Comparison of Various Therapeutic Approaches to Manage Infertility in Polycystic Ovarian Syndrome.

OBJECTIVE: To compare the efficacies of common therapeutic regimens and their combinations, used in polycystic ovarian syndrome (PCOS) to improve fertility in reproductive-age women. STUDY DESIGN: A descriptive study. Place and Duration of the Study: Department of Obstetric Gynaecologist, Medicare Cardiac and General Hospital, Karachi, Pakistan, from November 2022 to July 2023. METHODOLOGY: Out of 300 patients with the symptoms of menstrual irregularities and infertility, 152 were diagnosed as PCOS patients based on the ultrasound and hormonal assays and selected for study purpose. They were divided according to their therapeutic regimen into four treatment groups, treated by different therapeutic agents. Group A received metformin 500 mg/day (n = 38); Group B received metformin + myo-inositol 1g (n = 49); Group C received metformin + letrozole 2.5 mg (n = 36), and Group D received metformin + letrozole + myo-inositol (n = 29), orally for three months. All continuous variables, such as body mass index (BMI), FSH, LH, FT4, and FSI were analysed by applying t-test to all therapeutic groups, keeping p ≤0.05 as the level of significance. RESULTS: HCG-positive was found as 86% (n = 33) in Group A, 63% (n = 31) in Group B, 52% (n = 19) in Group C, and 27% (n = 08) in Group D. There were statistically significant (p <0.001) changes in BMI, FSH, LH, FT4, and FSI as well. Metformin alone and metformin plus myo-inositol came out to be more effective than other regimens. CONCLUSION: Metformin alone and myo-inositol plus metformin are effective therapeutic options in PCOS-induced infertility problems. KEY WORDS: Polycystic ovarian syndrome, Infertility, Metformin, Myo-inositol, Letrozole, Menstrual irregularities.

Single-Center Experiences of Preoperative Juvenile Nasal Angiofibroma Embolization With Gelfoam, Reducing Financial Burden on Patients in Developing Country.

Introduction Juvenile nasal angiofibroma (JNA) is a highly vascular tumor of the nasopharynx. Endovascular embolization followed by surgery is the treatment of choice. This study aimed to determine that single catheter technique with Gelfoam is an effective and safe technique for embolization to reduce the financial burden on patients in a developing country. Materials and methods We retrospectively reviewed the imaging, surgical, and histopathological records of 108 patients who underwent preoperative endovascular tumor embolization followed by surgical resection between March 2017 and March 2021. Results After embolization no major complication was observed in any patient. Complete devascularization of tumor was done in 87.8%. Intraoperative blood loss resulting in transfusion was almost the same as with other embolization techniques. Conclusion Single catheter with Gelfoam is a cost-effective and safe technique for JNA embolization.

Complications Associated with Permanent Internal Jugular Hemodialysis Catheter: A Retrospective Study.

Introduction A significant increase in patients with end-stage renal disease has been observed currently in our community. Kidney transplantation is the most promising cure but the problem is that large numbers of people are not good candidates for transplantation. Hemodialysis is the next appropriate medication for such patients and for patients with end-stage renal disease, who have no chance for transplantation. Morbidity and mortality are the consequences of vascular access complications. Local data related to the complication rate of permanent hemodialysis catheters is not available. The current study examines the complication rate in people due to permanent intrajugular hemodialysis catheterization. Materials and methods The study has been conducted in Dr Ziauddin University Hospital, Karachi. The dataset consists of 212 patients who had gone through jugular catheterizations for hemodialysis at this hospital from the year 2014 to the year 2015. A descriptive method has been chosen for obtaining appropriate results. Complications have also been categorized as early or late. Results Complications have been detected in around 24% of the patients from the dataset. Among these complications, infection has the highest percentage (around 13%) while 4% percent of patients have a failed puncture. The others have venous thrombosis, catheter thrombosis, hematoma, wrong canulation, and hemothorax and pneumothorax problems. Conclusion The study concludes that the placement of a permanent hemodialysis catheter in the internal jugular vein has a low complication rate. In addition, the method is safe and easy. So, it can be said that the internal jugular vein is a reliable and preferred route for hemodialysis catheterization.

