Current pandemic COVID-19 vaccine strategies and development: a comprehensive review

The coronavirus disease-19 pandemic with the characteristics of asymptomatic condition, long incubation period and poor treatment has influenced the entire globe. Coronaviruses are important emergent pathogens, specifically, the recently emerged sever acute respiratory syndrome coronavirus 2, the causative virus of the current COVID-19 pandemic. To mitigate the virus and curtail the infection risk, vaccines are the most hopeful solution. The protein structure and genome sequence of SARS-CoV-2 were processed and provided in record time; providing feasibility to the development of COVID-19 vaccines. In an unprecedented scientific and technological effort, vaccines against SARS-CoV-2 have been developed in less than one year. This review addresses the approaches adopted for SARS-CoV-2 vaccine development and the effectiveness of the currently approved vaccines(AU)

La pandemia de COVID-19, con sus características de condición asintomática, largo periodo de incubación y escaso tratamiento, ha tenido un impacto global. Los coronavirus son importantes patógenos emergentes, específicamente, el coronavirus del síndrome respiratorio agudo severo 2 descubierto recientemente, virus causal de la actual pandemia de COVID-19. Para mitigar el virus y reducir el riesgo de infección, las vacunas son la solución más esperanzadora. La estructura de la proteína y la secuencia del genoma del SARS-CoV-2 se procesaron y proporcionaron en un tiempo récord, lo que ha permitido el desarrollo de las vacunas contra el COVID-19. En un esfuerzo científico y tecnológico sin precedentes, se han desarrollado vacunas contra el SARS-CoV-2 en menos de un año. Esta revisión aborda los enfoques adoptados para el desarrollo de la vacuna contra el SARS-CoV-2 y la eficacia de las vacunas actualmente aprobadas(AU)

Metabolites in Conocarpus erectus leaves attenuate α-amylase activity by modulating amino acid residues of α-amylase: an in vitro and docking study / Los metabolitos en las hojas de Conocarpus erectus atenúan la actividad de la α-amilasa al modular los residuos de aminoácidos de la α-amilasa: un estudio in vitro y de acoplamiento

The antioxidant activity and the inhibitory potential of α-amylase of lyophilized hydroethanolic extracts of Conocarpus erectus leaves obtained by ultrasonication were determined. The most potent extract was subjected to ultra-high performance liquid chromatography system equipped with mass spectrometer for metabolite identification. The identified metabolites were docked in α-glucosidase to assess their binding mode. The results revealed that 60% ethanolic extract exhibited highest ferric reducing antioxidant power (4.08 ± 0.187 mg TE/g DE) and α-amylase inhibition (IC50 58.20 ± 1.25 µg/mL. The metabolites like ellagic acid, 3-O-methyl ellagic acid, ferujol, 5, 2 ́-dihydroxy-6,7,8-trimethyl flavone and kaempferol glucoside were identified in the extract and subjected to molecular docking studies regarding α-amylase inhibition. The comparison of binding affinities revealed 3-O-methyl ellagic acid as most effective inhibitor of α-amylase with binding energy of -14.5911 kcal/mol comparable to that of acarbose (-15.7815 kcal/mol). The secondary metabolites identified in the study may be extended further for functional food development with antidiabetic properties.

