The Safety and Efficacy of Anakinra, an Interleukin-1 Antagonist in Severe Cases of COVID-19: A Systematic Review and Meta-Analysis

This study aims to assess anakinra's safety and efficacy for treating severe coronavirus disease 2019 (COVID-19). Numerous electronic databases were searched and finally 15 studies with a total of 3,530 patients, 757 in the anakinra arm, 1,685 in the control arm were included. The pooled adjusted odds ratio (OR) for mortality in the treatment arm was 0.34 (95% confidence interval [CI], 0.21 - 0.54, I2 = 48%), indicating a significant association between anakinra and mortality. A significant association was found regarding mechanical ventilation requirements in anakinra group compared to the control group OR, 0.68 (95% CI, 0.49 - 0.95, I2 = 50%). For the safety of anakinra, we evaluated thromboembolism risk and liver transaminases elevation. Thromboembolism risk was OR, 1.59 (95% CI, 0.65 - 3.91, I2 = 0%) and elevation in liver transaminases with OR was 1.35 (95% CI, 0.61 - 3.03, I2 = 76%). Both were not statistically significant over the control group. Anakinra is beneficial in lowering mortality in COVID-19 patients. However, these non-significant differences in the safety profile between the anakinra and control groups may have been the result of baseline characteristics of the intervention group, and further studies are essential in evaluating anakinra's safety profile.

The Safety and Efficacy of Anakinra, an Interleukin-1 Antagonist in Severe Cases of COVID-19: A Systematic Review and Meta-Analysis

This study aims to assess anakinra's safety and efficacy for treating severe coronavirus disease 2019 (COVID-19). Numerous electronic databases were searched and finally 15 studies with a total of 3,530 patients, 757 in the anakinra arm, 1,685 in the control arm were included. The pooled adjusted odds ratio (OR) for mortality in the treatment arm was 0.34 (95% confidence interval [CI], 0.21 - 0.54, I2 = 48%), indicating a significant association between anakinra and mortality. A significant association was found regarding mechanical ventilation requirements in anakinra group compared to the control group OR, 0.68 (95% CI, 0.49 - 0.95, I2 = 50%). For the safety of anakinra, we evaluated thromboembolism risk and liver transaminases elevation. Thromboembolism risk was OR, 1.59 (95% CI, 0.65 - 3.91, I2 = 0%) and elevation in liver transaminases with OR was 1.35 (95% CI, 0.61 - 3.03, I2 = 76%). Both were not statistically significant over the control group. Anakinra is beneficial in lowering mortality in COVID-19 patients. However, these non-significant differences in the safety profile between the anakinra and control groups may have been the result of baseline characteristics of the intervention group, and further studies are essential in evaluating anakinra's safety profile.

Papillary Thyroid Carcinoma within Thyroglossal Duct Cyst: Case Series and Literature Review

Abstract Introduction Thyroglossal duct cyst (TGDC) is themost common congenital anomaly of the neck, and approximately 7% of all the adult population presents it. Ectopic thyroid tissue is found in the thyroglossal duct cyst wall in up to 65% of cases. This thyroid tissue has the potential to develop some type ofmalignancy, themost common of which is the papillary carcinoma of the thyroid. There are just over 270 cases of thyroglossal duct cyst malignancy reported in the literature. Objectives We aimed to study our population of patients in order to identify cases with thyroglossal duct cyst malignancy. Methods A retrospective chart review was conducted in the section of otolaryngology/ head and neck surgery at a hospital in Karachi, Pakistan, from January of 2004 to December of 2014 on patients with the diagnosis of thyroglossal duct cyst. Results Fifty-eight patients were diagnosed with TGDC, two of whom also presented with thyroglossal duct cyst carcinoma. Both patients revealed papillary thyroid carcinoma on histopathology. Case 1 had an open biopsy before undergoing definitive surgery. Both patients underwent subsequent total thyroidectomy after Sistrunk procedure, and case 2 had selective neck dissection revealing lymph node metastasis. Conclusion Thyroglossal duct cyst carcinoma is a rare finding that comes as a surprise to both the patient and the surgeon. We report 2 out of 58 cases diagnosed with thyroglossal duct cyst carcinoma.

