Ethnomedicinal and cultural practices of mammals and birds in the vicinity of river Chenab, Punjab-Pakistan

BACKGROUND

Although, use of animal species in disease treatment and culture practices is as ancient as that of plant species; however ethnomedicinal uses and cultural values of animal species have rarely been reported. Present study is the first report on the medicinal uses of mammals and bird species in Pakistan.

METHODS

Questionnaires and semi-structured interviews were applied to collect qualitative and quantitative data from local informants (N = 109). Relative frequency of mention (RFM), fidelity level (FL), relative popularity level (RPL), similarity index (SI) and rank order priority (ROP) indices were used to analyzed the data.

RESULTS

One hundred and eight species of animals, which include: 83% birds and 17% mammals were documented. In total 30 mammalian and 28 birds' species were used to treat various diseases such as rheumatic disorders, skin infections and sexual weakness among several others. Fats, flesh, blood, milk and eggs were the most commonly utilized body parts. Bos taurus, Bubalus bubalis, Capra aegagrus hircus, Felis domesticus, Lepus nigricollis dayanus and Ovis aries (mammals) and Anas platyrhynchos domesticus, Columba livia, Coturnix coturnix, Gallus gallus and Passer domesticus (birds) were the highly utilized species. Medicinal and cultural uses of 30% mammals and 46% birds were reported for the first time, whereas 33% mammals and 79% birds depicted zero similarity with previous reports.

CONCLUSION

Present study exhibits significant ethnozoological knowledge of local inhabitants and their strong association with animal species, which could be helpful in sustainable use of biodiversity of the region. Additionally, in vitro and in vivo evaluation of biological activities in the mammalian and birds' species with maximum fidelity level and frequency of mention could be important to discover animal based novel drugs. Some commonly used mammals and birds species of the study area.

An ethnobotanical survey of indigenous medicinal plants in Hafizabad district, Punjab-Pakistan

Present paper offers considerable information on traditional uses of medicinal plants by the inhabitants of Hafizabad district, Punjab-Pakistan. This is the first quantitative ethnobotanical study from the area comprising popularity level of medicinal plant species intendedby using relative popularity level (RPL) and rank order priority (ROP) indices.Ethnobotanical data were collected by interviewing 166 local informants and 35 traditional health practioners (THPs) from different localities of Hafizabad district. Demographic features of informants; life form, part used, methods of preparation, modes of application and ethnomedicinal uses were documented. Ethnobotanical data were analyzed using quantitative tools, i.e. Relative frequency citation (RFC), use value (UV), informant consensus factor (ICF) fidelity level (FL), RPL and ROP indices. A total of 85 species belonging to 71 genera and 34 families were documented along with ethnomedicinal uses. Solanum surattense, Withania somnifera, Cyperus rotundus, Solanum nigrum and Melia azedarach were the most utilized medicinal plant species with highest used value. The reported ailments were classified into 11 disease categories based on ICF values and highest number of plant species was reported to treat dermatological and gastrointestinal disorders. Withania somnifera and Ranunculus sceleratus with maximum FL (100%), were used against gastrointestinal and urinary disorders, respectively. The RPL and ROP values were calculated to recognize the folk medicinal plant wealth; six out of 32 plant species (19%) were found popular, based on citation by more than half of the maximum number of informant viz. 26. Consequently, the ROP value for these species was more than 75. The comparative assessment with reported literature revealed 15% resemblance and 6% variation to previous data;however79% uses of the reported species were recorded for the first time. The diversity of medicinal plant species and associated traditional knowledge is significant in primary health care system. Medicinal plant species with high RPL values should be screened for comprehensive phytochemical and pharmacological studies. This could be useful in novel drug discovery and to validate the ethomendicinal knowledge.

