Impacto da avaliação nutricional precoce e intervenção em pacientes com cirrose hepática / Evaluating the impact of early nutritional assessment and intervention in hospitalized liver cirrhosis patients

ABSTRACT Background Malnutrition is common in liver cirrhosis patients that is correlated with early complications, morbidity and mortality. Objective The purpose of the study was to assess nutritional status, impact of nutritional screening and intervention in liver cirrhosis patients by evaluating their actual energy and protein intake during hospital stay. Methods A cross sectional study was conducted wherein all patients' nutritional status was defined by Subjective Global Assessment tool. Adequate energy and protein supply were planned and executed by using individualized nutritional plan for patients with dietitian's collaboration. Anthropometric measurements included height, weight, body mass index, mid upper arm circumference, hand grip strength and triceps skin-fold thickness. Biochemical tests included haemoglobin, mean corpuscular haemoglobin, volume and concentration, albumin and liver function tests. To record the daily food intake, a 24-hour dietary recall was used. Results Overall 83 patients (mean age 55) were included, among them 46% of patients were moderately malnourished, 12% were normal, while 42% of cirrhotic patients were severely depleted according to Subjective Global Assessment. The mean intake of calories and protein was improved during stay in hospital after nutritional intervention and critical monitoring (P<0.05). Anthropometric measurements at baseline and discharge showed significant differences (P <0.05) in weight, body mass index, triceps skin fold thickness and mid upper arm circumference values, but not in hand grip strength that was associated with malnourishment among patients. Conclusion Providing individualized nutritional intervention and its monitoring by qualified dietitians during hospital stay helps to improve intake in patients that prevent further risk of malnutrition and related complications.

RESUMO Contexto A desnutrição é comum em pacientes com cirrose hepática e está correlacionada com complicações precoces, morbidade e mortalidade. Objetivo O objetivo do estudo foi avaliar o estado nutricional, o impacto da triagem nutricional e a intervenção em pacientes com cirrose hepática, avaliando sua ingestão real de energia e proteína durante a internação hospitalar. Métodos Foi realizado um estudo transversal em que o estado nutricional de todos os pacientes foi definido pela ferramenta de Avaliação Global Subjetiva. O fornecimento adequado de energia e proteína foi planejado e executado por meio de plano nutricional individualizado para pacientes com colaboração de nutricionista. As medidas antropométricas incluíram: altura, peso, índice de massa corporal, circunferência do braço médio, força de aderência da mão e espessura da dobra da pele tríceps. Os testes bioquímicos incluíram: hemoglobina, volume e concentração da hemoglobina corpuscular média, albumina e testes de função hepática. Para registrar a ingestão diária de alimentos, foi utilizado um recall dietético de 24 horas. Resultados Ao todo foram incluídos 83 pacientes (média de 55 anos), entre eles 46% dos pacientes estavam moderadamente desnutridos, 12% estavam normais, enquanto 42% dos pacientes cirróticos estavam severamente depletados de acordo com a Avaliação Global Subjetiva. A ingestão média de calorias e proteínas foi melhorada durante a internação hospitalar após intervenção nutricional e monitoramento crítico (P<0,05). As medidas antropométricas na linha de base e descarga apresentaram diferenças significativas (P< 0,05) em peso, índice de massa corporal, espessura da dobra da pele do tríceps e valores médios de circunferência do braço, mas não na força de aderência da mão que estava associada à desnutrição entre os pacientes. Conclusão Proporcionar intervenção nutricional individualizada e seu acompanhamento por nutricionistas qualificados durante a internação hospitalar ajuda a melhorar a ingestão em pacientes que previnem maior risco de desnutrição e complicações relacionadas.

Misconceptions, Hesitancy and Efficacy of COVID19 Vaccination in Dental Surgeons Working in A Teaching Dental Hospital, Peshawar

