Cerebral Edema in Patients with severe Hemispheric Syndrome: Incidence, Risk Factors, and Outcomes—Data from SITS-ISTR / 대한뇌졸중학회지

Background@#and Purpose Cerebral edema (CED) in ischemic stroke can worsen prognosis and about 70% of patients who develop severe CED die if treated conservatively. We aimed to describe incidence, risk factors and outcomes of CED in patients with extensive ischemia. @*Methods@#Oservational study based on Safe Implementation of Treatments in Stroke-International Stroke Treatment Registry (2003–2019). Severe hemispheric syndrome (SHS) at baseline and persistent SHS (pSHS) at 24 hours were defined as National Institutes of Health Stroke Score (NIHSS) >15. Outcomes were moderate/severe CED detected by neuroimaging, functional independence (modified Rankin Scale 0–2) and death at 90 days. @*Results@#Patients (n=8,560) presented with SHS and developed pSHS at 24 hours; 82.2% received intravenous thrombolysis (IVT), 10.5% IVT+thrombectomy, and 7.3% thrombectomy alone. Median age was 77 and NIHSS 21. Of 7,949 patients with CED data, 3,780 (47.6%) had any CED and 2,297 (28.9%) moderate/severe CED. In the multivariable analysis, age 128.5 mg/dL (RR, 1.21), and decreased level of consciousness (RR, 1.14) were associated with moderate/severe CED (for all P<0.05). Patients with moderate/severe CED had lower odds to achieve functional Independence (adjusted odds ratio [aOR], 0.35; 95% confidence interval [CI], 0.23 to 0.55) and higher odds of death at 90 days (aOR, 2.54; 95% CI, 2.14 to 3.02). @*Conclusions@#In patients with extensive ischemia, the most important predictors for moderate/ severe CED were age <50, high blood glucose, signs of acute infarct, hyperdense artery on baseline scans, and decreased level of consciousness. CED was associated with worse functional outcome and a higher risk of death at 3 months.

Evaluation of indigenous plants' extracts for mosquitocidal activity against different stages of Culex quinquefasciatus say (Diptera: Culicidae) / Avaliação de extratos de plantas indígenas quanto à atividade mosquitocida contra diferentes estágios de culex quinquefasciatus say (Diptera: Culicidae)

Abstract Being vector of West Nile Virus and falariasis the control of Culex quinquefasciatus is likely to be essential. Synthetic insecticide treatment is looking most effective for vectors mosquito control. However, these products are toxic to the environment and non-target organisms. Consequently, ecofriendly control of vectors mosquito is needed. In this regard botanical insecticide is looking more fruitful. Therefore, the present research aimed to investigate the effectiveness of methanolic extract and various fractions, including, n-hexane, ethyl-acetate, chloroform, and aqueous fraction, obtained from methanolic extract of Ailanthus altissima, Artemisia scoparia, and Justicia adhatoda using separating funnel against larval, pupal, and adult stages of Culex quinquefasciatus. The larvae and pupae of Culex quinquefasciatus were exposed to various concentrations (31.25-1000 ppm) of methanolic extract and its fractions for 24 hours of exposure period. For knock-down bioassay (filter paper impregnation bioassay) different concentration of the methanolic extract and its various fractions (i.e. 0.0625, 0.125, 0.25, 0.5 and 1mg/mL) were applied for 1 hour exposure period. The results were statistically analysed using standard deviation, probit analysis, and linear regression. The R2 values of larvae, pupae, and adult range from 0.4 to 0.99. The values of LC50 (concentration causing 50% mortality) for late 3rd instar larvae after 24 hours exposure period range from 93-1856.7 ppm, while LC90 values range from 424 -7635.5ppm. The values of LC50for pupae range form 1326.7-6818.4ppm and and values of LC90 range from 3667.3-17427.9ppm, respectively. The KDT50 range from 0.30 to 2.8% and KDT90 values range from1.2 to 110.8%, respectively. In conclusion, Justicia adhatoda may be effective for controlling populations of vector mosquito.

