Year 2019, Volume 35 - Issue 4

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Background and Objective: Mycobacterium tuberculosis (Mtb) harbors immune evasion that impairs immune responses and prevents optimal immunity against Mtb. However, little is known about mechanisms of immune evasion in Mtb infected individual. In this study, the relationship among the IL-35 level, IL-35-producing regulatory T cells (iTr35) subset, the bacterial burden and lung lesions in mice infected with Mtb were investigated to assess the impact of immune evasion on the infected mice.
Methods: A total of twenty C57BL/6 male 6-7 weeks old mice, were injected with 1 × 105 colony-forming units (CFU) of attenuated H37Ra strain of Mtb in a volume of 200 μL, to prepare mouse tuberculosis infection models. Colony forming units in left lung and spleen coefficient were determined followed by histopathology, quantitative RT-PCR for mRNA, Western blot analysis, cytokine IL-35 detection and flow cytometry of fork head box protein P3-expressing T cells.
Results: Compared with the control mice, the mRNA expressions of the p35 and EBI3 of IL-35 were significantly increased in the spleen of 8-week infected mice, and their protein expressions were not only increased in 8-week but in lungs of 4-week infected mice, accompanied with an elevated level of serum IL-35. In addition, iTr35 subset was increased in the spleen of 8-week infected mice compared with the control mice. Importantly, the high bacterial burden, lung lesions, and low mouse weight were found in the 8-week infected mice.
Conclusion: The mice infected with Mtb H37Ra strain resulted in elevated IL-35 levels and iTr35 subset. There were increased bacterial burden and lung lesions, suggesting that IL-35 and iTr35 cells play an immune evasion role in chronic Mtb infected mice.

Background and Objective: Plantar fasciitis is the commonest musculoskeletal disorder seen in subjects with history of frequent running and prolonged standing. This study was designed to determine the frequency of plantar fasciitis among traffic wardens of Lahore.
Methods: This was cross-sectional study comprising of consenting 147 traffic wardens from city of Lahore. A modified plantar fasciitis pain scale (PFPS) questionnaire was used to record the sociodemographic information, past history of heel pain and risk factors of plantar fasciitis. Diagnosis was based on patient history and physical examination using visual analogue scale (VAS). The data was gathered and SPSS version 23.0 was used to analyze the data.
Results: The frequency of plantar fasciitis among 147 wardens was 38.7%. A total of 90 (61.2%) subjects were having morning stiffness while 85 (57.8%) had pain on palpation of medial plantar calcaneal region. Ninety six (65.3%) wardens reported of having 4-8 hours daily standing work while VAS revealed severe pain experienced by 42 (28.6%) subjects. There was a significant relationship between plantar fasciitis, prolonged standing and frequent running (P > 0.001).
Conclusion: Plantar fasciitis is very common among traffic wardens that may be attributed mainly to prolonged standing. It is highly recommended that Traffic Police Department may take measures for creating awareness and promotion of preventive aspects among these important professionals.

Background and Objective: Recently, many scientific researchers are focusing on investigating the antimicrobial activity of medicinal plants against different gram positive and gram negative bacteria as well as against some cancer cell lines as an alternative substituent to the available drugs in the market. This study was designed to investigate the chemical composition of Ducrosia anethifolia solvent extracts with their potential as antibacterial and anticancer biomedical agents
Methods: Different extracts of Ducrosia anethifolia were analyzed to reveal their major chemical composition using the gas chromatography-mass spectrometry (GC-MS). These compounds were further tested for their antibacterial (agar well diffusion technique) and cytotoxic activities (MTT assay).
Results: In-vitro antibacterial assay against selected human pathogens indicated highest susceptibility of Bacillus subtilis organic and aquatic extracts of Ducrosia fruit and leaves (15.5 mm inhibition zone) followed by Staphylococcus aureus (15mm) mainly with acetone fruit extracts. Negligible or no effect against was observed against the gram negative bacteria tested in this study. On the other hand, cytotoxic activity of methanol and water fruit and leaves Ducrosia extracts were tested on K562, HL60 and TPH1 (human adenoma leukemia) and MDA and MCF7 (human breast carcinoma) cell lines. Potent effect was recorded with water leave extract on K562 and MCF7 in a concentration varying between 4-5µl of extract/100 µl of cell line medium.
Conclusion: Potent therapeutic effect was observed with Ducrosia anethifolia crude extracts that may add further to new promising natural therapeutic agents.

