An overview of inflammatory breast cancer

Inflammatory breast cancer is an uncommon and severe malignancy that frequently goes undiagnosed at first because it presents similarly to more benign breast diseases like mastitis, resulting in delayed treatment. Inflammatory breast cancer affects 1% to 5% of all occurrences of breast cancer and accounts for 8% to 10% of all breast cancer-related deaths. Erythema, skin abnormalities, nipple inversion, edema, and warmth of the affected breast are all signs of inflammatory breast cancer. Recognized risk factors for inflammatory breast cancer include young age at the time of diagnosis, obesity and African American ethnicity. Rapid onset within 3 months and pathologic evidence of invasive carcinoma leads to diagnosis of disease further including erythema occupying at least one-third of the breast, tumour may or may not be present in this case. Chemotherapy, surgery, and radiation make up the trimodal therapy used to treat inflammatory breast cancer. A modified radical mastectomy performed as part of an aggressive surgical strategy improves survival rates. Although patients with inflammatory breast cancer have worse outcomes than those with noninflammatory breast cancer, those who complete trimodal therapy have a positive locoregional control rate, highlighting the significance of an early diagnosis. Physicians must be aware and examine any clinical manifestation of inflammatory breast cancer if present to make a prompt diagnosis and refer patient for expert care timely also awareness and cancer screening can help in prevention of disease. The purpose of this research is to review the available information about an overview of inflammatory breast cancer.

Ingestive behavior of Girolando heifers in integrated crop, livestock (ICL), and forestry (ICLF) systems / [Comportamento ingestivo de novilhas Girolando mantidas em sistemas de integração lavoura-pecuária (ILP) e lavoura-pecuária-floresta (ILPF]

Aiming to compare integrated crop, livestock (ICL) and forest (ICLF) systems in relation to ingestive behavior of dairy heifers, a 2 × 2 crossover trial was conducted with two periods and two systems. Eight Girolando (3/4holstein × 1/4 Gyr) heifers were evaluated in pasture of Xaraés palisade grass (Urochloa brizantha 'Xaraes' syn Brachiaria brizantha) managed with intermittent stocking. The ICLF systemhad eucalyptus trees planted in tiers with 65% crown cover. Ingestive behavior parameters were obtained using acoustic data collected with mP3 recorders for 48hours. Statistical analysis was performed using the mixed procedure of SAS, and means were compared using the Tukey-Kramer test at 5% significance. The dry mater intake (DMI), number of daily grazing sessions, and the duration of the grazing sessions did not differ (P<0.05) between systems. A higher (P<0.05) bite rate and total daily bites and lower (P<0.05) bite mass was observed in the ICLF system in relation to ICL. Heifers in shaded pasture change their ingestive behavior in comparison with those in full-sun pasture.(AU)

Com o objetivo de comparar sistemas de integração lavoura-pecuária (ILP) e lavoura-pecuária-floresta (ILPF) em relação ao comportamento ingestivo de novilhas leiteiras, conduziu-se um ensaio em delineamento crossover 2 × 2, com dois períodos e dois sistemas. Oito novilhas Girolando foram mantidas em pastagens de capim-xaraés (Urochloa brizantha 'Xaraes' syn Brachiaria brizantha) manejadas com lotação intermitente. No sistema ILPF, havia renques de eucalipto com 65% de cobertura de copa. O comportamento ingestivo foi avaliado pela análise de áudios coletados com gravadores de Mp3, durante 48 horas. As análises estatísticas foram realizadas utilizando-se Proc mixed SAS. As médias foram comparadas pelo teste Tukey-Kramer, ao nível de 5% de significância. A ingestão de matéria seca (IMS), o número de sessões de pastejo por dia e a duração das sessões de pastejo não diferiram (P<0,05) entre os sistemas. As maiores (P<0,05) médias de taxa de bocado e de número de bocados por dia e a menor (P<0,05) média de massa de bocado foram observadas no ILPF quando comparado ao ILP. Novilhas em pastagem sombreada alteram seu comportamento ingestivo quando comparadas àquelas que são mantidas em pastagem a pleno sol.(AU)

In silico analysis of the structural and functional implications of SLC19A1 R27H polymorphism

