EFFICACY OF ORAL ZINC SULPHATE VERSUS TOPICAL APPLICATION OF SALICYLIC ACID (16.7%) & LACTIC ACID (16.7%) COMBINATION IN THE TREATMENT OF PLANTAR WARTS

Background; Warts are common epidermal growths caused by human papillomavirus that often cause significant discomfort and embarrassment. Current treatment options include topical therapies, cryotherapy, laser vaporization, and surgical excision. Objective: To compare the efficacy of oral zinc sulphate versus topical application of salicylic acid (16.7%) & lactic acid (16.7%) combination in the treatment of plantar warts. Material and Methods; Group A, having 78 patients, was given oral zinc sulphate (10 mg/kg/day) in 2 or 3 divided doses. In group B, 78 patients were advised to apply a combination of salicylic (16.7%) & lactic acid (16.7%) once at night daily. In group A, using oral zinc sulphate, the treatment was given for two months and follow up continued for next 1 month. In group B, the topical preparation was also continued for 2 months or till the complete removal of warts. Results; Of these 156 study cases, 94 (60.3 %) were male patients while 62 (39.7 %) were female patients. Mean age of our study cases was 34.42 ± 9.87 years. Monthly family income up to Rs. 30000 was noted in 68 (43.6%) while 88 (56.4%) had monthly family income more than Rs. 30000. Mean weight of our study cases was 61.96 ± 10.29 kilograms. Mean height of our study cases 161.24 ± 12.23 centimeters. Mean BMI of our study cases was 26.52± 1.87 kg/m2 and obesity was present in 31 (19.9%) of our study cases. Mean no. of lesions was noted to be 5.30 ± 2.45 lesions (with minimum no. of lesions was 4 and maximum no. of lesions was 10) and 131 (84%) had up to 5 lesions. Mean duration of disease was 4.69 ± 1.61 months and 112 (71.8 %) had disease duration up to 6 months. Efficacy was noted in 110 (70.5 %). Efficacy in group A was noted to be 83.3 % and in group B was 57.7 % (p= 0.001). Conclusion; Our study results support the use of oral Zinc Sulphate in the treatment of plantar warts as compared to the salicylic acid (16.7%) and lactic acid (16.7%) combination. Efficacy of Zinc Sulphate was significantly higher when compared with combination therapy and it was found to be safe and reliable mode of treatment having no side effects were observed in our study. Use of Zinc Sulphate can help to reduce chance of recurrence and disease morbidity. Being cost effective, it provides cheaper mode of treatment as compared with cryotherapy which is quite expensive which will provide economic relief to our large poor population. Early treatment can help patients to maintain routine daily lives and physical activities such as sports without any pain and side effects. Keywords; Plantar warts, Zinc Sulphate, Salicylic acid, lactic acid

FREQUENCY OF MICROALBUMINURIA IN PATIENTS WITH TYPE-2 DIABETES MELLITUS HAVING DIABETIC RETINOPATHY

Objective; To determine the frequency of microalbuminuria in patients with type 2 diabetes mellitus with retinopathy. Methodology:- This descriptive study was carried out in the Out Patient Department Nishtar Hospital Multan from June 2017 to December 2018. Sample size of 296 was calculated according to formula. Results:- Of these 300 study cases, 179 (59.7%) were male while 121 (40.3%) were female patients. Mean age of our study cases was 52.10 ± 5.65 years (with minimum age was 42 years while maximum age was 60 years).  Majority of our study cases had low educational level such as illiterate i.e. 60 (20%), primary education in 71 (23.7%) secondary education53% while only 3 % had bachelors degree or above. Mean duration of diabetes was 14.18 ± 2.73 years (with minimum duration of disease 10 years and 19 years was maximum duration of the disease). Among these patients Grade III diabetic retinopathy was more prevalent i.e. 149 (49.7%) followed by grade IV retinopathy i.e. 100 (33.3%) and grade11 retinopathy (17%). Diabetes was controlled (HbA1c<7%) in only 81 (27%) of our study cases and obesity(BMI>30kg/m2) was present in 101 (33.7%) of our study cases. Microalbuminuria was present in 121(40.3% of our study cases.  Conclusion:- Very high frequency of microalbuminuria was noted in patients with diabetic retinopathy in our study. Keywords; Microalbuminuria, Diabetic Retinopathy, Frequency

Large Subcapsular Hematoma of the Liver Due to Faja Corset: A Rare Case Report

Background: Subcapsular hematoma of the liver is a potentially life-threatening but extremely rare condition. It is often caused by a blunt trauma or other predisposing conditions such as a liver tumor, intra-tumor hemorrhage, surgery, preeclampsia, liver biopsy, and hemodialysis. Predisposing causes of liver hematoma include its large size and proximity to fixed structures. To date, there have been no reported cases of subcapsular liver hematoma caused by tight clothing such as corsets. Our case report is about an extremely rare case of subcapsular hematoma of the liver caused by wearing a tight faja corset in a young healthy female. Case presentation: A forty-five-year-old Spanish female without any underlying health problems presented with sudden onset epigastric and right upper quadrant abdominal pain after wearing a faja corset the night prior to the hospital presentation. CT abdomen was noted for subcapsular hematoma of the liver. Her symptoms persisted and repeat CT abdomen showing worsening of the liver hematoma. Patient had interventional radiology (IR) guided drainage and was subsequently discharged home. Conclusions: Subscapular liver hematomas need to be considered in patients presenting with acute onset abdominal pain after wearing certain tight clothing. The necessity of an early and accurate diagnosis is vital for management as hemodynamically stable patients can be managed conservatively. Our patient was managed with IR-guided aspiration drainage of the hematoma. Surgery can be considered a last resort in case of life-threatening hemodynamic instability, peritoneal signs, free abdominal fluid, and failure of arterial embolization. Our case highlights the importance of early recognition of traumatic subcapsular hematomas to prevent life-threatening complications

