Effect of antenatal counselling on exclusive breastfeeding

BACKGROUND

The promotion and support of breastfeeding is a global priority. However, in reality most of the mothers are unable to practice exclusive breastfeeding. Most mothers discontinue breastfeeding because of lack of confidence in their ability to breastfeed, problem with infant suckling, breast pain, perception of insufficient milk, in addition to other unspecified difficulties. Some these problems can be solved if the women are counselled antenataly about the benefits of breastfeeding and prepared mentally for exclusive breastfeeding. The aim of the study was to determine whether the mothers with antenatal counselling on breastfeeding would improve their exclusive breast feeding and compare this with that of the mothers without antenatal counselling. It was a cross-sectional comparative study which took place at the Maternity ward of Fauji Foundation Hospital, Rawalpindi.

METHODS

Hundred mothers selected by consecutive non probability sampling divided in two groups. Group A: 50 mothers who were counselled on breastfeeding and Group B: 50 mothers who were not counselled on breastfeeding. Fifty mothers practicing breast feeding after antenatal counselling in the maternity ward of Fauji Foundation Hospital, Rawalpindi were recruited in the study. Another fifty mothers practicing breastfeeding without antenatal counselling were asked to take part in the study as a control group. Performa was completed and an informed consent was obtained.

RESULTS

As compared to the not counselled group, the mothers who initiated breastfeeding immediately after birth were statistically significantly higher (p < 0.046) in the counselled group (84% and 96% respectively). Similarly the number of counselled mothers who practiced exclusive breastfeeding was statistically very highly significantly more (p < 0.001) than the not counselled group (68% and 16% respectively).

CONCLUSION

Antenatal counselling helps in motivating the mothers for initiation of breastfeeding immediately after birth and practicing exclusive breastfeeding for first six months of infant's life. Existing antenatal counselling on breastfeeding is inadequate in the population studied and needs to be strengthened.

Exact Solutions for the Axial Couette Flow of a Fractional Maxwell Fluid in an Annulus

The velocity field and the adequate shear stress corresponding to the rotational flow of a fractional Maxwell fluid, between two infinite coaxial circular cylinders, are determined by applying the Laplace and finite Hankel transforms. The solutions that have been obtained are presented in terms of generalized Ga,b,c(·,t) and Ra,b(·,t) functions. Moreover, these solutions satisfy both the governing differential equations and all imposed initial and boundary conditions. The corresponding solutions for ordinary Maxwell and Newtonian fluids are obtained as limiting cases of our general solutions. Finally, the influence of the material parameters on the velocity and shear stress of the fluid is analyzed by graphical illustrations.

A secondary metabolite amberin from Amberboa ramosa

Amberin (1), a new sesquiterpene lactone, has been isolated from the ethyl acetate soluble fraction of Amberboa ramosa together with apigenin (2), jaseocidine (3), crysoeriol (4), and 3β, 8α-dihydroxy-11α-methyl-1αH, 5αH, 6βH, 7αH, 11βH-guai-10(14), 4 (15)-dien-6, 12-olide (5). The structures of the isolated compounds have been elucidated by 1D and 2D NMR spectroscopy.

Intramedullary spinal tuberculoma

Spinal intradural intramedullary tuberculoma is extremely rare entity of tuberculosis involving the nervous system. Because of its atypical symptomatology, it must be considered in differential diagnosis of spinal cord lesions, especially where prevalence of tuberculosis is high. In this case report this atypical disease is described where good outcome was achieved by surgical excision of the intramedullary lesion followed by antituberculous therapy.

Vicarin, a new isoflavone from Eremostachys vicaryi

Vicarin (1), a new isoflavone, has been isolated from the ethyl acetate-soluble fraction of the ethanolic extract of Eremostachys vicaryi, along with soforanarin B (2), luteolin 7-O-β-D-glucopyranoside (3), and hamighriprasin (4). Their structures were elucidated on the basis of their spectral data including MS and 2D NMR.

An overview of human prion diseases

Prion diseases are transmissible, progressive and invariably fatal neurodegenerative conditions associated with misfolding and aggregation of a host-encoded cellular prion protein, PrP^C. They have occurred in a wide range of mammalian species including human. Human prion diseases can arise sporadically, be hereditary or be acquired. Sporadic human prion diseases include Cruetzfeldt-Jacob disease (CJD), fatal insomnia and variably protease-sensitive prionopathy. Genetic or familial prion diseases are caused by autosomal dominantly inherited mutations in the gene encoding for PrP^C and include familial or genetic CJD, fatal familial insomnia and Gerstmann-Sträussler-Scheinker syndrome. Acquired human prion diseases account for only 5% of cases of human prion disease. They include kuru, iatrogenic CJD and a new variant form of CJD that was transmitted to humans from affected cattle via meat consumption especially brain. This review presents information on the epidemiology, etiology, clinical assessment, neuropathology and public health concerns of human prion diseases. The role of the PrP encoding gene (PRNP) in conferring susceptibility to human prion diseases is also discussed.

Infrastructure and Growth

Physical Infrastructure stocks in Pakistan since the last two decades have been growing at a very low pace which resulted in increasing unemployment and very low economic growth in the last four years. The paper analyses the link between infrastructure, productivity and growth in Pakistan by applying two distinct methodologies—growth accounting and growth regressions. We find out that infrastructure stock has significantly positive impact on productivity and economic growth. At the individual level, electricity generation, agricultural water availability and telecommunications impact the economic growth positively and significantly, while, roads development have no impact. This is an indication of over investment in roads, especially highways. Based on model findings, we recommended that Pakistan will have to increase the allocation of PSDP to above 1.5 percent of the GDP if the problem of shortage of electricity is to be addressed on a priority basis so as to raise the growth rate of the economy.

An overview of animal prion diseases

Prion diseases are transmissible neurodegenerative conditions affecting human and a wide range of animal species. The pathogenesis of prion diseases is associated with the accumulation of aggregates of misfolded conformers of host-encoded cellular prion protein (PrP^C). Animal prion diseases include scrapie of sheep and goats, bovine spongiform encephalopathy (BSE) or mad cow disease, transmissible mink encephalopathy, feline spongiform encephalopathy, exotic ungulate spongiform encephalopathy, chronic wasting disease of cervids and spongiform encephalopathy of primates. Although some cases of sporadic atypical scrapie and BSE have also been reported, animal prion diseases have basically occurred via the acquisition of infection from contaminated feed or via the exposure to contaminated environment. Scrapie and chronic wasting disease are naturally sustaining epidemics. The transmission of BSE to human has caused more than 200 cases of variant Cruetzfeldt-Jacob disease and has raised serious public health concerns. The present review discusses the epidemiology, clinical neuropathology, transmissibility and genetics of animal prion diseases.

Frequency distribution of PRNP polymorphisms in the Pakistani population

Prion diseases are neurodegenerative conditions caused by misfolding of a normal host-encoded prion protein (PrPC) into pathogenic scrapie prion protein (PrPSc). In human prion diseases, the M129V prion protein polymorphism is known to confer susceptibility to the disease, determines PrPSc conformation and alters clinicopathological phenotypes. To date, all clinicopathologically confirmed cases of a variant form of Cruetzfeldt-Jacob disease (vCJD) have been 129MM homozygotes. There is also predominance of 129MM homozygotes in sporadic CJD (sCJD). No information regarding prion disorders is available from Pakistan. Although only invasive procedures like brain biopsy can confirm the diagnosis of prion disorders, testing a corresponding human population for variation in the prion protein gene (PRNP) may provide some insights into the presence of these disorders in a locality. The current study therefore aimed at exploring the genetic susceptibility of Pakistani population to CJD. A total of 909 unrelated individuals including 221 hemophiliacs representing all 4 major provinces of Pakistan were screened for M129V polymorphism and insertions or deletions of octapeptide repeats (OPRIs/OPRDs) using Polymerase Chain Reaction coupled with Restriction Fragment Length Polymorphism (PCR-RFLP). Concordance of the results of some PCR-RFLP reactions was also confirmed by dideoxy automated Sanger sequencing. The frequencies of M129V alleles (129M and 129V) and genotypes (129MM, 129MV and 129VV) were found in all 909 individuals to be 0.7101, 0.2899, 0.5270, 0.3663 and 0.1067, respectively. Deletion of 1 octapeptide repeat (1-OPRD) was detected in heterozygous state in PRNP of 10 individuals and in homozygous state in 1 individual. An insertion of 3 octapeptide repeats (3-OPRI) was found in 1 individual and an insertion of 1 octapeptide repeat (1-OPRI) in two individuals. Both 3-OPRI and 1-OPRI were present in heterozygous state and were linked to 129M allele. There were no significant χ2 differences between M129V allelic and genotypic frequencies of healthy individuals and hemophiliacs. However, M129V allelic and genotypic frequencies differed significantly between Pakistani population and East Asian and Western populations. Non-significant χ2 differences between M129V frequencies of healthy individuals and hemophiliacs suggest that individuals manifesting single gene disorders may provide naturally randomized samples for studies aiming at surveying the genetic variation. The combined excess of 129MM and 129VV homozygosity and the presence of 3-OPRI in 1 individual imply that Pakistani population is susceptible to prion disorders. Cases of prion disorders may exist in Pakistan, albeit at lower annual prevalence than other countries where life expectancy is greater than 65 years.

Leptin deficiency and leptin gene mutations in obese children from Pakistan

BACKGROUND

Congenital leptin deficiency is a rare human genetic condition clinically characterized by hyperphagia and acute weight gain usually during the first postnatal year. The worldwide data on this disorder includes only 14 cases and four pathogenic mutations have been reported in the leptin gene.

STUDY OBJECTIVE

The objectives of this study were to measure serum leptin levels in obese children and to detect leptin gene mutations in those found to be leptin deficient.

