Toxic effect of common poisonous plants of district Bannu, Khyber Pakhtunkhwa, Pakistan

The present paper was a part of Ph.D research work, conducted during the year 2014, in which 87 poisonous plants belonging to 54 genera, were collected, documented and preserved in the herbarium of Bannu, Department of Botany UST, Bannu Khyber Pakhtunkwa Pakistan. The plants were identified botanically, arranged alphabetically along with their Latin name, family name, common name, poisonous parts, toxicity, affects, toxin and their effects. Aim of the study was to induce awareness in the local people of district Bannu about the poisonous effects of the commonly used plants. Data about poisonous effect were collected from the local experienced and mostly old age people through questionnaire. Some information were collected from a number of veterinary texts and literature. The most important plants genera studied in the area were Brassica 6 species [11.11%], Lathyrus 5 spp [9.26%], Astragalus, Euphorbia and Prunus were with 4 spp [7.40%]. Datura, Jatropha, Ranunculus, Solanum and Sorghum were with 3 spp [5.56%] while Allium, Amaranthus, Chenopodium, Melilotus and Taxus were with 2 spp [3.70%]. These 15 genera contribute 48 species [55.17 %] while the remaining 39 genera have single species each and contribute 44.83% to the total poisonous flora of the research area. Other important poisonous plants were Anagallis arvensis L., Cannabis sativa, Datura stramonium L., D. metel L., Euphorbia species, Heliotropium europaeum, Ipomoea tricolor, Jatropha curcas, Lolium temulentum L., Malus domestica, Mangifera indica L., Medicago sativa L., Melilotus alba Desr., M. officinalis [L.] Lam., Mirabilis jalapa L., Narcissus tazetta, Nicotiana tabacum L., Sorghum halepense [L] Pers., and Xanthium strumarium. It was concluded that the local population had poor knowledge about the poisonous effect of the plants and the present research work was anticipated for use by health care professionals, veterinarians, farmers, homeowners, as well as botanically curious individuals

Comparison of wound healing with and without adjuvant topical oxygen therapy in infected diabetic wounds

Diabetes mellitus [D.M] is one of the main problems in health systems and a global public health threat that has increased dramatically over the past 2 decades. Patients with D.M are prone to multiple complications such as diabetic foot ulcer [DFU]. Despite of the advantages of debridement, adequate debridement must always precede the application of topical wound healing agents, dressings or wound closure techniques

Objective: The objective of the study was to compare the efficacy of adjuvant topical oxygen therapy with conventional methods and conventional methods alone in management of infected diabetic wounds

Study Design: Randomized Control Trial

Setting: Surgical Unit III, Allied Hospital, Faisalabad

Period: 4 months from March to June 2017

Methodology: A total of 120 cases included in this study were admitted either through OPD or emergency ward. Group A [Topical oxygen therapy was given along with conventional methods]. Group B [Only conventional methods of wound care were applied]. All patients were given single dose IV antibiotic half an hour before induction of anesthesia. All diabetic patients were administered regular insulin to control blood glucose levels. Good debridement was done, removing all dead tissue. Simple available cellophane bag applied, sterilized with antiseptic solution, tailored according to size of affected part used tapped on open side of body of patient like tourniquet. 100% oxygen was given in bag with routinely available oxygen cylinder exposing whole affected part of body or limb. Oxygen in chamber was given for maximum one and a half hour twice daily in one sitting for 7-10 days. Gram positive, gram negative and anaerobic cover was given with antibiotics. Wound was washed daily with normal saline. After clinical improvement patient was discharged and called for follow up at outdoor on weekly basis initially and then fortnightly for 6 months

Results: Mean age was calculated as 49.56+/-7.02 and 49.11+/-6.59years in group A and B respectively. 53.33% [n=32] in group A and 58.33% [n=35] in group B were males, while 46.67% [n=28] in group A and 41.67% [n=25] in group B were females. Comparison shows that 46.67% [n=28] in group A and 26.67% [n=16] in group B had efficacy; p value was calculated as 0.02 showing a significant difference

