Evaluation of safety and efficacy profile of Nigella sativa oil as an add-on therapy, in addition to alpha-keto analogue of essential amino acids in patients with chronic kidney disease.

Chronic kidney disease (CKD) encompasses a spectrum of different pathophysio- logic processes associated with abnormal kidney function. When it reaches end-stage renal disease (ESRD), the only option is dialysis and renal transplantation. This is unaffordable by most patients. Hence, newer treatment modalities are being looked for, which can slow down the progression of CKD and delay the development of ESRD. This study aimed to evaluate the efficacy and safety of Nigella sativa oil as an add-on therapy in addition to alpha-keto analogue of essential amino acids in patients with CKD Stages 3 and 4. The study was conducted at a tertiary care center in North India on patients with CKD Stages 3 and 4. It was a prospective, comparative, and open-labeled study. One hundred and fifty patients were enrolled and were randomly divided into two interventional groups. Fourteen patients were lost to follow-up. Group I (control) which had 66 patients received conservative management of CKD consisting of alpha-keto analogue (600 mg tablet three times a day), whereas Group II (test) which had 70 patients received conservative management along with alpha-keto analogue and N. sativa oil (2.5 mL, per orally, once daily) for 12 weeks. Hemogram, renal function, and serum electrolyte tests were done, and adverse events were recorded at baseline and at4, 8, and 12 weeks of treatment. After 12 weeks of treatment, there was a marked improvement in clinical features and biochemical parameters in both the control and test groups. There were a significant reduction in blood urea, serum creatinine, and 24-h total urine protein and a significant improvement in 24-h total urine volume and glomerular filtration rate. N. sativa oil supplementation along with alpha-keto analogue is more more efficacious and safe in delaying the progression of disease patients with CKD Stages 3 and 4.

Comparative evaluation of efficacy and safety profile of rhubarb and α-keto analogs of essential amino acids supplementation in patients with diabetic nephropathy.

To determine the efficacy and safety profile of rhubarb and α-keto analogs of essential amino acids supplementation in patients of diabetic nephropathy (DN), we studied 96 patients of DN attending a tertiary care center of the North India. The patients were randomly divided into three equal interventional groups. Group I (control) that received conservative management along with placebo, Group II (rhubarb) that received conservative management along with rhubarb capsule (350 mg, thrice daily), and Group III [keto amino acid (KAA)] that received conservative management along with α-keto analogs of essential amino acids (600 mg, thrice daily). The treatment was continued for 12 weeks. Clinical and biochemical parameters were assessed at 0, 4, 8, and 12 weeks of treatment. A progressive improvement in clinical features and biochemical parameters was seen in all three groups after 12 weeks of treatment. The KAA group showed more marked improvement in clinical features as well as biochemical parameters compared to the rhubarb group. There was a reduction in blood glucose, blood urea, serum creatinine, and 24 h total urine protein. There was an increase in hemoglobin, 24 h total urine volume, and glomerular filtration rate. There was no statistical difference between the rhubarb and KAA groups with respect to side effects (P > 0.05). Our study suggests that KAA is more effective than rhubarb as add-on therapy with conservative management in patients of DN.

Effects of Varying Levels of Fungal (Arachniotus sp.) Treated Wheat Straw as an Ingredient of Total Mixed Ration on Growth Performance and Nutrient Digestibility in Nili Ravi Buffalo Calves.

The study was carried out to explore the effects of replacing wheat straw with fungal treated wheat straw as an ingredient of total mixed ration (TMR) on the growth performance and nutrient digestibility in Nili Ravi buffalo male calves. Fungal treated wheat straw was prepared using Arachniotus sp. Four TMRs were formulated where wheat straw was replaced with 0 (TMR1), 33 (TMR2), 67 (TMR3), and 100% (TMR4) fungal treated wheat straw in TMR. All TMRs were iso-caloric and iso-nitrogenous. The experimental TMRs were randomly assigned to four groups of male calves (n = 6) according to completely randomized design and the experiment continued for four months. The calves fed TMR2 exhibited a significant improve in dry matter intake, average daily weight gain, feed conversion ratio and feed economics compared to other groups. The same group also showed higher digestibility of dry matter, crude protein, neutral-, and acid detergent fibers than those fed on other TMRs. It is concluded that TMR with 33% fungal-treated wheat straw replacement has a potential to give an enhanced growth performance and nutrient digestibility in male Nili Ravi buffalo calves.

