Efficacy and Tolerability of Tianeptine Versus Escitalopram in Patients with Irritable Bowel Syndrome: A Hospital based, Randomized Comparative Study

Introduction: The fallopian Tube or the oviduct has beennamed after Gabrielis Fallopius, who was the first to describethe tubes very accurately. It is one of the commonest surgicalspecimens received in the histopathological laboratory. It isthe commonest cause of infertility and inflammatory diseases.Malignancy of the fallopian tube is rarely encountered. Thepresent study was undertaken with the following objectivesto evaluate the histological patterns of the fallopian tube insurgically resected specimens and to determine its relationshipwith uterine or ovarian pathology.Material and Methods:A total number of 309 specimensof Fallopian tube were obtained from the patients whounderwent pan hysterectomy with salpingectomy andsalpingo-oophorectomies in Assam Medical College andHospital during the period from October 2016 to September2018. The clinical datas along with gross and microscopicfindings were studied. Incidence and prevalence of variouslesions were calculated.Results: In our study 10cases (3%) had been marked asunremarkable. 77.4% were diagnosed as Chronic Salpingitis,8.95% as Hydrosalpinx and 2.47% as Ectopic Pregnancy. Theother cases comprised mainly of Haematosalpinx andnormalhistologyConclusion: Fallopian tubes can present with differentpathological findings. Malignancies of the Fallopian Tube areuncommon but it has to be examined properly to exclude aprecursor Tubal Pathology

Metabolic effects of oral vitamin D supplementation as an adjuvant therapy on subjects with type 2 diabetes

Background: It is common for patients with type 2 diabetes mellitus (T2DM) to have vitamin D deficiency. Aim of the study is to determine the metabolic effects of oral vitamin D supplementation in a cohort of T2DM subjects.Methods: Subjects with T2DM were divided into two groups. Group A (Control) included subjects who received the standard treatment (conventional antidiabetic drugs). Group B (Intervention), apart from the standard treatment (conventional antidiabetic drugs), was also supplemented with Vitamin D3. All the patients were followed up at baseline, 6 months, 12 months and 18 months.Results: Vitamin D deficiency was noted down in all the study subjects. Even after 18 months of supplementation, all subjects remained vitamin D deficient. There was a significant improvement in the circulating levels of 25-hydroxyvitamin D. Improvement in the lipid profile of subjects was observed as evidenced by a decrease in total cholesterol (5.0±0.92 mmol/l) as compared to baseline (5.5±1.6 mmol/l). HOMA-IR changed significantly after 18 months of supplementation from baseline (7.0±1.06 vs 10.8±1.96 nmol/l).Conclusions: Supplementation to achieve higher levels of vitamin D remains a promising adjuvant therapy for T2DM patients. Additionally, the intervention brought out a favourable change in HDL/LDL ratio among study subjects.

Gastrointestinal Beriberi as a prodrome of non-alcoholic Wernicke’s encephalopathy: a study of an emerging nutritional deficiency disorder from Kashmir, India

Background: Gastrointestinal manifestations of thiamine deficiency have not been well described in literature. Authors aimed to study the symptoms of gastrointestinal beriberi in a cohort of patients of non-alcoholic Wernicke’s encephalopathy and review the relevant literature.Methods: In a retrospective analysis, case records of 52 patients diagnosed with non-alcoholic Wernicke’s encephalopathy were analyzed for the nature of gastrointestinal symptoms, their duration, severity and associated findings, investigations and response to treatment. The available literature on gastrointestinal symptoms in thiamine deficiency disorders and gastrointestinal beriberi was reviewed.Results: Gastrointestinal symptoms were found in 46 of the 52 patients. The most common gastrointestinal symptom in our patients was recurrent vomiting in 42 patients. Eight patients had water brash. Ten patients had epigastric pain and 10 patients had anorexia. Based on the nature and severity of symptoms, patients were evaluated for their symptoms using endoscopy, ultrasonography, amylase and lactate levels, and routine laboratory studies and the results were normal in the majority of patients.  Gastrointestinal symptoms settled in all the patients after receiving intravenous thiamine. On reviewing the literature multiple studies were found to have reported prominent gastrointestinal symptoms in patients of Wernickes encephalopathy and other thiamine deficiency related disorders. However, the definition of gastrointestinal beriberi is not clearly stated.Conclusions: Gastrointestinal symptoms were prominent prodromal manifestations in our cohort of Wernicke’s encephalopathy and have also been amply reported in literature. Presence of gastrointestinal symptoms in individuals predisposed to thiamine deficiency without alternative explanation should be enough to label a patient as gastrointestinal beriberi. The study highlights the importance of recognizing gastrointestinal beriberi as a distinct syndrome that may precede the development of Wernicke’s encephalopathy.