Conclusion: Efficacy of adjuvant topical oxygen therapy with conventional methods is significantly higher when compared with conventional methods alone in management of infected diabetic wounds

Cytotoxic activities of Rosa brunonii, Calligonum polygonoides Pegnum harmala and Sueda fruticosa extract using brine shrimp

The present study was carried out to record and evaluate the effect of Rosa brunonii, Calligonum polygonoides, Sueda fruticosa and Pegnum harmala L., extracts on brine shrimp collected during March-June 2013 from different regions of District Bannu. These four plants were medicinal xerophytes and widely distributed throughout Pakistan. Rosa brunonii is commonly used as a hedge plant for gardening. Calligonum polygonoides and Sueda fruticosa are locally used as a fuel, while Pegnum harmala [L.] is the most important multipurpose medicinal xeric plant, which is used for various purposes. All these selected medicinal xerophytes have inhibitory effect on bacterial growth. In this study the effect of different concentration [10-70 microg/ml] were tested on brine shrimp. The results showed that maximum cytotoxic activities were observed in Rosa brunonii [100.0+/-0.4], Calligonum polygonoides [100.0+/-0.2] and Pegnum harmala [L.] [90.0+/-5.2] while Sueda fruticosa [50.0+/-7.1] has less cytotoxic property. These activities are may be due to the presence of bioactive constituents

Frequency of hbv infection and its risk factors in asymptomatic military personnels

Objective: To determine the frequency of silent Hepatitis B virus [HBV] infection, its symptoms and risk factors in apparently healthy military personnel of Pakistan Army

Study Design: Descriptive cross sectional study

Place and Duration of Study: Department of medicine, Combined Military Hospital Okara from Oct 2012 to Mar 2013

Material and Methods: A total of 6236 healthy troops with age ranging from 18 to 57 years without previous or present history of HBV infection were selected by consecutive sampling from Okara Garrison. Blood samples were subjected to rapid screening of HBV infection using immunochrom atographic [ICT] kits [Intec production, Inc] with sensitivity and specificity of 99.8% and 95 % respectively. All positive cases were confirmed by 4th generation ELISA and PCR for HBV DNA were also sent. All infected cases were given a questionnaire about different risk factors of HBV infection. Finally variables were defined qualitatively and quantitatively and frequency, percentage, mean [SD] were calculated. All the data was analyzed using SPSS version 19

Results: Age ranged from 18-57 years with mean age of the study group 27 [ +/- 7.2] years. Mean age among those with HBs Ag positive was 32 [ +/- 7.3] years. Frequency of HBV infection was 2.03% [127 participants out of 6236] whereas PCR for HBV DNA was positive in 51 out of 127 [40.1%]. Most common symptom was anorexia in 16 patients [12.6%] followed by fatigue and fever in 15 patients [11.8%] each. While 42 patients [33.1%] were asymptomatic. Dental procedures was found to be most frequent risk factor [25.9%] followed by previous history of surgery [21.2%]

Conclusion: Although pre induction screening of HBV infection is carried out in Pak Army still its prevalence is matched with that of general Pakistani population. Soldiers' education and immediate vaccination is recommended at time of induction to stop the spread of this dreadful disease in Pak army

Complications of total extraperitoneal [TEP] repair for adult inguinal hernia

Objectives: To evaluate results of laparoscopic total extra peritoneal repair for inguinal hernia in terms of complications. Setting: Surgical Unit 3, Allied Hospital, Faisalabad. Period: From March 2013 to February 2016. Study Design: Simple Descriptive Study

Patients and Methods: 114 patients over the age of 30 years underwent TEP repair for unilateral reducible inguinal hernia. Complications assessed included pain score assessment, analgesia requirement, time taken to return to normal activity and complications like intraperitoneal injury, conversion to open procedure, seroma and hematoma formation and surgical site infection

Results: Out of the 114 patients, 6 [5.26%] needed TEP converted to open and none suffered from serious complication during the procedure. 8 [7.01%] developed postoperative hematoma, 7 [6.14%] developed seroma and 5 [4.38%] developed surgical site infection. Postoperative pain assessment at 8 hours after surgery showed 42[36.8%] patients required extra analgesia while 13[11.4%] patients required extra analgesia 24 hours after surgery

