Clinical study to evaluate the efficacy of Commiphora muku (Muqil) on thyroid function in hypothyroidism

Background: Hypothyroidism is a common endocrine disorder in which there is deficient production of thyroid hormone. Even though hormone replacement therapy is the mainstay treatment of hypothyroidism, but due to adverse effects on long term use, safe and effective Unani herbal drugs need to be researched. A decrease in serum concentrations of thyroid hormone causes an increased secretion of thyroid stimulating hormone (TSH), thus resulting in elevated serum TSH concentration. Methods: The methods used to determine thyroid dysfunction are still serum thyroid stimulating hormone and the main circulating thyroid hormones thyroxine and triiodothyronine either as total or estimated free concentrations, and it is indeed the improved assay sensitivities and specificities that have made it possible to diagnose these milder forms. TSH, T3 and T4 with safety parameters tests were done before treatment and after completion of treatment in both the groups in order to make the proper diagnosis, to exclude other systemic ailments and to assess the efficacy/safety of the proposed herbal drug. Results: The effects of test drug on lowering the raised serum TSH are attributed to the thyroid activities of the test drug which shoes highly significance p<0.01 before and after intervention. In respect of thyroxin there were no significant results between the test and control group. Conclusions: The study concluded that the efficacy of Commiphora mukul (Muqil) on thyroid function was designed to explore the role of Unani herbal drugs in the management of hypothyroidism on Unani principles is effective, safe and cost effective.

Clinical presentation of hypothyroidism: a study of 50 cases

Background: When the thyroid gland does not produce and release enough thyroid hormone into your circulation, it is known as hypothyroidism. Your metabolism becomes slower as a result. Hypothyroidism, also known as an underactive thyroid, can make you feel exhausted, put-on weight, and have trouble with cold weather. In utero, throughout infancy, during youth, or even during maturity, it may begin to develop. The frequency of unanticipated overt hypothyroidism varies from 1 to 18 cases per thousand persons when accompanied by biochemical and clinical symptoms of hypothyroidism. The aim of the study was to observe the various clinical presentations of hypothyroidism Methods: This cross-sectional observational case-based study was conducted at the institute of nuclear medicine, Dhaka medical college hospital, Dhaka, Bangladesh. The study duration was 6 months, from January 2005 to July 2005. A total of 50 patients attended at the study place during the study period who were biochemically hypothyroid were included in the study. Results: The age range of the patients was 13 months to 54 years with a mean age of 29.5 years in this series. The majority of the patients were between 20 to 49 years of age. Female comprises 80.0% in comparison to 20.0% of male cases of hypothyroidism. Spontaneous primary (idiopathic) hypothyroidism (90.0%), post-radioiodine therapy, and post-ablative hypothyroidism were the most important causes of hypothyroidism in this series. Most typical symptoms and signs of hypothyroidism were found in this study. The most common symptoms were generalized weakness, lethargy, slowness of activities, impairment of memory, loss of scalp hair, somnolence, dry skin, puffiness of the face, constipation, weight gain, hoarseness of voice, swelling of the body, decreased sweating and paraesthesia. Cases of idiopathic hypothyroidism and other types had similar symptoms. The mean duration of symptoms before medical consultation was 2.9 years. Dry and coarse skin topped the list of physical findings and was present in 60.0% of the cases. Other findings in order of frequency include goiter (56.0%), puffiness of the face (38.0%), cold and thick skin (44.0%), thick tongue (24.0%), peripheral edema (24.0%), Anemia (20.0%), pallor of the face (12.0%), bradycardia (08.0%), thick lips (4.0%), ascites (2.0%) and pericardial effusion (2.0%). Conclusions: Although in the present series a limited number of patients were included, it encompassed varieties of cases. Moreover, an attempt was made to evaluate the common presentation, age incidence, sex distribution, and laboratory status of hypothyroidism in our country, giving more emphasis on clinical findings.

Phenotypic Characterisation of Staphylococcus aureus Isolated from Patients in Healthcare Institutions in Zaria Metropolis, Kaduna State, Nigeria

BACKGROUND: Staphylococcus aureus is a cosmopolitan and pathogenic microorganism associated with various diseases spectra and antimicrobial resistance of public health importance.Aim: This study determined the phenotypic characteristics of S. aureus isolated from patients in healthcare institutions in Zaria metropolis.STUDY DESIGN: A cross-sectional hospital-based study was carried out in 5 healthcare institutions. Four hundred and twenty clinical samples were collected and analyzed. RESULTS: Majority of the patients (54.3%) were within the age range 21­40 years and mean age of 26.04 ± 12 years. Approximately, 70% of the respondents had history of antibiotic use prior to consultation in the hospitals and wereselfprescribed, and 91.2% were outpatients. The most commonly abused antibiotics were ampicillin-cloxacillin (19.5%) and cotrimoxazole (10.0%), and the mean duration of their use was 3.5 ± 1.3 days. The detection rate for S. aureus was 10% and 5.2% for MRSA. The S. aureus isolates showed the highest frequency of resistance against ampicillin 42 (100%), followed by penicillin G 39 (92.9%) and least was to gentamicin 5 (11.9%). The frequency of resistance for the MRSA were ampicillin 22 (100%), penicillin G 21(95.5%) and least was to gentamicin 2 (9.1%). The minimum inhibitory concentrations of oxacillin were greater than 128 µg /ml. CONCLUSION: The detection rate of S. aureus and MRSA strains are of great public health concern which requires continuous health education on rational use of antibiotics among others

Expression of TIMP-2 in HPV-16 infected oral squamous cell carcinoma in patients in Iraq

Aim: To determine the expression of tissue inhibitors of metalloproteinases (TIMP-2) in oralsquamous cell carcinoma (OSCC) and the difference in its expression level between positiveand negative HPV-16 (human papilloma virus- 16) OSCC patients. Methods: This study wasconducted on 33 biopsies obtained from patients with OSCC and 10 normal oral mucosa ascontrols. In situ hybridization (ISH) was used to investigate the presence of HPV-16, whileimmunohistochemistry (IHC) was used to estimate the expression level of TIMP-2. Results: TheTIMP-2 was expressed in 27 (81.8%) of OSCC sections with no significant difference betweenits expression level in HPV-16 positive and HPV-16 negative OSCC cases (p=0.058). TIMP-2was found to be highly expressed in OSCC sections, and the presence of HPV was not relatedto its overexpression. Conclusions: The percentage of samples that appeared to accommodatedetectable HPV-16 was high, but no significant difference was observed in relation to TIMP-2expression level. Future studies with a larger number of patients are highly recommended toaddress the possible association between TIMp-2 and OSCC positive HPV-16.

Blister and Bulla Following Snake Bite in Nigeria: A Prospective Cohort Study.

Introduction: Snakebites are a major health problem in several rural areas of tropical countries worldwide. Timely administration of appropriate antivenoms (AV) has been shown to significantly improve outcome. It has been hypothesized that presence of blisters may lead to poor outcome because of potential sequestration of snake venom with gradual systemic absorption. We explore the impact of blisters on outcome of snake bite envenomation. Methods: The study was a prospective cohort, enrolling all snake bite victim reporting to hospital in Febuary-April 2013. Data on demography, type of snake, circumstances of bite, presence or absent of blisters, systemic bleeding, 20min Whole Blood Clotting Time (WBCT), amount of anti-venom needed to restore clotting, and outcomes were recorded. Analyses explored relationship between blister and poor outcome (PO) defined as deaths, gangrene, prolonged Length of Hospital Stay (LOS), amputation, altered consciousness or requiring more than 10mls or 30mls of Echitab or Echitab plus respectively to restore clotting. Results: A total of 128 cases were studied, 101 were males. The mean age of the victims was 25.19 years ±17.51. Carpet viper was the most common responsible snake 89/106(84.0%). Local 84/128(65.6%), systemic bleeding 33/128(25.8%) and non-clotting 20WBCT 100/128(78.1%) were common while amputations 3/128(2.3%), gangrene 5/128(3.9%), altered consciousness 2/128(1.6%) and deaths 4/128(3.1%) were fewer. Blister was present in 42/128(32.8%) which had no relationship with gender (P=.39). Patients with blisters compared to those without blisters had more gangrene 4/42(9.5%) vs 1/86(1.2%) (P=.04), non-clotting 20WBCT 40/42(95.2%) vs 60/86(69.8%) (P<.001) and required more amount of antivenom to restore clotting >10mls (Echitab) or 30mls (Echitab plus) in 8/32(25%) vs 3/57(5.3%) (P=.03). Using Wilcoxon Rank-Sum test patients with blisters had a median LOS of 6.0±2.3 days compared to those without blisters 5.0±3.5 days (P=.02). In a logistic regression adjusting for LOS and systemic bleeding, blister predicted PO with P=.043 (95%CI: 0.110- 0.963). Conclusion: Presence of blister predicts PO (LOS, gangrene and large amount of antivenom needed to restore clotting). Deblistering of blister in snake bite patients may improve outcome. A randomised control trial is recommended to look at the effect of deblistering on outcome among patients with snake bite envenomation.

Diagnostic Accuracy of Imprint Cytology and Frozen Section for CNS Tumor.

