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SUMMARY: The main cause of mortality and disability globally is myocardial infarction (MI). Isoproterenol (ISO), a β-adrenoceptor agonist, has been used to induce rat myocardial necrosis. Whereas interleukin-37 (IL-37) has anti-inflammatory and cytoprotective properties. The study aimed to investigate the potential protective effects of IL-37 administration on cardiac architecture, oxidative stress, and inflammatory markers during ISO-induced MI in rats. Three groups of adult male rats were used in this study, the normal control group (n=8), ISO-induced MI group (n=8) that received isoproterenol hydrochloride (ISO) (100 mg/kg/day, SC, for the first 2 consecutive days), and IL-37-treated group (ISO+IL-37) (n=8) that received recombinant human IL-37 (40 µg/kg /day, intraperitoneally, for 2 weeks during and after ISO injections. Heart rate (HR.) and ECG changes were monitored. Some oxidative stress markers such as superoxide dismutase (SOD), nitric oxide (NOx), malondialdehyde (MDA), and glutathione (GSH) tissue levels in the tissue homogenate were assayed. Interleukin- 6 (IL-6), tumor necrosis factor- α (TNF-α), caspase-8, P53, and C- reactive protein (CRP) were among the inflammatory markers examined. In addition, serum levels of creatinine kinase (CK-MB) and lactate dehydrogenase (LDH) were analyzed to evaluate the myocardial injury. For histological analysis, tissues were sectioned, fixed in paraffin, and stained with hematoxylin and eosin (H&E), Masson Trichrome and, immunohistochemical against NF-kB, TNF-α, and Caspase-9. IL-37 improved ECG changes, cardiac enzyme markers, and some inflammatory markers of oxidative stress in ISO-induced MI. It also improved the histopathological and immunohistochemical changes in MI. In conclusion: IL-37 might be a promising therapeutic modality in myocardial infarction.
La principal causa de mortalidad y discapacidad a nivel mundial es el infarto de miocardio (IM). El isoproterenol (ISO), un agonista de los receptores adrenérgicos β, se ha utilizado para inducir necrosis miocárdica en ratas. Mientras que la interleucina-37 (IL-37) tiene propiedades antiinflamatorias y citoprotectoras. El estudio tuvo como objetivo investigar los posibles efectos protectores de la administración de IL-37 en la arquitectura cardíaca, el estrés oxidativo y los marcadores inflamatorios durante el infarto de miocardio inducido por ISO en ratas. En este estudio se utilizaron tres grupos de ratas macho adultas, el grupo control normal (n=8), el grupo con IM inducido por ISO (n=8) que recibió clorhidrato de isoproterenol (ISO) (100 mg/kg/día, SC, durante los primeros 2 días consecutivos) y el grupo tratado con IL-37 (ISO+IL- 37) (n=8) que recibió IL-37 humana recombinante (40 µg/kg/día, por vía intraperitoneal, durante 2 semanas durante y después de las inyecciones de ISO. Se monitorearon la frecuencia cardíaca (FC) y los cambios en el ECG. Se analizaron algunos marcadores de estrés oxidativo como la superóxido dismutasa (SOD), el óxido nítrico (NOx), el malondialdehído (MDA) y los niveles tisulares de glutatión (GSH) en el homogeneizado de tejido. La interleucina-6 (IL-6), el factor de necrosis tumoral-α (TNF-α), la caspasa-8, la P53 y la proteína C reactiva (CRP) se encontraban entre los marcadores inflamatorios examinados. Se analizaron los niveles de creatinoquinasa (CK-MB) y lactato deshidrogenasa (LDH) para evaluar la lesión miocárdica; para el análisis histológico se seccionaron los tejidos, se fijaron en parafina y se tiñeron con hematoxilina y eosina (H&E), Tricromo de Masson e inmunohistoquímica contra NF-kB, TNF-α y Caspasa-9. IL-37 mejoró los cambios de ECG, los marcadores de enzimas cardíacas y algunos marcadores inflamatorios de estrés oxidativo en el IM inducido por ISO. Además mejoró los cambios histopatológicos e inmunohistoquímicos en MI. En conclusión: la IL-37 podría ser una modalidad terapéutica prometedora en el infarto de miocardio.