Metabolic syndrome in soldiers of armed forces

Objective: To determine frequency of metabolic syndrome and its components amongst soldiers of Armed Forces

Study Design: Descriptive cross sectional

Place and Duration of Study: Medical department, Okara CMH, October 2012to March 2013

Patients and Methods: Our study included 2187 male soldiers. Age ranged from 20 to 52 years. Detailed history and examination of all the participants was done. Body mass index [BMI], waist circumference [WC] and blood pressure [BP] of each subject were recorded. BMI > 25 kg/m[2] and WC > 90 cm was considered obesity and abdominal obesity respectively. BP > 130/85 mmHg defined as hypertension. Blood glucose fasting, HDL cholesterol and triglycerides levels were checked in all participants. SPSS version 16 was used to analyzethe data. p value of less than 0.05 was considered statistically significant

Results: In our study, 783 participants [35.8%] were found to have abdominal obesity.Overall 491 [22.5%] soldiers had metabolic syndrome out of which 438 [89%] were physically inactive. Frequency of metabolic syndrome was 31.7% [156 out of 491] in age group 20 to 36 years while 68.3%[335 out of 491] in 37 to 52 years of age. Hypertriglyceredemia was present in 504 [23%], low HDL cholesterol in 496[22.6%], hypertension in 210 [9.6%] and abnormal glycemic control in 197 subjects [9%]

Conclusion: A large number of Army soldiers are suffering from metabolic syndrome. Its frequency is increased with increasing age, weight and physical inactivity.Patientswith previous history of diabetes or hypertension were 4 times at risk of developing Metabolic Syndrome as compared to others

Prevalence of non alcoholic fatty liver disease in patients with metabolic syndrome

To determine frequency of Non Alcoholic fatty liver disease in patients with Metabolic Syndrome [MetS]. Cross sectional study. Department of medicine, CMH Okara, Jan 2013 to July 2013. We included 491 adult males, diagnosed with metabolic syndrome [MetS], presenting in outpatient department for routine review. MetS was diagnosed as per the International Diabetes Federation [IDF] proposed criteria of 2004. Detailed history and examination of each individual was done and data entered in pre designed performa. Brightness and posterior attenuation on ultrasound abdomen were considered indices for fatty liver disease in presence of elevated ALT, negative hepatitis serology and absence of alcohol intake. All the data was analyzed using SPSS version 16. p value of less than 0.05 was considered statistically significant. Out of 491 participants with MetS, 222 [45.2%] had fatty liver disease. Mean BMI in patients with metabolic syndrome was 26.1 [ +/- .89] and mean BMI in fatty liver patients was 27.3 [ +/- 0.67].Out of total 5 components of Mets, patients with fatty liver disease had 3.24 [ +/- 0.25] components, as compared to 2.1 [ +/- 0.34] in whole of study group. A large number of patients with metabolic syndrome have fatty liver disease. Fatty liver disease is more frequent in patients who are overweight and those having multiple risk factors of metabolic syndrome

Frequency of coronary artery disease [cad] risk factors in armed forces

To determine the frequency of risk factors of coronary artery disease [CAD] in apparently healthy soldiers of Pakistan Armed Forces. Cross sectional descriptive study. Department of medicine, CMH Okara from July 2012 to Dec 2012. The study included 2215 male currently serving soldiers in age range of 18 to 52 years by consecutive sampling. Relevant history, body mass index [BMI], waist circumference [WC] and blood pressure [BP] of each subject were recorded. BMI > 25 kg/m[2] and WC > 90 cm was considered obesity and abdominal obesity respectively. BP > 140/90 mmHg was defined as hypertension. All the participants of study underwent blood glucose fasting, blood glucose random, ECG recording, personality assessment and lipid profile. Risk estimation was done using Eric Brittain scoring system. In our study group 95.5% patients were having at least 1 risk factor of CAD, 54% were having 2 to 4 risk factors while 3.93% had > 4 risk factors. Risk estimation of CAD using Eric Brittain scoring system showed that a large proportion of study group had high probability of developing ischemic heart disease in next 6 years. A large proportion of our soldiers are harboring risk of CAD due to increase in frequency of 8 conventional CAD risk factors especially obesity

