Multi-epitope vaccine against drug-resistant strains of Mycobacterium tuberculosis: a proteome-wide subtraction and immunoinformatics approach

Mycobacterium tuberculosis (Mtb) is the causative agent of tuberculosis, one of the most deadly infections in humans. The emergence of multidrug-resistant and extensively drug-resistant Mtb strains presents a global challenge. Mtb has shown resistance to many frontline antibiotics, including rifampicin, kanamycin, isoniazid, and capreomycin. The only licensed vaccine, Bacille Calmette-Guerin, does not efficiently protect against adult pulmonary tuberculosis. Therefore, it is urgently necessary to develop new vaccines to prevent infections caused by these strains. We used a subtractive proteomics approach on 23 virulent Mtb strains and identified a conserved membrane protein (MmpL4, NP_214964.1) as both a potential drug target and vaccine candidate. MmpL4 is a non-homologous essential protein in the host and is involved in the pathogen-specific pathway. Furthermore, MmpL4 shows no homology with anti-targets and has limited homology to human gut microflora, potentially reducing the likelihood of adverse effects and cross-reactivity if therapeutics specific to this protein are developed. Subsequently, we constructed a highly soluble, safe, antigenic, and stable multi-subunit vaccine from the MmpL4 protein using immunoinformatics. Molecular dynamics simulations revealed the stability of the vaccine-bound Toll-like receptor-4 complex on a nanosecond scale, and immune simulations indicated strong primary and secondary immune responses in the host. Therefore, our study identifies a new target that could expedite the design of effective therapeutics, and the designed vaccine should be validated. Future directions include an extensive molecular interaction analysis, in silico cloning, wet-lab experiments, and evaluation and comparison of the designed candidate as both a DNA vaccine and protein vaccine.

Gastrointestinal Beriberi as a prodrome of non-alcoholic Wernicke’s encephalopathy: a study of an emerging nutritional deficiency disorder from Kashmir, India

Background: Gastrointestinal manifestations of thiamine deficiency have not been well described in literature. Authors aimed to study the symptoms of gastrointestinal beriberi in a cohort of patients of non-alcoholic Wernicke’s encephalopathy and review the relevant literature.Methods: In a retrospective analysis, case records of 52 patients diagnosed with non-alcoholic Wernicke’s encephalopathy were analyzed for the nature of gastrointestinal symptoms, their duration, severity and associated findings, investigations and response to treatment. The available literature on gastrointestinal symptoms in thiamine deficiency disorders and gastrointestinal beriberi was reviewed.Results: Gastrointestinal symptoms were found in 46 of the 52 patients. The most common gastrointestinal symptom in our patients was recurrent vomiting in 42 patients. Eight patients had water brash. Ten patients had epigastric pain and 10 patients had anorexia. Based on the nature and severity of symptoms, patients were evaluated for their symptoms using endoscopy, ultrasonography, amylase and lactate levels, and routine laboratory studies and the results were normal in the majority of patients.  Gastrointestinal symptoms settled in all the patients after receiving intravenous thiamine. On reviewing the literature multiple studies were found to have reported prominent gastrointestinal symptoms in patients of Wernickes encephalopathy and other thiamine deficiency related disorders. However, the definition of gastrointestinal beriberi is not clearly stated.Conclusions: Gastrointestinal symptoms were prominent prodromal manifestations in our cohort of Wernicke’s encephalopathy and have also been amply reported in literature. Presence of gastrointestinal symptoms in individuals predisposed to thiamine deficiency without alternative explanation should be enough to label a patient as gastrointestinal beriberi. The study highlights the importance of recognizing gastrointestinal beriberi as a distinct syndrome that may precede the development of Wernicke’s encephalopathy.

