Cost and clinical effectiveness of aggressive surgical debridement and delayed primary closure of infected cardiac surgical wounds.

OBJECTIVE: Postoperative wound infection in cardiac surgery remains a subject of significant concern due to associated morbidity, prolonged hospital stay and rise in treatment cost. A conservative management approach to postoperative wound infection with topical dressings and healing by secondary intention is not cost-effective and cosmetic results are less acceptable. We developed our institutional protocol for the treatment of infected postoperative cardiac surgical wounds to reduce hospital stay and improve cosmetic outcome. This study aims to compare our institutional protocol with the conservative management approach. METHODS: Adult patients with postoperative superficial or deep sternal and/or leg wound infection were divided into two equal-sized groups and data collected from medical records. Group A was treated according to our institutional protocol of aggressive surgical debridement and delayed primary closure. Group B was treated according to conservative management with topical antiseptic wound dressings and healing by secondary intention. Data were analysed in retrospect with comparative statistics. RESULTS: A total of 30 patients took part in the study. Group A (n=15, seven male, eight female) had a mean age of 55.34±12.84 years. Group B (n=15, eight male, seven female) had a mean age of 56.46±10.21 years. Mean length of hospital stay in Group A and Group B was 5.13±2.06 and 36.67±22.28 days, respectively (p<0.0001). Calculated mean hospital costs were 16,271.61±6815.50 Saudi Riyals (approximately equivalent to $4330±700 USD) in Group A and 116,212.2±26,311 Saudi Riyals (approximately equivalent to $30,932±1813 USD) in Group B (p<0.05). Patients in Group A had linear scars comparable with primary postoperative wound scars, whereas patients in Group B had excessive non-linear scarring. CONCLUSION: In this study, cost and clinical effectiveness of aggressive surgical debridement and delayed primary closure was superior to conservative management with topical antiseptic wound dressings and healing by secondary intention in terms of a shorter hospital stay and better cosmetic outcome.

The effect of 8 weeks of combined interval (resistance-interval training) and combined endurance (endurance-resistance training) on plasma levels of adropin and nitric oxide in males with high blood pressure.

INTRODUCTION: Nitric oxide (NO) is a vasodilator that plays an important role in blood pressure control. The purpose of the present study was to compare the effect of 8 weeks of resistance-interval and endurance-resistance trainings on plasma levels of adropin and NO in males with hypertension. METHOD: Forty-five patients with hypertension were recruited and divided into 3 groups of control (age = 51.1 ± 6.4 years, body mass = 80.4 ± 9.2 kg), resistance-interval training (age = 50.7 ± 5.5 years, body mass = 78.1 ± 11 kg), and endurance-resistance training (age = 52.8 ± 6.1 years, body mass = 79.6 ± 9.2 kg). The resistance training program was performed in 2 sets, 10 to 15 repetitions, with 50% intensity of one repetition maximum. Increasing endurance training was performed for 30-40 min at 60-70% of maximum heart rate (HRmax) on the bike. The high-intensity interval training program consisted of 4 intervals of 80 to 90% of HRmax and 3-min recovery periods of 60 to 70% of HRmax. Blood samples were collected 1 week before the start of the training program and 48 h after the last training session. Plasma levels of adropin and nitrite/nitrate were measured by ELISA before and after the exercise interventions. RESULTS: Eight weeks of resistance-interval and endurance-resistance trainings increased plasma levels of adropin and NO and decreased blood pressure (P ≤ 0.05). Furthermore, plasma levels of adropin increased in both exercise groups, whereas NO levels increased only in the endurance-resistance training. Systolic blood pressure decreased in the resistance-interval training (P ≤ 0.05) while it remained unchanged in the endurance-resistance group. CONCLUSION: Resistance-interval and endurance-resistance trainings are effective in decreasing blood pressure by increasing cardiorespiratory capacity and plasma levels of adropin and NO.