Novel homozygous sequence variants in the GDF5 gene underlie acromesomelic dysplasia type-grebe in consanguineous families

Acromesomelic dysplasia Grebe type (AMDG) is characterized by severe knob like non-functional fingers and short acromesomelic limbs, and is inherited in an autosomal recessive manner. Disease causing sequence variants in the GDF5 (Growth Differentiation Factor 5) gene located on chromosome 20q11.22 are responsible for causing AMDG. In the study, presented here, two consanguineous families with AMDG were clinically and genetically characterized. After establishing linkage in the two families (A and B) to GDF5 gene on chromosome 20q11.22, Sanger DNA sequencing was performed in all available affected and unaffected members. Sequence analysis of the GDF5 gene revealed two novel variants including a duplication (c.157_158dupC, p.Leu53Profs*41) in family A, and a nonsense (p.Trp291*) in family B. Our findings extend the body of evidence that supports the importance of GDF5 in the development of limbs.

Evaluation of the CropSyst Model during Wheat-Maize Rotations on the North China Plain for Identifying Soil Evaporation Losses

The North China Plain (NCP) is a major grain production zone that plays a critical role in ensuring China's food supply. Irrigation is commonly used during grain production; however, the high annual water deficit [precipitation (P) minus evapotranspiration (ET)] in typical irrigated cropland does not support double cropping systems (such as maize and wheat) and this has resulted in the steep decline in the water table (~0.8 m year^-1 at the Luancheng station) that has taken place since the 1970s. The current study aimed to adapt and check the ability of the CropSyst model (Suite-4) to simulate actual evapotranspiration (ET_a), biomass, and grain yield, and to identify major evaporation (E) losses from winter wheat (WW) and summer maize (SM) rotations. Field experiments were conducted at the Luancheng Agro-ecosystem station, NCP, in 2010-2011 to 2012-2013. The CropSyst model was calibrated on wheat/maize (from weekly leaf area/biomass data available for 2012-2013) and validated onto measured ET_a, biomass, and grain yield at the experimental station from 2010-2011 to 2011-2012, by using model calibration parameters. The revalidation was performed with the ET_a, biomass, grain yield, and simulated ET_a partition for 2008-2009 WW [ET_a partition was measured by the Micro-lysimeter (MLM) and isotopes approach available for this year]. For the WW crop, E was 30% of total ET_a; but from 2010-11 to 2013, the annual average E was ~40% of ET_a for the WW and SM rotation. Furthermore, the WW and SM rotation from 2010-2011 to 2012-2013 was divided into three growth periods; (i) pre-sowing irrigation (PSI; sowing at field capacity) to emergence period (EP), (ii) EP to canopy cover period (CC) and (iii) CC to harvesting period (HP), and E from each growth period was ~10, 60, and 30%, respectively. In general, error statistics such as RMSE, Willmott's d, and NRMSE in the model evaluation for wheat ET_a (maize ET_a) were 38.3 mm, 0.81, and 9.24% (31.74 mm, 0.73, and 11.89%); for wheat biomass (maize biomass) they were 1.25 Mg ha^-1, 0.83, and 9.64% (0.78 Mg ha^-1, 0.96, and 7.96%); and for wheat grain yield (maize grain yield) they were 0.65 Mg ha^-1, 0.82, and 9.87% (0.2 Mg ha^-1, 0.99, and 3.79%). The results showed that CropSyst is a valid model that can be use with a reliable degree of accuracy for optimizing WW and SM grain yield production and water requirement on the NCP.

A Novel Heterozygous Intragenic Sequence Variant in DLX6 Probably Underlies First Case of Autosomal Dominant Split-Hand/Foot Malformation Type 1

Split-hand and foot malformation (SHFM; MIM 183600) is a rare human genetic limb malformation. It is characterized by missing digital rays in the hands and feet. SHFMs vary in severity from mild abnormalities affecting a single limb to acute malformations involving all 4 limbs. It is inherited, as part of both a syndromic and nonsyndromic disorder, in an autosomal recessive, autosomal dominant, and X-linked patterns. So far, 9 loci of hand and foot malformation have been mapped on human chromosomes. The present study describes a family with 2 affected individuals segregating SHFM in an autosomal dominant fashion. Sanger sequencing of the genes involved in SHFM was performed to identify the disease-causing variant. Sequence analysis revealed the first heterozygous missense variant (c.632T>A, p.Val211Glu) in the distal-less homeobox 6 (DLX6) gene, located in chromosome 7q21, causing SHFM in the present family. This study supports the evidence of DLX6 as an SHFM-causing gene.

