Exploring threatened traditional knowledge; ethnomedicinal studies of rare endemic flora from Lesser Himalayan region of Pakistan

ABSTRACT Himalayas are one among the world biodiversity hotspots harboring many endemic medicinal plants. Despite augmentation in the documentation of ethnopharmacological knowledge of medicinal plant species, information regarding endemic species is still underway. Current paper highlights the traditional medicinal uses of rare endemic and unexplored group of plants having potential for novel chemical constituents with effective pharmacological activities. In total, 142 informants (91 male and 51 female) including seventeen traditional healers were interviewed using semi-structured questionnaire, personal observations and group discussions. Interviews were taken in field or otherwise photographs were shown for identification. Females were interviewed indirectly through male family members. For data analysis, quantitative analytical approach was adopted using ethnopharmacological indices as Relative frequency of citations and Fidelity Level. In total, 38 endemic plant species belonging to nineteen families were utilized by the local inhabitants. Highest number of endemics was belonging to Ranunculaceae (7), followed by Gentianaceae and Rosaceae (4 each) with respect to number of species. Highest number of endemics was used in fever, wound healing, throat infection and tonic (4 species each). Root was the most widely used part (36.17%) in cure of diseases and the leading mode administered was decoction (25.49%). Highest use reports and RFC values were recorded for Pimpinella stewartii (58 citations, 0.41 RFC), Caltha alba var. alba (52 citations, 0.37 RFC). Endemic plant species considerably contribute toward ethnomedicinal knowledge and despite rarity, the communities prefer their utilization. Conservation of endemics is necessary for future availability to the local communities.

Prevalence of hepatitis C genotypes in district Swabi, Khyber Pakhtunkhwa

The present study was conducted to determine the prevalence and genotype of Hepatitis C in District Swabi. Blood samples were collected from 100 seropositive patients from various hospitals of District Swabi, out of which, 93 samples were found positive by qualitative analysis through PCR. Positive samples were genotyped using Nested PCR. It was observed from the analysis of positive samples that 1a, 1b, 2a, 3a, 3b along with mixed genotypes are prevalent in Swabi. The most prevalent genotype was 3a with the rate of 73.13% followed by 3b with 11.82% rate and 1b to be the least common genotype at rate of 1.10%. From the present study it was concluded that HCV genotypes 1a, 1b, 3a and 3b are distributed in various parts of Swabi and genotype 3a is the most frequent genotype

Exploring Durable Genetic Resistance against Leaf Rust through Phenotypic Characterization and Lr34Linked STS Marker in Wheat Germplasm / Explorando a resistência genética duradoura contra a ferrugem da folha através da caracterização fenotípica e do STS marker relacionado ao (GENE) LR34 do germoplasma do trigo

Present study was aimed to screening the population of 25 wheat genotypes from Baluchistan region of Pakistan along with five commercial cultivars for leaf rust adult plant resistance (APR) through gene postulation using natural inoculation of Puccinia triticina Erikss local pathotype. Infection severity was recorded on scale in comparison with susceptible control "Morroco" cultivar. On the basis of phenotypic score, seven accessions and four varieties (Zardana-89, Sariab-92, Zarlashta-99 and Raskoh-05) with AUDPC values up to 20% were characterized as resistant genotypes. Coefficient of infection (CI) score ranged from 0-10 for some accessions and cultivars showing high level of adult plant resistance. Furthermore, bi-allelic STS marker csLV34 having close linkage with Lr34 (0.4cM). This marker amplified one gene specific allele of 150bp in 21 genotypes, including 19 accessions and two commercial varieties (Sariab-92 and Zarghoon-79) which confirmed presence of Lr34 gene conferring adult plant resistance against leaf rust. The rust pathogenicity scale varied for accessions from resistant to moderately susceptible. However, beside Lr34, phenotypic gene postulation, in combination with marker assisted selection for leaf rust resistance, has revealed presence of some other unknown resistance genes in local wheat germplasm which signified its use in wheat improvement programs both locally and abroad.

