An updated systematic review of Zika virus-linked complications

Objective: To determine the breadth of Zika virus (ZIKV)-associated brain anomalies in neonates and adults. Methods: Systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using electronic databases ScienceDirect, Pubmed, Medline, Scopus, and Global Health Library. Only those research articles, case studies, case-control studies, case-cohort studies, cross-sectional studies, and organizational survey reports were included in the study that reported any fetal outcomes for pregnant women who had infected with ZIKV during the gestational period and ZIKV-related neurological complications in adults as well. Results: Out of total 72 retrieved articles, 50 met the inclusion criteria. We estimated a significant increase in incidence of neural abnormalities such as Guillain-Barre syndrome and microcephaly in the regions that are experiencing ZIKV outbreaks. Other neurological malformations found in ZIKV patients include hydrancephaly/hydrops fetalis, myasthenia gravis, meningoencephalitis and myelitis. Conclusion: Our systematic analysis provides the broad spectrum of neurological malformations in ZIKV infected patients and these data further support the causal link of ZIKV with neurological disorders.

An updated systematic review of Zika virus-linked complications

Objective:To determine the breadth of Zika virus (ZIKV)-associated brain anomalies in neonates and adults.Methods:Systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using electronic databases ScienceDirect, Pubmed, Medline, Scopus, and Global Health Library. Only those research articles, case studies, case-control studies, case-cohort studies, cross-sectional studies, and organizational survey reports were included in the study that reported any fetal outcomes for pregnant women who had infected with ZIKV during the gestational period and ZIKV-related neurological complications in adults as well.Results:Out of total 72 retrieved articles, 50 met the inclusion criteria. We estimated a significant increase in incidence of neural abnormalities such as Guillain-Barre syndrome and microcephaly in the regions that are experiencing ZIKV outbreaks. Other neurological malformations found in ZIKV patients include hydrancephaly/hydrops fetalis, myasthenia gravis, meningoencephalitis and myelitis.Conclusion:Our systematic analysis provides the broad spectrum of neurological malformations in ZIKV infected patients and these data further support the causal link of ZIKV with neurological disorders.

Impact of morning and rotational duties on physical health of nurses working in tertiary care hospitals of karachi

Background and Objectives: In the system related to health care, shifting duties are considered essential and obligatory to make sure the stability of care in hospitals. Scheduling and shifting are the key uniqueness of shift work and nurses are mostly bounded into different schedules that facilitate 24-hour care. Our objective was to identify the impact of morning and rotational duties on physical health of nurses working in tertiary care hospitals

Methods: A total of 154 nurses from two tertiary care hospitals in Karachi were included in this study. Data were collected through the Short Form Health Servay-26 between May to June 2017. Questionnaire form consisted of five domains including Physical functioning, Role limitations due to physical health, Energy/ Fatigue, Pain and General health

Results: Most of the study participants were staff nurses [66.9%] and few were head nurse and assistant head nurses 13.6% and 8.4% respectively. Nurses' characteristics such as gender, age, educational level, designation and monthly income were found significant with duty shift with p-values 0.049, 0.007, <0.001 and 0.017 respectively. Energy/Fatigue was only domain of SF-26 which showed significant mean difference [p-value <0.001] between morning and rotational duties

Conclusion: This research concludes that nurses working in rotational duties were more prone to develop physical problem as compared to morning duties. Energy/Fatigue showed significant mean difference

Drug resistant acinetobacter baumannii: pattern of infection and in vitro tigecycline activity

Objective: The purpose of this study is; firstly, to find out the prevalence of drug resistant Acinetobacter baumannii, secondly, to find the most common site of infection by Acinetobacter baumannii, and thirdly, to assess the in vitro effectiveness of tigecycline against drug resistant Acinetobacter baumannii, in our hospital setting

Study Design: Retrospective/Observational study

Setting: Charsada Teaching Hospital affiliated with Jinnah Medical College Peshawar

