Comparison of volume and frequency advancement feeding protocols in very low birth weight neonates

Objective: To determine the outcomes in very low birth weight [VLBW] neonates receiving volume advancement versus frequency advancement feeding protocols

Methods: This controlled clinical trial was conducted in Children Hospital Multan within duration of 6 months from February 2017 to August 2017. VLBW neonates having weight < 1500 g at the time of birth were included. The protocol for frequency advancement [FA] group was to give 1 ml/kg human or preformula milk after every 8 hours and in volume advancement [VA] group after every 3 hours initially. After three days, in FA group duration of feeds was decreased gradually from 8 to 2 hours and feed volume of 10 ml.kg-1.day-1 until full-recommended dose of feeding i.e. 150 ml.kg-1.day-1 reached. While in VA group, volume of 20 ml.kg-1.day-1 was given until full-recommended dose of feeding reached. Days to achieve full feed, weight gain, and length of hospital stay were primary study outcomes

Results: Baseline weight of neonates was 1148 [111] grams in VA 1179 [106] grams in FA groups [p-value 0.18]. In VA group, full feed was achieved in 11.04 [2.38] days versus 15.76 [2.48] days in FA group [P-value <0.001]. Duration of IV fluid therapy were 13.5 [8.4] days in FA group versus 9.4 [7.6] in VA group [p-value <0.001]. Moreover weight gain at the end of feeding protocol was significantly higher in VA group 1440 [78] grams versus 1284 [99] grams in FA group [P-value <0.001]. Necrotizing entero-colitis occurred in only one neonate that was belonging to volume advancement group

Conclusion: Volume advancement [VA] feeding is better as compared to frequency advancement [FA] feeding in very low birth weight neonates

Association of in-hospital outcome of acute kidney injury [AKI] with etiology among newborns at a tertiary care unit

Objective: To determine association of in-hospital outcome of AKI with etiology in newborns at a tertiary care hospital

Methods: This descriptive cross-sectional study was conducted at Department of Pediatric Neonatology, The Children's Hospital and Institute of the Child Health, Multan by using non-probability purposive sampling technique from June 2016 to June 2017. A total of 101 newborns diagnosed with acute kidney injury were registered. Etiological factors were assessed and these patients were followed till discharge to monitor in-hospital outcomes

Results: Of these 101 newborns, 75 [74.3%] were boys while 26 [25.7%] were girls. Mean age of these newborns was 7.59 +/- 6.13 days [range; 1 day to 28 days]. Mean age of the boys was 5.73 +/- 7.20 days while that of girls was 6.77 +/- 6.16 days. [p=0.515]. Mean weight of these neonates was 2545.05 +/- 600.42 grams [range; 1000 grams to 4000 grams]. Mean serum potassium level was 4.94 +/- 0.92 mgEq/L ranging from 3.1 mgEq/L to 7.0 mgEq/L. Mean urea level was 73.35 +/- 27.65 mg/dl ranging from 18 mg/dl to 206 mg/ dl. Mean serum creatinine level was 1.98 +/- 0.27 mg/dl, ranging from 1.6 mg/dl to 2.8 mg/dl. Mean serum sodium level was 145.72 +/- 12.64 mgEq/L ranging from 126 to 166 mEq/L. Eighty one [80.2%] were term babies while 20 [19.8%] were pre-term babies. Of these 101 study cases, 29 [28.7%] delivered vaginally while 72 [71.3%] through cesarean section. Delayed crying was noted in 48 [47.5%], dehydration 13 [12.9%], sepsis in 36 [35.6%] and renal malformation in only 4%. Neonatal mortality in these patients was 15 [14.9%] while 86 [85.1%] were discharged from hospital after recovery

Conclusion: Acute kidney disease in newborns is associated with significant disease morbidity and mortality with asphyxia and sepsis are the main etiological factors responsible. It is predominantly more common in boys compared with girls. Mortality rate was high in our study and it was significantly associated with female gender. Mortality was also associated with elevated serum sodium and urea level

Validation of serum C-reactive protein for the diagnosis and monitoring of antibiotic therapy in neonatal sepsis

Objective: To evaluate the adequacy of serum C-reactive protein [CRP] in diagnosing neonatal sepsis and role of CRP in determining the duration of antibiotic treatment in neonatal sepsis

