Classification of Control and Neurodegenerative Disease Subjects Using Tree Based Classifiers

Background: The medical researchers are developing different non-invasive methods for early detection of Neurodegenerative Diseases (NDDs) when pharmacological interventions are still possible to further prevent the disease progression. The NDDs are associated with the degradation in the complex gait dynamicsand motor activity. The classification ofgait data using machine learning techniques can assist the physiciansfor early diagnosis of the neural disorder when clinical manifestation of the diseases is not yet apparent. Aims: The present study was undertaken to classify the control and NDD subjects using decision trees based classifiers (Random Forest (RF), J48 and REPTree).Methodology:The data used in the study comprises of 16 control, 20 Huntington’s Disease (HD), 15 Parkinson’s Disease (PD), and 13 Amyotrophic Lateral Sclerosis (ALS) subjects, which were taken from publicly available database from Physionet. The age range of control subjects was 20-74, HD subjects was 36-70, PD subjects was 44-80, and ALS subjects was 29-71. There were 13 attributes associated with the data. Important features/attributes of the data were selected using correlation feature selection -subset evaluation (cfs) method. Three tree based machine learning algorithms (RF, J48 and REPTree) were used to classify the control and NDD subjects. The performance of classifiers were evaluated using Precision, Recall, F-Measure, MAE and RMSE.Results:In order to evaluate the performance of tree based classifiers, two different settings of data i.e. complete features and selected featureswere used. In classifying control vs HD subjects, RF provides the robust separation with classification accuracy of 84.79% using complete features and 83.94% using selected features. While in classifying control vs PD subjects, and control vs ALS subjects, RF also provides the best separation with classification accuracy of 86.51% and 94.95% respectively using complete features and 85.19% and 93.64% respectively using selected features.Conclusion:The variability analysis of physiological signals provides a valuable non-invasive tool for quantifying the system of dynamics of healthy subjects and to examine the alternations in the controlling mechanism of these systems with aging and disease. It is concluded that selected features encode adequate information about neural control of the gait. Moreover,the selected featuresalong with tree based machine learning algorithms can play a vital for early detection of NDDs, when pharmacological interventions are still possible

Molecular characterization and spoligotyping analysis of multi drug resistant mycobacterium tuberculosis from a high TB endemic area of Pakistan

Background: Multidrug resistant tuberculosis caused by Mycobacterium tuberculosis is an infection that is resistant to rifampicin and isoniazid. Management of Multidrug resistant tuberculosis is a serious challenge worldwide

Objectives: To investigate hotspot mutations in rpoB, katG and inhA genes and its possible co-relation with predominant genotypes in Khyber Pakhtunkhwa, Pakistan

Study design, settings and duration: This cross sectional study was conducted after approval from research and ethics committee of Provincial TB Control Program, Khyber Pakhtunkhwa in March 2015

Materials and Methods: A total of 166 clinical isolates were analysed which were collected from programmatic management of drug-resistant tuberculosis units. All samples were characterized by phonotypical drug susceptibility test, genotypic drug resistant test [line probe assay] and spoligotyping analysis using ''TB-SPRINT' micro bead assay

Results: Out of the total 166 samples, 97 strains were resistant to rifampicin [RIF] and 106 strains were resistant to isoniazid [INH]. Most common mutation in rpoB was S531L in 75 [77%] isolates followed by D516V in 10 [10%] and H526Y in 6 [6%] samples respectively. A rare mutation in rpoB gene at codon 522 and deletion of codon 518 was also reported. In 106 INH resistant strains, 97[91%] were associated with mutation in katG gene while resistance in 9 [8.4%] strain was due to mutation in the inhA promoter region. Spoligotyping analysis revealed 55 distinct types of different patterns. Spoligotyping patterns of 146 samples matched with 15 different linage of M.tuberculosis in which 101 [60%] were identified as the predominant CAS1-Delhi linage. The pattern of 20 strains [12%] did not matched to any other pattern in the SITVIT database and were named orphan KP

Conclusion: Molecular characterization of M.tuberculosis is very helpful in the early identification of MDR-TB. As CAS1-Delhi is the predominant type in this region, its association with drug resistance, treatment failure and patient demographic profiles should be investigated

Phytochemical screening and antimicrobial activities of red silk cotton tree [Bombax ceiba L.]

