Impact of diabetes mellitus on nerves

Background: Involvement of the peripheral and autonomic nervous systems is probably the most common complication of diabetes. The main symptoms of diabetic polyneuropathy include negative symptoms (those related to nerve fiber loss or dysfunction) such as numbness and weakness, and positive symptoms (those related to abnormal function of surviving nerve fibers) such as tingling and pain.Methods: This was a cross-sectional study held in diabetic clinic of Nishter hospital, Multan, Pakistan. The study included any diabetic patients showing symptoms of neuropathy.Results: There were total of 140 in this study. This study included 85% of male and 15% of female. Most common symptoms of diabetic neuropathy were pain (70%) and tingling (70%) followed by numbness in 65% of patients. There were 28 patients in 5 years duration of diabetes, 35 people in 6-10 years duration, 21 patients in 11-15 years duration, and 14 patients in 20+ years duration.Conclusions: Neuropathy due to diabetes is crippling especially when pain is the prominent symptoms. Autonomic symptoms like constipation and lightheadedness are discomforting for the patients. The most commonly used screening test is vibrating tuning fork test which is east to perform is clinical setting and is not time consuming. Diabetic patients need to take special care of.

Efficacy of Doxycycline as Peluridising Agent in Cases of Malignant Pleural Effusion (MPE)

Objective: To determine the efficacy of doxycycline as pleuridising agent in cases of malignant pleural effusions (MPE). Subject and methods: This was a descriptive case series that was conducted at Medical and Pulmonology Department of Combined Military Hospital Lahore from January 2018 to August 2018. In this study, the cases of malignant pleural effusion assessed on history and proven by histopathology on any biopsy of either gender falling in range of 30 years or more were included. The pleural fluid was drained by appropriate size intercostal chest tube (ICT). These cases then underwent pleurodesis with Doxycycline. For pleurodesis 10 capsule of Doxycycline each carrying 100 mg in it were taken and mixed with 50 ml of normal saline. A repeat chest X-ray and USG chest was done to see for presence of fluid, complete absence of fluid was labelled as efficacious pleurodesis. Results: In this study, there were total 60 cases of malignant pleural effusion (MPE) included, out of which 35 (58.33%) were females and 25 (41.67%) females. The mean age of the subjects was 57.32 ± 7.28 years. There were 29 (48.33%) cases with CA breast, 22 (36.67%) with CA lung and 9 (15%) had the other miscellaneous malignancies. The efficacy of pleurodesis with Doxycycline was seen in 26 (43.33%) of cases. There was significant better efficacy (p=0.001) in cases that had pleural effusion less than 1 liter at presentation where it was seen in 14 (63.64%) of cases as compared to 12 (31.58%) cases that had effusion less than 1 liter. There was no significant difference in terms of duration of pleural effusion with p=0.21. Conclusion: Doxycycline is efficacious in almost half of the cases and it is significantly better in cases that had effusion less than 1 liter.

Acupuncture/Electroacupuncture as an Alternative in Current Opioid Crisis / 中国结合医学杂志

Opioid drugs are the first line of defense in severe pain but the adverse effects associated with opioids are considered as a serious issue worldwide. Acupuncture/electroacupuncture is a type of Chinese medicine therapy which is an effective analgesic therapy, well documented in animals and human studies. Electroacupuncture stimulation could release endogenous opioid peptides causing analgesia in a variety of pain models. It can be used as an alternative therapy to control the opioid crisis.

