Chemicals Constituents from Leaves of Diospyros iturensis (Gürke) Letouzey & F. White and their Biological Activities

he chemical investigation of the methanolic crude extract of leaves of Diospyros iturensis gave us 15 known secondary metabolites identified as mixture of α-amyrenone (1) and β-amyrenone (2), β-amyrin (3), mixture of β-sitosterol (4) and stigmasterol (5), betulin (6), uvaol (7), betulinic acid (8), ursolic acid (9), corosolic acid (10), actinidic acid (11),11-O-p-hydroxybenzoylbergenin (12), bergenin (13) and mixture of stigmasterol glucoside (14) and β-sitosterol glucoside (15) respectively. The structures of secondary metabolites were elucidated with the help of NMR and mass spectral data and by comparison of their spectral data with literature.Among the fifteen isolated compounds, four compounds were identified for the first time in Diospyros genus.These included uvaol (7), corosolic acid (10), actinidic acid (11) and 11-O-p-hydroxybenzoylbergenin (12).Crude methanolic extract of leaves and four isolated compounds including betulin (6), betulinic acid (8), 11-O-p-hydroxybenzoylbergenin (12) and bergenin (13) were evaluated for their antiproliferative activity against two cancer cell lines CAL-27 and NCI-H460 by the MTT assay, antioxidant potential and inhibitory activity against the lipoxygenase and urease enzymes, respectively. The results indicated that the methanolic crude extract of leaves exhibited moderate antioxidant activity and was inactive against the two cancer cell lines. Betulin (6),11-O-p-hydroxybenzoylbergenin (12) and bergenin (13) exhibited moderate antioxidant and lipoxygenase inhibition with IC 50 = 65.8, 85.6, 82.5 µM and IC50 = 58.5, 95.2, 76.2 µM, respectively. Furthermore, 11-O-p-hydroxybenzoylbergenin (12) and bergenin (13) exhibited moderate urease inhibition activity with IC50 values of 45.6 µM and 49.8 µM, respectively.

Chemicals Constituents from Leaves of Diospyros iturensis (Gürke) Letouzey & F. White and their Biological Activities

he chemical investigation of the methanolic crude extract of leaves of Diospyros iturensis gave us 15 known secondary metabolites identified as mixture of α-amyrenone (1) and β-amyrenone (2), β-amyrin (3), mixture of β-sitosterol (4) and stigmasterol (5), betulin (6), uvaol (7), betulinic acid (8), ursolic acid (9), corosolic acid (10), actinidic acid (11),11-O-p-hydroxybenzoylbergenin (12), bergenin (13) and mixture of stigmasterol glucoside (14) and β-sitosterol glucoside (15) respectively. The structures of secondary metabolites were elucidated with the help of NMR and mass spectral data and by comparison of their spectral data with literature.Among the fifteen isolated compounds, four compounds were identified for the first time in Diospyros genus.These included uvaol (7), corosolic acid (10), actinidic acid (11) and 11-O-p-hydroxybenzoylbergenin (12).Crude methanolic extract of leaves and four isolated compounds including betulin (6), betulinic acid (8), 11-O-p-hydroxybenzoylbergenin (12) and bergenin (13) were evaluated for their antiproliferative activity against two cancer cell lines CAL-27 and NCI-H460 by the MTT assay, antioxidant potential and inhibitory activity against the lipoxygenase and urease enzymes, respectively. The results indicated that the methanolic crude extract of leaves exhibited moderate antioxidant activity and was inactive against the two cancer cell lines. Betulin (6),11-O-p-hydroxybenzoylbergenin (12) and bergenin (13) exhibited moderate antioxidant and lipoxygenase inhibition with IC 50 = 65.8, 85.6, 82.5 µM and IC50 = 58.5, 95.2, 76.2 µM, respectively. Furthermore, 11-O-p-hydroxybenzoylbergenin (12) and bergenin (13) exhibited moderate urease inhibition activity with IC50 values of 45.6 µM and 49.8 µM, respectively.

Spectrum of Paediatric Tuberculosis at a Tertiary Care Children`s Hospital in Kashmir: A Prospective Study