Maxillary intermolar width of Pakistanis with untreated normal occlusion

Objective: Intermolar width is a key measurement which assists in treatment planning of orthodontic patients requiring expansion as an alternate to premolar extraction. The present research was aimed at determining the mean value of intermolar arch width [IMW] of untreated normal arch Pakistani patients visiting tertiary care dental hospital

Material and Methods: This cross sectional study was carried out using IMW measurements on plaster model of 120 untreated normal occlusion patients, at Department of Orthodontics, Faisalabad Medical University and de'Montmorency College of dentistry, from 15-12-2016 to 15-10-2017. The non probability consecutive sampling technique was used in this study. Data analysis was done using SPSS software 21.0.0

Results: The mean age of the subjects was 18.23+/-3.75 years. The mean value of IMW in selected subjects was 45.33+/-3.42 mm

Conclusion: Study results concluded that in Pakistanis, ideally align maxillary arch and occlusion can be achieved with upper intermolar distances of 45.33+/-3.42 mm

Infected scrotal lymphangioma mimicking testicular torsion

Lymphangiomas are the benign cystic swellings, usually tend to occur in areas of major lymphatic channels, especially in cervical and axillary regions. The usual presentation is a cystic, painless mass which increases in size with age. lymphangioma of scrotal region is very rare. In our case infected lymphangioma of scrotumpresented as acute scrotum

Diagnosis of hypertension on the basis of four temperament theory of avicenna in al-qanoonft al-tibb

According to WHO in Pakistan above about 150,000 people suffer from cardiac diseases, in 2002 and hypertension is top of the list. Developing country like Pakistan faces sever social, economical and psychological burden as shown in Table 1. Human get affected by its psychology, diet and environment which become source of his health or disease. The Canon of Medicine [Arabic: Al-Qanun fi al-Tibb] is an encyclopedia of medicine in five books compiled by Ibn Sina [Avicenna] and completed in 1025. It presents a clear and organized summary of all the medical knowledge of the time. The Canon of Medicine is based upon the Four Humors of Hippocratic medicine, but refined in various ways. There are four major groups of causes which are responsible in hypertension increase in dryness, hotness, moistness and coldness. When we apply the laws of nature to inhibit the cause like nature do we can hypertension and get cure. Nature always treat the dryness [Autumn/Spring] with hotness [summer], hotness with moistness [Rain], moistness with coldness [winter] and coldness with dryness in the form of seasons. There are specific character of each temperament. In present study patients [n=40] randomly selected in Outpatient Department of Shifa-ul-Mulk Memorial Hospital at Hamdard University, Karachi, Pakistan. These patient according to their temperaments classified according to their temprament. The most common temperament in hypertensive patients was atrabilious [Dry] followed by phlegmatic [Cold and Moist]?

Ischemic stroke in patients with ST elevation myocardial infarction and its relation to left ventricular thrombus

Objective: To determine the frequency of stroke in patients with ST elevation Myocardial infarction and its association to LV thrombus

Methodology: This descriptive cross sectional study was carried out in department of Cardiology of Hayatabad Medical complex, Peshawar. Total 119 patients were included. Patients were assessed for the presence or absence of Left ventricular thrombus Si its association with stroke

Results: Out of 119 patients, there were 36 [30.2%] female patients and 83 [69.7%] male patients. The mean age of presentation was 59.5 +/- 11.0 years. Out of total 119 patients, 06 had thrombi in the Left ventricle and 03 had stroke. Four out of 6 patients with Left ventricular thrombus had Anterior wall Myocardial infarction

Conclusion: Left ventricular thrombus formation is associated with anterior wall myocardial infarction Si stroke

Visual outcome after pars plana vitrectomy in diabetic vitreous hemorrhage

Objectives: To determine visual outcome and frequency of complications after pars plana vitrectomy in diabetic vitreous hemorrhage

Methodology: This was interventional case series conducted at department of ophthalmology, Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from January 2013 to June 2014. Known diabetic patients above 16 years of age, having vitreous hemorrhage were included. Standard three ports pars plana vitrectomy [PPV] with membrane peeling, endolaser and without endotamponade by single study surgeon was done in all patients. Best corrected visual acuity was noted pre operatively and on 1st day, 2nd week and 8th week post operatively. P- value <0.05 was considered statistically significant. Post-operative complications and visual improvement were noted at final visit

