Abstract (English) In Cholistan desert various landform units and associated plant communities we... more Abstract (English) In Cholistan desert various landform units and associated plant communities were recognized. Out of sixteen, ten communities were identified in smaller Cholistan ie Calligonum polygonoides-Haloxylon salicornicum, Tamarix aphylla-Suaeda ...
Abstract A study was conducted at the National Agricultural Research Center (NARC) of Pakistan Ag... more Abstract A study was conducted at the National Agricultural Research Center (NARC) of Pakistan Agricultural Research Council (PARC) by planting trees of four different species: Eucalyptus camaldulensis, Albizia procera, Morus alba and Leucaena leucocephala ...
Journal of the American College of Cardiology, Mar 1, 2020
Background: Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy that usually presents with... more Background: Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy that usually presents with progressive left and right heart failure, angina and syncope. It leads to significant morbidity and mortality which is compounded by the fact that it is a diagnostic challenge even with imaging Case: A 79-year-old male with history of hypertension and COPD presented to the cardiology clinic for worsening dyspnea on exertion for six months. Initial treatment for COPD exacerbation did not improve symptoms. His exam revealed a mid-systolic crescendo-decrescendo murmur accentuating with Valsalva and his EKG showed normal voltage. An echo showed severe concentric left ventricular hypertrophy (LVH) with ejection fraction of 60%. Resting peak velocity across the left ventricle outflow tract (LVOT) was 5.78 m/s and peak gradient 133 mmHg, which increased to 6.59 and 174 respectively with Valsalva. Systolic anterior motion (SAM) of mitral valve was present Decision-making: Due to high suspicion for Hypertrophic Obstructive Cardiomyopathy (HOCM), Cardiac MRI was ordered which showed LVH with severe septal thickening. However, it also showed global subendocardial late gadolinium enhancement indicative of CA. Nuclear pyrophosphate scan was strongly suggestive of Amyloid ATTR subtype. The patient was started on Tafamidis. For symptom management of his LVOT obstruction, he was started on beta blockers, with septal ablation versus disopyramide being consider which are off label for CA Conclusion: Differentiating CA and HOCM is a dilemma as both can present with asymmetrical septal hypertrophy. LVOT obstruction and SAM can add to this confusion and lead to missed diagnosis of CA which could be treated with targeted drug therapy. MRI with supplemental information from nuclear pyrophosphate scan are the diagnostic imaging modalities that help distinguish the two, with MRI's sensitivity and specificity up to 88% and 90%. Some amyloid cases can actually present without the typical late gadolinium enhancement and are discovered by positive Congo red dye staining of biopsy specimen of treated HOCM patients. This case underscores the importance of choosing the right imaging modality to diagnose CA
Journal of the American College of Cardiology, Mar 1, 2018
Background: The left atrial appendage (LAA) is muscular projection of the left atrium with variab... more Background: The left atrial appendage (LAA) is muscular projection of the left atrium with variable shapes and a narrow neck where blood can collect and form clots leading to stroke and other embolic phenomena. Congenital absence of the left atrial appendage is extremely rare [1, 2] , limiting our understanding of its clinical significance. Case: An 84 year old Caucasian male with new onset atrial fibrillation (AF) and CHADS2VASC2 score of 2 for age, was seen for elective TEE guided cardioversion due to new dyspnea on exertion.His TTE showed normal ejection fraction with mild left ventricular hypertrophy and mildly dilated left atrium. A TEE was performed and no LAA seen on multiple views. (Fig A). His surgical history was reviewed, and he had no history of surgical or percutaneous LAA ligation. Decision-making: Congenital absence of LAA was suspected. Dedicated cardiac CT confirmed the absence of the LAA (Fig D and E). The patient was cardioverted to normal sinus rhythm. Significance of congenital absence of the LAA remains uncertain with no guidelines or recommendations about long term anti-coagulation in such rare cases. CHADS2VASC2 scoring system may not apply to this particular population and true risk of AF related strokes may not be accurately predicted. Based on the limited data available from LAA closure and effect of LAA morphology on stroke,risk in these patients may be equivalent to those undergoing LAA closure. Our patient after extensive discussion opted not to continue long term anti-coagulation. Conclusion: Based on recent data from LAA closure studies [3, 4] , one can postulate that congenital absence may portend a lower risk of intra-atrial thrombosis and stroke in patient with AF. Our patient has continued to do well on daily aspirin 81 mg over last 1 year of follow up.
