Pathological Mechanism of Atherosclerosis

Atherosclerosis is a multifactorial, smoldering, focal (intima of bifurcated blood arteries), chronic, progressive asymptotically, immune-inflammatory, disorder driven by lipid imbalance, in the large to medium sized (upto3mm external diameter) arteries with many cardiovascular clinical manifestations. Atherosclerosis developmentinvolves many cells, organs and even disturbed blood flow. The progression of atherosclerotic disease depends on the presence, degree, and persistence of risk factors like high-fat diet, smoking, hypertension, history of heart diseases, or diabetes. Endothelial dysfunction, ROS, accumulation of LDL, recruitment of Monocytes and T cells, differentiation of monocytes into macrophages and foam cells, formation of plaque and rupturing of plaque are key steps behind the clinical manifestation of atherosclerosis in cardiovascular diseases. This article describes the pathogenesis of atherosclerosis, possibility of therapeutically targeting mechanism and interventions which can be helpful to reverse or slower the atherosclerosis.

Ameliorate Effect of Ajwa (Phoenix dactylifera) on C-Reactive Protein, Lipid Profile and Cardiac Histopathology in Rabbits

Background: High fat diet causes oxidation of accumulated fat cells which leads to Atherosclerosis. The inflammatory marker C-reactive protein has recently been identified as an independent predictor of future coronary heart disease. The inflammatory marker C-reactive protein has recently been identified as an independent predictor of future coronary heart disease. Present study evaluated the cardioprotective role of Ajwa seed paste on lipid profile and C-reactive protein (CRP) level in rabbits. Methodology: 7 months old rabbits (n=15) for 30 days were kept in animal house school under standard laboratory conditions. Rabbits were divided into three groups (n=5). Group1 served as control group fed basal diet, group 2 fed high fat diet, group 3 fed high fat diet supplemented with 6gm ajwa seed paste. Feed consumption ratio was determined in all groups on daily basis.  Results: Feed consumption ratio showed significant (P>0.05) decrease in group 2and 3 fed high fat diet. In this study, lipid profile (cholesterol, triglyceride, LDL and VLDL) values were increased in group 2 compared to control group. It was found that significant (P>0.05) decrease in the level of bad cholesterol (LDL, VLDL) in group 3 (fed ajwa seed supplemented diet).HDL value showed significant (P>0.05) increase in group 3. HDL is good cholesterol and increased the level of HDL protect against the stroke and heart attack. and increase the level of good cholesterol (HDL).HDL takes the cholesterol from the body and back to liver where liver removes the bad cholesterol. The value of CRP is higher in group 2 due to the consumption of HFD and CRP level in group 3 showed significant (P>0.05) reduction.  Conclusion: It is concluded from present study that ajwa seed paste is beneficial for heart health

Loss-to-follow-up and delay to treatment initiation in Pakistan's national tuberculosis control programme

BACKGROUND: Researchers and policy-makers have identified loss to follow-up as a major programmatic problem. Therefore, the objective of this study is to quantify TB related pre-treatment loss to follow up and treatment delay in private sector health care facilities in Pakistan. METHODS: This was a retrospective, descriptive cohort study using routinely collected programmatic data from TB referral, diagnosis and treatment registers. Data from 48 private healthcare facilities were collected using an online questionnaire prepared in ODK Collect, for the period October 2015 to March 2016. Data were analysed using SPSS. We calculated the: (1) number and proportion of patients who were lost to follow-up during the diagnostic period, (2) number and proportion of patients with pre-treatment loss to follow-up, and (3) the number of days between diagnosis and initiation of treatment. RESULTS: One thousand five hundred ninety-six persons with presumptive TB were referred to the laboratory. Of these, 96% (n = 1538) submitted an on-the-spot sputum sample. Of the 1538 people, 1462 (95%) people subsequently visited the laboratory to submit the early morning (i.e. the second) sample. Hence, loss to follow-up during the diagnostic process was 8% overall (n = 134). Of the 1462 people who submitted both sputum samples, 243 (17%) were diagnosed with sputum smear-positive pulmonary TB and 231 were registered for anti-TB treatment, hence, loss in the pre-treatment phase was 4.9% (n = 12). 152 persons with TB (66%) initiated TB treatment either on the day of TB diagnosis or the next day. A further 79 persons with TB (34%) commenced TB treatment within a mean time of 7 days (range 2 to 64 days). CONCLUSION: Concentrated efforts should be made by the National TB Control Programme to retain TB patients and innovative methods such as text reminders and behavior change communication may need to be used and tested

