Frequency of hepatocellular carcinoma in cirrhotic patients with hepatitis-C virus positive patients in Karachi-Pakistan

Background: Hepatocellular Carcinoma is the 5th most common neoplasm in the world and 4th most common cancer death. Most patients with HCC have an underlying chronic liver disease (often cirrhosis), resulting mainly from chronic infection by Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), excessive alcohol consumption, and often an association of these causes. HCC has recently gained more interest due to its increasing incidence in industrialized countries. Objective: To determine the frequency of hepatocellular carcinoma in hepatitis C reactive cirrhotic patients.Methods: Place and duration of study: Department of medicine, civil hospital Karachi. Duration: Six months from 16-12-2012 to 15-6-2013. Subjects and methods: Patients admitted in medical wards of civil hospital Karachi with liver cirrhosis due to hepatitis C virus were included in the study. Investigation relevant to hepatocellular carcinoma like alpha fetoprotein and ultrasound was performed. If the Alpha fetoprotein is greater, then 200 ng/ml in the setting of a mass in a cirrhotic liver the likelihood of hepatocellular carcinoma is greater then 90% and biopsy is not required.Results: Overall mean age was 41.1 ± 7.1 years with Male:Female = 4.2:1. Out of 141 cases; hepatocellular carcinoma was diagnosed in 8 (5.7%) of patients with HCV related cirrhosis with mean age 48.6 ± 6.4 years. Proportion of hepatocellular carcinoma was high 7 (6.1%) in male. 7 (6.4%) cases had child pugh-C, 1 (5%) case had child pugh-B and while no HCC was seen in child pugh-A.Conclusion: In this study hepatocellular carcinoma was 5.7% in cases with hepatitis-C induced cirrhosis. Older age (>54 years), male sex and child pugh-C were predominant factors leading to hepatocellular carcinoma.

Study of anti-diabetic, beta-carotene-bleaching inhibiting and iron chelating properties of Carissa opaca root extracts

Degenerative diseases diabetes and oxidative stress constitute a major health concern worldwide. Medicinal plants are expected to provide effective and affordable remedies. The present research explored antidiabetic and antioxidant potential of extracts of Carissa opaca roots. Methanolic extract (ME) was prepared through maceration. Its fractions were obtained, sequentially, in hexane, chloroform, ethyl acetate and n-butanol. An aqueous decoction (AD) of the finely ground roots was obtained by boiling in distilled water. The leftover biomass with methanol was boiled in water to obtain biomass aqueous decoction (BAD). The extracts and fractions showed considerable porcine pancreatic α-amylase inhibitory activity with IC50 in the range of 5.38-7.12 mg/mL while acarbose had 0.31 mg/mL. The iron chelating activity in terms of EC50 was 0.2939, 0.3429, 0.1876, and 0.1099 mg/mL for AD, BAD, ME, and EDTA, respectively. The EC50 of beta-carotene bleaching activity for AD, BAD, ME, and standard BHA were 4.10, 4.71, 3.48, and 2.79 mg/mL, respectively. The total phenolic content (TPC) and total flavonoid content (TFC) of AD and BAD were also considerable. In general, ethyl acetate fraction proved to be the most potent. Thus, the C. opaca roots had excellent antioxidant activity while having moderate α-amylase inhibitory potential

Value of routine preoperative tests for coagulation before elective cranial surgery. Results of an institutional audit and a nationwide survey of neurosurgical centers in Pakistan

Background: Routine preoperative blood testing has become a dogma. The general practice is to order preoperative workup as a knee-jerk response rather than individualize it for each patient. The fact that the bleeding brain tends to swell, which coupled with limited options for proximal control, packing, and overall hemostasis, leads to an overemphasis on the preoperative coagulation profile.Material and methods: This is a retrospective review of the medical records of patients admitted at Aga Khan University Hospital from January 2010 to December 2015 for an elective craniotomy. The hospital registry was used to identify files for review. Data were collected on a predefined proforma. A nationwide survey was performed, and 30 neurosurgery centers were contacted across Pakistan to confirm the practice of preoperative workup.Results: The survey revealed that all centers had a similar practice of preoperative workup. This included complete blood count, serum electrolytes, and coagulation profile, including prothrombin time, activated partial thromboplastin time (aPTT), and international normalized ratio (INR). A total of 1800 files were reviewed. Nine (0.5%) patients were found to have deranged clotting profile without any predictive history of clotting derangement; 56% were male and 44% were female. Median age was 32 years with an interquartile range of 27 years. Median aPTT was (40.8 with 20.8 IQR). Median INR was (1.59 with 0.48 IQR). Median blood loss was (400 with 50 IQR). No significant association between coagulation profile (aPTT, INR) and blood loss was found (P = 0.85, r = -0.07).Conclusions: We conclude that patients without a history of coagulopathy and normal physical examination do not require routine coagulation screening before elective craniotomy

