Open Access Original Research Article

Bleeding Origin and Its Frequency in Laparoscopic Cholecystectomy

Ghulam Sarwar Majeedano, Lekhraj Mal, Ahmed Ali Danish, Bushra Tasneem, Aisha Tasneem, Yumna Ilyas

Journal of Pharmaceutical Research International, Page 8-15
DOI: 10.9734/jpri/2022/v34i36A36176

Objective: Laparoscopic cholecystectomy (LC) has recognized itself as the ‘gold standard’ treatment of gallstone disease, but it can, sometimes, be related with considerable complication leads to mortality and morbidity. Therefore, this study was intended to assess the frequency of many sources of bleeding in patients underwent laparoscopic cholecystectomy.

Methodology: This was a cross sectional study conducted in the Department of Surgery, Bhitai Dental and Medical College Hospital by using consecutive sampling technique. The duration of study was about one year from Feb 2021 to  Dec 2021. A total of 163 patients of age between 30 to 55 years of both genders of diagnosed cholecystitis with cholelithiasis, disease duration of >6 weeks identified by patient’s history were included in the study. To assess the effect modification, age, gender, duration of disease, and amount of bleeding and operative time were stratified followed by application of chi-square with a p value < 0.05 considered as significant.

Results: The study results showed that out of 163 cases of laparoscopic cholecystectomy, 141(87%) were females and 22(13%) were males with their mean age were 38.99±10.96 years. Bleeding in laparoscopic cholecystectomy from gallbladder bed was reported in 128(79%) cases followed by cystic artery in 28(17%) cases. There were78(80.4%) cases reported bleeding from gallbladder bed in < 40 years of age and 50(75.75%) cases reported in >40 years of age although with an insignificant association between them (p=0.477). 109(77.3%) cases reported bleeding from gallbladder bed in female and 19(86.3%) cases reported in males with an insignificant association between them (p=0.336). 

Conclusion: This study concluded that the most frequent bleeding site was the gallbladder bed followed by cystic artery in laparoscopic cholecystectomy. Furthermore, bleeding from gallbladder bed was common in females and < 40 years of age although there was an insignificant association observed with respect to age and gender.

Open Access Original Research Article

Comparison of Effects of Azadirachta indica Mouth Rinse on Streptococcus mutans and P. gingivilis

Fatimah Kamran, Uzma Anam Iqbal, Syeda Bisma Naseem, Syeda Noor Israr, . Nazrah-E-Zahrah, Faizan Ashar

Journal of Pharmaceutical Research International, Page 16-21
DOI: 10.9734/jpri/2022/v34i36A36177

Background: Leaves of Azadirachta indica have been studied vastly to observe their pharmacological properties. The leaves of the Neem tree and the constituents present in the leaves have reported antibacterial, antihyperglycaemic, immunomodulatory, antiulcer, antimalarial, antifungal, antiviral, antimutagenic, and anticarcinogenic properties. Conventional mouthwashes, containing chlorhexidine, used for their antimicrobial effect against bacteria in the oral cavity have certain adverse effects including alteration in taste, tartar formation and staining of teeth, restoration, and sometimes tongue. Hence the study was aimed to analyze the antimicrobial activity of Azadirachta indica mouth rinse against Streptococcus mutans and P. gingivilis colonies.

Methodology: It was an in-vivo preclinical experimental study conducted at Baqai Medical and Dental College Karachi., from February 2022 to March 2022. The calculated sample size was n =60. The participants were given an envelope for group randomization. The organisms were grown on appropriate media and extract was prepared and diluted. The extract was diluted in distilled water at 1:4 (Extract: Distilled water) concentration. Study participants were instructed to not brush their teeth before sampling. Study participants were divided into three groups (negative control, positive control, Neem tree extract rinse group) each group had 20 participants. Diluted neem tree extract was given to the experimental group for rinses, distilled water was given to the negative control group and positive controls were given a standard commercially available mouth rinse. The next sample of plaque was collected after two hours to observe the effects of neem tree leaves extract on bacterial colonies.

Results: The growth of colonies was calculated on growth media plates in samples collected before rinsing and samples that were taken after the rinsing. The pre and post samples showed a significant (p-value <0.05) decrease in the number of colonies in the positive control group (conventional rinse) and neem leaf extract group. The intragroup comparison of negative and positive control showed a significant difference in the number of colonies and the same was observed with the neem leaf extract rinse. However, the positive control and the Neem leaves extract comparison was insignificant.

