Phytocompounds of Anonna muricata leaves extract and cytotoxic effects on breast cancer cells

Objective:To identify the phytochemical compounds from Annona muricata (A. muricata) and to determine their in vitro anti-proliferative activities against breast cancer cells, MCF7 and MDA-MB-231.Methods:A. muricata leaves were successively extracted by soxhlet method using n-hexane, ethyl acetate and methanol, and decocted with water. Each extract was analysed by gas chromatography mass spectrometry (GCMS) and characterized with Wiley and NIST library searches. Anti-proliferative activity of each extract was evaluated on MCF7 and MDA-MB-231 breast cancer cells using MTT assay.Results:The GCMS analysis of different solvent extracts of A. muricata leaves showed presence of different chemical groups of compounds such as steroids, terpenoids, phenolic compounds, sugars, sugars alcohol and others including vitamin E. Ethyl acetate leaves extract exhibited the lowest ICConclusion:Steroids and phenolic compounds were the main phytocompound groups identified from all A. muricata leaves extracts. The antiproliferative activity of n-hexane and ethyl acetate extract towards breast cancer MCF7 and MDA-MB-231 respectively might be due to the presence of biologically active compounds in the extracts, hence, providing some scientific evidences of the effectiveness of its traditional usages.

Effect of angiotensin converting enzyme inhibitoron glomerular hyperfiltration in patients with type 1 diabetes

Objective: To assess the effect of angiotensin converting enzyme inhibition on glomerular filtration rate [GFR] in normotensive patient with type 1 diabetes

Methods: A two year non-placebo control prospective study was conducted after ethical approval at Diabetes Centre of Diabetic Association of Pakistan, a WHO collaborating centre in Karachi, Pakistan. All patients with type 1 diabetes visited the out-patients department from August 2009 till July 2011 and those who fulfilled the inclusion criteria were invited to participate. A total of 121 people aged >/=18 years and >/= 5 years of diabetes were included. Pregnant and lactating woman and those aged <18 years were excluded. GFR was calculated by using CKD-EPI formula [eGFR] at baseline and after two year. On the basis of estimated GFR, patients at baseline were divided according to KDIGO classification of chronic kidney diseases into, hyperfiltration [eGFR >/= 100 ml/min] and normal filtration group [eGFR < 100 ml/min]. All subjects in hyperfiltration group received ACE inhibitor [treatment group] while patients with normal filtration did not receive ACE inhibitor [control group]

Results: Fifty two patients [43%] were in the treatment and sixty nine [57%] were in the control group. At baseline eGFR, systolic and diastolic blood pressures between groups were non-significantly different. After two years, compared to baseline, eGFR of the treatment group declined and the control group increased significantly. No significant difference in systolic while diastolic blood pressure of the treatment group increased significantly after two years compared to baseline. In contrast both systolic and diastolic blood pressure of control group increased significantly after two years compared to their baseline values

Conclusion: Present study demonstrated that initiation of ACEI in hyperfiltration stage declined GFR and keep blood pressure within normal range

Frequency, severity and risk indicators of retinopathy in patients with diabetes screened by fundus photographs: a study from primary health care

To determine the frequency, severity and risk indicators of diabetic retinopathy [DR] in patients with diabetes attending a primary care diabetes centre. This observational study was conducted at Diabetic Association of Pakistan - a World Health Organization collaborating center in Karachi, from March 2009 to December 2011. Registered patients with diabetes were screened by two field fundus photographs. Retina specialists graded the signs of retinopathy according to diabetic retinopathy disease severity scale. Of total registered diabetic patients [n=11,158], 10,768 [96.5%] were screened for DR. Overall DR was found in 2661 [24.7%] patients. DR was found in decreasing order of frequency in patients with type 2 [n= 2555, 23.7%] followed by patients with type 1 diabetes [n=101, 0.93%] and patients with gestational diabetes mellitus [GDM] [n=5, 0.46%]. Among patients with DR, signs of non-sight threatening retinopathy was dominant. Females and patients of working age group predominantly had retinopathy. Type 1 patients >16 years and type 2 patients < 5 years of history of diabetes had sign of retinopathy in increased frequency. Every forth patient with diabetes in this large cohort had signs of diabetic retinopathy. Females and patients in working age group predominantly had retinopathy. Type 2 patients with short while type 1 patients with long history of diabetes most frequently had DR. Dissemination of the present study findings may help in increasing the awareness of this serious complication of diabetes

Ramadan fasting related awareness, practices and experiences of a representative group of urban Pakistani diabetics