Protective effects ofEmblica officinalis [Amla] on metal-induced lipid peroxidation in human erythrocytes

The protective potential of Emblica officinal is [amla] was investigated on metal-induced lipid per oxidation in human erythrocytes. Increases in the levels of MDA and catalase activity were assessed as lipid per oxidation. In addition, glutathione peroxidase [GPX], glutathione [GSH], and ascorbic acid levels were assessed as antioxidant indices. Preliminary investigation of the extract exhibited a significant reduction in lipid per oxidation and an increase in antioxidant abilities, such as a decrease in MDA, GPx and GSH [P<0.05]. A significant reduction in erythrocyte hemolysis induced by hydrogen peroxide was observed using amla extract [PO.05]. These findings show that amla extract has significant protective potential against lipid per oxidation

In vitro evaluation of bioactive potential of Bacillus methylotrophicus YML008 against Propionibacterium acnes

Acne vulgaris is the most common skin diseases that people experience during their lives. Thirteen rhizosphere isolates were screened against Propionibacterium acnes. The bacterium exhibited the highest activity against P. acnes was identified as Bacillus methylotrophicus YML008 by 16S rRNA gene sequencing. Scanning electron microscopy was used to assess the changes in morphology of P. acnes. Preliminary studies on the antimicrobial substance demonstrated the hydrophilic nature of compound with MIC of 0.17mg/ml and MBC of 0.3mg/ml. The cytotoxic effect of the extract was least [80% survival] as compared to benzyperoxide [40% survival]. These results suggest YML008 as a promising bioresource and may be useful as a lead bacterium to develop a new type of anti-acne skin care prep to cure or prevent acne. Further, mechanism of action and proper clinical trials may be promising for this research

Ulcerative colitis and probiotics: an overview

Ulcerative colitis is an inflammatory disease of the large intestine whose effects are bloody diarrhea, cramping and bloating. The disease is usually relapsing and remitting. However, the cause of ulcerative colitis is not yet known. Due to this reason, finding an effective treatment has been a great challenge. The suggested medical treatment is usually composed of two portions; keeping the flare up from happening and treating the flare up when it has happened. Active flare ups are treated with corticosteroids. There are several hypothesis which suggest that ulcerative colitis could be due to the micro flora present in gut. For this reason, several researchers tried to modify the gut microflora with probiotics. However, there is no probiotics found that can induce emission faster than the placebo. The ulcerative colitis patients taking probiotics showed fewer and less severe symptoms during the flare up. This means that even though the probiotics did not end up the flare up faster, it slowed up the severity of the symptoms of the patients

Isolation, serotype diversity and antibiogram of Salmonella enterica isolated from different species of poultry in India