Methods: In this validation study, we included 135 neonates with suspected diagnosis of sepsis within duration of nine months from September 2016 to May2017 in Children Hospital Multan. Blood samples were drawn from every neonate for culture sensitivity and measurement of serum C-reactive proteins. In all suspected neonates, empirical antibiotics e.g. Gentamycin or Ampicillin were started after taking blood samples. Serum CRP levels >5 mg/dl were marked as positive results. 2nd blood samples for measurement of serum CRP were taken after 72 hours of the first sample. There were two primary endpoints; one to determine the sensitivity and specificity of CRP against blood culture and second was to determine the negative predictive value of CRP in determining the duration of anti-biotic in neonates presenting with sepsis

Results: Out of these 135 babies, 102 [75.5%] were confirmed to have sepsis using blood culture reports. CRP results were Positive in 85 [62.9%] neonates on first baseline measurement and were positive in 103 [76.29%] neonates after 72 hours of admission. The sensitivity of CRP in diagnosing sepsis was 98.03%, specificity was 91.0%, positive predictive value [PPV] was 97% and negative predictive value [NPV] was 93.7%. The mean duration of antibiotic treatment in CRP guided group was 5.03 days versus 7.02 days in standard treatment duration group [p-value <0.001]. The NPV of CRP in determining the duration of antibiotics was 100.0%

Conclusion: Serum CRP level is a reliable test in establishing the diagnosis of neonatal sepsis. It accurately monitors the duration of antibiotic therapy and results in significant reduction in the treatment duration of neonatal sepsis

Psychosocial implications of blindness and low vision in students of a school for children with blindness

Objective: To find out the psychosocial implications of blindness and low vision in students of blind school Bahawalpur

Methods: A cross sectional descriptive study was carried out in Higher Secondary School for blind, Bahawalpur after getting approval from Institutional review board of Quaid-e-Azam Medical College, Bahawalpur and Principal of Blind School, Bahawalpur. Forty willing students filled a customized questionnaire, consisting of questions about logistic variables and questions regarding areas of satisfaction. Statistical analysis was performed using SPSS version 18

Results: Out of 40, 55% [22/40] of them were found depressed [as assessed through DSM-lV], 50% [20/40] were having difficulty in making new contact but 52.5% [21/40] were satisfied with family care

Conclusion: Sixty percent [24/40] of blind school children experienced difficulty in their life. This study showed that blindness or low vision does have psychological implications like feeling of guilt, anxiety, sadness and depression

Assessment of hearing loss in multi-drug resistant tuberculosis (MDR-TB) patients undergoing Aminoglycoside treatment.

Background: Incomplete treatments and treatment failures has led to Multi-drug resistant tuberculosis, which has emerged as a significant problem in treating tuberculosis and thus the second line drugs are used with the concomitant increase in the incidence of adverse effects. Methods: This prospective study was carried out from June 2009 to May 2014 in the department of ENT in collaboration with TB & Chest at Teerthanker Mahaveer Medical College & Research Centre. Out of 104, only 84 patients were included in our study. Patients were divided into three groups: group I (n=27) patients using Amikacin, group II (n=40) patients using kanamycin and group III (n=17) patients using streptomycin. Baseline pre-treatment pure tone audiometry was performed on all the patients and repeated every three months until completion of therapy. Results: Patients included were 15 to 55 years age with higher number of males (65%, n=55) than females (35%, n =29). Only 22.7% (n=19) of patients were found to be suffered from Hearing Loss. At the end of the study (at 12 month), Overall incidence of HFL was 58.0% (n=11) while incidence of Dead ear was 31.5% (n=6) and LFL was 10.5% (n=2). Amikacin was found to be more Ototoxic than Kanamycin and streptomycin. Conclusion: Aminoglycosides in MDR-TB patients may cause irreversible hearing loss involving higher frequencies and can become a hearing handicap as speech frequencies are too implied in more or less of the patients, thus underlining the need for regular audiologic evaluation in patients of MDR-TB during the treatment.

