Quantitative ethnomedicinal study and conservation status of medicinal flora used by the indigenous peoples of Sultan Khail valley, Dir Upper, Pakistan

The present study was conducted to explore the ethnomedicinal uses, quantitative analysis and conservation status of medicinal flora of Sultan Khail valley, Dir Upper, Pakistan. The data was collected during 2017-2019 using a semi-structured questionnaire. Ethnomedicinal uses of plant species were determined and the plant species were classified based on habits, parts used, and method of preparation of remedies. Frequency of citation (FC), relative frequency of citation (RFC) and family importance values (FIV) were calculated. The plant species were assessed for their conservation status as per IUCN standard criteria. The inhabitants of the Sultan Khail valley use 88 plant species belonging to 57 families for the treatment of different human diseases. Lamiaceae was the dominant family represented with 8 medicinal species (9%) followed by Rosaceae (5 species, 6%). The most commonly used plant parts were leaves (33.1%) followed by fruits (16.1%), while the main method of remedy preparation was decoctions (33.3%). The highest RFC value was recorded for Geranium wallichianum (0.47), followed by Berberis lycium (0.44). Lamiaceae was the most cited family (FIV, 231), followed by Polygonaceae (73). Five plant species were found to be endangered, 39 species were vulnerable, 32 species were rare, and 12 species were found to be infrequent. The medicinal flora of the area is under severe biotic pressure and needs proper conservation; otherwise, they will be lost in the near future.

Learning of object-in-context sequences in freely-moving macaques

Flexible learning is a hallmark of primate cognition, which arises through interactions with changing environments. Studies of the neural basis for this flexibility are typically limited by laboratory settings that use minimal environmental cues and restrict interactions with the environment, including active sensing and exploration. To address this, we constructed a 3-D enclosure containing touchscreens on its walls, for studying cognition in freely moving macaques. To test flexible learning, two monkeys completed trials consisting of a regular sequence of object selections across four touchscreens. On each screen, the monkeys had to select by touching the sole correct object item ('target') among a set of four items, irrespective of their positions on the screen. Each item was the target on exactly one screen of the sequence, making correct performance conditioned on the spatiotemporal sequence rule across screens. Both monkeys successfully learned multiple 4-item sets (N=14 and 22 sets), totaling over 50 and 80 unique, conditional item-context memoranda, with no indication of capacity limits. The enclosure allowed freedom of movements leading up to and following the touchscreen interactions. To determine whether movement economy changed with learning, we reconstructed 3D position and movement dynamics using markerless tracking software and gyroscopic inertial measurements. Whereas general body positions remained consistent across repeated sequences, fine head movements varied as monkeys learned, within and across sequence sets, demonstrating learning set or "learning to learn". These results demonstrate monkeys' rapid, capacious, and flexible learning within an integrated, multisensory 3-D space. Furthermore, this approach enables the measurement of continuous behavior while ensuring precise experimental control and behavioral repetition of sequences over time. Overall, this approach harmonizes the design features that are needed for electrophysiological studies with tasks that showcase fully situated, flexible cognition.

National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK

A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.

Multi-attribute group decision-making problem based on some induced Einstein aggregation operators under complex fuzzy environment

The aim of the paper is to introduce some complex Einstein aggregation operators for aggregating the different complex Pythagorean fuzzy sets (CPFSs) by considering the dependency between the pairs of its membership degrees. In the existing studies of fuzzy and its extensions, the uncertainties present in the data are handled with the help of degrees of membership that are the subset of real numbers, which may also loss some valuable data and hence consequently affect the decision results. A modification to these, complex Pythagorean fuzzy set handles the uncertainties with the degree whose ranges are extended from real subset to the complex subset with unit disc and hence handle the two dimensional information in a single set. Thus motivated by this and this paper we present some novel Einstein aggregation operators, namely complex Pythagorean fuzzy Einstein weighted averaging (CPFEWA) operator, complex Pythagorean fuzzy Einstein ordered weighted averaging (CPFEOWA) operator, complex Pythagorean fuzzy Einstein hybrid averaging (CPFEHA) operator, induced complex Pythagorean fuzzy Einstein ordered weighted averaging (I-CPFEOWA) operator, and induced complex Pythagorean fuzzy Einstein hybrid averaging (I-CPFEHA) operator. Also develop some of their desirable properties. Furthermore, based on these operators a multi-attribute group decision making problems developed. An illustrative example related to the selection of the best alternative is considered to show the effectiveness, of the novel developed methods.

Mathematical calculation of COVID-19 disease in Pakistan by emergency response modeling based on complex Pythagorean fuzzy information

The new emerged infectious disease that is known the coronavirus disease (COVID-19), which is a high contagious viral infection that started in December 2019 in China city Wuhan and spread very fast to the rest of the world. This infection caused millions of infected cases globally and still poses an alarming situation for human lives. Pakistan in Asian countries is considered the third country with higher number of cases of coronavirus with more than 649824. Recently, some mathematical models have been constructed for better understanding the coronavirus infection. Mostly, these models are based on classical integer-order derivative using real numbers which cannot capture the fading memory. So at the current position it is a challenge for the world to understand and control the spreading of COVID-19. Therefore, the aim of our paper is to develop some novel techniques, namely complex Pythagorean fuzzy weighted averaging (abbreviated as CPFWA) operator, complex Pythagorean fuzzy ordered weighted averaging (abbreviated as CPFOWA) operator, complex Pythagorean fuzzy hybrid averaging (abbreviated as CPFHA) operator, induced complex Pythagorean fuzzy ordered weighted averaging (abbreviated as I-CPFOWA) operator and induced complex Pythagorean fuzzy hybrid averaging (abbreviated as I-CPFHA) operator to analysis the spreading of COVID-19. At the end of the paper, an illustrative the emergency situation of COVID-19 is given for demonstrating the effectiveness of the suggested approach along with a sensitivity analysis, showing the feasibility and reliability of its results.

