Pharmacokinetic Interactions of Rosuvastatin: A Review

Rosuvastatin was claimed a “super-statin” to lower the LDL cholesterol comparing with other statins. An excellent benefit-risk profile of Rosuvastatin makes it more acceptable to treat dyslipidemia.   Safety profile is also comparable with other marketed statin. This statin is widely prescribed to treat hyperlipidemics in combination with other drugs. Interactions with other co-prescribed drugs might potentiate or lower its therapeutic effectiveness. This review accentuates the origin of rosuvastatin in the family of statins and highlights the various interactions specifically pharmacokinetic interactions with other drugs that are commonly prescribed in its combination. Keywords: Rosuvastatin, Interactions, Statins, Hyperlipidemi

Complications of Tube Thoracostomy- How Well Are We Training our junior Doctors?

Objective:   This study aims to explore the common causative factors of dysfunctional closed chest drainage unit, their relative frequency and to give recommendations for its prevention. Study Design: Retrospective study Place and Duration of study: Department of Thoracic surgery, Nishter Medical University, Multan, between February 2015 and January 2017 Method: 139 patients were included in whom tube thoracostomy had been performed but it had failed in draining the pleural collection. Detailed history and thorough physical examination were carried out, Chest x-ray and where necessary chest CT scan were done to evaluate placement of chest tube and to work out the causative factor of dysfunctional closed chest drainage unit. Results: Out of the 139 study cases, 36(25.9%) were females while 103(74.1%) were male patients. Mean age of our study cases was 37.2 ±14.5 years (minimum age was 12 while maximum age was 65 years). A wrong connection of CDU was the most common cause of dysfunctional closed CDU. It was found in 24 cases (17.3%).Where as inadequate prime fluid, loose connections, kinked tubes; over full bottles were the other common problems. Conclusion: Dysfunctional closed chest drainage unit is a common but serious clinical problem which results in significant rise in morbidity, prolonged hospital stay and economic burden. It can be prevented by adopting proper protocol of tube thoracostomy. Keywords: Dysfunctional chest drainage unit, Faulty chest tubes, Non-functioning tube thoracostomy, Failure of chest drainage system. Abbreviations: Chest drainage unit-CDU, tube thoracostomy-T

Diagnostic value of fine needle aspiration cytology in parotid tumors

Objective: To evaluate the usefulness and accuracy of fine needle aspiration cytology in the diagnosis of parotid gland tumors.Methods: We reviewed files of all patients who underwent parotidectomy for various parotid pathologies at Aga Khan University Hospital. Study design included a comparison between results of preoperative FNAC with final histopathological diagnosis. Galen & Ganbino method was used to calculate sensitivity and specificity of FNAC.Results: Among 50 patients reviewed, there was one false positive and 3 false negative results reported on FNAC. This gives a sensitivity of FNAC for reporting malignancy to be 74% and specificity to rule out malignancy 97%. No significant complications were reported while performing the procedure.CONCLUSION: FNAC is a safe and effective modality in diagnosis and treatment planning of patients with parotid tumors

Culture Sensitivity Pattern of Infectious Meningitis in Pediatric Population at a Tertiary Care Hospital

Objective: This study aims to determine the culture sensitivity pattern and clinical features of patients suffering from infectious meningitis presenting at Nishtar medical university hospital Multan, Pakistan. Study design: Descriptive cross-sectional study Place and duration of study: Pediatric department, Nishtar Hospital Multan the duration of the study was January 01, 2017 to December 31, 2017. Method All the children of age 1 month to 12 years with suspected meningitis were included in our study. The patients who were critically ill or immune compromised were not included in the study. All these cases were evaluated by detailed history, thorough physical examination and the necessary investigations. All the demographic data and other variables related to clinico-epidemiological features were measured and recorded using a specifically designed Proforma. The data were analyzed by using computer program SPSS 21 version. Result Of the 178 patients included in the final analysis, 113 (63.6%) were females and 65 (36.4%) males. The age ranged from 1 month to 12 years with a median of 31 months (6.00 - 72.50). Seventy-five percent of them were below 5 years. On the basis of investigations, bacterial meningitis was diagnosed in 91, viral meningitis in 27, tuberculous meningitis in 21 and cryptococcal meningitis in 15 patients. The most common clinical presentations of meningitis were fever, vomiting, headache, irritability, neck stiffness and altered level of consciousness. While the photophobia and fits were less common. The GCS score was more than 13 in 33 patients (18.8%) and 8-13 in 93 patients (52%). Whereas, less than eight GCS score was observed in 52 children (29.2%). Most of the complications were observed in the initial 48 hours of admission. The commonly observed complications were an altered level of sensorium, seizure, and shock. The minimum length of hospitalization was three days and the maximum was 36 days with median (IQR) of 12 days (4-15). The mortality was observed in 29 patients (16.2%) of Pediatric Department. Conclusion Infectious meningitis is a common disease of Pakistani pediatric population. The female children of rural areas, having age less than 5 years are more prone to suffer from this disease. For effective management of infectious meningitis, the antimicrobial sensitivity data should be continuously monitored. Keywords: Meningitis, children, culture sensitivity patterns, clinical feature

Transforming Financial Services: The Impact of FinTech Innovation on the Customer Adoption

This study aimed to determine the correlations between FinTech innovation, banking sector transformation, and customer adoption of FinTech-based services in Pakistan's banking sector. Data was collected from Pakistani bank employees using a quantitative research methodology. A survey questionnaire was used to gather responses on innovation in fintech, banking sector transformation, and customer uptake of fintech-based services. The results showed a strong positive correlation between FinTech innovation and customer uptake in the banking industry, which was mediated by banking sector transformation. This highlights the importance of banks altering their business models and services to effectively utilise FinTech solutions. By adopting FinTech innovations and supporting banking sector change, financial institutions can increase consumer uptake, position themselves for sustainable growth, and remain competitive in the rapidly changing financial services industry. This study provides valuable insights for banking executives and decision-makers seeking to enhance customer service and support the growth of the banking industry in innovation and resilience

Clopidogrel Interactions: Consider while prescribing

Clopidogrel reduces the cardiovascular risks because of inhibitory action on platelets aggregation but some co-administered drugs compromise its main therapeutic effects. Clopidogrel is a prodrug and converted into active metabolite by the hepatic cytochrome P450. The active thiol metabolite inhibits the P2Y12 adenosine di-phosphate receptors and decrease the platelet aggregation processes. The activity of clopidogrel is dependent on the metabolic conversion by cytochrome P450 due to this fact proton pump inhibitors, atorvastatin and several other drugs that competitively inhibit the clopidogrel metabolism might alter its therapeutic response. Conversely other agents potentiate the clopidogrel responsiveness by inducing the cytochrome activity. Combinational drug therapy increases the risks of drug-drug interactions. The previous pharmacodynamic studies have reported clinically significant risks that are associated with combined therapy of clopidogrel with other drugs which are commonly used in coronary artery disorders. These reported studies did not demonstrate the consistent evidence for sever drug-drug interaction hazards in cardiovascular events. This review highlights the various controversies among the studies about common clopidogrel interactions when prescribed in various cardiovascular disorders to achieve targeted therapeutic outcomes. The clopidogrel is commonly prescribed in many serious disorders such as cardiovascular, hypercholesteraemia and lack of information or uncertainty may cost serious outcomes. Keywords: Clopidogrel, Interactions, Cardiovascular, Proton pump inhibitor

Genetic diversity in Balkhi, Hashtnagri and Michni sheep populations using SSR markers

Morphological and genetic diversity among the three neighboring sheep breeds native to Central valley of Khyber Pukhtunkhwa (KP, Pakistan) was investigated. A total number of 138 non relative individuals of Balkhi (46), Hashtnagri (44) and Michni (48) was sampled for morphological as well as molecular characters using 31 ovine specific SSR markers. Morphological observations and morphometric traits varied significantly among different sheep breeds. Balkhi having usually brown or white colour, with a tucked up fat tail was the larger breed. Hashtnagri is a medium sized breed; body covered with white wool, having long white tail, with a tail switch. The body colour of Michni sheep was usually brown or some times white. This breed is comparatively small in size with longer fat tail, hanging near  (33.3%) or below (66.7%) hock. Total number of 119 alleles was identified with mean number of 3.8 alleles per locus, ranging from 2 to 8. Twelve unique alleles  were identified in Michni population at different loci. Average gene diversity was higher in Michni (0.561). Inbreeding estimate (FIT) was significantly higher  (27.1%) among three breeds and was highest between Balkhi and Hashtnagri (31%), similarly highest gene flow (Nm = 60.4) and lowest population differentiation (FST = 4.3%) was estimated between these two  breeds. Maximum genetic distance was observed between Balkhi and Michni; however, Balkhi was genetically closed to Hashtnagri population. Balkhi and Michni were assigned at high accuracy to their respective population; however, the identity of Hashtnagri is obscure.Key words: Balkhi, Hashtnagri, Michni, simple sequence repeat (SSR) markers, morphological characteristics, genetic diversity

Exact solutions for unsteady axial Couette flow of a fractional Maxwell fluid due to an accelerated shear

The velocity field and the adequate shear stress corresponding to the flow of a fractional Maxwell fluid (FMF) between two infinite coaxial cylinders, are determined by means of the Laplace and finite Hankel transforms. The motion is produced by the inner cylinder that at time t = 0+ applies a shear stress fta (a ≥ 0) to the fluid. The solutions that have been obtained, presented under series form in terms of the generalized G and R functions, satisfy all imposed initial and boundary conditions. Similar solutions for ordinary Maxwell and Newtonian fluids are obtained as special cases of general solutions. The unsteady solutions corresponding to a = 1, 2, 3, ... can be written as simple or multiple integrals of similar solutions for a = 0 and we extend this for any positive real number a expressing in fractional integration. Furthermore, for a = 0, 1 and 2, the solutions corresponding to Maxwell fluid compared graphically with the solutions obtained in [1–3], earlier by a different technique. For a = 0 and 1 the unsteady motion of a Maxwell fluid, as well as that of a Newtonian fluid ultimately becomes steady and the required time to reach the steady-state is graphically established. Finally a comparison between the motions of FMF and Maxwell fluid is underlined by graphical illustrations