Immunomodulatory activities of gemifloxacin in mice

OBJECTIVES

Gemifloxacin is a broad spectrum antibiotic and has shown excellent coverage against a wide variety of microorganisms. In this study, an attempt was made to evaluate the immunomodulatory potential of gemifloxacin in male swiss albino mice in vivo.

MATERIALS AND METHODS

Three doses of gemifloxacin 25 mg/kg, 50 mg/kg and 75 mg/kg were used intraperitoneally (IP) for the evaluation of immune responses in mice. Delayed type hypersensitivity (DTH), heamagglutination assay, jerne hemolytic plaque formation assay and cyclophosphamide induced neutropenia assay were performed to evaluate the effect of gemifloxacin on immune responses.

RESULTS

DTH assay has shown the significant immune suppressant potential of gemifloxacin at 25 mg/kg dose and 75mg/kg dose. Total leukocyte count (TLC) has shown decrease in leukocyte count (P<0.05) in drug treatment groups before cyclophosphamide administration and significant decrease (P<0.001) in leukocyte count after cyclophosphamide administration as compared to negative control group. Differential leukocyte count (DLC) has shown significant decrease (P<0.001) in percentage count of lymphocytes in 75 mg/kg treatment group in leukopenic mice while increase (P<0.01) in monocytes percentage in 50 mg/kg treatment group in leukopenic mice and increase in neutrophil percentage count (P<0.05) in all treatment groups was observed after cyclophosphamide administration. Humoral immune response is shown to be suppressed in dose dependent manner by both heamagglutination titre values (P<0.001) and jerne hemolytic plaque formation assay (P<0.001).

CONCLUSION

The results of this work clearly demonstrate that gemifloxacin has significant immunomodulatory potential.

Exome sequencing revealed a novel splice site variant in the ALX1 gene underlying frontonasal dysplasia

Frontonasal dysplasia (FND) is a heterogeneous group of disorders characterized by hypertelorism, telecanthus, broad nasal root, wide prominent nasal bridge, short and wide nasal ridge, broad columella and smooth philtrum. To date one X-linked and three autosomal recessive forms of FND have been reported in different ethnic groups. We sought to identify the gene responsible for FND in a consanguineous Pakistani family segregating the disorder in autosomal recessive pattern. Genome-wide homozygosity mapping using 250KNsp array revealed five homozygous regions in the selected affected individuals. Exome sequencing found a novel splice acceptor site variant (c.661-1G>C: NM_006982.2) in ALX1. Sanger sequencing confirmed the correct segregation of the pathogenic variant in the whole family. Our study concludes that the splice site variant identified in the ALX1 gene causes mild form of FND.

RELATIONSHIP OF PARENTAL HEALTH AND SOCIAL SUPPORT DURING PREGNANCY WITH THE RISK OF NON-SYNDROMIC ORAL CLEFTS: A CASE � CONTROL STUDY

AbstractOral clefts are divided into cleft lip, cleft palate and cleft lip along with cleft palate. Cleft palate is defined as an inability of palatal shelves to approximate and close during the first months of embryogenic period thus leaving an opening in the roof of the mouth and forming communication between the nasal and oral cavities.Objective:To determine the relationship of risk of oral clefts with parental health and social support.Study Design: Case Control Study.Study Setting and Duration:Various hospitals in Lahore and 3 month duration.Materials and Methods:A Case Control Study was conducted. A total of 100 subjects (50 cases, 50 controls) were included. Sampling was done by purposive method. Data was collected with the help of Cornell Medical Index Health Questionnaire and Social Support Questionnaire after taking their informed consent. Data was analyzed by using SPSS version 20.0. Mean and standard deviation were used to describe quantitative variables like age. Test of significance were applied.Results:56% of cases were females and 44% were males. Mean age of mothers was 27 and fathers was 31. Most mothers were uneducated (36%) while most fathers were educated till matric (34%). Income of most parents was in the range of 10,000-20,000 PKR (44%). 24% of controls were females and 76% were males. The associations of oral cleft was found significant with parental respiratory, cardiovascular, gastro-intestinal, musculoskeletal, skin-related, genitourinary health, easy fatigability, health habits, anxiety, anger, paternal nervous system health, sensitivity, and mater-nal frequency of illness, depression and feeling of inadequacy (p < 0.05). Maternal social support catego-ries indicated that cases were less supported than con-trols: number of persons available and level of satisfaction (p < 0.05).Conclusion:Oral clefts have a multi-factorial etio-logy. Hence, an effective preventive program should take into account parental health and social support factors.Key Words:Non-syndromic Oral Clefts, Parental Health, Social Support.