The main objective of this retrospective study was to observe Ramadan related awareness, practices and experiences of diabetic patients. It is expected that the outcome of this study would assist the healthcare professionals in providing effective fasting related guidance. A total number of 1050 diabetic patients were interviewed post Ramadan. Closed ended questionnaires were administered and responses were recorded by the trained data collectors. Out of 1050 subjects, 33% [n=350] were males and 67% were females [n=700]. About two third of the study participants monitored their blood glucose at home or at health care facilities. Frequency of monitoring blood glucose once a month was the most common pattern. During Ramadan blood glucose level was monitored by 70% of subjects. Majority of the subjects did their blood sugar 1-3 times in a month. Dosage of oral hypoglycemic/insulin was adjusted before Ramadan in 80.8% of the patients with diabetes who planned to fast. Overall 3.1% of subjects broke the fast due to hypoglycemia, while 75% of study population had never experienced symptoms of hypoglycemia during fasting. The majority of diabetic patients were fasting without any adverse events however 15-20% of them were at risk as they continued fasting without checking their blood sugar even when they felt hypoglycemia. Diabetic patients should be counseled about the symptoms of hypoglycemia during fasting and the option for breaking the fast in case of low blood sugar

effect of fasting on QT Interval

QT interval reflects the total duration of ventricular depolarization and repolarization in the ECG. Experimental hypoglycaemia and spontaneous clinical episodes of hypoglycaemia lead to the lengthening of the heart rate corrected QT interval or QTc. This is associated with elevated risk of sudden death. To find out the effect of fasting blood glucose levels on QT interval and the corrected QT interval [QTc]. Fasting and post prandial blood glucose levels and ECG of healthy young adults were studied and QT interval, RR interval and QTc were determined. The fasting QTc came out to be 0.408 +/- 0.020 as compared to the post prandial value of 0.380 +/- 0.019. The student's t test showed a highly significant value [p<0.0001]. There is significant prolongation of QT interval and QTc during fasting but within normal physiological limits

Acetylator phenotype in Iraqi patients with systemic lupus erythematosus

The study was designed to determine the acetylator status in patients with systemic lupus erythematosus [SLE] and compare it to a matched group of healthy volunteers. Disease severity was determined using the revised American College of Rheumatology criteria for classification and the SLE disease activity index. After an overnight fast, each participant received a single oral dose of 100 mg dapsone. After 3 hours, plasma dapsone/monoacetyldapsone ratio was determined. In the control group, frequency of slow acetylators was 73.3%; frequency of rapid acetylators was 26.7%. In SLE patients, frequency of slow acetylators was 78.0%; frequency of rapid acetylators was 12.0%. However, 8.0% were non-acetylators [monoacetyldapsone not detected in plasma]. There was no association between acetylator status and severity of SLE

Left atrial appendage function in patients with nonrheumatic atrial fibrillation

In this study, 36 patients with non-rheumatic AF and 10 healthy subjects were investigated. The patients were subjected to thorough history taking, thorough clinical examination, plain X-ray chest to assess the cardiothoracic ratio and pulmonary vasculature, 12-lead surface ECG to define the patient's rhythm, rate and type of AF [course or fine], transthoracic echocardiographic examination and transesophageal echocardiography. The flow pattern of all patients and normal subjects was assessed by transesophageal pulsed wave and color Doppler and two distinct flow patterns were recorded [low flow pattern in 18 patients and high flow pattern in 18 patients]. This study confirmed that LAA is a highly contractile dynamic pump with a pattern of contraction that is quite distinct from that of the main body of the LA. LAA thrombus formation is associated with LAA dilatation, decreased LAA EF percentage and slow forward and backward velocity

Survey of chest specialists and trainees knowledge and practice of TB guidelines

To investigate the fundamental knowledge of TB guidelines and their application in day to day practice by the chest specialists and trainees working in teaching hospitals. A questionnaire-based survey was conducted among the participants of 5th biennial chest conference. The data of 195 doctors was analyzed. 96% of doctors said they were treating their TB patients according to guidelines and categorize their patients for treatment, but only 54% knew the correct number of categories for treatment as recommended by the guidelines. Only 49% knew about the components of DOTS. 85% doctors considered sputum microscopy most important diagnostic test for TB and 61% would use it for monitoring of their patients. 88% would advise sputum AFB culture and sensitivity in suspected cases of suspected drug resistance, 59% doctors would treat MDR TB patients themselves and 33% would refer to specialized centers. 5 declared them incurable. 47% and 30% doctors respectively recommended changes in WHO recommended fixed drug combination FDC during pregnancy and lactation. 58% doctors recommended chemoprophylaxis for tuberculosis in our setting. Overall fundamental knowledge of consultants regarding management of TB was good. Knowledge about DOTS and TB guidelines among all the doctors was average and needs improvement. Management of MDR TB by trainees is alarming in the absence of adequate knowledge and experience