The present study was conducted to investigate the phytochemical screening and antimicrobial activities of stem bark of Bombax ceiba L. The methanol extract was subjected to qualitative phytochemical screening using standard procedures. The results indicated the presence of alkaloids, tannins, glycosides, reducing sugar, saponins, phlobatanins and terpenoids. The antimicrobial activity was measured by disc diffusion method. Data revealed that Pseudomonas aeruginosa was inhibited by both methanol and ethanol extracts at the concentration of 2mg disc-1 [21.8mm [68.12%] and 21.3mm [66.56%]]. Similarly, methanol extract reduced the growth of Bacillus subtilis by 17.1mm [74.34%] at the concentration of 1 mg disc-1. However, ethanol extract showed a good activity of 18mm [121.6%] and 20.6mm [112.5%] against Xanthomonas maltophilia at concentrations of 1 and 2 mg disc-1, respectively. Aqueous extract showed 16 mm [53.33% Z.I] against Escherichia coli at 2 mg disc-1. Klebsiella pneumoniae was found resistant to all of the three extracts, while the growth of Candida albicans was inhibited by methanol through 16.5 mm [58.92% Z.I] at 1 mg disc-1. The above study concluded the medicinal potential of B. ceiba

Effects of chromium on testes and protective role of mulberry

Background: The chromium supplements and medicines are used to reduce sugar and boost sexual performance without recommendations. This practice may cause hyperlipidemia and testicular anomalies which can be partially ameliorated by natural phytochemicals of Mulberry [Morus nigra] fruit extract [MFE]

Objective: To determine the protective effects of mulberry [Morus Nigra] against injury on testes caused by hexavalent chromium

Methodology: This experimental study was conducted at DHQ teaching Hospital Sargodha and experimental work was conducted in Sargodha University. Thirty male mice [Mus musculus] were equally grouped as: C; Control, Cr; 50ppm in water ad-libitum [10 days] followed withdrawal for 5days, Cr-M; as Cr group but followed by 0.25mL/12h MFE and sacrificed on 16[th] day. The laboratory work was completed in 3 months. The data was entered and analyzed by using SPSS version 17

Results: Cr[+6] exposure significantly [p < 0.05] reduced sugar but caused hyperlipidemia, atrophy, steatosis, cirrhosis and necrosis in testes. The accumulation of debris with tail-less sperms raise cross sectional area of seminiferous tubules [ST] to generate pressure potential to lyse some ST. There significant [P< 0.001] reduction of Spermatogonia, primary spermatocytes and dislodged parrot beak headed spermatozoa [PBH] /area specifies sperm deformities and infertility, while Mulberry ameliorates such anomalies

Conclusion: Cr contamination in water and food supplementation may produce histpatholgical changes in the testes while Mulberry has rehabilitation and metal chelating capability to recover anomalies

Prevalence of ACS and Causal Relation of Hypomagnesaemia.

