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.

Comparison of timolol alone with fixed combination of latanoprost/ timolol to control intra-ocular pressure in primary open angle glaucoma

To evaluate the effectiveness of Timolol only and fixed combination Latanoprost- Timolol in lowering intraocular pressure in patients with primary open angle glaucoma. Comparative Randomized Controlled trial This study was conducted at Institute of Ophthalmology, Mayo Hospital, Lahore over a period of one year from January 2012 to December 2012. Total 80 patients were selected by Non-Probability Purposive Sampling technique after fulfilling inclusion and exclusion criteria. After informed consent these patients were divided into two groups by random number table. Group-I consisted of 40 patients which were put on topical Timolol therapy one drop in each eye twice daily. Group-II consisting of 40 patients was put on topical fixed combination Latanoprost-Timolol therapy, one drop once daily in both eyes. On each follow-up visit all patients were assessed by monitoring intraocular pressure with Goldmann Applanation Tonometer. The follow up examinations were scheduled at one week, one month, and three months from the start of therapy. Later on, all patients were followed for at least 6 months and according to requirement they underwent modification in medication or surgical procedure. At the end of study, mean reduction of intraocular pressure from baseline in Group- I [using 0.5% Timolol twice daily] was 6.7 mm of Hg [27.57%] and the mean reduction of intraocular pressure in Group-II [using Fixed Combination Timolol-Latanoprost once daily] was 7.9 mm of Hg [32.24%]. The effectiveness i.e. reduction of intraocular pressure by 30% from baseline was noted among 32.5% patients in Group-I and 70% patients in Group-II. Latanoprost-Timolol fixed combination is well tolerated, convenient and an effective ocular hypotensive agent than Timolol alone in lowering IOP in primary open angle glaucoma

Brain abscess in cyanotic congenital heart disease: a preventable complication with heavy financial burden and poor outcome

To evaluate the financial burden and outcome of the children with brain abscess and underlying congenital cyanotic heart disease. To emphasize the need of early diagnosis and surgery of congenital cyanotic heart disease. Cross Sectional Descriptive Study. This study was conducted at the department of paediatric cardiology The Children's Hospital and The Institute of Child Health, Multan from February 2010 to January 2012. All the patients presenting with brain abscess and having underlying congenital heart disease were included in the study. All the patients underwent transthoracic echocardiography and computed tomography [CT] scan of the brain. Data was taken on a written proforma after proper consent. A total of 58 patients with cyanotic congenital heart disease presented with CNS manifestations including headache, fever, focal neurological signs, fits or altered sensorium during the study period. Out of these 24 turned out to have brain abscess. Multiple brain abscesses were found in 7 patients. All the patients were given broad spectrum IV antibiotics. 19 of the patients required surgical intervention. Repeat CT scan was performed in all the patients. Only 5 patients recovered without any neurological sequalae. 7 patients expired during hospital stay. All of the remaining 12 patients survived but with some permanent neurological deficit. IV antibiotics, supportive treatment, CT scan, other laboratory investigations and surgery, all have a lot of cost. Around 1500 to 2000 US [dollar sign], on an average, were spent by the government on one patient during hospital stay. The only way to avoid CNS complications of CCHD is early diagnosis and early surgical treatment. But unfortunately, in this country because of lake of paediatric cardiology services and deficiency of paediatric cardiac surgery centers, corrective surgery of congenital cyanotic heart disease is delayed. It increases the risk of brain abscess formation which in turn leads to excessive financial burden on government resources and also increases the risk of long term neurological sequalae. Establishment of more and more paediatric cardiac surgery centers in this country is urgently required

Efficacy of transcutaneous electric nerve stimulation [TENS] therapy in overactive non-neurogenic neurogenic bladder [Hinman's Syndrome]

To compare the outcome of the patients of overactive non-neurogenic neurogenic Bladder Syndrome with traditional treatment alone and traditional treatment plus Transcutaneous electrical nerve stimulation [TENS] therapy. Twenty eight patients of Hinmans syndrome [all below 12 years] were recruited for the study at The Children's Hospital and The Institute of Child Health Multan, from August 2008 to November 2010. It was a randomized controlled trial and individual patients were categorized as having mild moderate or severe disease, on the basis of Overactive Non-neurogenic neurogenic bladder symptom score [OABSS] scoring system. The patients with equal grades of severity were placed in control and study groups each comprising 14 patients. Group A was given traditional treatment while group B was treated with TENS therapy in addition to traditional treatment. Improvement was observed by OABSS and voiding diaries. After 12 weeks of treatment, the patients were re-evaluated for their symptoms and grade of severity of disease, t-test was applied to compare outcome between two groups and p < 0.05 was considered to be statistically significant. At the start of treatment, dribbling and increased frequency was observed in all 28 patients and urgency was noted in 22 patients [11 patients in each group]. At the completion of treatment after 12 weeks, dribbling was observed in 11[78.51%] vs. 3[21.4%] children in group A and B respectively. Frequency was reduced to 8[57.14%] in group A and 5[35.7%] in group B patients. Urgency was also reduced to 8[72.7%] in group A while 3[27.3%] in group B patients. No marked side affect were noted, except local skin irritation in some patients. Transcutaneous electrical nerve stimulation [TENS] Therapy is an effective and safe tool to improve the symptoms and quality of life of the patients with Hinman syndrome but still large scale studies with longer follow up are required

pattern of ventricular septal defects and the severity of associated pulmonary hypertension in our set-up

