Clinical outcomes of pneumocystis pneumonia from a tertiary care centre in Pakistan.

Objective: To assess the predisposing immunocompromised states, administration of pneumocystis jirovecii pneumonia prophylaxis, the disease course and outcomes of patients with pneumocystis jirovecii pneumonia. Methods: The retrospective study was conducted at the Aga Khan University Hospital in Karachi. The medical records of patients diagnosed with pneumocystis jirovecii pneumonia from January 1995 to October 2015 were retrieved. Baseline characteristics, clinical course, treatment, and mortality rates were noted. SPSS 19 was used for data analysis. Results: Of the 37 patients, 24(64.9%) were men and 13(35.1%) were women. The overall mean presenting age was 47.08±16.21 years(range: 19-83 years). Ten (27%) patients were positive for human immunodeficiency virus; 12(32.4%) had an underlying autoimmune disease; 3(8.1%) were transplant recipients; 10(27%) had an underlying malignancy, and 19(51.3%) were on long-term corticosteroid therapy. Only 2(5.4%) patients had received pneumocystis jirovecii pneumonia prophylaxis with trimethoprim-sulfamethoxazole. Moreover, 8(21.6%) patientsrequired intensive care unit admission with a mean stay of 2.03±4.91 days (range: 1-22 days).The overall mortality rate was 7(18.9%). Conclusion: Pneumonia due to pneumocystis jirovecii was found to be a life-threatening disease in the immunocompromised population. The high mortality burden and resource intensive management of the disease emphasizes the need for PCP prophylaxis in immunosuppressed individuals

Inhibition of protein glycation and advanced glycation end products by ascorbic acid

Advanced glycation end products (AGEs) formation is increased in diabetes mellitus, leading to microvascular and macrovascular complications. Recently, much attention has been focused on natural and synthetic inhibitors to delay the onset or progression of diabetes and its comorbidities. Ascorbic acid (AA) can react with proteins, including hemoglobin and possibly interfere with protein glycation process. An in vitro glycation model containing plasma from type 2 diabetic and non-diabetic healthy volunteers together with glucose as glycating agent was used to study antiglycation activity of AA. Samples with different concentrations of glucose and AA were incubated for five weeks at 37°C. Nonenzymatic glycation (NEG) was quantitated by thiobarbituric acid calorimetry and AGEs were measured by enzyme linked immuno-sorbent assay (ELISA). The NEG and AGEs levels were reduced by AA. Increasing the AA concentrations greatly diminished protein glycations, indicating dose-dependent effects of AA. Plasma NEG and AGEs were decreased with an average of 20 to 26% (p < 0.05) and 26 to 28% (p < 0.05). A significant correlation was found between the glycation inhibition and the inhibition of AGE formation (p < 0.05). The antiglycation role of AA is evident in the present study and it also indicates the possibility of inexpensive, relatively non-toxic vitamin therapy for the prevention and treatment of diabetic complications. It is plausible that AGEs inhibition by AA may also form the basis for future intervention strategies in both diabetic and non-diabetic individuals.Keywords: Diabetes mellitus, glycation, advanced glycation end products, hyperglycemia, ascorbic aci

ANALYSIS OF BLOOD CIRCULATING SERUM BIOMARKERS FOR THE DIAGNOSIS OF BREAST CANCER

Introduction: Breast cancer is the most common neoplasm in women and the second leading cause of cancer-related mortality in females worldwide. Breast cancer is the second most common type of cancer (after lung cancer), and the fifth most common cause of cancer death. Objectives of the study: The main objective of the study is to assess the blood circulating serum biomarkers for the diagnosis of breast cancer. Methodology of the study: This cross sectional study was conducted at DHQ teaching hospital Sahiwal during February 2018 to November 2018. Breast cancer notifications were confirmed and characterized by postal questionnaire sent to treating clinicians (consultant, or General Practitioner if details not provided by the volunteer), which was designed to ascertain clinical and histological data on diagnosed cases (date of diagnosis, histology, nodal status, staging, grade, prognosis, ER, PR and HER2 status). Results: The results indicates that CTC, CEA and ALP are the best indicating serum biomarkers for the diagnosis and progression of breast cancer. Mean, median and SD shows that there is a significant relationship in these serum biomarkers. Conclusion: It is concluded that biomarkers are the useful tool for the analysis of progression of breast cancer in females. Key words: Diagnosis, Breast, Cancer, Female

Trauma Management: Should it be a part of Medical Curriculum?

