Introduction: Facial trauma is without a doubt a most challenging area for any emergency physician. Despite many researches and advances in the understanding of multiple techniques; initial assessment and management of facial injuries in emergency and early stages remained a complex area for patient care. Objective: The aim of this study is to identify the prevalence of facial trauma among patients with head injuries that may help emergency department physicians to deliver accurate and quick diagnosis and decision. Trauma to this region is often associated with mortality and morbidity and varying degree of physical and functional damage. Study Design: Prospective Cross-sectional Descriptive Study. Place and Duration of Study: Department of Emergency Medicine, Ziauddin University Hospital, Karachi from four months from Feb 2014 to May 2014. Methodology: This study was conducted at Ziauddin university hospital emergence medicine department. It is a prospective cross sectional descriptive hospital based study. 115 patients who were diagnosed of having head injuries were included in this study. Information on age, sex and cause of injury was taken for each case. Each patient was then examined for the presence of facial trauma using the CT 3D face. Data was analyzed using the SPSS program. Result: Out of 115 patients, 85 (74%) were males and 30 (26%) were females. A total of 59 (51%) patients were between 15 – 30 years of age; 26 (23%) were aged between 31 – 50; and 30 (26%) were above 51 years of age. 76% patients had facial trauma where head injuries were evident. 63% female and 80% male had facial trauma where head injuries were found in patients. Out of these 115 patients majority were involved in road traffic accidents and are from the age group 15 – 30 and predominantly male. Conclusion: Based on the study conducted; it is safe to conclude that patients who have facial trauma associate with head injuries are young males and is mainly caused by road traffic accident. The result might vary by governmental, culture or social differences.

Introduction: Metoclopramide is a dopamine receptor agonist and well known antiemetic and gastrokynetic agent. Its usage has been restricted by European Medicines Agency (EMA), because of acute and chronic neurological adverse events. Extrapyramidal syndromes, including parkinsonism, tardive dyskinesia, akathisia and acute dystonias, are the most reported and most often drug side effects. Contingent and methods: We present a case of 23 years old woman with a 3-year history of Metoclopramide-induced recurrent oculogyric crises. Results: The patient suffered from examinophobia, with minimal benzodiazepine symptoms relief. She willfully took small dosages of oral Metoclopramide for nausea relief before her examinations, which lead to recurrent oculogyric crises, short after the drug intake. After a detailed explanation of drug side effects and medicine discontinuation, they disappeared. She had no significant medical and family history of neurological and psychiatric conditions. Laboratory data were normal. Conclusions: Metoclopramide could induce acute or chronic neurological conditions and its usage should be restricted in general population to some specific conditions. Some of its adverse reactions are often misdiagnosed and improperly treated. Critical drug anamnesis with a focus on Metoclopramide usage in some cases could enhance diagnosis.

We have previously demonstrated that in patients with myelodysplastic syndrome (MDS) monocyte-derived DCs (MoDC) exhibit some phenotypic and functional abnormalities. However, the mechanisms underlying the defective response have not yet been clarified. Aim: In the present study three different signaling pathways, ERK, p38K and NF-κB, were studied on MoDC from patients with MDS. Materials and methods: 7 patients with MDS and 5 healthy controls were included in the study. MACS separated CD14 cells were cultured for DC generation and further stimulated with TNF-α and LPS. A migration assay and ELISA were performed for the analysis of migration and IL-12p70 secretion. Western blot analysis was used for the detection of the phosphorylated forms of ERK and p38K. NF-κB binding activity was evaluated by electrophoretic mobility shift assay (EMSA). Results: In 6/7 patients the NF-κB binding activity in TNF-α and LPS stimulated MoDCs was lower compared to controls. This was accompanied by lower migratory capacity and IL-12p70 secretion. TNF-α and LPS induced phosphorylation of p38 and ERK at similar levels in control MoDC, whereas in MDS MoDC the pattern was heterogeneous with predominant activation of ERK over p38K. Conclusion: Our results provide strong evidence that defective signaling through NF-κB and MAPK underlies the functional abnormalities of MoDC in patients with MDS.

Purpose: To evaluate the application of Bangerter foils in the postoperative management of esotropia Methods: A retrospective study of 200 patients who underwent bimedial recessions for various forms of alternating/alternated esotropia in the period of 2000-2013. In the cases of residual postoperative angle, tendency of recurrence of strabismus and preferred fixation, Bangerter foil was fixed on the corrective glass of the dominant eye- either on the next day of surgery, or on the 10-th postoperative day and was in use for at least 6 months. Results: Bangerter foils were applied in 67(35,1%) under corrected patients with a mean residual angle for near 7,01±3,51Δ. Mean residual angle in patients without foils was 3,47±4,06Δ (p<0,001). Statistically significant factors in patients with filters were amblyopia treatment before surgery (p<0,001), anisometropia (p=0,003) and type of esotropia (accommodative vs. non accommodative (p<0,001). Within the group without filters there was a significant increase of the residual angle for near on the third (p<0,001) and sixth month (p=0,036), while within the group with foils angle was not significantly changed (p=0,325; p=0,058) with time. In the group with foils no cases with relapse of strabismus and amblyopia were recorded and even a decrease of the postoperative angle was clinically observed in some patients. Conclusion: To our experience Bangerter foils are a reliable tool in the postoperative management of undercorrected esotropia.

Herpes gestationis, also known as pemphigoidgestationis (PG) is an extremely rare autoimmune bullous dermatosis of the gestation and postpartum period. The disease was originally named herpes gestationis on the basis of the morphological herpetiform feature of the blisters. We report a 21-year-old woman, pregnant in the third trimester, who presented with a pruritic bullous cutaneous eruption of two weeks duration. The disease started with a red plaque in the abdominal area accompanied by mild itching. Soonafter, blisters appeared and affected almost the entire body. Physical examination revealed a primiparous woman in good general state, pregnant in 36 weeks of gestation. The skin changes affected the abdomen, back of the trunk, upper and lower extremities, hands and feet. They were manifested by a polymorphous eruption, consisting of erythematous urticaria-like plaques, small tense vesicles and multiple excoriations. Mucous membranes were not affected. Routine laboratory examinations were within normal limits. Direct immunofluorescence (DIF) on perilesional skin showed linear deposition of IgG (++) and C3 (++) at the cutaneous basement membrane zone (BMZ). Indirect immunofluorescence (IIF) on human esophagus substrate revealed circulating IgG anti-BMZ antibodies at a titer of 1:80. ELISABP180 NC16A was strongly positive. The diagnosis of PG was confirmed and a treatment with systemic methylprednisolone 60 mg/day was initiated, later gradually tapered to 20 mg/day, together with topical corticosteroids. As a result on the 10th day of the treatment we already achieved significant improvement with reduction of erythema and itching, absence of new skin lesions. The pregnancy ended in term with successful childbirth. No flare of the skin disease was observed in the puerperal period.

bjective: Bevacizumab improved survival when added to chemotherapy for patients with metastatic colorectal cancer (mCRC). The aim of this study was to explore the efficacy and safety of Bevacizumab containing chemotherapy regimen in the treatment of patient with mCRC. Methods: From January 2010 to March 2012 twenty two consecutive patients with inoperable mCRC entered the study. Treatment schedule consist of intravenous Irinotecan 180 mg/m2 on day 1, Leucovorin 200 mg/m2 administered as intravenous infusion on day 1 and 2 and 5- Fluorouracil 400 mg/m2 bolus and Bevacizumab 5 mg/kg as an intravenous infusion with repetition every two weeks. Results: Overall response rate was 31,9% with one complete response and six partial responses achieved. The overall survival time was 16,6 months. The main toxicities observed were leukopenia and diarrhea. Conclusions: That data suggest that chemotherapy with Irinotecan/ 5- Fluorouracil/ Leucovorin and Bevacizumab remain reasonable regimen for the treatment of patients with mCRC.

Objective: The aim of this study was to evaluate elevated platelet count as a prognostic factor for survival in patients with advanced (stage IIIB/ IV) non- small cell lung cancer (NSCLC) receiving first- line chemotherapy. Methods: From 2005 to 2009 three hundreds forty seven consecutive patients with stage IIIB or IV NSCLC, treated in Department of Medical Oncology, UMHAT "Dr Georgi Stranski" entered the study. The therapeutic regimens included intravenous administration of platinum- based doublets. Survival analysis was evaluated by Kaplan- Meier test. The influence of pretreatment thrombocytosis as prognostic factor for survival was analyzed using multivariate stepwise Cox regression analyses. Results: Elevated platelet counts were found in 78 patients. The overall survival for patients without elevated platelet counts was 9,6 months versus 6,9 months for these with thrombocytosis. In multivariate analysis as independent poor prognostic factors were identified: stage, performance status and elevated platelet counts. Conclusions: These results indicated that platelet counts as well as some clinical pathologic characteristics could be useful prognostic factors in patients with unresectable NSCLC.