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Copper [Cu], is an essential trace element. Along with lead, arsenic, mercury, cadmium etc. it is classified as a member of heavy metal group. Deficiency of copper is involved in the etiology and promotion of many disease processes related to gastrointestinal and neurological systems as well as affect functions of heart, blood vessel, pancreas etc. Deficiency of copper in early part of gestation can produce major organ malformations in the developing fetus and this in turn if persistently present can lead to neurological as well as immunological abnormalities in the newborn. Conversely presence of enormous concentrations of copper is also a great danger for the human health. Acute copper toxicity predisposes to various pathological conditions and can cause death in severe cases. Chronic exposure to copper produces anemia, liver toxicity and severe neurological defects
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Objective: To identify and evaluate the frequency, severity, mechanism and common pairs of drug-drug interactions [DDIs] in prescriptions by consultants in medicine outpatient department
Methods: This cross sectional descriptive study was done by Pharmacology department of Bahria University Medical and Dental College [BUMDC] in medicine outpatient department [OPD] of a private hospital in Karachi from December 2015 to January 2016. A total of 220 prescriptions written by consultants were collected. Medications given with patient's diagnosis were recorded. Drugs were analyzed for interactions by utilizing Medscape drug interaction checker, drugs.com checker and stockley's drug interactions index. Two hundred eleven prescriptions were selected while remaining were excluded from the study because of unavailability of the prescribed drugs in the drug interaction checkers
Results: In 211 prescriptions, two common diagnoses were diabetes mellitus [28.43%] and hypertension [27.96%]. A total of 978 medications were given. Mean number of medications per prescription was 4.6. A total of 369 drug-drug interactions were identified in 211 prescriptions [175%]. They were serious 4.33%, significant 66.12% and minor 29.53%. Pharmacokinetic and pharmacodynamic interactions were 37.94% and 51.21% respectively while 10.84% had unknown mechanism. Number wise common pairs of DDIs were Omeprazole-Losartan [S], Gabapentine- Acetaminophen [M], Losartan-Diclofenac [S]
Conclusion: The frequency of DDIs is found to be too high in prescriptions of consultants from medicine OPD of a private hospital in Karachi. Significant drug-drug interactions were more and mostly caused by Pharmacodynamic mechanism. Number wise evaluation showed three common pairs of drugs involved in interactions
Subject(s)
Humans , Male , Female , Drug Interactions , Inappropriate Prescribing , Cross-Sectional StudiesABSTRACT
Objective: To evaluate and compare feto-maternal outcomes and glycemic control in metformin versus insulin treated gestational diabetics
Methods: The study was conducted in 2010-2012 as a part of M. Phil at Civil hospital, Lyari General Hospital and Mamji Hospital in Karachi. After written informed consent, 71 GDM diagnosed females with WHO criteria were enrolled. They were divided into two groups. Group-A, 32 females were given oral metformin 500 mg TDS while Group-B, 39 females were given insulin 0.8-0.9 mg/kg/day in two divided doses subcutaneously. Patients were followed till term. Feto-maternal outcomes were evaluated in 25 patients in each group who completed the study
Results: When groups were compared, newborns in Group-B were significantly more in weight [p=0.01], Significant numbers of babies were delivered after 38 weeks of pregnancy in Group-B [P=0.021]. There were two intrauterine deaths and significantly higher HbC at term in Group-B. [P=0.03]. FBS at term was nonsignificant [p=0.079] and there was more number of cesarean sections due to feto-maternal disproportion in Group-B [28% vs.2%]. Results analyzed for glycemic control before and after the treatment revealed that FBS was statistically less in Group-A [p=0.00] whereas for Group-B the value of FBS and HbCwas statistically high. [p=0.002 a 0.04 respectively]
Conclusion: Metformin has produced better effects on feto-maternal outcomes and glycemic control in comparison to Insulin in GDM
Subject(s)
Humans , Female , AdultABSTRACT
Objective: To evaluate the effects of diet control and Metformin on placental morphology in gestational diabetes mellitus [GDM]
Methods: After written informed consent 62 GDMs were enrolled. According to WHO criteria, 30 cases of GDMs with blood sugar level <130 mg/dl, were assigned Group B [2000-2500Kcal/day and 30 minute walk thrice weekly were kept on diet control and 32 cases of GDM with blood sugar level >130 mg/dl, assigned Group C were kept on diet with tablet Metformin, [500mg TDS] Finally 25 normal pregnant females were kept in Group A as control. After delivery placentae were preserved and evaluated for morphology