Subject(s)
Animals , Male , Rats , Interleukins/administration & dosage , Heart/drug effects , Myocardial Infarction/chemically induced , Myocardial Infarction/prevention & control , Immunohistochemistry , Rats, Wistar , Oxidative Stress/drug effects , Inflammation , Isoproterenol/adverse effectsABSTRACT
Purpose: Colorectal cancer (CRC) is one of the most fatal tumors worldwide. In Egypt, most CRC cases occur in individuals > 40 years old. TUG1 has been proved to be disrupted in different malignancies and may have a critical role in tumor progression, invasion, and metastasis. However, its role in CRC has not been adequately studied. Materials / Methods: Quantitative real-time polymerase chain reaction (PCR) was used to evaluate the expression levels of long non-coding RNA (LncRNA) taurine upregulated gene 1 (TUG1), in nonmetastatic and metastatic CRC tissues and adjacent noncancerous tissues as control. Results: LncRNA TUG1 expression was significantly upregulated in both nonmetastatic and metastatic CRC tissues, in comparison with the adjacent noncancerous tissue. It was found that TUG1 could have a possible prognostic role in CRC, by comparing the sensitivity and specificity of TUG1 with those of CEA and CA19-9. Conclusion: The results of the current study suggest that the LncRNA TUG1 participates in the malignant behaviors of CRC cells. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Adenocarcinoma , Reverse Transcriptase Polymerase Chain Reaction , RNA, Long Noncoding , Colorectal Neoplasms/pathologyABSTRACT
Background: Anemia is widespread public health problem with 1.62 billion people affected globally. In India, Anemia is considered a major health problem. Children, women of child bearing age and pregnant women are more prone to develop anemia. Anemia affects the physical and mental growth of children, associated with increase maternal and fetal mortality, leads to reduced work productivity in adults. The present study was undertaken to determine prevalence and severity of anemia among patients who attended the outpatient clinics of a Unani research hospital in Telangana. Methods: This hospital based retrospective observational study wasconducted from January 2020 to December 2020 to investigate the prevalence, type, and determinants of anemia. The complete haemogram values of all the patients who underwent haemogram investigation were noted, information was compiled, tabulated, and analysed. Descriptive statistics were computed with percentages, mean, standard deviation, and student抯 t-test was used find the significance of study parameters.Results: Prevalence of anemia was 26.2% (872/3326), high prevalence of anemia was observed in females (44.04%) compared to males (5.72%) (p<0.0001). The prevalence was more in reproductive age group (58.6%). Moderate anemia (58.6%) was more prevalent followed by mild anemia (36.6%). Microcytic hypochromic blood picture predominates with the incidence of 53.6% followed by normocytic blood picture 42.2%.Conclusions: Results confirmed high prevalence of anemia in females and moderate anemia being more prevalent followed by mild anemia and majority of anemia cases were microcytic, suggesting iron deficiency as the main cause of anemia.
