Pam3CSK4 enhances adaptive immune responses to recombinant Mycobacterium bovis bacille Calmette-Guérin expressing Plasmodium falciparum C-terminus merozoite surface protein-1

Objective: To determine the effects of toll-like receptor 2 (TLR-2) agonist, Pam3CSK4, on cellular and humoral immune response against recombinant Mycobacterium bovis bacille Calmette-Guérin (rBCG) expressing the C-terminus of merozoite surface protein-1 of Plasmodium falciparum. Methods: Six groups of mice (n=6 per group) received intraperitoneal phosphate buffered saline T80 (PBS-T80), BCG or rBCG in the presence or absence of Pam3CSK4. Enzyme-linked immunosorbent assay was carried out to measure serum total IgG, IgG1, IgG2a, and IgG2b production. Spleens were also harvested and splenocytes were co-cultured with rBCG antigen for in vitro determination of IL-4 and IFN-γ via enzyme-linked immunosorbent assay. Results: The production of total IgG and the isotype IgG1, IgG2a and IgG2b was significantly higher in rBCG-immunised mice than in the BCG and PBS-T80-immunised mice, and Pam3CSK4 further enhanced their productions. A similar pattern was also observed in IFN-γ production. Moreover, there was no significant difference in IL-4 production in all groups either in the presence or absence of Pam3CSK4. Conclusions: We present evidence of the adjuvant effects of TLR-2 agonist in enhancing the production of total IgG, IgG1, IgG2a, IgG2b, as well as IFN-γ in response to rBCG. However, the presence or absence of Pam3CSK4 had no effect on IL-4 production.

Frequency of awareness in mothers about risk factors of asthma in 1 to 12 years old children

Objective: To determine the frequency of awareness in mothers about the risk factors of asthma in children aged 1-12 years, attending pediatric department, Combined Military Hospital, Quetta

Study Design: Descriptive, cross sectional study

Place and Duration of Study: The study was conducted at department of Pediatrics, Combined Military Hospital Quetta. Duration of the study was six months from Oct 2011 to Apr 2012

Material and Methods: All the mothers of children with asthma were selected for this study. Informed consent was taken from all the patient's parents participated in the study. Every patient was assigned a serial number. Detailed history about risk factors was taken by the researcher and all the information entered in the proforma and collected data was analyzed by SPSS version 22

Results: Total 150 mothers were included in study. There were 9 [6.0 percent] mothers who had awareness of any relation between breast feed and the risk of asthma in children, 15 [10 percent] mother had awareness of relation between pet animals/birds and the risk of asthma in children, 3 [2 percent] mothers had awareness of relation between carpets at home and the risk of asthma, 24 [16 percent] mothers had awareness of relation between cigarette smoke and the risk of asthma in children. There were 15 [10 percent] mothers who had awareness about relation between food and the risk of asthma, 3 [2 percent] mother had awareness of relation between repeated use of medicines in children under six months of age and the risk of asthma, 5 [3.3 percent] mothers had awareness of relation between the use of pillows and the risk of asthma, 3 [2 percent] mothers had awareness of relation between the presence of cockroaches in child's bedroom and the risk of asthma in children

Conclusion: In Quetta region, mothers had lower frequency of awareness among mothers regarding pediatric [1-12 years] asthma development and its associated risk factors

Cord care practices among mothers in a tertiary care center

Objective: to assess the frequency of different cord care practices among mother presenting in a tertiary care center

Methods: this study was conducted on women who are presenting in Gynecology department of Services Hospital Lahore. Women were inquired about the use of method whatever the type for cord care after the delivery of neonates thus information was recorded in a well-defined questionnaire

Results: out of 4000 women, 1757 used desi ghee [43.925%]. 1139 used spirit [28.47%], 423 used alcohol swabs [10.57%], 262 used surma and other things like polyfax, lotions and herbals [6.55%], 219 used gentian violet [ 5.45%], 200 used pyodine solution [5%]

Conclusion: the most common way to care the cord was application of desi ghee that was easily available in urban and rural area

Correlation between innercanthal distance and the mesiodistal width of the maxillary central incisors

