EXPRESSION OF PEROXISOME-PROLIFERATOR ACTIVATED RECEPTORS-γ IN DIABETICS, OBESE AND NORMAL SUBJECTS.

BACKGROUND: Current researcn in type 2 diabetes mellitus focuses on the role of Peroxisome- Proliferator Activated Receptors (PPARs) in the pathogenesis of the Insulin Resistance Syndrome (IRS), which are pre-diabetic lesion and the hallmark of fully developed type 2 diabetes mellitus. This study aims at identifying the abnormal status of the PPAR-γ in adipose tissues of type 2 diabetes mellitus patients, when compared with matched normal controls. METHODS: This cross-sectional study was conducted in Ayub Medical College, Abbottabad, from 2012 to 2014. Sample included three equal groups of patients. Group-1 with diagnosed type 2 diabetes mellitus, aged 40-65 years, acting as the test group, Group-2 included non-diabetic obese, and Group-3 with normal subjects. Transcription Factor Assay for Peroxisome Proliferator Activated Receptor Gamma (gamma PPAR) was done on ELISA Technique from Nuclear Extract procured from Adipose Tissue of the subjects. RESULTS: Mean age of enrolled participants was 48.93 SD ± 6.52 years. Patients ranged between ages of 40 years to 67 years. The mean values of PPAR in normal, obese and diabetic group were 1.72 SD ± 0.28, 1.282 SE ± 0.18 and 1.283 SE ± 0.18 respectively. The difference in mean values of PPAR was significant p < 0.05: CONCLUSION: The levels of PPAR-γ in patients with type 2 Diabetes Mellitus and Obese cases are significantly lower than normal controls.

EFFECT OF NEBIVOLOL ON TONE OF TRACHEAL MUSCLE OF GUINEA PIG.

BACKGROUND: The use of ß-blockers is limited by adverse effects such as bronchospasm in asthmatics. Third generation ß-blockers such as nebivolol may show better tolerability in asthmatic subjects because they lack ß-blocker induced bronchoconstriction. Methods: Effects of nebivolol on the tracheal muscle strips prepared from ovalbumin-sensitised guinea pigs of both sexes were studied. Two sets of experiments were designed after dividing the animals randomly into two groups. Using oxygenated Krebs-Henseleit solution as the nutrient medium, the trachealis muscle activity was measured with isometric force displacement transducer and recorded on 4-channel Oscillograph. RESULT: Nebivolol 10(-6) M did not produce significant effect on contractions evoked by histamine in concentrations ranging from 10(-7) M to 10(-3) M. The mean of amplitude of contraction for different concentrations of histamine were calculated and compared with the group treated with histamine only. Mean of amplitude of contraction, percent responses and percent deviations when compared with the control group were insignificant (p>0.05). CONCLUSION: Nebivolol did not affect the tone of airway smooth muscle in ovalbumin-sensitised guinea pigs. Nebivolol may be considered safe in patients with airway disease however, further clinical evaluation and exploratory work is required.

EFFECT OF INTRAOPERATIVE MITOMYCIN-C APPLICATION IN OUTCOME OF EXTERNAL DACRYOCYSTORHINOSTOMY.

BACKGROUND: Patients develop postoperative fibrosis at the site of operation after dacryocystorhinostomy (DCR) which results in impairment of the osteum patency. This quasi-experimental study was undertaken to determine the role of intraoperative Mitomycin C (MMC) application in maintaining postoperative patency of the osteum. METHODOLOGY: The present study was conducted at the Eye department of Ayub Medical College, Abbottabad on patients in whom routine DCR was indicated. Subjects were divided into mitomycin C (Test) and non mitomycin C (Control) groups. In test group, Mitomycin C was applied to the anastomosed flaps and osteotomy site for 30 minutes. Postoperative patients were followed for up to 6 months and outcome of patency was documented. RESULTS: A.total of 73 patients were included, divided into test (30) and control (43) groups. An overall success rate of 86.3% was obtained for patent ostia; this was based on 96.67% success in test group compared to 79.1% in the control group (p=0.031). CONCLUSION: Intraoperative application of Mitomycin-C significantly improves the success rate in external dacryocystorhinostomy.

IN VITRO ACTIVITY OF VACCINIUM MACROCARPON (CRANBERRY) ON URINARY TRACT PATHOGENS IN UNCOMPLICATED URINARY TRACT INFECTION.