O presente estudo teve como objetivo a triagem da população de 25 genótipos de trigo do Baluchistão, região do Paquistão, juntamente com cinco cultivares comerciais para o estudo da resistência à ferrugem da folha em plantas adultas (leaf rust adult plant resistance, APR, em inglês) através da postulação gênica usando a inoculação natural do patótipo local da Puccinia triticina Erikks. A gravidade da infecção foi registrada na escala em comparação ao cultivar de controle suscetível "Morroco". Com base na pontuação fenotípica, sete acessões e quatro variedades (Zardana-89, Sariab-92, Zarlashta-99 and Raskoh-05) com valores de AUDPC (area under the disease progress curve, em inglês) até 20% foram caracterizados como genótipos resistentes. A pontuação do coeficiente de infecção (CI) variou no intervalo de 0-10 para algumas acessões e cultivares evidenciando uma elevada resistência nas plantas adultas. Além disso, o STS marker para o csLV34 bi-alélico demonstrou uma ligação estreita com o Lr34 (0.4cM). Este marcador amplificou um alelo específico do gene do 150bp em 21 genótipos, incluindo 19 acessões e duas variedades comerciais (Sariab-92 and Zarghoon-79) o que confirmou a presença do gene Lr34 conferindo resistência às plantas adultas contra a ferrugem da folha. A escala de patogenicidade da ferrugem para as acessões de resistente a moderadamente suscetível. Contudo, além do Lr34, a postulação gênica fenotípica, em combinação com a seleção auxiliada (ou assistida) por marcadores para a resistência da ferrugem da folha, revelou a presença de outros genes resistentes desconhecidos no germoplasma do trigo local o que justifica a sua utilização em programas de melhoramento do trigo tanto a nível local quanto a nível internacional.

Comparison of effects of propofol and isosorbide dinitrate during rewarming on cardiopulmonary bypass

Objectives: Comparison of effects of propofol and isosorbide dinitrate during rewarming on cardiopulmonary bypass in patients undergoing coronary artery bypasses grafting

Methods: it was randomized prospective clinical trial. One hundred and twenty patient [120] undergoing CABG surgery were included in this study. Group-1 [Study group, n=60]: in which only propofol infusion used during rewarming and Group-ll [control Group, n=60] in which isosorbide dinitrate and propofol infusion combination was used during rewarming. The data was entered and analyzed through SPSS Version 19

Independent sample T-test and chi-square test were used for data analysis. P value of < 0.05 was taken as significant

Results: Mean arterial pressures during rewarming were 63.41 +/- 3.61 mmHg in propofol group versus 60.80 +/- 4.86 mmHg in control group [p-value 0.001]. Core temperature on weaning from cardiopulmonary bypass was 37.11 +/- 0.49 °C in propofol group and 37.00 +/- 0.18 °C in control group. After drop in core temperature was little more in propofol group [1.02 +/- 0.36 °C] versus 0.96 +/- 0.37 °C in control group but this difference was not statistically significant [p-value 0.41]. Mean Ventilation time after surgery in propofol group was 4.65 +/- 0.65 hours versus 5.03 +/- 0.81 hours in control group [p-value 0.006]

Conclusion: Propofol alone is capable of fulfilling the requirements of adequate rewarming during Cardiopulmonary bypass and can produce more hemodynamic stability and early post-operative recovery

Effect of applying lignocaine gel, diclofenac gel or their combination on endotracheal tube on the hemodynamic response and incidence of postoperative complications in patients undergoing CABG surgery

Objectives: Hoarseness of voice, cough and sore throat are well known complications of endotracheal intubation. Many pharmacological strategies are used to reduce the incidence of these complications post surgery. We conducted this study to see the effectiveness of local application of diclofenac sodium gel, lidocaine gel or the effect of these two drugs when applied in combination on tracheal tube during intubation, regarding hemodynamic response and the incidence of postoperative sore throat, hoarseness of voice and cough

Methodology: In this prospective, randomized single blind trial, 150 patients undergoing coronary artery bypass graft [CABG] surgery at Chaudhry Pervaiz Elahi Institute of Cardiology from January 2016 to March 2016, were selected. The patients were divided into three groups; Group X [control Group] in which endotracheal tube [ETT] was lubricated with 2% lignocaine gel. Group D: ETT was lubricated with diclofenac sodium gel [2%]. And Group XD: where a mixture of lignocaine and diclofenac sodium gels was used to lubricate ETT before insertion. Data were analyzed in SPSS V16. One way ANOVA and chi-square test was used for analysis of quantitative and qualitative variables respectively taking p-value < 0.05 to be significant

