Physiotherapists' knowledge, usage and attitude towards non-steroidal anti-inflammatory drugs (NSAIDs) in Karachi, Pakistan.

OBJECTIVE: This study aimed to investigate the knowledge, usage and attitude of physiotherapists towards non-steroidal anti-inflammatory drugs (NSAIDs) in Karachi, Pakistan. METHODS: A cross-sectional study was conducted among clinical physiotherapists working in Karachi who were enrolled through convenient sampling. A questionnaire was distributed to the participants, which consisted of questions regarding physiotherapists' current knowledge, current practice and their attitude towards NSAIDs prescription. RESULTS: Responses of 310 physiotherapists out of the 350 questionnaires distributed were received (response rate = 88%). Results show that most physiotherapists (60.3%) recommended NSAIDs to their patients despite having a variable understanding of the contraindications, adverse reactions and drug interactions of NSAIDs. Most physiotherapists demonstrated poor knowledge of the legislation on NSAIDs prescription as most of them believed that they were allowed to advise (71.9%), prescribe (66.1%) and recommend (72.2%) NSAIDs to their patients. CONCLUSION: This study implicates that physiotherapists should be trained through proper educational sessions such as certification courses on pharmacotherapy (specifically pain medications) in order to become certified to prescribe NSAIDs and other analgesics.

An evidence-based guide to the treatment of osteonecrosis of the femoral head.

Non-traumatic osteonecrosis of the femoral head is a potentially devastating condition, the prevalence of which is increasing. Many joint-preserving forms of treatment, both medical and surgical, have been developed in an attempt to slow or reverse its progression, as it usually affects young patients. However, it is important to evaluate the best evidence that is available for the many forms of treatment considering the variation in the demographics of the patients, the methodology and the outcomes in the studies that have been published, so that it can be used effectively. The purpose of this review, therefore, was to provide an up-to-date, evidence-based guide to the management, both non-operative and operative, of non-traumatic osteonecrosis of the femoral head. Cite this article: Bone Joint J 2017;99-B:1267-79.

Fowl adenovirus: history, emergence, biology and development of a vaccine against hydropericardium syndrome.

The poultry industry has emerged as one of the largest and fastest growing public sectors in the developed and developing countries. Unfortunately, this industry is under a major threat from diseases that are viral (Newcastle disease, infectious bursal disease, influenza, hydropericardium syndrome), bacterial (colibacillosis, pasteurellosis, salmonellosis, mycoplasmosis), parasitic (coccidiosis, histoplasmosis) or nutritional (dyschondroplasia, osteoporosis). Among these diseases, hydropericardium syndrome (HPS) is one of the important emerging diseases occurring in the specific areas of the world where broilers (chickens) are reared under intensive conditions. HPS was first observed in 1987 at Angara Goth, an area near Karachi, Pakistan, where broilers are raised. Since then, HPS has been reported in many countries of the world. From these reported cases, an adenovirus that was either isolated from or visualized electron microscopically in the liver of affected broilers has been implicated in the syndrome. The syndrome has been reproduced by inoculation of isolated fowl adenovirus (FAdV) strains, and hence, the syndrome is also called infectious hydropericardium syndrome. To our knowledge, HPS has not been observed in humans, so it is not considered a zoonotic disease, but it is of economic importance and causes huge losses to the poultry industry. Efforts have been made to develop conventional vaccines against this disease, which were formulated from infected liver homogenate. Formalin-inactivated liver organ vaccines have failed to protect the poultry industry. Hence, there is a dire need to develop a suitable vaccine to combat this disease. Currently, recombinant vaccine candidates are being developed by using molecular biology and biotechnological approaches for the prevention and control of infectious diseases, including HPS. Therefore, it is suggested that the immunogenicity of these recombinant proteins should be evaluated for their use as subunit vaccines.

Management of blunt renal trauma: a profile of 65 patients.

OBJECTIVE: To outline the pattern and trends in the management of patients of renal trauma at the Department of Urology and Renal Transplantation, Jinnah Hospital, Lahore, from January 1998 to June 2003. METHODS: We retrospectively reviewed 65 patients identified with blunt renal trauma. RESULTS: Of 65 patients of renal trauma, injuries were graded I to V in 18 (27%), 9 (14%), 13 (20%), 16 (24%) and 9 (14%) respectively. Nephrectomy was done in all patients of Grade V and in 3 patients of Grade IV injury. Two patients in each group of grade IV and V died of associated injury. Rest of the patients were treated conservatively with blood transfusion, parenteral fluid, antibiotics, analgesics and bed rest. Of 53 patients treated conservatively two (4%) developed fever and eight (15%) hypertension. Two (4%) patients of grade III underwent delayed exploration for perinephric collection. CONCLUSION: Conservative management of blunt renal trauma without associated abdominal injury is feasible in patients who are hemodynamically stable at presentation.

Effect of wheat flour, Bengal gram flour and corn flour on lipid metabolism in rats.

