During Pregnancy the Comparison of Hydralazine and Nifedipine for Severe Hypertension

Objective: The research paper aims at the comparison of Nifedipine and Hydralazine safety and efficacy in the hypertension management during pregnancy. Study Design: The in-hand research design is RCT (Randomized Control Trial). Place and Duration: The venue of the in-hand research paper was Mother and Child Health Unit-II which is located in Pakistan Institute of Medical Sciences, Islamabad. The research commenced from 1st January, 2017 and concluded on 1st July, 2017. Methodology: The number of patients included in research paper was. These patients were diagnosed hypertension and their age was beyond twenty-eight weeks of gestation were enrolled as sample of the research paper after informed consent. Total number of patients was divided into two groups namely Nifedipine and Hydralazine groups. Patients were allocated groups randomly either Nifedipine or Hydralazine group. Before the start of treatment on the right side the blood pressure was checked in supine position, the same check was repeated at the interval of half hour continuously till two hours. Patients were also noticed for the presence of any side effect of the drugs. Results: Initial mean Blood Pressure reading was noted as 170/113 mmHg. One-hour time was effective for the control of systolic blood pressure of Nifedipine group; whereas, one and half hour was for the Hydralazine group. Both the groups were observed same time for the diastolic blood pressure that was one hour respectively for both the groups. Mean time of four and a half days was observed for the pregnancy prolongation in Nifedipine group; whereas, the same time for the Hydralazine group was two days. The p-value was significantly calculated as 0.02. Nifedipine group was treated with few doses of medication. Hydralazine group reflected association of palpitation, flushing, persistent Hypertension and tachycardia with the respective proportions of 56%, 56%, 16.7% and greater than 110 bpm (20%). No other significant difference was observed in the scaled variables of feto-maternal results with an exception of headache caused by Nifedipine in seventy-three percent of the cases after drug administration. Conclusion: In the scholastic research it is concluded that during pregnancy hypertension can best be controlled through Nifedipine in comparison with Hydralazine.

Um levantamento transversal sobre a soroprevalência da hepatite B e hepatite C entre a população geral dos distritos rurais de Sindh, Paquistão / A cross-sectional screening survey on the seroprevalence of hepatitis b and hepatitis c amongst the general population of rural districts of sindh, pakistan

ABSTRACT BACKGROUND: Viral hepatitis is a global phenomenon, with the disease burden varying on a daily basis. Amongst chronic infections, hepatitis B virus and hepatitis C virus (HCV) are egregiously linked to severe health-related complications, with a worldwide prevalence of 248 million and 71 million respectively. Amongst the developing world, a hand full of countries are exhibiting a gross decline in chronic viral infection prevalence, like Bangladesh. While countries such as India have a consistent prevalence, Pakistan bears one of the largest proportions of chronic viral hepatitis globally with increasing trends shown year-by-year. Various old literature texts have stated an approximate national prevalence rate around 2.6% and 5.3% of hepatitis B and C respectively. OBJECTIVE: The objective of this study was to determine the current seroprevalence rates of chronic viral hepatitis amongst the general population of rural Sindh using a screening program to determine the current disease burden. METHODS: An observational, cross-sectional survey based on a screening program was conducted in 5 districts with a combined population of over 6.5 million. The screening was carried out via the administration of various camps with the assistance of local social workers and welfare organizations. A total of 24,322 individuals met the inclusion criteria and were screened through (HBsAg/HCV) rapid test cassette (WC) Imu-Med one-step diagnostic test. RESULTS: Hepatitis B was found positive in 964 (3.96%) individuals including 421 (43.67%) males and 543 (56.32%) females, while hepatitis C was positive in 2872 (11.80%) individuals including 1474 (51.32%) males and 1398 (48.67%) females. The prevalence amongst the districts varied between 0.97% and 9.06% for hepatitis B, and 1.61% and 29.50% for hepatitis C, respectively. Umerkot was found to be the most prevalent district amongst rural Sindh, while Badin had the least number of seropositive people. The second most prevalent district of the study population was found to be Tando Allahyar followed by Mirpur Khas. The combined seroprevalence of 15.76% was calculated for hepatitis B and C together amongst the five studied districts of rural and peri-urban Sindh. CONCLUSION: The alarmingly high prevalence rates revealed in our study warrant the urgent need to generate multiple effective strategies in the region to enhance awareness amongst the general population regarding screening, prevention, and prompt treatment of the disease.