Se determinó la actividad antioxidante y el potencial inhibidor de la α-amilasa de extractos hidroetanólicos liofilizados de hojas de Conocarpus erectus obtenidos por ultrasónicación. El extracto más potente se sometió a un sistema de cromatografía líquida de ultra alto rendimiento equipado con un espectrómetro de masas para la identificación de metabolitos. Los metabolitos identificados se acoplaron en α-glucosidasa para evaluar su modo de unión. Los resultados revelaron que el extracto etanólico al 60% exhibió el mayor poder antioxidante reductor férrico (4.08 ± 0.187 mg TE/g DE) e inhibición de la α-amilasa (IC50 58.20 ± 1.25 µg/mL. Los metabolitos como el ácido elágico, 3-O-metil elágico ácido, ferujol, 5, 2 ́-dihidroxi-6,7,8-trimetil flavona y kaempferol glucósido se identificaron en el extracto y se sometieron a estudios de acoplamiento molecular con respecto a la inhibición de la α-amilasa. La comparación de las afinidades de unión reveló 3-O-metil El ácido elágico como inhibidor más eficaz de la α-amilasa con una energía de unión de -14,5911 kcal/mol comparable a la de la acarbosa (-15,7815 kcal/mol). Los metabolitos secundarios identificados en el estudio pueden ampliarse aún más para el desarrollo funcional de alimentos con propiedades antidiabéticas.

In vitro pharmacological attributes and metabolite's fingerprinting of Conocarpus lancifolius / Atributos farmacológicos in vitro y huellas dactilares de metabolitos de Conocarpus lancifolius

Search for safe antioxidants and novel nutraceuticals urged to evaluate the antioxidant, anti-acetylcholine esterase and anti-lipoxygenase activity of various leaf extracts of Conocarpus lancifolius. Extraction was optimized from freeze dried plant extracts quenched with liquid nitrogen using water, ethanol, methanol, hexane, ethyl acetate and chloroform. Maximum extract yield, total phenolic contents and total flavonoid contents were obtained in case of ethanolic extraction. The highest 2,2-diphenyl-1-picrylhydrazylradical scavenging in terms of IC50 value of 55.26 µg/mL was observed for ethanolic leaf extract. The acetylcholine esterase and lipoxygenase inhibitory activities (IC50) were also observed for ethanolic extract. These findings for ethanolic extract were statistically significant when compared with other extracts (ρ<0.05). The haemolytic % values indicated that all extracts were associated with very low or negligible toxicity. The epicatechin, isorhamnetin, rutin, scopoleptin, skimmianine, quercetin-3-O-α-rhamnoside, quercetin-3-O-ß-glucoside, cornoside, creatinine, choline, pyruvic acid, α-hydroxybutyric acid, phyllanthin and hypophyllanthin were identified as major functional metabolites in ethanolic leaf extract of C. lancifoliusby 1H-NMR. The identified metabolites were probably responsible for the pharmacological properties of C.lancifolius. The findings may be utilized as pharmacological leads for drug development and food fortification.

Se insta a la búsqueda de antioxidantes seguros y nuevos nutracéuticos para evaluar la actividad antioxidante, anti-acetilcolina esterasa y anti-lipoxigenasa de varios extractos de hojas de Conocarpus lancifolius. La extracción se optimizó a partir de extractos de plantas liofilizados enfriados con nitrógeno líquido usando agua, etanol, metanol, hexano, acetato de etilo y cloroformo. En el caso de extracción etanólica se obtuvo el rendimiento máximo de extracto, el contenido de fenoles totales y el contenido de flavonoides totales. La mayor eliminación de radicales 2,2-difenil-1-picrilhidrazilo en términos de valor de CI50 de 55,26 µg/mL se observó para el extracto de hoja etanólico. También se observaron las actividades inhibidoras de la acetilcolina esterasa y lipoxigenasa (CI50) para el extracto etanólico. Estos hallazgos para el extracto etanólico fueron estadísticamente significativos en comparación con otros extractos (ρ<0.05). Los valores del % hemolítico indicaron que todos los extractos estaban asociados con una toxicidad muy baja o insignificante. Se identificaron la epicatequina, isorhamnetina, rutina, escopoleptina, skimmianina, quercetina-3-O-α-ramnosido, quercetina-3-O-ß-glucósido, cornosido, creatinina, colina, ácido pirúvico, ácido α-hidroxibutírico, filantrina e hipofillantina. como metabolitos funcionales principales en el extracto etanólico de hojas de C. lancifoliuspor 1H-NMR. Los metabolitos identificados probablemente fueron responsables de las propiedades farmacológicas de C. lancifolius. Los hallazgos pueden utilizarse como pistas farmacológicas para el desarrollo de fármacos y la fortificación de alimentos.

