Lethal toxic Dose [i.p LD50], total protein contents and comparative hemolytic potential of [99mTc labeled and non-labeled] Naja naja karachiensis venom

Recent recognition about snake bite envenomation on June, 2017 as neglected tropical disease under categoryA by World Health Organization advocated again its undeniable importance. Present circumstances reasoned to work on a neglected subspecies of Naja naja, i.e., Naja naja karachiensis [N. n. karachensis] has been documented for frequent deaths in Pakistan. In this study median lethal toxic dose [LD50] was determined intraperitoneally in Swiss albino mice and was found to be 2.0microg/g [2.0mg/kg] equal in potency to Naja pallida [red spitting African cobra]. Total protein contents [188+/-0.011microg / 200microg of dry weight] were high enough [94%] to represent an arsenal of proteins. Furthermore, 99mTc was labeled 99.9% with venom and didn't find to alter hemolytic activity of venom in dose dependent manner at 125 microg/ml [p<0.5], 250 microg/ml [p<0.1] and 500 microg/ml [p<0.1] when compared with its crude form. Present work will pave the way for proteomics study in effective production of antidote against specific species of snakes as dare demand of it has been felt since long period of time in Pakistan

To determine correlation between biochemical parameters of nutritional status with disease severity in HCV related liver cirrhosis

Objective: To identify correlation between biochemical parameters of nutritional status with disease severity in HCV related liver cirrhosis in patients attending tertiary care hospital

Methods: Total 259 HCV related liver cirrhosis patients who attended the outpatient department of KRL Hospital, Islamabad from June 2016 to January 2018 were included in this crosssectional study. HCV status was confirmed with PCR. Cirrhosis was preestablished by ultrasound, while cirrhosis severity was gauged by CTP score. Biochemical parameters for nutrition status included serum albumin, creatinine, cholesterol, LDL, HDL, triglycerides, hemoglobin, ferritin, sodium, potassium, magnesium and calcium. Other demographic and clinical data were also recorded

Results: The mean age of patients was 58.73 +/- 6.04 years with 57.1% being males. The average BMI was 22.72 +/- 1.69 kg/m[2]. Majority patients i.e. 123 [47.5%] belonged to CTP-A, 67 [25.9%] were in CTP-B and 69 [26.6%] in CTP-C groups. Significant negative correlations of cirrhosis severity were established with BMI, albumin, creatinine, cholesterol, LDL, TG, HDL, hemoglobin, sodium and magnesium indicative of malnutrition. Analysis of biochemical parameters amongst individual cirrhosis groups revealed significant negative correlation across the same factors in group CTP-C, while CTP-A correlated positively with these parameters. The only significant correlation found in CTP-B was with albumin, HDL, hemoglobin, sodium and magnesium

Conclusion: Considering limitations of standard ways alone to assess malnutrition in liver cirrhosis, biochemical parameters are valid to aid in diagnosing malnutrition

Frequency and risk factors of frequent exacerbations of asthma in patients in a tertiary care hospital: a hospital-based comparative study

Objective: To determine the frequency of recurrent exacerbations in asthma patients and compare the risk factors for frequent and non-frequent exacerbations. Study Design: Cross-sectional study. Place and Duration of Study: KRL Hospital Islamabad from Jun to Dec 2016

Patients and Methods: Non-probability technique was used to sample two hundred and eighty one patients. Asthma exacerbations were defined by GINA guidelines. Frequent exacerbations were defined as two or more in the previous year. Data regarding demographics and risk factors were collected. Inhaler technique was checked. BMI and blood eosinophil levels were measured. SPSS 22 was used for data analysis

Results: Out of total 281 patients, frequent asthma exacerbations were observed in 143 [50.9%] patients. Female gender [p=0.00] and lower education [p=0.02] led to frequent exacerbations. Patients education about disease or treatment [p=0.03], URTI [p=0.00], allergen exposure [p=0.00], drug history [p=0.04], treatment step-II [p=0.00], medication non-compliance [p=0.00], incorrect inhaler technique [p=0.01], anxiety [p=0.01], previous ICU admission [p=0.02] and blood eosinophilia [p=0.00] were significantly associated with frequent exacerbations. Of these, independent predictors were patient education [p=0.02], URTI [p=0.00], allergen exposure [p=0.00], drug history [p=0.00], treatment step-II [p=0.03], medication non-compliance [p=0.02], anxiety [p=0.01] and eosinophilia [p=0.00]

