Multifocal Skeletal Tuberculosis

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Metabolic Acidosis in Children: A Literature Review

Metabolic acidosis is characterised by a primary decrease in the serum bicarbonate concentration, a secondary decrease in the arterial partial pressure of CO­2, and a reduction in blood pH. Metabolic acidosis, acute or chronic, may have deleterious effects on cellular function and cause increased morbidity and mortality. A systematic review of the available literature was performed to identify data on the prevalence, manifestations, cause, outcomes, and treatment of metabolic acidosis in children. Online databases (Ovid Medline, Embase, and PubMed), commercial search engines (including Google), and chapters on metabolic acidosis in the standard textbooks of paediatrics and medicine were reviewed. Systematic approach to acute metabolic acidosis starts with proper history taking and examination. This is followed by assessment of acid-base parameters, including pH, partial pressure of CO2, and bicarbonate concentration in arterial blood. Blood gas is needed to differentiate primary metabolic acidosis from compensated respiratory alkalosis. Once the diagnosis of a metabolic acidosis has been confirmed, serum electrolyte values are used to determine the serum anion gap. The various causes of increased and normal anion gap metabolic acidosis have been discussed in the article. The main aim of treatment in metabolic acidosis is to reverse the primary pathophysiology. In acute metabolic acidosis, sodium bicarbonate therapy is not beneficial due to potential complications and is reserved for specific situations. Base therapy is used in chronic metabolic acidosis where it ameliorates many of its untoward effects. Other modalities of treatment of metabolic acidosis include peritoneal or haemodialysis and tris-hydroxymethyl aminomethane

Severe hypertension in pediatric diabetic ketoacidosis – a case report and review of literature

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus in children. Despite the presence of dehydration, hypertension occurs in a significant proportion of children with DKA. There is a lack of clarity in the literature regarding the management of hypertension in patients with paediatric DKA. Herein, we report the case of an adolescent boy who presented with DKA and severe hypertension. His neurological status was closely monitored. There was a gradual decline in his blood pressure with an improvement in the pH over the next 72 hours. The combination of severe DKA and hypertension can be a challenging clinical dilemma, especially regarding fluid management. Studies on severe DKA in children are exacting, given the rarity of this condition. A multi-centre study is suggested to provide a meaningful analysis of this aspect of DKA

Knowledge, attitude and misconceptions regarding tuberculosis in Pakistani patients

Objective: To assess knowledge of patients with tuberculosis; about their disease and misconceptions regarding TB. Methods: A cross sectional study was conducted at Out-patient clinics of two teaching hospitals (private and public) in Karachi, Pakistan. A questionnaire was filled for the purpose. Results: A total of 170 patients were interviewed, 112 from private and 58 from a public sector hospital. Cough, fever, bloody sputum and chest pain were recognized as the common symptoms of TB. Eleven (7%) patients thought TB was not an infectious disease and 18 (10.6%) did not consider it a preventable disease. Contaminated food was considered the source of infection by 81 (47.6%) and 96 (57%) considered emotional trauma/stress the causative agent of TB. No counseling about preventing spread was received by 81 (50%) patients and 97 (57%) considered separating dishes as an important means of preventing spread. Thirty one (18%) patients would have discontinued their medications following relief of symptoms. Thirty nine (23%) of the respondents thought that TB could lead to infertility and 66 (38.8%) believed that there were reduced chances of getting married following infection. Conclusion: Misconceptions concerning TB are common in Pakistani patients. Lack of knowledge on Tuberculosis is alarming. (JPMA:56:211;2006

Effects of calcium and chitosan treatments on controlling anthracnose and postharvest quality of papaya (Carica papaya L.)

