Renal Scarring in Children with Primary Vesicoureteral Reflux Disease

Aims:To determine the incidence of renal scarring among patients with primary vesicoureteral reflux (VUR) and the possible risk factor(s), we studied 69 children (42 girls and 27boys) with VUR attending the Pediatric opd.Study Design:Prospective Observational study.Place and duration of Study:Department of pediatrics,Sher I Kashmir Institute of Medical Sciences,Srinagar, Kashmir between June 2017 to June 2018.Methodology:All the patients were assessed for VUR grade by voiding cystoureterography and for presence of renal scarring by (99 m) technetium dimercapto–succinic acid scintigraphy. Results:Grade of reflux and number of urinary tract infection (UTI) episodes (≥3) were found to be statistically significant risk factors for renal scarring (P <0.05). However,there was no significant association with gender,familial history and laterality of the disease (P >0.05). Similarly, there was no statistically significant difference of frequency of renal scarring among the different age groups (P >0.05).Conclusions:It was concluded that recurrences of UTI and VUR severity are significant risk factors for renal scarring in children with VUR. Therefore,identification of VUR at an early age may offer the opportunity to prevent episodes of UTI and possible formation of renal scars that may result in end-stage renal failure

Cerebrospinal fluid lactate: a differential biomarker for bacterial and viral meningitis in children / Lactato no líquido cefalorraquidiano: um marcador diferencial para meningite bacteriana e meningite viral em crianças

Abstract Objective: To assess the performance of cerebrospinal fluid (CSF) lactate as a biomarker to differentiate bacterial meningitis from viral meningitis in children, and to define an optimal CSF lactate concentration that can be called significant for the differentiation. Methods: Children with clinical findings compatible with meningitis were studied. CSF lactate and other conventional CSF parameters were recorded. Results: At a cut-off value of 3 mmol/L, CSF lactate had a sensitivity of 0.90, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.963, with an accuracy of 0.972. The positive and negative likelihood ratios were 23.6 and 0.1, respectively. When comparing between bacterial and viral meningitis, the area under the curve for CSF lactate was 0.979. Conclusions: The authors concluded that CSF lactate has high sensitivity and specificity in differentiating bacterial from viral meningitis. While at a cut-off value of 3 mmol/L, CSF lactate has high diagnostic accuracy for bacterial meningitis, mean levels in viral meningitis remain essentially below 2 mmol/L.

Resumo Objetivo: Estudar o desempenho do lactato no líquido cefalorraquidiano como biomarcador para diferenciar a meningite bacteriana da meningite viral em crianças, e definir uma concentração de lactato ótima no líquido cefalorraquidiano que possa ser significativa para a diferenciação. Métodos: Foram estudadas crianças com achados clínicos compatíveis com meningite. O nível de lactato no líquido cefalorraquidiano e outros parâmetros convencionais do líquido cefalorraquidiano foram registrados. Resultados: Em um valor de corte de 3 mmol/L, o lactato no líquido cefalorraquidiano apresentou uma sensibilidade de 0,90, especificidade de 1,0, valor preditivo positivo de 1,0, valor preditivo negativo de 0,963, com uma precisão de 0,972. Os índices de probabilidade positivo e negativo foram 23,6 e 0,1, respectivamente. Para comparação entre a meningite bacteriana e viral, a área abaixo da curva do lactato no líquido cefalorraquidiano foi 0,979. Conclusões: Concluímos que o lactato no líquido cefalorraquidiano possui alta sensibilidade e especificidade na diferenciação da meningite bacteriana da meningite viral. Embora em um valor de corte de 3 mmol/L o lactato no líquido cefalorraquidiano possua alta precisão de diagnóstico da meningite bacteriana, os níveis médios na meningite viral permanecem basicamente abaixo de 2 mmol/L.

