Serum Zinc Level in Persons with Prediabetes and it’s Relation with Glycemic Status Attending Tertiary Care Hospital in Bangladesh

Background: Type 2 diabetes mellitus is becoming one of themajor health problems worldwide. Especially in South EastAsia, type 2 diabetes has gained critical significance. Asprediabetes prevalence is increasing worldwide, it has becomean important concern to prevent diabetes at an early stage inBangladesh.Objectives: Estimation of serum zinc level and establishmentof its relation with glycemic status in individuals with prediabetes.Materials and Methods: This cross-sectional studyencompassed 126 (age: 35.09±9.96 years, mean ± SD; Sex:16/110, M/F) subjects with prediabetes and 126(age:29.08±9.28 years, mean ± SD; Sex: 22/104, M/F) healthynondiabetic controls from the out-patient department ofEndocrinology, BSMMU consecutively. Serum zinc wasmeasured by using Atomic Absorption Spectrophotometry.Height, weight, waist circumference, acanthosis nigricans,hypertension, SGPT& serum creatinine were recorded asconfounding variables.Results: Serum zinc level in persons with prediabetes waslower than that in control (0.76±0.01 vs. 0.78±0.01mg/L,M±SEM, p=0.28). There was statistically significant differencefor zinc level in gender groups (M vs. F: 0.84±0.02 vs.0.75±0.01 mg/L, M±SEM, p<0.001) and monthly family incomegroups (p=0.02). Also zinc level was statistically similar amongglycemic status groups apart from zinc level in between controland combined glucose intolerance (CGI) groups (control vs.CGT: 0.78±0.01 vs. 0.72±0.02mg/L, M±SEM, p=0.03). Amongcases comparisons between groups with or without risk factorslike: smoking (0.72±0.03 vs. 0.76±0.10 mg/L, p=0.42),smokeless tobacco (0.73±0.03 vs. 0.76±0.01mg/L, p=0.46),hypertension (0.80±0.03 vs. 0.75±0.01 mg/L, p= 0.14), familyhistory of DM (0.75±0.02 vs. 0.77±0.02mg/L, p=0.52), familyhistory of CVD (0.74±0.02vs.0.77±0.01mg/L,p=0.28), overweight (0.76±0.01 vs.0.74±0.05mg/L, P=0.59), waistcircumference (0.75±0.01 vs. 0.79±0.04mg/L, p=0.40) andacanthosis nigricans (0.75±0.02 vs. 0.76±0.02mg/L, p=0.70),showed no statistically significant difference. None of thevariables like age (r= -0.02, p=0.19), BMI (r= 0.14, p=0.12),FPG (r= -0.05, p=0.60) and PG 2h after 75g glucose (r=0.10,p=0.28), HbA1c (r=0.04, p=0.64), serum creatinine (r=0.01,p=0.87) showed significant relationship with the level of zincexcept SGPT which showed significant relation with zincamong cases (r= 0.28, p=0.002) and among all participants(r=0.17, p=0.008) but not in control group (r=0.07, p=0.43).Conclusion: It is concluded that persons with prediabetes hadserum zinc level within normal limit and there was found nostatistically significant relationship between HbA1c and zinc

Effect of fluoxetine and paroxetine on intestinal motility

Background: Serotonin (5-HT) is a biogenic amine that functions as a neurotransmitter of sensorimotor functions in the digestive tract. Te role of 5-HT agents in the modulation of lower gastrointestinal function. Selective serotonin reuptake inhibitors (SSRIs) are of potential benefit in functional gastrointestinal diseases although formal evidence is lacking. Apart from central effects, they may have peripheral. The present study was carried out to find out the possible effects of fluoxetine and paroxetine on gastrointestinal smooth muscles of rabbit as they cause severe nausea and vomiting initially.Methods: Experimental study design. Power lab (USA) for recording the contractions of ileal smooth muscle of rabbit in response to serotonin, fluoxetine and paroxetine.Results: The percent responses with serotonin, fluoxetine and paroxetine were 100, 10.53, and 4.75 percent respectively.Conclusions: SSRIs (fluoxetine and paroxetine) were unable to enhance the serotonergic transmission in vitro inturn decreases the qualitative response.

