Post-PCNL renal artery pseudoanurysm

A renal artery pseudoaneurysm is a rare but important complication that can occur after renal trauma, renal biopsy, percutaneous nephrostomy, percutaneous nephrolithotomy [PCNL], and partial nephrectomy. The incidence of this potentially life-threatening complication is less than 1%, but is likely to increase with the increasing popularity of endoscopic renal procedures. We present a case of a 30-year female who underwent right PCNL for a right renal pelvic stone. Two weeks later, she presented with massive hematuria. Renal angiography revealed psuedoanurysm of interlobar artery which was successfully treated with coil embolization

Dietary isoflavones, the modulator of breast carcinogenesis: Current landscape and future perspectives

Breast cancer is a frightful disease and serious concern in women around the world causing significant health care burden in both developed and developing countries. Extensive research work has shown that breast cancer provides strong resistance to chemical agents, UV radiation, and hormonal treatments. It is generally accepted that cell genetics is not the only main reason for breast cancer and genetic risk factors, for example, mutations in BRCA1 and BRCA2 genes constitute 5%-10% of all breast cancer rates. Other related factors include age, gender, race, ethnicity, weight, reproductive factors, exo- and endogenous hormonal exposures, oral contraceptives use, ultraviolet radiation, diet, and night work (circadian disruption). Many studies have revealed that dietary isoflavones regulate breast cancer occurrence, recurrence and prognosis. Dietary isoflavones have long been part of Asian population diet and there is a significant increase as compared to dietary isoflavones intake among other populations. Dietary isoflavones are natural phytoestrogens having both estrogenic and anti-estrogenic potentials on breast cancer cells in culture, animal models and in experimental trials. This literature survey provides a comprehensive overview on the tumor preventive and tumor promoting potentials of dietary isoflavones on breast cancer. In addition, this paper provides a literature review of dietary isoflavones and their effects on up-regulation and down-regulation of different signaling pathways, genes and proteins. Finally, future perspectives of dietary isoflavones and breast cancer researchers are also critically discussed, which will provide a deeper insight regarding the inner molecular mechanisms of action.

Detection of genes for superantigen toxins in methicillin-resistant Staphylococcus aureus clinical isolates in Karachi

To detect genes for enterotoxins, exfoliative and toxic shock syndrome toxins in Staphylococcus aureus [S. aureus] strains isolated from clinical specimens. Cross-sectional observational study. Department of Molecular Genetics, Dr. Ziauddin Hospital, Karachi, from January to December 2010. Two hundred and ninety eight S. aureus clinical isolates were obtained from various clinical samples received at Dr. Ziauddin Hospital, Karachi. Out of these, 115 were detected as methicillin resistant [MRSA] by cefoxitin disk diffusion test showing a prevalence rate of 38.6%. Detection of individual toxin genes was performed by Polymerase Chain Reaction [PCR] by using only one primer pair for each tube. Uniplex primers were preferred as multiplex primers are longer in base pairs and have the potential for cross reaction due to non-specific binding and increase in optimization time. The possession of a single gene or more than a single gene in MRSA isolates was found in 61.73% of clinical samples; the highest number was found in pus swab, followed by sputum, blood, urethral swab, and urine. The prevalence of toxin genes was higher in MRSA as compared to methicillin sensitive [MSSA] isolates [19.12%]. PCR detects strains possessing toxin genes independent of their expression. The possession of genes for super-antigens seems to be a frequent and habitual trait of S. aureus more so in MRSA

Study on alternative therapeutic agents on methicillin-resistant staphylococcus aureus from clinical and environmental isolates

The in vitro antimicrobial activity of Sea buckthorn [SBT] [Hippophaerhamnoides], Green tea [Camellia sinensis] and Dandasa [Juglansregia] on selected methicillin resistant Staphylococcus aureus [MRSA] isolates from clinical samples was tested. The in vitro antimicrobial activity of six antiseptics/disinfectants against MRSA isolated from environmental samples was also evaluated. Experimental Observational. This study was conducted in Immunology and Infectious Diseases Research Laboratory [IIDRL] Lab, University of Karachi from January 2011 to July 2011. Minimum Inhibitory Concentration [MICs] of plant extracts was determined by micro- broth dilution method and, susceptibility of MRSA isolates from environmental samples against antiseptics/ disinfectants was estimated by the agar disk diffusion and agar well diffusion methods. None of the plant extracts inhibited the isolates originating from blood samples. SBT offered comparatively more inhibitory zones and among the antiseptics/disinfectants, savion was the most effective. In view of the rising antibiotic resistance, exploring possible natural plant extracts for their antimicrobial action seems like an attractive substitute. The results showed some degree of susceptibility and can be suggested for use in vivo after standard clinical trials

