143 Effect of corpus luteum on recovery rate, quality, and in vitro developmental competence of oocytes in Bos indicus dairy cows

Assisted reproductive technologies have modernized the dairy industry for the rapid multiplication of superior genetic traits. However, the exploitation of genetics through in vitro embryo production in farm animals has been struggling during the last 3 decades. The presence or absence of a corpus luteum (CL) on ovaries from which cumulus-oocyte complexes were recovered has been shown to affect the quality of oocytes and in vitro embryo production outcome in Bos taurus cows. Similar information is lacking in Bos indicus cows. Therefore, the objectives of the present study were to determine the effect of presence or absence of a CL on recovery rate, quality, and in vitro developmental competence of oocytes in Bos indicus dairy cows. This study was conducted from December 2017 to April 2018. The ovaries were harvested from a local abattoir (Bos indicus; 5- to 8-year-old cows having mixed parity with clinically normal reproductive tracts). These ovaries (n=750) were divided into 2 groups [(1) CYCLIC (n=318) and (2) ACYCLIC (n=432)] based on the presence or absence of mature CL having follicles on either left or right ovaries of slaughtered cows. Blood samples from the jugular vein were collected at slaughter. Serum concentrations of progesterone of CYCLIC and ACYCLIC cows were measured using radioimmunoassay. Mean number of recovered oocytes per ovary and serum concentration of progesterone were compared using PROC TTEST model. However, quality, maturation, cleavage, 8-cell, 16-cell, and morula rates were analysed by PROC FREQ model of Chi-squared. All the data was analysed using SAS (SAS Institute Inc., Cary, NC, USA). Results revealed that the mean serum concentrations of progesterone (4.21±0.4v. 0.5±0.2ng mL−1; P<0.05) were higher in CYCLIC as compared with ACYCLIC cows, respectively. The mean number of oocytes recovered per ovary (6.5±4.5v. 4.0±4.4; P<0.05) was higher in CYCLIC than in ACYCLIC cows. The oocytes with grade I+II quality (55.3v. 47.6%; P<0.05) were higher, whereas oocytes with grade III+IV quality (44.5v. 52.4%; P<0.05) were lower, in CYCLIC as compared with ACYCLIC cows, respectively. Furthermore, cleavage rate (70.9v. 52.8%; P<0.05) was higher in CYCLIC than in ACYCLIC cows, respectively. Similarly, the 8-cell (38.5v. 20.8%; P<0.05) and 16-cell (20.0v. 10.9%; P<0.05) stage embryos were greater in CYCLIC as compared with ACYCLIC cows, respectively. In conclusion, the presence of CL has a beneficial effect on recovery rate, quality, and in vitro embryo production outcomes in Bos indicus dairy cows. It is implied that for ovum pickup, cyclic cows should be preferred.

142 Effect of follicular size on oocyte recovery rate, quality, and in vitro developmental competency following maturation, fertilization, and culturing in Bos indicus cows

Applied reproductive technologies include AI, multiple ovulation and embryo transfer, IVF, cloning, ovum pickup, and zygote intra-fallopian tube transfer in farm animals. Modern commercialized dairy farming is ever more relying on in vitro embryo production for maximal utilisation of superior genetics of female animals. Follicular size influenced the quality of the oocytes and their in vitro developmental competence in Bos taurus cows. However, this information is lacking in Bos indicus cows. Therefore, the objectives of the present study were to determine the effect of follicular size on recovery rate, quality, and in vitro developmental competence of the oocytes in Bos indicus cows. The ovaries (n=508) of 5- to 8-years-old Bos indicus cows, body condition score 2.75±0.25, having mixed parity and clinically normal reproductive tracts, were collected. These follicles on the ovaries were divided into 2 groups based on their size: (1) <6mm diameter and (2) ≥6mm diameter. The data on recovery; quality; maturation; cleavage rates; 4-cell, 8-cell, and 16-cell stages; and morula rate were analysed by Chi-squared test using SPSS version 20 software (IBM Corp., Armonk, NY, USA, 2016) system for windows. Results revealed that oocytes with grade I+II quality (68.4v. 42.1%; P<0.05) were higher, whereas grade III+IV quality (31.6v. 57.5%; P<0.05) were lower, in ≥6mm as compared with <6mm groups, respectively. Moreover, the 4-cell (34.5v. 18.7%), 8-cell (15.4v. 7.7%), 16-cell (8.7v. 2.2%) stages and morula rate (4.5v. 0.3%) were higher (P<0.05) in ≥6mm as compared with <6mm groups, respectively. However, the maturation and cleavage rates did not differ (P>0.05) between both groups. It is concluded that oocytes having follicle size ≥6mm have better quality in terms of morphological grades and in vitro developmental competence in Bos indicus cows. It is implied that for maximum production of embryos through ovum pickup, the most appropriate follicular size for aspiration is ≥6 mm.

