Clinical Evaluation and Serum Lipid Profile between Individuals with Acute Hepatitis C.

Aim: Hepatitis C virus (HCV) exerts an intense impact on host lipid metabolism. It has been shown that the synthesis of cholesterol and fatty acids (FA) is directly affected in HCV patients but serum FA profile of acute HCV patients have not been directly quantified in humans. Methodology: In present study the serum lipid and FA’s profile (free and total) of acute hepatitis C patients (n=50) is evaluated in comparison to healthy controls (n=50). The acute HCV patient’s were diagnosed by center of diseases control (CDC) criteria. Blood hematology, serum proteins, enzymes, waste metabolites and nutrition status were also assessed by standard methods. Results: The acute HCV patients have significantly lower (P<0.05) lipid profile including triglycerides, cholesterol, HDL and LDL in relation to controls. Results of serum lipid FA’s (total and free form) reveal elevated level of saturated fatty acid (SFA) and monounsaturated fatty acid (MUFA), with lower content of polyunsaturated fatty acid (PUFA) in acute hepatitis C patient as compared to controls. Among SFA, myristic and palmitic acid were increased and five unsaturated FA including nervonic, linoleic, α-linolenic, docosahexaenoic and arachidonic acid were reduced than control subjects. Significantly higher (P<0.05) alanine transaminase, alkaline phosphatase, direct bilirubin and globulin levels were found in acute HCV patients possibly due to viral infection. Conclusion: This work makes available direct proof that lipogenesis is elevated in acute HCV patients while as evident from reduced serum PUFA and elevated SFA as well as MUFA. Hence acute HCV patients have low PUFA levels, which put forward importance of PUFA supplementation.

Effect of smoking on C-reactive protein levels in chronic periodontitis

The objective of the study was to compare the effect of smoking on the level of C-reactive protein [CRP] in chronic periodontal disease. The response of periodontal treatment and its effect on the level of the CRP was also observed in both groups. Hundred patients with chronic periodontitis were taken. Smoking history of the patients was assessed and accordingly, they were categorized as: Group A [smokers] and Group B [non- smokers]. Periodontal evaluation was done on every patient and blood samples were collected for noting the levels of CRP. All patients were then given treatment of chronic periodontitis by mechanical removal of calculus as well as prescription of antimicrobials and mouth rinses. Periodontal evaluation and blood samples were repeated three months after the given treatment to check the change in CRP levels. At Baseline, CRP levels of smoker group was more than non- smoker group. Three months after the given periodontal treatment, the periodontal health was significantly improved. Mean CRP level in both smoker group and non- smoker group was significantly decreased. Chronic periodontitis has significant effect on CRP levels. Chronic periodontitis may add to the inflammatory burden of an individual and this can be reverted to some extent if appropriate treatment is given. This response will not be affected by adverse effects of smoking

Comparison of accuracy of working length measured by apex locator and periapical radiograph

The aim of this study was to compare the accuracy of working length measured by electronic apex locator andperiapical radiograph. This cross sectional analytical study was conducted at Department of Operative Dentistry, Dental section, Dow International Medical College, DUHS from November 2014 till December 2014. Thirteen teeth with twenty three canals were selected in patients having age between 18 to 60 years, who were advised extraction of teeth due to any reason. Access opening was performed and working lengths of all canals were measured using Kfile with apex locator and periapical radiographs. Access opening was filled with restorative GIC with the files present in canals. Teeth were then subjected to extraction. All extracted teeth were evaluated by sectioning the lower half or lower one third of the apices longitudinally. The distance of the file tip from the minor constriction was measured and recorded. Data were analyzed by using SPSS version 16. Intraclass co-efficient test was applied to see the agreement between the lengths measured with radiograph and apex locator than compared to the actual lengths as noted after sectioning. P-value of <0.05 was considered as significant. The results of the study showed that accuracy of apex locator were 65% [n=15] with the file tip at minor constriction, while 22% [n=5] for periapical radiograph. Thus it is concluded that electronic apex locator is more accurate and reliable then periapical radiograph

Knowledge, attitude and perception of dental fraternity towards practice of rubber dam

Rubber dam isolates operating field and makes treatment less invasive and safer for the patient. The aim of this study was to evaluate knowledge, attitude and practice of using rubber dam among different strata of dental fraternity. This cross sectional survey was conducted at Dental section, Dow International Medical College; DUHS from November 2014 till may 2015. Four hundred questionnaires were distributed amongst dental students, house officers and postgraduate trainee. General practitioners and retired dentist were excluded from the study. Three hundred and seventy four questionnaires were returned with over all response rate of 93.5%. Data was analyzed by using SPSS version 20. Statistically there was a significant association between knowledge and designation [p=0.031]. Dentist showed positive attitude towards rubber dam application [p=0.00]. It is concluded that dentists have significant knowledge about rubber dam use, but general reluctance towards it require change in the attitude by improvising regular practice

