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Objective: To evaluate the antioxidant potential and pancreatic lipase inhibitory action of optimized hydroethanolic extracts of Solanum nigrum. Methods: Optimized extraction for maximum recovery of metabolites was performed using a combination of freeze-drying and ultrasonication followed by determination of antioxidant and antiobesity properties. The ultra-high performance liquid chromatography equipped with mass spectrometry was used to analyze metabolite profiling of Solanum nigrum. Computational studies were performed using molecular docking and electrostatic potential analysis for individual compounds. The hypolipidemic potential of the most potent extract was assessed in the obese mice fed on fat rich diet. Results: The 80% hydroethanolic extract exhibited the highest extract yield, total phenolic contents, total flavonoid contents along with the strongest 2,2-diphenyl-1-picrylhydrazyl scavenging activity, total antioxidant power, and pancreatic lipase inhibitory properties. The 80% hydroethanolic extract not only regulated the lipid profile of obese mice but also restricted the weight gain in the liver, kidney, and heart. The 80% hydroethanolic extract also reduced alanine transaminase and aspartate transaminase concentrations in serum. The effects of plant extract at 300 mg/kg body weight were quite comparable with the standard drug orlistat. Conclusions: Solanum nigrum is proved as an excellent and potent source of secondary metabolites that might be responsible for obesity mitigation.
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Objective: To evaluate the antioxidant potential and pancreatic lipase inhibitory action of optimized hydroethanolic extracts of Solanum nigrum. Methods: Optimized extraction for maximum recovery of metabolites was performed using a combination of freeze-drying and ultrasonication followed by determination of antioxidant and antiobesity properties. The ultra-high performance liquid chromatography equipped with mass spectrometry was used to analyze metabolite profiling of Solanum nigrum. Computational studies were performed using molecular docking and electrostatic potential analysis for individual compounds. The hypolipidemic potential of the most potent extract was assessed in the obese mice fed on fat rich diet. Results: The 80% hydroethanolic extract exhibited the highest extract yield, total phenolic contents, total flavonoid contents along with the strongest 2,2-diphenyl-1-picrylhydrazyl scavenging activity, total antioxidant power, and pancreatic lipase inhibitory properties. The 80% hydroethanolic extract not only regulated the lipid profile of obese mice but also restricted the weight gain in the liver, kidney, and heart. The 80% hydroethanolic extract also reduced alanine transaminase and aspartate transaminase concentrations in serum. The effects of plant extract at 300 mg/kg body weight were quite comparable with the standard drug orlistat. Conclusions: Solanum nigrum is proved as an excellent and potent source of secondary metabolites that might be responsible for obesity mitigation.
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Objective: To determine health related quality of life [HRQOL] of medical students and its correlation with their academic performance
Methods: Cross sectional study at Services Institute of Medical Sciences, included students of 4th and final year MBBS, who filled SF-36 proforma of HRQOL. Scores of 8-domains and of physical component and mental component summary were determined. Marks in all professional examinations were used to stratify students as high performers [>/= 70% marks] and average performing students [< 70%]. HRQOL scores was correlated with academic performance using unpaired student's t-test
Results: Among 267 students included, mental health score [56.2+/-21.3] was lower than physical health component score [69.03+/-18.5]. Role limitation due to emotional health [RE] [44.81], Vitality [VT] [54.19] and general health perception [GH] [58.89] had lower scores among 8domains of questionnaire. Female students had significantly lower scores in role limitation due to emotional problems [p value <0.04], vitality [<0.05], bodily pain [p value <0.05] and general health perception [p value<0.03] than male students. Physical health and role limitation due to physical health domains were better in high performing students
Conclusion: Mental health of medical students is suboptimal, especially among female students. Students with better physical health have better academic performance
