Pediatric congenital heart diseases: Patterns of presentation to the emergency department of a tertiary care hospital

Objective: To observe presentation of Pediatric congenital cardiac defects to the Emergency Department (ED) of a tertiary care hospital in Pakistan.Methods: This is a retrospective chart review of patients under the age of 16 years with congenital cardiac defects presenting to the Emergency Department of Aga Khan University Hospital over a period of eighteen months, from January 2012 to June 2013. Study population was divided into two groups; first group constituted children with undiagnosed congenital cardiac defects, whereas second group constituted children with diagnosed congenial cardiac defects presented to ED. In previously diagnose cases each visit was counted as a separate encounter.Results: Out of 133 children, 44 (33.5%) were diagnosed congenital cardiac disease for the first time (Group-1) in ED, while 89 (66.5%) children were diagnosed cases of congenital heart disease (Group-2). Among Group-1; main reasons for ED visits were cyanosis, cardiac failure, murmur evaluation and cardiogenic shock where as in Group-2; main presentations were cardiac failure, hyper cyanotic spells, gastroenteritis, lower respiratory tract infection, and post-operative issues. There were total 13 deaths.Conclusion: High index of suspicion is necessary for early diagnosis and management of children with congenital heart disease in the pediatric emergency department

Voice onset time of Mankiyali language: an acoustic analysis

The endangered Indo-Aryan language Mankiyali, spoken in northern Pakistan, lacks linguistic documentation and necessitates research. This study explores the Voice Onset Time (VOT) values of Mankiyali's stop consonants to determine the duration of sound release, characterized as negative, positive, and zero VOTs. The investigation aims to identify the laryngeal categories present in the language. Using a mixed methods approach, data were collected from five native male speakers via the Zoom H6 platform. The study employed the theoretical framework of Fant's (1970) source filter model and analyzed each phoneme using PRAAT software. Twenty-five tokens of a single phoneme were recorded across the five speakers. The results reveal that Mankiyali encompasses three laryngeal categories: voiceless unaspirated (VLUA) stops, voiceless aspirated (VLA) stops, and voiced unaspirated (VDUA) stops. The study highlights significant differences in VOTs based on place of articulation and phonation. In terms of phonation, the VLUA bilabial stop /p/, alveolar stop /t/, and velar stop /k/ exhibit shorter voicing lag compared to their VLA counterparts /pʰ, tʰ, kʰ/. All VLUA and VLA stops display +VOT values, while all VDUA stops exhibit -VOT values. Regarding place of articulation, the bilabial /p/ demonstrates a longer voicing lag than the alveolar /t/ but a shorter lag than the velar /k/. Additionally, the results indicate similarities in voicing lag among the VDUA stops /b, d, ց/. This study offers valuable insights into the phonetic and phonological aspects of Mankiyali and holds potential significance for the language's preservation

Alpha-glucosidase and carbonic anhydrase inhibition studies of Pd(II)-hydrazide complexes

This study focused on the synthesis and characterization of hydrazide ligands and their respective Pd(II) complexes and used high throughput screening to determine their α-glucosidase and carbonic anhydrase II enzyme inhibition activities. The physical, analytical (elemental analyses for C, H, N and Pd) and spectral (FT-IR, 1H NMR, 13C NMR, EI-mass) techniques utilized during characterization revealed the formation of square planar, neutral and 1:2 Pd(II)-hydrazide complexes with the general formula [PdL2Cl2]. In these Pd(II) complexes, the hydrazide ligands are monodentate; the terminal nitrogen is the donor atom. The uncoordinated hydrazide ligands were inactive against both α-glucosidase and carbonic anhydrase II enzymes; however, the respective Pd(II)-hydrazide complexes were approximately 300 times more potent α-glucosidase inhibitors than the standard compound, 1-deoxynojirimycin (DNJ). Some of the Pd(II) complexes also demonstrated potential carbonic anhydrase (CA) inhibition properties comparable to the standard compound, acetazolamide (ACZ).Higher Education Commission of Pakistan for financial support (‘The National Research Grants Program for Universities’, grant No.1862/R&D/10) and MMT acknowledges the support from Fulbright Scholar Award from The J. William Fulbright Foreign Scholarship Board. Open Access funded by King Saud University

Impact of duration of therapy on side effect profile of anti-HCV protocol: A retrospective cohort study from two tertiary health facilities in Pakistan

