Tylophora hirsuta L. leaf extract attenuates alloxan-induced diabetes in mice by suppressing oxidative stress and α-Amylase

Objective: To evaluate the antidiabetic potential of leaf extracts of Tylophora hirsuta (T. hirsuta). Methods: The methanolic and ethyl acetate extracts of T. hirsuta leaves were analyzed by high pressure liquid chromatography. In vitro antioxidant activity was determined by ferric ion reduction, 1, 1-diphenyl-2-picrylhydrazyl, and hydrogen peroxide scavenging methods. In vitro alpha amylase (α-Amylase) inhibitory activity of the plant extracts was assessed. In vivo antidiabetic potential was determined in alloxan-induced diabetic mice to assess glycated hemoglobin (HbA1c), oral glucose tolerance, serum amylase, lipid profile, fasting blood glucose, and body weight. Histopathological lesions of the pancreas, liver and kidney were observed. Oxidative stress biomarkers such as superoxide dismutase, catalase and peroxidase were also determined. Results: Quercetin, chlorogenic acid, p-coumaric acid, and m-coumaric acid were found in the plant extracts. The methanolic plant extract exhibited higher in vitro antioxidant activities than the ethyl acetate extract. Moreover, methanolic plant extract exhibited (83.90±1.56)% α-Amylase inhibitory activity at 3.2 mg/ mL concentration. Animal study showed that the methanolic extract of T. hirsuta improved the levels of fasting blood glucose, HbA1c, serum α-Amylase, lipid profile, liver function biomarkers, and kidney functions of diabetic mice. Moreover, the methanolic extract ameliorated diabetes-related oxidative stress by increasing superoxide dismutase and catalase activities and decreasing peroxidase and malondialdehyde levels. Histopathological examination showed that the plant extract had improved the integrity of pancreatic islets of Langerhans and reduced the pathological lesions in the liver and kidney of diabetic mice. Conclusions: The methanolic extract of T. hirsuta exhibits pronounced antidiabetic activity in mice through reduction of oxidative stress. The plant extract has several natural antioxidants such as phenolic acids. T. hirsuta extract could serve as a nutraceutical for managing diabetes mellitus.

Tylophora hirsuta L. leaf extract attenuates alloxan-induced diabetes in mice by suppressing oxidative stress and α-Amylase

Objective: To evaluate the antidiabetic potential of leaf extracts of Tylophora hirsuta (T. hirsuta). Methods: The methanolic and ethyl acetate extracts of T. hirsuta leaves were analyzed by high pressure liquid chromatography. In vitro antioxidant activity was determined by ferric ion reduction, 1, 1-diphenyl-2-picrylhydrazyl, and hydrogen peroxide scavenging methods. In vitro alpha amylase (α-Amylase) inhibitory activity of the plant extracts was assessed. In vivo antidiabetic potential was determined in alloxan-induced diabetic mice to assess glycated hemoglobin (HbA1c), oral glucose tolerance, serum amylase, lipid profile, fasting blood glucose, and body weight. Histopathological lesions of the pancreas, liver and kidney were observed. Oxidative stress biomarkers such as superoxide dismutase, catalase and peroxidase were also determined. Results: Quercetin, chlorogenic acid, p-coumaric acid, and m-coumaric acid were found in the plant extracts. The methanolic plant extract exhibited higher in vitro antioxidant activities than the ethyl acetate extract. Moreover, methanolic plant extract exhibited (83.90±1.56)% α-Amylase inhibitory activity at 3.2 mg/ mL concentration. Animal study showed that the methanolic extract of T. hirsuta improved the levels of fasting blood glucose, HbA1c, serum α-Amylase, lipid profile, liver function biomarkers, and kidney functions of diabetic mice. Moreover, the methanolic extract ameliorated diabetes-related oxidative stress by increasing superoxide dismutase and catalase activities and decreasing peroxidase and malondialdehyde levels. Histopathological examination showed that the plant extract had improved the integrity of pancreatic islets of Langerhans and reduced the pathological lesions in the liver and kidney of diabetic mice. Conclusions: The methanolic extract of T. hirsuta exhibits pronounced antidiabetic activity in mice through reduction of oxidative stress. The plant extract has several natural antioxidants such as phenolic acids. T. hirsuta extract could serve as a nutraceutical for managing diabetes mellitus.