The metabolic model of heart failure: the role of sodium glucose co-transporter-2 (SGLT-2) inhibition

Heart failure (HF) is one of the leading causes of hospital readmissions and health care expenditures. With a vast degree of advancements in the clinical approach and diagnosis, its management protocol is limited in terms of enhancing quality of life and prognosis. Type 2 diabetes mellitus (T2DM) is considered as one of the commonly associated comorbid conditions in the HF population. The understanding of the molecular and metabolic models of HF has led to the utilization of therapeutic goals of T2DM in improving HF-related complications. In the recent era, SGLT-2 inhibitors have shown success in decreasing cardiovascular mortality in the T2DM population. This article will help the reviewer to comprehend the pathophysiology of HF and the potential role of SGLT-2 inhibitors in the management algorithm of HF and its associated risk factors in T2DM.

Fever is associated with higher morbidity and clot burden in patients with acute pulmonary embolism

BACKGROUND

Fever is considered as a presenting symptom of pulmonary embolism (PE). We aim to evaluate the association between PE and fever, its clinical characteristics, outcomes and role in prognosis.

METHODS

A retrospective chart review of patients who were hospitalised with the diagnosis of acute PE was conducted. Patients in whom underlying fever could also be attributable to an underlying infection were also excluded.

RESULTS

A total of 241 patients met the study criteria. 63 patients (25.7%) had fever within 1 week of diagnosis of PE of which four patients had fever that could be due to underlying infection and were excluded. Patients in PE with fever group were younger compared with PE without fever group (52.52 vs 58.68, p=0.012) and had higher incidence of smoking (44.1% vs 20.9%, p<0.001). Patients in PE with fever group were more likely to require intensive care admission (69.5% vs 35.7%, p<0.001), had a longer hospital length of stay (19.80 vs 12.20, p<0.001) and higher requirement of mechanical ventilation (30.5% vs 6.6%, p<0.001) compared with those without fever. PE with fever group were more likely to have massive and submassive PE (55.9% vs 36.8%, p=0.015) and had higher incidence of deep vein thrombosis (33.3% vs 17.4%, p=0.0347) compared with PE without fever. In a univariate model, there was higher likelihood of in-hospital mortality in PE with fever group compared with PE without fever (22.0% vs 10.4%, p=0.039).

CONCLUSION

Patients with acute PE and fever have higher morbidity and clot burden.

Secondary intraocular lens implantation with absence of capsular support: Scleral versus iris fixation

PURPOSE

To assess the outcomes of iris fixated (IF) posterior chamber (PC) intraocular lens (IOL) versus scleral-fixated (SF) PC IOL implantation, and compare them with the results reviewed from the literature.

SETTING

The study took place in the ophthalmology department of the Eye and Ear Hospital (Lebanon).

DESIGN

This is a retrospective institutional study that collected the records of patients admitted for secondary IOL implantation between January 2007 and December 2016.

METHODS

A total of 28 eyes that underwent PC IOL fixation were included, 13 of which underwent trans-scleral PC IOL fixation and 15 of which underwent iris PC IOL fixation. Data were analyzed over a period of 3 years.

RESULTS

Of the 28 patients, 18 (64.3%) were male and 10 (35.7%) were female (mean age at intervention 36.78±23.47 [standard deviation, SD] years). There were no significant intergroup differences with regard to baseline values and demographic characteristics. Trauma was the most common etiology for posterior capsule insufficiency (82.1%). The mean preoperative baseline BCVA was 0.58±0.27 logMAR for SF and 0.27±0.20 logMAR for IF (P=0.07). Both groups had significant improvement in vision during the follow up period. No significant differences were noted regarding early or late postoperative complications between the two groups.

CONCLUSION

SF and IF techniques for PC IOL have similar outcomes and result in a significant improvement in BCVA. When compared to AC (anterior chamber) IOL, both techniques seem to yield fewer complications.

