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The metalloelement Palladium has a number of potential Pharmaco-clinical advantages. Palladium compounds have antiviral, antibacterial, neuroprotective and antitumor properties. However studies have also indicated some mild to serious toxic effects of Palladium metalloelements. Biothiols are important antioxidants that provide protection against metals toxicity. The interaction of metalloelements with biothiols can provide valuable information about the level of toxicity of the metalloelements and about the protective role of biothiols thereof. In this piece of work the effect of salt and complexes of Palladium on the status of different thiols [GSH, NAC, and D-Pen] in aqueous medium, were examined, The thiol quantification was carried out using Elman's method through UV-visible spectrophotometry and 1 HNMR. Results of the study performed in aqueous medium showed that level of different thiols depleted after the addition of the inorganic salts and organic complexes of Palladium. The mechanism of interaction of Palladium with thiols was examined using H-NMR. The results indicate that the depletion in the level of thiols may be due to 1:1 or 1:2 conjugation of Palladium with thiols. These conjugation reactions further suggest that the Palladium have xenobiotic nature causing oxidative stress and thiols play their role in detoxification and biotransformation of these metalloelements
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Objective: To compare the efficacy of intravenous lignocain versus sevoflurane in prevention of coughing and desaturation at extubation in children less than 6 years of age. Study Design: Randomized controlled trial. Place and Duration of Study: This study was carried out at Combined Military Hospital Nowshera, from May 2013 to May 2016
Material and Methods: This randomized controlled trial study was conducted at Combined Military Hospital Nowshera from May 2013 to May 2014 after obtaining approval from the hospital ethics committee [IREC-0003/5/13/Aneas]. Sample size [n=710 patients] was calculated by using WHO Sample Size calculator with confidence level of 95%, level of significance 5%. Children aged three months to six years undergoing surgical procedures requiring the placement of definitive airway were randomly assigned into two groups. Patients were anaesthetized by standardized balanced anaesthesia technique. In group-A [n=355], three minutes prior to extubation lignocain 2% was used intravenously. In group-B [n=355], isoflurane was switched off, breathing circuit changed and sevoflurane started at minimum alveolar concentration [MAC 3-4%] for 3 minutes prior to extubation. Assessment for extubation was clinical. Oxygen saturation and severity of coughing were noted for 5 consecutive minutes, after extubation. Data were analysed by using statistical package for social sciences [SPSS] version 20. A p-value
Results: In group-A, 156 patients were less than 2 years of age while in group-B, 135 patients were less than 2 years old. In group-A, 199 and in group-B, 220 children were 2-6 years of age respectively. Post stratification the p-value for weight was 0.17 [p-value>0.05] and t-statistic was 1.36. Post stratification p-value for gender was 0.12 [p-value>0.05] and chi square statistic was 2.49. Demographic comparison described in table-I. Group A had more eventful extubation with 270 cases of cough [76%] as compared to group-B where it were noted in 199 cases [56%]. Similarly desaturation was observed in 85 cases in group-A [24%] as compared to 28 cases [8%] in group-B. The difference between the groups was satistically significant as shown in table-II and III
Conclusion: Sevoflurane based anaesthetic vapor mixture results in statistically significant prevention from events like coughing episodes and desaturation in post-extubation in children less than six years of age undergoing elective surgery
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Thallium has been shown to significantly influence various tissues of living organisms; Exposure to Thallium can disturb mitochondrial function, degenerate neurons, and interfere with the function of critical metabolic enzymes and co-enzymes. Glutathione [GSH] an essential biomarker is considered a key factor in harnessing the thallium toxicity. In the present study the interaction of Thallium [Thallium Chloride] and glutathione was investigated spectro- photometrically in aqueous media. The renowned Elman's experimental protocol was followed at a wavelength of 412nm for Glutathione quantification in each sample. The pH of each sample was maintained at 7.6 using Phosphate buffer during the entire course of the experiment. A concentration as well as time dependent depletion of glutathione after exposure to various concentration of Thallium metal was observed, revealing chemical interaction between the metal and glutathione. The exact mechanism of interaction of Thallium and glutathione is still to be investigated. However, this piece of research suggests that a decrease in the concentration of Glutathione may be due to Thallium-GSH abduct or oxidize glutathione [GSSG] formation. This study was performed in-vitro as a model of in vivo
