Synthetic N-[[substitutedsulfamoyl]phenyl]acetamides as moderate chymotrypsin inhibitors

A facile method has been implemented for the synthesis of different N-substituted sulfamoylacetamides by reacting 4-acetamidobenzenesulfonyl chloride [1] with different alkyl/aralkyl/aryl amines [2a-q] in basic aqueous media under controlled pH to afford -[[Substitutedsulfamoyl] phenyl]acetamides [3a-q] which were confirmed through spectral analysis like FT-IR, EIMS and [1]H-NMR. Moreover, the synthesized derivatives were screened against alpha-Chymotrypsin. The enzyme inhibitory results revealed that most of the synthesized compounds were found to be moderate enzyme inhibitors

Down regulation of KLK7 expression in breast tissues and identification of a novel spliced KLK7 mRNA

Background: Alternative splicing commonly occurs in cancer cells and many cancer specific splice variants have been reported as potential candidate biomarkers of the disease. We have studied human tissue Kallikrein 7 (KLK7) mRNA expression profile in breast cancer patients of our region. KLK7 is member of a multi-gene family consisting of 15 members (KLK1-KLK15). Methods: We optimized touch down nested PCR method for the amplification of KLK7 isoforms/variants. Various bioinformatics tools were used for sequence analysis, identification of splicing pattern and prediction of encoded proteins. Results: We observed an unusual splicing event consisting of exon 3 (E3) truncation at 3' end (by 124 nucleotides), exon 4 (E4) exclusion and exon 5 (E5) truncation at 5' end (by 33 nucleotide) in 2 normal breast tissues, one obtained from invasive ductal carcinoma grade II patient and other collected from mammary dysplasia patient. Moreover, 3 other KLK7 mRNAs (KF963190, KF963191, and KF963193) expressed in breast cancer were noticed to exhibit single nucleotide polymorphism (SNPs). Bioinformatic analysis revealed that the alternatively spliced mRNA (KF963192) will potentially encode a truncated and non-functional protein. Similarly although encoded proteins have considerable homology with normal hK7 protein, SNPs seem to cause great variations in pIs, structures and molecular weights of encoded proteins. Conclusions: There is need to further explore the impact of the unique splicing event, SNPs and characterize these population specific mutations and their possible role in the pathogenesis of breast cancer (AU)

Comparison of efficacy of oral fluconazole with intramuscular meglumine antimoniate in treatment of cutaneous leishmaniasis

Objective: To compare the efficacy of oral fluconazole with intramuscular meglumine antimoniate in patients of cutaneous leishmaniasis

Study Design: Randomized Control Trial

Place and Duration of Study: Study was conducted from 1[st] January 2013 to 30[th] June 2013, at Dermatology department, Military Hospital, Rawalpindi

Patients and Methods: Eighty histopathologically diagnosed patients of cutaneous leishmaniasis were selected. Patients were randomly allocated into two groups. Group-A was given oral fluconazole 200mg/day for six weeks. Group-B was given intramuscular meglumine antimoniate 20 mg/kg/day for 21 days. Status of each lesion was regularly documented and efficacy of drugs was measured at the end of three months. The drug was considered efficacious if there is more than 75% regression in size and induration of lesions

Results: Clinical efficacy was seen in 70% [n=28] in Group-A and 92.7% [n=37] in Group-B at end of three months. When compared by Chi-square test, these results were found to be statistically significant with pvalue 0.010[< 0.05]

Conclusion: Efficacy of Intramuscular meglumine antimoniate is better than oral fluconazole in treatment of cutaneous leishmaniasis

Relationship between head posture and lower arch dental crowding

Objective of the study was to determine the relationships between head posture and lower arch crowding. Hundred cases records [lateral cephalograms and casts] were used in this study. Fifty percent were females and fifty percent males. The cases were divided into two groups; crowded and non-crowded. Each group containing 50 cases. The head posture [craniocervical angles- NSL I CVT, NSL I OPT] were measured in the both groups. Data were analyzed using SPSS for Windows version 16.0. The postural variables were calculated as the mean and standard deviation. The independent Student's t-test was used to determine if significant head postural difference exists between the two groups [crowded and non-crowded]. Statistical significance was set as P < 0.05. Out of total 100 patients in which 50 were females and 50 were males. Fifty cases were crowded and 50 were non-crowded. Their age ranged from 12 to 20 years with a mean age 16 +/- 3.2. The mean value for craniocervical angles; NSL/OPT and NSL/CVT were 97.34 and 101.50 respectively in non - crowded group. While the mean value for craniocervical angles; NSL/OPT and NSL I CVT were 106.57 and 111.40 respectively in crowded group. The difference in craniocervical angles [head posture] was statistically significant. It was concluded that extended posture is associated with lower crowded cases

