Study of anti-diabetic, beta-carotene-bleaching inhibiting and iron chelating properties of Carissa opaca root extracts

Abstract Degenerative diseases diabetes and oxidative stress constitute a major health concern worldwide. Medicinal plants are expected to provide effective and affordable remedies. The present research explored antidiabetic and antioxidant potential of extracts of Carissa opaca roots. Methanolic extract (ME) was prepared through maceration. Its fractions were obtained, sequentially, in hexane, chloroform, ethyl acetate and n-butanol. An aqueous decoction (AD) of the finely ground roots was obtained by boiling in distilled water. The leftover biomass with methanol was boiled in water to obtain biomass aqueous decoction (BAD). The extracts and fractions showed considerable porcine pancreatic α-amylase inhibitory activity with IC50 in the range of 5.38-7.12 mg/mL while acarbose had 0.31 mg/mL. The iron chelating activity in terms of EC50 was 0.2939, 0.3429, 0.1876, and 0.1099 mg/mL for AD, BAD, ME, and EDTA, respectively. The EC50 of beta-carotene bleaching activity for AD, BAD, ME, and standard BHA were 4.10, 4.71, 3.48, and 2.79 mg/mL, respectively. The total phenolic content (TPC) and total flavonoid content (TFC) of AD and BAD were also considerable. In general, ethyl acetate fraction proved to be the most potent. Thus, the C. opaca roots had excellent antioxidant activity while having moderate α-amylase inhibitory potentia

Designing a novel mRNA vaccine against Vibrio harveyi infection in fish: an immunoinformatics approach

Vibrio harveyi belongs to the Vibrio genus that causes vibriosis in marine and aquatic fish species through double-stranded DNA virus replication. In humans, around 12 Vibrio species can cause gastroenteritis (gastrointestinal illness). A large amount of virus particles can be found in the cytoplasm of infected cells, which may cause death. Despite these devastating complications, there is still no cure or vaccine for the virus. As a result, we used an immunoinformatics approach to develop a multi-epitope vaccine against most pathogenic hemolysin gene of V. harveyi. The immunodominant T- and B-cell epitopes were identified using the hemolysin protein. We developed a vaccine employing three possible epitopes: cytotoxic T-lymphocytes, helper T-lymphocytes, and linear B-lymphocyte epitopes, after thorough testing. The vaccine was developed to be antigenic, immunogenic, and non-allergenic, as well as having a better solubility. Molecular dynamics simulation revealed significant structural stiffness and binding stability. In addition, the immunological simulation generated by computer revealed that the vaccination might elicit immune reactions in the actual life after injection. Finally, using Escherichia coli K12 as a model, codon optimization yielded ideal GC content and a higher codon adaptation index value, which was then included in the cloning vector pET2+ (a). Altogether, our experiment implies that the proposed peptide vaccine might be a good option for vibriosis prophylaxis.

The effect of rehabilitation protocol using mobile health in overweight and obese patients with knee osteoarthritis: a clinical trial

Abstract Objective: The objective of this randomized controlled trial (RCT) was to investigate the effectiveness of the lower limb rehabilitation protocol (LLRP) combined with mobile health (mHealth) applications on knee pain, mobility, functional activity and activities of daily living (ADL) among knee osteoarthritis (OA) patients who were overweight and obese. Methods: This study was a single-blind, RCT conducted at Teaching Bay of Rehmatul-Lil-Alameen Post Graduate Institute of Cardiology between February and November 2020. 114 knee OA patients who were overweight and obese were randomly divided by a computer-generated number into the rehabilitation group with mHealth (RGw-mHealth) to receive LLRP + instructions of daily care (IDC) combined with mHealth intervention, rehabilitation group without mHealth (RGwo-mHealth) to receive LLRP + IDC intervention and control group (CG) to receive IDC intervention. All three groups were also provided leaflets explaining about their intervention. The primary outcome measure was knee pain measured by the Western Ontario and McMaster Universities Osteoarthritis Index score. The secondary outcome measures were mobility measured by the Timed up and go (TUG) test, functional activity measured by the patient-specific functional scale (PSFS), and ADL measured by the Katz Index of independence in ADL scores. Results: Among the 114 patients who were randomized (mean age, 53 years), 96 (84%) completed the trial. After 3-months of intervention, patients in all three groups had statistically significant knee pain reduction (RGw-mHealth: 2.54; RGwo-mHealth: 1.47; and CG: 0.37) within groups ( P < 0.05). Furthermore, patients in the RGw-mHealth and RGwo-mHealth had statistically significant improvement in mobility, functional activity, and ADL within groups ( P < 0.05), but no improvement was noted in the CG ( p > 0.05). As indicated in the overall analysis of covariance, there were statistically significant differences in the mean knee pain, mobility, functional activity, and ADL changes between groups after 3-months ( p < 0.001). The pairwise between-group comparisons (Bonferroni post hoc analysis) of the knee pain, mobility, functional activity, and ADL scores at 3-months revealed that patients in the RGw-mHealth had significantly higher mean change in the knee pain, TUG test, functional activity, and ADL scores compared to patients in the RGwo-mHealth or CG. Conclusion: Reduction in knee pain, improvement in mobility, functional activity, and ADL were more among patients in the RGw-mHealth compared with the RGwo-mHealth or CG. Trial registration National Medical Research Registry: NMRR-20-1094-52911. Date of registration: 05-05-2020. URL: https://www.nmrr.gov.my.