Diabetes risk assessment among squatter settlements in Pakistan: A cross-sectional study.

INTRODUCTION: Diabetes mellitus (DM) has evolved as a major public health concern worldwide, as its prevalence is increasing exponentially. Pakistan now ranks seventh among the countries with the highest burden of DM. It is expected to become one of the major causes of morbidity within the next 25 years. Therefore, finding an effective way to identify individuals at risk of developing diabetes is a necessity. The Finnish Diabetes Risk Score (FINDRISC) has proved to be an effective noninvasive screening tool for identifying individuals at risk for developing diabetes. The objective of this study was to determine the frequency of individuals who are at risk for developing DM and their risk of developing DM over the next 10 years using the FINDRISC tool. METHODS: A cross-sectional survey was conducted on 241 adults. The data were collected using the FINDRISC questionnaire followed by calculation of a summated score and analysis to determine the association between the risk factors under study and the risk of developing diabetes. RESULTS: Out of 241 study participants, 137 (56.8%) were men and 104 (43.1%) were women. Our study showed that 129 (53.5%) participants had low risk, 68 (28.2%) had slightly elevated risk, 27 (11.2%) had moderate risk and 17 (7%) had high risk of developing DM. CONCLUSION: The general population should be educated about the importance of healthy lifestyle, with special emphases on maintaining an ideal body mass index and a low-risk waist circumference, along with daily fruit and vegetable intake and physical activity of at least 30 min/day.

Gluteal fold flap in perineal reconstruction for Crohn's disease-associated fistulae.

INTRODUCTION: Crohn's disease is increasing in incidence worldwide. It is associated with many complications including fistulae, which may require surgical intervention. Occasionally, formal perineal reconstruction is needed for extensive or definitive fistula surgery. Reconstruction for inflammatory disease presents unique challenges and often calls for innovative solutions. Gluteal fold flaps (GFFs), which have been widely used in vulvo-vaginal malignancy and anorectal cancer surgery, have not hitherto been reported for Crohn's disease-associated fistulae. CASE PRESENTATION: A 30-year-old female presented with a 5-year history of Crohn's-associated perianal and rectovaginal fistulae. She had a previous small bowel resection and ileostomy. A laparascopic pan-proctocolectomy was carried out followed by perineal reconstruction in a single stage procedure using a pedicled fasciocutaneous GFF. Seven months postoperatively, revisional surgery was carried out using the contralateral GFF due to two areas of persistent wound dehiscence. The outcome was complete resolution of the fistulae, stable wound closure and good cosmesis. DISCUSSION & CONCLUSION: This case demonstrates that it is practical to use the GFF for perineal reconstruction following excision of complex Crohn's-associated fistulae. The flap avoids the sequelae associated with sacrifice of regional muscle flaps and specifically circumvents the unavailability of the rectus abdominis flap in slim patients or those with in-situ ileostomies. It is easy and quick to raise and does not require an intra-operative change in the patient's position. The GFF ensured well vascularised skin cover, adequate flap volume with no loss of function and low donor site morbidity.

Evaluation of Rhubarb Supplementation in Stages 3 and 4 of Chronic Kidney Disease: A Randomized Clinical Trial.