BACKGROUND: Urinary tract infection is the most common bacterial infection in the community, mainly caused by Escherichia coli (E coli). Due to its high incidence and recurrence, problems are faced in the treatment with antibiotics. Cranberry being herbal remedy have long been the focus of interest for their beneficial effects in preventing urinary tract infections. This study was conducted to analyse in vitro activity of cranberry (Vaccinium macrocarpon) on uropathogenic E coli in uncomplicated urinary tract infections. METHODS: In this laboratory based single group experimental study, anti-bacterial activity of Vaccinium macrocarpon concentrate on urinary tract E coli was investigated, in vitro. Ninety-six culture positive cases of different uropathogens were identified. Vaccinium macrocarpon concentrate at different concentrations was prepared in distilled water and put in wells punched in nutrient agar. E coli isolates were inoculated on the plates and incubated at 37 °C for 24 hours. A citric acid solution of the same pH as that of Vaccinium macrocarpon was used and put in a well on the same plate to exclude the effect of pH. RESULTS: A total of 35 isolates of E coli were identified out of 96 culture positive specimens of urine and found sensitive to Vaccinium macrocarpon (p<0.000). Results revealed that Vaccinium macrocarpon has antibacterial effect against E coli. Furthermore the antibacterial activity of Vaccinium macrocarpon has dose response relationship. Acidic nature of Vaccinium macrocarpon due to its pH is not contributory towards its antibacterial effect. CONCLUSION: Vaccinium macrocarpon concentrate may be used in urinary tract infection caused by E coli.

Common risk factors for the development of anti tuberculosis treatment induced hepatotoxicity.

BACKGROUND: Tuberculosis is a global pandemic which affects millions of people every year. The treatment of tuberculosis consists of simultaneous use of a number of drugs for a prolonged period of time, therefore anti-tuberculosis treatment induced toxicity is a real problem. Many risk factors which make a tuberculosis patient prone to the development of hepatotoxicity associated with the anti-tuberculosis treatment have been identified. The aim of this study was to determine common risk factors responsible for precipitation of hepatotoxicity following treatment with anti-tuberculosis drugs. METHODS: This cross-sectional study was conducted in the Department of Pulmonary Medicine, Ayub Teaching Hospital, Abbottabad from 20th April 2013 to 19th March 2014. Patients -' , who were newly diagnosed cases of tuberculosis in whom treatment of tuberculosis with first line anti-tuberculosis drugs was initiated and were 20 years or older, were included. The precipitation of drug induced hepatotoxicity was diagnosed with detailed history taking and physical examination followed by laboratory investigations, i.e., Liver Function tests (LFT). RESULTS: Of the total 179 patients included in this study, 100 (55.8 %) were males and 79 (44.2 %) were females. Out of them 23 (12.85%) developed hepatotoxicity. Drug induced hepatotoxicity was observed in the older patients. No relationship was found with the sex, body mass index (BMI), and pre-existing liver disease. CONCLUSION: The study showed that the risk of development of drug-induced hepatotoxicity following treatment with first line anti-tuberculosis treatment increased with the age of the patient.

Expectations of a medical student: the deficit between 'what is' and 'what should be'.

BACKGROUND: Over past few decades, the expectations of medical students about their academics, extracurricular support from college and about their social life at campus have all been changed greatly. The relative scarcity of data about the expectations of Pakistani medical students has merited this study. METHOD: A cross-sectional survey was undertaken at Ayub Medical College, Abbottabad at the in December, 2012 based on random sampling technique. Expectation questionnaire of University of Northumbria for Survey of Student Attitudes, Experiences and Expectations was used. RESULTS: One hundred and sixty-two students responded to the questionnaire with 93 (58.1%) males. Students had a fairly realistic picture of academic demands and college environment. There was major difference in the opinions of male and female students about physical environment of college with female having prior misconception about it. Forty-eight percent student found medical education challenging. About 63.3% students had realistic picture about study habits needed in the college. About 77.9% and 73.8% students had reasonable picture of academic staff and teaching methods at the college respectively. Students had a fair picture of the thorough help from teachers. About 63.5% students seemed well-prepared for the extent to which they would need to be independent learners at medical college. However expectations of 55.6% students about non-academic support were higher than provided. Also only 20.3% students found social adjustments easier than expected. About 39.5% students had fairly accurate expectations regarding the physical environment of the college; however in gender based comparison, about 55% female students felt being mistaken about the environment. CONCLUSION: Academic demands are fairly in accordance with the expectations of students. However there is a need to make course content interesting and more understandable. Also the extracurricular support in form of various facilities should be bolstered. Most importantly, the physical environment needs to be made more amicable especially for female students.

Postnatal encephalitis: a diagnosis not to be missed.

BACKGROUND: Viral encephalitis is a common condition but only a few studies are available on occurrence of viral encephalitis in postnatal women. The objective of this study was to determine the frequency of postnatal encephalitis among patients presenting with cerebral neurological complications during puerperium and to determine a response to 10 day course of acyclovir therapy and final outcome of the patients. METHODS: This cross-sectional descriptive study was conducted at Department of Medicine, Unit A, Ayub Teaching Hospital, Abbottabad from Jan to Dec 2011. All patients presenting with encephalitis in their postnatal period were enrolled. Eclampsia patients were excluded from study. The diagnosis of encephalitis was made on clinical assessment, CSF routine examination, CT scan and MRI. RESULTS: Among patients 16 (84.2%) presented with fever, 13 (68.42%) with headache, 8 (42.1%) with meningeal irritation, 7 (36.84%) with hemiparesis, 18 (94.7%) with altered sensorium, 13 (68.42%) with seizures, and 7 (36.84%) with coma. Cerebrospinal fluid of 16 (84.21%) patient had the changes consistent with viral encephalitis. It was normal in 2 (10.52%) patients and showed picture of pyogenic meningitis in 1 (5.26%) cases. On CT scan of brain, 3 (15.78%) had normal scans, 3 (15.78%) had cerebral oedema, 4 (21.05%) had ischemic infarct, 3 (15.78%) had meningo-encephalitis, 2 (10.52%) had infarct plus cerebral oedema, 1 (5.26%) had encephalitis and 3 (15.78%) had infarct plus haemorrhage. On MRI brain 15 out of 17 (88.2%) had lesions consistent with encephalitis. All 19 (100%) patients were treated with 10 days course of acyclovir and a broad spectrum third generation antibiotic. After hospitalisation 11 (57.8%) patients were discharged with complete recovery, 5 (26.31%) were discharged with partial recovery and 3 (15.78%) patients expired. CONCLUSION: Clinical presentation of the patient is most important in diagnosing viral encephalitis in postnatal women especially when patient presents with fever, altered sensorium and convulsions. Acyclovir therapy should be started without delay while awaiting other investigations.

Presentations of tuberculosis in northern Pakistan.

BACKGROUND: Tuberculosis (TB), which is a very common droplet infection. If untreated, the disease may be fatal within 5 years in more than half of cases. The aim of this hospital based descriptive study was to see mode of its presentation in our set-up. METHOD: The study was conducted in Medical Unit, Ayub Teaching Hospital, Abbottabad and 500 diagnosed cases of tuberculosis were included in this study. History regarding presenting symptoms, age, sex, etc. was taken. RESULTS: Out of the 500 patients, 277 (55.4%) were male and 223 (44.6%) were female. Two-hundred-three (40.5%) were in age group 21-35 years, 136 (27.1%) were in age group 36-50 years, 141 (28.1%) were in age group 51-65 years while 20 (4%) were above 65 years of age. Three-hundred-and-eighty (76%) presented as Pulmonary TB, 47 (9.4%) as Abdominal TB, 45 (9%) as TB Meningitis, 13 (2.6%) as Pott's Disease. 7 (1.4%) as TB Lymphadenitis, 6 (1.2%) as Constrictive Pericarditis, 1 (0.2%) as Psoas Abscess and 1 (0.2%) as TB Orchitis. CONCLUSION: TB in its various forms remains a killer disease in our part of the world. The commonest presentation is Pulmonary TB which is probably due to three major factors namely poor hygienic practices, late diagnosis and non-compliance.

Health impact caused by poor water and sanitation in district Abbottabad.

BACKGROUND: Large proportions of people still do not have excess to safe drinking water and proper sanitation. METHODS: Qualitative and quantitative approaches were used to assess the health impacts. Random households were selected. Information was collected from questionnaire through interview schedule method, group discussion and observation checklist. RESULTS: People rated water and sanitation condition in urban as: 10% very good, 27% good, 20% bad, 43% very bad, and none of them said we don't know While in rural areas they rated 10% very good, 36% good, 44% bad, 6% very bad, and 4% of them said we don't know. Water sources in selected urban and rural areas were different. 37% in urban and 68% in rural area depended on bore wells as water source, 22% depended on hand pumps. In urban areas, the disease ratio was typhoid 20%, hepatitis 13%, diarrhoea 27%, skin infection 23%, stomach problems 53% and allergies 33%. In rural areas, after stomach problems, diarrhoea, hepatitis and typhoid ratio was very high as compared to urban area. In rural community, 70% were unaware of poor water and sanitation consequences on health. CONCLUSION: The water and sanitation condition in urban as well as in rural community is poor but in rural community it is even worse The drinking water was contaminated with E. coli, Enterobacter, Salmonella and Clostridium. This observation was correlated with prevalence of many water born diseases especially in rural communities of Abbottabad.