Sensitivity and specificity of phenotypic and genotypic tests for detection of methicillin-resistant staphylococcus aureus in clinical isolates

Methicillin-resistant Staphylococcus aureus [S. aureus] [MRSA] is an important pathogen in hospitals and communities. There is advance in technologies but infections by MRSA are difficult to diagnose. The current study was conducted to compare three phenotypic methods for with a genotypic method. Cross-sectional study. Methicillin resistance was tested in 450 isolates of S. aureus retrieved from various clinical samples received in Dr. Ziauddin Laboratory Department of Molecular Genetics [DMG], Karachi from January to October 2011. Methods used were, oxacillin disc diffusion, oxacillin screen agar, cefoxitin disc diffusion and Polymerase Chain Reaction [PCR] for mecA gene, which was taken as the gold standard. The Kirby Bauer disc diffusion, using cefoxitin discs 30microg, identified a total of 174 [38.6%] S. aureus isolates as methicillin resistant. With oxacillin disk diffusion test, 152 [33.77%] strains were MRSA with sensitivity of 87.35% and specificity of 100%. Oxacillin-agar screen detected 168 [37.33%] strains with sensitivity of 96.5% and specificity of 100%. PCR method detected mec A gene in 169 [37.55%] isolates with sensitivity of 97.12%, specificity of 100%. The cefoxitin disc diffusion, as suggested by the Clinical and Laboratory Standards Institute [CLSI], is a consistent method for MRSA diagnosis but must be augmented with other methods like oxacillin screen agar, so that no MRSA is overlooked. PCR although taken as the gold standard cannot be recommended as routine because of the high cost and time consumption

Frequency of congenital anomolies in polyhydramnios

Polyhydramnios is a relatively uncommon but distressing complication associated with pregnancy. To find frequency of congenital anomalies with increasing severity of polyhydramnios. Prospective study. This study was conducted in Lady Willingdon Hospital, Lahore from July 2009 to June 2011. Total 70 diagnosed cases of polyhydramnios from 20-41 weeks of gestation were included in the study. Polyhydramnios was diagnosed in 170 pregnancies. Mild polyhydramnios [AFI 24.0-29.9cm] was found in 112 [65.88%] pregnancies, moderate [AFI 30.0-34.9 cm] in 38 [22.35%] pregnancies and severe [AFI 35.0 cm or more] in 20 [11.76%] pregnancies. Antenatal detection of anomalies was 71 [41.76%] fetuses. The prevalence of anomalies was higher in pregnancies with more amniotic fluid. A total of 83 anomalies were detected in 71 fetuses. Pregnancies complicated with severe polyhydramnios had maximum number of fetuses with multiple anomalies. 37 pregnant women out of 170 [21.76%] with polyhydramnios had maternal diabetes. Of these 37 pregnancies 11 [29.72%] had pregestational diabetes, 13 [35.13%] had gestational insulin treated diabetes, 13 [35.13%] had gestational diet controlled diabetes. Anomalous fetuses were present in 5 [13.51% of diabetic pregnancies with polyhydramnios. There were 7 [4.11%] fetal deaths in pregnancies complicated with polyhydramnios. This study proves that pregnancies with severe polyhydramnios have a greater frequency of fetal anomalies. Diagnosis of second trimester polyhydramnios should initiate a search for possible associated fetal anomalies and causative factors

