Volume 5 Issue-3 July-Aug, 16

On his sad demise, many described Professor Naeem Aon Jafarey as:
A Man of Vision……
An iconic figure….
An inspiration to all….
A transformational leader ……
A leader not easy to be replaced….
A simple and gentle personality….

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Visionary, far sighted, strong willed, dynamic, honest, kind, noble, gentle and ethical, an excellent teacher, a person of impeccable integrity, a humble person with no single mean bone in his body, 100 years ahead of time.

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Visionary, far sighted, strong willed, dynamic, honest, kind, noble, gentle and ethical, an excellent teacher, a person of impeccable integrity, a humble person with no single mean bone in his body, 100 years ahead of time.

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Background:

This study aims to describe our surgical technique and results for endoscopic transnasal dacryocystorhinostomy for the blocked nasolacrimal passage in patients presented in the department of Otolaryngology and ophthalmology at a tertiary care center.

Methods:

A consecutively presenting case series of blocked nasolacrimal passage were selected for transnasal endoscopic dacryocystorhinostomy. Bone removal done by cold instruments and the drill was used to remove the bone over the superior aspect of the sac. Medial wall of the sac was removed to marsupialize the sac in the nasal cavity. Septoplasty was done in 13 patients (17.10 %). The specific surgical approach with or without septoplasty and the use of endolight was discussed. Postoperative follow up including endoscopic examination and results are documented.

Results:

A total of 76 cases were included. Mean age was 37.32 (range 6-76)). An endolight was used in all cases to localize the site of nasolacrimal sac72 cases (94.74 %) have successful outcome in terms of relief of symptoms, whereas 4(5.26 %) cases had persistent epiphora. Revision procedure were done and 3(3/4, 75 %) cases had successful outcome. The overall success rate in our series of primary and revision ETDCR is 98.68 %.

Conclusion:

Endoscopic transnasal dacryocystorhinostomy is an effective treatment for nasolacrimal duct obstruction. Use of the endolight to localize and the power drill to expose the sac and septoplasty; contribute to the ultimate surgical success

Key Words:

Dacryocystorhinostomy, Nasoendoscopy, Dacryocystitis, Epiphora

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Background:

Oral cancer is regarded as the sixth most common malignant tumor and is one of the leading cause of death. Lymph node metastasis is a major factor for the prognosis of oral squamous cell carcinoma (OSCC). The objective of study was to compare the lymph node metastases with different histopathological parameters to identify high risk patients with the need for extensive treatment plans.

Methods:

140 histologically proven OSCC patients visiting Ziauddin College of Dentistry were included in this study. The clinico-pathological parameters were compared by using Chi-square, Kruskal-Willis and Mann-Whitney.

Results:

There were 90 male and 50 female patients with 29.8% in 49-58 years age group. Buccal mucosa was the most common site of tumor. The predominant morphology of OSCC was moderately differentiated OSCC with stage IV disease. Lymph node metastasis was present in 48.6% of patients. Perineural invasion (22.9%), lymphovascular invasion (8.6%) and distant metastasis (11.1%) were also recorded. The mean tumor size was 3.45mm ± 1.95mm and mean tumor thickness was 1.8 ± 1.6mm.

Conclusion:

A significant association between grade, stage, tumor size, tumor thickness and distant metastasis with lymph node involvement was found. However further studies with larger sample size are required to validate these results.

Key Words:

Oral squamous cell carcinoma; Lymph node metastases; Tumor size; tumor thickness.

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Background:

Xanthogranulomatous cholecystitis is a benign, uncommon, localized or diffuse inflammatory pathological condition of the gallbladder and a catastrophic distinct transformation of chronic cholecystitis. Macroscopically distinguished by multiple yellowish with lipid packed tumor like foamy masses (nodules or streaks) in the wall of the gallbladder. Microscopically, it is distinguished by a number of bubbly histiocytes with acute or chronic inflammatory cells, while in upcoming phase manifest with tremendous fibrosis. The present study was undertaken to analysis of the histopathology reports to see the frequency of incidental xanthogranulomatous cholecystitis after elective cholecystectomy.

Methods:

1522 cholecystectomies performed from January 2011 to December 2015, at tertiary care single centre Ziauddin University and Hospitals Karachi Pakistan. On Histopathology of ten gallbladder specimens after elective cholecystectomy revealed xanthogranulomatous cholecystitis. These histologically confirmed cases are identified from the retrospective analysis of patient’s record.

Results:

During the study period 1522 patients underwent cholecystectomy. Histopathologically confirmed xanthogranulomatous cholecystitis in ten patients (0.65% of all cholecystectomies). The mean age and standard deviation of patients with xanthogranulomatous cholecystitis was 54 + 17.19 years (range 29-85), with male to female ratio is 1:1. The most common clinical features were abdominal pain and tenderness in the right hypochondrium. Biliary colic and acute cholecystitis were the most common preoperative diagnostic features. Ultrasonogram was performed in all patients.