Period: One year from January 2016 to December 2016

Methodology: All the reports occurring during this study period with positive diagnosis for Acinetobacter were retrieved from the archives, irrespective of patient's age and gender. Only one isolate of Acinetobacter per patient was considered in the study. The organisms were identified and species determined manually. Susceptibility for antimicrobial agents was determined according to criteria of CLSI 2016. MIC for tigecycline in the isolates was determined by E-test

Results: On analyzing all the Acinetobacter isolates [n=391] during one year time, it was found that the large majority of these isolates were of Acinetobacter baumannii [96.2%], while only few were of Acinetobacter lwoffii [3.8%]. Multidrug resistant Acinetobacter baumannii represented about one third [31%] of all the Acinetobacter baumannii isolates. Most of the isolates of Acinetobacter baumannii were from skin and soft tissue wounds [44.4%], followed by isolates from respiratory secretions [42.7%], urine [6.8%], blood [5.2%] and CSF [0.9%] [Table II]. The isolates of Acinetobacter baumannii showed maximum sensitivity to Tigecycline [88.9%], followed by Colistin [81.2%] and Polymyxin [79.5%] [Table III]

Conclusions: Drug resistant Acinetobacter baumannii is present in 31% of isolates, it is most commonly isolated from infected wounds and respiratory tract secretions in debilitated patients, and also Tigecycline is an excellent treatment choice for infections caused by drug resistant Acinetobacter baumannii

Advances in research on Zika virus

Zika virus (ZIKV) is rapidly spreading across the America and its devastating outcomes for pregnant women and infants have driven this previously ignored pathogen into the limelight. Clinical manifestations are fever, joint pain or rash and conjunctivitis. Emergence of ZIKV started with a first outbreak in the Pacific area in 2007, a second large outbreak occurred in the Pacific in 2013/2014 and subsequently the virus spread in other Pacific islands. Threat of explosive global pandemic and severe clinical complications linked with the more immediate and recurrent epidemics necessitate the development of an effective vaccine. Several vaccine platforms such as DNA vaccine, recombinant subunit vaccine, ZIKV purified inactivated vaccine, and chimeric vaccines have shown potent efficacy in vitro and in vivo trials. Moreover, number of drugs such as Sofosbuvir, BCX4450, NITD008 and 7-DMA are ready to enter phase I clinical trial because of proven anti-ZIKV activity. Monoclonal based antibodies offer promise as an intervention effective for use in pregnant women. In this review, we describe the advances in research on ZIKV such as research strategies for the development of antiviral drugs & vaccines, molecular evolution, epidemiology emergence, neurological complications and other teratogenic outcomes as well as pathogenesis.

Advances in research on Zika virus

Zika virus (ZIKV) is rapidly spreading across the America and its devastating outcomes for pregnant women and infants have driven this previously ignored pathogen into the limelight. Clinical manifestations are fever, joint pain or rash and conjunctivitis. Emergence of ZIKV started with a first outbreak in the Pacific area in 2007, a second large outbreak occurred in the Pacific in 2013/2014 and subsequently the virus spread in other Pacific islands. Threat of explosive global pandemic and severe clinical complications linked with the more immediate and recurrent epidemics necessitate the development of an effective vaccine. Several vaccine platforms such as DNA vaccine, recombinant subunit vaccine, ZIKV purified inactivated vaccine, and chimeric vaccines have shown potent efficacy in vitro and in vivo trials. Moreover, number of drugs such as Sofosbuvir, BCX4450, NITD008 and 7-DMA are ready to enter phase I clinical trial because of proven anti-ZIKV activity. Monoclonal based antibodies offer promise as an intervention effective for use in pregnant women. In this review, we describe the advances in research on ZIKV such as research strategies for the development of antiviral drugs & vaccines, molecular evolution, epidemiology emergence, neurological complications and other teratogenic outcomes as well as pathogenesis.

