Molecular characterization of Aeromonas hydrophila isolates from diseased fishes in district Kasur, Punjab, Pakistan

Abstract Pakistan is an agricultural country and fisheries play a very important role in the economic development of the country. Different diseases are prevalent in Pakistani fish but information related to the causative agents is not well-known. Keeping in view the significance of bacterial pathogens as the causative agents of multiple fish diseases, the present study was conducted for identification, characterization and analysis of virulence genes of Aeromonas spp. isolated from diseased fishes. A total of fifty fish samples having multiple clinical indications were collected from different fish farms of district Kasur, Punjab Pakistan. For isolation of Aeromonas spp. samples were enriched and inoculated on Aeromonas isolation medium. Isolates were identified and characterized by different biochemical tests, Analytical Profile Index (API) 20E kit and Polymerase Chain Reaction (PCR) assays. All isolates were screened for three putative virulence genes including aerolysin (aer), haemolysin (hyl) and heat labile cytotonic enterotoxin (alt). Seven isolates of Aeromonas (A.) hydrophila were retrieved and identified based on API 20E. These isolates were further confirmed as A. hydrophila on the basis of PCR assays. Three isolates were detected positive for the presence of virulence genes (alt and hyl). Whereas aerolysin (aer) gene was not present in any of A. hydrophila isolates. The present study confirmed A. hydrophila as the causative agent of epizootic ulcerative syndrome and motile Aeromonas septicemia in fish farms of district Kasur, Punjab Pakistan. Moreover, detection of two virulence genes (alt and hyl) in A. hydrophila isolates is a threat for fish consumers of study area.

Resumo O Paquistão é um país agrícola, onde a pesca desempenha um papel muito importante para o desenvolvimento econômico. Diferentes doenças são prevalentes em peixes do Paquistão, mas as informações relacionadas aos agentes causadores não são bem conhecidas. Tendo em vista a importância dos patógenos bacterianos como agentes causadores de múltiplas doenças em peixes, o presente estudo foi conduzido para identificação, caracterização e análise de genes de virulência de isolados de Aeromonas spp. de peixes doentes. Foram coletadas 50 amostras de peixes com múltiplas indicações clínicas em diferentes fazendas do distrito de Kasur, Punjab, Paquistão. Para isolar Aeromonas spp., as amostras foram enriquecidas e inoculadas em meio de isolamento. Os isolados foram identificados e caracterizados por diferentes testes bioquímicos, kit Analytical Profile Index (API) 20E, e ensaios de reação em cadeia da polimerase (PCR). Todos os isolados foram selecionados para três genes de virulência putativos, incluindo aerolisina (aer), hemolisina (hyl) e enterotoxina citotônica termolábil (alt). Sete isolados de Aeromonas hydrophila foram recuperados e identificados com base no API 20E. Esses isolados foram posteriormente confirmados como A. hydrophila de acordo com ensaios de PCR. Três isolados indicaram a presença de genes de virulência (alt e hyl), enquanto o gene aerolisina (aer) não esteve presente em nenhum dos isolados de A. hydrophila. O presente estudo confirmou A. hydrophila como o agente causador da síndrome ulcerativa epizoótica e septicemia móvel por Aeromonas em fazendas de peixes, no distrito de Kasur, Punjab, Paquistão. Além disso, a detecção de dois genes de virulência (alt e hyl) em isolados de A. hydrophila é uma ameaça para os consumidores de peixes da área de estudo.

Molecular characterization of Aeromonas hydrophila isolates from diseased fishes in district Kasur, Punjab, Pakistan / Caracterização molecular de isolados de Aeromonas hydrophila de peixes doentes no distrito de Kasur, Punjab, Paquistão

Abstract Pakistan is an agricultural country and fisheries play a very important role in the economic development of the country. Different diseases are prevalent in Pakistani fish but information related to the causative agents is not well-known. Keeping in view the significance of bacterial pathogens as the causative agents of multiple fish diseases, the present study was conducted for identification, characterization and analysis of virulence genes of Aeromonas spp. isolated from diseased fishes. A total of fifty fish samples having multiple clinical indications were collected from different fish farms of district Kasur, Punjab Pakistan. For isolation of Aeromonas spp. samples were enriched and inoculated on Aeromonas isolation medium. Isolates were identified and characterized by different biochemical tests, Analytical Profile Index (API) 20E kit and Polymerase Chain Reaction (PCR) assays. All isolates were screened for three putative virulence genes including aerolysin (aer), haemolysin (hyl) and heat labile cytotonic enterotoxin (alt). Seven isolates of Aeromonas (A.) hydrophila were retrieved and identified based on API 20E. These isolates were further confirmed as A. hydrophila on the basis of PCR assays. Three isolates were detected positive for the presence of virulence genes (alt and hyl). Whereas aerolysin (aer) gene was not present in any of A. hydrophila isolates. The present study confirmed A. hydrophila as the causative agent of epizootic ulcerative syndrome and motile Aeromonas septicemia in fish farms of district Kasur, Punjab Pakistan. Moreover, detection of two virulence genes (alt and hyl) in A. hydrophila isolates is a threat for fish consumers of study area.