Results: There was no difference in the age and gender of patients between groups. Post intubation HR increased more in Group D [108.94 +/- 7.40 beats/min.], and least in Group XD 96.62 +/- 3.84 beats/min and 100.72 +/- 6.98 beats/min in group X [p < 0.0001]. HR returned back to baseline value in group X and Group XD within five minutes after intubation but remained higher in diclofenac group [p < 0.0001]. The rise in blood pressure after intubation was highest in Group D [162.46 +/- 5.05 mmHg], then 157.34 +/- 5.43 mmHg in Group X, and least in Group XD [154.12 +/- 6.07 mmHg] [p < 0.0001]. Similarly blood pressure after five minutes of intubation was still high in Group D and was least in Group XD [p < 0.0001]. The time of return of HR and systolic blood pressure to baseline value was 9.00 +/- 1.33 min in Group D, 4.59 +/- 1.03 min in Group X and 3.43 +/- 0.81 min in group XD [p < 0.0001]. Incidence of sore throat, hoarseness of voice and cough was highest in Group X and less in Group D and was least in Group XD [p-values 0.039, 0.025 and 0.002 respectively]

Conclusion: Local application of a combination of lignocaine and diclofenac sodium gels over the endotracheal tube before intubation is associated with better hemodynamic control and significantly lower incidence of postoperative sore throat, hoarseness of voice and cough

Continuous low tidal volume ventilation during cardiopulmonary bypass reduces the risk of pulmonary dysfunction

Objective: Pulmonary dysfunction is considered to be the most important complication after open heart surgery. Different maneuvers like intermittent or continuous positive pressure ventilation, low tidal volume ventilation and different vital capacity maneuvers have been used for reducing the incidence of pulmonary dysfunction after cardiac surgery. In this study we evaluated the effects of low tidal volume ventilation versus no-ventilation during cardiopulmonary bypass [CPB] in patients undergoing conventional CABG surgery

Methodology: This randomized clinical trial was conducted in a tertiary care cardiac hospital. One hundred patients who were planned to undergo conventional CABG surgery were divided into two groups by using draw randomization procedure. In Group A patients [ventilation group] ventilation was continued at low tidal volume of 3 ml/kg, respiration rate of 12 breaths/min and PEEP of 5 cmH[2]O. In Group B patients [non-ventilation group] ventilation was arrested during CPB. For data analysis Statistical Package for Social Sciences [SPSS] V17 was used. Parametric variables were compared using unpaired t-test and non-parametric variables were compared using o[2]-test

Results: The mean patient's age in this study was 57.70 +/- 8.57 years in ventilated group and 54.5 +/- 8.33 years in non-ventilated group. PaO[2]/FiO[2] ratio and alveolar-arterial oxygen tension gradient immediately after intubation was same in groups. But PaO[2]/FiO[2] was significantly high in ventilated group after one hours of CPB and even after four hours of CPB [p < 0.001 and 0.002 respectively]. Alveolar arterial oxygen tension [A-a O[2]] gradient after 1 hour and four hours of CPB was significantly low in Ventilated group [p < 0.001 and 0.001 respectively]. Total Mechanical ventilation time was also significantly shorter in ventilated group 5.19 +/- 1.96 hours versus 6.42 +/- 2.60 hours in non-ventilated group [p 0.009]. On 4th post-operative day, incidence of atelectasis was significantly low 20% in ventilated group versus 38% in non-ventilated group [p = 0.04]

Conclusion: Continuous low tidal volume ventilation is associated with better oxygenation after surgery and reduced risk of post-op pulmonary complications during cardiopulmonary bypass in patients undergoing conventional coronary artery bypass graft surgery

public purchase of aphrodisiac products without prescriptions in the Alahsa region of KSA

Objectives: To investigate requests for common prescription-only aphrodisiacs across community pharmacies in the Alahsa region of KSA

Methods: A cross-sectional study was conducted among conveniently selected pharmacies in the eastern region of Alahsa, KSA. Self-administered questionnaires were directly distributed to 73 consenting community pharmacies. Completed questionnaires were coded, reviewed for accuracy and entered into a database in Statistical Package for the Social Sciences [Version 19.0; IBM Corporation, Somers, NY]. The data were analysed using descriptive analysis

Results: The survey response rate was 72.60%. With respect to the availability of aphrodisiacs and sexual supplements, most of the pharmacists disclosed that they had stocks of Viagra and Cialis. The most common men's health complication reported by pharmacists was erectile dysfunction [n ¼ 12, 22.6%], followed by premature ejaculation [n ¼ 4, 7.5%] and low sexual desire [n ¼ 1, 1.9%]. Less than half of pharmacists [n ¼ 9, 16.9%] cited Viagra and Cialis as preferred drugs for treating premature ejaculation. Approximately 32 [60.3%] proposed delayed sprays as the first line of action, while 13 [24.5%] considered antidepressants as their first-choice drug

