A cross-sectional study of musculoskeletal disorder and their environmental determinants among cycle rickshaw pullers of Delhi: A geographical information system-based analysis

Introduction: Rickshaw pulling is among the major activities in the informal sector. Cycle rickshaw pulling involves the task of prolonged sitting, fixed posture, and vibrations which could increase the risk of developing many health problems including one of the major problems of musculoskeletal disorder (MSD). Rickshaw pulling remains important for urban transport system, and such activities contribute in terms of employment and transportation services. The injury and illness resulting from work leads to lower productivity and quality employment which force them to increase their daily hours of working. The work environment and various other environmental determinants for MSD were assessed. The spatial variability of these environmental determinants and MSDs of cycle rickshaw pullers was studied in Delhi. Material and Methods: A cross-sectional study was conducted among cycle rickshaw pullers of Delhi. Five districts were randomly selected, and out of 448 study subjects, a total of 425 were included in the study. Consent was obtained before the study. The Nordic Musculoskeletal Questionnaire instrument for MSDs was used. The spatial distribution of MSD and risk factors was studied using QGIS software. Results: MSD was observed in 51.5% of the cycle rickshaw pullers and the prevalence increased with age from 9.6% to 34.7%. A statistically significant association of MSD with duration of work, sleeping hour, and sleeping place was observed. Poor road condition and posture were also having an association with MSD. Conclusion: Every second cycle rickshaw puller was having MSD. Lifestyle, road conditions, harsh environmental condition, strenuous physical exertion, and ergonomics of the cycle rickshaw were important factors contributing for MSD.

Enhancing pharmaceutical potential and oral bioavailability of Allium cepa nanosuspension in male albino rats using response surface methodology

Objective: To enhance the pharmaceutical potential and oral bioavailability of quercetin contents of Allium cepa peel extract by novel nanosuspension technology. Methods: Nanoprecipitation approach was successfully used for the formulation of nanosuspension. To obtain pharmaceutical-grade nanosuspension with minimum particle size and polydispersity index, sodium lauryl sulphate was selected as a stabilizer. Important formulation parameters were statistically optimized by the response surface methodology approach. The optimized nanosuspension was subjected to stability and in vitro dissolution testing and characterized by scanning electron microscopy, atomic force microscopy, Fourier transform infrared spectroscopy, and zeta sizer. To evaluate the preeminence of nanosuspension over coarse suspension, comparative bioavailability studies were carried out in male albino rats. The pharmaceutical potential of developed nanosuspension was evaluated by antioxidant, antimicrobial, and toxicity studies. Results: The optimized nanosuspension showed an average particle size of 275.5 nm with a polydispersity index and zeta potential value of 0.415 and -48.8 mV, respectively. Atomic force microscopy revealed that the average particle size of nanosuspension was below 100 nm. The formulated nanosuspension showed better stability under refrigerated conditions. Nanosuspension showed an improved dissolution rate and a 2.14-fold greater plasma concentration of quercetin than coarse suspension. Moreover, the formulated nanosuspension exhibited enhanced antioxidant and antimicrobial potential and was non-toxic. Conclusions: Optimization of nanosuspension effectively improves the pharmaceutical potential and oral bioavailability of Allium cepa extract.

Enhancing pharmaceutical potential and oral bioavailability of Allium cepa nanosuspension in male albino rats using response surface methodology