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Background and Introduction: Insulin-Like Growth Factor-1 [IGF-1] belongs to the growth factor family, structurally resembling pro-insulin, enabling it to bind to insulin receptors. It plays an important role in many tissues including skin, particularly acne pathogenesis by stimulating sebum production and affecting androgen levels. Studies comparing IGF-1 levels in acne patients and controls have found statistically significant differences, proving acne as a sign of insulin resistance. However, no such study has been carried out in Pakistan
Methodology: After approval from the institutional ethical board and informed consent, a case-control study was carried out with 270 acne patients and 80 age and gender- matched controls. Patients belonged to either gender and aged between 15 - 35 years were divided into mild, moderate and severe categories. IGF-1 levels were noted after exclusion of any condition interfering with IGF-1 level and correlated with acne severity and with levels of testosterone, dihydrotestosterone [DHT] and dehydroepiandrosterone sulphate [DHEAS]. Quantitative variables were expressed as median and percentiles. Comparisons were done by Mann-WShitney test and correlations by Spearman correlation. A p value of
Results: Out of 350 cases and controls, There were 142 [41%] males and 208 [59%] females. In cases, there were 155 females and 115 males, whereas in controls, there were 54 females and 26 males. Median age of the patients was 20 years. Ninety-Seven patients had mild, 108 moderate and 65 had severe disease. Median levels of IGF-1 were 292 ng/m in cases. IGF-1 levels were significantly different between cases and controls and between mild and severe acne, but not between mild and moderate acne. IGF-1 levels were strongly correlated with the levels of androgenic hormones
Conclusion: Increase of IGF-1 levels in acne point to the role of insulin resistance and diet in acne. Future treatments may be targeted to treat IGF-1 levels by dietary interventions reducing glycemic load
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Objective: to determine the frequency of positive patch tests for nickel in patients suspected of household and occupational metal contact dermatitis
Methods: this was a cross-sectional analytical study carried out in the outpatient department of dermatology unit-II, Mayo Hospital, Lahore. A total of 50 patients were inducted in the study with ages 12 and above and either sex, who were suspected of metal contact dermatitis. The patients were patch tested with the allergen nickel sulphate hexahydrate 5% in petrolatum base from the European standard series
Results: in this study, out of 50 patients, 62% of the patients positively tested for nickel sulphate out of which 38% of the patients showed a strong positive reaction. Only 12% showed a weak positive reaction whereas 12% patients exhibited an extreme positive reaction. Most patients were females i.e. 46 out of 50. The most commonly affected age group was 21 to 30 years. Most patients belonged to middle class. Housewives and students were most commonly affected. Most frequent symptoms encountered were itching 84%, burning 48%, redness 42% and oozing 36%. The dermatitis aggravated in most patients' due to hyperhidrosis and wet work
Conclusion: nickel sulphate is a common allergen in patients suspected of metal contact dermatitis. Nickel contact dermatitis is a very common problem prevalent in our community and the cultural trend towards artificial jewelry predisposes our community to risk
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Objectives: to evaluate the therapeutic efficacy and safety of 0.1% tacrolimus ointment versus mometasone furoate 0.1% ointment in mild to moderate chronic hand eczema
Methods: it was a randomized control trial carried out in dermatology department unit-II, KEMU/ Mayo Hospital, Lahore. Patients with mild to moderate chronic hand eczema were enrolled with age range between 18-70 years, of either sex. We randomized the patients in two groups A and B by balloting. Group A used tacrolimus 0.1% ointment twice daily for 6 weeks. Group B used mometasone furoate 0.1% ointment twice daily for 6 weeks. The data were collected and analyzed by SPSS version 18 and p-value <0.05 was taken as significant
Results: the study was completed by 102 patients, with 51 in each group, with mean age of 32 years and majority were married females. Both the treatment options were found to be equally efficacious with PGA Score showing significant p value at the end of study [p-value = 0.042]. The side effects noted were itching and irritation. Irritation was observed in both treatment groups but did not lead to discontinuation of the treatment, as it was transient. This complaint was seen more among the Group A patients
Conclusion: it is concluded from our study that 0.1% tacrolimus ointment and 0.1% mometasone furoate ointment are equally efficacious and safe in the treatment of mild to moderate chronic hand eczema
