Early recovery in post Varicella transverse myelitis

A two and a half year old Kenyan girl presented with recurrent chest infections and difficulty in swallowing. Her clinical and laboratory workup was suggestive of lower respiratory tract infection for which she received a course of antibiotics; however, she remains symptomatic after the management of her suspected diagnosis. Therefore, further radiological workup including a chest CT scan and barium study were performed. This showed a homogeneous mass surrounded by ascending and descending aorta in the posterior mediastinum that was compressing the middle esophagus. She had a posterolateral thoracotomy which revealed a cystic mass with smooth surfaces (5 x 5 cm) in the posterior mediastinum. Histopathology showed branchial cleft cyst predominately lined by stratified squamous epithelium, with lymphocytes predominance. A final diagnosis of posterior mediastinal branchial cleft cyst was made. She was discharged home and remained well at follow-up

Assessment of Knowledge of Cardiopulmonary Resuscitation among Pharmacy Students of Mirpur, Azad Jammu & Kashmir

Introduction: Cardiopulmonary resuscitation (CPR) is the most important lifesaving technique in several emergency situations such as cardiac arrest. In future, being part of health care professionals, pharmacy students are deemed to possess basic skills and expertise which are required to perform CPR. Objective: To access the knowledge of cardiopulmonary among pharmacy students of Mirpur Azad Jammu & Kashmir. Methods: It was a questionnaire-based, descriptive cross-sectional study, conducted among 4th and 5th year students of two Pharmacy institutes of Mirpur AJ&K from November 2018 to January 2019. A pre-tested questionnaire from previous study was used to collect data. It comprised of 13 dichotomous questions with “Yes/No” options, regarding knowledge of CPR. Descriptive statistics was used to unfold the demographic characteristics. Inferential statistics (Kruskal Wallis and Man Whitney) tests were used for evaluating difference between dependent continuous variables and independent variables and Chi-square was applied to determine difference between grouped variables. P-value of less than 0.05 is considered significant. The data was analyzed using SPSS version 20. Result: Overall, 131 out of 150(response rate= 92%) students participated in current study. Gender distribution among the participants was almost equal with 66 males (50.4%) males and 65 (49.6%) females took part in current study. Participants of the age group 21-23 years (n=88, 67.2%) were dominant. Only few students (n=23, 17.6%) reported to have taken training in CPR previously. Eighty-eight (66.7%) had average knowledge of CPR. No significant differences among male and female, 4th and 5th year students of both the institutes were found. Conclusion: The study revealed that knowledge level of CPR is adequate in most of the students of pharmacy. However, further improvements are required to perform CPR in an efficient manner. Thus, training in CPR should be mandatory in the pharmacy curriculum

The effect of financial development and MFI’s characteristics on the efficiency and sustainability of micro financial institutions

Artigo publicado em revista científica internacionalThe Micro Financial Institutions (MFIs) have been touted as development strategies for Emerging Markets and Developing Economies (EMDEs) which merits research into the effect of financial development on the efficiency and sustainability of the MFIs. The Efficient and sustainable MFIs significantly paved the way for the economic development of a country particularly in developing countries. Surprisingly there are very rare studies that examine the nexus of financial development, MFIs efficiency, and sustainability. Also, these studies are confined to the impact of financial development either on the efficiency or sustainability of MFIs. Addressing this gap, the study attempts to explore the country-specific and MFIs-specific factors which significantly affect the efficiency and sustainability of the MFIs. For this purpose, the study first determines whether financial development contributes to the efficiency and sustainability of MFI. Secondly, the effect of MFIs’ specific characteristics such as credit risk, market risk, liquidity risk, lending strategy, Development Financial Institutions (DFIs) funds management, financial outreach, and poverty alleviation on the efficiency and sustainability of MFIs. The study has been conducted for Bangladesh, India, and Pakistan consisting of a panel data set of 12 MFIs over a period spanning from 2008–2018 using Stochastic Frontier Analysis and Cobb Douglas production function regression analysis. Overall empirical analysis reveals that financial development has significantly affected the efficiency and sustainability of the MFIs. While specific characteristics such as poverty alleviation and DFIs funds management have been shown to improve MFIs efficiency whereas an increase in credit risk, lending strategy, and market risk decrease MFIs sustainability and liquidity risk along with an increase in financial outreach leads to a decrease in MFIs efficiency. The directions and magnitudes of the findings suggest the stakeholders for all three countries for the significant direction leads to the efficiency and sustainability of MFIs. Moreover, future research could strive to understand the aspects of financial development which negatively correlate with the MFIs’ efficiency and sustainability such as stringent tax policies, creditor rights protection, and implementation of rules and regulations.info:eu-repo/semantics/publishedVersio