Objective: To enhance the pharmaceutical potential and oral bioavailability of quercetin contents of Allium cepa peel extract by novel nanosuspension technology. Methods: Nanoprecipitation approach was successfully used for the formulation of nanosuspension. To obtain pharmaceutical-grade nanosuspension with minimum particle size and polydispersity index, sodium lauryl sulphate was selected as a stabilizer. Important formulation parameters were statistically optimized by the response surface methodology approach. The optimized nanosuspension was subjected to stability and in vitro dissolution testing and characterized by scanning electron microscopy, atomic force microscopy, Fourier transform infrared spectroscopy, and zeta sizer. To evaluate the preeminence of nanosuspension over coarse suspension, comparative bioavailability studies were carried out in male albino rats. The pharmaceutical potential of developed nanosuspension was evaluated by antioxidant, antimicrobial, and toxicity studies. Results: The optimized nanosuspension showed an average particle size of 275.5 nm with a polydispersity index and zeta potential value of 0.415 and -48.8 mV, respectively. Atomic force microscopy revealed that the average particle size of nanosuspension was below 100 nm. The formulated nanosuspension showed better stability under refrigerated conditions. Nanosuspension showed an improved dissolution rate and a 2.14-fold greater plasma concentration of quercetin than coarse suspension. Moreover, the formulated nanosuspension exhibited enhanced antioxidant and antimicrobial potential and was non-toxic. Conclusions: Optimization of nanosuspension effectively improves the pharmaceutical potential and oral bioavailability of Allium cepa extract.

Multienzyme and Antibacterial Potential of Bacteria Isolated from gut of Asian Honey Bee (Apis cerana Indica), Lahore Using Culture Dependent Method

Abstract The bacteria residing in the gut of honey bees (HB) has demonstrated a significant role in protecting bees against various pathogens, production of honey and wax. However, no information exists about the antibacterial potential of bacterial isolates from gut of Asian HB, Apis cerana Indica F. (Hymenoptera: Apidae), against human pathogens. This study aims to investigate the antibacterial and multienzyme potential of aerobic bacteria from A. cerana gut using culture dependent approach. A total of 12 HB gut bacteria were characterized morphologically and biochemically. These strains were further screened for their antimicrobial activity against pathogenic human microorganisms Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Bacillus licheniformis and Bacillus subtilis using cross streak (primary screening) and agar well diffusion methods (secondary screening). Preliminary characterization of cell-free supernatant (CFS) of two promising isolates was performed by measuring lactic acid concentrations, enzymatic digestion of antimicrobial compounds, stability over a range of temperature, pH and amplification of spaS (subtilin) and spoA (subtilosin) genes. In primary screening, among 12 HB isolates, eight strains showed statistically significant highest zones of inhibition (p≤0.05) against E. coli, K. pneumoniae and P. aeruginosa. 16S rRNA sequencing revealed that these isolates belong to Bacillus genus, identified as B. tequilensis, B. pumilus, B. xiamenensis, B. subtilis, B. amyloliquefaciens, B. safensis, B. licheniformis, B. altitudinis (Accession numbers: MT186230-MT186237). Secondary screening revealed that among eight isolates, B. subtilis and B. amyloliquefaciens showed statistically significantly strong inhibition (p≤0.05) against all tested pathogens. Antibiotic susceptibility testing revealed that both isolates were resistant to antibiotics and possesses proteolytic, lipolytic and cellulolytic activities. The nature of the compound causing inhibitory activity was found to be proteinaceous and showed stability over a wide range of temperature as well as pH. PCR study confirmed the presence of bacteriocins by successful amplification of important antimicrobial peptide biosynthesis genes spaS and spoA. These results suggest that the HB gut is a home to bacteria that possess antimicrobial activity and important enzymes with antimicrobial potential. To our knowledge, this is the first report demonstrating the antimicrobial potential of bacteria isolated from gut of HB (A. cerana) against human pathogens.

Isolation and characterization of antihypertensive peptides from soy bean protein

