Adipo-myokine Irisin, a Promising Antioxidant against Nicotine Induced Oxidative Stress in BALB/c mice.

Objectives: To determine the role of r-irisin in attenuating nicotine-induced oxidative stress by estimating serum oxidative stress markers and antioxidant enzymes in BALB/c mice. Method: This 18 month experimental study was carried out at Foundation University Islamabad and National Institute of Health starting in 2020. Thirty healthy BALB/c mice were divided into three groups. Group-I (control group) received normal saline 1ml/kg body weight intra-peritoneally daily for 28 days. Experimental group, Group-II received nicotine 2mg/kg body weight intra-peritoneally, for 28 days to induce oxidative stress. Experimental Group-III was given r-irisin 0.5 µg/g body weight/day via tail vein injection, for the last 14 days in addition to intraperitoneal nicotine for 28 days. On 29th day, intra-cardiac blood samples were taken for estimation of serum antioxidant enzymes [Superoxide dismutase (SOD), Reduced Glutathione (GSH) and Catalases (CAT)], and Thiobarbituric Acid-Reactive Substances (TBARS) levels as lipid peroxidation marker using ELISA. SPSS version 24 was used for statistical analysis. Significant difference in parameters across groups was calculated using one way ANOVA. P-value of < 0.05 was considered significant. Results: Group-II showed statistically significant increase in serum lipid peroxidation marker (TBARS) levels (p<0.001) and reduction in serum anti-oxidative enzymes (SOD, CAT, GSH) levels (p< 0.001) as compared to Group-I. In Group-III, with co administration of r-irisin, significant improvement in antioxidant enzymes levels and reduction in TBARS levels was observed (p< 0.001) as compared to Group-II. Conclusion: Irisin ameliorates nicotine induced oxidative stress by improving serum anti-oxidant enzyme levels and reducing serum lipid peroxidation marker.

Effectiveness of modified Valsalva maneuver by using wide bore syringe for emergency treatment of supraventricular tachycardias: Findings from Pakistan.

Background and Objectives: The Valsalva maneuver (VM) is the most effective measure that can be carried out to treat supraventricular tachycardia (SVT). Our objective was to compare the efficacy of postural modified VM with 20 ml syringe to standard VM for the emergency treatment of SVT. Methods: This randomized control trial study was conducted at the Accident and Emergency Department, Pakistan ordinance factories hospital, Wah Cantt from July 2019 to September 2020. In the standard Valsalva group, fifty patients were placed at an angle of 45 with continuous monitoring of vitals and electrocardiogram. Patients blew into a 20ml syringe to generate 40 mmHg pressure for 15 seconds and remained in the same position for 45 seconds before a reassessment of cardiac rhythm at one-minute and three-minute intervals. In the modified Valsalva group same procedure was repeated with the other fifty patients, but immediately at the end of the strain, they were laid flat with their legs raised to 45° for 15 seconds. Participants returned to semi-recumbent position and cardiac rhythm was reassessed after 45 seconds and then at one and three minutes. Results: In the standard Valsalva maneuver (SVM)20.0% of participants versus 58% of participants in the modified Valsalva maneuvers group(MVM) reverted to sinus rhythm at one min (odds ratio or 5.52, 95% CI 2.26-13.47; p<0.001) and time of stay in the emergency room was (odds ratio or 2.39, 95% CI 1.45- 3.93; p<0.0001). Conclusion: Modified Valsalva by using a wide-bore syringe is more effective method than standard Valsalva in terminating SVT.

Survey of knowledge and attitude towards fibromyalgia among physicians in Karachi, Pakistan.

Objectives: Our study aims to assess knowledge and understanding of FM among doctors employed at a tertiary care hospital in Karachi, Pakistan with a focus on its diagnostic criteria, treatment modalities, and general knowledge of symptoms. Study Design: Cross-sectional Study. Methods: Our cross-sectional study recruited participants through convenience sampling. A total of 104 participants responded, which included (a) House Officers, (b) Medical Officers, and (c) Residents. A structured questionnaire was used, and an electronic form was generated which was then emailed to the participants to acquire their responses. Results: The majority (66.3%) of our respondents were female and the median age was 26 years. A majority (93.3%) accepted FM as a separate and distinct clinical identity, and 79.8% were confident in recognizing its general symptoms. Widespread pain (95.2%) and fatigue (80.8%) were correctly identified as most commonly observed symptoms. Moreover, 68.3% of respondents possessed no knowledge of both ACR 1990 and 2010 diagnostic criteria for FM. Of those aware, majority favored using the most recent ACR 2010 criteria (72.7%). Majority of our respondents (75%) preferred using pharmaceutical and non-pharmaceutical interventions simultaneously in the treatment. Conclusions: Our study indicates that while physicians have satisfactory knowledge of the symptoms and treatment modalities of FM, a knowledge gap concerning its diagnostic criteria exists. Proper treatment can only be successful when physicians successfully diagnose FM, therefore, future training programs should use this fact as a stepping stone for advances in its healthcare.

Frequency of Interstitial Lung Disease in Rheumatoid Arthritis Patients: A Hospital-Based Study.

