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Objective: To compare mean platelet volume in neonates with and without sepsis. Study Design: Cross-sectional study. Place and Duration of Study: Neonatal Intensive Care Unit, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2017 to Jan 2018. Methodology: A total of 140 neonates of either gender with ages between 0-28 days, suspected of neonatal sepsis presenting with any two of the signs: a core body temperature of >38.5°C or <36°C at time of presentation, pulse rate beyond the range of 100-200 beats/minute, leukocyte count beyond the range of 4000 to 30,000/mm3 or >10% immature neutrophils on peripheral smear, tachypnea (>60 breaths/minute) and oxygen saturation (<90%) on the pulse oximeter, were included. Three ml of blood was drawn and sent for culture, while another 3ml of blood was sent for peripheral smear and mean platelet volume. Conclusion: Neonates having sepsis were found to have significantly raised mean platelet volume. As a result, mean platelet volume is available in complete blood counts without additional cost to prove cost-effective. [ABSTRACT FROM AUTHOR]

Objective: To determine the epidemiology of coeliac disease in the children presenting at the tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of Study: Department of Paediatrics, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr 2015 to Jul 2016. Methodology: Ninety-five consecutive children presenting with the suspicion of celiac disease were included in this study after taking written informed consent. A pre-designed proforma was used to record the patient's demographic details and the presenting complaints, laboratory, endoscopic and histological findings. Results: The mean age of the patients was 6.48 ± 3.20 years and the majority 53 (55.8%) of the children, were aged between 5 to 10 years. Failure to thrive was the most frequent presenting complaint and was recorded in 53 (55.8%) children, followed by pallor (54.7%), chronic diarrhoea (34.7%), short stature (29.5%), pain abdomen (28.4%) and recurrent vomiting (6.3%). The patients' haemoglobin ranged from 5.3 g/dl to 12.8 g/dl with a mean of 8.81±1.24 g/dl. The serum Anti-tTG level ranged from 8.0 U/ml to 759.0 U/ml with a mean of 298.75 ± 225.51 U/ml. Upon endoscopy, atrophic mucosa was revealed in 60 (63.2%) children, while 24 (25.3%) children had normal mucosa. Partial villous atrophy was the most frequent histological diagnosis (37.9%). Normal duodenal mucosa was reported in 4 (4.2%) children, while 21 (22.1%) children had mild non-specific duodenitis. Frequency of pallor (p=0.025), anaemia (p=0.017) and complete villous atrophy on histology (p=0.004) were significantly higher in patients with higher anti-tTG levels. Conclusion: Celiac disease has a diverse presentation for age, gender and clinical and biochemical markers. [ABSTRACT FROM AUTHOR]

Objective: To determine the etiology and clinical profile of chronic liver disease in children presenting at Pak Emirates Military Hospital Rawalpindi. Study Design: Cross-sectional study. Place and Duration of Study: This study was conducted at the Department of Pediatrics, Pak Emirates Military Hospital Rawalpindi, from Sep 2015 to Sep 2016. Methodology: After informed written consent, 84 consecutive children diagnosed of chronic liver disease were included in the study and demographic features, presentation and underlying etiology. Results: There were 43 (51.2%) male and 41 (48.8%) female children with a mean age of 46.62 ± 46.89 months. Frequent presenting complaints were jaundice (32.1%) persistent neonatal jaundice (29.8%), abdominal distension (27.4%). Hepatosplenomegaly was the frequent presentation of children with glycogen storage disease while persistent neonatal jaundice was associated with biliary atresia and neonatal hepatitis. Wilson disease presented with neurological symptoms. Glycogen storage disease and biliary atresia were the most frequent underlying etiologies recorded in 15 (17.9%) children. The frequency of Wilsons disease was significantly higher among children aged between 5-10 years. Conclusion: The frequent clinical presentations of children with chronic liver disease were jaundice, abdominal distension and hepatosplenomegaly. Glycogen Storage Disorders, Biliary atresia and Wilsons Disease and were the most frequently encountered etiologies. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of serum IgA anti-tissue transglutaminase antibody in the diagnosis of celiac disease taking histopathology as gold standard. Study Design: Cross-sectional survey. Place and Duration of Study: This study was conducted at the department of Pediatrics, Military Hospital Rawalpindi from April 2015 to July 2016. Patients and Methods: Ninety-five consecutive children presenting with suspicion of celiac disease were included in this study after taking written informed consent. A predesigned proforma was used to record patient's demographic details. Anti-tTG level of =25 U/ml was taken as diagnostic of celiac disease while results of histopathology on endoscopic biopsy were taken as gold standard. Results: The mean age of the patients was 6.48 ± 3.20 years and majority (n=53, 55.8%) of the children were aged between 5 to 10 years. The serum anti-tTG level ranged from 8.0 U/ml to 759.0 U/ml with a mean of 298.75 ± 225.51 U/ml. Taking a cut-off value of =25 U/ml for anti-tTG, 81 (85.3%) children were suspected of celiac disease. Histopathology of endoscopic biopsy confirmed celiac disease in 68 (71.6%) children with 62 true positive, 19 false positive, 6 false negative and 8 true negative cases. It yielded 91.18% sensitivity, 29.63% specificity and 73.68% accuracy for anti-tTG (=25 U/ml) in the diagnosis of celiac disease with positive and negative predictive values of 76.54% and 57.14% respectively. Conclusion: IgA anti-tissue transglutaminase antibody (=25 U/ml) was found to be highly sensitive test for the detection of celiac disease in children. [ABSTRACT FROM AUTHOR]

Introduction: Nicardipine is a type of calcium channel blocker that is commonly used in the treatment of angina pectoris, hypertension, and related cardiovascular disorders. This systematic review assesses the reported pharmacokinetic (PK) and associated pharmacodynamic (PD) parameters of nicardipine in humans., Areas Covered: An exhaustive literature search using four internet databases was conducted up to 5 October 2023, which yielded 871 papers, of which 32 fulfilled the eligibility requirements by including human PK and related PD data. The area under the plasma concentration vs. time curve from zero to infinity (AUC 0-∞ ) and maximum plasma concentration (C max ) of nicardipine rise proportionately with increasing dosage. One study revealed that AUC 0-∞ of nicardipine was increased by 5-fold in hepatic cirrhosis patients compared to the control subjects. Moreover, related PD data in renal-impaired hypertensive patients revealed that a notable reduction in blood pressure was associated with nicardipine administration., Expert Opinion: This review covers comprehensive data on clinical PK, drug-drug interaction studies, effects of dosage form on ADME, and associated PD parameters of nicardipine using all relevant published studies. The present study will also aid in the development and evaluation of PK models for suggesting model-informed dosing regimens., Prospero Number: CRD42024533051.