The Effect of Obesity on Severity of Asthma: An Observational Prospective Study from Pakistan.

Objective: The current research study aimed to access the relationship between obesity and asthma exacerbations and severity among adult patients at the outpatient section of a federal hospital (PIMS) in Islamabad, Pakistan. Methods: A cross-sectional research study was carried out on 207 asthma adult patients belonging to different areas and ethnic groups from the country. The study setting was the PIMS hospital, which attracts patients from all over the country due to its facilities and cost-effective treatments. The body mass index (BMI) of asthma patients was calculated using the heights and weights of the study subjects. However, the pulmonary functions were calculated using a computerized spirometer i-e Spirolab III S/N 303681 in line with Winspiro PRO 7.1.version software. It presents the patient's forced vital capacity that expires in the first second of expiration to full (FEV1) in comparison to forced vital capacity (FVC) ratio, that is, Tiffeneau-Pinelli index was also recorded to determine the asthma severity. Results: According to recent surveys, the overall prevalence of patients with overweight and obesity was 29.0% and 23.7%, respectively. A Chi-square test was used, and a statistically significant relationship was observed between BMI and asthma severity (P < 0.001). The adult obese female patients presented poor pulmonary functions. The average FEV1/FVC ratio presented significant variance among four different categories of BMI with P < 0.05. This difference was due to the normal BMI category as the Tiffeneau-Pinelli index, that is, FEV1/FVC in the normal BMI group was significantly lower as compared to that in underweight and obese patients. Conclusion: The study subjects presented raised asthma severity in accordance with the raised BMI. Obese patients presented comparatively raised asthma exacerbations. Moreover, a statistically significant association of gender difference was observed between obesity and asthma severity. It was concluded that adult asthmatic women with obesity presented raised asthma severity as compared to adult asthmatic males.

The influence of pharmacist-led collaborative care on clinical outcomes in type 2 diabetes mellitus: a multicenter randomized control trial.

Background: Health care providers are mandated to deliver specialized care for the treatment and control of type 2 diabetes mellitus. In Malaysia, Diabetes Medication Therapy Adherence Clinics (DMTAC) in tertiary hospitals have designated pharmacists to administer these services. Objective: To assess the effects of pharmacist-led interventions within DMTAC on the outcomes of patients with type 2 diabetes mellitus in two distinct hospitals in Kedah, Malaysia. Methods: Patients with type 2 diabetes were randomly selected from the two hospitals included in this study. The study population was divided into two equal groups. The control group consisted of 200 patients receiving routine care from the hospitals. On the other hand, the intervention group included those patients with type 2 diabetes (200), who received separate counseling sessions from pharmacists in the DMTAC departments along with the usual treatment. The study lasted 1 year, during which both study groups participated in two distinct visits. Results: Parametric data were analyzed by a paired t-test and one-way ANOVA, while non-parametric data were analyzed by a Chi-squared test using SPSS v24. A p < 0.05 was considered statistically significant. The study presented the results of a greater reduction in HBA1c levels in the intervention group compared to the control group, i.e., 3.59 and 2.17% (p < 0.001). Moreover, the Systolic and Diastolic values of BP were also significantly reduced in the intervention group, i.e., 9.29 mmHg/7.58 mmHg (p < 0.005). Furthermore, cholesterol levels were significantly improved in patients in the intervention group, i.e., 0.87 mmol/L (p < 0.001). Conclusion: Based on the findings of the current study it has been proven that the involvement of pharmacists leads to improved control of diabetes mellitus. Therefore, it is recommended that the government initiate DMTAC services in both private and government hospitals and clinics throughout Malaysia. Furthermore, future studies should assess the impact of pharmacist interventions on other chronic conditions, including but not limited to asthma, arthritis, cancer, Alzheimer's disease, and dementia.

Antibiotic resistance genes prediction via whole genome sequence analysis of Stenotrophomonas maltophilia.

