Feasibility of Primary PCI as the Reperfusion Strategy for Acute ST elevation MI at PIMS

Objective: To determine the feasibility of primary PCI in terms of frequency of patients with acute ST elevation MI found to have a first-medical-contact to needle time of 90 minutes.Methodology: The descriptive, cross sectional case series was conducted at department of Cardiology, PIMS, Islamabad from January 2017 to April 2017Results: A total of 350 patients were enrolled into the study, 67% (235) of which were males and 33% (115) females. Mean age of the participating population was 54 ±7.8 years. The mean first medical contact needle time was 2.3±1.1 hours, out of which a vast majority (73%) fell into the 90 minutes range. The patients had a median first medical contact to needle time of 74 minutes.Conclusion: The study concluded that majority of patients presenting to the emergency department with acute STEMI were found to be feasible for primary PCI as the reperfusion strategy with an FMC to needle time of less than 90 minutes. Therefore, accelerated efforts need to be made to develop this center as a primary PCI capable facility providing such standards of care to patients with ST-elevation MI

A reproducible protocol for raising clonal plants from leaf segments excised from mature trees of Betula utilis a threatened tree species of Kashmir Himalayas

Tissue culture techniques such as micropropagation provide a fast and dependable method for production of a large number of uniform plantlets in a short time and offer potential means not only for rapid mass multiplication of existing stocks but also for the conservation of important, elite and rare plants. In this study, callusing was achieved from leaf explants of Betula utilis on MS medium supplemented with 2, 4-D (2.5mg/l). The callus was friable, nodular, having numerous embryoids which exhibited organogenesis on subculturing. Production of multiple shoots was achieved on MS medium supplemented with BAP (1.5mg/l). Rooting from these shoots was obtained within 10 days of inoculation on MS medium fortified with NAA (1.0mg/l). A combination of BAP (2.0mg/l) + NAA (0.5mg/l) proved to be the best auxin-cytokinin combination in which explants exhibited best morphogenetic potential in terms of development of shoots along with roots within 8-10 days of inoculation. The maximum frequency of root differentiation (8.2) roots was achieved on MS basal medium supplemented with NAA (1.0mg/l) after 10 days of inoculations in 80% cultures. The complete plantlets were produced which showed enhanced growth after transferring in the same media composition

Role of Oxidative Stress in various stages of Psoriasis

Background: Psoriasis is a chronic inflammatory, immune mediated, provocative and challenging skin condition. It is a non-contagious but debilitating disease and a leading cause of socioeconomic burden on the health system. Objective: To evaluate the role of antioxidant levels, lipid peroxidation status and lipid profile in the etiology and degree of severity of psoriatic illness among psoriasis patients presenting in Dermatology department. Study Design: This study was carried out as a retrospective case control study. Place and duration of Study: It was carried out by the Department of Biochemistry, Basic Medical Sciences Institute (BMSI) in collaboration with Departmnt of Biochemistry, Khyber Medical College, Peshawar and Department of Skin and Venereal disease, Jinnah Post Graduate Medical Centre (JPMC) Karachi. Material and Methods: One hundred and twenty cases (n=130) of already diagnosed psoriasis patients were randommely and fifty healthy matched controls (n=50) of the same age and gender were included from the general population for comparison. Lipid profile including serum total cholesterol, TG, HDL-c and LDL-c levels were measured by enzyme colorimetric analysis on Micro Lab 300 (Merck & Germany). Antioxidant status SOD and lipid peroxidation status MDA were measured by ELISA technique. Statistical analysis was performed using SPSS software Version 16. In this analysis, a “p” value of less than 0.05 was considered to be significant. Results: The study showed significantly elevated levels of MDA, serum TG, total cholesterol and LDL-c levels in psoriatic patients in comparison with controls, whereas SOD levels and HDL-c levels were found to be significantly lower in psoriatic patients as compared to normal healthy matched controls. Conclusion: The findings of this study support the hypothesis that an imbalance in oxidant-antioxidant system may play a role in the etiology of psoriasis and the degree of severity of its presentation. The study also concluded that dyslipidemia was an observed risk factor for the development of cardiovascular diseases in psoriatic patients.