Zika virus - an international public health emergency

Zika Virus is a member of the virus family flaviviridae and the genus flavivirus. It is spread by day time active Aedes mosquitoes, such as A. aegypti and A. albopictus. This is the same mosquito that spread and causes dengue, chikungunya and yellow fever

The first known case of Zika fever was reported in a sentinel rhesus monkey stationed on a tree platform in the Zika Forest in Uganda in 1947. Sexual transmission of Zika virus from men to women has been witnessed in at least 4 cases

Zika virus has also been isolated from semen samples. Cases of vertical perinatal transmission, from mother to the baby during pregnancy have been reported. WHO declared the couple of microcephaly and Guillain-Barré syndrome [GBS] cases reported in Brazil are strongly suspected to be associated with the Zika virus outburst. Thus, World Health Organisation [WHO] declared that a coordinated and an organized international response is required to improve surveillance, identification of infections, congenital malformations, and neurological complications, to heighten the control of mosquito populations at risk, and to execute the development of diagnostic tests and vaccines to secure people from this international public health emergency

Early detection of doxorubicin-induced cardiotoxicity and its prevention by carvedilol.

Background: The objective was to detect doxorubicin (Dox) - induced myocardial injury at early stage by quantitative estimation of cardio specific protein, cardiac troponin I (cTnI) and to explore the cardioprotective effects of carvedilol. Methods: The study design was lab-based randomized controlled in-vivo in rabbits conducted from January to August 2012. Cardiotoxicity was produced by single intravenous injection of 12 mg/kg body weight (BW) of Dox in a group of rabbits, control group was treated with normal saline only and the rabbits of third group were pre-treated with carvedilol 30 mg/kg of BW for 10 days before injecting Dox. Results: Dox induced cardiotoxicity was depicted by markedly raised serum levels of cTnI, creatine kinase-MB, lactate dehydrogenase, and Grade 3 necrosis of the heart tissue in rabbits. The pre-treatment with carvedilol resulted in improved serum levels of these biomarkers and the histological picture of heart tissue. Conclusions: Quantitative serum estimation of cTnI detects the presence of cardiotoxicity much before cardiac dysfunctions can be revealed by any other diagnostic technique. It can lead to significant economic impact in the management of cancer patients because the troponin-negative subjects can be excluded from long-term cardiac monitoring programs that involve high costs imaging techniques. The outcome of Dox chemotherapy can be made successful with the concurrent use of carvedilol.

Fluoxetine causes decrease in intestinal motility.

Background: Major depression is the most frequent disorder occurring in 16% of the population worldwide. In the middle of the 20th century, the discovery of selective serotonin (5-HT) reuptake inhibitors acted as a miracle in the antidepressant therapy. We explored the acute effects of fl uoxetine and possible mechanism underlying the contractile effects of fl uoxetine on isolated ileal smooth muscles of rabbit in vitro. Methods: Effects of increasing concentrations of acetylcholine (Ach), 5-HT and fl uoxetine were studied on isolated ileal tissue of the rabbit in vitro by constructing cumulative concentration response curves. The ileal smooth muscle contractions were recorded on power lab (USA). Results: Ach, 5-HT and fluoxetine, produced a concentration-dependent reversible contraction of isolated ileal muscle of rabbit. The mean ± standard error of the mean of maximum amplitudes of contraction with Ach, 5-HT and fl uoxetine, were 24.8±1.22 mm, 44±0.527 mm and 2.6±1.16 mm, respectively. Fluoxetine shifted the concentration-response curve right and downwards. Conclusion: Our study has indicated that fl uoxetine on isolated ileal intestinal smooth muscle decrease the motility and this decrease in motility is possibly due to the inability of fl uoxetine in vitro to enhance the serotonergic transmission and also because of the interaction of these agents with some of the other receptors, present in the intestinal smooth muscles.