Resumo O Paquistão é um país agrícola, onde a pesca desempenha um papel muito importante para o desenvolvimento econômico. Diferentes doenças são prevalentes em peixes do Paquistão, mas as informações relacionadas aos agentes causadores não são bem conhecidas. Tendo em vista a importância dos patógenos bacterianos como agentes causadores de múltiplas doenças em peixes, o presente estudo foi conduzido para identificação, caracterização e análise de genes de virulência de isolados de Aeromonas spp. de peixes doentes. Foram coletadas 50 amostras de peixes com múltiplas indicações clínicas em diferentes fazendas do distrito de Kasur, Punjab, Paquistão. Para isolar Aeromonas spp., as amostras foram enriquecidas e inoculadas em meio de isolamento. Os isolados foram identificados e caracterizados por diferentes testes bioquímicos, kit Analytical Profile Index (API) 20E, e ensaios de reação em cadeia da polimerase (PCR). Todos os isolados foram selecionados para três genes de virulência putativos, incluindo aerolisina (aer), hemolisina (hyl) e enterotoxina citotônica termolábil (alt). Sete isolados de Aeromonas hydrophila foram recuperados e identificados com base no API 20E. Esses isolados foram posteriormente confirmados como A. hydrophila de acordo com ensaios de PCR. Três isolados indicaram a presença de genes de virulência (alt e hyl), enquanto o gene aerolisina (aer) não esteve presente em nenhum dos isolados de A. hydrophila. O presente estudo confirmou A. hydrophila como o agente causador da síndrome ulcerativa epizoótica e septicemia móvel por Aeromonas em fazendas de peixes, no distrito de Kasur, Punjab, Paquistão. Além disso, a detecção de dois genes de virulência (alt e hyl) em isolados de A. hydrophila é uma ameaça para os consumidores de peixes da área de estudo.

Human sperm parameter improvement associated with Ceratonia siliqua extract as a cryopreservation supplement after vitrification / 대한생식의학회지

Objective@#Given the destructive effects of oxidative stress on sperm structure, this study was conducted to investigate the antioxidant effects of different concentrations of Ceratonia siliqua plant extract on human sperm parameters after the freezing-thawing process. @*Methods@#A total of 20 normozoospermic samples were frozen. Each sample was divided into two control groups (fresh and cryopreservation) and three cryopreservation experimental groups (containing C. siliqua extract at concentrations of 20, 30, and 40 μg/mL in the freezing extender). Motility, intracellular levels of reactive oxygen species (ROS), plasma membrane integrity (PMI), mitochondrial membrane potential (MMP), viability, and acrosome reaction parameters were evaluated. @*Results@#Statistical analysis showed that the highest motility, viability, and PMI were associated with the 20 μg/mL concentration of C. siliqua extract. At all concentrations, intracellular ROS levels were significantly lower and the levels of MMP and the acrosome reaction were significantly higher than in the cryopreservation control group (p≤0.05). @*Conclusion@#C. siliqua extract supplements at concentrations of 20, 30, and 40 μg/mL improved sperm motility, viability, PMI, MMP, intracellular ROS, and the acrosome reaction.

Metabolites in Conocarpus erectus leaves attenuate α-amylase activity by modulating amino acid residues of α-amylase: an in vitro and docking study / Los metabolitos en las hojas de Conocarpus erectus atenúan la actividad de la α-amilasa al modular los residuos de aminoácidos de la α-amilasa: un estudio in vitro y de acoplamiento

The antioxidant activity and the inhibitory potential of α-amylase of lyophilized hydroethanolic extracts of Conocarpus erectus leaves obtained by ultrasonication were determined. The most potent extract was subjected to ultra-high performance liquid chromatography system equipped with mass spectrometer for metabolite identification. The identified metabolites were docked in α-glucosidase to assess their binding mode. The results revealed that 60% ethanolic extract exhibited highest ferric reducing antioxidant power (4.08 ± 0.187 mg TE/g DE) and α-amylase inhibition (IC50 58.20 ± 1.25 µg/mL. The metabolites like ellagic acid, 3-O-methyl ellagic acid, ferujol, 5, 2 ́-dihydroxy-6,7,8-trimethyl flavone and kaempferol glucoside were identified in the extract and subjected to molecular docking studies regarding α-amylase inhibition. The comparison of binding affinities revealed 3-O-methyl ellagic acid as most effective inhibitor of α-amylase with binding energy of -14.5911 kcal/mol comparable to that of acarbose (-15.7815 kcal/mol). The secondary metabolites identified in the study may be extended further for functional food development with antidiabetic properties.