An Analytical Study to Explore Iron Stores in a Population of Nowshera Based on Age and Gender Perspective

OBJECTIVES:  To analyze the impact of age and gender on iron stores in a population of the Nowshera region. METHODOLOGY: This cross sectional study was conducted in the Department of Pathology Qazi Hussain Ahmed Medical Complex Nowshera from 1st January 2019 to 31st March 2020. All patients were selected by convenience sampling in the Pathology department irrespective of age and gender.   Both descriptive and inferential statistics were applied to analyze data by the latest SPSS version 25.  RESULTS: Out of the total study population males were 70 (27.1%) and females 188 (77.9%) with median age 30 years.  The median ferritin level was 12.8 ng/ml. Out of total, 142 (55%) of cases were with serum ferritin less than 15ng/ml. A significant (p=0.03) gender based median ferritin level difference was observed with 1.5 times more probability of low iron stores in females as compared to males (OR=1.5). No statistically significant difference in body iron stores exists in different age groups. CONCLUSION:  A significant difference was noted in the iron stores in gender groups and the probability of depleted/low iron stores was higher in female gender as compared to male gender in all age groups in our population.  

On Morphology and Morphometry of Trichuris ovis Abildgaard, 1795 Recovered from Ruminants of Ladakh, India

Abstract: Morphology and morphometry is used as tools for parasite identification since times immemorial, however this trend has been no longer used since the last decades and the identification became dependent on molecular characterization. However, this is possible in developed Countries while as the developing and underdeveloped Countries, like India, still largely depend on the traditional techniques. In this investigation an attempt was made to study the morphology and morphometry of adult Trichuris ovis recovered from caecum of the ruminants in Ladakh in order to access the effect of the study area, host, intensity, age, sex of the host and methodology on morphology of the parasite. It has been found that all these factors pose a little effect on the parasite identification were of minor importance because they were found within the range of similarity and were not good enough to label it as a new species as was expected. However, some descriptive features might be helpful in the parasite identification

Larsen syndrome

Larsen syndrome is a rare inherited disorder characterized by congenital dislocation of multiple joints along with other anomalies of heart, face, hands and bones. Larsen syndrome was first described in 1950 by Larsen, Schottstaedt and Bost. In the present report, we describe a 10 year old girl who presented with mid facial hypoplasia with depressed nasal bridge, high arched palate, bilateral talipes equinovarus and high arched feet. On examination, she had short stature (HAZ -3.5 SD) with hyperextension of knee joint, fixed flexion of elbow joint. Awareness of this condition and associated complications may help in management and follow up of these patients.

Level of conus medullaris termination in adult Kashmiri population: a magnet resonance imaging-based study

Background: The spinal cord is considered as the principle content of vertebral canal. It begins as a downward extension of medulla oblongata at the level of upper border of first cervical vertebrae (C1). The terminal part of spinal cord is conical and is termed as conus medullaris. In adults the level of termination of conus medullaris varies between T12 to L3 vertebrae. The level of termination of conus medullaris is clinically important to avoid injuries during spinal anaesthesia and lumber puncture. Methods: The saggital magnetic resonance images of 168 patients were reviewed in the Department of Radiodiagnosis, Government Medical College, Srinagar from January 2022 to June 2022. The most caudal point of the cord was considered as the tip of conus medullaris. A line was drawn through the tip perpendicular to the long axis of spinal cord to determine its location with adjacent vertebra. Results: The level of conus medullaris termination was most commonly located at T12-L1 intervertebral disc level. The results revealed a significant statistical difference in levels of termination of conus medullaris with respect to age and sex. Conclusions: In literature, the highest level of conus medullaris termination is stated to be at T11-T12 Intervertebral disc and the lowest level at the body of L3 vertebra. Therefore, spinal anaesthesia and lumber puncture procedure should be done below L3 vertebral body in order to avoid iatrogenic complications

Effect of L-type calcium channel blocker (amlodipine) on myocardial iron deposition in patients with thalassaemia with moderate-to-severe myocardial iron deposition: protocol for a randomised, controlled trial