INTRODUCTION: Among various extra-articular manifestations of rheumatoid arthritis (RA), interstitial lung disease (ILD) is the most frequent and concerning manifestation. The reported frequency of RA-associated ILD (RA-ILD) varies in the literature. The objective of the present study was to determine the frequency of ILD in RA patients at a teaching hospital in Rawalpindi. METHODS: 175 male and female patients between 18-70 years were enrolled in the study from January 21, 2022, till July 24, 2022. Patients diagnosed with RA were screened for the concomitant presence of ILD (increased pulmonary markings on chest X-rays and total lung capacity ≤ 80%, predicted on pulmonary function tests). In addition, the frequency of RA-ILD was noted and compared across various subgroups of patients based on age, gender, and disease duration. RESULTS: The mean age of the patients was 45.3 ± 11.5 years. The male-to-female ratio was 1:3.1. The mean disease duration was 6.2 ± 3.5 years at the time of presentation. A total of 118 (67.4%) patients were diagnosed with RA-ILD. The frequency of RA-ILD was significantly higher among patients with a prolonged duration of disease, < 5 years vs. ≥ 5 years (59.1% vs. 75.9%; p-value=0.018). Among 118 patients with RA-ILD, usual interstitial pneumonia (UIP) was the most frequent pattern and was noted in 74 (62.7%) patients, followed by nonspecific interstitial pneumonitis (NSIP), which was noted in 44 (37.3%) patients. When compared, there was no statistically significant difference in the frequency of high-resolution CT (HRCT) pattern of RA-ILD across various subgroups of patients based on age (p-value=0.969), gender (p-value=0.934), and duration of disease (p-value=0.881). CONCLUSION: In the present study, a substantial proportion of RA patients suffered RA-ILD, which warrants routine screening of these patients for undiagnosed pulmonary involvement so that timely identification and anticipated management may improve the outcome of such cases in future clinical practice.

Role of r-irisin in Nicotine-induced Oxidative Stress and Endothelial Dysfunction in BALB/c mice.

OBJECTIVE: To determine the protective role of irisin in attenuating nicotine-induced oxidative stress in vascular tissue in mice. STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: Foundation University, Islamabad, Pakistan, from January 2019 to June 2020. METHODOLOGY: Thirty healthy BALB/c mice were divided into 3 groups. Group 1 was control, group II received nicotine 2 mg/Kg body weight intraperitoneally for 28 days, and group III, in addition, received r-irisin 0.5 µg/g body weight /day via tail vein, for the last 14 days. The tissue anti-oxidant enzymes (SOD, CAT, and GR) and lipid peroxidation marker (TBARS) were estimated. Aortic endothelium was analysed for atherosclerotic changes. The significant difference across groups was calculated using ANOVA. RESULTS: Group II showed statistically significant increase in lipid peroxidation marker (TBARS) levels (1059.04±32.31 ng/ml, p<0.001) and reduction in anti-oxidative enzymes (SOD, CAT and GR) levels (5479.24±25.38 pg/ml, 11.51±0.24 ng/ml and 1924.88±31.23 ng/ml, p<0.001) in aortic tissue homogenate as compared to group I. In Group III, with co- administration of r-irisin, significant improvement in antioxidant enzymes i.e. SOD, CAT, and GR levels (7958.70±110.54 pg/ml, 20.86±0.57 ng/ml, and 2897.18±52.93 ng/ml) and reduction in TBARS levels (239.14±19.90 ng/ml) was observed as compared to Group II (p<0.001). Endothelial damage manifested to type IV on histological examination. Co-administration of r-irisin in group III showed significant improvement in histological grading (only Type I and II lesions were seen). CONCLUSION: Exogenous administration of irisin improves anti-oxidant enzyme levels, ameliorates nicotine-induced oxidative stress, and endothelial dysfunction in the BALB/c mice. KEY WORDS: Irisin/FNDC-5, Oxidative stress, Anti-oxidant enzymes, Endothelial dysfunction, Atherosclerosis.

Continuous infusion of vancomycin improved therapeutic levels in term and preterm infants.

BACKGROUND: Growing evidence suggests that continuous infusion of vancomycin (CIV) is superior to intermittent infusion of vancomycin (IIV) in neonates. This quality improvement (QI) project aimed to transition from IIV to CIV with earlier and improved attainment of therapeutic vancomycin levels. METHODS: The Model for Improvement framework with Plan Do Study Act cycles was used. Prospective data were collected during three phases: IIV, CIV-1 and CIV-2. INTERVENTIONS: A QI team developed a CIV drug monograph and a multidisciplinary education package. RESULTS: Using IIV, 36% (9/25) of first vancomycin levels were within target range. CIV achieved therapeutic levels twice as quickly as IIV (p < 0.05) with improved first vancomycin target levels (IIV 36%, 9/25; CIV-1 55%, 16/29; CIV-2 61%, 14/23) and total therapeutic levels (IIV 44%, 37/84; CIV-1 56%, 55/98; CIV-2 69%, 79/114). CONCLUSIONS: This QI project demonstrated a successful transition from IIV to CIV with reduced time to achieve target vancomycin and an increased proportion of therapeutic levels.