Derangement of liver function tests in dengue patients

Background: Changes in the liver function test may serve as an early marker for timely diagnosis and identification of patients who may develop severe dengue. The purpose of this study was to examine the link between dengue fever severity and liver function test. Methods: This prospective observational study was conducted in the Department of General Medicine, Madhesh Institute of health sciences, provincial hospital, Janakpurdham in which we included dengue positive patients (aged 18 years or more) based on NS1 antigen or high titer on IgM/IgG testing from July 2023 till August 2023. We excluded patients with diseases like malaria, cirrhosis of liver, enteric fever, viral hepatitis or any other disease or taking any medication which can derange LFT. Results: We included 96 patients fulfilling the study criteria. Of these, 71% had DF, 22% had DHF and 7% had DSS. Among liver enzymes, mean AST of the patients was significantly higher in DSS group of patients (775.19�.65 U/l), as compared to those in the DF and DHF group of patients, p value <0.01. Similarly, mean ALT of the patients was significantly higher in DSS group of patients (387.8�.6 U/l), as compared to those in the DF and DHF group of patients, p value<0.01. On the contrary, mean alkaline phosphatase levels were similar between the three patient groups. Conclusions: Based on the results our study, we conclude that raised AST and ALT levels were significantly associated with severity of DSS and DHF. Patients with dengue infection should have a baseline liver function test and subsequent LFT monitoring to detect early hepatic impairment.

Postmarketing pharmacokinetic and pharmacodynamic equivalence of generic and brand atenolol in Egypt

Concerns have raised regarding the postmarketing quality of generic drugs. This study assessed the pharmacokinetic and pharmacodynamic equivalence of generic and brand atenolol tablets in 24 healthy male volunteers in a single-dose, open, randomized, two-period crossover study under fasting conditions. Blood samples were collected for 24 h post dosing and assayed for atenolol using HPLC. Blood pressure and heart rate were measured at baseline and throughout blood sampling. The mean plasma concentration-time curves for both products were similar. Pharmacokinetic and statistical analysis indicated bioequivalence based on the mean ratios of log-transformed Cmax and AUC values. Both products had similar time courses of pharmacodynamic activity with a significant fall in blood pressure and heart rate [maximum after 5 h] followed by a gradual increase towards baseline. Both products were well tolerated. Both atenolol products were bioequivalent in the postmarketing setting and can be used interchangeably in clinical practice

[Cloning, sequencing and expression of HSP70 c-terminal domain in Mycobacterium avium subsp. paratuberculosis]

Heat shock proteins [HSPs] have been shown to act as an adjuvant when co-administered with different antigens, especially tumor antigens or antigens from infectious agents. C-terminal domain of Mycobacterium tuberculosis heat shock protein 70 [Hsp70], when fused to peptide antigens, provides a unique structure that is able to induce potent immune responses. In this study, aneukaryotic expression vector pEGFP-N1, containing C-terminal domain of Mycobacterium paratuberculosis HSP 70, Green Fluorescent Protein [GFP] gene in the plasmid construct, was designed for use as a reporter. With GFP system, expression of the target protein was evaluated in the cell culture. The nucleotide sequence of the cloned gene was revealed by sequencing. The protein expression of designed plasmid was also proved by reverse transcriptase polymerase chain reaction [RT-PCR]. Our eukaryotic expression vector [pEGFP-N1 -hsp70 c-terminal] was successfully constructed and HSP70 c-terminal domain protein was expressed effectively. The current experiment, as a basis for a new DNAvaccine design, can be used for the future studies on reverse vaccinology

Cloning and high level expression of bovine interferon gamma gene in eukaryotic cells [COS-7]

Interferon gamma [IFN-gamma] is one of the key cytokines in defining T helper 1 lymphocyte immune responses. In this study, the bovine IFN-gamma gene was cloned from spleen tissue RNA using the reverse transcription-polymerase chain reaction [RT-PCR]. IFN-gamma cDNA was sub-cloned and expressed in mammalian expression plasmid [pcDNA3.1[+]] under the control of the human cytomegalovirus [CMV] promoter. The predicted amino acid [aa] sequence of bovine IFN-gamma compared with corresponding known sequence from bovine [Bos taurus] was 100% identity and with ovine, caprine, camel, lama, equine, canine, feline, human, mice and chicken cytokine was 95, 95, 86, 83, 77, 75, 75, 61, 44 and 35%, respectively. Invitro expression of recombinant bovine IFN-gamma [rBoIFN-gamma] and secretion to culture medium was confirmed by ELISA test. Maximum expression of rBoIFN-gamma occurred at 96 and 144 h after transfection in COS-7 cells. These results showed that pcDNA3.1 expression vector and COS-7 cells transfected by diethylaminoethyl [DEAE]-dextran allowed the high level expression of bovine IFN-gamma gene and the release of protein in supernatant of cell culture

