ABSTRACT
Objective: To explore the nephropreventive effects of melatonin on vancomycin-induced nephrotoxicity in rabbits
Study Design: Laboratory based randomized controlled trial
Place and Duration of Study: Department of Pharmacology and Therapeutics, Army Medical College, Rawalpindi, from May 2017 to June 2017
Material and Methods: Seventy rabbits were divided into three groups. Group A served as a control group [n=10], group B [n=30] received I/P vancomycin 200mg/kg twice a day for seven days while group C [n=30] received I/P melatonin 10mg/kg 30 minutes prior to vancomycin administration for seven days. Animals were sacrificed on the eighth day. Biochemical analysis was done for serum urea, creatinine, sodium and potassium on day 0 and day 8. Kidneys were sent for histopathology. Statistical analysis was carried out by using Microsoft Office Excel 2010 and SPSS version 21. One way ANOVA, followed by 'Post Hoc Tukey' test was used for biochemical parameters
Results: Vancomycin induced massive renal damage [grade III] and led to elevation in biochemical parameters, while melatonin pretreatment prevented the renal damage and the biochemical parameters were also significantly reduced with a p-value of <0.001 for serum urea, creatinine and potassium but had insignificant p-value for serum sodium levels
Conclusion: The study outcome indicates the potential of melatonin to prevent Vancomycin induced nephrotoxicity by virtue of its antioxidant property
ABSTRACT
Objective: This study was aimed to evaluate the various clinical and histopathological features of carcinoma of breast in the surgical unit of Combined Military Hospital [CMH] Rawalpindi in an attempt to appraise about the pattern of disease in this setting
Study Design: Descriptive cross sectional study
Place and Duration of Study: The study was conducted from September 2013 to August 2015 in surgical unit of CMH, Rawalpindi, Pakistan
Material and Methods: A total of 446 female patients diagnosed with carcinoma breast in surgical unit CMH during 2 years were included in this study. Patient's age, clinical examination and histopathological findings were recorded
Results: Among the 446 female patients, 269 patients [60.3%] presented in an age group between 40-49 years making it the most common age group. About 393 patients [88.1%] had the tumor size more than 2 cm. The commonest quadrant involved was upper outer quadrant [n=236; 52.9%]. Axillary lymph nodes were positive in 76.0% [n=339] of patients. Most common type of carcinoma was invasive ductal carcinoma in 336 patients [75.3%]. The disease was left sided in 249 cases. The most common was stage III [n=200] and grade II [n=289] carcinoma
Conclusion: In our settings the breast cancer is affecting the middle age group more commonly with upper outer quadrant being the commonest site and invasive ductal carcinoma being the commonest variant. The majority of patients presented in the later stages of disease with a moderate grade, more common lymph node metastasis and a size larger than 2 cm
ABSTRACT
Artemether-Lumefantrine is the most widely recommended antimalarial combination used to treat millions of patients suffering from malaria. Artemether undergoes rapid metabolism and gets converted to its active metabolite dihydroartemisisn. Drug analysis is a vital aspect to evaluate drugs in research. There are a number of methods available for the determination of artemether in biological fluids. These methods include HPLC based UV detection, GS-MS, HPLC-ECD and HPLC-MS/MS. This article reviews different methods for the determination of artemether in the biological fluids. Among the available methods HPLC-MS/MS proves to be the most accurate and reliable one for analysis. This has the advantage of improved sensitivity and selectivity with smaller sample volume
Subject(s)
Chromatography, High Pressure Liquid , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Gas Chromatography-Mass Spectrometry , Antimalarials , Malaria/therapyABSTRACT