@#The objective of this study was to assess misconceptions, hesitancy and efficacy of COVID-19 Vaccine among Faculty, House Officers (HO) and Postgraduates (PG) dental trainees towards the novel COVID-19 vaccine and to assess the association between COVID-19 vaccine acceptance and conspiracy beliefs. A cross sectional study was conducted on 150 participants from Sardar Begum Dental hospital, Peshawar, Khyber Pakhtunkhwa. A self-administered questionnaire was developed with questions related to perception of participants regarding misconceptions, safety, hesitancy and efficacy of COVID-19 Vaccination. The questionnaire comprised of 26 closed-ended questions. Data was analyzed using SPSS statistical package 26.0. More than half of the participants (87.3%) reported to be tested positive for COVID-19 at some point. Majority of participants (87.3%) reported that they were vaccinated and 86.7% reported that they had post-vaccination reactions such as pain in arm, fever and body aches. A notable number of participants that were part of the study believed in the misconceptions related to the COVID-19 vaccine. This study concluded that despite widespread vaccination awareness campaigns, significant number of dental surgeons believed in misconceptions regarding COVID-19 vaccination that may pose a significant challenge to Pakistan's COVID-19 immunization program.

Therapeutic potential of medicinal plants against Leishmaniasis: a public healh concern / Potencial terapeútico de plantas medicinales contra la Leishmaniasis: un problema de salud pública

Leishmaniasis is an important disease affecting global public health which is spread by sand fly having different species. Various chemical drugs are used to treat and control Leishmaniasis including pentavalent antimonials, antimicrobial and antibiotics. Due to emergence of drug resistance, these therapeutic options are losing effectiveness in attaining success. Furthermore, these drugs are expensive and have toxic effects on liver and kidneys. There has been an emerging interest and excellent response by using plant based drugs and extracts to control Leishmaniasis. Different medicinal plants including Glycyrrhiza glabra, Allium sativum, Peganum harmala and Nigella sativa have shown excellent anti-leishmanial activity. Therefore, medicinal plants can help in effective drug development against Leishmaniasis diseases in both animals and humans which will be safer and health protective.

La Leishmaniasis es una enfermedad importante que afecta la salud pública mundial y que es transmitida por las moscas de la arena, que tienen diferentes especies. Se utilizan varios medicamentos químicos para tratar y controlar la Leishmaniasis, incluidos los antimoniales pentavalentes, antimicrobianos y antibióticos. Debido a la aparición de resistencia a los medicamentos, estas opciones terapéuticas están perdiendo eficacia para lograr el éxito. Además, estos medicamentos son costosos y tienen efectos tóxicos en hígado y riñones. Ha habido un interés emergente y una excelente respuesta mediante el uso de extractos y medicamentos a base de plantas para controlar la Leishmaniasis. Diferentes plantas medicinales como Glycyrrhiza glabra, Allium sativum, Peganum harmalay Nigella sativahan mostrado una excelente actividad anti-leishmanial. Por lo tanto, las plantas medicinales pueden ayudar en el desarrollo de fármacos eficaces contra las enfermedades de la leishmaniasis tanto en animales como en seres humanos, lo que será más seguro y proteja la salud.

Anticancer effect of Psidium guajava (Guava) leaf extracts against colorectal cancer through inhibition of angiogenesis

Objective: To evaluate the anti-angiogenic and anticancer activities of Psidium guajava leaf extracts against angiogenesis-dependent colorectal cancer. Methods: Three extracts were produced using distilled water, ethanol, and n-hexane as solvents. The extracts were physically characterised through gas chromatography-mass spectrometry, ultraviolet-visible spectroscopy, and Fourier transform infrared spectroscopy. Their antioxidant activity was evaluated using the 2,2-diphenyl-1-picrylhydrazyl, total phenolic content, and total flavonoid content assays. To assess their anti-angiogenic activity, cell viability and rat aortic ring assays were conducted, while cell migration, tube formation, colony formation, and VEGF ELISA assays were conducted to elucidate their effects on different aspects of angiogenesis. Molecular docking was used to assess the anti- angiogenic potential of some possible compounds in the extracts. Tumour spheroid assay was used to assess the extracts' potential as a treatment for colorectal cancer. Results: The ethanol extract showed the best antioxidant activity. The distilled water and ethanol extracts exhibited more inhibitory activity against EA.hy926 cell viability and aortic ring microvessel growth. In addition, the ethanol extract performed significantly better than the distilled water extract against cell migration and colony formation, and VEGF expression of the cells was suppressed by the ethanol extract. Both the distilled water and ethanol extracts showed significant inhibitory effect on EA.hy926 tube formation and tumour spheroids consisting of EA.hy926 and HCT116 cells. The ethanol extract contained β-caryophyllene and β-elemene by phytochemical analysis and subsequent docking studies, which may contribute to its anti-angiogenic activity. Conclusions: The ethanol extract of Psidium guajava has potential in the treatment of colorectal cancer through the inhibition of angiogenesis.

