Pharmacognostic standardization and DNA fingerprinting of leaves of Datura stramonium, growing naturally in Asir region of Saudi Arabia.

Evaluation of the various pharmacognostic quality parameters and DNA fingerprint of Saudi Arabian medicinal plant namely Datura stramonium growing in Asir region was the objective of the study. The pharmacognostical parameters were done in terms of macroscopic characters, microscopic details, physico-chemical evaluations, phytochemical analysis, fluorescence analysis and DNA fingerprint by using standard techniques and random polymorphic DNA primer. The detailed microscopy of the leaf revealed the presence of pre-medullary phloem, xylem, endodermis, parenchymatous pericycle, lower epidermis and calcium oxalate crystals. There are various amounts of foreign material, ash values, moisture content and extractive values, found after estimations. Preliminary phytochemical screening exhibited the presence of alkaloids, flavonoids, glycosides, tannins and sterols in variable amounts. Random amplified polymorphic DNA (RAPD) showed there are a prominent scorbale DNA bands. These evaluations provided referential information for correct authentication and quality standardization of the important medicinal plant material. These information will also be supportive to differentiate Datura stramonium from the closely related other species.

Life threatening angioedema in a patient on ACE inhibitor (ACEI) confined to the upper airway.

INTRODUCTION: ACE inhibitors accounts for 8% of all cases of angioneurotic edema and the overall incidence is 0.1 to 0.7% of patients on ACE inhibitors. It is a leading cause (20-40%) of emergency room visits in the US with angioedema. We report a case of angioedema caused by ACE inhibitors confined to the upper airway after four years on treatment with Lisinopril which persisted for three weeks and required endotracheal intubation and subsequent tracheostomy due to delayed resolution. This case is one of the rare cases presented as upper airway edema which persisted for a long time. PRESENTATION: A 60-year-old Sudanese male patient with osteoarthritis in both knees underwent bilateral total knee replacement under single-shot epidural anesthesia. He had significant past medical history of type II diabetes, bipolar affective disorder and hypertension managed with Lisinopril for the past four years. Postoperatively after 10 hours the patient desaturated and developed airway obstruction requiring intubation. Laryngoscopy revealed an edematous tongue and upper airway and vocal cords were not visualized. In view of this clinical picture a provisional diagnosis of angioedema secondary to Lisinopril was made and it was discontinued. CT scan of the neck and soft tissues revealed severe airway edema with snugly fitting endotracheal tube with no peritubal air. A repeat CT neck on the tenth postoperative day showed no signs of resolution and an elective tracheostomy was performed on the eleventh postoperative day. C1 inhibitor protein and C4 levels were assayed to exclude hereditary angioedema and were found to be within normal range. Decannulation of tracheostomy was done after airway edema resolved on the twenty-fourth postoperative day as confirmed by CT scan. Subsequently he was transferred to the ward and discharged home. CONCLUSION: ACEI induced angioedema is a well-recognized condition. Early diagnosis based on a high index of suspicion, immediate withdrawal of the offending drug followed by supportive therapy is the cornerstone of management.

Demographic and surgical evaluation of typhoid ileal perforation.