Resumo Por ser o vetor do vírus do Nilo Ocidental e da falaríase, o controle de Culex quinquefasciatus Say é provavelmente essencial. O tratamento com inseticida sintético parece ser mais eficaz para o controle dos mosquitos vetores. No entanto, esses produtos são tóxicos para o meio ambiente e organismos não visados. Consequentemente, o controle ecológico dos mosquitos vetores é necessário. Nesse sentido, o inseticida botânico parece mais produtivo. Portanto, a presente pesquisa teve como objetivo investigar a eficácia do extrato metanólico e de várias frações, incluindo n-hexano, acetato de etila, clorofórmio e fração aquosa, obtidos do extrato metanólico de Ailanthus altissima (Mill.) Swingle, Artemisia scoparia Waldst. & Kit. e Justicia adhatoda L. usando funil de separação contra os estágios larval, pupal e adulto de C. quinquefasciatus. As larvas e pupas de C. quinquefasciatus foram expostas a várias concentrações (31,25-1000 ppm) de extrato metanólico, e suas frações por 24 horas de período de exposição. Para o bioensaio knock-down (bioensaio de impregnação de papel de filtro), diferentes concentrações do extrato metanólico e suas várias frações (ou seja, 0,0625, 0,125, 0,25, 0,5 e 1 mg / mL) foram aplicadas por um período de exposição de 1 hora. Os resultados foram analisados ​​estatisticamente usando desvio padrão, análise Probit e regressão linear. Os valores de R2 de larvas, pupas e adultos variaram de 0,4 a 0,99. Os valores de LC50 (concentração que causa 50% de mortalidade) para larvas de terceiro estádio tardio após 24 horas de período de exposição variaram de 93-1856,7 ppm, enquanto os valores de LC90 variaram de 424-7635,5ppm. Os valores de LC50 para pupas variaram de 1326,7-6818,4 ppm e os valores de LC90 variaram de 3667,3-17427,9 ppm, respectivamente. O KDT50 variou de 0,30 a 2,8% e os valores de KDT90 variaram de 1,2 a 110,8%, respectivamente. Por fim, a espécie J. adhatoda pôde ser eficaz para controlar populações de mosquitos vetores.

Evaluation of indigenous plants' extracts for mosquitocidal activity against different stages of Culex quinquefasciatus say (Diptera: Culicidae) / Avaliação de extratos de plantas indígenas quanto à atividade mosquitocida contra diferentes estágios de culex quinquefasciatus say (Diptera: Culicidae)

Being vector of West Nile Virus and falariasis the control of Culex quinquefasciatus is likely to be essential. Synthetic insecticide treatment is looking most effective for vectors mosquito control. However, these products are toxic to the environment and non-target organisms. Consequently, ecofriendly control of vectors mosquito is needed. In this regard botanical insecticide is looking more fruitful. Therefore, the present research aimed to investigate the effectiveness of methanolic extract and various fractions, including, n-hexane, ethyl-acetate, chloroform, and aqueous fraction, obtained from methanolic extract of Ailanthus altissima, Artemisia scoparia, and Justicia adhatoda using separating funnel against larval, pupal, and adult stages of Culex quinquefasciatus. The larvae and pupae of Culex quinquefasciatus were exposed to various concentrations (31.25-1000 ppm) of methanolic extract and its fractions for 24 hours of exposure period. For knock-down bioassay (filter paper impregnation bioassay) different concentration of the methanolic extract and its various fractions (i.e. 0.0625, 0.125, 0.25, 0.5 and 1mg/mL) were applied for 1 hour exposure period. The results were statistically analysed using standard deviation, probit analysis, and linear regression. The R2 values of larvae, pupae, and adult range from 0.4 to 0.99. The values of LC50 (concentration causing 50% mortality) for late 3rd instar larvae after 24 hours exposure period range from 93-1856.7 ppm, while LC90 values range from 424 -7635.5ppm. The values of LC50for pupae range form 1326.7-6818.4ppm and and values of LC90 range from 3667.3-17427.9ppm, respectively. The KDT50 range from 0.30 to 2.8% and KDT90 values range from1.2 to 110.8%, respectively. In conclusion, Justicia adhatoda may be effective for controlling populations of vector mosquito.

Por ser o vetor do vírus do Nilo Ocidental e da falaríase, o controle de Culex quinquefasciatus Say é provavelmente essencial. O tratamento com inseticida sintético parece ser mais eficaz para o controle dos mosquitos vetores. No entanto, esses produtos são tóxicos para o meio ambiente e organismos não visados. Consequentemente, o controle ecológico dos mosquitos vetores é necessário. Nesse sentido, o inseticida botânico parece mais produtivo. Portanto, a presente pesquisa teve como objetivo investigar a eficácia do extrato metanólico e de várias frações, incluindo n-hexano, acetato de etila, clorofórmio e fração aquosa, obtidos do extrato metanólico de Ailanthus altissima (Mill.) Swingle, Artemisia scoparia Waldst. & Kit. e Justicia adhatoda L. usando funil de separação contra os estágios larval, pupal e adulto de C. quinquefasciatus. As larvas e pupas de C. quinquefasciatus foram expostas a várias concentrações (31,25-1000 ppm) de extrato metanólico, e suas frações por 24 horas de período de exposição. Para o bioensaio knock-down (bioensaio de impregnação de papel de filtro), diferentes concentrações do extrato metanólico e suas várias frações (ou seja, 0,0625, 0,125, 0,25, 0,5 e 1 mg / mL) foram aplicadas por um período de exposição de 1 hora. Os resultados foram analisados estatisticamente usando desvio padrão, análise Probit e regressão linear. Os valores de R2 de larvas, pupas e adultos variaram de 0,4 a 0,99. Os valores de LC50 (concentração que causa 50% de mortalidade) para larvas de terceiro estádio tardio após 24 horas de período de exposição variaram de 93-1856,7 ppm, enquanto os valores de LC90 variaram de 424-7635,5ppm. Os valores de LC50 para pupas variaram de 1326,7-6818,4 ppm e os valores de LC90 variaram de 3667,3-17427,9 ppm, respectivamente. O KDT50 variou de 0,30 a 2,8% e os valores de KDT90 variaram de 1,2 a 110,8%, respectivamente. Por fim, a espécie J. adhatoda pôde ser eficaz para controlar populações de mosquitos vetores.

