Effects of Arterial Stiffness on Visual Field Severity and Progression in Malay Patients with Primary Open Angle Glaucoma

@#Introduction: Vascular dysregulation is postulated to be involved in the pathogenesis of primary open angle glaucoma (POAG). Systemic arterial stiffness may accelerate the pre-existing damage. The purpose of this study was to determine the association of arterial stiffness with severity and progression of visual field in Malay patients with POAG. Methods: A cross-sectional study was conducted with 55 patients with POAG and 55 age- and sex-matched control subjects. The patients with POAG were further divided in accordance with their Advanced Glaucoma Intervention Study (AGIS) scores on their visual fields (VFs) (mild in 23 patients, moderate in 18, and severe in 14). Progression was defined as the worsening of the VF defect quantified as an increase in AGIS score of 4 points from the baseline. Arterial stiffness was measured using SphygmoCor and quantified as pulse wave analysis (PWA) and pulse wave velocity (PWV). Results: No significant differences in PWA and PWV were found between the patients with POAG and the control subjects (p=0.333 and p=0.443, respectively). The mean follow-up duration for the patients with POAG was 4.7±3.1 years. PWA and PWV showed no significant association with POAG severity after the confounding factors were controlled for. Ten patients with progression of VF were identified. In the analysis of covariance, a significantly higher PWV was found in the patients with disease progression (p=0.036). Conclusion: VF severity and progression were not associated with systemic arterial stiffness. The probable reason is that other factors affecting retinal microcirculation may play a larger role in the severity and progression of POAG.

Urine Drugs of Abuse Testing at Hospital Universiti Sains Malaysia: A Review of Trends from 2009 – 2019

@#Introduction: Substance abuse is a major social and health bane worldwide, including Malaysia, inflicting extensive morbidity and mortality. Our study aims to review the request and results of urine drugs of abuse testing conducted at the Pharmacology Laboratory of Hospital Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia, over a period of 11 years. Methods: Data for urine drugs of abuse testing requested and their results performed at the Pharmacology Laboratory between January 2009 and December 2019 was retrospectively extracted. Data on patient demographics, types of drugs requested, and types of drugs tested positive were analysed. Testing was performed using the enzyme multiplied immunoassay technique. Results: The absolute number and percentage of positive cases for amphetamine type stimulant (ATS) drugs has steadily risen over the past decade making it the current drug of abuse of most concern. Opiate abuse, although still seen, remained static. The peak age range for abusing drugs falls between 25–34 years with a male predominance; an alarming finding was of positive cases observed among neonates and children below the age of 12. Majority of requests came from the Psychiatric and Emergency Departments. Conclusion: Over the past eleven years, ATS abuse has superseded opiate in being the most abused drug type, detected even at young ages. Therefore, societal awareness and education on the dangers of ATS abuse, and intensive detection of ATS use must be implemented.

Alphacalcidol Supplementation Improves AcetylcholineMediated Relaxation in Aorta of Diabetic Rats on Vitamin D-Deficient Diet

@#Introduction: Vitamin D deficiency has been implicated as one of the factors involved in endothelial dysfunction associated with diabetes. This study aimed to evaluate the effects of active vitamin D (alphacalcidol) supplementation on aortic endothelial function in diabetic rats receiving vitamin D-deficient diet. Methods: Streptozotocin-induced diabetic rats were fed with standard diet (D) or vitamin D-deficient diet (DD and DDS) for 10 weeks. Group DDS was then supplemented with 0.2 μg/kg alphacalcidol at the last four weeks of the study duration. Non-diabetic rats were fed with standard diet (N) or vitamin-D deficient diet (ND). At the end of the experiment, the rats were sacrificed, and their aortic rings were harvested for endothelial functional study. Results: Acetylcholine-induced relaxation in aorta of diabetic rats (D and DD) were significantly lower compared to non-diabetic rats (N). In the presence of endothelial nitric oxide synthase blocker (L-NAME), maximal relaxation induced by acetylcholine in aorta of D and DD groups were significantly higher compared to N, ND and DDS groups, indicating involvement of non-nitric oxide (NO) relaxation pathways in diabetes. Four weeks supplementation with alphacalcidol in DDS group significantly improved acetylcholine-induced relaxation and reduced the reliance on non-NO relaxation pathways. Conclusion: The present study suggests that impairment of acetylcholine-induced relaxation in aorta of diabetes and diabetes with vitamin D-deficient diet was largely due to a decrease in NO related pathways, and this was compensated by non-NO pathways. Supplementation with alphacalcidol alleviated endothelial impairment in aorta of diabetic rats with vitamin D-deficient diet.

