Synthesis of some new 2-[4-[2-furoyl]-1-piperazinyl]-N-aryl/aralkyl acetamides as potent antibacterial agents

In this work, a new series of 2-[4-[2-furoyl]-1-piperazinyl]-N-aryl/aralkyl acetamides has been synthesized and evaluated for their antibacterial potential. The synthesis was initiated by the reaction of different aryl/aralkyl amines [1a-u] with 2-bromoacetylbromide [2] to obtain N-aryl/aralkyl-2-bromoacetamides [3a-u]. Equimolar quantities of different N-aryl/aralkyl-2-bromoacetamides [3a-u] and 2-furoyl-1-piperazine [4] was allowed to react in acetonitrile and in the presence of K2CO3, to form 2-[4-[2-furoyl]-1-piperazinyl]-N-aryl/aralkyl acetamides [5a-u]. The structural elucidation was done by EI-MS, IR and 1 H-NMR techniques of all the synthesized compounds. All of the synthesized molecules were active against various Gram positive and Gram negative bacterial strains. Among them 5o and 5c showed very excellent MIC values. The cytotoxicity of the molecules was also checked to find their utility as possible therapeutic agents, where 5c [0.51%] and 5g [1.32%] are found to be least toxic in the series

Ameliorating role of methanolic leaves extract of Fraxinus xanthoxyloides against CCl4-challanged nephrotoxicity in rats

Roots, bark, stem/twigs, and leaves of Fraxinus xanthoxyloides are being used regionally for the cure of malaria, jaundice, internal injuries, pneumonia, pain, rheumatism and also in fracture of bones. Our objective was to assess the methanolic leaves extract of F. xanthoxyloides for its antioxidant capability against oxidative stress induced by carbon tetrachloride [CCl[4]] in the kidney of Sprague-Dawley rats. Duration of this experiment was 30 days and doses were given on alternative days. Urine of rats was assessed for kidney function and renal tissues for antioxidant enzymes activity, biochemical markers, comet assay and histopathology. Enhanced urinary creatinine, urobilinogen levels and decreased creatinine clearance, protein contents, and albumin levels were observed by CCl[4] administration when matched to controls. CCl[4] injection also decreased the level of reduced glutathione, catalase, super oxide dismutase, peroxidase, glutathione s-transferase, glutathione reductase, and tissue protein while elevated the levels of thiobarbituric acid reactive substances, DNA damages and H[2]O[2] in renal tissues of experimental animals. Co-treatment of FXM and silymarin, lead to the restoration of all the above tested parameters of kidney. Through this study we affirmed the ameliorating role of F. xanthoxyloides in oxidative stress affiliated disorders of kidney

Determination of anti-oxidative, anti-microbial activity and heavy metal contents of Leucoagaricus leucothites

Mushrooms, a treasure of diverse bioactive scaffolds, have been widely admired due to their nutritional and medicinal significance all over the world. The current study intended to evaluate the therapeutic potentiality of an edible mushroom, Leucoagaricus leucothites [Vittad.] Wasser. Thus, anti-oxidant potential of L. leucothites was determined using DPPH assay and for the determination of anti-microbial potential agar dilution procedure was followed. TOS [total oxidant status], TAS [total anti-oxidant status], and OSI [oxidative stress index] values were evaluated utilizing Rel Assay Kits. For the assessment of heavy metal contents, wet decomposition approach with atomic absorption spectrophotometry was adopted. Screening of phytochemicals present in ethanolic extract of L. leucothites were determined by HPLC. TAS, TOS and OSI values were found to be 8.291mmol/L, 10.797ìmol/L and 0.130 respectively. Our results declared that heavy metal contents are generally in the safe range. Phytochemical analysis of L. leucothites has affirmed the presence of important phenolics such as gallic acid, catechin, and hesperidin. Investigations on antioxidant and anti-microbial potential of L. leucothites has uncovered the fact that this naturally occurring, biologically active, and therapeutically effective mushroom specie has natural borne anti-oxidant and anti-microbial potential and it would be worthwhile to use it for nutritional as well as medicinal purpose

Synthesis of 2-Furyl [[4-aralkyl]-1-piperazinyl] methanone derivatives as suitable antibacterial agents with mild cytotoxicity