Unusual Presentation of Differentiated Thyroid Cancer Metastasis

Abstract Introduction The rates of thyroid cancers are on a rise, especially well-differentiated thyroid cancers. This could be partly due to newer diagnostic modalities, like highresolution ultrasound, that can pick up smaller lesions. Differentiated thyroid cancers with distantmetastases are not common, and even rarer is the initial presentation with complaints not related to the neck. Objectives The objective of this series was to study and report the unusual cases of patients with differentiated thyroid cancer with distant metastasis. There is a lack of data in the literature on these cases, and due to the rarity of such metastases, no definite treatment protocol has been defined. Methods A retrospective chart review of 1,200 cases of thyroid surgeries was performed. A total of 10 cases of well-differentiated thyroid cancer on the final histopathology exam that had initially presented with usual complaints to departments other than the Otolaryngology Department were identified. Results A total of 6 patients had papillary carcinoma, whereas 4 patients had follicular carcinoma on final the histopathology exam. Two patients presented with iliac crest lesions, 2 with vertebral lesions one each with parapharyngeal mass, supraclavicular mass, labia majora swelling and bleeding, lung, rib and neck of femur lesion. Conclusion There are still no specific guidelines on how to address these patients with differentiated thyroid cancer with distant metastasis (except for the cases of bone and lung lesions) and on which treatment should be offered in case of recurrence. More studies on the subject are required.

relationship of dyspnea and disease severity with anthropometric indicators of malnutrition among patients with chronic obstructive pulmonary disease

Objective: To find the association of dyspnea and disease severity with anthropometric indicators of malnutrition among chronic obstructive pulmonary disease patients

Methods: The cross-sectional analytical study was carried out at Sir Ganga Ram Hospital, Lahore during October 2013 to December 2014. Total 138 adult patients with severe COPD were enrolled. The severity of disease was measured by global initiative for chronic obstructive lung disease criteria; and dyspnea was assessed by modified medical research council dyspnea scale. Anthropometric indicators of malnutrition such as body mass index [BMI] and mid upper arm circumference [MUAC] were measured to evaluate the nutritional status of COPD patients. Data was analyzed by using Statistical Package for Social Sciences version 20

Results: The mean age of 138 patients was 55±3 years. The frequency of male patients [76.8%] was threetimes higher than female patients [23.2%]. The overall frequency of underweight patients measured by BMI was 44%, which was increased to 92% undernourished patients by using MUAC. When compared with female patients, the male patients showed lower means of BMI, MUAC, FEV1% and FEV1/FVC ratio. The significant relationship of high grade dyspnea with BMI [p=0.001], and MUAC [p=<0.001] revealed that malnourished COPD patients had more shortness of breathing as compared to normal-weight patients. Similarly, the association of FEV1% with BMI [p=0.001], and MUAC [p=<0.001] showed that malnourished patients had very severe type of COPD than normal-weight patients

Conclusion: Dyspnea and severity of disease had significant association with BMI and MUAC among COPD patients. Thus, assessment of nutritional status by measuring BMI and MUAC should be considered to predict the severity of disease among adult COPD patients

Phytochemical analysis and antimicrobial activity of aqueous and methanolic extracts of the flowers of Nelumbium speciosum

In present investigation aqueous and methanolic extracts of Nelumbium speciosum flowers were screened for phytochemical constituents and antibacterial activity to ascertain their traditional use. Antimicrobial activity of both extracts was tested by Kirby-Bauer disc diffusion method against four Gram positive strains, viz. Staphylococcus aureus [ATCC25923], Streptococcus agalactiae [13813], Bacillus subtilis [ATCC 6633], Staphylococcus epidermidis [ATCC 12228] and four Gram negative bacterial strains Escherichia coli [ATCC 8739], Pseudomonas aeruginosa [ATCC 27853], Proteus mirabilis [12453] and Klebsiella pneumoniae [10031]. Phytochemical analysis showed the presence of tannins, saponins and alkaloids in both extracts while flavonoids and steroids were present only in methanolic extract. Methanolic extract of Nelumbium speciosum flower showed concentration dependent antibacterial activity against all tested strains with maximum zone of inhibition [17.3 +/- 0.3mm] against P. aeruginosa. Aqueous extract showed concentration dependent activity against S. aureus, E. coli, B. subtilis and S. epidermidis with maximum antibacterial activity against E. coli [14.3 +/- 0.3mm]. MIC of methanolic and aqueous extracts was in the range of 0.015-0.251 and 0.0625-0.251 mg/mL, respectively. Results showed that methanolic extract of Nelumbium speciosum exhibits superior antibacterial activity than aqueous extract

Therapeutic outcome of Pulmonary tuberculosis in type-2 diabetes patients

Objective: Tuberculosis is a major cause of morbidity and mortality and diabetes is a leading risk factor of tuberculosis. Co-existence of tuberculosis and diabetes may increase the disease severity and worsen the treatment outcome. Therefore, objective is to find the anti-tuberculosis treatment outcome among pulmonary tuberculosis patients with or without diabetes mellitus; and to see the drug resistance pattern among treatment failure cases in both groups

Methodology: The cross-sectional study was carried out at PHRC Research Center FJMU Lahore in collaboration with PHRC TB Research Centre KEMU Lahore during the year 2013-14. The data of 268 patients including 187 pulmonary tuberculosis patients without diabetes and 81 with diabetes was analyzed. Anti-tuberculosis treatment according to current guidelines of Directly Observed Therapy [DOT] was provided to all patients; and were assessed for improvement of AFB smear; AFB culture and Chest X-Ray before and after four months of starting ATT. Data were analyzed by using Statistical Package for Social Sciences version 20

Results: Mean age of non-diabetic TB patients was 36+/-16 years; and of diabetic TB patients was 50+/-12 years. Mean duration of diabetes was 6+/-4 years. Other characteristics included 57.8 percent males, 42.2 percent females, and 53.7 percent had history of contact. Cough, expectoration, fever and weight loss were commonly occurring symptoms. Infiltration [76.1 percent] was the commonest type of lesion followed by consolidation [14.6 percent] and cavitation [9.3 percent]. Findings of AFB Smear conversion, AFB Culture, and Chest X-ray were improved with time in both groups; and rates of improvement were significantly higher among non-diabetic TB patients [p <0.05]. The frequency of drug resistance was lower among non-diabetic TB patients [7.0 percent vs. 19.8 percent] but the difference was insignificant. The rates of drug resistance and MDR were considerably higher among patients with poor glycemic control [p 0.036]

Conclusion: Therapeutic outcome of pulmonary tuberculosis was poor among diabetic TB patients as compare to non-diabetic TB patients. Therefore, along with anti-tuberculosis treatment, improvement of glycemic control must be considered among diabetic TB patients for better treatment outcome and reduced drug resistance rate

Traditional medicines and their in-vitro proof against Staphylococcus aureus in Pakistan

