Glycemic control and antioxidant potential of distinct fractions of camelus dromedaries fresh milk in streptozocin induced diabetic rats.

To analyze the antiglycemic effects and to evaluate the anti-oxidant levels in pre and post-camel milk fractions treated albino diabetic rats, sixty male Swiss albino rats weighing 30-40gm aged 2 to 3 months were randomly divided into six groups, A, B, C, D, E & F, each comprised of 10 animals. as Group A: Normal control, Group B: Streptozocin induced Diabetic group while Groups C, D, E & F were diabetic groups treated with various fractions of camel milk. Noteworthy alteration in blood glucose and antioxidant activity was observed between disease control (group B) and all the treated groups with a percentage decrease of about 25%, 12.98%, 11.57% and 10.17% in blood sugar in groups C, D, E and F respectively. Changes in total antioxidant capacity were significant with the rise of 92.30%, 30.76%, 46.15% and 38.46% respectively in groups C, D, E and F. Percentage difference in superoxide dismutase between group B and Group C of 85% was highest as compared to 45.90 %, 52.45% and 39.34% for groups D, E and F. Group C also showed a significantly higher increase in serum copper, zinc and Vitamin C. It is inferred that Camel milk has significant antiglycemic and antioxidant potential and may prove good complementary therapeutics for diabetes.

Shock Index As A Predictor Of Hyperlactatemia For Early Detection Of Severe Sepsis In Patients Presenting To The Emergency Department Of A Low To Middle Income Country.

BACKGROUND: Early detection of sepsis in the emergency department is of prime importance and requires tools that are time and cost-effective. The Systemic Inflammatory Response Syndrome (SIRS) has been poorly associated with sepsis. Timothy et al in a retrospective analysis of Emergency Department (ED) visit stated estimate of SIRS at 17.8% accounting to an annual yield of 16.6 million adult visits with SIRS per year, among these only 26% accounted as an infectious aetiology of SIRS, trauma being 10% and other causes being rare. Shock index is found to be independently associated with 30-day mortality in a broad population of ED patients including sepsis. With limited health resources in a low to middle income country, focused utilization is important and so is the need for markers that are non-invasive, readily available, cost effective, and easy to interpret. Shock index can serve this purpose as a surrogate marker of disease severity in patients with severe sepsis and thus resulting in early detection of such patients. METHODS: This cross-sectional study was conducted from December 2014 to May 2015 at a tertiary care setup (Aga Khan University Hospital) in Karachi consisting of all septic patients received at the emergency department. Non-probability sampling technique was used. p-value <0.05 was taken as significant. RESULTS: Out of 180 study participants 94 (52.22%) were males while 86 (47.78%) were females. The mean age was 57.48±18.8 years. Cohen's κ was used to determine an agreement between the Shock index and Lactate levels. Shock index with cut off value of > 0.7 was used and moderate to the strong agreement between the two was found with kappa κ = 0.786 which was statistically significant (p=<0.001). Sensitivity was found to be 0.99, specificity 0.75, NPV 0.98, PPV 0.87. CONCLUSIONS: To conclude the shock index has some very favourable features, including availability, low cost, and direct relevance to sepsis in terms of its high validity. A high SI predicts elevated lactate levels in patients with sepsis.

Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan.

OBJECTIVE: Our study aimed at identifying the characteristics and etiology of various causes of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care hospital. METHODS: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever. RESULTS: A total of one hundred and fifty five patients were included. Out of these 97 (62.6%) were males and 58 (37.4%) were females. Most patients (25.2%, n= 39) were diagnosed as malaria followed closely by dengue fever (n=33, 21.3%) and then enteric fever (n= 10, 6.5%). while 41.9% (n=65) were diagnosed as suspected viral fever based on clinical judgment and inconclusive laboratory results. CONCLUSION: Malaria was found to be the most common confirmed cause of acute undifferentiated fever followed by dengue and enteric fever. The provision of accurate epidemiological data will enable resources to be directed towards key areas and will be of practical importance to clinicians.

Frequency of Vitamin D deficiency and its association with serum PTH levels in end stage renal disease patients.