Comparative studies on rabbit plasma lipid profile fed with Silybum marianum oil, sunflower oil and vegetable ghee

Present work is aimed to compare the physicochemical characterization and biochemical effects of oil extracted from Silybum Marianum and Sunflower oil, collected from Peshawar [Pakistan]. To investigate the comparative effects on the body weight, organ weight and lipid profile, the crude oil of Silybum marianum, edible sunflower oil and vegetable ghee were given to three groups of rabbits under study. Percent proximate composition and food consumption of all rabbits were determined which showed no significant statistical variation. There is no data available about Silybum marianum oil on animal model in literature. This study clearly revealed that oil from Silybum marianum significantly reduces plasma cholesterol level in rabbits. A threefold higher Triglyceride levels was observed in vegetable ghee feeding groups compared with the sunflower and Silybum marianum oil feeding groups. The crude oil of Silybum marianum was found to be safe in rabbits compared with sunflower oil and vegetable ghee. The results of these studies revealed most valuable information and also support the refining and purification to convert this non-edible oil to edible oil

Tibial shaft fractures: interlocking nail versus plating

Objective: To evaluate and compare the treatment results of tibial shaft fractures treated by two different methods, interlocking nail and plating

Study design: Randomized controlled trial

Place and Duration of study: Department of Orthopaedics and Traumatology, Lady Reading Hospital Peshawar, from February 2014 to February 2017.Methodology: A total of 50 patients with closed tibial shaft fractures were randomly assigned to two equal groups [one treated with closed interlocking nail and the other with plating]. Postoperative results were assessed at one year follow up with Ekeland and Thoresen criteria and graded as excellent, good, fair and poor. Complications like infection, delayed union, nonunion and knee pain were assessed and compared for each groups

Results: Mean age of interlock group was 36+/-10.6 year and plating group 35.1+/-9.9 year. Plating achieved excellent results in 72% patients while interlocking in 44% [p value = 0.04]. Postoperative infection, delayed union, knee pain and screw breakage were 20%, 24%,11% and 20% [ p value = 0.05] respectively in interlocking nail group but none in plating group

Conclusions: Tibial shaft fractures treated with plating gave excellent results with minimal postoperative complications than interlocking nail. We therefore recommend plating as a treatment of choice for treating such fractures

Pattern of ear diseases in surgical pathology

Objective: The purpose of this study is, firstly, to find the pattern of ear diseases in the community, as no such pattern study is currently available. Secondly, to impart awareness regarding microscopic appearances of the common ear diseases encountered in this pattern study

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the Surgical Pathology archives of the Laboratory of Charsada Teaching Hospital affiliated with Jinnah Medical College Peshawar from 2010 to 2015

Materials and Methods: In this study, all the cases of ear diseases from surgical pathology archives of the laboratory of Charsada Teaching Hospital were retrieved. All the slides and the diagnoses for the retrieved cases were reviewed by the histopathologist and the final diagnoses were recorded; the disease pattern was determined, keeping in view the number of cases for each diagnostic category and the patient's age

Results: The review of these cases between 2010 and 2015 showed that most of the biopsy specimens were from external ear while few were from the middle ear. The first five commonest conditions constituted almost two thirds of the total number of cases. The congenital anomalies and juvenile xanthogranulomas were most common in the first decade of life. Benign and malignant tumors were uncommon and seen mostly after the third decade of life

Conclusions: Congenital anomalies and inflammation associated diseases are common in the first three decades of life, whereas benign and malignant neoplasms are more common after the third decade of life

Zika: As an emergent epidemic

Zika virus is a new global threat for 2016 that has been swept to almost all Americas and is now posing serious threats to the entire globe. This deadly virus is playing havoc to unborn lives because of its reported association with upsurge of fetal deformation called microcephaly and neuropathic disorders including Guillain-Barré syndrome. Till today, there is no vaccine prospect, antiviral therapy or licensed medical countermeasures to curb the teratogenic outcomes of this destructive viral infection. Diagnosis, treatment, chronicity and pathogenesis are still vague and unsettled. Therefore, this review article addresses all the aspects related to this disease to mitigate the explosive rise in Zika virus infection.