Results: Heavy placentae with abundant villous immaturity, chorangiosis and syncytial knots in group B and fibrinoid necrosis and calcification in group C were seen. In group B versus A placental and cord width while in Group C versus A only cord width in gross morphology showed significant results. In group B versus A villous immaturity, chorangiosis, infarction and syncytial knots in light microscopy were present; similarly in B versus C placental width, chorangiosis and syncytial knots showed significant results, while in C versus A results were non-significant
Conclusion: Metformin produced beneficial effects on placental morphology being comparable to normal control in contrast to diet group
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Metals are important source of pollutant toxicants which occur naturally in the environment. Now-a-days many metals have become essential to various biological processes and some level of human exposure is therefore unavoidable. Lead has been used by humans for at least 7000 years alone and in combination with other metals. It is highly toxic, ductile, malleable and easy to smelt. A wide range of adverse effects could be induced in human beings depending upon the dose and time period of lead exposure. Central nervous system of children is the most sensitive to lead effects while peripheral neuropathy, chronic nephropathy, and hypertension are the main concerns in adults. Other target tissues include the gastrointestinal, immune, skeletal, and reproductive systems. Effects on the heme biosynthesis provide a sensitive biochemical indicator even in the absence of other detectable effects. Present review is therefore written to provide comprehensive awareness regarding lead and its health hazards
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Objective: To evaluate the effect of leflunomide on laboratory parameters in patients of rheumatoid arthritis
Materials and Methods: A 24-week, single-blind study was carried out on 158 consecutive patients, aged 29-70 years, diagnosed with rheumatoid arthritis. They received tablet leflunomide 20 mg daily, orally. Laboratory tests were recorded at the initial visit and follow-ups. Leflunomide has been known to bring about changes in various blood parameters like hemoglobin, total white cell and platelet counts, erythrocyte sedimentation rate, serum creatinine and serum glutamic pyruvic transaminase levels. All patients were subjected to these laboratory tests
Results: At the end of the study at 24 weeks the hemoglobin was raised to 12.62 grams per deciliter [g/dl] from a baseline of 10.81 g/dl, white cell count fell to 6,728 per cubic mm [cmm] from 8,318 / cmm, the ESR fell to 39.01 millimeters of mercury [mm of Hg] in 1st hour from 82.10 mm of Hg, the platelet count fell to 2,37,419 / cmm from 2, 96,166 / cmm, the SGPT levels were raised to 38.01 international units per litre [IU/l] from 31.84 IU/l and the serum creatinine fell to 0.936 mg/dl from 0.937 mg/dl. All values, except serum creatinine, were found to be highly significant statistically [p<0.001]
Conclusion: Leflunomide showed significant effects on the laboratory parameters. These parameters may be utilized in patients follow up to monitor the drug response and as a marker of drug safety of leflunomide
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Arsenic is detected virtually in all environmental matrices.Two forms of arsenic, reduced and oxidized can be absorbed and accumulates in tissues and body fluids causing impairment of cell respiration and subsequently diminishes ATP formation. Several million people are exposed to arsenic chronically throughout the world. Diet, for most individuals, is the largest source of exposure. It is also called as "king of poisons". Immediate symptoms of acute arsenic poisoning include vomiting, abdominal pain and diarrhea being followed by numbness, tingling of extremities, muscle cramping and death. Long-term exposure to high arsenic level usually affects skin. Blood, urine, hair, and fingernails are used for diagnosis of toxicity.This is treated by chelating agents and removal of arsenic from body. Awareness should be created among the communities. Governmental measures for provision of clean water, uncontaminated food and reduction of hazards at occupational level could play a vital role for preventing morbidity and mortality
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Objective:To identify the errors in the prescription writing of general practitioners [GPx] from different parts of Karachi
