Lesions of the rotator cuff(RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an agedependent increase in numbers. Other associated fact...Lesions of the rotator cuff(RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an agedependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears(PTT) can be bursalsided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears(FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations- cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, antiinflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being costeffective, this helps in providing a functional shoulder witha stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, costeffective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.展开更多
Mutation of the p53 gene is a key event in the carcinogenesis of many different types of tumours. These can occur throughout the length of the p53 gene. Anti-p53 auto-antibodies are commonly produced in response to th...Mutation of the p53 gene is a key event in the carcinogenesis of many different types of tumours. These can occur throughout the length of the p53 gene. Anti-p53 auto-antibodies are commonly produced in response to these p53 mutations. This review firstly describes the various mechanisms of p53 dysfunction and their association with subsequent carcinogenesis. Following this, the mechanisms of induction of anti-p53 auto-antibody production are shown, with various hypotheses for the discrepancies between the presence of p53 mutation and the presence/absence of anti-p53 auto-antibodies. A systematic review was performed with a descriptive summary of key findings of each anti-p53 auto-antibody study in all cancers published in the last 30 years. Using this, the cumulative frequency of anti-p53 autoantibody in each cancer type is calculated and then compared with the incidence of p53 mutation in each cancer to provide the largest sample calculation and correlation between mutation and anti-p53 auto-antibody published to date. Finally, the review focuses onthe data of anti-p53 auto-antibody in colorectal cancer studies, and discusses future strategies including the potentially promising role using anti-p53 auto-antibody presence in screening and surveillance.展开更多
The main objective of the current study is to investigate the potential of Carica papaya leaves extracts against Dengue fever in 45 year old patient bitten by carrier mosquitoes.For the treatment of Dengue fever the e...The main objective of the current study is to investigate the potential of Carica papaya leaves extracts against Dengue fever in 45 year old patient bitten by carrier mosquitoes.For the treatment of Dengue fever the extract was prepared in water.25 mL of aqueous extract of C.papaya leaves was administered to patient infected with Dengue fever twice daily i.e.morning and evening for five consecutive days.Before the extract administration the blood samples from patient were analyzed.Platelets count(PLT),White Blood Cells(WBC) and Neutrophils(NEUT) decreased from 176×10~3/μ L,8.10×10~3/μ L,84.0%to 55×10~3/μ L,3.7×10~3/μL and 46.0%.Subsequently,the blood samples were rechecked after the administration of leaves extract.It was observed that the PLT count increased from 55×10~3/μ L to 168×10~3/μ L,WBC from 3.7×10~3/μ L to 7.7×10~3/μ L and NEUT from 46.0%to 78.3%.From the patient feelings and blood reports it showed that Carica papaya leaves aqueous extract exhibited potential activity against Dengue fever.Furthermore,the different parts of this valuable specie can be further used as a strong natural candidate against viral diseases.展开更多
Objective:To determine the frequency of risk factors of congestive cardiac failure in a tertiary care hospital of Peshawar.Methods:This retrospective observational study was conducted in department of Cardiology,Postg...Objective:To determine the frequency of risk factors of congestive cardiac failure in a tertiary care hospital of Peshawar.Methods:This retrospective observational study was conducted in department of Cardiology,Postgraduate Medical Institute,Lady Reading Hospital Peshawar,from March 2005 to September 2007.Relevant information regarding the risk factors of congestive cardiac failure were recorded on questionnaire prepared in accordance with the objectives of the study.Results:1 019 patients with established diagnosis of cardiac failure (based on clinical findings and relevant investigations) were included.Out of total sampling 583 (57.12%) were males and 436(42.78%) were females.The age range of the patients was from 6 years to 82 years with mean age of 48.5 years and mode of age was 45 years.The distribution of causative factors of CCF was:ischemic heart disease(IHD) 36.31%,hypertension 26.30%,dilated cardiomyopathy 10.10%,obstructve and restrictive cardiomyopathies 5.39%,valvular heart diseases(VHD) 9.32%,congenital heart disease like ventricular septal defects(VSD) 4.41%,atrial septal defects(ASD) 0.58%,atrial fibrillation (AF) 2.25%,constrictive pericardidtis 1.07%.Pericardial effusion 0.68%,chronic obstructive pulmonary disease and pulmonary hypertension 1.47%,thyrotoxicosis 0.68%,complete heart block 0.29%and paget disease in 0.09%cases.Conclusion:Ischemic heart disease,hypertension,cardiomypathies,valvular heart disease and congenital heart disease are major contributor to CCF in our patients.展开更多