Effectiveness of simple strategies in reducing multidrug resistant blood stream infections in neonatal intensive care unit of tertiary care hospital in Karachi, Pakistan

To report reduction in transmission of multidrug resistant organisms from the neonatal intensive care unit after the implementation of simple risk-reduction strategies. Using a pre-and-post design, the study was carried out from June 2010 to December 2011 at the neonatal intensive care unit of Aga Khan University Hospital, Karachi, which is 12-bed, level III facility. The intervention comprised hand washing certification for all staff, use of chlorhexidine instead of povodine iodine for skin preparation, use of non-sterile gloves for diaper change, implementation of barrier nursing for clinically-suspected and culture-proven infections, provision of separate intubation and central line trolley for each room and limiting the use of umbilical catheters to 7 days. Data is reported for 3-month pre-intervention period, one-month implementation phase, and for 3-month post-intervention phase. Data for 12 months post-implementation is reported to show sustainability. The average pre intervention rates of bloodstream infections due to extended spectrum beta lactamase, Acinetobacter, Pseudomonas and methicillin resistant staphylococcus aureus were 4.7, 3.3, 1.2 and zero respectively. The average number of admissions during the 3 phases was almost similar [49, 46 and 53 respectively]. There was sustained reduction in rates for all organisms 12 months after the intervention period. Nosocomial transmission of multi drug resistant organisms within the neonatal intensive care unit can be effectively reduced by adopting simple strategies

Suppression and treatment of haloperidol induced extra-pyramidal side effects and anxiety syndrome by the coadministeration of red rice bran oil in rats

Antipsychotic medications may reduce or eliminate symptoms of psychosis. They are not a 'cure' for mental illnesses, but can be an effective part of treating mental disorders. Even though many of the antipsychotics such as haloperidol cannot cure mental illnesses, they are effective in eliminating or reducing psychotic symptoms. However, prolong administration of haloperidol may result in parkinsonian like effects and tardive dyskinesia. The objective of the present research was to determine the effects of long term co-administration of RRBO in diet on haloperidol induced anxiety and EPS. It was hypothesized that co-administration of RRBO by the free radicals scavenging property could alleviate parkinsonian like effects and tardive dyskinesia. The present results showed a reversal of haloperidol induced parkinsonian like effects and tardive dyskinesia in rats cotreated with RRBO

Assessment of microleakage of three restorative materials in class V cavities. an in vitro study

To evaluate the marginal microleakage in class V cavities restored with three different restorative materials using dye penetration scoring system. Cross sectional study. This study was conducted at Dental Clinic laboratory, Juma building research laboratory, and Multidisciplinary laboratory, The Aga Khan University, Karachi for a period of six months from April 2008 to September 2008. One hundered and fifty extracted premolars were randomly selected. Standardized class V cavities were prepared and then divided into three equal groups: Group I was restored with composite resin, Group II with glass ionomer cement and group III with resin modified glass ionomers. They were then subjected to thermocycling, immersed in 2% methylene blue dye, sectioned and examined under dissection microscope. Dye penetration for each section was recorded and data was analyzed. Lowest leakage was found in Group I [composite resin] and maximum in Group II [conventional glass ionomer]. Microleakage at gingival margins was significantly more than that at occlusal margins in all groups. Composite resins and resin modified glass ionomers provide a better seal than glass ionomers in class V cavities. All materials show more microleakage at gingival margins as compared to occlusal margins

Psychosocial experiences of women with vesicovaginal fistula: a qualitative approach

Vesicovaginal fistula [VVF] is a condition associated with a number of physical and psychological consequences. In order to gain a deeper understanding of the issues faced by women diagnosed with VVF, a qualitative exploratory study was carried out to explore the experiences of women suffering from VVF. The study included 8 women hospitalized with the diagnosis of vesicovaginal fistula at Kohi Goth Women's Hospital, Karachi, Pakistan. Semi structured interviews of each participant were conducted, recorded, and transcribed. Five major themes were identified, among which all of the participants experienced physical discomforts, psychological disturbances, issues with social and interpersonal relationships and financial constraints. However, concerns with religious practices were experienced by 87.5% of the participants. Pakistani women who are suffering through VVF face many challenges. Combined efforts should be made to offer supportive services to women suffering from this condition.

Socioeconomic risk factors for asthma in child

The purpose of the study was to explore and explain different socioeconomic conditions and factors related to childhood asthma, Cross sectional descriptive study, This study was conducted at the Children's Hospital and the Institute of Child Health, Lahore for a period of three month. This is a descriptive study done at the asthma clinic of the Children's Hospital and the Institute of Child Health, Lahore. Total 110 patients were included in the study between 2-16 years, An objectively designed structured questionnaire was used and data was collected after taking consent from the parents. Out of 110 patients, the commonest age was 2-8 years for both males and females. The disease was most common in boys [63.6%] and urban area [57.3%] had higher frequency than patients from semi urban [24.5%] or rural areas [18.2%]. Asthma was more common in lower and middle class than upper. Different socioeconomic risk factors involved in the increased frequency of asthma were smoking, animals at home and environmental dust. Allergic reactions to food, change in weather and preceding upper respiratory tract infections also play an important role. Poor socioeconomic class, uneducated families, urban life and environmental allergen exposure are responsible for increase frequency of asthma and by investing resources in to community based education and support services we can provide a better control of asthma to our community

Determination of some toxic and essential trace metals in some medicinal and edible plants of Karachi city

Trace metals in eight different medicinal plants commonly available in Karachi namely Azadirachta indica [Neem], Syzygium aromaticum [Clove], Murraya koenigii [Curry Leaves], Trachyspermum ammi [Ajowan], Foeniculum vulgare [Fennal], Brassica oleracea [Cabbage], Brassica rapa [Turnip], and Pipper nigrum [Black pepper] have been quantitatively analyzed using Atomic Absorption Spectroscopy and Flame Photometry. A wet digestion procedure involving the use of H[2]SO[4] [95%] and H[2]O[2] [35%] has been adopted to digest medicinal plants. Nine heavy metals [Cd, Cr, Co, Cu, Fe, Pb, Mn, Ni and Zn] and two alkali metals [K and Na] were chosen on the basis of their effects upon health. In general the order of concentration of toxic metals in medicinal plants was found to follow the order Pb> Ni> Cr> Co> Cd. Sodium and Potassium content was found to be very high in all the samples. Concentration of sodium were recorded to be the highest in roots of Brassica rapa and Murraya koenigii i.e., more than 1000 micro g/g. Postassium concentrations are around 9038 micro g/g in Foeniculum vulgare. Plante samples of Trachyspermum ammi, leaves of Brassica rapa, and Foeniculum vulgare, Brassica oleracea [Cabbage], contained comparatively higher amounts of Fe i.e., > 100 micro g/g. Out of all toxic metals Lead is present at noticeable levels in all the samples that indicates higher soil pollution. Concentrations of Na, K and Mn and Cu are found to be very high in Brassica rapa roots as compared to its leaves while Fe levels are found to be high in leaves

Reasons for extraction in permanent dentition a study in a tertiary care setting in Pakistan

The aim of this study was to investigate the primary reasons for simple extraction of permanent teeth In Dental Section of a tertiary care hospital and to identify the most frequently extracted teeth. The patients selected for this study were identified by reviewing dental notes from medical records of patients who had undergone dental extraction at Dental clinic, at The Aga Khan University Hospital, Karachi. Total of 124 charts were reviewed retrospectively. Data regarding the age, gender, co morbid conditions, date of extraction, number and type of tooth extracted and the cause of exodontia were recorded in a proforma. Descriptive analysis was done using SPSS version13.0. A total of 147 teeth extracted from 77 patients were included for analysis. Out of 77 patients, 56%were females and 44% were males. Average age was 49.7 + 16 years. [11-83 years]. Reasons for extraction were: 42.2% extractions were due to caries, 30.6% were extracted for periodontal reasons, 6.1%for orthodontic reasons, 10.2% for mixed reasons, 6.1% for failed endodontics, 4.1% on account of tooth fracture and 0.7% for pre-prosthetic reasons Maxillary second molars were the most frequently extracted teeth. More posterior teeth were extracted due to caries while periodontitis was the main reason for extraction in the anterior teeth. Caries was found to be the primary reason for exodontia of permanent teeth in all age groups, followed by periodontitis and orthodontic reasons. Maxillarymolars were the most frequently extracted teeth

Development and validation of a Multidimensional Religiosity Scale for Muslims

The main objective of the present research was to develop a Multidimensional Religiosity Scale [MDRS] to measure the religious orientations of Muslims. Initially a list of 280 items was generated from three different sources, namely, the Holy Quran, Mazamin-ul-Quran operational definitions of religiosity by the experts. After item analysis, the number of items was reduced to 175. The first draft of MDRS was administered on 671 adults. The data was subjected to principal factor analysis. As a result, seven factors were extracted called subscales. Psychometric properties and percentile norms were determined for the final scale, i.e. Multidimensional Religiosity Scale. It is a 5-point Likert type rating scale. Our findings demonstrate that MDRS is a reliable and valid instrument to be used for religious orientation of Pakistani Muslims

Effects of water and sanitation on childhood nutrition in Pakistan

To examine the impact of type of household water supply and toilet facilities on the nutritional status of children < 3 yrs of age. Descriptive study. Rural areas of district Malir, Karachi. From November 2000 to April 2001. 400 children < 3 years of age were assessed by anthropometric examination. A pre-designed questionnaire was filled, collecting information on type of water supply and toilet facilities in each of the selected household. Only 190 out of 400 families interviewed had access to piped water and only 185 of 400 families had proper flush toilets. Lack of piped water and toilet facilities had a significant correlation. Statistics for stunting were not significant, probably because it represents a more chronic process. Provision of unpolluted water supply with proper toilet and sewerage facilities play an important role in preventing childhood malnutrition and solutions to address this problem are the need of the day

Solitary infantile myofibromatosis of the skull

This is the report of a 6 months old boy presenting with a firm, solitary mass on the temporal region, associated with lysis of local bone. Investigations lead to a diagnosis of infantile myofibromatosis [IM]. Wide local excision was performed. At one year follow-up, no recurrence was noted

Role of oral misoprostol in first trimester pregnancy failure

To prove the effectiveness and safety of oral Misoprostol in first trimester pregnancy failure. Prospective interventional study. Obstetrics and Gynaecology department, Fatima Memorial Hospital Lahore. A period of 4 months from June 2006 to September 2006. A total of 64 women at 7 to 12 weeks of gestation with confirmed pregnancy failure were enrolled. Every woman included in the study was prescribed tablet Misoprostol 400 ugm by oral route followed by 200 ugm every 4 hourly up to 4 doses and instructed to report back in case of side effect such as nausea, vomiting abdominal pain or vaginal bleeding. Follow up was scheduled on day 2 and day 7. The course of same regimen was repeated if process did not start in 48 hours. Dilatation and curettage was done in case of incomplete expulsion or heavy bleeding. Major outcome measures were complete expulsion rate, need for surgical evacuation and cervical dilatation and side effects. Forty seven [73.43%] women had complete expulsion at one week while 43.75% [28] achieved it within 48 hours. Fifteen [23.43%] women needed surgical intervention out of which 40% needed cervical dilatation prior to evacuation. Forty [62.50%] women had pre-abortion bleeding which was mild to moderate in nature in 82% of cases while 53.12% [34] had abdominal pain. Rest of the side effects were transient and well tolerated. Oral Misoprostol is safe and effective mode of medical management for first trimester pregnancy failure and repeating the second course after 48 hours has significantly increased expulsion rate

Acquired aplastic anemia: treatment in a developing country

The aim of this study was to evaluate the clinical presentation of aplastic anemia as well as to assess the efficacy of Cyclosporin-A in patients with aplastic anemia. This is a hospital based interventional study. During the three year study period, 44 children were enrolled. Mean age was 9.3 years and there was a male predominance. Most common clinical presentation was anemia and bleeding. Four children died before therapy was started. Cyclosporin-A was started in 40 patients. Eleven patients died before completion of therapy and three patients were lost to follow-up. Out of 26 patients who completed therapy, 11 were cured and 9 were responders while 6 were non responders according to the selected criteria. In developing third world countries like Pakistan majority of the patients with aplastic anemia cannot afford BMT. Alternative modalities of treatment must therefore be looked into. Cyclosporin-A seems to be a reasonable therapeutic option in such cases

Pattern of gynaecological cancer at a tertiary care hospital Lahore-at twelve years study

To determine the relative frequency of gynaecological cancers and also to ascertain the age and parity distribution as well as the stage of disease at presentation. Observational study. Department of Gynaecology and Obstetrics unit II Sir Ganga Ram Hospital/Fatima Jinnah Medical College, Lahore. January1994 to October2005 During the study period of 12 years, there were 13849 admissions in the gynaecology ward, of which 209 women [1.5%] were diagnosed to have gynaecological cancers. The record of these cancer patients was maintained on specially designed proforma and was analyzed for relative frequency, age, parity distribution and stage of disease at presentation. Ovarian cancer was the commonest malignancy [47.84%] followed by cancer of the cervix [32.05%] and of the endometrium [12.91%]. The mean ages for ovarian, cervical and endometrial cancer were 44.52, 51.10 and 57.45 years respectively. 30% of the women with ovarian cancer were between 31-40 years of age. However; about 10% of cases were under 20 years of age. Out of all study subjects, about 45% had a parity of six and above. However; in the group of women with ovarian cancer; 47% cases were Para 1 to 5. At time of initial presentation 66% of ovarian cancer and about 47% of cervical cancer cases were in advanced stage disease [III and IV] while for endometrial carcinoma majority presented at earlier stage. Four patients with ovarian malignancy had family history of ovarian and breast cancer. Ovarian cancer is the commonest malignancy occurring comparatively in younger age group and with advanced stage presentation. Cervical cancer being preventable, is tragically still a major health burden. Although this study has limited epidemiological importance however such data of a teaching hospital can be an incentive for other institutes to carry out similar work, which can help in establishing cancer registry in our country

Management of Acute Asthma in children using metered dose inhaler and small volume nebulizer

To determine whether the administration of 32 - agonist by Metered Dose inhaler [MDI] with accessory device [AD] is a as effective as the administration of 32 - agonist by small volume nebulizers [SVN] for the treatment of acute asthma. A cross sectional study was conducted at Emergency Room [ER] of National Institute of Child Health [NICH], Karachi, between October 2000 to March 2001. This study included 150 children, 6 months and older with a history of wheeze and presenting with an acute asthma exacerbation. Children were categorized into mild, moderate and severe asthma according to medical scoring system. Children were assigned randomly into group A and B to receive standard dose of 32 - agonist [salbutamol] by MDI/AD [group A] or SVN [group B]. Baseline : characteristics and asthma severity were recorded. All variables [dyspnoea, use of accessory muscles, cyanosis, respiratory rate, heart rate, blood pressure, oxygen saturation, pulsus paradoxus, and wheeze] and Peak Expiratory Flow Rate [PEFR] in children 5 years and older, were determined at pre and post inhalation therapy. Both groups did not differ in demographic characteristics. There were no significant differences in outcome measures. In children treated with MDI/ADs and SVNs. PEFR increased significantly in both the groups after completion of treatment, but PEFR was not statistically significant when compared in between groups. The data suggested that MDI/AD is an effective alternative to nebulizer for the treatment of children with acute asthma exacerbation in the ER

importance of contact history in childhood tuberculosis

Tuberculosis is an ancient disease that is known to have existed in the prehistoric times, and has been a major health burden, even today 95% of the cases are present in the developing countries. The exact proportion of children with tuberculosis is unknown but it is estimated to be between 3-13% of all cases [Ejaz and Mumtaz, 2002]. The child with TB in a community will represent a failure of TB control in that community. Patients included in the study were children age between 1-15 years of either sex coming to a tertiary hospital with history, clinical and laboratory findings of tuberculosis. Diagnosis of tuberculosis was made on the basis of WHO criteria, with the support of MT, chest X-ray, clinical history and history of contact with patients of pulmonary tuberculosis. There were total 160 patients include in our study, 109 [68.1%] patients had positive history of contact from home, close relatives and from neighbors while in 51[30%] cases there was no history of contact detected

Determinants of bottle use amongst economically disadvantages mothers

There is documented evidence of increased risk of infant mortality in formula fed infants versus breast fed babies. The hazards of bottle use for infant feeding, especially in underprivileged communities, are also well known. As the issue of bottle use is directly related to childhood survival and mortality, there is legislation against propagation of bottle-feeding in Pakistan. To obtain information about determinants of bottle use for infant feeding in a low-income periurban community. Community based cross-sectional study. 150 mothers with infants up to one year of age were included in the study period from October 03 to March 04. Out of these 102 mothers were found using bottle for infant with or without breast-feeding. The tendency to use the bottle increased in relation to child's increasing age. Only 17% of the infants under the age of 3 months were offered bottle, it was 69% between 4 to 6 months and it increased to 76%.in infants from 7 months to 1 year. The attributes associated with increased bottle use were mother's older age, illiteracy and increased parity. Bottle use is a public health issue in poor and illiterate mothers of developing countries. While, in Pakistan, laws are enacted against its propagation, we need community-based strategies to bring about a socio-cultural shift in the growing prevalence of bottle use found in the study