Relationship of platelet-lymphocyte ratio with severity of obstructive sleep apnea syndrome.

Objective: Objective of study was to assess the inflammation in obstructive sleep apnea syndrome patients by using platelet lymphocyte ratio and relationship between platelet lymphocyte ratio and severity of obstructive sleep apnea. Study Design: Cross sectional study Place and Duration: Pulmonology department of Nishtar Hospital Multan and Jinnah Hospital, Lahore  from June 2018 to March 2019. Methods: This cross sectional study was conducted in Pulmonology department of Nishtar Hospital Multan from June 2016 to March 2017.Total 280 patients were selected by non-probability consecutive sampling. All patients underwent whole night polysomnography. Patients were divided into control group (AHI <5), mild OSAS group (AHI 5-15), moderate OSAS group (AHI 15-30) and sever OSAS group (AHI >30) according to their AHI score. Numerical variables like age, body mass index, white cell count, platelets, hemoglobin (Hb) and platelet lymphocyte ratio were statistically analyzed by mean and standard deviation and t-test applied to assess their significance. Qualitative variables like gender and smoking status were statistically analyzed by frequency and percentage. Chi square test was applied to check the significance. P value <0.05 was regarded as significant. Results: Platelet lymphocyte ratio was significantly raised in patients with obstructive sleep apnea syndrome. There was significant correlation between platelet lymphocyte ratio and AHI (p<0.05). So study showed that there was significant association between obstructive sleep apnea syndrome severity (represented by AHI) and systemic inflammation (represented by PLR). Significant differences were found between age (p =0.000), ESR (p =0.000), CRP (p =0.003), Cholesterol (p =0.000), Platelets (p =0.048), Hb (p =0.000), PLR (p =0.000) and white blood cells (p =0.000), in groups. Association was found between gender (p =0.000) and smoking status (p =0.030) in groups. So, gender and smoking were the effect modifiers. Conclusion: the observations of our study suggest that Platelet lymphocyte ratio was significantly raised in patients with obstructive sleep apnea syndrome. There was significant correlation between platelet lymphocyte ratio and AHI (p<0.05). So study showed that there was significant association between obstructive sleep apnea syndrome severity (represented by AHI) and systemic inflammation (represented by PLR). Key words: Obstructive sleep apnea syndrome, Platelet lymphocyte ratio, polysomnography DOI: 10.7176/JMPB/54-08 Publication date: April 30th 201

Role of N-Acetylcysteine in Clearance of Secretions in Mechanical Ventilated Patients

Objective: To determine the role of nebulized N-acetylcysteine in mechanical ventilation in clearing the airway of these patients Study Design: A Randomized Control Trial. Place and Duration of Study: Department of Anaesthesia and Intensive Care Unit Nishtar Medical University Hospital and Jinnah Hosptal, Lahore. From January 2017 to July 2018. Material and Methods: In this project total 50 patients were enrolled by consecutive sampling who remained on mechanical ventilation for more than 24 hours and were between ages 15 to 80 years old. Written consent of this project was taken from relative of each patient. These patients were divided into two groups by lottery method into case and control. The case group received 2 ml of NAC 20% with 8 ml normal saline 3 times a day for 1 day. The control group only received 10 ml normal saline via their nebulizers 3 times a day at 8 AM, 2 PM, and 9 PM. Data was collected and was analyzed. SPSS 22 was used for this purpose. All numerical variables of this research such as mean FiO2, mean peak and plateau pressure of airway, mean blood pressure, mean age and importantly mean density of secretions were calculated. In these values t test was applied and p value was calculated. If it was less than .005, then it was considered significant. Similarly, qualitative data such as type of disease were calculated in percentage and chi square test was used to check the significance. Results: The mean O2 saturation of baseline, 12 hours and 24 hours of the controls was 93.84±2.28, 94.27±2.33 and 94.08±1.81 respectively. The mean peak airway pressure of baseline, 12 hours and 24 hours of the controls was 23.16±3.49, 25.38±8.86 and 24.01±4.91 respectively. The mean plateau airway pressure of baseline, 12 hours and 24 hours of the controls was 19.04±7.79, 21.37±4.86 and 21.85±8.93 respectively. The mean secretion density of baseline, 12 hours and 24 hours of the controls was 1.04±0.024, 1.05±0.03 and 1.03±0.002 respectively. While, the mean O2 saturation of baseline, 12 hours and 24 hours of the cases was 93.08±2.37, 94.61±2.56 and 94.11±2.34 respectively. The mean peak airway pressure of baseline, 12 hours and 24 hours of the cases was 26.58±5.81, 23.81±8.28 and 24.34±6.15 respectively. The mean plateau airway pressure of baseline, 12 hours and 24 hours of the cases was 21.88±78.01, 24.88±6.67 and 23.51±7.55 respectively. The mean secretion density of baseline, 12 hours and 24 hours of the cases was 1.01±0.021, 1.08±0.022 and 1.008±0.0195 respectively. The differences were statistically insignificant. P-value ≤ 0.05 is considered as significant. Conclusion: It is concluded from our observations that use of N-acetylcysteine in patients on mechanical ventilation is very effective in clearance of secretion and to maintain airway clear. Key words: N-acetylcysteine, mechanical ventilation, airway clearance, normal saline DOI: 10.7176/JMPB/54-07 Publication date: April 30th 201

Enhanced production of butyric acid by solid-state fermentation of rice polishings by a mutant strain of Clostridium tyrobutyricum

Purpose: To enhance butyric acid production by solid-state fermentation with a hyper-producing mutant of Clostridium tyrobutyricum generated by random mutagenesis.Methods: Wild type C. tyrobutyricum was mutagenized with UV irradiation, nitrous acid, and ethidium bromide to obtain a hyper-producing strain. Various physiochemical parameters were optimized to increase the butyric acid yield.Results: The UV-induced mutant (C.TUV) produced significantly higher concentrations of butyric acid than the wild type parent, nitrous acid-induced, and ethidium bromide-induced strains. C.TUV increased butyric acid production 1.4-fold more than the parent strain. Fermentation with C.TUV with 2.5 g of rice polishings (w/w), a 2 % inoculum volume (v/v), and a 48-h incubation period at 37°C under anaerobic conditions produced 11.63 mg/100 g of butyric acid. The addition of 0.6 % corn steep liquor as a nitrogen source increased the butyric acid concentration to 26.09 mg/100 g.Conclusion: These optimized fermentation parameters on a small scale can be used on a commercial scale to mass-produce butyric acid.Keywords: Butyric acid, Mutant, Clostridium tyrobutyricum, Mutagen, Solid-state fermentatio

Role of Tuition Centers in the Performance and Achievement of Students: A Case of Hyderabad District, Sindh, Pakistan

This research is designed to explore the importance of tuition centers in the perception of students. It tries to find out the role, supporting methods, environment and good characteristics of tuition centers, their owners and management to support the student to learn effectively and bring good grades in their board examinations. A qualitative research method employed to collect data from the 30 participating students who receive tuition at different centers of Hyderabad district. Semi-structured interview protocol was design; discussed with five experts of field; improved as per suggestions of field experts; piloted on three students; and then implemented and conducted on the recruited sample of students of class Higher Secondary Certificate -II (XII) in order to collect data. The results revealed that the students who receive tuition at different centers bring good grades in their examination and have suitable knowledge about their subjects taught at centers. Their previous grades were found good and attractive such as A-1 and A with more than 80% and 70% marks respectively, due to coaching received at tuition centers that time, reveled from experiences shared by students

Wheat germ oil enrichment in broiler feed with α-lipoic acid to enhance the antioxidant potential and lipid stability of meat

