LA ADAPTACIÓN DE LA HEMOGLOBINA Y LOS GLOBULOS BLANCOS EN CASOS SEVEROS DE SARS-COV-2 / THE ADAPTATION OF HEMOGLOBIN AND WHITE BLOOD CELLS IN SEVERE CASES OF SARS-COV-2

Dado que el SARS-CoV-2 causa alteraciones en los parámetros hematológicos, muchos estudios se han concentrado en esta área y los han correlacionado con la gravedad de la enfermedad. Se revisó en un estudio retrospectivo de casos graves de COVID-19, en el cual se contabilizaron y documentaron los datos de hemoglobina (Hb) y glóbulos blancos (WBC) de pacientes reclutados en el período de marzo a julio de 2021. Retrospectivamente, los datos extraídos fueron sobre el nivel de Hb y los recuentos de glóbulos blancos de los informes de laboratorio tanto al ingreso como cuando alta de los pacientes. Se calcularon las frecuencias de anemia o eritrocitopenia (Hb <12 g/dL) y leucocitosis (WBC >11×103/µL) en la población estudiada. De 3637 casos de SARS-COV-2, 250 pacientes con condiciones graves de COVID-19 según la definición de la OMS, ingresaron en la UCI o fallecieron, De 250, 80 (32%) ingresaron a UCI, y el resto 170 casos (68%) fallecieron. Mientras que la edad media de los pacientes fue de 55,46±17,49 años, los pacientes con la condición grave tuvieron significativamente mayor edad que aquellos con la condición leve-moderada (edad media de 50,68 frente a 68,59; P: <0,01). El número medio de glóbulos blancos (WBC) fue de 8,88±7,29 x109/L en todos los pacientes con SARS-COV-2, que es significativamente mayor en los casos graves en comparación con aquellos con enfermedad leve-moderada (10,56 frente a 8,95; P: <0,01). El nivel de Hb (<12 g/dL) fue más bajo en el COVID-19 grave que en otros grupos; sin embargo, no fue estadísticamente significativo. El aumento del número de glóbulos blancos y la disminución de la Hb durante la hospitalización de pacientes con SARS-COV-2, puede predecir un mal resultado. Llegamos a la conclusión de que no sólo el número medio de glóbulos blancos era significativamente mayor en los casos severos también la leucocitosis fue un hallazgo común; lo que indica que un mayor número de glóbulos blancos probablemente puede predecir un mal resultado. Asimismo, el nivel de La Hb fue mayor en el grupo leve-moderado; sin embargo, no fue estadísticamente significativo.

SARS-CoV-2 cause alterations in the hematological parameters and many studies have concentrated on this area and correlated these with severity of disease. A retrospective study of severe cases of COVID-19 were reviewed. The data of hemoglobin (Hb) and white blood cells (WBCs) were accounted and documented. Patients recruited at period from March to July, 2021. Retrospectively, data extracted on the Hb level and WBC counts from Lab reports both at admission and when patients discharge. The frequencies of anemia or erythrocytopenia (Hb <12 g/dL) and leukocytosis (WBC >11×103/µL) was calculated in the studied population. Of 3637 SARS-COV-2 cases, 250 patients with severe conditions of COVID-19 as de ne by WHO, which were either admitted to ICU or died. Of 250, 80(32%) were entered to ICU, and the rest 170 cases (68%) who died. While the mean age of the patients was 55.46±17.49 years, patients with the severe condition were signi cantly older than those with the mildmoderate condition (mean age of 50.68 vs. 68.59; P: <0.01). The mean number of white blood cells (WBC) was 8.88±7.29 x109/L in all SARS-COV-2 patients, which is signi cantly higher in the severe cases compared to those with the mild-moderate disease (10.56 vs. 8.95; P: <0.01). The Hb level (<12 g/ dL) was lower in the severe COVID-19 than other groups; however, it was not statistically signi cant. Increased number of WBCs and dropped Hb level during hospitalization of SARS-COV-2 patients may predict a poor outcome. We concluded that not only the mean number of WBCs was signi cantly higher in the severe cases also leukocytosis was a common nding; indicating that an increased number of WBCs may probably predict a poor outcome. Also, the level of Hb was higher in the mild-moderate group; however, it was not statistically signi cant.

Acute Physiology and Chronic Health Evaluation Apache II - An ICU Scoring Tool to Assess Critically Ill.

