Aliskerin: a direct renin inhibitor improves pancreatic functional b cell mass in type 2 diabetic mice

Objective: To evaluate the effects of Aliskerin on functional pancreatic beta cell mass in type 2 diabetic mice. Study Design: Analytical experimental study. Place and Duration of Study: The study was conducted at the animal house of National Institute of Health, Islamabad. Duration of the study was of twelve weeks after initial acclimatization of one week

Material and Methods: Twenty four BALB/c mice, both male and female, of 35 to 40 grams were used for this study. Animals were randomly divided into four groups. Two served as control, one was normal and the other was diabetic control. The remaining two were used as interventional groups and received either pioglitazone or aliskerin for four weeks after induction of diabetes. Fasting blood glucose levels with fasting insulin levels were estimated. Insulin resistance was determined by calculating homa IR and pancreatic morphology was assessed by evaluating pancreatic beta cell mass

Results: After treatment, pioglitazone reduced all the biochemical parameters significantly when compared with diabetic control and negative correlation between glucose and insulin was changed into positive correlation [r value, 0.92] with significant p-value [0.015], while aliskerin caused a significant rise [p-value 0.009] in functional pancreatic beta cell mass

Conclusion: Aliskerin has a significant anti-diabetic role as far as pancreatic morphology is concerned

Drug induced acute kidney injury: an experimental animal study

Objective: To assess the extent of drug induced nephrotoxicity in laboratory animals for determining the role and extent of iatrogenic kidney damage in patients exposed to nephrotoxic drugs in various clinical setups

Study Design: Randomized control trail

Place and Duration of study: Pharmacology department and animal house of Army Medical College from Jan 2011 to Aug 2011

Material and Methods: Thirty six mixed breed rabbits were used in this study. Animals were randomly divided into six groups consisting of six rabbits in each. Groups were named A, B, C, D, E and F. Group A was control group. Group B was given 0.9% normal saline. Group C rabbits were given acute nephrotoxic single dose of amphotericin B deoxycholate. Group D received 0.9% normal saline 10ml/kg followed by amphotericin B infusion. Group E was injected acute nephrotoxic regimen of cyclosporine and amphotericin B infusion. Group F received saline loading along with acute nephrotoxic regimen of cyclosporine and amphotericin B infusion

Results: Biochemical and histopathological analysis showed significant kidney injury in rabbits exposed to acute nephrotoxic doses of amphotericin B and cyclosporine. Toxicity was additive when the two drugs were administered simultaneously. Group of rabbits with saline loading had significantly lesser kidney damage

Conclusion: Iatrogenic acute kidney damage is a major cause of morbidity in experimental animals exposed to such nephrotoxic drugs like amphotericin B and cyclosporine, used either alone or in combination. Clinical studies are recommended to assess the extent of iatrogenic renal damage in patients and its economic burden. Efficient and cost effective protective measure may be adopted in clinical setups against such adverse effects

Intragenic deletion mutation in the gene desmoglein 4 underlies autosomal recessive hypotrichosis in six consanguineous families

Objectives: Localized autosomal recessive hypotrichosis is a non-syndromic human hair loss disorder, affecting scalp, eyebrows and eyelashes, and other parts of the body. Six consanguineous families with this form of hair loss disorder were investigated at both the clinical and molecular levels

Methods: Linkage in six families with twenty-one affected members was tested by genotyping microsatellite markers linked to autosomal recessive hypotrichosis loci including localized autosomal recessive hypotrichosis [LAH] 1, 2 and 3. Sequence analysis of the entire coding and splice sites of the gene DSG4 was performed to search for the disease-causing mutation

Results: Genotyping established linkage in families to the DSG4 gene at LAH1 locus on chromosome 18q21.1. Sequence analysis detected an intragenic deletion mutation [Ex5_8 del] in affected members of all six families

Conclusion: Identification of recurrent mutation in six additional Pakistani families strengthens the body of evidence that this is an ancestral mutation that is widespread among different Pakistani ethnic groups

Placenta previa accreta; comparison of outcome of antenatal diagnosed cases in previous caesarean scar with undiagnosed cases of placenta previa accreta in previous caesarean scar

To compare outcome of antenatal diagnosed cases of placenta previa accreta in previous caesarean scar with undiagnosed cases of placenta previa accreta in previous caesarean scar.Cohort Study. The study was carried out in department of Obstetrics and Gynecology Nishtar Hospital Multan. Population: Total 206 cases were included in the study divided into two groups. Group A had 103 antenatal diagnosed cases of placenta previa accreta in previous caesarean scar and Group B comprised 103 cases un-diagnosed having placenta previa accreta in previous caesarean scar. Outcome Measure: Outcome was determined in terms of morbidity [i.e Hysterectomy] and mortality. It was found that hysterectomy was performed in 47 [45.6%] vs 36 [35%] diagnosed and un-diagnosed cases respectively. 9 [8.7%] vs 2[1.9%] cases died in diagnosed and undiagnosed Cases respectively. No significant difference in term of morbidity was found between diagnosed and un- diagnosed cases of placenta previa accreta in previous caesarean scar. Mortality was high in diagnosed cases of placenta previa accreta in previaous caesarean scar

Breech presentation at term; fetal outcome in planned cesarean section versus planned vaginal birth

To compare the fetal outcome of elective cesarean section with elective vaginal birth for Term Breech presentation in terms of APGAR Score, Respiratory Distress Syndrome, Admission in Neonatology Unit and Neonatal mortality. Quasi experimental study. Department of Obstetrics and Gynaecololgy Bahawal Victoria Hospital, Bahawalpur. Total 120 cases were included in the study divided into two groups, each having 60 fulfilling the inclusion criteria. Group 'A' had those who delivered by planned cesarean and Group 'B' comprised those having planned vaginal delivery. It was found that neonatal mortality was 3.33 in vaginal and 0 in cesarean group. Mean APGAR Score at 1 and 5 minute was 8.47 and 9.53 in vaginal and 8.58 and 9.62 in cesarean group. RDS was more in cesarean [5] than vaginal group [1.6]. Admission in Neonatalogy Unit was more in vaginally delivered group [8.33] as compared to the cesarean section group [5]. Planned cesarean delivery in breech presentation at term is associated with a reduction in neonatal mortality and morbidity as compared to the planned vaginal birth

ten year review of emergency peripartum hysterectomy in a tertiary care hospital

Emergency peripartum hysterectomy [EPH] is a life saving procedure considered in cases of severe haemorrhage unresponsive to medical and conservative surgical procedures.The aim of present study was to review the frequency, indications, maternal morbidity and mortality associated with emergency peripartum hysterectomy in a tertiary care hospital in a developing country. This was a cross sectional study in which data was retrospectively collected from January 2000 to December 2010. Main outcome measures were maternal morbidity and mortality associated with EPH. The incidence of EPH was 10.52/1000 deliveries. The main causes of EPH were rupture uterus 76 [34.86%], atonic uterus 65 [29.81%], placenta accreta 19 [8.71%], placenta previa 17 [7.7%], and placental abruption 36 [16.5%]. Mostly subtotal hysterectomy was the preferred method done in 196 [89.9%] of cases, while total abdominal hysterectomy was done only in 22 [10.09%] of cases. The over all complication rate was 81.2% which included both minor and major complications like hypovolemic shock 180 [82.5%], febrile morbidity 108 [49.5%], wound infection 40 [18.3%], bladder injury 6 [2.75%], and thrombophlebitis 22 [10.09%]. The maternal mortality in present review was [10.5%]. Frequency of EPH was found to be high in this study. Obstetricians must be skilled in it particularly in developing countries where the main indication of hysterectomy is rupture uterus.

Safety of caesarean myomectomy

Uterine fibroids are the most common type of tumours in women arising from uterine myometrium and less commonly from cervix. Objective of the study was to check the safety of caesarean myomectomy. Patients attending Gynaecology-B Unit of Ayub Teaching Hospital having pregnancy with fibroid and undergoing myomectomy along with caesarean section [CS] were included in this prospective study during Jan 2010-Dec 2011. Intra-operative and postoperative maternal morbidity in terms of blood loss, operative time and length of hospital stay was compared to matched pregnant woman with caesarean section alone. Out of 6,000 antenatal mothers registered during the study period myoma was detected in 96 [1.6%] cases. Mean age of mother having myoma was 28 years, 70% were primigravida, and mean haemoglobin was 10.56 gm%. Size of myoma was 12 Cm in 30% cases 5 Cm in 23% and more than 1 myoma in 60% cases. There was no significant difference in intra-operative haemorrhage and length of hospital state in comparison matched women with CS although operating time was double than later. None required caesarean hysterectomy. Myomectomy can be safely performed in majority of carefully selected patients with myomas without any serious life threatening complications.