Determination of Glyoxalase-1 levels and Identification of Genetic Variants in GLO1 Gene in Patients of Diabetic Nephropathy.

Objective: To determine the association of diabetic nephropathy with glyoxalase-1 enzyme levels and a genetic missense variation (SNP rs4746) in its gene (GLO-1). Methods: This cross-sectional comparative study was conducted at the Department of Biochemistry and Molecular Biology, Army Medical College, Rawalpindi from November 2020 to December 2022. One hundred patients and one hundred and thirteen healthy controls were enrolled using the nonprobability convenience sampling method. Medical history and 10ml blood were obtained from each individual after written informed consent. Blood samples were subjected to biochemical tests and DNA extraction which was later used for single nucleotide polymorphism (SNP) analysis (C332C variant of rs4741 GLO-1 gene) using Tetra primer ARMS PCR and gel electrophoresis. Glyoxalase-1 enzyme activity in serum was measured using ELISA. Results: There was a significant difference in serum glyoxalase-1 levels in the two groups (p-value< 0.001). The patient group had lower levels (16.24 ± 22.51mg/dl) of glyoxalase-1 as compared to the control group (48.70 ± 42.54mg/dl). In genotypic analysis, 98 out of 100 control individuals had AA genotype-while only one had CC and another AC genotype. In the patient group, 94 out of 100 patients showed AA genotype, three AC, and three CC genotypes. As the statistical significance (p-value) was 0.37, there was no significant association found between AC or CC genotype and diabetic nephropathy. Conclusion: Glyoxalase-1 levels are linked to the development of diabetic nephropathy in our patients while a known missense variant rs4746 in the GLO-1 gene is not associated with increased risk.

New paradigms of USP53 disease: normal GGT cholestasis, BRIC, cholangiopathy, and responsiveness to rifampicin.

Biallelic variants in the USP53 gene have recently been reported to segregate with normal gamma glutamyltransferase (GGT) cholestasis. Using whole-exome sequencing (WES), we detected two USP53 homozygous variants (c.951delT; p. Phe317fs and c.1744C>T; p. Arg582*) in five additional cases, including an unpublished cousin of a previously described family with intractable itching and normal GGT cholestasis. Three patients, a child and two adults, presented with recurrent episodes of normal GGT cholestasis, consistent with a diagnosis of benign recurrent intrahepatic cholestasis (BRIC). Cholangiopathic changes, possibly autoimmune in origin, were recognized in some patients. Additional phenotypic details in one patient included an enlarged left kidney, and speech/developmental delay. Notably, two patients exhibited a complete response to rifampicin, and one responded to ursodeoxycholic acid (UDCA). Two adult patients were suspected to have autoimmune liver disease and treated with steroids. This report describes new cases of USP53 disease presenting with normal GGT cholestasis or BRIC in three children and two adults. We also describe the novel finding of a dramatic response to rifampicin. The association of cholangiopathy with normal GGT cholestasis provides a diagnostic challenge and remains poorly understood.

Chronic Dyspnea: Diagnosis and Evaluation.

Dyspnea is a symptom arising from a complex interplay of diseases and physiologic states and is commonly encountered in primary care. It is considered chronic if present for more than one month. As a symptom, dyspnea is a predictor for all-cause mortality. The likeliest causes of dyspnea are disease states involving the cardiac or pulmonary systems such as asthma, chronic obstructive pulmonary disease, heart failure, pneumonia, and coronary artery disease. A detailed history and physical examination should begin the workup; results should drive testing. Approaching testing in stages beginning with first-line tests, including a complete blood count, basic chemistry panel, electrocardiography, chest radiography, spirometry, and pulse oximetry, is recommended. If no cause is identified, second-line noninvasive testing such as echocardiography, cardiac stress tests, pulmonary function tests, and computed tomography scan of the lungs is suggested. Final options include more invasive tests that should be done in collaboration with specialty help. There are three main treatment and management goals: correctly identify the underlying disease process and treat appropriately, optimize recovery, and improve the dyspnea symptoms. The six-minute walk test can be helpful in measuring the effect of ongoing intervention. Care of patients with chronic dyspnea typically requires a multidisciplinary approach, which makes the primary care physician ideal for management.