Focal triphasic sharp waves and spikes in the electroencephalogram

There is a plethora of data in the EEG literature on the characteristics of the most prominent component of interictal epileptiform discharges (IED), namely the negative (fast) phase. Surprisingly, however, little attention has been drawn to the after-coming slow wave (ASW), and its pathological as well as clinical significance. In this paper, we will address the significance of prominent (high amplitude) ASW, giving rise to a triphasic morphology of the IED (focal triphasic sharp waves and spikes—FTSW). We will discuss this EEG pattern with respect to its clinical, neurophysiological, and neuropathological significance. This investigation was conducted on a heterogeneous group of patients at KKH, Ha'il, KSA. Our data revealed that FTSW were rare EEG events occurring primarily in the first two decades of life. Ninety percent of the patients with FTSW had epilepsy, presenting clinically with generalized convulsive seizures, often without partial onset. The majority of these patients responded favorably to anticonvulsant monotherapy. We were surprised to find that half of the patients with FTSW had chronic and/or static CNS pathology, particularly congenital CNS anomalies. Even though more than one mechanism may be involved in the pathogenesis of FTSW, we believe a deeply seated pacemaker as the source of this EEG pattern is the most compelling theory. The presence of FTSW should alert clinicians to the possibility of an underlying chronic and/or static CNS pathology, in particular congenital CNS anomalies, underscoring the significance of neuroimaging in the work-up of this population. Moreover, it is conceivable that the prominent ASW may contribute to the interictal intellectual dysfunction of these patients, justifying aggressive anticonvulsant therapy.

Abstract W P26: Meta-analysis Of Studies Using Solitaire And Trevo Pro Stent Retriever Devices For Mechanical Thromboembolectomy In Acute Cerebral Ischemia

Objective: To report rates of recanalization and symptomatic intracerebral hemorrhage (SICH) after mechanical thromboembolectomy using Solitaire and Trevo Pro devices in acute cerebral ischemia using meta-analysis of published studies.

Methods: We identified all studies that used Solitaire or Trevo devices for mechanical thromboembolectomy in treatment of acute cerebral ischemia using a search on PubMed and Cochrane libraries, stroke trials database, proceedings of neurology and neurosurgery related conferences, and supplemented by a review of bibliographies of selected publications. Recanalization was assessed using TICI >2a and rates of SICH were recorded. For the meta-analysis, forest plots and statistical analysis including event rates [ER] with 95% confidence intervals [CI] based on both fixed and random models were performed using Comprehensive Meta-Analysis Software. The presence of publication bias was interrogated by funnel plot of Standard Error by log odds ratio.

Results: Eighteen studies with Solitaire device and five with Trevo device were identified and included in the meta-analysis. There were a total of 433/505 (85%, ER 0.85 [CI] 0.80-0.88, P<0.001) successful recanalizations with Solitaire device whereas 196/243 (80%, ER 0.80 [CI] 0.74-0.85, P<0.001) successful recanalizations were noted with Trevo device. The incidence of SICH was 45/505 (9%, ER 0.09 [CI] 0.06-0.14, P<0.001) with Solitaire device and 17/243 (6%, ER 0.06 [CI] 0.049-0129, P<0.001) with Trevo device after mechanical thrombectomy. There was no publication bias.

Conclusions: Meta-analysis of studies reveals similar rates for recanalization and SICH after mechanical thromboembolectomy using Solitaire or Trevo Pro devices.

Abstract 58: Rates of In-Hospital Adverse Events and Discharge Outcomes Among Ischemic Stroke Patients Admitted to Joint Commission Primary Stroke Centers in United States

Background: The beneficial impact of certification by Joint Commission (JC) for primary stroke centers (PSCs), on in hospital adverse events and outcomes remains unproven.

Objective: To compare the rates of in-hospital adverse events and discharge outcomes among ischemic stroke patients between PSC and no PSC hospitals in United States.

Methods and Results: We obtained the data from Nationwide Inpatient Sample from 2010 and 2011. The analysis was limited to states that publicly reported hospital identity. PSCs were identified by matching the NIS hospital files with the list provided by JC. The analysis was limited to patients (age ≥18 years) discharged with a principal diagnosis of ischemic stroke (ICD9 codes 433.x1, 434.x1, 436).

Results: We identified a total of 123,131 ischemic stroke patients from 28 states. A total of 72,982 (59.3%) patients were admitted at PSCs. Patients admitted at PSCs were more likely to be men (48.3 vs. 46.7, p<0.0001), white (75.2 vs. 73.3, p<0.0001) and younger in age (71.1±14.7 vs. 72.3±14.3 p<0.0001. Total length of stay was similar among PSCs and non-PSCs (5.09±6. vs. 5.14±6.15 p<0.0001), while total charges were higher at PSCs ($48828 vs. $35946±14.3 p<0.0001). After adjusting for age, sex, race co-morbidities, DRG-based disease severity, and hospital characteristics, patients admitted at PSCs were at lower risk of in hospital adverse events complications; pneumonia (OR, 0.8; 95% CI, 0.7 to 0.9)-, urinary tract infection (OR, 0.97; 95% CI, 0.0.92 to 1.02), sepsis (OR, 0.65; 95% CI, 0..56 to 0..76), deep venous thrombosis (OR, 1.0; 95% CI, 0.76 to 1.33) and pulmonary embolism (OR, 0.58; 95% CI, 0.43 to 0.72). Patients evaluated at PSCs were more likely to receive rt-PA (OR, 1.32; 95% CI, 1.19 to 1.45) with less impatient mortality (OR, 0.88; 95% CI, 0.81 to 0.96) and more likely to get discharge to home (OR, 1.11; 95% CI, 1.07 to 1.15).

Conclusions: Patients admitted to PSCs are less likely to have in hospital adverse events and better discharge outcomes.

Abstract 50: Oral Contraceptive Use and Incident Stroke in Women With Sickle Cell Disease

Background: Oral contraceptives increase the risk of ischemic stroke among women. However, the effect is not studied in the stroke prone sickle cell disease population.

Objective: To determine the rate of incident stroke among women with sickle cell disease enrolled a large cohort with longitudinal follow-up.

Methods: A total of 1263 women aged ≥15 and <45 years, were enrolled in Phase 1 of Cooperative Study of Sickle Cell Disease from 23 centers across the US. Participants underwent a baseline examination for assessment of demographics, prior medical history, lab assessments, and clinical data. Post baseline data included routine follow-up examinations, measures of organ damage, and collection of acute and chronic complications. The effect of oral contraceptive use on incident stroke were assessed after adjusting for age, cigarette smoking, and history of exchange transfusion by Cox Proportional Hazards analysis.

Results: A total of 281 (22.2%) of 1263 women with sickle cell disease reported use of oral contraceptives. There was no difference in the mean age (±SD) of the women who reported use compared with those without of oral contraceptives (27 ±6 versus 27±8, p=0.9). History of exchange transfusions (24.2 % versus 15.0 %, p=0.003) and cigarette smoking (24.7 % versus 18.5 %, p=0.03) were more common among women who report use of oral contraceptives. The age adjusted annual incidence of incident stroke among women who used oral contraceptives was four folds higher than those who did not report use (1.4% versus 0.3%, p= 0.04). After adjusting for exchange transfusion and cigarette smoking, oral contraceptive use was not associated with rate of ischemic stroke (HR, 0.3 95% CI 0.06-1.3, p= 0.2) or stroke free survival (HR, 0.98 95% CI 0.6-1.6, p= 0.9).

Conclusions: The four fold higher risk of incident stroke associated with use of oral contraceptives in women with sickle cell disease can be mitigated by avoiding cigarette smoking.