Objective: To study the occurrence and serotype diversity of Salmonella isolates in different species of poultry (chicken, emu and duck) and determine their resistance pattern against various antibiotics of different classes. Methods: About 507 samples comprising 202 caecal contents and 305 fecal samples from chicken, emu and duckwere processed for isolation of Salmonella enterica. Salmonellaewere isolated and detected by standard protocol of ISO 6579 Amendment 1: Annex D. Genetic confirmation was also made by using 16S rRNA genus specific PCR. Serotype specific PCR was also done to detect the most common serovars viz. Salmonella Enteritidis, Salmonella Typhimurium and Salmonella Gallinarum. All obtained isolates were subjected to a set of 25 antibiotics to study their antibiogram by using Baeur-Kirby disk diffusion method. Results: Out of 507 samples processed, 32 isolates of Salmonella enterica (18 from caecal contents and 14 from faecal samples) were obtained, of which 24 belonged to 6 different serovars, 6 were untypeable and 2 were rough strains. Salmonella Enteritidis was the most predominant serotype (9), followed by Salmonella Typhimurium (5), Salmonella Virchow (4), Salmonella Gallinarum (3), Salmonella Reading (2) and Salmonella Altona (1). Antibiotic resistance pattern was maximum (100%) to oxacillin, penicillin and clindamycin, followed by ampicillin (68.75%), tetracycline (65.62%), nalidixic acid (56.25%) and colistin (46.87%). High sensitivity of isolates was recorded for chloramphenicol (96.87%) followed by meropenem (84.37%). Conclusions: Occurrence of high proportion of serovars in our study which can cause serious gastroenteritis in humans is a matter of concern. Salmonella Altona has been detected for the first time in India from poultry. This serotype is known to cause serious outbreaks of gastroenteritis in humans. Multidrug resistant isolates were recovered at high percentage which can be attributed to non-judicious use of antibiotics both in prophylaxis and treatment regimen. This observation draws serious attention as poultry serves as an important source of transmission of these multidrug resistant Salmonella serovars to humans.

role of nanotechnology in fuel cells and renewable energy

Nanotechnology deals with the study and manipulation of matter at minute scales of the order of less than 1mm in length, and is a leading research topic among scientists and engineers. This study discusses the contributions that nanotechnology has to offer in the context of renewable energy. Focus is mainly on improvements in efficiency, feasibility and supply of renewable energy resources. Specific emphasis is placed on hydrogen technologies. Considerable growth is being witnessed in the rene- wable energy industry. Climate change, triggered by greenhouse gas emissions, and consequent changes in public opinion, and pressure have all resulted in renewed interest in renewable energy sources. Only certain specific areas of renewable energy technologies, such as material strength and its physical properties, are influenced by nanotechnology as there are no alternative means of achieving the desired thermochemical/electrochemical efficiencies than through the use of nano-scale technologies

Celiac disease and celiac crisis in children

To determine the frequency of clinical features of Celiac disease [CD] and Celiac crisis in children. Case series. Paediatrics Unit, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, from September 2009 to September 2010. Forty children aged between 4 to 13 years of either gender, presenting with complaints of recurrent diarrhea, abdominal distention, severe emaciation and dehydration were included. The information about breast feeding, weaning diets, age of introduction of wheat diets, onset of diarrhea, characteristics and frequency of stools, growth, vaccination status, symptoms in 1st degree relatives, restriction of Gluten diet in the past and anthropometric measures were recorded. Serological tests against anti-Tissue Transglultaminase [anti-tTG] antibodies were obtained in all cases. Upper gastrointestinal endoscopies were performed and multiple biopsies were taken from distal parts of duodenum. Among the forty children, twenty four [60%] were females and 16 were males [40%]. The mean age was 6.35 +/- 2.83 years. Thirty five [87.5%] parents were cousins. Breast feeding was not exclusively given and the Gluten containing weaning diets were given as early as 3.5 months of age. Thirty [75%] children presented with typical sign and symptoms of CD. Celiac crisis presented with profuse diarrhea, severe dehydration; abdominal distention; pedal edema, carpopedal spasm due to tetany; wasted muscles; head drop and inability to stand. The serum TtG antibodies in thirty-eight cases [95%] were above the cut off level of 7u/ml ranging from 35-99 u/ml. The histopathology of specimens from distal duodenum revealed lesions of M3 type in thirteen [32.5%] and M2 type in eighteen cases [45%]. All cases recovered and improved on follow-up after strict adherence to gluten-free diet [GFD]. Majority of children with Celiac disease presented with typical symptom, while Celiac crisis was characterized by severe dehydration, weakness and calcium deficiency signs. Most were the product of consanguineous marriages and were given Gluten - containing weaning foods as early as the 4th month of life

Involvement of the cervical cord and medulla in posterior reversible encephalopathy syndrome