In view of the documented association of solute carrier family 19 member 1 (SLC19A1) G80A (R27H) polymorphism with the risk for different types of cancers and systemic lupus erythematosus (SLE), we have reanalysed the case–control study on breast cancer to ascertain the conditions in which this polymorphic variant exerts the risk of breast cancer. Association statistics have revealed that this polymorphism exerts the risk for breast cancer under the conditions of low folate intake, and in the absence of well-documented protective polymorphism in cytosolic serine hydroxymethyltransferase. To substantiate this observation, we have developed a homology model of SLC19A1 using glycerol-3-phosphate transporter (d1pw4a) as a template where 73% of the residues were modelled at 90% confidence while 162 residues were modelled ab initio. The wild and mutant proteins shared same topology in S3, S5, S6, S7, S11 and S12 transmembrane domains. The topology varied at S1 (28–43 residue vs 28–44 residue), S2 (66–87 residue vs 69–87 residue), S4 (117–140 residue vs 117–139 residue), S8 (305–325 residue vs 305–324 residue), S9 (336–356 residue vs 336–355residue), and S10 (361–386 residue vs 361–385 residue) transmembrane domains between wild versus mutant proteins. S2 domain is shortened by three amino acid residues in themutantwhile in other domains the difference corresponds to one amino acid residue. The 3DLigandSite analysis revealed that the metallic-ligand-binding sites at 273Trp, 277Asn, 379Leu, 439Phe and 442Leu are although unaffected, there is a loss of active sites corresponding to nonmetallic ligand binding. Tetrahydrofolate and methotrexate have lesseraffinity towards the mutant protein than the wild protein. To conclude, the R27H polymorphism affects the secondary and tertiary structures of SLC19A1 with the significant loss in ligand-binding sites.

Correlation cyclooxygenase-2 expression and histopathological grading in locally advanced breast cancer

Background: Cyclooxygenase-2 (COX-2) is involved in the carcinogenesis process and tumor progression into cancer. It has been reported recently, there was a COX-2 expression at breast cancer. Patients with a high level of COX-2 expression can have a local recurrence and decrease life expectancy, and an increase of COX-2 expression in tissue likelihood has prognostic value. This study aims to correlation cyclooxygenase-2 (cox-2) expression and histopathological grading in locally advanced breast cancer patient in AW Sjahranie Hospital in Samarinda city.Methods: This study was an observational study with crossectional design to analysis the correlation COX-2 expression and histopathological grading in patients with locally advanced breast cancer and using data analysis with the Chi-Square test.Results: The results showed that the correlation was not significant (P>0.05), where there was no correlation of COX-2 expression with histopathological grading (P=0.221) and there was no correlation with the last condition of patients (P=0.61). Although patients with breast cancer high grade and moderate grade percentages were significantly higher in positive COX-2 than in COX-2 negative expression.Conclusions: There were no correlation between COX-2 expression and histopathological grading and there was no significant relationship between COX-2 expression and the last condition, as evidenced by the statistical test results showing that the differences were not significant.

Application of multiple linear regression and machine learning algorithms to elucidate the association of poor glycemic control and hyperhomocysteinemia with microalbuminuria

Microalbuminuria is an early biomarker of general vascular dysfunction and a predictor of risk for cardiovascular and renal diseases. It is also considered as a marker of insulin resistance in both diabetic and non-diabetic patients. The rationale of this study was to elucidate threshold values of fasting blood glucose (FBS) and glycosylated hemoglobin (HbA1c) that are associated with microalbuminuria. In the parallel association of microalbuminuria with hyperhomocysteinemia was investigated. Machine learning algorithm and multiple linear regression were applied to study the association of poor glycemic control on microalbuminuria and hyperhomocysteinemia. In non-diabetic subjects with FBS <102 mg/dL and HbA1c <6.3%; and in diabetic subjects with good glycemic control (FBS: 102-118 mg/dL; HbA1c: 6.3-7.0%), urinary microalbumin levels were <40µg/mg creatinine. Poor glycemic control (FBS >172 mg/dL and HbA1c >9.0%) was associated with microalbumin >40µg/mg creatinine. Age, gender, HbA1c and FBS were shown to explain variability in urinary microalbumin to the extent of 54.4% as shown by multiple linear regression model. Analysis of variance (ANOVA) revealed higher levels of FBS (F: 39.77, P <0.0001), HbA1c (F: 64.31, P <0.0001) and total plasma homocysteine (F: 3.69, P =0.04) in microalbuminuria and clinical microalbuminuria groups when compared to subjects with normal microalbumin levels. Diabetic patients with poor glycemic index had a more B12 deficiency. Poor glycemic index and hyperhomocysteinemia were associated with clinical microalbuminuria.

