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BACKGROUND: Industrial workers often have musculoskeletal disorders due to the nature of their work. OBJECTIVE: The goal was to investigate the scientific use of polyherbal gel in relieving pain and stiffness due to musculoskeletal injuries and improving activities of daily living (ADLs) in industrial workers. METHODS: A pragmatic, single-blinded, randomized control study divided 200 musculoskeletal injury patients into four parallel groups (n = 50). Groups 1 and 2 were applied polyherbal gel via phonophoresis with therapeutic ultrasound and superficial massage. Groups 3 and 4 received diclofenac diethyl-ammonium 1% gel by phonophoresis and superficial massage. The Global Pain Relief Scale, Numeric Pain Rating Scale (NPRS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used to measure pain, stiffness, and ADLs. Data was analyzed using one-way analysis of variance (ANOVA) and paired t-test to compare mean±SD of four independent groups before and after gel application. The confidence interval was 95%, with p < 0.05 considered significant. RESULTS: The results revealed that polyherbal gel reduced pain (NPRS, WOMAC and Global pain relief scales) more efficiently (p≤0.000) when applied with phonophoresis as compared to applied with massage and standard diclofenac (p≤0.005), furthermore, polyherbal gel when applied with phonophoresis showed more efficient results. CONCLUSION: Industrial workers with musculoskeletal injuries benefited from the use of polyherbal gel for pain and inflammation relief. The polyherbal gel is natural, cost-effective, and easy to formulate. [ABSTRACT FROM AUTHOR]

Background: Steroid sensitive nephrotic syndrome patients usually develop relapses in 40-50% of cases and exert significant burden on healthcare system and different treatment modalities are being used for sustained remission of relapses. Objective: To compare the efficacy of levamisole versus mycophenolate mofetilin children with frequently relapsing steroid sensitive nephrotic syndrome. Study type, settings & duration: This study was conducted at Department of Pediatric Nephrology, The Children's Hospital and Institute of the Child Health, Multan from July 2020 to June 2021. Methodology:; Children (n = 80) with Steroid-sensitive Nephrotic syndrome frequent Relapsers were randomized in 2 groups; Group A received Levamisole 2-2.5 mg/kg on alternate days for 6 months while group B received MMF (750-1000 mg/m2 daily) along with standard therapy i. e prednisolone at a dose of 60 mg/m2 per day for 4-8 weeks or less if reached absence of proteinuria for 3 consecutive days, followed by 40 mg/m2 on alternate days for 2 weeks followed by gradual tapering over 1-2 months to the minimum dose of 0.5 to 1 mg/kg/day for a total duration of 6 months. Results: Our study included 80 children presenting with frequently relapsing steroid sensitive nephrotic syndrome. Of these 80 study cases, 63.8% (n=51) were boys while 36.2% (n=29) were girls. Mean age of our study cases was 7.45±2.08 years (ranging from 3 to 12 years (boys 6.78±1.50 years versus girls 8.62±2.44 years, p=0.001) and 61.3% (n=49) were aged more than 6 years. Mean weight of our study cases was 24.98±8.12 kilograms (minimum weight 17 Kg to maximum 37 Kg). Mean duration of nephrotic syndrome was noted to be 2.11±1.02 years (1 year to 3 years) and most of these children i.e. 43 (53.7%) belonged to urban areas and 37 (46.3%) were from poor family background. Overall efficacy was noted to be 70.0% (n=56). Efficacy in group A was 90% (n=36) while that in group B it was 50.0% (n=20) (p=0.001). Conclusion: Our study results support the use of Levamisole in children with frequently relapsing steroid sensitive nephrotic syndrome as it was significantly more efficacious in remission of relapses in these children as compared with mycophenolatemofetil. Levamisole was found to be quite safe, reliable and without any side effects which should be given to these children for desired outcomes. [ABSTRACT FROM AUTHOR]

