Evaluation of quality of urban life with emphasis on health; A case study in Mashhad city

Background: The quality of life of the citizens is one of the most important issues studied in different countries and used in the planning and monitoring of public policies. The present study measured and evaluated the indicators of quality of urban life among citizens of Mashhad city

Methods: This analytical study was conducted on 375 citizens of various regions in Mashhad city. The random sampling method using population distribution and short-form questionnaires for data collection were applied. The validity of the questionnaires was verified by experts and the points given each question based on a 5-point Likert scale, and the Cronbach acoefficient was used to measure the reliability of the questionnaire; the questionnaire rated 0.853%. To analyze the variables under study, SPSS and other statistical methods such as average answers and t test for independent variables were used

Results: Findings of this research showed that the average health-sanitation dimension and environmental quality dimension are lower than 50% in Mashhad city. Sanitation and health, with a standard deviation of 5.838, are situated below the median level. The most common weakness is related to the dietary intake of protein. Environmental quality with a standard deviation of 5.857 is lower than the median level which is related to garbage separation and landfill sites. This result indicates that the quality of health and the environment in Mashhad is undesirable

Conclusion: Citizens' satisfaction with quality of life index is lower than average in Mashhad city. Plans for improving the quality of life and developing services are highly necessary for increasing the quality of life

Effect of herb-drug interactions of Bacopa monnieri Linn. (Brahmi) formulation on the pharmacokinetics of amitriptyline in rats

ABSTRACT Interactions between herbs and drugs may increase or decrease the pharmacological or toxicological effects of either component. Experimental data on the pharmacokinetic interactions between herbal products and drugs are limited. This study attempted to investigate the effect of Bacopa monnieri Linn. (Brahmi) formulation on the pharmacokinetics of amitriptyline in rats. In this study, rats were randomly divided into two groups (n = 6 each) which were served as a control (amitriptyline alone) and treatment group (amitriptyline with B. monnieri), respectively. Rats in the treatment group received B. monnieri (31 mg/kg/day) whereas the control group received normal saline by oral gavage for seven days before a single intragastric administration of 25 mg/kg amitriptyline. Plasma concentrations of amitriptyline were measured up to 24 h after its administration by a developed and validated high-performance liquid chromatography method. Pretreatment with B. monnieri produced a significant increase in the maximum plasma concentration (Cmax), area under the curve (AUC0-t) and elimination half-life (t1/2) of amitriptyline by 16.8%, 26.5%, and 15.5%, respectively, compared to amitriptyline alone. Moreover, oral clearance and volume of distribution (Vss) were decreased by 26.2% and 15.5% respectively. This study concluded that B.monnieri significantly enhanced the oral bioavailability of amitriptyline in rats.

Frequency of psychotropic drugs use by patients with schizophrenia in eight years follow-up

Objective: To measure the frequency of various psychotropic drugs used by patients with schizophrenia in 8 years follow up

Methodology: It was a descriptive observational study. This study was conducted at Department of Psychiatry Lady Reading Hospital Peshawar from 2004 to 2012. A sample of 52 patients diagnosed as schizophrenics was included through consecutive sampling. These patients were part of a project known as Severe Mental Illness [SMI]. They were regularly assessed once in a month and were provided antipsychotic, antidepressants and mood stabilizers

Results: The study included 52 [n = 52] patients. Males were 33 [62%] and females were 19 [37%]. Age of patients ranged from 15-60 with the mean age of 28.82 +/- 10.67. Mean age of males was 31.08 +/- 9.66 and of females was 25.84 +/- 11.43. Number of visits missed during the study was 2%. Fifty two% of patients were stable on 4mg of risperidone per day. Fifty percent of the patients were stable on 5 to 10mg of olanzapine per day. Depot preparation was required by 38% and less than 50% of the patients required carbamazepine as mood stabilizers from 200 to 400mg per day. Twenty three percent of the patients required 20gm of fluoxetine per day

Conclusion: During 8 years follow up the most frequent anti psychotic drugs used by patient to remain stable were risperidone 4mg per day followed by olanzapine 5 to 10 mg per day

Host genome polymorphisms and tuberculosis infection: What we have to say?

