One-Year Review Of Reduced Fetal Movements In Izzat Ali Shah MCH Center: A Predictor Of Poor Perinatal Outcome

Objectives: To find out common causes of reduced fetal movements. The purpose is to reduce perinatal morbidity and mortality. Methodology: This Prospective, Observational study was conducted at Izzat Ali Shah Maternal and child health center, unit III Gynae, Wah medical college Wah Cantt, from January 2019 to December 2019. A total of participants 160, who presented in the antenatal outpatient or emergency department with reduced fetal movements, were included in the study. Patients in the active phase of labor were excluded from the study. Patients were followed up till delivery. All necessary information, investigations, and examination points were noted on the predesigned proforma. Data were analyzed by using SPSS version 22. Results: Out of a total of 160 patients, 144 had alive and stable babies. Regarding the age group, out of 160, six patients were teenagers (3.75%), 98 (61.25%) were between 20-30 years, and 55(34.3%) were in the age group of 30-40 years. Regarding gestational age at presentation, 27 out of 160(16.8%) were between 30-35 weeks, 133(83.12%) was at 36-40 weeks. None of the patients presented below 30 weeks. Concerning the number of pregnancy, primigravida 82(51.25%), 60(37.5%) were multigravida, and 18 (11.25%) was grand multipara. Regarding medical history, anemia was seen in 31 patients (19.37%), pregnancy-induced hypertension in 20(12.5%), and 65 %( 104) has no significant medical history. Concerning past obstetrical history, 107(66.8%) fell under low-risk pregnancies, 18(11.25%) had previously normal deliveries but 08(05%) patients had H/O still births. Regarding placental position, 71(44.37%) had anterior, 71(44.37%) had posterior, and 18 (11.25) had fundal placenta. Regarding UAD, 136(85%) had normal umbilical artery Doppler, 13(8.12%) had altered, 06(3.75%) were Absent and 05 (3.12%) has reversed end diastolic flow. During study, 78(48.7%) had normal AFI, 69(43.12%) has Oligohydramnios, 10(6.25%) anhydramnios, while only 03(1.87%) had polyhydramnios.  Regarding birth weight, 122(76.25%) had average weight, 32(20%) were low birth weight and 05(3.12%) were very low birth weight. 61(38.12%) went into NICU, while 99(61.8%) no admission required. Conclusion: Most common risk factor or cause of reduced fetal movements was reduced liquor, (79). Out of which 69 remained alive and stable after birth, while 15 had early neonatal deaths. The second cause found was abnormal umbilical artery Doppler,(24). Out of which, 14 had early neonatal deaths and intrauterine deaths. This study showed the increased obligation of care required by patients with decreased fetal movement. Although the number of live births is more as compared to demise, it results in increased neonatal unit admission rates, higher induction and cesarean section rates, higher surveillance demands, and an increased financial burden on parents. It signifies the need for more vigilance in this area of practice. But we can’t neglect the perception of a mother. Mother’s feelings are more important than any other test

Thyroid hormone dependent gene expression

The presented work is destined to review the advances that had been made to study the role of thyroid hormone and thyroid hormone nuclear receptors in regulating the gene expression. Triiodothyronine (T3) and tetraiodothyronine (thyroxine or T4) are most important thyroid hormones. The thyroid hormones bind to their specific nuclear hormone receptors, as ligand, and play important role in gene expression and transcriptional gene regulation in human and higher animals. Thyroid hormone receptors form heterodimers by making combination with retinoid X receptors. The capability of heterodimerization of thyroid hormones generates novel complexes which allow altered specificity and higher affinity for DNA-receptor binding. Thyroid hormone receptors work as ligand activated transcription factor and play with transcriptional gene expression process. The consensus structural features of thyroid hormone receptors are N-terminal regulatory domain that contains activation function, the domain for strong gene expression and the domain for binding to DNA. The structures for individual domains have been extensively and reviewed through several latest and successful techniques.

Association Between Malnutr ition & Colostrum For Severe Pneumonia

Background: Pneumonia remains one of the main causes of childhood mortality despite the availability of simple, safe, effective and inexpensive interventions to curb its mortality. This could result from sub-optimal care seeking practices and child rearing, supplemented by lack of access to healthcare.We conducted a studyto identify the association of malnutrition and initiation of breastfeeding variables with severe pneumonia and pneumonia/no pneumonia Objective: To determine association of malnutrition and colostrums intake among children aged 2-24 months admitted in tertiary care hospital for severe pneumonia. Methods: A total of 288 patients with severe pneumonia were included in this case-control study. Patients were divided into 2 groups with 144 patients in each group selected through non-probability consecutive sampling. Sample size was calculated using WHO sample size calculator keeping power of test at 80%, P1= 1% and P2=7.8%. Data was analyzed through SPSS version 19 and p-value < 0.05 considered as significant. Association between study variables and severe pneumonia was computed using Chi Square Test. Results: Mean age for group A (67 males and 77 females) was 13.00±6.40 months and group B (78 males, 66 females) 12.83±6.90 months. Malnutrition was seen in 41% of group A and 17.4% of group B patients. Colostrum intake (Initiation of breast feeding with 72 hours) was reported in 78.5% of group A and 79.2% of group B. There was a significant association of malnutrition with severe pneumonia (p=0.000) whereas, no significant relation was found with colostrum intake (p=0.885). Conclusion: Malnutrition was significantly associated with severe pneumonia. Colostrum was the most prevalent factor in both groups but the difference was insignificant

