Comparative Assessment Of Subclinical Carotid Atherosclerosis In Hiv Patients And Healthy Controls By Ultrasonography & Its Correlation With Antiretroviral Therapy

Background: The study was planned to detect an association of HIV infection and sub-clinical atherosclerosis in the form of increased carotid intima-media thickness (IMT) Methods: 50 HIVpatients and 50 matched healthy controls were studied. The HIVpatients were further sub classified into those on ARTor not on ART. All of them underwent carotid doppler to identify subclinical atherosclerosis in the form of presence of either pathological intima-media thickness (IMT) or atherosclerotic plaque. Mean IMTwas calculated in various groups and the statistical analysis done. Results: The mean IMT in the test group (HIV), ART, Non ART, control groups was 0.746 mm (SD 0.181), 0.817 mm (SD 0.167), 0.58 mm (SD 0.068) ,0.572 mm (SD 0.101) respectively. There is significant difference in the mean IMT of HIV Vs control groups, ART Vs Non ART sub groups. There is no significant difference in mean IMTof Non ARTVs Control group. Conclusion: HIV patients have higher prevalence of subclinical atherosclerosis and significantly higher mean IMT as compared to Healthy controls. The prevalence of subclinical atherosclerosis is even higher in ARTtreated HIVpatients.

Angiogenic Potential of Extracellular Matrix of Human Amniotic Membrane

Combination between tissue engineering and other fields has brought an innovation in the area of regenerative medicine which ultimate aims are to repair, improve, and produce a good tissue construct. The availability of many types of scaffold, both synthetically and naturally have developed into many outstanding end products that have achieved the general objective in tissue engineering. Interestingly, most of this scaffold emulates extracellular matrix (ECM) characteristics. Therefore, ECM component sparks an interest to be explored and manipulated. The ECM featured in human amniotic membrane (HAM) provides a suitable niche for the cells to adhere, grow, proliferate, migrate and differentiate, and could possibly contribute to the production of angiogenic micro-environment indirectly. Previously, HAM scaffold has been widely used to accelerate wound healing, treat bone related and ocular diseases, and involved in cardiovascular repair. Also, it has been used in the angiogenicity study, but with a different technical approach. In addition, both side of HAM could be used in cellularised and decellularised conditions depending on the objectives of a particular research. Therefore, it is of paramount importance to investigate the behavior of ECM components especially on the stromal side of HAM and further explore the angiogenic potential exhibited by this scaffold.

Aloe emodin enhances tamoxifen cytotoxicity effect on era-positive breast cancer cells, mcf-7, through downregulation of mek1 and mek2

The positive response to tamoxifen in ERa-positive breast cancer patients is usually of a short duration as many of the patients eventually develop resistance. Our preliminary results show that aloe emodin extracted from the leaves of the Aloe barbadensis Miller demonstrated a cytotoxicity that is selective to ERa-positive breast cancer cells (MCF-7), but not to ERa-negative breast cancer cells (MDA-MB-231) and to the control cells (MCF- 10A). The objective of this study was to test the hypothesis that aloe emodin may enhance the response of MCF-7 cells to treatment with tamoxifen. MCF-7 cells were treated with aloe emodin alone, tamoxifen alone or a combination of emodin and tamoxifen, at their respective IC50 concentrations and at different time points of 24 hours, 48 hours and 72 hours. The respective IC50s were the concentrations of aloe emodin and tamoxifen required to achieve 50% inhibition of the cells in the study. Cell viability and apoptosis were determined using trypan blue exclusion and DNA fragmentation assays, respectively. The involvement of RAS/MEKs/ERKs genes of MAPK signalling pathways with aloe emodin was determined using QuantiGene 2.0 Plex assay. Data was evaluated using the one-way ANOVA test. Our findings showed that aloe emodin enhanced the cytotoxicity of tamoxifen on MCF-7 cells through apoptosis by downregulation of MEK1/2 genes. Our research may provide a rational basis for further in vivo studies to verify the efficacy of a combination of aloe emodin and tamoxifen on the viability of ERa-positive-breast cancer cells.

Out Of Hospital Cardiac Arrest In Kuala Lumpur: Incidence; Adherence To Protocol; And Issues: A Mixed Method Study

Information regarding out of hospital cardiac arrest incidence including outcomes in Malaysia is limited and fragmented. This study aims to identify the incidence and adherence to protocol of out of hospital cardiac arrest and also to explore the issues faced by pre-hospital personnel in regards to the management of cardiac arrest victim in Kuala Lumpur, Malaysia. A mixed method approach combining qualitative and quantitative study design was used. Two hundred eighty five (285) pre-hospital care data sheet for out of hospital cardiac arrest during the year of 2011 were examined by using checklists to identify the incidence and adherence to protocol. Nine semi-structured interviews and two focus group discussions were performed. Based on the overall incidence for out of hospital cardiac arrest cases which occurred in 2011 (n=285), the survival rate was 16.8%. On the adherence to protocol, only 89 (41.8%) of the cases adhered to the given protocol and 124 did not adhere to such protocol. All the relevant qualitative data were merged into few categories relating to issues that could affect the management of out of hospital cardiac arrest performed by pre-hospital care team. The essential elements in the handling of out of hospital cardiac arrest by pre-hospital care teamwasto ensure increased survival rates and excellent outcomes. Measures are needed to strengthen the quick activation of the pre-hospital care service, prompt bystander cardiopulmonary resuscitation, early defibrillation and timely advanced cardiac life support, and also to address all other issues highlighted in the qualitative results of this study.

27G Quincke spinal needle for spinal anaesthesia in Caesarean section: A study of 50 cases.

Background: Post dural puncture headache (PDPH) is a serious complication of spinal anaesthesia and incidence is more particularly in parturient. Aims & Objective: The present study was designed to investigate the use of 27 Gauge (G) spinal needle for spinal anaesthesia in Caesarean section in terms of success and PDPH rate. Material and Methods: We included total 50 female patients of aged 20-40 years old, were administered spinal anaesthesia with 27G Quincke spinal needle for Caesarean section by same investigator having enough experience. Redirections and attempts for lumbar puncture, success rates of spinal anaesthesia and PDPH were recorded. Results: We succeeded in 49 patients (98%) to administer spinal anaesthesia. The mean attempt and redirections for lumbar puncture were 1.1 and 1.24 respectively. We found PDPH in 1 patient (2%), which was mild in severity and subsided within two days. Conclusion: Spinal anaesthesia using a 27G Quincke spinal needle, in experienced hands can have successful spinal block with reduced PDPH rates in patients undergoing Caesarean section.

Analgesic efficacy of surgeon-assisted transverse abdominis plane block in patients undergoing open cholecystectomy.

Background: Unavailability of ultrasound and unpredictable success with traditional blind technique makes Transversus Abdominis Plane Block under-utilized in developing country like India. Aims & Objective: The present study was designed to evaluate the analgesic efficacy of Surgeon-assisted Transversus Abdominis Plane Block as an adjuvant to routine analgesic in reducing pain score during first 12 hours postoperatively in patients undergoing open cholecystectomy. Material and Methods: This was randomized, double-blinded, controlled, clinical trial carried out in tertiary care, teaching hospital. All the patients received a routine general anaesthesia with standard monitoring. Group A received routine analgesic which included Diclofenac sodium 75 mg intravenously (IV) at 8 hourly and group B received routine analgesic & Transversus Abdominis Plane Block with 15 ml of bupivacaine 0.25% at the end of surgery. Visual analogue score for pain, incidence of post-operative nausea and vomiting and demand of rescue opioid (Tramadol 2 mg/kg IV) in post-operative period were assessed every 2 hourly up to 12 hours after the surgery by an investigator blinded to group allocation. Results: Transversus Abdominis Plane block reduced visual analogue scale for pain on emergence and at all postoperative time points up to 12 hours (p < 0.0009). The incidence of post-operative nausea and vomiting, and demand of rescue opioid in the first 12 postoperative hours were also reduced (p < 0.0001). There were no complications attributable to the block. Conclusion: Transversus Abdominis Plane Block is effective as an adjuvant to routine analgesic to reduce pain after open cholecystectomy and reduces post-operative opioid demand and nausea & vomiting.

Usefulness of propofol to prevent succinylcholine induced fasciculations and myalgia, a comparison with thiopentone sodium as an induction agent.

Background: Succinylcholine induced fasciculations and myalgia may be a source of greater distress to the patient than the surgical pain. Aims & Objective: This study was designed to see if propofol offered any protection against succinylcholine induced fasciculations and myalgia compared with thiopentone sodium. Material and Methods: This prospective, randomized study was conducted in a teaching and tertiary care hospital. The study included 99 adult patients scheduled to undergo general anaesthesia for elective surgery. The patients were allocated randomly and equally into Group P1, P2 and T. Anaesthesia was induced in group P1 with propofol 2.5 mg/kg, group P2 with propofol 3.5 mg/kg and group T with thiopentone sodium 5 mg/kg. Tracheal intubation was facilitated by administration of intravenous succinylcholine 2 mg/kg. Incidence and severity of fasciculations were recorded. Anaesthesia was maintained with 50% Nitrous oxide in oxygen, Isoflurane and Vecuronium bromide. At the end of surgery, neuromuscular blockage is reversed and patients were extubated. All the patients were assessed at 6, 12 and 24 hours postoperatively to evaluate the incidence and severity of myalgia. Anova test was applied for quantitative data and Chi-square test for qualitative data. P value < 0.05 was taken as significant. Results: The demographic data of patients of the three groups were comparable. The total incidence of fasciculations were 25(75.76%), 16(48.48%) and 26(78.79%) in group P1, P2 and T respectively (p<0.001). Total score of fasciculations was 44(44.44%), 22(22.22%) and 53(53.54%) in group P1, P2 and T respectively. The severity of fasciculations was reduced more in group P2 than group P1 and T (p=0.0006). The total incidence of myalgia were 19(57.57%), 10(30.3%) and 23(69.7%) in group P1, P2 and T respectively (p<0.001). Total score of myalgia was 35(35.35), 18(18.18) and 45 (45.45) in group P1, P2 and T respectively. The severity of myalgia was reduced more in group P2 than group P1 and T (p<0.001). There was no correlation between fasciculations and myalgia in the present study (Pearson’s r correlation, r = - 0.139). Conclusion: Propofol 3.5 mg/kg in comparison with propofol 2.5 mg/kg and thiopentone sodium 5 mg/kg is effective in reducing the incidence and severity of succinylcholine induced fasciculations and myalgia.

Staphylococcal resistance against five groups of life saving antibiotics in the year 2003-2005

In the year 2003 to 2005 a prospective study was conducted to find out the predominance of Staphylococcus [Staphylococcus aureus] resistance pattern in opposition to five life saving antibiotics as these are the sole agents to treat critically ill patients in hospitals. During the period of two years almost 2500 samples of bacterial culture were taken from different pathological laboratories and hospitals in Karachi. Among these 1500 were Gram positive cocci and 1000 samples were identified as Staphylococcus aureus. Life saving antibiotics were taken from five different groups and by mean of disk diffusion technique antibiogram of Staphylococcus aureus against these antibiotic were determined. During the course of study imipenem showed 11%, amikacin exhibited 58%, cefipime showed 31%, vancomycin and piperacillin/tazobactam displayed 24% resistance against Staphylococcus aureus. Imipenem was found to be most effective against Staphylococcus aureus.Resistance to other antibiotics developed quickly in Staphylococcus aureus collected from clinical areas where these antimicrobial agents are extensively used

Human Pappilomavirus [HPV] induced cancers and prevention by immunization

Incidences of different types of cancer are increasing in Pakistan, among which cancer of Cervix and Respiratory pappilomatosis are of great concern because of their association with human Pappilomavirus [HPV]. Cervical cancers typically distress women of middle age or older; however it may affect women in any age after the puberty. Two serotypes of HPV [16 and 18] accounts 70% of cervical cancer cases, while HPV [6 and 11] are considered low-risk viruses associated with genital warts [Condyloma acuminata] and Respiratory pappilomatosis in both gender. Generally, there is transient role of HPV in human body and are removed by immune system in or around 1 year. Data from different Pakistani hospitals provides sound evidence for increasing trends of cervical cancer, which is, being developing country imperative for us. As the cost of cancer management is increasing day by day with poor survival rate and its burden is borne by patient, their family or society in-large, so if screening or prevention is possible then there would be need to identify target population for screening and vaccination. By quality adjusted life year [QALY] measurement, the data from different sources indicates that adolescent age is the appropriate target population and is cost effective for vaccination. Two vaccines manufactured by recombinant DNA technology are licensed in some parts of the world for prevention of HPV related cancers, however both have certain advantage over another, as one of the vaccines contains viral like proteins of two HPV serotypes 16 and 18 and provide additional cross protection against HPV type 13 and 45 with 100% seroprotection, while the other vaccine, being quadrivalent offers protection against four serotypes 6, 11, 16 and 18. Both vaccines tolerability and safety profiles are similar and acceptable, however bivalent vaccine appears to provide long-lasting immunity by the development of memory B-cells hypothetically due to difference of adsorbing agent used by manufacturer, on the other hand, quadrivalent vaccine offers protection against cervical cancer but also offers additional protection against Condyloma acuminata and respiratory Pappilomatosis. As these vaccines are new in the market and initial trials indicate availability of antibodies for up to around 5 years i.e. why it is controversial at the moment that whether booster dose is recommended or not, however it is assumed that, there is no harm to have booster dose at 5[th] year of vaccination

Morphine inhibits testosterone secretion from rat leydig cells in vitro

To study the effect of morphine on in vitro production of testicular T from un-stimulated or LH stimulated Leydig cells. Experimental study. Biological and Biomedical Sciences Department, Aga Khan University Karachi. De-capsulated testes from two rats were subjected to enzymatic dispersion for each experiment. Cells were pre-incubated in the incubation medium to remove endogenous Testosterone Thereafter, 80K cells were used for each treatment in 2001 of suspension. Incubation medium contained either no treatment [control] or different concentrations of morphine [5x10-5 -10-9 M]. Leydig cells were also incubated with different doses of LH [16-500 mIU] and morphine. Naloxone, an opioid receptor antagonist [10-6 M], was used to determine if morphine induced effects on the Leydig cells could be reversed. Incubations were carried out for three hours in a shaking water bath at 340C. Reaction was stopped by placing the tubes in a water bath at 600C, and thereafter the tubes were transferred to a tray containing ice before freezing. Testosterone was measured directly in the incubation medium by radioimmunoassay. Morphine reduced Testosterone production from Leydig cells at all concentrations tested [p<0.01]. There was a dose dependent response to LH stimulation by the Leydig cells and testosterone levels were significantly different from control [p<0.01] and incubation with morphine in the presence of LH significantly reduced T levels [p<0.01]. Inhibition of opioid receptors with naloxone significantly attenuated morphine induced inhibition of T [p<0.01]. These in vitro results show that the morphine inhibits T secretion directly at the testis level

Validation of ELISA test kits for detection of beta-agonist residues in meat.

Three ELISA test kits, the Randox ELISA beta-agonist test kit, Euro-Diagnostica test kit, and Ridascreen beta-agonist test kit, were evaluated for screening of meat and liver for beta-agonist residues in fortified and field-incurred samples. It was found that the Randox beta-agonist test kit was more suitable as a screening tool due to its accuracy, ease of use, and lower cost. The tests were able to detect beta-agonist residues at the minimum level of detection, as claimed by the suppliers. The performance of the method as assessed through recovery rates of beta-agonists in fortified samples was satisfactory with a low coefficient of variation (1-3%). Repeatability, as measured through the coefficient of correlation was also satisfactory. For field-incurred positive samples, the test kit showed a sensitivity of 100% and a low rate of false positives for goat and cow tissues. However, a high rate of apparent false positives was obtained for tissues of swine.

Pharyngitis Sicca-An Aetiopathological Study

Pharyngitis sicca is a source of considerable mental anguish to the patient as well as to the clinician due to lack of accurate indentification of aetiological factors and an effective treatment. A study of 200 patients conducted in E.N.T. department. of SMHS Hospital Srinagar (Kashmir) revealed an associations of various disorders with phayngitis sicca. One hundred and sixty-four cases (82%) clinically presented in winter when there was significant fall in temperature and 104 cases had recurrence in next winter, chronic nasal obstruction was observed in 137 cases (68.5%). chronic sinusitis in 90 cases (45%) vitamins and iron deficiency in 90 cases (45%), pulmonary tuberculosis in 7 cases (3.5%) and 4 cases (2%) of each chronic liver diseases and renal diseases. History of smoking was positive in 58 cases (29%) and urban to rural patients ratio was 3 : 2.

Aneurysmal bone cyst of skull - case report and review of literature

We report a case of Aneurysmal Bone Cyst ABC] arising in a rare location [Skull] of three years old female child presented at Department of Neurosurgery, Jinnah Postgraduate Medico I Centre, Karachi with history of gradually increasing swelling in parietal region since birth. Tumour was excised with clinical diagnosis of dermoid cyst. Histological examination revealed an aneurysmal bone cyst. A three year old female child presented with complaints of gradually increasing swelling on parietal region of the skull since birth. C.T. Scan showed lytic bone lesion. Excision of the lesion was done and submitted for histopathological examination. Examination revealed a whitish firm mass measuring 10xbx5 cms in dimension. The outer surface was smooth. Cut surface shows numerous dilated spaces of varying sizes and shapes separated by thick fibrous septae containing brownish and yellowish gelatinous material. Some spaces were empty. Microscopic Examination: Revealed a bone with lytic lesion composed of numerous blood filled cavernomatous spaces widely separated by fibrous connective tissue septae of variable cellularity. The walls of the cavernomatous spaces lacked normal features of blood vessels with no lining endothelial cells Multinucleated giant cells were prominent in some part of connective tissue. Osteoid and formation of new bony tissue was evident in some septae