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Objective: To compare the Salbutamol alone and Ipratropium Bromide supplemented Salbutamol in children with exacerbation of asthma in terms of PEFR. Study Design: Randomized Controlled Trial. Setting: Pediatrics Emergency, KRL Hospital Islamabad. Period: 1st August 2016 to 31 January 2017. Material & Methods: Group A patients were given only Salbutamol (0.15mg/kg per dose with minimum 2.5 mg, maximum 5 mg/dose). Group B was given Ipratropium Bromide supplemented Salbutamol (250 mcg/dose for 20kg of Ipratropium Bromide with same dose of Salbutamol as prescribed for Group A). Baseline spirometry was performed on each patient and after measurement of baseline peak expiratory flow. The outcome was measured by Peak flow meter and reassessed at 60 minutes. Results: Comparison of salbutamol alone and ipratropium bromide supplemented salbutamol in children with exacerbation of asthma in terms of PEFR shows that 40.5 + 4.28 in Group-A and 59.5 +4.75 in Group-B, P-value was calculated as 0.0001, showing a significant difference between the two groups while the difference in increase was recorded as 19%. Conclusion: We concluded that salbutamol alone is significantly less effective when compared with Ipratropium Bromide supplemented Salbutamol in children with exacerbation of asthma in terms of PEFR.

Objective: To compare the mean hemoglobin levels and frequency of polycythemia in full term neonates after early and delayed cord clamping. Study Design: Randomized Controlled Trial. Setting: KRL General Hospital Islamabad (Labor Room/ Neonatology). Periods: December 2017 to June 2018. Material & Methods: 190 full term neonates were selected and divided into 2 equal groups randomly: Early cord clamping group after delivery and late cord clamping group. Two hours after clamping the venous blood samples were taken for the hemoglobin and hematocrit levels. Mean and standard deviation were calculated for gestational age, birth weight, hemoglobin and hematocrit. Frequency and proportions were calculated for gender and polycythemia. Results: Mean gestational age of the mothers was 39.27 ± 1.50 weeks. Of 190 neonates, 91 (47.9%) were males, 99 (52.1%) were females. Mean birth weight was 3.64 ± 0.72 kg while mean Hb and HCT levels were 16.07 ± 2.30 g/dl and 63.26 ± 5.32% respectively. Keeping cut off value of 13.5 g/dl of Hb to label anemia or no, 35 (18.4%) neonates were anemic in this study. The polycythemia (HCT >65%) was present in 72 (37.9%) of neonates. There was no difference between groups in terms of gender, anemia, gestational age and birth weight (p values 0.663, 0.852, 0.700 and 0.491 respectively). The distribution of polycythemia was different among groups (p value 0.007). The mean hemoglobin level in group A was 15.52 ± 1.90 g/dl while in group B it was 16.62 ± 2.53 g/dl (p value 0.001). Mean Hb levels were statistically not different among some of the groups (gestational age 4 kg. Rest of the stratification groups showed significant difference. Conclusion: The delayed cord clamping in neonates results in increased mean hemoglobin and hematocrit levels with increased frequency of polycythemia as compared to early cord clamping.

Objective: To compare the efficacy of probiotics in prevention of necrotizing enterocolitis (NEC) among low birth weight (LBW) preterm neonates. Study Design: Randomized controlled trial. Setting: Department of Pediatric Medicine, Unit-II, Services Hospital, Lahore. Period: September 2019 to February 2020. Material and Methods: A total of 260 LBW preterm neonates were enrolled. All the neonates were allocated to 2 groups with equal number of cases (130 in each group). Group-A was given probiotics whereas placebo was administered in Group-B. All the cases were admitted and follow ups were made up until 7th day. Occurrence of NEC was recorded among both groups. Results: Out of a total of 260 LBW preterm neonates, 142 (54.6%) were male and118 (45.4%) female. Overall, mean age was noted to be 1.48+0.50 days. Table-I shows that there was no statistical difference among neonates of both study groups in terms of age, gestational age and birth weight (p>0.05). Five (3.8%) neonates in Group-A and 14 (10.8%) in Group-B were found to have NEC. Efficacy of treatment in Group-A was significantly higher in comparison to Group-B. Conclusion: Probiotics are effective in the prevention of NEC in preterm LBW neonates. Prophylactic usage of probiotics among preterm neonates is noted to be helpful in avoiding development of NEC.

Background: Enlarged lymph glands almost always represent a local or systemicdisease that may be benign or malignant. We see many patients including the referred onesin our OPD clinic and subsequently do the excision of quite a big proportion of the enlargedglands especially the cervical glands. Study Design: Descriptive study. Setting: Retrospectby reviewing the operative and histopathology department of King Edward Medical University.Period: April 2016 to April 2017. Methods: We will analyse the record of 121 patients who hadperipheral lymph gland enlargement and presented to us. Results: Ours results show that themean age of our patients was 25.03±18.06 years. We found that 40% of our patients had adefinitive diagnosis from the histopathology of excised lymph nodes while 35.5% of the patientshad reactive hyperplasia and 25% of the patients had inconclusive results and we were unableto help them. Conclusion: Our results conclude that the lymph nodes are a very good source ofgetting the diagnosis especially the cervical lymph nodes with a diagnostic yield of 76.4% andwe may need to have a more robust criteria for excising the peripheral lymph glands in order toimprove the diagnostic yield from 40%.