Although nasopharyngeal carcinoma (NPC) is common in this part of the world, the incidence among children is still very low worldwide. The diagnosis is sometimes delayed because of the late reporting of the symptom by the patient or parents, or difficulty in reaching the final diagnosis due to its hidden anatomical location. The challenges include the difficult endoscopy in children, inability to differentiate an adenoid from the tumour on radiograph and often the inconclusive fine needle aspiration findings. If the tumour mass at Fossa of Rosenmuller can be clearly appreciated and biopsied with undoubtedly proven histology of NPC, the diagnosis can be straight forward and treatment can be commenced as early as possible. We report a 10-year-old child presented with bilateral neck cervical lymphadenopathy and epistaxis with fine needle aspiration cytology (FNAC) of the neck mass reported as lymphoma. Further work-up confirmed he was suffering from NPC.

Plants have provided sources to find novel compounds. These plants are being used as therapeutic purposes since the birth of mankind. The traditional healers normally utilize medicinal plants as crude drugs while scientists using the folk claim as guides to explore medicinal plants. Moringa oleifera is a famous edible plant having therapeutic and nutritive values. The present study was designed to cumulate the research data regarding to what extent, phytochemical, nutritional and glycemic control studies has been explored using its different extracts. The articles indicated that the powder, aqueous, methanol and ethanol extracts of Moringa oleifera (leaves, pods, seeds, stem and root bark) have significant therapeutic herbal potential to treat diabetes mellitus. Collectively, the mechanism behind is intestinal glucose inhibition, insulin release as well as decrease in insulin resistance probably regeneration of b-cells of pancreas, increase in glutathione and reduction in malondialdehyde. Conclusively, this article give descriptive information about antidiabetic effect, claimed marker compounds and proposed antihyperglycemic mechanism of a single plant. It can be suggested a potential herbal source to treat diabetes mellitus as being widely accepted by major population as nutrition and therapeutic agent.

The effect of loud noise to the army personnel is often identifi ed when hearing loss had already developed. Acoustic trauma during shooting training can also lead to acute changes in the ear which is shown on otoscopic examination. This study was undertaken to determine the effectiveness of hearing protective device (earplug) on the prevalence of external ear changes amongst military personnel during shooting. This is a prospective cross sectional study that was conducted among 76 military personnel, who were divided into two groups: those with and without earplugs during shooting. Each participant underwent 3 otoscopic examinations: (a) pre-shooting, (b) immediate post-shooting (within 48 hours) and (c) 2 weeks after shooting. A total of 78 army personnel who were scheduled to undergo shooting training were otoscopically examined. Eighty three percent of them did not wear earplugs before. The percentage of infl ammation of external auditory canal and tympanic membrane dullness increased tremendously among subjects from non–earplug group less than 48 hours post-shooting. Assessment after 2 weeks showed improvement in around 30% of the subjects. Loud noise has become an occupational hazard not only to the inner ear but it also predisposes the external and middle ear structures to some form of injury. Although improvement is seen after some period, a protective device such as an earplug should be recommended and the usage should be reinforced among the army personnel involved in shooting.
Hearing Loss, Noise-Induced

Six compounds have been isolated from the leaves of Pyrenacantha staudtii,two of which are new compounds.The new compounds have been characterized as kaempherol 3-O-β-rhamnopyranosyl (1→6)β-D-glucopyranoside (1) and 4-β-glucopyranosyl-(2-furyl)-5-methy-1,2-glucopyranoside phenylmethanone (2).The known compounds are 3-pyridinecarboxylic acid (3),β-sitosterol (4),sitosterol 3-O-β-glucopyranoside (5) and taraxerol (6).Their structures were determined by spectroscopic and chemical evidences.The two new compounds together with 3-pyridinecarboxylic acid showed significant in vitro xanthine oxidase inhibitory activity.To the best of our knowledge,this is the first report of these compounds from this plant.

