Growth and Yield of Tomatillo as Influenced by Planting Time and Macronutrients

With the use of a strategic pairing of planting time and macronutrients, tomatillo growth and yield can be boosted. Due to their complementing effects, the ideal combination of different planting times and macronutrients may significantly boost tomatillo growth and yield. The experiment was set by taking two treatment factors. Our treatment factors were: (1) Planting time (three time’s viz. T1 = 02 November, T2 = 12 November, and T3 = 22 November); and (2) Macro nutrients (four levels viz. F0 = N0P0K0 Kg/ha, F1 = N200P60K100 Kg/ha, F2= N250P90K120Kg/ha, F3 = N300P120K140 Kg/ha). The two factors experiment was laid out in a Randomized Complete Block Design (RCBD) with three replications. In case of planting time, the sharp increase of fruits per plant (37.06), fruit weight (42.7 g), yield per plant ( 2.04 kg) and per hectare ( 85.06 t) were obtained from T3 (22 November). In case of macronutrients, the maximum number of fruits per plant (47.26), fruit weight ( 48.47 g), yield per plant ( 2.75 kg) and per hectare ( 114.59 t) were obtained from F1 (N200P60K100 Kg/ha). Combined effect (T3F1) had improved the number of fruits per plant (49.66), fruit weight ( 55.64 g), yield per plant ( 2.94 kg) and per hectare ( 122.84 t), vitamin C content (25.92 mg) and noted from T1F0 (02 November with N0P0K0Kg/ha) treatment combination that minimum number of fruits per plant (14.0), fruit weight ( 24.69 g), yield per plant ( 0.5 kg) and per hectare ( 20.85 t), vitamin C content (16.63 mg). So, the T3F1 treatment combination appeared to be the best for achieving the higher growth and yield of tomatillo.

Effect of Sowing Date and Phosphorus on Growth, Seed Yield and Quality of Fenugreek

The effect of sowing date (three sowing dates viz., S1= 01 November, S2= 15 November and S3= 30 November) and phosphorus levels (four phosphorus fertilizer levels viz., P0= Control, P1= 35 kg P ha-1, P2= 45 kg P ha-1 and P3= 55 kg P ha-1) on growth, seed yield and quality of fenugreek was investigated at Horticulture Farm, Sher-e-Bangla Agricultural University, Dhaka, Bangladesh, during 10 October 2020 to April 2021. Growth-related data was maximum on S1 (01 November) treatment but S2 (15 November) treatment showed the best result in case of seed yield. In case of growth characters, P3 (55 kg ha-1) revealed the best result but in case of seed yield, P2 (45 kg ha-1) treatment showed the best effect. Under this investigation, it was revealed that the maximum growth was obtained by S1P3 (01 November with 55 kg P ha-1) and the minimum growth was obtained by S3P0 (30 November with control) treatment combination. The maximum pods per plant (52.61), seeds per pod (12.87), weight of individual pod (147.11 mg), the weight of seeds per plant (7.67 g) and weight of 1000-seed (13.86 g), seed yield per plot (306.72 g), seed yield per hectare (2.13 t) and vigor index (570.27) was observed from the treatment combination S2P2 (15 November with 45 kg P ha-1). It was concluded that the combination of sowing date S2 (15 November) along with phosphorus application P2 (45 kg P ha-1) were given the better performance of all the yield contributing parameters and seed yield of fenugreek. So, S2P2 (15 November with 45 kg P ha-1) treatment combination can be repeated in different agro-ecological zones of Bangladesh.

