Correlation of Chronic Obstructive Pulmonary Disease severity with C-Reative Protien levels in patients at tertiary care Hospital

Objective: To determine the correlation of chronic obstructive pulmonary disease (COPD) severity and C-reactive protein (CRP) among patients at tertiary care Hospital. Methodology: This cross-sectional study was conducted at Medicine department of Isra University Hospital Hyderabad. All the patients of chronic pulmonary disease either of gender were included. The severity of the disease was assessed as per GOLD standards criteria as mild, moderate, severe and very severe based on spirometry. After taking informed consent, 3 ml blood sample was taken from each patient for C - reactive protein measurement. All the data was recorded in the proforma. Results:  Total of 101 patients were studied; their mean age was 56.59±13.35 years. Males were in majority 94.06%. 43.6% patients had mild COPD, 25.7% had moderate, 20.7% had severe and 9.9% patients had very severe COPD. There was a significant association between the severity of disease and elevated CRP level, p-value 0.001. A strong positive correlation was found between C - reactive protein level and chronic pulmonary disease, r-value 0.726 and p-value 0.005. Conclusion: Elevated serum level of CRP is a predictive factor for COPD as an inflammatory biomarker because it increases in chronic obstructive pulmonary disease patients causing a systemic chronic inflammatory process

Diagnostic accuracy of serum albumin for diagnosis of esophageal varices in patients of chronic liver disease

Objective: To determine the diagnostic accuracy of serum albumin for detection of esophageal varices (EVs) in patients of chronic liver disease (CLD) taking Esophagogastroduodenoscopy (EGD)as a gold standard.Methodology: The cross sectional study was accomplished at the department of gastroenterology, Isra University Hospital Hyderabad in collaboration with department of Gastroenterology, AIMS Hospital, Hyderabad, during six months from February 2017 to July 2017. All the Patients of age 20-60 years of either gender presenting with CLD were included. Blood samples from each patient submitted to laboratory to assess serum albumin level. Serum albumin level <3.4 g/dl was assessed as positive. Then patients were referred to department of gastroenterology for EGD. The data recording process was carried out by a proforma. Results: mean age of the patients was 53.63±14.61 years with male to female ratio was 2.3:1. Esophageal varices on serum albumin were found positive in 39 (41.1%) cases and EGD was found positive in 38.95% cases. The sensitivity of esophageal varices on serum albumin was 81.08% with specificity of 84.48%. The PPV value was 76.92%, NPV value was 87.5% and diagnostic accuracy of esophageal varices on serum albumin was 83.16% taking esophageal varices on EGD as gold standard.Conclusion: Serum albumin is a useful forecaster of esophageal varices among patients of chronic hepatic disorder with 81.08% sensitivity and of 84.48% specificity

Extrapulmonary tuberculosis in Pakistan- A nation-wide multicenter retrospective study

Background Pakistan is fifth among high burden countries for tuberculosis. A steady increase is seen in extrapulmonary tuberculosis (EPTB), which now accounts for 20% of all notified TB cases. There is very limited information on the epidemiology of EPTB. This study was performed with the aim to describe the demographic characteristics, clinical manifestations and treatment outcomes of EPTB patients in Pakistan. Method We performed descriptive analysis on routinely collected data for cohorts of TB patients registered nationwide in 2016 at health facilities selected using stratified convenient sampling. Findings Altogether 54092 TB including 15790 (29.2%) EPTB cases were registered in 2016 at 50 study sites. The median age was 24 years for EPTB and 30 years for PTB patients. The crude prevalence of EPTB in females was 30.5% (95%CI; 29.9–31.0) compared to 27.9% (95%CI; 27.3–28.4) in males. The likelihood of having EPTB (OR), was 1.1 times greater for females, 2.0 times for children, and 3.3 times for residents of provinces in the North-West. The most common forms of EPTB were pleural (29.6%), lymphatic (22.7%) and abdominal TB (21.0%). Pleural TB was the most common clinical manifestation in adults (34.2%) and abdominal TB in children (38.4%). An increase in the prevalence of pleural and osteoarticular and decline in lymphatic and abdominal TB was observed with advancing age. Diversity in demography and clinical manifestations were noted between provinces. The treatment success rate for all type EPTB was significantly high compared to bacteriology confirmed PTB with the exception of EPTB affecting CNS with a high mortality rate. Conclusions The study provides an insight into demography, clinical manifestations and treatment outcomes of EPTB. Further studies are needed to explain significant diversities observed between provinces, specific risk factors and challenges concerning EPTB management.publishedVersio

