Frequencies of acute intra-dialytic complications: a single centre experience

Objective: To determine frequencies of various acute complications in patients undergoing hemodialysis

Study Design: Descriptive cross-sectional study

Place and Duration of Study: Department of Nephrology Military Hospital [MH] Rawalpindi, from Jan 2016 till Mar 2016

Material and Methods: A total of 150 patients who underwent haemodialysis at MH were enrolled in the study after informed consent on justification of inclusion and exclusion criteria. The patients were evaluated for the frequency of various intra-dialytic complications and data were analysed using SPSS version 19

Results: Out of the 150 enrolled patients, males were 125 [83.33%] and females were 25 [16.67%]. A total of 2520 haemodialysis session were performed. Hypotension was the most frequently observed complication during 318 [12.62%] dialysis sessions, followed by hypertension in 208 [8.25%] and fever in 193 [7.66%] sessions. Other complications were muscle cramps in 116 [4.60%], shivering in 94 [3.73%], headache in 70 [2.78%], nausea/vomiting 60 [2.38%], itching 41 [1.62%], chest pain 37 [1.47%], hypoglycaemia 31 [1.23%], seizures 23 [0.91%] and arrhythmias in 13 [0.52%] dialysis sessions

Conclusion: Haemodialysis, one of the renal replacement therapies, is a life-saving treatment modality but it is not without complications despite the advances in technology. However frequency with which they occur is low and majority are not life threatening

Phytochemical screening and assessment of analgesic, anti-inflammatory and hematological properties of the fruit of Berberis baluchistanica

Traditionally Berberis species have been used as anti-inflammatory, anti-rheumatic, analgesic and anti-anemic drugs. This study was aimed to determine chemical constituents and to assess analgesic, anti-inflammatory and hematological effects of the crude extract of the berries of Berberis baluchistanica to verify these folkloric claims. Phytochemical screening, carried out by using different chemical reagents and techniques like Thin Layer Chromatography [TLC] and Fourier Transform Infra-Red [FTIR] indicated presence of flavonoids, saponins, phytosterols and carbohydrates including reducing sugars. Analgesic and anti-inflammatory activities were assessed on mice by using acetic acid induced writhing method and formalin method. Potent anti-inflammatory and analgesic effects were observed during these experiments. The extract also showed anti anemic effect as it increased the levels of hemoglobin and red blood cells significantly. Increase in the platelet count was also noted. The extract of the berries was used at oral doses of 300 and 500 mg/kg during experiments. Anti-inflammatory and analgesic activities were determined by comparing with the standard i.e. aspirin 300 mg/kg. Both doses produced significant anti-inflammatory and analgesic activities at P-0.05. These activities were seemingly attributable to flavonoid and saponin contents of the drug. These results justify the folkloric claims that the drug could be used as good anti-inflammatory, antirehumatic, analgesic and anti-anemic drug. However, further chemical investigations on the drug are suggested for isolation and identification of compounds that could be safer and more effective than the currently available medicines in treating these disorders

Frequency of post dural puncture headache in patients undergoing elective cesarean section under spinal anesthesia with median versus paramedian approach

Objective: Post dural puncture headache [PDPH] is one of major complications of spinal anesthesia. There are two approaches to administer spinal anesthesia i.e. median and paramedian. We conducted this study to compare the frequency of PDPH after spinal anesthesia for cesarean section with median versus paramedian approach using 25 gauge pencil point needle

Methodology: This randomized controlled trial was conducted at Departments of Anesthesiology, Surgical Intensive Care and Pain Management Centre as well as Gynecology and Obstetrics, Peoples University of Medical and Health Sciences, Nawabshah, Benazirabad [Pakistan]. One hundred and twenty females underwent elective cesarean section under spinal anesthesia were enrolled. After informed written consent, the parturients were randomly divided into two equal groups by lottery method; Group A patients received spinal block with median approach and Group B patients received it with paramedian approach. All spinal blocks were performed with 25 gauge pencil point needle. The patients were asked about the presence or absence of headache through Visual Analogue Scale [VAS] in the next 72 hours

