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.

Identification and Characterization of the ATG8, a Marker of Eimeria tenella Autophagy / Identificação e Caracterização do ATG8, um marcador de autofagia em Eimeria tenella

Abstract Autophagy plays an important role in maintaining cell homeostasis through degradation of denatured proteins and other biological macromolecules. In recent years, many researchers focus on mechanism of autophagy in apicomplexan parasites, but little was known about this process in avian coccidia. In our present study. The cloning, sequencing and characterization of autophagy-related gene (Etatg8) were investigated by quantitative real-time PCR (RT-qPCR), western blotting (WB), indirect immunofluorescence assays (IFAs) and transmission electron microscopy (TEM), respectively. The results have shown 375-bp ORF of Etatg8, encoding a protein of 124 amino acids in E. tenella, the protein structure and properties are similar to other apicomplexan parasites. RT-qPCR revealed Etatg8 gene expression during four developmental stages in E. tenella, but their transcriptional levels were significantly higher at the unsporulated oocysts stage. WB and IFA showed that EtATG8 was lipidated to bind the autophagosome membrane under starvation or rapamycin conditions, and aggregated in the cytoplasm of sporozoites and merozoites, however, the process of autophagosome membrane production can be inhibited by 3-methyladenine. In conclusion, we found that E. tenella has a conserved autophagy mechanism like other apicomplexan parasites, and EtATG8 can be used as a marker for future research on autophagy targeting avian coccidia.

Resumo A autofagia desempenha um papel importante na manutenção da homeostase celular através da degradação de proteínas desnaturadas e outras macromoléculas biológicas. Nos últimos anos, muitos pesquisadores se concentraram no mecanismo da autofagia em parasitas apicomplexos, mas pouco se sabe sobre esse processo na coccidia aviária. No presente estudo, a clonagem, sequenciamento e caracterização de gene relacionado à autofagia Etatg8 foram investigados pela PCR quantitativa em tempo real (RT-qPCR), mancha ocidental (WB), ensaios indiretos de imunofluorescência (IFAs) e microscopia eletrônica de transmissão (TEM), respectivamente. Os resultados mostraram que o gene Etatg8 de E. tenella possui uma ORF de 375 bp, codificando uma proteína de 124 aminoácidos com estrutura e propriedades semelhantes à de outros apicomplexos. RT-qPCR revelou que Etatg8 é expresso durante os quatro estágios de desenvolvimento de E. tenella. Entretanto, seus níveis transcricionais foram significativamente mais elevados na fase de oocisto não esporulados. Os ensaios de manchas ocidental (WB) e de imunofluorescência (IFA) mostraram que a proteína EtATG8 foi lipidada para ligar-se à membrana do autofagossomo sob condições de deficiência nutritiva (em presença de rapamicina) e se agregar no citoplasma de esporozoítas e merozoítas. No entanto, o processo de produção de membrana do autofagossomo pode ser inibido por um inibidor de autofagia (3-meetiladeninatiladenina, 3-MA). Em conclusão, foi demonstrado que E. tenella tem um mecanismo de autofagia conservado, semelhante ao de outros parasitas apicomplexos, e que EtATG8 pode ser usado como um marcador para futuras pesquisas sobre autofagia direcionada à coccidiose aviária.

Efficacy of Probiotics Supplementation on Growth Performance, Carcass Composition and Hematological Parameters of Cyprinus carpio Fingerlings Fed Corn Gluten Meal-Based Diet