Effects of oral vanadium on glycaemic and lipid profile in rats.

OBJECTIVE: Vanadyl sulphate, an inorganic tetravalent salt of transition metal vanadium is conventionally used to treat diabetes and by athletes as body-building supplement. Vanadyl sulphate is a constituent of many supplements and herbal preparations available over the counter in many parts of the world. In this study the efficacy of the salt as hypoglycaemic agent and its effects on lipid profile were determined when administered in therapeutic dose range (in humans) to healthy Sprague Dawley rats for a considerable duration. METHODS: One hundred and five rats were randomly divided into three groups of 35 rats each. Animals of all three groups were provided normal rodent diet and water ad libitum. Group I animals were administered 0.5 ml plain water through oral gavage while group II and group III rats, 0.25mg/Kg/day and 1.2mg/Kg/day vanadyl sulphate respectively for 24 weeks. At the end of 24 weeks intra-cardiac blood sampling was done and blood glucose, insulin and lipid profile were measured. RESULTS: There was significant decrease in plasma glucose, insulin and HDL-c levels while LDL-c, TGs and TC levels were significantly increased in a dose dependent manner in treated groups. CONCLUSIONS: Our study showed that vanadyl sulphate possesses hypoglycaemic effect in healthy rats while insulin levels are also decreased which may be secondary to hypoglycaemia. Moreover it causes unfavorable derangement of lipid parameters in treated rats. In conclusion vanadyl sulphate though contains significant hypoglycaemic effects; its use in humans may be re-evaluated to establish its safety in relation to lipid profile.

Diagnostic validity of ultrasonography in thyroid nodules.

OBJECTIVE: To determine the diagnostic validity of thyroid ultrasound in differentiating between benign and malignant thyroid nodules. METHODS: The cross-sectional study was conducted at Aga Khan University Hospital, Karachi, from August 2011 to January 2013, and comprised all patients of either gender with thyroid nodules referred for ultrasound thyroid and fine needle aspiration cytology. Ultrasonography was performed by radiologists and ultrasound parameters were assessed and compared with cytology results in all nodules. Diagnostic validity of each ultrasound feature was calculated. RESULTS: Of the 101 patients, 81(80%) were female. The overall mean age was 43±13 years (range: 15-73 years). On histocytopathology, 96(95%) nodules were benign and 5(4.9%) were malignant. The sensitivity and specificity of ultrasound features in predicting malignancy were calcification 80% and 68%; hypoechogenecity 80% and 52%; ill-defined lobulated margin 40% and 96%; solid 80% and 40%; taller than wider 50% and 63%. Each ultrasound feature had negative predictive value ranging from 95% to 98% in malignant nodules. CONCLUSIONS: Identification of calcification, hypoechogenecity and solid with ill-defined margins in a thyroid nodule on ultrasound was helpful in suspecting thyroid malignancy and warranted urgent diagnostic fine needle aspiration cytology.

Demographic characteristics, presentations and treatment outcome of patients with prolactinoma.

BACKGROUND: Prolactinomas are the most common type of functional pituitary tumours. The objective of this study was to determine demographic profile of patients with prolactinomas, and to compare the outcomes in patients treated with Cabergoline versus those receiving Bromocriptine treatment. METHODS: This descriptive study was conducted at Endocrinology Section, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan. We reviewed the medical record of 68 patients with prolactinoma. Data about demographic characteristics, clinical presentation and treatment were entered on a pre-designed pro forma. RESULTS: Out of the total 68 patients, 36.8% were males and 63.2% were females, with a mean age of 34±10.7 years. The most frequent presenting complaint amongst the patients was of headache, present in 57.4% patients. Galactorrhea, amenorrhea and infertility were next highest reported symptoms. Results of the tumour size on initial MRI showed macroprolactinomas 52.9% (36), microprolactinomas in 33.8% (23), and giant prolactinomas in 13.3 % (9) patients. Decreasing trend of prolactin levels were also seen on follow up visits at 9 months and 12 months. Tumour size was decreased in 48.53% (33) patients and lesion completely disappeared in 16.18% (11) patients after 6 months of treatment and also almost similar trend in tumour size change was seen after one year. There was no significant difference between the two drugs in bringing prolactin to, normal range at each follow up duration. CONCLUSION: Most of the prolactinoma patients were females and the common the most frequent presenting complaint was headache. The decreasing trend of serum prolactin and tumour size reduction in patients was noted, suggesting the beneficial impact of medical therapy as it is the first line treatment modality in these patients.

