Seasonal variation of phenolics, flavonoids, antioxidant and lipid peroxidation inhibitory activity of methanolic extract of Melilotus indicus and its sub-fractions in different solvents

In the present work, seasonal variations of total phenolic and flavonoid contents, antioxidant activity and lipid peroxidation inhibitory activities of methanolic extract of Melilotus indicus and its sub-fractions in different solvents have been evaluated. The study was conducted on plant samples collected in February and April which are its flowering and fruiting seasons respectively. Both phenolic and flavonoid contents were higher in methanolic extract of the plant collected in April than in February. Free radical scavenging activity measured through DPPH method was low in methanolic extracts of both the samples, although it decreased as we go from February to April. Ethyl acetate fractions showed highest % inhibition. Total antioxidant activity of methanolic extracts measured through phosphomolybdate assay remained almost same. Chloroform fraction showed the highest value in both the seasons with value in April higher than in February, 57.24 and 46.44 µg of ascorbic acid equivalents per mg of the dried mass, respectively.  The methanolic extract of April sample showed higher FRAP (ferric reducing antioxidant power) value than that of February. In February, ethyl acetate fraction showed highest FRAP value, while in April, chloroform exhibited the highest value. Methanolic extracts and fractions in all solvents showed remarkable ability to inhibit peroxidation in linoleic acid. After 72 hours, all samples were much more effective than the standard BHA. Seasonal variations affect biosynthesis of different types of antioxidant and free radical scavenging compounds in Melilotus indicus. Thus, the medicinal and nutritional value of the plant will depend on harvesting season

Sepsis management: An evidence-based approach.

The Surviving Sepsis Campaign (SSC) guidelines have outlined an early goal directed therapy (EGDT) which demonstrates a standardized approach to ensure prompt and effective management of sepsis. Having said that, there are barriers associated with the application of evidence-based practice, which often lead to an overall poorer adherence to guidelines. Considering the global burden of disease, data from low- to middle-income countries is scarce. Asia is the largest continent but most Asian countries do not have a well-developed healthcare system and compliance rates to resuscitation and management bundles are as low as 7.6% and 3.5%, respectively. Intensive care units are not adequately equipped and financial concerns limit implementation of expensive treatment strategies. Healthcare policy-makers should be notified in order to alleviate financial restrictions and ensure delivery of standard care to septic patients

Overcrowding in the emergency departments: challenges and opportunities for improvement

With the advent of Emergency Medicine, one can observe an increase in the number of Emergency Departments (ED) across the country. However, most EDs struggle due to an overwhelming number of patients. Overcrowding can lead to delays in patient care. For a city like Karachi which is an active disaster zone, preemptive preparedness is required in the face of terror threats and such overcrowding needs to be decreased to a bare minimum. The most frequent causes of prolonged length of stay (LOS) in the ED include non-availability of in-hospital beds, delays in response to subspecialty consultations and escalating medical expenses. All of these can negatively impact patient care by putting patient safety at risk and patient care in jeopardy. There is an increased risk of unintentional medical errors and a concomitant increase in unwanted lawsuits. A few simple interventions which may help alleviate this situation to some extent have been discussed

Evidence of the COVID-19 virus targeting the CNS: Tissue distribution, host-virus interaction, and proposed neurotropic mechanisms

The recent outbreak of coronavirus infectious disease 2019 (COVID-19) has gripped the world with apprehension and has evoked a scare of epic proportion regarding its potential to spread and infect humans worldwide. As we are in the midst of an ongoing pandemic of COVID-19, scientists are struggling to understand how it resembles and differs from the severe acute respiratory syndrome coronavirus (SARS-CoV) at the genomic and transcriptomic level. In a short time following the outbreak, it has been shown that, similar to SARS-CoV, COVID-19 virus exploits the angiotensin-converting enzyme 2 (ACE2) receptor to gain entry inside the cells. This finding raises the curiosity of investigating the expression of ACE2 in neurological tissue and determining the possible contribution of neurological tissue damage to the morbidity and mortality caused by COIVD-19. Here, we investigate the density of the expression levels of ACE2 in the CNS, the host-virus interaction and relate it to the pathogenesis and complications seen in the recent cases resulting from the COVID-19 outbreak. Also, we debate the need for a model for staging COVID-19 based on neurological tissue involvement

