Finding Factors Causing Postdural Puncture Headache In Obstetric Patients After Spinal Anaesthesia

Objective: Among various recognized factor of spinal headache the single most important causative factor is size of spinal needle. The aim of this study was to determine incidence of spinal headache with 27 GQuincke Babcock spinal needle in Caesarean section patients. Materials and Methods: This observationalcross sectional study was carried out in the Combined Military Hospital Gujranwala and Pakistan Naval Shipping Rahat Hospital Karachi from Jan 2011 to Jan 2013. In 500 Caesarean section (C section) cases preloaded with 1000 ml Ringers Lactate, 27 G QuinckeBabcok spinal needle was used in sitting as well as left lateral position for spinal anaesthesia in all patients using local anaesthesia plain lidocaine 2% 1-2ml.In interspace L 2-3 / L3-4 eitherBupivacaine hydrochloride hyperbaric 0.75 % or 0. 5% was injected. All Caesarean cases were included except contraindicated. Spinal needle Quincke Babcock 27 G alone was used.The results were presented in percentages, mean and standard deviation. Results: A total of 500 patients of c-section were evaluated. Overall incidence of true spinal headache was 2%, failed spinal anaesthesia 4%, spinal needle was changed in 3 %, success rate of 96 % and maternal acceptance 47.4 %. Single pricks were 59.4 % while 2-3 pricks were 40.6 % . Conclusion: Smaller spinal needle has changed the safety profile of spinal anaesthesia in C section cases by very low failure rates and true PDPH a rarity. PDPH will continue as long as dura is punctured but incidence can be decreased by different technique

Antidiabetic and Hypolipidemic Effects of Aqueous Methanolic Extract of Acacia Nilotica Pods in Alloxan-Induced Diabetic Rabbits

This study was designed to investigate the effect of an aqueous methanol extract of Acacia nilotica pods (Anp) on various biochemical parameters, namely blood glucose levels, total cholesterol, High density lipids (HDLs), triglycerides, Serum Glutamate Oxaloacetate and Pyruvate Transaminase (SGOT, SGPT) and serum creatinine clearance in alloxan-induced diabetic rabbits. Rabbits were divided into three experimental groups: control, diabetic and Anp treated. The Anp treated group was further subdivided into three different groups based on the dose administered. This showed that a dose of 400 mg/kg body weight maximally reduced the blood glucose levels as compared to the diabetic group (p<0.001). This dose also significantly (p<0.05) lowered the plasma total cholesterol, triglyceride and Low-density lipids (LDLs) in treated rabbits as compared to diabetic rabbits. Furthermore, the same dose also significantly increased the plasma HDL levels of the treated group when compared with the diabetic group. Whereas the activity of SGOT and SGPT were decreased significantly (p<0.001). Anp extract in treated diabetic rabbits. Anp treatment showed no significant effect on creatinine clearance. For interest a paper with similar aims, but using water extract of Nigella stiva L. appeared in this journal in 2004, (Merel et at, 31 (1), 49-53)

Diagnostic accuracy of strain ultrasound elastography in differentiating benign and malignant thyroid nodules, taking histopathology as gold standard

Background: Elastography is a method recently being used in the evaluation of thyroid nodules by comparing tissue elasticity. Strain and shear wave elastography are two types of elastography still being used in clinical practice. Two kinds of elasticity can be assessed by strain elastography. First, colors around and within the nodules are evaluated and visually scored according to the 4-5 scale scoring systems. The aim of this study was to determine the diagnostic accuracy of strain ultrasound elastography in differentiation between benign and malignant thyroid nodules, taking histopathology as gold standardMethods: Total of 101 patients with palpable thyroid nodule of any size of age 30-70 years of either gender were included. Patients with previous thyroid surgery and already proven histopathology were excluded. Strain ultrasound elastography was performed in every patient by using a highresolution unit with a linear array probe centred at 7.5 MHz. Strain ultrasound elastography was performed in every patient by a consultant radiologist in the presence of researcher and benign or malignant thyroid nodules was noted. Strain USG elastography findings were compared with histopathology report.Results: All the patients were subjected to strain ultrasound elastography. USG supported the diagnosis of malignant thyroid nodules in all 52 patients. Histopathology confirmed malignant thyroid nodules in 47 (true positive) cases where as 5 (false positive) had no malignant lesion on histopathology. In USG negative patients, 46 were true negative while 3 were false negative. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of strain ultrasound elastography in differentiation between benign and malignant thyroid nodules, taking histopathology as gold standard is 94.0%, 90.20%, 90.38%, 93.88% and 92.08% respectively.Conclusions: According to this study, strain ultrasound elastography is the non-invasive modality of choice with high diagnostic accuracy in diagnosing malignant thyroid nodules