Development of skin hypopigmentation in a patient with metastatic papillary carcinoma thyroid treated with Sorafenib.

BACKGROUND: Sorafenib can be considered as the effective option of treatment in patients with metastatic radioiodine refractory differentiated thyroid cancers. The cutaneous manifestations of Sorafenib include rash, desquamation, hand foot skin reactions, pruritus, alopecia and erythema. We report the first case of hypopigmentation related to sorafenib therapy. CASE PRESENTATION: We report the case of a middle aged gentleman with metastatic papillary carcinoma of thyroid diagnosed in 2005. He was managed with total thyroidectomy, radioactive iodine and TSH suppressive therapy. Despite receiving radioactive iodine 530 mci cumulative dose, patient had persistant disease with lung metastasis. Therefore a TKI, sorafenib, was started. He developed hypopigmentation of the skin more prominent on face six weeks after starting sorafenib treatment.He also developed diarrhea, desquamation of hands and feet, hair loss over scalp, eye brows and moustache. Sorafenib treatment was discontinued. His diarrhea stopped in one week and after four weeks his skin became normalized whereas he regained his hairs in six weeks. CONCLUSION: To our knowledge, hypopigmentation in our patient appears to be the first reported of its kind in the literature to date. Sorafenib is used in Renal cell carcinoma, Hepatcellular carcinoma and radioactive iodine refractory thyroid carcinoma therefore it is very important to be aware of hypopigmentation as a potential side effect for both physicians and patients.

A facile synthesis approach of silica aero-gel/eicosane particles and its potential application on polyester fabric to impart thermoregulation properties.

This article aims to study the thermo-regulating properties of infiltrated Phase change material (PCM) micro-particles treated on polyester fabric. The melt infiltration method was implemented for the synthesis of the Silica aero-gel/Eicosane particles by dispersing eicosane in silica aero-gel. Synthesized particles were incorporated into the polyester knitted fabric by both exhaustion dyeing and coating method to impart the thermoregulation characteristics. The crystalline structure and the particle size of aero-gel infiltrated PCM particles were measured by X-ray diffraction (XRD) analyzer. The presence of eicosane particles deposited on the fabric surface was confirmed by the Fourier Transform Infrared Spectroscopy (FT-IR) and Scanning Electron Microscope (SEM). Finally, while the sample was subjected to heating, both the dyed and coated fabric showed resistance against the rise of temperature due to the presence of phase transition PCM micro-particles compared to the untreated raw fabric sample.

Development of high-performance composite via innovative route using water hyacinth extracted nanocellulose and analysis of its physical properties.

This study focuses on the development of a high-performance composite using a novel technique incorporating nanocellulose extracted from water hyacinth. The extraction procedure of nanocellulose from water hyacinth stems involves acid hydrolysis and sonication, followed by its incorporation into jute, glass, and cotton fabric through the dip coating method. The crystallinity index of the nanocellulose was determined to be 40.72% using X-ray diffraction (XRD) analysis. Additionally, the functional groups of the extracted nanocellulose were identified through FT-IR analysis, while scanning electron microscopy (SEM) demonstrated morphological changes after nanocellulose coating. Our synthesized water hyacinth nanocellulose exhibited compliance with previously studied results in FT-IR analysis. Both tensile and flexural strength tests revealed that the nanocellulose coating significantly improved the strength of the jute, cotton, and glass fabric-reinforced composites compared to their raw counterparts. Specifically, the jute nanocomposite exhibited a 24.61% increase in strength, the cotton woven nanocomposite showed a 19.39% enhancement, and the glass nanocomposite displayed 8.47% increment in strength. Similarly, the flexural stress of jute and cotton fabric nanocomposites showed a notable 11% and 8.9% increase, surpassing the 3.59% rise observed in glass nanocomposites. Overall, this research successfully completed all tests and achieved superior findings compared to earlier studies.

