Synergy in penicillin, cephalosporin, amphenicols, and aminoglycoside against MDR S. aureus isolated from Camel milk

Abstract This study investigated the synergy testing of penicillin, cephalosporin, amphenicols, and aminoglycoside in the camel milk (n=768 samples), subsequently used for isolation of MDR S. aureus targeting mecA gene. Antibiotic susceptibility of S. aureus showed >90% isolates were sensitive to ciprofloxacin and trimethoprim and resistant against oxacillin, ampicillin, and cefoxitin. Further, 50-85% of the S. aureus were sensitive to gentamicin, oxytetracycline, and chloramphenicol and resistant against cefotaxime, vancomycin, and cefixime. Minimum inhibitory concentration (MIC) of cefotaxime, (C) and ampicillin (A) in combination with gentamicin (G) was reduced by 99.34% and 70.46%, respectively, while with chloramphenicol (Ch), reduction was 57.49% and 60%, respectively. In addition, the Fractional Inhibitory Concentration Index (FICI) of G+A, Ch+C and Ch+G combinations showed synergy against 80%, 60%, and 30% of MDR S. aureus, respectively. Similarly, C+A and Ch+G displayed indifferent interaction against 70 % and 30% of isolates, respectively, while the later showed additive interaction against 10% of MDR S. aureus. Altogether, our results described effective combination of gentamicin and chloramphenicol with ampicillin and cefotaxime to combat MDR S. aureus

Morin attenuates L-arginine induced acute pancreatitis in rats by downregulating myeloperoxidase and lipid peroxidation

Objective:To explore the therapeutic role of morin against L-arginine-induced acute pancreatitis in rats. Methods:The group 1 received two intraperitoneal injections of normal saline, and groups 2-4 were given two intraperitoneal injections of L-arginine (250 mg/100 g body weight) at 1 h interval to induce acute pancreatitis. Subsequently, group 2 received no further treatment while groups 3 and 4 were treated with morin (30 mg/kg) and diclofenac sodium (30 mg/kg), respectively. Blood glucose and serum levels of insulin, α-amylase, malondialdehyde, myeloperoxidase, alanine aminotransferase, aspartate aminotransferase and cholesterol were measured. Moreover, histopathological study was carried out to investigate the effect of morin treatment on physiology of the pancreas. Results:L-arginine significantly altered the level of blood glucose and serum levels of insulin, α-amylase, malondialdehyde, myeloperoxidase, alanine aminotransferase, aspartate aminotransferase and cholesterol. Treatment with morin or diclofenac sodium significantly improved the levels of these biomarkers. Furthermore, morin showed more significant effect than diclofenac sodium. Histopathological analysis verified that morin protected the pancreas from deleterious effects of L-arginine. Conclusions:Morin plays a protective role against L-arginine-induced acute pancreatitis via reducing lipid peroxidation and tissue inflammation, and attenuating acute pancreatitis-associated alteration in insulin secretion and glucose metabolism.

Evaluation of a maternal, neonatal and child health intervention package in a rural district of Pakistan: a quasi-experimental study

Background: Pakistan is among the countries which have the highest maternal, neonatal and child mortality rates. Immediate efforts are required to enable Pakistan to achieve the health related sustainable development goals. The continuum of care interventions can substantially reduce the mortality burden, however local evidence to implement them is lacking in Pakistan. We implemented the maternal, neonatal and child health intervention package comprised of health facility strengthening, capacity building, continuum of care interventions and community mobilization and evaluated its effectiveness on maternal, neonatal and child health care practices and neonatal mortality.Methods: The intervention package was delivered through existing public health system in a rural district of Pakistan. We used a quasi-experimental design to assess the impact of interventions. Baseline and end line surveys were conducted and neonatal mortality was considered as the primary outcome measure. Data were analysed using bivariate and difference and difference analysis techniques.Results: We found a reduced risk of neonatal mortality (RR 0.704; 95% CI 0.557-0.889; p=0.0033), in intervention areas compared to control area. For secondary outcomes; including mortality for infants and under five children, antenatal care, skilled birth attendance, institutional deliveries, postnatal care, delayed bathing, inappropriate cord care practices, birth asphyxia, exclusive breastfeeding and immunization a significant difference (p<0.001) was observed in the intervention area compared to control area.Conclusions: This study provides local evidence from Pakistan that effective methods for delivering MNCH interventions within the existing health infrastructure can improve the MNCH outcomes especially in the rural areas

