Antibacterial potential of indigenous medicinal plants against methicillin-resistant Staphylococcus aureus isolated from septic wounds

Aims@#This study was aimed to screen indigenous medicinal plants for their antibacterial potential against methicillin-resistant Staphylococcus aureus (MRSA).@*Methodology and results@#Three indigenous plants (Nigella sativa, Zingiber officinale and Calotropis procera) and thymoquinone were screened for antibacterial activity against MRSA, isolated from septic wounds of patients admitted to Mayo Hospital Lahore, Pakistan. Isolated bacteria were screened for methicillin and cefoxitin resistance by the Kirby-Bauer method, followed by mecA gene-specific polymerase chain reaction (PCR). Confirmed MRSA was processed for antibacterial activity of plant extracts and thymoquinone followed by cytotoxicity assay of plant extract having least minimum inhibitory concentration (MIC) value. Out of total samples (n=100), S. aureus (29%), MRSA (26%) and vancomycin-resistant S. aureus (VRSA) (21.7%) isolates were recovered based on morphology, biochemical profile and antibiotic susceptibility testing. Nigella sativa showed the highest antibacterial activity (10.06 ± 6.53 mm) against MRSA followed by Z. officinale (4.06 ± 3.72 mm) and C. procera (3.65 ± 3.33 mm) in comparison to standard thymoquinone (17.93 ± 10.14 mm). The least MIC value recorded was for Z. officinale at 36.89 ± 3.75 μg/mL. Zingiber officinale was the most effective antibacterial agent, followed by N. sativa and C. procera and non-toxic for eukaryotic cells at all tested concentrations (1500 μg/mL to 2.92 μg/mL).@*Conclusion, significance and impact of study@#It was concluded that Z. officinale may be used as an effective alternative for treating septic wound infection in local or topical preparations. As pathogenic S. aureus is becoming life-threatening among antibiotic-resistant bacteria and traditional plants are in used for centuries to treat septic wound infections.

Tangled Throughout Life: A Case of Paediatric Ruptured Cerebral Arteriovenous Malformation

@#Arteriovenous malformation (AVM) in children is uncommon occurrence defined as presence of arteriovenous shunting through coiled and tortuous vascular connections. We discussed a case of a 3-year old girl presented with acute left facial asymmetry and right-sided limb weakness. Neurological examination revealed MRC scale of 0 out of 5 for power on her right side. Magnetic Resonance Angiography (MRA) revealed bilateral thalamic AVM. Surgical resection was not advisable in view of deep-seated location. Paediatric AVM most often become apparent following rupture with majority presents with headache. Ruptured paediatric AVM carries high burden of morbidity and mortality. Paediatric intracranial haemorrhage posed tremendous concern regarding its long-term outcome. Treatment would be more appropriate sooner rather than later especially for those presented with ruptured AVM. Surgical resection remains the gold standard treatment for all accessible paediatric AVMs with embolization and radiosurgery as adjunctive therapies. AVM in paediatric population is rare but carries grim prognosis.

Types and clinical presentation of stroke

Background: Stroke is one of the leading causes of mortality and morbidity worldwide. In this study, authors worked on clinical presentation and types of stroke. The two main types of strokes are ischemic and haemorrhagic. Brain infarction is caused by decrease blood flow due to either narrowing of artery or complete obstruction to blood flow owing to embolism. While haemorrhage is caused by rupture of artery or aneurysms leading to accumulation of blood in the brain parenchyma.Methods: Cross sectional study of group of patients in Nishtar hospital Multan, Pakistan who presented with variety of neurological symptoms who were subsequently diagnosed as non-traumatic stroke. All patients were subjected to a detailed history and thorough clinical examination and investigations after obtaining informed consent.Results: Of 122 patient, 66 patients were male and 56 were female. Ischemic stroke was more common: present in 76 patients as compared to 46 patients with hemorrhagic stroke. Hypertension was present in 40.9% of ischemic stroke and 27.8% of hemorrhagic strokes. Most of the patients (67.2%) had altered sensorium at presentation followed by hemiplegia in 39.3 % of patients.Conclusions: Prevalence of ischemic strokes is higher than that of haemorrhagic stroke. Hypertension is associated with both types of these strokes. Moreover, hyperglycaemia and high blood pressure are common in early phase of stroke. Vomiting in stroke favors haemorrhagic stroke.

