Synergistic neuroprotection by phytocompounds of Bacopa monnieri in scopolamine-induced Alzheimer's disease mice model.

BACKGROUND: Millions of people around the globe are affected by Alzheimer's disease (AD). This crippling condition has no treatment despite intensive studies. Some phytocompounds have been shown to protect against Alzheimer's in recent studies. METHODS: Thus, this work aimed to examine Bacopa monnieri phytocompounds' synergistic effects on neurodegeneration, antioxidant activity, and cognition in the scopolamine-induced AD mice model. The toxicity study of two phytocompounds: quercetin and bacopaside X revealed an LD50 of more than 2000 mg/kg since no deaths occurred. RESULTS: The neuroprotection experiment consists of 6 groups i.e., control (saline), scopolamine (1 mg/kg), donepezil (5 mg/kg), Q (25 mg/kg), BX (20 mg/kg), and Q + BX (25 mg/kg + 20 mg/kg). Visual behavioral assessment using the Morris water maze showed that animals in the diseased model group (scopolamine) moved more slowly toward the platform and exhibited greater thigmotaxis behavior than the treatment and control groups. Likewise, the concentration of biochemical NO, GSH, and MDA improved in treatment groups concerning the diseased group. mRNA levels of different marker genes including ChAT, IL-1α, IL-1 ß, TNF α, tau, and ß secretase (BACE1) improved in treatment groups with respect to the disease group. CONCLUSION: Both bacopaside X and quercetin synergistically have shown promising results in neuroprotection. Therefore, it is suggested that Q and BX may work synergistically due to their antioxidant and neuroprotective property.

Optimizing Eg Orbital Occupancy of Transition Metal Sulfides by Building Internal Electric Fields to Adjust the Adsorption of Oxygenated Intermediates for Li-O2 Batteries.

Li-O2 batteries are acknowledged as one of the most promising energy systems due to their high energy density approaching that of gasoline, but the poor battery efficiency and unstable cycling performance still hinder their practical application. In this work, hierarchical NiS2 -MoS2 heterostructured nanorods are designed and successfully synthesized, and it is found that heterostructure interfaces with internal electric fields between NiS2 and MoS2 optimized eg orbital occupancy, effectively adjusting the adsorption of oxygenated intermediates to accelerate reaction kinetics of oxygen evolution reaction and oxygen reduction reaction. Structure characterizations coupled with density functional theory calculations reveal that highly electronegative Mo atoms on NiS2 -MoS2 catalyst can capture more eg electrons from Ni atoms, and induce lower eg occupancy enabling moderate adsorption strength toward oxygenated intermediates. It is evident that hierarchical NiS2 -MoS2 nanostructure with fancy built-in electric fields significantly boosted formation and decomposition of Li2 O2 during cycling, which contributed to large specific capacities of 16528/16471 mAh g-1 with 99.65% coulombic efficiency and excellent cycling stability of 450 cycles at 1000 mA g-1 . This innovative heterostructure construction provides a reliable strategy to rationally design transition metal sulfides by optimizing eg orbital occupancy and modulating adsorption toward oxygenated intermediates for efficient rechargeable Li-O2 batteries.

Use of Transthoracic Echocardiogram to Detect Left Ventricular Thrombi.

BACKGROUND: The presence of a left ventricular thrombus (LVT) poses a risk of thromboembolic complications and excludes patients from undergoing left ventricular assist device (LVAD) implantation without the aid of cardiopulmonary bypass (CPB). Transthoracic echocardiography (TTE) and transesophageal echocardiography are used to detect LVT in patients with heart disease; however, the detection validity of these imaging studies has not been definitively elucidated. METHODS: A retrospective analysis of patients with end-stage heart failure who underwent LVAD implantation from May 2012 to August 2018 in a single center was completed. To be included, patients' medical records had to have presurgical TTE and transesophageal echocardiographic images, as well as intraoperative digital and visual exploration observations. A total of 301 patients underwent LVAD implantation; 239 of these patients had an LVAD implanted with the use of CPB. A total of 230 patients had complete data sets and were included in the analysis. RESULTS: Preoperative TTE identified LVT in 23 of the 230 patients (10%); 15 patients (6.5%) had LVT confirmed by surgical intraventricular visualization. Of the patients with visual LVT confirmation, preoperative TTE identified an LVT in all but 1 case (93%; 14 of 15). Preoperative TTE of LVT had a high sensitivity (94%) and specificity (96%), as well as high negative predictive value (99%). CONCLUSIONS: The results of this study show that preoperative TTE is highly accurate for LVT detection. The high negative predictive value could have significant implications for the choice of surgical procedure because with TTE, surgeons can reasonably determine whether LVAD placement procedure can be attempted without CPB support.

