Hepatitis E virus seroprevalence in pregnant women in Pakistan: maternal and fetal outcomes

Hepatitis E virus [HEV] is endemic in Pakistan. Although otherwise asymptomatic, HEV infection becomes fatal in pregnancy, with considerable maternal and fetal morbidity and mortality. We conducted a descriptive study from April to October 2015 in 10 tertiary care hospitals throughout Pakistan to determine maternal and fetal morbidity and mortality in HEV-positive pregnant women with acute jaundice or raised liver function tests. Twenty-one of 135 women were HEV positive and in 3rd trimester except for 1 in 1st trimester. Overall prevalence of HEV in pregnancy was 0.19%. Ten women were artificially induced, 3 had premature labour, 4 delivered spontaneously [full term], 3 died and there was 1 intrauterine death. One woman had a home abortion before coming to hospital. There were 7 perinatal infant deaths: 4 intrauterine, 3 stillbirths and 1 abortion. Maternal mortality was significantly associated with delivery, as 17 mothers who lived went into labour spontaneously or were artificially induced, whereas 3 women who continued their pregnancy and did not deliver, died. Case fatality rate of HEV infection in pregnancy was 14.2%

Phytochemical screening, antiglycation and antioxidant activities of whole plant of Boerhavia repens L. from Cholistan, Pakistan

Present study was aimed to explore a traditionally used indigenous medicinal plant Boerhavia repens [Nyctaginaceae family] of the Cholistan desert, Pakistan. Crude aqueous and methanolic extracts of the whole plant were investigated in vitro for preliminary phytochemical screening, antioxidant and antiglycation activities. Antioxidant activities were determined by total phenolic contents, 1,1-diphenyl-2-picrylhydrazyl [DPPH] free radical scavenging and inhibition of lipid peroxidation. For antiglycation activities browning production was noted and thiobarbituric acid [TEA] technique was used to determine glycation level. Boerhavia repens expressed considerable amounts of phytochemicals. Extract yield was found to be 4.59%-7.85% g/100g of dry matter with total phenolics ranging from 47.9- 190.77mg/GAE per g for aqueous and methanol extract respectively. Strong inhibitory effect was exhibited by methanolic extract in linoleic acid per oxidation system [86.11%, EC[50]=0.99mg/mL] and DPPH assay [88.65%, EC[50] =212.33 Lig/ml]. In term of browning maximum inhibition [81.50%] was exhibited by methanolic extract at 37°C at third week of incubation. Both extracts expressed significant [P>0.05] and comparable inhibition of glycation level. In conclusion, Boerhavia repens showed promising antioxidant and antiglycation activities validating its therapeutic potential

Vitamin D status among vegetarians and nonvegetarians

Vitamin D helps in maintaining bone and muscle health. Vitamin D deficiency is a global problem, with the prevalence of deficiency being widespread in Pakistan. The present study was planned to associate serum vitamin D, Parathyroid Hormone [PTH], calcium and phosphate concentrations with dietary habits of individuals living in urban/rural areas of Sindh, Pakistan. This was a crosssectional study at two locations, urban [Karachi] and rural [Haji Goth of Shadadpur city]. The study period was May-October 2012 on 176 healthy subjects, aged 20-80 years. Venous blood was collected for analysis of vitamin D, PTH, calcium and phosphorus. Statistical analysis was done using SPSS-18. Statistical differences between variables were determined by student's t-test and p<0.05 was considered significant. The 176 subjects were divided into non-vegetarians [93, 52.84%] and vegetarians [83, 47.16%] with each group subdivided into urban and rural. The BMI of non-vegetarians vs vegetarians was high [p<0.001]. Vitamin D in non-vegetarians vs vegetarians was low [p<0.001]. The vegetarians of urban compared to rural had low vitamin D [p<0.05]. The PTH of non-vegetarians vs vegetarians was significantly high [p<0.001]. Serum calcium was significantly low [p<0.05] in urban and rural subjects on either diet. Non-vegetarians had severe vitamin D deficiency, while vegetarians had vitamin D insufficiency irrespective of belonging to urban or rural area