Abstract Plant based protein sources are one of the best, cost effective and easily available protein sources being used in fish feed. But due to a lower number of micro-biota in fish gut plant meal based diets cannot be digested and absorbed well in fish body. Probiotics were supplemented at 0, 1, 2, 3, 4 and 5 gkg-1 levels in fish feed for formulating one control and five test diets. In this study, three replicates of each treatment were used and number of fingerlings was 15 in each replicate. The C. carpio (common carp) fingerlings were fed at 5% of live wet weight on their prescribed diet twice daily. The results revealed that supplementation of probiotics in corn gluten meal based diets significantly (p<0.05) improved growth performance, carcass composition and hematological parameters. Most optimum values of growth performance parameters were noted at 2 gkg-1 level of probiotics supplemented diet. C. carpio fingerlings fed corn gluten meal based diet supplemented with 2 gkg-1 level of probiotics indicated significant (p<0.05) improvements in crude protein (17g) crude fat (9g) and gross energy (3 kcalg-1) whereas higher red blood cells (RBCs), white blood cells (WBCs) and hemoglobin (Hb) was also recorded in fish blood when fed 2 gkg-1 probiotics level diet. From these results, it was concluded that 2 gkg-1 probiotics supplementation in corn gluten meal based diet is optimum for improving growth performance, body composition and hematology of C. carpio fingerlings.

Effectiveness of thrombolytic therapy in patients with acute myocardial infarction within 12 hours of symptoms

Background: Atherosclerotic coronary artery disease particularly myocardial infarction is the leading cause of morbidity and mortality all over the world and its incidence is also on the rise in Pakistan. This study was done to assess the effectiveness of thrombolytic therapy in patients with acute myocardial infarction and comparison between diabetics and non- diabetics.Methods: This cross sectional study was conducted at Department of Cardiology, Bahawal Victoria Hospital, Bahawalpur from January to June 2019. Total 380 patients of aged 30-70 years either male or female with diagnosis of acute ST-elevation myocardial infarction presenting within 12 hours of the onset of chest pain were selected. Patients were given thrombolytic therapy with Streptokinase 1.5 MIU over 1 hour and post therapy, efficacy was assessed.Results: Mean age of the patients was 51.37±10.08 years. Mean duration of diabetes mellitus was 5.99±3.47 years. Duration of chest pain ranged from 1 hour to 12 hours with mean duration of 4.66±2.98 hours. Out of 380 patients of MI, treatment was found effective in 202 (53.2%) patients. Female gender, type of MI, and duration of chest pain were significantly associated with reduced efficacy (p value < 0.05). Presence of hypertension, smoking, dyslipidemia or family history of MI did not alter the efficacy significantly (p>0.05) while patients having diabetes had significantly reduced efficacy (p value < 0.001).Conclusions: There is reduced effectiveness of thrombolytic therapy in diabetic patients with ST elevation myocardial infarction.

Tumor budding and depth of invasion can be used as prognostic risk factors in determining treatment plan for early stage oral squamous cell carcinoma

Background: The grading of oral squamous cell carcinoma can be useful along with TNM staging in determining treatment plan. The aim is to evaluate the prognostic value of histopathological grading of oral squamous cell carcinoma and to find its importance in setting appropriate treatment plan.Methods: The study includes 60 oral squamous cell carcinoma cases surgically operated during January 2012 to December 2018. From the archival paraffin blocks and available resected specimens of each case, the histological parameters used in Bryne’s invasive grading system and Almangush BD model were evaluated and compared to their prognosis.Results: The parameters used in BD model-tumor budding and depth of invasion were found to be statistically significant with prognosis of the disease. Except for nuclear polymorphism, the parameters used in Bryne’s invasive front grading system do not correlate with prognosis.Conclusion: Based on the prognostic significance, tumor budding ≥5 buds in the invasive front area and depth of invasion ≥4mm can be used as risk factors in prospective clinical trials by considering them in early stage disparity cases for multimodality treatment approach and elective neck dissection.