Conclusion: Majority of our patients underwent frequent exacerbations. Risk factors found to be associated with frequent exacerbations were female gender, lower education, patient unawareness, URTI, allergen and drug exposure, treatment step-II, medication non-compliance, anxiety and blood eosinophilia

Lobectomy for congenital lobar emphysema, experience of two centers in Pakistan

Objective: To assess outcome of lobectomy in congenital lobar emphysema in pediatrics group of patients

Methods: This retrospective study was conducted in Department of Thoracic Surgery Nishtar Hospital Multan and Services Hospital Lahore from October 2003 to December 2015.All the patients of pediatric group who underwent lobectomy for congenital lobar emphysema were included in study. Demographic data, operative findings outcome of the procedure in terms of post operative complications and 30 days morbidity and mortality were recorded .All the patients presented with respiratory distress. Standard lobectomy was performed and bronchial stump was buttressed with surrounding lymph nodes, pericardial or pleural flap

Results: Of these 41 study cases, 30 [73.2%] were boys while 11 [26.8%] were girls and male to female ratio was 2.72: 1. Mean age of our study cases was 3.32 +/- 1.59 months [with age range; 15 days to 7 months]. Mean age of the boys was noted to be 3.38 +/- 1.52 months while that of girls was 3.18 +/- 1.84 months [p = 0.405]. Of these 41 study cases, left upper lobectomy was performed in 27 [65.9%] patients, right middle lobectomy in 11 [26.8%] patients, left lower lobectomy in 2 [4.9 %] patients and right upper lobectomy in 1 [2.4%] patients. Out of 41 patients 8 [19.5%] were preoperatively on ventilator. Out of 8 ventilated patients one had left sided chest intubation which was malpositioned and was in the lung parenchyma. Morbidity was superficial wound infection in 2 [4.9%] patients and post lobectomy empyema in 2 [4.9%] patients who required prolonged tube thoracostomy, antibiotics and chest physiotherapy. Mortality was recorded in 1 [2.4%] patient who was preoperatively on ventilator and had misplaced chest tube. That patient died on the 3rd post-operative day due to respiratory failure secondary tolung parenchymal injury

Conclusion: Our study results support surgical management of congenital lobar emphysema as Lobectomy was found to be safe, reliable and effective in these children presenting with respiratory distress due to lobar emphysema. There were no significant morbidities in these patients and clinical outcomes were satisfactory and surgical management is reported to be treatment of choice in pediatric patients with CLE

Analysis of primary intrathoracic extrapulmonary hydatid cysts a rare clinical entity

To evaluate the anatomic location of cysts, operative characteristics of intrathoracic extrapulmonary hydatid cyst and to determine the outcome of aggressive surgical interventions.Case series. Thoracic Surgery Unit Lady Reading Hospital Peshawar from 1[st] July 2008 to 30[th] June 2011. All patients admitted to Thoracic unit from July 2008 to June 2011 with intra thoracic hydatid cysts were evaluated prospectively as to age, sex, symptoms, diagnostic procedures, anatomic location of cysts, surgical procedures, complications, and outcomes. Chest radiography, computed tomography, and thoracic and abdominal ultrasonography had been performed preoperatively in all of them. Bronchoscopy and spirometry was also performed in all patients for assessment and operability.Echocardiography had been used in 2 patients to determine the contiguity of the cyst to the pericardium. Cystectomy and wide resection were the chief operative procedures. Most of the patients were having cysts in the pulmonary parenchyma only 10 patients had intrathoracic cysts in extrapulmonary locations. This group of patients was included in the study. We excluded patients who had a parenchymal cyst that had perforated to the pleura, myocardial hydatid and patients who had Total of 149 patients were operated for hydatid cystectomy, out of these 139 patients had pulmonary hydatid and 10 patients had intrathoracic extrapulmonary hydatid cysts. These 10 patients constitute our study group; out of these 7 were men and 3 women whose mean age was 39.14 +/- 16.8 years range, [16-69 years]. Eight [80%] of these were symptomatic, most commonly with chest pain, two patients were asymptomatic. There were 2 [20%] mediastinal hydatid, 2 [20%] diaphragmatic, 2 [20%] pericardial, 2 [20%] oblique fissure, and 1 [10%] each in chest wall and pleural hydatid in our study. Albendazole [10 mg/kg] was prescribed to all patients for as long as 3 months postoperatively. No complication, recurrence, or death occurred during the follow up period of 13 +/- 15.4 months [range, 2-36 months].The extrapulmonary location of Hydatid cysts within the thorax is very rare. This rarity may cause difficulties in diagnosis. To avoid recurrence, it is necessary to resect the affected tissues completely and an anthelmintic medical regimen post operatively

