Pregnancy-related lumbopelvic pain in early postpartum period and risk factorr

Background: Pregnancy-related lumbopelvic pain is known as lower back and pelvic girdle pain of unclear etiology, which affects almost half of pregnant women, often starts at 18 weeks and decreases at 6 months postpartum. The purpose of this study is to identify the risk factors in patients with pregnancy-related lumbopelvic pain in early postpartum period and determine the factors associated with pain in patients suffering from lumbopelvic pain at 1 month postpartum.Methods: 339 women of 18-40 years of age who were in the 1st month of postpartum period were included in the study. Socio-demographic data, gynecological history and method of delivery were recorded for all subjects. All subjects were evaluated for pregnancy-related lumbopelvic pain. The Oswestry disability index was used for functional evaluation and the Beck depression inventory was used for assessment of depression.Results: 114 (33.6%) patients had a history of pregnancy-related lumbopelvic pain. 59 (18.9%) patients had ongoing pain at 1 month postpartum. When patients were divided into two groups, consisting of women with and without lumbopelvic pain at 1 month postpartum, no statistical difference was observed between two groups in terms of age, parity, employment status, smoking status, depression score, method of delivery, type of anesthesia, and emergency or elective cesarean section. When the risk factors affecting postpartum lumbopelvic pain were evaluated by using the Stepwise Logistic regression analysis, weight gain during pregnancy, body mass index and presence of lumbopelvic pain during previous pregnancy were found to be independent risk factors (p<0.05).Conclusion: Pregnancy-related lumbopelvic pain is a significant cause of disability that affects many pregnant women. Control of weight gain during pregnancy could be important in avoiding the development of lumbopelvic pain. In patients experiencing lumbopelvic pain in previous pregnancies, necessary measures should be taken against development of lumbopelvic pain during a new pregnancy.

Occurrence of RD149 and RD152 deletions in Mycobacterium tuberculosis strains from Pakistan

Introduction: Central Asian Strain 1 (CAS1) is the predominant Mycobacterium tuberculosis genotype in Pakistan. The occurrence of deletions in regions of differences (RDs) among CAS1 and other predominant genogroups in the country were investigated. Methodology: Using stratified random sampling, 235 M. tuberculosis (185 pulmonary, 50 extrapulmonary) strains were selected from 926 previously spoligotyped isolates, including 171 CAS strains (133 CAS1 (ST26), 38 CAS subfamily), 8 Beijing isolates, 47 isolates belonging to other previously defined ( Other ) clusters, and 9 previously undefined Unique isolates. Commonly reported RD deletions, RD1, RD750, RD207, RD149, RD152, RD105, RD150, RD142 and RD181, were investigated using a PCR - based method. Results: Deletions in RDs 750, 149 and 152 were identified among CAS strains, and in RDs 207, 149, 152, 105, 150, 142 and 181 in Beijing isolates. CAS1 strains showed more frequent RD149 deletions compared with CAS subfamily strains (p=0.036), and more frequent RD152 deletions compared with Other clusters (p=0.003). RD149 and RD152 deletions were more frequent in Beijing isolates compared with CAS1 strains (p \u3c 0.001). Concurrent RD149 and RD152 deletions were more frequent in CAS1 compared with Other clusters (p \u3c 0.001) and in Beijing strains compared with CAS1 (p \u3c 0.001). No significant difference was detected in RD deletion patterns between pulmonary and extra pulmonary isolates. Conclusion: Higher frequencies of RD149 and RD152 deletions and of concurrent RD149 and RD152 deletions were found in CAS1 and Beijing strains compared with CAS subfamilies, Other clusters and Unique strains. No association between these deletions and disease presentation, pulmonary or extrapulmonary tuberculosis, was observed

M. leprae inhibits apoptosis in THP-1 cells by downregulation of Bad and Bak and upregulation of Mcl-1 gene expression

BACKGROUND: Virulent Mycobacterium leprae interfere with host defense mechanisms such as cytokine activation and apoptosis. The mitochondrial pathway of apoptosis is regulated by the Bcl-2 family of proteins. Expression of Fas ligand and apoptotic proteins is found in leprosy lesions and M. leprae has been shown to activate pro-apoptotic Bcl-2 genes, Bak and Bax. However, the mechanism by which M. leprae modulates apoptosis is as yet unclear. We investigated expression of apoptotic genes in THP-1 monocytes in response to infection by M. leprae and non-pathogenic M. bovis BCG. RESULTS: M. leprae did not induce apoptosis in THP-1 cells, while BCG induced a significant loss of cell viability by 18 h post-infection at both (multiplicity of infection) MOI-10 and 20, with an increase by 48 h. BCG-induced cell death was accompanied by characteristic apoptotic DNA laddering in cells. Non-viable BCG had a limited effect on host cell death suggesting that BCG-induced apoptosis was a function of mycobacterial viability. M. leprae also activated lower levels of TNF-alpha secretion and TNF-alpha mRNA expression than BCG. Mycobacterium-induced activation of apoptotic gene expression was determined over a time course of infection. M. leprae reduced Bad and Bak mRNA expression by 18 h post-stimulation, with a further decrease at 48 h. Outcome of cell viability is determined by the ratio between pro- and anti-apoptotic proteins present in the cell. M. leprae infection resulted in downregulation of gene expression ratios, Bad/Bcl-2 mRNA by 39% and Bak/Bcl-2 mRNA by 23%. In contrast, live BCG increased Bad/Bcl-2 mRNA (29 %) but had a negligible effect on Bak/Bcl-2 mRNA. Heat killed BCG induced only a negligible (1–4 %) change in mRNA expression of either Bak/Bcl-2 or Bad/Bcl-2. Additionally, M. leprae upregulated the expression of anti-apoptotic gene Mcl-1 while, BCG downregulated Mcl-1 mRNA. CONCLUSION: This study proposes an association between mycobacterium-induced apoptosis in THP-1 cells and the regulation of Bcl-2 family of proteins. M. leprae restricts apoptosis in THP-1 cells by downregulation of Bad and Bak and upregulation of Mcl-1 mRNA expression

Differential Combination of Cytokine and Interferon- γ +874 T/A Polymorphisms Determines Disease Severity in Pulmonary Tuberculosis

BACKGROUND: Mycobacterium tuberculosis infects nearly 1/3 of the world population and this reservoir forms the largest pool from which new cases arise. Among the cytokines, IFN-γ is a key determinant in protection against tuberculosis. Single nucleotide polymorphisms (SNPs) in IFN-γ gene (+874 T/A) which determine TT high ((hi)), AA low ((lo)) and TA intermediate ((int)) responder phenotypes have shown variable associations with tuberculosis disease outcome in different ethnic populations. The objective of the current study was to analyze IFN-γ gene combinations with other IFN-γ regulating cytokine genes (IL-10, TNF -α, IL-6) to see the effect of gene- combinations on disease severity outcome in pulmonary tuberculosis. METHODS AND FINDINGS: Study groups comprised of pulmonary TB patients stratified according to lung tissue involvement into mild (Pmd = 74) or advance (Pad = 23) lung disease and compared with healthy controls (TBNA = 166). Genotype analysis was carried out using amplification refractory mutation system-PCR (ARMS-PCR). IFN-γ gene (+874 T/A) functional SNP combinations in TNFα (-308 G/A), IL-10 (-1082 A/G) and IL-6 (-174 G/C) were analyzed. Single gene analysis (Pearson χ²) showed a dominant association of IFN-γ TT (hi) genotype (p = 0.001) and T allele (p = 0.001) with mild disease. IFN-γ(lo) -IL-10(lo) genotype combination was associated with advanced disease (p = 0.002). IFN-γ(hi) -IL-6(hi) combination was associated with mild disease (p = 0.0005) while IFN-γ(lo) -IL-6(int) was associated with protection against both forms of pulmonary disease (p = 0.002). CONCLUSION: Our results show that a limited number of IFN-γ gene combinations with other cytokine functional SNPs determine the outcome of disease severity in tuberculosis

Differential combination of cytokine and interferon- gamma +874 T/A polymorphisms determines disease severity in pulmonary tuberculosis.

Background:Mycobacterium tuberculosis infects nearly 1/3 of the world population and this reservoir forms the largest pool from which new cases arise. Among the cytokines, IFN-gamma is a key determinant in protection against tuberculosis. Single nucleotide polymorphisms (SNPs) in IFN-gamma gene (+874 T/A) which determine TT high ((hi)), AA low ((lo)) and TA intermediate ((int)) responder phenotypes have shown variable associations with tuberculosis disease outcome in different ethnic populations. The objective of the current study was to analyze IFN-gamma gene combinations with other IFN-gamma regulating cytokine genes (IL-10, TNF -alpha, IL-6) to see the effect of gene- combinations on disease severity outcome in pulmonary tuberculosis. Methods andFindings:Study groups comprised of pulmonary TB Patients stratified according to lung tissue involvement into mild (Pmd = 74) or advance (Pad = 23) lung disease and compared with healthy controls (TBNA = 166). Genotype analysis was carried out using amplification refractory mutation system-PCR (ARMS-PCR). IFN-gamma gene (+874 T/A) functional SNP combinations in TNFalpha (-308 G/A), IL-10 (-1082 A/G) and IL-6 (-174 G/C) were analyzed. Single gene analysis (Pearson chi) showed a dominant association of IFN-gamma TT (hi) genotype (p = 0.001) and T allele (p = 0.001) with mild disease. IFN-gamma(lo) -IL-10(lo) genotype combination was associated with advanced disease (p = 0.002). IFN-gamma(hi) -IL-6(hi) combination was associated with mild disease (p = 0.0005) while IFN-gamma(lo) -IL-6(int) was associated with protection against both forms of pulmonary disease (p = 0.002).Conclusion:Our results show that a limited number of IFN-gamma gene combinations with other cytokine functional SNPs determine the outcome of disease severity in tuberculosis

Transient osteoporosis of the hip associated with pregnancy: case report

Transient osteoporosis of the hip associated with pregnancy is a clinical condition with an unclear etiology seen in pregnant women in the 3rd trimester that may lead to severe pain and disability. In this article we present a case getting transient osteoporosis associated with pregnancy based on clinical and radiological findings and discussed it under the guidance of the literature

Awareness of dentists regarding immediate management of dental avulsion : Knowledge, attitude, and practice study.