The posterior reversible encephalopathy syndrome [PRES] is characterized by patchy cortical and subcortical lesions in the distribution of the posterior circulation. The lesions are classically reversible. This syndrome has multiple etiologies, most of which cause acute hypertension. We present a case of PRES with involvement of the medulla and cervical cord [apart from the typical parieto-occipital lesions]-an extremely rare imaging manifestation of PRES. It is important to recognize the imaging findings of PRES in spinal cord, and avoid misdiagnosis as myelitis by proper clinical correlation. Typically patients with myelitis have a profound neurodeficit, while patients with spinal manifestations of PRES are asymptomatic. Involvement of the cord in PRES has probably been an underrecognized entity as spinal imaging is not routinely performed in posterior reversible encephalopathy syndrome

Hepatocellular carcinoma in cirrhotic patients: frequency, seroprevalence of hepatitis B and C and patient profile

Objective: to find out frequency of hepatocellular carcinoma in cirrhotic patients and to determine seroprevalence of hepatitis Band C and profile of these patients

Material and Methods: this study was done in Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from February to August 2009. One hundred cirrhotic patients admitted in medical wards were evaluated for demographic and clinical features, Seroprevalence of hepatitis B and C and Child Pugh score and class. Those having focal defect in liver on ultrasound were further investigated for serum alpha-fetoprotein, CT scan abdomen and fine needle aspiration for histopathological examination

Results: eighteen patients were found to have HCC with mean age of 53 years, 78% of these patients were male. Eighty three percent were anti-HGV positive, 6% were both HBs Ag and anti HGV positive and 11 % were seronegative. Mean Child score of these patients was 9.16. Main presenting symptoms were massive ascites, hematemesis/melena, hepatic encephalopathy and jaundice

Conclusion: HCC is a common complication of hepatitis C associated cirrhosis

Response to standard interferon and ribavirin combination in the treatment of patients with chronic hepatitis C

Background: Chronic hepatitis C is common in our country and before development of decompensation, it is treated with interferon and ribavirin. This is a costly treatment and many patients remain untreated due to financial constraints

Objective: To determine end of treatment response [ETR] to combination of standard interferon and ribavirin [non original brands] provided through Prime Minister program for prevention and control of hepatitis in management in chronic hepatitis C in our setup

Patients and Methods: This interventional study was carried out in medical outpatient clinic of Sheikh Zayed Hospital, Rahim Yar Khan, from August 2006 to February 2009. Adult patients [more than 18 years of age] suffering from HCV RNA positive chronic hepatitis were enrolled. Patients were given standard interferon 3 mu s/c thrice a week and ribavirin 800-1200 mg per day for 24 weeks. Four different brands of drugs were used. HCV RNA by qualitative PCR was tested at the end of treatment. End of treatment response was defined as absence of viral RNA

Results: 260 patients of chronic hepatitis C were enrolled. 148 patients were male and 112 were female. Their mean age was 34.11 +/- 9.18 years. Mean baseline serum ALT of these patients was 91.44 +/- 63.00. 217 patients [83.5%] achieved ETR. There was no statistically significant difference in ETR between various brands of interferon and ribavirin. Moreover, there was no significant difference in gender, age and ALT between patients who achieve ETR and those who did not achieve it

Conclusion: Combination treatment with non original brands standard interferon and ribavirin provided through Prime Minister program for prevention and control of hepatitis is effective in our patients with chronic hepatitis C

Upper gastrointestinal endoscopy: indications and outcome experience at sheikh Zayed hospital Rahim Yar khan

Background: upper Gastrointestinal [UGI] complaints are very important medical complaints both in outdoor and indoor patients. Upper GI endoscopy is the most important diagnostic as well as therapeutic tool in diagnosing these complaints

Objectives: the objective of the study was to document various indications of referral for UGI endoscopy and to determine endoscopic findings in these patients

Methods: all consecutive patients referred for endoscopy from November, 2005 to April, 2008, were included in the study. Demographic features, reasons for referral and endoscopic diagnosis were noted

Results: among 1000 patients, 59 % were referred due to upper GI bleeding, 7 % due to dysphagia, 7 % due to persistent vomiting and 4.6 % due to dyspeptic symptoms. Common endoscopic diagnoses were esophageal varices [43 %], reflux esophagi tis [9 %], gastritis [5 %] and gastric ulcer [3%]

Conclusion: the most common presenting complaint was upper GI bleeding and the most common endoscopic finding was esophageal varices