Terminalia arjuna restores the levels of alkaline phosphatase and aspartate aminotransferase of acetaminophen intoxicated mice

Background: Herbal medicines are natural and comparatively safer than conventional treatments and are well-documented for carrying little potential for harm.  Therefore, phytonutrients have occupied a central stage in the therapeutics. Terminalia arjuna, a medicinal plant, has been reported to have homeostatic, laxative, diuretic, antidiabetic, anticancer and cardiotonic actions.Methods: The current study was designed to investigate the protective role of T. arjuna leaf extract at three dose levels (100, 250, 500 mg/kg body weight) against acetaminophen (250 mg/kg body weight) induced liver damage.Results: The administration of hepatotoxin (Acetaminophen) resulted in disturbance of hematological and serological profile including alkaline phosphatase (ALP) and aspartate aminotransferase (AST) which was assayed in control and drug treated experimental models. Treatment with T.  arjuna leaf extract for 7 days restored the normal levels of markers and response was dose dependent.Conclusion: This study adds to the very limited existing literature regarding hepatoprotective effect of T. arjuna against acetaminophen toxicity. It is also important to get a step closer to development of accessible, authoritative, and independent information resources about herbal medicines and wide-ranging health disorders, which are currently lacking in Pakistan.Keywords: Hepatoprotective; Terminalia arjuna; ALP; AST   

Role of fine needle aspiration cytology in the diagnosis of parotid gland tumors: Analysis of 193 cases

Introduction: Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings. Objective: To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors. Methods: A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed. Results: Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%. Conclusion: Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis

Overexpression of EGFR in oral premalignant lesions and OSCC and its impact on survival and recurrence

Introduction: Oral squamous cell carcinoma (OSCC) the sixth leading cancer worldwide ranks as the most common cancer in males, and the third most common in females in Pakistan. It is influenced by risk factors which are widely consumed in our population. The epidermal growth factor receptor (EGFR) is a tyrosine kinase receptor that is imperative for cell signalling, growth and differentiation. It is mutated and overexpressed in a variety of cancers, while in OSCC it has been linked to poor patient survival; premalignant to malignant transformation and recurrence. This study investigates the use of EGFR as a prognostic factor for OSCC.Materials and Methods: Premalignant (n=29) and OSCC (n=100) formalin-fixed paraffin-embedded tissues were retrieved from the surgical archives of Aga Khan University Hospital (AKUH). Immunohistochemistry for EGFR overexpression was performed using monoclonal antibody on both groups. EGFR expression was correlated with habits of risk factor consumption, clinicopathologic features and 5-year survival and recurrence.Results: 15/29 premalignant and 67/100 OSCC patients had overexpressed EGFR. The upper/lower lip had the highest EGFR positivity among all premalignant sites of lesion (p=0.041). In OSCC patients, those who had EGFR overexpression had worse 5-year survival (univariate: p=0.048, multivariate: p=0.056) and higher chances of recurrence (univariate: p=0.01, multivariate: p=0.004) as compared to EGFR negative patients.Conclusion: EGFR is a viable candidate for an OSCC prognostic marker since its overexpression leads to poor survival and markedly increases the chances of recurrence