Conclusion: The non-prescription dispensing of prescription-only medicines, including sexual enhancement products, is common in KSA. The majority of pharmacists continue to violate pharmaceutical laws

New modification of modified bentall procedure [a single centre experience]

Background and Objectives: Modified Bentall procedure has become a gold standard in the treatment of combined aortic root and aortic valve diseases. Bleeding is an important predictor of morbidity and mortality after the Bentall operation. Our objective was to evaluate the early outcomes of Modified Button-Bentall procedure with cuff technique for aortic root replacement surgery regarding hemostasis

Methods: A total number of 32 patients who underwent elective Bentall operation from January 2008 to December 2014 were included in the study. In 18 patients [Group I] modified Button-Bentall procedure with formation of cuff was used and in 14 patients [Group II] Modified Button technique without cuff formation was used for aortic root replacement. Data was analyzed using SPSS V16. Chi-square test, Fisher's Exact test and independent sample t-test was used to analyze Qualitative and Quantitative variables

Results: Three patients in Group II and two patients in group I was in congestive cardiac failure pre-operatively. Out of thirty two patients two patients were having Aortic root dissection one in each group. Total bypass time and cross-clamp time were significantly high in Group I. There was no significant difference regarding duration of inotropic support, ventilation time, ICU stay and hospital stay time in patients of Group I and Group II. But post-op Chest drainage was very high in Group II 1158+451.25 ml versus 488.89+168.27 ml in group I [p-value <0.0001]. There was one in hospital death in Group II

Conclusions: Formation of cuff of remnant of aorta during proximal anastomosis results in significant reduction in post-operative bleeding and was better in hospital outcomes

Aortic valve replacement; relation of aortic annulus measured by echocardiography and prosthesis size required

Precise determination of the size of aortic annulus is very important for the preoperative evaluation before aortic valve replacement

Objectives: to determine the preoperative prosthesis size using echocardiography in patients undergoing aortic valve replacement

Study Design: prospective observational study

Setting: Ch. Pervaiz Elahi Institute of Cardiology [CPEIC] Multan. Period: January 2013 to October 2014

Methods: [100 patients] Aortic annulus sizes were measured with TTE one week before surgery and with the help of sizer per-operatively. The data was analyzed by using SPSS V16. Quantitative variables were analyzed using mean and standard deviation and percentages were used for qualitative variables. Dependent sample t test was used to see accuracy of TTE in measuring aortic annulus size

Results: out of hundred patients, 84[84%] were male. Mean age of the patients was 33.77 +/- 13.17 years. 51% patients underwent isolated Aortic valve replacement; redo-operations were done only in 4% patients. In 96% patient's mechanical prosthesis was used and in 4% patient's boiprosthesis was used for valve replacement. We found no significant difference in Aortic annulus measured pre-operatively with the TTE [23.54 +/- 3.54] and measured per-operative with the sizer [23.96 +/- 3.36] with highly insignificant p-value 0.58.Aortic annulus size was almost same measured by these two techniques. Conclusion: Aortic annulus size measured with TTE helps to arrange the optimum size prosthesis before aortic valve replacement surgery

Delayed presentation of Morel-Lavallee lesion

Closed degloving skin lesions of the limbs are uncommon, and diagnosis may be missed at the time of acute trauma. Usually, they are associated with pelvic fractures but may occur in absence of any bony injury. When this closed internal degloving occurs over the greater trochanter, it is known as a Morel-Lavallee lesion. We report a case of unusually delayed presentation of Morel-Lavallee lesion treated successfully by debridement, packing, and delayed closure

Knowledge, attitude and practice for breast cancer risk factors and screening modalities in staff nurses of ayub teaching hospital abbottabad

Background: Breast cancer is the commonest cancer modality in female worldwide. Avoiding the risk factors can reduce its incidence and adhering to screening and early detection can reduce its mortality. A sufficient knowledge regarding the risk factors and screening modalities is therefore essential. We assessed the knowledge level about these parameters in our staff nurses. Methods: A self-administered questionnaire survey was performed. Knowledge regarding the risk factors and screening modalities were categorised into good, fair, poor and very poor categories. Results: Knowledge regarding most of the factors was found to be fair. A few things were termed as good knowledge like role of breast-feeding in protecting against breast cancer. Practice regarding the screening modalities was not satisfactory. Only a few nurses had good knowledge of the risk factors and screening modalities. Practice of the Screening modalities was also poor. Conclusion: There is a need to improve the nursing curriculum, training at the workplace and motivate them for screening practices. They should be encouraged to talk to their patients and their female attendants about prevention and early detection of breast cancer. Keywords: Breast cancer, BSE, knowledge

