A meta-analysis of photosynthetic efficiency and stress mitigation by melatonin in enhancing wheat tolerance.

BACKGROUND: Our meta-analysis examines the effects of melatonin on wheat under varying abiotic stress conditions, focusing on photosynthetic parameters, chlorophyll fluorescence, leaf water status, and photosynthetic pigments. We initially collected 177 publications addressing the impact of melatonin on wheat. After meticulous screening, 31 published studies were selected, encompassing 170 observations on photosynthetic parameters, 73 on chlorophyll fluorescence, 65 on leaf water status, 240 on photosynthetic pigments. RESULTS: The analysis revealed significant heterogeneity across studies (I² > 99.90%) for the aforementioned parameters and evidence of publication bias, emphasizing the complex interaction between melatonin application and plant physiological responses. Melatonin enhanced the overall response ratio (lnRR) for photosynthetic rates, stomatal conductance, transpiration rates, and fluorescence yields by 20.49, 22.39, 30.96, and 1.09%, respectively, compared to the control (no melatonin). The most notable effects were under controlled environmental conditions. Moreover, melatonin significantly improved leaf water content and reduced water potential, particularly under hydroponic conditions and varied abiotic stresses, highlighting its role in mitigating water stress. The analysis also revealed increases in chlorophyll pigments with soil drenching and foliar spray, and these were considered the effective application methods. Furthermore, melatonin influenced chlorophyll SPAD and intercellular CO2 concentrations, suggesting its capacity to optimize photosynthetic efficiency. CONCLUSIONS: This synthesis of meta-analysis confirms that melatonin significantly enhances wheat's resilience to abiotic stress by improving photosynthetic parameters, chlorophyll fluorescence, leaf water status, and photosynthetic pigments. Despite observed heterogeneity and publication bias, the consistent beneficial effects of melatonin, particularly under controlled conditions with specific application methods e.g. soil drenching and foliar spray, demonstrate its utility as a plant growth regulator for stress management. These findings encourage focused research and application strategies to maximize the benefits of melatonin in wheat farming, and thus contributing to sustainable agricultural practices.

Relation between hydrophilic/hydrophobic characteristics of sludge extracellular polymeric substances and sludge moisture-holding capacity in hot-pressing drying.

Sludge poses a serious threat to the environmental health. Hot-pressing drying has been proven efficient in sludge treatment because of the reduced thermal contact resistance, rapid increase in sludge temperature, and high drying rate. Sludge extracellular polymeric substances (EPS) significantly influence moisture transfer. However, whether in hot-pressing or traditional thermal drying, the effect of EPS on sludge moisture-holding capacity is rarely reported. Thereby, this study investigated the relationship between hydrophilic/hydrophobic characteristics of EPS and sludge moisture-holding capacity at various drying time and mechanical compression using XAD resin fractionation. Thermodynamic analysis indicated that sludge moisture desorption isotherms, net isosteric heat of desorption, and differential entropy presented a downward trend with the increase in drying time and mechanical compression, suggesting reduced sludge moisture-holding capacity. EPS analysis showed that at the same drying time, applying 25 kPa mechanical compression increased sludge temperature by 16 % and protein content by 13.8 %. At the same sludge temperature, protein content rose by 7.3 % compared to the drying without mechanical compression. It was concluded that the fast rise in sludge temperature and the mechanical extrusion facilitated the destruction of sludge microbial flocs, accelerating the release of intracellular and EPS-bound moisture and contributing to the decrease in moisture-holding capacity. Besides, tryptophan protein-like substances were the major source of hydrophilic/hydrophobic organic matter, compared to polysaccharide and humic acid-like substances. The gradually reduced sludge moisture-holding capacity was divided into three stages. Below 67 °C, the moisture desorption was dominated by the release of intracellular moisture. Below 85 °C, the increase in protein and the enhanced exposure of hydrophobic functional groups in protein improved the hydrophobicity of EPS. Above 85 °C, protein consumption due to thermal decomposition and browning reaction facilitated the desorption of EPS-bound moisture. Hence, this study provided novel insights into the mechanism of sludge drying.

