Dapagliflozin, a sodium glucose cotransporter 2 inhibitors, protects cardiovascular function in type-2 diabetic murine model

Diabetes mellitus and its complications are major international health problems in which there are many limitations to the orthodox approaches in the treatment. Sodium glucose cotransporter 2 (SGLT2) inhibitors are a new class of diabetic medications, with a different mechanism of action that may reduce risk of cardiovascular complications. To evaluate the effect of SGLT2 inhibitor monotherapy on cardiovascular complications in patients with type-2 diabetes and to compare its effect with the first-line therapy, metformin. Eighty rats divided into four groups were used: nondiabetic, diabetic nontreated, diabetic ? met and diabetic ? dapa. At the end, the arterial blood pressure and cardiac performance were assessed. Glycemic index, lipid profile, total antioxidant capacity, malondialdehyde, tumour necrosis factor a were measured. DNA changes were assessed from the hearts and aortae. Aortic tissue changes recorded using haematoxylin and eosin, Masson trichrome and iNOS immune stain. Glycemic index, lipid profile, oxidative stress and inflammatory parameters were significantly improved in both metformin and dapagliflozin treated groups with significant improvement in blood pressure and cardiac performance. Also, there were noticeable significant reduction in DNA fragmentation in aortic and cardiac tissues and reduction in collagen deposition and iNOS expression in aortic tissue. Dapagliflozin treatment results’ significantly surpassed improvement of metformin treatment nearly in all parameters. Total genomic DNA extraction proved that SGL2 inhibitor (dapagliflozin) has superior glycemic control and cardiovascular protective effect over metformin especially in type-2 diabetes with high fat intake.

Cephalosporin resistance in community acquired spontaneous bacterial peritonitis

Objective: To determine 3rd generation cephalosporin resistance in patients with community-acquired spontaneous bacterial peritonitis [SBP] using early response assessment

Methods: This prospective quasi-experimental study was carried out at Doctors Hospital and Medical Center from January 2016 to September 2018. Patients with cirrhosis and SBP were included. Third generation cephalosporins i.e. cefotaxime/ceftriaxone were used for treatment of SBP. Response after 48 hours was assessed and decline in ascitic fluid neutrophil count of < 25% of baseline was labelled as cephalosporin resistant. Carbapenem were used as second line treatment. Recovery and discharge or death of patients were primary end points

Results: Male to female ratio in 31 patients of SBP was 1.2/1 [17/14]. Hepato-renal syndrome was diagnosed in 11[37.9%] patients. Cefotaxime was used for 16[51.6%] patients whereas ceftriaxone for 15[48.3%] patients. Early response of SBP was noted in 26[83.8%] patients while 5 [16.2%] were non-responders to cephalosporins. SBP resolved in all non-responding patients with i/v carbapenem. In-hospital mortality was 12.9% and had no association with cephalosporin resistance. High bilirubin [p 0.04], deranged INR [p 0.008], low albumin [p 0.04], high Child Pugh [CTP] score [p 0.03] and MELD scores [p 0.009] were associated with in-hospital mortality

Conclusion: Cephalosporin resistance was present in 16.2% of study patients with community-acquired SBP. Mortality in SBP patients is associated with advanced stage of liver disease

Is peripheral neuropathy a part and parcel of chronic hepatitis-c in south asian population?

