Study of effect of Nigella sativa on prevention of nephrotoxicity induced by colistin in experimental animals

ABSTRACTBackground: Nigella sativa, a widely used medicinal plant throughout the world belongs to family ranunculaceae. Its Seeds and oil have a long history of folklore usage in various traditional systems of medicines and food. This study was performed to evaluate the protective effect of Nigella sativa oil (NSO) on kidney when simultaneously given with colistin sulfate (CS) which induces tubular damage in rats.Methods: Animals were treated for 7 days: Group I (n=6) with normal saline and CMC, Group II, III and IV with 300.000IU/kg/day of CS (n=6). Group III and Group IV with NSO at the dose of 1 and 2ml/kg per orum prior to CS administration. All the animals were sacrificed on 8th day. Afterwards, the plasma creatinine (pCr), blood urea, renal tissue level of malondialdehyde (MDA), reduced glutathione (GSH) and renal histology were performed.Results: Colistin sulfate induced tubular damage, increased the plasma creatinine (pCr), blood urea and MDA levels and decreased the reduced glutathione (GSH). However, simultaneous treatment with Nigella sativa oil at the dose of 1ml/kg and 2ml/kg for one week produced dose dependant improvement in tubular damage and reduced the biochemical alteration.Conclusions: It could be concluded that, Colistin sulfate induced nephrotoxicity is ameliorated by NS oil especially in higher dose of (2ml/kg). This nephroprotective effect is ascribed to free radical scavenging and potent antioxidant activity in Nigella sativa.

Deferred Stenting as an Alternative Strategy for Management of ST-Elevation Myocardial Infarction with Significant Thrombus Burden.

Objectives: We evaluate a deferred stenting strategy following intense antithrombotic and antiplatelet therapy as an alternative to primary percutaneous coronary intervention with immediate stenting in ST-Elevation myocardial infarction (STEMI) patients with large thrombus burden. Methods: We identified all consecutive patients where a deferred stenting strategy was chosen as initial management strategy. Baseline characteristics, clinical outcomes and complications were collected from local and provincial databases. Procedural characteristics were evaluated from detailed review of angiograms. Results: Between June 2011 and March 2014, thirty eight patients were treated with a deferred stenting strategy. TIMI thrombus grade scale 4 or 5 on the initial angiogram was seen in 82% of cases. Immediate thrombectomy or balloon angioplasty was performed in 25 out of 38 patients to restore flow. Aggressive antithrombotic (86% heparin) and antiplatelet (100% Eptifibatide and 100% dual antiplatelet therapy) was administered. No emergency repeat catheterisation was required. Thirty six patients had a relook angiogram. No further coronary intervention was required in 12/36 (33%) of patients, 23/36 (64%) patients received at least one stent and one patient was sent for coronary bypass surgery. No major bleeding occurred. One patient treated with deferred stenting died at 2 months from stent thrombosis. No other major adverse cardiovascular events occurred. Discussion: In our experience deferred stenting is safe and has the potential to reduce no reflow and thereby reduce infarct size.

Pharmacological and toxicological investigation of coded Unani formulation UNIM-211

The Pharmacological and toxicological investigation of the aqueous extract of coded compound Unani formulation UNIM-211 was undertaken to evaluate its efficacy and safety in experimental animals. Hypoglycemic activity of the drug extract was evaluated in alloxan induced diabetic rats. Drug extract only at a dose of 3 gm/kg significantly reduced the blood glucose level after 8 days of treatment. The hypoglycemic effect of drug extract was compared with standard hypoglycemic agent glibenclamide. The drug extract is found to be less effective in lowering the blood glucose level in diabetic rats when compared with glibenclamide. The acute toxicity study carried out in albino mice revealed that it tolerated a dose of 10 gm/kg of drug extract and animals showed no abnormal sign and symptoms and no overnight mortality when observed for 24 hours after drug treatment. The investigation of subacute toxicity revealed that the aqueous extract of the drug at doses of 1 gm/kg and 3 gm/kg showed no change in the parameters of liver function test and lipid profiles, but a significant increase in blood urea level was observed at both the doses of the drug. The haematological studies revealed no significant change in percent haemoglobin, ESR, but a significant change in TLC and DLC was observed at a dose level of 3 g/kg. The organ to body weight ratio of liver, heart and spleen remained unaltered but a significant increase in the organ to body weight ratio of kidney at a dose of 3 g/kg was observed. These results show that the drug is effective in lowering alloxan induced blood glucose level only at high dose, and it is quite safe except some adverse effect on kidney

