hydroxyproline

Our study included thirty premenopausal and thirty postmenopausal women and their serum calcium, inorganic phosphate, alkaline phosphatase and urinary calcium, phosphates, creatinine and hydroxyproline were determined. Serum calcium and its urinary excretion was found to be significantly higher in postmenopausal group while urinary hydroxproline was also markedly raised in postmenopausal women. Serum phosphorous does not appear to be of importance although it was slightly higher. Alkaline phosphatase showed no significant changes. Our findings show that serum and urinary calcium and urinary hydroxyproline can be used as biochemical markers to assess bone changes in post menopausal women