Medical students’ attitudes towards the clinical importance of embryology

Objective of study: The objective of the study is to identify the attitudes of medical students towards the clinical importance of embryology. Methodology: The cross-sectional questionnaire-based survey was conducted at a private medical college of Sialkot, Islam Medical College from September 2019 to November 2019. Ethical approval was obtained from the Institutional Research and Ethics Committee prior to the study. Hundred First year and 100 final year medical students of Islam Medical College, participated in the survey. Thurdstone and Chave attitude analysis scoring was used to assess the attitudes.  The questionnaire consisted of 20 statements. Students had to tick only those statements with which they were in full agreement. Prior to conducting the study a median score was taken out of 50 anatomy teachers, showing their opinion toward each statement. Results: The results of the study showed that the medical students do appreciate the importance of embryology in the early years and to a more extent in the clinical years. The attitude scores remained on the positive side. Female students showed better attitudes towards embryology in both years. Conclusion:  To understand the importance of embryology efforts are required by the teachers teaching anatomy, and medical educationalists, to inform medical students of the relevance of embryology in attaining clinical competence. Key words: Attitude, Clinical, Embryology, Continuous..

Antimicrobial and Antioxidant Activity of Honey

Honey a super saturated concentrated solution with complex constituents has been used as therapeutic agent since ancient times. Natural products have been used as a substitute for various conventional treatments and drug discoveries. They have properties of honey including antioxidant, antibacterial, and anti-inflammatory, anti-cancerous. The advent of antibiotics in Modern Western Medicine has made the use of honey in the treatment of infectious diseases abandoned wound healing. Hence, this review exposes why honey remains the best antibiotic and its potency as an antioxidant, antibacterial, and anti-inflammatory. Honey possesses some vital components such as Methylgyloxal, Bee defensin-1, Hydrogen peroxide, osmotic effect and phenolic compounds. Honey also possesses properties that inhibit the formation of bio films. These made honey more powerful because it prevents the formation of antibiotic-resistant bacteria while conventional antibiotic fail because they only target the essential growth processes of bacteria and this allows bacteria to build up resistance over time

Fingerprint changes in CSF composition associated with different aetiologies in human neonatal hydrocephalus: Glial proteins associated with cell damage and loss

BACKGROUND: In hydrocephalus an imbalance between production and absorption of cerebrospinal fluid (CSF) results in fluid accumulation, compression and stretching of the brain parenchyma. In addition, changes in CSF composition have a profound influence on the development and function of the brain and together, these can result in severe life-long neurological deficits. Brain damage or degenerative conditions can result in release of proteins expressed predominantly in neurons, astroglia, or oligodendroglia into the brain interstitial fluid, CSF and blood. Determination of such products in the CSF might be of value in diagnosing cause, aetiology and/or assessing the severity of the neurological damage in patients with hydrocephalus. We therefore analysed CSF from human neonates with hydrocephalus for these proteins to provide an insight into the pathophysiology associated with different aetiologies. METHODS: CSF was collected during routine lumbar puncture or ventricular tap. Samples were categorized according to age of onset of hydrocephalus and presumed cause (fetal-onset, late-onset, post-haemorrhagic or spina bifida with hydrocephalus). Glial fibrillary acidic protein (GFAP), myelin basic protein (MBP), vimentin and 2(′) , 3(′)-cyclic nucleotide 3(′)-phosphodiesterase (CNPase) were analysed through Western blotting of hydrocephalic CSF samples (n = 17) and compared with data from CSF of normal infants without neurological deficits (n = 8). RESULTS: GFAP was significantly raised only in CSF from post-haemorrhagic hydrocephalus while MBP was significantly raised in post-haemorrhagic and in spina bifida with hydrocephalus infants. Vimentin protein was only detected in some CSF samples from infants with late-onset hydrocephalus but not from other conditions. Surprisingly, CNPase was found in all neonatal CSF samples, including normal and hydrocephalic groups, although it was reduced in infants with late onset hydrocephalus compared with normal and other hydrocephalic groups. CONCLUSIONS: Apart from CNPase, which is an enzyme, the markers investigated are intracellular intermediate filaments and would be present in CSF only if the cells are compromised and the proteins released. Raised GFAP observed in post-haemorrhagic hydrocephalus must reflect damage to astrocytes and ependyma. Raised MBP in post-haemorrhagic and spina bifida with hydrocephalus indicates damage to oligodendrocytes and myelin. Vimentin protein detected in some of the late-onset hydrocephalic samples indicates damage to glial and other progenitors and suggests this condition affects periventricular regions. The presence of CNPase in all CSF samples was unexpected and indicates a possible novel role for this enzyme in brain development/myelination. Less CNPase in some cases of late-onset hydrocephalus could therefore indicate changes in myelination in these infants. This study demonstrates differential glial damage and loss in the developing human neonatal hydrocephalic brain associated with different aetiologies

