Volume 4 Issue-4 Oct-Dec, 15

Pakistan comes under the category of countries with significant cancer load and surprisingly rising trends of risk factors. Amongst all the cancers, Breast cancer takes the lead. It has been reported to be accountable for one third of the cancers in the females…..

Background:

Catheterization of the internal jugular vein (IJV) is common and used for several clinical procedures. Internal jugular venous valves are the only barrier between the heart and the brain. The presence and structure of these valves is variously described in the literature. The purpose of the current study was to explore the presence of IJV valves, their location and structure.

Methods:

Observations for the unilateral or bilateral presence or absence, exact location and number of cusps of the IJV valves were recorded by dissection on 62 formalin-fixed adult male and female cadavers.

Results:

IJV valves were found in 76.62% subjects. Most common of these valves were bicuspid (68.54%) while the least common were the tricuspid valves (0.80%). Unicuspid valves (collectively 7.25 %) were more common on the right side in the male while the same was true for the females on the left side. Only one tricuspid valve was observed on the right side in a female. Valves were mostly inferior to the clavicle (54.73 %) followed by posterior (38.94 %) while the least common position was superior (6.31 %).In the male the commonest location was inferior to the clavicle (70.00 %) followed by posterior (28.33%) while in the female the more common location was posterior (57.14%) followed by inferior (28.57%): the difference was significant. Superior position in the male was the least common (01.66%) while being relatively more common in the female (14.28%): the gender difference was statistically significant.

Conclusion:

The prevalence of internal jugular venous valves, their types and location are variable and probably reflect a genetic and racial attribute

Key Words:

Internal jugular vein, valves, morphology, anatomy, cannulation, catheterization

Background:

Chronic kidney disease (CKD) is now a public health problem with a high prevalence in Pakistan. However, there has been very little research on the profile of chronic kidney disease-related bone mineral disorders (CKD-MBD) in Pakistan. We thus aimed to assess the bone-mineral metabolism parameters in patients with CKD who are being followed at the Ziauddin University Hospital (a tertiary care hospital) in the southern city of Karachi, Pakistan.

Methods:

A hospital based cross-sectional study was conducted on 101 patients. The following clinical and biochemical data was collected: age, gender, serum creatinine and stage of CKD, serum PTH, calcium, albumin, phosphorus and Vitamin D levels- all at the same point in time.

Results:

The percentages of patients with serum levels within the recommended KDOQI guidelines for stages 3, 4 and 5 were as follows: serum PTH: 11.1, 31.8, 25.8, serum corrected calcium: 88.8,31.8, 42.9, phosphate 66.6, 50.0, 57.1, respectively. A significant number of patients were found to have secondary hyperparathyroidism as per the KDOQI criteria. 25-OH Vitamin D deficiency was also noted, as was hypocalcemia especially in CKD stage 5. However, our study demonstrated optimal control of serum phosphate levels for the majority of patients.

Conclusion:

This study highlights the difficulty of achieving KDOQI recommended serum PTH levels, and the need for raising awareness for more aggressive management of bone mineral metabolism parameters in order to decrease the morbidity and mortality associated with this disorder.

Key Words:

KDOQI, Chronic Kidney Disease (CKD), PTH, calcium, phosphorus

Background:

To determine the diagnostic accuracy of CT in characterizing the Paranasal fungal Infection

Methods:

All patients suspected of having Paranasal fungal infection underwent CT scan examination on 4 slice Toshiba Asteion multislice CT scanner. Final diagnosis was based on smear analysis for fungal culture which was done subsequently. Statistical analysis was performed by SPSS version-17.

Results:

Out of 65 patients, 48 were confirmed having fungal sinusitis and remaining 17 were negative on the gold standard culture analysis. While on CT, 44 patients were positive for fungal sinusitis and four patients had a normal scan (false negative). Out of 17 patients, 14 patients were also negative on CT and three were positive for fungal infection (false positive). Sensitivity of CT was 93.6% and accuracy was 89.2%.

Conclusion:

CT scan is highly accurate in diagnosing and characterizing paranasal fungal infection. CT scan also guides in defining disease extent as well as aids in deciding the surgical approach to be used.

Key Words:

Paranasal Sinuses. Computed Tomography. Culture Analysis. Magnetic Resonance Imaging

Background:

Liver biopsy so far, is the mainstay of diagnosing hepatic fibrosis. Activated HSCs express certain mesenchymal markers, of which Smooth Muscle Actin is a well-known marker. This study aims to appreciate expression of Alpha Smooth Muscle Actin in hepatic stellate cells of CHC cases and to find out the frequency of α-SMA positive HSCs in perisinusoidal, periportal and pericentral regions of liver.