Platinum complexes of curcumin delivered by dual-responsive polymeric nanoparticles improve chemotherapeutic efficacy based on the enhanced anti-metastasis activity and reduce side effects

Platinum-based chemotherapy is used for non-small cell lung cancer (NSCLC). However, it has side effects and minimum efficacy against lung cancer metastasis. In this study, platinum-curcumin complexes were loaded into pH and redox dual-responsive nanoparticles (denoted as Pt-CUR@PSPPN) to facilitate intracellular release and synergistic anti-cancer effects. Pt-CUR@PSPPN was prepared by a nano-precipitation method and had a diameter of ∼100 nm. The nanoparticles showed increased anti-cancer effects both and . In addition, Pt-CUR@PSPPN blocked PI3K/AKT signal transduction pathway and inhibited MMP2 and VEGFR2, resulting in enhanced anti-metastatic activity. Furthermore, reduced side effects were also observed. In conclusion, Pt-CUR@PSPPN provided a novel and attractive therapeutic strategy for NSCLC.

Gall stones: a fundamental clinical review

Formation of stones in the gall bladder is known as cholelithiasis. About 10% to 20% of Western population are suffering from gall stones and this percentage is increasing day by day. Biochemically gall stones are classified into black pigment stones, brown pigment stones and cholesterol stones. Gall stones can be anatomically located at two possible sites; in the gall bladder known as cholelithiasis and in the common bile duct known as choledocholithiasis. Gall stones may present with symptoms known as symptomatic gallstones or without symptoms known as asymptomatic gallstones. The major causes of gallstones are high cholesterol diet, low bile salt levels, decreased gall bladder motility etc. Obesity, female gender, family history, rapid weight loss and vitamin B12 or folic acid deficiency are considered as important risk factors in the development of gall stones. The clinical presentations include acute cholecystitis and febrile illness with pain and tenderness in the right upper quadrant (Murphy sign). Generalized body weakness and weight loss are considered as generalized symptoms of gallstones. The complications include cholangitis, empyema of gall bladder, pancreatitis, abscess formation, porcelain gall bladder and gall bladder perforation. The differential diagnosis of gall stones is carried out based on endoscopy, ALT and AST serum levels. Non-surgical treatment for gall stones is oral dissolution therapy. The standard surgical treatment for gall stones is cholecystectomy.

Biosurfactants production potential of native strains of bacillus cereus and their antimicrobial, cytotoxic and antioxidant activities

Present study was designed to evaluate the biosurfactant production potential by native strains of Bacillus cereus as well as determine their antimicrobial and antioxidant activities. The strains isolated from garden soil were characterized as B. cereus MMIC 1, MMIC 2 and MMIC 3. Biosurfactants were extracted as grey white precipitates. Optimum conditions for biosurfactant production were 37°C, the 7[th] day of incubation, 0.5% NaCl, pH 7.0. Moreover, corn steep liquor was the best carbon source. Biuret test, Thin Layer Chromatography [TLC], agar double diffusion and Fourier Transform Infrared Spectroscopy [FTIR] characterized the biosurfactants as cationic lipopeptides. Biosurfactants exhibited significant antibacterial and antifungal activity against S. aureus, E. coli, P. aeruginosa, K. pneumoniae, A. niger and C. albicans at 30 mg/ml. Moreover, they also possessed antiviral activity against NDV at 10 mg/ml. Cytotoxicity assay in BHK-21 cell lines revealed 63% cell survival at 10 mg/ml of biosurfactants and thus considered as safe. They also showed very good antioxidant activity by ferric-reducing activity and DPPH scavenging activity at 2 mg/ml. Consequently, the study offers an insight for the exploration of new bioactive molecules from the soil. It was concluded that lipopeptide biosurfactants produced from native strains of B. cereus may be recommended as safe antimicrobial, emulsifier and antioxidant agent