Areca Nut Chewing and the Risk of Re-hospitalization and Mortality Among Patients With Acute Coronary Syndrome in Pakistan / 예방의학회지

OBJECTIVES: Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. METHODS: A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. RESULTS: Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p < 0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p < 0.001). CONCLUSIONS: The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.

Effects of lower limb cycle training on echocardiographic parameters of left ventricle in dilated cardiomyopathy patients

Objective: To determine the effect of lower limb ergometric training on echocardiographic parameters of left ventricle in dilated cardiomyopathy [DMC] patients. Study Design: Randomized control trial. Place and Duration of Study: Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan, from September 2016 to February 2017

Methodology: Clinically stable patients with DCM [n=60], were randomly allocated into an interventional group with two month interventional program and a non-trained control group [n=30 each]. Treatment protocol for interventional group was lower limb ergometer exercise for 8 weeks, 4 days/week. Pre and post-treatment echocardiography was done in both groups at baseline and after 8 weeks. SPSS 21 was used for data analysis

Results: The median [IQR] age of the patients was 51 [18] years in interventional group and 62 [11] years in control group. Male to female ratio was 18:9 in control group and 17:12 in Interventional group. Statistically significant results were detected within the groups regarding ejection fraction [EF], left ventricular internal dimension systole [LVIDS] and left ventricular internal diastolic dimension [LVIDD] [p<0.001]

Conclusion: Exercise training with lower limb ergometer was effective in improving the ejection fraction and left ventricular dimensions in patients with dilated cardiomyopathies

Epigenetics: Quest for no-escape to HIV, a persistent pathogen

Acquired Immune Deficiency Syndrome [AIDS] is a disease infection mix, which is primarily because of 'deficient' immune system. Human Immune-deficiency Virus [HIV] makes the immune system susceptible to many infections by infiltrating it. Many researchers believe that HIV is a mutated form of Simian Immune-deficiency Virus [SIV]. After being clinically discovered in 1981 in America, it is said to have caused 36 million deaths. Treatment of AIDS has been a 'burning ' issue ever since its discovery. There is no cure for AIDS! Although, Recombinant Transcriptase Inhibitors [RTis] are being considered a major treatment against HIV that can not only lessen the effect of HIV but also can prolong the life of HIV positive patients. More recent advancement includes 'transplantation of transgenic stem cells' in HIV positive patients. As latency of HIV provirus in host genome is the preeminent weapon of this virus against RTis that compel it to hide from host immune system and a persistent pathogen thereof. Thus, epigenetic activation of latent provirus pool by methyl inhibitors along with nontoxic chemical drugs seems to be a more promising treatment to avoid the burden of lifelong RTI

MicroRNAs: a new paradigm towards mechanistic insight of diseases

In 1993 miRNAs were discovered during a research on Caenorhabditis elegans conducted by Victor Ambros and Gary Ruvkun. The gene lin-4 that played important role in development in C. elgans was observed not encoding any protein but a very small RNA molecule of just 22 nucleotides. Main objective of this review is to highlight the significance of miRNAs in regulating the expression of many genes, which are either directly or indirectly involved in many diseases. One of the major causes of illness and death in developed countries of the world is cardiovascular disease. Some of the miRNAs have certain role to play in heart that are not specified for heart. So miRNAs have been found to be in other tissues like fibroblasts, endothelial cells and smooth muscle cells that are part of physiological study of cardiovascular system. Adult heart has limited capacity of regeneration therefore lost cardiomyocytes due to myocardial ischemia or infarction can result in low performance of heart. miRNAs have been shown to play a role in apoptotic regulation of cardiomyocytes in vivo. Many studies have shown that miR146a and 155 are up regulated in peripheral blood mononuclear cells, synovial fibroblasts, synovial fluid and Th-17 cells from rheumatoid arthritis patients as compared to healthy persons. Several types of miRNAs are playing important roles in type 1 diabetes mellitus including miR-375 and miR-375 with intolerance to glucose and decreased beta cells account due to impaired proliferation. Up regulation of miR-125a in WAT of type 2 Diabetes mellitus have been observed. miRNAs have proved to be the important regulators of cytokines and growth factor expression. Thus, suggested as a good biomarker and target of therapy. miRNA profiling techniques have revealed the role of miRNAs in Multiple sclerosis