The aim of the present research work was synthesis of some 2-furyl [[4-aralkyl]-1-piperazinyl] methanone derivatives and to ascertain their antibacterial potential. The cytotoxicity of these molecules was also checked to find out their utility as possible therapeutic agents. The synthesis was initiated by reacting furyl[-1-piperazinyl] methanone [1] in N,N-dimethylformamide [DMF] and lithium hydride with different aralkyl halides [2a-j] to afford 2-furyl[[4-aralkyl]-1piperazinyl] methanone derivatives [3a-j]. The structural confirmation of all the synthesized compounds was done by IR, EI-MS, 1H-NMR and 13C-NMR spectral techniques and through elemental analysis. The results of in vitro antibacterial activity of all the synthesized compounds were screened against Gram-negative [S. typhi, E. coli, P. aeruginosa] and Gram-positive [B. subtilis, S. aureus] bacteria and were found to be decent inhibitors. Amongst the synthesized molecules, 3e showed lowest minimum inhibitory concentration MIC = 7.52 +/- 0.[micro]g/mL against S. Typhi, credibly due to the presence of 2-bromobenzyl group, relative to the reference standard, ciprofloxacin, having MIC = 7.45 +/- 0.58[micro]g/mL

Frequency of hypomagnesemia in patients with uncontrolled type II diabetes mellitus

Objective: The objective of this study was to determine the frequency of Hypomagnesemia in patients with uncontrolled type II diabetes mellitus

Study Design: Cross-sectional study

Place and Duration of Study: Department of Medicine, PNS Shifa Naval Hospital Karachi, from Jul 2012 to Dec 2012 over a period of six months

Material and Methods: In this study, three hundred and twenty three patients of uncontrolled diabetes mellitus type-II on oral hypoglycemic agents for more than five years, presenting to medical OPD, were recruited. All patients fulfilled inclusion and exclusion criteria. Blood samples of all patients for serum HbA1c and serum magnesium levels were analyzed at the time of enrollment. Statistical analysis was done on SPSS 20

Results: Out of 323 patients, 243 [75.23%] were males and 80 [24.76%] were females with the age ranging from 40 - 65 years [mean age and SD 54.76 +/- 6.43]. Hypomagnesemia was found in 117 patients, without any significant difference in men and women [38.45% and 35.39% respectively]. The mean duration of diabetes was 12.5 years [ranging from 5 to 22 years]. By frequency test in SPSS-20, the highest frequency of hypomagnesemia [49.42%] is seen in [8.6-9.0] HbA1c group while lowest frequency hypomagnesemia [15.38%] is seen in [>10.0] HbA1c level group mean standard deviation and p-value calculated by Pearson correlation statistic in SPSS-20 for quantitative variables [HbA1c, Magnesium level]

Conclusion: Hypomagnesemia is frequent in poorly controlled type-II diabetes mellitus having increased level of HbA1c. So it may be prudent in clinical practice to periodically monitor plasma magnesium and HbA1c in type-II diabetes mellitus patients

Comparison of post-operative atelectasis in patients undergoing coronary artery bypass grafting with and without pre-operative incentive spirometry

Objective: To see the effect of pre-operative incentive spirometry on postoperative atelectasis in patients undergoing Coronary Artery Bypass Grafting

Methodology: This was a randomized prospective study. The duration of study was 05 months from 01-02-2015 to 31-06-2015. A total number of 170 patients were included in this study. In Group I, there were patients in whom incentive spirometry was done before surgery [Study group]. While in Group II patients pre-operative spirometry was not done [Control group]. There were 85 patients in each group. Data was analyzed using SPSS Version 19. Chi-square test and independent sample t-test were used for analysis of qualitative and quantitative variable respectively. P-value < 0.05 was taken as a significant difference

Results: There were 42.4% patients who have positive smoking history in group I as compared to only 24.7% smoker patients in group II [p-value 0.02]. Ventilation time was significantly less in group I patients, it was 5.49 +/- 2.28 hours versus 6.74 +/- 5.46 hours in group II patients [p-value 0.05]. Incidence of post-operative atelectasis was 14.10% in group I and 27.10% in group II patients [p-value 0.04]. So we found that pre-operative incentive spirometry results in considerable reduction in incidence of post-operative atelectasis and it also can reduce ventilation time as well

Conclusion: Pre-operative incentive spirometry helps to reduce and prevent post-operative atelectasis in patients undergoing coronary artery bypass grafting

Early outcomes of on-pump versus off-pump coronary artery bypass grafting

Objectives: To see the early post-operative outcomes of off-pump versus on-pump coronary artery bypass graft surgery

