Biofuel production potential of indigenous isolates of Scenedesmus sp. from lake water in Pakistan

Aims@#This paper presents the report on biodiesel and biogas production at a laboratory scale from Scenedesmus strain.@*Methodology and results@#Previously isolated and identified Scenedesmus were grown in 10 Liter flask using BG-11 media at 16 h light and 8 h dark cycle. Oven-dried biomass (20 g) from 16-day-old culture of Scenedesmus was finely grounded and subjected to lipids extraction by chloroform-methanol-NaCl mixture. Microalgal lipids (6 mL) were subjected to transesterification by using NaOH leading to the production of 5 mL biodiesel and 4 mL of glycerin. Biodiesel was rich in methyl esters of linoleic acid, phosphorothioc acid and dodecanoic acid, as shown by gas chromatography-mass spectrometry (GC-MS) analysis. Oven-dried microalgae (2 g) without lipid extraction and leftover biomass (2 g) after lipid extraction were subject to biogas production through anaerobic digestion. Biogas (34, 27 and 19 mL) were recorded respectively in oven-dried whole biomass; lipid extracted biomass and control over a period of 15 days of anaerobic digestion.@*Conclusion, significance and impact of study@#It was concluded that water bodies are rich in diverse algae, especially Scenedesmus sp., and this algae can be cultured to produce biodiesel and biogas. But the lipid accumulation potential of microalgae requires special treatment and lipid extraction methods are not up to the mark, which is a major bottleneck in biofuel production from microalgae.

Efficacy of serum blood urea nitrogen, creatinine and electrolytes in the diagnosis and mortality risk assessment of patients with acute coronary syndrome

Background Although blood urea nitrogen (BUN), creatinine (Cr) and electrolytes are not the mainstay of diagnosis in acute coronary syndrome (ACS) patients but they may have a role in providing a more detailed view of the complications and mortality rates. The aim of this study was to determine the efficacy of these parameters in the diagnosis and mortality risk-assessment of patients with ACS. Methodology A total of 200 patients with ACS were recruited in this prospective study. The relationship of serum BUN, Cr and electrolytes with cardiac enzymes, Global Registry of Acute Coronary Events (GRACE) and mortality was assessed during a 6-months follow-up. Statistical test like multivariate linear regression and binary logistic regression analysis were applied. Results On multivariate linear regression analysis, serum potassium (K) (Unstandardized Coefficient B = −3.77; p = 0.04) showed significant negative association with Creatine Kinease and serum BUN (Unstandardized Coefficient B = 0.52; p = 0.001) showed significant positive association with Troponin I. The patients with GRACE > 105 had significantly higher levels of serum BUN and Cr. Receiver operating characteristic curves showed that area under curve (AUC) of BUN (0.7) was higher than AUC of Cr (0.5). Multiple adjusted model showed that patients with BUN > 32.5 mg/dl were almost 20 times more likely to be associated with mortality as compared to reference group. Conclusion In addition to cardiac enzymes, K along with BUN and Cr may serve as important aid in diagnosis of ACS. BUN and Cr may also serve as important tools in mortality-risk assessment of ACS patients.

Prognostic value of blood count parameters in patients with acute coronary syndrome

Background Recent studies have shown that complete blood count (CBC) parameters can effectively predict long-term mortality and re-infarction rates in acute coronary syndrome (ACS). However, the role of these parameters in predicting short term mortality has not been studied extensively. The main objective of this study was to determine whether CBC parameters can predict 30-days mortality and the incidence of major adverse cardiac event (MACE) in ACS patients. Methodology A total of 297 patients with ACS were recruited in this prospective study. The relationship of baseline white blood cell (WBC) to mean platelet volume ratio (WMR) with MACE and mortality was assessed during a 30-days follow up. The patients were divided into two groups: Group A [WMR < 1000] and Group B [WMR > 1000]. Multivariate COX regression was performed to calculate hazard ratios (HR). Results WMR had the highest area under receiver operating characteristics curve and highest discriminative ability amongst all CBC parameters in predicting mortality. Patients in Group B had a higher mortality rate (p < 0.001) than patients in Group A. WBC count (p = 0.02), platelet count (p = 0.04), WMR (p = 0.008), platelet to lymphocyte ratio (p < 0.001) and neutrophil to lymphocyte ratio (p = 0.03) were significantly higher in the MACE-positive group as compared to MACE-negative. In multivariate cox regression analysis, WMR > 1000 (HR = 2.9, 95% confidence interval 1.3–6.5, p = 0.01) was found to be strongest biochemical marker in predicting mortality. Conclusion WMR is an easily accessible and an inexpensive indicator, which may be used as a prognostic marker in patients with ACS.

