Ethnobotanical profiling of the medicinal flora of Kotli, Azad Jammu and Kashmir, Pakistan: Empirical reflections on multinomial logit specifications

OBJECTIVE@#To report the indigenous people's uses of plants from a multidimensional perspective in a remote area where strong ethnobotanical cultural practices prevail.@*METHODS@#An ethnobotanical survey was conducted in the field during 2014-2016. Ethnobotanical data were gathered from 182 informants through oral interviews and semi-structured questionnaires. The distribution of plants was explored using both descriptive and graphical methods. Further, a Multinomial Logit Specification was applied to find out the probability of the occurrence of diverse utilization of plants in multipurpose domains.@*RESULTS@#The study identified 202 plant species distributed among 71 families and 156 genera. Ethnobotanical data indicate that there are more medicinal (36.96%) uses of plants as compared to all other use categories. The output from the Multinomial Logit Specifications (MLS) model reveals that perennial and non-woody plants are exploited more for medicinal and food uses than annual and woody plants. In the context of ethnomedicinal uses, aerial plant parts particularly leaves are more extensively used for the preparation of herbal recipes as compared to underground parts.@*CONCLUSIONS@#The results of the study emphasize the need to create awareness among the local communities about the conservation status of plant species in order to maintain a sustainable resource of plant-derived materials into the future. The novel econometric approach employed in this study adds a new insightful methodology to the existing body of literature in the field of ethnobotany. We strongly recommend conservation measures, alongside phytochemical and pharmacological studies on the useful plant species identified in this study in order to ensure their sustainable and effective utilization.

Ethnobotanical profiling of the medicinal flora of Kotli, Azad Jammu and Kashmir, Pakistan: Empirical reflections on multinomial logit specifications

Objective To report the indigenous people's uses of plants from a multidimensional perspective in a remote area where strong ethnobotanical cultural practices prevail. Methods An ethnobotanical survey was conducted in the field during 2014–2016. Ethnobotanical data were gathered from 182 informants through oral interviews and semi-structured questionnaires. The distribution of plants was explored using both descriptive and graphical methods. Further, a Multinomial Logit Specification was applied to find out the probability of the occurrence of diverse utilization of plants in multipurpose domains. Results The study identified 202 plant species distributed among 71 families and 156 genera. Ethnobotanical data indicate that there are more medicinal (36.96%) uses of plants as compared to all other use categories. The output from the Multinomial Logit Specifications (MLS) model reveals that perennial and non-woody plants are exploited more for medicinal and food uses than annual and woody plants. In the context of ethnomedicinal uses, aerial plant parts particularly leaves are more extensively used for the preparation of herbal recipes as compared to underground parts. Conclusions The results of the study emphasize the need to create awareness among the local communities about the conservation status of plant species in order to maintain a sustainable resource of plant-derived materials into the future. The novel econometric approach employed in this study adds a new insightful methodology to the existing body of literature in the field of ethnobotany. We strongly recommend conservation measures, alongside phytochemical and pharmacological studies on the useful plant species identified in this study in order to ensure their sustainable and effective utilization.

Preload Versus Coload and Vasopressor requirement for the prevention of spinal anesthesia induced hypotension in non-obstetric patients

Objective: To compare the effectiveness of preload and coload for the prevention of Spinal Induced Hypotension [SIH] and vasopressor requirements

Study Design: Randomized trial

Place and Duration of Study: Department of Anesthesia, The Aga Khan University Hospital, Karachi, Pakistan, from June 2007 - June 2010

Methodology: Sixty patients were randomly divided into preload and coload group of 30 each. Patients with ASA 1 - 3, aged 20 - 60 years were included. Patients with history of IHD, COPD, BMI > 30 and surgical procedure TURP were excluded. All patients received crystalloid 10 ml/kg before induction of spinal anesthesia in preload group and at the time of spinal anesthesia in coload group. Blood pressure and heart rate were recorded at different time intervals till 45 minutes. Patients received ephedrine 5 mg when systolic blood pressure dropped below 90 mmHg and heart rate was less than 60 beats/minute and/or phenylephrine 50 micrograms when systolic blood pressure dropped below 90 mmHg and heart rate was more than 60 beats/minute

Results: There was no statistically significant difference at different time intervals in heart rate, systolic and mean arterial pressure between the groups. Diastolic blood pressure was significantly different in both groups at 6 - 15 minutes after spinal anesthesia. SIH occurred [21] 70% and [15] 50% in preload and coload groups, respectively [p=0.187]. Ephedrine requirement for SIH was significantly high in preload group [p=0.017]. Phenylephrine requirement for SIH was high in preload group which was statistically non-significant [p=0.285]

Conclusion: Coload group has lower incidence of spinal induced hypotension and significantly less vasopressor requirement than the preload group

