Optimization of Biostimulants Application for Phenology and Quality of Oats

Abstract In modern agriculture the use of biostimulants not only reduces the cost of production but also increase yield and quality of crops without harming environment. The response of fodder oat to biostimulants was evaluated in a pot experiment using four biostimulants at different concentrations i.e Moringa leaf extract at ratio of 1:10, 1:20, 1:30, 1:40, 1:50, Sea weed extract at 1%, 2%, 3%, 4%, 5%, Thiourea at 100 ppm, 200 ppm, 300 ppm, 400 ppm, 500 ppm and Chitosan at 25 ppm, 50 ppm, 100 ppm, 125 ppm, 150 ppm. Oat crop was treated with biostimulants using foliar application, at two growth stages i.e tillering and booting. Data on various agronomic and quality parameters were recorded and analyzed. Results showed that biostimulants significantly affected phenology and quality of oat. The highest green fodder yield (872.32 g) was observed in the pots treated with 2%Solution of seaweed extract similarly highest dry matter yield was also highest at 170.85 g Interestingly crude protein was highest for thiourea at 400 ppm. In each biostimulant following doses stood out both in terms of yield and quality. In case of moringa leaf extract the ratio of 1:40with 900 g per pot yield and 9.43 % protein, for sea weed extract 2% was better than other doses with 981 g yield and 9.17% protein, for thiourea the 400 ppm was better than other concentrations as it shows highest yield (872.32 g) and crude protein (9.52%) and for chitosan 100 ppm was comparatively better in performance with 964.98 g yield per pot and 9.35% CP. It is concluded from our study that biostimulants improve fodder oat yield and quality.

Assessment of Respiratory Problems in Workers Associated with Intensive Poultry Facilities in Pakistan

Background@#The poultry industry in Pakistan has flourished since the 1960s; however, there are scarce data regarding the impact of occupational exposure on the pulmonary health of farm workers in terms of years working in the industry. The objective of the present study was to assess the effect of poultry environment on the health of occupationally exposed poultry farmers in countries of warm climatic regions, such as Pakistan. This study will also show the effect of exposure to poultry facilities on the health of poultry farmers in the context of low-income countries with a relatively inadequate occupational exposure risk management. @*Materials and methods@#The lung function capacity of 79 poultry workers was measured using a spirometer. Along with spirometry, a structured questionnaire was also administrated to obtain information about age, height, weight, smokersonsmokers, years of working experience, and pulmonary health of farm workers. The workers who were directly involved in the care and handling of birds in these intensive facilities were considered and divided into four groups based on their years of working experience: Group I (3-10 months), Group II (1-5 years), Group III (6-10 years), and Group IV (more than 11 years). The forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and the FEV1/FVC ratio were considered to identify lung function abnormalities. Statistical analysis was carried out using independent sample t test, Chi-square test, Pearson's correlation, and linear regression. @*Results@#Based on the performed spirometry, 68 (86 %) of workers were found normal and healthy, whereas 11 (14 %) had a mild obstruction. Of the 11 workers with mild obstruction, the highest number with respect to the total was in Group IV (more than 11 years of working experience) followed by Group III and Group II. Most of the workers were found healthy, which seems to be because of the healthy survivor effect. For the independent sample t test, a significant difference was noticed between healthy and nonhealthy farmers, whereas Chi-square test showed a significant association with height, drugs, and working experience. Linear regression that was stratified by respiratory symptoms showed for workers with symptoms, regression models for all spirometric parameters (FVC, FEV1, and FEV1/FVC) have better predictive power or R square value than those of workers without symptoms. @*Conclusion@#These findings suggest that lung function capacity was directly related to years of working experience. With increasing number of working years, symptoms of various respiratory problems enhanced in the poultry workers. It should be noted that most of the poultry workers were healthy and young, the rationale being that there is a high turnover rate in this profession. The mobility in this job and our finding of 86% of the healthy workers in the present study also proposed healthy worker survivor effect.

