Effects of a Low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyol Diet on Symptoms of Functional Abdominal Pain in Pediatric Patients / 대한소아소화기영양학회지

Purpose@#Recently, great interest has been focused on dietary fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) for the treatment of functional abdominal pain (FAP). Several meta-analyses, including those on the adult population, have been published, potentiating its role. However, pediatric studies are scarce. We aimed to evaluate the effect of a low-FODMAP diet on the severity of FAP in children. @*Methods@#This clinical trial included 50 patients aged 3–18 years with irritable bowel syndrome and FAP that were not otherwise specified. The patients were instructed to receive a low FODMAP diet guided by a dietitian. The primary outcome was the percentage of responders after 2 months of dietary intervention compared with baseline. Other outcomes included changes in stool consistency and quality of life (QoL) scores using the KIDSCREEN-10 questionnaire, and weight-for-age z-scores. @*Results@#After the dietary intervention, 74% of patients showed more than 30% lower pain intensity, as examined using the Wong-Baker Faces pain rating scale. Their QoL significantly improved, and patients have gained weight. @*Conclusion@#A low FODMAP diet can improve pain intensity and QoL among children with functional abdominal pain, with no detrimental effects on body weight.

Maternal Overt Hypothyroidism and Neurobehavioral Outcome of Neonates: A Cohort Study from an Iodine-deficient Area of Northern India.

Objective: To study the relation between maternal overt hypothyroidism and neurodevelopmental outcome of neonates in iodine-deficient region of Northern India (Kashmir Valley). Design: Prospective cohort study. Setting: Endocrinology department of a tertiary-care hospital. Participants: 82 hypothyroid pregnant women were enrolled and followed up till delivery. The neonates born to this group represented the case neonates. 51 euthyroid healthy pregnant women were selected as control group. The neonates born to these mothers served as controls. Main outcome measures: Early neonatal behavioral assessment at 3-4 weeks of age. Results: The mean TSH and free T4 in neonates of mothers with well controlled hypothyroidism was significantly different from those born to mothers with poorly controlled hypothyroidism and controls in 1st trimester, but the difference was statistically insignificant for 2nd and 3rd trimester values. Conclusion: Overt maternal hypothyroidism in iodine-deficient area constitutes a risk factor for an abnormal neurobehavioral development of affected child.

Potential antibacterial activity of coumarin and coumarin-3-acetic acid derivatives

Abstract: Coumarin and coumarin-3-acetic acid derivatives were synthesized by reacting phenols with malic acid, ethyl acetoacetate and ethyl acetylsuccinate in appropriate reaction conditions. All synthesized compounds were subjected to test for their antimicrobial activities against variety of gram positive [Bacillus subtilis, Staphylococcus aureus] and gram negative bacterial stains [Shigella sonnei, Escherichia coli] by agar dilution method. Several of them exhibited appreciable good antibacterial activity against the different strains of gram positive and gram negative bacteria. These findings suggest a great potential of these compounds for screening and use as antibacterial agents for further studies with a battery of bacteria

Seminal volume in the investigation of male infertility

To determine the seminal volume among infertile males and the frequency distribution of hypospermic and hyperspermic patients in infertile males. Cross-sectional observational study. Department of Reproductive Physiology/Health, Public Health Laboratories Division, National Institute of Health, Islamabad, from 2002 to 2009. Semen examinations of infertile male were carried out according to the standardized method of the World Health Organization. Seminal volume of 2-6 ml were considered normal, while volumes less than 2 ml and higher than 6 ml were considered hypospermic and hyperspermic respectively. Out of 1521 patients, 355 were hypospermic [23.34%], 1046 were normospermic [68.78%] while 120 were hyperspermic [7.88%]. In the hypospermic cases, 57 out of 355 [16.05%] had a volume of less than 1 ml. Of those 57 patients, 34 were found to be azoospermic, 12 were asthenozoospermic, one each were terato and polyzoospermic, while 6 had normal counts. Among the hyperspermic patients [n=120], 3 were azoospermic, 24 were oligozoospermic and 19 cases [15.84%] had count within the normal range, while 1 patient was polyzoospermic. Significant differences [p < 0.05] were observed among azoospermic, oligoasthenozoospermic and teratozoospermic groups when comparing hypo and hyperspermic patients. Seminal volume is an important parameter for assessment of infertility investigation and its abnormalities constitute a valuable index of problems with the male partner, even if the count and motility are well within the acceptable limits