Bilirubin interference in plasma amino acid analysis by ion exchange chromatography

Objective: To evaluate the effect of bilirubin interference on plasma amino acid analysis by Ion Exchange Chromatography [IEC]

Study Design: Cross-sectional [method validation] study

Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi from August 2016 to July 2017

Methodology: Twenty non-icteric samples from paediatric patients were collected in lithium heparin tubes and analysed for amino acids on IEC-based BiochromeR 30+ Analyzer [Harvard Biosciences UK]. Baseline bilirubin levels were noted. Samples were spiked with neonatal bilirubin standard with concentration of 488.4 Mu mol/L [SpinreactR-Spain] at final concentrations of 50, 150 and 230 Mu mol/L and re-analysed for amino acids at these three concentrations

Results: Among the 20 selected patients with normal amino acid profiles, 12 [60%] were males. Majority [55%] were in age group of 1-5 years. Significant difference was observed for Arginine [p = 0.01], Histidine [p = 0.001], Isoleucine [p = 0.01], Leucine [p = 0.007], Lysine [p = 0.005], Ornithine [p = 0.03] and Phenylalanine [p = 0.02]. Mean rank of these amino acids showed decreasing trend with the increase of bilirubin concentration, and pronounced interference was identified at bilirubin level of 50 Mu mol/L. No difference was observed for alanine, citrulline, glutamic acid, glycine, methionine, proline, threonine, tyrosine, asparagine, aspartic acid, cystine, valine and tryptophan

Conclusion: Bilirubin significantly interferes with certain amino acid levels when analysis is carried out by ion exchange chromatography. A close follow-up of such patients with other biochemical tests and a repeat amino acid analysis, after jaundice is settled, is recommended to confidently rule out any possible inherited metabolic disorder in these patients

Efficacy of Azadirachta indica organic extracts against clinical methicillin resistant Staphylococcus aureus isolates

In current study we investigated the efficacy of organic extracts of Azadirachta indica leaves against Methicillin Resistant Staphylococcus aureus [MRSA] clinical isolates. For this purpose fresh leaves were used to prepare ethanol, methanol and chloroform extract. Secondly, a cross sectional study was conducted to isolate MRSA in clinical samples from patients having surgical/ non-surgical wounds from Allied Hospital and District Head Quarter Hospital, Faisalabad. The S. aureus isolates were initially identified by biochemical characterization, followed by identification of MRSA using cefoxitin disc diffusion test that was finally confirmed by genomic amplification of mecA gene, responsible for resistance. All MRSA isolates were tested to find vancomycin resistant S. aureus [VRSA] using E-strips [M.I.C. EvaluatorTM, Oxide, UK]. The data showed an overall 37% prevalence of S. aureus including 56.75% clinical MRSA isolates while none of the isolated S. aureus showed resistance to vancomycin. The antimicrobial activity was measured as mean zone of inhibition for each extract against all MRSA isolates and it was found as 15.38+/-2.26, 16.09+/-3.09 and 17.42+/-2.48 for methanol, ethanol and chloroform extracts respectively. Chloroform extract showed significantly high antimicrobial activity against MRSA isolates. Altogether, the current study exposed the high prevalence of MRSA isolates from tertiary care hospitals. However, all MRSA isolates were found susceptible to organic extracts of A. indica leaves

Prevalence of hypertriglyceridemia and risk factors of ischemic versus hemorrhagic stroke

Objective: To find the prevalence of hypertriglyceridemia in ischemic and hemorrhagic strokes and to assess the risk factors associated with them