Epidemiological surveillance of dengue infections: a community based study in rural, Karachi (2010 - 2012)

Objective: To determine the incidence cases and their demographic, clinical and haematological risk factors of dengue infections in a low resource rural community during outbreaks of 2010-2012 in Gadap town Karachi, Pakistan. Methods: An active surveillance data collection on epidemiological and clinical observations on patients with Dengue infections in a low resource community during 2010 - 2012 was done. The surveillance reports were collected from union councils of Gadap Town, Karachi. The diagnosis of Dengue fever, Dengue haemorrhagic fever and Dengue shock syndrome was confirmed by IgM and IgG anti bodies detection using Enzyme-linked immunosorbent assays [ELISAs] technique based on World Health Organization [WHO] criteria. The sampling technique was cluster random sampling from the union councils of Gadap Town, Karachi and sample size calculated was 350. Data was collected on a performa after informed consent of patients. Data analysis was done on SPSS version 16. Frequency was reported for categorical variables and chi-square test performed for statistical significance to determine associated risk factors among positive cases of dengue infections. Results: Out of 350, 105 [30%] cases had dengue infections in rural area of Gadap town Karachi. About 58 [16.6%] had dengue fever, 30 [8.6%] dengue haemorrhagic fever and 17 [4.9%] had dengue shock syndrome. Twelve patients died during treatment. Presence of fever and cutaneous manifestation were observed in all cases. The significant associated risk factors were found in female, unmarried having 5 years education and severe pain at p<0.001. Conclusion: In endemic areas during dengue surveillance dengue infections were found in 30% cases. The significant associated risk factors were female, unmarried, with 5 years education and severe pain. Febrile illness represented patients with typical clinical features and haematological findings suggestive of dengue fever

Dose-dependent Modulation of Lipid Parameters, Cytokines and RNA by -tocotrienol in Hypercholesterolemic Subjects Restricted to AHA Step-1 Diet.

Aims: Evaluate the consumption of -tocotrienol (free from tocopherols) on serum lipid parameters, and several cytokines (TNF-, IL-4, IL-6, IL-8, IL-10), including gene expression and circulating microRNAs (miRNAs) in hypercholesterolemic subjects. Study Design: The present preliminary dose-response study consisted of six phases. All hypercholesterolemic subjects took increasing doses of -tocotrienol (125, 250, 500,750 mg/d) plus AHA Step-1 diet for 4 weeks during the 30 weeks study period. Methodology: Hypercholesterolemic (n = 31; serum cholesterol > 5.2 mmol/L) subjects (males- 26/females 5; age range 50-71 years) were enrolled in the study from Wah Cantonment, Pakistan. Serum lipid parameters were measured by auto analyzers. Various plasma cytokines, cDNA, and miRNAs were estimated by Signosis kits. Results: All participants (n = 31) completed all phases of study. The -tocotrienol plus AHA Step-1 diet caused reductions in lipid parameters in a dose-dependent manner with maximum effects on serum total cholesterol (15%), LDL-cholesterol (18%), triglycerides (14%) with 250 mg/d dose (P< 0.001). Doses above 500 mg/d resulted ininduction in levels of all lipid parameters, except HDLcholesterol. The cytokines associated with cardiovascular disease (plasma TNF-, IL-2, IL-4, IL-6, IL-8, IL-10) were all down-regulated 39%-64% by -tocotrienol treatment (P< 0.01). Similar results were obtained with gene expression of these cytokines using whole blood messenger-RNA. In contrast, circulating miRNA-7a, miRNA-15a, miRNA-20a (anti-angiogenic), miRNA-21, miRNA- 29a, miRNA-92a, miRNA-200, miRNA-206 (skeletal muscle regeneration) down-regulated in hypercholesterolemic subjects, were up-regulated by -tocotrienol treatment as compared to baseline (P< 0.01). Conclusion: The present results confirm that consumption of -tocotrienol plus AHA Step-1 diet causes significant reduction in serum lipid parameters and several cytokines (TNF-, IL-2, IL-4, IL- 6, IL-8, IL-10) at a low optimal dose (250 mg/d). The capacity of -tocotrienol to modulate inflammation is partly attributable to dose-dependent properties of inhibition/activation, which may play a major role in future treatment of cardiovascular diseases.

comparative study of the beneficial effects of ipratropium and beclomethasone against insulin-induced tracheal tissue contraction in a guinea pig model