Evaluation of indigenous plants extracts for mosquitocidal activity against different stages of Culex quinquefasciatus say (Diptera: Culicidae)

Abstract Being vector of West Nile Virus and falariasis the control of Culex quinquefasciatus is likely to be essential. Synthetic insecticide treatment is looking most effective for vectors mosquito control. However, these products are toxic to the environment and non-target organisms. Consequently, ecofriendly control of vectors mosquito is needed. In this regard botanical insecticide is looking more fruitful. Therefore, the present research aimed to investigate the effectiveness of methanolic extract and various fractions, including, n-hexane, ethyl-acetate, chloroform, and aqueous fraction, obtained from methanolic extract of Ailanthus altissima, Artemisia scoparia, and Justicia adhatoda using separating funnel against larval, pupal, and adult stages of Culex quinquefasciatus. The larvae and pupae of Culex quinquefasciatus were exposed to various concentrations (31.25-1000 ppm) of methanolic extract and its fractions for 24 hours of exposure period. For knock-down bioassay (filter paper impregnation bioassay) different concentration of the methanolic extract and its various fractions (i.e. 0.0625, 0.125, 0.25, 0.5 and 1mg/mL) were applied for 1 hour exposure period. The results were statistically analysed using standard deviation, probit analysis, and linear regression. The R2 values of larvae, pupae, and adult range from 0.4 to 0.99. The values of LC50 (concentration causing 50% mortality) for late 3rd instar larvae after 24 hours exposure period range from 93-1856.7 ppm, while LC90 values range from 424 -7635.5ppm. The values of LC50for pupae range form 1326.7-6818.4ppm and and values of LC90 range from 3667.3-17427.9ppm, respectively. The KDT50 range from 0.30 to 2.8% and KDT90 values range from1.2 to 110.8%, respectively. In conclusion, Justicia adhatoda may be effective for controlling populations of vector mosquito.

Resumo Por ser o vetor do vírus do Nilo Ocidental e da falaríase, o controle de Culex quinquefasciatus Say é provavelmente essencial. O tratamento com inseticida sintético parece ser mais eficaz para o controle dos mosquitos vetores. No entanto, esses produtos são tóxicos para o meio ambiente e organismos não visados. Consequentemente, o controle ecológico dos mosquitos vetores é necessário. Nesse sentido, o inseticida botânico parece mais produtivo. Portanto, a presente pesquisa teve como objetivo investigar a eficácia do extrato metanólico e de várias frações, incluindo n-hexano, acetato de etila, clorofórmio e fração aquosa, obtidos do extrato metanólico de Ailanthus altissima (Mill.) Swingle, Artemisia scoparia Waldst. & Kit. e Justicia adhatoda L. usando funil de separação contra os estágios larval, pupal e adulto de C. quinquefasciatus. As larvas e pupas de C. quinquefasciatus foram expostas a várias concentrações (31,25-1000 ppm) de extrato metanólico, e suas frações por 24 horas de período de exposição. Para o bioensaio knock-down (bioensaio de impregnação de papel de filtro), diferentes concentrações do extrato metanólico e suas várias frações (ou seja, 0,0625, 0,125, 0,25, 0,5 e 1 mg / mL) foram aplicadas por um período de exposição de 1 hora. Os resultados foram analisados estatisticamente usando desvio padrão, análise Probit e regressão linear. Os valores de R2 de larvas, pupas e adultos variaram de 0,4 a 0,99. Os valores de LC50 (concentração que causa 50% de mortalidade) para larvas de terceiro estádio tardio após 24 horas de período de exposição variaram de 93-1856,7 ppm, enquanto os valores de LC90 variaram de 424-7635,5ppm. Os valores de LC50 para pupas variaram de 1326,7-6818,4 ppm e os valores de LC90 variaram de 3667,3-17427,9 ppm, respectivamente. O KDT50 variou de 0,30 a 2,8% e os valores de KDT90 variaram de 1,2 a 110,8%, respectivamente. Por fim, a espécie J. adhatoda pôde ser eficaz para controlar populações de mosquitos vetores.

