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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.

Objectives: Asthma affects about 15% of children while it is one of the commonest reason for admissions in pediatric emergencies and wards. We aimed this study to determine outcome of Salbutamol alone and salbutamol in combination with Ipratropium Bromide in acute asthma in children. Study Design: Randomized Controlled trial (RCT). Setting: Unit-II Department of Pediatric Medicine, Nishtar Medical College and Hospital, Multan. Period: 20th Nov 2017 to 30th June 2018. Material & Methods: The study consisted of 104 children, with 52 children each in Group ‘A’ and ‘B’ who were subjected to salbutamol alone and salbutamol in combination with Ipratropium bromide respectively. In both groups oxygen was administered via nasal prongs at a flow rate of 3L/minute. These children was monitored at 30 minutes interval for 2 hours (least value out of these 4 values was taken). Both groups were compared for outcome in terms of mean heart rate, respiratory rate, accessory muscle score, peak expiratory flow rate (PERF) percentage and SPO2. Results: Of these 104 study cases, 61 (58.7%) were boys while 43 (41.3%) were girls. Mean age of our study cases was noted to be 9.92 ± 3.01 years. Mild level of asthma severity was noted in 35 (33.7%) and moderate severity in 69 (66.3%). Mean heart rate in group A was noted to be 119.40 ± 12.22 and in group was 119.29 ± 8.51 beats per minute. (p=0.956). Mean respiratory rate in group A was 29.98 ± 4.00 while in group B was 27.88 ± 3.85 (p=0.000). Mean accessory muscle score in group A was 0.537 ± 0.336 while in group B was 0.130 ± 0.030 (p = 0.000). Mean PEFR percentage in group A was 68.69 ± 18.64 while in group B was 87.12 ± 17.10 (p = 0.000). Mean SPO2 in group A was 96.15 ± 1.05 while it was 95.94 ± 1.29 (p = 0.362). Conclusion: Our study results have shown that nebulization of salbutamol in combination with Ipratropium Bromide is more effective in the management of children with acute asthma. It was safe, effective and reliable as there was no adverse side effect noted in our study. We recommend the use of this combination nebulization therapy in children with acute asthma.

Objectives: Acute gastroenteritis is a common illness that leads to significant morbidity and mortality in pediatric population. This study was aimed to determine the frequency of hyponatremia among hospitalized children having acute gastroenteritis. Study Design: Cross-sectional Study. Setting: Unit-ll, Department of Pediatric Medicine, Nishtar Medical College and Hospital, Multan. Period: From 1st January 2018 to 30th June 2018. Material & Methods: A total of 232 children aged 1-12 years of either sex, clinically assessed cases of acute gastroenteritis with duration of illness < 7 days, were considered. Mean and standard deviation was calculated for quantitative variables while frequencies and percentage were tabulated for the qualitative variables. Post stratification chi-square test was applied to see effects of studied variables and P value 3 days were significantly associated (P value < 0.05) with hyponatremia. Conclusion: Frequency of hyponatremia was high in children with AGE. Male children, poor socioeconomic status, no use of hypotonic IV fluid therapy, no intake of ORS and prolonged disease duration were significantly associated with hyponatremia.

Objectives: To determine the frequency of risk factors and acute complications for SGA in term new borns during first 24 hours after delivery. Study Design: Descriptive Case Series. Setting: Department of Pediatric Medicine, Nishter Hospital, Multan. Period: 15 Aug 2014 to 30 Apr 2015. Material & Methods: A total of 157 term babies, delivered in labor room in Nishter hospital Multan were evaluated in 24 hours of birth. Mother of each SGA baby was examined regarding history, clinical examination and nutritional status were noted. SGA babies were completely monitored for 24 hours in the department of pediatric medicine for complications. Results: There were 88 (56.1%) male and 69 (43.9%) female. Mean age and weight of the patients at the time of presentation were 12.73 + 6.65 hours and 2.03 + 0.65 Kg respectively. Among mothers, 61.1% were nulliparous, anemia was found in 47.8%, inter pregnancy intervals of less than or equal to one year in 58.6% and hypertension in 61.8%. Among SGA babies, perinatal asphyxia was found to be present in 63.7%, meconium aspiration in 51%, hypothermia in 37.6%, hypoglycemia in 24.2%, hypocalcaemia in 32.5%, polycythemia in 47.1% and thrombocytopenia in 41.4%. Conclusion: Maternal hypertension, nulliparity, short inter pregnancy interval and anemia were frequently encountered risk factors for SGA babies. The most frequently encountered perinatal complications observed were perinatal asphyxia, meconium aspiration, polycythemia, thrombocytopenia, hypothermia, hypocalcaemia and hypoglycemia in decreasing order of frequency.

Many perinatal deaths follow birth asphyxia that occurs in babies of women who are referred on developing life-threatening obstetric complications. Objectives: To determine the antenatal and intrapartum risk factors for perinatal asphyxia among babies delivered by women admitted as emergency obstetric referrals. Study Design: Cross-sectional study. Setting: Pediatric Unit 1, Nishtar Hospital Multan, Pakistan. Period: From May 2017 to April 2018. Material & Methods: A total of 150 newborn term babies (and their mothers) with a 1, 5, & 10-minutes Apgar score 4 or less (perinatal asphyxia) were considered for the study. Antepartum and intraparturn risk factors were noted among newborn babies (and their mothers) from socio-demographic characteristics, obstetric complications or labour management. Results: Out of150 neonates, 57(38%) were presented with perinatal asphyxia at the age of 1 minute, 62(41.3%) at the age of 5 minutes and 31(20.1%) neonates were presented at the age of 10 minutes. In these cases, 45(30%) were related to maternal causes, 71(47.3%) to placental causes and 34(22.7%) to fetal cause. Conclusions: Early recognition of antepartum and intraparturn risk factors for perinatal axphyxiaamong emergency obstetric referrals, followed by prompt and appropriate management, may reduce the perinatal deaths from perinatal asphyxia.

Objectives: Magnesium is the 2nd most abundant intracellular cation and it is vital for more than 300 enzymatic reactions which are involved in various metabolic processes in our body, but still, it is often a parameter which is overlooked by the clinicians. This study was conducted to determine the frequency of hypomagnesaemia among children admitted in pediatric intensive care unit (PICU). Study Design: Cross-sectional study. Setting: Department of Pediatric medicine, Unit-I, Nishtar Hospital, Multan. Periods: From 1st August 2017 to 31st May 2018. Material & Methods: A total of 379 children of age group 1-12 years and either gender were admitted at PICU irrespective of presenting complaint with duration of illness less than 2 weeks were included. Post stratification chi-square test was applied to see the effect of different variables like age of the patients, BMI, duration of illness and serum Magnesium levels, hypomagnesaemia, residential status, socioeconomic status, mother’s education and gender, on hypomagnesaemia. P value < 0.05 was considered as significant. Results: Of these 379 study cases, 221(58.3%) were boys while 158 (41.7%) were girls. Mean age of our study cases was 4.81 ± 2.27 years. Mean duration of illness was 5.57 ± 2.34 days. Mean weight of study cases was 17. 30 ± 5.92 kilograms. Mean serum Magnesium level was 1.45 ± 0.67 mg/dl. Hypomagnesemia was found to be present in 190 (50.1%). Male gender, urban residential status, illiteracy, hospitalization before PICU admission, disease duration of 1 to 2 weeks and weight < 20 kg turned out to be significantly associated (p < 0.05) with hypomagnesaemia. Conclusion: High frequency of hypomagnesaemia was noted among children admitted at PICU. Children with hypomagnesaemia had prolonged hospital stay and adverse outcomes. Hypomagnesaemia was significantly associated with male gender, residential status, mother’s educational level, hospitalization before PICU admission, disease duration and weight.