Awareness and knowledge of the general public at southern region of Saudi Arabia regarding dental implants

Aims: To assess the awareness, knowledge, and information sources regarding dental implants as anoption of treatment to replace missing teeth among patients in Jazan Province, Saudi Arabia.Materials and methods: The current study consisted of 14 questions used to assess the patients’awareness, expectations and level of knowledge of dental implants. Three categories of questionswere used, with the first one related to the patients’ knowledge and options for replacement of missingteeth, the second about dental implants and their providers, and the third on the techniques, materials,care, and durability of dental implants. The collected data was analyzed using Chi-square tests, and Pvalues less than 0.005 were considered significant. Results: A total of 380 subjects were divided intotwo groups, medical (40.3%) or non-medical (59.7%) related. We found that 85% and 71.0% of themedical and non-medical subjects, respectively know the importance of replacement of missing teeth,while 50% had known the different types of dental implants with no significance (P< .001) betweenthe two groups. Dentists were the sources of the information (43.3% and 34.8% for the medical andnon-medical groups respectively). Around 50% of the medical subjects thought that dental implantscame with a screw compared with 36.6% of non-medical subjects with value of P .025. In total, 60%-70% of respondents from both groups answered that dental implants should be provided by specialistsonly. Around 29% of all patients cited “lifetime” as the survival period of implants. Also, 52%-77%of the respondents related the implant site to the “the jaw bone,” with significant difference of P .000.Conclusions: The awareness and knowledge of the subjects were acceptable with higher percentageamong respondents in the medical group. Dentists followed by friends were the main sources ofinformation for dental implants. Dental implants are considered as the best choice for replacement ofmissing teeth with excellent durability and need of much more special care than natural teeth

Bioacústica como método de avaliação do comportamento em pastejo de novilhas Girolando / Bioacoustics as a tool for evaluating grazing behavior of Girolando heifers

Objetivou-se validar o método de análise de dados bioacústicos na descrição do comportamento em pastejo de novilhas em área de integração lavoura-pecuária (iLP) e floresta (iLPF). Foram utilizadas oito novilhas Girolando (¾Holandês x »Gir) com média de 25±6,8 meses de idade e 268±83kg de peso vivo (PV), distribuídas em delineamento crossover 2x2 (dois sistemas x dois períodos de avaliação). A coleta de dados para análise bioacústica foi realizada utilizando-se gravadores MP3. Esses dados foram analisados pelo software Audacity® para identificação das atividades de pastejo, ruminação e ócio. Concomitantemente, o comportamento também foi avaliado pelo método de observação visual, realizado no período de 8 até 16 horas, em intervalos de 15 minutos. Não houve diferença (P>0,05) entre médias dos tempos (minutos) de pastejo, ruminação e ócio registrados pelos métodos de bioacústica e avaliação visual, sendo, respectivamente, 127 vs. 137; 122 vs. 113 e 238 vs. 216, no sistema iLP, e 134 vs. 103; 130 vs. 165 e 233 vs. 203, no sistema iLPF. Por meio desses resultados, foi possível concluir que o método da bioacústica é uma importante ferramenta para avaliar o comportamento de pastejo em diferentes sistemas de produção a pasto, com a vantagem de possibilitar o registro de atividades durante o período noturno, além de maior praticidade e precisão do que o método observacional.(AU)