A Study to Determine the Intradialytic Hypotension among Patients on Maintenance Heamodialysis

Objective: The aim was to govern the intradialytic hypotension frequency among patients on maintenance dialysis and its relationship with various risk factors. Study design: A Cross-Sectional analytical study. Place and duration: In the Nephrology department of Services Hospital Lahore for Six months duration from January 2019 to June 2019. Methods: The intradialytic hypotension frequency was determined and specified as a percentage. All statistical variables such as weight, age, blood flow, dialysate temperature, standard deviation and mean were recorded. The relationship between qualitative risk factors and intradialytic hypotension was paralleled using the Student’s t-test with a z-test for proportional and quantitative risk factors. Results: In total sessions; Symptomatic intradialytic hypotension was recorded in 5.4%. In the hypotensive group the pre-dialysis diastolic, systolic, pulse, blood pressure was higher than the other groups with substantial p-values. In the hypotensive group, diastolic, systolic and low mean blood pressure was lesser than the other groups. However, in pulse rate the mean change between the 2 groups (normotensive group, p=0.8 to -2.4 ± 11.1 and hypotensive group -2.1 ± 14.1) did not significantly change with the drop in B.P. Cardiac events were also higher significantly in the hypotensive group.

Clinical Efficacy and Safety of Injectable Levetiracetam Versus Phenytoin as Second-Line Therapy in the Management of Generalized Convulsive Status Epilepticus in Children: An Open-Label Randomized Controlled Trial

BACKGROUND AND PURPOSE: There is sparsity of quality evidence for the use of drugs after first-line benzodiazepines in convulsive status epilepticus in children. The aim of the study was to compare the clinical efficacy and safety of intravenous levetiracetam versus intravenous phenytoin as second-line drugs in the management of generalized convulsive status epilepticus in children. METHODS: This open-label randomized controlled trial was conducted in the Emergency Department of The Children's Hospital and The Institute of Child Health, Multan, Pakistan over a period of 4 years and 6 months from January 2014 to June 2018. This study included 600 children with generalized convulsive status epilepticus: 300 in the 40 mg/kg levetiracetam group, and 300 in the 20 mg/kg phenytoin group. Cessation of a clinical seizure (seizure cessation rate) within 30 minutes after the end of drug administration was the primary outcome in this study, and the presence or absence of adverse effects was noted as the secondary outcome. Data were analyzed using SPSS (version 20.0). RESULTS: The children in the levetiracetam and phenytoin were aged 3.5±0.2 and 3.4±0.2 years (mean±SD), respectively, their seizure durations before the start of treatment were 25.1±0.6 and 23.8±0.4 minutes, and their treatment efficacies were 278/300 (92.7%) and 259/300 (83.3%). Levetiracetam was significantly more effective than phenytoin (p=0.012), with no significant difference in safety. Adverse events were observed in eight children in the phenytoin group. CONCLUSIONS: Levetiracetam is significantly more effective than phenytoin for the treatment of convulsive status epilepticus in children who have failed to respond to benzodiazepines.

Metabolic dysregulation in early onset psychiatric disorder before and after exposure to antipsychotic drugs

Antipsychotic Drugs (APDs) are being widely prescribed to treat various disorders, including schizophrenia and bipolar disorder; however, abnormal glucose metabolism and weight gain have been reported with Atypical Anti-Psychotic drugs (AAPDs) that can lead to insulin-resistance and type 2 diabetes mellitus. The study was designed to assess various biochemical parameters including insulin and blood sugar before and after exposure to APDs in order to exclude the involvement of psychiatric disorders and certain other factors in metabolic dysregulations. Fifty seven APDs-naïve patients with first episode psychosis were divided into six groups who received olanzapine, quetiapine, risperidone, aripiprazole, haloperidol or combination of olanzapine with escitalopram and haloperidol. The serum samples were taken before the intake of the first dose and then on follow-up. Decrease in the level of elevated insulin and glucose was observed post-treatment in some patients, while others were observed whose insulin and glucose levels increased post-treatment, yet some patients did not show any disturbance in the insulin and glucose levels. It is concluded that psychiatric disorders by itself, narcotics, cigarette smoking and use of oral snuff may be also be implicated in metabolic dysregulations. The effects of APDs on insulin and glucose in healthy volunteers might be different than in patients with psychiatric disorders.

