Determinants of Urolithiasis in Adult Patients Presenting to Urology Outdoor Mayo Hospital, Lahore

This study was focused on The Determinants of Urolithiasis in Adults presenting to outdoor of Mayo Hospital, Lahore. Urolithiasis means stones in the urinary tract which may be of oxalate, phosphate or calcium. Objectives: To identify the frequency of various precipitating factors of urolithiasis and the percentage contributed by each factor in the disease. . Design: Sample study. Place: Lahore. Study Period: 2-3 months. Subjects and Methods: A sample was taken out of a 100 subjects having urinary tract stones presenting to Urology Outdoor, Mayo Hospital, Lahore. Selection methods were discussed to define the criteria for selection of the population. Patients were interviewed through questionnaires. Modern data collection, compilation and analysis techniques were adopted.After describing the demographic characteristics using frequency tables, pie charts and bar charts were prepared for illustration. Results: Out of 100 subjects, urolithiasis was found to be more in people above 35 yrs (64%), mostly common in women (54%) as compared to males (46%). Less water intake (in57% cases), unfiltered/ unboiled drinking water (in 82% cases), high intake of green vegetables/tomatoes (in 40% cases) and urinary tract infections (in 57% cases) were found to be significantly associated with urolithiasis, 69.5% of the males had pre existing Benign Prostate Hyperplasia. 24% of the cases were on diuretics when they developed urolithiasis. Contribution of commonly notorious risk factors like high calcium intake, high protein diet was not found to be significant. 23% of the individuals were taking high calcium supplements.4% of the individuals were on high protein diet. 25% of the individuals had pre existing hypertension. Only 21% of the individuals had co existing gouty arthritis. 13% had pre existing diabetes mellitus. None of them was on drugs like triamterene, indinavir, and sulfadiazine

CO1-Based DNA barcoding for assessing diversity of Pteropus giganteus from the state of Azad Jammu Kashmir, Pakistan / Código de barras de DNA à base de CO1 para avaliar a diversidade de Pteropus giganteus do estado de Azad Jammu e Caxemira, Paquistão

Abstract The flying fox (Pteropus giganteus) also familiar with the name of the greater Indian fruit Bat belongs to the order Chiroptera and family Pteropodidae. Current research emphasis on the DNA barcoding of P. giganteus in Azad Jammu Kashmir. Bat sequences were amplified and PCR products were sequenced and examined by bioinformatics software. Congeneric and conspecific, nucleotide composition and K2P nucleotide deviation, haplotype diversity and the number of haplotypes were estimated. The analysis showed that all of the five studied samples of P. giganteus had low G contents (G 19.8%) than C (27.8%), A (25.1%) and T (27.3%) contents. The calculated haplotype diversity was 0.60% and the mean intraspecific K2P distance was 0.001% having a high number of transitional substitutions. The study suggested that P. giganteus (R=0.00) do not deviate from the neutral evolution. It was determined from the conclusion that this mtDNA gene is a better marker for identification of Bat species than nuclear genes due to its distinctive characteristics and may serve as a landmark for the identification of interconnected species at the molecular level and in the determination of population genetics.

Resumo A raposa-voadora (Pteropus giganteus), também conhecida como morcego indiano, pertence à ordem dos Chiroptera e à família Pteropodidae. A presente pesquisa dá ênfase ao código de barras de DNA de P. giganteus em Azad Jammu e Caxemira. Sequências genéticas dos morcegos foram amplificadas, e os produtos de PCR foram sequenciados e examinados por software de bioinformática. De espécies congenérica e coespecífica, foram estimados composição nucleotídica e desvio de nucleotídeos K2P, diversidade de haplótipos e número de haplótipos. A análise mostrou que todas as cinco amostras estudadas de P. giganteus apresentaram baixos teores de G (19,8%) em comparação com C (27,8%), A (25,1%) e T (27,3%). A diversidade de haplótipos calculada foi de 0,60%, e a distância média intraespecífica de K2P foi de 0,001%, com um elevado número de substituições transicionais. O estudo sugeriu que P. giganteus (R = 0,00) não se desviou da evolução neutra. É possível concluir que o gene mtDNA é um marcador favorável para identificação de espécies de morcegos do que genes nucleares por causa de suas características distintivas e pode servir como um marco para a identificação de espécies interconectadas em nível molecular e para a determinação genética de populações.