The Acute Physiology and Chronic Health Evaluation (APACHE II) is the severity score and mortality estimation tool developed for use in ICU’s around the world. It is calculated during the first twenty four hours of admission of the patient to an ICU. An integer score ranges from values 0 to 71. During the stay, the score is not recalculated; and by definition, is an admission score.METHODSThis is a cross sectional study done on 100 patients admitted in the medical ICU in Sri Ramachandra Institute of Higher Education and Research.RESULTSOur results showed an APACHE II score of 16.5 which was significant and values equal to and higher than that correlated with the severity of illness.CONCLUSIONSAPACHE II score is a good predictor of mortality in acute respiratory failure patients. It is a useful audit tool which helps the healthcare professionals to interpret and compare their care performance over time.

IL-12 Levels in Pregnancies with Preeclampsia and Periodontitis

Introduction: Periodontal pathology has become amomentous concern of public health due to its increasingprevalence in adults around the globe. Study was aimed tocompare serum IL-12 p-70 levels in preeclampted and nonpreeclamptic women and to observe serum IL-12 p-70 levelsin preeclamptic with and without chronic periodontitis.Material and methods: It was a Longitudinal Cohort Study.The sampled population belonged to Narowal District ofPunjab, Pakistan. Duration of the study was from June 2016to February 2018. All pregnant subjects’ aged in-between18-34 years were participated though convenience samplingand consented. Out of total 73 subjects, 33 were with healthyperiodontium (6 preeclamptic and 27 normotensives) and40 were with chronic periodontitis (6 preeclamptics and 34normotensives). Sampling was performed in two phases; Firstwhen all subjects were in 2nd trimester and second when allwere in postpartum period. Periodontal status was assessed byCPITN (Community Periodontal Index for Treatment Need)probing technique and for preeclampsia, monthly bloodpressure profile of each participant was taken by her doctor.Serum estimation of IL-12 p-70 was confirmed throughsandwich ELIZA technique. Microsoft Excel and Minitabwere used for data analysis.Results: Normotensives with healthy periodontium showed17.4% high serum IL-12 p70 (pg/ml) in antepartum thanpostpartum. Similarly preeclamptics with healthy periodontiumexhibited 13.4% high serum IL-12 p70 in antepartum thanpostpartum. While normotensives with periodontitis displayed10% high serum IL-12 p70 in postpartum than antepartum.Preeclamptics with periodontitis exhibited 17.4% high serumIL-12 p70 in postpartum than antepartum.Conclusion: Preeclampsia and chronic periodontitisboth decrease serum IL-12 p-70 levels in antepartum andpuerperium.

Genetic study in congenital heart defects

Background: Congenital heart diseases (CHD) are relatively common with a prevalence ranging from 3.7 to 17.5 per 1000 live births. Little is known about genetic link with respect to congenital heart disease. Iroquoise (Irx) homeobox genes have been widely studied and their expression in both developing and adult heart. Author tried to study the role of irx4 and irx5 genes in structural congenital heart disease, keeping the focus on study reported by Cheng Z et al.Methods: Author studied reported mutation site sequences in 25 various congenital heart disease patients and control healthy relatives of patients. It is a unique study and there has not been such a study reported in literature till date. Besides comparison with healthy related controls, author took cardiac tissue biopsy in patients while doing corrective cardiac surgery. However, blood samples were taken from controls due to ease of feasibility.Results: Although, there were no sequence variations in the studied exon regions, but author got a base pair sequence change at 6 bp intron region, which is near the exon splice site in irx4 gene. Besides two ASD patient’s male children (one child each) had ASD prompting us to believe some role of sex linkage. However later needs pedigree analysis and sex chromosome studies for further analysis.Conclusions: Gene sequence in the Kashmiri population is unique. There is possibility of role of irx genes in CHD. ASD might have sex linkage in some.

Lab diagnosed anemia among women in Alyamamah Hospital in Riyadh, Saudi Arabia

Background: anemia in pregnancy is a common problem. Easy diagnosis and treatment enhance focus on anemia cases

Aim and Objectives: to determine the common types and grades of anemia in a hospital lab in Riyadh and to compare types of anemia among age and pregnancy status

Method: cross-sectional study. Study area: a hematology-log in lab

Samples: convenience samples of 120 anemic ladies

Tool: questionnaires. Methods of data collection: CBC results

Results: This study-addressing anemia among women in a lab in Riyadh involves 120 ladies. When they were distributed as pregnant and non-pregnant women, 70% were pregnant. About 70% of the pregnant and 39% of non-pregnant had iron deficiency anemia, this difference statistically significance (P= 0.0013). Normocytic normochromic anemia was falling in 26% and 50% of the pregnant and non-pregnant ladies respectively; this difference was statistically significant (P= 0.0112). About 94.5% of iron deficiency anemias have low MCH. PCV was low in all cases of anemia

Conclusion: Anemia in women of child bearing age are more commonly observed in study. Most common type of anemia among cases was iron deficiency anemia. Iron deficiency anemia was the most common in pregnant, while normochromic normocytic anemia was the most common in non-pregnant. MCV and MCH were significant characteristics finding in iron deficiency anemia

pattern of utilization and outcome of complementary and alternative medicine among primary health care attendees in Tabuk, KSA

Background: Despite all the marvelous advancements in modern medicine, traditional medicine [TM] has always been practiced

Aim of the work: We aimed to assess Patterns of utilization and outcome of complementary and alternative medicine among primary health care attendees in Tabuk, KSA

Subjects and Methods: This cross-sectional study conducted among 345 patients attending the primary health care centers [PHC] in Tabuk, Saudi Arabia during the period from January 2015 to January 2016. Participants were selected from 29 centers by a stratified selection method. A structured questionnaire was used to collect socio-demographic data, going to a non-medical practitioner [TH] for advice about a health problem within the last year, the reason for that, type of TH provided prescription/advice, outcome, and personal satisfaction. The Statistical Package for Social Sciences [SPSS] was used for data analysis. The Chi-square and Fischer exact tests were used to examine the associations and differences between two categorical variables

Results: Participants [57.1% males], 62.9% had a history of visiting a Traditional Healer, Visiting a traditional healer was commoner among females [72.3% versus 55.8%, p=0.002] No significant statistical differences were found regarding other characteristics. Ineffective medical management was the reason in 55.3%, while the firm belief in TH that it was the reason behind 36.9%. Medical treatment was the most frequent [50.7%] followed by Zikr [25.8%], 87.6% said the visits were affordable, and 70% of visitors improved

Conclusion: Traditional medicine practice was prevalent in Tabuk, Saudi Arabia and was most prevalent among females. No significant differences were found between traditional medicine visitors and their counterparts regarding other characteristics

Severe tracheomalacia secondary to double aortic arch. Any role in posterior aortopexy? A case report

Tracheomalacia is the abnormal collapse of the tracheal lumen and is common after cardiac compression. In the severe types, tracheomalacia can lead to significant morbidity, especially if encountered in a critical area, such as the distal part of the trachea, immediately above the tracheal bifurcation. We report a case that did not improve after cardiac surgery with persistent airway narrowing of more than 90%, requiring ventilatory support for a year. The case was difficult to manage, but the patient eventually showed a significant improvement after a posterior aortopexy that helped a lot in weaning him off the ventilator with a residual persistent audible wheeze and recurrent chest exacerbation. The diagnostic and therapeutic options for the case will be discussed

Knowledge, attitude and practice towards hepatitis B virus among medical students in Tabuk City, Saudi Arabia

Background: Medical students are at high risk of hepatitis B during their training, and are expected to be future doctors to acquire proper knowledge and attitude about the virus

The aim of the work: The present study aimed at assessing knowledge, attitude, and practice regarding hepatitis B virus among Saudi medical students

Materials and Methods: This cross-sectional study conducted among 147 clinical phase medical students during the period from may 2017 to April 2017. A self-administered questionnaire [five components and 46 choice questions with yes/no or yes/no/don't know] was used to assess knowledge [16 queries], attitude [18 items], symptoms and signs [6 questions], prevention [4 questions], and treatment [two issues]. The Statistical Package for Social Sciences [IBM, SPSS, version 20, New York] was used for data analysis. The data were presented as percentages and mean+/- SD unless otherwise specified. A P-value of <0.05 was considered significant

Results: Out of 147 medical students [51% males], their age was 22.90+/-1.2 years, the student's overall knowledge was 70.54+/-26.51%, the knowledge regarding symptoms and complications was 83.9+/-9.11%, while the prevention, treatment, and attitude scores were 67.17+/-20.96%, 51.7+/-32.66%, and 53.52+/-26.11% respectively