Awareness of different treatment options for missing teeth in patient visited at hamdard university dental hospital

The study was conducted to know the awareness, level of knowledge and attitude about teeth-re-placement options among patients who visited Hamdard University Dental Hospital for prosthodontic treatment. A self-administered questionnaire was distributed to patients reported to Prosthodontics Department at Hamdard University Dental Hospital. Questions focused on the awareness to replace the missing teeth and the preferable methods of choice for replacement. Age limits of the participants ranged between 14-77 years. All the participants were partially edentulous excluding the third mo-lars. A total of 201 patients were examined, 114 were males and 87 females. Data were analyzed by Statistical Package for Social Sciences [SPSS] version-16.Descriptive statistics i.e., frequencies were computed. Results of the present study showed that patient's awareness was 45% for fixed partial denture, 26% for acrylic removable partial denture, 17% for cast partial denture and only 4% for im-plants. The patients awareness for different treatment options for missing teeth was very low. So there is a need to increase the awareness about various dental prosthesis among patients need replacement for missing teeth. The oral health care providers have to play a vital role in this regard

Relation of breast cancer with parity and breastfeeding

Objective: The purpose of this study was to evaluate the relationship of breast cancer with parity and breastfeeding in local settings since no such studies have been carried out previously. The results of such study can provide data for comparison from other parts of country and international research

Study Design: Observational study

Place and Duration: Department of Surgery Allied Hospital Faisalabad between October 2013 and October 2014

Methods: A sample of 500 breast cancer patients diagnosed clinically and histopathologically was included in the study after informed consent. Patients were interviewed using a questionnaire. We observed the variables of age, parity, menstrual history and months of breastfeeding for each child. Analysis was done using SPSS version 12. 0

Results: In present study, 500 patients of breast cancer were included with age ranging from 28 years to 80 years. Most common age group was 40 to 50 years. 91.8% females with breast cancer were multiparous and all 91.8% females gave history of breastfeeding their children. 48% of the females breastfed for more than 5 years, 40% of them for 1to5 years and 3.8% of them for less than 1 year. Only 8.2% females who were either unmarried or had no issues did not breastfeed at all

Conclusion: In our local settings, multiparity and breastfeeding do not alter the risk of breast cancer and thus other risk factors must be studied

Sacrificial protection method during disinfection to avoid corrosion

Alloys are used in every aspect of dentistry. Corrosion of an alloy is a major issue during disinfection and method adopted for anti-corrosion treatment is very costly. The purpose of this paper was to demonstrate the sacrificial protection [SP] technique and preventing the corrosion of dental metals. The method used in the present was Sacrificial protection [SP] technique to control the corrosion of a metal surface by attachment of a metal [i.e., aluminum,] with a higher ionization potential to the original metal which acts as the anode of an electrochemical cell. The study was conducted at Dr Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences in September-November 2013. The results of the present were that there is no corrosion found on the surface of the metal while immersing them into electrolyzed water for 7 days. It was concluded that during immersion into functional waters for disinfection, dental metals often undergo tarnishing and corrosion due to which their properties will be compromised. Therefore, to prevent the corrosion of dental metals, the present study revealed an effective and simple method. Sacrificial protection is very simple and cost effective method to prevent the dental material from corrosion

Prostate cancer: Leading and misleading routes to TRAIL of death

Prostate cancer is a multifaceted disease that arises because of misrepresentation of linear and integrated signaling cascades that regulate gene network in normal and cancer cells

Programmed cell death is modulated by intracellular regulators within each cell and various lines of evidence suggest that there is under- expression and over-expression of pro-apoptotic and anti-apoptotic gene subsets respectively

Apoptosis is a response to the cellular microenvironment, and the cell microenvironment can be regulated by multiple signaling cascades at a higher organizational level by suppressing survival signals notably at genetic, epigenetic, transcriptional and post-transcriptional level

Unquestionably, drug-discovery approaches over the last decade aiming at neutralizing anti-apoptotic proteins, over-expressing pro-apoptotic proteins and enhancing the cell surface appearance of TRAIL receptors have revolutionized our current information about inducing and maximizing TRAIL mediated signaling in resistant prostate cancer phenotype. In this mini-review we outline outstanding developments in the field of prostate cancer that have played a role in understanding the underlying mechanisms that control TRAIL mediated apoptosis in prostate cancer cells, which may be helpful in the development of cancer therapies based on the apoptotic pathway

Neonatal seizures, experience at children hospital and institute of child health Multan

Objective: The study was conducted to determine the etiology of seizures in neonates

Methods: This was a descriptive Cross-sectional study. This study was conducted at neonatal unit of children hospital and institute of child health Multan from June 2012 to April 2013. A total of 285 neonates who presented with seizures were enrolled for the possible causes. First line investigations including blood glucose, serum calcium, serum magnesium, serum sodium, complete blood counts, serum creatinine, liver function tests, ABGs, cerebrospinal fluid examination, cranial ultrasound and EEG were done in all neonates. Second line investigations [blood culture, CT scan, MRI, screening for inborn error of metabolism and Torch antibody titer] were done in selected neonates. The data was analyzed using SPSS-10

Results: Out of 285 neonates, 175[61.4%] were male and 110[38.6%] female. There were 199[69.8%] term and 86 [30.2%] preterm. Birth asphyxia was the commonest cause of seizures and present in 53.7% neonates and metabolic disturbance in 17.5%. Seizures with unknown etiology were present in 5.3% neonates

Conclusion: In most of the cases, the causes of neonatal seizures were present. Birth asphyxia was the main etiology identified. However, to establish the exact cause of seizures, more extensive work up is needed

Male contraception; knowledge, attitude and practice among male population of Hansra Basti Bahawalpur

To determine the knowledge and practice regarding male contraceptive methods among married male population of Hansra basti Bahawalpur, Pakistan. This observational [Descriptive] cross sectional study was carried out at Hansra Basti Bahawalpur from May 2011, to June 2011. A total of 100 married males were selected by simple random sampling. Data was collected by pre-designed, pre-tested, questionnaire to collect the information from study population. An interview was conducted at respondents' house in local language. Privacy was ensured. About 82% have knowledge about any of the male contraceptive methods and out of those 18% were practicing any one of the family planning methods. Condom [Barrier] was most used method [77.7%] followed by the traditional methods i.e abstinence [27.7%] and coitus interrupts [11.11%] where as result regarding vasectomy was nil. Source of knowledge mainly was media [44%] followed by through health professional [30%], wife [25%] and friends [21%]. In present setting men have good knowledge of male contraceptive methods. However very small number is practicing the contraceptive measures

Spectrum of trigeminal neuralgia

Trigeminal neuralgia [TN] is a very painful condition characterized by paroxysmal shock like pain in the distribution of one or more branches of trigeminal nerve caused by neurovascular conflict at the root entry zone of trigeminal nerve. This study was conducted to analyse the demography and pattern of TN in our setup. This descriptive study was conducted in the Oral Surgery unit, Department of Dentistry, Ayub Medical College, Abbottabad, from April 2009 to October 2011. A total of 117 patients were included in study by convenience [non probability] sampling technique. All the patients presenting with the clinical features of TN were included in study. Out of 117 cases, 49 [41.9%] were males and remaining 68 [58.1%] were females. Age of the patients ranged from 32-72 [53.90 +/- 10.21] years. Right side was involved in 63 patients [53.8%], while the left side was involved in 51 patients [43.6%]. In only three cases [2%] there was bilateral involvement. The maxillary division was involved in 68 cases [58.1%] and mandibular division was involved in 37 cases [31.6%]. The most common site of involvement was infra-orbital, which was involved in 68 cases [58.11%]. The next common site was the mental nerve which showed involvement in 35 cases [29.9%] followed by inferior alveolar nerve which was affected in 14 cases [12%]. Thirty three [28.2%] patients were having mild pain, 54 [46.2%] patients having moderate, 21 [18%] patients with severe and 9 [7.7%] patients were having very severe pain. No patient in our study had a family history of TN. Among our patients 103 [88%] patients underwent dental extraction for the same pain. The incidence of TN is more in old age especially in females. TN is frequently misdiagnosed in with tooth ache, so there is need to educate the medical practitioners and masses in order to avoid un-necessary tooth extractions

Molecular markers in management of ex situ PGR – A case study.