Cardiotoxicity Related to Radiation Therapy.

With increasing survival from cancer, the incidence of cardiovascular diseases is increasing as a chronic side effect of radiation therapy. Prevention, early recognition, and prompt intervention should be the major focus in the care of these patients.

Knowledge, Attitude, and Practices Related to Cervical Cancer Among Adult Women in Azad Kashmir: A Hospital-based Cross-sectional Study.

Objective To assess the knowledge, attitude, and practices (KAP) related to cervical cancer among the adult women of Azad Kashmir, Pakistan. Methods A cross-sectional study, involving 594 patients visiting the Gynecology and Obstetrics outpatient departments of Khalifa bin Zayed Hospital, Rawalakot, Azad Kashmir, Pakistan, was done. The study questionnaire (interviewer-administered) included 26 items to measure the knowledge, attitude, and practices related to cervical cancer and was formulated and validated with the help of gynecologists and epidemiologists. Descriptive statistics were used to present the knowledge, attitude, and practice level of respondents. The respondents' knowledge, attitude, and practice score was compared across gender and level of education. Data analysis was done using SPSS v 23.0 (IBM Corporation, Armonk, NY, US) at 95% CI. Results A total of 346 (58.2%) women heard about cervical cancer and 210 (35.4%) women heard about the pap smear test. Thirty-five women (5.9%) underwent a pap smear test in their lifetime. More than half (51.7%) thought that undergoing a pap smear test is embarrassing. But 382 respondents (64.3%) will undergo a pap smear test if the test is provided free of cost. Unmarried women had a better KAP score as compared to married women (13.58±5.14 vs 9.12±4.04, p<.001). The KAP score was significantly different in respondents with different levels of education (p<.001). Conclusion This study showed a better KAP score as compared to previous Pakistani studies but, still, there is plenty of room to improve. Women of developed countries have significantly better knowledge, attitude, and practices related to cervical cancer. Local authorities may run a free pap smear screening program in communities to detect cervical cancer early.

Screening of Bifidobacterium strains with assignment of functional groups to bind with benzo[a]pyrene under food stress factors.

The purpose of this study was to find the component of the Bifidobacterium cell wall more particularly the functional groups from peptidoglycan involved in the mechanism of binding with Benzo[a]pyrene. Additionally, the effect of different stress factors (acid, heat, alkaline, oxidative, osmotic, enzymatic, and detergent factors) on the functional group and the overall binding mechanism of Bifidobacterium with B[a]p were also evaluated. Scanning electron microscopy (SEM) and Fourier-transform infrared spectroscopy (FTIR) were used to explain the binding mechanism of Bifidobacterium with B[a]p along with HPLC (high-performance liquid chromatography). The peptidoglycan-B[a]p complexes were highly stable after benzene washing. Peptidoglycan from Bifidobacterium infantis BY12 showed highest binding rate with B[a]p out of nine selected strains. FTIR spectra showed that the main functional groups involved in B[a]p binding were CO, OH and/or NH. FTIR spectrums along with SEM electrographs as a function of stress factors reveal that peptidoglycan structural integrity is important in B[a]p binding. Bifidobacterium longum subsp. infantis BY12 may be employed as a biological detoxification agent for the elimination of B[a]p from human diet and animal feed in the future.

