Association of demographics, lumbar active range of motion and disability in chronic low back: a baseline data analysis of a randomized controlled trial from Pakistan.

BACKGROUND: The disability and significant economic costs accredited to Low back pain (LBP) are likely to rise which is an essential problem in low and middle-income countries like Pakistan. The associated factors of LBP are age, sex, and race including physical activity, high spinal load, lifting, bending, and twisting occupations. The literature highlighted there is substantial differences in associated factors of LBP within available studies in developing countries. The objective is to investigate the association of demographic factors and lumbar range of motion with disability in patients with chronic low back. METHODS: A baseline data analysis was performed as an analytical cross-sectional study among 150 patients with chronic low back in a randomized controlled trial with a duration from March 2020 and January 2021. After recording demographics, Modified-Modified Schober's test was used to measure lumbar flexion and extension and Oswestry disability index for disability. After the descriptive analysis the continuous variables, age and pain were analyzed with Spearman's correlation. Variables that were significant in bivariate analysis were then fitted in a multivariable linear regression. The Kruskal-Wallis test was used to analyze variations of disability in gender, marital status, work status, education level, and duration of pain. The p-value of 0.05 was significant. RESULTS: The results showed a significant correlation between age and pain in sitting (rh=-0.189, p = 0.021 and rh = 0.788, p < 0.001) with the disability but no significant effects of age and pain in sitting (B=-0.124, p = 0.212 and B = 1.128, p = 0.082) on disability were found. The decrease in lumbar flexion and extension was found to increase disability (B=-6.018 and - 4.032 respectively with p < 0.001). Female gender (x2(1) = 15.477, p = < 0.001) and unmarried marital status (x2(1) = 4.539, p = 0.033) had more disability than male gender and married marital status, respectively. There was a significance between groups of the duration of pain regarding disability (x2 (2) = 70.905, p < 0.001). Age, education level, and work status showed no significance (p > 0.05). CONCLUSIONS: The female gender and unmarried marital status are associated with functional disability. Decreased lumbar range of motion accompanies more disability, while age, education level, and work status do not effect on disability.

Impact of diet and physical activity on reproductive profile: A comparison of middle-aged and elderly men.

Age is a known determinant of reproductive health and fertility in both genders. The present work aims to assess the reproductive hormone profile of a middle-aged and elderly man. For this descriptive cross-sectional study, healthy male subjects (n=77) were recruited from the valley. Any individual suffering from any acute or chronic diseases and on drugs was ruled out from the study. Group A consisted of 40 elderly men between 60-70 years of age, and Group B comprised 37 men between 35-46 years of age. Blood samples were taken to estimate the reproductive hormone profile. Level of oxidant and antioxidant: Malondialdehyde and Glutathione. The demographic variables, which included retrospective and prospective questions, helped to assess the physical activity and diet intake behaviour of all inducted individuals. The analysis of the reproductive profile of both groups was similar and within the normal range of standards. However, the median level of LH was higher in group A than in group B: 6.7 mIU/ml versus 3.4 mIU/ml, respectively, and p<0.003. Both groups showed predominantly involvement in physical activity, >90%. The correlation of biochemical variables gives an insight into the fact that the Mediterranean diet and physical activity help to maintain a normal BMI. These implicate the normal secretion of various hormones, leading to intact spermatogenesis. We can safely deduce from this study that physically active lifestyles and a healthy diet are crucial factors in maintaining an endocrine profile.