Proteins and peptides are the most diverse biomolecules found in nature and make our interest due to their wide applications in food and pharmaceutical industry. Angiotensin Converting Enzyme (ACE) plays a major role in controlling blood pressure. The inhibition of ACE with peptides is a main target in the regulation of hypertension. The objective of the present study was to investigate the therapeutic potential of soy bean. This was accomplished by isolation of ACE inhibitory peptides using response surface methodology (RSM) and characterization of these bioactive peptides by mass spectrometry. 31 hydrolyzed fractions were isolated and evaluated for their ACE inhibition potential. Hydrolyzed fraction having highest ACE inhibitory activity was characterized by liquid chromatography-mass spectrometry (LC-MS) technique. RSM results showed maximum ACE inhibition potential (64%) by hydrolyzate was obtained at 45 ºC temperature, pH 8.0, E/S 0.2 in 2 hours hydrolysis time. Results of LC-MS analysis revealed Ser-Gly, Ser-Pro, Met-Ala, His-Ala, Lys-Pro, Phe-Thr, Met-Leu, Pro-Arg, Ala-Pro-Val, Pro-Ala-Leu, Val-Met-Gly, Pro-Leu-Val, Pro-Pro-Gln, His-Arg-Gly, Ser-Phe-Val-Leu, Ala-Val-His-Try, Arg-Thr-Val-Arg, His-His-Tyr-Leu-Val, Asp-Gly-Ala-Cys-Ser-Ala-Asn and MetVal-Thr-Gly-Pro-Gly-Cys-His bioactive peptides in hydrolyzed fraction of soy bean. Our data provide evidence that response surface methodology is a good approach for isolation of antihypertensive bioactive peptides with more potent activity as nutraceuticals or pharmaceuticals. Therefore soy bean can be use for industrial production of pharmaceutical grade natural medicines for handling high blood pressure.

Does Low Dose Of Piper Nigrum Extract Exert Anti-Obesity Activity?

Objective: To evaluate anti-obesity effect of aqueous P. nigrum extract in a murine model of high-fat diet (HFD) induced obesity. Methods: Male Wistar rats were fed with a high-fat diet (HFD) (20g/day/rat) for a period of 50 d to induce obesity. Aqueous P. nigrum extract (20 mg/kg) administered orally to high-fat diet (HFD) fed rats from 8th day to 50th day (total 42 d). The parameters like gain in body weight, serum lipids, insulin and leptin were measured. Results: The rats treated with extract showed a significant reduction in body weight gain, serum insulin, leptin, lipids as compared to rats fed with only a high-fat diet (HFD). In addition, the extract-treated group showed a considerable rise in high-density lipoprotein (HDL-C) level (29.61±7.68 mg/dl) as compared to the control group (23.23±9.69 mg/dl). Conclusion: The results indicate that aqueous P. nigrum extract possess the potential to reduce obesity markers in a high-fat diet (HFD) fed rats.

A case of pigmented fungiform papillae of tongue in a young female with iron deficiency anaemia

Fungiform papillae are red/pink, mushroom shaped projections located on the tip and dorsolateral part of tongue. It harbours several taste buds. Pigmented fungiform papillae is a not so common benign condition which involves pigment deposition in fungiform papillae. Authors report a case of 35 years female who presented with history of blackish spots over tongue for past 10 years with no other associated symptom. Patient had conjunctival pallor (moderate) and rest of the examination was normal. Investigations showed iron deficiency anaemia with Hb. of 9.5 mg/dl. A clinical diagnosis of Pigmented Fungiform Papillae (PFP) with associated Iron Deficiency Anaemia (IDA) was made. Patient was explained in detail about the benign nature of disease and was put on oral iron therapy. Follow up after 2 months was advised.

Nanosuspension enhances dissolution rate and oral bioavailability of Terminalia arjuna bark extract in vivo and in vitro

Objective: To enhance the dissolution rate and oral bioavailability of Terminalia arjuna bark extract by formulating its nanosuspension. Methods: Nanoprecipitation approach was used for the formulation of nanosuspension using polysorbate-80 as a stabilizer. The formulated nanosuspension was assessed for particle size, polydispersity index, zeta potential value and for in vitro dissolution study. Oral bioavailability studies were carried out in Wistar male albino rats by administering a single dose (50 mg/kg. b. wt) of the formulated nanosuspension and coarse suspension. The storage stability of the formulated nanosuspension was determined after three months of storage at room temperature and under the refrigerated condition. Mutagenicity assay was carried out to evaluate the toxicity of the formulated nanosuspension using two mutant strains (Salmonella typhimurium TA100 and Salmonella typhimurium TA98).Results: The mean particle size of the formulated nanosuspension was 90.53 nm with polydispersity index and zeta potential values of 0.175 and ?15.7 mV, respectively. Terminalia arjuna nanosuspension showed improved dissolution rate and 1.33-fold higher oral bioavailability than its coarse suspension. The formulated nanosuspension also showed better stability under the refrigerated condition and was non-mutagenic against both strains. Conclusions: Our study demonstrates that nanosuspension technology can effectively enhance the dissolution rate and oral bioavailability of Terminalia arjuna bark extract.