RESUMO CONTEXTO: A hepatite viral é um fenômeno global, com a intensidade da doença variando diariamente. Entre as infecções crônicas, o vírus da hepatite B e o vírus da hepatite C (VHC) estão fortemente ligados a complicações graves relacionadas à saúde, com prevalência mundial de 248 milhões e 71 milhões, respectivamente. Entre o mundo em desenvolvimento, uma quantidade de países está exibindo um declínio bruto na prevalência de infecção viral crônica, tal como Bangladesh. Embora países como a Índia tenham uma prevalência consistente, o Paquistão tem uma das maiores proporções globais de hepatite viral crônica, com tendências crescentes mostradas ano a ano. Vários textos da menos recentes têm declarado uma taxa de prevalência nacional aproximada em torno de 2,6% e 5,3% da hepatite B e C, respectivamente. OBJETIVO: O objetivo deste estudo foi determinar as atuais taxas de soroprevalência da hepatite viral crônica entre a população geral do Sindh rural utilizando um programa de triagem para determinar a carga atual da doença. MÉTODOS: Foi realizada uma pesquisa observacional e transversal baseada em um programa de triagem combinada em cinco distritos com população de mais de 6,5 milhões. A triagem foi realizada por meio da administração de diversos acampamentos com o auxílio de assistentes sociais locais e organizações de assistência social. Um total de 24.322 indivíduos atenderam aos critérios de inclusão e foram examinados através do teste rápido (HBsAg/VHC) Imu-Med em uma etapa. RESULTADOS: Hepatite B positiva foi encontrada em 964 (3,96%) indivíduos incluindo 421 (43,67%) homens e 543 (56,32%) mulheres, enquanto hepatite C foi positiva em 2.872 (11,80%) indivíduos incluindo 1.474 (51,32%) homens e 1.398 (48,67%) mulheres. A prevalência entre os distritos variou entre 0,97% e 9,06% para hepatite B, e 1,61% e 29,50% para hepatite C, respectivamente. Umerkot foi encontrado como o distrito mais prevalente entre Sindh rural, enquanto Badin tinha o menor número de pessoas soropositivas. O segundo distrito mais prevalente da população de estudos foi encontrado como Tando Allahyar, seguido por Mirpur Khas. A soroprevalência combinada de 15,76% foi calculada para hepatite B e C em conjunto entre os cinco distritos estudados do Sindh rural e periurbano. CONCLUSÃO: As taxas de prevalência alarmantemente reveladas em nosso estudo justificam a necessidade urgente de gerar múltiplas estratégias efetivas na região para aumentar a conscientização da população em geral sobre rastreamento, prevenção e tratamento rápido da doença.

Occurrence of unusual haemoglobinopathies in balochistan: hb sd and hb se - presentation with osteomyelitis / Ocorrência de hemoglobinopatias incomuns no baluchistão: hb sd e hb se - apresentação com osteomielite

ABSTRACT Objective: To describe two cases of unusual variants of sickle cell disease. Case description: We present two cases of sickle cell disease variants (haemoglobinopathies), from unrelated families, in the state of Balochistan (Pakistan). One was diagnosed with sickle cell disease in the haemoglobin electrophoresis, whereas the other was diagnosed with sickle cell SE disease. Both were diagnosed based on the presentation of osteomyelitis. Comments: Haemoglobin SD disease (Hb SD) and haemoglobin SE disease (Hb SE) are rare haemoglobinopathies in the world. The lack of available literature suggests that both are variants of sickle cell disease (SCD), with heterogeneous nature. The prevalence of sickle cell disease with compound heterozygotes was found at a variable frequency in the population of the Asian Southeast. The frequency of osteomyelitis in SCD is 12 to 18%, but its occurrence among variant haemoglobinopathies is little reported. Both reported cases presented with osteomyelitis as a characteristic of the disease presentation.

