Perforated appendicitis: accuracy of ct diagnosis and correlation of ct findings with the length of hospital stay

Objective: To determine the sensitivity and specificity of CT findings in the differentiation of perforated from nonperforated appendicitis and correlate CT diagnosis with the length of hospital stay.STUDY Design: An analytical study.PLACE AND DURATION OF STUDY: This study was conducted at Radiology Department of Aga Khan University Hospital, Karachi, from January 2004 to June 2005.PATIENTS AND Methods: The study included 70 patients who presented with right lower quadrant abdominal pain and underwent pre-operative CT scan followed by appendectomy. Patients were divided into two groups of having perforated and nonperforated appendicitis on the basis of CT scan findings. The surgical and pathological reports combined were considered the reference standard for the diagnosis of perforated appendicitis. Various CT scan findings and average duration of hospital stay in days was compared by t-test.Results: Twenty-six (37%) of 70 patients had perforated appendicitis. It was correctly identified on pre-operative CT scan in 18 patients. There were 18 true positive diagnoses, 43 true negative diagnoses, 1 false positive diagnosis and 8 false negative diagnoses which yielded a sensitivity of 69%, specificity of 97%, positive predictive value of 94% and negative predictive value of 84%. Mean length of hospital stay in perforated group was 6.3 days and 2.9 days in nonperforated group. Severe periappendiceal inflammation, periappendiceal and or abdominopelvic fluid and abscess were significantly associated with perforated appendicitis and with a significant longer hospital stay (p \u3c .001).CONCLUSION: CT scan is 69% sensitive and 97% specific for the diagnosis of perforated appendicitis and constellation of CT findings can be used to select patients with perforated appendicitis for initial non-operative management. Presence of CT signs of significant appendiceal inflammation is independent predictor of longer hospital stay

Synthesis, single crystal X-ray diffraction, Hirshfeld surface and biological activity of quinolone derivatives

Two new quinolone derivatives, 5-nitroquinolin-8-yl-3-bromobenzoate (1) and 5-nitroquinolin-8-yl-3-chlorobenzoate (2), were synthesized and their structures were elucidated using X-ray diffraction techniques. Both compounds crystallized in P21/n (monoclinic) space group having four independent molecules in asymmetric unit. The dihedral angle between benzene and planner quinoline rings in compounds 1 and 2 were found to be 117.7(2) and 117.4(2)ᵒ, respectively. No intermolecular hydrogen bonding was observed in compound 1. However, C-H···O intermolecular interaction was found to connect the molecules in crystal lattice of compound 2. Hirshfeld surfaces analysis was performed to evaluate the directions, and strength of interactions of molecules of compounds and 1 and 2 with neighbouring molecules, and the major contribution in the crystal packing was due to O-H (1, 24.6% and 2, 25.1%) interactions. The synthesized quinoline derivatives were found as potent anti-bacterial agents against E. coli reference (ATCC25922 and ATCC 35218) and multi-drug resistant strains (M2 and M3) with 91.42 to 94.72% inhibition. Both compounds 1 and 2 showed weak antileishmanial activity against L. Major promastigotes in vitro with IC50 values 73.2±3.1 and 72.2±2.3 mg/mL, respectively, and also found as cytotoxic in nature against 3T3 fibroblast cell line

Association of Beta-2 Adrenoreceptor Single Nucleotide Polymorphism with Risk of Type II Diabetes Mellitus

Objective: To determine the genotype of Arg16Gly & Gln27Glu polymorphism in type-2 diabetes mellitus and to find possible association of ADRβ2with type-2 diabetes mellitus. Methodology: A case control study was designed and a total of 192 subjects (98 in each group) were included. After formal approval, subjects were recruited from North West General Hospital (NWGH) Peshawar. After taking consent blood samples were collected from the participants and DNA analysis was done using commercially available kits by salting out protocols, while other biochemical parameters were analyzed using normal laboratory protocols for respective tests. Results: The comparative analysis of SNP rs1042713 indicates that allele G/A was 42(49.4%) in diabetic and 43(50.6%) in non-diabetic subjects. While GG was more frequent 22(59.5%) in diabetic as compare to non-diabetic 15(40.5%). Among AA allele, 19 (65.5%) were non-diabetic while 10(34.5%) were diabetic. However the difference was not statistically significant (p=0.22). In case of “rs1042714” gene the commonest allele was C/C 80 (41.7%) out of which, 47(58.8%) was found in diabetic and 33(41.2%) were non-diabetic. Similarly CG was second common allele out of which diabetics were 27(44.3%) while non-diabetics were 34(55.7%). Allele G/G was found only among 11 subjects (p=0.085). Conclusion: Based on the result of the present study, it is concluded that polymorphism in ADRB2 genes rs1042713 (Arg16Gly) and rs1042714 (Gln27Glu) is associated with susceptibility of T2DM through alteration in BMI & HbA1c

