Short term donor outcomes after hepatectomy in living donor liver transplantation

Objective: to determine the outcome of living-donor liver transplant [LDLT] donors from the first liver transplant program in Pakistan

Study Design: cohort study

Place and Duration of Study: shifa International Hospital, Islamabad, from April 2012 to August 2014

Methodology: a total of 100 live donors who underwent hepatectomy were included. Demographics, etiologies, graft characteristics and operative variables were retrospectively assessed. Outcome was assessed based on morbidity and mortality

Results: median donor age was 28 [17 - 45] years and median body mass index [BMI] was 24 kg/m[2] [15 - 36]. Male to female ratio was 1.5:1. Hepatitis B and C were the most common underlying etiologies and accounted for 79/100 [79%] of LDLT's. Overall, 93/100 [93%] donors donated a right lobe graft. Median estimated graft weight to recipient body weight [GW/BW] ratio was 1.03 [0.78 - 2]. Standard arterial anatomy was present in 56% donors. The 90-day morbidity was 13/100 [13%] and overall morbidity was 17/100 [17%]. Bile leak was encountered in 3 [3%] patients. There was no donor Mortality

Conclusion: acceptable short-term donor outcomes were achieved in an LDLT program in Pakistan with careful donor selection and planning

Frame factors for implementation of integrated curriculum in public sector medical college - faculty's perspective

Objective: To prospectively explore the frame factors influencing the planned implementation of integrated curriculum at Allama Iqbal Medical College, Lahore from the faculty's perspective

Study Design: Qualitative exploratory phenomenological design using constructivist approach

Place and Duration of Study: Allama Iqbal Medical College Lahore from Sep to Dec 2014

Material and Methods: Purposive sampling was done and consisted of seventeen teaching faculty members of undergraduate subjects and two qualified medical educationists. Face to face semi structured in-depth interviews were carried out which were audio recorded. The interviews were then transcribed and thematic analysis carried out through manual matrix method and by using software N VIVO 1O. Triangulation of themes, subthemes and nodes was done in the content by relating to their respective frequency of quotes and word cluster. Data verification was done through member checking by second and third authors

Results: The promoting factors were political will, strong leadership, faculty training and development, ownership of new curriculum, teamwork, incentives and communication. The potential impediments to curricular change were fear of the unknown, fixed mindset, faculty resistance due to age and competing agendas. However, to address these impediments besides augmenting promoting factors, piloting of the portion of a curriculum for phase was considered essential

Conclusion: The faculty's perspective in regard to the frame factors influencing the planned implementation of integrated curriculum at public sector medical college yielded new information which will serve as a road map to the intended implementation of integrated curriculum at public sector medical colleges from the year 2017

Prediction of promiscuous T-cell epitopes in the Zika virus polyprotein: An in silico approach

OBJECTIVE@#To predict immunogenic promiscuous T cell epitopes from the polyprotein of the Zika virus using a range of bioinformatics tools. To date, no epitope data are available for the Zika virus in the IEDB database.@*METHODS@#We retrieved nearly 54 full length polyprotein sequences of the Zika virus from the NCBI database belonging to different outbreaks. A consensus sequence was then used to predict the promiscuous T cell epitopes that bind MHC 1 and MHC II alleles using PorPred1 and ProPred immunoinformatic algorithms respectively. The antigenicity predicted score was also calculated for each predicted epitope using the VaxiJen 2.0 tool.@*RESULTS@#By using ProPred1, 23 antigenic epitopes for HLA class I and 48 antigenic epitopes for HLA class II were predicted from the consensus polyprotein sequence of Zika virus. The greatest number of MHC class I binding epitopes were projected within the NS5 (21%), followed by Envelope (17%). For MHC class II, greatest number of predicted epitopes were in NS5 (19%) followed by the Envelope, NS1 and NS2 (17% each). A variety of epitopes with good binding affinity, promiscuity and antigenicity were predicted for both the HLA classes.@*CONCLUSION@#The predicted conserved promiscuous T-cell epitopes examined in this study were reported for the first time and will contribute to the imminent design of Zika virus vaccine candidates, which will be able to induce a broad range of immune responses in a heterogeneous HLA population. However, our results can be verified and employed in future efficacious vaccine formulations only after successful experimental studies.