Trends in prescribing antiplatelet drugs for secondary prevention of non-cardioembolic ischemic stroke

Objective: To determine the trends of physicians and neurologists in prescribing anti-platelet agents for secondary prevention of non-cardio embolic stroke after 3 months of stroke

Study Design: A descriptive study

Place and Duration of Study: Combined Military Hospital [CMH] Lahore over a period of four months

Material and Methods: Patients suffering from old [>/=3 months] non-cardio embolic stroke, taking anti-platelet agents for secondary prevention and visiting CMH Lahore neurology clinic. Information about their stroke and treatment was obtained from their previous investigations and medical prescriptions

Results: A total of 60 patients met the inclusion criteria of the study; 36 [60 percent] were taking a combination of clopidogrel 75mg plus Aspirin 75 mg and 12 [20 percent] received Aspirin 75 mg daily while 12 [20 percent] were getting other regimens

Conclusion: Combination of clopidogrel 75mg plus Aspirin 75 mg was the most common anti-platelet regimen prescribed for secondary prevention of non-cardio embolic stroke in our study population

Cypermethrin-induced Repeated-dose Immuno-toxicity in Oryctolagus Cuniculus: An Investigation into Pathology of Spleen and Blood

Background: Cypermethrin is a pyrethroid insecticide widely used in agriculture and medicines. Its toxicity effects on spleen and blood in male and female rabbits is studied in this research. Methods: Age- and weight-matched does/females (n=24) and bucks/males (n=24) of Japanese White rabbits were subjected to intraperitoneal cypermethrin administration @50, 100 and 150 mg.kg-1 b.wt. in groups B, C and D, respectively.  The experimental rabbit does and bucks were tested for hematology alterations after each of 5 CY-treatments, at days 1, 8, 15, 22 and 29.  One rabbit doe and one rabbit buck were sacrificed fortnightly (days 15, 29, 43, 57 and 71) to obtain spleen for histological studies. Results: CY-treated rabbit bucks developed anemia, leukopenia, neutropenia, monocytosis, eosinophilia and basocytopenia mostly in dose and time dependent manner.  In contrast, rabbit does show transient but significant leukocytosis, neutropenia, lymphopenia, monocytosis, eosinophilia and basophilia only in high dose group.  Moreover, spleen histology revealed congestion, depletion of white pulp with increased red pulp and hemosiderin deposition in CY treated rabbit bucks, but not rabbit does. Conclusions: This study concludes that immuno-toxicity by cypermethrin insecticide is not similar in male and female subjects.

Poor adherence with ACE inhibitors is a risk factor of CVA with oral hypoglycemic agents in diabetic patients

Poor adherence with medicine declines the clinical outcome of pharmacotherapy. It may carry serious sequelae especially in case of antihypertensive drugs like cerebrovascular accident [CVA]. This study has been planned to find the association of poor adherence with anti-hypertensive with CVA in diabetic and non- diabetic patients. One hundred CVA patients who were admitted through Emergency in Abbasi Shaheed hospital, a tertiary care hospital in Karachi, were recruited from Jun 2013 till Dec 2013. The criteria of inclusion was, diagnosed case of CVA, with primary hypertension, availability of patient's therapeutic record, consent of the patient or legal successor/heir. The criteria of exclusion was, secondary hypertension, newly diagnosed primary hypertensive patients and complete adherence with medication. Morisky medication adherence scale was applied. Therapeutic record was accessed. The mean age was 62.15 years with 3:1 male to female ratio. Adherence to medicine was graded <6. Patients with hypertension were 41 and with diabetes and hypertension were 59. Majority of patients were on monotherapy as compared to polytherapy [62% versus 38%].The mode of therapy was significantly different [P<0.05] in the two groups. ACE Inhibitors, Calcium Channel Blockers, Beta Blockers and other agents were used by 45.16%, 35.48%, 16.12% and 03.24% patients respectively. The aforementioned drugs were used by 57.14%, 33.33% and 09.52% respectively in 21 patients who were on antihypertensive and oral hypoglycemic agents. A statistical significant difference [P<0.05] was seen in the case of ACE Inhibitors. Similarly they were used by 42.10%, 39.47% and 18.42% in 38 patients respectively, who were on antihypertensive and insulin. No statistical significant difference [P>0.05] was seen in any combination [p>0.05]. Thus it is concluded that poor adherence with ACE inhibitors may be a risk factor of CVA in diabetic patients using oral hypoglycemic agents