Human organ and tissue transplantation in Pakistan; when a regulation makes a difference

Organ transplantation must be viewed in relation to the prevailing cultural, religious and socio-economic conditions of a nation. Over the past two decades, Pakistan has emerged as one of the largest centres for commercial renal transplantation. Government efforts, supported by professional associations, civil society organizations and the media, along with World Health Organization technical assistance, have led to the development of legislation regulating this practice and curbing organ trade in conformity with international guidelines. Although only two years have passed since the enactment of the law, there is evidence that conditions have significantly improved, raising hopes for ethical and safe organ transplantation in Pakistan. This study reviews the salient features of the legislation and lists the foreseeable evolving challenges and opportunities

Growing burden of noncommunicable diseases: the contributory role of oral diseases, Eastern Mediterranean Region perspective

Associations of oral diseases with noncommunicable diseases such as diabetes, cardiovascular diseases, chronic respiratory diseases, osteoporosis and chronic renal failure are widely reported in the literature from developed countries. Commonality of risk factors, changes in systemic inflammatory mediators and body metabolism play a role in this association. This paper reviews current knowledge on the burden and association of oral and systemic diseases, and highlights the paucity of information and research from the Eastern Mediterranean Region and other developing countries. A call is made for further research to understand the status and significance of oral-systemic disease associations and develop guidelines for their control in this Region

[ case repost: vagal paraganglioma with neck mass presentation]

Paragangliomas are neoplasms that arise from paraganglionic "bodies" of the autonomic nervous system. These paraganglia are distributed symmetrically and segmentally in the para-axial regions of the trunk and are typically related to arterial vasculature and cranial nerves of the ontogenetic gill arches. We repot a case of vagal paraganglioma with all diagnostic therapeutic approach which has not been reported previously in this manner

[Evaluation of treatment in 15 patients with congenital muscular toricollis]

Congenital muscular torticollis is the most common type of congenital painless torticollis. The aim of this study was to determine the frequency of age, sex, signs and symptoms, method of treatment and treatment outcome in this disease. In this descriptive study between 1996-2005, 15 patients with congenital muscular torticollis who were admitted to otorhinolaryngology department in Ahwaz, lmam Khomeini hospital, were investigated. Of 15 patients, 60% were males and 40% were females. The mean age of patients was 18.1 years. The most common associated deformity was hip dysplasia. 93.4% had good result after surgery. Muscular torticollis is a congenital disorder causing deformity in the head and neck area. Early treatment have a better final result with fewer complications

[ effect of hudroxyurea on extramedullary hematopoietic masses in patients with beta-thalassemia intermediate]

Since the need for transfusions in thalassemia intermediate [TI] patients is limited into some rare occasions they are almost always referred complaining of problems due to chronic anemia, bone marrow hyper-functioning [such as gall stones, osteoporosis] and also extramedullary hematopoiesis masses [EHM]. Different treatment modalities have been reported for managing the latter complication. We carried out this study to evaluating the effects of Hydroxyurea in reducing the size of such masses. The study was clinical trial comparing before and after characteristics of the patients referred to the Talassemia Research center from 2003 to 2006. Presentation of all was pain, weakness, paresthesia of legs and paraparesia/paraplegia. Diagnosis of EHM was confirmed by Spinal MRI [a 1.5 Tesla, Toshiba machine]. Hydroxiurea [Syrea, Medac, Germany] was administered 10-20 mg/kg/day. CBC, Urea, Creatinin were checked monthly. A Neurologist was observing the progression of patients. The second MRI was performed 3-6 months later. Another radiologist unaware of the sequence of imaging reported the changes of EHM during the period. Paired-t test and McNemar test were applied to compare the results. P< 0.05 was considered as statistically significant. Eight patients [7 males and 1 female] were enrolled in our study. Their age ranged from 26-44 years old. None had undergone transfusion, nor had they used pain killers. Neurologic symptoms were initiated from one week to a couple of months prior to their admission. They had administered Hydroxyurea in recommended dosage. The follow up takes 0.7 - 4.7 years. All subjects improved within 2 weeks, whereas none of them needed surgical procedures and radiotherapy. Both the MCV and NRBC changes were significant [P<0.02]. No considerable side-effects were noticed within the follow up period. HU is proved to be both effective and safe in treatment of EHM amongst patients with thalassemia intermediate who develop neurological symptoms. We suggest hydroxyurea as a "prophylactic agent" for several complications of TI

[Incidental sinus abnormalities in 256 patients referred for brain MRI]

Imaging abnormalities in the paranasal sinuses are regularly noted as incidental findings on MRI, however, little is known about their prevalence in the Iranian population. The purpose of this study was to classify these findings in the paranasal sinuses as seen on MRI and to investigate the prevalence, according to site and type of paranasal abnormality. In this cross-sectional study, the T2-weighted axial MRI of 256 patients with diseases unrelated to their paranasal sinuses were reviewed between May 2002 and June 2003. The findings were categorized according to the anatomic location and the imaging characteristics of the abnormality. The abnormalities recorded included total sinus opacification, mucoperiosteal thickening >/= 5mm, air fluid levels and retention cysts or polyps. Unilateral or bilateral involvement and septal deviation were also noted. A sinus was considered normal if it was fully aerated and no soft-tissue density was apparent within the cavity. Among our cases, 111 [43.5%] were male and 145 [56.5%] were female. Of these patients, abnormalities in one or more of the sinus groups were found in 110 subjects [42.9%], 55.5% of which were male and 44.5% were female [P=0.001]. Maxillary sinus abnormalities were observed in 66.4% of the patients, while ethmoid sinus abnormalities were found in 63.6%. Of the ethmoid abnormalities, 21% were found in the anterior section, 9% in the middle ethmoid, and 8% in the posterior ethmoid. The most common abnormality found was mucosal thickening. Among our cases, 23.4% had septal deviation, which was significantly higher among those with sinusitis [29% versus 19.1%; P<0.01]. Of those patients with sinus involvement, 16% were involved in the sphenoid sinus and 5% in the frontal sinus. The results obtained from the patients with sinus abnormality revealed that 85% suffered from cough, nasal obstruction, runny nose, facial pain and post nasal discharge and 24% had been diagnosed with chronic sinusitis by physician. Our results showed that there was a high rate of incidental abnormalities in the paranasal sinuses that are unrelated to the patient's presenting problems

[Effect of gamma irradiation sterilization on the osteoinductive capacity of demineralized bone matrix]

Gamma irradiation has been widely used for secondary sterilization of bone allograft before clinical use to reduce the risk of infection and associated complications. The current study evaluated the effect of gamma irradiation sterilization on the osteoinductive capability of human demineralized bone matrix using a rat model. Eighteen euthymic rats received two separate implants consisting of 30 mg sterile-harvest demineralized bone matrix and 30 mg gamma irradiation-sterilized demineralized bone matrix. The demineralized bone matrix from each group was placed into two separate muscle pouches created in the paravertebral muscles of each rat. All 18 rats were euthanized after 4 weeks and each implantation site was removed with 0, 5 cm normal tissue around the implant. Histological examination was performed to determine the presence or absence of new bone, cartilage and bone marrow elements, All except one of 18 [94.4%] sterile-harvest demineralized bone matrix sites histologically contained new bone elements and five of 18 [27.7%] ethylene oxide sterilized demineralized bone matrix sites showed evidence of new bone elements, which was statistically significant [p<0.05]. The results of this study indicate that demineralized bone matrix sterilized with gamma irradiation loses its osteoinductive capacity in a manner similar to that of steamsterilized demineralized bone matrix, making it unsuitable as a method of secondary sterilization of demineralized bone matrix

[Effects of rapeseed meal and iodine supplement on broiler chicks]

To study the effects of rapeseed meal and iodine supplementation on performance, organs weight and some biochemical parameters of broiler chicks. Completely randomized design with 3 dietary treatments. One hundred and twenty one-day-old Arian broiler chicks [mixed male and female]. Chickens were categorized into 3 groups: soybean meal, rapeseed meal, and rapeseed meal plus iodine [2mg/kg]. feed intake, body weight gain and feed conversion ratio were determined at the end of starter, grower, finisher and whole priod states Moreover, the values of relative weight of liver, gallbladder, heart, spleen, gizzard, abdominal fat pad and carcass accompaning with serum concentrations of triiodothyronine, thyroxine, gamma glutamyltransferase and alanin aminotransferase were determined at 49 day of age. Significant differences among treatments determined by Duncan's multiple range tests. While rapeseed meal [RSM] reduced, body weight gain and feed conversion ratio, iodine supplement did not affect body weight gain and feed conversion ratio during starter, grower and whole period states. In contrast to iodine treatment the highest weight of gallbladder and its ratio to whole body weight were seen with RSM. The weight of abdominal fat pad and its ratio to whole body weight were reduced in RSM and RSM puls iodine supplementation. Iodine Supplementation had effect on the concentration of thyroxine, triiodothyronine gamm glutamyltransferase and alanin aminotransferase in RSM group. The complete replacement of rapeseed meal with soybean reduced performance and concentration of triiodothyronine hormone, and increased some organs weight, idoine supplementation had no effect on erfrmanc