Objective. To evaluate the efficacy and safety of Rhubarb supplementation in patients of chronic kidney disease. Material and Methods. This study was a prospective comparative study conducted in patients of chronic kidney disease (stages 3 & 4) attending Renal Clinic of Department of Medicine, JN Medical College & Hospital, AMU, Aligarh. Patients were randomly divided into two interventional groups. Group I (Control) was given conservative management while Group II (Rhubarb) received conservative management along with Rhubarb capsule (350 mg, thrice daily) for 12 weeks. Haemogram and renal function tests were measured at 0, 4, 8, and 12 weeks of treatment. Results. There was progressive improvement in clinical features in both the groups after 12 weeks of treatment but Rhubarb group showed more marked improvement as compared to control group. Both groups showed gradual improvement in the biochemical parameters as compared to their pretreated values which was more marked in Rhubarb supplemented group. There was reduction in blood glucose, blood urea, serum creatinine, and 24 hour total urine protein (TUP). There was increase in haemoglobin, 24 hour total urine volume (TUV), and glomerular filtration rate (GFR). There was no statistical difference in two groups with respect to side effects (P > 0.05). Conclusion. Rhubarb supplementation improved the therapeutic effect of conservative management in stage 3 and stage 4 patients of chronic kidney disease.

Reconstruction of chest wall chondrosarcoma with an anterolateral thigh free flap: An illustration of decision-making in chest wall reconstruction.

INTRODUCTION: Chondrosarcomas are the most common primary chest wall malignancy. The mainstay of treatment is radical resection, which often requires chest wall reconstruction. This presents numerous challenges and more extensive defects mandate the use of microvascular free flaps. Selecting the most appropriate flap is important to the outcome of the surgery. PRESENTATION OF CASE: A 71-year-old male presented with a large chondrocarcoma of the chest wall. The planned resection excluded use of the ipsilateral and contralateral pectoralis major flap because of size and reach limitations. The latissimus dorsi flap was deemed inappropriate on logistical grounds as well as potential vascular compromise. The patient was too thin for reconstruction using an abdominal flap. Therefore, following radical tumour resection, the defect was reconstructed with a methyl methacrylate polypropylene mesh plate for chest wall stability and an anterolateral thigh free flap in a single-stage joint cardiothoracic and plastic surgical procedure. The flap was anastomosed to the contralateral internal mammary vessels as the ipsilateral mammary vessels had been resected. DISCUSSION: The outcome was complete resection of the tumour, no significant impact on ventilation and acceptable cosmesis. CONCLUSION: This case demonstrates the complex decision making process required in chest wall reconstruction and the versatility of the ALT free flap. The ALT free flap ensured adequate skin cover, subsequent bulk, provided an excellent operative position, produced little loss of donor site function, and provided an acceptable cosmetic result.

Prevalence of plasmid mediated bla(TEM-1) and bla(CTX-M-15) type extended spectrum beta-lactamases in patients with sepsis.

OBJECTIVE: To characterize the bacterial pathogens in patients having gram negative septicaemia. Further, to evaluate the antimicrobial resistance and underlying molecular mechanisms in these strains. METHODS: A total number of 70 cases of gram negative sepsis were included in this prospective, open labeled, observational study. Standard methods for isolation and identification of bacteria were used. Antimicrobial susceptibility and ESBL testing was performed by the standard disc diffusion method. PCR amplification was performed to identify bla(CTX-M), bla(SHV) and bla(TEM) type ESBLs. Conjugation experiments were performed to show resistant marker transfer. RESULTS: The most prevalent isolates Escherichia coli (E. coli) 58.6%, Klebsiella Spp. 32.9% and Pseudomonas 8.6%, were resistant to most of the antimicrobials including cefazolin, ceftriaxone, cefuroxime, ampicillin and co-trimoxazole but sensitive to imipenem and meropenem. ESBL and MBL production was seen 7.3% and 12.2% of E. coli isolates respectively. Three isoaltes were found to have bla(CTX-M-15) and two of them also showed bla(TEM-1) type enxyme. Whereas, none of them showed bla(SHV). Conjugation experiments using J-53 cells confirmed these resistant markers as plasmid mediated. CONCLUSIONS: This work highlights the molecular epidemiology of escalating antimicrobial resistance and likely switch over of bla(CTX-M-15) type extended spectrum beta-lactamases by bla(TEM) type ESBLs in India. Further, the antimicrobial resistance by horizontal gene transfer was predominant among Enterobacteraceae in the community setting.

Fiberoptic bronchoscopy, as a valuable diagnostic option in sputum negative pulmonary tuberculosis: A prospective study.