OBJECTIVE: To assess the frequency of Vitamin D Deficiency and its association with serum Parathormone (PTH) levels in End stage renal disease patients in a tertiary setup. METHODS: This cross sectional study was conducted in the Department of Nephrology, Liaquat National Hospital from January to December 2016 and comprised patients with End stage renal disease on maintenance haemodialysis. Sample size of 113 at 8% prevalence was calculated inflated to 150. Participants were selected through purposive sampling technique. Numerical variables were expressed as mean ± SD (standard deviation) while categorical variables were expressed as frequency and percentages. To determine association between Vitamin D and serum Parathormone (PTH) levels chi-square test was applied. Association of serum alkaline phosphatase levels with both Vitamin D levels and PTH levels was analyzed using chi-square test. SPSS 20 was used for data analysis. P-value <0.05 was taken as significant. RESULTS: Of the 150 participants, 33 were drop outs, 63(53.8%) were males and 54(46.2%) were females. The overall mean age was 52.47±15.21 years. Of all, hypertension as a comorbidity was present in 64(54.7%), Diabetes mellitus was present in 8(6.8%) and cardiovascular disease in 7(6%). Among the biochemical markers, mean serum vitamin D levels were 18.6±13.6ng/ml, mean Serum PTH levels were 253.8±227.2pg/ml, mean serum alkaline phosphatase levels were 143.7±125.4µg/L, mean serum phosphorus levels were 4.81±3.46mg/dl and mean serum calcium levels were 21.41±114.4mg/dl. Among the study participants, 67(57.3%) were found to be Vitamin D deficient. Both low and normal vitamin D was associated with High PTH (P <0.001) Other significant associations noted were that of High Alkaline Phosphatase with High PTH levels and a normal Vitamin D level (P<0.001). CONCLUSIONS: Our study revealed more than half of our participants were Vitamin D deficient and an association was found between Normal Vitamin D levels and high serum PTH levels with associated high alkaline phosphatase levels.

Diagnostic Accuracy of MR Mammography in Diagnosing Malignant Breast Lesions Taking Histopathology as Gold Standard.

OBJECTIVE: To find out the diagnostic accuracy of MR Mammography in diagnosing malignant breast lesions taking histopathology as gold standard. STUDY DESIGN: Cross-sectional survey. PLACE AND DURATION OF STUDY: Department of Radiology in collaboration with Department of Pathology, Sir Ganga Ram Hospital, Lahore, from April 2015 to April 2016. METHODOLOGY: 150 female patients with either suspicious mammographic findings or palpable lesions suspicious for malignancy referred from surgical OPD of Sir Ganga Ram Hospital were assessed. Dynamic contrast enhanced MRI was done on 1.5 Tesla MRI machine and the images were evaluated on morphological and kinetic basis. MR findings were then compared with preoperative FNAC and biopsy findings. RESULTS: The mean age of the patients was 52.5 ±13.4 years with maximum patients of age group 46-55 years. Out of 150, 118 (78.6%) patients were found to have malignant lesions on MRM while 116 (77%) patients were proved to have malignant lesions on histopathology. There was 93.9% sensitivity, 73.5% specificity, 89.3% diagnostic accuracy, 92.3% PPV, and 78.1% NPV of MR mammography in diagnosing malignant breast lesions taking histopathology as gold standard. CONCLUSION: Breast MRI has high sensitivity, specificity, and diagnostic accuracy in diagnosis of malignant breast lesions and must be used as primary imaging tool for proper characterisation of the breast lumps.

Antiangiogenic agents for nonmalignant brain tumors.

Objective To assess the treatment response and side effects for the use of antiangiogenic agents such as vascular endothelial growth factor (VEGF) inhibitors for patients with vestibular schwannomas and meningiomas. Design and Methods Retrospective review of eight male and two female patients (ages 14 to 70, mean 36 years), treated with bevacizumab (9) or pazopanib (1). Six patients had neurofibromatosis type 2 (NF2) with bilateral vestibular schwannomas and meningiomas, and the four others had aggressive recurrent meningiomas. Results During treatment (range 4 to 21 months, mean 9.1) with antiangiogenic agents, two patients with an atypical meningioma and radiation necrosis had dramatic partial response, the six NF2 patients had stable or slightly improved disease, and two meningioma patients had disease progression. Hearing was stable in three of the NF2 patients and was improved in three NF2 patients (one of whom received a cochlear implant). Minor toxicities included epistaxis, nausea, diarrhea, weight loss, and abdominal pain. No grade 3 or 4 toxicities were observed. Conclusion Antiangiogenic agents appear to be safe for the treatment of patients with nonmalignant brain tumors, and in select cases may be efficacious.