Genetic characterization of Sarcoptes scabiei var. hominis from scabies patients in Pakistan

@#Scabies occurs in human due to the burrowing ectoparasite Sarcoptes scabiei var. hominis resulting in intense itching and inflammation, and manifesting as a skin allergy. Limited information is available about the genetic diversity of S. scabiei in human. In this study, we characterized S. scabiei var. hominis using nuclear marker ITS-2, mitochondrial marker 16S and microsatellite markers. To examine the extent of the genetic variation, individual mite gDNA was first amplified using ITS-2, 16S and microsatellite primers by PCR, later amplicons were sequenced directly and analysed by MEGA 7. Sequence analysis of ITS- 2 showed no host segregation and geographical isolation, whereas 16S indicated presence of both hosts adapted and geographically segregated populations of S. scabiei. Results of microsatellites revealed polymorphism as allelic variability between and within the populations studied. The different varieties of Sarcoptes mites belong to different host species and geographic regions recommended that Sarcoptes mites are genetically isolated. This is the first report on the molecular characterization of S. scabiei var. hominis from Pakistan. Additionally, genetic studies including a greater number of specimens are required to comprehend the molecular epidemiology of Sarcoptes mite in Pakistan.

Glutathione s-transferase M1 and T1 gene deletions and susceptibility to acute lymphoblastic leukemia [ALL] in adults

Objective: Biotransformation of xenobiotics is critical for their metabolism and removal from the body which is carried out by xenobiotic metabolizing enzymes. Individuals carrying variants of genes that encode these enzymes have an altered ability to metabolize xenobiotics which may lead to an increased risk of acute lymphoblastic leukemia. The current study aimed to investigate the impact of GSTM1 and GSTT1 gene deletions in causing predisposition to adult ALL

Methods: The current case-control study involved 62 adult ALL patients and 62 age and gender matched healthy controls. Whole blood samples processed with standard phenol chloroform protocol for DNA isolation were genotyped using multiplex PCR approach for simultaneous identification of GSTM1 and GSTT1 deletions. The genotype frequency obtained for patients was compared to controls using odds ratio and chi-square

Results: The null genotype frequency of GSTM1 and GSTT1 in a group of adult ALL patients from Pakistan were 47% and 11% respectively. Deletion of GSTM1 and GSTT1 did not show statistically significant association with adult ALL [p=0.86 and p=0.35 respectively]. The combined GSTM1/GSTT1 deletion was observed in 2% patients and was not significantly associated with ALL in adults [p=0.85]

Conclusions: The results reveal that homozygous null polymorphism of GSTM1 and GSTT1 genes does not influence ALL susceptibility among adult patients. Cancer susceptibility associated with GST polymorphism varies with ethnic and geographic differences. Therefore, further investigation on different populations is needed to understand the role of these genetic variations in modifying adult ALL risk

Cypermethrin-induced Repeated-dose Immuno-toxicity in Oryctolagus Cuniculus: An Investigation into Pathology of Spleen and Blood

Background: Cypermethrin is a pyrethroid insecticide widely used in agriculture and medicines. Its toxicity effects on spleen and blood in male and female rabbits is studied in this research. Methods: Age- and weight-matched does/females (n=24) and bucks/males (n=24) of Japanese White rabbits were subjected to intraperitoneal cypermethrin administration @50, 100 and 150 mg.kg-1 b.wt. in groups B, C and D, respectively.  The experimental rabbit does and bucks were tested for hematology alterations after each of 5 CY-treatments, at days 1, 8, 15, 22 and 29.  One rabbit doe and one rabbit buck were sacrificed fortnightly (days 15, 29, 43, 57 and 71) to obtain spleen for histological studies. Results: CY-treated rabbit bucks developed anemia, leukopenia, neutropenia, monocytosis, eosinophilia and basocytopenia mostly in dose and time dependent manner.  In contrast, rabbit does show transient but significant leukocytosis, neutropenia, lymphopenia, monocytosis, eosinophilia and basophilia only in high dose group.  Moreover, spleen histology revealed congestion, depletion of white pulp with increased red pulp and hemosiderin deposition in CY treated rabbit bucks, but not rabbit does. Conclusions: This study concludes that immuno-toxicity by cypermethrin insecticide is not similar in male and female subjects.