Materials and Methods: A descriptive study was conducted in the department of Pharmacology at Bahria University Medical and Dental College, Karachi, from 1st January to 30th February 2014. A total of 100 prescriptions were collected 25 each, randomly, from 04 general practitioner`s clinics [east, west, central and south districts] of Karachi. Verbal consent of the respective [GPx] was taken few days prior to collection of prescriptions. Patient's consent was taken at the time of obtaining the prescription.All prescriptions were analysed for errors in superscription, inscription, subscription, transcription, signatures and refill information
Results:A total of 473errors were identified in 100 prescriptions. 303 errors in superscription, 06 in inscription, 67 in subscription, 34 in transcription, 1 in prescriber's signature , and 62 in refill information
Conclusion: Errors in prescription writing are found to be common in the prescriptions of general practitioners. Measures should be taken to refresh the prescription writing skills of general practitioners through Continuous Medical Education Sessions [CMEs] and workshops
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Objective: To evaluate the effect of herbal syrup Linkus on acute and gross toxicity and electrolytes level in blood and organs
Materials and Methods: This interventional study was carried out in the department of Pharmacology, Faculty of Pharmacy,University of Karachi after approval from BASR-KU. In this study twenty-eight healthy rabbits of either sex weighing 0.90 kg to 1.2 kg. All animals were equally divided into four groups, one served as control group while, remaining three groups received herbal syrup Linkus at three different doses. Acute toxicity was tested in mice by Lorke's method whereas effect on gross toxicity, blood and organ electrolytes was evaluated in Rabbits
Results: Herbal syrup Linkus exhibited LD50 values greater than 5 gm / kg per 24 hrs. No gross toxicity and mortality was observed during the whole experimental period. Non significant changes were observed in blood and organ electrolytes [Calcium, Potassium and Sodium] level
Conclusion: Herbal syrup Linkus has produced no toxic effect at the administered doses neither showed any significant change in the electrolytes level in the blood and vital organs
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Objective: To identify the errors in the prescriptions of consultant [CPx] from different parts of Karachi
Materials and Methods: A descriptive study was conducted in the department of Pharmacology at Bahria University Medical and Dental College, Karachi, from 21st April to 23rd June 2015. A total of 100 prescriptions were collected randomly after verbal consent from four consultants from four districts of Karachi. All prescriptions were analyzed for identifying errors in Superscription,Inscription, Subscription, Transcription, Signature and Refill information. Verbal consent of the respective consultants was taken few days prior to collection of prescriptions. Patient's consent was taken at the time of obtaining the prescription
Results: A total of 562 errors were identified in 100 prescriptions of consultants.303 errors in superscription, 103 in inscription,100 in subscription, 6 in transcription, and 50 in refill information
Conclusion: Errors in prescription writing are found to be common in the prescriptions of consultants. Measures should be taken to refresh the prescription writing skills of consultants through Continuous Medical Education Sessions [CMEs] and workshops
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To observe and compare placental histology for hypoxic changes in diet plus exercise alone versus dietplus exercise and insulin treatment in patients with Gestational Diabetes Mellitus [GDM]. Comparative / analytic study. The study was conducted in Lyari General Hospital and Mamji Hospital after approval from the Institutional Review Board [1KB] and Ethical Committee of Dow University of Health Sciences from Jan 2010- Jan 2011. After written informed consent, 30 patients were diagnosed to have GDM with RBS between 126-129 mg/dl were given diet control plus exercise therapy [Group A]. 39 GDM patients with RBS greater than 130 mg/dl were kept on diet plus exercise and insulin [Group B]. After delivery placentae were collected from 25 patients in each group. Histological slides of placentae were prepared and parameters of hypoxia such as villous immaturity, villous fibrinoid necrosis, syncytial knots, chorangiosis, calcification etc. were observed and compared between the two groups using light microscope. Results were evaluated by SPSS 16 using student t- test and chisquare test. Statistically non-significant results were obtained for the hypoxic parameters. However numerically more calcification was found in Group A while villous immaturity, villous fibrinoid necrosis and syncytial knots were present more in Group B. Histological examination of placentae showed presence of hypoxic features in both Group A and Group B patients with more propensities in diet plus exercise and insulin treated GDM group
