Construction and validation of ShaMaq developmental screening tool.

INTRODUCTION: The diagnosis of developmental delay and early intervention ameliorates long-term sequelae. There is a need for an appropriate, regionally adapted and reliable developmental screening tool to be used in low and middle-income countries with scarce resources. AIM: The aim of this research is to construct and validate a screening tool for identifying developmental delay in Pakistani children. METHOD: ShaMaq developmental screening tool (SDST) was developed consisting of five proformas to be administered at different age groups: 6-8 weeks (Group 1), 6-10 months (Group 2), 18-24 months (Group 3), 3-3.5 years (Group 4), and 4.5-5.5 years (Group 5). On an average, Groups 1-3 took 10-15 min, whereas Groups 4 and 5 took 20-25 min. We sampled children between the ages of 6 weeks to 5.5 years and tested them all within their designated age groups. Internal consistency was assessed by Cronbach's alpha. Interobserver testing was done for reliability and concurrent validity was undertaken by using the senior consultant developmental paediatrician's final diagnosis as the gold standard. RESULTS: Out of 550 healthy children, 8-19% in the five groups were found to have some form of developmental delay using SDST. Approximately 50% of the families were in the low-to-moderate income bracket, and nearly 93% lived in a joint family system. Internal consistency of items in the five groups ranged from 0.784 to 0.940, whereas both interobserver reliability and concurrent validity ranged from 0.737 to 1.0. SDST showed 94.4% sensitivity and 92.9% specificity. CONCLUSION: SDST is an effective tool for identifying delay in healthy children with good internal consistency, reliability, and validity.

Sublethal toxicity of carbofuran in cattle egret (Bubulcus ibis coromandus): hematological, biochemical, and histopathological alterations / Toxicidade subletal do carbofurano na garça-vaqueira (Bubulcus ibis coromandus): alterações hematológicas, bioquímicas e histopatológicas

Abstract This study was aimed to investigate Carbofuran (CF)-induced pathological changes in cattle egret. Two hundred cattle egrets were reared and equally divided into four groups and given different CF concentrations (0.03 mg/L, 0.02 mg/L, 0.01 mg/L and 0 mg/L (control group)). Hematology, serum biochemistry, histopathology, and immunological markers were studied. Our results confirm that CF induces anemic conditions, leukocytosis, elevated liver enzymatic activity, and alterations in renal biomarkers. Moreover, specific microscopic lesions such as multifocal necrosis, pyknotic nuclei, hemorrhages, congestion, and inflammatory cell proliferation were observed in the liver, kidney, spleen, and thymus. These findings suggest that CF can induce harmful effects, so the application of this pesticide in the field must be strictly monitored to mitigate the possibility of exposure to non-target species.

Resumo Este estudo teve como objetivo investigar as alterações patológicas induzidas por carbofurano (CF) em garças-vaqueiras. Duzentas dessas garças foram criadas e divididas igualmente em quatro grupos e receberam diferentes concentrações de CF: 0,03 mg/L; 0,02 mg/L; 0,01 mg/L; e 0 mg/L (grupo controle). Foram realizadas análises de hematologia, bioquímica sérica, histopatologia e marcadores imunológicos. Nossos resultados confirmaram que CF induz condições anêmicas, leucocitose, atividade enzimática hepática elevada e alterações nos biomarcadores renais. Além disso, lesões microscópicas específicas, como necrose multifocal, núcleos picnóticos, hemorragias, congestão e proliferação de células inflamatórias, foram observadas no fígado, rim, baço e timo. Esses achados sugerem que o CF pode causar efeitos nocivos, portanto a aplicação desse agrotóxico no campo deve ser rigorosamente monitorada para mitigar a possibilidade de exposição a espécies não alvo.

Sublethal toxicity of carbofuran in cattle egret (Bubulcus ibis coromandus): hematological, biochemical, and histopathological alterations

Abstract This study was aimed to investigate Carbofuran (CF)-induced pathological changes in cattle egret. Two hundred cattle egrets were reared and equally divided into four groups and given different CF concentrations (0.03 mg/L, 0.02 mg/L, 0.01 mg/L and 0 mg/L (control group)). Hematology, serum biochemistry, histopathology, and immunological markers were studied. Our results confirm that CF induces anemic conditions, leukocytosis, elevated liver enzymatic activity, and alterations in renal biomarkers. Moreover, specific microscopic lesions such as multifocal necrosis, pyknotic nuclei, hemorrhages, congestion, and inflammatory cell proliferation were observed in the liver, kidney, spleen, and thymus. These findings suggest that CF can induce harmful effects, so the application of this pesticide in the field must be strictly monitored to mitigate the possibility of exposure to non-target species.

Resumo Este estudo teve como objetivo investigar as alterações patológicas induzidas por carbofurano (CF) em garças-vaqueiras. Duzentas dessas garças foram criadas e divididas igualmente em quatro grupos e receberam diferentes concentrações de CF: 0,03 mg/L; 0,02 mg/L; 0,01 mg/L; e 0 mg/L (grupo controle). Foram realizadas análises de hematologia, bioquímica sérica, histopatologia e marcadores imunológicos. Nossos resultados confirmaram que CF induz condições anêmicas, leucocitose, atividade enzimática hepática elevada e alterações nos biomarcadores renais. Além disso, lesões microscópicas específicas, como necrose multifocal, núcleos picnóticos, hemorragias, congestão e proliferação de células inflamatórias, foram observadas no fígado, rim, baço e timo. Esses achados sugerem que o CF pode causar efeitos nocivos, portanto a aplicação desse agrotóxico no campo deve ser rigorosamente monitorada para mitigar a possibilidade de exposição a espécies não alvo.

Sublethal toxicity of carbofuran in cattle egret (Bubulcus ibis coromandus): hematological, biochemical, and histopathological alterations.

This study was aimed to investigate Carbofuran (CF)-induced pathological changes in cattle egret. Two hundred cattle egrets were reared and equally divided into four groups and given different CF concentrations (0.03 mg/L, 0.02 mg/L, 0.01 mg/L and 0 mg/L (control group)). Hematology, serum biochemistry, histopathology, and immunological markers were studied. Our results confirm that CF induces anemic conditions, leukocytosis, elevated liver enzymatic activity, and alterations in renal biomarkers. Moreover, specific microscopic lesions such as multifocal necrosis, pyknotic nuclei, hemorrhages, congestion, and inflammatory cell proliferation were observed in the liver, kidney, spleen, and thymus. These findings suggest that CF can induce harmful effects, so the application of this pesticide in the field must be strictly monitored to mitigate the possibility of exposure to non-target species.

Autologous bone marrow stem cell transplant in acute myocardial infarction.

OBJECTIVE: To evaluate the effects of autologous bone marrow stem cell transplant on clinical symptoms, overall left ventricle ejection fraction and myocardial perfusion in patients with recent anterior myocardial infarction in left anterior descending artery territory. METHODS: The study was conducted in the department of interventional cardiology of Armed Forces Institute of Cardiology, National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi from June 2004 to November 2006. There were 26 male patients with recent anterior myocardial infarction, having anterior/apical hypokinesia and disease process involving only left anterior descending artery, who were recruited. The whole procedure was explained to the patients in the language of their best understanding and informed consent was obtained. Stem cell harvest was obtained from both posterior superior iliac crests, which were processed to note total and mean mononuclear cell counts. Stem cells were transplanted into the damaged myocardium using stop flow technique through lumen of over-the-wire balloon catheter, placed in mid left anterior descending artery. All patients tolerated the procedure well except for a few complications which were tackled by the experienced operators. The patients were advised to continue conventional medical therapy. The efficacy of stem cell transplant was objectively assessed by comparing effects on three parameters--clinical, left ventricle cineangiographic, and nuclear scintigraphic status--at baseline and at 12 weeks after transplantation. RESULTS: There is improvement in general well being, left ventricle ejection fraction and myocardial perfusion after stem cell therapy. CONCLUSION: Autologous bone marrow stem cell transplant seems to be a favourable and secure way of treatment for improvement of post-myocardial infarction ejection fraction and perfusion. There is dire need to conduct larger randomised controlled trials to assess efficacy of this cost-effective mode of therapy, especially in our part of the world.