The comparison of dexmedetomidine, esmolol, and combination of dexmedetomidine with esmolol for attenuation of sympathomimetic response to laryngoscopy and intubation in patients undergoing coronary artery bypass grafting

Background: The aim of this study was to compare the effects of dexmedetomidine, esmolol, and combination of both on control of sympathetic response to laryngoscopy and tracheal intubation in coronary artery disease patients. Material and Methods: A prospective, randomized, double-blinded clinical study included 90 patients scheduled for elective coronary artery bypass surgery. Patients were randomly allocated into three groups of 30 each: dexmedetomidine group (Group D) 1 μg/kg, esmolol group (Group E) 2 mg/kg, and group dexmedetomidine with esmolol (Group DE) 0.5 μg/kg of dexmedetomidine with 1 mg/kg of esmolol. Each drug was diluted with 0.9% normal saline to 20 ml volume and infused in 10 min before induction of anesthesia. Hemodynamic changes (heart rate [HR], arterial blood pressure, and pulmonary artery pressure) were compared at various time intervals as follows-baseline, after study drug, after induction, and 1, 3, and 5 min after intubation. Statistical analysis included analysis of variance, Chi-square, and Fisher's exact test. Results: In Group DE, there was no significant increase in HR at all-time intervals, and the HR was stable compared to Group D and Group E. Blood pressure values were comparable in all groups except in Group E at 5 min. The pulmonary arterial pressures were statistically less in DE group except at 3 and 5 min. Conclusions: The combination of dexmedetomidine and esmolol group has beneficial effect on HR and pulmonary arterial pressures but has no additional advantage with respect to arterial blood pressure when compared with dexmedetomidine and esmolol groups in patients undergoing elective coronary artery bypass grafting.

Neonatal Sepsis: Frequency and Antibiogram Profiling of Bacterial Isolates in a Tertiary Teaching Hospital Lahore, Pakistan.

Introduction: Nеоnаtаl ѕерѕіѕ is one of the most commoncause of neonatal morbidity and mortality in Pakistan andworldwide so the present study was aimed tо evaluatefrequency and antibiotic sensitivity pattern of bacteriaassociated with nеоnаtаl ѕерѕіѕ in Paediatric Intensive CareUnit of a teaching hospital in Lahore, Pakistan.Material and methods: It was an observational, crosssectional study conducted at Paediatric Intensive Care Unit,Dераrtmеnt оf Раеdіаtrіϲѕ, Arif Memorial Hospital, Lahorefrom 1st July 2018 till 31st December 2018. Total 166 Nеоnаtеѕ(1 – 28 dауѕ оf lіfе) ԝіth neonatal sepsis were included in thisstudy. Nеоnаtеѕ ԝіth grоѕѕ ϲоngеnіtаl mаlfоrmаtіоn or thosewho had already received any antibiotic ԝеrе еxϲludеd frоmthе ѕtudу. Аll those nеоnаtеѕ ԝhо mеt thе іnϲluѕіоn ϲrіtеrіаwere further investigated in laboratory (ϲоmрlеtе blооd ϲоunt,рrоthrоmbіn tіmе, and blооd ϲulturеѕ). Positive Blood cultureswere checked for their sensitivity to various antibiotics.Rеѕultѕ: Thе mеаn аgе of cases ԝаѕ 17.3±7 dауѕ. Genderdistribution was 90 (54.2%) mаlеs аnd 76 (45.8%) fеmаlеs.Out of total 166 cases, 100 (60.2%) had еаrlу оnѕеt nеоnаtаlѕерѕіѕ аnd 66 (39.8%) had lаtе оnѕеt ѕерѕіѕ. History of PretermРrеmаturе ruрturе оf mеmbrаnе was present in 24.6%.Thе mоѕt ϲоmmоn оrgаnіѕm іѕоlаtеd on blооd culture wasKlеbѕіеllа рnеumоnіае (38.29%) fоllоԝеd bу Еscherichia ϲоlі(23.40%) аnd Stарhуlоϲоϲϲuѕ аurеuѕ (17.02%). Klebsiellawas sensitive to Amikacin, Gentamycin and Ciprofloxacinin 100% cases, while it was resistant to Ampicillin in 100%cases.Cоncluѕіоn: Іt іѕ ϲоnϲludеd frоm our ѕtudу thаt Klеbѕіеllаpneumoniae iѕ thе mоѕt ϲоmmоn оrgаnіѕm fоr nеоnаtаl ѕерѕіѕand it is ѕеnѕіtіvе tо ϲоmmоn аntіbіоtіϲѕ.