RESUMO Objetivo: Descrever dois casos de variantes raras da hemoglobinopatia falciforme. Descrição do caso: Apresentamos aqui dois casos de hemoglobinopatias variantes das células falciformes, de famílias não relacionadas, no estado do Baluchistão (Paquistão), sendo um diagnosticado como doença da hemoglobina SD na eletroforese de hemoglobina, enquanto o outro com doença da hemoglobina SE. Ambos foram diagnosticados a partir da apresentação de osteomielite. Comentários: Hemoglobina SD (Hb SD) e hemoglobina SE (Hb SE) são hemoglobinopatias raras no mundo. A escassez de literatura disponível sugere que ambas são variantes da doença falciforme (DF) com natureza heterogênea. A prevalência de hemoglobinopatia falciforme com heterozigosidade composta foi encontrada com frequência variável na população do sudeste asiático. A frequência de osteomielite na DF é de 12 a 18%, mas sua ocorrência entre as hemoglobinopatias falciformes variantes é pouco relatada. Os dois casos reportados apresentaram osteomielite como característica de apresentação da doença.

Successful anesthetic management of patient with stiff person syndrome

We herein describe the successful anesthetic management of a patient with stiff person syndrome undergoing right total hip replacement under spinal anesthesia. We also describe the problems associated with general anesthesia. The advantage of using regional anesthesia in these patients is the avoidance of muscle relaxants. The use of general anesthesia carries the risk of hypotonia in stiff person syndrome postoperatively due to enhancement of gamma aminobutyric acid [GABA] action on synaptic transmission by drugs that have a gamma GABA agonistic action

Outcome of patients with acute pancreatitis requiring intensive care admission: a retrospective study from a tertiary care center of Pakistan

Background and Objective: Acute pancreatitis [AP] is an inflammatory disease. Patients presenting with severe disease may require intensive care unit [ICU] admission. Factors predicting mortality and morbidity need to be identified for improving outcome. The objective of this study was to see the outcome of these patient presented to single center over a period of ten years. The secondary objective was to identify the factors responsible for adverse outcome

Methods: The medical records of adult patients from year 2006 to 2016 requiring ICU admission for AP were reviewed retrospectively. The data was collected on the predesigned Performa for patient's demographic, etiology, severity of disease and reason of ICU referral. Besides this physiological and biochemical parameters at time of arrival in ICU were also recorded. Management aspects related to disease course including the ICU related complications were also recorded. The outcome was predicted on the basis of mortality and length of stay [LOS] in ICU and hospital

Results: Total 85 patients were identified of having AP requiring ICU admission. 56 percent of these cases were referred from emergency. Mean Ranson score [RS] was 2.6 and 2.7, at and after 48 hours of admission. Necrosis was present in 48 percent of cases. Mean APACHE-II score was 23. Sepsis was the commonest complication in ICU. The median LOS in ICU and hospital was six and 12 days respectively. The overall hospital mortality was 52 percent, out of which 82 percent died in ICU. RS at admission and APACHE were correlated well with outcome. Similarly associations of factors like need of vasopressors, ARDS, pneumonia, sepsis and AKI requiring intervention were also related to mortality. Likewise development of necrosis or intra-abdominal hypertension showed increased mortality. Biochemical parameters serum blood urea nitrogen [BUN], PH and serum glutamic-oxaloacetic transaminase were also directly linked to adverse outcome

Conclusion: AP patients requiring ICU admission represent severe form of disease. There is a need to develop protocol based care, which should be started immediately after hospital admission. This should have special focus on fluid resuscitation and nutritional therapy. Role of simple bed site parameters like BUN needs to be evaluated

Cumulative fluid balance as a major predictor of clinical outcome in patients admitted to surgical intensive care unit

Objective: Fluid balance remains a highly controversial topic in the critical care field, and there is no consensus about the amount of fluid required by critically ill patients. In this study, the objective was to find the relationship between fluid balance and in hospital mortality in critically ill surgical patients. Our secondary objective was to identify the association between use of colloid and acute kidney injury and use of blood products and development of ARDS

Study Design: The medical records of adult patients admitted to a surgical intensive care unit [ICU] >48 hours, from Aug 2014 to Feb 2016 [18 months] were reviewed retrospectively

Place and Duration of Study: The study was conducted in the surgical intensive care unit of a tertiary care hospital. Medical records of 18 months from Aug 2014 to Feb 2016 were reviewed

