Gastroprotective potential and mechanisms of action of Hedera nepalensis

Abstract Hedera nepalensis (H. nepalensis) , belonging to the family Araliaceae, is a medicinal plant traditionally used to treat stomach problems. The current study investigated the gastroprotective potential and the mechanism of action of H. nepalensis in diclofenac-and ethanol-induced ulcer models. Anti-oxidant and lipid peroxidation inhibitory prospects of H. nepalensis were checked out by free radical scavenging assay and UV spectrophotometer respectively. Effect of H. nepalensis on the pH, gastric total acidity of gastric juice and protective effects of H. nepalensis against ulcer models have been examined. Histopathological studies have been carried out. The aqueous methanol extract of H. nepalensis (100 µg/mL) showed anti-oxidant (83.55%) and lipid peroxidation inhibitory (70.88%) potential at 1000 µg/mL; the extract had no buffer potential. The extract (400 mg/kg) significantly (81.12% and 63.46%) showed gastroprotective effect in diclofenac and ethanol-induced rat ulcer models respectively. Histopathological studies confirmed the biochemical findings. FTIR analysis showed the presence of carboxylic acid, alkanes, conjugated alkanes, aldehydes and alkyl-aryl ethers. Gallic acid, M-coumaric acid and quercetin were found by HPLC analysis. H. nepalensis exhibited significant protection against diclofenac and ethanol induced gastric damage by anti-oxidant and lipid peroxidation suppression effects suggesting potential broad utility in treatment of diseases characterized with gastric damage.

Implantação de stent na bifurcação do tronco da coronária esquerda: uma análise em 2023 / Left main bifurcation stenting: a 2023 appraisal

Por várias décadas, a revascularização do miocárdio foi considerada o tratamento padrão-ouro de lesões não protegidas do tronco da coronária esquerda. No entanto, a acessibilidade anatômica e o grande calibre dos vasos tornam as lesões de tronco uma opção atraente para a intervenção coronária percutânea. A aplicação dessa intervenção nesse cenário foi expandida ainda mais como resultado da introdução de novos stents farmacológicos, com rápidos avanços em técnicas, dispositivos e farmacoterapias adjuvantes. As evidências atuais têm demonstrado que pacientes com complexidade coronariana baixa ou intermediária têm desfechos similares com a intervenção coronária percutânea ou a revascularização cirúrgica do miocárdio por até 10 anos. O tratamento das lesões da bifurcação do tronco da coronária esquerda continua tecnicamente complexo, apesar dos recentes avanços. A abordagem provisional é a estratégia padrão na maioria dos tipos de lesões da bifurcação do tronco da coronária esquerda. No entanto, algumas lesões complexas da bifurcação do tronco da coronária esquerda justificariam uma técnica eletiva com implante de dois stents. A abordagem integrada, que incorpora técnicas dedicadas, uma avaliação fisiológica e anatômica adjuvante e agentes farmacológicos, é fundamental para abordar com sucesso esse desafio ímpar e melhorar os desfechos clínicos.

For several decades coronary bypass grafting has been considered the gold standard treatment for unprotected left main coronary artery lesions. However, the anatomic accessibility and the large caliber of the vessel render the percutaneous coronary intervention a very attractive treatment option for left main coronary artery lesions. The use of percutaneous coronary intervention in this subset of lesions has been further expanded as a result of the introduction of newer drug-eluting stents along with rapid advancements in techniques, devices, and adjunctive pharmacotherapies. The current evidence has demonstrated that patients with low or intermediate coronary complexity treated with percutaneous coronary intervention or coronary bypass grafting have comparable outcomes, for up to 10 years. Treatment of left main bifurcation lesions remains technically demanding despite recent developments. The provisional approach is the default strategy in most types of left main bifurcation lesions. However, a few complex left main bifurcation lesions would warrant an elective two-stent technique. An integrated approach incorporating custom- tailored techniques, adjunctive physiological and morphologic evaluation, and pharmacologic agents is critical to tackle this unique challenge and improve clinical outcomes.

Drug-coated balloon in the treatment of coronary bifurcation lesions: A hope or hype?