Conclusion: The Azadirachta indica leaf extract has better or equal efficacy against oral microflora when compared with the standard chlorhexidine containing conventional mouth wash.

Open Access Original Research Article

Harmonic Scalpel versus Electrocautery: An Experience of Modified Radical Mastectomy at Tertiary Care Teaching Hospital

Ambreen Munir, Ramsha Khan, Aisha Masroor Bhatti, Sorath Bukhari, Urham Jalees, Maira Sangrasi, Syed Zulfiquar Ali Shah, Kanwal Ahmed Tagar

Journal of Pharmaceutical Research International, Page 22-30
DOI: 10.9734/jpri/2022/v34i36A36178

Background: The harmonic scalpel, commonly used in laparoscopic surgery, now has promise for MRM dissection. The harmonic scalpel's high frequency mechanical vibrations cut and coagulate intraoperatively at the same time, generating less heat injury than electrocautery.

Objective: To compare the outcome of modified radical mastectomy using harmonic scalpel versus electrocautery at tertiary care teaching hospital.

Methodology: The randomized controlled trial was conducted from 12th September 2018 11th March 2019 at Department of Surgery, Liaquat University of Medical and Health Science, Jamshoro. A total of 128 patients with infiltrating ductal carcinoma undergoing modified radical mastectomy, 20 to 50 years of age were included. Chronic Hepatitis, diabetes, and neo-adjuvant treatment patients were excluded. Modified radical mastectomy employing harmonic scalpel for Group A and electrocautery for Group B. Postoperative problems such as seroma development, postoperative hematoma, marginal necrosis, lymphedema, and wound infection were also observed.

Results: The mean age of women in group A was 39.81 ± 6.73 years and in group B was 39.45 ± 6.60 years. Mean duration of disease was 5.41 ± 1.91 months. The frequency of seroma formation in harmonic scalpel group as 7.81% vs 26.56% in electrocautery group, p=0.005), frequency of pain is 53.13% vs 68.75% respectively, p=0.070, frequency of hematoma is 1.56% vs 17.19% respectively, p=0.002), frequency of marginal necrosis was 0.0% vs 7.81% respectively, p=0.023), lymphedema 3.13% vs 14.06% respectively, p=0.027) and wound infection 17.19% vs 35.94% respectively, p=0.016.

Conclusion: This research indicated that harmonic scalpel is superior to electrocautery in modified radical mastectomy.

Open Access Original Research Article

Comparison between Partial versus Complete Excision of Sublingual Gland in Plunging Ranula Management (A Clinical Study)

Agha Taj Mohammad, Jamshed Bashir, Mukhtar Ibrahim Singapuri, Bushra Tasneem, Rasool Bux Behan, Syed Ghazanfar Hassan

Journal of Pharmaceutical Research International, Page 31-35
DOI: 10.9734/jpri/2022/v34i36A36181

Objective: To compare the postoperative complications of complete versus partial excision of the sublingual gland (SLG) in the management of plunging ranula.

Subject and Methods: A total of 24 patients were equally divided into two groups; Group A was treated with partial excision, while Group B was treated with Complete excision. . CT and MRI were used to diagnose the lesions. Postoperatively, complications like pain, hematoma, and temporary numbness of tongue, dysgeusia, dysphgia and recurrence were recorded.

Results: In both groups, males were in majority as compared to females. 10 males and 2 females, 9 males and 3 females were reported in Group A and B respectively. Mean age of patients in group A was 22.34±3.61, while in group B it was 21.25±3.55. Nearby 25% recurrence rate was found in patients treated with partial excision of SLG, while none of the patient reported with recurrence in complete excision group.

Conclusion: Complete excision of sublingual gland was found superior management modality as compared with partial excision in terms of postoperative recurrence.