Methodology: This cross-sectional study was conducted in Medical OPD/ Emergency, PAF Hospital Mushaf, Sargodha over a period of six months from Nov-2010 to May-2011. All patients of either gender diagnosed as having stroke, with hyper dense or hypo dense area on CT scan brain and of age more than 30 years were included in the study. Patients on anti-hyperlipidemic drugs, with previous history of stroke, having blood disorders, like hemophilia and idiopathic thrombocytopenic purpura and, on warfarin therapy were excluded from the study

Results: 203 patients were enrolled in the study. Out of these 203 patients 138[68%] were males, 65 [32%] were females.127[62.6%] stroke patients had hypertriglyceridemia. In multivariate analysis, hypertriglyceridemia was found to be the only risk factor associated with ischemic stroke adjusting for all the other variables. It was found that patients with hypertriglyceridemia had 3.24 times higher odds of having ischemic stroke [P-value=0.017]

Conclusion: Hypertriglyceridemia was found in majority of the patients with stroke. Furthermore, it was found to be an independent risk factor of ischemic stroke

Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic nonspecific low back pain: a randomized controlled clinical trial

Background GtObjective: Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain

However, there is lack of consensus on the best exercise treatment and numerous studies are underway

Conclusive studies are tacking especially in this part of the world. This study was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exercise provided in patients with nonspecific chronic mechanical low back pain

Methods: This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A and B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale [VAS] pretreatment, at 2[nd], 4[th] and 6[th] week post treatment

Results: The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2[nd], 4[th] and 6[th] week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively

Conclusion: Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with non-specific low back pain

Frequency of depressive and anxiety symptoms among patients on interferon and pegylated interferon

Background: Chronic Hepatitis C [CHC] is highly prevalent in Pakistan. Current standard treatment is Interferon alpha/ Peginterferon with oral ribavirin. Interferon therapy is associated with development and worsening of depressive symptoms in CHC patients and to determine the frequency of depressive and anxiety symptoms among patients on treatment with interferon/ Pegasus

Methods: This cross sectional study was conducted at OPD of Liaquat University Hospital Hyderabad during a period of 4 months [from July2013 to October2013]. A sample of 120 patients aged 18-60 years, either currently receiving interferon/ Pegasus treatment or had received that treatment during last 12 months was taken. Known cases of anxiety, depression and those suffering from other debilitating co morbid conditions like carcinoma and non-consenting were excluded. Ethical approval was taken from LUH ethical review committee. A Proforma was used to gather the data. The data collected were analyzed using SPSS version 20.0. Mean [+/-SD] were computed for quantitative variables. Categorical variables [such as gender and outcome variables i.e. anxiety and depressive symptoms] were measured in frequencies and percentages. Stratification was done with regard to age group and gender to see the impact of these on the outcome followed by application of chi-square test with P-value <0.05 taken significant

Results: Total 120 patients were included in the study and 119 completed the questionnaire. Male patients were 55.5%. Mean age of patients was 32.59 +/- 8.56 years [Range: 16-56 years]. Primary outcome i-e; frequency of depression and anxiety in patients on interferon were 77.3% and 70.6% respectively. [n=92] had depression. Frequency of depression of almost similar in both genders [77.3% in males and 77.4% in females; p value= 0.584], while anxiety was more in females than males [75% vs 68.2%; p value= 0.273]. Both psychiatric symptoms increased with increasing age from 16-26 years to 47-56 years of age [p values = 0.432 and 0.736 respectively]. Vast majority [86.6%] were treated with interferon while only 13.4% received the PEGylated interferon therapy. Patients treated with PEGylated interferon had less frequency of depression than those treated with interferon [62.5% vs 79.6%; p value= 0.131]

Conclusion: Depression and anxiety were found to be common in CHC patients who had been or are being treated with antiviral treatment leading to increased risk of morbidity and mortality. Screening for risk of depression, proper education and timely treatment through anti-depressant followed by close monitoring is mandatory to achieve success in antiviral treatment

Antioxidant and antiacetylcholine esterase potential of aerial parts of Conocarpus erectus, Ficus variegata and Ficus maclellandii

