Comparison of Efficacy of Topical Betamethasone Dipropionate and Topical Minoxidil in Patients With Alopecia Areata.

Background and objective Alopecia areata (AA) is a reiterative and nonscarring type of hair loss that can affect any hairy area of the body, particularly the scalp. It manifests as patchy or confluent hair loss with variations in demographics and ethnicity. There are numerous treatment options available, including topical and systemic steroids, topical minoxidil, dithranol, tacrolimus, psoralen and ultraviolet therapy (PUVA), contact immunotherapy, and oral immunosuppressive drugs. However, no previous contrast for efficacy is present between the topical betamethasone versus topical minoxidil alone in our population. This study aims to compare the efficacy of topical betamethasone dipropionate versus topical minoxidil in patients with AA. Methodology A nonrandomized controlled study was conducted at the Department of Dermatology, Jinnah Hospital Lahore, incorporating the data of patients between July 26, 2016, and January 26, 2017, after obtaining institutional ethical approval. One hundred patients with alopecia, either on the scalp or any other hairy part, from both genders, aged between 18 and 50 years, were included in the study. Two groups were created, and patients were assigned to these groups based on the clinician's choice. Group A patients were administered betamethasone dipropionate (0.05%) lotion twice daily on affected areas for 12 weeks. Group B patients were administered minoxidil (5%) solution twice daily on affected areas for 12 weeks. A four-week follow-up plan was followed. A five-point scale score system was used for alopecia grading. After 12 weeks, the hair regrowth score (RGS) was used to compare the efficacy of treatment between the two groups. Results A total of 100 patients with grades S1 to S3 AA of less than three months duration were enrolled. Two groups were created, with 50 patients in each group. The mean age in Group A was 29.08 ± 6.51 years, while in Group B, it was 29.38 ± 6.62 years. In Group A, there were 76% males and 24% females, while in Group B, there were 74% males and 26% females. Comparison of efficacy of topical betamethasone dipropionate versus topical minoxidil in patients with AA demonstrated a greater efficacy of 74% (Grade 3 and Grade 4 responses) in Group A, while in Group B, only 42% of patients showed efficacy. A statistically significant difference was found, with a P-value of 0.001. No serious side effects were noted. Conclusions Our study concluded that topical betamethasone dipropionate (0.05%) lotion has statistically significantly higher efficacy compared to topical minoxidil (5%) solution in patients with AA.

Alternative treatment of polycystic ovary syndrome: pre-clinical and clinical basis for using plant-based drugs.

The most common cause of infertility and metabolic problems among women of reproductive age is polycystic ovary syndrome (PCOS), a multifaceted disorder. It is an endocrine disorder that occurs in approximately one in seven women. Among these PCOS patients, two thirds will not ovulate on a regular basis and seek treatment for ovulation induction. The symptoms vary in their severity, namely ovulation disorders, excessive androgen levels, or polycystic ovarian morphology. All these symptoms require a therapeutic approach. Many drugs are used to eradicate PCOS symptoms, like metformin, clomiphene citrate, spironolactone, and pioglitazone. Long-term treatment is required to achieve the desired outcome, which is often accompanied by significant adverse reactions. Some herbs and phytochemicals are equally effective for treating PCOS and produce minimal side effects. Recently, herbal products are gaining popularity due to their wide biological activities, safety, availability, and efficacy. The present review covers aetiology, current treatment, pathophysiology, and detailed pre-clinical and clinical studies on plants and phytochemicals that are proven to be useful for the treatment of symptoms associated with PCOS.

Synthesis and Characterization of ZIF-67 Mixed Matrix Nanobiocatalysis for CO2 Adsorption Performance.

In this study, ZIF-67-based mixed matrix membrane was synthesized with a solution casting method using tetrahydrofuran as the solvent. The as-synthesized ZIF-67 was characterized using PXRD, TGA, ATR-FTIR, and BET analysis for the surface area measurements. The minimum 3 wt% loading of ZIF-67 was incorporated within a hydrophobic polymer to evaluate the CO2 adsorption performance of ZIF-67. The stability of ZIF-67 in pure water and inorganic solvents was investigated. The maximum CO2 adsorption of the ZIF-67 mixed-matrix membrane (MMM) was 0.5 mmol/g at 273 K, which is higher than that of the pure polymer. The fabricated ZIF-67-based mixed-matrix membrane showed higher CO2 capture even at lower MOF loading using THF. The current study highly recommends the combination of hydrophobic polysulfone and a water-stable ZIF-67 for CO2 capture from wet flue gases.

