Role of probiotics in acute diarrhea in children

Objective: To determine the effect of Bifidobacterium BB12 on mean change in stool frequency and hospital stay in the management of acute diarrhea. Study Design: Randomized controlled trial. Place and duration of study: Study was conducted at department of pediatrics. DHQ hospital, Faisalabad from 1[st] July 2013 to 31[st] December 2013

Patients and methods: Ninety eight patients after fulfilling inclusion criteria were registered and sorted out into group A [study] and Group B [Control] randomly [By lottery method]. Group A patients were given Bifidobacterium BB12 [6 Billion units BD for five days] diluted in ORS while group B patients were given ORS only. The cases were assessed daily for decrease in frequency of stool and total duration of illness at discharge

Results: Mean age at the time of admission was 17.6 +/- 7 months for study group and 14.6 +/- 7.4 months for controls. Duration of hospital admission was 1.88 +/- 0.21 days in the probiotic group compared with 3.38 +/- 0.13 days in the control group [P = 0.02]. Mean reduction in the frequency of stool per day was 5.08 +/- 0.34 times for study group and 2.3 +/- 0.35 times for the control group [P = 0.05]

Conclusion: We conclude that effect of Bifidobacterium bifidum is statistically significant in reducing the mean change in stool frequency and hospital stay in management of acute diarrhea in children

Correlation between acute ischemic stroke, higher total cholesterol level and high barthel index score

Objectives: To determine the correlation between higher total cholesterol level and high Barthel Index score in patients with acute ischemic stroke

Methodology: This cross sectional study was conducted at Radiology department and Medical Unit 1, Allied Hospital, Faisalabad for duration of 6 months from January 2015 to June 2015. 200 patients were included through Consecutive [non-probability] sampling technique. All the patients were undergone CT scan Brain from the radiology department of the Allied hospital to determine the respective changes [hypo dense area] of the ischemic stroke. Fasting serum cholesterol was measured in all patients after an overnight fast of 12 hours by drawing blood through 5cc BD syringe by me. Then all the patients were assessed by using Barthel Index score [BI]. Higher total cholesterol and high BI score were labeled after assessing the laboratory and clinical findings. The data was analyzed by using SPSS version 17.0. Spearman Rank correlation coefficient was calculated to BI score in patients with ischemic stroke. P-value<0.05 was considered as significant

Results: The mean age of the patients was noted as 61.76 +/- 11.55 years. In this study 55.50% were males and 44.50% patients were females. The mean total cholesterol value of patients was noted as 251.59 +/- 71.15 mg/dl. Out of 200 patients, 112 [56%] patients had high cholesterol [>200mg/dl] whereas 88 [44%] patient had low cholesterol of [<200mg/dl]. In this study the results showed that the mean value of total Barthel index score was 57.50 +/- 19.52. The study results described that 103 [51.50%] patients had high Barthel index score [>53] whereas 97 [48.50%] patients had low Barthel index score [<53]. Spearman correlation coefficient was calculated between high TC and high BI score as r= 0.631. This value was statistically significant i.e. p-value=0.000

Conclusion: With the help of this study, we found a significant positive relationship between high TC and high BI score in patients presented with ischemic stroke. Now we can better prognosticate the functional outcome of ischemic stroke in our patients

Audit of childhood tetanus patients admitted in tertiary care hospital

Background: Childhood tetanus has high mortality and is preventable

Objective: To enlist the risk factors of childhood tetanus among patients admitted in a tertiary care hospital. Methodology: Study design: Cross sectional study. Place and duration of study: Children ward, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1 September 2012 to 28 February 2015. In this study 97 patients were included. Their parents were interviewed according to the given performa. The data was entered and analyzed by using SPSS version 19

Results: Out of 97 patients, the fathers of 68[64%] patients and mothers of 84 [86%] patients were either illiterate or primary education only. Most 57 [58%] of the patients belonged to a low socioeconomic family having the monthly income of less than PKR 10,000. The fathers of 37[38%] patients were Sindhi. 57[58.76%] patients were from rural areas. Most 69 [71%] of the affected patients were boys, age range of 5 to 10 years, was found 39 [40%] of patients were boys, age range of 5 to 10 years, was found in 39 [40%] of patients