Prediction of promiscuous T-cell epitopes in the Zika virus polyprotein: An in silico approach

Objective To predict immunogenic promiscuous T cell epitopes from the polyprotein of the Zika virus using a range of bioinformatics tools. To date, no epitope data are available for the Zika virus in the IEDB database. Methods We retrieved nearly 54 full length polyprotein sequences of the Zika virus from the NCBI database belonging to different outbreaks. A consensus sequence was then used to predict the promiscuous T cell epitopes that bind MHC 1 and MHC II alleles using PorPred1 and ProPred immunoinformatic algorithms respectively. The antigenicity predicted score was also calculated for each predicted epitope using the VaxiJen 2.0 tool. Results By using ProPred1, 23 antigenic epitopes for HLA class I and 48 antigenic epitopes for HLA class II were predicted from the consensus polyprotein sequence of Zika virus. The greatest number of MHC class I binding epitopes were projected within the NS5 (21%), followed by Envelope (17%). For MHC class II, greatest number of predicted epitopes were in NS5 (19%) followed by the Envelope, NS1 and NS2 (17% each). A variety of epitopes with good binding affinity, promiscuity and antigenicity were predicted for both the HLA classes. Conclusion The predicted conserved promiscuous T-cell epitopes examined in this study were reported for the first time and will contribute to the imminent design of Zika virus vaccine candidates, which will be able to induce a broad range of immune responses in a heterogeneous HLA population. However, our results can be verified and employed in future efficacious vaccine formulations only after successful experimental studies.

Sliding Amyand's hernia

Amyand's hernia is defined as appendix inside the inguinal hernia sac. It is a rare pathology and literature present over it comprises of case reports or small case series. Diagnosis is difficult and mostly made intraoperatively after opening of the hernial sac, and treatment relies upon the condition of appendix. In this report we share our experience of a case where the caecum and inflamed vermiform appendix were part of boundary of the sac, thus leading us to name it a sliding amyand's hernia

Antibacterial and antifungal activities of leaf extract of Achyranthes aspera [Amaranthaceae] from Pakistan

Alcoholic extract and various fractions of Achyranthes aspera leaves, traditionally used in Pakistan for treatment of infectious diseases was screened for in vitro antibacterial and antifungal activity. The chloroform and butanol fractions were found to be the most active among the fractions, showing considerable antibacterial activity against Shigella flexneri and Escherichia coli. The highest activity was found in the ethylacetate fraction [17 mm zone of inhibition] against gram-negative [Salmonella typhi] bacteria, with MIC value as 0.29 mg/mL. In antifungal screening, moderate activity was shown by the chloroform fraction [50 % inhibition] against Microsporum cams, with MIC value as 0.25mg/mL. Considerable level of antifungal activity was depicted by crude extract, hexane and butanol fractions against Aspergillus flavus and Microsporum canis. The ability of various extracts of Achyranthes aspera to inhibit different strains of fungi and bacteria indicates its potential use for the treatment of microbial infections

Evaluation of anti-inflammatory activity of selected medicinal plants of Khyber Pakhtunkhwa, Pakistan

In present study, the anti-inflammatory potential of three medicinal plants, Xanthium strumarium, Achyranthes aspera and Duchesnea indica were evaluated, using both in vitro and in vivo assays. Carrageenan induced hind paw edema model was used to carry out the in vivo anti-inflammatory activity, while for in vitro screening lipoxygenase inhibition assay was used. Crude extract of all the selected plants depicted significant [p

Screening of selected medicinal plants for their enzyme inhibitory potential - a validation of their ethnopharmacological uses