BACKGROUND: Typhoid perforation of small intestine is one of the most common causes of bowel perforation in the developing countries. The purpose of this study was to determine the prevalence, factors affecting prognosis, and optimal surgical management for typhoid perforation in Sindh. METHOD: One hundred and thirty patients with typhoid perforation were included in the study from July 2005 to June 2007 in the Department of Surgery, Liaquat University Hospital, Hyderabad. Patients were admitted as cases of acute abdomen. Detailed history, clinical examination and relevant investigations were carried out. Double layer primary closure, primary loop ileostomy and segmental resection with end-to-end anastomosis were performed according to the operative findings and condition of the patients. Attention was paid to postoperative complications and course of the morbid condition. RESULTS: Majority of patients belonged to deserted areas of district Umerkot (n = 35, 26.93%), and Mithi (n=20, 15.38%) followed by Dadu (n = 17.13.08%), Badin (n = 5, 11.54%), Jamshoro (n= 11, 8.46%), Hyderabad (n = 10, 7.69%), Thatta (n = 9, 6.92%), Mirpurkhas (n = 7, 5.38%) and Sanghar (n = 6, 4.62%). Double layer primary closure of single perforation was done in 50 (38.46%) patients, primary loop ileostomy was performed in 68 (52.30%) patients and primary resection and end-to-end anastomosis was performed in 12 (9.23%) patients. Postoperative complications were observed in 79 (60.76%) patients. Wound infection was the commonest complication seen in 70 (53.84%) patients followed by wound dehiscence in 10 (7.69%), faecal fistula in 9 (6.92%), septicaemia in 8 (6.15%), postoperative chest infection in 25 (19.23%), and intra abdominal abscess in 15 (11.53%) patients. Ten (7.69%) patients died due to septicaemia and other reasons. CONCLUSION: Typhoid perforation remains a frequently fatal illness with high prevalence in remote areas of Sindh. Primary loop illeostomy is the single most successful and life saving surgical procedure in terms of overall morbidity and mortality.

Influence of Fiber Angle on Steady-State Response of Laminated Composite Rectangular Plates.

Significant advances in the field of composite structures continue to be made on a variety of fronts, including theoretical studies based on advances in structural theory kinematics and computer models of structural elements employing advanced theories and unique formulations. Plate vibration is a persistently interesting subject owing to its wider usage as a structural component in the industry. The current study was carried out using the Co continuous eight-noded quadrilateral shear-flexible element having five nodal degrees of freedom, which is ground on first-order shear deformation theory (FSDT). For small strain and sufficiently large deformation, the geometric nonlinearity is integrated using the Von Kármán assumption. The governing equations in the time domain are solved employing the modified shooting technique along with an arc-length and pseudo-arc-length continuation strategy. This work explored the effect of fiber angle on the steady-state nonlinear forced vibration response. To explain hardening nonlinearity, the strain and stress fluctuation throughout the thickness for a rectangular laminated composite plate is determined. The cyclic fluctuation of the steady-state nonlinear normal stress during a time period at the centre of the top/bottom surfaces is also provided at the forcing frequency ratio of peak amplitude in a nonlinear response. Because of the variation in restoring forces, the frequency spectra for all fiber angle orientations show significantly enhanced harmonic participation in addition to the fundamental harmonic.

Sustainability and efficiency analysis w.r.t adoption of climate-smart agriculture (CSA) in Pakistan: a group-wise comparison of adopters and conventional farmers.

Climate change, conventional agricultural management practices, and increasing water scarcity pose a major threat to agricultural production and biodiversity as well as environmental sustainability. Climate-smart agriculture (CSA) is recognized as an efficient, sustainable, and feasible agricultural system that plays a vital role in addressing the potential impacts of climate change in Pakistan. First-hand information was collected from 450 farm households in 24 villages from Okara, Sahiwal, and Khanewal irrigation divisions, having various wheat-based cropping systems of Pakistan. This includes rice-wheat (RW), maize-wheat (MW), and cotton-wheat (CW) cropping systems in the Lower Bari Doab Canal (LBDC) irrigation system. This study estimated and compared the sustainability and efficiency analysis of CSA and conventional agricultural practices. This study also estimated the impact of water-smart practices of the CSA, technical training, and groundwater quality on agricultural production by using production function and bootstrap truncated regression. The findings of this study revealed that adopters of CSA of the wheat-based cropping systems have higher economic benefits and improved resource use efficiencies compared to the conventional farmers. The findings of the study also revealed the increased efficiency of CSA adopters over other two systems in CW cropping system. The water-smart practices of CSA, access to credit, technical training, use of groundwater of varying quality, and other inputs also showed variations in the agricultural production and resource use efficiency. It has been concluded that farmers can earn more profit, save inputs (such as water), and increase their production by adopting water-smart practices of CSA. Hence, the government and other relevant institutions should devise and implement policies that adequately addressed the importance and enhance the use of water-smart practices of CSA in Punjab and beyond.

