Effectiveness of a Glyceryl Trinitrate (GTN) Patch in Preventing Amputation, Improving Pain Control and Reducing the Size of Tissue Loss for a Patient With Critical Limb-Threatening Ischaemia (CLTI).

Background  Foot ulcer is a common complication of poorly controlled diabetes and peripheral vascular disease (PVD). The current standard of treatment for diabetic foot ulcers includes the management of underlying risk factors, wound debridement, use of antibiotics for infection, off-loading with cast, and revascularisation surgery. The glyceryl trinitrate (GTN) patch is currently off-licence in treating PVD or diabetic foot ulcers. This study aims to evaluate the effectiveness of the GTN patch in preventing amputation, improving pain control, and reducing the size of tissue loss (ulcer/gangrene) or localised ischaemic area. Method This is a pilot study of 30 patients who were started on the GTN patch from February 2020 to October 2021. Inclusion criteria were patients who have critical limb-threatening ischaemia (CLTI) and with no viable options or are at high risk for revascularisation, both endovascular and open surgery. Patients who were on a GTN patch for less than six weeks at the time of data collection or had unclear outcomes were excluded. The outcomes were retrospectively collected on prevention of amputation, improvement in pain control, and reduction in tissue loss (the size of ulcer/gangrene) or localised ischaemic area with the use of a GTN patch. The binomial test was used to compare the observed outcome of the GTN patch and the expected outcome, which was assumed to be 50% in this study. Results  Ninety-three per cent (93%) of the patients who had GTN patches successfully avoided amputation (p<0.0001). Eighty-four per cent (84%) of patients reported better pain control (p=0.0022) and improvement in the size of ulcer/gangrene/localised ischaemic areas (p=0.0005). Conclusion The GTN patch is effective in preventing amputation, improving pain control, and reducing the size of ulcer/gangrene/localised ischaemic areas in patients who have end-stage CLTI and no viable options or who are at high risk for revascularisation surgery.

Comparison of light-emitting diodelights vs fluorescent light phototherpy for the treatment of unconjugated hyperbilirubinemia in preterm infants - Randomised Control Trial.

OBJECTIVE: To compare the mean treatment duration of phototherapy when done with light-emitting diodelights versus fluorescent lights for the treatment of unconjugated hyperbilirubinaemia in preterm infants. METHODS: The randomised controlled trial was conducted at Allied Hospital, Faisalabad, Pakistan, from September 12, 2015, to March 11, 2016, and comprised patients with unconjugated hyperbilirubinaemia. Detailed history, including demographic information, were noted. The patients were divided into two groups using computergenerated random number tables. Group A received light-emitting diode light phototherapy and group B received fluorescent light phototherapy. Initially complete blood count with peripheral film, retic count, coombs test, blood group, serum bilirubin level (total, direct, indirect) were done. Serum bilirubin was checked by bilirubinometre 6hourly till the end of treatment. Data analysis was done using SPSS 20.. RESULTS: There were 460 patients divided into two equal groups of 230(50%) each. Mean age was 32.34}2.28 weeks in Group A and 32.21}2.11weeks in Group B. In Group A, 116(50.43%) subjects were boys and 114(49.57%) were girls. In Group B, 120(52.17%) were boys and 110(47.83%) were girls. Mean duration of treatment was recorded as 36.83+2.09 hours in Group A and 45.66+2.52 hours in Group B. (p=0.0001). CONCLUSIONS: The mean duration of treatment of phototherapy with light-emitting diodelights lights was significantly shorter compared to fluorescent lights.

FREQUENCY OF SPLENOMEGALY IN DENGUE FEVER IN CHILDREN.

BACKGROUND: Dengue Fever is caused by arthropod born viruses. According to World Health Organization approximately 50-100 million infections of dengue fever occur yearly. Objective of this study was to determine the frequency of splenomegaly in dengue fever in children. METHODS: This cross sectional study was conducted at the Department of Paediatrics, Allied Hospital, Faisalabad, during a period from June 2012 to May 2013 by including 93 Children, aged 4-14 years presenting with fever of less than 14 days with thrombocytopenia and positive IM or IgM and IgG dengue antibodies by ELISA. Patients were thoroughly evaluated by detailed history and clinical examination. Ultrasonography of the patients was performed to confirm the splenomegaly. The data was analysed to determine the frequency and percentage of disease. RESULTS: Out of 93 children, 51 (54.8%) were male and 42 (45.2%) were female. The most common clinical presentation was noted is chills and rigors in 80 (86.02%). Unusual clinical features were encephalopathy in 3T (39.78%) followed by bleeding manifestations and upper respiratory tract infection (upper RTI). Splenomegaly was seen in 45 (48.4%) children. CONCLUSION: Dengue fever is increasingly presenting with atypical presentation like splenomegaly, encephalopathy, bleeding manifestations and upper RTI.

Comparison of deferiprone and deferrioxamine for the treatment of transfusional iron overload in children with beta thalassemia major.