Purpose: To evaluate the plausible risks and adverse effects related to the duration of therapy in hepatitis C (HCV) patients in Lahore, Pakistan.Method: A retrospective observational study involving 250 HCV patients who received combination therapy with ribavirin and interferon was conducted. The patients were segregated into two groups on the basis of duration of therapy (≤ 6 months and > 6 months). Adverse effect profiles of patients under treatment were collected using a pre-validated questionnaire and compared using Pearson’s Chi- Square Test/Chi-Square Goodness-of-Fit tests and unpaired t-test.Results: Patients who underwent treatment for ≤ 6 months frequently encountered side-effects such as GIT disturbance (23.77 %) and joint pains (29.63 %). Additionally, diabetes mellitus (27.86 %) and frequent injections (74.59 %) were the most commonly observed co-morbid condition and disease risk, respectively. On the other hand, in patients who underwent therapy for > 6 months, skin disorders (30.46 %) and gastric acidity (10.15 %) were the most frequently observed side-effects with less frequent reporting on co-morbid conditions and disease risk factors. Moreover, there was a significant reduction in body weight (p = 0.03), serum bilirubin (p = 0.0005), albumin (p = 0.003) and triglycerides (p = 0.006) levels due to longer duration of treatment.Conclusion: The data suggest that treatment-related risks are higher among HCV patients on shorter treatment duration whereas adverse events subside in patients on longer duration of therapy (>6 months). Changes in biochemical profile were also more evident in those receiving treatment for periods >6 months.Keywords: Interferon, Ribavirin, Side effects, Duration of therapy, Outcomes of therap

Managing acute pain in HIV+/AIDS patients: Knowledge and practice trends among emergency physicians of major tertiary care centers of a developing country

Objective: To assess knowledge and practice trends in managing acute pain in patients infected with human immunodeficiency virus (HIV+) or having acquired immunodeficiency syndrome (AIDS) among emergency physicians of four tertiary care hospitals. Acute pain management in such patients is complex because of multiple concomitant painful conditions related to their disease. After obtaining ethical approval and written informed consent, emergency physicians were requested to fill out a questionnaire.Results: Out of 84 physicians who participated, 49 had managed HIV+/AIDS patients during the preceding year. Out of the 49, 30 (61.2%) physicians stated that they used a combination of analgesics for acute pain in these patients. Forty-two (50%) out of the 84 participants believed that routine doses of opioids were adequate for pain relief, while 42 (50%) agreed that pain management was more complex in these patients mainly due to presence of multiple coexisting problems and psychological issues. Only 26 (31%) respondents considered that pain was under-reported and under-treated in these patients, mainly because physicians were more focused on patients\u27 other disease related complications and issues. Formulation of guidelines are recommended for effective acute pain management in these patients encompassing associated issues, including concomitant painful conditions, opioid dependence, psychiatric problems, etc

Correlation of Uric Acid Levels with Feto-Maternal Outcomes in Hypertensive Disorders in Pregnancy

Objective: To explore the correlation between uric acid levels and feto-maternal outcomes in women with hypertensive disorders of pregnancy. Study Design: Comparative cross-sectional study. Place and Duration of Study: Obstetrics & Gynaecology Department, Combined Military Hospital, Rawalpindi Pakistan, from Feb to Aug 2021. Methodology: In this cross-sectional study, 90 pregnant women with hypertensive disorders having greater than 26 weeks of gestation were included after seeking Ethical Committee approval. Selected parameters were noted on a structured proforma. Results: Among the participants, 38(42.2%) had pregnancy-induced hypertension, 32(35.5%) had pre-eclampsia, 13(14.5%) had chronic hypertension with pre-eclampsia, and 7(7.8%) had eclampsia. Mean Uric acid levels ranged between 363.66±50.45 μmol/L and 451.86±120.62μmol/L, with a significant difference between PIH and eclampsia (p<0.001). Mode of delivery was avaginal, primary cesarean section, and repeat cesarean section in 31(34.4%), 38(42.2%), and 21(23.4%) patients, respectively(p<0.001). Liquor was meconium stained in 49(54.4%) while clear in 41(45.6%) births, with (p<0.001). Early neonatal deaths6(6.7%) participants had significantly higher uric acid levels than no NICU admission 22(24.4%). In maternal outcomes, 83 patients (92.2%) required routine post-operative care, while 7(7.8 %) went to the intensive care unit. Uric acid levels had a negative correlation with gestational age. Conclusion: Maternal uric acid levels differ significantly in different hypertensive disorders of pregnancy and affect the mode of delivery and neonatal outcomes

Cardiopulmonary resuscitation: outcome and its predictors among hospitalized adult patients in Pakistan.

