Frequency of Hypertension in Ischemic and Hemorrhagic Strokes: A Cross-sectional Study at a Tertiary Care Hospital of Multan, South-Punjab Pakistan

Background: Stroke is a global health problem. Stroke is responsible for major disabilities in adult population, and is 2nd leading cause of deaths all over the world. Estimated 15 million people all over the world become victim of stroke every year all over the world, of which 5 million die and other 5 million are left permanently disabled and thus major burden on the sufferer and families as well. Different studies have reported hypertension as major cause of stroke in different populations. Objective: To determine the frequency of hypertension among ischemic stroke and hemorrhagic stroke at a tertiary care hospital. Subjects and Methods: Our study included 246 stroke patients which were recruited from Department of Medicine Nishtar Medical University Hospital Multan. Specific history concerning hypertension was inquired from all patients. Blood pressure of all the patients was measured. Blood pressure levels were measured by researcher using random-zero sphygmomanometers with the subject seated quietly. Two readings of blood pressure were taken and average   of the two readings was noted in the proforma. ECG of all the patients was done and checked for the fulfillness of criteria of left ventricular hypertrophy i.e. Sokolow-Lyon Index, Cornell Voltage Criteria. Results: Our  study included 246 stroke patients, 160 (65%) were male patients and 86 (35%) were female patients. Mean age of our study cases was 59.63 + 11.24 years. Ischemic stroke was observed in 133 (54.1%) of our study cases, while hemorrhagic stroke was noted in 113 (45.9%) of our study cases and 13 (5.3%) had previous history of stroke as well. Smoking was observed in 110 (44.7%) of our study cases and all the smokers were male patients. Alcohol consumption and family history of stroke was zero in our study cases. Of these  246  stroke patients, 148 (60.2%) were known hypertensive and all of them were taking anti-hypertensive medication. Frequency of hypertension in our study was 168 (68.3%) at presentation. Conclusion: Higher frequencies of modifiable risk factors was seen with Hypertension was the leading risk factor of stroke in our study. These findings point towards well directed efforts regarding conventional interventions in our population. Hemorrhagic stroke was significantly associated with elevated blood pressure. Hypertension was significantly associated with increasing age, diabetes, previous history of stroke, hemorrhagic stroke and smoking in stroke patients. Keywords: Stroke, Hypertension, Ischemic, hemorrhagic

Macrocycles: Recent Advances in Synthesis, Reactivity, and Medicinal Chemistry

Introduction: A cyclic compound is common motif in natural product structures. Cyclic peptides, a vast subset of natural products, display a wide variety of biological activities. Owing to their size, cyclic peptides are particularly attractive scaffolds for interrogating challenging biomolecular interactions, such as those at protein–protein interfaces. Methods and Results: This review takes an overview of the literature for the synthesis of peptide and non-peptide macrocycles, concentrating on advances in the last five years up to the end of 2017. These methods are clustered by strategies for preparation and further derivatization of preformed macrocycle-containing building blocks. Examples of the use of macrocycles in medicinal chemistry are reported, including a collation of macrocycle derivatives appearing in recent patents for medicinal chemistry applications. Conclusions: This review aims to provide an overview of the extensive recent studies involving macrocycles in synthesis and medicinal chemistry and to highlight the continuing challenges

Effect of Social Support on Health Related Quality of Life in Pregnant Women- A Cross-sectional Study at a Tertiary Care Hospital Multan, South-Punjab Pakistan

Objective: To explore the relationship between social support and health-related quality of life among pregnant women. Method: This cross-sectional study was conducted at Nishtar Medical University Hospital Multan, Pakistan. The duration of study was from January to March2017. Pregnant women presenting to our hospital were approached for data collection. The chronological age range of the sample was 15-35 years and ages of pregnancy in months were included. Social support of pregnant women was measured through multidimensional scale of perceived social support and health-related quality of life was measured through medical outcomes study questionnaire. Results: Of the 120 participants, 66(55%) were from rural areas, and 54(45%) from the urban areas. Subjects who were in their first trimester of pregnancy were 72(60%), while 25(20.8%) were in their second trimester and 23 (19.2%) in the third. Of the total, 80(66.66%) were educated women and 40 (33.34%) were illiterate. Subjects with a history of physical illness were 76 (63.30%) while 60 (50%) suffered from psychological illness too. There was a significantly positive relationship between social support and health-related quality of life among the pregnant subjects (p<0.05). Conclusion: More social support can increase the health-related quality of life of pregnant women. Keywords: Social support, Health related quality of life, pregnant women

New secure and low-cost design for defense in depth implementation using open source software

In this paper, we propose a new design with high-level security and low-cost implementation for different network topologies. Achieving both factors at the same time is a challenging work for network experts, especially when they want to apply defense in depth strategy in various components of their networks. Offered scenario has been done for one of the most visited web sites in an Iranian organization with more than 15,000 concurrent web users that all of them reliably and smoothly were served. Also, defense in depth strategy has been used to provide sufficient level of security in diverse components of the project. All applied security solutions in this project were based on open source [1] tools that results in saving a tangible cost by the prevention of purchasing commercial options. We will describe project big map, acquired results and all main components with their functions in this paper

Investigating Web impact factors of type 1, type 2 and type 3 medical universities in Iran

