Effect of eight weeks endurance exercise on liver enzymes in stopping drug women with methadone

Previous studies indicated that endurance exercise decreases levels of liver enzymes. The aim of this study was to determine the effect of endurance exercise on liver enzymes in eight weeks in Iranian women who are stopping the drug with methadone. sixty Iranian women prisoners including 30 cases as experimental group and 30 volunteers served as control. The mean age, height, weight, percent of BF, BMI and vo2max of experimental group was 33/8 years, 162/2 cm, 62/2 kg, 33/10, 24/22 and 16/18 ml/kg respectively. Experimental group was should run with 65%vo2max for 2 weeks (3 sessions in a week and for 25 minutes), with 65-75% vo2max for 3 weeks (3 sessions in a week for 35 minutes) and with 75-85% vo2max for 3 weeks (3 sessions in a week for 40 minutes). The blood samples were collected in amount of 5 ml 48 hours before the first session and after the last session of the protocol. Other causes of abnormal liver enzymes such as hepatitis and autoimmune disorders etc. were excluded. The level of ALT (alanine aminotransferase) between experimental group and control group in post-test was not significant. But it was significantly differenced for level of AST (aspartate aminotransferase) when we compared the groups. On the other hands, the level of ALT and AST in post-test in contrast with pre-test in experimental group was not significant. The result of this study showed that endurance exercise for eight weeks did not normalize the level of ALT and AST of the study group. Therefore more investigation such as diet habits, demographic and other risk factors is recommended for these types of patients

Association of Menopause with Osteopenia and Osteoporosis: Results from Population Based Study Done in Karachi