Background and Objective: Cigarette smoke contains nicotine that has numerous health hazards ranging from mild to life threatening morbidities. The health benefits of date palm against the toxic substances are well documented in the literature. This study is designed to investigate the effect of nicotine on body weight of mice and its amelioration by date palm pit powder (DPP).
Methods: Thirty two adult male albino mice were divided into four groups each having eight animals. Date’s pit were first soaked for 48 hours in cold distilled water and then dried by air convection drying method. DPP was administered by oral gavage. Control group ‘A’ was given saline 1.5 ml per kg for 15 days. The experimental groups were given 0.5 mg/kg nicotine intra-peritoneally for 15 days. For the next 30 days, Group C received 0.9% saline orally and Group D received 500 mg/kg of DPP orally. Solid food intake was measured daily and then calculated as per week intake.
Results: The reduction in mean animal weight and food intake of experimental groups on 15th day were statistically significant (P = 0.001) in comparison with that of the control. The mean animal weight and food intake significantly improved after 30 days in experimental groups D.
Conclusion: Nicotine administration to the albino mice significantly reduces their body weight and food intake which are gradually improved by the use of date palm pit powder.

Background and Objective: Monosodium glutamate (MSG) is used as a taste enhancer and is a common ingredient of some foods as canned vegetables, soups, processed meat and traditional seasoning. Garlic, on the other hand, is known to have antibacterial and antiviral effects and has also been used for cancer prevention. The objective of current study is to observe the effect of aqueous garlic extract (AGE) in MSG induced toxic effects on the body weight of adult Wistar rats.
Methods: The present study was carried out in the Department of Anatomy at University of Health Sciences, Lahore in 2016. A total of 24 adult male Wistar rats, 6-8 weeks old of 150-175 grams weight were taken and divided into four groups (6 rats in each). Group A served as a control and received 6 ml/kg of distilled water orally via gavage tube and intraperitoneally for 14 days; Group B was treated with MSG 4 gm/kg dissolved in 6 ml of distilled water administered intraperitoneally for 14 days;
Group C was treated with AGE 200 mg/kg dissolved in 0.4 ml of distilled water orally by gavage tube for 14 days and Group D was given 4 gm/kg MSG dissolved in 6ml of distilled water, intraperitoneally first, followed by AGE 200 mg/kg dissolved in 0.4 ml of distilled water, orally, by gavage tube for a period of 14 days. All doses were given once a day.
Results: At the end of study, the body weight of rats in MSG treated group was found to be decreased and was statistically significant (P < 0.003) and garlic did counter the effects of MSG though not significantly.
Conclusion: Aqueous garlic extract improves the deleterious effects of MSG on the body weight of Wistar rats.

Background and Objective: Tuberculosis has been an epidemic for humans over ages caused by Mycobacterium Tuberculosis (MTB). First line drugs in fixed dosage are employed for its treatment. Therefore this study was designed to observe the clinical outcomes after two months of initial treatment with antituberculous drugs in patients with pulmonary tuberculosis.
Methods: The study was conducted on n = 30 newly diagnosed patients having pulmonary tuberculosis confirmed with acid fast bacilli positive sputum at Gulab Devi Chest Hospital, Lahore. After informed written consent, blood samples were drawn at 02 and 06 hours post dose intervals for antituberculous drugs in fixed dose combination (FDC). Liver and renal enzyme levels in relation with clinical signs and symptoms were assessed and recorded before and during drug therapy on day 1, 14 &
56. Data was entered and analyzed by Statistical Package for Social Sciences (SPSS software, version 20). ANOVA test was used to determine the mean differences in laboratory parameters.
Results: Clinical improvement was seen at the end of therapy particularly in fever and weight status. Plasma levels of hepatic enzymes and renal urea and creatinine were raised (P > 0.05) however no renal and hepatic toxicity was reported.
Conclusion: Anti-tuberculous drugs as FDC were effective with improved compliance and minimal hazardous effects.