Role of Citrus Concentrate in Extraction and Evaluation of Herbal Polymer

Background: The use of natural polymers as excipients in the pharmaceutical sector is expanding day by day. Low cost, safety issues, availability, and biodegradability are the main causes that make them differ from other sources. Natural sources have a wide range of varieties and characteristics. So, they can be used numerous times in pharmaceutical products as excipients to serve the desired purposes.  Aim:  To extract and evaluate the natural polymeric substances that can be used as excipients in pharmaceuticals from fenugreek seeds by using solvent extraction method. Methods: Trigonella foenum-graceum fenugreek mucilage is drive from the endosperm of the seeds it consists of galactose and mannose of it gives high viscosity in aqueous solution the fenugreek seeds used for thickening, stabilizing and emulsifying food agent. In this procedure we use grapefruit juice to treat with extract mucilage from fenugreek seeds which enhance its stability and bioavailability. Grapefruit juice increases the bioavailability of some orally administered drugs that are metabolized by CYP3A4 and normally undergo extensive presystemic extraction. Results: In addition, grapefruit juice it can decrease the oral absorption of a few drugs that rely on organic anion transporting polypeptide in the gastrointestinal tract for their uptake. The number of drugs shown to interact with grapefruit juice in vitro is far greater than the number of clinically relevant grapefruit juice drug interactions

EFFECT OF ETHANOLIC EXTRACT OF GLYCYRIZZA GLABRA AGAINST STEREPTOZOTOCIN AND HIGH FAT DIET INDUCED DIABETES AND HYPERLIPIDEMIA

Objective: To study the effect of ethanolic extract of Glycyrrhiza glabra against streptozotocin and high-fat-diet-induced diabetes and hyperlipidemia.Methods: The present study was conducted on a 14 d model in which Glycyrrhiza glabra extract was given to Streptozotocin (STZ; 50 mg/kg; i. p.) induced diabetic rats fed with high fat diet (HFD), and its protective effect has been studied. The antihyperlipidemic and antihyperglycemic effects have been evaluated on the basis of physical, biochemical as well as histomorphological parameters.Results: The Glycyrrhiza glabra extract pre-treated group showed a significant decrease in biochemical parameters like Total cholesterol (TC), Triglyceride (TG), High-density lipoprotein (HDL), Lactate dehydrogenase(LDH), Alanine transaminase (ALT) compared with D-HFD group (p<0.01). The pre-treated groups also showed significant protection in physical parameters as compared to D-HFD group (p<0.01) which was also confirmed by histopathological studies. All these results were compared and found to be similar with two standard drugs metformin (500 mg/kg) and atorvastatin (10 mg/Kg).Conclusion: This study concluded that alcoholic extract of Glycyrrhiza glabra (500 mg/kg) has significant antidiabetic and antihyperlipidemic potential against streptozotocin and high-fat diet induced diabetic hyperlipidemic rats comparable to the clinically used drugs.Keywords: Atherosclerosis, Diabetic hyperlipidemia, Diabetes mellitus, Hyperlipidemia, Lipid profile, Streptozotoci

Effects of cardiopulmonary conditioning on body mass index, physical activity and general psychological health of young adults

Objective: To determine the effects of cardiopulmonary conditioning on bodymass index (BMI), physical activity (PA), and general psychological health ofhealthy young adults and their interrelationship. Methodology: A quasi-interventional study was conducted in Pakistan RailwayHospital, Rawalpindi from February to July 2017. A total of 97 healthy youngadults who sustained moderate physical exertion were selected through nonprobabilityconvenient sampling to perform cardiopulmonary conditioningexercises for 12 weeks at moderate intensity. Individuals with any systemicdisease were excluded. The pre and post levels of PA, general psychologicalhealth and BMI were assessed through International Physical ActivityQuestionnaire (IPAQ), General Health Questionnaire (GHQ-12) and BMI formularespectively and performed statistical analysis on SPSS 20 software.Results: We recruited 97 participants; mean age was 23.40 ± 2.29years.Majority, around 74% of the participants were females. The descriptive analysisshowed that 73.2 % participants were minimally active before the interventionthat improved to 0.0 % after the intervention. No participant was HEPA activebefore intervention that significantly improved to 38.1 %. In the pre-intervention,87.6 % participants were overweight and 12.4 % participants were obese whereas in post-intervention, 85.6 % participants had normal weight and 14.4 %participants were overweight. The Wilcoxon Signed Rank Test revealedsignificant improvement in all outcome measures (p= 0.001). The Spearman'sCorrelations of PA and general psychological health and PA and BMI wasdemonstrated as -0.262 (p=0.01) and -0.081 (p=0.431) respectively. Conclusion: Cardiopulmonary conditioning is an effective approach forimproving BMI, general psychological health and physical activity. With higherlevels of PA general psychological health improves unlike BMI that does not haveany significant relation with PA