British journal of medicine and medical research, Jan 10, 2014
Guillain Barre Syndrome (GBS) is an acute neuromuscular weakness and paralysis associated with ar... more Guillain Barre Syndrome (GBS) is an acute neuromuscular weakness and paralysis associated with areflexia and often spontaneous recovery, but carries the potential risk of respiratory depression owing to muscle weakness. Worldwide, 1 to 3 cases/100,000 are reported. The syndrome is most commonly reported as symmetrical ascending weakness in arms and legs accompanied by hyporeflexia or areflexia. Sensory disturbances are not required for diagnosis, but may or may not be present. Acute inflammatory demyelinating poly-radiculoneuropathy (AIDP) is the most common variant, but acute motor and sensory axonal neuropathy (ASMAN) is more severe and usually leads to partial or slow recovery. We present a case of GBS presenting with asymmetric weakness and sensory disturbance in a patient with bloody diarrhea of unknown etiology. This patient had asymmetrical paralysis mimicking stroke, but the physical findings, laboratory studies, normal CT and MRI of the brain, Electromyogram (EMG) and the patient’s improvement with Intravenous Immunoglobulin (IVIG) support the diagnosis of GBS. People with inflammatory bowel disease are at increased risk of
Journal of the American College of Cardiology, Mar 1, 2020
Background: Adult congenital heart disease patients often present with challenging diagnosis. Cas... more Background: Adult congenital heart disease patients often present with challenging diagnosis. Case: A 50 year old physically active male presented for evaluation of left sided chest pain. Medical history was significant for VSD diagnosed at age 8, not requiring surgical correction and subsequently lost to follow up. Exercise stress testing was normal. Echocardiogram showed restrictive perimembranous VSD with aneurysm of the membranous septum (Figure) and normal biventricular size and function. Continuous wave doppler showed elevated peak velocity (2.5 m/s) in the pulmonic area. Subsequent cardiac catheterization showed normal coronaries, peak to peak gradient of 20 mm Hg from right ventricle (RV) to pulmonary artery (PA) and Qp:Qs of 1.9. Cardiac MRI (CMR) was ordered for accurate assessment of ventricular volumes and further delineation of RV-PA gradient. It showed perimembranous VSD with Qp:Qs 1.6 and a large RVOT mass measuring 2.7x2.8 cm (Figure). The mass demonstrated increased perfusion and late gadolinium enhancement with central clearing and rim appearance. Decision-making: The mass on CMR was likely a ventricular septal aneurysm with redundant tricuspid valve tissue from the aneurysm prolapsing into the RVOT. This was responsible for the RV-PA gradient. Cardiac CT was ordered for further evaluation of this mass. Conclusion: We present an unusual case of perimembranous VSD with a large ventricular septal aneurysm prolapsing into the RVOT and producing a subpulmonic gradient.
British journal of medicine and medical research, Jan 10, 2014
Distal renal tubular acidosis (dRTA) is seen in the human immunodeficiency virus/acquired immunod... more Distal renal tubular acidosis (dRTA) is seen in the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) population in the setting of hypergammaglobulinemia and antiretroviral agents, whereas isolated HIV infection is rarely reported to be associated with dRTA. We report a case of a young woman with a history of untreated HIV/AIDS who presented with profound generalized weakness and refractory hypokalemia along with non-anion gap metabolic acidosis and inappropriately high urine pH. Her serum gamma-globulin level was not significantly elevated and she was not on highly active antiretroviral therapy (HAART). No other cause of dRTA was evident. Subsequently, a diagnosis of dRTA secondary to isolated HIV/AIDS was made. Distal RTA can be acquired or inherited and is caused by defects in proton pumps or pH pressure gradients. In dRTA, the potassium level can be low, normal, or even high depending upon the pathophysiologic abnormality. Early recognition and prompt Case Study British Journal of Medicine & Medical Research, 4(1): 522-528, 2014 523 treatment is imperative to avoid the serious consequences of severe electrolyte and metabolic disturbances. Our case report is a reminder to clinicians to be mindful of this rare condition when evaluating unexplained dRTA and to include HIV/AIDS as part of the differential diagnosis of dRTA even in the absence of significant hypergammaglobulinemic (IgG level was slightly elevated) state or antiretroviral agents. We believe this is the second such case to be documented.
