Development of a rapid resolution HPLC method for the quantitative determination of sitagliptin in human plasma

A new high performance liquid chromatography [HPLC] method for the quantitative determination of sitagliptin in human plasma was developed and validated for pharmacokinetics study. The plasma was spiked with the internal standard [Salbutamol, IS], extracted with trichloro acetic acid. The extracted analyte was injected into a Symmetry ODS C18 column [250mm×4.5mm, 5m] and the flourometric detector was operated at 267 nm for excitation and 575 nm for emission. The mobile phase consisting of Potassium dihydrogen phosphate buffer pH [4.9]- Acetonitrile Methanol [30:50:20 v/v] at flow rate of 1.0mL/min. The method showed high specificity. Calibration curves of the peak area ratio of each analyte/IS versus sitagliptin concentration were linear in the range of 0.122-31.25 micro g/mL [r>0.989] for plasma and 0.012-25 ug/ml for QC solution[r>0.995]. The lower limit of quantification [LLOQ] was 0.122microg/mL in plasma and 0.012 in QC solution. The intraday and interday coefficient of variation was lower than 10%. The accuracy [relative recovery] at three levels was 100.95%, 101.03% and 97.79% respectively. The extraction recovery was 97.6%, 92.2% and 91.96% at the concentrations of 6.25, 25 and 100microg/mL, respectively. Short term and long term, freeze thaw stability of standard solutions and plasma samples were satisfactory. The optimized HPLC method was validated and proved to be specific, robust and accurate for determination of Sitagliptin in human plasma

Diagnostic accuracy of early ultrasound for congenital anomalies

Detection of fetal anomalies on antenatal scan is very important as it may help the couple to decide whether they want continuation of pregnancy or termination and it also helps them to get the delivery in appropriate settings suitable for the resuscitation and management of the abnormal baby. Early detection even before 20 weeks if reliable may help reduce the anxiety of couple having previous history of congenital anomalies and early management with lesser morbidity

Objective: To find the diagnostic accuracy of 11-14 weeks ultrasound in fetal anomalies detection among high risk women taking 20 weeks scan as gold standard

Study Design: The study adopted a cross-sectional design which consisted of validation

Setting: The study is conducted in -Fatima Ward, Gynaecology and Obstetrics Department, Allied Hospital, Faisalabad” in collaboration with -Allied Hospital, Faisalabad Radiology Department

Duration of Study: Six months after the approval of research proposal

Period: August 2015 to January 2016

Methodology: After the approval of the study by the ethical committee of the Allied Hospital and written informed consent, the cases fulfilling the inclusion criteria were registered through OPD of Allied Hospital, Faisalabad. Patients were counseled and referred to ultrasound department of this same hospital, for trans-abdominal scan. A single operator performed all the scans after obtaining a verbal consent. Ultrasound was done on the Siemens machine using 2.5 - 3.5 MHz probe. To assess the diagnostic accuracy of 11 - 14 weeks scan, for anomaly detection; the screening was done and sensitivity was evaluated; patients were followed by taking contact numbers and a detailed anomaly scan at 20 weeks was done

Results: In our study, out of 611 cases, 22.91%[n=140] were between 18-25 years of age while 77.09%[n=471] were aged between 26-35, with a mean+/-sd value of 28.33+/-3.71 years, the occurrence of fetal anomalies [on gold standard] was documented in 9% presenting [n=55]. However, 91% respondents [n=556] had no morbidity. The Diagnostic precision of 11-14 weeks ultrasound in fetal anomalies detection among high risk women taking 20 weeks scan as gold standard was calculated, it is showing that 7.36%[n=45] had true positive, while 1.80%[n=11] presented a false +ive outcome. 89.20% [n=545] had true -ive and 1.64% [n=10] had false -ive, sensitivity is calculated as 81.80%, specificity is calculated as 98.02%, positive predictive value [PPV] is calculated as 83.35%, negative predictive value [NPV] is calculated as 98.19% and overall accuracy rate is calculated as 96.56%

Conclusion: We finalized that the diagnostic accuracy of 11-14 weeks ultrasound in fetal anomalies detection among high risk women taking 20 weeks scan as gold standard is higher and useful in our population

Detection of Amp-C Beta-Lactamases in Urinary isolates of Escherichia Coli through various Phenotypic methods

Objective: To determine the prevalence of Amp C beta lactamases in urinary isolates of Escherichia coli [E. coli], and to evaluate and compare different phenotypic methods for its detection in a cost effective way

Study Design: Descriptive study

Place and Duration of Study: Department of Microbiology, Combined Military Hospital Lahore Pakistan, from Jan 2016 to Jun 2016

Material and Methods: Modified Three Dimensional Test [M3DT] taken as Gold standard, Modified Hodge Test [MHT] [Cefoxitin], Nitrocephin test and three screening strategies for the detection of Amp C Beta-lactamases were tested on urinary isolates of E. coli collected during a period of 06 months