The current study was designed to check the antioxidant and enzyme inhibition potential of various extracts/fractions of three selected plants. The aerial parts of Conocarpus erectus [Combretaceae], Ficus variegata [Moraceae] and Ficus maclellandii [Moraceae] were extracted with ethanol [95%] and the resulting crude extracts were partitioned with n-hexane, chloroform and n-butanol successively. Folin-Ciocalteu reagent was used to calculate the total phenolic contents, flavonoids contents were calculated with aluminum chloride while antioxidant and enzyme studies were carried out through standard protocols. All extracts/fractions contained reasonable amount of phenolic compounds ranging from 0.58-58.23mg CE/g of DW and 0.43-30.56mg GAE/g of DW. Total flavonoids were determined using rutin and quercetin standards, ranging from 2.65-18.2 mg rutin equivalent/g of dry weight and 0.92-5.41mg quercetin equivalent/g of dry weight. Antioxidant studies such as DPPH inhibition FRAP and total antioxidant capacity [TAC] was checked. The crude ethanolic extract of C. erectus showed maximum antiradical scavenging power [90.43%; IC[50]=7 micro g] and ferric reducing antioxidant power [16.5micro M eq.FeSO[4].7H[2]O], respectively while leave extract of F. variegata [chloroform] was the most active [0.6577] in TAC among other extracts of the selected medicinal plants. Butanolic leave extract of C. erectus exhibited maximum enzyme inhibition activity [91.62% with IC50 40micro g/ml] while other extracts showed significant activity. It was observed from results that all extracts/fractions of under consideration plants, exhibited significant bioactivities especially ethanolic and butanolic fractions, which may be the richest source of such type of activities

Hypertriglyceridemia in patients with type II diabetes Mellitus

Objective:To determine the frequency of type II diabetic patients with hypertriglyceridemia

Materials and Methods:This was a cross sectional study carried out at medical unit, PAF Hospital Mushaf, Sarghoda from 19th January 2013 to 18th July 2013. A total of 200 patients of either gender having age >30 years with type II diabetes either controlled or uncontrolled for at least 5 years were enrolled in the study. Patients on anti-hyperlipidemic drug, with history of ischemic heart disease, nephrotic syndrome, hypothyroidism and type I diabetes mellitus were excluded from the study

Results: Mean [+/-SD] age of enrolled participants was 53.25 [+/-7.5] years. 86 [43%] were males and 114 [57%] were females. Mean [+/-SD] fasting blood sugar level was 135 [+/-23.04] mg/dl and random blood sugar was 205.62 [+/-31.87] mg/dl. Mean [+/-SD] duration of diabetes was 6.69 [+/-1.87] years. Out of 200 patients of type II diabetes, 102 [51%] had hypertriglyceridemia out of which majority [63.7%] of patients had uncontrolled diabetes

Conclusions:The frequency of type II diabetic patients with hypertriglyceridemia is found to be 51% with majority having uncontrolled diabetes

Usefulness and safety of early against delayed oral intake after appendectomy

To evaluate the usefulness and safety of early versus late oral intake after appendectomy. Randomized clinical trial. Combined Military Hospital Multan from August 2008 to February 2009. One hundred patients with uncomplicated acute appendicitis, undergoing appendectomy under general anesthesia were included in the study and randomly divided into two equal groups. Early oral intake group [group A] was allowed fluids, when patients were out of effects of general anesthesia. Delayed fed [group B] was started oral fluids, on appearance of normal bowel sounds or passage of flatus. Low residue solid diet was started, after tolerance of oral fluids, in both groups. Early oral intake resulted in start of solid diet earlier by average 9 hours; these patients had normal bowel sounds, and passed flatus, earlier, after 4 hours and 5 hours as compared to late feeding group. Six [12%] patients had mild ileus in early fed group whereas 4[8%] patients in delayed fed group had mild ileus. Thirty eight [76%] early fed patients were very satisfied, as compared to 29 [58%] delayed fed patients. The hospital stay was prolonged by 2 days in delayed fed group. Early oral feeding implemented after appendectomy is safe and effective, with a shortened hospital stay as the primary benefit in patients after appendectomy

