Advances in liposomes loaded with photoresponse materials for cancer therapy

Cancer treatment is presently a significant challenge in the medical domain, wherein the primary modalities of intervention include chemotherapy, radiation therapy and surgery. However, these therapeutic modalities carry side effects. Photothermal therapy (PTT) and photodynamic therapy (PDT) have emerged as promising modalities for the treatment of tumors in recent years. Phototherapy is a therapeutic approach that involves the exposure of materials to specific wavelengths of light, which can subsequently be converted into either heat or Reactive Oxygen Species (ROS) to effectively eradicate cancer cells. Due to the hydrophobicity and lack of targeting of many photoresponsive materials, the use of nano-carriers for their transportation has been extensively explored. Among these nanocarriers, liposomes have been identified as an effective drug delivery system due to their controllability and availability in the biomedical field. By binding photoresponsive materials to liposomes, it is possible to reduce the cytotoxicity of the material and regulate drug release and accumulation at the tumor site. This article provides a comprehensive review of the progress made in cancer therapy using photoresponsive materials loaded onto liposomes. Additionally, the article discusses the potential synergistic treatment through the combination of phototherapy with chemo/immuno/gene therapy using liposomes.

The association of ABCB1 gene polymorphism with clinical response to carbamazepine monotherapy in patients with epilepsy

BACKGROUND

Epilepsy is a common neurological disease but around 30% of patients fail to respond to antiepileptic drug (AED) treatment. Genetic variation of the ATP-binding cassette subfamily B, member 1 (ABCB1) gene, a drug efflux transporter may infer treatment resistance by decreasing gastrointestinal absorption and preventing AED entry into the brain. This study examined the impact of ABCB1 genetic variants on carbamazepine responsiveness.

MATERIALS AND METHODS

Genomic DNA was extracted from whole blood of 104 epileptic patients. Genotyping of 3 ABCB1 variants (c.C3435T, c.G2677T/A and c.C1236T) was undertaken using validated TaqMan allelic discrimination assays. Plasma carbamazepine levels were measured at 3 and 6 months following the initial dose using high-performance liquid chromatography (HPLC) alongside clinical outcomes evaluation.

RESULTS

Nonresponse to carbamazepine (CBZ) was associated significantly with the ABCB1 variants c.C3435T, c.G2677T/A, c.C1236T and TTT, TTC haplotypes (P < 0.05). There was no significant association between variants and plasma CBZ level (P > 0.05).

CONCLUSIONS

Our results showed that variant alleles of the ABCB1 gene and TTT, TTC haplotypes were significantly associated with CBZ resistance without affecting the plasma level of carbamazepine. The findings of this study may help to predict patient's response to treatment ultimately it will improve the personalized and evidence based treatment choice of patients with epilepsy.

Integrating network pharmacology and experimental verification to investigate the pharmacological mechanisms of Buzhong Yiqi decoction in the treatment of non-small cell lung cancer

Among all types of cancers, non-small cell lung cancer (NSCLC) exhibits the highest mortality rate with a five-year survival rate below 17% for patients. The Buzhong Yiqi decoction (BZYQD), traditional Chinese medicine (TCM) formula, has been reported to exhibit clinical efficacy in the treatment of NSCLC. Nevertheless, the underlying molecular mechanism remains elusive. This study aimed to assess the mechanistic actions exerted by BZYQD against NSCLC using network pharmacological analysis and experimental validation. The public databases were searched for active compounds in BZYQD, their potential targets, and NSCLC-related targets. The protein-protein interaction (PPI) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to predict the core targets and signaling pathways of BZYQD against NSCLC. After screening, this study validated the results of predictions through in vitro experiments and public databases. We found 192 common targets between BZYQD and NSCLC. KEGG analysis showed that the anti-NSCLC effects of BZYQD were mediated through the PI3K-AKT signaling pathway. The results of in vitro experiment indicated that BZYQD could inhibit cell viability and proliferation of A549 and H1299 cells apart from inducing cell apoptosis. In addition, western blot results substantiated that BZYQD could treat NSCLC by inhibiting the activation of the PI3K-AKT signaling pathway. The current study investigated the pharmacological mechanism of BZYQD against NSCLC via network pharmacology and in vitro analyses. Overall, the results revealed that BZYQD could be a promising therapeutic agent for the treatment of NSCLC in the future. Still, more experimental investigations are needed to confirm the applicability of BZYQD for clinical trials.

Evaluation of potential bacterial protease inhibitor properties of selected hydroxyquinoline derivatives: an in silico docking and molecular dynamics simulation approach

Antimicrobial drug resistance (AMR) is a severe global threat to public health. The increasing emergence of drug-resistant bacteria requires the discovery of novel antibacterial agents. Quinoline derivatives have previously been reported to exhibit antimalarial, antiviral, antitumor, antiulcer, antioxidant and, most interestingly, antibacterial properties. In this study, we evaluated the binding affinity of three newly designed hydroxyquinolines derived from sulfanilamide (1), 4-amino benzoic acid (2) and sulfanilic acid (3) towards five bacterial protein targets (PDB ID: 1JIJ, 3VOB, 1ZI0, 6F86, 4CJN). The three derivatives were designed considering the amino acid residues identified at the active site of each protein involved in the binding of each co-crystallized ligand and drug-likeness properties. The ligands displayed binding energy values with the target proteins ranging from -2.17 to -8.45 kcal/mol. Compounds (1) and (3) showed the best binding scores towards 1ZI0/3VOB and 1JIJ/4CJN, respectively, which may serve as new antibiotic scaffolds. Our in silico results suggest that sulfanilamide (1) or sulfanilic acid (3) hydroxyquinoline derivatives have the potential to be developed as bacterial inhibitors, particularly MRSA inhibitors. But before that, it must go through the proper preclinical and clinical trials for further scientific validation. Further experimental studies are warranted to explore the antibacterial potential of these compounds through preclinical and clinical studies.Communicated by Ramaswamy H. Sarma.

Biological investigations of Aspergillus ficuum via in vivo, in vitro and in silico analyses

Serious human health impacts have been observed worldwide due to several life-threatening diseases such as cancer, candidiasis, hepatic coma, and gastritis etc. Exploration of nature for the treatment of such fatal diseases is an area of immense interest for the scientific community. Based on this idea, the genus Aspergillus was selected to discover its hidden therapeutic potential. The genus Aspergillus is known to possess several biologically active compounds. The current research aimed to assess the biological and pharmacological potency of the extracts of less-studied Aspergillus ficuum (FCBP-DNA-1266) (A. ficuum) employing experimental and bioinformatics approaches. The disc diffusion method was used for the antifungal investigation, and the MTT assay was performed to assess the anticancer effects. Mice were employed as an in vivo model to evaluate the antispasmodic effects. A standard spectrophotometric technique was applied to gauge the urease inhibitory activity. The antifungal studies indicate that both n-hexane and ethyl acetate extracts were significantly active against Candida albicans (C. albicans) with their zone of inhibitions (ZOI) values reported as 19 ± 1.06 mm and 25 ± 0.55 mm, respectively at a dose of 30 µg.mL-1. In vitro cytotoxicity assay against HeLa, fibroblast 3T3, prostate PC3, and breast MCF-7 cancer cell lines was performed. The ethyl acetate extract of A. ficuum was found to be significantly active against MCF-7 with its IC50 value of 43.88 µg.mL-1. However, no substantial effects on the percent cell death of HeLa cancer cell lines were observed. In addition, the A. ficuum extracts also inhibited the urease enzyme compared to standard thiourea. The antispasmodic activity of A. ficuum extract was assessed by an in vivo model and the results demonstrated promising activity at 150 mg.kg-1. Molecular docking results also supported the antifungal, anticancer, and antiurease potency of A. ficuum extract. Overall, the results display promising aspects of A. ficuum extract as a future pharmacological source.

