Comparative investigation of the free radical scavenging potential and anticancer property of Diospyros blancoi (Ebenaceae)

Objective: To investigate the comparative effects of Diospyros blancoi (Ebenaceae) leaves (DBL), root bark (DBRB) and stem bark (DBSB) on free radicals and cancer. Methods: The polyphenol contents, antioxidant and free radical scavenging properties were determined using standard spectrophotometric methods. Cytotoxicity and anticancer activities were performed on brine shrimp nauplii and Ehrlich ascite carcinoma cells, respectively. Results: Among the extracts, DBSB showed the highest total antioxidant capacity and reducing capacity on ferrous ion. Based on 1,1-diphenyl-2-picrylhydrazyl and hydroxyl radical scavenging activities, DBSB showed (95.760 ± 0.343)% and (67.460 ± 2.641)% scavenging with IC

Venous thromboembolism in a medical intensive care unit. The effect of implementing clinical practice guidelines

To determine the incidence of VTE in medical patients admitted to the intensive care unit [ICU] following the implementation of a standard deep venous thrombosis [DVT] prophylaxis protocol using unfractionated heparin [UFH], and to identify risk factors for DVT in these patients. We prospectively studied 123 consecutive patients admitted to the Medical ICU of King Khalid University Hospital, Riyadh, Saudi Arabia. We excluded patients on anticoagulation or with contraindications for heparin. Patients who were negative for DVT by screening Doppler Ultrasound [U/S] were started on UFH twice a day. The Doppler U/S was repeated twice weekly for 6 weeks. One hundred and four critically ill medical patients were included. A DVT was diagnosed in 10 patients while receiving UFH, an incidence rate of 9.8%. The compliance rate was 98%. Sepsis [p=0.0167], limited mobility [p<0.0001], previous DVT [p=0.024], and nephrotic syndrome [p=0.008] were significantly more common in patients who developed DVT compared with others. However, by backward logistic regression, previous DVT was the only significant factor for the development of DVT [B=-0.439, AOR=5.01, p<0.0001]. The implementation of clinical practice guidelines for VTE prophylaxis in critically ill medical patients using UFH twice daily resulted in a high compliance rate and low incidence of VTE. Previous DVT was a significant risk factor for development of VTE

Antidiabetic and hypolipidemic effects of different fractions of coccinia cordifolia L. on normal and streptozotocin-induced diabetic rats

The present study was carried out to observe the antidiabetic and hypolipidemic effects of petroleum-ether, ethyl acetate and chloroform fractions isolated from ethanolic extract of the leaves of Coccinia cordifolia Linn. [150 mg/kg body weight] on normal and streptozotocin [STZ]-induced diabetic rats for one day experiment. Single doses [150 mg/kg, i.p.] of C. cordifolia extracts were given to normal and diabetic rats. The fasting blood glucose [FBG], serum triglyceride [TG] and serum total cholesterol [TC] levels were investigated in normal and STZ-diabetic rats on 0, 1, 2, 3, 6, 10, 16, and 24[th] hours. In normoglycemic rats the pet-ether and ethyl acetate fractions of C. cordifolia reduced blood glucose level significantly [39.66% and 40.68% at 16[th] and 24[th] hour respectively]. In the STZ-diabetic rats pet-ether and ethyl acetate fractions also reduced blood glucose level significantly [50.39% and 50% at 10[th] and 24[th] hour respectively]. Ethyl acetate fraction is most effective which reduced total cholesterol level by 31.04% and 36.69% in normal and STZ-diabetic rats respectively. Ethyl acetate fraction reduced triglyceride level by 43.82% and 42.01% in normal and STZ-diabetic rats respectively. Our results indicate that pet-ether and ethyl acetate fractions of C. cordifolia have potentiality against diabetes