INTRODUCTION One of the implications of menopause is postmenopausal osteoporosis, the resultant of bone remodeling in the skeleton secondary to estrogen deficiency. Bone remodeling rates have been shown to double at menopause, triple 13 years later and remain elevated till osteoporosis, contributing to the age related skeletal fragility in women. Proportion of elderly in Pakistan is growing steadily and persons more than 65 years are estimated to be 4%. Over half of women over the age of 60 years live in the developing countries. ABSTRACT Objective: To assess the association of osteopenia and osteoporosis with menopause and compare the health seeking behaviour of women related to menopause in different strata of society. Study Design: A cross-sectional study. Place and Duration of Study: Three different socioeconomic strata of Karachi from May till August 2004. Methodology: A sample of 925 women, over 35 years of age, was selected from 16 clusters of 250 households (50 houses in each cluster). All apparently healthy women having age between 35 and 50 years were selected in the cluster houses. Those who were not willing to be the part of the study or giving history of taking treatment for any disease for more than 4 weeks were excluded. In-depth interviews were conducted at their houses by the fourth year medical students trained and supervised by the senior faculty of the Medical College. T-scores were calculated to get BMD (Bone Mineral Density) for all the subjects through heel ultrasound. Results: A total of 287 women were found to be experiencing menopause. The mean age of menopause was 47.8 + 4.7 years. Out of those 287 women, 135 (47%) wanted their menses to continue and 235 (82%) had consulted a physician after menopause. There was a significantly lower score of BMD of postmenopausal women (mean = -1.833 + 0.65) compared to pre-menopausal women (mean = -1.597 + 0.60, p=0.016). Out of the 925 women interviewed, 53% had consulted a physician for various symptoms related to menopause. The symptoms experienced by pre-menopausal women included lack of sleep (25%), fear of becoming sterile (13%) and urinary incontinence (18%). Conclusion: The average age of menopause was found to be similar to other studies of the country. Lower bone mineral density was found in greater proportion among older females. Majority needed intervention inclusive of awareness through health education and medication. The symptoms experienced by menopausal women reported in literature include sleep disturbances inclusive of insomnia and quality of sleep. The bone mineral density is measured conventionally by Dual Energy X-ray Absorptiometry (DEXA), which is a costly and highly technical procedure. Ultrasound of heel is now frequently used and moderately comparable with DEXA for assessing the BMD in community studies and first level health care facilities due to its costeffectiveness and convenience. METHODOLOGY This cross-sectional study was conducted from May to August 2004, in Karachi. Sixteen clusters in three stratas of society (defined on the basis of socioeconomic status) were selected randomly through the Federal Bureau of Statistics. Each cluster consisted of approximately 250 households and from each cluster 50 houses were selected through systematic random sampling to get a total of 800 households. All women over 35 years of age in the houses were interviewed. Any house with no women in that age group was discarded and no replacement was done. The clusters consisted of six squatter settlements (2 each in North Nazimabad and Gulshan-e Iqbal while one each in Liaquatabad and Federal B Area), 5 middle income communities (3 in North Nazimabad and 2 in Gulshane-Iqbal) and 5 high income communities (2 each in North Nazimabad and Clifton and one in Gulshan-eIqbal) of Karachi. In-depth interviews were conducted at their houses by the fourth year medical students trained and supervised by the senior faculty of the college. Interview and questions consisted of their knowledge, attitude and practices related to menopause. Their health problems related to menopause were assessed through directional questions asking about relevant signs and symptoms. BMD was measured through the use of heel ultrasound done at site and T-scores were calculated. The machine used for this study was USA made; model number 03329, Hologic Sahara, Bedford. Ethical approval was taken from the ethical committee of the college. BMD could only be measured for 925 women, out of whom 285 were postmenopausal. SPSS 11 was used for data entry and analysis. Association of BMD to age, menopausal status and socioeconomic status was tested by using Chi-square test. RESULTS A total of 285 women, out of the total 925 women tested for BMD, belonged to the menopausal group. The mean age of menopause was 47.094+4.689 years (95% CI, 46.82-47.64). Out of the total 925 women, 300 (32.4%) had osteopenia and 62 (6.7%) had osteoporosis. A higher proportion of women in low income group had lower BMD Fifty nine percent (n=541) women were experiencing symptoms related to menopause. These 541 women were asked as to how these symptoms were affecting their lives and 41.9%, (n=227) reported lack of sleep, 21.6% (n=117) had stress due to fear of becoming sterile and 30.4% 241 Association of menopause with osteopenia and osteoporosis: results from population based study done in Karachi someone, which included a close family member by 96 women, friends by 69 women and medical personnel by 184 women When asked about their health seeking behaviour, a majority of the women replied that one should consult a physician during pre-menopausal stage (53%), a lesser proportion believed in consulting during the menopausal stage (42%) and only 18% thought that consultation is required in postmenopausal stage. In postmenopausal stage, more women consulted a physician, even though they said that it was not required, with a significant (p<0.001) difference amongst socioeconomic groups. Only 31% of the women said that medication should be taken during menopausal time and there was a statistically significant difference amongst the three socioeconomic groups (p<0.001). Out of those 291 women, 51.5% (n=150) said use of hormones, 46.3% (n=135) said herbal drugs and 2% (n=6) named other drugs (refer to DISCUSSION The present sample of 285 menopausal women found the mean age of menopause to be 47 years, which is similar to the mean age quoted before in studies done in Pakistan. It was found that 32.4% women had osteopenia and 6.7% had osteoporosis, which is similar to the data reported from Pakistan. Older age was associated with osteopenia and osteoporosis; it was found that 16% women over the age of 45 years had osteoporosis, which was similar to western studies where one in 6 women over the age of 50 were affected. There was a need to cater to the needs of these menopausal women through primary health care services and training of private practitioners in dealing with such women. Mass Media could be used to address the issue and provide information to women with lower levels of education and limited access to health care providers. The investigators used ultrasound heel as an economical screening test for osteopenia and osteoporosis for this large sample but validity of the results would have been better with DEXA testing. CONCLUSION The average age of menopause was 47+4.7 years. Women with age above 45 years had significantly low BMD as compared to younger females. A majority of women were aware of manifestations specific of menopause and felt that they would need to consult the physicians during that time. In majority of females the quality of life was affected as they were not taking any proper medication for their symptoms. Acknowledgement: The authors are thankful for the technical support of Novartis Pharmaceutical Company, who extended their help by providing free BMD through their mobile unit

