Comparison of efficacy and safety of intramuscular magnesium sulphate with low dose intravenous regimen in treatment of eclampsia

INTRODUCTION: Eclampsia contributes to maternal mortality in developing, underdeveloped world. Various drugs have been tried to treat eclampsia. Magnesium sulphate has become the drug of choice due to various advantages and is associated with adverse outcome for both mother and fetus if not used correctly. OBJECTIVE: To compare the efficacy and safety of intramuscular magnesium sulphate with low dose intravenous regimen in treatment of eclampsia STUDY SETTING: The study was conducted at Gynecology and Obstetrics Department unit II, Holy Family Hospital, Rawalpindi, from June 20, 2020 to December 20, 2020. Study design was Randomized Controlled Trial. SUBJECTS & METHODS: Patients were randomly distributed into two groups, group-A (IM Group) and group-B (IV Group). Group-A patients received a loading dose of 4 gm IV MgSO4 over 5-10 minutes+10 gm MgSO4 deep intra-muscular injection (5 gm in each buttock) and a maintenance dose of 5 gm MgSO4 deep intramuscular injection in alternate buttock every 4 hourly. Group-B patients received MgSO4 4 gm slow IV over 5-10 minutes as loading dose and 1 gm MgSO4 per hour as continuous intravenous maintenance infusion. Clinical response to therapy for both drugs was calculated in terms of efficacy and safety. All the data were entered & analyzed by using SPSS v25.0. Both the groups were compared in terms of efficacy and safety by using Chi-Square test. A p-value less than 0.05  was taken as significant. RESULTS: A total of 160 patients with eclampsia were enrolled for this study. Patients were divided into two groups i.e. Group-A (IM MgSO4) and Group-B (IV MgSO4). In group-A, there were 45(56.3%) in 18-30 years age group and 35(43.8%) in 31-40 years age group, while in group-B, there were 48(60.0%) in 18-30 years age group and 32(40.0%) in 31-40 years age group. In IM MgSO4 group, prevention from recurrence of seizure was noted in 74(92.5%) and 78(97.5%) in IV MgSO4 group, which is statistically insignificant with a p-value of 0.147. CONCLUSION: Both IM and IV regimen are equally effective in controlling the recurrence of convulsions. IM Magnesium Sulphate is associated with a higher incidence of toxicity as evidenced by significantly higher incidence of loss of knee jerk reflex. Both IM and IV regimen are equally effective but IM Magnesium Sulphate is associated with a higher incidence of toxicity. KEY WORDS: Eclampsia, Intramuscular MgSO4, Intravenous MgSO4

Association of Serum PSA Levels with Histopathological Pattern of Prostate Lesions

Background: Pathological changes that mainly affect prostate gland are prostatitis, benign prostatic hyperplasia (BPH) and cancerous lesions. Digital rectal examination (DRE), Transrectal Ultrasonography (TUS), and prostate specific antigen (PSA) followed by histopathological examination, are routinely used tests for diagnosis of prostate lesions. The aim of the present study is to determine the role of serum PSA levels in differentially diagnosing the different types of prostate lesions.Material and Methods: This retrospective (observational) study was conducted in Ibn-e-Sina Hospital Multan. Data of 2189 patients who were operated from 2007 to 2017 due to prostatic lesions were included in this analysis. Patients with BPH, prostatitis, prostate carcinoma and Prostatic Intraepithelial Neoplasia (PIN) were grouped according to serum PSA levels (ranging from 0 to >100 ng/ml) into five groups. Frequencies and percentages were calculated for different histopathological findings. Association of PSA levels with different histological patterns was determined with chi-square test with P-value < 0.05 taken as significant difference.Results: Mean age of patients was 62.45+10.64 years. On histopathology, BPH was diagnosed in 1676 (76.56%) patients, prostatitis in 133 (6.07%), carcinoma in 378 (17.26%) and PIN in 02 (0.09%) patients, respectively. Serum PSA levels of 4.01-10 ng/ml were found in 1050 (62.64%) BPH patients and in 59 (44.36%) prostatitis patients. Serum PSA levels of 10.01-20 ng/ml were found in only 40 (2.4%) BPH patients, 47 (35.33%) prostatitis patients, 22 (5.82%) carcinoma patients and in 1 (50.0%) PIN patient. Serum PSA levels of 20.01-100 ng/ml were found in 32 (1.9%) BPH patients, 11 (8.27%) prostatitis patients, 302 (79.89%) carcinoma patients, and in 1 (50.0%) PIN patient. Serum PSA levels of >100 ng/ml were absent in patients with BPH and PIN, and present in 1 (0.75%) prostatitis and 54 (14.28%) carcinoma patients.Conclusion: Benign prostatic hyperplasia was the commonest lesion in our patients (76.56%) with serum PSA levels >10 ng/ml reported in all patients with prostate carcinoma and prostatic intraepithelial neoplasia (PIN) patients

