Synthesis and antibacterial activity of the sulfonamide based schiff base and its transition metal [II] complexes

A Schiff base 3 has been synthesized by equimolar reaction [condensation] of sulfonamide i.e. sulfamethoxypyridazine 1 and substituted aromatic aldehyde i.e. 2-Hydroxy-1-Napthalene aldehyde 2. The synthesized Schiff base 3 and its Metal [II] complexes were characterized by its physical, analytical [CHN analysis] and spectral [UV and IR] analysis. The Staphylococcus aureus and Escherichia coli bacterial strains were used for antibacterial activity of Sulfamethoxypyridazine 1, its Schiff base 3 and its transition metal [II] complexes 4-8. All of them showed varied levels of activity

Social networking and depression among university students

Background: Students in the modern world are busy using social media for different purposes along with other activities. Research studies revealed that excessive use of social media influence the mental health of students. This study was design to measure the relationship of social media and depression among university students

Objectives: The main objectives of the study were, to investigate the perception of university students regarding the usage of social media networks, to find out gender-wise differences of university students in using social media networks and depression level and to measure the relationship of social media and depression among university students

Subjects and Methods: Following quantitative correlational research design, the sample which was consists of 200 Facebook and Twitter users comprising of 123 male and 77 female students from university of Swat and Peshawar were surveyed through two research instruments i.e. a questionnaire and Beck Depression Inventory (BDI]

Results: The main findings of the study were; most of the male social media users were more depressed than female. The students who spent more time on social media were found depressed. The students who spent more time on social media for searching health information and playing games were more depressed than those who used social media for chat with friends and family

Conclusion: It was concluded that male students who spent more time on social media were found more depressed than female and students who used social media for searching health information and playing games were more depressed than those who used social media for chat with friends and family

Prevalence of different types of temporomandibular disorders seen at armed forces institute of dentistry

The temporomandibular joint [TMJ] is a synovial joint that connects the mandible to the skull. Each joint is composed of condyle of the mandible, an articulating disc and an articular fossa of the temporal bone. Temporomandibular joint disorders [TMD's] are characterized by decreased mandibular range of movements, inadequate mouth opening and TMJ sounds such as click, pop, crepitations. TMD's can be classified as masticatory muscle disorders, Temporomandibular joint disorders, chronic mandibular hypomobility disorders and growth disorders. This cross sectional study was carried out in the Prosthodontics department at Armed Forces Institute of Dentistry, Rawalpindi. A total of 140 subjects were evaluated both clinically and radiographically to estimate the prevalence of symptoms of TMDs as a function of age and gender. The most common disorder in the age frame, less than 20 years was found to be disc dislocation with reduction, while disc displacement was the most common disorder in older age groups. Inferior head of lateral pterygoid muscle was most commonly found to be involved in 88.6% individuals, followed by Medial pterygoid muscle that was tender in 82.9% individuals

Conservation of indigenous knowledge of medicinal plants of Western Himalayan region Rawalakot, Azad Kashmir, Pakistan

The aim of present was to document indigenous knowledge of medicinal plants traditionally used by inhabitants of Rawalakot Azad Kashmir and to screen selected medicinal plants for their antibacterial potential. Several field surveys were conducted to document indigenous knowledge of medicinal plants through interviews from local inhabitants during 2010-2013. During the study, 58 plant species, belonging to 37 families, were identified and their medicinal uses were recorded. Ethnobotanical data indicates that inhabitants of Rawalakot use medicinal plant mainly for the treatment of stomach, liver and sexual disorders. Usually fresh plant materials were used for medicinal preparations and administrated orally. Among all the species studied, three most frequently used medicinal plants Achillea millefolium, Berberis lycium and Zanthoxylum armatum were screened for their antibacterial potential by using disc diffusion method. The crude aqueous, petroleum ether and ethanolic extracts were found to be very active against selected bacterial strains. The present study contributes significantly to the medicinal plant knowledge and shows that medicinal plant knowledge is deteriorating among younger generations. Therefore, further research is needed to document indigenous knowledge, to find conservation status of medicinal plant species and to find antimicrobial compounds for more sophisticated usage of medicinal plants in future

