Review of and Updates on Hypertension in Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a prevalent sleep disorder as is hypertension (HTN) in the 21st century with the rising incidence of obesity. Numerous studies have shown a strong association of OSA with cardiovascular morbidity and mortality. There is overwhelming evidence supporting the relationship between OSA and hypertension (HTN). The pathophysiology of HTN in OSA is complex and dependent on various factors such as sympathetic tone, renin-angiotensin-aldosterone system, endothelial dysfunction, and altered baroreceptor reflexes. The treatment of OSA is multifactorial ranging from CPAP to oral appliances to lifestyle modifications to antihypertensive drugs. OSA and HTN both need prompt diagnosis and treatment to help address the growing cardiovascular morbidity and mortality due to these two entities

Malrotation after reamed intramedullary nailing with and without a fracture table for closed fractures of the femoral shaft

Abstract Introduction: To observe the effect of the choice of surgical table on the incidence of malrotation. Methods: The randomised trial was conducted from July 2012 to January 2013 at the Aga Khan University Hospital, Karachi, during which 74 patients were inducted. Randomisation was done via random allocation software version 1.0.0 and sealed envelopes were used to guide the choice of table. Malrotation was assessed by the operating surgeon using the lesser trochanteric shape signunder intra-operative fluoroscopy. SPSS 19 was used for statistical analysis. Results: The 74 patients in the study were divided into two groups of 37(50%) each using fracture table and the regular table.Overall, there were 55(74%) male and 19(26%) female patients with a mean age of 37±17 years. Overall incidence of malrotation was 13(17.6%). Malrotation was observed in 7(19%)patients in the fracture table group and 6(16%)in the regular table group (p=0.760). Conclusion: The choice of fracture table did not influence the occurrence or direction of malrotation

Use of Strychnos nux-vomica (Azraqi) seeds in Unani system of medicine: role of detoxification

Some plants used in Unani system of medicine are toxic, even deadly poison. The drugs having such plants as their components are detoxified before they are dispensed to the patients. One such drug, capsule Hudar, has Strychnos nux-vomica L. (Azraqi) seeds as one of its components and is very effectively used to elevate blood pressure. Ancient manuscripts describe many methods of its detoxification. It has been found that the detoxification processes studied reduce the strychnine amount, as determined either by using uv-vis spectrophotometer or HPLC, present in Strychnos nux vomica seeds which is responsible for Strychnos nux vomica toxicity. The decrease in strychnine amount was maximum when the seeds were immersed for detoxification in excess of water for 5 days, in milk for 2 days followed by their boiling in milk. Strychnine in small amounts has been reported to give subjective feeling of stimulatio

Musculoskeletal tumours throughout history and beyond: Clinical features, imaging, staging and biopsy

Background: Over the last century, there has been a remarkable development in the study of bone and soft tissue sarcomas. This is primarily due to the improved knowledge of the nature of these lesions and the improved imaging technology. In literature there are many protocols that are being used and all of them have reported various advantages and disadvantages of each technique used. However, there is no set guideline and whatever has been proposed has been developed on the basis of the experience of different centres and different surgeons.Objective: The current systematic review was planned to thoroughly evaluate the levels of evidence on which we base decisions for surgical management of lower extremity bone tumours.Methods: The review included descriptive studies published in the English language. Studies included case reports, case series and experiences of different centres for the surgical management of lower extremity bone tumours. Articles reporting all levels of evidence - Level I to V - were included. PubMed, ERIC, MEDLINE, EMBASE and Cochrane Reviews databases from 2002 to 2012 were searched.Results: Information was gathered and thoroughly studied from 63 articles. There were no Level I studies, 2(3.2%) Level II studies, 47(74.6%) Level III, and the remaining 14(22.2%) studies were Level IV and Level V

An Application of Fairclough’s Three Dimensional CDA Approach to Fraser Anning\u27s Speech in Australian Senate

