Objective: To compare the validity of a new index (Hb×RDW×100/ (RBC)2×MCHC) with twelve discriminating functions (DFs) to differentiate iron deficiency anemia (IDA) and beta-thalassemia trait(ß –TT).

Methodology: A total of 823 patients (317 IDA and 506 ß –TT) aged 15 to 35- year- old were enrolled in this study. The diagnostic sensitivity, specificity and other validity parameters were calculated to assess the diagnostic reliability of the novel index [Keikhaei index (KI)] vis-a-vis the other published DFs [Mentzer Index (MI), Green & King Index (G&KI),red cell distribution width index (RDWI), England & Fraser Index (E&FI), Bessman and Feinstein index (B&FI), Telmissani et al index (TI), Srivastava and Bevington index (S&BI), Shine and Lal index (S&LI), Ricerca et al index (RI), Ehsani et al index (EI), Sirdah et al index (SI), and Red Blood Cell Count(RBC)] were calculated in all patients.

Results: All thirteen DFs didn’t have the sensitivity and specificity of 100%. The KI, RDWI, G&KI and E&FI showed the most sensitivity and specificity for both IDA and TT; moreover, the lowest reliable indices belonged to B&FI, S&LI and RI.

Conclusion: According to Youden’s index (YI), DFs in the order of highest to lowest were KI > G&KI > RDWI > E&FI > RBC> M I> EI > TI > SI > S&BI > RI> S&LI >B&FI.

Objective: To determine the correlates and the prevalence of Dysmenorrhea in a group of women.

Methodology: This cross sectional study was carried out on the 556 subjects aged 18-45 years in a town of western Turkey between January, and March 2009. We used visual analogue scale to assess the severity of dysmenorrhea. The data were evaluated by Logistic Regression Analysis and Chi-square tests.

Results: The prevalence of dysmenorrhea was 66.7%. About 32.3% of the women described their dysmenorrhea as severe. When compared to the age group of 35 and over, the risk of dysmenorrhea was 2.677 fold higher in the age group of 24 and over. The risk of dysmenorrhea was nearly 2.5 fold higher in those who had family history of dysmenorrheal.

Conclusion: The prevalence of depression among women was relatively high. This indicates the need for knowledge concerning dysmenorrhea to be addressed by menstruation-related health education programs.

Aggressive Angiomyxoma (AAM) is a rare mesenchymal tumor with a locally aggressive course. The most common location is in the pelviperineal region and occurs mostly in females of childbearing age. In males, it is extremely rare and thus is apt to be mistakenly diagnosed as an inguinal hernia or hydrocele. We report a case of 45 year old man who had right sided scrotal swelling for about four years. It was diagnosed as an inguinal hernia clinically. On further investigations, it was found to be a soft tissue tumor of the scrotum. The patient underwent scrotal exploration. At surgery, a huge lobulated gelatinous mass surrounding the right testicle was found. The mass was excised including the testicle and sent for histopathological analysis. Histologic examination of the excised mass revealed a nonencapsulated lesion composed of sparse spindle-shaped cells and a myxoid stroma with a prominent vascular component. The cells showed focal and weak positivity for desmin. The findings were thus consistent with aggressive angiomyxoma of the scrotum. The margins of the specimen were clear. The patient we report has so far done well with no evidence of recurrence.

Objective: To evaluate the quality of life in patients with tracheostomy.

Methodology: All the patients, who have had tracheostomy operations between 1998-2009 at a University Hospital, Turkey, constitute the population of the study (70 patients). The data have been collected between June -July 2009 by using the Short Form 36 Quality of Life Scale (QoL).

Results: It has been determined that the QoL scores of patients, whose life span with tracheostomy is three months to one year, who have received chemotherapy or radiotherapy, have difficulties in breathing and eating are lower in the various sub-dimensions of the QoL scale. Together with this, it has been determined that the scores of patients who can perform their tracheostomy care independently, have no complications, use esophageal speech, whose sense of smell has not been impaired, and state that their physical appearance has not been affected are higher in the various sub-dimensions the Quality of Life (QoL) scale.

Conclusions: Tracheostomy has a profoundly negative impact on quality of life.

Objective: In a search for natural substances with potential for the treatment of typhoid fevers and urogenital infections, the methylene chloride extract of the seeds of Peucedanum zenkeri was investigated.

Methodology: The extract was subjected to column chromatography leading to the isolation of seven compounds. Their structures were determined using modern 2D NMR techniques and by comparison with published NMR data. These compounds were tested against Salmonella typhi, Salmonella paratyphi B, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus, using both agar diffusion and broth dilution techniques.

Results: The compounds isolated were umbelliprenin (1), prangenin (2), imperatorin (3), isopimpinellin (4), bergapten (5), cnidilin (6) and stigmasterol (7). Among the above seven compounds, only two (1 and 2) exhibited antibacterial activity. For compound 1, the MIC value was 300 µg/ml against P. aeruginosa, S. aureus, S. typhi and S. paratyphi B. For compound 2, the MIC values varied between 200 and 300 µg/ml against all the bacteria strains tested.

Conclusion: These data suggest that Peucedanum zenkeri seed extract contains antibacterial agents which are active against Salmonella species causing typhoid and paratyphoid fevers, and some bacteria strains causing urogenital infections. The antibacterial activity of compound 2 appears to be due to the epoxide group present in its structure.

Objective: Iranian breast cancer patients are relatively younger than their Western counterparts. The objective of the present study was to investigate risk factors for breast cancer in Iranian women and compare it with other data driven from other studies.

Methods: A study was conducted in April 2008 in Tehran, Iran. Demographical data and risk factor related information, including data from their mammograms were collected using a questionnaire.

Results: In all, 109 participants were interviewed. The mean age of participants was 40.48 ± 0.56 years. 1.8% of women were unmarried, while 78% were married and 20.2% were divorced/widowed. The mean age for menarche was 13.34 ±1.47 years and 46.89±4.98 for the menopause, respectively. The mean parity time was 2.36±1.13 and breastfeeding in women was 23.27±14.16 months. About 5.5% of the participants used oral contraceptive as a method for contraception. 8.3% of women experienced menopause, at the mean age of 46.89±4.98. 33.3% of menopaused women, used Hormone Replace Therapy (HRT).Moreover, 8.3% of women had a positive history of breast cancer in their family. Of those women on whom mammography was done, 10.1% had breast mass in radiological findings, mostly in favour of fibrocystic change. In 20.2% of participants, further investigation was advised.