When compared to non-bifurcation lesions, percutaneous coronary intervention in coronary bifurcation lesions is technically demanding and has historically been limited by lower procedural success rates and inferior clinical results. Following the development of drug-eluting stents, dramatically better results have been demonstrated. In most of the bifurcation lesions, the provisional technique of implanting a single stent in the main branch (MB) remains the default approach. However, some cases require more complex two-stent techniques which carry the risk of side branch (SB) restenosis. The concept of leaving no permanent implant behind is appealing because of the complexity of bifurcation anatomy with significant size mismatch between proximal and distal MB which may drive rates of in-stent restenosis and the potential impact of MB stenting affecting SB coronary flow dynamics. With the perspective of leaving lower metallic burden, a drug-coated balloon (DCB) has been utilized to treat bifurcations in both the MB and SB. The author gives an overview of the existing state of knowledge and prospects for the future for using DCB to treat bifurcation lesions.

Tratamento de complicações durante intervenção coronariana percutânea: avaliação da situação atual / Management of complications during percutaneous coronary intervention: a current appraisal

Tecnologias mais avançadas, drogas melhores e profissionais mais experientes contribuíram para desfechos otimizados das intervenções coronarianas percutâneas complexas. As complicações com impacto significativo na sobrevida do paciente e alto custo para o sistema de saúde não foram totalmente eliminadas pelos procedimentos modernos de intervenções coronarianas percutâneas. Os procedimentos preventivos e a experiência do operador são as únicas formas de se evitarem os efeitos colaterais graves das intervenções coronarianas percutâneas. As dissecções, o fechamento abrupto da artéria, a perfuração coronariana, o non-reflow, a embolia gasosa, a deformação do stent, a embolização do dispositivo e o aprisionamento da ogiva de aterectomia rotacional são algumas das complicações abordadas neste artigo.

More advanced technology, better drugs and more experienced operators have contributed to improved complex percutaneous coronary intervention outcomes. Complications with significant impact on patient survival and healthcare costs have not been completely eliminated by modern percutaneous coronary intervention procedures. Professional expertise and consistent preventive procedures are the only ways to avoid severe side effects of percutaneous coronary intervention. Dissections, abrupt arterial closure, coronary perforation, no-reflow, air embolism, stent deformation, device embolization, and rotating atherectomy burr entrapment are some of the periprocedural complications covered in this article.

Terapia intervencionista da embolia pulmonar aguda: onde estamos e para onde vamos? / Interventional therapy of acute pulmonary embolism: where are we and where are we heading towards?

A embolia pulmonar, uma doença com risco de vida, é prevalente em todo o mundo, afetando grande porcentagem da população e representando uma das principais causas de morte cardiovascular. Para reduzir sua mortalidade e morbidade e melhorar os desfechos, é fundamental uma estratificação precoce do risco. Há uma ampla variação na gravidade de uma embolia pulmonar, desde leve até com risco de vida. Quando um paciente tem uma embolia pulmonar de alto risco e está em choque ou parada cardíaca, é razoável realizar trombólise sistêmica ou embolectomia de emergência, mas a anticoagulação isolada tem ótimos resultados na embolia pulmonar de baixo risco. Há várias estratégias para aproveitar os benefícios da trombólise e minimizar seus riscos, mas a experiência clínica com essas novas estratégias de intervenção é limitada. A equipe de resposta à embolia pulmonar, composta de cardiologista intervencionista, radiologista intervencionista, cirurgião cardíaco, radiologista especializado em imagem cardíaca e intensivista, pode ajudar a determinar o tipo de intervenção em um determinado paciente. Este artigo traz um esboço das terapias intervencionistas endovasculares atuais e seu contexto.

This life-threatening condition, known as pulmonary embolism, is prevalent throughout the world, affecting a large percentage of population and representing one of the leading causes of cardiovascular death. To reduce mortality and morbidity and improve outcomes, early risk stratification is critical. There is a wide range in the severity of a pulmonary embolism, from mild to life-threatening. When a patient has a high-risk pulmonary embolism and is in shock or cardiac arrest, emergency systemic thrombolysis or embolectomy is reasonable, but anticoagulation alone has great results in low-risk pulmonary embolism. Multiple strategies exist to capture the benefits of thrombolysis while minimizing its risks, but clinical experience with such novel intervention strategies is limited. The pulmonary embolism response team comprises interventional cardiologist, interventional radiologist, cardiac surgeon, cardiac radiologist, and critical care specialist, can help determine the type of intervention in a given patient. This article provides an outline of current endovascular interventional therapies and their context.

Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis / 대한뇌졸중학회지

Background@#and Purpose There are reports of decline in the rates of acute emergency presentations during coronavirus disease 2019 (COVID-19) pandemic including stroke. We performed a meta-analysis of the impact of COVID-19 pandemic on rates of stroke presentations and on rates of reperfusion therapy. @*Methods@#Following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, we systematically searched the literature for studies reporting changes in stroke presentations and treatment rates before and during the COVID-19 pandemic. Aggregated data were pooled using meta-analysis with random-effect models. @*Results@#We identified 37 observational studies (n=375,657). Pooled analysis showed decline in rates of all strokes (26.0%; 95% confidence interval [CI], 22.4 to 29.7) and its subtypes; ischemic (25.3%; 95% CI, 21.0 to 30.0), hemorrhagic (27.6%; 95% CI, 20.4 to 35.5), transient ischemic attacks (41.9%; 95% CI, 34.8 to 49.3), and stroke mimics (45.6%; 95% CI, 33.5 to 58.0) during months of pandemic compared with the pre-pandemic period. The decline was most evident for mild symptoms (40% mild vs. 25%–29% moderate/severe). Although rates of intravenous thrombolytic (IVT) and endovascular thrombectomy (EVT) decreased during pandemic, the likelihood of being treated with IVT and EVT did not differ between the two periods, both in primary and in comprehensive stroke centers (odds ratio [OR], 1.08; 95% CI, 0.94 to 1.24 and OR, 0.95; 95% CI, 0.83 to 1.09, respectively). @*Conclusions@#Rates of all strokes types decreased significantly during pandemic. It is of paramount importance that general population should be educated to seek medical care immediately for stroke-like symptoms during COVID-19 pandemic. Whether delay in initiation of secondary prevention would affect eventual stroke outcomes in the long run needs further study.

Callus Induction, Proliferation, Enhanced Secondary Metabolites Production and Antioxidants Activity of Salvia moorcroftiana L. as Influenced by Combinations of Auxin, Cytokinin and Melatonin

Abstract: Tissue culture technique is one of the best methods to reproduce salvia plant Therefore, the aim of this research was to enhance the in-vitro callus proliferation and production of secondary metabolites of S. moorcroftiana using different combinations of auxin, cytokinin and melatonin. Initially, callus induction was optimized using indole acetic acid (IAA), 2, 4-dichlorophenoxy acetic acid (2,4-D), and naphthalene acetic acid (NAA) applied at different concentrations in combination with 1 mg L-1 of 6-benzylaminopurine (BAP). The results indicates that earliest days to callus induction (14.67 days) was occurred in the media fortified with 2, 4-D+BAP (2.0+1.0 mgL-1). Whereas the highest callus initiation (100%) was induced on MS medium incorporated with 2,4-D+BAP (1+1mgL-1). Furthermore, maximum fresh weight was obtained when 2,4- D + BAP at the rate of (1+ 1mg L-1) was incorporated and dry weight was attained when 2,4- D + BAP at the rate of (2+1 mg L-1) was added to MS media. The maximum fresh and dry weight was obtained when melatonin at rate of 1.5 mg L-1 was supplemented with MS media including 2,4-D + BAP (1+1mg L-1), moreover the maximum DPPH scavenging activity, total phenolic and flavonoid content was noted when supplemented with melatonin at rate of 1.5 mg L-1. In conclusion, among various concentrations of plant growth regulators, 2,4- D + BAP at the rate of (1+ 1mg L-1) along with 1.5 g L-1 melatonin was the best for callus growth and production of secondary metabolites of S. moorcroftiana.