Recent Trends in Faculty Promotion in U.S. Medical Schools: Implications for Recruitment, Retention, and Diversity and Inclusion.

PURPOSE: Faculty promotion is important for retention and has implications for diversity. This study provides an update on recent trends in faculty promotion in U.S. medical schools. METHOD: Using data from the Association of American Medical Colleges Faculty Roster, the authors examined trends in faculty promotion over 10 years. Promotion status for full-time assistant and full-time associate professors who started between 2000 and 2009 inclusive was followed from January 1, 2010 to January 1, 2019. The authors used bivariate analyses to assess associations and promotion rates by sex, race/ethnicity, department, tenure status, and degree type. RESULTS: The promotion rate for assistant professors was 44.3% (2,330/5,263) in basic science departments, 37.1% (17,232/46,473) in clinical science departments, and 33.6% (131/390) in other departments. Among clinical departments, family medicine had the lowest rate of promoting assistant professors (24.4%; 484/1,982) and otolaryngology the highest rate (51.2%; 282/551). Faculty members who were male (38.9%; 11,687/30,017), White (40.0%; 12,635/31,596), tenured (58.7%; 98/167) or tenure-eligible (55.6%; 6,653/11,976), and holding MDs/PhDs (48.7%; 1,968/4,038) had higher promotion rates than, respectively, faculty who were female (36.3%; 7,975/21,998), minorities underrepresented in medicine (URM; 31.0%; 1,716/5,539), nontenured (32.5%; 12,174/37,433), and holding other/unknown degrees (20.6%; 195/948; all P < .001). These differences were less pronounced among associate professors; however, URM and nontenured faculty continued to have lower promotion rates compared with White, Asian, or tenured faculty at the associate professor level. CONCLUSIONS: Promotion rates varied not only by faculty rank but also by faculty sex, race/ethnicity, department, tenure status, and degree type. The differences were more pronounced for assistant professors than associate professors. URM faculty members, particularly assistant professors, were promoted at lower rates than their White and Asian peers. More research to understand the drivers of disparities in faculty promotion seems warranted.

Frequency Of Raised Serum Lactate Dehydrogenase In Patients With Jak2 Positive Polycythaemia Vera.

BACKGROUND: Serum Lactate Dehydrogenase (LDH) is an easily available bio marker used to determine prognosis in various Myeloproliferative Neoplasms (MPN). Its utility in Polycythaemia Vera (PV) is yet to be accessed. The purpose of this study was to determine the frequency of raised serum LDH in patients with JAK2 V617F positive PV patients and its clinic-pathological association. METHODS: A cross-sectional study using non probability consecutive sampling was conducted at our institute from July 2018 to June 2019. Adult patients of either gender, newly diagnosed with JAK-2 V617F positive PV were included. Patients' demographics, clinical characteristics and baseline CBC and LDH levels were analysed. Stratification was done with regards to age, gender, diabetes mellitus, hypertension, splenomegaly and thrombosis to see the effect of these modifiers on patients with raised LDH by using Chi Square test. p-value≤0.05 was considered as significant. RESULTS: Forty patients were inducted in the study with male to female ratio of 2:1. Twenty-two (55%) patients had raised LDH levels and showed significant association with diabetes mellitus (p=0.001), splenomegaly (p=0.001) and thrombosis (p=0.018). CONCLUSIONS: This study observed raised LDH levels in almost half of JAK2 V617F positive PV patient. It warrants a larger scale study and suggests the value of plasma LDH to be used as a future prognostic marker in PV.