LMBiS-Net: A Lightweight Multipath Bidirectional Skip Connection based CNN for Retinal Blood Vessel Segmentation

Blinding eye diseases are often correlated with altered retinal morphology, which can be clinically identified by segmenting retinal structures in fundus images. However, current methodologies often fall short in accurately segmenting delicate vessels. Although deep learning has shown promise in medical image segmentation, its reliance on repeated convolution and pooling operations can hinder the representation of edge information, ultimately limiting overall segmentation accuracy. In this paper, we propose a lightweight pixel-level CNN named LMBiS-Net for the segmentation of retinal vessels with an exceptionally low number of learnable parameters \textbf{(only 0.172 M)}. The network used multipath feature extraction blocks and incorporates bidirectional skip connections for the information flow between the encoder and decoder. Additionally, we have optimized the efficiency of the model by carefully selecting the number of filters to avoid filter overlap. This optimization significantly reduces training time and enhances computational efficiency. To assess the robustness and generalizability of LMBiS-Net, we performed comprehensive evaluations on various aspects of retinal images. Specifically, the model was subjected to rigorous tests to accurately segment retinal vessels, which play a vital role in ophthalmological diagnosis and treatment. By focusing on the retinal blood vessels, we were able to thoroughly analyze the performance and effectiveness of the LMBiS-Net model. The results of our tests demonstrate that LMBiS-Net is not only robust and generalizable but also capable of maintaining high levels of segmentation accuracy. These characteristics highlight the potential of LMBiS-Net as an efficient tool for high-speed and accurate segmentation of retinal images in various clinical applications

Production of Remedial Proteins through Genetically Modified Bacteria

Recombinant DNA technology has created biological organisms with advanced genetic sequences and has been extensively used to express multiple genes for therapeutic purposes when expressed in a suitable host. Microbial systems such as prokaryotic bacteria has been successfully utilized as a heterologous systems showing high therapeutic potency for various human diseases. Bioengineered bacteria have been successfully utilized for producing therapeutic proteins, treating infectious diseases, and disease arise due to increasing resistance to antibiotics. Prominently E. colifound to be the most widely used expression system for recombinant therapeutic protein production i.e. hormones, enzymes and antibodies. Besides E. coli, non-pathogenic lactic acid bacteria has also been considered as an excellent candidate for live mucosal vaccine. Likewise, S. typhimuriumhas been deployed as attenuated type of vaccination as well as in treatment strategy of various cancers due to its ability of wide progression in tumors. The present article is a summarized view of the main achievements and current developments in the field of recombinant therapeutics using bacterial strains focusing on their usability in therapeutics and future potential. 

Disparities in cardiovascular research output and disease outcomes among high-, middle- and low-income countries - An analysis of global cardiovascular publications over the last decade (2008-2017)

Background: Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Health research is crucial to managing disease burden. Previous work has highlighted marked discrepancies in research output and disease burden between high-income countries (HICs) and low- and lower-middle-income countries (LI-LMICs) and there is little data to understand whether this gap has bridged in recent years. We conducted a global, country level bibliometric analysis of CVD publications with respect to trends in disease burden and county development indicators.Methods: A search filter with a precision and recall of 0.92 and 0.91 respectively was developed to extract cardiovascular publications from the Web of Science (WOS) for the years 2008-2017. Data for disease burden and country development indicators were extracted from the Global Burden of Disease and the World Bank database respectively.Results: Our search revealed 847,708 CVD publications for the period 2008-17, with a 43.4% increase over the decade. HICs contributed 81.1% of the global CVD research output and accounted for 8.1% and 8.5% of global CVD DALY losses deaths respectively. LI-LMICs contributed 2.8% of the total output and accounted for 59.5% and 57.1% global CVD DALY losses and death rates.Conclusions: A glaring disparity in research output and disease burden persists. While LI-LMICs contribute to the majority of DALYs and mortality from CVD globally, their contribution to research output remains the lowest. These data call on national health budgets and international funding support to allocate funds to strengthen research capacity and translational research to impact CVD burden in LI-LMICs

Study of anti-diabetic, beta-carotene-bleaching inhibiting and iron chelating properties of Carissa opaca root extracts