Dexibuprofen: Statistical assessment of drug release kinetics and investigative quality perspective

Healthcare professionals including physicians and pharmacists have been trying since long to come across and work out regarding the issue of generic alternatives, which is highly affected by factors like therapeutic efficacy, cost effectiveness, aesthetic and elegant appearance and implementation of packaging number over the drug product. However, the community pharmacist professionals are also facing difficulty in making decision regarding selection and dispensing the most efficacious brand to the patients. In this regard, the initiation of recent approaches for the development of amenable drug products has led to evolve the concept of generating new avenues for achieving higher patient compliance. Hence, the objective of this study was to evaluate the quality attributes and make comparisons regarding different brands of Dexibuprofen available in market of Karachi, Pakistan. The study is based on evaluation of physical chemical parameters of five different brands. Moreover, a comparative dissolution profile of selected brands of Dexibuprofen was also performed by applying numerous approaches. DEX-1was selected as reference while DEX-2-DEX-5was selected as test brands. Results of all the selected brands met all the compendial requirements. Interpretation of the entire aforementioned test was evaluated using model independent, model- dependent and one - way ANOVA. The work presented in this study has been designed to provide quality standard products easily accessible in Pakistani market

relationship of dyspnea and disease severity with anthropometric indicators of malnutrition among patients with chronic obstructive pulmonary disease

Objective: To find the association of dyspnea and disease severity with anthropometric indicators of malnutrition among chronic obstructive pulmonary disease patients

Methods: The cross-sectional analytical study was carried out at Sir Ganga Ram Hospital, Lahore during October 2013 to December 2014. Total 138 adult patients with severe COPD were enrolled. The severity of disease was measured by global initiative for chronic obstructive lung disease criteria; and dyspnea was assessed by modified medical research council dyspnea scale. Anthropometric indicators of malnutrition such as body mass index [BMI] and mid upper arm circumference [MUAC] were measured to evaluate the nutritional status of COPD patients. Data was analyzed by using Statistical Package for Social Sciences version 20

Results: The mean age of 138 patients was 55±3 years. The frequency of male patients [76.8%] was threetimes higher than female patients [23.2%]. The overall frequency of underweight patients measured by BMI was 44%, which was increased to 92% undernourished patients by using MUAC. When compared with female patients, the male patients showed lower means of BMI, MUAC, FEV1% and FEV1/FVC ratio. The significant relationship of high grade dyspnea with BMI [p=0.001], and MUAC [p=<0.001] revealed that malnourished COPD patients had more shortness of breathing as compared to normal-weight patients. Similarly, the association of FEV1% with BMI [p=0.001], and MUAC [p=<0.001] showed that malnourished patients had very severe type of COPD than normal-weight patients

Conclusion: Dyspnea and severity of disease had significant association with BMI and MUAC among COPD patients. Thus, assessment of nutritional status by measuring BMI and MUAC should be considered to predict the severity of disease among adult COPD patients

Frequency of nasal carriage of Staphylococcus Aureus among health care workers at a Tertiary Care Hospital

Objective: To determine the frequency of Methicillin resistance staphylococcus aureus [MRSA] and identification of drug susceptibility for MRSA isolates among health care workers [HCWs] of a tertiary care hospital of South Punjab Pakistan

Methods: We included 225 HCWs including laboratory staff, doctors, nurses and paramedical staff in this cross-sectional study. The study was conducted in Nishtar medical university/Hospital Multan. The study duration was July-2016 to April-2017. HCWs having no signs of infections and any other systemic disease were included in this study. We used sterile nasal swab sticks for sample collection for determination of S. aureus prevalence. All these samples were processed in the laboratory for MRSA, methicillin sensitive S. aureus (MSSA) and for antimicrobial sensitivity of S. aureus. Chi-square test was used for comparison of frequency of MRSA and MSSA between different HCWs by assuming p-Value