Several epidemiology studies suggest that host genetic factors play important roles in susceptibility, protection and progression of tuberculosis infection. Here we have reviewed the implications of some genetic polymorphisms in pathways related to tuberculosis susceptibility, severity and development. Large case-control studies examining single-nucleotide polymorphisms [SNPs] in genes have been performed in tuberculosis patients in some countries. Polymorphisms in natural resistance-associated macrophage protein 1 [NRAMP1], toll-like receptor 2 [TLR2], interleukin-6 [IL-6], tumor necrosis factor alpha [TNF-alpha], interleukin-1 receptor antagonist [IL-1RA], IL-10, vitamin D receptor [VDR], dendritic cell-specific ICAM-3-grabbing non-integrin [DC-SIGN], monocyte chemoattractant protein-1 [MCP-1], nucleotide oligomerization binding domain 2 [NOD2], interferon-gamma [IFN-gamma], inducible nitric oxide synthase [iNOS], mannose-binding lectin [MBL] and surfactant proteins A [SP-A] have been reviewed. These genes have been variably associated with tuberculosis infection and there is strong evidence indicating that he genetic factors play critical roles in tuberculosis susceptibility, severity and development

Status of lipid profile in different stages of chronic kidney disease

To estimate and compare dyslipidemia in patients with different stages of chronic kidney disease as compared to healthy controls and to determine whether dyslipidemia is independently associated with rapid renal impairment. This study was conducted in department of Biochemistry Basic Medical Institute [BMSI], Jinnah Postgraduate Medical Centre [JPMC] Karachi. A total of 150 participants were recruited for the study from the Nephrology department of JPMC. These were grouped as 30 stage II CKD patient, 30 stage III CKD patient, 30 stage IV CKD patient, 30 stage V CKD patient and 30 normal healthy individuals. Cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, urea and creatinine were measured by commercially available kit method. Statistical analysis was done using SPSS version 11. Serum Cholesterol, Triglyceride and LDL-C among all groups were significantly increased when compared with control p<0.05. Serum HDL-C among all study groups was significantly decreased p<0.05, along with increase in LDL / HDL ratio among all study groups when compared with control p<0.05. Dyslipidemia occurs gradually in CKD patients as disease progresses. Evaluation of dyslipidemia in early stages of CKD is useful to assess the risk for future cardiovascular disease in these patients

Endometrial carcinoma arising in a bicornuate uterus

Endometrial carcinomas arising in a bicornuate uterus are rare, only five case of which have been previously reported. We present a case of endometrial cancer arising in a bicornuate uterus, occurring in a 65-year-old woman. Unlike previously reported cases, our case showed mixed endometrial adenocarcinoma and undifferentiated carcinoma in one horn and focal adenocarcinoma in the other. Adequate tissue sampling of both horns is necessary for accurate diagnosis of malignancy in patients with a bicornuate uterus. Physicians should be aware of the possibility of this abnormality in cases when endometrial cancer is suspected but histology fails to confirm.

Zinc and copper levels fluctuate with altered glucose homeostasis

Background: Type 2 diabetes mellitus is becoming one of the major health problems worldwide. Especially in South East Asia, type 2 diabetes has gained critical significance. As pre-diabetes prevalence is increasing worldwide, it has become an important concern to prevent diabetes at an early stage. Trace elements have been gaining attention in improving the glucometabolic conditions like pre-diabetes and diabetes. Zinc and copper are the major trace elements present in the human body and they play a significant role in the pathogenesis of diabetes mellitus and pre-diabetes

Objectives: The purpose of this study was to compare serum zinc and copper levels in type 2 diabetes and pre-diabetes

Methods: This study was conducted in department of Biochemistry BMSI, JPMC Karachi. Total 90 subjects were taken out of which 30 were type 2 diabetics, 30 were pre-diabetics and 30 were normal healthy individuals. Serum fasting glucose was measured by glucose oxidase method. Serum zinc and copper were measured by colorimetric method. Statistical analysis was done using SPSS version 16

Results: Serum zinc levels were significantly lower in type 2 diabetics as compared to pre-diabetics and normal individuals [mean differences were 45.17+/-15.63 micro g/dl, 59.97+/-13 micro g/dl and 86.57+/-14.34 micro g/dl respectively]. Serum copper was significantly increased in type 2 diabetics compared to pre-diabetes and control samples [mean differences were 325.55+/-88.34 micro g/dl, 175.53+/-47.45 micro g/dl and 126.87+/-21.57 micro g/dl respectively]

Conclusion: it was concluded that serum zinc was significantly lower in type 2 diabetics and pre-diabetics and is inversely related to serum fasting glucose while serum copper is significantly higher and positively related with fasting blood glucose

Method Development and Validation of Levosalbutamol in Pure and Tablet Dosage Form by RP-HPLC.