Background: Pain remains a global public heath priority. Phonophoresis, also known as sonophoresis or ultrasonophoresis, is when an ultrasound is used to maximize the effects of a topical drug. Purpose: The objective of this study was to test, in patients injured in sports or accidents (N = 200), the efficacy of diclofenac potassium (DK) 6%, 4%, and 2% formulated gels with and without phonophoresis in comparison with market available standard diclofenac sodium (DS or DN) gel. Methods: The patients were enrolled after informed consent. By using the lottery method, 100 patients were randomly segregated into five groups without phonophoresis and repeated similarly with phonophoresis at a frequency of 0.8 MHz, an intensity of about 1.5 W/cm2, and at continuous mode (2:1). Group-1 was treated with 6% DK gel, group-2 was treated with 4% DK gel, group-3 was treated with 2% DK gel, group-4 was treated with 4% DS gel and group-5 was given control gel three to four times a week for 4 weeks. The patients were screened by using NPRS and WOMAC scales. They were assessed on the baseline, 4th session, 8th session, 12th session, and 16th session. Results: Significant dose-dependently relief was observed in NPRS (Numeric Pain Rating Scale) and the WOMAC (Western Ontario McMaster Osteo-Arthritis) index for pain in disability and stiffness for each group treated with DK gel compared to DS gel. Phonophoresis increased these benefits significantly when used after topical application of DK gel or DS gel, and the dose-dependent effects of DK gel plus phonophoresis were stronger than the dose-dependent effects of DS gel plus phonophoresis. The faster and profounder relief was due to phonophoresis, which allows more penetration of the DK gel into the skin as compared to the direct application of DK gel in acute, uncomplicated soft tissue injury, such as plantar fasciitis, bursitis stress injuries, and tendinitis. In addition, DK gel with phonophoresis was well tolerated. Thus, in this personalized clinical setting, according to the degree of inflammation or injured-induced pain, disability, and stiffness, DK gel 6% with phonophoresis appeared more effective and thus more recommendable than DS gel 6% alone or DS gel 6% combined to phonophoresis. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To study the role of montelukast in preventing relapses in childhood idiopathic steroid sensitive nephrotic syndrome (SSNS). METHODS: This quasi-experimental, open label study was conducted at Department of Paediatric Nephrology, The Children's Hospital and The Institute of Child Health, Multan, Pakistan. Total of 106 patients with firstepisode of nephrotic syndrome aged 1-10 years were enrolled from February-May 2019 and non-randomly assigned to Group-A & Group-B (53 patients in each group). All patients in both groups were started on prednisolone 2mg/kg single morning dose for 4-weeks as per institutional protocol. Group-A (Cases) also received montelukast 5 mg daily at bedtime for at least 12 months while Group-B (control) was not given montelukast. All patients were followed up for one year till May 2020 to monitor the response to treatment and evidence of relapse. Ten patients were excluded from final analysis due to loss to follow-up (n=3; 2 in Group-A and 1 in Group-B) or showing steroid resistance (n=7; 3 in Group-A and 4 in Group-B). RESULTS: Out of 96 children (48 each in Group-A & B), 58 (60.4%) were males. Mean age was 4.7±1.9 years and most of children (n=64; 66.7%), were aged between 2-6 years. Overall relapse rate of 35.4% (n=34/98) was observed, with 9/48 (18.8%) patients in Group-A compared to 25/48 (52.1%) patients in Group-B (p<0.001). Out of 34 patients with relapse, 20 (58.8%) were males and 14 (41.2%) were females. CONCLUSION: Montelukast showed significant efficacy in preventing relapse rate in children with SSNS during one year of follow-up. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To study the role of montelukast in preventing relapses in childhood idiopathic steroid sensitive nephrotic syndrome (SSNS). METHODS: This quasi-experimental, open label study was conducted at Department of Paediatric Nephrology, The Children's Hospital and The Institute of Child Health, Multan, Pakistan. Total of 106 patients with firstepisode of nephrotic syndrome aged 1-10 years were enrolled from February-May 2019 and non-randomly assigned to Group-A & Group-B (53 patients in each group). All patients in both groups were started on prednisolone 2mg/kg single morning dose for 4-weeks as per institutional protocol. Group-A (Cases) also received montelukast 5 mg daily at bedtime for at least 12 months while Group-B (control) was not given montelukast. All patients were followed up for one year till May 2020 to monitor the response to treatment and evidence of relapse. Ten patients were excluded from final analysis due to loss to follow-up (n=3; 2 in Group-A and 1 in Group-B) or showing steroid resistance (n=7; 3 in Group-A and 4 in Group-B). RESULTS: Out of 96 children (48 each in Group-A & B), 58 (60.4%) were males. Mean age was 4.7±1.9 years and most of children (n=64; 66.7%), were aged between 2-6 years. Overall relapse rate of 35.4% (n=34/98) was observed, with 9/48 (18.8%) patients in Group-A compared to 25/48 (52.1%) patients in Group-B (p<0.001). Out of 34 patients with relapse, 20 (58.8%) were males and 14 (41.2%) were females. CONCLUSION: Montelukast showed significant efficacy in preventing relapse rate in children with SSNS during one year of follow-up. [ABSTRACT FROM AUTHOR]