Evaluation of MicroRNA-99a and MicroRNA-205 Expression Levels in Bladder Cancer.

Bladder cancer is the second most common cancer in the genitourinary tract, showing often recurrence and progress into invasive states. Epigenetic changes, such as microRNA alteration are involved in bladder cancer tumorigenesis through a variety of signaling pathways. The epigenetic state depends on geographic and lifestyle conditions. The aim of this study was to investigate the expression level of microRNA-99a and microRNA-205 in bladder cancer in Iranian populations and to determine the relationship between their expressions with clinicophatological features. 36 patients with bladder cancer were included in the study. The control group was the healthy adjacent tissue of the same patients. Total RNA was extracted from approximately 50 mg tissue using TRIzol reagent. cDNA was synthesized and Real-Time PCR was carried out using specific primers. The Unisp6 rRNA was used as a reference gene. A significant decrease was found in the expression level of miR-99a in tumor samples, compared to healthy adjacent tissues (P<0.001). The increased expression level of miR-99a was significantly associated with muscle invasion (P=0.02). The receiver operating characteristic (ROC) analysis for miR-99a showed AUC value equal to 0.944, with specificity of 97%, sensitivity of 91%, and cut off value of 8.31 (P<0.001). A significant association was found between smoking and miR-99a (P=0.04) and miR-205 (P= 0.01) expression levels. Dramatic down-regulation of miR-99a in bladder cancer tissues confirmed the tumor suppressor role of miR-99a in bladder cancer. A higher amount of miR-99a expression was associated with invasive bladder cancer. According to ROC analysis, miR-99a could be considered as a valuable diagnostic biomarker.

Environment effects for earliness and grain yield traits in F1 diallel populations of maize (Zea mays L.).

BACKGROUND: Five maize inbred lines, 20 F1 diallel hybrids and two check genotypes were evaluated through genotype × environment interaction (GEI) and GGE biplot for earliness and yield traits at four locations. RESULTS: Genotype, environment and GEI showed highly significant differences for all the traits. In total sum of squares, environment and genotype played a primary role, followed by GEI. Larger effects of environment and genotype to total variation influence the earliness and yield traits. However, according to the GGE biplot, the first two principal components (PC1 and PC2) explained 95% of the variation caused by GEI. GGE biplot confirmed the differential response of genotypes across environments. F1 hybrid SWAJK-1 × FRHW-3 had better stability, with a good yield, and was considered an ideal genotype. F1 hybrid FRHW-2 × FRHW-1 showed more earliness at CCRI and Haripur, followed by PSEV3 × FRHW-2 and its reciprocal at Swat and Mansehra, respectively. F1 hybrids FRHW-1 × SWAJK-1, PSEV3 × SWAJK-1 and SWAJK-1 × FRHW-3 at Mansehra and Swat produced maximum grain yield, followed by SWAJK-1 × FRHW-1 and PSEV3 × FRHW-1 at Haripur and CCRI, respectively. CONCLUSION: Overall, maize genotypes showed early maturity in plain areas (CCRI and Haripur) but higher yield in hilly areas (Mansehra and Swat). © 2017 Society of Chemical Industry.

Ascitic Fluid Culture in Cirrhotic Patients with Spontaneous Bacterial Peritonitis.