novel clinico-biochemical score for screening of inherited metabolic diseases in children

Objective: to evaluate a novel clinico-biochemical score for screening of inherited metabolic diseases [IMDs] in children in our setup

Study Design: descriptive analytical study

Place and Duration of Study: department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from August 2016 to August 2017

Methodology: clinical data, preliminary biochemical investigations, plasma amino acid [PAA] and organic acid profiles [where indicated] of 354 children, aged <1 year to 12 years, referred to the study place for evaluation of suspected inherited metabolic diseases, was collected and evaluated. A clinico-biochemical score card named Rawalpindi Inherited Metabolic Diseases Score [RISc] was devised, on a scale from 1 to 10, incorporating 5 clinical and 5 important biochemical findings, and each variable was assigned a score, based on its relative frequency/risk. Each case was then assigned the RISc score and evaluated for presence or absence of any inherited metabolic disease, based on the score. This score was validated keeping plasma amino acids and organic acid profiles [in selected cases] as reference standard

Results: patients were divided into three groups, based on RISc score as low RISc [0.5-2.5], medium RISc [3.0-5.5] and high RISc [6-10]. A total of 354 cases reported in 2016 and 2017 and 33 [9.3%] were diagnosed to be having IMDs. One [3.0%] patient from low RISc, four [12.1%] from medium RISc, and 28 [84.8%] from high RISc group were found to test positive for any one IMD. High RISc group had a statistically significant higher IMD rate than the other two groups [p<0.001]. Specificity, sensitivity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value and accuracy were 93%, 85%, 11.8, 0.16, 55%, 98% and 90%, respectively

Conclusion: the cost effective RISc, based on clinical data and preliminary biochemical investigations, is highly accurate in diagnosing IMDs in cost restrained setups. It is strongly suggested that the initial screening for suspected IMDs and decision for advanced laboratory testing be carried out, based on the RISc card presented in the study

Mutation analysis of PAX9 gene in affected family of Hypodontia attending tertiary care hospital of Quetta

Objective: To identify the phenotype and genotype of hypodontia for a Pakistani family with hypodontia and to map the genes locus responsible for this disease

Study Design: Descriptive study

Place and Duration of Study: This descriptive study was performing in human molecular genetics [HMG] laboratory of Baluchistan University of information technology, engineering and management sciences [BUITEMS]. The study was of 4 months duration

Material and Methods: Blood samples [5ml] were collected from all 15 families' members [35participant]. Genomic DNA was extracted by using inorganic method. All the three coding exons of PAX9 [NM_006194] were amplified and sequenced. Sequencing of the PAX9 coding exons and splice sites showed a homozygous misses substitution in exon 3 [c. 718G>C; p.Ala240Pro] in the affected individuals of the family

Results: Intra-oral and panoramic radiographs revealed that the proband [II-1] and her father [I-1] have hypodontia denoted by the complete absence of teeth in maxillary arch, while all other family members maintained normal dentitions. The missing teeth are both upper lateral incisors [12, 22 FDI numbering] and third molars [18, 28]. Mandibular arch show; retained deciduous teeth and no teeth permanent teeth missing. Pedigree construction indicated that phenotypes in this family showed an autosomal recessive segregation pattern. The sequencing of coding exons and splice sites of PAX9 gene showed a homozygous missense mutation in exon number 3 [c. 718G>C; p.Ala240Pro] in the affected individuals of the family