Methods:

Liver biopsies of sixty Chronic Hepatitis C cases were immmunostained using anti α-SMA antibody. To assess immunoexpression, semi quantitative scoring was done in three areas in each sample; pericentral, periportal and perisinusoidal area.

Results:

Immunoexpression of α-SMA was observed in all area with strongest staining on HSCs of perisinusoidal area.

Conclusion:

α-SMA can represent a useful marker for early hepatic stellate cells activation in our population and can help target patients requiring aggressive therapy.

KEY WORDS:

α-SMA, CHC, liver fibrosis, Hepatic Stellate Cells.

Background:

Continuing professional education (CPE) or continuous education (CE) is the means by which people maintain their knowledge and skills related to their profession. Mandatory continuing education is a major factor in relicensure that is being licensed to practice for a specific period with the license either getting renewed at the end of that period or forfeited. This study is designed to assess the awareness regarding importance of continuing professional education as a requirement for re-licensing among General Dental Practitioners and Specialists and to identify the role of governing bodies for endorsing re-licensure procedure on the basis of CME

Methods:

Cross sectional study was conducted among 450 dentists practicing in Karachi (July 2013 to Dec 2013), divided in to two groups ;General Dental Practitioners (n=350)and Consultant Specialists(n=100). Simple Random sampling technique was applied thorough lottery from available list of Dentists and Consultants. Data was collected through a self administered questionnaire. SPSS version 20 was used for analysis and Chi –square test to assess associations of categorical variables. P value less than 0.05 was considered as significant.

Results:

Majority participants n= 250 (55.6%) were aware about re -certification and re-licensing and n= 292 (64.9%)knew the difference between the two. Only n=153 (34%) were of the view that re -certification and re-licensing should be made mandatory in Pakistan.

Conclusion:

The awareness of CME & re-certification is high among our professionals

Key Words:

Re-certification, Re-licensing, Continuous Medical Education.

Background:

Hospital admission data can be a valuable tool for assessing the epidemiology of diseases within populations. With a minimum amount of data collection, substantial insight can be had into the types of diseases, the age at which conditions present, and their burden on inpatient service. And although these data are inevitably referral and access biased, they can provide useful information on morbidity in the community. Little is known about the surgical and medical diseases burden in tertiary care hospitals in Pakistan. Incomplete information has made it difficult to define an appropriate role for tertiary health care hospitals and the objectives of this research is to determine the referral profile of patients who are attending medical and allied OPD in Jinnah Hospital Lahore and compare disease burden from local and peripheral areas in surgical and medical units of Jinnah Hospital Lahore.

Methods:

Cross sectional study in medical and surgical wards of Jinnah Hospital, Lahore

Results:

In our study, it was found that public Tertiary Care Hospitals, such as Jinnah Hospital Lahore, has much more patients referred to it from rural cities compared to urban population with a referral burden of 63.01% subjects from rural areas or outside city versus 36.99% subjects belonging from urban areas or within city. Many of these patients, 35.6%, obtaining this facility equipped with all modalities in single setting belonged to poor socio economic status. 72.6% had a total family income of < Rs.20, 000/- per month. And the interesting fact causing the demise of Health Care Facility system is that 72% of the subjects were self-referred without any referral profile and diverting burden of Primary and Secondary Health Care facilities on the Tertiary Health Care setup.

Conclusion:

The disease burden from peripheral/rural areas is far greater than local/urban areas in surgical and medical units of Jinnah Hospital Lahore, and the most of the subjects are self-referred.

Key Words:

Burden of disease, referral profile, inpatient

Oral Cancer (95% of which is squamous cell carcinoma) is a common and fatal malignancy.Globally, Oral Cancer accounts for 2–4% of all cases while it is regarded as the sixth most common cancer in Asia.Prevalence of Oral Squamous Cell Carcinoma (OSCC)in Pakistan is 10 %. Saliva, a reflection of human health has been used as an investigative tool forover more than two thousand years.Direct contact between saliva and the Oral Cancer makes assessment of salivary tumor markers an effective alternative to serum testing. A saliva based test could be a non –invasive as well as cost-effective method in the diagnosis and follow-up of subjects with Oral Cancer.This article reviews the recently established biomarkers for OSCC such as Matrix Metalloproteinase (MMP), Cytokeratin’s, Cancer Antigen, Tumor suppressor gene P53 etc.which are of great importance in early detection.Oral cancer is usually diagnosed in late stages due to lack of definitive tumor markers for early detection. Initial diagnosis of Oral Squamous Cell Carcinoma can lead to early cure as compared to a diagnosis at a later stage. Thousands of presumptive biomarkers have been analyzed and revealed, amongst which we included only those which have been thoroughly investigated by different researchers for Oral Cancer.The purpose of this review article is to providethe current status of knowledge regarding tumor markers in saliva of Oral Cancer patients. This precise review included all articles that were used for the advancement of information about potential biomarkers in Oral Squamous Cell Carcinoma. Appropriate articles were determined according to a reconsideration of abstracts. Search of academic and published literature was carried utilizing the electronic databases of Pub Med, Google scholar, Elsevier from 2000 to 2015 for English-language articles. The search terms applied were: “biochemical markers and Oral Squamous Cell Carcinoma” The subjects, titles and abstracts of articles were appraised. Entire and complete text matter and reviews of the studies and researches were analyzed when the abstract met the inclusion framework. Evaluation of selected data includes a serious and detailed review of abstracts or full text papers.

Key Words:

Oral Squamous Cell Carcinoma, Biomarkers,Saliva

Abstract:

Oral Squamous Cell Carcinoma (OSCC) is an aggressive epithelial malignancy which has a rising incidence in the developing countries. Karachi South has reported OSCC as the second most common cancer in both genders according to 2002 statistics.It has a high mortality rate and is usually diagnosed at late stages. Precise and early diagnosis of OSCC by pathologists is important for optimum patient management. Keratins formerly known as cytokeratins are epithelial predominant intermediate filament proteins. They are a component of the keratin containing intermediate filaments in the intra cytoplasmic skeleton of epithelial cells.Keratins maintain structural integrity of epithelial cells and have certain regulatory functions as well. The expression of various keratins is found to be altered during and after the neoplastic transformation in oral malignancy and several of these can be used in immunohistochemical diagnosis and also in classification and subtyping of oral tumors.Therefore, differential expression of various keratins is extensively used in routine diagnostic pathology for precise categorization of oral cancer and also have been shown to have prognostic value.

Key Words:

Oral Squamous Cell Carcinoma, Keratins, Immunohistochemistry, Epithelium

Clinical waste is a major source of infection amongst patients, hospital workers and the community. The Hospital Waste Management committee established in Dr. Ziauddin Hospital has active involvement of Nursing, Housekeeping and Infection Control departments. This multifaceted approach has brought about changes in the form of educational campaigns, involving training sessions and informational posters to improve awareness among hospital workers. This not only decreases the number of injuries and accidents occurring in relation to clinical waste disposal, but proper disposal of hazardous waste is beneficial for the community and the environment we live in. The first step is to target the areas which need the most attention and then to develop a tailor-made plan focusing on the major problems. Effective communication and teamwork help control the issue from all different angles and provide a pro-active approach to improve the waste management facilities of the hospital and serve the community as a whole.

Background:

Sensorineural hearing loss in adults is commonly associated with aging, trauma or autoimmune disease. In children, however, sensorineural hearing loss can also be due to genetic causes, leading to malformation of internal ear structures, like the vestibular aqueduct. In this article we present a rare anatomic malformation which causes progressive hearing loss in children.

Methods:

Our patient is a 12 year old boy who presented with deafness and tinnitus after mild trauma to the side of the head. Steroids and carbogen were administered but showed no improvement.

Results:

Audiological evaluation demonstrated profound bilateral sensorineural hearing loss. Radiological investigations including CT scan and MRI of the temporal bone showed bilateral enlargement of the vestibular aqueduct.

Conclusion:

The patient was diagnosed with Large Vestibular Aqueduct Syndrome and recommended cochlear implantation which has a high success rate and improves the quality of life for the patient.

Key Words:

Sensorineural hearing loss, Enlarged vestibular aqueduct, enlargedvestibular aqueduct syndrome.

Abstract:

As it stands, Spigelian hernias are rare and generally overlooked or misdiagnosed. We report a case in which a Spigelian hernia presented to us as a painless abdominal swelling in a 39 year old obese female with no known co-morbids The hernia appeared as swelling in the right lower quadrant, which was non tender at the time of admission and showed no signs of strangulation. Diagnosis of the hernia was made on CT-scan and an open technique was adapted to repair it. The post op period was insignificant in the patient.

Key Words:

Spiglelian Hernia, Hernia, Spigelian Fascia Defect.