The impact of corticosteroid use on inpatients with inflammatory bowel disease and positive polymerase chain reaction for Clostridium difficile

BACKGROUND/AIMS: Optimal management of inflammatory bowel disease (IBD) with concomitant Clostridium difficile infection (CDI) is controversial, especially when CDI diagnosis is made by polymerase chain reaction (PCR) testing, which may reflect colonization without infection. METHODS: We performed a multicenter review of all inpatients with IBD and PCR diagnosed CDI. Outcomes included length of stay, 30- and 90-day readmission, colectomy during admission and within 3 months, intensive care unit (ICU) admission, CDI relapse and death for patients who received corticosteroid (CS) after CDI diagnosis versus those that did not. Propensity-adjusted regression analysis of outcomes based on CS usage was performed. RESULTS: We identified 177 IBD patients with CDI, 112 ulcerative colitis and 65 Crohn's disease. For IBD overall, CS after CDI diagnosis was associated with prolonged hospitalization (5.5 days: 95% confidence interval [CI], 1.5–9.6 days; P=0.008), higher colectomy rate within 3 months (odds ratio [OR], 5.5; 95% CI, 1.1–28.2; P=0.042) and more frequent ICU admissions (OR, 7.8; 95% CI, 1.5–41.6; P=0.017) versus no CS. CS use post-CDI diagnosis in UC patients was associated with prolonged hospitalization (6.2 days: 95% CI, 0.4– 12.0 days; P=0.036) and more frequent ICU admissions (OR, 7.4; 95% CI, 1.1–48.7; P=0.036). CONCLUSIONS: CS use among IBD inpatients with CDI diagnosed by PCR is associated with poorer outcomes and would seem to reinforce the importance of C. difficile toxin assay to help distinguish colonization from infection. This adverse effect appears more prominent among those with UC.

CO1-Based DNA barcoding for assessing diversity of Pteropus giganteus from the state of Azad Jammu Kashmir, Pakistan

Abstract The flying fox (Pteropus giganteus) also familiar with the name of the greater Indian fruit Bat belongs to the order Chiroptera and family Pteropodidae. Current research emphasis on the DNA barcoding of P. giganteus in Azad Jammu Kashmir. Bat sequences were amplified and PCR products were sequenced and examined by bioinformatics software. Congeneric and conspecific, nucleotide composition and K2P nucleotide deviation, haplotype diversity and the number of haplotypes were estimated. The analysis showed that all of the five studied samples of P. giganteus had low G contents (G 19.8%) than C (27.8%), A (25.1%) and T (27.3%) contents. The calculated haplotype diversity was 0.60% and the mean intraspecific K2P distance was 0.001% having a high number of transitional substitutions. The study suggested that P. giganteus (R=0.00) do not deviate from the neutral evolution. It was determined from the conclusion that this mtDNA gene is a better marker for identification of Bat species than nuclear genes due to its distinctive characteristics and may serve as a landmark for the identification of interconnected species at the molecular level and in the determination of population genetics.

Resumo A raposa-voadora (Pteropus giganteus), também conhecida como morcego indiano, pertence à ordem dos Chiroptera e à família Pteropodidae. A presente pesquisa dá ênfase ao código de barras de DNA de P. giganteus em Azad Jammu e Caxemira. Sequências genéticas dos morcegos foram amplificadas, e os produtos de PCR foram sequenciados e examinados por software de bioinformática. De espécies congenérica e coespecífica, foram estimados composição nucleotídica e desvio de nucleotídeos K2P, diversidade de haplótipos e número de haplótipos. A análise mostrou que todas as cinco amostras estudadas de P. giganteus apresentaram baixos teores de G (19,8%) em comparação com C (27,8%), A (25,1%) e T (27,3%). A diversidade de haplótipos calculada foi de 0,60%, e a distância média intraespecífica de K2P foi de 0,001%, com um elevado número de substituições transicionais. O estudo sugeriu que P. giganteus (R = 0,00) não se desviou da evolução neutra. É possível concluir que o gene mtDNA é um marcador favorável para identificação de espécies de morcegos do que genes nucleares por causa de suas características distintivas e pode servir como um marco para a identificação de espécies interconectadas em nível molecular e para a determinação genética de populações.

