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Background and Objective: Everolimus-eluting stents, compared with bare metal stents, reduced the risk of restenosis in clinical trials with strict inclusion and exclusion criteria. The objective of this study was to determine the three months clinical outcomes of Everolimus Eluting Stents in patients with stable angina pectoris in Pakistani population
Methods: It was a descriptive cross-sectional study and the data was collected from Catheterization Laboratory Cardiology Department Lady Readings Hospital Peshawar. Our study included all the patients with stable coronary artery disease who had received Everolimus eluting stents from August, 2013 to April, 2014. Total study duration was 09 months. The primary end points were the rate of target vessel revascularization, myocardial infarction at three months. All those patients who received Everolimus coronary stents were recalled after three months from the index procedure and enquired about target vessel revascularization [TVR], myocardial infarction and hospitalization over the last three months. Data analysis was done using SPSS version 16
Results: Our study included 378 patients with stable ischemic heart disease who underwent revascularization with Everolimus eluting stent.These patients were followed up for a period of 3 months for target vessel revascularization [TVR] and myocardial infarction [MI]. Mean age was 57.04+/-9.307, males were [72%]. Left Anterior Descending [LAD] and Left circumflex [LCx] were the predominant vessels vascularized. Mean length of Everolimus eluting stent was 21.91+/- 4.6 while mean diameter of stent was 2.90+/-0.248. Thirteen [3.4%] patients had TVR and 14 [3.7%] patients had MI during three months follow up after PCI. TVR and MI were prevalent in patients who received longer Everolimus stents as compared to those who received shorter stents at three months, and the difference between the two was statistically significant
Conclusion: Short-term results from this study suggest that real-world outcomes among 378 patients are comparable to those reported in other registries and trials, and safety outcomes as measured by rates of TVR, MI were low. The long-term safety of Everolimus-eluting stents needs to be ascertained in large, randomized trials
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Objective: To determine the frequency of intraventricular dyssynchrony among patients with left bundle branch block
Methods: The study was conducted at Hayatabad Medical Complex, Peshawar, from January, 2017 to July, 2017. All patients aged 18 years and above with Left Bundle Branch Block [LBBB] on ECG with or without heart failure were included in the study. Patients with valvular heart disease, predominant diastolic heart failure, acute coronary syndromes or coronary revascularization in last three months and atrial fibrillation were excluded. Tissue Doppler Imaging [TDI] parameters were measured from 2-D images in apical 4-chamber and 2chamber views. Consecutive non-probability sampling technique was used for sample collection
Results: Our study included 159 patients. Mean age was 52 years with SD +/- 2.74. Ninety-nine [62%] patients were male and 60 [38%] patients were female. One hundred and three [65%] patients had heart failure while 56 [35%] patients didn't have heart failure. More over in our study 124 [78%] patients had Intraventricular dyssynchrony while 35[22%] patients didn't have Intraventricular dyssynchrony
Conclusion: The incidence of Intraventricular dyssynchrony is high among patients with heart failure and left bundle branch block
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Objective: To study the relationship between serum calcium level and blood pressure level in patients presenting with type 2 diabetes mellitus
Methods: This cross sectional study was conducted at East Medical Ward, Department of Medicine Mayo Hospital Lahore. This study was done in six months period from March 10, 2015- Sep 10, 2015. The non-probability consecutive sampling technique was used in this study. Informed consent and demographic information like name, age and address was recorded. Systolic and Diastolic Blood pressure was measured by using standard and absolute sphygmomanometer. 3ml Blood sample of each patient was taken with informed consent and was sent to the laboratory of the hospital to assess serum calcium level [as per operational definition). Reports were assessed and calcium level was recorded. Pearson correlation coefficient was calculated to measure the relationship between serum calcium level and systolic and diastolic blood pressure. pvalue