Clinical profile and impact of proper treatment in acute organophosphorus pesticide poisoning

Background: acute poisoning with organophosphorus [OP] pesticides is one of the most common forms of poisoning worldwide. It generally results from accidental or intentional ingestion, inhalation or cutaneous exposure

Objective: to determine the demographic and clinical features, management and outcome of patients with acute organophosphorus poisoning

Patients and Methods: this observational study was conducted in medical department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1st April to 30th September, 2009. Fifty patients above 12 years of age, who presented with acute organophosphorus poisoning, were included in this study. Demographic features, mode and route of poisoning, clinical presentations, management, and outcome were noted

Results: mean age of 50 patients was 24 +/- 6.17 years. Thirty nine [78%] patients were male and 11 [22%] were female. Accidental exposure was present in 13 [26%] patients and suicidal attempt in 37 [74%] patients. Forty eight [96%] patients took OP orally and 2 [4%] were exposed to it through inhalation. Mean time from exposure to presentation in emergency department was 1.68 hours and mean hospital stay was 2.52 days. Three patients with OP poisoning died

Conclusion: OP poisoning is usually suicidal and more common in young males. Prompt treatment ensures low mortality rate

Propranolol, isosorbide mononitrate and endoscopic band ligation - alone or in varying combinations for the prevention of esophageal variceal rebleeding

To compare the efficacy of propranolol, propranolol with nitrate, band ligation, and band ligation with propranolol and nitrate for the prevention of esophageal variceal rebleeding. A prospective randomized trial. Department of Gastroenterology and Hepatology, Sheikh Zayed Hospital, Lahore, from November 2003 to July 2005. One hundred and sixty cirrhotic patients with esophageal variceal bleeding were randomized to four treatment groups [propranolol, propranolol plus isosorbide mononitrate, band ligation, band ligation plus propranolol and nitrate] with 40 patients in each group. Patients were followed for 6 months after the enrolment of last patient. Primary end points were recurrence of esophageal variceal bleeding and death. Treatment complications were noted. Four treatment groups were comparable regarding baseline characteristics. Esophageal variceal rebleeding occurred in 22% patients in band ligation plus drugs group, 26% patients in drug combination group, 31% patients in banding group and 38% patients in propranolol group [p=0.41]. Difference in mortality rates was also not significant. There was no significant difference between treatment groups in prevention of esophageal variceal rebleeding

L-ornithine-L-aspartate infusion efficacy in hepatic encephalopathy

To determine the efficacy of L-ornithine-L-aspartate in treatment of hepatic encephalopathy. Randomized, placebo-controlled trial. Department of Gastroenterology and Hepatology, Sheikh Zayed Hospital, Lahore, from February to August 2005. Cirrhotic patients with hyperammonemia and overt hepatic encephalopathy were enrolled. Eighty patients were randomized to two treatment groups, L-ornithine-L-aspartate [20g/d] or placebo, both dissolved in 250mL of 5% dextrose water and infused intravenously for four hours a day for five consecutive days with 0.5 g/kg dietary protein intake at the end of daily treatment period. Outcome variables were postprandial blood ammonia and mental state grade. Adverse reactions and mortality were also determined. Both treatment groups were comparable regarding age, gender, etiology of cirrhosis, Child-Pugh class, mental state grade and blood ammonia at baseline. Although, improvement occurred in both groups, there was a greater improvement in L-ornithine-L-aspartate group with regard to both variables. Four patients in the placebo group and 2 in L-ornithine-L-aspartate group died. L-ornithine-L-aspartate infusions were found to be effective in cirrhotic patients with hepatic encephalopathy

Esophageal varices: major endoscopic finding on upper GI endoscopy

To document the frequency of esophageal varices and their importance in a tertiary care hospital of Southern Punjab. Endoscopy unit of Sheikh Zayed Medical College/Hospital. From Nov 2005 to May 2007. The data of 500 patients who underwent upper GI endoscopy was analyzed. Demographic features, reasons for referral and endoscopic diagnoses were noted. Among 500 patients, 57% were referred due to upper GI bleeding, 9% due to dysphagia, 8% due to persistent vomiting and 7% due to dyspeptic symptoms. Common endoscopic diagnoses were esophageal varices [44%]. Major Endoscopic finding in our study was esophageal varices gastric or duodenal ulcers, congestive gastropathy, obstructive lesions of esophagus and stomach were the next most common observations