Methods: This retrospective analytical study was conducted at Ch. Pervaiz Elahi Institute of Cardiology Multan, Pakistan. Our Primary outcome variables were; necessity of inotropic support, nonfatal myocardial infarction, ICU stay, nonfatal stroke, new renal failure requiring dialysis and death within 30 days after operation. There were two groups of patients; Group-1 [On-pump group] and Group-11 [Off-pump Group]. SPSS V17 was used for data analysis. Independent sample t-test and Mann Whitney U test were used to compare quantitative Variables. Chi-square test and Fisher's exact test were used to analyze qualitative variables. P-value < 0.05 was considered significant

Results: Three hundred patients were included in this study. There were no significant difference regarding risk factors except hyper-cholestrolemia which was high in off pump group [p-value 0.05]. Angiographic and Echocardiographic characteristics e.g. preoperative ejection fraction, LV function grade and severity of CAD was same between the groups. Mortality risk scores and Priority status for surgery were also same. Regarding post-operative outcomes; Post-op CKMB Levels, need and duration of inotropic support, mechanical ventilation time and ICU stay was significantly less in Off-Pump group [p-value 0.001, <0.0001, 0.006, 0.025 and 0.001 resp.]. Peri-operative chest drainage was significantly high in On-pump CABG group [p-value 0.027]. Incidence of post-op complications was not statistically different between the groups

Conclusions: At 30 days follow-up, Incidence of myocardial infarction, necessity and duration of inotropic support, ICU stay period and peri-operative bleeding were significantly less in off-pump group. The incidence of neurologic, pulmonary and renal complications was same between the off-pump and on-pump groups

Frequency of thyroid dysfunction during TFT in interferon and ribavirin therapy in patients with chronic hepatitis C

Objective: To determine the frequency of thyroid dysfunction among patients of chronic hepatitis C [HCV] infection receiving combination of interferon-alpha and ribavirin therapy

Study Design: Cross-sectional study

Place and Duration of Study: Department of Medicine, PNS Shifa Naval Hospital Karachi, from September 2012 to March 2013 over a period of six months

Patients and Methods: In this study, 170 diagnosed patients of chronic HCV [confirmed by anti-HCV and HCV RNA-positive] presenting to medical OPD with normal thyroid functions were recruited. All patients fulfilled inclusion and exclusion criteria. They were prescribed IFN-alpha 2b [3 million units subcutaneously 3 days a week] and oral preparation of antiviral drug ribavirin [800 to 1200 mg daily in divided doses according to weight]. At the end of 12 weeks of combination antiviral therapy, their thyroid profile was worked up. Serum TSH, free T4 and T3 levels were determined by chemiluminescence technique in chemical pathology lab of the hospital. Statistical analysis was done on SPSS 17

Results: Out of 170 patients, 83 [48.82%] were females and 87 [51.18%] were males with the age ranging from 22-46 years [mean +/- SD: 33.86 +/- 5.32]. After 12 weeks of antiviral therapy, thyroid functions were normal in 156/170 [91.76%] patients, whereas in 14/170 [8.24%] cases thyroid dysfunction was observed. Out of those patients having thyroid dysfunction, 10/14 [71.42%] were hypothyroid whereas 4/14 [28.58%] had hyperthyroidism

Conclusion: Managing patients of chronic HCV with combination antiviral therapy comprising IFN-alpha 2b and ribavirin can cause thyroid dysfunction. These patients should be monitored before and during treatment to avoid complications and poor compliance

Post-operative atrial fibrillation; incidence after coronary after bypass graft surgery

Atrial fibrillation is the most common arrhythmia observed following Coronary Artery Bypass Graft surgery

Objectives: To determine the incidence of post-operative atrial fibrillation in patients undergoing coronary artery bypass grafting

Materials and Methods: Study Design: Non-randomized prospective

Setting: Cardiac Surgery Department of Multan Institute of Cardiology, Multan. Period: 20-1-2014 to 01-05-2015. A total number of four hundred and ninety [490] patients having age more than 40 years undergoing isolated coronary artery bypass graft surgery were included in the study. Data was analyzed in SPSS V20 software. Frequency and percentages were used for Atrial Fibrillation. To see the impact of AF on morbidity, patients developing AF was compared with those who do not develop Atrial Fibrillation post-operatively using independent sample t-test for quantitative variables. Chisquare test and Fischer's Exact test [whenever appropriate] was used to compare qualitative variables