Helicobacter pylori infection in patients with calcular cholecystitis: a hospital based study.

BACKGROUND: Helicobacter pylori, a gram negative bacillus has been recognised as a public health problem and approximately half of the world population has H. pylori infection causes chronic gastritis, peptic ulcer disease and gastric malignancies. Objective of this study was to determine the frequency of H. pylori infection in patients of chronic calcular cholecystitis. METHODS: This cross-sectional descriptive study was conducted at Liaquat University Hospital, Hyderabad, Pakistan from April 2010 to September 2010. All patients with history of gallstone presented with acute abdominal pain, dyspepsia, bloating and epigastric discomfort and diagnosed as calcular cholecystitis were further evaluated for the detection of H. pylori by serology and histopathology. Frequency and percentage of H. pylori infection in patients with calcular cholecystitis was calculated. RESULT: Total 100 patients of cholelithiasis underwent laparoscopic cholecystectomy were recruited. The pain in upper right part of the abdomen was observed in all 100 patients, fever in 75%, nausea and vomiting in 68%, loss of appetite in 45%, feeling of tiredness or weakness in 22%, headache in 38%, chills in 52%, backache in 58%, pain under the right shoulder in 45%, heartburn in 67%, belching in 54%, indigestion in 80%, dyspepsia in 90%, bloating in 88%, and epigastric discomfort in 85% patients. Eighty-two percent patients had family history of gallstones. The mean age of overall study population was 48.72 +/- 8.78 years and mean age of H. pylori infected calcular cholecystitis patients was 47.98 +/- 5.43 years in male and 48.76 +/- 6.68 years in females. The H. pylori infection was identified in 55% patients with calcular cholecystitis, of which 32.7% were males and 67.3% were females (p=0.03, statistically significant). Majority of females (60%) had > or = 40 U/ml antibody titre (p=0.917, non-significant). CONCLUSION: A possible relationship was identified between Helicobacter pylori and calcular cholecystitis.

Synchronous and metachronous malignant tumours expect the unexpected.

OBJECTIVE: To evaluate occurrence of synchronous and metachronous malignant tumours, to find tumour types, age group, and relationship to treatment received. METHODS: Previously diagnosed 1st primary tumour cases experiencing a synchronous or metachronous tumour, seen at AOI from February 2003 to August 2009 (78 months) were included. The cases were analyzed for morphology/histology of 1st primary tumour, age and gender of patient, treatment received for first tumour, time interval between the 1st and 2nd primary tumour, morphology/histology of second tumour, and the treatment conferred for 2nd tumour. RESULTS: The 2nd synchronous and metachronous tumours were 46/4025 (1.14%), in 18 males and 28 females (M:F 1:1.6). The age range was 16-75 years (median 43 years). The follow up time was 24-150 months. The time to 2nd primary tumour was 2-132 months. The 1st primary tumours were breast, ovary, GIT and urinary bladder. The patients received surgery, radiotherapy, chemotherapy, and hormonal therapy alone or as multi-modality treatment for the 1st tumours. The frequent 2nd tumours were breast, ovary and Gastro Intestinal tumours. CONCLUSION: It is imperative that patients with a primary malignant tumour should be thoroughly, closely, and regularly followed. Genetic counseling, risk estimation, cancer screening and chemoprevention must be emphasized. Every subsequent occurring tumour should be biopsied. The effect of 1st tumour on the 2nd or vice versa are still not fully understood and need exploration. The 2nd primary tumour is usually more aggressive, treatment resistant, and metastasizes early requiring a more aggressive treatment strategy.

Walnut tree falls as a cause of musculoskeletal injury--a study from a tertiary care center in Kashmir.

BACKGROUND: Fall from height is one of the important causes of musculoskeletal injuries. Fall from walnut trees constitutes an important entity that leads to a significant mortality and morbidity amongst those engaged in fruit collection. The present study aimed to determine the prevalence of different musculoskeletal injuries in these victims and to highlight the importance of recognizing this incident as an occupational injury. METHODS: A retrospective study of all patients admitted to the Orthopedic Department of the Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Medical College from January 2003 to December 2007 was conducted. The medical records were studied for the different types of bony injuries, associated injuries and delay in the referral of patients. RESULTS: 94% of falls occurred from August to October. Of the 115 patients, 63 (54.7%) had associated non-orthopedic injuries. Head injury was the most common associated injury, presenting in 34 patients (29.5%). Thoracolumbar (16.5%), calcaneum (10.5%) and distal radius (8.7%) fractures constituted the common fractures encountered in the victims. CONCLUSION: Walnut tree injuries mostly involve young males who form the productive group of the population. Being a seasonal injury, it puts a considerable load on the health resources of the region over a small period of time.

Performance evaluation of conventional and hybrid woven fabrics for the development of sustainable personal protective clothing.

This study examines the performance level of hybrid woven protective clothing (HWPC), manufactured from Kevlar® (K) and Ramie (R) yarns. The weave structures (plain, twill 1/3) and variables fiber ratios were used to produce HWPC. The performance level of HWPC was measured according to EN 388:2016. We came to the conclusion that blade cut resistance of plain and twill structure sustained protection level up to increase of KR 80:20 and KR 70:30, respectively; puncture resistance of K100% and HWPC remained in the same level of protection for plain and twill weaves; Abrasion resistance of K100% and HWPC of plain and twill weaves samples presented abrasive performance of same protection level, but the average number of cycles sustained for twill weave samples was slightly higher than plain weave. However, comparing the plain and twill weaves sample for tear resistance, twill weave samples have higher tear resistance than plain weave. A gray relational analysis and Taguchi method was performed to optimize the performance of two structures with variable fiber ratios. It was established that the article produced with K&R yarns with KR 80:20 ratio and twill weave presented the best performance against all test runs. The main objective of this study is to reduce plastic pollution by reducing the amount of synthetic fiber proportion in personal protective clothing and thereby reducing the dependence on nonrenewable sources for synthetic fiber. The 41 g/m2 reduction of Kevlar® fiber has been made in a conventional PC with ramie fiber, without compromising the protection level. This will enhance the sustainability of HWPC.

Rosuvastatin and retinoic acid may act as 'pleiotropic agents' against ß-adrenergic agonist-induced acute myocardial injury through modulation of multiple signalling pathways.

Cardiovascular disorders constitute the principal cause of deaths worldwide and will continue as the major disease-burden by the year 2060. A significant proportion of heart failures occur because of use and misuse of drugs and most of the investigational agents fail to achieve any clinical relevance. Here, we investigated rosuvastatin and retinoic acid for their "pharmacological pleiotropy" against high dose ß-adrenergic agonist (isoproterenol)-induced acute myocardial insult. Rats were pretreated with rosuvastatin and/or retinoic acid for seven days and the myocardial injury was induced by administering isoproterenol on the seventh and eighth day. After induction, rats were anaesthetized for electrocardiography, then sacrificed and different samples were collected/stored for various downstream assays. Myocardial injury with isoproterenol resulted in increased cardiac mass, decreased R-wave amplitude, increased QRS and QT durations; elevated levels of cardiac markers like cTnI, CK-MB, ALT and AST; increased lipid peroxidation, protein carbonylation and tissue nitric oxide levels; decreased endogenous antioxidants like SOD, CAT, GR, GST, GPx and total antioxidant activity; increased inflammatory markers like TNF-α and IL-6; decreased the mRNA expression of Nrf2 and Bcl-2; increased the mRNA expression of Bax, eNOS and iNOS genes. Pretreatment with rosuvastatin and/or retinoic acid mitigated many of the above biochemical and pathological alterations. Our results demonstrate that rosuvastatin and retinoic acid exert cardioprotective effects and may act as potential agents in the prevention of ß-adrenergic agonist-induced acute myocardial injury in rats. Cardioprotective potential of rosuvastatin and retinoic acid could be attributed to their influence on the redox pathways, immunomodulation, membrane stability, Nrf2 preservation, iNOS and Bax expression levels. Thus, they may act directly or indirectly at various steps, the breakpoints, in the pathophysiological cascade responsible for cardiac injury. Our study gives insights about the pharmacological pleiotropism of rosuvastatin and retinoic acid.

Retroperitoneal laparoscopic uretero-pyelostomy for symptomatic yo-yo reflux.

Incomplete ureteric duplication is usually an incidental finding. However, this condition may occasionally be symptomatic and warrant surgical correction. Various surgical procedures are used to treat this condition with varying degrees of success. We present the case report of a 21-year-old female who had right-sided symptomatic incomplete ureteric duplication and was managed by retroperitoneal laparoscopic ureteropyelostomy. To our knowledge, this is the first reported case of such a procedure.

Extraction of a rectal foreign body - an alternative method.

We present a case report of trans-anal extraction of a foreign body from the rectum using an unconventional instrument. Our patient presented with impacted retained rectal foreign bodies. As the patient suffered from psychosis, a laparotomy with a stoma would have been difficult to manage. It was thus decided to make every effort to retrieve the objects transanally. After failed attempts with retractors and endoscopy, Kielland obstetric forceps were used successfully to retrieve the foreign body transanally. The authors have found no other report describing use of Kielland obstetrical forceps to retrieve foreign bodies from the rectum.

Synchronous perforation of sigmoid diverticula: a rare presentation.

Diverticular disease affects more than 50% of the population over the age of 60 years in the west and becomes even more common as the population ages. Diverticulitis is one of the complications of diverticular disease and can culminate into colonic perforation. Though perforated diverticular disease is not uncommon, synchronous colonic perforations in diverticulitis is rare. Our patient was admitted with acute abdomen and exploratory laparotomy revealed two side-by-side perforations of the sigmoid colon. A Hartmann's procedure was performed. Macro- and microscopic evaluation confirmed the presence of two perforated sigmoid diverticula due to diverticulitis. Simultaneous perforation of two abreast sigmoid diverticula is uncommon; thus, a cautious surgeon should always take into account such a probable diagnosis.

Recurrent Unexplained Cystitis Due to an Ingested Foreign Body-An Extremely Rare Case.

We present the images of a 4-year-old male child with history of recurrent unexplained urinary tract infections which was found to be due to an ingested wooden foreign body which had perforated the small bowel into the posterior bladder wall. Such cases are very rare, usually due to domestic abuse or in patients with psychiatric illnesses. The adults usually report early but in children these cases go un-noticed. These patients may present with features of bowel obstruction, perforation, or hematochezia.1 as recurrent urinary tract infections seems to be the first case to be reported.

Development and Validation of a LC-MS/MS Method for the Simultaneous Estimation of Amlodipine and Valsartan in Human Plasma: Application to a Bioequivalence Study.

A reliable, simple, and robust liquid chromatography-tandem mass spectro-metric (LC-MS/MS) method has been developed and validated that employs solid-phase extraction for the simultaneous estimation of amlodipine and valsartan in human K3EDTA plasma using amlodipine-d4 and valsartan-d9 as internal standards. Chromatographic separation of amlodipine and valsartan was achieved on the Luna C18 (2)100A (150 × 4.6 mm, 5 µm) column using acetonitrile: 5 mM ammonium formate solution (80:20, v/v) as the mobile phase at a flow rate of 0.8 mL/min in isocratic mode. Quantification was achieved using an electrospray ion interface operating in positive mode, under multiple reaction monitoring (MRM) conditions. The assay was found to be linear over the range of 0.302-20.725 ng/mL for amlodipine and 6.062-18060.792 ng/mL for valsartan. The method has shown good reproducibility, as intra- and interday precisions were within 10% and accuracies were within 8% of nominal values for both analytes. The method was successfully applied for the bioequivalence study of amlodipine and valsartan after oral administration of a fixed dose of the combination. Additionally, as required by the current regulatory bodies, incurred sample reanalysis was performed and found to be acceptable.