Results: Total of 50 patients having diabetic vitreous hemorrhage were included in the study. Mean age was 41.4 years. Male patients were 66%. Clear lens was present in 46% patients and cortical lens vacuoles in 36% patients. Fresh vitreous hemorrhage was present in 80%. Baseline and final post-operative best corrected visual acuity logarithm minimal angle of resolution was 1.01 +/- 0.17 and 0.74+/- 0.25 respectively. The difference in pre and post-operative best corrected visual acuity logarithm minimal angle of resolution was 0.045 which was statistically significant. There were no post-operative complications in 82% patients. Visual improvement was observed in 82%

Conclusion: Most patients with diabetic vitreous hemorrhage regain or retain useful vision after PPV. Many patients may suffer late complications like recurrent vitreous hemorrhage and retinal detachment after successful initial surgery requiring secondary intervention

Left atrium volume as a surrogate marker of left ventricular diastolic dysfunction

Objective: To determine correlation between left atrial volume and left ventricular diastolic dysfunction

Methodology: This was a single center observational study conducted at Lady Reading Hospital, Peshawar. Patients above 18 years of both genders, who were in sinus rhythm and having no significant systolic dysfunction or significant mitral insufficiency on echocardiography, were included in the study, using purposive non-probability sampling technique. A total 339 patients underwent transthoracic echocardiography from July 2013 to June 2014. Detailed cardiac echocardiography was performed to determine left atrial volume, ejection fraction, E and A velocities, deceleration time and e've-locity, E/e

Results: A total of 339 patients were studied. Male were 61.9%. Mean age of study population was 58.42 +/- 10.48 years. Baseline characteristics of patients having some degree of diastolic dysfunction were; mean age 65.5 +/- 12.3, mean body mass index 25.2 +/- 2.5 kg/m2, mean ejection fraction 55.1 +/- 7.5%, hypertension 48.6%, diabetes mellitus 10.1% and left ventricular hypertrophy 38.6%. Echocardiographic findings in diastolic dysfunction patients were as follow: mean left atrial volume was 65.3 +/-10.1 ml, E/A 1.4 +/- 0.6, TDI e' was 6.7 +/-1.3 m/sec and TDI E/e' was 12.7 +/- 2.1. Increasing left atrial volume was well correlated with increasing severity of left ventricular diastolic dysfunction [y = +0.8, Spearman rank correlation]

Conclusion: Increase in left atrial volume is directly correlated with severity of diastolic dysfunction. Severity of diastolic dysfunction increases with increased left atrial volume

Duplication cyst presenting as hydrocoele in a child

Enteric duplication cyst can occur anywhere in Gastrointestinal Tract [GIT], from oropharynx to rectum. Their presentation depends upon the portion of GIT involved. The most common site of GIT involved is small intestine, in 50% of cases. Small intestinal duplication cyst usually present with abdominal pain or mass and rarely as intussusception, volvulus or small bowel obstruction. It may also present very rarely as inguinal hernia of which only 2 cases have been reported yet. We report a 3 years child presenting as hydrocoele of the cord which turned to be duplication cyst which is very rare presentation

Pterygium; comparison of results excision through bare sclera technique with and without intraoperative Mitomycin C application

To study the results of primary pterygium excision through bare sclera technique with and without intraoperative Mitomycin C use. This was an experimental study with randomised controlled trial. This study was conducted at Eye A unit, Khyber Teaching Hospital, Peshawar from May, 2007 to April,2009. One hundred patients with primary pterygium were selected from ophthalmology Deptt. OPD at Khyber Teaching Hospital, Peshawar. Detailed history was taken. Complete ocular examination done and those fulfilling inclusion criteria were included in the study. Anesthesia used was topical proparacaine 0.5% and local infiltration of 2% lignocaine. Mitomycine C [MMC] 0.02% [0.2mg/ml] was applied through a cotton swab at the bare part of the sclera for five minutes in 50 of these patients. Patients were followed up till three months. In bare sclera technique without MMC, recurrence rate was 70% [35 patients] while in MMC group, it was 16% [08 patients].There was one punctuate epithelial keratitis in MMC group and two cases of conjuntival granuloma one in each group. Pterygium excision through simple bare sclera technique had significantly high recurrence rate as compared to intraoperative use of MMC