Biodegradation study of Polyethylene and PVC using naturally occurring plastic degrading microbes.

One of the most serious man-made concerns today is the ever-increasing amount of plastic waste overwhelming the planet. The worldwide interest in using polymers consistently expanded over the years. Because of the plastic wastes thrown into the environment, outrageously the plastic pollution is increasing. In the present study, degradation of PVC and polyethylene-derived synthetic polymers has been carried out. The fungi and bacteria were isolated from the soil of the plastic waste environment and were used for the biodegradation of plastic films. Successful bacterial candidates for biodegradation were identified after screening. The bacterial strain Sb1 was identified as Bacillus licheniformis and Sb2 as Achromobacter xylosoxidans. The fungal strains Sf.1 and Sf.2 were identified as Aspergillus niger and Aspergillus glaucus, respectively. The degraded polymeric films were critically assessed by following the characterization methods like weight loss, FTIR and SEM. The results indicate that the polymers of polyethylene sample showed 32.2% degradation using bacterial strains and 40% using fungal strains in a time duration of just 4 weeks. PVC samples degraded 17 and 32% by fungal strains after 4 weeks. The changes in surface topography was confirmed by scanning electron microscopy and the changes in functional groups intensity was observed using the FTIR. Different parameters, varying temperature, pH, and inoculum concentration, were also evaluated, which implied that plastic waste treated by fungal and bacterial strains gives significant (p < 0.05) result in polymer degradation. As a result, the current research gave a scientific justification that bacteria and fungus could be further developed as promising candidates for plastic bioremediation.

Biodeterioration of Microplastics: A Promising Step towards Plastics Waste Management.

Polyethylene and Polyester materials are resistant to degradation and a significant source of microplastics pollution, which is an emerging concern. In the present study, the potential of a dumped site bacterial community was evaluated. After primary screening, it was observed that 68.5% were linear low-density polyethylene, 33.3% were high-density, and 12.9% were Polyester degraders. Five strains were chosen for secondary screening, in which they were monitored by FTIR, SEM and weight loss degradation trials. Major results were observed for Alcaligenes faecalis (MK517568) and Bacillus cereus (MK517567), as they showed the highest degradation activity. Alcaligenes faecalis (MK517568) degrades LLDPE by 3.5%, HDPE by 5.8% and Polyester by 17.3%. Bacillus cereus (MK517567) is better tolerated at 30 °C and degrades Polyester by 29%. Changes in infrared spectra indicated degradation pathways of different strains depending on the types of plastics targeted. Through SEM analysis, groves, piths and holes were observed on the surface. These findings suggest that soil bacteria develop an effective mechanism for degradation of microplastics and beads that enables them to utilize plastics as a source of energy without the need for pre-treatments, which highlights the importance of these soil bacteria for the future of effective plastic waste management in a soil environment.

Non-fasting OGTT versus Fasting OGTT for screening of Hyperglycaemia in Pregnancy (HIP).

OBJECTIVES: To compare the reliability of non-fasting oral glucose tolerance test (OGTT) versus fasting OGTT for screening of hyperglycaemia in pregnancy (HIP). METHODS: This cross sectional analytic study was conducted by the Department of Obstetrics & Gynaecology, Isra University Karachi Campus from October 2016 to April 2017. A total of 225 pregnant women irrespective of gestational age were included in the study. They underwent non fasting 75 grams OGTT. Venous plasma glucose was done 02 hours after the glucose load. Same women were advised to come again within three to seven days for fasting OGTT. Venous plasma glucose (VPG) was estimated in fasting and 2 hours post glucose load. RESULTS: Using the non-fasting OGTT, out of 204 women, 32 were diagnosed with hyperglycemia. All these 204 women were again called for fasting OGTT three to seven days after the initial non-fasting OGTT. Only nine were diagnosed with hyperglycemia, out of these nine women, seven women who were screen positive on non-fasting OGTT were found to be screen positive on fasting OGTT as well. However, only two women were additionally diagnosed with hyperglycemia who were initially screen negative on non-fasting OGTT. The non-fasting OGTT has diagnosed HIP with sensitivity of 77.7%, specificity of 87.1%, positive predictive value of 21.8% and negative predictive value of 98.8%. CONCLUSION: The use of the non-fasting OGTT at first antenatal visit may be a practical approach to detect the HIP as screening and diagnostic tool in the resource constrained settings.