Conclusion: The findings of the present study were in accordance with other studies done in Iran and in some aspects in tune with other studies about breast cancer in other countries. However, more multicentric larger scale studies should be conducted in Iran to determine a pattern for breast cancer in Iranian women.

Objective: To study the attitudes of health caregivers on teamwork & safety climate in an educational Medical Center in Tehran Iran.

Methodology: In this descriptive study, 225 residents physician, nurses and other paramedics working for at least one month in the studied hospital participated. Data collection tool was Safety Attitudes Questionnaire (SAQ) which consisted of three sections: provider group characteristics, 14 teamwork questions, and 13 safety climate questions. Validity (content) and reliability (test-retest) of the questionnaire were confirmed and chi square test was used for data analysis.

Results: The results indicated that from 225 subjects, 39.11% were male and 60.89% were female, with 70.23% being married and 26.66% being single. There was not a significant relationship between caregivers’ attitudes on teamwork & safety climate with provider group characteristics (gender, experience in organization, marital status, and organizational position). By comparing teamwork & safety climate points, the status of teamwork in the studied hospital was better than that of safety climate and the caregivers were more satisfied with status of teamwork in the hospital.

Conclusion: Achievement of patient safety depends on teamwork. Safety climate also leads to an appropriate feedback and culture of learning from errors. Therefore, further studies on safety climate related factors, for continuous improvement in patient safety is recommended.

Behcet’s Disease is a multi-system, chronic inflammatory disorder characterized by chronic relapsing course. Its principal manifestations are oral and genital ulcers as well as inflammation of the eyes, skin and joints, while vascular and neurological complications may results in death. The etiology and pathogenesis of the disease are still obscure and specific treatment is not available. We report the case history of a patient with Behcet’s Disease. He presented with fever, arthritis and weight loss of 3-week duration. He was also found to have hyperthyroidism, extra-pulmonary tuberculosis, and strongyloidiasis. Although, the association between thyroid diseases and auto-immune connective tissue disorders as well as tuberculosis is well recognized, there had been, to the best of our knowledge, no reports of Behcet’s Disease associated with thyroid dysfunction. However, further studies are required to investigate any association between Behcet’s Disease and thyroid dysfunction.

Objective: Guillain-Barre syndrome (GBS), acute postinfectious polyneuritis, is the most common cause of acute neuromuscular paralysis. Infection with Campylobacter jejuni is recognized as a common antecedent of the GBS. This study aimed to determine the frequency of this infection in children with GBS and, the clinical and epidemiologic features of this association.

Methodology: We performed a prospective case-control study on a cohort of 47 children with GBS admitted to Tabriz Children,s Hospital in the northwest of Iran between July 2006 and July 2008. Serologic investigations were used to diagnose preceding C. jejuni infection.

Results: We found evidence of recent C. jejuni infection in 40.4% of the patients with GBS, as compared with 6.1% in household controls (odds ratio 10.5, 95% CI: 2.2-49.2, P<0.001). Duration to achieve independent walking was longer in C. jejuni-associated patients (P<0.013). However 95% of C. jejuni-associated GBS patients achieved independent walking at end of one year. The patients with preceding C jejuni infection were more likely to have axonal neuropathy (P<0.05).

Conclusions: Campylobacter jejuni infection is an important antecedent illness in childhood Guillain-Barre syndrome in Iranian children, and is associated with good prognosis.

Objective: To determine the perceptions and practices regarding communication skills of doctors in a paediatric department of a tertiary care hospital.

Methodology: This was a cross-sectional study conducted in the Department of Paediatrics, Dow Medical College and Civil Hospital Karachi from October to December 2008. Fifty four doctors including faculty, consultants, registrars, postgraduates and medical officers of indoor and outdoor departments and wards were enquired regarding their behavior and communication with parents and physicians. Their responses were recorded on a questionnaire based on standards IMNCI/WHO guidelines for good communication skills. The data was later analyzed and given as frequencies and percentages.

Results: Sixty five percent doctors were spending less than 10 minutes with patients, seventy percent of the doctors claimed that they were polite and friendly with their patients, thirty seven percent were using simple language, thirty nine percent were listening carefully without interruption whereas eighty percent did not knew the appropriate time of follow up. Seventy four percent doctors claimed that lack of parental understanding is one of the important reasons for lack of effective communication. Other reasons reported were large number of patients (56%) lack of adequate time (50%), inadequate numbers of doctors (35%) and other paramedical staff (30%).

Conclusion: Majority of doctors of Paediatric Department are using inadequate communication skills. Large number of patients, lack of adequate number of doctors and paramedical staff and lack of parental understandings were the reasons given by the doctors for inadequate communication practices.

Objective: To compare the effects of cabergoline and bromocriptine on serum prolactin levels and liver and renal functions in hyperprolactinemic women.

Methodology: This study involved one hundred women, who had symptoms of hyperprolactinemia and elevated serum prolactin concentration. They were divided into two groups of 50 women. The first group received 0.5 mg of cabergoline weekly and the second group received bromocriptine up to a maximum of 2.5 mg twice daily. Serum prolactin, total bilirubin, serum alkaline phosphatase activity, AST activity, ALT activity, serum creatinine and serum urea concentrations and creatinine clearance were determined at baseline and at 8 week interval (at the end of the trial). The efficacy of treatment was assessed with the regular menstrual cycle, absence of galactorrhea, oligomenorrhea and normalization of serum prolactin levels.

Results: Normalization of serum prolactin level was achieved in 28 of 50 (56%) women taking bromocriptine and in 40 of 50 (80%) women taking cabergoline. Cabergoline group showed a higher percent of improvement of the symptoms of hyperprolactinemia. Figures of 83.33% for amenorrhea, 71.4% for galactorrhea and 95.45% for oligomenorrhea have been noted with cabergoline versus 55.5%, 33.33% and 72%, respectively for bromocriptine. Sixty six percent of the women taking bromocriptine were reported to have adverse effects as compared with 30% of those taking cabergoline therapy. No significant adverse effects on liver and kidney functions have been reported in the study.