Failure rates of miniscrews inserted in the maxillary tuberosity

ABSTRACT Introduction: Anchorage conservation in orthodontics has always been a challenge. Objective: The aim of this current study was to find out the failure rate of miniscrews inserted in the maxillary tuberosity (MT) region. Methods: This pilot study consisted of 40 patients (23 female, 17 male; mean age = 20.1±8.9 years) that had received 60 MT miniscrews for orthodontic treatment. Clinical notes and pictures were used to find out the primary outcome of miniscrew failure. Independent failure factors were also investigated. Logistic regression analysis was done for predictor's relation with MT miniscrews failure. Results: There was no significant correlation in failure rate according to various predictor variables, except for miniscrews installed by lesser experienced operators, which showed significantly more failure. The odds ratio for miniscrew failure placed by inexperienced operators was 4.16. Conclusion: A 26.3% failure rate of mini-implants inserted in the MT region was observed.

RESUMO Introdução: a manutenção da ancoragem sempre foi um desafio na Ortodontia. Objetivo: o objetivo do presente estudo foi descobrir a taxa de falhas dos mini-implantes instalados na região da tuberosidade maxilar (TM). Métodos: o presente estudo piloto avaliou 40 pacientes (23 mulheres, 17 homens; idade média = 20,1 ± 8,9 anos) que receberam 60 mini-implantes na TM durante o tratamento ortodôntico. Anotações clínicas e fotografias foram usadas para investigar o principal motivo para a falha do mini-implante. Fatores de insucesso independentes também foram investigados. Uma análise de regressão logística foi realizada para medir o impacto de cada fator preditivo sobre a falha na instalação dos mini-implantes na TM. Resultados: as diferentes variáveis preditivas não demonstraram correlação significativa com a taxa de falhas, com exceção da instalação dos mini-implantes realizada por operadores inexperientes, que mostrou quantidade significativamente maior de falhas. A razão de chances para a falha dos mini-implantes instalados por operadores inexperientes foi de 4,16. Conclusão: observou-se uma taxa de falhas de 26,3% para os mini-implantes instalados na região da TM.

Pregnancy induced hypertension: lipid peroxidation and antioxidant status

Background: Pregnancy is a stressful condition accompanied by a high energy demand and increased oxygen requirement. Oxidative stress has been recognized as a significant factor linked to hypertension. Elucidation of anti-oxidant cascade in patients with pregnancy induced hypertension (PIH). can give insights about the oxidative stress and lead to better management of the condition. It was a prospective case control study to elucidate the parameters of oxidative stress in patients with PIH.Methods: Levels of Malondialdehyde (MDA), superoxide dismutase (SOD) and catalase (CAT) were eludidated using enzyme linked immunosorbent assay (ELISA) in hypertensive mothers and their age matched pregnant and non-pregnant controls to determine the lipid peroxidation and oxidative stress.Results: A total of four hundred and twenty study subjects were enrolled in the study. Malondialdehyde levels from mothers with hypertension were significantly higher than their age matched pregnant controls. The results indicate that oxidative stress induced by pregnancy induced hypertension manifests as increased lipid peroxidation. Conclusion: There is a decrement in anti-oxidant status reflecting the ineffective scavenging of reactive oxygen species resulting in oxidative damage and tissue injury.

Nosocomial Infections: Awareness and Practices of Nurses Regarding its Spread in a Tertiary Care Hospital of Lahore, Pakistan