Temperature monitoring and perioperative heat loss

To assess the temperature fall at various stages in the perioperative period and identification of contributing factors. This observational study was carried out at Blackpool Victoria Hospital, UK from August 2005-January 2006 on 32 patients undergoing major lower limb vascular surgery. Semistructured data collection form was designed to record the time and tympanic temperature at different stages in perioperative period and the warming methods used. A median fall of 0.1°C [0-0.5°C] in core temperature was recorded in ward and theatre reception area. The median fall of temperature in the anaesthetic room was 0.3°C [0-.8°C]. Patients [n=16] spending more than 0.5 hour in the anaesthetic room had a significant [p=0.002] temperature drop recorded at 0.4°C as compared to 0.2°C for those spending less than 30 minutes. During operation, a median fall of temperature by 0.8°C [0.3-2.1°C] was recorded. Operations lasting for 2.5 hours or more [n=16] resulted 2 in a 1°C temperature fall as against 0.5°C for the rest. Seven patients, in whom a warming mat was used, had a temperature drop of 0.6°C compared to 0.35°C in patients who received warm touch. In the recovery unit, 23 patients had a further drop of 0.3°C, while 9 patients who were actively warmed gained 0.6°C. Significant heat loss occurs in the anaesthetic room relevant to the length of time consumed in anaesthetising the patient. Furthermore active warming measures in the perioperative period have a positive impact on maintaining core temperature

Oral glucose tolerance test [OGTT] in normal control and glucose induced hyperglycemic rats with Coccinia Cordifolia L. and Catharanthus roseus L

The aim of this study is to investigate the hypoglycemic effects of petroleum ether, chloroform and ethyl acetate fractions isolated from ethanolic extracts of Coccinia cordifolia and Catharanthus roseus on normal control and orally glucose-induced hyperglycemic rats. Single doses [150 mg/kg] of different fractions of C. cordifolia and C. roseus extracts were intraperitonelly administered. The serum blood glucose level was obtained by pricking the tail vein using glucometer at time 0, 30, 60, 90, 150 and 270 minutes.In the orally glucose induced hyperglycemic rats, chloroform-coccinia [CHCl[3]-CC] fraction showed maximum reduction of blood glucose level by 21.94% on 60 minute of the experiment. On the other hand maximum reduction [p<0.05] of 17.92% was observed for petroleum ether-catharanthus [PET-CR] on 30 minute of the experiment. Metformin HCl was used as standard drug.Our results indicate that the CHCl[3]-CC fraction is relatively more potent than other fractions of C. cordifolia. Similarly the PET-CR is found to be better than other fractions of catharanthus. Phytochemical screening test results showed that chloroform fraction of C. cordifolia contain saponins and flavonoids compounds, which are known to be hypoglycemic. On the other hand petroleum ether fraction of C. roseus contains tannins, flavonoids and alkaloid compounds produced varying degree of blood sugar reduction. On the pharmacological point of view C. cordifolia and C. roseus appears to be a valuable plant, which can be useful, at least as an adjunct, in the therapy of diabetes

Hematologic and cytogenetic findings in eleven chronic myelogenous leukemia patients treated with imatinib mesylate at a Tertiary care hospital

Objective: To evaluate the response of Imatinib mesylate in patients with myeloid leukemia in chronic, accelerated and blast phase

Material and Methods: Eleven patients with established diagnosis of chronic myeloid leukemia were treated with Imatinib mesylate. Adverse events were documented with regular follow ups. Hematological and cytogenetic responses were assessed according to established criteria. Patients with zero percent Philadelphia positive metaphases were labeled as complete cytogenetic response while patients with 1% to 35% Philadelphia positive metaphases were termed as partial responders

Results: Of 11 cases there were 7 males and 4 females with a mean age of 39.5 years and median age 51 years [range 21-69]. Male to female ratio was 7:4. Median follow-up was 34 weeks [range 8-78]. Four patients were in blast crisis, 1 in accelerated phase and remaining six patients were in chronic phase. All patients achieved hematological response. Cytogenetic response was present in six patients, 3 were responders and the remaining were non responders. Two patients achieved complete cytogenetic response and one patient had partial cytogenetic response. Both patients with complete cytogenetic response relapsed in twelve weeks time

Conclusion: Imatinib mesylate is a drug with curative potential and can be used as a first line drug in the management of CML, however at present the cure rate is unknown

Prevalence of Hepatitis C virus in lymphoproliferative disorders

Objective: To study the prevalence of hepatitis C virus in lymphoproliferative disorders