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Introduction: Indigenous people in a far-flung mountainous area without basic facilities, mainly rely on medicinal plants to cope with various veterinary health problems. Objective: The present study was carried out to explore the traditional knowledge of ethnoveterinary practices in Kaghan Valley, district Mansehra, Western Himalayas-Pakistan. Method: Ethnoveterinary data were collected between February to October 2014 from nine villages of the Kaghan Valley by involving 80 local people include traditional healers using a semi-structured interview. Results: A sum of 41 plant taxa of ethnoveterinary medicinal plants was documented for treating livestock ailments. Out of which, herbaceous plants were recorded with high percentage (27 species, 65.8 %). Most of the species were used to treat gastrointestinal diseases (12 taxa), followed by health improvement (7 taxa). The widely used part of plants for livestock aliments was the whole plant (9 species) followed by leaves (7 species), and preparation were paste (18 species) followed by powder with 10 species. The highest used values were recorded for Arisaema costatum (0.82), Primula denticulata (0.76), and high relative frequency citations for Berberis lyceum and Dryopteris ramosa with 0.37 each. Among the plant species Skimmia laureola, Thymus linearis and Phytolacca latbenia were among the taxa with cent fidelity level. Conclusion: The flora used in traditional remedies of the valley was found mostly endemic due to excessive utilization. Thus, further chemical investigation, better utilization and conservation of indigenous use of the reported species should be considered for future work.
Introducción: Los pueblos indígenas de zonas montañosas lejanas sin facilidades básicas dependen principalmente de las plantas medicinales para afrontar problemas de salud de tipo veterinario. Objetivo: Explorar el conocimiento tradicional en las prácticas etnoveterinarias en el valle de Kaghan, distrito de Mansehra, Himalaya occidental-Pakistán. Métodos: Se recopilaron datos etnoveterinarios mediante una entrevista semiestructurada entre febrero y octubre de 2014 en nueve aldeas del valle de Kaghan, con la participación de 80 habitantes locales, incluidos curanderos tradicionales. Resultados: Se documentó un total de 41 taxones de plantas medicinales etnoveterinarias para el tratamiento de enfermedades del ganado. Se registró un alto porcentaje de plantas herbáceas (27 especies, 65.8 %). La mayoría de las especies utilizadas han sido para tratar enfermedades gastrointestinales (12 taxones), y mejora de la salud (7 taxones). Para el tratamiento de enfermedades del ganado, lo más usual fue utilizar la planta entera (9 especies), seguida de las hojas (7 especies), con preparación en pasta (18 especies) y en polvo (10 especies). Las especies registradas con más uso fueron: Arisaema costatum (0.82), Primula denticulata (0.76) y Berberis lyceum y Dryopteris ramosa con la misma alta frecuencia relativa (0.37 cada una). Las especies Skimmia laureola, Thymus linearis y Phytolacca latbenia se reportaron entre los taxones con mayor nivel de fidelidad porcentual. Conclusión: La flora utilizada en los remedios tradicionales del valle de Kaghan fue mayoritariamente endémica. Se propone para trabajos futuros mayor investigación química, y mayor utilización y conservación en las especies de plantas reportadas por los indígenas.
Subject(s)
Animals , Cattle , Cattle Diseases/therapy , Medicine, Traditional/methods , PakistanABSTRACT
Background: The aim of the study was to determine the degree of awareness and practice of proper menstrual hygiene management among women living in low-income neighbourhood in Karachi, Pakistan.Methods: A cross-sectional study was conducted at the Bizerta Lines, Karachi between January and June 2019. All women of reproductive age were included in the study. Amenorrheic, menopausal, or women on birth control were excluded from the study. Degree of awareness and current practices pertaining to menstrual hygiene management were assessed through pro-forma. The study tool collected the participant’s knowledge, awareness, and misconceptions about menstruation. The factors affecting the quality of life during menstruation of women living in poor socio-economic conditions were also observed. Statistical Package for Social Sciences (SPSS v.23) was used to analyze the collected data.Results: Of the 338 participants, 82.5% had no knowledge of menstruation prior to their first menstrual period. Only a minority of the women knew that the source of menstrual blood was the uterus while 41.4% of the women incorrectly claimed that the menstrual blood and urine were expelled from the same orifice. More than half of the participants used disposable sanitary napkins (55.5%). 65% of the participants changed the absorbent at least 1 to 3 times a day.Conclusions: Most of the participants used disposable sanitary napkins. However, the basic knowledge of female anatomy and physiology behind menstruation was poor among women.