Survey of awareness and management attitudes of chest specialist and trainees towards asthma

The study was aimed at three objectives: i. To know about doctors understanding of pathophysiology of Asthma. ii: To assess the knowledge of treatment of asthma and actual treatment practices by Chest specialists and Postgraduate trainees. iii: To assess the baseline knowledge, attitude and treatment practice in the absence of any local treatment guidelines and then see the effectiveness of the guidelines in changing their practice. A preset questionnaire was distributed among doctors from all over Pakistan, during 5th Biennial Conference on Lung Health in 2002. Each question was followed by a set of answers, of which one was to be tick marked. 66 doctors participated, 14 teaching consultants, 24 chest specialists, 14 postgraduate students, and 14 other doctors. 82% doctors would treat their patients on long-term basis and 18% would treat them acutely. 71% thought asthma was chronic inflammation of the airways whereas 28% thought it was due to bronchoconstriction and mucus plugging. Airways remodeling was considered to be partially or fully reversible by 90% and not reversible by 8%, 2% did not respond. 89% were fully aware of stepwise management of asthma and 11% were little aware. The grading of asthma severity was done by clinical examination 44% and clinical plus spirometery 56%. Inhalers were prescribed always by 35%, frequently by 57% and sometimes by 6%. 78% prescribed steroid inhalers alone or in combination with Beta 2 agonist, whereas 12% used only Beta 2 agonist. 93% would teach inhaler technique by themselves or by trained technician and 7% would leave it to chemists or patients. 88% would check inhaler technique on follow-up visit. 92% used oral drugs with inhalers. The choice of oral drugs varied between steroid [8%], theophylline [28%], Beta 2 agonist [37%], and leukotriene inhibitors [18%], no response [9%]. 47% sometimes and 50% never advised desensitization while 3% recommended it frequently. A significant proportion of doctors lacked a good understanding of pathophysiology of asthma. Although the majority of chest physicians and trainees were fully aware and correctly practiced, a significant number [i.e. one fourth] of doctors were not managing their patients with asthma correctly according to the guidelines

Mortality and morbidity of abdominal inferior vena-caval injuries

To evaluate the outcome of abdominal inferior vena-caval [IVC] injuries in patients presented to Accident and Emergency Department, Lady Reading Hospital, Peshawar. Design: An observational study. Place and Duration of Study: The study was conducted at Postgraduate Medical Institute [PGMI]/Lady Reading Hospital, Peshawar, from January 1995 to January 2003, Patients and Case records of all patients operated within specified period for vascular trauma having injuries to the abdominal inferior vena cava. In all cases vascular trauma management was done mainly on clinical assessment in a low equipped set up. Data on age, gender, mechanism, nature and location of inferior vena-caval injuries, other vascular and non-vascular injuries were recorded. There were 22 patients, 77.27% male and 22.72% female. Age ranged from 10 to 40 years with mean age of 25.09 years. Majority of injuries were caused by penetrating injury [77.27%], blunt injury in 04.54% and 18.87% were iatrogenic. Majority [95.45%] were having single laceration of inferior vena cava and 04.54% were having more than one laceration. Associated vascular injuries involved aortic 9.09%, internal iliac in 4.54% and renal vein in 4.54%. Most common associated non-vascular injury involved small intestine [72.72%] and large gut [50%]. Inferior vena-caval injuries carries high mortality rate. When associated with multiple organ injuries and retrohepatic inferior vena-caval injuries are almost fatal

Management of pilonidal sinus

A prospective study was conducted in 'Surgical A' Lady Reading Hospital, Peshawar from December 2000 to May 2001 to evaluate the results of different methods of treatment of pilonidal sinus. Twenty patients who were fit for general anaesthesia were selected for operative treatment and were included in the study. Acute infection was treated first. Twelve patients were treated by Karydaki's procedure and eight were treated by open method. The mean hospital stay was 4-5 days in Karydaki's but multiple admissions were required for open procedure patients. There was two recurrence in the open procedure. The technique of asymmetric cleft closure is the best method of treatment for the management of pilonidal sinus

ischemic heart disease in women

Ischaemic heart disease is very common in females after the menopause. Diabetes mellitus and hypertension are documented to be strong predictors of obstructive C.A.D. in females, in Pakistan. Females present as angina more often than myocardial infarction, but the mortality is higher in females with myocardial infarction than in angina. There are special problems in analysing chest pain syndrome in females, even though E.T.T. coronary angiographic data. Coronary bypass surgery is only used in about 8-10% female patients at the present time in our country as compared to male patients. In this paper an effort is made to summarize the clinical findings, E.T.T., Angiography, coronary bypass surgery, angioplasty findings in females published in Pakistan and compare it with that from the western countries