OBJECTIVE: To determine the frequency and compare the culture yield of bacterial isolation by conventional and blood culture BACTEC bottle techniques in cirrhotic patients with spontaneous bacterial peritonitis (SBP). STUDY DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: Pathology Department, Bannu Medical College, Bannu, KPK, from January 2012 to December 2013. METHODOLOGY: Paracentesis of 20 ml of ascitic fluid tapped from cirrhotic patients with SBPwas carried out by a single technologist. The analysis included differential leukocyte count (DLC), while 5 ml each of the fluid was inoculated into conventional culture media and BACTEC blood culture bottle. All the data were analysed on (SPSS) version 16 to determine frequencies with percentages and mean values with standard deviation. Chi-square test was used for comparing the yield of conventional and blood culture bottle methods. P-value was considered significant if < 0.05. RESULTS: In 105 cases of ascitic fluid analyses, 27 (25.72%) had positive ascitic fluid culture whereas 78 (74.28%) had negative ascitic fluid culture. Ascitic fluid culture was positive in 6 cases by conventional culture media and in 27 cases by BACTEC culture bottle media (p < 0.001). Bacterial isolation was obtained by both culture methods in 6 cases (p < 0.001). CONCLUSION: Direct bedside inoculation of ascitic fluid by BACTEC culture bottle method has better yield as compared to conventional culture method.

Histopathological Pattern Of Soft Tissues Tumors And Tumour Like Lesions In The Pathology Department Of Lady Reading Hospital Peshawar, Pakistan.

BACKGROUND: Soft tissues tumours are tumours of mesenchymal origin excluding epithelial, skeletal tissue, reticuloendothelial system, brain coverings and solid viscera of the body. The objective of this study was to know the histopathological pattern of soft tissues tumours in the Pathology Department of Lady Reading Hospital Peshawar Khyber Pakhtunkhwa Pakistan. METHODS: This descriptive study was conducted on retrospective data from January 2009 to December 2013. All the soft tissues biopsy specimens were received in 10% formalin, labelled, gross performed, sections processed in alcohol, xylene, wax, block prepared, frozen, microtome sections taken and processed for H&E staining, mounted and reported by a Histopathologist. The inclusion criteria were any sufficient soft tissue tumour biopsy specimen of any age, sex, location in body whereas the exclusion criteria were autolysed biopsy specimen. A minimum of four and maximum of eight sections and 5 micron thick were taken from each specimen. RESULTS: A total of 267 soft tissues tumours biopsy specimens were received in the pathology laboratory with age range of 1-75 years, with mean age of 30.68±17.71 years. Male to female ratio was 1.13:1. Amongst the total, benign tumours were 176 (65.91%). Haemangioma, 73 (27.3%) was the commonest tumours followed by lipomas 41 (15.4%) cases. Amongst the total malignant tumours, i.e., 91 (34.08%), rhabdomyosarcoma, 35 (13.1%) was the commonest tumour followed by angiosarcoma 14 (5.2%) cases. CONCLUSIONS: Haemangioma is the commonest benign tumour and rhabdomyosarcoma is the commonest malignant tumour in this study.

An alternative approach to explantation and exchange of the HeartWare left ventricular assist device.

OBJECTIVES: Left ventricular assist device (LVAD) explantation and exchange is a relatively infrequent but potentially complex procedure. Patients requiring such procedures have multisystem suboptimal physiological reserve due to end-stage heart failure and are prone to complications. Less-invasive procedures are believed to facilitate postoperative recovery and early mobilization. We describe an alternative approach to explantation and exchange of the HeartWare LVAD through left thoracotomy. METHODS: Six patients (M = 4, F = 2, mean age = 49.16 years) underwent device explant/exchange or initial implant (explant = 2, exchange = 3, initial implant = 1) through left thoracotomy utilizing cardiopulmonary bypass and induced ventricular fibrillation (VF). The mean bypass time and mean VF arrest time were 82 and 3 min, respectively. A new outflow graft was anastomosed to the previous outflow graft in 3 cases of device exchange and to the descending aorta in 1 case of initial implant. RESULTS: One patient died in the intensive care unit due to unrelated causes (gram-negative sepsis) after device exchange. All others were discharged alive and currently remain on follow-up. The mean length of hospital stay was 40.66 days. CONCLUSIONS: On-pump approach through single thoracotomy incision is safe and equally suitable for device explant, exchange and initial implant. However, structural heart defects requiring surgical correction and the requirement of simultaneous right ventricular assist device are the limitations of this approach.