L'âge est un déterminant connu de la santé reproductive et de la fécondité chez les deux sexes. Le présent travail vise à évaluer le profil hormonal de la reproduction d'un homme d'âge moyen et âgé. Pour cette étude transversale descriptive, des sujets masculins en bonne santé (n = 77) ont été recrutés dans la vallée. Toute personne souffrant de maladies aiguës ou chroniques et prenant des médicaments a été exclue de l'étude. Le groupe A était composé de 40 hommes âgés de 60 à 70 ans et le groupe B de 37 hommes âgés de 35 à 46 ans. Des échantillons de sang ont été prélevés pour estimer le profil des hormones reproductives. Niveau d'oxydant et d'antioxydant : Malondialdéhyde et Glutathion. Les variables démographiques, qui comprenaient des questions rétrospectives et prospectives, ont permis d'évaluer l'activité physique et le comportement alimentaire de tous les individus intronisés. L'analyse du profil reproducteur des deux groupes était similaire et se situait dans la fourchette normale des normes. Cependant, le taux médian de LH était plus élevé dans le groupe A que dans le groupe B : respectivement 6,7 mUI/ml versus 3,4 mUI/ml et p<0,003. Les deux groupes présentaient une participation prédominante à l'activité physique, > 90 %. La corrélation des variables biochimiques donne un aperçu du fait que le régime méditerranéen et l'activité physique contribuent à maintenir un IMC normal. Celles-ci impliquent la sécrétion normale de diverses hormones, conduisant à une spermatogenèse intacte. Nous pouvons déduire de cette étude qu'un mode de vie physiquement actif et une alimentation saine sont des facteurs cruciaux pour maintenir un profil endocrinien.

Trends in managing femoral neck fractures with arthroplasty in the ≥ 50 years age group.

Objective: To know about the trends in the management of neck of femur fractures with arthroplasty in patients ≥ 50 years. Methods: It is a retrospective cross-sectional study with data collection from Hospital Management Information System from 1st January 2020 to 31st July 2023. SPSS version 25 was used for data analysis. Mean & standard deviation was reported for quantitative variable & frequency and proportion were reported for qualitative variables. The cross- tabulations were performed to evaluate the association between the variables. Results: Total number of patients in this study was 305. Mean age was 67.80 ± 10.5 SD. Male to female ratio was 150:155. Co-morbidities were found in 126 patients. The surgical options used were Austin Moore prosthesis (64), Cemented Bipolar (36), Hybrid Total Hip Replacement (7), Non-cemented Total Hip Replacement (86), Cemented Total Hip Replacement (32), Uncemented Bipolar (71). Garden Type-2 fracture was noted in 33 patients, Type-3 in 170 patients and Type-4 in 87 patients. Cemented stem was used in 74 patients while 222 patients had non-cemented stem. Conclusion: One quarter of the patients had cemented stem implanted compared to three quarter of the patients who had non-cemented stem.

Presentations and management of hospitalized patients with upper extremity fractures at a level 1 trauma center: a 5-year observational study.

BACKGROUND: Upper extremity injuries (UEIs) are common in the emergency departments, yet they are under-reported in developing countries. This study examined the frequency, injury characteristics, and treatment approaches of upper extremity fractures (UEFs) among hospitalized trauma patients in a nationally representative population. METHODS: We conducted a retrospective, observational study including all the hospitalized patients with UEFs in the only level 1 trauma center in Qatar between July 2015 and August 2020. Comparative analyses were performed according to injury mechanisms, severity, and management approach. RESULTS: A total of 2,023 patients sustained UEIs with an average age of 34.4 ± 12.9 years, and 92% were males. Motor vehicle crashes (MVCs; 42.3%) were the primary cause of shoulder girdle injuries in 48.3% of cases. Fractures of the radius, ulna, and hands occurred in 30.8, 16.5 and 14.5%, respectively. Young adults were more involved in MVCs and motorcycle crashes (MCCs), while pedestrians who were typically older had a higher rate of humerus fractures. Patients with MCCs had a higher rate of clavicle and ulna fractures. Pedestrians were at risk of serious injuries, with a higher mean injury severity score and lower Glasgow Coma Scale. CONCLUSION: Most UEFs patients were young males and mainly affected by MVCs. Shoulder girdle, particularly clavicle and scapula/glenoid fractures, emerged as common injury sites. The study highlighted the potential risk of pedestrian injuries, as reflected in higher injury severity, concomitant injuries, and higher mortality. Future studies are needed to optimize preventive measures by incorporating insights into specific injury mechanisms and patterns of UEIs.

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus.

BACKGROUND: Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. METHODS: Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. RESULTS: Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redo-procedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. CONCLUSION: Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.

Bariatric and metabolic surgery in patients with low body mass index: an online survey of 543 bariatric and metabolic surgeons.

BACKGROUND: Metabolic and bariatric surgery (MBS) in patients with low body mass index patients is a topic of debate. This study aimed to address all aspects of controversies in these patients by using a worldwide survey. METHODS: An online 35-item questionnaire survey based on existing controversies surrounding MBS in class 1 obesity was created by 17 bariatric surgeons from 10 different countries. Responses were collected and analysed by authors. RESULTS: A total of 543 bariatric surgeons from 65 countries participated in this survey. 52.29% of participants agreed with the statement that MBS should be offered to class-1 obese patients without any obesity related comorbidities. Most of the respondents (68.43%) believed that MBS surgery should not be offered to patients under the age of 18 with class I obesity. 81.01% of respondents agreed with the statement that surgical interventions should be considered after failure of non-surgical treatments. CONCLUSION: This survey demonstrated worldwide variations in metabolic/bariatric surgery in patients with class 1 obesity. Precise analysis of these results is useful for identifying different aspects for future research and consensus building.

Isolation and Identification of Phytocompounds from Maytenus dhofarensis and Their Biological Potentials.

Maytenus dhofarensis Sebsebe (Celestraceae) is a naturally growing shrub in Oman. It is not a reputed medicinal plant in Oman, but it is regionally endemic and causes shivering attacks on goats that graze on it. The chemical investigation of the hexane and chloroform extracts of the fruits and stems of M. dhofarensis afforded dihydro-ß-agarofuran-type sesquiterpene pyridine alkaloid (1), lupanyl myristoate (2) and lignanolactone (3). Compounds (1-3) are new isolates from M. dhofarensis. The structures of these compounds were assigned through comprehensive IR, NMR, and ESI-MS analyses, and the relative configurations of compounds 1 and 3 were deduced from density function theory (DFT) calculations and NMR experiments. Compound 1 was assayed against the kinase enzyme and showed no inhibition activity for p38 alpha and delta at a 10 µM test concentration. Compound 3 inhibited the 2,2'-diphenyl-1-picrylhydrazyl radical (DPPH) by 69.5%, compared to 70.9% and 78.0% for gallic acid and butylated hydroxyanisole, respectively, which were used as positive controls.

Mapping potential groundwater accumulation zones for Karachi city using GIS and AHP techniques.

Karachi is the largest industrial metropolitan of Pakistan facing an acute water shortage which is leading to an overdraft of groundwater resources in the city. Groundwater is an important freshwater resource for the city as millions of people depend for sustenance. However, over-exploitation of groundwater has led to decreased groundwater levels within the city leading to environmental issues of depleting aquifers, deteriorating groundwater quality, land subsidence, and harm to groundwater-dependent ecosystems. The objective of the study was to assess the potential groundwater accumulation zones by integrating hydrogeological aspects of the city through nine thematic layers using the Geographic Information System (GIS) based multi-criteria decision analysis (MCDA) technique. The potential groundwater accumulation map reveals that 20% of the area has a low potential, 70% has moderate potential, and around 10% of the area in the city is composed of a high potential accumulation zone. The upstream regions of the city have the highest recharge potential because of sandy soil and barren land use, which promote high infiltration rates. The urbanized downstream areas have the lowest recharge potential due to impervious fabric. The findings reveal that the MCDA technique can be used with confidence in data-scarce regions for groundwater resource assessment and management. The recharge potential map can help better manage groundwater resources in the city by helping explore groundwater extraction opportunities and could hint at areas suitable for artificial recharge wells/ponds.

Epidemiology of hip & knee replacement across Pakistan: Multicenter cross-sectional study.

Objective: To know about the predictive prevalence of hip and knee arthroplasty across Pakistan. Methods: It is retrospective cross-sectional study with data collection from Pakistan National Joint Registry (PNJR) of number of hip and knee arthroplasty cases in seven years (2014-2021). Fourteen high volume centers across Pakistan who consented for data publication were included. Stata version 16 was used for data analysis. Mean & standard deviation was reported for quantitative variable & frequency and proportion were reported for qualitative variables. Results: Our results showed a total of 9572 people had total knee replacement in last seven years from 2014-2021 with the rate of 9.57/100,000 population. Mean age of the patient was 61.7±8.95 with 69.5% patients being female and 30.5% being male. Our results showed a total of 2265 people had total hip replacement in last seven years from 2014-2021with the rate of 2.26/100,000 population. Mean age of the patient was 50.7±15.4 with 62% patients being male and 38% being female. Conclusion: This is the first epidemiological study in Pakistan on the rates of hip and knee arthroplasty cases in Pakistan based on registry data, showing that more knee arthroplasty cases are being performed as compared to hip arthroplasty.