Nanosuspension enhances dissolution rate and oral bioavailability of Terminalia arjuna bark extract in vivo and in vitro

Objective: To enhance the dissolution rate and oral bioavailability of Terminalia arjuna bark extract by formulating its nanosuspension. Methods: Nanoprecipitation approach was used for the formulation of nanosuspension using polysorbate-80 as a stabilizer. The formulated nanosuspension was assessed for particle size, polydispersity index, zeta potential value and for in vitro dissolution study. Oral bioavailability studies were carried out in Wistar male albino rats by administering a single dose (50 mg/kg. b. wt) of the formulated nanosuspension and coarse suspension. The storage stability of the formulated nanosuspension was determined after three months of storage at room temperature and under the refrigerated condition. Mutagenicity assay was carried out to evaluate the toxicity of the formulated nanosuspension using two mutant strains (Salmonella typhimurium TA100 and Salmonella typhimurium TA98). Results: The mean particle size of the formulated nanosuspension was 90.53 nm with polydispersity index and zeta potential values of 0.175 and-15.7 mV, respectively. Terminalia arjuna nanosuspension showed improved dissolution rate and 1.33 fold higher oral bioavailability than its coarse suspension. The formulated nanosuspension also showed better stability under the refrigerated condition and was non-mutagenic against both strains. Conclusions: Our study demonstrates that nanosuspension technology can effectively enhance the dissolution rate and oral bioavailability of Terminalia arjuna bark extract. Zafar Fatiqa 1 Department of Chemistry, University of Okara, Okara Jahan Nazish 2 Department of Chemistry, University of Agriculture, Faisalabad Khalil-Ur-Rahman 3 Department of Biochemistry, University of Agriculture, Faisalabad Asi Muhammad 4 Food Toxicology Lab, Plant Protection Division, Nuclear Institute for Agriculture and Biology, Faisalabad Zafar Waseeq-Ul-Islam 5 Department of Computer Science, COMSATS University of Information and Technology, Islamabad Pawar SS, Dahifale BR, Nagargoje SP, Shendge RS. Nanosuspension technologies for delivery of drugs. Nanosci Nanotech Res 2017; 4(2): 5966. Kilor V, Sapkal N, Daud A, Humne S, Gupta T. Development of stable nanosuspension loaded oral films of glimepiride with improved bioavailability. Int J Appl Pharm 2017; 9(2): 28-33. He J, Han Y, Xu G, Yin L, Neubi MN, Zhou J, et al. Preparation and evaluation of celecoxib nanosuspensions for bioavailability enhancement. RSC Adv 2017; 7: 13053-13064. 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Assessment of Community-Based Home Health Programs among Children with Chronic Disease in Tertiary Care Center, Riyadh

Background: Home health care (HHC) is a newly developed model of care that helps patients to be treated at their home and avoid hospital admission with the aim of promoting, maintaining or restoring health as part of their comprehensive services. Objective: To assess the effectiveness of HHC in reducing the days of admissions and ED visits for children with chronic diseases. Materials and methods: A cross-sectional study held at a tertiary care center. Consecutive sampling technique was used to review all patients’ files registered for HHC program from 2016 to 2018. Continuous variables were reported as mean and standard deviation, whereas categorical were reported as percentages and frequencies. Wilcoxon rank test was used to assess differences before and after enrolment in the HHC program. SPSS V22.0 was used for analysis. Results: A total of 92 patients were involved in this study; 57% were males and 44% were females. 42% of them had neurodevelopmental diseases. Among all the services provided, nursing care was the most needed service. The total number of days of admission was reduced from 28 ± 0.6 to 6.75 ± 0.39 days in 4 months period and from 38.37 ± 62 to 9.02 ± 14 days in 6 months period with p-value<0.001. However, the ED visits were not affected by the p-value of 0.19 and 0.33 for both 4 months and 6 months period, respectively. Conclusion: HHC program showed an effective result in reducing the frequency of hospital admission and days of children’s admission, yet it had no effect on lowering the ED visits.