Introduction: Management of chronic Hepatitis C and its complications is a major concern for physicians. Peripheral neuropathy is a disease affecting the nerves, and is one of the complications of Hepatitis C

Objective: The aim of this study is to determine the prevalence of peripheral neuropathy in chronic hepatitis-C patients. Study design and duration: The type of study is a cross-sectional study, which was conducted over a period of one month from 01-11-2015 to 30-11-2015

Setting: The study was conducted at a tertiary care hospital in Karachi, Pakistan

Sample size and procedure: The study population consisted of a random sample group of 139 Hepatitis C positive patients who presented to the Internal Medicine Department either via out-patient clinic or via emergency. After due informed consent, variable such as demographic data and type and degree of neuropathy were recorded. All the Hepatitis-C patients who presented to us during that time were evaluated clinically, serologically and electrophysiologically. Data Analysis: Data was analyzed using SPSS version 20

Results: Out of the total study population of n= 139 patients peripheral neuropathy was present in n= 77 [55.39%] of the patient population; n= 3 [2.15%] had sensory type of neuropathy, n=13 [9.35%] had motor neuropathy and n= 61 [43.88%] had mixed type of neuropathy

Conclusion: According to the results of our study there is a significant association of peripheral neuropathy with hepatitis C in patients in South Asian population as more than hald of the participants had some form of peripheral neuropathy.

Sofosbuvir based therapy in Hepatitis C patients with and without cirrhosis: Is there difference?

Objective: To compare sustained viral response to sofosbuvir/ribavirin +/- interferon therapy in patients of hepatitis C with and without liver cirrhosis

Methods: This observational study of chronic hepatitis C patients was carried out at Doctors Hospital and Medical Center [DHandMC]. After diagnostic workup, Sofosbuvir/ribavirin for 24 weeks or sofosbuvir/ribavirin/pegylated interferon for 12 weeks were prescribed. Primary outcome was negative HCV RNA by PCR 12 weeks after treatment completion SVR[12]. Chi square Chi[2] and student's t test were used to analyze data

Results: Of 216 patients included, liver cirrhosis was present in 112 [51.9%] patients and 69[31.9%] were treatment experienced. Liver disease was decompensated in 37 [17.1%] patients. Of 206 patient who completed study protocol, 173[83.1%] achieved SVR[12], 89.2% [25/28] with triple therapy and 82.2% [148/180] with sofosbuvir/ribavirin therapy. Treatment response was similar between treatment naïve 86.2% [119/138] and treatment experienced 79.4% [54/68] patents. [p value 0.19] SVR[12] was inferior in cirrhosis patients 75.4% [80/106] as compared to those with no cirrhosis 93% [93/100] [p value < 0.000]. It was even lesser in those with decompensated liver disease 68.8% [24/35] [p value < 0.000]

Conclusion: Treatment outcome with sofosbuvir/ribavirin combination therapy in cirrhosis patients is suboptimal especially in those with decompensation as compared to patients without liver cirrhosis

AAA syndrome, case report of a rare disease

Triple A [Allgrove] syndrome, an autosomal recessive disease is characterized by achalasia, alacrimia and ACTH-resistant adrenal failure with progressive neurological syndrome including central, peripheral and autonomic nervous system impairment, and mild mental retardation. The triple A syndrome gene, designated AAAS, localized on chromosome 12q 13 encodes for a 546 amino acid protein called ALADIN [Alacrimia-Achlasia-Adrenal Insufficiency and Neurologic disorder]. This report relates to two sisters, aged 8 and 12 years, who had vomiting, muscle weakness, alacrimia, excessive fatigue and dysphagia. Abdominal sonography, esophago-gastroduodenoscopy, barium swallow, esophageal manometry, CT scan abdomen and brain, biochemical profiles, as well as neurologic and ophthalmic evaluations were consistent with Allgrove's syndrome. Management consisted of pneumatic balloon dilatation for achalasia and initiation of cortisone therapy with successful resolution of dysphagia and other symptoms

Validity of modified alvarado scoring system [mass] in the diagnosis of acute appendicitis

Objective: To determine the validity of Modified Alvarado Scoring System [MASS] in the diagnosis of acute appendicitis. Study Design: Cross sectional validation study. Place and Duration of Study: Department of Surgery Combined Military Hospital [CMH] Kohat Pakistan, from Nov 2013 to Oct 2014