Preparation and properties of chitosan-metal complex: Some factors influencing the adsorption capacity for dyes in aqueous solution.

Chitosan-metal complexes have been widely studied in wastewater treatment, but there are still various factors in complex preparation which are collectively responsible for improving the adsorption capacity need to be further studied. Thus, this study investigates the factors affecting the adsorption ability of chitosan-metal complex adsorbents, including various kinds of metal centers, different metal salts and crosslinking degree. The results show that the chitosan-Fe(III) complex prepared by sulfate salts exhibited the best adsorption efficiency (100%) for various dyes in very short time duration (10min), and its maximum adsorption capacity achieved 349.22mg/g. The anion of the metal salt which was used in preparation played an important role to enhance the adsorption ability of chitosan-metal complex. SO42- ions not only had the effect of crosslinking through electrostatic interaction with amine group of chitosan polymer, but also could facilitate the chelation of metal ions with chitosan polymer during the synthesis process. Additionally, the pH sensitivity and the sensitivity of ionic environment for chitosan-metal complex were analyzed. We hope that these factors affecting the adsorption of the chitosan-metal complex can help not only in optimizing its use but also in designing new chitosan-metal based complexes.

Diagnostic Accuracy of Pelvic MRI for Determination of the Cervical Involvement in Endometrial Cancer.

OBJECTIVE: To determine the diagnostic accuracy of pelvic MRI for assessment of the cervical involvement in endometrial cancer. STUDY DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Radiology Department of the Aga Khan University Hospital, Karachi from January 2014 to December 2015. METHODOLOGY: Patients with biopsy-proven endometrial cancer were included, who had both their MRI and histopathological diagnosis performed at our institution. Those patients treated with chemo/radiotherapy or had incomplete medical records, were excluded. The extent of cervical involvement by endometrial carcinoma was seen on T2WI images, and findings were correlated after surgery taking histopathology as the gold standard. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. RESULTS: The mean age of the 56 patients was 60.87 ±8.80 years (range 37-84 years). The most common clinical indication was post-menopausal bleeding (n=37, 66.1%). The most common histological subtype was endometrioid adenocarcinoma (n=50, 89.3%). The sensitivity, specificity, diagnostic accuracy, positive and negative predictive values of MRI in the detection of cervical invasion were 92.85%, 88.09%, 89.28%, 72.22% and 97.36%, respectively. CONCLUSION: MRI is a highly sensitive and specific imaging modality for detection of cervical invasion in endometrial carcinoma.

Diagnostic Accuracy of CT Scan in Diagnosing Paranasal Fungal Infection.

OBJECTIVE: To assess the diagnostic accuracy of CTscan in detecting paranasal sinus fungal infections. STUDY DESIGN: Cross-sectional, observational study. PLACE AND DURATION OF STUDY: Department of Radiology, Ziauddin University Hospital, Karachi, from April to September 2014. METHODOLOGY: Patients with clinical suspicion of fungal sinusitis were included in this study. Patients with already diagnosed or history of recurrent fungal infections were excluded. All these patients underwent CTscan examination of paranasal sinuses. Findings were recorded. Final diagnosis was based on smear analysis for fungal culture. Accuracy analysis was conducted for CTdiagnosis using smear analysis as the gold standard. Kappa analysis was conducted to determine agreement. RESULTS: Out of the 120 patients, 71 (59%) were male. The sensitivity, specificity, positive predictive value and negative predictive value of CTwere 96.19%, 93.33%, 99.01%, 77.77%, respectively. The diagnostic accuracy was 95.83%. Kappa statistics showed 82% agreement beyond chance. CONCLUSION: CTscan is highly accurate in diagnosing and characterizing fungal infection of paranasal sinuses. It also determines the extent of disease which eventually aids in deciding the surgical approach to be used.

Increased nuchal translucency and adverse pregnancy outcomes.