Results: In our study the mean age of the patients was 59.42 +/- 11.02 years, 30% patients were males and 70% patients were females. The mean SBP value of the patients was 140.56 +/- 11.35 mmHg and mean DBPvalue was 87.98 +/- 6.11 mmHg. In this study the mean value of calcium level of the patients was 8.22 +/- 1.24 mg/dl. The negative correlation was observed in our study between the calcium level and SBP, DBPof the DM patients i.e. r= -0.665 and -0.401 respectively
Conclusion: The study concluded that negative correlation was observed between the serum calcium level and the blood pressure level in patients presenting with type 2 diabetes mellitus
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The present report is a significant effort to explore detail description of N. Sativa, its pharmacognostic characteristics, morphological characteristics, and mechanism of actions, doses and medicinal uses. Nigella sativa [N. Sativa] is greatest form of healing medicine. It is also known as Prophetic Medicine as its use has been mentioned in Prophetic Hadit, as natural remedy for all the diseases except death. It is recommended on daily basis in Tibb-e-Nabwi [Prophetic Medicine]. Hazrat Abu Hurairah States ''I have heard from Rasool Allah [PBUH] that there is cure for every disease in black seeds except death and black seeds are shooneeze''. Salim Bin Abdullah narrates with reference to his father Hazrat Abdullah Bin Omar that Rasool Allah [PBUH] said, 'Let all the black seed upon you, these contain cure of all diseases except death'. N. sativa claimed to have anti-inflammatory, analgesic, hepato-protective, neuro-protective, gastro-protective and other useful properties. Biological and pharmacological effects are attributed to its two important constituents Thymoquinone [TQ] and Nigella sativa oil [NSO]. TQ has interaction with human serum albumin. Seeds containing volatile oils mainly Melanthin showed toxicity at larger doses. This report is a reference for all pharmaceutical researchers, physicians and biologists researching on N.Sativa and will open a door towards novel agent
Subject(s)
Benzoquinones , Phytotherapy , Plants, Medicinal , Oils, Volatile/pharmacology , Religion and Medicine , Medicine, TraditionalABSTRACT
Background: Inherited retinal diseases [IRDs] are a group of genetic disorders with high degrees of clinical, genetic and allelic heterogeneity. IRDs generally show progressive retinal cell death resulting in gradual vision loss
IRDs constitute a broad spectrum of disorders including retinitis pigmentosa and Leber congenital amaurosis. In this study, we performed genotyping studies to identify the underlying mutations in three Iranian families
Methods: Having employed homozygosity mapping and Sanger sequencing, we identified the underlying mutations in the crumbs homologue 1 gene. The CRB1 protein is a part of a macromolecular complex with a vital role in retinal cell polarity, morphogenesis, and maintenance
Results: We identified a novel homozygous variant [c.1053-1061del; p.Gly352-Cys354del] in one family, a combination of a novel [c.2086T>C; p.Cys696Arg] and a known variant [c.2234C>T, p.Thr745Met] in another family and a homozygous novel variant [c.3090T>A; p.Asn!030Lys] in a third family
Conclusion: This study shows that mutations in CRB1 are relatively common in Iranian non-syndromic IRD patients
Subject(s)
Humans , Mutation , Retinitis Pigmentosa/genetics , Leber Congenital Amaurosis/genetics , Chromosome Mapping , Whole Genome Sequencing , Eye Proteins , Membrane Proteins , Nerve Tissue Proteins , HomozygoteABSTRACT
In the current study, the antimicrobial, phytotoxic, haemagglutination and antioxidant potential of crude methanolic extract [Crd. MeOH Ext.] and four organic fractions of Arisaema tortuosum was investigated. All fractions have been screened for antimicrobial properties against eight bacterial pathogens and six fungal pathogens using agar well diffusion and tube dilution method, respectively. Furthermore, the organic fractions were also screened for its phytotoxicity against Lemna minor. Haemagglutination was performed against all human blood groups while free radical scavenging activity was performed to investigate the antioxidant potential of A. tortuosum. Results obtained for antibacterial activity exhibited various degree of zone of inhibition and significant activity was observed for Pseudomonas aeruginosa [27.16 +/- 0.60] followed by Bacillus cereus [18.55 +/- 0.69] for Crd. MeOH Ext. and chloroform [CHCl3] fraction, respectively while some strains showed resistant at same concentration. Similarly, non-significant antifungal