Study of efficacy of Hypofractionated Radiotherapy 8 Gray in single fraction in Palliation of pain secondary to bone Metastasis

Objectives: To determine the efficacy of hypo-fractionated radiotherapy 8 Gray in 1 fraction for palliation of pain secondary to bone metastasis

Study Design: Quasi-experimental study

Place and Duration of Study: Oncology department, Combined Military Hospital, Rawalpindi, Sep 2012 to Nov 2013

Patients and Methods: Forty three patients were included after permission from concerned authorities and Hospital Ethical Committee. OPD registration numbers, name, age, gender, Eastern Cooperative Oncology Group [ECOG] performance status [PS], diagnosis of primary malignancy along with histopathology and sites of skeletal metastasis were recorded. Radiotherapy 8 Gy in 1 fraction was administered using 6MV [mega voltage] Primus Linear Accelerator with 2-2.5 cm margin around the gross disease at the Oncology department, CMH Rawalpindi. Pain score was recorded using visual analogue scale on the day of administering radiotherapy [day 0] and thirty days [day 30] after radiotherapy to assess response to treatment

Results: There was a statistically significant [<0.001] improvement in the scores of pain with treatment at day 30. Thirty four out of forty three patients [86 percent] showed an improvement in pain score

Conclusion: Based on our results hypofractionated radiotherapy 8 Gy in 1fraction is an effective modality in the palliation of pain secondary to bone metastasis

Diagnostic accuracy of risk of ovarian malignancy algorithm [ROMA] in post-menopausal patients with ovarian mass

Objective: To determine the diagnostic accuracy of ROMA in postmenopausal women with history of ovarian mass

Study Design: Observational study

Place and Duration of Study: Dr. Ziauddin University Hospital, Karachi, from May 2014 to June 2015

Methodology: Two hundred and sixty postmenopausal women of 40-65 years of age with ovarian masses, planned for surgery, were included in the study. Their samples were obtained preoperatively and analysed on Abbot Architect i1000 SR immunoassay analyser for quantitative estimation of tumor markers, i.e. HE4 and CA125. By combination of these two tumor markers, ROMA scores were calculated and studied after histopathological verification of masses

Results: Total number of patients were 260, out of which 122 [46.9%] were diagnosed as having ovarian cancer, while 138 [53.0%] were diagnosed as benign condition. Median ROMA score levels in patients with malignant masses were 95.58 [IQR=44.4] as compared to 20.6 [IQR=14] in benign masses. ROMA had sensitivity 92.6% [CI=86.47-96.04], specificity 78.3% [CI=70.09-83.82], positive predictive value 79% [CI=70.87-84.29], negative predictive value 92.3% [CI=86.02-95.9] and positive likelihood ratio 4.26, while negative likelihood ratio 0.1. Diagnostic accuracy of ROMA was 85%, based on ROC curve analysis. ROMA had the highest sensitivity in detecting ovarian carcinoma

Conclusion: ROMA is a very useful diagnostic tool for the preoperative stratification of patients with ovarian masses showing 85% diagnostic accuracy. However, there is need of more studies with homogenous laboratory procedures for HE4 and CA125 assays as well as patients, selection criteria, so we can draw firm conclusion about utility of ROMA in clinical setups

Secondary ameloblastic carcinoma of mandible with pulmonary metastasis

Ameloblastic carcinoma [AC] is a very rare odontogenic malignancy. Primary AC is more common in maxilla, while secondary AC is more common in mandible. Histologically, it is an ameloblastoma with features of cancer. Presence of metastasis is not necessary to establish the diagnosis. This tumor usually metastasises in bone or lungs. We report a case of aggressive secondary AC of mandible with lung metastasis. There are few cases in medical literature discussing management of AC with lung metastasis. In this case, a 42-year woman, who was diagnosed with ameloblastoma of right mandible, was treated with right hemi-mandibulectomy. However, 10 years later, the patient developed AC with pulmonary metastasis. Patient received six cycles of carboplatin-paclitaxel-based regimen. There was noted a partial response to the therapy. However, the patient went into respiratory failure, although she was provided adequate analgesic control as part of end-of-life care. Further, oncological or surgical management was not possible as patient had poor performance status

Scenario of dengue infection & its control in Pakistan: An up-date and way forward

