Type ii aortopulmonary window with isolated left subclavian artery from left pulmonary artery

Abstract Type II Aortopulmonary window (APW) accounts for only 10% of total cases of APW, which by itself is a rare congenital anomaly. Various cardiac malformations have been reported to be associated with this rare anomaly. We report one such association of origin of left subclavian artery (LSCA) from left pulmonary artery (LPA) via ductus arteriosus that was surgically repaired.

Anticancer effect of Psidium guajava (Guava) leaf extracts against colorectal cancer through inhibition of angiogenesis

Objective: To evaluate the anti-angiogenic and anticancer activities of Psidium guajava leaf extracts against angiogenesis-dependent colorectal cancer. Methods: Three extracts were produced using distilled water, ethanol, and n-hexane as solvents. The extracts were physically characterised through gas chromatography-mass spectrometry, ultraviolet-visible spectroscopy, and Fourier transform infrared spectroscopy. Their antioxidant activity was evaluated using the 2,2-diphenyl-1-picrylhydrazyl, total phenolic content, and total flavonoid content assays. To assess their anti-angiogenic activity, cell viability and rat aortic ring assays were conducted, while cell migration, tube formation, colony formation, and VEGF ELISA assays were conducted to elucidate their effects on different aspects of angiogenesis. Molecular docking was used to assess the anti-angiogenic potential of some possible compounds in the extracts. Tumour spheroid assay was used to assess the extracts' potential as a treatment for colorectal cancer. Results: The ethanol extract showed the best antioxidant activity. The distilled water and ethanol extracts exhibited more inhibitory activity against EA.hy926 cell viability and aortic ring microvessel growth. In addition, the ethanol extract performed significantly better than the distilled water extract against cell migration and colony formation, and VEGF expression of the cells was suppressed by the ethanol extract. Both the distilled water and ethanol extracts showed significant inhibitory effect on EA.hy926 tube formation and tumour spheroids consisting of EA.hy926 and HCT116 cells. The ethanol extract contained β-caryophyllene and β-elemene by phytochemical analysis and subsequent docking studies, which may contribute to its anti-angiogenic activity. Conclusions: The ethanol extract of Psidium guajava has potential in the treatment of colorectal cancer through the inhibition of angiogenesis.

Exploring threatened traditional knowledge; ethnomedicinal studies of rare endemic flora from Lesser Himalayan region of Pakistan

ABSTRACT Himalayas are one among the world biodiversity hotspots harboring many endemic medicinal plants. Despite augmentation in the documentation of ethnopharmacological knowledge of medicinal plant species, information regarding endemic species is still underway. Current paper highlights the traditional medicinal uses of rare endemic and unexplored group of plants having potential for novel chemical constituents with effective pharmacological activities. In total, 142 informants (91 male and 51 female) including seventeen traditional healers were interviewed using semi-structured questionnaire, personal observations and group discussions. Interviews were taken in field or otherwise photographs were shown for identification. Females were interviewed indirectly through male family members. For data analysis, quantitative analytical approach was adopted using ethnopharmacological indices as Relative frequency of citations and Fidelity Level. In total, 38 endemic plant species belonging to nineteen families were utilized by the local inhabitants. Highest number of endemics was belonging to Ranunculaceae (7), followed by Gentianaceae and Rosaceae (4 each) with respect to number of species. Highest number of endemics was used in fever, wound healing, throat infection and tonic (4 species each). Root was the most widely used part (36.17%) in cure of diseases and the leading mode administered was decoction (25.49%). Highest use reports and RFC values were recorded for Pimpinella stewartii (58 citations, 0.41 RFC), Caltha alba var. alba (52 citations, 0.37 RFC). Endemic plant species considerably contribute toward ethnomedicinal knowledge and despite rarity, the communities prefer their utilization. Conservation of endemics is necessary for future availability to the local communities.

