Factors Associated within 28 Days In-Hospital Mortality of Patients with Acute Respiratory Distress Syndrome

Objective. To determine the factors leading to in-hospital mortality within 28 days in hospitalized patients with ARDS. It was a prospective observational cohort study conducted in Intensive Care Unit of Aga Khan University Hospital Karachi from March to August 2011. Methodology. Data was collected from patients admitted in the intensive care unit on the basis of inclusion and exclusion criteria. The patients were followed daily for 28 days to record any in-hospital complications and the outcome of patients. Results. Total of 46 patients were included during this period out of which 56% (26) were males and 43% (20) were females. Mean age was 44 ± 19 years. There were 11 (23.9%) patients with age \u3e65 and 35 (76%) had age \u3c65 years. There were 21 (45.6%) patients with pulmonary ARDS and 25 (54.3%) had extrapulmonary ARDS. APACHE II score of \u3e20 was present in 23 (50%) patients while the rest had score of \u3c20. Regarding in-hospital complications, 23 (50%) patients developed sepsis, 31 (67.4%) had multiorgan failure, 14 (30%) had refractory shock, and 15 (32.6%) developed refractory hypoxemia. Out of 46 patients, 26 (56.5%) died within 28 days. On univariate analysis, high APACHE score, multiorgan failure, refractory shock, and refractory hypoxemia were main causes of death. Conclusion. ARDS is a syndrome of high mortality with mortality rate of 56.5% in this study. High APACHE, sepsis, multiorgan failure, refractory shock, and refractory hypoxemia are the leading causes of death in our patients

The Possible Role of Nitric Oxide and Oxidative Stress in the Enhanced Apoptosis of Cardiac Cells in Cirrhotic Rats

Abstract- Cirrhosis has been related with hyperdynamic circulation, manifesting as increased cardiac output and decreased systemic vascular resistance. In the present study we examined the cirrhosis outcome on apoptosis of rat hearts. We also tried to explore the role of nitric oxide (NO) and oxidative stress in the probable changed apoptosis of cirrhotic hearts. Twenty eight days after ligation of bile duct, heart tissues were tested for apoptosis. The extent of malondialdehyde (MDA), and the activities of catalase (CAT), glutathione peroxidase (GSHPx) and superoxide dismutase (SOD) have been calculated in heart tissues. The cirrhotic hearts exhibited structural defects and greater apoptosis. Chronic treatment of cirrhotic rats with LNAME, a non-selective inhibitor of NO synthase, inhibited heart structural defects and reduced apoptosis of hearts. We also showed that cirrhotic rat hearts had an enhanced level of MDA and reduced activities of CAT, GSHPx and SOD. When the animals were treated by L-NAME chronically, the MDA level reduced and activities of CAT, GSHPx and SOD augmented in cirrhotic heart. In conclusion, increased apoptosis of cirrhotic hearts probably happen due to NO overproduction and increased oxidative stress in hearts of cirrhotic rats

The Possible Role of Nitric Oxide and Oxidative Stress in the Enhanced Apoptosis of Cardiac Cells in Cirrhotic Rats

Abstract- Cirrhosis has been related with hyperdynamic circulation, manifesting as increased cardiac output and decreased systemic vascular resistance. In the present study we examined the cirrhosis outcome on apoptosis of rat hearts. We also tried to explore the role of nitric oxide (NO) and oxidative stress in the probable changed apoptosis of cirrhotic hearts. Twenty eight days after ligation of bile duct, heart tissues were tested for apoptosis. The extent of malondialdehyde (MDA), and the activities of catalase (CAT), glutathione peroxidase (GSHPx) and superoxide dismutase (SOD) have been calculated in heart tissues. The cirrhotic hearts exhibited structural defects and greater apoptosis. Chronic treatment of cirrhotic rats with LNAME, a non-selective inhibitor of NO synthase, inhibited heart structural defects and reduced apoptosis of hearts. We also showed that cirrhotic rat hearts had an enhanced level of MDA and reduced activities of CAT, GSHPx and SOD. When the animals were treated by L-NAME chronically, the MDA level reduced and activities of CAT, GSHPx and SOD augmented in cirrhotic heart. In conclusion, increased apoptosis of cirrhotic hearts probably happen due to NO overproduction and increased oxidative stress in hearts of cirrhotic rats

Etiology, clinical, radiological, and microbiological profile of patients with non-cystic fibrosis bronchiectasis at a tertiary care hospital of Pakistan

Objectives: To identify the etiology of non-cystic fibrosis bronchiectasis (NCFB), to assess the clinical presentation, radiological findings, and microbiological profile of patients presenting with a diagnosis of bronchiectasis in a tertiary care center of Pakistan.Methods: This was a prospective observational cohort study where patients with a diagnosis of bronchiectasis proven by high-resolution computed tomography (HRCT) were evaluated for etiology, clinical characteristics, microbiology, radiology, spirometric profile, and in-hospital outcomes.Results: During the study period, 196 patients were diagnosed with NCFB. The majority of the patients were men 76.5% (n = 150) and 83.6% (n = 163) of the total patients were younger than 60 years of age. The majority of these patients (58.7%, n = 111) had a duration of symptoms between 5-10 years. The etiology of bronchiectasis was identified in 92.9% of cases. Post-infectious bronchiectasis was the most common cause (67.8%, n = 133), followed by chronic obstructive pulmonary disease (COPD) (9.2%, n = 18), and allergic bronchopulmonary aspergillosis (ABPA) (7.1%, n = 14). Among the post infectious causes, a history of TB was present in 85% (n = 114/133) of patients. Obstructive impairment was the most common spirometric pattern, observed in 68.9% (n = 135) of patients. Pseudomonas aeruginosa was the most commonly isolated organism (36.2%, n = 71). Hemoptysis was the most frequent complication found in 20.9% of patients (n = 41). Out of these 196 patients, 94.4% (n = 185) received medical management and were discharged from the hospital. Respiratory failure was significantly associated with the Pseudomonas group as compared to non-pseudomonas group [(n = 21 (29%) vs n = 18 (14.4%) p = 0.01]. During hospitalization seven patients (3.6%) were died because of respiratory failure.Conclusions: Post TB bronchiectasis was the leading cause of non-cystic fibrosis (CF) bronchiectasis in this cohort, with Pseudomonas was the commonest pathogen isolated from the respiratory specimen, which was significantly associated with respiratory failure. On spirometry, obstructive impairment was found in the majority of patients and hemoptysis was the most frequent complication

Contaminated Turmeric Is a Potential Source of Lead Exposure for Children in Rural Bangladesh

Background. During the conduct of a cohort study intended to study the associations between mixed metal exposures and child health outcomes, we found that 78% of 309 children aged 20–40 months evaluated in the Munshiganj District of Bangladesh had blood lead concentrations ≥5 µg/dL and 27% had concentrations ≥10 µg/dL. Hypothesis. Environmental sources such as spices (e.g., turmeric, which has already faced recalls in Bangladesh due to high lead levels) may be a potential route of lead exposure. Methods. We conducted visits to the homes of 28 children randomly selected from among high and low blood lead concentration groups. During the visits, we administered a structured questionnaire and obtained soil, dust, rice, and spice samples. We obtained water samples from community water sources, as well as environmental samples from neighborhood businesses. Results. Lead concentrations in many turmeric samples were elevated, with lead concentrations as high as 483 ppm. Analyses showed high bioaccessibility of lead. Conclusions. Contamination of turmeric powder is a potentially important source of lead exposure in this population

Case series and literature review of multiple nodular sarcoidosis.

Background: Nodular lung disease is a rare presentation of sarcoidosis. Radiologically it can present as multiple pulmonary masses or solitary lung nodule. Case presentation: We report three cases of nodular sarcoidosis in young females of Asian origin who had initially presented with dry cough and worsening dyspnea non-responsive to initially administered antibiotics. Pulmonary nodules were discovered upon radiographic imaging in all three cases which raised concern for the possibility of neoplastic processes. Subsequent biopsies revealed granulomatous inflammation indicative of sarcoidosis. All cases responded very well to systemic corticosteroids. Conclusion: Sarcoidosis may present as nodular infiltrates which alerts the treating physician to other neoplastic and infectious diseases of the lungs. Appropriate workup may reveal the true nature of this disease and hence, simplify treatmen

N-(2-Hy­droxy-1,1-dimethyl­eth­yl)­benzene­sulfonamide

In the title mol­ecule, C10H15NO3S, the S atom is bonded in a distorted tetra­hedral geometry. In the crystal structure, inter­molecular N—H⋯O, O—H⋯O and weak C—H⋯O hydrogen bonds connect the mol­ecules to form a two-dimensional network parallel to (100). The 2-methyl­propan-1-ol group is disordered over two orientations with occupancies of 0.570 (3) and 0.430 (3)

An Innovative EPW Design Using Add-on Features to Meet Malaysian Requirements

Electric Powered Wheelchair (EPW) is a special Electric Vehicle (EV). It is used by senior citizens, handicapped, disabled, people with mobility impairment or people who have health complaints. Therefore, it is not always safe to use an EPW independently as users are more subject to fatigue, weakness and emergency situations. Due to the special needs of EPW drivers/users, the design of the EPW and its controlling system should fulfill their requirements. This paper proposes a new design for EPW which is suitable for Malaysian community needs. The design takes in consideration the easiness of the independent use, the price reduction and the flexibility in changing the controlling method. A smartphone is used as an add-on controlling option besides to the normal joystick. A health monitoring system which implements Internet of Things (IoT) features is also presented as an add-on device. The EPW system is designed to be extendable and accepts other add-on devices. The system is tested in real modes and it is validated as a real-time system

Phytoremediation of potentially toxic elements from contaminated saline soils using Salvadora persica L.: seasonal evaluation

Plants in coastal ecosystems are primarily known as natural sinks of trace metals and their importance for phytoremediation is well established. Salvadora persica L., a medicinally important woody crop of marginal coasts, was evaluated for the accumulation of metal pollutants (viz. Fe, Mn, Cu, Pb, Zn, and Cr) from three coastal areas of Karachi on a seasonal basis. Korangi creek, being the most polluted site, had higher heavy metals (HM’s) in soil (Fe up to 17,389, Mn: 268, Zn: 105, Cu: 23, Pb: 64.7 and Cr up to 35.9 mg kg−1) and S. persica accumulated most of the metals with >1 TF (translocation factor), yet none of them exceeded standard permissible ranges except for Pb (up to 3.1 in roots and 3.37 mg kg−1 in leaves with TF = 11.7). Seasonal data suggested that higher salinity in Clifton and Korangi creeks during pre- and post-monsoon summers resulted in lower leaf water (ΨWo) and osmotic potential at full turgor (ΨSo) and bulk elasticity (ε), higher leaf Na+ and Pb but lower extractable concentrations of other toxic metals (Cr, Cu, and Zn) in S. persica. Variation in metal accumulation may be linked to metal speciation via specific transporters and leaf water relation dynamics. Our results suggested that S. persica could be grown on Zn, Cr and Cu polluted soils but not on Pb affected soils as its leaves accumulated higher concentrations than the proposed limits.Higher Education Commission, Islamabad | Ref. 6592/Sindh/NRPU/R&D/HEC/201