Escape from abluminal LRP1-mediated clearance for boosted nanoparticle brain delivery and brain metastasis treatment

Breast cancer brain metastases (BCBMs) are one of the most difficult malignancies to treat due to the intracranial location and multifocal growth. Chemotherapy and molecular targeted therapy are extremely ineffective for BCBMs due to the inept brain accumulation because of the formidable blood‒brain barrier (BBB). Accumulation studies prove that low density lipoprotein receptor-related protein 1 (LRP1) is promising target for BBB transcytosis. However, as the primary clearance receptor for amyloid beta and tissue plasminogen activator, LRP1 at abluminal side of BBB can clear LRP1-targeting therapeutics. Matrix metalloproteinase-1 (MMP1) is highly enriched in metastatic niche to promote growth of BCBMs. Herein, it is reported that nanoparticles (NPs-K-s-A) tethered with MMP1-sensitive fusion peptide containing HER2-targeting K and LRP1-targeting angiopep-2 (A), can surmount the BBB and escape LRP1-mediated clearance in metastatic niche. NPs-K-s-A revealed infinitely superior brain accumulation to angiopep-2-decorated NPs-A in BCBMs bearing mice, while comparable brain accumulation in normal mice. The delivered doxorubicin and lapatinib synergistically inhibit BCBMs growth and prolongs survival of mice bearing BCBMs. Due to the efficient BBB penetration, special and remarkable clearance escape, and facilitated therapeutic outcome, the fusion peptide-based drug delivery strategy may serve as a potential approach for clinical management of BCBMs.

Impact of Tibial Tubercle Osteotomy on Final Outcome in Revision Total Knee Arthroplasty:Our Experience and Technique in Pakistan

Background@#Due to extensive fibrosis during revision surgery, adequate exposure is essential and it can be achieved with several extensile approach options, such as tibial tubercle osteotomy. Information regarding surgical exposure during revision arthroplasty is limited in developing countries, such as Pakistan, due to the lack of adequate data collection and follow-up. Therefore, the purpose of this study was to evaluate the impact of tibial tubercle osteotomy on final outcome of revision total knee arthroplasty (TKA). @*Methods@#A total of 231 revision TKAs were performed between January 2008 and December 2017. Twenty-nine patients underwent tibial tubercle osteotomy for adequate exposure during revision surgery. Of these, 27 patients with complete follow-up were included in our study. Factors examined include age at the time of revision surgery, gender, comorbidities, arthroplasty site (right or left), body mass index (BMI), and primary indications for the tibial tubercle osteotomy during revision TKA. Functional outcome was measured by using Knee Society score (KSS) at 3 months and the final follow-up. All statistical analysis was done using SPSS version 20.0 with a p-value < 0.05 considered significant. @*Results@#Out of 27 patients, 6 patients (22.2%) were men and 21 patients (77.7%) were women. Right knee revision arthroplasty was performed in 15 patients (55.5%), left knee revision arthroplasty was performed in 12 patients (44.4%), and bilateral revision surgery was performed in only 1 patient (3.7%). The mean BMI was 29.2 kg/m 2 . We used a constrained condylar knee in 20 patients (74%), a rotating hinge knee in 5 patients (18.5%), and mobile bearing tray plus metaphyseal sleeves in 2 patients (7.4%).The KSS was 52.21 ± 4.05 preoperatively, and 79.42 ± 2.2 and 80.12 ± 1.33 at 3 months and 12 months, respectively. Radiological union was achieved in all patients at 3 months. Of 27 patients, only 1 patient (3.7%) had proximal migration of the osteotomy site at 6 months: the patient was asymptomatic and union was also achieved and, therefore, no surgical intervention was performed. @*Conclusions@#Tibial tubercle osteotomy during revision TKA can be a safe and reliable technique with superior outcomes and minimal complication rates.

In Silico Study of Protein-Protein Interactions in Mapks and pp2cs of Medicago sativa Discloses its Docking Sites Variations