Background: Thioacetamide (TAA) has been used extensively in the development of suitable animal models of acute and chronic liver injury employing various doses, times and routes of its administration, particularly in...Background: Thioacetamide (TAA) has been used extensively in the development of suitable animal models of acute and chronic liver injury employing various doses, times and routes of its administration, particularly in drinking water due to its resemblance with human liver fibrosis and cirrhosis. The aim of this study was to investigate and compare hematological alteration during the acute and chronic liver inflammation. Methods: Acute Liver inflammation was induced in Wistar rats via intraperitoneal injection of thioacetamide and the animals were sacrificed 12 h after the TAA administration. Induction of chronic liver inflammation was performed by continuous administration of TAA in the drinking water (200 mg/L) during 18 weeks of experiment. After that all animals were sacrificed and Blood samples were collected for further analysis. Results: Single intra peritoneal injection of TAA (300 mg/kg B.W.) induced an acute condition with hematological changes including leukocytosis with marked neutrophilia (P = 0.0429), lymphopenia, thrombocytosis as well as increased hemoglobin concentration (P 0.05) and decline of erythrocytic count (P = 0.0009). Eighteen weeks of uninterrupted supply of TAA (200 mg/L) in drinking water lead to chronic inflammation and the hematological alterations were leucopenia (P = 0.0197) accompanied with neutropenia and thrombocytopenia. Increase in RBCs (P = 0.0073) and Hb contents was also observed with a decline of red cell indices. Conclusion: Taken together these findings we can conclude that the animals respond differently under acute and chronic inflammatory condition with TAA administration. Leukocytosis with marked neutrophilia, thrombocytosis as well as increased hemoglobin concentration and decline of erythrocytic count were observed in acute while leucopenia accompanied with neutropenia and thrombocytopenia and increase in RBCs, Hb and Hct was also observed with a decline of other red cell indices during chronic phase.展开更多
Background:The therapeutic effectiveness of interleukin-6 receptor inhibitor in critically ill hospitalized patients with coronavirus disease 2019(COVID-19)is uncertain.Methods:To evaluate the efficacy and safety of t...Background:The therapeutic effectiveness of interleukin-6 receptor inhibitor in critically ill hospitalized patients with coronavirus disease 2019(COVID-19)is uncertain.Methods:To evaluate the efficacy and safety of the outcome as recovery or death of tocilizumab for severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)infection,we conducted a randomized,double-blinded,placebo-controlled phase 2 trial in critically ill COVID-19 adult patients.The patients were randomly assigned in a 4:1 ratio to receive standard medical treatment plus the recommended dose of either tocilizumab or the placebo drug.Randomization was stratified.The primary outcome was the recovery or death after administration of tocilizumab or a placebo drug.The secondary outcomes were clinical recovery or worsening of the patients’symptoms and inflammatory markers and discharge from the hospital.Results:Of 190 patients included in this study,152 received tocilizumab,and 38 received a placebo.The duration of hospital stay of the interventional group was 12.9±9.2,while the placebo group had a more extended hospital stay(15.6±8.8).The mortality ratio for the primary outcome,ie,mortality or recovery in the tocilizumab group was 17.8%;p=0.58 by log-rank test).The mortality ratio in the placebo group was 76.3%;p=0.32 by log-rank test).The inflammatory markers in the tocilizumab group significantly declined by day 16 compared to the placebo group.Conclusions:The use of tocilizumab was associated with decreased mortality,earlier improvement of inflamma-tory markers,and reduced hospital stay in patients with severe COVID-19.展开更多
文摘Lesions of the rotator cuff(RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an agedependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears(PTT) can be bursalsided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears(FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations- cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, antiinflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being costeffective, this helps in providing a functional shoulder witha stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, costeffective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.