To evaluate the acute effects of insulin on airway reactivity and the protective effects of beclomethasone and ipratropium against insulin-induced airway hyperresponsiveness on isolated tracheal smooth muscle in a guinea pig model. Materials and The trachea of each guinea pig was excised; one end of the tracheal strip was attached to the hook of the oxygen tube of a tissue bath and the other end was connected to a research-grade isometric force displacement transducer. The effects of varying concentrations of insulin [10[-7] to 10[-3]M] and insulin pretreated with a fixed concentration of beclomethasone [10[-6]M] and ipratropium [10[-6]M] on the isolated tracheal tissue were studied by constructing cumulative concentration-response curves. Changes in tracheal smooth muscle contractions were recorded on a 4-channel oscillograph. The means +/- standard error of the mean of the maximum amplitude of contraction with increasing concentrations of insulin and of insulin pretreated with fixed concentrations of beclomethasone and ipratropium were 35 +/- 1.13, 22 +/- 1.15 and 27.8 +/- 1.27 mm, respectively. The data showed that beclomethasone inhibited the contractile response of insulin to a greater extent than ipratropium. Thus we suggest that inhalational insulin pretreated with beclomethasone may be more efficacious than with ipratropium for the amelioration of potential respiratory adverse effects such as bronchoconstriction

Frequency and risk factors of cognizable physical violence by intimate partner against women seeking medical care at a tertiary care centre, Karachi

Objective: To determine the cognizable frequency of physical violence by intimate partners against women seeking medical care at a tertiary care center, Karachi

Methods: A hospital based cross sectional survey was conducted at a medical care emergency of a tertiary care center, Karachi. The sample size was 345. A non-probability purposive sampling technique was used for selecting the study subject. A Performa was used to collect the information directly through recorded data and interviews. Written informed consent was obtained from each participant. Data was entered and analyzed by using SPSS software version 15. Means with standard deviation for numerical variables and proportions for categorical variables are presented. Chi square test was performed for association of education level and occupation with frequency of physical violence by intimate partners

Results: There were 345 cases reported during August 2014 to February 2015. Mean age +/- SD was 33.50 +/- 8.41 years and family income 1,855 +/- 962 rupees per month. Cognizable physical violence was observed in 286 [77.7%] by intimate partners against women seeking medical care at a tertiary care center Karachi. Housewives were 271 [78.6%] seeking care for physical violence injury. Fractures were found in 226 [65.5%] women. There was no education in 46 [13.3%] and 5 year education was 191 [55.4%]. The percentage of cognizable physical violence was 77.7%. Non-cognizable physical violence found higher among younger age group 24-36 years as compare to older women

Conclusion: The frequency of cognizable physical violence was two third by intimate partners against women seeking medical care in metropolis megacity, Karachi. Major risk factors found were age more than 36 years, housewives, low family income and only five years education

Behavioral risks factors associated with spread of dengue infections: a community based study

Objective: To determine the behavioral risks factors associated with spread of dengue infections in a rural community of Gulshan-e-Iqbal town, Karachi, Pakistan

Methods: A questionnaire based cross sectional survey was conducted during September 2013- February 2014 in union councils of Gulshan-e-Iqbal town, Karachi. The sample size was 350. Systematic random sampling was used for selecting the study subject, from each household taken as one unit. Sample was taken from a total of 3225 houses to achieve total sample of 350 households. All the data was entered and analysed by using SPSS software version 15. Means with standard deviation for numerical variables and proportions for categorical variables are presented. Chi square test was performed to find the association of behavioral risks factors with spread of dengue infections in a rural community of Karachi, Pakistan

Results: Dengue infection was clinically diagnosed in 203 [58%] patients and were hospitalized during August 2012 to February 2013. Among all patients, higher frequency was found in the middle age group 37 to 54 years i.e. 44% [n=154].The behaviors of self-mosquito bite protection [p<0.01], selfprevention in breading mosquitoes [p<0.01], density of vegetation [p<0.01], behaviors regarding lack of self-efficacy in controlling vector [p<0.01] and lack of preventive measure in community [p<0.01] were significantly associated with transmission of dengue infections

Conclusion: The behavioral risks factors associated with spread of dengue infections in a rural community included lack of preventive measure in community, lack of comprehension of Health belief models, lack of knowledge,lack of self- prevention in breading mosquitoes, high density of vegetation and lack of self-efficacy in controlling vector

Comparative study of protective effects of salbutamol and beclomethasone against insulin induced airway hyper-reactivity on isolated tracheal smooth muscle of guinea pig