Investigation of calcium silicate as a natural clay-based sunblock: Formulation and characterization.

BACKGROUND: Sunlight exposure causes several types of health issues to humans, and in particular, it affects especially the skin. Among the most common harmful issues developed by UV exposure are erythema, pigmentation, and lesions in DNA, which may lead to cancer. These long-term effects can be minimized with the use of sunscreen. OBJECTIVE: The use of commercial UV filters causes severe side effects such as skin allergy and whitening of the skin. Therefore, in this study the effectiveness of Ca2 SiO4 , a compound abundantly present in the soils of certain South Asian regions, has been the first time explored as UV filter. This compound leaves a low amount of white residue on the skin and is highly stable. METHOD: The comparative study of a cosmetic formulation having 5% Ca2 SiO4 , and other formulations containing 5% TiO2 and 5% ZnO as inorganic UV filters, was performed to evaluate the physical and chemical stability. RESULT: The zeta potential and chemical stability of formulations containing these different UV filters were investigated by using UV-Vis spectroscopy, FTIR-ATR, and X-ray diffraction. Results indicated Ca2 SiO4 as a promising innovative UV filter with an SPF value of 37.94. One of the reasons is its low interaction with organic filter, that is, PABA, as compared to commercial ZnO and TiO2 inorganic UV filters. Biological absorption in organs was studied by ICP-MS on model mice. CONCLUSION: It also has a low photocatalytic activity; thus, formation of radicals is minimum. Moreover, Ca2 SiO4 showed a recognized ability to leave a low amount of white residue on the skin combined with great stability.

Bacterial-mediated synthesis of silver nanoparticles and their significant effect against pathogens.

Silver nanoparticles are potent antimicrobials and could be used as a promising alternative of conventional antibiotics. The aim of this study was to isolate bacteria from soil that have ability to produce AgNPs by secondary metabolite activity and their elucidation against human pathogens. These strains Escherichia coli, Exiguobacterium aurantiacumm, and Brevundimonas diminuta with NCBI accession number MF754138, MF754139, and MF754140 respectively were grown for secondary metabolite production. The nanoparticles were confirmed and characterized by UV-Vis spectroscopy and transmission electron microscopy. The optimization study was also carried out to obtain the maximum production of silver nanoparticles. Three parameters, temperature, pH, and AgNO3 concentration, were used to optimize the production of silver nanoparticles. Antimicrobial potential of these nanoparticles was addressed on the Muller-Hinton Agar, and their zones of inhibitions were measured. TEM analysis revealed the size and shape of the silver nanoparticles. All types of AgNPs were spherical in shape; their size range is from 5 to 50 nm. The findings of optimization study showed the maximum production of silver nanoparticles at the pH 9, temperature 37 °C, and 1 mM AgNO3 concentration. All the strains exhibited the great potential as antimicrobial agents against MRSA and several other MDR bacteria with minimum 10 mm to maximum 28 mm zone of inhibition. It was concluded that the present study is an eco-friendly approach for the synthesis of AgNPs that will be beneficial to control the nosocomial infections triggered by MRSA and other human pathogens.

Cancer and how the patients see it; prevalence and perception of risk factors: a cross-sectional survey from a tertiary care centre of Karachi, Pakistan.

BACKGROUND: The incidence of cancer is rising but data available regarding prevalence of cancer and patient perception of the disease in Pakistan is limited. It is difficult to deal with Cancer if the main causes are negligence towards risk factors and bizarre myths. This study was aimed to investigate common cancer presentations at a government sector hospital and to gain insight into patient knowledge of the disease. METHODS: This was a cross-sectional study conducted on cancer patients from Jinnah Postgraduate Medical Centre. A self-made questionnaire was used to assess the norms related to cancer prevalence in our society, associated myths, and the most common risk factors per them. RESULTS: A total of 402 participants consented to participate in the study (mean age 42.3 ± 15.07 years), 204(50.7%) were females and 190(47.3%) were illiterate. Biomass exposure was found in 147(37%), drug abuse in 132(33%) and smoking in 63(16%). We found 103(25.6%) had positive family histories of cancer. The most common primary tumor site was breast for females 98(48%) and Head and neck 66(33.3%) for males. Patients considered fate 328(82%), gutka 284(71%) and injuries 282(70%) as the most common causes for cancer; while 222(55.5%) considered black magic and 236(58.75%) considered evil eye as a risk factor for cancer. Cancer treatment caused significant financial stress in 376(93.5%) patients. CONCLUSION: Breast and head and neck cancers were found to be prevalent among patients. It was noted that patients are negligent in daily life regarding the consumption of substances that commonly cause cancer. Individuals had diminished knowledge and majority linked cancer to unrelated causes and myths like black magic and fate. Almost all the patients complained of severe financial stress imposed by the disease.

