Children with Febrile Seizures have Lower Zinc Levels

Objective: To find the association between zinc deficiency and febrile seizures in children of 6 months and 5 years of age. Materials and Methods: Cross-Sectional Descriptive Study was carried out at the Department of Pediatrics, Benazir Bhutto Hospital, Rawalpindi for a duration of six months (From 11th March to 31st August 2017). After taking approval of the Ethical Research Committee of Rawalpindi Medical College and taking informed consent from the parents/ guardians, children selected according to the inclusion/exclusion criteria. Patient profile including name, age, sex, address, hospital number, serial number, date of inclusion in the study was noted. Data was collected from the Patient’s charts and/or by direct interview of the child’s guardian. Using aseptic measures, 2ml of blood from venipuncture utilizing a 22-gauge antiseptic needle, in no more than 24 hours of hospital visitation was reserved. Evaluation of serum zinc was completed in no more than 6 hours of collection. The copy was then given to the lab testing and thus this report was then approved by the physician. Results: In our study, out of 145 cases, 52.41%(n=76) were between 1-3 years of age whereas 47.59% (n=69) were between 4-6 years of age, the mean and standard deviation was calculated as 3.54 + 1.50 years, 50.34% (n=73) were male whereas 49.66% (n=72) were females. Mean serum zinc levels were calculated as 64.28 + 12.13 mcg/dl. The frequency of hypozincemia in febrile seizures among children presenting at tertiary care hospitals was 54.48% (n=79). Conclusion: These analysis outcomes depicted that children with febrile seizures had notably lesser serum zinc measures

Knowledge, attitude and perception survey of doctors regarding antibiotic use and resistance in Karachi, Pakistan

Objective: To establish a better understanding of physicians\u27 knowledge and beliefs, and to compare distinctions in knowledge, attitude and perception of junior and senior doctors regarding rational use of antibiotics.Methods: The cross-sectional study was conducted at a tertiary care hospital in Karachi, from June 1 to July 31, 2016, and comprised senior and junior doctors. A 26-item questionnaire divided in three sections was used to test knowledge, attitude and perception of the subjects regarding rational use of antibiotics. Data was analysed using SPSS 23.Results: Of the 200 subjects, 132(66%) were senior doctors; 68(34%) were junior; 116(58%) were females; 84(42%) were males; and the highest number of respondents were from General Medicine 65(32.5%). While 182(91%) doctors realised that antibiotic resistance was a pressing issue, only 131(65.5%) felt confident about their prescriptions and 94(47%) admitted that they over-prescribed antibiotics. Among young physicians, 13(19.1%) believed that antibiotics did not cause side effects even when prescribed unnecesarily. Also, 47(69.1%) junior doctors felt that patients\u27 demands influenced their prescriptions compared to 66(50%) senior doctors (p=0.01).Conclusion: Although physicians were found to be knowledgeable about rational use of antibiotics, there were gaps in knowledge and perception

Prevalence and characteristics of resistant hypertensive patients in an Asian population

Background: Resistant hypertension is a well-recognized clinical challenge yet there are no reported data on its prevalence in Pakistan. These patients are subjected to a higher risk of developing hypertensive complications. The objective of our study was to evaluate the prevalence and determinants of resistant hypertension in an Asian cohort of hypertensive patients.Methods: This cross-sectional study was carried out among hypertensive patients visiting a tertiary care hospital in Karachi from September-December 2015. Patient data and characteristics were recorded using a pre-coded questionnaire. Morisky and Berlin questionnaires were used to assess compliance to medications and determine the risk of developing obstructive sleep apnea, respectively. Pearson\u27s chi-square test was used to analyze statistical differences between hypertensive patients and related factors.Results: A total of 515 patients were included in the study. Overall, 12% of the total patients (n=62) were resistant hypertensives and 25% (n=129) had pseudo-resistant hypertension. Resistant patients were more often females, older and had a higher body mass index (all P\u3c0.001). Use of painkillers and noncompliance to dietary recommendations were found to be significant determinants of resistant hypertension. Prevalence of comorbid conditions, including diabetes (p=0.33), hyperlipidemia (p=0.46), and chronic kidney disease (p=0.23), was not significantly higher in patients with resistant hypertension.Conclusion: Nearly one in ten hypertensive patients had true resistant hypertension, and twenty-five percent of patients had pseudo-resistance. Resistance hypertensions is significantly associated with female gender, older age, obesity, dietary noncompliance and increased use of NSAIDs

Focal dystonia and ataxic hemiparesis as the initial presentation of a thalamic tuberculoma: a diagnostic challenge in an immunocompetent pediatric patient

