Intracranial tuberculomas: presenting symptoms and outcome with anti tuberculosis drugs treatment

Background: Tuberculosis is still common in developing countries, and sometimes involves central nervous system, proper diagnosis and early treatment effectively reduces the mortality and morbidity associated with this disease

Objective: Observe presenting symptoms and outcome on anti-tuberculosis drug treatment

Material and Methods: This prospective study was conducted in the Department of Neurosurgery in collaboration with Department of Pathology, Ayub Teaching Hospital Abbottabad from March 2010 to December 2016. 22 patients; 8 females and 14 males were studied for their signs and symptoms and outcome after anti-tuberculosis drug treatment

Results: The most common location of tuberculous lesions was supratentorium [81%] particularly in parietal lobe [50%] followed by frontal lobe [22.7%] and occipital lobe [18.2%]. 45% patients had prior history of tuberculosis. Headache was the predominant complaint [72.7%] followed by altered sensorium [31%], seizures [27.3%] and cranial nerve palsies [22.7%]. After 12 months of anti-tuberculosis treatment ATT, about 87% of patients had either resolved or regressed tuberculoma

Conclusion: Brain tuberculomas are benign lesions with" malignant" behavior. Early diagnosis and anti-tuberculosis drug treatment can effectively treat this lesion forever. So in developing countries like Pakistan, when there is cystic, nodular or multiple lesions, there should be suspicion for brain tuberculoma and work up should be done because of very good prognosis associated with anti-tuberculosis drug treatment

Comparison of efficacy of tacrolimus versus cyclosporine in childhood steroid-resistant nephrotic syndrome

Objective: To compare the efficacy of tacrolimus versus cyclosporine [Calcineurin Inhibitors] in the management of childhood steroid-resistant nephritic syndrome [SRNS]

Study Design: Quasi-experimental study

Place and Duration of Study: Department of Paediatric Nephrology at The Children's Hospital and Institute of Child Health, Lahore, from August 2014 to September 2015

Methodology: Patients of either gender aged 1-12 years, with the diagnosis of mesangioproliferative glomerulonephritis [MesangioPGN], focal segmental glomerulosclerosis [FSGS] or minimal-change disease [MCD] were included. Patients were assigned into two groups, one given tacrolimus in dose of 0.1 - 0.2 mg/kg/day in two divided doses, and other given cyclosporine in dose of 150 - 200 mg/m2/day in two divided doses along with oral steroids 30 mg/m2/day in divided doses, followed by alternate day with tapering dosage. Trough drug levels were done with dose adjustment accordingly. Patients were monitored and followed for the response to treatment and adverse effects of these two calcineurin inhibitors

Results: A total of 84 patients, 58% males and 42% females, were included in the study. The age ranged from 1.25 to 12 years. The most common histopathological diagnosis was Mesangio PGN [69.04%], FSGS [21.4%], and MCD [9.52%].

Complete response was seen in 80.95% and 97.6% patients treated with cyclosporine and tacrolimus, respectively

Partial response was in 19.05% patients treated with cyclosporine and 2.4% in patients with tacrolimus. The most common adverse effect with cyclosporine and tacrolimus was hypertrichosis in 80.95% and 2.38%, hypertension 16.66% and 11.9% respectively while gum hypertrophy with cyclosporine was seen in 26.19% patients

Conclusion: Tacrolimus was more efficacious than cyclosporine in achieving remission in childhood SRNS with insignificant adverse effects

Presentation and aetiological aspects of tuberculous lymphadenitis at district sialkot

The present study was conducted to assess the presentation and etiological aspects of tuberculosis cervical lymphadenopathy for early detection, diagnosis and prompt specific therapy. Descriptive study. This study was conducted at the Department of Surgery and ENT of Allama Iqbal Memorial Hospital Sialkot from July 2009 to July 2014. Data was collected including history, family history, socioeconomic status, history of contact and symptoms. They have already undergone FNAC and only those with inconclusive FNAC underwent excision biopsy. Total sample size was 372 males and females were 232, age range of 0 to 70 years. The younger was anewborn of 2 months of age with history of tuberculosis in mother and the oldest was a 70 year of age with prolonged history of pulmonary tuberculosis. Frequency of tuberculosis is more common in Sialkot district. The main reason of prevalence of tuberculosis is poor hygiene, poverty, overcrowding, tanneries spill over contaminating drinking water. Timely diagnosis is better option in order to reduce such incidence and therapy reducing cost of treatment

Epidemiology of gun shot injuries in district Sialkot

Background: Gunshot injuries [GSI] is a public health problem in developing countries, our studies attempted to define the circumstances, risk factors, extent and severity of firearm related injuries