Clinical Profile and Outcome of Diabetic Foot Ulcer in Teritary Care Hospital

Background: The goal of this study was to estimate the disease burden of diabetic foot ulcer (DFU) admissions in a tertiary care hospital in a developing country in terms of clinical profile and outcome. Method: In this descriptive study, the data were collected from the medical record of diabetic patients with foot ulcer who were treated in Saveetha medical college and hospital between the period of February to November 2020. The demographic characteristic, type of foot lesion, etiology, isolated microorganism, treatment, and outcome were reviewed. Results: There were 180 admissions with diabetic foot problems involving 100 patients. All of the patients had type 2 diabetes, and there was no gender bias. The average age was 50, and diabetes control was poor. The majority of patients had no knowledge what had caused their symptoms. In 56 % of cases, ulcers were neuropathic, 25% were neuro ischemic, and a smaller fraction were pure ischemia. More than 70% of ulcers were Wagner grade 3 or higher, with infection occurring in nearly every patient. Gram-negative bacteria were the most prevalent isolates from culture. A total of 30 lower extremity amputations (LEAs) were performed at various levels of the foot. Conclusion: Diabetic foot problems are a source of morbidity, a reason for LEA surgery, and a cause of death in people who have diabetes mellitus.

Correlation between CT scan Findings of the Head and Motor Disturbances in Children with Cerebral Palsy

Cerebral palsy (CP) is the commonest movement disorder in childhood. Clinical spectrum of CP is variable and CT scan of brain is an important mode of diagnosis and prognosis in recourse limited set up. This study was done to categorize the CT scan findings and correlate them with the type of motor disturbances of CP patients. This was a cross sectional study done in 100 children diagnosed as CP carried out in Pediatric Neurology unit, BSMMU from July 2009 to July 2010. The patients were randomly selected and CT scan was done in all the patients. Detailed history and clinical examination was done to find out the baseline characteristics, risk factors and topographic type of CP patients. Among 100 patients 92% had abnormal CT scan finding. Most common abnormality was cerebral atrophy. Maximum number of abnormal CT scan was found in quadriplegic CP (92%). Highest number of children was in 13-24 months (29%) and a slight male predominance was found. Commonest risk factor was perinatal asphyxia (75%). The brain lesions are often associated with a clinical phenotype where specific needs may be anticipated and addressed. This is important for the planning of intervention in the child with CP.

Use of voice messaging via mobile phone to communicate female adolescents in Bangladeshi urban slum

Problem

Utilization of available maternal health services is comparatively low among adolescent population in Dhaka urban slum areas and lack of adequate knowledge is one major contributor to low service utilization among slum dwelling adolescent mothers.

Description of problem

Dhaka urban slum dwelling female adolescents are difficult to reach adequately with health messages through traditional home visit by community health workers for counseling, because many of these adolescents in Dhaka urban slums have a job outside home. We designed and implemented an innovative health communication intervention “Health Boost” - an approach to provide reproductive, maternal and newborn health information for married female adolescents using the voice message system on mobile phone.

Methods

We delivered ‘Health Boost’ (HB) voice messages to enrolled married adolescent girls, twice a week, with re-listening option. Pregnant and non-pregnant participants received separate sets of messages. Enrollment was started after baseline survey (September 2016) and continued during October 2016 - April 2017. Pregnant participants received messages at least for 6 months before delivery. For evaluation, we followed pre-post observation study design and had the endline survey in November 2017.

Results

Comparing HB non-receivers at baseline (n = 321) and HB receivers at endline (n = 45), statistically significant improvement was revealed for knowledge on danger signs - (a) during pregnancy (55.5% vs. 93.3%; p < 0.001), (b) during child delivery (54.2% vs. 82.2%; p < 0.001), (c) for newborn (56.7% vs. 75.6%; p < 0.02). We also found significantly higher utilization of service among HB receivers: Utilization of antenatal care increased from 70.4% to 87.5% (p < 0.02); and use of postnatal care increased from 31.6% to 73.7% (p < 0.03).

Lessons

‘Health Boost’ messages were instrumental and effective to increase knowledge and service utilization among married adolescent girls in Dhaka urban slum areas.

Key messages

Voice message is an innovative way to reach hard-to-reach population by using mobile phone technology. Voice messages were instrumental and effective to increase knowledge and service utilization among urban female adolescent population, for reproductive, maternal and newborn health.

Achieving Self-Directed Integrated Cancer Aftercare (ASICA) in melanoma: protocol for a randomised patient-focused pilot trial of delivering the ASICA intervention as a means to earlier detection of recurrent and second primary melanoma

BACKGROUND

Melanoma is common; 15,906 people in the UK were diagnosed with melanoma in 2015 and incidence has increased fivefold in 30 years. Melanoma affects old and young people, with poor prognosis once metastatic. UK guidelines recommend people treated for cutaneous melanoma receive extended outpatient, hospital follow up to detect recurrence or new primaries. Such follow up of the growing population of melanoma survivors is burdensome for both individuals and health services. Follow up is important since approximately 20% of patients with early-stage melanoma experience a recurrence and 4-8% develop a new primary; the risk of either is highest in the first 5 years. Achieving Self-directed Integrated Cancer Aftercare (ASICA) is a digital intervention to increase total-skin-self-examination (TSSE) by people treated for melanoma, with usual follow up.

METHODS

We aim to recruit 240 adults with a previous first-stage 0-2C primary cutaneous melanoma, from secondary care in North-East Scotland and the East of England. Participants will be randomised to receive the ASICA intervention (a tablet-based digital intervention to prompt and support TSSE) or control group (treatment as usual). Patient-reported and clinical data will be collected at baseline, including the modified Melanoma Worry Scale (MWS), the Hospital Anxiety and Depression Scale (HADs), the EuroQoL 5-dimension 5-level questionnaire (EQ-5D-5 L), and questions about TSSE practice, intentions, self-efficacy and planning. Participants will be followed up by postal questionnaire at 3, 6 and 12 months following randomization, along with a 12-month review of clinical data. The primary timepoint for outcome analyses will be12 months after randomisation.

DISCUSSION

If the ASICA intervention improves the practice of TSSE in those affected by melanoma, this may lead to improved psychological well-being and earlier detection of recurrent and new primary melanoma. This could impact both patients and National Health Service (NHS) resources. This study will determine if a full-scale randomised controlled trial can be undertaken in the UK NHS to provide the high-quality evidence needed to determine the effectiveness of the intervention. ASICA is a pilot study evaluating the effectiveness of the practice of digitally supported TSSE in those affected by melanoma.

TRIAL REGISTRATION

Clinical Trials.gov, NCT03328247 . Registered on 1 November 2017.

Evaluation of Preoperative Ultrasonography in Gall Stone Disease to Predict Technical Difficulties during Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the gold standard in the treatment of gallstones. This study was carried out to determine the technical difficulties that can be encountered during laparoscopic cholecystectomy and to evaluate the role of ultrasonography in identifying patients at risk of conversion returning to open surgery. The objective of this study was to evaluate the efficacy of preoperative ultrasonography in assessing technical difficulty faced during laparoscopic cholecystectomy in gallstone disease. This was an observational comparative study which was conducted in the Department of Surgery of Shaheed Suhrawardy Medical College & Hospital, Dhaka, Bangladesh from January 2016 to January 2017. A purposive sampling method was applied to select the study sample. A total of 160 patients were included this study. Data processing and analysis were done using SPSS (statistical package for social sciences), version 20. The summarized data were presented in the form of figures and tables with due statistical interpretation. In this study, there was a total of 160 cases, among which 90(56.25%) turned out to have undergone normal laparoscopic cholecystectomies. Seventy (43.75%) were difficult, among which 6(3.75%) were converted to open cholecystectomies. Among 160 patients, 120(75%) were female and 40(25%) were male. There is a total of 136/160 (85%) patients with gallbladder wall thickness <3mm and 24/160 (15%) patients >3mm. Among the 136 patients with gallbladder wall thickness <3mm, there was difficulty in holding the gallbladder in 28(25%) cases, 28(20.6%) had undergone gallbladder perforation, 32(23.5%) had undergone moderate bleeding and only 2(1.5%) had undergone severe bleeding. Among the 24 patients with gallbladder wall thickness >3mm, there was difficulty in holding the gallbladder in 22(91.7%) cases, 18(75%) had undergone gallbladder perforation, 18(75%) had undergone moderate bleeding and only 2(8.33%) had undergone severe bleeding. It shows a total of 124/160 (77.5%) patients with normal gall bladder, 26/160 (16.25%) patients with contracted gallbladder and 10/160 (6.25%) patients with distended gallbladder. Among the 124 patients with normal gallbladder, 16(12.9%) had undergone difficult Calot's dissection, 26(21%) had undergone difficult gallbladder bed dissection, 26(21%) had undergone moderate bleeding and none had undergone severe bleeding. Among 26 patients with contracted gallbladder, 20(76.9%) underwent difficult Calot's dissection, 24(92.3%) had undergone difficult gallbladder bed dissection, 18(69.2%) had undergone moderate bleeding and 4(15.4%) had undergone severe bleeding. Among 10 patients with distended gallbladder, 4(40%) underwent difficult Calot's dissection, 6(60%) underwent difficult gallbladder bed dissection, 6(60%) had undergone moderate bleeding and none had undergone severe bleeding. From this study, we conclude that preoperative ultrasonography is a good predictor of difficulty in laparoscopic cholecystectomy in the majority of cases and should be used as a screening procedure.

Clinicopathological profile of paroxysmal nocturnal haemoglobinuria clone-positive aplastic anaemia paediatric patients-A single centre study from North India

INTRODUCTION

There is a paucity of literature related to the prevalence of Paroxysmal Nocturnal haemoglobinuria (PNH) clones in paediatric aplastic anaemia (AA) patients.

METHODS

We performed a retrospective analysis over a period of 42 months to study the prevalence of PNH clones in paediatric (age less than 18 years) AA cases, using Fluorescein-labelled proaerolysin-based flow cytometric screening and analysed their clinico-pathological features.