Psychiatric Co-morbidity in Patients With Irritable Bowel Syndrome at a Tertiary Care Center in Northern India

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a chronic psycho-physiological disorder. It is considered to be the most common functional gastrointestinal disorder, and about 50–90% of IBS patients have associated psychiatric co-morbidity. We aimed to study psychiatric co-morbidities in patients with IBS visiting a tertiary care center. METHODS: This was a cross-sectional case-control study conducted over a duration of one and a half years from January 2014 to July 2015. Patients were selected from the out-patient department of gastroenterology. About 160 patients with IBS who fulfilled the inclusion criteria and who gave written informed consent were selected as study cases. The healthy attendants of cases were selected as controls. A total of 200 controls were selected. Rome-III criteria were used to diagnose IBS. For diagnosing psychiatric disorders, we used the Mini International Neuropsychiatric Interview Schedule Plus. RESULTS: Mean age of our cases and controls was 39.7 ± 11.4 and 37.7 ± 9.6 years, respectively. Females outnumbered males in our cases as well as their controls by a ratio of 2:1 approximately. Psychiatric disorders were seen in 84.4% of IBS patients as compared to 41.5% in controls. Major psychiatric disorders seen in our patients were generalized anxiety disorders (30.0%) and depression (28.0%). CONCLUSIONS: The majority of patients with IBS who present to a tertiary care center have co-morbid psychiatric disorders. We need to screen these patients for such co-morbidities and develop a holistic approach for better outcome in such cases.

Management of variceal hemorrhage in children with extrahepatic portal venous obstruction-shunt surgery versus endoscopic sclerotherapy.

Extrahepatic portal venous obstruction (EHPVO) is a common cause of portal hypertention in children. Esophageal variceal hemorrhage is a major cause of morbidity and mortality in these patients. For many decades, portal systemic shunts were considered as the most effective treatment of variceal hemorrhage. Endoscopic injection sclerotherapy (EIS) was first introduced for emergency management of bleeding varices and subsequently as definitive treatment to prevent recurrent hemorrhage. The purpose of the study was to compare the safety and efficacy of shunt surgery and endoscopic sclerotherapy for patients with proven esophageal variceal bleeding due to EHPVO. The study was a prospective randomized study of 61 children with bleeding esophageal varices due to EHPVO carried out jointly by the department of General Surgery and Gastroenterology at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, between March 2001 and September 2003. Thirty patients received surgery and other 31 patients received EIS. Overall incidence of rebleeding was 22.6% in sclerotherapy group and 3.3% in shunt surgery group. Treatment failure occurred in 19.4% patients in sclerotherapy group and 6.7% in shunt surgery group. The rebleeding rate of sclerotherapy is significantly higher than that of shunt surgery. However, the therapy failure rate of sclerotherapy is not significantly different from that of shunt surgery.

Small lateral access--an alternative approach to appendicitis in paediatric patients: a randomised controlled trial.

BACKGROUND: Conventionally the appendix is removed through a right lower quadrant transverse incision or a gridiron incision approximately 5 cm in length. In this modern era of minimally invasive surgery, there is a lot of emphasis on cosmesis and early recovery. We performed a prospective, double blind, randomised trial to evaluate a new incision for appendectomy to compare with conventional appendectomy. METHODS: One hundred and twenty patients, aged between 3 and 18 years, were randomized to receive either small access appendectomy (SAA) (n=60, 53 acute appendicitis and 7 interval appendectomy) or conventional appendectomy (CAP) (n=60, 55 acute appendicitis and 5 interval appendectomy). SAA was performed through an incision in the lateral 1/3 of the spino-umbilical line, lateral to McBurney's point. The caecum along with the appendix could be delivered through this small incision easily as the ileal loops did not interfere with the delivery. All patients suspected of acute appendicitis were evaluated by the modified Alvarado's system to reduce the rate of negative appendectomies. Patients with diffuse peritonitis were excluded. RESULTS: The demographic data for the two groups were similar. The SAA group required less analgesics (p<0.001), had earlier ambulation and shorter hospital stay (p<0.001), and better cosmetic score (p<0.001), but the operation took longer (p<0.001) compared to the CAP group. CONCLUSION: We conclude that SAA can be done safely without the need for any special equipment, with definite advantages over conventional appendectomy.