Potential of botanical driven essential oils against Haemonchus contortus in small ruminants / Potencial de aceites esenciales botánicos contra Haemonchus contortus en pequeños rumiantes

The livestock sector is continuously facing problems in controlling parasitic diseases especially Haemonchosis due to emergence of anthelminthic resistance and failure in vaccination control programmes. Therefore, to increase milk and meat production and emerging demand of meat free from drug residues development of new alternative approaches are appealing for prevention and control of Haemonchosis in small ruminants. Among alternatives, plants driven essentials oils have shown promising results in control of Haemonchus contortus infection at various concentrations by different assays including egg hatch assay, larval development assay, larval exsheathment assay and adult motility assay. Essential oils are complex mixtures of various impulsive or volatile compounds which have potential to control Haemonchosis. The current study reviews the therapeutic effects of essential oils of plants against Haemonchus contortus and to be used them against Haemonchus contortus for future perspectives.

El sector ganadero enfrenta continuamente problemas para controlar las enfermedades parasitarias, especialmente la hemoncosis, debido a la aparición de resistencia antihelmíntica y al fracaso en los programas de control de vacunación. Por lo tanto, para aumentar la producción de leche y carne, y la demanda emergente de carne libre de residuos de medicamentos, el desarrollo de nuevos enfoques alternativos es atractivo para la prevención y el control de la hemoncosis en pequeños rumiantes. Entre las alternativas, los aceites esenciales producidos por las plantas han mostrado resultados prometedores en el control de la infección por Haemonchus contortus a diversas concentraciones mediante diferentes ensayos, incluido el análisis de eclosión de huevos, el desarrollo de larvas, el análisis de vaciado de larvas y el ensayo de motilidad en adultos. Los aceites esenciales son mezclas complejas de varios compuestos impulsivos o volátiles que tienen potencial para controlar la hemonchosis. Este estudio revisa los efectos terapéuticos de los aceites esenciales de las plantas contra Haemonchus contortus y evalúa sus perspectivas futuras como agentes para combatir las enfermedades causadas por este parásito.

A Comparison of Sensitivity and Specificity of AST to Platelet Index (APRI) and FIB-4 with Transient Elastography i.e. Fibro Scan in Chronic HCV Infected Patients

Background: Hepatitis C is a leading cause of liver fibrosis, cirrhosis, and cirrhosis associated complications. In this study, we compared readily available non-invasive fibrosis indexes with fibro scans for fibrosis staging and predicting its progression in Pakistani population. Methods: The retro prospective cross-sectional study was conducted in medicine unit 1 and 2 and hepatitis clinic of Lahore General Hospital, Lahore starting from February 12, 2018 to January 8, 2019. We studied 1464 HCV infected patients which were got CBC, LFTs, ELISA, PCR and fibro scan was done to perfectly diagnose ongoing hepatitis C infection. In order to differentiate HCV fibrosis progression, we compared the effectiveness of readily available AST to Platelet Index (APRI), and FIB-4 with fibro scan. Results: Readily available serum indexes AST to Platelet Index (APRI) and FIB-4 were able to stage liver fibrosis in advanced stages of fibrosis (F4 especially) with correlation coefficient indexes 0.462, and 0.131 with considerable specificities and sensitivities. For APRI >1.5, it did predict F4 stage with sensitivity of 87.6% and specificity of 74.8%. For Fib-4> 3.25, it did predict F4 stage with sensitivity of 72.3% and specificity of 53.2%. Conclusion: Readily available and cheap serum indexes, AST to Platelet Index (APRI) and FIB-4 accurately predicted distinguished between cirrhotic and non- cirrhotic stages in HCV infected patients in comparison to the costly and rarely available Fibro scan score.