Current Scenario of Oppoutunistic Fungal Infections other than the Candida and Aspergillus Species, their correlation and Outcome with the CD4+T Cell Counts among Various Respiratory Samples in Immuno Competent and Immunocomporomised Individuals in Aligarh Region, A North India Town

Introduction: Invasive fungal infections other than theCandida species and Aspergillus species are becomingcommon in the nosocomial setting particularly among theimmunocompromised patients but there is a hinderance intheir accurate diagnosis. Aim of our study was to know theprevalence of rare fungal species and to know the patientsoutcome in our region. Aim of our study is to know theprevalence of rare fungal species and to know the patientsoutcome in our region.Material amd Methods: The present study was carried outon the patients attending outpatient department and inpatientdepartment of T.B. and Respiratory Diseases, along with thoseattending antiretroviral treatment clinic and ICTC (Departmentof Microbiology), in J. N. Medical College, AMU during theperiod of January 2015 to October 2016.Results: Majority of the cases i.e., 47 (31.3%) were between31-40 years with a mean age of 32.5 years. Of 65 isolates,Cryptococcus neoformans and Pneumocystis jiroveciirepresented 2 (6.1%) isolates each, all of which were foundin HIV positive cases. 1 (3.1%) isolate of Mucor from adiabetic patient and 1 (3.1%) isolate of Penicillium marneffeifrom an HIV positive patient as detected. Cryptococcus andPneumocystis jirovecii were isolated from both patients withCD4 count< 200. and 114(+19.9) respectively.Conclusions: Invasive fungal infections other than thecandidia species and aspergillus species are becoming verycommon now a days.

Trends of Antifungal Drug Susceptibility Profile in Candida and Aspergillus Isolates in Respiratory Samples Obtained from Immunocompetent and Immunocompromised Patients in Aligarh District in Northern India

Introduction: Incidence of invasive fungal infections is now rising. An estimated 4.7 million HIV-1–infected persons are living in Asia. The aim of the study was to know the anti fungal susceptibility profile of Candida spp. and Aspergillus spp.in northen India region. Material and methods: In this study we took 150 patients attending outpatient department and admitted in the wards of T.B. and Respiratory Diseases, along with those attending antiretroviral treatment clinic and ICTC (Department of Microbiology), in J. N. Medical College, AMU. Results: Amongst Candida isolates, resistance to fluconazole was seen in 6.9% isolates of C. albicans. 50% of C. dubliniensis and 20% of C.glabrata were resistant to fluconazole. Also, resistance to ketoconazole was observed in 25% isolates of C. dubliniensis. Only 1 isolate was resistant to AMB which was of C.glabrata (20%) and no isolate was resistant to Caspofungin. Resistance to Amphotericin B was seen in 11.8% of A. fumigatus, 10% of A. flavus and 33.3% of A. niger. Resistance to Itraconazole was found in 11.8% of A. fumigatus, 20% of A. flavus and 33.3% of A. niger. Resistance to Ketoconazole was seen in 11.1% of A. fumigatus, 14.2% of A. flavus and 100% of A. niger. No resistance was seen against Caspofungin against any species of Aspergillus. Conclusion: There is gradual increase in the antifungal resistance among higher drugs reported from other regions, is a major concern for today.