A Cross-sectional Study: Bone Markers in Different Body Mass Index Groups of Newly Diagnosed Breast Cancer Females in Karachi, Pakistan

Background: Pakistan is a big victim of breast cancer and vitamin D deficiency. Interestingly, bones are the common site of breast cancer metastasis and vitamin D deficiency makes this condition more worst. The present study designed to estimate bone markers and minerals in different BMI groups of newly diagnosed breast cancer patients. Materials & Methods: diagnosed breast cancer females were approached and their characteristics including age, marital status, menstrual & family history, receptor status, tumor grade & type and presence of metastasis were noted from their medical reports. Whereas bone markers and minerals viz., alkaline phosphatase (ALP), bone specific ALP (BALP), vitamin D, carboxyl terminal collagen crosslinks (CTX), human epidermal growth factor 2 receptor (Her2) protein, albumin, calcium (Ca), phosphorus (P) and magnesium (Mg) were estimated plus body mass index (BMI) measured. Results: Most of the recruited females found aged less than 50 yrs, wedded, belonged to plump to obese BMI groups, had invasive ductal carcinoma, expressed triple positive receptor status and tumor grade II. Very few had metastasis and family history of breast cancer. Patients in all BMI groups showed insufficient level of vitamin D but normal levels of ALP, Ca, Mg, P, albumin, Her2 protein and CTX. Whereas Ca and BALP found slightly low in underfed BMI group patients. Conclusion: The results concluded and recommended that vitamin D levels must be monitored in breast cancer patients before and after treatment otherwise it will decrease more and may affect other bone markers.

Assessment of Haematological Markers in Relation with Blood Urea Nitrogen and Serum Creatinine in Pre-dialysis Patients with Chronic Kidney Disease

Background: To investigate the hematological and biochemical parameters in pre – dialysis chronic kidney disease (CKD) patients and compared with the normal individuals.  Methods: The samples of CKD patients (n= 30) belong to both genders were collected from different tertiary care hospitals of Karachi, Pakistan and compared with normal individuals (n = 30) not suffering from any disease used as control. Results: 18 of CKD patients and 19 from normal groups were male and 12 from CKD and 11 from normal group were female. The average age (yr) was 38 ± 12.06 for normal group and 44 ± 09.10 for CKD. The mean height (cm) of normal subjects was 163 ± 6.87 and body weights (kg) were 71.04 ± 10.12. Mean height of CKD group was 165.3 ± 7.79 and weights were 64.35 ± 12.23. Higher magnitudes of blood urea nitrogen (BUN) and serum creatinine were found as 85.63 ± 56.11 and 6.86 ± 3.42 mg/dL respectively in CKD group. Hemoglobin, red blood cells (RBCs), pack cell volume, lymphocytes and eosinophils were found significantly (p<0.01) very low while white blood cells, monocytes and neutrophils were found high (p<0.01) in CKD patients. Conclusions: Findings concluded that hematological parameters were severely affected in CKD patients as compared to normal controls. Kidney dysfunction in turn not only affects the erythropoietin synthesis that normally stimulates the bone marrow to produce RBC’s but also the synthesis of rennin and Vitamin D that normally regulates blood volume and blood pressures and involves in making bones respectively.

Rauwolfia serpentina improves altered glucose and lipid homeostasis in fructose-induced type 2 diabetic mice

Rauwolfia serpentina is well-reported in traditional medicines for the treatment of hypertensive and neurological disorders. However, its antidiabetic potential has been currently described in both alloxan-treated and normoglycemic mice. Present effort was carried out to investigate the effect of methanol root extract [MREt] of R.serpentina in fructose-induced type 2 diabetic mice. Experimental mice were grouped into normal control [distilled water 1ml/kg] and fructose-induced type 2 diabetic groups [10% fructose 1 ml/kg].The second group sub-divided into negative [0.05% DMSO 1ml/kg] control, positive [pioglitazone 15mg/kg] control and three test groups [MREt 10, 30 and 60 mg/kg]. Each treatment was given orally for 14 days consecutively then mice were sacrificed in order to collect serum and liver samples to analyze physical, biochemical as well as hematological markers. MREt significantly improved percent body weight and glycemic change along with serum insulin, total cholesterol [TC], triglycerides [TG], lowdensity lipoprotein [LDL-c], very low-density lipoprotein [VLDL-c], high-density lipoprotein-cholesterols [HDL-c], total hemoglobin, glycosylated hemoglobin, hepatic glycogen, coronary risk and fasting insulin resistance indices while suppressed down the activity of 3-hydroxy-3-methylglutaryl Coenzyme A reductase enzyme in test groups when compared with diabetic controls. The present findings conclude that MREt of R. serpentina can effectively betters the carbohydrate and lipid homeostasis by either inhibiting fructose absorption in intestine or decreasing insulin resistance in fructose-induced type 2 diabetic mice

Methanolic Root Extract of Rauwolfia serpentina Lowers Atherogenic Dyslipidemia, Arteriosclerosis and Glycosylation Indices in Type 1 Diabetic Mice.