Adsorption performance and mechanism of cationic and anionic dyes by KOH activated biochar derived from medical waste pyrolysis.

The massive generation of medical waste (MW) results in a series of environmental, social, and ecological problems. Pyrolysis is one such approach that has attracted more attention because of the production of value-added products with lesser environmental risk. In this study, the activated biochar (ABC600) was obtained from MW pyrolysis and activated with KOH. The adsorption mechanism of activated biochar on cationic (methylene blue) and anionic (reactive yellow) dyes were studied. The physicochemical characterization of biochar showed that increasing pyrolysis temperature and KOH activation resulted in increased surface area, a rough surface with a clear porous structure, and sufficient functional groups. MB and RYD-145 adsorption on ABC600 was more consistent with Langmuir isotherm (R2 ≥ 0.996) and pseudo-second-order kinetics (R2 ≥ 0.998), indicating chemisorption with monolayer characteristics. The Langmuir model fitting demonstrated that MB and RYD-145 had maximum uptake capacities of 922.2 and 343.4 mg⋅g-1. The thermodynamics study of both dyes showed a positive change in enthalpy (ΔH°) and entropy (ΔS°), revealing the endothermic adsorption behavior and randomness in dye molecule arrangement on activated-biochar/solution surface. The activated biochar has excellent adsorption potential for cationic and anionic dyes; hence, it can be considered an economical and efficient adsorbent.

Mixed culture chain elongation for consumption of acetate and ethanol in anaerobic fermentation: The impact of salt type, dosage and acclimation.

Microbial chain elongation is a newly developed carboxylate platform-based bioprocess, which often encounters high salinity stress due to saline feedstock and pH adjustment. In this study, we systematically investigated the effects of salt types (Na+, K+, and NH4+), dosage, and salinity acclimation on microbial chain elongation, and identified the microbial community by high throughput 16S rRNA gene sequencing. The results showed that a high level of Na+ and NH4+ (12.5 g/L of cations) exerted seriously inhibitory effects without chain elongating activity, while K+ had the slightest inhibition only with a little longer lag phase and lower products yield. The chain elongating products yields and the selectivity of caproate decreased with the increasing Na+ concentration, and 8.6 g/L of Na+ was found to be the threshold value for un-acclimated inoculum used for chain elongation. The acclimation to high saline conditions greatly promoted the consumption of acetate and ethanol with a shorter lag phase, and recovered a robust elongating activity for butyrate production. Furthermore, the high throughput 16S rRNA gene sequencing analysis results indicated that six genera, such as Clostridium IV and Clostridium sensu stricto, closely relating chain elongation process were depressed by high salinity, and the salinity acclimation helped to enrich the functional microbes. These findings could provide useful information for engineering microbial chain elongation process under saline conditions.

Experimental analysis on products distribution and characterization of medical waste pyrolysis with a focus on liquid yield quantity and quality.

The massive generation of medical waste (MW) poses a serious risk to the natural environment and human health. The pyrolysis technique is proposed as a potential treatment for MW to tackle the associated environmental issues and produce value-added products. In this work, medical waste pyrolysis has been conducted at various temperatures using a fixed bed reactor with a 20 °C·min-1 heating rate and nitrogen was used as a career gas with a flow rate of 100 ml·min-1. In addition, the effect of temperature on products yield and chemical composition of MW pyrolysis have been investigated. The maximum yield of 57.1% for liquid oil was observed from the mixed MW pyrolysis at 500 °C. The gas and char yield were found between 26.5-37.3% and 24.2-12.4%, respectively, for the pyrolysis temperature of 450 °C to 600 °C. According to GC analysis, the concentration of the main gaseous products such as CH4, H2, and C2H4 was increased with increasing temperature, while CO and CO2 experienced a decreasing trend. The results of GC-MS analysis revealed that the main components of MW pyrolysis oil were aromatic hydrocarbons, cyclic hydrocarbons, aliphatic hydrocarbons, alcohol, carboxylic acids, and their derivatives. The aromatic and cyclic hydrocarbons content increased up to 38.2% at a pyrolysis temperature of 600 °C. As pyrolysis oil tends to have more long-chain hydrocarbons therefore carbon distributions from C7 to C35 were observed. The ultimate analysis of oil and char revealed that the increased temperature enhanced the carbon content up to 78.6% and 68.0%, respectively. Furthermore, the higher heat values of 41.8, 24.4, and 52.7 MJ·kg-1 were reported for oil, char, and gas, respectively.