Assessment of knowledge, attitude and practice regarding oxygen therapy at emergency departments in Riyadh in 2017: A cross-sectional study / 世界急诊医学杂志（英文）

BACKGROUND@# Administering oxygen therapy (OT) has an essential role in preventing/managing hypoxemia in both acute and chronic conditions. It should be adjusted to achieve the normal oxygen saturation of 94%–98% in most cases. This study aims to evaluate knowledge, attitude and practice (KAP) of nurses, paramedics, emergency medical technicians (EMTs) and Emergency Medical Services (EMS) physicians working at emergency departments (ED) in Riyadh, Saudi Arabia.@*METHODS@# In this cross-sectional study, a structured questionnaire was used to assess KAP related to OT of nurses, paramedics, EMTs and EMS physicians currently working at an ED of a tertiary care hospital. Knowledge and attitude were assessed using a Likert scale from 1–5, whereas practice was assessed as a yes/no categorical variable.@*RESULTS@# A total of 444 emergency health-care workers (EHCWs) participated, of which 225 (50.7%) were male, with the majority (77%) in the age group of 20–35 years. Over half of the sample were nurses (266; 59.9%). The mean score for knowledge about OT was 5.51±1.45, attitude was 26.31±3.17 and for practices 4.55±1.76. The main factors which were associated with poor KAP were workload and lack of local guidelines. The distribution of overall practice score was significantly better among paramedics – nurses group and EMT – nurses group.@*CONCLUSION@# This study demonstrates that there is a gap in EHCWs' KAP, particularly regarding when to provide OT to a patient. This gap can affect patients' safety. Extensive educational and training programs about OT are needed to raise awareness among health-care providers.

Hepatitis-C and it's seroconversion in end stage kidney disease patients on maintenance hemodialysis and factors affecting it

Objective: To determine frequency of hepatitis-C in dialysis patients at start of hemodialysis, seroconversion from HCV negative to HCV positive over study duration and factors affecting seroconversion

Methods: This descriptive prospective observational study done in dialysis center of DHQ hospital Sheikhupura, Punjab, Pakistan. The study was conducted from October 2016 to October 2017. Data was collected on Performa and later followed prospectively in same cohort of patients. All the patients on maintenance hemodialysis for more than one month were included in the study. Patients with acute kidney disease and on dialysis less than one month were excluded. Patients were analyzed by dividing them in three groups, group-I patients who were HCV positive at start of dialysis, Group-II who were negative and seroconvert to HCV positive, Group-III who were negative and remained negative. All seronegative patients were followed at one, three, six and twelfth months on being hemodialysis for seroconversion

Results: Out of 230 surveyed patients 52 were HCV positive at start of dialysis and 19 were loss of follow up. Out of remaining 159 HCV negative patients 95 became HCV positive, only 64 patients remained HCV negative by end of study

Conclusion: Frequency of HCV seroconversion among chronic hemodialysis patient is found to be 53.37%. Arteriovenous access, number of dialysis, reuse of dialyzer and blood transfusions are important risk factors

Prevalence of Oral Mucosal Lesions among Tobacco Chewers in North Indian Population

Background: The oral mucosa acts as a protective barrier against pathogens, and carcinoma causing agents. It can be affected by different lesions and conditions, few of which are harmless, while some may have harmful complications. Objective: To study the prevalence of oral mucosal variants & Lesions among tobacco users in North Indian population.Methods:A total of 640 subjects consisting of 492 males and 148 females reporting to the outpatient Department of Oral Medicine and Radiology were selected. The subjects were divided into two groups. The first group was control group with subjects not having tobacco chewing habit consisting of 320 subjects including 246 males and 74 females. Another group included tobacco with same no of subjects as that of control group. All subjects were examined for presence of oral mucosal variants in accordance with the WHO acknowledged coloured atlas, clinical examination and history. Results: Prevalence of oral mucosal variants was found to be 75.0% among tobacco chewers. Males were more affected (70.0%) than the females. The maximum no of cases reported were in the age group of 20-40 years. Leukoplakia was the most common oral mucosal lesion among tobacco chewers. Conclusion: Tobacco chewing can be considered to be a concerned habit and necessary public health programmes should be taken to eradicate this habit.

