Composition and structure of plant communities in the Moist Temperate Forest Ecosystem of the Hindukush Mountains, Pakistan

Abstract Here, we investigated the relationship between Plant communities and the environment from the moist temperate vegetation of Lakoo mountainous forest District Swat. We sampled data from 162 sampling units (Quadrates) using 1x1m2 for herbs 5x5m2 and shrubs, while 10 x10m2 for trees, systematically considering six elevation gradients between the altitudinal from 1970m to 3095m. We performed statistical analysis like Canonical correspondence analysis (CCA) and TWINSPAN (two-way indicator species analysis) for ecological assessment and clustering of plant communities. To check upon the correlation of species (CR) with topographic and edaphic variables we used statistical software PC-ORD version 7. We recognized 264 species plants belonging to thirty families. We recorded key sampling measurements of density, frequency, and cover for all these species which are vital for community description. The results showed Shannon-Winner,s, and Simpson diversity values as 19.18 and 3.17 respectively. The importance value indexes (IVI) were used to identify the leading and rare species of plant in each community or cluster group. In total we recognized eleven different communities as: Berberis- Abies- Bergeni, Picea - Indigofera- Poa,Abies- Parrotiopsis- Poa, Quercus- Viburnum- Poa, Picea- Salix- Primula, Abies- Viburnum- Poa, Viburnum- Taxus- Poa, Pinus- Viburnum- Lithospermum, Abies-Berberis- carex, Pinus- Viburnum- Poa and Parrotiopsis- Picea- Poa through hierarchical cluster analysis (TWINSPAN). CCA analysis revealed that of all studied edaphic and topographic variables altitude, silt, calcium carbonate, and organic matter were the strongest factors determining plant community diversity and composition in each microclimate of the eleven communities. Visually the vegetation of the forest was dominated by small-sized trees followed by shrubs, and regenerates indicating the stage of secondary regeneration. We found severe human interference in disturbing the existing biodiversity, which requires immediate conservation to ensure sustainable management and utilization of natural resources of the Lalkoo moist temperate forest.

Outcome of post cardiac surgery acute myocardial infarction and role of emergency percutaneous coronary interventions

Funding Acknowledgements

Type of funding sources: None.

Background

The rapid haemodynamics deterioration and  presence of myocardial ischemia  early  after cardiac surgical operations is a complex life threatening condition  where rapid diagnosis and management is of fundamental importance. Objective: to  analyse the factors associated with mortality of patients with post cardiotomy MI  and  to study the role of emergency coronary angiography in management and outcome . Methods: we retrospectively enrolled  adult patients  diagnosed to have post cardiotomy MI and underwent emergency coronary angiography  at our tertiary care hospital  between January 2016 and August 2019. Results: Sixty one patients from consecutive  1869 adult patients who underwent cardiac surgeries were enrolled in our study.  The studied patients had a mean age of 49 ±16.2 years with a mean BMI of 29.5 ± 6.6 and 65.6% of them were males. As compared to the survivors group, the non-survivors of perioperative MI had significant preoperative CKD , postoperative AKI , longer CPB time , frequent  histories of  previous PCI , previous cardiotomies , pre and postoperative ECMO use , higher median troponin I levels , higher peak and 24 hours mean lactate levels. Regression analysis revealed that re-operation for revascularization  (OR:23 ; 95% CI: 8.27-217.06; p = 0.034) and hyperlactataemia  (OR: 3.21 ; 95% CI:1.14-9.04 ; p = 0.027) were independent factors associated with hospital mortality after perioperative MI . Hospital mortality occurred in ( 25.7% vs 86.7% ,p < 0.001 ) , AKI occurred in ( 37.1% vs 93.3 %,p < 0.001 ) , haemodialysis was used in (28.6 % vs 80%. P = 0.002), mediastinal exploration for bleeding done in (31.4% vs 80%, p = 0.006 ) in PCI and re-operation groups respectively while there were no significant differences regarding gastrointestinal bleeding , cerebral strokes nor intracerebral bleeding . Absence of significant angiographic findings occurred in 18% of patients. Conclusions: Perioperative MI is associated with significant morbidities and hospital mortality . Re-operation for revascularization  and progressive hyperlactataemia are independent predictors of hospital mortality. Emergency coronary angiography is helpful in diagnosis and management of perioperative MI. Predictors of hospital mortality.Significant variablesP valueOR95% CIPost-op ECMO0.1360.0390.001 -2.775Troponin0.6611.0000.998 -1.001Lactate peak0.0273.2121.141 - 9.042Re-operation0.03423.0058.27 - 217.06Abstract Figure. Hospital outcomes of PCI and Reoperation