Clinical profile of patients with normal coronary angiogram

To observe the clinical and bio-chemical profile of patients having normal coronary angiogram following an abnormal stress test. This was a single center retrospective, descriptive study. Coronary angiograms done from July 2009 to December 2011 were retrieved and reviewed for normal coronary arteries. Clinical and bio-chemical profile of the patients having normal coronary angiogram was retrieved from hospital record. Patients, whose computerized data could not be retrieved from department database, were excluded from the study. Out of 8425 angiograms reviewed, 816[9.7%] were having normal coronary arteries. Mean age was 4 +/- 27.4 years. Females were 66.7%. Clinical and biochemical profile for normal coronary angiograms was as follows: smokers 59%, family history of premature coronary artery disease 41%, hyperlipidemia18.5% and hypertension 14%. Diabetes was present only in 2.1%. Among females: 11% were current users of oral contraceptives pills, 3.4% were post menopausal and 0.87% pregnant. Mean BMI was 25.4 +/- 5.2 and total cholesterol and triglyceride were 278 +/- 31mg/dl and 180 +/- 28mg/dl respectively. Normal coronary angiogram is infrequently observed in catheterization laboratories and mostly found in younger to middle aged females. Smoking is very common in such patients. Hyperlipidemia, hypertension, diabetes mellitus are not frequently present in these patients.

Frequancy of hyponatremia and in hospital clinical outcomes in these patients hospitalized for heart failure

To determine the frequency of hyponatremia and in-hospital clinical outcomes in hyponatremic patients hospitalized for heart failure.This was a descriptive study conducted in department of cardiology, Lady Reading Hospital, Peshawar. Both male and female patients aged 14 years and above admitted with heart failure fulfilling the inclusion criteria, were included in the study. Patients were subjected to detailed history and clinical examination. Admission Serum sodium was measured in all patients. All the patients were managed according to guidelines. All patients were followed for in hospital mortality and length of hospital stay [LOHS].The total number of patients was 241. Mean age was 59.2 +/- 14.9 [range 18-100] years. Females were 123 [51%] patients. Mean serum sodium was 136 +/- 5.1mmol/L. Hyponatremia [serum sodium

Pattern of ocular trauma in District Swabi

Background: Ocular trauma is a significant proportion of emergency presentations

Objectives: This study was conducted to determine the pattern of ocular trauma presented in the ophthalmic casualty room of the secondary care hospital in District Swabi

Subject and Methods: This cross-sectional, descriptive study was conducted at the Eye Department of District Head Quarter Hospital, Swabi, over a period of two years; from 1[st] March, 2010 to 28[th] February, 2012. Five hundred and Six patients who presented with ocular trauma either through the outpatient or emergency department were included in the study. The patients demographic data, medical history, detailed examination and final diagnosis were recorded in a questionnaire. Statistical analysis were based on age, gender, presentation, ocular features and diagnosis

Results: Total of five hundred and six patients were included in the study. Male were 77.7% [n=393] and female were 22.3% [n=113]. One hundred and forty five [28.7%] patients were workers while 17.8% [n=90] were housewife. Most of the patients [56.5%, n= 286] reported within few hours of trauma. Home [29.1%] and workplace [26.3%] was common place of injury. Mechanical trauma was observed in 80% [n= 405] of patients. Accidental trauma caused by wood [11.8%], assault due to finger/ fist [26%] and sports related trauma caused by ball [40%] was common. Presenting visual acuity was hand movement in 32% [n=162] patients. Both globe and extra globe injuries [44.5%], extra globe injuries [23.7%], globe injuries [23.3%] and complex injuries [8.5%] were noted. In globe injuries, open globe injuries [OGI] were 42.4%, corneal perforation was most common in 36% patients. Close globe injury was present in 28% patients, punctuate keratitis observed in 29.5% patients. Eyelid was commonly injured [63%] in extra globe injuries. Full thickness laceration was found in 38.9% patients

