Sarcoidosis presenting as fatigue and weakness

Sarcoidosis is a systemic granulomatous disorder of unknown cause that occurs in both men and women of all races. It typically presents in patients after 20 years of age. Sarcoidosis most frequently involves the lung, but up to 30 percent of patients present with extra-thoracic manifestations. It can involve multiple organs to a variable extent and degree. In areas, where tuberculosis is endemic, the diagnosis of sarcoidosis may be overlooked and misdiagnosed because of clinical and radiographic resemblance. Herein, we present a case of a middle-aged man who visited multiple physicians with constitutional symptoms and was treated symptomatically but did not improve. He later developed skin lesions which were biopsied and led to correct diagnosis of sarcoidosis. Hence, a clinician should be aware of all the spectrums of presentations of rare diseases like sarcoidosis and always keep it as a differential when treating common diseases like tuberculosis. Key Words: Sarcoidosis, Skin lesions, Fatigue

Comprehensive Review on Magnetic Drug Delivery Systems: A Novel Approach for Drug Targeting

Magnetic drug delivery systems have been emerged as a prominent technique for site-specific targeting of various pharmacological agents throughout the last few decades. With the support of a magnetic field, it avoids reticuloendothelial system and directs the drugs to reach the target precisely. Magnetic carriers like nanoparticles, microspheres, liposomes and emulsion have been found advantageous of the fact that they reduces the free drug concentration in the blood and to minimize the adverse effects provoked by these drugs. It has made the most crucial tumor targeting possible without damaging the healthy tissues. In this review, we will summarize the facts about magnetic drug delivery systems comprehensively

Impact of Money Supply and Exchange Rate on Agricultural Prices in Pakistan

This study analyzed the impact of the long-run neutrality of money supply and exchange rate on Pakistan's agricultural prices using data from 1975 to 2019. Engle and Granger and Johansen and Jusileius techniques were used to analyze the data. The results showed that the exchange rate's neutrality does not hold in the long-run. Simultaneously, the money supply coefficient was found to be insignificant in the long-run, emphasizing money's neutrality. The study concluded that monetary authorities can control the exchange rate by designing and implementing appropriate policies to overcome the overshoot problem of agricultural prices in Pakistan

In the cost-conscious era: Ilizarov circular frame or uniplanar external fixator for management of complex open tibia shaft fracture, retrospective cohort study from a level-1 trauma center

Objective: External fixation is the most commonly used method for temporary management of open fractures of the Tibial shaft followed by internal fixation. This can also be used as a definitive method of fixation. Ilizarov is more superior and can be the primary and definite option where expertise is available. This study was conducted todetermine the outcome of open tibia shaft fracture treated with either Ilizarov or AO External Fixator.Methods: Anon-commercial retrospective cohort was conducted at Aga Khan University Hospital Karachi on patients operated for isolated open tibia fractures Gustillo type III (A, B, C) stabilized with external fixation either circular or uniplanar external fixator. These two groups were compared in terms of fracture pattern, healing and complications. For fracture healing, Radiographic union score (RUST) for tibial fractures were used.Results: A total of 93 patients were included in the study. Mean age 36.7 +/- 17.3 years comprising 83 males and 10 females. Circular Fixator was used for 46 whereas 47 were treated with uni-planar fixator. Mean new injury severity score was 21 ± 3.4 for circular fixator group and 26 ± 7 in uniplanar fixator group. Mean time fur fracture healing was 6±1months in circular fixator group and 9 months in Uniplanar Fixator group. Mean RUST score for circular fixator was 9.5±1.2.and of uniplanar it was 7.3±1.0.Conclusions: Circular fixator works as a single stage procedure with acceptable outcomes for Gustilo grade III open tibial shaft fractures as compared to uniplanar external fixator

Hip reconstruction osteotomy by Ilizarov method as a salvage option for abnormal hip joints