Screening lactic acid bacteria strains with ability to bind di-n-butyl phthalate via Turbiscan technique.

Di-n-butyl phthalate (DBP) is a ubiquitous environmental contaminant that poses a risk to humans. Previous work indicates that the ability of lactic acid bacteria (LAB) to bind phthalic acid esters is strain-specific. As cell suspensions of LAB strains in aqueous solution are likely to be colloidal dispersions, this study provided a technique to efficiently screen LAB strains that bind DBP via Turbiscan, which has been widely used to measure the stability of emulsions or colloidal dispersions. Eleven LAB strains belonging to Lactobacillus plantarum, Lb. pentosus, Lb. paralimentarius, Lb. helveticus, Leuconostoc mesenteroides, Lb. acidophilus, Bifidobacterium lactis, and Bifidobacterium bifidum species were used in this study, and seven of them were selected to test in an earlier stage of exploring the process for finding a screening method; others were used for a validation test. It was observed that the various values of the 10 h Turbiscan Stability Index (TSI) of the cell suspension from each strain, at the equilibrium time of dispersed particles according to the peak thickness of cell-suspensions as measured by Turbiscan, had significant negative correlations with the DBP-binding percentage of LAB strains. Higher TSI values are correlated with lower binding of bacteria strains to DBP with a correlation coefficient of 0.8292. Cell surface hydrocarbons of LAB strains and their adherence were observed to correlate with DBP-binding percentages and may lead to the different states of aggregation or equilibrium of bacterial cell-suspensions, and the aggregation of bacterial cells resulted in fewer binding sites in the cell wall for DBP. Finally, four LAB strains were randomly selected to verify the feasibility of the method. In all, the findings demonstrate that TSI might be used as a tool to quickly screen strains that bind DBP. The present work could be extended to the removal of other toxic compounds, when screening of high-efficiency strains is required.

Ipilimumab and Stereotactic Radiosurgery Versus Stereotactic Radiosurgery Alone for Newly Diagnosed Melanoma Brain Metastases.

BACKGROUND: We compared the safety and efficacy of ipilimumab and stereotactic radiosurgery (SRS) to SRS alone for newly diagnosed melanoma brain metastases (MBM). MATERIALS AND METHODS: We reviewed records of newly diagnosed MBM patients treated with SRS from 2009 to 2013. The primary endpoint of overall survival (OS), and secondary endpoints of local control, distant intracranial failure, and radiation necrosis were compared using Kaplan-Meier method. Univariate and multivariate analysis were performed using the Cox proportional hazards method. RESULTS: Fifty-four consecutive MBM patients were identified, with 20 (37.0%) receiving ipilimumab within 4 months of SRS. Ipilimumab-treated and non-ipilimumab-treated patients had similar baseline characteristics. No difference in symptomatic radiation necrosis or hemorrhage was identified between cohorts. Compared with patients in the nonipilimumab group, 1 year local control (71.4% vs. 92.3%, P=0.40) and intracranial control (12.7% vs. 29.1%, P=0.59) were also statistically similar. The ipilimumab cohort also had no difference in 1-year OS (37.1% vs. 38.5%, P=0.84). Patients administered ipilimumab within 14 days of SRS had higher 1-year (42.9%) and 2-year OS (42.9%) relative to ipilimumab delivered >14 days (33.8%, 16.9%) and SRS alone (38.5%, 25.7%) but these difference were not statistically significant. Univariate analysis and multivariate analysis both confirmed single brain metastasis, controlled primary, and active systemic disease as predictors for OS. CONCLUSIONS: Use of ipilimumab within 4 months of SRS seems to be safe, with no increase in radiation necrosis or hemorrhage; however, our retrospective institutional experience with this treatment regimen was not associated with improved outcomes.

Cardiomyopathy with inverted tako-tsubo pattern in the setting of subarachnoid hemorrhage: a series of four cases.