Objective:To gather the fragmented literature on ethnobotany, phytochemistry and in-vitro activities of medicinal plants of Pakistan being used against common infections caused by Staphylococcus aureus (S. aureus).Methods:A large number of published and unpublished research studies related to the ethnomedicinal, phytochemical and anti-S. aureus activity of medicinal flora of Pakistan published from 1990-2018 were reviewed using online bibliographic databases such as PubMed, Web of Science, Science Direct, ResearchGate and libraries.Results:S. aureus can cause many human ailments including endocarditis, staphylococcal scalded skin syndrome, septic arthritis, respiratory problems with an estimated infection rate of 25%-35% across the globe. This review comprised of 86 medicinal plants. Data showed that people mostly used leaves (50%) for the preparation of traditional medicines. Correlation analysis on the reviewed data revealed that methanolic extract concentrations of medicinal plants was highly significantly positive correlated (r=0.8; P<0.01) with the S. aureus zone of inhibitions. S. aureus reportedly showed complete resistant to the commonly used antibiotic erythromycin. Isolated compounds like altheahexacosanyl lactone, cinnamaldehyde, niloticane, gobicusin A, asparacosin A, muzanzagenin, isoagatharesinol, friedelin, inophynone and eugenol were active against S. aureus. This study provided in-vitro proof for the flora of Pakistan used against different infections caused by S. aureus.Conclusions:Antibacterial agents from natural sources could be more effective against bacterial pathogens and will be helpful in minimizing the adverse effects of synthetic drugs, and hence provides a base for the pharmaceutical industries.

Traditional medicines and their in-vitro proof against Staphylococcus aureus in Pakistan

Objective: To gather the fragmented literature on ethnobotany, phytochemistry and in-vitro activities of medicinal plants of Pakistan being used against common infections caused by Staphylococcus aureus (S. aureus). Methods: A large number of published and unpublished research studies related to the ethnomedicinal, phytochemical and anti-S. aureus activity of medicinal flora of Pakistan published from 1990-2018 were reviewed using online bibliographic databases such as PubMed, Web of Science, Science Direct, ResearchGate and libraries. Results: S. aureus can cause many human ailments including endocarditis, staphylococcal scalded skin syndrome, septic arthritis, respiratory problems with an estimated infection rate of 25%-35% across the globe. This review comprised of 86 medicinal plants. Data showed that people mostly used leaves (50%) for the preparation of traditional medicines. Correlation analysis on the reviewed data revealed that methanolic extract concentrations of medicinal plants was highly significantly positive correlated (r=0.8; P<0.01) with the S. aureus zone of inhibitions. S. aureus reportedly showed complete resistant to the commonly used antibiotic erythromycin. Isolated compounds like altheahexacosanyl lactone, cinnamaldehyde, niloticane, gobicusin A, asparacosin A, muzanzagenin, isoagatharesinol, friedelin, inophynone and eugenol were active against S. aureus. This study provided in-vitro proof for the flora of Pakistan used against different infections caused by S. aureus. Conclusions: Antibacterial agents from natural sources could be more effective against bacterial pathogens and will be helpful in minimizing the adverse effects of synthetic drugs, and hence provides a base for the pharmaceutical industries. http://www.apjtm.org/article.asp?issn=1995-7645;year=2018;volume=11;issue=6;spage=355;epage=368;aulast=Adnan;type=2.

Posttraumatic stress disorder: a serious post-earthquake complication / Transtorno do estresse pós-traumático: complicação séria pós-terremoto

Abstract Objectives Earthquakes are unpredictable and devastating natural disasters. They can cause massive destruction and loss of life and survivors may suffer psychological symptoms of severe intensity. Our goal in this article is to review studies published in the last 20 years to compile what is known about posttraumatic stress disorder (PTSD) occurring after earthquakes. The review also describes other psychiatric complications that can be associated with earthquakes, to provide readers with better overall understanding, and discusses several sociodemographic factors that can be associated with post-earthquake PTSD Method A search for literature was conducted on major databases such as MEDLINE, PubMed, EMBASE, and PsycINFO and in neurology and psychiatry journals, and many other medical journals. Terms used for electronic searches included, but were not limited to, posttraumatic stress disorder (PTSD), posttraumatic symptoms, anxiety, depression, major depressive disorder, earthquake, and natural disaster. The relevant information was then utilized to determine the relationships between earthquakes and posttraumatic stress symptoms. Results It was found that PTSD is the most commonly occurring mental health condition among earthquake survivors. Major depressive disorder, generalized anxiety disorder, obsessive compulsive disorder, social phobia, and specific phobias were also listed. Conclusion The PTSD prevalence rate varied widely. It was dependent on multiple risk factors in target populations and also on the interval of time that had elapsed between the exposure to the deadly incident and measurement. Females seemed to be the most widely-affected group, while elderly people and young children exhibit considerable psychosocial impact.