Comparative Study of Antioxidant, Antidiabetic, Cytotoxic Potentials, and Phytochemicals of Fenugreek (Trigonella foenum-graecum) and Ginger (Zingiber officinale)

Trigonella foenum-graecum and Zingiber officinale are used as traditional medicinal plants for the treatment of infectious and inflammatory diseases. However, a comparative analysis and bioactivities of T. foenum-graecum and Z. officinale lack some necessary information for therapeutic purposes. This study was designed to evaluate the biochemical characterizations and biological efficacy of T. foenum-graecum and Z. officinale as antioxidant, antidiabetic, antiamnesic, and cytotoxic agents. Antioxidant activity was determined by DPPH free radical scavenging assay. Antidiabetic potentials were evaluated by glycation, alpha-amylase, and acetylcholinesterase inhibition assays. We performed biochemical characterization through analyses of high-performance liquid chromatography (HPLC) and FTIR (Fourier transform infrared spectroscopy). Results revealed that total phenolic contents (TPCs) (g GAE/100 g) of T. foenum-graecum and Z. officinale were 5.74 ± 0.81 g and 6.15 ± 0.06 g, respectively, and total flavonoid contents (TFCs) varied from 1.51 ± 0.58 g CE/100 g to 17.54 ± 0.58. DPPH scavenging potentials of T. foenum-graecum and Z. officinale extract were 50.27% and 88.82%, respectively. Antiglycation potentials of T. foenum-graecum and Z. officinale showed a maximum activity at 16–29% and 96%. Alpha-amylase and alpha-glucosidase inhibition ranged from 9.43–24.95 and 10.52–27.89 and 54.97%, respectively. All the test samples of T. foenum-graecum and Z. officinale showed acetylcholinesterase inhibition potential at 0.37–46.88%. HPLC analysis of T. foenum-graecum revealed the presence of quercetin, gallic acid, caffeic acid, vanillic acid, syringic acid, and cumeric acid, while Z. officinale revealed the quercetin, gallic acid, vanillic acid, benzoic acid, chlorogenic acid, p.Coumaric acid, ferulic acid, and cinnamic acid. FTIR analysis revealed the presence of aldehydes, ketones, aromatic compounds, amines, and carbonyl groups in T. foenum-graecum, while alcohol, alkane, alkene, ketone, amine, and ether are bioactives present in the methanolic extract of Z. officinale. It was concluded that a comparative analysis of T. foenum-graecum and Z. officinale showed that Z. officinale showed higher therapeutic effects.

Recent Advances on the Antimicrobial Activities of Schiff Bases and their Metal Complexes: An Updated Overview

Schiff bases represent a valuable class of organic compounds, synthesized via condensation of primary amines with ketones or aldehydes. They are renowned for possessing innumerable applications in agricultural chemistry, organic synthesis, chemical and biological sensing, coating, polymer and resin industries, catalysis, coordination chemistry, and drug designing. Schiff bases contain imine or azomethine (-C=N-) functional groups which are important pharmacophores for the design and synthesis of lead bioactive compounds. In medicinal chemistry, Schiff bases have attracted immense attention due to their diverse biological activities. This review aims to encompass the recent developments on the antimicrobial activities of Schiff bases. The article summarizes the antibacterial, antifungal, antiviral, antimalarial, and antileishmanial activities of Schiff bases reported since 2011.

Management Outcome of Patients with Infected Sternotomy Wounds

Objective: to evaluate management outcomes of post-sternotomy wounds. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad Pakistan, from Jan 2020 to Dec 2021. Methodology: We reviewed 35 patients who had developed sternal wound infections post-cardiothoracic surgery. Outcomes of the study were measured using the SF-36 Quality of Life questionnaire. Results: Our patients presented with either Pairolero Type-II 11(31.4%) or Type-III 19(54.2%) sternal wound infection. Preoperatively patients scored 296.667±69.40 in physical functional, 100.00±30.51 in limitations due to physical health, 16.67±37.90 in role limitation due to emotional problems, energy/fatigue scored 43.53±23.70, emotional well-being 163.33±23.54, social functioning as 11.40±11.66, pain score 31.25±19.90 and general health 131.67±35.31. The improvement in scores was noted in all domains postoperatively. Physical functioning mean scored as 790.00±48.07, role limitations due to physical health scored as310.34±67.32, role limitations due to emotional problems scored as 266.67±47.94, energy/fatigue 284.67±18.71, emotional well being 448.67±18.71, social functioning 185.83±12.60, pain score 164.17±22.01 and general health 316.67±34.95. Thirty-four (97.1%) out of 35 patients recovered well postoperative, with a maximum follow-up of 4 years and a minimum follow-up of 1 year. One patient expired on the sixth day of muscle flap coverage of the wound due to cardiac arrest. Conclusion: A positive prognosis can be obtained by this treatment protocol.

Molecular docking and dynamic simulations of Cefixime, Etoposide and Nebrodenside A against the pathogenic proteins of SARS-CoV-2

The catastrophe of the coronavirus continues from one part of the world to another, and hardly a country is left without its devastations. Millions of people were infected and several hundred thousand died of the COVID-19 pandemic across the world. There is no clear targeted drug therapy available for the treatment of the patients. The discovery of vaccines is not enough to curtail its spread and disastrous implications. An instantly qualifying approach is needed to utilize the current drugs and isolated compounds. The purpose of this work is to determine potent inhibitors against the target proteins of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For this purpose, molecular docking study of pathogenic spike glycoproteins (S), nucleocapsid phosphoprotein (N), an envelope protein (E), two drugs i.e., cefixime, etoposide, and a previously isolated compound nebrodenside A is performed. Promising results were obtained via complimentary analysis of molecular dynamics (MD) simulations performed for the complexes of three proteins with etoposide drug. Minimum values were recorded for the docking scores and binding energies of the complexes. These results were further supported by the RMSD, RMSF data for the stability of proteins and ligands. Additionally, ligand properties and ligand-protein contacts were also explained with histograms of every simulation trajectory. The computational studies confirmed that cefixime, etoposide, and nebrodenoside A can be used as potent inhibitors of COVID-19. Nevertheless, additional experimental investigations and validation of the selected candidates are mandatory to confirm their applicability for clinical trials.