Roux-en Y duodenojejunostomy for larger duodenal defects

Objective: To find the outcome of lateral duodenojejunostomy for larger duodenal defects due to different surgical conditions

Study design: Case series

Methodology: The clinical records were traced from the unit and hospital clinical record room. The data was collected and analyzed for the outcome of the procedure

Results: A total of six patients were managed with the surgical technique. All patients were allowed oral sips on 3[rd] postoperative day. One patient out of six needed ICU care of 42 days. Patient stay in ICU was of 42 days. Postoperative complications including anastomosis leak occurred in one patient. Nausea and vomiting was reported in two and wound infection in two patients. Mean hospital stay of the patients was 16.67 days

Conclusion: Roux-en Y duodenojejunostomy is a safe technique for the reconstruction of larger duodenal defects involving >50% [2/3[rd]] of the duodenal circumference

Association of ADIPOQ C-11377G [rs266729], TNF-alpha G-308A [rs1800629] and TNF-alpha G-238A [rs361525] single nucleotide polymorphisms with type 2 diabetes mellitus in Pakistani population

Objective: to determine the frequencies of adiponectin [ADIPOQ] C-11377G, tumor necrosis factor-alpha [TNF-alpha] G-308A and TNF-alpha G-238A single nucleotide polymorphisms [SNP] and their association with serum levels in Pakistani T2DM and healthy population

Study Design: Case control study

Place and Duration of Study: Military Hospital, Rawalpindi, Army Medical College and Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan, from June 2012 till 2014

Methodology: cases [n=539] and controls [n=250] comprising of T2DM and healthy subjects, respectively, belonging to Pakistani Punjabi Rajput ethnicity were genotyped for SNPs. Serum adiponectin, TNF-alpha, insulin, blood sugar fasting [BSF], lipid profile, body mass index [BMI], and insulin resistance [IR] was determined and correlated with genotypes

Results: serum TNF-alpha was significantly higher and adiponectin was lower in T2DM than healthy controls [p < 0.003 and 0.0001, respectively, Mann-Whitney U-test]. The frequency of ADIPOQ CC, GC and GG was 340 [63.1%], 167 [31%] and 32 [5.9%] in T2DM patients. ADIPOQ -11377 SNP was not significantly associated with T2DM [OR = 1.116 [95% CI 0.81- 1.53], p = 0.27- Fisher's exact test]. Genotypes deviated from Hardy-Weinberg equilibrium. Minor alleles of TNF-alpha G-308A and TNF-alpha G-238A were not found in either groups

Conclusion: frequency of ADIPOQ -11377 risk allele is low and does not functionally affect the serum adiponectin levels; hence, ADIPOQ C-11377G SNP is not a risk factor for T2DM in Pakistani Punjabi Rajput patients. Moreover, TNF-alpha G-308A and TNF-alpha G-238A SNPs are not prevalent in this ethnic group

Polymorphisms of the ABCB1 gene in the pakistani population

To investigate the frequency of the single nucleotide polymorphism C1236T in exon 12 of the ABCB1 gene in Pakistani population and to compare it with published data on Asian and Caucasian populations. A cross-sectional observational study. Combined Military Hospital, Rawalpindi and Institute of Biomedical and Genetic Engineering [IBGE], Islamabad, from August 2012 to May 2013. C1236T polymorphism was investigated in 426 Pakistani subjects. The frequency was compared with the published data on other Asian and Caucasian populations. The frequencies of ABCB1 C1236T were 16.4% for CC, 44.1% for CT and 39.4% for TT. Pakistanis differed significantly from all the European populations compared in the distribution of the TT genotype of C1236T ABCB1 [p < 0.05]. The Pakistani population also differed significantly from some of the European populations in the distribution of CC and CT genotype [p < 0.05]. There was significant difference in the genotype frequency of the ABCB1 gene compared to other populations. This study has provided a framework for future pharmacogenetic and pharmacokinetic studies on this polymorphic variant of ABCB1 gene in the Pakistani population

