Spectrum of Complications in Children with Moderate to Severe DKA Admitted in Pediatric Intensive Care Unit of a Tertiary Care Hospital

Background: Diabetic Ketoacidosis (DKA) is the major source of mortality and morbidity in type 1 Diabetes Mellitus. Cautious fluid resuscitation, insulin and electrolyte replacement along with observation for complications is the mainstay of treatment. Early identification of complications lead to better management and outcome. Objective: To find out the complications of moderate to severe DKA in pediatric patients admitted in Pediatric Intensive Care Unit (PICU). Methods: Cross-sectional Study was conducted in PICU of University of Child Health Sciences & The Children’s Hospital, Lahore from Jan, 2015 to Dec, 2018.Data was collected from retrospective records of patients admitted in PICU. All patients with moderate/severe DKA were included. Patients with developmental delay were excluded. Data was analyzed using SPSS version 25. Chi-square test was used to find out p-value. Results: A total of 152 patients with moderate/severe DKA were included in the study, having mean age of 7.86 ± 4.06 years. Most patients 42% (n=64) were more than 10 years of age. Mean weight of the children was 19.89 ± 8.70 kg. Majority 59% (n= 89) were of new onset diabetes. Severe DKA was seen in 74% while moderate DKA in 26% patients. The complications seen were: hypokalemia 33% (n=50), cerebral edema 28% (n=42), hypernatremia 18% (n=27), hyponatremia 8% (n=12) and acute kidney injury (AKI) in 7% (n=11). Survival rate was 85% while mortality rate was 15%. Conclusion: Hypokalemia and cerebral edema were the most common complications observed. Complications were more common in those patients who presented with DKA in first presentation. Key words: complications, DKA severity, children, PICU

Spectrum of Complications in Children with Moderate to Severe DKA Admitted in Pediatric Intensive Care Unit of a Tertiary Care Hospital

Background: Diabetic Ketoacidosis (DKA) is the major source of mortality and morbidity in type 1 Diabetes Mellitus. Cautious fluid resuscitation, insulin and electrolyte replacement along with observation for complications is the mainstay of treatment. Early identification of complications lead to better management and outcome. Objective: To find out the complications of moderate to severe DKA in pediatric patients admitted in Pediatric Intensive Care Unit (PICU). Methods: Cross-sectional Study was conducted in PICU of University of Child Health Sciences & The Children’s Hospital, Lahore from Jan, 2015 to Dec, 2018.Data was collected from retrospective records of patients admitted in PICU. All patients with moderate/severe DKA were included. Patients with developmental delay were excluded. Data was analyzed using SPSS version 25. Chi-square test was used to find out p-value. Results: A total of 152 patients with moderate/severe DKA were included in the study, having mean age of 7.86 ± 4.06 years. Most patients 42% (n=64) were more than 10 years of age. Mean weight of the children was 19.89 ± 8.70 kg. Majority 59% (n= 89) were of new onset diabetes. Severe DKA was seen in 74% while moderate DKA in 26% patients. The complications seen were: hypokalemia 33% (n=50), cerebral edema 28% (n=42), hypernatremia 18% (n=27), hyponatremia 8% (n=12) and acute kidney injury (AKI) in 7% (n=11). Survival rate was 85% while mortality rate was 15%. Conclusion: Hypokalemia and cerebral edema were the most common complications observed. Complications were more common in those patients who presented with DKA in first presentation. Key words: complications, DKA severity, children, PICU

Clinical outcome of tetanus based on dakar tetanus severity score in paediatric intensive care unit of a tertiary care hospital

Objective: To evaluate the validity of  Dakar scoring system in predicting the outcome of tetanus in children of post neonatal age. Method: A prospective single center study conducted at ICU (Intensive Care Unit) of –removed for blind review-- 131 children with diagnosis of tetanus from January 2020 to June 2021 by analyzing demographic and clinical parameters. Results: Mean age of children was 8.11 ± 3.45 years with male predominance 91(69.5%). Major proportion of children were in range of 5-10 years comprising 65(50%). Period of onset of spasm was < 2 days in 92(70%) that correlate well with shorter incubation period (p-value <0.001). Mean duration of ICU stay was (18.81 ± 11.73) days. Only 14(10.7%) received three doses of vaccination but no one received booster dose. In majority of patients trauma due to road traffic accident 86(65.6%) was the predisposing factor followed by ear discharge 31(23.7%) and other causes 14(10.7%). Out of 131 patients 104(79.3%) received mechanical ventilation because of disease severity. Regarding outcome mild cases 2(1.5%), moderate 61(46.6%) and severe were 68(51.9%) according to Dakar scoring system and out of these severe cases 18(13.7%) expired (p-value < 0.001). However, 53(40.4%) discharged, 50(38.1%) shifted out to other wards after stabilization and 10(7.6%) left against medical advice. (p-value 0.001) Conclusion: Dakar scoring system correlates well with disease severity and should be adopted to aid clinical triage and management as with effective and appropriate treatment patients can have good prognosis. However, preventive aspects should be emphasized regarding booster dose of tetanus. Keywords: Tetanus, Outcome, Dakar scoring syste

Diagnostic Accuracy of Increased Total Leucocyte Count (TLC) And Decreased Absolute Neutrophil Count (ANC) For Diagnosis Of Neonatal Sepsis Taking Culture Sensitivity As Gold Standard