Plasmid-mediated mcr-1 gene in acinetobacter baumannii and pseudomonas aeruginosa: first report from pakistan

Abstract INTRODUCTION: The increased use of colistin against infections caused by Acinetobacter baumannii and Pseudomonas aeruginosa has resulted in colistin resistance. The purpose of this study was to detect plasmid-mediated mcr-1 gene in colistin-resistant A. baumannii and P. aeruginosa isolates. METHODS: A total of 146 clinical isolates of A. baumannii (n = 62) and P. aeruginosa (n = 84) were collected from the four largest tertiary care hospitals in Peshawar, Pakistan. All bacterial isolates were phenotypically screened for multidrug resistance using the Kirby-Baur disc diffusion method. The minimum inhibitory concentration (MIC) of colistin in all isolates was phenotypically performed using dilution methods. mcr-1 gene was detected through polymerase chain reaction and the nucleotide sequence of amplicon was determined using Sanger sequencing. RESULTS: Approximately 96.7% A. baumannii and 83.3% P. aeruginosa isolates were resistant to multiple antibiotics. Colistin resistance was found in 9.6% (6/62) of A. baumannii and 11.9% (10/84) of P. aeruginosa isolates. Among 16 colistin resistant isolates, the mcr-1 gene was detected in one A. baumannii (1.61% of total isolates; 16.6% of colistin resistant isolates) and one P. aeruginosa strain (1.19% of total isolates; 10% of colistin resistant isolates). Nucleotide BLAST showed 98-99% sequence similarity to sequences of the mcr-1 gene in GenBank. CONCLUSIONS: Our study reports, for the first time, the emergence of plasmid-mediated mcr-1-encoded colistin resistance in multidrug resistant strains of A. baumannii and P. aeruginosa. Further large scales studies are recommended to investigate the prevalence of this mode of resistance in these highly pathogenic bacteria.

Cross-sectional epidemiological investigations of Giardia lamblia in children in Pakistan

ABSTRACT BACKGROUND: The prevalence of Giardia lamblia in Pakistani children is currently unknown. The aim here was to evaluate the prevalence and risk factors of Giardia lamblia in children exhibiting diarrhea. DESIGN AND SETTING: Cross-sectional study at different district healthcare hospitals in Pakistan. METHODS: A total of 800 samples were collected from children aged 0-10 years. Information regarding personal data, demographic data and supposed risk factors was collected through a structured questionnaire. Giardia lamblia was detected through direct microscopy and antigens through the enzyme-linked immunosorbent assay (ELISA). RESULTS: The prevalence of Giardia lamblia was 2.75% through direct microscopy and inflated to 9.5% through ELISA. The demographic factors positively associated with occurrences of giardiasis were age (P = 0.035; odds ratio, OR = 1.96; 95% confidence interval, CI = 1.094-3.533), mother's educational level (P = 0.031; OR = 2.67; 95% CI = 1.186-6.045) and father's educational level (P = 0.004; OR = 3.56; 95% CI = 1.612-7.899). Similarly, among the supposed risk factors, rural residency (P = 0.032; OR = 1.76; 95% CI = 1.098- 2.851), absence of proper sewerage system (P = 0.000; OR = 6.60; 95% CI = 4.029-10.841) and unavailability of safe drinking water (P = 0.000; OR = 4.08; 95% CI = 2.207-7.547) were the factors strongly connected with giardiasis. Abdominal discomfort was a prominent clinical sign with 46% frequency. CONCLUSION: Various risk factors were associated with occurrences of Giardia, thus emphasizing the importance of parents' education, safe drinking water and proper sewerage systems for Pakistani children's health.

Acaricidal and insecticidal effects of essential oils against ectoparasites of veterinary importance / Efectos acaricidas e insecticidas de los aceites esenciales contra los ectoparásitos de importancia veterinaria

Ectoparasitism in animals has become an issue of great concern that needs to be resolved to prevent huge economic losses occurring to livestock industry all over the world. Synthetic adrugs have been playing a major role in controlling ectoparasites, but their frequent and irrational use has resulted in drug resistance to routinely used chemicals and their residual effects on food and environment. Therefore, this approach of using chemical acaricides and insecticides is losing its popularity and effectiveness in controlling ectoparasites. So, the development of alternative approaches in ectoparasite management is currently required. Among alternative protocols, plants and their essential oils have played remarkable role in controlling different ectoparasites (ticks, flies, mites, lice) of veterinary importance. Essential oils have been proved to be cheaper, more effective and safer therapeautic agents against different ectoparasites of livestock importance.

