Single flexible postprandial plasma glucose test as a new screening modality for diabetes mellitus

The study was aimed at assessing the adequacy of single flexible potprandial plasma glucose [FPPPG] test with time of sampling between 30-120 min after breakfast/meal as a screening test for diabetes mellitus and IGT. Cross sectional study. Study was carried out in the Department of Chemical Pathology and Endocrinology at Armed Forces institute of Pathology, Rawalpindi from January to November 1995. Eighty eight consecutive patients referred to AFIP for oral glucose tolerance test were included. The ages of patients ranged from 30-65 y. In the first step, on day 1 oral glucose tolerance test and in the second step, on day 2 flexible time based postprandial plasma glucose [FPPPG] 30-120 min after breakfast/snack/meal were performed. 12 patients did not turn up on day 2 for FPPPG test. In this study we performed FPPPG test on 76 patients as a screening test, with a cutoff point of 7.0 mmol/l. The study revealed that all 22 diabetic patients [100%] had levels above the limit whereas, 15 [83.3%] out of 19 patients of IGT had levels above cutoff level. On the other hand out of 35 healthy subjects only 2 [5.71%] had values above the limit. This study proposes a new screening test [FPPPG] for diabetes mellitus and IGT, which has a sensitivity of [100%], specificity of [66.7%] and positive predictive value of [55%]

Histamine receptors; responses and modulations towards agonist and antagonist on the rabbit ileum, in vitro study

This research work deals with the mechanism of action involved in determining the therapeutic potential of histamine and its blockers in gastrointestinal motility. Rabbits of equal weights were used in this study. They were brought from the animal house of BMSI, sacrificed in the Pharmacology Research laboratory. lleum strip were isolated and with special recommended methodology, longitudinal and circular muscles were separated. Individual muscle strip were then exposed separately to the desired drugs in the organ bath and reading were recorded on the polygraph machine. Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. 1996 to 1998. Histamine increases the contractile effects of longitudinal and circular muscle. H[1] and H[2] blockers potentiate its effects on longitudinal muscle while in circular muscle no change was observed with H[1] blocker whereas H[2] blocker antagonized the histaminic effects. However when H[1] blocker applied directly it increases the amplitude of contraction in longitudinal and circular muscle whereas H[2] blocker decreases the height of contractions. Histamine in the presence of H[1] and H[2] blocker augmented their effects in longitudinal muscle and antagonizes in circular layer. Gastrointestinal motility can be controlled through histamine and its antagonist. New drugs can be formulated on the basis of this study for the regulation of intestinal motility

Effect of prostaglandin F[2] alpha and indomethacin on the rabbit ileum; invitro study

The smooth muscle of gastrointestinal tract undergoes almost continuous but slow electrical activity. This activity tends to have two basic types of electrical waves. Slow electrical waves are generated in the longitudinal muscle layer of small intestine and are not found in the circular muscle in the absence of longitudinal muscle. The other waves are peristaltic waves which are a reflex response. The purpose of the study was to deal with the mechanism of action involved in determining the therapeutic potential ofPGF2a and its antagonist in gastrointestinal motility. Rabbits of equal weights were brought from the animal house of BMSI and sacrificed in the Pharmacology Research laboratory. Ileum strips were isolated and with a special recommended methodology, longitudinal and circular muscles were separated. Individual muscle strips were then exposed separately to the desired drugs in the organ bath and readings were recorded on the polygraph machine. The study was performed at Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center, Karachi from 1996 to 1998. PGF[2]alpha decreases the contractile effects of longitudinal muscles whether applied before or after the antagonist whereas in circular muscle it increases the amplitude of contraction. Indome-thacin antagonizes the effects of PGF[2]alpha in both longitudinal and circular muscle. Secondly when indomethacin applied directly it causes reduction in the amplitude of contraction in longitudinal muscle and increase in the force of contraction in circular muscle. Prostaglandin has a definite role on the smooth muscle ofileum; hence can be used in the regulation of intestinal motility. New drugs as an analogue or as an antagonist can be developed on the basis of these results

Organophosphate poisoning in the urban population; study conducted at National Poison Control Center, Karachi

The present study was performed to evaluate the patients suffered from pesticide poisoning during four years [1999-2002]. The study conducted at National Poison Control Center, Karachi. The patients were categorized according to the severity of poisoning ranges from mild, moderate to severe and designated as A, B and C. Laboratory tests included blood complete picture, serum urea, creatinine, electrolyte and serum cholinesterase. S. Cholinesterase was checked on zero day of admission, repeated after 24 hrs., 3rd day, 5th day and 7th day. The results revealed that 44.97% had S. Cholinesterase level below the normal value, 33.21% landed within threshold range while 13.10% had their value above 10000 IU/ml. Other parameters showed altered haemoglobin, WBC count and S. Electrolytes. We suggest that the need of the day in developing countries is to educate the people, launch programs to change their attitude, train them regarding the safety profiles of pesticide use and implementation of law in true sense

