Vol. 1, No. 1 (Jan–Jun, 1998)
J. Baqai Med. Univ.
CONTENTS
EDITORIAL
Human Diseases and Microbes
Syed Riaz Baquar
(1-2)
ORIGINAL ARTICLES
Management of Necrotising Fasciitis
Fariduddin Baqai, S. Tajuddin Qadri, Fareya Usmani
(3-4)
Abstract:
Necrotising fasciitis is an uncommon condition characterized by extensive loss of skin fascia and
subcutaneous tissues with sparing of underlying muscles. Mortality of this group of patients is
quite high. It is a case study of nine patients who presented to us with necrotizing fasciitis at
the site of intra-muscular or intra-venous injection caused by use of unsterile or dirty syringe.
Infection is usually of poly-microbial drug resistant organisms. Fasciotomy and surgical
debridement was done in these cases under antibiotic cover but antibiotics failed to prove as
effective mode of treatment.
Study of Antibiotics Resistance Pattern of Clinical Isolates
Saima Kanwal, Khursheed A. Khan, Anisa M. Ali, Shamsa Aqeel Ahmed
(5-7)
Abstract:
The antibiotic resistance pattern of the forty five clinical isolates (consisting of 33 Gram
negative and 12 Gram positive bacterial) were determined, against nine antibiotics including
streptomycin, gentamycin, neomycin, tetracycline, kanamycin, ampicillin, amoxicillin,
chloramphenicol and vibramycin.
The level of resistance was determined by Replica plate technique and tube dilution method.
Minimum inhibitory Concentration (MIC), MIC50, MIC90 and % of sensitive and resistant
organisms were determined. The Gram negative isolates were found resistant to may
antibiotics as compared to the Gram positive clinical isolates. Vibramycin was the only
antibiotics which was bound effective against 85% of the Gram negative and almost all the
Gram positive clinical isolates tested. Where as against the rest of the antibiotics moderate to
higher resistance were observed.
The resistance of the clinical isolates was due to the presence of antibiotic resistant plasmid.
This was determined by agarose gel electrophoresis. It was found that 75% of the Gram
negative and 58% Gram positive clinical isolates have plasmid and probably the higher
resistance pattern was due to presence of R-plasmid.
Keywords: Antibiotic Resistance Pattern, Clinical Isolates.
Sero-Survey of Rubella in Karachi
Hilla R. Dossabhoy, Aqeel Ahmed and Shamsa Aqeel
(8-11)
Abstract:
Rubella or German measles, an exanthematous disease of childhood, has a world-wide
distribution. Infection occurs throughout the year with a peak incidence in spring. Epidemics
occur every 6-10 years, while pandemics occur every 20-25 years. Infection is transmitted by
repiratory route usually by nasal secretions. The virus is of significant importance because of its
teratogenic effects on the fetus. The importance of rubella is that women who contract the
disease in the first trimester of pregnancy may bear congenitally deformed infants (growth
retardation, cardiac anomalies, defects in eye, ear, CNS etc.).
A Sero-Survey was conducted in conjunction with a campaign to raise the immunity levels of
adolescent & adult women by ELISA. The presence of 1gM antibodies persist throughout
lifetime and is an evidence of immunity, as there is only one serotype of rubella virus.
In the 15-19 years age grout 81% had protective levels of immunity, 18% showed both 1gM &
1gG levels which indicated that the individuals were exposed to rubella virus either due to
infection or due to vaccination. 36% possessed only 1gM, which indicated recent exposure.
However 1gG alone was detected in 27% of the total samples, 66% had protective levels of
antibodies, 20% possessed both 1gM or 1gG. However, 16% possessed 1gM and 30% 1gG
alone.
Sero-Survey of Pakistan Women indicates that only 66% of the population has protective levels
of antibodies against rubella. The immunity level of the population belonging to lower socioeconomic status is very poor (55%) in contrast to the middle and upper class society (76% and
69% respectively). A high % of vaccinated population were found to have protective levels of
antibodies. Low antibody level possessing women were advised to take Rubella vaccine to raise
their immune status.
Keywords: Sero-Survey, Rubella.
