Surgical retention for immediate obturator in maxillectomy patients

Total maxillectomy for patients with malignant lesions will often incapacitate the patient both functionally and aesthetically. An immediate surgical obturator prosthesis would be of utmost importance for patients in these critical situations to aid in deglutition, phonetics, respiration and effectively avoiding various post-surgical complications. This article emphasizes on utilizing circum-zygomatic wiring for retention of the immediate surgical obturator in cases of total maxillectomy or edentulous patients.

Comparison of the efficacy of budesonide by nebulizer, metered dose inhaler and dry powder inhaler in chronic stable bronchial asthma

Background: The study has been performed to evaluate the efficacy of budesonide delivery by different form of devices like nebulizer, metered dose inhaler and dry powder inhaler to adult patients of chronic stable bronchial asthma. The changes in pulmonary function test parameters have been consider for evaluation.Methods: This prospective study was undertaken to assess the relative efficiency of budesonide administered from devices like nebulizer, metered dose inhaler and dry powder inhaler in adult patients of chronic stable bronchial asthma. Fifty subjects where administered budesonide (1mg) via nebulizer, budesonide (400 microgram) by metered dose inhaler and dry powder inhaler consecutively each week for four weeks under direct supervision. To analyze the effect of budesonide delivered through different devices pulmonary function test was carried out on the subject before and one hour after administration of the drug on each visit.Results: No significant difference in Peak expiratory flow rate (P=0.77), forced expiratory volume in one second (P=0.851), forced vital capacity (P=0.178) and forced expiratory volume in one second and forced vital capacity ratio (P=0.298) was seen after giving budesonide by different devices.Conclusions: Budesonide delivered by different devices (nebulizer, metered dose inhaler, and dry powder inhaler) have similar effect on lung function in patients of chronic stable bronchial asthma. In the daily clinical practice, the correct choice of an inhaler device should be related with the patient's characteristics. They may be used interchangeably depending on availability, cost and compliance of the patients.

Pharmaceutical equivalent dissertation of Metformin hydrochloride brands

The aim of study is to establish pharmaceutical equivalence of different brands of Metformin tablets available in Karachi, Pakistan. The quality control parameters which are studied are weight variation test, hardness test, thickness, friability, disintegration and dissolution specified by BP/USP [British and United State Pharmacopoeia]. Weight variation and hardness value requirement was complied by all brands. Disintegration time for all brands was within range i.e. 15 minutes and also complies with the BP/USP recommendation. All brands showed more than 90% drug release within forty five minutes. The present conclusion suggests that almost all the brands of Metformin that are available in Karachi meet the specification for quality control analysis. Assay performed by HPLC by keeping flow rate of 1.0 ml/min of the mobile phase and the quantitative evaluation at 225 nm was performed. The retention time of Metformin was found to be 2.5min. Method suitability for the quantitative determination of the drugs was proved by validation according to the International Conference on Harmonization [ICH] guidelines

Phytochemical screening and antibacterial potential of Artemisia absinthium L., Swertia chirayita and Sphaeranthus indicus

Utilization of herbs for medicinal purpose started in the early history of mankind several thousand years ago. In this study, some plants that are used for lowering cholesterol level in local areas of Pakistan, such as Artemisia absinthium L., Swertia chirayita and Sphaeranthus indicus were screened for their phytochemical and antibacterial properties. For this purpose, these plants were extracted in different solvents i.e. ethanol, hexane and ethyl acetate. Phytochemcial analysis unveiled the existence of different bioactive compounds in these extracts. Presence of sugars was further confirmed by performing TLC. Antibacterial activity was determined against indicated bacterial strains, among all extracts Gul-e-mundi had maximum inhibition zone [23mm]. DPPH free radical assay revealed the significant antioxidative potential of all the extracts where Gul-e-mundi showed maximum potential i.e., 83%. Plant extracts were also showing anti-proliferative activity on root tips of Allium cepa and Gul-e-mundi was observed to have maximum antimitotic activity i.e. 5%. GC-MS analysis revealed that oleic acid and linoleic acid were the compounds responsible for imparting antibacterial potential to Gul-e-mundi. In conclusion, among all the tested extracts Gul-e-mundi had maximum antibacterial, antioxidative and antimitotic potential. For future studies, phytochemcials responsible for these activities can be isolated and modified for pharmacological purpose

