RISK OF HYPOTENSION IN PREGNANT LADIES UNDERGOING SPINAL ANESTHESIA INDUCED CESAREAN SECTION DELIVERIES.

Background; Cesarean section, one of most commonly performed surgical procedure, is associated with significant increase in maternal morbidities as well as mortalities. Objective: To determine frequency of hypotension in normotensive and preeclemptia patients undergoing spinal anaesthesia induced cesarean section. Material and Methods; Spinal anaesthesia was employed following standard technique after aspiration of free flow of CSF from needle in all four quadrants. After induction of spinal anaesthesia continuous monitoring of heart rate, oxygen situation and blood pressure was done immediately and at regular intervals of 5,10,15,20,.25 and 30  minutes to diagnose hypotension. Results; Mean gestational age of our study cases was noted to be 39.23 ± 2.16 weeks and 101 (69.2%) had gestational age more than 38 weeks. Mean age of our study cases was 27.49 ± 2.93 years. Diabetes was presented in 19 (13 %) of our study cases. Status of blood pressure in pregnancy was also noted, 73 (50%) were normotensive and 73 (50%) were pre-eclamptic patients. Mean body mass index of our study cases was 26.23 ± 1.92 kg/m2 and obesity was present in 43 (29.5 %) of our study cases. Of these 146 study cases, 44 (30.1 %) had elective cesarean section and 102 (69.9%) had emergency cesarean section. Hypotension was noted in 74 (50.7%) of our study cases. Hypotension was 35.6 % in normotensive cases while 65.8% among pre-eclamptic patients. Conclusion; Frequency of hypotension among women undergoing cesarean section with spinal anesthesia was high and hypotension was significantly more prevalent among women with the history of pre-eclampsia. Hypotension was significantly associated with age, residential status, monthly family income, diabetes, obesity and type of Cesarean section.  Keywords; cesarean section, hypotension, spinal anesthesia DOI: 10.7176/JMPB/61-06 Publication date: November 30th 2019

COMPARISON OF 0.1 % TOPICAL ADAPALENIN GEL VERSUS 0.05 % ISOTRETINOIN GEL IN PATIENTS WITH MILD TO MODERATE ACNE VULGARIS

Background; Acne Vulgaris leads to significant increase in psychological issues among patients and has negative impact on quality of life and their productivity. Objective; The objective of this study is to compare efficacy of 0.1 % topical adapalenin gel versus 0.05 % isotretinoin gel in patients with mild to moderate acne vulgaris. Material and Methods; Group A, having 30 patients, was treated with 0.1 % adapalene gel in the morning and evening (twice a day) while Group B, also having 30 patients treated with 0.05 % isotretinoin gel  twice a day for 6 weeks. The patients were followed weekly till 6 weeks from the beginning of therapy to observe efficacy. Results; Of these 60 study cases, 18 (30.0 %) were male patients while 42 (60.0 %) were female patients. Mean age of our study cases was 20.43 ± 3.37 years. Mean body mass index of our study cases was 25.12 ± 2.21 kg/m2 and obesity was present in 13 (21.7 %) of our study cases. Of these 60 study cases, 30 (50%) had mild acne and 30 (50%) moderate acne Mean disease duration was 4.52 ± 2.68 months and 54 (90.0 %) had duration of illness up to 6 months. Of these 60 study cases, 17 (28.3 %) were illiterate and 43 (71.7 %) were literate. Efficacy was noted in 35 (58.3%), in group A efficacy was noted to be 23 (76.7%) and efficacy in group B was noted be 12 (40.0%). (P=0.008). Conclusion; Adapalene gel was found to be more effective, safe and reliable therapy for the treatment of mild to moderate acne as this therapy was significantly more efficacious as compared with 0.05 % isotretinoin gel. Our study results support the use of Adapalene gel for the treatment of mild to moderate acne as it provides desired outcomes which leads to improvement in quality of life these patients and also their productivity. This will also provide psychological relief to the patients having significant burden of psychological stress. Keywords; Acne vulgaris, Adapalene, Isotretinoin gel, efficacy. DOI: 10.7176/JMPB/61-05 Publication date: November 30th 201

Visual and treatment outcomes of tubercular uveitis: a prospective case series from a referral hospital in Pakistan

Objective: Pakistan is the fifth highest TB burden country. Tuberculous uveitis (TbU) is a form of extrapulmonary TB, that is not uncommon in high burden country but very limited data is available on its outcome. The aim of the study is to assess the outcome of TbU with anti-tuberculous treatment (ATT). Results: A prospective study was conducted at Jinnah Medical College Hospital (JMCH) Karachi, Pakistan from July to December 2017. Patients with suspected TbU were started on standard ATT chemotherapy for 12 months. Their response was assessed via slit lamp examination and visual acuity at 1, 3, 6 and 12 months of treatment. Forty patients with probable TbU were treated with ATT, mean age was 36 ± 3 years and 24 (60%) were females. Around 26 (65%) had Monteux test of 15 mm or more. History of TB contact was positive in 24 (60%) and 12 (30%) had previous history of TB. All patients complained for blurring of vision and floaters. Posterior uveitis seen in 36 (90%) of patients. Complete response achieved in 32 (80%) after ATT while 6 (14%) had changed in inflammation and 2 (6%) had no benefit

Does Short Term Atorvastatin Treatment Improve Symptomatic Control in Patients with Mild to Moderate & Uncontrolled Asthma?

Introduction: Asthma is a chronic disease characterized by recurrent episodes of breathlessness and wheezing. Keeping in view the problems in asthma control and side effects of available medication, there is a need for alternative treatments with better efficacies and fewer side effects. Atorvastatin is a statin that blocks HMG CoA reductase enzyme found in the liver, inhibiting the synthesis of cholesterol. Blockade of this pathway also inhibits production of GTPases which are involved in airway inflammation, airway remodeling and contraction of smooth muscles of the bronchi. Aims & Objectives: To evaluate the symptomatic control in mild to moderate and uncontrolled asthma patients using standard treatment versus its combination with atorvastatin. Place and duration of study: This study was conducted in Pulmonology Department of Lahore General Hospital; Lahore over a 4-week duration from October 2018 till February 2019. Material & Methods: Patients of mild to moderate and uncontrolled asthma were enrolled in this study based on inclusion and exclusion criteria. Patients were divided into two groups by lottery method, Group 1 and Group 2, with 34 patients in each group. Group 1 was continued with standard therapy of asthma and the Group 2 was administered atorvastatin 40 mg, once daily in addition to standard therapy for 4 weeks. The control of asthma before and after treatment was assessed based on Global Initiative for asthma (GINA) guideline questionnaire score. SPSS (Statistical Package for Social Sciences) version 22 was used for analysis of data. P-Value < 0.05 was taken as significant. Results: Nonsignificant results were obtained when comparison between the groups was made based on GINA guidelines questionnaire score by Mann Whitney Utest Conclusion: It was concluded that atorvastatin has no role in symptomatic control in patients of mild to moderate and uncontrolled asthma

Investigating the effect of Aspergillus niger inoculated press mud (biofertilizer) on the potential of enhancing maize (Zea mays. L) yield, potassium use efficiency and potassium agronomic efficiency

Globally field application of mineral potassium (K) fertilizer has grown, followed by reduced K use efficiency (KUE) and K agronomic efficiency (KAE) which ultimately leads to environmental pollution and economic loss. The soils of Pakistan have a low K level due to a higher proportion is present in an unavailable form. The objective of the current study was to isolate efficient plant growth-promoting fungus to sustainably manage huge burden of sugar industry waste press mud into a productive biofertilizer. K from biofertilizer was then evaluated in different treatments for maize biological yield, grain yield, harvest index (HI), K uptake in different maize parts, KUE and KAE in comparison to mineral fertilizer (MF). The efficiency of treatment was measured on higher KUE and KAE. In-vitro studies revealed that A. niger PM-4 was found to solubilize phosphate (389 ug/ml) and zinc (115 ug/ml) from insoluble tri-calcium phosphate and zinc oxide, respectively, at a wider temperature and pH range. The strain was also found to inhibit the production of aflatoxins and its inoculation into press mud produced non-phytotoxic and mature biofertilizer with germination index 96.5%. Bio-augmentation of press mud with A. niger shortens maturity period with improved nutrient contents. Higher grain yield and harvest index of maize were achieved with a higher amount of incorporated K from mineral and biofertilizer T5(100%Org+50%MF) than any other treatment. However, higher KUE and KAE were found in the following order: T6 > T5 > T2 > T3 > T4 > T1, demonstrating the integrated and balanced use of K from mineral and biofertilizer without threatening the environment

Efficacy and safety of mavacamten in treatment of hypertrophic cardiomyopathy: a systematic review and meta-analysis

Aim: This meta-analysis was performed to assess the efficacy and safety of mavacamten in patients with hypertrophic cardiomyopathy. Methods & materials: A search was conducted using PubMed, Cochrane, and Scopus up to August 2022 for randomized studies reporting our pre-specified outcomes. Results: It was observed that mavacamten significantly improved New York Heart Association class (p < 0.009), Clinical Summary Score of the Kansas City Cardiomyopathy Questionnaire (p = 0.02), post-exercise left ventricular outflow tract gradient (p < 0.00001), functional end point (p = 0.05), and lowered septal reduction therapy rates (p < 0.00001). However, there were no significant differences in the ≥1 severe adverse events, ≥1 treatment-emergent adverse events, left ventricular volume index, left ventricular filling pressure, left ventricular end-diastolic volume index, and peak oxygen uptake (pVO2). Conclusion: Future large-scale trials are required to confirm our results and determine the long-term benefits and risks of mavacamten use in these patients

Post COVID-19 sequelae of the respiratory system. A single center experience reporting the compromise of the airway, alveolar and vascular components

The long-term sequelae of COVID-19 have now become more common and appreciable. The SARS-CoV-2 virus can cause a variety of infectious and non-infectious pulmonary complications. The purpose of this study is to raise awareness about post-COVID-19 pulmonary sequelae, both infectious and non-infectious, in this geographical area. A retrospective study was conducted from July 1st 2020 to December 20th 2020. A total of 1200 patients were evaluated, with 83 suffering from post-COVID-19 pulmonary complications. The patients\u27 mean age was 62 years (IQR 55-69), with 63 (75.9%) being male. The most common co-morbid illnesses were hypertension (49, 59%) and diabetes (45, 54.2%). The majority of them (37, 44.6%) had severe COVID-19, followed by critical COVID-19 (33, 39.8%). There was no statistically significant difference in recurrence of respiratory symptoms or duration of current illness between non-severe, severe, and critical COVID-19 patients. Non-infectious complications were observed in the majority of patients (n=76, 91.5%), including organizing pneumonia/ground glass opacities in 71 (88%) patients, fibrosis in 44 (55%), pulmonary embolism in 10 (12.5%), pneumomediastinum in 6 (7.4%) and pneumothorax in 7 (8.6%). Infective complications (25, 30.1%) included aspergillus infection in 10 (12.0%) and bacterial infection in 5 (8.47%), with more gram-negative infections and one patient developing Mycobacterium tuberculosis. Post COVID-19 mortality was 11 (13.3%). The long-term pulmonary sequelae of COVID-19 are not rare. Cryptogenic organizing pneumonia, ground glass opacities, and fibrosis were common post-COVID-19 sequelae in our patients. This necessitates frequent close monitoring of these patients in order to initiate early appropriate management and prevent further morbidity and eventual mortality