The aim of this study was to highlight impression markers, identify key concerns, and describe cultural as well as social implications of a speech delivered by William Fraser Anning (an Australian Senator) in the Australian Senate on August 14, 2018. In this regard, Fairclough’s three-dimensional model was employed to interpret the data. The speaker was observed employing different impression markers (e.g. discourse and punctuation markers, cultural and historical references, personal pronouns, self and other markers, and expressive and rational values) to create coherence in the speech, emphasize the stance, and thereby grab the attention of the audience. Social problems, common man’s worries like joblessness, poor living standard, race, ethnicity and immigration were the concerns of the speech. Muslim immigrants were not treated as humans equal to Australians or other Europeans. They were labeled as ‘welfare-blunders’, ‘terrorists’, ‘gang-terrorists’, ‘criminals’, and ‘illegal occupants’. The speech was followed by an extremist attack on a Mosque in New Zealand. It might cause serious threat to peaceful coexistence, immigration process, and basic human rights

A Study on Methylation Changes in Mismatch Repair Gene (hMLH1) in Esophageal Cancer Patients of Kashmir Valley

The Study was a Case Control undertaken to understand the etiology of esophageal cancer in the population of Kashmiri origin. This case control study was designed to assess the relationship of promoter hypermethylation of Mismatch Repair Gene MutL homolog 1 (hMLH1) with esophageal cancer. Also further an association of hypermethylation of hMLH1 gene with esophageal cancer in relation to clinicopathological features of Gender and Age was evaluated. Esophageal cancers are one of the most fatal cancers in the world and are considered to be the eighth most common malignancy. The prognosis of Esophageal Cancer is poor as its symptoms appear in the late stage of the disease. This cancer is one of the most prevalent cancers in Jammu and Kashmir region of India and has multi-factorial etiology involving dietary habits, genetic factors, and gene environmental interactions. Genetic abnormalities of proto-oncogenes, tumor suppressor genes and mis-match repair genes have been demonstrated to be involved frequently in esophageal carcinogenesis; chronic inflammation leading to malignancy in the esophagus may be due to errors in mismatch repair (MMR) genes such as hMLH1. Inactivation of the hMLH1 gene expression by aberrant promoter methylation plays an important role in the progression of esophageal carcinoma. In the present study the role of hMLH1 promoter methylation in 50 histopathologically confirmed esophageal cancer tissues and compared it with corresponding histopathologically confirmed Normal adjacent tissues was studied by methylation-specific polymerase chain reaction (MS-PCR). For evaluating the status of hMLH1 promoter hypermethylation and its association with Esophageal Cancer, a methylation specific polymerase chain reaction (MS-PCR) was used. DNA was extracted and treated with sodium bisulfite which converts unmethylated cytosines to uracil and does not affect methylated cytosines. The modified DNA was amplified in MS-PCR reaction by applying methylated and unmethylated promoter specific primers. Universally methylated DNA was used as positive control and DNA from normal lymphocytes used as negative control. The MS-PCR products were run on 3% agarose and bands were visualized under UV light. It was found that the frequency of promoter region hypermethylation of mismatch repair gene (hMLH1) in esophageal cancer cases was 56% (28 out of 50) and in histopathologically confirmed normals it was 15% (03 out of 20).Statistically the association of promoter region hypermethylation of mismatch repair gene (hMLH1) with esophageal cancer was evaluated using χ2-test (chi-square test) with odds ratio and was found significant and the p0.05.From the data it was concluded that The Frequency of MutL homolog 1 (hMLH1) gene promoter region hypermethylation was found high in Esophageal Cancer Cases of above 40 years of age (56%) and in controls (16%) and was significant as p0.05 and was evaluated by Fishers exact test. Observing similar level of hMLH1 promoter hypermethylation in patients with Esophageal Cancer in this high risk region and comparing it with other parts of the world could support the hypothesis that a common molecular mechanism might be involved in tumorigenesis of Esophageal Cancer. As regards promoter hypermethylation status of mismatch repair gene hMLH1 shows a significant increase in promoter region hypermethylation of esophageal cancer patients of Kashmiri origin as compared to controls was observed. This became more apparent when the data for hypermethylation was interpreted taking Gender into consideration here it was seen that Males shows higher frequency of promoter region hypermethylation as compared to females which was earlier reported in literature and also patients of above 40 years of age shows high frequency compared to below 40 years of age

Early experience of dynamic hip screw with spiral blade and locking side plate for the stabilization of trochanteric fractures.

Abstract OBJECTIVE: To evaluate early experience with helical hip system in osteoporotic elderly patients with per-trochanteric fractures. METHODS: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised records of patients having low-velocity pertrochanteric fractures who were fixed with spiral blade Dynamic Helical Hip Systemfrom July to December 2014 and were followed up for a minimum of 3 months. Demographic variables and clinical outcomes were noted from the medical records whereas operative details were recorded from the operative note. Radiological variables and outcomes were assessed by viewing appropriate pre-operative, post-operative and follow-up radiographs. RESULTS: Of the 32 patients in the study, 14(44%) were men and 18(56%) were women, with an overall mean age of 77.81±7.04 years and mean body mass index of 25.99±4.13 kg/m2. Of the total, 1(3.13%) patient had implant cut-out, 1(3.13%) had myocardial infarctionand 2(6.2) expired. CONCLUSIONS: The introduction of spiral blade dynamic hip screw manifested favourable results and good clinical and radiological outcomes with low cut-out rates

Antioxidant and Protective Effect of Ethyl Acetate Extract of Podophyllum Hexandrum Rhizome on Carbon Tetrachloride Induced Rat Liver Injury

The antioxidant and hepatoprotective activities of ethyl acetate extract was carefully investigated by the methods of DPPH radical scavenging activity, Hydroxyl radical scavenging activity, Superoxide radical scavenging activity, Hydrogen peroxide radical scavenging activity and its Reducing power ability. All these in vitro antioxidant activities were concentration dependent which were compared with standard antioxidants such as BHT, α-tocopherol. The hepatoprotective potential of Podophyllum hexandrum extract was also evaluated in male Wistar rats against carbon tetrachloride (CCl4)-induced liver damage. Pre-treated rats were given ethyl acetate extract at 20, 30 and 50 mg/kg dose prior to CCl4 administration (1 ml/kg, 1:1 in olive oil). Rats pre-treated with Podophyllum hexandrum extract remarkably prevented the elevation of serum AST, ALT, LDH and liver lipid peroxides in CCl4-treated rats. Hepatic glutathione levels were significantly increased by the treatment with the extract in all the experimental groups. The extract at the tested doses also restored the levels of liver homogenate enzymes (glutathione peroxidase, glutathione reductase, superoxide dismutase and glutathione-S- transferase) significantly. This study suggests that ethyl acetate extract of P. hexandrum has a liver protective effect against CCl4-induced hepatotoxicity and possess in vitro antioxidant activities

Does tranexamic acid reduce blood transfusion following surgery for inter-trochanteric fracture? a randomized control trial

Abstract OBJECTIVE: To compare the frequency of blood transfusion after surgery for fixation of inter-trochanteric fractures in patients given tranexamic acid versus placebo. METHODS: The randomised control trial was conducted at the Aga khan university hospital from May 1 to October 31, 2014, and comprised patients diagnosed with Inter-trochanteric fracture based on X-ray imaging. The patients were randomised into two equal groups based on a computer-generated random number table. The Intervention group received two doses of 10mg/kg body weight of tranexamic acid just before surgery and three hours later intravenously. The Control group received two doses of 10mg/kg body weight of normal saline at similar intervals. Numbers of blood transfusions required postoperatively were noted based on the postoperative haemoglobin readings. RESULTS: There were 100 patients who were divided into groups of 50(50%) each. Mean post-op haemoglobin for the intervention group was 10.2±2.4 g/dl and for the control group it was 8.9±2.4 g/dl (p=0.007). Nine (18%) patients in intervention group required blood transfusion compared to 21(42%) in control group (p=0.009). CONCLUSIONS: Administering tranexamic acid was a useful and safe option for reducing requirement of blood transfusion postoperatively after inter-trochanteric hip fractur