Economic Burden of Periprosthetic Joint Infection Following Primary Total Knee Replacement in a Developing Country

Background@#Periprosthetic joint infection is one of the devastating complications after primary total knee arthroplasty, which increases the financial burden on patients and affects their quality of life as well. The financial burden of periprosthetic joint infection after joint replacement in developed countries is well known. There is a need to evaluate the economic burden in developing countries such as Pakistan. @*Methods@#This is a single-center, retrospective, case-control study conducted at the Department of Orthopedic Surgery, Liaquat National Hospital Karachi. Cases of primary total knee arthroplasty performed during this study were divided into 2 groups: uneventful primary total knee arthroplasty and periprosthetic joint infection treated with 2-stage revision. To calculate the final cost, we divided the total hospital cost into the hospital stay cost and operating room cost. @*Results@#During study period, 32 patients were diagnosed with periprosthetic joint infection. The total cost of revision surgery for periprosthetic joint infection considering 2 hospitalizations was 1,780,222 ± 313,686 Pakistani rupee (PKR). The total cost of uneventful arthroplasty was 390,172 ± 51,460 PKR. We observed significant difference with respect to economic details between the 2 groups. @*Conclusions@#Management of periprosthetic joint infection was 4.5 times more expensive than uneventful primary total knee arthroplasty. Measures should be undertaken to reduce the prevalence of periprosthetic joint infection, thereby reducing patients’ economic burden.

Effect of Salinity Stress on Various Growth and Physiological Attributes of Two Contrasting Maize Genotypes

Abstract The response of two local maize (Zea mays L.) genotypes designated as Sahwal-2002 (salt-tolerant) and Sadaf (salt-sensitive) to salt stress was investigated under controlled growth conditions. The role of phenylalanine and seed priming under salt stress in maize with different morphological parameters were studied. The genotype Sadaf, being salt-tolerant, experienced more oxidative damage than the Sahiwall-2002 genotype under salt stress. The salinity affected both growth and physiological attributes of the maize species whereas the phenylalanine successfully increased the salinity tolerance in maize species at the seedling stage.

Identification and growth optimization of a Marine Bacillus DK1-SA11 having potential of producing broad spectrum antimicrobial compounds

Control of harmful bacteria in food, aquaculture, pharmaceuticals, agriculture, hospitals and recreation water pools are of great global concern. Marine bacteria are an enormous source of bio-controlling agents. The aim of this study was to identify and optimize the growth conditions including effect of different biotic and abiotic factors on antimicrobial activity of strain DK1-SA11 isolated from Qingdao Bay of China Yellow Sea. Microscopic characterization, API[registered sign] 20E and 50 CHB kit base carbohydrates utilization, 16S rDNA and DNA gyrB gene sequencing studies identified the bacterium as Bacillus subtilis subsp. spizizenii DK1-SA11. Antimicrobial spectrum of cell free supernatant [CFS] has shown antimicrobial activities against all test strains including methicillin-resistant Staphylococcus aureus, E. coli O157:H7, Candida albicans, Klebsiella pneumoniae, Listeria monocytogenes, Vibrio parahaemolyticus, E. coli, Pseudomonas fluorescens, Salmonella typhimurium and Vibrio cholerae. Among all the media tested, Marine Broth 2216 was found to be the best medium for bacterial growth and production of antibacterial compounds. The other optimum conditions for growth were pH:7 and incubation temperature: 25[degree sign] C with >/= 180 rpm for 60-72 h. Out of 49 different carbohydrates tested, D-mannose increases the antibacterial activity by 33.3% while Darabitol decreases it by 44.4%. Crude CFS showed activity even after three months of storage below -20[degree sign] C and boiling for 10 min, whereas it loses 100% of its antimicrobial activity after enzymatic treatments of lipase, trypsin and papain. The production of antimicrobial compounds and broad spectrum of antimicrobial activity against all tested pathogens suggested that the strain DK1-SA11 can be used as a source for probiotics, synbiotics and antibiotics

Effectiveness of gastrografin in resolving small bowel obstruction

Objectives: To determine the effectiveness of Gastrografin in resolving intestinal obstruction

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted in the Department of Surgery, Shaikh Zayed Hospital, Lahore from 02-10-2013 to 02-04-2014