En los animales el ectoparasitismo se ha convertido en un tema de gran preocupación que debe resolverse para evitar que se produzcan grandes pérdidas económicas para la industria ganadera en todo el mundo. Los aditivos sintéticos han desempeñado un papel importante en el control de los ectoparásitos, pero su uso frecuente e irracional ha dado como resultado la resistencia a los fármacos utilizados habitualmente y efectos residuales sobre los alimentos y el medio ambiente. Por lo tanto, el enfoque basado en el uso de acaricidas e insecticidas químicos está perdiendo popularidad y efectividad en el control de los ectoparásitos. Por lo tanto, actualmente se requiere el desarrollo de enfoques alternativos en el manejo de ectoparásitos. Entre los protocolos alternativos, las plantas y sus aceites esenciales han jugado un papel notable en el control de diferentes ectoparásitos (garrapatas, moscas, ácaros, piojos) de importancia veterinaria. Se ha demostrado que los aceites esenciales son agentes terapéuticos más baratos, más efectivos y más seguros contra diferentes ectoparásitos de importancia ganadera.

Mid-upper-arm circumference as a screening measure for identifying children with elevated body mass index: a study for Pakistan / 소아과

PURPOSE: Mid-upper-arm circumference (MUAC) is considered an alternative screening method for obesity. The aims of this investigation were to examine the ability of MUAC to correctly identify children with elevated body mass index (BMI) and to determine the best MUAC cutoff point for identification of children with high BMI. METHODS: Anthropometric measurements (height, weight, and MUAC) from a cross-sectional sample of 7,921 Pakistani children aged 5–14 years were analyzed. Pearson correlation coefficients between MUAC and other anthropometric measurements were calculated. Receiver operating characteristic curve analysis was used to determine the optimal MUAC cutoff point for identifying children with high BMI. RESULTS: Among 7,921 children, the mean (±standard deviation) age, BMI, and MUAC were 10.00 (±2.86 years), 16.16 (±2.66 kg/m2), and 17.73 (±2.59 cm), respectively. The MUAC had a strong positive correlation with BMI. The optimal MUAC cutoff points indicating elevated BMI in boys ranged from 16.76 to 22.73, while the corresponding values in girls ranged from 16.38 to 20.57. CONCLUSION: MUAC may be used as a simple indicator of overweight/obesity in children, with reasonable accuracy in clinical settings.

Combined application of bio-organic phosphate and phosphorus solubilizing bacteria (Bacillus strain MWT 14) improve the performance of bread wheat with low fertilizer input under an arid climate

Abstract This study was aimed to investigate the effect of bio-organic phosphate either alone or in combination with phosphorus solubilizing bacteria strain (Bacillus MWT-14) on the growth and productivity of two wheat cultivars (Galaxy-2013 and Punjab-2011) along with recommended (150100 NP kg ha1) and half dose (7550 NP kg ha1) of fertilizers. The combined application of bio-organic phosphate and the phosphorous solubilizing bacteria strain at either fertilizer level significantly improved the growth, yield parameters and productivity of both wheat cultivars compared to non-inoculated control treatments. The cultivar Punjab-2011 produced the higher chlorophyll contents, crop growth rate, and the straw yield at half dose of NP fertilizer; while Galaxy-2013, with the combined application of bio-organic phosphate and phosphorous solubilizing bacteria under recommended NP fertilizer dose. Combined over both NP fertilizer levels, the combined use of bio-organic phosphate and phosphorous solubilizing bacteria enhanced the grain yield of cultivar Galaxy-2013 by 54.3% and that of cultivar Punjab-2011 by 83.3%. The combined application of bio-organic phosphate and phosphorous solubilizing bacteria also increased the population of phosphorous solubilizing bacteria, the soil organic matter and phosphorous contents in the soil. In conclusion, the combined application of bio-organic phosphate and phosphorous solubilizing bacteria offers an eco-friendly option to harvest the better wheat yield with low fertilizer input under arid climate.

Analysis of Estrogen receptor [ER] and Progestrone receptor [PR] expression in surface Epithelial Tumors of Ovary and its correlation with their clinical stage

Objective: To evaluate ER and PR expression in epithelial ovarian cancers [EOC] and to determine its association with clinical stage

Study Design: Cross sectional study

Place and Duration of Study: Histopathology department, Armed Forces Institute of Pathology [AFIP] Rawalpindi, from Mar to Oct 2017

Material and Methods: A total of thirty three [n=33] histologically confirmed EOCs were analyzed. ER and PR expression status was assessed by immunohistochemistry using Allred scoring system and was compared with the clinical stage defined by The International Federation of Gynecology and Obstetrics [FIGO] staging system

