Comparison of classical and non-classical turner syndrome at NICH Karachi

Objective: to analyse chromosomal abnormalities of the patients who were referred for the screening of short stature and delayed puberty and to verify the association between karyotype and phenotype in confirmed Turner Syndrome [TS] patients

Study Design: descriptive study

Place and Duration of Study: department of Pediatric Endocrinology and Diabetes Unit-II, National Institute of Child Health, Karachi, from January 2011 to June 2016

Methodology: patients referred for the evaluation of short stature or delayed puberty were for the assessment of karyotype and phenotype correlations; standard karyotyping was executed and analysed on the basis of routine G-banding technique. Echocardiography and pelvic ultrasonography was also performed

Results: the study population consisted of 79 registered patients, with short stature and delayed puberty 48/79 [60.75%], short stature 68/79 [86.07%], and ambiguous genitalia 5/79 [6.32%]. Conferring to the karyotype analysis, classical Turner Syndrome 45, X was found in 42/79 [53.16%], isochromosomes 13/79 [16.45%], and mosaicism was present in 11/79 [14.1%]. Only 7/79 [8.86%] cases were diagnosed in infancy

Conclusion: the results of the study showed the consistency of short stature and delayed puberty in most of patients. Monosomy of X chromosome was the commonest followed by isochromosomes, mosaicism and structural abnormalities of X chromosome. No remarkable difference was found among classical and non-classical TS patients' height

Estimation of severity and outcome of acute kidney injury in children by using pRIFLE criteria

Background: acute kidney injury [AKI] is rapid decrease of renal function. AKI has been resulted in significant morbidity and mortality. The term RIFLE consist of risk, injury, failure, loss, and end-stage renal disease. A modified version of this criteria pRIFLE is used in pediatric population with AKI, for the severity assessment and its outcome. Therefore early intervention can be made. This study helps to make recommendations based on pRIFLE criteria for severity and outcome

Objectives: to determine severity and outcome of AKI in pediatric population using pediatric RIFLE criteria

Study design, settings and duration: it was a descriptive case series carried out in departments of Pediatric ICU and pediatric nephrology unit at National Institute of Child Health [NICH], Karachi from August 2010 to March 2011

Patients and Methods: total ninety seven children with acute kidney injury [AKI] were included in this study. Schwartz equation was applied for calculation of estimated glomerular filtration rate [eGFR] and severity of AKI was assessed using pRIFLE criteria at presentation andt then on daily basis till discharge. Outcome was labeled as death or alive. Data entered and analyzed by using SPSS version 19.0

Results: the pediatric RIFLE identified those at risk, injury, and failure in 16 [16.5%], 25 [25.8%], and 56 [57.7%] patients respectively. Outcome in term of mortality was observed in 11.3% cases. There was 6.3% death in those at risk, 17.9% [10/56] in those with failure and no significant in injury

Conclusion: there are significant number of patients in renal failure due to AKI, this implies lack of early detection of AKI and delayed referral to the pediatric tertiary care hospital so "pRIFLE criteria" can be widely used by all pediatricians for early detection of children with AKI in risk category so that early interventions may halt the progression of AKI to failure

Molecular detection of Leishmania species in human and animals from cutaneous leishmaniasis endemic areas of Waziristan, Khyber Pakhtunkhwa, Pakistan