Objective: The objective of this study was to determine the epidemiology of gunshot injuries, related to its circumstances, risk group, extent of injury and its severity in Sialkot District

Materials and Methods: Study Design: Retrospective study. Place and Duration: This study was conducted at Allama Iqbal Memorial Teaching Hospital, from 1[st] January 2008 to 31[st] December, 2012. The data was extracted, including patient demographic data, manner of injury, date, time, season of injury, type of weapon used, location where victim was attacked, and site of Injury. The data was entered and analyzed in SPSS version 15

Results: Total number of patients were 1240, male and female ratio was 6.2:1 and the most frequent age group was 3[rd] decade of life, it was more frequent in rural as compare to urban areas, majority of the incidences occurred in summer, most involved region was lower limb

Conclusion: Research on GSI provides new results and information which can be used to assist medical resource allocations and preventive campaigns. There is need for educational efforts and community, societal curriculum to reduce the GSI which is not possible without addressing root causes and bringing such changes which may minimize mortality, disability, and cost to community

Epidemiology of gun shot injuries in district sialkot

Background: Gunshot injuries [GSI] is a public health problem in developing countries, our studies attempted to define the circumstances, risk factors, extent and severity of firearm related injuries

Objective: The objective of this study was to determine the epidemiology of gunshot injuries, related to its circumstances, risk group, extent of injury and its severity in Sialkot District

Materials and Methods: Study Design: Retrospective study. Place and Duration: This study was conducted at Allama Iqbal Memorial Teaching Hospital, from 1st January 2008 to 31[st] December, 2012. The data was extracted, including patient demographic data, manner of injury, date, time, season of injury, type of weapon used, location where victim was attacked, and site of Injury. The data was entered and analyzed in SPSS version 15

Results: Total number of patients were 1240, male and female ratio was 6.2:1 and the most frequent age group was 3[rd] decade of life, it was more frequent in rural as compare to urban areas, majority of the incidences occurred in summer, most involved region was lower limb

Conclusion: Research on GSI provides new results and information which can be used to assist medical resource allocations and preventive campaigns. There is need for educational efforts and community, societal curriculum to reduce the GSI which is not possible without addressing root causes and bringing such changes which may minimize mortality, disability, and cost to community

Adult intussusception -temple of surprise 7 year experience in Sialkot

Intussusception is a rare entity in adults, it is expected to be found in 1/30,000 of all hospital admission, 1/1300 of all abdominal operations, 1/30 to 1/100 of all cases operated for intestinal obstruction, and one adult intussusception for every 20 childhood. Retrospective case series study. This study was carried out at the department of surgery Allama Iqbal Memorial Teaching Hospital Sialkot from June 2006 to June 2013. While operating cases for intestinal obstruction five cases of adult intussusception with M-F ratio was 4:1, mean age was 46.5 year. Ileo-Ileal Intussusception were found in all cases. All five patients presented with intestinal obstruction on radiological evidences, exploratory laparotomy were carried out, four patients had Ileo-Ileal Intussusception while fifth one involved terminal ileum for which right hemicolectomy was performed. All patients recovered and discharged home. Adul Intussusception is a rare entity usually has a causative pathological lead point and always difficult to diagnose, always treated by surgery

Terminal ileal perforation due to various etiologies and their treatment modalities

Terminal ileum perforation is quite common in developing countries carrying high morbidity and mortality. Retrospective case study. This study was carried out at the Department of General Surgery, Allama Iqbal Memorial Hospital, Sialkot from March 2007 to March 2013. The study was aimed to find aetiological factors of Terminal ileum perforation and different treatment modalities for such perforation. There were 34 typhoid, 6 tuberculous, 14 non-specific and 2 others of foreign body and ascariasis. Various surgical procedures like Covering ileostomy, Closure with exteriorization, Ileostomy alone, Resection of perforation with covering ileostomy and Right hemicolectomy were done depending upon the severity of disease and clinical status of the patient. Treatment of Terminal ileal perforation is always surgical regardless of the techniques. Operation must be done as soon as possible and should be associated with aggressive resuscitation before operation. This results in remarkable decrease in morbidity and mortality of the patients. Response of treatment modalities varies from patient to patient depending upon the aetiological factors. The outcome is very encouraging in those who present earlier

Clinical manifestations and semen analysis of patients with varicocele

Background: Infertility is a major problem worldwide affecting 60-80 million women and men, all over the world causing social and family life disturbances leading to divorces

Objective: This study was planned to determine the prevalence of poor quality serum among varicocele patients