Conclusion: The various factors which are responsible for the development of childhood tetanus were; poor educational status of the parents, Sindhi, ethnicity, low socioeconomic status and rural area residence

Frequency of placenta previa in previously scarred and non scarred uterus

To determine the frequency of placenta Previa in patients coming to a tertiary care unit with previously scarred and non-scarred uterus. A descriptive cross sectional study was carried on 114 cases who underwent caesarean sections [37 cases out of 645 cases with non scarred uterus and 77 cases from 721 cases with scarred uterus] in the department of obstetrics and gynecology Lady Willingdon Hospital from January 2008- December 2011. Most patients [47.36%] were between 26-30 years age group, presented with gestational age between 36-40 weeks [70.17%], were mostly G2-4, while frequency of placenta Previa in non-scarred uterus was 32.45% [37 cases], and frequency in previously scarred uterus was 67.54% [77 cases]. Major degree Previa was found in 88 cases [77.19%]. There were 5.70% cases of placenta Previa from non-scarred uteruses and 10.67% cases of placenta Previa [10.67%] from already scarred uteruses. Stratification revealed a higher trend of the morbidity with the increase in number of previous caesarean sections. A significantly higher frequency of placenta Previa was found among patients coming to a tertiary care hospital with previously scarred uterus

Acute severe asthma in children; role of intravenous magnesium sulfate in treatment

To compare the efficacy of intravenous magnesium sulfate and conventional treatment with conventional treatment alone in acute severe asthma in children of age group 5 to 15 years known cases of bronchial asthma. Randomized control trial. Indoor and outdoor patients of pediatrics department of DHQ hospital, Faisalabad. Six months. In this study, 43.58%[n=17] in Exposed and 53.85% [n=21] in Un-exposed group were male and remaining 56.42%[n=22] and 46.15%[n=18] were females, mean pulse rate in both groups was recorded which shows 97.32 +/- 6.58 in Exposed Group and 103.67 +/- 8.32 in Un-exposed Group, p value was calculated as 0.02, mean FEV1 rate in both groups was recorded which shows 60.32 +/- 7.56 in Exposed Group and 54.07 +/- 6.43 in Un-exposed Group, p value was calculated as 0.03. We concluded that intravenous magnesium sulfate along with conventional treatment is significantly better than conventional treatment alone for the management of acute severe asthma attack

Treatment of benign essential blepharospasm with botulinum toxin type A

Background: Benign Essential Blepharospasm [BEB] is difficult to treat clinical entity

Objective: To evaluate the efficacy and safety of Botulinum toxin type A for the management of benign essential blepharospasm

Patients and Methods: Ten essential blepharospasm patients were evaluated according to gender, ocular complaints, time of disease, treatment outcome and complications. Study design: Prospective randomized. This study was done in Department of Ophthalmology at Nawaz Sharif Social security Hospital /University of Lahore. The duration of study was from 1[st] June 2012 to 30[st] June 2014. All were suffering from BEB for several months to years. All these patients were followed up from 6 months to 2 years

Results: Mean age was 50 years, 6 [60%] patients were female and four [40%] were male out of essential blepharospasm. Many patients complained of dry eye due to infrequent blinking. Botulinum toxin A showed a positive outcome in 90% of the treated patients. The complications observed after treatment were dry eye [10%] and lagophthalmos [10%]. No systemic reaction or toxicity observed in any patient

Conclusion: Essential blepharospasm which affects the elderly people treatment with botulinum toxin A was useful, with very low complication rates

Comparison of ranibizumab and bevacizumab in diabetic macular edema

Background: Diabetic retinopathy is one of leading causes of blindness

Objective: To compare the efficacy of ranibizumab and bevacizumab in the treatment of diabetic macular oedema

Material and Methods: Study Design: Prospective, randomised trial evaluating efficacy of ranibizumab and bevacizumab in diabetic macular oedema [DME]. Place and duration of study: Study was done at Nawaz Sharif Social Security Hospital Lahore / University of Lahore, from 1[st] January 2012 to 31[st] December 2013. Thirty two eyes were included in the study consisting of twenty eight patients. They were classified into 2 groups; Group A where 16 eyes received monthly intravitreal injections of Ranibizumab and Group B: Where 16 eyes received monthly intravitreal injections of Bevacizumab for the treatment of DME. Patients were followed on monthly basis