THE ROLE OF PAROXETINE IN POSTMENOPAUSAL HOT-FLASHES FREQUENCY REDUCTION

Background: To evaluate the effects and safety profile of Paroxetine on hot - flashes in post - menopausal women. Methods: It was prospective open label control clinical trial. This study is conducted in the Department of pharmacology & Therapeutics in collaboration with the Department of Obstetrics & Gynecology JPMC. The patients were selected from outpatients department (OPD) of Obstetrics & Gynecology. Duration of the study was 12 month from January 2014 to January 2015. Enrolling 180 outpatients who had menopause with hot flushes divided into three groups. The Greene Climacteric Score Scaling was applied to observe the effects of 12.5mg, 20mg Paroxetine on frequency of hot flashes as compared to Placebo. Results: Mean GCS scoring frequency in 12.5mg Paroxetine group at 12 week was 1.97±0.31 and the baseline 2.64±0.29. In 20mg Paroxetine mean GCS at baseline was 2.76±0.23 and 12 week 2.04±0.12. Where as in Placebo mean GCS scoring frequency at 12 week was 2.80±0.24 and at baseline 2.76±0.24. Conclusion: The frequency of hot flashes with Paroxetine 20mg and 12.5mg, is significantly reduced in post menopauseal women as compared to Placebo

EVALUATION OF ANTIOXIDANT AND ANTIMICROBIAL POTENTIAL OF TWO ENDANGERED PLANT SPECIES ATROPA BELLADONNA AND MATRICARIA CHAMOMILLA

Background: Plants are the natural source of antioxidants as well as antimicrobial compounds that has great potentials in pharmaceutical industry. In the present study, two medicinal plants Atropa belladonna and Matricaria chamomilla were collected from Northern areas of Pakistan. Materials and Methods: The extracts of the collected plants were obtained by microwave assisted extraction (MAE) with changing parameters, power level and time; methanol and ethanol were solvents used during extraction. The extracts of plants were tested against different bacterial strains. Results: It was observed that ethanolic extracts of Atropa belladonna has more significant antimicrobial activity against S.aureus than E.coli. In parallel, methanolic extract of Matricaria chamomilla showed greater significant antibacterial activity against S.aureus when compared with E.coli. In comparison, ethanolic extracts of Matricaria chamomilla has shown more significant results against S. aureus than E.coli (p≤0.05). Both plants had no antibacterial activity against S.typhi. The free radical scavenging activity observed by DPPH assay, indicate that both plants have antioxidant activity at all levels of concentrations in solvent tested during the present work. However, methanolic extracts had greater antioxidant activity when compared with ethanolic extracts. Conclusion: Present study is thus helpful in highlighting present potentials for antioxidant and antimicrobial properties in the selected plants

Cytoplasmic DNAs: Sources, sensing, and roles in the development of lung inflammatory diseases and cancer

Cytoplasmic DNA is emerging as a pivotal contributor to the pathogenesis of inflammatory diseases and cancer, such as COVID-19 and lung carcinoma. However, the complexity of various cytoplasmic DNA-related pathways and their crosstalk remains challenging to distinguish their specific roles in many distinct inflammatory diseases, especially for the underlying mechanisms. Here, we reviewed the latest findings on cytoplasmic DNA and its signaling pathways in inflammatory lung conditions and lung cancer progression. We found that sustained activation of cytoplasmic DNA sensing pathways contributes to the development of common lung diseases, which may result from external factors or mutations of key genes in the organism. We further discussed the interplays between cytoplasmic DNA and anti-inflammatory or anti-tumor effects for potential immunotherapy. In sum, this review aids in understanding the roles of cytoplasmic DNAs and exploring more therapeutic strategies

PREVLANCE AND PRESCRIBING TRENDS OF ANTI-DIABETIC DRUGS IN TYPE 2 DIABETES MELLITUS ACCORDING TO STANDARD TREATMENT GUIDELINES IN DIFFERENT HOSPITALS OF LAHORE

The objective of study was to identify the prevalence and prescribing trends of anti-diabetic drugs in type 2 diabetes mellitus according to standard treatment guidelines in different hospitals of Lahore. In this retrospective observational study, data was collected from prescriptions of ambulatory diabetic patients by different physicians practicing in different public sector hospitals of Lahore, from February 2016 to April 2016. For this purpose 100 prescriptions were evaluated from various hospitals of Lahore, Pakistan. Type 2 Diabetes Mellitus is more prevalent in 40-50years age group. Mono oral therapy which includes Metformin is more prescribed by physician as compared to any other groups of drugs. According to our study, standard guidelines were followed for biguanides which is first line therapy type 2 diabetes mellitus.&nbsp

