Use of E-Technology, physical activity and obesity among adolescents of Rawalpindi and Islamabad

Objective: To determine the relationship of e-technology use and physical activity with obesity among adolescents of Rawalpindi and Islamabad

Study Design: Cross sectional study

Place and Duration of Study: Different schools of Islamabad and Rawalpindi, from Mar to Aug 2015

Material and Methods: A cross sectional study was conducted among 305 adolescents between ages 17-19 years, from different schools of Islamabad and Rawalpindi, selected through consecutive sampling technique. Structured close-ended questionnaire was administered and data obtained was analyzed by SPSS version 22. Correlation test was used to ascertain association between BMI, time spent using e-technology and physical activity duration

Results: The mean age of the participants was 15.7 +/- 2.4 years. It was revealed that 13.3 percent of the respondents were underweight, 64.5 percent were of normal weight, 17.3 percent were overweight and 9.5 percent were obese. The majority of females were found watching television [73.1 percent] and using cell phone [60.6 percent] whereas majority of the males were fond of playing videogames [63.7 percent] and using computer [72 percent]. A positive correlation of 0.64 was found between e-technology use and BMI of individuals whereas physical activities were having negative correlation of -0.231 with BMI

Conclusion: The current study concluded that use of e-technology was directly associated and physical activity was inversely associated with obesity, suggestive of elevated consequences of sedentary activities on adiposity during adolescence. This issue must be addressed by raising awareness among adolescents about healthy lifestyle practices for their healthy and productive life in future

Epidemic of kala pathar [paraphenylene diamine] poisoning: an emerging threat in Southern Punjab

Objective: To assess cases of the spectrum of Kala Pathar poisoning in all age groups. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital [CMH] Bahawalpur and Bahawal Victoria Hospital [BVH], Bahawalpur, from January 2016 to April 2017

Methodology: All the cases of Kala Pathar [Paraphenylene diamine [PPD]] poisoning, admitted and treated at the study places during said period were included in the study. The assessed variable included gender, age, education status, socioeconomic status, reason of poisoning and mortality. Chi-square was applied for qualitative variables with p-value less than 0.05 was considered significant

Results: A total of 1,258 cases of PPD poisoning were included in the study; 814 [64.7%] females and 444 [35.3%] males. Their age ranged from 5 - 63 years, with median age 21 [IQR 4]. Sixty-six [5.2%] were children and the rest 1,192 [94.8%] were adults. In adults 1,125 [94.37%] cases of PPD poisoning were suicidal and 62 [5.20%] accidental cases; only 5 [0.42%] adults were intentionally poisoned. On the other hand, only one child took it with suicidal intent, 54 [81.81%] ingested it accidentally and 11 [16.66%] children were given poison deliberately with the intent to murder. The overall mortality was 24.08% - 22.81% in adults, and 46.96% in children

Conclusion: Kala Pathar [PPD] is a lethal substance when ingested. PPD poisoning is not limited to adults; many cases of pediatric poisoning are also being reported in Southern Punjab. Mortality due to Kala Pathar is high. Tracheostomy should be done immediately in all such cases; and high intensive multidisciplinary approach is required

Serum uric acid level in the severity of congestive heart failure [CHF]

Background and Objective: It has been observed that in a clinical condition like hypoxemia there is an increase in the serum Uric acid level. The objective of our study was to find out the relationship between serum uric acid levels in the severity of Heart failure

Methods: We analyze 285 patients with a diagnosis of Congestive heart failure admitted in Lady Reading Hospital Peshawar from March 1[st] to August 2016. Age group of patients was 17- 67 years. New York Health Association [NYHA] scoring were used to access the severity of Congestive Heart Failure. Serum UA level >7.0 mg/dl was considered high

