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Objective: To compare outcomes (plantar fascia thickness, Visual analogue scale scores, role and maudsley scores of satisfaction and complication) of ultrasound guided plasma rich protein injection and steroid injection in chronic plantar fasciitis. Study Design: Quasi experimental study. Place and Duration of Study: Department of orthopedics, Sheikh Khalifa Bin Zayed Al Nahyan/Combined Military Hospital (CMH), Muzaffarabad, from Jun 2018 to Jun 2019. Methodology: Plantar fasciitis patients were selected through non probability consecutive sampling. Patients were randomly divided into two groups, group A received ultrasound guided PRP injection while group B received steroid injection. Both groups were followed for outcomes for 6 months. Results: Total 42 patients were included in study. There were 20 (47.6%) male and 22 (52.4%) female. Mean age of patients was 42.6 years ± 9.5 SD. Plasma rich protein group showed significantly low visual analogue scores (p<0.01), American Orthopedic foot and ankle scores (p<0.01), reduced plantar fasciitis thickness (p<0.01), Roles and Maudsley satisfaction scores (p<0.01). Age and gender showed insignificant association with outcomes (p=0.538 & p=0.653 respectively). Conclusion: Ultrasound guided Plasma rich protein injection is a safe, well tolerated and effective method of plantar fasciitis management with long lasting accuracy as compared to steroid injection. Early diagnosis and management of plantar fasciitis leads to better health outcomes. [ABSTRACT FROM AUTHOR]

Background: Distal radius fractures account for most of the injuries presenting in trauma centers. Colle's fractures are defined as fractures within 2.5 cm of the wrist with dorsal angulation of the distal fragment. The cornerstone of treatment remains immobilization of the wrist in a cast. The objective of the study was to determine the outcome of closed reduction and plaster cast immobilization of Colle's fractures in adults using Radiological parameters. It was a descriptive case series study, conducted at the Department of Orthopaedics Sheikh Khalifa Bin Zayed Al Nahyan /CMH Muzaffarabad Azad Kashmir from June 2018 to June 2019. Methods: Patients with distal radius fractures fulfilling the criteria of Colle's fractures presenting in the Emergency Department were selected through non-probability consecutive sampling. They were managed as per stated protocols and followed up for 06 months. Results: A total of 106 patients of either gender were included in this study. The average age of patients was 30.36±4.12. Fall on an outstretched hand is the major cause of Colle's fracture. In the older age group, most of the fractures are caused by falls while trauma was responsible for the younger age group. Normal post reduction radial inclination was seen in 72% cases; dorsal angulation was normal in 75% while post reduction height was normal in 91% cases. Post reduction radiological parameters were excellent in 49% and good results were seen in 40%. Poor post reduction anatomical results were found in 11% of cases. Overall, the Stewart Anatomical score was 84/100 (p<0.01). Conclusion: A large majority of Colle's fractures achieved excellent Radiological results after treatment by closed reduction and cast immobilization. [ABSTRACT FROM AUTHOR]

Chemotherapy, radiotherapy, surgery and depression are the conditions that run in parallel fashions. All these conditions cause the release of an increased amount of serotonin in the body. Serotonin acts on these 5HT3 receptors and causes nausea and vomiting. Ondansetron acts by blocking serotonin from acting on the receptors and thus is useful in decreasing episodes of nausea and vomiting but when used concomitantly with SSRIs (selective serotonin reuptake inhibitors) as cancer patient also suffered from depression. This combination tends to decrease the efficacy of ondansetron. The present study was carried out to observe the modulatory role of ondansetron on ileal smooth muscle motility in vitro. Experiments were performed in four groups (n=6) and ileal smooth muscle activity was recorded on the power lab (USA). The effects of increasing concentrations of serotonin, ondansetron and paroxetine alone were observed. In the fourth group effects of paroxetine in the presence of fixed concentration (1ml) of ondansetron (10-6M) was observed. The maximum response obtained by serotonin served as a control for our study (100%). Paroxetine response on intestinal motility was completely blocked in the presence of ondansetron. Our findings hence, reinforce the hypothesis that paroxetine decreases the antiemetic activity of serotonin antagonist ondansetron, by super sensitization of serotonergic receptors resulting in an increased incidence of nausea and vomiting in cancer patient despite adequate antiemetic prophylaxis. [ABSTRACT FROM AUTHOR]