Objective: To establish whether a correlation exists between the innercanthal width and maxillary central incisors

Study Design: A Descriptive cross sectional study

Place and Duration: Department of Prosthodontics, Dr Ishrat ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences Karachi and from 15th October 2012 to 25th March 2014

Methodology: One hundred and seventy five dentate individuals with intact maxillary anterior teeth were investigated. The innercanthal space was calculated among the inner canthal angles utilizing computer software. The mean dimension of the two central incisors was determined extra orally at their widest dimension. Teeth measurement and inner canthal distance association in respect to gender was evaluated by paired t test. Pearson correlation coefficients test was premeditated to establish any association amongst innercanthal space and central incisors width, significance was set at a = 0.05

Results: The mean value for male and female subjects was 33.24 +/- 3.4 mm and 34.90 +/- 3.8 mm correspondingly. The mean width of maxillary central incisors for male and female subjects was recorded 15.84 +/- 1.4 mm and 15.92 +/- 1.3 mm. The value [P = 0.000] for both estimations were significant. The Pearson correlation coefficient were positive [r = 0.202] and highly significant [P = 0 .008] between innercanthal dimension and the maxillary central incisors. The results indicated that innercanthal ratio ratio of 1:0.462 may be used to calculate the combined width of maxillary central incisor teeth

Conclusion: Mean of maxillary central incisor width and inner canthal distance were higher in females significantly. The results proposed that innercanthal distance is a good prognostic factor for determining the maxillary central incisors mesiodistal width

Colonoscopic evaluation of bleeding per rectum in children

Objective: to evaluate the role of colonoscopy in the diagnosis and management of bleeding per rectum in children

Material and Methods: it was descriptive type of study conducted at Department of Pediatrics, Services Hospital, and Lahore including 50 patients of either sex with age range of 5-15 years in whom colonoscopy was performed for bleeding PR. The patients with acute dysentery, melena and rectal prolapse were excluded from study. Gut preparation was started forty-eight hours before procedure. The children were given clear liquids without any milk and fiber containing diet. Liquid paraffin was given orally as laxative and two doses of kleen enema were given, 12 hours and 1 hour before procedure. Colonoscopy was performed under deep sedation [Midazolam 0.25-0.5mg/kg] using fiber optic pediatric colonoscopy in Medical Unit-1 of Services Hospital, Lahore. Polypectomy was done in patient with pedunculated polyps and colonic biopsy was taken where indicated. The samples were sent for histopathology in the Department of Pathology of the same hospital. After procedure all patients were kept under observation for4-6 hours in pediatric ward

Results: colorectal polyps were the most common cause of bleeding per rectum [56%] followed by ulcerative colitis [12%], solitary rectal ulcer [8%], non-specific colitis [8%] and hemorrhoids in 2%. There was suspicion of malignancy in 2 children on colonoscopy. Biopsy was taken and it was confirmed as adenocarcinoma on histopathology in one child. Among patients with polyps [n=28], 22 [78.6%] have single polyp and 6 [21.4%] have more than one. Main site of polyps was rectum [20 patients] while it was sigmoid/recto sigmoid junction in 5 and descending colon in 2 children. Polypectomy was performed in 21 children while it was not possible in 7 due to sessile polyps in 6 and polyp size larger than snare in 1 child

Conclusion: colons-copy is safe and very useful tool in the diagnosis and management of bleeding per rectum in pediatric patients and juvenile polyps are the commonest cause of bleeding per rectum in this age group

Frequency and risk factors of post renal transplant anaemia among Egyptian patients

Background: There is a relative lack of recent information about post kidney transplantation anemia [PTA], especially in the developing countries. In Egypt data are scarce about the frequency and risk factors of PTA, although the first kidney transplantation was done in 1976

Objective: is to identify the frequency and risk factors of post renal transplant anemia