Comparison of nasal patency following submucosal diathermy of inferior turbinate versus inferior turbinectomy

To compare the nasal patency following sub mucosal diathermy [SMD] of inferior turbinate and inferior turbinectomy [IT]. Randomized controlled trial. Department of ENT Combined Military Hospital Rawalpindi. Study was completed in one year from 15[th] September 2009 to 15[th] September 2010. Total 160 patients with symptomatic inferior turbinate hypertrophy were included in the study. Patients were randomly divided into two groups of 80 each using random numbers table. Group A underwent submucosal diathermy [SMD] of inferior turbinate where as Group B underwent inferior turbinectomy [IT]. Post-operative nasal patency was judged after 03 weeks by visual analog scale [VAS]. Both the groups are comparable with respect to age and gender. Post-operative nasal patency is significantly better in group B as compared to group A. IT is a more effective method to improve nasal patency as compared to SMD in case of inferior turbinate hypertrophy

Association between quantitative troponin T levels and angiographic findings in unstable angina and non st elevation myocardial infarction

Background: Patients with elevated Troponin T levels had more complex lesion characteristics in baseline coronary angiogram. Cardiac troponin T positive patients had predominantly multi vessel disease, greater coronary narrowing and frequently complex lesion morphology

Objective: To determine the association between quantitative Troponin T levels and angiographic findings in unstable angina/non ST elevation MI

Patient and Methods: The study population was composed of 210 consecutive patients with clinical diagnosis of unstable angina, admitted at Punjab Institute of Cardiology, Lahore. Samples for troponin T levels were obtained 6-12 hours after the onset of chest pain. Patients were grouped into quartiles according to the level of troponin T measured. Coronary angiography was performed in every patients before discharge. All coronary angiograms were evaluated without knowledge of clinical or Troponin T status

Results: The mean age was 53.3 +/- 10.49. 165[76%] were males. Left main disease [LMD] was present in 13.3% [n=28]. Three vessels, two vessels and single vessel disease was present as 41.4%, 27.1% and 26.7% respectively. Normal coronary angiogram was noted in 4.8%. More than 70% luminal narrowing at least in 1 vessel was present in 95.2% of the patients, 3.3% has calcification, 67.6% has occlusion and 6.2% had visible thrombus as well

Conclusion: Our study has demonstrated that there was a significant association between elevated quantitative Troponin T levels and number of diseased vessels. Therefore, Troponin T positive patients should be evaluated by coronary angiography to know the severity of the disease

Prevalence of long QT syndrome and other cardiac defects in deaf-mute children

Long QT syndrome is considered a fatal disease because of its association with ventricular arrhythmias and sudden cardiac death. Objectives of study were to determine the prevalence of long QT syndrome and other heart diseases, in deaf-mute children. A Cross-sectional descriptive study was conducted at Cholistan special education centre and Cardiology department, Sheikh Zayed hospital Rahim Yar Khan, Pakistan in September 2006. A total of 104 congenitally deaf-mute children were assessed. Height, weight and blood pressure measured, 12-lead electrocardiogram done and QTc calculated using Bazette's formula. Children with prolonged QTc underwent 24-hour ambulatory ECG recording. All were auscultated following complete protocol. A child with murmur was further evaluated with colour Doppler echocardiography. Audiometry was performed on all the children and the result interpreted according to WHO recommendations. Diagnosis of LQTS was based on Revised Schwartz criteria. Out of 104 children, 62 were male with mean age 11.89 yrs. The average systolic and diastolic BP was 97/67 mmHg. Average height was 126 Cm. All children had moderate to severe bilateral sensorineural hearing loss [40-80 dB]. One child had associated Patent Ductus Arteriosis. Fifteen had an innocent murmur. Prevalence of congenital heart disease was found to be 0.1/1000. Four children had QT interval more than 440 mSec, [range 0.46-0.47 mSec.]. Both genders were equally affected. Three children had high probability of LQTS and one had intermediate probability. Screening of family of these 4 patients showed prolonged QT interval in the sibling of one patient. Our study highlights the significant prevalence of Jervell Lange-Nielsen Syndrome in Pakistani deaf-mute children, which may be associated to the high level of consanguinity in this region. Awareness of this syndrome among health care providers is needed as timely diagnosis and subsequent treatment may prevent fatal complications.