Resumo Objetivos Terremotos são desastres naturais imprevisíveis e devastadores. Eles podem causar destruição em massa e morte, e os sobreviventes podem apresentar sintomas psicológicos severos. O objetivo deste estudo foi revisar estudos publicados nos últimos 20 anos pra compilar o conhecimento disponível acerca da ocorrência de transtorno do estresse pós-traumático (TEPT) após terremotos. A revisão também descreve outras complicações psiquiátricas que podem estar associadas a terremotos, oferecendo aos leitores um melhor entendimento geral sobre o assunto, e discute vários fatores sociodemográficos que podem estar associados com TEPT pós-terremoto. Métodos Foi realizada uma busca de literatura nas principais bases de dados, como MEDLINE, PubMed, EMBASE e PsycINFO, e também em revistas de neurologia e psiquiatria, e vários outros periódicos médicos. Os termos usados nas buscas eletrônicas incluíram, mas não se limitaram a, posttraumatic stress disorder (PTSD), posttraumatic symptoms, anxiety, depression, major depressive disorder, earthquake e natural disaster. As informações relevantes foram então utilizadas para determinar as relações entre terremotos e sintomas de estresse pós-traumático. Resultados A revisão revelou que o TEPT é a condição de saúde mental mais comum em sobreviventes de terremoto. Depressão maior, transtorno de ansiedade generalizada, transtorno obsessivo-compulsivo, fobia social e fobias específicas foram outras condições encontrados. Conclusão A prevalência de TEPT variou bastante. O transtorno foi dependente de múltiplos fatores de risco em populações-alvo e também do intervalo de tempo decorrido entre a exposição ao incidente fatal e a avaliação. As mulheres pareceram ser o grupo mais amplamente afetado, ao passo que idosos e crianças demonstração considerável impacto psicossocial.

Initial results of efficacy and safety of sofosbuvir among Pakistani population: a real life trialhepatitis eradication accuracy trial of sofosbuvir [HEATS]

Objective: The uridine nucleotide analogue sofosbuvir is a selective inhibitor of hepatitis C virus [HCV] NS5B polymerase approved for the treatment of chronic HCV infection with genotypes 1 - 4. The objective of the study was to evaluate the interim results of efficacy and safety of regimens containing Sofosbuvir [Zoval] among Pakistani population with the rapid virologic response [RVR2/4 weeks] with HCV infections

Methods: This is a multicenter open label prospective observational study. Patients suffering from chronic Hepatitis C infection received Sofosbuvir [Zoval] 400 mg plus ribavirin [with or without peg interferon] for 12/24 weeks. The interim results of this study were rapid virological response on week 4. Data was analyzed using SPSS version 21 for descriptive statistics

Results: A total of 573 patients with HCV infection were included in the study. The mean age of patients was 46.07 +/- 11.41 years. Out of 573 patients 535 [93.3%] were treatment naive, 26 [4.5%] were relapser, 7 [1.2%] were non-responders and 5 [1.0%] were partial responders. A rapid virologic response was reported in 563[98.2%] of patients with HCV infection after four weeks of treatment. The treatment was generally well tolerated

Conclusion: Sofosbuvir [Zoval] is effective and well tolerated in combination with ribavirin in HCV infected patients

Transversus abdominis plane block offers prolonged postoperative analgesia than surgical incision infiltration by bupivacaine in cesarean section patients

Background and objective: Postoperative pain requires a well-planned analgesia regimen to ensure adequate patient comfort, satisfaction, early mobilization and also to decrease the hospital stay after anesthesia. We conducted this study to compare the transversus abdominis plane block with direct infiltration of bupivacaine into surgical incision in cesarean section to prolong the mean duration of postoperative analgesia

