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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: Pakistan is a resource limited country with one of the highest neonatal mortality rate (NMR) in the world. Kangaroo Mother Care (KMC) helps in reducing the mortality and improving the care of preterm babies. The objective of this study was to identify the benefits of KMC in hospitalized newborns in terms of better weight gain and early discharge from hospital. Subjects and methods: A retrospective case-control study was conducted in the Neonatal Department of Services Hospital from 01.02.2019 to 31.01.2020. A total of 144 case notes, who met inclusion criteria were included. Subjects were divided in 2 Groups of 77 each. Group 1 did not receive KMC and Group 2 received KMC (partial or complete). Admission weight, gestational age at birth, duration of hospital stay and the average weight gain was noted for subjects in both groups. SPSS version 23 was used to analyze data. Independent samples t-test was applied. A p-value of ˂0.05 is taken as significant. Results: Mean weight gain in Group 1 was 5.521 g/kg/day (±6.664), whereas in Group 2 was 15.635 g/kg/day (±9.268). Mean hospital stay in Group 1 was 12.558 days (±10.856) and in Group 2 it was 8.208 days (±6.473). Weight gain and duration of hospital stay was significantly better in KMC Group with a p-value ˂0.05. This benefit was observed both for partial and complete KMC. Conclusion: KMC (partial or complete) leads to better weight gain and reduces the duration of hospital stay.

BACKGROUND & OBJECTIVE: As Rota virus leads to significant morbidity in children 2 months to 5 years, this study was done to observe the effect of one dose of nitazoxanide on the total duration of rotavirus diarrhea. The primary objective was to evaluate the reduction in the mean duration of viral diarrhea in children after administration of first dose of Nitazoxanide. METHODLOGY: This descriptive study was done in the Department of Pediatric Medicine Unit I, Mayo Hospital, Lahore from Jan 2016 to June 2016 after approval from the ethical review committee. Sample size calculated was 175 using WHO sample size calculator. Patients of 4–5 years were given 200 mg nitazoxanide twice daily for 3 days; 100 mg nitazoxanide was given twice daily to 12–47 months age group, and patient of

The carbonate factories of the tropical to sub-tropical regions characterize a number of facies, attributable to biological and oceanographic variables. For this purpose, the Middle Jurassic carbonate rock unit (Samana Suk Formation) of the Upper Indus Basin of Pakistan was studied to understand the various Tethyan platform attributes. Four sections from Hazara area were chosen which were also compared with a section from the Nizampur Basin. The resultant microfacies were placed in their paleoenvironmental settings to reveal the facies distribution and geometry of the platform. The platform represents a gently dipping ramp, dominated by peloidal–bioclastic–ooidal grainstones and peloidal lime mudstones. The allochems and fauna show some contrasting signatures regarding paleoclimate. These microfacies infer about existence of a relatively extended tropical climatic belt in the paleo Tethys during the Middle Jurassic. The notable presence of planktonic lime mudstone facies corresponds with global marine transgression, occurring in the middle of rock unit. The nature of ooids and types of fauna of sub-tropics to tropics advocate an extended warm climatic zone in comparison with today. The dominance of gently dipping inner-ramp shoals accompanied by lagoons to steep dipping outer-ramp planktonic lime mudstones restricted the development of least encountered middle-ramp facies. The ramp platform was struck by waves and tides of different strengths including low-middle amplitude storms and the overall absence of evaporites and primary dolostones designate a humid region as manifested by euryhaline conditions. The study has drawn paleoenvironmental and palaeoceanographic similarities with sections in Tanzania, western India, NW Iran, NW Afghanistan and Western Australia. The oceanic parameters compare with present day Trucial Coast of Persian Gulf, reflecting an almost similar nature of paleoceanography in the paleo Tethys.