Prevalence and associated factors of burnout among military doctors in Pakistan

To determine the frequency of factors contributing to burnout among military Physicians in Lahore, Pakistan. Cross-sectional analytical study. Combined Military Hospital [CMH] Lahore and CMH Lahore Medical and Dental College from March 2014 to September 2014. Sample consisted of 133 physicians [n=66] males and n=67 females]. Convenient sampling procedure was used. Mashlach Burnout Inventory [MBI] which included 22 questions was used to measure emotional exhaustion, depersonalization and personal accomplishment. The questionnaire also elicited information about socio-demographic and work characteristics. Data was entered and analyzed by using Statistical Package for Social Sciences [SPSS version 20.0]. Chi-square test of significance was used to see the significance of association between age, gender, duration of service in years and working hours per week. p value <0.05 was considered statistically significant. On the MBI, 29 [21.8%] physicians showed high emotional exhaustion, 22 [16.6%] showed high depersonalization and 34 [25.6%] showed low personal accomplishment. Thirty-seven physicians [27.8%] were identified as experiencing a high degree of burnout [high emotional exhaustion and depersonalization and low personal accomplishment]. The frequency of high degree of burnout was higher among males [36.4%] as compared to females [17.9%] and this difference was statistically borderline significant [p = 0.057]. However, there was statistically significant difference [p = 0.03] of burnout between those working >/= 41 hours per week as compared to working

Early onset neonatal sepsis in preterm premature rupture of membranes

To determine the frequency of early onset neonatal sepsis in newborn with various duration of preterm premature rupture of membranes [PPROM]. Cross sectional study. Neonatal Intensive Care Unit Combined Military Hospital, Lahore from November 2009 to November 2010. Neonates of singleton pregnancies complicanted by pretern premature rupture of the membranes [PPROM] with delivery between 30 and 36 weeks gestation were included in the study. The overall frequency of neonatal sepsis was calculated on clinical and serological basis. Comparison of the frequency of sepsis among groups with varying duration of rupture of membranes was done. Out of 164 babies, 84 [51.2%] were female and 80 [48.8%] were male. Mean maternal age was 23 year [range: 18-36 years] .Mean gestational age was 33 weeks [range: 30-36 weeks]. Sepsis was suspected in 41 [25%] babies on clinical grounds. C-reactive protein was raised in 36 [22%] neonates. There was statistically insignificant difference between clinical versus serological diagnosis [p=0.515]. Frequency of neonatal sepsis was significantly higher in mothers with longer duration of rupture of membrane [p< 0.001]. Frequency of neonatal sepsis was observed to be 22%. PPROM is an important risk factor for early onset neonatal sepsis

Standard of Care in Clinical Research Involving Human Subjects: A Perspective from Developing World.

Abstract: Standard of care is an ordinary, reasonable formal treatment and diagnostic process that a physician should follow for his/her patient with specific disease. Standard of care followed in one country may not suit to other country; the reason may involve economic conditions, certain norms, beliefs, tradition and culture of that society. It may be considered ethical if it does not exploit human rights and poor vulnerable population, once it exploits the human rights it creates ethical dilemmas that need to be sort out to protect vulnerable population and to make the research more ethical. Patients attending medicine department of Bolan Medical Complex (BMC) Quetta, Balochistan, Pakistan were selected randomly interviewed and requested to fill the questionnaire. The ethical issues in clinical research conducted on human population have been perplexing and remains to be the same in clinical research settings. Exploitive use of research participants in resource poor developing countries has intensified the debate on the ethics of international research and led to increasing attention to exploitation of vulnerable study subjects. The issues of conducting research in developing countries will remain and need to be focused and debated where and whenever require. One has to try sincerely to sort out the ethical problems while conducting a research study, he might fail to solve all the issues but the situation may improve by the time if tried sincerely.

Pterygium; comparison of results excision through bare sclera technique with and without intraoperative Mitomycin C application

To study the results of primary pterygium excision through bare sclera technique with and without intraoperative Mitomycin C use. This was an experimental study with randomised controlled trial. This study was conducted at Eye A unit, Khyber Teaching Hospital, Peshawar from May, 2007 to April,2009. One hundred patients with primary pterygium were selected from ophthalmology Deptt. OPD at Khyber Teaching Hospital, Peshawar. Detailed history was taken. Complete ocular examination done and those fulfilling inclusion criteria were included in the study. Anesthesia used was topical proparacaine 0.5% and local infiltration of 2% lignocaine. Mitomycine C [MMC] 0.02% [0.2mg/ml] was applied through a cotton swab at the bare part of the sclera for five minutes in 50 of these patients. Patients were followed up till three months. In bare sclera technique without MMC, recurrence rate was 70% [35 patients] while in MMC group, it was 16% [08 patients].There was one punctuate epithelial keratitis in MMC group and two cases of conjuntival granuloma one in each group. Pterygium excision through simple bare sclera technique had significantly high recurrence rate as compared to intraoperative use of MMC

Comparison and correlation of hepatic and hematological parameters in patient with plasmodium vivax and plasmodium falciparum

Objectives: To compare and correlate hepatic and hematological parameters in patients with Vivax and Falciparum Malaria

Study design: A retrospective comparative study

Place and duration: The study was conducted the Department of Biochemistry, Basic Medical Sciences Institute with collaboration of National Institute of Child Health and malaria control program counter at Jinnah Postgraduate Medical Center Karachi during 1st August 2005 to 31st December 2006

Methodology: The study included 120 consecutive patients. All patients were between 1 to 10 years of age. They were divided equally into two groups, Plasmodium vivax malaria [Group A] and Plasmodium falciparum malaria [Group B]. Those patients having a history of icterus, taking hepatotoxic drugs or had evidence of hepatic dysfunction were excluded from the study. Liver function tests and hematological parameters performed

Results: All patients had fever, chills with rigors and body aches. On evaluation an increasing tendency of jaundice and hepatosplenomegaly along with statistically significant value [p<0.05] in serum bilirubin, alanine transaminase [ALT], hemoglobin, bleeding time [BT] and prothrombin time [PT] was found in patients with Falciparum as compared to vivax malaria. In Group A, serum bilirubin has negative correlation with hemoglobin but positive with PT. PT has negative correlation with ALT but positive with aspartate transaminase [AST]. Platelet has negative correlation with ALT but positive with alkaline phosphatase [ALP]. In Group B, hemoglobin has negative correlation with bilirubin, ALT and AST but positive with ALP; serum AST, and ALT were negatively correlated with, platelet and PT but positive with bleeding and clotting time. Platelets have significant coefficient correlation [0.524] regarding total protein and clotting time shows significant coefficient correlation [0.606] with alanine transaminase shown in table- 111

Conclusions: Liver function test and hematological parameters should be performed in patients with diagnosed Plasmodium Falciparum Malarial infection to prevent complication

Issues of research ethics and clinical ethics in developing world, possible solution: a way forward.

ABSTRACT: Research plays a pivotal role in the progress of inventions in medicines and medical technology. It is noticed that researchers from developing world or multinational companies are interested to conduct their research studies in developing countries, in doing so sometimes it is noticed that rather benefiting the participants it causes significant harm to the research study participants of developing countries. Ethical lapses in research can significantly harm human subjects. In research ethics the basic aim of ethics is distinguishing between right and wrong, to recognize the wrong doings and try to avoid them from harming research subjects in any research study whether that is done in developing country or developed country. It must follow the principle of non malefiecence or do no harm.