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Objective: To determine the efficacy of trimodality therapy in patients with muscle invasive carcinoma of the bladder with deranged renal profile
Study Design: Quasi-experimental study
Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi over 14 months, from Sep 2015 to Nov 2016
Patients and Methods: Forty patients [n=40] having histopathologically confirmed [urothelial] urinary bladder cancer, clinical stage II or III, aged 18 to 80 years, with Eastern Cooperative Oncology Group [ECOG] perfor-mance status ?2 and having deranged renal functions were included in this study. After maximal transurethral resection of bladder tumour [TURBT], they received 4 courses of chemotherapy with mitomycin and 5 fluorou-racil, followed by concurrent chemoradiation using same chemotherapy received 50 Grays in 20 fractions. Response was assessed using RECIST criteria
Results: Efficacy; defined in terms of complete and partial response, was observed in 85 percent [n=34] of patients. Treatment efficacy was better in males as compared to females [90.6 percent vs. 62.55: p<0.05]. Patients with better ECOG-PS [0-1] and early stage [2] responded well to treatment while response was almost same in different age groups, [p>0.05 in all cases]. Thirty-seven patients were able to complete the full study protocol, 2 had severe mucositis and hand-foot syndrome while one patient died after septicaemia
Conclusion: Trimodality treatment with TURBT, chemotherapy and chemo-radiation is a feasible option for bladder preservation in muscle invasive bladder cancer patients with compromised renal functions if we use 5-fluorouracil and mitomycin chemotherapy
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Objective To determine the impact of psoriasis on quality of life [QoL] using Dermatology Life Quality Index [DLQI] in patients of psoriasis presenting in a tertiary care setting
Methods An observational study was carried out at Department of Dermatology, King Edward Medical University/ Mayo Hospital, Lahore from May 2013 till November 2013. A total of 200 patients compatible with inclusion criteria were enrolled after taking informed consent and were asked to fill DLQI questionnaires
Results Out of 200 patients, there were 107 males and 93 females. The mean age was 34.89+/-14.96 years while the mean DLQI score was 11.51+/-4.81. There were 58 [29 percent] married and 142 [71 percent] unmarried patients in the present study. Patients with moderate psoriasis were 184 with PASI score 40-60 and mean DLQI score 11.14+/-4.55 whereas 16 patients had severe psoriasis with PASI score 60-72 and mean DLQI score 15.8+/-5.68. The maximum mean DLQI score was highest for question 10 [treatment] followed by question 1 and 2 [symptoms and feelings]
Conclusion Psoriasis is a serious condition and is associated with significantly lower quality of life regardless of age, gender, duration and severity of disease or marital status
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Objective: To review the validity of the future of health and care of older people [TFHCOP], good death perception criteria in Muslim patients and health care providers in cultural background of Pakistan
Study Design: A mixed method design with qualitative and quantitative components
Place and Duration of Study: Oncology Department, Combined Military Hospital, Rawalpindi, from July 2015 to October 2015
Material and Methods: It is a sequential explanatory type of mixed method research. A total of 110 participants were included in the study by non probability convenient sampling technique. A modified questionnaire was used based on the principles of TFHCOP good death definition comprising of 8 questions. This was followed by interviews. For data collection and analysis grounded theory approach was used with constant comparisons and open coding. Descriptive statistics were used to analyze questionnaire responses. For bivariate analysis we used chi-square test
Results: There was a consensus on the principles presented in the modified questionnaire in the two groups studied. Total of three domains measured non-significant difference in patient's and health care provider's perspectives. Participants identified four more domains. The first domain was related to faith in Allah Almighty, second domain is about leaving the will for bereaved, third domain was about the concerns to finish unfinished agendas and the fourth domain was related to the importance of family security over treatment or death
Conclusion: Perception of good death by Muslim patients and health care providers in Pakistan is different from that of Western and Arab communities in certain domains like religious beliefs, leaving will for the bereaved, finishing unfinished work and the importance of family concerns