Validation of the Mizaj of heart by determining the ash value of vital organs of three species

This study aimed to determine the cause of Yabis attribution in the heart by estimating the ash value of three vital organs, such as heart, brain, and liver, of three species, chicken, goat, and buffalo. Creatures are composed of Arkan Arba'a in varied proportions, qualitatively and quantitatively most suitable for accomplishing their functions. Philosophers have described the structural and functional variabilities of species in terms of the Mizaj, which relates to its possible dominant Rukn. The Mizaj of human beings is described as the reflection of the Mizaj of their heart and the organs connected to it. The Mizaj of heart is attributed as Harr-Yabis

Twenty-seven samples of vital organs of three species, each obtained from market, were subjected to total ash value determination. The procedure was followed in accordance with the International Standard, ISO 936:1998[E]

The mean ash value of the chicken's heart, brain, and liver was 5.18%, 7.62%, and 6.56%, respectively. The mean ash value of the goat's heart, brain, and liver was 2.53%, 11.18% and 4.24%, respectively. The mean ash value in the buffalo's heart, brain, and liver was 5.32%, 8.74%, and 6.56%, respectively

Interpretation and Conclusion: Yubusat is required for hardness, stiffness, and durability to stay active and dynamic. Compared with the brain and liver, the heart's rigid nature, consistent action, and resemblance with the coniferous shape of Rukn Nar indicates the presence of Yubusat Nariyya. In this study, the least mean total ash value of the heart among all the three species implies the least presence of Ajza' Ardiyya, thus validating the presence of Yubusat Nariyya in it. Therefore, the heart's structure and function are in accordance with its Hararat and Yubusat Nariyya

Tracheostomy complications in admitted IDPs patients in a teaching hospital of Bannu

Objectives: The main objectives of this study were to evaluate the complications of tracheostomy in IDPs patients who were admitted in DHQ teaching hospital Bannu and further the study of complications in relation with tracheostomy types, age and tracheostomy tubes types

Study Design: Observational / analytic / cross sectional study

Place and Duration of Study: The study was conducted at the ENT Unit, DHQ Teaching Hospital, Bannu from April 2015 to December 2015

Materials and Methods: 60 patients undergoing tracheostomy, having an age group of 3 to 65 and fulfilling inclusion and exclusion criteria were selected. Elective and emergency tracheostomy was included in the study period. "Open surgical technique" was done. Metallic and portex cuffed rubber tubes ware used. To record any possible complication, a pre-designed proforma was used

Results: The study comprised 42 males and 18 females. The mean age of the patients was 30 years[SD+18.20]. Elective tracheostomy was done in 10% while emergency tracheostomy was done in rest of the 90% patients. Metallic tubes were used in 20% and portex cuffed rubber tubes in 80% of the patients. The recorded complication rate was 40% overall. There was an 18% immediate, 11% intermediate and 11% late complications. Complication rate was somewhat elevated in early age. Bleeding was commonest complication [20%] among all followed by emphysema, dysphagia and aspiration [4% each]. Complication rate of emergency tracheostomy was higher than elective one. Similarly, complication rate with portex cuffed rubber tubes was greater than metallic tubes

Conclusion: Rate of complication in emergency tracheostomy was higher than elective tracheostomy where as in elder patients; it was lower than in younger patients. Similarly, complication rate was greater with portex cuffed rubber tubes. From the study, it is concluded that post op care can minimize the chances of post tracheostomy complications

Intragenic deletion mutation in the gene desmoglein 4 underlies autosomal recessive hypotrichosis in six consanguineous families

Objectives: Localized autosomal recessive hypotrichosis is a non-syndromic human hair loss disorder, affecting scalp, eyebrows and eyelashes, and other parts of the body. Six consanguineous families with this form of hair loss disorder were investigated at both the clinical and molecular levels

Methods: Linkage in six families with twenty-one affected members was tested by genotyping microsatellite markers linked to autosomal recessive hypotrichosis loci including localized autosomal recessive hypotrichosis [LAH] 1, 2 and 3. Sequence analysis of the entire coding and splice sites of the gene DSG4 was performed to search for the disease-causing mutation

Results: Genotyping established linkage in families to the DSG4 gene at LAH1 locus on chromosome 18q21.1. Sequence analysis detected an intragenic deletion mutation [Ex5_8 del] in affected members of all six families