Conclusion: The present study demonstrated that both bromocriptine and cabergoline are effective in the treatment of hyperprolactinemia but cabergoline has the advantage over bromocriptine in terms of both efficacy and tolerability. Therefore it is preferred in the treatment of women with hyperprolactinemia. However, both drugs showed no abnormality in liver function as well as kidney function tests.

Objective: To compare the efficacy of submucosal electrocautry versus submucosal diathermy for the surgical treatment of inferior turbinate hypertrophy of nose and to analyze the outcome of both treatment options.

Methodology: Retrospective study was done in 100 cases at the department of otorhinolaryngology, head and neck surgery department JPMC and PMCH Nawabshah, form January 2007 to July 2008. The patients suffering from inferior turbinate hypertrophy were included in this study having ages between 20 to 35 years. Demographic data were obtained from the patient files at the Hospital and were complied for result.

Results: Among one hundred patients which were evaluated and surgically treated, 30 cases were of allergic rhinitis, 28 cases of vasomotor rhinitis, 22 cases were of chronic hypertrophic rhinitis and rest of 20 cases had mild septal deviation. The results were evaluated for the patients, pre-, post-operative symptoms and clinical findings.

Conclusion: Submucosal diathermy was found more successful in relieving the patients’ symptoms and decreasing the size of the inferior turbinates as compared to mucosal electrocautry.

Objectives: The aim of this study was comparison of the effects of Metformin and Cyproterone-estradiol compound on serum androgens & highly sensitive C-reactive protein levels.

Methodology: Sixty patients with Poly Cystic Ovary Syndrome (PCOS) were enrolled in this study conducted during a period of 16 months from December 2004 to March 2006. Thirty subjects were in each group and treated with Metformin one gram per day or Cyproterone-estradiol compound 21 days monthly and at the beginning and after 3 and 6 months, weight, height, testosterone, dehydroepiandrosterone sulfate (DHEA-S) and hs-CRP levels were measured.

Results: Mean age of patients was 23.5±8.7 years with the range of 15 to 49 years. In both groups significant decreases in DHEA-S levels and in Cyproterone-estradiol compound group a significant decrease in testosterone levels were seen after 6 months, but there were no significant decrease on hs- CRP levels. Comparison of two groups showed that there were no significant differences in the effects of these two drugs on serum testosterone, DHEA-S and hs-CRP levels. In our study the level of hs- CRP at the beginning of treatment were significantly higher in patients who were overweight and obese. Also we found that Cyproterone-estradiol compound causes significant decrease at the level of hs-CRP in overweight and obese patients.

Conclusion: The results of this study are different from those of previous studies about beneficial effects of Metformin on hs-CRP levels but are similar to the results of studies that revealed probably obesity and overweight has important role in inducing inflammation and increasing CRP levels.

Objectives: The study aimed at determining the extent of use of complementary-alternative medicine (CAM) various CAM methods used, and factors influencing CAM application by patients with disc herniation.

Methodology: The subjects of this descriptive study consisted of 134 patients with disc herniation attending the physical therapy and rehabilitation outpatient clinic of a hospital in Erzurum, Turkey, between January and June 2008. The data were analyzed using Chi-square test based on mean and percentages calculated.

Results: While most patients preferred CAM use (71.6%) for treatment of disc herniation disease, some did not (28.4%). Types of CAM used by the patients varied: 67.7%, herbal medicine; 63.5%, wool belt; 34.4%, hot application; 20.8%, plaster; 14.6%, Turkish baths and/or hot springs; 13.5%, fish and/or fish oil; 9.4%, spinal manipulation; 6.3%, cupping therapy; 6.3 %, salt; 5.3%, massage; 3.1%, corset; 2.1%, plastic bag and soap treatment. No differences were identified between the socio–demographic and disease characteristics of both groups of patients regardless of CAM use (P>0.05).

Conclusions: Study showed that patients with disc herniation had higher rates of CAM use (71.6%). No differences were determined between the socio–demographic and disease characteristics of both groups of patients regardless of CAM use. Thus, nurse professionals should train patients about effective and appropriate application of CAM.

Visceral leishmaniasis (kala-azar) is caused by the protozoan parasite Leishmania donovani and transmitted by the bite of infected sand fly Phlebotomus argentipes. Only a few cases of congenital transmission have been reported. We are reporting a 15 days old baby with congenital visceral leishmaniasis and then the literature is reviewed.

Objective: This study was designed to evaluate the effect of hormone replacement therapy (HRT) and folic acid supplementation on Homocysteine (Hcy) level in postmenopausal women.

Methodology: This is a randomized clinical trail conducted on 66 postmenopausal women (menopause at least for 2 years) attending Hamedan outpatient Fatemieh teaching hospital. Since March 2006 till April 2007. The patients were randomly divided into four groups. Before studying plasma level of Albumin, total protein, folate, fasting level of plasma Hcy was measured. The patients of first group received folic acid 5mg daily. In the second group of patients took oral conjugated estrogen 0/625mg and medroxy progesterone acetate 2/5 mg daily. In third group the patients received combination of folic acid and HRT and placebo in fourth group. Fasting plasma level of Hcy was measured four weeks later.

Results: Plasma level of Hcy was significantly decreased in group1, 2 and 3(P<0/05) after treatment. There was significant difference between group 1, 3(p=0/026) and 1, 4 (P=0/005) for plasma level of Hcy

Conclusion: HRT and folic acid therapy can reduce plasma Hcy. Combination of both HRT and folic acid supplementation is more effective than HRT or folic acid alone in reduction of hyperhomocysteinemia.

Background: To investigate the effect of soybean on serum lipids and lipoproteins in hypercholesterolemic postmenopausal women.

Methodology: One hundred participants were included and divided randomly into two arms. One arm received two grams of soy every day, while the other group received similar shaped capsules filled with placebo. Subjects and outcome assessors were kept blind to the contents of the capsules. Serum cholesterol, triglyceride and low- and high-density lipoproteins were measured before and after the intervention.

Results: The two groups were similar in their baseline characteristics. We observed no favorable changes in lipid profile in either of the two groups. The two arms of the study responded similarly to the intervention and no statistically significant difference was observed between these responses.