Open Access Original Research Article

Screening of the Antimicrobial Potential of Aqueous Extracts of Some Plants Collected from the City of Narafominsk, Moscow, Russia

Mbarga M. J. Arsene, Podoprigora I. Viktorovna, Kezimana Parfait, Manar Rehailia, Smolyakova L. Andreevna, Souadkia Sarra, Yashina N. Vyacheslavovna, Kulikova A. Alekseevna, Anyutoulou K. L. Davares, Ibrahim Khelifi, Ndandja T. K. Dimitri, Nyasha Kavhiza

Journal of Pharmaceutical Research International, Page 36-45
DOI: 10.9734/jpri/2022/v34i36A36182

Background:  The antimicrobial properties of medicinal plants, including those from Russian flora, can be a considerable asset in the fight against antibiotic resistance and the search for new antimicrobials. The present work aimed at assessing the antimicrobial properties of plants collected from the Narafominsk's flora, a city located on the outskirts of Moscow, Russia.

Methods: The plants were collected from June to August 2021, the extraction was carried out with water as a solvent and the antimicrobial activity of the extracts was tested on 3 referenced microorganisms from the American Type Culture Collection (Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 6538 and Candida albicans ATCC 10231). We determined the inhibition diameters by the well diffusion method, the minimum inhibitory concentrations (MIC) & minimum bactericidal concentrations (MBC) by the microbroth dilution method.

Results: A total of 59 samples from 33 plants were extracted and included 44.1% of leaves (n=26), 32.2% of flowers (n=19), 8.5% of barks (n=5), 5.1% of whole plant (n =3) and 1 stem and 1 root (1.7%). Inhibition diameters ranged from 0 to 28 mm, MICs and MBCs from 0.5<  to  >128 mg/ml. 69.49% (n=41) of the plants showed an inhibition diameter greater than zero (>0 mm) against S. aureus, 42.37% (n=25) against E. coli and only 23.72% (n=14) against C. albicans. The plant parts ranked in decrease order of antimicrobial activity were as follows: flower < bark < leaf < whole plant < root < stem < fruit. The plants having shown a noteworthy antimicrobial (MIC ≤0.5 mg/ml) activity against at least 1/3 microorganisms tested and which deserve to be investigated in depth were: flowers of Epilobium angustifolium, Spirea japonica, Heracleum mantegazzianum and Saponaria officinalis, bark of Picea abies and the whole plant extract of Rumex obtusifolius. The second group (1≤ MIC ≤ 4 mg/ml) of plants with no less worthy antimicrobial abilities were flowers of Angelica sylvestris, Arctium minus, Centaurea jacea, Convallaria majalis, Melampyrum nemorosum and Physocarpus opulifolius, leaf of Achillea millefolium and Heracleum mantegazzianum, and bark of Quesrcus robur.

Conclusion: Flower extracts of Epilobium angustifolium, Spirea japonica, Heracleum mantegazzianum, Saponaria officinalis against are highly recommended for further studies since they presented the best MIC and inhibitions diameters.

Open Access Original Research Article

Musculoskeletal Disorders among Male Tailors in Clifton Karachi Pakistan

Anny Dhanwani, Sarika Bai, Azra Shaheen, Zafar Iqbal Shams, Haresh Kumar, Anwar Ali Jamali, Arslan Ahmer

Journal of Pharmaceutical Research International, Page 46-54
DOI: 10.9734/jpri/2022/v34i36A36183

Objective: The study was done to assess the prevalence of musculoskeletal disorders among the workers (tailors) who are working in tailoring occupation and see if they ever consult physician.

Methodology: A cross sectional survey was conducted in various large markets of Clifton area of Karachi city administration from February 2017 to December 2017.  Sample size of 278 tailors was chosen by random sampling technique. Nordic questionnaire was used to assess the musculoskeletal symptoms among subjects that include the bio data of respondent, factors associated with the symptoms, pain symptoms, and other problems faced due to symptoms through self-reported questionnaire. The collected data was inputted and analyzed in SPSS v16 and considered significant p value of   <0.05.

Results: 78.4% of the participants were observed for musculoskeletal disorder during last 12 months. From total of 278 subjects included in the study 34.9% subjects were in the age group 31-40 years, and majority of them (36.7 %) working from 6- 10 years, and 87.1 % reported working more than 8 hours per day . The most affected anatomical body part was lower back which is 26.6% followed by upper back 18.3 %, neck 12 %, knees 13.3%, ankle 11 %, wrist 7.3%, shoulder 6.9 %, hips 2.3% and elbow 2.3%.72 (33%) individual ever seen a physician while 146 (67 %) not ever seen a physician. There was statistically significant association between the pain and number of working years (p <0.001), and also statistically significant association between working hours per day and pain among the workers (P =0.002). There was no association between the age and sleeping disturbance due to pain.