Objective To evaluate probable association of dietary risk factors with childhood leukaemia. Methods The case-control study was conducted at the Children Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from January to December 2017, and comprised children of either gender aged 2-12 years with recently diagnosed acute lymphocytic or acute myelocytic leukaemia An age and gender matched equal group of healthy children was taken as controls. Dietary-intake data was collected for six food groups, namely raw vegetables, fresh fruits, packed fruit juices, caffeinated drinks, junk foods, and processed/precooked food items. Frequency of the selected food group consumption was summarised in six categories: rarely/never, 1-3 days/week, 4-6 days/week, once daily, twice daily and thrice daily. Data was collected through interviews with the mothers using a pre-designed questionnaire, and was analysed using SPSS 21. Results Of the 90 subjects, 45(50%) were in each of the two groups. There were no differences in baseline characteristics between the two groups (p>0.05). Consumption of caffeinated drinks and junk food was significantly higher in cases (p=0.001) while controls showed significantly higher consumption of fresh fruits (p=0.0012). No significant difference was noted for consumption of vegetables, packed fruit juices and processed food between the groups (p> 0. 05 ). Conclusions Higher consumption of caffeinated drinks and junk food was observed in cases compared to controls.

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%.

To determine the accuracy of ultrasonography in estimation of fetal weight and comparison with post delivery birth weight. Methods: This cross-sectional study was conducted at Department of Gynaecology and Obstetrics Sughra Shafi Medical Complex affiliated with Sahara Medical College, Narowal, from 1 st January to 30th June 2018. In this study, 265 pregnant women of ages 20 years to 40 years were randomly selected. After taking informed consent from all pregnant women, detailed evaluation of all patients was done by thorough history examination and investigations. Literacy level, socio-economic status, patient’s weight, height and parity were also noted. Fetal weight at 37-42 weeks of gestation was estimated by using ultrasound and compared it to post delivery birth weight. Results: Out of all 265 patients, 144(54.33%) patient’s ages were between 20 to 30 years, 90(33.96%) patients were between 30 to 35 years and rest 31(11.70%) had ages greater than 35 years. Patient’s weight was in range between 50kg to 90 kg. Minimum fetal weight was observed as 2.30kg while maximum was 4.60kg at 37-42 weeks gestation. After birth weight accuracy of ultrasound resulted 71.70%. Error estimation was noted as 71.70%, 15.09% and 13.20% as accurate, over and under estimated.

OBJECTIVE To determine the frequency and grading of myelofibrosis in patients of chronic myeloid leukaemia in chronic phase, and the association of cytopenias/cytosis with the degree of fibrosis. STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY King Edward Medical University, Lahore, from March 2015 to April 2017. METHODOLOGY Patients of both genders and all age groups with Philadelphia chromosome/BCR-ABL positivity were included in the study. Detailed medical history and examination findings were recorded. Sample for CBC was taken in EDTA and run on automated haematology analyser. Bone marrow aspirate and trephine biopsy was done from posterior iliac crest. Bone marrow aspirate slides were stained with Giemsa stain. The trephine biopsy was processed and stained with haematoxilyn and eosin. Silver (reticulin) and trichrome staining was done on trephine biopsy to assess the degree of fibrosis. Grading of fibrosis was done according to WHO revised classification 2016. RESULTS Among the 82 cases, 65% (n=53) were having WHO Grade MF 1 myelofibrosis, 27% (n=22) WHO Grade MF 2 myelofibrosis; whereas, 08% (n=07) WHO Grade MF 3 myelofibrosis. CBC counts were analysed to see any association between anemia, thrombocytocytosis and leucocytosis with advanced fibrosis (p=0.148, 0.413 and 0.174, respectively). CONCLUSION Some degree of bone marrow fibrosis was present in all patients of chronic myeloid leukemia, while advance fibrosis (WHO Grade MF 2 and 3) is also common. Peripheral blood counts are not predictor of increased fibrosis. Therefore, bone marrow biopsy with special staining should be done in all cases of chronic phase of CML.