Effect of post-isometric relaxation versus myofascial release therapy on pain, functional disability, rom and qol in the management of non-specific neck pain: a randomized controlled trial.

BACKGROUND: Non-specific neck pain is the most prevailing musculoskeletal disorder which has a large socioeconomic burden worldwide. It is associated with poor posture and neck strain which may lead to pain and restricted mobility. Physical therapists treat such patients through several means. Post isometric relaxation and Myofascial release therapy are used in clinical practice with little evidence to be firmed appropriately. So, this study was conducted to explore the effect of Post-isometric relaxation in comparison to Myofascial release therapy for patients having non-specific neck pain. METHODOLOGY: Sixty patients were randomly allocated to Post isometric group and the Myofascial group. The treatment period was of 2 weeks. All the patients were evaluated using the Visual analogue scale (VAS), Neck disability index (NDI), Universal Goniometer, and WHO BREF Quality of life-100 in the 1st and 6th sessions. Recorded data was entered on SPSS 21. Data were examined using two-way repeated ANOVA to measure the variance of analysis (group x time). RESULTS: Analysis of the baseline characteristics revealed that both groups were homogenous in terms of age and gender i.e. a total of 60 participants were included in this research study 30 in each group. Out of 60 patients, there were 20(33.3%) males and 40(66.7%) females with a mean age of 32.4(5.0) years. Participants in the Post Isometric group demonstrated significant improvements (p < 0.025) in VAS, NDI, Cervical Extension, left side rotation ranges, and QoL (Social Domain) at the 2-week follow-up compared with those in the Myofascial group. In addition, the Myofascial group indicated significantly better improvement in the mean score of CROM (flexion and right and left side bending). CONCLUSION: The study demonstrated patients with nonspecific neck pain can benefit from the post isometric relaxation with significant improvement in pain, disability, cervical ROM, and Quality of life compared with myofascial release therapy. TRIAL REGISTRATION: Clinical Trial registered on clinicaltrial.gov (NCT number) NCT04638062 , 20/11/2020 (prospectively registered).

InteliRank: A Four-Pronged Agent for the Intelligent Ranking of Cloud Services Based on End-Users' Feedback.

Cloud Computing (CC) provides a combination of technologies that allows the user to use the most resources in the least amount of time and with the least amount of money. CC semantics play a critical role in ranking heterogeneous data by using the properties of different cloud services and then achieving the optimal cloud service. Regardless of the efforts made to enable simple access to this CC innovation, in the presence of various organizations delivering comparative services at varying cost and execution levels, it is far more difficult to identify the ideal cloud service based on the user's requirements. In this research, we propose a Cloud-Services-Ranking Agent (CSRA) for analyzing cloud services using end-users' feedback, including Platform as a Service (PaaS), Infrastructure as a Service (IaaS), and Software as a Service (SaaS), based on ontology mapping and selecting the optimal service. The proposed CSRA possesses Machine-Learning (ML) techniques for ranking cloud services using parameters such as availability, security, reliability, and cost. Here, the Quality of Web Service (QWS) dataset is used, which has seven major cloud services categories, ranked from 0-6, to extract the required persuasive features through Sequential Minimal Optimization Regression (SMOreg). The classification outcomes through SMOreg are capable and demonstrate a general accuracy of around 98.71% in identifying optimum cloud services through the identified parameters. The main advantage of SMOreg is that the amount of memory required for SMO is linear. The findings show that our improved model in terms of precision outperforms prevailing techniques such as Multilayer Perceptron (MLP) and Linear Regression (LR).

A practical approach towards causality mining in clinical text using active transfer learning.