Results: There were 65.3 percent [147] female participants and only 34.7 percent [78] male participants. S. aureus was diagnosed in the nasal flora of 24 percent [54] participants, out of which 9.3 percent [21] were MRSA positive and remaining 14.7 percent [33] were MSSA positive. There was no significant difference in frequency of MRSA and MSSA among different HCWs [p-value 0.79]. Amikacin and vancomycin were 100 percent sensitive for MRSA and MSSA. Clindamycin and ciprofloxacin was 80.9 percent [17] and 71.4 percent [15] sensitive for MRSA and 100 percent and 84.8 percent [28] for MSSA respectively. While oxacillin and Cefoxitin were 100 percent [21] resistant for MRSA and sensitive for MSSA

Conclusion: Prevalence of MRSA and MSSA is high among HCWs in Pakistan. Amikacin, vancomycin and clindamycin have high sensitivity for MRSA and can be used for empirical treatment of MRSA in suspected patients

Spectrophotometric method development and validation for determination of chlorpheniramine maleate in bulk and controlled release tablets

Spectrophotometric technique is considered to be the simplest and operator friendly among other available analytical methods for pharmaceutical analysis. The objective of the study was to develop a precise, accurate and rapid UV-spectrophotometric method for the estimation of chlorpheniramine maleate [CPM] in pure and solid pharmaceutical formulation. Drug absorption was measured in various solvent systems including 0.1N HCl [pH 1.2], acetate buffer [pH 4.5], phosphate buffer [pH 6.8] and distil water [pH 7.0]. Method validation was performed as per official guidelines of ICH, 2005. High drug absorption was observed in 0.1N HCl medium with lambdamax of 261nm. The drug showed the good linearity from 20 to 60microg/mL solution concentration with the correlation coefficient linear regression equation Y= 0.1853 X + 0.1098 presenting R2 value of 0.9998. The method accuracy was evaluated by the percent drug recovery, presents more than 99% drug recovery at three different levels assessed. The % RSD value

Frequency of macroprolactin in hyperprolactinemia

Objective: To determine the frequency of Macroprolactin [MaPRL] in patients with increased total prolactin and its clinical and financial impact

Study design: Cross-sectional study

Place and duration of study: Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from March to May 2015

Methodology: Patients with high total prolactin were screened by polyethylene glycol [PEG] precipitation for determination of MaPRL. Clinical history, imaging work-ups, and cost incurred in further investigations were collected by telephonic interview after verbal consent. Patients were stratified into true hyperprolactinemia and macroprolactinemia after PEG treatment, based on monomeric prolactin levels. Medical records of cases registered with AKUH were reviewed to confirm the diagnosis

Results: Two hundred and thirty-nine patients were identified with high prolactin levels. Macroprolactinemia was identified in 145 [60.7%] and true hyperprolactinemia in 94 [39.3%] patients. Galactorrhea was significantly more in true hyperprolactinemic females [p=0.022], followed by visual disturbances [p=0.01] and headache [p=0.006]. Moreover, as majority of population were females, the clinical features in the macroprolactinemia group as compared to true hyperprolactinemic group were mostly related to non-pituitary causes like drug intake [42.5% [54] vs. 37% [30]], heat intolerance due to thyroidal illness [41.7% [53] vs. 38.3% [31]] and surgery [26.8% [34] vs 22.2% [18]] in females. Further radiological workup [MRI, CT] were conducted in 35 [37.2%] patients with true hyperprolactinemia. Twenty-one [60%] of the patients were confirmed to have pituitary adenomas. In eight [5.5%] patients with MaPRL, only one had pituitary microadenoma on radiological workup. Total cost impact on the basis of investigations, was significantly higher in the group undergone imaging, despite 7 out of 8 individuals found to have normal imaging results. The median total cost in true hyperprolactinemic group undergone imaging was Rs. 4370 [IQR=2412.5, 22850] as compared to macroprolactinemic groups; Rs. 3,250 [IQR=2150, 4278]. There was significant difference in the cost burden of both the groups [p <0.001]

Conclusion: High frequency of MaPRL was identified in patients with hyperprolactinemia. Screening with PEG precipitation in hyperprolactinemic sera is simple and cost-effective

Elective division of ilioinguinal nerve in inguinal hernioplasty: remedy for the morbid postoperative inguinal pain