Results: A total number of four hundred and ninety [490] patients were included in this study. There were more 431 males [88.0%] in this study. of the patients 71.6% were in LV Grade I before surgery. Incidence of post-operative atrial fibrillation was 13.5%. In 4.5% patients IABP was inserted due to hemodynamic instability. Ventilation time and hospital stay time was significantly higher in patients with AF postoperatively [p value 0.03 and 0.02 respectively]. But duration of inotropic support, post-op CKMB levels and IABP use were not significantly different in both groups

Conclusion: The incidence of post-operative Atrial Fibrillation is 13.5% according to this study. And these patients were associated with increased risk of morbidity

Aortic valve replacement; relation of aortic annulus measured by echocardiography and prosthesis size required

Precise determination of the size of aortic annulus is very important for the preoperative evaluation before aortic valve replacement

Objectives: to determine the preoperative prosthesis size using echocardiography in patients undergoing aortic valve replacement

Study Design: prospective observational study

Setting: Ch. Pervaiz Elahi Institute of Cardiology [CPEIC] Multan. Period: January 2013 to October 2014

Methods: [100 patients] Aortic annulus sizes were measured with TTE one week before surgery and with the help of sizer per-operatively. The data was analyzed by using SPSS V16. Quantitative variables were analyzed using mean and standard deviation and percentages were used for qualitative variables. Dependent sample t test was used to see accuracy of TTE in measuring aortic annulus size

Results: out of hundred patients, 84[84%] were male. Mean age of the patients was 33.77 +/- 13.17 years. 51% patients underwent isolated Aortic valve replacement; redo-operations were done only in 4% patients. In 96% patient's mechanical prosthesis was used and in 4% patient's boiprosthesis was used for valve replacement. We found no significant difference in Aortic annulus measured pre-operatively with the TTE [23.54 +/- 3.54] and measured per-operative with the sizer [23.96 +/- 3.36] with highly insignificant p-value 0.58.Aortic annulus size was almost same measured by these two techniques. Conclusion: Aortic annulus size measured with TTE helps to arrange the optimum size prosthesis before aortic valve replacement surgery

New modification of modified bentall procedure [a single centre experience]

Background and Objectives: Modified Bentall procedure has become a gold standard in the treatment of combined aortic root and aortic valve diseases. Bleeding is an important predictor of morbidity and mortality after the Bentall operation. Our objective was to evaluate the early outcomes of Modified Button-Bentall procedure with cuff technique for aortic root replacement surgery regarding hemostasis

Methods: A total number of 32 patients who underwent elective Bentall operation from January 2008 to December 2014 were included in the study. In 18 patients [Group I] modified Button-Bentall procedure with formation of cuff was used and in 14 patients [Group II] Modified Button technique without cuff formation was used for aortic root replacement. Data was analyzed using SPSS V16. Chi-square test, Fisher's Exact test and independent sample t-test was used to analyze Qualitative and Quantitative variables

Results: Three patients in Group II and two patients in group I was in congestive cardiac failure pre-operatively. Out of thirty two patients two patients were having Aortic root dissection one in each group. Total bypass time and cross-clamp time were significantly high in Group I. There was no significant difference regarding duration of inotropic support, ventilation time, ICU stay and hospital stay time in patients of Group I and Group II. But post-op Chest drainage was very high in Group II 1158+451.25 ml versus 488.89+168.27 ml in group I [p-value <0.0001]. There was one in hospital death in Group II

Conclusions: Formation of cuff of remnant of aorta during proximal anastomosis results in significant reduction in post-operative bleeding and was better in hospital outcomes

Liver cirrhosis; frequency and severity of thrombocytopenia in patients

To determine the frequency and severity of thrombocytopenia in patients with liver cirrhosis. Cross sectional study. 01-03-2013 to 31-08- 2013. Liaquat University Hospital, Hyderabad. The cirrhotic patients were assessed for thrombocytopenia and its severity. The data was analyzed in SPSS version 11.00 and frequency and percentage was computed. The chi-square test was applied and p -value

