[en] Fractures of the acetabulum result from high energy accidents. The anatomic location of the acetabulum, as well as the three-dimensional structure of the bone, makes the treatment of these injuries extremely challenging. The objective of this study was to determine the outcome of operative treatment of acetabulum fractures with one year follow-up. Methods: In this descriptive case series, 31 patients with acetabular fracture were admitted in North West General Hospital, Peshawar, from July 2010 to Sept 2013. Patients were followed-up till one year. In follow-up, patients were assessed clinically with Merle Aubigne and Postel grading method. Radiological assessment was done using Matta criteria. Results: All patients were male. Twelve (38.7 %) were managed non-operatively, as they fulfilled criteria for non-operative treatment and 19 (61.3%) patients were operated after fulfilling the criteria for internal fixation; they were included for analysis. Ages ranged from 20-60 years with mean age of 37.21 ± 10.07 years. Fourteen (73.7%) patients had anatomic reduction and 5 (26.3 %) patients had imperfect reduction based on Matta radiographic criteria. At 1 year follow-up, we had 16 (84.2 %) excellent hips, 2 (10.5%) good hips and 1 (5.3%) poor hip , based on radiographs; and clinically we had 9 (47.4 %) hips with excellent function, 7 (36.8 %) hips with good outcome, 2 (10.5 %) had fair function and 1 (5.3 %) patient had poor function. Conclusion: Our results show that internal fixation of acetabular fractures lead to good outcome in majority of patients. (author)

[en] Picrorhiza kurroa (Pk) is a traditional Ayurvedic herb famous as a potent hepatoprotective agent, only few studies are available on the nephroprotective activity of this herb. The objective of this pilot study was to determine the therapeutic effectiveness of Pk against nimesulide induced toxicity. Methods: This laboratory based experimental study was conducted on mice at National Institute of Health, Islamabad from Dec 2012 to Jan 2013. The mice were divided in to 4 groups. One group was given only PK while the other three groups were given nimesulide in a dosage of 750 mg/kg body weight for 3 days to induce nephrotoxicity and protective effect of Pk was noted by giving 250 mg/kg and 500 mg/kg pk for 14 days to the two of the nimesulide induced nephrotoxicity groups. Biochemical assessment of kidney was done by measuring serum urea and creatinine. Also histology was done to confirm the findings of biochemical assessment. Results: In our pilot study out of 20 mice, 19 mice survived. Only 1 mouse of nimesulide group died. Mean serum urea of nimesulide group was 60 mg/dl and was decreased to 23 mg/dl and 25 mg/dl by two doses of Pk. Mean creatinine in group 2 was 0.55 mg/dl and was decreased to 0.21 and 0.19 mg/dl by two doses of Pk. Conclusion: Our study shows that nimesulide is a potential nephrotoxic drug and its toxic effects on kidney can be minimized by using glycosidal extract of Pk. (author)

[en] Antibiotics are used both pre and post-operatively in acute appendicitis for preventing wound infection. It has been observed that the routine use of post-operative antibiotics is not necessary in cases of non-perforated appendicitis as only prophylactic antibiotics are sufficient to prevent wound infection. The aim of this study was to see the frequency of wound infection in non-perforated appendicitis with single dose preoperative antibiotics only. Method: This observational study was conducted at the Department of Surgery, Ayub Medical College, Abbottabad from May to November 2014. A total of 121 patients with non-perforated appendicitis were included in the study. Only single dose preoperative antibiotics were used. The patients were followed for wound infection till 8th post-operative day. Results: 121 patients, 56(46.28%) male and 65(53.72%) female were included in the study. The mean age of patients was 27.41 ± 7.12 years with an age range of 18 to 45 years. In the entire series, 7(5.78%) patients developed wound infection. The infection was minor which settled with conservative therapy. Prophylactic antibiotics were found efficacious in 114(94.21%) patients. There was no significant association between wound infection and age and gender. Conclusion: Single dose preoperative antibiotics were found effective in controlling post-operative wound infection without the need of extending the antibiotics to post-operative period in cases of non-perforated appendicitis. (author)

