Search

Objectives: To determine the microbiologic spectra and their antibiotic susceptibility patterns in type 2 diabetic patients with UTIs Materials and Methods: This descriptive cross-sectional study was conducted in the Department of Medicine, Khyber Teaching Hospital, Peshawar from 1st July 2021 to 31st December 2021. Type 2 Diabetic patients with urinary tract infections were recruited in the study. Their urine cultures for sensitivities were carried out. The frequency of positive urine culture was stratified among age and gender to see the effect modifications. Antibiotic sensitivity and resistance patterns were stratified among male and female diabetic patients. Results: Out of 150 patients, 125 were females and 25 were males. Twenty-seven (27) patients (24.3%) had positive urine cultures, out of whom 19 (70.4%) were females, and 8 (29.6%) were males. The most common organism found in females was E.coli (42%). Among male patients with positive urine cultures, E.coli was the most common organism isolated in 5 (62.51%). Cefixime had the highest resistance, with 21(77.8%) of 25 culture-positive patients resistant to it. All the patients with positive urine cultures were sensitive to piperacillin/tazobactam, Meropenem, Doripenem, Cefepime, Aztreonam, and Tigecycline. Conclusion: Diabetic females are more prone to UTIs with an increased prevalence of positive urine cultures as compared to diabetic men. The most common isolate was E.coli. The highest antimicrobial resistance was reported for Cefixime. All patients were sensitive to Meropenem, Tazobactam/Piperacillin, Aztreonam, Tigecycline, Doripenem, and Cefepime. [ABSTRACT FROM AUTHOR]

The synthesis of water dispersible phosphor materials is important due to the possibility of their applications in sensors, bioimaging, magnetic resonance imaging (MRI), etc. Surfactants are in use for the controlled size synthesis of nanomaterials as well as for tuning the dispersibility of colloidal particles in different solvents. In this study, we exploited cetrimonium bromide (CTAB) with pre-added lanthanide ions or with "so called modified counterions" for the synthesis of water dispersible phosphor materials. Colloidal GdF3:Ce3+(5%), Eu3+(x%) (where x is 1, 3, 5 and 7% Eu+3) and GdF3:Ce3+(5%), Eu3+(5%)/SiO2 phosphor nanocomposites were synthesized. Initially, cationic CTAB system was altered by pre-adding selected lanthanides required for synthesizing phosphors as well as silica–phosphor nanocomposite. Later, the same modified CTABs were used for single step synthesis of nanoparticles as well as nanocomposites. The elemental and structural characterizations were performed using x-ray photoelectron spectroscopy (XPS), and powder x-ray diffraction (XRD) techniques. The size and morphology of the samples were checked using a transmission electron microscope (TEM). The photoluminescence (PL) properties were explored using a spectrofluorometer, and the results established the formation of phosphor nanocomposite. The method expanded the possibilities of size and shape control in for phosphor materials. Furthermore, the study offered a way to decrease the use of lanthanide while keeping the phosphor's overall properties intact. The results shown that this study can pave an alternate way for the synthesis of nano-sized structures of GdF3: Ce3+(5%) Eu3+(x%) and also for size and shape control in GdF3: Ce3+(5%) Eu3+(x%)/SiO2 type nanocomposites. [ABSTRACT FROM AUTHOR]