Neutrophil lymphocyte ratio: a prognostic marker in acute ST elevation myocardial infarction

Objective: To investigate if neutrophil lymphocyte ratio [NLR] predicts in-hospital adverse events and mortality, and shortterm [30-day] mortality in ST-elevated myocardial infarction [STEMI] patients thrombolysed with streptokinase [SK]

Study Design: An observational study

Place and Duration of Study: Rawalpindi Institute of Cardiology, from June 2014 till January 2015

Methodology: The STEMI patients, thrombolysed with SK had blood samples at admission, analysed for complete blood counts and NLR calculated. They were grouped into two, low and high NLR, taking 4.50 as cut-off. Chi square test was used to compare rate of adverse events and death in hospital stay. Mann-Whitney test was used to compare median NLR between patients died and discharged alive. Logistic regression analysis was used to estimate predictive ability of NLR for 30-day mortality

Results: A total of 145 [45.3%] patients had complications; 49 [15.3%] died in hospital, and 13 [4.06%] died in 30 days. Patients in high NLR group had higher rate of complications [63.5% vs. 25.5%, p <0.0001] and death [19.2% vs. 11.1%, p=0.046] in hospital than those in low NLR group. Cardiogenic shock [27.5% vs.11.1%, p <0.0001], heart failure [19.2% vs. 7.2%, p=0.002], arrhythmias [18% vs. 6.5%, p <0.0001], reinfarct/angina [9.6% vs.2% p=0.004] occurred more in high NLR group. Median NLR in patients died was higher than those discharged alive [7.46 vs. 4.70, p <0.0001]. Regression analysis showed NLR an independent predictor of mortality [OR 1.131 at 95% CI, p = 0.029]. Age, serum creatinine, Killip class were other predictors [p=0.002 and p=0.02, respectively]. ROC curve showed AUC 0.908 [p <0.0001]

Conclusion: A high NLR predicted increased in hospital complication rate, and in-hospital as well as 30-day mortality in STEMI patients thrombolysed with streptokinase

Peripartum cardiomyopathy in a Pakistani cohort

Objective: To describe the demographics, risk factors, and clinical presentation in Pakistani patients with peripartum cardiomyopathy

Study Design: A descriptive observational study

Place and Duration of Study: Rawalpindi Institute of Cardiology, Rawalpindi, from June 2014 to June 2015

Methodology: Seventy patients meeting criteria of peripartum cardiomyopathy were included in the study. A detailed history, physical examination and investigations were done. Epidemiologic data, risk factors, New York Heart Association [NYHA] class and echocardiographic findings were recorded. Statistical analyses were done using SPSS version 19

Results: The mean age was 28.66 +/-4.57 years. Mean parity and weight was 3.04 +/-1.7 and 60.97 +/-12.40 Kg, respectively. Fifty-five [78.6%] cases were diagnosed in the postpartum period. Thirty-three [50.8%] and 31 patients [44.7%] presented in NYHA - III and IV classes, respectively. Pregnancy-induced hypertension was seen in 16 [22.9%] cases, diabetes in 6 [8.6%], and twin pregnancy in 2 [2.9%] cases. The mean hemoglobin and brain natriuretic peptide [BNP] was 11.26 +/-1.61 gm/dl and 1583.70 +/-1237.65 pg/ml, respectively. Echocardiography showed mean ejection fraction of 21.74 +/-7.45%. Left ventricle systolic and diastolic diameters were 53.71 +/-9.74 mm and 63.37 +/-8.48 mm, respectively

Conclusion: Peripartum cardiomyopathy was seen in younger women with higher parity and pregnancy induced hypertension, often manifesting in the postpartum period with NHYA class III and IV status

Clinical safety and parameters of maximum oxygen uptake [VO[2] max] testing in Pakistani patients with heart failure

