Determination of Bergenin in Different Parts of Bergenia ciliata using a Validated RP-HPLC Method

Bergenia ciliata (Family: Saxifragaceae) is a folklore remedy for the treatment of various ailments in Asian countries. Bergenin (1) has been isolated as an active constituent in many studies, however, the amount of bergenin has not been determined in all parts of the plant. A simple RP-HPLC method was developed to determine the amount of bergenin in methanol extracts of leaves, rhizomes and roots of the plant. Separation was achieved on an Agilent Eclipse XDB-C18 column maintained at 25 o C using isocratic solvent system (water: methanol: acetic acid; 62.5:37:0.5 v/v/v) adjusted at pH 2 0 at a flow rate of 1.0 mL/min. and detected at 275 nm. Correlation coefficient (0.9952) showed linearity of concentration (5-200 μg/mL) and response. The values of LOD (0.00947 μg/mL) and LOQ (0.02869 μg/mL) indicated that method was sensitive. The recovery of bergenin was 99.99-100% indicating accuracy of method. The methanol extract of rhizomes contained higher amount of bergenin (19.4%) than roots (9.2%) and leaves (6.9%). It is concluded that methanol extract of rhizomes is a better source of bergenin than other parts of the plant. The findings are useful for standardization of bergenin containing extracts and herbal preparations.

Determination of Bergenin in Different Parts of Bergenia ciliata using a Validated RP-HPLC Method

Bergenia ciliata (Family: Saxifragaceae) is a folklore remedy for the treatment of various ailments in Asian countries. Bergenin (1) has been isolated as an active constituent in many studies, however, the amount of bergenin has not been determined in all parts of the plant. A simple RP-HPLC method was developed to determine the amount of bergenin in methanol extracts of leaves, rhizomes and roots of the plant. Separation was achieved on an Agilent Eclipse XDB-C18 column maintained at 25 o C using isocratic solvent system (water: methanol: acetic acid; 62.5:37:0.5 v/v/v) adjusted at pH 2 0 at a flow rate of 1.0 mL/min. and detected at 275 nm. Correlation coefficient (0.9952) showed linearity of concentration (5-200 μg/mL) and response. The values of LOD (0.00947 μg/mL) and LOQ (0.02869 μg/mL) indicated that method was sensitive. The recovery of bergenin was 99.99-100% indicating accuracy of method. The methanol extract of rhizomes contained higher amount of bergenin (19.4%) than roots (9.2%) and leaves (6.9%). It is concluded that methanol extract of rhizomes is a better source of bergenin than other parts of the plant. The findings are useful for standardization of bergenin containing extracts and herbal preparations.

Factors associated with low birthweight in term pregnancies: a matched case–control study from rural Pakistan

Low birthweight [LBW] remains a significant public health problem in Pakistan and further understanding of factors associated with LBW is required. We conducted a hospital-based matched case control study to identify risk factors associated with LBW in a rural district of Pakistan. We found that illiteracy [AOR: 2.68; 95% CI: 1.59 - 4.38], nulliparity [AOR: 1.82; 95% CI: 1.26-2.44], having a previous miscarriage/abortion [AOR: 1.22; 95% CI: 1.06-2.35], having < 2 antenatal care [ANC] visits during last pregnancy [AOR: 2.43; 95% CI: 1.34-2.88], seeking ANC in third trimester [AOR: 3.62; 95% CI: 2.14-5.03], non-use of iron folic acid during last pregnancy [AOR: 2.72; 95% CI: 1.75-3.17], having hypertension during last pregnancy [AOR: 1.42; 95% CI: 1.13-2.20], being anemic [AOR: 2.67; 95% CI: 1.65-5.24] and having postpartum weight of <45 kg [AOR: 3.30; 95% CI: 1.97-4.52] were significantly associated with an increased odds of having a LBW baby. Our study identifies modifiable risk factors requiring immediate commitment from the health authorities

Analytical, nutritional and biological evaluation of various brands of fortified and non-fortified wheat flour

In Pakistan, a funded flour fortification program was launched for malnourished population, residing mainly in rural low income areas, but the urban population having comparatively better nutritional as well as economic status was focused wherein excessive intake of fortificants might cause complications. Therefore, the present study describes the physicochemical properties, elemental composition, nutritional components and hemoglobin/ferritin increasing potential of fortified and non-fortified flour. Domesticated chicken [Gallus gallus domesticus], either sex, age one month, weight 380 +/- 18.28 g, were randomly segregated into 4 groups [n=6]. The group I, II and III were fed on fortified flour, whereas group IV was fed on non-fortified flour for 30 days. The birds were weighed and blood samples of each of the birds were analyzed for determination of markers of iron status, hemoglobin [Hb] and serum ferritin [SF]. Moisture, ash and iron contents were found to be lower in non-fortified flour than that of the fortified samples. Hb and SF levels in groups fed on fortified flour were significantly higher than the one received non-fortified flour [P < 0.05]. The consumption of iron-fortified flour increases iron stores in the body without any further complication but long-term usage needs to be monitored.

Toxic epidermal necrolysis

Toxic epidermal necrolysis [TEN] is a clinical syndrome characterized by severe exfoliative skin changes, erosive mucosal involvement, and potentially life-threatening multisystem involvement. We present a 1 year old boy with recurrent rashes and fever, who turned out to be a case of toxic epidermal necrolysis

Modified Turco's postero medial release for congenital talipes equino-varus

Talipes Equino-Varus [TEV] is one of the most common congenital anomaly. It is managed by various methods i.e. conservative and surgery. Objective of this study was to determine the efficacy of modified Turco's postero-medical release in children's having congenital TEV. This descriptive observational study was conducted from June 2004 to June 2008 in the Orthopaedics Unit of Lady Reading Hospital [LRH] Peshawar. The inclusion criteria were children of age 6 months to 3 years of age having moderate and severe club foot. The exclusion criteria were clubfoot secondary to some other disorders such as cerebral palsy, arthrogryphosis multiplex congenita, myelodysplasia or congenital dislocation of the hip. The deformity was treated by modified Turco's one stage release. Follow-up was for one year. Results were graded according to modified McKay rating system. A total 70 patients were included in this study with the age range of 6 months to 3 years with moderate to sever deformity. Thirty-eight were male [54.2%] and 32 patients [45.72%] were female, twenty three patients [32.85%] had bilateral club foot while the rest of 47 patients [67.15%] had unilateral deformity. Positive family history of club foot was in 10 patients [14.2%]. Results were concluded on 52 patients who completed one year follow-up. Excellent results were observed in 34 patients [65.38%], good in 9 patients [17.30%], fair in 2 patients [3.84%], and poor in 7 patients [13.46%]. Children up to three years age with congenital TEV can be successfully treated in almost all the cases by modified Turco's one stage postero-medial release

Frequency of disorders causing childhood thrombocytopenia

Objective: To study the relative frequency of the disorders causing childhood thrombocytopenia

Patients and Methods: This descriptive study was conducted in the Department of Hematology and Transfusion Medicine Division, the Children Hospital and the Institute of Child Health, Lahore and the Department of Pediatrics, Services Hospital Lahore. The duration of the study was 1 year from March 2005 to April 2006. Two hundred cases having platelet countless than 1, 50,000/mm3 were included in this study. Causes of thrombocytopenia were determined on the basis of history, physical examination and various investigations. The data were collected on a proforma and analyzed using SPSS for Windows version 8. The results were compared with other studies. Chi- Square test was applied to determine P-values

Results: Acute lymphoblastic leukemia was found to be the commonest cause of childhood thrombocytopenia observed in 60 [30.0%] cases, followed by hypoplastic / aplastic anemia 40 [20%] cases, AML in 30 [15%], ITP in 28 [14%] cases and megaloblastic anemia in 20 [10%] cases. Drugs and infections together caused thrombocytopenia in a considerable number of patients. 96 children [48.0%] had platelet count in the range of 11-40 x 10[9]/L. Hemorrhagic manifestations were seen in 123 [61.5%] children. Epistaxis and purpura / bruises were the main presenting bleeding manifestations

Conclusion: Thrombocytopenia is associated with different disorders and acute lymphoblastic leukemia was found be the most common of childhood thrombocytopenia

Evaluation of results of interlocking nails in femur fractures due to high velocity gunshot injuries