Background and Objective: Chronic hepatitis C infection and its associated mortality and morbidity is a big health challenge in Pakistan. Chronic hepatitis C infection leads to marked reduction of serum hepcidin levels leading to systemic iron overload. Present study was aimed to determine the levels of serum hepcidin in chronic hepatitis C patients and controls.
Methods: This cross-sectional study was conducted in Department of Physiology, University of Health Sciences, Lahore from January 2012 to January 2014. A total of 81 individualsin each of the two groups were recruited after taking written informed consent. Group A was a control group (with no history of hepatitis) while Group B comprised of chronic hepatitis (CHC) patients. Both groups were tested for serum hepcidin levels measured by ELISA technique. Frequencies and percentages were calculated for serum hepcidin levels in each group. Comparative analysis of serum hepcidin value was done between two groups by applying Kruskal Wallis test.
Results: In Group A, 89% subjects had reduced serum hepcidin levels while in Group B, 93% CHCpatients showed decreased serum hepcidin levels. No significant difference in serum hepcidin was seen among both groups.
Conclusion: Reduced hepcidin levels are seen in hepatitis C patients. Insignificant difference observed in both groups open the horizon towards other etiological factorsthat may result in decreased serum hepcidin levels in these patients.

Background and Objective: Patients having diabetes mellitus type 2 (DM-2) are increasing all over the world. Early detection could decrease the risk of morbidities in general population. Glycated haemoglobin-A (HbA1C) is not only a reliable screening test for diabetes but also provides an insight in long-term complications related with this disease. Therefore this study was designedto determine the association of HbA1C with clinical symptoms of DM-2 in general, undiagnosed population of Lahore.
Methods: A cross sectional survey was conducted for 15 months enrolling 2500 participants from community of Lahore, Punjab. A well-structured questionnaire recorded familial histories and clinical symptoms (if any present) related with DM-2. HbA1C levels were detected by standard methods. Data was analyzed using SPSS version 20.
Results: HbA1C level > 7% was observed in 1651 (66%) patients who were previously unaware of their diabetic condition. There was a highest positive association of HbA1C status with polyuria [Odds ratio: 2.60 (2.14–3.17)]. No significant association was observed from adjusted odds ratios with hypertension, cardiovascular disease and numbness. When odds ratios were adjusted for all factors, blurred vision, body mass index and age showed a negative association with HbA1C status.
Conclusion: Approximately two third of patients tested positive for diabetes were previously unaware of their status. Earlier detection of prediabetes offers an opportunity to take stringent measures for deferring its progression to diabetes.

Background and Objective: Health care workers are the most vulnerable group to be infected with viral hepatitis. At this time there is limited data related to seroconversion after vaccination against Hepatitis B Virus (HBV) especially in the hospital staff. The current study aims to find out the frequency of seroconversion after hepatitis B vaccination in healthcare workers and factors affecting seroconversion.
Methods: A descriptive study was carried out in the Department of Gastroenterology at Fatima Memorial Hospital, Shadman Lahore from November 2015 to May 2016. After taking written informed consent, 250subjects from various Departments of Fatima Memorial Hospital Lahore were enrolled, who fulfilled the inclusion criteria. Demographic data like name, age, gender, height and weight were recorded. History related to smoking was taken and their body mass index (BMI) was calculated. After
completion of course of three vaccines, blood sampleswereanalyzed for quantitative determination of anti-hepatitis B antibodies by Enzyme Linked Immunosorbant Assay (ELISA). A cut off level of > 10 IU/L of anti-hepatitis B antibodies was considered as positive for seroconversion. Data was analyzed in SPSS version 20.
Results: The mean age of subjects enrolled was 43.65 ± 11.64 years. Among seroconverted subjects 40.83% were in 18 – 40 years of age. There was a slight female preponderance of 52% and a male to female ratio of 1:1.08. In 35.2% subjects with history of smoking, 67% had seroconversion. Among 32% of subjects with BMI > 30, 31.25% showed seroconversion. Hepatitis B seroconversion in healthcare workers after HBV vaccination was found in 83.2% subjects. There was a poor response to hepatitis B vaccine in smokers.
Conclusion: Frequency of hepatitis B seroconversion in healthcare workers after HBV vaccination is higher however smoking is a significant risk factor which hinders seroconversion after anti hepatitis B vaccination.