Materials and Methods: One hundred thirty five patients who having small bowel obstruction were admitted through out-patient, accident and emergency departments. Every participant was explained about both procedures and their consequences

Results: Average age was 44 +/- 70 years. 77 [57%] were males and 58 [43%] were females with a male to female ratio was 1.32:1. In 58 [43%] male patients the obstruction was resolved, but in 19 [14%] male patients obstruction was not resolved. In 41 [30%] female patients the obstruction was resolved and in 17 [12%] female patients the obstruction could not be resolved. Overall, in 99 [73%] patients, the obstruction was resolved but in 36 [27%] of patients the obstruction was not resolved

Conclusion: Gastrografin is a secure and reduces the need for surgery when conservative treatment fails. It remains a leading cause of hospital admission in surgical departments

combined role of alvarado score and ultrasonography for the diagnosis of acute appendicitis

Objectives: Objective of the study was to evaluate use of Alvarado score and ultrasonography in diagnosis of acute appendicitis

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at Department of Surgery along with Department of Radiology at Shaikh Zayed Hospital Lahore from 1[st] January 2013 to 31[st] August 2013

Materials and Methods: 250 patients of Alvarado Score were enrolled for the diagnosis of acute appendicitis attending out-patient, accident and emergency departments

Results: There were 184 [74%] were males and 66 [26%] were females with mean age of 35.27 +/- 12.57 years. One hundred and seventy patients had anorexia while 76 patients had no anorexia. 49.6% patients while in 50.4% were reported anorexia. Right iliac fossa was noted in all patients. 95% patients had rebound tenderness 203 patients have elevated temperature

Conclusion: Alvarado score is a simple and reliable non-invasive diagnosis modality without any extra cost and complication. It has also proved to be handy for our peripheral hospital settings where backup facilities not available. By application of Alvarado scoring system with non-invasive ultrasonography improves diagnosis accuracy by reducing negative appendicectomies hence reducing complications rate in our settings

Comparison of serum lipid profile in Type-2 Diabetics with and without retinopathy in Pakistani population

Objective: To compare serum cholesterol, TG, HDL-C and LDL-C concentrations between type-2 Diabetes mellitus [DM] patients with retinopathy and without retinopathy and to study association between various modifiable risk factors of Diabetic retinopathy [DR]

Methods: The study included 300 patients with type 2 DM; 140 of them were without DR [Group-I] and 160 were with DR [Group-II]. Serum total cholesterol, LDL-C, HDL-C, and TG levels were determined. SPSS 17.0 for windows was used for statistical analysis

Results: Overall, mean age of study population was 48.86 +/- 5.62 years. Subjects with DR were older [P < 0.018], had higher fasting plasma glucose [P < 0.01] and higher HbA1c [P <0.01] concentrations compared with those without DR. Analysis of serum cholesterol, LDL-C, HDL-C and TG among subgroups of patients with no DR, with NPDR and PDR showed statistically significant difference [p <0.01]. There was strong positive correlation of severity of DR with BSF, HbA1c, serum LDL-C, total cholesterol and TG

Conclusion: The serum cholesterol, TG, HDL-C and LDL-C concentrations were found to be significantly deranged in patients with DR as compared to those without DR

Comparison of circumcision by plastibell versus open method

Objective: The objective of the study is to compare circumcision by plastibell and open method in terms of bleeding, infection and cosmesis

Study Design: Randomized clinical trial

Place and Duration of Study: Surgical ward, Combined Military Hospital, Kharian from Aug 2011 to Sep 2012

Material and Methods: All individuals fulfilling inclusion criteria underwent circumcision in the operation theatre of CMH Kharian as indoor patients, under local anaesthesia and aseptic measures. In group 1, circumcision was done using plastibell where as in group 2, circumcision was done by open method

Results: Mean age in plastibell group was 3.37 months [SD=1.77] and in open group was 3.12 months [SD=1.33] [p=0.100]

In plastibell group 18% had bleeding however in open group 4% had bleeding [p<0.001]. In plastibell group 4% patients had infection. However in open group 15% had infection [p<0.001]

In plastibell group 82% parents were satisfied whereas 18% had extra skin, whereas in open group 96% parents were satisfied, 1% had extra skin and 3% had less skin [p<0.001]

Conclusion: Circumcision being a commonest surgical procedure demands careful selection of the operative procedure because plastibell method is superior in terms of post-operative infection whereas open method is better in terms of cosmesis and post-operative bleeding

Broad spectrum anti-microbial compounds producing bacteria from coast of Qingdao bays

Anti-microbial resistance burden and hazard associated with chemical treatment of infections demanded for new anti-microbial natural products. Marine associated microorganisms are the enormous source of bioactive compounds. In this study we have isolated 272 marine bacteria among them 136 [50%] were antagonistic to at least one of the four pathogenic strains Listeria monocytogenes, Vibrio cholerae, E. coli and S. aureus. Only two strains exhibited antibacterial activity against all four test strains, which were identified by 16S rDNA sequencing as Bacillus sp. DK1- SA11 and Vibrio sp. DK6-SH8. Marine isolate DK1-SA11 has potential to resist boiling temperature and pH 2-12. Furthermore cell free extract [CFE] inhibited all test organisms including superbug MRSA and pathogenic yeast Candida albicans. Marine isolate Bacillus sp. DK1-SA11 could be a potential combatant for the battle of drugs and bugs

Diaphyseal femoral fractures; outcome treated with close vs open

The femur fractures usually happen with oomph forces like motor vehicle accidents. To assess the mode of injury and complications of the management, in diaphyseal femoral fractures, in comparison of close versus open intramedullary interlocking nail [IMN]. Experimental and comparative study. April 2013 to March 2014. Department of Orthopaedic Surgery, Peoples University of Medical and Health sciences, Nawabshah. The cases were divided into two groups A and B. Group A was treated by open nailing [n = 20] and group B by close nailing [n = 20], all the cases were operated within 48 hours of admission. All the data were recorded on well structured proforma. Serial radiographies were performed at 3, 6, 12 weeks, and 6 months; additional radiographies were performed as needed postoperatively. Knee, ankle, and hip motions were begun and protected weight bearing was started on the second day postoperatively and increased gradually to full WB depending on x-ray findings of callus formation. The patients were followed for two years. Results of open and closed I.M.N were assessed and the complications if any were observed over a mean follow-up period of two years. The mean age in group A was 29.40 years and the mean age in group B was 30.45 years. Out of 40 cases, 32[80.0%] were males with male to female ratio 1:4. Mean +/- SD hospital stay was 19.80 +/- 14.60 days in group A, and 17.90 +/- 5.95 days in group B [p value 0.55]. Average time between injury and admission was 1.53 days [n = 40], in the group A it was 1.05 days, and in the group B it was 2.0 days [p value 0.03]. The average of time between injury and operation in the group A was 8.75 days, and in the group B, it was 8.20 days, [p value 0.71]. The average of time between admission and discharge in the group A was 11.0 days, and in the group B was 9.15 days, [p value 0.55]. Mean +/- SD union time was 11.70 +/- 6.45 weeks, in group A and 11.90 +/- 5.77 weeks, in group B. [p value 0.91]. All the patients had full ranged of hip motion and 2 [10.0%] patients of group A had mild limitation of knee motion with a flexion ranges between 80 and 110 degrees. Final functional results based on Thoresen BO criteria16. Excellent results were observed in 19 [47.5%] cases, out of them 5[25.0%] were in group A and 14[70.0%] were in group B. Good results were found in 13[32.5%] patients, out of these 7[35.0%] were in group A and 6[30.0%] were in group. Fair and poor results were detected in 4[10.0%] cases of group A. Road traffic accidents by motorcycle was found the commonest [47.5%] cause of femur fracture, a few complications were observed in open interlocking nailing as compared to closed interlocking nails

Efficacy of external dacryocystorhinostomy [DCR] with and without mitomycin-C in chronic dacryocystitis