Femoral shaft fractures are common in adult population due to vulnerability to road traffic accident and firearm injuries. There are various treatment modalities to treat the femur shaft fracture i.e. Plating and screws, Intramedullary nailing, External fixator and Interlocking nails. Comminuted fractures due to gun shot injuries are a challenging problem for orthopaedic surgeons. The objective of this study is to evaluate the role of interlocking nailing in the management of femoral fractures due to high velocity gunshot injuries. This descriptive study was conducted on 68 patients at Orthopaedic unit Postgraduate Medical Institute, Lady Reading Hospital Peshawar, from March 2002 to March 2004. The patients of each gender from age fifteen years onward having femoral shaft fracture due to high velocity gunshot injuries who had not previous surgical intervention were included in the study. The exclusion criteria were intertrochanteric, supracondylar femoral fractures and those who failed the follow-up. All the patients were treated with close or open interlocking nails. The outcome measures were graded excellent, good and poor according to radiological and clinical results. Follow-up was for eighteen months and in some cases up to thirty months. Out of 68 patients 64 [94.12%] were male and 4 [5.88%] were female patients. The age range was from 15 to 65 years [average age of twenty nine years. The close interlocking nails were done in 64 patients [94.12%] and open interlocking nails were done in 4 patients [5.88%]. The static interlocking nailing was performed in 58 patients [85.29%] while dynamic interlocking nailing was performed in 10 patients [14.71%]. Knee flexion contracture in 5 cases [7.35%] and limb shortening of less than 2 Cm in 2 patients [2.94%]. Non-union were in 4 cases [5.88%]. Excellent results were in 42 patients [61.76%], good in 18 patients [26.47%] and poor in 8 patients [11.77%]. Interlocking nailing is one of the best options for the management of femoral shaft fractures due to high velocity gunshot injuries

Dental caries and oral hygiene in male dental students of king Saud university college of dentistry, Riyadh

The objective of the present study was to determine caries experience, oral hygiene status and practices in male dental students of King Saud University, Riyadh, Saudi Arabia. A total of 211 male undergraduate dental students were examined for dental caries and oral hygiene. The information about oral hygiene practices was obtained through a self-administered questionnaire. The prevalence of caries was 95.3%. Mean decayed, missing and filled [DMFT] score in the dental students was 7.97 [SD 4.64] with decay [D] component of 3.59 [SD 3.88], missing [M] component of 0.67 [SD 1.29] and filled component of 3.71 [SD 3.89]. There was no significant difference [p>0.05] between the mean DMFT scores of the students from various academic levels. Only one-fifth [20.9%] of the students had good oral hygiene. The percentage of students with poor oral hygiene significantly [p<0.05] decreased as the academic level increased. The use of toothbrush significantly [p<0.05] increased through senior academic levels, with a majority cleaning their teeth either once [33.2%] or twice [35.1%] daily. It can be concluded that the caries prevalence and severity among the dental students was very high. Only a small percentage of the students had good oral hygiene

Current practice of doctors regarding the diagnosis and use of antibiotics in enteric fever in children: knowledge, attitude and practice

The objectives were to know current practice and knowledge of doctors regarding the diagnosis and use of antibiotics in Enteric Fever in children. The study was conducted in Lahore-city. It was a descriptive, epidemiological study. 150 doctors participated in the study. 51% were MBBS, 33% were postgraduate trainees and 16% had postgraduate degrees. Ciprofloxacin was prescribed as first choice by 51% and second choice by 37.8%. Ofloxacin was advised as first line by 21% doctors and injection Ceftriaxone by 18.6%. Chloramphenicol was advised by 8% doctors. Only 67.3% doctors prescribed the antibiotics for recommended duration. 62% doctors did not know the dosage in children. Second line antibiotics are used irrationally and those are prescribed for less than recommended duration, which leads to multi-drug resistance and relapse of fever

Outcome of closed reduction and casting in displaced supracondylar fracture of humerus in children

Supracondylar fracture of humerus in children is most common in first decade of life and needs proper management to prevent complications like cubitus varus, elbow stiffness and compartment syndrome. There are various treatment modalities i.e. traction, closed reduction and casting, open reduction and internal fixation and percutaneous pinning. Purpose of the study was to know the outcome of closed reduction and casting in displaced supracondylar fracture of humerus in children while comparing the results with published literature. Study was conducted at the Orthopaedics unit of Lady Reading Hospital Peshawar from January 2002 to December 2002 and 25 patients at random, with age range of 04 ' 12 years with displaced supracondylar fracture of humerus were treated with closed reduction and casting. Based on assessment through Flynn's criteria, results were excellent in 04 patients [16%], good in 11 [44%], fair in 03 [12%] and poor in 07 patients [28%]. Good results can be obtained in displaced supracondylar fracture Gartland type II of humerus in children with closed reduction and casting while the results with Gartland type III fracture were not satisfactory

Electrodiagnosis of thoracic outlet syndrome

This is a prospective study of 50 patients of suspected neurogneic thoracic outlet syndrome [TOS] who were referred to Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi. In this article we have presented our 2 years experience [Jul 1998 to Jun 2000] of clinical evaluation and electrophysiological studies of patients between 14 -75 years of age [mean age 39.72]. Nerve conduction studies [NCS] were performed on MS6 system [MEDELEC] and needle electromyography [NEMG] was performed with NEUROPACK electromyography model MEM -7102 K. Final diagnosis made on electrophysiological studies showed 30 cases of TOS, CTS, ulnar tardy syndorme, ulnar compression at canal of Guyon, C8 radiculopathy and normal study. TOS was twice more common in women. It most commonly affected patients in the 3'd and 4"' decade. Most frequent symptoms were pain, paraesthesia and weakness of hand muscles. Roos test was positive in 92% patients. Electrophysiological studies are very useful to confirm the diagnosis, rule out other entrapment neuropathies and decide the mode of treatment in neurogenic TOS