Turn on the Lights: Macroeconomic Factors Affecting Renewable in Pakistan

The objective of the study is to examine the relationship between macroeconomic factors (i.e., population growth; urbanization, industrialization, exchange rate, price level, food production index and live stock production index) and renewable energy in Pakistan over a period of 1975-2012. In addition, this study uses oil rent as an intervening variable to overcome the biasness of the single equation model. The results indicate that macroeconomic factors positively contributed to renewable energy consumption in Pakistan. The causality test indicate that there is a unidirectional causality running towards macroeconomic factors to renewable energy in Pakistan, however, renewable energy Granger cause oil rent but not via other route. In addition, there is bidirectional causality between exchange rate and live stock production in Pakistan. Variance decomposition analysis shows that economic growth has a major contribution to increase renewable energy in Pakistan

Turn on the Lights: Macroeconomic Factors Affecting Renewable in Pakistan

The objective of the study is to examine the relationship between macroeconomic factors (i.e., population growth; urbanization, industrialization, exchange rate, price level, food production index and live stock production index) and renewable energy in Pakistan over a period of 1975-2012. In addition, this study uses oil rent as an intervening variable to overcome the biasness of the single equation model. The results indicate that macroeconomic factors positively contributed to renewable energy consumption in Pakistan. The causality test indicate that there is a unidirectional causality running towards macroeconomic factors to renewable energy in Pakistan, however, renewable energy Granger cause oil rent but not via other route. In addition, there is bidirectional causality between exchange rate and live stock production in Pakistan. Variance decomposition analysis shows that economic growth has a major contribution to increase renewable energy in Pakistan

Correlation of Chronic Obstructive Pulmonary Disease severity with C-Reative Protien levels in patients at tertiary care Hospital

Objective: To determine the correlation of chronic obstructive pulmonary disease (COPD) severity and C-reactive protein (CRP) among patients at tertiary care Hospital. Methodology: This cross-sectional study was conducted at Medicine department of Isra University Hospital Hyderabad. All the patients of chronic pulmonary disease either of gender were included. The severity of the disease was assessed as per GOLD standards criteria as mild, moderate, severe and very severe based on spirometry. After taking informed consent, 3 ml blood sample was taken from each patient for C - reactive protein measurement. All the data was recorded in the proforma. Results:  Total of 101 patients were studied; their mean age was 56.59±13.35 years. Males were in majority 94.06%. 43.6% patients had mild COPD, 25.7% had moderate, 20.7% had severe and 9.9% patients had very severe COPD. There was a significant association between the severity of disease and elevated CRP level, p-value 0.001. A strong positive correlation was found between C - reactive protein level and chronic pulmonary disease, r-value 0.726 and p-value 0.005. Conclusion: Elevated serum level of CRP is a predictive factor for COPD as an inflammatory biomarker because it increases in chronic obstructive pulmonary disease patients causing a systemic chronic inflammatory process

Diagnostic accuracy of serum albumin for diagnosis of esophageal varices in patients of chronic liver disease

Objective: To determine the diagnostic accuracy of serum albumin for detection of esophageal varices (EVs) in patients of chronic liver disease (CLD) taking Esophagogastroduodenoscopy (EGD)as a gold standard.Methodology: The cross sectional study was accomplished at the department of gastroenterology, Isra University Hospital Hyderabad in collaboration with department of Gastroenterology, AIMS Hospital, Hyderabad, during six months from February 2017 to July 2017. All the Patients of age 20-60 years of either gender presenting with CLD were included. Blood samples from each patient submitted to laboratory to assess serum albumin level. Serum albumin level <3.4 g/dl was assessed as positive. Then patients were referred to department of gastroenterology for EGD. The data recording process was carried out by a proforma. Results: mean age of the patients was 53.63±14.61 years with male to female ratio was 2.3:1. Esophageal varices on serum albumin were found positive in 39 (41.1%) cases and EGD was found positive in 38.95% cases. The sensitivity of esophageal varices on serum albumin was 81.08% with specificity of 84.48%. The PPV value was 76.92%, NPV value was 87.5% and diagnostic accuracy of esophageal varices on serum albumin was 83.16% taking esophageal varices on EGD as gold standard.Conclusion: Serum albumin is a useful forecaster of esophageal varices among patients of chronic hepatic disorder with 81.08% sensitivity and of 84.48% specificity

Accuracy of 99mTechnetium-labeled RBC Scintigraphy and MDCT With Gastrointestinal Bleed Protocol for Detection and Localization of Source of Acute Lower Gastrointestinal Bleeding