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Background: Diabetes, hypertension, oxidative stress, obesity, adipocytokine dysfunction, and dyslipidemia are causative factors in development of Chronic Kidney Disease (CKD). Adiponectin secreted from adipose tissue, has Reno protective effect against development of albuminuria in animal studies. The previous studies investigated the relationship between serum adiponectin level and urinary albuminuria in kidney disease patients, but the results are conflicting.Methods: The pre diagnosed kidney disease patients were divided into microalbuminuria and macroalbuminuria groups, while control subjects were called as normoal buminuria group. The pre diagnosed adult kidney disease patients of both genders with age matching control subjects with no known comorbidity were included in the study. Whereas pregnant female patients and the patients with comorbidity were excluded from the study. The demographic data and the anthropometric data of control and kidney patients were recorded. The blood was analyzed for Glycosylated Hemoglobin (HbA1c), electrolytes, glucose, calcium, total protein, albumin, urea, creatinine adiponectin and malondialdehyde. The Urine was analyzed for Creatinine and albuminuria. The glomerular filtration rate was estimated.Results: The blood pressure, blood urea, creatinine, glycated hemoglobin, malondialdehyde, adiponectin levels were higher in albuminuric kidney patients as compared to normal control subjects. The mean glomerular filtration rate was lowest in macroalbuminuric patients as compared to micro and normoalbuminuric patients. The serum adiponectin and serum malondialdehyde both showed positive correlation with serum creatinine, and with albuminuria/urinary creatinine ratio.Conclusions: The study concludes that, positive correlation of serum malondialdehyde with adiponectin and albuminuria.
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Salinity is one of the most important constraints threatening the cultivation of potato plants (Solanum tuberosum L.). Itaffects plant growth and leads to significant yield loss. Consequently, it is important to improve the tolerance of potatoplants to salinity. In this context, we investigated the involvement of a potato ethylene responsive factor (StERF94) in plantresponse to salinity, since our previous genome-wide analysis showed that it may be related to biotic and abiotic stressresponse. ERF proteins belong to a large family of transcription factors that participate in plant response to abiotic stresses.We have previously identified the StERF94 gene which shows increased expression in potato plants submitted to salttreatment. In this study, transgenic potato plants overexpressing StERF94 were produced and submitted to salt treatment(100 mM NaCl) in vitro and under greenhouse culture conditions. StERF94 transgenic lines showed lower decrease of stemelongation under salt treatment in comparison to non-transgenic wild-type plants. Moreover, these plants showed a lowlevel of H2O2 and Malondialdehyde content, and an increase in catalase and GPX (Gluthation peroxidase) activitiescompared to non-transgenic plants. In a second step, enhanced expression of some target genes for example CuZn-SOD,DHN25 (Dehydrin) and ERD (Early Responsive to Dehydration) was noted in the StERF94 transgenic plants, submitted tosalt treatment. The StERF94 factor was also involved in the activation of osmoprotectant synthesis. Taken together, all thesedata suggest that overexpression of the StERF94 transcription factor increases the tolerance of potato plants to salinity byimproving plant growth, osmoprotectant synthesis and antioxidant activityleading to low oxidative stress damage.