Results: Twenty eight patients [32 eyes] completed 48 weeks of follow-up. At baseline, mean best-corrected visual acuity [BCVA] on snellens chart was [20/100] in the bevacizumab group and [20/120] in the ranibizumab group. A significant improvement in mean BCVA was seen in both groups at subsequent follow up visits, post treatment BVCA was 20/160 and 20/200 in Group A and Group B as compared to pretreatment BVCA of 20/120 and 20/100 respectively

Conclusion: Bevacizumab and ranibizumab are both effective antivascular endothelial growth factor drugs preferred in the treatment of DME. Our comparison of both therapies suggested that the effect on BCVA was not statistically different in both groups

Anemic patients; relationship of frequency and severity of iron deficiency anemia with preterm labor and eventual perinatal outcome

Pregnant women are particularly considered to be the most vulnerable group because of the additional demands that are made on maternal stores during pregnancy. The iron deficiency anemia is the most common nutritional deficiency problems in females and is responsible of high maternal death rate in our society

Objectives: to determine the relationship of frequency and severity of iron deficiency anemia to preterm labor and eventual perinatal out come in anemic patients

Study Design: it was a case control study

Study Setting: in Obstetrics and Gynecology Unit-III, Sir Ganga Ram hospital, Lahore from July 2012 to June 2013

Methodology: the study was conducted on 200 patients [100 cases and 100 controls] were studied. Cases were patients admitted in labor room with preterm labor and Controls were females in labor at term at. Convenience sampling was done. On admission relevant history taking examination and investigation were done. The data was collected on a Performa

Results: there were 50 patients with anemia amongst the patients with preterm labor. In the control group, 40 patients were suffering from anemia. In the patients with preterm labor the mean hemoglobin was 9.83 grams/deciliter. In the control group the mean hemoglobin was 10.3gm/dl. [Pregnant women having hemoglobin <10 gm/dl are considered to be anemic]. The odds ratio was calculated to be 3.4 and P value was <0.05

Conclusions: iron deficiency anemia was associated with increased risk for low birth weight, preterm delivery, and perinatal mortality. The frequency of iron-deficiency anemia was seen in both groups of pregnant women

Treatment of Bronchiolitis; role of inhaled beta-agonists in infants and children

Objective: To compare the efficacy of normal saline and inhaled beta-agonist in the treatment of bronchiolitis

Study design: Randomized clinical trial

Settings: The study was conducted in Paediatric Medicine Department, DHQ hospital/Punjab Medical College Faisalabad. Period: 06 months from 1[st] October 2013 to 31[st] march 2014

Results: In this study, 58.33%[n=21] in Group-A and 66.67%[n=24] in Group-B were between 0-9 months of age, mean and sd was calculated as 11.43 + 3.87 months in Group-A and 10.52 +/- 3.32 months in Group-B, 52.78%[n=19] in Group-A and 61.11%[n=22] in Group-B were male while 47.22%[n=17] in Group-A and 38.89%[n=14] were females, mean clinical score in both groups was recorded as 4.11+1.32 in Group-A and 5.65 + 1.89 in Group-B, comparison of efficacy in both groups was recorded which shows 58.33%[n=21] in Group-A and 25%[n=9] in Group-B were treated effectively while rest of 41.67%[n=15] in Group-A and 75%[n=27] in Group-B were not treated effectively, p value was calculated as 0.008, which is statistically significant

Conclusions: The results of this study reveal that inhaled beta-agonists are more effective than normal saline

EPI status under one year children and their mothers attending paediatric department sheikh zayed medical college and hospital, Rahim Yar Khan

To determine the EPI status in children <1 year of age and the status of Tetanus immunization in their mothers attending paediatric department. This will help us to determine the facts and figures in our population and to construct a plan to improve the vaccination status. Cross-sectional analytical study This study was conducted at the Department of Paediatrics, Sheikh Zayed Medical College and Hospital, Rahim Yar khan from April 2011 to July 2011. In the study 492 consecutive children whether admitted in the ward or visited in Paediatric OPD and their mothers were inquired about EPI status in ttie child and the status of Tetanus immunization in their mothers, strictly following the inclusion and exclusion criteria. Out of 492 patients, we have found three groups. Group 1 includes those children who were unvaccinated. Group 2 includes those children who were incompletely vaccinated. Group 3 include those who were completely vaccinated according to EPI schedule. Similarly three groups were found in mothers. Group 1 includes those who were unvaccinated. Group 2 includes incompletely vaccinated ladies. Group 3 include those who were completely vaccinated according to EPI schedule. In our study, we found that EPI status is very poor in our low socioeconomic and illiterate population. Those people living in peripheries and remote areas are particularly not properly following the EPI programme