Methods: A case control prospective study was performed on 143 patients with lymphoproliferative disorders and 29 patients with non-hematological malignancies were taken as controls. All the patients in both groups were analyzed for various risk factors for infection with hepatitis C virus and were tested for the presence of hepatitis C virus antibody [anti HCV], cryoglobulins and rheumatoid factor antibody. Hepatitis C viremia was documented by detection of HCV RNA by polymerase chain reaction

Results: There was no significant difference for risk factors for hepatitis C virus infection in both the groups except for the increase in number of surgical procedures being carried out in the control group. There was no significant difference in the presence of rheumatoid factor antibody in both the groups and cryoglobulins were not positive in any individual. Five percent patients with lymphoproliferative disorders and 3.4% with non-hematological malignancies were positive for anti HCV. HCV RNA was detected in 29.2% cases and 31.0% in controls

Conclusion: There was no association between hepatitis C virus infection and lymphoproliferative disorder in our population. However, further studies are required from this region to establish any causal relationship between hepatitis C virus infection and lymphoproliferative disorder

Polycythemia vera and idiopathic eryhrocytosis: comparison of clinical and laboratory parameters

To evaluate the various clinical and laboratory parameters of Polycythemia vera and idiopathic erythrocytosis in order to differentiate between two entities at the Aga Khan University Hospital. Twenty six patients of polycythemia vera and 34 patients of idiopathic erythrocytosis were analyzed with respect to clinical features and laboratory findings. Patients with idiopathic erythrocytosis were males with a mean age of 41 years and no splenomegaly. Patients with polycythemia were older males and females with splenomegaly, red cell count of mor than 6.5 million/cmm, haematocrit 55%, leucocytosis, thrombocytosis and low erythropoietin level. Based on the above-mentioned findings, we suggest that polycythemia vera and idiopathic erythrocytosis are separate entities and the diagnosis of these can be made on the basis of clinical and laboratory parameters

Increased expression of HLA DR2 in acquired aplastic anemia and its impact on response to immunosuppressive therapy

To study the frequency of HLA DR2 status of patients with aplastic anemia and their response to immunosuppressive therapy at a tertiary care hospital. Thirty eight consecutive patients of acquired aplastic anemia were evaluated with respect to demographic features, severity of HLA DR2 status and response outcome to immunosuppressive therapy. The mean age of the patients was 24.6 years + 16.4 with a male to female ratio of 2.8:1. Positivity of HLA DR2 was markedly high in acquired aplastic anemia patients. Twenty four [65%] out of 38 patients as compared to 45 [15%] of 300 healthy controls [p<0.0001] were positive for HLA DR2. Response to immunosuppressive therapy, which included antilymphocyte globulin, cyclosporin and methylprednisolone, was available in sixteen HLA DR2 positive patients and was found satisfactory in 12/16 [75%] patients. HLA DR2 was significantly higher in patients with acquired aplastic anemia and favourable response to immunosuppressive therapy was also associated with HLA DR2 positivity

Pulmonary infiltrates during chemotherapy-induced febrile neutropenia: incidence, patterns and outcome

To analyze the incidence, etiologies, radiographic patterns, and clinical outcomes of adult leukemics with prolonged febrile neutropenia and pneumonia. A retrospective study was conducted at a tertiary care hospital. The medical records of adult patients with acute myeloid leukemia diagnosed between January 1989 and June 2000 and undergoing induction chemotherapy were included. Only the patients who presented with a pulmonary infiltrate, secondary leukemia [e.g., transformed chronic myeloid leukemia underlying myelodysplastic syndrome, or disease following alkylating agent therapy] were included and those developing infiltrates following consolidation chemotherapy were excluded. A total of 124 patients were admitted to the hospital with a diagnosis of AML during the study period. Thirty-one patients were excluded; 93 patients received induction chemotherapy and were included in the study analysis. The median age was 36 years [15 - 70 years]; 58 males and 35 females. Sixty two% patients received Cytosine Arabinoside [Ara-C], 17% received Etoposide, 11% received Ara-C and Mitoxantrone, and 6% received All-trans-retinoic Acid. The mean onset and duration of neutropenia were 5 and 15 days, respectively. Pulmonary infiltrates were identified during 45% of neutropenic episodes. A presumptive causative organism was isolated from 50% of patients with an infiltrate: Gram- positive bacteria were most common [47%] followed by Gram-negative bacilli [33%] and fungi [20%]. Survival data were available for 88 patients; median disease free survival for the entire cohort was 7 months. Male sex [p=0.015], onset of neutropenia [p=0.02] and bilateral distribution of an infiltrate [p=0.03] were statistically significant predictors of early mortality. For patients with and without pneumonia, the median disease-free interval and overall survival were 2.5 and 4.6 months and 9 and 13 months [p=0.038 and p=0.095] respectively. Neutropenia occurred at a mean of 5.0 after initiation of induction chemotherapy. The majority of patients had bilateral pulmonary infiltrates. Male sex, onset of neutropenia and bilateral distribution of an infiltrate were found to be statistically significant predictors of early mortality

Diffuse alveolar hemorrhages and hemorrhagic pleural effusion after thrombolytic therapy with streptokinase for acute mycardial infarction

Thrombolytic therapy with streptokinase is commonly used in acute myocardial infarction and has markedly reduced morbidity and mortality from this condition. However, it can cause various hemorrhagic and immunological complications.We report a patient who developed diffuse pulmonary hemorrhages and bilateral hemorrhagic pleural effusion after thrombolytic therapy with streptokinase for acute myocardial infarction. This was recognized by a drop of hematocrit, pulmonary infiltrates, hemorrhagic pleural effusion and hypoxemia. The diagnosis was confirmed by demonstration of iron-laden macrophages [siderophages] in bronchoalveolar lavage. The patient required mechanical ventilation and recovered successfully. This combination of pulmonary hemorrhages and hemorrhagic pleural effusion following streptokinase therapy is extremely unusual and has not been reported previously

Use of intravenous anti-D in patients with refractory and relapsed immune throm bocytopenic purpura

To determine the response to IV anti-D and its comparison with splenectomy as second line therapy in refractory and relapsed cases of ITP, in the Aga Khan University Hospital, Karachi. A total of 23 patients with chronic ITP were treated with either anti-D or splenectomy as second line treatment. The patients were assessed for time to achieve a response to second line treatment, duration of response and adverse events. There were 12 patients in the anti-D group and 11 in the splenectomy group. The mean platelet count at presentation was 9,000/cumm. The mean age was 8.9 years and 13.0 years and the male to female ratio was 1:1 and 1:1.2 in anti-D and splenectomy group respectively. 54.5% of the patient in the anti-D group responded compared to 81.8% in the splenectomy group. Median time to achieve a response was 7 days in the anti-D group and 1 day in the splenectomy group. Mean time to relapse was 87.8 days in the anti-D group and 55.4 days in the splenectomy group. No adverse events were recorded for any of the infusions of anti-D and none of the patients had more than 0.5 gm /dl fall in the hemoglobin level following anti-D infusion. It was thus concluded that Anti-D is a relatively safe, convenient and effective therapy for chronic ITP and can be used as a splenectomy sparing agent when treatment is clinically indicated

Chromosomal abnormalities as a cause of recurrent abortions: a hospital experience

To analyze the chromosomal abnormalities in couples with history of recurrent abortions. Retrospective study. Cytogenetic section, Department of Pathology at the Aga Khan University Hospital, Karachi, Pakistan. Three hundred couples with history of recurrent abortions. Structural chromosomal abnormalities in carrier couples. G-banded chromosomes were analyzed from both partners of 300 couples who had had two or more spontaneous abortions. Sixteen [5.3%] couples showed a chromosomal aberration in one of the partners. Seven translocations, 5 inversions, 2 deletions and 2 sex chromosomal abnormalities were identified. There was an increase in structural aberations, which was not significantly different from that reported worldwide. Chromosomal analysis is advocated as a primary tool in the evaluation of couples with repetitive fetal wastage