Se determinó la actividad antioxidante y el potencial inhibidor de la α-amilasa de extractos hidroetanólicos liofilizados de hojas de Conocarpus erectus obtenidos por ultrasónicación. El extracto más potente se sometió a un sistema de cromatografía líquida de ultra alto rendimiento equipado con un espectrómetro de masas para la identificación de metabolitos. Los metabolitos identificados se acoplaron en α-glucosidasa para evaluar su modo de unión. Los resultados revelaron que el extracto etanólico al 60% exhibió el mayor poder antioxidante reductor férrico (4.08 ± 0.187 mg TE/g DE) e inhibición de la α-amilasa (IC50 58.20 ± 1.25 µg/mL. Los metabolitos como el ácido elágico, 3-O-metil elágico ácido, ferujol, 5, 2 ́-dihidroxi-6,7,8-trimetil flavona y kaempferol glucósido se identificaron en el extracto y se sometieron a estudios de acoplamiento molecular con respecto a la inhibición de la α-amilasa. La comparación de las afinidades de unión reveló 3-O-metil El ácido elágico como inhibidor más eficaz de la α-amilasa con una energía de unión de -14,5911 kcal/mol comparable a la de la acarbosa (-15,7815 kcal/mol). Los metabolitos secundarios identificados en el estudio pueden ampliarse aún más para el desarrollo funcional de alimentos con propiedades antidiabéticas.

Assessment of knowledge regarding tracheostomy care and management of early complications among healthcare professionals / Avaliação do conhecimento sobre cuidados com a traqueostomia e manejo de complicações precoces entre profissionais de saúde

Abstract Introduction: Tracheostomy is commonly performed surgical procedure in ENT practice. Postoperative care is the most important aspect for achieving good patient outcomes. Unavailability of standard guidelines on tracheostomy management and inadequate training can make this basic practice complex. The nursing staff and doctors play a very important role in bedside management, both in the ward and in the intensive care unit (ICU) setup. Therefore, it is crucial that all healthcare providers directly involved in providing postoperative care to such patients can do this efficiently. Objectives: The objective of this study is to assess the knowledge regarding identification and management of tracheostomy-related emergencies and early complications among healthcare professionals so as to improve practice and further standardization. Methods: Cross-sectional observational study included two hundred and fifty-four doctors and nurses from four large tertiary care hospitals. The questions used were simple and straightforward regarding tracheostomy suctioning, cuff care, cuff management, tube blockage, and feeding management in patients with tracheostomy. Results: Based on evidence from our study, knowledge level regarding tracheostomy care ranges from 48% to 52% with knowledge scores above 50% being considered satisfactory. Significant gaps in knowledge exist in various aspects of tracheostomy care and management among healthcare professionals. Conclusion: Our findings demonstrated an adequate knowledge level among health care professionals ranging from 48% to 52% with knowledge scores above 50% being considered satisfactory and revealed that gaps in knowledge still exist in various aspects of tracheostomy care and management.

HIGHLIGHTS Healthcare workers should be well versed in identifying tracheostomy management, its complications and responding accordingly. Doctors and nurses (131 =52%) possessed good knowledge about various aspects of tracheostomy care and management. The poorest scores were regarding cuff pressure (38.9%), suction pressure (39.4%) and first response in tube blockade (31.1%). Higher scores were found in age group 26 to 30 years (54.2%) and those having 1-3 years of clinical experience (41.2%). No statistically significant assoiation of knowledge regarding tracheostomy care was apparent with age, gender or years of practice.

Resumo Introdução: A traqueostomia é um procedimento cirúrgico comumente feito na prática otorrinolaringológica. O cuidado pós-operatório é o aspecto mais importante para alcançar bons resultados para o paciente. A indisponibilidade de diretrizes padrão para o manejo da traqueostomia e o treinamento inadequado podem tornar complexa essa prática básica. A equipe de enfermagem e os médicos desempenham um papel muito importante no manejo à beira do leito, tanto na enfermaria quanto na unidade de terapia intensiva (UTI). Portanto, é crucial que todos os profissionais de saúde diretamente envolvidos na prestação de cuidados pós-operatórios a esses pacientes possam fazer isso de forma eficiente. Objetivo: Avaliar o conhecimento sobre a identificação e manejo de emergências relacionadas à traqueostomia e complicações precoces entre os profissionais de saúde, a fim de melhorar a prática e sua padronização. Método: Estudo observacional transversal que incluiu 254 médicos e enfermeiras de quatro grandes hospitais terciários. As perguntas foram simples e diretas em relação à aspiração da traqueostomia, cuidados com o cuff, manejo do cuff, obstrução da cânula e manejo da alimentação em pacientes traqueostomizados. Resultado: Com base nas evidências de nosso estudo, o nível de conhecimento sobre os cuidados com a traqueostomia varia de 48% a 52%, com escores de conhecimento acima de 50% considerados satisfatórios. Existem lacunas significativas no conhecimento em vários aspectos dos cuidados e manejo da traqueostomia entre os profissionais de saúde. Conclusão: Nossos achados demonstraram um nível de conhecimento adequado entre os profissionais de saúde, variação de 48% a 52%, com escores de conhecimento acima de 50% considerados satisfatórios e revelaram que ainda existem lacunas no conhecimento em vários aspectos do tratamento e manejo do paciente traqueostomizado.