PATIENTS AND RESULTS

A total of 25 obese children were recruited for the study. Leptin deficiency was detected in nine of them. Leptin gene sequencing identified mutations in homozygous state in all the leptin deficient children. Two cases carried novel mutations (c.481_482delCT and c.104_106delTCA) and each of the remaining seven the previously reported frameshift mutation (c.398delG).

CONCLUSION

The results suggest that leptin deficiency caused by mutations in the leptin gene may frequently be seen in obese Pakistani children from Central Punjab.

Surface microbial consortia from Livarot, a French smear-ripened cheese

The surface microflora (902 isolates) of Livarot cheeses from three dairies was investigated during ripening. Yeasts were mainly identified by Fourier transform infrared spectroscopy. Geotrichum candidum was the dominating yeast among 10 species. Bacteria were identified using Biotype 100 strips, dereplicated by repetitive extragenic palindromic PCR (rep-PCR); 156 representative strains were identified by either BOX-PCR or (GTG)(5)-PCR, and when appropriate by 16S rDNA sequencing and SDS-PAGE analysis. Gram-positive bacteria accounted for 65% of the isolates and were mainly assigned to the genera Arthrobacter , Brevibacterium , Corynebacterium , and Staphylococcus . New taxa related to the genera Agrococcus and Leucobacter were found. Yeast and Gram-positive bacteria strains deliberately added as smearing agents were sometimes undetected during ripening. Thirty-two percent of the isolates were Gram-negative bacteria, which showed a high level of diversity and mainly included members of the genera Alcaligenes , Hafnia , Proteus , Pseudomonas , and Psychrobacter . Whatever the milk used (pasteurized or unpasteurized), similar levels of biodiversity were observed in the three dairies, all of which had efficient cleaning procedures and good manufacturing practices. It appears that some of the Gram-negative bacteria identified should now be regarded as potentially useful in some cheese technologies. The assessment of their positive versus negative role should be objectively examined.

Using surveillance data for action: lessons learnt from the second generation HIV/AIDS surveillance project in Pakistan

Although many countries are now collecting useful, high-quality HIV surveillance data, more efforts are put into the collection of data than into ensuring it is deployed effectively. The Canada-Pakistan HIV/AIDS surveillance project has strengthened and expanded the existing national AIDS control programme surveillance system in Pakistan through a comprehensive estimate of the size and location of some of the most at-risk populations (sex workers and injection drug users) and annual assessments of their sociodemographic characteristics, behaviours and HIV prevalence. The country now uses second generation surveillance data at a broad level to lobby for policy change, mobilize resources, improve programming and measure the success of prevention through an integrated national effort. This article aims to share the experiences and lessons learnt in the development of a second generation surveillance system for HIV/AIDS in Pakistan.

Pharmacotherapy-Based Problems in the Management of Diabetes Mellitus: Needs Much More to be Done!

A total of 856 diabetic patients were evaluated for pharmacotherapy-based problems like for possible drug interactions, adverse drug reactions, and other mismatches, if any. Poor correlation between the advised insulin therapy and patients’ fasting blood glucose levels (12%, n=103) was observed. To most of the patients (41.66%, n= 357), insulin therapy was advised in combination with glucocorticoides, thiazides diuretics, and propranolol. Prescribing beta blocker (propranolol) with insulin is contraindicated. The higher incidence of diabetic foot patients was in the mean age of 57±3.4 years that was controlled with combination therapy of insulin and oral antidiabetics (63.0%, n=516). 11.1% of the treated patients could not take the prescribed therapy due to poor acceptance of insulin therapy due to its syringe needle prick. 41.66% risks of potential drug interactions, 7.93% adverse drug reactions, and 6.6% mismatches were recorded, as per the international approved algorithm, for managing a diabetes mellitus that reflects poor health care system. All these events necessitate for coordinating with other health professionals to make the therapy safer in the better interest of the patients. It is concluded that in practice prescribing pattern carries more risks for patients. It is imperative to improve the practice of pharmacotherapeutics rather than to practice in routine.

Effect of support size on the catalytic activity of metal-oxide-doped silica particles in the glycolysis of polyethylene terephthalate

Zinc oxide (ZnO) and cerium oxide (CeO2) nanoparticles were deposited on the surface of preformed silica spheres with diameters ranging from 60 to 750 nm. Ultrasonic irradiation was employed to promote the deposition of the metal oxide nanoparticles on the surface of silica. Silica-supported zinc oxide or cerium oxide was used as a catalyst in the glycolysis of polyethylene terephthalate, one of the key processes in the depolymerization of polyethylene terephthalate. The effect of the support size on the catalytic activity was studied in terms of monomer yield, and the monomer concentration was analyzed via high-performance liquid chromatography (HPLC). The morphologies and surface properties of the catalysts were characterized using a scanning electron microscope, a transmission electron microscope, and a BET surface area analyzer, while the monomer was characterized via HPLC and nuclear-magnetic-resonance spectroscopy. Both the zinc oxide and cerium oxide deposited on a smaller support showed better distribution and less aggregation. The high specific surface area of the smaller support catalysts provided a large number of active sites. The highest monomer yield was obtained with a catalyst of 60-nm silica support.

Screening of a model for the distribution of dye in dye-encapsulated silica through the gradual etching of the outermost silica layer using hydrofluoric acid

Monodispersed spherical silica particles emitting blue light were prepared by incorporating 2,5-bis(5-tert-butyl-2-benzoxazolyl)thiophene (BBOT) into a silica matrix. The morphological and photoluminescent properties were investigated to confirm the proper incorporation of BBOT into the silica matrix, using an electron microscope and a fluorescence spectrometer. Four possible models representing the distribution of the dye molecules in a dye-encapsulated silica particle were proposed. To analyze the distribution of the BBOT dye in the BBOT-encapsulated silica, the fluorescent emission intensity was measured while reducing the particle diameter by etching the outermost silica layer with hydrofluoric acid with 0-0.5 wt.% concentrations. The distribution of BBOT in a silica particle was investigated based on the relationship between the changes in particle diameter and the changes in emission intensity. The emission intensity of the BBOT-encapsulated silica particle oscillated with the decreasing particle diameter. This result supported the multilayered model. Information regarding the distribution of the dye in the silica matrix will provide valuable information for understanding the formation mechanism of dye-encapsulated silica.

Detection of four novel polymorphisms in PrP gene of Pakistani sheep (Damani and Hashtnagri) and goats (Kamori and Local Hairy) breeds

Scrapie is a fatal neurodegenerative disorder of sheep and goats caused by post-translational conformational change in the host-encoded prion protein (PrPC). Susceptibility or resistance to scrapie has been associated with the presence of polymorphisms in the prion protein (PrP) gene. In the present study, we analyzed the PrP gene sequence to determine the frequency of polymorphisms in 56 sheep (28 each from Damani and Hashtnagri breeds) and 56 goats (28 each from Kamori and Local Hairy breeds). A total of 7 amino acid polymorphisms were detected in the PrP gene for sheep and 4 for goats. These amino acid polymorphisms were combined in 13 alleles and 15 genotypes in sheep and 5 alleles and 6 genotypes in goats. The overall frequency of the most sheep scrapie-resistant polymorphism (Q171R) was calculated to be 0.107. The most scrapie-susceptible polymorphism (A136V) was not detected in any of the studied sheep. The overall frequency of scrapie-associated polymorphism (H143R) in goats was found to be 0.152. Along with already known amino acid polymorphisms, two novel polymorphisms were also detected for each of sheep (Q171N and T191I) and goats (G22C and P63L). However, the overall frequency of these polymorphisms was extremely low.

Exact solutions for unsteady axial Couette flow of a fractional Maxwell fluid due to an accelerated shear

The velocity field and the adequate shear stress corresponding to the flow of a fractional Maxwell fluid (FMF) between two infinite coaxial cylinders, are determined by means of the Laplace and finite Hankel transforms. The motion is produced by the inner cylinder that at time t = 0+ applies a shear stress fta (a ≥ 0) to the fluid. The solutions that have been obtained, presented under series form in terms of the generalized G and R functions, satisfy all imposed initial and boundary conditions. Similar solutions for ordinary Maxwell and Newtonian fluids are obtained as special cases of general solutions. The unsteady solutions corresponding to a = 1, 2, 3, ... can be written as simple or multiple integrals of similar solutions for a = 0 and we extend this for any positive real number a expressing in fractional integration. Furthermore, for a = 0, 1 and 2, the solutions corresponding to Maxwell fluid compared graphically with the solutions obtained in [1–3], earlier by a different technique. For a = 0 and 1 the unsteady motion of a Maxwell fluid, as well as that of a Newtonian fluid ultimately becomes steady and the required time to reach the steady-state is graphically established. Finally a comparison between the motions of FMF and Maxwell fluid is underlined by graphical illustrations.

The severity of pseudohyperkalaemia is not dependent upon the stage of chronic kidney disease: a prospective study

BACKGROUND

Pseudohyperkalaemia may result from delay in centrifugation and storage at 4°C. We investigated whether the stage of chronic kidney disease (CKD), its aetiology or medications influence this.

METHODS

Seventy-seven patients with CKD were recruited. Lithium heparin plasma samples were analysed for sodium, potassium, urea and creatinine, chloride, bicarbonate, magnesium, calcium and inorganic phosphate at 0 h and after storage of whole blood at 4°C for 6 h and 20 h. K-EDTA and fluoride-EDTA samples were analysed for full blood count and glucose at 0 h. CKD stage was determined by standard criteria.

RESULTS

K(+) increased on average by 1.0 and 3.6 mmol/L after 6 and 20 h storage of whole blood at 4°C, independent of cause or stage of CKD. K(+) increase at 6 h was correlated with haemoglobin but not with white blood cell count, platelet count or glucose. Patients taking ACE inhibitors and/or angiotensin receptor blockers (ARBs) had slightly higher K(+) at 0 h and increased K(+) after storage for 6 h. Na(+) decreased on average by 3.8 mmol/L at 20 h and was independent of CKD stage, and correlated with K(+) increase.

CONCLUSIONS

K(+) increased significantly with time in samples stored at 4°C in all stages of CKD. This was greater in some patients on ACE inhibitors and ARBs, and increased with haemoglobin, but was not related to the stage of CKD, white blood cell count or platelet count for the samples used in this study.

Pneumoperitoneum in peritoneal dialysis patients; one centre's experience

The pneumoperitoneum (PP) on upright chest X-ray (CXR) usually indicates a perforated viscus. As peritoneal dialysis (PD) catheter provides an additional port of air entry into the peritoneal cavity, the incidence and clinical significance of PP in PD patients has been debated in the literature (a variable incidence from 4 to 34% has been reported in previous studies). With improvement in patient training and connecting devices of PD catheters, technique-related PP is quite rare. Following a recent patient with PP, we reviewed our 3-year data to evaluate the incidence and significance of this radiological sign in PD patients.

We reviewed all upright CXRs in our PD patients from 2006 to 2008, using an electronic radiology database. Over 3 years, we had a total of 156 patients on PD. We have reviewed a total 312 upright CXRs (mean 2 X-rays per patient), which were performed for various clinical reasons during this period.

Seven PD patients had 11 CXRs showing free air under the diaphragm (total incidence of PP 4% of PD population and 3% of CXR performed in PD patients). One patient had two episodes of PP with a total of four X-rays demonstrating free air. Two patients had surgical complications of PD catheter insertion and PP was diagnosed just after the insertion of PD catheter, both of them needed laparotomy. Five patients had incidental PP, which was possibly technique related. In four of these patients with incidental PP, no definite intervention was needed. However, one of these five patients was symptomatic. We established that the cause of PP was faulty technique. Aspiration of PP with a patient in the Trendelenburg position gave her immediate symptomatic relief. We also retrained her to prevent further episodes of PP.

This review demonstrates the quite low and falling incidence of PP (<4% in a prevalent PD population) most likely due to improvement in training and technique. The air should not enter the peritoneal cavity in normal properly performed exchanges. Air under the diaphragm in a PD patient requires appropriate evaluation to exclude visceral perforation. After that, patient technique of PD exchanges should be reviewed. However, if PP persists, aspiration of air can give symptomatic relief.

Taylor–Couette flow of a fractional second grade fluid in an annulus due to a time-dependent couple

Exact solutions for the velocity field and the associated shear stress, corresponding to the flow of a fractional second grade fluid between two infinite coaxial cylinders, are determined by means of Laplace and finite Hankel transforms. The motion is produced by the inner cylinder which is rotating about its axis due to a time-dependent torque per unit length 2πR1ft2. The solutions that have been obtained satisfy all imposed initial and boundary conditions. For β → 1, respectively β → 1 and α1 → 0, the corresponding solutions for ordinary second grade fluids and Newtonian fluids, performing the same motion, are obtained as limiting cases.

Metal-oxide-doped silica nanoparticles for the catalytic glycolysis of polyethylene terephthalate

Polyethylene terephthalate (PET) was depolymerized to monomer bis(2-hydroxyethyl) terephthalate (BHET) using excess ethylene glycol (EG) in the presence of metal oxides that were impregnated on different forms of silica support [silica nanoparticles (SNPs) or silica microparticles (SMPs)] as glycolysis catalysts. The reactions were carried out at 300 degrees C and 1.1 MPa at an EG-to-PET molar ratio of 11:1 and a catalyst-to-PET-weight ratio of 1.0% for 40-80 min. Among the four prepared catalysts (Mn3O4/SNPs, ZnO/SNPs, Mn3O4/SMPs, and ZnO/SMPs), the Mn3O4/SNPs nanocomposite had the highest monomer yield (> 90%). This high yield may be explained by the high surface area, amorphous and porous structure, and existence of numerous active sites on the nanocomposite catalyst. The BHET yield increased with time and reached the highest level where equilibrium was established between BHET and its dimer. The catalysts were characterized by their SEM, TEM, and BET surface areas, and via XRD, whereas the monomer BHET was characterized by HPLC and FT-IR. The glycolysis with the Mn3O4/SNPs nanocomposite as the glycolysis catalyst produced a maximum BHET in a short reaction time.

A comparison between open and closed hemorrhoidectomy

BACKGROUND

Haemorrhoidectomy is associated with complications including pain, bleeding and wound infection which can result prolonged hospital stay. Haemorrhoidectomy is considered to provide a better outcome in terms of postoperative pain and wound healing. Aims were to compare postoperative pain, bleeding, operating time and wound healing in patients undergoing open and closed haemorrhoidectomy.

METHODS

This comparative study was conducted in the surgical department at Fauji Foundation Hospital, Rawalpindi from December 13, 2006 to December 31, 2011. Consecutive patients, both male and female, presenting with 3rd and 4th degree haemorrhoids in the surgical Outpatient Department were included in this study. Half of the patients were assigned to the open haemorrhoidectomy group while the other half was put in the closed haemorrhoidectomy group. Each patient was evaluated by detailed history and examination. Both digital rectal examination (DRE) and proctoscopy were done to confirm the diagnosis.

RESULTS

A total of 260 patients were assessed, 130 in each group. In the open group, 52 patients experienced mild pain and 78 moderate while in the closed group, 30 patients experienced mild pain, 87 moderate and 13 patients severe pain. All 130 patients in the closed group showed complete wound healing after 2 weeks as compared to only 66 patients in the open group with a p<0.001. Early and late postoperative bleeding was similar in both groups.

CONCLUSIONS

The closed technique provides a better outcome in terms of less postoperative bleeding and complete wound healing, but it is associated with more pain.

Effect of maternal anaemia on birth weight

BACKGROUND

Anaemia is a common medical problem in pregnancy. The extent up to which, maternal anaemia effects maternal and neonatal health is still uncertain. Maternal anaemia is commonly considered a risk factor for low birth weight (LBW) babies. Some studies have demonstrated a strong association between low haemoglobin before delivery and LBW babies. However, others have not found a significant association. Therefore, there is insufficient information to assess the overall adverse impact of anaemia during pregnancy. The aim of this study was to determine whether maternal anaemia would affect the birth weight of the baby and compare this with that of non-anaemic mothers. It was a cross-sectional comparative study carried out at the maternity ward of Fauji Foundation Hospital, Rawalpindi.

METHODS

One hundred subjects divided into two groups each containing 50 subjects on the basis of consecutive non probability sampling were included in the study. Group-A included 50 Anaemic pregnant women and Group-B 50 non-anaemic pregnant women. Information was collected by direct interviewing method through a precoded structured questionnaire. The Hb level and birth weights were taken from the labour room record.

RESULTS

The mean age of the mothers in anaemic group was found to be older than the non anaemic group, i.e., (29.44 versus 27.98), though the difference was statistically non significant. The number of low birth weight infants (64%) was statistically very highly significantly more (p<0.001) in the anaemic group of mothers than the non anaemic group (10%).

CONCLUSION

The results of this study show an association of maternal anaemia in pregnancy with increased risk of LBW babies.

Active food packaging evolution: transformation from micro- to nanotechnology

Predicting which attributes consumers are willing to pay extra for has become straightforward in recent years. The demands for the prime necessity of food of natural quality, elevated safety, minimally processed, ready-to-eat, and longer shelf-life have turned out to be matters of paramount importance. The increased awareness of environmental conservation and the escalating rate of foodborne illnesses have driven the food industry to implement a more innovative solution, i.e. bioactive packaging. Owing to nanotechnology application in eco-favorable coatings and encapsulation systems, the probabilities of enhancing food quality, safety, stability, and efficiency have been augmented. In this review article, the collective results highlight the food nanotechnology potentials with special focus on its application in active packaging, novel nano- and microencapsulation techniques, regulatory issues, and socio-ethical scepticism between nano-technophiles and nano-technophobes. No one has yet indicated the comparison of data concerning food nano- versus micro-technology; therefore noteworthy results of recent investigations are interpreted in the context of bioactive packaging. The next technological revolution in the domain of food science and nutrition would be the 3-BIOS concept enabling a controlled release of active agents through bioactive, biodegradable, and bionanocomposite combined strategy.

Exact solutions for the unsteady rotational flow of a generalized second grade fluid through a circular cylinder

Here the velocity field and the associated tangential stress corresponding to the rotational flow of a generalized second grade fluid within an infinite circular cylinder are determined by means of the Laplace and finite Hankel transforms. At time t = 0 the fluid is at rest and the motion is produced by the rotation of the cylinder around its axis with a time dependent angular velocity Ωt. The solutions that have been obtained are presented under series form in terms of the generalized G-functions. The similar solutions for the ordinary second grade and Newtonian fluids, performing the same motion, are obtained as special cases of our general solution.

Early results of oesophagectomy for carcinoma oesophagus in 1008 cases

OBJECTIVE

To determine the early results of 1008 oesophagectomies done for carcinoma oesophagus over a 9 years period.

METHODS

This observational descriptive study was conducted at Department of Cardiothoracic Surgery, Lady Reading Hospital, and Khyber Medical Centre Peshawar from June 2002 to June 2011. All patients had apart from routine investigations, Barium studies, Endoscopy and biopsy, CT thorax/upper abdomen with oral and I/V contrast and abdominal ultrasound. The operative approaches included left thoracolaparotomy with left neck anastomosis, transhiatal, left thoracolaparotomy with Roux en-Y, McKeown with right decortication, Ivor Lewis and left thoracolaparotomy with left decortication. All operations were done by one surgical team. The hospital records and operation reports of these patients were carefully analysed for demographic feature; operative approach and outcome.

RESULTS

Out of 1008 cases, 698 were males and 310 were females with a mean age of 51.6 years. The age range was 17-80 years. Out of 1008 cases 611 (60.61%) cases had lower one third tumours, 384 (38.09%) cases had middle one third tumours while 13 (1.28%) tumours were just below the thoracic inlet. Of the 611 lower 1/3 tumours stomach involvement was present in 271 (44.35%) cases. Adenocarcinoma was present in 516 (51.19%) cases, squamous cell carcinoma was present in 485 (48.11%), adenosquamous was 6 (0.59%) and carcinoma in situ was present in 1 case (0.09%). Morbidity was 63/1008 (6.25%), and comprised anastomotic leaks 15, aspiration pneumonia 13, wound infection 13, hoarseness 8, and strictures 14, 30-day mortality was 23/1008 (2.28%) and causes included aspiration pneumonia-respiratory failure (5), myocardial infarction (4), anastomotic leak (6), tracheal injury (2), and presumed pulmonary embolism (6).

CONCLUSION

More than 1000 cases in 9 years is a very high oesophageal workload for malignancy. Morbidity of 6.25% and mortality of 2.28% shows that such major operations can be done safely in thoracic centres.

Structural determination of crotamides A and B, the new amides from Croton sparsiflorus

Two new amides crotamides A and B, have been isolated from the n-hexane soluble fraction of Croton sparsiflorus in addition to salisomide and N-(4-hydroxyphenethyl)-octacosanamide reported for the first time from this species. Their structures were assigned from spectral data including 1D and 2D NMR spectroscopic data.

Functionalization effects of single-walled carbon nanotubes as templates for the synthesis of silica nanorods and study of growing mechanism of silica

Silica nanorods were successfully prepared through a sol-gel process in the presence of carboxylic-functionalized single-walled carbon nanotubes (C-SWCNTs). The effect of chemical functionalization of single-walled carbon nanotubes (SWCNTs) on the growth of the silica layer was investigated using pristine SWCNTs (P-SWCNTs) and C-SWCNTS. The C-SWCNTs served as a unique template to fabricate silica hybrid composite materials. The crystalline formation and growing mechanism of the silica layer on C-SWCNTs were explained by the hydrolysis and chemical bonding between silica precursors and carboxylated SWCNTs. The C-SWCNTs, as templates, were successfully encapsulated using silica, and used templates were removed by oxidation at high temperature. Finally, silica nanorods/nanowires were synthesized in forms of mold, and this silica fabrication mechanism could be applied for large-scale production of silica nanomaterials and highly flexible nanocomposites. The sequence of a silica encapsulation process of C-SWCNTs and removed C-SWCNTs was characterized using SEM, TEM, EDX, FT-IR and Raman spectroscopy, XRD, and electrical analysis.

Abstract 3112: TIS21BTG2/PC3 enhances down-regulation of c-Myc expression during all-trans-retinoic acid-induced differentiation of acute promyelocytic leukemia cells

c-Myc is a transcription factor that promotes cell growth and proliferation. Deregulated c-myc can induce aberrant proliferation, loss of terminal differentiation and oncogenesis. On the other hand, the 12-O-tetradecanoyl phorbol-13-acetate inducible sequence 21 (TIS21), ortholog of human B-cell translocation gene-2 (BTG2) is an antiproliferative tumor suppressor gene, working as a pan-cell cycle regulator. In this study we have evaluated the effects of all-trans retinoic acid (ATRA) and TIS21BTG2/PC3 on the expression c-Myc in HL-60 promyelocytic leukemia cells, harboring amplified c-myc. We observed that ATRA induced granulocytic differentiation of HL-60 cells as monitored by the expressions of CD11b, CD14, CD38 and microscopic examination of the cells. ATRA treatment led to decrease in cells proliferation accompanied by down-regulation of cyclin D1, cyclin E and cyclin A while up-regulation of p21WAF1 and p27KIP1 and hence G1 phase arrest. Expression of c-Myc was significantly down-regulated during all-trans-retinoic acid induced differentiation, while BTG2TIS21/PC3 was up-regulated (∼2.5 folds). Employing adenovirus carrying TIS21 gene, we observed the slight down regulation of c-Myc expression; TIS21 however, enhanced ATRA-induced differentiation of HL-60 cells to granulocytes and significantly increased down-regulation of c-Myc expression at protein level but mRNA level didn't change. Proteosomal inhibition with MG132 didn't attenuate c-Myc protein levels indicating that ubiquitination/proteosome-mediated proteolysis is not involved in TIS21BTG2/PC3 mediated down-regulation of c-Myc. Inhibition of PI3K/Akt/mTOR pathway with LY294002 however, suggested the possible involvement of TIS21BTG2/PC at least in part through PI3K/Akt/mTOR pathway in regulating c-Myc expression. The present results suggest the modulating effect of TIS21BTG2/PC3 on c-Myc expression in a promyelocytic leukemia cells.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3112.

Relationship of awards in multiple choice questions and structured answer questions in the undergraduate years and their effectiveness in evaluation

BACKGROUND

A number of evaluation tools for assessing the cognitive and affective domains in accordance with Bloom's taxonomy are available for summative assessment. At the University of Health Sciences, Lahore, Multiple Choice Questions (MCQs) and Structured Answer Questions (SAQs) are used for the evaluation of the cognitive domain at all six hierarch levels of taxonomy using the tables of specifications to ensure content validity. The rationale of having two evaluation tools seemingly similar in their evaluative competency yet differing in feasibility of construction, administration and marking is being challenged in this study.

METHODS

The MCQ and SAQ awards of the ten percent sample population amounting to 985 students in fifteen Medical and Dental Colleges across Punjab were entered into SPSS-15 and correlated according to the cognitive and affective level of assessment in relation to the Bloom's taxonomy and their grouping in the Tables of Specifications, using parametric tests. 3494 anonymously administered questionnaires were analyzed using ethnograph.

RESULTS

No statistically significant difference was found in the mean marks obtained by the students when MCQs and SAQs were compared according to their groupings in the Tables of Specifications at all levels of cognitive hierarchical testing. End-of-yearcognitive level testing targets set were not met and more questions were set at the lower cognitive testing levels. Expenses incurred in setting MCQs and SAQs were comparable but conduct and assessment costs for MCQs and SAQs were 6% and 94% of the total respectively. In both MCQs and SAQs students performed better at higher cognitive testing levels whereas the SAQs and MCQs were able to marginally test the lower levels of affective domain only. Student's feedback showed that attempting MCQs required critical thinking, experience and practice.

CONCLUSION

MCQs are more cost effective means at levels of cognitive domain assessment.

Posttransplantation lymphoproliferative disorder with skin involvement

Posttransplantation lymphoproliferative disorders (PTLD) are lymphoid proliferations or lymphomas that develop as a result of immunosuppression in recipients of solid organs and bone marrow allografts. The disorder is seen in 1-2% of renal transplant recipients with a variable time period of presentation and is usually seen within the first year following transplantation. We report a case of B-cell lymphoma (PTLD WHO class-3) presenting with skin involvement in a patient of renal transplantation, 8 years after receiving the transplant.

Structural determination of abutilins A and B, new flavonoids from Abutilon pakistanicum, by 1D and 2D NMR spectroscopy

Two new flavonoids, abutilin A and B, were isolated from the chloroform soluble fraction of Abutilon pakistanicum and their structures assigned from (1)H and (13)C NMR spectra, DEPT and by 2D COSY, HMQC and HMBC experiments. Ferulic acid (3), (E)-cinnamic acid (4), 5-hydroxy-4',6,7,8-tetramethoxyflavone (5), kaempferol (6), luteolin (7) and luteolin 7-O-beta-D-glucopyranoside (8) have also been reported from this species.

Association of polycystic ovary syndrome with cardiovascular risk factors

BACKGROUND

Polycystic ovary syndrome (PCOS), also clinically known as Stein-Leventhal syndrome, is an endocrine disorder that affects 5-10% of women.

OBJECTIVE

To evaluate the risk factors for developing early onset of cardiovascular disease (CVD) in young patients with PCOS from our local population.

DESIGN

Case-control study.

METHODS

Fifty women with PCOS selected by history and transvaginal ultrasounds and 30 age-matched healthy women (controls). The case subjects and controls were further divided into two age categories comprising of equal number of subjects, of 20-29 and 30-39 years of age. The subjects underwent a detailed medical history, general physical examination, systolic (SBP) and diastolic blood pressures (DBP). Fasting blood samples were analyzed for glucose, insulin, triacylglycerides (TAG), total cholesterol, high density lipoprotein-C (HDL-C), low density lipoprotein-C (LDL-C), follicle-stimulating hormone (FSH), and luteinizing hormone (LH).

RESULTS

Women with the PCOS had significantly higher mean arterial pressure (MAP), serum TAG, LDL-C, insulin, and LH levels when compared with the age-matched control subjects. No significant differences were observed between serum cholesterol, glucose, and FSH levels between cases and controls. However, no marked differences were observed in biochemical parameters between the two age groups of PCOS patients.

CONCLUSIONS

Younger women with PCOS are equally at risk of developing CVD as older women.

Standards for labelling and storage of anaesthetic medications--an audit

OBJECTIVE

To check compliance of anaesthetist to current policies set for the use of medication within operation room and for induction room floor stock.

METHODS

The initial audit was conducted from 1st October to 31st November 2006 and reaudit after dissemination and sharing of results within the department repeated in July-August 2007. In each audit four operating rooms were visited twice a week. Syringes were checked for standard drug labelling for narcotic and non narcotic preparations. Drug trolley was checked for any expired drugs and whether the trolley was locked in case of operating room (OR) where list was ended or was on hold. Any unattended drug was noted and Induction room was checked twice weekly for accurate drug inventory and for standard drug storage recommendations.

RESULTS

Labels were according to standard in non narcotic drugs on 25% syringes in first audit and 63% in second audit, likewise, narcotics labels were according to standards in 41% in first and 57% in second audit. Unattended drugs were present once in first and twice in second audit. There was 100% compliance in other drug storage policy parameters in both audits.

CONCLUSION

Poor compliance of drug labelling standards for both narcotic and non narcotic drugs was present. However, second audit revealed improvement in all areas of drug handling. Dissemination of policies and reminders are important for continuing improvement in use of medication within operation room and within induction room floor stock.