Frequency of retinopathy in newly diagnosed patients of type 2 Diabetes Mellitus [DM]

This study was to determine the frequency of retinopathy in newly diagnosed type-I1 Diabetics. Cross sectional descriptive study. It was conducted at Department of medicine, Military Hospital [MH], Rawalpindi from 1st Jan 2012 to 30 Jun 2012. We included 200 patients of type-I1 DM from both genders diagnosed in last 03 months from both outdoor and indoor departments in the age range of 40 to 70 years by consecutive sampling. All patients having co morbidities affecting retina were excluded. Informed written consent was taken before enrollment. Formal approval of the study was taken from hospital ethical committee. Ocular Fundoscopy was performed with WelchAllyn Ophthalmoscope [REF 11470] as per standard protocols and both eyes were elamined. The grade of DR [diabetic retinopathy] awarded as per highest changes in any of the two eyes. All tests were carried by a single person to avoid inter-observer variations. Findings of ocular fundoscopy were confirmed by ophthalmologist. All data was analyzed by using SPSS version 11. Out of 200 subjects 63.5% were male and 36.5% were female. Age ranged from 40 to 70 years with mean age of 51.05 + 6.910 years. 29 [14.5%] subjects had Diabetic retinopathy. Out of 29 patients, 24 [82.8%] had preproliferative and 5 [17.2%] had proliferative diabetic retinopathy. A significant proportion of diabetic patients have retinopathy at the time of diagnosis of their disease which is more common in males and with increasing age. It is recommended to thoroughly screen the newly diagnosed diabetics for early detection of diabetic retinopathy and its management involving early referral to eye specialist

Frequency of resistant hypertension in a hypertensive population

To determine the frequency of resistant hypertension in hypertensive population. Descriptive study. CMH Kohat, Pakistan from Aug 2010 to Dec 2010. One hundred and fifty patients were selected for the study. All had blood pressure > 140/90 mmHg despite use of 3 antihypertensive drugs including one diuretic. Once admitted, patients were given the same medicines in the doses which they were taking under DOT [direct observed therapy] programme executed by a nursing assistant to exclude non-compliance to treatment. All the data was analyzed using SPSS version 16. Out of total 150 patients, 96 [64%] patients were males and 54 [36%] were females. Male to female ratio was 1: 1.8. Mean age was 46.93 years [SD +/- 16.38]. Compliance of patients to anti hypertensive treatment was ensures by DOT. There was no step up treatment. Mean BMI was 25.95 kg/m[2] [SD +/- 2.38], patients 71.3% were overweight i.e. BMI > 25 kg/m[2]. Out of total 150 patients, 16 [10.7%] patients had resistant hypertension using the cut off value of BP >140/ 90 mmHg. A significant number of hypertensive patients are suffering from resistant hypertension. Such patients need further evaluation to rule out any genetic, secondary and life style/diet related cause

Hypomagnesemia; frequency in patients with type 2 diabetes mellitus

To determine frequency of Hypomagnesaemia in patients of type 2 diabetes mellitus in our population. Random selection of DM II patients from Outpatient Department CMH, Kharian.: Cross sectional study. Combined Military Hospital Kharian, Department of Medicine. January 2011 to December 2011. We selected outdoor patients of DM-2 from both gender between 40 to 70 yrs of age by random sampling. Those selected, were subjected to blood fasting and random glucose measurements as well as serum magnesium levels. Blood samples were collected using full aseptic measures and vtfthin one hour, samples were transported to Armed Forces institute of Pathology [AFIP] for analysis. Serum magnesium level estimation was done by timed endpoint method using calmagite dye. DXC 600 automated analyzer was used. The results were verified by Pathologist. The overall frequency of Hypomagnesemia was 32.2% [124 out of the 385 subjects] using the cutoff value of less than 0.6mmol/l for Hypomagnesaemia, whereas 67.8% [261 out of the 385 individual] had normal serum magnesium levels. Significant number of patients with type 2 diabetes mellitus suffers from Hypomagnesaemia. These patients have increased risk risk of poor Glycemic control and diabetic complications due to Hypomagnesemia. Therefore, it is recommended that serum magnesium levels should be checked regularly in patients with type 2 diabetes mellitus and oral magnesium replacement should be done