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)

Characterization and survival of broad-spectrum biocontrol agents against phytopathogenic fungi / Caracterización y supervivencia de agentes de control biológico de amplio espectro frente a hongos fitopatógenos

Resumen Este estudio tuvo como objetivo aislar, caracterizar e identificar bacterias de control biológico que poseen actividad antifúngica de amplio espectro de la filosfera de diferentes cultivos, incluidos el maíz, el trigo y la papa, así como evaluar su actividad en la promoción del crecimiento. En este estudio, 14/113 bacterias de control biológico mostraron actividad antifúngica. Los aislamientos bacterianos M11 y M33 (de maíz), del total de 113, fueron reseleccionados debido a su fuerte actividad antifúngica de amplio espectro (más del 50%) después de su evaluación contra cuatro hongos fitopatógenos que afectan cultivos de alta importancia económica, entre ellos, Alternaría alternata, Rhizoctonia solani, Fusarium oxysporum y Fusarium verticillioides. Los aislamientos se evaluaron, adicionalmente, para determinar los rasgos que promueven el crecimiento de las plantas, es decir, producción de ácido indolacético, solubilización de fosfato, producción de celulasa, compuestos orgánicos volátiles microbianos, cianuro de hidrógeno y sideróforos. Las 14 cepas aisladas mostraron resultados positivos para la producción de la hormona ácido indolacético y la enzima celulasa; 10 cepas fueron positivas para la producción de cianuro de hidrógeno. Además, se observó producción de sideróforos en el caso de 7 cepas, mientras que 5 pudieron solubilizar fosfato inorgánico. Los compuestos orgánicos volátiles microbianos solo fueron sintetizados por los aislamientos M11 y M33, que fueron identificados como Bacillus amyloliquefaciens y Bacillus subtilis, respectivamente, mediante secuenciación del gen ARNr 16S. El estudio de supervivencia mostró que las bacterias de control biológico, es decir, B. amyloliquefaciens y B. subtilis, tienen la capacidad de sobrevivir sobre un sustrato a base de melasa, por un período de tres meses.

Increased ERCP volume improves cholangiogram interpretation: a new performance measure for ERCP training?

Background/Aims@#Cholangiogram interpretation is not used as a key performance indicator (KPI) of endoscopic retrograde cholangiopancreatography (ERCP) training, and national societies recommend different minimum numbers per annum to maintain competence. This study aimed to determine the relationship between correct ERCP cholangiogram interpretation and experience. @*Methods@#One hundred fifty ERCPists were surveyed to appropriately interpret ERCP cholangiographic findings. There were three groups of 50 participants each: “Trainees,” “Consultants group 1” (performed >75 ERCPs per year), and “Consultants group 2” (performed >100 ERCPs per year). @*Results@#Trainees was inferior to Consultants groups 1 and 2 in identifying all findings except choledocholithiasis outside the intrahepatic duct on the initial or completion/occlusion cholangiogram. Consultants group 1 was inferior to Consultants group 2 in identifying Strasberg type A bile leaks (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.77–0.96), Strasberg type B (OR, 0.84; 95% CI, 0.74–0.95), and Bismuth type 2 hilar strictures (OR, 0.81; 95% CI, 0.69–0.95). @*Conclusions@#This investigation supports the notion that cholangiogram interpretation improves with increased annual ERCP case volumes. Thus, a higher annual volume of procedures performed may improve the ability to correctly interpret particularly difficult findings. Cholangiogram interpretation, in addition to bile duct cannulation, could be considered as another KPI of ERCP training.

Stroke Etiology and Outcomes after Endovascular Thrombectomy: Results from the SITS Registry and a Meta-Analysis / 대한뇌졸중학회지

Background@#and Purpose The influence of stroke etiology on outcomes after endovascular thrombectomy (EVT) is not well understood. We aimed to investigate whether stroke etiology subgrouped as large artery atherosclerosis (LAA) and cardiac embolism (CE) influences outcomes in large artery occlusion (LAO) treated by EVT. @*Methods@#We included EVT treated LAO stroke patients registered in the Safe Implementation of Treatment in Stroke (SITS) thrombectomy register between January 1, 2014 and September 3, 2019. Primary outcome was successful reperfusion (modified Treatment in Cerebral Infarction 2b-3). Secondary outcomes were symptomatic intracranial hemorrhage (SICH), 3-month functional independence (modified Ranking Scale 0–2) and death. Multivariable logistic regression models were used for comparisons. In addition, a meta-analysis of aggregate data from the current literature was conducted (PROSPERO, ID 167447). @*Results@#Of 7,543 patients, 1,903 (25.2%) had LAA, 3,214 (42.6%) CE, and 2,426 (32.2%) unknown, other, or multiple etiologies. LAA patients were younger (66 vs. 74, P<0.001) and had lower National Institutes of Health Stroke Scale score at baseline (15 vs. 16, P<0.001) than CE patients. Multivariable analyses showed that LAA patients had lower odds of successful reperfusion (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.57 to 0.86) and functional independence (OR, 0.74; 95% CI, 0.63 to 0.85), higher risk of death (OR, 1.44; 95% CI, 1.21 to 1.71), but no difference in SICH (OR, 1.09; 95% CI, 0.71 to 1.66) compared to CE patients. The systematic review found 25 studies matching the criteria. The meta-analysis did not find any difference between etiologies. Conclusions From the SITS thrombectomy register, we observed a lower chance of reperfusion and worse outcomes after thrombectomy in patients with LAA compared to CE etiology, despite more favorable baseline characteristics. In contrast, the meta-analysis did not find any difference between etiologies with aggregate data.

Stroke Etiology and Outcomes after Endovascular Thrombectomy: Results from the SITS Registry and a Meta-Analysis / 대한뇌졸중학회지

Background@#and Purpose The influence of stroke etiology on outcomes after endovascular thrombectomy (EVT) is not well understood. We aimed to investigate whether stroke etiology subgrouped as large artery atherosclerosis (LAA) and cardiac embolism (CE) influences outcomes in large artery occlusion (LAO) treated by EVT. @*Methods@#We included EVT treated LAO stroke patients registered in the Safe Implementation of Treatment in Stroke (SITS) thrombectomy register between January 1, 2014 and September 3, 2019. Primary outcome was successful reperfusion (modified Treatment in Cerebral Infarction 2b-3). Secondary outcomes were symptomatic intracranial hemorrhage (SICH), 3-month functional independence (modified Ranking Scale 0–2) and death. Multivariable logistic regression models were used for comparisons. In addition, a meta-analysis of aggregate data from the current literature was conducted (PROSPERO, ID 167447). @*Results@#Of 7,543 patients, 1,903 (25.2%) had LAA, 3,214 (42.6%) CE, and 2,426 (32.2%) unknown, other, or multiple etiologies. LAA patients were younger (66 vs. 74, P<0.001) and had lower National Institutes of Health Stroke Scale score at baseline (15 vs. 16, P<0.001) than CE patients. Multivariable analyses showed that LAA patients had lower odds of successful reperfusion (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.57 to 0.86) and functional independence (OR, 0.74; 95% CI, 0.63 to 0.85), higher risk of death (OR, 1.44; 95% CI, 1.21 to 1.71), but no difference in SICH (OR, 1.09; 95% CI, 0.71 to 1.66) compared to CE patients. The systematic review found 25 studies matching the criteria. The meta-analysis did not find any difference between etiologies. Conclusions From the SITS thrombectomy register, we observed a lower chance of reperfusion and worse outcomes after thrombectomy in patients with LAA compared to CE etiology, despite more favorable baseline characteristics. In contrast, the meta-analysis did not find any difference between etiologies with aggregate data.

Study of malignant tumours of the uterine corpus: histopathology and immunohistochemistry

Background: The uterine corpus represents the second most common site for malignancy in the female genital tract. This study was performed to ascertain the profile of malignant tumours of the uterine corpus reported at our centre.Methods: A retrospective analysis of cases retrieved from the archives of the department of pathology from January 2014 to December 2016. Clinical information of the patients was collected from the hospital records.  Classification and grading of the tumours were done according to the current WHO classification.Results: Nineteen cases were studied. There were ten cases of endometrial adenocarcinoma, five cases of leiomyosarcoma, three cases of endometrial stromal sarcoma and one case of carcinosarcoma(malignant mixed mullerian tumour). The age range of endometrial adenocarcinoma was 55 to 85 years and presented with post menopausal bleeding, whereas endometrial stromal sarcomas occurred in women above 45 years of age. Leiomyosarcomas had age range from 26 to 65 years. All leiomyosarcomas were clinically diagnosed as fibroid. Majority of endometrial adenocarcinomas were well differentiated endometroid type. Out of the three endometrial stromal sarcomas two were high grade, one with metastasis. All leiomyosarcomas showed mitotic rate above 10/10hpf.Conclusions: Endometrial carcinomas form the majority of malignant tumours of uterine corpus and occur in older age group followed by leiomyosarcomas. Endometrial stromal sarcomas are less common and occur in middle aged and older patients. Leiomyosarcomas and stromal sarcomas are usually misdiagnosed as fibroids clinically unless metastases are present.

Approach for reporting serous effusion fluid in pleural, peritoneal and pericardial cavity and immunohistochemistry

Background: The aim of this study is to make a detailed cytological study of effusion fluids and compare with cell block study of the representative cases and IHC studies were done.Methods: Prospective study of 216 cases effusion fluids from in and around hospitals, Mangalore. This study conducted over a period of 18 months from October-2014 to April-2016. This study scrutinized and approved by Institutional Ethics Committee. The samples were processed by conventional cytology using Papanicolaou-stain and Cell Block (CB) method using 10% Alcohol-formalin fixative and stained with H and E. The cellularity, architectural patterns, morphological details were studied both smears. Ancillary immunohistochemical staining with calretinin and EMA are done.Results: A total of 216 cases of effusion fluids with cell block study were included, age range of 13 years to 93 years. Pleural fluid comprised of 55.09%, peritoneal fluid of 43.51% and pericardial fluid of 1.38%. 71% were clinically diagnosed as non-neoplastic and 29% were neoplastic condition. In CS study, 84.5% cases were benign/reactive effusion and 8.5% were positive for malignancy. In CB study, 84.5% were benign/reactive effusion and 10.2% were positive for malignancy. In comparison authors found an increase in diagnostic efficacy by 18%. IHC EMA for adenocarcinoma cells has sensitivity of 100% and calretinin for reactive mesothelial cells has specificity of 100%.Conclusions: Authors concluded that cell block technique when used as an adjuvant to routine smear examination in effusion fluids has increased the diagnostic yield and better preservation of architectural pattern. IHC is helpful in differentiating between reactive mesothelial and adenocarcinoma cells.