Conclusion: This double-blind randomized controlled trial does not support the hypothesis that the use of soybean improves serum lipid constituents in postmenopausal women having hypercholesterolemia.

Objectives: To explore the changes in Purkinje cells in adult rats after inducing chemical hypoxia by sodium nitrite

Methodology: Adult male albino rats, weighing 180-200 gm were used in this study. The animals were fasted for three hours prior to drugs administration. One hour after sodium nitrite (75 mg/kg) subcutaneous injection, rats were decapitated. The brains were removed and placed overnight in fixative containing 10% formalin. Cerebellum were paraffin- embedded for hematoxylin and eosin staining and cut at 5 µm in the coronal plane. Fifty Purkinje cells along the line of cells from two randomly chosen portions of each section were counted at a magnification of x20. Cells in a total of five sections were counted to compute the ratio of damaged cells to intact neurons.

Results: There was no marked difference in the general appearance and thickness of the cerebellar cortices of the control and the sodium nitrite treated rats. The principal findings in the treated group were that almost all the Purkinje cells showed autolytic changes. Their arrangement as a single layer was also deranged in certain areas. Some areas showed complete loss of Purkinje neurons.

Conclusion: Sodium nitrite-induced hypoxia results in severe damage to the Purkinje neurons.

Objective: To compare the outcome of laparoscopic and open appendecectomies in terms of operative time and post-operative morbidity.

Methodology: This prospective study was done from March, 2008 to March, 2009, at Surgical "C" Unit of Khyber Teaching Hospital, Peshawar. All consecutive appendectomies (open and laparoscopic) performed over this time were included. Demographic details, operative time, conversion, infective post-operative complications and delay in discharge were recorded. The patients were divided into two groups, laparoscopic appendectomies (LA) and open appendectomies (OA).

Results: A total of 165 appendectomies were performed, 72 in the LA group and 93 in OA group. Eighteen appendectomies were perforated at the time of operation. The patients’ ages ranged from 12-65 years (median 24 years). Eighty were males and eighty five were females. Operative time in LA group was longer with mean duration of 45 minutes (range 35-75 minutes) compared with 35 minutes (range 30-55 minutes) in OA group. A glove finger was used as extraction bag in 59 (83%) in LA group. LA patients’ wound infection was recorded in12 patients, two out of 72 in LA and 10 out of 93 in OA group. The site of infection was the port of specimen extraction in LA group. Intra-abdominal abscesses complication was observed in one case in the OA group. LA group had shorter hospital stay (mean 1.5 days) than (OA) (mean 3.5 days), and early return to normal activity, 8-15(mean 10.5) days in LA and15-25(mean18.5) days in OA.

Conclusion: Laparoscopic Appendectomy (LA) is safe and has major benefits like less post-operative pain, decreased wound infection, early hospital discharge and earlier return to work than Open Appendectomy (OA). LA is recommended in all patients with acute appendicitis if laparoscopy is not contraindicated.

Iatrogenic foreign body in the airway is a known complication of medical treatment that may occur in various clinical settings. The foreign material can be from extraluminal or intraluminal source. The symptoms may manifest acutely or months and years after treatment. Our case highlighted the possibility of the dislodgement of the foreign body during retrieval from the initial site, and the importance of prompt identification and management.

Objectives: To report the pattern of injuries from high speed road traffic accidents (RTA) in the Southern Region of Saudi Arabia.

Methodology: In this prospective criteria based one year study; data was collected upon arrival of patients to the accident and emergency department. The patients were grouped into two, with fractures (Group-1) and without (Group-2).

Results: A total of 1513 patients were included, 628 in Group-1 and 885 in Group-2. There were 1356 male and 157 female patients in total. Majority were in the younger age group, drivers and front seat passengers. Fewer were using restrains and more reported driving with high speeds in group-1 compared to group-2. Most accidents occurred during 12:00 hrs to 24:00 hrs in both groups.

Conclusion: Although most of the causative factors of Road traffic accidents in this region of Saudi Arabia are similar to the rest of the world; some remain unique to the region.

Vaginal foreign bodies in girls may be accidental, self-inflicted or secondary to child abuse. These may causes a number of complications like Infections, abscess formation, intestinal perforation, vaginal discharge and internal fistulae. We are presenting a case of a 13 years old girl who presented with a supra-pubic mass and dysuria. X-ray showed a radio-opaque shadow in pelvis. The child was admitted in medical ward with the diagnosis of bladder stone and UTI. She was pouring frank pus from the vagina. On rectal digital examination a hard foreign body was felt in the rectum. Investigations revealed that she had a large pelvic collection, a sharp wooden Foreign Body (FB) extending from the rectum through the vagina in to the urinary bladder forming a bladder stone. Patient also developed recto-vaginal and vesico-vaginal fistulae. Foreign body was removed along with the bladder stone, pelvic abscess drained and colostomy was performed. Later repair of vesico-vaginal fistula were performed, recto-vaginal fistula closed spontaneously and colostomy closed. Patient became fully continent for urine and feces after completion of surgical procedures. A careful history from the child revealed that she had inserted the foreign body herself as a self-exploring practice.

Objective: In this study we tried to find relationship between location, size and clinical symptoms of uterine polyps.

Methodology: Our cross sectional study was performed during the year 2008 in Ahwaz Imam Khomayni Hospital. Patients who underwent office hysteroscopy were evaluated and those with hysteroscopic diagnosis of polyp were entered in the study. Hysteroscopic findings of location and size of polyps and clinical presentations of Abnormal Uterine Bleeding (AUB) dysmenorrhea, infertility, discharge, spotting plus discharge were evaluated.

Results: One hundred and twenty four patients were evaluated. The most common location of polyp and clinical presentation were cervical canal and AUB, respectively. Polyp sizes of equall or less than 1 cm are commonly seen in cervical canal and cornea and more than 1 cm polyps are commonly found in uterine cavity and near internal os.

Conclusion: In this study we showed that location of polyp is important in clinical presentation. Patients presented with AUB had polyps more common in uterine cavity, patients with spotting plus discharge had polyps more in cervical canal.