activity was observed for the plant extracts. However, the highest activity among the strains was observed for Alternaria alternata [22 +/- 1.24%] and Aspergillus niger [20 +/- 1.00%] for ethyl acetate [EtOAc] fraction and Crd. MeOH Ext., respectively. The plant extracts showed good phytotoxic activity with 77.06% inhibition for n-hexane fraction at 1000microg/mL. The result of Nitric Oxide [NO] reducing assay revealed that the plant has less antioxidant activity with 46.06% inhibition for CHCl3 fraction at 900microg/mL. For haemagglutination assay, the result displayed no agglutination in all the testing concentration. Based on the current results, it can be concluded that A. tortuosum has significant antimicrobial and moderate phytotoxic potential and therefore can leads to antibiotics and herbicide production
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Liver transplantation [LT] is the treatment of choice for localized hepatocellular carcinoma [HCC] associated with cirrhosis. Extra hepatic metastasis is the most common cause of death in these patients. There is very little evidence regarding the natural history and treatment options for patients developing HCC recurrence after LT
Surgical resection offers a unique opportunity for solitary metastasis
We report a 61 year old male with solitary right adrenal metastasis 15 months post LT which was managed with open adrenalectomy. The patient is alive and disease free 24 months after the surgery. The case, histo-pathological findings and literature review is discussed
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Objective: to determine the clinical spectrum and surgical outcome of gastro-intestinal tuberculosis
Study design: descriptive case series
Place and Duration of study: department of General surgery ward 3 Jinnah Postgraduate Medical Center [JPMC] Karachi, from June 2010 - July 2015
Methodology: all patients who were diagnosed as cases of gastrointestinal tuberculosis and underwent operative procedures were included. Data was collected on a structured proforma. The variables collected included age of the patients, gender, clinical presentation, surgical procedures performed and outcome
Results: a total of 100 patients were managed. There were 67 female and 33 male patients. Female to male ratio was 2:1. The minimum age was 13 year and maximum 50 year with the mean age of 32 year. Apart from the constitutional symptoms like nausea, vomiting and low grade fever, abdominal pain was the commonest presentation. Eighty-eight patients were operated. End ileostomy, limited right hemicolectomy and resection anastomosis with primary repair were the commonly performed procedures. Two patients developed enterocutaneous fistulae. Five patients presented with septic shock and died
Conclusion: intestinal TB had varied presentation. It was found more frequently in females. Fever and weight loss were common presentations. High index of suspicion must be exercised in making a diagnosis
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Arrhythmias are common during the perioperative period. These abnormal rhythms can alter the hemodynamics by reducing cardiac output and may contribute to an increase in morbidity and mortality. Early diagnosis and identification of correctable causes is essential for appropriate management of arrhythmias. Some of these arrhythmias are benign requiring no intervention, while others may need urgent therapeutic intervention. This article focuses on the diagnosis and management of arrhythmias in the perioperative setting
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Objective: Thrombotic thrombocytopenic purpura [TTP] is a life-threatening disease. The primary aim was overall response rate [ORR] assessment in the treated patients
Methods: This retrospective study included 24 patients treated during 2006-2015. TTP patients with microangiopathic hemolysis [MAHA] and thrombocytopenia were included. We analyzed clinical features, laboratory characteristics and treatment outcomes of 24 TTP patients treated at our tertiary care center [KFMC]
Results: Twenty-four TTP patients [18 females; 6 males] had a mean age of 33.5 +/- 13.9 years; 22[91%] had neurologic features, 7[29%] fever, 10[42%] renal impairment; 4[20.83%] cardiac manifestations; 22[91.7%] had triad with additional neurologic abnormalities; only 2[8.2%] had pentad of TTP. Majority [54.16%] had idiopathic TTP. All patients received therapeutic plasma exchange [TPE]; 23[95.8%] received adjunctive corticosteroids and 13[54.2%] received rituximab either due to refractoriness to TPE on tilde day7, or earlier. Twenty-one out of 24 [87.5%] achieved complete remission [CR] without any subsequent relapse. At 22 months [median, range 1-113], 20 patients [83.3%] are alive at the time of report. Three patients died during acute episode because of sever disease or delayed treatment and one died in CR