Enhanced production of Lovastatin by filamentous fungi through solid state fermentation

Lovastatin is a natural competitive inhibitor of 3-hydroxy-3-methyl glutaryl coenzyme-A [HMG-CoA] reductase and inhibits specifically rate limiting step in cholesterol biosynthesis. Further, lovastatin in comparison with synthetic drugs has no well-reported side effects. Four pure isolated filamentous fungal strains including Aspergillus niger IBL, Aspergillus terreus FFCBP-1053, Aspergillus flavus PML and Aspergillus nidulans FFCBP-014 have been cultured by solid state fermentation [SSF] using rice straw as substrate for the synthesis of lovastatin. After selecting Aspergillus terreus FFCBP-1053 as the best producer of lovastatin, various selected physical parameters including pH, temperature, inoculums size and moisture content were optimized through response surface methodology [RSM] under center composite design [CCD] for lovastatin hyper production. Maximum lovastatin production of 2070+/-91.5 was predicted by the quadratic model in the medium having moisture content 70% and pH 4.5 at 35 degree C which was verified experimentally to be 2140+/-93.25Mug/g DW of FM [microgram/gram dry weight of fermentation medium], significantly [P<0.05] high as compared to un-optimized conditions while it was noted that lovastatin production is independent on inoculum size [P>0.05] measured by spectrophotometer at 245 nm against standard. It was determined that optimized conditions for the hyper-production of lovastatin from fungal sources have a significant effect

Arterial stiffness during acute and recovery phases of children with rheumatic fever

Acute rheumatic fever (ARF) is associated with systemic inflammation and arterial stiffness during the acute stage. It has not been reported if arterial stiffness remains after recovery. The aim of this study was to determine the arterial stiffness during acute stage and 6 months after recovery from ARF. Arterial stiffness was assessed by carotid femoral pulse wave velocity (PWV) in 23 ARF patients during the acute stage of ARF and 6 months later. Simultaneously, erythrocyte sedimentation rate (ESR) and other anthropometric measurements were taken during both stages. There was a significant reduction in PWV; 6.5 (6.0, 7.45) m/s to 5.9 (5.38, 6.48) m/s, p=0.003 6 months after the acute stage of ARF. Similarly, ESR was also significantly reduced from 92.0 (37.5, 110.50) mm/hr to 7.0 (5.0, 16.0) mm/hr, p=0.001. In conclusion, arterial stiffness improved 6 months after the acute stage with routine aspirin treatment; this correlates well with the reduction in systemic inflammation.

relation between the mesiodistal crown widths of the deciduous second molars and the permanent first molars

The objective was to determine the relation between mesiodistal dimension of primary second molars and permanent first molars in local population of Peshawar

One hundred children from age 4 to 11 years with healthy and fully erupted primary second molars and permanent first molars were included in the study. After taking impression in alginate and pouring in the dental stone, maximum mesiodistal width was measured with digital vernier caliper for primary second molars and first permanent molars. Data were analyzed using SPSS version 20.0. Pearson co-efficient test was applied for relation between the mesio-distal crown widths of the deciduous second molars and the permanent first molars t-test was used to compared tooth sizes between males and females

One hundred cases; 50 males and 50 females were included in this study. The mean age was 8 +/- 1.2 years. Males had larger mesiodistal widths of than females [p<0.05]. A significant strong correlation existed between primary second molars and first permanent molars. The correlation was weaker in the females than males

A concordance was found between the sizes of the deciduous second molars with the size of the permanent first molars, this might be helpful in prediction for arch length discrepancy

Prevalence of dental anomalies in orthodontic patients

This study was done to determine prevalence of dental anomalies in orthodontics in a sample of Peshawar population

Panoramic [OPG]examination was done of150patients on standard light boxes, undergood lighting conditions, standardized screen brightness and resolution to determine the dental anomalies. Patients' dental records and radiographs were examined in order to detect the dental anomalies: congenitally missing teeth, impactions, ectopic eruption, supernumerary teeth, dilacerations, microdontia, and any other unusual finding that can be assessed with OPG. Cleft lip and palate, syndromic and patients with metabolic disorders were excluded from the study

Mean age calculated was 17.11 +/- 3.1 years. Maximum age was 30 years and minimum age was 13. There were 70 male cases and 80 cases of female. Male to Female ratio 1:1.14. Eighty nine [59.3%] patients had dental anomalies of various types. Forty-two patients [28%] were found with missing teeth. Third molar was most common missing tooth. Third molar impaction carried the highest percentage [10.3%] followed by maxillary canine [4.1%]. Six cases had supernumerary teeth [4.1%] while three have odontomes [2%]

