Effect of Morus alba (white mulberry) leaf on HbA1c of patients with type II diabetes mellitus

@#Introduction: Diabetes mellitus is a wide spread metabolic disorder characterized by hyperglycemia. In Pakistan, many traditional or medicinal plants are being used to treat ailments or disorders, both in children and adults. To date, there has been no research study done to investigate the effect of Morus alba (white mulberry) leaves on blood glucose levels of individuals with type II diabetes mellitus in Pakistan. The present study was conducted to determine the effect of Morus alba (white mulberry) leaf powder on glycated haemoglobin (HbA1c) of patients with type II diabetes mellitus. Methods: The study design of this study was a randomised controlled trial. Eighty patients with type II diabetes mellitus were randomly selected from the Fatima Memorial Hospital and were equally divided into two groups - control group and experimental group. Patients in the control group were asked to follow their regular hypoglycaemic medications, while patients in the experimental group were administered with 500mg of Morus alba leaf tablet twice a day, 15 minutes before breakfast and dinner, along with their regular hypoglycaemic medications. HbA1c of patients in both groups were assessed on day zero before the study and on the ninetieth day at study completion. Results: HbA1c of patients in the control group at baseline was 8.92% and 8.91% at final, whereas HbA1c of patients in the experimental group at baseline was 9.13% and 8.59% at final. Conclusion: The results of this study concluded that Morus alba leaves had a significant effect in lowering high blood sugar levels.

Vitex negundo induces an anticonvulsant effect by inhibiting voltage gated sodium channels in murine Neuro 2A cell line

Vitex negundo [Vn] extract is famous for the treatment of neurological diseases such as migraine and epilepsy. These neurological diseases have been associated with abnormally increased influx of sodium ions into the neurons. Drugs that inhibit voltage gated sodium channels can be used as potent anti-epileptics. Till now, the effects of Vn on sodium channels have not been investigated. Therefore, we have investigated the effects of methalonic fraction of Vn extract in Murine Neuro 2A cell line. Cells were cultured in a defined medium with or without the Vn extract [100 microg/ml]. Sodium currents were recorded using whole-cell patch clamp method. The data show that methanolic extract of Vn inhibited sodium currents in a dose dependent manner [IC50 =161microg/ml]. Vn [100 microg/ml] shifted the steady-state inactivation curve to the left or towards the hyper polarization state. However, Vn did not show any effects on outward rectifying potassium currents. Moreover, Vn [100 microg/ml] significantly reduced the sustained repetitive [48 +/- 4.8%, P<0.01] firing from neonatal hippocampal neurons at 12 DIV. Hence, our data suggested that inhibition of sodium channels by Vn may exert pharmacological effects in reducing pain and convulsions

Detection of acute dengue infection using NS1 rapid test on blood donors of Rawalpindi

Background: During recent years, many cases of dengue virus transmission, through blood transfusion have been reported, including two cases from Karachi, Pakistan. NS1 antigen detection in blood donors can serve as a rapid mean for detection of acute dengue infection thus could prevent transmission through blood donation by affected individuals

Objectives: The aim of this study was to screen high risk blood donors for active dengue infection during an outbreak in the city of Rawalpindi and rejection of NS1-positive donors to save patients from dengue infected transfusions

Subjects and Methods: After approval from the IRB Shaikh Zayed Hospital, high risk blood donors during the outbreak were identified in blood banks of selected government hospitals. The objective of the study was explained and an informed consent was obtained from each participant. Blood sample of 3cc was drawn at the time of cross-match. Serum was separated and analyzed for dengue NS1 Ag. Data was entered and analyzed using SPSS version 20.0

Results: Overall 600 blood donors were included in the survey with the majority of male participants [n=583] than female participants [n=17]. Most of the blood donors [57.8%] were falling in the age group of less than 30 years and highest donations were from [B] positive blood group followed by [O] positive and [AB] negative with least donations. None of the sample screened positive for NS1 antigen

Conclusion: Blood of high risk asymptomatic donors taken were having no dengue NS1 Ag positivity

Vitamin A deficiency among school going children affected by flood

Background: Vitamin A deficiency increases the risk of night blindness and death due to common childhood illnesses that are prevalent during emergencies like floods. The relief diet provided to flood victims is often deficient in micronutrients and minerals including vitamin A. There is a need to assess the levels of vitamin A among flood affected children to prevent morbidity and mortality caused by malnutrition

Objective: To assess the frequency of Vitamin A deficiency among school going children [8-14 years] affected and unaffected by floods of 2010 in district Nowshera

Subjects and Methods: Study was conducted in Government-registered schools situated in flood affected and unaffected areas of district Nowshera of KPK Province of Pakistan. A total of 353 children [8-14 years] were registered for study, including 190 from flood affected and 163 from unaffected areas. A questionnaire was filled for each child which included the demographic information. Three milliliter blood was drawn from each child which was processed for the estimation of vitamin A levels. Data was entered and analyzed using SPSS 20.0

Results: Among flood affected children frequency of vitamin A deficiency was 18.9%, whereas among flood unaffected children it was 6.1% showing strong association with children affected by floods [p < 0.001].Among illnesses during floods, children who had acute respiratory infection were on an average 3.5 times more likely to have vitamin A deficiency as compared to those who did not suffer from this disease [p = 0.037]

Conclusion: Vitamin A deficiency was substantially higher among children affected by floods and those who had acute respiratory infection

Newborn screening for congenital hypothyroidism in a public sector hospital

Congenital hypothyroidism if left untreated results in growth failure, irreversible mental retardation, and cretinism. National neonatal screening programs are therefore, launched to diagnose congenital hypothyroidism and manage it timely. To screen newborns for congenital hypothyroidism in two public sector hospitals of Lahore. Cross sectional descriptive study conducted at departments of Gynae/Obs and Pediatric Shaikh Zayed Hospital and Jinnah Hospital, Lahore from February 2010 to November 2011. Awareness brochures for congenital hypothyroidism were developed and attached with the antenatal card of each pregnant case attending antenatal clinic at Gynae/Obs OPD. Newborns who had stayed in hospital for more than 24 hour, and whose parents consented for heal prick were tested for blood spot thyroid-stimulating hormone. Results were reported within four days and thyroid-stimulating hormone >/= 20mIU/L was taken as high value. Parents of those neonates who had high value were contacted to give a fresh sample for confirmation. Confirmed results were provided within next 4-5 days to the parents and treating pediatrician for appropriate treatment. A total of 1357 samples were screened using blood spot thyroid-stimulating hormone and out of these 1330 were normal [< 20mIU/L] while 27 had high levels [>/= 20mIU/L]. These 27 neonates were further tested using confirmatory tests for serum thyroid-stimulating hormone, T3 and T4. After confirmatory tests only one case had congenital hypothyroidism who was referred for treatment. Three cases were suspected to have subclinical hypothyroidism and these were retested after six months which, picked another case of confirmed subclinical hypothyroidism who was referred for treatment. The incidence of congenital hypothyroidism was 2 out of 1357 cases. The screening could pick 2 cases of hypothyroidism from a total of 1357 cases which is high when compared to global rates. Routine screening of neonates for thyroid disease can pick the disease early and thus prevent later complications

Assessment of knowledge, attitude and practices pattern of hand washing in some major public sector hospitals of Pakistan [a multi-center study]

To assess knowledge, attitude and practices of hand washing in major Public sector Hospitals of Pakistan and see the differences in practices in different levels of health care workers. Cross sectional hospital based survey conducted in all provinces of Pakistan in major tertiary care hospitals. A Cross sectional hospital based survey was conducted on knowledge, attitude and practices of hand washing in doctors, nurses and paramedical staff. From each hospital 10 OPD's and 10 wards i.e. 2 medical, 2 Surgical, Gynae, Peads, Dermatology, Eye, ENT, and Causality/ICU were selected and from each unit. Four doctors, four nurses and two paramedical staff were interviewed. A total of 3243 respondents were interviewed. Of these 87.3% had knowledge of hand washing. Hand washing facilities were available at 75% places and 69% respondents practiced hand hygiene, but only 58.8% washed their hands for more than 20 seconds. Majority used antibacterial soap bought by them. Rush of the patients, shortage of time, non availability of soap and water and lack of encouragement by seniors were the major causes for low hand hygiene practice. Almost 25% sites in major public sector tertiary hospitals did not have hand washing facilities but where available most health care providers were using them. Majority despite having knowledge, need motivation and continuous education of hand hygiene. Facilities of hand hygiene should be made available

Perceptions of cadaveric dissection in anatomy teaching

Background: Anatomy professors world over are lamenting about medical students' lack of interest in dissections and its diminishing utilisation in medical studies. The objective of our study was to find out the reasons why some of the Pakistani medical students were avoiding dissections. Method: We conducted this study in 5 medical colleges of Pakistan from Dec 2010–Oct 2011. Questionnaires were prepared and administered to more than 500 Pakistani medical students, at least 6 months after their first cadaver dissecting session. Mostly 1 st and 2 nd year medical students participated in this study. Result: Around 43% students have actually performed dissections in some form, whereas around 57% had never touched the cadaver. Further evaluation of these results revealed that out of 57% of students, 45% avoided dissection due to bad smell of formaldehyde, 37% due to moral/ethical grounds, 22% due to low motivation and respect of human body, 19.4% due to anxiety, 18.6% due to religious reason, 16% due to fear, asthma and emotional reaction, 9.4% due to toxic chemical, 8.6% due to laziness and 7% due to nightmares. Conclusion: In spite of availability of required number of cadavers in all 5 medical colleges and a clear realisation amongst the students that dissecting cadaver is an effective way of learning anatomy; majority of students were not very keen and had therefore not performed dissection even once. Keywords: Anatomy, dissection, cadaver, questionnaire, medical student, formaldehyde

Anaemia: the neglected feale health problem in developing countries

Background: Anaemia is arguably the biggest female health problems in developing countries. The world is still to fully fathom the extent and gravity of the problem. This problem aggravates particularly during and after pregnancies due to increased nutritional demands and inadequate iron supply and is therefore more widespread in parous segments of female population. Objective of this study was to determine prevalence of anaemia in apparently healthy parous female population of Abbottabad and investigate underlying causes. Methods: This descriptive, cross-sectional study was conducted from October 2001 to March 2011 in Abbottabad. Women reporting for various surgical procedures were investigated for anaemia by obtaining history through a structured performa, specifically designed to identify the underlying causes. Sixteen thousand women of child bearing age [20–40 years] were included in the study; 14, 800 with history of at least one pregnancy and remaining with no previous pregnancy. Haemoglobin [Hb] was measured using haematology analyser Sysmex [KX21]. Results: Of the screened women, 60% were found anaemic [Hb <12 g/dl] 10% of which were severely anaemic [Hb <6 g/dl]. Anaemia was related to socio-demographic and obstetric history characteristics. The prevalence of anaemia was significantly lower in women who used iron supplements during their pregnancies. Lactating mothers not making up for the iron deficiencies during pregnancies usually carried their anaemia postpartum and beyond. Lower gaps between pregnancies also contributed significantly to the problem. Conclusion: Prevalence and severity of anaemia in reproductive age females reporting to surgical units were found to be exceptionally high. Frequency of anaemia in the parous females of relatively affluent city of Abbotabad indicates that anaemia may be on the rise in developing countries. Addressing pregnancy related anaemia and nutritional deficiencies through intake of supplements on regular basis in women before and between pregnancies is essential. Keywords: Anaemia, Reproductive age, nutritional deficiency, parous, Lactation

Usefulness of st segment depression limited to the recovery phase of exercise stress test

To determine the diagnostic value of ST segment depression limited to recovery phase of Exercise Tolerance Test [ETT]. An observational cross-sectional study. The study was carried out at Punjab Institute of Cardiology, Lahore, from March to August 2007 for a period of 6 months. In this study, 100 patients were selected with purposive non-probability sampling technique and were divided into two groups, group A having ST segment depression during exercise phase of ETT, and group B having ST segment depression only in recovery phase after undergoing ETT according to Bruce protocol. The patients were subjected to coronary angiography later on. The chi-square or Fischer's exact test of significance was applied at 0.05 level of significance to compare the coronary angiographic finding between two groups. Diagnostic value of ST segment depression was computed keeping angiographic finding as gold standard. There were no major differences between the two groups regarding angiographic finding. Significant coronary artery stenosis [>50% narrowing] was found in 68 [93%] patients of group A and 23 [85%] patients of group B [p=0.18]. Three vessel disease was found in 30 [41%] patients in group and 7 [26%] patients in group B [p=0.08]. Left main stem disease was found in 5 [6.8%] patients of group A and 1 [3.7%] patient of group B. Normal coronaries were found in 6% of patients among group A and 14% of patients among group B[p=0.12]. Specificity, sensitivity, Positive Predictive Value [PPV] and Negative Predictive Value [NPV] of ST segment depression in recovery phase was 55, 25, 85 and 6 percent respectively [95%Cl; 1.16-2.25]. In patients undergoing exercise stress test, ST segment depression occurring only in recovery phase of ETT has a diagnostic value largely comparable with that of ST segment depression induced during exercise phase of ETT. Thus careful evaluation of ST segment depression occurring only in recovery phase may add significantly to the clinical information derived from the results of ETT

Thyroid dysfunction and autoimmunity in females in goitre endemic area

To study thyroid dysfunction and thyroid autoimmunity among females with and without goitre in goitre endemic area. A cross sectional survey was carried out during the year 2007 in Chakar, district Muzafarabad. A group of 100 females 18-65 years of age were included; among them 50% having goitre were included in group I as cases and 50% asymptomatic females were included in group II as asymptomatic controls. Goitre was graded according to World Health Organization recommended criteria. For each study participant thyroid function status was assessed by T3, T4, thyroid stimulating hormone levels and thyroid autoimmunity by anti thyroid peroxidase and anti thyroglobin antibody levels. Data was analyzed using SPSS 12. Mean thyroid stimulating hormone levels were found higher [18.0 +/- 7.4] in cases [group I] than in asymptomatic controls [group II] [3.2 +/- 1.6]. On the basis of thyroid stimulating hormone, among cases 32 [64%] were primary hypothyroid, 11 [22%] were subclinical hypothyroid and 7 [14%] were euthyroid, whereas among asymptomatic controls it was 10 [20%], 13 [26%] and 27 [54%] respectively. Mean thyroid stimulating hormone decreased from 27.3 to 13.0 mIU/ml in goitre and from 5.6 to 1.2 mIU/ml in non-goitre at 16-65 years of age. Frequency of anti thyroid peroxidase and anti thyroglobin antibody was found 22 [44%] and 18 [36%] among cases, while 16 [32%] and 15 [30%] among asymptomatic controls respectively. No association was found between age and presence of goitre with anti thyroglobin or anti thyroid peroxidase positive antibodies [p>0.05], whereas association between anti thyroglobin and anti thyroid peroxidase antibodies with high thyroid stimulating hormone levels among study groups was found significant [p<0.05]. High proportions of anti thyroid peroxidase and anti thyroglobin positive cases were found between ages 26-45 years. The frequency of thyroid dysfunction and autoantibody in females of goitre endemic area was high, but showed no relation with the presence of goitre. Thyroid stimulating hormone had an inverse relationship with age among goitre and non-goitre cases. Positive anti thyroid peroxidase and anti thyroglobin antibodies were not age related, however they were found to be associated with elevated levels of thyroid stimulating hormone

Electrophoretic analysis of serum proteins in prostate cancer

Objective: This work was undertaken to analyse qualitatively serum proteins separated by SDS-PAGE and stained with Coomassie Brilliant Blue R-250, to detect novel proteins, which could possibly serve as markers for the early detection of prostate cancer

Design: This study [carried out on subjects who were confirmed by biopsy as cancer prostate [CaP] patients] was a preliminary step towards the detection of some new protein markers for CaP

Place and Duration of Study: This study was conducted at the Institute of Biochemistry and Biotechnology University of the Punjab Lahore, from January to March 2003

Subjects and Methods: Serum samples, 36 cases of cap and 36 controls of similar age group were separated by SDS-PAGE on a 12% gel, and then stained using Coomassie Brilliant Blue R-250. Protein fractions were analyzed using the computer software program "GeneGenius Gel Documentation and Analysis System"

Results: The appearance and relative raw volumes of 14 major protein fractions ranging in molecular weight from 0.23-157 kD in each group were studied. It was seen, on the whole, that the raw volume of most of the protein fractions decreased in the CaP cases as compared to the controls. Furthermore, the protein fractions of 1.27, 100, 114, 122 and 140 kD were absent in a significant number of the cases. However, it was seen that the protein fraction of 0.23 kD was absent in all the control samples while it appeared in most of the cases

Conclusion: A number of proteins were found to have been lost during malignant transformation. Further investigations are warranted to identify these novel proteins using 2D-PAGE followed by immunoblotting