Ventricular Septal Defect [VSD] is commonest of all the congenital heart diseases. This is found as an isolated lesion as well as in association with other congenital cardiac lesions. The management and outcome of isolated VSD is not only dependent upon the size but also depends on the associated complications of ventricular septal defect [VSD]. Pulmonary hypertension is not only the most common complication but also the most important indication of surgery in our setup. To study the pattern of various types of ventricular septal defects [VSDs] and assessment of severity of associated pulmonary hypertension in our population. Cross sectional descriptive study. The study was conducted at the paediatric cardiology department of The Children Hospital and The Institute of Child Health Multan, from October 2009 to March 2011. All patients with ages between 1 day to 15 years presenting with isolated VSD during the study period were studied using 2-D, continuous wave Doppler and color Doppler transthoracic echocardiography. Out of 403 patients with isolated VSD, 288 were of perimembranous type [71.4%], 57 were of muscular type [14.2%], 19 were of doubly committed sub arterial [DCSA] type [4.7%] and 39 patients were having inlet VSD [9.7%]. The mean age was 2.4 years. Females were 137 [34.0%] and males were 266 [66.0%]. Pulmonary hypertension was present in 210 patients [52.1%]. Amongst these mild pulmonary hypertension was present in 86 [40.9%], moderate in 65 [30.9%] and severe pulmonary hypertension was present in 59 [28.1%]. Perimembranous [PM] VSD is the commonest type of ventricular septal defect presenting to our hospital. The incidence of pulmonary hypertension is very high [52.1%] and even severe pulmonary hypertension was found in about a quarter of the patients. This shows the degree of delay in surgery and the major reason is non availability of pediatric cardiac surgery centers in government setups

Type and severity of valvular involvement in pediatric rheumatic heart disease patients

To assess frequency and severity of type of valvular involvement in pediatric patients with Rheumatic Heart Disease. This descriptive study was conducted in the Department of Pediatric Cardiology Children Hospital Complex, Multan from April 2008 to April 2010. The data of all pediatric patients below 15 years of age undergoing detailed cardiac evaluation including ECG, X-Ray and Echocardiography were reviewed. Only new cases of Rheumatic Heart Disease were studied for type and severity of valvular involvement. The data was analyzed using SPSS version 13. A total of 2381 echocardiograms were performed during the study period. 190 [08%] patients were diagnosed as having Rheumatic Heart Disease. Mitral regurgitation was the commonest lesion: In 148 [77.9%] patients mitral regurgitation was found either alone [104, 54.7%] or in combination [44, 23.2%] with other lesions. In 50 [26.3%] patients aortic regurgitation was found either alone [06, 3.2%] or in combination [44, 23.2%] with other lesions. Mitral stenosis was found in only 14 [7.4%] patients. No patient had Rheumatic tricuspid or pulmonary valve. Amongst mitral regurgitation patients 54 [28.4%] had severe MR, 76 [40%] had moderate MR and 18 [9.5%] had mild MR. Amongst aortic regurgitation patients 06 [3.2%] had severe AR, 18 [9.5%] had moderate AR and 26 [13.7%] had mild AR. The commonest combination lesion was MR + AR which was found in 44 [23.2%] patients. The commonest valve involved in patients with Rheumatic Heart Disease was mitral valve followed by aortic valve. Regurgitant lesions are much more common in our younger age group patients as compared to the adult Rheumatic patients in whom mitral stenosis is usually the common lesion

Various presentations of typhoid fever in children

To study various presentations of typhoid fever in children. As certain laboratory investigations are required to make the definite diagnosis of typhoid fever, it is very important to see the clinical spectrum of the disease, so to start appropriate treatment while waiting for laboratory investigations. Descriptive study of inpatients involving 60 subjects suffering from typhoid fever. The study was conducted over 18 month's period [September 2002 to February 2004] at Children's Hospital Complex Multan. A total of 60 admitted patients [Age group 6 months-14 years] with biologically and/or serologically diagnosed typhoid fever cases were included in the study. There were 42 [70%] male and 18 [30%] female patients. Out of 60 patients 4 [6.7%] were below 2 years of age and 5 [8.3%] above 10 years. In addition to the typical manifestations like fever [100%], headache [55%], anorexia [70%], diarrhea [30%], constipation [5%], vomiting [35%], abdominal pain [15%], abdominal distension [10%], bleeding per rectum [5%], bronchitis [10%], lobar pneumonia [3.3%], jaundice [5%], epistaxis [5%], meningeal irritation [15%], fits [5%], encephalopathy [6.7%], cerebellar ataxia [1.7%] and choriform symptomatology, so a presumptive clinical diagnosis may be made to start early treatment

Protein-energy malnutrition: a descriptive study to evaluate risk factors in children under five years of age

To see the risk factors responsible for malnutrition in children less than five years of age in the region of Multan. A descriptive observational study. This study was conducted in the department of paediatrics, Children Hospital Complex Multan from November 2002 to October 2003. A total of 80 malnourished patients [34 males and 46 female], with 3[rd] degree malnutrition according to modified Gomez classification were included in the study. Welcome's classification was also used to assess the type of malnutrition. The age of the patients ranged from 1 month to 5 years with mean age of 21.7 months. A questionnaire comprising 25 different aspects of malnutrition was designed. Data was collected and analyzed. Out of these 80 patients, marasmus was the most frequent type of malnutrition found, followed by marasmic kwashiorkor and then kwashiorkor. Malnutrition was more frequent during first 2 years of life and number of malnourished patients decreased as the age increased. The significant risk factors predisoposing to malnutrition were illiteracy, lack of breast feeding, poverty, inadequate weaning, use of diluted milk, bottle feeding practices, vaccination failure, large family size, recurrent infections history of measles and tuberculosis. Though poverty and household income play a direct role in the development of malnutrition but illiteracy and lack of knowledge about breast feeding and weaning practices, poor awareness about immunization and family planning are the also the main contributory factors