BACKGROUND: Lipid peroxidation is the cause of declining the meat quality. Natural antioxidants plays a vital role in enhancing the stability and quality of meat. The supplementation of natural antioxidants in feed decreases lipid peroxidation and improves the stability of meat. METHODS: The present research was conducted to determine the effect of α-lipoic acid, α-tocopherol and wheat germ oil on the status of antioxidants, quality and lipid stability of broiler meat. One day old male broilers were fed with different feeds containing antioxidants i.e. natural (wheat germ oil) and synthetic α-tocopherol and α-lipoic acid during the two experimental years. RESULTS: The feed treatments have significant variation on the body weight and feed conversion ratio (FCR) while having no influence on the feed intake. The broilers fed on wheat germ oil (natural α-tocopherol) gained maximum body weight (2451.97 g & 2466.07 g) in the experimental years 2010–11 & 2011–12, respectively. The higher total phenolic contents were found in the broilers fed on wheat germ oil plus α-lipoic acid in breast (162.73±4.8 mg Gallic acid equivalent/100 g & 162.18±4.5 mg Gallic acid equivalent/100 g) and leg (149.67±3.3 mg Gallic acid equivalent/100 g & 146.07±3.2 mg Gallic acid equivalent/100 g) meat during both experimental years. Similar trend was observed for the 2,2-diphenyl-1-picrylhydrazyl (DPPH) and ferric reducing antioxidant power assay (FRAP). The production of malondialdehydes in the breast and leg meat increased with progressive increase in the time period. The deposition of α-tocopherol (AT) and α-lipoic acid (ALA) contents were found to be higher in the broilers fed on wheat germ oil plus α-lipoic acid in breast and leg meat during the both experimental years. CONCLUSION: In conclusion, the combination of wheat germ oil and α-lipoic acid has more beneficial for stability and the quality of the broiler meat and more work should be needed in future for the bio-evaluation of this kind of functional meat in humans

Association of Clinicopathological features of Cholecystitis with Helicobacter Pylori Infection in Gall bladders

Background: Helicobacter pylori (H. pylori) have been associated with gastritis, but its presence in other parts of the gastrointestinal system has not been studied much. Few previous studies have identified “H. pylori” in gallbladder and found its association in causing cholecystitis and gallstones, but there is limited data showing a significant association in Pakistan. This study was designed to identify H. pylori microorganism in cholecystitis patients and find its association with the morphological changes seen in the affected gall bladders. Material and Methods: All patients with acute and chronic cholecystitis admitted in Akbar Niazi Teaching Hospital (ANTH) between the ages of 18 and 80 years from January 2017 till March 2019, who underwent cholecystectomy, were included in the study. Gall bladder specimens were sent to Pathology department, ANTH after surgery and were analyzed for the presence of H pylori bacteria using Hematoxylin and Eosin and Giemsa staining. Signs of inflammation, hyperplasia, metaplasia, mucosal atrophy or erosion, lymphoid infiltration, fibrosis, cholesterolosis or any other morphological changes were also noted. Association of H. pylori with cholecystitis and other morphological changes were assessed by Chi Square analysis. P value less than 0.05 was considered statistically significant.Results: Chronic cholecystitis was present in 91% cases and acute cholecystitis in 9%. Other histological findings were Hyperplasia (10%), Metaplasia (15%), Fibrosis (79%), Cholesterolosis (19%) and ulcerations (36%). H pylori was found in 17% of gall bladders and all the cases were of chronic cholecystitis, with 11.7% males and 88% females. Gallstones were present in 76.4% cases and were more common in 41-60 years’ age group (64.7%). Other histological findings seen in H. pylori positive cases were; Hyperplasia in 11.7% cases, Metaplasia in 17.6%, Fibrosis in 94.1%, cholesterolosis in 23.5% and ulcerations in 17.6% cases. Association of H. pylori with gender, cholecystitis, gall stones, histological features and age distribution was non-significant.Conclusion: Although H. pylori infection has been found in cases of chronic cholecystitis and gall stone formation, its association with cholecystitis and other morphological changes could not be proved. Hence, it is uncertain whether H. pylori eradication in patients with gastritis can prevent cholecystitis or gall stones formation

Ultrasound-guided Intralesional Bleomycin Injection (IBI) for Treatment of Cutaneous Hemangiomas and Vascular Malformations