To investigate the frequency of the single nucleotide polymorphism C1236T in exon 12 of the ABCB1 gene in Pakistani population and to compare it with published data on Asian and Caucasian populations. A cross-sectional observational study. Combined Military Hospital, Rawalpindi and Institute of Biomedical and Genetic Engineering [IBGE], Islamabad, from August 2012 to May 2013. C1236T polymorphism was investigated in 426 Pakistani subjects. The frequency was compared with the published data on other Asian and Caucasian populations. The frequencies of ABCB1 C1236T were 16.4% for CC, 44.1% for CT and 39.4% for TT. Pakistanis differed significantly from all the European populations compared in the distribution of the TT genotype of C1236T ABCB1 [p < 0.05]. The Pakistani population also differed significantly from some of the European populations in the distribution of CC and CT genotype [p < 0.05]. There was significant difference in the genotype frequency of the ABCB1 gene compared to other populations. This study has provided a framework for future pharmacogenetic and pharmacokinetic studies on this polymorphic variant of ABCB1 gene in the Pakistani population
ABSTRACT
To determine the association of ABCB1polymorphism G2677T with anti-emetic efficacy in patients treated with ondansetron for preventing postoperative nausea and vomiting. A clinical trial. Combined Military Hospital, Rawalpindi and Institute of Biomedical and Genetic Engineering, Islamabad, from 2012 to 2013. Four mg ondansetron was administered intravenously 30 minutes before the end of surgery. A total of 246 patients with the complaints of nausea and vomiting and 244 patients without nausea and vomiting were analyzed for G2677T polymorphism using PCR-RFLP method. Results were described as frequency percentages and chi-square test with significance at p < 0.05. The patients with TT genotype had significantly lower incidence of postoperative nausea and vomiting during the first 2 hours [p < 0.001] and between 2 - 24 hours after surgery as compared to other genotypes [p < 0.001]. The patients with GG genotypes had significantly higher incidence of this complaint [p=0.014]. Polymorphism of ABCB1 has an association with responsiveness for ondansetron. There is a role for genetics in the management of PONV
ABSTRACT
To investigate the frequency of CYP2D6*4 in Pakistani breast cancer patients for the first time and also investigate its association with tamoxifen induced hot flashes. A retrospective study carried out in Nuclear Medicine, Oncology and Radiotherapy Institute [NORI] Islamabad and Combined Military Hospital Rawalpindi [CMH]. Pre and postmenopausal breast cancer women who were advised 20mg/day of tamoxifen as adjuvant therapy were recruited for the study. The data from January 2000 to September 2013 was collected from the medical records of the outpatient breast cancer clinics. 232 women who fulfilled the eligibility criteria were initially recruited and their peripheral whole blood samples were taken. CYP2D6*4 was determined by using PCR-RFLP, allele*4 was not identified in 9 women and study was conducted on 223 women. None of the women died during the study period. Data of 223 women was analysed and the allele frequency of CYP2D6*1 was 86% and that of CYP2D6*4 was 14%. Women with CYP2D6*4/*4 did not experience mild to moderate or severe hot flashes as compared to women heterozygous or homozygous for wild type allele *1. The frequency of CYP2D6*4 allele in Pakistani breast cancer women is 14% which is comparable to the Caucasians moreover CYP2D6*4/*4 genotypes have lower incidence of hot flashes, but the results are not statistically significant
ABSTRACT
Objective: to compare the intubation time, number of attempts to intubation and complications of BNTIbyusing normal ETTs against those softened by warming them with water at 50[degree]C
Methodology: eighty adult patients both male and female scheduled to undergo elective maxillofacial surgery under general anesthesia [GA] were randomly divided into two groups; Group A: BNTI carried out in patients using ETT without warming, Group B: BNTI using ETT warmed and softened with water at 50[degree]C for 5 minutes. The intubation time, number of attempts to intubation and complications of BNTI in both the groups were recorded and compared
Results: we found that BNTI in group B required lesser time and lesser number of attempts for intubation, with low incidences of complications as compared to group A. We found that the most frequent position of nasotracheal tube was tracheal followed by esophageal and anterior positions
Conclusion: ETT softened by warm water facilitated BNTIwith reduced frequency and severity of observed complications like epistaxis, bronchospasm, laryngospasm, painful nose and post-operative sore throat
ABSTRACT
To find the association of various risk factors with breast cancer. It was a case-control study. The study was carried out in NORI Hospital Islamabad and Combined Military Hospital Rawalpindi between August, 2013 and February, 2014. Two hundred breast cancer patients and 200 control subjects were inducted. A short approved and planned questionnaire was used to collect data regarding basic demographic, menstrual and reproductive characteristics of participating females. Cases and controls were then interviewed after taking written consent. Breast cancer patients and control subjects did not differ regarding age [p = 0.15], early menarche [OR for menarche at <13 years vs. >/=13=1.3, 95% CI = 0.84 - 2.02], and history of breast cancer in 1st degree relatives did not increase breast cancer risk [OR = 1.0, 95% CI = 0.57- 1.74]. Nulliparous women had significantly higher risk than parous women [OR = 2.43, 95% CI = 1.22 - 4.84] and women with late menopause compared to women with early onset of menopause were also at higher risk for breast cancer [OR for menopause at >/= 50 vs. < 50 = 5.16, 95% CI = 2.59 - 10.29]. Nulliparity and menopausal age of more than 50 years was associated with increased breast cancer risk. Breastfeeding and age less than 25 years at first live birth was not protective against breast cancer
ABSTRACT
Objective: To determine the effect of smoking on the post-operative nausea and vomiting [PONV] as well as severity of pain in the post-operative period
Methodology: A total of 147 patients undergoing elective laparoscopic cholecystectomy under general anesthesia were divided into 2 groups of non-smokers [n=75] and smokers [n=72]. In the first 24 hours after surgery the frequency of PONV and the severity of pain on Visual Analogue Score were assessed
Results: The group of non-smokers had statistically more nausea and vomiting [n=59, 78.6%] as compared to that of smokers [n=20, 27.7%] [p<0.05]. However there was no significant difference in the maximum pain scores in both the groups [p>0.05]
Conclusion: We conclude that frequency of PONV is less in smokers as compared to non-smokers
ABSTRACT
Succinylcholine revolutionized anaesthetic practice by providing intense neuromuscular blockade of very rapid onset and ultrashort duration, thereby greatly easing the maneuver of tracheal intubation. However the worth of succinylcholine is limited by the frequent occurrence of muscular side effects which manifest biochemically in the form of rise in serum creatine kinase [CK]. The administration of small doses of nondepolarizing muscle relaxants before the administration of succinylcholine has been shown to decrease the incidence and severity of muscular side effects experienced by the patients. This study was aimed at evaluating the efficacy of technique in reducing the muscular side effects of succinylcholine, biochemically manifested as rise in CK. Sixty healthy adults were enrolled in the study who were scheduled for minor muscle cutting surgeries under general anaesthesia. They were assigned at random to two groups of thirty patients each. They randomly received succinylcholine for intubation and a precurarization dose of rocuronium followed by succinylcholine for intubation. Blood samples were drawn for estimation of serum creatinine kinase. There was a significantly raised CK in the succinylcholine group. In the precurarization group the rise in CK was prevented and the levels were significantly less as compared to the group which received succinylcholine alone. Present study concluded that precurarization with rocuronium was effective in reducing the succinylcholine-induced rise in creatinine kinase
Subject(s)
Humans , Female , Male , Succinylcholine/administration & dosage , Androstanols/adverse effects , Biomarkers/blood , Creatine Kinase, MM Form/blood , Neuromuscular Nondepolarizing Agents/adverse effects , Muscle, Skeletal/drug effects , Prospective Studies , Single-Blind Method , Time Factors , Up-RegulationABSTRACT
The endothelial cells of the blood brain barrier prevent the transport of enormous number of substances into the brain. An important component of this barrier is the P-glycoprotein [P-gp]. It is an efflux protein that is ATP dependent and thus rightly called the "traffic ATPase" involved in extrusion of compounds, using the energy of ATP hydrolysis to move the variety of structurally unrelated compounds and preventing their accumulation within the brain. Understanding of structure and function of the drug transporter P-gp in the blood brain barrier will pave the way to more tailored and targeted therapies for complex diseases
ABSTRACT
Post-operative nausea and vomiting is the most annoying and at the same time a dangerous side effect of general anaesthesia. Ondansetron is a routinely used anti emetic drug which is being administered by the trial and error principle. Though it did revolutionized the management of this condition but by and large failed to completely eliminate the problem. Recently an important factor possibly elucidating this failure is said to be the differing expression of genes controlling proteins that are involved in transport and receptors related to this drug. Quite surprisingly these transporter and receptor pathways have been found to be polymorphic and at the same time shown to be related to efficacy of the drug. The differentiation between those responding to treatment and those not responding may pave a way to individualize treatment for emesis to a greater extent. This review highlights the pharmacogenetics related to this commonly used anti-emetic drug in anaesthesia. It is visualized as a promising way to achieve the target of individualized therapy. It seems obvious that pharmacogenetics will become an important field of anaesthesia research in the future
ABSTRACT
Succinylcholine revolutionized anaesthetic practice by providing intense neuromuscular blockade of very rapid onset and ultrashort duration, thereby greatly easing the maneuver of tracheal intubation. However the worth of succinylcholine is limited by the frequent occurrence of muscular side effects which manifest biochemically in the form of rise in serum creatine kinase [CK]. The administration of small doses of nondepolarizing muscle relaxants before the administration of succinylcholine has been shown to decrease the incidence and severity of muscular side effects experienced by the patients. This study was aimed at evaluating the efficacy of technique in reducing the muscular side effects of succinylcholine, biochemically manifested as rise in CK. Sixty healthy adults were enrolled in the study who were scheduled for minor muscle cutting surgeries under general anaesthesia. They were assigned at random to two groups of thirty patients each. They randomly received succinylcholine for intubation and a precurarization dose of Rocuronium followed by succinylcholine for intubation. Blood samples were drawn for estimation of serum creatine kinase. There was a significantly raised CK in the succinylcholine group. In the precurarization group the rise in CK was prevented and the levels were significantly less as compared to the group which received succinylcholine alone. Present study concluded that precurarization with Rocuronium was effective in reducing the succinylcholine-induced rise in creatine kinase
Subject(s)
Humans , Succinylcholine/adverse effects , Creatine Kinase, MM Form/blood , Succinylcholine/administration & dosage , Neuromuscular Nondepolarizing Agents/adverse effects , Muscle, Skeletal/drug effects , Muscle, Skeletal/enzymology , Biomarkers/bloodABSTRACT
Succinylcholine remains the drug of choice in conditions where rapid paralysis and airway control are priorities. However it is associated with muscular side effects that have an overall incidence ranging from five to 83 percent. The administration of small doses of nondepolarizing muscle relaxants before the administration of succinylcholine has been shown to decrease the incidence and severity of muscular side effects experienced by the patients. This study was aimed at evaluating the efficacy of technique in reducing the muscular side effects of succinylcholine. Sixty healthy adults were enrolled in the study who were scheduled for minor muscle cutting surgeries under genera lanaesthesia. They were assigned at random to two groups of thirty patients each. They randomly received succinylcholine for intubation and a precurarization dose of rocuronium followed by succinylcholine for intubation. Intraoperative fasciculations and postoperative myalgia were graded and scored. There was a significantly increased incidence of fasciculations and myalgia in the succinlcholine group. In the precurarization group the incidence and severity of fasciculations and myalgia was significantly less as compared to the group which received succinylcholine alone. We found significant correlation between fasciculations and myalgia in the succinylchloine group. Present study concluded that precurarization with rocuronium was effective in reducing the succinylcholine-induced fasciculations and myalgia