Optimized biotransformation of acid-treated water melon peel hydrolyzate into ethanol

Abstract Today, global focus of research is to explore the solution of energy crisis and environmental pollution. Like other agricultural countries, bulk quantities of watermelon peels (WMP) are disposed-off in environment as waste in Pakistan and appropriate management of this waste is the need of hour to save environment from pollution. The work emphasizes the role of ethanologenic yeasts to utilize significant sugars present in WMP for low-cost bioethanol fermentation. Dilute hydrochloric acid hydrolysis of WMP was carried out on optimized conditions employing RSM (response surface methodology) following central composite design (CCD). This experimental design is based on optimization of ethanologenesis involving some key independent parameters such as WMP hydrolysate and synthetic media ratio (X1), incubation temperature (X2) and incubation temperature (X3) for maximal ethanol yield exploiting standard (Saccharomyces cerevisiae K7) as well as experimental (Metchnikowia cibodasensisY34) yeasts. The results revealed that maximal ethanol yields obtained from S. cerevisiae K7 was 0.36±0.02 g/g of reducing sugars whereas M. cibodasensisY34, yielded 0.40±0.01 g ethanol/g of reducing sugars. The yeast isolate M. cibodasensisY34 appeared as promising ethanologen and embodies prospective potential for fermentative valorization of WMP-to-bioethanol.

Resumo Hoje, o foco global da pesquisa é explorar a solução da crise energética e da poluição ambiental. Como em outros países agrícolas, grandes quantidades de cascas de melancia (WMP) são descartadas como resíduos no meio ambiente no Paquistão, mas a gestão adequada desses resíduos é a mais recente solução para salvar o meio ambiente da poluição. O trabalho enfatiza o papel das leveduras etanologênicas para utilizar açúcares significativos presentes no WMP para fermentação de bioetanol de baixo custo. A hidrólise de ácido clorídrico diluído de WMP foi realizada em condições otimizadas empregando RSM (metodologia de superfície de resposta) e seguindo o projeto de composto central (CCD). Este projeto experimental é baseado na otimização da etanologenesis envolvendo alguns parâmetros independentes importantes, como hidrolisado de WMP e razão de meio sintético (X1), temperatura de incubação (X2) e temperatura de incubação (X3) para rendimento máximo de etanol explorando o padrão (Saccharomyces cerevisiae K7) também como leveduras experimentais (Metchnikowia cibodasensis Y34). Os resultados revelaram que os rendimentos máximos de etanol obtidos a partir de S. cerevisiae K7 foi de 0,36 ± 0,02 g / g de açúcares redutores, enquanto M. cibodasensis Y34 rendeu 0,40 ± 0,01 g de etanol / g de açúcares redutores. O isolado de levedura M. cibodasensis Y34 apareceu como um etanologeno promissor e incorpora um potencial prospectivo para a valorização fermentativa de WMP em bioetanol.

Optimized biotransformation of acid-treated water melon peel hydrolyzate into ethanol / Biotransformação otimizada de hidrolisado de casca de melancia tratada com ácido em etanol

Abstract Today, global focus of research is to explore the solution of energy crisis and environmental pollution. Like other agricultural countries, bulk quantities of watermelon peels (WMP) are disposed-off in environment as waste in Pakistan and appropriate management of this waste is the need of hour to save environment from pollution. The work emphasizes the role of ethanologenic yeasts to utilize significant sugars present in WMP for low-cost bioethanol fermentation. Dilute hydrochloric acid hydrolysis of WMP was carried out on optimized conditions employing RSM (response surface methodology) following central composite design (CCD). This experimental design is based on optimization of ethanologenesis involving some key independent parameters such as WMP hydrolysate and synthetic media ratio (X1), incubation temperature (X2) and incubation temperature (X3) for maximal ethanol yield exploiting standard (Saccharomyces cerevisiae K7) as well as experimental (Metchnikowia cibodasensisY34) yeasts. The results revealed that maximal ethanol yields obtained from S. cerevisiae K7 was 0.36±0.02 g/g of reducing sugars whereas M. cibodasensisY34, yielded 0.40±0.01 g ethanol/g of reducing sugars. The yeast isolate M. cibodasensisY34 appeared as promising ethanologen and embodies prospective potential for fermentative valorization of WMP-to-bioethanol.