Degenerative diseases diabetes and oxidative stress constitute a major health concern worldwide. Medicinal plants are expected to provide effective and affordable remedies. The present research explored antidiabetic and antioxidant potential of extracts of Carissa opaca roots. Methanolic extract (ME) was prepared through maceration. Its fractions were obtained, sequentially, in hexane, chloroform, ethyl acetate and n-butanol. An aqueous decoction (AD) of the finely ground roots was obtained by boiling in distilled water. The leftover biomass with methanol was boiled in water to obtain biomass aqueous decoction (BAD). The extracts and fractions showed considerable porcine pancreatic α-amylase inhibitory activity with IC50 in the range of 5.38-7.12 mg/mL while acarbose had 0.31 mg/mL. The iron chelating activity in terms of EC50 was 0.2939, 0.3429, 0.1876, and 0.1099 mg/mL for AD, BAD, ME, and EDTA, respectively. The EC50 of beta-carotene bleaching activity for AD, BAD, ME, and standard BHA were 4.10, 4.71, 3.48, and 2.79 mg/mL, respectively. The total phenolic content (TPC) and total flavonoid content (TFC) of AD and BAD were also considerable. In general, ethyl acetate fraction proved to be the most potent. Thus, the C. opaca roots had excellent antioxidant activity while having moderate α-amylase inhibitory potential

A comparative study of ohmic and conventional pasteurization on camel milk

The present study was about the comparison of effect of ohmic and conventional pasteurization on camel milk. The objectives were to analyze the pasteurization effect of both methods on microbial and nutritional quality of camel milk. Camel milk was pasteurized by both methods, conventional heating as well as ohmic heating by maintaining the temperature of milk at 63°C and changing the time of pasteurization for 3.75, 7.5, 15 and 30 minutes. After pasteurization the milk was tested for microbes by total plate count (TPC) and nutritional profile of milk by different analysis. The pasteurized milk by ohmic heating showed a reduction of bacterial count from 2.35 to 1.83 log CFU/ml of TPC. The pH obtained was 6.54, moisture content was 88.19%, fat content was 3.09%, protein content was 2.43%, lactose content was 3.25% and ash content was 0.85% by pasteurization of camel milk with ohmic heating. The pasteurized milk by conventional heating showed a total plate count value of 2.37 to 1.87 log CFU/ml. The pH obtained was 6.6, moisture content was 87.66%, fat content was 2.99%, protein content was 2.33%, lactose content was 3.16% and ash content was 0.84% with conventional heating of pasteurization.&nbsp

Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review

Pregnancy in adolescence and malnutrition are common challenges in low- and middle-income countries (LMICs), and are associated with many complications and comorbidities. The preconception period is an ideal period for intervention as a preventative tactic for teenage pregnancy, and to increase micronutrient supplementation prior to conception. Over twenty databases and websites were searched and 45 randomized controlled trials (RCTs) or quasi-experimental interventions with intent to delay the age at first pregnancy (n = 26), to optimize inter-pregnancy intervals (n = 4), and supplementation of folic acid (n = 5) or a combination of iron and folic acid (n = 10) during the periconception period were included. The review found that educational interventions to delay the age at first pregnancy and optimizing inter-pregnancy intervals significantly improved the uptake of contraception use (RR = 1.71, 95% CI = 1.42–2.05; two studies, n = 911; I2 = 0%) and (RR = 2.25, 95% CI = 1.29–3.93; one study, n = 338), respectively. For periconceptional folic acid supplementation, the incidence of neural tube defects were reduced (RR = 0.53; 95% CI = 0.41–0.77; two studies, n = 248,056; I2 = 0%), and iron-folic acid supplementation improved the rates of anemia (RR = 0.66, 95% CI = 0.53–0.81; six studies; n = 3430, I2 = 88%), particularly when supplemented weekly and in a school setting. Notwithstanding the findings, more robust RCTs are required from LMICs to further support the evidence

Prevention of common mental disorders among women in the perinatal period: a critical mixed-methods review and meta-analysis

Perinatal depression and anxiety account for a high burden of perinatal morbidity and poor psychosocial functioning. There is a growing interest among mental health professionals, to devise interventions to prevent this condition. This review synthesizes evidence for the effectiveness of psychological and psychosocial interventions aimed at the prevention of perinatal depression and anxiety. We also explore qualitative evidence to understand the acceptability and feasibility of these interventions. Using a mixed-methods approach, data from a total of 21 studies were collated to inform the evidence for preventive interventions for perinatal depression and anxiety. Based on their theoretical orientations, these interventions were described by authors as cognitive-behavioral (n = 7); psychoeducational (n = 6); mindfulness (n = 2); and interpersonal psychotherapy (n = 2). These also included psychosocial approaches such as social support (n = 1) and multicomponent interventions (n = 3). For depressive symptoms, these interventions yielded moderate to strong effect sizes in favor of the intervention group [standardized mean difference (SMD) = −0.59; 95% confidence interval (CI) −0.95 to −0.23]. For anxiety symptoms, a strong effect size was estimated in favor of the intervention group (SMD = −1.43, 95% CI −2.22 to −0.65). Preventive interventions significantly reduce the severity of perinatal depressive and anxiety symptoms. These interventions are also acceptable and feasible in many settings