Conclusion: We identified a missense mutation [p.Ala240Pro] in gene PAX9 coding exon 3 in Pakistani family with hypodontia

Anti-avian influenza virus H[9]N[2] activity of aqueous extracts of Zingiber officinalis [Ginger] and Allium sativum [Garlic] in chick embryos

In the present study, anti-Avian influenza virus H9N2 activity of aqueous extracts [5, 10, 15, 20, 25%] of Zingiber officinalis and Allium sativum was evaluated. Embryo-toxicity was evaluated by histopathological scoring of Chorio-allantoic membrane of chick embryos. Cytotoxicity of extracts was determined by MTT assay on Vero cells. Aqueous extract of ginger had antiviral activity at 10, 15, 20 and 25% while garlic had activity at 15, 20 and 25%. Histopathological scoring of chorio-allantoic membrane for aqueous extracts [5, 10, 15, 20, 25%] of ginger [0.66+/-0.57, 1.33+/-0.57, 1.66+/-0.57, 2.66+/-0.57, 3.66+/-0.57, respectively] and garlic [1.00+/-0.00, 1.33+/-0.57, 2.00+/-0.00, 2.33+/-0.57, 3.66+/-0.57, respectively] was concentration dependant. MTT assay revealed cytotoxicity of both plants was also concentration dependent. Extracts of ginger [5, 10, 15, 20, 25%] had lower cytotoxicity [71, 59, 28, 22, 0 % cell survival, respectively] as compared to garlic [61, 36. 20, 11, 3% cell survival, respectively]. Overall results revealed that concentration of aqueous extract of ginger [10%], showing antiviral activity against H[9]N2, was less toxic to vero cells [> 50% cell survival]. It is insinuated that ginger may have anti- Avian influenza virus H9N2 potential and its active compounds needs further investigations

Synthesis, characterization and biological evaluation of some 5-methylpyrazine carbohydrazide based hydrazones

Pyrazine carbohydrazide based hydrazones were synthesized starting from 5-methylpyrazine-2-carboxylic acid. The acid was first converted to its methyl ester, which on further treatment with hydrazine hydrate transformed to carbohydrazide. The carbohydrazide was treated with differently substituted aromatic carbonyl compounds giving hydrazones. Characterization of the synthesized compounds was carried out using modern spectroscopic techniques and unambiguously confirmed through X-ray crystallographic studies of compound 3d. The purity of the compounds was verified using elemental analysis. The target molecules were evaluated for urease inhibition, antioxidant and antimicrobial activity

Efficacy of intra-vitreal bevacizumab combined with phaco-emulsification in the prophylaxis of macular edema in patients with non-proliferative diabetic retinopathy

Objective: This study was designed to evaluate the prophylactic efficiency of intra-vitreal Bevacizumab combined with cataract surgery in patients of non-proliferative diabetic retinopathy without macular edema for the prevention of macular edema by assessing the visual outcome

Methodology: This was interventional, randomized, open-label and control study of two parallel groups of already diagnosed patients with pre-proliferative diabetic retinopathy without macular edema. The study included sixty eyes of sixty patients, having non-proliferative diabetic retinopathy without macular edema and lens opacity [grade 1 to 3]. One group [n=30] received intra-vitreal injection of Bevacizumab and the control group [n= 30] did not received intra-vitreal injection of Bevacizumab at the time of standard phaco-emulsification. Main outcome measure was best-corrected visual acuity [BCVA] at the end of two months compared with the baseline visual acuity recorded along with central macular thickness [CMT] measured on optical coherence tomography [OCT] as required

Results: The outcome was an improvement of BCVA at the end of 8[th] week compared with that at baseline in the Bevacizumab group and a worsening of visual acuity in the control group [p = 0.005]

Conclusions: Prophylactic use of intravitreal Bevacizumab combined with phacoemulsification appears to be beneficial in preventing post-surgical visual loss in eyes with NPDR by preventing the chance of macular edema

Profile of ocular trauma in patients under the age of sixteen years in allied hospital, Faisalabad

Aims and Objectives: Evaluation of epidemiological contributing factors in occurrence of ocular trauma in patients under the age of 16 years. Study Design: Descriptive and analytical study carried on 216 children. Period: 13-02-2014 to 26-12-2015. Setting: At Ophthalmological Department, Allied Hospital, PMC, Faisalabad

Patients and Methods: The patients with eye injury who presented to the ophthalmological Department of Allied Hospital, PMC, FSD from 13-02-2014 to 26-12-2015 were included in the study. The Activity at the time of injury, place of injury, identifiable objects causing trauma, age 1-16 years, any sex, use of eye protectors, were noted

Results: Out of 216 patients, there were 166 male [76.85 %] while female were 50 [23.15 %]. There were 76 patients having age between 0-5 years while 78 [36.11 %] were between 6-10 years of age. Out of 216 only 62 [28.7 %] patients were of age between 11 years to 16 years. The injuries due to knife and scissors, occurred in home and were the commonest [17.59 %]. The injuries occurring due to fire cracker and vegetable matter outside home were also common 16.20% and 13.89 % respectively. The fist and hand bite injuries in this group were least common [0.93 %]. In our setting commonest eye injuries involving corneo-scleral were [35+25] [27.78 %]. The frequency of subconjuctival hemorrhage was 11.11 %. The cases having lid tear and canicular cut were 6.48 %

Conclusion: Ocular trauma is an important cause of preventable visual morbidity particularly among younger people who are at the lower risk for chronic ocular diseases. Pediatric ocular trauma is a common cause of ophthalmic consultation

Stem cell-derived exosomes: roles in stromal remodeling, tumor progression, and cancer immunotherapy / 癌症

Stem cells are known to maintain stemness at least in part through secreted factors that promote stem-like phenotypes in resident cells. Accumulating evidence has clarified that stem cells release nano-vesicles, known as exosomes, which may serve as mediators of cell-to-cell communication and may potentially transmit stem cell phenotypes to recipient cells, facilitating stem cell maintenance, differentiation, self-renewal, and repair. It has become apparent that stem cell-derived exosomes mediate interactions among stromal elements, promote genetic instability in recipient cells, and induce malignant transformation. This review will therefore discuss the potential of stem cell-derived exosomes in the context of stromal remodeling and their ability to generate cancer-initiating cells in a tumor niche by inducing morphologic and functional differentiation of fibroblasts into tumor-initiating fibroblasts. In addition, the immunosuppressive potential of stem cell-derived exosomes in cancer immunotherapy and their prospective applications in cell-free therapies in future translational medicine is discussed.

Variation in admission rates of acute coronary syndrome patients in coronary care unit according to different seasons

Environmental stresses, especially extreme cold and hot weathers, have tendency to have more admissions for acute coronary syndromes. Due to scarcity of local data, we studied the variation in patient admission rates with acute coronary syndrome according to different seasons. Descriptive study. Coronary Care Unit, Civil Hospital and Pakistan Steel Hospital, Karachi, from January 2011 to December 2011. The study group comprised consecutive patients with acute coronary syndrome [unstable angina, Non STElevation Myocardial Infarction [NSTEMI], ST-Elevation Myocardial Infarction [STEMI] admitted to the coronary care unit. Patients with stable angina and valvular heart disease were excluded. Data was analyzed for admission according to different seasons, [winter, spring, summer and autumn]. The mean age of the 428 cases was 48.5 +/- 10.4 years [range 27 to 73 years]. Among the study group, 261 [61%] and 167 [39%] cases were male and female respectively. ST-elevation myocardial infarction, non ST-elevation myocardial infarction and unstable angina were present in 206 [48%], 128 [30%] and 94 [22%] respectively. Among the 428 patients, 184 [43%] cases had hypertension, 133 [31%] cases were smokers, 103 [24%] cases had dyslipidemia and diabetes mellitus and 08 [2%] cases had history of premature coronary artery disease. The number of patients admissions with acute coronary syndrome tended to change with sudden change in season. It increased in Winter 158 [36.9%] and Summer 130 [30.3%] in comparison to Spring 80 [18.69%] and Autumn 60 [14.02%] season. It was found variation in admission rates of acute coronary syndrome patients according to different seasons. The number of admissions not only increased in the cold season [winter] but also in hot season [summer] with sudden changes in temperature