OBJECTIVE: Causality mining is an active research area, which requires the application of state-of-the-art natural language processing techniques. In the healthcare domain, medical experts create clinical text to overcome the limitation of well-defined and schema driven information systems. The objective of this research work is to create a framework, which can convert clinical text into causal knowledge. METHODS: A practical approach based on term expansion, phrase generation, BERT based phrase embedding and semantic matching, semantic enrichment, expert verification, and model evolution has been used to construct a comprehensive causality mining framework. This active transfer learning based framework along with its supplementary services, is able to extract and enrich, causal relationships and their corresponding entities from clinical text. RESULTS: The multi-model transfer learning technique when applied over multiple iterations, gains substantial performance improvements. We also present a comparative analysis of the presented techniques with their common alternatives, which demonstrate the correctness of our approach and its ability to capture most causal relationships. CONCLUSION: The presented framework has provided cutting-edge results in the healthcare domain. However, the framework can be tweaked to provide causality detection in other domains, as well. SIGNIFICANCE: The presented framework is generic enough to be utilized in any domain, healthcare services can gain massive benefits due to the voluminous and various nature of its data. This causal knowledge extraction framework can be used to summarize clinical text, create personas, discover medical knowledge, and provide evidence to clinical decision making.

Use of potentially inappropriate medications among older outpatients and inpatients in a tertiary care hospital in Malaysia.

BACKGROUND: Older individuals are seemingly having more medical conditions, which predispose them to a greater risk of polypharmacy. Potentially inappropriate medications (PIMs), including those having anticholinergic and sedative properties, are common in their prescriptions, often associated with functional decline and negative health outcomes. Thus, this study reports proportions of inappropriate drugs and drug burden exposures and its correlation with patient-reported outcomes (PROs) among cognitively intact older adults admitted to a ward or visiting the outpatient clinic at a tertiary care hospital in Malaysia. METHODS: This cross-sectional study included data from 344 older (173 inpatients and 171 outpatients) patients, aged 60 years and above, through validated questionnaires. Medication appropriateness was assessed via Medication Appropriateness Index (MAI) tool, whereas Beers and Screening Tool of Older Person's Potentially Inappropriate Prescribing (STOPP) criteria were used to evaluate PIMs and potentially inappropriate prescribing (PIP), respectively. The Drug Burden Index (DBI) and polypharmacy, as well as PROs, included Groningen Frailty Indicator (GFI), Katz Index of Independence in Activities of Daily Living (Katz ADL) and Older People's Quality of Life (OPQOL) were also evaluated. RESULTS: Overall, inpatients received significantly higher medications (6.90 ± 2.70 vs 4.49 ± 3.20) than outpatients. A significantly higher proportion of inpatients received at least one PIM (65% vs 57%) or PIP (57.4% vs 17.0%) and higher mean MAI score (1.76 ± 1.08 and 1.10 ± 0.34) and DBI score (2.67 ± 1.28 vs 1.49 ± 1.17) than outpatients. Inpatients had significantly higher total OPQOL (118.53 vs 79.95) and GFI score (5.44 vs 3.78) than outpatients. We only found significant correlations between GFI and DBI and total OPQOL and the number of PIMs. CONCLUSIONS: Proportions of PIMs and DBI exposure were significantly higher in an inpatient setting. No significant correlations between exposures to inappropriate medications or drug burden and PROs were observed.

Clinical characteristics, injury pattern and management of pediatric pelvic fracture: An observational retrospective study from a level I trauma center.

BACKGROUND: Pediatric pelvic fractures (PPF) are uncommon among children requiring hospitalization after blunt trauma. The present study explored our experience for the prevalence, patients demographics, clinical characteristics, injury pattern and management of pediatric pelvic fractures in a level I trauma center. METHODS: This is a retrospective review of prospectively collected data obtained from trauma registry database for all pediatrics trauma patients of age ≤18 years. Data were analyzed according to different aspects relevant to the clinical applications such as Torode classification for pelvic ring fracture (Type I-IV), open versus closed triradiate cartilage, and surgical versus non-surgical management. RESULTS: During the study period (3 and half years), a total of 119 PPF cases were admitted at the trauma center (11% of total pediatric admissions); the majority had pelvic ring fractures (91.6%) and 8.4% had an acetabular fracture. The mean age of patients was 11.5 ± 5.7, and the majority were males (78.2%). One hundred and four fractures were classified as type I (5.8%), type II (13.5%), type III (68.3%) and type IV (12.5%). Patients in the surgical group were more likely to have higher pelvis AIS (p = 0.001), type IV fractures, acetabular fractures and closed triradiate cartilage as compared to the conservative group. Type III fractures and open triradiate cartilage were significantly higher in the conservative group (p < 0.05). Patients with closed triradiate cartilage frequently sustained spine, head injuries, acetabular fracture and had higher mean ISS and pelvis AIS (p < 0.01) than the open group. However, the rate of in-hospital complications and mortality were comparable among different groups. The overall mortality rate was 2.5%. CONCLUSION: PPF are uncommon and mainly caused by high-impact trauma associated with multisystem injuries. The majority of PPF are stable, despite the underlying high-energy mechanism. Management of PPF depends on the severity of fracture as patients with higher grade fractures require surgical intervention. Furthermore, larger prospective study is needed to understand the age-related pattern and management of PPF.

