A Review on Guggulu [Commiphora Wightii (ARN.) Bhand.], its Phytochemical Constitution and Mode of Action

The history of human medicine goes back theoretically to the sheer onset of civilizations and evolved with the corresponding circumstances. Natural ingredients, that are plant based, animal based or mineral based have been incorporated since ages in the management of health and disease. The presently popular and universally accepted modern medicine has developed slowly and methodically, over generations of scientists with their application of scientific studies and an enormous amount of research. The popularity and acceptance of modern medicine may be huge today; however, the base of its research and resources stay put in traditional system of medicine itself. Even today the future of medicine in general has a tremendous scope for natural product-based drug and formulations and hopefully will prove to be more holistic, customized with a wise amalgamation of ancient and modern medicinal fundamentals and skills so as to give maximum benefit to the present and future human generations. Ayurveda, translated as the “Science of Life”, the ancient medicinal system of the Indian subcontinent, remains the oldest of all form of medications. Ayurveda incorporates a holistic approach to medicine and makes it highly personalized. There are around 45,000 species of plants with various medicinal properties attributed to them. This paper aims at understanding the composition, chemical constitution and exact mode of action of Guggulu.

Pattern of indications of flexible bronchoscopy among adult patients in a tertiary care hospital

Background: Flexible fiber optic bronchoscopy is frequently performed procedure in pulmonary medicine

Objective: To determine the Clinico-radiological indications of flexible bronchoscopy in a tertiary care hospital

Materials and Methods: This descriptive study was conducted in the bronchoscopy suit of pulmonology department post graduate medical institute[PGMI], Lady Reading Hospital, Peshawar from Jan 2008 to Dec 2010. This was a retrospective analysis of the well maintained records of patients in whom bronchoscopy was done in the above mentioned duration. All the patients above 15 years were included. All the bronchoscopies were done by expert brochoscopists under local aneasthesia. Data was analyzed by SPSS 13 to find the frequencies and percentages

Results: Total number of patients were 423, with a male to female ratio of 1.6:1, in which 191 had haemoptysis , 115 presented with chronic cough, 42 had shortness of breath [SOB] , 11 presented as superior venacaval [SVC] obstruction, 25 had lobar or full lung collapse on chest x rays and 9 patients had solitary or multiple nodules, 8 were scoped for removal of foreign bodies, 4 for medical fitness and 2 for persisted fever. After analysis of x-rays of proven malignancies out of 60 patients, 20 [33.33%] had right side non-resolving consolidation, 18 [30%] Left side consolidation,08 [13.4%] presented with hilar mass, 03 [5%] with multiple nodules, 04 [6.66%] with mediastinal widening , 03 [5%], with left sided lobar collapse, 02 [3.33%] with right lobar Collapse and 02 [3.33%] had either side full lung collapse

Conclusion: Bronchoscopy is an important tool for the diagnosis of the cause of radiological/clinical findings like haemoptysis, chronic cough, SOB, SVC obstruction, hoarseness of voice and persistent x-ray opacity, or lobar or lung collapse. Heamoptysis and chronic cough are the main indications in our setting. Bronchoscopy is minimally invasive procedure with high diagnostic yield for bronchogenic tumours especially central