Objective: To find diagnostic accuracy of increased total leucocyte count (TLC) and decreased absolute neutrophil count (ANC) for diagnosis of neonatal sepsis taking culture and sensitivity as gold standard.Methodology: Samples was collected from all the neonates with suspicion of sepsis admitted to neonatal due to severe bad health condition in the Children Hospital, Lahore. Parents were informed for consent. Total 3.5 cc sample was drawn by venipuncture.2.0 cc in CBC voil containing trisodium citrate, this sample was sent to CBC lab for automated CBC on sysmex KX-21 analyzer and peripheral smear. 1.5 cc was taken in specialized containers for blood culture and was sent to microbiology lab. Neonatal sepsis on TLC, ANC and blood count were be recorded. Patients of sepsis was managed as per hospital protocol. Data was analyzed using SPSS.Results: Neonates in this study was at mean age of 3.86±1.81 days. There was almost equal number of males and females neonates. Male were 155(51.7%) and female babies 145(48.3%). It was noted that 182(60.7%) babies were on term while 118(39.3%) were preterm neonates in this study. Neonatal sepsis was positive on TLC in 101(33.7%) cases. in 115(38.3%) on ANC.It was noted that sensitivity of the TLC was 71% while specificity was 66% with a diagnostic accuracy of 68%. On the other and, ANC sowed a sensitivity as 65%, specificity as 56% and diagnostic accuracy of 65%.Conclusion: Conclusively, TLC and ANC is not a good marker for the taking a neonate for the consideration of neonatal sepsis

Mixotrophic cultivation of Scenedesmus dimorphus in sugarcane bagasse hydrolysate

Overuse of the fossil fuels to fulfill existing energy requirements has generated various environmental problems like global warming. Emergence of environmental issues due to burning of the fossil fuel resources has provoked researchers to explore alternative sources of fuel. In this scenario, microalgal biofuels could present a promising alternative fuel if produced cost-effectively without competing for freshwater resources and arable land. Aim of the present study was to grow microalgae by employing lignocellulosic waste for production of lipids. Scenedesmus dimorphus NT8c was chosen based on its ability to tolerate heat, rapid growth, and ease of harvesting by overnight settling. Biochemical composition and growth parameters of microalgae were analyzed when cultivated mixotrophically on sugarcane bagasse hydrolysate, a low-value agricultural by-product, that is, currently underutilized. Despite a slight increase in turbidity in the medium, S. dimorphus NT8c cultures raised mixotrophically in 5 g/L sugarcane bagasse hydrolysate displayed significantly higher growth rates compared to photoautotrophic cultivation with an overall biomass productivity of 119.5 mg L d, protein contents of 34.82% and fatty acid contents of 15.41%. Thus, microalgae cultivated mixotrophically are capable of photosynthesizing while metabolizing and assimilating organic carbon, significant increases of biomass and lipid productivity can be achieved. However, high supplementation with organic carbon can result in unfavorable levels of turbidity and bacterial growth, reducing microalgal biomass productivity

Zinc nutrition application augments morpho-physiological attributes, productivity and grain zinc bioavailability of Paddy Rice

Zinc (Zn) deficiency is the most important micronutrient disorders affecting plants and human health. Present study evaluated the potential of various Zn application methods in improving the performance of selected rice genotypes and Zn bioavailability in grains. Pre-selected Zn application methods through pot experiments were validated in the field. Harvested grains were fed to albino rats for Zn bioavailability. Results revealed that soil + foliar application of Zn was effective in improving the seedling growth of rice genotypes by modulating the agronomic, water related and biochemical attributes. The rats gained more body weight fed with rice genotype Accession-164 (high Zn accumulator) compared with the minimum for Super Basmati (low Zn accumulator) feed. In crux, soil application of Zn at 15 kg ha-1 followed by foliar application of 0.25% ZnSO4.7H2O solution at tillering and heading stages produced the highest grain yield (26.25%, 29.11%) with maximum bioavailable Zn (21.02%, 22.50%) during both years, respectively, in the grains for combating malnutrition in the tested rats

Selection and adaptation of microalgae to growth in 100% unfiltered coal-fired flue gas

Microalgae have been considered for biological carbon capture and sequestration to offset carbon emissions from fossil fuel combustion. This study shows that mixed biodiverse microalgal communities can be selected for and adapted to tolerate growth in 100% flue gas from an unfiltered coal-fired power plant that contained 11% CO. The high SOx and NOx emissions required slow adaptation of microalgae over many months, with step-wise increases from 10% to 100% flue gas supplementation and phosphate buffering at higher concentrations. After a rapid decline in biodiversity over the first few months, community profiling revealed Desmodesmus spp. as the dominant microalgae. To the authors’ knowledge this work is the first to demonstrate that up 100% unfiltered flue gas from coal-fired power generation can be used for algae cultivation. Implementation of serial passages over a range of photobioreactors may contribute towards the development of microalgal-mediated carbon capture and sequestration processes

A Review on Pharmaceutical Waste Pollution in Water: Extent, Management and Removal Strategies

Pharmaceutical waste and presence of hazardous pollutants in them is a growing concern due to their fate, origin, higher rate of utilization and varying nature of active ingredients resulting in water contamination. However, there is few research on the graving nature of the problem. Cascading impacts on human and ecosystems can be expected from contaminated groundwater and other aquatic channels. While, various technologies used and studied for the removal/reduction/sedimentation of pharmaceutical pollutants. At the initial stages, level of toxicity should check with respect to flora, fauna, environment, and human health. Furthermore, the production of by-products from pharmaceutical pollutants should also be checked and regulated. These by-products can be much more toxic, than the original contaminants and can exert significant toxic effects. It was concluded that there should be ongoing efforts to reduce the cost associated with pharmaceutical waste and their pollutants removal processes to ensure sustainability in the environment and human being

A new CUSUM control chart under uncertainty with applications in petroleum and meteorology

Please read abstract in the article.http://www.plosone.orgpm2022Statistic