Malformin-A1 (MA1) Sensitizes Chemoresistant Ovarian Cancer Cells to Cisplatin-Induced Apoptosis.

High-grade epithelial ovarian cancer is a fatal disease in women frequently associated with drug resistance and poor outcomes. We previously demonstrated that a marine-derived compound MalforminA1 (MA1) was cytotoxic for the breast cancer cell line MCF-7. In this study, we aimed to examine the effect of MA1 on human ovarian cancer cells. The potential cytotoxicity of MA1was tested on cisplatin-sensitive (A2780S) and cisplatin-resistant (A2780CP) ovarian cancer cell lines using AlamarBlue assay, Hoechst dye, flow cytometry, Western blot, and RT-qPCR. MA1 had higher cytotoxic activity on A2780S (IC50 = 0.23 µM) and A2780CP (IC50 = 0.34 µM) cell lines when compared to cisplatin (IC50 = 31.4 µM and 76.9 µM, respectively). Flow cytometry analysis confirmed the cytotoxic effect of MA1. The synergistic effect of the two drugs was obvious, since only 13% of A2780S and 7% of A2780CP cells remained alive after 24 h of treatment with both MA1 and cisplatin. Moreover, we examined the expression of bcl2, p53, caspase3/9 genes at RNA and protein levels using RT-qPCR and Western blot, respectively, to figure out the cell death mechanism induced by MA1. A significant down-regulation in bcl2 and p53 genes was observed in treated cells compared to non-treated cells (p < 0.05), suggesting that MA1 may not follow the canonical pathway to induce apoptosis in ovarian cancer cell lines. MalforminA1 showed promising anticancer activity by inducing cytotoxicity in cisplatin-sensitive and cisplatin-resistant cancer cell lines. Interestingly, a synergistic effect was observed when MA1 was combined with cisplatin, leading to it overcoming its resistance to cisplatin.

Optimization of empagliflozin immediate release tablets (10 mg) using central composite rotatable design with response surface methodology.

Empagliflozin is a selective inhibitor of sodium glucose co-transporter II, given as mono therapy or an add-on treatment to reduce the glycated hemoglobin levels in type 2 diabetes. This work deals with designing, formulating and optimizing empagliflozin (10mg) immediate release (IR) tablets by direct compression technique using different excipients. Through central composite rotatable design (CCRD), total nine formulations (EF1-EF9) were generated by changing the composition of binder avicel PH 102® (X1) and superdisintegrant acdisol⌖ (X2). Formulation runs with in suitable weight range and powder properties were subjected to compression. The influence of interaction of excipients on friability (Y1), hardness (Y2) and disintegration (Y3) were analyzed by fitting the polynomial quadratic model with response surface methodology (RSM). Trials EF2, EF7, EF8 and EF9 exhibited acceptable tablet attributes upon physico-chemical testing. Different dissolution models were applied to observe the in vitro drug release pattern in phosphate buffer of pH 6.8. The cumulative drug release of IR tablet batches followed the Weibull kinetics with regression coefficient (r2) values of 0.983-0.992. Empagliflozin trials were exposed to accelerated storage conditions (40±2°C/ 75±5% RH) for stability testing. Shelf life period of exposed formulations were computed in range of 22 to 25 months. Keeping in view of the results, it is concluded that the employed technique of preparation and optimization are observed to be excellent for developing immediate release empagliflozin (10mg) tablets.

Determining the release kinetics of risperidone controlled release matrices to treat schizophrenia.