Subject(s)
Humans , Female , Adult , Placenta , Hypoxia , Diet , Insulin , ExerciseABSTRACT
To estimate blood lead level [BLL] and to assess the features of lead toxicity among lead acid battery [LAB] industrial workers. This prospective study was carried out in the medical centre of PCSIR Laboratories, Karachi from March 2012 - March 2013. Fifty LAB industry workers, males and females between 17-65 years were included in the study. They were divided into group 1 with 40 workers- directly related and group 2 with 10 workers -indirectly related, [administration staff members] to LAB manufacture. Detailed history, complete physical examination and BLL estimation by flameless atomic absorption spectrophotometer was done. Total 34 patients in group 1 and 3 patients in group 2 had elevated BLL. Comparison of group 1 and 2 revealed anemia [40v/s4], bone pain [38v/s7], abdominal pain [38 v/s 2], nausea [32v/s6], head ache and irritability [24v/s6], weakness and lethargy [21v/s6], tremors [13v/s0] insomnia [5v/s4], lead line [4v/s 0] and blood pressure above 140/90 mm of Hg [12v/s0] respectively. High blood lead level and features attributable to lead toxicity were prevalent among LAB industry workers of Karachi
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Background: Gestational diabetes is a condition due to glucose intolerance that occurs in the few of the mothers during gestation. The pathophysiology originates as a result of increased placental hormones which have strong diabetogenic effect. It is strongly associated with multiple problems in mother and the baby and can even leads to unexplained fetal deaths in the end trimesters. So it is important to diagnose and treat females who are at greater risk than the others for developing gestational diabetes mellitus
Objective: To access the high risk factors associated with the development of gestational diabetes mellitus in 75 GDM diagnosed females
Methods: After screening and diagnoses 75 GDM patients [Diabetic, Group B] and 25 normal healthy patients [Control, Group A] in Lyari General and Mamji Hospital were enrolled in the study. Their detailed history was taken regarding occupation, parity, history of abortions, still births, preterm births and family history of diabetes. Parameters including age, weight, fasting and random blood sugar level and glycated hemoglobin were recorded in a predesigned data form. The results were evaluated using SPSS 16
Results: Statistically significant difference was found between the mothers of diabetic and normal control group as regards the weight, age [p-value=0.01 and p=0.03] and family history of diabetes [p-value=0.00]. Non-significant differences were found in the maternal occupation, parity, abortions, still births and pre-term births between the two groups
Conclusion: Advance maternal age, weight and familial association of diabetes are the risk factors associated with the development of gestational diabetes
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To observe the effects of exogenous insulin on placental, fetal and maternal outcomes in Gestational Diabetes Mellitus [GDM]. After screening and diagnoses [WHO criteria] 30 GDM patients[Group A] were kept on diet control and 39 GDM [Group B] who did not achieve glycemic targets were added subcutaneous insulin. Term placental weight, size, shape, consistency, fibrinoid necrosis, hemorrhages, cord color, length of the cord, completeness of membranes, weight and condition of baby and mode of delivery were assessed in 25 patients in each group. Placental weight, cord width and baby weight were found to be more in Group B, than Group A and were statistically significant with p value 0.005, 0.02 and 0.003 respectively. Ten patients in group A and 17 patients in group B had cesarean deliveries. Exogenous insulin produces significant effects on the placental, fetal and maternal outcomes in patients with GDM
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To evaluate anti-inflammatory activity of Salvadora persicain rats. The anti-inflammatory activity of Salvadora persica was assessed in 63 albino rats of both sexes, weighing 400 gm. They were divided into three groups, A [control], B [crude drug], C [standard drug] with twenty one animals. Each group was divided into three subgroups with seven animals. Groups B and C were given crude drug and aspirin diluted in one ml of distilled water once daily orally, in doses of 300, 500, and 700 mg/kg body weight respectively, prior to induction of edema and Group A was given same volume of saline. Inflammation was induced in hind paw of rat by sub-planter injection of 0.1ml of 1% carrageenan. Paw volume was measured in terms of milliliters using plethysmometer, immediately before injection and then hourly up to 5 hours and mean was calculated. The inhibition of edema was calculated for each subgroup with respect to control group. After carrageenan injection mean paw volume of control group was 5.43 ml, while that of drug treated subgroup was 4.32 ml and standard group was 4.49 ml at the dose of 700 mg/kg body weight. Comparison of crude drug with the control was found to be statistically significant only at 700 mg/kg and was comparable with the standard drug aspirin. Salvadora persica has shown anti-inflammatory activity by decreasing the paw volume of carageenan induced edema