Classification and immunophenotyping of acute leukemias: a prospective study

Over a period of 3-1/2 years, 86 cases of acute leukemia were analyzed by immunohistochemical [IHC] means on ficoll separated cytospin preparations of peripheral blood and/or bone marrow samples. Antibodies included in the panel were specific against Tdt, HLA-DR, CD19/CD20/CD22, CALLA [CD10], CD2, CD11C as well as against Ig heavy chains. Of 86 cases analyzed, 48 cases were of ALL, [25 of common pre-B ALL, 15 of pre-B/NULL and 8 of T ALL phenotype], twenty-four [24] out of 86 cases were of non-lymphoblastic [AML/AMML] type. In six cases, there was suggestion of a mixed lineage, while in 8 cases there was inconclusive diagnosis. Mean age was lower in common ALL sub-set of ALL as compared to pre-B/NULL group [i.e., 8 vs 12 years], while in non-lymphoblastic group it was 36 years. T cell phenotype was invariably seen in young adults, who usually presented with a mediastinal mass

Management of intracranial aneurysm review of subarachnoid haemorrhage

We present a series of 25 cases of subarachoid haemorrhage [SAH] managed at the neurosurgical department of Allied Hospital, Faisalabad. They were between 12 to 70 years of age. Among these 16 were female and 9 male patients. All these patients were clinically graded according to Hunt and Hess classification. Every patient had coaxial tomographic [CT] scanning. Eleven patients [44%] had lumbar puncture prior to their admission. Cerebral angiography was performed in all grade 0, I and II patients. Initially all these patients were treated conservatively. Surgery was performed on 10 [40%] patients on or after 10th day of ictus. Mortality in conservatively treated group was 66% where as it was 0% in operated group with 90% functional recovery. Only one patient deteriorated postoperatively

Does red blood cell distribution width [RDW] improve evaluation of microcytic anaemias?

The red cell distribution width [RDW] is an index of the variation in red cells size [anisocytosis]. A study was conducted to examine the validity of using RDW in improving classification of microcytic anaemias. A total of 300 blood samples collected from a patient population aged 3 months to 55 years who were referred for haemoglobin electrophoresis were examined at the Aga Khan University Hospital [AKUH]. On complete blood count, initially 200 patients [66.6%] were found to have hypochromic microcytic anaemia. Following haemoglobin electrophoresis 41% [82/200] patients were diagnosed to have thalassemia minor and 59% [118/200] had hypochromic microcytic anaemia with either a normal haemoglobin pattern or an abnormal haemoglobin. The mean [ +/- SD] RDW estimated in 250 apparently healthy Pakistani population was 14 [ +/- 1.5%]. Elevated RDW of 23% was present in 94% [110/118] of the patients with hypochromic microcytic anaemia due to other causes, whereas 48% [39/82] of the patients with thalassemia minor had elevated RDW of 16%. Also, of the 82 thalassemia minor, 28 patients had normal haemoglobin level, of which 6 had elevated RDW and of the 54 with low haemoglobin level, 35 had elevated RDW. RDW was normal in 41 patients with thalassemia minor trait. Our results suggest that RDW alone cannot be used as a reliable indicator to distinguish between thalassemia minor and other causes of microcytosis

Nutritional parameters predicting postoperative infections

Thirteen nutritional parameters viz body mass index [BMI], mid arm circumference [MAC], mid calf circumference [MCC], triceps skin fold thickness [TST], abdominal skin fold thickness [ASFT], abdominal girth at umbilicus [AGU], haemoglobin [Hb], total leucocytes count [WBC], absolute lymphocyte count [ALC], serum proteins [Prot], serum albumin [Alb], serum total iron binding capacity [TIBC] and serum iron [Fe] were estimated in 52 [36 male and 16 female] consecutive patients admitted to a surgical service at the Abbasi Shaheed Hospital, Karachi. Nine males and one female developed surgical infections whilst the wounds of 27 males and 15 females healed by primary intent. There was a significant difference in the values of BMI, MCC, ASFT, Prot., and Alb between the patients with infected and clean wounds. Whilst MCC was significantly different, MAC was not as good a differentiator. Whilst Prot. and Alb were lower in the infected group, BMI, MCC, TST, ASFT were higher in the patients whose wounds healed by primary intent