Background: Central nervous system (CNS) tuberculomas are rare and account for approximately 1% of all tuberculosis (TB) cases. These intracranial lesions are more commonly observed in immunocompromised individuals, often as part of disseminated miliary TB or after latent infection reactivation. This case report presents the occurrence of a thalamic tuberculoma in an immunocompetent girl. Case Description: An 11-year-old girl presented with a 3-month history of progressive right-sided ataxic hemiparesis, hand dystonia/thalamic hand, and headache. There was only a mildly elevated erythrocyte sedimentation rate (25 mm/h.), and her remaining biochemistry and vitals were unremarkable. Magnetic resonance imaging (MRI) brain revealed an ill-defined intra-axial heterogeneous lobulated lesion with crenated margins involving the thalamus and the posterior limb of the internal capsule with significant vasogenic edema. Given the clinical picture, the working diagnosis was a high-grade brain tumor. Due to the absence of a viable operative corridor for a meaningful resection and the diagnostic uncertainty, a stereotactic biopsy was performed, and histopathological analysis confirmed the presence of granulomas consistent with TB. A human immunodeficiency virus test (negative) and interferon-gamma release assay (positive) were then obtained. The patient was commenced on a regimen of anti-TB drugs with a tapering steroid dose. At 8 months, her most recent MRI showed a significant reduction in the size of her tuberculoma, and there is a complete resolution of her hand dystonia and hemiparesis to allow for independence in her activities of daily living. Conclusion: This report emphasizes the importance of considering causes other than degenerative, vascular, or neoplasms in patients with hemiparesis with dystonia. CNS tuberculomas can present as such without prior history or specific clinical symptoms of TB, making them a diagnostic challenge. In cases with such uncertainty regarding the nature of an intracranial lesion and the role of resection, a stereotactic biopsy is invaluable

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

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Hepatoprotective potential and chemical characterization of Artocarpus lakoocha fruit extract

Artocarpus lakoocha fruits are widely consumed as food. The study was aimed at evaluating its hepatoprotective activity and chemical constituents. The extract was analysed by HPLC for the presence of flavonoids and phenolic compounds. Hepatoprotective potential was determined in mice following 8 days of extract or silymarin (standard therapy) administration. Hepatotoxicity was induced by administration of paracetamol (500 mg/kg). The blood and liver of treated and untreated mice were collected 24 hours post-paracetamol intoxication. HPLC analysis confirmed the presence of chromatotropic acid, quercetin, gallic acid, vanillic acid, cinnamic acid, ferulic acid and kaempferol. Acute toxicity study showed no observed effect at more than 2,000 mg/kg. The fruit extract prevented the rise in liver function tests and paracetamol related histopathological alterations. The hepatoprotective activity of extract was dose-dependent. This study confirms the preventive effect of methanolic extract of monkey jack fruits against paracetamol-induced liver toxicity. Video Clip of Methodology: 7 min 25 sec:   Full Screen   Alternat

Ameliorating effect of Malva Neglecta on hyperglycemia and hyperlipidemia in diabetic rats

The plant, Malva neglecta wallr., is widely consumed for medicinal and nutritional purposes. The current study was carried out to assess the hypoglycemic and antihyperlipidemic potential of aqueous methanolic extract of M. neglecta. Chemical evaluation of the extract was performed by high pressure liquid chromatography. Oral glucose tolerance test (OGTT) was done in diabetic rats pre-exposed to 250, 500 and 750 mg/kg plant extract via the oral route. For hypoglycemic and biochemical study, the same therapy was administered to alloxan induced diabetic rats for 14 days. The standard controlgroup received Glibenclamide (5 mg/kg). Ferulic acid, p-coumaric acid and other phenolic acids were detected and estimated in the extract. Administration of the plant extract significantly reduced blood glucose level in diabetic rats subjected to OGTT. The plant extract lowered the fasting blood glucose and alpha amylase, and prevented the damage to pancreas. It also corrected dyslipidemia in diabetic animals following 14 days therapy. Hence, this experimental study establishes the fact that M. neglecta exhibited significant antidiabetic and antihyperlipidemic activities in alloxan induceddiabetic rats

Photocatalytic Degradation of Cefixime Trihydrate by Bismuth Ferrite Nanoparticles

The present work was carried out to synthesize bismuth ferrite (BFO) nanoparticles by combustion synthesis, and to evaluate the photocatalytic activity of synthesized bismuth ferrite nanoparticles against cefixime trihydrate. BFO nanoparticles were successfully synthesized using bismuth (III) nitrate and iron (III) nitrate by a combustion synthesis method employing different types of fuels such as maltose, succinic acid, cinnamic acid, and lactose. The effects of the different types of fuels on the morphology and size of the bismuth ferrite nanoparticles were investigated. Characterization of the as-obtained bismuth ferrite nanoparticles was carried out by different techniques such as X-ray diffraction (XRD), scanning electron microscopy (SEM), Energy-Dispersive Spectroscopy (EDS), N2-sorption analysis, Fourier-transform infrared spectroscopy (FT-IR), and ultraviolet-visible (UV–vis) spectroscopy. Photoluminescence studies were also carried out for the various bismuth ferrite nanoparticles obtained. Degradation of cefixime trihydrate was investigated under sunlight to evaluate the photocatalytic properties of the bismuth ferrite nanoparticles, and it was found that the bismuth ferrite nanoparticles followed first-order degradation kinetics in solar irradiation in the degradation of antibiotic, cefixime trihydrate