Biochemical, Nutritional and End Use Perspectives of Wheat Grass as Potential Dietary Supplement

Wheat grass being substantial cereal grass crop in the world; copious source of nutrients with noteworthy nutritional and therapeutic value. The research, wheat grass was grown in indoor trays and then used as powder and in drink. The objective were to use the wheat grass to formulate a suitable processing procedure for wheat grass powder (WGP) enriched food products. Both raw WGP and cookies were analyzed for total dietary fiber (TDF), soluble dietary fiber (SDF), insoluble dietary fiber (IDF), total phenolic content (TPC) and antioxidant activity. Drink was analyzed for pH, viscosity and total soluble solids (TSS). WGP addition showed a significant effect on mixographic (peak height and peak time) and farinographic studies; water absorption, arrival time, dough development time (DDT) and mixing tolerance index (MTI). The cookies prepared using different levels were generally accepted by sensory panelists of the department but 3% substitution level of WGP have high acceptability. Moreover, on the basis of physicochemical and sensory attributes, 10% supplementation level of wheat grass in drink was best making it a nutrient enriched food source.

Role of intracellular adhesion icaAD and agr genes in biofilm formation in clinical S. aureus isolates and assessment of two phenotypic methods

Objective: To determine the role of icaAD and agr genes in biofilm formation and evaluate the consistency of two phenotypic methods for biofilm measurement

Methods: A total of 81 clinical S. aureus strains were included and analyzed for biofilm formation by two methods. The microtitration plate method was optimized using computational fluid dynamics and compared with the Congo red assay. The genes for icaAD and agr were detected using PCR

Results: Of 81 isolates, biofilm production was detected in 43% isolates using Congo red method while microtiter plate assay showed biofilm production in 92% isolates. Both methods showed correlation in 30% isolates. PCR detection showed icaAD gene in 42 [52%] isolates. Out of 81 S. aureus isolates 65 strains [80%] contained agr while 16 [20%] strains were non-typeable

Conclusions: In conclusion, biofilm production was observed for both agr positive and agr negative isolates. Furthermore, the presence of icaAD genes was not associated with all biofilm producing strains as some strains negative for icaAD genes displayed biofilm production

ex vivo up-take of levamisole molecules by cestode [Monezia expensa] of goat [Capra hirsa] and its detection through RP-HPLC

Detection of various molecules of drugs remained a prime issue especially in tissues of animals, humans and in their target parasites. The cestode/tapeworms pose a dilemma because of their weird body composition and uptake pattern of nutrients and medicines especially through absorption by tegument. We selected levamisole; thought to be potent antiparasitic/ ani-cestodal drug. The uptake of levamisole [LEV] through cestodeal tissues is studied through HPCL in this paper. High performance liquid chromatography technique has been utilized to know the uptake of levamisole in tissues of cestodes of Goat [Monezia expensa] in small ruminants. The drug was exposed to M. expensa by in vitro till its death or a parasite ceases its movement. The tissue/ part of proglattids of the M. expensa were homogenized with some modifications and levamisole extraction was performed with liquid phase extraction method. The evaporation of solvent was done and the residual cestodal tissues were cleaned by solid phase. After the solid phase extraction method, the recovery of drug, detection and quantification of levamisole from cestodal tissues was determined through Reverse Phase Column High Performance Liquid Chromatography [RP-HPLC]. Levamisole [LEV] molecules assay was obtained on a C18 reverse-phase [20um, 6mm x 150mm] column at flow rate of 1ml/min using acetonitrile and ammonium acetate as mobile phase and UV detection was done at 254nm. The development of method of Levamisole [LEV] detection from cestodal tissues by HPLC in vitro samples has been demonstrated first time in Pakistan, which can provide the solution of parasitic control and provide in sight in to the uptake of anti cestodal drugs either against human or livestock parasites