Dengue fever is one of the major health problems in tropical and subtropical areas throughout the world. The causative agent of dengue fever is the dengue virus which is an enveloped single stranded RNA virus belongs to the family Flaviviridae and has five distinct serotypes (DENV-1, DENV-2, DENV-3, DENV-4 and DENV-5). Dengue virus is transmitted to human via bite of Aedes aegypti and Aedes albopictus mosquitoes. The clinical symptoms of dengue fever ranging from mild to severe form as dengue hemorrhagic fever and dengue shock syndrome. Pakistan is dengue endemic since 1994 but from 2006, Pakistan faced the worst condition regarding dengue in which thousands of people affected by the disease and hundreds of people lost their lives. DENV-2, DENV-3 and DENV-1 are the prevalent serotypes in Pakistan. Common diagnostic techniques are being used in Pakistan such as enzyme-linked immunosorbent assay, polymerase chain reaction and rapid diagnostic tests, while differential diagnosis, limitations of diagnostic methods and poor health care system are the real challenges in dengue diagnosis. Favorable climatic conditions, unplanned urbanization, travelling etc., are major factors responsible for dengue epidemics in Pakistan. This presentation provides update about dengue circumstances in Pakistan and also describes the way how to improve dengue situation in Pakistan.

Thoracic impalement injury: A survivor with large metallic object in-situ / 中华创伤杂志(英文版)

Impalement injuries, is a severe form of trauma, which are not common in civilian life. These injuries rarely occurs in major accidents. Abdomen, chest, limbs and perineum are often involved due to their large surface area. Thoracic impalement injury is usually a fatal injury, due to location of major vessels and heart in the thoracic cavity. These injuries are horrifying to site, but the patients who are lucky enough to make it to hospital, usually survive. Chances of survival are larger in right sided impalement injuries while central injuries are always died at the scene. Our patient, 25 years old male, was brought to the emergency room (ER) with large impaled metallic bar (about 2.5 feet long) in situ, in right sided chest. The patient was immediately shifted to operation room (OR) and was operated, his recovery was uneventful without any sequelae. Such patients should be treated and resuscitated according to advanced trauma life support (ATLS) protocols and operated without any delay for further investigations. Such operations are carried out by the most experienced surgeon team available. The impaled objects should not be processed if not necessary to avoid major hemorrhage and damage to vital structures, until the patient is in operation room. Large size and unusual position of impaled objects, makes the job difficult for surgeons/anesthetists. Although horrifying at scene, patients with thoracic impalement injuries are mostly young and healthy, and those who survive the pre-hospital phase are potentially manageable with proper resuscitation. Usually these patients make recovery without any further complications.

Pattern and presentation of odontogenic jaw cysts: a clinical experience

Objective: To determine the pattern and presentations of odontogenic jaw cysts in patients reporting at the Armed Forces Institute of Dentistry

Study Design: Descriptive study

Place and Duration of Study: Armed Forces Institute of Dentistry, from Jan to Dec 2007

Material and Methods: Hundred patients including 70 males and 30 females with the age range 5-65 years were included in the study. History, clinical examination, radiographic examination and histopathologic examination of lesion were carried out for each patient. A proforma was filled for each patient for all relevant information, presentation and pattern. Diagnosis was confirmed by histopathology. Data were analyzed using SPSS version 10

Results: Out of total 100 patients, 58% were diagnosed with radicular cysts, 25% with dentigerous cysts, 15% with odontogenic keratocyst, 1% patient with calcifying epithelial odontogenic cyst and 1% patient was diagnosed with eruption cyst

Conclusion: The study demonstrates that radicular cyst was the most common odontogenic cysts followed by dentigerous and odontogenic keratocysts respectively in our study sample

Quad shot - hypofractionated radiotherapy for palliation in advanced squamous cell carcinoma of head and neck

Objective: The objective of this study was to determine the efficacy of quad-shot radiation therapy for palliation in locally advanced and metastatic inoperable squamous cell carcinomas of head and neck

Study Design: A quasi-experimental study

Place and Duration of Study: Oncology department, Combined Military Hospital Rawalpindi, from Sep 2012 to Sep 2013

