Cholera in children in Karachi from 1990 through 1995: A study of cases admitted to a tertiary care hospital

Although cholera is an endemic disease in Bangladesh, India and other countries, it was never a significant cause of gastroenteritis in Pakistan before 1988. Since then, cases of cholera are identified each year, both in adults and children in Pakistan. In order to see the contribution of Vibrio cholerae as a cause of gastroenteritis in children, we reviewed the cases of cholera admitted in the pediatric ward of the Aga Khan University Hospital, Karachi, Pakistan. Of 4346 children hospitalized with gastroenteritis during 1990 through 1995, 348 children (8%) were confirmed to have cholera. The youngest child with cholera was seven days old. The mean age was 31 +/- 34 months. The cases of cholera were received from all over the city. Most cases were due to Vibrio cholerae Ogawa biotype ELTOR but the new strain, i.e., Vibrio cholerae 0139 was isolated in 14% cases in 1994. The sensitivity of Vibrio cholerae has also changed. In 1994, the organisms were resistant to commonly recommended antibiotics, i.e., tetracycline, ampicillin and erythrocin but sensitive to ceftrioxone, cefixime, ofloxacin and nalidixic acid. Adequate measures to improve hygiene and sanitation and supply of safe potable water is needed to prevent any future epidemic of cholera in the city

Self-reported feeding advice by physicians for common childhood illnesses

Background: A nutritious diet is important for recovery during illnesses. Dietary advice by physicians and consumption of food by the patients are often based upon their hot and cold concepts and beliefs about various foods rather than on scientific basis.Objectives: To look at the food-advising behaviour of physicians during illnesses and to know the maternal concepts about various foods being hot or cold.Methods: A questionnaire was served to the physicians participating in a continuous medical education session held at the Aga Khan University and Hospital, asking them to write the foods they advise or restrict during different illnesses such as fever, jaundice etc. Mothers of sick children suffering from diarrhea and other illnesses were also interviewed to know their concepts about various foods.Results: Six (10%) out of sixty physicians believed in hot and cold concepts of the food. A variety of common foods were either restricted or strongly recommended by 10% to 50% of these physicians without any scientific basis, 23% physicians restricted fatty foods in jaundice, 17% physicians restricted in cough and cold. Although the interviewed mothers believed in hot-cold concepts of food but 55-63% of them were not sure what is meant by hot or cold food. In spite of that 70-80% of these mothers classified chicken, meat, egg, brinjal, masoor and mangoes are hot foods and rice, yogurt, moong, banana and orange as cold foods.Conclusion: Hot-Cold concept of food exists not only in mothers but also in physicians. Proper education regarding food intake is mandatory for both mothers and physicians to ascertain adequate intake of calories during sickness

Status epilepticus in children: A five-year experience at Aga Khan University Hospital

Objective: Status epilepticus is an under diagnosed entity in Pakistan. It is a potentially reversible condition but has a high mortality, if it is not recognized and managed on time. The purpose of this study was to determine the clinical profile and the relationship of mortality of status epilepticus with its known risk factors.Methods: This was a retrospective study. Medical records of all the patients admitted in the last five years (1998-2002) with a diagnosis of status epilepticus (ICDcode 345.30, 345.31) were reviewed. Data was recorded on a Performa and analyzed by using the statistical programme SPSS, chi square and Fischer exact test.Results: The total number of patients were twenty-four. Sixteen patients were males (66.7%). Mean age was fifty-eight months and mean duration of hospital stay 5.5 days (range 2 to 22days). Eight patients were diagnosed to have epilepsy. Four (16.7%) had a previous history of status epilepticus. Three patients presented with status epilepticus for the first time without any previous history of seizures. Ten patients required midazolam infusion (41.7%) and out of these 3 (12.5%) were also given thiopentone infusion to control the seizures. Nine patients were shifted to the ICU for ventilation and control of seizures. Mortality in our study was 25%. Risk factors for mortality included age less than or equal to one year, abnormal MRI, type of the status epilepticus and the total duration of status epilepticus. No significant relationship was found with any of the known risk factors.Conclusion: Status epilepticus is a neurological emergency. A very high mortality was seen in our study. No risk factors were identified for this high mortality

Ca2+ dependent activation of extracellular signal regulated kinases 1 and 2: role of intrasynaptosomal Ca2+ stores