Kinnow orchards grown in different agro-ecological regions of Punjab, Pakistan, namely Sargodha, Toba Tek Singh (TTS) and Vehari districts, were selected to assess the effect of climate variables on fruit-bearing patterns. Experiment was laid out in RCBD while selecting identical features Kinnow plants and labeled twigs at analogous canopy positions in all three sites. Temperature was reported higher in TTS and Vehari areas, while relative humidity in Sargodha accounted for different levels of agrometeorological indices by computing more variations in warm districts. Climate variables influenced fruit-bearing habits and vegetative growth trend in all three flushes while recording heavy fruit-bearing plants during on-year and light fruit-bearing in off-year at Vehari. Similarly, three vegetative flushes were recorded unevenly in all three sites due to different fruit-bearing patterns induced by climate variables. Harvesting pattern of orchards began earlier in Sargodha, where maximum orchards were harvested before new flowering to add evenness to fruiting habits during on & off-years. In warm conditions, fruit ripening arrived in the peak of winter and mostly domestic market-driven harvesting resulted in late start of fruit picking with more erratic fruit-bearing habits. Both physiological and pathological fruit drops have been significantly affected by climate variables with a higher degree of physiological drop in warm regions and pathological effects in the humid conditions of Sargodha on heavy fruit-bearing plants. Fruit yield and grading quality were also affected in both seasons by showing more asymmetrical trend in yield and fruit grading in warm areas of TTS and Vehari due to an irregular fruiting pattern compared to Sargodha. From now on, the climate variables of the three sites directly influenced the fruiting patterns, vegetative flushes, fruit drops, yields and grades of Kinnow mandarin.

Heat shock proteins (Hsps) are stress-responsive molecular chaperones, which uphold proper protein folding in response to external and internal stresses. The Hsp100 gene family plays a substantial role in thermos-tolerance of plants. This study investigated evolutionary relationship and expression of ClpB/Hsp100 gene family in tomato under heat stress. Six SlHsp100 genes were identified using bioinformatics tools. In silico sub-cellular localization indicated that of these 6 ClpB/Hsp100 members, 4 are found in chloroplast, 1 in mitochondria and 1 in the cytoplasm. For evolutionary study, 36 SlHsp100 genes were included in the phylogenetic tree showing a hierarchical clustering shared by the members of the kingdoms Plantae, Archaea, Chromista, Fungi and Bacteria. A total 4 pairs of orthologous and 5 pairs of paralogous genes were identified. Functional divergence between different Hsp100 clusters showed considerable functional homology. Thermo-tolerance measured in terms of cell viability, cell membrane stability and pollen viability indicated that it was paralleled by thermal resistance of Hsps. Reverse transcriptase polymerase chain reaction was used to analyze gene expression in leaves of five-week-old tomato seedlings following exposure to heat stress (45°C) and control (25°C). Chloroplastic LeHSP110/ClpB gene was upregulated in all tomato genotypes after exposure to heat stress highlighting the crucial role of this gene family in acquired thermo-tolerance.

A field experiment with five nitrogen (N) application rates (120, 140, 160, 180, 200 kg hm−2) under peanut/maize intercropping regime was conducted to evaluate cropping patterns and N application rates on yield, soil enzyme activities, and rhizosphere microbial community structure. The field experiment showed that the land equivalent ratio (LER) in maize/peanut intercropping system was not decreased as compared with the monoculture pattern, though the total N supply was approximately reduced by 20%. Terminal restriction fragment length polymorphism (T-RFLP) results showed that the treatments of intercropping (IMP100%, IMP80% and IMP60%) increased the abundance of Rhizobium hainanense, Rhizobium leguminosarum and Frankia which are associated with nitrogen fixation as compared to monoculture pattern (M100% and P100%). The qPCR results revealed that the copy number of nifH was significantly higher in the treatments of intercropping than in monoculture pattern. The result was also consistent with the T-RFLP analysis. In conclusion, peanut and maize under the condition of intercropping can promote the population of microorganisms associated with nitrogen-fixing in the rhizospheric soil. Our results provide a theoretical basis and technical support to soil N utilization, development of low carbon agriculture and protection of farmland ecological environment.

