Central venous catheterisation is a common procedure performed for emergency dialysis. It is usually carried out without any cardiac monitoring. Cardiac arrhythmias with associated conduction blocks are rare complications. The underlying pathogenesis is trauma to the endocardium by the guide wire or catheter. It occurs more frequently in patients with acute renal failure and azotaemia than patients with established end stage renal disease. Disturbances in acid base balance and electrolyte abnormalities are contributing factors. Fortunately, most are benign but occasionally can lead to potentially fatal arrhythmias. We report a case of a 46-year-old lady with end stage renal failure secondary to diabetes mellitus who developed runs of transient ventricular ectopics and right bundle branch block during internal jugular catheterisation. This spontaneously resolved 12 hours later.

Introduction: Aluminium exposure and toxicity are uncommon in humans. However it may occur in patients on long term haemodialysis (HD) due to water exposure during treatment. We retrospectively assessed the extent of aluminium exposure in our HD and peritoneal dialysis (PD) patients from 2002 to 2008. Materials and Methods: The study population included 43 HD patients and 77 PD patients whose blood samples were collected at four monthly intervals. In addition, HD patients were also interviewed on lifestyle factors (aluminium cookware, diet, aluminium-containing medications and tap water consumption) that may impact on serum aluminium levels. Reverse osmosis (RO) water aluminium levels were also collected during this timeframe. Results: More patients on HD had readings above the accepted range (>0.01mg/L) than peritoneal dialysis (36.9% vs. 23.8%). The mean aluminium values for HD and PD patients were 63.35 ± 34.69μg/L and 38.34 ± 17.02μg/L respectively (p<0.05). Use of aluminium cookware was identified as a risk factor for high aluminium readings in HD patients. The trend of serum aluminium correlated with that of RO water aluminium during the studied period. There was no evidence of clinical toxicity in our patients during follow up. Conclusion: The study showed that HD patients are at a higher risk of aluminium toxicity compared to PD patients. Treated RO water aluminium should be analysed on a regular basis to prevent aluminium toxicity in HD patients. Lifestyle factors may have an impact on aluminium levels in patients with renal disease.
Complications ; Dialysis ; Heavy Metal Toxicity ; Risk Factors

Objective: To report the patterns of species diversity, and regenerating capacity in the forest of Nikyal valley in relation to environmental variables and underlying anthropogenic influence. Methods: A study area was selected in a traditionally managed mountain woody pasture during July 2012 to June 2013. The area was sampled by quadrat method. The quadrats were laid down at regular intervals of 150 m. The size of quadrats was kept 10×10, 5×5 and 1×1 m

Objective To report the indigenous people's uses of plants from a multidimensional perspective in a remote area where strong ethnobotanical cultural practices prevail. Methods An ethnobotanical survey was conducted in the field during 2014–2016. Ethnobotanical data were gathered from 182 informants through oral interviews and semi-structured questionnaires. The distribution of plants was explored using both descriptive and graphical methods. Further, a Multinomial Logit Specification was applied to find out the probability of the occurrence of diverse utilization of plants in multipurpose domains. Results The study identified 202 plant species distributed among 71 families and 156 genera. Ethnobotanical data indicate that there are more medicinal (36.96%) uses of plants as compared to all other use categories. The output from the Multinomial Logit Specifications (MLS) model reveals that perennial and non-woody plants are exploited more for medicinal and food uses than annual and woody plants. In the context of ethnomedicinal uses, aerial plant parts particularly leaves are more extensively used for the preparation of herbal recipes as compared to underground parts. Conclusions The results of the study emphasize the need to create awareness among the local communities about the conservation status of plant species in order to maintain a sustainable resource of plant-derived materials into the future. The novel econometric approach employed in this study adds a new insightful methodology to the existing body of literature in the field of ethnobotany. We strongly recommend conservation measures, alongside phytochemical and pharmacological studies on the useful plant species identified in this study in order to ensure their sustainable and effective utilization.