Refractory Septic Shock due to Underlying Immunocompromised Disease: A Case of Fatal Peripheral T-Cell Lymphoma Not Otherwise Specified in a Young Hispanic Woman

Peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) is known as an unclassified group of non-Hodgkin lymphomas. PTCL-NOS is a subtype of peripheral T-cell lymphoma that accounts for 3% of all lymphomas in the United States. PTCL-NOS commonly presents as a disseminated disease, B symptoms (fever, night sweats, and weight loss), generalized lymphadenopathy, bone marrow infiltration, and extranodal involvement. Other rare and possible manifestations include peripheral eosinophilia, pruritus, or hemophagocytic syndrome. This type of lymphoma is aggressive in nature and carries a high mortality rate. There is no established standard-of-care treatment protocol for PTCL-NOS, several chemotherapy drug combinations are frequently used as a frontline treatment with an overall 5-year survival rate of 25%. We present a case of a 35-year old Hispanic woman who initially presented with a chief complaint of bilateral lower extremity swelling due to hypoalbuminemia and new-onset hyperkeratotic skin of the palms and soles.

Pulmonary renal syndrome: A case report of diffuse alveolar hemorrhage in association with ANCA negative pauci-immune glomerulonephritis

RATIONALE

Pulmonary renal syndrome (PRS) is a term most commonly used to describe a combination of glomerulonephritis and pulmonary hemorrhage as a manifestation of a multisystem autoimmune disease. It is usually associated with ANCA vasculitis and anti-GBM disease. Diffuse alveolar hemorrhage in a patient with ANCA and anti-GBM negative pauci-immune glomerulonephritis is rare and optimal management is unknown.

PATIENT CONCERNS

An 85-year-old man with hypertension, diabetes mellitus, prostate cancer and recently diagnosed pauci-immune necrotizing glomerulonephritis presented to our emergency department with worsening dyspnea and pedal edema for several days. Clinical presentation and radiological studies were suggestive of fluid overload but he developed worsening respiratory failure despite hemodialysis.

DIAGNOSES

Bronchoscopy confirmed diffuse alveolar hemorrhage. ANCA and anti-GBM antibodies were negative. The patient was diagnosed with pulmonary renal syndrome - diffuse alveolar hemorrhage in the setting of ANCA and anti-GBM negative pauci-immune glomerulonephritis.

INTERVENTIONS

Patient was started on intravenous pulse steroids, cyclophosphamide and received seven sessions of plasmapheresis.

OUTCOMES

There was an improvement in patient's respiratory status and repeat bronchoscopy at the end of treatment did not show diffuse alveolar hemorrhage.

LESSONS

Pauci-immune crescentic necrotizing glomerulonephritis is usually associated with the presence of ANCA, however, ANCA may be absent in 10% of these cases. Immunosuppression is the mainstay of treatment for ANCA and anti-GBM associated PRS. This case highlights the importance of immunosuppression and plasmapheresis in patients with ANCA negative vasculitis due to presence of unidentified serum antibodies. If left untreated, these patients can have a fulminant course with high mortality ranging from 25 to 50%.

A Rare Case of Colonic Metastases From Tonsillar Carcinoma: Case Report and Review of Literature

The incidence of tonsillar cancer has increased by four times in the United States over the last few decades likely due to recent increase in human papilloma virus (HPV) infections. The stage of the tumor predicts likelihood of metastasis, with advanced stages associated with higher chances of metastasis. The squamous cell carcinomas (SCCs) of the head and neck commonly metastasize to the lung, bone and liver in descending order. Tonsillar cancer rarely involves the small bowel and our review of the literature did not reveal any reported case of metastasis to the colon/large bowel. Our patient had locally metastatic tonsillar cancer, treated with partial pharyngectomy and selective neck dissection but later developed several bone and colonic metastases concurrently, likely secondary to hematogeneous dissemination after a few months of therapy. To the best of our knowledge, large bowel metastasis from head and neck SCC has never been reported in the literature. In these patients presenting with atypical gastrointestinal symptoms, a high index of suspicion should be maintained to determine the extent of metastasis and identify other metastatic sites.

A rare case report of a saddle pulmonary embolism presenting with high grade fevers, responsive to anticoagulation

RATIONALE

Pulmonary embolism can manifest by a myriad of clinical symptoms. High grade fever is a rare presentation of thromboembolic phenomenon.

PATIENT CONCERNS

A middle aged woman presented with high grade fevers.

DIAGNOSES

Patient remained febrile despite broad spectrum antibiotics. All cultures were negative. CT angiogram of the chest was done, eliciting a large saddle embolus.

INTERVENTIONS

Intravenous tissue plasminogen activator (t-PA) was administered and subsequently started on anticoagulation. Patient became afebrile 3 days after initiation of anticoagulation and all antibiotics were discontinued.

OUTCOMES

We demonstrate a case of a saddle pulmonary embolism presenting with high grade fevers that responded to anticoagulation.

LESSONS

It is imperative to include pulmonary embolism in the differential diagnosis, when presented with high-grade fever in patients with unclear diagnosis.

Hypertrophic osteoarthropathy in a young adult male from Berber, Sudan (2nd-3rd century CE)

Hypertrophic osteoarthropathy (HOA) is a pathological condition characterised by extensive periosteal new bone formation (NBF) on the diaphyses of the long bones, metacarpal and metatarsal bones. In modern clinical contexts, the secondary form of the disease is common and most often occurs secondary to intra-thoracic cancer and other forms of chronic pulmonary disease. Paleopathological evidence for HOA on the other hand has only occasionally been reported. Here we report a young adult male from the Meriotic cemetery at Berber in Sudan (2nd-3rd century CE) displaying widespread NBF on the diaphyses of the upper and lower limb bones, metacarpal and metatarsal bones, as well as the pelvis and scapulae. While several pathological conditions have to be considered as differential diagnostic options for NBF in the post-cranial skeleton, HOA is the most likely diagnosis, based on the distribution of the changes observed in this individual, as well as their macroscopic and radiographic characteristics. A chronic pulmonary condition as indicated by NBF on the visceral side of the ribs may represent the underlying cause for the HOA. This individual represents the first paleopathological case of HOA reported from an archaeological site in Africa.

Synthesis of carbon loaded γ-Fe2O3 nanocomposite and their applicability for the selective removal of binary mixture of dyes by ultrasonic adsorption based on response surface methodology

The contemporary problems concerning water purification could be resolved by using nanosorbents. The present studies emphasis on the synthesis of γ-Fe₂O₃-activated carbon nanocomposites (γ-Fe₂O₃-NP-AC) by sol-gel method. The composition and surface morphology of them were studied by FTIR, EDS, SEM and XRD techniques. Moreover they were employed for the selective removal of binary mixture of dyes including reactive red 223 dye (RR) and Malachite Green dye (MG) by ultrasonic assisted adsorption method. Sonication is the act of applying sound energy to agitate particles in the sample. The ultrasonic frequencies (>20kHz) were used to agitate experimental solutions in current studies. The response surface methodology based on 5 factorial central composite design (CCD) was employed to investigate the optimum parameters of adsorption. The optimum operating parameters (OOP) including sonication time, solution pH, amount of adsorbent, concentration of RR and MG were estimated for the selective removal of mixture of dyes. On OOP conditions of RR, the % removal of RR and MG were observed to be 92.12% and 10.05% respectively. While at OOP of MG, the % removal of MG and RR were observed to be 85.32% and 32.13% from the mixture respectively. Moreover the mechanisms of adsorption of RR and MG on the γ-Fe₂O₃-NP-AC were also illustrated. The significance of the RR-γ-Fe₂O₃-NP-AC and MG-γ-Fe₂O₃-NP-AC adsorption models was affirmed by ANOVA test. The Pareto plots for the selective removal of the RR and MG from the binary mixture also confirm the significance of the factors. Isothermal studies were performed and RR adsorption was observed to follow Langmuir isotherm model whereas MG adsorption was observed to follow Freundlich model. Thermodynamic studies were conducted and the outcomes suggested the spontaneous nature of adsorption processes. The kinetic models were employed to study the kinetics of the process. It was observed that the system followed pseudo second order, intra-particle diffusion and Elovich models as represented by the R² values of the respective models. The comparative study from the previously studies revealed that the proposed method is amongst them is the most efficient method to eliminate RR and MG dyes from the aqueous medium. Therefore the current study will be useful in reducing the toxicity of RR and MG contaminated effluent.

Anomalous nonradiative decay in Dy-doped glasses and crystals

Nonradiative relaxation in Dy-doped fluoroindate glass is measured and characterized in terms of the well-known exponential energy gap law. It is found that although three low-lying Dy transitions fit well with an exponential dependence on an energy gap, the overall magnitude of the Dy decay rate is an order of magnitude higher than that of other rare earth ions. It is also found that the nonradiative decay rates in InF₃ glass are comparable to those in ZrF₄ glass, contrary to expectations based on maximum phonon energy. These unexpected results have important implications for a potential 4 μm Dy:InF₃ fiber laser.

Synthesis of polyaniline nanoparticles and their application for the removal of Crystal Violet dye by ultrasonicated adsorption process based on Response Surface Methodology

The present study focuses the synthesis of polyaniline nanoparticles (PANP) by rapid mixing polymerization method. They were recognized by FTIR and SEM techniques. Moreover they were utilized for the removal of Crystal Violet (CV) dye by ultrasonicated adsorption process. It ensures a quick alternative method compared to other conventional processes, which led to enhancement of mass transfer by ultrasound waves. The effectiveness of the process was confirmed through the effect of certain conditions like sonication time, temperature, adsorbent dosage and CV concentrations. The validity of the process was estimated by various adsorption isotherms. Kinetics and thermodynamic studies was also conducted to authenticate the process. The optimum operating parameters (OOP) were evaluated by Response Surface Methodology (RSM) based on central composite design (CCD) for the removal of CV dye. Moreover analysis of variances (ANOVA) was employed to estimate the significance of experimental variables. The predicated removal efficiency was found to be 94.29% which prove to be effectiveness of the process.

Ahmed T, Kazani B, Husain H. Validity of the Diabetes, Hypertension and Hyperlipidaemia (DHL) Knowledge Instrument among Medical Students of Karachi

BACKGROUND: While there have been a number of studies on DM, hypertension and hyperlipidaemia, an instrument which assesses knowledge based on all three conditions has neither been established nor authorized in Pakistan. Hence, the focus of this study was to establish a pre- tested extensive questionnaire to evaluate medical students’ understanding of DM, hypertension, hyperlipidaemia and their medications for use.METHODS: A pre-validated and pre-tested DHL instrument was employed on 250 students of Dow Medical and Sindh Medical College and on 45 physicians working in a leading teaching hospital of Karachi. The DHL knowledge instrument was then distributed a second time to the very same set of students, after a period of 2 months, at the end of the foundation module, once they had received some basic formal medical education including diabetes and CVS diseases.RESULTS: The overall internal consistency for the DHL instrument failed to comply with the set standard of more than or equal to 0.7 as our results yielded Cronbach’s α of 0.6. Overall the average difficulty factor of 28 questions is 0.41, which highlighted that the instrument was moderately tough. The mean scores for all domains were substantially lower in the students section in comparison to that of the professional section, which had remarkable impact on the overall mean(SD) knowledge score (40.58 ± 14.63 vs. 63.49 ± 06.67 ; p value = 0.00).CONCLUSION: The instrument can be used to recognize people who require educational programs and keep an account of the changes with the passage of time as it could help in differentiating the knowledge levels among its participants based on their educational status.

Predictors of Awareness and Management Practices of Diabetes among Rural Dwellers of Sindh

<p><strong>INTRODUCTION: </strong>The most substantial method of control for the spread of DM, is the spreading of knowledge and information regarding DM and its complications. Therefore, the objective of this study was to investigate and evaluate the level of knowledge, awareness and management practices among people suffering from DM in the rural areas of Sindh.</p><p><strong>METHODOLOGY: </strong>A descriptive cross sectional survey was performed on 400 Diabetes Mellitus (DM) Type 2 patients from March 2015 to June 2015, dwelling in rural areas of Sindh province, South Pakistan. A paper based questionnaire was used to determine sociodemographic features, knowledge and awareness with regards to DM and its complications and last part evaluated management practices to manage diabetes.</p><p><strong>RESULTS:</strong> Only 50% participants knew that DM is a condition of high blood glucose and only 39% considered it as a preventable disease. With regards to management practices, only 65.0% had a home glucometer and 48% regularly checked their blood sugar levels. Family history of DM, BMI, education level, monthly household income, marital status and age were important predictors of knowledge among rural dwellers.</p><p><strong>CONCLUSION: </strong>Our study has revealed lack of knowledge and inadequate management practices among diabetic patients of rural areas of Sindh, especially in patients attending primary healthcare setups. Management techniques and knowhow of this silent and deadly pathological condition should be spread to rural populace through seminars and media, which would eventually mold their life in a better condition.</p>

Assessment of Blood Glucose and Electrolytes during Cardiopulmonary Bypass in Diabetic and Non-Diabetic Patients of Pakistan

Introduction:

Perioperative hyperglycemia has been shown to be related to higher levels of morbidity and mortality in patients on cardiopulmonary bypass (CPB) undergoing coronary artery bypass grafting (CABG), both diabetic and non-diabetic. Blood electrolytes, like sodium, potassium, calcium, and chloride play a very important role in the normal functioning of the body and can lead to a variety of clinical disorders if they become deficient. A minimal number of studies have been conducted on the simultaneous perioperative changes in both blood glucose and electrolyte levels during CPB in Pakistan. Therefore, our aim is to record and compare the changes in blood glucose and electrolyte levels during CPB in diabetic and non-diabetic patients.