Abstract A wide variety of cellular mechanisms such as cell division and metabolic processes are maintained by protein-protein interactions (PPIs). The identification of PPI through laboratory techniques is costly, time-consuming, difficult, and challenging. However, computational techniques were generated for PPIs prediction. In alfalfa (Madicago sativa), PPI was predicted among 12 MsMAPKs and 4 MsPP2Cs using a docking approach. For homology modelling, the Swiss model was employed while PROCHECK, ERRAT, and Verify3D were used to validate 3D models. The Ramachandran plots were obtained from PROCHECK which showed value more than 90% (nPP2C1, PP2C1, PP2C, and MSK-3 revealed 92.9%, 94.2%, 92.4%, and 91.1% respectively) for high-quality structures. The HawkDock server and the BIPSPI server were used to analyse protein docking and predict interaction sites, respectively. Our findings demonstrated that MsPP2C docking sites play an important role in the identification and docking of MsMAPKs. The binding free energy ranged from -0.16Kcal/mol to -49.15Kcal/mol for all MsMAPKs and MsPP2Cs, indicating that they interact. Docking site analysis showed that there were 48 pairs of PPIs which indicated that MsPP2Cs can perform a vital role in other signaling pathways. This study found that all MsPP2Cs have docking sites for MsMAPKs, indicating that this method can accurately determine protein-protein interactions.

Expression of Pinellia ternata leaf agglutinin under rolC promoter confers resistance against a phytophagous sap sucking aphid, Myzus persicae

BACKGROUND: Piercing/sucking insect pests in the order Hemiptera causes substantial crop losses by removing photoassimilates and transmitting viruses to their host plants. Cloning and heterologous expression of plantderived insect resistance genes is a promising approach to control aphids and other sap-sucking insect pests. While expression from the constitutive 35S promoter provides broad protection, the phloem-specific rolC promoter provides better defense against sap sucking insects. The selection of plant-derived insect resistance genes for expression in crop species will minimize bio-safety concerns. RESULTS: Pinellia ternata leaf agglutinin gene (pta), encodes an insecticidal lectin, was isolated and cloned under the 35S and rolC promoters in the pGA482 plant transformation vector for Agrobacterium-mediated tobacco transformation. Integration and expression of the transgene was validated by Southern blotting and qRT-PCR, respectively. Insect bioassays data of transgenic tobacco plants showed that expression of pta under rolC promoter caused 100% aphid mortality and reduced aphid fecundity up to 70% in transgenic tobacco line LRP9. These results highlight the better effectivity of pta under rolC promoter to control phloem feeders, aphids. CONCLUSIONS: These findings suggested the potential of PTA against aphids and other sap sucking insect pests. Evaluation of gene in tobacco under two different promoters; 35S constitutive promoter and rolC phloemspecific promoter could be successfully use for other crop plants particularly in cotton. Development of transgenic cotton plants using plant-derived insecticidal, PTA, would be key step towards commercialization of environmentally safe insect-resistant crops.

The Role Of Morphological Traits On The Batting Performance Of Cricket Batsmen – A Review Study

Background: The batting performance is assessed by considering the batting average and strike rate of a batsman. With the induction of T-20 cricket matches, the strike rate of a batsman has gained much attention from coaches and team management. To increase the strike rate a batsman required to hit powerful shots for boundaries, which assist in making maximum scores at the minimum ball. Therefore, this investigation was planned to determine the effect of body size on the batting performance of cricket batsman. Methods: the literature for this study was selected for cricket coaching manual, cricket books, cricket batting videos, a biography of cricket batsmen, research articles. The academic documents were downloaded and shortlisted from Google Scholar, Research Gate, EBSCO, and ProQuest from 1990 to 2019. Results: The synthesized literature review concludes, stature, longer legs, longer arms, and lean body mass of a batsman show positive effects on the execution of powerful shots in cricket. Furthermore, the maximum strength of muscles assists a batsman to boost up the initial velocity of bat swing to accomplish the ball speed for a successful and powerful shot. Conclusions: Although stature and longer limbs of batsmen are associated with batting performance. On the other hand, the specific training would also enhance the capacity of cricket batsman for powerful shots in cricket. A future study was proposed to investigate the effect of training on the batting performance.