Introduction: Paediatric tuberculosis (TB) accounts for10-15% of all TB with pulmonary TB and extra-pulmonary TBcontributing to 70-80% and 20-30% respectively in children.Incidence of EPTB is on rise as reported in recent studies. Nosuch study on paediatric TB has been conducted in Kashmirvalley before. Current research aimed to study the spectrumof paediatric TB in Kashmir valley and categorize childrentreated for TB into Definite TB, Probable TB, Possible TB andNo TB.Material and Methods: Children with suspected TB aged>1month upto 18 years were prospectively enrolled at atertiary care hospital in Srinagar, Jammu and Kashmir, Indiaover a period of 2 years.Results: overall 136 children received anti-tuberculosistreatment (ATT) which included 78 (57.35%) cases ofpulmonary TB and 58 (42.65%) cases of EPTB. Tubercularmeningitis (TBM) 21 (36.2%) was the most common formof EPTB followed by abdominal tuberculosis 14 (24.13%),tuberculous lymphadenopathy 11(18.96%), tuberculouspleural effusion 9(15.52%) and miliary TB 3(5.2%). A total of60(44%) children had bacteriological evidence of TB (definiteTB), 67 (49.3%) were diagnosed on clinical grounds (ProbableTB) and TB couldn’t be ruled out in 9 (6.7%) cases. Only36 (26.47%) children were <5 year old, 65(47.8%) childrenwere male, 112(82.35%) children were malnourished. BCGscar was present in 95(69.83%) cases and 56 (41.2%) weretuberculin skin test (TST) positive. History of TB contact waspresent in 65(47.8%) cases and none of the child was HIVpositive.Conclusion: Although Extra-pulmonary TB is increasing,Pulmonary TB is still the most common type of paediatric TB.BCG offers some protection against severe forms of TB andYoung children are at increased risk of severe forms of TB.

Titrated oral misoprostol solution versus intravenous oxytocin for augmentation of labour

Objective:To compare the efficacy of titrated oral mis oprostol solution with intravenous oxytocin for augmentation of labour in term primigravidae in active phase of labour with inadequate uterine contractions

Methodology:This randomized control trial was conducted in the department of Gynaecology and Obstetrics, Pakistan Institute of Medical Sciences, Islamabad, over a period of six months from 14-April to 13-October, 2014.A total of 760 [two groups of 380 each] primigravidae, between age 20-39 years, who had completed 37-42 gestational weeks by dates, or by ultrasound scan, with regular contractions and an effaced cervix dilated between 3-4 cm, and who later developed inadequate uterine contractions during the first stage of labour were included in the study. Group A received titrated oral misoprostol solution 200ìg tablet dissolved in 200ml tap water and 20ml [20ìg/hour] and group-B was given Intravenous oxytocin [10 units in 1000cc Hartman's solution at 8 drops/minute, doubling every 30 minutes up to a maximum of 64 drops/min for 2 hours]

Results: Mean [+/-SD] age of the patients was 26.4+/-4.4 and 26.6+/-4.6 years in group-A and B respectively. In group-A, 322 patients [84.7%] and in group-B 326 patients [85.8%] were delivered vaginally. Mean [+/-SD] augmentation to delivery interval was 293.82+/-99.36 and 311.65+/-106.73 minutes in group-A and B respectively. Mean [+/-SD] gestational age in group-A was 38.82+/-1.32 and in group-B 38.83+/-1.09 week. Caesarean section was performed in rest of the patients in both groups. There was no significant association between mode of delivery in both groups [P-value= 0.682]

Conclusion:Labour augmentation with titrated oral misoprostol or intravenous oxytocin resulted in about similar rates of vaginal delivery

Prevalence of hypertriglyceridemia and risk factors of ischemic versus hemorrhagic stroke

Objective: To find the prevalence of hypertriglyceridemia in ischemic and hemorrhagic strokes and to assess the risk factors associated with them

Methodology: This cross-sectional study was conducted in Medical OPD/ Emergency, PAF Hospital Mushaf, Sargodha over a period of six months from Nov-2010 to May-2011. All patients of either gender diagnosed as having stroke, with hyper dense or hypo dense area on CT scan brain and of age more than 30 years were included in the study. Patients on anti-hyperlipidemic drugs, with previous history of stroke, having blood disorders, like hemophilia and idiopathic thrombocytopenic purpura and, on warfarin therapy were excluded from the study

Results: 203 patients were enrolled in the study. Out of these 203 patients 138[68%] were males, 65 [32%] were females.127[62.6%] stroke patients had hypertriglyceridemia. In multivariate analysis, hypertriglyceridemia was found to be the only risk factor associated with ischemic stroke adjusting for all the other variables. It was found that patients with hypertriglyceridemia had 3.24 times higher odds of having ischemic stroke [P-value=0.017]

Conclusion: Hypertriglyceridemia was found in majority of the patients with stroke. Furthermore, it was found to be an independent risk factor of ischemic stroke

Association of liver histology with serum ALT levels in patients with chronic hepatitis C

Objective: To evaluate the incidence of liver damage based on grading of necro-inflammatory and fibrotic changes on hepatic cytology in patients suffering chronically with hepatitis C, presenting with alanine transaminase levels in normal ranges

