Volume 3 Issue-1 Jan-Mar,14

 

The articles for the PJMD Issue Jan-Mar 2014 are listed below. The articles are in PDF Format which requires Adobe Acrobat Reader for viewing.

EDITORIAL

A New CAM in the Market… Be Positive, Live Healthy

The later part of twentieth century has seen alternative medicine finally becoming a recognized entity, defined as a variant to conventional mode of management of diseases. It was named ‘Alternative’ as it was regarded as a substitute to the orthodox medical management. Finally the term Complementary and Alternative Medicine (CAM) was coined when combo treatment involving both conventional and alternative methods were used for optimum results..

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Volume 3 Issue-1 Jan-Mar,14
ISSN : 2308-2593
Page No. : 1-2
Published : 2014-01-01
Publisher Name : Ziauddin University
  • Farah Ahmed
    Assistant Professor, Department of Community & Health Sciences, Ziauddin University and Hospitals Karachi
  • Syed Hasan Danish
    Assistant Professor, Department of Community & Health Sciences, Ziauddin University and Hospitals Karachi
  • Mohsin Wahid
    Assistant Professor, DOW University of Health Sciences

ORIGINAL ARTICLE

Amino Acid Racemization in Human Detine as an Estimator of Chronological Age – A Study in Karachi Pakistan

Background:

Amino acid racemisation is a reliable method to estimate age in developed countries. This pilot study was designed to determine the coefficient of amino acid racemisation (AAR) with reference to age in our population. Also as no such study has been conducted in our setting, the study also aims to discuss reproducibility of this study on a larger scale.

Objective:

To determine the coefficient of amino acid racemisation (AAR) with reference to age; To measure the mean error in calculating age using this method; To identify any differences from earlier observation and discuss the reproducibility in our setting.

Methods:

Teeth were obtained from subjects between the age of 15 and 60 years who had come for routine extraction procedure or for orthodontic procedures. Incisors, canines, premolars and, first and second molars were included. Carious tooth and third molar were excluded. Samples were stored, dried, de-mineralised, hydrolysed, and derivatised. High-Pressure Liquid Chromatography (HPLC) was performed to quantify the L- and D- forms of aspartic acid in dentin. Correlation and regression was then tabulated based on the quantification, and was compared with data from other studies.

Results:

Based on the analysis of selected samples, a strong positive correlation of 0.93 was observed between co-efficient of racemisation and chronological age. The regression line derived was Age = 200 (KR) + 17.306 (where KR= coefficient of racemisation).The computed regression line was tested by using coefficient of racemisation for 8 samples selected during the study and the mean error (difference between actual and calibrated age) determined came out to be 3.99±5.77.

Conclusion:

The correlation coefficient was strongly positive. The results strongly suggests that aspartic acid racemisation of human dentine is a precise method for estimation of chronological age in living and in dead. The methodology should be standardized to make the results more accurate and prevent fallacies. However it remains an expensive procedure, especially the laboratory equipment that would not be available in most cities of Pakistan.

Key Words:

Age Estimation, Amino Acid Racemisation, Forensics Sciences, HPLC, Dentin, Pakistan Epidemiology.

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Volume 3 Issue-1 Jan-Mar,14
ISSN : 2308-2593
Page No. : 3-11
Published : 2014-01-01
Publisher Name : Ziauddin University
  • Qudsia Hassan 
    Professor, Department of Forensic Medicine and Toxicology, Ziauddin University and Hospitals, Karachi.
  • Anila Jaleel 
    Professor, Department of Biochemistry, Ziauddin University and Hospitals, Karachi.
  • Zahid Bashir
    Professor, Department of Forensic Medicine, Aga Khan University Hospital, Karachi.
  • Nadia Jajja
    Research Associate, Department of Forensic Medicine and Toxicology, Ziauddin University and Hospitals, Karachi.
  • Umer Mukhtar Tarar
    Senior Scientific Officer, Pakistan Council of Sceintific and Industria Research.
  • M. Samee Haider
    Senior Scientific Officer, Pakistan Council of Sceintific and Industria Research.
  • Lakht-e-Zehra
    Scientific Officer, Pakistan Council of Sceintific and Industria Research.

Cytotoxic Activity of Honey in Hepatoma Cells:In Vitro Evaluation

Background:

Honey is used extensively in south East Asia, Middle and Far Eastern countries as a sweetener as well as medication for its anti-bacterial, anti-fungal, and anti-viral properties with no risk of resistance or side effects. Recent studies suggest that honey can modulate tumor growth by reducing cell proliferation and increasing apoptosis susceptibility.