The development of QDs-based fluorescent bionanoprobe for cellular imaging fundamentally relies upon the precise knowledge of particle–cell interaction, optical properties of QDs inside and outside of the cell, movement of a particle in and out of the cell, and the fate of particle. We reported engineering and physicochemical characterization of water-dispersible Eu3+/Mn2+ co-doped ZnSe@ZnS core/shell QDs and studied their potential as a bionanoprobe for biomedical applications, evaluating their biocompatibility, fluorescence behaviour by CytoViva dual mode fluorescence imaging, time-dependent uptake, endocytosis and exocytosis in RAW 264.7 macrophages. The oxidation state and local atomic structure of the Eu dopant studied by X-ray absorption fine structure (XAFS) analysis manifested that the Eu3+ ions occupied sites in both ZnSe and ZnS lattices for the core/shell QDs. A novel approach was developed to relieve the excitation constraint of wide bandgap ZnSe by co-incorporation of Eu3+/Mn2+ codopants, enabling the QDs to be excited at a wide UV-visible range. The QDs displayed tunable emission colors by a gradual increase in Eu3+ concentration at a fixed amount of Mn2+, systematically enhancing the Mn2+ emission intensity via energy transfer from the Eu3+ to Mn2+ ion. The ZnSe:Eu3+/Mn2+@ZnS QDs presented high cell viability above 85% and induced no cell activation. The detailed analyses of QDs-treated cells by dual mode fluorescence CytoViva microscopy confirmed the systematic color-tunable fluorescence and its intensity enhances as a function of incubation time. The QDs were internalized by the cells predominantly via macropinocytosis and other lipid raft-mediated endocytic pathways, retaining an efficient amount for 24 h. The unique color tunability and consistent high intensity emission make these QDs useful for developing a multiplex fluorescent bionanoprobe, activatable in wide-visible region. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to assess the prevalence of post anaesthesia shivering and the role of Tramadol in its control in elective spinal surgery patients. Introduction: Postoperative shivering is a common side effect of general anaesthesia. Up to 40% of patients develop postanaesthesia shivering (PAS). Several empirical therapeutic methods are applied for PAS but their overall quality is low. The pharmacological and non-pharmacological anti-shivering methods are in use for controlling PAS. Different medications are analyzed but the conclusion about the optimal anti-shivering medications is difficult to be finalized. Material and Methods: This study was conducted from May 2019 to May 2020. All age groups and both genders were selected. Data was collected from a tertiary care hospital in Peshawar. It was a prospectively conducted cross-sectional study. Patients were selected having different spinal pathology. They were included based on history, physical examination, and MRI spine. For data analysis, SPSS version 22 software was used. Results: One hundred & fourteen (114) patients were studied. Among these patients, 34 patients (30 %) developed post anaesthesia shivering. Out of these 34 patients, 19 (56 %) were males and 14 (44 %) were females. In all thirty-four patients, Tramadol was used. It was effective in 28 patients (82 %) patients to control PAS. Only six patients (18 %) did not respond to Tramadol. Conclusion: 30 % of the sample population developed PAS. Tramadol is effective in controlling post-anaesthesia shivering and can be used as a favourable alternative to Pethidine whose availability is limited. [ABSTRACT FROM AUTHOR]

Objective: Chiari malformations (CMs) is the protrusion of hind brain tissue into the cervical vertebral canal through the foramen magnum. They are divided into four types i.e. I, II, III, and IV with type Zero and type 1.5 as sub classification. Patients of Chiari malformation present with variety of clinical symptoms and signs. These malformations frequently occur with hydrocephalus, spinal dysraphasim and kyphoscoliosis. Among these, surgical treatment is reserved only for symptomatic patients with CIM. Further clinical research is needed for determining the most acceptable surgical intervention among several available techniques. It is hypothesized that PF decompression with atlas posterior arch removal and augmentation duroplasty is a better surgical procedure for symptomatic CIM patients. This is a prospectively conducted randomized control trials, which was conducted at the Department of Neurosurgery, Naseer Teaching Hospital Peshawar from March 2017 to March 2020. Material and Methods: Both genders and all age groups were included in the study. Data was collected from four tertiary care hospitals in Peshawar, Pakistan. All the patients (n=84) were distributed randomly into group A and B with clinical and radiological findings of CIM. In Group B(n=42), simple Posterior fossa decompression with atlas post arch removal was done while in Group A (n=42), augmentation duroplasty was also done in addition. For dataset analysis, SPSS version 22 software was used. Result: Among the 84 patients, 57 patients (67.9 %) were females and 27 (32.1 %) were males. Occipital headache (76 %,n=64) was main symptom followed by unilateral or bilateral arms pain and fingers numbness (15.5 %, n=13). In four patients (4.7 %), gait was main problem while three patients (3.6 %) had trigeminal neuralgia along with same side hand weakness. In group B, 11 patients (26.2 %) required repeat surgery for complete relief while in group B, all patients except two did well on routine follow ups. In Group A, CSF leak was main post-operative problem. Conclusions: symptomatic CIM patients, PF decompression with augmentation duroplasty is a superior option. [ABSTRACT FROM AUTHOR]

Objectives: To compare the response of Tramadol and Ketorolac and to compare the side effects of the said drugs. Better post-operative pain control is always a difficult task for health care providers. The more potent analgesic drugs like opioids have more side effects like nausea, vomiting, pruritus and respiratory depression. Ketorolac is an NSAIDs that has shown promising results in controlling moderate to severe pain with lesser side effects. Open cholecystectomy is a common abdominal procedure and good intra and post-operative pain control will result in better recovery and patient relief. Methodology. It was a prospectively conducted double blind randomized control trials in which 101 cases were enrolled. It was six months duration study from July 2019 to January 2020. All patients were randomly distributed among two groups. In group A, inj. Tramadol 100 mg while in group B, inj. Ketorolac 30 mg was given. Pain intensity was assessed by numerical rating scale. Epiinfo Version 7.2 and Microsoft Excel 2007 Workbook were used for data set analysis. Results. In 101 patients 22 were males (21.8 %) and 79 were females (78.2 %) with male: female ratio1:3.6. The mean age group was 38 years ranging from 24 to 58 years. In Group A, Tramadol was given to 51 patients while in Group B, inj. Ketorolac was given to 50 patients. In Group A, 47 patients (92 %) were pain free at six hours while four and eleven (11) patients were given additional analgesia at 6th and 8th hour respectively. In group B, 44 patients (88 %) responded well to analgesic effect in first three hours. At 6th hour, 18 patients (36 %) were having moderate degree of pain and additional analgesia was given.12 more patients (24 %) needed additional analgesia at 8th hour. . Eight (16 %) and two (4 %) patients complained of nausea and vomiting in Group A and B at first hour respectively. No respiratory depression was observed in any group. Conclusions. Ketorolac may be used as an alternative to opioids including tramadol as it gives equivalent pain control for intermediate duration surgical procedures. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the incidence and effectiveness of ondansetron and metoclopramide in prevention and treatment of postoperative nausea and vomiting (PONV)after elective spinal surgery. Postoperative nausea and vomiting a common complication after general anesthesia which can be prevented and treated. Complications of this conditioncause higher rates of morbidity and mortality. PONV is a significant complication for neurosurgical patients. There are certain consequences of PONV specific to the laminectomy and fenestration done in prone position, including increased chance of aspiration, hematoma formation and wound site bleeding. Prophylaxis should be instituted in selected cases. It was descriptive cross sectional comparative study. At Anesthesia and Neurosurgery departments, Naseer Teaching Hospital, Peshawar KPK. It was fifteen months study, from February 2018 to May 2019. Materials and Methods Ninety seven (97)subjects of spinal tumors, spinal stenosis and lumbar prolapsed intervertebral disc were included, in whom laminectomy was done under GA. Twenty three (23) subjects developed nausea and vomiting and were selected in our study. Data collection was done and analyzed on SPSS version 22 software. Results. Among ninety seven subjects, fifty two(53.6%) were female and forty five (46.4%) were male with female to male ratio of 1.1:1.The incidence of PONV was 23.71%. Among twenty three patients who developed nausea and vomiting, fourteen(61%) were female and nine(39%) were male with a female to male ratio of 1.5:1. Among these twenty three patients, eleven (47.8%) patients were given metoclopramide intravenously. In nine (81.8%) patients, PONV was completely controlled with metoclopramideand only two (18.2%) patients required other antiemetic drug in combination with metoclopramide. Twelve (52.2%) were put on ondansetron, intravenously. Eleven (91.6%) patients responded and only one (8.4%) patient needed another antiemetic drug for complete control. Conclusion. Individual use of ondansetron or metoclopramide is nearly equally effective in prevention and treatment of PONV in elective laminectomy or fenestration. In some cases, these drugs may not work completely and other antiemetic drug may be required. Prophylactic use of antiemetic drugs can prevent PONV. Mortality and morbidity from PONV has markedly decreased due to availability of better antiemetic agents. [ABSTRACT FROM AUTHOR]