An ethnopharmacological survey and comparative analysis of plants from the Sudhnoti District, Azad Jammu and Kashmir, Pakistan

BACKGROUND

This is the first comprehensive report on the traditional and novel uses of medicinal plants practiced by the indigenous communities of the Sudhnoti district of Azad Jammu and Kashmir (AJK), Pakistan. The area is rich in folklore and indigenous medicinal knowledge due to a unique tribal composition and socioeconomic conditions. This study aimed to document traditional knowledge of native plant use by the local communities, particularly those used for therapeutic purposes.

METHODS

Field surveys were conducted from September 2015 to March 2017. Interviews with 125 local inhabitants of different tribes, age groups, genders, and occupations were conducted using structured and semi-structured questions along with group discussions. Data gathered on plant uses, local names, and modes of application of each plant species were organized in tables. Ethnobotanical indices such as use value (UV) and cultural significance index (CSI) were used to produce quantitative information on the plant use category, frequency, and cultural preference of species. Reports on therapeutic uses of medicinal plants were compared with previous studies.

RESULTS

In all, 88 plant species from 45 families were reported, out of which 67 (77%) were used in ethnomedical applications. Asteraceae, Rosaceae, Fabaceae, and Lamiaceae were the dominant families. Berberis lycium was the most valued plant species, followed by Zanthoxylum armatum and Taraxacum officinale. Mentha arvensis had the highest cultural significance, followed by Mentha longifolia, Punica granatum, and Zanthoxylum armatum. Leaves were the most preferred plant parts in the preparation of medicine exclusively or mixed with other parts. The most frequently used process of crude preparation of medicinal plants was cooking. Oral intake was the predominant route of administration.

CONCLUSIONS

Our comparative analysis confirmed that most of the plants documented have uses that match those previously reported for the region and other parts of the world, with the exception of novel medicinal uses for 11 plant species, including Verbascum thapsus for earache, Elaeagnus umbellata for hepatitis, Achillea millefolium for oral care, Dicliptera roxburghiana to prevent sunstroke in cattle, Rumex hastatus for allergy antidote, Pyrus pashia for hepatitis, and Nerium oleander for diabetes.

Hypoglycemic and hypocholesterolemic activity of leave of few medicinal plants against steptozotocin induced hyperglycemia

Diabetes mellitus (DM) is universal of the hormonal problem and Type II diabetes is foremost obstacle. Accessible management in medicine has numerous contrary paraphernalia. Medical flora shows an essential part in managing diabetes specifically in unindustrialized nations. The present study was done on leaves of Rhazya stricta Decane, Adhatoda zeylanica, Berberis lycium Royle and Olea furrrignea, whose methanolic extracts were used to check their hypoglycemic and hypolipidemic activity by using glucometer and kit method respectively in blood of male and female albino mice Balb C. Results showed that leaves of R. stricta were best for hypoglycemia (125.34±63.79mg/dl, 107.34±18.00mg/dl, 146.00±40.36mg/dl and 178.34±17.03mg/dl), hypocholesterolemia (147.88±21.83mg/dl and 125.89±14.03mg/dl) and triglycerides (103±8.88mg/dl and 89.±43.4mg/dl) in random and fasting conditions, in male and female mice respectively. All plant extract were most effective for hypoglycemia and hypocholesterolemia in female mice as compared to male mice. Moreover statistical analysis revealed that leaves of other plants were also effective but less than leaves of R. stricta. So this plant part and a combination of presently used plants can be used for further studies particularly among females by the purification of active compounds against hyperglycemia and hypercholesterolemia.