Material and Methods: A total of 248 patients fulfilling the inclusion criteria were enrolled in the study after getting the informed written consent. Modified Alvarado Score of all patients was calculated on a proforma which included migratory right iliac fossa pain, anorexia, nausea/vomiting, tenderness in right iliac fossa, rebound tenderness, elevated temperature and leucocytosis [>10 x 109/L]. Surgeries were performed by residents and consultant surgeons. Decision to operate upon was not only on the MASS of the patients rather it was on overall clinical condition of the patients using different scoring systems. Where required aid of different laboratory investigations, ultrasonography, CT scan and laparoscopy was also taken. After surgery histopathological examination of resected specimens was performed. Pre operative modified alvarado score and post operative histopathological results were endorsed on a proforma. A two by two table was used to determine the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of MASS

Results: Out of total 248 patients, 183 [73.8%] patients were males and 65 [26.2%] were females. Male to female ratio was 2.8:1. Sensitivity of MASS in this study was 89.39%, Specificity 84.06%, positive predictive value 93.57%, negative predictive value 75.32% and diagnostic accuracy was 87.90%

Conclusion: Modified alvarado score is a highly sensitive test with fair degree of specificity for the early diagnosis of acute appendicitis especially in the adults. It is particularly helpful for young doctors and in the peripheral hospitals where more sophisticated investigations are not available

Pneumatic Balloon Dilatation for Achalasia Cardia; Early and late results, a single center study

Objective: Achalasia Cardia is treated by Pneumatic balloon dilatation, Heller's Myotomy and recently, by Peroral Esophagaeal Myotomy. This study reports the efficacy of pneumatic balloon dilatation as a non-surgical motility in achieving relief of dysphagia, clinical improvement and recurrence. Long-term complications were reported

Methods: Eight hundred ninety two adult achalasia patients of both genders were treated from January 1988 till December 2011, with pneumatic balloon [Rigiflex Microvasive] dilatation, under fluoroscopy Barium swallow was obtained prior to and five minutes after dilatation to evaluate for efficacy of dilatation as well as for complications. Patients not responding to 30 mm balloon had repeat dilatation with 35 mm balloon after 8 weeks. All patients were enrolled in regular follow up at one, six months and yearly intervals up to a period of five years. Recurrence was defined as an increase in symptom score at 8 weeks greater than 50% of their baseline value. These patients were treated with 35 mm balloon or referred for surgical intervention

Results: Of 892 patients, follow up was obtained in 50% for 5 years, 9.2% for 4-years, 9.3% for 3-years, 10% for 2-years and 21.5% for 1-year of patients. One patient died after repeat dilatation. Eighty-eight patients were excluded from this analysis [20 died due to non-procedure related causes and another 68 were lost during follow up]. Statistically significant improvement was noted in reduction in height and width of barium column and symptom score coupled with weight gain during follow up. Forty-eight patients were subjected to repeat dilatation with 35 mm balloon, two of these developed post-procedure perforations with one mortality. Three non-responsive patients required surgical laparoscopic myotomy. No carcinoma of esophagus was reported during follow up. One patient post dilatation, developed esophageal bezoar. A single pneumatic dilatation achieved a remission rate of 93% at four years, 90% at three years, 95% at two years and 92% at one year post dilatation

Conclusion: Achalasia of esophagus can be effectively and safely treated with balloon dilatation to achieve adequate short and long-term symptomatic relief with a low complication rate

Hepatorenal syndrome: Response to terlipressin and albumin and its determinants

Objective: To determine the efficacy of terlipressin and albumin in improving renal functions in patient with hepatorenal syndrome [HRS] and to identify factors determinant of better response

Methods: In this quasi experimental interventional study patients of liver cirrhosis and ascites with HRS type I were treated with intravenous albumin and incremental dosage of terlipressin based on response with maximum dose of 12mg/day. Decline of creatinine below 1.5mg/dl was defined as complete response. Factors predictive of response to therapy were determined via linear regression analysis