Hip joint instability can be secondary to congenital hip pathologies like developmental dysplasia (DDH) or acquired such as sequel of infective or neoplastic process. An unstable hip is usually associated with loss of bone from the proximal femur, proximal migration of the femur, lower-extremity length discrepancy, abnormal gait, and pain. In this case series of 37 patients coming to our institution between May 2005 and December 2011, we report our results in treatment of unstable hip joint by hip reconstruction osteotomy using the Ilizarov method and apparatus. This includes an acute valgus and extension osteotomy of the proximal femur combined with gradual varus and distraction (if required) for realignment and lengthening at a second, more distal, femoral osteotomy. 18 males and 19 females participated in the study. There were 17 patients with DDH, 12 with sequelae of septic arthritis, 2 with tuberculous arthritis, 4 with posttraumatic arthritis, and 2 with focal proximal femoral deficiency. Outcomes were evaluated by using Harris Hip Scoring system. At the mean follow-up of 37 months, Harris Hip Score had significantly improved in all patients. To conclude, illizarov hip reconstruction can successfully improve Trendelenburg’s gait. It supports the pelvis and simultaneously restores knee alignment and corrects lower-extremity length discrepancy (LLD)

PAKISTAN’S TRADE POLICIES, NON-TARIFF MEASURES AND CONCERNS OF STAKEHOLDERS

Pakistan can increase its exports by 12 billion dollars till 2024 if integration with international market is improved, and strong linkages are developed among value chains (ITC, 2020). But this potential development is facing impediments due to transparency issues, imposition of non-tariff measures, ambiguous regulations at home and lack of information among both importers and exporters. This paper is dedicated to the discussion of Pakistan’s trade policies, tariff structure, rules governing non-tariff measures, and discussion about the concerns of business community and other stakeholders on NTMs. Application of NTMs in Pakistan, and their shortcomings are also discussed in detail. Then based on these discussions some recommendations are forwarded. Study shows that most of the hurdles faced by traders are home borne. If regulations are made easier at home and mutual recognition of standards is acquired with partner countries, then across the border trade can become much easier

METHODS USED TO ESTABLISH THE POSTERIOR PALATAL SEAL FOR MAXILLARY COMPLETE DENTURE PROSTHESIS

Background: The survey was conducted in Pakistani teaching hospitals to determine techniques and concepts which are used to establish the posterior seal in complete dentures. The aim of this study is to obtain the existing curriculum which is used for teaching the concepts of posterior palatal seal establishment for complete dentures. Methods: A questionnaire was made on online survey development software (Survey Monkey) that consisted of 7 multiple-choice based questions. The questions were related exclusively to the methods for establishing posterior palatal seal for complete denture prosthesis. The forms were forwarded and distributed via e-mail to 75 faculty members of 13 dental Institute of Pakistan who were teaching prosthodontics. A total of 64 faculty members (41 from public sector and 23 from private) responded and participated in the study. Results: Results of our survey indicated that 37.5% of the faculty members were teaching a combination of phonation, nose blowing and fovea palatinae methods. The two vibrating line concept for establishing posterior palatal seal was taught by 64.06% of faculty members, 53.65 % of these place the border of maxillary dentures at the posterior flexion line. Carving the maxillary posterior palatal seal on the master cast was taught by 92.18 % of faculty members. 64% were teaching the post palatal seal carving depth of 0.5-1.5 mm on the maxillary cast, along with consideration of Compressibility of the palatal tissues. The butterfly pattern was the mostly (79.6%) described pattern for carving post palatal seal on the maxillary cast. Conclusion: Statistically there was no significant difference in techniques and concepts which are used to establish the posterior palatal seal, between government and private dental institutes

Infected non-union of tibia treated with ilizarov external fixator: Our experience