A simple, rapid and accurate RP-HPLC method was developed for the determination of levosalbutamol in pure and tablet dosage form by RP-HPLC method using C18 BDS column (Phenomenex, 250 x 4.6 mm, 5 μm) in isocratic mode. The mobile phase consisted of Acetonitrile and buffer in the ratio of 20:80 (v/v) was used and maintain the pH 3. The flow rate was maintained at 1 mL/min and the injection volume was 20 μL . Detection wavelength with UV detector at 276 nm and run time was kept 10 min. The retention time of levosalbutamol was 5.4 min. The method was linear over the concentration range 7-12 μg/ml. The recovery was found to be 100.44± 0.27%. The validation of method was carried out utilizing ICH-guidelines. The described HPLC method was successfully employed for the analysis of pharmaceutical formulations.

Risk factors for postoperative recurrence of Crohn's disease

Postoperative relapse is a common feature of Crohn's disease [CD] in Western countries but its frequency and risk factors have not been studied in the Middle East where there is a rapid upsurge in the incidence of CD. This study aims to research the frequency and risk factors of its recurrence after surgery among 566 Iranian patients with CD in Tehran, Iran. All 566 patients diagnosed with Crohn's disease that enrolled in Digestive Diseases Research Center [DDRC] Inflammatory Bowel Disease [IBD] from April 1991 until November 2011 were included in our study. We reviewed clinical data that included time of surgery, possible risk factors and follow up after surgery. Multivariate regression analysis was performed to seek possible risk factors for early postoperative recurrence. The mean age of patients was 30.85 [range: 12-88] years at the onset of enrollment. During a mean follow up of 55 months, 139 [24.5%] out of 566 Crohn's disease patients underwent at least one surgery while 32 [23%] required additional surgery during the period after their first surgical intervention. Cigarette smoking was a risk factor for both initial [p=0.001] and additional surgery [p<0.0001]. The penetrating behavior of Crohn's disease, in addition to its effect on surgery [p<0.001], showed a significant influence on disease recurrence [p<0.0007] along with perianal involvement which was significantly associated with relapse [p=0.001]. Although disease duration of more than ten years was a significant risk factor for surgery [p=0.043] its effect on recurrence was insignificant [p=0.059]. The rate of initial and additional surgery is much lower in this region of the world, which is partially due to the relatively new occurrence of Crohn's disease in the Middle East. Cigarette smoking, disease duration over ten years, penetrating behavior of CD, and perianal disease were the main risk factors for surgery.

CpG Island Methylation According to the Histologic Patterns of Early Gastric Adenocarcinoma

BACKGROUND: Although the importance of aberrant DNA methylation in the development of gastric adenocarcinoma has been described, the mechanism of pathogenesis has not been revealed yet. We quantitatively analyzed methylation of four CpG islands and one repetitive DNA element, according to the histologic features of adenocarcinoma with precursor lesions. METHODS: We divided the cases as adenocarcinoma with intestinal type precursors (type A, n=19 cases) and adenocarcinoma with diffuse type precursors (type B, n=19 cases). We micro-dissected tumor cells and matched non-neoplastic gastric mucosa from the hematoxylin and eosin-stained slides. RESULTS: A total of 20 CpG sites of long interspersed nucleotide element-1 (LINE1), RAR-related orphan receptor alpha (RORA), Kruppel-like factor 7 (KLF7), mutL homolog 1 (MLH1), MINT25, and CD133 were analyzed. Methylation was determined by bisulfate-pyro-sequencing, and hypomethylation of LINE1 and CD133 was noted in the tumors, compared to the levels in the non-neoplastic gastric mucosa (p=0.014 and p=0.015, respectively). A statistically different methylation pattern of CpG sites at CD133 and KLF7 was noted only in type B lesions, compared to that in matched non-neoplastic gastric mucosa (p=0.027 and p=0.043, respectively). CONCLUSIONS: Given that aberrant methylation occurs in a relatively early phase of carcinogenesis, different patterns of methylation may determine the carcinoma phenotype. However, further large-scale study is required to clarify the significance of this difference.

