Maternal risk factors associated with low birth weight in Karachi: A case-control study

To evaluate maternal risk factors associated with low birth weight (LBW) among women aged 15-35 years, we carried out a hospital-based, case-control study on 262 cases (mothers of neonates weighing \u3c or = 2.5 kg) and 262 controls (mothers of neonates weighing \u3e 2.5 kg). Odds of delivering a low-birth-weight baby decreased with increase in maternal haemoglobin [odds ratio (OR): 0.701; 95% confidence interval (CI): 0.62-0.79]. Odds were greater among mothers not using iron supplements during pregnancy (OR: 2.88; 95% CI: 1.83-4.54). Mothers of LBW babies had lower haemoglobin levels before delivery

Development of an indigenous screening instrument in Pakistan: the Aga Khan University Anxiety and Depression Scale

The use of translations of instruments for detecting anxiety and depression continues to be debated. An indigenous screening instrument has been developed in Urdu for anxiety-depression syndromes at the Aga Khan University. It has been developed from the complaints of 150 anxious and depressed patients presenting to a non-speciality clinic and has been validated in 53 patients in a psychiatry clinic. The questionnaire has 25 items, 13 psychlogical and 12 somatic. At a score of 20 it has a sensitivity of 66%, a specificity of 79%, a positive predictive value of 83 and a negative predictive value of 60. In comparison with available instruments in Urdu, comprising of either psychological or somatic items, this scale includes both, which increases its reliability for use as a screening instrument by Community Health Workers in a primary health care setting, in epidemiologic work in Pakistan and in transcultural psychiatric research

Eusideroxylon Zwageri (Ulin) as Key Species in Two Zones of Sangkima Rain Forest, Kutai National Park, East Kalimantan

Aim of this research was to study trees' diversity quality in primary and intensively used forest of Sangkima area in Kutai National Park (TNK), East Kalimantan (Borneo). Field observation was carried out by vegetation analysis using 17 sampling plots of 25x25 m2. Community structure of each forest was determined by calculating trees' density, basal area, frequency, important value and stratification of species. While trees diversity was estimated by taxa richness, Shannon-Wiener diversity index, and rate of endemism. Both forests were compared by Morisita community similarity index. Data were tabulated by Microsoft Excel 2007 and statistically analyzed by PCA method and supported by hierarchical cluster analysis in SPSS 15.00 for windows. The result showed that diversity quality in primary and intensively used forest of Sangkima TNK was high, indicated by similar stratification. The forests were composed by A stratum trees of > 30 m high to ground cover plants, but they were dominated by B stratum trees of 20-30m high. Primary forest's formation was Eusideroxylon zwageri-Mixed Dipterocarpaceae, while intensively used forest's formation was E. zwageri. Taxa richness of both forests was not different significantly. In the primary forest was found 34 species, 25 families and 16 orders, while intensively used forest was found 36 species, 20 families and 13 orders. Diversity Index of primary forest (H=4.57) was slightly higher than secondary forest (H=4.28). Rate of endemism of both forests reached 100%. Eusideroxylon zwageri and Cananga odorata were co-dominant in the Borneo rain forest. Tree of E. zwageri showed a biggest trunk and largest canopy. Cananga odorata showed a high density in both zones. Luxurious jungle performed A to E strata, but B stratum was dominant. Based on those five characters, trees' diversity quality in Sangkima was still high. Bi plot analysis showed that trees' community structure of both forests composed by three groups. In secondary forest, E. zwageri was a key species and characterized by high important value, while species C. odorata, Dyospiros borneensis and Dillenia beccariana found in a high distribution, otherwise other trees were classified into the 3rd group. Comparing to the secondary forest, even though E. zwageri was also as dominant tree, but the virgin one showed more species growing in a better density, distribution and dominance

Prognostic indicators of childhood acute viral encephalitis

Objective: To devise a set of clinical signs and laboratory parameters that would help clinicians assess prognosis in patients and plan appropriate management.Methods: Medical records of 147 paediatric cases (with a discharge diagnosis of acute viral encephalitis) admitted over a ten year period from 1987 to 1997 were reviewed and relevant information collected on a data extraction form.Results: Of 147 patients, 24 (16.3%) died and 48 (32.7%) were left with severe neurological deficits. A GCS (Glasgow Coma Scale) score between 6-10 had an association with poor outcome (OR = 2.62, Chi-square = 5.57, p-value = 0.018) and that a GCS score of \u3e or = 5 was even more strongly suggestive of poor outcome (OR = 5.49, Chi-square = 12.08, p-value = 0.0005). A history of having seizures, for more than 3 days, also showed a strong association with poor outcome (OR = 3.66, Chi-square = 5.46, p-value = 0.019).CONCLUSION: Patients with an increased risk of death and severe disability can be identified using a few guidelines. Of these, a history of seizures of \u3e 3 days and/or impaired consciousness (GCS \u3c or = 10), at the time of presentation to the hospital, constitute high risk. These cases must be identified promptly and aggressive therapy initiated in order to improve long term outcome

Prevalence of Muscle Dysmorphia and Associated Health Activities in Male Medical Students in Karachi, Pakistan

Background: Muscle Dysmorphia (MD) is a subtype of body dysmorphic disorder (BDD) and is currently classified under anxiety disorders (subheading: Obsessive-compulsive disorder) in DSM 5. MD is hypothesized to affect the self-esteem and social outlook of the younger generation. MD shows a higher rate in males and may influence their self-confidence rendering them more prone towards using steroids, supplementary proteins and other drugs to alter their physical outlooks as shown in previous studies. This problem has been on the rise lately due to revolutionary advancement in the media and film industry and the abrupt changes about the standards of physical good looks and body shapes. With the lack of studies done in our population, our study will be helpful to consider the prevalence of the disease in our setting and increase awareness in the general public and clinicians. We hope to help clinicians/ therapists find better options in managing the disease. Materials: We performed a cross-sectional study with a sample size of 246 medical school students in Karachi to collect data through self-administered questionnaires. We used the DSM 5 criteria for the diagnosis of BDD and additional questions on the presence of MD. Nutritional habits, exercise routines, use of supplements and drugs were also obtained for exploratory analysis. Results: Our study predicted the prevalence of MD to be 25%. Other main findings included statistical significant associations between MD and the thoughts and practice of steroid use for muscularity. Conclusion: MD is an underdiagnosed and often unrecognized disease that we believe has significant consequences for the young male population. Further work is needed on this in our part of the world. Our research, we believe, can be a stepping stone for further studies that would incorporate wider populations

Preconcentration and Detection of Gefitinib Anti-Cancer Drug Traces from Water and Human Plasma Samples by Means of Magnetic Nanoparticles

Along of widespread application of anti-cancer drug Gefitinib (GEF), it appears in human body fluids as well as clinical wastewater. Consequently, a reliable and easy-to-adapt detection technique is of essential importance to quantify the drug in different media. The extraction and quantitative detection of anti-cancer drug Gefinitib (GEF) is demonstrated based on a straightforward and efficient magnetic nanoparticle-assisted preconcentration route from water and human plasma samples. Iron oxide magnetic nanoparticles (Fe3O4) have been prepared with an average particle size of 15 nm and utilized as extractible adsorbents for the magnetic solid-phase extraction (MSPE) of GEF in aqueous media. The method is based on MSPE and preconcentration of GEF followed by High-Performance Liquid Chromatography-Ultraviolet Detection (HPLC-UV). The yield of GEF extraction under the optimum MSPE conditions were 94% and 87% for water and plasma samples, respectively. The chromatographic separation was carried out isocratically at 25 °C on a Phenomenex C8 reversed phase column (150 mm × 4.6 mm, with 5 µm particle size). The proposed method was linear over concentration ranges of 15.0–300.0 and 80.0–600.0 ng/mL for water and plasma samples with limits of detection of 4.6 and 25.0 ng/mL in a respective order. Relative standard deviations (%RSD) for intra-day and inter-day were 0.75 and 0.94 for water samples and 1.26 and 1.70 for plasma samples, respectively. Using the magnetic nanoparticles (MNPs) as loaded drug-extractors made the detection of the anti-cancer drug environmentally friendly and simple and has great potential to be used for different drug-containing systems

Sunset Yellow and Allura Red modulate Bcl2 and COX2 expression levels and confer oxidative stress-mediated renal and hepatic toxicity in male rats

Studies on the adverse health effects caused by azo dyes are insufficient and quite contradictory. This work aims to investigate the possible toxic effect of two types of widely used food additives, Sunset Yellow and Allura Red, by assessing the physiological, histopathological and ultrastructural changes in the liver and kidney. Also, we investigated the genotoxic effect of both dyes on white blood cells. Thirty adult male albino rats were divided into three groups of 10 animals each: control (received water), Sunset Yellow-treated (2.5 mg/kg body weight) and Allura Red-treated (seven mg/kg body weight). The doses were orally applied for 4 weeks. Our results indicated an increase in the biochemical markers of hepatic and renal function (Aspartate aminotransferase, alanine aminotransferase, urea, uric acid and creatinine) in animals administered with the azo dyes. We also observed a noticeable increase in MDA and a marked decrease in total antioxidant levels in azo dye-treated animals compared to controls. Conversely, both dyes adversely affected the liver and kidney of albino rats and altered their histological and fine structure, with downregulation of Bcl2 and upregulation of COX2 expression. Our comet assay results showed a significant elevation in the fold change of tail moment in response to application of Sunset Yellow but not Allura Red. Collectively, we show that Sunset Yellow and Allura Red cause histopathological and physiological aberrations in the liver and kidney of male Wistar albino rats. Moreover, Sunset Yellow but not Allura Red induces a potential genotoxic effect