Patients and methods: This is across sectional hospital analytic study enrolling all kidney transplant recipients following in Assiut nephrology outpatient clinic, Kasr EL-Amy transplant outpatient clinic, and Sohag insurance hospital outpatient clinic, within the period from July 2014 to October 2015. Clinical and laboratory data were obtained from 86 patients; anemia was defined as Hb levels of < 13 g/dl for male patients and < 12 g/dl for female patients. Exclusion criteria were pregnancy, patients below 13 years old, multiple organ transplantation, and patients with less than six months from the transplantation

Results: The study showed that 53.5% of the patients were anemic. Multiple logistic regression analysis showed that GFR [p-value =0. 026] is a strong predictor for the development of post-transplant renal anemia. It also showed that high serum phosphorus level [p-value =0. 049] is significantly associated with post- transplant renal anemia. The use of Angiotensin converting enzyme inhibitors [ACEI], immunosuppressive treatments, presence or absence of co-morbidities, and donor type are not significantly associated with Post transplant renal anemia

Conclusion: Our study concluded that post-transplant renal anemia is common and under recognized. Risk factors include renal dysfunction and high serum phosphorus level

Analysis of gastric cancer tissues genome methylation by DNA methylation chip / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To detect the methylation status of gastric cancer tissue genome by DNA methylation chip.</p><p><b>METHODS</b>Methylation status of 6 samples of gastric cancer tissues and their matched adjacent tissues was analyzed using methylated DNA immunoprecipitation(MeDIP) combined with NibleGen chip. Significantly different methylated genes in promoter region and CpG island between two tissues were searched. Functions of these significantly different methylated genes were analyzed by Gene Ontology and Pathway assays.</p><p><b>RESULTS</b>In gene promoter regions, 113 significantly different methylated genes were identified in gastric cancer tissues, such as SHP1, FGF8 and CSF2RA, while 161 significantly different methylated genes were identified in their matched adjacent tissues, such as TNF, IGF2 and BMP7. In the CpG islands, 123 significantly different methylated genes were identified in gastric cancer tissues, such as WNT2B, JAK2 and TPT1, while 139 significantly different methylated genes were identified in their matched adjacent tissues, such as TNFRSF4, HOXC8 and NFYA. These genes located on different chromosomes. In gastric cancer tissues, the 1st and the 4th chromosomes had the most (both 11), the 18th and the 20th chromosomes had the least(both 1). In matched adjacent normal tissues, the 11th chromosome had the most (17), and no significantly different methylated gene was found on Y chromosome. These genes involved in many functions, such as protein phosphorylation, regulating cellular catabolism, ion transport, enzyme activity, transcriptional regulation, cell division, cell cycle regulation, and signal transduction.</p><p><b>CONCLUSIONS</b>There are significant differences between gastric cancer tissues and their matched adjacent tissues in DNA methylation. DNA methylation genes locate on different chromosomes, and their number and distribution vary widely. These genes may be associated with many pathways in carcinogenesis.</p>

Prosthodontic rehabilitation of maxillectomy patients with hollow bulb obturator clinical series

Prosthodontic Rehabilitation of maxillectomy defects is one of the complex treatment modalities practiced. Maxillectomy is performed for surgical treatment of congenital and acquired diseases and it is the most common of maxillofacial defects which need to be successfully rehabilitated to restore morphology, masticatory function, swallowing and speech. Prosthodontic rehabilitation of these defects is commonly done with an obturator prosthesis. Effective obturation of maxillectomy defect is a difficult task for the maxillofacial Prosthodontists. Multidisciplinary treatment planning is essential to achieve adequate function and retention for the prosthesis. The present clinical series describes the steps in fabrication of hollow bulb obturator prosthesis utilizing anatomical and mechanical means of gaining retention