Conclusion:

Xanthogranulomatous cholecystitis is a scarce variant of cholecystitis with marked topographical discrepancy and preoperative clinical uncertainty and a per-operative diagnosis is a challenging task. Many times diagnosis is a histopathological revelation.

Key Words:

Xanthogranulomatous cholecystitis, Histopathology, Gallstones, Cohort study.

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Background:

Discovery of hepcidin, and its receptor in year 2000 has revolutionized iron metabolism studies. Measurement of serum hepcidin, may supplement existing investigational parameters of iron status in anemias. The aim of the study is to estimate baseline hepcidin level and evaluate it as a predictor of response after treatment of iron deficiency anemic with oral iron.

Methods:

This was a purposive follow up study; involving 102 patients aged 18 years and above selected from medical outpatient departments of a tertiary care hospital of Karachi. Baseline CBC, iron studies, and serum hepcidin-25 were measured. Patients of IDA were treated with oral ferrous sulphate 200mg thrice daily for 8 weeks. Repeat CBC on follow up visit assessed response, defined as increment in hemoglobin level by >1gm/dl post treatment. Logistic regression analysis was applied and receiver operating characteristics curves were plotted to find utility and identify hepcidin cutoff values as a predictor for response.

Results:

Mean baseline serum hepcidin-25 was 37.34±22.60 ng/mL. Regression models showed for every one unit increase of hepcidin, the odds of hemoglobin improvement decreased by (1-0.972)=0.028gm/dl, serum hepcidin-25 by itself significantly predicted improvement in hemoglobin level P=<0.05. The area under the curve for hepcidin compared with post treated hemoglobin was 0.73 (95% CI: 0.63-0.83). For predicting response to therapy, hepcidin cutoff value of 40ng/mL, had sensitivity of 68%, specificity of 63%, positive predictive value of 85% and negative predictive value of 38%. Hepcidin quartiles were also constructed compairing 4th quartile parameters with 1st quartile parameters.

Conclusion:

Hepcidin 25 is a fair predictor for response of iron therapy in IDA patients; baseline hepcidin of 40ng/ml predicts treatment response.

Key Words:

Iron deficiency, Anemia, Parameters, Tablet Ferrous Sulphate 200mg, Serum Hepcidin-25, ELISA, Bio Predictor For Response, Cutoff Value, Logistic Regression.

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Background:

Appendicitis is one of the common cause of abdominal pain and surgical emergency. The diagnosis is mainly clinical, augmented by the imaging modality in which ultrasound still is a first paradigm. This study aims to assess the accuracy of ultrasound strategy in the diagnosis of acute appendicitis.

Methods:

This retrospective cross-sectional validation study was conducted in General Surgery Department, Ziauddin University and Hospitals, Karachi Pakistan from 2012 to 2015 on patients who underwent Appendectomy. It concerned 200 cases of appendectomy following, prior ultrasound examination of lower right abdomen. In 126 cases ultrasonography clearly showed the acutely inflamed appendix. In 59 cases the appendix was not visualized. In15 cases ultrasound showed periappendicular fluid collection. Among 200 patients later shown in surgery to have appendicitis, ultrasonography was unequivocally positive in 114 patients (Sensitivity 95%) and 24 patients in whom appendicitis was definitely excluded according to ultrasound examination (specificity 70%).

Results:

The gold standard for the diagnosis of appendicitis still requires histopathological confirmation after appendicectomy. Pooled sensitivity is 95% and specificity is 70%, ultrasound still remains the first line and extremely accurate measurement in the diagnosis of acute appendicitis.

Conclusion:

We conclude that ultrasonography is our first line useful aid in patients referred with clinically suspected acute appendicitis. Ultrasonography has high accuracy in diagnosing acute appendicitis and reduces negative appendectomies. A non-compressible tubular structure of 7-9 mm in diameter of the appendix is the most accurate ultrasound finding.

Key Words:

Acute appendicitis, Histopathology, Ultrasound, Cross sectional study, Retrospective

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Background:

Oral squamous cell carcinoma (OSCC) is one of the most common cancers in the world. Cigarette smoking, gutka and pan are the most common addictions in Pakistan. This study is conducted to evaluate the frequency of these risk factors (cigarette smoking, gutka and pan) and correlate it with histopathological grade of OSCC.The objective of the study is to evaluate the role of cigarette smoking, gutka and pan consumption in the histopathological differentiation of Oral Squamous Cell Carcinoma.

Methods:

A cross-sectional study was conducted. OSCC patients (n= 138) were recruited through purposive sampling technique from Dental OPD of Ziauddin Dental College, Ziauddin Hospital, Karachi. A detailed questionnaire was filled with information regarding patient’s medical history along with the daily consumption of cigarette, gutka and pan. Co-relations were studied between various continuous variables. Cross-tabulations were performed between frequency of habits and different histopathological grades of OSCC.