Clinical Presentations and Phenotypic Spectrum of Multiple Sclerosis at a University Hospital in Saudi Arabia

BACKGROUND AND PURPOSE: The objective of this study was to determine the frequencies of different clinical presentations and the phenotypic spectrum of multiple sclerosis (MS). METHODS: This cross-sectional study was performed in the Neurology Department of King Fahd Hospital of University Alkhobar in the Kingdom of Saudi Arabia (KSA). Data of 190 MS patients who fulfilled the McDonald criteria were retrieved from medical records and analyzed. RESULTS: The age at disease onset was 26.27±8.2 years (mean±SD) and disease duration was 6.38±5.10 years. The male-to-female ratio was 1:1.6. Optic neuritis and myelitis were the most-frequent first clinical presentations. Sensory (73.1%), motor (61%), and visual (58.4%) symptoms were the most-frequent established clinical symptoms. Relapsing-remitting multiple sclerosis (RRMS) was present in 75% of the cases. Supratentorial T2-weighted white-matter lesions and deep-gray-matter or juxtacortical lesions were the most-frequent magnetic resonance imaging (MRI) lesions, comprising 28% and 23.7% of all MRI lesions observed in 93.6% and 79.4% of the cases, respectively. The scores on the Expanded Disability Status Scale were within the range of 1.0–5.5 in 82.1% of the patients. There were 145 (76.3%) patients taking interferon β therapy. CONCLUSIONS: MS presenting in the hospital setting is more common in KSA than reported previously, and the number of diagnosed cases in increasing. It is therefore an emerging and disabling neurological illness in KSA with clinical characteristics not dissimilar to those in other middle eastern countries. A decrease in the frequency of patients with secondary progressive multiple sclerosis (SPMS) indicates either that more new cases of RRMS are being diagnosed or that adequate treatments of RRMS are preventing the evolution to SPMS. Further larger and population-wide epidemiological and clinical studies with the long-term follow-up of MS patients are required to better assess the clinical spectrum of MS in KSA.

Validity of bispectral index in diagnosis of mild and moderate head injury

Objective: The objective of the study is to determine the validity of bispectral in diagnosis of mild and moderate head injury keeping GCS as a gold standard. Study Design: A cross sectional validation study. Place and Duration of Study: This Study was conducted in main Intensive Care Unit of the Combined Military Hospital Rawalpindi and was carried out over eight months from Dec 2009 to Aug 2010

Material and Methods: A minimum of 137 patients were included in study. At the time of admission, Glasgow coma score was calculated by 3 different anesthetists and mean was calculated. At the same time BIS reading was taken using Aspect BIS monitor

Results: Mean age of the patients was 29.5 +/- 6.2. 108 [78.8%] patients were male while 29 [29.2%] patients were female. Mean glasgow coma score was 12.2 +/- 0.9 and mean bispectral index score was 69.9 +/- 8.4. A 2 x 2 table was made between GCS and BIS. Sensitivity was found to be 95.65%, specificity 98.53%, positive predictive value 98.50% and negative predictive value 95.7%. ROC curve was drawn and demonstrated area under curve value of 0.999

Conclusion: BIS monitor can prove to be a useful adjunct in the diagnosis and management of mild and moderate head injury patients in the intensive care units

Fawwad A. Association of serum liver enzyme Alanine Aminotransferase [ALT] in patients with type 2 diabetes

Objectives: To assess the association of raised serum liver enzyme [ALT] with type 2 diabetic subjects

Methods: This retrospective data was accessed at Baqai Institute of Diabetology and Endocrinology [BIDE] from January 2005 to May 2016. A total of 1966 subjects with type 2 diabetes were included in the study. Subjects were divided into two groups; in group A 1284 subjects had ALT within the normal range [ALT >/= 35iu/l] and in Group-B 682 subjects had elevated ALT [ALT>35iu/l]. Details of demographics, anthropometric measurements and biochemical results at baseline were extracted from the health management system of BIDE. Data analysis was conducted on Statistical Package for Social Sciences [SPSS] version 20