CONTEXT: World Health Organization recommends bacteriological confirmation of pulmonary tuberculosis (PTB) by the detection of acid-fast bacilli (AFB) in respiratory specimens. However about 40-60% of patients with PTB suspected clinically or radiologically may fail to produce sputum, or when it is available, AFB may be negative on repeated smear examination. These sputum smear negative patients and those who fail to produce any sputum can be diagnosed by flexible fiberoptic bronchoscopy. AIMS: Our study was an attempt to analyze the role of fiberoptic bronchoscopy in sputum smear negative PTB patients with respect to their association with clinical and radiological profile. MATERIALS AND METHODS: In this prospective, open label, observational study, 40 cases of sputum smear negative PTB were subjected to bronchoscopic examination after taking informed consent and samples like bronchial aspirate, bronchoalveolar lavage and post bronchoscopy sputum were collected. The data was analysed and the results were given in percentage. RESULTS: Out of the total 40 patients, overall diagnosis was confirmed in 24 (60%) patients. Of these 24 patients, 17 patients were confirmed for PTB whereas 7 had other diagnoses. CONCLUSION: The study concludes that fiberoptic bronchoscopy is a useful tool in diagnosing sputum smear negative PTB patients with respect to their association with clinical and radiological profile, and also identifies individuals at a higher risk for progression of disease, at an early stage despite not meeting routine bacteriological criteria for confirmation of PTB.

Prevalence of plasmid mediated bla(TEM-1) and bla(CTX-M-15) type extended spectrum beta-lactamases in patients with sepsis

OBJECTIVE@#To characterize the bacterial pathogens in patients having gram negative septicaemia. Further, to evaluate the antimicrobial resistance and underlying molecular mechanisms in these strains.@*METHODS@#A total number of 70 cases of gram negative sepsis were included in this prospective, open labeled, observational study. Standard methods for isolation and identification of bacteria were used. Antimicrobial susceptibility and ESBL testing was performed by the standard disc diffusion method. PCR amplification was performed to identify bla(CTX-M), bla(SHV) and bla(TEM) type ESBLs. Conjugation experiments were performed to show resistant marker transfer.@*RESULTS@#The most prevalent isolates Escherichia coli (E. coli) 58.6%, Klebsiella Spp. 32.9% and Pseudomonas 8.6%, were resistant to most of the antimicrobials including cefazolin, ceftriaxone, cefuroxime, ampicillin and co-trimoxazole but sensitive to imipenem and meropenem. ESBL and MBL production was seen 7.3% and 12.2% of E. coli isolates respectively. Three isoaltes were found to have bla(CTX-M-15) and two of them also showed bla(TEM-1) type enxyme. Whereas, none of them showed bla(SHV). Conjugation experiments using J-53 cells confirmed these resistant markers as plasmid mediated.@*CONCLUSIONS@#This work highlights the molecular epidemiology of escalating antimicrobial resistance and likely switch over of bla(CTX-M-15) type extended spectrum beta-lactamases by bla(TEM) type ESBLs in India. Further, the antimicrobial resistance by horizontal gene transfer was predominant among Enterobacteraceae in the community setting.

Effect of angiotensin converting enzyme gene I/D polymorphism in patients with metabolic syndrome in North Indian population.

BACKGROUND: Numerous studies have investigated the effect of angiotensin converting enzyme (ACE) gene I/D polymorphism and various cardiovascular risk factors in different populations with varied results. Currently, the association of ACE gene polymorphism with metabolic syndrome has not been studied in North Indians. While studies assessing the effect with polymorphism on each of the components of metabolic syndrome separately are present, data regarding the metabolic syndrome per se are sparse. The present study evaluated the effect of ACE gene I/D polymorphism in patients with metabolic syndrome in North Indian population at a tertiary care centre. METHODS: Fifty subjects, with thirty cases of metabolic syndrome (NCEP/ATP III guidelines, 2004) and twenty age and gender matched healthy controls were chosen. Detailed history was reviewed and clinical examination of the subjects was carried out. Relevant investigations including blood glucose (fasting and post prandial), blood urea, serum creatinine and serum lipids were done. DNA of cases and controls was analysed for I/D polymorphism using polymerase chain reaction. RESULTS: D/D genotype was more frequent in patients with metabolic syndrome as compared with healthy controls (P < 0.05). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) was significantly higher in the D/D genotype than I/D and I/I genotypes (P < 0.05). Our study also showed positive association between obesity, fasting blood glucose and ACE gene polymorphism while no association was found with triglycerides and high density lipoprotein cholesterol. The I/I group was significantly associated with waist circumference and fasting blood glucose (P < 0.05). CONCLUSION: Our study clearly showed that metabolic syndrome was associated with ACE gene polymorphism. However due to less number of subjects in the study further studies are needed to corroborate our results.