Abdominal pain: a common presentation of dengue fever

Dengue fever [DF] is a mosquito born viral disease caused by dengue virus and is endemic in large areas of southeast of Asia. Pakistan is an endemic country for dengue virus infection. Abdominal pain is a commonly reported symptom in dengue fever [DF]. The most common causes of abdominal pain are acalculus cholecystitis, ascites, acute pancreatitis, acute hepatitis, pleural effusion and peptic ulcer disease. A case series study. This study was conducted at Mayo and Lady Willingdon Hospitals, Lahore from September and October 2011. 105 patients with fever and abdominal pain admitted to Mayo and Lady Willingdon Hospitals, Lahore during months of September and October 2011 were included in the study. A provisional: headache, retro orbital pain, myalgia, arthralgia, skin rash, hemorrhagic manifestations and leucopenia. The diagnosis was confirmed by enzyme immunoassay based serology. The cause of pain was determined by blood tests [Serum amylase, serum lipase, liver function tests [LFTs]] and radiology [ultrasound contrast enhanced CT [CECT] and chest xray [CXR] except for pregnant patients. 67 patient had dengue fever and 38 patients had other causes of fever and abdominal pain. In patient with dengue fever causes of abdominal pain were acalculus cholecystitis, ascites, acute pancreatitis, acute hepatitis, pleural effusion and peptic ulcer disease. Among 67 patients 2 were pregnant, one at 28 weeks and other at 32 weeks of gestation. Results of this study show that among 105 patients having fever and abdominal pain, 67 patients had serologically proven dengue fever. Table I shows that among patients with serologically proven dengue fever 29 had acalculus cholecystitis, 14 had ascites, 9 had acute pancreatitis, 11 had gastrointestinal disorder and 4 had bilateral pleural effusion. Among 3 patients with menorrhagia 2 had acalculus cholecystitis and 1 had gastrointestinal disorder. 2 patients were pregnant and 28 and 32 weeks of gestation. Both of them had peptic ulcer disease. Among 67 ranging from 101 [degree sign] F to 104 [degree sign] F while mean duration of fever was 5 days. In patient with dengue fever etiology of abdominal pain should be aggressively looked into for proper and better management. If carefully looked into, the etiology of abdominal pain in dengue fever can be found and appropriately managed

Tsunami, post-tsunami malaria situation in Nancowry group of islands, Nicobar district, Andaman and Nicobar Islands.

Background & objectives: Due to tsunami in 2004 a large proportion of population in Nicobar group of Islands become homeless, and in 2006 large scale labour migration took place to construct the houses. In 2008, a significant increase in malaria incidence was observed in this area. Therefore, in March 2008, the situation of malaria was assessed in Nancowry Islands in Nicobar District to study the reasons for the observed upsurge in the number of cases, and to suggest public health measures to control the infection. Methods: The methods included a retrospective analysis of long term trend in the behaviour of malaria over the years from 2001 to 2008, analysis of the acute malaria situation, and rapid fever and malaria parasitemia survey along with environmental component. Mass radical therapy (MRT) and post-intervention parasitemia survey were carried out. The malaria situation in the aftermath of MRT was analysed. Results: During the post tsunami year (2005) there was a large increase in the incidence of malaria and this trend continued till 2008. The percentage of Plasmodium falciparum increased from 23 to 53 per cent from 2006 to 2007 that coincides with the labour influx from mainland. The study showed that Nancowry was highly endemic, with high transmission setting, and high risk area for malaria. Though, more number of migrant labourers suffered fever (75 vs 20%) and sought malaria treatment over past month but parasitemia survey showed higher point prevalence of malaria among native tribes (7.4 vs 6.5%). Post-MRT, there was a decline in the occurrence of malaria, though it did not last long. Interpretation & conclusions: The study findings suggest that the migrant workers hailing from non-endemic or moderately endemic settings became victims of malaria in epidemic proportion in high endemic and high transmission setting. To find out the reasons for deterioration of malaria situation at Nancowry in the aftermath of tsunami requires further research.

