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Objective: To assess the episodes of pneumonia and diarrhea in vaccinated and unvaccinated children under 60 months of age. Methods: This descriptive cross-sectional study was carried out at Darul Sehat Hospital and SESSI, Karachi in the Department of Pediatrics from 1st November 2018 to 3rd February 2019. An interview based questionnaire was administered and selection of participants was done by convenience sampling. Total of 196 participants were selected for interview. Results: Total 196 participants were interviewed which included mothers of children between the age group of 1- 60 months. The questions were entered on the questionnaire after taking consent from the mothers. Among them, males were 98 (52.7%) and females were 88(47.3%). One hundred seventy two (88.7%) children were vaccinated for pneumococcal and rotavirus whereas unvaccinated children were 22(11.3%). There was an incidence of 66(63.5%) for loose watery diarrhea. In vaccinated children, grading of diarrhea was found to be severe cases as 30 (34.9%), moderate cases as 27 (31.4%) and mild cases as 29(33.7%). For unvaccinated children, severe cases were 12 (66.7%) and for mild and moderate cases were (11.1%) and 04(22.2%) respectively with p value of 0.035. As compared to their unvaccinated counterparts, the frequency of severe pneumonia was far less than cough and cold in vaccinated children (p

Objective: To assess the level of symptoms control achieved by Asthmatic Patients in Pakistan and the associated factors making an impact on symptom control. Methods: A prospective cross-sectional study was carried out at Darul Sehat Hospital from December 2018 till December 2019. All patients of irrespective of age and gender diagnosed as bronchial asthma were consecutively included. Symptom control was assessed according to Global Initiative for Asthma (GINA) assessment tool. Prevalence of asthma symptom control was determined while association of risk factors with uncontrolled asthma was also evaluated. Results: Of 113 patients the mean age was 36.8 +-16.6 years. There were 76 (67.3%) patients had uncontrolled asthma. A significant association of uncontrolled asthma was observed with incorrect inhaler technique (p value of 0.039) more than 10 years asthma duration (p value

Introduction The world over, hepatitis C virus (HCV) engenders the risk of developing chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC). It has many extrahepatic manifestations, among which diabetes and metabolic syndrome (MetS) has been increasingly recognized and has become an active research field. The current study aimed to ascertain the frequency of MetS in chronic hepatitis C patients and to curb its long-term adverse outcomes. Methods In our cross-sectional analysis, a total of 331 subjects diagnosed with chronic HCV were registered from June 2017 to November 2018 in two tertiary care hospitals of Karachi, Pakistan. Metabolic syndrome (MetS) was delineated following the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III). Categorical variables were compared by using the Chi-square test, and a significant P value was at the value of < 0.05. Results We found that adults of 40 - 49 years of age were the worst sufferers of hepatitis C. Out of the total 331 patients of hepatitis C, 97 (29.3%) cases were suffering from metabolic syndrome. Conclusion Prevalence of MetS is substantial among HCV-infected individuals Therefore estimation of MetS in individuals with HCV infection is imperative and patients should be educated for lifestyle modification, diet, and weight control. However, we cannot generalized the results of our study as it was done in some tertiary care centres, so additional surveys are warranted to know the actual prevalence of MetS in our entire population.

Introduction Pulmonary tuberculosis (PTB) is caused by species of organisms in the Mycobacterium tuberculosis complex. It is a major public health problem worldwide and is endemic in Pakistan. Various clinical and biochemical markers exist for its diagnosis. Radiology has an important role in the diagnosis of PTB. Initially, a chest radiograph is warranted for PTB evaluation. High-resolution computed tomography (HRCT) also has high sensitivity and specificity for PTB diagnosis. Features of primary TB include consolidation, lymphadenopathy, pleural effusion and miliary nodules whereas post-primary TB include apical consolidation, nodules and cavitation. The aim of this study was to determine the diagnostic accuracy of HRCT chest in diagnosing sputum smear positive and smear negative PTB. Methods A cross-sectional study was conducted at a large tertiary care teaching hospital. A retrospective review of medical records of patients who underwent HRCT chest and sputum acid-fast bacillus (AFB) direct smear and AFB culture for suspicion of PTB was undertaken. All HRCT chest examinations were performed on multislice computed tomography (CT) scanner. On HRCT, PTB was defined as the presence of consolidation, centrilobular nodules, branching nodules with tree in bud appearance with or without lymphadenopathy and pleural effusion. Diagnostic accuracy of HRCT including sensitivity, specificity, positive and negative predictive values was calculated using 2 x 2 table, taking findings of AFB culture as a gold standard. Results A total of 108 patients were included in this study with a mean age of 51.85 ± 16.86 years. Diagnostic accuracy of HRCT in diagnosing PTB was found to be 84.26% with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 89.09%, 79.25%, 81.67%, and 87.50%, respectively. In sputum smear positive patients, HRCT has diagnostic accuracy, sensitivity, specificity, PPV and NPV of 87.50%, 88.57%, 84.62%, 93.94%, and 73.33%, respectively. In sputum smear negative patients, HRCT has diagnostic accuracy, sensitivity, specificity, PPV and NPV of 81.67%, 90.00%, 77.50%, 66.67%, and 93.94%, respectively. Conclusion HRCT has high sensitivity in diagnosing sputum smear positive and sputum smear negative PTB. The specificity of HRCT in diagnosing sputum smear positive PTB was high, whereas it was slightly low in diagnosing sputum smear negative PTB. Overall diagnostic accuracy of HRCT was high in diagnosing PTB.

Background & Objectives: Neonatal septicemia is responsible for 1.5 to 2.0 million deaths/year in the under developed countries of the world. Pakistan is number three among these countries and accounts for 7% of global neonatal deaths. The objective of the study was to determine the role of simple hematological parameter, immature to total neutrophil ratio (I/T ratio) in diagnosing early onset neonatal bacterial infection. Methods: A descriptive cross-sectional study was conducted in Neonatal Intensive Care Unit of Liaquat College of Medicine & Dentistry (LCMD) Hospital from January 2016 to January 2017. A total 85 neonates were admitted with clinical suspicion of presumed early onset sepsis or who had potential risk factors for sepsis like prematurity, prolonged rupture of membranes was carried out. After taking informed consent from parents of admitted neonates, data was collected in a structured questionnaire. Laboratory workup included White blood cell count, CRP, absolute neutrophil count, immature neutrophil count while blood C/S was kept as gold standard. Empirical antibiotics started after sample collection for workup. Manual differential count and immature neutrophil count of the peripheral blood smear was performed by a senior technician masked to clinical information. I/T ratio was calculated from WBC, neutrophils and immature neutrophil count by a simple formula. Results: Out of 85 neonates, 13 had positive blood cultures (15.29%). The mean white blood count was 18761.18 ± 8570.75 and mean I/T ratio was 0.1622 ± 0.0419.About 50% of proven sepsis cases had WBC higher than 26000 as compared to 50% of cases for negative diagnoses that had WBC

OBJECTIVE: To determine the frequency of potential risk factors of stroke among peopleattending the stroke (Falij) screening camps in Sindh provinceof Pakistan. METHODS: This descriptive cross-sectional study was conducted in the 12 rural and urban areas of Sindh through stroke screening camps, during the period of six months in 2018. A total of 1,480 consecutive persons18 years or above who had no prior stroke were enrolled.The questionnaire comprised of demographic information, stroke related risk factors, personal history, family history of stroke and investigations did during the camp. Stroke-related risk was categorized as low-risk (1-2 risk factors), moderate-risk (3 risk factors) and high-risk (≥4 risk factors). Out of 1,480 persons screened, twenty-eight persons were excluded due to missing information and final sample size was 1,452. Statistical analysis was performed on SPSS version-21. RESULTS: Out of 1,452 subjects, 802 (55.2%) were males and 650 (44.8%) were females. Mean age was 46.7±13.8 years and majority (n=1026; 70.6%) were aging >40 years.Mean BMI was 29.2±14.4. Low-, moderate- and high-risk groups included 691 (47.6%), 614 (42.3%) & 147 (10.1%) cases respectively. Common potential risk factors of stroke were hypertension (n=722; 49.8%), diabetes mellitus (n=518; 35.7%), dyslipidemia (n=290; 19.97%) and smoking (n=288; 19.8%). CONCLUSION: Common potential risk factors of stroke in our study are hypertension, diabetes, dyslipidemia and smoking. More than half of the participants have potentially moderate- and high-risk of stroke. Robust population-based studies are needed to study the epidemiology of stroke and its risk factors in Pakistan.

Background Pneumonia and diarrhea remain the leading infectious causes of mortality and morbidity in children under 5 years of age. 1According to the study carried out by WHO in 2017 the coverage of rotavirus is 23% while that of pneumococcal vaccine is 43% which accounts for serious health issues in children.2 An estimated 1 in 40 infants experience a severe episode of rotavirus gastroenteritis annually in Pakistan.3 Objective The objective of this study was to determine the frequency of diarrhea and pneumonia in vaccinated and unvaccinated children less than 5 years of age: A single center study Methods A descriptive cross sectional study was conducted in Department of Pediatrics at Darul Sehat Hospital and SESSI, Karachi from 1st November to 3rd February 2019.The 196 respondents were selected by convenience sampling and interview based questionnaire was administered. Variables such as age, gender, duration of illness, history of previous episodes, breastfeeding, number of vaccines, type of vaccines, reason for vaccination and not vaccinated were asked from participants. Results A total of 196 questionnaires were interviewed from mothers of children aged 1–60 months. ­­­­98 (52.7%) of the total was male and 88(47.3%) were females. Participants that received vaccination for rotavirus and pneumococcal vaccine were 172(88.7%) while 22(11.3%) remain unvaccinated. Incidence of watery diarrhea accounts for 66(63.5%). Frequency of diarrhoea was mild in 29(33.7%), moderate in27 (31.4%) and severe in 30(34.9)% in vaccinated children where as it was mild in 02(11.1%) moderate in 04 (22.2%) and severe in 12 (66.7%) in unvaccinated children with p value being 0.035. Frequency of severe pneumonia was far less then frequency of cough and cold in vaccinated participant as compared to unvaccinated participant with p value being Conclusion Human rotavirus and pneumococcal vaccines significantly reduced the occurrence of severe rotavirus gastroenteritis and acute respiratory tract infection. The research concludes that vaccination might not have significantly reduced the disease burden but has definitely reduced the severity of both diseases.

Objective: To determine frequency of electrolyte imbalance including sodium, chloride, potassium and magnesium levels present in patients with uncontrolled diabetes at a tertiary care hospital in Karachi. Methods: This was a descriptive cross sectional study conducted at Medicine Department, Darul Sehat Hospital, Karachi, Pakistan from March 2017 to October 2017. A total of one hundred and eighty one admitted and OPD patients with uncontrolled diabetes (HbA1c more than 7%) were included and their demographics, comorbidities, microvascular complications, drug history, fasting and random blood glucose and serum electrolyte levels were recorded. Results: In uncontrolled diabetes mellitus, decrease in serum sodium and chloride levels were observed to be statistically highly significant (p-value less than or equal to 0.05) while that of potassium and magnesium showed insignificant alterations. Sodium level was also observed to decline with increasing pattern of urine for microalbumin. Conclusion: Electrolyte imbalance is markedly present in patients with uncontrolled blood sugars therefore serum electrolytes should be routinely measured in patients with type 2 diabetes mellitus. Serum fasting blood glucose can be used as a predictor for electrolytes. doi: https://doi.org/10.12669/pjms.35.3.844 How to cite this:Khan RN, Saba F, Kausar SF, Siddiqui MH. Pattern of electrolyte imbalance in Type 2 diabetes patients: Experience from a tertiary care hospital. Pak J Med Sci. 2019;35(3):797-801. doi: https://doi.org/10.12669/pjms.35.3.844 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: The levels of adenosine deaminase (ADA) are increased in tubercular pleural effusion and its determination has acquired popularity as a diagnostic test which is inexpensive and is readily accessible. Pleural fluid ADA showed sensitivity (86.36%), specificity (61.54%), diagnostic accuracy (80.70%), positive predictive value (88.37%), and negative predictive value (82.42%) confirmed by pleural biopsy as a gold standard. Methodology: Our study was a prospective cross-sectional study which was conducted for three years at a tertiary care center in Karachi, Pakistan. The data were collected and analyzed using IBM statistics SPSS vs21. Results: There were 52 patients included in our study. Twenty one were males and thirty one were females. Most patients presented with shortness of breath. There was a significant association found between raised ADA levels and pulmonary tuberculosis (p < 0.05). The ADA levels are 12 times more likely to be raised in tubercular pleural effusion. Conclusion: The ADA level is an important marker for diagnosis of pulmonary tuberculosis in lymphocytic pleural effusion. It is a convenient and an inexpensive method. The ADA levels assessment is economical when compared to other diagnostic methods.

Bartter syndrome is a rare heterogeneous disease characterised by a deficiency in sodium and chloride absorption. Gain-of-function mutations in the CASR gene have been described in some patients with Bartter syndrome associated with hypocalcaemia and hypercalciuria. We describe a case of adult-onset Bartter syndrome with hypocalcaemia severe enough to cause osteomalacia. LEARNING POINTS Bartter syndrome is one of the rare heterogenous diseases that present with electrolyte disturbances. Bartter syndrome type 5 also causes hypercalciuria which is not severe enough to cause osteomalacia. Patients with adult-onset Bartter syndrome should be screened promptly for osteomalacia to prevent pathological fractures and consequent complications.