Conclusion: Identification of recurrent mutation in six additional Pakistani families strengthens the body of evidence that this is an ancestral mutation that is widespread among different Pakistani ethnic groups

Homozygous mutations in NTRK1 gene underlie congenital insensitivity to pain with anhidrosis in Pakistani families

Congenital insensitivity to pain with anhidrosis is a rare autosomal recessive disorder presenting with loss of pain sensation, thermal sensation defects, and self-mutilating behavior. In the present study, we recruited two consanguineous pedigree showing pain insensitivity symptoms from Pakistan for clinical and molecular investigations. In family A, one female patient displayed classical CIPA symptoms along with microcephaly and severe intellectual disability. During course of the disease, her right foot was amputated and had remarkable dental degeneration and teeth shedding. In family B, one boy presented with classical symptoms of congenital insensitivity to pain with anhidrosis. Blood was collected from both families for molecular studies. Sequencing with the Ilumina Trusight One Sequencing Panel covering 4813 OMIM genes revealed a known homozygous mutation c.2084C>T; p.P695L of NTRK1 in family A and a novel truncated mutation c.2025C>G; p.Y681X in family B. Protein modeling analysis of both mutations (p.P695L and p.Y681X) predicted loss of the rigidity in tyrosine kinase domain of NTRK1 that led to conformational changes as well as deleterious effect on protein function. The known mutation was reported more than a decade ago in a family from Northern Israel and other non-sense mutation is newly identified. It is interested that most of NTRK1 mutations are associated with this domain. This is first ever report of NTRK1 variants in congenital insensitivity to pain with anhidrosis patients from Pakistan.

Risk factors for diabetic foot ulcer

Diabetic foot is one of the common complications of diabetes mellitus. Many risk factors are involved in its causation. This study was conducted to determine risk factors responsible for foot ulcer in diabetic patients. A total of 196 consecutive patients with diabetic foot were included in the study. Detailed history, clinical findings and investigations were recorded. Lesions were graded according to Wagner's classification, and appropriate medical and/or surgical treatment was carried out. Patients who did not consent to participate in the study, had established gangrene of the foot, or had any medical co-morbidity especially chronic heart failure and chronic renal failure which could influence these risk factors were excluded from the study. Data were collected on a special proforma for analysis. Out of 196 patients 80.1% were male. One hundred and forty-six [74.48%] patients were in the range of 40-70 years. Right foot was more commonly involved [65.3%], 91.3% patients had diabetes of more than 5 years duration. No treatment had been received by 47.4% patients while 41.3% were on oral anti-diabetics; 11.2% patients were on insulin. All patients had type 2 diabetes mellitus. Neuropathy was present in 51% patients, 62.8% had absent or diminished peripheral pulses, 43.4% had poorly controlled diabetes. According to the Wagner classification 30.6% patients had grade 1, 26.5% had grade 2, and 42.9% had grade 3 diabetic foot. Evidence of infection was seen in 85.7% patients; staphylococcus aureus was isolated in 43.4% patients. Osteomyelitis was present in 42.9% patients. Surgical intervention was performed in 85.7% patients. Direct relation was found between the duration of diabetes, sugar control, peripheral neuropathy, peripheral arterial disease, grade of diabetic foot, evidence of osteomyelitis, intervention and the outcome of the disease. Neuropathy, peripheral arterial disease, duration of diseases and underlying osteomylitis are the major risk factors and need to addressed while educating patients

Physico-chemical standardization of Tukhm-e-qurtum [Carthamus tinctorius Linn]