Association of anti-emetic efficacy of ondansetron with G2677T polymorphism in a drug transporter gene ABCB1 in Pakistani population

To determine the association of ABCB1polymorphism G2677T with anti-emetic efficacy in patients treated with ondansetron for preventing postoperative nausea and vomiting. A clinical trial. Combined Military Hospital, Rawalpindi and Institute of Biomedical and Genetic Engineering, Islamabad, from 2012 to 2013. Four mg ondansetron was administered intravenously 30 minutes before the end of surgery. A total of 246 patients with the complaints of nausea and vomiting and 244 patients without nausea and vomiting were analyzed for G2677T polymorphism using PCR-RFLP method. Results were described as frequency percentages and chi-square test with significance at p < 0.05. The patients with TT genotype had significantly lower incidence of postoperative nausea and vomiting during the first 2 hours [p < 0.001] and between 2 - 24 hours after surgery as compared to other genotypes [p < 0.001]. The patients with GG genotypes had significantly higher incidence of this complaint [p=0.014]. Polymorphism of ABCB1 has an association with responsiveness for ondansetron. There is a role for genetics in the management of PONV

Prevalence of cyp2d6*4 genotype and its association with tamoxifen induced hot flashes in Pakistani female breast cancer patients

To investigate the frequency of CYP2D6*4 in Pakistani breast cancer patients for the first time and also investigate its association with tamoxifen induced hot flashes. A retrospective study carried out in Nuclear Medicine, Oncology and Radiotherapy Institute [NORI] Islamabad and Combined Military Hospital Rawalpindi [CMH]. Pre and postmenopausal breast cancer women who were advised 20mg/day of tamoxifen as adjuvant therapy were recruited for the study. The data from January 2000 to September 2013 was collected from the medical records of the outpatient breast cancer clinics. 232 women who fulfilled the eligibility criteria were initially recruited and their peripheral whole blood samples were taken. CYP2D6*4 was determined by using PCR-RFLP, allele*4 was not identified in 9 women and study was conducted on 223 women. None of the women died during the study period. Data of 223 women was analysed and the allele frequency of CYP2D6*1 was 86% and that of CYP2D6*4 was 14%. Women with CYP2D6*4/*4 did not experience mild to moderate or severe hot flashes as compared to women heterozygous or homozygous for wild type allele *1. The frequency of CYP2D6*4 allele in Pakistani breast cancer women is 14% which is comparable to the Caucasians moreover CYP2D6*4/*4 genotypes have lower incidence of hot flashes, but the results are not statistically significant

case control study of risk factors associated with female breast cancer

To find the association of various risk factors with breast cancer. It was a case-control study. The study was carried out in NORI Hospital Islamabad and Combined Military Hospital Rawalpindi between August, 2013 and February, 2014. Two hundred breast cancer patients and 200 control subjects were inducted. A short approved and planned questionnaire was used to collect data regarding basic demographic, menstrual and reproductive characteristics of participating females. Cases and controls were then interviewed after taking written consent. Breast cancer patients and control subjects did not differ regarding age [p = 0.15], early menarche [OR for menarche at <13 years vs. >/=13=1.3, 95% CI = 0.84 - 2.02], and history of breast cancer in 1st degree relatives did not increase breast cancer risk [OR = 1.0, 95% CI = 0.57- 1.74]. Nulliparous women had significantly higher risk than parous women [OR = 2.43, 95% CI = 1.22 - 4.84] and women with late menopause compared to women with early onset of menopause were also at higher risk for breast cancer [OR for menopause at >/= 50 vs. < 50 = 5.16, 95% CI = 2.59 - 10.29]. Nulliparity and menopausal age of more than 50 years was associated with increased breast cancer risk. Breastfeeding and age less than 25 years at first live birth was not protective against breast cancer