Short-term oral administration of risperidone induces pancreatic damage and hyperamylasemia in Sprague-dawley rats

Risperidone is an atypical antipsychotic acting mainly as a dopamine D2 and serotonin 5-HT2 receptors antagonist prescribed in the treatment of schizophrenia and various affective disorders. Risperidone has been reported to be associated with weight gain, panreatitis and type 2 diabetes mellitus. Various mechanisms of risperidone-induced toxicities have been reported but the histology of tissues especially pancreas has never been studied. Therefore, the current study was designed to elucidate the toxic effects of chronic administration of risperidone on pancreas, liver and kidneys. Animals (rats) of either gender were divided into two groups, the risperidone and control groups. Risperidone was administered in a dose of 2.5 mg/kg/d for three weeks. The controls received acidified saline only. Both the groups received restricted diet (20 g/12 h). The body weight and level of random blood sugar (RBS) were measured on a weekly basis. The levels of lipase and amylase were determined at the conclusion of the experiment. At the end of the experiment, the tissues were dissected out for histopathological evaluation. Risperidone showed no weight gain, hyperglycemia or rise in the level of lipase (P> 0.05); however, the level of amylase was raised (***P<0.05). Histological examination under light microscope showed no hepatotoxicity, nephrotoxicity but did show damage to the pancreas. The findings of this study indicated that the incidence of adverse effects associated with risperidone could be prevented/alleviated/delayed by allowing restricted diet.

Identification of metabolic risk phenotypes predisposing to non-alcoholic fatty liver disease in a Oakistani cohort

Objectives: Non-alcoholic fatty liver disease [NAFLD] has emerged in the last two decades with worldwide prevalence of 25.24%. Due to its increasing frequency in Pakistan, it was aimed to identify disease predisposing metabolic risks and their association with NAFLD

Methods: Anthropometric and biochemical investigations were collected from 1366 subjects with minor metabolic disturbances. Comparative analyses were performed to compute frequencies of common metabolic risk phenotypes while their associations with NAFLD were explored using regression analyses. The prevalence of NAFLD was also estimated in total, age, and gender-based population cohorts

Results: Among metabolic risk phenotypes obesity, hyperglycemia, hypertension, and dyslipidemia significantly associated [p<0.001] with NAFLD risk irrespective of age, gender, and BMI. Prevalence of NAFLD in total study cohort was 14.8%, 16.1% in males, 13.4% in females, 19.9% in >/=40 years and 8.7% in

Conclusion: General Pakistani populations experiencing common metabolic disturbances are at high risk of NAFLD development, especially male gender and advanced age. Based on these parameters the stratified NAFLD population could be treated accordingly

Impact of different organic acids on solubility enhancement of cefpodxime proxetil immediate release tablet and its stability studies

Cefpodoxime proxetil is a third generation cephalosporin antibiotic demonstrates pH dependent solubility and is highly soluble only in acidic pH. The purpose of this investigation was to design and develop immediate release tablets of cefpodoxime proxetil by direct compression method and determine the effect of different solid buffers [organic acids] such as fumaric acid [formulations F1-F4], maleic acid [formulations M1-M4] and citric acid [formulations C1- C4] by using cefpodoxime and acid in the ratios of 4:1, 2:1, 1:1 and 1:2 to achieve pH-independent release of the drug. Physical parameters and assay were found to be within the acceptable range as prescribed in USP 36 / NF 31. In vitro dissolution studies of each formulation were performed in distilled water, USP dissolution medium, HCl buffer solution of pH 1.2, phosphate buffer solutions of pH 4.5 and 6.8 to observe the drug release. The formulations F3, F4, M4 were selected for film coating on the basis of better drug release profile, to protect the drug from chemical degradation through hydrolysis. Film coated formulation F3, F4 and M4 showed a remarkable in vitro release of the drug [72.88+/-0.43 to 92.67+/-0.71%] within 30min of observation in all dissolution media and further evaluated by model independent and model dependent approaches. The drug release was found to be best fit to Weibull model as highest r[2] [adjusted] [0.924- 0.998] and lowest AIC [18.416-54.710] values were obtained in all dissolution media. R Gui[registered sign] applied for stability studies of F3 and F4 formulations, showing shelf lives of 28 and 27months at ambient and 33 months at accelerated temperatures. Formulation F4 was chosen as best formulation on the basis of physical properties, highest dissolution rate and stability studies

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

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

Risk factors of neonatal mortality in Faisalabad, Pakistan

The objective of study was to find out major correlates of neonatal mortality. The main focus was in determining the impact of different demographic and health related characteristics of neonates and their mothers. A planned questionnaire was prepared in order to collect the information from mothers of newborns. The data were collected from different public and private hospitals of Faisalabad district. Discharge condition of neonate [dead or alive] was taken as response. Binary logistic regression was applied in order to unveil the impact of different contributory factors on the chances of neonatal mortality. Marriage age of mother, age of mother at baby birth, number of pregnancies, time since last birth, antenatal care, delivery mode, gender of baby, baby weight, baby disease and its nature, domestic violence, baby nutrition and residence were found to be significant factors affecting neonatal mortality. Odds ratio was used as a measure of association. From the results, it can be summed up that marriages at optimal ages, lesser frequency of pregnancies, early initiation of mother feeding, increased care during pregnancy to avoid low birth weight and birth time diseases, and increased facilities of antenatal care in rural areas can effectively reduce the neonatal mortality rates