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Background and Objective: Alpha [alpha] thalassemia is a hereditary disorder and is caused by deletions or mutations in globin genes. It is present in two clinically significant forms: hemoglobin Bart hydrops fetalis [Hb Bart] syndrome and hemoglobin H [HbH] disease. It is highly prevalent in South-East Asia or Mediterranean countries. The most common deletion reported in alpha thalassemia in Pakistani population was -alpha[3.7] with a frequency of 8.3%, and the rare forms were -alpha[4.2] [0.2%] and alphaalphaalpha[anti3.7] [0.9%]. In our study, diagnosis of severe anemia cases without any alpha and beta mutations or deletions were made by using extended alpha thalassemia deletions panel. The main objective of this study was to determine the prevalence and to study the spectra of alpha thalassemia gene deletions in beta thalassemia patients with the use of an extended panel including -[SEA], --[FIL], --[MED], --[20.5], --[THAI] in addition to -alpha [3.7], -alpha [4.2] and - alphaalphaalpha[anti3.7]
Methods: The samples were collected in ethylenediaminetetraacetic acid [EDTA] vacutainers. A total of 156 samples were analyzed for alpha thalassemia mutations. This cohort included 121 samples of beta thalassemia major, nine samples of beta thalassemia minor and 26 without any evidence of beta thalassemia mutations. DNA was extracted with Qiagen extraction kit. The primers for determination of different subsets of alpha thalassemia deletions were included. PCR amplification was performed and result interpreted on agarose gel
Results: Co-inheritance of alpha thalassemia [-alpha [3.7], -alpha [4.2]] with homozygous beta thalassemia was detected in 30% cases of studied cohort [37 out of 121]. The most common found was -alpha[3.7] deletion [35/37] as single/double deletions or in combination with -alphaalphaalpha[anti3.7]. In undiagnosed cases screened for beta thalassemia major, we found Mediterranean [-alpha [MED]] deletion at specifically 875 bp on agarose gel. This is distinctive finding in case of detecting -alpha [MED] instead of any other deletion from Pakistan
Conclusion: Alpha thalassemia deletions [-alpha[3.7], -alpha[4.2]] are the common co-inherited deletions found in beta thalassemia major patients. On the basis of results, we propose an extended alpha thalassemia genetic mutation panel should be used for screening of children presenting with anemia with suspicion of haemoglobinopathy
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Adams-Oliver syndrome is a rare disease, which presents with cutaneous, cardiac and skeletal defects. We, herein, describe a case of 1-month-old girl with aplasia cutis, cutis marmorata telangiectatica and terminal transverse limb reduction defects with a positive HCV serology. The patient is put on regular follow-up
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Background: Pakistan is a developing country of 180 million people with low health and educational standards. According to the Human Development Index of the United Nations, it is ranked 146[th] out of 187 countries
Objective: To know the actual disease burden of Chronic Hepatitis Viruses B and C in Southern Punjab. Study Design: Cross-sectional, Observational study. Setting: Ibn-e-Sina Hospital and Research Centre. Period: March 2010 to February 2014
Methodology: A total of 26800 people from general population were included in the present study. Free vaccination camps were established in rural and urban union councils with the help of local politicians, in Schools, Madrassahs and Industrial units and a permanent camp was established in Ibn-e-Sina Hospital. People of all age groups and either sex were vaccinated
Results: A total of 26800 individuals were screened, [mean: 36.47 +/- 13.81]. 2090 [7.8%] tested positive for Anti-HCV. Among these 68.6% [n=1433] were males while 31.4% [n=657] were females. 616 [2.3%] tested positive for HBsAg of which 401 [65.2%] were male and 215 [34.8%] were female. 75 subjects [0.28%] were positive for both HBsAg and Anti-HCV
Conclusion:- We as a community need to be more vigilant as the disease burden of HBsAg is not decreasing in the general population and the Burden of Anti-HCV is one of the highest in the world
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Humanos , Masculino , Persona de Mediana Edad , Femenino , Adulto , Lactante , Recién Nacido , Niño , Preescolar , Hepatitis C/epidemiología , Estudios Transversales , Prevalencia , Hepatitis Viral Humana , VacunaciónRESUMEN