Extracorporeal membrane oxygenation in adults: experience from the Middle East.

BACKGROUND: The literature reports conflicting results for survival after extracorporeal membrane oxygenator support, and survival differs in pediatric and adult patients. We present our institutional experience of adult extracorporeal membrane oxygenator support. METHODS: From January 2007 to December 2009, 19 adult patients required extracorporeal membrane oxygenator support after cardiac surgery or catheter interventions. It was provided on an emergency basis to 11 patients, urgently to 5, and electively to 3. Indications included post-cardiotomy cardiogenic shock, post-cardiotomy acute respiratory failure, emergency cardiac resuscitation, and post-percutaneous coronary intervention cardiogenic shock. The mean duration of support was 4 days (range, 1-11 days). RESULTS: Seven (36.84%) patients could be weaned off extracorporeal membrane oxygenator support; one (14.28%) of them survived to hospital discharge and the other 6 (85.71%) died in hospital. Twelve (63.15%) patients could not be weaned off and died while still on extracorporeal membrane oxygenator support. Overall 30-day hospital mortality was 94.73%, and survival to discharge was 5.26%. CONCLUSION: Our institutional experience of extracorporeal membrane oxygenator support for cardiac indications in adult patients indicates poor survival. It significantly increased costs by delaying imminent death and prolonging stay in the intensive care unit.

Seminal volume in the investigation of male infertility.

OBJECTIVE: To determine the seminal volume among infertile males and the frequency distribution of hypospermic and hyperspermic patients in infertile males. STUDY DESIGN: Cross-sectional observational study. PLACE AND DURATION OF STUDY: Department of Reproductive Physiology/Health, Public Health Laboratories Division, National Institute of Health, Islamabad, from 2002 to 2009. METHODOLOGY: Semen examinations of infertile male were carried out according to the standardized method of the World Health Organization. Seminal volume of 2-6 ml were considered normal, while volumes less than 2 ml and higher than 6 ml were considered hypospermic and hyperspermic respectively. RESULTS: Out of 1521 patients, 355 were hypospermic (23.34%), 1046 were normospermic (68.78%) while 120 were hyperspermic (7.88%). In the hypospermic cases, 57 out of 355 (16.05%) had a volume of less than 1 ml. Of those 57 patients, 34 were found to be azoospermic, 12 were asthenozoospermic, one each were terato- and polyzoospermic, while 6 had normal counts. Among the hyperspermic patients (n=120), 3 were azoospermic, 24 were oligozoospermic and 19 cases (15.84%) had count within the normal range, while 1 patient was polyzoospermic. Significant differences (p < 0.05) were observed among azoospermic, oligoasthenozoospermic and teratozoospermic groups when comparing hypo and hyperspermic patients. CONCLUSION: Seminal volume is an important parameter for assessment of infertility investigation and its abnormalities constitute a valuable index of problems with the male partner, even if the count and motility are well within the acceptable limits.

In vitro and in vivo aggregation of a fragment of huntingtin protein directly causes free radical production.

Neurodegenerative diseases are characterized by intra- and/or extracellular protein aggregation and oxidative stress. Intense attention has been paid to whether protein aggregation itself contributes to abnormal production of free radicals and ensuing cellular oxidative damage. Although this question has been investigated in the context of extracellular protein aggregation, it remains unclear whether protein aggregation inside cells alters the redox homeostasis. To address this, we have used in vitro and in vivo (cellular) models of Huntington disease, one of nine polyglutamine (poly(Q)) disorders, and examined the causal relationship among intracellular protein aggregation, reactive oxygen species (ROS) production, and toxicity. Live imaging of cells expressing a fragment of huntingtin (httExon1) with a poly(Q) expansion shows increased ROS production preceding cell death. ROS production is poly(Q) length-dependent and not due to the httExon 1 flanking sequence. Aggregation inhibition by the MW7 intrabody and Pgl-135 treatment abolishes ROS production, showing that increased ROS is caused by poly(Q) aggregation itself. To examine this hypothesis further, we determined whether aggregation of poly(Q) peptides in vitro generated free radicals. Monitoring poly(Q) protein aggregation using atomic force microscopy and hydrogen peroxide (H(2)O(2)) production over time in parallel we show that oligomerization of httEx1Q53 results in early generation of H(2)O(2). Inhibition of poly(Q) oligomerization by the single chain antibody MW7 abrogates H(2)O(2) formation. These results demonstrate that intracellular protein aggregation directly causes free radical production, and targeting potentially toxic poly(Q) oligomers may constitute a therapeutic target to counteract oxidative stress in poly(Q) diseases.

