Seroprevalence of Toxoplasma gondii and associated hematological alterations in small ruminants of D.G. Khan district of Southern Punjab, Pakistan / [Soroprevalência de Toxoplasma gondii e alterações hematológicas associadas em pequenos ruminantes no distrito de D.G. Khan no sul de Punjab, Paquistão]

The present study was carried out to evaluate the prevalence and hematological effects of Toxoplasma gondii in sheep and goat in district Dera Ghazi Khan. Blood samples (n=204) were collected comprise goats (n=101) and sheep (n=103) alongwith age, gender and breeds of animals. Samples were collected randomly from 25 flocks of 7 different union council Viz. Vehova, Tibbi Qaisrani, Lakhani, Kohar, Tuman Qaisrani, Nutkani and Kot Qaisrani of Tehsil Taunsa Sharif at least 4 animals from each flock. All ruminants divide into three groups based on age, breed and gender. The prevalence was detected through two different kits Viz. LAT and ELISA kit. The overall prevalence suspected in goats through LAT and ELISA kit was (35.64%), (32.67%) and in sheep was (25.24%), (23.30%) respectively. The Toxoplasma gondii had a significant effect on goats in age groups and non-significant all other groups of goats and sheep. Toxoplasma gondii had a significant effect on all hematological parameters like Hemoglobin, total leukocyte cells, granulocytes, lymphocytes, platelets, and red blood cells, except monocytes. In conclusion of the current study, toxoplasmosis is prevalent among ruminants, reveals the possibility of transmission to humans on the use of host animals as protein source.(AU)

O objetivo do presente estudo foi avaliar a prevalência e efeitos hematológicos de Toxoplasma gondii em ovelhas e cabras no distrito Dera Ghazi Khan. Amostras de sangue (n=204) foram coletadas para incluir cabras (n=101) e ovelhas (n=103), além de idade, gênero e raça dos animais. Amostras foram coletadas aleatoriamente de 25 rebanhos de 7 conselhos sindicais: Vehova, Tibbi Qaisrani, Lakhani, Kohar, Tuman Qaisrani, Nutkani e Kot Qaisrani of Tehsil Taunsa Sharif com pelo menos 4 animais em cada rebanho. Todos os ruminantes foram divididos em três grupos baseados em idade, raça e gênero. A prevalência foi detectada usando dois kits, LAT e ELISA. A prevalência total suspeita em cabras através dos kits LAT e ELISA foi (35.64%), (32.67%) e em ovelhas foi (25.24%), (23.30%) respectivamente. O Toxoplasma gondii teve efeito significativo em cabras em grupos de idade e não significativo em todos os outros grupos de cabras e ovelhas. Toxoplasma gondii teve efeito significativo em todos os parâmetros hematológicos como hemoglobina, células totais de leucócitos, granulócitos, linfócitos, plaquetas e glóbulos vermelhos, exceto monócitos. O presente estudo conclui que toxoplasmose é prevalente entre ruminantes, e revela a possibilidade de transmissão para humanos com o uso de animais hospedeiros como fonte de proteína.(AU)

Study of Profile and Pattern of Information Sought from RTI Applications in a Tertiary Care Teaching Hospital of North India

Introduction: The Right to Information Act 2005 is asignificant development in Indian Democratic fabric. ItProvides a platform for Citizens where they have the right togain access to information which is under Public authority. Theaccess to information under the RTI act 2005 includes a rightto obtain Personal medical information generated within thehospitals and their research projects. The citizens are utilizingthe tool of RTI in health care services which has resulted inimproved care and better management of health centers. ThePresent study was conducted in 794 bedded tertiary careteaching hospital with an aim to find out the profile and patternof applications received through RTI act protocol.Material and Methods: This hospital record basedprospective observational study was carried out in Sherikashmir institute of medical sciences (SKIMS), a tertiary carehospital from October 2016 to February 2018. All the RTIapplications received during the study period were selectedfor the study. The data was collected by an investigator afterscrutiny of received applications and was verified from thedesignated PIO.Results: Among 119 applications, 115 cases (96.6%) weresolved by providing required information Among 115 resolvedRTI applications, majority i.e 47(40.8%) of cases wereresolved between 15-30 days, the process of 46 (40%) RTIapplications was expedited by issuing only one (1) reminderto concerned quarters, 105 cases were concluded at PIO levelwhile 10 applicants appealed to First appellant authority (FAA)which happened to be the Medical superintendent of Hospital,most of the applications were for Policy and Personal section(50, 42.01%), most common subject matter was informationregarding a Hospital staff member (21, 17.64%) and amongthe queries, most were information inquiry (83%, 69.74%).Conclusions: Healthcare personnel must acquire, process,store, retrieve and transfer clinical, administrative andfinancial health information. Privacy and confidentiality areimportant issues and their protection in the fiduciary doctorpatient relationship encourages citizens to seek necessarymedical care and disclosure of information is vital if largerpublic interest is involved.