Junctional epidermolysis bullosa [non-herlitz type]

Junctional epidermolysis bullosa [JEB] is a recessively inherited skin blistering disease and is caused due to abnormalities in proteins that hold layers of the skin. Herlitz JEB is the severe form and non-Herlitz JEB is the milder form. This report describes a case of congenitally affected male child aged 5 years, with skin blistering. He has mitten-like hands and soft skin blistering on hands, legs and knees. Symptoms almost disappeared at the age of 3 years but reappeared with increased severity after 6 months. Histopathological examination showed epidermal detachment with intact basal cell layer and sparse infiltrate of lymphocytes with few eosinophils in the dermis. There was no blistering on the moist lining of the mouth and digestive tract. Localized symptoms with less lethality and histopathological examination indicated the presence of non-Herlitz type of JEB. This is the first report which confirms the presence of non-Herlitz junctional epidermolysis bullosa in Pakistan

Diagnosis and phenotypic assessment of Pakistani Haemophilia B carriers

Objectives: 1: To assess the diagnostic utility of three polymorphisms [DdeI, XmnI and TaqI] and direct sequencing in haemophilia B [HB] carrier detection in Pakistani families. 2: To compare phenotypes of HB carriers with those of healthy females

Methods: The study was conducted from March 2014 till February 2016 at Khyber Medical University Peshawar and National Institute of Blood Diseases, Karachi. Individuals from HB families of Khyber Pakhtunkhwa [KP] and Federally Administered Tribal Areas [FATA] with known F9 mutation in the proband were enrolled into the study. FIX activity [FIX:C] levels were determined in all the participants. Bleeding scores [BS] and complete blood counts were performed in the female participants. Linkage analysis followed by targeted Sanger sequencing was carried out in all the study participants. Heterozygosity rate was determined for each polymorphism. Healthy females and the carrier groups were compared for bleeding phenotypes

Results: A total of 30 males and 48 females from 13 HB families were studied. The polymorphisms had a low heterozygosity rate. Direct sequencing determined the carrier status in all cases. The mean FIX:C was reduced whereas BS was raised in the carriers when compared with healthy females. A significant raise in white blood cells [WBCs] count was observed in the carriers

Conclusion: The three polymorphisms have a low heterozygosity rate in HB families from KP and FATA. Sanger sequencing is conclusive in determining carrier status in all the cases. FIX:C is low and BS is raised in the HB carriers in comparison to that of normal females. The mean WBCs count is significantly higher in the HB carriers than the normal females

Frequency of HBeAg positivity in chronic hepatitis B infected patients

Objective: To determine the frequency of HBeAg positivity in chronic hepatitis B infected patients

Methodology: This descriptive cross-sectional study was carried out for one year between June 01, 2014 till May 30, 2015 in a private consulting clinic at Ibrahimi Hospital, Dabgari Gardens, Peshawar - Pakistan. A total of 149 patients were included in the study. All patients of either gender between 15 to 70 years of age, newly diagnosed with HBV infection in the form of positive HBsAg on third generation ELISA were included in the study. In all the patients, HBeAg was checked. Data were analyzed using SPSS version 20.0

Results: Out of the total 149 patients between 20 to 60 years [mean 41 +/-8.7] included in the study, the males 112 [75.2%] outnumbered the females 37 [24.8%]. The prevalence of HbeAg in chronic HBV was 28.2 % [males 16.10 %, females 12.08%] with more patients [22.14%] between 21 and 40 years of age

Conclusion: The frequency of HbeAg was found in a significant number of chronic HBV patients. Its frequency was more in males and in the age group of 21 to 40 years

Intrathecal tramadol as an adjuvant in subarachnoid block to prolong the duration of analgesia

Objective: To assess the effect of intrathecal tramadol added to bupivacaine to prolong the duration of analgesia in subarachnoid block for lower limb orthopedic surgeries