Resumo Hoje, o foco global da pesquisa é explorar a solução da crise energética e da poluição ambiental. Como em outros países agrícolas, grandes quantidades de cascas de melancia (WMP) são descartadas como resíduos no meio ambiente no Paquistão, mas a gestão adequada desses resíduos é a mais recente solução para salvar o meio ambiente da poluição. O trabalho enfatiza o papel das leveduras etanologênicas para utilizar açúcares significativos presentes no WMP para fermentação de bioetanol de baixo custo. A hidrólise de ácido clorídrico diluído de WMP foi realizada em condições otimizadas empregando RSM (metodologia de superfície de resposta) e seguindo o projeto de composto central (CCD). Este projeto experimental é baseado na otimização da etanologenesis envolvendo alguns parâmetros independentes importantes, como hidrolisado de WMP e razão de meio sintético (X1), temperatura de incubação (X2) e temperatura de incubação (X3) para rendimento máximo de etanol explorando o padrão (Saccharomyces cerevisiae K7) também como leveduras experimentais (Metchnikowia cibodasensis Y34). Os resultados revelaram que os rendimentos máximos de etanol obtidos a partir de S. cerevisiae K7 foi de 0,36 ± 0,02 g / g de açúcares redutores, enquanto M. cibodasensis Y34 rendeu 0,40 ± 0,01 g de etanol / g de açúcares redutores. O isolado de levedura M. cibodasensis Y34 apareceu como um etanologeno promissor e incorpora um potencial prospectivo para a valorização fermentativa de WMP em bioetanol.

Effects of high-intensity interval training and strength training on levels of testosterone and physical activity among women with polycystic ovary syndrome

Objective@#Polycystic ovary syndrome is a diverse endocrine disorder characterized by hyperandrogenism and ovulatory dysfunction. Hyperandrogenism affects body morphology, resulting in excess weight (overweight or obesity). This study aimed to evaluate the efficacy of high-intensity interval training on serum testosterone levels, body fat percentage, and level of physical activity among women with polycystic ovary syndrome. @*Methods@#Fifty participants were enrolled in the study and randomly allocated into two groups. Group A performed highintensity interval training on alternate days per week (total of 12 weeks) and group B performed strength training on alternate days per week (total of 12 weeks). Baseline and 12th-week assessments included serum testosterone levels, body fat percentage using the skinfold method, and level of physical activity assessed using the International Physical Activity Questionnaire. @*Results@#After 12 weeks of intervention, both groups showed significant improvements in all the outcomes. However, group A (high intensity interval training) showed statistically significant results compared to group B (strength training) in lowering serum testosterone levels (P=0.049) and body fat percentage (P=0.001) and increasing physical activity levels (P=0.006). @*Conclusion@#After 12 weeks of exercise, both exercises benefited the participants; however, high-intensity interval training specifically was found to be a more effective exercise regimen than strength training in reducing serum testosterone levels and body fat percentage and enhancing levels of physical activity in women with polycystic ovary syndrome.

Antidepressant and Antiamnesic Potential of Foeniculum vulgare

Aim:To evaluate the antiamnesic and antidepressant effect of Foeniculumvulgarewhole crushed seeds.Study Design:Laboratory based randomized control study. Place and Duration of Study:Department of Pharmacology, University of Karachi between January 2018 to August 2018. Methodology:Thirty swiss albino mice and wistar rats were divided equally in three groups. Control group was fed on standard rodent diet, group 2 was fed on 2% Foeniculumvulgarediet and group 3 was given 4% Foeniculumvulgarediet. Antidepressant activity was assessed using forced swimming test. Memory enhancement effect was evaluated by stationary rod test, passive avoidance test and water maze test.Results:Increased durationof struggling time was noted in both group 2 and group 3 as compared to control in forced swimming test. Decrease in time to reach platform in both water maze and stationary rod test was recorded in both the study group (group 2 & 3). Increase in stepthroughlatency was also seen in group 2 and group 3 as compared to control group.Conclusion:The results showed the memory enhancing and antidepressant actions of Foeniculum

Effect of different industrial and domestic effluents on growth, yield, and heavy metal accumulation in Turnip (Brassica rapa L.)

In the suburbs of big cities, the vegetables are commonly irrigated with effluents due to paucity of good qualitywater. These effluents are loaded with toxic or heavy metals which may cause environmental or health hazard.The present study was performed in pot experiments to investigate the impacts of different effluents on thegrowth, yield, and heavy metals concentration of turnip (Brassica rapa). Pots were arranged in a completelyrandomized design with six treatments replicated four times. The treatments included 10% effluents ofsugar mill, sewage water, soap factory, ghee mill, slaughterhouse, and control. Data on the weight of rootplant−1 (g), root length, root diameter, yield ha−1, and heavy metals (Fe, Pb, Zn, Ni, and Cd) concentrationsin roots were recorded and analyzed statistically. Results revealed that higher yield and related traits wererecorded with sewage water followed by slaughterhouse wastage and sugar mill effluent. Application of sewagewater enhanced 11.2% yield while the increment with slaughterhouse wastage and sugar mill effluent was 7.8%and 2.3%, respectively. Heavy metal concentrations were increased with all types of effluents. The transferfactors showed that accumulation of metals was in the order of Pb > Cd > Zn > Fe > Ni.

Correlation of Obesity and Other Factors with Presence of Extra Hepatic Disease among the Patients Presenting with Fatty Liver

Purpose: To assess the Correlation of obesity and other factors with presence of extrahepatic disease among the patients presenting with fatty liver at CMH Rawalakot, Azad Kashmir. Study design: Correlational Study. Setting: Gastroenterology department CMH//Sheikh Khalifa Bin Zayad Al Nahyan Hospital Rawalakot. Duration of study: Six months, from 01-09-2018 to 01-03-2019. Patients and methods: A prospective study was conducted on 51 patients of fatty liver diagnosed on ultrasound by consultant radiologist of own hospital. The demographic profile included age, gender, presence of obesity, triglyceride levels and total cholesterol levels. Common extra-hepatic conditions which were looked for in this study included Diabetes mellitus (DM), Hypertension (HTN), Ischemic heart disease (IHD) and Osteoarthritis (OA) which were diagnosed with the help of detailed history taking, relevant physical examination and laboratory investigations. Results: Out of 51 patients included in the final analysis 31 were male and 20 were female. Twenty-seven participants had one or more co-morbid illnesses while 24 had no such diseases at the time of study. DM was the commonest comorbid illness while OA was least reported. Twenty four patients were obese while 27 had BMI less than 30. The presence of obesity and raised total cholesterol levels had a significant relationship with presence of extra-hepatic illness among the patients presenting with fatty liver. Conclusion: Patients presenting with fatty liver have high prevalence of extrahepatic diseases. Routine screening of common illnesses should be done on all the patients who have been diagnosed as having a fatty liver. Special attention should be given to the patients who had BMI more than 30 or raised total cholesterol levels.

Microbiota Of Pruritic Ears In Kashmir, India

AIM:To identify microflora of external auditory canal in patients with aural itching and to study susceptibility profiles of pathogenic organisms. Materials & Methods: A total of 194 patients with aural itching were selected. An external auditory canal swab was taken. The samples were emulsified in different media for studying different organisms. Culture and sensitivity was done for the pathogenic organisms. Results: Of the total 194 patients, 107 patients had no growth. Of the remaining 84 cases, 55 patients yielded aerobic bacteria and anaerobes were isolated in 04 cases. Of the aerobes isolated, coagulase negative staphylococcus was isolated from 31 patients, staphylococcus aureus from 17 patients and pseudomonas aeruginosa in 07. Fungi were isolated in 29 cases. Conclusion: Our findings suggest that asteatosis should be considered an etiology in patients with pruritic ears after bacterial and fungal infections have been ruled out. Our study showed that a combination of a topical antibiotic/steroid and oral antihistamine is effective in alleviating the symptoms of pruritic ears

Association of Maternal Knowledge and Practices Regarding Prevention and Care of Diarrhea at Home for Children less than 5 years of Age: A Study Conducted in Tertiary level Hospitals of Lahore, Pakistan

Background: Diarrhea is second major killer disease for children less than 5 year of age; and maternal lack of sound knowledge and related correct practices inn this regard conflicts with WHO treatment guidelines for diarrhea. Objective: 1) to assess the level of maternal knowledge and practices regarding prevention and management of diarrhea at home; in children below five year of age 2) to identify association between maternal knowledge and practices regarding prevention and care of diarrhea at home. Materials & Methods: It was a cross sectional study conducted in three tertiary level hospitals of Lahore selected randomly. Study population was mothers having children less than 5 year of age coming to pediatric Outdoor in these hospitals. Calculated sample size was 296; and non-probability purposive sampling technique used to recruit the sample. Data was collected from 300 respondents; study instrument was KAP questionnaire adopted and modified and data was taken upon the variables of knowledge and practice. Data analysis plan was: descriptive statistics for all variables, Bivariate analysis upon knowledge and practice scores, Pearson Correlation upon the two variable scores. Results: 61.7% respondents had good knowledge score, whereas 32% and 6.3% had average and poor score respectively. 39.3% were found to have good practice score, whereas 54% and 6.7% were found to have average and poor practice level score. Highly significant association (P- 0.000) was found between knowledge and practice levels; and Pearson correlation of 43.8% was found between the two variables. Conclusion: Health education communication should be conducted by health care workers so as to give the right knowledge about ORS intake and its preparation; and adoption of correct dietary practices by the mothers during diarrheal episode of the child.

Non-Invasive Treatment of muscle Invasive Bladder Cancer in patients with deranged renal profile

Objective: To determine the efficacy of trimodality therapy in patients with muscle invasive carcinoma of the bladder with deranged renal profile

Study Design: Quasi-experimental study

Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi over 14 months, from Sep 2015 to Nov 2016

Patients and Methods: Forty patients [n=40] having histopathologically confirmed [urothelial] urinary bladder cancer, clinical stage II or III, aged 18 to 80 years, with Eastern Cooperative Oncology Group [ECOG] perfor-mance status ?2 and having deranged renal functions were included in this study. After maximal transurethral resection of bladder tumour [TURBT], they received 4 courses of chemotherapy with mitomycin and 5 fluorou-racil, followed by concurrent chemoradiation using same chemotherapy received 50 Grays in 20 fractions. Response was assessed using RECIST criteria

Results: Efficacy; defined in terms of complete and partial response, was observed in 85 percent [n=34] of patients. Treatment efficacy was better in males as compared to females [90.6 percent vs. 62.55: p<0.05]. Patients with better ECOG-PS [0-1] and early stage [2] responded well to treatment while response was almost same in different age groups, [p>0.05 in all cases]. Thirty-seven patients were able to complete the full study protocol, 2 had severe mucositis and hand-foot syndrome while one patient died after septicaemia

Conclusion: Trimodality treatment with TURBT, chemotherapy and chemo-radiation is a feasible option for bladder preservation in muscle invasive bladder cancer patients with compromised renal functions if we use 5-fluorouracil and mitomycin chemotherapy