Results: Twenty four patients were included with male to female ratio 3.8/1[19/5] and mean age 53.3 [ +/- 10.06]. Complete response to terlipressin/albumin was seen in 14 [58.3%] patients, seven [29.2%] achieved partial response with > 25% creatinine decline while three [12.5%] had no response. Lower serum creatinine at diagnosis [P value 0.003], absence of hyperkalemia[p value 0.005] and absence of portal vein thrombosis [p value 0.05] are associated with response to treatment in HRS. Baseline serum creatinine [p value 0.003] was independent predictor of response to therapy in multivariate analysis

Conclusion: Terlipressin and albumin is an effective treatment for HRS type I. Patients with lower baseline serum creatinine are more likely to respond to this therapy

Hep-net opinion about the management of patients with chronic hepatitis C in Pakistan in the era of available direct acting antivirals

In Pakistan, we have 4.9% prevalence of HCV in general population, with 79% genotype 3. Recently Sofosbuvir has been made available at compassionate price in Pakistan. Management of chronic hepatitis C includes counseling of HCV patients, their proper assessment to select those who need antiviral therapy, initiation of appropriate antiviral agents and duration of therapy, along-with careful monitoring for safety and efficacy. Hepatic status as well as previous history of HCV therapy needs to be taken in the consideration before starting antiviral therapy. Other factors include co-morbid conditions like obesity, DM, NASH, etc. Treatment of special populations like liver transplant patients, patients with HBV co-infection, chronic kidney disease and hemoglobinopathies need special considerations when initiating HCV therapy

study of demineralized and remineralized enamel and hydroxyapatite using nuclear magnetic resonance (nmr)

The study was conducted to observe if there is any difference in the chemical structure of demineralized and remineralized enamel and hydroxyapatite using solid state 3IP MAS NMR techniques. Chemical structure and composition of enamel and hydroxy apatite powder were analyzed using different acids i.e. hydrochloric acid, citric acid and acetic acid, of different molarities, followed by treatment in remineralizing solution for a time period of 1, 3, 6 and in some cases 7 days, using NMR. We expected to change current concepts of remineralizing and demineralizing processes of enamel and hydroxy apatite

Synthetic hydroxy apatite provided by Plasma Biotal was used for the experiments, while extracted teeth provided by tissue culture labs were used for the enamel. The enamel crowns were converted into powder using Gyro Mill. All the measurements for NMR were done in Bruker NMR spectrometer which had a magnetic field strength of 600MHz or 14.1 Tesla. The nucleus used for the experiments was Phosphorous-31. Changes were observed in the peak positions of HAP as well as enamel powder samples. Remineralized samples [both enamel and HAP] also showed increase in mass which may be due to precipitation of hydroxy apatite on consuming the ions, used from the remineralizing solution

This study provides a better insight into the remineralization and demineralization of enamel and HAP and the changes that take place in the chemical structure after and during the processes. The work also demonstrates that NMR is a very powerful and modern technique which can be used to detect structural changes in different complicated materials

Anticancer potential of bee venom and propolis combined treatment on human breast adenocarcinoma cell line [MCF-7]

Backgrounds: Natural remedies were used for cancer treatments, particular breast cancer. Also, the consumption of food products containing high amount of flavonoids and antioxidants had reported to lower the risk of various cancers. Bee venom [BV] and propolis were produced by honey bee. They were characterized by naturopathic formulation, affordability and containing high amount of antioxidants. Moreover, they were used safely since ancient times globally. Although that, there is no information about the synergistic or antagonistic anticancer effects of their combination. This study was designed to evaluate cytotoxic and pro-apoptotic effects of BV, propolis, and their combination on breast cancer [MCF-7] cells