Objective: Many researchers have been more interested in inflammatory changes in tumor stroma recently. Recent studies have shown that mast cells are significantly increased in human skin basal cell carcinoma (BCC) and are associated with tumor aggressiveness. In this study, we compared the number of mast cell population expressing c-kit in the BCC samples and normal skin. We also evaluated the number of this cell type in infliltrative and noninfiltrative subtypes of this tumor.

Methodology: Tissue sections containing 30 cases of BCCs and 30 normal skins were prepared and after staining with c-kit were analyzed for the number of stromal mast cells.

Results: Our results indicate that the number of c-kit positive mast cells was significantly higher in BCC when compared with normal skin (P <0.01), and number of mast cells in the stroma of infiltrative subtypes of this tumor is higher than noninfiltrative subtypes (p <0.04). In our study there wasn’t any correlation between sex and age with mast cells count.

Conclusion: Our results are in line with previous studies indicating that mast cell numbers are increased in BCC. In addition, the results suggest that mast cell populations may contribute to BCC progression. Besides, we demonstrated that this increase in mast cell density was independent of the patients’ ages and sexes.

Objective: To determine the microbiological quality of home meals and salads samples.

Methodology: A total of 180 samples were collected between May 2007 and July 2007 in Ankara, Turkey. The samples were analysed for the presence of total aerobic bacteria (TAB), thermotolerant coliform bacteria (TCB), Esherichia coli, Salmonella spp. and Staphylococcus aureus.

Results: In the present study, S.aureus, coliforms, E.coli, and Salmonella were not detected in cooked meat meals samples. TAB was detected in 22 (24.4%) meat dishes ranges 102-104. The cooked meat dishes samples were analyzed for the presence of TCB, and detected in 2 (2.2%) meat dishes ranges 103-104. Numbers of the aerobic mesophilic bacteria ranged from 102 to 105 cfu/g and coliforms from 37 to 1400 MPN/g in 17 (18.9%) of salad samples. E.coli was detected at level 102-103 (n=12, 13.3%) and S. aureus was detected in 9 (10.0%) at levels of 103-104 cfu/g salad samples tested. In 4 (4.4%) of the salads samples S.aureus and E.coli were isolated together.

Conclusion: The results indicate that the type of vegetable salads analysed may contain pathogenic bacteria and thereby represent a risk to the consumers in regard to foodborne diseases. Thus, it remains essential to include the significance of effective hygiene practices as an important safety measure in programmes of home hygiene, consumer education, and advice

Objective: To compare the therapeutic role of leukotriene receptor blocker Montelukast with N. Sativa seeds in seasonal allergic rhinitis patients.

Methodology: Comparative uncontrolled single blind clinical assessment was carried out over forty seven untreated adult patients torment from seasonal allergic rhinitis and staring for outpatient management. All patients were chosen from different primary care health centers, registered and were divided in a single-blind approach to obtain Montelukast, 10 mg/day, group I (n=24) and 250 mg/day of N. Sativa, group II (n=23) orally for two weeks. Patients joined-up the study has completed the therapeutic plan.

Results: Montelukast and N. Sativa both demonstrated a significant and early decrease in daytime as well as ophthalmic symptoms, while montelukast showed diminished and late effects on nighttime symptoms when compared with N. Sativa. In addition montelukast has also been showing to cause drug allied side effects like headache, dizziness and heart burn.

Conclusion: It would come into view that N. Sativa is safe and thoroughly free from threat of adverse effects. So it is a liable management alternative for seasonal allergic rhinitis patients.

We report a case of severe tissue ischemia after umbilical catheterization in a preterm newborn. Umbilical catheters can accidentally enter branches of the iliac artery during attempted placement in the umbilical vein. If these misplacements are not recognized by radiology and promptly corrected, arterial obstruction may lead to ischemia and infarction of the extremities. This is the first report of below-knee gangrene due to peripheral vasospasm or thrombosis occurring after umbilical vein catheterization (UVC). We discuss that the radiographic verification is essential before infusing medications.

Objective: To investigate antioxidant status of women on four different methods of contraception.

Methodology: Sixty non-pregnant women aged 16-45 years on oral contraceptive pills, injectables, Norplant and intra-uterine contraceptive devices (IUD) attending the Family Planning Clinics of the University College Hospital (UCH) and Adeoyo Maternity Hospital, Ibadan were recruited for the study. Fifty-eight apparently healthy women aged 16-45 years who were not on any contraceptive served as a control group. The body mass index (BMI) of all participants (subjects and controls) was determined following standard protocol. Serum levels of ascorbic acid, tocopherol, malondialdehyde, bilirubin, creatinine, uric acid, total protein and albumin were determined using standard spectrophotometric methods. Progesterone was estimated by the chemilumiscence method while selenium was determined by atomic absorption spectrophotometry (AAS).

Results: The BMI was significant in women on oral contraceptive pills (OCP) when compared to the control group (P0.05) in intra-uterine device (IUD), injectables and Norplant users. The mean serum ascorbic acid (P<0.01), tocopherol (P<0.05), total protein (P<0.01), albumin (P<0.05), uric acid (P<0.05), selenium (P0.05) in users of other contraceptive methods. Serum levels of malondialdehyde was significantly elevated in women on OCP (P0.05) in users of other contraceptive methods. There was no significant association between progesterone and antioxidants in women on OCP, IUD, injectables and Norplant.

Conclusion: Oral contraceptive pills showed a significant decreasing effect on the antioxidant status of its users while IUD, injectables and Norplant did not indicate any significant effect. Routine monitoring of the antioxidant status of women on different methods of contraceptive particularly those on OCP is recommended.

Osteoid osteoma is a benign bone forming tumor with a characteristic radiographic appearance. Femur and tibia is the frequent site of involvement. Osteoid osteoma in the patella is a rare condition of which only a few cases have been reported in the literature. Non-specific knee pain, difficulty to distinguish nidus, and lack of typical sclerotic bone formation in plain radiographs cause a delay in diagnosis. We report a 15 years old girl with anterior left knee pain since 1.5 year. Imaging findings and biopsy of the lesion confirmed osteoid osteoma. The pain was relived after surgical resection of the tumor and patient was symptom free with no evidence of recurrence at 12 months after surgery.

Objective: To determine the outcomes and efficacy of transurethral urinary diversion/stenting with size six feeding tube and that of suprapubic cystostomy after hypospadias repair in children.