Glucose intolerance in relation to socioeconomic status and gender in population of Srinagar city

To assess the pattern of type -2 diabetes in different socioeconomic groups in the urban and peri-urban areas of Srinagar city. A detailed questionnaire on the Socioeconomic and Clinical background of the 1040 subjects was collected. After an overnight for blood fasting blood samples were drawn for determination of plasma glucose. Diagnosis of diabetes was based on the American Diabetes Association [ADA 2004]. The overall Prevalence of the diabetes in the study population was 6.05% which included 4.03% of known diabetic and 2.02% undiagnosed subjects. There was significant difference between the prevalence of type 2 diabetes in men and women [3.6%vs 8.3% respectively, P=0.0013]. Subjects belonging to higher socioeconomic status had greater prevalence of diabetes compared to lower 17.4% vs 3.2% [P<0.001][middle class [class II and Class III] versus lower class[Class IV]respectively]. Socioeconomic factors influence the occurrence of diabetes in this study population, with prevalence being more come in the middle class

Osteopetrosis, a rare cause for bone marrow failure

Osteopetrosis is a rare genetic disorder characterized by functional defect of osteoclasts resulting in failure of bone resorption, increased bone sclerosis and bone marrow failure. Patients present with stunted growth, skeletal changes, hepatosplenomegaly, features of pancytopenia and characteristic radiological changes. Osteopetrosis has variable inheritance pattern. Diagnosis is made on the basis of history with clinical findings, characteristic radiological and bone marrow findings. We present a case of a.10 years old female child with stunted growth, frontal bossing teeth abnormalities and characteristic radiological and bone marrow findings.

Effects of intake of nitrate, nitrite and isosorbid dinitrate (ISDN) on plasma nitrate/nitrite contents in rabbits

Background: The objective of the present study was to demonstrate the changes in plasma levels of nitrate and nitrite in rabbits after oral [intragastric] administration of inorganic nitrate [KNO[3]], inorganic nitrite [NaNO[2]] and organic nitrate [isosorbide dinitrate, ISDN]

Material and Methods: Twenty eight rabbits were divided into four groups [7 in each group] and various doses of these solutions were given via intragastric route. Group-1 [control] was given 6 ml distilled water. Group-11 [nitrate] was given 500 mg nitrate, group-Ill [nitrite] 50 mg nitrite and group-IV 20 mg ISDN per kg body weight per day. The experiment was conducted for 12 weeks and blood samples were taken at regular intervals. Plasma nitrate and nitrite levels were determined as stable metabolites of nitric oxide [NO] formation

Results: Results indicate 28.2+/-3.3 pmoles/dL nitrate and 21.24+/-2.8 pmoles/dL nitrite, a nitrite/nitrate ratio of 0.75 in all 28 rabbits at zero-day. After 1-day of nitrate intake, an 8.1-fold increase in nitrate content [from 29.3+/-3.32 to 238.5+/-48.9 pmoles/dL, p<0.05] and 2.3-fold increase in nitrite content [from 20.67+/-2.88 to 48.75+/-6.36 pmoles/dL] in group-ll animals was seen. No significant change was observed in their levels in group-Ill and IV animals during this period. On 2-day, plasma nitrate content decreased to 165.4+/-18.3 pmoles/dL and nitrite contents dropped to normal in group-ll animals. After 1-week, nitrate content in group-ll also decreased to normal values. However, nitrite content in group-Ill animals increased 3-fold [from 18.43+/-3.06 to 57+/-4.96 moles/dL] during 1-week with no increase in nitrate content. No sudden rise or fall in contents was observed for 12-weeks in all the groups

Conclusion: The results demonstrate that the plasma nitrate and nitrite contents are not changed significantly in all four groups in 12-weeks duration [except the initial rise in week-1] and I animals may possess some adaptive metabolic mechanisms to normalize these levels