Introduction: The infections acquired in patients duringadmission in a hospital and the patients have no evidenceof infection before admission in hospital are known asnosocomial infections or hospital acquired infections. Theetiological organism may be bacterial, fungal, viral orparasitic, found in the air or on hospital items; spreading fromone person to another person. The main objective of currentstudy was to assess the knowledge and practices of nurseswith respect to the spread of hospital infections in a tertiaryhospital of Lahore.Material and methods: A cross sectional, descriptive studywas carried out in a tertiary hospital of Lahore, Pakistanduring a period of four months from June 2018 to September2018. Sample size was 120 and simple random sampling wasdone. Data analysis was done by SPSS version 21.Results: Most of the participants 115(95.8%) were female and5(4.2%) were male. It was revealed that nurses had enoughawareness about the spread of hospital infections. Out of120 participants, 39 (32.5%) were agree and 34(28.3%) werestrongly agree that they are aware of handwashing guidelines,but their practices to reduce the spread of hospital infectionwere not good since 38(31.7%) were neutral and 9(7.5%)were disagree to follow the recommended guidelines for usingalcohol based solutions or other antiseptics before and aftereach contact with patients.Conclusion: Nurses had a good knowledge regarding thespread of nosocomial infections, use of safety precautionsand use of alcohol based formulations but their practicesfor reducing the spread of hospital infections were not up tosatisfactory level.

Effect of six-month use of oral contraceptive pills on plasminogen activator inhibitor-1 & factor VIII among women with polycystic ovary syndrome: An observational pilot study

Background & objectives: Polycystic ovary syndrome (PCOS) is an endocrinopathy warranting lifelong individualized management by lifestyle and pharmacological agents mainly oral contraceptive pills (OCPs). This study was aimed to report the impact of six-month OCP use on plasminogen activator inhibitor-1 (PAI-1) and factor VIII (FVIII) in women with PCOS. Methods: PCOS women diagnosed on the basis of Rotterdam 2003 criteria, either treated with OCPs (ethinyl estradiol-0.03 mg, levonorgestrel-0.15 mg) for a period of six months (n=40) or drug-naïve (n=42), were enrolled in this study. Blood was drawn to estimate glucose, insulin levels and lipid profile. Chemiluminescence immunoassays were used to measure hormones (LH, FSH, PRL, T4). Plasma levels of PAI-I and FVIII were measured by commercially available kits. Results: Menstrual regularity, Ferriman-Gallwey score and serum total testosterone significantly improved in the OCP group compared to drug-naïve group (P<0.01). No significant difference was observed in PAI-1 levels of the two groups; however, significant decrease in FVIII levels was observed in OCP group as compared to drug-naïve group. PAI-1 levels of OCP group correlated positively with blood glucose two hours, triglycerides and insulin two hours, while FVIII levels of OCP group correlated negatively with fasting insulin and homoeostatic model assessment-insulin resistance. Interpretation & conclusions: OCPs use has differential effect on pro-coagulant markers among women with PCOS. Well-designed, long-term, prospective, large-scale studies are prerequisite to elucidate the efficacy and safety of OCP in the treatment of PCOS.

Albendazole in the treatment of hymenolepiasis in school children

Hymenolepiasis is a helminthic and occasionally fatal disease of human imposing heavy economic losses to human society. Present study was aimed to diagnose the school children for the prevalence and control of Hymenolepiasis. A school based cross-sectional analysis of stool samples collected from 188 children aged 06-15 years was carried out [February to June 2016]. Two stool samples were collected from each student before diagnosing and after treatment. The samples were fixed in 10% formalin and observed under the light microscope using the methods of direct smear in Lugol's solution, normal saline and flotation techniques. On the basis of drugs accessibility all the H. nana infected children were divided in to 2- groups. Children in group A were treated with albendazole [bendazol] 400mg once orally, group B was treated with albendazole [zentel] 200mg orally. Eggs per gram of faeces were counted in each group before and after treatment. Of the 188 children, current study reveals only 6.08% [n=18/296] infection with H.nana and 10.5% [n=16/151] were diagnosed with co infections. The % efficacy of albendazole [Zentel] and albendazole [bendazol] against Hymenolepis nana infection was reported as 83% and 75% respectively. Present study was concluded that albendazole [zentel] is the drug of choice for the treatment of hymenolepiasis in children

Cytotoxic, embryotoxic, insecticidal and anti-microbial activities of standardized Areca catechu nut