Awareness of diabetic retinopathy among the known diabetic patients at a tertiary care eye hospital

To assess the awareness of diabetic retinopathy [DR] among the known diabetics at Al-Shifa Trust Eye Hospital [ASTEH] Rawalpindi. A cross sectional observational study. Study was conducted on 200 known diabetics from 1[st] April 2007 to 30[th] September 2007. Level of knowledge about DR was assessed on the basis of a face-to-face interview and graded according to the number of correct responses. All the information was recorded on proformas and data analysis was done using SPSS 13.0. There were 85 [42.5%] male and 115 [57.5%] female participants with a mean age of 56.0 [ +/- 9.740] years while mean duration of diabetes was 8.468 [ +/- 6.034] years. Knowledge of 72 [36%] patients was found satisfactory. Gender [p=0.000], socioeconomic status [p=0.000], education [p=0.001] and source of information [p=0.000] were significantly associated with awareness. Ophthalmologists were the major source of information for the patients. Awareness about DR is low in our diabetic patients. More emphasis should be given to health education of diabetics along with treatment

Psychosocial impact of October 2005 earthquake on children and adolescents aged 9 to 18 years, assessed after one year in Kashmir, Pakistan

On 8 October 2005, an earthquake of 7.6 magnitude hit Pakistan leaving about 75,000 dead and thousands homeless. Worst damage was in the territory of Kashmir. Children exposed to a natural disaster can develop symptoms of post-traumatic stress symptoms and disorder whose prevalence, associated symptoms and vulnerability varies from population to population. To asses post-traumatic stress symptoms and disorder, associated other symptoms and trauma related risk factors in children and adolescents one year after the earthquake. This is a comparative study to assess post traumatic stress disorder in children who faced the disasters of earthquake and comparisons were made with same age and gender children who faced the earthquake but did not face the disaster. The psychometric tools included Impact of Event Scale, Strengths and Difficulties Questionnaire and post-traumatic stress symptoms and disorder part of Kiddie-SADS Present and Lifetime [K-SADS PL] version 1.0. The mean age of cases was 11 years and they showed significantly high [p=0.03] levels of psychological impact of the disaster [49.2%] as compared to the controls [12.8%]. They also showed more difficulties in coping with life [mean SDQ=18] as compared to the controls [mean Strengths and Difficulties Questionnaire = 21]. Posttraumatic Stress Disorder was 8.6% in the exposed group and 1.2% in control group. A considerable proportion of children and adolescents exhibited difficulties as post-traumatic symptoms, and 8.6% had the psychological disorders. Policy message: Health care providers should be aware that children and adolescents need psychological evaluation and therapy in post disaster situations

Self esteem and psychosocial factors associated with juvenile delinquency

Objectives: The study was designed to assess the level of self Esteem of juvenile delinquents and to find the psychosocial factors associated with delinquency

Study Design: Cross sectional study

Duration and Place of Study: This study was conducted in Borstal jail of Faisalabad, Pakistan during a period of three months from February, 2008 to April, 2008

Subjects and Methods: A sample of 100 male juvenile delinquents was drawn from Borstal jail Faisalabad through Purposive Convenient Sampling technique. Data were collected from participants by using informed consent with the permission of the jail authorities

Result: In the over all picture of the data 56 [56%] of the total sample reported low self esteem. Mean of delinquents labeled as having low self esteem could only reach 13.46 on Rosenberg self esteem scale. High frequency of delinquent behavior was related to feeling of revenge with the mean of 6.00 and high frequency was also associated with love affairs with the mean of 2.80 in delinquents with low self esteem

Conclusion: Research findings concluded that low self-esteem, revenge and lack of supportive relationships are associated with delinquency

Patients with conversion disorder; psycho-social stressors and life events

To assess the frequency of the various psychosocial stressors and stressful life events in patients presenting with conversion disorder. Case series study. The study was conducted in the Department of Psychiatry and Behavioural Sciences, Bahawal Victoria Hospital and Quaid-e-Azam Medical College, Bahawalpur from January, 2009 to March, 2009. The sample consisted of 100 in-patients [89 Female, 11 Male] with Conversion Disorder. They were interviewed and results were analysed from the entries in a Performa. Stressors were clearly identified in 100 patients. In all patients, we found more than one stressor. Among patients, there were [24%] in-laws problems, [23%] love problems, [21%] relationship problems with family, [20%] exam/study stress, [15%] marriage against will, [13%] demanding and pampered child, [11%] issue less, [10%] sexual abuse, [8%] demand of marriage, [6%] overage in wait of marriage, [4%] death of partner, [3%] husband abroad and [3%] patient's engagement break. We concluded that stressors and life events were present in all conversion disorder's patients and these stressful life events are important causal factors for Conversion Disorder. Conversion Disorder has strong relationship with psychosocial stressors