Analgesic, anti-inflammatory and antipyretic activity of Salvia moorcroftiana

[number sign]Salvia moorcroftiana is an herbaceous plant commonly known as "Kallijari" in Pakistan and belongs to the family Lamiaceae. This study was carried out to evaluate its scientific base for its traditional use in pain, fever and inflammation. The powdered plant was extracted by the method of cold maceration using aqueous methanol [70:30] as solvents. Hot plate, flick tail and acetic acid induced writhing test were utilized for analgesic assessment. Antiinflammatory activity was evaluated by carageenan-induced mice paw edema. Brewer's induced pyrexia was used for the evaluation of antipyretic activity. Non-significant [p<0.01] results as compared to the standard were obtained in all experiments. It was evident from acute toxicity study that plant was non-toxic in nature. It is concluded from the study that plant had the potential to be safely used for pain, fever and inflammation

Frequency of different level of amputations in type-2 diabetics

Objective: To determine the frequency of different levels of amputations in type-2 diabetics. Study Design: Cross sectional study. Place and Duration of study: Department of Surgery Combined Military Hospital, Peshawar, from 27 Aug 2012 to 27 Feb 2013

Material and Methods: Non probability consecutive sampling technique was used to enroll 158 type-2 diabetics undergoing amputations satisfying inclusion/exclusion criteria. Data regarding level of amputation, glycosylated Hb% and duration of diabetes mellitus [DM] was recorded followed by analysis using SPSS version 17

Results: Total 158 patients were enrolled, 102 [64.5%] male and 56 [35.44%] female, with male female ratio of 1.8:1. Mean age of presentation was 54.99 +/- 7.84 years in males and 55.14 +/- 8.99 years in females respectively, the difference being statistically insignificant [p=0.912]. Mean duration of DM was found 10.88 +/- 3.16 years in males and 10.03 +/- 2.50 years in females while mean level of glycosylated hemoglobin was 7.54 +/- 0.68 and 7.35 +/- 0.63 in males and females respectively, both values statistically insignificant. Below knee amputation [BKA] was done in 55 [34.8%] patients, above knee amputation [AKA] 34 [21.5%], Toe amputation [TA] 42 [26.6%] and foot amputation [FA] in 27[17.1%]

Conclusion: Majority of the patients underwent major amputations and most frequent level of amputation was below knee amputation

Electrical storm or naxos syndrome in an adult causing recurrent syncope

Among the rare and well-known causes of sudden cardiac death by malignant arrthymias is a condition called arrhythmogenic right ventricular cardiomyopathy. It commonly presents with right ventricular dilatation, dysfunction and ventricular tachycardia of left bundle branch morphology due to fibro-fatty infiltration of right ventricle in second to fifth decade of life, making it an unrecognized and important cause of sudden cardiac death. Two rare variants of arrhythmogenic right ventricular cardiomyopathy are Carvajal syndrome and Naxos syndrome. Both variants have systemic manifestations. Being a rare variant of arrhythmogenic right ventricular dysplasia, Naxos syndrome was initially described in the families of the Greek island of Naxos. It is a recessive disorder with cardio-cutaneous manifestations characterized by arrhythmogenic right ventricular cardiomyopathy, palmoplantar keratoderma and wooly hair. We report a rare case of Naxos syndrome in an adult patient presented with recurrent episodes of palpitation and syncope

Frequency of Plasmodium falciparum and vivax species causing malaria and their clinicopathological features in children presenting to a tertiary care hospital in Lahore

Objective: The objectives of this study were to determine the frequency of Plasmodium falciparum and vivax species causing malaria in children presenting to Jinnah Hospital Lahore and compare the clinico-pathological features of malarial cases caused by Falciparum and Vivax

Materials and Methods: This Cross sectional study was done in the department of Pediatrics Jinnah Hospital Lahore from November 2012 to April 2014 .200 children fulfilling the inclusion criteria were included in this study after approval from ethical committee and an informed consent their sample was sent for malaria parasite. Subjects with infection by Falciparum and Vivax was further examined and investigated for presence of hepatomegaly, splenomegaly, thrombocytopenia and leucopenia which was noted