The study was aimed at evaluating various biological actions of widely consumed Areca catechu nut. The nut's ethanolic extract exhibited cytotoxicity [lung cancer cell line], embryotoxicity [chick embryo], phytotoxicity [Lemna minor], insecticidal [Rhyzopertha dominica], anti-bacterial [Pseudomonas aeruginosa], anti-fungal [Microsporum canis] and mitogenic [human blood lymphocytes] actions. The standardization results revealed presence of 1.7 microg arecoline per mg of extract. In conclusion, the Areca nut is endowed with both harmful and beneficial biological actions. Keeping in view its wide consumption and ease of availability, the aforesaid information should be channelized for health and agricultural benefits

Effectiveness of vascular markers [immunohistochemical stains] in soft tissue sarcomas

Objective: To ascertain the effectiveness of IHC markers of vascular origin like CD31, CD34, FLI1 and ERG in vascular soft tissue sarcomas including angiosarcomas, Kaposi sarcomas, epithelioid hemangioendothelioma and a non-vascular soft tissue sarcoma [Epithelioid sarcoma]. Study Design: Descriptive study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from 2011 to 2017

Methodology: Diagnosed cases of angiosarcomas [n=48], epithelioid hemangioendothelioma [n=9], Kaposi sarcoma [n=9] and epithelioid sarcoma [n=20] were selected. Immunohistochemical staining as performed on formalin fixed paraffin embedded sections. The sections were stained for the following markers: CD34 [VENTANA clone Q Bend 10], CD31 [Leica clone 1 A 10], FLI1 [CELL MARQUE clone MRQ-1] and ERG [CELL MARQUE clone EP111]

Results: A complete panel of CD34, CD31 and ERG was applied on 8/48 cases of angiosarcomas with triple positivity in 6 cases. Eight cases showed positivity for only CD31 and ERG and 2 cases showed positivity for only ERG. A complete panel of CD34, CD31 and ERG was applied on 3/9 cases of epithelioid hemangioendothelioma with positivity for all markers in 2 cases. Combined positivity for ERG and CD34 was seen in 2 cases and on 4 cases only CD31 immunohistochemical was solely applied with 100% positivity. FLI1 was not applied on any case. Among 9 cases of Kaposi sarcoma, ERG, CD34 and CD31 in combination were applied on only 1 case with triple positivity. Remaining cases show positivity for either CD34, CD31 or FLI1. Majority of cases of epithelioid sarcomas were diagnosed on the basis of cytokeratin and CD34 positivity with loss of INI1. The other vascular markers showed negativity in all cases

Conclusion: Among these four markers, ERG immunohistochemical stain is highly effective for endothelial differentiation due to its specific nuclear staining pattern in normal blood vessel endothelial cells [internal control] as well as neoplastic cells of vascular tumors and lack of background staining

Comparison of analgesic efficacy of intra-articular and peri-articular sacro-iliac joint injection in patients with sacro-iliac joint pain syndrome

Objective: To compare the analgesic efficacy of intra-articular vs peri-articular sacroiliac joint [SIJ] injection in patients with sacroiliac joint pain syndrome. Study Design: Prospective, randomized control trial. Place and Duration of study: The study was conducted at the department of Pain Medicine, Combined Military Hospital [CMH] Rawalpindi, from Jul 2015 to Jun 2016

Material and Methods: Forty eight patients of sacroiliac joint [SIJ] pain syndrome were randomly assigned into two equal groups. Group A [n=24] received intra articular SIJ injection of local anesthetic with steroid [Triamcinol one 40mg] under fluoroscopic guidance [drug volume 2.5] and group B [n=24] received Periarticular SIJ injection of local anesthetic with steroid [Triamcinolone 40mg] using land mark technique [drug volume 10ml]. Pain score was assessed at 0 [Preprocedural baseline], 4, 8, and 12 week intervals after intervention by using numerical rating scale [NRS]

