Study on awareness, knowledge, and practices towards antibiotic use among the educated and uneducated people of Khyber Pakhtunkhwa Province, Pakistan

INTRODUCTION: Antimicrobial resistance developed through the inadequate use of antibiotics; is an overriding task for global public health. OBJECTIVE: To explore awareness, knowledge, and practices, and compare the elements associated with antibiotic misuse in different University students and uneducated people of Khyber Pakhtunkhwa Province, Pakistan. METHODS: Cross-sectional study was conducted from July to December 2020 using a validated questionnaire. Data were collected from eleven different university students and uneducated people of Khyber Pakhtunkhwa, Pakistan. RESULTS: 3,600 questionnaires were completed, consisting of 56.9% Male and 43.0% Female. 1,999 (55.5%) of the antibiotic users reported through the survey used non-prescription antibiotics within a one-month study period. Out of the participants, 230 (6.3%) were uneducated or their education level was below matric rest were university students. 1999 (55.5%) reported buying Antibiotics with Medical Prescription. Most self-medicated participants (56.9%) stop taking antibiotics when they feel better. More than 90% of the respondents answered that doctors and pharmacist staff do not guide them well that how to use antibiotics. 2,171 (60.03%) respondents mistakenly believed that antibiotics improve restoration from coughs and colds. Only 720 (20%) respondents knew that antibiotics also disturb normal flora and 547 participants (15.9%) agree that unnecessary use of antibiotics causes bacterial resistance. CONCLUSION: Finding from this study may have important implications for public health policy in Khyber Pakhtunkhwa, Pakistan given the growing global resistance to antibiotics and the reported health issues related to their improper use.

Indications and Success Rate of Endo Crowns - A Systematic Review

Endodontically treated teeth are most commonly restored using post-retained foundation restoration and a crown which has certain well-established drawbacks. Nowadays, the emergence of minimal invasive dentistry has led to increased use of endocrowns for restoring such teeth. However, their indications and success rates have not been explored widely enough to merit their full implementation in dental practice. This systematic review attempts to achieve this purpose by accumulating evidence from current literature that underscores endocrowns’ indications and success rates. METHODSThe electronic search strategy was performed in three databases (PubMed, Google Scholar, and EBSCO) using MeSH terms endocrowns, or endocrown success rates of endocrowns or endo crowns in dentistry or endodontically treated teeth or ceramic or monoblock or CAD-CAM, confined to articles published between 1st January 2015 and 20th November of 2019. All selected articles were evaluated to determine as to whether or not they could be included in the SR. Abstracts and titles were screened independently by 2 investigators and duplicates if any were removed. For possible inclusion after reading abstract, full-text assessment of the article was performed based on eligibility criteria. Manual extraction of data from the retrieved publications was done. RESULTSA total of 20 articles was found on related topic from electronic and manual searching, out of which, 2 were duplicates and hence removed. Further 7 articles were removed in screening and again 2 were removed after reading full-text, thus making the final count of 9 articles for the systematic review. Among the nine articles, 3 were clinical studies, 1 was a retrospective patient series study, while remaining were in-vitro studies. Out of 9, 7 articles (77 %) reported endocrowns to be successful and 2 articles (22 %) gave contrary outcomes. CONCLUSIONS Most of the articles included in this SR agree that endocrowns are a desirable restorative tool in dentistry. Other systematic reviews and meta-analyses with a significant number of included publications and studies should be conducted to expand the generalizability potential of such results

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

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

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

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

Prevalence of non alcoholic fatty liver and non alcoholic steatohepatitis in Peshawar cantonment, Khyber Pakhtunkhwa, Pakistan