Background and Objective: Episiotomy is the most common surgical procedure in obstetrics and the utilization of this surgical technique is increasing day by day. The importance of absorbable sutures for episiotomy repair cannot be denied. This study was carried out to compare post-episiotomy repair complications between continuous subcutaneous stitching with vicryland interrupted mattress closure with catgut.
Methods: This cross-sectional study was carried out in Hussain Memorial Hospital Lahore and Kishwar Fazal Teaching Hospital Sheikhupura. Four hundred patients, admitted with labour pains were equally divided into two groups. Group A, comprised of patients, who had episiotomy repair by continuous subcuticular sutures with vicryl and group B patient’s episiotomy repair was done by interrupted mattress sutures with catgut. All patients were delivered by vaginal route with episiotomy, to widen the perineum. The details of history and post episiotomy repair complications like postpartum pain, in duration, process of healing, wound discharge, wound dehiscence and need for re-stitching were recorded in the relevant proformas. Post-partum pain in episiotomy stitches was assessed by a visual analogue scale.
Results: Among 400 patients mostly were primipara; 73% in group A and 75% in group B. A total of 44% of patients in the study belonged to age group between 21 to 25 years. Analgesia was required in 5% patients of group B and 9% of group A patients, which was statistically significant (P-value< 0.05). Among post-operative complications, feeling of stretch in the stitches and wound dehiscence were statistically significant in group B with P-value 0.02 and P-value 0.04 respectively when compared with group A.
Conclusion: It is concluded that repair of episiotomy by subcuticular stitches with vicryl causes less post-operative complications and a better healing with less complications than closure by interrupted mattress suture with catgut.

Background and Objectives: Research plays an essential part in academic advancement of medical students. At student level research experience is highly associated with future career achievements. This study was carried out to determine attitudes towards research among undergraduate and postgraduate students and also among male and female students.
Methods: It was a cross-sectional descriptive study conducted at Wah Medical College, Pakistan Ordinance Factory Hospital from January to June 2018. The study was carried out on 192 students, 64 postgraduate and 128 undergraduate students. They were selected by simple random sampling technique and a pre-tested attitude towards research (ATR) scale questionnaire was used for data collection. The first part of the questionnaire included demographic information and second part comprised of 30 questions to assess their attitude towards research. The questions were to be responded on seven points Likert scale from strongly disagree to strongly agree after taking informed consent. Data was analyzed by using Statistical Package for Social Sciences version 20.0 Means and standard deviations of each question and five different components i.e. research usefulness, research anxiety, positive attitude towards research, relevance to life and difficulty in research were calculated. Independent sample T test was applied on total mean scores of ATR scale and mean scores of all components of undergraduate and postgraduate students and the test was also applied on mean scores of ATR scale between male and female students.
Results: The means and standard deviations of ATR scale of undergraduate and postgraduate students were 125.15 ± 21.131 and 137.69 ± 22.371 respectively and the P value came out to be < 0.001. Other factors studied also varied significantly among undergraduate and postgraduate students; research usefulness (P =< 0.001), research difficulty (P = 0.027) and positive attitude towards research (P = 0.005).
Conclusion: The postgraduate students showed more positive attitude towards research than the undergraduate students and no difference was noted among male and female students.