Investigation of the cardiac depressant effect of Caralluma tuberculate N.E.Br on isolated rabbit heart

Purpose: To investigate the histopathological and cardiac depressant effect of the aqueous methanol extract of Caralluma tuberculata N.E. Br (AMECT) (family: Asclepiadaceae)’ and to determine if there is a scientific basis for its cardiovascular diseases-related folkloric use. Methods: The effect of AMECT in different concentrations ranging from 0.00001 to 1.0 mg/mL were evaluated in isolated perfused rabbit heart to assess their effect on the force of contraction and heart rate using Langendorff’s apparatus. Atropine and adrenaline were used to identify the underlying mechanism of response produced by AMECT. The extract was studied for its possible mechanism in the absence and presence of atropine and adrenaline. In addition, sub-chronic toxicity and histopathological study of heart tissues in rats were assessed by administering 500 mg/kg of extract. Results: At all concentrations, AMECT produced significant (p < 0.001) negative ionotropic and negative chronotropic effects. The most significant effect was observed at 0.001 mg/mL and higher concentrations hence 0.001 mg/mL was selected for further studies. Pre-incubation with atropine did not significantly inhibit the effects of AMECT. However, AMECT significantly (p < 0.01) blocked the cardiac stimulant effect of adrenaline. In the histopathological studies, AMECT did not produce any significant cellular changes or signs of toxicity in the sub-chronic toxicity study. Conclusion: The cardiac-depressant responses of AMECT may involve the β-adrenergic receptors in the myocardium of isolated rabbit heart thus confirming the rationale for its use in ethnomedicine for cardiac diseases

Abnormal aortic wall properties in women with Turner syndrome

Background Turner syndrome (TS) is associated with aortic dilatation and dissection, but the underlying process is unclear. The aim of this study was to investigate the elastic properties and composition of the aortic wall in women with TS. Methods In this cross-sectional study, 52 women with TS aged 35 ± 13 years (50% monosomy, 12 with bicuspid aortic valve [BAV] and 4 with coarctation) were investigated using carotid-femoral pulse wave velocity (CF-PWV) by echocardiography and ascending aortic distensibility (AAD) and aortic arch pulse wave velocity (AA-PWV) by magnetic resonance imaging (MRI). As control group, 13 women with BAV without TS and 48 healthy patients were included. Results Women with TS showed a higher AA-PWV (β = 1.08, confidence interval [CI]: 0.54–1.62) after correcting for age and comorbidities compared with controls. We found no significant difference in AAD and CF-PWV. In women with TS, the presence of BAV, coarctation of the aorta, or monosomy (45, X) was not associated with aortic stiffness. In addition, aortic tissue samples were investigated with routine and immunohistochemical stains in five additional women with TS who were operated. The tissue showed more compact smooth muscle cell layers with abnormal deposition and structure of elastin and diminished or absent expression of contractile proteins desmin, actin, and caldesmon, as well as the progesterone receptor. Conclusion Both aortic arch stiffness measurements on MRI and histomorphological changes point toward an inherent abnormal thoracic aortic wall in women with TS

Activation of Akt by the Bacterial Inositol Phosphatase, SopB, is Wortmannin Insensitive

Salmonella enterica uses effector proteins translocated by a Type III Secretion System to invade epithelial cells. One of the invasion-associated effectors, SopB, is an inositol phosphatase that mediates sustained activation of the pro-survival kinase Akt in infected cells. Canonical activation of Akt involves membrane translocation and phosphorylation and is dependent on phosphatidyl inositide 3 kinase (PI3K). Here we have investigated these two distinct processes in Salmonella infected HeLa cells. Firstly, we found that SopB-dependent membrane translocation and phosphorylation of Akt are insensitive to the PI3K inhibitor wortmannin. Similarly, depletion of the PI3K regulatory subunits p85α and p85ß by RNAi had no inhibitory effect on SopB-dependent Akt phosphorylation. Nevertheless, SopB-dependent phosphorylation does depend on the Akt kinases, PDK1 and rictor-mTOR. Membrane translocation assays revealed a dependence on SopB for Akt recruitment to Salmonella ruffles and suggest that this is mediated by phosphoinositide (3,4) P2 rather than phosphoinositide (3,4,5) P3. Altogether these data demonstrate that Salmonella activates Akt via a wortmannin insensitive mechanism that is likely a class I PI3K-independent process that incorporates some essential elements of the canonical pathway