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The National Health Policy in India mentions equity as a key policy principle and emphasises the role of affirmative action in achieving health equity for a range of excluded groups. We conducted a scoping review of literature and three multi-stakeholder workshops to better understand the available evidence on the impact of affirmative action policies in enhancing the inclusion of ethnic and religious minorities in health, education and governance in India. We consider these public services an important mechanism to enhance the social inclusion of many excluded groups. On the whole, the available empirical evidence regarding the uptake and impact of affirmative action policies is limited. Reservation policies in higher education and electoral constituencies have had a limited positive impact in enhancing the access and representation of minorities. However, reservations in government jobs remain poorly implemented. In general, class, gender and location intersect, creating inter- and intra-group differentials in the impact of these policies. Several government initiatives aimed at enhancing the access of religious minorities to public services/institutions remain poorly evaluated. Future research and practice need to focus on neglected but relevant research themes such as the role of private sector providers in supporting the inclusion of minorities, the political aspects of policy development and implementation, and the role of social mobilisation and movements. Evidence gaps also need to be filled in relation to information systems for monitoring and assessment of social disadvantage, implementation and evaluative research on inclusive policies and understanding how the pathways to inequities can be effectively addressed
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Background: In Pakistan age related vision disturbances are mainly due to cataract. Various studies have reported relationship of ocular lesion with senile changes and diabetes mellitus resulting in reduced quality of life due to vision. Oxidative stress is an important factor in the process of cataractogenesis. The pathogenesis of the cataract may involve decreased activity of antioxidant scavenging system which includes non-enzymatic natural antioxidants as biomolecules such as carotenoids and vitamins. So, it is planned to investigate the level of serum antioxidant vitamins in diabetic cataract patients and in non-diabetic cataract patients.Methods: The study was conducted at Biochemistry department, Al-Tibri Medical College Karachi from October 2016 to October 2017. Ninety pre diagnosed cataract patients were selected from Al-Ibrahim Eye Hospital Karachi 40 normal control subjects were selected from the same population with same socioeconomic group. The demographic data was analyzed. The random blood sugar, antioxidant vitamins (C, A and E) and malondialdehyde were analyzed in the blood sample of control and cataract patients. The data was analyzed by SPSS version 20.Results: There was no significant difference in the level of vitamin C, A, E and MDA between diabetic and non-diabetic cataract patients, but the blood levels of vitamins of control are higher as compared to the cataract patients. The level of MDA is significantly high in cataract patients as compared to control. Antioxidant vitamin E was negatively correlated with serum malondialdehyde in cataract patients.Conclusions: It is concluded that in diabetic and non-diabetic cataract low level of serum antioxidant vitamins may be a contributory factor for cataractogenesis.
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Background: Chemotherapy induced nausea and vomiting is the most distressing side effect of cancer chemotherapy. It can seriously impact patient抯 quality of life, influence the adherence to chemotherapy and progression free survival causing a delay or refusal of potentially life-saving therapy. The objective of this study was to compare the efficacy of palonosetron with ramosetron in achieving complete response to the chemotherapy.Methods: This was a prospective randomized open-label study conducted on 130 patients admitted in Medical Oncology ward of a Tertiary Care Hospitals, Bangalore, India. Patients were randomized to receive either palonosetron 0.25 mg or ramosetron 0.3 mg I.V. along with aprepitant and dexamethasone 30 minutes prior to chemotherapy and were followed up for a period of 5 days post chemotherapy. The observations such as number and severity of vomiting and nausea, the outcome was assessed at the end of 5 days. Pearson抯 Chi-square test was used to demonstrate the difference between both the study groups with respect to various categorical data.Results: The complete response rate in delayed phase was more significant in patients who received palonosetron than patients who received ramosetron (72.3% vs 50.8%). Total control was achieved in 38.5% patients with palonosetron as compared to 15.4% patients with ramosetron.Conclusions: Palonosetron is more efficacious than ramosetron in controlling chemotherapy induced nausea and vomiting especially in delayed phase of emesis.