Distal left main coronany stem lesion managed by intervententional crush technique

Intervententional Crush might end high rates of restenosis. Studying immediate and late outcome of crush technique in distal left main stem lesion intervention. [40] patient had crush technique intervention method for management of LMS lesions, [15] patients done as primary PCI method, while [25] patients as elective management. A total of 40 patients with distal left main stem lesion included in our study, their age range between 45-75 years with a mean +/- SD of 59 +/- 4.5 years, 25 were male, 15 female. One patient died in one year follow up because of noncompliance for medication. One patient had ISR treated by drug eluted balloon. Two patients lost follow up after 2 months. 25 patients [62.5%] had more than one significant lesion, 9 patients [22.5%] had low ejection fraction at time of intervention, functional MR were reported in 5 [12.5%] of patients. All ischemic chest pain disappeared after interventional procedure. LMS crush technique is favorable alternative method for the management of LMS especially in patients unable to do CABG

Primary percutaneous coronary intervention for acute myocardial infarction in Ibn Alnafees hospital, Baghdad

Primary percutaneous coronary intervention [PCI] provides outcomes superior to fibrinolytic therapy in acute myocardial infarction [AMI], but no registry or study in Iraq has demonstrated its use in hospital. To evaluate using of primary PCI for acute MI in Ibn Alnafees hospital -Baghdad. Patients between 2010 and march 2013 having symptom onset within 12 hours and either ST-segment elevation of - 1 mm in - 2 contiguous leads or presumed new left bundle branch block [LBBB] in electrocardiogram [ECG] who were treated with primary PCI were included in this study. Two patient had cardiogenic shock treated within 16 hours. A total of 76 patient included in this study having primary PCI for acute MI. successful result reported in 71 of cases, while death reported in 2 cases, slow flow in 2 cases, no re flow in one case and stent thrombus formation in one case. No need for urgent or elective CABG. Primary PCI for patients with AMI having ST-elevation or new LBBB is a safe and effective strategy

Prevalence and Antimicrobial Susceptibility Pattern of Methicillin-Resistant Staphylococcus aureus and Coagulase-Negative Staphylococci in Rawalpindi, Pakistan.

Methicillin resistant Staphylococcus aureus (MRSA) and methicillin resistant coagulase negative staphylococci (MRCoNS) are the important nosocomial infectious agents. There is a growing concern about the rapid rise in the resistance of Staphylococcus aureus to presently available antimicrobial agents. The aim of this study was to evaluate the prevalence rate of MRSA and MRCoNS and their rate of resistance to different antistaphylococcal antibiotics used broadly for treatment. Out of the total 350 staphylococcal isolates from different clinical specimens 148 isolates (60.40%) were identified as MRSA by oxacillin screen agar method, and 46 isolates (43.80%) were screened as MRCoNS. All the MRSA and MRCoNS isolates were tested for antibiotic resistance pattern by disc diffusion method for 16 different antibiotics. All the isolates of MRSA and MRCoNS were multi-drug resistant. Antibiotic resistance pattern of these isolates was high against penicillin. All the MRSA strains were resistant to penicillin and oxacillin (100%), followed by cephalothin and nalidixic acid (89.18%), cotrimoxazole (86.48%), erythromycin (85.81%), cephalaxin and cephradine (83.10%), levofloxacin (80.40%), imipenem (77.70%), gentamicin (76.35%), tetracycline (59.45%), ciprofloxacin (44.59%), chloramphenicol (18.24%) and rifampicin (10.13%). The MRCoNS strains also showed closely similar drug resistance pattern with 97.82% isolates being resistant to penicillin, followed by oxacillin (95.65%), cephalothin (86.95%), cephradine (82.60%), levofloxacin and nalidixic acid (80.43%), erythromycin, cephalaxin and imipenem (78.26%), cotrimoxazole (73.91%), gentamicin (69.56%), ciprofloxacin and tetracycline (63.04%), chloramphenicol (13.04%) and rifampicin (6.52%). However, all the MRSA and MRCoNS isolates, even those with very high oxacillin MIC (>130 μg/ml) were uniformly susceptible to vancomycin. Chloramphenicol and rifampicin also showed excellent activity against methicillin-resistant isolates. Overall, data presented in this study indicated a slightly higher methicillin resistant rate in MRSA compared to MRCoNS strains. Multi-drug resistance rates in our MRSA and MRCoNS isolates were, 58.10 and 32.60%, respectively. Application of ß-lactamase production method revealed that 84% of MRSA and 87% of MRCoNS strains tested positive for the ß-lactamase production. This study indicated a high level prevalence of MRSA and MRCoNS strains resistance against widely used antimicrobial agents. An appropriate knowledge on the current antibiotic susceptibility pattern of MRSA and MRCoNS is essential for appropriate therapeutic regime determination.