Effect of task specific circuit training on Gait parameters and mobility in stroke survivors

Objective of the study was to investigate effects of task specific circuit gait training to improve gait parameters and mobility among sub-acute and chronic stroke patients. A randomized control trial was conducted on stroke survivors of either gender being capable of standing 10 seconds and having 2-4 score on Rankin Modified Scale. Sample comprised of 30 participants randomly assigned into two groups. Training was given for a session of 40-50 minutes for 3-4 days/week for six weeks. Timed get up and go test [TUG], Cadence, Step Length and Step Width assessed measures of concern. The sample included 16 males and 14 females with mean age of 54.10 +/- 10.10 years. After six weeks, significant improvement was recorded in TUG [p=0.014]. Cadence [p=0.001], step length [p<0.001] and step width [p=0.009] were also significantly improved. Circuit gait training improves mobility and gait in stroke patients

Histopathological changes in arsenic kushta induced nephrotoxicity in wistar rats

Objective: To determine the nephrotoxic effects of arsenic kushta [Kushta Sam-ul-Far] in Wistar rats

Study Design: Experimental study

Place and Duration of Study: Department of Morbid Anatomy and Histopathology, University of Health Sciences, Lahore from May to August 2014

Methodology: This experimental study was conducted on 48 healthy Wistar rats, each weighing 200 - 250 grams. The rats were randomly divided into 4 experimental groups each containing 12 rats. Group I was taken as control given flour pellets. Group II was given single dose [180 mg/kg] of arsenic kushta for 2 weeks. Group III received 150 mg/kg of arsenic kushta for 12 weeks; whereas, group IV was also given 150 mg/kg of arsenic kushta for 12 weeks along with 75 mg of BSA [bovine serum albumin]. Histopathological changes in glomeruli, tubules and interstitium were noted in the kidney

Results: Mesangial proliferation, thickening of basement membrane, necrosis, and interstitial edema were mainly observed in all the above groups except group I which served as control. These changes were seen in greater severity in high dose groups and the group given BSA injection along with kushta [group III, IV]

Conclusion: Herbo-mineral preparations of arsenic kushta are nephrotoxic in rats and may have similar toxic effects in human beings

Synthesis and in silico study of 2-furyl(4-{4-[(substituted)sulfonyl]benzyl}-1-piperazinyl)methanone derivatives as suitable therapeutic agents

Abstract In the study presented here, a new series of 2-furyl(4-{4-[(substituted)sulfonyl]benzyl}-1-piperazinyl)methanone derivatives was targeted. The synthesis was initiated by the treatment of different secondary amines (1a-h) with 4-bromomethylbenzenesulfonyl chloride (2) to obtain various 1-{[4-(bromomethyl)phenyl]sulfonyl}amines (3a-h). 2-Furyl(1-piperazinyl)methanone (2-furoyl-1-piperazine; 4) was then dissolved in acetonitrile, with the addition of K2CO3, and the mixture was refluxed for activation. This activated molecule was further treated with equi-molar amounts of 3a-h to form targeted 2-furyl(4-{4-[(substituted)sulfonyl]benzyl}-1-piperazinyl)methanone derivatives (5a-h) in the same reaction set up. The structure confirmation of all the synthesized compounds was carried out by EI-MS, IR and 1H-NMR spectral analysis. The compounds showed good enzyme inhibitory activity. Compound 5h showed excellent inhibitory effect against acetyl- and butyrylcholinesterase with respective IC50 values of 2.91±0.001 and 4.35±0.004 µM, compared to eserine, a reference standard with IC50 values of 0.04±0.0001 and 0.85±0.001 µM, respectively, against these enzymes. All synthesized molecules were active against almost all Gram-positive and Gram-negative bacterial strains tested. The cytotoxicity of the molecules was also checked to determine their utility as possible therapeutic agents.