Material and Methods: Sampling technique was convenience sampling. A total of 100 patients met the inclusion criteria. Abstracted data of patients admitted to surgical intensive care included body mass index, Acute physiology and chronic health evaluation [APACHE]-II scores, fluid balance during first 5 days of ICU stay, length of ICU stay and in hospital mortality. All statistical analysis was performed using statistical packages for social science version 19 [SPSS Inc., Chicago, IL]. Frequency and percentage were computed for qualitative observation and were analyze by chi-square test. Mean [+/-Standard deviation] and median [IQR] were presented for quantitative variables and analyze by independent sample t-test and Mann-Whitney test. Normality of quantitative data was also be checked by Kolmogorov-Smirnov test. Statistically significant results had a p-value less than 0.05

Results: A total of 100 patients fulfilled the inclusion criteria. The average age of patients was 44.08 +/- 18.14 [years], BMI [kg/m2] 27.84 +/- 5.56 and APACHE II Score 17.28 +/- 6.96. The in hospital mortality was 26 percent, median length of ICU and hospital stay was 6.91 +/- 4.07 and 14.74 +/- 7.78 days. In non-survivors fluid balance was significantly positive on 2nd, 3rd, 4th and 5th day of SICU [p-value: 0.005, 0.0005 and 0.024], APACHE II score [p<0.02], incidence of acute kidney injury [p<0.004] and mechanical ventilation days were significantly more. There was association between the use of colloid and acute kidney injury [p<0.014]. Use of blood products was significantly associated [p<0.03] with development of ARDS

Conclusion: Positive fluid balance, high APACHE II score and acute kidney injury is significantly associated with hospital mortality of non-cardiac surgical ICU patients

Labeling of epirubicin with technetium-99m: Optimization, biodistribution and scintigraphic imaging in tumor bearing mice

Epirubicin is an antineoplastic agent of anthracycline antibiotic, used for treating a variety of tumor types such as lymphoma, cancer of the breast, lung, ovary and stomach. The objective of this work was to demonstrate direct radiolabeling of epirubicin with 99mTc, quality control, biological characterization and scientigraphic evaluation in tumor bearing mice. The 99mTc-epirubicin labeling was optimized by varying the amounts of ligand 100-350microg, stannous chloride dihydride 20-50microg and pH range 2-10 by using NaOH or HCl. The radiochemical purity of 99mTc-epirubicin was evaluated by chromatographic techniques [Whatman No. 3 paper and ITLC-SG]. HPLC analyses were performed to check purity of epirubicin and radiochemical purity of labeled 99mTc- epirubicin. Biodistribution and scintigraphic imaging of 99mTc-epirubicin was performed in normal and tumor bearing mice at various time intervals. The optimum conditions ensuring 99mTc-epirubicin labeling yield as high as 99% by adding 35microg SnCl2.2H2O, 200microg of ligand at pH 6 for 30 min at room temperature [25 degree C +/- 2 degree C]. HPLC of 99mTc-epirubicin shows about 99% binding of the compound with technetium-99m. Electrophoresis study indicated the neutral nature of 99mTc-epirubicin. Biodistribution data and scintigraphic results showed that 99mTc-epirubicin accumulated in the liver as well as in tumor with significant uptake and excellent retention. 99mTc-epirubicin shows good stability in human serum. In vitro and in vivo studies revealed the significantly uptake of 99mTc-epirubicin in the tumor, and also indicating the efficiency of 99mTc-epirubicin as a tumor diagnostic agent

Psychophysiological Effects of Bamboo Plants on Adults / 生物医学与环境科学（英文）

The present study was conducted to clarify the psychophysiological relaxation effects of viewing bamboo on university students. Forty healthy Chinese participants enrolled in this study to clarify the psychophysiological relaxation effects of viewing bamboo. The effects of visual stimulation using a pot both with and without a bamboo were recorded by measuring the student's blood pressure, EEG and STAI. We observed that viewing bamboo plants resulted in significantly lower systolic (female, P < 0.001; male, P < 0.001; P < 0.05) and diastolic (female, P < 0.001; male, P < 0.001; P < 0.05) blood pressures, but no changes in the pulse rate (female, P = 0.09; male, P = 0.07; P > 0.05) were observed. The results of the EEG analysis indicated brainwave variation (all P < 0.05) and lower anxiety scores (P < 0.01) after 3 min of viewing bamboo compared with the control. These findings indicate that visual stimulation with bamboo plants induced psychophysiological relaxation effects on adults.