The present study deals with the production of ergot alkaloids from Penicillium commune and Penicillium citrinum, using surface culture fermentation process. Impact of various inorganic salts was tested on the production of ergot alkaloids during the optimization studies of fermentation medium such as impact of various concentration levels of succinic acid, ammonium chloride, MgSO[4], FeSO[4], ZnSO[4], pH and the effect of various incubation time periods was also determined on the production of ergot alkaloids from Penicillium commune and Penicillium citrinum. Highest yield of ergot alkaloids was obtained when Penicillium commune and Penicillium citrinum that were grown on optimum levels of ingredients such as 2g succinic acid, 1.5 and 2g NH[4]Cl, 1.5g MgSO[4], 1g FeSO[4], 1 and 1.5g ZnSO[4] after 21 days of incubation time period using pH 5 at 25[degree]C incubation temperature in the fermentation medium. Ergot alkaloids were determined using Spectrophotometry and Thin Layer Chromatography [TLC] techniques
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Alcaloides de Claviceps , Espectrofotometría , Cromatografía en Capa Delgada , Fermentación , Técnicas de CultivoRESUMEN
Arrhythmias are common during the perioperative period. These abnormal rhythms can alter the hemodynamics by reducing cardiac output and may contribute to an increase in morbidity and mortality. Early diagnosis and identification of correctable causes is essential for appropriate management of arrhythmias. Some of these arrhythmias are benign requiring no intervention, while others may need urgent therapeutic intervention. This article focuses on the diagnosis and management of arrhythmias in the perioperative setting
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Objective: To compare number of attempts, mean time of Insertion, mean airway leak pressure, insertion success and blood staining at removal of l-gel insertion through standard and rotational techniques, in adult anesthetized patients
Study design Randomized clinical trial
Place and Duration of study: Department of Anaesthesiology and SICU, Jinnah Postgraduate Medical Centre Karachi, from January 2016 to April 2016
Methodology: Patients scheduled for elective surgical procedures under general anaesthesia with controlled ventilation, were included in this study. A total of 150 patients were randomly assigned by random number into Group S [standard insertion technique - n=75] and Group R [rotational technique - n=75]. Comparison was done in terms of mean time taken for I-gel insertion, mean air leak pressure, number of attempts taken for insertion and presence of blood staining on removal
Results: Mean time of insertion in Group S was 14.6 +/- 3.7 second and in Group R 13.2 +/- 2.7 seconds. Mean airway leak pressure was 23.1 +/- 4.6 cm of H2O in Group S and 24.4 +/- 2.9 cm of H2O in Group R. The median number of attempts taken for insertion in each group was 1. Success of insertion was 93.3% [n=70] in Group S and 98.7% [n=74] in Group R. Blood staining of I-gel at removal was noted in 22 [29.3%] and 14 [18%] patients in group S and R respectively
Conclusion: The rotational technique for I-gel insertion was better than the standard technique
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abstract A series of N-substituted 2-{[5-(1H-indol-3-ylmethyl)-1,3,4-oxadiazol-2-yl]sulfanyl}acetamides (8a-w) was synthesized in three steps. The first step involved the sequential conversion of 2-(1H-indol-3-yl)acetic acid (1) to ester (2) followed by hydrazide (3) formation and finally cyclization in the presence of CS2 and alcoholic KOH yielded 5-(1H-indole-3-yl-methyl)-1,3,4-oxadiazole-2-thiol (4). In the second step, aryl/aralkyl amines (5a-w) were reacted with 2-bromoacetyl bromide (6) in basic medium to yield 2-bromo-N-substituted acetamides (7a-w). In the third step, these electrophiles (7a-w) were reacted with 4 to afford the target compounds (8a-w). Structural elucidation of all the synthesized derivatives was done by 1H-NMR, IR and EI-MS spectral techniques. Moreover, they were screened for antibacterial and hemolytic activity. Enzyme inhibition activity was well supported by molecular docking results, for example, compound 8q exhibited better inhibitory potential against α-glucosidase, while 8g and 8b exhibited comparatively better inhibition against butyrylcholinesterase and lipoxygenase, respectively. Similarly, compounds 8b and 8c showed very good antibacterial activity against Salmonella typhi, which was very close to that of ciprofloxacin, a standard antibiotic used in this study. 8c and 8l also showed very good antibacterial activity against Staphylococcus aureus as well. Almost all compounds showed very slight hemolytic activity, where 8p exhibited the least. Therefore, the molecules synthesized may have utility as suitable therapeutic agents.