comparative study of loratidine physiochemical properties from different brands

Loratidine is a piperidine derivative resemble to azatadine long acting non sedating commonly used for the treatment of allergic condition like watery or itchy eyes, runny nose, chronic urticaria or throat itching. In the present study different brands of loratidine were evaluated for the weight variation, hardness, friability, disintegration time and dissolution. Dissolution release study performed by using paddle method [USP 2] in 900 ml of 0.1N HCl at 50 rpm. The physicochemical of loratidine did not give any variation. By this study we conclude that all parameter for physicochemical properties like weight variation, hardness of tablets, friability, their disintegration time and the dissolution release study for all the brands of loratidine that are available in Karachi meet the British pharmacopoeia [BP] and United State pharmacopoeia [USP] specification for quality control analysis.Weight variation, hardness and friability value requirement was complied by all brands .Disintegration time for all brands was less than 15 minutes complying the BP/USP recommendation. All brands showed more than 80 % drug release within 45 minutes. The present findings suggest that almost all the brands of loratidine meet the BP/USP specification for QC analysis

Knowledge, attitude and practices of Pakistani women regarding Breast Cancer

Objective: To assess the knowledge, attitude and practices of Pakistani women about breast cancer

Study Design: Descriptive cross-sectional study

Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Sep 2012 to Feb 2013

Material and Methods: Two hundred adult female patients and their accompanying attendants were randomly selected [Those with breast complaints were excluded] in outpatient department of military hospitals and were interviewed. In order to gather data patients were asked to reply through a questionnaire along with their demographic profile structure questionnaire, comprising of 28 questions [included both open and closed ended], was used to collect data which was analyzed in the end with the help of SPSS version 15

Results: Mean age of participants was 37.5 +/- 7.5 years. Majority were married [87 percent], housewives [89 percent] with average family income of Rupees 15000 [53 percent]. Majority 94 percent [n=188] had heard about breast cancer. Questions regarding knowledge showed that participants awareness about relationship of breast cancer with obesity, smoking and increasing age was more than 50 percent. Up to 70 percent women had knowledge of breast lump as main symptom of breast cancer. Knowledge regarding diagnostic modalities was very poor. Only 16 percent knew about FNAC/Biopsy and 7.5 percent about mammography. A large majority [90 percent] showed positive attitude and were ready to see a doctor immediately in case they felt a lump in breast but practices of breast self-examination were poor [39 percent]

Conclusion: It was concluded that knowledge of most respondents was limited, practices were poor, but attitude towards breast cancer was positive. Lack of education, socio-cultural taboos and getting information from wrong sources surfaced as leading reasons of unawareness

Determination of mean clycated aemoglobin in healthy adults of a local population

Objective: To determine the mean hemoglobin HbA1C levels of disease-free adults in a local population and its optimum cutoff for the diagnosis of diabetes

Study Design: Cross-sectional study

Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from January to September 2015

Methodology: Healthy subjects aged 18 years and above of either gender were recruited from local population. Pregnant ladies and individuals with known diabetes, chronic kidney disease, chronic liver disease, congestive cardiac failure, anemia, hemoglobinopathies, mental illness and individuals on glucocorticoid therapy were excluded. Fasting plasma glucose [FPG] or 2-hour plasma glucose [2-h PG] was analyzed using hexokinase methodology and glycated hemoglobin [Hb A1C] was also analyzed using turbidimetric inhibition immunoassay technique. Receiver operating characteristic [ROC] curves were plotted. Differences among the groups were tested by one-way ANOVA, and p <0.05 was considered statistically significant

Results: Among 558 subjects, 88.8% [496] were normoglycaemic [NG], 5.7% [32] were with impaired glucose fasting [IFG], and 5.4% [30] were diagnosed with diabetes mellitus [DM]. A1C was 5.00 +/-0.44% in NG and 6.28 +/-1.16% in diabetics. FPG in NG was 4.55 +/-0.95 mmol/L and in diabetics was 8.28 +/-1.78 mmol/L. The optimal HbA1C cutoff value for diagnosis of DM was at 6.05% [AUC 0.827 95% CI 0.732 to 0.923, p ²0.05 with its sensitivity of 53.3% and specificity of 98.5%. However, HbA1C showed suboptimal sensitivity and specificity for prediabetes