DESTAQUES Profissionais de saúde devem estar bem familiarizados com a identificac¸ão do manejo da traqueostomia, suas complicac¸ões e como agir de acordo com a necessidade. Médicos e enfermeiras (131 = 52%) possuíam bons conhecimentos sobre vários aspectos dos cuidados e manejo da traqueostomia. Os piores escores foram em relac¸ão à pressão adequada do cuff (38,9%), à pressão de aspirac¸ão adequada (39,4%) e primeiros socorros em caso de obstruc¸ão da cânula (31,1%). Os melhores escores foram encontrados no grupo 26 a 30 anos (54,2%) e aqueles com experiência clínica de 1-3 anos (41,2%). Não houve associac¸ão estatisticamente significante entre o conhecimento sobre os cuidados com a traqueostomia, idade e gênero e os anos de prática de médicos e enfermeiras.

Concept of cervical ectopy/Quruhal Rahim in Unani system of medicine: a review

Cervical ectopy is one of the commonest gynecological conditions seen in OPD’s, about 80-85% of women suffer from cervical ectopy during their life time. Many a times, it is an accidental finding in an asymptomatic woman coming for routine gynecological examination. Although it is a benign lesion, but may predispose to complications like infertility, cervical intraepithelial neoplasm, risk of various sexually transmitted infections like C. trachomatis, N. gonorrhoea, human papilloma virus, human immunodeficiency virus, cytomegalovirus and shows malignant changes as it progresses. Ectopy occurs when the columnar epithelium lining the endocervix, extends onto the ectocervix. As the disease takes 10-20 years to progress from pre invasive to invasive disease, preventive measures such as screening and treatment modalities should be adopted. Early diagnosis of cervical ectopy is important for its effective management and for prevention of its long-term sequel. The treatment option available in conventional medicine includes surgical procedure either electro or, cryocautery, but have their own complications. Hence, this treatment is limited due to its complications and contraindications and need for safer alternate therapy. In Unani system of medicine, various formulations are available as treatment of quruhal rahim, which have been recommended to be used locally in the form of humool for immediate healing of wound, exhibiting the properties of anti-inflammatory (muhallile warm), desiccant (mujaffif), wound healing (mundamile qurooh), sedative (musakkin), antiseptic (dafa’e ta’ffun) etc. This review article gives a detailed description of cervical ectopy as mentioned in classical Unani text including its etiopathogenesis, clinical presentation and principles of treatment as well as evidence-based Unani medicine.

Relationship Between Household Food Insecurity and Growth Disorders in Children Aged 3 to 6 in Qazvin City, Iran / 대한소아소화기영양학회지

Purpose@#Food insecurity, which is the inability to obtain food or inadequate food consumption in terms of quality and quantity, has physical and psychological consequences on children's health. This study aimed to investigate the relationship between children's growth disorders and food insecurity in Qazvin city, Iran. @*Methods@#A case-control study was conducted on 177 cases and 355 controls of children aged 3 to 6 years, who were referred to health centers in Qazvin city. The case group consisted of children with growth disorders. Data were obtained with the 18-item US Department of Agriculture questionnaire, a household socioeconomic questionnaire, a and growth monitoring card. The data were analyzed with using IBM SPSS Version 22.0, by independent sample t-test, chi-square test, and logistic regression. @*Results@#A significant relationship was found between children's growth disorders and household food insecurity with (p<0.05, odds ratio [OR]=17.0, confidence interval [CI]=5.9, 48.8) and without hunger (p<0.05, OR=2.69, CI=1.4, 4.9). There were also significant relationships between children's growth disorders and socioeconomic status (p<0.05, OR=3.4, CI=1.4, 8.5), the duration of breastfeeding (p<0.05, OR=0.94, CI=0.9, 0.98), and children's ages (p<0.05, OR=0.94, CI=0.92, 0.96). Sex and birth order, and the age of the parents was not found to be significantly related with growth disorders. @*Conclusion@#Lower socioeconomic status and household food insecurity were the important predictors of children's growth disorders. Policymakers should focus more on promoting steady employment and income among family members. Nutritional education for mothers is also recommended, in order to better meet the nutritional needs of the children.

Seasonal variations among admitted paediatric patients at tertiary care hospital, Gadap Town, Karachi, Pakistan

Background: In pediatrics, the season is one of the elements contributing to the etiological factors of community based diseases. Awareness of this variation can help the physicians for prevention and counseling of the patients. A cross-sectional observational study was designed with non-probability convenient sampling technique to determine the frequency of patients admitted to the paediatric ward of the hospital in a whole calendar year and to ascertain which disease presentation is most common. Methods: Study conducted at paediatric ward of Al-Tibri Medical College and Hospital Karachi, Pakistan having patients admitted during May 2018 to April 2019. After ethical approval and informed consent from their parents/ guardian, a total of 734 paediatric patients that were admitted from paediatric OPD/ emergency were selected for the study. Paediatric patients that were referred, in emergency/ ICU and surgical paediatric patients were excluded from the study. Chi-square test was applied to evaluate the statistical variation among the patients.Results: From the 734 patients, 357 (48.6%) patients were of acute gastroenteritis, 104 (14.2%) of respiratory illness, 86 (11.7%) of viral fever, 67 (9.1%) of urinary tract infection, 36 (4.9%) of neurological illness, 29 (4.0%) of protein calorie malnutrition, 25 (3.4%) of enteric fever, 20 (2.7%) of haematological illness and 10 (1.4%) patients were admitted due to sepsis.Conclusion: Our study concluded that majority of the patients admitted were of acute gastroenteritis / admitted due to gastric issues, therefore further studies in the vicinity would help to better understand the issues and help plan a strategy to combat the diseases.

