Risk Factors of Subependymal Hemorrhage-Intraventricular Haemorrhage in Preterm Infants

To determine the frequency and peaktime of occurrence of subependymal hemorrhageintraventricularhemorrhage (SEH-IVH) in preterminfants and to identify the predisposing risk factors.Methods: In this descriptive study consecutive liveborn babies (n=135), between the gestational ages of28-34 weeks, were enrolled. Information regardingweight, gestational age, mode of delivery andpresence of risk factors were recorded. Each newbornunderwent cranial ultrasound on designated daysand was followed up till the fourth week of lifeunless expired.Results: The frequency of SEH-IVH was found tobe 20.8%. The most vulnerable group in terms ofgestational age and weight were infants < 32 wksand weighing < 1.5 kg respectively. The peak age ofoccurrence of SEH-IVH was first three days of life.Risk factors found to be associated with SEH-IVHwere RDS with ventilation, exchange transfusionand thrombocytopenia.Conclusion: The incidence of SEH-IVH in infantsbetween 28-34 wks gestation is significantly high.The crucial period is the first three days of life andrespiratory distress syndrome (RDS) withventilation, exchange transfusion andthrombocytopenia carry the highest risk ofhemorrhage. There is a need to emphasize on theprevention of prematurity and optimum perinatalmanagement to minimize the risk of hemorrhage

Is Grown Up Congenital Heart (GUCH) disease different in a developing country?

Abstract In the current era grown up congenital heart disease (GUCH) patients undergoing surgical interventions are increasing. Most of the interventions in the developed countries are either complex or redo-operations in patients who had previously undergone repair, palliation or correction. However, in the developing countries most of the interventions are primary and corrective. This descriptive retrospective study comprised GUCH patients who underwent surgical intervention for congenital heart disease (CHD) at Aga Khan University Hospital, Karachi, from January 2006 to December 2015. A total of 195 patients had been treated surgically with a mean age of 31.0±13.5 years. Majority of the patients underwent surgical interventions for closure of atrial 109(55.3%) and ventricular 51(26.2%) septal defect. The most common complications were prolonged ventilation 16(8.1%). Overall mortality was 4(2.1%). GUCH in our practice is for primary procedure with simple diagnosis that should have been treated before reaching adulthood as is done in the developed countries

Molecular Docking of Known Carcinogen 4- (Methyl-nitrosamino)-1-(3-pyridyl)-1-butanone (NNK) with Cyclin Dependent Kinases towards Its Potential Role in Cell Cycle Perturbation

Cell cycle is maintained almost all the times and is controlled by various regulatory proteins and their complexes (Cdk+Cyclin) in different phases of interphase (G1, S and G2) and mitosis of cell cycle. A number of mechanisms have been proposed for the initiation and progression of carcinogenesis by abruption in cell cycle process. One of the important features of cancer/carcinogenesis is functional loss of these cell cycle regulatory proteins particularly in CDKs and cyclins. We hypothesize that there is a direct involvement of these cell cycle regulatory proteins not only at the genetic level but also proteins level, during the initiation of carcinogenesis. Therefore, it becomes significant to determine inconsistency in the functioning of regulatory proteins due to interaction with carcinogen 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). Hence, we investigated the interaction efficiency of NNK, against cell cycle regulatory proteins. We found a different value of ΔG (free energy of binding) among the studied proteins ranging between -3.29 to -7.25 kcal/mol was observed. To validate the results, we considered Human Oxy-Hemoglobin at 1.25 Å Resolution, [PDB_ID:1HHO] as a +ve control, (binding energy -6.06 kcal/mol). Finally, the CDK8 (PDB_ID:3RGF) and CDK2 (PDB_ID:3DDP) regulatory proteins showing significantly strong molecular interaction with NNK -7.25 kcal/mol, -6.19 kcal/mol respectively were analyzed in details. In this study we predicted that CDK8 protein fails to form functional complex with its complementary partner cyclin C in presence of NNK. Consequently, inconsistency of functioning in regulatory proteins might lead to the abruption in cell cycle progression; contribute to the loss of cell cycle control and subsequently increasing the possibility of carcinogenesis

Atrial natriuretic peptide levels in Plasma and in Cardiac tissues after chronic hypoxia in Rats