Globally recognized antihypertensive phytomedicine Rauwolfia serpentina Benth is also well-known for its diversified ethno-medicinal usefulness. The objective of present study is to evaluate the effect of methanolic root extract (MREt) of R. serpentina on atherogenic dyslipidemia, arteriosclerosis and glycosylation indices in alloxan-induced type 1 diabetic mice. After the single intraperitoneal injection of alloxan monohydrate (150 mg/kg), forty two mice were allocated into diabetic control (1 ml distilled water), negative control (0.05% DMSO 1 ml/kg), positive control (5 mg/kg glibencalmide) and three test dose groups (MREt 10, 30 & 60 mg/kg). Normal control (1ml distilled water) was also used. After 14 days of respective treatments, fasting blood glucose, insulin, haemoglobin (Hb), glycosylated haemoglobin (HbA1c), triglyceride (TG), total cholesterol (T-CHOL), low density lipoprotein cholesterol (LDL-c), very low density lipoprotein cholesterol (VLDL-c), and high density lipoprotein cholesterol (HDL-c) levels were determined. Wet organ weight, relative weight, percent change in glycosylation and non-HDL-c level was also determined. MREt maintained the wet organ and relative weight, as did not produce any harmful changes in kidney, liver, spleen and heart. Significant reduction in percent glycosylation was observed from -37.35 to -48% in all test groups. Upto two fold significant (p< 0.0001) decrease in atherogenic (AI) and arteriosclerotic (ArtI) indices, while improvements in atherogenic dyslipidemia ratio (ADR) were also observed in all test groups. Significantly (p< 0.0001) lowered level of non-HDL-c and glucose to lipid profile ratios were estimated in all test groups. The obtained results indicated the therapeutic potential of MREt in lowering the risk of atherogenic dyslipidemia, arteriosclerosis and glycosylation in alloxan-induced diabetic mice.

Centratherum anthelminticum minimizes the risk of insulin resistance in fructose-induced type 2 diabetes.

The study was focused on investigating the effect of Centratherum anthelminticum ethanolic seed extract in fructose-induced type 2 insulin resistance diabetic rabbits after determining its qualitative analysis, acute toxicity, and effect on glucose tolerance. The phytochemical analysis revealed the presence of alkaloids, flavonoids, tanins, gallotannins, phlabotanins, phenols resins, saponins, and steroids. The same extract was found completely harmless up to 3000 mg/kg by showing no sign of acute toxicity in experimental rabbits. In oral glucose tolerance test, all doses (200-600mg/kg) of seed extract effectively produced percent reduction in blood glucose levels at 60 and 120 min. However, its high doses (400 and 600mg/kg) efficiently induced percent reduction (-10 to - 11.9%) in post-prandial blood glucose level after 30 min as compared to diabetic control group. Similarly, the oral administration of same three doses (200-600 mg/kg) of extract for 14 days consecutively were found effective in decreasing blood glucose and serum total cholesterol, triglycerides, low- & very low-density lipoproteins while increasing high-density lipoprotein in fructose-induced type 2 diabetic test rabbits. In addition, fasting insulin resistance index (FIRI) was also decreased by normalizing insulin levels in these test groups as compared to fructose-induced type 2 diabetic control group (P<0.05). Therefore it is concluded that ESEt of C. anthelminticum would be effective in improving hyperglycaemia, hypertriglyceridemia, hypercholesterolemia, hyperinsulinemia in fructose-induced type 2 diabetic rabbits by either decreasing insulin resistance or inhibiting fructose absorption in intestine.