Molecular detection of Shiga toxin-producing Escherichia coli (STEC) O157 in sheep, goats, cows and buffaloes.

BACKGROUND: Shiga toxin-producing E. coli (STEC) are important foodborne pathogens that causing serious public health consequences worldwide. The present study aimed to estimate the prevalence ratio and to identify the zoonotic potential of E. coli O157 isolates in slaughtered adult sheep, goats, cows and buffaloes. MATERIALS AND METHODS: A total of 400 Recto-anal samples were collected from two targeted sites Rawalpindi and Islamabad. Among them, 200 samples were collected from the slaughterhouse of Rawalpindi included sheep (n = 75) and goats (n = 125). While, 200 samples were collected from the slaughterhouse of Islamabad included cows (n = 120) and buffalos (n = 80). All samples were initially processed in buffered peptone water and then amplified by conventional PCR. Samples positive for E. coli O157 were then streaked onto SMAC media plates. From each positive sample, six different Sorbitol fermented pink-colored colonies were isolated and analyzed again via conventional PCR to confirm the presence of rfbE O157 gene. Isolates positive for rfbE O157 gene were then further analyzed by multiplex PCR for the presence of STEC other virulent genes (sxt1, stx2, eae and ehlyA) simultaneously. RESULTS: Of 400 RAJ samples only 2 (0.5%) showed positive results for E. coli O157 gene, included sheep 1/75 (1.33%) and buffalo 1/80 (1.25%). However, goats (n = 125) and cows (n = 120) found negative for E. coli O157. Only 2 isolates from each positive sample of sheep (1/6) and buffalo (1/6) harbored rfbE O157 genes, while five isolates could not. The rfbE O157 isolate (01) of sheep sample did not carry any of STEC genes, while the rfbE O157 isolate (01) of buffalo sample carried sxt1, stx2, eae and ehlyA genes simultaneously. CONCLUSION: It was concluded that healthy adult sheep and buffalo are possibly essential carriers of STEC O157. However, rfbE O157 isolate of buffalo RAJ sample carried 4 STEC virulent genes, hence considered an important source of STEC infection to humans and environment which should need to devise proper control systems.

Enhancement of conductive drying of sewage sludge with mechanical compression: Drying kinetics, and interfacial heat transfer behavior.

Improving sludge drying efficiency is of tremendous importance for public health, subsequent treatment, and comprehensive utilization. The interfacial thermal resistance between sludge and hot wall greatly limits the conductive drying performance. This study employed mechanical compression to decrease the interfacial thermal resistance. The drying kinetics and interfacial heat transfer behavior were investigated at mechanical loads of 25 to 200 kPa, temperatures of 120 to 210 °C, and sludge thicknesses of 1.0 to 3.0 mm, and were compared to those in the conventional drying process without mechanical load. The increase of temperature and mechanical load and the decrease of thickness improved drying rates. The drying experienced one warm-up period and two falling rate periods. The breakthrough of interfacial vapor film was responsible for the rapid rise in drying rates initially. At the thickness of 3.0 mm, 210 °C, and 100 kPa, the effective moisture diffusivity was increased by 2.5 times, and the apparent activation energy was reduced by 34% compared to the traditional process in the first falling rate period, implying that mechanical compression facilitated moisture migration and bound water desorption. The effective moisture diffusivity in the first falling rate period was increased by 35% compared to the diffusivity in the second falling rate period because of the pressure-driven flow. The decrease in drying rates was due to the transformation from the pressure-driven flow to vapor diffusion-limited flow in the first falling rate period. Additionally, this study provided essential information on developing a new sludge treatment method and establishing the drying model.