Juvenile Nasopharyngeal Angiofibroma: A Tertiary Hospital-based Experience.

Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular histologically benign, locally aggressive neoplasm of the nasopharynx. It accounts for 0.5% of all head and neck neoplasms with a high incidence of persistence and recurrence. Modern methods of investigation and ambitious surgical procedures have focused attention on the region of sphenopalatine foramen as the site of origin-based on the observation that larger tumors present as bilobed dumbbell swellings straddling the sphenopalatine foramen, with one component filling the nasopharynx and the other extending out into the pterygopalatine and infratemporal fossae. A prospective and retrospective hospital-based study was conducted in the Dept. of Otorhinolaryngology, Head and Neck Surgery, SMHS Hospital, Srinagar on patients of juvenile nasopharyngeal angiofibroma. A total of 24 cases of juvenile angiofibroma were included in this study.

Descriptive psychiatric profile of patients presenting with overdose in an inner city hospital

Background: The risk faced by elderly people living in Great Britain of accidentally harming themselves by taking potentially lethal mixtures of medicines is high which was found in the survey of 695 people aged between 78 and 86 years old, living in 24 sheltered housing complexes in Scotland. Aim: To find out the profile of patients attending an inner city hospital after taking overdose which would in turn help understanding of the reasoning for overdose. Method: The socio-demographic profile of adults attending the inner city hospital in the United Kingdom was recorded and studied for over dose. It was a retrospective study with recordings from the medical case notes during admission in January 2008 – January 2009 who were brought to the accident and emergency department. Results: Average age of 48.67 years with more number of males (n=17) compared to females (n=13), predominantly White British (76.7%) individuals attempted overdose. Out of the sample studied 86% were found to be deliberate overdose, intent to die was recorded to be present in 63.3%. Multiple reasons for overdose were predominant (40%) which includes relationship difficulties, pain, debts, feeling low / depressed, argument, bereavement and stress. Types of medication for overdose, recording made in medical notes regarding overdose has also been studied. Conclusion: There is a significant psychiatric morbidity among patients who overdose and appropriate psychiatric liaison services are needed to manage patients. Further studies focusing on the patterns of overdose, timing, medication prescriptions and age of patients are necessary to further explore the understanding of overdose. Key message: Older adults attempt suicide with a significant intent to end their lives. Careful consideration is needed when prescribing medication to older adults who suffer from mental health problems.

Sharing information with patients: adverse effects of medications

Introduction: The General Medical Council (GMC) provides information regarding sharing information with patients under Good Medical Practice for health care professionals and suggests that medication and treatment side effects must be explained appropriately. Method: To achieve the aim of this study all Consultants, Specialist Registrars (SpRs), Staff Grades / Associate Specialists (SASGs), Senior House Officers (SHOs) and Foundation doctors were sent postal / e-mail questionnaire to inform regarding side effects information they provide to patients. Results: 110 postal / e-mail questionnaires were sent out for doctors to respond about the information they provide regarding the serious and or common side effects of medication. The investigators received 52 (47.3%) responses which included 25 Consultants, 1 SpR, 4 SASGs, 18 SHOs and 4 Foundation doctors. Clozapine and Lithium stand out to be medications for which most doctors would always provide information about common side effects. It was interesting to note that the common side effect information of anti psychotic medications is provided by less than 60% of doctors. In our study we found that 68% of Consultants tend to always provide information about common side effects and 71% of them always provide information about serious side effects of medications. Due to small number of staff grades and SpRs we cannot comment on comparison but 57% and 67% of SHOs provide information about common and serious side effect of medications respectively. Conclusion: Doctors provide more information to the patients if the medication is Clozapine or Lithium but not for Benzodiazepines. Medication adherence could be increased if the patients are well aware of what to expect when they are on medications. Doctors provide information but are poor in documenting the same and our hypothesis is accepted

Joubert’s Syndrome: A Case Report.

Joubert’s syndrome is an autosomal recessive congenital disorder having characteristic clinical features like hypotonia, ataxia, developmental delay and many neurological problems. Other variable features include retinal dystrophy, cystic kidney disease liver fibrosis etc. Treatment for Joubert syndrome is symptomatic and supportive. Infant stimulation and physical, occupational, and speech therapy may benefit some patients. Infants with abnormal breathing patterns should be monitored.