[en] Breast cancer is the most common female malignancy worldwide. Pakistan has the highest incidence rate of breast cancer than any other Asian population. The purpose of the study was to evaluate the worth of sono-mammography in diagnosis of symptomatic breast diseases by comparing it with mammogram. Methods: In this cross-sectional validation study, 45 subjects with mean age of 45+-12.07 were included. Majority of the patients presented with complaint of breast lump. After complete history and clinical examination, all the patients had high resolution ultrasound of bilateral breasts and axilla followed by bilateral mammography. Histopathology was taken as gold standard in this study. The exclusion criteria were pregnancy and patients having direct clinical signs of breast malignancy. Results: Based on histopathology, out of 45 patients with breast symptoms, 12 patients had benign lesions, whereas 32 patients were diagnosed as the cases of breast cancers. Finally one patient did not have biopsy proven final diagnosis. Sensitivity and specificity of ultrasound were calculated to be 100% and 67% as compared to sensitivity and specificity of 90.6% and 91.7% for that of mammography. Conclusions: Ultrasound is a useful complementary tool to mammography in assessment of symptomatic breast diseases since it helps in characterization and localization of breast lesions seen on mammogram and it is not limited by dense breasts. Also it should be the considered as initial imaging technique for assessment of palpable breast lumps. (author)

[en] Role of vitamin D in the health of bones has been well established for over decades. It was known that its deficiency caused rickets in children and osteomalacia in adults. Later it was discovered that these can be corrected by giving vitamin D. Researchers discovered that vitamin D can be synthesized by exposure to sun. Hence it was also named ^the sunshine vitamin^. As time passed it was observed that low levels of vitamin D were associated with multiple diseases. This sparked the interest of the scientific community to further the research on vitamin D which led to the studies that started associating vitamin D with various diseases like cancers (prostate, colon and breast), autoimmune diseases (rheumatoid arthritis), infectious diseases (tuberculosis, hepatitis B, hepatitis C, HIV), cardiovascular diseases, mental illnesses (schizophrenia), diabetes mellitus (type 1, type 2 and gestational) and allergic conditions like asthma. With time, more studies were carried out relating levels of vitamin D to development of asthma, asthma exacerbations and risk factors leading to development of asthma like respiratory tract infections with positive associations. A number of studies were carried out which tried to explain the possible molecular mechanisms relating deficiency of vitamin D in pathogenesis of asthma. This review summarizes the role of vitamin D in development of asthma and probable mechanisms relating vitamin D to the pathogenesis of asthma. (author)

[en] Pakistan is a resource limited society and gold standard parameters to monitor HIV disease activity are very costly. The objective of the study was to evaluate total lymphocyte count (TLC) as a surrogate to CD4 count to monitor disease activity in HIV/AIDS in resource limited society. Methods: This cross sectional study was carried out at HIV/AIDS treatment centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad. A total of seven hundred and seventy four (774) HIV positive patients were enrolled in this study, and their CD4 count and total lymphocyte count were checked to find any correlation between the two by using Spearman ranked correlation coefficient. Results: The mean CD4 count was (434.30 ± 269.23), with minimum CD4 count of (9.00), and maximum of (1974.00). The mean total lymphocyte count (TLC) was (6764.0052 ± 2364.02) with minimum TLC (1200.00) and maximum TLC was (20200.00). Using the Pearson's correlation (r) there was a significant and positive correlation between TLC and CD4 count. (r2=0.127 and p=0.000) at 0.01 level. Conclusion: Our study showed a significant positive correlation between CD4 count and total lymphocyte count (TLC), so TLC can be used as a marker of disease activity in HIV infected patients. (author)

[en] Anatomy has always been considered as an essential basis for clinical sciences. In recent decades there has been an increased trend towards incorporation of clinical problems in the teaching of anatomy. To promote clinical knowledge clinico-anatomical conferences have been conducted in our department for the last five years. This study has been undertaken to determine perception of medical students regarding these conferences and to formulate recommendations for their improvement based on feedback obtained from students. Method: A cross-sectional study was conducted from December 2013 to January 2014 at the Lahore Medical and Dental College (LMDC), Lahore. A sample of 200 students of first and second year MBBS classes was selected for the study through convenience sampling technique. A 5-point Likert scale ranging from 1 (strongly agree) to 5 (strongly disagree) was used to determine students perception about clinic-anatomical conferences, using a self-administered questionnaire. Data was analysed using SPSS-19.0. Results: Out of total 144 (72%) students were of the opinion that clinico-anatomical conferences were a good source of clinical knowledge, 126 (63%) opined that these conferences promoted understanding rather than memorization, 122 (61%) found them interesting, and 15 (30%) found improvement in their grades in the subject of anatomy after attending the conferences. Conclusion: The clinico-anatomical conferences were found interesting and reported to be a good source of clinical knowledge. It is recommended that these conferences should be conducted frequently, made interactive and patients should be presented as case studies during the conferences. (author)