Challenges faced by women entrepreneurs: a Case study of Tangwani Kandhkot/ Kashmore District Sindh Pakistan

The research investigates the domestic violence against women in Tangwani District Kandhkot Kashmore Sindh Pakistan. Data were collected from 150 women by using qualitative and quantitative methods were used. The qualitative methods involved initial focus group meetings that were followed by the survey questionnaire. The survey questionnaire was more of an in depth interview because of the sensitive nature of the issues and therefore included open ended questions with certain inferences on the types of violence recorded on a quantitative sheet. Data were analyzed by using E-View 7. It was revealed that most of the surveyed women were quiet depressed and their male counterparts not working but they are solely depending on women work in SMEs. It was further revealed that the rural women is less confident and their husbands were always given them hard time once they are exposing themselves to outside the boundaries of the house. The biggest challenges which they were facing they were doing all business in house, lack of marketing facilities, Karo Kari criminal activities and they were deprived from the basic rights. The number of women who died of stove burns in the first six months of 2011-2014 was 300 compared to 1300 murders that took place at the same time

Comparison of the efficacy of partial inferior turbinectomy and submucosal diathermy on nasal obstruction in allergic rhinitis

The purpose of this study was to compare the effects of bilateral partial inferior turbinectomy and submucosal diathermy of inferior turbinates on nasal obstruction in patients with allergic rhinitis. Prospective comparative study. This study was conducted at Departments of ENT, Mufti Mehmood Memorial [MMM] Teaching Hospital and District Headquarter Teaching Hospital [DHQ], Lakki Marwat from January 2009 to June 2013. Subjects of either sex, aging more than 10 years with symptomatic bilateral enlarged inferior turbinates due to allergic rhinitis attending ENT OPD were included. They were divided into two groups. An alternate sequential entry was made to group A and group B. Patients in group A were offered bilateral partial inferior turbinectomy [PIT] while those in group B underwent mono-polar sub-mucosal diathermy [SMD] of inferior turbinates. Data was collected at first visit prior to intervention, second at 1 month and third at 3 months after surgery. Anterior rhinoscopy and visual analogue scale were used to assess treatment outcomes. Out of 96 patients with 48 patients in each group, males [58%.3] out-numbered the females [41.7%] in both groups. Mean age of the patients in group 1 was 21.88 +/- 7.528 range [10-35] years and in group 2 was a 19.75 +/- 6.525 range [10-33] year. The mean nasal obstruction score was lower in group 1 than in group 2 at 1 month, and 3 months after surgery suggesting a good outcome, although statistically non-significant [p=value 0.177, 0.198 respectively]. Both bilateral PIT as well as SMD are effective in improving nasal obstruction in patients with hypertrophied inferior turbinates due to allergic rhinitis

Resistance to ondansetron: role of pharmacogenetics in post-operative nausea and vomiting

Post-operative nausea and vomiting is the most annoying and at the same time a dangerous side effect of general anaesthesia. Ondansetron is a routinely used anti emetic drug which is being administered by the trial and error principle. Though it did revolutionized the management of this condition but by and large failed to completely eliminate the problem. Recently an important factor possibly elucidating this failure is said to be the differing expression of genes controlling proteins that are involved in transport and receptors related to this drug. Quite surprisingly these transporter and receptor pathways have been found to be polymorphic and at the same time shown to be related to efficacy of the drug. The differentiation between those responding to treatment and those not responding may pave a way to individualize treatment for emesis to a greater extent. This review highlights the pharmacogenetics related to this commonly used anti-emetic drug in anaesthesia. It is visualized as a promising way to achieve the target of individualized therapy. It seems obvious that pharmacogenetics will become an important field of anaesthesia research in the future