Effect of angiotensin converting enzyme gene I/D polymorphism in patients with metabolic syndrome in North Indian population / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Numerous studies have investigated the effect of angiotensin converting enzyme (ACE) gene I/D polymorphism and various cardiovascular risk factors in different populations with varied results. Currently, the association of ACE gene polymorphism with metabolic syndrome has not been studied in North Indians. While studies assessing the effect with polymorphism on each of the components of metabolic syndrome separately are present, data regarding the metabolic syndrome per se are sparse. The present study evaluated the effect of ACE gene I/D polymorphism in patients with metabolic syndrome in North Indian population at a tertiary care centre.</p><p><b>METHODS</b>Fifty subjects, with thirty cases of metabolic syndrome (NCEP/ATP III guidelines, 2004) and twenty age and gender matched healthy controls were chosen. Detailed history was reviewed and clinical examination of the subjects was carried out. Relevant investigations including blood glucose (fasting and post prandial), blood urea, serum creatinine and serum lipids were done. DNA of cases and controls was analysed for I/D polymorphism using polymerase chain reaction.</p><p><b>RESULTS</b>D/D genotype was more frequent in patients with metabolic syndrome as compared with healthy controls (P < 0.05). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) was significantly higher in the D/D genotype than I/D and I/I genotypes (P < 0.05). Our study also showed positive association between obesity, fasting blood glucose and ACE gene polymorphism while no association was found with triglycerides and high density lipoprotein cholesterol. The I/I group was significantly associated with waist circumference and fasting blood glucose (P < 0.05).</p><p><b>CONCLUSION</b>Our study clearly showed that metabolic syndrome was associated with ACE gene polymorphism. However due to less number of subjects in the study further studies are needed to corroborate our results.</p>

Seroprotection after hepatitis B vaccination in chronic kidney disease patients with modified schedule and dosage.

BACKGROUND: This study was conducted to determine the efficacy of four doses of 40 microg vaccine in chronic kidney disease patients as compared to the three-dose 20 microg vaccine schedule given to the normal healthy population. METHODOLOGY: This study included 130 chronic kidney disease patients. Of these 84 were given 20 microg vaccine (52 patients were given three doses at 0, one and two months, and 32 patients were given four doses at 0, one, two and six months) and 46 patients were given 40 microg vaccine (30 patients were given three doses at 0, one and two months and 16 patients were given four doses at 0, one, two and six months). Patient response was assessed by measuring antibodies to hepatitis B surface antigen (anti HBs) one month after receiving the third and fourth doses each. RESULTS: Of the patient who received three doses of 20 microg vaccine, 57.7% showed seroprotection while 68.7% of the patients who received four doses of this vaccine showed seroprotection. In contrast, 60% of the patients who received three doses of 40 microg vaccine had seroprotective antibody titers while 87.5% of the patients receiving four doses of 40 microg vaccine showed seroprotection. CONCLUSIONS: Seroprotection after four doses of 40 microg vaccine at 0, one, two, and six months was found to be better and cost effective in chronic kidney disease patients compared to three doses of 20 microg vaccine given to normal healthy individuals with adequate renal function.

Production performance of Dera Din Panah goat under desert range conditions in Pakistan.