Results: In median approach [Group A], 3 patients [5%] had PDPH; whereas in paramediannapproach [Group B] only 1 patient [1.6%] had PDPH. All the patients were of younger age and low parity. They developed PDPH within 24 -48 hours which was of mild to moderate in degree on VAS and relieved by rest, plenty of fluids and simple analgesics containing caffiene in mild case. While strong analgesics and muscle relaxants were added in cases of moderate PDPH. PDPH was relieved within 2-3 days in all cases without any complication. The difference was statistically insignificant [p-value=0.30]

Conclusion: Paramedian approach is better than median approach in terms of reduction in the frequency of PDPH, though the results were statistically insignificant?

Comparison between Captopril and Imidapril in relation to their in vitro effects on tracheal tissue

Objective: To observe two drugs [captopril and imidapril] action on smooth muscle tone of trachea and to facilitate safe and rational use of ACE inhibitors, particularly in patients with chronic obstructive airway disease

Study Design: Comparative controlled in-vitro experimental Study

Place and Duration of Study: This study was conducted at the Pharmacology Department, Army Medical College, Rawalpindi from December 2012 to May 2013

Materials and Method: First the effect of bradykinin acetate on the smooth muscle of trachea has been observed. Cumulative concentration-effect relationship was studied with different concentrations of bradykinin on the smooth muscle starting with 22 micro g to 132 micro g/dl. The method was done again with captopril 10[-5] M concentration and imidapril 10[-5] M respectively. In second set of experiments cumulative concentration-response curves were prepared by increasing concentrations of captopril and imidapril separately with fixed concentration of bradykinin 66 micro g/dl

Results: Dose related vacillating contraction of smooth muscle of trachea is produced by bradykinin. The average value of effect received with 132 micro g/dl of bradykinin in the presence of captopril was 51.33 +/- 2.79 and in the presence of imidapril was 25 +/- 7.26. All these ACE inhibitors displaced the concentration effect curves of bradykinin to left and upward. On comparison among themselves it was observed that imidapril produced least enhancement of tracheal contraction. Similar results were produced by second set of experiments

Conclusion: Imidapril is found to cause least enhancement of contraction caused by bradykinin on tracheal muscle. Further clinical trials may be conducted to establish the differential effects of various clinically used ACE inhibitors on the respiratory passages in hypertensive patients concomitantly suffering from COAD

Framingham risk score in impaired glucose tolerant population: a sub analysis of diabetes prevention and awareness program of Pakistan

Objective: To assess the 10-year risk of coronary artery disease [CAD] in subjects with impaired glucose tolerance [IGT] using Framingham risk score

Methods:Data for this study was collected from Diabetes Prevention and Awareness Program. Primary prevention team visited different primary health care centers, factories, service organizations and offices within Karachi, Pakistan. IGT was diagnosed according to World Health Organization criteria after taking informed consent. Information regarding social-demography, dietary habits and physical activities were obtained by a designed questionnaire on one-to-one based interview. Framingham risk score [FRS] was used to assess risk of developing CAD

Results:A total of 315 subjects with IGT were recruited for the study. Mean age of subjects was 44.1 +/- 9.8 years and mean BMI was 27.3 +/- 5.0 kg/m[2]. Overall, 31.4% of the participants were at risk of having CAD. Males were 6.4 times and hypertensive subjects were 2.44 times more likely to have CAD in next 10 years

Conclusion:According to the findings of the study, male and hypertensive IGT subjects were more likely to develop CAD in next 10 years. Community based awareness programs are needed to educate people regarding healthy lifestyle in order to reduce the risk of IGT and CAD

Tube thoracostomy in penetrating thoracic injuries

Objective: To determine the frequency of tube thoracostomy in penetrating thoracic injuries at a tertiary care hospital

Study design: Cross sectional study

Place and Duration of study: Department of Surgery Unit III, Civil Hospital / Dow University of Health Sciences Karachi, from March 2012 to March 2014

