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Patel V.,University of Warwick | Adya R.,University of Warwick | Chen J.,University of Warwick | Ramanjaneya M.,University of Warwick | And 6 more authors.
PLoS ONE | Year: 2014

Aims: Fibroblast growth factor 21 (FGF21) is a hepatic metabolic regulator with pleotropic actions. Its plasma concentrations are increased in obesity and diabetes; states associated with an increased incidence of cardiovascular disease. We therefore investigated the direct effect of FGF21 on cardio-protection in obese and lean hearts in response to ischemia. Methods and Results: FGF21, FGF21-receptor 1 (FGFR1) and beta-Klotho (βKlotho) were expressed in rodent, human hearts and primary rat cardiomyocytes. Cardiac FGF21 was expressed and secreted (real time RT-PCR/western blot and ELISA) in an autocrine-paracrine manner, in response to obesity and hypoxia, involving FGFR1-βKlotho components. Cardiac-FGF21 expression and secretion were increased in response to global ischemia. In contrast βKlotho was reduced in obese hearts. In isolated adult rat cardiomyocytes, FGF21 activated PI3K/Akt (phosphatidylinositol 3-kinase/Akt), ERK1/2(extracellular signal-regulated kinase) and AMPK (AMP-activated protein kinase) pathways. In Langendorff perfused rat [adult male wild-type wistar] hearts, FGF21 administration induced significant cardio-protection and restoration of function following global ischemia. Inhibition of PI3K/Akt, AMPK, ERK1/2 and ROR-α (retinoic-acid receptor alpha) pathway led to significant decrease of FGF21 induced cardio-protection and restoration of cardiac function in response to global ischemia. More importantly, this cardio-protective response induced by FGF21 was reduced in obesity, although the cardiac expression profiles and circulating FGF21 levels were increased. Conclusion: In an ex vivo Langendorff system, we show that FGF21 induced cardiac protection and restoration of cardiac function involving autocrine-paracrine pathways, with reduced effect in obesity. Collectively, our findings provide novel insights into FGF21-induced cardiac effects in obesity and ischemia. © 2014 Patel et al.

PubMed | Ziauddin University, Dow International Medical College and Dean College
Type: Journal Article | Journal: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP | Year: 2016

To determine the mean age of fusion of medial end of clavicle by radiography.Cross-sectional study.Departments of Forensic Medicine, Dow Medical College and Ziauddin University, Karachi, from June 2010 to May 2011.The subjects for this study were selected from various government colleges of Karachi. The subjects were analyzed for age and further confirmation was done by interviews where birth records and other physical parameters of age were also assessed. X-rays chest PA view was taken focusing on the medial end of clavicle; and were examined by a consultant radiologist and complete fusion of the medial end was noted. P-value less than 0.05 was considered significant.The mean age of fusion of medial end of the clavicle was found to be 21 1.43 years. Significant difference was observed in male to female age of fusion 21.14 1.41 years versus 20.65 1.94 years (p > 0.05). Similarly, statistically significant differences were observed between lower to middle income class and higher income class of all society. No difference was observed among various ethnic groups.Socio-economic factors, such as diet and nutrition, directly affect bone growth and hence bones age. The results of fusion of the medial end of the clavicle are not affected by ethnicity; however, it is significantly affected by gender. More studies should be conducted in various parts of the country to make a natural standard in setting up uniform criteria for assessing age at or above 21 years.

PubMed | Sindh Medical College, Liaquat National Medical College, Dow International Medical College and Basic Medical science Institute
Type: Journal Article | Journal: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP | Year: 2016

To determine the effect of pitavastatin, a third generation statin, on development of osteopenia in ovariectomized rats.Experimental study.Department of Pharmacology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center, Karachi, from January to July 2013.Forty female Sprague Dawley rats were divided into ovariectomized (OVX), Sham OVX and OVX given pitavastatin 0.4 mg/kg/day, 0.8 mg/kg/day, for 8 weeks. Bone density measurements using CT scan and Archimedes’ principle were made on femora and tibiae. Blood samples were analyzed for acid phosphatase (ACP) and alkaline phosphatase (ALP) levels.Ovariectomy-induced osteopenic changes were indicated by significant decrease in bone densities and Hounsfield (HU) index of distal femoral and proximal tibial metaphyses and elevation of ACP and ALP levels. 0.4 mg/kg pitavastatin did not significantly alter the evaluated parameters. 0.8 mg/kg produced a restoration of HU of lower femur and femoral density comparable to Sham. HU of upper tibia and tibial density following 0.8 mg/kg was significantly higher than OVX but was not approximate to Sham. ALP and ACP with 0.8 mg/kg were comparable to Sham.Supra-therapeutic dose of pitavastatin was effective in preventing estrogen deficiency-induced decrease in bone density of ovariectomized rates, over an 8-week period.

PubMed | Ziauddin University, Civil Hospital Karachi, Nadia Shams, Dow University of Health Sciences and Dow International Medical College
Type: Journal Article | Journal: Pakistan journal of medical sciences | Year: 2016

To find out the frequency of Alzheimers and Vascular dementia in the elderly patients.This cross sectional descriptive study was conducted in Department of Medicine, Ziauddin Hospital Karachi from 1Four hundred twenty two patients were included in this study. There were 232 (54.98 %) male and 190 (45.02 %) were female. The mean age SD of the patients was 72.585.34 years (95% CI: 72.07 to 73.09), similarly average duration of symptoms was 10.142.85 months. About 18.96% of patients were illiterate, 32.23% were matric, 28.44% were intermediate and 20.33% were graduate and post graduate. Hypertension and diabetes were the commonest co-morbid i.e. 81.3% and 73.7%, hyperlipedimia and smoking were 38.2% and 45% respectively. Frequency of Alzheimers disease and vascular dementia in the elderly was observed in 3.79% (16/422) and 2.61% (11/422) cases.A good number of patients, 27 out of 422, in this hospital based study were suffering from Alzheimers disease and vascular dementia. Early detection and prompt treatment can reduce the burden of the disease in our population.

PubMed | Tibri Hospital, Dow International Medical College and Civil Hospital
Type: Journal Article | Journal: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP | Year: 2016

To determine the frequency of hepatic hydrothorax and its association with Child Pugh Class in patients with liver cirrhosis.Descriptive, analytical study.Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, (Ward- 7), from June 2012 to May 2013.All patients with established diagnosis of decompensated chronic liver disease were included. Detailed history, thorough physical examination, routine laboratory investigations, chest X-ray and abdominal ultrasound were carried out in all patients to find out the presence of pleural effusion and ascites, respectively. Fifty milliliters of pleural fluid was aspirated in all patients with pleural effusion using the transthoracic approach, taking ultrasound guidance, wherever required. Fluid was sent for microscopic, biochemical, and microbial analysis. SBEM defined if pleural fluid with polymorphonuclear (PMN) cell count > 500 cells/mm3 or positive culture with PMN cell count > 250 cells/mm3 with exclusion of a parapneumonic effusion.Two hundred and six patients met the inclusion criteria, with mean age of 41.25 13.59 years. Among them, 149 (72.3%) were males and 57 (27.7%) females. Twenty-three (11.2%) had hydrothorax; right sided involvement was in 18 (78.3%) subjects, 3 (13%) had left sided while bilateral pleural effusion was found in 2 (8.7%) cases. SBEM was found in 07 (30.43%) cases. Mean serum albumin 3.125 0.71 gram/dl. There was association between serum albumin levels and hydrothorax. Asignificant association of hydrothorax with Child Pugh scoring system (p=0.018), but not with serum albumin (p=0.15).The frequency of hepatic hydrothorax has a significant association with hepatic function as assessed by Child Pugh scoring system, but not with serum albumin.

Jawaid M.,Dow International Medical College | Raheel S.,Dow University of Health Sciences | Ahmed F.,Dow University of Health Sciences | Aijaz H.,Dow University of Health Sciences
Journal of Research in Medical Sciences | Year: 2013

Background: Assessing educational environment is vital in determining the success or failure of any institute. A positive environment leads to achievements of students in learning while a negative one would hinder their accomplishments. The aim of this study was to evaluate the medical students' perceptions of their educational environment and to identify any differences related to gender and colleges affiliated with the University. Materials and Methods: This cross-sectional study involved all medical colleges affiliated with Dow University of Health Sciences from September to November 2011. DREEM questionnaire was administered to undergraduate medical students of the colleges. Mean and standard deviation of total DREEM score and five subscales were reported. The internal consistency coefficient (Cronbach's alpha) was calculated. Student's t test and one-way ANOVA were used for statistical analysis. Results: Total respondents were 586 students (response rate = 90.1%), 463 (79.0%) were female. Total DREEM mean score was 114.4/200 (57.2%). Highest score was found in the domain of student's academic self-perceptions (58.7%) and lowest in domain of student's perception of learning (53.7%). The inventory was found to have good reliability, with an alpha-coefficient of 0.89. There was significant difference of total DREEM score, student's perception of learning, teachers, and atmosphere between different colleges. Females perceived their educational environment to be more positive compared to male students. Conclusion: The undergraduate educational environment of the university is more positive than negative. Highest score was found in domain of student's academic self-perceptions and lowest in domain of student's perception of learning.

Naqvi S.A.H.,Government of Pakistan | Chaudhry F.F.,Dow International Medical College
Journal of the College of Physicians and Surgeons Pakistan | Year: 2012

Objective: To study the frequency of Clostridium difficile in postantibiotic diarrhoea in patients admitted to the medical ward of a secondary care hospital. Study Design: Observational study. Place and Duration of Study: Sindh Government Hospital, Liaquatabad, Karachi, from June 2002 to May 2009. Methodology: Adults of either gender who received antibiotics after admission and subsequently had watery stools at least 2 days after admission were selected. The exclusion criteria were past history of inflammatory bowel disease or any type of malabsorption state and those who did not show WBCs in stools. All variables of these patients along with clinical findings, type of antibiotic received, and number of stool motions per day were recorded. Three samples of the stools were sent for detailed reports to analyze the number of leukocytes per high field and culture, on cycloserine - cefoxitin - fructose agar (CCFA). All findings were entered into and analyzed by SPSS 16 for statistical analysis. Results: Out of the 473 patients who received antibiotics for any reasons, 191 (40.38%) developed diarrhoea. The mean age was 45.6 ± 17.73 years and male to female ratio was 1.85:1. The average number of stools passed per day was 4.84 ± 1.24 and all patients showed leukocytes in stool samples with a mean count of 6.67 ± 0.89/HPF. The stool culture on CCFA was positive for 57 patients (29.18%), while 134 patients (70.15%) were stool culture negative as well as negative for evidence of any parasites; these samples were labelled benign antibiotic associated diarrhoea (BAAD). Ampicillin and amoxicillin with clavulanate were the most implicated antibiotics in this study. Conclusion: Clostridium difficile is the main putative agent in postantibiotic diarrhoea. In settings with limited resources, use of specific culture media such as CCFA proves to be highly cost effective, and sensitive for this diagnosis. Macrolides and quinolones are the safest agents to prescribe in this context.

PubMed | Dow University of Health Sciences and Dow international Medical College
Type: Journal Article | Journal: JPMA. The Journal of the Pakistan Medical Association | Year: 2016