Frequency of dysnatremia in patients admitted with COVID-19 infection and its prognostic implication

Objective: We aimed to investigate the frequency of dysnatremia among patients admitted with COVID-19 infection and its association with inpatient mortality.Methods: This retrospective longitudinal study was conducted for 12 weeks. Serum sodium levels were recorded at admission, during the hospital stay, and within 48 hours of discharge or death. Logistic regression was used to determine the predictors of mortality.Results: This study included 574 patients (69.7% men, age 55.6 ± 14.4 years). On admission, mean sodium was 135.9 ± 6.4 mEq/L; 39% had hyponatremia and 4.7% had hypernatremia. During admission, hypernatremia increased to 18.8%; maximum sodium in patients who survived was 140.6 ± 5.0 mEq/L versus 151.0 ± 9.9 mEq/L in those who died. The final sodium was 145.4 ± 9.4 mEq/L in patients who died versus 137.7 ± 3.7 mEq/L in those who survived (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.13-1.32). Other predictors of mortality included ischemic heart disease (OR: 3.65, 95% CI: 1.39-9.61), acute kidney injury (OR: 6.07, 95% CI: 2.39-15.42), invasive ventilation (OR: 28.4, 95% CI: 11.14-72.40), and length of stay (OR: 0.91, 95% CI: 0.86-0.97).Conclusion: Hypernatremia was frequently observed in patients who were critically ill and died and may be considered a predictor of mortality in COVID-19 infection

Relationship between CO2 emissions, tourism receipt, energy use and international trade in Pakistan

The current study explores the potential impact of economic growth, tourism receipt, energy consumption and trade openness on CO2 in Pakistan over the period of 1980-2017. The study adopted the Autoregressive Distributed Lagged (ARDL) model to investigate the short and long-run estimates simultaneously. The study further applied Granger causality to find out the direction of causalities. To arrive at long-run robust estimates, the study employed the Dynamic Ordinary Least Squares (DOLS) model. Last but not least, the current study also used an innovative accounting approach i.e. Variance decomposition and Impulse production function. The results found that economic growth has a significant impact on CO2 emission and negative and highly significant impact on tourism receipt while emission, energy consumption and international trade are also the main determinants of tourism in Pakistan. The study found unidirectional causality from GDP, tourism receipt, energy consumption and trade openness towards CO2 emission. The outcomes of ARDL model are also supported by the DOLS results. The innovative accounting approach further strengthens the results of the study. In a nutshell, overall results indicate that tourist receipts, CO2 emission, energy consumption, and trade openness are interlinked. The findings of the current study thus suggest that the government should encourage investment in the industry\u27s services sector to enhance its efficiency. In addition, it will also need to ensure that the services sector contributes far more to the GDP than to the manufacturing sector. The results demonstrate investments should be diverted towards the services sector on a broader range as less-polluting services industries (tourism as one of the main sectors) are more feasible than polluting capital industries to invest in

Outcome of inadvertent high dose BCG administration in newborns at a tertiary care hospital, Karachi- Case series