resumo Uma série de acetamidas 2-{[5-(1H-indol-3-ilmetil)-1,3,4-oxadiazol-2-il]sulfanila} N-substituídas (8a-w) foi sintetizada em três fases. A primeira etapa envolveu a conversão sequencial de ácido 2-(1H-indol-3-il)acético (1) a éster (2), seguido por hidrazida (3) e, finalmente, a e ciclização na presença de CS2 e KOH alcoólico produziu 5-(1H-indol-3-il- metil)-1,3,4-oxadiazole-2-tiol (4). Na segunda etapa, aminas arílicas/aralquílicas(5a-w) reagiram com brometo de 2-bromoacetila (6), em meio básico, para se obter acetamidas 2-bromo-N-substituídas (7a-w). Na terceira etapa, estes eletrófilos (7a- w) reagiram com 4, para se obter os compostos alvo (8a-w). A elucidação estrutural de todos os derivados sintetizados foi realizada por 1H-NMR, IR e técnicas de espectrometria de EI-MS. Além disso, eles foram submetidos a triagem de atividade antibacteriana e hemolítica. Análise da inibição enzimática foi bem apoiada pelos resultados de docking molecular. Por exemplo, o composto 8q exibiu melhor potencial inibitório contra α-glicosidase, e os compostos 8g e 8b exibiram, comparativamente, melhor inibição contra butirilcolinesterase (BChE) elipoxigenase (LOX), respectivamente. Do mesmo modo os compostos 8b e 8c mostraram excelente potencial antibacteriano contra SalmonellaTyphi, semelhante ao do ciprofloxacino, antibiótico padrão usado neste estudo. Os compostos 8c e 8l também mostraram excelente potencial antibacteriano contra Staphylococcus aureus . Quase todos os compostos mostraram pequena atividade hemolítica, sendo que o composto 8p apresentou menor atividade. Assim, as moléculas sintetizadas podem ter a sua utilidade como agentes terapêuticos adequados.
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Ácido Hidroxiindolacético/análisis , Acetamidas/análisis , Butirilcolinesterasa/análisis , Ensayo de Actividad Hemolítica de Complemento/clasificación , Lipooxigenasas/farmacocinética , Glicósido Hidrolasas/farmacocinéticaRESUMEN
To determine the frequency of early onset neonatal sepsis in newborn with various duration of preterm premature rupture of membranes [PPROM]. Cross sectional study. Neonatal Intensive Care Unit Combined Military Hospital, Lahore from November 2009 to November 2010. Neonates of singleton pregnancies complicanted by pretern premature rupture of the membranes [PPROM] with delivery between 30 and 36 weeks gestation were included in the study. The overall frequency of neonatal sepsis was calculated on clinical and serological basis. Comparison of the frequency of sepsis among groups with varying duration of rupture of membranes was done. Out of 164 babies, 84 [51.2%] were female and 80 [48.8%] were male. Mean maternal age was 23 year [range: 18-36 years] .Mean gestational age was 33 weeks [range: 30-36 weeks]. Sepsis was suspected in 41 [25%] babies on clinical grounds. C-reactive protein was raised in 36 [22%] neonates. There was statistically insignificant difference between clinical versus serological diagnosis [p=0.515]. Frequency of neonatal sepsis was significantly higher in mothers with longer duration of rupture of membrane [p< 0.001]. Frequency of neonatal sepsis was observed to be 22%. PPROM is an important risk factor for early onset neonatal sepsis
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Humanos , Masculino , Femenino , Recién Nacido , Rotura Prematura de Membranas Fetales , Estudios Transversales , Proteína C-ReactivaRESUMEN
Objective: to determine the diagnostic accuracy of doppler ultrasonography for diagnosing esophageal varices in cirrhotic patients taking endoscopic findings as gold standard
Material and Methods: one hundred and thirty five patients fulfilling inclusion criteria underwent doppler ultrasound of abdomen for esophageal varices. This was followed by upper GI endoscopy in all patients. Data was analyzed for sensitivity, specificity, positive predictive values, negative predictive values and accuracy rate of doppler ultrasonography for diagnosing esophageal varices
Results: frequency of esophageal varices in cirrhotic patients on endoscopy was 62.22 % [n=84 ]. Diagnostic accuracy of doppler ultrasonography for diagnosing esophageal varices in cirrhotic patients taking endoscopy as gold standard was recorded. Results showed that 51.85% [n=70] were true positive, 2.96% [n=4] false positive, 34.81% [n=47] true negative and 10.37% [n=14] false negative. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate were calculated as 83.33%, 92.16%, 94.59%, 77.05% and 86.67% respectively
Conclusion: the diagnostic accuracy of Doppler Ultrasonography for diagnosing esophageal varices in cirrhotic patients' standard is high