Objective:

To find out the apoptotic effect of honey on hepatoma cancer cell lines.

Methods:

The growth of hepatoma cell lines (Huh-7) was checked by adding Honey to the cells before culturing in a 24 well plate. Wells were selected and labeled for each of the variables (controls, honey). After 2 days, cells were studied under an inverted phase contrast microscope and fields were recorded. Approximately four fields per slide of higher intensity were selected randomly to determine the dead cell density, and the procedure was repeated 10 or more times. Frequency and percentages were calculated for dead or alive cells in controls, honey and their mixture. Odds Ratio was used to compare the qualitative variables

Results:

Honey was found to induce cell death in hepatoma cell lines (Huh-7). At a magnification of 40x, the dead cells were 1% in controls whereas, 70.8% in honey. At magnification of 20x and 10x the dead cells density was 52.3% and 82.4 % respectively in honey treated cells compared to 4% in controls.

Conclusion:

Honey induced cell death in Huh-7 cells. Huh-7 exposed to honey have high probability of apoptosis/necrosis. Honey should be considered as co-adjuvant treatment against cancer.

Key Words:

Traditional Medicine; Honey; Hepatoma Cells (Huh7).

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Volume 3 Issue-1 Jan-Mar,14
ISSN : 2308-2593
Page No. : 12-16
Published : 2014-01-01
Publisher Name : Ziauddin University
  • Saeeda Baig
    Professor and HOD, Department of Biochemistry, Ziauddin University and Hospitals, Karachi.
  • Hira Attique
    Lecturer, Department of Basic Health Sciences, Ziauddin University and Hospitals, Karachi.

Association of Resistin & Interleukin 6 in Ischemic Heart Disease and Diabetic Patients

Background:

Honey is used extensively in south East Asia, Middle and Far Eastern countries as a sweetener as well as medication for its anti-bacterial, anti-fungal, and anti-viral properties with no risk of resistance or side effects. Recent studies suggest that honey can modulate tumor growth by reducing cell proliferation and increasing apoptosis susceptibility.

Objective:

To measure the serum levels of resistin and interleukin 6 levels in single, two vessel and three vessel disease on angiography in ischemic heart disease patients with diabetes and without diabetes. To determine an association between the biomarkers(resistin, IL-6 levels) and cardiovascular disease.

Methods:

A comparative cross sectional study was designed in which samples of 147 subjects were selected. Age was in range of 40 to 70 years. Subjects were divided into two groups of 38 diabetics with complication of ischemic heart disease and 38 non diabetic with ischemic heart disease. Plasma glucose was measured using the Glucose oxidase method. Resistin and interleukin-6 were determined by ELISA. Extent of vessel disease was determined by standard angiography method.

Results:

The total subjects included in the study were 76.Angiographic findings of 76 patients with IHD revealed that, 19 (25%) had single vessel disease (SVD), 16 (21.05%) had two vessels disease (2VD) and 41 (53.95%) had three vessels disease (3VD). Group of 38 non diabetic patients with IHD, 8 (21.1%) had SVD, 7 (18.4%) had 2VD and 23 (60.5%) had 3VD.Among 38 patients of IHD with DM, 11 (28.9%) had SVD, 9 (23.7%) had 2VD and 18 (47.4%) had 3 VD. Positive correlations of Interleukin-6 and resistin in single vessel disease group (r=0.190, p=0.112) was found, but higher positive correlation in two vessels disease group (r=0.240, p=0.323) and the highest positive correlation of interleukin-6 and resistin was found in three vessels disease group (r=0.324, p=0.221).

Conclusion:

The study showed that the resistin and interleukin plasma concentrations were significantly increased in 3VD which shows the role of these cytokines in ischemic heart disease.

Key Words:

Resistin, Interleukin 6, Ischemic Heart Disease

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Volume 3 Issue-1 Jan-Mar,14
ISSN : 2308-2593
Page No. : 17-22
Published : 2014-01-01
Publisher Name : Ziauddin University
  • Faisal Yaseen

Current Consideration Regarding Operative Versus Non-Operative Outcome of Brain Contusion Patients

Background:

Brain contusion surgeries versus conservative treatment are considered to be the typical decisions faced by doctors, resolved usually based on the experience of respective departments. Till date there are no standard guidelines regarding conservative versus surgical management.