Hepatitis B surface antigen carrier rate in unvaccinated and vaccinated children with thalassaemia major at Bahawal Victoria Hospital, Bahawalpur, Pakistan

Screening of blood reduces but does not eliminate the risk of hepatitis B virus [HBV] infection in multi-transfused thalassaemia patients. This study was done to evaluate efficacy of HBV vaccination on hepatitis B virus surface antigen [HBsAg] carrier rate in children with thalassaemia major receiving multiple blood transfusions. In a cohort study conducted at a hospital in Bahawalpur, Pakistan, during 2009-10, children with thalassaemia major aged < 60 months who received more than 24 blood transfusions and were HBsAg negative at the time of first blood transfusion were included. Of 196 unvaccinated children, the seropositive rate was 12.2%; while among 218 children vaccinated during the first year of life via the Pakistan Expanded Programme on Immunization, the seropositive rate was only 0,9%. The HBV vaccine was highly effective in reducing the HBsAg carrier rate in children with thalassaemia aged < 5 years

C-reactive protein as a predictor of adverse outcome in patients with acute coronary syndrome

The acute-phase reactant C-reactive protein [CRP] has been shown to reflect systemic and vascular inflammation and to predict future cardiovascular events. The objective of this study was to evaluate the prognostic value of CRP in predicting cardiovascular outcome in patients presenting with acute coronary syndromes. This prospective, single-centered study was carried out by the Department of Pathology in collaboration with the Department of Cardiology, Bolan Medical College Complex Quetta, Balochistan, Pakistan from January 2009 to December 2009. We studied 963 consecutive patients presenting with chest pain to Accident and Emergency Department. Patients were divided into four groups. Group-1 comprised patients with unstable angina; group-2 included patients with acute ST elevation myocardial infarction [STEMI]; group-3 comprised patients with Non-ST elevation myocardial infarction [Non-STEMI] and group-4 was the control group. All four groups were followed-up for 90 days for occurrence of cardiovascular events. The CRP was elevated [>3 mg/L] among 27.6% patients in Group-1; 70.9% in group- 2; 77.9% in group-3 and 5.3% in the control group. Among cases with elevated CRP, 92.1% had a cardiac event compared to 34.3% among patients with CRP œ3 mg/L [P < 0.0001]. The mortality was significantly higher [P < 0.0001] in group-2 [8.9%] and group-3 [11.9%] as compared to group-1 [2.1%]. There was no cardiac event or mortality in Group-4. Elevated CRP is a predictor of adverse outcome in patients with acute coronary syndromes and helps in identifying patients who may be at risk of cardiovascular complications

Malignant Nerve Sheath Tumor of the Spinal Accessory Nerve: A Unique Presentation of a Rare Tumor

BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs), sarcomas originating from tissues of mesenchymal origin, are rare in patients without a history of neurofibromatosis. CASE REPORT: We report a case of an MPNST of the spinal accessory nerve, unassociated with neurofibromatosis, which metastasized to the brain. The tumor, originating in the intrasternomastoid segment of the spinal accessory nerve, was removed. Two years later, the patient presented with focal neurological deficits. Radiographic findings revealed a well-defined 2.2x2.2x2.2 cm, homogeneously enhancing mass in the left parieto-occipital region of the brain surrounded by significant vasogenic edema and mass effect, culminating in a 1-cm midline shift to the right. The mass was surgically removed. The patient had nearly complete recovery of vision, speech, and memory. CONCLUSIONS: To our knowledge, this is the first documented case of an MPNST arising from an extracranial segment of the spinal accessory nerve and metastasizing to the brain.