BACKGROUND: Severe subarachnoid hemorrhage may be associated with regional wall motion abnormalities (RWMA) in the absence of epicardial coronary occlusion. The RWMA extends beyond the distribution of a single coronary artery and may present in a typical tako-tsubo cardiomyopathy pattern. Other variants have also been recognized, including an inverted tako-tsubo pattern of severe basal hypokinesis that spares the apex. The mechanism of this cardiomyopathy is not well understood but likely involves catecholamine excess. While classic tako-tsubo cardiomyopathy from emotional stress carries a favorable prognosis, cardiac dysfunction from subarachnoid hemorrhage is a marker of overall poor prognosis. METHODS: We collected cases over a period of 4 years at a large teaching hospital. The cases represent cardiac dysfunction in the setting of subarachnoid hemorrhage in the unusual distribution of basal hypokinesis with relative sparing of the apex (inverted tako-tsubo pattern). RESULTS: A total of four cases were identified. All cases were female between the ages 43-67 years and had echocardiographic evidence of basal hypokinesis after suffering from an intracranial hemorrhage. CONCLUSIONS: The typical and inverted patterns may represent a spectrum within the same disease process or distinct clinical entities with dramatically different prognostic implications. Larger studies comparing the two presentations will help elucidate this further.

Plasma exchange for severe hypertriglyceridemia-induced pancreatitis in an orthotopic heart transplant recipient.

We here report a 33-year old male with diabetes, hypertension and history of orthotopic heart transplantation treated by plasma exchange for severe HTG (hypertriglyceridemia) induced pancreatitis. At the time of presentation, his serum TG (triglyceride) level was 10,278 mg/dL. He underwent one of the three planned sessions of plasma exchange, resulting in a decrease in TG level from 4728 mg/dL to 1708 mg/dL. The hospital course was complicated with shock, hemorrhagic transformation of the pancreatitis and acute respiratory distress syndrome. This prevented any further plasma exchange sessions. He was subsequently discharged home in a stable state and TG level of 80 mg/dL. Plasma exchange can be safely used to manage HTG induced pancreatitis in heart transplant recipients.

Effect of percutaneous mitral vavuloplasty on pregnant mother and foetus--a tertiary care hospital experience from a developing country.

UNLABELLED: This study evaluated the short and long-term consequences of Percutaneous Mitral Valvuloplasty (PMV) in pregnant patients and their offspring, in a tertiary care setting, Karachi, Pakistan. The hospital database was used to retrieve all patients who underwent PMV during pregnancy in the period 1998-2007. The follow up data of the patients and the born children were obtained from the hospital records and also by contacting the patients via phone. Six patients underwent PMV but follow-up was available for 5 patients only. All 5 patients were admitted due to severe mitral stenosis with symptoms of dyspnea and palpitation. Mean age was 27 +/- 5.3 years with a mean gestational age at the time of procedure of 22.20 +/- 1.6 weeks. The mean valve area increased from 0.94 +/- 0.22 cm2 preoperatively to 1.62 +/- 0.50 cm2 post-operatively. The ejection fraction changed from a mean of 50 +/- 11.7% to 56 +/- 2.2%. There were no maternal deaths, abortions or stillbirths. Developmental milestones were achieved at the appropriate ages in all babies. PMV appears to be a safe and effective intervention for patients with severe MS during pregnancy. KEYWORDS: Mitral stenosis, Percutaneous Mitral

Adherence to the European Society of Cardiology (ESC) guidelines for chronic heart failure--a national survey of the cardiologists in Pakistan.