Loss-to-follow-up and delay to treatment initiation in Pakistan’s national tuberculosis control programme

Abstract Background Researchers and policy-makers have identified loss to follow-up as a major programmatic problem. Therefore, the objective of this study is to quantify TB related pre-treatment loss to follow up and treatment delay in private sector health care facilities in Pakistan. Methods This was a retrospective, descriptive cohort study using routinely collected programmatic data from TB referral, diagnosis and treatment registers. Data from 48 private healthcare facilities were collected using an online questionnaire prepared in ODK Collect, for the period October 2015 to March 2016. Data were analysed using SPSS. We calculated the: (1) number and proportion of patients who were lost to follow-up during the diagnostic period, (2) number and proportion of patients with pre-treatment loss to follow-up, and (3) the number of days between diagnosis and initiation of treatment. Results One thousand five hundred ninety-six persons with presumptive TB were referred to the laboratory. Of these, 96% (n = 1538) submitted an on-the-spot sputum sample. Of the 1538 people, 1462 (95%) people subsequently visited the laboratory to submit the early morning (i.e. the second) sample. Hence, loss to follow-up during the diagnostic process was 8% overall (n = 134). Of the 1462 people who submitted both sputum samples, 243 (17%) were diagnosed with sputum smear-positive pulmonary TB and 231 were registered for anti-TB treatment, hence, loss in the pre-treatment phase was 4.9% (n = 12). 152 persons with TB (66%) initiated TB treatment either on the day of TB diagnosis or the next day. A further 79 persons with TB (34%) commenced TB treatment within a mean time of 7 days (range 2 to 64 days). Conclusion Concentrated efforts should be made by the National TB Control Programme to retain TB patients and innovative methods such as text reminders and behavior change communication may need to be used and tested

Data Quality: A Negotiator between Paper-Based and Digital Records in Pakistan’s TB Control Program

Background: The cornerstone of the public health function is to identify healthcare needs, to influence policy development, and to inform change in practice. Current data management practices with paper-based recording systems are prone to data quality defects. Increasingly, healthcare organizations are using technology for the efficient management of data. The aim of this study was to compare the data quality of digital records with the quality of the corresponding paper-based records using a data quality assessment framework. Methodology: We conducted a desk review of paper-based and digital records over the study duration from April 2016 to July 2016 at six enrolled tuberculosis (TB) clinics. We input all data fields of the patient treatment (TB01) card into a spreadsheet-based template to undertake a field-to-field comparison of the shared fields between TB01 and digital data. Findings: A total of 117 TB01 cards were prepared at six enrolled sites, whereas just 50% of the records (n = 59; 59 out of 117 TB01 cards) were digitized. There were 1239 comparable data fields, out of which 65% (n = 803) were correctly matched between paper based and digital records. However, 35% of the data fields (n = 436) had anomalies, either in paper-based records or in digital records. The calculated number of data quality issues per digital patient record was 1.9, whereas it was 2.1 issues per record for paper-based records. Based on the analysis of valid data quality issues, it was found that there were more data quality issues in paper-based records (n = 123) than in digital records (n = 110). Conclusion: There were fewer data quality issues in digital records as compared with the corresponding paper-based records of tuberculosis patients. Greater use of mobile data capture and continued data quality assessment can deliver more meaningful information for decision making

Additional file 1: of Loss-to-follow-up and delay to treatment initiation in Pakistan’s national tuberculosis control programme

De-identified data taken from patient registers. (XLSX 413 kb