Clinical profile and outcomes of paediatric patients with diabetic ketoacidosis at a tertiary care hospital in Pakistan

OBJECTIVES: This study aims to present an experience in the management and clinical features of 88 children presenting with diabetic ketoacidosis (DKA) from Pakistan. METHODS: A retrospective medical chart review of all patients, \u3c or = 15 years of age, who presented to the Aga Khan University Hospital, Karachi, Pakistan in the last ten years with a diagnosis of diabetic ketoacidosis was carried out. Severity of DKA was defined as mild (venous pH \u3c 7.30 or bicarbonate=15mEq/l), moderate (venous pH \u3c 7.2 or bicarbonate = 10 mEq/l) and severe (venous pH \u3c 7 or bicarbonate \u3c 5 mEq/l). These classes correspond to 1st, 2nd and 3rd degrees of diabetic ketoacidosis severity respectively. Cases in which diabetic ketoacidosis had occurred at onset of diabetic diagnosis were not included in the study. RESULTS: Mean age was 7.5 +/- 3.6 years; 58 (66%) patients were male. Twenty six patients had mild diabetic ketoacidosis, 44 had moderate while 18 had severe diabetic ketoacidosis at the time of presentation. Severity of diabetic ketoacidosis was significantly associated with the presence of infection, history of omission of insulin, poor compliance, presence of shock at time of presentation, length of stay in the hospital, final outcome (p \u3c 0.01 for each of these associations) and Glasgow Coma Scale score (p = 0.02). Mortality in this series was 3.4%. CONCLUSION: Poor compliance was associated with the severity of diabetic ketoacidosis. Paediatric endocrinologists\u27 should ensure that patients and their parents understand the importance of the need for regular insulin injections and regular monitoring of blood glucose

Pregnancy related complications due to obesity and gestational diabetes mellitus among women in Saudi Arabia

Gestational Diabetes mellitus (GDM) is one of the major maternal health problems in Middle East countries. In Saudi Arabia, the prevalence rates of GDM fall in the range of 16.2% to 24.2%. The study determined the antenatal complications and adverse pregnancy outcomes associated with GDM among a sample of Obese/GDM and Non-Obese/GDM women. A record based retrospective study was conducted including females who received obstetric care in a tertiary care hospital in Ha’il city of Saudi Arabia from December 2020 to June 2021. We gathered data from the medical records of 376 pregnant females who were registered and delivered at Maternity and Children Hospital (MCH). Multinomial regression analysis was applied to determine independent association of GDM and Obesity with pre-postnatal health outcomes. Out of 376 pregnant women 29.2% were identified as (Non-Obese/Non-GDM); 37.1% of women as having both conditions (GDM/Obesity); 19.2% as (Non-Obese/GDM) and 14.1% as (Obese/Non-GDM). The proportion of underweight and overweight babies were high in women with both conditions (Obese/GDM). Findings from our regression analysis demonstrated that Non-Obese/GDM women were 2.7 times more likely to have high child birthweight (p<0.001) when compared to Non-Obese/Non-GDM. Obese/GDM women were more likely to have low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores (p<0.001) and increase neonatal intensive care unit (NICU) admissions (p<0.01). Healthcare policy makers and professionals should revisit gaps in existing obstetrical care to prevent adverse impact on women and newborn health. Non-Obese women at risk of GDM should also be given due attention for early screening, timely diagnosis, and appropriate pre-postnatal care

C -Reactive Protein, Leukocyte Count and Neutrophils: A Diagnostic Aid in Acute Appendicitis

Background: Malnutrition is known to be a poor prognostic factor affecting the outcome of pediatric cancers. The objective of this study was to assess the pre-existing malnutrition in newly diagnosed pediatric cancer patients presenting at the Pediatric Oncology Department, Children Hospital, PIMS and their number of hospital admissions due to causes other than chemotherapy. Methodology: Data of 44 newly diagnosed children with cancer was analyzed to find out the association of nutritional status according to z-score for weight and height for age, body mass index (BMI) and mid-upper arm circumference (MUAC) with their number of hospital admissions for 6 months since their date of diagnosis. Results: The mean age of the study subjects was 4.25 ± 2.85 years, out of which 33(75%) were males and 11(25%) females. Most of the patients were diagnosed with leukemia or lymphoma.  Nutritional status evaluation of thirty patients who got admitted was mild to moderate wasting in 24(80%) assessed by weight for age, mild to moderate stunting in 21 (70%) according to height for age and mild to severe malnutrition in 10 (33%) based on body mass index and mid upper arm circumference (MUAC). There was significant association between nutritional status of patients at the time of diagnosis with additional hospitalization with p value less than 0.05 Conclusion: Malnutrition at the time of diagnosis is significantly associated with an increase in the number of hospital admissions in pediatric cancer patients. Key words: Hospitalization, Malnutrition, Oncology, Pediatric &nbsp