Conclusion: The mean HbAIC and cutoff point for diabetes in the study population is 5.07 +/-0.58% and 6.05%, respectively [AUC 0.827, 95% CI: 0.732 to 0.923, p<0.001] with 53.3% sensitivity and 98.5% specificity

Association of [hypovitaminosis v] with persistent non-specific musculoskeletal pains

Objective: The study was conducted in Pakistani population to find association of vitamin D deficiency with persistent non-specific musculoskeletal pains by comparing with pain free controls

Study Design: Case control study

Material and Methods: Patients aged 12 years or more presenting to Medical OPD with persistent nonspecific musculoskeletal pains for more than 3 months were selected as cases, while healthy individuals served as controls

Results: A total of 60 cases [patients with persistent non-specific pains] presenting to medical outpatients department at Military Hospital Rawalpindi and 60 controls were studied. Mean age of cases was 43.9 +/- 14.0 years and amongst controls were 33.2 +/- 17.8 years. Mean serum vitamin D level of 32.8 nmol/L was reported in cases whereas mean serum vitamin D level amongst controls was 26.7 +/- 17.8 nmol/L. Hypovitaminosis D amongst cases and controls was 86.6% and 95% respectively. The proportion of vitamin D deficiency did not differ significantly as compared to controls. There was non-significant difference in proportion of deficiency amongst cases and controls

Conclusion: Overall there was no association between persistent non-specific musculoskeletal pains and vitamin D deficiency

Epidemiology Study on P53 (Rs1614984) C>T Mutation in Cigarette Smokers

ABSTRACT Epidemiology data have established that smoking is a prime threat for the cancers, largely lung cancer. Single-nucleotide polymorphisms (SNPs),P53 SNPs have been found to be associated with the predisposition of different cancers. Their decreased expression is reported in breast and lung cancer patients. p53 (rs1614984) had been reported to be linked with the SNPs found associated with breast cancer. The primary aim of this study to determine the association of p53 variant rs1614984 with the cigarette smokers and smoking related cancers in smokers. Among the smokers, 38% were found with CC genotype, 55% were heterozygous CT and 7% were TT, respectively. The homozygous TT genotype was seen in lower percentage of smokers (7%) when compared to non-smokers (8%) whereas; Significant difference was not observed when encompassed by CC, CT and TT genotypes (χ2 = 4.892, p=0.087). However, CC vs CT genotype showed a significant difference between smokers and non-smokers (p=0.031, OR 1.447 (1.035-2.025) and the dominant model CC vs CT+TT was also significantly different among smoker and non-smokers (p=0.047, OR 1.39 (1.004-1.924). Furthermore, smokers are at the risk of developing variety of diseases including lung cancer. Our finding suggests a higher percentage of heterozygous CT genotype in smokers when compared to non-smokers. Therefore, this finding gives a clue that the transition mutation of C>T (rs1614984) may leads to the lung diseases including cancer in smokers. However, there will be a need of more extensive and elaborated study to set down the aspect of p53(rs1614984) C>T in lung cancer among smokers.

Effect of hormonal contraceptives on serum lipids: a prospective study

To estimate the effects of using hormonal contraceptives on serum lipoprotein levels. Lipid profile was measured at baseline and afterward at 3, 6, 9 and 12 months. 1391 Pakistani females taking COCs, DMPA, or non hormonal [NH] contraceptives. The results were calculated by repeated measure ANOVA subsequent to tukey's post hoc test for the multiple comparisons. Statistical examination revealed that differences in lipid profile were significant [p <0.001] among all treated group in comparison with control. DMPA also caused significant rise in Castelli index-I and Castelli index-II as compared to COCs group and control group. This study demonstrated raise in total cholesterol [TC] and triglycerides [TG] as well as very low density lipoprotein [VLDL-C] and low density lipoprotein cholesterol [LDLC]. Whereas, an obvious decrease was observed in high density-lipoprotein cholesterol [HDL-C] in the DMPA-treated group. We concluded that, this inductive study specifies atherogenic cardiovascular risk in women using DMPA on long term basis

Accuracy of non-fasting lipid profile for the assessment of lipoprotein coronary risk

Objective: To determine the diagnostic accuracy of non-fasting lipid profile in the diagnosis of hyperlipidemia, taking fasting lipid profile as gold standard, in adult population

Study Design: Cross-sectional validation study

Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from July to December 2014

Methodology: One hundred seventy-five adult patients coming for fasting lipid profile were included; their non-fasting samples were taken on the next day. Patients on anti-cholesterol treatment and indoor patients were excluded. Total cholesterol [TC], high density lipoprotein-cholestrol [HDL-C], and triglycerides were measured by direct enzymatic colorimetric method by Modular p-800[registered]. Low density lipoprotein-cholesterol [LDL-C] was calculated by Friedewald's formula, but when triglyceride was greater than 4.5 mmol/l, then LDL-C was measured directly by homogenous enzymatic colorimetric method. Non-HDL-C was calculated by simple equation, i.e. TC-HDL-C

Results: Non-fasting lipid profile had 93% specificity, 51% sensitivity, 94% positive predictive value and 49% negative predictive value; and 65% accuracy with 7.28 positive likelihood ratio and 0.52 negative likelihood ratio. Non-fasting TC and non-HDL-C were significantly higher than fasting TC and non-HDL-C by mean difference of 0.2 mmol/l each with p=0.001 and p=0.004, respectively. Fasting and non fasting HDL-C are comparable to each other with mean difference of 0.01 mmol/l [p=0.745]. Receiver operating curve [ROC] of non-fasting non-HDL-C showed 0.804 [95%CI [0.738-0.870], [p=0.000] area under the curve [AUC] indicating that it was a significant test for ruling out hyperlipidemia. Bland-Altmann plot showed a significant difference between non-fasting, non-HDL-C and fasting LDL-C and non-fasting, non-HDL-C -0.087540 with bias -0.00109; therefore, these cannot be alternative to each other

Conclusion: Diagnostic accuracy of non-fasting lipid profile was found significantly higher than fasting lipid profile [p=0.004] for the assessment of lipoprotein coronary risk on the basis of non-HDL-C, which seemed to be significant test for ruling out hyperlipidemia

Determine the diagnostic accuracy of HbA1C for detection of diabetes mellitus by taking fasting blood sugar as gold standard

Background: HbA1c is now formally endorsed in many countries as a diagnostic test for [type 2] diabetes as well as for monitoring, although some debate still continues regarding its applicability for diagnosis

Objective: The objective of the study was to: Determine the diagnostic accuracy of HbA1C for detection of diabetes mellitus by taking fasting blood sugar as gold standard. Study Design: Cross Sectional Study [Validation]. Setting: Medical department, Allied Hospital, Faisalabad. Duration of Study: 6 Months Duration from 25-02-2015 to 25-08-2015

Methodology: A total of 145 cases with more than 40 years of age of either gender were enrolled in the study. Informed consent was taken from each participant of the study from medical department, Allied Hospital, Faisalabad. Information was collected by trainee researcher and comprised age, Gender, address and contact number, HbA1C and Fasting Blood Sugar. HbA1C and Fasting blood sugar was measured by drawing 3cc blood from a peripheral vein after antiseptic measures and sent to pathology laboratory, Allied Hospital, Faisalabad where it was reported by Pathologist. All the information was collected on Performa by Principal Investigator

Results: In our study, 71.72% [n=104] were between 40-60 years while 28.28% [n=41] had >60 years of age, mean +/- sd was calculated as 56.75 +/- 6.45 years, 52.41% [n=76] were male and 47.59% [n=69] were females, frequency of diabetes mellitus on gold standard was recorded as 26.21% [n=38] while 73.79% [n=107] had no findings of the morbidity. Diagnostic accuracy of HbA1C for detection of diabetes mellitus by taking fasting blood sugar as gold standard was calculated for sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate as 78.95%, 83.17%, 62.15%, 91.75% and 82.07% respectively

Conclusion: We concluded that the diagnostic accuracy of HbA1C at cutoff point more than 6.15% for detection of diabetes mellitus by taking fasting blood sugar as gold standard is high and this modality can be used in our population

Decreased serum 25-hydroxycalciferol levels in pre-diabetic adults

Objective: To determine the serum 25-hydroxycalciferol levels [25[OH]D] in adults with pre-diabetes and normoglycaemia to examine a possible association of vitamin D deficiency with pre-diabetes

Study Design: Case control study

Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi, from November 2012 to July 2013

Methodology: A total of 272 adults including 136 pre-diabetics and 136 normoglycaemics of either gender aged 20 years and above were consecutively inducted. Patients with diabetes mellitus, pregnancy, rickets and osteomalacia, ischemic heart disease, chronic kidney disease and chronic liver disease were excluded. Fasting Plasma Glucose [FPG] was estimated with hexokinase method on Modular p800 Roche chemistry analyzer while serum 25[OH]D was measured on Diasorin Liaison immunoassay analyzer using the chemiluminescent technique. Mean 25[OH]D levels in pre-diabetic and normoglycaemic groups were compared using Mann-Whitney U test. Spearman's correlation coefficient 'r[s]' was determined between serum 25[OH]D and FPG. Odds ratio for vitamin D deficiency was also calculated

Results: Mean serum 25[OH]D level was low in pre-diabetics [23.2 nmol/L] as compared to normoglycaemics [29 nmol/L; p=0.001]. Serum 25[OH]D level had inverse correlation with FPG [r[s] = -0.448, p=0.000]. There was also significant association of vitamin D deficiency with pre-diabetes compared with normoglycaemia [OR: 2.21, p= 0.016; 95% CI: 1.15-4.27]

Conclusion: Vitamin D deficiency with pre-diabetes suggested that vitamin D may have an important role in pathogenesis of pre-diabetes

Morphological Study of the Placenta; A Reflection of Intrauterine Life of the Foetus.

Background: Placenta is a vigorous, energetic, resourceful organ which in most cases of placental insufficiency is showing compensatory changes in response to an unfavourable maternal milieu, (H Fox 1975).The present study is an attempt to find out the morphological and histopathological changes in the placentas of hypertensive patients. Methods: The study was conducted on 60 cases of pregnant women admitted and delivered in the department of Obstetrics & Gynaecology, Subharti Medical College Meerut. The patients were divided into two groups. Control group included cases with normal blood pressure and study group included cases having blood pressure more than 140/90 mmHg. Placentas of each group were kept in separate container filled with 10% formalin solution for at least one week. At the onset of examination, placental size, thickness & weight is recorded. Results: The result reveals the mean placental area ± SD in placenta of control group was 240.5 ± 51.7% and in study groups was 206.3 ± 67.4% (p<0.05). The mean placental thickness ± SD in the control group was 2.3 ± 0.4% and in the study group was 2.8 ± 0.6% (p<0.001). The mean placental weight ± SD in the control group was 390.3 ± 49.0% and in the study group was 346.7 ± 97.4% (p<0.05). Conclusion: Placenta is a mirror which reflects the intrauterine status of the fetus. The examination of the placenta gives a clear idea of what had happened with it, when it was in the mother’s womb and what is going to happen with the fetus in the future.

Validity of the Pittsburgh sleep quality index in Indian university students

Despite the demonstrated utility of the Pittsburgh Sleep Quality Index [PSQI] in various demographic groups, it has never been validated in a sample of Indian subjects. To extend and confirm the PSQI's applicability for South Asian subjects, this preliminary study aimed to assess its psychometric and diagnostic validity in a sample of university students. Forty-seven male students were recruited from Jamia Millia Islamia, a public central university in New Delhi, India. The mean age of the students was 23.4 +/- 3.9 years, and they had a mean body mass index [BMI] of 23.3 +/- 3.3kg/m[2]. The PSQI was administered to all subjects and overnight polysomnographic testing was carried out as a concurrent validation measure. Cronbach's alpha for the questionnaire was found to be 0.736. Internal homogeneity was high, with the majority of correlations between questionnaire component scores and the summed global score being significant [p<0.010]. Criterion validity-correlations between the PSQI global score and polysomnography [PSG] measures were low. However, the questionnaire component scores and the related polysomnographic measures did show some significant relationships. The optimal cut-off scores for distinguishing students with/without sleep problems was >6 and was generated using receiver operating characteristic curve analysis. The area under the curve, sensitivity, specificity, positive and negative likelihood ratios at the cut-off score were 0.838 [p<0.0001], 75.0%, 88.9%, 6.75, and 0.280, respectively. The study found evidence that the PSQI had internal consistency, internal homogeneity, and diagnostic characteristics that compared well with PSG among a sample of young adult male students in India. This supports the applicability and certain aspects of the validity of the PSQI in the population

Acute ischemic stroke; correlation between higher total cholesterol level and high barthel index score in patients

Among all deaths, 40-50% are due to vascular events and out of these 10% are due to stroke. More than 66% of the global stroke occurrence is in developing countries, where the average age of patients with stroke is 15 years less than in developed countries. Objectives: To determine the correlation between higher total cholesterol level and high Barthel Index score[estimate of functional daily independent activity level] in patients with acute ischemic stroke. Design: Cross sectional study. Period: May 2013 to Apr 2014. Setting: Medical Units of DHQ and Allied Hospital, Faisalabad. Methodology: Sample size of 200 patients was collected and patients were included through Consecutive [non-probability] sampling technique. All patients underwent CT scan Brain from the radiology department of the hospital to determine the respective changes [hypo dense area] of the ischemic stroke. Fasting serum cholesterol was measured in all patients after an overnight fast of 12 hours. Then patients were assessed by using Barthel Index score [BI]. The data was analyzed by using SPSS version 16.0. Spearman Rank correlation coefficient was calculated to BI score in patients with ischemic stroke. Results: The mean age of the patients was noted as 61.76+/-11.55 years. In this study 55.50% were males and 44.50% patients were females. The mean total cholesterol value of patients was noted as 251.58+/-71.15 mg/dl. Out of 200 patients, 111[55.5%] patients had high cholesterol [>200mg/dl] whereas 89[44.5%] patient had low cholesterol of[<200mg/dl].In statical analysis the results showed that the mean value of total Barthel index score was 57.50+/-19.52. The study results described that 51.50% patients had high Barthel index score [>53] whereas 48.50% patients had low Barthel index score [<53]. Spearman correlation coefficient was calculated between high TC and high BI score as r= 0.641. This value was statistically significant i.e. p-value=0.000*. Conclusions: With the help of this study, we found a significant positive relationship between high TC and high BI score inpatients presented with ischemic stroke. Now we can better prognosticate the functional outcome of ischemic stroke in our patients.

Premature coronary artery disease; potential role of a 13 SNP gene risk score in the risk prediction of Pakistani patients

Introduction: Genetic information which is specific to an individual has the potential to improve Coronary Artery Disease [CAD] risk prediction. 13 CAD risk SNPs were selected by removing SNPs in loci which had not been identified in CARDIoGRAMplusC4D GWAS. Linkage disequilibrium patterns differ between ethnic groups pointing towards the need to investigate how the gene score would perform in different populations which is still largely unknown. Objective of the study was to investigate whether the 13 SNP CAD risk gene score has a role in the risk prediction of Pakistani Premature Coronary Artery Disease [CAD] cases and controls and to compare the CAD risk allele frequency between Pakistanis and Caucasians [samples obtained from the Northwick Park Heart Study II]

Study Design: Case control study

Setting: Army Medical College, National University of Sciences and Technology [NUST] in collaboration with the Cardiovascular Genetics Institute, University College London, UK

Materials and Methods: Total of 650 subjects with a history of chest pain were selected by non-probability convenience sampling. Out of these subjects with > 70% stenosis in at least 1 coronary vessel on angiography were labelled as Premature coronary Artery disease [PCAD] cases [n=340]. The 13 SNPs were genotyped in a Pakistani case-control study [n=340 CAD cases, 310 controls] using KASPar and Taqman assays. The use of 13 SNP gene score was tested in the prospective Northwick Park Heart Study [NPHSII] of 2775 healthy UK men [284 cases] and the Pakistani case-control study subjects [n=650]