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To assess levels of Interleukin-1 Beta and CRP, in Diabetic and Non-diabetic Myocardial Infarction patients, prior to and post angioplasty. 200 patients were recruited in the study. MI patients between the age of 40 and 60 years.Patients came to NICVD with complaints of chest pain, positive Troponin T test and ECG was the confirmatory test for MI. They were divided into 2 groups 100 patients each. First group comprised of MI patients without DMT-II and second group comprised of MI patients with DMT-II. Serum triglycerides, cholesterol, LDL and HDL, FBS, by enzymatic kits, Insulin by RIA. HbA1C, Interleukin-1 Beta and CRP by ELIZA. Interleukin1Beta and CRP were significantly higher [P<0.001] in patients at the time of the infarction, prior to angioplasty as compared post angioplasty levels in both groups, which indicate their importance in development of ischemia and MI. FBS and Insulin were significantly higher [P<0.001], while HDL and HbA1C were significantly lower [P<0.001] in MI without DMT-II when compared to MI with DMT-II. BMI, SBP pressure were significantly higher [P<0.001] in MI patients with DMT-II when compared with MI patients without DMT-II. Interleukin1Beta and CRP were found to be significantly higher prior to angioplasty as compared to post angioplasty levels in both groups which confirms their role in development of ischemia and MI
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Objective: To determine the major stresses of house officers, causes of these stress and the coping strategies
Study Design: Descriptive cross sectional study
Place and Duration of Study: Study was conducted in 13 different tertiary care hospitals of Karachi in both government and private sectors from Oct to Nov 2017
Material and Methods: A descriptive cross sectional study with multistage random sampling technique was done in which a self-designed and self-explanatory questionnaire was used. Results were analyzed using statistical package for social sciences [SPSS] version 20
Results: About 300 questionnaires were distributed to interns. From the total, 83.9 percent participants were female. The mean age of the participants was 24 years. Out of the total respondents, 9.4 percent participants stated no any significant medical mistake. Issues arising due to lack of knowledge or incompetency leading to mis diagnosis of patients were reported by 20.5 percent respondents. One of the common mistakes reported was wrong drug administration; either route, dosage or incorrect medicine, committed by about 25.3 percent of doctors participated. The most reported reason thought to be the underlying cause of mistakes was work overload that was about 36.3 percent
Conclusion: It can be concluded by the present study that house officers are susceptible to stress which affects their overall work performance and it leads to significant medical mistake due to which patient suffer and because of this pressure it's very hard both physically and mentally for a doctor to cope up
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Diabetes mellitus [DM] is a metabolic syndrome, in which there is chronic high blood glucose level. Amongst non-communicable diseases [NCD], type II Diabetes Mellitus is not only the most prevalent disease but its global burden is increasing rapidly. If the blood glucose level is not maintained appropriately, there is a high probability of the development of both macro-vascular as well as microvascular compli-cations. Multiple antidiabetic drugs are in line, but they fail to give long-term control of hyperglycemia, on the other hand these drugs have side effects as well. So there is a need to switch to natural products. The herbal extracts like Azadirachta indica [Neem] is well known for its powerful antioxidant, anti-inflammatory, antipyretic, antimicrobial and antidiabetic properties. It causes hypoglycemia and peroxi-dation of lipid metabolites while increasing the enzymatic activities of glutathione perox-idases, catalases and superoxide dismutases to enhance the antioxidation