Results:

In the present study, 138 OSCC patients, 108 (78.3%) males and 30 (21.7 %) females, were enrolled and histopathologically diagnosed into well differentiated, moderately differentiated and poorly differentiated OSCC. Association of histopathological grades of OSCC with different age groups revealed moderately differentiated OSCC as the predominant histopathological differentiation in 30-39 years age group (46.3%). Majority of OSCC cases with cigarette smoking and gutka consumption used these products with frequency of > 15 packets per day, while, most of the pan consumers used 5-15 pan per day. All these patients had poorly differentiated OSCC i.e. 48.7% cigarette smokers, 64.1% gutka and 43% pan consumers.

Conclusion:

This study concludes that most of OSCC patients with habits of gutka, cigarette smoking and pan were associated with poorly differentiated carcinoma with more cases occurring in younger age group. This point to an alarming situation and se¬rious thought should be given to early detection and prevention.

Key Words:

Oral squamous cell carcinoma, frequency, cigarette smoking, gutka, pan, grading.

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Background:

The Maternal Mortality Ratio (MMR) of a country is indicative of its health and developmental status. The aim of the study is to determine the frequency of maternal mortality and identify the causes with different age groups, parity and gestational in 4 campuses of Ziauddin University and Hospitals, during the period 2012- 2014.

Methods:

retrospective review of validated records of hospital registers in the last 3 years during January 2012 to December 2014. Convenience sampling used to access the records. A self-structured proforma designed to collect data on variables like age, parity, gestational age, cause of death, condition at the time of admission, duration of stay in hospital before death, cause of delay were part of the questionare.

Results:

In the three years period from January 2012 to December 2014 there were 32 maternal deaths. Total number of births was 14219 out of which 14184 were live births. MMR (Maternal Mortality Ratio) was 226 per 100000 live births. Eclampsia and haemorrhage were the leading cause of maternal mortality. Seven (21.8%) patients died due to postpartum haemorrhage and 7 (21.8%) from eclampsia and its complications, while 4 (12.5%) patients had puerperal sepsis.

Conclusion:

Maternal mortality was high with leading causes as, eclampsia, haemorrhage, and sepsis in the age of 20-30 years and parity 1-4. Mostly, deaths were due to delay in getting full term females to the health facility in time.

Key Words:

Maternal Mortality, Eclampsia, Hemorrhage

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Despite recent advancement in pathogenesis and management of disease, oral cancer remains the most common human malignancy, worldwide. The aggressive behavior of OSCC is a challenge for new treatment modalities for primary as well as metastatic lesions. HER receptors play an important role in the normal physiological process as well as in the development of many cancers including oral squamous cell carcinoma. An electronic article search was done through PubMed, Google Scholar and Medscape were used for an electronic search of articles, using the following keywords: oral cancer, EGFR, Her/2, Her/3 and Her /4. All types of articles were included. The aim of this review is to outline the current knowledge on the role of HER receptors in the progression of OSCC in order to use them as a therapeutic target in high risk OSCC patient and to prevent them from aggressive surgeries causing post-operative morbidity.

Key Words:

Oral squamous cell carcinoma, HER1, HER-2, HER-3 and HER-4, over expression, Immunohistochemistry.

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The vast potential of plants has bioactive compounds that could be effective or inhibitory to microorganisms. Several experiments aimed at understanding the plant composition and its safe usage in the modern world have been conducteddue to their traditional importance in herbal medicine. Psidiumsppis a phyto-therapeutic plant believed to have active components that helps to manage and/ or treat different disease conditions such as vomiting, fever, diarrhea, dysentery, ulcer etc. Thus, understanding of the antimicrobial nature via research on their extracts will further explain their role in the history of herbal medicine and application in modern world.After application of inclusion and exclusion criteria, a systematic review composed of sixteen published research articles of twenty trials from different parts of Psidiumspp extract against Escherichia coli and Staphylococcus aureus were appraised. The outcome was evaluated via zones of inhibition with consideration to the extraction solvent and the plant part. Analysis of the available data showed that the choice of solvent (95% C.I) affected the amount of composition extracted in the order of methanol, aqueous, acetone and ethanol while the plants part also varied in terms of their bioactive properties to inhibit the target organism in order of leaf, fruit, stem bark, twig and seed. Due to the ability of these extracts to inhibit the target organisms, it can therefore be deduced that concentration of the active components of Psidiumspp can be used as an alternative to treat diseases related to E. coli and S.aureus.

Key Words:

Bioactive, Psidiumspp, Escherichia coli, Staphylococcus aureus, Antibiotics.

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Structured morning meetings (SMM) were introduced in department of Physiology at Bahria University Medical & Dental College from May 2009. The responses from faculty members who attended the SMM for a period of one year affirmed this to be a healthy activity. It helped 9 (90%) and 7(70%) faculty members in preparation and improvement of multiple choice questions and objective structured practical examination for the examination. The presentation skills of 7(70%) presenters were improved by this exercise. The respondents recommended its continuation in future.

Key Words:

Structured morning meetings. Medical education, Faculty, Capacity building

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