Immunoglobulins content in colostrum, transitional and mature milk of Bangladeshi mothers: Influence of parity and sociodemographic characteristics.

BACKGROUND: The study investigated the concentration of IgA, IgM and IgG in colostrum, transitional and mature milk and the effect of parity, age, BMI and family income on secreted immunoglobulin contents of human milk. METHODS: Sequential samples of colostrum, transitional and mature milk were collected from 38 women. Enzymelinked immunosorbent assay was used to analyse the immunoglobulin concentrations. RESULTS: The study revealed that IgA was the dominant immunoglobulin and mean concentration in colostrum, transitional and mature milk was 5.92 ± 1.50 g/L, 3.85 ± 0.64 g/L and 3.72 ± 0.68 g/L, respectively. Both IgA and IgM levels of colostrum decreased significantly in both transitional (P = 0.000) and mature milk (P = 0.000), while the concentration of IgG rises significantly in them (colostrum vs. transitional milk, P = 0.000; and colostrum vs. mature milk P = 0.011). While maternal age, BMI and family income had no significant influence on the immunoglobulin levels at different stages of lactation, parity showed significant influence on IgG (P = 0.03) and IgM (P = 0.05) levels of transitional milk and IgA level of colostrum (P = 0.05). CONCLUSION: The findings suggest that immunoglobulin composition in breast milk is strongly associated with stage of lactation and is likely to be more susceptible to parity than BMI and socioeconomic characteristics.

Fabrication of an Efficient Planar Organic-Silicon Hybrid Solar Cell with a 150 nm Thick Film of PEDOT: PSS.

Organic-inorganic hybrid solar cells composed of p-type conducting polymer poly (3,4-ethylene-dioxythiophene): polystyrenesulfonate (PEDOT: PSS) and n-type silicon (Si) have gained considerable interest in recent years. From this viewpoint, we present an efficient hybrid solar cell based on PEDOT: PSS and the planar Si substrate (1 0 0) with the simplest and cost-effective experimental procedures. We study and optimize the thickness of the PEDOT: PSS film to improve the overall performance of the device. We also study the effect of ethylene glycol (EG) by employing a different wt % as a solvent in the PEDOT: PSS to improve the device's performance. Silver (Ag) was deposited by electron beam evaporation as the front and rear contacts for the solar cell device. The whole fabrication process was completed in less than three hours. A power conversion efficiency (PCE) of 5.1%, an open circuit voltage (Voc) of 598 mV, and a fill factor (FF) of 58% were achieved.

Retracted: Experimentally investigated the asparagus (Asparagus officinalis L.) drying with flat-plate collector under the natural convection indirect solar dryer.

The above article, published online on 21 February 2018 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the journal Editor in Chief, Y. Martin Lo, and Wiley Periodicals, Inc. The retraction has been agreed at the authors' request due to unattributed overlap between this article and the following article published in the Journal of Mechanical Engineering and Sciences, "Analysis of ginger drying inside a natural convection indirect solar dryer: An experimental study" by S. K. Sansaniwal and M. Kumar, Volume 9, pp. 1671-1685.

Correlation of serum calcium with severity of acute ischaemic stroke.