Recent facts of eating habits and obesity among adolescent; a case of Pakistan

Background: Obesity is an escalating problem that is reaching to pandemic level. Multiple factors may involve in causing obesity such as improper food pattern of physical activities, social and ecological variables, choice of menu and other biological factors. Conducting to a study to evaluate the primary cause. However, a few studies are conducting to see the impact of eating patterns on health and weight. Methods: University students (n=150, ages 18-24 years) 50% males and 50% females were selected for data collection via questionnaire. The outcomes showed that 70 individuals prefer to eat saturated fats that can lead to accumulation of bad cholesterol. 5% females and 5% males prefer using trans-fat that is even worse. On the other hand, 44 respondents prefer to choose low fat food. Results: About 25% individuals are unaware of nutritional on facts of the products but females are more conscious as compared to the men. 55% individuals eat unconsciously while watching television and consume more than the requirement. 94 individuals got attracted by advertisement tactics of food companies and but to eat them. It is also witnessed that males (32%) consume more carbonated drinks than females (13%). 64 students strongly agreed that supplements lead to obesity. In our sample population 10% obese, 14% were overweight and 47% were of normal weight. Conclusion: The major reason of obesity could be that they are eating out more often. It could be due to the fact they are dependent on high calorie food. There is a lack of vegetables and fruits in their diet. On the other hand, fruits, veggies and whole grains are linked to less gain and even weight loss. Making smart food choices can help you stay slim and healthy.

Insulin Resistance Estimated by HOMA IR for Diagnosis of Gestational Diabetes in Squatter Settlement of Karachi

Background: Gestational diabetes mellitus (GDM), one of the most common metabolic disorders of pregnancy, is estimated to raise 16-27% worldwide every 10 years. Researchers, using Homeostasis model assessment test (HOMA IR), a tool for assessing insulin resistance, have found a number of causes. This study was designed to investigate the correlation between insulin resistance and GDM in the second trimester. Methods: This study recruited 84 pregnant women (24 to 28 weeks of gestation) from OPD of Gynaecology/Obstetrics and Family Medicine Department, Dr. Ziauddin Hospital Karachi Pakistan from May 2018 to January 2019. A thorough anthropometric measurements and antenatal history was recorded through structured questionnaire after informed consent. After 10 hours fast, venous blood (5ml) was drawn for fasting blood glucose (FBS), insulin levels and Glucose challenge test (GCT) for screening gestational diabetes. Results: Out of 84 subjects, 37 had higher GCT values while 47 had normal level. FBS was found significantly associated (p < 0.05). With GCT among GDM subjects 16(19%) had normal Body Mass Index (BMI) and 18(21.4%) had normal body fat percentage however, 2(2.4%) had high insulin levels and 13(15.5%) high FBS levels. The value HOMA IR, ≤1.29 was found in 38(45.2) healthy mothers and 25(29.8) GDM. Patients’ GCT had positive association with parity, FBS, insulin, HOMA IR and BMI. Conclusion: Linear strong positive correlation was found between insulin resistance and GCT in the second trimester. Patients with significantly higher GCT values and index value of HOMA IR greater than >1.29 are at risk for developing GDM

Association of burnout with doctor–patient relationship and common stressors among postgraduate trainees and house officers in Lahore—a cross-sectional study