Association of Hyperuricemia with Ischemic Stroke in Adult Population

Background and Objective: Stroke is the second most prevalent cause of dementia, the third biggest cause of mortality, and the top cause of disability globally. Hyperuricemia is frequently seen in patients with vascular risk factors. The objective of this study was to determine the association of hyperuricemia with ischemic stroke in adult patients presenting to neurology department of a tertiary care hospital. Methods:This was a case-control study of 200 patients, 100 patients with stroke and 100 unmatched controls were accessed for vascular risk factors and hyperuricemia. The setting was Pakistan Institute of Medical Sciences, Islamabad and study duration was six months (August 2021 to February 2022). Odds Ratio (OR) was calculated to measure the association of ischemic stroke with hyperuricemia for each group. OR\u3e1 was taken as significant. Results:Out of 100 patients in the case group, 25 (25%) had hyperuricemia. Whereas, out of 100 patients in the control group, 07 (7%) had hyperuricemia. The P-value was 0.001. Odds ratio was 4.42. Out of 100 patients in the case group, the median patient age was 35 and the highest patient age was 75. The mean age, symptom duration, and uric acid level were 55.216.24 years, 20.588.97 hours, and 7.212.24 mg/dl, respectively. The control group had 100 patients with an average age of 35 and a maximum age of 75. The median age was 52.48 years old, and the median uric acid level was 2.48 mg/dl. Conclusion:Hyperuricemia is linked positively to occurrence of ischemic stroke as evidenced by the positive odds ratio. Further studies need to be done to investigate whether uric acid lowering therapy is useful in preventing stroke or reducing mortality

Petrography and geochemistry of dolomites of samanasuk formation, Dara Adam khel section, Kohat ranges, Pakistan

Replacement dolomite occurs in Jurassic Samanasuk Formation in Dara Adam khel area of Kohat ranges, North-Western Himalayas, Pakistan. This study, for the first time, document the process of dolomitization and evolution of strata bound dolomitic bodies. Field investigation, petrography and geochemistry helped in unraveling the formation of several dolomitic bodies. Petrographically dolomites comprises of: (1) medium grain crystalline planer subhedral dolomite (Dol-I); (2) fine grained crystalline anhedral non-planer dolomite rhombs (Dol-II); (3) medium to coarse grained crystalline subhedral-anhedral non-planer dolomite (Dol-III) and coarse to very coarse grained crystalline saddle dolomite cements (SD). The saddle dolomites (SD) postdate the replacement dolomites and precede telogenetic calcite (TC) cements. Stable O and C isotope analysis shows that these dolomites have δ18Ovpdb ranging from -4.09% to -10.4 whereas the δ13Cvpdb ranges from +0.8 to +2.51. Major and trace elements data show that Sr concentrations of 145.5 to 173 ppm; Fe contents of 2198 to 8215 ppm; and Mn contents of 93.5 to 411 ppm. Petrographically replacive dolomites, saddle dolomite, and δ18Ovpdb values depicts neomorphism of replacement dolomites that were formed earlier were exposed to late dolomitizing fluids. As a result of basin uplift during the Himalayan orogeny in Eocene time, dolomitization event was stopped through occurrence of meteoric water. The Main Boundary Thrust (MBT) and its splays were most likely essential conduits that channelized dolomitizing fluids from siliciclastic rocks that were buried deeply into the Jurassic carbonates rocks, leading to more extreme dolomitization

Electrochemical reduction of CO2: a review of cobalt based catalysts for carbon dioxide conversion to fuels

Electrochemical CO2 reduction reaction (CO2RR) provides a promising approach to curbing harmful emissions contributing to global warming. However, several challenges hinder the commercialization of this technology, including high overpotentials, electrode instability, and low Faradic efficiencies of desirable products. Several materials have been developed to overcome these challenges. This mini-review discusses the recent performance of various cobalt (Co) electrocatalysts, including Co-single atom, Co-multi metals, Co-complexes, Co-based metal–organic frameworks (MOFs), Co-based covalent organic frameworks (COFs), Co-nitrides, and Co-oxides. These materials are reviewed with respect to their stability of facilitating CO2 conversion to valuable products, and a summary of the current literature is highlighted, along with future perspectives for the development of efficient CO2RR

Pituitary dysfunction in pediatric patients with Optic Nerve Hypoplasia: a retrospective cohort study (1975-2014)