Six compounds have been isolated from the leaves of Pyrenacantha staudtii, two of which are new compounds. The new compounds have been characterized as kaempherol 3-O-beta-rhamnopyranosyl (1-->6)-beta-D-glucopyranoside (1) and 4-beta-glucopyranosyl-(2-furyl)-5-methy-1,2-glucopyranoside phenylmethanone (2). The known compounds are 3-pyridinecarboxylic acid (3), beta-sitosterol (4), sitosterol 3-O-beta-glucopyranoside (5) and taraxerol (6). Their structures were determined by spectroscopic and chemical evidences. The two new compounds together with 3-pyridinecarboxylic acid showed significant in vitro xanthine oxidase inhibitory activity. To the best of our knowledge, this is the first report of these compounds from this plant.
Enzyme Inhibitors ; chemistry ; isolation & purification ; pharmacology ; Glucosides ; chemistry ; isolation & purification ; pharmacology ; Kaempferols ; chemistry ; isolation & purification ; pharmacology ; Magnoliopsida ; chemistry ; Molecular Structure ; Niacin ; chemistry ; isolation & purification ; pharmacology ; Plant Leaves ; chemistry ; Plants, Medicinal ; chemistry ; Xanthine Oxidase ; metabolism

Purpose: This study was aimed to assess the feasibility of laparoscopic rectal surgery, comparing quality of surgical specimen, morbidity, and mortality. Methods: Prospectively acquired data from consecutive patients undergoing laparoscopic surgery for rectal cancer, at 2 minimally invasive colorectal units, operated by the same team was included. Locally advanced rectal tumors were identified as T3B or T4 with preoperative magnetic resonance imaging scans. All the patients were operated on by the same team. The 1:1 propensity score matching was performed to create a perfect match in terms of tumor height. Results: Total of 418 laparoscopic resections were performed, out of which 109 patients had locally advanced rectal cancer (LARC) and were propensity score matched with non-LARC (NLARC) patients. Median operation time was higher for the LARC group (270 minutes vs. 250 minutes, P=0.011). However, conversion to open surgery was done in 5 vs. 2 patients (P=0.445), reoperation in 8 vs. 7 (P=0.789), clinical anastomotic leak was found in 3 vs. 2 (P=0.670), and 30-day mortality rates was 2 vs. 1 (P>0.999) between LARC and NLARC, respectively. Readmission rate was higher in the NLARC group (33 patients vs. 19 patients, P=0.026), due to stoma-related issues. There was no statistically significant difference in the R0 resection between the 2 groups (99 patients in LARC vs. 104 patients in NLARC, P=0.284). Conclusion This study demonstrates that standardized approach to laparoscopy is safe and feasible in LARC. Comparable postoperative short-term clinical and pathological outcomes were seen between LARC and NLARC groups.

Infectious bursal disease (IBD) is an acute and highly contagious disease of young chickens caused by Birnavirus. Mortality of infected birds can be best prevented if injected with antibodies. The present study was an attempt to raise specific hyper-immune polyclonal antibodies against IBD virus in Pakistan. Commercial layers divided into four groups were injected with IBD vaccine subcutaneously according to four different treatment regimens. Eggs were collected daily and antibodies were purified from yolk with dextran sulphate. Titers of antibodies in serum and yolk were evaluated with enzyme linked immunosorbant assay and agar gel precipitation test. Antibody titers were significantly higher in yolk than serum. Eggs collected at 28 days post-vaccination had maximum antibody titers. Of treatment regimens, T3 was found to be most effective for hyperimmunization. Lyophilized antibodies stored at 4oC did not lose their activity till the end of experiment. IBD virus infected birds were injected with purified antibodies which induced 92% recovery as compared to control birds. The study implicates that the purified antibodies may be useful as a therapeutic agent to cure IBD infected birds.
Animals ; Antibodies, Viral/blood ; Birnaviridae Infections/immunology/*therapy/*veterinary/virology ; *Chickens ; Egg Yolk/immunology/virology ; Enzyme-Linked Immunosorbent Assay/veterinary ; Female ; Immunization/methods/*veterinary ; Immunoglobulins/*immunology ; Immunotherapy/methods/veterinary ; Infectious bursal disease virus/*immunology ; Poultry Diseases/immunology/*therapy/*virology ; Precipitin Tests/veterinary ; Viral Vaccines/*immunology/therapeutic use