Patterns of prescription writing in psychiatric clinics

To screen the prescription-writing pattern of psychiatrists in private clinic in Peshawar for the essential elements of prescriptions and to investigate the prescribing trends at Peshawar. This observational study was carried out at LRH Peshawar on 602 prescriptionsin 5 months duration. The prescriptions were collected from the patients admitted to LRH and the variables were checked and noted directly into electronic form. Averagely 3.34 drugs were prescribed per prescription, in which drug-related variables: [i] strength of medication was indicated for all drugs in 409 [67.94%] of the prescriptions and were missing for some drugs in 177 [29.4%] prescriptions, [ii] total quantity of a drug to be dispensed was indicated for any drug in just over 111[18.43%] of prescriptions, [iii] The instructions for taking the medication were complete in only 301 [50%] of prescriptions. Fluoxetine alone or in combination [8.4%] was the most commonly prescribed antidepressant. There were 319 [15.8%] non-steroidal anti-inflammatory drugs [NSAIDs] and/or analgesics. Vitamin preparations accounted for 4.02% of all drugs dispensed. SSRI's were the most frequently prescribed medication in majority of prescriptions. Inconsistency regarding different prescription components was observed, such as strength of medication, frequency or instruction for medication use etc

Causes and management of epistaxis at a district hospital

To determine causes, types, laterality, need for hospital admission and success rate of treatment modalities of epistaxis. This study was conducted at Department of ENT, Mufti Mehmood Memorial Teaching Hospital, D.I. Khan, Pakistan from September 2010 to June 2012. All patients of acute epistaxis due to any cause were included. Those in whom bleeding stopped spontaneously were excluded. The data for the following nine variables was collected; gender, age in years, age group, cause, type and laterality of epistaxis, need for hospital admission and success rate of treatment modalities. Out of 275 patients. 199 [64%] were male and 76 [36%] female. Mean age of the patients was 38.30 +/- 23.69 years. Trauma was the commonest [46.9%] cause followed by hypertension [26.9%]. Anterior epistaxis was commoner [61.45%] than posterior [20.75%]. Silver Nitrate Cautry was the commonest [57.80%] treatment modality followed by anterior nasal packing [31.3%]. The success rate was 91.80% for Silver Nitrate Cautry. Carrying good success rate, Silver Nitrate Cautry is a preferred choice for treatment of anterior epistaxsis

Validation of PCR assay for identification of sarcoptes scabiei var. hominis

Infestation of the skin by the "itch mite" Sarcoptes scabiei var. hominis results in a contagious skin infection in humans called "scabies". By resolving morphology issues, the present study was designed to be acquainted with itch mite by molecular markers. The mite samples were collected from scabies patients by visiting government hospitals of twin City, Pakistan. For successful mo-lecular detection approach, preparation of Sarcoptes mite DNA by commercial DNA extraction kit method. Furthermore, two primers i.e. Sarms 15 F/R and 16S D1/D2 were used to amplify target sequence by using PCR. The amplified products were then separated by agarose gel, electrophoresis and analyzed after staining and visualizing in UV transilluminator. Analysis of PCR product showed one specific band of 178 bp with primer Sarms 15 F/R, while, with primer 16S D1/D2 bands of 460 bp and 600 bp were observed on 2% agarose gel. The appearance of different band of 600 bp revealed that it might be due to heteroplasmy state present in the Pakistani Sarcoptes mites population. Current study adds validity to the claim that PCR is more accurate, specific and sensitive in the detection of the ectoparasites even in smallest amount

Outcome of silver nitrate cauterization in controlling anterior epistaxis in children