Materials and Methods:

This was a prospective, observational study conducted on 200 patients who underwent CABG with CPB, from October 2014 to March 2015. The patients were recruited from the Cardiac Surgery Ward, Civil Hospital Karachi after they complied with the inclusion criteria. Repeated-measures analysis of variance (ANOVA) was used to compare the trend of the changes perioperatively for the two groups.

Results:

There was no significant difference in changes in blood glucose between the two groups (P = 0.62). The only significant difference detected between the two groups was for PaCO₂ (P = 0.001). Besides, further analysis revealed insignificant group differences for the trend changes in other blood electrolytes (P > 0.05).

Conclusion:

Our findings highlighted that there is no significant difference in blood electrolytes changes and the increase in blood glucose levels between diabetic and non-diabetic patients.

The Prevalence and Risk Factors of Gallstone among Adults in Karachi, South Pakistan: A Population-Based Study

<p><strong>INTRODUCTION: </strong>The present study was aimed to determine the prevalence and risk factors of GSD among a sample of general population in Karachi, South Pakistan.</p><p><strong>METHODOLOGY: </strong>A multistage random sampling method was employed on 30 clusters, where 60 subjects of age&gt;=25 years were randomly recruited from the study population from June 2013 till March 2015. Finally, data was analyzed and logistic regression models were used to find the correlation between selected variables and gallstone disease.</p><p><strong>RESULTS: </strong>It was found that 184 patients had echogenic mass with shadowing on ultrasonography; yielding a prevalence of 10.2% for gallstones in the study participants. The occurrence was higher in females (14.8%) than in male participants (5.7%). Further, participants over 40 years of age and single, widow/separated subjects had higher incidence of gallstones than married individuals. Moreover, an indirect correlation was obtained with daily physical activity, consumption of fruits, vegetables and fish with development of GD.</p><p><strong>CONCLUSION: </strong>It can be evaluated that daily physical activity, female gender, increasing age and marital status play an important role in progression of GSD. Understanding pathogenesis and physiological mechanism involved in GSD can help to determine therapeutic options other than surgical treatment.</p>

"Why we could not eradicate polio from pakistan and how can we?"

Polio is a major health problem and a deadly infectious disease in the developing countries. It is a viral illness caused by polio virus that can lead to paralysis, limb deformities, breathing problems or even death. Polio virus resides only in humans and passes on to the environment in the faeces of someone who is infected. Polio is still endemic in three countries, i.e., Pakistan, Nigeria and Afghanistan and is eradicated from the rest of the world. Pakistan is considered as the exporter of Wild Polio Virus (WPV) with highest number of polio outbreaks among endemic countries. With the start of World Polio Eradication Initiative in 1988, the number of polio cases has been reduced up to 99% worldwide until now. In 2015, Pakistan has shown a decrease of 70-75% in number of polio cases as compare to last year which is the result of good government's initiatives. Militant organizations such as Tehreek-e-Taliban Pakistan, Al-Qaeda and Boko haram movement of northern Nigeria are a major hurdle in the eradication of polio from these countries. The misconception of people about polio vaccine, insecurity within the country and poor health system are the reasons of failure of polio eradication campaigns in these regions. Awareness campaigns about polio for locals and development of proper health system will help in the eradication of polio. Once polio is eradicated, about 40-50 billion dollars can be saved globally. With the strong commitment, seriousness and good initiatives, polio will be eradicated from Pakistan within two years more likely.

Factors associated with patient visits to the emergency department for asthma therapy in Pakistan

BACKGROUND

Acute asthma is a chronic condition affecting people of all ages around the world and hence, is one of the leading causes of emergency department (ED) visits and hospital admissions globally. Most of them are related to poor patient practices and a weak healthcare system. The aim of our study was to assess the reasons for the increased usage of the ED by asthmatic patients in Pakistan.

METHODS

A cross-sectional study was conducted on 600 asthmatic patients reporting to the ED of Civil Hospital Karachi over a 6-month period. The consenting patients were given a questionnaire to fill and the following data was collected: demographic information, duration of the disease, medications prescribed the, frequency of and reasons for outpatient clinic and ED visits for issues related to asthma.

RESULT

According to our results most of the participants visited the ED to obtain a nebulized bronchodilator (90 %) or oxygen (79.5 %). Moreover, 44.8 % of the people visited the ED to get treatment without any delay and 24.0 % considered that the severity of asthma does not allow the patient to wait for clinic visits. Strikingly, 92.8 % claimed that inhaled corticosteroid therapy treatment should be stopped when patients feel better. Irregular follow ups with clinics, low education about asthma and an education level higher than a Bachelors degree were the most important factors associated with three or more ED visits per year, p values = 0.0289, 0.0110 and 0.0150 respectively.

CONCLUSION

This study identifies several preventable risk factors responsible for recurrent visits to the ED by asthmatic patients in Pakistan.

Impact of tobacco health warnings on smokers in Pakistan

OBJECTIVE

To see the impact of health warnings cigarette packets on the smoking habits of smokers.

METHODS

The cross-sectional study was conducted in Karachi from July to October 2014, and comprised adult male cigarettes smokers. A self-administered questionnaire was presented to the participants who were selected through non-probability convenience sampling irrespective of their educational background. Data was analyzed using SPSS 17.

RESULTS

Out of the 1500 subjects, 1330(88.7%) noticed warning on cigarette packets; 730(54.8%) considered the picture to have significant impact; 630(47.3%) tried to decrease smoking; and 430(32.4%) actually attempted to quit. Of the 430 who tried to quit, 300(69.7%) considered the picture as having had an impact.

CONCLUSIONS

The current health warnings on cigarette packets sold in Pakistan do not carry a significant deterrent impact.

Influence of effluent organic matter on copper speciation and bioavailability in rivers under strong urban pressure

This study focuses on spatiotemporal variations in the type of dissolved organic matter (DOM) and copper binding ability both upstream and downstream of Paris. It also compares the relative influence of both natural DOM upstream of Paris and effluent dissolved organic matter (EfDOM) output from a wastewater treatment plant (WWTP) on trace metal speciation and bioavailability in aquatic systems. In addition to the typical high- and low-affinity binding sites, a third family of very high-affinity binding sites has been highlighted for EfDOM. In receiving waters downstream of Paris during low-flow periods, the percentage of high- and very high-affinity sites originating from EfDOM reaches nearly 60 %. According to the speciation computation, the free copper concentration upstream of Paris exceeds the downstream Paris concentration by a factor of 2 to 4. As regards copper bioavailability, the highest EC50tot values were observed for EfDOM and downstream DOM, with a very low aromaticity and low UV absorbance. This finding suggests that specific ultraviolet absorbance (SUVA) is unlikely to be useful in assessing metal speciation and toxicity in aquatic systems subject to strong urban pressures. These results also highlight that the copper speciation computation for surface water exposed to considerable human pressures should include not only the humic and/or fulvic part of dissolved organic carbon but more hydrophilic fractions as well, originating for example from EfDOM.

Knowledge, attitudes and perceptions among non blood donor female health care professionals

Introduction:

Blood donation is necessary in order to maintain an adequate supply of blood to patients who are suffering from any kind of disease or trauma, which requires them to have blood transfusion. Female non-blood donors are generally low in number. Therefore, this research was carried out to assess the main reasons behind the lack of blood donations made by females, and their knowledge, attitude and perceptions towards voluntary blood donation.

Methodology:

A cross-sectional study was conducted on 664 female health professionals, who were selected by non-probability convenience sampling from two tertiary care hospitals. A pretested questionnaire was presented to the sample population, and the data was entered and analyzed on SPSS (V17).

Results:

94.6 % were aware with the fact that blood is screened for AIDS, Hepatitis B and C before transfusion. Moreover, 83.7% said that they will only donate blood if a family, relative or friend would need it and similarly 83.4% suggested that they would donate blood if blood donation camps are arranged in hospital premises. 81.8 % thought that blood donors can contract Hepatitis B after donation whereas only 29.5% did not blood due already blood loss in menstrual cycle.

Conclusion:

The participants had adequate knowledge about the benefits of blood donation. The most important reason identified for not donating blood is the lack of facilities within the workplace or lack of approach by responsible authorities. The results of the study may help in minimizing the misconceptions of the participants about blood transfusion, which would increase their contribution towards blood donation.

Effect of Topical Insulin on Second-Degree Burns in Diabetic Rats

The healing process is complex in diabetic wounds, and the healing mechanism of burn wounds is different from that of incisional or excisional wounds. Data from our previous study indicated that topical insulin cream reduced wound closure time in diabetic rats. Our aim was to investigate the effect of topical insulin cream on wound healing following second-degree burns in control and diabetic rats. Rats were divided into four groups: control (nondiabetic) rats treated with placebo (CP), control (nondiabetic) rats treated with topical insulin cream (CI), diabetic rats treated with placebo (DP), and diabetic rats treated with topical insulin cream (DI). The wounds were assessed at 4 time points (1, 7, 14, and 26 days) post-wounding for morphometric analysis of wound sections stained with hematoxylin/eosin, α-smooth muscle actin, and Picrosirius red to evaluate general aspects of the wound, inflammatory infiltrate, blood vessels, and Types I and III collagen fibers. Histological analysis showed that topical insulin cream increased the inflammatory cell infiltrate in the DI group (at 7 and 14 days postburn, p < .05) and blood vessels (at 14 days postburn, p < .05) to levels similar to those of groups CP and CI. Wounds treated with topical insulin cream (CI and DI groups) showed significantly stronger staining for fibrillar collagen than wounds of the DP group. The use of topical insulin may reduce the duration of the inflammatory phase; improve wound reepithelialization, tissue granulation, and wound contraction; and increase collagen deposition in second-degree burns in healthy and diabetic animals.

Knowledge, Awareness and Self-Care Practices of Hypertension Among Cardiac Hypertensive Patients

Introduction:

The most prevalent form of hypertension is systolic blood pressure (SBP) and it is considered to be predisposing risk factor for cardiovascular disease. The objective of the study was to assess self-care practices, knowledge and awareness of hypertension, especially related to SBP among cardiac hypertensive patients.

Methodology:

A Cross sectional study was conducted on 664 cardiac hypertensive patients, which were selected by non-probability convenience sampling from cardiology outpatient department of three tertiary care hospitals. Face to face interviews were conducted using a pre designed questionnaire. Data was entered and analyzed by SPSS (V17).

Results:

81.8%, did not know that hypertension is defined as high blood pressure. 97.1% of the sample population did not know that top measurement of blood pressure was referred to as systolic and only 25.0% correctly recognized normal systolic blood pressure to be less than 140mmHg. 7.4% of the patients consulted their doctor for hypertension once or twice in a month. Risk factor for high blood pressure most commonly identified by the participants was too much salt intake

Conclusions:

The results state that there is an inadequate general knowledge of hypertension among cardiac patients and they do not recognise the significance of elevated SBP levels. There is a need to initiate programs that create community awareness regarding long term complications of uncontrolled hypertension, particularly elevated SBP levels so that there is an improvement in self-care practices of the cardiacpatients.

Micropollutants in urban stormwater: occurrence, concentrations, and atmospheric contributions for a wide range of contaminants in three French catchments

This study aimed at: (a) providing information on the occurrence and concentration ranges in urban stormwater for a wide array of pollutants (n = 77); (b) assessing whether despite the differences between various catchments (land use, climatic conditions, etc.), the trends in terms of contamination level are similar; and (c) analyzing the contribution of total atmospheric fallout (TAF) with respect to sources endogenous to this contamination. The studied contaminants include conventional stormwater contaminants (polycyclic aromatic hydrocarbons (PAHs), Zn, Cu, Pb, etc.), in addition to poorly or undocumented pollutants such as nonylphenol and octylphenol ethoxylates (NPnEO and OPnEO), bisphenol A (BPA), polybrominated diphenyl ethers (PBDEs), a wide variety of pesticides, and various metals of relevance (As, Ti, Sr, V). Sampling and analysis were performed using homogeneous methods on three urban catchments with different land use patterns located in three distinct French towns. For many of these pollutants, the results do not allow highlighting a significant difference in stormwater quality at the scale of the three urban catchments considered. Significant differences were, however, observed for several metals (As, Cr, Cu, Ni, Sr and Zn), PAHs, and PBDEs, though this assessment would need to be confirmed by further experiments. The pollutant distributions between dissolved and particulate phases were found to be similar across the three experimental sites, thus suggesting no site dependence. Lastly, the contributions of TAF to stormwater contamination for micropollutants were quite low. This finding held true not only for PAHs, as previously demonstrated in the literature, but also for a broader range of molecules such as BPA, NPnEO, OPnEO, and PBDEs, whose high local production is correlated with the leaching of urban surfaces, buildings, and vehicles.