Synthetic berberine derivatives as potential new drugs

Abstract The modern process of new drug discovery and development is an exciting, yet a challenging, endeavor. Although it can result in significant financial income and meet the medical needs of patients, it ultimately may result in failure. To achieve a fast and successful new product discovery and development process, natural products which are evolutionarily optimized as drug-like molecules have gained great attention as better potential sources of new chemical entities. Historically, plant species containing berberine are used in various traditional phytotherapy. However, despite the various therapeutic effects it exerts, berberine is not yet developed into a drug product. Addressing the barriers that hinder its successful development and the efforts made to overcome them is thus crucial. The toxicological and pharmacokinetic properties of berberine are the main barriers towards its development into a marketed drug product. It has low aqueous solubility, poor absorption, fast metabolism, and wide tissue distribution which lead to low bioavailability limiting its clinical application. Synthetic berberine derivatives with improved properties are suggested as better alternatives for further development and future therapeutic application. Hence, this paper summarizes the preclinical research studies conducted in the last decade to reveal the therapeutic potential of synthetic berberine derivatives for the treatment of various diseases and hence achieve successful berberine-based drug development in the future. To exploit the value of natural products as a source of leads for the development of effective drugs, collaboration among the different discovery and development scientists is essential.

Modified Early Warning Score como preditor de readmissão à unidade de terapia intensiva dentro de 48 horas: um estudo observacional retrospectivo / Modified Early Warning Score as a predictor of intensive care unit readmission within 48 hours: a retrospective observational study

RESUMO Objetivo: Avaliar a hipótese de que o Modified Early Warning Score (MEWS) por ocasião da alta da unidade de terapia intensiva associa-se com readmissão, e identificar o nível desse escore que prediz com maior confiabilidade a readmissão à unidade de terapia intensiva dentro de 48 horas após a alta. Métodos: Este foi um estudo observacional retrospectivo a respeito do MEWS de pacientes que receberam alta da unidade de terapia intensiva. Comparamos dados demográficos, escores de severidade, características da doença crítica e MEWS de pacientes readmitidos e não readmitidos. Identificamos os fatores associados com a readmissão em um modelo de regressão logística. Construímos uma curva Característica de Operação do Receptor para o MEWS na predição da probabilidade de readmissão. Por fim, apresentamos o critério ideal com maior sensibilidade e especificidade. Resultados: A taxa de readmissões foi de 2,6%, e o MEWS foi preditor significante de readmissão, juntamente do tempo de permanência na unidade de terapia intensiva acima de 10 dias e traqueostomia. A curva Característica de Operação do Receptor relativa ao MEWS para predizer a probabilidade de readmissão teve área sob a curva de 0,82, e MEWS acima de 6 teve sensibilidade de 0,78 (IC95% 0,66 - 0,9) e especificidade de 0,9 (IC95% 0,87 - 0,93). Conclusão: O MEWS associa-se com readmissão à unidade de terapia intensiva, e o escore acima de 6 teve excelente precisão como preditor prognóstico.

ABSTRACT Objective: To evaluate the hypothesis that the Modified Early Warning Score (MEWS) at the time of intensive care unit discharge is associated with readmission and to identify the MEWS that most reliably predicts intensive care unit readmission within 48 hours of discharge. Methods: This was a retrospective observational study of the MEWSs of discharged patients from the intensive care unit. We compared the demographics, severity scores, critical illness characteristics, and MEWSs of readmitted and non-readmitted patients, identified factors associated with readmission in a logistic regression model, constructed a Receiver Operating Characteristic (ROC) curve of the MEWS in predicting the probability of readmission, and presented the optimum criterion with the highest sensitivity and specificity. Results: The readmission rate was 2.6%, and the MEWS was a significant predictor of readmission, along with intensive care unit length of stay > 10 days and tracheostomy. The ROC curve of the MEWS in predicting the readmission probability had an AUC of 0.82, and a MEWS > 6 carried a sensitivity of 0.78 (95%CI 0.66 - 0.9) and specificity of 0.9 (95%CI 0.87 - 0.93). Conclusion: The MEWS is associated with intensive care unit readmission, and a score > 6 has excellent accuracy as a prognostic predictor.