Spectrum of ocular injuries presenting at emergency department of pakistan institute of medical sciences

To determine the proportion, pattern and burden of eye injuries presenting at emergency department [A and E] of Pakistan Institute of Medical Sciences [PIMS], Islamabad. Study Design: Observational case series. The study was carried out of all cases of ocular trauma presenting in PIMS via emergency department during a 1 year period. After presentation in the emergency department the detailed history of the patient was taken with particular reference to age, sex, mode of injury. Initial examination was carried out by using torch, slit lamp examination. Relevant investigations including X-ray orbit, B-scan of the orbit, X-ray skull and C.T-scan were also done where needed. Patient with superficial injuries were discharged after management, while those with serious injuries were admitted. 209 cases were enrolled in the study. Most were males [83.7%] between 16 and 30 years of age. The commonest place of injury was work place [30.6%] followed by home [30.1%]. 194 patients [92.8%] presented in emergency within 24 hours and only 15 patients [7.2%] came after one day. 202 patients [96.7%] presented directly to emergency and only 7 [3.3%] were referred by other hospitals. Visual acuity was 6/6 in 31.6% of patients while five patients [2.4%] had no light perception. Most of the patients were treated without hospitalization and only 58 patients [27.8%] were admitted in the hospital. The current burden of eye injuries presented to A and E department of PIMS had been estimated. Ocular trauma remained an important cause of blindness, particularly among younger age groups

Role of fast and DPL in assessment of blunt abdominal trauma

To assess and compare the diagnostic accuracy of Diagnostic Peritoneal Lavage [DPL] and Focused Assessment Sonography for Trauma [FAST]. A comparative study. SU II Department of surgery Allied Hospital Faisalabad. From Jan 2006 to Dec 2006 A total of 50 patients irrespective of age and sex, presenting to casualty department with blunt trauma abdomen were included in the study. Patients with equivocal signs of peritonitis under went abdominal ultra sonography followed by diagnostic peritoneal lavage. The operative findings were also recorded. Out of total 50 patients, Sensitivity of FAST was 88.88%, Specificity 91.30%, Accuracy 90.00%, and Positive predictive value 92.30%, Negative predictive value 91.30%. In 3 patients ruled out on ultra sonography but confirmed on Diagnostic peritoneal lavage and exploratory laparotomy [false negative]. Sensitivity of DPL was 96.66%, Specificity 85.00%. Accuracy 92.00%, Positive predictive value 90.62%, Negative predictive value 94.44%. Out of 50 patients 29 had positive DPL wrongly positive in 3 patients, true negative in 17 patients, false negative in 1 patient. 3 patients falsely negative on abdominal ultrasonography, 2 of them were having gut contents on DPL and 1 was having frank blood on DPL.Focused Assessment Sonography for Trauma [FAST] being non invasive should be the first step in assessment of patients with blunt abdominal trauma, when complimented by DPL may helps in defining the organ injury

Abdominal tuberculosis: a surgical perspective

To document the clinical presentation, operative findings, surgical procedures and complications of abdominal tuberculosis. Retrospective study. This study was conducted in Surgical Unit II of Bolan Medical Complex Hospital, Quetta during August 2001 to August 2006. This study included patients, who presented with clinical features of intestinal obstruction. They were either known cases of abdominal tuberculosis or diagnosed at the time of laparotomy. Tissue biopsy specimen was taken from all the cases for histopathological examination. A total of 7983 patients were admitted during the last 5 years. Among them 294 were admitted with acute or chronic intestinal obstruction. All of them were operated. Two hundred were suffering from abdominal tuberculosis. Majority of them were in their 4th decade of life. The male to female ratio was1:1.63. The most common clinical presentation was the weight loss [88%], abdominal distension [73%] and abdominal pain [46%]. Peroperative findings revealed ileal perforation in 44.0%, multiple adhesions in 26.5% and ileocaecal mass in 14.0%. Resection of gut and primary anastomosis was performed in 38.0% and adhesiolysis in 22.0%. The major cause of morbidity was wound infection [17.0%], faecal fistula [9.5%] and burst abdomen [6.5%]. The mortality was 12.0%. Abdominal tuberculosis is one of the major causes of acute abdomen in developing countries. It affects the people of working age group of the society. It imparts a great deal of morbidity as well as economic loss

