Prevalence Of Peptic Ulcer In Patients Of Liver Cirrhosis Presenting With Upper Gi Bleed

BACKGROUND:  Although major cause of upper GI bleed in patients of liver cirrhosis is variceal bleed. However a significant proportion also presents with non-variceal bleeding (NVB). AIM: The aim of study is to determine the frequency of peptic ulcers in patients of liver cirrhosis presenting with upper GI bleed. METHODS: This descriptive cross sectional study was conducted in Gastroenterology section of medicine department at Benazir Bhutto Hospital from April 2017 to December 2018 . 672 patients of liver cirrhosis presenting with upper GI bleed were enrolled in study through non probability consecutive sampling. Upper GI endoscopy of all patients was performed by consultant Gastroenterologist and findings were documented on standardized Performa. RESULTS: 672 patients were included in study with mean age of 54.68 ±11.15. Among these 370 (55.1%) were males and 302 (44.9%) were females. 92 patients (13.1%) had peptic ulcer as cause of upper GI bleed. 112 patients (16.6%) had both peptic ulcer and variceal bleed as cause of Upper GI Bleed and endoscopic findings of remaining 468 patients (69.6 %) showed varices (oesophageal + gastric) as prime source of bleeding. CONCLUSIONS: In this study, peptic ulcer accounted for 13.1 % of all cases of UGI bleeding. Keywords: Peptic Ulcer, Variceal bleeding, Upper GI bleed, Cirrhosis

Prognostic Role of Optical Coherence Tomography in Outcome of Idiopathic full thickness Macular Hole Surgery

Abstract Purpose: To assess the prognostic value of Optical Coherence Tomography indices preoperatively in outcome of idiopathic full thickness macular hole surgery. Material & Methods:  A Quasi experimental study was carried out at Al Ibrahim eye hospital, Karachi from June 2019 to Feb 2020. Patients between 50 to 70 years of age, including both genders with full thickness idiopathic macular hole on Optical Coherence Tomography (OCT) were included while patients with secondary causes of macular hole like trauma, myopia, detachment of retina with macular hole, macular hole with other causes of poor vision like corneal scaring, Age related macular degeneration and diabetic retinopathy were excluded. OCT measurements are basal diameter, height of macular hole, right and left arm length and derived indices are macular hole index (MHI) and hole form factor (HFF). Results: A total 33 patients including 23 (69.6%) male and 10(30.3%) females of idiopathic full thickness macular hole were taken. Patients  mean age was 55.25±6.9. Among 33 patients, MHI (>0.5) was found in 21(63.6%) patients while 12 (36.3%) patients had MHI (< 0.5). In 25 patients HFF calculation was possible. 17(68%) patients had HFF (>0.9) while 8  (32%) patients had HFF (< 0.9). Anatomical and visual outcomes were assessed at 1st and 3rd month follow-up. Of 21 patients for MHI >0.5, vision improved (i.e. ≥ 6/18) in 15 (71.4%). Similarly, out of 17 patients for HFF > 0.9, 13 (76.47%) patients had improved vision post-operatively. Conclusion: Optical coherence tomography indices can be helpful to predict surgical outcomes of idiopathic full thickness macular hole surgery

Transcriptome Analysis and Genetic Engineering

Genetic engineering is the most powerful technology of this century which is dramatically revolutionizing the agriculture, health, pharmaceutical, and food industries all over the world. Transcriptomics and genetic engineering go hand in hand from the development of a genetically modified organism (GMO) to its utilization by the humans. Transcriptome analysis is the analysis of messenger RNAs (mRNAs), which are produced by transcription of deoxyribonucleic acid (DNA) in an organism in response to a specific internal/external environment. Transcriptome analysis is not only useful to dig out the potential target genes for genetic modifications but also utilized to study the proper functioning of a genetically engineered gene, evaluation of the GMO for biosafety risks and for monitoring the presence and movement of GMO. Despite huge scope of genetic engineering, these manipulations can upset the natural balance of a genome by insertional, soma clonal, and pleiotropic effects of a foreign gene resulting in unintended alterations along with the targeted changes. The untargeted alterations pose risks to environment and health of animals and plants. In this chapter, the key advancements in the field of biotechnology and the relevant biosafety issues are reviewed. The advantages and limitations of the current methods used for the evaluation, monitoring, and regulation of GMOs are discussed

CT scan in children with acute bacterial meningitis: experience from emergency department of a tertiary-care hospital in Karachi, Pakistan

Objective: To determine the role of computed tomography scan in children presenting to emergency department with symptoms and signs of suspected acute bacterial meningitis. Methods: The retrospective analysis was done on children who were admitted through the Emergency Department at Aga Khan University Hospital, Karachi, from September 2009 to September 2011 with the diagnosis of acute bacterial meningitis. Information related to age, gender, presenting complaints, clinical signs and symptoms, computed tomography scan findings and final outcome of patients was gathered from the medical records. SPSS 19 was used for statistical analysis. Results: A total of 192 patients were admitted with the relevant diagnosis. The male-female ratio was 2.3:1. Computed tomography scan was done in 114 (59.4%) patients. The scan was reported normal in 90 (78.94%) patients. However, cerebral oedema was found in 16 (14.03%) patients, cerebral infarct in 6(5.26%) and hydrocephalus in 2 (1.75%) patients. Overall, there were 6 (3.1%) deaths. Conclusion: Comuted tomography scan may have a beneficial role in children with acute bacterial meningitis. However, further studies are required to use the scan as a routine investigation for such a diagnosis