To compare the efficacy of external dacryocystorhinostomy [DCR] with and without intraoperative application of mitomycin-C in patients with chronic dacryocystitis. An experimental study. Department of Ophthalmology, Bahawal Victoria Hospital [BVH], Bahawalpur, from September 2009 to December 2010. One hundred and sixty patients with chronic dacryocystitis undergoing external DCR were divided into two groups comprising of 80 patients each. Group A included patients, who underwent external DCR with intraoperative use of mitomycin-C. Group B included those patients who were not administered intraoperative mitomycin-C. Sociodemographic information and the data regarding the patency of the lacrimal drainage system by irrigation with normal saline were collected at the end of the third month after the surgery. Chi-square test was used, at 95% confidence level, as the test of significance to compare the success of surgery between the two groups. Surgical success rate [efficacy] in group 'A' was found to be 97.5% and 86.25% in group 'B'. The difference in success rate was statistically significant [p=0.017]. External dacryocystorhinostomy with intraoperative mitomycin-C is more efficacious in achieving lacrimal system patency than external dacryocystorhinostomy without mitomycin-C

Burn wound infection; significance of rule of nine in microbial surveillance

Burn injuries are common and major health problem throughout the world. The burn wound represents as a favorable area for opportunistic colonization of microorganisms with exogenous and endogenous origin. In burns patients infections arise from multiple sources. Burn wounds become initially colonized and infected with Gram positive bacteria, mainly Staphylococci, that are superseded during the second week by Gram Negative bacteria. it is a microbial surveillance retrospective study; that aimed to evaluate the significance of Rule of nine in diagnosis of aerobic bacterial burn wound infection and carried out in between June 2007 to September 2011 in the Department of Pharmaceutics, University of Karachi.Descriptive retrospective study. A total of 118 patient irrespective of age, sex, date and time of burn, date and time of hospital admission, interval between time of burn and hospital admission, degree and percentage [%] of burn and duration of hospital stay [when specimen collected] were registered for this study. All patients were divided into two groups [A and B]. Out of 58 patients of group A isolation rate per patient was 1.1 while in group B it becomes 3.0. According to TBSA the isolation rate in group B rises with rise in TBSA. Most prevalent organism in these patients was found S. aureus[23%] P.aeruginosa[21%]. Burn patients are incubator for variety of aerobic bacteria and rate of isolation of these organisms increase with rise in TBSA. The wounds of these patient must required continuous microbial surveillance that may reduce the rate of mortality

Dyslipidemia; Helicobacter pylori infected patients

To determine the frequency of dyslipidemia in Helicobacter pylori infected patients. This cross sectional descriptive study of six months study was conducted at Liaquat University Hospital Hyderabad from 01-03-2012 to 31-08- 2012. All the patients between 19 to 60 years of age present with symptoms of dyspepsia, bloating or epigastric discomfort for more than 01 week duration were admitted and evaluated for Helicobacter pylori infection. Thereafter the positive cases [Helicobacter pylori infected patients] were further evaluated for dyslipidemia. During six month study period, total 144 patients [95 males and 49 females] with Helicobacter pylori infection were evaluated for dyslipidemia [lipid profile]. Majority of patients were from urban areas 110/144 [76%]. The mean +/- SD for age of patients with Helicobacter pylori infection was 35.94 +/- 10.77. The mean age +/- SD of dyslipidemic patient was 32.62 +/- 6.52. The dyslipidemia was identified in 87 [60.4%] patients, of which 51[58.6%] were males and 36[41.4%] were females. Regarding the pattern of dyslipidemia, ten [11.4%] patients had raised serum triglycerides level, twenty eight [32%] had raised LDL-C level, twenty six [28.9%] had raised serum cholesterol level, seven [8.7%] had low HDL-C level and sixteen [18.3%] had mixed dyslipidemia. The mean +/- SD of hypertriglyceridemia, [Upwards Arrow] HDL-C, [Upwards Arrow] LDL-C and hypercholesterolemia in dyslipidemic Helicobacter pylori infected was 280.72 +/- 22.85, 24.21 +/- 2.63, 180.63 +/- 12.98 and 285.21 +/- 23.63 respectively. The H. pylori infected patients are prone to acquire dyslipidemia, therefore the present study observed 60.4% prevalence of dyslipidemia with male predominance [58.6%]