Synthesis, pharmacological screening and computational analysis of some 2-[l-Indol-3-yl]-A [[un]substituted phenylmethylidene] acetohydrazides and 2-[l-Indol-3-yl]-7V[[un]substituted benzoyl/2-thienylcarbonyl] acetohydrazides

The undertaken research was initiated by transforming 2-[l-Indol-3-yl]acetic acid [1] in catalytic amount of sulfuric acid and ethanol to ethyl 2-[l-Indol-3-yl]acetate [2], which was then reacted with hydrazine monohydrate in methanol to form 2-[l-Indol-3-yl]acetohydrazide [3]. Further, The reaction scheme was designed into two pathways where, first pathway involved The reaction of 3 with substituted aromatic aldehydes [4a-o] in methanol with few drops of glacial acetic acid to generate 2-[l-Indol-3-yl]-AD-[[un]substitutedphenylmethylidene]acetohydrazides [5a-o] and in second pathway 3 was reacted with acyl halides [6a-e] in basic aqueous medium [pH 9-10] to afford 2-[l-Indol-3-yl]-AD-[[un]substitutedbenzoyl/2-thienylcarbonyl]acetohydrazides [7a-e]. All The synthesized derivatives were characterized by IR, EI-MS and !H-NMR spectral techniques and evaluated for their anti-bacterial potentials against Gram positive and Gram negative bacterial strains and it was found that compounds 7a-d exhibited antibacterial activities very close to standard Ciprofloxacin. The synthesized derivatives demonstrated moderate to weak anti-enzymatic potential against oc-Glucosidase and Butyrylcholinesterase [BChE] where, compounds 7c and 5c exhibited comparatively better inhibition against these enzymes respectively. Compounds 7a, 7d and 7e showed excellent anti-enzymatic potentials against Lipoxygenase [LOX] and their IC[5]o values were much lower than the reference standard Baicalein. Enzyme inhibitory activities were also supported by computational docking results. Compounds 5c, 7a, 7b and 7c also showed low values of % hemolytic activity as well, showing that these molecules were not toxic, indicating that these molecules can be utilized as potential therapeutic agents against inflammatory ailments

Comparision of post operative chronic pain after excision of ilioinguinal nerve in lichtenstein's hernioplasty

Objective: To provide a comparative analysis of mean post-operative pain score after preservation and elective excision of ilioinguinal nerve [UN] using standard Lichtenstein hernia repair [LHR] technique

Study Design: Randomized controlled trial

Place and Duration of Study: Department of Surgery Combined Military Hospital [CMH] Rawalpindi/ Peshawar, from 15 May 2013 to 15 May 2014

Materials and Methods: One hundred and fifty patients with diagnosis of inguinal hernia satisfying inclusion/exclusion criteria were included. Patients were divided into two groups randomly. In group A, UN was carefully protected while excision were done in group B. Demographic as well as data concerning groin pain at 03 months post operatively were collected and analyzed using SPSS

Results: A total of 150 patients were included. Mean age in group A was 37.32 +/- 10.45 years while in group B was 36.56 +/- 10.26 years [p=0.653]. Majority of the patients in both groups were male [group A 89.33% [67], 92% [69] in group-B], while female constituted only minority [8 [10.67%] in group A and 6 [8%] group-B], the difference being statistically insignificant [p=0.571]. Majority of the patients had indirect hernia and mean operation time was similar in both groups. Mean postoperative pain score was 3.76 +/- 1.11 and 2.82 +/- 0.677 in group A and B respectively, the difference being statistically significant [p<0.001]

Conclusion: Mean post-operative pain score is higher in preservation techniques compared to elective excision of UN for the treatment of inguinal hernia

Abnormal ribs, hemivertebrae and sacral agenesis: a rare skeletal deformity in infant of a diabetic mother: a case report

A good weight male baby of 4 kg delivered at 40 weeks gestation on 28th January, 2016 at Darul Sehat Hospital, Karachi. At birth he had Apgar score of 6/1, 7/5 and admitted in Neonatal Intensive Care Unit for blood glucose monitoring and basic laboratory investigations which included complete blood count, C-reactive protein, blood culture and sensitivity and chest x-ray. An incidental finding on chest x-ray was present as abnormal rib cage with fractured ribs followed by infantogram which showed hemi-vertebrae and agenesis of sacral bones which is a part of caudal regression syndrome, this is a very rare finding of skeletal deformity seen in infant of diabetic mother. Hence this case is being reported, as local literature is scarce

Endoscopic transnasal dacryocystorhinostomy: our experience and case series analysis

Background: This study aims to describe our surgical technique and results for endoscopic transnasal dacryocystorhinostomy for the blocked nasolacrimal passage in patients presented in the department of Otolaryngology and ophthalmology at a tertiary care center

Methods: A consecutively presenting case series of blocked nasolacrimal passage were selected for transnasal endoscopic dacryocystorhinostomy. Bone removal done by cold instruments and the drill was used to remove the bone over the superior aspect of the sac. Medial wall of the sac was removed to marsupialize the sac in the nasal cavity. Septoplasty was done in 13 patients [17.10 %]. The specific surgical approach with or without septoplasty and the use of endolight was discussed. Postoperative follow up including endoscopic examination and results are documented

Results: A total of 76 cases were included. Mean age was 37.32 [range 6-76]]. An endolight was used in all cases to localize the site of nasolacrimal sac72 cases [94.74 %] have successful outcome in terms of relief of symptoms, whereas 4[5.26 %] cases had persistent epiphora. Revision procedure were done and 3[3/4, 75 %] cases had successful outcome. The overall success rate in our series of primary and revision ETDCR is 98.68 %

Conclusion: Endoscopic transnasal dacryocystorhinostomy is an effective treatment for nasolacrimal duct obstruction. Use of the endolight to localize and the power drill to expose the sac and septoplasty; contribute to the ultimate surgical success

To determine the efficacy of locking compression plating in comparison with intramedullary nailing for humeral shaft fractures at a tertiary care hospital in Karachi, Pakistan

Objective: The purpose of our study is to compare the effectiveness, surgical outcome and complications of locking compression plating as compared with intramedullary nailing for the purposes of fixation of humeral shaft fractures in the adult population

Methodology: The type of study is a prospective randomized controlled trial, which was carried out for a period of three years from Jan 2012 to December 2014, at a tertiary care hospital in Karachi Pakistan. Patients coming to the hospital via the A and E department with radiographic evidence of a humeral shaft fracture were included in the study. 50 patients were selected for the study, who were randomly divided into two groups, group A [n=25] comprised of patients who underwent intramedullary nailing procedure, while group B [n=25] patient underwent compression plating for the fixation of the humeral fracture. The surgical outcome was assessed based on the operative time, intra operative blood loss, the time of hospital stay, the time required for the union of bone, functional outcome and complications. [American shoulder and elbow surgeons score] ASES and the constant score was used to assess the functional outcome of patients

Results: According to our study, the operative time, hospital stay and intra operative blood loss was much lower in group A [the intramedullary nail group] as compared to those in the group B [locking compression plate group]. The rate of bone union, constant and ASES score did not show any significant difference. The union time for group A was lower as compared to group B. Complications such as radial nerve palsy were observed to be associated more with the locking compression plate as compared with the group of patients who underwent intramedullary nailing

Conclusion: According to our study the intramedullary nailing technique for the repair of humeral shaft fractures is a superior technique as compared to the locking compression plate, as it has decreased incidence of blood loss during the procedure, less time required for the procedure, less time of hospital stay and union of bone. It also has a low incidence of complications

Comparison of Negative Pressure Wound Therapy using Vacuum-Assisted Closure with Advanced Moist Wound Therapy in the treatment of Diabetic Foot Ulcers