Conclusion: Traumatic globe, adnexal and open globe injuries are the main ocular emergencies seen. Majority of ocular trauma is preventable. It can be assumed that health education, as well as application of safety measures and regulations, will significantly reduce the incidence of ocular injuries

Frequency and pattern of ocular emergency in district Swabi

Objectives: To determine the frequency and pattern of ocular conditions presented to the ophthalmic casualty room at a secondary care hospital in District Swabi

Study design: Descriptive Cross- sectional study

Place and duration of study: Eye Department of District Head Quarter Hospital, Swabi over a period of two years from 1[st] March 2010 to 28[th] February 2012

Methodology: Nine hundred and Sixty patients who presented either with acute ocular condition or ocular injury through the outpatient or emergency routes were included in the study. The patients demographic data, detailed history, examination and final diagnosis were recorded in a questionnaire. Statistical analysis was based on age, gender, presentation, ocular features and diagnosis

Results: In our study male were 57.8% [n=555] and female were 42.2% [n=405]. Five hundred and thirty Six[55.8%] patients were in traumatic group while four hundred and twenty four [44.2%] patients were in non-traumatic group. Infective conjunctivitis [62.2%], Stye [12.6%], corneal ulcer [10.10%], retinal vascular disease [1.2%], acute post operative endophthalmitis [1.1%], acute uveitis [2.6%] and acute glaucoma [1.0%] were the leading causes in the non-traumatic group. In traumatic group 94.2% patients were non-infected while 5.8% were infected. In non-infected patients, both globe and extra globe injuries [44.6%], extraglobe injuries [23.8%] and globe injuries[23%] were present. In globe injuries, open globe injuries [OGI] were 39.7%.Post traumatic endophthalmitis was reported in 54.8% of traumatic ocular infection. Mechanical injuries [70.7%] were leading the list of traumatic ocular emergency. Work place [31.5%] was the most common place for ocular trauma

Conclusion: Common non- traumatic ocular emergency were Infective conjunctivitis, infective keratitis, acute glaucoma and acute uveitis. Females mostly middle age housewives had non-traumatic ocular emergencies. Traumatic ocular emergency commonly reported were both globe and extra globe injuries and open globe injuries. Males mostly young workers had traumatic ocular emergency. Mechanical injuries mostly the result of occupational accidents in workers

Bilateral irreversible blindness

To find out the causes of bilateral irreversible blindness in patients of different age groups in District Swabi. It is a prospective observational study of one hundred and eighty nine consecutive blind cases. The study was conducted from July 2010 to June, 2012 at the Ophthalmology Department of District Headquarter Hospital, Swabi. Informed consent was taken from the patient or guardian of the patient. Patients fulfilling inclusion and exclusion criteria were included in the study. A standard proforma was designed and entries were made regarding present, past and family history, thorough ocular examination of every patient was performed on slit-lamp with relevant biomicroscopic aids and posterior segment examination was conducted with direct as well as indirect ophthalmoscope. Biomicroscopy was performed as and when required. lntraocular pressure using schiotz tonometer, corneal diameters, retinoscopy and ocular mobility were noted and relevant investigations were performed when needed. Children and mentally retarded patients were examined using short general anaesthesia. Of 189 patients 61.4% were males and 38.6% were females. Congenital Causes were present in 49.7% and acquired causes in 50.3%. Diseases accounted for 88.9%, trauma in 10.1% and unknown causes in 1.1% cases. Congenital diseases included congenital glaucoma in 35.1%, retinitis pigmentosa in 29.7% and albinism in 19.1% cases. Acquired diseases included primary glaucoma in 33.8%, diabetic retinopathy 23 %, secondary glaucoma in 17.5% and childhood infection in 10.8% cases. Corneal findings included corneal opacity in 31.2%, corneal edema in 4.8% and absent cornea in 7.4%. Optic nerve findings included optic atrophy in 16.4%, glaucomatous optic atrophy in 16.9%, new vessels in 9.5%. Retina findings included retinal dystrophy in 14.3%, maculopathy in 5.3%, chorioretinopathy in 0.5%, vascular retinopathy and hypopigmentation in 9.5% each respectively. Irreversible blindness is more common in children and young adults and mostly males are affected. Glaucoma is the commonest cause followed by retinitis pigmentosa and albinism in this study