Investigation of the web impact factor and analysis of the web links belong to webometric studies. A high impact factor, accompanied by more frequent links to a particular website, can indicate greater influence and better accessibility of that particular site. In this regard, bearing in mind the significance of medical universities' web sites for education and research, the current study compared and analyzed their impact factors, their web links and web pages, using AltaVista search engine. The investigation included different ranks of medical universities, commonly referred to as type 1, type 2 and type 3 universities in Iran. The median was used as a measure of central tendency of the scores. The search engines of AltaVista were adopted on 26 February 2010 to collect the data. According to the results, in terms of indexed pages, Shahid Baheshti of type 1, Guilan of type 2, and Shahrekord of type 3 universities had the best records. Regarding web links, medical universities of Iran, Kermanshah and Lorestan, from type 1, type 2 and type 3 universities had the best records and, in terms of impact factor, universities of Ahvaz (type 1), Zahedan (type 2), and Fessa (type 3) manifested the greatest influence. As the results imply, the universities are expected to pay more attention to webometric issues; they are also recommended to allocate more budget to enhance their web pages

Sulfonated organic heteropolyacid salts as a highly efficient and green solid catalysts for the synthesis of 1,8-dioxo-decahydroacridine derivatives in water

AbstractIn the present study, we introduce two nonconventional ionic liquids [MIMPS]3PW12O40 (a) and [TEAPS]3PW12O40 (b) as green and highly efficient solid acid catalysts for the synthesis of 1,8-dioxo-decahydroacridine derivatives. The one-pot three component reaction of 1,3-cyclohexanediones, aromatic aldehydes and aromatic amines or ammonium acetate in water afforded the corresponding 1,8-dioxo-decahydroacridines in excellent yields. This reaction has been carried out in the presence of 1mol% of catalysts at room temperature. The reusability of the catalysts was demonstrated by a five-run test. Additionally, the catalysts pose several advantages including mild reaction conditions, cleaner reactions and shorter reaction times

Leaving against medical advice from In-patients departments rate, reasons and predicting risk factors for re-visiting hospital retrospective cohort from a tertiary care hospital

Background: Approximately 1% to 2% of hospitalized patients get discharged or leave from the hospital against medical advice and up to 26% in some centers. They have higher readmission rate and risk of complications than patients who receive complete care. In this study we aimed to determine the rate of leave against medical advice (LAMA) and reasons for the same across different in-patient departments of a tertiary care hospital. Methods: Retrospective cohort study on patients admitted in all departments at our institute over a 1-year period. All patients who were admitted to an in-patient ward at the hospital and who left against medical advice by submitting a duly filled LAMA form were included. Univariate and multivariate logistic regression models with forward selection methods were employed. Revisit to hospital within 30 days; to clinic or emergency department was outcome variable for regression. Results: From June 2015 to May 2016 there were 429 LAMA patients, accounting for 0.7% of total admissions. Females were 223 (52%) compared to males 206 (48%). Finances were quoted as the most common reason for LAMA by 174 (41%) patients followed by domestic problems 78 (18%). Internal medicine was the service with the highest number of LAMA patients ie, 153 (36%) followed by Pediatric medicine with 73 (17%). Of the 429 patients, 147 (34%) patients revisited the hospital within 30 days. Sixty-one percent of these \u27bounced-back\u27 LAMA patients had worsening or persistence of same problem, or new problem/s had developed. In unadjusted bivariate logistic model, patients who were advised for follow-up during discharge against medical advice were four times more likely to revisit the hospital. Patients who were married had an increased odd of revisiting the hospital. Conclusion: Financial reasons are the most common stated reasons to LAMA. Patients who LAMA are at a high risk of clinical worsening and \u27bouncing back.\u27 This is the first study from our region on in-patient LAMA rates, to our knowledge. The results can be used for planning measures to reduce LAMA rates and its consequences

Phospholipase A2 activity of the Persian Gulf upside-down jellyfish venom (Cassiopea andromeda)

Background: The venomous jellyfish Cassiopea andromeda can produce envenomation and different toxicological and biological effects by their nematocysts. The phospholipase A2 enzymes (PLA2) are toxic and induce various pharmacological effects including neurotoxicity, myotoxicity, and anticoagulant activities. The main aim of the current project was to screen the in vitro PLA2 activity of the C. andromeda crude venom. To better understand the experimental result; a molecular docking study was also performed. Materials and methods: The live specimens were collected from Nayband lagoon, by a trawl net, and separation of their tentacles was done according to Bloom 's et al., method. The PLA2 activity of crude venom was performed according to the acidimetric method of Tan and Tan. The lyophilized venom was subjected to Gas Chromatography/ Mass Spectroscopy, and the obtained structures were used for docking study against PLA2. The indoxam was considered as standard control. Results: The PLA2 activity of the jellyfish crude venom was 413 ±0.08 µmol/min/mg. Analysis of the crude venom detected seven compounds (i-vii) using GC-MS. Docking data was also confirmed the experimental results. According to the docking results, the highest affinity [-6.7 (kcal/mol)] was observed in the compound “Pregn-5-ene-3,11-dione, 17,20:20,21 bis [methylenebis(oxy)]-, cyclic 3-(1,2-ethane diyl acetal”. Conclusions: A high PLA2 level was found in the venom of C. andromeda. There was a good correlation between in vitro and in silico studies