Inhalational insulin was withdrawn from the market due to its potential to produce airway hyper-reactivity and bronchoconstriction. So the present study was designed to explore the acute effects of insulin on airway reactivity of guinea pigs and protective effects of salbutamol and beclomethasone against insulin induced airway hyper-responsiveness on isolated tracheal smooth muscle of guinea pig. Effects of varying concentrations of insulin [10[-7] to 10[-3] M], insulin pretreated with fixed concentration of salbutamol [10[-7] M] and beclomethasone [10[-6] M] were studied on isolated tracheal tissue of guinea pig by constructing cumulative concentration response curves. Changes in tracheal smooth muscle contractions were recorded on four channel oscillograph. The mean +/- SEM of maximum amplitudes of contraction with increasing concentrations of insulin, insulin pretreated with fixed concentration of salbutamol and beclomethasone were 35 +/- 1.13 mm, 14.55 +/- 0.62 mm and 22 +/- 1.154 mm respectively. Although salbutamol and beclomethasone both had a profound inhibitory effect on insulin induced airway hyper-reactivity, yet salbutamol is more efficacious than beclomethasone. So we suggest that pretreatment of inhaled insulin with salbutamol may be preferred over beclomethasone in amelioration of its potential respiratory adverse effects such as bronchoconstriction

Validity of computed tomography scan for the diagnosis of ovarian carcinoma and its stages

To determine the validity of CT scan for the diagnosis of ovarian carcinoma and its stages taking histopathology as gold standard. Cross sectional validation study. The study was conducted in the Department of Radiology, DHQ Hospital Rawalpindi, RMC and Allied hospitals from October 2011 to March 2012. This study included one hundred thirty six consecutive subjects with symptoms of ovarian pelvic mass with an age range of 20 years to 70 years and pre-operative CA -125 level were enrolled in the study by the Principle Investigator [PI]. All 136 patients were gone through CECT scan. Imaging findings of all patients were compared with results of histologic examinationto determine the diagnostic accuracy of CECT scan in the evaluation of disease status. The Histopathological staging of ovarian carcinoma was obtained on the basis of FIGO Classification. Histopathological findings of each patient were obtained from laboratory were actually reported by consultant Pathologist. The mean age of the patient is 50.37 years. The sensitivity and specificity of CT in diagnosis of malignant ovarian carcinoma is 100% with the p value was 0.0001 and 84.85% respectively. The Positive Predictive Value [PPV] and Negative Predictive Value [NPV] is 95.37% and 100% respectively, taking histopathology as Gold Standard. The overall accuracy of CT in diagnosis and staging of ovarian carcinoma is 96% and 93% respectively. The beneficial effect of the study is to find a non-invasive, less time consuming and relatively easy modality for the diagnosis of ovarian carcinoma including its staging. Prompt diagnosis will lead to instant decision making for the management of this debilitating disease

Insulin causes airway hyper-reactivity.

Background: We explored the acute effects of insulin and one possible mechanism underlying the acute contractile effects of insulin on isolated tracheal smooth muscle of guinea pig in vitro. Methods: Effects of increasing concentrations of histamine (10−7-10−3 M), insulin (10−7-10−3 M), insulin pretreated with a fixed concentration of indomethacin (10−6 M) were studied on isolated tracheal tissue of guinea pig in vitro by constructing cumulative concentration response curves. The tracheal smooth muscle contractions were recorded with transducer on four channel oscillograph. Results: Histamine and insulin produced a concentration-dependent reversible contraction of isolated tracheal muscle of guinea pig. The mean±standard error of the mean of maximum amplitudes of contraction with histamine, insulin and insulin pretreated with indomethacin were 92.5±1.20 mm, 35±1.13 mm and 14.55±0.62 mm respectively. Indomethacin shifted the concentration-response curve of insulin to the right and downwards. Conclusions: Insulin has acute contractile effects on guinea pig airways, which were significantly inhibited by prostaglandin synthesis inhibitor indomethacin confirming the involvement of contractile prostaglandins in insulin-induced airway hyper-responsiveness.

community based knowledge and practices survey on passive tobacco smoking and its impact on fetal outcome