Antidiabetic and hypolipidemic potential of Rhazya stricta Decne extract and its fractions

Diabetes mellitus is the most common human disease and there is growing interest for plant based therapy in managing diabetes mellitus specifically in the developing world. In the present study, Rhazya stricta Decne extract was analysed for its antidiabetic activities. Crude methanolic extracts of different plant parts were tested in vivo on albino mice Balb-C, for the reduction of blood glucose, urea, cholesterol, triacylglycerides and glycosylated haemoglobin. Results obtained showed that leaves of R. stricta have best antidiabetic effect by reducing blood glucose level, Glycosylated haemoglobin, triacylglycerides and Cholesterol in hyperglycaemic mice. The R. stricta leaves extract being most active was further fractionated by solvent extraction using n- Hexane, ethyl acetate, chloroform and water and all fractions were tested for same activities. It was found that ethyl acetate fraction is most effective in the reduction of blood glucose level at fasting and random conditions and blood glucose reduction was comparable to Glucophage, a standard antidiabetic drug. The present study suggests that Rhazya stricta leaves extract and its ethyl acetate fraction has great potential for development of antidiabetic drug.DOI: http://dx.doi.org/10.3329/icpj.v4i2.21484 International Current Pharmaceutical Journal, January 2015, 4(2): 353-361

Effect of leaf extracts of Taraxacum officinale on CCl4 induced hepatotoxicity in rats, in vivo study

Taraxacum officinale L is a medicinal plant, which has enormous medicinal values against various types of liver disorders and it has traditionally been used for the treatment of liver problems by people from the South East Asia. Previously we have screened the crude methanolic extract of T. officinale against cytotoxicity induced by CCl4. Present study was designed to compare the protective effect of ethanolic and n-hexane extract of leaves in carbon tetrachloride (CCl4) induced liver toxicity in rats. The extract (200 mg/kg and 400mg/kg body weight) along with silymarin (100 mg/kg) a standard drug was administered to experimental animals. It was observed that ethanolic plant extract has significantly reduced the negative effect of CCl4 as compared to n-hexane extract and effect of extract was increased with increasing dose level. Although both leaf extracts decreased the concentration of TBARS, H2O2 and nitrite contents which enhance due to CCl4 toxicity but effect was higher in ethanolic extract. The results clearly indicated that Taraxacum officinale ethanolic leaves extract has better protective effect against CCl4 induced liver tissues toxicity. This claim was also supported by histopathological results obtained during this study and this might be due to presence of various polar phytochemicals that might be more prevent in this extract.

Targeted case finding for hepatitis B using dry blood spot testing in the British-Chinese and South Asian populations of the North-East of England

Chronic infection with the hepatitis B virus (HBV) is a frequent cause of cirrhosis and liver cancer. Targeted HBV screening is recommended by the Centre for Disease Control (CDC) and Prevention for subjects born in countries with >2% HBV prevalence. However, there are no UK guidelines. Here, we applied the (CDC) recommendations to the British-Chinese and British-South Asian community of North-East (NE) England. British-Chinese and South Asian subjects were invited to attend for HBV education and screening sessions held in community centres. Hepatitis B surface antigen (HBsAg) and hepatitis B core total antibody (HBcAb) were tested with dry blood spot tests. South Asians were also tested for hepatitis C antibody (HCVAb). A total of 1126 subjects (606 Chinese and 520 South Asian) were screened. Sixty-two (5.5%) were HBsAg positive. Ten of these reported a previous diagnosis of HBV. The prevalence of HBsAg positivity was 4.6% when previously diagnosed individuals were excluded. The HBsAg prevalence was significantly higher in the Chinese subjects compared with South Asians (8.7% VS. 1.7% P < 0.001). In Chinese subjects, HBsAg positivity was highest in subjects born in Vietnam (17.4%), followed by China (11%), Hong Kong (7.8%) and the UK (6.7%). Subjects from Pakistan had the highest HBsAg and HCV Ab prevalence in the South Asians (3.1% and 1.8%, respectively). Ten percentage of HBsAg positive patients who had follow-up assessment had active disease requiring antiviral treatment. Undiagnosed HBV infection was above the 2% threshold for screening suggested by the CDC in the British-Chinese and Pakistani community of NE England, which provides evidence for a UK HBV-targeted screening programme.