Results: Modified Hodge Test, was found to be simple, highly specific and sensitive in detecting these enzyme producers. Collectively these tests detected 45.07% of E. coli to be Amp C producers

Conclusion: Each of the three tests can be used as an acceptable phenotypic confirmatory tool when Amp C production in E. coli is suspected

Rising cesarean sections rate

Objective: To identify cesarean section [CS] rate in Bahrain and evaluate the reasons for the rise of CS rate

Design: A Retrospective Cross-Sectional Analysis

Setting: Salmaniya Medical Complex, Kingdom of Bahrain

Method: All CS performed from 1 May 2011 to 31 October 2011 were included

The following patients' characteristics and clinical data were documented: age, nationality, maternal weight, parity, gestational age, number of gestation, birth weight and presentation. In addition to primary or repeat CS, indications of the procedure, uterine incision, type of anesthesia provided and immediate complications were documented

Result: One thousand five hundred thirty-five women had CS. Five hundred fifty-eight CS who had complete data were included in the study. The mean maternal age was 32 years +/- [SD 5.8]. Three hundred seventeen [56.8%] patients were Bahrainis

The mean gestational age was 37.1 weeks +/- [SD 2.7] with a mean neonatal birth weight of 3,012 grams +/- [SD 0.750]

One hundred sixty-one [28.9%] were primiparous and 397 [71.1%] were multiparous. Forty-six [8.2%] were performed for multiple gestations

Two hundred eighty-six [51.3%] were primary CS and 272 [48.7%] were repeat CS

The main indications for the procedure were repeat CS in 176 [31.5%], failure to progress in 104 [18.6%], non-reassuring fetal heart rate in 100 [17.9%] and breech presentation in 80 [14.3%]

Conclusion: CS rate is increasing in Bahrain; more than 30% of deliveries in Bahrain are by CS. Physicians should aim to reduce CS rate by lowering primary CS and allowing trial of scar in patients with previous CS

Rapidly progressive effusive constrictive pericarditis caused by methicillin sensitive staphylococcus aureus [MSSA]

Effusive-constnctive pericarditis is a clinical syndrome characterized by concurrent pericardial effusion and pericardial constriction, where constrictive hemodynamics are persistent after effusion is drained. It may present at any point along the clinical course, from the occurrence of an effusion to the development of chronic pericardial constriction. We refer an unusual case of effusive constrictive pericarditis developing rapidly within days, following purulent pericarditis secondary to chest trauma

Frequency of aspirin resistance in patients with coronory artery disease in Pakistan

Aspirin resistance is an emerging clinical entity. However the data available on aspirin resistance in Asian population is scarce. This study was initiated to prospectively evaluate the frequency of aspirin resistance in patients with stable coronary artery disease [CAD] in Pakistan. A cross sectional prospective study was conducted in cardiology and hematology departments at Shifa International Hospital, Islamabad from January to December 2007. Two hundred and fifty patients were enrolled from cardiology out patient department having met the specific inclusion criteria. Details were entered on a pre-designed questionnaire and aspirin response assay was performed on IMPACT-R [Dia Med AG 1785 Cressier Morat, Switzerland]. Data was analyzed using SPSS V12. Aspirin resistance was observed in 12% of patients. 73.2% of study population were male and 26.8% were female, with a mean age of 57.2 years. There was no significant correlation of aspirin resistance with traditional risk factors like Diabetes Mellitus [DM], Hypertension or Dyslipidemia. 84% of Aspirin non responders were taking 75mg per day and 16% were on 150mg per day. A positive trend was noted between aspirin resistance and cigarette smoking. Aspirin resistance is a real phenomenon in Pakistani population with an estimated frequency of 12%. Large scale prospective randomized trials with long term follow up are needed to assess the impact of different doses and the clinical significance of this biochemical entity

Trends in referral patterns of coronary angiography

This study aimed to document the demographics and trends in referral patterns for coronary angiography in the setting of a tertiary care hospital in Pakistan. The study followed a convenient non-probability sampling design. A non-standardized questionnaire was administered and data analyzed. An exponential increase was noted in coronary angiography procedures from 2000 to 2006. We interviewed a total of 250 patients out of which 71.4% were males falling in the age group 50-59 years. Only a 3rd [30.8%] of patients were referred from their internist, however more than a 3rd [37.7%] came directly to the cardiologist. 47.7% of patients were from Punjab and 31.4% were from Federal capital. Half of the well-educated patients [50.0%] were well aware of the purpose and side effects of coronary angiography in contrast to only 4.8% of the un educated patients. But more than a 3rd of well-educated patients [40.4%] were not well aware or were unaware [17%] of the exact method for the procedure and its possible side effects despite signing and informed consent. Diagnostic coronary angiography is rapidly increasing in most tertiary care hospitals in Pakistan and in more than one third of the patients, direct self-referral was the predominant means of referral. In addition, the level of awareness about the purpose and side effect profile of the procedure was directly proportional to the level of education.