Frequency of comorbidities and risk factors among ischaemic heart disease patients in Karachi-perspective from three tertiary care hospitals

To evaluate comorbidities and risk factors among ischaemic heart disease patients. The descriptive study was conducted at the cardiology wards of three hospitals in Karachi, and comprised and comprised data related to patients from September 5, 2013 to January 15, 2014. Data was analysed using SPSS 20. Out of 377 individuals, 238[63.1%] were males and 139[36.9%] were females. Depression outnumbered all other comorbids 137[58%] in males and 103[74%] in females. It was followed by anxiety in 129[54%] males and 90[65%] females. In risk factors, high-cholesterol diet outnumbered all other risk factors 137[58%] followed by stressful life 123[52%]in males, while in females physical inactivity 91[65%]and stressful life 91[65%] both were leading risk factors. A variety of risk factors existed in ischaemic heart disease patients. Special attention should be paid to stressful lifestyle and high cholesterol, two of the most common risk factors in both genders

Endovascular treatment of renal artery stenoses

To evaluate the procedure success and effect on hypertension after stenting of incidentally diagnosed atherosclerotic renal artery stenoses. An experimental study. A multicentric study was conducted at the Plastic Surgery and General Hospital, National Medical Center and Ziauddin University Hospital, Karachi, Pakistan from January 2009 to March 2013. Hypertension [systolic blood pressure > 160 and diastolic > 90 mmHg with two or more than two medications] with coronary artery disease were initially evaluated for coronary angiography, Renal artery angiography was also endovascular performed and stent was deployed for atherosclerotic renal artery stenosis when found. Blood pressure readings, reduction in need of antihypertensive medication and serum creatinine levels were taken as outcome measures. Patients having renal artery stenoses secondary to connective tissue disorders and fibromuscular dysplasia were excluded. There were 25 patients, 14 [56%] male and 11 [44%] female, with mean age of 49 +/- 6 years. Diabetes mellitus, dyslipidemia and smoking were seen in 11 [44%], 10 [40%] and 4 [16%] patients respectively. Renal insufficiency [serum creatinine > 1.5 mg/dl] was seen in one [04%] patient. Bilateral, and isolated right and left renal artery stenoses was seen in 5 [20%], 9 [36%] and 11[44%] patients respectively. Mean percentage of renal artery stenoses was 89%, ranged from 70% to 99% while ostial lesion was found in 20 [80%] patients. A significant decrease in systolic [168.20 +/- 9.987 vs. 140.60 +/- 5.649 mmHg, p < 0.001] and diastolic blood pressure [88.60 +/- 5.50 vs. 77.20 +/- 5.017 mmHg, p < 0.001] and reduction of medication [2.72 +/- 0.458 vs. 1.5 +/- 0.510, p < 0.01] were noted without a change in renal function [p= 0.061] after renal artery stenting. Endovascular stenting of renal artery stenoses in patients with poorly controlled hypertension is a safe and effective treatment

Isolation and antibiotic susceptibility of E. coli from urinary tract infections in a tertiary care hospital

The study was conducted to isolate and determine the antibiotic resistance in E. coli from urinary tract infections in a tertiary care hospital, Lahore. Urine samples [n=500] were collected from patients with signs and symptoms of Urinary tract infections. Bacteria were isolated and identified by conventional biochemical profile. Antibiotic resistance pattern of E. coli against different antibiotic was determined by Kirby-Baur method. Bacterial etiological agent was isolated from 402 samples with highest prevalence of E. coli [321, 80%] followed by Staphylococcus aureus [9.4%], Proteus species [5.4%] and Pseudomonas species [5.2%]. The E. coli were highly resistant to penicillin [100%], amoxicillin [100%] and cefotaxime [89.7%], followed by intermediate level of resistance to ceftazidime [73.8%], cephradine [73.8%], tetracycline [69.4%], doxycycline [66.6%], augmentin [62.6%], gentamycin [59.8%], cefuroxime [58.2%], ciprofloxacin [54.2%], cefaclor [50%], aztreonam [44.8%], ceftriaxone [43.3%], imipenem [43.3%], and low level of resistance to streptomycin [30%], kanamycin [19.9%], tazocin [14%], amikacin [12.7%] and lowest to norfloxacin [11.2%]. Out of 321 E. coli isolates, 261 [81%] were declared as multiple drug resistant and 5 [1.5%] were extensive drug resistant. It is concluded that most of the urinary tract infections in human are caused by multiple drug resistant E. coli