Mitral valve replacement on beating heart; safety an evaluation

Cardiac reperfusion injury is a well-described complication occurring after ischemia or following cardioplegic arrest. The primary aim of this study was to evaluate and compare safety of Mitral valve replacement on beating heart without using cross clamp with the conventional Mitral valve replacement. It was a retrospective observational study for study duration from 2012-2014. A total of 50 patients were randomly selected and were divided in 2 groups, 25 patients in each group. This study was conducted at the Department of Cardiovascular Surgery of Choudhry Pervaiz Elahi Institute of Cardiology, Multan. We divided the patients in two groups. All operations were carried out by team led by a consultant surgeon in our institution. Our patients had the age range from 12 to 65 years [Mean ages=32.5 years +/- 13.9000] the mostly this study included males 60%. The study included Group A and Group B [beating heart versus conventional heart surgery] both groups contained randomized controlled patients with purposeful sampling. Minimum operative time 100 minutes or maximum operative time 160 minutes [Mean 195 +/- 95.75] The P value remained non significant that P <0.001. The CPB time was 22 to 388 minutes [104.8 +/- 97.4. Cross Clamp time, ICU stay intubation time, drainage, inotrope remained almost same in both groups. With P <0.001 Outcome variables of the patients. The hazards of cardiopulmonary bypass and Cardioplegia are well known. Various studies have demonstrated decreased accumulation of extra cellular fluid, diminished lactate production and greater preservation of high energy stores when a strategy of myocardial protection simultaneous antegrade/ retrograde continous normothermic, normokalemic blood perfusion was used. These findings were the basis for using beating heart technique for mitral valve replacement, Aortic cross-clamping, Cardioplegia, and reperfusion injury leads to myocardial ischemia and is a critical issue in mitral valve surgery despite novel approaches to myocardial protection. Myocardial edema induced by the lack of myocardial contractions and impaired lymphatic flow due to Cardioplegia in the heart remaining in diastole is another cause of myocardial dysfunction. Outcomes obtained using this strategy of myocardial protection seem to compare favorably to those of historical series in which conventional myocardial protection with cardioplegic arrest were used

Synthesis, characterization and enzyme inhibition study of O-substituted derivatives of chlorinated coumarin

Coumarins have much importance in dyes, drugs, perfumes and pesticides. In the demonstrated research work, a benignant series of chlorinated coumarins was synthesized and screened against different enzymes. First, 6-Chloro-7-hydroxy-4-methyl-2H-chromen-2-one [3] was geared up by the reaction of 4-chlororesorcinol [1] and ethyl acetoacetate [2] in the presence of concentrated H[2]SO[4]. Second, various O-substituted derivatives of chlorinated coumarins, 5a-j, were set up by pairing different alkyl/aralkyl halides, 4a-j, with 3 in the presence of NaH in DMF as solvent. The structures of all the synthesized compounds were clarified through spectral analysis using EI-MS, IR and [1]H-NMR. The different enzymes used for the evaluation of bioactivity of all the synthesized compounds were acetyl cholinesterase [AChE], butyryl cholinesterase [BChE] and lipoxygenase [LOX]. The most proficient activity was shown against both cholinesterase enzymes

Acute myocardial infarction; hypomagnesemia in patients

This descriptive case series study evaluates the frequency of hypomagnesemia in patients with acute myocardial infarction. This multidisciplinary conducted at Liaquat University Hospital Hyderabad and a private hospital Hyderabad from May 2010 to October 2010. All patients diagnosed as acute myocardial infarction were further evaluated for type of myocardial infarction and serum magnesium level. Out of 100 diabetic patients, 77 were males and 23 patients were females. The mean age and standard deviation of patients of male and female was 54.78 +/- 8.82 [SD] and 53.64 +/- 10.82 [SD], respectively. The mean +/- SD for serum magnesium in overall subjects was 1.24 +/- 0.48. Regarding the type of AMI inferior wall in 22 [29%], lateral wall in 17 [22%], anteroseptal in 12 [16%], anterolateral -V1 in 07[09%], right ventricular in 10 [13%] and posterior wall in 07 [09%]. The mean duration of acute MI in male and female population was 8.71 +/- 6.73 hours and 17.70 +/- 14.57 hours [p<0.01] where as the mean duration of acute MI in hypomagnesemic and normomagnesemic patient was 5.16 +/- 2.49 hours and 26.60 +/- 8.27 [p = 0.02] respectively. The mean serum magnesium level in male as well as female population was 1.32 +/- 0.21 mg/dl and 1.46 +/- 0.53 mg/dl p = 0.05, respectively. Regarding the hypomagnesemia in male and female population was 34[75.6%] and 16[53.3%] p=0.04, respectively. The hypomagnesemia was more predominant in inferior 18[36.0%] and lateral 16 [32.0%] wall MI. The hypomagnesemia was observed in patients with acute myocardial infarction with statistical significance