To determine the proportion of passive tobacco smoking during pregnancy and estimate the level of knowledge and practices regarding Passive tobacco smoking and its adverse fetal outcome. A community based cross sectional survey was conducted in four union councils of Malir Town. This is a small semi urban community of 77216 population. Currently pregnant women were interviewed regarding passive tobacco smoking consumption and their knowledge about its adverse fetal outcome. A semi structured questionnaire was used during June to August 2011. Pregnant women either exposed or not exposed to passive tobacco smoking were interviewed for their knowledge and practices regarding its impact as adverse fetal outcome. A total of 190 mothers were interviewed. In the study 133 [70%] women were found subjected to passive tobacco smoking. About [85.5%] exposed to passive tobacco smoking were knowledgeable about adverse effect of maternal passive tobacco smoking on fetus. The fetal adverse effects comprehend by mothers included stillbirth 35 [63.6%], small size baby 65 [100%], fetal congenital abnormality 33 [86.6%]. The proportion of passive smoking exposure during pregnancy was 70% and 85.5% mothers were knowledgeable regarding Passive Smoking exposures and adverse fetal outcome including stillbirth 63.6%, small size baby 100%, fetal congenital abnormality 86.8%

Domestic violence causing abruptio placenta and feto-maternal death: case report on autopsy

A 22 year old primigravida with 28 weeks/7 months pregnancy was brought in police custody 10 hours after her death reported at a Tertiary Care Center, Karachi. There was a history of soft tissues direct abdominal trauma 10 hours back. On complete physical examination there were no external marks of violence except a contusion on her back of 5 cm diameter. The internal examination after opening the uterus, placenta was separated and baby was delivered after opening the amniotic sac. A fresh still birth of male baby with 1.5 kg was delivered. The chemical and histopathology report evidenced that uterus, fallopian tubes and ovaries had decidua with necrotic tissues, edema and congestion. The final opinion after receiving the chemical/histopathology reports on this post mortem was that the death occurred due to fetal hypoxemia developing secondary to maternal shock as a result of direct uterine trauma and disseminated intravascular coagulation [DIC]. DIC develops due to circulating placental products responsible for fetal losses. This case reports fetal hypoxemia developing secondary to maternal shock, maternal hypotension, abruptio placentae, direct uterine trauma and disseminated intravascular coagulation [DIC]

Determinants of lower extremity amputations: an institutional experience

To determine the determinants of lower extremity amputations in diabetics and non-diabetics in a tertiary care institute. Cross-sectional, analytical study. Outpatients Department of the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, from January 2007 to December 2010. All patients with amputations reporting at the study centre for prosthesis fitting were included in the study. Patient's age, level of amputation, stump complications and associated risk factors of amputation were recorded on a structured proforma. Prosthesis and orthotic assessment were carried out. The frequency and determinants were collected to compare diabetic and non-diabetic amputees. The data was analyzed in SPSS windows version 16. A total of 1091 subjects were provided prosthesis, including 847 males [77.6%]. Mean age in diabetic and nondiabetics being 49.6 +/- 15.2 and 26.6 +/- 17.9 years respectively which is significant at [p < 0.001]. Socioeconomic status and educational levels were significantly associated with diabetic status [p < 0.001]. Amputation was more common in non-diabetic 858 [78.6%] compared to diabetics 233 [21.4%]. This study has identified that most common and significant predictors were gender, low social status and educational levels. Other significant predictors of amputation identified were type of lesion, [infections and ischaemia], initial diagnosis acute/chronic arterial insufficiency and diabetic foot

Prevention of insulin induced airway hyper-reactivity with montelukast on isolated tracheal muscle of Guinea Pig

To explore the inhibitory effects of montelukast against insulin induced tracheal smooth muscle contraction of guinea pigs in vitro. Inhalational insulin was withdrawn from market in 2007 due to its potential to produce airway hyper-reactivity and bronchoconstriction. So we investigated the acute effects of insulin on airway reactivity and protective effects of montelukast against insulin induced airway hyper-responsiveness on isolated tracheal smooth muscle of guinea pig. Experimental study. This study was conducted in the Department of Pharmacology, Army Medical college Rawalpindi from December 2011 to June 2012. Effects of increasing concentrations of histamine [10[-8]- 10[-3] M], insulin [10[-8]- 10[-3] M] and insulin pretreated with fixed dose of montelukast [10[-5] M] were studied on isolated tracheal tissue of guinea pig. The tracheal smooth muscle contractions were recorded with Transducer on Four Channel Oscillograph.: Histamine and insulin produced a concentration dependent reversible contraction of isolated tracheal muscle of guinea pig. The mean +/- SEM of maximum amplitude of contraction with histamine was 92.5 +/- 1.20 mm as compared to 35 +/- 1.13 mm in insulin treated group. The maximum amplitude of contraction achieved with insulin in the presence of montelukast was 34.5 +/- 1.024 mm. Montelukast did not significantly inhibit the contractile response of insulin on isolated tracheal muscle of guinea pig, so pretreatment of inhaled insulin with montelukast has no clinical implication in amelioration of its respiratory adverse effects such as bronchoconstriction