Carthamus tinctorius, Linn. [Qurtum] of the family Compositae, is an annual plant which grows in tropical and sub-tropical parts of India. The seeds of the taxon are extensively used in Unani system of medicine as anti-inflammatory, antiasthmatic, aphrodisiac, blood purifier, carminative, diuretic, emmenagogue, expectorant, hepatoprotective, lithotryptic, liver tonic, purgative, sex stimulant, spermatogenic and tonic. In view of the medicinal value of this plant as described in Unani literature, the present study has been designed to set the physico-chemical standards of the seeds of Carthamus tinctorius, Linn. evolving some important parameters such as extractive value in different solvents, alcohol and water soluble contents, moisture contents, total ash value, water soluble ash value, acid insoluble ash value, bulk density, pH, chemical reactions, fluorescence analysis and thin layer chromatography. These parameters shall be valuable in quality control and identification of the drug

Ethnomedicinal plants of Mansoora, Malegaon

An ethnobotanical survey of Mansoora, Malegaon, India was conducted to record the plants and mentioned in the present paper. The people living in the surroundings of Mansoora use these plants to meet their daily requirements of medicine, food, fodder and shelter. The ethnomedicinal uses range in diverse diseases like gonorrhoea, impotency, irregular menstruation, stomach complaints, white discharge, prostate enlargement, urinary stones, goiter, pimples, ringworm, jaundice, toothache, rheumatism etc.; apart from common diseases/ailments like fever, cold, cough, headache, burns, snake bite and swellings. The botanical and vernacular names, family, plant part used and traditional uses are given for each plant. The present study aims to draw the attention of phytochemists and pharmacologists to the need of further critical study. If the efficacy of each plant is scientifically established then these plant drugs can be recommended to the rural people who can frequently employ these potential drugs due to their availability

Ibn Sina The Prince of Physicians

Abu Ali al-Husain Ibn Abdullah Ibn Sina who has been called the 'Prince of Physicians', is known as Avicenna in the West. He was born in the village Afshana near Khorasan in Iran in August, 980 A.D. [Safar 370 H] and brought as a child to Bukhara where he received his earliest education under the direction of his father who was a high official. With an exceptional memory he had memorized the Qur'an and much Arabic poetry by the age of 10 years. Thereafter, he studied logic and metaphysics under teachers whom he soon outgrew and then spent the few years until he reached the age of 18 years in his own self education. He read avidly and mastered Islamic law, then medicine and finally metaphysics. He became court physician at the age of 18 years. He is supposed to have written 105 works upon a great variety of subjects in Arabic and Persian. The collection of his original observations intended as an appendix to the theoretical works, was unfortunately lost even before publication. He particularly contributed in the field of Aristotelian philosophy and medicine. He composed the Kitab ash-Shifa [Book of Healing], a vast philosophical and scientific encyclopedia, and Al-Qanoon Fi al-Tibb [The Canon of Medicine] which is among the most famous books in the history of medicine in both East and West. It was a compilation of his experiences in the practice of medicine and a compendium of all that was known about medicine at that time. It became the medical authority for several centuries and used at many medical schools as late as 1650 and reputedly is still used in the East. There is a need to evaluate the works done by Ibn Sina for further development of Unani medicine. Therefore, present paper is aimed at discussing the life of Ibn Sina and his contribution to medicine and related fields. The details are discussed in full length paper.

Physico-chemical standardization of seeds of kaknaj [Physalis alkekengi Linn]

Physalis alkekengi Linn. [Kaknaj] of the family Solanaceae, is a diffuse perennial herb about 80 cm [32 inches] in height. The fruits are reddish or orange red in colour, fully covered in a thin sheath of membrane giving it a shape of urinary bladder and contain large number of flattened reniform seeds of light brown colour. The fruits are extensively used in Unani System of Medicine as anaesthetic, anthelmintic, anti-inflammatory, cicatrizant, contraceptive, diuretic, haemostyptic, hepatoprotective, lithotriptic and nephroprotective. In view of the medicinal value of this plant as described in Unani literature, the present study has been designed to set the physico-chemical standards of the fruits of Physalis alkekengi Linn, evolving some important parameters such as extractive value in different solvents, alcohol and water soluble contents, moisture contents, total ash value, water soluble ash value, acid insoluble ash value, bulk density, pH, chemical reactions, fluorescence analysis and thin layer chromatography. These parameters will prove to be instrumental in quality control and identification of the drug