Results: Mean NRS pain score of group A was 7.5 +/- 0.99 and 3.1 +/- 1.6 at 0 and 12 week respectively. Mean NRS pain score of group B was 7 +/- 1.10 and 5.55 +/- 1.0 at 0 and 12 week respectively. A p-value <0.05 at 12 week between group A vs group B. There was a reduction in mean pain score from baseline to 12 week in both the groups but this reduction in mean pain score was statistically significant in group A as compared to group B

Conclusion: Pain relief score was found to be statistically significant in fluoroscopic guided intra-articular technique as compared to peri-articular landmark technique for sacroiliac joint pain syndrome at 12 weeks post procedure

Antibiotic therapy versus appendicectomy in uncomplicated acute appendicitis in terms of efficacy

Objective: To compare antibiotic therapy and appendectomy in uncomplicated acute appendicitis in terms of efficacy

Study Design: Randomized controlled trial

Place and Duration of Study: Surgical Ward Forward Treatment Centre [FTC], 5 Mountain Medical Battalion Forward Kahuta Azad Jammu Kashmir [AJK], from Oct 2011 to Mar 2013

Material and Methods: A total of 103 patients with clinical diagnosis of acute appendicitis [AA] were admitted during the duration of study and divided into two groups by consecutive sampling. The antibiotic group consisted of 51 patients who received intravenous antibiotics for 48 hours and oral antibiotics for another 8 days. The appendectomy group comprised of 52 patients who all underwent standard appendectomy. All the patients were followed up at 1 month and 1 year for assessing efficacy and post treatment complications

Results: The efficacy of antibiotic treatment is 90.625% as compared to appendectomy which was 88.46% [p=0.759] at 1 month follow up after treatment. At one year post treatment, the comparison between the efficacy of antibiotic therapy [71.87%] and appendectomy [87.14%] remains statistically insignificant [p=0.055]

Conclusion: Antibiotic therapy is comparable to appendectomy in AA in terms of efficacy at 1 month and 1 year post treatment

Cytotoxicity and chromosomal aberrations induced by methanolic extract of Cuscuta reflexa and its pure compounds on meristematic cells of Allium species

Cuscuta reflexa [Convolvulaceae], is commonly known as amarbel or akashbel. In Bangladesh and Nepal some of the tribes use C. reflexa against edema, body ache, cancer, skin infections and liver disorders. Despite its traditional uses there is no information regarding genotoxic effects of either the plant extract or its pure compounds. Methanolic extract of C. reflexa [MECR] and pure compounds derived from it namely, odoroside H, neritaloside, and strospeside, were evaluated in Allium cepa L. and A. sativum L. for their effects on root growth, root apical meristem mitotic index [MI], and chromosomal aberrations [CAs]. In this study, we adopted a new method of calculating percent change in root length. MECR caused a concentration- and time- dependent inhibition in root length at 100 - 10000micro g/ml in A. cepa root. It was accompanied by a subsequent decline in MI which is an indicative of its cytotoxic effect. On the contrary, at low concentrations a significant rise in root length was noticeable. In A. sativum, MECR also reduced the root length having IC 50 values [tilde]8 x and 4.3 x lower than A. cepa. A variety of CAs were evident in both Allium systems after treatment with MECR, odoroside H and neritaloside. Thus in MECR, cardenolides glycosides, i.e. odoroside H and neritaloside could be accountable for its genotoxicity

In vivo antiviral potential of Glycyrrhiza glabra extract against Newcastle disease virus

Newcastle disease is highly infectious viral disease causing huge economic losses worldwide. These losses can be prevented by control of viral diseases. Medicinal plants have been traditionally used for treatment of different diseases since long. In this study the effect of extracts from Glycyrrhiza glabra leaves are investigated against Newcastle disease virus [NDV] by an in-vivo assay. Seven groups of nine-day-old embryonated chicken eggs were inoculated with various treatments of different plant extracts. All the groups except uninoculated negative control group were inoculated with velogenic NDV strain; five groups received different concentrations of the three extracts. Daily observe the rate of embryo survival. Allantoic fluid from treated eggs was collected for hem agglutination test. Results showed that embryo survival rate was higher 300micro g/mL treated group as all the extracts showed antiviral activity. Similarly, the plant extracts effectively control virus as no viruses were identified in the allantoic fluids of all groups treated with low doses of plant. The current results have clearly verified that all the extracts especially that of methanol 300micro g/mL from leaves of Glycyrrhiza glabra have strong antiviral activity against NDV in vivo