Pre-Ramadan health seeking behavior, fasting trends, eating pattern and sleep cycle in pregnant women at a tertiary care institution of Pakistan.

OBJECTIVE: To observe the pre-Ramadan health seeking behavior, fasting trends, eating pattern and, sleep cycle in pregnant women. METHODS: It is a cross-sectional observational study, from July to September 2017, conducted at Tertiary Care Hospital in Karachi. The tool used for data collection was interviewer based closed ended questionnaire, 279 pregnant women who fasted during Ramadan were included in the study. RESULTS: One to ten days of fasting was observed by 85.7% (198) of women. About 72.4% (202) never consulted any doctor for pre-Ramadan advice regarding fasting in pregnancy. Pregnant women 81.7% (228) believed that fasting would not cause any harm to their unborn child, while 42.7% (119) of family members feared about the health of mother and unborn child. Seventy four percent (208) of respondents had a reduced sleep cycle of about 3-4 hours. The food items consumed at Sehri and Iftar were rich in carbohydrates and fats. CONCLUSIONS: Pre-Ramadan medical consultation regarding safety of fasting during pregnancy should be structured and customized for women and their families. Gaps in knowledge identified in this study may help healthcare professionals to address these issues.

Vesicouterine fistula.

A 41 years lady presented with 13 years history of urinary incontinence alongwith menouria, which had developed after the first vaginal delivery. However, she had four normal vaginal deliveries later. Intravenous urography showed normal flow on both sides but there was spillage of contrast from the urinary bladder into the uterus, in the cystographic phase. Cystoscopy showed a fistulous opening in the posterior wall of bladder above the trigone. She was subjected to total abdominal hysterectomy with repair of the fistulous bladder opening. Postoperative recovery was smooth and the patient became asymptomatic.

Ureterovaginal fistula--etiological factors and outcome.

OBJECTIVE: To assess the etiological factors and the outcome of ureterovaginal fistula in an urban setting. METHODS: The observational study was conducted at the Armed Forces Institute of Urology, Military Hospital, Rawalpindi, from January 2009 to January 2011. All the patients of uretero-vaginal fistula at the centre were included on the basis of non-probability purposive sampling. The etiology, clinical presentation and the investigative procedures were recorded. The operative modality contemplated was noted and post-operative results were evaluated. The data was entered in a structured proforma and analysed for descriptive statistics using SPSS version 14.0. RESULTS: Seventeen cases of ureterovaginal fistula were recorded. Amongst these 10 (58.8%) were post-hysterectomy, while 7 (41.1%) cases post-caesarean section. The emergency procedures performed by the residents/junior registrars contributed 12 (70.2%) of the cases. All these patients were treated surgically; 14 (82.3%) were managed with ureteroneocystostomy, 2 (11.7%) required Boari Flap reconstruction, and in psoas hitch was performed in 1 (5.8%) case. The time of intervention was 4 - 12 weeks (9.76 +/- 2.223). Post-operatively, only 1 (5.8%) case had superficial wound infection and 1 (5.8%) urinary tract infection. All the patients remained dry with a follow-up period of 3 - 24 months (mean 12.24 +/- 6.879). CONCLUSION: Ureterovaginal fistula is one of the complications of emergency procedures, especially in the hands of inexperienced surgeons. Prompt diagnosis and surgical intervention produce excellent results. Intervention can be done safely as early as 4 weeks after the initiation of the condition.

Postoperative complications in emergency versus elective laparotomies at a peripheral hospital.