BACKGROUND: Stenotrophomonas maltophilia (S. maltophilia) is the first dominant ubiquitous bacterial species identified from the genus Stenotrophomonas in 1943 from a human source. S. maltophilia clinical strains are resistance to several therapies, this study is designed to investigate the whole genome sequence and antimicrobial resistance genes prediction in Stenotrophomonas maltophilia (S. maltophilia) SARC-5 and SARC-6 strains, isolated from the nasopharyngeal samples of an immunocompromised patient. METHODS: These bacterial strains were obtained from Pakistan Institute of Medical Sciences (PIMS) Hospital, Pakistan. The bacterial genome was sequenced using a whole-genome shotgun via a commercial service that used an NGS (Next Generation Sequencing) technology called as Illumina Hiseq 2000 system for genomic sequencing. Moreover, detailed in-silico analyses were done to predict the presence of antibiotic resistance genes in S. maltophilia. RESULTS: Results showed that S. maltophilia is a rare gram negative, rod-shaped, non sporulating bacteria. The genome assembly results in 24 contigs (>500 bp) having a size of 4668,850 bp with 65.8% GC contents. Phylogenetic analysis showed that SARC-5 and SARC-6 were closely related to S. maltophilia B111, S. maltophilia BAB-5317, S. maltophilia AHL, S. maltophilia BAB-5307, S. maltophilia RD-AZPVI_04, S. maltophilia JFZ2, S. maltophilia RD_MAAMIB_06 and lastly with S. maltophilia sp ROi7. Moreover, the whole genome sequence analysis of both SARC-5 and SARC-6 revealed the presence of four resistance genes adeF, qacG, adeF, and smeR. CONCLUSION: Our study confirmed that S. maltophilia SARC-5 and SARC-6 are one of the leading causes of nosocomial infection which carry multiple antibiotic resistance genes.

Evaluation of Safety of Stewart's Wood Fern (Dryopteris stewartii) and Its Anti-Hyperglycemic Potential in Alloxan-Induced Diabetic Mice.

Diabetes has become a critical challenge to the global health concerns. Cytotoxicity and development of resistance against available drugs for management of diabetes have shifted the focus of global scientific researchers from synthetic to herbal medications. Therefore, the current study was conducted to investigate the possible anti-hyperglycemic potential of Dryopteris stewartii using Swiss albino mice. To evaluate any possible toxic effect of the plant, acute oral toxicity test was performed while the anti-diabetic effects of aqueous and ethanol extracts at 500 mg/kg, positive, negative and normal control were assessed simultaneously. The anti-diabetic study revealed that aqueous extract has higher anti-diabetic potential than ethanol extract while lowered blood glucose level at second week reaching 150 mg/dL, exerting stronger anti-diabetic effects, compared to ethanol extract (190 mg/dL). Oral glucose tolerance findings revealed that aqueous extract decreased blood glucose level by -0.41-fold, compared to ethanol extract showing a decrease by only -0.29-folds. The histopathological evaluation of liver and pancreas of all groups revealed normal cell architecture with no morphological abnormalities. These results suggested the possible use of D. stewartii as anti-diabetic herbal drug in near future. However, these recommendations are conditioned by deep mechanistic studies.

Anti-Neutrophil Cytoplasmic Antibodies: To Care or Not to Care.

Anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis is a disease process with a wide range of presentations, from asymptomatic or minimally symptomatic disease with positive laboratory testing, to florid acute end-organ damage. Consensus has not been established as to the frequency and/or protocol by which ANCA testing should be repeated. We present the case of a 53-year-old woman who initially came to medical attention with persistent dyspnea and pulmonary infiltrates presumed to be due to acute exacerbation of chronic diastolic congestive heart failure. Extensive infectious disease testing was negative, but ANCA testing was positive. However, because antinuclear antibody (ANA) interference in the original sample rendered the test result difficult to interpret, the test was not repeated. The patient presented eight months after the initial hospitalization with acute hypoxemic respiratory failure requiring intubation, with an ANCA titer of 1:1280 with a negative ANA titer, and renal biopsy-proven severe crescentic glomerulonephritis. In the discussion of our case, we review the importance of interpreting ANCA testing in the correct clinical context. The ANCA laboratory testing requires cautious interpretation, and diagnosed ANCA-associated vasculitis (AAV) requires vigilance for prompt and proactive treatment.

Myocardial infarct size and sex-related angiographic differences in myocardial infarction in nonobstructive coronary artery disease.

BACKGROUND: Myocardial infarction in nonobstructive coronary artery disease (MINOCA) is a recently described infarct subtype. There are few studies that examine coronary artery disease (CAD) extent, MI size and type, and treatment differences at hospital discharge compared to myocardial infarction in obstructive coronary artery disease (MICAD), or that explore sex-specific MINOCA attributes of coronary anatomy and infarct size. METHODS: Our study population consisted of a single tertiary-center of consecutive patients that had coronary angiography for acute MI between 2005 and 2015. The MI type at presentation, MI size and ejection fraction (post-MI), and gender differences between MINOCA patients were examined. RESULT: Among 1698 cases with acute MI, 95 had MINOCA (5.6%). MINOCA patients were younger, more often had NSTEMI, lower peak cardiac troponin (cTn) values, and greater ejection fraction than MICAD patients (all P-values <0.005). At hospital discharge, 30-day re-admission rates were similar. MINOCA patients less frequently received optimal medical therapy. When women were analyzed, the 45 women with MINOCA had smaller MIs (P < 0.001) and greater ejection fraction (P = 0.002) than the 358 women with MICAD. Sex comparisons of the 95 MINOCA patients revealed women were older than men (P < 0.001), had lower mean peak cTn values (P < 0.001), greater ejection fraction (P = 0.02), and more single-vessel disease involvement than men (P < 0.0001). CONCLUSION: The average MI size is smaller in MINOCA than MICAD patients, and there are sex-related differences in clinical presentation, coronary artery disease extent, and MI size. Re-admission rates are similar and MINOCA patients are less likely to receive guideline recommended medical therapy at discharge.