In-hospital complications of acute right ventricular myocardial infarction

To determine the in-hospital complications of acute right ventricular myocardial infarction[RVMI]. This study was conducted at Cardiology Department, Lady Reading Hospital, Peshawar from May to October 2009. A total of 100 patients with acute RVMI were evaluated for in-hospital complications. Male patients were 77 [77%] and females 23 [23%]. Patient's mean age was 59.96+12.3 years with age range 28-82 years. Total in-hospital complication events were 174. In-hospital complications were present in 77% patients. Cardiogenic shock was the commonest complication with frequency of 25.8%followed by acute left ventricular failure [LVF] in 17.8% and atrioventricular blocks [AV Blocks] in 14.3% respectively. Re-infarction occurred in 5.7% [10] patients. Thirty eight patients died in our study [21.8%]. Among RVMI patients, 65% stayed in-hospital for more than 4 days. Frequency of complications is higher and cardiogenic shock is the most common complication in acute RVMI patients

Comparative analysis of type of myocardial infarction in patients with successful or unsuccessful streptokinase thrombolysis following st elevation myocardial infarction

To study the effect of thrombolytic therapy in term of success and failure on the type of ST elevation MI, using streptokinase. This was a comparative study, conducted at Department of Cardiology, Lady Reading Hospital, Peshawar, from October 2006 to October 2007. Patients with first acute myocardial infarction were divided into group A [successful thrombolysis] and group B [unsuccessful thrombolysis] using ECG criteria. Total number of patients were 200. Group A included 136 [68%] patients and group B included 64 [32%] patients. There were total 88 [44%] patients of anterior MI with 47 patients in group A and 41 patients in group B [34.6% vs 64.0%, p<0.001]. There were total 110 [55.0%] patients of inferior MI with 88 patients in group A and 22 patients in group B [64.7% vs 34.4%, p<0.001]. Lateral myocardial infarction was diagnosed in 2 [1%] patients with 1 patient each in group A and group B [0.7% vs 1.6%, p=0.583]. Anterior MI was associated with a higher rate of thromblysis failure while inferior MI and lateral wall MI was associated with a higher rate of successful thrombolysis.

Clinical presentation of Vernal Keratoconjunctivitis in District Swabi

Objective: To determine the various clinical manifestations of Vernal Keratoconjunctivitis [VKC] in District Swabi

Subjects and Methods: This was a hospital based descriptive study, conducted at the Eye Department of District Head Quarter Hospital, Swabi from March 2010 to February 2012. Patients between age 5 to 25 years presenting with signs and symptoms of VKC belonging to different villages of district Swabi were clinically evaluated

Results: A total of 250 patients were examined. 179 patients [71.6%] were male and 71 patients [28.4%] were female. 154 patients [61.6%] came in the first decade of life. 153 patients [61.2%] had average monthly income between Rs. 2000- 5000. Regarding symptoms, 34% cases had combination of symptoms, 26.8% cases had itching and 10.4% cases had redness only. Seasonal variation was present in 88.4% cases, mostly occurred in spring in 48% cases for which prior treatment was received in 96.8% cases. 237 patients [94.8%] had no history of atopy and 246 patients [98.4%] had no family history of atopy. The commonest palpebral conjunctival sign was diffuse conjunctival hyperemia in 220 [88%] patients, giant papillae in 20 patients [8%] and cobblestones in 10 patients [4%]. Limbitis was present in 148 patients [59.2%]. Superficial punctate keratitis was most common corneal sign and was present in 89.2% patients

