Advancing Age as a Risk Factor for Acute Myocardial Infarction

Background: Acute myocardial infarction (AMI) is one of the leading causes of death in developed and developing countries. Age is an important non-modifiable risk factor for acute myocardial infarction. Objectives: The objective of the study was to explore the relationship of advancing age with the risk of acute myocardial infarction. Methods: It was a cross-sectional study conducted in 2019 after getting approval from Institutional Review board of University of Health Sciences, Lahore. Written informed consent and thorough history was taken from the study participants. Group 1 included 45 AMI patients aged 20-60 years. Group 2 included 45 healthy individuals aged 20-60 years. Independent sample t test and chi-square tests were applied for analysis of data. Results: Mean age was significantly higher in AMI patients (50.52±7.31) as compared to healthy controls (30.67±7.20). The risk of AMI increases with advancing age (p<0.001, OR= 2.78). Conclusions: Advancing age is an important risk factor for acute myocardial infarction

Comparison of Bacterial Load measured by X-pert / MTB RIF Assay with Smear & Myco-Bacterial Culture, as a marker for monitoring disease outcome in Cavitary Pulmonary Tuberculosis

Introduction:&nbsp;Tuberculosis (TB) is one of the major public health problems in Pakistan. Treatment depends on the diagnosis and bacterial load. The smear and culture of the sputum sample are considered as the gold standard. However, another recently invented diagnostic criteria i.e. X-PERT / MTB RIF Assay can also give high accuracy and can be used as a substitute for sputum culture. Objective:&nbsp;To determine the validity of Xpert MTB/RIF and sputum smear in monitoring the outcome of cavitary pulmonary tuberculosis by taking culture as the gold standard Study design:&nbsp;Descriptive Cross-sectional Study. Setting:&nbsp;Department of Pulmonology, Fauji Foundation Hospital Rawalpindi. Duration:&nbsp;15th Feb to 15th Dec 2018. Materials and Methods:&nbsp;250 Patients who meet the criteria were integrated into the study. A sputum sample was taken two times and two samples were sent to the laboratory of the hospital for Xpert MTB/RIF, sputum smear, and culture. Findings were recorded. Then patients were given standard treatment for tuberculosis. Data was entered in SPSS 23. Age, laboratory variables like HB, Platelets count, etc. were presented as mean and standard deviation. Gender, outcome of diagnosis were presented as mean and standard deviation. Sensitivity, specificity measure on –rays, findings, smear test, and Xpert MTB/RIF. Results:&nbsp;Total 187 patients including 12 (6.4%) male and 175 (93.6%) female. The mean age was 44.14+17.13 years. Positive findings on X-pert and smear were found in 35(53%) patients and MTB/ RIF were found in 41(62.1%). Sensitivity, specificity of X-pert MTB/RIF were found to be 77.6% and 13.6% at baseline while 40% and 40% respectively at end of treatment. Conclusion:&nbsp;Thus, X-pert MTB/RIF is an important tool than sputum smear and AFB culture in monitoring the outcome of cavitary pulmonary tuberculosis

Comparison of Bacterial Load measured by X-pert / MTB RIF Assay with Smear & Myco-Bacterial Culture, as a marker for monitoring disease outcome in Cavitary Pulmonary Tuberculosis

Introduction:&nbsp;Tuberculosis (TB) is one of the major public health problems in Pakistan. Treatment depends on the diagnosis and bacterial load. The smear and culture of the sputum sample are considered as the gold standard. However, another recently invented diagnostic criteria i.e. X-PERT / MTB RIF Assay can also give high accuracy and can be used as a substitute for sputum culture. Objective:&nbsp;To determine the validity of Xpert MTB/RIF and sputum smear in monitoring the outcome of cavitary pulmonary tuberculosis by taking culture as the gold standard Study design:&nbsp;Descriptive Cross-sectional Study. Setting:&nbsp;Department of Pulmonology, Fauji Foundation Hospital Rawalpindi. Duration:&nbsp;15th Feb to 15th Dec 2018. Materials and Methods:&nbsp;250 Patients who meet the criteria were integrated into the study. A sputum sample was taken two times and two samples were sent to the laboratory of the hospital for Xpert MTB/RIF, sputum smear, and culture. Findings were recorded. Then patients were given standard treatment for tuberculosis. Data was entered in SPSS 23. Age, laboratory variables like HB, Platelets count, etc. were presented as mean and standard deviation. Gender, outcome of diagnosis were presented as mean and standard deviation. Sensitivity, specificity measure on –rays, findings, smear test, and Xpert MTB/RIF. Results:&nbsp;Total 187 patients including 12 (6.4%) male and 175 (93.6%) female. The mean age was 44.14+17.13 years. Positive findings on X-pert and smear were found in 35(53%) patients and MTB/ RIF were found in 41(62.1%). Sensitivity, specificity of X-pert MTB/RIF were found to be 77.6% and 13.6% at baseline while 40% and 40% respectively at end of treatment. Conclusion:&nbsp;Thus, X-pert MTB/RIF is an important tool than sputum smear and AFB culture in monitoring the outcome of cavitary pulmonary tuberculosis

Comparison of High Intensity Non-Invasive Ventilation With Low Intensity Non-Invasive Ventilation In Patients With Acute Copd Exacerbation

Objective: To determine the outcome of high intensity non-invasive positive pressure ventilation (HI-NPPV) as compared to low intensity non-invasive positive pressure ventilation (LI-NPPV) in patients with acute COPD exacerbations. Methodology: This Randomized controlled trial Department of PulmonologyFauji Foundation Hospital Rawalpindi from  31st December 2016 to 30thJune 2017. Arterial blood gases will be taken at admission. If values of pH and paCO2 meet the criteria for non-invasive ventilation then patients will be enrolled in the study. Patients will be randomly divided into two groups by lottery method. GROUP A and GROUP B. GROUP A will receive high intensity NIV (HI-NPPV) and GROUP B will receive low intensity NIV (LI-NPPV) by TRIOLOGY machine. Expiratory positive airway pressure (EPAP) will remain between 4 to 6 cmH2O.  Arterial blood gases (ABGs) will be done at baseline and then 72 hours after admission. Improvement in PaCO2, HCO3, and FEV1 will be recorded 72 hours from baseline and collected on proforma (attached). Results: Mean age (years) in the study was 55.54+3.81. There were 08 male patients included the study meeting the inclusion criteria. Of these, 05 and 03 male patients among both the groups respectively. Similarly, there were 92 female patients included the study meeting the inclusion criteria, of these, 45 and 47 female patients among both the groups respectively. Outcome of the study was assessed in terms of mean PaCO2 (mmHg), HCO3 (mmol/L) and FEV1 at baseline and after 72 hours. Mean PaCO2, HCO3 and FEV1 at baseline was 64.87+5.22, 33.75+4.17 and 0.66+0.04 respectively. After 72 hours, mean PaCO2 (mmHg) , HCO3(mmol/L), and FEV1 among both the groups was 63.98+6.58 vs 41.46+2.40, 33.10+4.81 vs 23.12+2.01, 0.66+0.05 vs 0.72+0.04 with following P value of (0,000, 0.000, 0.000) respectively. Conclusion: High intensity non-invasive positive pressure ventilation (HI-NPPV) has no different outcome as compared to low intensity non-invasive positive pressure ventilation (LI-NPPV) in patients with acute COPD exacerbations

Current Diagnostic Techniques for Pneumonia:A Scoping Review

Community-acquired pneumonia is one of the most lethal infectious diseases, especially for infants and the elderly. Given the variety of causative agents, the accurate early detection of pneumonia is an active research area. To the best of our knowledge, scoping reviews on diagnostic techniques for pneumonia are lacking. In this scoping review, three major electronic databases were searched and the resulting research was screened. We categorized these diagnostic techniques into four classes (i.e., lab-based methods, imaging-based techniques, acoustic-based techniques, and physiological-measurement-based techniques) and summarized their recent applications. Major research has been skewed towards imaging-based techniques, especially after COVID-19. Currently, chest X-rays and blood tests are the most common tools in the clinical setting to establish a diagnosis; however, there is a need to look for safe, non-invasive, and more rapid techniques for diagnosis. Recently, some non-invasive techniques based on wearable sensors achieved reasonable diagnostic accuracy that could open a new chapter for future applications. Consequently, further research and technology development are still needed for pneumonia diagnosis using non-invasive physiological parameters to attain a better point of care for pneumonia patients

Role of Serum Vitamin B12 and Glutathione Peroxidase during Third Trimester of Pregnancy with Gestational Diabetes Mellitus

Objective: To investigate the role and relationship of serum Vitamin B12 and Glutathione peroxidase in pregnancy with gestational diabetes mellitus (GDM). Study Design: Comparative cross-sectional study. Place and Duration of Study: Physiology Department, University of Health Sciences, Lahore Pakistan, from Feb 2019 to Mar 2020. Methodology: Ninty pregnant women were recruited, fulfilling the inclusion and exclusion criteria. Women with GDM were the cases, and those without GDM were the controls. Serum Vitamin B12 and Glutathione peroxidase were measured by ELISA. Results: Serum Vitamin B12 was significantly lower in cases compared to controls (158.98±7.38 and 357.48±42.07mg/dL, respectively, at p<0.001. Glutathione peroxidase was also significantly lower in cases compared to controls (2.68±1.13U/mL and 5.53±1.05U/mL, respectively, at p<0.001. Correlation analysis showed that Vitamin B12 and Glutathione peroxidase had a significant positive correlation in cases (p<0.001 and rho=0.76) and a non-significant correlation in controls (p=0.87 and rho=-0.024). Linear regression analysis showed that Vitamin B12 positively affects Glutathione peroxidase (β=0.13, p<0.001).Vitamin B12 and Glutathione peroxidase have a significant, negative effect on fasting blood glucose (β =-0.06, p<0.001 and β=- 3.66, p<0.001, respectively). Conclusion: Deficient Vitamin B12 leads to reduced Glutathione levels in GDM pregnancy. A deficiency of these two predicts elevated blood sugar levels

An Updated Review on Rheumatoid Arthritis (RA): Epidemiology, Pathophysiology, Diagnosis, and the Current Approaches for Its Treatment

Rheumatoid arthritis (RA) is a systemic self-inflicted inflammatory disease that primarily affects middle-aged women. Globally, 1% of people live with RA. This review aims to provide updated information on the different aspects of RA, including its epidemiology, pathophysiology, diagnosis, treatment, and management. A web-based literature search was conducted through various databases, including PubMed, Google Scholar, and Science Direct, to identify the most relevant studies. Epidemiological studies have suggested that the prevalence and occurrence of RA have remained inconsistent across geographical areas in different periods. Many factors such as age, gender, inheritances, and environmental exposure can contribute to the severity of the disease. The acute form of RA usually presents with pain, and if left untreated, it can result in joint deformities and influence a patient’s quality of life (QoL). RA diagnosis is usually based on the manifestation of pain with inflammation. Currently, many therapeutic strategies are available for the cure of RA. The management of daily routine activities is required with treatment to curtail the damage, avoid future deformities, and ultimately minimize the aching trouble of the patient

The possible 'calming effect' of subchronic supplementation of a standardised phospholipids carrier-based Melissa officinalis L. extract in healthy adults with emotional distress and poor sleep conditions: results from a prospective, randomized, double-blinded, and placebo-controlled clinical trial

Background: Emotional distress conditions such as depression, anxiety, stress, and poor sleep are widespread health problems that have a significant impact on people’s lives. Conventional drugs are commonly prescribed to treat emotional distress and poor sleep conditions; however, these medications have several limitations and have shown multiple side effects. Over recent years botanicals-based pharmacological agents have gained increasing research and clinical interest in the management of emotional distress and sleep disorder. Of note, Melissa officinalis L. (MO) leaf extract has demonstrated considerable neuropharmacological properties both in animal and human studies and has emerged as a promising natural “calming agent.” However, research in this area is limited, and more studies are needed to validate its efficacy in amelioration of emotional distress and poor sleep conditions. Objectives: We aimed to assess the pharmacological effects of subchronic supplementation of an innovative standardised phospholipid carrier-based MO aqueous extract on emotional distress and poor sleep conditions. Design: A 3-week prospective, randomised, placebo-controlled, parallel-group, double-blinded clinical trial was conducted in 100 healthy adults complaining of a moderate degree of depression, anxiety, or stress, with scores of ≥14, ≥10, and ≥19, respectively, in the self-report Depression, Anxiety, and Stress Scale (DASS-42) or poor sleep, as indicated by the score of >5 in the Pittsburgh Sleep Quality Index (PSQI) scale. In addition, the impact of emotional distress and/or poor sleep on participants’ mental wellbeing, emotional feelings, and quality of life was also assessed using the self-reported Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS), Positive and Negative Affect Schedule (PANAS) scale, and quality of life (WHO-QoL-BREF) scale, respectively. Results: Oral supplementation of 200 mg of phospholipid-based MO aqueous extract (Relissa™) tablets twice a day (i.e., 400 mg/day) for 3 weeks led to significant improvements in the depressive mood, anxiety, stress, positive and negative affect (emotional feelings), overall mental wellbeing, and quality-of-life scores (all p values <0.001). Supplementation of MO extract was well tolerated, and no treatment-emergent effects or serious adverse events were reported. Conclusion: According to the results of this study, the phospholipid carrier-based MO aqueous extract possesses considerable neuropharmacological properties, and its supplementation may provide a promising therapeutic option for the management of moderate emotional distress and/or poor sleep conditions

Revamping of Chronic Respiratory Diseases in Low- and Middle-Income Countries

Low- and middle-income countries (LMICs) endure an asymmetrically high burden of worldwide disease and death caused by chronic respiratory diseases (CRDs), i.e., asthma, emphysema, bronchiectasis, and post-tuberculosis lung disease (PTLD). CRDs are firmly related with indigence, infectious diseases, and other non-communicable diseases (NCDs) and add to complex multi-disease with great impact on the lives and livelihood of those affected. The pertinence of CRDs to health and demographic wellbeing is relied upon to increment in the long time ahead, as expectations of life rise and the contending dangers of right on time youth mortality and irresistible infections level. The WHO has distinguished the counteraction and control of NCDs as an earnest improvement issue and crucial for the sustainable development goals (SDSs) by 2030. In this review, we center on CRDs in LMICs. We examine the early life roots of CRDs, challenges in their avoidance, identification and administration in LMICs, and the pathways to resolve for accomplish valid widespread wellbeing inclusion