Androgen deprivation therapy and cardiovascular risk in patients with prostate cancer

Objective: The objective of this study was to investigate the effects of androgen deprivation therapy [ADT] on risk of subsequent cardiovascular morbidity in men with prostate cancer

Study Design: Quasi experimental study

Place and Duration of Study: Department of oncology Combined Military Hospital Rawalpindi, from Sep 2014 to May 2015

Patients and Methods: Thirty consecutive patients fulfilling inclusion criteria were enrolled. All patients were subjected to medical castration/ androgen deprivation therapy [ADT] with monthly 3.75 mg leuprorelin acetate intramuscular injection until castrate levels of testosterone [<50ng/dL] were achieved. We used Framingham's score for assessment of 10 years cardiovascular risk of individual patient before initiation and after completion of 6 months ADT. Serum lipid profile [fasting], systolic blood pressure, history of smoking, diabetes and antihypertensive medication were recorded. Proforma was designed to get clinical information. A p-value of <0.05 was considered significant. A paired-samples t-test was conducted to compare Framingham cardiovascular risk scores before initiation and after completion of 6 months ADT

Results: We enrolled 30 men with high/intermediate risk localized prostate cancer. Mean age was 63.47 +/- 7.32 years. All patients received 6 months ADT with monthly 3.75mg leuprorelin acetate intramuscular injection. There was a significant difference in Framingham cardiovascular risk scores before [mean +/- sd; 20.95 +/- 7.98] and after [mean +/- sd; 25.72 +/- 6.15] 6 months ADT; t [29] =-4.54, p<0.01, two-tailed. Hence ADT resulted in a significant increase [mean +/- sd; 25.7 +/- 6.15] in 10 years cardiovascular morbidity risk t [29] =-4.54, p<0.01, twotailed. Subset analyses revealed significant increase in fasting serum total cholesterol, triglycerides and Lowdensity lipoprotein [LDL] levels after 6 months ADT [p<0.01, <0.01 and <0.01 respectively] however high density lipoprotein [HDL] remained un-changed [p=0.043] in comparison to pre-ADT values

Conclusion: Androgen deprivation therapy results in significantly increased risk of cardiovascular morbidity in patients with prostate cancer however this relationship between ADT and risk of cardiovascular morbidity may be confounded by unmeasured variables like obesity, atherosclerosis and body mass index [BMI] variations

Surgical outcome of spontaneous supra tentorial intracerebral hemorrhage

Objective: To assess the risks and benefits of surgical treatment [Open Craniotomy] of Intra-cerebral hematoma [ICH]

Methods: Twenty seven patients of ICH who underwent surgical treatment at Neurosurgical department of Sheikh Zayed Hospital, Rahim Yar Khan, from 1[st] January 2015 to 31[st] December 2015 were included in this study

The primary outcome measured was death and improvement in GCS Status among survivor's at three months

Results: Mean age of the patients was 58.4+/-10.7 and majority of patients [48.1%] were in the age range of 60-70 years. There were 22.2% patients with ICH volume of >50 ml. Six [6] patients had 8 GCS with 50ml volume, who later died in ICU. Three of the patients who expired developed post-operative pneumothorax. These patients also acquired RTI resulting in deterioration of GCS

The rest of the expired patients showed deterioration in their GCS associated with oedma on brain CT scan. One patient died as a result of re-bleed. Twenty one [21] patients were discharged from hospital, two of these patients were lost in second follow up. Rest of the patients showed a gradual improvement in GCS touching 15/15 by 2[nd] follow up visit

Conclusion: Surgical prognosis of ICH depends on the patients GCS received and size of hemorrhage at the time of presentation. Urgent surgical evacuation in patients with rapid deterioration carries good outcome, hence should be considered

Thoracolumber vertebral fractures; outcome of short segment transpedicular fixation

For spinal injuries, thoracolumbar junction is common site in our population. Surgical management of unstable fractures and fracture dislocations of thoracolumbar spine is still controversial. This study was conducted to document efficacy of short segment fixation of thoracolumbar verterbral fractures

Objectives: To determine the outcome of short segment transpedicular fixation of thoracolumbar fractures

Study design: Descriptive cross-sectional study

Sampling technique: Non-probability purposive sampling

Material and Methods: A total of 103 study cases with thoracolumbar vertebral fractures were taken in this descriptive case series study which was conducted at department of Neurosurgery, Nishtar Hospital Multan from February 2014 to June 2015. Informed verbal consent was taken from each patient before participation in this study ensuring them confidentiality of the information and explaining them objectives and procedure of our study. Once registered, detailed history and clinical examination was done by a Neurosurgeon, investigations like X-ray dorsolumbar spine, CT scan and Magnetic resonance imaging [MRI] dorsolumbar spine were also done. Short segment transpedicular fixation was done and outcome of surgical management was assessed in terms of improvement in power, hardware failure and infection by consultant neurosurgeon. All the study cases were called for follow up visits after every month till 6 months to record final outcome of management. All the information were recorded in the study proforma. Data were entered and analyzed by SPSS version 22

Results: Out of these 103 study cases, 66 [64.1%] were male patients and 37 [35.9%] were female patients and male to female ratio was 1.85:1. Mean age of our study cases 33.92 +/- 9.72 years ranging from 20 years to 54 years. Mean ages of male patients was 36.68 +/- 10.37 years while in female patients it was 29.00 +/- 5.89 years [p=0.000].Post-surgical management improvement in power was seen in 55 [53.4%] of our study cases, hardware failure in 11 [10.7%] and infection was observed in 20 [19.4%]

Conclusion: According to our study short segment transpedicular fixation is safe and effective procedure providing efficient spinal stability. Short segment fixation is associated with minimum blood loss and trauma and leads to early mobilization of the patient and ease in physiotherapy. Transpedicular screw fixation is a useful choice for achieving better neurological recovery and good pain control in post-traumatic thoracolumbar fractures

Cervical spine injury; clinical outcome of patients treated with and without surgical intervention

Objectives: To measure outcome of patients with cervical spine injury treated with and without surgical intervention

Study Design: Cross sectional study

Place and Duration of Study: 3years, Department of neurosurgery, Nishtar hospital Multan

Patients and Methods: Total 43 patients with cervical spine injury fulfilling the inclusion and exclusion criteria were admitted from OPD and emergency department of Nishtar Hospital Multan. Patients were examined for motor loss at the time of admission and on follow after the assigned treatment. MRI neck was performed in all patients

Results: There were 43 patients in total. Males were 31 [72%] while females were 13 [28%] with 2.5:1 ratio. Mean age was 33.92 +/- 11.4. Mean Power grade was 2.2 +/- 1.4 at the time of admission while on follow mean Grade of power was 3.34 +/- 1.51 with P value of 0.00

Conclusion: Cervical spine injury patients are associated with Improvement in power with or without surgical intervention

Cholecystectomy; laparoscopic vs open in patients with mild liver cirrhosis and symptomatic gall stones

To compare the operative time, blood loss, postoperative pain and length of hospitalization between open [OC] and laparoscopic cholecystectomy [LC] in Liver cirrhotic patients with Child -Pugh class A and B. Randomised Control Trial [RCT]. This study was conducted at Surgical department, Holy Family Hospital, Rawalpindi from Jan 2010 to Dec 2011. A total of 142 patients having Liver cirrhosis secondary to Hepatitis A and Hepatitis B, who presented in OPD and ER with signs and symptoms of gall stones were randomly allocated into two groups for open [OC] and laproscopic cholecystectomy [LC]. All of them were either in Child-Pugh class A or B. Data on the above two groups [LC and OC] was collected and analyzed for operative time, blood loss and length of hospitalization after operation. The mean blood loss in LC group was 61.33+39.64 ml vs 90.84+29.88 ml in OC group, Mean operation time was 50.49+18.26 min in LC group vs 59.22+15.66 in OC group which is statistically significant [p<.05]. In LC group, the mean hospital stay was 1.8+.97 days, while in OC group is 2.4+.91 days which is also statistically significant. LC [laparoscopic cholecystectomy] is a safe and effective approach for the treatment of symptomatic cholelithiasis in patients with mild cirrhosis with less blood loss, less postoperative pain, shorter operative time and decreased hospital stay

Emergency dilatation and curettage in a patient with bombay blood group

Bombay blood group is a rare autosomal recessive phenotype within the ABO blood group. It represents genetically suppressed A, B and H genes. When considering such patients for transfusion, only blood of identical Bombay type can be safely transfused. We are reporting a patient having Bombay phenotypic blood, underwent emergency dilatation and curettage with active per vaginal bleeding due to retained products of placenta. There are numerous anaesthetic considerations, including emergency surgery with hemodynamic instability due to ongoing blood loss, dilutional coagulopathy as well as presence of Bombay phenotype that severely limit the possibility of red blood cell transfusion. Only four donors were registered with the blood bank of the institution and none was traceable. It becomes a real challenge for the anesthesiologist to manage such type of patients without having units of red packed cell which management is described hereby

Formulation and evaluation of a single vial lyophilized preparation of technetium-99m labeled ethylene dicysteine as a renal scintigraphic agent

Tc labeled N-N-ethylene-L, L-dicysteine [EC] was introduced in form of multiple-step kit as an alternate renal imaging radiopharmaceutical for commonly used [99m] Tc-MAG3. We developed a single component lyophilized kit of EC ready to be labeled with [99m]Tc

We present the optimization of the components of our formulation, its evaluation in animal models, normal human volunteers and patients of various renal diseases, in comparison with[99m] Tc-MAG3. Efficient labeling of EC was achieved with our preparation at pH 7 to 12. The formulation at pH 8 was used further for bio distribution studies in organs of sacrificed Sprague Dawley rats and a live rhesus monkey using scintigraphy

After satisfactory bio-distribution results, the kit was then evaluated in normal human volunteers through renography. But the renogram parameters of [99m] Tc-EC[pH 8] were statistically inferior to[99m] Tc-MAG3. Surrogate kit at pH 10 was therefore developed and re-evaluated in rats for organ bio distribution. After favorable results the kit was then assessed further in normal volunteers and a group of patients with various renal disorders via scintigraphy

The EC kit developed at pH 10 gave images better than and scintigraphic parameters comparable to [99m] Tc-MAG3. It was concluded that single vial kit we formulated easy to prepare than three-vial kit and can be used as an alternate to[99m] Tc-MAG3

Frequency of non-diabetic renal disease [NDRD] in type II diabetes mellitus

To describe the frequency of NDRD in type II diabetic patients who underwent renal biopsy for deranged renal functions that includes haematuria, proteinuria in the nephrotic and non-nephrotic range and rapidly worsening renal failure. A descriptive study was undertaken in the Department of histopathology at The Kidney Postgraduate Center, Karachi, Pakistan from January 2000 to May 2005. The renal biopsies of 73 patients of type II diabetes were evaluated when a renal disease other than diabetic glomerulosclerosis [DGS] was suspected because of unexplained haematuria, clinically significant proteinuria in nephrotic and non-nephrotic range and rapidly progressive renal failure or unexplained renal failure with normal sized kidney. Three groups of patients were defined on the basis of renal damage noted on light microscopy and immunoflourescence investigations. Group I was NDRD alone, group II NDRD with co-existent DGS and group III DGS alone. The relationship of histology with clinical profile in each group and duration of diabetes were noted and analyzed using SPSS 15 software. Of the 73 patients studied 46 were males and 27 were females [1.7:1]. Group I and II tended to have a younger age group at presentation [49.26 +/- 9.37 years and 49.0 +/- 5.72 years respectively] than group III [53.62 +/- 6.62 years]. The mean duration of diabetes was 9.9 +/- 10.42 years in group I, 7.5 +/- 3.78 years in group II and 13.31 +/- 1.71 years in group III. Among patients 30 [41.1%] had NDRD alone, 06 [8.21%] had NDRD co-existent with DGS, and 37 [50.7%] had DGS alone. Focal segmental glomerlosclerosis [FSGS] and tubulointerstitial nephritis [TIN] were the most common lesion and accounted for 22.2% and19.4% respectively. Amount of proteinuria was higher in patients of NDRD [3.064 +/- 1.38 gms/24 hrs in group I and 3.316 +/- 0.97 gms/24 hrs in group II] than those of DGS [2.815 +/- 0.916 gms/24 hrs] but it did not reach statistical significance. Serum creatinine was significantly raised in patients of group III [3.391 +/- 0.927 mg/dl] versus group I [2.563 +/- 0.95 mg/dl] and II [2.633 +/- 0.952 mg/dl] [p 0.002]. The presence of haematuria was seen in greater number in patients of NDRD [32.5% in group I and 33.3% in group II] versus DGS [in group III 29.6%], but it did not reach statistically significant values. This study shows a high frequency of NDRD in type II diabetic patients who underwent a renal biopsy for impaired renal functions emphasizing the significance of biopsy in such patients in order to tailor their management accordingly