Results: Out of 1966 type 2 diabetic subjects 1284 [65.4%] were observed with normal value of ALT [35]. Overall mean age of subjects was 54.66 +/- +/- 10.98 years and mean BMI was 27.34 +/- +/- 5.99 kg/m[2]. Significant difference was observed between the groups in age [if ALT>35], gender [more likely to be male] and triglyceride [higher if ALT>35].Whereas no significant difference was found between the groups in HbA1c, cholesterol, HDL and LDL

Conclusion: High frequency of elevated ALT suggests the association of liver disease with type 2 diabetes. The type 2 diabetic subjects need to be routinely screened and further studies to assess the possible associations with NAFLD and insulin resistance are required to further clarify the disease process

Flagellar motility plays important role in Biofilm formation of Bacillus cereus and Yersinia enterocolitica

Bacteria live either independently as planktonic cells or in organized surface associated colonies called as biofilms. Biofilms play an important role in increased pathogenesis of bacteria and it is assumed that motility is one of the contributing factors towards biofilm initiation. This study was planned to identify the role of flagella in biofilm formation by constructing flagellated [wild type] and physically disrupted variants [non-motile]. Total 10 clinical bacterial strains were isolated and characterized. Morphological and biochemical study identified these strains as Enterobacter spp., Pseudomonas spp., Yersinia spp., Escherichia spp., Salmonella spp., Proteus spp., Staphylococcus spp., Streptococcus spp., Lactobacillus spp. and Bacillus spp. Among all strains, two strains including Yersinia spp and Bacillus spp. showed higher antibiotic resistance, hence studied at molecular and physiological level. Biofilm formation capacity of strains was analyzed using three methods including Congo red assay, Test tube assay and Liquid-interface coverslip assay. Afterwards, flagellar disintegration was induced by blending and centrifugation for 5, 10 and 15 minutes. 16S rRNA sequencing showed two strains as Bacillus cereus and Yersinia enterocolitica. Both strains produced significant biofilm by all three above mentioned methods. A motility test of these blended variants showed partial/diminished motility with increased blending time. The significant loss in biofilm formation after 15 minutes blending confirmed the important flagellar contribution to the initiation of biofilm formation. This biofilm defect observed in flagella paralysed/minus variants presumably may be due to defects in attachments to surface at early stages. This study indicated that flagellar motility is crucial initially for surface attachment and subsequently for biofilm formation

Relationship between glycated haemoglobin and carotid atherosclerotic disease among patients with acute ischaemic stroke

Objectives: This study aimed to determine the relationship between glycaemic control and carotid atherosclerotic disease among patients with acute ischaemic stroke [AIS]

Methods: This retrospective crosssectional study took place in the Neurology Department of King Fahad Hospital of University, Khobar, Saudi Arabia, from April to October 2017. Data were collected from the medical records of 244 patients with a diagnosis of AIS confirmed by computed tomography. Doppler ultrasounds of the carotid artery were performed to determine the presence of increased carotid intima media thickness [CIMT] and plaques

Results: Significantly higher mean glycated haemoglobin [HbA1c] levels were noted in cases with high CIMT values [P = 0.002], but not in cases with carotid plaques [P = 0.360]. In addition, there was a significant association between diabetes mellitus [DM] and high CIMT [P = 0.045], but not with carotid plaques [P = 0.075]. Finally, while dyslipidaemia and age were independently correlated with high CIMT values [P = 0.034 and <0.001, respectively] and carotid plaques [P <0.001 each], no independent relationships were noted in terms of gender and other risk factors like DM, hypertension and smoking [P >0.050 each]

Conclusion: High HbA1c levels were associated with high CIMT values, but not with carotid plaques. Therefore, HbA1c levels may be useful as an indirect marker of the initial stages of carotid artery atherosclerosis