The study highlights the spectrum of abdominal TB in emergency surgery and its outcome. A proforma based prospective cross sectional study was conducted from March 2008 - March 2014, at the Department of General Surgery, Dow University of Health Sciences & Civil Hospital Karachi, Pakistan. Total patients studied were hundred. Ninety percent patients presented through the emergency department. Mean age was 30 7.29 years. Family history of TB was positive in 46 (46%) patients. Pulmonary TB was present in 22 (22%), and 52 (52%) - were already on Antitubercular Therapy-- Emergency exploratory laparotomy was performed in 85 (85%) patients with 61 (61%) having peritonitis. and 24 (24%) having acute intestinal obstruction. A total of 15 (15%) patients were kept on ATT under observation, Of these 7(7%) were diagnosed with Ileocaecal mass, 5 (5%) with enterocutaneous fistula, and 3(3%) had sub-acute intestinal obstruction. Ileum was the most common site for abdominal TB in 36(36%), followed by ileocaecal TB in 13 (13%) and jejunal TB in 12 (12%). Stoma and abdominal washout was the minimum procedure which was performed in 34 (34%) cases. Fourteen (14%) patients diagnosed with ileocaecal TB, received limited right hemi colectomy with two end stoma whereas 7(7%) patients were subjected to limited right hemi colectomy with primary anastomosis. Patients with multiple strictures and perforations were subjected to segmental resection with two end stoma. This was performed, in 12 (12%) cases and primary repair and anastomosis in 9 (9%). Only washouts and laparostomy was performed in 5 (5%) and adhenolysis in 4(4%) cases. Redo surgery was required in 44 (44%). The overall mortality was 18%. This study concludes that abdominal TB patients usually present late with complications in emergency surgery because of diagnostic delay, having a high morbidity and mortality.

PubMed | University of Mississippi Medical Center, Midtown Dental Practice, Dow International Medical College and Emory University
Type: Journal Article | Journal: Clinical medicine & research | Year: 2016

Facial computed tomography (CT) is often performed in the emergency department as a part of the diagnostic workup for patients presenting with the signs and symptoms of dentoalveolar abscess (DA). This investigation evaluated the diagnostic yield of the facial CT and its effects on management change in patients suspected of DA. Furthermore, we assessed secondary consequences of routine facial CT use in this population by using turn-around time (TAT), cost, and radiation exposure as the key parameters.We retrospectively reviewed records of suspected DA patients over a 5-year period, from June 2008 to June 2013. TAT was calculated for patients from the time the examination was ordered by the emergency department physician, to the time the report was finalized by the attending radiologist. Effective radiation dose for facial CT was calculated by multiplying dose length product by the standard conversion coefficient K (K = 0.0021 mSv/mGy x cm). CT cost was included for reference but was not analyzed extensively due to the lack of standardization of costs across the various institutions.Our investigation consisted of 117 patients; 75 males of average age 41 (12) years and 42 females of average age 44 (17) years. Out of the total 117 patients that underwent CT for the suspicion of a simple DA, only a single individual (0.85%) underwent a management change. Mean TAT of facial CT was 110 (63) minutes, and a median TAT was 87 (71) minutes. Average effective radiation dose for a facial CT was 2.4 (0.4) mSv. Approximate estimated cost of a contrast enhanced facial CT was $253 and non-contrast facial CT was $209.Our study shows that routine use of facial CT has a very limited diagnostic value in the workup of simple DA and rarely results in management change. The overall impact on patient management is miniscule in the context of prolonged TAT, radiation exposure, and adding to the rising medical costs.

Jawed S.,Dow International Medical College
JPMA. The Journal of the Pakistan Medical Association | Year: 2012

To determine the effect of smoking on forced vital capacity, forced expiratory volume in 1 sec. and the ratio between the two. The cross-sectional study was conducted in two Karachi-based medical colleges, Dow International Medical College and Bahria University Medical and Dental College between March 2010 and February 2011. The study comprised 244 male students (aged 19-25 years) who were selected by simple random sampling. A detailed questionnaire was got filled up by each participant to assess the smoking status and respiratory disease symptoms. Spirometry was performed by power lab spirometer according to the recommended guidelines of the American Thoracic Society and the European Respiratory Society by highly trained power lab instructor. Data was analysed using SPSS version 16. Means and standard deviations were worked out for continuous variables, while analyses of variance was done to see the difference among various categories. A statistically significant difference was found in the mean spirometric values of forced expiratory volume, forced expiratory capacity and their ratio between the smokers and the non-smokers. The first two factors were significantly lower among those who smoked > 10-20 cigarettes/day. But there was no statistically significant difference in the mean ratio of passive smokers and former smokers. The deterioration of lung functions and habitual cough is directly related to the number of cigarettes smoked per day in young smokers.

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