Materials and Methods: As preliminary study, MCF-7 cells were treated with BV [5, 10, and 20micro g/ml] and propolis [50, 150, and 450micro g/ml] to specify the desired combination doses of each treatment with no anticancer effect individually. Consequently, doses of [5micro g/ml BV+ 50micro g/ml propolis and 5micro g/ml BV+ 150micro g/ml propolis] were chosen to evaluate the possible synergistic anticancer potential between them. All groups in this study were examined at 2, 4, and 12 hours intervals. The morphological changes were evaluated by acridine orange/ ethidium bromide dual fluorescent staining and Giemsa staining to reveal the formation of apoptotic bodies or nuclear condensation and cytoplasmic blebbing, respectively. DNA fragmentation assay was also carried out to record the reduction in DNA content and apoptosis. Bcl-2 expression, cytoplasmic anti-apoptotic marker, was used to prove the apoptotic properties, and autophagic cell death by florescent microscopy was evaluated also

Results: Morphological observation by inverted and florescent microscopy revealed apoptotic cell death under exposure to BV [10 and 20micro g/ml] and propolis [450micro g/ml]. On the other hand, the results of combined treatments revealed significant morphological alterations after fluorescent and Giemsa staining. Apoptotic DNA fragmentation was clearly observed and Bcl-2 recoded significant down regulation which proved the apoptotic properties of combined treatments. Additionally, autophagic degradation results also supported the occurrence of stress on treated cells leading finally to cell death. All results of powerful anticancer potential were obvious among all combined-treated groups in dose and time dependent manner. This clear that, the combined treatments have possible synergistic effect which, propose it as potential candidates to be used in development of chemotherapy

Predicting prognosis in hepatocellular carcinoma: comparison of staging systems in Pakistani cohort

To determine the clinical, biochemical and radiological prognostic indicators and to compare the performance of six staging systems in patients of hepatocellular carcinoma [HCC]. Descriptive study. Department of Gastroenterology, Doctors Hospital, Lahore, from October 2007 to December 2013. Patients with HCC were included. Baseline clinical, hematological and radiological variables were noted. Patients were followed for 5 years or till death. Survival predictors were identified using Cox proportional hazard analysis and 6 prognostic staging systems were evaluated by determining homogeneity, discriminatory ability and monotonicity. Of the 228 patients included, male to female ratio was 2.6/1 [165/63] and mean age was 56.5 +/- 10.4 years. Majority of patients 189 [82.9%] were anti-HCV positive. Solitary HCC lesion was seen in 121 [53.1%] patients, 16 [7%] had 2 lesions while 73 [32%] had 3 or more lesions. Only 36 [15.8%] patients had palliative therapy for HCC. Survival rate was 45.2%, 25%, 12.3%, 7%, 2.2% and 1% for 6 months, 1, 2, 3, 4 and 5 years respectively. Male gender, portal vein thrombosis, serum albumin < 3.5 g/dl, tumor size >/= 6 cm and alpha fetoprotein [AFP] >/= 147 U/ml were bad prognostic indicators. OKUDA, GRETCH and early stages of CLIP had better homogeneity while CLIP showed superior discriminatory ability and monotonicity for predicting survival. Male gender, presence of portal vein thrombosis, low serum albumin, large tumor size and high AFP level are poor prognostic indicators in patients of HCC. CLIP has better performance in predicting mortality

Response guided interferon therapy for genotype 3 of chronic hepatitis C: compliance and outcome