Prediction of promiscuous T-cell epitopes in the Zika virus polyprotein: An in silico approach

OBJECTIVE@#To predict immunogenic promiscuous T cell epitopes from the polyprotein of the Zika virus using a range of bioinformatics tools. To date, no epitope data are available for the Zika virus in the IEDB database.@*METHODS@#We retrieved nearly 54 full length polyprotein sequences of the Zika virus from the NCBI database belonging to different outbreaks. A consensus sequence was then used to predict the promiscuous T cell epitopes that bind MHC 1 and MHC II alleles using PorPred1 and ProPred immunoinformatic algorithms respectively. The antigenicity predicted score was also calculated for each predicted epitope using the VaxiJen 2.0 tool.@*RESULTS@#By using ProPred1, 23 antigenic epitopes for HLA class I and 48 antigenic epitopes for HLA class II were predicted from the consensus polyprotein sequence of Zika virus. The greatest number of MHC class I binding epitopes were projected within the NS5 (21%), followed by Envelope (17%). For MHC class II, greatest number of predicted epitopes were in NS5 (19%) followed by the Envelope, NS1 and NS2 (17% each). A variety of epitopes with good binding affinity, promiscuity and antigenicity were predicted for both the HLA classes.@*CONCLUSION@#The predicted conserved promiscuous T-cell epitopes examined in this study were reported for the first time and will contribute to the imminent design of Zika virus vaccine candidates, which will be able to induce a broad range of immune responses in a heterogeneous HLA population. However, our results can be verified and employed in future efficacious vaccine formulations only after successful experimental studies.

Cardiovascular risk score in Rheumatoid Arthritis

Objective: To determine the 10-year Cardiovascular risk score with QRISK-2 and Framingham risk calculators in Rheumatoid Arthritis and Non Rheumatoid Arthritis subjects and asses the usefulness of QRISK-2 and Framingham calculators in both groups

Methods: During the study 106 RA and 106 Non RA patients age and sex matched participants were enrolled from outpatient department. Demographic data and questions regarding other study parameters were noted. After 14 hours of fasting 5 ml of venous blood was drawn for Cholesterol and HDL levels, laboratory tests were performed on COBAS c III [ROCHE]. QRISK-2 and Framingham risk calculators were used to get individual 10-year CVD risk score

Results: In this study the mean age of RA group was [45.1 +/- 9.5] for Non RA group [43.7 +/- 8.2], with female gender as common. The mean predicted 10-year score with QRISK-2 calculator in RA group [14.2 +/- 17.1%] and Non RA group was [13.2 +/- 19.0%] with [p-value 0.122]. The 10-year score with Framingham risk score in RA group was [12.9 +/- 10.4%] and Non RA group was [8.9 +/- 8.7%] with [p-value 0.001]. In RA group QRISK-2 [24.5%] and FRS [31.1%] cases with predicted score were in higher risk category. The maximum agreement scores between both calculators was observed in both groups [Kappa=0.618 RA Group; Kappa=0.671 Non RA Group]

Conclusion: QRISK-2 calculator is more appropriate as it takes RA, ethnicity, CKD, and Atrial fibrillation as factors in risk assessment score

Zika: As an emergent epidemic

Zika virus is a new global threat for 2016 that has been swept to almost all Americas and is now posing serious threats to the entire globe. This deadly virus is playing havoc to unborn lives because of its reported association with upsurge of fetal deformation called microcephaly and neuropathic disorders including Guillain-Barré syndrome. Till today, there is no vaccine prospect, antiviral therapy or licensed medical countermeasures to curb the teratogenic outcomes of this destructive viral infection. Diagnosis, treatment, chronicity and pathogenesis are still vague and unsettled. Therefore, this review article addresses all the aspects related to this disease to mitigate the explosive rise in Zika virus infection.