mean visible labial length of maxillary and mandibular anterior teeth at rest

To determine the mean visible labial length of maxillary and mandibular anterior teeth at rest. Cross-sectional study. Department of Prosthodontics, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Karachi, from October 2012 to March 2013. A total of 200 subjects were included. Measurements were carried out using digital caliper from the border of the lip to the incisal edges of incisor and to the cusp tip for the canines. The length of the upper lip was measured from subnasale to stomion. Statistical analyses were performed by Mann Whitney-U test and Kruskal Walli's test. The age of the participant ranged between 20 and 65 years. At rest, females significantly displayed more of the maxillary central incisor [2.93 +/- 1.57 mm; p=0.003], lateral incisor [1.87 +/- 1.12 mm; p=0.005] and canine [0.59 +/- 0.62 mm; p=0.031]. With increasing age, the amount of maxillary anterior teeth visible at rest significantly decreased [p < 0.001], and increased for the mandibular teeth [p < 0.001]. Subjects with shorter upper lips significantly displayed more maxillary anterior incisor structure than subjects with longer upper lip [p < 0.001]. Females displayed significantly more labial length of the maxillary anterior teeth. The mean visible labial length of maxillary anterior teeth significantly decreased with increasing age and increased for the mandibular teeth. As the upper lip length increased, the mean visible labial length of maxillary anterior teeth significantly decreased

Frequency of gingival display during smiling and comparison of biometric measurements in subjects with and without gingival display

To determine the frequency of gingival display during smiling and to compare biometric measurements in subjects with and without gingival display. Cross-sectional study. Department of Prosthodontics, Dr. Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, from October 2012 to March 2013. A total of 275 subjects [121 men and 154 women] were included in this study. The age of the participants ranged between 21 and 65 years. Measurements were carried out using digital caliper. For each participants, the gingival display was judged as either visible or not. The amounts of horizontal and vertical overlap of anterior teeth were measured using a digital caliper. Gender differences in these parameters and the relationship between subjects showing gingival display when smiling and the two intraoral dental biometric measurements were determined. Statistical analyses of data were performed using SPSS version 17.0 software. The mean scores for gender were calculated and a Student's t-test was used to identify significant differences between both groups. Significant level was set to 0.05. A relatively small percentage of the subjects [37.8%] displayed gingiva when smiling. More women significantly displayed gingiva when smiling than men, with a 2:1 female: male ratio. Women had significantly [p=0.001] more horizontal overlap [3.34 +/- 1.45 mm] than men [2.90 +/- 1.44 mm], although no significant gender difference were found in vertical overlap. Subjects with gingival display had significantly [p < 0.05] more horizontal [3.49 +/- 1.36 mm] and vertical [3.26 +/- 1.47 mm] overlap of anterior teeth compared to those who did not display gingiva when smiling. Significantly more women displayed gingiva in smiling. Women had significantly more horizontal overlap than men. No gender differences were recorded between vertical overlap. Subjects who displayed gingiva when smiling had more horizontal and vertical overlap of anterior teeth

Outcome of different percutaneous transhepatic interventions for malignant biliary obstruction

Background: Percutaneous transhepatic biliary drainage [PTBD] is effective in the management of biliary obstruction. PTBD can he used as an alternative to endoscopic approach when it is unavailable, or unsueecssful due to anatomical variations or technical difficulty

Objectives: To evaluate the success rare, complications, morbidity and mortality in patients with inoperable malignant obstructive jaundice treated with PTBD with or without stenting

Subjects and methods: 67 percutaneous transhiepatic biliary procedures were performed for forty five selected patients with inoperable malignant extrahepatic cholestasis, in total there were 21 male [46.7%] and 21 female [53.3%] patients. The mean age was 69 years and ranged from 48-88 ears. These patients were subdivided into three equal groups according to the planned drainage for internal-external drainage, external drainage or metallic stenting. Statistical analysis included Chi square test, values were considered significant when P values 0.05

Results: The overall technical success rate was 83% while the overall therapeutic success was 86.6% with the best results [100%] reported in the group of metallic stenting. There was no procedure related mortality in the different groups. The overall immediate, early and late complications were 20%, 29% and 20% respectively, with the highest complications rate reported ill group of external drainage. The overall 30 days mortality was 26.7% with the highest incidence was reported in the group of external drainage [53.3%]

Conclusion: PTBD and stenting oiler a sale and effective method in providing palliative treatment for patients with malignant biliary obstruction

E-learning: how important it is for medical schools?

Technological and social drifts taking place in recent years are influencing the ways of presenting and transferring knowledge from one generation to the other. Today, Continuous Medical Education [CME] is a critical factor, because the life of information and skills in medicine is shorter than ever. That causes an increasing pressure on doctors to remain at the vanguard of medical education throughout their career

With increasing restrictions being placed on medical instructors, one needs to discover other paths for efficient transfer of information to trainees in health care system. The frequent use of technology, specifically internet-based tools, unlocks the doors for cooperation among both students and teachers.

Effect of staining solutions on the colour stability of direct resin composite

Resin-based composite dentures or teeth are used as replacement of missing teeth. Their success depends largely on their colour stability as they undergo discoloration after prolonged exposure in oral environment and therefore, need replacement for esthetic reasons. To evaluate the colour stability of a nanofill composite resin [Filtek Z350] when exposed to different immersion media. Study design and settings: An in-vitro experimental study was carried out at Dr. Ishrat-ul-ebad Khan Institute of Oral Health Sciences and colour testing was done at Al Karam textiles limited. Forty resin-based composite specimens measuring 1 mm. of thickness and 5x5 mm. in length and breadth were prepared using a plastic sheet. Specimens were light-cured for 20 seconds from both sides and were randomized into 4 groups [n=10] according to immersion solutions: distilled water [control], coke, turmeric powder solution and coffee solution. Specimens were left immersed in these solutions for 10 days A digital spectrophotometer was used to evaluate the colour changes after 10-days and the colour differences [deltaE] were analyzed using paired t-test [p < 0.05]. After 10 days of immersion in coffee solution, coke and turmeric powder solution specimens showed significant colour change. The turmeric powder exhibited maximum staining followed by coffee and coke. The composite resin was susceptible to staining by coffee, turmeric powder and coke

Altered alvarado score; role of caecal gurgling as a new sign in diagnosis of acute appendicitis

Background: Diagnosis of acute appendicitis is mainly clinical and many scoring systems are being used

Objectives: To assess the reliability of caecal gurgling as clinical sign in the diagnosis of acute appendicitis in equivocal cases with Alvarado score of 5-6

Patients and Methods: This descriptive study was conducted in the department of General Surgery, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, from 1st September 2009 to 31st September 2012. All the patients were presented in OPD and emergency department with history of pain in right lower abdomen of short duration and have no co morbid condition. We divided the patients into three groups on the basis of Alvarado score. Group I with score 1-4, Group II with score 5-6, Group III with score 7 or above. Group II was further subdivided into Ila having no caecal gurgling and IIb having caecal gurgling on clinical examination. We calculated the rate of negative appendicectomies on histopathology in different groups. Data was entered and analyzed in SPSS version 15

Results: A total of the 840 patients were included in the study with age ranges from 12-60 years, out of which 67% were male. 185 patients fall in group I, 180 of which were managed conservatively successfully on oral medicine without admission. In group I only 5 patients needed to be operated and found appendicitis on histopathology. Group II included 286 patients, which was further subdivided into Group Ila [172 patients] having no caecal gurgling on examination and Group Ilb [114 patients] having caecal gurgling on clinical examination. Out of 172 patients of group Ila, 135 were operated and 24 negative appendicectomies were found on histopathology. While all 114 patients of group lib were operated and only 3 appendices were found normal on histopathology. In group III, 369 patients were recruited, all were operated and only 12 appendices were proved normal on histopathology report. So with the addition of caecal gurgling, in group II with equivocal cases having alvarado score 5- 6, there is decrease in rate of negative appedecectomies from nearly 17% reported in literature to 10.8% reported in this study

Conclusion: Appendicitis is the common surgical emergency and diagnosis is mainly clinical. Delay in diagnosis and proper treatment increases morbidity. Altered Alvarado scoring, with addition of caecal gurgling as a clinical sign, is slightly more reliable as compared to the conventional Alvarado scoring system especially in equivocal cases with score of 5-6

Late onset erythropoietic porphyria [gunther's disease]

