Spectrum of celiac disease in paediatric population: experience of tertiary care center from Pakistan

Objective: To determine clinical features and relevant laboratory investigations of patient with celiac disease (CD) and comparing classical celiac disease (CCD) with Non-diarrheal celiac disease (NDCD).Methods: This is a five years retrospective study conducted at The Aga Khan University Hospital Karachi, Pakistan from January 2010 to December 2015, enrolling children from one year to 15 years of either gender diagnosed as celiac disease in accordance with revised ESPGHAN criteria. Biopsy samples with grade 2 or more on Modified Marsh Classification were considered as consistent with celiac disease. Celiac patients were categorized into Classical celiac disease (with Chronic Diarrhea) and non-diarrheal celiac disease (Atypical celiac) and their clinical features and relevant laboratory investigations were documented.Results: Total 66 patients were selected with celiac disease according to inclusion criteria, 39 (59.09%) patients were labeled as CCD and 27 (40.91%) patients were labeled as NDCD. Marsh grading 3a and above were more marked in CCD as compared to NDCD. Mean titer for Tissue transglutaminase antibodies (TTG) were higher in CCD group in comparison to NDCD group. In CCD, the most common clinical presentations were abdominal distension whereas in NDCD, the most remarkable features were recurrent abdominal pain (62.9%). Frequency of failure to thrive is significantly high in CCD (82.05%) but patients merely with short stature were more common in NDCD (33.3%). Refractory anemia was present in 66.6% patients in NDCD group and 41.1% patients in CCD group. 74.3% patients in CCD group were vitamin D deficient whereas 85% patient had vitamin D deficiency in NDCD group (p= 0.03). Conclusion: NDCD is not uncommon in our population. Recurrent abdominal pain, failure to thrive or patients only with short stature and refractory anemia are prominent features in NCDC group whereas abdominal distension, failure to thrive and recurrent abdominal pain were noticeable features in CCD. High grade histopathology and raised antibodies titer is hallmark of CCD. Vitamin D deficiency is almost equally present in both groups

Study endoscopic and colonoscopy findings in children under 16 years of age with gastrointestinal bleeding from 2018 to 2021

Background: One of the most common reasons for Children to visit clinics is gastrointestinal issues in which endoscopic studies are used occasionally to investigate it’s etiology more accurately. GI bleeding eventhough uncommon in children, can be life threatening. The aim of this study was to study endoscopic and colonoscopic findings in children with GI bleeding. Methods: This descriptive analytical study was done on 73 children under 16 years in Ardabil with the diagnosis of gastrointestinal bleeding. A checklist including demographic and treatment information of patients like severity of bleeding, bleeding type (melena, hematochezia, occult blood), laboratory results (hemoglobin, hematocrit) and clinical findings (abdominal pain, nausea and vomiting, ETC), endoscopic and colonoscopic results were collected and then analyzed by statistical methods in SPSS version 21. Results: Total 38 cases (52.1%) were gone under upper endoscopy and 35 cases (47/9%) were gone under colonoscopy. The most common indications for upper endoscopy was GI bleeding (76.3%) and the most common involved anatomical part was lower portion of esophagus (44.7%). The most common indication for colonoscopy was recurrent abdominal pain (62.9%). Pathologic cases were often seen in sigmoid, rectum and anus (52/8%). The most common colonoscopic findings were nodular hyperplasia (25/7%) and solitary nodule (20%). Conclusions: Results of study showed that, the frequency of endoscopic evaluation has been significantly lower in female children. According to the most common indications for upper and lower endoscopy, it is important to consider the frequency pattern of indications for endoscopic study

Motor and Somatosensory Evoked Potential Monitoring Without Wakeup Test during Scoliosis Surgery

Background: Available evidence suggests that Transcranial electric motor evoked potentials and somatosensory evoked potential are safe methods to check the integrity of the spinal cord during spine deformity correction surgery. We compare the efficacy of Transcranial electric motor evoked potentials and somatosensory evoked potential to detect the nerve injury during Scoliosis surgery. Objectives: To demonstratethe advantages of combined motor and sensory evoked potential monitoring during Scoliosis surgery. Methods: We analyzed records of 65 (48 female and 17 male) Scoliosis surgery cases of Transcranial electric motor evoked potential and Somatosensory evoked potential.Mean age was 15.6 years. Patients who showed significant (at least 55%) of unilateral or bilateral amplitude loss , for at least five to ten minutes during the intervention in scoliosis surgery under total intravenous anesthesia will be included. Results: From 65 patients during surgery seventeen patients have a significant or complete drop of baseline amplitude on transcranial electric motor evoked potentials. Thirteen patients have the complete return of baseline amplitude by surgeon intraoperative intervention, whereas four patients havea reversal of motor response after 8 hours post-operatively. Transcranial electric motor evoked potential monitoring was 100% specific and 100% sensitive, whereas Somatosensory evoked potential was 100% specific and 85% sensitive. Conclusions: SSEPs and MEPs , in combination give accurate and quick information of nerve or spinal cord insult intraoperatively

Paediatric inflammatory bowel disease: Clinical presentation and disease location