Efficacy of intracoronary bolus administration of tiroflban in acute coronary syndrome patients with no-reflow phenomenon during percutaneous coronary intervention [PCI]

Currently in acute coronary syndrome, PCI is most common strategy. No-reflow phenomenon [NR] is one of serious complication. Aim of this study was to evaluate role of intracoronary bolus administration of tiroflban in acute coronary syndrome patients with no-reflow during PCI. It is prospective and observational study. It is multicenter study, conducted in Karachi, Pakistan from August 2011 to July 2013. Total of 62 patients of acute coronary syndrome underwent for PCI and developed no-reflow, received intracoronary bolus tiroflban were included. The angiographic definition of successful reperfusion should include both TIMI 3 flow as well as MBG 2 or 3. No-reflow, assesed by thrombolysis in myocardial infarction [TIMI] flow and myocardial blush grade [MBG] during treatment. Data were entered and analyzed using SPSS-16 software. Statistical significance was defined as p-value <0.05. Out of 62 patients, 43 were males .The mean age was 51 +/- 13, range from 37 to 70 years. TIMI flow 1 and 11 seen in 17, 37 patients while MBG 1 and 11 seen in 20 and 33 patients before intracoronary bolus administration of tiroflban. After bolus administration of tiroflban, TIMI flow 111 was seen in 61[98.387 %] out of 62 patients while MBG 11 and 111 was also noted in 61[98.387 %] out of 62 patients. It showed better Thrombolysis In Myocardial Infarction flow grades and TIMI myocardial perfusion grades [OR 0. 22, 95% CI 0 .12 -0 .39, p-value <0.001] immediately after intracoronary bolus administration of tiroflban in-reflow phenomenon patients during PCI. In patients with ACS, Intracoronary bolus adminstration of tiroflban is effective drug to improve no-reflow during percutaneous coronary intervention especially when patient blood pressure is at lower-side

Characterization of hospital waste in Lahore, Pakistan / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It is a common practice in developing countries that medical/infectious waste openly dumped with municipal solid waste. This paper presented a generation and characterization study of hospital waste. Determination of the waste composition is a basic step for selecting the most efficient treatment method of hospital waste.</p><p><b>METHODS</b>Stratified random sampling was used to collect the samples of general as well as medical wastes for seven days. Medical waste was sorted into 10 categories whereas general waste was classified into 11 categories. Incineration was observed thoroughly for observing flaws in the incineration process. Data was analyzed by using SPSS software version 16.0.</p><p><b>RESULTS</b>The studied hospital produced an average 297 kilograms of medical waste daily and it comprises plastics (71.0%), glass (13.9%), papers etc. (3.8%), cotton/dressings (5.7%), masks/gloves/sheets (0.3%) diapers (0.4%), wasted machines used in operation theaters (2.0%) and blades (0.1%). Laboratories, cancer ward, nursery ward, OPD and emergency ward are the largest infectious waste producing departments in the hospital. The hospital produced an average 3 511 kilograms of general waste daily in which organics constitute (44.3%), diapers etc. (42.8%), demolition materials (3.7%), plastic waste mixing medical plastic waste (2.5%), miscellaneous (2.14%), cloth/clothes (1.6%), cardboard (1.3%), papers (0.8%), cotton dressings (0.28%), glass (0.27%) and iron materials (0.18%). Other alarming facts are: medical waste is recycled in study area, after incineration of hospital waste, ash simply dumped in the premises of the hospital without any liner system.</p><p><b>CONCLUSIONS</b>The studied hospital produces 10% of infectious waste and 90% of general waste. The largest components of the infectious waste are plastic and glass. Organics and diapers are major components of the general waste coming from different sites of the hospital. Lack of training, inadequate knowledge regarding to the composition of the infectious waste and risks associated with the waste are the major issues which must be addressed and resolved.</p>

