Correlation of Atrial Fibrillation with Left Atrial Volume in Patients with Mitral Stenosis. a Single Centre Study From Pakistan

Background: Rheumatic heart disease has a strong association with mitral valve stenosis. Atrial fibrillation is one of the most common complications of this condition and is a poor prognostic factor. Early detection and prompt management of atrial fibrillation can help to improve the quality of life and increase the life expectancy of the patients. We carried out this study to investigate the significance of left atrial volumetric changes in mitral stenosis and its correlation with atrial fibrillation. Methodology: We audited the data of 60 patients of rheumatic heart disease who had mitral valve stenosis. The patients were randomized into atrial fibrillation (Group A) and normal sinus rhythm (Group B). We conducted this cross-sectional analytical study at Cardiology Department, Mayo Hospital, Lahore, from 1st February 2017 to 31st January 2018. We only included those patients who consented to be a part of this study and fulfilled our predefined inclusion criteria. Left atrial volume was measured by prolate ellipse method and biplane methods on echocardiography. The Data was analyzed on SPSS v20. Results: Sixty patients were included in the study. Among the subjects, thirty-six (60%) were males, and twenty-four (40%) were females. Atrial fibrillation was noted in 43.33% of the patients of mitral valve stenosis. There was a marked difference in the mean volume of the left atrium among the two groups. We observed that the mean area of the mitral valve for Group A patients was larger than that of patients in Group B. Our study showed an inverse correlation between left atrial volume and mitral valve area among Group A patients. Conclusion: Patients of mitral stenosis are at an increased risk of developing atrial fibrillation if the left atrial volume is increasing. All patients with mitral stenosis should have routine echocardiography & measurement of left atrial volumes, so that proper treatment can be started if the left atrial volume is increasing, to prevent atrial fibrillation

Delivery of Analeptics via Painless Transdermal Patches

Putting into service a preliminary transdermal patch on the skin, an appropriate dosage of drug can be delivered to the site of therapeutic effect within the body. This supreme delivery system is painless and more efficacious. These patches are designed by adhering analeptic compounds over them. In conjugation to these therapeutic compounds essential oils having anti-inflammatory, anticancer, antioxidant and healing properties are also used, increasing the durability of drug. Natural and synthetic polymers comprising cellulose derivatives and polyvinyl chloride respectively are significant in their designing. There are assorted categories of transdermal drugs, depending on the layers of therapeutic compounds, inclusive of single layer, bi-layer, multilayer, matrix and reservoir. Transdermal delivery has its own wondrous aptness. It enhances bioavailability of drugs eliminating the first pass effect in gastrointestinal tract. It is efficient in treating not only extraneous skin infection, but it also holds a strong curable impact on internal disorders extending from hormonal imbalance to either neurodegenerative diseases or cardiovascular diseases. Nicotine patches are prodigiously practiced treating nicotine addicts. 

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

The Association Between Cervical Radiculopathy and Quality of Life in Patients With Cervical Spondylosis

Objectives: To determine the association between cervical radiculopathy and quality of life (QoL) in patients with cervical spondylosis. Methods: This analytical cross-sectional study was conducted on 273 patients in five hospitals in Lahore within 3 months from April to June 2021. The Spurling test was used to measure cervical radiculopathy. The participants were selected according to the inclusion criteria. The Spurling test was used to measure cervical radiculopathy and its symptoms. The World Health Organization quality of life scale (WHOQoL) was used to evaluate the QoL of patients suffering from cervical spondylosis.  Results: Of 273 patients, 42.9% were male and 57.1% female. Their Mean±SD age was 42±11.9 years. Also, 70.3% had positive Spurling test, and 29.7% had negative results. Their Mean±SD physical health score was 11.70±1.74 (out of a total of 20), and their Mean±SD psychological health score was 11.75±1.78 (out of a total of 20). The Mean±SD social relationships score was 11.19±2.98 (out of a total of 20), and their Mean±SD environment health score was 11.13±3.08 out of a total of 20. P indicates a significant difference in the QoL between patients with positive and negative Spurling tests. Patients with negative Spurling tests had higher QoL scores. Greater scores denote a higher QoL Discussion: There is a significant association between cervical radiculopathy and QoL in patients with cervical spondylosis. These results will help us in the future to design educational programs or modify the lifestyle of those patients with cervical radiculopathy. This research concluded that there is a significant difference in the QoL among patients with positive and negative Spurling tests. Patients with negative Spurling tests have higher QoL scores. Hence there is a significant association between diagnosed cervical radiculopathy and QoL

A Facile Synthesis of FeCo Nanoparticles Encapsulated in Hierarchical N-Doped Carbon Nanotube/Nanofiber Hybrids for Overall Water Splitting

Development of efficient and cost-effective transition metal-based catalysts for overall water splitting is desired. Herein, a facile synthesis procedure for the development of FeCo bimetallic alloy nanoparticles (NPs) located on the tips of multi-walled carbon nanotubes (CNTs) supported over N-doped carbon nanofibers (CNFs) is presented. The CNTs, not only prevent FeCo NPs from agglomeration by encapsulating them at the tip but also provide an efficient electron pathway. The materials exhibited excellent performance in oxygen evolution reaction (OER) and decent activity in hydrogen evolution reaction (HER) with long-term durability of up to 48 hours on glassy carbon electrode. The best OER activity with a overpotential of 283 mV@10 mAcm(-2) and Tafel slope of 38 mV/dec was achieved with a hierarchically porous catalyst having Fe : Co molar ratio of 1 : 2. This synthesis approach is promising for growing well-dispersed CNTs over N-doped carbonaceous support using bimetallic alloys for electrocatalytic applications

Structure-Function Mutational Analysis and Prediction of the Potential Impact of High Risk Non-Synonymous Single-Nucleotide Polymorphism on Poliovirus 2A Protease Stability Using Comprehensive Informatics Approaches

Polio viral proteinase 2A performs several essential functions in genome replication. Its inhibition prevents viral replication, thus making it an excellent substrate for drug development. In this study, the three-dimensional structure of 2A protease was determined and optimized by homology modelling. To predict the molecular basis of the interaction of small molecular agonists, docking simulations were performed on a structurally diverse dataset of poliovirus 2A protease (PV2Apr°) inhibitors. Docking results were employed to identify high risk missense mutations that are highly damaging to the structure, as well as the function, of the protease. Intrinsic disorder regions (IDRs), drug binding sites (DBS), and protein stability changes upon mutations were also identified among them. Our results demonstrated dominant roles for Lys 15, His 20, Cys 55, Cys 57, Cys 64, Asp 108, Cys 109 and Gly 110, indicating the presence of various important drug binding sites of the protein. Upon subjecting these sites to single-nucleotide polymorphism (SNP) analysis, we observed that out of 155 high risk SNPs, 139 residues decrease the protein stability. We conclude that these missense mutations can affect the functionality of the 2A protease, and that identified protein binding sites can be directed for the attachment and inhibition of the target proteins