Comparison The Effectiveness Of Steroid Therapy With And Without Physiotherapy For The Management Of Lateral Epicondylitis

Objective: To compare the effectiveness of steroid therapy with and without physiotherapy for the management of lateral epicondylitis (tennis elbow). Methodology: Patients, who fulfil the inclusion criteria of selection were admitted to study in the Department of Physiotherapy PSRD, Lahore. Each patient received an informed consent. Demographic data including name, age, sex, height and weight were noted. Participating individuals were randomly allocated into two groups by lottery method. Patients of group A were treated by steroidal therapy without physiotherapy manoeuvres and the individuals of group B were treated by combination of steroidal therapy and physiotherapy. The follow-up was carried out for up to 4 weeks.All the information has been collected with pre-defined preforms.Data was interpreted and analysed through SPSS version 22.0. Results: The overall mean age of cases was 38.90±6.97 years and 42.07±7.03 years. There were 38(63.33%) male and 22(36.67%) female in this study. Before treatment the mean pain of participating individuals of group-A and in group-B was 7.40±1.45 and 7.63±1.27 with insignificant difference. After treatment the mean pain in group-A and group-B was 3.40±1.73 and 2.53±1.57 with significantly lower pain in group-B, p-value < 0.05. When we compared mean pain before and after injection was significantly improved in both groups but the improvement was higher in group-B. The mean pain difference in group-A and group-B was 3.77±2.18 and 4.90±1.83 with higher improvement in group-A, p-value < 0.05. Conclusion: Results of study concludesteroid injection with addition to physiotherapy was more effective in reducing pain.We must encourage orthopedic and physiotherapist teamwork to treat tennis elbow.

Exploring threatened traditional knowledge; ethnomedicinal studies of rare endemic flora from Lesser Himalayan region of Pakistan

ABSTRACT Himalayas are one among the world biodiversity hotspots harboring many endemic medicinal plants. Despite augmentation in the documentation of ethnopharmacological knowledge of medicinal plant species, information regarding endemic species is still underway. Current paper highlights the traditional medicinal uses of rare endemic and unexplored group of plants having potential for novel chemical constituents with effective pharmacological activities. In total, 142 informants (91 male and 51 female) including seventeen traditional healers were interviewed using semi-structured questionnaire, personal observations and group discussions. Interviews were taken in field or otherwise photographs were shown for identification. Females were interviewed indirectly through male family members. For data analysis, quantitative analytical approach was adopted using ethnopharmacological indices as Relative frequency of citations and Fidelity Level. In total, 38 endemic plant species belonging to nineteen families were utilized by the local inhabitants. Highest number of endemics was belonging to Ranunculaceae (7), followed by Gentianaceae and Rosaceae (4 each) with respect to number of species. Highest number of endemics was used in fever, wound healing, throat infection and tonic (4 species each). Root was the most widely used part (36.17%) in cure of diseases and the leading mode administered was decoction (25.49%). Highest use reports and RFC values were recorded for Pimpinella stewartii (58 citations, 0.41 RFC), Caltha alba var. alba (52 citations, 0.37 RFC). Endemic plant species considerably contribute toward ethnomedicinal knowledge and despite rarity, the communities prefer their utilization. Conservation of endemics is necessary for future availability to the local communities.

A Cross-Sectional Study Determining Pain in Lower Back and Calf Muscles among Females Due to High Heel Shoe Wear

To determine pain in lower back and calf muscles among females due to high heels shoe wear. Methodology: A sample size of 87 females working women and students were recruited on the basis of the purposive sampling technique. Participants were requested to wear 5 cm stiletto high heels and they were asked to walk on treadmill at the pace of 4km/hr for 20 minutes. Modified McGill Questionnaire for pain measurement was used as a tool before and after test data collection. Results: In this study observation of muscular pain was significant in lower limb and lower back muscles due to high heels i.e. 29.6% and 24.7% respectively. Conclusion: Back and lower limbs musculature pain contribute only 8.6% whereas, only back pain had been observed in 9.9%. Paired sample t-test was used to determine pain before and after test was significant with p-value 0.000.