Conclusion: work related musculoskeletal disorders are high among the tailors and most common complaints include lower back. Age, working years, working hours could predispose the work related musculoskeletal disorder among tailors.  Improvement of work posture, ergonomic tools and further research has been recommended.

Open Access Original Research Article

Cytological Study of Salivary Gland Lesions in Accordance with the Milan System of Reporting Salivary Gland Cytopathology

Barnali Paul, Arpana Dharwadkar, Vidya Viswanathan, Shruti Vimal, Rupali Bavikar

Journal of Pharmaceutical Research International, Page 55-63
DOI: 10.9734/jpri/2022/v34i36A36184

Aim: Fine needle aspiration cytology is an essential diagnostic tool for preoperative diagnosis of salivary gland lesions. Due to overlapping cytological features and heterogenecity of the lesions, a universal classification system was proposed, known as the “Milan System of Reporting Salivary Gland Cytopathology (MSRSGC). This system helps clinicians to plan further diagnosis and management according to the risk of malignancy (ROM) in different categories. Therefore, the aim was to stratify the lesions according to the system and calculate the risk of malignancy.

Study Design: Retrospective and prospective study.

Place and Duration of Study: Department of Pathology, Dr.D.Y.Patil Medical College, Hospital and Research Centre, Pune, between August 2016 and July 2021.

 Methodology: A five year study was conducted on 100 cases. FNAC was performed and correlation to histopathological aspects of resected and/or biopsied lesions were carried out in which tissue specimens were available. The cytological diagnosis was re-evaluated as follows: Category 1: Non‑diagnostic (ND), Category 2: Non‑neoplastic (NN), Category 3: Atypia of undetermined significance (AUS), Category 4a: Neoplasm: Benign (NB),Category 4b: Neoplasm: Salivary gland neoplasm of uncertain malignant potential (SUMP),Category 5: Suspicious of malignancy (SM) and Category 6: Malignant (M).

Results: Total 100 cases were studied. Histopathology reassessment was available in 38 cases. Case distribution in various categories were ND (0%), NN(36%), AUS(3%), NB(54%), SUMP(1%), SM(3%) and M(3%). Overall ROM reported were 0%, 11.11%, 100%, 0%, 100%, 100% and 100% respectively for each category. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the study was 94.74%, 75%, 100%, 100% and 100% respectively.

Conclusion: The Milan system is an universal 6-tier reporting system of lesions of salivary gland that helps with risk assessment and guides the clinicians for appropriate treatment.

Open Access Review Article

Postinfection Post-vaccination Autoimmune Neural Long COVID-19

Ibrahim M. S. Shnawa

Journal of Pharmaceutical Research International, Page 1-7
DOI: 10.9734/jpri/2022/v34i36A36175

Normal human subject can have baseline auto-antibodies and auto-reactive immune cells constituting the normal physiological autoimmune state. On, post- sars-cov-2 infection and post-vaccination periods either the virus built in spike protein in case of post-infection . Or the peptide expressed from the spike protein sequence within the human COVID -19 mRNA vaccines have an auto-reacting epitopes within the human vaccinee cells. Both of the virus spike protein and vaccinee cells are bearing either pan-sharing molecular mimicking or mono-specific molecular mimicking epitopes that initiate on continual exposure to the immune system cells mediating an autoimmune responses. Such responses may cause an immune conversion of the antibody and /or auto-reactive immune cells levels from the baseline limits to the clinically indicative levels of auto-antibody and/or auto-reacting cells. The immune conversion state may pose to an autoimmune tissue injuries as single or multiple organs defects expressing the patho-biologic features of autoimmune long COVID-19.This mechanistic view to the long Covid-19 is parallel with inclusion of long COVID-19 on the list of autoimmune registry 2021.Some workers holds the believe that autoimmune long COVID-19 is an auto-antibody mediated condition .Other workers are of the opinion that both auto-antibody and auto-reacting immune cells may be involved in, Though there is still existing some debate .A literature show case analysis of neural autoimmune long COVID-19 was tempted .A laboratory animal model for Post-infection-Post-vaccination autoimmune long COVID-19 was suggested .Both of these disease entities are being over-lapping.