OBJECTIVE: To determine the correlation of serum calcium with severity of acute ischaemic stroke. METHODS: This cross-sectional study was conducted at the Khyber Teaching Hospital, Peshawar, Pakistan, from January to September 2013, and comprised patients who had suffered ischaemic stroke. All patients aged above 18 years who had been diagnosed to have suffered ischaemic stroke through history, physical examination and computed tomography scan, and who were admitted within the first 72 hours of the onset of the illness were included. Serum calcium was obtained within 78 hours of the onset of stroke and the severity of stroke was assessed at the same time using the National Institute of Health Stroke score. RESULTS: Of the 138 patients, 71(51.4%) were women and 67(48.6%) men. The overall mean age was 61.09±11.93 years (range: 34-100 years). The mean National Institute of Health Stroke score was 17.77±7.73 (range: 2-35). Serum calcium of all patients was measured and adjusted for serum albumin level. The mean serum calcium level was 8.82±0.69 mg/dl (range: 6.84-10.48). Bivariate correlation was calculated for continuous data of serum calcium and National Institute of Health Stroke score. The overall Pearson's correlation coefficient was r= -0.237 (p=0.005). CONCLUSIONS: Lower serum calcium levels may be associated with more severe clinical findings at the onset of stroke.

SHORT STATURE: WHA T IS THE CAUSE IN OUR POPULATION.

BACKGROUND: Globally children and adolescents with growth failure are referred to specialized units for evaluation and management. We designed this study to determine the cause of short stature in children and adolescents referred to our endocrine unit for evaluation and further management. METHODS: This descriptive cross sectional study was performed in the Department of Endocrine, Diabetes and Metabolic Diseases, Hayatabad Medical Complex, Peshawar. Children and adolescents between 2-20 years with height below 2 SDS or less then 3rd percentile for their age and gender were included while those with kyphoscoliosis, thalassemia major, diabetes mellitus type-1 were excluded. Detailed history was obtained followed by detailed physical examination and a pre-set penal of investigations. RESULTS: Seventy-three children with mean chronological age of 11.75.3 ± 4.06 years, 56.31% boys and 43.83% girls (p < 0.05) were included. Mean height was 117.28 ± 17.55 cm, -4.23 ± 2.06 SDS below for this population age group. Mean parental height was 156.87 ± 11.82 cm, mean bone age was 8.56 ± 4.03 years while mean bone age delay was 3.23 ± 1.94 years. Common causes found were variants of normal growth present in 38.35%. Constitutional Delay of Growth and Puberty (CDGP) were found in 13.7%, Familial Short Stature (FSS) in 11.0% while overlapping features of both in other 13.7%. Isolated Growth Hormone Deficiency (GHD) was found in 23.3%, primary hypothyroidism in 9.6% and pan- hypopituitarism in 2.7%. Common non endocrine causes found were Turner's syndrome, rickets, chronic anaemia, bronchial asthma and achondroplasia. CONCLUSION: Isolated GHD, CDGP and FSS, primary hypothyroidism and Turner's syndrome are the most common causes of short stature in our set up.

Quality Evaluation of Biscuits Supplemented with Alfalfa Seed Flour.