Male albino rats were fed on respective diets of wheat flour, Bengal gram flour and corn flour for 8 weeks at the 59% level. It was observed that the increase in weight after wheat flour and Bengal gram flour feeding was 6.8 and 12.0% respectively and that the decrease after corn flour feeding was 5.2% as compared to the control animals on sucrose diet. Serum cholesterol and liver cholesterol levels were significantly (p less than 0.01) decreased after wheat flour, Bengal gram flour and corn flour feeding.

Influence of garlic on serum cholesterol, serum triglycerides, serum total lipids and serum glucose in human subjects.

Human subjects were used for a garlic experiment. The subjects were given a fat-rich diet for 7 days and on the 8th day the fasting blood was analyzed for serum cholesterol, serum triglycerides, serum total lipids and serum glucose. The human subjects were then given a fat-rich diet with 40 g of garlic for 7 days and on the 15th day the fasting blood was analyzed for the above investigations. On a fat-rich diet the serum cholesterol, serum triglycerides and serum total lipids were significantly increased as compared to normally fed diet. When 40 g of garlic was substituted in fat-rich diet for 7 days, the garlic significantly reduced the serum cholesterol and serum triglycerides.

Effect of triglycerides on the production of lipids and lipase by Mucor hiemalis.

The effect of triglycerides on the growth of Mucor hiemalis and the production of lipase and mycelial lipids was studied. Addition of 1% triglycerides to the fermentation medium was best for the mycelial as well as the broth lipase production. The added triglycerides seemed to be utilized through the formation of free fatty acids, and towards the end of the growth phase most of the triglycerides and their hydrolysis products were utilized. The mycelial lipase activity was maximum (66 U/g dry mycelium) at the end of the growth phase, while the maximal broth lipase activity (204 U/100 mL) was achieved after the cell lysis had started. The lipids produced per gram mycelia were high initially (260 mg/g dry weight at 48 h), reducing gradually later. With increase in growth the maximum mycelial lipids per 100 mL of culture medium was obtained after 96 h (176 mg/100 mL). The various fractions detected in the mycelial lipid extracts were sterol esters, triglycerides, free fatty acids, diglycerides, sterols, monoglycerides, phosphatidyl ethanolamine, phosphatidyl choline, and small amounts of an unknown polar lipid at all the stages of fermentation studied. Proportion between total neutral and total polar lipids remained nearly constant throughout fermentation.

Efficiency of haematological screening tests for detecting disease.

A new "intermediate' reference (normal) range for the erythrocyte sedimentation rate has been compared with published "low' and "high' reference ranges in a study of 354 hospital patients. The "intermediate' range showed superior balance between sensitivity and specificity in the detection of disease-induced plasma protein abnormalities and and gave a test efficiency of 81.9%; this reference range can therefore be recommended for routine use in the diagnostic laboratory. Four other screening tests (whole-blood viscosity, plasma viscosity, zeta sedimentation ratio, and C-reactive protein level) were compared in the same 354 patients. Whole-blood viscosity proved to be unsuitable as a screening test (efficiency 44.8%) but the three other tests showed good balance between sensitivity and specificity and gave a test efficiency of 74.4-79.7%.

Lipase Induction in Mucor hiemalis.

The influence on lipase induction in Mucor hiemalis of different types of triglycerides containing mainly oleic acid (olive oil), erucic acid (mustard oil), or saturated fatty acids of 8 to 16 carbons (coconut oil) was studied. The fungus was grown in shake flasks in a fermentation medium containing peptone, minerals, and glucose or one of the oils as the carbon source. Maximum lipase was produced when the initial pH of the fermentation medium was kept at 4.0. Addition of Ca to the medium did not increase lipase production. The optimum pH for activity of both the mycelial and extracellular lipases was found to be 7.0. The fungus produced a significant amount of lipase in the presence of glucose, but the lipase activity increased markedly when olive oil was added to the medium at the beginning of the fermentation. Addition of olive oil at a later stage did not induce as much enzyme. Studies with washed mycelia showed that a greater amount of lipase was released when olive oil was present than when glucose was present. Among the various types of triglycerides used as the carbon source, olive oil was found to be most effective in inducing the lipase. Olive oil and mustard oil fatty acids inhibited the lipase more than those of coconut oil. The lipase induced by a particular type of triglyceride did not seem to be specific for the same triglyceride, nor was it inhibited specifically by it. Irrespective of the triglyceride used in the fermentation medium, the lipase produced was most active against coconut oil triglyceride, and this specificity, as shown by lipase activities in an n-heptane system, was not found to be due to a better emulsification of this oil. The lipase of M. hiemalis can be considered to be both constitutive and inducible.

An immunological approach to dementia in the elderly.

A study into the relationship of immune change in the serum and the presence of senile dementia is reported. Three groups were studied, senile dementia, cerebrovascular disease and subjects without evidence of brain disease. All were aged 65 years and over. The immunofluorescent studies showed an excess of antineuronal reactivity and a fall in antinuclear antibody in females with senile dementia. There was no significant difference between the groups in respect of immunoglobulins, slide latex and a complement fixation test, against a variety of tissues. The significance of the findings in relation to other published results is discussed.