Risperidone is an atypical antipsychotic agent clinically used to treat schizophrenia, bipolar diseases, and autism. Usually, the frequency of doses is twice daily. In the present study, risperidone controlled release matrices formulated using hydrophilic and hydrophobic polymers. The tablets were prepared by direct compression. The pre-compression and post-compression properties were assessed, along with swelling studies. The morphology of particles observed using scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FT-IR). The stability study on the drug was performed using thermal gravimetric analysis (TGA) and differential thermal analysis (DTA). The optimized formulation was prepared with the help of hydrophilic polymer K100M (40% ratio). Furthermore, release kinetics had investigated. The release pattern of optimized formulation FT5 fitted best to zero-order kinetics and showed excellent release characteristics. The model-independent approach had been used, formulations FT6 and FT8 showed resemblance with FT5 in all three media, respectively. The once daily formulation of risperidone could be beneficial for schizophrenia patients and their caregivers and will improve patient compliance.

A cross-sectional analysis of the effects of everyday life situations on stuttering and associated physical features.

OBJECTIVE: To explore the effects that everyday situations of varying stress/anxiety have on stammering. METHODS: The cross-sectional study was conducted in the first six months of 2018 at Central Park Medical College Lahore, and comprised people with stammer. The subjects were categorised into two groups on the basis of severity of symptoms assessed using the fluency severity rating scale. Group A had subjects with mild to moderate stammer, while Group B had those with moderate to severe stammer. An 8-point Likert scale was employed to evaluate responses towards 33 questions of which 30 were situation-based while 3 focussed on physical fitness, blinking and body jerks. SPSS 23 was used for data analysis. RESULTS: Of the 56 subjects, there were 26(46.4%) in Group A, and 30(53.5%) in Group B. Higher degree of blinking and body jerks were found in Group B (p<0.05 each). CONCLUSION: Subjects with severe stammer had more body jerks and blinking compared to those with mild to moderate condition.

Antidiarrheal potential of lactobacillus strains isolated from pharmaceutical formulations for the treatment of pediatric diarrhea.

The consumption of probiotics in the prevention and treatment of diarrhea have been clinically justified, comprehensive studied and explored in many products around the world. In Pakistan, recommendation of probiotic formulations is being emerged to control the increased mortality and morbidity from diarrhea under 5 years of age children. The objective of the study was to evaluate the antimicrobial potential of isolated Lactobacillus strains against diarrheagenic Escherichia coli. Twelve strains were isolated from different probiotic pharmaceutical formulations available in Pakistan. Physiological and biochemical characteristics of isolates were analyzed. Selective media was used for the growth of probiotic isolates and E. coli. Agar spot and well diffusion methods were employed to evaluate the antimicrobial activity of isolates and measured as a zone of inhibition (mm). Changes in cell morphology was observed by Scanning Electron Microscopy. Statistical analysis was adopted with a level of significance p<0.05. L. reuteri (28 mm) and L.plantarum (26 mm) showed significant inhibitory actions against E. coli due to increased organic acids and bacteriocins formations. Rest of isolates exhibited mild to moderate activity with an average inhibition (20 mm). L. sporogenes demonstrated weak antagonistic behavior. Use of multiple strains of Lactobacillus along with L. reuteri or L.plantarum as a therapeutic agent or in nutritional supplements could be a novel approach for the prevention and treatment of pediatric diarrhea.

Hepatoprotective effect of Ziziphus oxyphylla Edgew in paracetamol-induced hepatotoxic rat model.

Ziziphus oxyphylla Edgew (Z. oxyphylla) is a small shrub to a medium sized tree. The aim of the present study was to evaluate the hepatoprotective activity of Z. oxyphylla in paracetamol-induced hepatotoxic rat model. Silymarin was used as a standard drug. Methanol extract was found to be the most potent in in-vitro antioxidant studies. The methanol extract of Z. oxyphylla was administered to experimental animals. The hepatoprotective effect of extract was evaluated by measuring liver biochemical markers, anti-oxidant enzymes and blood lipid profile. Treatment with the paracetamol increased the level of hepatic biomarkers, blood lipid profile and decreased anti-oxidant enzymes. Pre-treatment with Z. oxyphylla caused restoration of hepatic biomarkers, blood lipid profile and antioxidant enzymes levels. It is concluded that the methanol extract of Z. oxyphylla possesses hepatoprotective activity that might be due to quercetin and kaempferol glycosides present in the plant extract. Further studies are required to elucidate the exact mechanism of action of these isolated flavonoid glycosides.