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Objective: To investigate the impact of sitagliptin and vildagliptin on hemodynamic and metabolic parameters in type 2 diabetic patients
Study Design: A comparative randomized clinical trial
Settings: Outdoor patient of diabetic clinic of Sheikh Zayed medical College/ Hospital Rahim Yar Khan. Duration: Six months, July to December 2017
Methodology: Overall 120 type 2 diabetic patients with dyslipidemia and mild to moderate hypertension were randomized at diabetic clinic for treatment with sitagliptin and vildagliptin respectively for a period of 12 week. Body weight, BMI, blood pressure and serum lipid profile were analyzed pre and post treatment by using SPSS 16
Results: There was significant improvement in HbA1C after 12 weeks treatment with sitagliptin[8.1+/-2.2 to 6.8+/-3.5]vildagliptin[8.5+/-3.1 to 6.4+/-4.2] with in group. However no significant changes were observed between groups [p-0.64]. This improvement in glycemic control was further accompanied by reduction in blood pressure within groups i.e. systolic [152+/-12.2 to 130.2+/-9.8 vs142+/-15.5 to 122+/-12.4] diastolic [90.5+/-8.4 to 80.4+/-6.5 vs 93+/-9.4 to 82.5+/-10.6]. When comparison was done between two groups in terms of blood pressure it found to be non-significant [p=0.82 and p=0.77]. Serum lipid profile also improved significantly with in groups but non significantly between groups i.e. total cholesterol [265+/-14.5 to 202+/-17.2 vs 255+/-14.82 to 210+/-14.5 p=0.12] triglycerides [210+/-20.5 to182+/-27.2 vs 192+/-32.5 to 148+/-42.55 p=0.37]LDL-cholesterol [152+/-14.4 to120+/-20.6 vs 158+/-15.4 to 110+/-9.5 p=0.86] HDL-cholesterol[42.4+/-3.5 to 47.4+/-3.8 vs 44+/-2.8 to 49+/-2.2 p=0.21] However no significant changes were recorded in terms of body weight and body mass index[BMI] within and between both study groups
Conclusion: DPP-4 inhibitors [sitagliptin andvildagliptin] significantly improved hemodynamic and metabolic parameters in type 2 diabetic patients
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Background: Acute poisoning is a significant health problem being the leading cause of morbidity and mortality all over the world. Poisoning due to ingestion of Aluminum Phosphide and Organophosphates is considered among the commonest poisons leading to fatal consequences
Objective: To study the clinical profile and outcome of the patients with [Wheat Pills] Aluminum Phosphide [ALP] poisoning brought to the District Head Quarter [DHQ] Teaching Hospital, Sahiwal
Setting and Duration: The study was carried out in DHQ Hospital Sahiwal [a tertiary care health institution attached with Sahiwal Medical College, Sahiwal, Pakistan] for the period of one year i.e. 1[st] January, 2017 to 31[st] December, 2017
Methodology: The patients above 12 years of either gender brought to the DHQ Hospital Sahiwal, with history of ingestion of [wheat pills] Aluminum phosphide; were included in study by non-probability convenient sampling. The data retrieved from the hospital record / treatment charts of the patients admitted in Accident and Emergency / Medical Units. Prior permission from the controlling authorities was also taken. The data entered in predesigned proforma for further analysis
Results: Of the total one hundred and ten patients; 94[85.45 percent] belonged to the younger age group 12-30 years while 65[59.1 percent] cases of Aluminium Phosphide poisoning were females and 45[40.9 percent] males. Similarly, females represented 30[27.27 percent] poisoning cases compared to males 16[14.54 percent] in the age stratum 12-20 years. Majority 48[43.63 percent] cases were between the age group of 21-30 years. The intake of Aluminium Phosphide with suicidal intent was found in 82[79.6 percent] cases. The frequent clinical features were Shock / Tachycardia observed in 32[29.1 percent] cases whereas 62[56.36 percent] patients couldn't survive in spite of extensive resuscitation
Conclusion: Aluminium Phosphide is frequently used poison with suicidal intent especially in the younger population. Shock / Tachycardia were the most frequent clinical presentation of the patients. Mortality rate was higher in Aluminium Phosphide poisoning in spite of resuscitative measures. No antidote is available so far whereas role of magnesium sulphate and coconut oil are controversial
Recommendations: Situation could be improved by reducing the occupational exposure, resolving the conflicts leading to self-poisoning and adequate training of the medical / paramedical staff in poisoning management at the primary, secondary and tertiary care hospitals. Proper legislation is to be done for strict control on the sale of aluminium phosphide. Further research is required to find out the effective antidote in order to reduce the mortality because of aluminium phosphide poisonin