Objective: To report the relationship of vegetation structure and environmental gradient and physiochemical properties of soil at Nikyal valley, Azad Jammu and Kashmir Methods: A survey of natural vegetation and soil of Nikyal valley was undertaken. Phytosociological survey was conducted by using Braun-Blanquet's approach. The study also investigated the vegetation structure and its relationship with altitude and edaphic factors. The floristic data was analyzed by cluster anlaysis, detrended correspondence analysis and canonical correspondence analysis using CANACOO 5.0. Results: A total of 110 plant species and 13 stands were merged into five major associations as dema rcated by cluster analysis and detrended correspondence analysis. The associations were Olea- Pinus- Themeda association, Myrsine- Rhus- Quercus association, Quercus- Rubus- Pinus association and Quercus association. Soil organic matter, saturation, pH and altitude play the major role in distribution of species. Conclusions: The variation in vegetation structure is controlled by the altitudinal gradient and physiochemical properties of soil. These results indicate a deteriorated forest structure and reduced regeneration pattern, demanding immediate attention of forest management authorities.

There are 300 known Saussurea species. Among them, Saussurea lappa (S. lappa) is a representative perennial herb, globally distributed across Himalaya region. S. lappa has been traditionally used in medicines without obvious adverse effects. Despite significant progress in phytochemical and biological analyses of S. lappa over the past few years, inclusive and critical reviews of this plant are anachronistic or quite limited in scope. The present review aims to summarize up-to-date information on the active constituents, pharmacology, traditional uses, trade and challenges in conservation and sustainable use of S. lappa from the literature. In addition to botanical studies and records of the traditional use of S. lappa in over 43 diseases, scientific studies investigating the latent medicinal uses of this species and its constituent phytochemicals for a range of disorders are presented and discussed. The structure, bioactivity, and likely mechanisms of action of S. lappa and its phytochemicals are highlighted. Although some progress has been made, further scrupulous efforts are required to investigate the individual compounds isolated from S. lappa to validate and understand its traditional uses and develop clinical applications. The present review offers preliminary information and gives direction for further basic and clinical research into this plant.

Opioid drugs are the first line of defense in severe pain but the adverse effects associated with opioids are considered as a serious issue worldwide. Acupuncture/electroacupuncture is a type of Chinese medicine therapy which is an effective analgesic therapy, well documented in animals and human studies. Electroacupuncture stimulation could release endogenous opioid peptides causing analgesia in a variety of pain models. It can be used as an alternative therapy to control the opioid crisis.

This study presents the intercomparison of the outdoor environmental gamma dose rates measured using a NaI (Tl) based survey meter along with thermoluminescent dosimeters (TLDs) and estimation of excess lifetime cancer risk (ELCR), for the inhabitants of Poonch division of the Azad Kashmir, Pakistan. CaF2: Dy (TLD-200) card dosimeters were installed at height of 1 m from ground at fifteen different locations covering the entire Poonch division comprising of three districts. During three distinct two month time periods within the six month study period, all the installed dosimeters were exposed to outdoor environmental gamma radiations, retrieved and read out at Radiation Dosimetry Laboratory, Health Physics Division, PINSTECH laboratory, Islamabad. The ambient outdoor gamma dose rate measurements were also taken with NaI (Tl) based portable radiometric instrument at 1 m above the ground. To estimate the annual gamma doses, NaI (Tl) based survey data were used for one complete year following the deployment of the dosimeters. The mean annual gamma dose rates measured by TLDs and survey meter were found as 1.47±0.10 and 0.862±0.003 mGy/y respectively. Taking into account a 29% outdoor occupancy factor, the annual average effective dose rate for individuals was estimated as 0.298±0.04 and 0.175±0.03 mSv/y by TLDs and survey meter, respectively. For outdoor exposure, the ELCR was calculated from the TLD and survey meter measurements. The environmental outdoor average annual effective dose obtained in present study are less than the estimated world average terrestrial and cosmic gamma ray dose rate of 0.9 mSv/y reported in UNSCEAR 2000. The possible origins of gamma doses in the area and incompatibilities of results obtained from the two different measurement techniques are also discussed.
Gamma Rays ; adverse effects ; Humans ; Neoplasms ; etiology ; Pakistan ; Radiation Monitoring ; instrumentation