Prediction of promiscuous T-cell epitopes in the Zika virus polyprotein: An in silico approach

Objective To predict immunogenic promiscuous T cell epitopes from the polyprotein of the Zika virus using a range of bioinformatics tools. To date, no epitope data are available for the Zika virus in the IEDB database. Methods We retrieved nearly 54 full length polyprotein sequences of the Zika virus from the NCBI database belonging to different outbreaks. A consensus sequence was then used to predict the promiscuous T cell epitopes that bind MHC 1 and MHC II alleles using PorPred1 and ProPred immunoinformatic algorithms respectively. The antigenicity predicted score was also calculated for each predicted epitope using the VaxiJen 2.0 tool. Results By using ProPred1, 23 antigenic epitopes for HLA class I and 48 antigenic epitopes for HLA class II were predicted from the consensus polyprotein sequence of Zika virus. The greatest number of MHC class I binding epitopes were projected within the NS5 (21%), followed by Envelope (17%). For MHC class II, greatest number of predicted epitopes were in NS5 (19%) followed by the Envelope, NS1 and NS2 (17% each). A variety of epitopes with good binding affinity, promiscuity and antigenicity were predicted for both the HLA classes. Conclusion The predicted conserved promiscuous T-cell epitopes examined in this study were reported for the first time and will contribute to the imminent design of Zika virus vaccine candidates, which will be able to induce a broad range of immune responses in a heterogeneous HLA population. However, our results can be verified and employed in future efficacious vaccine formulations only after successful experimental studies.

Importance of atropine challenge test in the current era of electrophysiology.

Mobitz II block is misunderstood more than any other abnormality of rhythm or conduction”. The concept of 2:1 AV block remains poorly understood by many physicians even after so many years of advancement in the field of electrophysiology. It cannot be classified into type I or type II second-degree AV block because there is only one PR interval to examine before the blocked P wave A 46 year male admitted with chief complaints of effort intolerance and non anginal chest pain of fifteen days duration. His resting ECG revealed 2:1 conduction of P wave, before and after non conducted P wave PR interval was constant and of normal duration. So in order to define the site of block we performed the atropine challenge test as the patient was not able to walk. On administration of atropine ECG revealed worsening of AV block in a 3:1 to 4:1 conduction of P wave with narrow complex QRS. This finding suggesting the block is in bundle of his or branches. This patient underwent Electrophysiological study. Electro physiological tracings showed normal PR interval, QRS duration, with 2:1 AV block. The non conducted P wave was blocked at the level of distal His bundle. This case illustrated the importance of localisation of site of block in 2:1 AV block in order to manage the case appropriately. Both vagal manoeuvres and exercise can help in localising the site of block, which will be confirmed by electrophysiology study.

Role of preloading with and without intramuscular ephedrine to prevent post spinal hypotension in elderly patients

To evaluate the efficacy of intramuscular ephedrine along with preloading in prevention of post Spinal hypotension in elderly patients. Randomized controlled trial. Department of Anaesthesia and Intensive Care Combined Military Hospital Peshawar, from 20[th] March 2007 to 20[th] March 2008. A total of 100 patients of ASA I and II were selected. The patients were randomly divided by random numbers table into two groups of 50 each. Group A was preloaded with ringer solution 15 ml/kg and intramuscular injection of 1 ml normal saline as placebo was given. Group B preloaded with 7.5 ml/kg and intramuscular injection of ephedrine 0.5 mg/kg was given. Heart rate and mean arterial pressure were monitored after the spinal blockade. Hypotension was treated with intravenous bolus of 5mg ephedrine and additional rapid infusion of lactated ringers. In group A, hypotension occurred in 30 [60%] patients as compared to group B, where hypotension occurred in 11 [22%] patients. In group A, ephedrine 10mg [2 boluses] were given in 14 [28%] patients, while in group B, ephedrine 5mg [1 bolus] was given in 11 [22%] patients. It is concluded from the results of this study that less preloading is required in intramuscular preloading along with intramuscular ephedrine is more effective in preventing patients after spinal anaesthesia as compared to preloading alone