PURPOSE: The purpose of this study was to investigate differences in component alignment between first and second knees in simultaneous bilateral total knee arthroplasty (SBTKA) and unilateral TKA (UTKA). MATERIALS AND METHODS: 274 SBTKAs and 198 UTKAs were included in study. Patients were divided into three groups as SBTKA on the right knee (group A), SBTKA on the left knee (group B) and UTKA (group C). Femoral and tibial component alignment was checked in both coronal plane (alpha [α] and beta [β] angles) and sagittal plane (gamma [γ] and delta [δ] angles) radiographs. RESULTS: There were no statistically significant differences among groups in the preoperative anatomical varus angle and Kellgren–Lawrence gonarthrosis classification grade (p=0.139 and p=0.329, respectively). In the coronal plane, the alignment of femoral component (α angle) and tibial component (β angle) was similar in all three groups (α angle, 95.01 vs. 95.14 vs. 94.9, p=0.945; β angle, 90.03 vs. 89.67 vs. 89.98, p=0.483). The sagittal plane alignment of femoral component (γ angle) and tibial component (δ angle) did not show significant differences (γ angle, 7.04 vs. 6.98 vs. 7.00, p=0.132; δ angle, 86.56 vs. 87.41 vs. 86.73, p=0.610). CONCLUSIONS: The angular alignment of components was similar between SBTKA and UTKA.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Classification ; Humans ; Knee

BACKGROUNDHepatitis C virus (HCV) constitutes a major public health issue around the world, especially in developing countries like Pakistan. In this study, we assessed outcome of interferon (INF) treatment in chronic hepatitis C patients categorized by gender, age, and viral load.

METHODSIn this study, 750 HCV positive patients with genotype 3 were selected, out of which 616 completed the entire treatment. Their personal history, pre-treatment HCV RNA and serum alanine transaminase (ALT) was quantified. Patients were treated with combination therapy of INF-α 2b three million units (thrice a week) plus ribavirin (1000 - 1200 mg per day) for 24 weeks. After 24 weeks their HCV RNA and serum ALT level was quantified.

RESULTSOut of the 616 patients, 391 (63.5%) responded to therapeutic regimen (INF-α 2b plus ribavirin). Among the responders, 27.1% were men and 36.4% were women. Best treatment response was observed in patients having low viral load < 8 × 10(5) IU/ml and age ≤ 40 years than patients having low viral load and age > 40 years (73.2% vs. 60.3%, P = 0.05).

CONCLUSIONSBetter response to IFN-α 2b plus ribavirin was observed in patients with lower viral RNA and younger age. It suggests that all patients considered for treatment should have quantification of serum HCV RNA level. The result can be used to counsel patients on the likelihood of response and may influence the patient's decision on treatment.

Adult ; Antiviral Agents ; therapeutic use ; Female ; Genotype ; Hepatitis C, Chronic ; drug therapy ; virology ; Humans ; Interferon-alpha ; therapeutic use ; Male ; Pakistan ; Polymerase Chain Reaction ; RNA, Viral ; genetics ; Ribavirin ; therapeutic use ; Treatment Outcome

OBJECTIVE: The aim of this study was to assess the analgesic effect of a single application of low-level laser therapy (LLLT) on spontaneous pain and pain on chewing after placement of initial archwires. METHODS: Forty-two patients (26 women, 16 men) were randomly recruited for this split-mouth randomized clinical trial. Each patient received super-elastic nickel-titanium (NiTi) initial archwires (0.012, 0.014, 0.016, and 0.018-inch [in]) in the maxilla for leveling and alignment for an interval of 4 weeks between archwires. One side of the mouth was randomly designated as experimental, while the other side served as placebo. After insertion of each archwire, the experimental side was irradiated with a diode laser for 3 seconds each on 5 points facially and palatally per tooth, from the central incisor to first molar. On the placebo side, the laser device was held the same way but without laser application. A numerical rating scale was used to assess the intensity of spontaneous and masticatory pain for the following 7 days. The Mann-Whitney U test was used to compare pain scores between sides. RESULTS: Patients in the LLLT group exhibited significantly lower mean scores for spontaneous pain after insertion of the initial two archwires (0.012-in and 0.014-in NiTi; p < 0.05), while there was no significant difference for 0.016-in and 0.018-in wires between the LLLT and placebo groups. LLLT significantly reduced chewing pain scores (p < 0.05) for all archwires. CONCLUSIONS: A single dose of LLLT considerably lessened postoperative pain accompanying the placement of super-elastic NiTi wires for initial alignment and leveling.
Female ; Humans ; Incisor ; Lasers, Semiconductor ; Low-Level Light Therapy* ; Mastication ; Maxilla ; Molar ; Mouth ; Pain, Postoperative ; Tooth