3D Chromatin Architecture, BRD4, and Mediator Have Distinct Roles in Regulating Genome-Wide Transcriptional Bursting and Gene Network

Discontinuous transcription is evolutionarily conserved and a fundamental feature of gene regulation; yet, the exact mechanisms underlying transcriptional bursting are unresolved. Analyses of bursting transcriptome-wide have focused on the role of cis-regulatory elements, but other factors that regulate this process remain elusive. We applied mathematical modeling to single-cell RNA sequencing data to infer bursting dynamics transcriptome-wide under multiple conditions to identify possible molecular mechanisms. We found that Mediator complex subunit 26 (MED26) primarily regulates frequency, MYC regulates burst size, while cohesin and Bromodomain-containing protein 4 (BRD4) can modulate both. Despite comparable effects on RNA levels among these perturbations, acute depletion of MED26 had the most profound impact on the entire gene regulatory network, acting downstream of chromatin spatial architecture and without affecting TATA box-binding protein (TBP) recruitment. These results indicate that later steps in the initiation of transcriptional bursts are primary nodes for integrating gene networks in single cells

Addressing TB Multimorbidity in Policy and Practice: An Exploratory Survey of TB Providers in 27 High-TB Burden Countries

In people with TB, co-existence of long-term conditions (e.g., depression, diabetes and HIV) and risk factors (e.g.,alcohol misuse, malnutrition, and smoking) are associated with increased mortality and poor treatment outcomes including delayed recovery, TB treatment failure and relapse. However, it is unclear as to what extent these comorbidities are addressed in TB policy and practice. Between August and October 2021, we conducted an online cross-sectional survey in high-TB burden countries. We recruited a purposive sample of TB health workers, managers, policy makers, advisors and advocates from these countries. The survey enquired about the extent to which various comorbid conditions are: (a) mentioned in TB policies, plans, and guidelines; (b) screened, diagnosed, treated or referred to specialist services by TB healthcare workers. We summarised using descriptive analysis. Of the 1100 potential respondents contacted in 33 countries, 543 responded but only 446 (41%) from 27 countries provided sufficient data for inclusion in the study. We found no notable differences between these providing insufficient data and those completing the survey. HIV, diabetes mellitus, depression and tobacco and alcohol use disorders were identified as the most common and concerning comorbid conditions in TB. HIV was screened for and managed by TB services in most countries. Screening for diabetes and/or tobacco and alcohol use disorders was offered by almost half of all TB services but only a few offered relevant treatments. Depression was rarely screened for, almost never treated, and only infrequently referred to specialist services. Most respondents felt confident in screening/diagnosing these comorbid conditions but not in treating these conditions. With the exception of HIV, chronic comorbid conditions are only partially screened for and rarely managed within TB services. Mental health conditions are for the most part neglected. Given their adverse impact on TB outcomes, integrating screening and management of these comorbidities within TB programmes offers a significant opportunity to meet TB targets, address non-communicable diseases and improve patient well-being

Integrating depression care within NCD provision in Bangladesh and Pakistan : a qualitative study

Background Co-morbidity of depression with other non-communicable diseases (NCDs) worsens clinical outcomes for both conditions. Low- and middle-income countries need to strengthen mechanisms for detection and management of co-morbid depression within NCDs. The Behavioural Activation for Comorbid Depression in Non-communicable Disease (BEACON) study explored the acceptability and feasibility of integrating a brief depression intervention (behavioural activation, BA) into NCD services in healthcare facilities in Bangladesh and Pakistan. Methods Face-to-face qualitative interviews were conducted with 43 patients and 18 health workers attending or working in NCD centres in four healthcare facilities in Bangladesh and Pakistan, and with three policy makers in each country. The interviews addressed four research questions (1) how NCD care is delivered, (2) how NCD patients experience distress, (3) how depression care is integrated within NCD provision, and (4) the challenges and opportunities for integrating a brief depression intervention into usual NCD care. The data were analysed using framework analysis, organised by capability, opportunity and motivation factors, cross-synthesised across countries and participant groups. Results Patients and health workers described NCD centres as crowded and time pressured, with waiting times as long as five hours, and consultation times as short as five minutes; resulting in some patient frustration. They did not perceive direct links between their distress and their NCD conditions, instead describing worries about family and finance including affordability of NCD services. Health worker and policy maker accounts suggested these NCD centres lacked preparedness for treating depression in the absence of specific guidelines, standard screening tools, recording systems or training. Barriers and drivers to integrating a brief depression intervention reflected capability, opportunity and motivation factors for all participant groups. While generally valuing the purpose, significant challenges included the busy hospital environment, skill deficits and different conceptions of depression. Conclusions Given current resource constraints and priorities, integrating a brief psychological intervention at these NCD centres appears premature. An opportune first step calls for responding to patients’ expressed concerns on service gaps in provisioning steady and affordable NCD care. Acknowledging differences of conceptions of depression and strengthening psychologically informed NCD care will in turn be required before the introduction of a specific psychological intervention such as BA