Aiming to validate the analysis of bioacoustic data for describing grazing behavior of heifers in integrated crop, livestock (ICL) and forestry (ICLF) systems. Eight 25±6.8 month-old Girolando (¾Holstein × »Gir) heifers with 268±83kg of live weight (LW) were distributed in 2x2 crossover design (two systems x two evaluation periods). Data collection for bioacoustic analysis was done with MP3 recorders. These data were analyzed by Audacity® software for identification of the activities of grazing, rumination, and resting. Concomitantly, behavior was also analyzed by the method of visual observation from 8AM to 4PM in intervals of 15 minutes. There was no difference (P>0.05) between the methods of bioacustic and visual observation considering the means of time (minutes) of grazing, rumination, and resting, respectively: 127 vs. 137; 122 vs. 113; and 238 vs. 216 in ICL system and; 134 vs. 103; 130 vs. 165 and 233 vs. 203 in ICLF system. In conclusion, the bioacustic method is a tool that can be useful for evaluating bovine grazing behavior within different grazing systems, with the advantage of allowing report of activities during the night with higher practicality and precision than the visual observation method.(AU)

demographic and clinical characteristics of leprosy in Saudi Arabia

Leprosy is a chronic disease caused by Mycobacterium leprae. Although the occurrence of leprosy has declined in Saudi Arabia, it has not yet been eradicated. To our knowledge, this descriptive retrospective study is the first to assess the clinical presentation of leprosy at the time of diagnosis in Saudi Arabia. All study subjects were leprosy patients admitted to Ibn Sina hospital, the only referral hospital for leprosy in Saudi Arabia, between January 2000 and May 2012. A total of 164 subjects, the majority of whom [65%] were between 21 and 50 years of age, were included, and the male-to-female ratio was 2.8:1. Of these 164 patients, 63% were Saudis, and 77% of all admitted patients were from the western region. Lepromatous leprosy was observed most frequently [33%], and 31% of cases had a positive history of close contact with leprosy. At the time of diagnosis, 84% of all subjects presented with skin manifestation. The prevalence of neurological deficit at the time of diagnosis was 87%. Erythema nodosum leprosum [E.N.L.] developed in only 10% of all subjects. Further studies are needed to determine the clinical characteristics pertaining to each type of leprosy in the region, and training courses in caring for and diagnosing patients with leprosy should be organized for health workers

Implante de conducto apicoaórtico en paciente con estenosis aórtica severa post reemplazo valvular protésico / Apicoaortic valved conduit implanted in a patient with severe aortic stenosis due to mismatched aortic valve prosthesis

Introducción: La estenosis aórtica fibrocálcica es el tipo de valvulopatía más frecuente, especialmente en los adultos mayores, siendo el reemplazo valvular aórtico el tratamiento definitivo. Un mal resultado post operatorio puede deberse a un mal funcionamiento de la válvula protésica. Caso clínico: Paciente de 42 años de edad sometido a reemplazo valvular aórtico por presentar estenosis aórtica severa fibrocálcica en una válvula bicúspide y aorta de pared muy fina. Evoluciona asintomático durante 4 años, al cabo de los cuales y luego de abandonar su tratamiento anticoagulante consulta por disnea y dolor anginoso. Un ecocardiograma muestra estenosis severa de la válvula protésica. Dado los antecedentes de su cirugía previa se decide implantar un conducto de dacrón valvulado ápico-aórtico a través de toracotomía posterolateral izquierda. Evolución post operatoria muy satisfactoria permaneciendo asintomático, con un seguimiento de 15 meses. La recidiva de la estenosis aórtica severa post reemplazo valvular protésico tiene en el bypass ápico-aórtico una excelente alternativa de tratamiento efectivo, especialmente cuando el recambio valvular tradicional implica un alto riesgo quirúrgico.

Introduction: The most frequent surgical procedure of severe left ventricular outflow tract obstruction due to severe aortic stenosis is aortic valve replacement, but there is an alternative and less conventional method described by Cooley used in patients with previous aortic valve replacement and severe aortic wall calcification that bypasses the left ventricular outflow tract through the implant of an apicoaortic valved conduit. Clinical case: We describe the case of 42 years old patient with severe aortic stenosis due to mismatched valve prosthesis previously installed treated by of apicoaortic conduit implanted through left posterolateral thoracotomy.

Adjuvant therapy for old age glioblastoma patients

Since the advent of Temozolomide [TMZ], optimum management for elderly patients with newly diagnosed Glioblastoma [GBM] is still elusive. The object of this study was to clarify outcomes of present management. Long term prospective study. This study was carried out on patients who were treated at the Aseer Central Hospital Abha KSA, Frontier Medical College Abbottabad, Women Medical College Abbottabad and those operated privately between August 2001 and August 2013. This is a long term study of 41 consecutive cases involving patients aged 55 years or more with newly diagnosed GBM. The patients' median age was 61 years [range 55-87 years]. Twenty nine patients underwent resection and rest underwent biopsy. Patients with deep-seated lesions and multifocal lesions [12 patients 29.26%] were preferably biopsied than gross total resection. Eighteen patients [43.90%] were treated with chemotherapy [mostly TMZ] with radiation therapy [RT] and Six [14.63%] with RT alone. Three patients [7.31%] received only palliative care after surgery. New neurological deficits developed in 5 patients [12.19%]. Postoperative hemorrhage occurred in 8 patients [19.51%], all of whom underwent biopsy. Chemotherapy complications occurred in 19.51% [Advanced hematological complications in 14.63%]. The overall median values for progression-free survival and overall survival were 4.5 and 6 months respectively. Younger age, single lesion resection and adjuvant treatment were associated with better overall survival. Only adjuvant treatment was significantly associated with prolonged progression-free survival. With combined therapy containing resection, RT, and chemotherapy, the median progression-free survival and overall survival were 7.5 and 11 months, respectively. The prognosis for GBM worsens with increasing age in elderly patients. When high risk factors are present, resection with adjuvant treatment are associated with prolonged survival but are with associated risks. Advanced age alone should not preclude optimal resection followed by adjuvant radio-chemotherapy

Surgical outcome of thoracic and thoraco-lumbar injuries of the spine: a case for posterior instrumentation

Management of unstable thoracic spine fractures remains controversial. The results of treatment of injuries of the thoracic and thoraco-lumbar spine with neurological involvement have been evaluated. Advantage of pedicle screw fixation are that neural canal dissection is not required and hence potential neural element injury by intracanal instrumentation avoided. To evaluate outcome of pedicle screw fixation and bony fusion for the surgical management of traumatic thoracic and lumbar spine fractures, their respective performance and complication rates. This study was carried out in the Department of Neurosurgery at Assir Central Hospital Abha KSA from January 2003 to December 2004. Twenty one patients with 32 individual vertebral injury levels [T2-L4] treated conservatively or with transpedicular spinal stabilization and bone fusion were evaluated during a 2-year consecutive period. Male: female ratio was 15:6 [2.5:1]. A total of 42 pedicle screws were placed from T2-L4 levels. Fracture healing and radiographic stabilization occurred at an average of 4.8 months after the initial operation. Of the patients treated conservatively, [5]35% showed significant neurological improvement compared to [6] 38% of those treated surgically, but the latter group contained a much higher proportion of incomplete lesions with a far better prognosis. There were no reported cases of hardware failure, loss of reduction, or painful hardware removal. These results provide evidence that with appropriate preoperative radiographic evaluation of pedicular size and orientation using computed tomography, transpedicular instrumentation is a safe and effective alternative in the treatment of unstable thoraco-lumbar [T2-L4] spinal injuries. The place for early operation might be still further restricted

Translation and validation study of the first modified pakistani version of the neck disability index and its revalidation

The purpose of our study was the translation and validation of the Neck Disability Index in our specific cultural background. The Pakistani Urdu version of Neck Disability Index [NDI] was tested for validity and reliability. The Neck Disability Index [NDI] is a valid and reliable tool, designed to measure disability in routine life activities due to neck pain. International standards were followed for the translation strategy comprising forward translations, reconciliation, backward translation and pre-testing steps. The translation of the original questionnaires was performed in accordance with published guidelines and this was adapted to cultural differences in the patient population. These procedures resulted in the Pakistani modified version of the NDI. comparative study. This study was carried out at the Department of Neurosurgery Outdoor Clinics at Benazir Bhurto Shaheed Teaching Hospital Abbottabad from April 2007-March 2009. In the first stage, Fifty five patients [32 men, 23 women] were included over two years period at the Department of Neurosurgery Outdoor Clinics at Benazir Bhutto Shaheed Teaching Hospital Abbottabad attached with Women Medical College Abbottabad. Seventeen patients were suffering from acute phase after a neck sprain, 20 had chronic neck pain and 18 had no neck pain but had other musculoskeletal symptoms. On 3 occasions, the patients completed the Neck Disability Index and other surveys. Levels of sensitivity, test-retest reliability and validity were acceptable. In the next stage, Thirty-eight patients [16 men, 22 women] were included in a study of the modified version, twenty patients with acute neck sprain and 18 with other musculoskeletal symptoms filled out to test the modified version of the Neck Disability Index, which provided a more specific measure of disability due to neck pain. We have accumulated enough evidence to show that the Urdu version of the Neck Disability Index measures disability in activities of daily living in patients with neck pain in a reliable, valid and responsive manner. The questionnaire is considered a useful tool for research and clinical settings in local or international studies since its psychometric properties are comparable with other versions validated in different countries. The Pakistani version of NDI is a reliable and valid instrument to measure psychometric properties and functional status in Pakistani patients suffering from neck disability. Being a simple and fast scale, its use can be recommended in a clinical setting and future outcome studies in Pakistan