Clinical skills assessment: comparison of student and examiner assessment in an objective structured clinical examination

BACKGROUND

Learning of basic clinical skills is introduced in Years 1 and 2 of the MBBS Program; the Aga Khan University, Pakistan, through a structured Clinical Skills Teaching program. Acquisition of competence in performing these skills is assessed through use of the Objective Structured Clinical Examination (OSCE). Self-assessment is defined broadly as the involvement of learners in judging whether or not learner-identified standards have been met.

OBJECTIVE

Compared Year 2 students' self-assessment of clinical skills with examiners' assessment of performance in an OSCE using a standard rating scale.

METHODS

A self-assessment questionnaire was completed by all Year 2 students immediately after the OSCE. Students assessed their performance at three stations, using a performance rating scale. Examiners observed and evaluated the students during history-taking and physical examination using the same rating scale.

RESULTS

There were significant positive correlations between examiners' assessments of performance and students' self-assessed ratings in taking consent, obtaining demographic information, history of presenting problems and summarization. Significant differences were observed in pre-procedural skills, comment on prostate, liver palpation percussion and spleen percussion.

CONCLUSIONS

Findings highlight the strengths and weaknesses in clinical competence at the end of Year 2 and provide a direction to improve the gaps in the Clinical Skills Teaching program.

Maternal risk factors associated with low birth weight in Karachi: a case-control study

To evaluate maternal risk factors associated with low birth weight (LBW) among women aged 15-35 years, we carried out a hospital-based, case-control study on 262 cases (mothers of neonates weighing < or = 2.5 kg) and 262 controls (mothers of neonates weighing > 2.5 kg). Odds of delivering a low-birth-weight baby decreased with increase in maternal haemoglobin [odds ratio (OR): 0.701; 95% confidence interval (CI): 0.62-0.79]. Odds were greater among mothers not using iron supplements during pregnancy (OR: 2.88; 95% CI: 1.83-4.54). Mothers of LBW babies had lower haemoglobin levels before delivery.

Increased body fat percentage and physical inactivity are independent predictors of gestational diabetes mellitus in South Asian women

OBJECTIVE

This study aims to identify lifestyle predictors of gestational diabetes mellitus (GDM) in South Asian women. Pre-gravid body mass index, body composition, rate of weight gain during pregnancy, physical activity (PA) and dietary intake were studied.

DESIGN

Prospective cohort study (n=611) of South Asian women at Aga Khan University Hospital antenatal clinic in Karachi, Pakistan. Weight, height and body fat % were measured and data on PA, diet and socio-economic covariates were collected at baseline. A glucose screen was performed at 29.8+/-2.6 weeks.

RESULTS

Using logistic regression analysis for the full cohort, the risk of GDM increased with older maternal age (odds ratio (OR) 1.13, confidence interval (CI) 1.06-1.21), increased body fat % (OR 1.07, CI 1.03-1.13) and the risk was inversely associated with PA (100 kcal) (OR 0.79-0.99, CI 0.89). Using a nested case (n=49) control (n=98) design to study dietary intake, the risk of GDM decreased with increasing protein (% energy) in the diet (OR 0.75, CI 0.60-0.95).

CONCLUSIONS

Body fat %, physical inactivity and, possibly, diet quality are important modifiable risk factors for GDM. 2006.