BACKGROUND: The aims of this study were to evaluate the awareness of and attitudes towards the 2005 European Society of Cardiology (ESC) guidelines for Heart Failure (HF) of the cardiologists in Pakistan and assess barriers to adherence to guidelines. METHODS: A cross-sectional survey was conducted in person from March to July 2009 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta and Peshawar). A validated, semi-structured questionnaire assessing ESC 2005 Guidelines for HF was used to obtain information from cardiologists. It included questions about awareness and relevance of HF guidelines (See Additional File 1). Respondents' management choices were compared with those of an expert panel based on the guidelines for three fictitious patient cases. Cardiologists were also asked about major barriers to adherence to guidelines. RESULTS: A total of 372 cardiologists were approached; 305 consented to participate (overall response rate, 82.0%). The survey showed a very high awareness of CHF guidelines; 97.4% aware of any guideline. About 13.8% considered ESC guidelines as relevant or very relevant for guiding treatment decisions while 92.8% chose AHA guidelines in relevance. 87.2% of respondents perceived that they adhered to the HF guidelines. For the patient cases, the proportions of respondents who made recommendations that completely matched those of the guidelines were 7% (Scenario 1), 0% (Scenario 2) and 20% (Scenario 3). Respondents considered patient compliance (59%) and cost/health economics (50%) as major barriers to guideline implementation. CONCLUSION: We found important self reported departures from recommended HF management guidelines among cardiologists of Pakistan.

Contrast-induced nephropathy in patients undergoing percutaneous coronary intervention.

Contrast Induced Nephropathy (CIN) is a feared complication of numerous radiological procedures that expose patients to contrast media. The most notorious of these procedures is percutaneous coronary intervention (PCI). Not only is this a leading cause of morbidity and mortality, but it also adds to increased costs in high risk patients undergoing PCI. It is thought to result from direct cytotoxicity and hemodynamic challenge to renal tissue. CIN is defined as an increase in serum creatinine by either ≥0.5 mg/dL or by ≥25% from baseline within the first 2-3 days after contrast administration, after other causes of renal impairment have been excluded. The incidence is considerably higher in diabetics, elderly and patients with pre-existing renal disease when compared to the general population. The nephrotoxic potential of various contrast agents must be evaluated completely, with prevention as the mainstay of focus as no effective treatment exists. The purpose of this article is to examine the pathophysiology, risk factors, and clinical course of CIN, as well as the most recent studies dealing with its prevention and potential therapeutic interventions, especially during PCI. The role of gadolinium as an alternative to iodinated contrast is also discussed.

Prevalence of mistreatment or belittlement among medical students--a cross sectional survey at a private medical school in Karachi, Pakistan.

BACKGROUND: Mistreatment or belittlement of medical students either by faculty or fellow students has often been reported. Perception of mistreatment has also been associated with increased degree of psychological morbidity. There is a lack of such studies being conducted amongst the medical students of Pakistan. The aim of this study was to determine the prevalence and forms of perceived mistreatment and presence of mental health morbidity in a private medical school in Pakistan. Also, any association between mental health morbidity and mistreatment was to be identified. METHODS: A cross sectional study was carried out on medical students from Aga Khan University Hospital, Karachi, Pakistan during the period of June-September 2007. A self administered questionnaire, adapted from Frank et al and Baldwin et al was distributed to a total of 350 students. The questionnaire consisted of three parts: the first dealing with the demographics of the population, the second concerning the various forms of mistreatment, while the third assessed the mental health of students using the General Health Questionnaire 12(GHQ12). Descriptive statistics were performed. The Chi-square test and Fisher's exact tests were applied. RESULTS: A total of 350 students were approached out of which 232 completed the questionnaire giving a response rate of 66.2%. Mistreatment was reported by 62.5% (145/232) of the respondents. Of these, 69.7% (83/145) were males and 54.9% (62/145) were females. There was a significant relationship between gender, year division, stress at medical school and possible use of drugs/alcohol and reported mistreatment but no statistical relationship was seen with psychiatric morbidity. The overall prevalence of psychological morbidity was 34.8% (77/221). CONCLUSION: This study suggests high prevalence of perceived mistreatment and psychological morbidity among Pakistani medical students. However, no association was found between these two aspects of medical student education. There is a need to bring about changes to make the medical education environment conducive to learning. Increased student feedback, support systems and guidance about progress throughout the year and the provision of adequate learning resources may provide help with resolving both of these issues.

The burden of stroke and transient ischemic attack in Pakistan: a community-based prevalence study.