To know the frequency of right ventricular infarction in patients with inferior wall myocardial infarction

To know the frequency of right ventricular infarction in patients with acute inferior wall myocardial infarction. Retrospective study. This study was carried out in Department of Medicine at Civil Hospital Karachi from 1[st] November 2011 to 30[th] April 2012. In this study 65 adult patients of either sex with ECG evidence of inferior wall infarction were enrolled who were admitted in medical department at Civil Hospital Karachi. The duration of the study was 6 months. Inclusion criteria were age > 12 years of either sex or acute inferior wall myocardial infarction on electrocardiography [ST- segment elevation of more than or equal to 1 mm in at least two or three leads i.e. II, III, and aVF]. Exclusions criteria were age less than 12 years and evidence of either right or left bundle branch block on ECG. Data was analyzed through SPSS software. Out of these 65 patients, 45 [69%] were male and 20 [31 %] were female. All patients with acute inferior wall myocardial infarction were divided into three age groups i.e. 3[4%]cases were < 40 years, 44[58.66%] cases between 40-60years , and 18[24%] cases in > 60 years. From a total of 65 patients presented with acute inferior wall myocardial infarction, 40 [62%] were not associated with right ventricular infarction [Group-I], whereas 25 [38%] were associated with right ventricular infarction [Group-II], On ECG, ST-segment elevation in leads V 3R and V 4R was present in 1 out of 40 [2.5%] patients in Group-I, and 23 out of 25 [92%] in Group-II [p=<0.001]. The sensitivity, specificity, positive and negative predictive value of raised JVP was 72%, 82.5%, 78.2% and 82.5% respectively. The sensitivity, specificity, positive and negative predictive value of clear lung fields in the presence of raised JVP was 84%, 87.5%, 80.7% and 89.7% respectively. ST-segment elevation in leads V3R and V4R was 92% sensitive, 97.5% specific, having 95.8% positive and 95.12% negative predictive value. On echocardiography right ventricular dilatation was 96% sensitive, 97.5% specific, having 96% positive and 97.5% negative predictive value. In conclusion, frequency of right ventricular infarction is 38.46% in association with inferior infarction in our clinical settings

Role of nitric oxide in the effect of nebivolol on isolated tracheal muscle of guinea pig

The use of beta blockers is limited by their ability to produce bronchospasm in asthmatics. Third generation beta-blockers like Nebivolol may show better tolerability because they may augment the release of nitric oxide [NO] from endothelial cells. However the involvement of NO in the respiratory effect of Nebivolol remains controversial. The present study, carried out on isolated tracheal muscle strips of guinea pigs, was designed to explore this controversy. Varying concentration of histamine ranging from 10[-7] M to 10[-3] M were used to plot a concentration response curve on the isolated tracheal muscle strips of guinea pig and was used as a control. The same concentration response curve was plotted in presence of a fixed concentration of Nebivolol 10[-6] M and then again in presence of a fixed concentration of L-Nitro Arginine Methyl Ester [L-NAME] 10[-4] M and Nebivolol 10[-6] M together in a series of experiments using six sets of isolated tracheal muscle strips in each case. Nebivolol did not produce any significant shift in the concentration response curve while in the presence of L-NAME, Nebivolol shifted the histamine concentration response curve upwards and to the left. Nebivolol does not augment the histamine induced contraction of respiratory smooth muscle of guinea pig but in the presence of Nitric Oxide inhibitor L-NAME a significant augmentation of the same curve occurs, indicating a role of NO in the sparing of respiratory smooth muscle by Nebivolol