Acute myocardial infarction; serum zinc level in patients

To determine the serum zinc level in patients with acute myocardial infarction at Liaquat University Hospital Hyderabad. This six months study was conducted on the patients with acute myocardial infarction presented at coronary care unit [CCU] of Liaquat University Hospital Hyderabad. All the patients with myocardial infarction, of >/= 30 years of age and either gender diagnosed as acute myocardial infarction were admitted and evaluate for their serum zinc level by taking 2cc fasting venous blood sample on admission and at one or two day interval thereafter. The data entered, saved and analyze in SPSS version 11.00. Total 142 patients with acute MI were registered for study. Of these 92[64.8%] were males and 50 [35.2%] were females. The mean age +/- SD for male and female was 54.98 +/- 11.88 and 50.52 +/- 9.85 respectively. Regarding plasma zinc level, hypozincemia [low zinc level] was observed in 90[63%] patients, of which 53[58.9%] were males and 37[41.1%] were females while the 52[37%] subjects had normozincemia [normal zinc level]. In 33 [36.7%] patients the serum zinc was low at admission, 38[42.4%] patients had hypozincemia on 3rd day of admission while 19[21.1%] had low serum zinc level on 5th day of admission. The mean +/- SD for serum zinc level in overall population was 9.78 +/- 2.31 and the mean +/- SD of patients with hypozincemia was 7.85 +/- 3.42, whereas the mean +/- SD of patients with normozincemia was 16.85 +/- 2.53. During hospitalization the complications of acute MI identified in hypozincemic population were cardiac arrhythmias, cardiac failure, pericarditis, recurrent infarction, thromboembolism and mitral regurgitation. It is observed that serum zinc level appears to be low in patients with acute myocardial infarction

Type 2 diabetes mellitus; dental caries in patients

To determine the frequency and pattern of dental carries in patients with type 2 diabetes mellitus. Cross sectional descriptive study. Patients with history of type 2 diabetes mellitus for >/=02 years duration with >/=35 years of age and of either gender with dental pain visit at medical and dental outpatient department [OPD] of Liaquat University Hospital Hyderabad. The detail history was taken and the blood samples were taken for haemoglobin A1c [HbA1c] to assess the glycemic status. The existence of dental carries and its pattern was diagnosed through dental examination by consultant dentist had clinical experience >/=05 years. The data was collected on pre-designed proforma, entered and analyzed in SPSS version 11.00. A total of 137 type 2 diabetic patients were selected for this study, out of these 82 were males and 55 females. The dental carries was found in 98 [71.5%] patients. Out of these ninety eight, 53 [54.08%] were males and 45 [45.92%] were female. Upper molar teeth involvement was present in 46 patients and lower molar teeth were involved in 52 patients. Dentine carries was seen in 35 patients, enamel carries in 19, white spot carries in 20 patients, pulpitis in 16 patients, and pulp capping in 8 patients. Involvement of individual teeth was also assessed, the upper molar involvement was present in 32 patients, premolar involvement was present in 11, incisor involvement in 03 patients. The lower molars were involved in 28 patients, lower pre molar in 21 and lower incisors in 03 patients. Dental carries was present in 43 [43.9%] patients in patients whose duration of diabetes was between 5-10 years, whereas those patients having duration >10 years had 31.6% frequency of dental carries, while regarding duration of <5 years only 24 [24.5%] patients had dental carries. The diabetic patients are more prone to acquire dental caries

Comparison of King's College Hospital Criteria [KCH] with Model for End-Stage Liver Disease [MELD] for Predicting Outcome in Patients with Acute Liver Failure