RESULTS

PNH clone was identified in 100 (33.2%) of the 301 patients screened. These were comprised of 51 cases of non-severe AA, 33 cases of severe AA and 16 cases of very severe AA. The median age was 13 years with an M:F ratio of 2.5:1. The median clone size (taken as the proportion of PNH-positive neutrophils) was 2.15% (range: 0.05%-93.1%). Although a majority of patients (n = 77) had a clone size of less than 10%, a significant proportion (n = 23) did harbour a clone size of more than 10%. Evidence of haemolysis was observed in 3 patients, all of them having a clone size of more than 10%. Interestingly, 1 patient with dural sinus thrombosis harboured a clone size of 1.25% only. Chromosomal breakage analysis was performed in 61 patients, none of which was positive. Complete and partial response to immunosuppressive therapy was found in 55.1% patients (16/29).

CONCLUSION

There is a high prevalence of PNH clones in paediatric AA patients, which in a majority of cases are of small clone sizes. The use of immunosuppressive therapy does not show a better outcome as compared to PNH-negative cases.

Utility of a Single-Tube, Six-Color Flow Cytometry Panel for the Diagnosis of Myelodysplastic Syndrome: Experience of a Tertiary Care Centre in India

Background: Diagnosis of myelodysplastic syndromes (MDS) is challenging in the presence of morphological mimickers. Flow cytometric immunophenotyping (FCI) has been added to the diagnostic armamentarium, but its use in clinical practice is variable. Materials and Methods: Bone marrow aspirate samples from 54 patients with a clinical and/or morphological suspicion of MDS were subjected to FCI using a single-tube, 6-colour panel comprising of monoclonal antibodies against CD13, CD11b, CD16, CD34, CD45 and CD56. Analysis was centered on the abnormal maturation pattern of granulocytes, blast percentage (≥3%) and ratio of side scatter peak channel value (SSC-PCV) of granulocytes and lymphocytes. Each of these parameters was assigned a score of 1. Overall sensitivity and specificity of this panel was ascertained to differentiate cytopenia/s of MDS from non-MDS cases. Results: Forty MDS and 14 non-MDS cases were diagnosed based on morphology and cytogenetic results. Twenty control samples were also processed simultaneously for FCI to assign the cutoff for various flow cytometric parameters. A score ≥2 was defined as positive for MDS. Hypogranularity was present in 62.5% cases of MDS. The median SSC-PCV of granulocytes and lymphocytes was 6.16 in the MDS group, 7.9 in the non-MDS group and 8.90 in the control group (p <0.05). This cut-off value of 6.16 had a specificity of 92.5% based on the ROC curve analysis. Abnormal granulocyte maturation patterns for CD13/16, CD13/11b and CD11b/16 dot plots were observed in 95.3, 69.8 and 74.4% cases, respectively. The overall sensitivity and specificity of the panel was found to be 87.5% and 64.2%, respectively. Conclusion: FCI is now an important tool for diagnostic workup in patients presenting with persistent cytopenia with or without morphological evidence of dyspoiesis. Inclusion of objective parameters like SSC-PCV would also reduce inter-lab variability in MDS diagnosis.

The triple-negative (CD34-/HLA-DR-/CD11b-) profile rapidly and specifically identifies an acute promyelocytic leukemia

INTRODUCTION

The genetic testing to confirm or rule out an acute promyelocytic leukemia (APL) typically takes a minimum of 24-72 hours. Flow cytometric immunophenotyping (FCI) on the other hand provides rapid and objective information to differentiate APL from non-APL.

METHODS

FCI features, with single-tube 8-color combination using CD45, CD34, HAL-DR, CD11b, CD13, CD33, and CD117 and CD64, were compared for the 30 consecutive APL and 30 non-APL acute myeloid leukemia (AML) cases which morphologically mimicked an APL. The diagnosis was confirmed by cytogenetic or molecular genetic testing in the form of t (15:17) (q22; q21)/variant translocations or PML-RARA fusion transcript analysis.

RESULTS

The APL cells lacked CD34, HLA-DR, and CD11b in 90%, 90%, and 93.3% cases, respectively. Myeloid antigens such as CD33, CD13, CD117, and CD64 were expressed in 96.7%, 96.7%, 76.7%, and 70% cases, respectively. The dual negative profiles, CD34-/HLA-DR- or HLA-DR-/CD11b-, were noted in 90% and 93.3% cases. The triple-negative (CD34-/HLA-DR-/CD11b-) profile was noted in 90% of the cases. The sensitivity, specificity, and positive predictive value (PPV) of CD34-/HLA-DR- and HLA-DR-/CD11b- profiles for the diagnosis of APL were found to be 90%, 80% & 81.1% and 93.3%, 86.7%& 87.5%, respectively. Combining the above two profiles resulted in a triple-negative profile (CD34-, HLA-DR- and CD11b-), which had a better specificity (93.3%) and positive predictive value (93.1%), with similar sensitivity.

CONCLUSION

FCI is a rapid and reliable modality for the diagnosis of an APL. The triple-negative profile (CD34-/HLA-DR-/CD11b-) rapidly and specifically identifies an APL case.