Electrodiagnostic evaluation of diabetic polyneuropathy

In this prospective study, 47 cases of diabetes mellitus [IDDM and NIDDM] suspected of diabetic neuropathy were studied to delineate the underlying pathology and localize lesion. Nerve conduction studies [NCS] were performed with MS 6 [MEDLEC] using surface electrodes. Concentric needle electromyography was done using Neuropack electromyographic model MEM7102K. On the basis of electrophysiological studies 39 patients had diabetic neuropathy, rest of patients had radiculopathies, thoracic outlet syndrome [TOS] and other abnormalities. Electrodiagnostic studies were helpful in confirming the diagnosis, localizing the entrapment neuropathies and in segregating the axonal/demyelinating neuropathies

Childhood nephrotic syndrome in Pakistan: clinical features and response to steroid therapy

Hundred children with nephritic syndrome [NS] were seen at Paediatric Department, Services Hospital, Lahore from March 1993 to August 1994. All were treated according to the protocol of NS in international study for kidney diseases in children [ISKDC]. 93.75% responded initially to corticosteroids whereas the remaining 6.25% were resistant. Out of those who initially responded 73.75% relapsed. All five resistant cases were treated with cyclophosphamide. Four achieved complete remission and one patient did not respond. This study revealed that majority have steroid responsive NS. i.e. minimal change diseases

Tetanus neonatorum: treated by intratecal tigh and single circum-umbilical ATS injection

Fifty cases of neonatal tetanus have been treated by us in the Nursery of Services Hospital, Lahore from July 1998 to December 1989. Human tetanus immunoglobulin [TIGH] 250 I.U. were given intrathecally along with a subcutaneous infusion in the abdominal wall around umbilicus of 200 [cc] half strength Normal saline [0.45%] with 50, 000 units of ATS. The traditional method of sedation with valium, phenobarbitone, largectil is followed along with benzyl penicillin. With the above mentioned protocol and isolation, even from light, sound, touch and by a good nursing care, we have succeeded to decline mortality rate from 60% to 34%

Surveillance of infectious diseases at Faisalabad

This study is based on a survey of six infectious diseases in children against which vaccination is done in the EPI. History of 703 patients was recorded from October 1991 to September 1992 in Punjab Medical college, Allied Hospital Faisalabad, District Headquarter Faisalabad and Kachi Abadi, Islam Nagar. Out of these, 105 [14.93%] had received prior immunization and 598 [85.07%] cases were unvaccinated. Out of a total of 105 vaccinated cases, 68 were of measles alone. It has been claimed that the EPI target has been achieved but one should not overlook findings that many vaccinated children have developed infectious diseases, especially measles. The EPI activities need to be looked into and improvements made where necessary

Immunogenicity and reactogenicity of VI-typhoid vaccine in 2-10 years old children

A cohort of 200 children grouped according to the age: 2-1-3b months, 3G-17 months, 18-59 months and 5 years through 9 years and 11 months was studied for immunogenicity and reactogenicity. Each child received a single intramuscular injection of the Vi capsular polysaccharide typhoid vaccine [Typhim Vi]. Specific Vi antibodies were measured by passive haemagglutination on two blood samples a month before and after immunization. For each age group, results were expressed as an inverse of dilution and compared with one another. There was excellent seroconversiun in 98% of cases. Local and systemic reactions were evaluated at days 2 and 30. Among the 158 children who completed the study, 1.6% showed local reactions such as redness and pain at the site of injection and 3. 1% had a temperature of more than 38 §C. All reactions subsided within 18 hours and were mild. This study shows that Vi capsular polysaccharide typhoid vaccine is significantly immunogenic in children between 2-10 years of age and showed very few reactions. No reactions were observed on day 30

Impaired cellular immunity in malnourished hospitalized children

One hundred malnourished children in the age group six months to 5 years were investigated for cell mediated immune respone by DNCB skin contact sensitization test. Maximum number of children [54%] belonged to marasmus group and clinical infections were found in 46% of children. Tonsillar atrophy was detected in 83% of severely malnourished children. Skin reponsiveness to antigenic stimulation by DNCB was significantly [P < 0.001] impaired in malnourished children with maximum infection in Kwashiorkor [100%]. A direct correlation was found between serum proteins and DNCB skin test results