Knowledge and awareness of pregnant women about ultrasounsd scanning and prenatal diagnosis

OBJECTIVE

Antenatal screening and ultrasound scan has become an integral part of the antenatal care in the present time. The aim of this study is to accurately describe the background knowledge and awareness of pregnant women about ultrasound scan and prenatal diagnosis.

METHODS

It is a clinic based cross sectional study. Four hundred women, attending the antenatal clinics, were asked to fill in a pre tested structured questionnaire. Different variables of interest were collected. Statistical Program for the social sciences (SPSS) was used for the data management.

RESULTS

Over 93.5% of the women were aware that ultrasound examination is an important investigation. They believed that it should be performed at least twice during pregnancy but were not sure about the timing of the test. Most of them felt that it was to check the growth of the baby and 97% of women considered ultrasound to be safe. However, only 26% of women had any knowledge about Down's syndrome or its screening.

CONCLUSION

Pregnant women in our set-up are aware of importance of ultrasound examination during pregnancy. However, there is a need to improve public awareness of problems like Down's syndrome.

Antimicrobial activity of varying concentrations of sodium hypochlorite on the endodontic microorganisms Actinomyces israelii, A. naeslundii, Candida albicans and Enterococcus faecalis

AIM

To determine the resistance of microorganisms associated with refractory endodontic infections to sodium hypochlorite used as a root canal irrigant.

METHODOLOGY

Two strains each of Actinomyces naeslundii, Candida albicans and Enterococcus faecalis were tested as late logarithmic phase inocula, against sodium hypochlorite adjusted to 0.5, 1.0, 2.5 and 5.25% w/v. Contact times used were 0, 10, 20, 30, 60 and 120 s. In the case of E. faecalis, additional experiments used contact times of 1.0, 2.0, 5.0, 10.0 and 30.0 min. Anti-microbial action was halted by sodium thiosulphate addition. Survivors were measured primarily using viable counts on drop plates. Additionally, pour plates were used to count low colony-forming units (cfu) and dilutions to 10(-6) were used to count high cfu.

RESULTS

All concentrations of NaOCl lowered cfu below the limit of detection after 10 s in the case of A. naeslundii and C. albicans. However, E. faecalis proved to be more resistant to NaOCl. Using 0.5% NaOCl for 30 min reduced cfu to zero for both strains tested. This compares with 10 min for 1.0%, 5 min for 2.5% and 2 min for 5.25% (P < 0.001). Regression analysis for the dependent variable log(e)(count + 1) with log(e)(time + 1) and concentration as explanatory variables gave rise to a significant interaction between time and concentration (P < 0.001).

CONCLUSION

The published association of E. faecalis with refractory endodontic infection may result, at least partially, from high resistance of this species to NaOCl. This does not appear to be the case with A. naeslundii or C. albicans.

Antimicrobial activity of varying concentrations of sodium hypochlorite on the endodontic microorganisms Actinomyces israelii, A. naeslundii, Candida albicans and Enterococcus faecalis

AIM

To determine the resistance of microorganisms associated with refractory endodontic infections to sodium hypochlorite used as a root canal irrigant.

METHODOLOGY

Two strains each of Actinomyces naeslundii, Candida albicans and Enterococcus faecalis were tested as late logarithmic phase inocula, against sodium hypochlorite adjusted to 0.5, 1.0, 2.5 and 5.25% w/v. Contact times used were 0, 10, 20, 30, 60 and 120 s. In the case of E. faecalis, additional experiments used contact times of 1.0, 2.0, 5.0, 10.0 and 30.0 min. Anti-microbial action was halted by sodium thiosulphate addition. Survivors were measured primarily using viable counts on drop plates. Additionally, pour plates were used to count low colony-forming units (cfu) and dilutions to 10(-6) were used to count high cfu.

