Variables Impacting Gfr Estimation Method For Drug Dosing In Ckd: Artificial Neural Network Prediction Model

Objective: This study aimed to measure concordance between different renal function estimates in terms of drug doses and determine the potential significant clinical differences. Methods: Around one hundred and eighty patients (≥ 18 y) with chronic kidney disease (CKD) were eligible for inclusion in this study. A paired-proportion cohort design was utilized using an artificial intelligence model. CKD patients refined into those who have drugs adjusted for renal function. For superiority of Cockcroft-Gault (CG) vs. modified diet in renal disease (MDRD) guided with references for concordance or discordance of the two equations and determined the dosing tiers of each drug. Validated artificial neural networks (ANN) was one outcome of interest. Variable impacts and performed reassignments were compared to evaluate the factors that affect the accuracy in estimating the kidney function for a better drug dosing. Results: The best ANN model classified most cases to CG as the best dosing method (79 vs. 72). The probability was 85% and the top performance was slightly above 93%. Creatinine levels and CKD staging were the most important factors in determining the best dosing method of CG versus MDRD. Ideal and actual body weights were second (24%). Whereas drug class or the specific drug was an important third factor (14%). Conclusion: Among many variables that affect the optimal dosing method, the top three are probably CKD staging, weight, and the drug. The contrasting CKD stages from the different methods can be used to recognize patterns, identify and predict the best dosing tactics in CKD patients.

To study the influence of different grades of Ethylcellulose ether derivative polymer Ethocel[registered] and co-excipient on drug release profile of controlled release matrix tablet of acarbose

The aim of the study presented is to formulate and evaluate Acarbose controlled release matrix tablets by means of different grades of polymer Ethocel and different co-excipients with the intention to see their effects on drug release profile during in vitro dissolution studies. Controlled release dosage forms is gaining rapid popularity due to its positive aspect of reduction in dosage frequency and curtailing side effects. Controlled released tablets of Acarbose were prepared by direct compression method, using Ethocel[registered sign] Standard 7 Premium and Ethocel[registered sign] Standard 7 FP premium polymer. The effect of co-excipients including hydroxypropyl methylcellulose [HPMC], Carboxymethyl cellulose [CMC] and starch on the drug placing 30% lactose were also examined. In-vitro studies were carried out with the help of phosphate buffer [PH 7.4] as dissolution medium. Drug release mechanism was assessed by applying various kinetic models. Similarly / dissimilarity factor f[2]/ f[1] were applied for determination of dissolution profile of the test and reference formulations. Physiochemical characteristics were in the USP satisfactory limits. Conventional Acarbose tablet released 97% of the drug within 2 hrs. Ethocel[registered sign] Standard 7 premium and Ethocel[registered sign] standard 7 FP released 59.9% and 47.01% of the drug within 6 and 99.9% and 97% within 24 hours, respectively. This effect possibly has been aceived owing to the smaller particle size of the Ethocel[registered sign] Standard 7 FP premium which show evidence of anomalous, nonfickian release kinetics. Co-excipients like HPMC, CMC and starch augment the drug release rates from the matrices which may be attributed to their hydrophilic nature. Ethocel[registered sign] Standard 7 Premium and Ethocel[registered sign] Standard premium 7 FP polymers show a promising response in fruitful production of controlled release tablets by direct compression method

Antidiarrhoeal, anti-inflammatory and analgesic activities of Symplocos racemesa roxb. Bark

The antidiarrheal activity of the drug Symplocos racemosa was performed in-vivo on isolated rabbit intestine. The effects of crude extract and fractions were observed at different doses. The overall response of the crude extract on isolated tissue of rabbit intestine was decreased in the tone of smooth muscle. Further studies were carried out on different fractions [ethylacetate, chloroform, n-butanol and aqueous] of crude extract of S. racemosa. The standard drugs were also used for further screening of the fractions of S. racemosa. Hot plate, writhing test, formalin test and carrageenan-induced paw edema in mice and rats were performed for determination of analgesic and anti-inflammatory activities respectively on S. racemosa bark extract. The results exhibited significant anti-inflammatory and analgesic effect at 300 and 500mg/kg doses

Spasmolytic effects of Scrophularia nodosa extract on isolated rabbit intestine

Scrophularia nodosa [figwort], an indigenous medicinal plant grows in moist and cultivated waste ground. It contains saponins, cardioactive glycosides, flavonoids, resin, sugar and organic acids. It is traditionally used for anti-inflammatory purpose and in skin disorders. It has diuretic and cardiac stimulant properties. The present studies were carried out on crude extract of Scrophularia nodosa and its n-hexane, chloroform, ethyl acetate, n-butanol and aqueous fractions. During phytochemical studies seven known compounds of flavonoid nature were isolated from the chloroform fraction of crude extract of S. nodosa. The structures of these compounds were elucidated by spectroscopic [UV, IR, Mass [EIMS, HREIMS] and NMR [[1]H-NMR, [13]C-NMR, DEPT, and [1]H-[1]H, COSY, HMQC, HMBC and NOESY] techniques. Compound 1 was identified as 5, 4'-hydroxy-3, 6, 7-trimethoxyflavone, compound 2 as 5-hydroxy-3,6,7,4'-tetramethoxyflavone, compound 3 as Centaurein, compound 4 as 5-hydroxy-7,8,2',3',4'-pentamethoxyflavone [Serpyllin], compound 5 as Kaempferol 7-O- alpha -L-rhamnopyranoside, compound 6 as sakuranetin 4'-O [6"-O-alpha-Lrhamnopyranosyl]-beta-D-glucopyranoside [Vitexoside] and compound 7 as Spinoside. Crude extract and its fractions were tested on isolated rabbit intestine [in vitro] for their effects. The results of crude extract and its fractions in different doses showed the decrease in normal movement of the smooth muscles of rabbit intestine [jejunum]. The chloroform fraction showed maximum relaxant effect [77.37%] at 15mg/ml dose and aqueous fraction showed 38.56% spasmogenic response which was not present in the crude extract. Further study was carried out on different fractions to investigate the possible mechanism of action of S. nodosa extract. For this purpose spasmolytic effect of different fractions were compared with agonist and antagonist activities of standard drugs including adrenaline, atropine andacetylcholine [1x10[-2], 1x10[-4] and 10[-6] M conc.]. It is concluded that the chemical constituents present in S. nodosa having spasmolytic action are possibly acting through muscarinic receptors

Biological screening of Scrophularia nodosa extract and its fractions

Biological screening of Scrophularia nodosa crude extract and its fractions [hexane, chloroform, ethyl-acetate, n-butanol and aqueous] was carried out on phytotoxicity, cytotoxicity, antibacterial, antifungal and analgesic activities. Crude extract and its fractions produced 50-100% phytotoxicity at 1000 micro g/ml concentration whereas 25-77% phytotoxicity was observed at 10 micro g/ml concentration. The fractions exhibited significant antibacterial and antifungal effects. The non-toxic results of this plant were recorded in Brine Shrimps Bioassay method at all concentrations. Similarly no significant insecticidal activity was observed in crude extracts and fractions. Analgesic activity results of S. nodosa in mice were found highly significant in crude extract as compared to fractions. In writhing test crude extract at 500 mg/kg showed 65.6% highest inhibitory response in mice

Mesh hernioplasty: surgeons' training ground?

To clinically evaluate the outcome of Inguinal Hernioplasty in terms haematoma, wound infection and recurrence, with special reference to surgery done by trainee surgeons. Case control study with prospective data collection, conducted from Sep. 2005 to August 2006. Surgical Unit two, Civil Hospital, Karacho. All male patients above 30 years of age with Inguinal hernia were included in the study. Patients presenting in emergency and those with age less than 30 years were excluded, as they did not undergo Mesh Hernioplasty. Patients with symptoms like chronic cough and constipation, and those with conditions like anaemia, diabetes and hypertension were optimized before surgery. Anaesthesia fitness was taken after necessary investigations. Patients were mostly operated under Regional [Spinal] anaesthesia. Two doses of a first generation cephalosporin or co-amoxiclav were used as a prophylactic antibiotic. Data was collected on a pre-designed proforma; record was also duplicated on the computer in the SPSS Version 10. Out patient follow-up was done for 6 months as a minimum. A total of 75 males with 78 inguinal hernias were operated during the study period; three patients had bilateral hernia. Sixty five percent of our patients had hernia on the right side and 31% on the left side, while 4% were bilateral. The ages of the patients ranged from 30 to 81 years; majority [72%] were under the age of 60 years. Sixty percent of the patients were manual workers. Sixty nine [88.5%] inguinal hernias were reducible and 9 [11.5%] irreducible; 6[7.7%] were recurrent. Trainee surgeons did 70% of the operations. Haematoma occurred in five cases, seroma in nine, urinary retention in four, wound infection in four and recurrence in one case. No mortality occurred during the study. In our set-up Mesh Hernioplasty has proven to be effective with low complication and recurrence rates. It is easily learnt by trainee surgeons. Early ambulation should be the aim. Cost of the mesh is a minor stumbling block, but the long term benefits of this hernia repair makes it the benchmark for all

Post operative wound infection: a surgeon's dilemma

Keeping in view the prevalence of wound infection in our set up, this study was designed to evaluate the frequency, clinical presentation, common risk factors and different organisms involved in cases of clean and cleancontaminated surgery. Observational descriptive study from March 2005 to February 2006. Surgical Unit III, Civil Hospital, Karachi. One hundred patients who underwent clean and clean-contaminated surgery. Biodata of the patients together with their clinical features, diagnosis, type of surgery performed and the development of any complications including wound infection was noted and the data analyzed. Out of the 100 patients [52 males and 48 females] in the study, 69 belonged to the clean surgery group and 31 to the clean-contaminated surgery group. The overall incidence of surgical site infection [SSI] in the study was 11%; 5[7.2%] cases in the clean surgical group and 6[19.4%] cases in the clean-contaminated group developed infection. Patients in the age group 51-60 years were infected more than those in the younger age groups. The incidence of wound infection was more in male patients [11.5%] as compared to female patients [10.4%]. Obesity was also a main cause of SSI as evident from the fact that patients with more than 60kg/m2 were infected more [20%] as compared to 30-40kg/m2 [7.1%]. Surgical site infection was found more in patients with extended pre-operative hospital stay. Anaemia, smoking, diabetes mellitus, prolonged surgery, operations by junior surgeons and operations late in the list were also associated with more surgical site infection. The usual time of presentation of SSI was within three weeks following surgery and most patients presented with wound abscess and cellulitis, while two patients had wound dehiscence. The common organisms involved in the SSI were Staphylococcus aureus, E. coli, Streptococcus pyogenes and Pseudomonas group. Meticulous surgical technique, proper sterilization, judicious use of antibiotics, improvement of operation theatre and ward environments, control of malnutrition and obesity, treatment of infective foci and diseases like diabetes, and avoidance of smoking helps control the morbidity of surgical wound infections

Two-stage aivar bracka repair in hypospadias salvage cases

To evaluate the outcome of Aivar Bracka repair in hypospadias salvage cases. This descriptive study was conducted in Plastic Surgery Unit, Hayatabad Medical Complex Peshawar, from 1999 to 2004. Two stage Hypospadias repair was performed in 78 re-operative cases having at least one previous failed attempt. Number of previous surgeries, meatal site and state were recorded. Any associated problem at presentation was noticed. Post-operatively, patients were followed up at two weeks, three months, six months and yearly as per protocol. Any functional or cosmetic complication was recorded. Mean age at presentation was 11.86 years [range 3-39 years]. Mean previous surgeries were 2.2 per patients [range 1-9]. Major complications necessitating an additional procedure were noticed in 10 patients [12.82%] with fistula in 6 [7.69%] cases, circumcision for redundant prepuce in 2 [2.56%] cases and exploration for bleeding in 2 [2.56%] patients. Excellent cosmetic and functional results were achieved in rest of 68 patients [87.17%] with two-stage Aivar Braka repair. Two-stage Aivar Bracka repair is a simple, safe and versatile procedure with low complication and high success rate. Even in salvage surgery, the results are excellent both functionally as well as cosmetically

Blunt abdominal trauma; does clinical evaluation suffice?

To correlate preoperative clinical diagnosis with per-operative findings in cases of Blunt Abdominal Trauma. Observational study with prospective data collection from Jan. 2004 to Dec. 2005. Surgical Unit III of Civil Hospital, Karachi. All patients over 12 years of age who underwent surgery for admitted with Blunt Abdominal Trauma. The patients were resuscitated and prepared for surgery: starting. blood transfusion in haemodynamically unstable patients, passage of nasogastric tube, bladder catheterization and doing appropriate investigations where conditions permitted. Pulse, Blood pressure, Temperature, Respiratory rate, Oxygen saturation and Urinary output monitoring started. As soon as possible surgical exploration was carried out through a midline incision under general anaesthesia. The surgical procedures performed depended upon the laprotomy findings. The data collection was done on a standard performa. During the two-year study period 25 patients, 21 males and 4 females, aged 16-52 years [mean 27 years] were admitted with Blunt Abdominal Trauma. At the time of presentation in the Casualty Dept. most of the patients [64%] were in a state of circulatory shock. Road Traffic Accident [RTA] was the commonest cause of Blunt Abdominal Trauma in our study, accounting for 16 [64%] patients, followed by fall from height in six [25%] and assault in three [12%] cases. A clinical diagnosis of splenic injury was made in 11 [44%] cases, liver injury in eight [32%],intestinal perforation in five [20%] and bladder injury in one [4%] case. Our pre-operative clinical diagnosis correlated with the operative findings in 22 [88%] cases. However in three [12%] cases, the operative findings did not correlate with clinical diagnosis. An early examination of Blunt Abdominal Trauma patients, enables the surgeon to reach a correct working diagnosis in the majority of cases

Management of postburn digital flexion contractures

To determine the outcome of plantar/palmer skin graft for the management of postburn digital flexion contracture in terms of functional and cosmetic improvements. Interventional quasi-experimental study. Department of Plastic and Reconstructive Surgery, PGMI, Hayatabad Medical Complex, Peshawar. The duration of the study was 1-1/2 years [from January 2001 to June 2002]. Fifty patients with postburn digital flexion contracture were recruited in the study. Patients with posttraumatic and postinfective contractures were excluded from the study population. The contracture was released and the deficit produced was replaced by plantar/palmer split skin graft. Active range of motion [ROM] was measured before and after surgery. Postoperative follow-up was done for one year. The outcome measurements were color and texture match of graft with the adjacent palmer skin, sensibility, recurrence rate of contracture and donor site morbidity. The data collected was labeled with the help of statistical package for social sciences [SPSS] and descriptive statistics were calculated accordingly. The graft take was complete [100%] in 48 patients, 50% in one patient [2%] and nil in one [2%] patient. Recurrence of contracture occurred in 5 patients [10%]. Pre-operative median active range of motion [ROM] at proximal interphalangeal [PIP] joint was 60 degree to 90 degree [extension/ flexion]. Postoperatively median active range of motion [ROM] at PIP joint was 0 degree to 90 degree at one year follow-up examination. The healed graft showed good colour and texture match with the surrounding palmer skin. The sensory function return was satisfactory and there was no significant donor site morbidity. The excellent colour, texture match and the functional advantages in terms of active range of motion and sensibility offered by the split thickness palmer/plantar skin grafts exceeded the expected outcome of conventional techniques [thigh, groin and buttock skin grafts]

assessment of incomplete facial basal cell carcinoma excision

To determine the rate and cause[s] of incomplete excision of basal cell carcinoma, occurring on face. Design: A non-interventional, descriptive study. Place and Duration of Study: Plastic Surgery Unit, Hayatabad Medical Complex, Peshawar, from January 2002 to March 2004. Patients and Patients with basal cell carcinoma of the face reporting to the OPD were included in the study and were booked for surgery. After excision, all tumors specimens were marked at 12 o'clock and sent to laboratory for histopathology to confirm the diagnosis and to know the completeness/incompleteness of tumor excision. If biopsy reported residual tumor in any of the margins it was noted and projected as percentage for the purpose of our results. Out of 56 patients, 49 [87.5%] had complete excision of tumor. Six [10.7%] had residual tumor while in one [1.7%] patient, biopsy report failed to mention the involvement/clearance of margins. Six patients with residual tumor were given postoperative radiotherapy. All patients were followed for a minimum of 2-1/2 years [critical period for recurrence] with careful watch on those with residual tumor. So far, only 2 of these 6 had recurrence of lesion. Both of them were greater than 2 cm in diameter and were located on medial canthal and nasolabial region. Chances of incomplete tumor excision are more on the mid face region. Patients with residual tumor are more prone to recurrence

Functional outcomes of single follicular hair graft technique

To assess the percentage survival of follicular hair graft technique and the factors influencing it. A non-interventional descriptive study. Plastic Surgery Unit, Hayatabad Medical Complex from November 2003 to April 2004. A total of 30 patients were included in the study with pattern of baldness ranging from type II to type VII. Age ranged from 24 years to 50. Hair bearing skin strips were harvested from occipital area and sliced under magnification into grafts of various sizes. Either punch or slit knife was used for making holes in recipient area and grafting follicles. Patients were followed at 2 weeks, 3 months and 6 months. Graft survival was measured at 6 months postoperative interval. In 7 patients graft survival was above 90%; in 12 patients above 80% but less than 90%; in 7 patients between 70 and 80%; in 2 patients above 60% but less than 70%; in 2 patients less than 20% which was considered as failure. Survival was greater with punch method than use of slit knife. Chances of failure increased with the large size session, larger grafts and unknown factors that need further investigations

Outcome of urethrocutaneous fistula repair after hypospadias

Analyze the outcome of urethrocutaneous fistula repair after Hypospadias surgery. It is a descriptive study carried out during 1997-2003. Patients underwent for urethrocutaneous fistula repair were included. Patients were followed for 2 weeks, 3 months, 6 months and 1 year period. 52 patients of post Hypospadias repair fistulae with 76 fistulas were operated. 71% had single fistula while 29% had more than one fistula. Simple closure was done in 68 [89%] fistulae. Success rate was 65% to 100%.While only 33% of our patients had proximal hypospadias, 44.23% were hypospadias cripples. While 4 of our patients [7.69%] had meatal stenosis needing Meatotomy and five adult patients [9.6%] had erection episode history in early postoperative period, in rest of the patients no obvious cause was found. In 37 patients [48.68%] fistula site was at corona or distal penile.Optimal results can only be achieved by adhering to the basic principals of plastic surgery including gentle tissue handling, using fine sutures, avoidance of opposing suture lines, absolute Haemostasis and tension free anastomosis

modified water proofing layer in two stage hypospadias repair: five years experience

To assess the outcome of modified water proofing fascial layer in two stage hypospadias repair.January 1999 to December 2003, Plastic surgery unit Hayatabad Medical Complex, Peshawar.Descriptive and prospective study.A modified waterproofing technique was used in two stage repair of Hypospadias. Two hundred consecutive cases were included in this study. Fifty two cases were Hypospadias cripple. Fistula was the most common major complication occurring in 18 patients. Four of these fistulae closed spontaneously while 14 underwent surgical repair. Catheter related minor complication occurred in 5 patients. 4 patients underwent revisional surgery for cosmetic reason.This modified waterproofing technique is simple, safe and versatile adjuvant to Hypospadias repair. Reduction in complication rate is significant with minimal learning curve

Studies on serum triglyceride level in patients with myocardial infarction.

Myocardial Infarction (MI) is the most common form of heart disease and the single most important cause of premature death in the developed and developing world. Unfortunately the incidence of the condition is increasing rapidly in many developing countries like Bangladesh. Effort should therefore be taken to minimize the risk factors of MI. Large scale randomized clinical trials have shown that lowering high triglyceride concentration mainly by drugs reduces the risk of cardiac events like MI. So the present work has been designed to see the serum triglyceride levels in normal healthy subjects, to compare serum triglyceride levels in patients with MI and those of healthy subjects and to evaluate the association of serum triglyceride in Bangladeshi MI patients. The present study was carried out in the Department of Biochemistry, BSMMU in collaboration with Department of Cardiology, BSMMU and NICVD, Dhaka during the period of July 2001 to December 2002. A total of 50 subjects were selected, Group A (30 subjects of control ) and Group B (20 subjects of test ). The mean level of serum triglyceride in control subjects were 117.07 +/- 32.41 mg/d1 and in test subjects were 176.87 +/- 37.15 mg/d1. So the present study showed that serum triglyceride level is significantly higher in patients with MI. From the present study, it is difficult to draw any definite conclusion but suggested that high serum triglyceride concentration is a cause of the incidence of MI.

Glomus tumor: alleviation of symptoms after the surgery

To assess the outcome of surgical excision in management of subungual glomus tumour. It was a prospective and descriptive study carried out in the Plastic Surgery unit, Hayatabad Medical Complex, Peshawar and Plastic surgery clinic. From 1994 to 2001, all patients presenting with clinical diagnosis of subungual glomus tumour and later confirmed by histopathology were included in the study. All patients were regularly followed up for recurrence of symptoms/tumours. A total of 6 patients were managed during study period of 7 years. Predominantly the young females were affected [M:F = 1:5]. The average symptoms duration was 3.6 years. Symptoms were completely alleviated by surgery. There was no sign of recurrence on clinical examination on an average follow up of 34.5 month. Minor skin infection occurred in one case. No other complication was recorded. The threshold for the possible diagnosis of glomus tumour should be kept low in patients presenting with severe subungual and finger pulp pain on localized pressure and cold exposure. Surgical excision provides cure to this crippling disease

Treatment of necrotizing fasciitis with quinolones

To evaluate the effect of high dose quinolones therapy in patients with necrotizing fasciitis. Design: descriptive analytical study. Place and Duration of Study: the department of Plastic and reconstructive surgery, Hayatabad Medical complex, Peshawar, from January 2001 to March 2002. Subjects and Twenty consecutive patients, diagnosed with necrotizing fasciitis, were treated with intravenous quinolones [400 mg 8 hourly]. The response was evaluated in terms of subsidence of fever and C-reactive proteins levels. Majority of the patients was male [60%]. Lower limb involvement was most commonly involved [70%]. The most common initiating cause was injection abscess [45%]. Majority of the cultures showed polymicrobial infection [90%]. The most common isolate was streptococcus pyogenes [65%]. Majority of the patients showed excellent response with intravenous quinolones [Ciprofloxacin] in high doses in 24-48 hours. Only two patients [10%] failed to respond to therapy due to severe infection and delay in seeking treatment. Intravenous quinolones [Ciprofloxacin] in high doses are effective in controlling necrotizing soft tissue infections

Comparison of prepucial skin, postauricular skin and buccal mucosal graft results in hypospadias repair

To compare the results of the prepucial, postauricular skin grafts and buccal mucosal graft in two-stage hypospadias repair. Design: Comparative study. Place and Duration of Study: The department of Plastic Surgery, Hayatabad Medical Complex, Peshawar. The duration of the study was three years [from January 1999 to December 2001]. Patients and The study subjects included 242 patients with hypospadias who underwent two-stage Aivor Bracka repair. The best results were obtained with prepucial skin graft in which the graft take was 95.3% and fistula rate was 3.2%. The incidence of graft contracture and graft loss was 20.5% and 11.7% respectively in buccal mucosal graft. The prepucial skin graft, postauricular skin graft and buccal mucosal graft gives excellent results in terms of graft acceptance in stage I and graft contracture and fistula rate in stage II