Protection of DNA during oxidative stress and cytotoxic potential of Artemisia absinthium

Medicinal plants are rich in secondary metabolites (alkoloids, glycosides, coumarins, flavonides, steroids, etc.) and considered to be more effective and a safer alternative source to manage a variety of diseases related to liver, heart and kidney disordered. This study determines in vitro antioxidant and in vivo toxicological profile including hemolytic, brine shrimp lethality and mutagenicity of aerial parts of Artemisia absinthium. DNA protection assay was performed on pUC19 plasmid vector using H(2)O(2) as oxidative agent. Total phenolic and flavonoid content were determined using colorimetric methods. Toxicity of the plant was evaluated by brine shrimp lethality, hemolytic and mutagenic activity. DNA protection assay of the plant showed concentration dependent protective effect and at concentration 10μL/mL revealed complete protective effect against H(2)O(2) induced DNA damage. Highest phenolic and flavonoid content was found to be 167.3 (mg GAE 100g DW(-1)) and 14 (mg CE 100g DW(-1)) respectively. Results showed that A. absinthium is potent against standard toxicological procedures, that indicates the presence of bioactive components in the plant and possess antioxidant activity that protects DNA against H(2)O(2) induced oxidative damage. Thus the results showed/support that A. absinthium provides significant health benefits.

Moving Beyond Cancer: Immediate Impact on-the Health-Related Quality of Life of Breast Cancer Patients After Mastectomy

During the last decade, survival rates for breast cancer have increased as a result of earlier detection and increased use of adjuvant therapy. Limited data exist on the post mastectomy quality of life in the process of transition from health to cancer in its different phases of treatment. The aim of current study was to evaluate the changes of health-related quality of life (HRQoL) after mastectomy and to measure their impression about future perspectives in Bangladeshi Breasts cancer patients. A group of 250 women with a diagnosis of primary breast cancer who was admitted in the department of surgical oncology in National Institute of Cancer Research and Hospital, Dhaka were enrolled in this study from January 2012 to March 2013. Two-point interview like pre(MI) and post mastectomy(M2) was taken using the structured questionnaire made by European Organization for Research and Treatment of Cancer (EORTC)- EORTC Q30 and BR23. The mean age of the patients was 44.7?9.87 years, 52.6% were locally advanced. HRQoL scores of breast cancer patients deteriorated after mastectomy, general features like presence of fatigability, nausea, apatite loss, sleeplessness and pain has got tremendous effect on the quality of life(p<.005). Financial difficulties and sleep disorders did not affect much. Four of the Global Health status/QOL parameters like physical functioning, role functioning, emotional functioning, cognitive functioning deteriorated but only physical functioning status affected significantly(p<0.005). Breast symptoms like body image problem, general breast symptoms like pain, arm swelling and sexual feeling affected their (HRQOL) after mastectomy. A diagnosis of cancer and associated treatments affects multiple domains of life. The complicated transitions between health, illness and living with cancer can often be challenged with a preoperative information for the patient confronted with breast cancer should include possible psychological effects of cancer diagnosis, surgery, and other treatment. Breast conservation particularly in the young group may give a better outcome in the treatment protocol of breast cancer patients.

Epidemiology, Risk Factors and Tumor Profiles of Breast Cancer in Bangladeshi underprivileged women

Similar to cancer statistics in developed countries, breast cancer is also the leading cause of cancer-related death in the women population of Bangladesh particularly the poor and underprivileged. The objective of this study was to study the socio-demography, tumor patterns and risk factors that affect these women from Dhaka and Bangladesh in general.

METHOD

This cross-sectional study involved 250 patients who presented to NICRH, Dhaka for treatment. These patients were interviewed, physically examined and vital information were gathered using approved questionnaires. Various personal, social, reproductive and tumor related factors were recorded and analyzed.

RESULT

The mean age of the study group was 44.7 years, standard deviation (SD) was 9.82 (range: 21-67), 87% have children, 57.2% were postmenopausal, 92% were housewives, 51.4% were illiterate, 62% attended 6 months after initiation of symptoms, 72% of the patients' yearly family income were less than US$1000/year. Almost 100% of the patients gave history of cooking from wooden fire source in the rural areas. In our study group, 79.7 percent women were within the group of BMI 20 kg/m2or more. Locally advanced breast cancer patients (T3 and T4) were 52.6%, axillary lymph node involvement was present in 80% of cases, 61.6 % patient received neoadjuvant chemotherapy. In the elderly group (above 40 years) Estrogen receptor was positive in 53.2% cases, 26.6% were Triple negative breast cancer patients.

CONCLUSION

Women with poor socio-economic status and have none or low educational level are often victims of late presentation and tend to have a higher stage at diagnosis. Poverty, literacy and assorted risk factors have influenced the outcome of breast cancer cases among Bangladeshi women.

Gemmomodification: an emerging source of natural antioxidants from Silybum marianum

Gemmomodification is a form of herbal medicine in which young freshly growing buds of plants are used. At germinating stage, plants metabolic activities are maximum and various nutrients, hormones enzymes and bioactive phytoconstituents are released and available at this stage. Plants may be promising source of natural antioxidants at growing stage. Oxidative stress leads to many chronic and degenerative diseases. Antioxidants are very essential for human body; they can protect the body from damage caused by free radical induced oxidative stress. This research project had been designed to investigate the antioxidant potential of gemmo modified and native (dry leaves) extract of Silybum marianum. Total phenolic contents was calculated by using Folin-Ciocalteu reagent and antioxidant potential was evaluated by using four radical assays (DPPH, ABTS, Super oxide and nitric oxide), reducing power assay and lipid peroxidation assay spectrophotometrically. Gemmo modified extract showed significantly higher (p<0.050) TPC (830 mg GAE/g of plant extract) as compared to native extract (800 mg GAE/g.) Results of this study revealed that gemmo modified extract demonstrated better antioxidant potential than natively used parts of Silybum marianum.