Results: A total of thirty three [n=33] females were enrolled. Mean age of the study females was 50.8 +/- 12.9 years. Most frequent histologic type was serous carcinoma [SC] 60.6 percent [n=20] followed by mucinous carcinoma [MC] 15.2 percent [n=5], endometrioid carcinoma [EC] 9.1 percent [n=3], clear cell carcinoma [CC] 9.1 percent [n=3], Brenner tumor [MBT] 3 percent [n=1] and seromucinous carcinoma [SMC] 3 percent [n=1]. Most patients were in clinical stage I 61 percent [n=20] followed by stage II 24 percent, [n=8] and stage III 15 percent [n=5]. Among SC, 90.0 percent [n=18/20] were ER and 65 percent [n=13/20] were PR-positive. All MC and CC were ER/PR negative. Two of the three ECs were ER and one was PR-positive. Higher percentage of stage I tumors exhibited ER 65 percent [n=13/20] and PR 45 percent [n=9/20] positive status [p>0.5]. The correlation was very weak positive between clinical stages and both ER and PR scores [Allred] r=0.11 and 0.15 respectively p>0.05

Conclusion: Higher percentages of stage I tumors exhibited ER and PR positive status yet not statistically significant from stage II/III. Estimation of ER and PR receptor status may help to select the women with ovarian malignancy for hormonal therapy, which is more likely to improve the response rate

Combined application of bio-organic phosphate and phosphorus solubilizing bacteria (Bacillus strain MWT 14) improve the performance of bread wheat with low fertilizer input under an arid climate

Abstract This study was aimed to investigate the effect of bio-organic phosphate either alone or in combination with phosphorus solubilizing bacteria strain (Bacillus MWT-14) on the growth and productivity of two wheat cultivars (Galaxy-2013 and Punjab-2011) along with recommended (150-100 NP kg ha−1) and half dose (75-50 NP kg ha−1) of fertilizers. The combined application of bio-organic phosphate and the phosphorous solubilizing bacteria strain at either fertilizer level significantly improved the growth, yield parameters and productivity of both wheat cultivars compared to non-inoculated control treatments. The cultivar Punjab-2011 produced the higher chlorophyll contents, crop growth rate, and the straw yield at half dose of NP fertilizer; while Galaxy-2013, with the combined application of bio-organic phosphate and phosphorous solubilizing bacteria under recommended NP fertilizer dose. Combined over both NP fertilizer levels, the combined use of bio-organic phosphate and phosphorous solubilizing bacteria enhanced the grain yield of cultivar Galaxy-2013 by 54.3% and that of cultivar Punjab-2011 by 83.3%. The combined application of bio-organic phosphate and phosphorous solubilizing bacteria also increased the population of phosphorous solubilizing bacteria, the soil organic matter and phosphorous contents in the soil. In conclusion, the combined application of bio-organic phosphate and phosphorous solubilizing bacteria offers an eco-friendly option to harvest the better wheat yield with low fertilizer input under arid climate.

Extended islanded reverse sural artery flap for staged reconstruction of foot defects proximal to toes

Objective: To assess the outcome of extended delayed reverse sural artery flap for reconstruction of foot defects proximal to toes in terms of flap survival, complication and extended area

Study Design: Case series

Place and Duration of Study: Jinnah Burn and Reconstructive Surgery Centre, Lahore, from February 2015 to April 2017

Methodology: Cases who underwent delayed sural artery flap were inducted. Preoperative hand-held doppler was done to confirm the location of perforator. Two suitable perforators were chosen to raise the extended flap by crossing the proximal limit in all cases. The pedicle was kept minimum 3 cm wide and perfusion was assessed. Flap was delayed for one week and vaccum-assisted closure [VAC] dressing was applied over wound. The second surgery was performed after one week. Proximal perforator was clamped and ligated after checking adequate perfusion of flap. Flap was insetted into defect

Results: Thirty-two patients were reconstructed with delayed reverse sural artery flap. The mean age of the patients was 26.5 +12.2 years. Twenty-four [75%] patients were males and 8 [25%] were females. Twenty-two [68.7%] cases were degloving wounds after road traffic accidents [RTA], 6 [18.7%] were diabetic foot wounds, 4 [12.5%] sustained injury after falling from height and 7 [21.8%] patients had fracture of metatarsals. Twenty-eight flaps were transferred after one week delay, and only in 4 cases, flap were transferred after two weeks. All flaps survived completely. Complications of infection noted in 3 [9.3%] flaps, 3 [9.3%] flaps showed tip necrosis, 2 [6.2%] flaps undergone epidermolysis and only 2 [6.2%] showed venous congestion

Conclusion: Delayed islanded reverse sural artery perforator flap is a reliable and versatile option for resurfacing soft tissue defects of lower limb proximal to the toes with lesser complications and extended coverage area

Anisometropia and refractive status in children with bilateral congenital nasolacrimal duct obstruction

Objective: To evaluate the state of refraction in children with bilateral congenital nasolacrimal duct obstruction [CNLDO]

Study Design: Descriptive study

Place and Duration of Study: Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from April 2014 to April 2016

Methodology: Children with bilateral CNLDO were studied. Patients' refractive status were evaluated by performing cycloplegic refraction, followed by appropriate management plan. The refractive errors of both eyes were noted and compared for any significant anisometropia

Results: One hundred and seventeen [n=117] children with median age [IQR] of 32 [12] months having bilateral CNLDO were enrolled. Children with bilateral CNLDO had insignificant interocular difference in terms of spherical equivalent [SE] and cylindrical refractive errors [p>0.05]. The rate of the anisometropia [>/=1 D difference between the two eyes] was 5.98% [n=7] in children with bilateral CNLDO

Conclusion: Performing cycloplegic refraction routinely in patients with bilateral CNLDO is not as urgent as compared to ones with unilateral CNLDO. Further, avoidance of early surgical intervention in children with bilateral CNLDO will spare the parents from the emotional trauma and positively influence the health economics worldwide

Optimization of antibacterial activity of ethanolic extracts of eucalyptus tereticornis and nigella sativa: response surface methodology

The screening of plants for medicinal purposes represents an effort to discover newer, safer, and possibly more effective drugs. Design of the present study was made aiming to the optimization of the antibacterial activity of ethanolic extracts of Eucalyptus tereticornis [leaves] and Nigella sativa [seeds] against bacteria belongings to both Gram-positive [Bacillus subtilis and Staphylococcus aureus] and Gram-negative [Escherichia coli] spectrum by using response surface methodology. 20 g powder of each E. tereticornis [leaf] and N. sativa [seeds] were mixed with 200ml of ethanol at room temperature, and then it was centrifuged at 4000 rpm for 10 min to separate the supernatants, and allowed to dry in order to obtain ethanol free extracts. A fresh bacterial culture of 100microl of test microorganism was inoculated onto media and spread homogeneously. The antimicrobial activity of ethanolic extracts showed that all the concentrations tested were effective against the test microorganisms. The diameters of zones of inhibition exhibited by S. aureus PCSIR-83 were in the range of 0-28mm, E. coli PCSIR-102 [0-28mm] and B. subtilis PCSIR-05 [15-26mm]. The combination of N. sativa [15mg/micro l] and E. tereticornis [20mg/micro l] were found most effective at pH 9.0 and temperature 35°C. Our results clearly indicate that Gram positive bacteria showed more sensitivity than Gram-negative bacteria

Cypermethrin-induced Repeated-dose Immuno-toxicity in Oryctolagus Cuniculus: An Investigation into Pathology of Spleen and Blood

Background: Cypermethrin is a pyrethroid insecticide widely used in agriculture and medicines. Its toxicity effects on spleen and blood in male and female rabbits is studied in this research. Methods: Age- and weight-matched does/females (n=24) and bucks/males (n=24) of Japanese White rabbits were subjected to intraperitoneal cypermethrin administration @50, 100 and 150 mg.kg-1 b.wt. in groups B, C and D, respectively.  The experimental rabbit does and bucks were tested for hematology alterations after each of 5 CY-treatments, at days 1, 8, 15, 22 and 29.  One rabbit doe and one rabbit buck were sacrificed fortnightly (days 15, 29, 43, 57 and 71) to obtain spleen for histological studies. Results: CY-treated rabbit bucks developed anemia, leukopenia, neutropenia, monocytosis, eosinophilia and basocytopenia mostly in dose and time dependent manner.  In contrast, rabbit does show transient but significant leukocytosis, neutropenia, lymphopenia, monocytosis, eosinophilia and basophilia only in high dose group.  Moreover, spleen histology revealed congestion, depletion of white pulp with increased red pulp and hemosiderin deposition in CY treated rabbit bucks, but not rabbit does. Conclusions: This study concludes that immuno-toxicity by cypermethrin insecticide is not similar in male and female subjects.