Worldwide germplasm collections contain about 7.4 million accessions of plant genetic resources for food and agriculture. One of the 10 largest ex situ genebanks of our globe is located at the Leibniz Institute of Plant Genetics and Crop Plant Research in Gatersleben, Germany. Molecular tools have been used for various gene bank management practices including characterization and utilization of the germplasm. The results on genetic integrity of longterm- stored gene bank accessions of wheat (self-pollinating) and rye (open-pollinating) cereal crops revealed a high degree of identity for wheat. In contrast, the out-pollinating accessions of rye exhibited shifts in allele frequencies. The genetic diversity of wheat and barley germplasm collected at intervals of 40 to 50 years in comparable geographical regions showed qualitative rather than a quantitative change in diversity. The inter- and intraspecific variation of seed longevity was analysed and differences were detected. Genetic studies in barley, wheat and oilseed rape revealed numerous QTL, indicating the complex and quantitative nature of seed longevity. Some of the loci identified were in genomic regions that co-localize with genes determining agronomic traits such as spike architecture or biotic and abiotic stress response. Finally, a genome-wide association mapping analysis of a core collection of wheat for flowering time was performed using diversity array technology (DArT) markers. Maker trait associations were detected in genomic regions where major genes or QTL have been described earlier. In addition, new loci were also detected, providing opportunities to monitor genetic variation for crop improvement.

Frequency of pain associated with ultrasound guided percutaneous liver biopsy

To determine the frequency of pain associated with ultrasound guided percutaneous trucut needle liver biopsy. This prospective descriptive study was conducted in Radiology Department, Lady Reading Hospital Peshawar over a period of six months from April 2009 to October 2009. Cases were referred from wards as well as OPD. Patients of ages between 14 and 75 years [48.42+9.91], having diffuse or focal hepatic solid lesion [s] seen on ultrasound abdomen, were included and patients with pregnancy, moderate to marked ascites, abnormal PT and/or APTT even after correction, thrombocytopenia, coagulopathy and those using anticoagulants were excluded from the study. After informed written consent, procedure was done and data analyzed. Out of 52 procedures, pain occurred in 42 [80.8%] cases. Mild to moderate pain occurred in 41 [78.8%] cases whereas severe pain was observed in 1 patient [1.9%]. Frequency of pain was more in females [14/15=93.4%] than males [28/37=75.7%]. Frequency of pain was more in subcostal [18/21=85.8%] than intercostal [24/31=77.4%] approach. 27 of 33 [81.8%] patients with focal solid hepatic lesion and 15 of 19 [78.9%] patients with diffuse hepatic disease reported pain. Percutaneous ultrasound-guided liver biopsy is associated with low frequency of severe pain. This study shows that females report pain more frequently than males. The incidence of biopsy associated pain is more in patients who are addicted to narcotics

Attitudes of the adult residents of different communities towards reproductive health education in Dera Ismail Khan

Reproductive health implies that people are able to have a responsible, satisfying and safer sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. The purpose of the study was to explore the attitudes of adults of different communities towards reproductive health education in Dera Ismail Khan. The population of the study consisted of adult residents of different communities in Dera Ismail Khan. The sample of the study consisted of 100 adults selected through convenience sampling. A Questionnaire was used for data collection. The data show that the attitude of adult residents of different communities was positive towards reproductive health education in Dera Ismail Khan. However, demographic variables do not seem to influence the attitudes of respondent's towards reproductive health education

experience of the treatment of unstable inter-trochanteric fractures with the Ao/Asif proximal femoral nail

To evaluate the use of local-made proximal femoral nail in the treatment of unstable inter-trochanteric fern oral fractures. This descriptive study was conducted in the Department of Orthopaedics, Lady Reading Hospital, Peshawar, from February 2009 to June 2010. Sixty-two patients with unstable inter-trochanteric femoral fractures, admitted through the Accident and Emergency Department were included in this study. All patients were treated with AO/ASIF proximal femoral nail and followed at least till fracture consolidation which takes minimum of 6 months. The mean age of the patients was 74.27 +/- 5.84 years. Two patients died and thirteen patients were lost to follow-up. The results are thus based on a sample of 47 patients. There were no complications in 81% [n=38] patients and they achieved fracture consolidation within six months. Three patients underwent revision surgery due to non-union; two had lag screw penetration into the hip joint, three patients developed deep wound infection while one patient developed superficial wound infection. The mean pre injury mobility score was 6.8 +/- 2.5 while the mean post-operative mobility score was 6.48 +/- 2.7 [p=.000]. The advantage of immediate stability in difficult and unstable fractures, and the relatively few complications serve to recommend the wider use of AO/ASIF proximal femoral nail