Improvement of Abiotic Stress Tolerance in Plants with the Application of Nanoparticles

Plants are under the threat of climatic changes and there is a reduction in productivity and deterioration in quality. The application of nanoparticles is one of the recent approaches to improve plant yield and quality traits. A number of nanoparticles, such as zinc nanoparticles (ZnO NPs), iron nanoparticles (Fe2O3 NPs), silicon nanoparticles (SiO2 NPs), cerium nanoparticles (CeO2 NPs), silver nanoparticles (Ag NPs), titanium dioxide nanoparticles (TiO2 NPs), and carbon nanoparticles (C NPs), have been reported in different plant species to play a role to improve the plant physiology and metabolic pathways under environmental stresses. Crop plants readily absorb the nanoparticles through the cellular machinery of different tissues and organs to take part in metabolic and growth processes. Nanoparticles promote the activity of a range of antioxidant enzymes, including catalase (CAT), peroxidase (POD), and superoxide dismutase (SOD), in plant species, which in turn improve the growth and development under stressful conditions. The present review focuses on the mode of action and signaling of nanoparticles to the plant systems and their positive impact on growth, development, and ROS scavenging potential. The appropriate elucidation on mechanisms of nanoparticles in plants leads to better growth and yields under stress conditions, which will ultimately lead to increased agricultural production

Gendered effects of COVID-19 school closures: Pakistan case study

This brief summarizes a case study conducted to assess the gendered impacts of COVID-19 school closures on adolescent girls and boys in three districts in the province of Punjab in Pakistan. Data as well as discussions and interviews with adolescents, teachers, and parents shed light on difficulties in accessing and adjusting to remote learning, learning loss, deterioration of behaviors and health, and other effects. Based on these findings and further reflections by stakeholders on the successes and gaps of mitigation measures, the case study proposes recommendations for improved teacher training, digital access, alternative learning options, and a gendered focus in interventions

The cross-sectional study of anxiety levels and ratio of severity of thirteen symptoms of anxiety among medical students

Background: Anxiety is defined as physical, behavioral, social and psychological response to treat self-concept characterized by subjective, consciously perceived feelings of tension. Nowadays anxiety is most commonly found among medical students. This study was conducted to find out the anxiety levels and ratio of severity of thirteen symptoms of anxiety.Methods: A questionnaire based study was conducted among 178 medical students which tests the level of anxiety and severity of symptoms of anxiety. The questionnaire used was hamilton anxiety rating scale (HAM-A).Results: Out of 178 students, 80 (44.94%) students scored mild anxiety levels, 63 (35.39%) students scored moderate anxiety levels and 35 (19.66%) students scored severe anxiety levels.Conclusions: Mild form of anxiety is much more common among medical students and majority of these medical students are females. Moreover, the symptoms of anxiety including tension, anxious mood, depressed mood, insomnia, fear and CVS symptoms appear with moderate severity in majority of medical students while on the other hand some symptoms including general somatic muscular and sensory symptoms, difficulties in concentration and memory, genitor-urinary symptoms, respiratory symptoms, GIT symptoms and other autonomic symptoms appear with least severity among majority of medical students

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

Background Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis. Methods In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability. Findings Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis