Clinical Efficacy and Safety of Injectable Levetiracetam Versus Phenytoin as Second-Line Therapy in the Management of Generalized Convulsive Status Epilepticus in Children: An Open-Label Randomized Controlled Trial

BACKGROUND AND PURPOSE: There is sparsity of quality evidence for the use of drugs after first-line benzodiazepines in convulsive status epilepticus in children. The aim of the study was to compare the clinical efficacy and safety of intravenous levetiracetam versus intravenous phenytoin as second-line drugs in the management of generalized convulsive status epilepticus in children. METHODS: This open-label randomized controlled trial was conducted in the Emergency Department of The Children's Hospital and The Institute of Child Health, Multan, Pakistan over a period of 4 years and 6 months from January 2014 to June 2018. This study included 600 children with generalized convulsive status epilepticus: 300 in the 40 mg/kg levetiracetam group, and 300 in the 20 mg/kg phenytoin group. Cessation of a clinical seizure (seizure cessation rate) within 30 minutes after the end of drug administration was the primary outcome in this study, and the presence or absence of adverse effects was noted as the secondary outcome. Data were analyzed using SPSS (version 20.0). RESULTS: The children in the levetiracetam and phenytoin were aged 3.5±0.2 and 3.4±0.2 years (mean±SD), respectively, their seizure durations before the start of treatment were 25.1±0.6 and 23.8±0.4 minutes, and their treatment efficacies were 278/300 (92.7%) and 259/300 (83.3%). Levetiracetam was significantly more effective than phenytoin (p=0.012), with no significant difference in safety. Adverse events were observed in eight children in the phenytoin group. CONCLUSIONS: Levetiracetam is significantly more effective than phenytoin for the treatment of convulsive status epilepticus in children who have failed to respond to benzodiazepines.

Needle stick injuries: knowledge, attitude, practices [KAP] and frequency of hepatitis B and C among nursing students in Karachi

Objective: The objectives were to determine the Knowledge, Attitude, Practices regarding needle stick injuries [NSI] and frequency of Hepatitis B and C among nursing students at two tertiary care hospitals of Karachi

Study Design: Cross-sectional study

Place and Duration of Study: This study was conducted at the Department of Medicine, DMC, JPMC and Hilton Pharma, Karachi from January 2014 to June 2014

Materials and Methods: This study was carried out on NSI exposed 214 nursing students from 1[st] year to 4[th] year, visiting their respective hospitals and engaging in clinical activities. A hundred of those students who reported needle stick injuries randomly selected and screened for Hepatitis B surface antigen [HbsAg] and anti-HCV in sera

Results: Approximately thirty four percent [34%] of the students reported to have NSI one time. Out of the 214 students only 143 [66.8%] of the students were aware of the Universal Precaution Guidelines while 71 [33.2%] were unaware of it. After getting NSI only 18.2% reported it to the infection control team while 81.8% failed to report it. Of the 100 students randomly selected for screening, four tested positive for HbsAg and two tested positive for Anti-HCV

Conclusion: Allowing nursing students to practice without prior knowledge of their immune status poses a major risk of acquiring hazardous infections. Prior to practice, students should be ingrained with the universal precaution guidelines and screened for blood borne infections that should be followed up every year

Effectiveness of sodium hyaluronate eye gel in patients with dry eye disease: a multi-centre, open label, uncontrolled study

To assess the effectiveness of sodium hyaluronate Eye Gel in Dry Eye Disease [DED] patients. A Multi-center, Open-label, Uncontrolled clinical trial was conducted in different centers of Pakistan. Ten ophthalmologists conducted this study in which 250 diagnosed patients with dry eye disease were enrolled after obtaining a written informed consent. Ten patients were dropped out during the study period. All patients were assessed as per following criteria for enrolling a patient into the study: Tear Film Break - up time [TBUT]

Efficacy of telbivudine in the treatment of chronic hepatitis B infection in population of Peshawar, Pakistan

To study the efficacy of telbivudine in 2 years treatment of chronic hepatitis B infection in local population of Peshawar. This study was conducted in Khyber Teaching Hospital, Peshawar from June 2007 to June 2012. 83 patients, 56 males and 27 females of chronic hepatitis B with no other liver problem like hepatitis C and D, alcoholic hepatitis, fatty liver, hepatocellular carcinoma etc were included in the study. HIV, pancreatitis and pregnancy was also ruled out before study was undertaken. Base line investigations of CBC, Liver and kidney profile, CPK, HBsAg, HBeAg, HBe antibody, HBV DNA, Ultra sound abdomen and upper GI endoscopy were conducted in the subjects. Each patient was given oral telbivudine 600mg/d for 2 years. Biochemical, serological, virological and clinical follow ups were conducted after one month of starting treatment and then every 3 months. Biochemical, serological and virological end points were observed beside adverse effects of telbivudine. Data was analyzed using SPSS version 15.0. Mean serum ALT was reduced from 36.9 iu/ml from first visit to 21.0 iu/ml [p value=0.001] after 24 months of treatment. The serum viral load decreased from 165277.82 iu/ml to 3.80 iu/ml from initial to final visit after 2 years of treatment. No viral breakthrough was reported during 24 months of treatment with telbivudine. The drug was well tolerated without any significant adverse effects. Treatment of chronic hepatitis B patients with telbivudine shows statistically significant reduction in viral load and serum ALT with no significant adverse effects