Purpose: To report the therapeutic outcome of ultrasound-guided intralesional injection of bleomycin in the treatment of cutaneous hemangiomas and vascular malformations. Material & Methods: The medical records of patients with cutaneous hemangiomas and vascular malformations treated with the intralesional injection of bleomycin under ultrasound guidance between August 2009 and June 2013 at the Indus Hospital, Karachi were reviewed retrospectively using a computerized medical record information management system. Data were extracted using a pre-coded performa that included patient demographics, type and location of lesion, number of treatments, presenting/pre- and post-treatment clinical symptoms (pain, swelling, heaviness, size, discoloration), ultrasound appearance and vascularity, and post-treatment side effects. The dose range of bleomycin was 0.5-1.0 mg/kg, but not exceeding 15 mg in a single session. A maximum of four treatments were given in any given patient except for one, who presented with recurrence after a year of complete resolution. Therapeutic outcome was determined using review of ultrasound images and recorded clinical assessment. Treatment response was categorized as: (i) complete resolution [more than 90% reduction]; (ii) substantial reduction [more than 50% reduction]; (iii) mild reduction [25% reduction]; or, (iv) no improvement [ \u3c 10% reduction]. Results: A total of 30 patients (16 female, 14 male), ranging in age from 8 months to 48 years (mean age 10.2 years), were treated from 2009 to 2013. There were 23 hemangiomas. Seven were vascular malformations, of which five were lymphatic malformations and two were venous malformations. Twenty-eight lesions were located in the head and neck region, and two were peripheral.. In 24 of the 30 patients (76%), treatment had been completed. In six patients (21%) treatment was ongoing at the time of this report. Seventeen of the 23 hemangiomas (74%) were completely resolved clinically and on ultrasound, five (22%) showed substantial improvement and one (4%) showed mild improvement. In five of the seven vascular malformations (71%) lymphatic malformations resolved completely, and two (29%) venous malformations showed substantial improvement. Of the 13 patients presenting with discoloration, there was complete resolution in one (7.7%), marked reduction in 11 (84.6%) and mild reduction in one (7.7%). Of seven patients presenting with pain, there was complete resolution in two (28.6%), marked reduction in two (28.6%), mild reduction in two (28.6%), and no improvement in one (14.3%). There were no pulmonary complications. Conclusion: Ultrasound-guided intralesional injection of bleomycin is an option to consider for the treatment of certain types of cutaneous hemangiomas and vascular malformations. Prospective studies should be undertaken to understand the various factors contributing to therapeutic success

Adaptive Backstepping Integral Sliding Mode Control for 5DOF Barge-Type OFWT under Output Constraint

This article presents a new control solution for a dynamical model of a translational oscillator with a rotational actuator (TORA) based on multi-body dynamics for a barge-type offshore floating wind turbine (OFWT). TORA has been employed as an active structural control strategy. The solution of bounding the output movements of platform pitch and tower bending angle to a certain limit, along with mitigating the OFWT vibrations due to environmental disturbances and uncertainties, is presented in this novel control framework. This new control algorithm consists of a high-gain observer (HGO)-based adaptive backstepping integral sliding mode control (ISMC) and a barrier Lyapunov function (BLF). This guarantees satisfying the constraints on the states and effectively resolves the problem of the unavailability of the system states. The proposed control law based on the BLF has been compared with an adaptive backstepping ISMC to show the efficiency of the output-constraint control scheme. Through MATLAB/SIMULINK numerical simulations and their numeric error table, the effectiveness of the proposed control scheme has been examined. The results confirm the validity and efficiency of the proposed control approaches

US Print Media Framing of Nuclear Ambiguity: Israel vs. Iran

This research work aims at studying the “Nuclear Ambiguity” by evaluating the coverage of Israeli and Iranian nuclear issue in the US print media. The main objective of the study was to examine the news stories and editorial treatment of the above mentioned issue with reference to the foreign policies of the related countries. Content analysis was employed to study the two newspapers; The New York Times and The Washington Post. The data was collected by usingcensus approach and the whole population was considered as sample from the time period of January, 2014 to December, 2015. The theoretical framework of the study comprised of Agenda setting and Framing theory that explain how media can “play up” or “play down” any issue. To determine the significance of the research hypothesis, statistical test chi square was applied and results approved all the hypotheses. The study concluded that US print media followed their national policies and played up the issue of nuclear ambiguity in case of Iran’s nuclear program, while played down the Israel’s nuclear program because Israel is a vital ally of American