To determine the parameters of maximum oxygen uptake [VO[2] max] in a Pakistani systolic heart failure cohort and its safety in a clinical setting. Descriptive study. Armed Forces Institute of Cardiology, National Institute of Heart Diseases, Rawalpindi, from June 2011 to January 2013. Maximum oxygen uptake test was performed in patients with severe heart failure, who could perform the VO[2] max treadmill test. Age, Body Mass Index [BMI] ejection fraction, VO[2] max and respiratory exchange ratios and their correlations were determined. Out of 135 patients, 77% [n=104] were males, with a mean age of 45.9 +/- 15.7 years. Weight of patients ranged from 30 kg to 107 kg [mean 63.29 +/- 13.6 kg]; mean BMI was 23.16 +/- 4.56 kg/m2. All patients presented with either NYHA class of III [50.3%; n=68] or IV [49.7%; n=67]; mean ejection fraction was 22.54 +/- 5.7% [10 - 35%, IQ:20 - 25]. The VO[2] max of the patients ranged from 3 to 32 ml/kg/minute [mean 12.85 +/- 4.49 ml/kg/minute]. Respiratory exchange ratio was over 1 for all patients [1.12 - 1.96, mean = 1.36 +/- 0.187]. There was a negative correlation with age [r = 0.204; p = 0.028] whereas a positive correlation was found with exercise time [r = 0.684; p = 0.000], hemoglobin [r = 0.190; p = 0.047] and ejection fraction [r = 0.187; p = 0.044]. Cardiopulmonary exercise testing in a high-risk heart failure cohort is safe and provides information beyond the routine clinical evaluation of heart failure patients

Pattern of MRI brain in neuro-psychiatric SLE. effect of anti-phospholipid antibodies: a study at a tertiary care teaching hospital

To compare the neuro-radiologic findings in Systemic lupus erythematosus [SLE] patients with and without antiphospholipid antibodies [aPL] in different neuro-psychiatric manifestations. This cross-sectional comparative study was carried out at King Khalid University Hospital, a tertiary care teaching hospital, Riyadh, Saudi Arabia from June 2012 to January 2015. Ninety seven SLE patients with neuro-psychiatric manifestations were included in the study and divided into two groups. Group I [50 patients] SLE with aPL and group II [47 patients] SLE without aPL. We compared Demographic features, clinical manifestations and magnetic resonance imaging [MRI] brain findings. Demographic and clinical characteristics of two groups were similar. In Group-l, anticardiotipin antibodies [aCL] were most common [86%]. In patients with headache, most of the patients in Group-l had white matter hyperintensities [WMHIs] [50% vs 27%] while most of the patients in Group-ll had normal MRI brain [38% vs 73%]. Similarly WMHIs were found more in Group-l patients with seizures [60% vs 21%], while ischemia/infarction, atrophy and normal MRI were found in Group-ll. MRI brain in patients with neurological deficit and psychiatric disorder were not much different in both the groups. We found no statistically significant differences in frequencies of MRI brain abnormalities in SLE patients with and without aPL antibodies. Each of the three aPL may have a variable effect on the brain

Hemi-hamate arthroplasty for unstable dorsal proximal interphalangeal joint fracture dislocation of the fingers

To assess restoration of finger functions after hemi-hamate reconstruction. Experimental / Analytic study. This study was carried out at two different centres at Jinnah Hospital, Lahore and King Khalid Hospital, Najran KSA from between 2010 and 2013. We performed hemi-hamate autograft arthroplasty in 20 patients age 16-45 years. All were having comminuted metaphyseal fracture of volar surface of middle phalynx involving more than 50% [55%-90% average 70%] of articular surface with dorsally displaced unstable proximal interphalyngeal joint. Functional outcome was assessed by grip strength, proximal interphalyngeal joint, distal interphalyngeal joint range of motion and residual pain and patient's satisfaction. At the end of average 24.4 months follow-up mean active range of motion for proximal interphalyngeal joint was 62 °[40°- 90°], distal interphalyngeal joint was 54°[40°-65°] and flexion contracture was 150[00-35°]. Grip strength was achieved upto 95% [50%-95%] of opposite normal hand. Almost all patients were satisfied with functional outcome and appearance of the finger. We had not come across donor site morbidity, graft resorption, avascular necrosis, subluxation/dislocation, coronal/sagittal instability, infections except 4 patients, one scar tenderness, one ulnar digital nerve paresthesia and 2 with early osteoarthritic changes. Non-vascularized hemi-hamate autogarft is a good treatment option for comminuted proximal interphalyngeal fracture dislocation having more than 50% volar lip involvement, resulting in satisfactory functional outcome as compared to other surgical treatments. We recommend it in patients of active age group

Pattern of MRI brain abnormalities in rheumatic patients with neurological involvement: a tertiary care teaching hospital experience

To explore the pattern of abnormalities seen on MRI in rheumatic patients with neurological manifestations and to interpret the findings in relation to clinical picture. Descriptive study. Rheumatology unit, King Khalid University Hospital, Riyadh, Saudi Arabia from January 2013 to February 2014. We prospectively included rheumatic patients with neurological symptoms and signs. The clinical data were correlated with MRI findings by a team comprising of a rheumatologist, neurologist and neuro-radiologist. Data was analyzed using simple statistical analysis. Fifty patients were recruited with a mean age of 36.4 +/- 10.76 years [range 17-62]. Among SLE patients with seizures, focal deficit and headache white matter hyperintensities were found in 9 [64.28%], 4 [50%], 4 [80%] patients respectively. Out of seven SLE patients with global dysfunction, 3 [42.85%] had brain atrophy and 2 [28.57%] normal MRI. In Behcet's disease with focal deficit, 3 [75%] patients had white matter hyperintensities and 1 [25%] had brainstem involvement. In Behcet's disease with headache, 2 [50%] had normal MRI, 1 [25%] brainstem hyper-intensities and 1 [25%] had subacute infarct. Two [66%] of three Primary APS patients had white matter hyperintensities while third [33%] had old infarct. Both patients of polyarteritisnodosa, had white matter hyperintensities. Out of two Wegener's granulomatosis one had white matter hyperintensities and other had ischemic changes in optic nerves. The only one scleroderma patient had white matter hyperintensities. We found that white matter hyperintensities was the most common MRI abnormality in our study group which in most of the cases had poor clinical correlation. No distinct pattern of CNS involvement on MRI was observed in various rheumatic disorders

Frequency of celiac disease in children with iron deficiency anemia at the children hospital and the institute of child health Multan

Objective: To determinethefrequency of celiac disease in patients presenting with iron deficiency anemia"

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at Department of Pediatric Gastroenterology, Children's Hospital and the Institute of Child Health; Multan lasted from December 2014 to October 2015

Materials and Methods: Total one hundred patients were enrolled after fulfilling criteria. Non Probability consecutive sampling technique was used for sample collection. Patients were included in study fulfilling age one year to 14 years of both gender and diagnosed as iron deficiency anemia on serum ferittin level less than 15ng/ml. Results: One hundred patients with iron deficiency anemia were enrolled in this study. The mean age of patientswas 4.48 +/- 2.733. Fifty three[53%] male and forty seven [47%] were female. There was a significant difference between groups 1 and 2 in term of gender [p<0.05]. The frequency of celiac disease was 21% in children with iron deficiencyanemia

Conclusion: Screening of celiac disease should be done as a routine investigation in children with iron-deficiency anemia

Normative data of hepato-splenic sizes in pakistani pediatric population using ultrasonography

Background: Hepatosplenic sizes of children vary with age .There are many diseases which affect the sizes of the liver and spleen ranging from acute liver disease to other hepatosplenic disorders . Ultrasound is a quick and reliable method .Unfortunately there is lack of sufficient data in our population therefore my study would be beneficial in determining various disease processes

Objective: To establish normative data of Hepato-Splenic sizes in Pakistani pediatric population using ultrasonography

Methods: The study was conducted at the Ziauddin University Hospital, a tertiary care teaching facility in Karachi. The cross sectional prospective hospital based study was conducted with 150 patients aged 1 month to 14 years. Ultrasonographic evaluation for the assessment of liver, spleen and portal vein size was performed. These were correlated with the age, sex, height/length and weight of the children

Results: Normal liver and spleen length and its ranges with portal vein diameter were obtained. The liver, spleen length and portal vein significantly correlated highly with the height/length [r=0.7,0.7,0.6]respectively and weight of the subjects [r=0.7,0.7,0.4 respectively]

Conclusion: The study provides the normal values of liver and spleen size by ultrasonography in healthy Pakistani pediatric population

Description and follow-up of patients with coronary perforations during percutaneous coronary interventions at AFIC-NIHD

This study was conducted to determine the frequency and describe the lesion characteristics, clinical factors, device responsible and outcomes for coronary perforations at Armed Forces Institute of Cardiology - National Institute of Heart Diseases [AFIC -NIHD] on all patients undergoing percutaneous coronary interventions [PCI] from 2007 to May 2012. A total of 13,366 PCI procedures were performed during this period; coronary perforation occurred in 16 cases [0.001%]. All patients had elective PCI. Fifty percent [n = 8] patients had type C lesions. Grade III perforations were seen in 10 patients. Seven perforations were caused by angiography wires. None of the perforations was related to atherectomy devices. Six patients needed pericardiocentesis. There were 3 in-hospital deaths. One patient needed CABG. At followup, all patients who had been discharged were alive. The frequency of coronary perforations was very low. Old age and type C lesions were identified as a risk factor for coronary perforations. Grade III [or greater] perforation was a predictor of mortality. Patients who are discharged to home generally had better outcomes.

Doppler ultrasound for assessment of pulsatility index variation of middle cerebral artery in intrauterine growth retardation

To assess variation of pulsatility index of middle cerebral artery [MCA-PI] in intrauterine growth retardation [IUGR]. Descriptive study. Hospital Lahore, from March 2006 to September 2006. A total 100 patients with IUGR in third trimester were selected. Ultrasound estimation of fetal weight [using fetal biometry] below 10[th] percentile for that gestational age was labeled as IUGR. MCA-PI value of less than 0.751 was labeled as abnormal. Abnormal values of PI-MCA were found in 79% of IUGR cases while 21% had normal values. PI-MCA is a sensitive modality of assessing IUGR

Validation of the Seattle heart failure model [SHFM] in heart failure population

To determine the effectiveness of Seattle Heart Failure Model [SHFM] in a Pakistani systolic heart failure cohort in predicting mortality in this population. Cohort study. The Armed Forces Institute of Cardiology - National Institute of Heart Diseases, Rawalpindi, from March 2011 to March 2012. One hundred and eighteen patients with heart failure [HF] from the registry were followed for one year. Their 1-year mortality was calculated using the SHFM software on their enrollment into the registry. After 1-year predicted 1-year mortality was compared with the actual 1-year mortality of these patients. The mean age was 41.6 A +/- 14.9 years [16 - 78 years]. There were 73.7% males and 26.3% females. One hundred and fifteen patients were in NYHA class III or IV. Mean ejection fraction in these patients was 23 A +/- 9.3%. Mean brain natriuretic peptide levels were 1230 A +/- 1214 pg/mL. Sensitivity of the model was 89.3% with 71.1% specificity, 49% positive predictive value and 95.5% negative predictive value. The accuracy of the model was 75.4%. In ROC analysis, AUC for the SHFM was 0.802 [p < 0.001]. SHFM was found to be reliable in predicting one-year mortality among patients with heart failure in the Pakistani patients

Early psychosis symptoms

To determine the prodromal symptoms of schizophrenia in the pathways to help-seeking. A cross-sectional study. The Department of Psychiatry, the Aga Khan University, Karachi, from 2008 to 2009. A total of 93 patients were interviewed in the pathways to care of schizophrenia. The diagnosis was based on ICD-10 criteria. The pathways to care were assessed through a semi-structured questionnaire. The onset, course and symptoms of psychosis were assessed through Interview for Retrospective Assessment at Age at Onset of Psychosis [IROAS]. Fifty five [59%] participants were male while 41% [n=38%] were female. Using IROAS, 108 symptoms were identified as concerning behaviour. Alternatively, 60 [55%] concerning behaviours were reported in the open-ended inquiry of the reasons for help seeking as assessed by the pathways to care questionnaire with a statistically significant difference between most symptoms category. The difference was most pronounced [p < 0.001] for depressed mood [66%], worries [65%], tension [63%], withdrawal/mistrust [54%] and loss of self-confidence [53%]. Thought withdrawal [22%] and passivity [15%] were elicited only through structured interview [IROAS]. When symptoms were categorized together, about 83% of the subjects presented with affective and non-specific prodromal symptoms. Roughly, 10% of the subjects presented with positive symptoms and 3% presented with the negative symptoms of psychosis. The non-specific, affective symptoms appear to predominate the prodromal phase of the illness. Prodromal symptoms of schizophrenia include non-specific, affective symptoms. Attention needs to be paid on identifying the prodromal symptoms and change in social functioning in order to identify those who are at risk of longterm psychosis