Analysis of the clinical indications for opiate use in inflammatory bowel disease

BACKGROUND/AIMS: Opiate use for inflammatory bowel disease (IBD), particularly high-dose (HD) use, is associated with increased mortality. It's assumed that opiate use is directly related to IBD-related complaints, although this hasn't been well defined. Our goal was to determine the indications for opiate use as a first step in developing strategies to prevent or decrease opiate use. METHODS: A retrospective cohort was formed of adults who were diagnosed with IBD and for whom outpatient evaluations from 2009 to 2014 were documented. Opiate use was defined if opiates were prescribed for a minimum of 30 days over a 365-day period. Individual chart notes were then reviewed to determine the clinical indication(s) for low-dose (LD) and HD opiate use. RESULTS: After a search of the electronic records of 1,109,277 patients, 3,226 patients with IBD were found. One hundred four patients were identified as opiate users, including 65 patients with Crohn's and 39 with ulcerative colitis; a total of 134 indications were available for these patients. IBD-related complaints accounted for 49.25% of the opiate indications, with abdominal pain (23.13%) being the most common. Overall, opiate use for IBD-related complaints (81.40% vs. 50.82%; P=0.0014) and abdominal pain (44.19% vs. 19.67%; P=0.0071) was more common among HD than among LD. CONCLUSIONS: Our findings show that most IBD patients using opiates, particularly HD users, used opiates for IBD-related complaints. Future research will need to determine the degree to which these complaints are related to disease activity and to formulate non-opiate pain management strategies for patients with both active and inactive IBD.

Clinico-haematological profile of childhood visceral leishmaniasis: a single-center study from Islamabad

Objective: This study describes the clinical and haematological features of childhood Visceral Leishmaniasis from Pakistan

Materials and Methods: A total of 32 children, all below twelve years of age, with a confirmed diagnosis of Visceral Leishmaniasis [VL] were included in this study. All cases presented to the Children Hospital, Pakistan Institute of Medical Sciences [PIMS] Islamabad, from January 2014 to December 2016. The diagnosis of VL was established by the demonstration of Leishmania Parasites in bone marrow aspiration. Demographic information, physical signs at presentation, results of complete blood count and findings on bone marrow aspiration were recorded. The relationship between lymphadenopathy and histiocyte prominence with peripheral blood counts was also determined. The data was analyzed on SPSS version 23

Results: It was found that fever, pallor and abdominal distention were present in 100% of cases observed. Among the hematological features, pancytopenia in the peripheral blood was present in 20[62.5%] cases, histiocyte prominence in 19 [59.3%] cases and extracellular distribution of LD bodies in the bone marrow in 23[71.8%] cases. The values of peripheral blood counts were not significantly associated with the presence or absence of lymphadenopathy or increased Histiocytes in the bone marrow

Conclusion: Children from endemic areas coming with features of pallor, fever, abdominal distension, and reduced peripheral counts should prompt the clinician to suspect Visceral Leishmaniasis and the pathologist to carefully search for the presence of LD bodies in the bone marrow, in order to aid in the early identification and treatment of this infection

Marine Sponges as a Drug Treasure

Marine sponges have been considered as a drug treasure house with respect to great potential regarding their secondary metabolites. Most of the studies have been conducted on sponge's derived compounds to examine its pharmacological properties. Such compounds proved to have antibacterial, antiviral, antifungal, antimalarial, antitumor, immunosuppressive, and cardiovascular activity. Although, the mode of action of many compounds by which they interfere with human pathogenesis have not been clear till now, in this review not only the capability of the medicinal substances have been examined in vitro and in vivo against serious pathogenic microbes but, the mode of actions of medicinal compounds were explained with diagrammatic illustrations. This knowledge is one of the basic components to be known especially for transforming medicinal molecules to medicines. Sponges produce a different kind of chemical substances with numerous carbon skeletons, which have been found to be the main component interfering with human pathogenesis at different sites. The fact that different diseases have the capability to fight at different sites inside the body can increase the chances to produce targeted medicines.