Methodology: This Randomized control trial was conducted in department of anesthesia, Nishtar Hospital, Multan from July 2016 to December 2016. A total of sixty patients were included in the study and randomly divided into two equal groups of 30 each; Group-T and Group-I. Group-T received TAP block with 0.3 ml/kg of 0.25% bupivacaine on each side under double pop technique, and Group-I received 0.6 ml/kg of 0.25% bupivacaine infiltration in surgical incision. Postoperatively all the patients were monitored in PACU. VAS was noted at 1/2, 1, 2, 4 and 6 h intervals. Inj tramadol 1.5 ml/kg was given as rescue analgesia when VAS score >/=4. Time to requirement of first rescue analgesia was noted. Sample size was calculated with 80% power of test, 95 % confidence interval taking mean and standard deviation of rescue analgesia in Group-T 148 +/- 46.7 and in Group-I 85.38 +/- 38.07. Data were analyzed with computer software SPSS version 23. Mean +/- SD was calculated for quantitative variables and frequency [percentage] was calculated for qualitative variables. Student t-test and chi square test were applied. P value 0.05 was considered as significant

Results: Mean VAS score at half hour in Group-T was 3.8 +/- 2.9 and in Group-I was 5.0 +/- 3.0; and mean VAS score at one hour was 4.4 +/- 3.01 in T Group and in Group-I was 5.3 +/- 3.09 respectively; at two hours 4.7 +/- 2.9 and 6.3 +/- 4.2, and at four hours was 5.2 +/- 2.9 and 5.7 +/- 2.8 in Group-T and Group-I respectively. Mean VAS score during six hours was 5.5 +/- 2.8 and 6.1 +/- 2.5 in Group-T and Group-I respectively. Mean time for 1st analgesia in Group-T was 296.3 +/- 37.1 min and in Group-I was 202.0 +/- 34.9 min, by applying t-test P= 0.000 a significant value

Conclusion: TAP block is a promising technique in alleviating postoperative pain in patients' cesarean section. The procedural simplicity of this block, along with reliable level of analgesia [T10-L1], and longer duration makes the TAP block a good option

Non-urgent visits to emergency department and comparison of urgency evaluation between patients and doctors

Objective: To assess the proportion of non urgent patients presenting to the emergency department and to compare urgency evaluation between patients and doctors. Study Design: Descriptive cross sectional study. Place and Duration of Study: Emergency department Combined Military Hospital [CMH] Jhelum, from November 2015 to December 2015

Material and Methods: All the patients presenting to the emergency department after working hours between 4-6 pm were documented for 16 consecutive working days. They were assessed as to the urgency of their condition by the doctor. The patients or guardians in case of children were also required to rate the level of urgency of their medical condition. The level of urgency was graded on visual analog scale from 0-10. A 5 and above score was labeled as urgent while a score of less than 5 was considered non urgent

Results: A total of 205 patients reported in 32 hours over 16 days, to the emergency department. Of these 31 [15.12%] were assessed as emergencies by doctors while 49 [24%] were thought to be emergencies by patients. The p-value for this difference was 0.021. The largest group of patients visiting the emergency department was pediatric and they comprised the largest group of non urgent visits to the hospital as well

Conclusion: Actual emergencies comprise a small proportion of visits to emergency departments while the main bulk consists of non urgent visits

Ethnomedicinal, phytochemical and antibacterial activities of medicinal flora of Pakistan used against Pseudomonas aeruginosa-A Review