Depression and drug non- adherence

To determine the different levels of drug non-adherence in patients suffering from Depression. A case-controlled study. Hayatabad Medical Complex Peshawar, From February 2008 to August 2008. 50-Cases were selected from the out patient department with the DSM-IV diagnosis of major depressive disorder, 50- non psychotic patients were selected as controls. Both sexes were included. The basic socio-demographic characteristics and the clinical profile of all the patients were collected. The level of drug non-adherence was recorded at week 4, week 8 and week 12. SPSS version 15 was used for statistical analysis. The applied method for group comparison was the Chi-square test. The age in mean was 33.78 +/- .30 for the sample and 30.65 +/- 40 for control group. 38% of these patients were males and 62% females. 58% were married and uneducated from lower socio-economical class. 70% of the study group and 59% of control group received treatment. The rates of non adherence were statistically not significant at week 4. However, at week 8 and week 12 the rates of non adherence were statistically significant with the p values of less than [0.001] respectively. Rates of non-adherence with psychotropic / antidepressants are difficult to summarize because they vary with setting, diagnosis, severity of illness and type of adherence difficulties. Drug non-adherence is a serious clinical problem and it has direct effects on illness management and prognosis. The available evidence suggests that the outcome for patients who vary medication doses without consulting a professional is poor

Antinociceptive and anti-pyretic activity of benincase hispida [thumb] cogn. in wistar albino rats

The seeds of Benincasa hispida [Thunb] COGN. [Family: Cucurbitaceae] was extracted with ethanol and was used to study acute toxicity, antinociceptive and anti-pyretic effects. Brewer's yeast [15%] was used to induce pyrexia in rats. The extract was non lethal to the rats up to the dose of 5000 mg/kg b.w. At doses of 250 and 500 mg/kg b.w, the extract significantly [P<0.05] increased the antinociceptive effective in a dose dependent manner in rats. Similarly, at doses of 250 and 500 mg/kg b.w the extract significantly [P<0.05] decreased yeastinduced pyrexia in rats. These results indicate that ethanolic extract of Benincasa hispida possesses potent antinociceptive and antipyretic effects and thus pharmacologically justifying its folkloric use in the management of fever and pain conditions

Experience of amniotic membrane transplant in corneal diseases at al-shifa trust eye Hospital, Rawalpindi, Pakistan

To assess the quality of human amniotic membrane [HAM] processing at Al-Shifa HAM bank and to analyze the outcome of amniotic membrane transplant in different corneal pathologies at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan. Prospective Interventional Case Series .Consecutive 102 eyes of as many patients [72 males and 30 females] from July 2006 to August 2007 presented at Corneal Clinic were included in the study. Average age of patients was 38 years [4.5-90 years]. Frozen human amniotic membrane [HAM] from a seronegative donor stored at -80°C in Dulbecco's Modified Eagle Medium [DMEM] and glycerol was used for transplant in different corneal diseases after thawing at room temperature for half an hour. HAM was applied epithelial side up. It was spread over the whole cornea beyond limbus and anchored through continuous/interrupted 10/0 monofilament nylon sutures on the corneal side and 7/0 vicryl on the conjunctival side. Over lay [patch] and in lay [graft] technique was used in most of the cases while multilayered technique was used in case of deep ulcer and corneal perforation. Bandage contact lens [BCL] was applied and discontinued after epithelialization in all the cases. The follow up visits were on post operative day one, one week, one month, three months and then after every six months. In clinical examination luster and lubrication of the eye and stability of corneal surface was noted. In subjective examination, a performa was designed to assess reduction in pain, watering, irritation and status of overall comfort of the patient. Average follow up period was 132 days. Overall 85.3% patients had subjective improvement while 74.5% showed clinical improvement; Visual acuity improved in 49% patients. AMT was repeated in 8 patients. No intraocular infection was reported in study cases. The study concludes that AMT is a useful treatment option in a variety of ocular surface pathologies. However, its efficacy varies in different diseases. The study also proved reliability of processing technique at Al-Shifa Human Amniotic Membrane Bank