Conclusion: TPE, steroids and or rituximab was very effective in preventing high risk of mortality and achieving durable CR in 87.5% of patients. More awareness is needed for early diagnosis and early referral to centers with appropriate tertiary care facilities
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Penile tuberculosis [TB] is an uncommon variety of genitourinary TB. It is either primary [via local spread] or secondary [spread of infection from other organs]. We encountered a case of rapidly growing penile ulceration, resembling carcinoma. Biopsy revealed the classic picture of TB, which responded well to antitubercular treatment
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Objective: To compare the outcomes in terms of healing after fistulotomy and fistulectomy for low lying fistulae in ano
Study design: Cross sectional analytic
Place and Duration of study: Department of Surgery, Surgical Unit I, Jinnah Postgraduate Medical Centre Karachi, from June 2013 to May 2015
Methodology: Patients of both genders between 12 to 60 year of age with clinical diagnosis of fistula in ano were included in the study. Pain was assessed on visual and analog scale [VAS] Hospital stay was also recorded. All were followed for four week for any complications
Results: During the study period 120 patients were enrolled. Out of these 60 patients had fistulotomy and 60 underwent fistulectomy for fistula in ano. Male predominated with male to female ratio of 3:1. Swelling [86.6%], discharge [37%] and itching [27%] were the common symptoms. The mean duration of hospital stay was 3 +/- 1 day. Postoperative wound healing and pain assessed by VAS, were high in fistulectomy group. All patients recovered during follow up except one who continued to complain incontinence from fistulectomy group
Conclusion: Fistulotomy yielded better results as compared to fistulectomy for the treatment with low fistula in ano
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Avian influenza [AI] is a highly contagious disease causing significant economic losses worldwide. The aim of this study is to evaluate the effect of mannan-oligosaccharide [MOS] on tracheal and cloacal virus shedding in AI challenged broilers and contamination of environment with H[9]N[2]. A total of 300 1-day-old-broiler chicks were randomly divided into 3 groups [A, B and C] and supplemented 0.2, 0.5 and 0.0% MOS, respectively in NRC recommended diet for 36 days. On day 21 the groups were further split into two sub groups A+ve, A-ve, B+ve, B-ve, C+ve and C-ve with 5 replicates each. The positive groups were shifted to remote sheds and were challenged intranasally with 0.1 ml of reference virus [AIV; Pk-UDL/01/08 H[9]N[2]] with EID[50] = 10[-6.66]. Treatment reduces [P<0.05] cloacal virus shedding from day 24 to 26 and 28 to 32. Tracheal virus shedding was lower [P<0.05] on days 25-26 and 28-30 in treatment groups. Day 27 showed highest [P>0.05] virus shedding in all groups. However the reduction of viral shedding is faster in treatment groups and showed no virus shedding on day 32. Maternal antibody titer against AI showed a declining pattern but MOS influenced [P<0.05] the titer in treated groups. Hence the use of MOS may constitute a novel and effective plausible alternative that reduces the spread of disease by decreasing virus shedding and contamination of environment from AIV [H[9]N[2]] infection in poultry
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Objective: to determine the frequency of depression in patients with migraine coming to Services Hospital, Lahore
Methods: one hundred and fifty cases fulfilling the inclusion/exclusion criteria were enrolled in the study and informed consent was taken, regarding inclusion of patient in study. All patients after confirmation of migraine with consultant having at least 5 years of experience of consultancy, depression were evaluated by the researchers themselves
Results: frequency of depression in patients with migraine coming to services hospital, Lahore was recorded in 48 % [n=72] while 52 % [n=78] had no findings of the morbidity
Conclusion: we concluded that the frequency of depression is high among patients with migraine. So, it is recommended that every patient who present with migraine, should be sort out for psychological disturbance