OBJECTIVE: To assess the adverse outcome in pregnancies with raised Nuchal translucency measurement. METHODS: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, Pakistan between January 2001 and December 2015. Women attending the Fetal Medicine unit for first trimester screening by Nuchal translucency were included in the study. All pregnancies were followed up till delivery. Those with incomplete information about the delivery were excluded from the analysis. Pregnancy outcome was observed in normal Nuchal translucency measurements and in raised Nuchal translucency measurements. RESULTS: Out of the 1941 fetuses, there were 54 (2.8%) with raised Nuchal translucency measurement. Adverse pregnancy outcome was found in 32 (59.3%) of fetuses with raised Nuchal translucency measurement. Invasive testing was done in 15 (27.8%) of pregnancies with raised Nuchal translucency measurement. Among them there were nine (16.7%) cases with abnormal karyotype. It included six (11.1%) cases of trisomy 21, three (5.6%) cases of trisomy 13 and 18. CONCLUSION: Raised Nuchal translucency measurement is associated with adverse pregnancy outcome. One in three fetuses are affected by it. Live birth in this group where there is no aneuploidy is around 3.7%.

Biopolymer-induced morphology control of brushite for enhanced defluorination of drinking water.

Due to the relatively lower potential health risks as well as the good affinity for fluoride anion, calcium-based minerals have been widely carried out for the adsorption of fluoride. The improvement of adsorption capacity can be accomplished by regulation of particle size, shape and structure. Thus, here we report the controllable synthesis of petal-like nanosheets of brushite by using chitosan as a regulator. The addition of chitosan polymer in calcium precursor not only could serve ideal nucleation sites but also could play a vital role in confining the calcium phosphate aggregates and thus controlling the size of the brushite flakes. When the concentration of chitosan was 0.01wt%, the as-synthesized brushite showed nanosheet-structured with the dimensions ranged from 100 to 200nm and displayed outstanding fluoride adsorption capacity of 231.5mg/g according to the fitted Langmuir model, which was comparatively higher than that of the previously reported calcium-based adsorbents. Moreover, the pH change and common co-existing anions in solution almost presented less negative effect on the F- adsorption onto petal-like brushite nanosheets. We hope that these petal-like nanosheets based on green nanotechnology can help to achieve the intention of safe drinking water.

Phthalate degradation by glow discharge plasma enhanced with pyrite in aqueous solution.

In order to prevent health risk from potential exposures to phthalates, a glow discharge plasma (GDP) process was applied for phthalate degradation in aqueous solution. The results revealed that the phthalate derivatives 4-hydroxyphthalic acid, 4-methylphthalic acid and 4-tert-butylphthalic anhydride could be degraded efficiently in GDP process (498 V, 0.2 A) with high removal efficiencies of over 99% in 60 minutes. Additionally, pyrite as a promising heterogeneous iron source in the Fenton reaction was found to be favorable for GDP process. The phthalate degradation reaction could be significantly enhanced by the continuous formation of •OH and the inhibition of the quenching reaction in the pyrite Fenton system due to the constant dissolution of Fe(II) from pyrite surface. Meanwhile, the initial pH value showed little impact on the degradation of phthalates and the energy efficiency of GDP system for phthalate degradation ranged between 0.280 × 10-9 and 1.210 × 10-9 mol/J, which is similar to the GDP system with phenol, bisphenol A and methyl tert-butyl ether as the substrates. Further, the X-ray diffraction and scanning electron microscopy with energy dispersive X-ray spectroscopy analyses indicated that the pyrite was relatively stable in GDP system and there was no obvious polymeric compound formed on the catalyst surface. Overall, this GDP process offers high removal efficiency, simple technology, considerable energy efficiency and the applicability to salt-containing phthalate wastewater.

Selective conversion of organic pollutant p-chlorophenol to formic acid using zeolite Fenton catalyst.

Effective remediation technologies which can converse the harmful organic pollutants to high-value chemicals are crucial both for wastewater treatment and energy regeneration. This study provides an evidence that extracting useful chemicals from wastewater is feasible through selective conversion of p-chlorophenol to high value formic acid as an example. The reported system works with a readily available Fe-containing ZSM-5 catalyst, water as the solvent and hydrogen peroxide as the oxidant. The yield of formic acid reached up to 50.7% when the Si/Al ratio of ZSM-5 was 80 and the Fe-content was 1.4%. By X-ray adsorption fine structure (XAFS), NH3 temperature-programmed desorption (NH3-TPD) technique, the pyridine adsorption Fourier-transition infrared (Py-IR) spectroscopy and adsorption measurements, it was concluded that the controllable degradation of p-CP could be approached through selective adsorption, the moderate Brønsted acid sites for H2O2 activation and the properly selective conversion control due to extra-framework coordination unsaturated sites (CUS) of Fe. This approach might provide a new avenue for the field of organic pollutant remediation.