Spectrum of medico-legal deaths in metropolis of Karachi: an autopsy based study

Background: The number and variety of medico-Iegal deaths has inflated tremendously in the recent years in relation to acts of terrorism using explosive material and street crimes which often result in tragic death

Objectives: To determine the frequency, causes and manners of medico-legal autopsies at three major mortuaries in Karachi

Methods: A case study, involving the medico legal deaths autopsied at three major mortuaries in Abbasi Shaheed Hospital, Jinnah Postgraduate medical center and Civil Hospital, from March 01, 2008 to February 28, 2009. A detailed autopsy was conducted in each case to determine the cause of death. The bodies were first examined externally followed by dissection of body cavities in accordance with Robert Virchow's technique. The results were collected from the respective institutions on a structured performa and were statistically analyzed using SPSS version 15. The Mean +/- SD was calculated for age

Results: Out of total 2,090 autopsies c0nducted during the period of study, 98.7% of the deaths were found to be due to unnatural causes. Homicides accounted for 54% of the deaths where as 39.3% were accidental deaths. Firearms were the most common cause of deaths [44.6%], followed by road traffic accidents [27.7%]. Male to female ratio was 9:1 with 88.8% of the victims being males. Majority of the victims belonged to age group 19-32 years [47.3%]

Conclusion: Homicides were the most common manner of death [54%], followed by accidents [39.3%]. Frequency in relation to cause of death revealed firearm injuries accounting for 446% deaths followed by road traffic accidents [278%]

experience of teaching bioethics at secondary schools in Karachi

Bioethics is the "critical analysis of emerging moral issues in health". The term was first used to refer to "the moral problems of the life sciences encompassing medicine, biology, environment, population and social sciences". Teaching bioethics is complex and challenging within multi-system educational program as in Pakistan for secondary schools. The objectives are difficult as bioethics teaching require changes in knowledge, skills and attitudes along with strong improvement in moral reasoning. The objectives of the study were to teach bioethics and evaluate comprehension and skills of ethical reasoning in students of secondary school in Karachi. This was a quasi-experimental study conducted in two schools [public and private-sector] of Karachi from January 2007 to December 2009. This was a preliminary study and used simple random sampling to recruit one hundred and ten students. The qualitative analysis of comprehension and skills were evaluated on numeric scales. The study found higher comprehension and skills level in females [66%] compared to male students during class-room sessions

Diabetes mellitus and limb loss: an analysis from a tertiary care center

To compare the frequency and determinants of prosthesis fitting [artificial limbs] in diabetic and non-diabetic amputees at a tertiary care center. Cross Sectional Comparative Study This study was conducted at Institute of Physical Medicine and Rehabilitation [IPM and R] at Dow University of Health Sciences, Karachi during Oct 2007- Sep 2010. Data was collected from amputee records files seeking carefor prosthetic fitting. There were 1469 prosthesis fitted in both diabetic and non-diabetics patients. The data from both groups were compared for frequency of amputation in diabetic and non-diabetics. The data was entered and analysis was performed on SPSS windows version 16. The analysis of data was performed for patients who were provided prosthesis fitting at IPM and R. Diabetic males were 327[73.6%] female were 117 [26.4%].About a third of amputees had primary, secondary and tertiary health care services for control of diabetes. About 60% of all diabetics were not able to seek medical care for control of diabetes. The use of primary, secondary and tertiary health care services to control diabetes were also recorded to correlate with health seeking facilities among diabetics. The prosthesis fitting was given to one third of diabetic patients after lower limb amputation. The major determinants of diabetic amputees were old age, man uneducated, low socioeconomic status. The facilities for primary, secondary and tertiary health care services to control diabetes are available only to one third of diabetic patients. Diabetic control, education of foot care and accessibility to diabetic and prosthesis centre can markedly improve functional integration of diabetic amputees in community