Posterior interosseous neuropathy during appendicectomy

Intraoperative and anesthesia related radial nerve injuries have been reported in different surgical procedures and various mechanisms proposed for its occurrence. The present case resulted from a procedure of a short duration of 45 minutes. Understanding the pathophysiology of these events and correction of the patient's posture during surgery can prevent such complications

Total leucocyte count, C-reactive protein and neutrophil count: diagnostic aid in acute appendicitis

Acute appendicitis is one of the most common acute intraabdominal affections seen in surgical departments, which can be treated easily if an accurate diagnosis is made in time. Otherwise, delay in diagnosis and treatment can lead to diffuse peritonitis. A study was conducted on 110 patients who were operated for acute appendicitis to determine the role and predictive value of the total leucocyte count [TLC], C-reactive protein [CRP] and percentage of neutrophil count in the diagnosis of acute appendicitis. Preoperative TLC, CRP and percentage of neutrophil count were determined and were compared with the results of the histopathology of the removed appendix. Of all the patients studied, 92 had histopathologically positive appendicitis. The TLC was found to be significantly high in 90 patients who proved to have acute appendicitis, whereas CRP was high in only 88 patients and neutrophil percentage was raised in 91; four had a normal CRP level. Thus, TLC had a sensitivity, specificity and positive predictive value of 97.82%, 55.55% and 91.8%, respectively. CRP had a sensitivity, specificity and positive predictive value of 95.6%, 77.77% and 95.6% respectively. Percentage of neutrophil count had a sensitivity, specificity and positive predictive value of 98.9%, 38.88% and 89.21%, respectively. When used in combination, there was a marked improvement in the specificity and the positive predictive value to 88.04% and 98.7%, respectively. The inflammatory markers, i.e., TLC, CRP and neutrophil count can be helpful in the diagnosis when measured together as this increases their specificity and positive predictive value

Safety in laboratories: Indian scenario

Health and safety in clinical laboratories is becoming an increasingly important subject as a result of emergency of highly infectious diseases such as Hepatitis and HIV. A cross sectional study was carried out to study the safety measures being adopted in clinical laboratories of India. Heads of laboratories of teaching hospitals of India were subjected to a standardized, pretested questionnaire. Response rate was 44.8%. Only 60% of laboratories had person in-charge of safety in laboratory. Seventy three percent of laboratories had safety education program regarding hazards. In 91% of laboratories staff is using protective clothing while working in laboratories. Hazardous material regulations are followed in 78% of laboratories. Regular health check ups are carried among laboratory staff in 43.4% of laboratories. Safety manual is available in 56.5% of laboratories. 73.9% of laboratories are equipped with fire extinguishers. Fume cupboards are provided in 34.7% off laboratories and they are regularly checked in 87.5% of these laboratories. In 78.26% of laboratories suitable measures are taken to minimize formation of aerosols. In 95.6% of laboratories waste is disposed off as per bio-medical waste management handling rules. Laboratory of one private medical college was accredited with NABL and safety parameters were better in that laboratory. Installing safety engineered devices apparently contributes to significant decrease in injuries in laboratories; laboratory safety has to be a part of overall quality assurance programme in hospitals. Accreditation has to be made necessary for all laboratories

prevalence of gestational diabetes in patients attending diabetic clinic at sir Syed hospital

The present study was designed to find the prevalence of gestational Diabetes mellitus [GDM] in patients attending Diabetic Clinic of Sir Syed Hospital from June 2005 to December 2005 with gestational age between 24[th] to 28[th] weeks with or without risk factors. Fifty gm glucose challenge test was used for screening with cut off value of blood glucose > 130 mg/dl [7.2 mmol/L]. Out of 405 women seventy-two women screened positive and 100 gm oral glucose tolerance test was offered and seventeen women were diagnosed as gestational diabetes mellitus. Eight women were classified as impaired glucose tolerance while the gestational diabetes mellitus is more prevalent in high risk groups. The whole method was applied on pregnant female, irrespective of the last meal taken. Age between 20-40 yrs, and avoiding severely ill, and known diabetes

Reference values of common blood chemistry analttes in healthy population of Rawalpindi-Islamabad area