Results: The mean age of patients was 5.99 +/- 3.27 years, and there were 88 [44%] male and 112 [66%] female patients in the study.It was found that majority of patients [136; 68%] were having Vivax species while 64 [32%] were having Falciparum species of malaria.The clinical findings showed among 64 patients with falciparum species, 24 [37.5%] had splenomegaly patients with vivax species, 88 [64.7%] had splenomegaly. There was a significant association between splenomegaly and species of malaria [p-value= 0.000]. Out of 64 patients with falciparum species, 16 [25%] and among 136 patients with vivax species, 72 [52.9%] had hepatomegaly. There was a significant association between hepatomegaly and species of malaria [p-value= 0.000]. Out of 64 patients with falciparum species, 8 [12.5%] had leucopenia and out of 136 patients with vivax species, 32 [23.5%] had leukopenia while 104 [76.5%] did not have leukopenia. There was no significant association between leukopenia and species of malaria as indicated by p-value = 0.069. Out of 64 patients with falciparum species, 56 [87.5%] had thrombocytopenia while in patients with vivax species, 112 [82.4%] had thrombocytopenia. There was no significant association between thrombocytopenia and species of malaria as indicated by p-value = 0.352.When we stratified our data and we found that for falciparum species the clinico-pathological findings were same in relation to gender and age groups, p-value > 0.05, while for vivax species the falciparum species were statistically different in both gender and age groups, p-value < 0.005

Conclusion: According to this study Vivax species was most prevalent causing malaria in children. Splenomegaly, hepatomegaly were statistically higher inVivax species as compare to Falciparum species but Leukopenia and Leukopenia were statistically same in both groups

Evaluation of nephrotoxicity by aspirin-clopidogrel combination therapy in patients with acute coronary syndrome

Although aspirin-clopidogrel combination is more useful for acute coronary syndrome [ACS], the renal safety of this combination had not been established. A total 60 patients with ACS were divided into three groups; receiving aspirin, clopidogrel and aspirin-clopidogrel combination. For determination of renal function, serum BUN, creatinine, uric acid, uric acid clearance and GFR were estimated for four months. The study showed that there were no significant [p>0.05] variations in the parameters when used the drugs in combination [aspirin-clopidogrel] compared with the drugs given alone

Clinical and laboratory parameters monitored in children extubated from ambu bag and endotracheal tube

Objective: to study the clinical and laboratory parameters of children extubated from ambu bag and endotracheal tube after being manually ventilated for at least more than 24 hours

Methods: various clinical and laboratory parameters were evaluated initially at the time of intubation and then at the time of extubating. The clinical parameters evaluated included the heart rate and respiratory rate, Glasgow coma scale, spontaneous respiratory effort, respiratory distress and pupillary reaction. The Laboratory parameters evaluated included TLC, CRP, and arterial blood pH, HCO3, PO2 and PCO2, CXR, flow rate of oxygen required to maintain oxygen saturation and the dose of cardiac support in the form of dopamine infusion

Results: total 24 patients were included in the study, 11[46%] male and 13[54%] female. Age range was from 0 to 36 months with mean of 6.5 months. The mean values of Laboratory parameters at the time of intubation included a pH of 7.13, HCO3 17, 02 sat 64, PCO2 52, and rate of oxygen flow 3.5 liters/min. The mean values of same parameters at the time of successful weaning were, pH 7.36, HCO318, 02 sat 94, PCO2 29, and rate of flow of oxygen 3.5 liters/min. Regarding clinical parameters the mean value for GCS at intubation was 5 which later improved to 13 at extubating. Similarly the pupillary reaction at intubation showed constriction of pupils in 6[25%] and mid-dilated with sluggish reaction in remaining 18[75%], while almost 95% cases had reactive pupils at extubating

Conclusion: ambu-bagging though crude but is a successful tool for respiratory support in the absence of ventilator. Clinical and lab parameters can predict the outcome in children who are solely intubated and ve11tilated by ambu bag

Clinical spectrum of dengue fever in pediatric age at a tertiary care hospital in Lahore

Objective: to assess frequency of various clinical presentations of dengue fever in pediatric age group at a tertiary care hospital in Lahore

Methods: a cross sectional survey was conducted from Dec 2012 to Sep 2013 in pediatrics department of Jinnah hospital Lahore. 150 patients were enrolled as per inclusion criteria. Clinical features were abstracted on a standardized Performa and investigations were done, including complete blood count, hematocrit, anti-dengue lgM [If fever more than 5 days], NS1 antigen [If fever less than 5 days] by Elisa and ultrasound scan of abdomen to document free fluid in abdominal or thoracic cavity. Data was analyzed using SPSS Version 17

Results: one hundred and fifty patients with mean age of 8.4 years [SD of+/- 2.8 years] were enrolled. 86 patients [57.3%] were males with male to female ratio of 1.3: 1. High grade fever was present in all the 150 patients [100%] and Diarrhea in 21[14 %] patients. Other clinical features included: petechial in 25 [16.3%], epistaxis in 20 [13.3%], hematemesis in 8 [5.3%], hepatomegaly in 33[22%] and splenomegaly in 15 [10%] subjects. The evidence of dengue hemorrhagic fever was seen in 23 patients [15 %], while there was no case of Dengue Shock Syndrome

Conclusion: most of dengue fever cases were from 5 to 10 years of age group. High grade fever was the most common clinical manifestation of dengue fever, followed by hepatomegaly, petechial, diarrhea, epistaxis, splenomegaly and hematemesis. Dengue fever was more common in males as compared to females, and about one in six cases had dengue hemorrhagic fever

Pulmonary tuberculosis; cardiac manifestations

To determine the cardiac manifestations in patients with pulmonary tuberculosis. Case series study. Jan 2014 to June 2014. Liaquat University Hospital Hyderabad. All the patients presented with shortness of breath, cough with sputum, fever, haemoptysis, anorexia and weight loss were recruited and then the subjects with early morning sputum positive for acid fast bacilli and radiological lesions suggestive of pulmonary tuberculosis, of ?20 years of age and either gender were enrolled and entered in the study. The data was analyzed in SPSS 16 and the frequency and percentage was calculated. Total one hundred patients with pulmonary tuberculosis were evaluated for cardiac manifestation during six months study period. The mean +/- SD for age of patients with pulmonary tuberculosis was 45.21 +/- 8.95. The mean age +/- SD of patient with cardiac manifestations was 48.95 +/- 5.53. The majority of the subjects were in 30-49 years age group with male predominance [p<0.01]. The electrocardiographic findings were observed in 72/100 [72%] patients whereas echocardiographic changes were observed in 50/72 [69.4%] patients with pulmonary tuberculosis. The common ECG findings identified were tachycardia 30.5%, P-pulmonale 12.5% and PR prolonged in 9.7% patients with tuberculosis whereas the common echocardiographic findings noticed were pericardial effusion 42% and multiple abnormalities in 24% subjects with tuberculosis. The sinus tachycardia, cor-pulmonale and low voltage QRS complexes were predominant abnormalities on electrocardiograph whereas pericardial effusion was the common abnormality on echocardiography in patients with pulmonary tuberculosis

Metabolic syndrome; serum ferritin level in patients

To determine the frequency of raised serum ferritin level in patients with metabolic syndrome. Case series study. Liaquat University Hospital Hyderabad. All the patients with metabolic syndrome for >/= 01 year duration, >/=20 years of age and of either sex were recruited and entered in the study. The metabolic syndrome was detected according to the NCEP-ATP III protocol. After confirmation of metabolic syndrome, the 2cc venous blood sample was taken in a sterilize 5cc disposable syringe, labeled it and sent to laboratory for evaluation of serum ferritin levels. The data was analyzed in SPSS 16 and the frequency and percentage was calculated. Total one hundred patients with metabolic syndrome were evaluated for serum ferritin level during the study period. The mean +/- SD for age of patients with metabolic syndrome was 52.73 +/- 7.83 while the mean age +/- SD of patient with raised ferritin level was 50.23 +/- 8.21. The majority patients were 30-49 age group with female predominance [p<0.01] and exist four component of metabolic syndrome. The ferritin was raised in 60 patients with female predominance [p<0.04]. The mean +/- SD of raised ferritin level in male and female population was 350.10 +/- 19.38 and 270.34 +/- 34.39 [p<0.01]. The raised serum ferritin level was identified [60%] with female predominance in patients of metabolic syndrome

Acute febrile illness; during the course of oral anticoagulation warrants immediate INR check

Oral anticoagulation is needed in many patients like after prosthetic valves insertion, in atrial fibrillation, clots in LA, clots in LV and DVT etc. It is mainly achieved by warfarin sodium which has many interactions with multiple other drugs and its action varies in different other chronic diseased states. to see the response of acute febrile illness on the chronic stable state of INR on a fixed dose of oral warfarin sodium. All the patients with acutely deranged INR who had a stable and controlled INR previously and a fixed dose of warfarin sodium were admitted in the cardiac surgical ward at FIC and their history was explored and recorded. A total of 966 patients were admitted in [CSW] during the period of April, 2012 to April, 2014 with deranged INR. INR was checked twice or sometimes thrice to rule out the laboratory error. 504 patients were female and 462 patients were male, 56 patients had repeated admission for their INR control, most of them were callous regarding taking dose of warfarin so they were excluded from the study. A total of 631 patients had low INR due to missed dose of warfarin sodium. Out of them 13 patients got stuck valve for which emergency redo prosthetic valve replacement was done. 06 patients died in emergency due to late presentation after the prosthetic valve got stuck. Only 279 patients had high INR on the previous dose of warfarin sodium, out of them 216 patients had out of range INR. They were treated by FFP transfusion and holding the Warfarin sodium dose for certain period of time.76% of the patients give H/o acute febrile states 101-103 with rigor and chills [Malaria, enteric fever, pharangitis, cellulitis, boils and UTI etc. etc.] since last 3-4 days for which they had got treatment from some local Gen. practitioners and gave the H/o bleeding gums, general body malaise, bruising, joint aches and pains. 24% of patients denied any acute febrile illness before their INR got out of range 2 patients died in emergency due to intra cerebral bleed after INR got uncontrolled. Any acute febrile illness even of short duration may cause sudden derangement of previously controlled INR on certain fixed dose of warfarin sodium which can create a life threatening situation like intra-cerebral bleed, haem-arthrosis, excessive menstrual blood loss leading to severe anemia. Other less dangerous situation are gum bleed, bruising, joint aches and pains and general malaise. So, it is always advisable and logical to get INR check when ever any acute febrile illness even of short duration is encountered to avoid grave situations

Comparative study of chromium toxicity with hypertension and end stage renal failure cases

Objective: To assess the association between hypertension and chronic renal failure with lethal effects of chromium on the beginning of the Chronic Kidney disease

Study Design: A prospective cross sectional study

Place and Duration of Study: Jinnah post graduate medical centre and Kidney centre Karachi during December 2012 to December 2013

Materials and Methods: The present study was conducted on a total of 150 patients [age > 40 years] divided into three groups. Patients in Group I included 50 patients with hypertension whereas Group II included 50 patients with hypertension associated with chronic renal failure [CRF] and Group III consisted of 50 healthy controls

Results: Results showed that levels of fasting blood sugar and HbA1c in both group I and group II weresignificantly higher as compared to controls. The levels of serum urea [132.0 +/- 28.2] and creatinine [7.8 +/- 1.38] in group II patients were significantly high as compared to group I and group III patients. The Creatinine clearance [55.1 +/- 9.61] in group II patients were significantly less as compared to group I and group III patients. Serum chromium levels were significantly high in group II patients[59.6 +/- 6.73]as compared togroup I andcontrols

Conclusion: Serum chromium level has significant correlation with glycemic index in both group I and group II patients compared to controls, while correlation with renal failure was significant only in group II patients

Valvular patients; post operative course, size of the left atrium can predict the cost effectiveness

Cost effectiveness in any surgical procedure is a major contributory factor in the continuation of medical services in developing countries. Limited data is available in assessing the factors related with the duration of ICU stay and treatment after valvular replacement surgeries. Our aim was to see the correlation of pre operative Left Atrial size of the patient and duration of post operative stay in ICU. Observational Study. March 2010 to April 2014. Faisalabad Institute of Cardialogoy, Faisalabad. A total of 550 consecutive patients with valvular lesions were included in the study. Their Left Atrial size was measured echocardiographically pre-operatively and their stay /course in the ICU was monitored. Three categories were identified in regard with the Left Atrial size and the ICU stay. If LA size is below 60 cm2, the post operative course and stay in ICU is normal and lasts for about 1-2 days. If LA size is between 60-65 mm2, the post operative course may be complicated and prolonged by the atrial fibrillation / flutter for which pharmacological cardio version may be needed and the stay in ICU is prolonged and may last for about 2-3 days. And if pre-operative LA size is more the 65 mm2 the patient may behave in entirely different way. His atrial fibrillation persists in spite of electro cardiovertion or pharmacological cardiovertion and his stay in ICU may last up to 4-5 days and thus the cost of treatment is raised. LA size can predict the post operative behavior of the patient in ICU and duration of stay and expected cost of the treatment. Smaller is the size of LA, shorter is the stay in ICU and thus lesser is the post operative cost and vice versa

Early postoperative valvular patient; modified devaga's repair for moderate to sever TR is a cost-effective maneuver

Rheumatic Heart Disease is affecting the tricuspid valve almost as equally as it affects the other valves of the heart and the fact is that the single valvular disease of the heart is rare in our population. Objectives: To determine the cost effectiveness of modified devagia repair in relief of post operative valvular patient. Period: 2009-2014. Setting: Faisalabad Institute of cardiology Faisalabad, Method: All the patients with mitral valve disease having concomitant tricuspid valve regurgitation operated upon. Average age of 14 years to 45 years without gender discrimination. Result: A total of 380 patients were studied having concomitant mitral and tricuspid disease. Out of which 276 patients had moderate to severe tricuspid regurgitation on per-operative digital assessment for which modified DeVaga's repair was essential and done. Only 104 patients had moderate tricuspid regurgitation on per-operative digital assessment which was the main population of address in our study. Out of these, 76 patients were decided for modified DeVaga's repair due to their moderate tricuspid regurgitation and 28 patients were left alone without modified DeVaga's repair due to their mild to moderate tricuspid regurgitation. Then their early post operative course was monitored in terms of ICU stay and their functional recovery after operation. Patients with modified DeVaga's repair for moderate tricuspid regurgitation showed 30-42 hours early weaning of inotropes and mobilization from ICU than the patients without modified DeVaga's repair for mild to moderate tricuspid regurgitation. It is thus evident that modified DeVaga's repair for moderate tricuspid regurgitation saved hours of ICU stay, cost of ICU treatment, man hours of doctors, nurses and paramedical staff showing good post surgical functional recovery as well. Conclusions: Modified DeVaga's repair for moderate tricuspid regurgitation has a cost effective impact in the treatment of valvular patients causing early and good functional recovery after valvular replacement procedures, saving man hours of Cardiac surgeons, Nurses, Paramedical staff, patients and thus their cost of treatment.

Pakistamide C, a new sphingolipid from Abutilon pakistanicum

The Abutilon genus from the Malvaceae family is of medicinal importance, and members of this genus are distributed in the tropical and subtropical regions of Asia and other parts of the world. Abutilon pakistanicum Jafri & Ali is mainly found in Pakistan. It has been used by different systems of traditional medicines to treat different diseases. Pakistamide C, a new sphingolipid, has been isolated from the ethyl acetate soluble fraction of the methanolic extract of A. pakistanicum. Different spectroscopic techniques such as NMR (1H, 13C, COSY, NOESY, HSQC, HMBC) and Mass spectrometry (EI-MS, and FAB-MS experiments) were used to elucidate the structure of pakistamide C.