Primary embryonal rhabdomyosarcoma of the liver in a young male

Rhabdomyosarcoma [RMS] occurs infrequently in the liver. Rhabdomyosarcomas are malignant tumours that display features of striated muscle differentiation. They are the most common soft-tissue sarcomas among children. In adults however, these are very rare. We report a case of a primary embryonal rhabdomyosarcoma of the liver in a 17 years old boy. This was confirmed by histological examination using immunohistochemical analysis [LCA negative, desmin positive, myogenin focally positive and cytokeratin negative] and site was confirmed by PET CT scan. He received multiple chemotherapies including [doxorubicin, ifosfamide, dacarbazine; gemcitabine, paclitaxel; vincristine, actinomycin D, cyclophosphamide] but longest sustained stable disease was seen with gemcitabine-paclitaxel regimen. The patient died 31 months after the first presentation, secondary to complicated abundant abdominal progressive disease. The poor prognosis and early death of most previously reported cases imply the need for investigation of a more effective treatment method of this uncommon tumour

Fabrication of an acrylic interim denture employing two-part impression technique for distal extension bases - Kennedy class 1 with modifications

Impression procedure forms the basis of a successful Removable Partial Denture however, in distal extension bases the residual ridge must be recorded in functional form and the remaining natural teeth in an anatomic form. Zinc oxide eugenol impression paste is a material of choice for functional impression whilst irreversible hydrocolloid is suitable for an anatomic impression. Therefore two-part impression technique is a suggestive impression technique that enables the operator to make an impression utilizing two different types of impression materials loaded in two different trays, one of which is a special tray and other a stock tray, so as to control the differential support predicament

evaluation of renal biopsy in type-II diabetic patients

To determine the renal damage in type-II diabetic patients, who underwent renal biopsy for impaired renal functions and its role in overall patient management. Descriptive, cross-sectional study. The Kidney Postgraduate Centre, Karachi, Pakistan from January 2000 to May 2005. Histopathological evaluation of 73 patients of type-II Diabetes mellitus were included who underwent renal biopsy. Renal biopsy was performed when a renal disease other than diabetic nephropathy was suspected because of the presence of haematuria, nephrotic syndrome, non-nephrotic proteinuria < 3 gms/day in the absence of retinopathy, rapidly progressive glomerulonephritis and renal insufficiency of unknown origin. On the basis of light microscopy and immunofluorescence, three groups of patients were defined. Group I was characterized by diabetic glomerulosclerosis [DGS] only, group II by the prevalence of vascular changes, while group III had sub-groups IIIa [DGS co-existing with nondiabetic renal diseases] and IIIb [non-diabetic renal diseases without DGS]. Among the 73 patients studied, 20 [27.3%] had diabetic glomerulosclerosis alone [group I], 17 [23.3%] showed occurrence of vascular changes [group II], and 36 [49.3%] had non-diabetic renal diseases [group III]. Mean serum creatinine level was significantly greater in group II than in group I and III [p < 0.001]. Amount of proteinuria and the presence of haematuria did not show a statistically significant difference in groups I, II and III. The systolic and diastolic blood pressure was higher in groups II as compared to group I and III [p < 0.001]. The percentage of sclerotic glomeruli, tubular injury and interstitial inflammation in group II were significantly greater than group I and III [p < 0.001]. Type-II diabetic patients undergoing renal biopsy for impaired renal functions constituted a heterogeneous group of renal damage. This study emphasized the usefulness of renal biopsy for determining the pattern of renal damage that would aid in the overall management of the patients