Dobutamine and exercise echocardiography in the evaluation of known or suspected coronary artery disease: an observational study from single centre

Stress echocardiography has emerged as an important tool for non-invasive assessment of coronary artery disease [CAD]. Exercise and dobutamine stress echocardiography [DSE] are frequently used modalities with distinct clinical indications and procedural variations. We report our findings on these two tests comparing various aspects and outcomes. Four hundred seventy one consecutive patients underwent SE at Sheikh Zayed Hospital Rahim Yar Khan. Exercise Echo [Ex.E] was performed on treadmill using Bruce's protocol. DSE performed in standard method. SE was considered as positive with the appearance of new or worsening wall motion abnormality. Ex.E performed by 300 patients and DSE 171 with mean age of 48.09 and 54.92 respectively. Males were dominant in both groups. The risk factors were almost same in both groups. Ex.E was more performed for diagnosis of CAD than DSE [59% vs 25%]. Viability testing was exclusively done by DSE. Post revascularization status was assessed in 10% and pre-operative assessment for non cardiac surgery in only 2%. Incidence of side effects was 26% in DSE and none in Ex.E. The double product was greater in Ex.E. Positive tests were reported in 43% and 33% in DSE and Ex.E respectively. Stress induced LV dysfunction was more common in DSE. Comparing available coronary angiograms, single vessel disease was better detected by DSE [60% vs 46%]. Double vessel disease was relatively higher in Ex.E [35% vs 28%]. Ex.E is safer and better non invasive diagnostic imaging modality in patients who can perform physical exercise, however DSE is more useful for viability, pre-operative evaluation and patients physically disabled for treadmill or ergometer exercise test

Prevalence of hypomagnesaemia in patients with acute myocardial infarction compared with normal subjects

Background: Magnesium, the second most abundant intracellular cation has several clinically important roles in the human ++ body. In addition to energy production and maintenance of electrolyte balance, Magnesium [Mg] is essential for normal ++ neuromuscular functions, excitation contraction coupling, maintenance of vascular tone, blood coagulation, as well as Ca and +++ K transport across the plasma membrane. Mg has also important role to play in cardiovascular homeostasis

Objectives: To ++ find out serum Mg levels in Acute Myocardial Infarction [AMI] patients at presentation to emergency departments and its comparison with normal subjects

Patients and Methods: This was a comparative study, conducted at Punjab Institute of Cardiology, Lahore from June to December 2000. A total of 125 subjects were enrolled for this study, with 88 patients having their first episode of AMI. These patients were divided into three groups A, B and C depending on age. 37 normal subjects were taken as comparative group

Results: There was hypomagnesemia [p< 0.001] in all the sub groups. Our results show that hypomagnesemia is present in all groups and as it is an important risk factor for post AMI complications. The corrective dose should not be empirical but be based on individual patient requirements, as mortality rate due to AMI and its complications is high

Conclusion: Hypomagnesemia was observed in all the sub groups A, B and C. Therefore, it is suggested that serum Magnesium ++ should be estimated in each case of AMI patient and emphasis given to Mg supplementation when needed

Trends of utilizing medication, recommended by evidence based guidelines, for myocardial infarction, in a tertiary care hospital, "too far but not too dark"

Background: acute myocardial infarction [MI] is a major health problem with a substantial mortality and morbidity. Numerous guidelines have been established that should be followed in the management of acute MI

Objective: to determine whether the current practice in managing patients admitted with acute MI in a tertiary care hospital is evidence based compliant

Patients and Methods: this retrospective study was based on the record of the patients with diagnosis ofMI admittedbetween January to June 2007, at Sheikh Zayed Hospital, Rahim Yar Khan, who fulfilled the predefined criteria