Discovery of Biomarkers in Hepatocellular Carcinoma Metastasis Using Bioinformatic Analysis

Background:

Liver cancer is one of the most deadly malignancies worldwide. Tumor metastasis is the main cause of liver cancer-related death. So far, the mechanism of liver cancer metastasis is far away from fully elucidated. In this study, we aimed to discover key regulators involved in liver cancer metastasis by data mining.

Methods:

Two different types of data, including mRNA microarray (GSE6222 and GSE6764) and miRNA microarray (GSE67138), were analyzed. A total of 83 intersectant differently expressed genes (DEGs) with the same expression pattern in GSE6222 and GSE6764 were identified. One hundred and thirty-one differently expressed miRNAs (DEMs) were identified in GSE 67138. Furthermore, a total of 26 pairs of miRNA-target, including 18 DEMs and 13 DEGs were identified as critical miRNA-target axis via miRNA-target gene interaction analysis.

Result and Conclusion:

Among the 18 DEMs and 13 DEGs, 10 miRNAs and 10 target genes are significantly correlated with patients’ survival (p<0.05). Our results and methods might be interesting for data mining and helpful for further experimental functional validation.

Radiological outcome of acute subtrochanteric fractures fixed with Recon intramedullary nailing, a retrospective case series

The aim of this study was to evaluate the radiological outcome of acute subtrochanteric fractures fixed with Recon intramedullary nail. Charts of 48 patients with subtrochanteric fractures treated with Recon IM Nailing from January 2014 to December 2015 were retrospectively reviewed. Thirty (62%) patients were male and 18 (38%) were female. The mean age was 52±7 years. The most common mechanism of injury was road traffic accident (RTA) which was in 27 (56%) patients followed by a history of fall in 18 (38%) patients. Mean Radiological Healing time was 14±2 weeks. The mean duration of surgery was 2.27±1 hours while Mean Hospital Stay was 5±2 days. Four patients had delayed fracture healing. This study suggests that intramedullary nailing in Recon Mode is a reliable and effective device especially for subtrochanteric fractures, leading to a high rate of bone union and minimal complications.

Taking a step down on the reconstruction ladder for head and neck reconstruction during the COVID-19 pandemic

Background

Most of the head and neck cancers are time-critical and need urgent surgical treatment. Our unit is one of the departments in the region, at the forefront in treating head and neck cancers in Pakistan. We have continued treating these patients in the COVID-19 pandemic with certain modified protocols. The objective of this study is to share our experience and approach towards head and neck reconstruction during the COVID-19 pandemic.

Results

There were a total of 31 patients, 20 (64.5%) were males and 11 (35.4%) patients were females. The mean age of patients was 52 years. Patients presented with different pathologies, i.e. Squamous cell carcinoma n = 26 (83.8%), mucoepidermoid carcinoma n = 2 (6.4%), adenoid cystic carcinoma n = 2 (6.4%) and mucormycosis n = 1 (3%). The reconstruction was done with loco-regional flaps like temporalis muscle flap n = 12 (38.7%), Pectoralis major myocutaneous flap n = 8 (25.8%), supraclavicular artery flap n = 10 (32.2%) and combination of fore-head, temporalis major and cheek rotation flaps n = 1 (3%). Defects involved different regions like maxilla n = 11 (35.4%), buccal mucosa n = 6 (19.3%), tongue with floor of mouth n = 6 (19.3%), mandible n = 4 (12.9%), parotid gland, mastoid n = 3 (9.6%) and combination of defects n = 1 (3%). Metal reconstruction plate was used in 3 (9.6%) patients with mandibular defects. All flaps survived, with the maximum follow-up of 8 months and minimum follow-up of 6 months.

Conclusion

Pedicled flaps are proving as the workhorse for head and neck reconstruction in unique global health crisis. Vigilant use of proper PPE and adherence to the ethical principles proves to be the only shield that will benefit patients, HCW and health system.

Research developments in the syntheses, anti-inflammatory activities and structure-activity relationships of pyrimidines

Pyrimidines are aromatic heterocyclic compounds that contain two nitrogen atoms at positions 1 and 3 of the six-membered ring. Numerous natural and synthetic pyrimidines are known to exist. They display a range of pharmacological effects including antioxidants, antibacterial, antiviral, antifungal, antituberculosis, and anti-inflammatory. This review sums up recent developments in the synthesis, anti-inflammatory effects, and structure-activity relationships (SARs) of pyrimidine derivatives. Numerous methods for the synthesis of pyrimidines are described. Anti-inflammatory effects of pyrimidines are attributed to their inhibitory response versus the expression and activities of certain vital inflammatory mediators namely prostaglandin E2, inducible nitric oxide synthase, tumor necrosis factor-α, nuclear factor κB, leukotrienes, and some interleukins. Literature studies reveal that a large number of pyrimidines exhibit potent anti-inflammatory effects. SARs of numerous pyrimidines have been discussed in detail. Several possible research guidelines and suggestions for the development of new pyrimidines as anti-inflammatory agents are also given. Detailed SAR analysis and prospects together provide clues for the synthesis of novel pyrimidine analogs possessing enhanced anti-inflammatory activities with minimum toxicity.

Two years analysis of acute poisoning in patients presented to Emergency Department of Ayub Teaching Hospital, Abbottabad

BACKGROUND

Acute poisoning is one of the most common causes of poisoning worldwide and is the fourth leading cause of death. It is either accidental or suicidal and causes a high mortality and morbidity. It is more common in males due to prolonged occupational exposure. The objective of this study is to find the pattern of acute poisoning and its relation with demographic variables in the emergency department of Ayub Teaching Hospital, Abbottabad.

METHODS

This cross-sectional study was carried out on patients of acute intoxication brought to the emergency department of Ayub Teaching Hospital in the year 2017-18. Data was analyzed by SPSS-16.0 and presented as tables and figures. Chi-square test was applied at 5% level of significance.

RESULTS

A total of 76 patients, 48 (63.16%) females and 28 (36.84%) males were included during the period. Mean age was 24.12±9.058 years. Thirty-nine (51.32)% cases belonged to rural areas and 37 (48.68)% were from urban areas. Cases of medicinal poisoning were 25 (32.89%) followed by 19 (25%) cases of organophosphate poisoning. Most cases of poisoning 36 (47.4%) were presented in the night shift. Thirty-one (40.79%) cases were brought to the hospital within 1-2 hours of incident. Cases of intentional poisoning were 51 (67.11%) while 25(32.89%) were due to accidental poisoning.

CONCLUSION

Females within the age group 21-35 belonging to rural areas were more prone to poisoning. The common type of poisoning is medicinal poisoning. Most patients were presented to the emergency in the night shift within 1-2 hours of intoxication.

Synergistic Effect Of Oral Allopurinol And Intralesional Sodium Stibogluconate In The Treatment Of Cutaneous Leishmaniasis

BACKGROUND

Leishmaniasis is an endemic disease and a major public health problem throughout the world. Its geographic distribution has been extended over the past few years in Pakistan. The available treatment options of Leishmaniasis are limited and mostly parenteral, and hence a nontoxic oral alternative therapy is urgently needed to overcome the problem. The objective of this study was to evaluate the synergistic effect of Allopurinol as an adjunct therapy along with conventional intra-lesional sodium Stibogluconate in the treatment of cutaneous Leishmaniasis.

METHODS

This single blinded randomized controlled trial was carried out at the tertiary care hospitals of district Peshawar, Pakistan. A total of one hundred and sixty-four (164) patients of age range from 19-56 years, consisting of both genders were included in this study. All subjects were randomly allocated to Group-1 and Group-2 where each group had 82 patients of comparable age and genders. Group-1 patients were given an intra-lesional injection of sodium Stibogluconate at a dose of 1-5 ml depending on the lesion size, where one ml injection contained 100 mg of the drug. Group-2 patients were given combination therapy of oral Allopurinol (20 mg/kg/day in divided doses) along with the same intra-lesional sodium Stibogluconate dose as group-1 until complete cure of the lesion.

RESULTS

Combination therapy of sodium Stibogluconate along with Allopurinol was found superior to sodium Stibogluconate alone in terms of duration of treatment. Group-1, patients who received only sodium Stibogluconate required prolonged treatment duration of 6-9 weeks depending upon the lesion size, while group-2 patients who received combination therapy of sodium Stibogluconate and Allopurinol responded more quickly and their lesions cured in 3-6 weeks depending upon the lesion size.

CONCLUSIONS

Oral Allopurinol has a synergistic effect when used with intra-lesional sodium Stibogluconate and effectively reduces the treatment duration required for complete cure of cutaneous Leishmaniasis. Treatment duration was reduced by 3 weeks in the present study when combination therapy was given to the patients of cutaneous Leishmaniasis.

Negative Pressure Wound Therapy (NPWT): Our Experience in Pakistan With Locally Made Dressing

Introduction

Worldwide numbers of patients suffering from complex wounds appear to increase annually. These patients present with acute, sub-acute and chronic wounds which can be difficult to manage. Management of these patients typically requires a multi-disciplinary approach by a plastic surgeon, orthopaedic surgeon and infectious disease control team. Despite the advent of numerous new techniques and technologies, negative pressure wound therapy (NPWT) remains a cornerstone to the management of complex wounds. We present our experience with NPWT in this study.

Methods

This is a retrospective study of 380 patients who were treated with NPWT in the last 10 years at a single center. We receive hundreds of infected wounds of limbs each year which are either post-traumatic or post-debridement. Frequency of dressing change, C-reactive protein levels, bacterial cultures, complication rate and cost of apparatus in each case were noted. All patients received systemic antibiotics during the treatment.

Results

We reviewed hospital data of 520 patients in which debridement was performed. Of the 520 patients derided, 380 patients were treated with NPWT, and included in study. Number of NPWT sessions was decided on the basis of wound status (adequate healthy granulation tissue, clinically improved circulation). A single session of NPWT dressing was applied in 84% (n = 320) patients, 8% (n = 31) patients needed two sessions of NPWT dressing, 6% (n = 24) patients had three sessions of NPWT dressing and only 1% (n = 5) patients did not respond to NPWT dressing. 78% (n = 297) patients had reduced levels of C-reactive protein levels and wound cultures were negative in 54% (n = 208) patients after application of NPWT dressing. Minor complications occurred in 0.7% (n = 3) patients due to occult osteomyelitis. In 0.5% (n = 2) patients, NPWT dressing was discontinued due to persistent leakage near a natural orifice. Sinus formation was seen in 6% (n = 23) patients who were treated with curettage and conventional dressings. The mean pain score on the verbal analogue scale was 3 out of 10. The mean cost of an NPWT dressing apparatus was 90 dollars.

Conclusion

We conclude from this study that NPWT dressing can be easily applied to any region of the body and it can be customized to the needs of patients from different socio-economic status.

Resection and Reconstructive Options in the Management of Dermatofibrosarcoma Protuberans of the Head and Neck

Objective To discuss resection and various reconstructive options in patients with dermatofibrosarcoma protuberans (DFSP). Methods This study was conducted at Shifa International Hospital, Islamabad, Pakistan, from May 2018 to December 2019. All patients aged 20 years or above of either gender who were diagnosed to have DFSP over this period were included in the study. All the patients underwent wide local excision of the tumor under general anesthesia. A peroperative frozen section was conducted in all the cases to confirm complete excision. Immediate reconstruction was performed following the tumor excision. The choice of reconstruction, i.e. free, regional, or local flap was based on the size of the resultant defect. Results The mean age of the patients was 37.11 ±10.91 years. There were 12 (66.7%) males and six (33.3%) females. The mean duration of the disease was 11.22 ±2.94 months. The affected anatomical site showed that the face was involved in the majority, nine (50%) patients, followed by the scalp in four (22.2%), nape of the neck in three (16.7%), and supraclavicular region in two (11.1%) patients. In most of the cases, the free flap was observed, i.e. (n=9, 50%), followed by a regional flap in seven (38.9%), and the local flap in two (10.1%) patients. Conclusion Wide local excision of the disease, confirmed on frozen section, offers improved survival. Among DFSP of the head and neck, the face was found to be the affected anatomical site in half the cases. Also, reconstruction following tumor excision with a free flap is the most favorable option among patients with DFSP.

Anti-cancer potential of sophoridine and its derivatives: Recent progress and future perspectives

Cancer is the second leading cause of mortality and has resulted in about 9.6 million deaths around the world in 2018. Cancer-caused deaths are expected to be 11.5 million by 2030 all over the world. Because of the fatal nature of cancer, substantial efforts are made all over the world to combat it. Phytoconstituents such as certain alkaloids, saponins, tannins, polyphenols, and terpenoids exhibit anticancer effects. Sophoridine is a tetracyclic quinolizidine alkaloid isolated from the stem and leaves of medicinal plants Sophora alopecuroides L., and Euchresta japonica Benth, and roots of Sophora alopecuroides Ait. Chinese Food and Drug Administration (CFDA) approved sophoridine as an antitumor agent in 2005. This review covers the antitumor activities of sophoridine and its derivatives. The efficacy of sophoridine analogs is expressed with respect to their half-maximal inhibitory concentration (IC₅₀ values). Structure-activity relationship (SAR) study for most of the sophoridine derivatives has been explained. Moreover, the current market of anticancer drugs and its expected growth are discussed. Prospects provide suggestions and clues for novel sophoridine-based anticancer agents with enhanced expected efficacy and minimum toxicity.

Three Years Analysis Of Poisoning Cases Of Forensic Medicine Toxicological Laboratory, Khyber Medical College, Peshawar

BACKGROUND

Poison is defined as any substance which harms, endangers or even kills a person irrespective of the quality or quantity. Pakistan is a developing country and farming is the major occupation of the majority of the population. Due to the easy availability and increased use of pesticides, the accidental and suicidal poisoning is very common. The objective of the study is to find out the most common poison used by the people in the general population and its frequency in our setup.