1. Atrial natriuretic peptide (ANP) levels were measured in cardiac tissues and in plasma from adult rats exposed to chronic alveolar hypoxia for periods of 2 h, 24 h and 7 days. Levels were also measured in rats that were maintained in hypoxia for 7 days and then returned to air for 24 h. 2. Plasma ANP was not altered at 2 h but was significantly increased at both 24 h and at 7 days. Plasma ANP in animals exposed to hypoxia for 7 days was normal 24 h after returning to air breathing, despite the persistence of indices of pulmonary hypertension. 3. No significant right atrial hypertrophy was observed under these conditions of chronic hypoxia. A reduction in right atrial ANP content was found at 24 h and was accompanied by a decrease in the number of electrondense granules per right atrial muscle cell. After exposure to hypoxia for 7 days, right atrial ANP and granule number was not different from control, and no alteration was found in right atrial ANP level after removal from the hypoxic environment. 4. No significant right ventricular hypertrophy was produced by exposure to hypoxia for 2 or 24 h. In the former group ventricular ANP had decreased significantly compared with control. Right ventricular hypertrophy was found in both the hypoxic groups after exposure for 7 days, when selective increases in right ventricular ANP content were found. 5. These findings are consistent with the hypothesis that ANP release occurs on exposure to chronic hypoxia and is independent of the associated cardiac hypertrophy and pulmonary vascular remodelling. The findings may have relevance to the natriuresis and reported changes in the renin-angiotensin-aldosterone axis under hypoxic conditions

Knowledge Attitude and Practice of Dental Professionals Towards Diabetes Mellitus in Islamabad Dental Hospital

OBJECTIVES The aim of this study was to determine general dentists and dental students knowledge, attitudes and practices regarding diabetes mellitus, a major public health issue with oral complications. METHODOLOGY This cross-sectional study design was conducted in Islamabad dental hospital for three months on House officers and final year BDS students. A convenience sampling technique was used for the sample. A pretested questionnaire was selected from the previous study. After approval of the IRB, the questionnaires were distributed among participants of the research. The descriptive analysis of the collected data was done by using SPSS software version 20. RESULTS The overall results of knowledge of dentists towards diabetes scored high (90%), 80% of the respondents had a positive attitude towards diabetes mellitus. Less than half (20%) of the dentists scored poor in the practice of diabetes mellitus, while about three fourth of the respondents had a good score (80%). CONCLUSION Dentists in Islamabad dental hospital have good knowledge and practice skills regarding diabetes. The attitude of the dental practitioners in Islamabad dental hospital regarding diabetes is also positive

Patent foramen ovale closure in young Patients with cryptogenic stroke: a case series and follow up from Saudi population.

One quarter of cerebral infarctions are cryptogenic and most of these patients are young. Patent Foramen Ovale (PFO) is found to be more prevalent in young persons with cryptogenic stroke and risk of stroke recurrence in such patients ranges from as low as 2% per annum to as high as 12% per annum. Since patients with PFO and cryptogenic stroke are young they need more effective ways to reduce risk of stroke recurrence hence percutaneous closure of PFO seems reasonable approach to deal with this etiology of stroke in such population. We report four cases of cryptogenic stroke in young Saudi patients. PFO closure was performed in all. After closure, none of them developed either recurrence of symptoms or any complication on follow up for more than one year

Utility of the CHA2DS2-VASc score for predicting ischaemic stroke in patients with or without atrial fibrillation: a systematic review and meta-analysis

AIMS: Anticoagulants are the mainstay treatment for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), and the CHA2DS2-VASc score is widely used to guide anticoagulation therapy in this cohort. However, utility of CHA2DS2-VASc in NVAF patients is debated, primarily because it is a vascular scoring system, which does not incorporate atrial fibrillation related parameters. Therefore, we conducted a meta-analysis to estimate the discrimination ability of CHA2DS2-VASc in predicting ischaemic stroke overall, and in subgroups of patients with or without NVAF. METHODS AND RESULTS: PubMed and Embase databases were searched till June 2020 for published articles that assessed the discrimination ability of CHA2DS2-VASc, as measured by C-statistics, during mid-term (2-5 years) and long-term (\u3e5 years) follow-up. Summary estimates were reported as random effects C-statistics with 95% confidence intervals (CIs). Seventeen articles were included in the analysis. Nine studies (n = 453 747 patients) reported the discrimination ability of CHA2DS2-VASc in NVAF patients, and 10 studies (n = 138 262 patients) in patients without NVAF. During mid-term follow-up, CHA2DS2-VASc predicted stroke with modest discrimination in the overall cohort [0.67 (0.65-0.69)], with similar discrimination ability in patients with NVAF [0.65 (0.63-0.68)] and in those without NVAF [0.69 (0.68-0.71)] (P-interaction = 0.08). Similarly, at long-term follow-up, CHA2DS2-VASc had modest discrimination [0.66 (0.63-0.69)], which was consistent among patients with NVAF [0.63 (0.54-0.71)] and those without NVAF [0.67 (0.64-0.70)] (P-interaction = 0.39). CONCLUSION: This meta-analysis suggests that the discrimination power of the CHA2DS2-VASc score in predicting ischaemic stroke is modest, and is similar in the presence or absence of NVAF. More accurate stroke prediction models are thus needed for the NVAF population