Urgency index and time management in a work environment

Objective: The objective of this study was to identify the urgency patterns and the effect of time management

Study Design: A survey based descriptive study

Place and Duration of Study: Army Medical College, Rawalpindi Pakistan, from June to August 2015

Material and Methods: Through random sampling, sample size was limited to 50 respondents. Questionnaire was introduced after the informed consent to the management and faculty of the Army Medical College. It was divided into section of demographic data and and data regarding the awareness about time management and practices of effective time management in the organization. Second section composed of the urgency index questions and calculations of the total score. Third section was the Steve Covey Time Management Grid to categorize activities into four quadrants. The time management matrix technique [TMMT] was constructed by Steve Covey to focus on the control of personal actions rather than purely scheduling time

Results: Twenty eight [56%] males and 22 [44%] females participated in the study with mean age of 43.54 +/- 7.58. Four [8%] were single and 46 [92%] were married. Mean working experience of the participants was 17.55 +/- 7.36. Categories of the participants into low urgency and high urgency index after calculation of the scores reflected that most of the participants irrespective of the gender or length of the work experience were suffering from high urgency patterns of life style

Conclusion: Most of the participants were suffering from high urgency patterns of life style. Urgent tasks have short-term penalties while important tasks are those with objective-oriented consequences

Hepatoprotective evaluation of aqueous-ethanolic extract of Capparis decidua [Stems] in paracetamol induced hepatotoxicity in experimental rabbits

Liver diseases are the most common ailment all over the world mostly caused by viruses, toxic chemicals, excessive intake of alcohol, high doses of paracetamol, carbon tetrachloride, chemotherapeutic agents and peroxides oil, etc. There is a great need to assess the scientific basis for the medicinal plants that are claimed to have hepatoprotective activity. We investigate the hepatoprotective effects of aqueous-ethanolic extract of Capparis decidua [Stems] against paracetamol induced liver injury in experimental animals. To observe the level of improvement, biochemical parameters such as SGPT, SGOT, ALP and Total bilirubin levels as well as histopathological changes in liver tissues were studied. Silymarin [50mg/kg, p.o.] was used as reference drug. The levels of the biochemical parameters were increased in rabbits which were intoxicate by paracetamol. Capparis decidua extract [750mg/kg, b.w.] treated rabbits showed maximum reduction of biochemical parameters in a significant [p<0.001] manner. Histopathological examination of the liver tissues of control and treated groups also confirmed the hepatoprotective activity. The phytochemical screening of the extracts revealed the presence of tannins, alkaloids, saponins and flavonoids. The results of the present study therefore suggest that the different doses of Capparis decidua possess significant hepatoprotective effect and this effect might be due to the presence of flavonoids and tannins

Frequency and antibiogram of isolates from surgical units of a tertiary care hospital in Quetta

Objective: To determine the frequency and antibiogram of the isolates from infected patients in surgical units of a tertiary care hospital

Study Design: Cross-sectional, descriptive study

Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Quetta, from March to October 2015

Methodology: Clinical samples from the surgical units received in Department of Microbiology for culture and sensitivity were analyzed by Gram stain, culture and biochemical tests for identification of the isolates; and the antibiotic susceptibility was determined by modified Kirby Bauer disc diffusion method. Data was analyzed by Statistical Package for Social Sciences [SPSS] version 19

Results: The commonest isolate was Acinetobacter baumannii [22%] followed by Escherichia coli [20%], Pseudomonas spp. [15%] and Methicillin-resistant Staphylococcus aureus [MRSA] [11%]. Acinetobacter baumannii showed highest susceptibility to doxycycline [41%], Enterobacteriaceae to meropenem [96%], Pseudomonas spp. to polymyxin-B [100%] and Gram positive bacteria to linezolid [100%]. Seventy-two percent of the isolates were found to be multi-drug resistant

Conclusion: There was a high infection rate in surgical patients with Acinetobacter baumannii, Eschericia coli, Pseudomonas spp. and MRSA being the commonest isolates. Acinetobacter baumannii showed highest susceptibility to doxycycline, Enetrobacteriaceae to meropenem, Pseudomonas spp. to polymyxin-B and Gram positive bacteria to linezolid