Conclusion: The students in Tabuk had a negative attitude towards hepatitis B virus in spite of the fair knowledge, their knowledge regarding the virus prevention and treatment were suboptimal

Comparison of effectiveness of mineral trioxide aggregate and calcium hydroxide in apexification procedure

An incompletely formed apex [open apex] is one of the most common features seen in immature permanent teeth after dental trauma. Endodontic treatment of open apex teeth presents with problems of overfilling and poor apical seal, thus it is imperative to create an artificial apical barrier or to induce apical closure with calcified tissue. Different materials have been tried for Apexification procedure, the most common are calcium hydroxide and mineral trioxide aggregate [MTA]. The objective of this article was to compare the effectiveness of Mineral Trioxide Aggregate and Calcium hydroxide in creating apical closure.This is a comparative study of 80 patients with Open Apex teeth. They were randomly allotted into two groups [Group A and Group B]. In Group A[ 40 patients], calcium hydroxide was used as an apexification material, While in Group B [ 40 patients] apical plugs were produced with mineral trioxide aggregates [MTA] followed by obturation. In Group A,30 patients showed complete absence of lesion while in Group B, 37 patients showed complete healing. Ten patients showed no healing in Group A, because of improper packing of mate-rial into the canal, while only three patients showed no healing in Group B because of poor delivery of MTA to the apex. The results showed that 75% teeth had complete healing in Group A and 92.5 % had complete healing in Group B. The results of the study concluded that MTA is significantly better than Ca [OH]2 in Apexification of non- vital immature permanent teeth

Urinary incontinence in healthy Saudi women

Background: urinary incontinence is a distressing common medical disease in which patient cannot control leakage of urine. The prevalence of urinary incontinence differs between countries and between different studies. The risk factors for urinary incontinence including increasing age, chronic cough, medical co-morbidity, childbirth, obesity, depression, smoking, gender and previous hysterectomy

Aim of the work: this study aimed to assess the prevalence of urinary incontinence in Saudi females and its associated risk factors

Methods: this was a cross-section study based on a survey on the internet, it included 400 female participants with a minimum age of 30 years old

Results: the prevalence of urinary incontinence was 44.25%, 66.3% of them were in age of 50 years and above. 43.5% of participants were obese, 19.5% were post-menopausal, 6.25% performed hysterectomy, 37.5 % had parity more than 3 times, 33% had depression and 35.5% had diabetes

Conclusion: prevalence of urinary incontinence was moderate. The most common risk factors for urinary incontinence were older age, menopause and high parity

Thyroid functions in pregnant women with gestational hypertension

Background: In normal pregnancy, changes in thyroid function are well acknowledged; however, information about thyroid function in gestational hypertension [GH] is scanty. Hypertensive disorders complicating pregnancy are common and contribute greatly to prenatal and maternal morbidity and mortality in the developing countries. The aim of this study was to investigate thyroid functions in pregnant women with gestational hypertension

Methods: This was a case-control study evaluated maternal thyroid hormonal status in 78 [62 hypertensive and 16 normotensive] women with pregnancy of >20 weeks to term, referred to Jinnah Hospital, Lahore. Thyrotropin [TSH], Total thyroxine [tT4] and Total triiodothyronine [tT3] were assayed with ELISA

Results: Serum TSH and tT3 were significantly higher in hypertensive pregnant [HP] compared to normotensive pregnant women [p=0.002, p=0.039 respectively]. Mean serum TSH was 3.28+/-0.29 microIU/ml in normotensive pregnant subjects and 6.71+/-1.06 microIU/ml in HP subjects, whereas mean serum tT3 in normotensive subjects was 1.22+/-0.03 etag/ml and 1.31+/-0.21 etag/ml in the HP subjects. There were no significant differences in serum tT4 levels of the subjects

Conclusion: Mean serum TSH and tT3 levels were significantly increased without concomitant changes in tT4 in HP compared to normal pregnant women. Raised TSH and tT3 levels might be associated with a risk for occurrence of gestational hypertension

Push-Out Bond Strength of Calcium Silicate-Based Materials

We appreciate the interest of Sora Yasri and Viroj Wiwanitkit in our publication: "Push-Out Bond Strength and Surface Micro-hardness of Calcium Silicate-Based Biomaterials: An in vitro Study" [1]. Below is our response to the comments.