Magnesium is an important intracellular cation [1], actually the second most abundant cation after Potassium, which has gained an essential role in normal human homeostasis. Low serum magnesium has been detected commonly in around 12% hospitalized patients and even more commonly in Intensive Care Patients as high as 60 to 65%. The link of low serum magnesium with acute coronary syndrome is being discussed widely and its actual role is being scrutinized [2,3]. Recently, Hypomagnesaemia has also been found to play an important role in the pathogenesis of a variety of clinical disorders including Hypertension, Diabetes Mellitus, Atherosclerosis and Acute Coronary Syndromes [4-8]. Acute coronary syndrome (ACS) has been defined as a group of conditions due to decreased blood flow in the coronary arteries. Acute coronary syndrome includes a vast spectrum like: ST elevation myocardial infarction (STEMI / 30%), non ST elevation myocardial infarction (NSTEMI / 25%), or unstable angina (U.A. / 38%).These are described according to ECGs and Cardiac Biomarkers of myocardial necrosis (troponin T, troponin I, and CK MB), in patients presenting with acute cardiac chest pain (Medscape). Aim: To look for any association between Hypomagnesaemia and Acute Coronary Syndrome. Materials and Methods: It’s a retrospective study involving 1198 patients who presented to the Accident and Emergency department (A & E), Trauma Center, Rashid Hospital, Dubai, with Acute Coronary Syndrome (ACS) between April 2010 and May 2013. We reviewed the records of all patients including their clinical history and presentation. The Magnesium levels of all the patients in the ACS pathway were checked along with, Cardiac biomarkers - Troponin, CPK and CK MB and Lipid profiles were also analyzed. A Chi-Square test was performed at 5% level of significance to test the null hypothesis of no association between cardiac markers, lipid profile and magnesium level. Inclusion Criteria: All new patients presenting to A & E Department at Rashid Hospital with an acute coronary syndrome (both NSTEMI & STEMI). All new patients presenting with non-specific chest pain who test positive for cardiac markers. All the age groups presenting to A & E Department at Rashid Hospital from 11/04/2010- 30/05/2013 were included. Both the genders were included. Exclusion Criteria: Patients diagnosed initially with acute coronary syndrome that eventually had negative cardiac markers. Results: Out of 1198, 1087(91%) patients were male. 49% were between 50 and 75 years of age group whereas 46% were between 25 years and 50 years of age. 77% patients were Asians and 17% belonged to Arabic peninsula. The Magnesium level was normal in 1097(92%), low in 63(5.3%). Troponin was negative in 431(36%) and positive in 767(64%) patients with low, medium and high levels in 338(28.2%), 426(35.5%) and 03(0.3%) respectively. These results indicate that there is no statistically significant association between Magnesium levels and Troponin groups (positive and negative) (chi-square with two degree of freedom = 3.30, p = 0.192). Conclusion: Our study proves that there is no significant association between Hypomagnesaemia and Acute Coronary Syndrome.

Emergency Room High Index of Suspicion in Apparently Innocent Wounds Can Encounter Missed Tendon Injuries.

Introduction: Limb injuries by sharp objects commonly result in tendon or neurovascular damage. The aim of this study is (1) to determine the incidence of significant neurological, musculotendinous or vascular injury; (2) to explore the cause of such wounds; (3) to determine the incidence of missed injuries; and (4) to assess the prognosis of neurological, vascular and musculotendinous injuries. Methods: Fifty eight adult patients were evaluated in the Emergency Department of our institution for incised wounds sustained to upper and lower extremities. Major trauma with obvious musculotendinous, vascular and neurological injuries was excluded. An injury was characterized as being missed if a patient had received inappropriate treatment or had returned due to persistent symptoms despite being examined, treated and discharged. Only wounds of less than 24 hours duration were included. Non-accidental injuries were excluded. Results: Fifty one (89%) patients sustained upper extremity wounds while only seven (11%) sustained injuries to the lower limb. Neurovascular and tendon injuries occurred exclusively in the upper limb. Twenty one (36%) patients sustained tendon, nerve and/or vascular injuries (41.2%). Glass injury was found to be the most common cause (41.3%) followed by Knife injuries (15.5%). Fifteen patients were offered an admission to hospital by the Trauma service for definitive treatment. Four of these patients signed DAMA (Discharge against Medical Advice). Six patients did not warrant admission and were discharged from the Emergency Department following appropriate treatment. Thirty seven patients were treated by Emergency Physicians and subsequently discharged. A missed tendon injury was reported in one patient (1.7%). Conclusion: A thorough clinical examination and accurate injury documentation in the Emergency Department is fundamental in recognizing tendon injuries.

Assessment of OPD patient's satisfaction with health care services at Al-Nafees medical hospital

Objective: To determine socio-demographic profile among the OPD patients and the overall satisfaction level of the patients utilizing the OPD

Study Design: A descriptive cross sectional study

Place and Duration: Conducted in OPD of Al-Nafees Hospital Islamabad from 12th January -12th March 2015

Methodology: Through convenient sampling a closed ended structured questionnaire was employed to collect the quantitative data. OPD patients aged 18-64 who showed willingness to participate were included in the study. Indoor patients, patients below 18 and above 64 and those who were not willing were excluded

Results: The study was conducted on 209 patients. Overall satisfaction level of patients with the OPD health services was 86.2%. Satisfaction level was found to be more in females than males. 42.6% had a family income of >15000 Rupees but satisfaction level with OPD services was same among respondents falling in different categories of family income. Patients with primary level of education were more satisfied. 41.1% waited 15-30 minutes for the examination by the doctor. 89% of the patients were satisfied from the registration staff. 73.3% were satisfied with doctor's service. The satisfaction level from the nurses was 64.6%. 63.3% were satisfied from the services provided by the pharmacy. 63.2% said that the medical expenses were affordable. 88% of the patients agreed upon the cleanliness of the building of the hospital and 77% stated that that signs and boards were easy to follow

Conclusion: In the current study it was found that majority of respondents were highly satisfied with the OPD services offered at Al-Nafees Hospital. Patients were satisfied with the behavior of registration staff, Physicians' communication skills, waiting time for examination, nursing care, pharmacy services and logistic arrangements

histopathological pattern of ovarian teratomas at a tertiary care centre

To determine the frequency and types of various ovarian teratomas amongst various age groups, and 2] To compare the results with other workers. Study Design: Retrospective study. The study was conducted at the Department of Pathology, Basic Medical Sciences Institute[BMSI], Jinnah Post graduate medical centre [JPMC], Karachi from 1[st] January 2001 to 31[st] December 2005. 1128 cases of ovarian biopsies were received for histopathological examination at the Department of Pathology, Basic Medical Science Institute, JPMC,Karachi.Out of 365 cases of ovarian neoplasms teratomas were separated, analyzed and classified according to the WHO classification system 1994 and their relative frequencies were recorded. Teratomas account for 14.52% [53/365] of all ovarian neoplasms. Mature cystic teratomas were the most common i.e 86.80% [46/53].Immature teratomas were 9.43% [05/53] followed by special subtypes 3.77% [02/53]. Mature cystic teratomas are the most common germ cell neoplasms of ovary. Immature teratomas are rare above 30 years of age

Post operative analgesia following open cholecystectomy; is intermittent epidural bupivacain bolus administration more effective than continuous administration?

Pain following surgery is a universal phenomenon; it is often underestimated and undertreated. Epidural analgesia is considered to be the best method of pain relief after subcostal cholecystectomy. Epidural is effective technique that offers comparable analgesia and better side effect profile. Quasi Experimental study. Jan2010 to June 2010. Military Hospital Rawalpindi. This is a prospective, randomized control trial. The main objective of this study was to compare the number of rescue doses for postperative pain relief, after subcostal cholecystectomy under epidural anesthesia, in patients receiving continuous epidural infusion of bupivacain 0.125% with those receiving intermittent boluses. Thoracic epidural catheter was placed for post operative pain relief. Patients were divided into two equal groups. Patient receiving continuous epidural anaesthesia were placed in group A and those receiving intermittent doses were included in group B. Purposive [non probability] sampling. Patient who received intermittent boluses [group B] required less rescue doses of nalbuphine as compared to the patients who received continuous infusion of 0.125 bupivacain. Intermittent boluses of 0.125% bupivacain are considered a better method of postoperative pain relief than continuous infusion of 0.125% bupivacain

Frequency of endoscopic gastric neoplasms in five years at JPMC

Gastric cancer is among the most common malignancies in Pakistan. The aim of our study are i] to document different histological types of gastric malignancies as per age and sex ii] discuss its possible association in patients who underwent endoscopy and iii] compare our data with local and abroad studies. Retrospective study. This study was conducted in the Department of Pathology, Basic Medical Science Institute, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from 1[st] January 2003 to 31 December 2007. A total of 740 cases of gastric endoscopic biopsies were received for histopathological evaluation at the Department of Pathology, Basic Medical Science Institute, JPMC, Karachi. Out of these cases, a total of 70 gastric neoplasms were separated, analyzed and classified according to the WHO classification system and their relative frequencies were recorded. Gastric adenocarcinoma was the commonest neoplasm with male predominance in 5th to 7[th] decade of life, account for 88.57% [62/70] of all gastric neoplasms. Gastric lymphoma was the second common with 8.57%[06/70] and gastric carcinoid was least common with 1.43%[1/70] of all gastric neoplasms. This study highlights that adenocarcinoma is the most common gastric malignancy seen in most high risk group includes elderly males followed by lymphoma with no gender difference. So we advise regular endoscopic biopsies surveillance at least in high risk age group for the early detection of cancer

Optical urethrotomy in strictures following fracture pelvis

Management of posterior urethral injuries with pelvic fracture remains a major controversy and has always been a challenge to urologists. Objective of this study was to see the outcome of optical internal urethrotomy in treatment of urethral strictures following fracture pelvis. This prospective study was conducted at the Urology Department, Lady Reading Hospital, Peshawar from January 2007 to July 2008. A total of 45 male patients [20-60 years of age] and having urethral strictures following fracture pelvis were treated with internal optical urethrotomy. Follow-up ranged from 3 months to 1 year. Fracture pelvis resulting from the road traffic accident, was the cause of urethral stricture. The good and fair results of internal optical urethrotomy were 68.56% patients who were treated with single internal optical urethrotomy. Internal optical urethrotomy was repeated in 22.86% of patients. Clean intermittent self urethral dilatation was applied as adjuvant treatment to prevent recurrence of stricture for variable period ranging from 1 to 3 months. Internal optical urethrotomy is safe and effective procedure for short yet inaccessible strictures from the perineum

Effects of summer and winter on blood picture among young adults

To find out the effects of summer and winter seasons. The blood pictures of 252 healthy students were studied in the last week of June, 2006 and the last week of January, 2007. Total leucocyte, absolute neutrophil, absolute lymphocyte and red blood cell counts and hamemoglobin concentration were highly significantly [P < 0.001] higher in the summer than in the winter. Packed cell volume was also significantly [P < 0.01] higher in the summer. Mean corpuscular volume [MCV] mean corpuscular haemoglobin [MCH], mean corpuscular haemoglobin concentration [MCHC] and platelet count showed a non-significant [P > 0.05] difference between the two seasons. It is concluded that there are significant seasonal variations in the blood picture of healthy young adults

Experience with splenic trauma in Ayub Teaching Hospital, Abbottabad

This study was carried out to estimate the prevalence, severity and mode of splenic trauma and management technique from amongst the abdominal trauma cases admitted in Ayub Teaching Hospital The study was carried out at Surgery units of Ayub Teaching Hospital, Abbottabad, the only referral hospital for major trauma cases, from July 2001 to Dec. 2002. One hundred consecutive abdominal trauma patients admitted to all surgical units which were followed up through complete documentation were included in the study. Their injuries were classified, treatment strategies outlined and complications were documented. Out of the 100 patients presenting in emergency, 25% presented with blunt and 75% with penetrating trauma. 97 patients underwent laparotomy and 03 treated conservatively. Mean age was 27.26 [range 19-49] years. Out of these cases 19 patients had splenic injury, 6 [31.57%] with Type-I and II while 13 [68.42%] with Type-III and IV. 11[57.89%] of the splenic injuries were due to blunt abdominal trauma and 8 [42.10%] due to penetrating abdominal injuries. 14 [83.6%] of the patients with splenic injury underwent splenectomy and 5[26.3%] splenorrhaphy. The commonest cause of splenic injury was blunt abdominal trauma; Assessment of the severity of splenic injuries at the time of laparotomy resulted in splenic salvage procedures in some cases. Splenorraphy was associated with fewer complications

Cancelled elective general surgical operations in Ayub teaching hospital

Cancellation of operations in hospitals is a significant problem with far reaching consequences. This study was planned to evaluate reasons for cancellation of elective surgical operation on the day of surgery in Ayub Teaching Hospital, Abbottabad. From July 2006 to June 2007 the medical records of all the patients who had their operations cancelled on the day of surgery in all the three General Surgical units of Ayub Teaching Hospital, Abbottabad were audited prospectively. The number of operation cancelled and reasons for cancellations were documented. 3756 patients were scheduled for surgery during the study period. 2820[75%] patients were operated upon. 936 [25%] operations were cancelled out of which 338[36%] were cancelled due to shortage of time, 296[31.6%] were cancelled due to medical reasons, 152[16.2%] were cancelled due to shortage of beds while 55[5.8%] were cancelled due to shortage of anaesthetists. Three operation lists were lost completely. The Anaesthetist cancelled 43%, Surgeon 39% while 18% of operations were cancelled due organizational reasons. Cancellation of patients on operation lists occupy a substantial population [25%] of cases. Majority of cancellation were due to reasons other than patients medical conditions. Better management could have avoided most of these cancellations