Anthropometric, Physical Fitness And Kinematics Analysis Of The Jump Shot Of Female Handball Players - A Case Study Of The Islamia University Bahawalpur, Pakistan

Background: This study was designed in two poles, 1st to examine the kinematic parameters of the handball jump shot and 2nd to compare the anthropometric, and physical fitness of novice and skilled female handball players of the university level. Methods: This study design was cross-sectional, and a purposive sampling method was adopted for selecting the participants. The sample consisted of (n = 20) novice, and (n = 20) university female handball players. The selected variables were standing broad jump, vertical jump, flexibility, 30-m dash, agility, stride length, stature, body mass, arm length, upper arm girth, leg length, chest girth, waist girth, hip girth, thigh girth, calf girth, hand length, handbreadth and shoulder breadth, pelvic breadth, transverse breadth, elbow and knee breadth, handgrip and arm span, left and right knee angle, left and right elbow angle. An Independent t-test was applied to examine differences between skilled and novice players in kinematics and anthropometric variables. Results: Results showed the skilled female players were significantly higher than the novice players in the following as right elbow angle at the start of movement (<. 03), left elbow angle at the start of movement (<. 00), right knee angle at the start of movements (< .03), stride length at release (< .01), 30-meter dash (< .04), handgrip strength(< .02), agility (< .03), forearm girth (< .03), thigh girth (< . 03) and arm span (< .04). Conclusion: It was concluded the higher angle of elbows, right knee along with more prolonged stride increase the movement capacity of skilled female handball player while attempting the jump shots than novice female players. On the other hand, the anthropometric and fitness measures as arm span, thigh girth, running speed, handgrip strength, and agility increase the performance of skilled players than the novice. The female handball coaches may enhance the performance of novice players by focusing on the specific training of extension and flexion of elbows and stride movement as well as enhancing the physical fitness of female handball players. Future studies would focus on the training of handball players to increase the jump shot performance of players.

Effect of nabumetone on humoral immune responses in mice / Efeito da nabumetona nas respostas imunes humorais em camundongos

Nabumetone is used to reduce the pain and inflammation in rheumatoid arthritis. In the current study, immunomodulatory effect of Nabumetone is investigated in mice. The control group was administered normal saline orally as placebo. Nabumetone was administered orally via gavage in two treatment groups at 14mg/kg.b.w. doses and 28mg/kgb.w., respectively. Haemagglutination (HA) assay, Jerne hemolytic plaque and mice lethality assays were applied. In HA assay, the titer was significantly decreased in Nabumetone treatment groups (P< 0.001). In Jerne hemolytic plaque formation assay, there was a significant reduction (P< 0.001) in number of plaques in Nabumetone treated groups when compared with control. In mice lethality assay, there was a significant difference in mortality ratio of mice in control and Nabumetone treated groups (P< 0.001). Therefore, it is concluded that Nabumetone suppresses the humoral immune response in mice.(AU)

A nabumetona é usada na redução da dor e inflamação da artrite reumática. No presente estudo, o efeito imunomodulador é investigado em camundongos. O grupo de controle recebeu solução salina via oral como placebo. Nabumetona foi administrada oralmente via gavagem em dois grupos de tratamentos com doses de 14mg/kg.b.w. e 28mg/kgb.w., respectivamente. Foram realizados ensaios de hemaglutinação (HA), placa hemolítica de Jerne e letalidade dos camundongos. No ensaio HA, o grau foi significativamente menor nos grupos de tratamento com nabumetoma (P< 0.001). No ensaio de formação de placa hemolítica de Jerne houve redução significativa (P< 0.001) no número de placas em grupos tratados com nabumetoma comparado ao controle. No ensaio de letalidade dos camundongos houve diferença significativa no grau de mortalidade de camundongos no grupo de controle e grupos tratados com nabumetoma (P< 0.001). Portanto, conclui-se que a Nabumetoma suprime a resposta imune humoral em camundongos.(AU)

Comparison The Effectiveness Of Steroid Therapy With And Without Physiotherapy For The Management Of Lateral Epicondylitis

Objective: To compare the effectiveness of steroid therapy with and without physiotherapy for the management of lateral epicondylitis (tennis elbow). Methodology: Patients, who fulfil the inclusion criteria of selection were admitted to study in the Department of Physiotherapy PSRD, Lahore. Each patient received an informed consent. Demographic data including name, age, sex, height and weight were noted. Participating individuals were randomly allocated into two groups by lottery method. Patients of group A were treated by steroidal therapy without physiotherapy manoeuvres and the individuals of group B were treated by combination of steroidal therapy and physiotherapy. The follow-up was carried out for up to 4 weeks.All the information has been collected with pre-defined preforms.Data was interpreted and analysed through SPSS version 22.0. Results: The overall mean age of cases was 38.90±6.97 years and 42.07±7.03 years. There were 38(63.33%) male and 22(36.67%) female in this study. Before treatment the mean pain of participating individuals of group-A and in group-B was 7.40±1.45 and 7.63±1.27 with insignificant difference. After treatment the mean pain in group-A and group-B was 3.40±1.73 and 2.53±1.57 with significantly lower pain in group-B, p-value < 0.05. When we compared mean pain before and after injection was significantly improved in both groups but the improvement was higher in group-B. The mean pain difference in group-A and group-B was 3.77±2.18 and 4.90±1.83 with higher improvement in group-A, p-value < 0.05. Conclusion: Results of study concludesteroid injection with addition to physiotherapy was more effective in reducing pain.We must encourage orthopedic and physiotherapist teamwork to treat tennis elbow.

To Determine the Frequency of Successful Outcome of Multi-Drug Resistant Tuberculosis Treated as Outpatient in a Tertiary Care Center

Objectives: To determine the frequency of successful outcome of multidrug-resistant tuberculosis treated as outpatient in a tertiary care center. Subject and methods: This was a descriptive cross-sectional study done from 13 April, 2018 to 13 Oct, 2018. All the patients fulfilling inclusion criteria having age 20-60 years of either gender under treatment of MDR-TB for more than six months were enrolled in study the from Programmatic Management of Drug Resistance Tuberculosis (PMDT) site at Department of Pulmonology. Informed consent was taken from patients. Strictly exclusion criteria i.e. patients having neurological or psychological problems before diagnoses of MDR-TB (as per medical record in history), co-infection with HIV, was followed to exclude potential confounder and biases. Education status was evaluated and the response of treatment was checked in matriculate & under matric patients, also socioeconomic status was evaluated by asking about monthly salary whether below or above 12000, and subsequently their effect on treatment outcome. HIV screening is done through ICT method and DST for tuberculosis done on sputum of the patients in the Provincial Reference Lab in Hayat Abad Medical Complex Peshawar for diagnosis. Results: A total of 151 patients were included in this study, among which males were 94, and females were 57. The mean age was 41 years and S.D 10.82. As per the results, 110 (72.84%) patients were having a successful outcome. Conclusion: This study concludes that the out-patient treatment strategy success rate was 72.84% and it is feasible and safe for the treatment of MDR-TB patients.

Economic Burden of Periprosthetic Joint Infection Following Primary Total Knee Replacement in a Developing Country

Background@#Periprosthetic joint infection is one of the devastating complications after primary total knee arthroplasty, which increases the financial burden on patients and affects their quality of life as well. The financial burden of periprosthetic joint infection after joint replacement in developed countries is well known. There is a need to evaluate the economic burden in developing countries such as Pakistan. @*Methods@#This is a single-center, retrospective, case-control study conducted at the Department of Orthopedic Surgery, Liaquat National Hospital Karachi. Cases of primary total knee arthroplasty performed during this study were divided into 2 groups: uneventful primary total knee arthroplasty and periprosthetic joint infection treated with 2-stage revision. To calculate the final cost, we divided the total hospital cost into the hospital stay cost and operating room cost. @*Results@#During study period, 32 patients were diagnosed with periprosthetic joint infection. The total cost of revision surgery for periprosthetic joint infection considering 2 hospitalizations was 1,780,222 ± 313,686 Pakistani rupee (PKR). The total cost of uneventful arthroplasty was 390,172 ± 51,460 PKR. We observed significant difference with respect to economic details between the 2 groups. @*Conclusions@#Management of periprosthetic joint infection was 4.5 times more expensive than uneventful primary total knee arthroplasty. Measures should be undertaken to reduce the prevalence of periprosthetic joint infection, thereby reducing patients’ economic burden.

Polymeric emulgel carrying Cinnamomum tamala extract: promising delivery system for potential topical applications

Currently, the use of natural compounds obtained from plants tremendously increased due to their promising therapeutic properties. The aim of this study was to formulate a stable emulgel formulation loaded with Cinnamomum tamala (CT) extract. The antioxidant activity of plant extract was determined by DPPH inhibition assay. The extract was successfully loaded into an emulgels using different concentrations of carbopol-940, liquid paraffin, emulsifying agents and preservatives. Preliminary stability study was performed of 17 CT emulgel formulations at accelerated temperature of 50 °C for 2-months. Organoleptic evaluation, centrifugation, globule size, pH, electrical conductivity and rheological studies were performed for a period of 90-days at different temperature including 8, 25, 40 and 40 °C ±75% RH. The CT extract showed promising antioxidant activity of about 81%. On the other hand, the CT loaded emulgel formulation displayed high physical stability at all tested conditions of temperature and time. However, slight decrease in pH and minimum increase in conductivity was observed at 40 and 40 °C±75% RH. The rheological examination of CT emulgel indicated the flow index values of all the samples kept at different temperatures were less than 1, demonstrated non-newtonian and pseudo-plastic nature of CT emulgel. Taken together, the CT emulgel formulation has been evinced to be an excellent addition in the field of topical formulations.

Role of miRNA-182 and miRNA-187 as potential biomarkers in prostate cancer and its correlation with the staging of prostate cancer

ABSTRACT Purpose The microRNAs expression has emerged as a potential biomarker for the diagnosis and prognosis of prostate cancer. This study investigated the expression of miRNA-182 and miRNA-187 in prostate cancer patients and established a correlation between miRNA expression and staging of prostate cancer. Materials and Methods This prospective observational study involved patients undergoing transrectal ultrasound-guided biopsy for suspicion of prostate cancer. Pre-biopsy urine samples and prostatic core tissue samples of the patients were preserved and the miRNA-182 and miRNA-187 were studied. Results Sixty-three patients were included in this study, thirty-three patients were diagnosed with prostate cancer and thirty patients having benign histopathology were considered as controls. The expression of miRNA-182 was significantly increased (p=0.002) and miRNA-187 significantly decreased (p <0.001) in prostate cancer tissue specimens. However, the expression of these miRNAs did not significantly differ in the urine of prostate cancer patients as compared to controls. Serum Prostatic Specific Antigen (PSA) inversely correlated with the median expression of miR-187 in prostatic tissue (p=0.002). Further, the expression of miRNA-187 in prostate cancer tissue was significantly decreased in metastatic prostate cancer (p=0.037). Using ROC analysis, miRNA-187 expression was able to distinguish the presence or absence of bone metastasis [area under ROC (AUROC) (±SD) was 0.873±0.061, p <0.001]. Conclusion The miRNA-182 and miRNA-187 appear to be promising biomarkers in prostate cancer and miRNA-187 can serve as an important diagnostic marker of metastatic prostate cancer.

Morphological and molecular characterization of Acanthamoeba isolated from contact lens paraphernalia in Malaysia: Highlighting the pathogenic potential of T4 genotype

Objective: To determine the morphological and molecular characterization of Acanthamoeba isolates from contact lens paraphernalia in Malaysia and to investigate their pathogenic potential based on the physiological tolerance. Methods: One hundred and eighty contact lens wearers donated their contact lens, lens storage cases and lens solutions between 2018 and 2019. The samples were inoculated onto 1.5% non-nutrient agar plates for 14 d. Polymerase chain reaction (PCR) was performed and the amplified PCR products were sequenced and compared with the published sequences in GenBank. The pathogenic potential of positive isolates was further tested using temperature-tolerance and osmo-tolerance assays. Acanthamoeba species were categorized into three distinct morphological groups established by Pussard and Pons. Results: Acanthamoeba was successfully isolated from 14 (7.8%) culture-positive samples in which 11 belong to morphological group II and 3 belong to morphological group III, respectively. The sequencing of 18S ribosomal RNA gene led to the identification of the T4 genotype in all the isolated strains. In vitro assays revealed that 9 (64.3%) Acanthamoeba isolates were able to grow at 42 °C and 1 M mannitol and were thus considered to be highly pathogenic. Conclusions: To the best of our knowledge, this is the first report identifying the Acanthamoeba genotype and their pathogenic potential among contact lens wearers in Malaysia. The potentially pathogenic T4 genotype isolated in this study is the most predominant genotype responsible for human ocular infection worldwide. Hence, increasing attention should be aimed at the prevention of contamination by Acanthamoeba and the disinfection of contact lens paraphernalia.