Prevention and management of coronary artery disease in patients with diabetes mellitus.

Diabetes mellitus (DM) is a common medical problem and a major risk factor for the development of atherosclerotic coronary artery disease (CAD). Coronary artery disease is highly prevalent and is the major cause of morbidity and mortality in diabetic patients. Patients with CAD and prediabetic states should undergo lifestyle modifications aimed at preventing DM. In patients with CAD and DM, routine use of aspirin and an angiotensin-converting enzyme inhibitor (ACE-I)-unless contraindicated or not tolerated-and strict glycemic, blood pressure, and lipid control are strongly recommended. Intense insulin therapy might be needed for glycemic control, and high-dose statin therapy might be needed for lipid control. For blood pressure control, ACE-Is and angiotensin receptor blockers are considered as first-line therapy. The outcomes after revascularization in diabetic patients are usually worse compared with non-diabetic patients. Advances in PCI include the use of drug-eluting stents and adjunctive drug therapies, such as abciximab. Glycemic control is an important determinant of outcome after revascularization in diabetic patients. Improvements in PCI and coronary artery bypass graft surgery are leading to better results in diabetic patients, and clinical trials are presently comparing contemporary PCI with surgery.

Prevalence of hypertension in patients with new onset type 2 diabetes mellitus.

This study was conducted to find out the prevalence of hypertension in newly diagnosed patients with type 2 diabetes mellitus. Five hundred patients (229 men and 271 women) with type 2 diabetes mellitus diagnosed in the last 6 months were evaluated for hypertension and presence of various diabetes related complications. Overall 42% (210/500) of the patients had hypertension; more women (46.1%) than men (37.1%) were affected. Patients with hypertension were older, had higher body mass index and plasma triglyceride levels, and evidence of ventricular hypertrophy on electrocardiogram. Female sex, higher age, family history of hypertension or diabetes, history of neuropathic pains, higher body mass index, presence of albuminuria, dyslipidaemia or cardiac hypertrophy were found to affect prevalence of hypertension in newly diagnosed patients with type 2 diabetes mellitus.

From HIV abandonment to adoption. Case study of new life home for abandoned babies, Kenya

The number of orphaned and vulnerable children [OVC] worldwide has increased as a result of the Human Immunodeficiency Virus [HIV] pandemic. New Life Home [NLH] specialises in the care of infants who have been orphaned or abandoned, often because of their exposure to HIV and places them for adoption. This paper documents the lessons learnt from the Home's first 8.5 years of existence. This retrospective study analyses the pattern of the 490 infants admitted at NLH. The characteristics of the infants' stay are analysed: bio-data, weight, HIV exposure, referring organisation/agent and outcome. This study ceased to follow infants after adoption, death, transferral to other homes, or reunion with own family. The infants came via health facilities [58%], local authorities [15%], good Samaritans [2%], and other children's homes [25%]. At the end of the study period, 425 [92%] of babies were still alive. Of those who died, 80% were less than 6 months old [p<0.003] and 45% were HIV positive. A child mortality rate of 77.6/1000 was demonstrated with the key associated factors being HIV exposure [p <0001], and weight at admission [p=0.002]. The mortality rate for the HIV exposed was 71/1000 at 6 months, 94.7/1000 at 12 months and 100.6/1000 at 18 months, while for those not exposed to the virus it was 43.3/1000 at 6 months and 46.7/1000 at 12 months. The major cause of death in the HIV exposed was pneumonia [56%] and septicaemia [22%]. The majority of infants, 323 [67%] were adopted, some were reabsorbed into their biological families 31[6.3%] and a minority 7[1.4%] transferred to other children's homes which cater for older children. NLH demonstrates a possible model of care for OVC as majority of vulnerable child can have the opportunity to be adopted and thereby a 'second lease' of life. This strategy is worth studying and duplicating in the mitigation of the OVC dilemma in HIV high prevalence countries in sub-Saharan Africa