[en] The incidence of early post-traumatic seizures after civilian traumatic brain injury ranges 4-25%. The control of early post-traumatic seizure is mandatory because these acute insults may add secondary damage to the already damaged brain with poor outcome. Prophylactic use of anti-epileptic drugs have been found to be have variable efficacy against early post-traumatic seizures. The objective of this study was to compare the efficacy of Phenytion and Levetiracetam in prevention of early post-traumatic seizures in moderate to severe traumatic brain injury. Methods: This Randomized Controlled Trial was conducted in department of Neurosurgery, Ayub Medical College, Abbottabad from March, 2012 to March 2014. The patients with moderate to severe head injury were randomly allocated in two groups. Patients in group A were given phenytoin and patients in group B were given Levetiracetam. Patients were followed for one week to detect efficacy of drug in terms of early post traumatic seizures. Results: The 154 patients included in the study were equally divided into two groups. Out of 154 patients 115 (74.7%) were male while 29 (25.3%) were females. Age of patients ranges from 7-48 (24.15 ± 9.56) years. Ninety one (59.1%) patients had moderate head injury while 63 (40.9%) patients had severe head injury. Phenytoin was effective in preventing early post traumatic seizures in 73 (94.8%) patients whereas Levetiracetam effectively controlled seizures in 70 (90.95%) cases (p-value of .348). Conclusion: There is no statistically significant difference in the efficacy of Phenytoin and Levetiracetam in prophylaxis of early post-traumatic seizures in cases of moderate to severe traumatic brain injury. (author)

[en] Foot ulcers are one of the most important complications of diabetes mellitus and often lead to lower limb amputation. Diabetic foot ulcers are susceptible to infection. The objective of this study was to determine the frequency of common bacteria infecting these ulcers and their antibiotic sensitivity pattern. Methods: This descriptive cross-sectional study was performed in the Departments of Medicine and Surgery, Khyber Teaching Hospital, Peshawar from April, 2011 to February, 2012. Specimens collected from ulcers of 131 patients were inoculated on Blood Agar and MacConkey Agar, and antibiotic sensitivity was tested using standard disc diffusion method. Results: Out of 131, specimens from 120 patients yielded 176 bacteria. Sixty-six patients had monomicrobial infection while polymicrobial growth was obtained in 54 patients. Overall, Staphylococcus aureus (38.6%) was the most common isolate followed by Pseudomonas aeruginosa (27.3%). Staphylococcus aureus was most often sensitive to Moxifloxacin, Imipenem/Meropenem, Vancomycin and Linezolid while it showed varying sensitivity to Penicillins and Cephalosporins. 47.1% isolates of Staphylococcus aureus were resistant to Methicillin. Most of the gram negative rods were sensitive to Imipenem/Meropenem, Piperacillin-Tazobactam and Ticarcillin-Clavulanate. Majority of gram negative bacteria were found resistant to Cephalosporins and Moxifloxacin except Pseudomonas which showed variable sensitivity to Ceftriaxone, Ceftazidime and Moxifloxacin. Conclusions: Majority of isolates were found resistant to the commonly used antibiotics. Most commonly isolated bacterium, Staphylococcus aureus was most often sensitive to Moxifloxacin, Imipenem/Meropenem, Vancomycin and Linezolid, while majority isolated gram negative rods were sensitive to Imipenem/Meropenem, Piperacillin-Tazobactam and Ticarcillin-Clavulanate. (author)

[en] Many investigators reported the amount of fluoride release from glass ionomer cement. However, the work on fluoride release from GIC containing fluoroapatite and hydroxyapatite is scarce. Therefore, this study was conducted to find out the amount of fluoride release from Glass ionomer cement containing fluoroapatite and hydroxyapatite. Methods: The study was conducted in the Department of Materials, Queen Marry University of London. A total of 108 samples equally divided in to three groups namely fluoroapatite added GIC, Hydroxyapatite added GIC as an experimental group and unmodified GIC as a control group. The specimens were prepared by mixing powder and liquid in the ratio of 1:1. Amount of fluoride released was measured by Ion electrode method at 1, 3, 7, 14, 21 and 28 days. Results: On day 1, the combination of FA +GIC showed the highest amount of fluoride release followed by the control group (GIC) whereas the combination of HA+GIC released the least amount of fluoride. On day 7, the amount of fluoride release started declining in all three groups. The amount of fluoride release continued decreasing on day 21 in which combination of FA +GIC and the control group are shown to release equal amount of fluoride whereas the combination of HA+GIC gave the least activity the amount of fluoride release fall to a minimum level in all three group by day 28. Conclusion: It is concluded that addition of fluoroapatite into GIC has significant effect on the amount of fluoride release as compared to GIC alone; however, addition of hydroxyapatite into GIC has no additive effect on the amount of fluoride release. (author)