Pathology-Based Tumour Registry Analysis of Cases of Female Genital Tract Malignancies

Objective: To study the frequency and distribution of Female genital tract (FGT) malignancies through data recouped from the tumour registry of Armed Forces Institute of Pathology, Rawalpindi Pakistan. Study Design: Retrospective longitudinal study. Place and Duration of Study: Histopathology Department, Armed Force Institute of Pathology, Rawalpindi Pakistan, from 2009-2018 Methodology: A total of 1586 cases of malignant tumours of FGT were retrieved from the AFIP tumour registry, and data were analyzed in terms of the age of the patients' site of the tumour. It was also compared with regional and international data. Results: Thirty-seven thousand seven hundred ninety-three malignant cases were reported at AFIP from 2009-2018, out of which 1586(4.19%) were of the female genital tract. Ovarian malignancies were most frequent among FGT tumours,637(40.1%), followed by uterine tumours 519(32.6%). Carcinoma of the cervix was found in 237 cases (15%). Vulva and vaginal cases were seen in only 7.7% patients. The FGTs ranked fourth among the top ten commonest tumours in females. Conclusion: The most common malignancy of the female genital tract was ovarian cancer. Endometrial carcinoma was the second most frequent gynaecological malignancy, followed by cervical carcinoma. Ovarian malignancies were in fourth position among the top ten commonest female tumours in the current analysis as well, as in the previous analysis from AFIP

Performance of the TIMI risk score in predicting mortality after primary percutaneous coronary intervention in elderly women: Results from a developing country

Background: Despite women undergoing primary percutaneous coronary intervention (PPCI) having a higher rate of adverse outcomes than men, data evaluating prognostic risk scores, especially in elderly women, remains scarce. This study was conducted to validate the predictive value of Thrombolysis in Myocardial Infarction (TIMI) risk score in elderly female patients. Materials and Methods: This was a retrospective analysis of elderly (\u3e65 years) female patients who underwent PPCI for ST-elevated myocardial infarction (STEMI) from October 2016 to September 2018. Patients\u27 demographic details and elements of TIMI risk score including age, co-morbidities, Killip classification; weight, anterior MI and total ischemic time were extracted from hospital records. The primary outcome was in-hospital mortality and post-discharge mortality reported on telephonic follow-up. Results: A total of 404 elderly women with a median age of 70 years were included. The mean TIMI score was 5.25±1.45 with 40.3% (163) patients of TIMI score \u3e 5. In-hospital mortality rate was 6.4% (26) and was found to be associated with TIMI score (p\u3c0.001). The in-hospital mortality rate increased from 3.1% at TIMI score of 0-4 to 34.6% at the score of 8. On follow-up (16.43±7.40 months) of 211 (55.8%) patients, the overall mortality rate was 20.3%, and this was also associated with TIMI score (p\u3c0.001). The mortality rate increased from 5.6% at the score of 0-4 to 54.5% at the score of 8. The predictive values (area under the curve) of TIMI risk score for in-hospital and post-discharge mortality were 0.709 (95% CI 0.591-0.827; p \u3c0.001) and 0.689 (95% CI 0.608-0.770; p \u3c0.001), respectively. Conclusion: Increased adverse outcomes were observed with higher TIMI risk score for in hospital and post-discharge follow-up. Therefore, the prognostic TIMI risk score is a robust tool in predicting both in-hospital as well as post-discharge mortality in elderly females