Results: Mean +/- SD age of CAD patients was 42.7 +/- 3.80yrs while in controls it was 39.0 +/- 7.8yrs. Complete genotyping was obtained for 635 samples [333 cases, 302 controls]. The mean 13 SNP gene score was significantly higher in cases compared to controls [p=0.044]. Odds ratio for CAD for each quintile of 13 SNPs gene score showed a trend for higher quintiles of gene score to have increased odds ratio for CAD [p-value for trend=0.01] especially after adjusting for age, sex and ethnicity. There was a significant difference in risk allele frequency between Pakistanis and Caucasians [NPHSII] for all CAD risk SNPs except rs599839 [SORT1] [p=0.08]

Conclusion: A 13 SNP gene score has significant potential role at differentiating between Pakistani PCAD cases and controls. Risk allele frequencies for CAD differ significantly between Pakistanis and Caucasians stressing the need to develop population specific gene score keeping in view the ethnic stratification

Private and public nursing schools in Karachi, Pakistan

Nursing is a field which is directly affecting patients' quality of life. For this, there is a dire need to bring competent and professional nurses who pass on the dignity of their nursing profession. This heavy responsibility to produce such competent and professional nurses lies on educational institutions and nursing schools. Educational institutions play a vital role in offering a standard of education for future nurses. Hence, it is essential or educational institutions of nursing to undergo a quality assurance process in order to monitor their efficiency and standards of nursing education. While comparing two nursing institutions, we found some issues and challenges in both private and public institutions. Public institution has the resources, but poor strategic planning for initiating the new programs; while private institute cannot expand their programs due to lack of resources. Private institute has a better education system as compared to the public institute despite of limited possessions

Dose-dependent Modulation of Lipid Parameters, Cytokines and RNA by -tocotrienol in Hypercholesterolemic Subjects Restricted to AHA Step-1 Diet.

Aims: Evaluate the consumption of -tocotrienol (free from tocopherols) on serum lipid parameters, and several cytokines (TNF-, IL-4, IL-6, IL-8, IL-10), including gene expression and circulating microRNAs (miRNAs) in hypercholesterolemic subjects. Study Design: The present preliminary dose-response study consisted of six phases. All hypercholesterolemic subjects took increasing doses of -tocotrienol (125, 250, 500,750 mg/d) plus AHA Step-1 diet for 4 weeks during the 30 weeks study period. Methodology: Hypercholesterolemic (n = 31; serum cholesterol > 5.2 mmol/L) subjects (males- 26/females 5; age range 50-71 years) were enrolled in the study from Wah Cantonment, Pakistan. Serum lipid parameters were measured by auto analyzers. Various plasma cytokines, cDNA, and miRNAs were estimated by Signosis kits. Results: All participants (n = 31) completed all phases of study. The -tocotrienol plus AHA Step-1 diet caused reductions in lipid parameters in a dose-dependent manner with maximum effects on serum total cholesterol (15%), LDL-cholesterol (18%), triglycerides (14%) with 250 mg/d dose (P< 0.001). Doses above 500 mg/d resulted ininduction in levels of all lipid parameters, except HDLcholesterol. The cytokines associated with cardiovascular disease (plasma TNF-, IL-2, IL-4, IL-6, IL-8, IL-10) were all down-regulated 39%-64% by -tocotrienol treatment (P< 0.01). Similar results were obtained with gene expression of these cytokines using whole blood messenger-RNA. In contrast, circulating miRNA-7a, miRNA-15a, miRNA-20a (anti-angiogenic), miRNA-21, miRNA- 29a, miRNA-92a, miRNA-200, miRNA-206 (skeletal muscle regeneration) down-regulated in hypercholesterolemic subjects, were up-regulated by -tocotrienol treatment as compared to baseline (P< 0.01). Conclusion: The present results confirm that consumption of -tocotrienol plus AHA Step-1 diet causes significant reduction in serum lipid parameters and several cytokines (TNF-, IL-2, IL-4, IL- 6, IL-8, IL-10) at a low optimal dose (250 mg/d). The capacity of -tocotrienol to modulate inflammation is partly attributable to dose-dependent properties of inhibition/activation, which may play a major role in future treatment of cardiovascular diseases.