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Background: Pharmacology is an important part of medical education. A competent doctor should be able to prescribe rational treatment to the patients to minimise the adverse effects and contribute to the improvement of overall healthcare system. There is a dire need to reform the undergraduate pharmacology curriculum to match up to the rapidly evolving medical field. Feedback system is one of the most successful instruments in improving any system. We have undertaken a similar feedback system to study the advantages and disadvantages of various study methods for teaching theory and practical exercises to the medical undergraduates.Methods: This is a cross sectional questionnaire based study conducted in the department of pharmacology. Students of MBBS 2nd year were enrolled into the study. The purpose of the study was explained to them and clarifications were made if any. The questionnaire included questions on various aspects of teaching methodology and graded by students on internationally accepted ‘Likert’ scale.Results: In our study students favoured teaching by blackboard method (96%) and many preferred a combination of blackboard and power point presentation. Discussing on issues of clinical significance of the topic was favoured by 96% of the students and 67% students responded that stressing on the facts concerned with Post graduate entrance exams is more important. Sixty nine percent and 85% students preferred short essays and MCQs respectively as method of evaluation and 68% of them favoured evaluation by both the methods. Regarding pharmacology practical exercises most of the students preferred clinical problems, dosage calculation, ADR reporting and other problem based learning techniques. Studying pharmacology as an integrated subject with other clinical subjects was preferred by 68% of the students.Conclusions: It is well known that students learn better when they are involved actively in learning process than when they are passive recipients. In our study we realised that undergraduate pharmacology teaching pattern should be modified mostly towards pharmacotherapeutics and clinical pharmacology.
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Background: Pharmacovigilance is the science and activities relating to detection, monitoring, assessment, understanding and prevention of adverse effects or any other drug related problem from any pharmaceutical products. The core purpose of pharmacovigilance is to enhance patient care and generate the evidence based information on safety of medicines. The objective of present study was to evaluate the knowledge, attitude and practices of the healthcare professionals about pharmacovigilance and to assess the reasons for underreporting of ADRs.Methods: A cross-sectional study was conducted by administering KAP questionnaire to the healthcare professionals. There were 22 multiple choice questions. Ten related to knowledge, 5 related to attitude, and 6 related to practice. One question was asked to determine the reasons for underreporting of ADRs. The performance in each category was graded as good, average and poor if the number of participants giving correct/positive responses were >70%, 50-69%, <50% respectively. Question no 22 was assessed independently to find out reasons for underreporting of ADRs. Data was compiled and analyzed by descriptive statistics, Chi-square and ANOVA test.Results: The response rate in this study was 62.5%. The study included professors (11%), associate professors (6%), assistant professors (20%), postgraduates (26%) and interns (37%). That there was statistically very highly significant difference of mean score of knowledge, attitude and practice among health care professionals (P<0.001). The performance score with respect to attitude of health care professionals towards pharmacovigilance was good as compared to knowledge which was average followed by practice which showed poor performance (72.5% >51.6% >36.8%) (p <0.001).Conclusions: Awareness campaigns, CMEs, workshops on pharmacovigilance should be conducted regularly such that good knowledge about pharmacovigilance can be imparted which can be moulded into good practice.
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The study is conducted to observe and investigate the effects of oral dosing of methanolic extracts of Cuminum nigrum [L] and Centratherum anthelminticum [L] on neuropharmacological activities of mice. Methanolic extracts of Cuminum nigrum [L] and Centratherum anthelminticum [L] were soluble in Dimethyl sulphoxide [DMSO] i.e. an organic solvent, so it is used in this study. Screening for anxiolytic and antidepressant effects were performed using open field test, head dip test, stationary rod test, cage crossing test, light and dark box and swimming- induced depression test. Thirty animals were divided into three groups of 10 animals each and numbered as 1 [control, on DMSO], 2[on methanolic extract of Cuminum nigrum [L], 3 [on methanolic extract of Centratherum anthelminticum [L]. The extracts and DMSO were administered orally for 60 days. Any possible change in animal behavior was evaluated on day 15, 30 and 60 of dosing. The groups 2 and 3 showed significant increase [p<0.001, p<0.01] in open field activity and light and dark box test respectively, while significantly decreased activity was observed in head dip and cage crossing activity [p<0.01] after 60 days of dosing. Based on above findings, it is suggested that the extracts of Centratherum anthelminticum [L] and Cuminum nigrum [L] have antidepressant and anxiolytic potential with sedative effects
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Objective:To assess the role of miRNA712_3p as a specific biomarker in early detection of toxoplasmosis in plasma of mice acutely infected with Toxoplasma gondii.Methods:Real-time PCR was used to measure the level of miRNA712_3p in plasma of infected mice. Immune-competent and immune-suppressed mice were examined, three and five days post-infection.Results:Results revealed significant up-regulation of plasma miRNA712_3p in both immune- competent and immune-compromised groups in comparison to the control non-infected group. Additionally, an increase in the level of miRNA712_3p was noticed correspondently in the parasite density detected in liver impression smears.Conclusions:miRNA712_3p can be used as a novel biomarker for the detection of Toxoplasma gondii infection in both immune-competent and immune-compromised host.