Teicoplanin is a potential inhibitor of SARS CoV-2 replication enzymes: A docking study

Objective: To explore potential inhibitors of viral enzymes of SARS CoV-2.Methods: The in-silico docked potential of anti-viral, antibiotic, and analgesic drugs were studied for inhibition of the nonstructural protein (NSP) 9, NSP3, and NSP15 of SARS CoV-2 using recent structural peculiarities of these enzymes, 3D optimized structures of drugs and algorithm-based ligand inhibitory potential. Results: Teicoplanin, azithromycin, and remdesivir potentially inhibited NSP9 (Dock-score 9?620, 5?472 and 6?252, respectively), NSP3 (Dock-score 9?846, 5?604 and 5?548, respectively) and NSP15 (Dock-score 10?960, 6?414 and 6?002, respectively). Conclusions: Teicoplanin acts as a significant receptor antagonist and potentially inhibits the SARS CoV-2 enzymes.

Teicoplanin is a potential inhibitor of SARS CoV-2 replication enzymes: A docking study

Objective: To explore potential inhibitors of viral enzymes of SARS CoV-2. Methods: The in-silico docked potential of anti-viral, antibiotic, and analgesic drugs were studied for inhibition of the nonstructural protein (NSP) 9, NSP3, and NSP15 of SARS CoV-2 using recent structural peculiarities of these enzymes, 3D optimized structures of drugs and algorithm-based ligand inhibitory potential. Results: Teicoplanin, azithromycin, and remdesivir potentially inhibited NSP9 (Dock-score 9 620, 5 472 and 6 252, respectively), NSP3 (Dock-score 9 846, 5 604 and 5 548, respectively) and NSP15 (Dock-score 10 960, 6414 and 6 002, respectively). Conclusions: Teicoplanin acts as a significant receptor antagonist and potentially inhibits the SARS CoV-2 enzymes.

Donor site morbidity after bone harvesting from iliac crest for maxillofacial region

This study was conducted to determine postoperative donor site complications after bone harvesting from iliac crest for maxillofacial reconstruction in patients presented at Pakistan Institute of Medical Sciences [PIMS Hospital Islamabad]. One hundred and ten patients having bony defects in maxillofacial region had undergone iliac crest grafting over a period of one year. The data were recorded on a strurctured proformas and were entered in SPSS version 17.0 [SPSS, Inc, Chicago, IL, USA]. Analysis was done to determine the frequency and percentages for all variables. Morbidity to donar site [Illiac crest] was evaluated postoperatively at 3[rd] month. Among 110 patients, male to female ratio was 1:1.2. Out of total 16.4% had mild pain, 0.9% had gait disturbances with walking aid needed. It was concluded that complications after iliac crest harvesting was found to be moderate to low, but the procedure was still necessary and frequently used with predictable results in terms of pain and gait disturbance at donor site

Non-vascularized autogenous bone grafts for reconstruction of maxillofacial osseous defects

Objective: To determine the outcomes of non-vascularized bone grafts for reconstruction of maxillofacial defects. Study Design: Case series. Place and Duration of Study: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, from January 2013 to December 2015

Methodology: Descriptive analyses of 30 patients, who underwent maxillofacial reconstruction with non-vascularized bone grafts, were conducted. The demographic information, diagnosis, and type of graft harvested to reconstruct the defect were statistically analyzed. Outcomes of reconstruction with non-vascularized bone grafts were analyzed in terms of mouth opening, success of dental rehabilitation, and postoperative complications, i.e. surgical site infection and hardware loosening

Results: A total of 30 patients ranging from 8 to 60 years [33.57 +/- 14.74 years] had maxillofacial defects reconstructed mostly due to gunshot injuries, followed by post-resection defects. Overall 15 cases [50%] were reconstructed with iliac crest cortico-cancellous bone graft, 11 cases [36.7%] with rib; while in four cases [13.3%], costochondral graft was used for reconstruction. In 26 cases [86.7%], graft was found to be successful. In three cases, re-operation for onlay bone graft was required to provide optimal dental rehabilitation; while in just one case, postoperative surgical site infection was observed

Conclusion: Non-vascularized bone grafts provide a reasonable and effective modality for reconstruction of maxillofacial defects

Pleural effusion developing in two patients on continuous ambulatory peritoneal dialysis

Two patients with end-stage-renal-disease on continuous ambulatory peritoneal dialysis [CAPD] presented with pleural effusions. The aspirated fluid was categorised as transudate, based on alkaline pH, low protein and lactic dehydrogenase level. A striking feature of the pleural fluid was, its very high glucose content that resulted from translocation of dextrose containing peritoneal dialysate into the pleural space via a pleuroperitoneal connection. One patient was transferred to hemodialysis, which led to complete resolution of pleural effusion. The other patient was switched to automated peritoneal dialysis, using small dwell volumes with consequent reduction in size of the pleural effusion. Pleuroperitoneal leak should always be considered in the differential diagnosis of pleural effusion in CAPD patients. Although isotopic peritoneography can demonstrate reflux of the tracer in the pleural space, measurement of pleural fluid glucose is a simpler and reliable way of diagnosing pleuroperitoneal communication

Post operative nausea and vomiting [ponv]: comparison of timing of administration of antiemetics in prolong surgeries

The objective of this study was to compare the timing of administration of Ondansetron and Dexamethasone in terms of prevention of postoperative nausea and vomiting when given at induction verses thirty minutes before the end of prolong surgeries. Randomized control trial. The study was conducted in Main Operation Theatre of Combined Military Hospital Rawalpindi over a period of six months from 17 Apr 2009 to 16 Oct 2009. Cases were selected from OPDs, emergency and also by referral. Total 120 patients were included in this study [60 patients in each group] Group A patients received Ondansetron 4 milligrams and Dexamethasone 8 milligrams intravenous at induction and group B patients received Ondansetron 4 milligrams and Dexamethasone 8 milligrams thirty minutes before reversal of neuromuscular blockade at the end of surgery. Mean age was observed 41.7 +/- 3.7 and 39.9 +/- 1.9 in group-A and B, respectively. Comparison of pre-induction and 30 minutes before end of surgery at 0-6 hours reveal nausea and vomiting in 11 [18.3%] in group-A and in 3 [5.0%] patients of group-B. Results were statistically significant [p=0.022]. At 7-12 hours results were also statistically significant when comparison was made between group-A and B [p=0.051], while at 13-24 hours difference between two groups was statistically non-significant [p=0.314]. It is therefore established that administering a combination of Inj. Ondansetron 4mg with Inj. Dexamethasone 8mg, was more efficacious in reducing post-operative nausea and vomiting at 0-6 hours when administered 30 minutes before the completion of surgery

Infant health care; practices in Pakistan: a systematic review

In Pakistan 1 in every 14 infants die before reaching one year of age. Infant mortality highly depends upon the health care practices by the caretakers. To investigate the infant risky health care practices and their impact on infants' health in Pakistan. Descriptive systematic literature review. All the research articles that was published in between 2000 to 2015. Focusing on newborn health care practices with special reference to mother's utilization of antennal and postnatal care, pre-lacteal feedings, colostrum, breastfeeding, cord care practices and complementary feeding. A systematic search of national and international literature especially from developing countries was undertaken from peer-reviewed indexed journals and news articles from 2000-2015 to access the infant health care practices. Sixty five articles were included in this review article. All the studies focused on the determinants of infant health care practices. It was found that mother's prenatal and postnatal care utilization service was poor. It was further investigated that colostrum is not preferred first feed of the mothers and family members to their infants. Mostly mothers gave the pre-lacteal feeding to their children irrespective to their education and social status and it cause the delayed in initiating the breastfeeding to the neonates. Only a small proportion of the mothers initiate the breastfeeding with in the first hour of birth and mothers are unaware about the importance of breastfeeding. Furthermore, the mothers are also unaware about cord care and use conventional methods for cord care. It was investigated that infant health care practices is highly influenced by the culture and religious beliefs of the caretakers. Due to the lack of proper health care of infants, Pakistan is facing high infant mortality rate and substandard infant health indicators. It is suggested that government and policy makers should arrange the trainings/ workshops for the mothers and adolescents for the purpose to discourage the risky health care practices

VAAFT: video assisted anal fistula treatment; bringing revolution in fistula treatment

To share our findings that the new treatment modality Video Assisted Anal Fistula Treatment [VAAFT] is a better alternate to the conventional treatments of Fistula in Ano in our setup with minor changes in the initial method described by Meinero. Karl Storz Video equipment including Meinero Fistuloscope was used. Key steps are visualization of the fistula tract, correct localization of the internal fistula opening under direct vision and endoscopic treatment of the fistula. This is followed by an operative phase of fulguration of the fistula tract using glycine solution mixed with manitol, curetting the tract with curette and fistula brush. Internal opening is closed with a Vicryl 1 suture. Total of 40 patients were operated using VAAFT from October 2013 to March 2014. Three were re-operated. The other 37 cases were followed up at 6 weeks, 3 months and 6 months. Primary healing took place in 20 [50%] cases at 6 weeks. In the remaining 17 [42.5%] cases, minor discharge occurred with itching which resolved till the next visit at 8 weeks and 12 weeks. As the main aim in treating fistula is proper identification of the internal opening, excision of the tract and sparing the sphincter function, VAAFT achieves all aims with additional benefits of patients' satisfaction and negligible scaring

Reproductive health issues of mothers; a study in Faisalabad

In Pakistan maternal mortality rate is very high as compared to other low income countries. Maternal mortality rate in Pakistan 260/100,000 is the highest in South Asia. In developing countries one woman dies in sixteen from pregnancy related diseases

Objective: This study was aimed to explore reproductive health issues of mothers in Faisalabad

Study Design: A sample of 200 respondents was obtained from Faisalabad city through multistage sampling technique

Period: 2013-2014

Setting Area: Urban Area of district Faisalabad

Material and Method: Uni-variate [frequency distribution and percentage] and Bi-variate analysis [Chi square and Gamma Statistics] was carried out

Results: It was found that antenatal and postnatal care utilization services were poor. Majority of the respondents 79% got at least one antenatal care service but only more than one third 34% got the four recommended checkup during pregnancy. It was also investigated that only 60% women got postnatal visits and only 18% deliveries took place at homes. Two third of the respondents 66% had the positive attitude towards the contraceptive methods for birth spacing. The bi-variate analysis shows that age [p=.003], education [p=.013], income [p=.001], type of family [p=.002] were significantly associated with the positive attitude towards the contraceptive for birth spacing

Conclusion: It is suggested that mothers should be aware of the importance of antenatal and postnatal recommended visits to overcome the reproductive health issues through LHW's visits mass media compaigns and easy assess towards the health care centers

Molecular Detection of Giardia lamblia and Cryptosporidium parvum in Different Water Sources of District Bannu, Khyber Pakhtunkhwa, Province of Pakistan.