Erratum to “Marine Sponges as a Drug Treasure” Biomol.Ther. 24 (2016) 347–362

The authors request to correct the title of Table 3.

Hashimoto's thyroiditis: not uncommon in simple benign goiter. A review of 1102 thyroidectomies for simple benign goiter

Objective: To see the frequency of Hashimotos Thyroiditis [HT] in patients operated with the diagnosis of simple goiter

Study Design: A retrospective multicenter study

Place and duration: From 1[st] January 1999 to 31[st] March 2011 at three tertiary care hospitals

Methodology: All patients with simple benign goiter irrespective of age and sex are included in the study. Patients already diagnosed for hashimotos thyroiditis, recurrent goiter, abnormal thyroid hormone profile, diagnosed congenital thyroid pathology or non availability of postoperative histopathology were excluded from the study. Histopathology of all patients reviewed to see the frequency of hashimotos thyroiditis in patients operated for benign simple goiter

Results: Among a total of 1102 patients, 91.28% [n=1006] were female and the majority were in 5[th] decade [35.48%, n=391] of life. Histopathology review of all patients operated for benign simple goiter showed that 2.81% [n=31] were having Hashimoto's thyroiditis and majority [87.09%, n=27] were female. Hashimoto's thyroiditis were common in patients who was in the 3[rd] decade of life followed by 4[th] decade, i.e. 35.48% [n=11] and 32.26% [n=10] respectively

Conclusion: Hashimotos thyroiditis is not uncommon and due to its varied clinical presentation it should be ruled out in simple benign goiter before surgery

epidemiological study: assessment of symptomatic osteoarthritis and its management in general population of Karachi with joint pain

Object: to determine the frequency of symptomatic osteoarthritis in general population of Karachi presenting with joint pain

Introduction: people easily get tired due to heavy duty occupations to keep pace with the society. Arthralgia commonly called as "Joint pain" is one of the most frequently observed complain, especially in individuals aged 50 above

Methods: a cross-sectional study was conducted at Jinnah Postgraduate Medical Centre [JPMC] from 1[st] November 2013 to 25[th]November 2013. The data was collected from 316 patients presenting to the department of rheumatology and orthopedics with joint pain. A structured questionnaire was designed based on the clinical symptomatology of osteoarthritis. It was administered to the participants aged above 18 yrs. old. 17.7% of males and 82.3% of females participated in the study

Result: out of 316 patients with joint pain, 71.2% [n=225] was diagnosed osteoarthritis on the basis of symptoms present with a high prevalence in females than males. The most common joints to be involved in osteoarthritis were found to be knee joint [90.2%] and hip joint [55.7%]. The majority of the patients [n=109] had an X-ray of their joint and n=125 was getting analgesics as an effective therapy for osteoarthritis

Conclusion: the frequency of osteoarthritis is increasing in Karachi with globalization due to high level occupational stress along with recreational activity stress and other contributive factors. Female predominance as compare to that of man is quite alarming that needs to be controlled for maintaining future quality of life and providing ease for daily activities

Wife battering trends in Pakistani population

Objective: to study the present trends about wife battering in Pakistani population

Material and Methods: two hundred cases of battered wife were selected from Emergency and OPD of Islam Hospital Sialkot, OPD and Emergency of Fouji Foundation Hospital Rawalpindi, PD and Emergency Department of Railway Hospital Rawalpindi, OPD and Emergency Department of Services Hospital, Lahore, and OPD and Emergency Department of Shahina Jamil Hospital Abbottabad. The data was collected on preform with relation to age, socio economic status, literacy rate, occupation, addiction, joint family system and residential area with the permission of authorities of the hospitals. The data was analyzed for results statistically