Objectives:To detect Leishmania species in human patients, animal reservoirs and Phlebotomus sandflies in Waziristan, Pakistan.Methods:Tissue smears and aspirates from 448 cutaneous leishmaniasis (CL) suspected patients were analyzed. To sort out role of the reservoir hosts, skin scrapings, spleen and liver samples from 104 rodents were collected. Furthermore, buffy coat samples were obtained from 60 domestic animals. Sandflies were also trapped. All human, animals and sandfly samples were tested by microscopy, kinetoplastic PCR and internal transcribed spacer 1 (ITS1) PCR followed by restriction fragment length polymorphism for detection of Leishmania species.Results:An overall prevalence of 3.83% and 5.21% through microscopy and ITS1 PCR respectively was found. However, the statistically non-significant correlation was found between area, gender, and number of lesions. The presence of rodents, sandflies, domestic animals and internally displaced people increased the risk of CL. Using ITS1-PCR-RFLP, Leishmania tropica (L. tropica) was confirmed in 106 samples while 25 of the isolates were diagnosed as Leishmania major (L. major). Similarly, 3/104 rodents were positive for L. major and 14 pools of DNA samples containing Phlebotomus sergenti sandflies were positive for L. tropica. None of samples from domestic animals were positive for leishmaniasis.Conclusions:In the present study, L. tropica and L. major are found to be the main causative agents of CL in study area. Movement of internally displaced people from CL endemic areas presents a risk for nearby CL free areas. To the best of our knowledge, we report for the first time L. major infection in rodents (Rattus rattus) and L. tropica in Phlebotomus sergenti sandflies trapped in Waziristan, Pakistan.

Molecular detection of Leishmania species in human and animals from cutaneous leishmaniasis endemic areas of Waziristan, Khyber Pakhtunkhwa, Pakistan

Objectives: To detect Leishmania species in human patients, animal reservoirs and Phlebotomus sandflies in Waziristan, Pakistan. Methods: Tissue smears and aspirates from 448 cutaneous leishmaniasis (CL) suspected patients were analyzed. To sort out role of the reservoir hosts, skin scrapings, spleen and liver samples from 104 rodents were collected. Furthermore, buffy coat samples were obtained from 60 domestic animals. Sandflies were also trapped. All human, animals and sandfly samples were tested by microscopy, kinetoplastic PCR and internal transcribed spacer 1 (ITS1) PCR followed by restriction fragment length polymorphism for detection of Leishmania species. Results: An overall prevalence of 3.83% and 5.21% through microscopy and ITS1 PCR respectively was found. However, the statistically non-significant correlation was found between area, gender, and number of lesions. The presence of rodents, sandflies, domestic animals and internally displaced people increased the risk of CL. Using ITS1-PCR-RFLP, Leishmania tropica (L. tropica) was confirmed in 106 samples while 25 of the isolates were diagnosed as Leishmania major (L. major). Similarly, 3/104 rodents were positive for L. major and 14 pools of DNA samples containing Phlebotomus sergenti sandflies were positive for L. tropica. None of samples from domestic animals were positive for leishmaniasis. Conclusions: In the present study, L. tropica and L. major are found to be the main causative agents of CL in study area. Movement of internally displaced people from CL endemic areas presents a risk for nearby CL free areas. To the best of our knowledge, we report for the first time L. major infection in rodents (Rattus rattus) and L. tropica in Phlebotomus sergenti sandflies trapped in Waziristan, Pakistan.

Quantification, classification and management of hospital waste in Lahore City

Systematic disposal of hospital waste is a major problem encountered by different countries including Pakistan. Efforts are on the way to achieve this objective techno-economically. To quantify infectious and total waste produced by the hospitals of Lahore, classify it to know the nature of their components and to collect information about its management. The background information and secondary data were collected by consultation of literature in the libraries and visiting different websites on Internet. The primary data were collected by gathering the responses of the Chief Executives, Medical Superintendents and Medical and Environmental Staff of all hospitals scheduled as reference models through interview. The total quantity of infectious waste produced by the hospitals and other health care units is approximately 785 million tons per annum while the total waste including municipal component is approximately 3,925 million tons per annum. The current status of awareness about proper health care waste disposal is improving but at a slow pace. It may be concluded that the management of hospital waste in five hospitals of Lahore city is systematic. However, the staff handling the waste was not fully trained for proper segregation of the hospital wastes. Incinerators being used for waste disposal are a major source of secondary air pollution therefore, this method should be discouraged. Instead, the feasibility of thermoelectric power generation may be looked into. Proper disposal of hospital wastes should be in placed in every hospital and trained staff should be employed for the job