Polypropylene suture versus skin staples for securing mesh in lichtenstein inguinal hernioplasty

To compare polypropylene suture and skin staples for securing mesh in Lichtenstein inguinal hernioplasty in terms of mean operating time and postoperative pain. Randomized clinical trial. Surgical Ward, Combined Military Hospital, Kharian, from August 2011 to February 2012. All individuals fulfilling inclusion criteria underwent elective Lichtenstein inguinal hernioplasty as admitted patients, under spinal anaesthesia and with aseptic measures. In group 1, during the operation, mesh fixation was done with 2/0 polypropylene suture and skin was closed with subcuticular 2/0 polypropylene suture whereas in group 2, the anchorage of mesh was done with skin staples and skin was closed with staples from the same stapler. Mean operative time and postoperative pain, assessed on a visual analog score, were compared between the groups. The overall postoperative pain was lower [p = 0.026] when staples were used to anchor mesh. Moreover, operative time was also lower [37.42 +/- 2.69 minutes] in staple group versus [42.44 +/- 2.55 minutes in polypropylene group]. Mean operating time and postoperative pain is less in securing mesh with skin staples as compared to polypropylene suture in Lichtenstein inguinal hernioplasty

Histopathological patterns in childhood steroid resistant nephrotic syndrome

To determine the frequency of various histopathological lesions in children with steroid resistant nephrotic syndrome [SRNS] presenting to the Children's Hospital and the Institute of Child Health, Multan. Retrospective observational study. This study was conducted at the Department of Paediatric Nephrology, The Children's Hospital and The Institute of Child Health, Multan, Pakistan from October 2005 to December 2012. Medical record of 152 children with SRNS, who were biopsied was reviewed all SRNS patients, both initial steroid resistant and late non-responders were included in the study out of the total 152 patients, 98[64.5%] were males and 54[35.5%] females, with a male to female ratio of +/- 1.8: 1. Mean age and standard deviation of patients was micro 8.11 +/- 3.58 years with age range of 1 to 15 years. Histopathological spectrum showed focal segmental glomerulosclerosis [FSGS] as the commonest [59; 38.81%] lesion followed by mesangioproliferative glomerulonephritis [MesPGN] [40; 26.31%], minimal change disease [MCD] [35; 23.02%] and mesangiocapillary glomerulonephritis [MCGN] [13; 08.55%]. Four [2.63%] patients had membranous nephropathy. One patient of renal amyoidosis was also diagnosed on renal biopsy. Overall FSGS was the commonest lesion followed by MesPGN, MCD, and MCGN. IgMN was an associated finding in 25% cases of MesPGN. FSGS was significantly more common among children >10 years. MCD was significantly more common among children 1-5 years. MesPGN and MCGN were significantly more common among children >5 years

Hepatocellular carcinoma; different child-pugh classes based on alpha-fetoprotein level

To determine the frequency of hepatocellular carcinoma in different Child-Pugh classes based on Alfa fetoprotein level. Case series study. Six months. Medical Unit-I of Liaquat University Hospital, Hyderabad Sindh Pakistan. A total of 100 patients admitted [inpatients] in Medical Unit I with the diagnosis of cirrhosis were enrolled in the study. Patients with cirrhosis of liver [more than six month duration] of either gender were included. If patients had metastatic lesion of the liver, liver abscess, or acute liver failure then they were excluded. Child-Pugh score was calculated which included ascites, encephalopathy, prothrombin time, albumin and serum bilirubin. The levels of alpha-fetoprotein were measured and HCC was diagnosed. The primary outcome variable was presence of HCC in cirrhotic patients. The proportion of males [53%] was higher as compared to females [47%]. The mean age of the study patients was 40.47 years with a standard deviation of 11.5. At the beginning patients were categorized according to Child Pugh Classes [A= up to 6, B=7-9 and C=10-11], age groups [15-30 years, 31-50 years and 51- 70 years respectively]. The mean Child Pugh score was 6.83 with +/- 1.8 S.D. The majority of the cases of HCC [75.61%] occurred in the Child Class A, whereas 21.95% occurred in Child Class B and finally only one case of HCC [2.44%] was present in Child Class C. This study comprehensively demonstrated that hepatocellular carcinoma [HCC] is far more common in compensated cirrhosis [Child Pugh Class A] vs. decompensated cirrhosis [Child Pugh Class B and C]