Objective: Our study is to compare effectiveness of ketamine and pethedine in post operative shivering in head trauma patients. One of the common and unpleasant side effects of general anaesthesia is shivering in post operative patients, specially in head trauma patients. Post anaesthesia Shivering (PAS) occurs in 35-40% of patients recovering from general anaesthesia. Most of the times, it is preceded by central hypothermia and peripheral vasoconstriction which indicates thermoregulatory mechanism. There are several therapeutic methods which are empirical, and applied for PAS but the overall quality of the antishivering therapies is low. There are two major therapeutic methods for management of PAS; the pharmacological and non-pharmacological antishivering methods. Different medications are being analysed but conclusion is difficult to be finalized. Nevertheless, control of PAS is possible and clinically effective with simple pharmacological interventions combined with non pharmacological methods. This is a prospectively conducted case series of a descriptive nature and was conducted at the Department of Neurosurgery, Naseer Teaching Hospital Peshawar from March 2018 to March 2019. Material and Methods: Both genders and all age groups were included in our study. Data was collected from Naseer Teaching Hospital, Lady Reading Hospital and Hyatabad Medical Complex, Peshawar. All the patients were selected randomly with head trauma undergoing surgery under GA. Patients were selected on the basis of history, physical examination and CT scan. For data analysis SPSS version 20 software was used. Result: We studied 114) patients. Among these patients, 48 patients (42.10 %) developed post anesthesia shivering. Out of them 47 patients, 18 (37 %) were males and 30 (63 %) were females. In 23 patients (48.9 %) ketamine was used and in 24 patients (51.1 %) pethedine was used. In all patients, PAS was controlled equally with individual drug. Only one patient (2.12%) did not respond to either drug. Conclusion: Effective prevention and treatment of shivering has become an essential step in increasing postoperative comfort and reducing shivering. Non pharmacological or physical method is applied firstly to keep the patient normothermic and warming with the administered fluid. In pharmacological therapy, we compared the efficacy of ketamine and pethedine in treating PAS. We concluded that both drugs are equally potent in controlling post anaesthesia shivering. Control of PAS is possible and clinically effective with simple pharmacological interventions combined with non pharmacological methods. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of erectile dysfunction and retrograde ejaculation in patients with benign prostatic hyperplasia (BPH) receiving combined pharmacotherapy with dutasteride and tamsulosin Methodology: This cross sectional study was conducted on 205 patients enrolled from outpatient department (OPD) of Institute of Kidney Diseases (IKD) Peshawar from September 2017 to March 2018. The International Prostate Symptom Scores (IPSS) score and ultrasound were used to select patients of BPH suitable for medical management rather than surgery. The International Index Erectile Function scoring (IIEFS) was used to measure erectile dysfunction, prior to and after treatment with dutasteride and tamsulosin. Retrograde ejaculation was recorded from history after two months follow-up. Results: The mean age was 60 years with SD ± 2.16. IIEF score for all patients was = 25, which reflected normal erectile function prior to treatment. But after 2 months of follow up 17% patients had IIEF score < 11 (severe dysfunction) and 83% patients had IIEF score = 22 (mild to moderate dysfunction). Thirty seven (37%) patients had retrograde ejaculation. Conclusion: Retrograde ejaculation and erectile dysfunction are important adverse effects of combined drug regimen for the treatment of symptoms of benign prostatic hyperplasia. [ABSTRACT FROM AUTHOR]

The study explores the relationship among income, consumption and remittances in Pakistan. Two Stage Least Squares (2SLS) technique is used to analyze the impact of international remittances upon consumption during the period of 1973-2010. Specification of the model is based upon the two sectors Keynesian National Income Model. Results of the study suggest that international remittances positively affect the consumption level in Pakistan. The results explain that one per cent increase in the average annual amount of remittances in the country would yield a 0.95 per cent increase in the average annual aggregate consumption in the country. The Co-integration analysis shows the log-run stable relationship between consumption, remittances, income and investment. It is believed that remittances increase the money supply and stimulate demand for consumption and investment in the country. Hence remittances play imperative role in the improvement of the well being of the people in aggregate. [ABSTRACT FROM AUTHOR]

Objective: To find out the effectiveness and tolerability of tocilizumab in the treatment of rheumatoid arthritis (RA) patients refractory to conventional disease modifying anti-rheumatic drugs (DMARDS). Methodology: This cross-sectional study was conducted in the department of medicine, Lady Reading Hospital, Peshawar from September 2017 to March 2018. It included 84 patients with diagnosed RA who were refractory to conventional DMARDs therapy. Tocilizumab was given to all patients along with methotrexate (MTX) and low dose prednisolone. Effectiveness of tocilizumab therapy was evaluated by Disease Activity Scale version 28 (DAS- 28) score before and 3 after months of the end of the 3rd dose of tocilizumab. Drug tolerability was assessed by recording the early and late adverse events. Data was analyzed with SPSS version 20. Frequency and percentage were expressed for categorical variables, while mean ± SD were used for numerical variables. Results: The response was more significant in female patients (about 70%) as compared to male patients (50%). Infusion-related allergic reactions were observed only in 2 patients. Headache was more significant which was observed in 6 patients. Overall adverse events in the form of allergy, headache, diarrhea, upper respiratory symptoms, gastritis, and oral ulcers were observed in about 24. 8% of patients. Leukopenia was observed in 4.7% but no life-threatening cytopenias or severe allergic adverse reactions were noted. Conclusion: Tocilizumab is effective and tolerable therapeutic addition in the treatment of patients with rheumatoid arthritis who are refractory to the conventional DMARD treatment. [ABSTRACT FROM AUTHOR]

The development of QDs-based fluorescent bionanoprobe for cellular imaging fundamentally relies upon the precise knowledge of particle-cell interaction, optical properties of QDs inside and outside of the cell, movement of a particle in and out of the cell, and the fate of particle. We reported engineering and physicochemical characterization of water-dispersible Eu 3+ /Mn 2+ co-doped ZnSe@ZnS core/shell QDs and studied their potential as a bionanoprobe for biomedical applications, evaluating their biocompatibility, fluorescence behaviour by CytoViva dual mode fluorescence imaging, time-dependent uptake, endocytosis and exocytosis in RAW 264.7 macrophages. The oxidation state and local atomic structure of the Eu dopant studied by X-ray absorption fine structure (XAFS) analysis manifested that the Eu 3+ ions occupied sites in both ZnSe and ZnS lattices for the core/shell QDs. A novel approach was developed to relieve the excitation constraint of wide bandgap ZnSe by co-incorporation of Eu 3+ /Mn 2+ codopants, enabling the QDs to be excited at a wide UV-visible range. The QDs displayed tunable emission colors by a gradual increase in Eu 3+ concentration at a fixed amount of Mn 2+ , systematically enhancing the Mn 2+ emission intensity via energy transfer from the Eu 3+ to Mn 2+ ion. The ZnSe:Eu 3+ /Mn 2+ @ZnS QDs presented high cell viability above 85% and induced no cell activation. The detailed analyses of QDs-treated cells by dual mode fluorescence CytoViva microscopy confirmed the systematic color-tunable fluorescence and its intensity enhances as a function of incubation time. The QDs were internalized by the cells predominantly via macropinocytosis and other lipid raft-mediated endocytic pathways, retaining an efficient amount for 24 h. The unique color tunability and consistent high intensity emission make these QDs useful for developing a multiplex fluorescent bionanoprobe, activatable in wide-visible region.