The reference values of common blood chemistry analytes in healthy population, aged newborn to 80 years, of Rawalpindi Islamabad area were determined at AFIP, Rawalpindi. A total of 2115 healthy subjects, 1206 males and 909 females, were included in the study. Plasma glucose was analysed by GOD/POD, serum cholesterol by CHOD/PAP, triglycerides by GPO/PAP, urea by urease/GLDH, creatinine by Jaffe' rate reaction, uric acid by uricase, total bilirubin by Jendrassik and Grof, total protein by biuret, alanine transaminase [ALT] by optimized IFCC and alkaline phosphatase [AP] by optimized DGKC method. The between batch CVs of all the parameters were within acceptable quality goals. The reference values were calculated using 2.5 and 97.5 percentiles as lower and upper limits [95% CI]. In healthy adult males the reference values were: fasting plasma glucose, 3.6-6.0 mmol/l; serum cholesterol; 3.2-6.6 mmol/l; triglycerides, 0.6-2.3 mmol/l; urea, 2.8-6.4 mmol/l; creatinine, 65-132 umol/l; uric acid, 164-430 umol/l; total bilirubin, 5-18 umol/l; total protein, 57-83 g/l; ALT, 15-45 U/l and AP, 185-620 U/l. The values in adult females, children and elderly subjects were slightly different than adult males. The reference values of our population show mild to moderate differences from the other Asian, European and American populations. It is recommended that reference values of different biochemical investigations should be established in various areas of Pakistan to make appropriate use of such investigations

Tamoxifen increases the proliferation of human endometrial stromal cells in in vitro. A model for evaluation of endometrial hyperplasia.

Tamoxifen given for breast cancer therapy, has a complex and an unclear action on the endometrium. A large number of literatures has attributed the proliferous changes in the endometrium caused by tamoxifen (Tam). No report has appeared on the endometrial cellular changes induced by Tam. The present study shows a significant (P < 0.001) increase in the proliferative activity due to Tam in endometrial stromal cells over control and estradiol (E2). This in vitro model is useful for the study of the hyperplasic effect of Tam at the cellular level.

Effect of tamoxifen, estradiol 17 beta on coenzymes NAD, NADPH and the metabolism of estradiol and estrone in rabbit uterus in vivo.

Biotransformation of estradiol (E2) and estrone (E1) and the concentrations of NAD, NADPH and 17 beta-estradiol dehydrogenase (E2DH) were measured in the uterus of rabbits treated with tamoxifen (Tam) in two doses; 100 micrograms/day, (Tam 100) and 500 micrograms/day, (Tam 500), E2 (10 micrograms/day) and combination of E2 + Tam 500 for 4 days. The concentration of NAD in Tam 500 treated group was significantly higher than E2, low dose Tam and E2 + Tam 500 treated groups (P < 0.01). The concentration of NAD in E2+ Tam 500 uteri was also significantly higher than E2 treated uteri. The concentration of NADPH was not significantly different from each other amongst the various treatment groups. The studies have shown that E2DH in E2 treated uteri was less than control and Tam 500 treated groups. A significant rise in the enzyme estradiol oxidoreductase (E2OR) activity (P < 0.02) was observed in E2 + Tam 500 treated uteri over control and other treated groups whereas high dose Tam decreased the E2OR activity significantly over the E2 treated group. The rate of conversion of E1 to E2 in Tam 500 treated group was significantly less than the other treatment groups except E2 + Tam 500 treated group (P < 0.04). This study showed that E2 decreases the uterine biosynthesis of NAD and E2DH and the biotransformation of E2 to E1, while high dose Tam increases uterine NAD, E2DH activity and E2 to E1 conversion.

Short term treatment of tamoxifen and estradiol on estradiol and progesterone receptors in rabbit uterus.

Effects of tamoxifen (Tam) on cytosolic estradiol (E2) receptors (ERc), progesterone (P4) receptors (PRc), nuclear estradiol (ERn) and progesterone receptors (PRn) were studied in adult normal rabbit uterine tissue. The ratio of cytosol: nuclear estradiol receptors (ER) was greater in rabbits treated with Tam than E2 or control uterine tissues. Rabbit uterine progesterone receptors (PR) in E2 treated animal were greater than Tam-treated animals. Tam caused nuclear accumulation of estradiol receptor, and simultaneous administration of E2 + Tam 500, estradiol could not revert Tam mediated accumulation of ER. The results suggest that Tam has an essentially antagonist action in the rabbit uterine tissue.

In vitro effect of human placental lactogen on steroidogenesis in human placental tissue from early pregnancy.

Studies were carried out with human placental lactogen (hPL) to elucidate its role in regulation of steroidogenesis (progesterone and estrogens) during early pregnancy in humans. Our in vitro studies with early pregnancy placenta under different doses of hPL demonstrated that this hormone could stimulate the synthesis of progesterone as well as estrogens (estrone and estradiol) from their respective precursors.