Subacute sclerosing panencephalitis: clinical and demographic characteristics

Objective: To determine the clinical and demographic characteristics of children diagnosed with Subacute sclerosing panencephalitis (SSPE). Study Design: Case series. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2000 to June 2012. Methodology: A retrospective analysis was done, regarding medical charts of 43 children under the age of 16 years with a discharge diagnosis of SSPE. Demographic and clinical characteristics were recorded. Results were expressed as percentages. Results: Most of the 43 patients were male (72%). The average age at presentation was 8.7 years with average duration of symptoms being 100.6 days. History of measles was present in 17 patients (39.5%). All children had seizures at presentation and 65% had cognitive impairment. Most patients required poly therapy for control of seizures. Sodium valproate was the most commonly used anti-epileptic agent; Isoprinosine was tried in 22 (51%) patients. CSF for antimeasles antibodies was positive in approximately 86% of the 40 (93%) children. EEG showed burst suppression pattern in 36 (83.7%) cases. Forty-two patients (97.6%) were discharged home in a vegetative state. Conclusion: SSPE is progressive neurodegenerative disorder. It can be prevented by timely immunization against measles. Measles antibody in the CSF is diagnostic for SSPE and is helpful in early diagnosis. Most patients experience a gradual but progressive decline in motor and cognitive functions

Hepatoprotective Effect of Berberis Lycium in Αlpha-Naphthylisothiocyanate Induced Cholestatic Mouse Models

Cholestasis is characterized by the obstruction of bile flow from hepatocytes to the intestine. It results in accumulation of bile acids in the liver, which cause oxidative stress, inflammation, apoptosis, fibrosis, and cirrhosis. Till now, the treatment options against cholestasis are limited. Therefore, there is an utmost requirement to develop and evaluate the drugs with potential anti-cholestatic effects. In the current study, the drug-induced cholestasis mouse models were generated via oral administration of α-naphthylisothiocyanate (ANIT). The mice were placed into three groups of six animals each. Group I was the control group and was given saline. The cholestasis model Group II was given saline for 19 days. On 19th day (48 hours before sacrifice) they received a single dose of ANIT (75 mg/kg). Group III served as the plant extract treatment group and received root extract for 19 days. On nineteenth day (48 hours before sacrifice) they received a single dose of ANIT (75 mg/kg). On 21st day, mice were sacrificed for analysis of serum biochemistry and liver histology. The results revealed that Berberis lycium extract has hepatoprotective properties, as serum level of AST (aspartate aminotransferase) and ALT (alanine transaminase) are significantly lower in the plant treatment group compared to the cholestasis model group. Furthermore, liver histology validated the serological results since the hepatocyte architecture in the plant treatment group was similar to that of control group. In conclusion, the data exhibit that B. lycium possess protective activities against ANIT induced cholestasis

Efficacy of Electroconvulsive Therapy and Ketamine Therapy in Major Depressive Disorder; A Comparative Study

Objective: To evaluate and compare the efficacy of Electroconvulsive therapy (ECT) and Ketamine infusions in hospitalized patients suffering from major depressive disorder (MDD). Study Design: Comparative cross-sectional study. Place and duration of study: Armed Forces Institute of Mental Health, Rawalpindi Pakistan, from Feb to Apr 2021. Methodology: Forty in-patients diagnosed as having MDD were randomly allocated ECT/Ketamine intervention as per international standards. Either group of patients acted as a control for the other. Their Beck Depressive Inventory (BDI) scores before and after the completion of treatment cycles were assessed to determine their response to treatment. Results: The Ketamine-Group showed fewer depressive symptoms than the ECT Group. The depressive symptoms were reduced in 16(80.78%) patients after Ketamine infusions, while 15(77.78%) patients showed improvement after ECT sessions.In addition, the response to Ketamine was quicker. Conclusion: This study has reported that low dose Ketamine has a more rapid impact than Electroconvulsive therapy in improving symptoms of depression in major depressive disorder patients

Impact of Hypoxia on Astrocyte Induced Pathogenesis

Astrocytes are the most abundant cells of the central nervous system. These cells are of diverse types based on their function and structure. Astrocyte activation is linked mainly with microbial infections, but long-term activation can lead to neurological impairment. Astrocytes play a significant role in neuro-inflammation by activating pro-inflammatory pathways. Activation of interleukins and cytokines causes neuroinflammation resulting in many neurodegenerative disorders such as stroke, growth of tumours, and Alzheimer’s. Inflammation of the brain hinders neural circulation and compromises blood flow by affecting the blood–brain barrier. So the oxygen concentration is lowered, causing brain hypoxia. Hypoxia leads to the activation of nuclear factor kappa B (NFkB) and hypoxia-inducible factors (HIF), which aggravates the inflammatory state of the brain. Hypoxia evoked changes in the blood–brain barrier, further complicating astrocyte-induced pathogenesis