Molecular docking, simulation and MM-PBSA studies of nigella sativa compounds: a computational quest to identify potential natural antiviral for COVID-19 treatment.

Nigella sativa or black seed is used as a medicinal plant around the globe. Oil and seeds have a long tradition of folklore use in various medicinal and food systems. The conventional therapeutic use of Nigella sativa, in different ways, has been reported in several studies to treat different diseases including influenza, headache, hypertension, diabetes, inflammation, eczema, fever, cough, asthma, bronchitis, and fever. Based on previously reported potential therapeutic uses of N. sativa compounds, and keeping in mind the dire need of time for the development of potent antiviral, a combined docking, ADMET properties calculation, molecular dynamics, and MM-PBSA approaches were applied in the current study to check the therapeutic potentials of N. sativa chief constituents against COVID-19. Among the studied compounds, we found that dithymoquinone (DTQ), with binding affinity of -8.6 kcal/mol compared to a positive control (chloroquine, -7.2 kcal/mol) , has the high potential of binding at SARS-CoV-2:ACE2 interface and thus could be predicted as a plausible inhibitor to disrupt viral-host interactions. Molecular dynamics simulation of 100 ns well complemented binding affinity of the compound and revealed strong stability of DTQ at the docked site. Additionally, MM-PBSA also affirms the docking results. Compound DTQ of the present study, if validated in wet lab experiments, could be used to treat COVID-19 and could serve as a lead in the future for development of more effective natural antivirals against COVID-19. Communicated by Ramaswamy H. Sarma.

Speckle tracking echocardiography can predict subclinical myocardial involvement in patients with sarcoidosis: A meta-analysis.

BACKGROUND: This meta-analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are limited by cost and availability. METHODS: We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra-cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD), comparing sarcoidosis group with healthy controls. A random-effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics. RESULTS: Nine studies were included in our final analysis with an aggregate of 967 patients. LVGLS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD -3.98, 95% confidence interval (CI): -5.32, -2.64, P < .001, also was significantly lower in patients who suffered major cardiac events (MCE), -3.89, 95% CI -6.14, -1.64, P < .001. GCS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD: -3.33, 95% CI -4.71, -1.95, P < .001. CONCLUSION: LVGLS and GCS were significantly lower in extra-cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS.

An Unusual Presentation of Kikuchi-Fujimoto Disease with Recurrent Subdural Effusion.

A 24-year-old man complained of a right temporal headache for four weeks. The patient denied any trauma or previous anticoagulation use. He also reported tender right facial swelling. His physical exam was unrevealing except for right cranial nerve (CN) VI palsy, right parotid enlargement, and cervical adenopathy. Laboratory findings were significant for mild leukopenia at 3300 cells/uL. The computed tomography (CT) scan obtained showed a chronic left subdural effusion with a 4 mm midline shift and confirmed right parotid enlargement and cervical lymphadenopathy. Surgical burr hole evacuation was done and the fluid was sent for wound culture analysis. The infectious diseases service recommended initiating antibiotics, which were later stopped due to cerebrospinal fluid (CSF) cultures with no growth of any organisms. His CN VI palsy resolved during admission. The patient was discharged with follow-up for biopsy. The patient was lost to follow-up. The patient presented to the emergency department (ED) three months later, with a left-sided frontal headache. A repeat CT scan showed a new, right-sided fluid collection outside the brain parenchyma. Burr hole evacuation was done again and purulent fluid was drained. Antibiotics were held this time, but anti-tuberculous therapy was initiated empirically. The otolaryngology service was consulted and a lymph node biopsy was performed. The pathology showed histiocytic necrotizing lymphadenitis. A dural biopsy was done as well and was consistent with histiocytic necrotizing lymphadenitis involving the dura. Cultures from the subdural fluid did not grow any organism. The patient remained neurologically intact. He improved after surgery was done to drain the fluid and was managed by analgesics. The cultures from the extra-parenchymal fluid collection remained negative for pathogens and tuberculous mycobacteria. The patient was discharged with rheumatology clinic follow-up. He saw the rheumatologist six weeks after the discharge. During his clinic visit, the patient reported no recurrence of headaches, fevers, rash, or joint pain. Our patient had a rare presentation of Kikuchi-Fujimoto disease, in which he had a subdural fluid collection resulting in neurological complications that required surgical intervention.