Intralobar bronchopulmonary sequestration with large aberrant vessel presenting as recurrent pneumonias

Bronchopulmonary sequestration is a rare congenital malformation of the lower respiratory tract comprising of a nonfunctioning lung tissue mass that lacks normal communication with the tracheobronchial tree. The diagnosis may be easily missed as many of the symptoms of bronchopulmonary sequestration overlap with that of other pulmonary diseases. Bronchopulmonary sequestration can be complicated by recurrent infections, hemorrhage and malignant transformation and, therefore, needs to be timely diagnosed and resected to decrease both morbidity and mortality. A high degree of suspicion in the differential diagnosis helps diagnose the positive cases. The parenchymal abnormalities associated with bronchopulmonary sequestration are best visualized using computed tomography, although their appearance is variable. We report the case of a 14 years old boy with intralobar bronchopulmonary sequestration with the sole manifestation of recurrent pneumonias

Useful ethnophytomedicinal recipes of angiosperms used against diabetes in South East Asian Countries [India, Pakistan and Sri Lanka]

This paper is based on data recorded from various literatures pertaining to ethnophytomedicinal recipes used against diabetes in South East Asia [India, Pakistan and Srilanka]

Traditional plant treatments have been used throughout the world for the therapy of diabetes mellitus. In total 419 useful phytorecipes of 270 plant species belonging to 74 Angiospermic families were collected. From the review it was revealed that plants showing hypoglycemic potential mainly belong to the families, Cucurbitaceae [16 spp.], Euphorbiaceae [15 spp.], Caesalpiniaceae and Papilionaceae [13 spp. Each], Moraceae [11 spp], Acanthaceae [10 spp.], Mimosaceae [09 spp], Asteraceae, Malvaceae and Poaceae [08 spp. Each], Hippocrateaceae, Rutaceae and Zingiberaceae [07 spp. Each], Apocynaceae, Asclepiadaceae and Verbenaceae [06 spp. Each], Apiaceae, Convolvulaceae, Lamiaceae, Myrtaceae, Solanaceae [05 spp.each]

The most active plants are Syzigium cumini[14 recipes], Phyllanthus emblica [09 recipes], Centella asiatica and Momordica charantia[08 recipes each], Azadirachta indica [07 recipes], Aegle marmelos, Catharanthus roseus, Ficus benghalensis, Ficus racemosa, Gymnema sylvestre [06 recipes each], Allium cepa, A. sativum, Andrographis paniculata, Curcuma longa [05 recipes each], Citrullus colocynthis, Justicia adhatoda, Nelumbo nucifera, Tinospora cordifolia, Trigonella foenum-graecum, Ziziphus mauritiana and Wattakaka volubilis [4 recipes each]

These traditional recipes include extracts, leaves, powders, tlour, seeds, vegetables, fruits and herbal mixtures

Data inventory consists of botanical name, recipe, vernacular name, English name

Some of the plants of the above data with experimentally confirmed antidiabetic properties have also been recorded. More investigations must be carried out to evaluate the mechanism of action of diabetic medicinal plants

Toxicity of these plants should also be explained. Scientific validation of these recipes may help in discovering new drugs from these medicinal plants for diabetes

Medicinal uses of honey [Quranic medicine] and its bee flora from Dera Ismail Khan District, KPK, Pakistan

This study was carried out during 2005-2008 to identify existing plant species visited by workers of honeybees for nectar and pollen collection in Dera Ismail Khan [D.I.Khan] District, Pakistan. The honeybee species investigated in the area were, rock bee [Apis dorsata F.], little bee [A. florea F.] and European honeybee [A. mellifera L.]. A detailed list of 86 plant species both wild and cultivated was prepared, out of which 12 species, Phulai [Acacia modesta Wall.], Sarsoon [Brassica campestris L.], Kaghzi nimboo [Citrus aurantifolia L.], Khatta [C. medica L.], Malta [C. sinensis [L.] Osbeck.], Shisham [Dalbergia sissoo Roxb.], Date [Phoenix dactylifera L.], Barseen [Trifolium alexandrianum L.], Shaftal [T. resupinatum L], Makai [Zea mays L.], Ber [Zizyphus mauritiana Lam.] and Jher beri [Z. numularia [Burm. f.] Wight and Arn.,] were found as major sources [table 1] for the production of surplus honey in a year at different localities in the District. Among the minor sources various plant species were included [table 2]. These plants fill the flowering gaps between the major sources in various parts of the year and help in continuous supply of food to honey bees

prospective study of factors predicting postoperative pulmonary complications [PPC] in patients undergoing noncardiothoracic surgery under general anaesthsia in a developing country