Systolic anterior motion (SAM) of the mitral valve is a well-known phenomenon associated with lef... more Systolic anterior motion (SAM) of the mitral valve is a well-known phenomenon associated with left ventricular outflow tract obstruction and hemodynamic compromise. This finding may occur in patients with or without hypertrophic cardiomyopathy. In this report, a patient with no prior medical history presented to the hospital with left-sided chest pain and high-risk echocardiogram (ECG) findings. Left heart catheterization with coronary angiography was negative for coronary artery disease. His initial examination was significant for a systolic murmur due to the underlying SAM, as demonstrated by transthoracic echocardiogram. During his hospitalization, he developed acute heart failure syndrome as a result of dynamic outflow tract obstruction. He was treated with fluid resuscitation with a resolution of his hemodynamic compromise. On a follow-up examination, there was no murmur and SAM was no longer present on echocardiogram. This case demonstrates the importance of recognizing the clinical manifestations of SAM as well as its role in maintaining an appropriate hemodynamic status.
Brugada syndrome (BrS) is an inherited disorder of cardiac ion channels characterized by peculiar... more Brugada syndrome (BrS) is an inherited disorder of cardiac ion channels characterized by peculiar ECG findings predisposing individuals to ventricular arrhythmias, syncope, and sudden cardiac death (SCD). Various electrolyte disturbances and ion channels blocking drugs could also provoke BrS ECG findings without genetic BrS. Clinical differentiation and recognition are essential for guiding the legitimate action. Hyperkalemia is well known to cause a wide variety of ECG manifestations. Severe hyperkalemia can even cause life threatening ventricular arrhythmias and cardiac conduction abnormalities. Most common ECG findings include peaked tall T waves with short PR interval and wide QRS complex. Since it is very commonly encountered disorder, physicians need to be aware of even its rare ECG manifestations, which include ST segment elevation and Brugada pattern ECG (BrP). We are adding a case to the limited literature about hyperkalemia induced reversible Brugada pattern ECG changes.
Photocatalytic hydrogen generation from direct water splitting is recognized as a progressive and... more Photocatalytic hydrogen generation from direct water splitting is recognized as a progressive and renewable energy producer. The secret to understanding this phenomenon is discovering an efficient photocatalyst that preferably uses sunlight energy. Two-dimensional (2D) graphitic carbon nitride (g-C 3 N 4)based materials are promising for photocatalytic water splitting due to special characteristics such as appropriate band gap, visible light active, ultra-high specific surface area, and abundantly exposed active sites. However, the inadequate photocatalytic activity of pure 2D layered g-C 3 N 4-based materials is a massive challenge due to the quick recombination between photogenerated holes and electrons. Creating 2D heterogeneous photocatalysts is a cost-effective strategy for clean and renewable hydrogen production on a larger scale. The 2D g-C 3 N 4-based heterostructure with the combined merits of each 2D component, which facilitate the rapid charge separation through the heterojunction effect on photocatalyst, has been evidenced to be very effective in enhancing the photocatalytic performance. To further improve the photocatalytic efficiency, the development of novel 2D g-C 3 N 4-based heterostructure photocatalysts is critical. This mini-review covers the fundamental concepts, recent advancements, and applications in photocatalytic hydrogen production. Furthermore, the challenges and perspectives on 2D g-C 3 N 4-based heterostructure photocatalysts demonstrate the future direction toward sustainability.
Pulmonary arterial hypertension (PAH) is a rare disorder characterised by progressive obliteratio... more Pulmonary arterial hypertension (PAH) is a rare disorder characterised by progressive obliteration of the pulmonary microvasculature resulting in elevated pulmonary vascular resistance and premature death. According to the current classification PAH can be associated with exposure to certain drugs or toxins, particularly to appetite suppressant intake drugs, such as aminorex, fenfluramine derivatives and benfluorex. These drugs have been confirmed to be risk factors for PAH and were withdrawn from the market. The supposed mechanism is an increase in serotonin levels, which was demonstrated to act as a growth factor for the pulmonary artery smooth muscle cells. Amphetamines, phentermine and mazindol were less frequently used, but are considered possible risk factors, for PAH. Dasatinib, dual Src/Abl kinase inhibitor, used in the treatment of chronic myelogenous leukaemia was associated with cases of severe PAH, potentially in part reversible after dasatinib withdrawal. Recently, several studies have raised the issue of potential endothelial dysfunction that could be induced by interferon, and a few cases of PAH have been reported with interferon therapy. PAH remains a rare complication of these drugs, suggesting possible individual susceptibility, and further studies are needed to identify patients at risk of drug-induced PAH.
... antagonism'. There is justification for concern in the view that residual flow t... more ... antagonism'. There is justification for concern in the view that residual flow to the Arabian Sea is 'wastage' (Asrar-ul-Haq et al., 1997) or 'escapages' (Tarar, 1997) rather than an important element of environmental sustainability. Failure ...
Parathyroid cysts are rare lesions found in the neck and anterior mediastinum. They are often non... more Parathyroid cysts are rare lesions found in the neck and anterior mediastinum. They are often nonfunctional (>90%) and rarely in the functional form. This paper discusses a case of severe hypercalcemia (23 mg/dL) secondary to a rare functional parathyroid cyst. The patient was later found to have a hemorrhagic cyst with compression of the right recurrent laryngeal nerve. Preoperative diagnosis of the lesion was parathyroid carcinoma. However, reexploration of the parathyroid mass along with microscopic study confirmed the diagnosis of a parathyroid cyst. Following cystectomy, the patient restored her baseline functional status with preservation of the right recurrent laryngeal nerve. Postoperative followup three years later showed no evidence of cyst recurrence. This paper illustrates the rare presentation of parathyroid functional cysts with severe hypercalcemia and primary hyperparathyroidism. Physicians should be aware of the presence of hemorrhage, inflammation, and compressive symptoms in these cysts which mimic parathyroid carcinoma. These patients should be managed with aggressive medical and surgical intervention.
International Journal of Biology and Biotechnology, 2010
ABSTRACT Keenjhar Lake is one of the major fresh water reservoirs located at Thatta district of S... more ABSTRACT Keenjhar Lake is one of the major fresh water reservoirs located at Thatta district of Sindh province, spread on area of about 140 km-2. It has been designated as Ramsar site in 1976 and a wildlife sanctuary in 1977. The Lake is a vital wetland area of great ecological, biological and economic significance. It is a major source of domestic and industrial water supplies to Karachi metropolitan. It is an important breeding and wintering area for a wide variety of birds, reptiles and mammals. Local communities especially fishermen are dependent on this important wetland for their sustenance.
Subclinical mastitis is 3 to 40 times more common than clinical mastitis and causes great losses ... more Subclinical mastitis is 3 to 40 times more common than clinical mastitis and causes great losses in the dairy herds. Staphylococcus aureus (S. aureus) is one of the most common causative agents of subclinical bovine mastitis in dairy cattle worldwide and it has been observed that up to 50 100% of herds are infected with this pathogen. To determine prevalence and compare bacterial culture methods and polymerase chain reaction (PCR) for diagnosis of subclinical mastitis caused by S. aureus, milk samples from 164 apparently mastitis free Nili-Ravi buffaloes were collected from lactating herd at Livestock Experiment Station, Bahadurnagar Okara. These samples were initially tested by using subclinical mastitis detection kit “CMT Test” and eighteen milk samples (10.97%) were found positive for subclinical mastitis by using this kit. To compare cultural technique with PCR, all these 164 milk samples were cultured on blood agar and the bacteria were identified by standard methods. Ten out of 164 samples showed cultural growth of the organism, thus showing prevalence 6.09 % (10 /164) of S. aureus by using conventional culturing technique. DNA was extracted from all 164 milk samples as well as from samples cultured in broth & blood agar plate colonies. All these were then subjected to PCR test with primers STAA-AUI and STAAAVII, for a 420 bp amplicon specific for S. aureus. Thirty two (19.51 %) out of 164 milk samples,18 broth culturing and 10 bacterial colonies were found positive for S. aureus by PCR. The results of this study indicate that PCR is sensitive and specific for diagnosis of S. aureus subclinical mastitis and can detect this pathogen in milk samples within few hours in Nili-Ravi buffaloes.
Abstract (English) In Cholistan desert various landform units and associated plant communities we... more Abstract (English) In Cholistan desert various landform units and associated plant communities were recognized. Out of sixteen, ten communities were identified in smaller Cholistan ie Calligonum polygonoides-Haloxylon salicornicum, Tamarix aphylla-Suaeda ...
Abstract A study was conducted at the National Agricultural Research Center (NARC) of Pakistan Ag... more Abstract A study was conducted at the National Agricultural Research Center (NARC) of Pakistan Agricultural Research Council (PARC) by planting trees of four different species: Eucalyptus camaldulensis, Albizia procera, Morus alba and Leucaena leucocephala ...
Journal of the American College of Cardiology, Mar 1, 2020
Background: Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy that usually presents with... more Background: Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy that usually presents with progressive left and right heart failure, angina and syncope. It leads to significant morbidity and mortality which is compounded by the fact that it is a diagnostic challenge even with imaging Case: A 79-year-old male with history of hypertension and COPD presented to the cardiology clinic for worsening dyspnea on exertion for six months. Initial treatment for COPD exacerbation did not improve symptoms. His exam revealed a mid-systolic crescendo-decrescendo murmur accentuating with Valsalva and his EKG showed normal voltage. An echo showed severe concentric left ventricular hypertrophy (LVH) with ejection fraction of 60%. Resting peak velocity across the left ventricle outflow tract (LVOT) was 5.78 m/s and peak gradient 133 mmHg, which increased to 6.59 and 174 respectively with Valsalva. Systolic anterior motion (SAM) of mitral valve was present Decision-making: Due to high suspicion for Hypertrophic Obstructive Cardiomyopathy (HOCM), Cardiac MRI was ordered which showed LVH with severe septal thickening. However, it also showed global subendocardial late gadolinium enhancement indicative of CA. Nuclear pyrophosphate scan was strongly suggestive of Amyloid ATTR subtype. The patient was started on Tafamidis. For symptom management of his LVOT obstruction, he was started on beta blockers, with septal ablation versus disopyramide being consider which are off label for CA Conclusion: Differentiating CA and HOCM is a dilemma as both can present with asymmetrical septal hypertrophy. LVOT obstruction and SAM can add to this confusion and lead to missed diagnosis of CA which could be treated with targeted drug therapy. MRI with supplemental information from nuclear pyrophosphate scan are the diagnostic imaging modalities that help distinguish the two, with MRI's sensitivity and specificity up to 88% and 90%. Some amyloid cases can actually present without the typical late gadolinium enhancement and are discovered by positive Congo red dye staining of biopsy specimen of treated HOCM patients. This case underscores the importance of choosing the right imaging modality to diagnose CA
Journal of the American College of Cardiology, Mar 1, 2018
Background: The left atrial appendage (LAA) is muscular projection of the left atrium with variab... more Background: The left atrial appendage (LAA) is muscular projection of the left atrium with variable shapes and a narrow neck where blood can collect and form clots leading to stroke and other embolic phenomena. Congenital absence of the left atrial appendage is extremely rare [1, 2] , limiting our understanding of its clinical significance. Case: An 84 year old Caucasian male with new onset atrial fibrillation (AF) and CHADS2VASC2 score of 2 for age, was seen for elective TEE guided cardioversion due to new dyspnea on exertion.His TTE showed normal ejection fraction with mild left ventricular hypertrophy and mildly dilated left atrium. A TEE was performed and no LAA seen on multiple views. (Fig A). His surgical history was reviewed, and he had no history of surgical or percutaneous LAA ligation. Decision-making: Congenital absence of LAA was suspected. Dedicated cardiac CT confirmed the absence of the LAA (Fig D and E). The patient was cardioverted to normal sinus rhythm. Significance of congenital absence of the LAA remains uncertain with no guidelines or recommendations about long term anti-coagulation in such rare cases. CHADS2VASC2 scoring system may not apply to this particular population and true risk of AF related strokes may not be accurately predicted. Based on the limited data available from LAA closure and effect of LAA morphology on stroke,risk in these patients may be equivalent to those undergoing LAA closure. Our patient after extensive discussion opted not to continue long term anti-coagulation. Conclusion: Based on recent data from LAA closure studies [3, 4] , one can postulate that congenital absence may portend a lower risk of intra-atrial thrombosis and stroke in patient with AF. Our patient has continued to do well on daily aspirin 81 mg over last 1 year of follow up.
British journal of medicine and medical research, Jan 10, 2014
Guillain Barre Syndrome (GBS) is an acute neuromuscular weakness and paralysis associated with ar... more Guillain Barre Syndrome (GBS) is an acute neuromuscular weakness and paralysis associated with areflexia and often spontaneous recovery, but carries the potential risk of respiratory depression owing to muscle weakness. Worldwide, 1 to 3 cases/100,000 are reported. The syndrome is most commonly reported as symmetrical ascending weakness in arms and legs accompanied by hyporeflexia or areflexia. Sensory disturbances are not required for diagnosis, but may or may not be present. Acute inflammatory demyelinating poly-radiculoneuropathy (AIDP) is the most common variant, but acute motor and sensory axonal neuropathy (ASMAN) is more severe and usually leads to partial or slow recovery. We present a case of GBS presenting with asymmetric weakness and sensory disturbance in a patient with bloody diarrhea of unknown etiology. This patient had asymmetrical paralysis mimicking stroke, but the physical findings, laboratory studies, normal CT and MRI of the brain, Electromyogram (EMG) and the patient’s improvement with Intravenous Immunoglobulin (IVIG) support the diagnosis of GBS. People with inflammatory bowel disease are at increased risk of
Journal of the American College of Cardiology, Mar 1, 2020
Background: Adult congenital heart disease patients often present with challenging diagnosis. Cas... more Background: Adult congenital heart disease patients often present with challenging diagnosis. Case: A 50 year old physically active male presented for evaluation of left sided chest pain. Medical history was significant for VSD diagnosed at age 8, not requiring surgical correction and subsequently lost to follow up. Exercise stress testing was normal. Echocardiogram showed restrictive perimembranous VSD with aneurysm of the membranous septum (Figure) and normal biventricular size and function. Continuous wave doppler showed elevated peak velocity (2.5 m/s) in the pulmonic area. Subsequent cardiac catheterization showed normal coronaries, peak to peak gradient of 20 mm Hg from right ventricle (RV) to pulmonary artery (PA) and Qp:Qs of 1.9. Cardiac MRI (CMR) was ordered for accurate assessment of ventricular volumes and further delineation of RV-PA gradient. It showed perimembranous VSD with Qp:Qs 1.6 and a large RVOT mass measuring 2.7x2.8 cm (Figure). The mass demonstrated increased perfusion and late gadolinium enhancement with central clearing and rim appearance. Decision-making: The mass on CMR was likely a ventricular septal aneurysm with redundant tricuspid valve tissue from the aneurysm prolapsing into the RVOT. This was responsible for the RV-PA gradient. Cardiac CT was ordered for further evaluation of this mass. Conclusion: We present an unusual case of perimembranous VSD with a large ventricular septal aneurysm prolapsing into the RVOT and producing a subpulmonic gradient.
British journal of medicine and medical research, Jan 10, 2014
Distal renal tubular acidosis (dRTA) is seen in the human immunodeficiency virus/acquired immunod... more Distal renal tubular acidosis (dRTA) is seen in the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) population in the setting of hypergammaglobulinemia and antiretroviral agents, whereas isolated HIV infection is rarely reported to be associated with dRTA. We report a case of a young woman with a history of untreated HIV/AIDS who presented with profound generalized weakness and refractory hypokalemia along with non-anion gap metabolic acidosis and inappropriately high urine pH. Her serum gamma-globulin level was not significantly elevated and she was not on highly active antiretroviral therapy (HAART). No other cause of dRTA was evident. Subsequently, a diagnosis of dRTA secondary to isolated HIV/AIDS was made. Distal RTA can be acquired or inherited and is caused by defects in proton pumps or pH pressure gradients. In dRTA, the potassium level can be low, normal, or even high depending upon the pathophysiologic abnormality. Early recognition and prompt Case Study British Journal of Medicine & Medical Research, 4(1): 522-528, 2014 523 treatment is imperative to avoid the serious consequences of severe electrolyte and metabolic disturbances. Our case report is a reminder to clinicians to be mindful of this rare condition when evaluating unexplained dRTA and to include HIV/AIDS as part of the differential diagnosis of dRTA even in the absence of significant hypergammaglobulinemic (IgG level was slightly elevated) state or antiretroviral agents. We believe this is the second such case to be documented.
Systolic anterior motion (SAM) of the mitral valve is a well-known phenomenon associated with lef... more Systolic anterior motion (SAM) of the mitral valve is a well-known phenomenon associated with left ventricular outflow tract obstruction and hemodynamic compromise. This finding may occur in patients with or without hypertrophic cardiomyopathy. In this report, a patient with no prior medical history presented to the hospital with left-sided chest pain and high-risk echocardiogram (ECG) findings. Left heart catheterization with coronary angiography was negative for coronary artery disease. His initial examination was significant for a systolic murmur due to the underlying SAM, as demonstrated by transthoracic echocardiogram. During his hospitalization, he developed acute heart failure syndrome as a result of dynamic outflow tract obstruction. He was treated with fluid resuscitation with a resolution of his hemodynamic compromise. On a follow-up examination, there was no murmur and SAM was no longer present on echocardiogram. This case demonstrates the importance of recognizing the clinical manifestations of SAM as well as its role in maintaining an appropriate hemodynamic status.
Brugada syndrome (BrS) is an inherited disorder of cardiac ion channels characterized by peculiar... more Brugada syndrome (BrS) is an inherited disorder of cardiac ion channels characterized by peculiar ECG findings predisposing individuals to ventricular arrhythmias, syncope, and sudden cardiac death (SCD). Various electrolyte disturbances and ion channels blocking drugs could also provoke BrS ECG findings without genetic BrS. Clinical differentiation and recognition are essential for guiding the legitimate action. Hyperkalemia is well known to cause a wide variety of ECG manifestations. Severe hyperkalemia can even cause life threatening ventricular arrhythmias and cardiac conduction abnormalities. Most common ECG findings include peaked tall T waves with short PR interval and wide QRS complex. Since it is very commonly encountered disorder, physicians need to be aware of even its rare ECG manifestations, which include ST segment elevation and Brugada pattern ECG (BrP). We are adding a case to the limited literature about hyperkalemia induced reversible Brugada pattern ECG changes.
Photocatalytic hydrogen generation from direct water splitting is recognized as a progressive and... more Photocatalytic hydrogen generation from direct water splitting is recognized as a progressive and renewable energy producer. The secret to understanding this phenomenon is discovering an efficient photocatalyst that preferably uses sunlight energy. Two-dimensional (2D) graphitic carbon nitride (g-C 3 N 4)based materials are promising for photocatalytic water splitting due to special characteristics such as appropriate band gap, visible light active, ultra-high specific surface area, and abundantly exposed active sites. However, the inadequate photocatalytic activity of pure 2D layered g-C 3 N 4-based materials is a massive challenge due to the quick recombination between photogenerated holes and electrons. Creating 2D heterogeneous photocatalysts is a cost-effective strategy for clean and renewable hydrogen production on a larger scale. The 2D g-C 3 N 4-based heterostructure with the combined merits of each 2D component, which facilitate the rapid charge separation through the heterojunction effect on photocatalyst, has been evidenced to be very effective in enhancing the photocatalytic performance. To further improve the photocatalytic efficiency, the development of novel 2D g-C 3 N 4-based heterostructure photocatalysts is critical. This mini-review covers the fundamental concepts, recent advancements, and applications in photocatalytic hydrogen production. Furthermore, the challenges and perspectives on 2D g-C 3 N 4-based heterostructure photocatalysts demonstrate the future direction toward sustainability.
Pulmonary arterial hypertension (PAH) is a rare disorder characterised by progressive obliteratio... more Pulmonary arterial hypertension (PAH) is a rare disorder characterised by progressive obliteration of the pulmonary microvasculature resulting in elevated pulmonary vascular resistance and premature death. According to the current classification PAH can be associated with exposure to certain drugs or toxins, particularly to appetite suppressant intake drugs, such as aminorex, fenfluramine derivatives and benfluorex. These drugs have been confirmed to be risk factors for PAH and were withdrawn from the market. The supposed mechanism is an increase in serotonin levels, which was demonstrated to act as a growth factor for the pulmonary artery smooth muscle cells. Amphetamines, phentermine and mazindol were less frequently used, but are considered possible risk factors, for PAH. Dasatinib, dual Src/Abl kinase inhibitor, used in the treatment of chronic myelogenous leukaemia was associated with cases of severe PAH, potentially in part reversible after dasatinib withdrawal. Recently, several studies have raised the issue of potential endothelial dysfunction that could be induced by interferon, and a few cases of PAH have been reported with interferon therapy. PAH remains a rare complication of these drugs, suggesting possible individual susceptibility, and further studies are needed to identify patients at risk of drug-induced PAH.