Determination of toxic heavy metals in indigenous medicinal plants used in Rawalpindi and Islamabad cities, Pakistan.

ETHNOPHARMACOLOGICAL RELEVANCE: History of medicinal plants used in local healthcare systems dates back centuries as the user considers them safe from toxic effects. Present study was aimed to document the commonly used indigenous medicinal plants and to investigate the metal toxicity and impact of pollution load in most frequently used medicinal plants from study area. MATERIAL AND METHODS: Semi-structured interviews and rapid appraisal approach were employed to record the ethnomedicinal information and toxic metals were analyzed through flame atomic absorption spectrophotometer. RESULTS AND DISCUSSION: A total of 21 wild medicinal plants was reported, and 7 were screened for toxic metal analysis. Oral mode of application (93%) was the chief route of herbal remedy administration, and leaves were found to be used as major plant part against different diseases. Main sources of remedies were wild herb (68%) followed by wild trees (18%), wild spiny shrubs (09%) and wild shrubs (5%). Trend of metal concentration was found as Fe>Ni>Cr>Pb>Cu>Zn>Mn>Cd. Indigenous medicinal plants of both cities posed the toxicity risk for Ni, Cu, Fe and crossed the safety limits set by WHO. CONCLUSION: Medicinal plants of Rawalpindi were more toxic compared to the medicinal plants of Islamabad. Prolonged intake or over dose of these medicinal plants may lead to chronic accumulation of various elements that may cause severe hazardous effect upon human health.

Prostate cancer and immunoproteome: awakening and reprogramming the guardian angels.

Prostate cancer is a life-threatening molecular disorder that is undruggable to date because of stumbling blocks in the standardization of therapy. An emerging framework of research is addressing how pathways that are derailed during tumorigenesis are linked to immunological responses, which are instrumental in immunosurveillance of cancer. However, interestingly, cancer cells circumvent such immunosurveillance through development of poorly immunogenic tumor cell variants (immunoselection) and through subversion of the immunological nanomachinery (immunosubversion). Detailed mechanistic insights of molecular specificities that regulate natural killer (NK) cell function suggest that it might be promising to design NK cell-based immunotherapeutic interventions against prostate cancer. Here, we elucidate evidence for NK cell targeting of prostate cancer proteome and address critical questions that, in our view, need thoughtfulness for the development of successful NK cell-based therapies. This review also disproves our contemporary understanding of the versatile regulators of DNA damage repair (ATM, ATR) that trigger cell surface expression of NKG2D ligands and consequent elimination of the tumor cells by NK cells and other lymphocytes that express NK cell receptors. Substantial fraction of information has been generated that guarantees productive future for this technology as more optimized constructs, better trial designs, and improved platforms are being brought from benchtop to bedside.

Upon the tightrope in prostate cancer: two acrobats on the same tightrope to cross the finishline.

Prostate cancer is a multifactorial, multistep progressive disorder that is undruggable to date because of stumbling blocks in the standardization of therapy. It is triggered by a broad range of proteins, signaling networks and DNA damage response modulators. It is becoming increasingly apparent that DNA repair mediators have split personalities, as they are instrumental in suppressing and promoting carcinogenesis. In this article, we discuss on post-transcriptional processing of regulators of DNA damage response, and how DNA repair proteins trigger shuttling of androgen receptor. Substantial fraction of information has been added into the existing literature of ATM biology; however, the particular area of post-transcriptional processing errors and gene therapy for reprogramming of ATM has been left unaddressed in prostate cancer. It is therefore noteworthy that the facet of targeting strategy, antisense morpholino oligonucleotides chemistry, and systematic delivery of AOs has promising outlook in splice-targeted antisense-mediated therapy.