The aim of the thesis was to examine how Ca2+ activates the ERK pathway and the contribution of Ca2+ released from intracellular stores in physiological and pathophysiological conditions using isolated nerve terminals (synaptosomes) in a presynaptic model. The Ca2+-dependent phosphorylation/activation of ERK1 and ERK2 stimulated by depolarisation of the plasma membrane or by Ca2+ influx mediated by the ionophore ionomycin was significantly reduced by the removal of external Ca2+. Intrasynaptosomal Ca2+ contribution to the Ca2+-dependent component of ERK1 and ERK2 phosphorylation/activation was indicated by the depletion of intrasynaptosomal Ca2+ or inhibition of the smooth endoplasmic reticulum Ca2+-ATPase pump. Two main pathways were found to lead to the release of Ca2+ from intrasynaptosomal stores. Firstly, external Ca2+ influx directly activated ryanodine receptors (RyRs) to mediate Ca2+-induced Ca2+ release (CICR). Secondly, Ca2+ influx or activation of GPCRs coupled to Gq/11 activated phospholipase C (PLC) to effect PIP2 metabolism and IP3 production, with consequent activation of IP3-induced Ca2+ release (IPCR). The activation of group I metabotropic glutamate receptor (mGluR1/5) stimulation supported IPCR. Intriguingly, inhibition of Ca2+ influx through voltage-dependent calcium channels (VDCCs) by stimulating GABAB, group III mGluRs, 5-HT1A and A1 receptors was suppressed by prior depletion of the smooth endoplasmic reticulum. Mitochondria and acidic compartments also appear to store Ca2+ intrasynaptosomally, with mitochondrial depolarisation resulting in a transient increase in ERK1 and ERK2 phosphorylation/activation. Finally, a pathophysiological model of nerve terminal ischemia showed that intrasynaptosomal Ca2+ release contributes to the Ca2+-dependent component of phosphorylation/activation of ERK1 and ERK2 occurring when Na+/K+- ATPase is inhibited. In conclusion, extracellular Ca2+ influx and intracellular Ca2+ store release together support Ca2+ mediated stimulation of the ERK pathway in synaptosomes. This has important implications in the cross-talk of signalling pathways to ERK1 and ERK2 phosphorylation/activation and neurotransmitter release from nerve terminals in physiological and pathophysiological conditions

Lactose intolerance in persistent diarrhoea during childhood: The role of a traditional rice-lentil (Khitchri) and yogurt diet in nutritional management

Lactose intolerance is frequently encountered in children with persistent diarrhoea (PD). Selection of an appropriate milk-based formulation is a major management problem in the developing world. In a consecutive series of studies, we evaluated the role of feeding a traditional rice-lentil (khitchri) diet alone (KY) or in combination with either soy formula (KY-Soy) a dilute buffalo milk (KY-B), in children (age 6 months-3 years) with PD. Serial observations of stool output, caloric intake and weight gain of these children over a 14 day period indicated satisfactory tolerance of the KY diet with adequate weight gain. The weight gain and stool output was however higher in lactose intolerant children, with the worst results seen with K-Y and buffalo milk combination. While lactose intolerant children with PD do have higher. rates of therapeutic failure, our data indicates that a traditional diet and yogurt combination can be used satisfactorily for nutritional rehabilitation in over 80% of such children

Paediatric prescribing in Karachi

To assess amount of drug overuse we studied drug prescribing for common childhood problems by 65 general practitioners (GPs) and 29 paediatricians. A total of 2433 encounters between GPs or paediatricians and children under five years of age were observed. The presenting complaints were fever in 18%, cough in 9%, both fever and cough in 21%, vomiting in 20% and diarrhoea in 41% of encounters. Antibacterials were prescribed in 49% of encounters, analgesics and antipyretics in 29%, antiemetics in 8% and injectables in 15%. Antidiarrhoeals were prescribed in 41% encounters with children reported to have diarrhoea. Ampicillin and cotrimoxazole were the two common antibacterials prescribed by both GPs and paediatricians. Antibacterials were prescribed in significantly larger number of encounters with GPs than in those with paediatricians. Mean encounter time of patients with GPs was 3.4+/-2.7 minutes and with paediatricians 9.7+/-4.1 minutes

Biomass expansion factors of Olea ferruginea (Royle) in sub tropical forests of Pakistan

Wood biomass gives information about total productivity of the forest as well as individual tree. Olea ferruginea (Royle) which is small and evergreen is widely distributed in native sub tropical forests of Pakistan and extensively used as fuelwood domestically. This study was carried out in the sub tropical forests of Pakistan at 33° 38’ north and 73° 00’ east latitude and longitude, respectively, and at an elevation of 917 m. Trees with exploitable diameter were selected randomly from the entire forest.Destructive sampling techniques were used for measuring biomass (kgm-3) in all the tree components. For this purpose, 5 trees were felled and the biomass of each component of the tree including main stem, branches, leaves, twigs and roots were estimated separately using volume, weight and density. The generic data of wood density (kgm-3) was used to determine the biomass (kg). The study showed that average contribution of stem portion of the tree was 49.01% of the total tree biomass, and branches showed 31.17%, leaves 1.98%, twigs 1.05% and roots 16.65% of the total tree biomass. So, it was found that the major part of the total tree biomass was present in the stem portion of O. ferruginea. Totalvolume of the tree was also found to be dependent on the diameter of the tree. Mean volume of the tree was 0.475 ± 0.07 m3. The prepared  biomass expansion factor will be helpful in estimating productivity, carbon stocks and yield of the forest.Key words: Biomass, biomass expansion factor, tree volume, Olea ferruginea