Comparison of morbidity of three flank approaches for open renal surgery

The aim of this study was to compare the morbidity of three flank incisions, subcostal, transcostal and supracostal for open renal surgery in terms of incision times, postoperative pain, postoperative hospital stay and long term complications. Prospective comparative and analytic study. This study was conducted at Department of Urology, Nishtar Hospital Multan and Department of Urology, Ghulam Mohamed Maher Medical College/Teaching Hospital Sukkur from January 2007 to December 2011. In this study twelve hundred sixty [n-1260] patients who underwent open surgical procedures over a period of five years are analyzed. Patients were studied in three groups. Group A, subcostal,[n-407] 32.3%. Group B transcostal [n-526] 41.7% and Group C, supracostal, included [n-327] 25.9%. Mean incision time in Groups A, B and C was 17.3 min, 21.08 min and 23.81 min respectively. Mean amount of injectable analgesic required in first three post operative days in Groups-A, B and C was 41.36 mg, 46.87 mg and 49.40 mg of Nalbin respectively. Mean Post operative hospital stay in Group A Band C was 4.63, 5 days and 4.64 days respectively. Pleural injury was none in Group A, thirty five [n- 35] cases [6.61%] in Group B and thirty nine [n-39] cases [11.9%] in Group C. Incisional hernia was noted in Group A 12 cases 3%, Group B 6 cases 1.1 % and none in group C. With subcostal approach, incision time, dose of analgesia and pleural injury is minimum but high incidence of incisional hernia is there. In transcostal and supracostal approach the incision time, dose of analgesia and incisional hernia is minimum but incidence of pleural injury is relatively high

Effects of coronary artery bypass grafting on QT dispersion

Abnormal dispersion of QT interval [QTd] measured as the interlead variability of QT, reflects an in homogeneity of ventricular action potential. This is increased in coronary artery disease [CAD] due to ischemia of myocardium

Aims and Objectives: To determine / investigate the values of QT dispersion in our population. To investigate whether there is any short term influence of coronary artery bypass grafting [CABG] on QT dispersion, evaluated early [7 days] after surgery

Design of study: Single center observational study

Site of study: Department of Cardiology and Cardiothoracic Surgery, Shaikh Zayed Hospital, Lahore

Patients and Methods: A total of 50 consecutive patients, who underwent CABG in Shaikh Zayed Hospital, were included in the study. All the patients were given the standard therapeutic treatment for the management of ischemic heart disease [IHD]. Biochemical lab data including complete blood count, blood sugar level, serum electrolytes, urea and creatinine was collected and assessed for any abnormality before the operation. A twelve lead electrocardiogram [ECG] was recorded during a resting period in all patients planned for CABG 24 hours before surgery. ECG was repeated 48 hours after operation and at the time of discharge from the hospital. QT interval was calculated from the onset of QRS complex to the point of return of 'T' wave to isoelectric line or to the nadir between 'T' wave and 'U' wave, in cases where a 'U' wave was present. QT dispersion was measured as the difference between maximum and minimum QT from the 12 lead ECG

Results: The mean QTd in healthy individuals was [53.60+/-19.56 ms] [p=0.000]. There was significant reduction in QTd from 24 hours before CABG to 48 hours and seven days after CABG [74.80+/-28.59 ms] [p=0.000] vs. [46.40+/-17.82 ms] [p=0.000] and [33.20+/-15.44 ms] [p=0.000] respectively

Conclusion: There is a significant reduction of QTd early after CABG. It seems that QTd is a simple non-invasive and a reliable mode for detecting coronary ischemia and also for evaluating the effects of revascularization

Frequency of Angiotensin Converting Enzyme Inhibitor [ACEI] induced cough

The objective was to assess the frequency of ACE inhibitor induced cough in our patients. The study was prospective open labeled one centre, in and out patients of cardiology department Sheikh Zayed Hospital, Lahore 2011. 200 patients using six different types of ACEI were used. Preference was given to patients to whom ACEI were prescribed for the first time. Patients with chronic respiratory diseases were excluded. Patients were follwed up on fortnightly basis for three months. On each visit besides recording their blood pressure, they were not specifically inquired about occurrence of any cough. Patients themselves came with the complaint of cough. The dry cough frequency with different ACEI was 17%, ranging from almost 20% with Enalopril, 16.6% with Captopril, 10% with Lissinopril and Ramipril, 15% with Qurinapril and Perindopril. The dry cough was moderate in the majority of our patients and they were not willing to continue their ACEI, although their blood pressure was well controlled with it. They were switched over to other group of anti hypertensive drugs. Incidence was almost same in males and females. ACEI have a relatively high frequency of dry cough and our patients don't want to take it if cough occurs

Frequency of clot in left atrium [LA] in patients of severe mitral stenosis [MS] with atrial fibrillation [AF]