To compare the Model for End-Stage Liver Disease [MELD] and The King's College Hospital Criteria [KCH] as early clinical prognostic indicators in patients with Acute Liver Failure. This descriptive Case series study was conducted in emergency medical wards of Liaquat University Hospital Jamshoro and Hyderabad from February 2008 to July 2010. This study included 76 consecutive patients with ALF defined as onset of hepatic encephalopathy occurring within 12 weeks of onset of jaundice. The patients using sedatives, anticoagulants or if any evidence of chronic liver disease were excluded. Laboratory workup was done from laboratory of University. MELD score of >/= 33 and presence of positive criteria for KCH category were taken as a bad prognostic indicator. The primary end point was death during hospital stay. Continuous variables were computed as mean +/- standard deviation [SD] and categorical variables as frequency and percentage. Out of 76 patients 49 were male [64.47%] and 27 [35.53%] female. The mean age of patients was 24.62 +/- 10.3. Out of 76 patients a total of 59 patients [77.63%] died during the study period. The KCH criteria cut off point was reached in a total of 63 patients [out of 76] of which 50 patients died. The MELD criteria cut off point [MELD Score > 33] was reached in 49 patients [out of 76] of which 46 eventually died.KCH predicted outcome with the sensitivity of 80% and Positive predictive value [PPV] of 89% [p=0.001]. MELD predicted outcome with sensitivity of 82.4% and Positive predictive value [PPV] of 94% [p=0.001].Viral hepatitis B was the most common cause of Acute Liver Failure. Both criteria are good predictors of the outcome in acute liver failure

Peripheral arterial disease. [PAD] in type 2 diabetic patients

The increase in prevalence of type 2 diabetes and its complication is alarming. The incidence of diabetic foot ulcers due to peripheral arterial disease, which leads to foot amputations far too often, is unacceptably high especially in developing countries. This study has been conducted to find out frequency and degree of peripheral arterial disease in type 2 diabetics having foot ulcers at tertiary care settings in Abbottabad. This was a prospective descriptive study-being conducted at Northern Institute of Medical Sciences [NIMS] and Ayub teaching hospital Abbottabad from August 2009 to June 2010. Type 2 diabetics with non-healing foot ulcers lasting longer than then days, were selected for this study by non-probability purposive sampling method. All study subjects have undergone for palpation of peripheral arterial pulses in the lower limbs. Ankle-brachial index [ABI] is the ratio of the systolic blood pressure at the ankle to that in the arm Peripheral arterial disease [PAD] was considered to be present if ABI was less than 0.90. It was further graded as mild, moderate and severe according to ABI values between 0.70-0.90, 0.50-0.69 and less than 0.49 respectively, as per recommendations of American Diabetes Association. A total of 83 type 2 diabetics with foot ulcers were enrolled during eleven months period of this study. The mean age of study subjects was 53.68 +/- 9.51 years. There were 33 [39.75%] males and 50 [60.24%] females with M to F ratio of 1: 1.51. Mean duration of diabetes was 13.67 +/- 5.80 years [ranging from 9-23 years]. Majority 57 [68.67%] of our patients were obese having poor glycemic control. Peripheral arterial disease has been fond in 35 [42.16%] patients, out of them 18[51.42%] had mild PAD as their ABI values remained between 0.70-0.90, 15[42.85%] had moderate PAD due to their ABI values between 0.50- 0.69 and 2 [5.71%] had severe PAD as their ABI values lie below 0.49. Ankle-brachial index is a non-invasive, inexpensive and office-based diagnostic tool for peripheral arterial disease in type 2 diabetics having foot ulcers, Healthcare professionals must be trained about early referral and regular feet care of these patients

Urinary tract infection frequency and pattern in patients with diabetes mellitus

To determine the frequency and pattern of urinary tract infection in patients with diabetes mellitus. Descriptive case series study. February 2009 to July 2009. Department of medicine at Liaquat University Hospital]. All patients >/= 18 years of age, of either gender were known diabetes for >/= 2 years duration. The infection was labeled when>5/hpf leukocyte in urine and growth of organism on urine for C/S. The blood sugar and hemoglobin A1C [HbA1C] was also advised to evaluate the status of their diabetes i.e. control or poorly control. During study period total 150 diabetic patients were evaluated for urinary tract infection, of which 92[61%] had UTI. Out of ninety two 80[87%] had diabetes type 2 and 12[13%] were diabetes type 1. The female gender was predominant. The mean +/- SD for age of patients with type 2 and type 1 diabetes mellitus was 53.52 +/- 10.74 and 20.77 +/- 1.65 whereas the mean random blood sugar level in patients with type 2 and 1 diabetes was 232.85 +/- 5.87 and 288.99 +/- 7.87. The mean +/- SD for duration of diabetes type 2 and 1 was 4.77 +/- 2.31 and 2.56 +/- 1.42. The isolated microorganism were Staphylococcus aureus, Escherichia coli, Proteus, Pseudomonas aeruginosa, Klebsiella, Enterobacteriaceae and C.albicans. The urinary tract infection is more prevalent in patients with diabetes mellitus