Frequency of HLA DR2 in patients with severe and very severe Aplastic anaemia

To determine the frequency of HLA DR2 in Pakistani patients with severe and very severe aplastic anaemia. Introduction: In many cases aplastic anaemia is mediated by the immune mechanisms. Increased frequency of certain HLA haplotypes in patients with autoimmune diseases have led to the investigation of HLA subtypes in aplastic anaemia. HLA DR2 was found to be the most frequently encountered allele in aplastic anaemia. It has been reported that patients of aplastic anaemia, who possess HLA DR2 show a good response to immunosuppressive treatment. This study has been designed to establish frequency of HLA DR2 in patients of aplastic anaemia in our population. Setting: Armed Forces Institute of Pathology and Armed Forces Bone Marrow Transplant Centre, Rawalpindi-Pakistan. Materials and Fifty two cases of aplastic anaemia diagnosed at AFIP/AFBMTC during last 03 years [March 2001 to December 2003] were included in the study. Laboratory investigations to establish the diagnosis included blood complete picture, reticulocyte count, bone marrow aspiration and bone marrow trephine biopsy. Cytogenetic studies were carried out in selected cases to exclude possibility of hypoplastic myelodysplastic syndrome/Fanconi's anaemia. LAP score, ham's test, sucrose lysis test, urine for haemosiderin and CD59 analysis were carried out in suspected cases to exclude paroxysmal nocturnal haemoglobinuria. All cases were tested for HLA DR2 by standard National Institute of Health two stage microlymphocytotoxicity assay. Out of 52 patients, 35 were males and 17 were females [M: F 2:1]. Median age of the patients was 17 years [3-35 years]. Twenty eight [54%] of the patients were of severe aplastic anaemia and 24 [46%] were of very severe aplastic anaemia. HLA DR2 was positive in 31[60%] patients compared to 4,1% in healthy population [p. 0.007]. An increased frequency of HLA DR2 is also seen in Pakistani patients of aplastic anaemia which is associated with a good response to immunosuppressive therapy

Pneumocystis carinii and Trichosporon beigelii pneumonia following allogeneic haemopoeitic stem cell transplantation

Pneumocystis Carinii and Trichosporon beigelii are opportunistic infections in immunocompromised patients. We report a case of a young lady who underwent haemopoeitic stem cell transplantation for relapsed acute lymphoblastic leukemia. This 25 years old female developed fever, dry cough and rapidly progressive dyspnoea during post transplant neutropenia and was found to be suffering from Pneumocystis carinii pneumonia. She was successfully treated with Co-trimoxazole. The patient again presented with similar symptoms on day 55 post transplant. This time Trichosporon beigelii was isolated from bronchoalveolar lavage and she responded to prompt antifungal therapy. Other complications encountered during the subsequent course were extensive subcutaneous emphysema and spontaneous pneumothorax that required chest intubation and brief hospitalization. The patient is presently nine months post transplant and is asymptomatic

Diabetes mellitus [diagnosed and undiagnosed] in acute myocardial infarction

To determine the proportion of Diabetes Mellitus [DM] in patients with documented first episode of Acute Myocardial Infarction [AMI], in both genders. A prospective, case control observational study. Emergency Room, CCU and Medical wards of Chandka Medical College Hospital Larkana, Pakistan, from January 2005 to August 2005. 200 patients 100 consecutive males and 100 consecutive females, presenting with definite first episode of AMI. Diagnosis of D.M established on previous history of D.M, medical record and medications used by patient, patients without previous diagnosis of D.M [Undiagnosed], were diagnosed by performing Fasting Plasma Glucose [FPG], once within around 72 hours and 8 weeks later on. Out of 200 patients 49 [24.5%] were known diabetics, 20 [10%] revealed hyperglycemia [suspected diabetics] on routine plasma glucose level and Fasting Plasma Glucose [FPG] petformed within 72 hours of the onset of AMI and on subsequent follow up after 8 weeks, FPG level performed revealed 12 [6%] newly diagnosed definitive diabetics, while 5 [2.5%] revealed Impaired Glucose Tolerance Test [GTT] and 3 [1.5%] were found to be non-diabetics, so that a total 61 [30.5%] were labeled as diabetics. one out of every three patients with AMI had DM, elevated levels of random blood glucose and FPG at the time of admission are not reliable measures to establish the diagnosis of diabetes in cases of AMI and thus follow up measurements after a period of 6-8 weeks are necessary to establish the diagnosis. Awareness in general public regarding deleterious effects of DM should be promoted

Graft versus host disease in allogeneic stem cell transplantation - 3 1/2 years experience

To evaluate the frequency and outcome of graft versus host disease after allogeneic stem cell transplant in haematological disorders at Armed Forces Bone Marrow Transplant Centre, Rawalpindi from July 2001 to December 2004. Eighty-six patients with various haematological disorders namely aplastic anaemia [n=32], b-Thalassaemia [n=25], CML [n=22], ALL [n=3], AML [n=1] Fanconi's anaemia [n=2], and Gaucher's disease [n=1], underwent allogeneic stem cell transplantation. All patients received cyclosoprin, prednisolone and short course of methotrexate as GvHD prophylaxis. The patients who developed acute GvHD > grade-II or chronic extensive GvHD received steroids at a starting dose of 2 mg/kg body weight along with gradual increase in cyclosporine dosage [max dose 12.5 mg/kg]. The overall incidence of acute GvHD grade-II to IV was 44.2% [n=38/86] where as the incidence of chronic extensive GvHD was 14% [n=12/86]. Acute GvHD was 68% [n=17/25] in

Pattern of systemic fungal infections and antimicrobial susceptibility of isolates in cancer patients

Fungal pathogens are implicated as an important cause of morbidity and mortality in cancer patients. In Pakistan the pattern of systemic fungal infections in cancer patients is not known. The present study was done to determine the pattern of systemic fungal infections and antimicrobial susceptibility of fungal isolates in cancer patients in Rawalpindi. It is a non-interventional descriptive study carried out from May to October 2003 at the Armed Forces Institute of Pathology, Rawalpindi. Blood, urine, stool and sputum specimens were collected for culture isolation of fungi from 73 febrile cancer patients. Antifungal susceptibility of the isolates to amphotericin B, fluconazole and itraconazole was determined by Etest and broth macrodilution technique. Forty-five fungi were isolated from 28 patients. Twenty isolates were Candida albicans, 21 were non-Candida albicans yeasts: C. tropicalis [n=13], C. glabrata [n=5], C. kefyr [n=3], Rhodotorula rubra [n=1] and three were Aspergillus fumigatus. All the isolates of C. albicans were susceptible to itraconazole; one was resistant to fluconazole while 3 isolates showed intermediate resistance to amphotericin B. The non-Candida albicans were generally more resistant: all the isolates of C. kefyr were resistant to amphotericin B, two isolates of C. tropicalis were resistant to fluconazole and three isolates of C. glabrata were resistant to itraconazole. Isolates of A. fumigatus were susceptible to amphotericin B but resistant to fluconazole. Systemic fungal infections in cancer patients by non-Candida albicans are on the rise and they are generally more resistant than C. albicans. Antifungal susceptibility testing must be performed in these cases in order to improve survival and decrease morbidity. Itraconazole can be used for prophylaxis of fungal infections in these patients

Emergency hand assisted laparoscopic surgery [HALS] resection of a benign intragastric stromal tumour

A 52 years old male presented to the local casualty department, following an episode of binge drinking, with a history of malaena, upper abdominal pain and haematemesis. He was resuscitated in the emergency department and underwent endoscopy, which was inconclusive. He had a repeat episode of haematemesis while in the hospital and underwent transfusion of twelve units of packed red cells. Repeated endoscopy showed an intra gastric stromal tumour [GIST]. It was decided to operate on him using Hand Assisted Laparoscopic Surgery[HALS]. Emergency HALS is the first reported case in indexed literature, to deal with this sort of tumour

Transcatheter closure of atrial septal defect using buttoned device--Indian experience.

Transcatheter closure of secundum atrial septal defect (ASD) < 21 mm in diameter with adequate septal margins, assessed by transthoracic echocardiography (TTE) was attempted using Sideris buttoned device under fluoroscopic and TTE guidance in 27 patients (age range 5-35 years). The stretched diameter of ASD estimated by balloon sizing at cardiac catheterization was, on an average, 3 mm larger than assessed on TTE. A 25 to 50 mm second-generation Sideris device could be successfully implanted in 24 patients, with disappearance of left-to-right shunt, assessed by colour flow mapping on TTE in 17 patients. Residual shunt of 0.12-0.54 L/min/m2 was seen on day one in 7 patients which increased on follow-up in 3 patients over a period of 12 months. The maximum shunt in one patient was 1.1 L/min/m2. On follow-up (14.5 +/- 3.8 months), the device was in a stable position in all patients evaluated by fluoroscopy and TTE, and intracardiac ultrasound study in two patients. The procedure was unsuccessful in 3 patients, due to unbuttoning of the device in one and recurrent slippage of the device through the ASD in two patients. Mitral regurgitation was detected in 5 patients on follow-up (mild in 4 and moderate in 1). There was no mortality and none of the patients required any surgical intervention. It is concluded that transcatheter closure of some selected cases of secundum ASD can be safely and effectively done using Sideris buttoned device through a small sheath; however, a centering device is likely to close larger defects with less interference with mitral valve function.

Comparison of electrophysiologic effects and efficacy of single-dose intravenous and long-term oral amiodarone therapy in patients with AV nodal reentrant tachycardia.

Electrophysiologic effects and the efficacy of single-dose intravenous (i.v.) amiodarone were compared with those of long-term oral therapy in 9 patients of AV nodal reentrant tachycardia (AVNRT) utilising slow pathway (SP) for anterograde and fast pathway (FP) for retrograde conduction. Electrophysiologic data were obtained by programmed electrical stimulation (PES) before, 15 to 30 minutes after i.v. amiodarone (5 mg/kg body-weight over 10 minutes) and a mean of 64.6 +/- 23.7 days after oral therapy, on a maintenance dose of 200 to 400 mg daily. There was no significant influence on the sinus cycle length and infranodal conduction (HV) by i.v. or oral amiodarone as compared to pre-drug values. AV nodal conduction, evaluated by AH interval, increased significantly and comparably with both (8% after i.v., 10% after oral; p = NS). Anterograde conduction through SP, as evidenced by pacing cycle length producing AH block, was prolonged by both (31% after i.v., 52% after oral; p = NS). Oral amiodarone, however, was more effective than i.v. in lengthening the effective refractory period (ERP) of anterograde FP (45% vs 17%, p < 0.05). Although both depressed retrograde conduction significantly, long-term oral amiodarone was more effective in prolonging the paced cycle length (PCL) producing ventriculoatrial (VA) block (79% vs 50%; p < 0.05) and ERP of VA conduction system (72% vs 42%; p < 0.01). AVNRT was successfully terminated in 7 patients after i.v. amiodarone. However, tachycardia was reinducible in 3 patients after i.v. and in none after long-term oral therapy. None had clinical recurrence of tachycardia on maintenance oral therapy. The mean concentration of the drug was 3.1 +/- 1.81 micrograms/ml after i.v. and 1.3 +/- 0.47 micrograms/ml after oral therapy (p < 0.05). These results. suggest that i.v. amiodarone terminated AVNRT by depressing both anterograde and retrograde limbs of the reentrant circuit and eventually blocking one of these. Oral therapy prevented recurrence and reinducibility by its predominant effect in prolonging refractoriness of the atrium and ventricle, and depressing conduction through the retrograde FP. It is concluded that i.v. amiodarone is an effective drug in acute termination of tachycardia mediated by AV nodal reentry and that long-term oral therapy is excellent in preventing recurrence and reinducibility of tachycardia. There are significant differences in the electrophysiologic properties and mechanism of action between the two forms, not influenced by the blood levels of amiodarone.