Frequency of Zygosity in Jak-2 Positive Patients with Polycythemia Vera-Pakistan's Perspective.

BACKGROUND: Estimation of JAK2V617F mutational load in Polycythemia Vera (PV) helps to determine the severity of the disease phenotype, the risk of thrombotic events, progression to post-PV myelofibrosis and survival. Amplification Refractory Mutation Screening (ARMS) PCR or Allele Specific (AS) PCR is a simple easy method with a reasonable sensitivity for screening of zygosity.The purpose of this study was to see the frequency of disease burden and phenotypic characteristics in Pakistani patients diagnosed with JAK2V617F mutation positive PV. MATERIALS AND METHODS: A cross-sectional study using non probability consecutive sampling was conducted at Hematology Department, Liaquat National Hospital Karachi from October 2018 to July 2019.Adult newly diagnosed JAK2V617F positive PV patients of either gender were included. Patients' demographics, clinical characteristics and baseline CBC were noted. JAK2V617F zygosity was qualitatively analyzed by ARMS-PCR technique. Age and gender were stratified to see to see the result of qualitative and quantitative effect modifiers on these patients using Chi Square and fisher exact test as appropriate while mean comparison was done by independent t-test and one way ANOVAtest. P value of ≤0.05 was considered as significant. RESULTS: Fifty one patients were included in the study with an average age of 59.60±14.29years.90.2% of patients had hypertension.All patients tested positive for heterozygous state. Significant association of gender was found with smoking (p=0.001) while age was significantly linked with hypertension (p-0.033). CONCLUSION: JAK2V617F positive PV patients are mainly heterozygous males showing significant association with smoking and hypertension. ARMS-PCR is a robust technique to determine zygosity which can be used for screening purposes.
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Trends in Tenure Status in Academic Family Medicine, 1977-2017: Implications for Recruitment, Retention, and the Academic Mission.

PURPOSE: Tenure status has important implications for medical school faculty recruitment and retention and may affect educational quality, academic freedom, and collegiality. However, tenure trends in academic family medicine are unknown. This study aimed to describe trends in tenure status of family medicine faculty overall and by gender and status of minorities underrepresented in medicine (URM) in Liaison Committee on Medical Education-accredited medical schools. METHOD: Association of American Medical Colleges Faculty Roster data were used to describe trends in tenure status of full-time family medicine faculty, 1977 to 2017. Bivariate and trend analyses were conducted to assess associations and describe patterns between tenure status and gender, race, and ethnicity. Interdepartmental variations in tenure trends over the years were also examined. RESULTS: Among family medicine faculty, the proportions of faculty tenured or on a tenure track dropped more than threefold from 1977 (46.6%; n = 507/1,089) to 2017 (12.7%; n = 729/5,752). Lower proportions of women and URM faculty were tenured or on a tenure track than male and non-URM faculty, respectively. But the gaps among them were converging. Compared with other clinical departments, family medicine had the highest proportion of faculty (74.6%; n = 4,291/5,752) not on a tenure track in 2017. CONCLUSIONS: Proportion of tenure positions significantly decreased among family medicine faculty in U.S. medical schools. While gaps between male and female faculty and among certain racial/ethnic groups remained for family medicine tenure status, they have decreased over time, mainly because of a substantial increase in nontenured positions.

Outcome of heat stroke patients referred to a tertiary hospital in Pakistan: a retrospective study.