Study Design: Randomized controlled trial

Place and Duration of Study: Anesthesia department of Combined Military Hospital Sialkot, from Nov 2015 to Apr 2016

Material and Methods: Patients were selected by non-probability consecutive sampling. One hundred and fifty patients from American Society of Anesthesiologists [ASA] I, II and III category fulfilling inclusion criteria undergoing various lower limb orthopedic surgeries were divided into two groups by lottery system. Group tramadol bupivacaine [TB] received 25mg [1 ml] of tramadol plus 2ml [10mg] of 0.5% bupivacaine while group bupivacaine alone [SB] received 1 ml normal saline plus 2ml [10mg] of 0.5% bupivacaine. Time to first analgesia request was noted as a measure of duration of analgesia. Time of onset of sensory block level and peak sensory block level and time to reach the peak sensory block level were also noted. Quality of anesthesia was compared among two groups. Data were analyzed by using SPSS version 22

Results: Four patients were excluded from the study. The duration of anesthesia was effectively prolonged in group TB 181.56 +/- 12.42 mins as compared to group SB 120.93 +/- 15.54 mins. VAS score was significantly lower in group TB. Higher peak sensory block levels [T6] were achieved in group TB as compared to group SB. However time to reach the peak sensory block levels were significantly longer in group TB. [4.5 +/- 0.47mins vs 3.09 +/- 0.54 mins]

Conclusion: This study showed that intrathecal tramadol [25mg] can safely be used along with bupivacaine in subarachnoid blockade to prolong the duration of analgesia and improve the quality of anesthesia as well

Effect of early

Objective: To determine the effect of

Study Design: Randomized control trial

Place and Duration of Study: BARMWT Hospital, Rawalpindi, from March to August 2015

Methodology: A randomized controlled trial was conducted on 174 CABG and valvular heart disease patients undergoing cardiac surgical procedures. After selection of sample via non-probability purposive sampling, they were randomly allocated into interventional group [n=87] and control group [n=87]. Treatment protocol for experimental group was

Results: The patients' mean age was 51.86 +/-13.76 years. Male to female ratio was 132:42. Statistically significant differences in respiratory rate and SpO[2] [p=0.000 and 0.000, respectively] were found between both groups. Among ABG's, PCO[2] and pH showed significant differences with p values of 0.039 and <0.001, respectively. No significant differences were observed between both groups regarding electrolytes [Na[+], K[+], Cl[-], p-values of 0.361, 0.575 and 0.120 respectively] and creatinine [p=0.783]. Marked improvement in oxygen saturation, dyspnea and a fall in systolic BP was seen in interventional group. There was also observed to be a reduction in the length of ICU stay among interventional group patients as frequency with percentage of total stay was compared to control group

Conclusion: Early physical activity [

Validity of modified alvarado scoring system [mass] in the diagnosis of acute appendicitis

Objective: To determine the validity of Modified Alvarado Scoring System [MASS] in the diagnosis of acute appendicitis. Study Design: Cross sectional validation study. Place and Duration of Study: Department of Surgery Combined Military Hospital [CMH] Kohat Pakistan, from Nov 2013 to Oct 2014

Material and Methods: A total of 248 patients fulfilling the inclusion criteria were enrolled in the study after getting the informed written consent. Modified Alvarado Score of all patients was calculated on a proforma which included migratory right iliac fossa pain, anorexia, nausea/vomiting, tenderness in right iliac fossa, rebound tenderness, elevated temperature and leucocytosis [>10 x 109/L]. Surgeries were performed by residents and consultant surgeons. Decision to operate upon was not only on the MASS of the patients rather it was on overall clinical condition of the patients using different scoring systems. Where required aid of different laboratory investigations, ultrasonography, CT scan and laparoscopy was also taken. After surgery histopathological examination of resected specimens was performed. Pre operative modified alvarado score and post operative histopathological results were endorsed on a proforma. A two by two table was used to determine the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of MASS

Results: Out of total 248 patients, 183 [73.8%] patients were males and 65 [26.2%] were females. Male to female ratio was 2.8:1. Sensitivity of MASS in this study was 89.39%, Specificity 84.06%, positive predictive value 93.57%, negative predictive value 75.32% and diagnostic accuracy was 87.90%

Conclusion: Modified alvarado score is a highly sensitive test with fair degree of specificity for the early diagnosis of acute appendicitis especially in the adults. It is particularly helpful for young doctors and in the peripheral hospitals where more sophisticated investigations are not available