Sacroiliac joint syndrome in the differential diagnosis of low back pain and sciatica

Sacroiliac Joint syndrome [SIJS] is an extraspinal cause of low-back and lower-extremity pain that can present in so many different ways. The constellation of symptoms attributed to SIJS includes pain referral to numerous anatomic regions. Specific pain referral zones reported include the Posterior superior Iliac Spine [PSIS],[1] lower Lumbar Region,[2,3,4,5,6,7] Buttock,[3,,4,7,13,14,21] Groin and Medial Thigh [13,21], Posterior Thigh [8,13,14,22] Lower Abdomen [9,14], Calf and foot. To determine the origin of pain of the sacroiliac joint and to differentiate it from pain due to degenerated lumbar disc disease. Long term, prospective study. This study was conducted in the Department of Neurosurgery, Women Medical College, Abbottabad from August 2006 - July 2013. Fifty Three patients who satisfied clinical criteria and demonstrated a positive diagnostic response to sacroiliac joint injections were included in an attempt to solve the dilemma in neurosurgical patients when differentiation between discogenic pain and one origination from sacroiliac joint [Sacroiliac joint syndrome -SIJS] is difficult. Clinical and radiological differentiation were not so remarkable between two conditions and based on these the diagnosis can go either way. Each patients' pre-injection pain description was used to determine areas of pain referral and then sacroiliac joint was blocked by injections to see whether patients are still experiencing the Discogenic pattern of LBP and sciatica. To block sacroiliac joint by injection and then Invoking patients' pain by clinical tests to see the origin of pain. Seventeen men [36.0%] and 36 women [64.0%] were included with a mean age of 42.5 years [range, 20 to 75 yrs] and a mean symptom duration of 18.2 months [range, 1 to 72 months]. Twenty patients [37.73.0%] described buttock pain and 33 patients [62.26%] described lower lumbar pain. Groin pain was described in 7 patients [13.20.0%]. Twenty-five patients [47.16%] described associated lower-extremity pain. Fourteen patients [26.41.0%] described pain distal to the knee, and 6 patients [11.32%] reported foot pain. A statistically significant relationship was identified between pain location and age with younger patients more likely to describe pain distal to the knee. It was possible to identify a patient population consisting 15 patients [28.30%] who were actually suffering from SIJS and their treatment streamlined accordingly. After treating the sacroiliac joint and restoring symmetrical hip rotation, these patients no longer complained of low back pain. Pain referral from the sacroiliac joint does not appear to be limited to the lumbar region and buttock. The variable patterns of pain referral observed may arise for several reasons, including the joint's complex innervation , sclerotomal pain referral, irritation of adjacent structures, and varying locations of injury with the sacroliasjoint

Use of alternative medicine by Saudi liver disease patients attending a tertiary care center: prevalence and attitudes