Non-alcoholic fatty liver disease prevalence has not been well established. The aims of this study was to define prospectively non-alcoholic steatohepatitis [NASH] and non-alcoholic fatty liver disease [NAFLD] prevalence in hospitalized and ambulatory patients 20-65 years old during June 2013 to June 2014 were selected from Combined Military Hospital Peshawar Cantonment area. A base line questionnaire and right upper quadrant ultrasound was completed by all patients. On identifications of fatty liver among the selected cases further lab test data and liver biopsy reports were obtained. Mean BMI of female was 29.9 + 5.65 while prevalence of hypertension and diabetes was 49.8% and 16.6% respectively. Among all patients 62% were Punjabies, 23% were Pathans while 12% were Sindhies. Overall NAFLD prevalence was 47% while NASH was confirmed in 20 patients [12.3% of total and 30%of ultrasound positive patients]. Pathans had the highest prevalence of NAFLD [58.5%] as compared to Punjabies [44.5%] and Sindhies [35.3%]. Pathans also had a higher prevalence of NASH compared with Punjabies [19.5% VS 10%: P= 0.03]. In general, NAFLD patients were more prevalent among male [59%], Diabetic [P<0.00005], hypertensive [P<0.00005] and older [P =0.005]. They consumed more fast food [P=.049] had a higher BMI [P<0.0005] and had little or no exercise as compared to their normal or non NAFLD counter parts [P=0.02]. NAFLD was found in 75% and NASH in 22.5% among the 26 diabetic patients. ALT, AST, BMI, insulin, quantitative insulin sensitivity checks index and cytokeratin - 18 correlated with NASH. It was concluded that NAFLD and NASH prevalence is higher than estimated previously, Pathans and Patients with diabetes are at high risk

Isolation and preliminary evaluation of Mulva Neglecta mucilage: a novel tablet binder

ABSTRACT The aim of this study was to evaluate binding potential of Mulva neglecta mucilage (MNM) with subsequent comparison to PVP K30. Eight batches of Diclofenac sodium tablets were prepared by wet granulation technique keeping different concentrations (4, 6, 8 & 10% w/w) of Mulva neglecta mucilage (extracted from leaves of Mulva neglecta) and PVP K30 as standard binder. The granules of formulated batches showed bulk density (g/mL) 0.49 ± 0.00 to 0.57 ± 0.00, tapped density (g/mL) 0.59 ± 0.01 to 0.70 ± 0.01, Carr's index 09.27 ± 0.95 to 19.65 ± 0.59, Hausner's ratio 1.12 ± 0.00 to 1.24 ± 0.01 and angle of repose 30.37 ± 2.90 °C to 36.86 ± 0.94 °C. Tablets were compressed to hardness 7.50 to 7.95 kg/cm2. The tablets showed 0.39 ± 0.02 to 0.39 ± 0.01% friability and 7:20 to 14:00 min disintegration time. Granules and post-compression evaluation revealed that parameters assessed were all found to be within the pharmacopoeial limits. The results (hardness, disintegration and dissolution) proved that Mulva neglecta mucilage has better binding capacity for preparation of uncoated tablet dosage form as compared to PVP K30. Among all the formulations, MN-1 to MN-4 showed slow release as compared to PV-1 to PV-4 and thereby Mulva neglecta mucilage exhibited satisfactory drug release phenomenon tablets of diclofenac sodium.

RESUMO O objetivo deste estudo foi avaliar o potencial de ligação de mucilagem de Mulva neglecta (MNM), com posterior comparação ao PVP K30. Oito lotes de comprimidos de diclofenaco de sódio foram preparados pela técnica de granulação úmida, mantendo diferentes concentrações (4, 6, 8 e 10% w/w) de mucilagem de Mulva neglecta (extraída de folhas de Mulva neglecta) e PVP K30 como ligante padrão. Os grânulos de lotes formulados mostraram densidade aparente (g/mL) 0.49 ± 0.00-0.57 ± 0.00, densidade compactada (g/mL) 0.59 ± 0.01-0.70 ± 0.01, índice de Carr 09.27 ± 0.95-19.65 ± 0.59, a relação de Hausner 1.12 ± 0.00-1.24 ± 0.01 e ângulo de repouso 30.37 ± 2.90 °C a 36.86 ± 0.94 °C. Os comprimidos foram prensados à dureza de 7.50-7.95 kg/cm2. Os comprimidos apresentaram 0.39 ± 0.02-0.39 ± 0.01% friabilidade e 7:20-14:00 min de tempo de desintegração. A avaliação de grânulos e pós-compressão revelou que todos os parâmetros estavam dentro dos limites da farmacopeia. Os resultados (dureza, desintegração e dissolução) provaram que a mucilagem de Mulva neglecta tem maior capacidade de ligação na preparação da forma de dosagem de comprimido não revestido em relação à PVP K30. Entre todas as formulações, MN-1 e MN-4 mostraram liberação lenta em comparação com PV-1 e PV-4 e, assim, a mucilagem de Mulva neglecta exibiu liberação do fármaco satisfatória para os comprimidos de diclofenaco de sódio.

Assessing the frequency of dental pain and its associated factors in 11-14 years old children

Objective: the purpose of this study was to assess the frequency, characteristics and other factors affecting dental pain in 11-14 years old school children in Islamabad, Pakistan

Methods: a cross sectional survey was carried out in May 2015 to assess the frequency of dental pain in 11-14 years old school children attending government and private schools in Islamabad, Pakistan. Total samples consisted of 526 school children from 9 randomly selected government and 9 from private schools. Two hundred and seventy three children from government schools and 253 children from private schools participated in the study. Response rate was 83.65%. A standardised questionnaire comprised of 15 questions related to demographics and pain experience was completed by the children

Results: the frequency of dental pain in 11-14 years old school children was 29.1% in Islamabad, Pakistan. The frequency of dental pain in males was 30.2% and in females it was 27.6%. In this study, dental pain in the last six months was not significantly associated with gender in children [p=0.618]. Similarly dental pain was not statistically significantly associated with the type of school in which the child was studying [p=0.302]. However dental pain was significantly related to occupation of father [p=0.027]. The children, whose fathers had jobs as labourers, had a higher frequency of dental pain than fathers with white-collar jobs. Almost 36.7% of the children reporting dental pain described the intensity of pain as discomforting and 28.1% of children had mild pain. The pain did not radiate to the surrounding area in 36.7% of the children. The pain radiated to surrounding area to mild and moderate extent in 41.4% and 13.3% of children respectively. It was found that eating from the side of mouth with dental pain had no effect on the severity of pain in 15.6% of children. Almost 13.3% of children claimed that eating made the pain moderately more severe

Conclusion: overall the frequency of dental pain in children was 29%. Dental pain was not associated with gender of the school child. Efforts should be directed to determine the cause of dental pain in school children. Prevention of dental pain can be done by promoting oral health in children to reduce the impact of dental pain on quality of life

Comparative studies of binding potential of Prunus armeniaca and Prunus domestica gums in tablets formulations

The current study was undertaken to compare the binding potential of Prunus armeniaca L. and Prunus domestica L. gums in tablets' formulations. Tablet batches [F-1 to F-9] were prepared Diclofenac sodium as model drug using 5%, 7.5% and 10% of each Prunus armeniaca L., Prunus domestica L. gums as binder. PVP K30 was used as a st and ard binder. Magnesium stearate was used as lubricant. Flow properties of granules [like bulk density, tapped density, Carr's index, Hausner's ratio, angle of repose] as well as the physical parameters of compressed tablets including hardness, friability, thickness and disintegration time were determined. Flow parameters of granules of all the batches were found good. Physical parameters [drug content, weight variation, thickness, hardness, friability, disintegration time] of formulated tablets were found within limit when tested. The dissolution studies showed that tablets formulations containing each Prunus domestica showed better binding capacity compared to Prunus armeniaca gum. The binding potential increased as the concentration of gums increased. The FTIR spectroscopic investigation showed that the formulations containing plant gum are compatible with the drug and other excipients used.

Socioeconomic status and smokeless tobacco consumption in fishermen community of a coastal area of Karachi

Objective: The aim of this study was to assess the frequency of Gutka consumption and its relationship with socioeconomic status among fisherman community of Costal area of Karachi. Methods: Socioeconomic status and information about Gutka habit was collected from 408 fisherman of Ibrahim Hyderi, a coastal area of Karachi from 15th July 2014 to 21st July 2014.The Kuppuswamy scale was used to measure socioeconomic status [SES]. A subject was considered to be belonging to higher socioeconomic status if the family head's education and the number of earning members were higher and the number of children and dependents was less since childhood in his or her household. Single investigator carried out structured face-to-face interview. Convenient sampling technique was used. Results: Out of 408 subjects, 326 regularly consumed Gutka, the common reasons for the habit were the co-workers' influence and to keep awake at work. The prevalence of the Gutka chewing habit was much lesser [25%] among the people belonging to higher social class when compared to the minimal or no improvement group [75%]. A majority of those free from the habit [73.7%] were belonging to the group, which showed improved educational attainment. Among those with good social status, the percentage of workers with high frequency of Gutka chewing and those with a longer duration of the Gutka chewing habit was low when compared to the lower social class group. Conclusion: This study based on data collected by questioner and analyzed on SPSS version 17.It is recommended that intervention in the form of primary and secondary smokeless tobacco use, prevention with association and careful planning including restricted resources available to be implemented efficiently

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

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

Phytochemicals, in vitro antioxidant, total phenolic contents and phytotoxic activity of Cornus macrophylla Wall bark collected from the north-west of Pakistan

Plants are one of the precious creatures of Allah, producing a verity of useful bioactive compounds having definite pharmacological actions on human body. Keeping in view this idea, the methanolic extract from the bark of Cornus macrophylla was investigated for phytochemicals, antioxidant, total phenolic contents [TPC] and phytotoxic activities. Phytochemical analysis of Cornus macrophylla revealed the presence of tannins, anthraquinones, glycosides, reducing sugar, saponins and flavonoids. The percent free radicals scavenging potential of DPPH at 20, 40, 60, 80 and 100 micro g/ml was 72.69%, 73.32%, 73.51, 73.83% and 74.33% respectively and were compared to ascorbic acid [84.6%, 92.83%, 95.36%, 96.40% and 98.03%], gallic acid [85.49%, 92.47%, 95.14%, 98.22% and 98.03%] and quercetin [95.35%, 96.30%, 97.16%, 98.02% and 98.28%] as standards. The IC[50] value of Cornus macrophylla was 14.5/ micro g/ml. The TPC of the methanolic bark extract was 2.916 mg gallic acid equivalents/g of extract. The extract have shown excellent phytotoxic activity against the tested plant Lemna minor and inhibited the growth at 1000 micro g/ml. Our findings revealed that the crude methanolic extract of Cornus macrophylla is a potential source of natural antioxidants and herbicidal

Endovascular treatment of renal artery stenoses

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

Larvicidal, insecticidal, brine shrimp cytotoxicity and anti-oxidant activities of Diospyros kaki [L.] reported from Pakistan

Diospyros kaki is cultivated in different agro-ecological zones of Pakistan, especially in Malakand division. The current study was designed to investigate the hide potential of the vulnerable species of the plant. Aqueous extracts of Diospyros kaki leaves were screened for larvicidal, insecticidal cytotoxic and antioxidant activities. The extract exhibited moderate to outstanding larvicidal activity [100 to 28%] at 100, 80, 70, 50, 40, 30, 20 and 10% concentrations respectively after 24 hours, showing 42% LCso. Permitrin displayed 100% lethality at 0.3%. The extract demonstrated outstanding cytotoxic action against brain shrimps nauplii [Artemia salina], showing 10 ppm LC[50] which is closed to the LC[5]o [9.8jtig/ml] of standard drug Etoposide. Similarly profound insecticidal potential [100%] was recorded after 15 min against Cimex lectularius. In DPPH scavenging activity the extract demonstrated moderate 30.22%, while Quercetin, Gallic acid and Acetic acid showed 98, 96 and 97% activity respectively at lOOppm. Thus on the basis of our finding it could be concluded that the decoction of the leaves of D. kaki is a good natural alternative for the control of insects and neoplasia

Impact of statins on risk and survival of ovarian cancer / 부인종양

No abstract available.

Incidence of Pinhole Type Durotomy and Subsequent Cerebrospinal Fluid Leakage Following Simple Laminectomy

STUDY DESIGN: Cross sectional study. PURPOSE: The purpose of this study was to determine the incidence and the associated risk factors of pinhole type of durotomy and cerebrospinal fluid (CSF) leakage following a simple laminectomy for spinal stenosis. OVERVIEW OF LITERATURE: The incidence of spinal stenosis is expected to rise with increasing life expectancy. Moreover, lumbar spinal stenosis is the most common indication for spinal injury in the geriatric population. It is therefore important to identify and prevent the risks associated with laminectomy, the most widely used surgical procedure for spinal stenosis. The serious complication of incidental dural tear or durotomy and subsequent CSF leakage has not been studied in the region of Southeast Asia. METHODS: In this cross sectional study, we included 138 adult patients (age>18 years), who underwent a simple laminectomy for lumbar stenosis between 2011 and 2012. CSF leakage was the main outcome variable. Patients' wounds were examined for CSF leakage up to 1 week postoperatively. RESULTS: The incidence of pinhole type durotomy and subsequent CSF leakage in our region was 8.7%. Univariate analysis showed that hypertension, diabetes and smoking were significantly associated with durotomy and increased CSF leakage by 16.72, 44.25, and 33.71 times, respectively. Multivariate analysis showed that only smoking and diabetes significantly increased the chances of leakage. CONCLUSIONS: Glycemic control and cessation of smoking prior to a simple laminectomy procedure reduced the incidence of a dural tear. Larger clinical studies on this lethal complication are required.

Effect of Islamic fasting on mean arterial pressure

World Health Organization [WHO] introduced hypertension as an epidemic in developing countries. However, hypertension is adequately controlled in only 12.5% of patients. The aim of this study was to evaluate the relationship between Ramadan fasting and mean arterial pressure [MAP]. This clinical, observational study was carried out at Medical O.P.D of Jinnah Medical College Hospital [JMCH], Korangi, Karachi, Pakistan. A total of 150 hypertensive patients [120 males and 30 females] and 150 healthy adults [75 males and 75 females] were evaluated during the month of Ramadan [from August to September 2010]. Blood pressure was measured in patients' right arm in the sitting position. The measurements were taken a week before Ramadan and during each week of this month. The average of measurements was calculated, and the results were analyzed by SPSS version 17. A reduction was observed in the MAP of hypertensive patients [from 117.3 +/- 4.2 in the first week to 108.3 +/- 4.2 in the fourth week]. In the control group, the MAP was 93.1 +/- 0.6 in the first week and 92.4 +/- 0.6 in the fourth week. This study showed that MAP reduces during Ramadan fasting. This effect of fasting may help control blood pressure in hypertensive patients

Extraction of saponins and toxicological profile of Teucrium stocksianum boiss extracts collected from District Swat, Pakistan

BACKGROUND: The current era is facing challenges in the management of neoplasia and weeds control. The currently available anti-cancer and herbicidal drugs are associated with some serious side effects. Therefore numerous researchers are trying to discover and develop plant based alternative particularly for the rational management of cancer and weed control. Teucrium stocksianum possess antioxidant and analgesic activities. The current study was designed to evaluate crude saponins (CS), methanolic extract and sub-fractions of T. stocksianum for cytotoxic and phytotoxic potentials. CS, methanolic extract and sub-fractions were extracted from powdered plant material using different solvents. Cytotoxic potential of the extracts at a dose of 10, 100 and 1000 µg/ml were evaluated against Brine shrimp's nauplii. Phytotoxic assay also performed at the same concentration against Lemna minor. Etoposide and Paraquat were used as positive controls in cytotoxic and phytotoxic assays respectively. RESULTS: The percent yield of crude saponins was (5%). CS demonstrated tremendous brine shrimp lethality showing < 10 µg/ml LC50. The n-hexane (HF) and chloroform fractions (CF) demonstrated excellent cytotoxicity with 80 and 55 µg/ml LC50 respectively. Whereas the methanolic extract (TSME), ethyl acetate (EAF) and aqueous fractions (AF) revealed moderate cytotoxicity showing 620, 860 and 1000 µg/ml LC50 values respectively. In phytotoxic assay profound inhibition was displayed by HF (96.67%) and TSME (95.56%, 30 µg/ml LC50) against the growth of Lemna minor at 1000 µg/ml respectively. Both CF and EAF demonstrated profound phytoxicity (93.33%) respectively at highest concentration (1000 µg/ml), while AF and CS demonstrated weak phytotoxicity with 1350 and 710 µg/ml LC50 values respectively. CONCLUSION: Cytotoxicity and phytotoxicity assays indicated that the crude saponins, n-hexane and chloroform fractions of T. stocksianum could play a vital role in the treatment of neoplasia and as potential natural herbicides. Therefore these sub-fractions are recommended for further investigation with the aim to isolate novel anti-cancer and herbicidal compounds.