The effect of alfalfa seed flour supplementation on the quality characteristics of refined wheat flour-based biscuits was studied. The proximate composition of refined wheat flour and alfalfa seed flour was determined. Refined wheat flour contained 12.43% moisture, 11.52% crude protein, 1.61% crude fat, 0.71% crude fiber, 1.43% ash and 70.83% nitrogen free extract, while alfalfa seed flour contained 5.79%, 29.49%, 12.71%, 5.53%, 4.80% and 41.73% moisture, crude protein, crude fat, crude fiber, ash and nitrogen free extract correspondingly. Alfalfa seed flour at 5%, 10%, 15% and 20% supplementation levels was incorporated in refined wheat flour to produce composite flour. The biscuits prepared were subjected to quality evaluation. Physical analysis of biscuits disclosed that supplementation of alfalfa seed flour decreased the width from 47.25 to 42 mm and the spread factor from 62.7 to 53.12, while it increased the thickness from 7.53 to 8.10 mm. Supplementation of refined wheat flour-based biscuits with alfalfa seed flour at different inclusion levels significantly (p < 0.05) increased the crude protein content from 10.19% to 15.30%, the crude fiber content from 0.73% to 1.62%, the crude fat content from 17.46% to 21.59% and the ash content from 1.37% to 1.92%, whereas it decreased the moisture content from 3.57% to 3.26% and the nitrogen free extract from 66.90% to 59.32%. The effect of supplementation on the mineral contents of biscuits was also significant (p < 0.05). Potassium, magnesium, calcium, iron and zinc contents increased from 105.30, 14.65, 43.91, 3.74 and 0.94 to 145.00, 26.64, 79.60, 7.93 and 1.60 mg/100 g, respectively. Sensory evaluation revealed that the quality score of biscuits in terms of color, taste, texture and overall acceptability decreased with increased supplementation. The present research work confirmed that a maximum of 10% alfalfa seed flour supplementation in refined wheat flour could produce acceptable biscuits with an appropriate nutritional profile.

Frequency Of Common Bacteria And Their Antibiotic Sensitivity Pattern In Diabetics Presenting With Foot Ulcer.

BACKGROUND: Foot ulcers are one of the most important complications of diabetes mellitus and often lead to lower limb amputation. Diabetic foot ulcers are susceptible to infection. The objective of this study was to determine the frequency of common bacteria infecting these ulcers and their antibiotic sensitivity pattern. METHODS: This descriptive cross-sectional study was performed in the Departments of Medicine and Surgery, Khyber Teaching Hospital, Peshawar from April, 2011 to February, 2012. Specimens collected from ulcers of 131 patients were inoculated on Blood Agar and MacConkey Agar, and antibiotic sensitivity was tested using standard disc diffusion method. RESULTS: Out of 131, specimens from 120 patients yielded 176 bacteria. Sixty-six patients had monomicrobial infection while polymicrobial growth was obtained in 54 patients. Overall, Staphylococcus aureus (38.6%) was the most common isolate followed by Pseudomonas aeruginosa (27.3%). Staphylococcus aureus was most often sensitive to Moxifloxacin, Imipenem/Meropenem, Vancomycin and Linezolid while it showed varying sensitivity to Penicillins and Cephalosporins. 47.1% isolates of Staphylococcus aureus were resistant to Methicillin. Most of the gram negative rods were sensitive to Imipenem/Meropenem, Piperacillin-Tazobactam and Ticarcillin-Clavulanate. Majority of gram negative bacteria were found resistant to Cephalosporins and Moxifloxacin except Pseudomonas which showed variable sensitivity to Ceftriaxone, Ceftazidime and Moxifloxacin. CONCLUSIONS: Majority of isolates were found resistant to the commonly used antibiotics. Most commonly isolated bacterium, Staphylococcus aureus was most often sensitive to Moxifloxacin, Imipenem/Meropenem, Vancomycin and Linezolid, while majority isolated gram negative rods were sensitive to Imipenem/Meropenem, Piperacillin-Tazobactam and Ticarcillin-Clavulanate.

Association Of Serum Total Bilirubin Level With Diabetic Retinopathy In Type 2 Diabetes Mellitus.