Objective: To evaluate the clinical efficacy of Negative Pressure Wound Therapy [NPWT] using Vacuum Assisted Closure [VAC] compared with Advanced Moist Wound Therapy [AMWT] to treat Diabetic Foot Ulcer [DFU]

Study Design: Randomized control trial

Place and Duration of Study: Surgical Department, Combined Military Hospital [CMH] / Military Hospital [MH], Rawalpindi, from November 2010 to June 2012

Methodology: The study consisted of 278 patients, with 139 patients each in Group 'A' and 'B', who were subjected to AMWT and NPWT, respectively. Wound was assessed digitally every week for 2 weeks. Wound dimension and surface area were determined using University of Texas Health Centre at San Antonio [UTHCSA] image tool version 3.0. Efficacies of AMWT and NPWT were compared in terms of reduction in wound area over 2 weeks

Results: Mean age of presentation in group A was 55.88 +/- 10.97 years while in group B, it was 56.83 +/- 11.3 [p=0.48]. Mean duration of diabetes at presentation was 15.65 +/- 4.86 and 15.96 +/- 5.79 years in group A and B, respectively [p=0.74]. Majority of patients had Wagner's grade 2 ulcer [82% in group A and 87.8% in group B, p= 0.18]. Initial wound size in group A was 15.07 +/- 2.92 cm[2] and in group B 15.09 +/- 2.81 cm[2] [p = 0.95]. Wound size measured after 2 weeks, treatment was in group A 13.70 +/- 2.92 cm[2] and in group B 11.53 +/- 2.78 cm[2] [p < 0.001]. Wound area reduction in both groups revealed statistically significant faster healing in group B as compared to group A [p < 0.001]

Conclusion: NPWT using VAC was more efficacious than AMWT in the management of diabetic foot ulcers

Treatment of gingival recession with pedicle graft

One of the most common esthetic concerns associated with the periodontal tissues is gingival recession. Gingival recession is the exposure of root surfaces due to apical migration of the gingival tissue margins;gingival margin migrates apical to the cement-enamel junction,Therefore this deformity should be treated at its earliest detection. Exposed root surfaces are more likely to develop root sensitivity and root caries. Among various procedures, laterally positioned pedicle graft [LPG] is widely used successfully to cover recession defects. The main advantages of the laterally positioned pedicle graft are that it is relatively easy and not time-consuming, it produces excellent esthetic results and no second surgical site is involved for donor harvesting. The Present case report is about the successful surgical management of a patient with gingival recession i.e., Miller's class III defect using laterally positioned pedicle graft

HRCT lung findings in post chemotherapy patients - emerging challenge for radiologists

Objective: to characterize, diagnose and to differentiate various HRCT manifestations of lung abnormalities in post chemotherapy patients

Methodology: this was a retrospective study of 50 patients conducted at Ra-diology department of Rehman Medical Institute, Peshawar. Duration of study was 6months i.e from April 2013 to September 2013. Patients were investigated using 128-slice Multidetector Computed tomography [MDCT] scanner in the Radiology department of Rehman Medical Institute Peshawar. 0.5mm reconstructed images in lung window and 3mm images in mediastinal window were viewed on workstation in axial, coronal and sagittal planes. The data was processed using Microsoft excel 2007

Results: a total of 50 patients were included. Age of the patients ranged from 6 to 70 years with a mean age of 35 years. In our study, we found five radiologic patterns on CT scan; [1]non-specific ground-glass attenuation 17[34%],[2] patchy distribution of ground-glass attenuation accompanied by interlobular septal thickening 7[14%], [3]multifocal areas of airspace consolidation 7[14%],[4]extensive bilateral ground-glass attenuation or airspace consolidations with traction bronchiectasis 4[8%], and [5] nodules of variable sizes randomly distributed in both lungs 15[30%]

Conclusion: the most common pattern was found to be patchy areas of ground-glass attenuation. Pulmonary diseases that are induced by chemotherapy represent particular challenges for radiologists due to non-specific and atypical imaging features