Sero-prevalence of Hepatitis B virus infection in Balochistan Province of Pakistan

The objective was to evaluate the sero-prevalence of hepatitis B surface antigen [HBsAg] and IgM antibodies to hepatitis core antigen in Balochistan Province of Pakistan. Design of the study: a cross-sectional, population-based study. Place and time of the study: The study was conducted in Balochistan from 1[st] January 2004 to 31[st] December, 2008. The screening areas included Barkhan, Eashani, Khuzdar, Kodi Zikriani, Kohlu, Rakhni and Turbat. A total of 15,260 subjects were enrolled; 11,900 [78%] agreed to undergo screening. Fresh serum samples were tested for the presence of hepatitis B surface antigen and IgM antibodies to hepatitis B core antigen. HBsAg was detected in 1166 [9.8%] while anti-HBc IgM was found in 117 [10.0%]. HBsAg positivity was seen in 875 [12.7%] males and 291 [5.8%] females. The prevalence of hepatitis B in Balochistan varies from 3.3% in Khuzdar to 17.0% in Kodi Zikriani. It is utmost important to educate the public, to take proper measures to control the spread of infection and vaccination in order to interrupt transmission of this threatening public health problem in Balochistan province of Pakistan

Glycation pattern of captopril in diabetics

Captopril is a chemical which acts as vasodilator and angiotensin- I converting enzyme inhibitor. The present attempt is to study the glycation inhibition pattern of captopril in diabetics and normals. Experimental Study. This study was conducted at the Research Lab., Department of Biochemistry, University of Agriculture, Faisalabad from May 2006 to February 2007. The study was designed on blood plasma from apparently healthy non-diabetic and diabetic persons. Plasma samples with different concentrations of glucose and that of captopril were prepared, followed by incubation for 5 weeks at 37 °C temperature. Glucose was estimated by glucose oxidase method before and after dialysis. Glycation level was measured by TBA and Periodate assays. Increased glycation was observed from 1[st] to 3[rd] week of incubation while it decreased after 5[th] week due to the formation of advanced glycatiori end products. 10 mM concentration of captopril showed fairly good response to decrease glycation as compared to its other two concentrations. Highest concentration of captopril produced overall good enough of inhibition. Periodate borohydride appeared to be more reliable and sensitive glycation assay as compared to TBA

Systemic lupus erythematosus, female of fertile age changes in reproductive hormones estrogen and prolactin levels

Systemic lupus erythematosus [SLE] is an important autoimmune disease and occurs when the body is mistakenly attacked by its own immune system. Prolactin acts as a cytokine and plays an important role in human immune response including autoimmune diseases. SLE is an immune complex mediated disease and is more common during pregnancy. Research is designed to analyze the level of serum prolactin in the pathogenesis of systemic lupus erythematosus and compared with estrogen in female of fertile age. Observational Study was carried out in the Department of Biochemistry, BMSI, in collaboration of ward-6 JPMC Karachi. Thirty five diagnosed cases of SLE and in addition 35 normal healthy controls from general population were included in the study. Serum levels of prolactin, estrogen, RA factor and ESR were estimated and correlated. The data was analyzed by using SPSS version 17. The student t-test and chi-square test was used the p-value <0.05 consider significant. The results showed that patients suffering from SLE have highly significant [p<0.001] serum level of reproductive hormones prolactin and estrogen, in addition, significant changes in ESR indicate the infection when compared with control. Further, prolactin was negatively correlated with estrogen as well as with menarche while BMI have positively correlation with estrogen regardless of prolactin and menarche. Enhanced serum prolactin and estrogen changes in patients with systemic lupus erythematosus [SLE], may be used as a prognostic tool for autoimmune diseases

[Comparison of the percentages of peripheral blood CD4+ CD25+ T lymphocytes in recurrent abortion and normal pregnancy]

Background and Aims: Recent evidences indicate that parts of the immunoregulation system such as CD4+CD25+Tcells [Treg] and Th2 cells and Th1 cells, play very important roles in the maintenance of pregnancy. The deficiency in proper recognition of fetal alloantigen by the maternal immune system is associated with recurrent pregnancy failure. Here, we investigate the proportional changes of CD4+CD25+Tcells in peripheral blood of women with unexplained recurrent spontaneous abortion in comparison to women with normal pregnancy by using flowcytometry

Methods: The case group was comprised of 24 women who had at least three successive miscarriages with unexplained etiology. They had normal karyotypes, anticardiolipin and prolactin and their husbands had normal spermograms. The percentages of TCD4+CD25+cells in peripheral blood of these patients were compared with those of 21 women who had normal pregnancy with no history of pregnancy loss. Anti-CD4, anti-CD25 and anti-CD3 antibodies were added to lymphocytes isolated from peripheral blood. Then samples were incubated, centrifuged and washed. Finally cells were analyzed using FACS Caliber system and data of the two groups were compared

Results: Mean percentage of CD4+CD25+bright T cells in peripheral blood in case group was significantly lower compared to the control group [P=0.000]. Mean percentage of CD4-CD25 bright cells in the CD4+Tcell peripheral blood was significantly higher in case group campared to the control group [P=0.021]

Conclusion: Decrease of CD4+CD25 bright T cells plays a major role in tolerating conceptus antigens and cytokine and might contribute to the maintenance of pregnancy. Inadequate CD4+CD25+Tcells or their functional deficiency may link with miscarriage. Therefore, alteration of CD4+CD25+T cells can be used as an immunologic marker for monitoring of patients with unexplained recurrent spontaneous abortion

[Investigation of iron powder, hydrogen peroxide and iron hydrogen peroxide for removal of acid yellow powder 36 dye from aqueous solutions]

A great part of organic compounds cause more pollution in natural waters meet, are chemical dye material. Azo dyes have more usage in different industries. Azo dyes not only give undesirable dye to the water but also have mutation potential and carcinogenesis effects in human and cause the production of toxic substances in water environments. The purpose of this study is investigation of iron powder, hydrogen peroxide and iron powder-hydrogen peroxide processes in removal of acid yellow 36 dye from aqueous solutions. This study was conducted in laboratory scale. At this experiment synthetic solution was made from acid yellow 36 dye, and the removal of acid yellow 36 dye was studied by iron powder, hydrogen peroxide and iron powder-hydrogen peroxide processes .Also effect of dye concentration, pH solution, hydrogen peroxide concentration, iron powder concentration and the time of contact on decolorization, were evaluated. The results showed that iron powder-hydrogen peroxide process, compared to two other process has high decolorization power. Removal efficacy of iron powder-hydrogen peroxide process with H[2]O[2]=23.33 ml / L, pH=3, iron powder 2000 mg/L and 60 minute, was about 97.9% In general this investigation showed that, this method [Iron powder-hydrogen peroxide process] has high efficiency for removal of Azo dyes. But application this method in the industry, should be economically evaluated

Pediatric heart diseases in Madina, Saudi Arabia. Current status and future expectations

To demonstrate the magnitude of pediatric heart disease problem in Madina, current situation of heart service, obstacles and future expectations. We conducted this cross sectional study in Madina Maternity and Children Hospital, Madina, Kingdom of Saudi Arabia from January 2007 to June 2008. The study was approved by the Ethical Committee. A computer based program was established to register the data of all children attended the pediatric cardiology unit. A total of 4348 children were seen in the study period; 2301 were follow up cases while 2047 were new cases. Of the new cases, 794 [38.8%] were found to have heart diseases. Of this, 705 have CHD [cardiomyopathies 34, rheumatic heart disease 26, mitral valve prolapse 15, Kawasaki disease 9, and arrhythmia 5]. Ventricular septal defect was the most common CHD [34.5%], and followed by atrial septal defect [8.9%]. Other CHDs were as follows pulmonary stenosis [7.9%], patent ductus arteriosus [6%], atrioventricular septal defect [3.8%], aortic stenosis [3.5%], dextro-transposition of great arteries [3.5%], tetralogy of fallot [3%], coarctation of aorta [2.8%], and others [26%]. Three hundred and ten patients required referral to the cardiac centers in Riyadh for catheterization or surgical intervention. Urgent referral was required in 128 patients. All patients were transferred via medical evacuation service. Pediatric heart disease constitutes a major health problem in Madina. The majority of patients have CHD. The need for cardiac centre in Madina was emphasized to avoid problems of transportations

Contamination and impacts of new antifouling biocide lrgarol-1051 on subtropical coral reef waters

Coral reefs are deteriorating worldwide due to various stresses, including pollution of hazardous chemicals such as antifouling chemicals. Occurrence and impacts of a new antifouling biocide Irgarol-1051 [2-methylthio- 4-tert- butylamino -6-cyclopropylamino -s-triazine] have been studied in coral reef waters around Okinawa Islands, Japan. The average concentration of Irgarol detected at commercial and fisheries Ports was 24.70 +/- 9.88 ng/L. In Naha Bay, the average concentration of Irgarol was 10.00 +/- 12.98 ng/L. The average level detected around the Ports has already approaches the environmental risk limit for the marine organisms. Irgarol was detected in waters at the frequency of 92.3% [24/26] of the total samples collected during two sampling campaigns [September and December, 2007] at the Ports. In Naha Bay, Irgarol was detected by 40.5% [17/42] of the total water samples collected monthly from Sep., 2007 to Feb., 2008, indicating that Irgarol is widely detected along the coastal shorelines of Okinawa Island. The ecotoxicological study revealed that the rate of photosynthesis in the coral Galaxea fascicularis was significantly reduced by 18% and 121% relative to control when the corals were exposed to 1000 and 10,000 ng/L of Irgarol, respectively. The calcification rate dropped by 98.3% relative to control when the corals were exposed to 10,000 ng/L of Irgarol. The results of the present study report the wide occurrence of new antifouling biocide Irgarol around coastal areas of Okinawa Island. However, the contamination does not pose serious threat on the photosynthesis and calcification of corals under short term exposure [96 h]

[Comparison of postmortem heart and femoral vein blood ethanol concentrations]

Alcohol abuse is a major cause of medical and social problems and ethanol analysis is the most frequently performed assay in forensic toxicology laboratories. Femoral vein blood is the choice specimen, but occasionally there is no access to it. The aim of this study is the comparison of ethanol concentration between heart blood and femoral venous blood. Ethanol concentrations were determined in femoral vein blood and heart blood obtained from 50 forensic necropsies that the time of death was less than 24h. The specimens were stored in duplicate state at 4°C within filled, dark and closed containers with preservative and analyzed by headspace gas chromatography in Forensic Toxicology Laboratory of Tehran's Legal Medicine Organization with a precision coefficient of variation 5%-7%. The limit of detection was /1 mg/dl and the limit of quantification was 10 mg/dl. The mean concentration of ethanol in heart blood was 131.88 +/- 93.46 mg/dl and in femoral vein blood was 135.96 +/- 95.47 mg/dl. The heart blood/femoral blood ethanol concentration ratio was 0.958 +/- .18 and regression correlation coefficient was 0.98. When considered specimens with concentrate 100 mg/dl was 0.943. There was no considerable difference between femoral vein blood and heart blood alcohol concentration if the death was happened before 24h and sampling and storage be correct and appropriate

Prevalence of microalbuminuria with relation to glycemic control in type-2 diabetic patients in Karachi

Diabetes is one of the most common endocrine disorders characterized by hyperglycaemia. Diabetic nephropathy is a consequence of long standing diabetes. The prevalence of microalbuminuria predicts progression to diabetic nephropathy. The present study was conducted to determine the prevalence of microalbuminuria in relation to duration of diabetes, BMI, Serum Creatinine and HbA1c in an ethnic group of Type 2 diabetes mellitus residing in Karachi. This cross-sectional descriptive study was carried out in a community diabetic centre, located at Garden East Karachi from July to December 2007. One hundred known Type 2 diabetic patients with age 30- 70 years were included in the study. Informed consent and a structured questionnaire of each patient were recorded. Fasting venous blood and morning urine sample was collected for analysis of creatinine, HbA1c and microalbuminuria respectively. Statistical analysis was done using SPSS version 13.0. Pearson correlation was applied to observe association of microalbuminuria with different parameters. All p-values <0.05 were considered as statistically significant. Microalbuminuria had a highly significant correlation with duration of diabetes, serum creatinine [p<0.001], HbA1c [p<0.05] and BMI [p<0.024]. A strong correlation exists between age and serum creatinine [r=0.73]. The present study found an early onset of microalbuminuria in the selected community which could be due to poor glycaemic control [high HbA1c>7%] or heredity factors. Screening for microalbuminuria and HbA1c test should be done in both newly and already diagnosed Type 2 diabetic patients as an early marker of renal dysfunction and glycaemic control