The present study was a cross-sectional type of descriptive one carried out with the objective of determining the diagnostic accuracy of imprint cytology and frozen section of central nervous system tumors. A purposively selected sample of 33 clinically diagnosed patients with CNS tumors has been included for the study. The relevant data on CNS tumors were collected by using imprint cytology, frozen section and paraffin section. The sensitivity of imprint cytology was 75.0% and specificity was 55.17% respectively. On the other hand positive predictive value of imprint cytology was 18.75% and negative predictive value was 94.11%. The sensitivity of frozen section was 100% and specificity was 86.21% respectively. Comparing the findings of the frozen section to histopathology, the positive predictive value was 50.0% and negative predictive value was 100%. The sensitivity and specificity of imprint cytology was lower in comparison to frozen section and paraffin section. Still then imprint cytology is preferred, because it can be carried out rapidly and easily. It will also be a very helpful aid especially when facilities for frozen section are limited but neurosurgical-procedure is available. A well designed research with adequate sample size should be carried out to get better diagnostic accuracy of imprint cytology in central nervous system tumors.

Assessment of Thyroid Peroxidase Antibody And Thyroid Stimulating Hormone In First Trimester Of Pregnancy.

Introduction: Maternal thyroid dysfunction during pregnancy has been associated with a number of adverse outcomes, like preterm birth, placental abruption, foetal death and impaired neurological development in the child. Simultaneously the presence of antibody to thyroid peroxidase results miscarriage, preterm birth and maternal post partum thyroid disease. Post partum thyroiditis is closely associated with the presence of antibodies to thyroid peroxidase (TPO). Indeed if a pregnant woman is positive for TPO antibodies early in pregnancy, her chances of developing post partum thyroiditis is 30-52%. Objective: To find out the level of TPO-Ab and thyroid status in first trimester of pregnancy. Method: The cross sectional study was designed in Department of Biochemistry, BSMMU, Dhaka. Following inclusion and exclusion criteria 200 sample was selected by purposive and convenient sampling. The study parameters were- thyroid peroxidase antibody (TPO-Ab); serum thyroid stimulating hormone (TSH); serum free thyroxin (FT4). Results: 43 (21.5%) pregnant women of first trimester was found to be TPO-Ab positive, among these 43 subjects 16 (8.0%) had raised TSH i.e. >2.5 mIU/L and 27 had TSH level <2.5 mIU/L. Low serum FT4 was in 9 (4.5%) subjects. The study revealed that, there was a significant positive correlation between positive TPO-Ab (>12 IU/mL) and serum TSH level of study subjects and there was negative correlation between serum TSH (>2.5 mIU/L) and serum FT4 in study subjects. Conclusion: TPO-Ab positivity in first trimester of pregnancy and TPOAb positivity was associated with higher TSH and low FT4 level.

Newly detected hypertension in an Iranian population: an epidemiological study

Background: Early detection of undiagnosed hypertension may prevent or reduce the onset and progression of many diseases.Objective: To investigate the prevalence of undiagnosed hypertension in an Iranian population and its relation with socio-demographic, anthropometric, and biochemical factors.Methods: Four thousand five hundred nineteen subjects, aged 15-65 years, were eligible for the study. They were entered into the study through the cluster sampling method.Results: The overall prevalence of previously unknown hypertension was 24.2%. It was higher among urban dwellers who were poorly educated, married, and were manual laborers by occupation compared to other groups.Conclusion: Poor literacy status as well socioeconomic conditions may be positively associated with hypertension. Undiagnosed hypertension can be lowered by increasing access to routine blood pressure measurement, pre-employment medical examination, and improvement of the health seeking behavior in these groups.

Pattern of Left Ventricular Geometry in Hypertension: a Study of a Hypertensive Population in Nigeria

Background: Hypertension is a leading cause of cardioxasular morbidity and mortality in Nigeria. The main aim of this study was to deterine the prevalence of left ventricular hypertrophy and left ventricular geometric patterns among hypertensives in Kano; Nigeria. Methods: The study was cross-sectional in design; and carried out in 3 echocardiography laboratories within the City of Kano; Nigeria. Patients with hypertension without other cardiac disorders were serially recruited and studied after obtaining informed consent. Results: A total of 186 patients were studied over 7 months; 89 males (47.9) and 97 females (52.1). The prevalence of left ventricular hypertrophy was 61.8. Thirty five patients (18.8) had normal left ventricular geometry and these were predominantly females and had the lowest mean age and shortest duration of hypertension. Sixty eight patients (36.6) had eccentric hypertrophy; 47 (25.3) had concentric hypertrophy and 36 (19.4) had concentric remodelling. Independent predictors of the various geometric patterns were identified. Conclusion: A high prevalence of left ventricular hypertrophy was observed with eccentric hypertrophy being the most common geometric pattern. Gender influenced the pattern of left ventricular geometry