Panoramic radiograph have a key role in diagnosis of many dental anomalies. In this sample 59.3% patients have dental anomalies of different kinds

Hepatitis B leading to megaloblastic anemia and catastrophic peripheral thrombocytopenia

Hepatitis B virus [HBV] typically causes chronic hepatitis, cirrhosis, and hepatocellular carcinoma. It is associated with a variety of extrahepatic complications. We herein, present a rare extrahepatic complication of HBV infection. A 32-year man presented with melena, bleeding from gums and fever. Peripheral blood examination revealed anemia, macrocytosis and severe thrombocytopenia. His hepatitis B surface antigen [HBsAg] was positive but deoxyribonucleic acid [HBV DNA] by polymerase chain reaction [PCR] was negative. Other hepatitis, human immune deficiency virus [HIV], dengue, and autoimmune serology were negative. Bone marrow examination revealed megaloblastic erythropoiesis. There was mild to moderate reduction of megakaryocytes in bone marrow, which was not compatible with severe peripheral thrombocytopenia. His response to cyanocobalamin and folic acid was remarkable for myeloid cell lines and moderate for erythroid cell lines, but poor to platelet counts. Platelet counts gradually improved to safe limits with eltrombopag, likely reflecting autoimmune pathogenesis for thrombocytopenia. This case report highlights multiple targets of HBV infection with associated multiple pathogenetic mechanisms

Pyrus pashia: a persuasive source of natural antioxidants

Pyrus pashia Buch. and Ham. was subjected to extraction with methanol. Methanolic extracts of fruit, bark and leaf were partitioned separately with four organic solvents in order of increasing polarity, asn-hexane, chloroform, ethyl acetate and n-butanol after dissolving in distilled water. Phytochemical screening revealed the presence of phenolics, flavonoides, alkaloids and cardiac glycosides in large amount in chloroform, ethyl acetate and n-butanol soluble fractions. The antioxidant activity of crude methanolic extracts, all the obtained fourorganic fractions and remaining aqueous fractions was evaluated by different methods such as: 1,1-diphenyl-2-picrylhydrazyl [DPPH] free radical scavenging activity, ferric reducing antioxidant power [FRAP] assay and total antioxidant activity by phosphomolybdenum complex method as well as determination of total phenolics. The results of antioxidant activity exhibited that chloroform soluble fraction of fruit showed the highest value of percent inhibition of DPPH [48.16 +/- 0.21 microg/ml] at the concentration of 10microg/ml. Ethyl acetate soluble fraction displayed the lowest antioxidant activity having/C[50] value of bark as [8.64 +/- 0.32microg/ml] relative to butylated hydroxytoluene [BHT], having IC[50] of 12.1 +/- 0.92microg/ml. The ethyl acetate soluble fraction of bark revealed the highest FRAP[s] value [174.618 +/- 0.11 TE microM/ml] among all the three parts. This fraction also showed the highest value of total antioxidant activity as [1.499 +/- 0.90], determined by phosphomolybdenum complex method. Moreover, this fraction also conferred the highest phenolic content [393.19 +/- 0.72] as compared to other studied fractions of fruit and leaf

Internally displaced persons [IDPS]; anxiety and depression

Most internally displaced persons [IDPs] live in low-income countries experiencing a war; their psychosocial health has not been well addressed. Objectives: To find out the prevalence of anxiety and depression in internally displaced persons [IDPs]. Design: A r and omized cluster sampling, case-controlled study. Period: 10th April 2009 to 10th July 2009. Setting: This study was conducted at Kacha Ghari camp and Sheikh Yaseen camp for IDPs. Patients and Method: A total of 220 cases [those whom were exposed to traumatic experiences] were selected through cluster r and om sampling. 220-matched controls [those whom were not exposed to traumatic experiences] were selected same day using the same sampling method. Both sexes were included. Socio-demographic information was obtained from IDP- information form. Anxiety and depression was assessed using Hopkins symptoms checklist – 25 [HSCL-25]. SPSS version -17 was used for statistical analysis. Chi square test was applied for group comparison to calculate statistical significance. Results: More than half of the participants [60 %] in this study were in age group between 18 to 38 years. 55 % of the population were females. Majority of participant were married [86% - 90%] and were uneducated [74% - 90%] belongs to lower socio-economical class. The total Scores and the Depression Scores on Hopkins symptoms checklist – 25 [HSCL-25], were significant high in case group than in control group with the P values of 0.04 and 0.05 respectively. Discussion:Traumaandtorture leaves a permanent scar on the survivors. It has physical, psychological and social squeals. Hopkins Symptoms Checklist-25 is intended to provide primary care physicians, mental health practitioners and other health care providers with an instrument for detecting anxiety and depression in torture and trauma victims. Conclusions: Besides being displaced from their residence exposure to trauma come out to be the important causative factor in creating psychological disturbance among internally displaced persons.