Post-operative pulmonary complications after non-cardiothoracic surgery are common and can adversely affect morbidity, mortality and length of hospital stay. Knowledge as regards factors predicting postoperative pulmonary complications in our local setting is imperfect. To study factors predicting post-operative pulmonary complications in developing countries. Data of consecutive 404 patients undergoing non-cardiothoracic surgery under general anesthesia with tracheal intubation was collected prospectively from Jan 2009 to Dec 2010. Chi-square was used for univariate analysis. Multivariate analysis was conducted using forward stepwise logistic regression. The mean age was 36 +/- 18 years with slight male predominence [54% vs 46%]. 22% [n=89] were smokers and the mean Body Mass Index was 23 +/- 4.5 kg/m2 with 35% [n=141] overweight and obese. 5% [n=20] of subjects had pre-existing chronic lung conditions while 23% [n=92] had non-pulmonary chronic conditions. 70% [n=282] of the surgeries were done electively and the mean duration of anesthesia was 78 +/- 44 minutes. The overall postoperative pulmonary complications rate was 8% [n=31] with atelactasis [48%, n=16] followed by bronchospasm [25%, n=8] and pneumonia [16%, n=5] being the commonest complications. The duration of hospital stay was significantly longer [11 +/- 9 days, p=0.00] in patients with post-operative pulmonary complications and 29% [n=9] of them required mechanical ventilation. Logistic Regression analysis identified premorbid chronic chest conditions, emergency surgery and prolonged duration of anesthesia as significant predictors of post-operative pulmonary complications while age, gender, Body Mass Index, smoking history and non-pulmonary premorbids were insignificant in this regard. Post-operative pulmonary complications after non-cardiothoracic surgery are common and lead to increased morbidity and prolonged hospital stay in our setting. We identified pre-existing chest disease, prolonged anesthesia and emergency surgery as significant predictors of post-operative pulmonary complications

audit of fibreoptic bronchoscopy service at KRL Hospital Islamabad

Fibreoptic bronchoscopy is an important diagnostic and therapeutic tool for a wide spectrum of thoracic disorders in interventional pulmonology. The British Thoracic Society published comprehensive guidelines in 2001 on the use of fibreoptic bronchoscopy. The purpose of this audit was to evaluate the performance of our bronchoscopy service in the light of these guidelines with a view to identify areas for further improvement. In this prospective audit a series of 50 consecutive bronchoscopies performed at KRL Hospital Islamabad was studied. For each examination we recorded patient demographics, indication of the procedure, radiological information, pre-procedure evaluation by the pulmonologist, the bronchoscopic appearance and histopathological and microbiological findings, where indicated, and any untoward events associated with the procedure. The mean age was 48.8yrs [SD +/- 17.9] with male predominance [M 78%, F 22%].The main indication of the procedure was sampling of bronchial washings for microbiological assessment [n=25; 50%], followed by evaluation of suspected malignancy[n=15; 30%], hemoptysis [n=9; 18%] and persistent cough [n=1; 2%]. Chest X-rays were abnormal in majority of patients [n=46; 92%] and radiological appearance of pulmonary mass lesion was seen in 24% [n=11] of abnormal CXRs. Thirty percent [n=15] of bronchoscopies were abnormal with 93% diagnostic yield of specimens obtained for histopathological assessment. A low diagnostic yield of 24% was observed in cases of specimens collected for microbiological assessment. No major procedure related complications were observed during or after the procedures. Fibreoptic bronchoscopy is a safe procedure provided all basic precautions are taken. The procedure should be considered in all patients with a mass lesion on CXR. Although thehistopathological diagnostic yield was well above the recommended standard in cases of endoscopically visible malignancy but a low diagnostic microbiological yield was observed especiallyin cases being evaluated for tuberculosis. The latter may be attributed to less selective study population and sub-optimal microbiological service. Hence the audit was useful in identifying an area for furtherimprovement. In a developing country, like Pakistan, gender bias is rampant even when it comes to access the healthcare facilities