Trauma management is an approach to assess and treat multiply injured patients. Casualties that present within the first twohours of injury are deaths that can be prevented. Medical professionals need to be trained to appraise and manage these patientsduring this period. A variety of courses are available, designed entirely to teach medical professionals to treat trauma patients.Many counties have adopted these programs and now they are being taught in over 60 countries worldwide. In developingcountries, injuries due to trauma are regrettably neglected, and accounts for more than five million deaths each year. This isnearly equal to combined number of deaths from tuberculosis, malaria and HIV/AIDS. Medical graduates are supposed to beable to handle all types of emergencies, common or traumatic. Lack of ATLS, BCLS and ACLS certified doctors in emergencydepartments lead to improper and un-necessary delay in provision of medical care to patients

CT-Guided Percutaneous Biopsy of Intrathoracic Lesions

Percutaneous CT-guided needle biopsy of mediastinal and pulmonary lesions is a minimally invasive approach for obtaining tissue for histopathological examination. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications. In this pictorial review, we reviewed important anatomical approaches, technical aspects of the procedure, and its associated complications

Focal dystonia and ataxic hemiparesis as the initial presentation of a thalamic tuberculoma: a diagnostic challenge in an immunocompetent pediatric patient

Background: Central nervous system (CNS) tuberculomas are rare and account for approximately 1% of all tuberculosis (TB) cases. These intracranial lesions are more commonly observed in immunocompromised individuals, often as part of disseminated miliary TB or after latent infection reactivation. This case report presents the occurrence of a thalamic tuberculoma in an immunocompetent girl. Case Description: An 11-year-old girl presented with a 3-month history of progressive right-sided ataxic hemiparesis, hand dystonia/thalamic hand, and headache. There was only a mildly elevated erythrocyte sedimentation rate (25 mm/h.), and her remaining biochemistry and vitals were unremarkable. Magnetic resonance imaging (MRI) brain revealed an ill-defined intra-axial heterogeneous lobulated lesion with crenated margins involving the thalamus and the posterior limb of the internal capsule with significant vasogenic edema. Given the clinical picture, the working diagnosis was a high-grade brain tumor. Due to the absence of a viable operative corridor for a meaningful resection and the diagnostic uncertainty, a stereotactic biopsy was performed, and histopathological analysis confirmed the presence of granulomas consistent with TB. A human immunodeficiency virus test (negative) and interferon-gamma release assay (positive) were then obtained. The patient was commenced on a regimen of anti-TB drugs with a tapering steroid dose. At 8 months, her most recent MRI showed a significant reduction in the size of her tuberculoma, and there is a complete resolution of her hand dystonia and hemiparesis to allow for independence in her activities of daily living. Conclusion: This report emphasizes the importance of considering causes other than degenerative, vascular, or neoplasms in patients with hemiparesis with dystonia. CNS tuberculomas can present as such without prior history or specific clinical symptoms of TB, making them a diagnostic challenge. In cases with such uncertainty regarding the nature of an intracranial lesion and the role of resection, a stereotactic biopsy is invaluable

In vitro biological assessment of 1,3,4-oxadiazole sandwiched by azinane and acetamides supported by molecular docking and BSA binding studies

The 1,3,4-Oxadiazole is an aromatic heterocyclic moiety recognized in drug research for its low lipophilicity. The multiple functionalities, heterocyclic azinane, sulfonamide, 1,3,4-oxadiazole and acetamide, are combined collectively to enhance the bioactivity potential of synthesized molecules. All the compounds were acquired by following microwave assisted and conventional techniques in a comparative way. The synthesized derivatives were screened for their antibacterial and enzyme inhibition potential. Furthermore, BSA binding analysis was executed to infer about the interaction with serum albumin. The spectral data of IR, EI-MS, 1H-NMR and 13C-NMR were used to elucidate the final structures of compounds. The synthesized compounds had a modest antibacterial potential. Compound 8f bearing 2-methyl-4,5-dinitrophenyl group was the most active one against all the bacterial strains taken into account and α-glucosidase enzyme. Compound 8d bearing 4-nitrophenyl group was the best acetyl cholinesterase inhibitor and 8i bearing phenylethyl group was the best urease inhibitor

Spectrum of Hematological and Non-Hematological Diseases on Bone Marrow Examination-A Study on 220 Cases at a Tertiary Care Centre

Background: Bone marrow examination is an invaluable tool in the diagnosis of hematological and non-hematological diseases. Referral is made based on the clinical after analyzing CBC and peripheral film.Objective: This study aims at evaluating the spectrum of diseases diagnosed on bone marrow biopsy at a tertiary care hospital of Rawalpindi, Pakistan.Materials and Methods: This descriptive, cross-sectional study was carried out at the pathology department of Holy family hospital for a duration of 1 year after ethical approval from IRF. All 220 cases requiring bone marrow examination were included in the study by consecutive sampling technique. Variables like age, gender, presenting complaints, examination findings, CBC, peripheral blood film, indications and diagnosis of bone marrow examination were noted. Data was analyzed using SPSS v22.Results: Mean age was 29.15±20.9 years. 117(53.2%) specimens were of males and 103(46.8%) were of females. Spectrum of hematological and non-hematological diseases found on bone marrow examination ranged from acute leukemia in 37(16.8%), megaloblastic anemia in 29(13.1%).The relationship between indications of referral and diagnosis of bone marrow examination was found to be statistically significant showing that suspected diagnosis made by the clinician was same as the final diagnosis in many cases. Pancytopenia was found major indication in most diseases (32.7%).Conclusion: Bone marrow examination is a useful tool in ascertaining diagnosis of various hematological and non-hematological disorders. Pancytopenia was found to be major indication whereas, acute leukemia and megaloblastic anemia were most common malignant and benign hematological disorders on bone marrow examination, respectively