Case of recurring Kikuchi disease and autoimmune hepatitis

Abstract We present a case of a 47‐year‐old female patient with a history of diagnosed Kikuchi disease and autoimmune hepatitis 13 years ago who presented with recurrent fevers and a desquamative rash on the lower extremities. Computed tomography neck showed enlarged lymph nodes, and with her daily fevers and skin rashes the presentation was concerning for recurrence of her Kikuchi disease. The patient was also found to have an elevated anti‐smooth muscle antibody titer, and subsequent liver biopsy confirmed the diagnosis of autoimmune hepatitis. She was started on methylprednisolone with improvement. Our case emphasizes the association of Kikuchi disease with autoimmune conditions other than systemic lupus erythematosus. Given the recurrence of the disease after a decade of quiescence, long‐term follow‐up of patients with Kikuchi disease should be implemented

Human papillomavirus infection in females with normal cervical cytology: Genotyping and phylogenetic analysis among women in Punjab, Pakistan

Background: Globally, cervical cancer is the fourth most common cancer in women and the seventh most common cancer overall, accounting for an estimated 300 000 annual deaths. Human papillomavirus (HPV) is the second most common cause of cervical cancer worldwide. HPV screening is not a common practice in Pakistan. The aim of this study was to determine the prevalence of HPV and HPV types in women with a normal cytology of the cervix living in the upper and lower regions of Punjab, Pakistan, and to analyze the risk factors for HPV in this region. Methods: PCR analysis was performed for 1011 female patients with a normal cytology of the cervix from various districts of Punjab Province, Pakistan. Risk factors for the acquisition of HPV were studied. High-risk HPV types (HPV16 and HPV18) were detected using the Abbott Real Time HR HPV test. To determine the genotype, partial L1 region sequences of HPV-positive samples were subjected to sequencing using MY/09/MY11 primers, and a phylogenetic tree was constructed using CLC software. Results: The study found a 4.74% prevalence of HPV, with the most frequent HPV type found being the low-risk HPV6 (in 25% of infected individuals), followed by HPV55 (22.9%), HPV11 (20.8%), and high-risk types HPV45 (12.5%), HPV33 (8.33%), HPV18 (6.25%), and HPV16 (4.16%). Phylogenetic analysis of all HPV types in this study showed 80–99% nucleotide identity with types related to the same species. The sequences were clustered with China, India, Mexico, Iran, Slovenia, and Germany, showing the diversity in origin of the various genotypes prevalent in Pakistan. Conclusions: In this population with a normal cervical cytology, the prevalence of high-risk HPV types was very low. The major prevalent HPV genotype in Punjab Province of Pakistan was the low-risk HPV type 6, followed by HPV type 55. Sequencing of the partial L1 region suggested that the region was highly conserved in all reported sequences. This study highlights the need to conduct robust epidemiological studies in the region and to develop regular HPV screening so that the situation does not reach an alarming stage resulting in cervical cancer

Ectoparasitosis, a rare cause of severe iron deficiency anemia: a case report

Pediculosis is a common condition caused by an infestation of head and body louse (ectoparasites) and remains a public health concern. Generally, infestation presents as pruritus in children and has a benign course, but there have been a handful of cases reported in the literature describing severe iron deficiency anemia (IDA) in high-risk groups such as children, history of psychiatric disorder including depression, and low socioeconomic status. Though an uncommonly encountered etiology of anemia, the aim of this case is to increase awareness of a rare cause of severe anemia from an ectoparasites affecting a high risk population, even in developed countries.</p

Sequencing and Characterization of Mitochondrial Protein-Coding Genes for Schizothorax niger (Cypriniformes: Cyprinidae) with Phylogenetic Consideration

The present study was conducted to get more information about the genome and locate the taxonomic position of Schizothorax niger in Schizothoracinae through mitochondrial 13 protein-coding genes (PCGs). These PCGs for S. niger were found to be 11409 bps in length ranging from 165 (ATPase 8) to 1824 bps (NADH dehydrogenase subunit 5) and encode 3801 amino acids. In these PCGs, 4 genes overlap on the similar strands, while one shown on the opposite one: ATPase 6+8 and NADH dehydrogenase subunit 4+4L overlap by 7 nucleotides. Similarly, ND5-ND6 overlap by 4 nucleotides, while ATP6 and COIII overlap by 1 nucleotide. Similarly, four commonly used amino acids in S. niger were Leu (15.6 %), Ile (10.12 %), Thr (8.12 %), and Ala (8.7 %). The results presented that COII, COIII, NDI, ND4L, and Cytb had substantial amino acid conservation as compared to the COI gene. Through phylogenetic analysis, it was observed that S. niger is closely linked with S. progastus, S. labiatus, S. plagiostomus, and S. nepalensis with high bootstrap values. The present study provided more genomic data to know the diversity of the mitochondrial genome and its molecular evolution in Schizothoracinae