Background: Cryptosporidium parvum and Giardia lamblia are intestinal parasites that predominantly causes "waterborne" infections that are transmitted through consumption of contaminated water. Both parasites typically cause an acute short-term infections with selflimiting diarrhea as the main symptom in people with intact immune systems. However, in immunocompromised individuals, the symptoms are particularly severe and might be fatal. Methods: The study was carried out in District Bannu Khyber Pukhtunkhwa, Pakistan for the detection of G. lamblia and C. parvum parasites in drinking water in different villages/localities (Kakki, Jamon Road, Kotka Juma Khan, Sokari, Mandan and Bannu City). Water samples n=75 were collected from different water sources between 1st August 2011 to 30th January 2012. These samples included tap, pond, borewell and hand pump water that were filtrated and residue was subjected to amplify by PCR. Results: Overall prevalence of parasites was 36% (25/75), containing tap 17.64% (9/51) and pond water 75% (6/8), bore well water 41.66% (5/12) and hand pump water 50% (2/4). Similarly over all prevalence rate of tap water for C. parvum was 7.84% (4/51) while for G. lamblia was 9.80% (5/51) positive. The present study revealed that the people of the area should use the cleaned and filtered water. Conclusion: Contamination of water with G. lamblia and C. parvum was found in water sources especially the drinking ones, of District Bannu which need proper water treatment to decontaminate and large scale studies are needed.

analysis of deformities in revision surgeries for secondary unilateral cleft lip

To analyze the secondary cleft lip deformities and the possible causes in a cohort of cases. A case series. Services Institute of Medical Sciences and WAPDA Teaching Hospital Complex, Lahore, from September 2008 to March 2012. Consecutive cases of secondary unilateral cleft lip deformities were selected for the study. These cases were interviewed and deformities recorded. Pre and postoperative photographs were taken for comparison. Per operative photographs were taken, after marking of the incisions, to keep a record of the intervention needed to correct the deformities. These cases were then further analyzed to know the deformities and interventions needed for correction of these deformities. Study subjects comprised 114 males and 75 females. Secondary correction was the most common in second decade of life with 82 cases in this group. The most common deformity was unfavorable scar in 150 cases followed by notch at the vermilion border in 124 cases. Short lip was found in 119 cases. Complete revision of the repair was required in 158 cases and 25 cases required partial redo of the initial repair. In other 6 cases, only scar revision was carried out. Unfavorable scar followed by vermilion notch and short lip were the most common secondary cleft lip deformities. Better technique helps favorable scar. Vermilion notch and short lip can be overcome by switching from rotation advancement repair to the triangular flap repair of Noordhoff

Outcome of manipulation under anaesthesia in adhesive capsulitis patients

Frozen shoulder although considered self remitting disease causes significant level of pain and stiffness. This study was planned to determine the immediate outcome of manipulation under anaesthesia [MUA] in patients with adhesive capsulitis in terms of gain of range of movement [ROM] and pain relief. Diagnosed cases of adhesive capsulitis [30 in number], who had symptoms of pain and stiffness lasting more than 2 months eventually underwent MUA. They were interviewed immediately before and after MUA to check the difference in pain intensity and ROM. All the subjects had significant improvement [p < 0.001] in range of motion in flexion followed by abduction and medial rotation. Least improvement [mean 2.06 / n=30] was observed in range of movement in external rotation. Significant decrease [p < 0.001] in pain intensity from mean intensity of 3.66 to 2.1 was seen. Hence, MUA is treatment indicated for those who are not responding to conservative methods of treatments.

Lignocaine toxicity in burn cases

Pain is one of the constant features of burn injuries. Many protocols are utilized to alleviate pain in these patients. Lignocaine containing ointment and fusidic acid in combination with hydrocortisone cream are routinely used as topical application in the wound care of burn patients in our setup. During a period of nine years, five patients experienced adverse effects of lignocaine, active ingredient of ointment, which were immediately controlled once this drug was discontinued. All these patients, who were being treated for burn injury involving more than 20% BSA [Body Surface Area], responded well on excluding the lignocaine from treatment medication and did not require any anticonvulsant to treat these adverse effects

Malaria: Still a Health Problem in the General Population of Bannu District, Khyber Pakhtunkhwa, Pakistan.

Aims: This study was aimed to know the burden of malaria infection and to re-evaluate its high prevalence in general population of Bannu District. Study Design: The current study was designed to re-evaluate the high prevalence of malaria and its demography in the human population of Bannu District. Place and Duration of the Study: This study was conducted during the months of May to September 2011 in local population of the Bannu District. Methodology: A total of 823 blood samples were randomly collected from both sexes; 513 males and 310 females of varying age groups <1 up to 50< years (mean 26.3± 9.1). Blood was drawn by pricking a left hand finger by using a sterilized lancet. Both thick and thin smears were prepared and examined through microscope for the detection of malarial parasites along with their impact on the general hematology. Results: Out of 823 blood samples, 223(27.1%) subjects were found positive for Plasmodiasis, while the distribution of species prevalence was observed as 186 (22.6%) and 25 (3.04%) for Plasmodium vivax, and Plasmodium falciparum, respectively along with a mixed infection of 12(1.46%). Variation with high incidence (42.65%) was found in the age group of 21-30 years. Moreover, males were found to be more malaria infected (30.64%) than females (24.95%). In addition, the prevalence of Plasmodiasis was found more frequent in rural population (33.42%) as compared to urban (21.00%) population. Conclusion: The present study revealed that the burden of malaria was high in rural areas of Bannu District and more attention is needed to overcome and control the high prevalence of malaria in this region.

Lumbar Disc Degenerative Disease: Disc Degeneration Symptoms and Magnetic Resonance Image Findings

STUDY DESIGN: Cross sectional and observational. PURPOSE: To evaluate the different aspects of lumbar disc degenerative disc disease and relate them with magnetic resonance image (MRI) findings and symptoms. OVERVIEW OF LITERATURE: Lumbar disc degenerative disease has now been proven as the most common cause of low back pain throughout the world. It may present as disc herniation, lumbar spinal stenosis, facet joint arthropathy or any combination. Presenting symptoms of lumbar disc degeneration are lower back pain and sciatica which may be aggravated by standing, walking, bending, straining and coughing. METHODS: This study was conducted from January 2012 to June 2012. Study was conducted on the diagnosed patients of lumbar disc degeneration. Diagnostic criteria were based upon abnormal findings in MRI. Patients with prior back surgery, spine fractures, sacroiliac arthritis, metabolic bone disease, spinal infection, rheumatoid arthritis, active malignancy, and pregnancy were excluded. RESULTS: During the targeted months, 163 patients of lumbar disc degeneration with mean age of 43.92+/-11.76 years, came into Neurosurgery department. Disc degeneration was most commonly present at the level of L4/L5 105 (64.4%).Commonest types of disc degeneration were disc herniation 109 (66.9%) and lumbar spinal stenosis 37 (22.7%). Spondylolisthesis was commonly present at L5/S1 10 (6.1%) and associated mostly with lumbar spinal stenosis 7 (18.9%). CONCLUSIONS: Results reported the frequent occurrence of lumbar disc degenerative disease in advance age. Research efforts should endeavor to reduce risk factors and improve the quality of life.

Leg length discrepancy; the reliability of tape measure method

Leg length discrepancy [LLD] has been deemed one of the causative factors for back, sacroiliac conditions and hip pathologies in patients. Increased LLD can exacerbate musculoskeletal impairments in patients that would require the clinician to reflect on the appropriate treatment strategies. The objective of the study was to measure the reliability of "Tape Measure Method" in Leg length discrepancy. This is a hospital based study. The procedures for obtaining leg length measures in the study were similar to those described by Magee DJ [Orthopedic physical assessment. 5thed].The primary investigator briefly reviewed the procedures for measuring the leg length with the subjects. Only the subject's right side was measured for the study. The subject's weight and height were measured using a standard scale and recorded. The first rater palpated the prominent aspect of the ASIS. The rater then guided the string to the prominent aspect of the MM. The rater repeated this procedure three times for each subject. After the first rater obtained three strings that correspond to the leg length, the second rater repeated the three measurements using the same procedure. After all cuts of strings were obtained each rater measured the lengths of his three strings with a standard tape measure and was recorded on a separate data sheet. Each rater was blinded to the other measures. Means and standard deviation for each subject's age, height, weight and BMI were measured. Mean standard deviation and 95% Confidence interval [95% CI] for leg length measurements for both raters are provided in Table 2. According to the results derived from data there were no significant differences in leg length measures between Rater 1 and Rater 2 [t-value = - 0.000; df = 58; p-value = .9981]. The ICC [3, 3] for Rater 1 was .999, [95% CI = .998 to .999]. This value indicates almost perfect agreement between the measures for Rater 1. The ICC [3, 3] for Rater 2 was .979 [95% CI = .962 to .990]. These findings are indicative of almost perfect agreement between the measures. The ICC [2, 2] between Rater 1 and Rater 2 was .987 [95% CI = .972 to .994]. A Bland-Altman plot identifies any bias between the two raters. The bias line is almost on zero, indicating no bias between the two raters. It can be concluded that any observed bias was not clinically important. Conclusions and Discussion: It was concluded measuring leg length using the tape measure was simple and highly reliable. There were several limitations that may have influence overall results of the study