Patterns and characteristics of injuries encountered in road traffic accidents and effect of pre-hospital care on their outcome: a tertiary-hospital study in Lahore, Pakistan

Background: Road traffic accidents are the eighth leading cause of death worldwide, contributing significantly to the global disease burden. As there is a paucity of published data on RTAs in Lahore, this study was carried out to highlight injuries encountered in RTA victims and provide baseline data for the establishment of prevention strategies in our locality.Methods: This is a descriptive cross-sectional study of RTA victims admitted in Mayo Hospital, Lahore to determine factors associated with RTAs, characteristics, and outcomes of injuries sustained and effect of Pre-hospital care in determining the outcome.Results: Out of total 100 subjects recruited, 89 were males and 11 females. Ages of patients ranged from 5 to 70 years with the most injured age group ranging between 11-30 years (59%). Motorcyclists were found as the most vulnerable road user group (61%). Most of the accidents occurred because of a collision with another vehicle (45%). 65 victims received pre-hospital care en route to Mayo Hospital, which was found effective in preventing major disabilities in 81% of cases (53 out of 65). Incidence of Musculoskeletal injuries was highest (55%). Most patients (86%) were discharged without permanent disabilities. No patient died during our study.Conclusions: This study shows road traffic accident is a major public health problem in our setting and contribute markedly to high morbidity. Urgent preventive measures should be established to reduce the risk of their occurrence. Early recognition and prompt treatment are important for the survival of the victims.

Acanthamoeba in Southeast Asia – Overview and Challenges

Acanthamoeba, one of free-living amoebae (FLA), remains a high risk of direct contact with this protozoan parasite which is ubiquitous in nature and man-made environment. This pathogenic FLA can cause sight-threatening amoebic keratitis (AK) and fatal granulomatous amoebic encephalitis (GAE) though these cases may not commonly be reported in our clinical settings. Acanthamoeba has been detected from different environmental sources namely; soil, water, hot-spring, swimming pool, air-conditioner, or contact lens storage cases. The identification of Acanthamoeba is based on morphological appearance and molecular techniques using PCR and DNA sequencing for clinico-epidemiological purposes. Recent treatments have long been ineffective against Acanthamoeba cyst, novel anti-Acanthamoeba agents have therefore been extensively investigated. There are efforts to utilize synthetic chemicals, lead compounds from medicinal plant extracts, and animal products to combat Acanthamoeba infection. Applied nanotechnology, an advanced technology, has shown to enhance the anti-Acanthamoeba activity in the encapsulated nanoparticles leading to new therapeutic options. This review attempts to provide an overview of the available data and studies on the occurrence of pathogenic Acanthamoeba among the Association of Southeast Asian Nations (ASEAN) members with the aim of identifying some potential contributing factors such as distribution, demographic profile of the patients, possible source of the parasite, mode of transmission and treatment. Further, this review attempts to provide future direction for prevention and control of the Acanthamoeba infection.

Cases and Causes of Depression among School Going Adolescents in Lahore, Pakistan

Depression is a mental syndrome and lifetime prevalence of depression is found to be 16.2% in general population. Symptoms of depression in adolescent are different in comparison to adults. These symptoms include disrupted sleep, weigh loss or gain, stubbornness, irritating behavior while getting ready for school and loss of interest in sports. Major risk factors for depressive disorder in adolescent are low socioeconomic status, poverty and low parental education. A descriptive study was conducted in which data was collected through a validated questionnaire from more than 15 randomly selected private and government schools in Lahore. Total 478 students (F=190, M=288) from different schools with different socioeconomics background participated in the present study. Around 438 (91.6%) students responded that they have gone through the depression at some phase of their life. 23.2% and 43.9% students answered that they feel ignored and worthless by their family members often or occasionally, respectively. Domestic fights, quarrel and unfriendly environment, like shouting and use of abusive language disturb the psychological health of the children and provoke feelings of loneliness and sadness. Depression is a mental illness and one should not be shy about and feel uncomfortable for getting help. Seminars for awareness should be conducted at Government and Private level to reduce the incidence of depression among teenagers.