Methodology: All patients who presented with penetrating chest injuries due to firearm, stabs etc were treated according to ATLS protocol. Tube thoracostomy was performed when indicated. Chest tube was passed under local anesthesia

Results: A total of 100 patients included in this study. There were 92 males and 8 females. Mean age of the patients was 30+7.29 year. Mechanism of injuries included gunshot injury [n=62], stabs [n=24] and shrapnel injury [n=14]. Pneumothorax was diagnosed in 39 patients, haemothorax in 35, sucking wound of the chest in 20 patients and major vascular injury in 4 patients. Associated extra thoracic injuries were present in 26 patients. Tube thoracostomy was performed in 78 patients. Twenty-two patients underwent thoracotomy

Conclusions: Majority of patients with penetrating chest injuries were managed by tube thoracostomy. No mortality occurred in this series

Association of SNP rs9939609 in FTO gene with metabolic syndrome in type 2 diabetic subjects, rectruited from a tertiary care unit of Karachi, Pakistan

To determine the association of SNP in FTO gene, rs9939609, with Metabolic Syndrome [MS] in type 2 diabetic subjects at a tertiary care unit of Karachi, Pakistan. We genotyped FTO rs9939609 SNP in 296 patients with type 2 diabetes from the Out Patient Department [OPD] of Baqai Institute of Diabetology and Endocrinology [BIDE]. MS was defined on the basis of International Diabetes Federation [IDF] and National Cholesterol Education program [NCEP]criterion. Association between the rs9939609 SNP and MS was tested through chi-square and Z-tests by using odds ratio [OR] with 95% confidence intervals. The frequency of MS as defined by IDF criterion was significantly higher in female subjects as compared to male subjects [p= 0.006]. Carriers of ? 1 copy of the rs9939609 A allele were significantly more likely to had MS [69.6%] than non-carriers [30.4%], corresponding to a carrier odds ratio [OR] of 0.52 [95% confidence interval [CI] [0.29-0.93], with a similar trend for the ATP III-defined MS."A" allele carriers under dominant model, carry all the criterion of MS more significantly as compared to non-carriers. The FTO rs9939609 SNP was associated with an increased risk for Metabolic Syndrome in type 2 diabetic populations at a tertiary care unit of Karachi, Pakistan

Ciprofloxacin; the frequent use in poultry and its consequences on human health

Fluoroquinolones are bactericidal agents that exhibit AUC/MIC dependent killing. In general, they are effective against Gram-negative organisms and some mycobacteria. Ciprofloxacin is the members of this group and its bactericidal action involves the impeding of enzyme topoisomerase II and IV. In human beings, this drug is recommended for a variety of infections including typhoid fever, chronic bacterial prostatitis, lower respiratory tract infections, skin infections, urinary tract infections, acute exacerbations of chronic bronchitis, complicated intra-abdominal infections, infectious diarrhea, and uncomplicated cervical as well as urethral gonorrhea. The drug is as effective in animals as in humans, and is therefore used in animals as well. According to European health law and National Office of Animal Health [NOAH], UK, the statutory withdrawal period for veterinary medicinal products must not be less than 28 days for meat from poultry. The chicken used for meat purpose usually is of the age between 6 to 8 weeks, therefore the use of the drug must be discontinued by the age of 2 weeks. Whereas the age of chick at which it usually develops indicated diseases, is 3 weeks. In this situation, it is not possible to attain a withdrawal period of 28 days. Based on these observations, ciprofloxacin use may not be recommended in poultry for treatment of diseases as it may cause unnecessary exposure to humans while utilizing poultry meat and may lead to the development of drug resistance

Differences in various biochemical and clinical parameters with respect to family history of non communicable diseases in fourth year MBBS students of Karachi, Pakistan