Screening for tuberculosis among household contacts of index patients

Household contacts of sputum positive pulmonary TB cases are at a high risk of getting infected with tuberculosis therefore symptomatic or vulnerable individuals should be screened and treated early. To determine the prevalence of pulmonary tuberculosis in the households contacts of index patients having pulmonary tuberculosis infection using standard diagnostic tests and refer the positive cases to DOTS program for treatment. This national descriptive study was conducted in seven Centers of PMRC throughout Pakistan form November 2010 to March 2012. A total of 580 index adult patients suffering from pulmonary tuberculosis, being treated at DOTs Centers of major tertiary care hospitals of Karachi, Lahore, Multan, Peshawar and Quetta living within 5-8 kilometers of the hospital, who consented to participate in the study were selected from the DOTs centres. Generally one but occasionally two close contacts of these index patients [spouses, parents or siblings] were called to the hospital for screening of TB using chest Xray, smear microscopy and tuberculin skin test. Out of 800 contacts screened, 125 [15.6%] were positive on sputum smear examination while 113 had infiltration on X-rays along with positive tuberculin skin test [Indurations of >10 mm] making a definitive diagnosis of TB. Calcified lesions were seen on X-rays in another 91 cases giving evidence of past infection, however 26 of these were AFB positive indicating either the relapse of disease or active lesion. Low grade fever and weight loss were the most significant findings in contacts that were positive on sputum smear and radiology. Almost 15.6% household contacts of pulmonary tuberculosis patients have pulmonary tuberculosis. Health care providers in general and DOTs staff in particular should be trained to inform all index cases that their close contacts especially those suffering from weight loss and fever should be screened for tuberculosis and treated if required

Postpartum stress; effects of pelvic floor muscle training [kegel exercises] in women with postpartum stress urinary incontinence

There is no consensus on the amount of exercise necessary to improve pelvic floor muscle [PFM] function. We reviewed the pathophysiology of PFM dysfunction and the evolution of PFM training regimens since Kegel introduced the concept of pelvic floor awareness and the benefits of strength. This paper describes the effect of pelvic floor muscle training [Kegel Exercises] in stress urinary incontinence. The design of PFM training logically requires multiple factors to be considered in each patient. The objective of the study was to determine the effects of pelvic floor muscle training with postpartum urinary incontinence [1] Improvement in urinary control. [2] Improvement in relieving urinary urgency. [3] Time duration in which patient returns to functional activities. [4] Any complications after exercises. Quasi Study. The study was carried out in department of physiotherapy Ghurki Trust Teaching Hospital Lahore the duration of study was 12 months from May 2011 to April 2012. The study was based on 28 patients who were having the complaint of postpartum urinary incontinence. Abdominal and pelvic control was assessed and recorded before commencing the exercises and was also assessed regularly on every follow up. Kegel exercises helps to control and eradicate the problem of postpartum stress urinary incontinence. Kegel exercises give a good result in postpartum stress urinary incontinence