Background: Acute lower gastrointestinal bleeding (LGIB) is a major cause of morbidity and mortality. Multidetector row computed tomography (CT) with gastrointestinal (GI) bleed protocol is a novel diagnostic technique for detecting and localizing LGIB. Being rapid and noninvasive, it may be useful as a first-line modality to investigate cases of acute LGIB.GOALS: To assess and compare diagnostic accuracy of Technetium (Tc)-labeled red blood cell (RBC) scintigraphy and multidetector row CT with GI bleed protocol for detection and localization of source of acute LGIB.STUDY: Requirement of informed consent was waived for this retrospective study. Seventy-six patients had undergone either RBC scintigraphy, CT with GI bleed protocol, or both, followed by conventional angiography for evaluation of acute persistent LGIB between January 2010 and February 2014 at our institution. Accuracy of both modalities was assessed using conventional angiography as reference standard and compared using the 2-tailed, Fisher exact test. A P-value of \u3c0.05 was considered statistically significant.Results: Fifty-one, 20, and 5 patients had undergone RBC scintigraphy only, CT with GI bleed protocol only, and both modalities, respectively. Fourteen of 25 patients in the CT group had angiographic evidence of active bleeding as compared with 32 of 56 patients in the scintigraphy group. CT with GI bleed protocol had higher accuracy (96%) than Tc-labeled RBC scintigraphy (55.4%, P\u3c0.001).CONCLUSIONS: CT with GI bleed protocol was more accurate in detecting and localizing the source of acute LGIB as compared with Tc-labeled RBC scintigraphy

Integrated computational analysis, in vitro, in vivo investigation on Myristica fragrans Houtt. essential oils for potential anti rheumatic activities

Rheumatoid arthritis (RA) is an inflammation associated autoimmune disorder that is prevalent worldwide. Occurrence of severe side effects with current therapeutic regimens is major concern these days. We investigated Myristica fragrans mace and seed for management of inflammation and RA. Oils were extracted and analyzed using ATR-FTIR conforming occurrence of the aromatic amine, phenolic, and carboxylic acid groups mostly found in terpenoids. Most of tested compounds exhibited compliance with drug likeness, bioavailability and ADMET set parameters of safety. Molecular docking analysis showed interaction (-0.6 ΔG (kJ mol-1) of Myristicin with 4F5S. A significant antioxidant activity with DPPH, H2O2 and FRAP assays was observed in case of essential oil. Essential oil part also presented a significant protective effect during heat induced hemolysis (66 ± 1.0 %), BSA denaturation assay (61 ± 1.4 %) and higher levels of proteinase inhibition (70 ± 1.4 %). Acute antiflammatory model in rat presented a significant decrease in inflammation with essential oil. It was concluded that Myrictica fragrans essential oil possess significant (p < 0.005) anti-inflammatory potential that can play a key role in management of RA

Extrapulmonary tuberculosis in Pakistan- A nation-wide multicenter retrospective study

Background Pakistan is fifth among high burden countries for tuberculosis. A steady increase is seen in extrapulmonary tuberculosis (EPTB), which now accounts for 20% of all notified TB cases. There is very limited information on the epidemiology of EPTB. This study was performed with the aim to describe the demographic characteristics, clinical manifestations and treatment outcomes of EPTB patients in Pakistan. Method We performed descriptive analysis on routinely collected data for cohorts of TB patients registered nationwide in 2016 at health facilities selected using stratified convenient sampling. Findings Altogether 54092 TB including 15790 (29.2%) EPTB cases were registered in 2016 at 50 study sites. The median age was 24 years for EPTB and 30 years for PTB patients. The crude prevalence of EPTB in females was 30.5% (95%CI; 29.9–31.0) compared to 27.9% (95%CI; 27.3–28.4) in males. The likelihood of having EPTB (OR), was 1.1 times greater for females, 2.0 times for children, and 3.3 times for residents of provinces in the North-West. The most common forms of EPTB were pleural (29.6%), lymphatic (22.7%) and abdominal TB (21.0%). Pleural TB was the most common clinical manifestation in adults (34.2%) and abdominal TB in children (38.4%). An increase in the prevalence of pleural and osteoarticular and decline in lymphatic and abdominal TB was observed with advancing age. Diversity in demography and clinical manifestations were noted between provinces. The treatment success rate for all type EPTB was significantly high compared to bacteriology confirmed PTB with the exception of EPTB affecting CNS with a high mortality rate. Conclusions The study provides an insight into demography, clinical manifestations and treatment outcomes of EPTB. Further studies are needed to explain significant diversities observed between provinces, specific risk factors and challenges concerning EPTB management