Predictive value of rockall score for rebleeding and mortality in patients with variceal bleeding

To validate Rockall scoring system for in-hospital rebleeding and mortality in cirrhotic patients with variceal bleed. Cohort type of case series. It was carried out at the Department of Gastroenterology and Hepatology, Shaikh Zayed Hospital, Lahore, from March 2005 to March 2006. All cirrhotic patients presenting with upper GI bleeding and later found to have variceal source of bleeding on endoscopy were included. Clinical and endoscopic features were noted to calculate Rockall score. After giving appropriate pharmacological and endoscopic therapy, patients were followed for rebleeding or death till discharge from hospital. linear regression analysis was used to determine predictive value of score and discrimination was evaluated by calculating the area under the receiver operating characteristic [ROC] curve. A total of 402 patients were included. Mean age was 52.57 [ +/- 11.39] and male to female ratio was 2:1 [269/133]. Esophageal varices were source of bleeding in 340 [84.5%], gastric fundal varix in 44 [11%] and ectopic duodenal varix in 3 [0.9%] patients. Both esophageal and gastric varices were present in 15 [3.6%] patients. In-hospital mortality was 6.7% while 22 [5.5%] patients had rebleeding. Rockall score was found to have good predictive value for mortality [p-value <0.001 and area under curve AUC 0.834] and in-hospital rebleeding [p-value < 0.001 and AUC 0.798]. Rockall scoring system has good predictive and discriminative value for in-hospital rebleeding and mortality in patients with variceal bleeding due to cirrhosis

Shifting proportions of carcinoma stomach: 18 Years experience of Shaikh Zayed Hospital

Objective: To study the demographic, endoscopic and histological features of patients with carcinoma stomach presenting in the Endoscopy suite at the Shaikh Zayed Hospital

Study Design: Cross sectional type of descriptive study

Place of study: Study was carried out at Department of Gastroenterology and Hepatology Shaikh Zayed Post-Graduate Medical Institute Lahore from November 2005 to March 2006

Method and Material: All patients diagnosed to have growth, ulcer or infiltrating lesion in stomach on upper gastrointestinal endoscopy were included from the record of the last eighteen years. Patients were divided in two groups depending on the time of endoscopy, each group comprising of endoscopies performed over nine years time. Both groups were compared using SPSS 11.1

Results: Total number of patients included was 267, male to female ratio was 1.42: 1 [158/109]. Mean age of patients was 52.11 [range 17-85 years] with 39% patients below 45 years of age. Predominant gross appearance was polypoidal, seen in 179 [67%] patients while in 151[56%] patients tumor was located in body of stomach, while 7 1[27%] patients had tumor in antrum and 45[17%] in fundus. Time based analysis oftwo groups of patients revealed no significant change in location, gross appearance or histological diagnosis over 18 years in patients presenting at the Shaikh Zayed Hospital

Conclusion: Gastric carcinoma involves younger age group in our population and is mostly located· in proximal two third of stomach. Features of gastric carcinoma have not shown much change over last 18 years in our population

Upper Gl endoscopy - A review of 500 cases at Sheikh Zayed Medical College/Hospital Rahim Yar Khan

To document various endoscopic findings in patients undergoing upper Gl endoscopy in our endoscopy unit. Observational. The data of 500 patients who underwent upper Gl endoscopy in Endoscopy Unit of Sheikh Zayed Medical College/Hospital from November 2005 to May 2007 was analyzed. Demographic features, reasons for referral and endoscopic diagnoses were noted. Among 500 patients, 57% were referred due to upper Gl bleeding, 9% due to dysphagia, 8% due to persistent vomiting and 7% due to dyspeptic symptoms. Common endoscopic diagnoses were esophageal varices [44%], reflux esophagitis [9%], gastritis [4%] and gastric ulcer [4%].The most common presenting complaint was upper Gl bleeding and the most common endoscopic finding was esophageal varices