Results: Total number of cases were 58, mean age of the study subjects was 47+ 8.65 years, with age range of 16 to 95 years. It was observed that 81% of study subjects were male. Half of the patients belonged to lower income group; Laborer and house wives were 3 1 % and 19% respectively. Sixteen percent of patients were hypertensive and diabetic. 19 % were smoker and 5% had family history of coronary artery disease. Anterior and inferior wall MI were reported in 64% and 32% of the patients, respectively. Injection Streptokinase [SK] was given to 52% of the patients. Aspirin, clopidogril and nitrates were given to all patients, whereas 34 % and 36% were prescribed Beta blocker [BB] and statins, respectively. Angiotensin converting enzyme inhibitor [ACEI] was given in 43% patients

Conclusion: SK, the only means of acute revascularization was given in only 52% patients mainly due to delayed presentation. Use ofAspirin is an unbeatable target and given to all patients. Use of BB and statins in < 40% and ACEI in<50% is not optimal. However, these trends of cardiac medication in a tertiary care hospital with limited provision, reflects the diffusion of light of evidence based medicine into darkness of periphery

Dobutamine stress echocardiography implications, feasibility and initial experience

Dobutamine Stress Echocardiography [DSE] is a relative and recent development with promising results in evaluation of CAD, viable myocardium and pre-operative assessment for non-cardiac surgery. We performed DSE on 100 consecutive patients with mean age of 51.83 years [range 30-90 years], male: female ratio of 2:1. Two third patients were unable to perform exercise due to various medical reasons, remaining had orthopedic limitation or debility. 76 percent were evaluated for coronary artery disease [CAD], 16 percent for viabilty study, 8 percent for post CABG evaluation. New regional wall motion abnormality or worsening of existing abnormality at rest was considered positive for test. Biphasic response [improvement at low dose and worsening at peak dose] was the most specific indicator for viability. Test stopped due to positive ischemic response in 5.1 percent patients. 49 percent were negative. One third had minor side effects. Most patients for viability study showed biphasic response, only few revealed persistent improvement with peak dose. In CABG, all grafts were patent, however native disease was detected. Excellent correlation observed with few available coronary angiograms. In conclusion DSE is safe, feasible, cost effective, comparable modality -for evaluation of suspect or known CAD and viable myocardium

Clinical and echocardiographic profile of rheumatic mitral stenosis in a rural based population survey

Mitral stenosis [MS] is the leading cause of morbidity and mortality among rheumatic valvular heart disease. Its incidence and clinical pattern has been described in hospital/school based data. We present the full spectrum of rheumatic MS in rural population sample of all ages and various ethnic groups from southern Punjab, Rahim Yar Khan. Study was conducted in 11 villages, randomly selected using scientific sampling technique for prevalence and pattern of RHD. Among 54 cases with RHD more than half were suffering from MS [total 30, isolated 13, and mixed 17] giving an overall prevalence of 3.15/1000. Females had significant preponderance over males. Juvenile MS occurred in 25 percent. Dyspnoea was the commonest symptom. Among abnormal ECG's, 25 percent had AF, 48 percent LAE, 25 percent RVH. Echo/Doppler studies revealed mild MS [53 percent], moderate 30 percent and severe 17 percent. Subvalvular disease and calcification in 16 percent, thrombus 3 percent and vegetation in 2 percent. This study concludes MS being the commonest rheumatic valvular disease, affecting majority of female patients in milder/asymptomatic form that can only be detected through cross-sectional survey

Prevalence of hyperuricaemia in clinical cases at Bahawalpur

A total of 184 patients were examined for their blood uric acid level. Sixty two [33.69%] were found to be hyperuricemic while none was found to be hypouricemic. Analysis of the results indicated a higher risk of hyperuricemia in patients, in age group of 30 and above especially females and those with O blood group. The prevalence of hyperuricemia was also higher in patients using a protein-rich diet, being poor with respect to their socio-economic position and those suffering from gout, rheumatic fever or liver and kidney diseases

Effect of priming treatments on germination of Acacia nilotica seeds

Acacia nilotica seeds have been tested for their germination performance at 37°C and at room temperature before and after priming treatments at 20°C using either pure distilled water or solution of PEG-6000, CaCO[3], and NaCl for 20 days. Untreated controls showed weak germination profiles while priming in water proved to be the most effective in increasing the germination performance of these seeds. However, even this treatment could not increase the germination percentage of these seeds beyond 12.5%. We, therfore, conclude that although priming affects the total number of seeds germinated and spread of germination of Acacia nilotica seeds, it alone is unable to generate any dramatic change in the germination performance of these seeds