Persimmon (Diospyros kaki) fruit: hidden phytochemicals and health claims

Currently, nutrition and health linkages focused on emerging strategy of diet based regimen to combat various physiological threats including cardiovascular disorders, oxidative stress, diabetes mellitus, etc. In this context, consumption of fruits and vegetables is gaining considerable importance as safeguard to maintain human health. Likewise, their phytochemicals and bioactive molecules are also becoming popular as promising demulcent against various ailments. The current review is an effort to sum up information regarding persimmon fruit with special reference to its phytochemistry and associated health claims. Accordingly, the role of its certain bioactive molecules like proanthocyanidin, carotenoids, tannins, flavonoids, anthocyanidin, catechin, etc. is highlighted. Owing to rich phytochemistry, persimmon and its products are considered effective in mitigating oxidative damage induced by reactive oxygen species (ROS). The antioxidant potential is too responsible for anti-malignant and anti-melanogenic perspectives of persimmon functional ingredients. Additionally, they are effectual in soothing lifestyle related disparities e.g. cardiovascular disorders and diabetes mellitus. There are proven facts that pharmacological application of persimmon or its functional ingredients like proanthocyanidin may helps against hyperlipidemia and hyperglycemia. Nevertheless, astringent taste and diospyrobezoars formation are creating lacuna to prop up its vitality. In toto, persimmon and its components hold potential as one of effective modules in diet based therapy; however, integrated research and meta-analysis are still required to enhance meticulousness

Haemodynamics During Induction with Sevoflurane Versus Propofol Using Laryngeal Mask Airways in Forearm Orthopaedic Surgeries in Older Children

Background: To compare the hemodynamicchanges during induction of anesthesia withpropofol and sevoflurane in children undergoingforearm orthopedic surgeries.Methods: In this descriptive study 60 pediatricpatients, scheduled for forearm orthopedic surgicalprocedure under general anesthesia requiring LMAinsertion were included. The selected patients wereallocated into two groups; A (Propofol) and B(Sevoflurane) of 30 each. Group A was induced withIV Propofol 2mg/kg while Group B was induced bysevoflurane 6-8%. Anesthetic induction wassupposedly achieved after loss of eyelash reflex.Results: Compared with base line, both groupsshowed a statistically significant decline in meanarterial pressure after induction. Propofol group (A)showed a larger transient decrease in MAP comparedto sevoflurane group (B) (p<0.001). There was astatistical significant overall greater decline in MAPand heart rate after induction with propofol whencompared with sevoflurane.Conclusion: Sevoflurane provides slightly betterhemodynamic stability compared to propofol duringanesthetic induction

AN UNUSUAL MASS OF THE CHEST WALL IN A 7 YEARS OLD CHILD: AN ASKIN'S TUMOUR

Askin’s tumour is a primitive neuroectodermal tumour developing from the soft tissues of the chest wall. It is commonly misdiagnosed due to features similar to other round blue cell tumours. The approach for its diagnosis and treatment is complex and requires a multidisciplinary team. The recommended treatment is chemotherapy and surgical excision mainly. The prognosis is dependent on many factors. We managed a child of Askin’s tumour using modalities such as neoadjuvant chemotherapy and surgical excision and found a good response.Key words: Chest wall mass, Askin’s tumour, Ewing sarcom

Thermal Influence on the Heart: The Impact of Hot Weather on Cardiovascular Conditions

Dear Editor, We are cognisant of the fact that cardiovascular diseases (CVDs) have a considerable impact on public healthcare systems. Cardiovascular disorders rank as the primary global reason of fatality, claiming an estimated 17.9 million lives in 2019, which equates to 32% of all global fatalities. The majority of these deaths, around 85 percent, result from heart attacks and strokes. Low- and middle-income countries tolerate the brunt of heart-related fatalities, accounting for over three quarters of all deaths attributed to these conditions. Additionally, out of the 17 million premature deaths caused by noncommunicable diseases in 2019, CVDs were responsible for 38 percent.1 The prevailing cardiovascular risk factors encompass increasing age, hypertension (commonly referred to as a double-edged sword), diabetes mellitus, tobacco use, obesity, dyslipidaemia, and stress.1,2 A sedentary lifestyle together with poor eating habits have also led to an increased rate of CVS-related illnesses.1 Often overlooked as a risk factor, experiencing high temperatures significantly adds to the increased occurrence of cardiovascular diseases. Multiple studies support the connection between extreme temperatures and heightened cardiovascular risks.2-5 Being exposed to higher temperatures can lead to intravascular volume depletion, haemoconcentration, a hypercoagulable state, electrolyte imbalance, and raised sympathetic activity, placing substantial stress on the heart, especially in individuals with pre-existing cardiovascular disease.3 To investigate cardiovascular mortality associations with extremes of temperatures, Barrak Alahmad et al. assembled daily counts of specific cardiovascular causes of death from 567 cities across 5 continents in overlapping periods ranging from 1979 to 2019, and the city-specific daily ambient temperatures were noted. The findings indicated that higher temperature extremes (99th percentile for heat and 1st percentile for cold) were linked to an increased probability of mortality from various cardiovascular conditions, including ischaemic heart disease, stroke, and heart failure.4 In a case-crossover study conducted using the England and Wales MINAP database, involving 24,861 participants (hospital admissions for myocardial infarction) during the warmest months (June to August) from 2003 to 2009, it was found that each 1-degree Celsius increase in temperature beyond the established threshold of 20 °C temporarily increased the risk of heart attack by 1.9 percent.5 The cardiovascular-related illness and fatalities are quite prevalent in Pakistan. Pakistan due to her geographical location, usually encounters summer temperatures ranging from 45 to 55 degrees Celsius across most areas of the country. ---Continu

Unveiling the psychiatric dimensions of hypopituitarism: investigating associations, challenges, and treatment strategies

Dear Editor, Hypopituitarism is a disorder characterized by insufficient hormone production from the pituitary gland,1,2 manifesting as either pan or partial dysfunction.2 Hypopituitarism is considered a rare disorder by National Institute of Health and there is limited information on its occurrence. A study in Spain demonstrated prevalence of 45.5 cases per 100,000 people.2 Hypopituitarism can be caused by pituitary tumours, head injury, infections, radiation therapy, autoimmune conditions, and genetic abnormalities.2 Hypopituitarism occurs when about 75% of the pituitary gland is affected, causing a spectrum of clinical features from mild to severe.2 Sheehan syndrome, resulting from anterior pituitary ischaemia typically after postpartum haemorrhage, occurs in approximately 5/10,000 births in developing countries.3 Hypopituitarism diagnosis may take a decade or longer due to its diverse clinical presentations.3 As of now, the link between psychotic disorders and hypopituitarism is not completely understood.1 While a few case reports have documented a link between pituitary insufficiency and mental health issues, larger-scale studies are limited in number. Hypopituitarism raises depression and anxiety risk, especially in females and those over 18, with females having tenfold higher risk of depression than males.1 Growth hormone deficiency (GHD) is linked to cognitive impairments, and atypical depression.4 In their 1949 report, Sheehan and Summer noted that one-third of total 143 hypopituitarism patients displayed loss of drive and initiative, and disinterest in social connections.5 Acute psychosis as an initial presentation of hypopituitarism has been reported in cases involving Sheehan's syndrome, traumatic brain injury, and glucocorticoid therapy.5 A 37-year-old pregnant woman diagnosed with Sheehan syndrome exhibited neuropsychiatric symptoms, prompting early diagnosis.3 The 2010 study found that growth hormone therapy improved cognitive function and reduced depression severity in traumatic brain injury patients with GHD. However, discontinuation of therapy led to worsened cognitive function and increased psychiatric symptoms, highlighting the potential benefits of growth hormone therapy and the need for more experimental studies to confirm its effects on neurophysiological and psychiatric wellbeing.4 Adults with Childhood Onset Multiple Pituitary Hormone Deficiency have a notably lower quality of life, underscoring the importance of addressing psychosocial and psychosexual challenges in this population.6 A 60-year-old man with macroprolactinoma and hypopituitarism developed acute psychosis due to non-adherence to cabergoline, treatment with hydrocortisone, and thyroxine lead to full recovery within 48 hours.5 A 41-year-old man with osmophobia improved with sertraline transiently. Later, he was diagnosed with partial hypopituitarism with adrenocorticotropic hormone deficiency. Prednisolone supplementation significantly improved his condition.7 ---Continu

Socioeconomic and Environment Conditions and Diarrheal Disease Among Children in Pakistan

Diarrheal disease poses mortality and morbidity risks to infants and young children. Based on losses in terms of disability-adjusted life years, the World Development Report (1993) estimates that diarrheal disease is the third most burdensome illness among children in the 1 to 5 years age bracket. Using 1990 data, Murray and Lopez (1994) estimated that about 3 million children die every year due to diarrheal disease. Severity of diarrheal illness and alternative interventions are necessary inputs into the government’s decision-making. However, there is currently much uncertainty about the most appropriate policies in the context of low-income environments such as Pakistan. The debate could be described in terms of efficacy of economic/behavioural or environment/infrastructure. In this study, we explore the socioeconomic and environment determinants of diarrheal disease for children in Paksitan. The diarrheal determinants equation was estimated by logistic techniques. Diarrheal illness jointly with defensive behaviour was estimated from the reduced form to fully capture the relationship between defensive actions and illness. Such an endeavour will provide decision makers and policy analysts information to formulate policy design for the necessary interventions and respective investment plans for the alleviation of dairrheal disease among children, depending upon the relative contribution of socioeconomic and enviromental factors. For the specific case of Pakistan, socioeconomic development strategies do not necessarily gaurantee lowering the incidence of diarrhea, particularly among children below five years of age, unless supported by environmental interventions

Health Demand and Outcomes in Pakistan

For the provision of better social services, the health sector has been an important part of the national strategy for reducing poverty and income disparities among different income groups in Pakistan. The distribution of access to and use of health services among households has long been a concern for policymakers. In this study, government health expenditure is treated as a fixed factor that influences household health behavior, conditional on factors such as household income, education, and family size. The results suggest that government health expenditure is associated with higher use of both preventive and curative health services by children. However, the results also indicate that increased government expenditure is associated with lower use of health services by the children of the poor, although this negative association is generally weak. If increased government spending improves health care opportunities for the nonpoor more than for the poor, the total effect of government spending on the health outcomes of the poor could be less, even though they have a higher marginal product of health care inputs