Objectives: Renal failure (RF) is associated with significant mortality and morbidity. its management still remains challenging for treating physicians. Acute peritoneal dialysis (APD) is an option for treatment of renal failure among young children. We aimed to determine the efficacy of peritoneal dialysis (PD) in RF among children admitted. Study Design: Case series study. Setting: Nephrology Department of Children's Hospital and Institute of Child Health, Multan. Period: February 2018 to July 2018. Material & Methods: A total of 74 children with renal failure were included. All the patients were treated with acute peritoneal dialysis. The outcome of interest was clinical and biochemical improvement. Result: Amongst all there were 46 (62.2%) male and 26 (37.8%) female. Mean age of the children was found to be 57.72 months. Mean weight of children was 12.36 kg with a standard deviation of 6.4 kg. Most of the children, 43 (58.1%) had acute renal failure (ARF) whereas 31 (41.9%) had chronic renal failure (CRF). With PD, mortality was reported in 22 (29.7%) children. Conclusion: Acute peritoneal dialysis showed good rates of improvement in renal function, so, it should be recommending among children with acute renal failure. [ABSTRACT FROM AUTHOR]

Objectives: Febrile seizures (FS) are the most common type of seizures and typically transpire in children with ages from 6 to 60 months. This study was planned to find out major clinical risk factors for seizures in febrile children who were aged 6 to 60 months. A total of 100 febrile children aged 6 to 60. Study Design: Analytical Study. Setting: Department of Neurology, Children's Hospital and the Institute of Child Health, Multan. Period: From 1st April 2018 to 31st December 2018. Material & Methods: Group A had 40 children with febrile seizures while group B had 60 febrile children but without seizures. Demographic features along with family history of (H/O) epilepsy as well as family history of febrile seizure, types of seizure and infection diseases were noted and analyzed using SPSS version 20. Odds ratio was calculated for various risk factors. Chi square test was applied and P value < 0.05 was considered as significant. Results: Out of a total of 100 children, there were 54 (54.0%) male and 46 (46.0%) female. There was no statistical difference in terms of gender between the two groups (p value = 0.566). Overall, mean age of the children was 26.02 months with standard deviation of 13.4 months. There were 28 (70.0%) children who reported with simple seizures while complex seizures were found in 12 (30.0%) cases. Statistically significant difference (p value = 0.001) was seen in terms of types of infections between the two study groups. When risk of seizures for various risk factors was calculated, family H/O FS, family H/O epilepsy, and upper RTI were as 14, 7 and 3 times respectively and turned out to be the major risk factors for seizures in febrile children. Conclusions: Family H/O FS, family H/O epilepsy and upper RTIs are the major risk factors related with seizures in febrile children. Measures to prevent these risk factors can decrease the burden of FS in our population. [ABSTRACT FROM AUTHOR]

Objectives: Recurrent abdominal pain (RAP) impacts quality of life of the children. RAP also hampers education and physical activity of the children. Current study was aimed to find out the frequency of Helicobacter pylori in children with RAP in our tertiary care hospital. Study Design: Descriptive, cross-sectional study. Setting: Department of Pediatric Medicine, Nishtar Hospital, Multan, Period: From 27-12-2017 to 26-06-2018. Material & Methods: A total of 185 patients suffering from RAP, aged 2-12 years, with a disease duration > 3 months, were enrolled. Age of the children, gender, duration of illness, number of episodes of pain, maternal literacy, family income, residential status, source of drinking water and h.pylori infection were calculated in these children. Post stratification chi-square test was applied to see its effect on H. Pylori infection. Results: Of these 185 study cases, 101 (54.6 %) were male patients while 84 (45.4%) were female. Mean age of our study cases was 7.57 ± 1.93 years. Of A total of 95 (51.4%) children belonged to rural areas and 90 (48.6 %) to urban areas. Helicobacter pylori infection was noted in 103 (55.7%) of our study cases. When helicobacter pylori was stratified with regards to study variables, male gender, age ≤ 8 years, monthly family income ≤Rs. 35000, source of drinking water as Hand Pump and disease duration ≤ 6 months turned out to be statistically significant (P value ≤ 0.05). Conclusion: Frequency of H.pylori was high in children with RAP. Helicobacter pylori was significantly associated with male gender, younger age, poor socioeconomic status, source of drinking water and disease duration. [ABSTRACT FROM AUTHOR]