Introduction:Our aim was to study the outcomes and predictors of in-hospital cardiopulmonary resuscitation (CPR) among adult Patients at a tertiary care centre in Pakistan.Methods:We conducted a retrospective chart review of all adult Patients (age \u3e or =14 years), who underwent CPR following cardiac arrest, in a tertiary care hospital during a 5-year study period (June 1998 to June 2003). We excluded Patients aged 14 years or less, those who were declared dead on arrival and Patients with a do not resuscitate order. The 1- and 6-month follow-ups of discharged Patients were also recorded.Results:We found 383 cases of adult in-hospital cardiac arrest that underwent CPR. Pulseless electrical activity was the most common initial rhythm (50%), followed by asystole (30%) and ventricular tachycardia/fibrillation (19%). Return of spontaneous circulation was achieved in 72% of Patients with 42% surviving more than 24 h, and 19% survived to discharge from hospital. On follow-up, 14% and 12% were found to be alive at 1 and 6 months, respectively. Multivariable logistic regression identified three independent predictors of better outcome (survival \u3e24 h): non-intubated status [adjusted odds ratio (aOR): 3.1, 95% confidence interval (CI): 1.6-6.0], location of cardiac arrest in emergency department (aOR: 18.9, 95% CI: 7.0-51.0) and shorter duration of CPR (aOR: 3.3, 95% CI: 1.9-5.5).Conclusion:Outcome of CPR following in-hospital cardiac arrest in our setting is better than described in other series. Non-intubated status before arrest, cardiac arrest in the emergency department and shorter duration of CPR were independent predictors of good outcome

Pharmacological screening of Viola Odorata L. for memory-enhancing effect via modulation of oxidative stress and inflammatory biomarkers

Purpose: Alzheimer disease (AD) is a progressive neurodegenerative disorder that is caused by neuroinflammation and oxidative stress. The present study aimed to characterize and then investigate the memory-enhancing potential of Viola odorata methanolic extract in lipopolysaccharide (LPS)–treated mice. Methods: V. odorata characterization was done by using the GCMS technique. Neuroinflammation was induced by the intracerebroventricular administration of LPS at a dose of 12 μg. Animals were divided randomly into six groups (n 10). Group I was normal control, which was given vehicle. Group II was disease control, which received LPS (12 μg) via the intracerebroventricular route. Group III was standard, which was administered with donepezil (3 μg) orally for 21 days. Groups IV–VI were the treatment groups, which were administered with the extract at 100, 200, and 400 mg/kg dose levels orally respectively for 21 days. Groups III–VI received LPS (12 μg) on the first day along with their treatments. During the treatment, the animals were assessed for memory retention by employing different behavioral paradigms namely elevated plus maze, passive avoidance, foot shock and open field. Various mediators [endogenous antioxidants, neurotransmitters, and acetylcholinesterase (AChE)] involved in the pathogenesis of AD were quantified by using the UV spectrophotometric method. Results: Extract-treated groups showed a remarkable improvement in cognitive impairment in all behavioral paradigms. Oxidative stress biomarkers, that is, superoxide dismutase, catalase, and glutathione were raised dose-dependently in the treatment groups with a dose-dependent decrease in the malonaldehyde and AChE levels in the brains of the treated animals. The treatment groups showed decreased levels of inflammatory biomarkers, that is, tumor necrosis factor–alpha, nuclear factor kappa light-chain enhancer of activated β-cells, and cyclo-oxygenase, which supports the therapeutic effectiveness of the treatment. Conclusion: Based on behavioral, oxidative stress biomarker, and neuroinflammatory data, it is concluded that V. odorata possesses memory-enhancing activity and may prove a beneficial role in the management of AD.peer-reviewe

Diagnosis of enteric fever in the emergency department: a retrospective study from Pakistan

Background:Enteric fever is one of the top differential diagnoses of fever in many parts of the world. Generally, the diagnosis is suspected and treatment is initiated based on clinical and basic laboratory parameters.Aims: The present study identifies the clinical and laboratory parameters predicting enteric fever in Patients visiting the emergency department of a tertiary care hospital in Pakistan.Methods:This is a retrospective chart review of all adult Patients with clinically suspected enteric fever admitted to the hospital through the emergency department during a 5-year period (2000-2005).Results:A total of 421 emergency department Patients were admitted to the hospital with suspected enteric fever. There were 53 cases of blood culture-positive enteric fever and 296 disease-negative cases on culture. The mean age in the blood culture-positive group was 27 years (SD: 10) and in the group with negative blood culture for enteric fever, 35 years (SD: 15) with a male to female ratio of 1:0.6 in both groups. Less than half (48%) of all Patients admitted with suspected enteric fever had the discharge diagnosis of enteric fever, of which only 13% of the Patients had blood culture/serologically confirmed enteric fever. None of the common clinical and laboratory parameters differed between enteric fever-positive Patients and those without it.Conclusion:Commonly cited clinical and laboratory parameters were not able to predict enteric fever

The Karachi intracranial stenosis study (KISS) Protocol: an urban multicenter case-control investigation reporting the clinical, radiologic and biochemical associations of intracranial stenosis in Pakistan.

Background: Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner. Methods/Design: The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians. Discussion: The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions