Antioxidant compounds and capacities of Gac (Momordica cochinchinensis Spreng) fruits

Objective: To identify and determine the composition of antioxidant compounds, and to evaluate the antioxidant abilities of Gac fruit parts (peel, pulp, seed and aril) grown in Malaysia.Methods: LC-MS/MS was used for identification of antioxidant compounds and UV-Vis for estimation of the contents of phenolics, flavonoids, and carotenoids. Lycopene and β-carotene were quantified using high-performance liquid chromatography. DPPH (2, 2-diphenyl-1-picrylhydrazyl) and ferric reducing antioxidant power assays were employed to evaluate antioxidant capacities.Results: Phytochemicals were found amongst all the fruit parts. Notably, significant amounts of carotenoids [(107.4 ± 4.5), (85.7 ± 4.4), (110.6 ± 2.1) mg/100 g dry weight (DW)], and relatively high levels of both phenolics [(27.3 ± 1.7), (28.9 ± 2.4), (30.8 ± 2.7) mg/100 g DW]and flavonoids [(38.1 ± 2.2), (8.8 ± 1.3), (24.5 ± 3.3) mg/100 g DW] were found in the fruit's peel, pulp and aril, respectively. Seed part also showed a relatively high level of flavonoids [(18.1 ± 2.3) mg/100 g DW]. Lycopene and β-carotene were found to be significantly high (P < 0.05)in aril [(579.3 ± 22.7) and (621.0 ± 35.0) μg/g DW], followed by peel [(51.0 ± 7.5) and (210.0 ± 12.5) μg/g DW] and pulp [(37.6 ± 10.9) and (205.6 ± 22.1) μg/g DW)]. Antioxidant assays revealed that aril possessed the highest scavenging activity (IC50 = 865 μg/mL), while the peel possessed the highest ferric reducing power of 140 μmol FeSO4/μg.Conclusions: The current results demonstrate that Gac fruit grown in Malaysia is a rich source of phytochemicals, especially carotenoids, and possesses antioxidant activities. Thus, such findings suggest Gac fruit as a source of an antioxidant plant.

Gac fruit extracts ameliorate proliferation and modulate angiogenic markers of human retinal pigment epithelial cells under high glucose conditions

To investigate the impact of the extracts of Gac fruit parts (peel, pulp, seed, and aril) on the cell viability and angiogenesis markers of human retinal pigment epithelial (ARPE-19) cells under high glucose conditions.Methods: The effect of the extracts of Gac fruit peel, pulp, seed and aril on the ARPE-19 cells was determined using MTT viability assay, Trypan blue dye and morphological changes were observed using light microscopy. Enzyme-linked immunosorbent-based assay was performed to evaluate the effect of Gac fruit parts on the reactive oxygen species (ROS), vascular endothelial growth factor (VEGF) and pigmented epithelium-derived factor (PEDF) secretions.Results: High glucose (HG) at 30 mmol/L increased ARPE-19 cell viability and ROS and VEGF secretions. While, the exposure of ARPE-19 cells in high glucose condition to Gac fruit extracts led to inhibition of cell viability, induced morphological changes, decreased ROS and VEGF secretions, and increased PEDF level. Gac pulp, seed, and aril at 1000 μg/mL showed significant inhibition activities [(7.5 ± 5.1)％, (2.7 ± 0.5)％, (3.2 ± 1.1)％, respectively] against HG-induced ARPE-19 cell viability. The findings also demonstrated that Gac aril at 250 μg/mL significantly decreased ROS and VEGF levels [(40.6 ± 3.3) pg/mL, (107.4 ± 48.3) pg/mL, respectively] compared to ROS [(71.7 ± 2.9) pg/mL] and VEGF [(606.9 ± 81.1) pg/mL] in HG untreated cells. Moreover, 250 μg/mL of Gac peel dramatically increased PEDF level [(18.2 ± 0.3) ng/mL] compared to that in HG untreated cells [(0.48 ± 0.39) ng/mL].Conclusions: This study indicates that the extracts of Gac peel, pulp, seed and aril reduced cell viability, minimized ROS generations and showed angiogenic activities. Therefore, our findings open new insights into the potentiality of Gac fruit against HG-related diabetic retinopathy disease.

Knowledge, practice and attitude of mothers regarding oral rehydration salt

Objective: To assess awareness about the knowledge; attitude and behaviour of mothers about use of ORS

Study Design: Cross-sectional study

Place and Duration of Study: This study was conducted at the Pediatric Outpatient Department, Civil Hospital Bahawalpur from May 10, 2015 to July 25, 2015

Methods and Materials: This study was conducted on mothers who attended Pediatric Outpatient Department, Civil Hospital Bahawalpur with 2 months to 5 years old child having history of diarrhea at the time of visit of the hospital or within the last two weeks. The mothers were interviewed by the one of the researchers using a structured questionnaire about ORS including the demographic data

Results: There were 200 mothers included in this study. Their mean age +/- SD was 27.78 +/- 7.637 years. Among the studied mothers 18.5% were having at least secondary school certificate and 90% mothers were house wives. 4.5% mothers did not hear about ORS, 50.5% heard it from medical practitioners, 33.5% from some family member/ neighbours while 16.5% from media. ORS use within the last two weeks was in 44.5% cases of diarrhea. 49% mother gave opinion that it 'stops diarrhea', 29.5% 'does not know' while 21.5% gave opinion that it 'stops dehydration.' 38% mothers knew the correct technique for making ORS solution. 35% mother were in the opinion of giving ORS to the child by 'cup and spoon' in 70 [35%], 34% by cup and 31% by feeding bottles. There were only 34% mothers could prepare ORS correctly. 33% mothers described the correct amount of ORS solution to be given to the child while 41.5% mothers replied to continue giving ORS even if child developed vomiting

Conclusion: The awareness of mothers about the use of ORS is moderate. Further community based research is needed in this respect

attitude and knowledge of mothers regarding use of colostrum in newborn feeding

Objective: To assess awareness about the knowledge, attitude and behaviour of mothers about the use of colostrum for the newborn feeding

Study Design: Observational / descriptive /cross-sectional study

Place and Duration of Study: This study was conducted at Pediatric Outpatient Department, Civil Hospital Bahawalpur from July 10, 2015 to August 8, 2015

Materials and Methods: This study was conducted on mothers who attended Pediatric Outpatient Department, Civil Hospital Bahawalpur for the medical checkup of their children less than one year of age. The mothers were interviewed by the one of the researchers using a structured questionnaire about colostrum including the demographic data

Results: There were 100 mothers included in this study. There were 4% mothers younger than 20 years, 63% in the age group 21-30 years, 20% age group 31-40 years while 3% were older than 40 years. 17% mothers were having at least matriculation, 59% were having education less than that while 34% were uneducated. 94% mothers were house wives. There were 79% mothers who had heard about colostrum; among which 51% heard from either family members or from friends, 21% from medical personnels, 7% from media while 21% never heard of it. There were only 25% mothers who believed that colostrum was the best first feed of newborn, while 61% mothers believed it is GHUTTI that was best. There were 22% mothers who believed that it was beneficial for the health, 13% were in the opinion that it is injurious for the health while 65% replied 'do not know'. There were 41% mothers who told colostrum as yellow and thick, 11% replied it was milk like. There were 32% mothers who believed that colostrum is sufficient for initial newborn feeding, 25% believed it is insufficient. There were only 19% mothers who believed that baby must be put on breast for feeding within half an hour

Conclusion: The awareness of mothers about the use colostrum is poor to moderate

Use of N-acetylcysteine in children with fulminant hepatic failure caused by acute viral hepatitis

To determine the efficacy of N-acetylcysteine [NAC] in children aged > 1 month to 16 years admitted with Fulminant Hepatic Failure [FHF] secondary to Acute Viral Hepatitis [AVH] in a tertiary care center of a developing country. Analytical study. Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan, from January 2007 to December 2011. Medical records of children [> 1 month - 16 years] with FHF admitted with AVH of known etiology who received NAC were reviewed retrospectively. Liver function tests [mean +/- SD] at baseline, 24 hours after NAC and before or at the time of discharge/death were recorded and compared via using repeated measures ANOVA[r-ANOVA]. Efficacy of NAC is defined in improvement in biochemical markers, liver function test and discharge disposition [survived or died]. Mortality associated risk factors were identified by using logistic regression analysis. P-value and 95% confidence interval were recorded. Forty children [mean age was 80 +/- 40 months] with FHF secondary to AVH received NAC. Majority were males [n=25; 63%]. Vomiting [75%] and jaundice [65%] were the main presenting symptoms, one-third had hypoglycemic, while 40% had altered sensorium at the time of admission. There was significant statistical difference in liver enzymes and prothrombin time on admission comparing at discharge in children received NAC [p < 0.001]. Fifteen [38%] children died. Severe vomiting [Odds Ratio [OR] 0.22, 95% Confidence Interval [CI] 0.05 - 0.8], jaundice [OR 9.3, CI 1.1 - 82.6], inotropic support [OR 20.6, CI 3.5 - 118.3] and mechanical ventilation [OR 4.3, CI 1.1 - 16.6] at the time of admission are associated with risk factors for mortality in children with FHF secondary to AVH. NAC used in children with FHF secondary to AVH is associated with markedly improved liver function tests and recovery. FHF with complications is high risk for mortality

Impact of Maternal Education about Complementary Feeding on Their Infants’ Nutritional Outcomes in Low- and Middle-income Households: A Community-based Randomized Interventional Study in Karachi, Pakistan.

This cluster-randomized interventional trial at peri-urban settings of Karachi was conducted to evaluate the impact of maternal educational messages regarding appropriate complementary feeding (CF) on the nutritional status of their infants after 30 weeks of educational interventions delivered by trained community health workers. Mothers in the intervention group received three education modules about breastfeeding (BF) and appropriate CF at a baseline visit and two subsequent visits 10 weeks apart. The control group received advice about BF according to national guidelines. Infants’ growth [weight, length, and mid-upper arm-circumference (MUAC), stunting, wasting, and underweight] were measured at four time points. At the end of the study, infants in the intervention group had a higher mean weight of 350 g (p=0.001); length of 0.66 cm (p=0.001), and MUAC of 0.46 cm (p=0.002) compared to the controls; proportionate reduction of stunting and underweight were 10% (84% vs 74%; ORadj 8.36 (5.6-12.42) and 5% (25% vs 20%; ORadj 0.75 (0.4-1.79) in the intervention compared to the control group. For relatively food-secure populations, educational interventions about appropriate CF to mothers had a direct positive impact on linear growth of their infants.

Empyema thoracis in children: clinical presentation, management and complications

To determine the etiology, clinical manifestation, management [medical and surgical] and complications of children with empyema thoracis in a tertiary care hospital from Karachi, Pakistan. Descriptive, analytical study. Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1996 to December 2010. Medical records of admitted children aged > a month to 15 years with discharge diagnosis of empyema thoracis and data was collected on demographic features, clinical manifestation, management and complications. Children managed medically were compared with those managed surgically by using interquartile range and median comparison. Mann-Whitney U test was used to compare age in months, weight [kg] and length of stay in days and presenting complaint, duration of illness; chi-square test was used to compare thrombocytosis in between groups and p-value was calculated. Among the 112 patients, 59 [53%] were younger than 5 years of age. Males [n=83, 74%] were predominant. Fifty [45%] children were admitted in winter. Thirty [27%] children found unvaccinated and one fourth [n=27; 24%] were severely malnourished. Fever, cough, and dyspnea were the major presenting symptoms. Sixty-six [59%] were on some antibiotics prior to admission. Staphylococcus aureus [n=13] and Streptococcus pneumoniae [n=5] were the commonest organism isolated from blood and pleural fluid cultures. Majority of the children required some surgical intervention [n=86]. Surgically managed children were younger [p=0.01]; had less weight [p=0.01] and prolonged fever [p=0.02]; and stayed longer in hospital [p < 0.001] as compared to medically managed children. Requiring readmission [n=8], subcutaneous emphysema [n=5] and recollection of pus [n=5] were the major complications. Staphylococcus aureus was the major organism associated with paediatric empyema thoracis. Early identification and empiric antibiotic as per local data is essential to prevent short and long-term complications. Younger, lower weight children with prolonged fever required surgical management

Acute lymphoblastic leukemia in a child with fanconi's anaemia

Fanconi anaemia [FA] is an autosomal recessive inherited disorder with progressive bone marrow failure, associated congenital malformation and solid and haematological malignancies. Acute myeloid leukemia is the commonest haematological malignancy followed by myelodysplastic syndrome in children with FA. FA transformed into acute lymphoblastic leukemia [ALL] is a rare phenomenon and one of the rarest haematological malignancies associated with this disorder. We are reporting a 13 years old girl with FA and positive chromosomal breakage. She required regular blood product transfusion. She was planned for haematopoietic stem cell transplantation [HSCT] but the sibling-matched donor was found to have chromosomal breaks as well. Later on, her peripheral smear showed blast cell. Bone marrow showed pre-B ALL. She was started on chemotherapy but died shortly due to complications of the treatment. For this rare condition conservative management is indeed essential, however, safe and appropriate chemotherapy regimen is needed

Experience of pediatric rapid response team in a tertiary care hospital in Pakistan.

Objective. To report our experience before and after implementation of pediatric rapid response team (RRT) in pediatric wards of a tertiary care hospital in Pakistan. Methods. An audit of RRT activity from December 2007 to August 2008 was conducted and reviewed patient diagnoses at the time of call placement, interventions done and post-intervention clinical outcomes. Clinical Outcomes in the nine months before RRT implementation were compared with those in the first operational nine months after RRT. Results. Eighty-three calls were generated during the post-intervention study period of 9-month (21 calls/1000 admissions). The median age of patients was 27 months; 37% calls were for infants. The majority of patients were under care of medical services (93% vs 7% under care of surgical services). Greater numbers of calls were made during 0800-1600 hours (45%). Respiratory issues were the most common reason for activation of RRT. Because of early interventions, majority (61%) of patients avoided unnecessary PICU stay and expenditure; only 17% required mechanical ventilation in PICU. The code rate per 1000 admissions decreased from 5.2 (pre-RRT) to 2.7 (post-RRT) (p=0.08; OR 1.88(95%CI 0.9 -3.93). The mortality rate of patients admitted in PICU from wards decreased from 50% to 15% (p=0.25; OR 1.64 (95%CI 0.63 – 4.29). Conclusion. Our experience with implementation of RRT was associated with reduction in cardiorespiratory arrest, mortality and saved a lot of PICU resource utilization. It is an excellent patient-safety initiative especially in resource-constrained countries by bringing PICU reflexes outside the PICU.

On admission hypomagnesemia in critically Ill children: Risk factors and outcome.

Objective. To determine the frequency and associated risk factors of hypomagnesemia in pediatric intensive care unit on admission in a developing country. Methods. It is a retrospective chart review of 179 children aged 1 mo – 15yr admitted in Pediatric Intensive Care Unit of our university during 18 months and recorded serum Mg level on admission. Patients were divided into two groups according to their Mg level (Normo-magnesemic and Hypomagnesemic) and their p-value, crude and adjusted odds ratios (AoR) were calculated. Results. Upon admission in PICU 79(44%) patients were found hypomagnesemia. There was no difference in age and gender between two groups. The important risk factors identified were age greater than one yr (p 0.05, AOR 3.71), sepsis (p 0.03, AOR 3.11), hypokalemia (p 0.06, AOR 1.8), hypocalcemia (p 0.05, AOR 1.6), diuretic use (p 0.05, AOR 1.37), Aminoglycoside use (p 0.003, AOR 3.12), and hospitalization greater than five days (p 0.03, AOR 1.71). Those with normomagnesemic had higher mortality rate (32/100 or 32%) than those with hypomagnesemia (22/79 or 27.8%). Conclusion. The present finding indicates that hypomagnesemia is a common among PICU patients and is influenced by several factors.

Measles in children younger than 9 months in Pakistan.

Pakistan has one of the highest burden of measles and measles-related deaths in the world. We compared the clinical course and outcomes of measles in infants aged £9 months with those >9 month old amongst children admitted to a tertiary care hospital. Data were collected by a retrospective chart review, and compared between age £9 months (Group A) and age >9 months (Group B). Severe malnutrition (P=0.039, adjusted odds ratio=3.02), anemia (P=0.017), leukocytosis (P<0.001, adjusted odds ratio 4.1), and conjunctivitis (P=0.021) were higher in Group A children. All four deaths occurred in Group B.

Does prophylactic use of dexamethasone have a role in reducing post extubation stridor and reintubation in children.

All children aged from 4 weeks to <5 year, were intubated for at least 48 hours [n=51] during 6 months. Data of the patients treated with DEX (0.5 ml/kg every 6 hours for 3 doses, beginning 6-12 hours prior to extubation) (n=30) were compared with control patients (who had not received medication) (n=21). The DEX and control groups were similar in age i.e., mean ages of DEX group were 16.85±14 months, and that of control group were 19.02 ± 19 months, mean duration of intubation and mechanical ventilation in DEX group was 5.17 ± 4.58 days, and that in control group was 3.98 ± 3.60 days. There was no significant difference between DEX and control group in the incidence of postextubation stridor [17% (5/30) vs. 10% (2/ 21); p = 0.5] and the reintubation rate [7% (2/30) vs. 10% (2/21); p = 0.7]. Our data revealed that the prophylactic use of dexamethasone in planned extubation of high risk children were not effective.

Factor XIII deficiency in children-clinical presentation and outcome

To determine the demographic features and clinical outcome of children with Factor XIII deficiency. Observational case series. The Aga Khan University Hospital, Karachi, from January 1996 to December 2006. Records of all hospitalized pediatric patients with discharge diagnosis of FXIII D, on the basis of factor XIII assay 5 mol/L urea test were retrospectively reviewed and abstracted on a pre-specified proforma. Demographic features, coagulation profile, family history and outcomes were noted. A total of 10 charts were reviewed. There were 5 boys and 5 girls. Almost all the children [9/10] were less than 5 years of age, out of whom 5 [50%] were infants, and 3 were neonates. Bruises and prolonged bleeding after trauma was the major presenting complaints in 80%, followed by prolonged bleeding from the umbilical stump in 2 patients. Nine patients had past history of prolonged umbilical bleeding. Two patients had history of FXIII D in siblings, while 2 had history of prolonged bleeding in other family members [cause unknown]. Consanguinity was present in 80% of the families. Initial coagulation screen were normal in all patients. Two patients had intracranial hemorrhage, proved on neuro-imaging, were managed with plasma infusions and required craniotomy. The rest were managed conservatively with plasma transfusions. All were discharged alive in good clinical condition. Almost all were followed regularly in clinic with monthly cryoprecipitate transfusions. Although factor XIII deficiency is a rare genetic disorder in children with history of brui sing, prolonged umbilical bleeding, family history of bleeding and consanguinity with normal initial coagulation screen [PT, APTT and platelets], FXIII D should be ruled out