BACKGROUND: Thalassemia major is the most common genetic disorder in Pakistan. The study was done to compare the efficacy and safety of the deferiprone with deferrioxamine for the treatment of iron overload in children with thalassemia major. METHODS: This randomized controlled trail was conducted at thalassemia blood transfusion unit of Allied Hospital, Faisalabad (AHF)/District Headquarter Hospital (DHQ), Faisalabad. Thalassemia-Unit Hilal-e-Ahmar, Alizeb Foundation and Blood Bank Services Faisalabad from November 2010 to December 2011.Children with beta thalassemia major of age more than 2 years and less than 16 years with transfusion iron over load were randomly allocated to one of the two groups each comprising of 67 patients. One group received deferiprone given at a daily dose of 75mg/kg in three divided doses orally while the other group received deferrioxamine at dose 50 mg/kg/24hrs for 5 days/week as parental infusion. Changes in the serum ferritin level were assessed. Cardiac function and toxicity were also examined. RESULTS: Serum ferritin was significantly reduced after 1 year in both treatment arms (p=0.01). Neutropenia observed in 13 (19.40%) non-splenectomized patients taking deferiprone. Transient elevations in ALT were observed in 3 (4.47%) children taking deferiprone. Left ventricular ejection fraction (LVEF) remained in normal range in both treatment arm but has decreased significantly in Deferrioxamine group compliance. Compliance was better in deferiprone as compared to deferrioxamine. Discontinuing percentage 2 (3%) vs 9 (13.43%). CONCLUSION: Deferiprone is a highly efficacious and safe chelation therapy for patients with thalassemia major who are non-compliant to Deferrioxamine. Deferiprone have an efficacy profile comparable to standard Deferrioxamine.

Iron status: is there a role in febrile seizures?

BACKGROUND: Febrile seizure a common convulsion disorder in children, can lead to increased morbidity and mortality because of risk of aspiration and hypoxia during prolonged febrile seizures. There are many risk factors associated with febrile seizures and their recurrence. We conducted this study to see if there is a role of iron status in febrile seizures. METHODS: This cross-sectional study was conducted in 323 children 6 months to 5 years of age admitted in department of Paediatric DHQ Hospital Faisalabad with fever and seizures from July 2009 to April 2011. Iron deficiency anaemia including haemoglobin concentration (Hb), Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH) and Plasma Ferritin were measured. RESULTS: Febrile seizures were more common between ages 12 months to 36 months. Of 323 children with febrile seizures 17 (5.3%) were iron deficient. Mean Hb was 11.71+/- 1.38 g/dL, mean MCV 78.40 +/- 3.29, mean MCH 27.11 +/- 3.28, and mean ferritin was 66.57 +/- 24.7. CONCLUSION: Iron deficiency anaemia was not common in patients with seizures. Iron status has no role in febrile seizures.

Is delayed diagnosis of hypothyroidism still a problem in Faisalabad, Pakistan.

OBJECTIVE: To determine the age at diagnosis of hypothyroidism, to signify the effect of delayed diagnosis on the clinical presentation of hypothyroidism and hence to emphasize the need for early diagnosis by cost effective neonatal screening. METHODS: The study was a descriptive case series carried out at the Department of Paediatrics, Allied Hospital, Faisalabad from 2004 to 2006. One hundred consecutive cases of hypothyroidism from birth to twelve years of life were included. The age at presentation and age related clinical features were determined. RESULTS: The age at diagnosis ranged from birth to 16 years. Male to female ratio was 1:1. Congenital hypothyroidism was more common than acquired(92% VS 8%). Maximum number of cases (42%) were diagnosed between 1-5 years of age while only 14% were diagnosed before 3 months of age. Developmental delay (66%), constipation (51%) and lethargy (37%) were more common symptoms while common signs were pallor (65%), short stature (61%), coarse facies (53%), wide anterior fontanellae (46%) and coarse skin (42%). CONCLUSION: Early diagnosis by neonatal screening and commencement of treatment is recommended to prevent the effects of delayed diagnosis.

Seizures etiology in the newborn period.

OBJECTIVE: To determine the causes of seizures in the newborn period. DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Neonatal Unit, Paediatric Department, Allied Hospital, Faisalabad, from April 2003 to June 2004. PATIENTS AND METHODS: A total of 200 neonates of either gender who presented with seizures or developed seizures during hospital stay were evaluated for the possible etiological factors. Blood glucose, serum calcium, blood counts, cerebrospinal fluid examination and cranial ultrasound were done in all patients while blood culture, serum creatinine, CT scan, metabolic screening and Torch antibody titre were done in selected patients guided by history, examination and initial investigations. Results were analysed using SPSS software and Chi-square test. P-value of less than 0.05 was considered significant. RESULTS: Birth asphyxia was the commonest cause of seizures in the newborn period present in 35% (n = 70) cases. Other commonly identified causes were septicaemia with or without CNS infections 34% (n = 68), metabolic abnormalities 12.5% (n = 25), and intracranial bleed 9.5% (n = 19) cases. Less common causes were kernicterus 4.5% (n = 9), hydrocephalus 1.5% (n = 3), brain malformations 1% (n = 2) and lignocaine toxicity 1% (n = 2) cases. Seizure with presumed idiopathic etiology i.e. 5th day fit was found in only 1% (n = 2) cases. CONCLUSION: Etiology of neonatal seizures was identified in 99% cases. It is concluded that neonatal seizures are rarely idiopathic, therefore, an extensive diagnostic work up is needed to establish the cause of seizures in the newborn period.