Bacillus Calmette-Guérin (BCG) vaccine is given to newborns soon after birth. BCG vaccine overdose has been rarely reported. Here we report the outcome of newborns who accidently received high dose BCG at a tertiary care hospital, Karachi. We reviewed records of 26 newborns, who accidentally received intradermal high dose BCG, used for the treatment of urinary bladder cancers and 80 times higher dose than the BCG used for routine vaccination. The incident happened from 14-16th April, 2016 at Aga Khan University Hospital, Karachi. Analysis was carried out using SPSS. A total of 23/26(88.5%) newborns were followed for atleast 3 months and 11/26 (42.3%) were followed for atleast one year. 13/26 (50%) were male. All 26 patients were prescribed isoniazid and rifampicin for 3 months. 3/26 (11.5%) were lost to follow-up before completion of anti-tuberculous drugs (ATT). Lesions at the BCG site were observed in 16/26 (61.5%) infants, of which 15 (93.8%) had a papule, 3 (18.8%) developed a pustule, 3 (18.8%) had skin induration and 2 (12.5%) had skin erythema. Axillary lymphadenopathy was observed in 1/26 (3.8%) patient. Coagulation was deranged in 3/26 (11.5%) of babies. Intracranial bleeding was observed in 1/26 (3.8%) case. Localized skin lesions were the most common adverse events. None of them developed clinical tuberculosis. Chemoprophylaxis for inadvertent high dose BCG administration should be given for atleast 3 months. Furthermore, vigilant follow-up, transparency and disclosure are the vital steps in the management of any medical error

Optimizing Lifespan and Energy Consumption by Smart Meters in Green-Cloud-Based Smart Grids

Green clouds optimally use energy resources in large-scale distributed computing environments. Large scale industries such as smart grids are adopting green cloud paradigm to optimize energy needs and to maximize lifespan of smart devices such as smart meters. Both, energy consumption and lifespan of smart meters are critical factors in smart grid applications where performance of these factors decreases with each cycle of grid operation such as record reading and dispatching to the edge nodes. Also, considering large-scale infrastructure of smart grid, replacing out-of-energy and faulty meters is not an economical solution. Therefore, to optimize the energy consumption and lifespan of smart meters, we present a knowledge-based usage strategy for smart meters in this paper. Our proposed scheme is novel and generates custom graph of smart meter tuple datasets and fetches the frequency of lifespan and energy consumption factors. Due to very large-scale dataset graphs, the said factors are fine-grained through R3F filter over modified Hungarian algorithm for smart grid repository. After receiving the exact status of usage, the grid places smart meters in logical partitions according to their utilization frequency. The experimental evaluation shows that the proposed approach enhances lifespan frequency of 100 smart meters by 72% and optimizes energy consumption at an overall percentile of 21% in the green cloud-based smart grid

Binary Pattern for Nested Cardinality Constraints for Software Product Line of IoT-Based Feature Models

Software product line (SPL) is extensively used for reusability of resources in family of products. Feature modeling is an important technique used to manage common and variable features of SPL in applications, such as Internet of Things (IoT). In order to adopt SPL for application development, organizations require information, such as cost, scope, complexity, number of features, total number of products, and combination of features for each product to start the application development. Application development of IoT is varied in different contexts, such as heat sensor indoor and outdoor environment. Variability management of IoT applications enables to find the cost, scope, and complexity. All possible combinations of features make it easy to find the cost of individual application. However, exact number of all possible products and features combination for each product is more valuable information for an organization to adopt product line. In this paper, we have proposed binary pattern for nested cardinality constraints (BPNCC), which is simple and effective approach to calculate the exact number of products with complex relationships between application's feature models. Furthermore, BPNCC approach identifies the feasible features combinations of each IoT application by tracing the constraint relationship from top-to-bottom. BPNCC is an open source and tool-independent approach that does not hide the internal information of selected and non-selected IoT features. The proposed method is validated by implementing it on small and large IoT application feature models with “n” number of constraints, and it is found that the total number of products and all features combinations in each product without any constraint violation

Comparing the Effects of Choline with Clozapine and Fluoxetine for Improving Cognitive Behavior in Rats