Effects of fodder availability and prolificacy on birth weight, weaning weight, weight at 6 and 9 months age, and pre- and post-weaning growth rates of Dera Din Panah goat were determined. A total of 350 records of Dera Din Panah (DDP) goats maintained at Sheep and Goat Development Centre, Rakh Khairewala, District Layyah, Punjab, Pakistan were analyzed using Harvey's Mixed Model Least Squares and Maximum Likelihood computer program. Fodder availability significantly affected (P < 0.05) the birth weight, weaning weight, and pre-weaning daily gain. The effect of prolificacy on the birth weight, weaning weight, pre-weaning growth rate was significant (P < 0.05). Effects of fodder availability and prolificacy on average daily weight gain during different stages, such as from birth to 3 months of age (GR1), 3 to 6 months of age (GR2), 6 to 9 months of age (GR3), 9 to 12 months of age (GR4), and overall growth rate from birth to 12 months of age (GR5) age were determined.

Effect of Nigella sativa oil on various clinical and biochemical parameters of insulin resistance syndrome.

AIM: The seeds of the Nigella sativa plant have been used to promote health and fight disease for centuries, especially in the Middle East and in Southeast Asia. This plant has been a focus of much research. This clinical study was undertaken to know the adjuvant effect of N. sativa oil on various clinical and biochemical parameters of the insulin resistance syndrome. MATERIALS AND METHODS: This prospective study was conducted at a tertiary health care center in North India. After confirmation of diagnosis, 60 patients who fulfilled the inclusion and exclusion criteria were enrolled in this study. Written informed consent was taken from all the patients enrolled. Approval from the institutional ethical committee was also obtained. The patients were divided into two groups of 30 each. In group I (the standard group), patients were advised tablet atorvastatin 10 mg once a day and tablet metformin 500 mg twice a day for a period of 6 weeks. In group II (the N. sativa group), the patients were advised tablet atorvastatin 10 mg once a day, tablet metformin 500 mg twice a day, and N. sativa oil 2.5 ml twice daily for a period of 6 weeks. Fasting and postprandial blood glucose, fasting lipid profile, and waist circumference were recorded before therapy and after completion of therapy. RESULT: The treatment group showed significant (P < 0.05) improvement with reference to total cholesterol, low density lipoprotein cholesterol (LDL-C), and fasting blood glucose (P < 0.05). CONCLUSION: N. sativa oil was found to be effective as an add-on therapy in patients of insulin resistance syndrome. N. sativa oil has a significant activity in diabetic and dyslipidemic patients.

Hepatitis E: review of a disease endemic in Pakistan.

Hepatitis E is enterically transmitted causing a self-limiting illness similar to hepatitis A. However, unlike hepatitis A, immunity to hepatitis E is not life long, hepatitis E is a disease of developing nations with improper sewage disposal and unclean water supplies. It is thought to be the most common cause of acute sporadic hepatitis in Pakistan, where it has also caused major epidemics. Hepatitis E causes a mild self-limiting illness with no long-term sequelae. However, it is especially severe in pregnant females in the second and third trimesters, in whom it results in a high mortality rate (up to 20%) and an increased incidence of stillbirths. Diagnosis depends on clinical findings and elevated hepatic enzymes. Protection from this disease in endemic areas lies mainly in prevention, as the vaccine for hepatitis E is still in the experimental stage. Provision of clean drinking water, hand washing before eating and proper disposal of sewage has been shown to decrease the incidence of this disease.

Clinical spectrum of systemic lupus erythematosus at the Aga Khan University Hospital.

BACKGROUND: Systemic lupus erythematosus is a disease of unknown etiology, which at onest may involve only one organ system or be multisystemic. The aim of our study is to determine the clinical presentation of SLE patients presenting to AKUH to establish whether guidelines laid down about this disease are in agreement with our experience. METHODS: A retrospective log review was carried out at AKUH, based on data obtained from 165 files of individuals admitted to the hospital over a period of 12 years with a confirmed diagnosis of SLE. RESULTS: From the sample size of 165, 143 (86.7%) were females and 22 (13.3%) males. The mean age of diagnosis was 30.9 years. Frequency of symptomatology was observed to be in the following order: systemic 78.8%, musculoskeletal 63% and hematological 60.6%. Oninvestigation ANA levels were positive in 112 patients. CONCLUSION: Our result lead us to conclude that the classification set forth by the American Rheumatological Association is applicable to patients presenting with SLE in our setting.