Introduction: Sideroblastic cardiomyopathy secondary to repeated blood transfusions is a feared complication in thalassaemia. Control of myocardial iron is thus becoming the cornerstone of thalassaemia management. Recent evidence suggests a role for L-type Ca2+ channels in mediating iron uptake by the heart. Blocking the cellular iron uptake through these channels may add to the benefit of therapy to standard chelation in reducing myocardial iron. We aim to determine the efficacy of amlodipine (a calcium channel blocker) as an adjunct to standard aggressive chelation in retarding myocardial iron deposition in thalassaemics with or without cardiomyopathy.Outcomes: The primary outcome is to compare the efficacy of amlodipine+chelation (intervention) versus standard chelation (control) in retarding myocardial iron deposition. Secondary outcomes include the effect of amlodipine therapy on systolic and diastolic function, strain and strain rate and liver iron content.Methods and analysis: This is a single-centre, parallel-group, prospective randomised control trial. Twenty patients will be randomised in a 1:1 allocation ratio into the intervention and control arms. In addition to conventional echocardiography, MRI T2* values for assessment of cardiac and liver iron load will be obtained at baseline and at 6 and 12 months. Cardiac T2* will be reported as the geometric mean and per cent coefficient of variation, and an increase in cardiac T2* values from baseline will be used as an end point to compare the efficacy of therapy. A p Value of Study setting: Department of Pediatric and Child Health, Aga Khan University Hospital, Karachi, Pakistan.Ethics and dissemination: This study has been approved by the Ethics Review Committee and Clinical Trials Unit at The Aga Khan University with respect to scientific content and compliance with applicable research and human subjects regulations. Findings will be reported through scientific publications and research conferences and project summary papers for participants

Efficacy of hypertonic saline versus isotonic saline among children with cystic fibrosis: A systematic review and meta-analysis

Background: Inhaled hypertonic saline (HS) reduces pulmonary exacerbations in patients with cystic fibrosis (CF) aged 6 or more years. However, the effectiveness of HS in improving clinical outcomes in younger children aged 6 or less years is not established. This study examines the efficacy of HS in younger CF patients. Methods: Searches were conducted across three databases (Medline, Cochrane Central and EMBASE) from inception through July 2022. Randomized controlled trials assessing the impact of HS in younger CF patients were included. Trials involving only patients greater than 6 years or control group other than isotonic saline (IS) were excluded. Outcomes measured included lung clearance index (LCI), cystic fibrosis questionnaire (CFQ-R) score, spirometry measures, oxygen saturation, respiratory rate, height and weight. Outcomes were reported as mean differences (MDs) with 95% confidence intervals. Results: Seven studies (n = 390 patients) were included in this review. HS significantly reduced the LCI (MD: -0.67; 95%CI, -1.05 to 0.29, P = 0.0006) compared to IS. In addition, HS was associated with significant improvements in height (MD: 2.23; 95%CI, -0.00 to 4.46, P = 0.05) and CFQ-R (MD: 4.30; 95%CI, 0.65–7.95, P = 0.02), but not in oxygen saturation (MD: -0.15; 95%CI, -0.54 to 0.25, P = 0.47), respiratory rate (MD: -0.21; 95%CI, -2.19 to 1.77, P = 0.83) or weight (MD: 0.70; 95%CI, -0.47 to 1.87, P = 0.24). Furthermore, HS did not significantly improve spirometry measures, including FEV1 (MD: -0.11; 95%CI, -0.21 to 0.43, P = 0.51) and forced vital capacity (MD: 0.27; 95%CI, -0.49 to 1.04, P = 0.48), but significantly improved FEF25-75 (MD: 0.12; 95% CI, 0.05–0.20; P = 0.002). Discussion: Treatment with HS in younger children with CF improves lung clearance, symptoms and quality of life. FEF25-75 may prove a more sensitive measure for assessing intervention related improvements in pediatric CF trials. Conclusion: The findings support HS as a therapeutic method in CF-affected children