文摘Mutation of the p53 gene is a key event in the carcinogenesis of many different types of tumours. These can occur throughout the length of the p53 gene. Anti-p53 auto-antibodies are commonly produced in response to these p53 mutations. This review firstly describes the various mechanisms of p53 dysfunction and their association with subsequent carcinogenesis. Following this, the mechanisms of induction of anti-p53 auto-antibody production are shown, with various hypotheses for the discrepancies between the presence of p53 mutation and the presence/absence of anti-p53 auto-antibodies. A systematic review was performed with a descriptive summary of key findings of each anti-p53 auto-antibody study in all cancers published in the last 30 years. Using this, the cumulative frequency of anti-p53 autoantibody in each cancer type is calculated and then compared with the incidence of p53 mutation in each cancer to provide the largest sample calculation and correlation between mutation and anti-p53 auto-antibody published to date. Finally, the review focuses onthe data of anti-p53 auto-antibody in colorectal cancer studies, and discusses future strategies including the potentially promising role using anti-p53 auto-antibody presence in screening and surveillance.
文摘The main objective of the current study is to investigate the potential of Carica papaya leaves extracts against Dengue fever in 45 year old patient bitten by carrier mosquitoes.For the treatment of Dengue fever the extract was prepared in water.25 mL of aqueous extract of C.papaya leaves was administered to patient infected with Dengue fever twice daily i.e.morning and evening for five consecutive days.Before the extract administration the blood samples from patient were analyzed.Platelets count(PLT),White Blood Cells(WBC) and Neutrophils(NEUT) decreased from 176×10~3/μ L,8.10×10~3/μ L,84.0%to 55×10~3/μ L,3.7×10~3/μL and 46.0%.Subsequently,the blood samples were rechecked after the administration of leaves extract.It was observed that the PLT count increased from 55×10~3/μ L to 168×10~3/μ L,WBC from 3.7×10~3/μ L to 7.7×10~3/μ L and NEUT from 46.0%to 78.3%.From the patient feelings and blood reports it showed that Carica papaya leaves aqueous extract exhibited potential activity against Dengue fever.Furthermore,the different parts of this valuable specie can be further used as a strong natural candidate against viral diseases.
文摘Objective:To determine the frequency of risk factors of congestive cardiac failure in a tertiary care hospital of Peshawar.Methods:This retrospective observational study was conducted in department of Cardiology,Postgraduate Medical Institute,Lady Reading Hospital Peshawar,from March 2005 to September 2007.Relevant information regarding the risk factors of congestive cardiac failure were recorded on questionnaire prepared in accordance with the objectives of the study.Results:1 019 patients with established diagnosis of cardiac failure (based on clinical findings and relevant investigations) were included.Out of total sampling 583 (57.12%) were males and 436(42.78%) were females.The age range of the patients was from 6 years to 82 years with mean age of 48.5 years and mode of age was 45 years.The distribution of causative factors of CCF was:ischemic heart disease(IHD) 36.31%,hypertension 26.30%,dilated cardiomyopathy 10.10%,obstructve and restrictive cardiomyopathies 5.39%,valvular heart diseases(VHD) 9.32%,congenital heart disease like ventricular septal defects(VSD) 4.41%,atrial septal defects(ASD) 0.58%,atrial fibrillation (AF) 2.25%,constrictive pericardidtis 1.07%.Pericardial effusion 0.68%,chronic obstructive pulmonary disease and pulmonary hypertension 1.47%,thyrotoxicosis 0.68%,complete heart block 0.29%and paget disease in 0.09%cases.Conclusion:Ischemic heart disease,hypertension,cardiomypathies,valvular heart disease and congenital heart disease are major contributor to CCF in our patients.