RESULTS

All concentrations of NaOCl lowered cfu below the limit of detection after 10 s in the case of A. naeslundii and C. albicans. However, E. faecalis proved to be more resistant to NaOCl. Using 0.5% NaOCl for 30 min reduced cfu to zero for both strains tested. This compares with 10 min for 1.0%, 5 min for 2.5% and 2 min for 5.25% (P < 0.001). Regression analysis for the dependent variable log(e)(count + 1) with log(e)(time + 1) and concentration as explanatory variables gave rise to a significant interaction between time and concentration (P < 0.001).

CONCLUSION

The published association of E. faecalis with refractory endodontic infection may result, at least partially, from high resistance of this species to NaOCl. This does not appear to be the case with A. naeslundii or C. albicans.

Risk factors and behaviours for coronary artery disease (CAD) among ambulatory Pakistanis

OBJECTIVE

To determine the frequency and distribution of various risk factors and behaviours for coronary artery disease (CAD) among ambulatory Pakistanis.

METHODS

It is a cross-sectional descriptive study carried out at the Aga Khan University Hospital, a teaching hospital in Karachi. All the subjects were adults (18-60 years) presenting at the general checkup clinic with no history or evidence of CAD by convenient sampling method. Demographic variables included risk factors and behaviors including diabetes, hypertension, dyslipidemia, family history of heart disease, obesity, smoking and sedentary lifestyle.

RESULTS

Among 370 ambulatory Pakistanis, the proportions of major risk factors for CAD were: sedentary life style 72%, family history 42%, dyslipidemia 31%, obesity 24%, hypertension 19% and diabetes mellitus 15%. Diabetes, hypertension and dyslipidemia were poorly controlled in the study population. Proportions of the three major risk factors (smoking, hypertension and dyslipidemia) occurring singly, doubly and all three together in the study population were found to be 39%, 11% and 1%, respectively. Data were also analyzed for risk factors by comparing those with and without family history of CAD to eliminate any bias. The results were not statistically significant except for the sedentary life style (P=0.016).

CONCLUSION

There is a high prevalence of CAD risk factors in this study population. Modifiable risk factors like diabetes, hypertension and high cholesterol need better control. Preventive screening programs and healthy lifestyle behaviours need to be emphasized upon in the community.

Prevalence and factors associated with anxiety and depression among family practitioners in Karachi, Pakistan

OBJECTIVE

We aimed to assess anxiety and depression and to identify the factors associated with these conditions among family practitioners in Karachi, Pakistan.

METHODS

A self-reported postal survey was conducted among 540 family practitioners in Karachi during the months of July - August 2003. Aga Khan University Anxiety and Depression Scale (AKUADS) was used to assess anxiety and depression. Additional questions were also inquired to get information about socio-demographic, professional and lifestyle characters.

RESULTS

Using AKUADS, 155 (39%) family practitioners had anxiety and depression. Mutlivariate analysis disclosed five factors to be significantly associated with anxiety and depression; these were female sex (AOR = 6.4, 95% CI 3.2-12.6); age group of < 35 years (AOR = 23.3, 95% CI 9.0-60.3); lack of regular exercise (AOR = 4.9, 95% CI 2.4-10.2) and working for more than 48 hours per week (AOR = 12.7, 95% CI 6.2-26.2).

CONCLUSION

This study reveals that prevalence of anxiety and depression among family practitioners in Karachi is high and higher than general population in Karachi. Further research and intervention studies are required to identify preventive measures in this regard and also to assess the impact of these interventions.

Knowledge about hepatitis B and C among patients attending family medicine clinics in Karachi

Knowledge about hepatitis B and C was assessed in a cross-sectional study of 300 adults aged 18 or older attending family medicine clinics at The Aga Khan University Hospital, Karachi. Most knew that hepatitis B and C are viral diseases that primarily affect the liver, but knowledge about risk factors for disease transmission was poor. Approximately 70% knew that hepatitis B is vaccine preventable; 60% had the misconception that hepatitis C is also vaccine preventable. The majority incorrectly believed that people with hepatitis B or C should follow the diet 'parhaiz'. Generally women knew more than men about the diseases. This study suggests that health education about these infections should be provided to the public. Family physicians can play an important role in educating people about the prevention of these diseases.