OBJECTIVE: To assess the knowledge of practising dentists regarding immediate management of dental avulsion. METHODS:The cross-sectional analytical study was conducted in various dental colleges and teaching hospitals of Karachi, Pakistan, in October-November 2016, and comprised dentists working in academic institutions / departments or as general dental practitioners for at least 1 year. The subjects were asked to fill out a self-administered questionnaire. Questions related to knowledge and practice regarding immediate management of dental avulsion was asked and then responses were categorised as good knowledge, moderate and poor knowledge. SPSS 22 was used for data analysis.. RESULTS: Of the 282 subjects, 179 (63.5%) were females and 103(36.5%) were males. The overall mean age was 28. 33±4.7 years, and 194 (68.8%) had clinical experience of less than 5 years. Of the total, 30(11%) dentists had good knowledge while 130(46%) had moderate and 122(43%) had poor knowledge. Statistically significant association of knowledge regarding tooth avulsion was observed with the specialty (p= 0.006) and qualification (p=0.001). CONCLUSIONS: The knowledge of dentists regarding immediate management of avulsion injuries was inadequate. Knowledge was significantly associated with specialty and qualification of the dentist

Range for normal body temperature in the general population of Pakistan.

OBJECTIVES: To determine the range for normal body temperature in the general population of Pakistan and to determine if any age, sex and ambient temperature related variations exist in body temperature. Moreover, to compare how much axillary temperature differs from oral temperature measurements. METHODS: Oral as well as left and right axillary temperature recordings were made using an ordinary mercury-in-glass thermometer in 200 healthy individuals accompanying patients at various clinics at the Sindh Institute of Urology and Transplantation (SIUT) between mid-May to mid-June 2006. Data analysis was done using Epi Info version 3.3. RESULTS: The range for Normal Oral Temperatures fell between 97 degrees F to 99.8 degrees F (mean 98.4 degrees F). There were no significant age related (p=0.68) and ambient temperature related variations (p=0.51) in body temperature, but women had slightly higher normal temperatures than men (mean 98.5 degrees F vs. 98.3 degrees F; p=0.01). A wide variation existed in the difference between oral and axillary temperatures, with axillary temperatures ranging up to 2.6 degrees F lower or up to 1.1 degrees F higher than the oral temperatures (mean difference = 0.85 degrees F). The correlation between oral and axillary temperatures increased at higher oral temperatures (p=0.009). CONCLUSION: There is a range for Normal Body Temperature and any temperature above 98.6 degrees F/37 degrees C is not necessarily pathological. Women appear to have higher body temperatures. As there is no uniform oral equivalent of axillary temperature, the latter should be interpreted with caution

Anticipated shock, monetary policy and welfare in the small open economy

This paper judges the welfare implications of anticipated and unanticipated Productivity shocks in a small open economy. The purpose model is two country New Keynesian dynamic stochastic general equilibrium model with the characteristics of nominal rigidities and monopolistic competition. This study finds out the higher degree of openness increase the welfare cost in the anticipated shocks. The response of optimal policy to anticipated shocks demonstrates the larger and delayed on macroeconomic variables than unanticipated shocks. Optimal monetary policy rule has a potential to curb the inflation and meet an optimal level of the real exchange rate volatility. Movements in real exchange rate resist the terms of trade externality and upturn the effectiveness of monetary policy. In addition, monetary authorities focus on the goal of exchange rate stabilization in their policy decisions.peer-reviewe

Age estimation of a sample of pakistani population using coronal pulp cavity Index in molars and premolars on orthopantomogram

The aim of the present study was to assess the validity of tooth-coronal index (TCI) in the age estimation. This retrospective charts review was conducted at the Aga Khan University Hospital, Karachi from January 2016 to March 2016, and comprised 315 teeth of 80 individuals. The teeth were analysed on Orthopantomogram. TCI was calculated for unrestored mandibular premolars and molars. Pearson\u27s correlation was applied to assess correlation between chronological age and TCI. Besides, 30(37.5%) subjects were male and 50(62.5%) female, and 140(44.4%) teeth were of male subjects and 175(55.6%) were of females. The mean correlation coefficient between chronological age and TCI was -0.27. The highest negative correlation was observed for tooth No.47 in males (r=-0.72) whereas among females the highest negative correlation was noted for tooth No.36 (r=- 0.61).There was very weak correlation between age and TCI of a tooth. Therefore, TCI index could not be predictably used for age estimation in the studied population