Combination effect of argan oil and low frequency electromagnetic field on open wound in mice

This study was conducted to evaluate the effect of argan oil with the exposure of low frequency electromagnetic field (EMF) on open wound healing in mice. Eighteen male mice (20-40 g) were divided into three groups: phosphate buffer saline (PBS) as negative control, solcoseryl gel as positive control, and argan oil with the exposure of low frequency EMF, 1.2 mT (treatment group). Full thickness wounds (4 mm diameter) were induced on the shaved dorsal of the mouse. All mice were sacrificed on day 12 after the final treatment. Macroscopic observation, wound contraction rate, histopathology analysis and total protein content were examined in this study. Results showed that wounds treated with argan oil and exposed to low frequency EMF has a significant increase in wound contraction rate (p < 0.05) and total protein content (p < 0.05). Moreover, histopathological analysis on the wound tissues displayed complete re-epithelization with thick and dense collagen fibers in the argan oil with low frequency EMF exposure treated group. In conclusion, topical treatment of argan oil with low frequency EMF exposure yield a better healing progress and showed the ability to accelerate wound healing

Effect of a multicomponent intervention on antihypertensive medication intensification in rural South Asia: post-hoc analysis of a cluster RCT

BACKGROUND: Inadequate treatment of hypertension is a widespread problem, especially in South Asian countries where cardiovascular disease mortality rates are high. We aimed to explore the effect of a multicomponent intervention (MCI) on antihypertensive medication intensification among rural South Asians with hypertension. METHODS: A post-hoc analysis of a two-year cluster-randomized controlled trial including 2645 hypertensives aged≥ 40 years from 30 rural communities, 10 each, in Bangladesh, Pakistan, and Sri Lanka. Independent assessors collected information on participants' self-reports and physical inspection of medications. The main outcomes were the changes from baseline to 24 months in the following: 1) the therapeutic intensity score (TIS) for all (and class specific) antihypertensive medications; 2) the number of antihypertensive medications in all trial participants. RESULTS: At 24 months, the mean increase in the TIS score of all antihypertensive medications was 0.11 in the MCI group and 0.03 in the control group, with a between-group difference in the increase of 0.08 (95% CI (0.03, 0.12); P=0.002). In MCI compared to controls, a greater increase in the TIS of renin angiotensin-aldosterone system blockers (0.05; 95% CI (0.02, 0.07); P<0.001) and calcium channel blockers (0.03; 95% CI (0.00, 0.05);p=0.031) , and in the number of antihypertensive medications (0.11, 95% CI (0.02, 0.19);P=0.016) was observed. CONCLUSIONS: In rural communities in Bangladesh, Pakistan, and Sri Lanka, MCI led to a greater increase in antihypertensive medication intensification compared to the usual care among adults with hypertension. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02657746

The Impact of Restrictive Versus Conservative Intraoperative Fluid Strategies upon the Renal Outcome in Colorectal Surgeries. A Randomized Controlled Trial

Background: intraoperative fluid handling has a lot of concerns upon the postoperative organ function. One of the most sensitive organs which could be affected is the kidney. Objectives: We conducted this trial to address the impact of restrictive vs. conservative fluid approaches on postoperative renal complications, hemodynamics and hospital stay. Patients and methods: Prospective, randomized, double-blind placebo-controlled trial at Assiut University Hospitals. The study included 60 adult patients with American Society of Anesthesiologists (ASA) grade II-III undergoing elective colorectal surgery with an expected operative duration of at least two hours. Grouping was based upon the intraoperative fluid management Group (R): 6 mL/kg/h. of lactated ringer (LR), Group (C): 12 mL/kg/h. of LR. The preoperative serum Neutrophil gelatinase-associated lipocalin (NGAL) level (basal value) then by the 2nd and 24th postoperative hours, KDIGO (Kidney Disease: Improving Global Outcomes), serum urea and creatinine were documented by the end of 1st and 2nd postoperative days. Intraoperative hypovolemia events were noted as well. Results: serum NGAL has increased >149 ng/mlin three patients within group C, and two patients within group R; however, the difference was statistically insignificant p= 0.5. KDIGO showed significant difference between the two groups, with higher number of patients in the group R with p= 0.043. Serum urea and creatinine, intraoperative hypovolemic episodes showed insignificant differences between groups. Conclusion: no evident difference between restrictive and conservative intraoperative fluid strategies was noticed upon the early postoperative serum NGAL and other systems complications in patients undergoing major colorectal surgeries