Developing local guidelines for management of sepsis in adults: sepsis guidelines for Pakistan [SGp] endorsed by global sepsis alliance

The purpose of developing [Sepsis Guidelines for Pakistan] [SGP] is to provide clinicians practicing in local hospitals with a framework to aid timely recognition and management of adult patients in sepsis by adopting evidence-based recommendations of Surviving Sepsis Campaign [SSC] tailored to available resources. These recommendations are not meant to replace the SSC Guidelines. SGP is an initiative of Pakistan Society of Critical Care Medicine [PSCCM]. Four key decision points to be addressed in the guidelines were identified by a thirteen member multidisciplinary committeei.e., grading the hospitals in the country, recognition of sepsis and associated organ dysfunction, essential interventions to manage sepsis, and general measures for provision of a comprehensive care to patients in sepsis according to the level of education and training of healthcare providers and facilities and resources available in different levels of hospitals. The draft was presented at the 3[rd] Sepsis Symposium held on13[th] September, 2014 in Karachi. The final document was approved by a panel of experts from across the country, representatives of relevant societies and Global Sepsis Alliance [GSA]. Hospitals are divided into basic, intermediate and tertiary depending on the availability of diagnostic facilities and training of the medical personnel. Modified definitions of sepsis,severe sepsis, and septic shock are used given the lack of facilities to diagnose sepsis according to international definitions and criteria in Pakistan. Essential interventions include fluid resuscitation,vasopressors to support the circulation, maintaining oxygen saturation >/= 90% with oxygen, non-invasive ventilation or mechanical ventilation with lung protective strategies, prompt administration of antibiotics as recommended by the Medical Microbiology and Infectious Diseases Society of Pakistan [MMIDSP] and early source control. It is recommended to avoid starvation, keep an upper blood glucose 7.20, avoid fresh frozen plasma in the absence of bleeding, transfuse platelets if indicated, not use intravenous immunoglobulins and avoid neuromuscular blocking agents [NMBAs] in the absence of ARDS, target specific titration endpoints when continuous or intermittent sedation is required in mechanically ventilated patients and use continuous renal replacement therapy [CRRT] to facilitate management of fluid balance in hemodynamically unstable septic patients in tertiary care centers. In addition a comprehensive, meticulous and multidisciplinary general care is required to improve outcome of sepsis by reinforcing hand hygiene and other infection control measures, adequate monitoring and documentation tailored to the available resources. Goals of care and prognosis should be discussed with patients and families early and either shifting the patient to a hospital with better facilities or limiting or withdrawing therapy in case of poor prognosis should be considered

Frequency of HBV, HCV andmalaria infections in cytopenic patients coming for bone marrow aspiration to bacha khan medical college mardan

Objective: To know the frequency of HCV, HBV, and Malaria infections in cytopenic patients coming for Bone Marrow Aspiration

Study Duration: Observational study

Place and Duration of Study: This study was conducted in Pathology and Medicine Departments of Bacha Khan Medical College Mardan from January 2012 to December 2014

Materials and Methods: 100 patients with cytopenia were referred for Bone Marrow Aspiration and were screened for HBV, HCV and malaria infections. Complete blood counts were performed on 50 healthy individual as a control group.Both Thick and Thin Blood smears were examined for Malaria, while Anti HCV and HBs Ag Screening was done by kit method [Immunochromatographic Method SD company]. Complete blood count was performed by Heamatologyanalyser. [Sysmex Hematology Analyzer ]