Background: In the past few decades there is rapid advancement in technology and hence tremendous innovations in diagnostic imaging. This has increased our ability to diagnose illness and monitor response to treatment in a manner which was not previously possible. As compared to previous times, there is also more easy availability of these diagnostic imaging modalities in our hospitals. Therefore, easy and frequent availability harbour the risk of injudicious use of these tests as well. This study is conducted to know the views of consultants about it. Methods: This cross-sectional descriptive study was conducted in Ayub Medical Institute MTI from March 2021 to July 2021. The data was collected through a self-administered anonymous questionnaire. Results: A total of 250 clinicians participated in the study with 54% males. Majority of them (n=140) 56% answered that consultants on round and on duty in OPD decide special radiological investigations for the patients. Most of them (90%, n=225) were aware of radiation hazards in CT, X-rays and fluoroscopy. Conclusion: The referring physicians working at MTI ATH Abbottabad have enough basic knowledge regarding the practice of radiological modalities but were unaware of specific health hazards and radiation doses to the patients associated with the use of these imaging modalities. [ABSTRACT FROM AUTHOR]

Background: Behavioral associated disturbance involves excitotoxic quinolinate in alcohol withdrawal syndrome in man due to increase availability of tryptophan. In present study we investigated alcoholism related clinical features in relation to tryptophan and 5-HT levels in rat’s model. Methods: Locally bred male Wistar rats, weighing 200–250 g were housed separately into 6 animals/group with 12 h light: dark cycle at room temp 22±3 °C. They were given diet ad libitum, for three days then alcohol 8% (v/v) was added into the liquid diet. Matched control rats of each group were given maltose-dextrin as a substitute of alcohol. Alcohol withdrawal syndrome was assessed after 7 hours by replacing the alcohol-containing liquid diet with tap water. Results: Alcohol withdrawal group showed significant increase (p<0.001) in holo, apo, and total tryptophan 2, 3 dioxygenase enzyme activities, no significant change in brain tryptophan and 5HIAA however significant decrease (p<0.001) in brain 5HT was observed when compared with chow controls. Both alcohols administered and withdrawal groups showed significant rise in serum corticosterone by p<0.05 and p<0.001 respectively. Liver quinolinic acid concentrations were increased significantly (p<0.01) with robust increase in alcohol withdrawn rats. Conclusion: We conclude that the excitotoxin tryptophan metabolite quinolinic acid of peripheral origin plays significant role in the behavioral manifestation of the alcohol withdrawal syndrome. Tryptophan metabolites should be targeted to develop new strategies in the progress of pharmacological interventions related to alcoholism. [ABSTRACT FROM AUTHOR]

The present study aims to investigate the neurochemical and behavioral effects of alcohol withdrawal (AW) syndrome in rats. Serotonergic antidepressants such as Citalopram and tianeptine at a dose of 20mg/ kg were tested separately for their ability to prevent seizures in AW groups of rats. Brain regional tryptophan (TRP), 5-hydroxytryptamine (5-HT; serotonin), 5-hydroxyindoleacetic acid (5-HIAA) concentrations were determined using high-performance liquid chromatography connected to the fluorimetric detector. Data analyzed showed increases brain TRP concentrations in all the three regions (amygdala, hippocampus and hypothalamus) after citalopram administered alcohol withdrawn rats; however, tianeptine increases brain TRP concentrations only in amygdala and hippocampus. Increases in brain serotonin concentrations were seen in all the regions only in citalopram administered alcohol withdrawn rats. Further, tianeptine was shown to increase 5-HT turnover in all the regions, however, citalopram appeared to increase 5-HT turnover only in the hippocampus. It is concluded that the citalopram and tianeptine behave differently on the intrinsic pathway of serotonin metabolism that appeared to be compensated by the pattern of 5-HT release. Further, it could be inferred that exposure of serotonergic agents might restore serotonin reuptake mechanism that is desensitized following chronic alcohol exposure. Thus the inclusive approach of the serotonergic system plays an undoubted role in the pharmacological management of AW syndrome. [ABSTRACT FROM AUTHOR]

Background: Integration of Radiology is challenging because in the traditional system it is introduced with a clinical subject while in an integrated curriculum, vertical integration of Radiology is done with anatomy in the first year and with pathology, forensic medicine, ophthalmology, ENT, gynaecology surgery, and medicine till the final year. This study was done with the purpose to evaluate Radiology teaching in an integrated curriculum in undergraduate students of Azad Jammu Kashmir Medical College/Sheikh Khalifa Bin Zaid Hospital Muzaffarabad. Method: This study was done to determine student's perceptions regarding Radiology teaching at Azad Jammu Kashmir Medical College (AJKMC), starting from the foundation module of the first year till the final year. It was a descriptive cross-sectional type conducted in the Radiology department of AJKMC. The study duration was six months. Students of final year and recent graduates were included in the study. All the information was collected on pro forma. Pro forma included 11 structured, close-ended, quantitative types of questions. Five points Likert scale was given starting from strongly agree to strongly disagree. Data was analysed by descriptive statistics. Results: In 100 students who gave feedback, the age range was from 23 to 26 year. Male students were 32 (32%) and female 68(68 %). 70% of students agreed and 14% strongly agreed for the integration of Radiology at the undergraduate level. Six percent students disagreed with the integration of radiology at the undergraduate level. Conclusion: Integration of Radiology in a modular system for undergraduate students at AJKMC was supported by the majority of participants. [ABSTRACT FROM AUTHOR]