To determine compliance and improvement in sustained viral response [SVR] by following response guided therapy [RGT] plan of interferon and ribavirin, for genotype 3 in chronic hepatitis C. Patients with chronic hepatitis C genotype 3, who were eligible for interferon-ribavirin therapy and consented for RGT, were included. Those with no rapid viral response [RVR], having coarse echotexture of liver or undergoing re-treatment, were advised 48 week treatment whereas, rest had 24 week standard therapy. PCR for HCV RNA checked 6 months after discontinuing treatment, was the primary end point of study. Of 154 patients, included in the study with mean age of 39.9 [+/-10.84] and male to female ratio 1.4/1 [94/60], majority of patients, 136 [88.4%] were treatment naïve whereas, 18 [11.6%] were being retreated. On ultrasound, 63 [40.9%] patients had coarse liver and 33 [21.4%] had splenomegaly. RVR was achieved in 99 [64.3%] patients. Overall 66[42.8%] patients merited extended duration of therapy as per RGT plan but only 22 [33%] were compliant. Treatment related side effects were the dominant reason for declining RGT in 33 [75%] patients. SVR was noted in 111 [72.1%] patients. Those patients with extended therapy [RGT], had SVR 90.9% [20/22], although, better but statistically not significant than those who stopped therapy at 6 months 77.2% [34/44] [p value 0.11]. Response guided therapy plan did not improve SVR to pegylatedinterferon and ribavirin therapy in patients with genotype 3 and it has low patient compliance due to treatment related side effects

Zinc and flouride containing bioactive glasses in dentistry

The bioactive glasses have been used in the medical field due to their wide spread benefits as implant coatings, bone substitutes and for treatment of dentine sensitivity. The purpose of this study was to incorporate zinc and fluoride in the bioactive glass for potential use in dentifrices as antibacterial and anticaries agents. A series of glass compositions based on SiO2, CaO, CaF2, MgO, and ZnO were prepared with varied amounts of ZnO content ranging from 0% to 15%. Glass synthesis was done by using melt-quench route and fine powder having particle size <38 micro m was obtained by grinding and sieving. Particle size analysis and Differential scanning calorimetry were performed on powder samples. The dissolution study was done in Tris buffer and Acetic acid. Zinc in bioactive glass caused a decrease in glass transition and crystallization temperature. The behavior of zinc free glass was entirely different from zinc containing glass in both Tris and acetic acid. There was rapid release of high concentrations of zinc along with other ions in acetic acid whereas relatively small amount was released in Tris. The fluoride release was slow and small concentrations were recorded in Tris while in acetic acid there was relatively high concentration of fluoride as compared to Tris. The release of calcium and magnesium has been affected in the presence of zinc in Tris and acetic acid. Zinc and fluoride containing bioglasses which are degradable in acetic acid were formulated. But the stability of glass in normal physiological condition has to be further improved with future research work

Validity of alpha fetoprotein for diagnosis of hepatocellular carcinoma in cirrhosis

To determine the accuracy of serum alpha fetoprotein [AFP] for diagnosis of hepatocellular carcinoma [HCC] in patients with cirrhosis. Observational study. Department of Medicine, The King Edward Medical University, Lahore, from November 2007 to August 2011. Consecutive patients, diagnosed with HCC by contrast enhanced CT, MRI or biopsy were included as cases. Patients of cirrhosis with no evidence of HCC were enrolled as controls. Demographic, laboratory and radiological data were recorded. Serum AFP was determined in all patients at outset and was analyzed using ROC curve for its accuracy in diagnosing HCC. A total of 275 patients were included; of them 173 had HCC and 102 had cirrhosis. One hundred and thirty nine cases [80.3%] with HCC and 86 [84.3%] without HCC had cirrhosis due to HCV. Stage of liver disease, as determined by Child Turcotte Pugh [CTP] score, was comparable; mean CTP value 7.97 A +/- 2.17 in HCC and 7.75 A +/- 2.21 in control group [p = 0.41]. Area under curve [AUC] for AFP was 0.85 [95%, CI: 0.80 - 0.90] with optimum cut off value of 20.85 ng/ml which showed 72.2% sensitivity, 86.2% specificity, 89.9% positive predictive value, 64.7% negative predictive value and 77.4% overall accuracy in diagnosing patients with HCC. Despite sub-optimal sensitivity, alpha fetoprotein is still a valid screening test for diagnosis of hepatocellular carcinoma till other more sensitive markers are developed. Till then, it should be used in conjunction with ultrasound

Prevalence of Vitamin A Deficiency in South Asia: Causes, Outcomes, and Possible Remedies.