Introduction Burnout is defined as a prolonged state of physical and psychological exhaustion. Doctors, due to the demanding nature of their job, are susceptible to facing burnout, which has far reaching implications on their productivity and motivation. It affects the quality of care they provide to patients, thus eroding the doctor–patient relationship which embodies patient centeredness and autonomy. The study aims at addressing the stressors leading to burnout and its effect on the doctor–patient relationship. Methods A descriptive, cross-sectional study design with convenience (non-probability) sampling technique was employed in six major hospitals of Lahore, Pakistan. A total of 600 doctors were approached for the study which included house officers or “HOs” (recent graduates doing their 1 year long internship) and post-graduate trainees or “PGRs” (residents for 4–5 years in their specialties). Burnout was measured using the Copenhagen Burnout Inventor (CBI) while attitudes towards the doctor–patient relationship was measured using the Patient Practitioner Orientation Scale (PPOS), which measures two components of the relationship: power sharing and patient caring. Pearson correlation and linear regression analysis were used to analyze the data via SPSS v.21. Results A total of 515 doctors consented to take part in the study (response rate 85.83%). The final sample consisted of 487 doctors. The burnout score was not associated with the total and caring domain scores of PPOS (P > 0.05). However, it was associated with the power sharing sub-scale of PPOS. Multiple linear regression analysis yielded a significant model, by virtue of which CBI scores were positively associated with factors such as female gender, feeling of burn out, scoring high on sharing domain of PPOS and a lack of personal control while CBI scores were negatively associated with private medical college education, having a significant other, accommodation away from home and a sense of never ending competition. Burnout levels varied significantly between house officers and post graduate trainees. Twenty-three percent of the participants (mostly house officers) had high/very high burnout levels on the CBI (Kristenson’s burnout scoring). Both groups showed significant differences with respect to working hours, smoking status and income. Conclusion Although burnout showed no significant association with total and caring domain scores of PPOS (scale used to assess doctor–patient relationship), it showed a significant association with the power sharing domain of PPOS suggesting some impact on the overall delivery of patient care. Thus, it necessitates the monitoring of stressors in order to provide an atmosphere where patient autonomy can be practiced

Elucidation of cellular targets and exploitation of the receptor-binding domain of SARS-CoV-2 for vaccine and monoclonal antibody synthesis

The pandemic caused by novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has resulted in over 452,822 deaths in the first twenty days of June 2020 due to the coronavirus virus disease 2019 (COVID-19). The SARS-CoV-2 uses the host angiotensin-converting enzyme 2 (ACE2) receptor to gain entry inside the human cells where it replicates by using the cell protein synthesis mechanisms. The knowledge of the tissue distribution of ACE2 in human organs is therefore important to predict the clinical course of the COVID-19. Also important is the understanding of the viral receptor-binding domain (RBD) a region within the spike (S) proteins that enable the entry of the virus into the host cells to synthesize vaccine and monoclonal antibodies (mAbs). We performed an exhaustive search of human protein databases to establish the tissues that express ACE2 and performed an in-depth analysis like sequence alignments and homology modeling of the spike protein (S) of the SARS-CoV-2 to identify antigenic regions in the RBD that can be exploited to synthesize vaccine and mAbs. Our results show that ACE2 is widely expressed in human organs that may explain the pulmonary, systemic, and neurological deficits seen in COVID-19 patients. We show that though the S protein of the SARS-CoV-2 is a homolog of S protein of SARS-CoV-1, it has regions of dissimilarities in the RBD and transmembrane segments. We show peptide sequences in the RBD of SARS-CoV-2 that can bind to the MHC alleles and serve as effective epitopes for vaccine and mAbs synthesis

Docking prediction of amantadine in the receptor binding domain of spike protein of SARS-CoV-2

Amantadine has recently been shown to improve patients with COVID-19. In addition to its known mechanism of actions, we performed docking prediction of this drug on the receptor-binding domain of severe acute respiratory syndrome coronavirus 2, SARS-CoV-2. We hypothesize that such interaction may possibly have contributed a role in the clinical improvements reported