All materials were mixed according to the manufacturers' instructions. Specimens were placed on the vibrator for 30 s after placing the test material to prevent air entrapment and allowing uniform filling of the cavity. The test was performed using the same stainless steel pin and universal testing machine. The apparatus was regularly tested and calibrated.

In addition to the differences in the composition of tested materials, the variations in the dentin structure from the coronal to the apical area could have influenced the bond strength values [2] because the adhesiveness of a material is directly dependent upon its interaction with the dentin surface [3]. In our study, every effort was made to minimize this effect. Coronal and apical dentin sections were evaluated separately. All dentin sections were cut and cavities were first enlarged to a standardized size, then they were randomly divided into different groups. This ensured the equal chance of each dentin section to be in a particular test material group.

The tested materials are mostly used as root repair materials/ retrograde filling or intraorifice barrier except for Biodentine that is used as dentin replacement material. Therefore, they are not directly exposed to the oral cavity and the influence of the biochemical condition of each individual oral cavity will have little or no effect.

Comparison of the efficacy of topical cyclosporine with fluromethalone in treatment of dry eye disease

Objective: To compare the efficacy of 0.05% cyclosporine eye drops with 0.1% fluromethalone eye drops on keratoconjunctivitis sicca [dry eye disease]

Study Design: Randomized controlled trial

Place and Duration of Study: Ophthalmology department of HIT Hospital Taxila, from Oct 2014 to May 2015

Material and Methods: The patients with keratoconjunctivitis sicca [KCS] were selected from outpatient and divided in two treatment groups. The dry eye disease was defined according to criteria set by International task force for dry eye disease [ITF]. The group I was treated with 0.05% cyclosporine drops while group-II was treated with 0.1% fluromethalone eye drops three times a day after informed written consent. The patients were followed up after three months and six months

Results: At the start of treatment 94 patients were placed in two treatment groups [n=47 in each group] and all the patients with KCS were graded according to severity following rules set by ITF. There were 46 patients in grade III [severe] KCS and 20 patients in grade IV [very severe] KCS. At the end of study only 24 were in grade II [moderate] KCS and 2 in grade III KCS. Of these only 5 patients in grade II and none in grade III were in treatment group I [cyclosporine]. The remaining 19 patients in grade II and 5 patients in grade III KCS belonged to group II [fluromethalone]

Conclusion: Cyclosporine eye drops are better than fluromethalone in treatment of keratoconjunctivitis sicca

Prevalence and epidemiological characteristics of patients with gastric cancer at Prince Rashid Hospital in north of Jordan

Objectives: The aim of the study is to determine the prevalence and epidemiological characteristics of gastric cancer in adult patients [>16 years] who underwent Upper Gastrointestinal Endoscopy at Prince Rashid Hospital in the north of Jordan

Methods: Analytical study on patients who underwent upper gastrointestinal endoscopy examinations at Prince Rashid Hospital between January 2011 and October 2015. Age, gender, symptoms, types and site of tumor were recorded for patients discovered to have gastric cancer

Results: Of 4115 patients who underwent upper endoscopy during the study period for different indications, only 115 patients[3%] were found to have macroscopic features of gastric cancer, and [90%] of them [104 patients] had the histopathological confirmation of gastric cancer; 70 males[67%] and 34 females [33%]; mean age was 48 [range 16-81] years. Fatigue, and bloating after meals were the most common symptoms of gastric cancer. The most common site of gastric cancer was in the distal stomach. Intestinal type and poorly differentiated carcinoma were the most common

Conclusion: The prevalence of gastric cancer in our patients who underwent upper gastrointestinal endoscopy at Prince Rashid Hospital was 3%. Studies are needed to determine the prevalence in the general population and to investigate the possible risk factors, so that a proper plan of action and treatment are put in place

Push-out bond strength and surface microhardness of calcium silicate-based biomaterials: an in vitro study

Objective: This was an in vitro evaluation of push-out bond strength and surface microhardness of calcium silicate-based biomaterials in coronal and apical root dentin

Materials and Methods: Ninety sections [2 mm thick] of coronal and apical root dentin were obtained from roots of 60 extracted teeth; the canals were enlarged to a standardized cavity diameter of 1.3 mm. Sections were randomly divided into 6 groups [n = 15 per group], and cavities were filled with Biodentine[™], BioAggregate, or ProRoot mineral trioxide aggregate [MTA], according to the manufacturers' instructions. Push-out bond strength values were measured using a universal testing machine under a compressive load at a speed of 1 mm/min. Samples were analyzed under a light microscope to determine the nature of bond failure. Ten samples [2 mm thick] were prepared for all the materials, and Vickers microhardness was determined using a digital hardness tester. Data were analyzed using one-way analysis of variance and Tukey-Kramer multiple comparison tests at a significance level of p < 0.05

Results: Biodentine [42.02; 39.35 MPa] and ProRoot MTA [21.86; 34.13 MPa] showed significantly higher bond strengths than BioAggregate [6.63; 10.09 MPa] in coronal and apical root dentin, respectively [p < 0.05]. Biodentine also differed significantly from ProRoot MTA in coronal dentin. Bond failure was predominantly adhesive in Biodentine and ProRoot MTA, while BioAggregate showed predominantly mixed failure. ProRoot MTA [158.52 HV] showed significantly higher microhardness and BioAggregate [68.79 HV] showed the lowest hardness

Conclusion: Biodentine and ProRoot MTA showed higher bond strength and microhardness compared to BioAggregate

Hepatitis-C virus infection among injecting drug users in Lahore, Pakistan: a cross sectional study

Objectives: To determine the prevalence and risk factors of hepatitis C virus among injecting drugs users, furthermore different genotypes of HCV infection and their effect on viral load were also found and subsequently most prevalent subtype was predicted

Methods: All samples were processed for Anti-HCV antibody detection through ELISA by using third generation ELISA Kit. The Anti-HCV positive serum samples were stored for RT-PCR to estimate the viral load and genotypes of HCV for study. Injecting drug users selected from in and around Lahore Metropolitan from July 2012 to August 2013 was included. The data analysis was completed by using SPSS version 16. A p-value of < 0.05 was considered to be significant

Results: A total of 241 Injecting drug users were enrolled and screened for Anti HCV in the study. Prevalence of HCV infection in IDUs from Lahore was found to be 36.09%. Education [p=0.000], low socioeconomic status [p=0.011], Blood transfusion [0.003], any tattoo on the body [p=0.002], use of injectable drugs with reused syringes [p=0.000] and sharing of syringes [p=0.001] in groups was significantly associated with HCV infection. Some utensils were also significantly associated with HCV status. The most common subtype of HCV genotype was 3a [n=65] followed by 2a [n=15] and 1a [n=6]

Conclusion: The study reveals that IDUs with reused syringes status and sharing of syringes in group had more chances to get HCV infection. The viral load in IDUs infected with different subtypes of genotype was significantly associated

Antioxidant and antiacetylcholine esterase potential of aerial parts of Conocarpus erectus, Ficus variegata and Ficus maclellandii

The current study was designed to check the antioxidant and enzyme inhibition potential of various extracts/fractions of three selected plants. The aerial parts of Conocarpus erectus [Combretaceae], Ficus variegata [Moraceae] and Ficus maclellandii [Moraceae] were extracted with ethanol [95%] and the resulting crude extracts were partitioned with n-hexane, chloroform and n-butanol successively. Folin-Ciocalteu reagent was used to calculate the total phenolic contents, flavonoids contents were calculated with aluminum chloride while antioxidant and enzyme studies were carried out through standard protocols. All extracts/fractions contained reasonable amount of phenolic compounds ranging from 0.58-58.23mg CE/g of DW and 0.43-30.56mg GAE/g of DW. Total flavonoids were determined using rutin and quercetin standards, ranging from 2.65-18.2 mg rutin equivalent/g of dry weight and 0.92-5.41mg quercetin equivalent/g of dry weight. Antioxidant studies such as DPPH inhibition FRAP and total antioxidant capacity [TAC] was checked. The crude ethanolic extract of C. erectus showed maximum antiradical scavenging power [90.43%; IC[50]=7 micro g] and ferric reducing antioxidant power [16.5micro M eq.FeSO[4].7H[2]O], respectively while leave extract of F. variegata [chloroform] was the most active [0.6577] in TAC among other extracts of the selected medicinal plants. Butanolic leave extract of C. erectus exhibited maximum enzyme inhibition activity [91.62% with IC50 40micro g/ml] while other extracts showed significant activity. It was observed from results that all extracts/fractions of under consideration plants, exhibited significant bioactivities especially ethanolic and butanolic fractions, which may be the richest source of such type of activities