Evaluation of suspected chronic pesticide poisoning among residents near agriculture fields

The present study was performed to evaluate the incidence of organophosphorus toxicity among agrarian and non agrarian subjects residing near agriculture fields. The location of this study was Nawakot village, Multan. From the cotton producing area of Multan, 225 volunteers [farmers] including 103 females and 122 males were selected. Children <12 years of age constitute 15% of the population. A total of 100 volunteers [non agrarians] from Multan city were taken as control. Blood [4 ml] was drawn from the volunteers to test the level of acetylcholine estrase [Ach E] in plasma. The blood samples were then analysed at the laboratory of National Poison Control Center [NPCC]. Organo-phosphate [OP] and carbamates [CM] both act to block Ach E hydrolysis, necessary for synaptic response in the CNS. Acute illnesses were seen in 6 [2.67%], children [group 1]. They had fever and signs of pulmonary infections. Generalised weakness was found in 9 males and 13 females. Paraesthesia was found in 11 volunteers of group IV. Blood sampling test revealed that 6 volunteers [2.67%] had plasma Ach E below 5300 IU/ml [< 50% reduction], whereas 4 volunteers had Ach E level between 5300 - 5500 IU/ml [< 45% reduction], 81 volunteers fall in group "c", and 126 individuals had an Ach E reduction of at least 25% and 8 volunteers had the serum cholinesterase level above 10000 IU/ml. None of volunteers had the value above 11000 IU whereas plasma Ach E level of control population was between 11500 - 13500 IU/ml. Medical tests of the level of Ach E in plasma suggest that the overall incidence of poisoning from exposure to OP and CM is quite high, and appears to be consistent with the results from other studies in other developing countries

comparative study of kinetic parameters of alprazolam in hepatic and renal insufficient patients

To compare the kinetic parameters of Alprazolam in both hepatic and renal insufficient patients. Jinnah Postgradute Medical Institute, Karachi. Blood samples were collected from three groups of the patients after giving tablet Alprazolam [0.25 mg B.D] for 21 days. These samples were then analyzed for kinetic parameters i.e. Plasma half life, clearance, plasma concentration and volume of distribution. The parameters included plasma concentration of Alprazolam, clearance [cl], serum alkaline phosphate, serum bilirubin and serum glutamate pyruvate transaminase. Patients were divided into three groups i.e. 1] control, 2] suffering from renal insufficiency, 3] suffering from hepatic insufficiency. On day seven and day twenty one, in the same group [both renal], plasma conc. and t 1/2 increased while Vd and cl decreased. On the other hand in the same group [both hepatic], on day 7 and 21, plasma conc. and t 1/2 increased while Vd and cI decreased. When comparative study done on day 7 and 21 in opposite groups [renal vs hepatic], plasma conc., Vd and t 1/2 increased while cI decreased. In hepatic insufficiency, the doses of Alprazolam [benzodiazepines] should be reduced but in renal insufficiency doses should be reduced in only severe forms of renal dysfunction

Snakebite: identification, prevalence and management

Bites from venomous and non-venomous snakes occur throughout the world, but are particularly important in tropical and subtropical regions, where the large number of snake species and the rural lifestyle of the population can lead to significant morbidity and mortality. To determining the goals for reducing the morbidity and mortality as we have tried to explore the every aspect of the incidence. Jinnah Postgraduate Medical Center, Karachi. Clinical confirmation of snakebite with envenoming was by identification of the dead snake brought by victims and by clinical signs and symptoms such as paralysis [krait and cobra] and rapid progressive local edema with active bleeding [viper]. Whole blood clotting test is a simple, rapid and reliable test of coagulopathy. It is also of use in assessing the effectiveness of ASV and is of crucial importance for controlling administration of expensive ASV in relation to restoration of blood coagulability. 130 [57.27%] patients were bitten from cobra and krait whereas 63 [27.76%] individuals were suffered from viper bites. 6 [2.64%] cases were victimized by sea snakes while 28 cases were bitten by some other species labeled as non venomous variety [Graph II]. These 28 cases did not have any signs of systemic envenoming. Among all snakebite victims 33[14.54%] developed complications like severe bleeding, jaundice, acute renal failure, intracranial bleed and respiratory failure. 25 [11.01%] deaths were ensue while remaining 202 were completely recovered. It was observed that Cobra, Krait, Russell's viper commonly called Dabois whereas saw scaled viper locally called as Lundi or Jalebi are responsible for practically all the snakes bite cases. As venom secretion is greater in the months of May to September the incidences of snakebite cases are higher in these months