Objective: To compare the postoperative pain in inguinal hernioplasty, by preserving versus wide elective division of ilioinguinal nerve. Study Design: Randomized controlled trial. Place and Duration of Study: Surgical Department, Civil Hospital, Karachi, from January till August 2015

Methodology: All patients of either gender above 15 years of age, undergoing mesh repair for unilateral, reducible inguinal hernia, were included. Patients with recurrent inguinal hernia, bilateral inguinal hernia, and those who will require emergency hernia surgeries like irreducible, obstructed, and strangulated hernia, were excluded. They were randomly assigned 42 into inguinal nerve preservation group [group A] and 42 in division [group B]. Postoperative pain was assessed at first day, at discharge and after one month using visual analogue scale

Results: There were a total of 84 patients. Group A patients had median [IQR] pain scores of 5 [1] and 3 [2] as compared to group B pain scores of 4 [2] and 2 [1] at 24 hours of surgery and at discharge, respectively [p<0.05]. Median [IQR] postoperative pain score one month after inguinal hernioplasty was 2.5 [1] in group A, while 0.5 [1] in group B [p<0.05]. A significant decline in the pain scores were observed in group B from the first day of surgery till one month afterwards [p<0.05]

Conclusion: Wide resection of ilioinguinal nerve has a lower frequency of postoperative pain in comparison to the ilioinguinal nerve preservation, in inguinal hernioplasty

Effectiveness of stretching exercises in symptomatic and asymptomatic phase in primary dysmenorrhoea

Background: Primary dysmenorrhoea is health related problem within females with high prevalence affecting different aspects of their life and their productivity. The objective of the study was to compare the effectiveness of stretching exercises done during symptomatic and asymptomatic phase of menstrual cycle in primary dysmenorrhea

Methods: Randomized controlled trial [RCT] [double blinded] study was carried out at Royal group of colleges Gujranwala, Pakistan. Sixty six students with confirmed diagnosis of primary dysmenorrhoea were included through non-probability convenience sampling. The students were randomly assigned to two equal [n=33] groups: Asymptomatic [A] and Symptomatic [B]. Each student was assessed for pain and associated symptoms of dysmenorrhoea by using numeric pain rating scale and Daily record of severity of problems [DRSP]. Stretching exercises were performed thrice per week for group A which did exercises during asymptomatic phase and same exercises were done twice a day for group B only in symptomatic days. Both groups did exercises for three months. Data was taken at baseline and post menstrual phase of three successive menstrual cycles. The data was analyzed using SPSS 20. An independent samples t test was used to compare both groups and repeated measures ANOVA was used to find the intervention-based effects within each group

Results: Mean age of students was 21.29+/-2.60 [Year], mean weight was 52.70+/-4.81 [Kg], mean age at menarche was 13.18+/-1.11 [Year] and mean BMI was 16.87+/-0.81 [Kg/m2 ]. Both groups were comparable at baseline for age, weight, BMI and age at menarche as p>0.05. Significant changes for pain and associated symptoms were found within each group [p>0.05]

Conclusion: It is concluded that stretching exercises in symptomatic phase and asymptomatic phase are equally effective to relieve pain and associated symptoms of Primary Dysmenorrhoea

Corneal complications of vernal Kerato-conjunctivitis

Objective: to determine the magnitude and types of corneal complications of Vernal Kerato Conjunctivitis [VKC] and their effects on vision

Study design: descriptive case-series

Place and duration: this study was conducted from September 2007 to January 2009 at three institutions in Karachi; Department of Ophthalmology, Dow University of Health Sciences and Civil Hospital, Baqai Medical University Hospital and Sindh Government Qatar Hospital Orangi Town

Methodology: all cases of vernal kerato-conjunctivitis presenting from the different areas of Karachi was included in the study. The diagnosis was made mainly on the basis of history and clinical examination

Results: total 200 patients were examined. Superficial punctate keratitis was the most common corneal complication [46%]. Visual impairment was more pronounced in case of Schield ulcer [16%] and corneal plaques [8%]. Association with keratoconus [13%] was also noted. Corneal opacification [13%] and psuedogerontoxon [4%] were also observed

Conclusion: severe corneal complications of vernal kerato-conjunctivitis [VKC] were observed. Superficial punctate keratitis was the most common. Other complications are potentially serious causing visual impairment