Superior vena cava thrombosis with peripartum dilated cardiomyopathy

A 30 years multiparous female with history of emergency caesarean section 10 days back was referred to us with cough, severe breathlessness at rest, orthopnea with pain in neck and arms. Clinical examination revealed signs of heart failure. Echocardiography showed ejection fraction of 15%, with no right ventricular strain. A diagnosis of peripartum cardiomyopathy was made. Doppler ultrasound of neck veins showed bilateral internal jugular vein thrombosis. Subsequent multislice CT examination showed thrombosis of superior vena cava and both internal jugular veins [with collateral formation] and pulmonary embolism. There were no mediastinal abnormalities on the CT scan. Her thrombophilia screen and CT scan brain was normal. She was managed in collaboration with cardiologist. Following treatment with subcutaneous enoxaparin therapy and warfarin her symptoms of upper limb pain improved. She responded very well to medical therapy for heart failure with marked improvement of NYHA functional class

Trans-radial primary percutaneous coronary intervention in ST-elevation myocardial infarction

To study the effect of trans-radial approach [TRA] on achievement of a door-to-balloon time [DBT] of

Papuloerythroderma of Ofuji - a case report

Papuloerythroderma of Ofuji is an uncommon skin condition seen in elderly patients characterized by pruritic eruption of infiltrating papules with sparing of large folds of skin. Very few cases have been reported in the literature and the frequent association of this rare entity with laboratory abnormalities and malignancy points towards its heterogenous nature. We report a case of Papuloerythroderma of Ofuji having peripheral eosinophilia but not associated with any malignancy

Role of traditional birth-practices causing maternal and neonatal mortality in Faisalabad: an anthropological approach of household decision making

Anthropology is a holistic science that targets the study of man in its social, cultural, economic, psychological, political, geographical and ecological settings. Anthropology views major's interventions in areas of health to be planned with the complete cognizance of cultural factors that largely effect the target populations regarding their participation in all such major interventions. The Social Impact Assessment [SIA] referred by Anthropology basically demand scientific verifications of all such hurdles that may later on impede the acceleration of such heavy funded programs. The objective of the study was to investigate the decision-making regarding Safe Child Birthing Process among pregnant females and role of their in-laws. Cross Sectional Study This study was commissioned to the research team on behalf of Pakistan National Council on Ageing [PNCA] based in Islamabad. The data collection was done in the BHU of Chak # 474 GB, Tehsil Samundari, District Faisalabad. The study duration was three months and lasted from July 2012 to September 2012. Structured questionnaire was developed to collect information on child birth practices as well as opinion of females of respective sample area. In this regard, an extensive questionnaire was designed and pre-tested vigorously. Questionnaire contained bio-informatics including demographic information of clients and the second part covered areas of decision making, role, agents and other stakeholders. Questionnaires were filled with the help of LHVs and LHWs after getting the permission from their senior authorities. Results show that 29.2% of the respondents were illiterate, while 33.4% of the respondents pass their primary education. Ratio of birth attendant at last delivery was 58.1% for TBA/Dai and 17.2% respondents used the services of doctor for delivery proposes. Mother-in-law was the most influential decision maker in the family. As result explains that, for antenatal visit 118 time, for normal delivery 135 times and for EmONC 128 times decision taken by mother-in-law [n=267]. The decisions regarding child birth largely remain a female issue and rest with the mother-in-law mostly. The second dominant agents are husband and the father-in-law/brother-in-law. On statistical level, the result show strong association between clients and in-laws. The study verifies that the para-medical staff is also required to get training on the importance of cultural factors and means to convince the target population with threatening their cultural mind-set. A complete cognizance of such cultural variable may lead to promotion of safe child birthing as well as contributed in reducing the maternal mortality rates among the rural women