Role of 5HT in the modification of intestinal motility, in vitro study

To determine with the mechanism of action involved in the therapeutic potential of serotonin and its blocker on gastrointestinal motility. The standard method was used for obtaining the longitudinal and circular muscles strip of rabbit ileum for in vitro studies. Each muscle strip was exposed to serotonin and its blocker and the result obtained was recorded on polygraph apparatus. The effects were recorded in vice versa fashion i.e. agonist v/s antagonist and antagonist v/s agonist on longitudinal and circular muscle strip separately. Serotonin had depressant effect on the force of contraction. On addition of antagonist in the presence of agonist, the effects were increased. Longitudinal muscle showed more pronounced effect i.e. 52.7% with methysergide in comparison to circular muscle, which was 15.6%. Circular muscle showed reduction in the force of contraction with serotonin, which was increased on addition of antagonist, but still below the level of base line contraction. Serotonin when given from external source in vitro, decreased the force, however, there was minimal increase in the rate of contraction. Hence, serotonin decreases the intestinal motility giving an impression of having antispasmodic effect. The results of this study can be utilized in the development of new drug related to G.I. motility mediated through 5HT receptors

Drug overdose; study conducted at national poison control center

A prospective study of 588 cases of drug overdose was carried out in National Poison Control Centre [NPCC], Jinnah Postgraduate Medical Centre Karachi [JPMC] from 1999-2002. It was done to determine the incidence of renal, hepatic, respiratory, neural and cardiac injuries or toxicity. In this study all age groups were included above 8 years. various investigations were carried out that include blood CP, sugar, electrolytes, urea, creatinine, blood gases, electrocardiogram, ultrasound and Urine examination. The drug Overdose cases admitted from 1999-2002 were exposed to various drugs, such as benzodiazepines, barbiturates, non-steroidal anti-inflammatory drugs [NSAID], beta-blockers, carbamezapine, and Vitamin-A. The mortality rate was 2.89% with a male/ female ratio of 76.47%: 23.53%. However the recovery was 94.22%. These drug overdose cases were found to be the consequences of suicidal, accidental or homicidal attempts. This study may help in determining the goals for reducing the morbidity and mortality of drug over dose as it shows the rate of incidence, gender ratio, clinical presentations, diagnostic evaluations, complications, management, outcome and medicolegal aspects

Effects of Azelastine and Sodium cromoglycate in the inhibition of Broncho - Constriction of ovalbumin sensitized Lung Parenchymal Tissues of Guinea Pigs in Vitro

To see the ability of Azelastine and Sodium cromoglycate in influencing antigen induced contractile responses in isolated parenchymal tissues of Guinea pig in vitro. An experimental study. Department of Pharmacology and Therapeutics of Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center [JPMC], Karachi during 1998. The Guinea pigs [n=10] were sensitized with ovalbumin and their parenchymal strips were exposed to different concentrations of ovalbumin to observe the EC50. Each sensitized parenchymal strip was treated with either Azelastine or Sodium cromoglycte in an organ bath for 10 minutes and treated with EC50 ovalbumin and contraction was recorded by Grass Polygraph model 7B. EC50 [n=6] of parenchymal strips [0.3x10-6 + 0.16x10-6g/ml] produced a mean response of contraction 9+0.44mm. Azelastine in concentration of 10-9 g/ml did not show any inhibitory effect but as the concentration increased to 10-8 g/ml, marked inhibition was recorded and with further increase in concentration by 10-7 g/ml, it completely antagonized the EC50 induced contraction. Sodium cromoglycate did not show any inhibition at concentration 10-8 g/ml while at higher concentration of 10-6 g/ml, it showed complete antagonism. Ovalbumin induced contraction of sensitized lung parenchymal tissues of Guinea pig in vitro is dose dependent and controlled better with Azelastine than Sodium cromoglycate

Stroke; therapeutic potentials

Stroke was defined according to WHO criteria as rapidly developing symptoms and I or signs of focal and at times global loss of cerebral function with no apparent cause other than that of vascular disease[1]. Stroke is grossly divided into either[2] 1]. Thrombotic. 2]. Embolic. 3].Hemorrhagic type [Which may be either intra cerebral bleed or subarachnoid hemorrhage]. The brain, like other organs of the body, requires an adequate vascular system in order to supply it with nutrients and oxygen and to remove metabolic wastes and carbon dioxide. Stabilization of medical problem with careful monitoring, and active prevention and timely management of secondary complications are of the utmost important for reducing stroke morality rates and avoiding further ischemic brain injury. For the ischemic cerebral lesion itself, as yet no treatment or combination of treatment has been established to be universally effective[3]. However, current studies allow for the following 5 potential therapeutic areas to be identified