Global school personnel survey among 5200 school personnel in India: comparison of the results for the years 2009 and 2006

BACKGROUND

The results of the Global School Personnel Survey (GSPS) conducted in India in 2009 are compared with 2006 GSPS to assess any change in 2009 on tobacco use and knowledge and attitudes to tobacco use, training and availability of tobacco control teaching material in schools and the existence of school tobacco control policies.

METHODS

GSPS is a cross sectional survey conducted twice (2006 and 2009) in entire India. A total of 180 schools were surveyed each time.

RESULTS

Of the participating school personnel, 2660 in 2006 and 2575 in 2009, about 95% were teachers and the balance administrators. In 2009, compared to 2006 the prevalence of current smoking of cigarettes (19.6% in 2006 and 10.3% in 2009) and bidis (21.5% in 2006 and 13.9% in 2009) was found to be significantly lower; the percentage of teachers receiving training on preventing youth tobacco use has significantly reduced (16.7% in 2006 and 10.1% in 2009); access of teachers to educational materials on tobacco use and how to prevent its use among youth had not increased (34.6% in 2006 and 37.8% in 2009); there was no change in policy prohibiting tobacco use among students and school personnel; however, ever use of any tobacco on school premises was significantly lower (15.6% in 2006 and 9.6% in 2009).

CONCLUSIONS

The prevalence of current smoking (cigarettes/bidis) among school personnel and use of any tobacco on school premises were significantly decreased in 2009 as compared to 2006. Necessary action should be planned to increase the number of teachers trained and the availability of teaching materials on preventing youth tobacco use in order to have effective prevention of tobacco use among students.

Hematology and serum chemistry reference values of stray dogs in Bangladesh

Hematology and serum chemistry values were obtained from 28 male and 22 female stray dogs in Chittagong Metropolitan area, Bangladesh. The goal of the study was to establish reference value for hematology and serum chemistry for these semi wild animals in relation to age, sex, reproductive stage and body condition. No significant differences were found for mean values of hemoglobin, packed cell volume, mean corpuscular hemoglobin concentration, white blood cell, differential leukocyte count, total protein, albumin, glucose, cholesterol, phosphorus and potassium among or between sexes, ages, reproductive states or body conditions. Significant differences were noted for erythrocyte sedimentation rate (p<0.02) between sexes. Among different age groups significant differences were found for total red blood cell count (p<0.001). Different body conditions have significant differences in red blood cell count, mean corpuscular volume and mean corpuscular hemoglobin (p<0.001). Pregnant and non-pregnant females differed significantly in their red blood cell count, mean corpuscular volume and mean corpuscular hemoglobin (p<0.001).

Reduced heart rate variability predicts poor sleep quality in a case-control study of chronic fatigue syndrome

Parasympathetic function is important in the induction and maintenance of sleep. We examined whether nocturnal vagal modulation of heart rate is related to the poor sleep quality commonly reported in chronic fatigue syndrome (CFS). Heart rate (HR, as R-R intervals) was continuously monitored during sleep in 20 patients with CFS and 20 matched control subjects. Questionnaires assessed demographic information, symptoms, functional impairment, and subjective sleep quality. CFS was associated with more sleep problems in general and poorer subjective sleep quality on the study night (all p < 0.003), and reports of repeated awakening during the night were 7 times more likely compared to healthy subjects (p = 0.017). Time and frequency-domain parameters of HR variability during sleep were significantly lower in patients with CFS (all p < 0.006). Multiple regression analyses revealed that heart rate variability (HRV) parameters were the best predictors of subjective sleep measures. This study identified significant reductions in vagal modulation of heart rate during sleep in CFS. Low HRV strongly predicted sleep quality-suggesting a pervasive state of nocturnal sympathetic hypervigilance in CFS.

A bioactive compound from Polygala tenuifolia regulates efficiency of chronic stress on hypothalamic-pituitary-adrenal axis

3,6'-Disinapoyl sucrose (DISS) is the active oligosaccharide ester component from roots of Polygala tenuifolia, and its antidepressant effects was found in the forced swimming test (FST) and tail suspension test (TST). We aimed to study the antidepressant effects of DISS in the chronic unpredictable mild stress (CMS) model in rats and explore the underlying mechanisms in the hypothalamic-pituitary-adrenal (HPA) axis. We found that when subjected to the chronic stress protocol for 28 days, animals showed reduced sensitivity to reward and abnormality in the HPA axis. DISS (10 or 20 mg/kg, i.g.) improved the reward reaction as measured by increasing sucrose consumption, remarkably reduced serum CORT, ACTH and CRH levels in the CMS-treated rats. In addition, DISS enhanced the expression of glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) mRNA. These results indicated that the antidepressant effects of DISS in chronically stressed animals might relate to the modulating effects on the HPA axis, which might be an important mechanism for its antidepressant effect.

Linking Global Youth Tobacco Survey 2003 and 2006 data to tobacco control policy in India

BACKGROUND

India made 2 important policy statements regarding tobacco control in the past decade. First, the India Tobacco Control Act (ITCA) was signed into law in 2003 with the goal to reduce tobacco consumption and protect citizens from exposure to secondhand smoke (SHS). Second, in 2005, India ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). During this same period, India conducted the Global Youth Tobacco Survey (GYTS) in 2003 and 2006 in an effort to track tobacco use among adolescents.

METHODS

The GYTS is a school-based survey of students aged 13-15 years. Representative national estimates for India in 2003 and 2006 were used in this study.

RESULTS

In 2006, 3.8% of students currently smoked cigarettes and 11.9% currently used other tobacco products. These rates were not significantly different than those observed in 2003. Over the same period, exposure to SHS at home and in public places significantly decreased, whereas exposure to pro-tobacco ads on billboards and the ability to purchase cigarettes in a store did not change significantly.

CONCLUSIONS

The ITCA and the WHO FCTC have had mixed impacts on the tobacco control effort for adolescents in India. The positive impacts have been the reduction in exposure to SHS, both at home and in public places. The negative impacts are seen with the lack of change in pro-tobacco advertising and ability to purchase cigarettes in stores. The Government of India needs to consider new and stronger provisions of the ITCA and include strong enforcement measures.

Malignant hemangiopericytoma in the gluteal region: a rare entity

We present here a case of malignant hemangiopericytoma in a 40-year-old female who presented with a history of slowly growing mass in left gluteal region for about 1.5 years. She was evaluated and a mass of 10 x 7.5 x 5.5 cm 3 was found on computed tomography. The tumor was resected and was sent for histopathological evaluation. Grossly the tumor was encapsulated and on cut section it was nodular. Microscopy showed spindle cells forming cords and sheets separated by thin delicate stroma consisting largely of thin-walled vessels revealed by reticulin stain. Pleomorphism and mitotic figures were seen. It was diagnosed as a case of malignant hemangiopericytoma of gluteal region. The patient underwent radiotherapy and did apparently well. She is on regular follow-up because long-term follow-up is essential in all cases as recurrence can occur several years after treatment.

Leiomyoma of scrotum

Leiomyoma is a benign tumor of smooth muscles. Leiomyoma originating from the scrotum is a rare entity. We report here a case of 50-year-old male who presented with a 4-cm lump in the left side of scrotum. Clinically, it was provisionally diagnosed as sebaceous cyst and was excised. The histopathology showed findings consistent with leiomyoma. There was no cytological atypia or mitosis. The final diagnosis of solitary leiomyoma of scrotum was given. The patient was followed up regularly and is doing fine for last 4 months.

Antinociceptive activity of n-butanol fraction from MeOH extracts of Paederia scandens in mice

The n-butanol fraction of the MeOH extract from Paederia scandens was evaluated for antinociceptive activity in mice using chemical and thermal models of nociception. The n-butanol fraction, given orally at doses of 150, 300 and 600 mg/kg produced significant inhibition of chemical nociception induced by intraperitoneal acetic acid and subplantar formalin or capsaicin injections, and of thermal nociception in the tail-flick test and in the hot plate test. More significant inhibition of nociception was observed at a dose of 600 mg/kg. In the pentobarbital sodium-induced sleeping time test and the open-field test, the n-butanol fraction neither significantly enhanced pentobarbital sodium-induced sleeping time nor impaired motor performance, indicating that the observed anti-nociception was unlikely to be due to sedation or motor abnormality. Moreover, the n-butanol fraction-induced anti-nociception in both the capsaicin and formalin tests was insensitive to naloxone or glibenclamide but was significantly antagonized by nimodipine. These results suggest that the n-butanol fraction produced anti-nociception possibly related to nimodipine-sensitive L-type Ca2+ channels, which merits further studies regarding the precise site and mechanism of action. Furthermore, four iridoid glycosides isolated from the n-butanol fraction might be related to its antinociceptive action fraction. Therefore, the effect on analgesic activity of each chemical compound in large quantity might well be considered in a further study.

Bioactivity-guided fractionation for anti-inflammatory and analgesic properties and constituents of Xanthium strumarium L

The aim of this study was to fractionate an extract of Xanthium strumarium L. (EXS) and to investigate the anti-inflammatory and analgesic properties of the extract and its fractions. The ethanol extract of X. strumarium (EXS) was fractionated on the basis of polarity. Among the different fractions, the n-butanol fraction showed the highest anti-inflammatory activity in the croton-oil-induced ear edema test and furthermore reduced the number of writhings induced by acetic acid in mice in a dose-dependent manner. This indicates that the n-butanol fraction of X. strumarium possesses potent analgesic effects which are likely to be mediated by its anti-inflammatory activity. Bioassay-guided fractionation of EXS led to the isolation and identification of ten caffeoylquinic acids and three heterocyclics by HPLC-DAD-MS(n) from the active n-butanol fraction, implying that the active compounds are polar in nature. The isolated caffeoylquinic acids could partially explain the antinociceptive effect of X. strumarium polar extract.

Estrogen-like activities in Vitex species from China determined by a cell based proliferation assay

Ethanolic extracts of four Chinese medicinally used Vitex species were selected and tested for their estrogen-like activities, using an ERalpha-positive MCF-7 cell based proliferation assay (E-screen assay) and cell cycle analysis (flow cytometry). Vitex negundo displayed the highest estrogenic-like activity, and could be useful in hormone replacement therapy (HRT).