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To assess the clinical efficacy of Metformin in the prevention of fetal macrosomia and neonatal morbidity in gestational diabetes pregnancies compared with insulin treatment. In this interventional study, randomized clinical trial a total of 150 patients with gestational diabetes between 20-35 weeks of gestation were selected for pharmacological treatment using metformin or insulin during the study period form 20-Dec-2008 till 20-Dec-2010 from Antenatal OPD after screaning with 75 grams OGTT. The primary outcomes were fetal macrosomia and neonatal morbidity. Patients on metformin and insulin were matched in age, parity, BMI and gestational age at study entry. Mean birth weight did not differ in both groups but fetal macrosomia was less in metformin group than in insulin group 18.67% V/S 10.65% P < 0.05. Neonatal morbidity and NICU admissions were less in metformin group. Metformin is a safe and effective alternative to insulin in gestational diabetes. Metformin treatment resulted in less fetal macrosomia and fewer NICU admissions and neonatal morbidity with advantages of cheap oral therapy in our resource poor setting
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To compare the effect of metformin with clomiphene citrate on ovulation and conception rate in patients with polycystic ovarian syndrome [PCOS] one hundred infertile patients due to PCOS were selected from the Gynecology Unit III of Dow University of Health Sciences. They were divided into 2 groups each with 50 patients. Group I received metformin 500 mg per orally thrice daily for 4 months while Group II received clomiphene citrate 50 mg per orally [which was increased to 100 mg according to response] per day for 5 days following spontaneous or medroxyprogesterone acetate induced withdrawal bleeding for 4 months. Serum progesterone level was estimated on day 0, then on day 21 and finally on day120. In both the groups significant increase was found in serum progesterone level from day 0 to day 120. In group I, serum progesterone increased from 1.7ng/ml at day-0 to 11.3ng/ml at day-120. In group II, it increased from1.5 ng/ml at day-0 to7.3 ng/ml at day-120. Out of 50 patients 40 [80%] patients showed evidence of ovulation in Group I and 13 [26%] patients showed evidence of ovulation in Group II with conception rate of 67% in Group I and 16% in Group II being confirmed by urine pregnancy test. In conclusion metformin has exerted highly significant effects on the ovulation and conception rate in comparison to clomiphene citrate in PCOS infertile patients
Subject(s)
Humans , Female , Metformin , Clomiphene , Ovulation , Ovulation Induction , FertilizationABSTRACT
Heart rate variability [HRV] is a measure of the balance between sympathetic mediators of heart rate that is the effect of epinephrine and norepinephrine released from sympathetic nerve fibres acting on the sino-atrial and atrio-ventricular nodes which increase the rate of cardiac contraction and facilitate conduction at the atrio-ventricular node and parasympathetic mediators of heart rate that is the influence of acetylcholine released by the parasympathetic nerve fibres acting on the sino-atrial and atrio-ventricular nodes leading to a decrease in the heart rate and a slowing of conduction at the atrio-ventricular node. Sympathetic mediators appear to exert their influence over longer time periods and are reflected in the low frequency power[LFP] of the HRV spectrum [between 0.04Hz and 0.15 Hz].Vagal mediators exert their influence more quickly on the heart and principally affect the high frequency power [HFP] of the HRV spectrum [between 0.15Hz and 0.4 Hz]. Thus at any point in time the LFP:HFP ratio is a proxy for the sympatho- vagal balance. Thus HRV is a valuable tool to investigate the sympathetic and parasympathetic function of the autonomic nervous system. Study of HRV enhance our understanding of physiological phenomenon, the actions of medications and disease mechanisms but large scale prospective studies are needed to determine the sensitivity, specificity and predictive values of heart rate variability regarding death or morbidity in cardiac and non-cardiac patients