Congenital erythropoietic porphyria [CEP] or Gunther's disease is inherited disorder of porphyrin heme synthetic pathway that usually presents early in life. A very rare form of this disease has its onset in later years of life, called late onset erythropoietic porphyria [late onset EP]. Fourteen cases of late onset EP have been reported to-date. We report another case of this rare entity in a 40 years old male with associated findings of haemolysis and thrombocytopenia

Comparison of clinical and sonographical findings of Achilles tendon involvement in newly diagnosed and established cases of psoriasis

To compare the clinical and sonographical findings of Achilles tendon involvement in newly diagnosed [disease duration <6 months] and established psoriatic patients [disease duration >5years]. This cross-sectional, comparative study was carried out in Departments of Dermatology and Radiology, Military Hospital, Rawalpindi, over a period of six months. 70 patients of psoriasis were divided into two groups comprising 35 patients in each. Group I patients were newly diagnosed cases while group II included the established psoriatic patients. All patients with clinical and histological evidence of psoriasis were included. Patients with history of osteoarthritis, rheumatoid arthritis or foot trauma were excluded. Detailed history and complete clinical examination was carried out as per pro forma. The condition was considered symptomatic when there was tendon swelling, pain, tenderness or functional impairment. Ultrasound of Achilles tendon was done, keeping patient in prone position by using Pro Sound SSD 5500 Toshiba ultrasonographic machine with high frequency probe [7.5MHz] to assess findings of Achilles tendon in psoriatic patients. Fibrillar tendon structures, tendon thickness, peritenon, and bursae were evaluated. On clinical assessment 1 [2.8%] patient in group I and 5 [14.3%] patients in group II had Achilles tendon involvement. On ultrasonographic assessment, 3 [8.5%] patients in group I and 15 [42.8%] patients in group II showed involvement of Achilles tendon [p <0.05]. Achilles tendon involvement occurs in significant number of patients with long standing psoriasis as compared to newly diagnosed cases. It also revealed that enthesitis progresses with the duration of disease

Herpes zoster: seasonal variations and morphological patterns in Pakistan

To determine the relevance of seasonal variations and pattern of herpes zoster among the labor community in Lahore. This observational, cross sectional study was conducted at Nawaz Sharif Social Security Teaching Hospital from June, 2009 to May, 2010. Entitled patients that included the industrial labour and their dependents who were clinically diagnosed to be suffering from Herpes zoster during the above mentioned period were included in the study. All the findings were recorded on a pre-designed pro forma. Fifty two enrolled patients constituted 0.46 per cent of overall OPD patients, with male to female ratio of 2:1 and the mean age at presentation was 47 years. Average duration of symptoms at presentation in Herpes zoster ophthalmicus [HZO] was 4.5 days while in remaining cases it was 5.6 days. The surge of the cases was noted with onset of summer and most common dermatomes involved were thoracic followed by ophthalmic division of trigeminal nerve. There is a relationship between Herpes zoster and seasonal variations which seems to be different from temperate climate of western countries

Factors associated with postpiercing auricular cartilage keloids

To determine the factors responsible for postpiercing auricular cartilage keloids. Observational study. Department of Plastic Surgery, King Edward Medical University [KEMU], Lahore, from March 2007 to July 2010. Fifty patients of post-earpiercing keloids affecting the cartilaginous portion were included in the study. Patients with keloids at any other site, positive family history of keloids and recurrent keloids were excluded. Information regarding age at piercing, site of piercing, use of gun or home sewing needle for piercing, use of jewellery other than gold postpiercing, itching or redness with use of jewellery, tight fitting of jewellery in the piercing hole and postpiercing infection was collected. Fisher exact and Wilcoxon rank sum tests were used to analyse the data. All the patients had low lobule piercing at a mean age of 4.52 +/- 1.15 years and cartilage piercing at an average age of 22.32 +/- 3.74 years [p < 0.001]. Eleven patients [22%] had also simultaneous high piercing in the lobule. Only cartilage piercing sites developed the keloids. Postpiercing infection was present in all the 50 patients of cartilage piercing whereas only 3 out of 11 high lobule piercing sites got infected [p < 0.001]. Cartilage bearing portion of the ear is more likely to form keloids due to its piercing in or after adolescence and prolonged wound healing caused by infection