In present study four medicinal plants namely Valeriana wallichii, Xanthium strumarium, Achyranthes aspera and Duchesnea indica belonging to different families were collected in Khyber Pakhtunkhwa province and crude extract and subsequent fractions were analyzed for their inhibitory potential against acetylcholinesterase, butyrylcholinesterase and alpha-glucosidase enzymes. Valeriana wallichii, Xanthium strumarium and Achyranthes aspera were significantly active against cholinesterases. Chloroform and ethylacetate fractions of Valeriana wallichii exhibited significant activity against acetylcholinesterase [IC50: 61microg/ml] and butyrylcholinesterase enzymes [IC50: 58microg/ml], respectively. Similarly ethylacetate fraction of Achyranthes aspera showed significant activity against acetylcholinesterase [IC50: 61 microg/ml] and butyrylcholinesterase enzymes [IC50: 61 microg/ml], respectively. In case of alpha-glucosidase enzyme, the chloroform fraction of Xanthium strumarium exhibited significant inhibitory activity [IC50: 72 microg/ml] as compared to the standard compound acarbose [IC50: 483 microg/ml]. Duchesnea indica showed no such activities.

Anti-inflammatory activity of the topical preparation of Valeriana wallichii and Achyranthes aspera leaves

In vivo and in vitro screening of anti inflammatory activity of Valeriana wallichii and Achyranthes aspera leaves crude extract was performed, using standardized procedures. Methanolic crude extract topical formulation [cream] of Valeriana wallichii and Achyranthes aspera leaves [Family Valerianaceae and Amaranthaceae respectively], were screened for their anti-inflammatory activity, through "Carrageenan induced hind paw edema" test, for their effect on the acute and chronic phase inflammation models in male Wistar rats. Methanolic extract and its fractions were also evaluated for their in vitro anti-inflammatory activity using lipoxygenase inhibition assay. Leaves of Valeriana wallichii showed significant [p<0.001], dose dependant anti inflammatory activity, comparable with that of the standard, in animal model. The ethyl acetate fraction of Valeriana wallichii also showed considerable [IC 50=73 +/- 0.36] in vitro antiinflammatory activity as compared to standard [6.11 +/- 0.02]. Similarly Achyranthes aspera leaves showed relatively weak [p>0.05] in vivo anti- inflammatory activity. However, its activity was comparable with that of standard at 10% concentration after 5 hrs of carrageenan injection. This activity was present in ethyl acetate fraction during in vitro screening [IC 50=76 +/- 0.14] as compared to that of standard [IC 50=6.11 +/- 0.02]. The combined in vitro and in vivo Antiinflammatory screening shows that the ethyl acetate fraction of the crude extract of Valeriana wallichii and Achyranthes aspera can be used for the isolation of new Anti-inflammatory lead compounds

Metal analysis, phytotoxic, insecticidal and cytotoxic activities of selected medicinal plants of Khyber Pakhtunkhwa

In the present study four medicinal plants traditionally used in Pakistan for treatment of various ailments were evaluated for their heavy metals content, insecticidal, cytotoxic and phytotoxic actions. The metals like Cr, Cu, Zn, Mn, Ni, Pb, Fe and Co were determined in crude extract and various fractions. Soil samples were also tested for heavy metals to determine assimilation of any metal by the plant. Lead, chromium, copper, nickel and cobalt exceeded the permissible limit in most of the tested samples while the concentration of zinc, manganese and iron was within the permissible limit. Chloroform fraction from Achyranthes aspera and ethyl acetate fraction from Duchesnea indica showed significant phytotoxic activities. Crude extract and chloroform fraction from Xanthium strumarium showed insecticidal activity comparable to that of permethrin and thus could be a significant source of natural insecticide. The butanol fraction from X. strumarium showed significant cytotoxicity with LC[50] 1.9306 microg/ml, having mortality rate 93% at highest dose, while the crude extract from Valeriana wallichii showed 90% mortality rate [LC[50] 4.9730 microg/ml] at highest dose. However, the extracts from other plants were not effective against the brine shrimps tested

