Anti-streptokinase titers and response to streptokinase treatment in Pakistani patients

In order to investigate whether anti-streptokinase (anti-SK) antibody titers have any effect on response to standard dose (1.5 million units) streptokinase (SK) therapy in patients with acute myocardial infarction, anti-SK titers in plasma were determined in 97 such patients. These patients were classified as "responders" or "non-responders" on the basis of a criteria which involved resolution of chest pain in less than 90 min after the start of thrombolysis, greater than 50% reduction of ST segment elevation in two contiguous leads showing maximum elevations in a 12-lead tracing, reperfusion arrythmias and slope of increase in creatine kinase over a 90-min period after initiation of thrombolysis. Anti-SK antibody levels in plasma were determined in these patients as well as in 50 normal healthy subjects by dissolution of clot method. Mean+/-S.D. anti-SK levels among responders, non-responders and normal healthy subjects were found to be 0.21+/-0.12, 0.25+/-0.22 and 0.21+/-0.15 million units, respectively. A comparison of these mean values by one-way ANOVA revealed no statistical difference (P=0.68). However, when compared with the reported values for a Western population, these values were found to be significantly higher (P<0.03). Whereas, compared to the reported values for an Indian population, these were significantly lower (P<0.0001). 42% of patients appeared to have responded to SK treatment, while 21% were found to be non-responders. There was no association between response to SK and anti-SK titers in these patients suggesting that the standard dose of SK (1.5 million units) may be quite appropriate for the Pakistani population requiring SK treatment for the first time.     

An Ex Vivo Evaluation of Moxifloxacin Nanostructured Lipid Carrier Enriched In Situ Gel for Transcorneal Permeation on Goat Cornea

The study was designed to fabricate the moxifloxacin nanostructured lipid carriers (MOX-NLCs) loaded in situ gel for opthalmic application to improve the corneal permeation and retention and also subside the toxic effect associated with intracameral injection of moxifloxacin in endophthalmitis treatment. Initially, Box-Behnken design was used to optimize the various factors significantly affecting the final formulation attributes. MOX-NLCs with particle size 232.1 ± 9.2 nm, polydispersity index 0.247 ± 0.031, zeta potential ?16.3 ± 1.6 mV, entrapment efficiency 63.1 ± 2.4%, and spherical shape was achieved. The optimized MOX-NLCs demonstrated the Higuchi release kinetics with highest regression coefficient. Besides this, FTIR, differential scanning calorimetry, and X-ray diffraction results suggested that MOX had excellent compatibility with excipients. Furthermore, the results of ex-vivo permeation study demonstrated 2-fold higher permeation (208.7 ± 17.6 μg), retention (37.26 ± 2.83 μg), and flux (9.57 ± 0.73 μg/cm² h) compared with free MOX in situ gel. In addition, MOX-NLCs exhibited normal corneal hydration and did not show any sign of structural damage to the corneal tissue as confirmed by histology. Therefore, the findings strongly suggest that MOX-NLCs in situ gel with higher permeation and retention can be a better alternative strategy to prevent and treat the endophthalmitis infection.     

Incidence of arrhythmias and impact of permanent pacemaker implantation in hospitalizations with transcatheter aortic valve replacement

Background

This study sought to analyze in‐hospital outcomes associated with preexisting and newly implanted permanent pacemaker (PPM) in patients who underwent transcatheter aortic valve replacement (TAVR). PPM implantation following the development of conduction abnormalities is a common adverse event following TAVR. Furthermore, PPM implantation rates are higher in TAVR hospitalizations compared with the surgical alternative, thus we have analyzed the predictors of pacing post‐TAVR.

Hypothesis

We hypothesize that incidence of arrhythmias are high post‐TAVR and have worse adverse outcomes after receiving PPM.

Methods

The study population was identified from the National Inpatient Sample database between 2012 and 2014. TAVR population was identified using ICD‐9‐CM procedure codes 35.05 and 35.06. Hospitalizations were divided into 3 group: (1) with preexisting PPM, (2) with newly implanted PPM, and (3) without any PPM.

Results

Overall, 0.8% of hospitalizations presented with preexisting PPM and 23.7% of hospitalizations received new PPM. The overall incidence of atrial fibrillation was 44.5%, left bundle branch block 8.9%, complete atrioventricular block 9.5%, and right bundle branch block 2.7%. In‐hospital mortality was higher in hospitalizations receiving PPM compared with those without (4.9% vs 4.0%; P = 0.05). Length of stay and cost were higher in the group receiving new PPM. Female sex, atrial fibrillation, left bundle branch block, and second‐degree and complete atrioventricular block were significant predictors for receiving PPM after TAVR.

Conclusions

A risk stratification for hospitalizations with conduction disorders is necessary to avoid longer hospital stays, added costs, and mortality. Further research is warranted to investigate additional predictors for PPM after TAVR.     

Asian earthquake: report from the first volunteer British hospital team in Pakistan

At 8:52 am on 8 October 2005 a massive earthquake wracked northern Pakistan and Kashmir. Various teams were sent to Islamabad and the disaster region from the UK. We discuss the types of injury patterns seen and recommend that a central register of volunteers should be created to deal with similar situations in the future.     

Interactions and associations of paraoxonase gene cluster polymorphisms with myocardial infarction in a Pakistani population

Polymorphisms of paraoxonase gene (PON) cluster have been investigated in numerous studies for their association with myocardial infarction (MI) but the results have been conflicting. Epistasis and gene-environment interactions at this locus could possibly modulate susceptibility toward MI and account for the discrepancies. We carried out a case-control study (211 MI patients and 370 control subjects) to test association of PON cluster polymorphisms with MI, their interactions with each other and with smoking. Genotyping was performed by PCR-restriction fragment length polymorphism based assays. The Q192R, C-108T, and A148G polymorphisms were associated with MI. Two haplotypes consisting of C-108T, C311S, and A148G, having allele frequencies of 0.17 and 0.14 in the control population, predisposed to MI (global haplotype statistic chi2 = 34.74, df = 15, p = 0.0027). Multifactor dimensionality reduction analysis showed a significant three-locus model (p = 0.02) involving these three polymorphisms, suggesting a potential gene-gene interaction between PON1 and PON2. These polymorphisms also interacted with smoking, in a three-locus and a four-locus model (p = 0.01 and p = 0.05, respectively). Additionally, the R192 allele may advance the age-at-onset of MI. The PON cluster appears to be a susceptibility locus for MI in Pakistani population, and the susceptibility is modulated through gene-gene and gene-environment interactions.