Device entrapment: a rare complication of percutaneous coronary intervention

Device entrapment is a rare complication of percutaneous coronary intervention. It has hazardous potentials for the patient. Emergent cardiac surgery is the only option after failure of retrieval devices. We have described here a case of a 55 years old male. During percutaneous coronary intervention, the balloon inflated only partially at its ends and entrapped in the lesion along with the stent. Multiple attempts at inflation failed and the patient developed severe chest pain for few minutes. Surgery was contemplated but final attempt at inflation was successful and the patient stabilized. It was an emergent situation and could have led to fatal outcome, although this patient escaped narrowly from any fatal outcome

Percutaneous image guided cutting needle biopsy of mediastinal masses: diagnostic yield and complications

To evaluate image guided cutting needle biopsy of mediastinal masses for diagnostic yield and complications. This was a descriptive study. Computed Tomography [CT] and ultrasound guided biopsies of mediastinal masses were performed in 30 patients. Tissue core obtained, were preserved in formalin and sent for histological examination. X-ray chest taken for evidence of pneumothorax and mediastinal widening. Hemoptysis, pneumothorax other complication were recorded. Definite histological diagnosis was obtained in all 30 patients. 70% [n=21] were malignant disease and 30% [n=9] were benign pathologies. Sensitivity and specificity, positive and negative predictive values were 100%. Pneumothorax occurred in 7% [n=2] cases. Hemoptysis occurred in 10% [n=3] cases. Chest intubation was not required in cases of pneumothorax. No hemodynamic instability occurred. There was no major complication. Image guided percutaneous transthoracic cutting needle biopsy in mediastinal masses is an accurate procedure for specific histological diagnosis and has a low complication rate

Percutaneous CT guided cutting need: biopsy of lung lesions

To evaluate the diagnostic yield of CT guided percutaneous cutting needle biopsy [CNB] of lung lesions. Our study was a descriptive study including 63 patients who underwent CT guided percutaneous core needle [cutting needle] biopsy of lung lesions. Of the total sampling, only 53 cases were followed up. Samples taken were preserved in formalin bottle and sent for histopathology. CT scan at the level of the biopsy was taken immediately after the procedure when patient was still on CT table. X-ray chest in erect position was taken after 04 hours to look for development of pneumothorax. Hemoptysis and pneumothorax were recorded. Other complications were also noted. Out of these 53 cases, histopathology showed 32 [60.4%] cases to be malignant, 17 [32.1%] cases benign and 4 [7.5%] cases being non-representative. The histological diagnostic yield [number of correct diagnosis obtained at CNB/number of definitive diagnosis] of this procedure was found to be 92.45% [49/53]. Pneumothorax occurred in 1 out 53 [1.9%] and hemoptysis in 4 of 53 [7.45%]. There was no major complication like hemodynamic instability or death. CT guided percutaneous CNB of the lung lesions is an accurate procedure for a specific histological diagnosis and has a low rate of complications

Association of smoking [pack years] with Agnor count in buccal mucosal cytology

Background: Tobacco smoking is a self-inflicted major health hazard worldwide. Cigarette smoking influences proliferative activity in normal oral mucosa. This proliferative activity can be detected by AgNOR count. This study was conducted in an attempt to find any association between smoking [Pack Years] and AgNOR count

Methods: Silver stained cytologic smears of buccal mucosa in 75 smokers and 75 nonsmokers were viewed for AgNOR count and a comparison between pack years of smoking and increased AgNOR number was assessed using SPSS analysis

Results: A positive correlation [r = .604] significant at the 0.01 level was found, between pack years and AgNOR count. This explains significant replicative activity under the influence of cigarette smoking

Conclusion: The effect of cigarette smoking in buccal mucosa is related to dose exposure [Pack Years of smoking] and a positive correlation exists between proliferative activity [AgNOR Count] and smoking [Pack Years]. An association between pack years of smoking and increased AgNOR count explains cigarette smoke`s effect on buccal mucosa