Objective: To determine different clinical presentationsand disease location demarcatedby upper and lower gastrointestinal endoscopyand relevant histopathologyin children diagnosed with inflammatory bowel disease (IBD).Methods: This is 5 years (2010 to 2015) retrospective studyconducted at the Aga Khan University Hospitalenrolling65admitted children between 6 months to 15years from either gender, diagnosed with IBD on clinical presentation, endoscopy and biopsy. Different clinical presentations at the time of diagnosis were noted in different categories of the disease. All patients underwent upper and lower (up to the terminal ileum) endoscopy with multiple punch biopsies and histologic assessment of mucosal specimens. All endoscopies were done by paediatric gastroenterologists at endoscopy suite of the hospital and all specimens were reported by the pathology department. ESPGHAN revised criteria for the diagnosis of inflammatory bowel disease in children and an adolescent was used to standardize our diagnosis. Extent of disease on endoscopy and relevant histopathology of the biopsy samples were noted at the time of diagnosis. Data was summarized using mean, standard deviation, numbers and percentages for different variables.Results: Total 56 children were enrolled according to inclusion criteria. There were 34children (61.53%) diagnosed with ulcerative colitis (UC), 10 patients (16.92%) had Crohn\u27sDisease (CD) and 11 (21.53%) patients were labeled as Indeterminate colitis (IC). Mean age at onset of symptoms was10.03±2.44 and mean age at diagnosis was11.10±2.36. Abdominal pain (80%) and chronic diarrhea (70%) were common symptoms in CD whereas bloody diarrhea (79.41%) and rectal bleeding(64.70%)were common presentation in UC. Patients diagnosed with indeterminate colitis(IC) had similar clinical features as in UC patients. Only 7% patients had some extra-intestinal features in the form of joint pain and/or uveitis. Aspartate aminotransferase level (95.18 ±12.89) was relatively high in patients withCD in comparison with other categories of IBD. Endoscopic findings and relevant histopathology of biopsy samples in UC showed 65% patient had pan-colitis and 13 % with disease restricted to rectum only whereas in CD 70% patient had disease in ileo-colon and only 10 % had involvement of ileum at the time diagnosis.Conclusion: Patients with UC dominated in our cohort. The most common clinical presentation in UC was bloody diarrhea and rectal bleeding and patients with CDhad abdominal pain and chronic diarrhea as predominant clinical features. Extraintestinal features were uncommon in our cohort. In endoscopic findings, pan-colitis was the mostfrequentfinding in UC and ileo-colonwas common location in CD. IC and UC shared common clinical features and disease location on endoscopy

A Corpus BasedStudyof Hedges and Boosters in the Speeches of Benazir Bhutto

Hedges and boosters are significant in writing since they show the writer’s point of view. The paper identifies two types of metadiscourse markers in Benazir Bhutto’s speeches. It further aims at analyzing the pragmatic function and frequency of selected markers. The sample included thirteen selected speeches delivered from 1989 to 1997 by Benazir Bhutto and are explained through Hyland’s (1996) theories related to hedging and boosters. AntConc software has been used to extricate the hedges and boosters from the corpus. This study indicates that hedges (131) are used frequently as compared to boosters (150). After the analysis of the data, the finding reveals that the most frequently occurred hedges are “could” which appears 35 times and “need” 27 times. Results show that the speaker’s usage of hedge marks shows her cautiousness in speaking style. Moreover, the most frequently occurring boosters are “should” which appear 65 times and “must”34 times. This shows that the authors’ voice is appeared assertive and confident. Frequency is also calculated to know which type of metadiscourse maker is used more frequently. The frequency shows that more boosters are used as compared to the hedges which show the potency of her speeches

Exploring organizational management of extrovert school leadership

The study aimed at determining the personality traits of extroversion and introversion of school leadership and evaluating their organizational management in Federal Government Educational Institutions (FGEIs). A quantitative research design along with a positivist paradigm was followed. The total population consisted of 68 school principals and 592 teachers of FGEIs in the Gujranwala, Fazaia, and Lahore Regions from which 54 principals and 381 teachers were selected using a random sampling technique. Eysenck Personality Inventory (EPI) was deployed to collect information about personality traits and data regarding organizational management, the researchers used a self-developed questionnaire. Pearson correlation r and t-tests were deployed for inferential stats. The results showed that extrovert school leaders perform their duties well as they hold a clear concept of the vision and mission of the organization, set up an accepted procedure to plan short-term and long-term goals, share responsibilities with all stakeholders following their skills, and ensure the smooth functioning of the school with the help of all stakeholders. In comparison, introverted school principals show less interest in the organizational management of their schools. Moreover, organizational management of school leadership has a positive correlation with the personality trait of extroversion and a significant difference can be seen in organizational management of an extrovert and an introvert school principal. It was recommended that the performance indicators and standards of school principals should be effectively communicated to school leadership. Introvert school leadership should be provided with the necessary psychological training to reduce this shortcoming of personality

Cellular Services Packages and their Impact on Social Values of Youth

Youth plays a significant role in building of the nation and in the development of a country. Their adoption, aspiration, and objective lead towards change in social value of a culture. Ongoing study investigates the impact of telecom cellular services packages like late night call & unlimited Short Messaging Service (SMS) on the social values of Pakistani youth. In today’s competitive environment cellular companies are mainly targeting youth through their advertisements and would like the youth to get indulge in these activities in order to increase their sales but the point is up to what extent youth showing receptiveness and emotional attachment to these packages. Study was conducted in capital city of Pakistan i.e. Islamabad, mainly considering three famous universities; Iqra University, Bahria University & Foundation University with the sample of 250 respondents; convenient sampling technique is used & results are measured using multiple regression test. Major findings concluded that cellular advertisements of unlimited Short Messaging Service (SMS) and late night call packages have a negative impact on youth but youth is still willing to accept these advertisements as they are negatively attached to the advertisement and use of these packages