Objective:

To determine the outcome of the surgical and medical management in posttraumatic brain contusion patients.

Methods:

The study was conducted on patients having small and large brain contusions admitted in the department were selected through custom Proforma. The 41 patients (31 males 10 females) included corresponded to no specific exclusion criteria. The patients who improved by Glasgow coma score, neurologically or resolution was confirmed by Computed tomography scan brain were categorized under conservative management. While the patients, who deteriorated by Glasgow coma score, neurologically, bradycardia or showed expansion in the size of contusion with mass effect underwent standard decompressive craniotomy or cranectomy and evacuation of contusions along with duroplasty. Complications and improvement of the patients were determined at follow up and monitored by the help of interval brain CT scan during their stay in the department subsequently followed by cranioplasties.

Results:

There was a male predilection with male to female ratio of 3.1:1. The age group more frequently affected was 20-40 years and the most causative agent was road trauma accident. Complications were found among two patients as intractable seizures, brain abscess formation, hydrocephalus and post operative jaundice in one patient each. Wound infections in four patients. Overall outcome was good in conservative and surgical intervention patients of brain contusions. The total mortality was four patients, two in each group of patients.

Conclusion:

Therefore we recommend that nonsurgical and surgical management has comparable results, but surgical decompressive craniotomy is the mainstay of treatment based on the essential monitoring tools as repeated interval scanning and neurological evaluation considering the timing of surgery, volume and size of hematoma, conscious status, bradycardia and hypertension.

Key Words:

Post Traumatic Brain Contusions, Glasgow Coma Score, Outcome.

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Volume 3 Issue-1 Jan-Mar,14
ISSN : 2308-2593
Page No. : 23-30
Published : 2014-01-01
Publisher Name : Ziauddin University
  • Saeed Mazher
    Consultant Neurosugeon, Ziauddin University and Hospitals, & Taj Medical Complex, Karachi.
  • Shahid Ahmed
  • Abdul Ali

Extrinsic Factors Strong Motivators for Nurses in the Tertiary Care Hospitals

Background:

Motivation and job satisfaction ultimately effect work performance of an individual. There are various factors which influence the work motivation and knowledge of these factors can help in improving the work performance.

Objective:

To assess the different factors that are associated with work motivation among nurses working in private and public tertiary care hospitals of Karachi.

Methods:

This descriptive, cross-sectional study was carried out among nurses for duration of 3 months in 2013. Total 240 nurses from two tertiary care hospitals of Karachi were selected by convenience sampling. A pretested and self-administered questionnaire was used to assess factors associated with work motivation. Data was analyzed using SPSS version 20.0.

Results:

Of total 240 study participants, 48.8% (117) nurses were in favor of financial incentives that motivate them most. Salary structure and appraisal system both showed significant difference (p-value= 0.000) between nurses from public and private hospitals while the most content place to work was reported government hospitals by 43.4% (104) nurses. Work motivation mean score revealed significant difference (p-value =0.003) among nurses from different working areas of hospital. Factors associated with job satisfaction showed significant difference (p value = 0.000) among nurses from private and public sector hospitals.

Conclusion:

Financial incentives were found to be the most important motivating factor for nurses that improve their performance. It was also concluded that public sector hospitals along with so many factors of satisfaction are the most content place of working that motivate them most.

Key Words:

Motivation, Nurses motivation, Tertiary care hospital, factors of motivation.

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Volume 3 Issue-1 Jan-Mar,14
ISSN : 2308-2593
Page No. : 31-36
Published : 2014-01-01
Publisher Name : Ziauddin University
  • Shahnaz Dar
    Principle, Paramedical Training Institute, Nazeer Hussan Medical Complex Karachi.
  • Nosheen Zehra
    Assistant Professor, Department of Community & Health Sciences, Ziauddin University and Hospitals, Karachi.
  • Farah Ahmad
    Assistant Professor, Department of Community & Health Sciences, Ziauddin University and Hospitals, Karachi.

CASE REPORT

Recovery of Projectile Through Nose – An Unusual Presentation

Presentation of civilian gunshot injuries, especially to the face, have increased tremendously in the past decade in Karachi. Cranio-facial region when affected has a high mortality rate because projectile may lodge anywhere in the skull. Management of these gunshot wounds demands experience and expertise. A case of 21 year old male is reported, who sustained such an injury by a stray bullet, with the projectile entering from the lateral margin of the left nasal cavity and getting lodged within. Position of the projectile was assessed via series of X-rays. The projectile was removed under direct visualization from the nasal cavity in the Emergency Room. Endoscopic approach has been discussed for removal of deeper projectiles.