Battlefield surgery: an experience from forward treatment centre WANA

Objective: To profile the spectrum of injuries and management of casualities treated in forward treatment centre [FTC] Wana over a period of one year by optimizing the available resources of a Field Hospital

Study Design: Descriptive cross sectional study

Place and Duration of Study: Forward treatment center Wana South Waziristan Agency, from 21 Jan 2014 to 08 Dec 2014

Material and Methods: A total of 62 cases brought in FTC were included in the study. Cases were managed according to Advanced Trauma Life Support [ATLS] protocol. A policy of aggressive resuscitation, early primary repair of injuries and evacuation was followed at our setup

Results: All patients were male with a mean age of 28.1 +/- 4.443 yrs. The majority of casualties were military [52 cases, 83.9%] and the major cause of injury was found to be improvised explosive device [33 cases, 53.2%]. Extremities were involved in majority of casualties [38 cases, 50.7%]. A total number of 91 operations were performed in 62 cases which included 14 laparotomies [15.4%], 21 chest intubations [23%], 9 amputations [9.9%], 19 cases of debridement [20.9%], 10 fasciotomies [11%], 1 tendon repair [1.1%], 10 closed reduction of fractures [11%], 5 closed reduction of dislocations [5.5%] and 2 cases of extremity vascular repair [2.2%]

Conclusion: Optimal utilization of limited resources warrants a responsible approach of surgeons towards injured brought at FTCs. A variety of injuries may be encountered by the forward surgical team who can significantly contribute by providing life and limb saving surgery

Cuscuta reflexa roxb. and its pure compounds-induced micronuclei in plant cells and downregulation of EGFR expression in NCI-H460 Cell Line

Cuscuta reflexa Roxb. [Convolvulaceae] has medicinal applications used in treating wide range of diseases including cancer. The methanolic extract of C. reflexa Roxb. [MECR] grown on host Nerium oleander L.] and its pure compounds namely, odoroside H [1], neritaloside [2] and strospeside [3] were assessed for genotoxicity using mitotic meristematic root tip cells of Allium species [A. cepa and A. sativum] and meiotic pollen mother cells from Tradescantia pallida var purpurea. The effect of pure compounds were also evaluated in human non-small cell lung cancer cell line [NCI-H460] on tumor suppressor gene [p53] and epidermal growth factor receptor [EGFR] expression using agarose gel electrophoresis. The MECR between 0.1 and 1 mg/ml was ineffective in mitotically dividing cells, whereas in meiotic pollen mother cells, higher concentrations [5-20 mg/ml] caused significant induction of micronuclei [MN]. In both mitotic and meiotic cells, odoroside H and neritaloside induced significant rise in MN frequency, however, strospeside had no effect. The genotoxic potential in both cells was in the order of: [1] = [2] > MECR > [3]. MECR and odoroside H [1] caused dose dependent growth inhibition in NCI-H460 cells with GI50 of 0.92 +/- 0.04 microg/ml and of 0.08+/-0.01 microg/ml, respectively. The antiproliferative action of MECR [1 microg/ml], odoroside H [1] [0.14 microM], neritaloside [2] [.16 microM] and strospeside [3] [0.5 microM] in comparison to control, significantly downregulated expression of epithelial growth factor receptor [EGFR] by two fold with no affect on p53 gene expression. This study clearly demonstrates that MECR is genotoxic at higher doses and should be taken into account if used for medicinal purposes. The mitotic cells of Allium species were more sensitive [2x] in MN formation than meiotic cells of T. pallida pu. Furthermore, MECR and pure compounds possesses antiproliferative activity against NCI-H460 cells that might be mediated through EGFR-dependent but p53-independent pathways?