Comparison of haemodynamic changes in patients undergoing unilateral and bilateral spinal anaesthesia

To assess the haemodynamic changes in patients receiving unilateral and bilateral spinal anaesthesia with their pre-anaesthesia recordings. Quasi-experimental study. Main Operation Theater, Liaquat National Hospital, Karachi, from May 2006 to February 2007. Sixty patients meeting the inclusion criteria were randomly allocated in two groups of 30 patients each. One and a half ml of 0.75% hyperbaric bupivacaine was injected with free flow of cerebrospinal fluid using a 23 gauge quincke needle. Lumbar puncture was performed in the sitting position at 3 - 4 or 4 - 5 lumbar interspace. Patients were then assigned to the supine or lateral decubitus position for 10 minutes. Heart rate, systolic, mean and diastolic blood pressures of patients were recorded with their pre-anaesthesia readings in the 1[st], 5[th], 15[th], 30[th] and then at every 15[th] minute till the end of procedure. Recovery room readings were also taken. The systolic, mean and diastolic blood pressure changes were significant in both groups. But from 1[st] minute to recovery room, statistically significant difference [p < 0.05] was found at each time interval, the unilateral groups [group A] being more stable with respect to pre-anaesthesia readings. The decrease in heart rate was comparable in both groups. Unilateral spinal anaesthesia was associated with a more stable cardiovascular profile, therefore, it is a valuable technique for high risk patients

Evaluation of depth dose characteristics of superficial X-rays machine using different kVp and applicators diameter

Radiotherapy Treatment Planning requires different dosimetric quantities as input in order to calculate a desired dose distribution. This study has been focused to evaluate the depth dose characteristics of superficial X-rays being used for radiotherapy treatment. Computerized 3-D water phantom of multi-data system was used. The measurements were made through PTW [Physikalirsch-Technische Werkstalten] farmer type NT-30006 waterproof ionization chamber of 0.6cc, and PTW electrometer for digital dose rate reading in Gy/min using five different diameter applicators and filters at five different values of accelerating potentials [kVps]. The dose rate at various kVp X-ray beams was observed to decrease significantly with increasing depth in water phantom for all applicator diameters from 98% [at 0.1cm depth] down to 43% [at 2cm i.e. reference condition]. The dose rate increases by increasing the value of kVp with a maximum at 150 kVp [1.6 and 0.93 Gy/min for respective applicator diameters 2.5cm and 10cm]. Applicator with 2.5cm diameter demonstrates better dose rate at 85kVp at different depths. PDD decreases lower than 50% for all combination of applicators and kVps at/or above 2cm depth so these measurements should not be considered for treatment planning. Higher energy X-rays are suggested to be used for applicators of higher diameters and smaller energy X-rays for applicators having smaller diameters

Protective role of zinc in piroxicam induced hepatic lobule damage in mice

To determine the effect of piroxicam in the hepatic lobule with protective role of zinc in mice and colorate the observation with serum enzyme level. An Experimental study. October 2008 to November 2008. Department of Anatomy, Basic Medical Sciences Institute, JPMC, Karachi. 30 adult mice [25-30gm] were divided into A, B and C groups. Group A served as a control, group B received piroxicam 0.3mg/kg body weight up, and group C received zinc 1mg/kg body weight lip and piroxicam as group B. After completion of study [i.e. 6 weeks] animals were scarified, blood sample was collected for serum enzyme level and their livers were removed and after processing, paraffin section were stained with H and E for the histological examination. U and E section of group A reveals normal histology of hepatic lobule, group B shows dilated central vein, irregular hepatic cord, distorted hepatocytes, dilated sinusoids and mononuclear infiltration, group C shows altered histological changes less then group B but more then group A Serum enzyme level [alkaline phosphatase] is within normal range in group A but significantly increase in group B and in group C less significantly increase as compare to group B but more then group A. Present study concludes that the therapeutic dose of piroxicam causes hepatic damage and zinc along with piroxicam is effective to prevent the hepatic injury

Role of [Kabdeen] [Unani compound drug] on liver function test in post choledocholithotomy patients

This study was conducted in Ajmal Khan Tibbia College Hospital on 23 patients presenting with biliary lithiasis [cholelithiasis with choledocholithiasis]. The duration of study was three years. We found that 65.21% patients were jaundiced or they had history of jaundice. In our study we have seen the result of Unani compound drug Kabdeen as it has been reported to be effective in the treatment of hepatitis. We observed that it is a hepatoprotective, possibly an immunomodulator drug and is helpful in early normalization of post operative deranged liver function and helps in speedy recovery of operated patients