The human serum is a vital component of the innate immunity of the host that acts as the first line of defence against invading pathogens. A key player in serum-mediated innate immune defence is a system of more than 35 proteins, collectively named as the complement system. After exposure of the pathogen, these proteins are activated in a cascade manner, ultimately forming a membrane attack complex (MAC) on the surface of the pathogen that directly lyses the bacterial cell. Formation of the MAC can be demonstrated in vitro by using serum bactericidal assay (SBA) that works in the absence of cellular components of blood after incubating the serum along with bacteria. Here, we describe the age-related differences in the bactericidal activity of human serum against Pseudomonas aeruginosa, an opportunistic human pathogen causing an array of hospital and community-acquired infections. We demonstrate that adult sera were highly effective in the in vitro killing of Pseudomonas aeruginosa as compared to children and the elderly (p < 0.0001). Sera from children were seriously compromised in the killing P. aeruginosa, whereas elderly sera showed a reduced level of killing. Data revealed a positive correlation between age and serum-killing with higher coefficient of determination values of 0.34, 0.27, and 0.58 and p values of < 0.0001, < 0.001, and < 0.0001, respectively, after 60, 90, and 120 minutes of incubation. Hence, our study highlights the age-related difference in the bactericidal activity of human sera. We conclude that sera of children are totally compromised, whereas elderly sera are only partially compromised, in the killing of P. aeruginosa.

Objective: To assess the efficacy of Valsalva maneuver in the treatment of Eustachian catarrh. Study design: QuasiExperimental Study. Place and duration of study: Frontier corp Hospital (Quetta) and Sheikh Khalifa Bin Zayad Al Nahyan Hospital(Muzzafarabad) from December 2010 to May 2011. Patients and methods: Total of sixty patients of Eustachian catarrh were randomlyassigned to two treatment groups. Group A was given Antibiotics, Antihistamine, systemic and nasal decongestants and group B wasadvised Valsalva maneuver in addition to the above mention treatment. Relief in aural fullness (assessed through tympanometry) andhearing improvement (assessed through audiometry) were compared between these two groups at the end of three weeks of treatment.Results: Audiogram done after three weeks of treatment showed statistically significant hearing and middle ear pressure improvement(assessed through audiogram and tympanogram respectively) in group B.

The overreliance on and overuse of fungicides is not only a health hazard but also induces natural resistance in plant pathogens, resulting in an economic burden on agricultural producers and a potential threat to natural systems across the globe. It is therefore necessary to identify natural substitutes of fungicides. This study was designed to evaluate the inhibitory effect of the root exudates of two different garlic cultivars, cv. Gailiang (G064) and Cangshan (G025), against Phytophthora capsici, a pepper fungus. All treatments (T1 to T4, i.e., 25%, 50%, 75% and 100% root exudate concentrations) of garlic cultivar G025 showed lower inhibition effects than cultivar G064. An intervarietal inhibition effect comparison at 100% concentration (T4) exhibited a 69.24% decline in hyphal growth for G064 compared with 49.06% for G025. The mycelial growth measured in the control was found to be significantly greater compared with the garlic treatments. The results of high performance liquid chromatography (HPLC) revealed that G064 possessed a large amount of allicin compared with G025. Scanning and transmission electron microscopy showed that, compared with the controls and hyphae treated with G025, the fungal hyphae treated with G064 exudates were misshaped, fragmented and had a smaller diameter, as well as empty cytoplasmic contents in the cell wall. Thus, the root exudates of the G064 cultivar had a significant fungicidal effect on P. capsici.

Bergenin is well-established and potent antioxidant compound with known gastro-protective effects. Main aim of the current investigation was to study the urease inhibitory potential of bergenin both experimentally and computationally. The target compound bergenin was isolated from acetone extract of Mallotus philippinensis bark. Bergenin inhibited the Bacillus pasteurii urease (IC50 value: 21.7 ± 0.2 μM). Thiourea was used as standard inhibitor (IC50 value: 25 ± 0.09 μM). Molecular docking studies revealed the potential binding mode of bergenin, according to which, Bergenin penetrated deeply into the active catalytic site of urease and was found in close interaction with nickel ions and the various important amino acid residues surrounding the catalytic site of B. pasteurii urease. This might be an additional gastro-protective mechanism by which, bergenin inhibits urease released by various urease producing bacterial strains especially Helicobacter pylori.