Antimicrobial and anti-inflammatory activities of leaf extract of Valeriana wallichii DC

Valeriana wallichii DC [Valerianaceae] is one of the most widely used traditional remedies for various complications associated with nervous system and digestion. No antimicrobial and anti-inflammatory studies have so far been carried out on the aerial parts of the plant. The present work was focused to evaluate the antimicrobial [antifungal and antibacterial] and anti-inflammatory properties of Valeriana wallichii using reported methods. Chloroform fraction [VW-2] and hexane fraction [VW-3] exhibited significant activity against Staphylococcus aureus and Bacillus subtilus, respectively. The chloroform fraction [VW-2] showed significant activity against Staphylococcus aureus with 0.27 mg/ml MIC, where 0.31 mg/ml MIC was deduced for hexaune fraction [VW-3] against Bacillus subtilus. Hexaune fraction [VW-3] was also found to be the most potent inhibitor of Microsporum canis, showing 70% inhibition with an MIC value of 0.19 mg/ml. Considerable inhibitory activity was also observed for Chloroform fraction [VW-2] and water fraction [VW-6] against Microsporum canis and Aspergillus flavus. A remarkable anti-inflammatory like activity was observed for the crude extract at a dose of 200 mg/kg at all observed durations. Other doses of the sample also showed excellent activity. Looking to these results it may be concluded that Valeriana wallichii may be a potential source for activity guided isolation of natural products with antimicrobial and anti-inflammatory-like properties

Extrathyroidal uptake from thyroid carcinoma on [99m]Tc-pertechnetate scintigraphy

Three cases of imaging with 99mTc-pertechnetate [[99m]TcO[4]] and unusual positive lymph node uptake in the neck are reported hereby. Two cases were later diagnosed to be well-differentiated thyroid carcinoma, [DTC] with nodal metastasis. The third was a confirmed case of carcinoma thyroid that had presented with mass in the neck soon after surgery, being prepared for ablative dose of radioactive iodine [131]I. All three were young females under 40 years of age. These 3 cases signify that extra thyroidal areas of uptake on a routine thyroid scan with [99m]TcO[4] can some time be due to thyroid carcinoma with regional metastases. Foci of metastasis in patients with DTC may be incidentlly detected with [99m]TcO[4] scan. Multinodular goiter with palpable lymph node should always be investigated for exclusion of malignancy. The patients underwent near total thyroidectomy and radical neck dissection; histopathology confirmed the scan findings

Stratospheric ozone in the perspectives of exploratory data analysis for Pakistan atmospheric regions

In order to study physical behavior of Stratospheric ozone in Pakistan's atmospheric regions [PARs], the Exploratory Data Analysis [EDA] is performed. Using this analysis Probabilistic and mean deviation models are developed to study the ozone layer depletion for Pakistan Atmospheric Regions. These models provided a comprehensive description of the underlying process. The information attained from these forecasts by analyzing these models, can be further employed to vary possible parameters and variables in the physical system to achieve an optimal performance. Such an approach is well explained within the likelihood of computational analysis. The models presented in this paper along with their physical interpretations are very useful for public and private sector organizations

Evaluating anatomical subunit approximation technique for unilateral cleft lip repair

To evaluate the outcome of anatomical subunit approximation in unilateral cleft lip of different severity. Seventy four consecutive patients with cleft lip were seen in the outpatient department of Plastic and Reconstructive Surgery at Hayatabad Medical Complex, Peshawar and Plastic Surgery unit at Said Anwar Medical Centre, Peshawar, from 1[st] June 2007 to 31[st] December 2008. The severity was assessed and all of them were operated using David Fisher's anatomical subunit approximation technique. Postoperatively the vertical height of the lip was compared on the cleft and non cleft side along with symmetry of Cupid's bow and philtral column, the alignment of white roll, quality of the cutaneous lip scar, vermilion fullness and vermilion notching. The nose was evaluated by noting the nasal tip symmetry; alar rim level; alar base height and width; and nostril sill size, both pre and post operatively. Seventy two patients showed adequate vertical height and good nostril size, alar base height. Two patients showed 1.0 mm discrepancy of the vertical height as compared to the non cleft side. These belonged to the severe complete cleft lip category. This technique has shown good results in achieving vertical height and nostril size symmetry especially in incomplete and mild to moderate severity of complete cleft lip