How many Malnourished Children are Currently Under Fed? Implication for Nutrition
Supplementation in PHC Programmes
(12-16)
Inayat H. Thaver & Asif Aslam
Abstract:
One of the most important problems in the world today is that of protein-energy-malnutr4ition
(PEM). Though an obvious response to PEM would be food supplementation, the results are not
very convincing. To target, through screening, the children needing nutritional
supplementation, special measurement ca be used. Thus a) three indicators of nutritional
status: weight for age, height for age, and weight for height and b) categorizing each indicator
into ‘low,’ ‘normal’ and ‘high’, at least 17 combinations have been generated by WHO for
indentifying the need for nutrition supplementation.
Date from a squatter settlement of Karachi and slum (Mohall) of Dhaka were used to find out
whether currently malnourished children are also currently underfed and need nutrition
supplementation? Anthropometric date of 280 children from Karachi and 245 from Dhaka were
analyzed. Nutritional status of study children showed that there were fewer (11%) children in
‘low’ weight for height as compared to children in ‘low’ weight for age (39-43%) and height for
age (39-58%) indicators, almost 74% of all ‘low’ weight for age children were also ‘low’ in height
for age. Only 4-6% of children were labeled as “Currently underfed” (needing nutritional
supplementation by using a combination of indicators chart.
It is inferred that these primary health care programs do not need a nutrition supplementation
program. A health and nutrition education component in these programs is showing promising
results. For screening of children for participation in a feeding program it is necessary that
estimates of prevalence of malnutrition in a population should also include height, besides
weight and age.
Keywords: Malnourished Children, Nutrition Supplementation.
Residues of Pesticides and their Metabolites in Adipose Tissue samples and Blood
Serum Samples of Selected Karachi People
Masarat Jahan, S. Naimul Hasan naqvi, M. Arshad Azmi
(17-21)
Abstract:
The experiments were performed to detect the insecticides in human biological material. The
adipose tissues were collected from patients during operation at Jinnah Hospital and Baqai
Hospital, whereas blood samples were collected from the patients of Aziz Laboratory. Holden
and Marsden (1969) and Dale et at. (1970) techniques were adopted for cleaning of adipose
tissues samples and blood samples, respectively.
All the tested blood and fat samples were fount to have insecticide residues. However, blood
samples were found to contain many insecticides than adipose tissue samples.
Keywords: Residues, Pesticides, Metabolites, Adipose tissue, blood, Karachi people.
Pruritis without Urticaria: An Allergic Manifestation of Giardiasis
Iqbal Akhtar Khan and Ghulam Murtaza
(22-26)
Abstract:
Giardiasis is defined as symptomatic or asymptomatic infection by the flagellated parasite
Giardia lamblia. Whereas the usual features of this ubiquitous enteric pathogen are related to
gastrointestinal system, atypical presentations do occur; among those allergic manifestations
deserve special mention. The present study discusses the parasitologically proven cases of
Giardiasis with no bowel symptoms and no dermatological problems - the sole complaint being
“Pruritis without Urticaria” – refractory to up to 72 hours of antihistamine therapy. Failure to
attribute the complaint to any other etiological factor, prompt response within 48 hour to
specific antigiardial therapy, complete resolution of the symptoms with that therapy, non
recurrence of symptoms within the follow up period of six months provided strong evidence
incriminating Giardiasis as the cause of “Pruritis without Urticaria.” The authors emphasize that
Giardial infection should be considered in patients with unexplained allergic manifestations
even when bowel symptoms are meargre or absent.
Keywords: Pruritis without Urticaria, Allergic Manifestation, Giardiasis
Fifty Years of Medical Education in Pakistan: Random Thoughts
Syed Azhar Ahmed
(27-30)
Abstract:
Pakistan is a young and dynamic nation. All new nations have the potential to turn a new leaf of
history. What changes we bring in the education of medical sciences to our youths, in the
practice of health delivery and other innovatives, may influence other developing counties. We
have started our march towards new goals and new directions. Only time will tell us whether
this new trend in community oriented medical education thought in an exclusively medical
university is the right choice.
Keywords: Medical education.