Disease patterns among hajj pilgrims attending medical facilities of pakistan Hajj medical mission 2016 [1437 hijri]

Objective: The purpose of this study was to determine the frequency of different diseases among Pakistani Hajj pilgrims attending the medical facilities of Pakistan Hajj Medical Mission during Hajj 2016 [1437 hijri]. Study Design: A descriptive cross sectional study. Place and Duration of Study: Pakistan Hajj Medical Mission hospitals and dispensaries at Makkah Mukkarrmah, Medina Munawwarah and Jeddah, from 10[th] Aug 2016 to 5[th] Oct 2016

Material and Methods: All Pakistani Hajj pilgrims reporting to various Pakistan Hajj Medical Mission Hospitals and dispensaries at Makkah, Medina and Jeddah were included in the study. A universal sample of all patients reporting to the Hajj medical mission [A total of 184,496 OPD visits] was used. The patient were initially assessed in Emergency Reception[ER] by medical officers and then referred to respective specialists if required. A specially designed proforma having information regarding name, age, disease and its duration was prepared and filled for each patient separately. A second hospital/dispensary visit of the Hajj pilgrim was considered separately on a new proforma. SPSS version 17 was used to analyze the data

Results: There were a total of 184,496 OPD [Out Patient Department] visits by Pakistani Hajj pilgrims during the study period. Age of the patients ranged from 20-96 years, 74.5% [n=137, 449] were male and 25.5% [n=47047] were female. Number of patients suffering from various diseases and their percentage in order of frequency was; respiratory diseases 29% [n=53187], musculoskeletal disorders 18% [n=33838], gastrointestinal diseases 15% [n=26696], Ear Nose and Throat [ENT] diseases 8% [n=14448], skin disorders 6% [n=10937], eye disease 3% [n=4530], mouth and dental diseases 3% [n=6101], wounds, fractures and burns 3% [n=6186], cardiovascular diseases 2% [n=4433], gynecological disorders 2% [n=4357], infectious disease 1% [n=1055], minor surgeries <1% [n=620], psychiatric disorders <1% [n=40] and other miscellaneous complaints 5% [n=9889]

Conclusion: Respiratory illness was the commonest disease among Pakistani Hajj Pilgrims while musculoskeletal and gastrointestinal complaints were also high. This study helps to identify the common diseases encountered during Hajj Medical Mission and may aid in the better preparedness of such missions in future

Battlefield surgery: an experience from forward treatment centre WANA

Objective: To profile the spectrum of injuries and management of casualities treated in forward treatment centre [FTC] Wana over a period of one year by optimizing the available resources of a Field Hospital

Study Design: Descriptive cross sectional study

Place and Duration of Study: Forward treatment center Wana South Waziristan Agency, from 21 Jan 2014 to 08 Dec 2014

Material and Methods: A total of 62 cases brought in FTC were included in the study. Cases were managed according to Advanced Trauma Life Support [ATLS] protocol. A policy of aggressive resuscitation, early primary repair of injuries and evacuation was followed at our setup

Results: All patients were male with a mean age of 28.1 +/- 4.443 yrs. The majority of casualties were military [52 cases, 83.9%] and the major cause of injury was found to be improvised explosive device [33 cases, 53.2%]. Extremities were involved in majority of casualties [38 cases, 50.7%]. A total number of 91 operations were performed in 62 cases which included 14 laparotomies [15.4%], 21 chest intubations [23%], 9 amputations [9.9%], 19 cases of debridement [20.9%], 10 fasciotomies [11%], 1 tendon repair [1.1%], 10 closed reduction of fractures [11%], 5 closed reduction of dislocations [5.5%] and 2 cases of extremity vascular repair [2.2%]

Conclusion: Optimal utilization of limited resources warrants a responsible approach of surgeons towards injured brought at FTCs. A variety of injuries may be encountered by the forward surgical team who can significantly contribute by providing life and limb saving surgery

Pharyngeal cervical brachial variant of guillain barre syndrome requiring prolonged ventilatory support

Patients with pharyngeal cervical brachial [PCB] variant of Guillain Barre Syndrome [GBS] typically present with rapid progression of oropharyngeal and cervicobrachial weakness. We report case of a 25 year old male soldier suffering from PCB who presented with brachiopharyngeal weakness which progressed to involve his lower limbs. He was intubated and mechanically ventilated and was treated with plasmapheresis. He made good recovery after remaining on ventilatory support for a long time. His electromyography and nerve conduction studies [EMG/NCS] were consistent with axonal polyneuropathy