Stress in female medical doctors; a cross-sectional study at tertiary care hospitals of Karachi

In present era stress remains a favorite subject of research especially in medical profession because with high competitive roles and responsibilities, this profession serves the need of mankind. Assessment of professional stress in female medical doctors employed at different tertiary care hospitals of Karachi, Pakistan. The cross-sectional non-experimental survey. Different tertiary care hospitals of Karachi. November, 2012 to July, 2013. Internationally validated and standardized questionnaire was used as survey tool for present research. It was distributed to total two hundred and twenty eight 228 female medical doctors. Total 191 respondents filled the research survey. 64.39% were MBBS, 20.42% were BDS and 15.18% were postgraduate respondents. Cronbach's alpha was 73.60%. Mean age of respondents was 29.32 +/- 6.96 years, average stress score was 12.09 +/- 4.33 with average years of experience were 4.58 +/- 5.57 years. Stress scores on the basis of demographic variables like age groups, experience, qualification and marital status showed average scores in range between10-12 units. However, high frequency of respondents scored moderate to severe stress when probed on the basis of levels of stress they have possess. Categorizing the equation for stress scores observed in the present survey as, MBBS respondents showed more stress units i.e., 12.50, BDS doctors have had 11.50 units stress and postgraduate respondents had 10 units stress scores. Results concluded that stress in female medical professionals is never underestimated as it is clearly indicated through present survey that all female respondents possess average job stress which need to address

Types of Rotavirus Causing Acute Diarrhea among Children in Western India, their Demographic Pattern and Disease Severity.

Background: Rotavirus infection is a major cause of severe acute gastroenteritis among infants and children all over the world1 with winter out-breaks of diarrhea in temperate and cooler parts almost round the year. However, this varies in different part of India.2-6 Diarrhea is a major cause of under-5 mortality, contributing to approximately over 1,50,000 infant deaths in our country per year.15,16 Different genotypes have been identified and many more are emerging by way of mutation, genetic shift and genetic drifts. Rotavirus are classified antigenically as A (Most common), B, C, D, E by ELISA and genotypically as G (1 through 12) and P (1 through 8) by Reverse Trans criptase PCR, in combinations. Materials and methods: Stool samples of 110 infants and children from 6 to 60 months of age, with suspected viral diarrhea over one year period were studied for serotypes and genotypes; and compared for their respective disease severity. Results: Thirty-four percent were found positive for Rotavirus-A by ELISA. Of the positive, 33.4% were found to be of G9 genotype, much higher than reported from other parts of the country. On the other hand, merely 13.6% of G1 and G4 each were detected, contrary to high prevalence elsewhere. On electro-pherotyping, the long-arm types were associated with more severe disease (64.6% showing moderate to severe dehydration) than their short-arm types (Only 16.6% showed moderate dehydration only) p < 0.009. No difference in incidence of severe dehydration between AD positive for Rotavirus (11.7%) and those found nega tive (11.8%), presumably due to other viruses, after excluding invasive diarrhea. Conclusion: Emergence of diverse strains, i.e. more of G9 and G12 genotypes than earlier reports of G1 and G2 types indicate considerable genetic shift in the region. Such trend could have significant implication on degree of seroconversion from currently used live vaccines, using G1 or bovine reassortant G1-3 strains only, seen in recent studies from Africa and Malayi.29 Contrary to claims that Rotavirus diarrhea usually threatened severe diarrhea, no significant difference in incidence of severe diarrhea was observed between Rotavirus positive and Rotavirus negative acute diarrhea.

Rauwolfia Serpentina Ameliorates Hyperglycemic, Haematinic and Antioxidant Status in Alloxan- Induced Diabetic Mice.