Methodology: An 8-year prospective experience at the University of Benin Teaching Hospital on the outcomes of suprapubic urinary diversion (2000-2002) and transurethral diversion/stenting (2003-2007) after hypospadias repair in children.

Results: During the study period, a total of 196 children had urinary diversion following hypospadias repair, 69 (35.2%) suprapubic and 127 (64.8%) transurethral. They were aged between 6 months and 12 years. Children who had transurethral diversion were relatively younger (mean age 2.3 ± 2.1 years) compared to suprapubic (3 ± 3.8 years). Although anchorage to the glans penis and bed restriction in 115 (90.6%) children were required, urinary diversion was more effective, postoperative complications were rare, no trigone irritation, and excellent cosmetic results [121(95.3%)] were recorded following transurethral diversion with a size six feeding tube. Conversely, the creation of suprapubic cystostomy increased operation and hospitalization duration with higher incidences of trigone irritation, 28 (4.6%), fistula formation, 18 (26.1%), catheter blockage, 10 (14.5%), soiling of operation site with urine and fewer number of children [48 (69.6%)] with excellent cosmetic results.

Conclusions: Transurethral urinary diversion/stenting with a size six feeding tube was very effective and gave better results than suprapubic cystostomy. The feeding tube is cheap, readily available and may provide a better means of post hypospadias repair urinary diversion in children where an ideal transurethral paediatric catheter is not available.

Objective: To observe the K562 cell line derived from a patient of chronic myelogenous leukemia differentiated into megakaryocytes by growing in the presence of phorbol myristate acetate (PMA).

Methodology: The differentiation process of K562 cells was monitored by the expression of a platelet cell marker, CD61 through immunocytochemistry using mouse alkaline phosphatase antialkaline phosphatase (APAAP) complex employing fast red TR as substrate, crystal violet and MTT assay used for cell growth analysis.

Results: The crystal in the presence of PMA, cells obtained were of large size and less in number as compared to cells incubated without PMA where they were of smaller size and more in number and immunochemical reaction used to detect the presence of CD61, a platelet cell marker that is expressed during differentiation of K562 cells to megakaryocytes.

Conclusion: The results showed that the addition of PMA to the growing culture of K562 cell lines induced differentiation, observed through CD61 expression and increase in cell size and cessation of proliferation.

Objectives: To study the clinical and lab parameters in adult patients with suspected or confirmed bacterial meningitis (BM) to find out the usefull predictors.

Methodology: This was a retrospective study conducted in Razi hospital, a training center affiliated to Ahvaz Joundishapoor University of Medical Sciences in Iran. All patients with meningitis aged 18 years ore more between 2003 and 2007, with CSF pleocytosis and who had not received antibiotic treatment before lumbar puncture were reviewed.

Results: Among 312 patients with CSF pleocytosis, two hundred fifteen (68.9%) had BM and ninety seven (31.1%) had aseptic meningitis (ASM). The mean age for patients with BM was 34.7 ± 17.7 years and for ASM was 32.2 ± 15.5 years (P=0.22, NS). Sixty percent of the cases of BM and 61.2% of the cases of ASM occurred in men (P=0.70, NS). We identified the following predictors of BM: CSF-WBC count>100 per micro liter, CSF-glucose level 80 mg/dl. Sensitivity, specificity, PPV, NPV of these predictors, and LR for BM are 86.5%,52.6%,80.2%, 63.7% and 104.1 for CSF-WBC count and 72.1%, 83.5%, 90.6%,57.4% and 164.2% for CSF glucose, and 49.7%, 91.8%, 93.4%,45.2% and 104.5% for CSF protein.

Conclusion: The CSF WBC count should not be used alone to rule out bacterial meningitis. When it is combined with other factors such as CSF glucose and protein it helps in decision making in patients suffering from bacterial meningitis.

Objective: The mortality rate after surgeries for congenital heart disorders is the most important factor for determination of the quality of these operations. A study that evaluate the mortality rate of these surgeries has not been done till now in Iran. Therefore, the purpose of this study was to determine the prevalence and risk factors of mortality after surgery for correction of congenital heart disease.

Methodology: In a retrospective study, 120 children who expired after cardiac surgery and also 150 children who survived after surgery were evaluated between 2005 and 2009. Personal and Social parameters and some risk factors were analyzed. Analysis of results was performed using SPSS version 14 and descriptive and inferential statistics.

Results: It showed that 12.64% of children died after surgery. Important risk factors of death were age, weight, height, body surface, preoperative Blood Urea Nitrogen, preoperative Prothrombin Time, preoperative cyanosis and postoperative bleeding.

Conclusion: The results of this study indicate that the death rate of children after heart surgery in cardiovascular center of Tabriz Medical University seems to be high. Because of the lack of studies in this field more trials are advised.

Objectives: The aim was to determine the prevalence of lower urinary tract symptoms (LUTS) in men aged 40 years or older, as well as to compare characteristics of patients with and without LUTS.

Methodology: The paper is a cross-sectional survey conducted on men with LUTS in a district of western Turkey between November 1st and December 31st. The questionnaire was filled in by a face to face method, and consisted of the men’s socio-demographic characteristics, LUTS related characteristics, and the questions pertaining to international prostate symptom score (IPSS).

Results: The prevalence of LUTS was 51.5%. The comparative analyses between patients who had and those who did not have LUTS showed that patients in settlement area Kaymaz, those aged 70 and over, those with primary school education and below, those who were married, those who had recurrent UTI, those who were using medicines continuously, those with a history of previous surgery, those with family history of LUTS had a higher prevalence of LUTS.

Conclusion: In conclusion the number of the respondents having LUTS was common among men in this region of Turkey.

Pyloric duplication cyst is one of the rarest congenital anomalies. We present such a case in a boy of 6-1/2 years old who was treated by us successfully. The theories of its embryogenesis, mode of presentations, diagnosis and treatment are discussed.

Objective: To evaluate the effects of modifications of the present technique of monopolar diathermy tonsillectomy on the incidence of post operative bleeding and compare them with international data for tonsillectomies done without modifications.