Methodology: A cross-sectional survey was accomplished at department of medicine, PAF Hospital Mushaf, Sargodha for six months of duration from April 2012 to October 2012. 100 cases were evaluated. Liver biopsy was done using large bore sure cut biopsy needle under all aseptic measures after ultrasound marking and sent in 10% formalin for histological studies of inflammation and necrosis. Liver damage was declared for patients having grade 1 or more activity on METAVIR scoring system

Results: Majority of the patients were between 31-40 years of age and lowest age was 20 years. Average age of the patients was 33.2+/-7.4 years. Out of 100 patients, 47 patients [47.0%] were male while remaining 53 patients [53.0%] were females Liver damage was found in 41.0% patients

Conclusion: Liver biopsy should be performed for a clear diagnosis in patients suffering from HCV with alanine transaminase level within the normal ranges. Patients may suffer advanced hepatic disease despite normal levels of hepatic enzymes

Three new anthraquinone derivatives isolated from Symplocos racemosa and their antibiofilm activity / 中国天然药物

Three new alkyl substituted anthraquinone derivatives, trivially named as symploquinones A-C (Compounds 1-3) were isolated from Symplocos racemosa. The structures of these compounds were determined on the basis of extensive spectroscopic analyses (UV, IR, Mass, H- and C-NMR, and two-dimensional (2D) NMR techniques). The resulting data were also compared with the reported literature. These compounds were then subjected to antibacterial or antibiofilm testing. Compounds 1 and 3 exhibited good antibacterial activity in the concentration range of 160-83 μg·mL against Streptococcus mutans, methicillin resistant Staphylococcus aureus and Proteus mirabilis. Both compounds were further screened for anti-biofilm activity, which revealed promising activities at sub-MIC concentrations. None of the compounds were found to be active against Klebsiella pneumoniae.

Hypertriglyceridemia in patients with type II diabetes Mellitus

Objective:To determine the frequency of type II diabetic patients with hypertriglyceridemia

Materials and Methods:This was a cross sectional study carried out at medical unit, PAF Hospital Mushaf, Sarghoda from 19th January 2013 to 18th July 2013. A total of 200 patients of either gender having age >30 years with type II diabetes either controlled or uncontrolled for at least 5 years were enrolled in the study. Patients on anti-hyperlipidemic drug, with history of ischemic heart disease, nephrotic syndrome, hypothyroidism and type I diabetes mellitus were excluded from the study

Results: Mean [+/-SD] age of enrolled participants was 53.25 [+/-7.5] years. 86 [43%] were males and 114 [57%] were females. Mean [+/-SD] fasting blood sugar level was 135 [+/-23.04] mg/dl and random blood sugar was 205.62 [+/-31.87] mg/dl. Mean [+/-SD] duration of diabetes was 6.69 [+/-1.87] years. Out of 200 patients of type II diabetes, 102 [51%] had hypertriglyceridemia out of which majority [63.7%] of patients had uncontrolled diabetes

Conclusions:The frequency of type II diabetic patients with hypertriglyceridemia is found to be 51% with majority having uncontrolled diabetes

Effect of Lactobacillus species on Streptococcus mutans Biofilm formation

Streptococcus mutans is the primary pathogen responsible for initiating dental caries and decay

The presence of sucrose, stimulates S. mutans to produce insoluble glucans to form oral biofilm also known as dental plaque to initiate caries lesion

The GtfB and LuxS genes of S. mutans are responsible for formation and maturation of biofilm. Lactobacillus species as probiotic can reduces the count of S. mutans. In this study effect of different Lactobacillus species against the formation of S. mutans biofilm was observed

Growing biofilm in the presence of sucrose was detected using 96 well microtiter plate crystal violet assay and biofilm formation by S. mutans in the presence of Lactobacillus was detected. Gene expression of biofilm forming genes [GtfB and LuxS] was quantified through Real-time PCR

All strains of Lactobacillus potently reduced the formation of S. mutans biofilm whereas Lactobacillus acidophilus reduced the genetic expression by 60-80%

Therefore, probiotic Lactobacillus species can be used as an alternative instead of antibiotics to decrease the chance of dental caries by reducing the count of S. mutans and their gene expression to maintain good oral health.

Back pain - are health care undergraduates at risk?