BACKGROUND: Serum bilirubin has anti-inflammatory, antioxidant and immunological properties. It is considered a protective substance against atherosclerotic and microvascular complications of diabetes mellitus (DM). This study was designed to find the association between total serum bilirubin concentration and diabetic retinopathy (DR). METHODS: This case control study was conducted in the Department of Endocrinology, Diabetes and Metabolic Diseases, Hayatabad Medical Complex, Peshawar. Type-2 DM patients more than 18 years of age of either gender with duration of T2DM more than 6 months were included and sub categorized in two groups. Cases (DM with DR) and Controls (DM without DR) while patients with acute and chronic liver diseases, haemolytic anaemia, history of chronic alcohol consumption, use of hepatotoxic drugs (anti-tuberculous, anti-epileptic), women on oral contraceptive pills were excluded. All participants underwent ophthalmic examination at diabetic retinopathy screening clinic followed by pre designed set of investigations. RESULTS: A total of 152 patients, 76 cases and 76 controls were included. Serum bilirubin concentration was found inversely and independently (p 0.000) associated and inversely co related (r -0.345and p 0.000) with prevalence of DR. Cases were concentrated in the lower quartiles of serum bilirubin concentration and vice versa. Low haemoglobin (p 0.00) and longer duration of DM (0.003) were independently and directly associated with prevalence of DR. CONCLUSIONS: Serum bilirubin concentration is inversely and independently associated and inversely correlated with the prevalence of DR and may predict progression of DR over time.

KNOWLEDGE OF DIABETIC COMPLICATIONS IN PATIENTS WITH DIABETES MELLITUS.

BACKGROUND: The prevalence of diabetes mellitus has risen exponentially over the last three decades, with resultant increase in morbidity and mortality mainly due to its complications. Limited data is available regarding the awareness and knowledge about these complications in our population. This study was carried out to evaluate the knowledge of diabetic complications in patients with diabetes mellitus. METHODS: This cross-sectional study was conducted in the Medical B Unit of Department of Medicine Khyber Teaching Hospital, Peshawar. All admitted diabetic patients above 15 years of age with duration of diabetes mellitus more than one year were included. RESULTS: Out of the 96 patients questioned, 58 were females and 38 were males. Mean age was 53.29 +/- 10.821 years while the mean duration of diabetes mellitus was 9.75 +/- 7.729 years. Of the total 76 (79.1%) of the patients were illiterate; 36 (37.50%) had good, 24 (25%) had average and 36 (37.50%) had poor knowledge about diabetic complications. Males and university graduate patients had slightly better knowledge. Between 50-60% patients were aware of different cardiac complications of diabetes mellitus. Awareness regarding other complications was foot ulcer/gangrene 70 (72.91%), poor wound healing 68 (70.83%), stroke 54 (56.25%), renal diseases 64 (66.66%), eye diseases 53 (55.20%), gastroparesis and other gastrointestinal problems 45 (46.87%), diabetic ketoacidosis 55 (57.29%), hypoglycaemia 50 (52.08%), lipid abnormalities 26 (27.08%) and symptoms of diabetic neuropathy ranging from 47-65%. CONCLUSIONS: Majority of diabetic patients are unaware of diabetic complications. Therefore, hospital and community based awareness programs should be launched to decrease the morbidity and mortality associated with diabetes mellitus.

EFFICACY OF 5 MG AND 10 MG ROSUVASTATIN IN TYPE-2 DIABETES MELLITUS WITH HYPERCHOLESTEROALEMIA.

BACKGROUND: Coronary Heart Disease (CHD) is the most important complication and the leading cause of death in patients with type 2 diabetes mellitus (T2DM). Hypercholesterolemia is an important modifiable risk factor for CHD. Statins are the first line drugs for the treatment of hypercholesterolemia in DM. Comparative studies between different statins are available but different doses of the same statin have not been compared in our population. The objective of this study is to compare mean reduction in serum LDL-C level after using 5mg and 10mg of rosuvastatin among T2DM patients with hypercholesterolemia. This study will help finding lowest effective dose of rosuvastatin to achieve internationally set low density lipoprotein cholesterol (LDL-C) goals. METHODS: A total of 82 patients with T2DM having fasting LDL-C levels equal or more than 100mg/dl were randomly allocated into two groups with 41 patients in each group. Baseline fasting serum LCL-C levels were obtained in all patients. Group A received 5mg while group B received 10mg of rosuvastatin daily at night. After 6 weeks, fasting LDL-C levels were obtained and analysed to compare the mean±SD reduction of LDL-C levels in both groups. RESULTS: Baseline mean±SD LDL-C levels in group A and group B were 134.12±30.02 and 143.49±32.01 respectively (p 0.176). Follow up mean±SD LDL-C levels were 81.59±28.47 and 83.24±36.06respectively (p 0.818). Mean±SD reduction in LDL-C levels from baseline levels in group A and group B were 52.51±19.49 and 60.20±24.09 (p 0.116). CONCLUSION: Rosuvastatin 5mg is as effective as 10mg in reducing the LDL-C levels in type 2 diabetic patients with hypercholesterolemia.