Prevalence and pattern of self-medication in Karachi: a community survey

To study the prevalence and pattern of self-medication among adult males and females in Karachi, Pakistan. This cross-sectional community- based survey was carried out at five randomly selected towns of Karachi [Defence, Gulshan-e-lqbal, North Nazimabad, Mlir, Orangi town] over a period of 3 months [October, November and December 2012]. A sample size of 500 adult cases [250 males and 250 females], with systemic random selection from different towns of Karachi were inducted in this study. The city was divided in 5 zones and one town from each zone was selected by systemic randomization. First available male and female from each randomly selected house were included in the study. After consent and confidentiality assurance they were interviewed on semi-structured Performa designed for this purpose. Results were analyzed and tabulated through SPSS v14.0. The prevalence of self-medication in males and females in Karachi is found to be 84.8% [males 88.4% and females 81.2%]. The most frequent symptoms for which self-medication used were headache [32.7%], fever [23.3%] and the medicines used were painkillers [28.8%], fever reducer medicines [19.8%]. The most common reason 33.3% was previous experience with similar symptom. Self-medication is highly prevalent [84.8%] in Karachi. It was frequently used for headache followed by fever. Predominantly painkillers, fever reducer and cough syrups were used in the form of tablets and syrups. Main source of medicines for males were friends and for females were relatives

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 lip thickness among different skeletal malocclusion classes

Facial appearance is fundamental for communication and interaction with the environment. In contemporary society, there is a widespread growing interest for facial esthetics. The creation of a harmonic occlusion, within a well-functioning stomatognathic apparatus, must always consider the effect of tooth position on facial soft tissues. The objective was to evaluate the upper lip thickness in different skeletal classes of malocclusions in patients reporting to Orthodontics, Khyber college of dentistry, Peshawar. A total of 90 patients 30 from each skeletal class of malocclusion were selected for this study. Lip thickness was measured using lateral Cephalograms. The measurements were: a] the distance between point A and subnasale b] the distance between prosthion and labrale superious c] the shortest distance between the upper incisor and the attachment points of the upper and lower lip d] the distance between infradentale and the vermilion border of the lower lip e] the distance between point B and the deepest point of the labiomental crease f] gnathion and soft tissue menton. The collected data were analysed by SPSS version 17.0. Mean, frequency and standard deviation were calculated for numerical variables. One-way ANOVA test used to made comparison between the skeletal classes. The largest range was found among skeletal class I, II and III malocclusion patients were the point A to Subnasale distance and gnathion to soft tissue menton distance. The only two variables showing statistically significant difference were i] Distance between point B and deepest point of labiomental crease ii] Shortest distance between upper incisor and attachment of both lips

Prevalence of mandibular asymetries in patients with mixed dentition

Mild facial asymmetry can occur during growth and development but if it exceeds the normal limit it can affect the esthetics and developing occlusion of the growing individual complicating the orthodontic diagnosis and treatment.The aim of the present study was to determine the prevalence of mandibular asymmetries during the mixed dentition in growing children of local population. A retrospective study was designed where various measurements were performed on the right and left sides of the mandible using panoramic radiographs of 50 children [males: 21; females: 29] in age range of 8-14 years. Two linear measurements, mandibular ramus height, ramus width and one angular measurement, mandibular gonial [Go] angle were analysed. All measurements were adjusted for the magnification factor. The final data were then processed for the asymmetry index [AI] to determine the severity of the asymmetries. Wilcoxon paired tests at the 95 per cent level of confidence was used for statistical analysis. A moderate-to-severe mandibular asymmetry for the linear dimensions when both sides of the mandible were contrasted was found in more than a half of the sample. There was also a high prevalence of moderate and severe asymmetries when comparing Go angle on both sides of the mandible in studied population

Patterns of third-molar agenesis in an orthodontic patient population with different skeletal malocclusions