To investigate the effect of methanolic root extract (MREt) of Rauwolfia serpentina on hyperglycemic, haematinic and antioxidative dysfunction associated with alloxan-induced diabetes. Mice were divided into normal and alloxan-induced diabetic groups, the second group was sub-divided into three MREt (10, 30 & 60mg/kg) treated test groups and three diabetic (distilled water 1ml/kg), negative (0.05% dimethyl sulphoxide 1ml/kg) and positive (glibenclamide 5mg/kg) control groups. Each treatment was done orally for 14 days. The MREt significantly reduced blood glucose level by improving the body weights, glycosylated hemoglobin (HbA1c) to total hemoglobin (Hb) ratio, red blood cell (RBC) & white blood cell (WBC) counts, packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) in test groups. Beside this, extract decreases the percent inhibition of catalase (CAT) & superoxide dismutase (SOD) enzymes and restores the liver function by recovering the total protein concentration and normalizing the levels of alanine transaminase (ALT), aspartate transaminase (AST) & alkaline phosphatase (ALP) in test mice. Therefore, MREt ameliorates hyperglycemic, haematinic and antioxidant status in alloxan-induced diabetic mice. Further work is still required to find out the active principle in same extract involved in antidiabetic activity.

Comparative effect of Trichoderma hamatum and host-specific Rhizobium species on growth of Vigna mungo.

The present study was designed to investigate the combine effect of Trichoderma hamatum and host-specific Rhizobium sp. of Vigna mungo on growth and biochemical parameters of same legume. The results proved that T.hamatum and host-specific Rhizobium sp are compatible with each other and their combine use was found effective not only in improving the growth parameters including lengths of roots & shoots and fresh biomass of experimental crop but also increasing the total chlorophyll, carbohydrate and crude protein contents as compared to control plants (p<0.05). Similarly, the amount of both nitrogen and phosphorus was significantly increased in leaves of the same legume (p<0.05). Therefore, T.hamatum could be a good alternate of chemical fertilizer and fungicide for improving the growth and productivity of V.mungo.

Antihyperlipidemic effect of Adonis vernalis

To study the effect of Adonis vernalis on triton-induced hyperlipidemic rabbits. Hyperlipidemia has become a major risk factor for a large variety of diseases including coronary artery disease and thus increasing mortality ratio globally. A. vernalis [AV] commonly called as Pheasant's eye is a Homoeopathic remedy and considered as cardiotonic due to presence of cardiac gylcosides with strong diuretic action. The present study investigates the hyperlipidemic effects of Adonis vernalis in chemically [triton; 400 mg/kg intraperitoneally] induced hyperlipidemic rabbits. Its effects on lipid profile, glucose, total protein, serum uric acid and liver specific enzyme alanine aminotransferase [ALT] were determined by administering alcoholic extract of A. vernalis [5 mg/kg] orally and compared against respective control groups. AV [5 mg/kg] had shown a significant decrease in serum cholesterol and triglycerides when compared with control, triton-induced hyperlipidemic control [TIC] and triton-induced positive control [TIPC] [p<0.05]. It slightly increased HDL, clear decrease in LDL and total protein while no effect was found on ALT, uric acid and glucose. According to the experimental findings the alcoholic extract of A. vernalis found to be a potent antihyperlipidemic agent and also showed hepatoprotective property

Effects of maternal anaemia on neonatal outcome – a study done in the specialized urban hospital set up in Bangladesh.

Context: Anaemia is a common pregnancy related disorder in Bangladesh that causes various maternal and fetal problems. A prospective study was designed to see the associated maternal factors and fetal outcome in different categories of anaemia and to compare with that of normal pregnancy. Methods: The study was carried out on 60 Bangladeshi women within 35-40 weeks of gestation. Among them, 20 with normal uncomplicated pregnancies were considered as control group or group A, another 27 having pregnancies with mild anaemia were considered as group B, and 13 having pregnancies with moderate anaemia were considered as group C. Severe anaemic mothers were considered as group D, but not found during the period of collection of data for this study. The mothers were selected as who were suffering from antenatal anaemia i.e. having heamoglobin level <10 gm/dl (mild, if <10 gm/dl; moderate, if <8 gm/dl; and severe, if <6 gm/dl) and control i.e. having heamoglobin level ≥10 gm/dl. The foetal outcome was observed and recorded after delivery. Results: The mean age of the mother was 23.65±3.83 years, 27.26±4.93 years and 25.85±4.62 years and the mean number of gravidity was 1.65±0.67, 2.15±0.72 and 2.69±1.03 in group A, group B and group C respectively. The difference was statistically highly significant in between A and C (p<0.001) and also significant in between A & B and B & C (p<0.05). The mean gestational age of the mother was 38.65±0.88 weeks, 37.37±1.01 weeks and 37.15±1.28 weeks in group A, group B and group C respectively and the difference was statistically significant between A & B and A & C (p<0.001). The mean birth weight of the neonate was 3.09±0.30 Kg., 2.99±0.16 Kg. and 2.95±0.21 Kg., while the mean APGAR score of the neonate at first minute of birth was 8.90±1.07, 8.11±0.89 and 7.69±0.48 in group A, group B and group C respectively. No significant difference was found in birth weight of the newborn babies in between the groups of the mothers. However, the difference was found significant in between A & B (p<0.01) and A & C (p<0.001), in case of APGAR score.