Anti-nociceptive and anti-hyperprolactinemia activities of Fructus Viticis and its effective fractions and chemical constituents

Vitex rotundifolia L. is widely distributed along the sea coast of China. The aim of this study was to investigate the anti-nociceptive and anti-hyperprolactinemia activities of substances isolated from Fructus Viticis (the fruit of Vitex rotundifolia), which may be effective in the treatment of pre-menstrual symptoms, using acetic-acid-induced writhing and metoclopramide-dihydrochloride-induced hyperprolactinemia in mice. The fractions effective in terms of anti-nociceptive and anti-hyperprolactinemia activities were obtained from Fructus Viticis by elution through macro-porous resin, and polyamide and silica gel column chromatography. The standardization of the fractions obtained from the separation procedures was carried out by means of high-performance liquid chromatography (HPLC)-fingerprint. In this study, the flavone-enriched fraction (Fraction 6) showed a higher inhibitory rate than indomethacin (69.4% vs. 56.4%) at a dose of 50 mg/kg body wt., and significantly reduced the prolactin level as compared to HPRL-treated mice (8.2 ng/ml vs. 25.5 ng/ml). Furthermore, this fraction showed anti-nociceptive activity in a dose-dependent manner (10-50 mg/kg body wt., i.g.). On further purification with silica gel, Casticin was isolated from this fraction and it decreased abnormal serum levels of prolactin by approximately 50% (p < 0.01). Using bioassay-screening methods, our results indicate that the presence of flavonoids such as Casticin in this plant may be responsible for the activity effects. Casticin has potent analgesic and anti-hyperprolactinaemia properties, is likely to be one of the active components of Fructus Viticis, and may have a role in treating PMS (premenstrual syndrom).

Radiological impact of dietary intakes of naturally occurring radionuclides on Pakistani adults

Daily dietary intakes of three naturally occurring long-lived radionuclides (232)Th, (238)U and (40)K were estimated for the adult population of Pakistan using neutron activation analysis (NAA), inductively coupled plasma mass spectrometry (ICP-MS) and atomic absorption spectrometry (AAS), respectively. The daily intakes of (232)Th ranged from 4 to 29 mBq, (238)U ranged from 17 to 82 mBq and (40)K ranged from 51 to 128 Bq. The geometric means of these intakes were 10 mBqd(-1) for (232)Th, 33 mBqd(-1) for (238)U and 78.5 Bqd(-1) for (40)K. The measured values give annual committed effective doses of 0.80, 0.53 and 178.75 microSvyr(-1) for (232)Th, (238)U and (40)K, respectively to Pakistani population. The net radiological impact of these radionuclides is 180.08 microSvyr(-1). This value gives cancer risk factor of 4.5 x 10(-4) and loss of life expectancy of 0.87 days only. Whereas ICRP cancer risk factor for general public is 2.5 x 10(-3) and total risk involve from the all natural radiation sources based on global average annual radiation dose of 2.4 mSvyr(-1) is 6.0 x 10(-3). The estimated cancer risk shows that probability of increase of cancer risk from daily Pakistani diet is only a minor fraction of ICRP values. Therefore, the diet does not pose any significant health hazard and is considered radiologically safe for human consumption.

Antinociceptive activity and chemical composition of constituents from Caragana microphylla seeds

This investigation was undertaken to ascertain the antinociceptive activity of Caragana microphylla Lam. seeds and isolate and characterize the constituents. Antinociceptive activity was screened using acetic acid-induced abdominal constriction in ICR mice. The 75% ethanol extract and some fractions showed analgesic activity, but the antinociceptive activity of chloroform fraction was the strongest and was more productive than other fractions. Seven compounds were isolated from it and identified as: (1) machaeric acid, (2) beta-sitosterol, (3) stigmasterol, (4) pratol, (5) dehydrocavidine, (6) formononetin and (7) sucrose. Caragana microphylla Lam. seeds showed analgesic activity, with the chloroform fraction showing the strongest analgesic activity among the fractions.

Linking Global Youth Tobacco Survey (GYTS) data to the WHO framework convention on tobacco control: the case for India

India ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) on February 27, 2005. The WHO FCTC is the world's first public health treaty that aims to promote and protect public health and reduce the devastating health and economic impacts of tobacco. Post ratification, each member state as part of general obligation has agreed to develop, implement, periodically update and review comprehensive multisectoral national tobacco control strategies, plans and programmes in accordance with this Convention and the protocols to which it is a Party. The Global Youth Tobacco Survey (GYTS) was developed to track tobacco use among young people across countries and the GYTS surveillance system intends to enhance the capacity of countries to design, implement, and evaluate tobacco control and prevention programs. The South-East Asia Region of WHO has developed the "Regional Strategy for Utilization of the GYTS" to meet this need for countries in the Region. In 2003, India has passed its national tobacco control legislation (India Tobacco Control Act [ITCA]), which includes provisions designed to reduce tobacco consumption and protect citizens from exposure to second hand smoke. Data in the GYTS (India) report can be used as a baseline measure for future evaluation of the tobacco control programs implemented by the Ministry of Health and Family Welfare, Government of India. India has to upscale some provisions of its National Law to accommodate all of the requirements of FCTC. Using determinants measured by GYTS in India, the government can monitor the impact of enforcing various provisions of the ITCA and the progress made in achieving the goals of the WHO FCTC and the Regional Strategies. Effective enforcement of the provisions of ITCA will show in the receding numbers of tobacco use prevalence figures and reduction in the expenditures associated with tobacco use in India.

Failed tracheal intubation in obstetrics: no more frequent but still managed badly

In the South-West Thames region of the United Kingdom, during a 5-year period from 1999 to 2003, there were 20 failed tracheal intubations occurring in 4768 obstetric general anaesthetics (incidence 1 : 238). In half of the 16 cases for which the patient's notes could be examined there was a failure to follow an accepted protocol for failed tracheal intubation.