To determine the frequency of clot in left atrium [LA] in patients suffering from tight mitral stenosis [MS] with atrial fibrillation. A cross-sectional descriptive type study at two centers was performed. A total of 50 adult patients with tight MS and AF were included. A 12 leads electrocardiography was performed once for each patients to look for AF after transthoracic echocardiography [TTE] and clinical examination features revealed tight MS. Patients with AF were selected and TTE was done to detect clot in LA. Tran esophageal echocardiography [TEE] was performed whenever clot could not be detected with TTE. Among 50 patients studied. There were 20 males and 30 females, TTE was done of all patients and LA clot were detected in 10 patients [20% of total] and TEE were performed in remaining 40 patients [80% of total] and additional 12 patients [24% of total] with clot in LA were detected. Therefore total of 44% of patients had LA clot. Among them 4% had clot in LA body and 40% had in LA appendage. LA dimension was found to be relevant [P value = 0.004] with the presence of clot in patients of severe MS with AF. LA spontaneous echo contrast [LASEC] was found in all patients. LA clot was present in 44% patients with tight MS and AF. Larger LA diameters is a strong predictor- of presence of LA clot in severe MS with AF

Thrombolysis in acute thrombosis of metallic mitral valve: case report

Prosthetic valve thrombosis is a potentially life-threatening complication associated with high morbidity and mortality. Transthorasic and transoesophageal echocardiography play an important role to the diagnosis and provides incremental information about the optimal treatment strategy, while fluoroscopy is a low-cost, noninvasive imaging technique, with limited radiation exposure that allows the correct evaluation of opening and closing angles and can add diagnostic value to echocardiography. Guidelines differ on whether surgical treatment or fibrinolysis should be the treatment of choice for the management of left-sided prosthetic valve thrombosis and these uncertainties underline the need for further prospective randomized controlled trials. Thrombus size, New York Heart Association functional class of the patient, the possible contraindications, the availability of each therapeutic option and the clinician's experience are important determinants for the management of prosthetic valve thrombosis

Role of red raisins [Monaka] in dyslipidemic patients

Introduction: Red Raisins [Monaka] are dried large sized red grapes. They contain some constituents common with red wines, which may play a crucial role in modulating lipoprotein metabolism, eicosanoid synthesis, oxidation and coagulation

Objective: Our objective was to assess the lipid altering efficacy and tolerability of MONAKA. Centre of Study: Department of Cardiology, Shaikh Zayed Hospital, Lahore. Duration of Study: Monaka was given to patients for 04 months. Design of Study: Interventional quasi experimental study

Methods: A total of 33 patients, aged 24 - 72 years, maintained on lipid lowering diet and having baseline total cholesterol > 240mg/d1 or LDL-C > 150mg/d1 or IML-C < 35mg/d1 were included in the study. Seven pieces of 'Monaka' twice a [lay as a monotherapy was given for 16 weeks and subjects reassessed thereafter. 26 patients completed the trial

Results: There was a ineaii reduction of total cholesterol of 11.39%, LDL-C of 16.33% and HDL-C of 7.58%, which were highly significant with p <0.002, < 0.001 and <0.031 respectively. 'Monaka' was well tolerated with one subject each having expistaxis, bleeding piles and diarrhea. One subject had difficulty controlling blood sugar and 03 were noncompliant

Conclusions: Monaka may be used as a lipid lowering agent but it needs more long term studies with larger number of patients and longer follow up

Heart rate variability in early phase of acute myocardial infarction and convalescence

This study was done to evaluate the degree of change in autonomic activity, manifested as heart rate variability [HRV], from acute phase of MI to convalescent period of AMI. Design: Single center, observational prospective study. Place and Duration of Study: Department of Cardiology, Shaikh Zayed Hospital, Lahore. The study was completed in one year from June 2000 to July 2001. Subjects and Thirty consecutive patients presenting within 24 hours of an ST segment elevation AMI with or without thrombolysis were included. First 24 hour Holter recording was done within 24-36 hours after AMI and the second was done before discharge. The mean hospital stay was 7.07 +/- 2.56 days. Mean duration between the two recordings was 5.47 +/- 2.36 days. The mean standard deviation of normal sinus interval [SDNN] was 65.07 +/- 25.11msec and 63-97 +/- 23.38msec; mean standard deviation of averaged sinus beats for 5 minutes segments of entire recording [SDANN] was 51.27 +/- 18.57msec and 55.83 +/- 19.65msec and mean SDDN index was 34.57 +/- 17.15msec and 30.57 +/- 14.89msec during early phase of acute MI and pre-discharge recordings respectively. There was no statistically significant difference in HRV between early phase of acute myocardial infarction and of pre-discharge recordings. HRV may be monitored for risk stratification at any time post AMI prior to discharge