Comparison of snod gross and para-meatal based flap technique for hypospadiasis

To compare the two surgical procedures Snod gross and parameatal based flap technique for mid and distal penile hypospadias including cosmosis. Randomized Clinical interventional trail. This study was conducted in the Urology Department of Assir Central University Hospital ABHA, KSA and Department of Urology and Renal transplantation, Jinnah Hospital, Lahore from June 2002 to Dec 2004. Thirty-two patients were selected for this randomized clinical intervention study with mid shaft and distal hypospadias fulfilling the inclusion criteria. Snod Gross and parameatal based flap technique was assigned randomly to patients comprising of two groups of sixteen each. Watertight closure was made with 6/0 vicryl. Tourniquet or 1:10000 epinephrine were used. Follow up at 2 weeks, three months; 6 months post catheter or stent removal and the patient were assessed on criteria of cosmosis, time for surgery and complications associated with the procedure. Thirty-two patients who underwent procedure of Snodgross and parameatal-based flap in the management of mid shaft and distal penile Hypospadias. Age ranged from 2-12 years. The mean age was 5.23+4 years. The presentation of patients was dystocia of external meatus with misdirected stream in sixteen [50%] patients, spraying of urine in six [25%] and narrow stream in 4[13%] patients. Eighteen patients were having distal penile and fourteen were having mid shaft hypospadias. Following Snod grass technique all patients had good cosmetic results without any complication. Following parameatal based flap, one patients [6.3%] develop wound dehiscence, three patients [18.8%] develop urethral fistula, two patients [12.5%] showed metal retrieval and twenty patients showed good cosmosis. In our study, comparison between Snodgross and parameatal-based flap, the success rate was 100% and 62.4% respectively. Success with Snod gross procedure is better with no complications and good cosmosis. Complications rate was 37.6% in-patient with para-meatal technique

Significance of PAP Smear in diagnosing Endometrial Carcinoma

To explore the role of cervical cytology in the diagnosis of endometrial disease in postmenopausal women in our set up. Study was conducted at Department of Pathology and Microbiology of The Aga Khan University, Karachi Pakistan during 2004. To assess the correlation between endometrial cells on routine cervical cytology and endometrial carcinoma, 57 Pap smears were taken from postmenopausal women with and without abnormal bleeding. The mean age was 54 +/- 7 years. The results of cervical cytology were compared and further confirmed with the endometrial histology. We found a positive association between endometrial cells in Pap smear and carcinoma of the endometrium in six out of 57 patients [11.02%] while remaining 51 patients [88.98%] were benign. However, the presence of atypical endometrial cells in Pap smear and the abnormal vaginal bleeding confirmed the diagnosis. The data indicate the importance of further diagnostic evaluation with endometrial sampling in postmenopausal women with endometrial cells seen in Pap smear, especially in abnormal vaginal bleeding

Preparation of fibrin glue as a biological sealant fo control bleeding in heart muscle and blood vessels

Fibrin glue is used for control of bleeding in various surgical procedures. In this work the ability of fibrin glue to seal punctures in the vascular system is demonstrated. Blood samples were taken from rabbits, fibrinogen was separated and fibrin glue was eventually prepared. The rabbits were anesthetized and a midline incision was carried out. The heart and abdominal aorta were exposed. Punctures were made in different parts of the vascular system and bleeding was controlled either with [test] or without [control] fibrin glue. Oozing was also tested by scratching the rabbit's ears. A minimum of 6 rabbits was employed for each experience. The mean bleeding time using fibrin glue was found to be 37 seconds. This average without fibrin glue was more than 3 minutes. This study shows the powerful effect of this biological glue in bleeding control, and its routine use is therefore recommended, especially in major surgery

Effect of suranjan [colchicum luteum] in Niqris [Gout]