Results: Total 285 patients with CHF were analyzed with a mean age of 54+/-2.8 years in which males were 65.96% and 34.03% were female. 40% were in class II of New York Health Association [NYHA], 32.63% in class III and 25.61% in class IV and 1.75% were in class I. Out of 285, 59.29% met the definition of hyperuricemia. In which 83.43% were male and 16.57% were female. Most of the Hyperuricemic patients 62.13% were in age group of 51- 60 years, with a mean age of 57+/-4.5 years. We found a significant correlation between uric acid level and BNP [p= <0.001], and use of diuretics [p=<0.001]. 34.93% of the Hyperuricemic CHF patients were in NYHA III and NYHA IV whose SUA was above 8 mg/dl as compared to 31.57% Hyperuricemic CHF patients whose SUA was below 8 mg/dl

Conclusion: High serum Uric acid was observed in 59.29% of patients with CHF. The observed significant correlation between UA level and some established prognostic markers in these patients may indicate that serum UA could provide additional prognostic information in this population. SUA as a marker can be measured anywhere at a low cost to help identify high-risk patients with CHF. Lowing uric acid is expected to be a new approach for prevention and therapy of HF

An Update on Endoscopic Management of Post-Liver Transplant Biliary Complications

Biliary complications are the most common post-liver transplant (LT) complications with an incidence of 15%–45%. Furthermore, such complications are reported more frequently in patients who undergo a living-donor LT compared to a deceased-donor LT. Most post-LT biliary complications involve biliary strictures, bile leakage, and biliary stones, although many rarer events, such as hemobilia and foreign bodies, contribute to a long list of related conditions. Endoscopic treatment of post-LT biliary complications has evolved rapidly, with new and effective tools improving both outcomes and success rates; in fact, the latter now consistently reach up to 80%. In this regard, conventional endoscopic retrograde cholangiopancreatography remains the preferred initial treatment. However, percutaneous transhepatic cholangioscopy is now central to the management of endoscopy-resistant cases involving complex hilar or multiple strictures with associated stones. Many additional endoscopic tools and techniques—such as the rendezvous method, magnetic compression anastomosis , and peroral cholangioscopy—combined with modified biliary stents have significantly improved the success rate of endoscopic management. Here, we review the current status of endoscopic treatment of post-LT biliary complications and discuss conventional as well as the aforementioned new tools and techniques.

Refining elements of medical professionalism in the undergraduate medical students

Objective: To assess the perception of professionalism in the students of Army Medical College

Study Design: A survey based descriptive study

Material and Methods: In the first phase of the study, experts were selected from various fields in medicine through email and their opinion was sought about the most important key elements of professionalism. On the basis of response, in the second phase, weighting of the elements were selected and re-forwarded to the experts for their confirmation. In the third phase, a survey of 1st year and final year was conducted amongst the students about their knowledge, perception and importance of selected element

Results: The first version of the professionalism assessment scale [PAS] consisted of 35 items. The experts also suggested 10 additional elements of professionalism other than proposed by the researchers. Based on their percentages, 33 out of the 45 items were excluded, so the second version of the PAS contained 12 items. When the mean scores of the different elements were compared among the responses of first year and the final year students, three elements i.e. integrity, teamwork and ethics were found to be significant

Conclusion: Professionalism assessment scale [PAS] can be used for the assessment of perception of professionalism among undergraduate medical students

Short term donor outcomes after hepatectomy in living donor liver transplantation

Objective: to determine the outcome of living-donor liver transplant [LDLT] donors from the first liver transplant program in Pakistan

Study Design: cohort study

Place and Duration of Study: shifa International Hospital, Islamabad, from April 2012 to August 2014

Methodology: a total of 100 live donors who underwent hepatectomy were included. Demographics, etiologies, graft characteristics and operative variables were retrospectively assessed. Outcome was assessed based on morbidity and mortality