To observe the differences of various biochemical and clinical parameters with respect to Family History [FH] of Non-communicable Diseases [NCDs] in fourth year Bachelor of Medicine, Bachelor of Surgery [MBBS] students. This observational study was conducted at Baqai Institute of Diabetology and Endocrinology from December 2013 to January 2014. Total 50 medical students from Dow University of Health Sciences [DUHS] participated in the study. Statistical Package for Social Sciences [SPSS] version 13 was used to analyze the data. For cross tabulation and mean comparison z-test and t test were applied. Out of 50 subjects, there were 26 [52%] females. Mean age of the study population was 21.56 +/- 0.90 years. Mean serum cholesterol levels with positive FH of NCDs was significantly higher than negative FH of NCDs [p=0.005]. Mean value of low density lipoprotein [LDL] of positive family history of NCDs was found higher than those with negative FH [p=0.006] being statistically significant. The insulin levels in subjects with positive FH of NCDs were higher than subjects with negative FH of NCDs [p=0.685]. However, serum leptin and plasma renin showed no significant difference with the negative FH of NCDs being higher compared to positive FH of NCDs [p=0.068] and [p=0.884] respectively. However, Waist circumference, Body mass index and central obesity in subjects with positive FH of NCDs shows increasing trend but no statistically significant difference [p > 0.05] was observed. In our study of various biochemical and clinical parameters with respect to FH of NCDs, Serum Cholesterol and LDL levels were observed higher and statistically significant

Complications of onlay and sublay mesh plasty in ventral abdominal hernia repair

Objective: To find out the frequency of seroma, wound infection and wound disruption in patients of ventral abdominal hernia operated with onlay and sublay mesh plasty

Study design: Cross sectional study

Place and Duration of study: Department of General Surgery Dow University of Health Sciences and Civil Hospital Karachi, from January 2010 - December 2014

Methodology: Ventral abdominal hernia patients were selected randomly for the procedure of onlay and sublay mesh plasty. Fifty patients each were operated with either of the techniques. Postoperatively patients were observed for the complications; seroma, wound infection and wound dehiscence. All patients were followed for a period of two weeks

Results: A total of one hundred patients were enrolled. Fifty of them had onlay and fifty underwent sublay mesh plasty for ventral abdominal hernia. There were 18 [18%] males and 82 [82%] females with male to female ratio of 1:4.5. Minimum age was 22 year and maximum 55 year. There were 55 [55%] para umbilical hernia, 14 [14%] umbilical, 14 [14%] epigastric and 17 [17%] incisional hernia. Maximum number of cases of wound infection were noted in onlay mesh plasty group [n=16, 16%] while in sublay group only six [6%] had this complication

Conclusion: Sublay mesh plasty technique for ventral abdominal hernia repair had less frequency of complications

Efficacy of cervical spine mobilization versus peripheral nerve slider techniques [neurodynamics] in cervicobrachial pain syndrome

The objective of this study was to compare the efficacy of cervical spine mobilization versus peripheral nerve slidertechniques [neurodynamics] incervicobrachial pain syndrome. The study design was arandomized interventional study. This study was conducted at the Armed Forces Institute of Rehabilitation Sciences [AFIRM], Rawalpindi from August 2014 to January 2015. Forty patients [n=40] were included by using purposive sampling technique. Patients of Age 30 to 60 years with Radiating neck pain, Limited ROM of neck and Pain persisting for more than 2 months, were included in study. Then randomly divided into two groups, each group contains 20 participants. One group was treated with neck mobilization and other was treated with neurodynamic treatment protocol. Pain and Active Range of Motion [AROM] was measured by Visual analog scale [VAS] and Inclinometer respectively. Neck Disability Index was also used. Patients were assessed before and after six week intervention. Data was analyzed on SPSS 20 and Independent t Test was used to compare the results of two groups. Pain was measured on VAS, the mean of Mobilization and Neurodynamics were [2.0+1.892 vs.4.8+2.397] respectively. There is significant [p<0.05] difference between two groups. There is also significant [p<0.05] difference for Range of Motion between two groups. The mean value for NDI of both groups were [14.5+7.564 vs 26.80+11.484]. It also shows better treatment is mobilization. The results of this comparison between two single interventions indicate that cervical mobilization treatment in neck pain is more useful than anneurodynamic treatment. For daily practice, we can recommend treatment according to the expert guidelines investigated

Evaluation of predictors for severity of dengue fever at the beginning of the disease

