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Background: Urinary tract infection (UTI) is a common clinical issue among pediatric population and might progress into renal scaring, hypertension as well as end stage kidney disease. This study was aimed at finding clino-pathological features of UTI and antibiotic sensitivity against most common causative agents involved at a tertiary care hospital of South Punjab, Pakistan.Methods: This descriptive case series study was conducted at department of Paediatric Medicine, Nishtar University Hospital Multan from July to December 2019. A total of 100 children fulfilling the inclusion criteria, presenting in outpatient department or emergency section of paediatric medicine department, having positive urine culture and sensitivity were selected. Their detailed history, clinical examination and relevant investigations were done.Results: Out of the 100 children, 73 (73.0%) were female and 27 (27.0%) were male. There were 57 (57.0%) children from 1 year to 4 years age group and 43 (43.0%) were of more than 4 years. Most common clinical presentations were fever 83 (83.0%), urinary symptoms, vomiting 52 (52.0%) and pain abdomen 48 (48.0%). Most common aetiological agents were Escherichia coli 74 (74.0%) and Klebsiella pneumoniae 9 (9.0%).Conclusions: UTI is more common in female children. Most common presentation observed was fever and/or urinary symptoms while most common aetiological agent was E. coli.
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Introduction: Many external and internal factors eitherdirectly or indirectly regulate our health. Similarly, manyparameters such as high glucose, high cholesterol, and highblood pressure are the indicators of our healthiness. BodyMass Index (BMI) and Waist to Height Ratio (WtHR) aresuch parameters which indicate the degree of healthiness of anindividual. Current study aimed at estimation and comparisonof the statistical relationships of BMI, body weight and WtHRwith serum cholesterol level in healthy Individuals of agegroup of 18-30.Material and methods: This study was done on total 54healthy persons (27 male and 27 females) of age group 18-30. The data of age, height weight and waist circumference ofall participants were collected. In their fasting blood samples,total serum cholesterol was measured by colorimetric kit.In this study statistical correlation was confirmed by threedifferent statistical methods.Results: Our statistical analysis suggested that BMI, bodyweight and WtHR are positively correlated with average totalserum cholesterol level with a significant p value (<0.05).Statistical correlation coefficient values further suggestedthat BMI could be a better predictor of cholesterol levelassociated diseases as compared to body weight and WtHR inhealthy individuals of age group 18-30. High BMI and Waistcircumference are indicators of overweight and/ obesity.Conclusion: These findings indicated that BMI could be abetter predictor of cholesterol level associated diseases ascompared to body weight and WtHR in healthy individuals ofage group 18-30.
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Background: Pulmonary Tuberculosis [TB] is traditionally classified into primary and post primary tuberculosis; both have distinct characteristics on radiology. Adetailed knowledge of different radiological patterns is helpful in diagnosis of TB
Objective: To determine the frequency of various radiological presentation of post primary tuberculosis in adult sputum smear positive patients
Methodology: This cross sectional study was carried out at Department of Pulmonology, Sheikh Zayed Medical College / Hospital, Rahim Yar Khan on adult sputum smear positive pulmonary TB patients. A total of 250 new cases of pulmonary TB with no previous history of Anti-Tuberculosis treatment were included in this study. Socio demographic data and findings of X -ray Chest from each sputum smear positive patient were collected and recorded on a predesigned performa. The data was entered and analyzed by using SPSS version 17
Result: Out of 250 patients, 146 were male and 104 were female with mean age of 35.76 +/- 16.25 years. Left lung was most affected in 40.4% cases, right lung in 35.6%, while 24% has bilateral involvement. Duration of illness prior to diagnosis was 3 +/- 1.66 months. Among the radiological presentation, cavitation was seen in 49.2% cases, alveolar consolidation in 42.4%, nodular pattern in 3.2%, reticulonodular pattern in 3.2% and reticular pattern in 2% cases. There was significant association of alveolar consolidation with male gender [0.03] while reticulonodular pattern was significantly seen in female gender [0.007]. Majority of the patients were young; 42.8% were below the age of 30 years and 82% patients were below the age of 50 years and there was a delay of > 03 months in the diagnosis