Methodology: This is a prospective, longitudinal experimental study. Fifteen hundred patients were studied from January 2000 to January 2008. Patient’s age ranged from five to fifteen years. All patients underwent tonsillectomies by modified monopolar diathermy method. The incidence of postoperative bleeding was assessed.

Results: Two patients developed significant secondary haemorrhage, which is defined as requiring a return to the operating theater for the control of bleeding. One patient with secondary bleed required blood transfusion in addition to a return to the operating theater. Five patients developed minor secondary bleed that was controlled by conservative means. Two patients developed reactionary bleeding that was controlled in the operating room before return of the patient to the bed.

Conclusion: Modifications in the existing technique produces a significantly lower incidence of post operative bleeding from the tonsillar fossae and compares well than those reported in the international literature.

Objective: To report preoperative gray-scale sonographic characteristics of adnexal Torsion.

Methodology: In a retrospective multi-centric study in 20 hospitals, 148 out of 3303 adnexal mass operations, proved histopathologically as Adnexal Torsion, were reviewed regarding age, involved side and gray-scale abdominal sonographic findings.

Results: Torsion occurred in 5% of benign adnexal surgeries. Mean age was 29(SD=12), Mean mass diameter was 9 cm and they mostly revealed a cystic pattern (84%). Free peritoneal fluid was seen in 29%. Right-sided involvement was shown in 62%.

Conclusion: Gray-scale sonographic findings are valuable besides clinical findings to suspect adnexal Torsion.

Objective: To see the sensitivity, specificity, positive and negative predictive value of mean corpuscular volume (MCV) in screening for beta thalassemia minor in pregnant women attending antenatal clinic at Isra University Hospital (IUH) Hyderabad.

Methodology: This validation study was conducted at the department of obstetrics & gynecology Isra University Hospital Hyderabad from 1st November 2004 to 30th October 2005. Women were interviewed using a pre designed questionnaire regarding their demographic profiles & Gestational age at the time of presentation. On their first antenatal visit MCV were checked as less than or equal to 70 ft on complete blood picture. HbA2 level were assessed by Hemoglobin electrophoresis to find out the carrier of beta thalassaemia minor. The data was analyzed on SPSS vr 15.

Results: This study showed that MCV is a good screening test for beta thalassemia minor. Out of 100 screened subjects 53% had MCV less than 70 fl or equal to 70 fl. Positive MCV test (< 70 fl) showed a sensitivity of 79% and specificity of 30% in screening for beta thalassaemia trait. The positive and negative predictive values were 56% respectively.

Conclusions: Our study showed that MCV is 79.9% sensitive and 30% specific and positive and negative predictive value is 56% in detection of beta thalassaemia minor. It was found to be a good screening tool in pregnant women for beta thalassaemia. This test can be adopted in future as part of evaluation for sub fertility in all young women.

Objectives: To examine day surgery patients’ satisfaction levels with nursing services using Scale of Patient Perception of Hospital Experience with Nursing (PPHEN).

Methodology: The study design was descriptive. Data were collected by the researcher in the Day Surgery clinic of a university hospital in Turkey. Participants with literacy were 18 years old and older. The sample included 148 patients agreeing to participate in the study. Data were collected using a questionnaire including socio-demographic questions for patients and PPHEN Scale, Turkish Version adapted to Turkish by Coban. The data were assessed through descriptive statistics, t-test, Man-Whitney U Test and Kruskal Wallis variance analysis.

Results: When PPHEN point averages according to age were compared, the point average for the age group of 66 years and above was 72.78 (SD= 8.28), for the age group of 19 to 40, 68.26 (SD= 11.6); and the difference between these points was found statistically significant (P= 0.041). For PPHEN point averages according to patients’ educational backgrounds, it was 70.50 (SD= 10.19) for primary school graduates, 64.57 (SD=15.97) for university graduates; and the difference was found statistically significant (P= 0.000).

Conclusions: In this study, it was, in general, found out that the patients were satisfied with the nursing services.

Objective: Sharing of blades and shaving kits, especially unsterilized ones are known risk factors for the transmission of Hepatitis C. The objective of this study was to determine the prevalence of Hepatitis C antibodies reactivity among the patients admitted due to any medical condition and who have been visiting roadside barbers.

Methodology: This was a descriptive study conducted from July 2007 to June 2008 in the Medical Unit-111, Jinnah Postgraduate Medical Center, Karachi. The study was designed to include patient’s demographics (age, occupation, marital status and education), clinical information and duration of the visits to roadside barbers with an approximate frequency of shavings per month. The patients with history of > 3 visits to a roadside barber during the last six months were included in the study. Whereas, the patients with history of liver disease, blood transfusion, surgery, dental treatment, tattoo marks, intravenous drug use, on regular injectable medicine (like insulin, etc), multiple sexual partners and on haemodialysis were excluded from the study. A blood sample was collected at the time of admission and the screening for HCV-antibodies was done by Enzyme Linked Immuno-Sorbant Assay (ELISA).

Results: A total of 184 male patients were included in the study. The mean age + SD of the patients under the study was 33.8+13.2 years. The majority of study patients were uneducated and belonged to low socioeconomic group. Out of 184 patients, 70(38%) were found to be HCV-antibodies reactive. In comparison to younger patients (age <40 years), the older patients as well as those with history of longer duration of visits to roadside barbers had high prevalence of HCV-antibodies reactivity, P.015 and P.02 respectively. There was no statistical significant difference for the prevalence of HCV- antibodies reactivity among the different socioeconomic groups, educational level and marital status.

Conclusion: In the present study, it is concluded that the sharing of unsterilized shaving kits and used blades by roadside barbers are the main sources for the transmission of HCV. The transmission rate of HCV infection increases with the duration and multiple exposures for shaving.

Objectives: To report our clinical experience of the effect of applying simple technique of uterine compression sutures to prevent primary postpartum hemorrhage in atonic uterus developed during caesarian section.

Methodology: The use of simple uterine compression sutures in atonic uterus during caesarian section was reviewed within the period of January 2006 to March 2008 in a tertiary obstetric unit in three Medical College. It is a descriptive observational study. In atony uterus, first to treat fundal compression, used Intravenous or Intramuscular uterotonic drugs followed by per-rectal use of misoprostol and observed 10-15 minutes and then applied simple technique of uterine compression sutures.