Knowledge, Attitude and Practice Regarding Infection Control Procedures among Dentists of Karachi

Aim: Infection control is crucial in any clinical setting. It is vital that all dentists must follow the infection control protocols in their clinics to prevent cross-infection. In a dental clinic, even simple dental procedures including extractions, scaling and root planning, dental crown preparations and root canal treatment, have a high risk of exposure to blood, which may cause transmission blood-borne diseases. Dentist’s compliance with these guidelines and recommendations have been recently studied in different parts of the world. Hence this study was performed to evaluate the knowledge, attitude, and practice regarding infection control measures among private dental practioners in Karachi, Pakistan.Study Design:Cross-sectional study.Place and Duration of Study:This study was conducted for a period of four months in Karachi, Pakistan. Materialsand Methods: Present cross–sectional study was performed by interviewing 234dentists via a questionnaire based upon various questions regarding infection control. Sample were collected using convenience sampling, from private dental clinics in Karachi, Pakistan. Setting:Questionnaire were sent to 400 general dentist in Karachi,out of which 234 replied.Results: Mostly (69%) dentists who took part in the study were males. Regarding infection control, most of the individuals had a comprehensive understanding of infection control techniques. Isolation was considered to play a vital role in cross-infection prevention by 97.3% of the dentists. 93.2% used autoclave for sterilization and majority had thorough knowledge of the process involved. Regarding preventive measures, 66.7% of the dentists were vaccinated against major infectiousagents in our society and 92.2% took protective measures required to prevent cross-infection.Conclusion: Knowledge, attitudes and practices regarding infection control of dentists in private clinic of Karachi, Pakistan are satisfactory.

Effect of Carbamazepine on the Serum Level of Thyrotropin-Releasing Hormone

Background: The thyroid gland is endocrine gland located in front and lower side of neck. Thyroid gland secretes two types of thyroid hormones that are triiodothyronine (T3) and tetraiodothyronine (T4). The hypothalamus is a center for regulation of thyroid hormones. It senses the low hormone levels and in turn releases thyrotropin-releasing hormone (TRH). TRH stimulates anterior pituitary to release TSH which then acts on the thyroid gland to maintain normal level of T3 and T4. The objective of study is to determine the effects of carbamazepine on TRH in euthyroid rabbits.Methods: An experimental study performed on 30 rabbits. These were divided into three groups having 10 rabbits in each group. 10 rabbits were treated with 10mg/kg/day of CBZ (OD), other 10 with 35mg/kg/day CBZ (three divided doses) and 10 rabbits served as control. T3, FT4, TSH and TRH levels were evaluated at baseline and after 21 days of treatment in all three groups by Electro-chemiluminescence immunoassay and ELISA respectively.Results: Comparison of the hormone levels of the control group and the group having a dose of 10 mg/kg/day for 21 day of treatment. Comparative results showed serum level of T3 (P=0.031), FT4 (P=0.030), and TRH (P=0.044) levels significantly lower than the control group and TSH (P=0.057) levels remain unaltered. It was also found that group having a dose of 35 mg/kg/day; TDS showed decrease in T3 (P value 0.001), FT4 (P=0.001), TSH (P=0.003) and TRH (P=0.001) level as compared to control group.Conclusions: Our data suggest that Carbamazepine monotherapy does alter thyroid hormones and its central regulatory hormone TRH. Decrease in TRH level increase level of depression and suicidal thoughts and also risk of tertiary hypothyroidism. These findings could have very important clinical implications.

Association of Elevated Blood Pressure Levels with Outcomes in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis: A Systematic Review and Meta-Analysis / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Although arbitrary blood pressure (BP) thresholds exist for acute ischemic stroke (AIS) patients eligible for intravenous thrombolysis (IVT), current international recommendations lack clarity on the impact of mean pre- and post-IVT BP levels on clinical outcomes. METHODS: Eligible studies involving IVT-treated AIS patients were identified that reported the association of mean systolic BP (SBP) or diastolic BP levels before and after IVT with the following outcomes: 3-month favorable functional outcome (modified Rankin Scale [mRS] scores of 0–1) and 3-month functional independence (mRS scores of 0–2), 3-month mortality and symptomatic intracranial hemorrhage (sICH). Unadjusted analyses of standardized mean differences and adjusted analyses of studies reporting odds ratios (ORadj) per 10 mm Hg BP increment were performed using random-effects models. RESULTS: We identified 26 studies comprising 56,513 patients. Higher pre- (P=0.02) and posttreatment (P=0.006) SBP levels were observed in patients with sICH. Patients with 3-month functional independence had lower post-treatment (P < 0.001) SBP whereas trended towards lower pre-treatment (P=0.06) SBP. In adjusted analyses, elevated pre- (ORadj, 1.08; 95% confidence interval [CI], 1.01 to 1.16) and post-treatment (ORadj, 1.13; 95% CI, 1.01 to 1.25) SBP levels were associated with increased likelihood of sICH. Increasing pre- (ORadj, 0.91; 95% CI, 0.84 to 0.98) and post-treatment (ORadj, 0.70; 95% CI, 0.57 to 0.87) SBP values were also related to lower odds of 3-month functional independence. CONCLUSIONS: We found that elevated BP levels adversely impact AIS outcomes in patients receiving IVT. Future randomized-controlled clinical trials will provide definitive data on the aforementioned association.