Malignant tumors; frequency at Sargodha, a single centre, retrospective study

As in most developing countries, incidence of cancer is also increasing in Pakistan. It is important that information on the frequency and epidemiology of malignant tumors be updated, as it is the basis of future health planning for the population at risk. This retrospective study was carried out to find the prevalence of various cancers in the population of Sargodha district [central Punjab, Pakistan] and to compare the regional and international studies, so as to plan and develop the oncology setup of Sargodha Medical College on a rationalized basis of disease prevalence. Data from July 2010 to June 2013 was retrieved from the department of statistics of the hospital and variables of interest were collected and analyzed using SPSS 10.0. It was observed that the most frequent cancer in our patients was breast cancer [n=172] while carcinoma of lungs was the most frequent carcinoma in male population [n=24]. However our observations were a bit different from the international studies published on the subject, the probable reason being the availability of treatment facility and easier access in the nearby districts of Faisalabad and Lahore where many patients still go directly. More over the illiterate and poorer faction of the society does not come to the hospitals for management of the disease but rather go to the quakes and faith healers to relieve them of their sufferings. It is concluded that the department of clinical oncology should arrange cancer awareness programs for the general population to avoid delays in getting consultation, as at present they report to the hospital when the disease is quite advance and surgery is often not possible. Our study also revealed a somewhat different pattern of malignancies in our community raising a need for further studies to evaluate the reasons for this changed pattern in relation to various etiological factors

Midstream urine isolates: sensitivity pattern of various antibiotics in pediatric patients

The objectives of the study was to determine different microorganisms responsible for causing urinary tract infections UTI in children and to evaluate sensitivity and resistance pattern of different antibiotics used in UTIs. Study was conducted in Children Hospital Complex [CHCM], Multan, Pakistan. Total 125 children having UTI were taken to determine the antibiotic sensitivity and resistance pattern against microorganisms causing urinary tract infections in children. The urine samples were collected in urine bottles and smears were made within 2 hours of sample collection. Urine sample was inoculated on agar media and then incubated for 24 hours. A smear was prepared on a slide form culture of microorganisms and gram testing was conducted. The microorganisms were then characterized by use of API [Analytical Profile Index] MICROBACT TM 24E of Oxoid England. The antimicrobial susceptibility testing of various antibiotics was performed by disc diffusion method. The percentage of Gram +ve bacteria causing urinary tract infections in children was 28%, Gram -ve 62.4% and Yeast 9.6%. The most prevailing species are S. aureus, S. epidermidis and E.coli. Results showed that female children are more prone to UTI than male children. Norfloxacin is effective in S. Aureus UTI while cefaclor is effective in S.epidermidis UTI. Amikacin, Norfloxacin and Cefuroxime are effective in UTI caused by E.coli

Single sheet skin graft coverage as treatment of post burn ectropion of eyelids

Objective: To describe the results of single sheet skin grafting after release of post burn contracture in both eye-lids of same eye

Study design: case series Place and duration of study: Department of Plastic Surgery and Burns, Allied hospital, PMC, Faisalabad from July 2012 to March 2014.

Methodology: All the patients with post burn contracture of upper and lower lid contracture of the same eye who presented in OPD and were operated for contracture release followed by coverage with single split thickness sheet graft [STSG], were included in the study. Variables considered were age, gender, mechanism of burn injury and histories of previous surgeries for the same problem. Outcome measures were studied in terms of improvement of contracture release, complications, recurrence and patient satisfaction

Results: A total of 24 patients were included in study. Male to female ratio was 2:1, age ranged from 19 to 45 years. 16 patients presented with history of flame burn, 05 patients were with scald burn and 03 were chemical burn contractures. All of them were operated for upper and lower lid contracture release of same eye with skin graft coverage with a single sheet of STSG. There were improvements in eye lid closure, recurrence rate was very less and all of the patients were satisfied with the results. Complications occurred in 20% of patients including partial graft failure and irritation in eye