Dermatophytes causing tinea cruris in our population

To find out etiology and species identification of dermatophytes causing tinea cruris. Prospective study.This study was conducted in the Department of Microbiology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi from September 2000 to August, 2001. Ninety-five patients having skin infections [clinically suspected cases of tinea cruris] were examined. The skin scraping were taken from active border of the lesions and subjected to direct microscopy and culture on mycobiotic agar [Difco] for isolation of dermatophytes. Various special media were used for species identification. Tinea cruris was predominantly seen in adult [85.2%] than in adolescent [9.5%] and children [5.3%]. Out of 95 cases studied 83 [87.4%] were males and 12 [12.6%] were females. Tinea cruris was significantly found more in males [87.4%] than females [12.6%] [P < 0.001]. Regarding various species of dermatophytes, 38 [67.9%] cases were caused by Trichophyton rubrum, 14 [25%] by Epidermophyton floccosum and Trichophyton mentagrophytes 02 [3.5%]. Trichophyton violaceum and Trichophyton tonsurans accounted for the remaining 01 [1.8%] case respectively. Tinea cruris is a common problem of our population affecting predominantly male population. Different species like Trichophyton rubrum, Epidermophyton floccosum, Trichophyton mentagrophytes and Trichophyton violaceum and Trichophyton tonsurans is most commonly isolated from study group. It is proposed that a large sample size study with antifungal drugs sensitivity should be designed to get a more clear picture of dermatophytes involved in Tinea cruris

Is vancomycin the only choice for methicillin resistant staphylococcus aureus? results from a multi-centered study on antibiotic sensitivity pattern of staphylococcus aureus isolated from nosocomial infections

To observe the pattern of antibiotic resistance in methicillin sensitive and methicillin resistant staphylococcus aureus. Materials and Two hundred Staphylococcus aureus isolates from patients with hospital- acquired infections were collected. Methicillin resistance was determined by disc [oxacillin 1 micro g] diffusion method. Sensitivity to other antimicrobial agents was determined by Kirby Baurer disc diffusion method. The methicillin resistant Staphylococcus aureus isolates were found sensitive to vancomycin [100%], fusidic acid [88.5%], chloramphenicol [80.8%] and fosfomycin [61.5%]. All the isolates were highly resistant to other classes of antimicrobial agents. Methicillin resistant Staphylococcus aureus shows multi-drug resistance and infections caused by these isolates are difficult to treat. However our results show that beside vancomycin; fusidic acid, chloramphenicol and fosfomycin are good choices and should be tried for the isolates showing sensitivity to these agents

Etiology of tinea corporis in Karachi

To find out the demographic distribution and species of dermatophytes causing tinea corporis in Karachi, Pakistan. Design: Prospective study. Place And Duration: This study was conducted in the Department of Microbiology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi from September 2000 to August, 2001. Subjects and Ninety-nine patients having skin infections [clinically suspected cases of tinea corporis] were examined. The skin scraping were taken from active border of the lesions and subjected to direct microscopy and culture on mycobiotic agar [Difco] for isolation of dermatophytes. Various special media were used for species identification. Tinea corporis was generally predominantly seen in adult [74.8%] than in adolescent [14%] and children [11.1%]. Out of 99 cases 53 [53.5%] were males and 46 [46.5%] were females. Tinea corporis was relatively more common in males. 48 strains were recovered out of these 29 [60.4%] strains of Trichophyton rubrum, 09 [18.7%] strains of Epidermophyton [floccosum], 08 strains of Trichophyton violaecum and two strains of Trichophyton mentagrophytes. Tinea corporis was relatively more common in males. Trichophyton rubrum was the most frequently isolated dermatophytes. Species identification is necessary to prevent spread of infection and choice of appropriate antifungal agent

Histopathological pattern of refractory dyspeptic gastro-oesophageal lesions

Forty cases of refractory dyspepsia were evaluated for histology after endoscopic biopsy. The most common lesion was gastritis [acute and atrophic types] followed by gastric ulcer, duodenitis and esophagitis