hysteria; conversion disorders

To find out the sociodemographic characteristics of conversion disorders and to find if there is any difference between the presenting symptoms of rural and urban population. A non-probability, purposive, hospital based sample. Psychiatry department of Victoria Hospital Bahawalpur, from February 2004 to April 2005. A sample of 100-patients was collected. Both sexes were included. DSM-IV criteria for conversion disorder were applied for diagnosis of all these patients. Informed consent was taken for inclusion in the study. Patients suffering from concurrent physical disorders were excluded. The first author [NM.] using a semi-structured pro-forma interviewed all these patients. The sociodemographic characteristics and the clinical profile were collected. Statistical analysis was made with the statistical package for windows, SPSS [version -10]. The applied method for group comparison was chi square- test. The mean age of patients from the urban area was 24.26 +/- 7.25 years, as compared to 22.15 +/- 7.49 years for the patients from the rural area. Most of the patients were females and were married. Majority of the patients from the urban as well as from the rural area were uneducated and from the lower socio-economic class. The onset of illness was typically acute and sudden, with precipitating life event. Majority of the patients had family history of the illness and co-morbid psychiatric disorders. The presenting symptoms were either sensory, motor, mixed symptoms and psuedoseizures. The presenting symptoms of patient from both urban [p value of 0.008], and rural area [P value =0.013], were statistically significant. There were no statistically significant association between the presenting symptoms and the area of living. The p values of the entire chi square tests were greater than [0.05]. Prompt elimination of the symptoms of conversion disorder is important to prevent secondary gains from reinforcing it and causing it t o persist or reoccur. Psychiatric services need to be developed and updated for the provision of prompt and efficient treatment, for the patients with these chronic and sometimes disabling conversion disorders

Experience of penetrating keratoplasties in 509 eyes at Al-Shifa trust eye hospital Rawalpindi

Keratoplasty is the leading organ transplant procedure in the world. Keratoplasties are being regularly performed at Al-Shifa Eye Hospital Rawalpindi since 1992. Results of our experience of 509 penetrating keratoplasties performed at our institution from 1992 to 2000 are being presented. A total of 509 Keratoplasties were done on 476 patients including 308 [65%] males and 168 [35%] females. Post operative corrected visual acuity was 6/12 or better in 45% cases. Associated procedures were performed on 77 eyes. Most important complications seen were, graft rejection [13%], secondary graft failure [8%], secondary glaucoma [7%] and secondary cataract [5.5%]. We conclude that these results compare favourably with other studies in the region and penetrating keratoplasty can effectively be performed with good visual out come in low risk cases with acceptable morbidity. Various associated procedures can also be safely added to the primary procedure in selected cases

Spectrum of corneal pathology in 1000 cases at cornea department of Al-shifa Trust eye hospital, Rawalpindi

Corneal diseases are among major causes of blindness in the world. Spectrum of corneal diseases varies from country to country. A retrospective analysis of 1000 consecutive new patients who presented at cornea clinic of Al-Shifa Eye Trust Hospital, Rawalpindi during the year 200 is being presented. Out of these 1000 patients, 642 were male and 358 were female. Corneal scar, keratoconus and corneal ulcer/abscess were three leading presentations seen in 30, 14 and 10% of the cases respectively. Other pathologies seen were herpitic corneal disease [7%], vernal keratoconjunctivitis [6.7%], bullous keratoplasty [6.7%], corneal degeneration [4.7%], dry eye [2%], trachoma [1.4%] and miscellaneous [8.6%]. Corneal scar was mostly present in patients between 16-70 years of age. Keratoconus was mostly seen in patients younger than 40 years of age. Vernal keratoconjunctivitis had a peak in patients under 15 years. Prevalence of corneal abscess/ulcer gradually increases through early age, peaking at about 50 years. We therefore conclude that most of the corneal diseases in our area are either preventable or treatable with better prevention and treatment strategies at primary health care level. A significant number of patients losing their sight as a result of these pathologies can benefit from corneal transplant. Although many eye care facilities in the country have got adequate infra structure and expertise for corneal transplant, lack of availability of donor cornea is the major limiting factor. Hence, attention should be given to motivation of masses for corneal donation and establishment of eye banks in our country