... antagonism'. There is justification for concern in the view that residual flow t... more ... antagonism'. There is justification for concern in the view that residual flow to the Arabian Sea is 'wastage' (Asrar-ul-Haq et al., 1997) or 'escapages' (Tarar, 1997) rather than an important element of environmental sustainability. Failure ...
Parathyroid cysts are rare lesions found in the neck and anterior mediastinum. They are often non... more Parathyroid cysts are rare lesions found in the neck and anterior mediastinum. They are often nonfunctional (>90%) and rarely in the functional form. This paper discusses a case of severe hypercalcemia (23 mg/dL) secondary to a rare functional parathyroid cyst. The patient was later found to have a hemorrhagic cyst with compression of the right recurrent laryngeal nerve. Preoperative diagnosis of the lesion was parathyroid carcinoma. However, reexploration of the parathyroid mass along with microscopic study confirmed the diagnosis of a parathyroid cyst. Following cystectomy, the patient restored her baseline functional status with preservation of the right recurrent laryngeal nerve. Postoperative followup three years later showed no evidence of cyst recurrence. This paper illustrates the rare presentation of parathyroid functional cysts with severe hypercalcemia and primary hyperparathyroidism. Physicians should be aware of the presence of hemorrhage, inflammation, and compressive symptoms in these cysts which mimic parathyroid carcinoma. These patients should be managed with aggressive medical and surgical intervention.
International Journal of Biology and Biotechnology, 2010
ABSTRACT Keenjhar Lake is one of the major fresh water reservoirs located at Thatta district of S... more ABSTRACT Keenjhar Lake is one of the major fresh water reservoirs located at Thatta district of Sindh province, spread on area of about 140 km-2. It has been designated as Ramsar site in 1976 and a wildlife sanctuary in 1977. The Lake is a vital wetland area of great ecological, biological and economic significance. It is a major source of domestic and industrial water supplies to Karachi metropolitan. It is an important breeding and wintering area for a wide variety of birds, reptiles and mammals. Local communities especially fishermen are dependent on this important wetland for their sustenance.
Subclinical mastitis is 3 to 40 times more common than clinical mastitis and causes great losses ... more Subclinical mastitis is 3 to 40 times more common than clinical mastitis and causes great losses in the dairy herds. Staphylococcus aureus (S. aureus) is one of the most common causative agents of subclinical bovine mastitis in dairy cattle worldwide and it has been observed that up to 50 100% of herds are infected with this pathogen. To determine prevalence and compare bacterial culture methods and polymerase chain reaction (PCR) for diagnosis of subclinical mastitis caused by S. aureus, milk samples from 164 apparently mastitis free Nili-Ravi buffaloes were collected from lactating herd at Livestock Experiment Station, Bahadurnagar Okara. These samples were initially tested by using subclinical mastitis detection kit “CMT Test” and eighteen milk samples (10.97%) were found positive for subclinical mastitis by using this kit. To compare cultural technique with PCR, all these 164 milk samples were cultured on blood agar and the bacteria were identified by standard methods. Ten out of 164 samples showed cultural growth of the organism, thus showing prevalence 6.09 % (10 /164) of S. aureus by using conventional culturing technique. DNA was extracted from all 164 milk samples as well as from samples cultured in broth & blood agar plate colonies. All these were then subjected to PCR test with primers STAA-AUI and STAAAVII, for a 420 bp amplicon specific for S. aureus. Thirty two (19.51 %) out of 164 milk samples,18 broth culturing and 10 bacterial colonies were found positive for S. aureus by PCR. The results of this study indicate that PCR is sensitive and specific for diagnosis of S. aureus subclinical mastitis and can detect this pathogen in milk samples within few hours in Nili-Ravi buffaloes.
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Papers by Ghulam Akbar