Delayed presentation of esophageal perforation simulating paraesophageal hernia

Generally, benign lesions, which make up the majority of mediastinal tumors and cysts, are asymptomatic; however, they may produce clinical findings. We report on a patient with presumed silent esophageal perforation whose clinical and radiologic assessment was suggestive of massive paraesophageal hiatus hernia. However, surgery revealed a paraesophageal cyst and histology was reported as acute organizing pleurisy. A reasonable, tentative, preoperative diagnosis for each mediastinal lesion can be frequently made by considering its location in the mediastinum, the age of the patient, the presence or absence of local or constitutional symptoms and signs, and the association of a specific systemic disease state. However, the precise nature of a lesion in the mediastinum, as elsewhere, cannot be determined without histologic examination of the tissue. To our knowledge, this unusual clinical case is not been reported in the literature.

Squamous cell carcinoma in esophageal remnant after 24 years: lessons learnt from esophageal bypass surgery

Cervical esophageal carcinoma has been a vexing problem because of the multicentric nature of the disease, the common advanced stage at presentation (with invasion of important adjacent structures, especially the trachea or larynx), and difficulty in satisfactorily reconstructing pharyngogastric continuity after extensive resection. In this case report, we highlight the complexity of managing squamous cell carcinoma of the cervical esophagus, which can reappear either as a new primary or recurrence, in a retained esophageal segment 24 years after esophageal bypass surgery. We strongly recommend total esophagectomy at the time of initial surgery and not 24 years later.

Placenta percreta with bladder invasion as a cause of life threatening hemorrhage

PURPOSE

Abnormal placental penetration through the myometrium with bladder invasion is a rare obstetric complication with potential for massive blood loss. Urologists are usually consulted after a life threatening emergency has already arisen. Their familiarity with this condition is crucial for effective management. We describe 2 cases of placenta percreta with bladder invasion to highlight the catastrophic nature of this clinical entity, and review the literature on current diagnostic and management strategies.

MATERIALS AND METHODS

Between 1986 and 1998, 250 cases of adherent placenta (0.9%) were identified in 25,254 births at our institution, including 2 (0.008%) of placenta percreta with bladder invasion. We treated these 2 multiparous women who were 33 and 30 years old, respectively. Each had undergone 2 previous cesarean sections.

RESULTS

Presenting symptoms were severe hematuria in 1 patient and prepartum hemorrhage with shock in the other. Ultrasound showed complete placenta previa in each with evidence of bladder invasion in 1 patient. Hysterectomy, bladder wall resection and repair, and bilateral internal iliac artery ligation were required to control massive intraoperative hemorrhage. The patients received 22 and 15 units of packed red blood cells, respectively. Fetal death occurred in each case. Convalescence was complicated by disseminated intravascular coagulation in patient 1 but subsequent recovery was uneventful.

CONCLUSIONS

A high index of suspicion for placenta percreta with bladder invasion is required when evaluating pregnant women with a history of cesarean delivery and placenta previa who present with hematuria and lower urinary tract symptoms. Ultrasonography and magnetic resonance imaging may assist in establishing the diagnosis preoperatively. With proper planning and a multidisciplinary approach fetal and maternal morbidity and mortality may be decreased.

Utility of restriction fragment analysis for typing herpes simplex virus amplicons following PCR of targets in the DNA polymerase gene

We compared the utility of restriction endonuclease cleavage to type herpes simplex virus DNA polymerase gene amplicons from two well established PCR primer sets. Amplicons typed using Ava II had a 96% correlation to type determined by monoclonal antibody staining, while amplicons typed using Drd I had a 72% correlation to type determined by monoclonal antibody staining.

Effect of dietary garlic (Allium Sativum) on the blood pressure in humans--a pilot study

OBJECTIVE

To find out whether individuals with blood pressures on the lower side consume more garlic in their diets. A pilot study to make grounds for more elaborate future trials.