Olive oil and clove oil-based nanoemulsion for topical delivery of terbinafine hydrochloride : in vitro and ex vivo evaluation

In this article, formulation studies for terbinafine hydrochloride nanoemulsions, prepared by high-energy ultrasonication technique, are described. Pseudo-ternary phase diagram was constructed in order to find out the optimal ratios of oil and surfactant/co-solvent mixture for nanoemulsion production. Clove and olive oils were selected as oil phase. Based on the droplet size evaluation, maximum nanoemulsion region were determined for formulation development. Further characterization included polydispersity index (PDI), zeta potential, Fourier transform infrared (FT-IR) spectroscopy, morphology, pH, viscosity, refractive index, ex vivo skin permeation, skin irritation, and histopathological examination. Droplet sizes of optimized formulations were in colloidal range. PDI values below 0.35 indicated considerably homogeneous nanoemulsions. Zeta potential values were from 13.2 to 18.1 mV indicating good stability, which was also confirmed by dispersion stability studies. Ex vivo permeation studies revealed almost total skin permeation of terbinafine hydrochloride from the nanoemulsions (96-98%) in 6 hours whereas commercial product reached only 57% permeation at the same time. Maximum drug amounts were seen in epidermis and dermis layers. Skin irritation and histopathological examination demonstrated dermatologically safe formulations. In conclusion, olive oil and clove oil-based nanoemulsion systems have potential to serve as promising carriers for topical terbinafine hydrochloride delivery.Peer reviewe

The many guises of primary hyperparathyroidism… an unchanged scenario

Abstract OBJECTIVE: To study the causes, characteristics and outcome of treatment of patients with primary hyperparathyroidism. METHODS: This retrospective cohort analysis was conducted at the Jinnah Postgraduate Medical Centre, Karachi, and comprised data of patients with primary hyperparathyroidism between 2004 and 2014. .SPSS 17 was used for data analysis. RESULTS: Of the 25 patients,1(4%)was male and 24(96%) were female. The overall mean age was 41.72±15.9 years, with a mean duration of symptoms of 4.1±3.3 years. The mean pre-operative parathyroid hormone level was 879.48±793.51 pg/ml. Skeletal manifestations were reported in 17(68%) patients, whereas 4(16%) patients had renal stone disease. Besides, 2(8.0%) patients presented with severe abdominal pain, 1(4%) had asymptomatic hypercalcaemia and 1(4%) patient presented with headache and was diagnosed as parathyroid adenoma in the context of multiple endocrine neoplasia type 2A. All patients underwent parathyroidectomy. A solitary adenoma was reported in 23(92%) patients, carcinoma in 1(4%) and an adenoma with hyperplasia of other glands in 1(4%) patient. CONCLUSIONS: A high index of suspicion is required for early diagnosis of primary hyperparathyroidism

A study on the Impacts of COVID-19 on health, Economy, Employment and Social Life of People in Indonesia

Background: The aftershocks of COVID-19 pandemic are still emanating in different regions of the world in term of increasing number of cases and deaths due to mutation in the virulence and pathogenicity of the virus. The pandemic affected almost every part of our lives including health, economy, employment, and social interactions. This study surveyed the Indonesian public to better understand their health, employment, and economic deterioration during the early stages of the COVID-19 outbreak.Methods: An online cross-sectional survey of 200 participants was conducted from eight different regions (Jawa Timur, DKI Jakarta, Kalimantan Tengah, Yogyakarta, Bali, Sulawesi Selatan, Jawa Tengah) of Indonesia who speak Bahasa. A standardized questionnaire was used to obtain information about COVID-19 impacts on health, employment, the economy, and social life from the respondents. Descriptive statistics and Chi-square tests were conducted to analyze the data.Results: According to the findings, out of 200 participants, 40% stated that the impact of COVID-19 did not affect their salary. People under the age of 20 with an intermediate education who worked in government sectors were more likely to lose their jobs (p-value 0.05), which would result in a loss in salary that would have an impact on the education of their children. Only the "use of hand sanitizers" indicated a statistically significant difference between the practices of male and female respondents (p-value = 0.038), which is one of the activities that helps to prevent fever and respiratory difficulties during the present pandemic.Conclusion: The finding of the study depicted that COVID-19 has no immediate collateral effects on the economy of the study participants. However, the pandemic has a negative impact on the employment, health, and social life of the people. To mitigate the negative effects of this pandemic on health, employment, economy, and social life, a complete evaluation of COVID-19 impacts, as well as public health interventions, should be conducted