[99m]Tc-nannocolloid localization of lymphorenal fistula causing chylurla

Chyluria is an abnormal condition in which chyle appears in the urine because of a fistulous communication between the lymphatics and the urinary tract. It is not life-threatening and spontaneous regression is reported in 50% of cases. Lymphangiography has been the main imaging modality for localization of the site of fistula, but it is invasive and requires expertise. Lymphoscintigraphy using Tc-99m labelled colloid is a safe, non-invasive, reproducible technique, which bears less radiation exposure. A 67-year-old male presented with 7-month history of chyluria following a spinal surgery. Bilateral lower limb lymphoscintigram revealed sluggish lymph flow in the left lower limb and visualization of tracer in the left kidney consistent with lymphorenal fistula. Subsequent cystography revealed appearance of chylous urine from left ureter. Patient refused surgery

Evaluation of diuretic activity of musli safed [chlorophytum arundinaceum baker] in albino rats

Musli Safed [Chlorophytum arundinaceum Baker] powder in triturated form has been evaluated for its diuretic activity at dose levels of 1 g and 3 g/kg in albino rats. The diuretic effect of the drug has been compared with standard diuretic agent frusemide [Lasix]. It was found that Musli Safed possesses the efficacy to bring about significant increase in urine output at the dose level of 3 g/kg. Continuous treatment of the animals with Musli Safed for a week resulted in significant increase in the urinary concentrations of Na[+], K[+] and Cl[-] at the close of 3 g/kg. These findings indicate that Musli Safed is a good diuretic agent

Isolated tuberculosis thyroiditis as solitary thyroid nodule

Isolated involvement of the thyroid by tuberculosis is very rare as reported in literature. We are presenting a case of isolated tuberculous thyroiditis presented as a solitary thyroid nodule. The patient was treated with anti-tuberculous regimen and he responded well with disappearance of the nodule and normalization of the thyroid scan

Cleaning methods for ultrasound probes

To determine the effectiveness of three different methods of ultrasound probe cleaning for the prevention of nosocomial infections. Experimental study. Radiology Department, the Aga Khan University Hospital, Karachi and Microbiology Department, JPMC, Karachi, from December 2006 to April 2007. A total of 75 culture swabs from ultrasound probes used for sonographic examinations of different body parts of patients were included in the study. Probes were prospectively randomized into three equal groups with 25 probes in each group. Culture was sent before and after using three different techniques of cleaning ultrasound probe, which included sterilized paper towel, 0.9% saline and swipe over with standard bath soap applied on group A [n = 25], group B [n = 25] and group C [n = 25] respectively. Number of Colony Forming Unit [CFU] of bacteria were calculated on standard agar plate to find out the effectiveness of cleaning methods in reducing bacterial count from the ultrasound probe after the procedures. All samples were tested in single microbiology lab by using same bacterial growth media provided by same manufacturer. Kruskall Wallis, Jonchkheere-Terpstra and Wilcoxon sign rank tests were applied to find out statistical significance. There was a significant reduction in bacterial count after applying either of all three cleaning methods for ultrasound probe compared to count on the probes before cleaning [p < 0.001], however, soap cleaning method was the most effective in decreasing bacterial count to the minimum level in comparison to other two methods [p < 0.001]. The overall reduction in pathogenic bacterial count after performing each cleaning method was 45%, 76% and 98% for paper cleaning, normal saline and soap cleaning method respectively. Cleaning ultrasound probe after performing each procedure is a cost-effective practice with potential of reducing nosocomial infections. Soap cleaning technique is the most effective method for reducing bacterial count acquired due to patients' body contact with the ultrasound probes

Bone scan: a sensitive modality for diagnosing and predicting outcome for reflex sympathetic dystrophy

Reflex sympathetic dystrophy is a consequence of overactive sympathetic nervous system that results in burning pain, stiffness, swelling and discoloration of the affected limb. This case report describes the condition in a man that was diagnosed with the help of radionuclide bone scan

Sentinel lymph node scintigraphy and radioguided dissection in breast carcinoma: an initial experience at Aga Khan University Hospital