Results: median donor age was 28 [17 - 45] years and median body mass index [BMI] was 24 kg/m[2] [15 - 36]. Male to female ratio was 1.5:1. Hepatitis B and C were the most common underlying etiologies and accounted for 79/100 [79%] of LDLT's. Overall, 93/100 [93%] donors donated a right lobe graft. Median estimated graft weight to recipient body weight [GW/BW] ratio was 1.03 [0.78 - 2]. Standard arterial anatomy was present in 56% donors. The 90-day morbidity was 13/100 [13%] and overall morbidity was 17/100 [17%]. Bile leak was encountered in 3 [3%] patients. There was no donor Mortality

Conclusion: acceptable short-term donor outcomes were achieved in an LDLT program in Pakistan with careful donor selection and planning

Evaluation of antimicrobial activities of Harmine, Harmaline, Nicotine and their complexes

Harmine, Harmaline, Nicotine and its various complexes synthesized have been characterized by physical, spectral and analytical methods and curtained for in-vitro antimicrobial activity against different bacterial and fungal species at two different concentrations i.e.100micro g/100micro l and 200micro g/100micro l dose level respectively. Analysis showed that Nicotine, Zinc-Nico, Cd-Nico, Hg-Nico, Ni-Nico, Cu-Nico, Co-Nico, Harmine, and Harmaline having conc. of 100ug/ 100ul had antibacterial activity on zero, 5, 4, 10, zero, 5, 7, zero, zero strain of bacteria having an average of zero [SD=0.0000], 15.2000 [SD=1.30384], 18.2500 [SD=3.30404], 20.2000 [SD=1.39841], zero [SD=0.0000], 14.6000 [SD=0.89443], 15.8571 [SD=1.34519], zero [SD=0.0000], zero [SD=0.0000] respectively. Zinc [II] chloride, Cadmium [II] Iodide, Mercury [II] chloride, Nickel [II] chloride, Copper [II] chloride, Cobalt [II] chloride, Mercury [II] chloride, Mercury [II] harmine, Mercury [II] harmaline at 100ug/100ul is valid for 7, 8, 9, 2, 7, 8, 9, 10, 8 strains of bacteria with an average of 7.1429 [SD=1.06904], 10.0000 [SD=5.01427], 14.8889 [SD=6.00925], 6.0000 [SD=0.0000], 8.5714 [SD=4.27618], 8.2500 [SD=0.88641], 14.8889 [SD=6.00925], 18.6000 [SD=2.45855], 18.5000 [SD=1.85164] respectively. The above given compounds at the conc. of 200 micro g/100ul is valid for 10, 9, 10, 8, 8, 10, 10, 10, 10 strains of bacteria with an average of 8.1 [SD=1.66333], 11.7778 [SD=5.28625], 16.1000 [SD=6.36745], 6.5000 [SD=0.92582], 9.7500 [SD=4.43203], 9.9000 [SD=2.76687], 16.1000 [SD=6.36745], 22.0000 [SD=2.44949], 20.4000 [SD=2.75681] respectively. The above given compounds at conc. of 200 micro g/100ul showed antibacterial action on 3, 8, 8, 10, 3, 9, 8, zero, 3 strains of bacteria with an average of 14[SD=0.000], 16.8750 [SD=1.35620], 18.2500 [SD=3.45378], 22.7000 [SD=1.82878], 14.3333 [SD=0.57735], 16.7778 [SD=1.71594], zero [SD=0.000], 12.0000 [SD=1.00000] respectively. Hence according to the average value of the zone of inhibition, maximum antibacterial activity at 100-200ug/100ul is of Hg-Nico and Mercury salt; Mercury [II] harmine having an average of 20.2000 [SD=1.39841]-22.7000 [SD=1.82878] and 18.6000 [SD=2.45855]-22.0000 [SD=2.44949]. Minimum antibacterial activity at 100-200ug/100ul is Nicotine100, Nicotine-Nico100, Harmine 100,Harmaline 100, Harmine 200 having zero average [SD=0.000]

Paediatric living donor liver transplantation: a single centre experience from Pakistan

Objective: To determine the outcomes of paediatric living donor liver transplantation [LDLT] recipients from Pakistan in terms of 90-day morbidity and mortality

Study Design: Cohort study

Place and Duration of Study: Shifa International Hospital, Islamabad, Pakistan, between April 2012 and April 2015

Methodology: All patients in paediatric age group [17 years] who underwent LDLT with a minimum follow-up of 3 months, were included. All grade 2 and above complications on Clavien-Dindo system were included as morbidity. The main outcome measure was 90-day morbidity and mortality

Results: Fourteen paediatric LDLTs were performed. Median age of the recipients was 8.5 years ranging between 6 months and 17 years. Wilson's disease and cryptogenic cirrhosis were the most common etiologies [28.6% each]. Acute liver failure was present in 5 [35.7%] patients. Overall 90-day morbidity and mortality was 71.4% and 14.2%; both were attributable to pulmonary infection. No difference was observed in morbidity [21.3% vs. 42.8%, p=0.3] and mortality rates [20% vs. 11%, p=1.0] between patients with acute and chronic liver failure. Estimated 3-year survival was 85%

Conclusion: Paediatric LDLT offers a promising treatment option for acute and chronic liver failure. Mortality was attributable to post-transplant pulmonary infections

Tuberculosis of intestine

Objective: to determine the clinical spectrum and surgical outcome of gastro-intestinal tuberculosis

Study design: descriptive case series

Place and Duration of study: department of General surgery ward 3 Jinnah Postgraduate Medical Center [JPMC] Karachi, from June 2010 - July 2015

Methodology: all patients who were diagnosed as cases of gastrointestinal tuberculosis and underwent operative procedures were included. Data was collected on a structured proforma. The variables collected included age of the patients, gender, clinical presentation, surgical procedures performed and outcome

Results: a total of 100 patients were managed. There were 67 female and 33 male patients. Female to male ratio was 2:1. The minimum age was 13 year and maximum 50 year with the mean age of 32 year. Apart from the constitutional symptoms like nausea, vomiting and low grade fever, abdominal pain was the commonest presentation. Eighty-eight patients were operated. End ileostomy, limited right hemicolectomy and resection anastomosis with primary repair were the commonly performed procedures. Two patients developed enterocutaneous fistulae. Five patients presented with septic shock and died

Conclusion: intestinal TB had varied presentation. It was found more frequently in females. Fever and weight loss were common presentations. High index of suspicion must be exercised in making a diagnosis

Acromion types and role of corticosteroid with shoulder impingement syndrome

Objective: To determine the association between shoulder impingement and morphological characteristics of acromion and the role of sub-acromial injection of methylprednisolone in the short-term treatment for relieving pain and improve functional disability of these patients

Study Design: A descriptive study

Place and Duration of Study: Department of Orthopedic Surgery and Traumatology Unit-I [DOST-I], Mayo Hospital, Lahore, between November 2013 to June 2014

Methodology: All patients presented in OPD with shoulder pain were included as subjects and evaluated by clinical test and categorised using X-ray scapula Y-view. Patients with impingement syndrome were correlated with Bigliani types and offered intra-lesional injection into sub-acromial space with 2ml of xylocaine 2% and 40 mg of methylprednisolone using 22 gauge needle. The effectiveness was assessed in terms of relieving pain and good functional outcomes; and rotator cuff tear was clinically assessed among impingement positive patient. The pain was assessed using visual analogue score before and after the administration of the injection. Demographic variables for frequencies and their associations were analysed using SPSS version 20.0. Significance level was p <0.05

Results: Among the 101 cases, there was no case of tear of rotator cuff tendon on clinical assessment. Majority of the patients [58.4%] were females with mean age of 31.38 +/- 1.13 years. Majority 57 [56.4%] of the patients had acromion type II [curved], which was the most common cause of shoulder impingement. Most had moderate pain. Thirty-four patients required intralesional steroid, which relieved the pain in 31 of them

Conclusion: Shoulder impingement syndrome without tear of rotator cuff tendon was found in younger age group between 40 to 45 years, which was relieved by intralesional corticosteroid administration. These patients had type II [curved] acromion, according to Bigliani classification

Comparison of fistulectomy with fistulotomy in low fistula in Ano

Objective: To compare the outcomes in terms of healing after fistulotomy and fistulectomy for low lying fistulae in ano

Study design: Cross sectional analytic

Place and Duration of study: Department of Surgery, Surgical Unit I, Jinnah Postgraduate Medical Centre Karachi, from June 2013 to May 2015

Methodology: Patients of both genders between 12 to 60 year of age with clinical diagnosis of fistula in ano were included in the study. Pain was assessed on visual and analog scale [VAS] Hospital stay was also recorded. All were followed for four week for any complications

Results: During the study period 120 patients were enrolled. Out of these 60 patients had fistulotomy and 60 underwent fistulectomy for fistula in ano. Male predominated with male to female ratio of 3:1. Swelling [86.6%], discharge [37%] and itching [27%] were the common symptoms. The mean duration of hospital stay was 3 +/- 1 day. Postoperative wound healing and pain assessed by VAS, were high in fistulectomy group. All patients recovered during follow up except one who continued to complain incontinence from fistulectomy group

Conclusion: Fistulotomy yielded better results as compared to fistulectomy for the treatment with low fistula in ano

Capsule endoscopy: is it really helpful in the diagnosis of small bowel diseases?

Objective: to determine the diagnostic yield and safety of capsule endoscopy for small bowel diseases

Introduction: the small bowel evaluation for any pathology has always been a difficult task because both upper GI endoscopy and colonoscopy could not access this area and other radiological tools like barium studies and CT enteroclysis were less sensitive with associated risk of radiation exposure. Only Push enteroscopy could evaluate the small bowel effectively but was laborious and invasive. Capsule endoscopy was introduced in year 2000 and was accepted with great enthusiasm all over the world3. Now, during the past few years it has also been used for the diagnosis of acute gastrointestinal bleeding in emergency departments and results are quite encouraging 5,6. The procedure was introduced at Department of Gastroenterology-Hepatology, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan in year 2009. Since then, it has been regularly used for investigation of small bowel abnormalities

Methods: video Capsule Endoscopy [VCE] using GIVEN Imaging system was performed on 60 patients having various indications like obscure GI bleeding, undiagnosed iron deficiency anemia, abdominal pain and malabsorption. This was a retrospective analytic study carried out at the Department of Gastroenterology-Hepatology, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan from February 2009 to June 2014. Statistical Analysis was done using SPSS version 22

Results: out of 60 patients, 41 [68.33%] were male, 19 [31.67%] were female. Mean age was 52 years with minimum 11 years and maximum of 85 years. No lesion was found on examination in 8.33% [n=5] patients while presence of blood in the gut resulted in poor visualization in 3.33% [n=2] patients. In remaining 88.34% [n=53] patients, the procedure detected various intestinal lesions. Our study detected presence of Angioectasias in 30.0% [n=18], visible vessels in 6.67% [n=4], strictures in 5.0% [n=3], small bowel ulcers in 10.0% [n=6], edema and erosions in 8.33% [n=5], loss of villi in 11.68% [n=7], intestinal worms in 3.33% [n=2], mass lesions in 8.33% [n=5] and Angioectasia with ulcers in 5.0% [n=3] of patients. The diagnosis in 3 patients was further verified by surgical operation, while enteroscopy was done in 2 patients for confirmation. Capsule impaction occurred in 2 patients. All images of Video Capsule Endoscopy [VCE] were of good quality

Conclusion: capsule endoscopy is a safe and effective procedure with a good diagnostic yield and can be used routinely for the diagnosis of small bowel diseases

Effect of place of birth, mode of transport and medical skills of the accompanying person on mortality of neonates

Objective: To determine the effect of place of birth, mode of transport and medical skills of the accompanying person on mortality of neonates

Study Design: A descriptive study

Place and Duration of Study: Military Hospital [MH], Rawalpindi from October 2011 to March 2012

Patients and Method: One thousand two hundred and ninety three neonates of either gender under the age of 28 days admitted to NICU either as indoor or outdoor were entered in the study. Data included high risk obstetric factors, gestational age, birth weight, APGAR score, gender, need for resuscitation, diagnosis, complications, place of delivery, mode of delivery and outcome. The associations between the place of delivery, mode of delivery and medical skills of the accompanying person with the neonatal mortality were associated using the Pearson Chi-Square method

Results: A total of 1293 neonates were included in the study and their data regarding place of delivery and mode of transport was evaluated. Four hundred and two [402/1293] cases died in our NICU and the mortality rate of the neonates admitted in our setup was 31.1%. The breakup of neonatal deaths was further subdivided into the patients born in health care with NICU facility [25%], those born in health care without NICU facility [33.60%] and those born in the community setting [40.54%]. The aforementioned percentages were calculated out of the total live births in that particular setup and do not represent mere breakup of total mortality. A total of 50.32% neonates brought to hospital in an unequipped vehicle expired versus 2.28% mortality of neonates that were brought in a medically equipped vehicle. The neonatal mortality rate in patients accompanied by unskilled personnel was 40% versus skilled personnel which was 1.62%. Statistically significant associations using Pearson Chi-Square method were seen between the place of delivery, mode of transport, the skills of the person accompanying the patient in the transport and neonatal mortality [p value = 0.001 each]

Conclusion: Results of this study prove that the quality of birth services and patient transport mechanisms directly affect the neonatal survival and babies who are born in community setting, transported in unequipped vehicle without a skilled medical attendant are at a higher risk for mortality than the patients born in NICU facility, transported in an equipped vehicle and accompanied by skilled medical attendant

Neonatal idiopathic primary hypoparathyroidism: a rare cause of neonatal seizures

Etiology of neonatal seizures [NNS] is diverse and hypocalcemia is one of the treatable causes. Neonatal hypocalcemia [NHC] due to congenital hypoparathyroidism, either permanent or transient, is extremely rare. Its biochemical abnormalities include hypocalcemia, hyperphosphatemia and low levels of intact parathyroid hormone [PTH]. Isolated congenital hypoparathyroidism in which deficiency of PTH has no association with maternal, syndromic or endocrine defects is a very rare entity. We are reporting a case of a newborn who presented with seizures on the 5th day of life and later on investigations revealed hypocalcaemia due to isolated congenital hypoparathyroidism

Phytochemicals, in vitro antioxidant, total phenolic contents and phytotoxic activity of Cornus macrophylla Wall bark collected from the north-west of Pakistan

Plants are one of the precious creatures of Allah, producing a verity of useful bioactive compounds having definite pharmacological actions on human body. Keeping in view this idea, the methanolic extract from the bark of Cornus macrophylla was investigated for phytochemicals, antioxidant, total phenolic contents [TPC] and phytotoxic activities. Phytochemical analysis of Cornus macrophylla revealed the presence of tannins, anthraquinones, glycosides, reducing sugar, saponins and flavonoids. The percent free radicals scavenging potential of DPPH at 20, 40, 60, 80 and 100 micro g/ml was 72.69%, 73.32%, 73.51, 73.83% and 74.33% respectively and were compared to ascorbic acid [84.6%, 92.83%, 95.36%, 96.40% and 98.03%], gallic acid [85.49%, 92.47%, 95.14%, 98.22% and 98.03%] and quercetin [95.35%, 96.30%, 97.16%, 98.02% and 98.28%] as standards. The IC[50] value of Cornus macrophylla was 14.5/ micro g/ml. The TPC of the methanolic bark extract was 2.916 mg gallic acid equivalents/g of extract. The extract have shown excellent phytotoxic activity against the tested plant Lemna minor and inhibited the growth at 1000 micro g/ml. Our findings revealed that the crude methanolic extract of Cornus macrophylla is a potential source of natural antioxidants and herbicidal

Methylmalonic acidemia

Methylmalonic Acidemia [MMA] is an inborn error of metabolism that results in accumulation of methylmalonic acid in blood and increased excretion in urine. The effects of MMA vary from mild to life threatening and it usually presents in early infancy. Affected infants can have vomiting, dehydration, hypotonia, developmental delay and failure to thrive. The emergency treatment of the newborn with MMA mainly comprises rehydration and promotion of anabolism, followed by long-term dietary management by both the restriction of precursor amino acids using a low protein diet and avoidance of prolonged fasting. Prognosis depends on the type of MMA and whether the condition is well controlled in general and during episodes of metabolic decompensation. We report here the presentation and management of a 2-year boy with MMA who failed to achieve expected milestones for age. To the best of our knowledge, only one case of MMA has been reported from Pakistan

Larvicidal, insecticidal, brine shrimp cytotoxicity and anti-oxidant activities of Diospyros kaki [L.] reported from Pakistan

Diospyros kaki is cultivated in different agro-ecological zones of Pakistan, especially in Malakand division. The current study was designed to investigate the hide potential of the vulnerable species of the plant. Aqueous extracts of Diospyros kaki leaves were screened for larvicidal, insecticidal cytotoxic and antioxidant activities. The extract exhibited moderate to outstanding larvicidal activity [100 to 28%] at 100, 80, 70, 50, 40, 30, 20 and 10% concentrations respectively after 24 hours, showing 42% LCso. Permitrin displayed 100% lethality at 0.3%. The extract demonstrated outstanding cytotoxic action against brain shrimps nauplii [Artemia salina], showing 10 ppm LC[50] which is closed to the LC[5]o [9.8jtig/ml] of standard drug Etoposide. Similarly profound insecticidal potential [100%] was recorded after 15 min against Cimex lectularius. In DPPH scavenging activity the extract demonstrated moderate 30.22%, while Quercetin, Gallic acid and Acetic acid showed 98, 96 and 97% activity respectively at lOOppm. Thus on the basis of our finding it could be concluded that the decoction of the leaves of D. kaki is a good natural alternative for the control of insects and neoplasia

Frequency of helicobacter pylori [HP] infection in children with recurrent abdominal pain [RAP]

To study the frequency of Helicobacter Pylori [HP[infection among children with recurrent abdominal pain [RAP]. Cross-sectional comparative study. Military Hospital [MH], Rawalpindi from December 2011 to February 2012. One hundred children of either gender aged 2 to 12 years presenting with RAP were tested for HP at Paediatric OPD MH, Rawalpindi who consented to participate in the study. Those children who tested positive for Helicobacter Pylori Stool Antigen Test [HPSAT] were labeled as those having Hp infection. The stool assay was performed using the HpSAT kit and the socio-demographic and clinical profiles of children were associated. Out of 100 children included in the study HpSAT was positive in 38% children. Frequency of Hp infection was significantly associated with source of drinking water [p = 0.014], socioeconomic status [p =0.001] and positive family history of dyspepsia [p= 0.023]. While age and gender have no significant association with HP infection. Hp infection is very common in children presenting with RAP in our Paediatric OPD. Children with family history of dyspepsia, from low socioeconomic class and those drinking filtered water are at greater risk for HP infection. It is recommended that children from other populations in our country should also be tested in their medical health facilities in order to have a wider analysis of this problem in our setup

five years old girl child with takayasu arteritis

Takayasu arteritis is a systemic vasulitis of large vessels that mainly involves the aorta and its branches. It normally presents in third decade of life and has rarely been reported in children under 10 years of age. We report here a case of Takayasu arteritis in a 5 years old girl who presented with headache, generalized body swelling, severe hypertension, proteinuria and minimal functioning kidneys. Conventional angiography demonstrated narrowing of descending aorta, right subclavian artery and right common iliac artery. She responded steroids, diuretics, antiplatelets and digoxin and discharged home on maintenance therapy.