α-Haloarylsulfonamides: Multiple Cyclization Pathways to Skeletally Diverse Benzofused Sultams

The development of new methods to skeletally diverse sultams based on a central α-halo benzene sulfonamide building block is reported. Several salient features of this building block are utilized in multiple reaction pathways, including the Heck reaction, C- and O-arylation, Sonogashira-Pauson-Khand, Sonogashira-intramolecular hydroamination, lithiative cyclization and domino aza-Michael Heck for the generation of 5-, 6- and 7-membered benzofused bicyclic and tricyclic sultams

What influences family planning in rural Pakistan: Franchised service provider and community health worker perspective

Background: Pakistan has a low modern contraceptive prevalence rate, 26%, leading family planning (FP) programmes to explore partnerships with local private providers to improve access to quality FP services. This study aims to understand the socio-cultural and organizational factors that influence delivery of quality family planning services. Methods: This qualitative study was conducted with private service providers and community health workers (CHW) in Marie Stopes Society\u27s (MSS) social franchise network. A total of 31 providers and 28 CHWs from Sindh, Punjab, and Khyber Pakhtunkhwa provinces of Pakistan were purposively selected for in-depth interviews. The study used thematic content analysis to understand providers\u27 and health workers\u27 perspectives of family planning service provision. Results: This study found that normative environment, propagation of myths and misconceptions, and health concerns remain major barriers to service provision in rural communities. Findings showed that CHWs were instrumental in increasing awareness and positive attitudes towards family planning in the catchment areas. Moreover, social franchising was effective in increasing access to high-quality, subsidised family planning services amongst economically marginalised and low-awareness communities. Providers and health workers expressed satisfaction with the franchising approach, and revealed that being part of this network substantially increased their client volume and ability to serve poorer segments of the population. Conclusion: The study found that franchising private service providers in rural areas enhances their ability to serve clients, and when coupled with demand-generation elements, such as vouchers and community health workers, it substantially increases their client volume. Albeit effective, the franchising approach currently lacks the element of long-term service provision at the current scale, and may require further strategizing by the franchisor. Moreover, alternate strategies should be explored to ensure continued provision of FP services without vouchers and CHWs

Synthesis and Evaluation of Anti-HIV Activity of Mono- and Di-Substituted Phosphonamidate Conjugates of Tenofovir

The activity of nucleoside and nucleotide analogs as antiviral agents requires phosphorylation by endogenous enzymes. Phosphate-substituted analogs have low bioavailability due to the presence of ionizable negatively-charged groups. To circumvent these limitations, several prodrug approaches have been proposed. Herein, we hypothesized that the conjugation or combination of the lipophilic amide bond with nucleotide-based tenofovir (TFV) (1) could improve the anti-HIV activity. During the current study, the hydroxyl group of phosphonates in TFV was conjugated with the amino group of L-alanine, L-leucine, L-valine, and glycine amino acids and other long fatty ester hydrocarbon chains to synthesize 43 derivatives. Several classes of derivatives were synthesized. The synthesized compounds were characterized by 1H NMR, IR, UV, and mass spectrometry. In addition, several of the synthesized compounds were evaluated as racemic mixtures for anti-HIV activity in vitro in a single round infection assay using TZM-bl cells at 100 ng/mL. TFV (1) was used as a positive control and inhibited HIV infection by 35%. Among all the evaluated compounds, the disubstituted heptanolyl ester alanine phosphonamidate with naphthol oleate (69), pentanolyl ester alanine phosphonamidate with phenol oleate (62), and butanolyl ester alanine phosphonamidate with naphthol oleate (87) ester conjugates of TFV were more potent than parent drug TFV with 79.0%, 76.5%, 71.5% inhibition, respectively, at 100 ng/mL. Furthermore, two fatty acyl amide conjugates of tenofovir alafenamide (TAF) were synthesized and evaluated for comparative studies with TAF and TFV conjugates. Tetradecanoyl TAF conjugate 95 inhibited HIV infection by 99.6% at 100 ng/mL and showed comparable activity to TAF (97–99% inhibition) at 10–100 ng/mL but was more potent than TAF when compared at molar concentration