Molecular detection of Leishmania species in human and animals from cutaneous leishmaniasis endemic areas of Waziristan, Khyber Pakhtunkhwa, Pakistan

Objectives: To detect Leishmania species in human patients, animal reservoirs and Phlebotomus sandflies in Waziristan, Pakistan. Methods: Tissue smears and aspirates from 448 cutaneous leishmaniasis (CL) suspected patients were analyzed. To sort out role of the reservoir hosts, skin scrapings, spleen and liver samples from 104 rodents were collected. Furthermore, buffy coat samples were obtained from 60 domestic animals. Sandflies were also trapped. All human, animals and sandfly samples were tested by microscopy, kinetoplastic PCR and internal transcribed spacer 1 (ITS1) PCR followed by restriction fragment length polymorphism for detection of Leishmania species. Results: An overall prevalence of 3.83% and 5.21% through microscopy and ITS1 PCR respectively was found. However, the statistically non-significant correlation was found between area, gender, and number of lesions. The presence of rodents, sandflies, domestic animals and internally displaced people increased the risk of CL. Using ITS1-PCR-RFLP, Leishmania tropica (L. tropica) was confirmed in 106 samples while 25 of the isolates were diagnosed as Leishmania major (L. major). Similarly, 3/104 rodents were positive for L. major and 14 pools of DNA samples containing Phlebotomus sergenti sandflies were positive for L. tropica. None of samples from domestic animals were positive for leishmaniasis. Conclusions: In the present study, L. tropica and L. major are found to be the main causative agents of CL in study area. Movement of internally displaced people from CL endemic areas presents a risk for nearby CL free areas. To the best of our knowledge, we report for the first time L. major infection in rodents (Rattus rattus) and L. tropica in Phlebotomus sergenti sandflies trapped in Waziristan, Pakistan.

Carbamazepine verses valproic acid as monotherapy in epileptic patients

Objective: To evaluate the effectiveness of carbamazepine and valproic acid as monotherapy in epileptic patients of Pakhtun population. Study Design: An experimental study. Place and Duration of Study: The outpatient Neurology Department, Lady Reading Hospital, Peshawar, from August 2014 to April 2016

Methodology: Epileptic patients placed on carbamazepine and volproic acid were inducted. Carbamazepine and valproic acid plasma levels were determined using reverse phase high performance liquid chromatography. Plasma levels of vitamin B6 and homocysteine were determined at baseline before the switching to carbamazepine and valproic acid therapy, and on the sixth month of the therapy. Hemoglobin [Hb] level were also determined through blood analyser. Clinical response [number of seizures per week] was evaluated on third and sixth month of the therapy

Results: There were 79 patients in carbamazepine group and 82 in the valproic acid group. Mean age of patients was 18.08 +/-8.6 years in carbamazepine group and 17.5 +/-7.04 years in the valproic acid group. Median dose of carbamazepine was 400 mg/day at baseline and at 6[th] month of therapy. Median dose of valproic acid was 500 mg/day and 750 mg/day of valproic acid at baseline and end study point. Difference in homocysteine, vitamin B6 and Hb levels were statistically significant [p<0.05] in carbamazepine cohort compared to valproic acid cohort. The frequency of seizures in the carbamazepine was 0.85 times more compared to valproic acid at the end study point

Conclusion: Hyperhomocysteinaemia and lower vitamin B6 and Hb levels was found in the carbamazepine cohort. The frequency of number of seizures/week was higher in the carbamazepine cohort compared to valproic acid cohort

Isolation of flavonoides from Artemisia macrocephala anticholinesterase activity: isolation, characterization and its in vitro anticholinesterse activity supported by molecular docking

In this study the flavonoids isolated from Artemisia macrocephala were screened out for anticholinesterase activity. The isolated flvanoids were characterized by HNMR, NOESY, COSY, HMBC, HSQC and mass spectroscopy. The compounds [1-4] in appropriate quantities were isolated from chloroform fraction using gravity column chromatography by eluting ethyl acetate/n-hexane solvent system. The flavonoids were characterized and resulted in the form of mono substituted methoxy flavones to tri substituted flavones. Ellman's assay techniques were used to find out enzyme inhibition. Operating environment [MOE] software was used for molecular docking studies. Compounds [1], [2] and [3] showed 88.42+/-2.76, 84.50+/-1.60 and 90.16+/-2.98 percent inhibition of the acetyl cholinesterase [AChE] respectively at 1000µg/mL concentrations with IC50 value 165, 60, 65µg/mL respectively which were comparable to that of standard galanthamine. While for butyryl cholinesterase [BChE], [1], [2] and [3] showed 91.63+/-4.32, 81.03+/-3.53 and 87.69+/-2.84 percent inhibitions respectively at 1mg/mL as compared to the standard galanthamine which caused 96.50+/-2.41 percent inhibition at the same concentration. Whereas, compound [4] exhibited moderate activity for both the enzymes. Molecular docking studies confirmed the experimental AChE and BChE inhibitory activities of the test samples by their virtue of multiple interactions with target enzymes. The results confirm that the specie has biologically active constituents that are more useful for the management of several neurodegenerative ailments like ataxia, Parkinson's disease, Alzeimer's disease and some other types of dementia