To evaluate the efficacy of SLN biopsy using imaging and gamma probe in breast cancer and to establish this technique at Aga Khan University Hospital. Thirty two patients [mean age 33-76 yrs] with operable breast carcinoma [4 with post-neo adjuvant therapy] with clinically negative axilla were studied. In 28 patients simultaneous axillary dissection was performed. Sentinel lymph nodes [SLN] scintigraphy was performed a day before surgery by injecting Tc-99m labeled nannocolloid sub-dermally in the peri-areolar region in 24 and peri-tumoral in remaining 8. First lymph node [LN] to appear to on the scan was labeled as SLN and marked on the skin. Blue dye was also injected in all patients and blue and hot LN was explored in the axilla using gamma probe. The sentinel LN was identified in 31 patients [96.9% success rate] while in one patient [3.1%] SLN was not visualized on the scan [negative study] and this was a post-neo-adjuvant therapy case. The blue dye successfully localized the sentinel LNs in all 32 cases The gamma probe guided localization was successful in all 31 while in one case with post-neo-adjuvant chemotherapy it failed. In 9 out of 32 [28.1%] cases SLN was positive for metastasis and in 6 out of these 9 [66.6%] the SLN was the only metastatic node. This includes the post-neo-adjuvant case as well. There was no case of skip metastasis, i.e. negative SNL and positive other axillary nodes. In remaining 23 [71.9%] cases SLN was negative for metastasis and in all, axilla was free of disease [NPV of 100%]. Lymphoscintigraphy with gamma probe guided SNL biopsy is safe, simple and highly reliable technique. With blue dye technique it reduces the blindness of the procedure if performed independently but increases the cost. Finally, this can accurately stage the axilla, possibly allowing axillary dissection to be foregone in patients where the SLN is clear

Extra pulmonary uptake of Tc 99m MAA perfusion lung scan as a result of right to left intra cardiac shunt

Extra pulmonary accumulation of Tc-99m-macroaggregate of albumin [MAA] is rarely seen on perfusion lung scan, and has been reported in less than 4% of a study population of nearly 380 patients1. It occurs when the agent bypasses the lungs due to a right to left [R-L] cardiac or pulmonary shunt, when it is shunted to the portal vein before reaching the right atrium and ventricle of the heart, and when the agent is degraded to a submicron particle size.2 When a pharmaceutical problem is excluded, extra-pulmonary uptake implies unusual hemodynamics with a shunt. A case is reported in which a clinically unsuspected shunt was diagnosed from the lung perfusion scintigraphy

Paediatric nosocomial infections: resistance pattern of clinical isolaten

Hospital acquired infections are transmitted to patients by hospital personnel and other patients, or they may arise from patient's own endogenous flora. Children are one of the most susceptible subjects associated in the hospitalacquired infections and have a higher prevalence rate for infections. This problem is at its extremes in developing countries like Pakistan where in most of cases the severity depends on the hygienic conditions of the Hospitals and lack or lapse of infection control measures. To have a surveillance type of data in this regard, one hundred and twenty four isolates of Pseudomonas aeruginosa/Pseudomonas species, Staphylococcus aureus [MRSA/MSSA] and Klebsiella species, that are commonest among the nosocomial infection causing organisms, were collected from pediatric hospital settings in Karachi. A study of incidence and resistance pattern by Kirby Baur disc diffusion method, with selected antimicrobials, was carried out. These isolates were resistant against most antimicrobials tested. Drugs like mmipenem, meropenem, amikacin, vancomycin [especially in MRSA or BRSA], Fucidic acid [for burns and other infections] and some of the 3rd generation cephalosporins were found quite effective

Incidence and etiology of neonatal seizures

To determine the incidence of seizures in admitted neonates and establish the etiological diagnosis. During the study period, 4.8% [97 cases] cases among admitted neonates, having seizures either at presentation or during their stay in the hospital, were included. Hypoxic ischemic encephalopathy was found to be the commonest cause [44.3%] of neonatal seizures, followed by hypoglycemia [19.5%] and hypocalcemia [12.3%] cases. Subtle seizures [41.2%] were the most frequently observed type of seizure, followed by tonic [32.9%] and clonic [20.6%] seizures. Nearly 55% cases had seizures during the first 48 hours of life. Cases of hypoxic ischemic encephalopathy were associated with higher mortality [39.5%] as compared to cases with metabolic seizures. Neonatal seizures were found as a common neurological disorder and presented most commonly as subtle type. Birth asphyxia was the commonest aetiology of neonatal seizures, followed closely by the metabolic seizures