Massive chondrogenic osteosarcoma of the maxilla: A case report.

Although osteosarcoma is the most common primary bone cancer, the incidence in head and neck bony structures is extremely low. As the surgical treatment requires a wide margin excision, the operation usually will be very challenging especially if it involves midline structures. We report a case of a young gentleman who had a bony growth over the epicenter of the hard palate which rapidly occupies the whole oral cavity within 6 months duration. The outline of management is discussed.

Efficacy of Short Course (<4 Days) of Antibiotics for Treatment of Acute Otitis Media in Children: A Systematic Review of Randomized Controlled Trials.

Objective: To determine the efficacy of a short course of antibiotics (<4 days) in comparison to a longer course (≥4 days) for the treatment of acute otitis media in children. Data sources: Electronic databases, hand search of reviews, bibliographies of books, abstracts and proceedings of international conferences. Review Methods: Randomized controlled trials of the empiric treatment of acute otitis media comparing antibiotic regimens of <4 days versus ≥4 days in children between four weeks to eighteen years of age were included. The trials were grouped by pharmacokinetic behavior of short-course antibiotics into short-acting antibiotics, parenteral ceftriaxone, and long-acting azithromycin. Results: We reviewed 35 trials, which provided 38 analytic components. Overall, there was no evidence of an increased risk of treatment failure until one month with a short-course of antibiotics (RR=1.06, 95% CI 0.95 to 1.17, P=0.298). Use of short-acting oral antibiotic in shortcourse was associated with a significantly increased risk of treatment failure (RR=2.27, 95% CI: 1.04 to 4.99). There was a slightly increased risk of treatment failure with parenteral ceftriaxone (RR=1.13, 95% CI 0.99 to 1.30). The risk of adverse effects was significantly lower with short-course regimens (RR=0.58, 95% CI: 0.48 to 0.70). Conclusion: There is no evidence of an increased risk of treatment failure with short course of antibiotics for acute otitis media. Among the short-course regimens, azithromycin use was associated with a lower risk of treatment failure while short-acting oral antibiotics and parenteral ceftriaxone may be associated with a higher risk of treatment failure.

A postmortem study on the weight of the human adrenal glands.

Objective: A cross-sectional descriptive type of study was designed to find out the difference in weight of the right and left adrenal glands of Bangladeshi people in relation to age and to compare with the previous studies. Materials & Methods: The study was done in the Department of Anatomy, Dhaka Medical College, Dhaka from July 2008 to June 2009 and performed on 140 post mortem human adrenal glands collected from 70 unclaimed dead bodies which were in the morgue under examination in the Department of Forensic Medicine, Dhaka Medical College, Dhaka. The samples were divided into four age-groups including group A (11-20 years), group B (21-30 years), group C (31-40 years) & group D (41-60 years) and the weight of the adrenal glands were measured and recorded. Results: There was no difference found in weight in between the right and the left adrenal glands in any age group. For the right adrenal gland, the differences in weight between group A & group B and group A & group D were statistically significant (p<0.05). For the left adrenal gland, the differences in weight between group A & group D and group C & group D were statistically significant (p<0.05).

Weight of the Human Thyroid Gland – A Postmortem Study.