Major ocular trauma: an analysis of 98 cases

Ocular trauma [OT] is a common but preventable disease. A total of 102 eyes with OT involving 98 admitted patients were analyzed in a retrospective study spanning over a period from Jan. 2001 to Jan. 2004 in Ophthalmology Unit II of Civil Hospital, Karachi. The aims of the study were to identify etiological factors, to assess the visual outcome and to explore possible methods of reduction of OT in our setting. Out of the 98 patients, 92 [93.88%] were males and the commonest age group involved was 11-30 years with 64 [65.30%] cases. OT most frequently [72.44%] occurred in out-door cases, mostly from sharp objects [68.36%], followed by blunt objects [26.53%] and intra-ocular foreign bodies [3.06%]. Primary enucleation was done in four cases, and the patients were followed-up for a mean period of 20 months. Phthisis bulbi occurred in two patients, but none developed sympathetic ophthalmitis, siderosis bulbi or post-operative infections. Predictors of better visual outcome i.e. visual acuity [VA] 6/12 or better were initial VA of hand movement, wound location anterior to the plane of insertion of recti, wound length of 10mm or less, and sharp injuries. Even blunt trauma when tackled urgently and methodically gives excellent final visual outcome. Major causes of decreased VA were astigmatism, central corneal scar and central retinal injury. This study has identified that OT requiring hospital admission remains a serious problem. Prevention, as the optimum management of trauma, should however remain a priority in order to reduce morbidity and costs

Oral hygiene status and brushing practices of individuals with sensory and physical disabilities in Lahore, Pakistan

Objective: this study was designed to determine the oral hygiene status and brushing habits of individuals with special needs having sensory and physical disabilities in Lahore, and compare the results with an age- and gender-matched healthy control group

Materials and methods: a cross-sectional descriptive study was conducted and a convenience sample of 300 individuals including 200 individuals with special needs having sensory and physical disabilities and 100 healthy control individuals with mean age of 11.49 +/- 2.961 years [age range: 6-17 years] was selected for the study. The oral hygiene status was determined utilizing the Simplified Oral Hygiene Index. Information regarding the brushing habits was obtained through an especially designed questionnaire. Study groups were selected from three special education institutions and one school for normal individuals from Lahore. All the subjects belonged to the low socioeconomic group

Results: the mean OHI [S] score for the complete sample was 2.0780 +/- 1.46470. Mean OHI [S] values for control individuals were significantly lower than that for individuals with sensory and physical disabilities. When the OHI [S] scores of individuals were analyzed based on the groups i.e. normal, sensory disabled and physically disabled, the difference was statistically significant [p <0.05]. Physically disabled persons were having significantly higher mean OHI [S] values than the sensory disabled group. Among individual classes of people with sensory disabilities, blind, individuals with uncontrolled reflexes and cerebral palsy were having the highest mean OHI [S] values. Data regarding the brushing practices suggested that normal individuals were more regular in brushing teeth as compared to individuals with sensory and physical disabilities. The difference was statistically significant [p < 0.05]. No significant age and sex differences were found in the oral hygiene and brushing practices of normal and special needs categories

Conclusions: oral hygiene status of special needs group was significantly poorer than that of control group. Among the individual classes of special needs group, blind individuals in the sensory disabled and individuals uncontrolled reflexes were having the worst oral hygiene status. The individuals with special needs were having more irregular brushing habits as compared to the control group

Narcotics and their toxic behaviour

Narcotics have been a matter of great concern and pose increasing threats and dangers to humanity. The lack of awareness and knowledge about the abused drugs has further aggravated the situation. Various aspects of the addictive chemicals have been studied and the introductory notes on the major abused drugs, amphetamine 1, methamphetamine 2, 2, 5-dimethoxy-4-methylamphetamine 3, mescaline 4, cocaine 5, morphine 6, heroin 7, codeine 8, diazepam 9, pencyclidine 10, 1-piperidinocyclohexane cardonitrile 11, methaqualone 12, delta9- tetrahydrocannabinol 13 and methadone 14 have been presented. The pharmacological behaviour of the abused drugs are, as well, being discussed