Conclusion: According to this study, cavitations and alveolar consolidation were the commonest radiological presentations of post primary TB. Majority of patients were young and there was a considerable delay in diagnosis
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Objective: To determine the frequency of organic acidurais [OA] and amino acidopathies [AA] in selected high-risk patients screened in two years
Study Design: Retrospective Observational study
Place and Duration of Study: The Aga Khan University Hospital [AKUH], Karachi, from January 2013 to December 2014
Methodology: Patients with OA and AA were included in the study and patients with IMDs other than OA and AA were excluded. Amino acids and organic acids were analyzed on high performance liquid chromatography and gas chromatography-mass spectrometry respectively. Clinical data and chromatograms of patients screened for IMDs were reviewed by chemical pathologist and metabolic physician
Results: Eighty-eight cases [4.7%] were diagnosed including 41 OA [46.5%], 28 AA [31.8%] and 19 others [21.5%] from 1,866 specimens analyzed. Median age of the patients was 1.1 years, with high consanguinity rate [64.8%]. Among OA, methyl CoA mutase deficiency was diagnosed in 9 [10.2%] and was suspected in 2 [2.3%] cases. Five [5.7%] cases of MHBD [2-methyl-3-hydroxybutyryl-CoA], 4 [4.5%] each of PPA [propionic aciduria] and HMG-CoA lyase deficiency, 3 [3.4%] cases each of IVA [isovaleric aciduria], multiple carboxylase deficiency, fructose-1, 6-biphosphatase deficiency, fumarase deficiency, GA-1 [glutaric aciduria type 1] and 2 [2.3%] cases of EMA [ethyl-malonic aciduria]. AA included 8 [9.1%] cases of MSUD [maple syrup urine disease], 6 [6.8%] cases of CBS [cystathionine beta-synthetase] and UCDs [urea cycle disorders] each, 5 [5.7%] cases of hyperphenylalaninemia and 3 [3.4%] cases of hyperprolinemia were reported. Other inherited metabolic disorders included: 9 [10.2%] cases of intracellular cobalamin defects, 2 [2.3%] cases each of alkaptonuria, Canavan's disease, SUCL [succinate CoA ligase] deficiency, and 1 [1.1%] case each of DPD [dihydropyrimidine] deficiency, GA-2, NKH [non-ketotic hyperglycinemia], AADC [aromatic amino acid decarboxylase] deficiency
Conclusion: This study presents frequency of OA and AA in the high-risk Pakistani pediatric population analyzed locally
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Humans , Male , Female , Infant , Amino Acid Metabolism, Inborn Errors/epidemiology , Child , Mass Screening , Retrospective Studies , Chromatography, High Pressure Liquid , Gas Chromatography-Mass SpectrometryABSTRACT
Background: tuberculosis is an important infectious health issue and its control strongly rely upon effective treatment. The drug resistance and its pattern are important determinant of the treatment regimen, its duration and outcome
Objective: to determine the frequency and pattern of drug resistance among 1[st] line anti tuberculosis treatment
Methodology: it was a cross sectional study carried on 100 cases of smear positive TB. This study was conducted from 1[st] January 2010 to 30 June 2011. Detailed demographic data and history of ATT was taken and their sputa were sent for drug susceptibility testing on LJ media. The cases with drug resistance and no previous history of ATT were labeled as primary while those with previous history of ATT were labeled as secondary resistant cases. The data was entered and analyzed by using SPSS version 15
Results: out of 100 patients enrolled, drug susceptibility report was available for 87 isolates as sputum failed to grow any organism in 13 patients. Out of these 87 cases, 48 [55.17%] were males and 39 [44.83%] females with age range of 9-91 years. Seventeen out of 87 patients [19.5%] had previous history of ATT. Out of 87 isolate, 62 [71.26%] were sensitive to all 1[st] line drugs [R, H, E, Z, S] while 25 [28.74%] were resistant to one or more drugs. Primary resistance was seen in 17 [24%] out of 70 cases in contrast to secondary in 8 [47%] out 17. The difference between primary and secondary resistance among various drugs was statistically significant for isoniazid [p value 0.003] and pyrazinamide [p value 0.036] while the difference to streptomycin, ethambutol and rifampicin was insignificant with p values of 0.20, 0.35 and 0.09 respectively. There was no case of primary MDR-TB and 5.9% of secondary MDR-TB. None of the sociodemographic parameter was significantly associated with drug resistance
Conclusion: resistance to 1[st] line anti-tuberculosis drugs at Rahim Yar Khan is still common. There are good number of patients in which this resistance pattern compromise the currently recommended regimens. However, larger surveillance studies are needed to strengthen this evidence
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Background: Pakistan has a high burden of drug resistant TB. Effective management of these cases needs the inclusion of 2[nd] line anti-tuberculosis drugs. A comprehensive knowledge of susceptibility pattern to these drugs is mandatory to formulate the best possible regimen
Objective: to determine the susceptibility pattern of 2[nd] line anti tuberculosis drugs
Methodology: this cross sectional study was carried out at Department of Pulmonology, Sheikh Zayed Medical College / Hospital, Rahim Yar Khan on smear positive cases of PTB. This study was conducted from 1[st] March 2010 to 30[th] April 2011. A total of 64 smear positive tuberculosis patients of any age and sex regardless of previous treatment with 1[st] line ATT and no history of prior exposure to 2[nd] line ATT were included. Sociodemographic data like age, sex, marital status and income were recorded. Early morning sputum samples were cultured on LJ medium at a reference lab. Drug susceptibility testing [DST] was done for ethionamide, amikacin, kanamycin, capreomycin and ofloxacin to determine the presence of resistance. The data was analyzed on SPSS version 15
Results: in this study, out of total 64 cases, 36 [56.25%] were males and 28 [43.75%] females with age range of 9 to 76 years. Thirteen cases [20.31%] had previous exposure to 1[st] line ATT. Twelve [18.8%] were resistant to one or more drugs. Resistance was highest for ofloxacin [14.1%] followed by ethionamide [6.3%], capreomycin [3.1%], amikacin [1.6%] and kanamycin [1.6%]. Sociodemographic characteristics also did not show any statistically significant association with drug resistance
Conclusion: there is high frequency of resistance to ofloxacin and ethionamide. To avoid addition of further resistance, DST should be available as early as possible by conventional methods or by rapid genotypic methods at the start of treatment
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Objective: To determine the frequency and severity of acute toxicity of pelvic radiotherapy for gynecological cancer
Study Design: A case series
Place and Duration of Study: Department of Oncology, The Aga Khan University Hospital, Karachi, from March 2011 to June 2012
Methodology: A total of 99 patients with histologically proven uterine and cervical cancer, receiving radiation therapy, were enrolled into the study after informed consent on justification of inclusion and exclusion criteria. Patients were evaluated for the frequency and severity of pelvic radiotherapy's side effects according to toxicity criteria based on RTOG/EORTC and CTC version 2 criteria at the start, during and at the end of treatment. The data was analyzed by using SPSS version 16
Results: Out of the 99 enrolled patients, 58 [58.6%] had uterine and 41 [41.4%] had cervical cancer. Mean age was 54.54 +/- 10.29 years. Thirty-five [35.4%] patients received chemotherapy with RT. Mean RT dose was 60.72 +/- 7.15 Gy. The most common gastrointestinal adverse effect was diarrhea in 64 [64.6%] followed by proctitis in 55 [55.5%], nausea in 33 [33.3%] and vomiting in 16 [16.2%] patients. Grade [G] 1 was the most frequently observed severity. The most common hematological toxicity was anemia in 37.8% [n=31/82] [[G1=18 [21.9%], G2=11 [13.4%], G3=2 [2.4%]] followed by thrombocytopenia in 22.8% [21/92] [[G1=16 [17.3%], G2=2 [2.1%], G3=3 [3.2%]] and neutropenia in 21 [21.2%] [[G1=12 [12.1%], G2=5 [5%], G3=3 [3%], G4=1 [1%]]. Urinary toxicity was observed in 49 [49.5%] patients. On stratification, chemotherapy and higher RT dose were strong predictor of increased hematological and upper gastrointestinal toxicity [p < 0.05] and age > 60 years for diarrhea [p < 0.05]
Conclusion: The frequency and severity of acute toxicity of pelvic radiotherapy in women with gynecologic cancers was found intermediate to high
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Biomarker rutin was analyzed in methanol extracts of leaves of five different species of genus Ficus [Ficus carica, Ficus nitida, Ficus ingens, Ficus palmata and Ficus vasta] by NP-HPTLC [Method I] and RP- HPTLC methods [Method II]. The development and validation for method I was carried out with silica gel 60F[254] plates using EA: GAA: FA: H[2]O [10:1:1:2.5, v/v/v/v] as developing system. Method II was carried out on silica gel 60F[254] RP-18 plates using mobile phase ACN: H[2]O [4:6 v/v]. Both analyses were scanned at 305 nm and were found to give well resolved peak of rutin at Rf 0.28 +/- 0.01 and 0.68 +/- 0.03 for Method I and Method II, respectively. The percentage of rutin was found to be 0.51% and 0.66% in F. ingens, 0.24% and 0.54% in F. palmata and 0.14% and 0.17% in F. vasta by Method I and Method II, respectively. Method II [RP-HPTLC] was found to be more accurate, precise and sensitive than Method I. Method II can be used as an important tool for standardization and quality control of bulk drugs and in-process formulations of rutin
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This study finds out drug usage trends in Stage I Hypertensive Patients without any compelling indications in Karachi, deviations of current practices from evidence based antihypertensive therapeutic guidelines and looks for cost minimization opportunities. In the present study conducted during June 2012 to August 2012, two sets were used. Randomized stratified independent surveys were conducted in doctors and general population - including patients, using pretested questionnaires. Sample sizes for doctors and general population were 100 and 400 respectively. Statistical analysis was conducted on Statistical Package for Social Science [SPSS]. Financial impact was also analyzed. On the basis of patients' doctors1 feedback, Beta Blockers,and Angiotensin Converting Enzyme Inhibitors were used more frequently than other drugs. Thiazides and low-priced generics were hardly prescribed. Beta blockers were prescribed widely and considered cost effective.This trend increases cost by two to ten times. Feedbacks showed that therapeutic guidelines were not followed by the doctors practicing in the community and hospitals in Karachi. Thiazide diuretics were hardly used. Beta blockers were widely prescribed. High priced market leaders or expensive branded generics were commonly prescribed. Therefore, there are great opportunities for cost minimization by using evidence-based clinically effective and safe medicines
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To determine the use of information technology [IT] and electronic media for improving compliance rate to doctors' advice in hypertensive patients in Karachi. Total 400 persons [200 males and 200 females] were randomly selected in six districts of Karachi. Data was collected through a pretested questionnaire. Following was sample criteria: age above 15 years, living in Karachi and ambulatory. Persons admitted in a hospital, individuals who were doing some physical activity during survey e.g. exercise, labor work etc., individual in stressed condition, non-cooperative individuals - not willing to get BP checked and fill questionnaire, and pregnant women were excluded. Those who did not sign the consent form were also excluded. SPSS was used for data analysis and descriptive statistics was employed for sensitivity analysis. For healthcare awareness, people look for health programs on radio and TV channels. Short Message Service [SMS] and phone are highly appreciated by patients for reminders. To increase compliance to doctors' advice, less educated people prefer phone calls over SMS whereas educated individuals favor SMS. Although price of medicine has not emerged as a major contributing factor for non-compliance, discount on medicinal products is highly appreciated by the patients. The study concludes that there is a widespread awareness of high blood pressure in the sample population of Karachi e.g. 72.5%. People consider reminder message system i.e. Calls and Short Messaging Service [SMS] would help them in improving compliance to doctors' advice
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Charismatic therapeutic potential of curcumin in biological research have triggered an interest to explore the thermal degradation pattern of curcumin, formation of ferulic acid and vanillin as degraded metabolites at different temperatures in methanol and corn oil. The results revealed 47% w/w loss of curcumin along with formation of 17% w/w vanillin and 9% w/w ferulic acid at boiling temperature of methanol while oil samples show 38.9% w/w loss of curcumin but not confirming the formation of ferulic acid and vanillin. Findings of this study revealed that formation of vanillin in methanol starts around 50[degree]C and its concentration goes on increasing up to 70[degree]C and then further degraded at boiling temperature of methanol. Formation of ferulic acid begins around 60[degree]C and initially increases with rise of temperature and then decreases approaching boiling point of methanol. Vanillin as well as ferulic acid was absent in corn oil samples though degradation of curcumin was observed by reduction in peak area of curcumin. The present study was done by applying a validated high-performance thin-layer chromatography method. The method involved glass-backed HPTLC plates precoated with silica gel 60F254 as the stationary phase and toluene: ethyl acetate: methanol [8:1:1, v/v/v] as mobile phase
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In the present study an analytical method of high-performance thin-layer chromatography [HPTLC] has been developed for quantification of glycyrrhizin for marketed antistress liquorice root capsules [LRC] and herbal tea [HT]. Chromatography was performed by using mobile phase ethyl acetate [EA]: glacial acetic acid [GAA]: Methanol [MeOH]: water [H2O] in proportion of 6:2:2:1, v/v/v/v. The developed plate was scanned and quantified densitometrically at absorption maxima 254nm. The method was validated for various analytical parameters viz. precision, accuracy, recovery, robustness, specificity, detection and quantification limits. The developed system was found to give compact spot for glycyrrhizin [Rf = 0.33 +/- 0.001]. The linearity relationship was described by the equation Y=6.841X+ 70.428. The limit of detection [34 ng band-1], limit of quantification [101ng band-1], recovery [99.4-99.8%], and precision [
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To determine the effectiveness of local protamine in reducing post-operative blood loss compared to loca1 tranexamic acid. Randomized controlled trial. Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi from January 2011 to September 2011. One hundred and twenty cardiac surgrcal patients were randomly divided into two equal groups, one receiving local protamine while the other group receiving local tranexamic acid before chest closure. The efficiency was measured as post-operative blood loss and requirement of blood and blood products in the post-surgical ICU. RAverage blood loss in protamine group was significantly less [252.97 ml] compared to tranexamic acie group [680.67 ml]. hTumber of patients requiring no post-operative blood transfusion was sigruficantly higher in protamine group [76.7%] compared to tranexamic acid group [53.3%]. Local protamine is more effective in reducing post-operative blood loss than local tranexamic acid
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Humans , Male , Female , Protamines/administration & dosage , Administration, Topical , Tranexamic Acid/administration & dosage , Postoperative HemorrhageABSTRACT
Fast disintegrating tablets [FDTs] have received ever increasing demand during the last decade, and the field has become a hastily growing area in the pharmaceutical industry. Upon introduction into the mouth, these tablets dissolve or disintegrate in the mouth in the absence of additional water for easy administration of active pharmaceutical ingredients. Aceclofenac, an NSAID, has been recommended orally for the treatment of bone and connective tissue disorder and thus the formulation of the same resulted in development of several FDT technologies. The present aim is to formulate a tablet which disintegrate and dissolve rapidly and give its rapid onset of action: analgesic, antipyretic and anti-inflammatory action. Besides, the conventional tablets also show poor patient compliance an attempt had been made to formulate for FDT of aceclofenac by using various super disintegrants like sodium starch glycolate, croscarmellose sodium and crosspovidone [polyplasdone XL] and PEG 6000 followed by novel technique. The tablets were evaluated for friability, hardness, weight variation, disintegration time, wetting time, in vitro dissolution studies and drug content studies. It was concluded that the batch which was prepared by using combination of crosspovidone and sodium starch glycolate as a super disintegrant shows excellent disintegration time, enhance dissolution rate, taste masking and hence lead to improve efficacy and bioavailability of drug
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Diclofenac , Diclofenac/pharmacology , Diclofenac/administration & dosageABSTRACT