Results: 4 out of 100 cytopenic patients were Anti HCV positive, who were referred for Bone Marrow Aspiration. These patients had a Hemoglobin level 10.5 +/- 0.978 G/dl, Platelets counts 120 +/- 24.768×103/uL. 2 out of 100 Cytopenic patients were HBs Ag Positive. They had anemia and thrombocytopenia, Hb level was 10.4 +/- 0.879 g/dland platelets count was 119 +/- 24.965×103/uL respectively. while 7 [7%] out of 100 cytopenic patients had malaria microscopy.TheypresentedwithHbof9.5 +/- 0.978g/dl,plateletcount120 +/- 24.768×103/uLandTLC3.8 +/- 1.365×103/uL respectively. Counts in HCV, HBV and malaria are significantly lower than the control groups value < 0.0024

Conclusion: Cytopenia is a significant finding in HCV, HBV and Malaria infections and patients presenting with any cytopenia patients referred for Bone marrow Aspiration presenting with cytopenia should be properly screened for HCV, HBV, and Malaria as these can be the cause of cytopenia thus unnecessary use of Bone Marrow Aspiration can be presented

Outcomes of fibrinolytics in patients of acute myocardial infarction

Objective: The aim of our study was to determine outcomes of fibrinolytics in patients of acute MI in a setup where streptokinase is the sole fibrinolytic used and where the facility of primary PCI is not available

Study Design: Descriptive cross sectional study

Place and Duration of Study: This study was conducted at the Department of Cardiology, Mardan Medical Complex Teaching Hospital, Mardan from January 2011 to December 2014

Materials and Methods: This study included 3,000 patients using non probability purposive sampling technique. The study was approved by the Hospital Ethical Committee. An informed written consent was obtained. Out of these, 2100 [70%] were non diabetic and 900 [30%]diabetics

Results: Those who presented within 6 hours of the index chest pain, streptokinase therapy was successful in 1709 [57%] patients and unsuccessful in 197 [6.6%] patients. Streptokinase was successful only in 771 [25.7%] patients and unsuccessful in 323 [10.8%] patients who presented in 6-12 hours of the index pain. Reinfarction occurred in 193 [6.4%] patients whereas 2807 [93.6%] were free of reinfarction. Hemorrhagic Stroke occurred 50 [1.7%] patients whereas 2 [0.1%] developed ischemic stroke

Conclusion: Our study convincingly showed that intra cranial hemorrhage was relatively low with this fibrinolytic

Antimicrobial, antitumor and brine shrimp lethality assay of Ranunculus arvensis L. extracts

To investigate the antitumor activity, brine shrimp lethality assay, antibacterial and antifungal activity of Methanol Extract [ME], Water Extract [WE], Acetone Extract [AE], Chloroform Extract [CE], Methanol-Water Extract [MWE], Methanol-Acetone Extract [MAE], Methanol-Chloroform Extract [MCE] of Ranunculus arvensis [L.]. Antitumor activity was evaluated with Agrobacterium tumefaciens [At10] induced potato disc assay. Cytotoxicity was evaluated with brine shrimp lethality assay. Antibacterial activity was evaluated with six bacterial strains including Escherichia coli, Enterobacter aerogenes, Bordetella bronchiseptica, Klebsiella pneumoniae, Micrococcus luteus and Streptococcus anginosus and antifungal screening was done against five fungal strains including Aspergillus niger, A. flavus, A. fumigates, Fusarium solani and Mucor species by using disc diffusion method. Best antitumor activity was obtained with ME and WE, having highest IC50 values 20.27+/-1.62 and 93.01+/-1.33µg/disc. Brine shrimp lethality assay showed LC50 values of AE, MAE and ME were obtained as 384.66+/-9.42µg/ml, 724.11+/-8.01µg/ml and 978.7+/-8.01µg/ml respectively. WE of R. arvensis revealed weak antimicrobial result against the tested microorganisms. On the other h and, the antifungal activity of the plant extracts was found to be insignificant. These findings demonstrate that extracts of R. arvensis possesses significant antitumor activity. Further extensive study is necessary to assess the therapeutic potential of the plant.