Medicinal plants have been used from ancient time against different infectious diseases caused by microorganisms across the globe. The present review represents different medicinal plants of Pakistan used traditionally for the treatment of variety of ailments caused by Pseudomonas aeruginosa, their in-vitro activities against/! aeruginosa and phytochemistry. These plants were extracted with different solvents that showed good in-vitro activities against P. aeruginosa, due to the presence of active phytoconstituents including alkaloids, terpenoids etc. Among all the solvents used for extraction process, alcoholic extracts were mostly preferred in Pakistan. However, non-alcoholic solvents like ethyl acetate and chloroform also showed good anti-P aeruginosa activities. Statistically, increase in concentration [mg/ml] of ethyl acetate and chloroform extracts significantly increase [p=0.000 and p= 0.046] inhibitory activity against P. aeruginosa. This review provides scientific validation of the traditional knowledge in using medicinal plants for the treatment of different diseases caused by this bacterium. Reported Pakistani medicinal plants contain variety of phytochemical compounds that could be very useful in the production of new drugs with fewer side effects on living system compared to some allopathic drugs. This review also provides baseline information for future research studies on the phytochemistry of unexplored plants. Further research studies should be carried out on non-alcoholic extracts that could be helpful in the extraction new compounds, which could lead to the development of some novel drugs in the pharmaceutical industries of Pakistan

Effects of diet and metformin on placental morphology in gestational diabetes mellitus

Objective: To evaluate the effects of diet control and Metformin on placental morphology in gestational diabetes mellitus [GDM]

Methods: After written informed consent 62 GDMs were enrolled. According to WHO criteria, 30 cases of GDMs with blood sugar level <130 mg/dl, were assigned Group B [2000-2500Kcal/day and 30 minute walk thrice weekly were kept on diet control and 32 cases of GDM with blood sugar level >130 mg/dl, assigned Group C were kept on diet with tablet Metformin, [500mg TDS] Finally 25 normal pregnant females were kept in Group A as control. After delivery placentae were preserved and evaluated for morphology

Results: Heavy placentae with abundant villous immaturity, chorangiosis and syncytial knots in group B and fibrinoid necrosis and calcification in group C were seen. In group B versus A placental and cord width while in Group C versus A only cord width in gross morphology showed significant results. In group B versus A villous immaturity, chorangiosis, infarction and syncytial knots in light microscopy were present; similarly in B versus C placental width, chorangiosis and syncytial knots showed significant results, while in C versus A results were non-significant

Conclusion: Metformin produced beneficial effects on placental morphology being comparable to normal control in contrast to diet group

Effects of cement dust on the pulmonary function indices of cement factory workers in Karachi

It has been observed that exposure to cement dust has been found to be associated with impaired pulmonary function and lung diseases. Therefore, this study aims to determine the effects of chronic exposure to cement dust on the pulmonary function of cement mill workers [non smokers] and comparing it to non-exposed otherwise matched individuals. Cross sectional study. the study has been completed in duration of 4 months and the data was collected from a cement factory of Karachi. A cross sectional study was carried out on a sample size of 100 cement mill workers who were divided into two groups of non-smoker exposed [n=46] and non-smoker non-exposed [n=54] workers and matched for age, height, weight, BMI, duration of work and their PEFR and FEV[1] were observed using electronic peak flow meter. It has been found that there was no difference in the age, work experience, height, weight and BMI between the two groups while statistically significant difference was found in FEV1 between the two groups, while PEFR was found to be insignificant. Occupational cement dust exposure is associated with impaired pulmonary functions which may lead to chronic lung diseases in these workers. This justifies the need to take preventive measures