Conclusion: VKC is an allergic disorder commonly affecting male children usually after the age of 5 years with seasonal variation mainly in warm and dry climate. Disease is influenced by certain factors like age, gender, poverty, overcrowding, poor hygienic conditions, family history of atopy and previous treatment received. It has variable severity and sometimes it is a potentially blinding disease. There is a need to stage the disease severity in order to develop standardized therapeutic guidelines

Comparison of the efficacy and safety of thrombolytic therapy for st-elevation myocardial infarction in patients with and without diabetes mellitus

This study compared the efficacy and safety of streptokinase as thrombolytic agent for ST-elevation myocardial infarction [STEMI] in patients with and without diabetes mellitus. This prospective interventional study was carried out in the department of Cardiology, Postgraduate Medical Institute Govt. Lady Reading Hospital Peshawar. A total of 444 patients admitted to coronary care unit with STEMI and eligible for thrombolytic therapy [no contraindications per AHA/ACC guidelines] were studied from December 2009 to December 2010. Among these half of patients were diabetic while rests were non-diabetic. Streptokinase was administered to all patients. Resolution [reduction] of elevated ST segment was evaluated after 90 min of streptokinase administration. Comlications of streptokinase infusion including hypotension, shock and hemorrhage was noted. Failed reperfusion [<30% ST resolution] was significantly higher in diabetic as compared to non-diabetic patients [21.6% vs. 9.5%; p<0.0003] while successful reperfusion [>/= 70% ST-resolution] was significantly higher in non-diabetic than diabetic patients [66.7% vs. 49.1%; p<0.0001]. Complication rates between the two groups were statistically similar. Hypotension occurred in 45 [20.3%] and 51 [23%]; p=0.458 patients in non-diabetic and diabetic group respectively while shock occurred in 10 [4.5%] and 13 [5.9%]; p= 0.506 and hemorrhagic manifestations in 13 [5.9%] and 10 [4.5%]; p=0.294 patients respectively. The outcome of thrombolytic therapy is adversely affected by Diabetes mellitus in patients with ST-elevation myocardial infarction. Secondly the risk of hazards associated with thrombolytic therapy is same in both diabetic and non-diabetic patients

Home remedies and traditional eye medicines used for the treatment of common eye aliments in district Swabi

To identify the different home remedies and traditional eye medicines used for the treatment of different common eye ailments in District Swabi. This was Cross Sectional study of fifteen months duration, from February 2010 to May 2011 conducted in out-patient department of District Headquarter Hospital Swabi. Initially different eye ailments and their home remedies and traditional eye medicines were identified by interviewing of the hospital staff belonging to different villages of district Swabi. 1500 patients, aged 20 years and above and also those patients who could answer were included in the study. The study comprised of 1500 patients belonging to different villages of district swabi. The mean age of patients was 42.33 years, ranging from 20 yrs to 80 yrs.818[54.5%] patients were male and 682[45.5] patients were female. The male to female ratio was 1.2: 1 .At least 7 common eye ailments and 11 home remedies or traditional eye medicines commonly used were recognized. The different home remedies and traditional eye medicines used in different eye ailments included surma [galena- lead sulfide] [39.24%], alum[6.70%], honey[14.30%], coldwater [5.69%], ice cube[0.93%], rose water[2.33%], black pepper[1.28%], turmeric paste[5.85%], hot fomentation[5.37%], olive oil[4.94%], goat milk[0.87%] and different combinations of these home remedies and traditional eye medicines[12.50%]. There is evidence of use of Home Remedies and Traditional Eye Medicines in Pakistan especially in rural population. Chemical substances and plant products are used frequently as Home Remedies and Traditional Eye Medicines