Vitamin A deficiency (VAD) has been recognized as a public-health issue in developing countries. Economic constraints, sociocultural limitations, insufficient dietary intake, and poor absorption leading to depleted vitamin A stores in the body have been regarded as potential determinants of the prevalence of VAD in South Asian developing countries. VAD is exacerbated by lack of education, poor sanitation, absence of new legislation and enforcement of existing food laws, and week monitoring and surveillance system. Several recent estimates confirmed higher morbidly and mortality rate among children and pregnant and non-pregnant women of childbearing age. Xerophthalmia is the leading cause of preventable childhood blindness with its earliest manifestations as night blindness and Bitot’s spots, followed by blinding keratomalacia, all of which are the ocular manifestations of VAD. Children need additional vitamin A because they do not consume enough in their normal diet. There are three general ways for improving vitamin A status: supplementation, fortification, and dietary diversification. These approaches have not solved the problem in South Asian countries to the desired extent because of poor governmental support and supervision of vitamin A supplementation twice a year. An extensive review of the extant literature was carried out, and the data under various sections were identified by using a computerized bibliographic search via PubMed, Web of Science, and Google Scholar. All abstracts and full-text articles were examined, and the most relevant articles were selected for screening and inclusion in this review. Conclusively, high prevalence of VAD in South Asian developing countries leads to increased morbidity and mortality among infants, children, and pregnant women. Therefore, stern efforts are needed to address this issue of publichealth significance at local and international level in lower- and middle-income countries of South Asia.

Professional attitudes and behaviors acquired during undergraduate education in the college of dentistry, King Saud University

The purpose of the study was to investigate and evaluate the professional attitudes and behaviors acquired by students and recently graduated dentists during undergraduate education at King Saud University. This cross-sectional survey used a 27-item questionnaire covering four cumulative theoretical dimensions of professionalism. Questionnaires were distributed to fifth-year students, interns, and demonstrators in the College of Dentistry during the academic year 2010-2011, and 203 completed questionnaires were used in analyses. Descriptive statistics were used to summarize responses. Crosstab and chi-squared tests were used, with statistical significance set at P < 0.05. The response rate was 79.3% [43.6% of males, 94% of females]. Eighty-seven questionnaires were collected from fifth-year students, 92 from interns, and 24 from demonstrators. Many [59%] participants demonstrated high levels of professional attitudes and behaviors, whereas 40% did not comply with the elements of professionalism. Analyses revealed highly significant differences in certain responses with regard to gender, academic level, and grade point average. Although some participants did not possess all professional qualities, all participants possessed at least some elements of professionalism measured in this study. We thus recommend a strategic effort to develop targeted plans emphasizing professionalism at all levels of the dental school curriculum. High-profile role modeling, lectures, seminars, and academic ceremonies are ways of achieving professional development among dental students in parallel with their acquisition of basic scientific knowledge and clinical skills. This approach will formally and informally communicate that professionalism is a core value

Hypoglycemic effect of the aqueous extracts of lupinus albus, medicago sativa [seeds] and their mixture on diabetic rats