BACKGROUND: Climate change has heightened the threat of heat stroke in previously temperate zones. AIMS: This study aimed to assess the outcome of patients in relation to mortality and the role of effect modifiers among heatstroke patients presenting to a tertiary care hospital in Karachi during June 2015. METHODS: A retrospective observational study was conducted on heatstroke patients 20-27 June 2015 at the Emergency Room(ER) of a private hospital in Karachi, Pakistan. Patients' demographic data, disease severity, presentation and outcomes were determined. Statistical data was reported as numbers, percentages and mean ± SD. RESULTS: In total, 315 patients reported to ER; 76.6% patients survived, 23% expired. Males were 55% and 60% patients were fully mobile. Hypertension was the most frequent concurrent disorder. Fever documented in 79.4% and CNS derangement in 73.3% patients were the top most presenting features. Fever and disease severity were found to exert significant impact on disease outcome. Mortality rate dropped from 26 June onwards from 24.35% to 15.9% by using evaporative cooling technique combined with air conduction and maintaining room temperature at 22-24°C. CONCLUSIONS: Poor outcome during heatstroke can be minimized by advance planning and timely intervention in lowand middle-income countries.

Genotoxic And Cytotoxic Effects Of Oral Vanadyl Sulphate.

BACKGROUND: Vanadyl sulphate is available as herbal medicine against diabetes mellitus and body building supplement, over the counter worldwide. The available data on its safety is controversial and inadequate. The objective of this study was to analyse its safety in usual therapeutic dose range. METHODS: It was an experimental study carried out at the Department of Biochemistry & Molecular Biology, Army Medical College, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan, from Jun 2014 to Oct 2018. The study was carried out on 105 Sprague Dawley rats for duration of 24 weeks. The animals were randomly distributed in three groups of 35 each. The group I rats were marked as control while rats of group II & III were administered vanadyl sulphate 0.06mg/day and 0.3mg/day respectively. Alanine amino transferase (ALT) and Malondialdehyde (MDA) were measured in serum while comet assay was performed on WBCs. RESULTS: The plasma levels of ALT and MDA were significantly raised in group II and III subjects. Single cell gel electrophoresis (SCGE) / comet assay showed minimal "tail moment" in control group and increased tail moment in group II and III in a dose dependent manner which indicates dsDNA breaks. CONCLUSIONS: It was observed that vanadyl sulphate causes hepatocellular toxicity, oxidative stress and damage to the DNA in usual therapeutic/ supplemental doses. Due to hazardous effects, its use in humans as alternate medicine may be reviewed.

Comparison Of Biliary Stenting And Surgical Bypass In Palliative Management Of Irresectable Periampullary Carcinoma.

BACKGROUND: Some 20-40% of the periampullary carcinoma is irresectable at the time of diagnosis. Biliary stenting and surgical bypass are commonly used palliative procedure. There is no consensus favouring one procedure over the other. This study compares the both procedures. METHODS: This Randomized Controlled Trial included 47 patients who presented with diagnosis of obstructive jaundice due to periampullary carcinoma to the Department of Surgery, Federal General Hospital, Islamabad from July 2012 to December 2014. RESULTS: Out of total 47 patients 27 (57.44%) were males and 20 (42.55%) were females. Group-A included 25 (53.19%) patients while group-B included 22 (46.81%) patients. The mean age in both groups was 62.34 years (SD=±5.01). All patients died during the study. The mean survival time for the stent patients was 7.5 months while the mean survival time for surgical bypass patients was 8.3 months. The jaundice was relived in all surgical (22, 100%) of the patients as compared to (18, 72%) of the patients in stent group. CONCLUSIONS: We concluded that surgical bypass as a primary procedure in selected patients provided better jaundice relieve as compared to biliary stenting..

Pituitary stalk interruption syndrome presenting as short stature: a case report.