Conclusion: Sheet graft coverage after post burn contracture release of upper and lower eyelids is an effective procedure for durable correction and to prevent recurrence of contracture

Tuberculous patients; cross sectional study of BCG vaccination and antibody TITRE in house hold contacts of tuberculous patients

This study was designed to analyze the BCG vaccination status and compare the immune globulins levels in the household contacts of tuberculous patients with non contacts of unexposed healthy peoples. Lahore. Cross sectional study. Investigations like ESR were done and the sera of 200 persons included in the study were tested for anti tuberculous antibodies by ELISA. BCG vaccination present or absent and scars were positive or negative in both groups were included. The combined serological positivity of the household contacts was 65.8% and for non-contacts was 34.1%. BCG scars were mostly absent in the household contacts as well as in non-contacts; But statistically IgG and IgA were present significantly by higher number in the household contacts as compared to non-contacts, where as no significant difference in the IgM levels. These immunoglobulins status were compared with BCG scars in both study and control groups. The results were analyzed by SPSS version 14. Household contacts of tuberculosis patients are more susceptible to tuberculosis as compared to the non-contacts, as shown by positive and negative status of cglitjirculous antibodies in the house hold contacts. More over BCG vaccination has no significant role in humoral evaluation

Radiological perspective of metastatic breast cancer in CENAR, Quetta

Background / Purpose: The study was conducted to evaluate the Breast cancer patients with metastasis to different body regions

Aims and Objectives: The primary aim was to highlight the most common site of metastasis and different Sonographic patterns in breast cancer patients at CENAR, Quetta. The secondary aim was to determine the average age of breast carcinoma [Ca] presentation

Material and Methods: A two year retrospective study of breast carcinoma diagnosed and treated at our centre was conducted. 278 patients pathologically proven invasive carcinoma breast were registered at CENAR from 1st January 2010 to December 2011 were analyzed

Results: During the study period, 278 patients were registered as Ca breast patients out of which 109 [39%] patients developed metastasis during or after treatment or initially at registration, majority of the patients were with liver metastasis 46 [42%]patients and most common Sonographic pattern was hypo echoic with 26[57%] patients. Most common age group was 25-40 years with 125[45%] patients, followed by 41-55 years with 97[35%] patients

Distal urethral stent: a patient friendly approach after repair of hypospadias

In this case report we present a case of surgical repair of hypospadias followed by stenting of only distal part of urethra. The purpose of this report is to discuss the effectiveness of stenting of only distal urethra leading to better post operative outcome and better patient compliance without any complication

Gastro-oesophagectomy with two field lymphadenectomy- an optimal treatment for resectible carcinoma of the oesophagus and gastric cardia

Background: The aim of the study was to examine the outcome of surgical treatment for carcinoma of the oesophagus and gastric cardia with two-field lymph node dissection at a high volume centre by a single surgeon over 7 years period

Methods: From January 1992 to March 1999, 316 patients underwent oesophagectomy with two field lymph node clearance for cancer of the oesophagus at our unit by a single consultant surgeon. Once the data collection at the base hospital was complete, it was sent to The Cancer Intelligence Unit Information Centre at Bristol for verification of data. The data analysis was then undertaken using SPSSv9. The main technique utilized was the Kaplan-Meier survival estimate. Kaplan-Meier survival functions were produced and compared, using the log rank test, for a number of pre-specified variables and their associated levels. Multivariate analysis was performed using Cox's proportional hazards modeling

Results: The average age at the time of surgery was 63.5 years, with a male to female ratio of 2:1. 86% of patients had dysphagia at the time of presentation. 88%[277] Patients had Ivor Lewis oesophagectomy, while 6%[20] had McKeown`s and 1%[4] had left thoracolaparotomy. 5% [14] of the patients underwent total laryngo-pharyngo-oesophagectomy. In total 62% [197] of patients had adenocarcinoma and 31% [99] had squamous cell carcinoma. 68% [215] of patients had lymph node metastasis while 32% [101] had no lymphatic involvement at resection. 80% had pyloroplasty or pyloromyotomy. 8% had anastomotic leak. 30-day mortality was 7%. Overall 5-year survival was 33%, with a very significant survival difference between lymph node negative and positive patients [25%vs 49%; p<0.01]. There was no statistically significant difference in survival on the basis of gender [p=0.47], histology [p=0.48] or age [p=0.299]. In total 72 patients received adjuvant treatment and had significant survival benefit [p=0.002] but because of selection bias the results are of doubtful significance