Niqris [gout] is a condition characterised by recurrent attacks of acute pain and swelling at first affecting only one joint, usually the metatarso-phalangeal joint of the big toe, later becoming polyarticular. Since ancient times it is believed that an excessive intake of baadi ghiza [food containing high purine contents] is the primary and essential cause of gout which results in deposition of Maddah-e-nigris [urates of tophi] in the articular and periarticular tissues. Although several potent and effective drugs like Allopurinol [Zyloric] and Sulphinpyrazone [Artiran] are available in modern medical treatment, they are not without side effects like gastritis, peptic ulcers, tolerance and dependence. Among several useful Unani drugs, Suranjan [Colchium luteum] is one which is claimed to be effective in this ailment. On an average the oral use of Suranjan Showed relief in symptoms in 94.3% of cases in 30 days without any side effect. Our study included 20 cases of chronic gout

Spectrum of pathological lesions in cystoscopic bladder biopsies: a clinicopathologic study

To determine the clinicopathologic characteristics and frequencies of different pathological lesions in cystoscopic bladder biopsies in patients with bladder diseases. Design: A single- institution based retrospective observational study. Place and Duration of Study: The study was conducted in the Department of Histopathology, Sindh Institute of Urology and Transplantation [SIUT], Karachi over a period of five years [December, 1996 to December, 2001]. Subjects and All patients, who presented to the urology clinic of SIUT between December 1996 and December 2001 with haematuria, dysuria, urgency and frequency and in whom a cystoscopy and bladder biopsy were performed to elucidate the nature of underlying pathology, were included in this study. A total of 784 patients were studied. Clinical and demographic data and pathological diagnoses were retrieved from the original surgical biopsy reports. Bladder biopsies were received in 10% buffered formalin, gross examination done and processed for paraffin embedding. Histologic sections were stained routinely with Hematoxylin and Eosin, PAS and PAS with diastase. Sections were examined under the light microscope to document the pathologic diagnosis. Of the total 784 patients, 577[73.6%] were males and 207 [26.4%] were females with an overall male to female ratio of 2.8:1. Age range was wide [4 to 86 years]. The spectrum of pathological lesions included tumours: 497 cases [63.7%], followed by acute and chronic non-specific inflammation: 86[11%], cystitis cystica and glandularis: 40 [5%], Tuberculosis: 17[2.16%], squamous metaplasia: 13[1.65%] and a number of other rare lesions. Among the tumours, transitional cell tumours [TCC] were most common [95.3%]. Tumours were more common in males than in females [male to female ratio: 5.3:1] and peaked in 4th through 7th decades. Pathologic staging was possible in 89.7% of the cases. A majority of these cases [62%] presented with superficial disease, while in 38% the disease was muscle-invasive when first diagnosed. Grading was possible in all except two cases, which contained only necrotic tissue. A vast preponderance of tumours [74.5%] were well-differentiated, while 25.5% belonged to poorly-differentiated category [Grade 3 and 4]. In a significant number of biopsies: 105 cases [13.4%], no significant pathology was noted. TCC is the most common lesion in cystoscopic bladder biopsies

Residue-concentration of malathion and its metabolites in blood, urine, milk and tissues of lactating goats after multiple oral administration

Determination of Residues of Malathion [M] and its metabolic fractions Malaoxon [MO], 0, O-dimethyl-phosphoro dithionate [DPDT], Malathion mono acid [MCA], Dicarboxylic acid [DCA] and desmethylmalathion [DMM], in serum, urine and tissues of lactating goats received a daily dose [10mg-1 kg] body weight of [M] for 5 successive days was investigated. Daily samples of blood and urine were collected during the period of administration as well as 7 and 14 days after withholding of [M]. Tissue samples were taken from slaughtered goats at 7 and 14 days after cessation of the insecticide. Gas chromatographic technique [GC] was adopted for determination of [M] and its metabolites. [M] was not detected in any serum samples collected during administration and/or after cessation of insecticide, while it was excreted unchanged in urine and milk till one week after cessation of treatment with neurotoxic concentration over 20 ng/ml. The active metabolites [MO] and [DPDT] were not detected in any milk samples collected during application or after stoppage of [M] administration, while both metabolites were detected in serum and urine with neurotoxic concentrations during period of administration and still detected in serum for 7 days [400 ng/ml] and DPDT for 14 days [241 ng/ml] after stopping of [M] administration. The major excretory detoxified metabolites was found in milk on the days 7 and 14 after cessation of Malathion. Tissue residue-analysis