Frequency of coronary artery anomalies in adult cardiology practice; an angiographic study

The aim of this paper was to measure the frequency of various coronary artery anomalies in our patient population who underwent coronary angiography for various indications. The data was collected retrospectively by analyzing the angiographic data of 13,615 consecutive patients undergoing coronary angiography between January 2008 and June 2012. Coronary artery anomalies were found in 305 patients [prevalence of 2.2%]. Among these patients, 186 [61.12%] were male and 119[39%] were female. Two hundred and ninety two [95.7%]anomalies were benign and 13[4.2%] were potentially of dangerous nature. Anomalies of the right coronary artery [RCA] in decreasing order of frequency included ectopic RCA from right sinus of valsalva [RSV] 54 [17.7%], coronary ectasia /aneurysm 24[7.8%], fistula 13[4.2%], RCA from left sinus of valsalva[LSV] with anomalous course 11[3.6%] and split RCA 3 [0.98%]. Anomalies of the left coronary artery[LAD] in decreasing order of frequency included myocardial bridge 71[23.3%], separate origin of LAD and circumflex from LSV [absent left main trunck] 58[19.02%], circumflex arising from RSV with anomalous course 28[9.18%], coronary ectasia/ aneurysm 23[7.54%], fistula 14[4.5%], LAD arising from RSV withanomalous course 3[0.98%], LCA arising from RSV with anomalous course[retroaortic] 1[0.32%] and single coronary artery 2[0.66%]. The prevalence and the pattern of coronary artery anomalies in our patient population were almost identical to previous studies. Cardiologists should be aware of the coronary anomalies because of its potential for serious cardiac events and its importance in interventional cardiology and cardiac surgery practice

Clinical audit and performance measurement in a newly established service of oral and maxillofacial surgery

The objective of this clinical audit was to evaluate the performance of a newly established Oral and maxillofacial surgery department during the first twenty four months of its existence.It was a Cross-sectional study. The audit took place from September 2011 till September 2013 consisting of 24 months duration at oral and maxillofacial surgery department of Rawal Institute of Health Sciences, Islamabad. Data were collected by the staff members during their routine work. Data was then compiled, categorized and analyzed, to evaluate the quality of work. During the audit period 8522 patients who visited the Department from September 2011 to Sep 2013 were included in the study irrespective of age and gender. Among which 5237[61.45%] were male and 3285[38.55%] were female [3:2].Majority of the patients were from Islamabad and Rawalpindi [85.70%] with the peak in the first decade of life. Maxillofacial injuries and Pathologies comprised 210 patients [2.46%], Patients who suffered maxillofacial trauma patient's mandible fractures were the most common 83[39.72%]. A service like this in the private sector is both valuable and commercially viable. The findings of this audit can be used to forecast the future service use. It will also provide the parameters for auditing the services provided by the department in future

Patient satisfaction; OPD services in a tertiary care hospital of Lahore

Patient satisfaction is a relative phenomenon, which embodies the patients perceived need, his expectations from the health system, and experience of health care. To determine the level of patient satisfaction towards OPD services with reference to doctor-patient interaction, registration desk, waiting area, and overall health facilities. Descriptive cross sectional study. Tertiary care hospital of Lahore. April 2013. A sample of 250 patients was selected by employing systematic random sampling technique. The patients were interviewed and data was collected using a pretested questionnaire. Data was analyzed using the statistical package for social sciences [SPSS] version 16.00. Data was presented in figures and tables. It was described using frequencies, percentages and mean. Majority of the patients i.e 232 [94%] reported being satisfied with the doctor. A vast majority agreed that hospital was clean 233 [94%] and adequately ventilated 224 [90%]. The hospital staff in the waiting area was found to be respectful 220 [89%] and fair 198 [80%] towards the patients. The patients had no difficulty locating the reception desk of the health facility 235 [95%]. A large proportion of patients i.e.220 [89%] said they would re-visit the hospital. The patients were highly satisfied with their doctors and were ready to re-visit the hospital. It is recommended that further studies should be conducted to assess patient satisfaction in the secondary and primary care health facilities and efforts should be made to get regular feedback from the patients