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Background percutaneous Nephrolithotomy [PCNL] is a surgical procedure used for the removal of renal stones. The technique is minimally invasive and is often used for the removal of renal stones that are located near the pelvis. The topical administration of local anesthetics in the surgical area has been proven effective in minimizing post-operative pain after various surgical procedures
Purpose this study was conducted to compare the mean post-operative pain score in patients with pre-operative Bupivacaine infiltration of nephrostomy tract with placebo in control group of patients undergoing percutaneous Nephrolithotomy
Methods a randomized controlled trial was carried out in Department of General Surgery, Kuwait Teaching Hospital, Peshawar with diagnosis of renal stones. A total of 66 patients [33 males and 33 females] age: 16-50 years were admitted with diagnosis of renal stones. Statistical analysis was performed by using SPSS version 17
Results patients with renal stones who underwent PCNL were randomly divided into Group A [Bupivacaine] and Group B [Placebo]. The overall Average pain score for Group A was 4.15 +/- 1.48 range [2 to 7] on visual analogue scale [VAS], while that for Group B was 6.06 +/- 1.02 range [4 to 8] p-value < 0.05, which indicates that preoperative infiltration of bupivacaine significantly decreases the postoperative pain in patients undergoing Percutaneous Nephrolithotomy
Conclusion the study concludes that local bupivacaine infiltration along the nephrostomy tract is an effective method of management of postoperative pain after PCNL, regardless of age and gender as shown by results of the study
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Prostate cancer is a multifaceted disease that arises because of misrepresentation of linear and integrated signaling cascades that regulate gene network in normal and cancer cells
Programmed cell death is modulated by intracellular regulators within each cell and various lines of evidence suggest that there is under- expression and over-expression of pro-apoptotic and anti-apoptotic gene subsets respectively
Apoptosis is a response to the cellular microenvironment, and the cell microenvironment can be regulated by multiple signaling cascades at a higher organizational level by suppressing survival signals notably at genetic, epigenetic, transcriptional and post-transcriptional level
Unquestionably, drug-discovery approaches over the last decade aiming at neutralizing anti-apoptotic proteins, over-expressing pro-apoptotic proteins and enhancing the cell surface appearance of TRAIL receptors have revolutionized our current information about inducing and maximizing TRAIL mediated signaling in resistant prostate cancer phenotype. In this mini-review we outline outstanding developments in the field of prostate cancer that have played a role in understanding the underlying mechanisms that control TRAIL mediated apoptosis in prostate cancer cells, which may be helpful in the development of cancer therapies based on the apoptotic pathway
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Objective: To assess the effects of hepatitis B vaccination on the antibody titer in patients with chronic hepatitis C and to compare it with response in normal healthy subjects. Study Design: Interventional study. Place and Duration of Study: Shifa International Hospital, Islamabad, Pakistan, from January 2007 to January 2012
Methodology: Hepatitis vaccination [Heberbiovac-HB 20] was given intramuscularly to the patients of chronic hepatitis C [HCV group] and normal healthy subjects [control group] at 0, 1 and 6 months intervals. Anti-HBs titer was determined after second and third injection to assess the antibody response
Results: There were 46 patients in the HCV group and 45 patients in the control group. Mean age was 40.9 +/- 9.8 years in the HCV group and 33.18 +/- 8.35 years in the control group. Weight was 67.04 +/- 13.5 kg in the HCV group and 71.78 +/- 14.63 kg in the control group. Height was 162.45 +/- 9.06 cm in the HCV group and 167.03 +/- 7.83 cm in the control group. Anti-HBs antibody levels after the second injection were 253.89 +/- 76.76 mlU/mL in the HCV group and 245.81 +/- 72.65 mlU/mL in the control group [p=0.172]. After third injection, the antibody levels were slightly higher in both groups
Conclusion: In patients with chronic hepatitis C and normal healthy subjects, Heberbiovac HB in standard dosage gave sero-protective levels in both groups and antibody titers were not significantly different in control and HCV group