Chronic gout and hyperuricemia; treatment with febuxostat versus allopurinol

To assess the urate-lowering efficacy and safety of Febuxostat versus Allopurinol in subjects with hyperuricemia and gout. Randomized controlled trial. Department of Orthopaedic and Trauma Surgery Mardan Medical Complex Teaching Hospital Bacha khan Medical College Mardan from February 2012 to March 2013. Fifty patients of chronic gout and hyperuricemia fulfilling the inclusion criteria were divided into two equal groups by random method having 25 patients each and received either a fixed dose [80 mg] of Febuxostat [Group A] or Allopurinol [Group B] 300mg once daily for 16 weeks. The primary end point was the percentage of patients reaching serum urate level <6.0 mg/dl [360 micro mol per liter] at final visit. The secondary end points include reduction in the incidence of gout flares and adverse drug reactions. There were 16[64%] males and 9[36%] females with mean age 44.92 years in group A while group B had 15[60%] males and 10[40%] females with mean age 46.24 years. At final visit Febuxostat group had mean uric acid level of 4.72 mg/dl +/- 1.56 SD while Allopurinol group had mean serum uric acid level of 6.34 mg/dl +/- 1.82 SD with majority of patients [84%, n=21] in group A achieving serum uric acid level of < 6 mg/dl [360 micro mol/l] while only 60 percent [n=15] of the patients in group B had serum urate level of < 6 mg/dl.[P= <0.05]. Gout flare was reported in 12% [n=3] of group A patients and 36% [n=9] in group B patients. Adverse drug reactions were reported in 12% [n=3] of group A patients while 24% [n=6] in group B. Febuxostat lowerd serum uric acid levels more potently than Allopurinol while having minimal gout flares and side effects

Histopathologic and clinicopathologic correlations in children with atypical nephrotic syndrome

To find histopathologic and clinicopathologic correlations in children with atypically presented nephrotic syndrome. Retrospective observational study. This study was carried out at the Department of Paediatric Nephrology, Children's Hospital and Institute of Child Health, Multan, Pakistan from December, 2005 to January, 2014. Medical record and the biopsy reports of 80 children [age 1-15 years] with nephrotic syndrome, who had atypical features at presentation and had a renal biopsy, were analyzed. Atypical features included hypertension, gross hematuria, hypocomplementemia, impaired renal function, and age more than 12 years, or manifestation of other systemic diseases in children. Overall results showed hypertension as the commonest [90%] atypical feature followed by impaired renal function [65%], atypical age [53.7%], gross hematuria [41.3%], and hypocomplementemia [31.3%]. Histopathologic reports revealed non-MCD lesions in 76 [95%] cases. The commonest lesion was FSGS [25%] followed by MesPGN [23.8%], MCGN [17.5%], and LN [12.5%]. Out of the total 80 patients, 62 were idiopathic atypical nephrotic syndrome cases and 18 were secondary [due to some underlying systemic cause] nephrotic syndrome cases. Secondary causes, in decreasing frequency, included lupus nephritis/nephrosis [LN] [n10; 55.5%], hepatitis B virus associated nephrosis [HBVAN] [n=4; 22.2%], Henoch Schonlein Purpra nephritis/nephrosis [HSPN] [n=2; 11.1%], hepatitis C virus associated nephrosis [HCVAN] [n1; 05.5%], renal amyloidosis [RA] [n1; 05.5%]. Renal biopsy done at the onset of atypically presented nephrotic syndrome provides useful guidance to the final diagnosis. Non-MCD lesions predominate. Some secondary nephrotic syndrome patients also present as atypical nephrotic syndrome; further clinical and laboratory evaluation reveals the secondary cause