Results: in this study the victims of battered wife were maximum at the age range 21 30 years 33 % [66 cases] as compared to age range 71 80 years 02 % [04 cases]. The house wives were the maximum victims of battered wife 25 % [50 cases] as compared to belonging to business community wives 05 % [10 cases]. In the lower class the victims of battered wife were 56 % [112 cases]; in middle class 24 % [48 cases] and in high gentry 20 % [40 cases] victims of battered wife were recorded. Among the addicted couples the battering of wife was higher 83 % [166 cases] as compared to non-addicted couples 17 % [34 cases]. The battered wives were 73 % [146 cases] in case of more than one wife as compared to single wife 27 % [54 cases]. Where there was sickness of the wife or husband the victims were 83 % [166 cases] as compared to healthy couple which were 17 % [34 cases]. In illiterate families the victims of battered wife were 63 % [126 cases] as compared to literate families 37 % [74 cases]. In joint family system the victims of battered wife were 67 % [134 cases] as compared to nuclear family system 33 % [66 cases] were seen. The victims of battered wife were maximum from rural area 67 [134 cases] as compared to urban area 33 % [66 cases]

Conclusion: the tendency of battered wife is a global problem. It is increasing day by day in developed/ under developed countries and nations. This trend is even going to be increased in Muslims countries where battering to the wife is prohibited [Haraam]

An assessment of dentists oral health

The aim of the study was to access the oral health maintenance behavior patterns among dentists. Questionnaire based cross sectional study. The study was conducted in the community dentistry department of Islamic International Dental College, Islamabad from March2013 to August 2013. A total of 65 dentists from Islamabad were included in this study. The dentists were sampled conveniently from Islamabad. Descriptive data was described for the reported frequencies of dentists' attitudes and practices related to oral health. Out of 65,61 dentists had shown positive attitude in responding close-ended questionnaires. Most of the dentists reported brushing their teeth twice a day [n= 40,65.5%].A total of 34 [55.7%] dentists reported carrying out brushing for about 2-4minutes. The self-reported Decayed Missing Filled Teeth [DMFT] score for 21 [34%] dentists was zero. The majority of dentists [n=48,78.7%] did not consider themselves to be having any dental problems, while 42 [68.9%] dentists perceived their oral health as being very good. Although most of the dentists reported as having good oral health, a large number of the participants did not maintain their oral health adequately. Dentists follow ROSC [Recommended oral self-care] recommendations to improve their oral health status

Strangulated paraesophageal hiatus hernia: a case report

Strangulation of hiatus hernia is a rare event and difficult to diagnose in emergency. We are reporting a case of 14 year old girl who was diagnosed sliding hiatus hernia since childhood but due to delayed treatment presented in emergency with perforation of stomach and generalized peritonitis. She was treated successfully

Massive retroperitoneal mass - giant schawanoma

Schwannoma are usually solitary, slow growing, and non-aggressive neoplasms usually found in head and neck region. Retroperitoneal Schawanoma especially large sized are rare and difficult to diagnose clinically. We are discussing a 43 years old lady, who presented with huge reteroperitoneal mass of left side, treated successfully

12 year study of medico-legal aspect of burns in females

Objective: To assess medico-legal aspects, risk groups, types and severity of burns in female patients coming to the tertiary care hospital

Study design: A descriptive study

Place and Duration of Study: Burns Unit Fauji Foundation Hospital Rawalpindi, from April 1997 to March 2009

Methodology: All female patients above 15 year of age reported with burn injuries were evaluated regarding their demographic details, nature and severity of burns. Circumstances leading to burn injuries and other important factors leading to homicidal or suicidal burns were also evaluated

Results: Rate of homicidal burns and suicidal burns was 16.54% and 4.32% respectively among 139 patients studied. Among these homicidal and suicidal burns, majority of females [51.08%]were less than 25 year of age, 86.21% from rural areas and 86.66% belonged to lower socio-economic group. Majority [51.72%] of them were married and 65.52% living with their in-laws at the time of incident. Flame burns [89.66%] were commonest and kerosene oil stove burst was the main cause of injuries in 89.66% cases. Most women [51.72%] were having disputes with in-laws. Among these, 48.27% female sustained 81- 90% of the total body surface area burn. Assault was done by in-laws in 34.49% patients and by husband in 20.49% patients respectively. Majority of these females [75.86%] were brought to the hospital by other relatives and 72% were brought to the hospital after 48 hours of the incident

Conclusions: Most of the women were less than 25 year of age. Majority were from the rural area and were from lower socioeconomic group. Flame burns due to kerosene oil was the commonest type

Assessment methods in medical education: a review

Good assessment is a major challenge in medical education. One of the major obstacle to a comprehensive assessment is the lack of familiarity on the part of medical educators about proper selection and effective use of different assessment methods. This primer [review] gives an overview of the basic ideas and vocabulary that one should understand in order to evaluate the quality of any assessment tool designed for the purpose of evaluating the undergraduates, postgraduates or other medical professionals. Applicability and effectiveness of different assessment tools are described along with their limitations and advantages. In addition, assessment methods currently in use are reviewed with attention to their psychometric strength and weaknesses. The data was collected from cross sectional studies, review articles, books on medical education and from guidelines for assessment between 1956 to 2013. Websites and other online resources of medline, NCBI and medscape were used to extract the data

Efficacy and safety of tap water iontophoresis for palmoplantar hyperhidrosis

To evaluate the efficacy and safety of tap water iontophoresis [TWI] for the treatment of palmoplantar hyperhidrosis in our local setting. Thirteen patients of idiopathic palmoplantar hyperhidrosis were enrolled in the study from the Department of Dermatology, Lahore Medical and Dental College/Ghurki Hospital and Skin Clinic, Gulberg, Lahore from May 2009 to August 2012. Two patients dropped out, and the study was completed by eleven patients. The patients were treated with TWI three times a week for six weeks and followed up at twelve weeks. Each session lasted for 20 minutes, with the polarity being reversed after 10 minutes. The results were assessed by the hyperhidrosis disease severity index, improvement of sweating on a scale of one to four and the starch-iodine test. Any adverse events were noted. All the patients responded well to the treatment with minimal discomfort. Tap water iontophoresis is a safe, effective, inexpensive and affordable treatment modality for palmoplantar hyperhidrosis. It improves quality of life significantly during treatment.

Malignant mesothelioma

Malignant Mesothelioma [MM] is a rare but rapidly fatal and aggressive tumor of the pleura and peritoneum with limited knowledge of its natural history. The incidence has increased in the past two decades but still it is a rare tumor. Etiology of all forms of mesothelioma is strongly associated with industrial pollutants, of which asbestos is the principal carcinogen. Mesothelioma is an insidious neoplasm arising from mesothelial surfaces i.e., pleura [65%-70%], peritoneum [30%], tunica vaginalis testis, and pericardium [1%-2%]. The diagnosis of peritoneal and Pleural mesothelioma is often delayed, due to a long latent period between onset and symptoms and the common and nonspecific clinical presentation. The definite diagnosis can only be established by diagnostic laparoscopy or open surgery along with biopsy to obtain histological examination and immunocytochemical analysis. Different treatment options are available but Surgery can achieve a complete or incomplete resection and Radical resection is the preferred treatment. Chemotherapy has an important role in palliative treatment. Photodynamic therapy is also an option under trial. Patients who successfully underwent surgical resection had a considerably longer median survival as well as a significantly higher 5-year survival. The data were collected from case reports, cross-sectional studies, Open-label studies and phase -II trials between 1973-2012. Web sites and other online resources of American college of surgeons, Medline, NCBI and Medscape resource centers were used to extract data. Malignant Mesothelioma [MM] is a rare but rapidly fatal and aggressive tumor with limited knowledge of its natural history. The diagnosis of peritoneal and Pleural mesothelioma is often delayed, so level of index of suspicion must be kept high