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Objectives: To determine the prevalence of violence among medical doctors in public sector hospitals of Karachi relating to physical violence, psychological violence (verbal and bullying/mobbing), sexual harassment and racial harassment). Methods: A cross-sectional study was carried out in three public sector hospitals in Karachi (JPMC, Civil Hospital and Sindh Government Lyari General Hospital Karachi). Medical doctors of any age and gender who worked in outpatient departments, wards, and emergency departments were eligible to participate in the study. A validated WHO-designed questionnaire was used, with questions about exposure to violence, the source and types of violence, and socio-demographic information. In descriptive statistics, frequencies and percentages were reported for all categorical variables. The Chi-square and Fisher's exact tests were used to investigate the relationship between workplace violence and other types of violence. Results: 350 questionnaires were distributed to qualified medical doctors in total. Only 300 of them responded, for an 85.7 percent response rate. The majority of respondents were under the age of 40, and male gender was slightly more exposed to violence. The majority of the doctors were subjected to verbal abuse as well as bullying and mobbing. Conclusion: It was then concluded that any type of violence was common in doctors aged >35 years and male gender was more exposed to any violence as compare to female gander. The main type of violence was verbal violence in our study, whereas racial harassment and sexual harassment was also seen.

Background and objectives: The enucleation of the pulmonary hydatid cyst is followed by individual closure of bronchial air leaks and obliteration of the residual pericystic cavity by capitonnage, either by circumferential or interrupted transverse suture. The objective of the study was to compare the surgical outcome of transverse and circumferential capitonnage in terms of postoperative recovery course, residual cavitations, air leaks, cavitatory or pleural collections and the recurrence of primary disease after enucleation of the pulmonary hydatid cyst. Methods: Patients with pulmonary hydatid cyst were included in the study and divided into two groups. Each group consisted of 30 patients. Patients of Group-1 underwent enucleation of the hydatid cyst followed by closure of bronchial air leaks with classical circumferential closure of the cavity and patients of Group-2 had enucleation of the hydatid cyst and closure of the cavity by transverse capitonnage. Results: Ten cases (33.33%) of Group-1 had hospital stay for more than 5 days compared to 4(13.33%) in Group-2 (p=0.03). Out of 30 patients who had undergone circumferential closure of the hydatid cavity, 5 (16.67%) patients had residual cavitatory fluid collection while there was none in the other group. In Group-1, 7 (23.3%) cases had reactionary intrapleural fluid collection compared to 2 (6.6%) in Group-2 (p=0.035). After 3 months of follow-up, 4 patients in circumferential capitonnage had mild haemoptysis and 1 had aspergilloma while no such complication occurred in any patient in the transverse capitonnage group. No recurrence of cyst occurred in any case in both groups. Conclusion: There was a considerable advantage of transverse capitonnage of the hydatid lung cavity after enucleation in terms of short hospital stay, minimal or no reactionary intrapleural or intra cavitatory collections and less air leaks. IMC J Med Sci 2021; 15(2): 002 *Correspondence: Farooq Ahmad Ganie, Department of Cardiovascular and Thoracic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar -190011, J & K, India. E-mail: farooq.ganie@yamil.com

Background and objectives: Radiofrequency ablation (RFA) is a recent modality of treatment of the affected varicose vein. In the present study, the outcome of great saphenous varicose vein disease treated byradiofrequency ablation technique was analyzed. Methods: Patients with varicosities of the lower limb affecting mainly the great saphenous vein were (GSV) included. The procedures were carried out under spinal anesthesia. The target varicose vein was accessed by Seldinger technique and the RFA catheter advanced 2 to 3 cm below sapheno-femoral junction under ultrasonography (USG) guidance. A tumescent anesthetic infiltration was given in a solution of normal saline and sodium bicarbonate before the vein being ablated. Results: The success rate of RFA was 97.5 % (39 out of 40). One patient showed episodic recanalisation of vein at one year duplex colour scan. Though the complications related to procedure were negligible, one patient developed endovenous heat induced thrombosis (EHIT) and non-fatal pulmonary thromboembolism (PTE) which was managed adequately. Conclusion: Endovenous RFA is a useful treatment modality for varicose vein disease primarily due to great saphenous insufficiency with marked symptomatic improvement and least recurrence. Although the complications are minimal, EHIT is a potential and serious complication of heat ablation. IMC J Med Sci 2021; 15(1): 006 *Correspondence: Farooq Ahmad Gganie, Department of Cardiovascular and Thoracic Surgery, Sheri-I-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, Kashmir, India. Email ID: farooq.ganie@ymail.com

Background and objective: In transhiatal esophagectomy, iatrogenic injuries to trachea are very uncommon but when it happens it is potentially lethal and has high morbidity. This study aimed to investigate the incidence and outcome of tracheal injuries during transhiatal esophagectomy. Methods: The medical records of 608 patients who underwent transhiatal esophagectomy for esophageal cancer from January 2000 to January 2019 were analyzed. Results: Out of 608 transhiatal esophagectomy, four (0.66%) patients sustained injuries to major airway. Three injuries occurred during transhiatal and one injury during transcervical part of dissection. All the injuries occurred in trachea proximal to carina. All four injuries were closed primarily, re-enforced by muscle and fascial pledgets. Conclusion: Tracheobronchial injury is a rare complication of transhiatal esophagectomy, mostly seen in patients who receive neo-adjuvant therapy or have locally advanced growth with dense adhesions. Its immediate recognition and closure decreases the mortality and morbidity associated with this rare but fatal intra-operative complication. It can be managed effectively by primary closure, with or without muscle and fascial pledget reinforcement. IMC J Med Sci 2021; 15(1): 003. OPEN ACCESS *Correspondence: Farooq Ahmad Gganie, Department of Cardiovascular and Thoracic Surgery, Sheri-I-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, Kashmir, India. Email ID: farooq.ganie@ymail.com

In this work a facile synthesis method is adopted to demonstrate the large mesoporous carbon foam. The green foam was made from fine flour, yeast and xanthan gum were used as a base, leaving agent and binding agent respectively. After the blowing process the foam is placed in a tube furnace for pyrolysis. Finally, the foam heat absorption properties as well as heat retarding properties were established in contrast to traditional aluminum-based heat sink as well as K23 (aluminosilicate refractory) brick.

Fractures in the elderly are often challenging due to osteoporotic bone and co-morbidities and long term disability can occur. Surgery is the standard mode of treatment and hence a quick surgical treatment for early weight bearing and mobilization is required in order to prevent long term complications due to prolonged bed rest. All patients were documented prospectively, complete demographic details and clinical history was obtained. Clinical and radiographic evaluation was done in all the patients. Informed consent was taken and all patients were treated with DFLCP and retrograde nailing randomly. Duration of hospitalization was documented and follow up was done for 2 years. In this study, fracture union time was12-24 weeks with among the patients of the DLFP group with 75 percent have union and was 12-24weeks among the patients of the retrograde nailing group with union occurring in 80 percent of patients respectively. Significant results were obtained while comparing the mean fracture union time among the patients of the two study groups. In our study, follow up was done up to 2 years with 60% of patients followed up to 15 months in both the groups.

Plants have been reported showing strong antimicrobial properties. Investigation of plants originated antibiotic agents explored a new chapter in the field of pharmacology. This study was designed to screen Argemone mexicana L. for its antibiotic properties and its positive effect against pathogenic bacteria and fungi. Flowers, berries and leaves were extracted from three solvents (methanol, ethanol and chloroform) and Antibacterial and antifungal activates were performed through agar disc diffusion and agar tube dilution methods, respectively. Antibacterial activity of ethanol, methanol and chloroform was about 80% against maximum bacterial strains. Antifungal activity was observed more than 50%. Crude plant extracts were potent 50–60% against A. fumigates while above 75% against A. niger. Keywords: Ethanolic extract, Antifungal, Antibacterial, Bioassays, Argemone mexicana

Metallic nanoparticles, such as gold nanoparticles (AuNPs), have been extensively studied as drug delivery systems for various therapeutic applications. However, drug-loaded-AuNPs have been rarely explored in vivo for their effect on bacteria residing inside tissues. Ciprofloxacin (CIP) is a second-generation fluoroquinolone with a broad-spectrum of antibiotic properties devoid of developing bacteria resistance. This research is focused on the synthesis and physical characterization of Ciprofloxacin-loaded gold nanoparticles (CIP-AuNPs) and their effect on the colonization of Enterococcus faecalis in the liver and kidneys of mice. The successfully prepared CIP-AuNPs were stable and exerted enhanced in vitro antibacterial activity against E. faecalis compared with free CIP. The optimized CIP-AuNPs were administered (500 µg/Kg) once a day via tail vein to infected mice for eight days and were found to be effective in eradicating E. faecalis from the host tissues. Moreover, unlike CIP, CIP-AuNPs were non-hemolytic. In summary, this study demonstrated that CIP-AuNPs are promising and biocompatible alternative therapeutics for E.-faecalis-induced infections resistant to conventional drugs (e.g., beta-lactams and vancomycin) and should be further investigated.

The current study aimed to develop poloxamer 407 (P407) gel for transungual delivery of antifungal hydrophobic drugs with sufficient gel strength and drug loading. Gel strength and drug loading of P407 gel was improved by use of functional additives. Hydration enhancement effect was used to select optimum nail penetration enhancer. Face-centered central composite design (FCCCD) was used to observe the effect of the selected penetration enhancer (thioglycolic acid (TGA)) and cosolvent (ethanol) on gelation behavior to develop formulation with enough loading of hydrophobic drug, i.e., terbinafine HCl (TBN), and its permeation across the nail plate without compromising on gel strength. It was observed that increasing concentration of P407 and TGA significantly reduced gelation temperature and enhanced the gel strength of P407 gel and can be used to improve P407 gel strength. Under the scanning electron microscope, the significant effect of TGA as an ungual penetration enhancer was observed on the morphology of the nail plate. Optimized P407 gel prepared with modified cold method showed a gelation temperature of 8.7 ± 0.16 °C, gel strength of 122 ± 7.5 s and drug loading of 1.2% w/w, which was four times more than the drug loading in the gels prepared with conventional cold method. Rheological behavior was pseudoplastic with 47.75 ± 3.48% of gel erosion after 12 washings and 67.21 ± 2.16% of drug release after 12 h. A cumulative amount of TBN permeated from P407 gel with and without PE after 24 h was 27.30 ± 4.18 and 16.69 ± 2.31 µg/cm2, respectively. Thioglycolic acid can be used as a nail penetration enhancer without the chemical modification or addition of extra additives while retaining the gel strength. Water miscible cosolvents with moderate evaporability such as ethanol, can be incorporated to P407 gel by minor modification in method of preparation to load the required dose of hydrophobic drugs. Developed P407 gel formulation with sufficient gel strength and drug loading will be a promising carrier for transungual delivery of hydrophobic antifungal agents.

Cryptosporidium spp. is a protozoan having the potential to cause zoonosis in humans and animals. Despite the zoonotic importance of this protozoan parasite, limited data are available about its prevalence in zoo felids in North-Eastern China. Hence, the current study was designed to determine the occurrence and molecular characterization of Cryptosporidium spp. from the fecal samples of captive zoo felids. Fecal samples (N = 244) were collected from different felids from five different zoos of North-Eastern China. 18S rRNA gene was amplified from the genomic DNA using species specific primers in nested polymerase chain reaction (nPCR) and Cryptosporidium parvum and Cryptosporidium spp. was found. The overall prevalence of Cryptosporidium was 9.43% (23/244). The 18S rRNA gene similarity analysis showed that 6 Cryptosporidium isolates were Cryptosporidium parvum and the remaining 17 Cryptosporidium isolates were resembling to a Cryptosporidium spp., which is similar to Cryptosporidium NEV10. Phylogenetic tree was constructed based on 18S rRNA of Cryptosporidium spp. The similarity of Cryptosporidium parvum was with its other isolates in China, India, Iran, Iraq, Turkey, Czech Republic, Spain and USA while Cryptosporidium NEV10 alike had a close relationship with Turkish isolates. In conclusion, Cryptosporidium was prevailing in feline animals of China zoo and zoo officials are directed to consider their control policy as it can be a cause of zoonosis.

Recurrent traumatic posterior dislocation of the hip is a rare entity in the paediatric age group. We report an exceptional case of a 5-year old boy who sustained a posterior dislocation of the right hip joint following recurrent trivial trauma while playing, three times in the past one and half year. On literature review, we found that only a few cases have been reported and the management options still remain controversial.

The fruits of Trapa bispinosa (TB) and seeds of Trigonella foenum-graecum (TF) are used for their nutraceutical properties in various systems of traditional medicine practiced in India. In this stu...

Background South Asia has become a major epicentre of the COVID-19 pandemic. Understanding South Asians’ awareness, attitudes and experiences of early measures for the prevention of COVID-19 is key to improving the effectiveness and mitigating the social and economic impacts of pandemic responses at a critical time for the Region. Methods We assessed the knowledge, behaviours, health and socio-economic circumstances of 29,809 adult men and women, at 93 locations across four South Asian countries. Data were collected during the national lockdowns implemented from March to July 2020, and compared with data collected prior to the pandemic as part of an ongoing prospective surveillance initiative. Results Participants were 61% female, mean age 45.1 years. Almost half had one or more chronic disease, including diabetes (16%), hypertension (23%) or obesity (16%). Knowledge of the primary COVID-19 symptoms and transmission routes was high, but access to hygiene and personal protection resources was low (running water 63%, hand sanitisers 53%, paper tissues 48%). Key preventive measures were not widely adopted. Knowledge, access to, and uptake of COVID-19 prevention measures were low amongst people from disadvantaged socio-economic groups. Fifteen percent of people receiving treatment for chronic diseases reported loss of access to long-term medications; 40% reported symptoms suggestive of anxiety or depression. The prevalence of unemployment rose from 9.3% to 39.4% (P, Highlights • South Asia has become a major epicentre of the COVID-19 pandemic and faces multiple challenges (health, economic, social). • Our findings identified important knowledge, access and uptake barriers to the prevention of COVID-19 in the region. • We demonstrated adverse impacts on chronic disease treatment, mental health, health behaviours, employment, finances. • There is a need for immediate large-scale action to close gaps in knowledge and access to essential resources for prevention. • Along with measures to safeguard economic production and mitigate socio-economic impacts on the young and the poor.

Objective: To determine the chances of adjacent segment disease (ASD) and risk factors after posterior lumbar interbody fusion (PLIF). Material and Methods: 110 patients of both genders with degenerative lumbar instability at L4/5 level were included in my study. We did PLIF in all our patients and followed our patients for one year. The following parameters were measured: the degree of lumbar lordosis, the degree lumbosacral angle, the disc space height and their dynamic angulation and the displacement of L3 over L4. We checked the outcome with the help of the Japanese orthopedic association (JOA) and Oswestry disability index (ODI). We divided the patients into groups A and B; group A includes patients with progression of degeneration at the proximal level (L3-L4), while group B with no progression of disease at proximal level. Results: The 86 patients (78.18%) were in group A, and 24 patients (21.88%) were in group B. There were no significant difference in radiological parameters of both groups; lumbosacral angle of lordosis, L3 laminar inclination angle, preoperative degenerative changes at proximal level, L4–L5 lordosis and BMD before surgery. The clinically and statistically significant differenceswere of the age of the patients falling in two groups. We found that at the completion of study ODI and JOA were not significantly different in both groups (P >0.05). Conclusion: Degenerative lumbar disease is an age related disease with no significant effect of radiological degenerations on the final outcome of our patients.No other possible risk factor has a significant effect on outcome.

There is an increase in demand on total knee and hip replacement surgeries, which can lead to long waiting list. Hip and knee scoring system is an important tool to help determine the need for early prioritization for surgery.

Morton neuroma is well described problem to metatarsophalangeal Joint (MTPJ) Etiology of Morton’s Neuroma which has wide range of problems from trauma, and nerve hypertrophy etc. Clinical evaluation is very important for diagnosis and sometimes investigations like ultrasound or MRI scan are helpful for conformation of diagnosis. Management varies from orthotics, shoe modification, injections or surgical excision. We are reporting a case which showed importance of surgical exploration when investigation is normal and difficulty in making diagnosis clinically.

Objective: To see outcome, accuracy and expected complications in passing lateral mass screws in patients with cervical spine injury, degenerative disease at the cervical spine level and neoplastic lesions.Materials and Methods: In this study, 35 patients were included and 205 screws passed in lateral mass patients’age ranged from 12-70 years (25 males and 10 females) with trauma to the cervical spine, degenerative disease at the cervical spine level and Intradural extramedullary benigntumors and extradural malignant neoplasm.Patients less than 12 years and more than 65 years of age,patients with traumatic ruptured disc causingspinal cord compression anteriorly and operated for cervical spine were excluded from our study.In all patients,we did lateral mass fixation with polyaxial screws and rods under fluoroscopic assistance.For assessment of screws trajectory and position, CT scan cervical spine with 3D reconstruction was performed on a first post op day to confirm screw orientation and direction and for fascet, foraminal, foramen transversarium violations.Results: All screws were passed by using Megrel’s trajectories. Not a single patient had nerve root, cord injury nor vertebral artery injury. One patient had screw pullouts requiring reoperation.12 to 14mm size screws were used under fluoro guidance. On postoperative CT cervical spine with 3D reconstruction shows no breach or violations of any foramen transversarium, nerve root injury or neural foramen penetration by screws. In all patients polyaxial screw/rod construct was used. Conclusion: Cervical spine lateral mass fixation with polyaxial screws is a safe and effective technique in expert hands under fluoroscopic assistance.

Patient: Male, 46 Final Diagnosis: Unilateral double level Achilles tendon tear Symptoms: Pain • swelling Medication: — Clinical Procedure: Achilles tendon rupture repair Specialty: Orthopedics and Traumatology Objective: Rare disease Background: Unilateral double-level Achilles tendon tear is a rare presentation that has not been previously reported in the English literature. Diagnosis and management of these cases are challenging, and outcomes are not well described in the literature. Case Report: A 46-year-old man presented to us with ankle pain following a football sports injury. Clinical examination and ultrasound scan showed unilateral Achilles tendon double-level partial tears that were managed conservatively. The patient presented again with another trauma and progression to full-thickness tear, managed operatively with open Achilles tendon repair technique. Conclusions: Management of these cases is complex and challenging. In the literature, both operative and non-operative management have been described. However, the recent literature shows no major difference between these 2 methods of treatment. Our case was quite unique, so we decided to use the open repair technique. Awareness about this rare presentation and the need for further research is necessary for proper management of such cases.

Oxidative stress is the process by which reactive molecules and free radicals are formed in cells. In this study, we report the blood-based gene expression profile of oxidative stress and antioxidant genes for identifying surrogate markers of liver tissue in chronic hepatitis C (CHC) patients by using real-time PCR. A total of 144 untreated patients diagnosed with CHC having genotype 3a and 20 healthy controls were selected for the present study. Liver biopsy staging and grading of CHC patients were performed using the METAVIR score. Total RNA was extracted from liver tissue and blood samples, followed by cDNA synthesis and real-time PCR. The relative expression of genes was calculated using the ΔΔCt method. The expression profile of 84 genes associated with oxidative stress and antioxidants was determined in liver tissue and blood samples. In liver tissue, 46 differentially expressed genes (upregulated, 27; downregulated, 19) were identified in CHC patients compared to normal samples. In blood, 61 genes (upregulated, 51; downregulated; 10) were significantly expressed in CHC patients. A comparison of gene expression in liver and whole blood showed that 20 genes were expressed in a similar manner in the liver and blood. The expression levels of commonly expressed liver and blood-based genes were also correlated with clinical factors in CHC patients. A receiver operating curve (ROC) analysis of oxidative stress genes (ALB, CAT, DHCR24, GPX7, PRDX5, and MBL2) showed that infections in patients with CHC can be distinguished from healthy controls. In conclusion, blood-based gene expression can reflect the behavior of oxidative stress genes in liver tissue, and this blood-based gene expression study in CHC patients explores new blood-based non-invasive biomarkers that represent liver damage.

Objectives: To measure correlation and concordance between measured LDL cholesterol (mLDLc) and Friedewald’s calculated LDL cholesterol (cLDLc). To compare the mLDLc and cLDLc values for various anthropometric measures and biochemical indices including insulin resistance, nephropathy, glycated hemoglobin and triglycerides. Methods: Two hundred thirty two subjects were included in this cross-sectional analysis from Jan-2016 to July-2017 from a target population visiting PNS HAFEEZ hospital. Mean age of the subjects was 46.56(±11.95) years (n=232). These subjects underwent clinical evaluation including measurement of anthropometric measurements, biochemical testing for fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), lipid profile, urine albumin creatinine ratio (UACR), and insulin. Correlation and concordance between mLDLc and Friedewald’s cLDLc were measured. Finally, Comparison of risk evaluation for mLDLc and cLDLc between groups formulated based upon UACR (Based upon a cut off of 2.5 mg/g) and fasting triglycerides (Group-1 :< 1.0 mmol/L, Group-2: 1.0-1.99 mmol/L and Group-3 :> 1.99 mmol/) was carried out. Results: There was significant positive linear correlation between mLDLc and cLDLc [r=0.468

Objectives: To Analyze and compare the effect of oral vs parenteral iron therapyon various hematological parameters in women suffering from post-partum iron deficiencyanemia. Study Design: Comparative, randomized and prospective study. Setting: Departmentof Pharmacology, HCMD, HU in collaboration with the Dept of Obs/Gynae, JPMC Karachi.Period: January to December 2015. Subjects and Methods: 40 patients divided in two groupsA and B of 20 each. Group A received oral iron (Tab Iberet 525 mg once daily) for a period of 3months while group B was treated with intravenous iron sucrose complex (Inj Venofer 100mg/Amp) the total no of doses were calculated according to Hemoglobin deficit. Hemoglobin,Hematocrit and MCV were observed at day 0, 45 and 90 of the treatment. Results: Group Ashows a mean increase of 25.85% at day 90th of the treatment in comparison to this group Bshows a much better result with a mean increase of 36.71% in Hemoglobin conc. At the end of12 weeks therapy. Conclusion: Parenteral iron therapy was found to be an effective means oftreatment in patients with postpartum iron deficiency anemia.

Background. Recent literature in lipidology has identified LDL-fractions to be more atherogenic. In this regard, small density LDL-cholesterol (sdLDLc) has been considered to possess more atherogenicity than other LDL-fractions like large buoyant LDL-cholesterol (lbLDLc). Recently, Srisawasdi et al. have developed a method for calculating sdLDLc and lbLDLc based upon a regression equation. Using that in developing world may provide us with a valuable tool for ASCVD risk prediction. Objective. (1) To correlate directly measured and calculated lipid indices with insulin resistance, UACR, glycated hemoglobin, anthropometric indices, and blood pressure. (2) To evaluate these lipid parameters in subjects with or without metabolic syndrome, nephropathy, and hypertension and among various groups based upon glycated hemoglobin results. Design. Cross-sectional study. Place and Duration of Study. From Jan 2016 to 15 April 2017. Subjects and Methods. Finally enrolled subjects (male: 110, female: 122) were evaluated for differences in various lipid parameters, including measured LDL-cholesterol (mLDLc), HDLc and calculated LDL-cholesterol (cLDLc), non-HDLc, sdLDLC, lbLDLC, and their ratio among subjects with or without metabolic syndrome, nephropathy, glycation index, anthropometric indices, and hypertension. Results. Significant but weak correlation was mainly observed between anthropometric indices, insulin resistance, blood pressure, and nephropathy for non-HDLc, sdLDLc, and sdLDLc/lbLDLc. Generally lipid indices were higher among subjects with metabolic syndrome [{sdLDLc: 0.92 + 0.33 versus 0.70 + 0.29 (p<0.001)}, {sdLDLc/lbLDLc: 0.55 + 0.51 versus 0.40 + 0.38 (p=0.010)}, {non-HDLc: 3,63 + 0.60 versus 3.36 + 0.65 (p=0.002)}]. The fact that the sdLDLc levels provided were insignificant in Kruskall Wallis Test indicated a sharp increase in subjects with HbA1c > 7.0%. Subjects having nephropathy (UACR > 2.4 mg/g) had higher concentration of non-HDLc levels in comparison to sdLDLc [{non-HDLc: 3.68 + 0.59 versus 3.36 + 0.43} (p=0.007), {sdLDLc: 0.83 + 0.27 versus 0.75 + 0.35 (p=NS)}]. Conclusion. Lipid markers including cLDLc and mLDLc are less associated with traditional ASCVD markers than non-HDLc, sdLDLc, and sdLDLc/lbLDLc in predicting metabolic syndrome, nephropathy, glycation status, and hypertension.

Background Metabolic syndrome over the years have structured definitions to classify an individual with the disease. Literature review suggests insulin résistance is hallmark of these metabolic clustering. While measuring insulin resistance directly or indirectly remains technically difficult in general practice, along with multiple stability issues for insulin, various indirect measures have been suggested by authorities. Fasting triglycerides-glucose (TyG) index is one such marker, which is recently been suggested as a useful diagnostic marker to predict metabolic syndrome. However, limited data is available on the subject with almost no literature from our region on the subject. Objective 1. To correlate TyG index with insulin resistance, anthropometric indices, small dense LDLc, HbA1c and nephropathy. 2. To evaluate TyG index as a marker to diagnose metabolic syndrome in comparison to other available markers. Design-cross-sectional analysis Place and duration of study-From Jun-2016 to July-2017 at PSS HAFEEZ hospital Islamabad. Subjects and methods From a finally selected sample size of 227 male and female subjects we evaluated their anthropometric data, HbA1c, lipid profile including calculated sdLDLc, urine albumin creatinine raito(UACR) and insulin resistance (HOMAIR). TyG index was calculated using formula of Simental-Mendía LE et al. Aforementioned parameters were correlated with TyG index, differences between subjects with and without metabolic syndrome were calculated using Independent sample t-test. Finally ROC curve analysis was carried out to measure AUC for candidate parameters including TyG Index for comparison. Results TyG index in comparison to other markers like fasting triglycerides, HOMAIR, HDLc and non-HDLc demonstrated higher positive linear correlation with BMI, atherogenic dyslipidemia (sdLDLc), nephropathy (UACR), HbA1c and insulin resistance. TyG index showed significant differences between various markers among subjects with and without metabolic syndrome as per IDF criteria. AUC (Area Under Curve) demonstrated highest AUC for TyG as [(0.764, 95% CI 0.700–0.828, p-value ≤ 0.001)] followed by fasting triglycerides [(0.724, 95% CI 0.656–0.791, p-value ≤ 0.001)], sdLDLc [(0.695, 95% CI 0.626–0.763, p-value ≤ 0.001)], fasting plasma glucose [(0.686, 95% CI 0.616–0.756, p-value ≤ 0.001)], Non-HDLc [(0.640, 95% CI 0.626–0.763, p-value ≤ 0.001)] and HOMAIR [(0.619, 95% CI 0.545–0.694, p-value ≤ 0.001)]. Conclusion TyG index, having the highest AUC in comparison to fasting glucose, triglycerides, sdLDLc, non-HDLc and HOMAIR can act as better marker for diagnosing metabolic syndrome.

Objective: To compare lipid parameters, HbA1c, uric acid and albumin creatinine ratio (UACR) among subjects having euthyroidism, Sub-Clinical Hypothyroidism (SCH) and overt hypothyroidism. Methods: This comparative cross-sectional analysis was carried out from Dec-2015 to Oct-2016 in collaboration between PNS HAFEEZ hospital and department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi. Biochemical parameters including lipid indices, HbA1c and UACR were compared between euthyroidism (TSH: 0.5 to 4.0 mIU/L, n=163), subclinical hypothyroidism (TSH: 4.0 to 10 mIU/L, n=16) and overt hypothyroidism (TSH:≥ 10.0 mIU/L, n=9). Results: LDL-cholesterol, non-HDL-cholesterol and UACR results were as: [(Euthyroid: 2.66 ± 0.73), (SCH: 2.68 ± 0.51) and (Overt hypothyroidism: 3.23 ± 0.59), p-value=0.063], [(Euthyroid: 3.49 ± 0.64), (SCH: 3.35 ± 0.59) and (Overt hypothyroidism: 4.01 ± 0.30), p-value=0.033] and [{Euthyroid: 2.48 (95% CI: 1.63-3.33)}, {SCH: 2.27 (95% CI: 0.37-4.90)} and {Overt hypothyroidism: 14.95 (95% CI: 10.71-19.14){, (p-value< 0.001)] Results for total cholesterol, triglycerides and HDL-cholesterol though increased in overt hypothyroid group were not found to be statistically significant. Conclusion: LDL-cholesterol, non-HDL-cholesterol and UACR increased from euthyroid subjects to overt hypothyroidism group. However, these changes were found to be more subtle in the subclinical hypothyroid subjects than cases with overt hypothyroidism.

Dengue illness has been a major health concern in Pakistan during the last decade. Dengue infection can result in a spectrum of clinically distinct outcomes, ranging from asymptomatic infection to potentially life-threatening forms of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). A single-nucleotide polymorphism in FcγRIIa (rs1801274) results in altered affinity of the receptor for different subclasses of immunoglobulin G, and is a key player in determining the susceptibility to or protection from severe clinical infection of dengue. In this study, we analyzed the allelic and genotypic distribution of rs1801274 in subjects of Pakistani origin with subclinical dengue infection (n = 40), dengue fever (DF) (n = 40), and DHF/DSS (n = 30). We found that HH homozygotes and heterozygotes were significantly more likely to develop clinical dengue (odds ratio [OR] = 3.21, 95% confidence interval [CI] = 1.29–7.97, P = 0.009), either DF (OR = 2.82, 95% CI = 1.00–7.97, P = 0.045) or DHF/DSS (OR = 3.90, 95% CI = 1.13–13.07, P = 0.024) than the asymptomatic dengue infection. Results of allelic distribution comparisons and logistic regression analysis also supported the same relationship. The results suggest complex nature of interacting factors in determining the course for severe dengue illness.

OBJECTIVE: To evaluate the effect of ATP – sensitive potassium channel opener, nicorandil on insulin production in alloxan – induced diabetic rats. METHODS: In an attempt to ascertain the involvement of ATP sensitive potassium channels in the regulation of insulin release, the effect of nicorandil on ATP sensitive potassium channel was studied. Albino rats of Wistar strain, weighing between 200 – 250 grams of e ither sex were used for the study. Diabetes was induced by injecting alloxan monohydrate 2% solution intra - peritoneally in a dose of 150 mg/kg body weight. Animals with fasting blood glucose (FBS) between 200 – 300 mg/dl were selected for the study. They were divided into 3 groups of six animals each. Group I serving as control received 2% gum acacia orally for 30 days, Group II as standard was given orally glibenclamide (0.5 mg/kg body weight) for 30 days & Group III was treated orally for 30 days with n icorandil (0.3 mg/kg body weight) respectively. Fasting blood sugar (FBS) was recorded in all the rats on 1 st , 3 rd , 7 th , 14 th , 21 st & 28 th days. RESULT: Results show that glibenclamide has significantly reduced the blood sugar levels (P

Diagnostic cardiac catheterization was reported in the nineteenth century and interventional cardiac catheterization was first described by Rubio-Alvarez in 1954 for the treatment of pulmonary valve stenosis. In some centres, MRI is increasingly used for diagnostic imaging. To ensure safety and quality images, the majority of these procedures in children require general anaesthesia. Cardiac catheterization may be challenging when dealing with complex congenital cardiac lesions. Good communication between the team members is essential, so that cardiovascular changes can be anticipated and minimized as far as possible. This includes the full team: anaesthetist and assistant, cardiologist, scrub team, radiographer, and a cardiac physiologist. It is a challenging and high-risk field of anaesthetic practice and requires consultant-led care by specialists in paediatrics and congenital heart disease (CHD).

Background: The objective is to evaluate the anticonvulsant activity of nitrendipine in seizure-induced mice. Methods: Albino mice (25-30 g) of either sex were randomly selected and divided into four groups of six mice each. After overnight fasting, Group I received 0.25 ml of propylene glycol and served as the control, Group II received valproic acid (110 mg/kg orally) as standard, Groups III received 5 mg/kg of nitrendipine and 100 mg/kg of valproic acid, Group IV received 5 mg/kg of nitrendipine and 75 mg/kg of valproic acid, and Group V received 5 mg/kg of nitrendipine and 50 mg/kg of valproic acid all of which were administered orally 60 mins prior to the test in this acute study. The anticonvulsant activity was screened using maximal electroshock (MES) model and pentylenetetrazole (PTZ) model. Results: The nitrendipine showed a considerable reduction in the duration of hindlimb extensor phase in MES model and also delayed the latency of seizures induced by PTZ when compared with control group. The probable mechanism of anticonvulsant action of nitrendipine could be due to its interference with the gamma amino butyric acid type aminergic mechanism, modulation of nicotinic, and N-methyl-D-aspartate receptors. Conclusion: Nitrendipine possesses the anticonvulsant activity and has a beneficial role in epilepsy.