To study the prevalence of low back pain in medical and nursing undergraduate students in our institutes and its association with physical activity, smoking, depression, use of computer and other variables. It was a comparative cross sectional study carried out at two institutes of Dow University of Health Sciences, Karachi, Pakistan during October to December 2011. Two hundred and fifteen undergraduate students representing different semesters were asked to fill out the structured questionnaire. Back pain was assessed in terms of lifetime one year and point prevalence. Bivariate analysis was done to study the relationship between back pain and different variables; including gender, study program, smoking, computer use, depression and level of physical activity. Both the groups were compared for duration/ intensity of pain, seeking medical advice and duration of computer use. There were 183 undergraduate students who completed the questionnaire for back pain. Mean age was 22.84 [SD +/- 5.85] years. Gender distribution was nearly equal [females = 51.4%]. Life time prevalence was 57.9% [72% in medical students; 41% in nursing students]. Medical students were 0.47 times more at risk of having back pain [95% CI 0.15-1.48; P=0.198]. Smoking [OD=0.39, 95% CI 0.04-3.6; P=0.001] and use of laptop [OD=4.9; 95% CI 1.2-19.2; P=0.031] were found to be associated with increased prevalence of back pain. Nursing students sought medical opinion more as compared to medical students but it was not significant. However duration of computer use was more in medical students which was significant [P=0.03]. High lifetime prevalence of back pain was observed in undergraduate students. Medical students appeared to be more at risk. Preventive measures are required to improve the quality of life in future health care professionals

Constipation as a complication of pica

Pica is a common eating disorder in children and pregnant women involving repeated or chronic ingestion of non-nutritive substances. We report a case of a three-year-old boy who was admitted in a local hospital for chronic constipation. The child was a known case of constipation and was on laxatives. Our initial suspicion was of chronic constipation but on further investigation, the X-ray abdomen showed tiny rod shaped shiny substances

Diagnostic accuracy of alvarado score in the diagnosis of acute appendicitis

To determine the diagnostic accuracy of Alvarado score in the diagnosis of acute appendicitis. Study was conducted in Surgical Ward 5, Pakistan Institute of Medical Sciences Islamabad. Duration of study was Six month from December 2006 to June 2007. Hundred consecutive patients which presented to our surgical team with acute appendicitis were assessed prospectively using Alvarado score. They were given specific scores according to the variable and divided into two groups, group one [score >7] group two [score <7]. All patients were operated irrespective of score, if clinical diagnosis of acute appendicitis was made. Postoperatively, diagnosis was confirmed by histopathology report. Validity of scoring system was assessed by calculating sensitivity, specificity and positive predictive value. Total 100 patients were included in the study, which included 65 males and 35 females, at score >7, appendicitis was confirmed in 53/54 patients, while at scores <7 appendicitis was confirmed in 38/46 patients. The sensitivity was 58.2%, specificity was 88.9% and positive predictive value was 98.1%. Clinical experience remains of major importance in diagnosing acute appendicitis. The Alvarado score is a simple, easy scoring system at both end of scale

Role of distal protection device in prevention of distal embolization during PCI of saphenous vein grafts at AFIC/NIHD; an experience of 26 cases

Failure of Saphenous vein grafts [SVG], an almost universally used conduit in coronary artery bypass grafting [CABG] patients, is a common problem. Distal embolization during percutaneous coronary intervention [PCI] of SVG can have serious consequences. Use of embolization protection devices [EPD] has resulted in lesser incidence of such complications. Spider Rx is a distal protection filter device, experience and results of use of this device are presented. This study was conducted at the interventional cardiology department of Armed Forces Institute of Cardiology National Institute of Heart Diseases during a period from Feb 2007 to May 2009. All patients having indications for PCI, angina CCS class I to IV, to vein grafts more than three years after CABG was included. Patients with acute myocardial infarction and totally occluded SVGs were excluded. No flow or slow flow phenomenon and pre and post procedure CKMB, at six and twenty four hours, levels were measured. Spider RX distal embolization protection is easy to use and its use resulted in embolization protection comparable to that of other devices reported in literature

Sentinel lymph node biopsy in breast cancer by using isosulfan blue

To determine the sensitivity of sentinel node involvement by breast cancer in case of clinically axillary lymph node negative breast cancer. The study was conducted at Pakistan Institute of Medical Sciences, Islamabad in department of general surgery ward 5 from March 2006 to July 2007. Thirty patients with tumor size of either T1 or T2 and clinically negative axillary lymph node were enrolled in this study. These patients were subjected to sentinel lymph node biopsy by blue dye injected in peri-tumor parenchyma then dissection was done to localize sentinel node followed by formal axillary dissection [level II]. The histopathology of sentinel node was compared with axillary lymph node. Sentinel lymph node was successfully localized in all 30 patients [100%]. The sensitivity, specificity, accuracy and false negative rate were 92.8%, 100%, 96.7%, 5.9% respectively. The axilla was metastatic in 14 cases [46.7%], one had negative sentinel lymph node but positive non sentinel lymph node [false negative], and four had sentinel lymph node metastasis alone. Sentinel lymph node biopsy by using blue dye have a high diagnostic accuracy and prevent unnecessary dissection of axilla in majority of patients with early node negative breast carcinoma