Present study aims to depict the role of serotonergic pathways in discrete brain areas (hypothalamus, amygdala, and hippocampus) and their interaction with hypothalamic pituitary adrenal (HPA) axis in alcohol dependence and subsequent withdrawal syndrome in rats. Albino Wistar rats were fed a liquid diet containing alcohol for 4 weeks. Matched control rats were fed isocaloric amounts of the alcohol-free liquid diet, in which the alcohol contribution was substituted with maltose-dextrin. Brain regional tryptophan, 5-hydroxytryptamine (5-HT), 5-Hydroxyindoleacetic acid (5-HIAA) concentrations were determined using high performance liquid chromatography with flourimetric detector. Serum corticosterone was determined spectrofluorimetrically. Data analysis showed that there was significant increase in tryptophan (hippocampus), 5-HT (hippocampus and amygdala) and 5-HT turnover in all the three regions examined when alcohol administered rats were compared with matched controls. In contrast withdrawal from alcohol decreased brain tryptophan, 5-HT and its turnover. It is concluded that the prolong alcohol use boost functions of serotonergic neuronal pathways, in particular, hypothalamus that regulate HPA-axis function and develop tolerance and adaptation. In addition, withdrawal from alcohol exacerbates serotonergic functions that results in failure to suppress corticosterone levels and hence induce low mood states and other signs and symptoms of alcohol withdrawal syndrome. [ABSTRACT FROM AUTHOR]

We aimed to investigate the effects of herbal St. John's Wort (SJW) on transcriptional regulation of hepatic tryptophan 2, 3 - dioxygenase (TDO) enzyme activity and brain regional serotonin (5-HT) levels in rats exposed to forced swim test (FST). TDO mRNA expression was quantified using real-time reverse transcription polymerase chain (RT-PCR) reaction and brain regional indoleamines were determined by high performance liquid chromatography coupled to fluorescence detector. Behavioral analysis shows significant reduction in immobility time in SJW (500mg/kg/ml) administered rats. It was found that pretreatment of SJW to rats did not prevent stress-induced elevation in plasma corticosterone levels however it increases serotonin synthesis by virtue of inhibiting hepatic TDO enzyme activity and its gene expression, ascertaining the notion that there exists an inverse relationship between hepatic TDO enzyme activity and brain 5-HT. The drug also decreases serotonin turnover in all the brain areas (hypothalamus, hippocampus amygdala) in stressed rats endorsing its monoamine oxidase inhibition property. Inhibition of TDO enzyme activity and its gene expression by the drug provides new insights for the development of therapeutic interventions for stress related mental illnesses. [ABSTRACT FROM AUTHOR]

The aim of present study is to see the effects of antidepressants in relation to tryptophan metabolism and disposition and to know whether they share any common mechanism of action in this regard. These are the monoamine oxidase inhibitor (moclobemide), atypical tricyclic (tianeptine), selective serotonin reuptake inhibitors (SSRIs) namely sertraline and citalopram and an herbal St John's Wort (SJW). Liver tryprophan pyrrolase activity, serum tryptophan, corticosterone and brain indoles were determined after drug administration in Albino Wistar rats at a dose of 10mg/kg. All five antidepressants inhibited tryptophan pyrrolase activity. Serum total tryptophan concentrations were increased by 19% and 33% by tianeptine and moclobemide respectively, however 34% decrease in total tryptophan was observed after SJW administration. Free tryptophan was increased by all the drugs being maximum (65% P<0.001) by sertraline and minimum (15%, P<0.05) by tianeptine. Corticosterone levels were significantly (P<0.01) decreased by 52 and 58 percent by citalopram and St John's Wort respectively. By contrast an increase by 16% was observed by tianeptine. It was also observed that all the drugs increase brain tryptophan by 21-61 percent but increases in 5-hydroxytryptamine (5-HT) were observed only by two drugs that is moclobemide and SJW, however in comparison increases were greater (68%) after SJW administration. 5-hydroxyindoleacetic acid (5HIAA) concentrations were increased by 45- 64% by all other drugs except tianeptine and moclobemide. It is concluded that attenuation of peripheral tryptophan metabolism and elevation of brain tryptophan contributes to the mechanism of action of antidepressants of different classes and pharmacological profile tested. [ABSTRACT FROM AUTHOR]