文摘Background: Thioacetamide (TAA) has been used extensively in the development of suitable animal models of acute and chronic liver injury employing various doses, times and routes of its administration, particularly in drinking water due to its resemblance with human liver fibrosis and cirrhosis. The aim of this study was to investigate and compare hematological alteration during the acute and chronic liver inflammation. Methods: Acute Liver inflammation was induced in Wistar rats via intraperitoneal injection of thioacetamide and the animals were sacrificed 12 h after the TAA administration. Induction of chronic liver inflammation was performed by continuous administration of TAA in the drinking water (200 mg/L) during 18 weeks of experiment. After that all animals were sacrificed and Blood samples were collected for further analysis. Results: Single intra peritoneal injection of TAA (300 mg/kg B.W.) induced an acute condition with hematological changes including leukocytosis with marked neutrophilia (P = 0.0429), lymphopenia, thrombocytosis as well as increased hemoglobin concentration (P 0.05) and decline of erythrocytic count (P = 0.0009). Eighteen weeks of uninterrupted supply of TAA (200 mg/L) in drinking water lead to chronic inflammation and the hematological alterations were leucopenia (P = 0.0197) accompanied with neutropenia and thrombocytopenia. Increase in RBCs (P = 0.0073) and Hb contents was also observed with a decline of red cell indices. Conclusion: Taken together these findings we can conclude that the animals respond differently under acute and chronic inflammatory condition with TAA administration. Leukocytosis with marked neutrophilia, thrombocytosis as well as increased hemoglobin concentration and decline of erythrocytic count were observed in acute while leucopenia accompanied with neutropenia and thrombocytopenia and increase in RBCs, Hb and Hct was also observed with a decline of other red cell indices during chronic phase.
基金financed by the Wyeth Pharmaceutical (Pvt) Ltd.The sponsor had no role in datacollectiondata analysisdata interpretation or writing of the report.The corresponding author had access to all data in the study and had final responsibility for the decision to submit for publication
基金was obtained from the research ethical committee of Lahore General Hospital,hav-ing approval number 00-144-20(ClinicalTrials.gov ID:NCT04560205)。
文摘Background:The therapeutic effectiveness of interleukin-6 receptor inhibitor in critically ill hospitalized patients with coronavirus disease 2019(COVID-19)is uncertain.Methods:To evaluate the efficacy and safety of the outcome as recovery or death of tocilizumab for severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)infection,we conducted a randomized,double-blinded,placebo-controlled phase 2 trial in critically ill COVID-19 adult patients.The patients were randomly assigned in a 4:1 ratio to receive standard medical treatment plus the recommended dose of either tocilizumab or the placebo drug.Randomization was stratified.The primary outcome was the recovery or death after administration of tocilizumab or a placebo drug.The secondary outcomes were clinical recovery or worsening of the patients’symptoms and inflammatory markers and discharge from the hospital.Results:Of 190 patients included in this study,152 received tocilizumab,and 38 received a placebo.The duration of hospital stay of the interventional group was 12.9±9.2,while the placebo group had a more extended hospital stay(15.6±8.8).The mortality ratio for the primary outcome,ie,mortality or recovery in the tocilizumab group was 17.8%;p=0.58 by log-rank test).The mortality ratio in the placebo group was 76.3%;p=0.32 by log-rank test).The inflammatory markers in the tocilizumab group significantly declined by day 16 compared to the placebo group.Conclusions:The use of tocilizumab was associated with decreased mortality,earlier improvement of inflamma-tory markers,and reduced hospital stay in patients with severe COVID-19.