Frequency of anti-tuberculous therapy-induced hepatotoxicity in patients and their outcome.

BACKGROUND: Tuberculosis (TB) is a very common droplet infection especially in the northern areas. If untreated, the disease may be fatal within 5 years in more than half of cases. To study the frequency of anti-tuberculous therapy (ATT) induced hepato-toxicity was the subject of the present hospital based descriptive study. METHOD: The study was conducted in Medical Unit, Ayub Teaching Hospital and patients with diagnosed Tuberculosis in whom ATT was initiated were included in the study. The subsequent development of elevated liver enzyme levels and hepatitis, amongst some members of the study group; was diagnosed, with the help of clinical findings and Liver Function Tests (LFT's) and were dealt with according to severity. RESULTS: Out of the 500 patients studied 277 (55.4%) were male and 223 (44.6%) were female, 203 (40.5%) were in age group 21-35 years, 136 (27.1%) in age group 36-50 years, 141 (28.1%) in age group 51-65 years while 20 (4%) were above 65 years of age. Out of them 40 (8%) developed hepatotoxicity, 21 (4.2%) patients amongst the study group developed overt hepatitis, 20 (4%) of them made an uneventful recovery while 1 (0.2%) died of Fulminant Hepatic Failure (FHF). CONCLUSIONS: ATT-induced hepato-toxicity, was frequently encountered in patients put on ATT.

Ethno-botanical studies from Northern Pakistan.

BACKGROUND: In this research paper efforts have been made to document the ethno-botanical knowledge of important plant species found in Northern Pakistan. It includes Thandiani, Galiat, Kaghan, Swat, Buner, Dir, Chitral and Northern Areas of Pakistan. The area has many climatic and vegetation zones or biomes. Locals residing in mountainous areas belonging to various ethnic groups are traditionally utilizing plants over many generations; these ethnic groups have their distinct life style, belief, traditions and cultural heritage. METHODS: Plant collection and data regarding traditional uses in various areas of Northern Pakistan has been done periodically in different flowering /fruiting seasons. Locals of old age belonging to various ethnic groups were personally interviewed for establishing uses of plants. Photography is done for easy identification and habitat recognition. Collected plant specimens and seeds were preserved. Plant species were dried, mounted, identified and authenticated. RESULT: 135 genera belonging from 66 families of angiosperms and gymnosperms were studied and described.76 species were known to have traditional and ethno botanical uses. Plants have been utilized for many generations. Ethnic groups have distinct life style and have different economic uses for these plants. Due to unsustainable exploitation of natural habitats scarcity of drug plants has occurred. As consequence some species are depleting and may become extinct in near future, e.g. Morchella esculenta, Colchicum lueteum and Viola serpens are just a few of these. CONCLUSION: Although some sporadic information is available about the flora of this region but very little documented record of the ethno-botanically important plants has been established. It is expected that this research paper will be beneficial for students, researchers, farmers, foresters and general public. On the basis of data obtained it is concluded that ethno-botanical Flora of Northern Pakistan is quite rich and is diverse, due to the difference in altitude, climate and other topographic conditions.

Mechanism Of Nephroprotection By Picrorhiza Kurroa.

BACKGROUND: Humans are exposed either deliberately or unintentionally to a variety of diverse chemicals that harm the kidney. To reduce the alarming high incidence of nephrotoxicity, some chemical as well as herbal alternatives are needed. Nimesulide belongs to a group of antiinflammatory drugs that are in common use in our society. Like all non-steroidal antiinflammatory drugs, it carries a potential threat of nephrotoxicity especially when other risk factors are present in user. The objective of this study was to find herbal alternative with antiinflammatory and nephroprotective qualities and to bring into light its mechanism of nephroprotection. METHODS: This experimental study was conducted on mice at National Institute of Health, Islamabad from Feb 2013 to March 2014. Nimesulide was given in a dosage of 750 mg/kg body weight for 3 days to induce nephrotoxicity and protective effect of Picrorhiza kurroa was noted in two doses of 250 mg/kg and 500 mg/kg for 14 days. Renal function tests were done and urinary PGE2 was measured to assess the effect of nimesulide and Pk on kidneys. RESULTS: In our study, significant improvement was seen in serum urea and creatinine levels in mice receiving low and high dose Picrorhiza kurroa. However, no significant improvement was noted in urinary PGE2 showing that the mechanism of nephroprotection is not by vasodilatory effect of Pk. CONCLUSIONS: This study showed nimesulide nephrotoxic potential and Pk is a good herbal antiinflammatory and nephroprotective alternative for nimesulide but its mechanism of nephroprotection is not by PGE2.