[Biological control of apples blue mold by two isolates of saccharomyces cerevisiae in order to reduce the environmental pollution]

In the recent decays, application of the fungicides has provided some concern in the scientific society. Recently, biological control was developed as an alternative to synthetic fungicides, and considerable success was achieved by utilizing antagonistic microorganisms for controlling postharvest diseases. In this present research, two yeast antagonists of Saccharomyces cerevisiae [04,69] applied instead of fungicide that it controlled blue mold of apple caused by Penicillium expansum. Blue mold agent isolated from infected apples. Dual culture, cell free metabolite and volatile test were used in vitro assay to evaluate as potential biological control agent against apple blue. In storage assays [in vitro assays], apple fruit wounds were inoculated with 40 microl of yeast cell suspension [10[7] cell/ml] followed 24h later by P.expansum [10[5] conidia/ml]. The apples were then incubated at 20[degree sign] C and 5 [degree sign] C. The inhibition varied among isolates of yeasts and ranged from 33.12% to 58.4%, in dual culture, from 54.93% to 72.87% in volatile metabolite and from 50.23% to 76.23% in cell free metabolite test. In the storage test, two isolates of S. cerevisiae reduced the decay area from 1416 to 1435 mm[2] compared to 3151.1 mm[2] in control after at 5 [degree sign] C. At 20[degree sign] C, the lesion area ranged from 1347 to 1598 mm[2] for the antagonist treatments compared to 3257.4 mm[2] for the control treatments. The two isolates of S. cervisiae were the effective isolates at both temperatures in this assay and could be two of important new biological control agents for apple blue mold

Experience with oral mexiletine in primary erythromelalgia in children

Primary erythromelalgia is characterized by burning pain, redness, and warmth in the extremities. We present two cases of primary erythromelalgia both of whom presented with a history of several months of severe burning pain in both hands and feet. Both patients had received multiple pain medications with no improvement in symptoms. Pain was relieved by putting affected parts in ice cold water, which resulted in immersion injury of the affected parts. Both patients stopped taking part in school and social activities. We tried oral mexiletine, a class Ib antiarrythmic agent, in view of its reported role in various chronic painful conditions. Dramatic improvement was observed with its use. Both patients improved after several weeks of use, and there were fewer soaking episodes. We observed no adverse effects with mexilitine therapy

Health of people working/living in the vicinity of an oil-polluted beach near Karachi, Pakistan

A short-term study was conducted after the oil spillage from the tanker Tasman Spirit to analyse seawater and sand samples taken from Karachi beach for hydrocarbon/organic contents. Blood samples were collected from people who were working or living in the vicinity of the beach. Lymphocyte and eosinophil levels were slightly increased. About 11 people had raised serum glutamic pyruvic transaminase, but this was not significant. Such steps are vital to ensure that there are no long-term hazardous effects of oil on human health

Cardiac metastasis in malignant fibrous histiocytoma

Malignant fibrous histiocytoma [MFH] is an aggressive spindle cell cancer and is the most common soft tissue tumor in the elderly, primarily affecting the extremities. It has high metastatic potential and can spread to various viscera including liver, lung, bone, and brain; however, cardiac metastasis is an extreme rarity. Here, we present a 50-year-old male, diagnosed as pleiomorhphic storiform MFH a of right arm who developed parenchymal pulmonary metastases and a mass lesion in left atrium. Patient had a downhill course and eventually succumbed

importance of ethics in health care system

Ethics form the base ground of values which differ from one culture to another. Ethics was applied in health care system, since ancient Egyptian times. A physician has moral obligations towards his patient based on physician -patient's relationship. The ethical principle of confidentiality confirms that patient can trust his health care provider not to disclose any information that the patient may have given in order to get cured. A current ethical issue in research involving human participant's informed consent has prime importance. The subject and his guardian must have the capacity to understand the issue in question and the possible risks of treatment in the trial study. We need to do more to ensure that medical research practices are sound and ethical, and the goals of research should be secondary to the well-being of the participants