Background: Cognitive behavior therapy is an important treatment for various psychiatric and psychological problems. Different psychotherapeutic treatments are used for improvement in patients. The study aimed to compare Clozapine and Fluoxetine with Choline on the progress of cognition and cognitive behavior in rats. Methods: This experimental study was conducted in the pharmacology department of Karachi University on locally bred male albino rats (n=24). These were divided into four treatment groups (Saline, Fluoxetine, Clozapine, and Choline) and measured the output at the 1st, 3rd, 5th, and 7th weeks. Familiar and Novel object recognition test and Passive avoidance test was used to observe learning and memory as well as the mechanism of cognition. One way-ANOVA and post-hoc analysis was done between groups. The p-value <0.05 and < 0.001 were considered statistically significant and highly significant respectively. Results: The comparative mean preference index percentage between saline, choline, clozapine, and fluoxetine at week one was non–significant (p>0.05) in the Novel and Familiar Object Recognition test. However, at week three it was highest for Fluoxetine (58.15±3.35) compared to Choline, Clozapine and Saline for the novel object. However, in Familiar objects, it was found highest for Clozapine (58.88±3.05) (p <0.05). Furthermore, the mean step-through latency time of the Passive Avoidance test was significant (p<0.05) at weeks three, five and seven. It was highest for choline (92.5±1.36) than fluoxetine and clozapine. Conclusion: Fluoxetine has a significant effect (p<0.001) on memory and learning compared to Clozapine. Clozapine and choline showed statistically same results on cognitive behavior.  Keywords: Cognitive Behavior; Choline; Clozapine; Fluoxetine; Effect; Compare.

Comparing Different Routes of Vitamin D Administration: A Randomized Interventional Trial

Background: Vitamin D maintains overall good health by boosting up of the immune system through proper function of lungs, heart, muscles, brain and bones. The goal of the study was to determine and compare different routes and formulation of vitamin D3 that was per oral, injectable formulation given orally and intramuscular injection in patients of different groups. Methods: This was a randomized clinical trial designed for vitamin D deficient patients. Patients were randomly assigned to three routes of administration i.e. orally, injection formulation given orally andintramuscular injection group. For mild deficiency, 2 doses of 200,000 IU, for moderate deficiency, 3 doses of 200,000 IU and for severe deficiency, 4 doses of 200,000 IU, 25[OH] D was prescribed. Chi-Square (χ2 ) test was used to evaluate the significant association . Results: A total of 150 patients were enrolled in the study. The mean age ±SD of patients was 48.29 ± 4.65 years. At 4 and 12 weeks after completion of vitamin D3 replacement, levels of 25-hydroxycholecalciferol were measured. In the majority of participants of all three groups, the levels of vitamin D were increased to normal range by week 4 after the final dose of vitamin D3. However, the majority of patients failed to maintain their Vitamin D3 levels within the normal range 12 weeks after the final dose. All three routes of administration of Vitamin D were found equally effective with no significant difference between the routes (p>0.05). Conclusion: All three routes of administration of vitamin D supplements had equal efficacy with no significant advantage over one another

The effect of endurance training on addicted women’s level of alkaline phosphates who use methadone

Introduction: Previous studies indicated that endurance exercise is effective to decrease or increase the levels of liver enzymes. The aim of this study was to determine the effect of endurance training on alkaline phosphates (ALP) enzyme in Iranian addicted women with methadone.Methods: Thirty Iranian female addicted prisoners and thirty non-addicted encompassed the sampling. The mean of age, height, weight, %BF, body mass index (BMI), and VO2max of experimental group was 33.8 years, 162.2 cm, 62.2 kg, 33.10, 24.22 kg/m2 and 16.18 ml/kg respectively. The case group was supposed to run with 65% HRmax for 2 weeks (3 sessions in a week and for 25 minutes), 65%-75% HRmax for 3 weeks (3 sessions in a week for 35 minutes) and 75%-85% HRmax for 3 weeks (3 sessions in a week for 40 minutes). The blood samples were collected in amount of 5 ml 48 hours before the first session and after the last session of the protocol. The history of heart and liver diseases or hepatitis was not reported in case group.Results: The level of ALP between case and control group in post-test was not significant. The level of ALP in post-test in contrast with pre-test in both groups was increased but this was not statistically significant in case group (P > 0.05).Conclusion: According to the results, the level of ALP in post-test in experimental group did not change after endurance training. Therefore, the investigation of other factors such as having suitable diet habits, quitting smoking, increasing the period of training is recommended for these types of addicts