Conclusion: It is concluded that for tumours of lower 1/2 of oesophagus Ivor Lewis oesophagectomy with two-field lymphadenectomy is safe and effective procedure. It can be performed with low morbidity and mortality and good long-term survival. Oesophageal cancer still remains a disease of old age and that on the basis of age alone no one should be denied the opportunity of surgical resection. Gastric outlet drainage had a strong influence on the incidence of postoperative leak

Association of hypothyroidism and hyperthyroidism with age and gender in balochistan, CENAR Quetta

Aims and Objectives: A retrospective study of all thyroid patients registered at the centre of Nuclear Medicine and Radiotherapy [CENAR], Quetta from 1st January2010 to December 2011[02years]. The aim of this study was to highlight gender and age wise distribution of hypothyroid and hyperthyroid patients in CENAR Quetta

Study design: A retrospective study

Place and Duration: A retrospective study of 2051 files of Thyroid patients was carried out in CENAR Quetta from1st January 2010 to December 2011 [02years]

Results: Out of 2051 patients, the most common gender was female with a total of 1442 [Hypothyroid female: 487; Hyperthyroid female: 231; Euthyroid female: 724] and the common age group was 16-40yr with a total of 1453[16-40yr Hypothyroid male: 153 and Female: 337; 16-40yr Hyperthyroid male: 113 and Female: 139; 16-40yr Euthyroid male: 158 and Female: 553]

Efficacy of herbal coded Hepcon on drug induced hepatitis in experimental animals through histopathological and biochemical analysis

Drug-induced liver injury is the leading cause for more than 50 percent of cases of acute liver failure. This study was conducted on herbo-mineral formulation "Hepcon" to evaluate its hepatoprotective effects in drug induced hepatitis in experimental animals. The liver injury was introduced with over dosage of non steroidal anti-inflammatory drugs [NSAIDs] and carbon tetrachloride [CCl[4]]. The herbo-mineral formulations "Hepcon" consist of Zingiber officinale, Piprum nigrum, Ammonium chloride and Arsenic trioxide [Hartal warqi]. The aqueous extraction was administered to experimental animals. Thereafter their LFTs, IgG, and tissue pathology was studied. It was observed on the basis of biochemical and histopathological analysis that animals which were subjected to Hepcon became normal in 60 days whereas those as control group did not showed improvements and most of them died. It was concluded that the efficacy of Hepcon to treat liver injury caused by CCl[4] and NSAIDs is very effective, and no side effects were noticed

Pattern of gastrointestinal [GIT] cancer in CENAR, Quetta Balochistan Pakistan: 10 year review [2001-2010]

To assess the most common type of GIT tumor, most common site of this tumor, Sex and staging in people of Balochistan including patients from Afghanistan. Retrospective, Analytic study. This study was carried out at the was carried out at the Centre for Nuclear Medicine and Radiotherapy [CENAR], Quetta from January 2001 to December 2010. 8324 cases of different malignancies were seen over the 10 year period with an average of 833 cases/ year. This 10 year review of patients with GIT cancers was carried out at the Centre for Nuclear Medicine and Radiotherapy [CENAR], Quetta. Information extracted from the cases notes of patients in record i.e. most common type of tumor, most common site of this tumor, sex and staging. The most common type was GIT tumors with a total of 2278 patients. GIT cancer occur among male most commonly, the esophagus being the most commonest site and mostly [more than half] presented cases are in Stage III and Stage IV. This result shows that in Balochistan including adjustant Afghanistan most common type of cancer/malignancy was GI among all malignancies. GI malignancy occurs among male most commonly, the esophagus being the most common site. Mostly [more than half] presented cases are in Stage III and Stage IV cases. Cancer management is a global health problem specially in this part due to lack of awareness, early diagnosis, better treatment system in multidisciplinary team as indicated in this article need of future research in G.I.T and other tumors