Clinical Efficacy and Safety of Injectable Levetiracetam Versus Phenytoin as Second-Line Therapy in the Management of Generalized Convulsive Status Epilepticus in Children: An Open-Label Randomized Controlled Trial

BACKGROUND AND PURPOSE: There is sparsity of quality evidence for the use of drugs after first-line benzodiazepines in convulsive status epilepticus in children. The aim of the study was to compare the clinical efficacy and safety of intravenous levetiracetam versus intravenous phenytoin as second-line drugs in the management of generalized convulsive status epilepticus in children. METHODS: This open-label randomized controlled trial was conducted in the Emergency Department of The Children's Hospital and The Institute of Child Health, Multan, Pakistan over a period of 4 years and 6 months from January 2014 to June 2018. This study included 600 children with generalized convulsive status epilepticus: 300 in the 40 mg/kg levetiracetam group, and 300 in the 20 mg/kg phenytoin group. Cessation of a clinical seizure (seizure cessation rate) within 30 minutes after the end of drug administration was the primary outcome in this study, and the presence or absence of adverse effects was noted as the secondary outcome. Data were analyzed using SPSS (version 20.0). RESULTS: The children in the levetiracetam and phenytoin were aged 3.5±0.2 and 3.4±0.2 years (mean±SD), respectively, their seizure durations before the start of treatment were 25.1±0.6 and 23.8±0.4 minutes, and their treatment efficacies were 278/300 (92.7%) and 259/300 (83.3%). Levetiracetam was significantly more effective than phenytoin (p=0.012), with no significant difference in safety. Adverse events were observed in eight children in the phenytoin group. CONCLUSIONS: Levetiracetam is significantly more effective than phenytoin for the treatment of convulsive status epilepticus in children who have failed to respond to benzodiazepines.

Breast feeding; awareness and complementary feeding in mothers of children with severe acute malnutrition at Nutrition Stabilization Centre Children Hospital and Institute Of Child Health Multan

Background: breast feeding is the most natural way of feeding the infants and help to reduce child mortality and morbidity and millions of deaths could be prevented each year if mothers were aware of benefits of exclusive breast feeding for 4 -6 months and early initiation of breast feeding

Objective: to evaluate the awareness regarding breast feeding and complementary feeding in mothers of severely malnourished children

Study Design: this is a descriptive /cross sectional study

Place and duration of study: this study was conducted at the department of preventive pediatrics Children hospital and institute of child health, Multan from March 2013 to September 2013

Materials and Methods: this study included a total of 100 females that were the mothers of malnourished children visiting the follow up room of department of preventive pediatrics Children hospital and institute of child health, Multan. A questionnaire was designed and others were interviewed in detail after taking proper consent

Results: in this study, the mean age of the sample was25years +/- 3 years. 70% females [70/100] were from urban areas while 30% [30/100] were from rural areas. Of the 100 respondents 54% [54/100] of mothers were illiterate and this study showed that 99% [99/100] considered breast milk safe and effective than other feeds but practically only 23% [23/100] babies were breast fed while 77% [77/100] were bottle fed. Pre-lacteal feed was given by 82% [82/100]. According to 58% [58/100] mothers there should be a early initiation of breast feeding, while 57% [57/100] were un aware of the facts that clostrum should be given while 43% [43/100]of then considered it unhealthy and non effective, 82% [82/100] considered 4 months a period of exclusive breast feeding,61% [61/100] were counseled by doctors regarding the benefits of breast feeding, 50% [50/100] were aware of the use of exclusive breast feeding as a contraceptive tool and 34% [34/100] were aware of its importance for the prevention of breast cancer

Conclusion: the findings of the study indicated the various important policy implications for the intervention of breastfeeding. Strategies to encourage mothers to follow breastfeeding recommendations should concentrate on improving their knowledge

Obstructed labour: the preventable factors

Sixty-two cases of obstructed labour were reviewed during 6 months at a district head quarter hospital, Faisalabad to highlight the prevalence of obstructed labour and ascertain how to manage and possibly avoid this complication with special emphasis on preventable factors. There were 1584 deliveries during this period giving an incidence of obstructed labour as one in 25 deliveries. Five patients had rupture of uterus and there was one maternal death

Chronic pelvic pain after hysterectomy

Chronic pelvic pain after hysterectomy is frequently ignored and attributed to psychosexual problems. Residual ovarian syndrome and ovarian remnant syndrome should always be considered in differential diagnosis. The diagnosis and treatment of these conditions presents a formidable challenge. The presented patient suffered for nine years till the residual ova -I was enlarged enough to be clinically palpable. Removal of ovary resulted in amelioration of pelvic pain with uneventful recovery

study of tuberculosis in obstetric and gynaecologic practice

Tuberculosis is relatively commonly encountered in gynaecologic practice and has varying modes of presentation. [i] To evaluate various aspects of patients who had confirmation of tuberculosis which included age distribution, symptoms signs and diagnosis. [ii] To highlight the fact that diagnosis was frequently not made till laparotomv was done or histology became available. Design: Case study. Setting: Gynaecologic unit of DHQ Hospital faisalabad between September 1993 and May 1995. Subjects and Thirty two patients had confirmation of diagnosis of tuberculosis. Medical treatment was started promptly in all patients. Ten patients underwent laparotomy. Tuberculosis is a common entity in gynaecologic patients and is sometimes seen in obstetric patients as well. The diagnosis requires a high index of suspicion in addition to diagnostic tests

Maylard incision in gynecology: report of 30 cases

The choice of incision in gynaecologic surgery is a very critical one and has a profound influence of surgical outcome. [i] To highlight that Maylard incision is under used in gvnaecologic surgery [ll] Maylard incision is a safe and effective alternative to Pfannenstiel incision with minimal complications. Design: Case study. Setting: Gynaecologic unit of DHQ Hospital Faisalabad between September 1993 and May, 1995. Objects and Thirty patients in whom Maylard incision was used when entering the abdomen for various gynaecologic procedures. A good outcome with no complications was noted in all cases

review of ectopic pregnancy in DHQ hospital Faisalabad

Ectopic pregnancy is a life threatening condition which poses a difficult diagnostic challenge because of varying modes of presentation. I. To evaluate various aspects of patients admitted with signs and symptoms suggestive of ectopic pregnancy. II. To highlight the fact that our patients still attend late resulting in high morbidity. III. To arrive at an early diagnosis in the patients who seek early consultation. DESIGN: Case study SETTING: Gynaecologic unit of DHQ Hospital Faisalabad between September 1993 and January 1995. SUBJECTS: Thirty seven patients with suspected ectopic pregnancy. Seventeen patients were diagnosed as ectopic pregnancy, giving an incidence of 1 in 250. Total number of deliveries during this period was 4161. MANAGEMENT AND The predisposing factors, signs and symptoms and various diagnostic tests were evaluated. All patients underwent laparotomy but conservative surgical procedure in the form of linear Salpingostomy was only possible in one case. CONCLUSIONS: Early diagnosis requires careful clinical evaluation and use of multiple modalities and it is essential for proper management