Method of quantitative bacterial count in burn wound

To describe a technique for conducting Quantitative bacteriology in burn wounds, which is a very important tool in the management of burn wound sepsis. Technique was used in 21 patients with burn wound injury. Biopsy for the bacteriology was taken with the help of punch forceps. Then it was directly put into sterilized pre weighed homogenizer bag containing 1ml normal saline. This bag was re-weighed. Weight of the tissue was obtained and bag was homogenized in homogenizer [Stomacher Lab Blender-80]. Four fold dilutions were made of homogenate specimen. From each dilution tube, 0.01ml was then inoculated on blood agar plates, incubated for 24 hours and number of colonies counted by formula. Four specimens were taken each day and repeated on alternate days for up to 6 days. Out of twenty one patients there were 10 male and 11 female with mean age of 25.95 years. Total body surface area burnt was from 9-41%. Bacterial counts obtained varied from 1.45-8.89. Quantitative bacteriology is simple by the above method and should be employed in every public and private sector burn center

Surgical management of tattoos

To study patients coming for surgical removal of their tattoos with regard to treatment outcome. It is a descriptive and observational study, conducted at Plastic, Reconstructive and Micro-Surgery Department of Dow Medical College and Civil Hospital, Karachi over a period of one year. Twenty four patient, 18 males and 6 females, who came for tattoo removal and were found to be psychologically fit, were included in the study. After explaining the treatment consequences they were subjected to either simple excision, serial excision, Dermabrasion or excision and skin grafting. Fourteen cases underwent serial excision, four had simple excisions and closure, three had dermabrasion and three cases excision and over grafting. Infection occurred in one case, dehiscence in one case and incomplete removal of tattoo by dermabrasion in one case. The long term follow up, of up to six months was available only in eight out of twenty four patients. Out of these eight, five developed hypertrophic scars. Though tattoo removal is a simple procedure in the hands of experienced plastic surgeon, it is not free form complications. Though scar is inevitable, patient's satisfaction was quite high as they got rid of stigmas, which was haunting them

Cleft lip day care surgery under infra-orbital nerve block

To study the outcome of Day Care Surgery in adult Cleft Lip patients. Prospective study over a period of one year. Dept. of Plastic Surgery, Civil Hospital, Karachi. Twenty two cases of Cleft Lip that were surgically repaired. All patients, that were selected by the inclusion criteria, underwent surgical repair of the Cleft Lip by Millard Technique under Local anaesthesia i.e. Infra-orbital block. Out of 22 cases operated, 17 were males and five females. Their ages vary from 14 years to 34 years with a mean age of 20.59 years. Thirteen cases were left sided, eight were right sided and one was midline. Twelve cases had Primary Cleft Lip, while 10 cases belonged to the category of Secondary Cleft Lip. During the operation 14 patients felt mild pain, six moderate and two severe pain. The stay in the recovery room was 50 minutes on an average. Day care surgery under local anesthesia of infra-orbital block is suitable for adult Cleft Lip population. It reduces the cost of surgery and the patient's burden on tertiary care hospitals

Anaesthetic management of mass casualties-what should be the drug of choice?

Based on the experience of earthquake 8[th] October 2005 choice of best anaesthetic management for mass casualties was determined. Patients were subjected to all types of anaesthesia and then best out of these came out to be ketamine. One month. A total of 180 patients were anaesthetized by different methods during one month after earthquake. Out of 120 patients 80 received general, 74 ketamine, 22 spinal and 4 regional anaesthesia. 41% who received ketamine anaesthesia showed uneventful recovery without any complication. It is concluded that ketamine alone can be used very safely in case of mass casualties as also recommended in literature

Penile Torniquet Syndrome

To study the presentation and outcome of cases of Penile Torniquet Syndrome.Retrospective study over a period of five years i.e. Jan.1998 to Dec.2002.Civil Hospital and Usman Memorial Hospital, Karachi, and Allied Hospital, Faisalabad. Patients: Six cases of Penile Torniquet Syndrome.The patients underwent either a two or three stage repair.The ages of the patients ranged from 2-10 years. All patients belonged to the poor socio-economic group. All patients were circumscribed. In all cases the presentation was late with part of the glans just hanging down because of the constriction ring and with a urethro-cutaneous fistula. The results of the surgical repair was good in five cases. One case was lost in follow up. We conclude that although Penile Torniquet Syndorme is a rare condition, but it should be in the mindsof the treating physicians and surgeons so that early diagnosis and prompt treatment can be carried out

Pudendal thigh flap for congenital absence of vagina

To increase the armamentarium of plastic surgeons with description of one of the relatively newer flap for the reconstruction of congenital absence of vagina. All patients of congenital absence of vagina selected for surgery were explained every detail about the procedure. Five out of ten opted for this procedure. In all patients bilateral pudendal thigh flap based on posterior labial artery, a branch of internal pudendal artery, were raised on either side of labia. They were sutured in midline and inserted into the neo-vagina created by dissection in between rectum and urinary bladder. This flap was used in five patients with minor postoperative problems and with good anatomical and functional results. Pudendal thigh flap is a useful technique to reconstruct the vagina

Effects of methysergide on serotonin and secretagogues treated gastric secretion in intact pylorus ligated rats of different age groups

To study the effect of antiserotonin drug methysergide on the serotonin and secretagogues on gastric acid secretion in younger and older age animals. Setting: The study was conducted at the pharmacology department, Basic Medical Science Institute, Jinnah Postgraduate Medical Centre, Karachi. Pylorus ligated rate stomach preparation was done on 48 hours starved animals. Drugs were administered, 4 hours latter on rat was sacrified. After opening abdomen, oesophagus was ligated and stomach removed. Contents of stomach were flushed with 3ml distilled water. The contents were used to determine the volume of gastric juice and free and total acidity by titration. Result: Methysergide significantly blocked the gastric inhibitory action for serotonin in the presence of histamine and bethanechol and values were found increased in older animals than younger. But when secretagogue was pentagastrin icnreased values were insigificantly found in older animal against younger. The effect of methysergide, serotonin, histamine and bethanechol on gastric juice volume and acidity is according to parietal cell mass which increases with advancement of age of animals. While pentagastrin's stimulatory action in the presence of serotonin and its antagonist is insignificantly higher in older animals

Effect of fresh and freeze dried human amniotic membrane on quantitative bacterial courts in burn wounds

Amniotic membrane in fresh or freeze dried from has been used at times in the management of burn wounds as a biological dressing. One of the qualities with which it is credited [by virtue of animal studies] is the reduction of the bacterial count of burn wounds. The present study was designed to test this claim in human burn wounds in a prospective controlled trial. Acute burn cases matched for age, sex and burn extent were randomly assigned to three group i.e. fresh membrane freeze dried membrane, and saline soaked gauze. The wound was tangentially excised and four biopsy samples one from each corner of the test site were taken on day zero, two, four and six. Each sample was weighed, homogenized and inoculated on blood agar plates. Colony counts were made at 24 hours. The results revealed that in the membrane groups by day four a decrease in the bacterial count begins which by day six becomes statistically significant as opposed to the controls [saline soaked]. The bacterial counts showed no statistically significant difference between the fresh and freeze dried membrane group. We conclude that amniotic membrane in either or properly prepared and used can contribute in diminishing the bacterial colonization of burn wounds of moderate extent [2-40% total body surface area]

scalping flap for nasal reconstruction

A 50 years old man reported to the out patient, department of Plastic surgery services of Civil Hospital Karachi with a traumatic cut nose by a sharp object. Examination revealed complete loss of both alae, tip and vestibule along with some loss of tissue over the root. The large defect was closed with "scalping flap of Converse" This flap is well known for its reliability, color match and the texture. It causes minimal donor area morbidity