Diabetic eye screening in Sir Ganga Ram hospital, Lahore

Diabetic retinopathy is the optical complication that may lead to impaired vision. It is one of the most prevalent but preventable blinding disease. Its early diagnosis is prerequisite for the prevention of the visual loss and blindness associated with diabetic complication. To estimate frequency of eye examination and various types of retinopathy; and to find the association between diabetic retinopathy and its risk factors. The cross sectional study was conducted from Apr-Sep 2012 by PMRC Research Centre, FJMC, Lahore. Using non probability convenient sampling, eighty known type II diabetics were recruited. Venous blood was drawn for plasma glucose level [GOD-PAP] and glycosylated hemoglobin [Ion-Exchange Resin]. Arterial blood pressure was measured using digital apparatus [Oscillometric method]. Visual acuity was tested by Snellen's chart and dilated fundus examination was done to screen diabetic retinopathy. Data was analyzed using Statistical Package for Social Sciences [SPSS-20]. The study included 41% males and 59% females. Mean age was 51 +/- 9 [33-67] years. Diabetics who never screened for retinopathy were 54.3%; and who examined during last year as per IDF guidelines were 25.7%. The frequency of bilateral and unilateral NPDR was 22.5% and 5%, respectively. The occurrence of NPDR was slightly higher in left eye, whereas PDR was more prevalent in right eye. The visual acuity was equal or better than 6/12 in better eye of 80% study participants; and was 6/18-6/36 in better eye of 20% participants. DR was significantly associated with longer duration of diabetes [p-0.010], poorly controlled diabetes [p-0.044] and hypertension [p-0.006]. Odd ratios [95% CI] showed that duration of diabetes [>/= 20 years], glycosylated hemoglobin [>/= 7.5%,]Systolic blood pressure [>/= 140 mm/ Hg] and diastolic blood pressure [>/= 90 mm/Hg] had 3-5 times higher risk of retinopathy. Conclusion: Majority of patients were neither knew nor referred for eye examination. Strict control of diabetes and hypertension may prevent or delay diabetic retinopathy. Policy Message: Annual eye examination must be prescribed by the physician/ diabetologist. An education and awareness program for diabetics and community based survey is highly recommended

Outcome of Internal Fixation of Fractures in a Tertiary Care Hospital in Peshawar

Objective: This study was aimed at reviewing internal fixation in our hospital and attendant complications with a view to identifying measures necessary to improve outcome. Study Design: Retrospective study Place and Duration of Study: This study was conducted at orthopedic department of Lady Reading Hospital, Peshawar from March 20 12to February 20 14. Materials and Methods: The operation register was used to identify patients who had undergone internal fixation in the main theatre of the hospital over a Three-year period were collected and their case notes were subsequently retrieved from the medical records unit of the hospital. Data pertinent to study interests were extracted using a questionnaire Results: One hundred and fifteen patients had intemal fixation during the study period but case notes of only 100 patients could be retrieved. Most patients were males with male to female ratio of 2.3:l. The mean age of patients was 32.87 and 15.2 years and the mean duration of surgery was 20.56 hours. Plate and screws constituted the most commonly used implants. Interval between surgery and fracture union was increased by long operation time [> 2. lhrs] and occurrence of post operative complications. Conclusion: Improvement in operating facilities and choice of implants would reduce operation time and post operative complications thereby impacting positively on fracture union time

Drug induced hepatitis; does hepatitis b and hepatitis c co-infection increases the risk during anti tuberculosis chemotherapy

We evaluated whether HBV +ve and HCV +ve patients are at high risk for developing drug induced hepatitis than control subjects during treatment for tuberculosis with standard short course regimens. Observational cohort study. This study was conducted at Department of Medicine, Liaquat University of Medical and Health Sciences Jamshoro from May 2008 to May 2011. All newly diagnosed active tuberculosis patients were included in the study population and they were further screened for hepatitis B surface antigen and HCV antibodies. All patients were divided into three groups. One having no co-infection with hepatitis B and Hepatitis C and was taken as control group, second group was co-infected with hepatitis B and third was co-infected with hepatitis C. short course anti tuberculous regimen was started and patients were followed for six months. One hundred and twenty eight tuberculous patients were divided into three groups. 92 in control groups without any co-infection with hepatitis B and C, 10 were HBV +ve and 26 were HCV +ve. During follow up 24 developed drug induced hepatitis, 8[38.33%, n = 24] in control group, 2[8.33%, n = 24] in hepatitis B group and 14[58.33%, n = 24] in hepatitis C group. These findings suggest that treatment for tuberculosis in HCV seropositive patients is a risk factor for the development of hepatitis exacerbation and HBV seropositive patients shows no any increased risk of hepatitis exacerbation