Knowledge of the People Regarding the Causes of Infant Mortality in North Karachi (31-34)
Muhammad Irfan Siddiqui
Abstract:
Literacy rate in Pakistan is only 34% and the knowledge of the people about health problems is
even less and that is why every 10th child in Pakistan dies even before his first birthday. The
objective of the study was to determine the knowledge of the people about most probable
causes of infant mortality.
This is a community based study undertaken through sample survey of the population. Two
hundred household were visited and only 167 could be interviewed. Respondents were asked
to name and prioritize the three more common causes of infant death. Diarrhea was recognized
as the most probable cause of infants death by 48%, while 1% recognized respiratory tract
infection as the serious disease of infants. A health education programme should be designed
and implemented to increase the awareness of community about health problem and their
management. There should be more than one approach for the collection of date so that bias
could be eliminated and a better picture could be obtained for this type of important variable.
Keywords: knowledge, Infant, Mortality, Karachi, Pattern, Pakistan.
REVIEW ARTICLES
Ocular Parasitic Worm Infections: A Review
Fatima M. Bilqees
(35-47)
Abstract:
Parasitic worm infections in the human eye are reviewed and reported here. These include
infection by the roundworms (nematodes), tapeworms (cestodes), and the flatworms
(trematodes). Most of the eye infection are caused by the larval forms and are transmitted by
various animals. Twenty nematode species, six species of cestodes and six species of
trematodes are known to infect human eye. Out of these only 2 species of nematodes are the
natural parasites of man infecting the eye. While all others are the parasites of animals or
infecting the abnormal sites, the eye in human.
Keywords: Parasitic worm, ocular infections, review.
Genetics of Hemophilia
Moinuddin
(48-51)
Rabies: Black Warrant from Man’s Best Friend
Muhammad Ahmad Khan
(52-57)
Abstract:
Rabies, which has a historical perspective, is a very lethal disease with worldwide distribution,
the impact being greatest in the tropics. It is transmitted to man via the bite of an infected
mammal which is usually a dog, the principal reservoir. The disease is universally incurable once
the symptoms have established. The diagnosis is in fact Black Warrant, issued by the man’s Best
Friend. However the doomed patient could have been saved if proper post-exposure
prophylasis was made available. The immunization regime is simple, sale and reliable. The
calamity thus becomes preventable.
Dental Considerations in Patients Receiving Radiotherapy for Oral Cancer: A Review of
Complications and their Management
(58-62)
Syed Mahmood Haider
Abstract:
A review of the complications of radiotherapy effecting the teeth, supporting structures and the
tissues of the maxillofacial region is presented. The most common recognised complications are
xerostomia, radiation caries, osteoradionecrosis, mucositis, damage to developing teeth, taste
loss and radionecrotic ulcers. The management and dental considerations are discussed in
detail.
CASE REPORTS
Abdominal Tuberculosis Presenting with Intestinal Perforation and Peritonitis
(63)
Fariduddin Baqai, B.U. Zakai, A.K. Qadri, M. Junaid, S. Tajuddin Qadri, and Fareya Usmani
Magnetic Resonance Cholangiopancreatogram: A Non-Invasive Tool for Earlier Diagnosis of
Carcinoma of Ampula of Vater
(64)
Fariduddin Baqai, M. Junaid, A.K. Qadri, Fareya Usmani and S.T. Qadri
Multiple Loose Bodies in the Knees
Shahid Ilyas and Mujahid Humail
(65)
A Plastic Whistle in the Trachea: A Case Presentation
Abdul Qayoom
(66-67)
Abstract:
A case of a foreign body in the Trachea is reported here. A child, eight years old, with a history
of whistling sound on exhalation and slight cough, as the early symptoms, was investigated.
Obstructive airway symptoms were completely absent. Routine plaint X-ray chest did not show
the signs of foreign body impact in respiratory passage. A plastic whistle was removed by
laryagoscopy, from the sub glottis region.
Keywords: Foreign body – Trachea.
NEWS OF MEDICAL INTEREST
Spores for Human Bodies
World Retina Day Observed
Genitically Targetted Weapons
A Variant Mad Cow Disease in Human
Cardiac-Valve Surgery Transmitted Live
Herbal Powder
(68-70)
INSTRUCTIONS TO AUTHORS
(71)