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Objective: To identify the chemical constituents of leaf essential oil of Forsythia koreana (F. koreana) and evaluate its effects on bacterial strains. Methods: The essential oil of leaf of F. koreana was extracted by using hydrodistillation process and the volatile components investigated with the help of gas chromatography coupled with mass spectrometry. The antibacterial study was carried out with the help of agar disc diffusion method, MIC, MBC and viable count. The mode of action was determined with help of potassium ion flux, cellular material release and scanning electron microscopy. The antioxidant activity was determined with the help of 2, 3-diphenyl-2-picrylhydrazyl method, nitric oxide scavenging activity and superoxide anion radical scavenging assay. Results: Total ten compounds were identified as trans-phytol (42.73%), cis-3-hexenol (12.95%), β-linalool (10.68%), trans-2-hexenal (8.86%), trans-2-hexenol (8.86%), myrcenol (3.86%), 4-vinylphenyl acetate (3.86%), (4Z)-4,6-heptadien-1-ol (3.18%), lemonol (2.73%) and benzeneacetaldehyde (2.27%) by gas chromatography coupled with mass spectrometry. The antibacterial study was demonstrated that leaf essential oil of F. koreana act against foodborne and other pathogenic bacteria. The mode of action revealed that this essential oil acted on the cytoplasmic membrane, resulting in loss of integrity and increased permeability. In addition, leaf essential oil of F. koreana was shown to be rich in linalool, which contributes to improved antioxidant activity. Conclusions: These results show that leaf essential oil of F. koreana has great potential as a natural food preservative, antibacterial and antioxidant agent.
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To share our findings that the new treatment modality Video Assisted Anal Fistula Treatment [VAAFT] is a better alternate to the conventional treatments of Fistula in Ano in our setup with minor changes in the initial method described by Meinero. Karl Storz Video equipment including Meinero Fistuloscope was used. Key steps are visualization of the fistula tract, correct localization of the internal fistula opening under direct vision and endoscopic treatment of the fistula. This is followed by an operative phase of fulguration of the fistula tract using glycine solution mixed with manitol, curetting the tract with curette and fistula brush. Internal opening is closed with a Vicryl 1 suture. Total of 40 patients were operated using VAAFT from October 2013 to March 2014. Three were re-operated. The other 37 cases were followed up at 6 weeks, 3 months and 6 months. Primary healing took place in 20 [50%] cases at 6 weeks. In the remaining 17 [42.5%] cases, minor discharge occurred with itching which resolved till the next visit at 8 weeks and 12 weeks. As the main aim in treating fistula is proper identification of the internal opening, excision of the tract and sparing the sphincter function, VAAFT achieves all aims with additional benefits of patients' satisfaction and negligible scaring
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The objective of the study is to find out functional outcome in patients with distal radius fractures irrespective of radiographic deformities after close reduction and cast splint age
Design: Case series study
Setting: Department of Orthopedics and Spine Surgery, Hayatabad Medical Complex Peshawar
Period: May 2010 to April 2015
Materials and Methods: 28 consecutive patients of either sex with age above 40 years, having distal radius fracture. Functional outcome was assessed with disability of arm, shoulder and hand [DASH] and Patient Rated Wrist/Hand Evolution [PRWHE] questionnaire
Results: Out of 28 patients male were 12[42.9%] and female were 16[57.1%]. minimum age was 40 maximum 81 and average was 50. Right side was involved in 17 [60.7%] while left side was involved in 11[39.3%]. The DASH Score Record shows that no Disability was seen in 13[46.4%], Minimal Disability in 7[25%], Mild Disability in 5[17.9%], Moderate Disability in 1[3.6%] and Severe Disability in 2[7.1%] patients. While the PRWHE Score Record shows that no Disability was seen in 14[50%], Minimal Disability in 6[21.4%], Mild Disability in 5[17.9%], Moderate Disability in 1[3.6%] and Severe Disability in 2[7.1%] patients
Conclusion: A majority of the distal radius fractures can achieve good results after treatment by closed reduction and cast immobilization, for which conservative treatment should be the first choice. Deformity of the distal radius cannot affect the functional outcome of the wrist and hand
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Objective: to determine the frequency of immediate pneumothorax after subclavian venous cannulation