INTRODUCTION: Pituitary stalk interruption syndrome is a rare congenital abnormality of the pituitary that is responsible for anterior pituitary deficiency. It is characterized by a classic triad of interrupted pituitary stalk, absent or ectopic posterior pituitary, and anterior pituitary hypoplasia or aplasia. Clinical presentation varies according to age. In adults it presents as short stature and anterior pituitary deficiency. Without early diagnosis and treatment, mortality and morbidity in these patients is high. Early diagnosis and treatment of this rare disease can prevent permanent short statue of the patient. We report the first case of pituitary stalk interruption syndrome from Pakistan. CASE PRESENTATION: A 17-year-old Pakistani young man presented with short stature and underdeveloped secondary sexual characters. His siblings and parents were healthy, with normal height. An examination showed his blood pressure was 90/60 mmHg, and his height, weight, and body mass index were 142 cm, 34.5 kg, and 17.10 kg/m2, respectively. He had no hair growth on his face, axilla, or pubis. His testes were between 1 and 2 mL in size, with a 4 cm-at-stretch micropenis. His lab investigations showed that his thyroid stimulating hormone (TSH) was 8.58 uIU/mL (0.4 to 4.2), his free thyroid hormone level FT4 was 0.46 ng/dL (0.89 to 1.76), his prolactin was 21.1 ng/mL (3.0 to 14.7), and his baseline cortisol was 0.30 ug/dL (4.3 to 22.4). His cortisol level after 60 minutes of cosyntropin injection was 3.5 ug/dL (4.3 to 22.4), his insulin like growth factor IGF-1 was 31.56 ng/mL (247.3 to 481.7), his testosterone level was under 2.5 ng/dL (2 to 800), his follicle stimulating hormone FSH was 0.41 uIU/mL (0.0 to 10.0), and his leutinizing hormone LH was under 0.1 uIU/mL (1.2 to 7.8). His bone age was 10 years according to the Greulich and Pyle method, as shown by X-rays. The results from his pituitary magnetic resonance imaging scan were consistent with pituitary stalk interruption syndrome. CONCLUSIONS: We describe a young man who presented with short stature and was found to have pituitary stalk interruption syndrome. Despite the fact that this is a rare disorder, it should always be kept in the differential diagnosis of a patient presenting with short stature. Patients with this disease have an excellent opportunity to reach normal height if they present before the joining of epiphyses.

Rising threat of terrorist bomb blasts in Karachi--a 5-year study.

OBJECTIVE: This study aims to determine the frequency of injuries and fatalities associated with terrorist bomb explosions in the city of Karachi from 1 January 2007 to 31 December 2011. Moreover, this study is aimed to determine age and sex vulnerability among the victims of blast explosion. STUDY DESIGN: A descriptive cross-sectional study was conducted. PLACE: The study was carried out at mortuaries and medicolegal sections at Jinnah Postgraduate Medical Center, Civil Hospital and Abbasi-Shaheed Hospital Karachi, the three main hospitals, which cater to all these cases of Karachi. DURATION OF STUDY: The study included all bomb blast victims examined and autopsied from January 2007 to December 2011 at Jinnah Postgraduate Medical Center, Civil Hospital and Abbassi Shaheed Hospital Karachi. MATERIAL AND METHOD: Details of 1142 cases were collected for those medicolegal deaths and injured persons, identified to be the victims of bomb blasts from January 2007 to December 2011. Data were collected on a preformed proforma from the mortuaries and medicolegal sections of these three public sector hospitals. The variables investigated include age, gender, year-wise distribution of the injured and the dead along with the cause of death and body parts injured in survivors. RESULTS: Out of the total 11,109 autopsies during the study period, 249 (2.24%) were carried out on deaths due to bomb blasts. Similarly, 135,065 injury cases were reported during the study period out of which 893 (0.66%) cases were due to bomb blasts. An initial peak in the year 2007, followed by a decline in 2008 and since then a steady rise of bomb blast incidences with casualties and fatalities, has been observed. The highest numbers of injured victims were reported in the year 2010 and fatalities in 2007. Among 1142 cases, 95.18% were male and 4.82% female with a male to female ratio of 19.76:1. Persons of ages between 15 and 45 years were chiefly involved. Shock due to multiple injuries was the leading cause of death, followed by head injury with or without haemorrhage. The lower extremities sustained the highest number of injuries in survivors, followed by the upper extremities. CONCLUSION: Fatalities and casualties due to explosions are increasing each year. The pattern of injuries indicates open-air bombing in Karachi. Males of the age group 15-45 years are the main victims. The forensic speciality needs to understand their role of correct certification, helpful to law enforcement agencies.