Abstract T MP24: Are There Disparities in Thrombolytic Treatment and Mortality in Acute Ischemic Stroke in the Hispanic Population Living in Border States versus Non-Border States?

Background: Recent studies have found an underutilization of hospital in-patient care for coronary artery disease in Hispanics living in Border States.

Objective: To identify acute treatment disparities in acute ischemic stroke Hispanic patients and determine the effect of such disparity on patient outcomes.

Methods: We identified Hispanic and non-Hispanic acute ischemic stroke patients from the Nationwide Inpatient Sample-2011 data files. We determined the rate of utilization of thrombolytics and outcomes according to patient’s demographic and clinical characteristics and whether or not they lived in a Border state (defined as California, Arizona, New Mexico and Texas).

Results: A total of 34,904 Hispanic patients were admitted with ischemic stroke; of those 21,130 were admitted in Border states and 13,774 in non-Border states. Patient demographics, risk factors, complications and discharge disposition are included in the Tables below. There was a significantly lower rate of thrombolytic use in Hispanic patients (1013 (4.8%) and non-Hispanics (5326 (5.7%, p=0.05). After adjusting for age, gender, and other confounding risk factors, Hispanics were 30% more likely to suffer in-hospital mortality versus there non-Hispanic counter-parts in Border states [OR 1.3 (1.1-1.6) p=0.009], which was not apparent in the non-Border states [OR 1.0 (0.8-1.2) p=0.9].

Conclusions: There was an underutilization of thrombolytics and higher mortality in the Hispanic population admitted in Border States but not in non-Border States. Further studies are warranted to better understand the associated factors.

Effectiveness of teaching methods in a medical institute: perceptions of medical students to teaching aids

OBJECTIVES

To discover the most effective mode of teaching from the perspective of medical students and to analyse their preferences for various pedagogical aids.

METHODS

The qualitative, descriptive survey designed as a cross-sectional study was conducted at the King Edward Medical University, Lahore, from April to June 2011. A 25-item questionnaire regarding perceptions towards teaching aids was handed out to 500 undergraduate medical students and the answers were analysed using SPSS 17.

RESULTS

Of the 500 questionnaires, 8 (1.6%) were left out for being incomplete.The study sample size, as such, was 492 with a response rate of 98.4%. Out of the 492 students, 325 (66%) disagreed that the whole lecture should be delivered via PowerPoint slides.To understand complex concepts, 246 (50%) approved of animation based learning. For retaining and recalling facts, the combination of PowerPoint slides and animations was considered by 157 (32%) as most effective, while transparencies were considered to be the least effective (n=5; 1%). Regarding their attention span 357 (76%) students said they experienced the lowest attention span during Overhead Projector lectures. Irrespective of the method used, 225 (46%) students responded that visual aids of any sort increased their concentration 'a lot'. For small groups, 283 (58%) students considered blackboards optimal, while for a large group, 243 (49%) students considered animations to be optimal. As far as combinations went, 291 (59%) preferred blackboard plus animations, 148 (30%) preferred blackboard plus PowerPoint.

CONCLUSION

The combination of animations alongside blackboard was preferred over other combinations. The subjects wanted animations to be incorporated frequently into medical pedagogy, while overhead projectors were clearly disliked by them.

Is depression an inflammatory condition? A review of available evidence

The current review examines the relationship between depression and the inflammatory immune response. Mood disorders are a significant cause of morbidity and the etiology of depression is still not clearly understood. Many studies have shown links between inflammatory cytokines and mood disorders, including elevated level of cytokines like tumour necrosis factor-alpha (TNF alpha), Interleukins (IL-1,IL-6) and others. Raised levels of cytokines have been shown to increase depressive behaviour in animal models, while many anti-depressants reverse this behaviour alongside reducing the Central Nervous System (CNS) inflammatory response and reduction in the amounts of inflammatory cytokines. Cytokines reduce neurogenesis, Brain Derived Neurotrophic Factor (BDNF) and neuronal plasticity in the CNS, while many anti-depressants have been shown to reverse these processes. The considerations of anti-depressants as anti-inflammatory agents, and implication of other anti-inflammatory therapeutics for the treatment of depression are pointed out.