To assess the outcome of silver nitrate cauterization in controlling unilateral spontaneous anterior epistaxis in children in terms of success on initial attempt and complications like recurrence of bleeding, pain, infection, exposure of septal cartilage, septal perforation and stenosis of the nostrils. Cross-Sectional Descriptive This study was conducted at Department of ENT, Mufti Mehmood Memorial Teaching Hospital, D.I.Khan, from October 2010 to September 2012. All patients having ages between 6-16 years with spontaneous unilateral anterior epistaxis were included in the study. Patients with bilateral anterior epistaxis, posterior epistaxis, post-traumatic epistaxis, and epistaxis due to bleeding diathesis or neoplastic lesions were excluded. Patients were managed by silver nitrate cauterization after packing the nose with ribbon gauze soaked in 4% lidocaine and adrenaline 1:1,000 in equal amounts for 5-10 minutes. Furacin antibiotic ointment was applied to the cauterized area and was continued two times daily for two weeks. All patients were reviewed fortnightly for six weeks. Mean age of the patients was 10.43 +/- 3.23 years with 49 [65.35%] males and 26 [34.65%] females. Silver nitrate cauterization was successful on initial attempt in 69 [92%] patients. Recurrence of bleeding, infection and exposure of septal cartilage were noted in 7 [9.35%], 2 [2.65%] and 1 [1.33%] cases respectively. The increased success rate and decreased post procedure morbidity associated with silver nitrate cauterization make it an effective and safe procedure for managing spontaneous unilateral anterior epistaxis in children

Antibacterial activity of local herbs collected from Murree [Pakistan] against multi-drug resistant klebsiella pneumonae, E. coli and methyciline resistant Staphylococcus aureus

Exploring healing power in plants emerged in prehistory of human civilization. Sustaining good health has been achieved over the millions of years by use of plant products in various traditional sockets. A major contribution of medicinal plants to health care systems is their limitless possession of bioactive components that stimulate explicit physiological actions. Luckily Pakistan is blessed with huge reservoir of plants with medicinal potential and some of them; we focused in this study for their medicinal importance. In this study we checked the antibacterial activity inherent in Ricinus communis, Solanum nigrum, Dodonaea viscose and Berberis lyceum extracts for multidrug resistance bacterial strains Klebsiella pneumonae, E. coli and methyciline resistant Staphylococcus aureus. MRSA showed sensitivity for Ricinus communis. Multidrug resistant Klebsiella pneumonae was sensitive with Pine roxburgii and Ricinus communis but weakly susceptible for Solanum nigrum. Multidrug resistant E. coli was resistant to all plant extracts. Treatment of severe infections caused by the bacterial strains used in this study with Ricinus communis, Pine roxburgii and Solanum nigrum can lower the undesired side effects of synthetic medicine and also reduce the economic burden

Substance abuse in patients with co-morbid adhd

To study the tendency of occurrence of attention-deficit hyperactivity disorder [ADHD] with substance abuse. A cross-sectional, hospital based study. The study was carried out at Lady Reading Hospital and Khyber Teaching Hospital, Peshawar, Pakistan from 4th April 2012 to 29th August 2012. A sample of 110 adult patients with 53 heroin dependents, 23 THC, 15 opium, 11 poly drug and 8 alcohol dependents were analyzed that whether they were ADHD and that childhood problem continues to manifest symptoms in adults. For retrospective assessment of childhood ADHD, the Wender Utah Rating Scale [WURS] as well as the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV] symptom checklist for ADHD was used. The Conners' Adult ADHD Rating Scales [CAARS] was used to assess the persisting symptoms of ADHD in adults.Patient diagnosed with drug and alcohol dependence according to DSM-IV were included in the study whereas patient co-morbid with any other psychiatric illnesses were excluded. Heroin dependent showed 41.5% [WURS] and 37.7% [DSM-IV diagnostic criteria], whereas THC validated 34.7% [WURS] and 30.4% [DSM-IV], opium demonstrated 46.6% [WURS] and 40%[DSM-IV], poly drug dependence established 63.6% [WURS] and 54.5% [DSM-IV] and alcohol dependent showed 50% [WURS] and 37.5% [DSM-IV] indicated evidence of retrospective ADHD affliction in childhood. CAARS was presented in 35.8% heroin dependent, 34.7% THC, 46.6% opioid, 33.3% poly drug dependence and 37.5% alcohol dependent; and exhibited a substantiation of ADHD persistent in adulthood. The difference between the mean score of WURS and CAARS of ADHD patients were significantly greater [P = 0.029], than the normal patients. Pese results revealed that ADHD is a risk factor associated with substance dependence, expressed in the form of heroine, THC, opioid, alcohol dependence and also in poly drug dependence