Material and Methods: this clinical trial was carried out in Mayo Hospital in all four medical ward [East, West, North, and South] and Nephrology ward of Mayo Hospital, Lahore during the period from15th March 2013 to 15th September 2013. It was descriptive case series study. A total of 450 cases fulfilling inclusion and exclusion criteria attending in patient department were selected. After antiseptic preparation of field, local anesthesia was administered. The subclavian vein was punctured at the junction between the middle and inner thirds of the clavicle. Negative pressure was maintained in the syringe to facilitate blood return when the subclavian vein was entered. A J guide-wire was advanced through the cannula to a length of 20 [15-16] cm. A small skin incision was placed at this site for ease of catheter passage. After dilatation, a catheter was inserted and advanced to predetermined point over the guide-wire. The lumen of catheter was sutured to avoid intra cardiac tip displacement and to prevent kinking and accidental withdrawal. Pneumothorax was checked by Chest X-ray taken within four hours of procedure
Results: in our study, 41.56%[n=187] patients were between 30-50 years while 58.44%[n=263] were between 51-70 years, Mean+SD was calculated as 51.92 +/-11.23 years, 57.56%[n=259] male and 42.44%[n=191] were females, frequency of immediate pneumothorax after subclavian venous cannulation was 6.44%[n=29] while 93.56%[n=421] had no findings of the such complications
Conclusion: we concluded that the frequency of immediate pneumothorax among patients with subclavian venous cannulation is in agreement with other studies and not very high. But it is recommended that every patient who undergo with subclavian venous cannulation should be sorted out for pneumothorax. However, it is also required that every setup should have its surveillance in order to know the frequency of this complication
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The objective of this study was to determine the incidence of retinopathy in chronic hepatitis C patients treated with Pegylated interferon alpha 2a and Ribavirin. This descriptive case series study was conducted in Medical Unit II of the Jinnah Hospital Lahore from September 2012 to February 2013. One hundred chronic hepatitis C patients visiting Medical Unit II outpatient department fulfilling inclusion criteria were selected for this study via non probability purposive sampling. Patients were started on pegylated interferon and ribavirin combination therapy. Subjects were subjected to dilated eye fundoscopic examination at the start of therapy and then after three months of the therapy. One hundred patients were included in this study. Out of these 100 patients 5% developed retinopathy whereas fundus examination was normal in rest of the patients. Interferon therapy can lead to retinopathy. Periodic fundoscopic examinations help in early detection and prevent progression to permanent visual loss
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Objectives: To evaluate the factors for preferring the traditional bone setters by people
Study Design: Observational study
Setting: Department of Orthopedics and Spine Surgery Hayatabad Medical Complex Peshawar
Period: October, 2013 to March, 2014
Materials and Methods: Sixty consecutive patients who presented at orthopedics out-patient clinic after attending Traditional Bone Setting Centers were recruited for the study. Information about the patients' bio data, mechanism of injury, who advised them to contact TBS and what are the factors that compelled them to attend TBS were obtained and filled into prepared proforma. The data obtained was recorded and analyzed on SPSS version 17
Results: The mean age was 25.57 years with minimum age 5 years and maximum 65 years. Sixteen patients were females and 44 were male. Two [3.3%] patients first attended Modern orthopedic service [MOS] and 58[96.7%] patients attended TBS.47[78.3%] patients were taken by their own immediate family members to TBS, 20% were referred by friends and 1.7% were self-referral. Thirty seven [61.7%] opted for TBS because of their belief, 11[18.3%] considered this service cheap, 7[11.7%] attended it because it is quick service and 5 [8.3%] reverted to TBS because of attitude of hospital personals
Conclusion: A considerable of people still have great trust on TBS regarding management of musculoskeletal problems. Belief is the most leading cause of consulting traditional bonesetters, other causes include low cast, quick service and attitude of hospital personnel