Comparison of sensitivity and specificity of blue yellow primetry versus standard automated primetry in early / glaucoma suspect patients

Purpose: To compare the sensitivity and specificity of short wavelength automated Perimetry [SWAP] with standard automated perimetry [SAP] using the SITA program to detect early or glaucoma suspect patients

Study Design: Cross sectional prospective and comperitative study of perimetric diagnostic sensitivity and specificity of two perimetric methods in early or glaucoma suspect patients

Study Duration: June 2010 - May 2012

Materials and Methods: Fifty patients with ocular hypertension, early glaucoma or suspect patients were enrolled for the perimetric tests. After complete ophthalmic examination, each patient was tested with the standard automated perimetry [SAP], 30-2 thrice and then on short wavelength automated perimetry [SWAP; 24-2] once

Results: The average MD in the SWAP group was significantly higher than in the SAP Group [SWAP - 6.55ds SAP- 2.60db P<0.001]. A significant difference also existed in PSD between the two groups [SWAP: 3.50db, SAP 2.50db, P<0.001]. The test time was longer in the SWAP group than in the SAP group [SWAP: 15min, SAP 13min P<0.001]. However the sensitivity indices were in normal limits. There were significant differences in number of depressed test point locations between two tests strategies. The number of eyes showing cluster of significantly depressed points were more with the SWAP test strategy than with SAP

Conclusion: The SITA, SWAP identified at least much earlier glaucomatous visual field defects than SITA, SAP. The study showed that greater MD and PSD with SWAP

Frequency of culture positive tuberculosis in exudative pericardial effusion

To evaluate the frequency of culture positive tuberculosis and to determine the sensitivity of drugs in exudative pericardial fluid. Descriptive observational study. This study was conducted on patients admitted in cardiology and Medical wards of Civil Hospital Karachi from 1[st] November 2010 to 30[th] April 2011. In this study 50 patients of pericardial effusion diagnosed on the basis of history, physical examination, electrocardiography, chest x-ray PA view and echocardiography underwent pericardiocentesis under fluoroscopy. Pericardial fluid D/R was done and all the patients having exudative pericardial fluid [protein] 3 gm% and LDH > 200 IU were selected. All the exudative pericardial effusion were sent for AFB culture and sensitivity on L.J. medium. Inclusion criteria were all patients with the diagnosis of exudative pericardial effusion above 12 years of age of either sex. Exclusion criteria were all patients with transudative pericardial effusion and below 12 years of age. 3 [6%] patients had culture positive for mycobacterium tuberculosis on L.J medium. 5 [10%] had culture positive of other bacteria of which 2 [4%] had culture positive for resistant Staphylococcus aureus, 2 [4%] had culture positive for Streptococcus pneumonia and 1 [2%] had culture positive for Streptococcus viridans and 42 [84%] patients had culture negative for AFB and other bacteria. Out of 50 patients, 16 [32%] were in age group between 20-40 years, 22 [44%] were in age group between 41-60 years and 12 [24%] were in age group> 60 years. Out of 16 patients having age between 20-40 years, 1 [6.25%] had culture positive for AFB, 3 [18.75%] had culture positive for other bacteria and 12 [75%] had culture -ve for all organism. Out of 22 patient having age between 41-60 years, 2 [9.09%] had culture +ve for AFB, 2 [9.09%] had culture for other bacteria and 18 [81.81%] had culture negative for all organisms. Out of 12 patients having age >60 years, none [0%] had culture +ve for AFB, none [0%] had culture +ve for other bacteria and all 12 [100%] had culture negative for all organisms. All 3 patients having culture positive for AFB were found to be sensitive to all antituberculous drugs. The concluded that frequency of culture positivity is only 6% for Mycobacterium Tuberculosis, so this should not be the investigation of choice to confirm tuberculous pericardial effusion. However, other parameters should also be looked for in establishing the diagnosis of pericardial effusion like clinical parameters, the prevalence of tuberculosis in relative area, ESR, MT, Mycobacterium tuberculosis DNA PCR and Mycobacterium tuberculosis culture on BACTEC