Combined intrauterine and bilateral tubal pregnancy

A rare case of combined intrauterine and bilateral tubal pregnancy [heterotopic pregnancy] in a young woman is described, who took a single dose of ovulation inducing drug [ART assisted reproductive techniques]. The possibility of heterotopic pregnancy should be considered and meticulous effort should be made to search for coexisting extrauterine gestational sac especially in patients who are on ovarian stimulation drugs in whom sonographically intrauterine gestation has been confirmed

Comparison of incidence of postdural puncture headache with 25[gram] quincke babcock spinal needle versus 27[gram] quincke babcock spinal needle in caesarean section

To compare the incidence of post dural puncture headache by using Quincke Babcock spinal needles of 25 G and 27 G in obstetrical patients. This comparative study was conducted in Obstetrics Units, Nishtar Hospital, Multan during the period. of 6 months i.e. from September 2004 to March 2005. A total of 80 patients were included in the study and divided into two groups. Out of the 80 patients, 9 were complicated by headache post-operatively. The overall incidence of PDPH was 15% in group-A, 7.5% in group-B. The difference in PDPH between groups was not statistically significant. The mean duration of headache was found to be 27.77 hours. In 5 patients out of 9, the duration of headache lasted less than 24 hrs. In 3 patients duration of headache was between 24-48 hours. in only one patient, the duration of headache was more than 48 hours. All the patients who developed PDPH had mild to moderate headache. In 8 patients out of 9 patients who had PDPH in the present study, the site was occipital region. Only one patient had generalized headache. Onset of headache was 24 hours to 72 hours after dural puncture. The incidence was found to be minimum with 27 Gauge Quincke Babcock spinal needle because the smaller the needle diameter the lesser the risk of cost dural puncture headache

Postoperative sore throat after endotracheal intubation of LMA

A prospective, randomized study was conducted to compare the postoperative throat complaints between two groups of patients with the airway managed either with an endotracheal tube [ETT] or a Laryngeal Mask Airway [LMA]. One hundred patients, ages 20-50 years and belonging to [ASA] class I and II were randomly allocated to the two groups. Patients in both groups underwent surgical procedures of less than one hour duration under general anaesthesia. Thirty percent of patients in the LMA group compared to sixty percent in [ETT] group had postoperative throat complaints. The difference was statistically highly significant [P=0.0005]. Moreover the degree of severity of sore throat in [ETT] group was higher than that in LMA group. It was concluded from the results that the use of LMA was associated with a reduced incidence and lower degree of severity of postoperative sore throat when compared to the ETT

[Effect of herbal hypoglycemic agents on antioxidant enzymes and metal ions in streptozotocin induced diabetic rats]

Background: up to know many herbal medicines with different oral formulations have been recommended for diabetes. The aim of this study was to investigate the effect of 4 herbal hypoglycemic agents include garlic [Allium sativum] neem [Azadirachta indica], tulsi [Ocimum sanctum] and bitter gourd [Momordica charantia] on blood glucose, antioxidant enzymes and metal ions in diabetics

Methods: crude extracts of herbal agents was prepared and each one was given to one group of diabetic rats. Two group of diabetic rats received insulin and glibenclamide. As controls, two groups of healthy and diabetic rats received saline. Body weight, fasting blood glucose, antioxidant enzymes and metal ions were measured before and after the study

Results: all agents including herbal preparations, insulin and glibenclamide reduced the levels of blood sugar and lipid peroxide when compared with diabetic control. These agents also increased levels of antioxidant enzymes in diabetic rats. Antioxidant enzymes decreased significantly in diabetic controls. Metal ions increased in diabetic rats treated with herbal agents, insulin and glibenclamide but decreased in diabetic controls

Conclusion: above mentioned herbal plants may be useful in the treatment of diabetes as they not only have hypoglycemic effect but they also protect rats from free radical mediated cellular injury by improving the activity of antioxidant enzymes. They also improve the levels of metal ions which are associated with antioxidant enzymes