Assessment of the level of trace element zinc in seminal plasma of males and evaluation of its role in male infertility.

BACKGROUND: Male infertility is a serious problem all over the world. Nutritional deficiency of trace element Zinc (Zn) may play a role in male infertility as Zn plays an important role not only in normal testicular development, but also in spermatogenesis and sperm motility. Deficiency of Zn is associated with hypogonadism and insufficient development of secondary sex characteristics. OBJECTIVE: The present study was designed to analyze the level of seminal Zn among different groups of infertile patients and to correlate it with sperm concentration, active, sluggish and immotile fractions of seminal parameters, with an objective to establish the role of Zn in male infertility. SETTING AND DESIGN: The present study was carried out in five- years period from 2004 to 2009. It was a descriptive analytical study with non probability sampling. MATERIALS AND METHODS: Semen examination of the patients was carried out according to the standardized method of the World Health Organization. Semen Zn was estimated by color 5 Br. PAPS method. STATISTICAL ANALYSIS: All statistical analyses were performed by using SPSS (Version 14.0 for windows) software, by applying student's t-test. RESULTS: The result showed that seminal Zn was 702.92±10.60, 598.48±12.95, 617.54±9.55, 542.29±22.75, 710.36±7.87, 712.06±7.96, 789.36±21.33, and 762.06±8.99 mg/dl in azoospermic, oligozoospermic, asthenozoospermic, oligoasthenozoospermic, teratozoospermic, normozoospermic, polyzoospermic, and proven fathers group, respectively. CONCLUSIONS: Decreased concentration of seminal Zn do affect the sperm count, while increased level of seminal plasma Zn causes decreased sperm motility; so, it is suggested that administration of Zn should be very carefully monitored in such patients having low sperm count but normal sperm motility, as adequate seminal Zn is required for normal sperm function.

Pattern of carcinoma of oral cavity reporting at dental department of Ayub medical college.

BACKGROUND: Carcinoma of oral cavity is amongst the first ten commonest malignancies in Pakistan. Districts of Hazara (NWFP) and Northern Areas of Pakistan are among the high risk. areas. Here we present a report of oral cancers received in this center over a period of 10 years. METHODDS: This clinicopathological study consists of cases of carcinoma of oral cavity presenting to dentistry department of Ayub Medical College Abbottabad during 1993-2003. All cases were clinically examined and provisionally diagnosed. Biopsy was taken from all the lesions and the tissues submitted to histopathology department of Ayub Medical College. RESULTS: There were 50 carcinoma cases in the study, including 30 (60%) males and 20 (40%) females. Among these, 47 (94%,) were diagnosed as squamous cell carcinomas, that consisted 30 (63.82 %) males and 17 (36.17%) females. The other 6 % lesions were histologically diagnosed as malignant melanoma, adenocarcinoma and acinar cell carcinoma. The age of squamous cell carcinoma cases was 41-71 years. The maximum number of squamous cell carcinomas (34%) effected buccal mucosa. The other common sites were lip (26%), tongue (21%) and gums (19%). CONCLUSION: The results of this study are comparable with other such studies done in Pakistan and else where in the world showing commonality of factors associated with the development of the disease in this region of the country, which necessitates a detailed prospective study.