BACKGROUND: Laparotomy is a commonly performed procedure in any surgical unit. Postoperative complications directly affect the outcome of the disease. The aim of the study was to evaluate and compare the postoperative complications in emergency versus elective laparotomies at a peripheral hospital. METHODS: This comparative cross-sectional study was carried out at the Department of General Surgery, Combined Military Hospital, Bahawal Nagar Cantonment from Feb 2006 to May 2009. One hundred and four consecutive patients undergoing laparotomy were included. They were divided into two groups: emergency laparotomies (Group-A) and elective laparotomies (Group-B). They were followed up meticulously and the postoperative complications/sequel were recorded. RESULTS: In Group-A there were 83 patients while in Group-B only 21 patients were recorded. A total of 73 postoperative complications were seen in 28 patients (33.7%) in Group-A, while 5 complications were seen in 3 patients (14.2%) in Group-B. The Group-A showed 21.6% postoperative fever and wound infection, postoperative nausea and vomiting was 13.2%, wound dehiscence 4.8%, incisional hernia 3.6%, pneumonia/anastomotic disruption 2.4% and duodenal fistula/peristomal excoriation/adhesive intestinal obstruction 1.2%. The septicaemia was seen in 6.0% and mortality in 8.4%. Group B showed 14.2% postoperative fever and 4.7% postoperative nausea and vomiting/wound infection. No case of septicaemia or mortality was seen. CONCLUSION: The postoperative complications are more common in emergency laparotomies as compared to the elective ones. Postoperative fever, wound infection, nausea and vomiting are the mostly encountered complications.

Acute acalculous perforated cholecystitis.

A case of acute acalculous perforated cholecystitis with acute generalized peritonitis in a middle aged cachectic man, presenting late in a moribund condition, is reported. He underwent emergency laparotomy (subtotal cholecystectomy), went into multi-organ failure and was managed accordingly. The patient recovered in about 2 weeks and was followed-up regularly.

Ruptured ovarian teratoma presenting as peritonitis.

A 55-year-old lady reported to the surgical OPD with clinical findings of acute peritonitis. Emergency laparotomy was performed. The peritoneal cavity was full of purulent material, however, the gut was normal. An 8 x 6 cm thick walled cyst was found in the left ovary with a minute perforation and purulent fluid coming out of it. Thorough peritoneal lavage along with left oophorectomy was performed. The postoperative recovery was smooth. Histopathology confirmed benign cystic teratoma of ovary.

Cholecysto-hydatid cyst fistula.

We present a case of recurrent hydatid cyst liver in a 32-year-old female. Previous surgery was performed 8 years ago elsewhere. Pre-operative assessment at presentation revealed a 110 x 105 mm hydatid cyst in the right lobe of the liver. On exploration, a 5 mm fistulous communication was found between the hydatid cyst and the gallbladder. Patient was subjected to endocystectomy (partial cystectomy), cholecystectomy and closure of the fistula followed by obliteration of the cavity with omentum. Postoperative recovery was uneventful.

Pierre robin sequence as birth asphyxia in a new born.

A new born baby boy presented with birth asphyxia and respiratory distress. He went into cardiac arrest twice but was resuscitated. On detailed evaluation, he had low set ears and micrognathia with glossoptosis consistent with features of Pierre Robin sequence. Episodes of apnoea disappeared, on nursing, the baby in prone position and later on tongue-lip retention suture were applied. Prompt diagnosis and efficient airway management by following the principles of airway resuscitation can save the lives of such babies without specialized care.

Retroperitoneal masses: different clinical scenarios.

We present two cases of retroperitoneal masses with different presentations and outcomes. The first case was a 22 years old primigravida lady who underwent emergency caesarean section for preterm premature rupture of membranes with breach. On the operating table, a large retroperitoneal mass was identified and the biopsy confirmed Burkitt's lymphoma. Post operative chemotherapy did not have a favourable result and the patient had a fatal outcome. The other case was a 15 years old boy who had a progressively increasing retroperitoneal mass. Exploratory laparotomy revealed a hard, fixed, unresectable tumour extending into the mesentery of the small gut, biopsies were taken which showed tuberculosis. Post operative antituberculosis treatment had a marked response and the tumour disappeared after 6 months.

Combined urethrolithotomy with vesicolithotomy in an 18-months old boy.

We present a case of 18 months old male child who reported with acute urinary retention. He had a urethral calculus along with a vesical calculus. He was subjected to combined external urethrotomy and open vesicolithotomy in one sitting. The patient made a smooth post operative recovery and was followed up for 6 months.

Multiple perineal sinuses in non-hodgkin's lymphoma.

A 60 years old male presented with a 10 years history of chronic discharging perineal sinuses with inguinal lymphadenopathy. Biopsy of the inguinal lymph node revealed follicular B-cell non-Hodgkin's lymphoma while the biopsy of the sinuses was non-specific. It was diagnosed as a case of primary nodal NHL with secondary cutaneous manifestations of multiple perineal sinuses (paraneoplastic dermatosis). After two courses of chemotherapy, the discharge from the sinuses disappeared and the lesions healed by scarring.