Delay and misdiagnosis in adult myasthenia gravis: A case report

Myasthenia gravis (MG) is a rare autoimmune disorder characterised by fluctuating and variable combination of muscle weakness and fatigue. Most cases are due to T-cell mediated autoantibodies against post-synaptic acetylcholine receptors (AChR-Ab), thus preventing acetylcholine from binding and signalling skeletal muscle to contract. 1 The annual incidence is 7-23 new cases per million. 1 It can occur at any age but with two peaks; an early- onset (20-40 years) female-predominant and a late-onset (60-80 years) male-predominant peak. MG is classified into ocular and generalised (80%). More than half the patients initially present with ptosis and diplopia but half will progress to generalised disease with involvement of bulbar, limb and respiratory weakness. Those presenting as generalised MG can also develop eye signs later. 1 It is important to recognise MG early because it is highly treatable. Untreated disease leads to permanent weakness. 2 Treatment reduces mortality from life- threatening myasthenic crisis. 1,3 Misdiagnosis leads to potentially harmful interventions and inappropriate management. 4,5 Diagnosis in late-onset MG is easily missed 2,3,4,5 because of overlapping symptoms with other diseases common in the elderly. We report a case of delay and misdiagnosis in an elderly patient with co-morbidities.

Knowledge, Attitude and Practices Concerning Cosmetic Surgery among Female Medical Students at the University Hospital, King Saud University, Riyadh, Saudi Arabia.

Background: This study investigates the knowledge, attitudes and practices of cosmetic surgery among female medical students at King Saud University (KSU). Methods: A quantitative observational cross-sectional approach was used to carry out the study at the KSU College of Medicine. A web-based questionnaire was first developed to collect the data necessary to fulfill the objectives of the research. The population under study included a random sample in which the questionnaire was sent to all female medical students at KSU. The sample size was estimated by using a single proportion formula with an acceptable margin of error at 5%. The sample size obtained was 384. Results: A response rate of 99% was achieved. The mean age of the participants was 20.9±1.48.Out of 381 KSU female medical students in our study, almost all participants (360, 94.5%) have heard about cosmetic surgery. Television was the source of knowledge for more than one third (38%) of participants who had already heard about cosmetic surgery. Just over half (51.4%) of surveyed KSU female medical students recognized the best definition of cosmetic surgery as “a surgery that modifies or improves the appearance of a physical feature electively”. A great majority of participants (86%) reported knowing of a particular type of cosmetic surgery, namely breast augmentation. Almost all participants (92.4%) agreed that “women perform more cosmetic surgery than men”. Only 9% of participants reported undergoing cosmetic surgery, where most of them (19 out of 35) went through laser treatment for the skin and almost the same number had a cosmetic surgery for personal satisfaction. Conclusion: From this research, we recommend further studies to go beyond educational institutions to the public at large, and to study different sub-populations.

Patient's influx at outpatient medical laboratory [OPML]; Forecasting of patient's influx at Mayo hospital, Lahore using arima model

Uni-variate time series data analysis has been reported in medical literature for prediction the patients volume, emergency overcrowding, stay length in hospital on surgical procedure and bed occupancy in hospital wards, patients influx or patients arrival, moreover to estimate the cost of hospital stay or any medical or surgical procedure. The present study was designed to fit an appropriate uni-variate ARIMA model [Box-Jenkin methodology] to forecast the patient's incoming at OPML, Mayo Hospital, Lahore. Mayo Hospital Lahore, September 2009 to December 2013 were used for fitting the best model. Time series data of male, female and peads patients coming/reporting in OPML, OPD. The appropriate model for male and female data was found as ARIMA [1, 0, 1] and for peads as ARIMA [1, 1, 1] after residuals diagnostic checks. The estimated number of male patients for Month of January2014 is 632 whereas the actual incoming of male patients in the month of January, 2014 was 649, which shows that the estimated model has ability to forecast the number of incoming patients accurately. It is now concluded that the fitted ARIMA model can be used to forecast the patients incoming to OPD Medical Laboratory for future planning and management