Frequency of ABO and RH blood groups in major ethnic groups and casts of Pakistan

To find out the frequency of ABO and RhD phenotypes in different ethnic groups and casts of Pakistan. Design: cross sectional descriptive study. Place and duration of Study: Combined Military Hospital Attock Punjab Pakistan from 1St Jan 2003 to 31 11 Dec 2003. Material and All healthy young adults reporting for recruitment in Armed Forces. Cast and sub cast were recorded. ABO grouping and Rhesus typing was done by slide method. Eight thousand three hundred seventy five young adults were screened. ABO blood group distribution in Arains was: A 25.6%, B 40.5%, AB 9.2%, O 24.7%. Awans: A 22%, B 31.7%, AB 9.9%, O 36.5%. Rajputs: A 23%, B 33.2%, AB 8.8%, O 35.1%. Misc Punjabi sub casts: A 23.6%, B 33.2%, AB 7.5%, O 35.7%. Balochs: A 23.3%, B 27.9%, AB 7.8%, O 40.9%. Sindhis: A 24.9%, B 31.8%, AB 6.9%, O 36.5%. Kashmiris: A 23.7%, B 32.5%, AB 10.2%, O 33.6%. Pathans: A 24.3%, B 31.4%, AB 8.9%, O 35.4% Rh-D negative [n=749] blood group in Araeens 8.3%, Awans 10.4%, Rajputs 8.5%, Misc Punjabi sub casts 8.8%, Balochs 7.8%, Sindhis 8.7%, Kashmiris 10.9% and Pathans 7.7%. There is no statistically significant difference of ABO and Rh-D distribution among various ethnic groups, O is the most common blood group except in Arains where B is the most common and O is less common

value of clinical signs in diagnosis of cirrhosis

To document the value of various clinical signs of cirrhosis in its diagnosis. It also reviews the current status of the disease. Observational and descriptive study.Place and duration of study: Medical wards of PNS Shifa, Karachi and Jinnah Postgraduate Medical Center, Karachi, Pakistan from June 2002 to May 2003.Subjects and One hundred and seventy diagnosed adult patients having an unequivocal evidence of cirrhosis on ultrasound examination of abdomen were included in the study. Two trained clinicians examined the cases and their clinical signs were recorded on a format specially designed to record the clinical signs. Age, gender, hepatitis status [hepatitis B, C, or other wise] was also documented. Sixty two percent were males and 38% were females. Patient average age was 53.2 years without gross age difference in the HCV positive and HBsAg positive groups.Twenty eight percent were HCV positive, 22% were HBsAg positive, 10% had no evidence of previous infection of hepatitis B or hepatitis C and 40% had no record of these tests. Males dominated the HBsAg group compared to HCV positive group. Pedal edema was present in 92 percent of patients, ascites in 89 percent, jaundice in 64 percent, clubbing in 25 percent, palmar erythema in 23 percent, Terry's nails in 21 percent, testicular atrophy in 4 percent, gynaecomastia in 4 percent, pectoral area hair loss in 2.4 percent, leuconychia in 2.4 percent and hepatic encephalopathy in different grades in 19 percent. No spider navei, caput medusae and Dupuytren's contracture were noted. We document that in current clinical practice the classical signs of cirrhosis expected to be present in advanced cases are observed quite infrequently and therefore, cannot be relied upon in clinical diagnosis of the disease alone. The diagnosis of cirrhosis should be supported by other means including ultrasound examination of the abdomen etc. Further multicenter studies should be conducted to consolidate our findings

Trichomonas vaginalis in vaginal smears of women using intrauterine contraceptive device

To detect the association between the use of an intrauterine contraceptive device [IUCD] and the presence of Trichomonas vaginalis [Tv] in the vaginal smears. Vaginal smears were collected from 800 women who attended the Gynaecology and Obstetrics unit at Federal Government Hospital [Polyclinic] Islamabad, between June 1995 ' June 1997. Among 45 IUCD users, 15 women were positive for Tv [33.33%]. Forty two of 755 non-users were also positive for Tv [5.56%]. There was a significant correlation between the use of IUCD and the presence of Tv [p<0.05]. The data also indicated that the prolonged use [>3 years] of copper-IUCD may promote the growth of Tv in the vaginal mucosa. The use of copper IUCD for a long period causes growth of Tv on the genital mucosa so special attention should be paid to women who have prolonged copper-IUCD for the possible presence of Tv