Intracoronary administration of autologous bone marrow stem cell transplant in myocardial infarction.

OBJECTIVE: To elaborate in detail the technique of intracoronary administration of autologous bone marrow stem cell transplantation in patients with acute myocardial infarction. METHODS: This procedure was carried out during a pilot study which was conducted in the department of interventional cardiology of Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi from June 2004 to November 2006. The inclusion criteria's were recent anterior myocardial infarction with anteroapical hypokinesia and single vessel disease in left anterior descending artery. The informed consent was obtained. After giving local anaesthesia and light sedation, both posterior superior iliac crests were accessed by multiple punctures to get stem cell harvest. The harvest was analyzed to document total and mean mononuclear cell count. An over the wire balloon catheter was parked in mid left anterior descending artery. The stem cells were injected intermittently into the infarcted myocardium during transient balloon inflation over 45-60 minutes. The clinical, left ventricle cineangiographic and nuclear scintigraphic parameters were analyzed and compared at week 0 and 12 to objectively document the effects of stem cell. RESULTS: The procedure was successfully carried out and well tolerated by all the patients. The minor complications were managed accordingly. Post autologous stem cell therapy, there was amelioration in clinical symptoms, left ventricle ejection fraction and myocardial perfusion. CONCLUSION: Intracoronary artery infusion of stem cells in acute myocardial infarction is simple, reasonably safe and effective mode of cell delivery in our set up.

Clinical profile of patients presenting with acute ST elevation myocardial infarction.

OBJECTIVE: To identify risk factors and clinical profile of the patients presenting with acute ST Elevation Myocardial Infarction (STEMI). METHODS: This prospective observational study was carried out from April to September 2005. The 300 consecutive patients presenting with typical electrocardiographic changes of acute ST elevation myocardial infarction to the Emergency Department of our hospital were recruited in the study. The physician (a fellow) on duty assessed the patients and documented the predefined independent variable and patients characteristics. The clinical history revealed information about age, gender, risk factors, modes of presentation and duration of symptoms. The details of physical examination including anthropometric data, vital signs and complete systemic evaluation were recorded. The regions of infarction and rhythm disturbances were also documented. RESULTS: This study was predominantly male dominated 234 (78%) patients, with a mean age of 58 +/- 11 years. Cigarette smoking was identified as a major risk factor in 138 (46%) patients. The least common risk factor i.e. obesity (BMI >25) was present in 12 (4%) patients. Majority of the patients, 282 (94%) presented with typical chest pain and within first six hours of onset of symptoms 216 (72%). Most of the patients 240 (80%) had normal examination at presentation and 60 (20%) had signs of Left Ventricle Failure. Isolated inferior and anterior myocardial infarction was noted in 138 (46%) and 48 (16%) patients respectively. Normal electrocardiographic rhythms at presentation were observed in 282 (94%) patients. CONCLUSION: Acute myocardial infarction was more common in adult males with smoking being the major risk factor. Most of the patients presented with typical chest pain and within six hours of onset of symptoms. The majority of patients demonstrated normal physical examination and cardiac rhythm. Inferior myocardial infarction was the most common lesion.

Hypertrophic cardiomyopathy in a patient of Klinefelter syndrome--a rare association.

A 36-year-old man presented with exertional dyspnoea and chest pain. He also had sexual dysfunction with poorly developed secondary sex characteristics. Echocardiography and thorough cardiac evaluation revealed obstructive hypertrophic cardiomyopathy. Hormonal profile suggested primary hypogonadism and cytogenetics report suggested a karyotype, 47, XXY, in all counted cells, consistent with the diagnosis of Klinefelter syndrome. He is being managed with beta-blocker and androgen replacement therapy.

Cardiac arrhythmia as presentation of snakebite.

Snakebite cases may have myriad presentations. we are describing a previously healthy young man presenting within half an hour of snakebite who experienced abrupt fatal cardiac rhythm changes ranging from bradycardia to ventricular tachycardia/fibrillation over a short span of time.