To evaluate the predictors of severity of dengue at the beginning of the disease. Prospective and Observational study. This study was conducted at Shan General Hospital and Trauma and General Hospital from July 2010 to 1[st] October 2011. The study was conducted on all patients who were admitted and confirmed to have dengue fever after positive serology on day VI. There was pre-assigned protocol and every predictive marker was given one point. Patients who had > 4 points at the time of presentation had more severe illness and developed more severe complications rather than those who had

Evaluation and comparison of different brands of domperidone tablets available in Karachi, Pakistan

Domperidone is an anti-dopaminergic drug used for the treatment of nausea, vomiting and dyspepsia. It has also been used in Parkinson's disease. In this study, five different brands of Domeperidone tablets were selected from the local market for evaluation of their quality as the local market is occupied of many competitors for a single generic. The evaluation of Domperidone tablets was done using various pharmacopoeial and non-pharmacopoeial tests. All the test results fell within BP specified limits for all the selected brands i.e. the results for Brands A to E for weight variation, thickness and diameter were satisfactory and within limits. For Brands A to E, the results for hardness and friability were also satisfactory i.e. 4-10kg/cm2and 0.1-0.6% respectively. The results for Brands A to E for disintegration were 2-6 minutes; for dissolution and assay, the results were 89-92% and 95-99% respectively. The results of similarity factor [f[2]]also showed that all brands of Domperidone have comparative dissolution profiles

Detection of osteoporosis by dual energy X-ray absorptiometry

An early detection of osteoporosis through DEXA procedure will not only improve the disease management practices but also would help in impeding national productivity losses by mass screening and awareness. Our objective was to measure efficacy of DEXA procedure in early detection of osteoporosis and prevention of its complications. This case series observational study was designed to confirm the bone mineral density by dual energy x-ray absorptiometery [DEXA]. The duration of study was three years from November 2010 to October 2013. Subjects aged between 30 [when the risk of osteoporosis is low] to 60 [when osteoporosis is almost sure to be found]. Three hundred thirty patients were evaluated. There were 23 [6.96%] male and 307 [93.03%] female. Normal male were 09 [39.10%], osteopenia 11 [47.80%] and osteoporosis 3 [13%]. Normal females were 72 [23.50%], osteopenia 140 [45.60%] and osteoporosis 95 [30.90%]. P-value was more then 0.005 and not significant. Mean age was 48.73, minimum 30, maximum 60 and SD 7.247. Population category distribution was 243 [76.6%] from urban and 87 [26.4%] rural. In urban areas normal were 56 [23%], osteopenia 113 [46.50%] and osteoporosis 74 [30.50%]. In rural areas normal 25 [28.70%], osteopenia 38 [43.70%] and osteoporosis 24 [27.60%]. P-value was 0.567. Out of 330 there were 81 [24.54%] normal, 98 [29.69%] osteoporosis and 151 [45.75%] osteopenia. Osteopenia was the most common diagnosis mostly in younger age group and early diagnosis of this problem can help prevent osteoporosis

Truncated type II isopentenyl diphosphate isomerase from hyperthermophilic achaeon thermococcus kodakaraensis implicates the necessity of its N-terminal amino acid residues in protein thermostability

The enzyme isopentenyl diphosphate isomerase [IDI, EC 5.3.3.2] interconverts isopentenyl diphosphate and dimethylallyl diphosphate. We had previously cloned Tk-idi gene encoding the thermostable Tk-IDI enzyme from Thermococcus kodakaraensis KOD1. Four putative start codons were found on Tk-idi gene at 123, 213, 297 and 321 positions downstream of the first start codon. In the present work four mutants were obtained by deleting 123, 213, 297 and 321 nucleotides from the 5'-end of Tk-idi gene to obtain Tk-idim, Tk-idim1, Tk-idim2, and Tk-idim3, respectively. When we tried to express these truncated genes in Escherichia coli only Tk-idim was expressed in the active form. The product, Tk-IDIM, was purified and characterized. The molecular mass of the enzyme, estimated by gel filtration chromatography, was 300 kDa which indicated that the truncated enzyme retained the octameric form. The removal of 41 N-terminal amino acids did not exhibit a significant effect on the enzyme activity however, the thermostability of the enzyme decreased. The decrease in thermostability of Tk-IDIM correlated well with the results of circular dichroism [CD] analysis and structural modeling

Indications and outcome of small and large bowel stomas in emergency intestinal surgery

To evaluate the indications and outcome of small and large bowel stomas made during emergency intestinal surgery. Cross sectional study. Dow University of Health Sciences Civil Hospital Karachi, from January 2006 to December 2012. All emergency exploratory laparotomies performed for intestinal surgery, managed by stoma were included in this study. Decision for making stoma was based upon etiology, condition of the gut and judgment of the operating surgeon. Total numbers of patients were 200 [male 114, female 86] with mean age of 32.7 year. Trauma was the most common etiology. Firearm injury was the commonest mode [n=67, 33.5%] followed by stab wounds and blunt trauma [n= 12, 6.0%]. Patients also presented with perforation leading to peritonitis [n=65, 32.5%] and intestinal obstruction [n=52, 26%]. Tuberculosis was diagnosed in 5 [26.5%] patients, typhoid perforations in 35 [17.5%] and malignancy in 30 [15%] cases. The mortality in this series was 10%. Wound infection occurred in 42 [21%], burst abdomen in 10[5%] and enterocutaneous fistula and stoma retraction noticed in 6 [3%] patients. Stoma formation was a helpful adjunct surgical procedure performed in emergency intestinal surgery for various conditions with satisfactory outcome

Knowledge, attitude and practice [KAP] about malaria among inhabitants of a slum area of Karachi

To assess the KAP regarding malaria among inhabitants of slum area of Karachi. A community based comparative cross sectional study was conducted in a slum area of Karachi i.e. Arafat town, for a period of seven months from Oct 2011 to April 2012. Total 151 inhabitants of Arafat Town were included and interviewed by trained Lady Health Worker using structured questionnaire, comprising of three components i.e. KAP about malaria. Individuals who scored more than 70% were labeled as having satisfactory KAP. Proportions of score regarding KAP were compared with one another and also with demographic variables by using chi-square test. Most of the participants were married female, having mean age of 33.87 +/- 7.5 years. Large proportion [97%] of sample had satisfactory attitude as compared to knowledge [50%] and practice [59%]. Difference in knowledge and practice was found to be significant [p=0.040]. Inhabitants of Arafat Town, had positive attitude towards prevention of malaria, but their levels of knowledge and practice were found to be low, may be due to low literacy rate or poor socioeconomic condition or both. Prompt interventions are required to enhance their knowledge and practice and thus ultimately would reduce the burden of malaria

Effect of Grewia asiatica fruit on Glycemic index and phagocytosis tested in healthy human subjects

The Grewia asiatica [commonly known as Phalsa or Fasla] is a shrub or small tree found in southern Asia. It produces purple to black color fruit when ripe. In folk medicine the edible Grewia asiatica fruit is used in a number of pathological conditions. The current study described the effects of Grewia asiatica fruit on glycemic index [GI] and phagocytosis in healthy non-diabetic human subjects. The results showed that Grewia asiatica fruit has low GI value of 5.34 with modest hypoglycemic activity. Luminol-enhanced chemiluminescence assay was carried out to determine the production of reactive oxygen species [ROS] in the oxidative burst activity of whole blood. ROS production was found to be significantly affected, having the 78.3, 58.6 and 30.8% when the subjects were fed with D-glucose, mixture of D-glucose and Grewia asiatica fruit and Grewia asiatica fruit alone respectively as compared to the control. The aqueous, methanolic and butanolic extracts of Grewia asiatica fruits were found to produce a stimulatory effect on ROS production however; the chloroform, hexane and ethanol-acetate extracted exerted significant inhibitory effect. These results demonstrated that Grewia asiatica fruit has desirable effects on blood glucose metabolism manifested as low glycemic response and modulation of ROS production