Key Words:

Gunshot, Projectile, Nasal Cavity, Stray Bullet.

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Volume 3 Issue-1 Jan-Mar,14
ISSN : 2308-2593
Page No. : 37-40
Published : 2014-01-01
Publisher Name : Ziauddin University
  • Muhammad Sohail Umerani
    Registrar, Department of Neurosurgery, King Fahad Military Medical Complex, Dhahran, KSA
  • Saad Ikram
    House Officer, Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi
  • Asad Abbas
    Resident, Department of Surgery, Ziauddin University Hospital

Small Breast Abscess Presented as Invasive Ductal Carcinoma in a Young Female

Invasive ductal carcinoma of breast and tuberculosis are very rare conditions to coexist. There are no pathognomonic symptoms or signs to distinguish both diseases. A female patient was referred from the emergency for incision and drainage of an abscess in the left upper outer quadrant; with severe localized pain accompanied by pain in the rest of the breast. It was found per-operatively that, besides the abscess in which thick pus was present, cancerous cells were found prevalent in three quadrants of the left breast. projectiles.

Key Words:

Invasive Ductal carcinoma, Tuberculosis, DCIS, IDC.

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Volume 3 Issue-1 Jan-Mar,14
ISSN : 2308-2593
Page No. : 41-43
Published : 2014-01-01
Publisher Name : Ziauddin University
  • Asma Niaz Khan
    Assistant Professor, Department of Anatomy, United Medical and Dental

Antidepressant Triggering Mania in Bipolar Disorder

Mood elevation by antidepressants is considered by DSM IV(Diagnostic and Statistical Manual of Mental Disorders) as a bipolar disorder, whereas earlier it was considered as a drug induced reaction. Risk of mood switching with anti depressant treatment is observed more in adolescence and early 20s rather than adults probably because adults with bipolar disorder are usually aware of their diagnosis. Elevation of mood is seen to be more common with TCAs (Tricyclic Antidepressant) than SSRIs (Selective Serotonin Reuptake Inhibitors). Bipolar individuals, taking an antidepressant, should also be on a mood stabilizer or atypical antipsychotic along with antidepressant. The case reported here is that of a young man aged 20, presenting clinical features of social withdrawal, lack of concentration, fear of the unknown in facing people and hesitancy in attending large gatherings. Being diagnosed as social phobia when started with anti depressants, within a month’s time ended in severe manic phase with blooming psychosis. projectiles.

Key Words:

Cognitive Behavior Therapy(CBT), Tricyclic Antidepressant (TCA), Bipolar Disorder (BPD), Selective Serotonin Reuptake Inhibitors (SSRIs).

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Volume 3 Issue-1 Jan-Mar,14
ISSN : 2308-2593
Page No. : 44-47
Published : 2014-01-01
Publisher Name : Ziauddin University
  • Fatima Jahangir
    Resident, Department of Family Medicine, Ziauddin University and Hospitals, Karachi

REVIEW ARTICLE

Perception of HPV in Children

Human papillomavirus (HPV), with its more than 100 genotypes, is a cause of different diseases, ranging from malignant epithelial tumors such as squamous cell carcinoma in cervix and mouth to benign skin warts. HPV transmission generally occurs through direct person to person contact and exposure to infected material. Since the involvement of HPV in oral carcinoma in adults has been established, high risk strains are being explored in oral cavity of children. The presence of HPV in children presents a serious problem especially when the modes of viral transmission in child always remain a controversial issue. In children presence of HPV shows a strong indication of sexual abuse, though infection from direct contact cannot be ruled out, since the virus has been proven to thrive successfully at a range of sites and infect healthy people. This review aims to discuss HPV mode of transmission in children and its associated epidemiology.

Key Words:

Human Papilloma, Pediatrics, Vertical Infection Transmission.

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Volume 3 Issue-1 Jan-Mar,14
ISSN : 2308-2593
Page No. : 48-52
Published : 2014-01-01
Publisher Name : Ziauddin University
  • Faisal Irshad
    Lecturer, Department of Pathology, Ziauddin University and Hospitals, Karachi.
  • Serajuddaula Syed
    Professor and HOD, Department of Pathology, Ziauddin University and Hospitals, Karachi.
  • Saeeda Baig
    Professor and HOD, Department of Biochemistry, Ziauddin University and Hospitals, Karachi.