Investigations for anti-inflammatory potential and categorization of Sudanese medicinal plants according to their potency. Anti-inflammatory effect of plants' extracts of 17 genera were studied using the carrageenan induced inflammation in rats' paws. The plant extracts were obtained using methanol and dichloromethane as solvent and administered intra peritoneally at the concentration of 2g/kg body weight. The results obtained in this experiment strongly support and validate the traditional uses of these Sudanese medicinal plants to treat various inflammatory diseases. 63.9% of plants extracts showed marked inhibition of inflammation induced by carrageenan [78.3% out of this percentage represented by methanolic extract], 27.8% showed no activity and 8.3% enhanced the carrageenan induced inflammation. The anti-inflammatory effect of many of these plants has not been reported previously, yet they have been extensively used in Sudanese folkloric medicine. The result of this study justify the traditional medicinal use of the evaluated plants species in treating inflammatory disorders and helped in categorizing the investigated plants into most useful, moderately useful and least useful category for inflammatory diseases. Out of the 17 investigated plant species 05 belongs to most useful and 06 belongs to moderately useful category. However, toxicity studies are required to prove the safety of these plant materials
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Animals, Laboratory , Plants, Medicinal , Plant Extracts , Rats, Wistar , InflammationABSTRACT
The present research work was carried out to investigate the antimicrobial [eight bacteria and one fungus] activities of different solvent [ethanol, petroleum ether, chloroform, ethyl acetate and isobutanol] extracted samples from flowers of P. obstusa by disc diffusion method. Analysis of the data revealed that all the five extracts from flowers of P. obstusa showed different ranges of antimicrobial activities. Petroleum ether fractions showed inhibitory activities against all the nine microbial species except Klebsiella pneumonia. Ethyl acetate and isobutanol fractions showed inhibitory effects against all the tested microbial species except Pseudomonas aeruginosa. Chloroform and ethanol extracts had varying levels of inhibitions against all of the tested microorganisms. The most susceptible gram positive bacterium was Bacillus subtilis which was inhibited by all the five extracts while the most resistant gram positive bacterium was Staphylococcus aureus. Erwinia carotovora was the most susceptible gram negative bacterium while Pseudomonas aeruginosa was highly resistant among the gram negative bacteria
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Anti-Infective Agents , Solvents , Flowers , FungiABSTRACT
Objective: To assess in-vitro antioxidant activity of different fraction and perform high performance thin layer chromatography fingerprint analysis of most active fraction of Rumex vesicarius L. (R. vesicarius). Methods: In the present study, acetone, ethyl acetate, n-butanol, and methanol extracts of R. vesicarius were evaluated for radical scavenging activity by studying the inhibition of the level of lipid peroxidation induced by Fe(
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Background: Tibial diaphysial fractures are among the notorious fractures as far as management is concerned
Objective: To compare the outcome [union] between reamed and unreamed nailing in transverse tibial diaphysial fractures
Patients and Methods: Study Design: Experimental study. Setting: Department of Orthopaedic Surgery, Bahawal Victoria Hospital Bahawalpur. Study Duration: 8 months from 1[st] January 2009 to 31[st] August 2009. Study subjects: 210 patients were divided into two groups A and B. Group A patients were managed by reamed interlocking nail tibia and group B patients by unreamed interlocking nail tibia. Follow up was done up to 3 months and outcome in terms of union was compared between two groups. 15 patients in each group were lost to followup so data analysis was done on 180 patients. Union was achieved in 80% of patients in group A while 70% in group B. Our study suggests that reamed interlocking nail tibia is better treatment option than unreamed interlocking nail tibia
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To evaluate the frequency of union of neglected femoral neck fractures treated with free fibular graft. Descriptive case series. Department of Orthopedics Bahawal Victoria Hospital Bahawalpur, from April 2009 to January 2010. Patients of neglected femoral neck fracture [one month postinjury] were included in the study. They were operated and internal fixation was done with concellous screws and free fibular graft placed. They were followed till the evidence of radiological union. Out of 55 patients there were 40 males and 15 females. Ages ranged from 20 year to 50 year. The duration of injury was from 4 weeks to 6 months. Fifty patients achieved complete union while five patients developed non-union with complaint of pain. There was no wound infection and hardware failure. Fracture reduction and internal fixation with use of free fibular graft and concellous screws for neglected femoral neck fractures is the treatment of choice