Results: Age of patients ranged from 15-40 years. 49 patients were primiparae and 54 patients were multiparae. Indications for caesarian section were previous caesarian section 21 (20%), large baby head to disproportion 23 (22%), obstructed labour and prolonged labour 29 (28%), twin pregnancy 16 (15.5%), polyhydromnios 4 (3.8%), abruptio placenta 4 (3.2%), placenta preavia accreta 7 (6.5%), All cases were maintained with post-operative 10 units oxytocin for 8 hours. Two patients needed one unit blood transfusion after surgery. No post-operative excessive bleeding was observed. There was no alteration of uterine involution and lochial discharge. In followed up cases subsequent pregnancy were 12(11.6%).

Conclusion: Extreme degree of uterine compression may leads to uterine anatomic damage. Simple compression technique is surgically easy, with life saving potential, offers relative safety, time saving and can be managed by trainee doctors after some experience.

Apical hypertrophic cardiomyopathy (HCM) is a relatively uncommon inherited disease. Spontaneous coronary artery dissection (SCAD) is also uncommonly observed, which often occurs in pregnant or post partum women but is rare in men. This report describes a 38 years old man with apical hypertrophic cardiomyopathy who developed SCAD leading to acute inferior myocardial infarction. After emergent appendectomy operation at another hospital, he was immediately transferred to the Cardiology Department of our hospital due to acute myocardial infarction. He emergently underwent coronary angiography which showed a long dissection involving the right coronary. He underwent an emergent CABG with cardiopulmonary bypass. Postoperative recovery was uneventful and he was discharged. According to our knowledge, no case of spontaneous coronary artery dissection associated with apical hypertrophic cardiomyopathy unrelated to postpartum period or oral contraceptive use has been reported so far.

We report a case of spontaneous tumour lysis syndrome [STLS] in a patient with disseminated hormonal refractory cancer prostate. Tumour lysis syndrome [TLS] complicating Non-Hematological malignancy is infrequent and STLS is a very rare occurrence in solid tumor. Clinicians should keep in mind the possibility of STLS in patients with solid tumor and should have the experience to interpret the clinical and laboratory tests to identify it and rapidly initiate its management.

Objective: To evaluate and compare stress level of Postgraduate trainee doctors in public and private sector Medical Universities.

Methodology: A comparative cross sectional study was conducted at Dow University of Health Sciences and Agha Khan University Hospital Karachi among Postgraduate Medical trainee who are doing FCPS, MCPS, and DCPS from Jan. 2008 – Dec. 2008. A total of 207 doctors were selected by non-probability convenience sampling technique. Main outcome was major stress level of Medical trainees or resident.

Result: Out of the total 207 trainee doctors 62.3% were found to be under stress. Proportion of females with stress was 66.3%. Most of the married PGs 67.2% had high stress level. A large proportion almost 69.7% of doctors who were in stress belongeds to low income group. This study did not find any statistical significance of stress with respect to different demographic and socioeconomic variable that were age, gender, monthly income, specialty and university.

Conclusion: The stress level of Postgraduate trainees in both the universities was found to be high. The stress was found to be high among female trainees but no risk factor showed significant association with stress. Every effort should be made to help the future healers in understanding the symptoms of stress and ways to deal with it effectively and safely.

Objective: To investigate the association between obesity and the risk of elevated blood pressure (BP) in adolescents in Dubai, United Arab Emirates (UAE).

Methodology: Representative sample of 661 adolescents aged 12 to 17 years were selected by means of a multistage stratified random sampling technique.

Results: The mean body mass index (BMI) of males was higher than that of females at all ages except at 13 years of age, where the females had higher mean BMI values (24.1kg/m2) compared to males (21.9 kg/m2). Males had higher levels of systolic blood pressure (SBP) (117.1mm Hg – 126.8 mm Hg) than females (109.2mmHg -117.1mmHg). The prevalence of high SBP increased as the weight increased, as 50% of males with high SBP were obese, compared with 62.5% among females. Male and female adolescents with elevated SBP were 5 times (95% CI 2.3, 9.7) and 16 times (95% CI 3.5, 17.3) respectively, more likely to be obese compared to those with normal SBP. Similarly, those with elevated diastolic blood pressure (DBP) were two times (95% CI 1.1, 4.4) and four times (95% CI 1.6, 8.5) more likely to be obese compared to those with DBP in the normal range.

Conclusion: The high prevalence of obesity among adolescents in Dubai and its association with high BP calls for urgent action to prevent and control obesity in this age group.

Objective: To compare the pregnancy outcomes in primiparous women and multiparous (more suitable word for our population) women over 35 and below 35 years.

Methodology: This is a descriptive comparative study which enrolled 1021 pregnant women and pregnancy outcomes were compared in 4 groups of primiparous and multifarious women over and below 35. To analyze the inputs using SPSS software, the ÷2 test, Fisher, Odds-Ratio and logistic regression with forward method were used

Results: In primiparous women, there is a statistically significant relation between the age over 35 and preeclampsia, gestational diabetes, preterm labor, cesarean section and low birth weight. In multiparous women, there is a significant relation between age of over 35, preeclampsia and low birth weight. In the women over 35 years parity is effective on the measure of preeclampsia and cesarean delivery.

Conclusion: Mother‘s increased age can be an independent factor for pregnancy outcomes. The primiparous women are more likely to be affected by age. As a matter of fact the aged women can have a natural vaginal delivery with a term infant and the over age mustn‘t be a contraindication for pregnancy.

Objectives: To investigate the effect of education on the stress levels associated with Coronary Artery Bypass Graft (CABG) surgery in the week after CABG surgery.

Methodology: The study used a quasi-experimental design. Patients were selected through convenience sampling at a university hospital in Turkey. There were 60 patients in the study; 30 in the experimental group and another 30 in the control group. Data were collected using the Stressors Scale associated with CABG on the third day of the post-operative period.

Results: Cronbach’s alpha of the scale was 0.89. Alpha coefficients ranged from 0.82 to 0.79.The difference between the score averages of the experimental and control group was p= 0.002 for the illness-related subscale, p=0.031 for the hospital-related subscale, and p= 0.006 in total.

Conclusion: Education was effective for reduction of stress associated with CABG surgery.