Comparison of Gaussian interpretation of solar mass ejection and ozone layer depletion [old] for active and quite sun periods at atmospheric region of Pakistan

The aim of this paper is to assess the variability in the normality of the process going on at the upper atmosphere. As Sun is the major deriving force of our terrestrial system an investigation of its influence can be correlated by its activity like, solar flare. One of the sample of Solar Flare Duration [SFD] from [1972-2006] have been utilized for estimating its population parameter. Another two samples of low and high solar activity between an interval of [1984-85] and [1980-81 and 1986-87] respectively be used to compare the corresponding ozone column in Dobson Unit, so that influence of solar flare on ozone be assessed. For this purpose the concept of sampling distribution is utilized to find the nearest estimate of mean solar flare duration and respective ozone thickness from the population where it derived. The degree of confidence for different intervals with hypothesis testing has been set-up to access the accuracy of sample statistic. Finally the statistical conclusions have been achieved on the behavior of ozone in response of SFD

Distally based sural fasciocutaneous flap for soft tissue reconstruction of the distal leg, ankle and foot defects

Soft tissue management around the lower third of the leg and foot presents a considerable challenge to the reconstructive plastic surgeon. The options in this region are limited. A durable flap is the preferred option for coverage of such defects. This descriptive study was conducted at Hayatabad Medical Complex and Said Anwar Medical Centre Peshawar over a period of 4 years to evaluate the efficacy of distally based Sural flap in coverage of the lower third of leg, ankle and foot defects, in 25 patients. A descriptive study was conducted at the department of Plastic and Reconstructive Surgery at Hayatabad Medical Complex and Said Anwar Medical centre Peshawar. 25 patients with soft tissue defects over the distal leg and foot were included in this study. Distally based sural fasciocutaneous flap was used for coverage in all cases and its survival, successful coverage of the defect and donor site morbidity studied. Out of 25 flaps, 20 showed complete survival [80%]. Partial flap loss was found in 2 patients [8%], marginal flap necrosis in 2 patients [8%] and complete loss in 1 patient [4%]. The distally based sural flap is a versatile and reliable flap for the coverage of soft tissue defects of the distal lower extremity. The procedure is done as a single stage; the dissection is easy with short operating time and minimal morbidity

Dehiscence of laparatomy wounds in children

To assess the various causes or factors leading to dehiscence of incised surgical wounds of the abdomen in children. The record and charts of all patients who developed dehiscence of the abdominal wounds after operation for various diseases were reviewed and data was collected. The age, sex, timing of surgery, reason for surgery, place of primary surgery, operating experience of surgeon, type of suture material, surgical technique, associated medical conditions, nutritional status and the use of per operative antibiotics were the variables which were analyzed. Different causes of wound dehiscence were assessed and analyzed. During the period of 12 months 22 patients developed wound dehiscence. Age ranged from 3 days to 10 years. There were 13 male and 9 female patients. The reason for primary surgery was: intussusceptions in 2 patients; worm obstruction: 2; colostomy for recto vaginal fistula: 3; colostomy closure: 3; posterior saggital anorectoplasty combined with abdominal approach: 1; abdominal injuries [blunt and penetrating]: 5; enteric perforation: 3; mass abdomen: 2 ; band obstruction and subsequent anastomotic leak: 1. Two patients died during the treatment. 17 patients developed complete burst which was repaired while 5 patients were treated conservatively and developed incisional hernia. Wound dehiscence was commonly seen in patients with abdominal wound infection, peritonitis and malnutrition. Control of infection, correction of anemia and malnutrition along with strict adherence to surgical principles plays a vital role in preventing the dreaded complication of abdominal wound dehiscence

Unilateral blindness as a presenting symptom of lung cancer treated with erlotinib

A non-smoker young man presented to the ophthalmologist with loss of vision in his left eye. Clinical work-up revealed metastatic deposits in left retina. Broadened workup also showed metastatic disease in the skull and brain. The search for the primary concluded on the histopathological evidence of Non-Small Cell Lung Carcinoma [NSCLC] in the upper lobe of the left lung. After the diagnosis and ascertaining disease extent, localized radiotherapy to whole skull and retina was given, followed by conventional chemotherapy [Gemcitabine, Carboplatin]. The results of radiation and chemotherapy were not satisfactory, therefore, patient was placed on a new agent [tyrosine kinase inhibitor] Erlotinib [150 mg per day orally in a single dose]. The response was evaluated using clinical and radiological parameters and was found to be satisfactory

Surgical management of hepatic hydatid cyst in children

To know the effectiveness of removal of hydatid cyst of liver along with pericyst [pericystectomy] as operative treatment, in terms of intra-operative and post-operative complications in the pediatric age group. This study was conducted on paediatric patients with liver hydatid cysts at Department of Paediatric Surgery, Lady Reading Hospital, Peshawar from January 2000 to December 2006. All patients with ultrasound findings for hydatid cyst disease of the liver were included in the study. They were evaluated according to age, clinical presentation, ultrasound and CT scan findings for operative management. After Laparatomy through right transverse incision, half of the contents of the cyst were aspirated, refilled with hypertonic saline solution of the aspirated volume and after waiting for five minutes Pericystectomy was carried out, followed by careful examination and stoppage of any leakage of blood or bile from the residual cavity. In infected cases the cavity was drained. Out of 21 paediatric patients operated for liver hydatid cysts during the study period, 11[52.4%] were girls and 10 [47.6%] were boys, with age ranging from 4 to 15 years. Cystectomy with tube drainage was performed in 20 patients while in one patient de-roofing was performed because of rupture. Hypertonic saline was used as a scoliocidal agent. There was no operative mortality. The mean hospital stay was 6.5+3.8 days. Recurrence after operation was seen in one [4.8%] patient. Hepatic hydatid cysts in children can be treated successfully by peri-cystectomy

Efficacy of combination of ezetimibe and simvastatin versus atorvastatin in reducing low density lipoprotein-cholesterol in male patients of hypercholesterolemia, at Bahawalpur

To see the efficacy of reducing Low-Density Lipoprotein cholesterol [LDL-C] with the combination of Ezetimibe/Simvastatin compared with Atorvastatin monotherapy in the local patients of hypercholesterolemia. This was a single-blind, randomized, uncontrolled, study [6 weeks of active treatment with Step 1 dietary advice and a 3 week wash out period]. Patients with hypercholesterolemia were randomized by an equal allocation to 2 treatment groups: Ezetimibe/Simvastatin [10/10 mg] and Atorvastatin [20mg]. Two hundred and nineteen [219] men came for follow up after 6 week treatment when their lipid levels were compared to those at the start of treatment to calculate the efficacy measures; the percent change from baseline to the end of the 6-week treatment period in LDL-C levels and the percentage of patients who achieved the treatment goals for LDL-C levels after 6 weeks of treatment. LDL-C concentrations [in milligram per deciliter] were calculated by using Friedewald equation. The subjects having Coronary Heart Disease [CHD], Diabetes Mellitus [DM], metabolic syndrome, thyroid disease, chronic renal disease and hepatic disease were excluded from the sample. Mean percentage change from baseline in LDL-cholesterol levels after 6 week treatment with the combination therapy was found significantly superior to that with the monotherapy. There is significant [P<0.01] advantage of the combination therapy over the monotherapy for the achievement of LDL-C levels reductions below the clinical cut off value of 100mg/dl. Combining Ezetimibe with statins looks to be advantageous to the statins alone for LDL-C lowering in patients of hypercholesterolemia