Vitamin d deficiency in patients with tuberculosis

To determine the frequency and association of Vitamin D deficiency in patients with tuberculosis. Case control study. Medical Department, Combined Military Hospital, Kharian, from July 2010 to June 2012. One hundred and five outdoor patients of tuberculosis were selected with 255 gender matched controls. Tuberculosis was diagnosed by presence of acid fast bacilli in sputum smears, positive culture for Mycobacterium tuberculosis or demonstration of chronic caseating granulomatous inflammation in tissue specimens. Controls were drawn randomly from general population. Serum 25 hydroxyvitamin D [25 [OH] D3] levels < 25 ng/ml was considered Vitamin D deficiency. The results were analyzed on SPSS version 17. Mean Vitamin D levels were 23.23 +/- 6.81 ng/ml in cases, 29.27 +/- 8.89 ng/ml in controls [p < 0.0001]. Vitamin D deficiency was found in 57% of cases and 33% controls [p < 0.0001]. Mean Vitamin D levels were significantly lower in females with tuberculosis [20.84 ng/ml] as compared to males [25.03 ng/ml, p = 0.002]. Mean BMI in patients of tuberculosis with Vitamin D deficiency were 19.51 +/- 1.77 kg/m2 and in patients with normal Vitamin D were 21.65 +/- 1.79 kg/m2 [p < 0.0001]. Mean Vitamin D levels in patients with multi-drug resistant tuberculosis was lower to a mean of 15.41 +/- 4.67 ng/ml [p < 0.0001]. There is significant deficiency of Vitamin D in patients with tuberculosis as compared to controls. This deficiency is more pronounced in females, individuals with low BMI, extra pulmonary and MDR tuberculosis.

Laparoscopic orchidopexy

Case series. Pediatric surgical department of B V Hospital [QAMC] Bahawalpur and Allied Hospital Faisalabad. From April 2005 to Mar 2007. Cryptorchidism is most frequent presentation in pediatric population. Laparoscopy has become [Gold Standard] in the diagnosis and therapy of nonpalpable undescended testis. We present our two year experience in the management of 40 cases at two centers. The age of the patients ranged from 9 months to 12 years. Laparoscopy was done to localize the testis prior to surgery. Thirty four patients underwent one stage laparoscopic orchidopexy, 7 patients had open orchidopexy and 3 needed two stage Fowler-Stephen orchiodopexy. Laparoscopy is a valuable tool in both diagnosis and treatment of nonpalpable testis

Ultrasound, Ct-scan, and laparoscopy, diagnostic observations on non-palpable testis

To evaluate the comparative diagnostic efficacy of Ultrasound, CT-Scan, and Laparoscopy in the diagnosis of non-palpable undescended testes in pediatric patients. Comparative study. Surgical and pediatric surgical department of B V Hospital [QAMC] Bahawalpur and Allied Hospital Faisalabad. From April 2006 to April 2007. A total forty boys with non palpable testis were subjected to Ultrasound, CT-Scan and diagnostic laparoscopy in a period of one year. The patients above 12 years and with cardiovascular anomalies were excluded from the study. Laparoscopy was performed under general anesthesia and findings were compared with Ultrasound and CT-Scan. Sensitivity and specificity of each were calculated. Diagnostic accuracy of Ultrasound was 25%, CT-Scan was 64% and Laparoscopy was 100%. Sensitivity was found to be 20%, 63% and 100% and specificity was 10%. 50% and 100% for Ultrasound, CT-Scan and Laparoscopy, respectively. Diagnostic laparoscopy is far more superior as compared to Ultrasound and CT-Scan in the diagnosis of non palpable testis