The number of people suffering diabetes mellitus is increasing worldwide at an alarming rate. A huge number of populations in the world are entirely dependent on traditional medications. This practice may be due to their safety, effectiveness, and availability as well as their fewer side effects when compared to the synthetic hypoglycemic agents. The present study was carried out to investigate and compare the activity of Lupinus albus [seeds], Medicago sativa [seeds] and the mixture of both plants seeds on some biochemical, hematological and histological parameters in alloxan-induced diabetic rats. Twenty-five male adult albino rats were divided into two groups: group 1: control group [five animals] and group 2: alloxan induced diabetic rats. Diabetic rats were further divided into four subgroups, five animals each. Subgroup1: diabetic untreated rats; subgroup 2: diabetic rates treated with aqueous extract of Lupinus albus seeds; subgroup 3: diabetic rats treated with aqueous extract of Medicago sativa seeds; and finally subgroup 4: diabetic rats treated with aqueous extract of the mixture of Lupinus albus and Medicago sativa seeds. After thirty days of treatment all rats were sacrificed, blood sample were collected to estimate some biochemical and hematological parameters. Liver samples were collected to determine their glycogen content and pancreatic samples were obtained and processed for microscopic and quantitative evaluation. In diabetic group, there was reduction in body weight's, hyperglycemia, hypoinsulinemia, significant increase in some parameters of liver and kidney functions as well as significant changes in lipids profile and proteins level with significant decreased liver glycogen content. All treated groups restored most of the mentioned parameters to their normal values. Moreover, these treatments recorded partial improvement in the histopathological changes produced by alloxan. The aqueous extract of Lupinus albus or Medicago sativa [seeds] or by their mixture has hypoglycemic and hypolipidemic effects by increasing insulin level and decreasing insulin resistance. In addition, they ameliorate most complications of diabetes

Antidiabetic and antihyperlipidemic effect of balanites aegyptiaca seeds [aqueous extract] on diabetic rats

Type II diabetes mellitus is increasing health problems that negatively affect health care systems worldwide. There is a constant urge to develop new therapies with better effects, lower side effects at lower prices to treat this disease. Therefore, the present study carried out to investigate whether Balanites aegyptiaca [seeds] could treat the hyperglycemic, dislipidemic, liver, and kidney toxicity and the pancreatic damage in diabetic rats. Fifteen adult male albino rats were divided into two groups; group 1: control group, group 2: alloxan induced diabetic rats that divided into two subgroups; subgroup1: diabetic untreated rats, subgroup2: diabetic treated with aqueous extract of B. aegyptiaca [seeds]. After thirty days of treatment, all rats were sacrificed. Blood sample were collected to estimate some hematological and biochemical parameters. Liver samples were collected to determine their glycogen content and pancreatic samples were obtained and processed for microscopic and quantitative evaluation of, alpha, beta and delta-cells number. Diabetic group recorded reduction in body weight's gained, hyperglycemia, hypoinsulinemia, significant increase in some parameters of liver and kidney functions, dislipidemia, changes in proteins level and decreased liver glycogen content. While, treatment with B. aegyptiaca [seeds] was ameliorated most of the toxic effects of alloxan and showed partially improvement in histological changes produced by alloxan. The aqueous extract of B. aegyptiaca [seeds] has hypoglycemic, hypolipidemic effects, increasing insulin level, and decreasing insulin resistance. Moreover, ameliorate the most complication associated with diabetes mellitus

Increasing trend of homicidal drone attacks in Pakistan

To study the increasing trend of Homicidal Attacks in Pakistan. Retrospective study. This study was carried out at 1. Benazir Civil Hospital Rawalpindi, 2. Forensic Medicine Deptt. General Hospital PGMI Lahore, 3. Civil Hospital Sialkot, 4. DHQ Benazir Hospital Abbottabad 5. DHQ Hospital Gujrat from 01.01.2012 to 31.05.2013. The data of Homicidal drone attacks and mortality was collected from news papers, internet and medical journals of Forensic Medicine. The Bureau of Investigative Journalism estimates the following cumulative statistics about US drone strikes: [As of March 2013]. Total strikes: 366. Total reported killed: 2,537 - 3,581. Civilians reported killed: 2000 - 3000. Children reported killed: 368 - 997. Total reported injured: 1,174-1,465 . Strikes under the Bush Administration: 52. Strikes under the Obama Administration: 314. The trend of Homicidal drone attack was increased in Pakistan in President Pervaiz Musharaf time in favour of Americans by giving our National Airports. The people of Waziristan are also responsible for these attacks as they give information about Taliban to their centers by giving signals in a cost of dollars