Context: A cross-sectional study was designed to find out the difference in weight of the thyroid gland of Bangladeshi people in relation to age and sex and to compare with previous local and foreign studies. Materials & Methods: The present study was performed on 60 post mortem human thyroid gland (39 of male and 21 of female) collected from unclaimed dead bodies which were in the morgue under examination in the Department of Forensic Medicine, Dhaka Medical College, Dhaka. The samples were divided into three age-groups including Group A (10-20 years), Group B (21-50 years) & Group C (>50 years) and the weight of the thyroid glands were measured and recorded. Results: The mean weight of the thyroid gland in male was 15.14 gm, 19.20 gm and 14.64 gm and in female was 16.02 gm, 19.03 gm and 14.67 gm in group A, B and C respectively. The mean weight of the thyroid gland was 15.48 gm in group A, 19.15 gm in group B and 14.65 gm in group C. There was no difference in mean weight of the thyroid gland between male and female. The difference in mean weight of the thyroid gland between group A & group B and group B & group C were found statistically significant. The weight of the gland was found to increase from early childhood and puberty up to 50 years of age and then decrease.

Are we adequately managing children with wheeze using the standard case management guidelines?

INTRODUCTION: Prevalence of wheezing is increasing, bronchodilators are sub-optimally utilized and antibiotics are over-prescribed. In Thailand, current case management guidelines based on WHO guidelines, recommend two doses of rapid-acting bronchodilator for children with audible wheeze and fast breathing (FB) and/or lower chest indrawing (LCI). OBJECTIVE: To document the response of children with wheeze with FB and/or LCI to up to three doses of bronchodilator therapy and followed children whose FB and LCI disappeared for 7 days. MATERIAL AND METHOD: We documented response to up to three dose of inhaled salbutamol in consecutively assessed eligible children 1-59 months of age presenting with auscultatory/audible wheeze and FB [WHO defined non-severe pneumonia (NSP)] and/or LCI [WHO defined severe pneumonia (SP)] at the outpatient department of a referral hospital. Data were collected for up to 7 days in responders to bronchodilator therapy. RESULTS: Of 534 children were screened from November 2001 to February 2003, 263 (49.3%) had wheeze and NSP and 271 (50.7%) had wheeze and SP Forty-eight children (9%) had audible wheeze. At screening, 224/263 (85.2%) children in the NSP group and 195/271 (72.0%) in the SP group responded to inhaled salbutamol. 86/419 (20.5%) responded to the third dose of bronchodilator Four hundred and nineteen responders were enrolled and followed up. On follow-up, 14/217 (6.5%) responders among the NSP group and 24/190 (12.6%) among the SP group showed deterioration. Age 1-11 months at screening was identified as an independent predictor of subsequent deterioration. Two seasonal peaks from December to March and from August to October were documented. CONCLUSION: A third dose of bronchodilator therapy at screening will improve the specificity of case management guidelines and reduce antibiotic use. Physicians should use auscultation for management of wheeze.

Longitudinal growth patterns of Pakistani infants in a clinic based growth promotion program.

OBJECTIVE: To describe the operation of growth monitoring and promotion (GMP) clinic and longitudinal growth patterns of children. DESIGN: Prospective observation and intervention. SETTING: Outpatient department of a teaching hospital. METHODS: Less than 6 months old infants were registered at GMP clinic and followed for up to two years of age. Mothers were provided information, education and counselling about healthy growth of their infants. The outcome measure was change in weight after follow-up. RESULTS: We enrolled a cohort of 553 children in the first 6 months of life, of which 318 were males. Mean follow up period was 15.7 (SD+/-6.4) months. At enrollment 207 were underweight [weight-for-age Z score (WAZ<-2], of which 153 were from low-income families. The children from poorer families also gained weight regularly, although it was less than the higher income families. Of 346 infants with normal weight at registration, 305 maintained their weight gain by last follow-up visit. Of 207 underweight infants at enrollment 128 improved their weight gain by the last follow-up visit. Overall 433 infants followed-up at our GMP clinic either maintained or improved their weight gain. CONCLUSIONS: Children at risk of undernutrition should be identified at an early age and through effective interaction between health workers and the family, their growth can be improved. Children of poor families can also benefit from this activity, provided a comprehensive approach is made available.