Salivary duct carcinoma of the parotid gland: report of two cases in females

Salivary duct carcinoma is a rare tumor, commonly involving parotid gland. It typically affects middle aged to elderly males. The tumor has an aggressive behaviour and is notorious for early metastasis, high rate of local recurrence, and high mortality. Treatment is mainly surgical but other modalities are also used. We are reporting 2 cases in females who had different presentation, course of disease, treatment, and prognosis

Appendicular diverticulosis with appendicitis

Appendicular diverticulosis is one of the very rare diseases which is also difficult to diagnose, especially clinically, due to its silent course and non-specific symptoms. It comes under the notation usually due to its complications like diverticulitis or perforation, but sometimes it also presents with acute appendicitis. This report describes a 44-year male patient who presented with the complain of right iliac fossa pain and was clinically diagnosed as acute appendicitis; but intraoperatively, it was found that the appendix also had diverticulosis along with appendicitis

Psychological distress and disease: level of stress in victims of type 2 diabetes mellitus

Objective: To measure the level of stress and its relationship and comparison with demographic variables among Type 2 diabetes mellitus patients

Methodology: This was a cross sectional comparative study conducted during April 2016 to July 2016 in Faisalabad. A sample of 120 diagnosed type 2 diabetes mellitus [T2DM] patients between aged 20 to 50 years, mean age 34.57+/-8.36 were selected through random sampling techniques from different public hospitals of Faisalabad. A self-report measure perceived stress scale 10 items [PSS- 10] Urdu was used to measure the level of stress among T2DM Patients. Statistical analysis was run through SPSS version 21

Results: A significant positive relationship observed between gender and stress at p<0.05, and significant negative relationship between age and stress p<0.01. Significant gender difference observed at p<0.05 and significant age differences at p<0.01among T2DM patients

Conclusion: Stress is negatively linked with increasing age and positively linked with gender. Men and adults experience low level of stress as compared to women and early adults with T2DM

Analgesic and anti-inflammatory activity of aqueous-methanolic extract of Aerva javanica

The present study was aimed to investigate the analgesic and anti-inflammatory activity of aqueous methanolic extract of Aerva javanica. For measuring analgesic activity, writhing test, hot plate method and formalin test were performed and abdominal writhing was induced by intra-peritoneal injection of 0.2ml of 3% acetic acid. While in formalin test, pain was experimentally induced by injecting 25 micro l of 2.5% formalin in left hind paw. In hot plate method, pain was induced thermally by keeping the animals on a hot plate with temperature of about 51[degree]C. Anti-inflammatory activity was assessed by carrageen an induced mice paw edema. The results showed that the extract had significant analgesic activity [p<0.05- p<0.001] and anti-inflammatory activity [p<0.01-p<0.001]. Therefore, it was concluded from this study that the extracts of Aerva javanica may be used against pain and inflammation

Pattern of karyotypic aberrations in pakistani patients with de novo acute myeloid leukemia

Background: Acute myeloid leukemia [AMI] is a malignant disease of the bone marrow in which karyotypic analysis is the most important diagnostic and prognostic tool for predicting remission rate, relapse and overall survival. This study was carried out to determine the frequency and type of cytogenetic aberrations in de novo acute myeloid leukemia in adults at a tertiary care hospital

Materials and methods: This descriptive cross-sectional study was carried out in the Hematology Department, Liaquat National Hospital from November 2014 to April 2016.A total of 51 cases were diagnosed with AMI during the study period. Cytogenetic analysis was carried out by banding technique on bone marrow aspirate samples

Results: The mean age of the study subject was 42.03+/-17.70 years. Frequency of karyotyping abnormalities was observed in 47% of cases, in which most frequently occurring cytogenetic abnormalities were those of good cytogenetics including t[15;17] and t[8;21], seen in 23.5% and 9.8% of cases respectively. Intermediate risk cytogenetics including Del 9q was seen in 1.96% of cases. However, poor risk cytogenetics including complex cytogenetics, t[11;q23] and del [13] were seen in 7.8%, 1.96% and 1.96% of cases respectively. Normal cytogenetics was seen in 27 [52.9%] patients

