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Objectives: To compare the nebulized salbutamol alone with combination of nebulized salbutamol and ipratropium for acute exacerbation of chronic obstructive pulmonary disease in terms of mean length of stay. Study Design: Quasi-experimental study Place and Duration of Study: Department of Medicine, Military Hospital, Rawalpindi Pakistan. Study was carried out over a period of six months from May to Nov 2017. Methodology: A total of 300 patients of chronic obstructive pulmonary disease (150 in each group) were recruited in the study. Group A received nebulized salbutamol (5mg) alone and Group B received a combination of nebulized salbutamol (5mg) and ipratropium bromide (0.5mg). Results: Mean age of the patients was 66.4±6.4 years and 65.7±6.8 years in Group-A and B, respectively. In Group-A, there were 136(90.7%) and in Group-B 134(89.3%) were males while 14(9.3%) and 16(10.7%) were females in Group-A and B, respectively. Mean duration of disease in Group-A was 5.2±2.4 years and in group-B 6.0±1.6 years. Comparison of mean length of stay (days) revealed in hospital between nebulized Salbutamol alone 5.0±0.5 days with combination of nebulized Salbutamol and Ipratropium 4.3±0.6 days with p-value <0.001. Conclusion: In conclusion, the routine addition of nebulized ipratropium bromide to salbutamol appears to be of benefit in the treatment of acute exacerbations of chronic obstructive pulmonary disease and in terms of mean length of hospital stay. [ABSTRACT FROM AUTHOR]

Objective: To compare the "HEART (History, ECG, Age, Risk factors, Troponin), GRACE (Global Registry of Acute Coronary Events), and TIMI (Thrombolysis in Myocardial Infarction)" scores in predicting major adverse cardiac events (MACE) in patients reporting with undifferentiated cardiac chest pain to the Emergency Department (ED). Study Design: Cross-sectional validation study Duration and place of Study: Emergency Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2021. Methodology: Two hundred and thirty-seven adult patients with atraumatic cardiac-like chest pain and non-diagnostic electrocardiogram (ECG) reporting to the ED were included in the study. HEART, GRACE and TIMI scores were calculated from the data. The number of patients with low risk was identified by each score and compared at a fixed safety level of minimum 95% sensitivity. The potential occurrence of MACE was confirmed using a telephonic follow-up six weeks after the presentation. Results: At an absolute safety level of minimum 95% sensitivity, the HEART score determined 101 patients as "low-risk" with 1.98% MACE missed. The GRACE score identified 49 "low-risk" patients with 4.08% MACE missed, and the TIMI score identified 66 "low-risk" patients with 3.03% MACE missed. Conclusion: Among the three scores under comparison, the HEART score performed better than the GRACE and TIMI scores at the same safety level and surpassed them in differentiating between those with MACE and without MACE. [ABSTRACT FROM AUTHOR]

Epilepsy remains a major chronic neurological disorder with significantly higher refractory seizure rate. Based on the folk medicine literature, we explored the anticonvulsant and antiepileptogenic activity of aqueous ethanolic extracts of Fumaria indica, Euphorbia lactea, Euphorbia helioscopia, Neurada procumbens, and Euphorbia nivulia. The acute anticonvulsant activity of the extracts was determined at different concentrations in different groups of Swiss albino mice. Among all the materials tested, the ethanolic extracts of Euphorbia nivulia (eth-EN) alone was found to exhibit concentration-dependent anticonvulsant effects when evaluated against the acute convulsant dose of Pentylenetetrazole (PTZ, 90mg/kg, s.c.). eth-EN extract at 100mg/kg i.p concentration showed maximum protection against the PTZ induced mortality (P<0.05). eth-EN (100mg/kg) treated animals also showed significant reduction in the progression of epileptogenesis (P<0.05) when tested against the PTZ-induced (50mg/kg s.c.) chemical kindling model of epilepsy. The FT-IR spectra of this extract showed both known and unknown spectral peaks from which the presence of the functional groups; i.e. aromatics, diketones, alkenes, carbonyls, carboxylic acids and amide compounds were confirmed. The unknown peaks strongly suggested the presence of novel compounds that may be responsible for its anticonvulsant and antiepileptogenic activity. [ABSTRACT FROM AUTHOR]

Cadmium (Cd) toxicity in paddy soil and accumulation in rice plants and grains have got global concern due to its health effects. This review highlights the effects of soil factors including soil organic matter, soil pH, redox potential, and soil microbes which influencing Cd uptake by rice plant. Therefore, a comprehensive review of innovative and environmentally friendly management practices for managing Cd stress in rice is lacking. Thus, this review discusses the effect of Cd toxicity in rice and describes management strategies to offset its effects. Moreover, future research thrusts to reduce its uptake by rice has also been highlighted. Through phytoremediation, Cd may be extracted and stabilized in the soil while through microbes Cd can be sequestrated inside the microbial bodies. Increased Cd uptake in hyperaccumulator plants to remediate and convert the toxic form of Cd into non-toxic forms. While in chemical remediation, Cd can be washed out, immobilized and stabilized in the soil through chemical amendments. The organic amendments may help through an increase in soil pH, adsorption in its functional groups, the formation of complexations, and the conversion of exchangeable to residual forms. Developing rice genotypes with restricted Cd uptake and reduced accumulation in grain through conventional and marker-assisted breeding are fundamental keys for safe rice production. In this regard, the use of molecular techniques including identification of QTLs, CRISPR/Cas9, and functional genomics may be quite helpful. Unlabelled Image • Cd stress influences rice growth and its grain accumulation poses health concerns. • Immobilization, adsorption and precipitation of Cd can reduce its bioavailability. • Amendments may can immobilize Cd in soil without affecting plant health. • Use of novel microbial strains can help reduce plant Cd uptake. • Breeding to develop rice genotypes with restricted Cd uptake is needed. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical efficacy of levonorgestrel intrauterine system with oral norethisterone for the treatment of idiopathic chronic abnormal uterine bleeding., Methods: This cross-sectional study was conducted at Bahawal Victoria Hospital, Jubilee Female Hospital, Civil Hospital and private clinics of consultant gynaecologists in Bahawalpur, Pakistan, from March to August 2014, and comprised patients presenting with abnormal uterine bleeding. The patients were equally and randomly divided into two groups, i.e. intrauterine levonorgestrel administered (group A) and norethisterone administered (group B). Mean age, duration of the disease and parity were determined using a predesigned questionnaire. The primary outcomes of the treatments, i.e. reduction in menstrual blood loss assessed by the pictorial blood assessment chart score, were recorded before the initiation of therapy, at 3 months and at 6months of the study. SPSS 16 was used for data analysis., Results: There were 76 subjects; 38(50%) in each group. In group A, the mean age and mean duration of the disease was 34.16±6.327 years and 6.18±2.415 years compared to 34.21±3.595 years and 6.21±2.418 years in group B. The reduction in menstrual blood loss did not differ significantly between the groups after 3 months (p= 0.321). However, levonorgestrel intrauterine system was found more effective in reducing menstrual blood loss in 36(94.73%) patients, compared to norethisterone-treated patients 28(73.68%) after 6 months of the treatment (p=0.041). The response of both the treatments was found independent of patient's age, parity and chronicity of the disease., Conclusions: The levonorgestrel intrauterine system was better than norethisterone with marked clinical benefit of profound reduction in menstrual blood loss.