Material and Methods: Thirty five patients were included with histologically confirmed advanced inoperable squamous cell carcinoma in head and neck region, performance status 2 or 3 and survival >/= 3 months. Patients were treated with radiation therapy 14 Gy in four fractions, megavoltage beam, twice daily fractions [at least 6 hours apart], for 2 consecutive days. Symptoms due to cancer [pain and dysphagia] were assessed as per common toxicity criteria adverse event version 4.0 on day 0 before treatment and day 21 after start of treatment

Results: Grades of pain and dysphagia showed significant improvement after treatment with a p-value <0.001. A total of 91.4% patients showed an improvement in grade of pain [32 out of 35 patients] and 45.7% of patients showed improvement in grade of dysphagia [16 out of 35 patients]. There was a statistically significant decrease in grades of pain and dysphagia after treatment

Conclusion: The short duration of hypofractionated radiotherapy with Quad Shot was effective with respect to symptom palliation in locally advanced and metastatic inoperable head and neck cancers

Management of community acquired pneumonia by Family Physicians

Background and Objective: Community Acquired Pneumonia [CAP] is a major burden on health system with significant mortality and morbidity. Family Physicians [FPs] can play important role. To determine management strategies and prescription of FPs regarding CAP

Methods: A multicenter cross sectional survey was done in 10 cities of Pakistan from November 2014 to January 2015. Self-administered questionnaire was filled by 110 Family Physicians

Results: Of total 71% of FPs reported to work in high prevalence areas for respiratory ailments. Only 32% of FPs used PSI and 34% CURB 65 for assessment of severity. It was alarming to note that only 58% of FPs treats severe pneumonia with Intravenous antibiotics while rests were comfortable with oral route

The overall use of quinolones to treat CAP, irrespective of severity, in combination or as single agent was > 60%

Duration of antibiotics for severe pneumonia was sub optimal [<10 days]. Only 52.8% patients came back for follow-up so true outcome cannot be anticipated

Conclusion: Major deficiencies were treatment of severe pneumonia in community, inappropriate use of quinolones and poor knowledge of recent guidelines. This can lead to emergence of resistant bacteria and high mortality and morbidity

Anemia and thrombocytopenia in malaria: an observational study of 115 patients in Mardan Pakistan

Objective: the aim of present study was to evaluate hematological changes in malaria in Mardan, Pakistan

Methods: this prospective observational study was conducted at O.P.D of Mardan MedicalComplex Mardan from July to September 2015. A total of 115 patients were divided to age groupsof< 15 and > 15 years old. Malaria parasite was examined using thick and thin smears stained with Giemsa stain and also cross-checked by ICT. Those patients with a confirmed diagnosis of malaria were investigated for platelets, hemoglobin and total leukocyte count on Automatic hematology analyzer [Mindray] and studied by hematologist. Data was tabulated, descriptive statistics analyzed; the chi-square test was applied to evaluate statistical significance of the studied variable between groups on SPSS version 20. A p-value of 0.05 or less was used for statistical significance

Results: a total of 115 patients were included in the study. Male were 56[48.7%] and females 59[51.3%], the mean age of study group was 10.62[3.89]. According to age group, patients were divided into two groups; those <15 years comprised of 102[88.7%], while> 15 years were found 13[11.3%]. P. vivax was seen in 108[93.9%] and P. falciparum 7[6.1%] patients. Out of total population 70[60.9%] were found anemic, 79[68.7%] had mild thrombocytopenia and 4[3.5%] with moderate thrombocytopenia and sever leucopenia were found 2[1.7%], mild leucopenia 24[20.9%], mid leucocytosis 1[0.9%]. Patients with P.vivax aged <15 years had found anemia 59[62.1 %] with p=0.56, moderate thrombocytopenia 4[4.2%] [p=0.05], sever leucopenia 2[2.11 %], mild leucopenia 13[13.7%] and mild leukocytosis 1 [1.1 %] with p=0.001

Conclusions: the present study concludes that thrombocytopenia and anemia are common hematological findings in patient with Plasmodium infection particularly vivax species infection in Mardan region. Therefore, malaria should be a consideration in febrile patients with low platelets and haemoglobin

Psychiatric morbidity and associated socio demographic factors in young unemployed people

Objective: To determine the prevalence of psychiatric morbidity in young unemployed people and analyze associated socio demographic factors

Study Design: Cross sectional study

Place and Duration of Study: Enrollment camps at Punjab and Kashmir, from Jan 2014 to March 2014

Material and Methods: The sample population comprised of unemployed people who came for recruitment in Pakistan Army at different parts of the country. General Health Questionnaire 12 [GHQ12] was used to screen the population for psychiatric morbidity, 3 was used as cut off score. Age, province, education, level of family income, tobacco smoking, naswar [a tobacco based substance] use, marital status, dependent family members, worrying about the future and social support status were correlated with high GHQ score. Descriptive statistics were used to describe the characteristics of participants and the distribution of GHQ score

Result Out of 2511 people 1887 [75.1%] had GHQ score more than 3 showing some psychiatric morbidity. A total of 696 were Kashmiris out of which 540 [77.5%] were GHQ positive, 1329 were Punjabis out of which 978 [73.5%] were GHQ positive, 339 were Pakhtoons out of which 258 [76.1%] were GHQ positive, 129 were Balti out of which 102 [79%] were GHQ positive and 18 were from other ethnicities out of which 9 [50%] were GHQ positive

With logistic regression we found that family size, smoking, naswar use, family income, family history of psychiatric disorder, lack of social support, and low education were significantly correlated with high GHQ score while age of individual, worry about future and marital status had no significant relation with high GHQ score among unemployed people in our study

Conclusion: This study showed a high prevalence of psychiatric morbidity among unemployed youth of our country. Special attention should be paid to poor people, people with low education and large families. Adequate social support should be provided to young people with no jobs and use of cigarette and naswar should be discouraged

Skeletonization of left internal mammary artery in coronary artery bypass grafting

Objective: To compare mean per-operative flow capacity between skeletonized and pedicled left internal mammary artery [LIMA] in patients undergoing coronary artery bypass grafting [CABG] surgery

Study Design: Randomized control trial

Place and Duration of Study: Department of Cardiac Surgery, Armed Forces Institute of Cardiology and National Institute of Heart Diseases [AFIC-NIHD], Rawalpindi, Pakistan from February to August, 2013

Methodology: Patients undergoing CABG for coronary artery disease, under 80 years, excluded by the exclusion criteria; and fulfilling the inclusion criteria were randomly assigned to two groups of 70 each. One group underwent skeletonized and the other underwent pedicled technique of LIMA harvesting. Free flow was checked just before anastamosis of each LIMA to the LAD, manually in blood flow in ml per minute during cardiopulmonary bypass by allowing it to bleed into a 100 ml container over 20 seconds. A specialized proforma was used to record the age, gender, weight, disease, type of IMA used, and free flow of the IMA. Data was analyzed using SPSS 18

Results: The mean age of the patients was 57.16 years in 40 patients, ranging from 36 to 75 years. Disease pattern analysis showed 5%, 10.7% and 84.3% single, double and triple vessel coronary artery disease, respectively. There was significantly higher free flow in the skeletonized group than the pedicled group [p=0.04]

Conclusion: Skeletonized IMA had superior flow to pedicled IMA in addition to its traditional proven advantages, which justifies its further use as a conduit for myocardial revascularization

Knowledge, practice and attitude of mothers regarding oral rehydration salt

Objective: To assess awareness about the knowledge; attitude and behaviour of mothers about use of ORS

Study Design: Cross-sectional study

Place and Duration of Study: This study was conducted at the Pediatric Outpatient Department, Civil Hospital Bahawalpur from May 10, 2015 to July 25, 2015

Methods and Materials: This study was conducted on mothers who attended Pediatric Outpatient Department, Civil Hospital Bahawalpur with 2 months to 5 years old child having history of diarrhea at the time of visit of the hospital or within the last two weeks. The mothers were interviewed by the one of the researchers using a structured questionnaire about ORS including the demographic data

Results: There were 200 mothers included in this study. Their mean age +/- SD was 27.78 +/- 7.637 years. Among the studied mothers 18.5% were having at least secondary school certificate and 90% mothers were house wives. 4.5% mothers did not hear about ORS, 50.5% heard it from medical practitioners, 33.5% from some family member/ neighbours while 16.5% from media. ORS use within the last two weeks was in 44.5% cases of diarrhea. 49% mother gave opinion that it 'stops diarrhea', 29.5% 'does not know' while 21.5% gave opinion that it 'stops dehydration.' 38% mothers knew the correct technique for making ORS solution. 35% mother were in the opinion of giving ORS to the child by 'cup and spoon' in 70 [35%], 34% by cup and 31% by feeding bottles. There were only 34% mothers could prepare ORS correctly. 33% mothers described the correct amount of ORS solution to be given to the child while 41.5% mothers replied to continue giving ORS even if child developed vomiting

Conclusion: The awareness of mothers about the use of ORS is moderate. Further community based research is needed in this respect

attitude and knowledge of mothers regarding use of colostrum in newborn feeding

Objective: To assess awareness about the knowledge, attitude and behaviour of mothers about the use of colostrum for the newborn feeding

Study Design: Observational / descriptive /cross-sectional study

Place and Duration of Study: This study was conducted at Pediatric Outpatient Department, Civil Hospital Bahawalpur from July 10, 2015 to August 8, 2015

Materials and Methods: This study was conducted on mothers who attended Pediatric Outpatient Department, Civil Hospital Bahawalpur for the medical checkup of their children less than one year of age. The mothers were interviewed by the one of the researchers using a structured questionnaire about colostrum including the demographic data

Results: There were 100 mothers included in this study. There were 4% mothers younger than 20 years, 63% in the age group 21-30 years, 20% age group 31-40 years while 3% were older than 40 years. 17% mothers were having at least matriculation, 59% were having education less than that while 34% were uneducated. 94% mothers were house wives. There were 79% mothers who had heard about colostrum; among which 51% heard from either family members or from friends, 21% from medical personnels, 7% from media while 21% never heard of it. There were only 25% mothers who believed that colostrum was the best first feed of newborn, while 61% mothers believed it is GHUTTI that was best. There were 22% mothers who believed that it was beneficial for the health, 13% were in the opinion that it is injurious for the health while 65% replied 'do not know'. There were 41% mothers who told colostrum as yellow and thick, 11% replied it was milk like. There were 32% mothers who believed that colostrum is sufficient for initial newborn feeding, 25% believed it is insufficient. There were only 19% mothers who believed that baby must be put on breast for feeding within half an hour

Conclusion: The awareness of mothers about the use colostrum is poor to moderate

Knowledge of Stroke Risk Factors among Individuals Diagnosed with Hypertension and Diabetes: A Hospital-based Survey.British Journal of Medicine and Medical Research. 2015; 10(6):1-8.

Background: Stroke is a major cause of mortality and morbidity worldwide and primary prevention, through adequate knowledge of its risk factors and attendant risk factor control/modification, remains the best solution. This study assessed knowledge of stroke risk factors among individuals diagnosed with two of the most common modifiable risk factors of stroke namely hypertension and diabetes. Methods: A consecutive sample of 200 clients diagnosed with hypertension and/or diabetes was recruited into this cross-sectional survey from a university teaching hospital in northern Nigeria between January and March 2011. Clinical, socio-demographic, and knowledge of stroke risk factors data were obtained through face-to-face interview using researcher-developed questionnaire. Descriptive and inferential statistics were utilized to identify level of knowledge and its associations with socio-demographic and clinical characteristics of the participants. Results: Mean (SD) age of the participants was 49.69 (16.27) years, with more female participants (55.5%) and those diagnosed with hypertension (40.5%). Majority (85%) of the participants knew at least one risk factor and the most commonly known risk factor was hypertension (80%) while family history of stroke (0.5%) and transient ischaemic attack (0.5%) were the least known risk factors. Only diagnosis (P<0.01) and level of educational attainment (P<0.05) had significant associations with knowledge of stroke risk factors with those diagnosed with diabetes (96.3%) and those who had tertiary education (93.1%) being more knowledgeable. Regarding specific risk factors, 64.3% of those with hypertension and 56.8% of those with diabetes respectively identified their conditions as risk factors of stroke. Conclusion: Although a substantial majority of participants in the study knew at least one stroke risk factor, knowledge of some specific risk factors was poor while a little above half of the participants identified their conditions as risk factors for stroke. Effective stroke risk factor awareness and educational strategies are therefore required.

Topical application of tranexamic acid reduces postoperative bleeding in open-heart surgery: myth or fact?

To determine the efficacy of topical application of Tranexamic acid in controlling postoperative bleeding in open-heart surgery. Double blind randomized control trial. Departments of Cardiac Surgery and Intensive Care of Armed Forces Institute of Cardiology and National Institute of Heart Diseases [AFIC-NIHD], Rawalpindi, Pakistan, from May to October 2011. A total of 100 consecutive adult patients fulfilling the inclusion criteria undergoing elective on-pump cardiac surgeries were randomly divided in groups [A] and [B]. A study solution that contained 2.5 g of Tranexamic acid in 250 ml normal saline in group-A and equal amount of normal saline [placebo] in group-B was poured in the pericardial cavity over the mediastinal tissues before sternal closure. Postoperative bleeding was measured in both groups for 24 hours in the cardiac surgical ICU. Efficacy of Topical Tranexamic Acid / Placebo was measured in terms of mean postoperative bleeding in ml. Kindly again include these lines which seem to have been omitted in the final proof. There was significant difference in the mean postoperative bleeding within 24 hours among the two groups 340.1 +/- 112.4 ml in Tranexamic acid group vs. 665 +/- 187.28 ml in placebo group [p < 0.001]. Patients who did not have topical Tranexamic acid before chest closure had a significantly higher postoperative bleeding. Topical Tranexamic acid application is an effective and economical way for controlling non-surgical bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass

Discovery and design of cyclic peptides as dengue virus inhibitors through structure-based molecular docking

OBJECTIVE@#To find potential peptide inhibitors against the NS2B/NS3 protease of DENV which in turn, can inhibit the viral replication inside host cell.@*METHODS@#Cyclic peptides were designed having combination of positively charged amino acids using ChemSketch software and were converted to 3D structures. DENV NS3 protein structure was retrieved from Protein Data Bank (PDB) using PDB Id: 2FOM. DENV NS3 and cylic peptides were docked using MOE software after structural optimization.@*RESULTS@#Through molecular docking it was revealed that most of the peptides bound deeply in the binding pocket of DENV NS2B/NS3 protease an had interactions with catalytic triad. Peptide 2 successfully blocked the catalytic triad of NS2B/NS3 protease. Peptide 1, 4 and 6 also had potential interactions with active residues of the NS2B/NS3 protease while all other peptides were in close contact with the active sites of NS2B/NS3 protease thus, these peptides can serve as a potential drug candidate to stop viral replication.@*CONCLUSIONS@#Thus, it can be concluded from the study that these peptides could serve as important inhibitors to inhibit the viral replication and need further in-vitro investigations to confirm their efficacy.

Aortic aneurysm: a rare cause of Ortner's syndrome

A young man presented with hoarseness of voice and was found to have left vocal cord paralysis and a large opacity on chest X-ray in the left upper zone. CT angiography showed a giant aneurysm of the aortic arch involving the left subclavian artery. Using a dual perfusion system, with the femoral bypass circuit taking care of the spinal protection and the aortic bypass circuit providing the cerebral protection, the aneurysm was excised and a 16 mm Dacron [registered] graft was anastomosed to the aortic arch and the left subclavian artery was anastomosed to the interposition graft. He had a smooth postoperative course and his hoarseness subsided in next 6 months.