Introduction: Tibia is the most common long bone fractured due its vulnerable subcutaneous location and most often associated with acquired complications of delayed union or non-union due to infection. Amongst the various treatment options to treat them, the Ilizarov external fixator application is considered superior due to its multiple advantages. The objective of this study was to analyse the role of Ilizarov fixation in infected tibial non-union, as well as to assess bony union and associated functional outcomes. Materials and Methods: A retrospective review was conducted for the duration between 1st January 2005 to 31st December 2016. Total of fifty-one patients with tibial non-union associated with infection who treated with the Ilizarov fixator were included in the study. Patient records were reviewed for union of bone, bone and functional outcomes and complications. Results: The most common organism for infection was identified to be Staphylococcus Aureus. At the time of final follow-up all patients had achieved union except two, one of whom had to undergo amputation due to non-union and sepsis. Majority of the patients had an excellent score as per ASAMI grading system for bone and function results. The most common complication noted was pin track infections. Conclusion: In our experience, Ilizarov external fixator is better suited for infected non-union of tibia because it can provide a stable mechanical environment, bone transport, correct deformities, and enable weight bearing and hence we recommend its use for the same

Experience of managing acute pancreatitis in a surgical unit of a tertiary care hospital

Objective: To study the etiology, diagnosis, treatment and complications of acute pancreatitis in a tertiary care hospital.  Methodology: Study Design: It was a descriptive study. The study was conducted at Surgical Unit of Benazir Bhutto Hospital (BBH) Rawalpindi from 1st January 2014 to 31 July 2017.  All the patients who presented in emergency with abdominal symptoms and diagnosed as a case of acute pancreatitis were included in the study. All the data of gender, age, serum amylase & lipase, etiology, CT severity index, Ranson’s criteria, complications, mortality and management were noted on a predesigned proforma. Percentages and frequencies were calculated for all the data by SPSS 21 version. Results: Total 161 patients were included in the study, with 60.9% females and 39.1% males. Maximum patients 31% were from age group of 26 to 40  years of age and minimum 1.2% from 71 to 85 years. Gall stones were the major cause of the disease contributing 67% of cases.  At admission Ranson’s score of the maximum patients 32.2% had total score of 1, While only 1.2% had moderate pancreatitis.  After 48 hours of admission 24.2% had 2 score while only 1.2%had severe pancreatitis.  The radiological CT severity index 82.6% patients had mild pancreatitis while1.2% patients had severe disease. 93.1% patients were managed conservatively, 1.9%  patients went Cystogastrostomy, 1.2% patients needed Exploratory laparotomy and  1.2% patients went for Pancreatic Necrosectomy.  On calculating the morbidity 67.7% patients had no significant morbidity. 32.3% had complications including pleural effusion, ascites, pancreatic necrosis, pseudo cyst formation, shock, acute renal failure and multi organ failure.  Overall mortality rate was  3.7%. Conclusion: Acute pancreatitis in our set up is mainly due to gall stones. A multidisciplinary approach, measurement of severity of disease with computerized tomography scan and Ranson’s scoring system is always helpful in disease management and its complications. Key Words : Acute pancreatitis, Gall stones, Ranson’s scoring, Pancreatic necrosis, Pseudocyst

Clinic-based biopsy with a small curette: is it a reliable and safe option in extremity tumours?

Abstract OBJECTIVE: To establish the diagnostic accuracy and safety of clinic-based biopsy done with a small curette. METHODS: The retrospective study was conducted at Aga Khan University Hospital Karachi and comprised data of patients who underwent biopsy procedure of extremity tumours in clinic under local anaesthesia from July 2009 to June 2012. Patients who underwent the procedure in operating room under general anaesthesia were excluded and so were those with insufficient or missing information, or those who had the final procedure done elsewhere. Clinical parameters were evaluated and histo-pathology was compared with the final resected specimen. RESULTS: The mean age of the 51 patients in the study was 32±19.6 years. Lower extremity was involved in 37(73%) cases, and the most common tumour was osteosarcoma in 9(17%).Biopsy was inconclusive in 2(4%) patients, leaving the clinical accuracy to be 94%. The cost of clinic-based biopsy was at least seven times less than those done in the operating room under general anaesthesia. CONCLUSIONS: Biopsy done in a clinic with a small curette is accurate, safe and cost-effective method