METHOD

A questionnaire was developed in order to estimate the dietary intake of garlic per person per month and to record three blood pressure readings on each individual. It was administered to 101 adult subjects, presenting to the Family Practice Centre of a hospital in the city of Karachi, Pakistan. The various demographic parameters including age, sex, marital status and education were recorded. Those subjects found to be overweight, with known history of hypertension, diabetes mellitus, ischaemic heart disease, and smoking and on medications, which effect blood pressure, were excluded from the study. This was done to remove the effect of confounding variables on Blood Pressure. The data was entered into the epi-info program and the analysis was done using the SPSS software.

RESULTS

An average garlic use of 134 grams per case per month was found. 67% of the subjects used garlic in cooked food while the rest used either in the raw form or in pickles. 59% thought that dietary use of garlic is healthy. Subjects with blood pressure on the lower side are found to consume more garlic in their diets. (The mean difference is significant for systolic with p value of 0.05).

CONCLUSION

This study shows that individuals whose blood pressures are on the lower side are more likely to consume more garlic in their diets. (Statistically significant for systolic blood pressure only). This was a pilot study and more elaborate trials are recommended to prove this association.

Low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) of thymus

This report describes a low-grade B-cell lymphoma of mucosa associated lymphoid tissue (MALT) involving the thymus of a 63-year-old woman with features suggestive of a connective tissue disease. Sections of the thymic lesion and of a lung biopsy performed at the same operation were examined histologically and by immunohistochemistry using the monoclonal antibodies CD45, CD20, CD79a, CD3, CD45RO, and AE1/AE3. Polymerase chain reaction (PCR) for immunoglobulin heavy chain gene rearrangement was also performed. The dense infiltrate of small lymphoid cells intimately admixed with ramifying epithelial elements, some of which had undergone cystic change, closely resembled a thymoma. The lymphoid infiltrate comprised centrocyte-like cells, small lymphocytes, plasma cells, and blasts. Most of the lymphoid cells were immunoreactive with the B-cell markers CD20 and CD79a, and PCR showed clonal immunoglobulin heavy chain gene rearrangement. The lung biopsy showed dense infiltration by small lymphoid cells, morphologically suggestive of lymphoid interstitial pneumonia. However, PCR showed a weak band in the amplification for immunoglobulin heavy chain gene rearrangement, identical to that within the thymus and suggesting either recirculation of cells to accumulated MALT or subhistological lymphoma. MALT lymphoma may rarely involve the thymus, and pathologists should be aware of this to avoid misdiagnosis as a thymoma. Immunohistochemical and/or molecular studies are of value in this regard. MALT lymphomas of the thymus, common with those arising in other organs, may develop in the setting of a connective tissue disease.

Syndrome X and family practitioners

BACKGROUND

Increased incidence of hypertension, non-insulin dependent diabetes (NIDDM) and coronary heart disease often cluster in the same individuals and there have been speculations that a common mechanism may be responsible for all of these pathological conditions. This risk factor constellation, which is associated with an enhanced risk for cardiovascular disease, is sometimes referred to as the "Insulin Resistance Syndrome", "Syndrome X", or the "Metabolic Syndrome".

AIM

To find out the prevalence of Syndrome X in the population of patients coming to a preventive health check clinic at a tertiary care teaching hospital in a megacity of the developing world.

METHODS

A total of 270 patients, above the age of 40 years, who attended preventive health check clinics of 2 Family Physicians at the Aga Khan University from January 1996 to July 1997 were selected. Patients below 40 years were excluded from the study.

RESULTS

The prevalence of Syndrome X, defined as association of obesity, NIDDM, hypertension, raised LDL and raised triglycerides is 2.6% in patients above 40 years, who were screened in this study.

CONCLUSION

The significant prevalence of Syndrome X is alarming and we need to strengthen our existing educational programs for prevention of obesity, increased physical activity and better control of hypertension. When drugs are selected for pharmacological treatment, priority should be given to those, which improve the insulin sensitivity index or are at least neutral in this respect.