METHODS

The present cross-sectional study with retrospective data collection was undertaken in the Department of Forensic Medicine, Khyber Medical College (KMC) Peshawar to determine the frequency of different poisons detected in various samples brought to the toxicological laboratory. A three-year data (1stJanuary 2014 to 31 December 2016) was retrieved from Forensic Laboratory of KMC, Peshawar. Different methods were used for the detection of poisons. All the cases coming from Khyber Pakhtunkhwa province were included whereas; cases from other provinces were excluded.

RESULTS

The study revealed that poisoning was more common among females and the most common age group affected was 21-25 years. The incidence of positive cases was more in Peshawar district followed by Swat district. The common poison detected was phosphine (wheat pill).

CONCLUSIONS

Female and young people from Peshawar and Swat are more prone to Aluminum Phosphide (wheat pill) poison. It is a dangerous and lethal poison, so healthcare workers at emergency department ought to be prepared for such cases. Furthermore, its routine use as a domestic pesticide has to be strictly prohibited by creating awareness among the public.

Post-traumatic stress disorder and association with low birth weight in displaced population following conflict in Malakand division, Pakistan: a case control study

Background

The northern part of the province of Khyber Pakhtunkhwa in Pakistan experienced armed conflict since September 2007 till the autumn of 2011. Conflict involved widespread insurgency activity and military intervention including in 2009 internally displacing the 2.5 million people of the valley of Swat to live in camps, with relatives, or in rented accommodation across the region for approximately 4 months. It was during this period the current study was conducted to determine whether Post-Traumatic Stress Disorder in pregnant women was independently associated with Low Birth Weight (LBW) in an area affected by conflict and militancy.

Methods

A case control study was conducted in tertiary care hospitals of district Peshawar, Khyber Pakhtunkhwa. Two hundred twenty-five cases (neonates with birth weight <  2.5 kg) and 225 controls (neonates with birth weight of > 2.5 kg) were enrolled within 24 h of delivery. Post-Traumatic Stress Disorder was assessed through the MINI Neuropsychiatric Interview 5.0, a validated questionnaire along with the birth weight of the newborn. Maternal anthropometry, anemia and other sociodemographic details were also obtained during data collection. Data was analyzed using statistical package (STATA version 14). Logistic regression analysis of the association between LBW and all variables collected with a p-value of < 0.25 on uni-variate analysis were entered.

Results

A total of 450 newborn and mother pairs participated in the study with 225 cases and 225 controls. On univariate analysis factors significantly associated with LBW include: less than 5 years of paternal schooling and PTSD. On logistic regression, PTSD was independently associated with low birth weight in the presence of other factors like maternal/paternal schooling, gravida, history of preterm, BMI of the mother and maternal anemia.

Conclusion

PTSD was found to be independently associated with LBW. In light of the current findings and other similar literature, intervention programs should be considered for pregnant women exposed to traumatic events.

Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial

BACKGROUND

Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications.

METHODS

HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896).

FINDINGS

Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4-9) in the accelerated-surgery group and 24 h (10-42) in the standard-care group (p<0·0001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0·91 (95% CI 0·72 to 1·14) and absolute risk reduction (ARR) of 1% (-1 to 3; p=0·40). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0·97 (0·83 to 1·13) and an ARR of 1% (-2 to 4; p=0·71).

INTERPRETATION

Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care.

FUNDING

Canadian Institutes of Health Research.

New modification strategy of matrine as Hsp90 inhibitors based on its specific L conformation for cancer treatment

The similarity of spatial structure between radicicol and matrine urged us to perform conformation modification of matrine, followed by L-shaped matrine derivatives, 6, 12, 21a-h and 22a-h were originally designed, synthesized and evaluated for Hsp90^N inhibitors as anticancer agents. TSA (Thermal Shift Assay) results indicated that 21e, 22a-c and 22e-g exhibited strong binding force against Hsp90^N with∣ΔTm∣ > 3, meanwhile, MTT assay also revealed these compounds displayed potent anticancer activity with IC₅₀ values below 25 μM against HepG2, HeLa and MDA-MB-231 cells lines. Then, compound 22g with a high ΔTm = 10.92 was chosen as a representative to perform further mechanism study. It can induce cell apoptosis, arrest the cell cycle at the S phase and decrease the expression level of Hsp90 in Hela cell. These results originally provided targeted modification strategy for matrine derivatives to serve as Hsp90 inhibitors for cancer therapy.

Correction to: Health seeking behaviour, delayed presentation and its impact among oral cancer patients in Pakistan: a retrospective qualitative study

In the original publication of this article [1], an author's name needs to be revised from Babar Tasneen Shaikh to Babar Tasneem Shaikh.

Correction of lower limb deformities with fixator assisted nailing

Introduction

Deformities of the lower extremities can be congenital or acquired. Various surgical treatments have been employed for such disorders including osteotomy followed by either external fixation, internal fixation or external fixator assisted internal fixation. The aim of surgery is correction of deformity and restoration of mechanical axis and joint line. External fixator assisted internal fixation with intramedullary (IM) nail insertion is considered the gold standard, however, it is less commonly practiced as expertise required are usually not available at most centers. This study was conducted to assess the radiological and functional outcomes after fixator assisted IM nailing for correction of lower limbs deformity.

Methods

It was a retrospective study at a tertiary care hospital. All cases of lower limb deformity whose correction was done with fixator assisted IM nailing from 2010 till 2017 were analyzed. Pre Op x-rays and post op x rays were analyzed for Mechanical Axis Deviation (MAD), anatomical Lateral Distal Femoral Angle (aLDFA), mechanical Lateral Distal Femoral Angle (mLDFA) and Medial Proximal Tibial Angle (MPTA), post-operative activity and functional status of the patients. Data was analyzed using SPSS.

Results

Thirteen patients were included in the study. Fixator assisted IM nailing was performed on 29 long bones of these patients including 16 femur and 13 tibial deformities. Pre Op and Post Op comparison was done for MAD, aLDFA, mLDFA, MPTA. Pre op mean MAD was 38.87 ± 25.58 post op mean MAD 17.54 ± 12.25 mm. Only 2 of our patients developed knee stiffness for which manipulation under anesthesia was done. One of our patients developed weakness in toe extension, which recovered after 6 months. On follow up evaluation patients had normal range of motion and no functional limitation.

Conclusion

Fixator assisted IM nailing for deformity correction is a better option, because it has advantages of both external fixator and internal fixator. Knee stiffness associated with external fixator can be prevented. It is more convenient for patient.

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Deformity correction is a practical challenge, even in most experienced hands.

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The aim of surgery is correction of deformity.

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The Fixator assisted nailing is gold standard methods of deformity correction.

Satisfaction in Patients After Rhinoplasty Using the Rhinoplasty Outcome Evaluation Questionnaire

Introduction

Rhinoplasty is a challenging procedure. The goal of the surgery is not only to restore the function and youthful appearance of the nose but also to improve quality of life. With the passage of time, the trend has been changing rapidly from more invasive to less invasive procedures. Although the technical aspects of rhinoplasty are important, patient satisfaction is the factor that dictates the success of the procedure.

Materials and methods

A total of 118 rhinoplasties were performed in our department between 2016 and 2018. The Rhinoplasty Outcome Evaluation (ROE) questionnaire was used to study the patients' satisfaction level. Ninety out of 118 patients took part in this study. Rhinoplasty was done using an open technique in all cases. The ROE questionnaire was filled preoperation and six months postoperation. Data analysis was done using SSPS statistic version 20 (IBM Corp., Armonk, NY, US).

Results

The main reasons for rhinoplasty in our patients were: aesthetic 23.3% (n=21), functional 25.5% (n=23), and a combination of both in 51% (n=46) patients. The mean ROE score of all patients preoperation was 30.5 (males: 31.3, females 29.8) and the mean score postoperation was 79.5 (males 78.2, females 80.9) at six months with no statistical differences (CI 17.11 - 12.59, P=0.762). However, both genders showed a statistically significant improvement between the preoperative and postoperative scores (mean difference = 49.3, CI 63.25 - 35.34, P<0.01), indicating an overall good satisfaction level after surgery. The satisfaction level of patients was inversely proportional to their level of understanding and knowledge of the surgical procedure. This difference was statistically significant ( CI 7.36-10.42, P<0.01). Minor corrections or modifications were done in eight patients under local anesthesia, with no significant difference in ROE scores as compared to those who had single surgery (CI 0.7 - 1.6, P=0.92). There was no statistically significant difference in the before and after surgery ROE scores among patients operated by different surgeons as well (P=0.82).

Conclusion

Our study shows that rhinoplasty, despite being a complex procedure, has proven benefits in terms of functional as well as aesthetic outcomes. The ROE questionnaire proves to be a valid tool for estimating patient satisfaction in our population. There is a need for further training and education of surgeons in Pakistan to improve the functional and aesthetic disabilities of nasal deformities.

Functional Outcomes of Secondary Procedures in Upper Extremity Replantation and Revascularization

Introduction

Traumatic amputation of the upper limb has significant associated morbidities and disabilities. After successful replantation surgery, the micro-surgeons’ tasks are far from over. The replanted and revascularized segments have numerous functional restrictions and need various corrective secondary procedures. The aim of our study was to compare the functional results after secondary procedures by administering the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire to patients who had successful upper limb replantation and revascularization.

Materials and methods

This prospective observational study involved 40 patients who had a partial or complete amputation of the upper limb and underwent secondary procedures to correct function after successful replantation and revascularization surgery. The patients’ functional outcomes after various secondary procedures were recorded using the QuickDASH questionnaire.

Results

The mean QuickDASH score for thumb injuries was 42.3 pre-surgery but improved to 29.5 after secondary procedures, which was statistically significant (CI 11.12-14.87, p<0.01). The mean difference in the QuickDASH scores for finger injuries was also statistically significant: 45.5 preoperation and 33.7 postoperation (CI 9.89-13.70, p<0.01). For wrist injuries, the mean QuickDASH score was 52.8 presurgery and was 46.3 postoperatively (CI 1.81-6.58, p=0.0023). The QuickDASH scores of the patients with arm and forearm injuries showed no statistically significant improvement, with a preoperation score of 58.3 declining to 55.2 (p=0.98). The overall replantation and revascularization scores were 49.725 and 41.175 pre and postoperation, respectively (CI 8.35-8.75, p<0.01).

Conclusion

The study finds that the level and mechanism of injury are important predictors of the functional outcomes of the replantation and revascularization of amputated upper-limb appendages. Most replanted and revascularized upper limbs have numerous functional limitations, and achieving good functional results requires one or more secondary procedures, whose type depends on various factors such as the injury type and mechanism. The QuickDASH results for functional outcomes before and after secondary procedures indicate that it is an easy-to-use, reliable, and effective measure of functional outcomes.

Results Of Immediate Facial Nerve Reconstruction In Patients Undergoing Parotid Tumour Resection

BACKGROUND

Facial nerve is usually sacrificed in total parotidectomy. The objective of this study is to present results of immediate reconstruction of facial nerve in total parotidectomy cases where facial nerve is sacrificed.

METHODS

This is a prospective study done in patients who had total parotidectomy including facial nerve and immediate reconstruction was done with inter-positional nerve grafts (sural n=12 and greater auricular n=10) from December 2017 till February 2018 by single surgeon (MR). Wounds were closed primarily (n=15), local flap (n=2) and free flap (n=5). Clinical evaluation was done at four months minimum follow up (those operated in January to February 2018) and eight months maximum follow up (those operated in December 2017), for facial nerve functional recovery using House and Brackmann grading system by single author (MR).

RESULTS

Total of 22 (male n=7, female n=15) patients included in study from December 2017 till February 2018. Sural nerve grafts were used in 54% (n=12) and greater auricular nerve grafts in 45% (n=10) patients for reconstruction of facial nerve. On clinical evaluation using House and Brackmann grading system, showed grade V (n=4), grade IV (n=7), grade III (n=8) and grade II (n=3) repairs.

CONCLUSIONS

Although primary end to end facial nerve repair is ideal but in situation where a significant segment of nerve is lost or where the repair is under tension, inter-positional nerve grafting is a simple and reliable reconstructive technique with good outcomes.

Long-term efficacy and safety of biosimilar infliximab (CT-P13) after switching from originator infliximab: open-label extension of the NOR-SWITCH trial

BACKGROUND AND OBJECTIVES

The 52-week, randomized, double-blind, noninferiority, government-funded NOR-SWITCH trial demonstrated that switching from infliximab originator to less expensive biosimilar CT-P13 was not inferior to continued treatment with infliximab originator. The NOR-SWITCH extension trial aimed to assess efficacy, safety and immunogenicity in patients on CT-P13 throughout the 78-week study period (maintenance group) versus patients switched to CT-P13 at week 52 (switch group). The primary outcome was disease worsening during follow-up based on disease-specific composite measures.

METHODS

Patients were recruited from 24 Norwegian hospitals, 380 of 438 patients who completed the main study: 197 in the maintenance group and 183 in the switch group. In the full analysis set, 127 (33%) had Crohn's disease, 80 (21%) ulcerative colitis, 67 (18%) spondyloarthritis, 55 (15%) rheumatoid arthritis, 20 (5%) psoriatic arthritis and 31 (8%) chronic plaque psoriasis.

RESULTS

Baseline characteristics were similar in the two groups at the time of switching (week 52). Disease worsening occurred in 32 (16.8%) patients in the maintenance group vs. 20 (11.6%) in the switch group (per-protocol set). Adjusted risk difference was 5.9% (95% CI -1.1 to 12.9). Frequency of adverse events, anti-drug antibodies, changes in generic disease variables and disease-specific composite measures were comparable between arms. The study was inadequately powered to detect noninferiority within individual diseases.

CONCLUSION

The NOR-SWITCH extension showed no difference in safety and efficacy between patients who maintained CT-P13 and patients who switched from originator infliximab to CT-P13, supporting that switching from originator infliximab to CT-P13 is safe and efficacious.

Comparison Of Microvascular Free Tissue Transfer In Adult And Paediatric Patients

BACKGROUND

Free tissue transfer is a routine practice in adults with good success rates. Further advances in techniques and microsurgical skills have proved that free tissue transfer in paediatric population is feasible, reliable and safe.

METHODS

This study is conducted to compare anastomosis duration, total general anaesthesia duration, hospital stay and outcomes of flaps (survival, partial loss, complete loss, complications) in paediatric group (age <15 years) and adult group (15-70 years age). All patients with large soft tissue defects, congenital defects, traumatic defects and post tumour extirpation were included in this study from December 1st 2017 to May 30th 2018. These patients underwent different microsurgical procedures, the reconstructive armamentarium included use of Latissimus dorsi flap, Anterolateral thigh flap, Fibula flap, Radial forearm flap, functioning Gracillis muscle, iliac crest flap, deep inferior epigastric artery perforator flap and Rectus abdominis muscle flap. Post-traumatic defects were the commonest indication of free tissue transfer in Paediatric population while post tumour extirpation defects were commonest defects encountered in adult population..

RESULTS

On average the total anaesthesia duration is slightly shorter in paediatric group than in adult patients while anastomosis duration is slightly shorter in adults then in paediatric patients. The overall complication rate is comparable in both groups and all the flaps survived well.

CONCLUSIONS

Microsurgical free tissue transfer can be confidently attempted in children and their results are comparable with those of adult group.

Promising anti-inflammatory effects of chalcones via inhibition of cyclooxygenase, prostaglandin E2, inducible NO synthase and nuclear factor κb activities

Chalcones (1, 3-Diphenyl-2-propen-1-one) consist of a three carbon α, β-unsaturated carbonyl system and act as precursors for the biosynthesis of flavonoids in plants. However, laboratory synthesis of various chalcones has also been reported. Both natural and synthetic chalcones are known to exhibit a variety of pharmacological activities such as anti-inflammatory, antitumor, antibacterial, antifungal, antimalarial and antituberculosis. These promising activities, ease of synthesis and simple chemical structure have awarded chalcones considerable attraction. This review focuses on the anti-inflammatory effects of chalcones, caused by their inhibitory action primarily against the activities and expressions of four key inflammatory mediators viz., cyclooxygenase, prostaglandin E₂, inducible NO synthase, and nuclear factor κB. Various methodologies for the synthesis of chalcones have been discussed. The potency of recently synthesized chalcones is given in terms of their IC₅₀ values. Structure-Activity Relationships (SARs) of a variety of chalcone derivatives have been discussed. Computational methods were applied to calculate the ideal orientation of a typical chalcone scaffold against three enzymes, namely, cyclooxygenase-1, cyclooxygenase-2 and inducible NO synthase for the formation of stable complexes. The global market of anti-inflammatory drugs and its expected growth (from 2018 to 2026) have been discussed. SAR analysis, docking studies, and future prospects all together provide useful clues for the synthesis of novel chalcones of improved anti-inflammatory activities.

Infected Non-union of Tibia Treated with Ilizarov External Fixator: Our Experience

Introduction: Tibia is the most common long bone fractured due its vulnerable subcutaneous location and most often associated with acquired complications of delayed union or non-union due to infection. Amongst the various treatment options to treat them, the Ilizarov external fixator application is considered superior due to its multiple advantages. The objective of this study was to analyse the role of Ilizarov fixation in infected tibial non-union, as well as to assess bony union and associated functional outcomes.

Materials and Methods: A retrospective review was conducted for the duration between 1st January 2005 to 31st December 2016. Total of fifty-one patients with tibial non-union associated with infection who treated with the Ilizarov fixator were included in the study. Patient records were reviewed for union of bone, bone and functional outcomes and complications.

Results: The most common organism for infection was identified to be Staphylococcus Aureus. At the time of final follow-up all patients had achieved union except two, one of whom had to undergo amputation due to non-union and sepsis. Majority of the patients had an excellent score as per ASAMI grading system for bone and function results. The most common complication noted was pin track infections.

Conclusion: In our experience, Ilizarov external fixator is better suited for infected non-union of tibia because it can provide a stable mechanical environment, bone transport, correct deformities, and enable weight bearing and hence we recommend its use for the same.

Hydrodesulfurization of dibenzothiophene using Pd-promoted Co–Mo/Al2O3and Ni–Mo/Al2O3catalysts coupled with ionic liquids at ambient operating conditions

Sulfur compounds in fuel oils are a major source of atmospheric pollution. This study is focused on the hydrodesulfurization (HDS) of dibenzothiophene (DBT) via the coupled application of 0.5 wt% Pd-loaded Co–Mo/Al₂O₃ and Ni–Mo/Al₂O₃ catalysts with ionic liquids (ILs) at ambient temperature (120 °C) and pressure (1 MPa H₂). The enhanced HDS activity of the solid catalysts coupled with [BMIM]BF₄, [(CH₃)₄N]Cl, [EMIM]AlCl₄, and [(n-C₈H₁₇)(C₄H₉)₃P]Br was credited to the synergism between hydrogenation by the former and extractive desulfurization and better H₂ transport by the latter, which was confirmed by DFT simulation. The Pd-loaded catalysts ranked highest by activity i.e. Pd–Ni–Mo/Al₂O₃ > Pd–Co–Mo/Al₂O₃ > Ni–Mo/Al₂O₃ > Co–Mo/Al₂O₃. With mild experimental conditions of 1 MPa H₂ pressure and 120 °C temperature and an oil : IL ratio of 10 : 3.3, DBT conversion was enhanced from 21% (by blank Ni–Mo/Al₂O₃) to 70% by Pd–Ni–Mo/Al₂O₃ coupled with [(n-C₈H₁₇)(C₄H₉)₃P]Br. The interaction of polarizable delocalized bonds (in DBT) and van der Waals forces influenced the higher solubility in ILs and hence led to higher DBT conversion. The IL was recycled four times with minimal loss of activity. Fresh and spent catalysts were characterized by FESEM, ICP-MS, EDX, XRD, XPS and BET surface area techniques. GC-MS analysis revealed biphenyl as the major HDS product. This study presents a considerable advance to the classical HDS processes in terms of mild operating conditions, cost-effectiveness, and simplified mechanization, and hence can be envisaged as an alternative approach for fuel oil processing.

Synergistic application of ionic liquids with Pd loaded Co–Mo@Al₂O₃ and Ni–Mo@Al₂O₃ catalysts for efficient hydrodesulfurization of dibenzothiophene at ambient conditions.

Characteristics and Kinetics of Rosin Pentaerythritol Ester via Oxidation Process under Ultraviolet Irradiation

A self-designed reaction device was used as a promising equipment to investigate the oxidation characteristics and kinetics of rosin pentaerythritol ester (RPE) under UV irradiation. Photo-oxidation kinetics and the initial quantum yield (Φ) of RPE were calculated. The initial oxidation product of the photo-oxidation reaction-peroxide was analyzed by iodimetry. The peroxide concentration is related to the light intensity (I) and the temperature (T), and the increasing T and I would destabilize the RPE by accelerating peroxide forming. Photo-oxidation of RPE follows the pseudo first-order reaction kinetics. The relationship between activation energy and logarithm of light intensity (ln I) is linear, and it is expressed as Ea = -4.937ln I + 45.565. Φ was calculated by the photo-oxidation kinetics, and the average value of Φ was 7.19% in the light intensity range of 200⁻800 μW cm^-2. This research can provide fundamental information for application of RPE, and help obtain a better understanding of the stability of rosin esters.

Can The Anterolateral Thigh Flap Replace The Rectus Abdominis Free Flap In The Reconstruction Of Complex Maxillary Defects?

BACKGROUND

Maxilla is perhaps the most essential and visible part of the mid-face. It is a threedimensional structure and when reconstructing maxillectomy defects the principles of aesthetics as well as the best functional outcomes are taken into account. The aim of this study is to compare the Anterolateral Thigh Flap (ALTF) to the standard option like the Rectus Abdominis Free Flap (RAMFF) for the reconstruction of complex maxillary defects.

METHODS

This descriptive case series was conducted at the Department of Plastic and Reconstructive Surgery, Shifa International Hospital Islamabad, Pakistan from 2009 to 2016. Patients of all age groups with complex maxillectomy defects, (Type III and IV according to Cordeiro classification) resulting from tumour resection, trauma, osteoradionecrosis or infection, underwent reconstruction with the free anterolateral thigh flap and the rectus abdominis free flap.

RESULTS

Over a period of 8 years, 49 Rectus Abdominis free flaps and 32 Anterolateral thigh free flaps were performed for reconstruction of Type III and IV maxillectomy defects. The follow up was weekly for 1 month and then 3 monthly for the 1st year, 6 monthly for 2nd year and then yearly. All the patients had an uneventful immediate recovery.

CONCLUSIONS

ALTF has advantages over the RAMFF in terms of the donor site morbidity, operative time and postoperative recovery in the reconstruction of complex maxillectomy defects.

Evaluation of current trends and recent development in insulin therapy for management of diabetes mellitus

OBJECTIVE

Diabetes mellitus is a major health problem in developing countries. There are various insulin therapies to manage diabetes mellitus. This systematic review evaluates various insulin therapies for management of diabetes mellitus worldwide. This review also focuses on recent developments being explored for better management of diabetes mellitus.

RESEARCH DESIGN AND METHOD

We reviewed a number of published articles from 2002 to 2016 to find out the appropriate management of diabetes mellitus. The paramount parameters of the selected studies include the insulin type & its dose, type of diabetes, duration and comparison of different insulin protocols. In addition, various newly developed approaches for insulin delivery with potential output have also been evaluated.

RESULTS

A great variability was observed in managing diabetes mellitus through insulin therapy and the important controlling factors found for this therapy include; dose titration, duration of insulin use, type of insulin used and combination therapy of different insulin.

CONCLUSION

A range of research articles on current trends and recent advances in insulin has been summarized, which led us to the conclusion that multiple daily insulin injections or continuous subcutaneous insulin infusion (insulin pump) is the best method to manage diabetes mellitus. In future perspectives, development of the oral and inhalant insulin would be a tremendous breakthrough in Insulin therapy.

Inclusion Complexes of a New Family of Non-Ionic Amphiphilic Dendrocalix[4]arene and Poorly Water-Soluble Drugs Naproxen and Ibuprofen

The inclusion complexes of a new family of nonionic amphiphilic calix[4]arenes with the anti-inflammatory hydrophobic drugs naproxen (NAP) and ibuprofen (IBP) were investigated. The effects of the alkyl chain’s length and the inner core of calix[4]arenes on the interaction of the two drugs with the calix[4]arenes were explored. The inclusion complexes of Amphiphiles 1a–c with NAP and IBP increased the solubility of these drugs in aqueous media. The interaction of 1a–c with the drugs in aqueous media was investigated through fluorescence, molecular modeling, and ¹H-NMR analysis. TEM studies further supported the formation of inclusion complexes. The length of lipophilic alkyl chains and the intrinsic cyclic nature of cailx[4]arene derivatives 1a–c were found to have a significant impact on the solubility of NAP and IBP in pure water.

Molecular modeling, simulation and docking study of ebola virus glycoprotein

Ebola virus (EBOV) is a filamentous, enveloped, non-segmented, negative-strand ribonucleic acid (RNA) virus which belongs to family Filoviridae. Ebola virus includes different glycoproteins each of which plays their roles in different aspects of viral life cycle. In this study secreted glycoprotein (Q7T9E0) of Ebola virus was acquired from Uniprot. The formation of alpha helix and beta sheets of secondary structures were predicted through online servers. Higher flexibility and disordered regions of proteins were determined through RONN, GLOBPLOT and DISSEMBLE. Three dimensional (3D) structure of the protein was built through homology modeling techniques and MOE software. The validation and evaluation of the refined models were determined with two stereochemical tests i-e RAMPAGE and ERRAT servers. Further docking studies of given protein was performed with different derivatives of two antiviral drugs dronedarone and amiodarone through MOE. Docking score and binding affinity of respective derivatives demonstrate that these might be used as protein receptors.

Cyclen-based Gd3+ complexes as MRI contrast agents: Relaxivity enhancement and ligand design

Magnetic Resonance Imaging (MRI) is a noninvasive radiology technique used to examine the internal organs of human body. It is useful for the diagnosis of structural abnormalities in the body. Contrast agents are used to increase the sensitivity of this technique. 1,4,7,10-Tetraazacyclododecane (cyclen) is a macrocyclic tetraamine. Its derivatives act as useful ligands to produce stable complexes with Gd³⁺ ion. Such chelates are investigated as MRI contrast agents. Free Gd³⁺ ion is extremely toxic for in vivo use. Upon complexation with a cyclen-based ligand, it is trapped in the preformed central cavity of the ligand resulting in the formation of a highly stable Gd³⁺-chelate. Better kinetic and thermodynamic stability of cyclen-based MRI contrast agents decrease their potential toxicity for in vivo use. Consequently, such agents have proved to be safest for clinical applications. Relaxivity is the most important parameter used to measure the effectiveness of a contrast agent. A number of factors influence this parameter. This article elucidates detailed strategies to increase relaxivity of cyclen-based MRI contrast agents. 1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA) and 1,4,7,10-tetraazacyclododecane-1,4,7-triacetic acid (DO3A) are two key ligands derived from cyclen. They also act as building blocks for the synthesis of novel ligands. A few important methodologies for the synthesis of DOTA and DO3A derivatives are described. Moreover, the coordination geometry of chelates formed by these ligands and their derivatives is discussed as well. Novel ligands can be developed by the appropriate derivatization of DOTA and DO3A. Gd³⁺-chelates of such ligands prove to be useful MRI contrast agents of enhanced relaxivity, greater stability, better clearance, lesser toxicity and higher water solubility.