Mammalian bite injuries to the head and neck region.

OBJECTIVE: To determine the frequency and presentation of mammalian bite injuries to the head and neck region seen in a plastic surgery unit. DESIGN: Observational study. PATIENTS AND DURATION OF STUDY: The Plastic and Reconstructive Surgery Unit, PGMI, HMC, Peshawar from July 1999 to June 2003. PATIENTS AND METHODS: During the study period 40 patients presented with mammalian bite injuries to the head and neck region. Information about patient's demographics, biting animal, circumstances of sustaining injury, duration of injury, location and extent of injury, treatment administered, cosmetic outcome and complications were noted. RESULTS: The mammalian bite injuries accounted for 10% of patients managed within the study period for soft tissue injuries to the orofacial region. Among the 40 cases studied, 3 patients were females and 37 were males. Age ranged from 2.5 years to 71 years with the mean of 23 years. The duration of injury varied from 1 hour to 1 year (median 3+2 days). Mammals implicated were humans, dogs, horse, donkey, bear and wolf. All of the 40 patients presented with head and neck injury. Auricular injury was seen in 10 patients, lip injuries in 10 patients, nasal injuries in 10 patients, cheek injuries in 6 patients and scalp injuries in 4 patients. In 70% (28) of cases avulsion of tissue (type-III) was noted. Patients presenting earlier for treatment achieved better cosmesis than the patients presenting late in the course of their injury. CONCLUSION: Mammalian bite injuries to the head and neck region can result in facial disfigurement with distressing physical and psychological consequences. Early management of such complex injuries usually guarantees satisfactory outcome.

Management of postburn digital flexion contractures.

OBJECTIVE: To determine the outcome of plantar/palmer skin graft for the management of postburn digital flexion contracture in terms of functional and cosmetic improvements. DESIGN: Interventional quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Plastic and Reconstructive Surgery, PGMI, Hayatabad Medical Complex, Peshawar. The duration of the study was 1-1/2 years (from January 2001 to June 2002). PATIENTS AND METHODS: Fifty patients with postburn digital flexion contracture were recruited in the study. Patients with posttraumatic and postinfective contractures were excluded from the study population. The contracture was released and the deficit produced was replaced by plantar/palmer split skin graft. Active range of motion (ROM) was measured before and after surgery. Postoperative follow-up was done for one year. The outcome measurements were color and texture match of graft with the adjacent palmer skin, sensibility, recurrence rate of contracture and donor site morbidity. The data collected was labeled with the help of statistical package for social sciences (SPSS) and descriptive statistics were calculated accordingly. RESULTS: The graft take was complete (100%) in 48 patients, 50% in one patient (2%) and nil in one (2%) patient. Recurrence of contracture occurred in 5 patients (10%). Pre-operative median active range of motion (ROM) at proximal interphalangeal (PIP) joint was 60 degree to 90 degree (extension/flexion). Postoperatively median active range of motion (ROM) at PIP joint was 0 degree to 90 degree at one year follow-up examination. The healed graft showed good colour and texture match with the surrounding palmer skin. The sensory function return was satisfactory and there was no significant donor site morbidity. CONCLUSION: The excellent colour, texture match and the functional advantages in terms of active range of motion and sensibility offered by the split thickness palmer/plantar skin grafts exceeded the expected outcome of conventional techniques (thigh, groin and buttock skin grafts).