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Objective: To assess the role of miRNA712_3p as a specific biomarker in early detection of toxoplasmosis in plasma of mice acutely infected with Toxoplasma gondii. Methods: Real-time PCR was used to measure the level of miRNA712_3p in plasma of infected mice. Immune-competent and immune-suppressed mice were examined, three and five days post-infection. Results: Results revealed significant up-regulation of plasma miRNA712_3p in both immune-competent and immune-compromised groups in comparison to the control non-infected group. Additionally, an increase in the level of miRNA712_3p was noticed correspondently in the parasite density detected in liver impression smears. Conclusions: miRNA712_3p can be used as a novel biomarker for the detection of Toxoplasma gondii infection in both immune-competent and immune-compromised host.
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Among the well-known Health care-associated infections [HAIs], surgical site infections [SSIs] contribute to considerable high mortality and morbidity rate, substantial prolongation in hospitalization period and extra expenses in terms of treatment cost. This study was aimed to evaluate the predictive variables associated with surgical site infections, and their clinical consequences. This was a prospective, cross sectional study conducted in the surgical department of tertiary care setting in Karachi, Pakistan. Each patient was followed up from the time of admission until time of the discharge postoperatively for 30 days. A total of 554 surgical procedures were performed and 81 SSIs were identified. The predictor variable/risk factors significantly associated with the presence of SSI were age, gender, BMI, ASA score, co-morbid condition, surgical wound class, emergency surgeries, duration of surgery, type of anesthesia, prosthetic implant, pre operative length of stay and pre operative blood transfusion. Outcomes of such studies may be utilized in the design of a multi factorial practice to get better patient's safety and clinical outcomes
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Objective: To determine skin changes in patients of End Stage Renal Disease [ESRD] on maintenance hemodialysis [MHD] and factors affecting these changes
Study design: Cross-sectional observational study
Place and duration of study: Nephrology Department, Mayo Hospital, Lahore in collaboration with Dermatology Department, King Edward Medical University, Lahore, from October 2015 to January 2016
Methodology: Two hundred patients who were undergoing MHD for more than three months were included in the study. Patients' demographic data, laboratory reports and dialysis records were noted in a predesigned questionnaire. Skin examination was carried out by consultant dermatologist after patient's permission
Results: Among 200 patients included in study, 105 were malesand rest of them were females. Major causes of ESRD were Diabetes Mellitus [n=83, 41.5%, followed by Hypertension [n=80, 40%], Nephrolithiasis [n=15, 7.5%] and Chronic glomerulonephritis [n=5, 2.5%]. At least one cutaneous finding was present in every patient. Common skin findings observed were pigmentation [86%], xerosis [83%], pallor [79%], pruritus [69%], acquired ichthyosis [50.5%], and bacterial skin infections [18.5%]. Among them, nail manifestations were half-and-half nails [52%], onychomycosis [30.5%], onycholysis [20.5%], subungual hyperkeratosis [23.5%], and Mee's lines [7.5]. Among hair changes were sparse scalp hair [38.5%], brittle and lustreless hair [28%]. The factors contributing to skin changes were patient's age, cause of ESRD, anti HCV positivity, high urea and creatinine levels, duration and frequency of hemodialysis, hemoglobin levels, calcium phosphate product and socioeconomic status. Some skin manifestations were interrelated with each other like xerosis with pruritus [p<0.001], pruritus with bacterial infection [p<0.022], acquired Ichthyosis [p=0.008] and hair changes [p=0.035]
Conclusion: ESRD patients on hemodialysis develop various skin changes during the course of disease process, which contribute to increased morbidity. Different factors affecting skin changes were the cause of ESRD, adequacy and duration of dialysis, employment, financial status, anti HCV positivity, and metabolic factors
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Drug-drug interactions [DDIs] are extremely significant concern, particularly in sensitive population including pediatric and geriatric. Propensity for the development of DDIs is high in patients admitted at intensive care units [ICU]. This study was conducted to evaluate the DDIs incidence, facts and measures in ICU. From a total of 150 cases studied for ICU patients, with the mean age of 56.37+/-12.45 years, 55.33% were male and the rest were female 44.66%. The demographic information like age, gender and main diagnosis details of study participants that were extracted from the patients' clinical record. A statistically significant association between the drug interaction and the number of drugs prescribed per prescription was observed [p <0.0001]. Concerning the onset of outcome, 52% of DDIs distinguished as delayed onset of effect [past 24 hours] and 35% were categorized as rapid onset [within 24 hours]. Despite the facts regarding patient safety and minimizing DIs error, polypharmacy is still frequent in critically ill patients admitted in ICU attributed high risk of adverse reactions due to use of multiple interventions to treat severity of disease condition. Such studies may be used to develop an effective tool for the diagnosis and management of DDIs
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Irrational, over and misuse of antibiotics arise as global concern in both hospital and community settings and lead to adverse events including antimicrobial resistance, associated health problems, amplified hospitalization stay and cost. Hence, Drug Utilization Evaluation [DUE] studies are designed to evaluate and improve the prescribing, administration and the rational use of medications. The present study was designed to assess the pattern of antimicrobial drug utilization in in-patients cohort of tertiary care setup in Karachi, Pakistan. This cross sectional observational study was conducted in retrospective manner. World health organization [WHO] guidelines and criteria are considered to evaluate the appropriateness of drug use in various disease conditions. ATC/DDD system was applied to determine the study outcome. High frequency of antibiotics utilization found in respiratory tract infections of both lower [LRTI] 16.8% [n=42] and upper [UTI] 13.2% [n=33]. The estimated total number of drug units administered per month was greater with cefixime [46] and ciprofloxacin [45] both. DDD/100 bed days drug utilization of antibiotics was higher with ciprofloxacin, cefexime and meropenem [47, 46 and 29.25] correspondingly. In conclusion, the current investigation signifies extensive scope for progress in prescribing trend. Drug adherence to customary guidelines of disease management and constraint policies to endorse judicious drug use may be considered vital in healthcare setup
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Objective: To determine the efficacy of metformin alone versus metformin plus simvastatin for treatment of polycystic ovarian syndrome [PCOS]
Study Design: Randomized controlled trial
Place and Duration of Study: Maternal and Child Health Centre, Unit II, Pakistan Institute of Medical Sciences [PIMS], from November 2014 to April 2015
Methodology: One hundred and eight patients [108] were randomly divided into metformin group [n=54] and metformin plus simvastatin group [n=54], detailed clinical history, including menstrual details, was taken with thorough examination performed. Baseline ultrasound was performed to evaluate ovarian size and these were considered enlarged with volume >10cc or with >12 follicles in any one ovary. Blood samples were taken at baseline and after three months of therapy to determine the LH/FSH ratio and lipid profile. Efficacy was defined as >15% decrease in the baseline values
Results: The mean age of patients was 28.82 +/- 7.18 years. Mean BMI of the patients was 22.41 +/- 1.55 Kg/m[2]. Efficacy was achieved in 66.7% patients with metformin alone, while in 92.6% with combination medication [p=0.001]
Conclusion: The combination of metformin plus simvastatin is more efficacious as compared to metformin alone for management of females with PCOS