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Background: Oxidative stress and antioxidative status caused by hepatitis C therapy plays a significant role in aggravating the disease. A number of reactive oxygen species are responsible for the damaging of cell machinery and ultimately disturbing the homeostasis of the cell
Objectives: To assess enzymatic, non-enzymatic antioxidants and circulating biomarkers in HCV patients receiving interferon therapy
Methods: Study subjects were divided into two groups; patients and controls. The levels of the Thiobarbituric acid reactive substances [TBARS, as a marker of lipid peroxidation], superoxide dismutase [SOD], glutathione [GSH], catalase [CAT] and lipid peroxidation product [MDA] in the serum were estimated
Results: There was statistically difference between patients and healthy controls in levels of CAT[p< 0.000**], SOD[ p< 0.000**], GSH [p< 0.000**] and MDA[p< 0.000**]. Similarly, the levels of ALT [p< 0.048*], AST [p< 0.005*] and ALP [p< 0.000**] were also statistically different between two groups
Conclusion: Imbalanced levels of superoxide dismutase, catalase, reduced glutathione, MDA and serum enzymes [e.g. ALT, AST, ALP] revealed that interferon itself play a crucial rule in disturbing oxidative vs. antioxidative status which ultimately results in tissue damaging. Increased levels of MDA have a significant correlation with disease development during the course of therapy
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Objective: to compare the clinical presentation and surgical outcome in early versus delayed presentation of childhood intussusceptions
Method and material: this comparative study was conducted in the Department of Pediatric Surgery, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad from January 2005 to July 2007.All the diagnosed patients of intussusception were categorized into early and delayed group [patient presented later than 24 hours from the onset of first symptom]. Data regarding age, sex, clinical presentation, duration of presentation [early or late], surgical findings, treatment and complications were recorded on proforma. All patients of intussusceptions were subjected to laparotomy due to non-availability of image intensifier. Parameters including clinical presentations, surgical findings, treatment options and compliations were analyzed with SPSS version 16
Results: this study was comprised of 80 patients; males 57[71.3%] and females 23[28.7%] with male: female ratio 2.5:1.Early presenting patients were 10 and delayed presenting were 70. Major clinical symptoms were pain in abdomen, vomiting and bleeding per rectum. Significant difference found in early and delayed presenting group was in bleeding per rectum [P<0.001], mass per rectum [P=0.001], mass per abdomen [P=0.029], fever [P=0.006] and abdominal distension [P=0.001]. Gangrene of bowel, complications and mortality were more common in delayed presenting group
Conclusion: pain in abdomen, disarrhea and vomiting were almost same in both groups, while distension of abdomen, palpable mass per rectum, bleeding per rectum, mass per abdomen, and fever had significant variability in both groups. There was also high morbidity in delayed presenting group. Early diagnosis and early treatment are main keys to curtail the morbidity and mortality in childhood intussusceptions
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Total 636 lower limbs of 318 normal Pakistani children from newborn to 12.5 years were marked for anterior superior iliac spine [ASIS], centre of the patella [PC] and centre of the intermalleolar line [IMC]. Limbs were photographed in straight standing position and knee angle was geometrically measured. Male and female difference of knee angle was insignificant [P>0.05]. We observed a general trend from extreme bowlegs in infancy to maximum knock-knees at 4 years. Then there was a gradual progression towards neutral knee angle. Greatest mean Varus of 10.01 degrees was noted in children less than 6 months. Maximum valgus of 5.96 degrees was measured at 4 years. After 11 years of age a mean valgus of 3.08 degrees was maintained. Compared to Chinese children, Pakistanis are 5 degrees less valgus at 2 years, values level at 4 years and become 4 degrees more valgus beyond 6 years of age. Compared to American white children, Pakistanis initially show less Varus, progress slow, attain less valgus and finally remain closer to the neutral knee angle. Racial difference in knee angle should be considered for Pakistanis to achieve the optimum results with regards to knee angle correction or knee replacement arthroplasty