Migration; Pastoralists; HIV Infection and Access to Care: the Nomadic Fulani of Northern Nigeria

The burden of HIV infection among the nomadic Fulani of northern Nigeria is unknown. Migration - a way of life for this population - is known to increase the rate of HIV transmission and may limit individuals' access to treatment and care. Many of Africa's other traditional; pastoral societies are similarly affected. This paper explores cultural practices and factors among the Fulani that may influence HIV transmission; vulnerability to infection; sustainability and challenges to treatment access; and avenues and models for outreach services; lastly; we proffer some solutions and recommendations. An extensive literature search with cross-referencing was done; and relevant publications on similar themes were reviewed. Three cases of Fulani nomads with HIV are presented to illustrate the challenge of providing a care continuum as well as to demonstrate successes when appropriate HIV interventions are employed. Patient interviews provide valuable insight and information on living and coping with HIV. Community mobility limits opportunities for counselling; testing and diagnosis; as well as HIV-related care access and maintenance. Consanguinity and certain cultural practices among the Fulani have clear amplification potential for HIV transmission. Treatment support through the use of coaches and life partners improves adherence to antiretroviral therapy (ART). Existing programmes for nomads afford opportunities for absorption and integration of HIV services. Nomadic communities should be provided with basic HIV-related services; including risk-reduction education and methods; counselling and testing; ART; medication adherence counselling; access to laboratory tests and health monitoring. These services should be taken to nomadic communities using novel approaches such as mobile units; extension services; case management; directly observed care; and treatment supporters linked to neighbouring health facilities in a hub-and-spoke model. Stronger collaborations are recommended between programmes for nomads and HIV services; and also between veterinary and public health services. Community participation and leadership should be encouraged to ensure the sustainability of HIV-related care delivery. More research is needed on the epidemiology and sociology of HIV infection and the best ways to provide services to hard-to-reach nomadic populations

Chest pain evaluation

Chest pain is one of the frequent complaints in patients presenting to emergency rooms and ambulatory care clinics. For the primary care physician evaluating these patients, there are three essential steps in the evaluation of chest pain. The first step is to determine whether the chest pain is cardiac in origin or not. If the pain is suspected to be cardiac, then the next step would be to determine if the chest pain is secondary to an acute coronary syndrome [acute myocardial infarction or unstable angina] that requires immediate referral to an emergency room to initiate therapy and admit to the hospital. If the pain is not considered to be due to an acute coronary syndrome, then we proceed with a systematic approach to try to determine the likelihood that a particular patient has significant coronary artery disease [CAD]. This is determined based on the patient's history, risk factors and electrocardiogram. Once the likelihood is assessed, this will determine what further invasive or non-invasive tests would be required to complete the patient's evaluation

Prevalence of anti - HCV in blood donors of hazara [NWFP]

Prevalence of hepatitis C in apparently health blood donors of Pakistan ranges from 4% to 9% in various published series. No data is available from northern Pakistan. To address this issue, 90 blood donors including voluntary and professional blood donors from various parts of Hazara, NWFP [North West Frontier Province] were screened for anti-HCV by ELISA. All sample tested negative for anti HCV. The prevalence of anti HCV is nil in our study group

Histomorphological study of indomethacin induced gastrointestinal lesions in rat.

This study was undertaken in Long Evans rat to investigate the effect of a single therapeutic as well as toxic dose of indomethacin on the gastrointestinal mucosa. The effect was studied morphologically six hours after oral administration of the drug. The affected tissue was then examined histologically. The histomorphological evaluation revealed that the drug has induced acute hemorrhagic erosive gastritis in the fasted animals (6 mg/Kg body weight) where as in normally fed (10 mg/kg body weight) rats the small intestinal mucosal inflammation and erosions were predominant.

Some socio-cultural attributes and status inconsistencies among the university academic community in Pakistan

Social scientists, specializing in social stratification have attempted to construct a new variable designaied as consistency inconsistency chaeracteristic by merging traditional status characteristics like income, education and occupation. Research focused on the viability of this new variable as explanatory for stress, mariginality, status striving and the like remains a topic of academic debate. The data have been derived from a representative sample of University teachers. The sample comprised of four status categories of respondents from six established universities in Pakistan. Status inconsistency has been markedly revealed by the two middle categories. Further, irrespective of consistency inconsistency, the university community identifies with Middle Class and expresses a sense of blocked opportunity. Inconsistency though affects job satisfaction and perception of power. An additive and interaction model have been suggested from more reliable conclusions