Conclusion: Karyotyping is one of the most important diagnostic and prognostic tools and a maximum benefit could be attained through cytogenetic analysis. Cytogenetic aberrations in our series are more or less similar as reported at national level with preponderance of good risk cytogenetics in our setting

Computational drug designing of newly synthesized triazoles against potential targets of methicillin resistant Staphylococcm aureus

Methicillin resistant Staphylococcus aureus [MRSA] is resistant to known antibiotics and has become a great challenge for healthcare professionals, therefore new molecules are needed to manage this situation. In this study, new lead molecules 4-Amino-5-[2-Hydroxyphenyl]-l,2,4-Triazol-3-Thione [Ul] and4-[2-hydroxybenzalidine] amine-5-[2-hydroxy] phenyl-l,2,4-triazole-3-thiol[U!A Schiff base] were synthesized by fusion method that showed promising antibacterial activity [U1A: 26mm and Ul: 14mm] against MRSA.FT-IR and NMR were used for structural characterization of these derivatives and their toxicity properties were assessed by Lipinski's rule of 5. New potential drug targets of this bacterium were also identified by comparative and subtraction genomics techniques. In particular, octanoyl-[GcvH]: protein N-octanoyl transferase and phosphor mevalonate kinase were used as potential targets in AutoDock Vina studies. This study can provide a framework to find potential drug targets for other pathogenic microorganisms that can successfully be docked with compound Ul and Ul A

Peri-operative arrhythmias: diagnosis and management

Arrhythmias are common during the perioperative period. These abnormal rhythms can alter the hemodynamics by reducing cardiac output and may contribute to an increase in morbidity and mortality. Early diagnosis and identification of correctable causes is essential for appropriate management of arrhythmias. Some of these arrhythmias are benign requiring no intervention, while others may need urgent therapeutic intervention. This article focuses on the diagnosis and management of arrhythmias in the perioperative setting

Efficacy of differently applied tyrosine and tryptophan for modulation of phenolic metabolism in Trachyspermum ammi [L.] sprague seedlings

Phenolics are pharmaceutically important molecules. Tyrosine and tryptophan are precursors of phenolic metabolism. It was aimed to investigate the potential of exogenously introduced precursors on the phenolic contents in Trachyspermum ammi [L.] Sprague seedlings. The seeds of two local varieties [Chakwal and Desi] were grown in completely randomized design in a growth chamber at 19 +/- 2[degree]C with two amino acids [tyrosine and tryptophan] applied [priming and supplementation in rooting medium] at two treatment levels [0, and 1%]. Ten days old seedlings were harvested and subjected for growth [root and shoot length, fresh weight and dry weight] and phenolic estimation was done by HPLC method. Presence of seven phenolic acids including quercitin, chromatotropic acid, gallic acid, chlorogenic acid, sinnapic acid, trans 4 hydroxy 3 methoxy cinamic acid and P-courmeric acid was confirmed in both varieties with dissimilar fraction. Poor growth was observed by "Desi" under controlled conditions that were efficiently enhanced by tyrosine and tryptophan treatments. As precursors both amino acids differed for allosteric regulation of the pathway. That varied from application to application and variety to variety too for a pattern of phenolic accumulation. In conclusion, tyrosine and tryptophan application can be useful for farmers for improved growth of T. ammi and for pharmaceutical scientists to modulate metabolites of interest

Clinical study on the efficacy of amoebex [coded herbal drug] compared with metronidazole for the treatment of amoebic dysentery

Amoebiasisis an infectious disease, which originated with the single-celled parasitic protozoan Entamoeba histolytica. The parasitic amoeba infects the liver and intestine and may cause mild diarrhea and serious dysentery with bloody and mucoid stool. A study was conducted to evaluate the efficacy of Amoebex [400mg], a herbal formulation for the treatment of amoebiasis infections as compared to that of Metronidazole [400mg]. The therapeutic evaluations of these medicines were carried out on 184 clinically diagnosed cases of the amoebiasis infection. Sample sizes of Ameobex for this study included a total of 93 patients and for Metronidazole a total of 91 were registered and treated. Comparison of the data recorded for the participants relating to sign and symptoms variables showed significant differences of efficacy between test and control groups [p<0.0357] and no side effects were at all recorded in test group. According to observation, there was a difference in the overall clinical success of both treatment groups, however, the efficacy of the test treated medication [Amoebex] was superior to that of Metronidazole as [p<0.03], and on the basis of the statistical analysis done by the chi square test, the null hypothesis was rejected. `It is clearly evident that Amoebex possesses therapeutic value for the treatment of amoebiasis associated symptoms but also the eradication rate of amoebiasis is superior by Amoebex as compared to that of Metronidazole [Control drug]