Patients and Methods: This was a descriptive study in which data of 200 cases was reviewed from 2006 to 2011, clinical assessment and semen analysis of these patients were carried out and graded accordingly. Semen analysis post-operatively was also carried out

Results: A total of200 patients were included in study, the overall mean age was 29 years, in grade I, it was 32 years in grade II, 29 years and in grade III, 26 years. Overall 55% has poor quality of semen. 45% had no rmozoospermia, 18% had oligozoospermia, 13% had oligoasthenozoospermia, 17.5% had asthenozoospermia, azoospermia in 7% of cases were found. Pathophysiology and relation between varicocele and infertility is yet to be understood but venous reflex and testicular temperature elevation may be the factor of development ofvaricocele induced testicular dysfunction

Conclusion: There is a relationship between the grades of varicocele and deterioration of semen quality. Grade III varicocele is associated with decreased sperm count. High frequency of varicocele in adolescents with poor quality of semen and the fact that early treatment of varicocele restores the testicular function and there after fertility, health education of children and parents should be mandatory

Presentation and management outcome of symptomatic haemorrhoids

Background: Haemorrhoids is one of the most common anorectal condition, which involved human beings both in ancient and recent times

Objective: The study was conducted to describe clinical profile and management outcome of symptomatic haemorrhoids

Patients and methods: A total of 405 patients of symptomatic haemorrhoids were included from outdoor and indoor department. Conservatively managed patients of grade I were 150 while for others open haemorrhoidectomy was performed. This descriptive study was planned to asses the outcome at week one and six and complications for one year

Result: Our results showed that majority of the patients has multiple symptoms. 75% of the conservatively managed patients of grade I were cured. Among grade II, 80% responded to treatment within one week, whereas, 88% of grade III responded in one week, 81% of grade IV responded in 1st week. It was noted that up to 10% of grade II, 26% of grade III and 38% of grade IV had complications

Conclusion: It is concluded that majority of the patients present with multiple symptoms, however, carefully categorized and subsequently managed patients has good outcome and minimum complications. All surgeons should tailor the treatment of haemorrhoids based on understanding of the indication and complications associated with the procedure

Antimicrobial activities of Aerva javanica and Paeonia emodi plants

Aerva javanica and Paeonia emodi plants extracts were studied for antibacterial activity against Escherichia coli [NCTC 10418], Klebsiella pneumoniae [ATCC 700603], Pseudomonas aeruginosa, Staphylococcus aureus, Salmonella typhi, Staphylococcus epidermidis [NCTC 11047] and Methicillin Resistant Staphylococcus Aureus [MRSA] [NCTC 13143] and antifungal activity against Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger and Fusarium solani. Extracts were obtained by using methanol, n-hexane, chloroform, ethyl acetate and aqueous fraction. The extracts of Paeonia emodi and Aerva javanica showed significant antibacterial activity but only Salmonella typhi was resistant to Aerva javanica. Moreover, the antifungal activity of Aerva javanica was very poor but the fractions of Paeonia emodi showed sufficient inhibition against fungal strains

Qualitative analysis of sputum specimens submitted for acit fast bacilli [AFB] microscopy to a teaching hospital at Rawalpindi

To find out the quality of sputum specimens submitted for AFB microscopy, to categorize these specimens on the basis of their quality and to compare the frequency of AFB positive smears in each category of these specimens. Five hundred and seventy convenient sputum samples from patients referred for AFB microscopy of sputum were examine after Ziehi Neelsen staining. Based on Heinman and Radano's criteria for sputum, all the sputa under study were divided into sputum and non-sputum categories. The non-sputum category was sub-divided into saliva and mixed samples based on the ratio of pus cells and epithelial cells. All the smears for qualitative categorization and for AFB were examined by the qualified microbiologist. The frequency of AFB positive smears in each category was calculated. Out of 570 specimens submitted, only 110 [19%] were found to be sputum specimens, while 324 [57%] were saliva and 136 [24%] were declared as mixed. The frequency of AFB positive smears was the highest in samples categorized as sputum, 23.6% [26 out of 110] followed by mixed samples 7.35% [10 out of 136], and saliva 0.31% [1 out of 324]. The overall frequency of AFB positive smears was 6.49% [37 out of 570]. Quality of sputum specimen plays a major role in the detection of AFB from the sputum smears. As evident from this study, the frequency of AFB positive smears in the sputum was found to be much higher as compared to saliva and mixed samples

Chronic venous ulcers

Ulcers of the lower leg secondary to venous insufficiency account for some 85% of all leg ulcers. The proper venous drainage of a leg requires three sets of veins. Thee deep vein surrounded by muscles, the superficial veins, and the veins connecting these two - the perforating or communicating veins