Determination of serum gonadotropin and testosterone levels in male infertility

To determine the levels and ratios of serum LH, FSH and Testosterone, among men having history of infertility, A non-interventional descriptive study was carried out in the Department of Public Health Laboratories Division, NIH, Islamabad from January 2004 to December 2005. Two hundred fifty infertile men, classified as azoospermic [50], oligozoospermic [75], asthenozoospermic [50] and normozoospermic [75] were studied for serum LH, FSH and Testosterone, in addition to 50 proven fathers. The respective FSH [mlU/ml] LH [mlU/ml] and Testosterone [nmol/L] levels for the groups were 22.924.15, 13.852.33 and 11.860.70 [Azoospermia], 16.823.79, 10.921.22 and 11.88 +/- 1.06 [Oligozoospermia], 3.220.61, 3.921.17 and 16.24 +/- 2.05 [Asthenozoospermia] while in normozoospermic men were 5.530.52, 7.400.60 and 17.29+1.02, The proven fathers group had 7.74 +/- 0.71 mlU/ml LH, 6.75+1.06 mlU/ml FSH and 15.88 +/- 1.15 nmol/ml testosterone, respectively. The LH/FSH and FSH/LH ratios were 0.77 +/- 0.08 and 1.84 +/- 0.22 [Azoospermia], 1.78 +/- 0.41 and 1.47 +/- 0.18 [Oligozoospermia], 1.51 +/- 0.46 and 1.28 +/- 0.28 [Asthenozoospermia] while in normozoospermic and proven fathers were 1.55 +/- 0.16 and 0.85 +/- 0.10,1.67 +/- 0.22 and 0.94 +/- 0.12. Similarly, the LH/T and T/LH ratios were 1.17 +/- 0.28 and 0.86 +/- 2.70 [Azoospermia], 0.92 +/- 0.28 and 1.08 +/- 0.17 [Oligozoospermia], 0.30 +/- 0.10 and 4.14 +/- 10.4 [Asthenozoospermia] and in normozoospermic were 0.42 +/- 0.08 and 2.34 +/- 0.48.The ratios observed for T/FSH and FSH/T were 0.52 +/- 0.17 and 1.93 +/- 5.95 [Azoospermia], 0.71 +/- 0.28 and 1.42 +/- 3.57 [Oligozoospermia], 5.04 +/- 3.38 and 0.20 +/- 0.30 [Asthenozoospermia] and in normozoospermic men were 2.82 +/- 0.90 and 0.35 +/- 1.12, while in proven fathers were 4.09 +/- 0.57and 1.04 +/- 0.53 respectively. Altered/disturbed concentrations of gonadotropins and androgenic hormones and their ratios cause infertility, since all these hormones act synergistically

Percutaneous CT guided cutting need: biopsy of lung lesions

To evaluate the diagnostic yield of CT guided percutaneous cutting needle biopsy [CNB] of lung lesions. Our study was a descriptive study including 63 patients who underwent CT guided percutaneous core needle [cutting needle] biopsy of lung lesions. Of the total sampling, only 53 cases were followed up. Samples taken were preserved in formalin bottle and sent for histopathology. CT scan at the level of the biopsy was taken immediately after the procedure when patient was still on CT table. X-ray chest in erect position was taken after 04 hours to look for development of pneumothorax. Hemoptysis and pneumothorax were recorded. Other complications were also noted. Out of these 53 cases, histopathology showed 32 [60.4%] cases to be malignant, 17 [32.1%] cases benign and 4 [7.5%] cases being non-representative. The histological diagnostic yield [number of correct diagnosis obtained at CNB/number of definitive diagnosis] of this procedure was found to be 92.45% [49/53]. Pneumothorax occurred in 1 out 53 [1.9%] and hemoptysis in 4 of 53 [7.45%]. There was no major complication like hemodynamic instability or death. CT guided percutaneous CNB of the lung lesions is an accurate procedure for a specific histological diagnosis and has a low rate of complications

Frequency of polyzoospermia and teratozoospermia in infertile men

This study was aimed to see the frequency of polyzoospermia and teratozoospermia, among men with history of infertility, presenting at National Institute of Health, Islamabad. Seven hundred and ninety married men presenting with a complaint of infertility underwent their semen analysis. They were categorized on the basis of sperm count and morphology. The sperm count was performed by Neubauer haemocytometer, while morphology assessed after staining the slides as described by the WHO methodology. The 790 men were classified as having azoospermia [203], oligozoospermia [353], polyzoospermia [13] and normozoospermia [221]. While on the basis of morphology as teratozoospermia [37] and normozoospermia [550]. The frequency of polyzoospermia in our study was 1.65% and teratozoospermia 6.30%. The study highlights the importance of both qualitative and quantitative analysis of sperms i.e. count and morphology in order to accurately diagnose the causes of infertility. It shows low frequency of polyzoospermia and teratozoospermia in infertile men

Etiology, presentation and managment outcome of pneumothorax

This study was carried to determine etiology, presentation, complications and management outcomes of pneumothorax in patients presenting at two hospitals in NWFP province of Pakistan. Pneumothorax patients reporting at the chest unit of Post Graduate Medical Institute, Lady Reading Hospital, Peshawar, and Pulmonology unit of Ayub Teaching Hospital, Abbottabad from 1999 to 2002 were included in the study. Patients of all ages were included. They were admitted and followed up to the full recovery/late complications. A total of 146 pneumothorax patients reported during this period. Majority of the patients were diagnosed to have pneumothorax due to pulmonary tuberculosis making about 36.30%] of the total cases. Second most common cause was primary spontaneous pneumothorax [19.86%]. Bacterial infections were also sizeable at 16.43%. Other causes included COPD, Asthma, latrogenic, Interstitial lung disease, tuberous sclerosis and bronchiectasis. It was concluded from this study that pulmonary tuberculosis is the commonest cause of pneumothorax in our setup

Efficacy, safety and tolerability of streptokinase in multiloculated empyema

Empyema thoracis is a common illness with significant morbidity and mortality. Standard treatment of Empyema includes tube drainage and antibiotics. But the tube drainage often fails if the fluid is loculated. Intrapleural Streptokinase has been used in multiloculated empyemas with good success rate. We evaluated the efficacy and safety of intra-pleural Streptokinase in loculated empyemas. A total of 15 patients admitted in Pulmonology unit with multiloculated empyemas whose drainage via drainage tube was less than 100 ml during the last 24 hours were included in the study. Aliquots of 250,000 units of Streptokinase in 100 ml of normal saline were instilled into the pleural cavity and the tube clamped for 3 hours. Response was assessed by clinical outcome, measurement of drain output after unclamping and subsequent chest radiography and serial chest ultrasounds. Streptokinase enhanced drainage in all patients with complete resolution of Empyema in 13 patients. Two patients with thickened visceral pleura following empyema drainage were referred to thoracic surgeon for decortication. The number of instillations of Streptokinase per patient ranged from 1 to 3 and the volume of drained empyema fluid ranged from 60 ml to 600 ml per patient. Streptokinase was well tolerated in all patients. Intrapleural Streptokinase is a safe and effective means of increasing the tube drainage in multiloculated Empyema without causing systemic fibrinolysis

Tuberous sclerosis-rare presentation as pneumothorax

A 33 years old lady was admitted in Pulmonology unit of the Post Graduate Medical Institute, Lady Reading Hospital Peshawar on September 6, 1999 with the complaints of dry cough, fever off and on and left-sided chest pain for the last five months. The pain started suddenly and was not related to exertion. There was no history of haemoptysis or weight loss. Her appetite was good. She used to get breathless on exertion. She gave a history of repeated attacks of epileptic fits since childhood. She consulted many physicians and the diagnosis of Pulmonary Tuberculosis with epilepsy was made for which she received treatment. She did not improve with the treatment. On physical examination, her pulse was 96 beats per minute and her blood pressure was 120/80 mm Hg. She was not anaemic and her temperature was normal. Her JVP was normal and lymph nodes were not enlarged. She was not cyanosed. Her chest examination revealed hyper resonant percussion note on the left side and breath sounds were decreased on the same side. There were no added sounds. Examination of other systems did not disclose any abnormality. Her laboratory investigations showed an Hb level of 12.4 g/dl, a fasting blood sugar level of 100 mg/dl and serum calcium of 9 mg/dl. Renal function tests were normal, serum electrolytes were normal, ECG and Echocardiography were normal. The diagnosis of Tuberous Sclerosis with left-sided pneumothorax was made. She was intubated and the lung got expanded in 6 days without any complications