Current study was performed to examine the relationship between third molar agenesis and different skeletal malocclusion patterns. Pretreatment records of 477orthodontic patients [aged13-17 years] were used. Third molar agenesis was calculated with respect to gender, number of missing teeth, jaws and skeletal malocclusion patterns. The Pearson Chi-Square test was performed to determine potential differences. Among the 477 subjects, 127 subjects were diagnosed with third molar agenesis [26.6%] with no statistical gender difference [P > .05]. It was more common in the maxilla than in the mandible or in both jaws [P > .05]. The prevalence of third molar agenesis in those with a class III malocclusion was higher than in those with Class I or Class II [P > .05]. These results suggest that agenesis of the third molar depends on sagittal skeletal malocclusions in this region

Morphological and histological changes in placenta of hypertensive and gestational diabetic women

To correlate the morphological and histo-pathological changes in placenta observed in normal, diabetic and hypertensive pregnancies. A cross sectional study. This study was carried at the department of Gynae and Obs Taluka hospital Hala, and Basic health unit Hala from 1[st] January, 2014 to 30[th] June, 2014. For this experimental study statistical analysis was carried on SPSS-11.0 version. Total 90 cases studied were divided in three equal groups. All placentae were processed through stages for final histo-pathological examination. The study showed that discoid shape were significantly less 4[13.3%] in hypertensive as compared to 16 [53.3%] diabetic and normal placentae [p<0.01], bilobed in 6 [20.0%] diabetic placenta. In hypertensive placenta 15[50%] had central attachment of umbilical cord, diabetic 22 [73.3%] and normal 30[100%]. Central thickness [Mean +/- S.D +/- SEM] of hypertensive placenta 2.2 +/- 0.58 +/- 0.11 were significantly less [p<0.01] as compared to normal placenta 3.0 +/- 0.03 +/- 0.01 but diabetic placenta 3.8 +/- 1.15 +/- 0.21 were significantly high [p<0.01] as compared to hypertensive and normal placenta. Gestational diabetes and hypertension had significant t-test that causes morphological changes in placenta that affects fetal and maternal wellbeing. This study is helpful for those who are concerned for mother and child health

Prevalence of tooth wear in different maloccusions of mixed dentition

The study was conducted to investigate the prevalence of tooth wear in different malocclusions of mixed dentition. Sample consisted of dental casts of 144 subjects, affected by class I [59] class II [45] and class III [40] malocclusions. Dental wear was assessed by using a modified version of tooth wear index. SPSS version 16 was used for data analysis. In class I malocclusion tooth wear was equal in both the jaws [40%], while in class II group increased tooth wear was found in maxilla [34%] than mandible [24.6%] and in class III more tooth wear was seen in mandible [69.6%]. Tooth attrition has a negative correlation with prevalence of malocclusion in our population. which can be related to decrease masticatory activity and increased usage of processed food

Evaluation of the nasolabial angle of Khyber Pakhtunkhwa sample

Esthetic features are different from one race to another, and this should be considered during the treatment planning. The great variance in soft tissue drape of the human face complicates accurate assessment. The nose-lip-chin relationships are exceedingly important in determining the facial esthetics. One important soft tissue parameter in orthodontic diagnosis is the nasolabial angle. The purpose of this study was to establish norms for nasolabial angle in the local population. Normative data for the nasolabial angle was produced from a sample of 50 [25 male and 25 female] adults [18-25 yrs] with well-balanced faces. Mean and standard deviation values from this pooled sample demonstrated a nasolabial angle of 105.8° +/- 3.95°. No statistically significant difference was demonstrated between the values for men and women in this study, but men did have a slightly larger nasolabial angle

Scrotal pathologies; role of high resolution and Doppler ultrasound in evaluation

To assess common presenting complaints and the role of Grey Scale and Doppler ultrasound in evaluation of scrotal pathologies. Cross sectional study, Khyber X rays, Khyber Medical Centre, Peshawar. July 2011 to December 2011. Data from patients presenting for evaluation of scrotal pathologies was analyzed for presenting complaints and ultrasound findings according to objectives of the study. In total 210 cases were included in the study. The age wise categorization included pediatric population [14.3%] adult population [80.9%] and geriatric population [4.3%]. Pain was the most common presenting feature in all age. Other major presenting complaints included swelling, absent testis, history of trauma, lower urinary tract symptoms [LUTS], and infertility. Hydrocele was the most common finding overall. Other major ultrasound finding included varicocele, epididymo-orchitis, spermatocele, atrophic testis, undescended testis tumors and complications of trauma. Scrotal pathologies are among the frequently encountered problems in our region. Ultrasound is a sensitive and useful tool for evaluation of scrotal pathologies