Complementary alternative medicine [CAM] covers many types of treatments and procedures that are usually not included in conventional medicine and are used in addition to physician-prescribed drugs to "complement" treatment. Although liver disease is prevalent in Saudi Arabia, not much is known about CAM use among Saudi liver disease patients. Thus, this study aimed to assess the prevalence of CAM use in these patients and their attitudes toward it. Patients were recruited randomly from a tertiary care hepatology clinic at King Khalid University Hospital [KKUH], Riyadh, Saudi Arabia from February 4 to March 20, 2012. A four-page questionnaire was used to interview patients. Of all the 232 participants surveyed, 55.6% have used or are using CAM to treat their liver disease with 45.0% of CAM users stating that they believe it has a positive effect on their treatment. Honey was the most used CAM treatment among the participants [39.0%]. Herb use was represented by 31.8% of all users, while 13.5% used bloodletting as a treatment. Cautery was the least used CAM method [3.4%]. Nearly 76.6% of CAM users were satisfied with using alternative treatments to help control their disease. Nearly 69.4% of users and nonusers stated that they believe CAM treatments to have numerous beneficial effects. Nearly 60.5% of CAM users stated that their physician had no knowledge of their CAM use. Of the factors included in linear multivariate regression analysis [including: Age, gender, and family CAM use, among other socioeconomic factors] only family CAM use was considered a significant independent factor affecting participants CAM use [Beta 0.582, 95% CI: 0.372-0.754, P 0.0001]. More than half of the patients have reported CAM use. Overall, more than two-thirds of the entire sample believed that CAM treatments have numerous health benefits

Genetic diversity analysis of Bemisia tabaci populations in Pakistan using RAPD markers

Background: The Bemisia tabaci is one of the most devastating pests of agricultural crops and ornamental plants worldwide. The genetic diversity and biotype status of the Bemisia tabaci in Pakistan was assessed by using random amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR). A total 80 samples of B. tabaci collected from 14 districts of the Punjab province and 7 districts of the Sindh province were included. Results: All 10 primers screened in this study generated 151 scorable amplification products, of which 117 or 77 percent were polymorphic. Pairwise Nei and Li’s similarity had ranged from 0.25 to 0.88 among all individuals analyzed. Based on Nei and Li’s similarity coefficients Bemisia populations were grouped into 3 main clusters and clearly distinguished the non B biotype from the B biotype. Conclusion: The level of similarity among populations of same biotypes was high whereas between populations of non B and B biotypes appeared to be less closely related. This analysis showed that non B biotype is prevalent in both provinces however B biotype is restricted to few locations in Sindh. This monitoring of the spread of B. tabaci in Pakistan will assist in the establishment of appropriate management strategies.

Syzygium aromaticum extracts as good source of betulinic acid and potential anti-breast cancer

Syzygium aromaticum (L.) Merr. & L.M. Perry, Myrtaceae, is an evergreen tree with anticarcinogenic, antimutagenic, aphrodisiac, antimicrobial, antioxidant and antiinflammatory properties. This study aims to investigate the anti-breast cancer effect of extracts from leaves, stem and bark of S. aromaticum and to develop a method for preparation of betulinic acid fraction from the leaves. Betulinic acid, ursolic acid and oleanolic acid contents of the extracts were determined by HPLC. A betulinic acid fraction was prepared by simple crystallization of leaves extract and was characterized by HPLC and mass analysis. Anti-breast cancer effects were studied on MCF-7 and MDA-MB-231 cells. The extracts were found to contain high levels of betulinic acid particularly the leaves extract which contained 17% wt/wt. The betulinic acid fraction contains 75% betulinic acid. Cytotoxicity testing reveals high and selective cytotoxic effect of the stem extract on MCF-7 cells with IC50 33±1.6 µg/mL. Cytotoxic effect of the stem extract was due to activation of apoptotic machinery of cell death. Combination studies of stem extract with tamoxifen reveals antagonistic effect at high concentration of tamoxifen and enhancement effect at low concentration. The selective cytotoxicity of the stem extract of S. aromaticum on MCF-7 is not due to betulinic acid but due to other constituents yet to be discovered.

Troponin I and creatine kinase [MB] as biochemical markers in acute myocardial infarction

Ischemic heart disease is the leading cause of death among adults. Broad based studies that include all ED patients who received an ECG for the evaluation of chest pain syndromes found that 5% of these patients were ultimately diagnosed with acute myocardial infarction [AMI] and an additional 10% had non-AMI acute coronary syndromes [ACS]. Thus, 85% of patients have non-ACS causes for their symptoms. To study the relation between the level of cardiac troponin I and creatine kinase [MB] in Acute Myocardial infarction. The present study was designed to investigate changes in serum cardiac biomarkers in patients with acute myocardial infarction. The present study consists of 61 patients who were admitted to the hospital with acute myocardial infarction. Serum levels of cardiac troponin I [cTnI] and creatine kinase [MB] were determined on day 1 [within24 hours] and the 3rd day after acute myocardial infarction. Serum cardiac biomarkers were compared between day 1 of acute myocardial infarction and the 3rd day after the acute myocardial infarction with healthy subjects [control group]. All measurements were taken through September 2009 to April 2010 in department of medical and molecular biotechnology/ Biotechnology Research Center/ Al-Nahrain university and Ibn Al-Nafees Hospital Department of Clinical Chemistry and Coronary Care Unit. Cardiac troponin I [cTnI] and CK-MB were measured by using microtitre plate ELISA method, absorbance is measured spectrophotometrically at 450 nm. Levels of serum cTnI and CK-MB for smoker patients who suffered from MI and other diseases[diabetes mellitus, and hypertension] [group 4] higher than levels for patients who complained from MI in addition to other diseases[group2], group 2 higher than levels for smoker patients who suffered from MI [group 3] and group 3 higher than levels for patients who complained from only MI [group 1]. Results showed significant [p<0.01] decreases observed for the levels of cTnI in group 4 with group 1 and group 2 with group 1, and significant [p<0.05] decreases in group 4 with group 3. Significant [p<0.05] decreases were observed for the levels of CK-MB in group 4 with group 1. Myocardial infarction patients with diabetes mellitus, hypertension and smoking suffer increase levels of cTnI and CK-MB. This proved that cardiac risk factors increase risk for heart injury. However, such results must be considered during the evaluation of the results of cardiac biomarker in patients of MI

Evaluation of antiangiogenic and antoxidant properties of Parkia speciosa Hassk extracts

Parkia speciosa Hassk is a traditional medicinal plant with strong antioxidant and hypoglycemic properties. This study aims to investigate the total phenolic content, antioxidant, cytotoxic and antiangiogenic effect of eight extracts from P. speciosa empty pods. The extracts were found to contain high levels of total phenols and demonstrated strong antioxidant effect in DPPH scavenging test. In rat aortic rings, P. speciosa extracts significantly inhibited the microvessel outgrowth from aortic tissue explants by more than 50%. The antiangiogenic activity was further confirmed by tube formation on matrigel matrix involving human endothelial cells. Cytotoxic effect was evaluated by XTT test on endothelial cells as a model of angiogenesis versus a panel of human cancer and normal cell lines. Basically the extracts did not show acute cytotoxicity. Morphology examination of endothelial cells indicated induction of autophagy characterized by formation of plenty of cytoplasmic vacuoles. The extracts were found to work by decreasing expression of vascular endothelial growth factor in endothelial cells

Socioeconomic status and impact of treatment on families of children with congenital heart disease

To assess the socioeconomic status, treatment being offered and the impact of congenital heart disease treatment on families. Observational study. The Children's Hospital / Institute of Child Health, Lahore, from 1st March to 31[st] August 2010. All patients undergoing a cardiac surgical or angiographic intervention were enrolled. Socioeconomic status was assessed by Kuppuswamy socioeconomic status scale with income group modification. The impact was measured by the source of financing, effect on family financing source and schooling and health of siblings. Of 211 patients undergoing treatment in the study period, surgery was the definitive treatment in 164 [77.7%] and angiographic intervention in 47 [22.3%] patients. Male to female ratio was 1.5:1. The mean age of the patient was 39.1 +/- 3.2 months [range 01 day to 15 years]. Majority of families belonged to middle [66.4%, n=140] and lower [27%, n=57] socioeconomic class. The mean cost of medicines and disposables was PKR 78378.2 +/- 8845.9 [US$ 933.1 +/- 105.3] in open heart surgery, PKR 12581 +/- 7010.8 [US$ 149.8 +/- 83.5] in closed heart surgery and PKR 69091 +/- 60906 in angiographic interventions. In 63.1% patients, families contributed towards these costs either completely [12.3%] or partly [50.8%] with significant contribution from the hospital. Adverse effect on families ranged from leave without pay to losing jobs or business [46%], and selling their assets [11.3%]. It also affected schooling and health of siblings [22.7% and 26.1% respectively]. Majority of children with congenital heart disease belonged to middle and lower socioeconomic status in this study. Main definitive treatment was surgery. The cost of health care facilities posed a marked socioeconomic burden on those families