Efficacy and safety of atorvastatin and rosuvastatin in ischemic heart disease patients: A prospective study

Purpose: To compare the safety and efficacy of two commonly used statins namely; atorvastatin and rosuvastatin, and determine the efficiency of CoQ10 in the reversal of statin-induced myopathy. Methods: An investigational study design was adopted using randomized trials involving patients suffering from ischemic heart disease and receiving either atorvastatin or rosuvastatin. The study was conducted at Punjab Institute of Cardiology, Lahore, Pakistan during the period, November 2016 - February 2017. A total number of 95 male and female patients, between the ages of 40 and 80 years, were selected. Their blood samples were analyzed for lipid profile, total cholesterol, serum high-density lipoprotein-cholesterol (HDL-C), serum triglycerides, low-density lipoproteins-cholesterol (LDL-C) and total cholesterol/HDL-C ratio. Results: Gender and dose showed significant correlation with creatine phosphokinase (CPK) levels, (p = 0.001) and (p > 0.001), respectively. The patients using rosuvastatin 20 mg had a higher risk of developing myopathy than those treated with atorvastatin 40 mg (p = 0.023), while atorvastatin 20 mg patients were more prone to induce myopathy than 10 mg (p = 0.001) recipients. Atorvastatin 20 mg produced higher CPK levels than rosuvastatin 10 mg (p = 0.002). A substantial increase in CPK levels was found with rosuvastatin 20 mg and atorvastatin 20 mg usage (p > 0.001). It was observed that rosuvastatin 20 mg significantly increased the risk of myopathy compared to atorvastatin 10 mg (p > 0.001). However, rosuvastatin 20 mg/day considerably reduced the blood cholesterol as compared to atorvastatin 10mg/day (p = 0.001). CPK levels reduced significantly following treatment with CoQ10 (p = 0.022). Conclusion: Rosuvastatin users are more prone to the risk of myopathy, myalgic symptoms and rise in CPK levels than atorvastatin users, and these effects are dose related. CoQ10 is effective in lowering CPK levels and reversing myalgia

Finding Factors Causing Postdural Puncture Headache In Obstetric Patients After Spinal Anaesthesia

Objective: Among various recognized factor of spinal headache the single most important causative factor is size of spinal needle. The aim of this study was to determine incidence of spinal headache with 27 GQuincke Babcock spinal needle in Caesarean section patients. Materials and Methods: This observationalcross sectional study was carried out in the Combined Military Hospital Gujranwala and Pakistan Naval Shipping Rahat Hospital Karachi from Jan 2011 to Jan 2013. In 500 Caesarean section (C section) cases preloaded with 1000 ml Ringers Lactate, 27 G QuinckeBabcok spinal needle was used in sitting as well as left lateral position for spinal anaesthesia in all patients using local anaesthesia plain lidocaine 2% 1-2ml.In interspace L 2-3 / L3-4 eitherBupivacaine hydrochloride hyperbaric 0.75 % or 0. 5% was injected. All Caesarean cases were included except contraindicated. Spinal needle Quincke Babcock 27 G alone was used.The results were presented in percentages, mean and standard deviation. Results: A total of 500 patients of c-section were evaluated. Overall incidence of true spinal headache was 2%, failed spinal anaesthesia 4%, spinal needle was changed in 3 %, success rate of 96 % and maternal acceptance 47.4 %. Single pricks were 59.4 % while 2-3 pricks were 40.6 % . Conclusion: Smaller spinal needle has changed the safety profile of spinal anaesthesia in C section cases by very low failure rates and true PDPH a rarity. PDPH will continue as long as dura is punctured but incidence can be decreased by different technique

The Role of Top Management as a Moderator on Project Success during Project Life Cycle

The paper identifies the role of top management as a moderator during planning, monitoring, controlling, and evaluation phases for the success of a project. This study also discusses the novelties of the coordination between role of top management and legitimate power of project manager as significant impact on project performance and success during project life cycle phases. The instrument is adapted to measure planning, monitoring, controlling, evaluation, the role of project manager, project performance, project success, and the role of top management. Managers are targeted for data collection from the construction sector, education sector, and IT sector for the analysis. The findings show that coordination between variables as well as the role of a project manager is like a bridge between top management and other team members in four phases of project life cycle (planning, monitoring, controlling, and evaluation) for ultimate success. This study has a significant advantage for the organization and industries before implementing any project as it will be helpful for the top management to give authority and responsibility to the project managers while considering the scope of the project. For academia, this study helps to enhance the knowledge area of project management by introducing coordination management while discussing the other knowledge areas of project management. Keywords: project planning, project monitoring, project controlling, project evaluation, role of project manager, project performance, project success. Jell Classification: H43; O2

AN UNUSUALLY PROLONGED SURVIVAL IN METASTATIC PERIAMPULLARY PANCREATIC ADENOCARCINOMA

Periampullary cancer is the term used for neoplasms arising from the head of pancreas, ampulla of Vater, distal bile duct and periampullary region of duodenum. Of these, the pancreatic adenocarcinoma carries the worst prognosis with majority of mortalities within the 1st year. The overall 5-year survival is <3%. Studies have shown that pancreatic carcinoma has the shortest median survival of 17.1 months of all periampullary carcinomas. With the development of metastasis, the median survival tends to reduce to 3–6 months. We are reporting a case of metastatic periampullary pancreatic adenocarcinoma that received minimal and interrupted chemotherapy due to poor tolerance and yet managed to survive far beyond the reported median survival. Key words: Adenocarcinoma, pancreas, periampullary, prognosis

A New Weighting Scheme in Weighted Markov Model for Predicting the Probability of Drought Episodes

Drought is a complex stochastic natural hazard caused by prolonged shortage of rainfall. Several environmental factors are involved in determining drought classes at the specific monitoring station. Therefore, efficient sequence processing techniques are required to explore and predict the periodic information about the various episodes of drought classes. In this study, we proposed a new weighting scheme to predict the probability of various drought classes under Weighted Markov Chain (WMC) model. We provide a standardized scheme of weights for ordinal sequences of drought classifications by normalizing squared weighted Cohen Kappa. Illustrations of the proposed scheme are given by including temporal ordinal data on drought classes determined by the standardized precipitation temperature index (SPTI). Experimental results show that the proposed weighting scheme for WMC model is sufficiently flexible to address actual changes in drought classifications by restructuring the transient behavior of a Markov chain. In summary, this paper proposes a new weighting scheme to improve the accuracy of the WMC, specifically in the field of hydrology

Nematodes of high altitudes in India. VIII. Pungentus duvatus N. sp. with a key to species of the genus Putzgetztus (Nematoda: Dorylaimida)

Pungentus clauatus n. sp. from the Simla hills (India) is distinct from al1 other species of the genus in the possession of an oesophago-intestinal disc and a short, clavate tail. This new species is close to P. siluestris (De Man, 1912) Coomans & Geraert, 1962 but differs in having narrower amphidial apertures, smaller odontophore and different tail shape. Alr ey to the valid species and a lisotf species inquirendae of the genus Pungentus are provided. Two nomenclatorial rearrangements are proposed : P. siluestris Eroshenlro, 1976 becomes a junior synonym of P. granosus Eroshenlro, 1976, (notet hat the specific name siluestris was preoccupied by P. siluestris (De Man, 1912) Coomans & Geraert, 1962) ; P. medianus Eroshenko, 1976 is considered a junior synonym of P. purnilus Andrassy, 1963

The Impact of Iqbal on Mir Ghlum Bheek Nairang’s Urdu Ghazal

Mir Ghulam Bheek Nairang is a prominent name of the contemporaries of Iqbal. Nairang devoted his whole life to academic, literary, political, and national causes and activities. Among the peers of Iqbal, Nairang was an ambitious and optimistic poet. Interaction with Iqbal and exposure to Iqbal’s poetic genius bestowed Nairang’s poetry with a novel spirit and poetic sense. Nairang’s Urdu Ghazal is particularly recognized for its simplicity, extempore expression, and aesthetic pleasure. Iqbal’s poetic influence is prominently felt in the underlying poetic sense and quite visible in the expression in Nairang’s poetry. Somewhere he adopted Iqbal’s art and meter of poetry. His Urdu ghazal is simple, straightforward, and articulate under the effects of Iqbal

DISASTER MANAGEMENT IN COAL MINE INDUSTRY OF BALOCHISTAN

The room and pillar mining method is responsible for high death toll and disability rate of coal mine workers in Baluchistan. The frequent incidents of roof falls day to day accidents, and suffocation due to sufficient emission of methane are the main causes of increased death rate. Substantial increase in injuries are also causing complications in the life of poor coal workers

Fabry’s Disease: Case Series and Review of Literature

Fabry’s disease is an X‑linked lysosomal storage disorder caused by a deficiency of alpha‑galactosidase A enzyme with the progressive accumulation of globotriaosylceramide in vascular endothelial cells leading to cardiovascular, renal, gastrointestinal, neuropathic, lenticular, and dermatological manifestations. It is a rare cause of end‑stage renal disease. It classically affects males whereas 10–15% of female heterozygote carriers are affected depending on localization. Both the FD and its association with ESRD is rare. With this background, this case series of five patient’s along with the review of literature is presented here.Keywords: Alpha‑galactosidase A, End‑stage renal disease, Fabry’s disease, Kidney transplantation, Proteinuri

Knowledge Sharing and Affective Commitment:Mediating Role of Trust Between Knowledge Sender and Receiver

The main determination of the current study is to explore the antecedents of knowledge sharing. Hence; affective commitment is an antecedent that shows how knowledge can be shared among the knowledge participants by using an employee’s emotional attachment and recognition with the organization. Similarly, the mediating role of trust was checked between employee’s knowledge sharing attitude and affective commitment. Data was collected from the hi-tech information technology (IT) industry from Pakistan with a sample of 143 as valid responses. Regression, correlation, factor loading, and path coefficients were used to check the reliability, validity, and model fit of the research framework. The findings suggested that employees’ recognition and emotional attachment with the organization are positively related to knowledge sharing. In addition, the mediating role of trust between affective commitment and knowledge sharing is significant and positive