This study was conducted to evaluate the in vitro fungicidal effects of calcium and chitosan on Colletotrichum gloeosporioides and to as well determine their effects on storage life and quality of papaya. Potato Dextrose Agar (PDA) incorporated with calcium at different concentrations (1.5, 2.5 or 3.5%) or in combination with chitosan at 0.75% or chitosan alone were used as treatments for in vitro tests. Uncorporated treatments with PDA and untreated fruits as control used on papaya fruits for storage life and quality evolutions. Chitosan had the greatest effect against Colletotrichum gloeosporioides in both in vitro and in disease incidence (%) on papaya fruits compared to calcium treatment and as well as control. Calcium reduced spores germination significantly as calcium concentrations increased from 2.5 to 3.5%, compared to the 1.5% and control treatments. However, it did not show any fungicidal effects on mycelial growth. The combination of 2.5% calcium with chitosan 0.75% completely inhibited spore germinations and significantly inhibited mycelia growth compared to calcium individual treatments and as well as control. Anthracnose disease incidence (%) was significantly controlled (5.6%) using calcium at 2.5% combined with chitosan compared with the other treatments. This demonstrated the best effect on controlling anthracnose disease incidence for papaya fruits. Moreover, this treatment proved able to extend the storage life of papaya fruits up to 33 days of storage life while maintaining valuable attributes of quality

Effect of different concentrations of chitosan coating on storage life and quality characteristics of Papaya (Carica Papaya L.)

Mature green stage of papaya fruits were treated with different concentrations of chitosan at 0, 0.5, 0.75 and 1%, and stored at 13±1 °C for 28 days to study the effect of these concentrations on the storage life and maintaining quality of papaya. Chitosan concentrations 0.75 and 1% showed the best control effect on decay compared with 0% (Control) and 0.5%. At 0.75 and 1% of chitosan, flesh firmness maintained resulted in prolonging in storage life of 28 and 26 days compared with 21 and 19 days, respectively for 0.5 and 0%. Furthermore, they were significantly decreased the weight loss of fruit. All of the treatments inhibited increase of soluble solid contents and pH values of pulp fruits after 21 days of storage at 13 ± 1°C. Titratable acidity and ascorbic acid were higher for coated fruits (0.5, 0.75 and 1%) compared with uncoated fruits. Concern treatments of chitosan at 0.75 and 1% improve papaya fruit quality and resistance to decay

Effects of different concentrations and applications of calcium on storage life and physicochemical characteristics of papaya (Carica papaya L.)

Papaya (Carica Papaya L.) fruits index 2 were treated with 1.5, 2.5 and 3.5% solutions of calcium chloride by dipping and vacuum infiltration (-33 Kpa) or untreated (0%) as control. Effects of these treatments were evaluated on storage life and postharvest quality characteristics of papaya. After 21 days of storage at 13±1°C, the fruits were removed from storage for physicochemical analysis. Following additional five days holding in the storage condition for fruits used for evaluation of the rate of disease incidence and storage life. Postharvest dip treatments at different concentrations of calcium prolonged storage life, slowed down the ripening processes and maintained the quality of papaya. Whereas, it was effectively greater with calcium infiltration treatments than that for dip treatments. Calcium infiltration extended the storage life and retained the quality as calcium concentrations increased up to 2.5% and then declined. The desired effect was obtained at 2.5% infiltration compared with other treatments. The least disease incidence was found in those fruits infiltrated with 2.5% calcium. Hence, it can be concluded that postharvest infiltration of calcium at 2.5% has the potential to control disease incidence, prolong the storage life and preserve valuable attributes of postharvest papaya, presumably because of its effects on inhibition of ripening and senescence process and loss of the fruit firmness of papaya

Advancing the Understanding of Clinical Sepsis Using Gene Expression-Driven Machine Learning to Improve Patient Outcomes

Sepsis remains a major challenge that necessitates improved approaches to enhance patient outcomes. This study explored the potential of Machine Learning (ML) techniques to bridge the gap between clinical data and gene expression information to better predict and understand sepsis. We discuss the application of ML algorithms, including neural networks, deep learning, and ensemble methods, to address key evidence gaps and overcome the challenges in sepsis research. The lack of a clear definition of sepsis is highlighted as a major hurdle, but ML models offer a workaround by focusing on endpoint prediction. We emphasize the significance of gene transcript information and its use in ML models to provide insights into sepsis pathophysiology and biomarker identification. Temporal analysis and integration of gene expression data further enhance the accuracy and predictive capabilities of ML models for sepsis. Although challenges such as interpretability and bias exist, ML research offers exciting prospects for addressing critical clinical problems, improving sepsis management, and advancing precision medicine approaches. Collaborative efforts between clinicians and data scientists are essential for the successful implementation and translation of ML models into clinical practice. ML has the potential to revolutionize our understanding of sepsis and significantly improve patient outcomes. Further research and collaboration between clinicians and data scientists are needed to fully understand the potential of ML in sepsis management