Comparison of toxic heavy metals concentration in medicinal plants and their respective branded herbal formulations commonly available in Khyber Pakhtunkhwa.

The present study was conducted on fifteen medicinal plants and their respective branded formulations, commonly used in Khyber Pakhtunkhwa, for the evaluation of toxic heavy metals. The purpose of the study was to assess the toxic profile of the crude medicinal plants with respect to the worldwide permissible limits of metal concentrations and to correlate it with their respective herbal formulations available on the market. Chromium (Cr), Copper (Cu), Lead (Pb), Manganese (Mn) and Nickel (Ni) content were evaluated using wet digestion and Atomic Absorption Spectrophotometry technique. The results exhibited that in 100% of the analyzed medicinal plants Cr and Ni are present in excess of the maximum limits, Cu and Pb in 73% and 60% respectively, while Mn is in the normal range. Likewise in the respective branded formulations Cr and Ni exceed the normal limit in 100% of the products, Cu and Pb in 27% and 20% of the products respectively, while Mn is in the normal range. It indicates that majority of people in Pakistan who frequently use herbal drugs in various forms are exposed to the hazardous elements, which may pose serious health effects. Regulatory measures should therefore be taken to protect the general public from their hazardous health effects.

Effect Of Internal Mammary Artery Harvesting With And Without Pleurotomy On Respiratory Complications In Patients Undergoing Coronary Artery Bypass Grafting.

BACKGROUND: Respiratory problems are one of the major issues faced by cardiovascular surgeons, which increase morbidity and mortality among patients undergoing coronary artery bypass grafting (CABG). It is possible to harvest the left internal mammary artery (LIMA) without opening the left pleura; however this cannot be reliably achieved in all cases due to intimate anatomical relationship. This study was designed to evaluate the effect of internal mammary artery harvesting with and without pleurotomy on respiratory complications in patients undergoing coronary artery bypass grafting. METHODS: In this observational study 90 patients who underwent coronary artery bypass surgery were included by review of records. Patients were stratified into two groups according to surgical procedures, i.e., Internal Mammary artery harvesting with pleurotomy; (WP Group) (n=45) and with extra pleural harvesting technique; (EP Group) (n=45). Inclusion criteria were elective coronary artery bypass grafting, age over 18 years, willingness to be randomly assigned, provision of informed consent. Exclusion criteria were chronic obstructive pulmonary disease (COPD) or skeletal abnormalities that caused pulmonary restriction. Only the first 30 days postoperative outcome was studied. Data was analysed using SPSS version 21. RESULTS: The demographic characteristics in terms of age and gender were comparable in study groups. The preoperative clinical presentation and medical history were also found similar. The hospital stay was significantly longer in WP Group than EP Group patients (7.2 vs 6.1 days, p<0.005). Moreover, post-operative morbidity was more prevalent in WP group 10 (22.2%) than EP Group 3 (66%) (p<0.03). In WP Group more respiratory complications were observed; 2 (4.4%) patients had dry cough and atelectasis, 1 (2.2%) patient experienced pleural effusion, 3 (6.6%) had bronchospasm while 1 (2.2%) patient each had sternal dehiscence and bleeding, however, these did not differ significantly among study groups. CONCLUSIONS: Respiratory complications were more frequent in patients undergoing Internal Mammary artery harvesting with pleurotomy compared to those managed extra pleural harvesting.

Report: Comprehensive nutrients analysis of rhizomes of Polygonatum verticillatum.

The current study was undertaken to estimate the concentration of micronutrients (Zn, Fe, Pb, Cu, Ni, Cd, Cr, Co, Sb and Mn), macronutrients (Na, Ca and K) and essential life nutrients (proteins, fats, carbohydrates and ascorbic acid) along with ash, fiber and moisture contents. Atomic absorption spectrophotometer was employed for the analysis of micronutrients while flame photometry for macronutrients. For proximate analysis (proteins, fats, carbohydrates, ash, fibers and moisture), Association of Official Analytical Chemists methods (AOAC) were used and titration method for ascorbic acid determination. It is evident from the results that the crude extract and its fractions accumulate significant concentrations of both micro and macro nutrients. The significant quantities of essential life nutrients like proteins, fats, carbohydrates and ascorbic acid along with ash, fiber and moisture contents were also found in extracts. It is concluded that the extracts of rhizomes accumulated significant quantities of life indispensible nutrients and validated the ethnobotanical uses of the plant as tonic and energizer.

Chemical composition and antioxidant activity of certain Morus species.

In the present work, the fruits of four Morus species, namely Morus alba (white mulberry), Morus nigra (black mulberry), Morus laevigata (large white fruit), and Morus laevigata (large black fruit), were analyzed for proximate composition, essential minerals, and antioxidant potentials. For this purpose, the ripe fruits were collected from the northern regions of Pakistan. The major nutritional components (moisture, ash, lipids, proteins, fibres, carbohydrates, and total sugar) were found to be in the suitable range along with good computed energy. Total dry weight, pH, and titratable acidity (percent citric acid) were (17.60±1.94)-(21.97±2.34) mg/100 g, (3.20±0.07)-(4.78±0.15), and (0.84±0.40)%-(2.00±0.08)%, respectively. Low riboflavin (vitamin B(2)) and niacin (vitamin B(3)) contents were recorded in all the fruits, while ascorbic acid (vitamin C) was in the range from (15.20±1.25) to (17.03±1.71) mg/100 g fresh weight (FW). The mulberry fruits were rich with regard to the total phenol and alkaloid contents, having values of (880±7.20)-(1650±12.25) mg/100 g FW and (390±3.22)-(660±5.25) mg/100 g FW, respectively. Sufficient quantities of essential macro-(K, Ca, Mg, and Na) and micro-(Fe, Zn, and Ni) elements were found in all the fruits. K was the predominant element with concentration ranging from (1270±9.36) to (1731±11.50) mg/100 g, while Ca, Na, and Mg contents were (440±3.21)-(576±7.37), (260±3.86)-(280±3.50), and (240±3.51)-(360±4.20) mg/100 g, respectivly. The decreasing order of micro-minerals was Fe>Zn>Ni. The radical scavenging activity of methanolic extract of fruits was concentration-dependent and showed a correlation with total phenolic constituents of the respective fruits. Based on the results obtained, mulberry fruits were found to serve as a potential source of food diet and natural antioxidants.

Fast tracking in adult cardiac surgery at Pakistan Institute of Medical Sciences.

BACKGROUND: Early extubation after cardiac operation is an important aspect of fast-track cardiac anaesthesia. The length of stay in ICU limits utilisation of operation theatre in cardiac surgery. Increasing cost, limited resources, and newer surgical strategies have stimulated effectiveness of all routines in cardiac surgery, anaesthesia, and intensive care. Aim of this study was to determine the feasibility of fast-tracking in adult cardiac surgery and its effects on post operative recovery in our setup. METHODS: This descriptive study was conducted over 14 months between 16th Jul 2007 to 16th Sep 2008. All the open heart cases were included unless absolute contraindications were there. We applied the rapid recovery protocol adopted from Oslo Hospital Norway in an attempt to achieve fast-tracking in our setup. RESULTS: Two-hundred-seventy-four consecutive cases out of 400 operated cases were included in this study. Mean age was 47.69 +/- 15.11 years, 27.7% were females, 5.8% were emergency cases. 5.1% were COPD, 11.1% were atrial fibrillation, and 6.9% were NYHA class-III cases. CABG was done in 66.1% cases and mean CPB-time was 75.92 +/- 16.20 min. Mean Ventilation-time was 4.47 +/- 4.48 hrs, 86% patients were fast-tracked to be extubated within 6 hours, and 85.4% patients remained free of post-op complications. Six (2.2%) re-intubatlions, 2.6% arrhythmias, 6.6% pleural effusions and 2.2% consolidation were observed post-operatively. Mean ICU stay was 2.49 +/- 0.95 days and in-hospital mortality was 2.2%. CONCLUSION: Fast-tracking with extubation within 6 hours is feasible approach which minimises the post-operative complications significantly in adult cardiac surgical patients.