BACKGROUND: The burden of cerebrovascular disease in developing countries is rising sharply. The prevalence of established risk factors of stroke is exceptionally high in Pakistan. However, there is limited data on the burden of stroke and transient ischemic attack (TIA) in South Asia. We report the first such study conducted in an urban slum of Karachi, Pakistan. METHODS: Individuals 35 years of age or older were invited for participation in this investigation through simple random sampling. A structured face-to-face interview was conducted using a pre-tested stroke symptom questionnaire in each participant to screen for past stroke or TIA followed by neurological examination of suspected cases. Anthropometric measurements and random blood glucose levels were recorded. Multivariable logistic regression was used to determine the association of vascular risk factors with prevalence of stroke. RESULTS: Five hundred and forty five individuals (49.4% females) participated in the study with a response rate of 90.8%. One hundred and four individuals (19.1%) were observed to have a prior stroke while TIA was found in 53 individuals (9.7%). Overall, 119 individuals (21.8% with 66.4% females) had stroke and/or TIA. Female gender, old age, raised random blood glucose level and use of chewable tobacco were significantly associated with the prevalence of cerebrovascular disease. CONCLUSION: This is the first study demonstrating an alarmingly high life-time prevalence of cerebrovascular disease in Pakistan. Individual and public health interventions in Pakistan to increase awareness about stroke, its prevention and therapy are warranted.

Massive fluid requirements and an unusual BUN/creatinine ratio for pre-renal failure in patients with cholera.

BACKGROUND: Cholera is an important infectious cause of secretory diarrhea. The primary symptom of infection is the sudden onset of watery diarrhea with subsequent volume depletion causing renal insufficiency. The objective of this research is to study the level of dehydration at presentation and subsequent fluid management in patients with cholera. METHODS: This study was conducted on 191 patients of Cholera admitted at a tertiary care hospital in Karachi, Pakistan during the period of 5 years. Medical charts were evaluated retrospectively for initial hydration status, baseline lab investigations on admission and discharge and fluid therapy given to all the patients while their stay in the hospital and the data was analyzed on SPSS 15.0. RESULTS: Out of the 191 patients, 83(43%) were males and 108 (57%) were females with mean age of 42.3 years (SD+/-18.34). The average duration of symptoms was 3.75 days (SD+/-2.04). Of 191 patients, 175 (92.1%) presented with dehydration, 80 (42.3%) were given Ringer's Lactate (R/L) + Normal Saline (N/S), 45 (24%) patients were given R/L + N/S + Oral Rehydration Therapy (ORS), 27 (14.3%) of the patients were kept on R/L only and remaining were given various combinations of R/L, N/S, ORS and Dextrose Saline (D/S). On admission mean Blood Urea Nitrogen (BUN) was 24.54 (SD+/-16.6), mean creatinine was 2.47 (SD+/-2.35) and mean BUN/Creatinine ratio was 11.63 (SD+/-5.7). CONCLUSION: Aggressive fluid rehydration remains the cornerstone of management of cholera. Instead of presenting with a classical BUN/Creatinine ratio of >20:1, patients with pre-renal failure in cholera may present with a BUN/Creatinine ratio of <15:1.

Knowledge and practice of healthy lifestyle and dietary habits in medical and non-medical students of Karachi, Pakistan.

OBJECTIVE: To objectively compare the differences in knowledge and practices regarding healthy lifestyle among medical and non-medical students of Karachi along with assessment of any perceived barriers. METHODS: This cross-sectional study included 350 students between ages 17-24 years from 6 private universities of Karachi--three medical and three non-medical Institutions. A self-reported questionnaire was employed to assess attitude and barriers to healthy practices among the simple random selection of students. RESULTS: On a 10-point scale, the average knowledge score of students on general and clinical nutritional knowledge was 5.7 +/- 1.51 and 4.4 +/- 1.77, respectively and the difference was statistically significant (p < 0.01). Conversely the diet and lifestyle score (85-point scale) among medical (41.3) and non medical students (40.8) was not significant (p = 0.646). There was no difference between the perception of medical and non-medical students regarding 'work-related stress' in their life. 'Lack of time' was cited as the most important reason for skipping meals and as a barrier to exercising regularly among both groups. CONCLUSION: The knowledge, attitudes and practices of medical students in Karachi suggest that superior knowledge about healthy lifestyle does not necessarily result into better practices.

Results of a cross-sectional survey about lipid-management practices among cardiologists in Pakistan: assessment of adherence to published treatment guidelines.

OBJECTIVES: The aims of this study were to assess how closely cardiologists in Pakistan followed published recommendations for lipid management and to identify the factors associated with such behavior. METHODS: A cross-sectional survey was delivered in person between September and December 2007 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta, and Peshawar). A standard questionnaire was used to obtain information from cardiologists. Adherence to the guidelines established by the 2004 National Cholesterol Education Program Adult Treatment Panel III was computed based on answers to 14 questions; each correct answer (ie, the answer that followed the guidelines) was assigned 1 point, for a maximum cumulative score of 14. Multivariable linear regression was performed to determine the factors independently associated with guideline knowledge. RESULTS: A total of 295 cardiologists were approached; 239 consented to participate (overall response rate, 81.0%). The median score was 9 out of a maximum of 14 (interquartile range, 8-11). There were important points of divergence from practice recommendations, including suboptimal targets for low-density lipoprotein cholesterol (LDL-C) (< or = 70 mg/dL was the target used by only 16.7% of respondents [40/239]), undertreatment of revascularized patients (31.4% [75/239]), cessation of statin therapy once LDL-C targets were achieved (20.9% [50/239]), and use of different treatment thresholds for patients aged >65 years (41.8% [100/239]) and female patients (46.4% [111/239]). In the adjusted analysis, experienced physicians, interventional cardiologists, and those who pursued continuing medical education activities (journals and conferences) had higher scores (P = 0.005, P = 0.041, P = 0.008, and P = 0.001, respectively). CONCLUSION: We found important self-reported departures from recommended lipid-management guidelines among cardiologists in Pakistan.

Moyamoya disease: a clinical spectrum, literature review and case series from a tertiary care hospital in Pakistan.

BACKGROUND: Moyamoya is a rare cerebrovascular disease of unknown etiology. The data on moyamoya disease from Pakistan is sparse. We report a case series of 13 patients who presented with moyamoya disease to a tertiary care hospital in Pakistan with a national referral base. METHODS: We conducted a retrospective review of thirteen patients who presented to The Aga Khan University and diagnosed with "Moyamoya Disease" during the period 1988 - 2006. These patients were identified from existing hospital database via ICD-9 codes. A predesigned questionnaire containing information about clinical presentation, management and neuroimaging was administered to all identified patients. RESULTS: There were seven males and six females. Mean age at presentation was 16.5 years and a female predominance was found in the pediatric age group (n = 10, 71.4%). Stroke (n = 11, 84.2%) was the most common presentation with motor deficit being the universal cortical symptom. Fever was a common symptom in the lower age groups (n = 4, 51.7%). Cerebral Angiography and Magnetic Resonance Angiography showed bilateral involvement of the vessels in eleven patients while unilateral in two. Subarachnoid and interventricular haemorrhage appeared in 2(15.4%) adults. Twelve (92.3%) patients were discharged as independent with minor deficits regardless of therapeutic modality. Only three (23.0%) patients underwent surgery whereas the remaining were managed conservatively. CONCLUSION: Physicians when dealing with childhood strokes and characteristic deficits in adult population should consider Moyamoya disease.

Assessment of asthma control using the asthma control test at a tertiary care centre in Karachi, Pakistan.

The aim of our study was to assess asthma control among asthmatics at a tertiary care setting in Karachi using ACT questionnaire. The ACT questionnaire was filled by known asthmatics in January 2007. A total of 150 questionnaires were filled of which, 61 (40%) were males and 89 (60%) females. Mean ACT score was 17.71 +/- 4.41. Association between sex and asthma control was not statistically significant. Significant association was seen with asthma control and Ipratropium bromide inhaler. Asthma control among patients at a tertiary care centre is moderate. ACT can be used to follow patients in the hospital.