A Cross-sectional Study: Bone Markers in Different Body Mass Index Groups of Newly Diagnosed Breast Cancer Females in Karachi, Pakistan

Background: Pakistan is a big victim of breast cancer and vitamin D deficiency. Interestingly, bones are the common site of breast cancer metastasis and vitamin D deficiency makes this condition more worst. The present study designed to estimate bone markers and minerals in different BMI groups of newly diagnosed breast cancer patients. Materials & Methods: diagnosed breast cancer females were approached and their characteristics including age, marital status, menstrual & family history, receptor status, tumor grade & type and presence of metastasis were noted from their medical reports. Whereas bone markers and minerals viz., alkaline phosphatase (ALP), bone specific ALP (BALP), vitamin D, carboxyl terminal collagen crosslinks (CTX), human epidermal growth factor 2 receptor (Her2) protein, albumin, calcium (Ca), phosphorus (P) and magnesium (Mg) were estimated plus body mass index (BMI) measured. Results: Most of the recruited females found aged less than 50 yrs, wedded, belonged to plump to obese BMI groups, had invasive ductal carcinoma, expressed triple positive receptor status and tumor grade II. Very few had metastasis and family history of breast cancer. Patients in all BMI groups showed insufficient level of vitamin D but normal levels of ALP, Ca, Mg, P, albumin, Her2 protein and CTX. Whereas Ca and BALP found slightly low in underfed BMI group patients. Conclusion: The results concluded and recommended that vitamin D levels must be monitored in breast cancer patients before and after treatment otherwise it will decrease more and may affect other bone markers.

Postoperative pain score of bupivacaine versusplacebo in patients undergoing percutaneous nephrolithotomy

Objective: to compare postoperative mean pain score of bupivacaine versusplacebo in patients undergoing percutaneous nephrolithotomy

Study Design: an experimental study

Place and Duration of Study: department of Urology, The Kidney Centre, Postgraduate Training Institute [PGTI], Karachi, from November 2014 to December 2015

Methodology: a total of 94 patients who underwent standard percutaneous nephrolithotomy, clinically diagnosed renal stone by CT scan, KUB, X-ray or ultrasound were included in the study. Patients were randomly divided into two groups. Forty-seven patients in-group A were treated with 20ml/50mg of 0.25% bupivacaine; and 47 patient's in-group B were treated with normal saline. Postoperatively, visual analog score was used to assess the pain at 6, 12 and 24 hours. Data was analysed using SPSS version 20.0 and student t-test was applied for comparison between the groups

Results: the average age of the patients was 37.23 +/- 11.31 years. Mean pain score in 24 hours was low in group A as compared to group B [5.22 +/- 0.76 vs. 7.85 +/- 0.78; p<0.001]

Conclusion: bupivacaine infiltration into the nephrostomy tract is a highly effective and safe in postoperative pain management for patients undergoing standard PCNL

DNA barcoding relates Trichuris species from a human and a man’s best friend to non-human primate sources

@#Trichuris trichiura, the whipworm of humans, is one of the most prevalent soiltransmitted helminths (STH) reported worldwide. According to a recent study, out of 289 STH studies in Southeast Asia, only three studies used molecular methods. Hence, the genetic assemblages of Trichuris in Southeast Asia are poorly understood. In this study, we used partial mitochondrial DNA (cytochrome c oxidase subunit 1 or COI) sequences for analysis. Trichuris grouped in a same clade with different hosts indicate the potential of cross infection between hosts. Based on COI, the adult Trichuris isolated from a Malaysian patient was most closely related to Trichuris isolated from Papio anubis (olive baboons) from the USA. The Trichuris isolated from the dog from Malaysia was genetically similar to a Trichuris species isolated from Macaca silenus (lion-tailed macaque) from Czech Republic. Both the human and dog isolated Trichuris grouped in clades with different hosts indicating the potential of cross infection between hosts. Specific PCR primers based on the partial COI of T. trichiura isolated from African green monkey and T. serrata were designed and successfully amplified using multiplex PCR of the pooled DNA samples. Our results suggest a complex parasite-host relationship, and support the theory of cross infection of Trichuris between humans and non-human primates as suggested in previous publications.

Association between TGFß1 polymorphisms and chronic hepatitis B infection in an Iranian population

Abstract INTRODUCTION: Transforming growth factor-beta 1 (TGFβ1) is a potent suppressive cytokine that contributes to chronic hepatitis B (CHB) infection. Disparities in TGFβ1 production among individuals have been attributed to TGFβ1 genetic polymorphisms. We examined whether three putative polymorphisms in TGFβ1[-509 C/T (rs1800469), +869 C/T (rs1800470), and +11929 C/T (rs1800472)]are associated with CHB infection in a South-Eastern Iranian population. METHODS: In total, 341 subjects were recruited, including 178 patients with CHB and 163 healthy individuals as controls. Genotyping of the three TGFβ1 SNPs was performed by tetra amplification refractory mutation system-PCR. RESULTS: TheTGFβ1 +869 TT vs.CC genotype in codominant (OR=0.445, p=0.012) and TT vs. TC+CC in the recessive (OR=0.439, p=0.003) model as well as the variant allele T vs. C(OR=0.714, p=0.038) were associated with lower CHB infection risk. However, the +11929 C/T polymorphism was associated with increased CHB risk, and the CT vs. CC genotype (OR=2.77, P=0.001) and T variant allele (OR=2.53, P=0.002) were risk factors for CHB. Furthermore, TTT (+869/-509/+11929) and CCC haplotypes were risk and protective factors for CHB, respectively. We found no significant association between viral DNA load and TGFβ1 genotype or hepatic enzyme levels (p >0.05). CONCLUSIONS: Results indicated that the TGFβ1+869TT genotype and T allele were protective factors, whereas the +11929 CT genotype and T allele were risk factors for CHB infection.

ratio of smear-negative tuberculosis in Sindh: an insight using fluorescence microscopy

Background: Sputum smear microscopy is the most useful tool used for the screening of presumptive tuberculosis cases. Conventionally Ziehl-Neelsen [ZN] based staining is used to microscopically screen sputum from the presumptive Tuberculosis Cases. However, Fluorescent microscopy [FM] is now gradually replacing the conventional ZN microscopy because of its higher efficiency and efficacy in detecting Mycobacterium tuberculosis. In patients, who do not produce sufficiently high number of bacilli, and are known as Smear-negative, efficacy of both types of microscopy remains questionable as no Mycobacteria are detected in the sputum of these patients and they are falsely labelled as smear-negative

Objective: This retrospective study was conducted on the patient samples received from different parts of Sindh to study the proportions of false-negative tuberculosis using fluorescent microscopy

Materials and Methods: A retrospective cross-sectional study was conducted from June 2014 to June 2016 at the Tuberculosis Laboratories of Dow University of Health Sciences. Data analyzed for 1439 samples received during 24-month period, which had subsequently been confirmed by culture. All laboratory work was performed as per guidelines of the National Program. Statistical analysis was performed on MedCalc[registered sign] and Open Epi[registered sign]

Results: During 24-month period, among the 1439 cases, 832[57.81%] were from males and 499 [34.67%] were smear negative. Culture showed that 72 [14.42%] were false-negative among all-negatives. Overall sensitivity observed was 92.21% [95%CI 90.29%-93.85%] and specificity 82.91% [95%CI 79.38%- 86.06%]. The proportion of false negativity among all negatives in females [16.11%] was significantly higher [p=0.002] as compared to males [13.47%]

Conclusions: Even with the introduction of Fluorescent Microscopy, smear microscopy cannot be solely relied upon for the diagnosis of tuberculosis, as considerable number of patients producing insufficient number of bacilli to be detected by microscopy

need for reviewing of log books in Birjand University of Medical Sciences clinical wards

Clinical education can be taken as a facilitating activity for learning in the clinical settings in which students gain experiences from patients' bedside and apply their previously learned concepts through their interactions with their teachers and routine works. Clinical education provides an opportunity for students to transform their theoretical knowledge into diverse intellectual and psychomotor skills essential to patient care. The evaluation process of teaching and learning is one of the noticeable activities in educational institutions because the training of skilled and competent manpower, to a large extent, is dependent on this process. The use of modern educational techniques, increasing productivity, and ultimately enhancing the effectiveness of educational centers is the goal followed all over the world but, this is more emphasized in the field of medical sciences that are directly connected with maintaining and improving the health of people and society. This is why for more effectiveness of medical education applying new methods is necessitated. One of the evaluated and structured methods focusing on learning experiences in education is "logbook". Logbook is a simple means for learners, a framework for organizing various educational activities and recording them. One of the unique characteristics of a logbook is that it requires students acquire a certain number of skills. This causes the students to do their tasks as planned and objectively too; and thanks to repetition and practice they would prevent probable errors. At present, a lot of clinical education aspects are different than in the past. Technology development, changes in the pattern of people's lifestyle and higher exposure to environmental risk factors [Such as the development of chemical industry, natural or synthetic chemicals, biological agents including viruses and other microorganisms, behavioral factors including psychological stress and drug addiction] cause changes in the pattern of diseases in general and particularly in the domain of communicable and non-communicable diseases. Therefore, in accord with these changes, the graduates and scholars are expected to promote their skills and abilities. Since, identification and analysis of the effectiveness of educational needs are prerequisite for a successful educational system, revision and continuous reviewing of educational programs based on the possibilities, conditions, and new needs are inevitable. Thus, the results of a study on 233 medical students passing their clinical stage [externs or interns] in Birjand University of Medical Sciences in the academic year 2016-2017 showed that 24.5% of them knew high or very high helpful completion of their log books activities in attaining of clinical wards skills and 74.5% expressed the necessity of reviewing available log books in clinical wards. According to the obtained results the necessity of reviewing log books used in clinical wards of BUMS considering the latest clinical issues, diseases- including emerging and reemerging ones- and diagnostic - therapeutic methods in accordance with changes in diagnostic - therapeutic guidelines using the newest resources is critically felt. Furthermore, due to the pervasive use of electronic log books in recent years in medical universities across the country that are in line with developments and innovations in medical education, it is recommended that the log books at this university too, should be presented and evaluated electronically. Electronic log books with ongoing record of activities and clinical techniques based on educational objectives, in addition to learning consolidation, determine unavailable measures to achieve clinical objectives and, thus, cause regular monitoring and evaluation on the part of students

Association between interleukin-4 [IL-4], gene polymorphisms [C-589T, T+2979G, and C-33T] and migraine susceptibility in Iranian population: a case-control study

Background: Migraine is a chronic neurological disease characterized by recurrent moderate to severe headaches commonly in association with neuro-inflammation. Interleukin-4 [IL-4], an anti-inflammatory cytokine, plays an important role in modulating pain threshold and has an essential role in stimulation of pain receptors in the trigeminal nerve fibers

Aim of the study: The current study aimed to investigate the possible associations between IL-4 single nucleotide polymorphisms [SNPs] and susceptibility to migraine in Iranian patients

Patients and methods: In a prospective case-control study, we studied blood samples of 190 patients with migraine [migraineurs] and 200 healthy controls [HCs] for analysis of gene variants. Genotyping for the IL-4 SNPs: C-589T [rs2243250], T+2979G [rs2227284], and C-33T [rs2070874] were performed using PCR-RFLP. Statistical analysis was performed using the SPSS version 21.0 [SPSS, Chicago] and SNPStats version 1.14.0

Results and Conclusion: Among IL-4 SNPs, rs2243250 [TC genotype, OR= 0.25, 95% CI= 0.13-0.50, P = 0.001] and rs2227284 [TG and TT genotypes, OR= 0.44, 95% CI= 0.23-0.92, P = 0.029 and OR = 0.38, 95% CI= 0.18-0.79, P = 0.009 respectively] were significantly associated with migraine. No significant associations between IL-4 SNP rs2070874 [TC, TT and CC genotypes] and migraine were found. The most frequent genotypes in the migraineurs were CC in both SNPs rs2243250 [79%], and rs2070874 [71.5%], as well as GG for SNP rs2227284 [64%]. There was no statistically significant relationship between these SNPs and different subclasses [common, classic and complicated] of migraine. Our findings revealed that in IL-4 rs2243250 and rs2227284 genotypes and allele frequencies have a role in susceptibility to migraine in our population. Therefore, it is suggested that in addition to other factors, IL-4 genetic variations also play a pivotal role in the progress of migraine

Determination of Atherosclerosis markers changes after HIIT and ginger consumption in response to acute exercise in overweight women.

The purpose of this study was to determine the effects of ten weeks of high intensity interval training (HIIT) with ginger supplementation on the systemic inflammatory response to acute HIIT exercise. Twenty four sedentary overweight women randomly assigned into three groups’ including HIIT + ginger (n=8), HIIT + placebo (n=8) and ginger (n=8). Sixteen women performed ten weeks of HIIT while the supplement consuming groups daily took 3 gm. of ginger pills and the HIIT + placebo group took placebo. Serum samples were collected at rest and immediately post-acute exercise, before and after the training. Two-way repeated measures ANOVA, paired t test, one-way ANOVA and post hoc Bonferroni were used to analyze data. Results indicated that three groups similarly affect the Monocyte Chemo tactic protein-1 (MCP-1) and Interlukine-10 (IL-10) changes in response to acute exercise (p>0.05) whereas significant increase in intercellular adhesion molecule-1 (ICAM-1) in HIIT + placebo group in comparison with HIIT + ginger group (p=0.02) in second acute exercise was observed. The combination of HIIT and ginger consumption may induce a modest inflammatory attenuation of atherosclerosis factors in response to acute exercise and improvement in Vo2max and PBF results rather than ginger and training alone, in young sedentary overweight women.

Bullous systemic lupus erythematosus and lupus nephritis in a young girl

Bullous systemic lupus erythematosus [BSLE] is an autoimmune blistering disease occurring in patients with systemic lupus erythematosus [SLE]. It is a rare disease, especially in children. A 14-year-old girl initially presented with fatigue, generalized vesiculobullous skin lesions, and ulcers over the hard palate and oral mucosa. Clinical investigations revealed hematuria and proteinuria, a high erythrocyte sedimentation rate and titer of antinuclear antibody, and anti-double-stranded DNA. Skin biopsy findings were suggestive of BSLE. A renal biopsy confirmed the features of class V lupus nephritis. Based on the clinical features and investigations, a diagnosis of BSLE with nephritis was made. She received methylprednisolone pulse therapy and hydroxychloroquine; however, it did not alleviate the vesiculobullous eruption, so treatment with dapsone started and resulted in the dramatic disappearance of the lesions. Interruption of dapsone due to hemolysis did not aggravate the bullous disease. During follow-up, she had multiple flare-ups of disease and nephritis without rebound of bullous lesions. BSLE is a rare presentation of SLE in children. Differentiating it from other skin bullous diseases and SLE with blister is important for the correct management. The unusual presentation of this disease may delay the diagnosis and therefore requires a high index of clinical suspicion