Background/Aims: The risk factors for pituitary hormone dysfunction (PHD) in children with optic nerve hypoplasia (ONH) are not well understood. This study identified the type, timing, and predictors of PHD in children with ONH. Methods: ONH patient charts were reviewed retrospectively. The incidence rate of PHD was calculated assuming a Poisson distribution. Predictors of PHD were identified through a multivariable Cox proportional hazards model. Results: Among 144 subjects with ONH, 49.3% (n = 71) developed PHD over 614.7 person-years of follow-up. The incidence was 11.55 (95% confidence interval [CI]: 9.02–14.57/100 person-years). The median time to first PHD was 2.88 (interquartile range: 0.02–18.72) months. Eighty-two percent developed their first PHD by their 5th and 90% by their 10th birthday, and 89% within 5 years of ONH diagnosis. Prematurity (adjusted hazard ratio [aHR]: 0.33; 95% CI: 0.1–1.07), blindness (aHR: 1.72; 95% CI: 1.03–2.86), maternal substance abuse (aHR: 1.51; 95% CI: 0.91–2.48), abnormal posterior pituitary (aHR: 3.8; 95% CI: 2.01–7.18), and hypoplastic/absent anterior pituitary (aHR: 2.52; 95% CI: 1.29–4.91) were significant predictors of PHD. Conclusions: The clinical predictors of PHD included blindness, pituitary gland abnormalities, and maternal substance abuse. These predictors help clinical decision-making related to the need for and frequency of hormone testing in pediatric patients with ONH

Pituitary Dysfunction in Pediatric Patients with Optic Nerve Hypoplasia: A Retrospective Cohort Study (1975–2014)

Background/Aims: The risk factors for pituitary hormone dysfunction (PHD) in children with optic nerve hypoplasia (ONH) are not well understood. This study identified the type, timing, and predictors of PHD in children with ONH. Methods: ONH patient charts were reviewed retrospectively. The incidence rate of PHD was calculated assuming a Poisson distribution. Predictors of PHD were identified through a multivariable Cox proportional hazards model. Results: Among 144 subjects with ONH, 49.3% (n = 71) developed PHD over 614.7 person-years of follow-up. The incidence was 11.55 (95% confidence interval [CI]: 9.02–14.57/100 person-years). The median time to first PHD was 2.88 (interquartile range: 0.02–18.72) months. Eighty-two percent developed their first PHD by their 5th and 90% by their 10th birthday, and 89% within 5 years of ONH diagnosis. Prematurity (adjusted hazard ratio [aHR]: 0.33; 95% CI: 0.1–1.07), blindness (aHR: 1.72; 95% CI: 1.03–2.86), maternal substance abuse (aHR: 1.51; 95% CI: 0.91–2.48), abnormal posterior pituitary (aHR: 3.8; 95% CI: 2.01–7.18), and hypoplastic/absent anterior pituitary (aHR: 2.52; 95% CI: 1.29–4.91) were significant predictors of PHD. Conclusions: The clinical predictors of PHD included blindness, pituitary gland abnormalities, and maternal substance abuse. These predictors help clinical decision-making related to the need for and frequency of hormone testing in pediatric patients with ONH

Risk factors of idiopathic pulmonary fibrosis in Pakistani population: a matched case-control study

Objective: To evaluate the factors associated with idiopathic pulmonary fibrosis risk. Method: The case-control study was conducted from January 5, 2017, to September 4, 2018, at the private-sector Aga Khan University Hospital and the public-sector Jinnah Postgraduate Medical Centre, two large tertiary care centres in Karachi, and comprised adult patients of either gender with diagnosed idiopathic pulmonary fibrosis, as defined by the Indian Chest Registry. Subjects without idiopathic pulmonary fibrosis but registered with the department of pulmonology of the two hospitals were enrolled as controls. Data was collected using a structured questionnaire, and anthropometric measurements were noted for each subject. Gastroesophageal reflux disease was assessed using GerdQ. This was followed by serological evaluations and spirometry. Data was analysed using SPSS 21. Results: Of the 459 subjects, 154(33.6%) were cases and 305(66.4%) were controls. Among the cases, 81(52.6%) were females and 73(47.4%) were males with mean age 66.1±10.9 years. Among the controls, 162(53.1%) were females and 143(46.9%) were males with mean age 64.6±11.1 years (p>0.05.) The most common ethnicity was Urdu-speaking; 89(58%) among the cases and 150(49%) among the controls (p<0.05). Ethnicity, number of persons in the household per room, and type of house were significantly associated with the risk of developing idiopathic pulmonary fibrosis (p<0.05). Conclusion: Ethnicity, type of house and the number of persons in a household per room were found to be the significant risk factors for idiopathic pulmonary fibrosis IPF. Key Words: Idiopathic pulmonary fibrosis, Risk factors, Epidemiology, Pakistan