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Portal venous thrombosis (PVT) is an uncommon complication in post-liver transplant recipients. The reported incidence is 1-4%. It may occur within a month, called early or after one month of transplantation, known as late PVT. Early PVT has a poor prognosis, leading to graft failure in most cases. Treatment of such cases is quite challenging because of difficult alternative portal inflow establishment. We performed successful thrombolysis of acute major PVT with a unique technique using ultrasound-guided percutaneous trans-splenic vein access in a post-liver transplant recipient. The per-cutaneous trans-splenic vein approach-based thrombolysis described here in this report might be very helpful in similar cases. This technique minimizes the potential risk of graft loss, avoids re-exploration, has a low risk of bleeding, and is cost-effective. [ABSTRACT FROM AUTHOR]

Objective: To determine Vitamin-D status in children with urinary tract infection., Methods: A Cross-sectional study was done at Pediatric Department, Liaquat University Hospital Hyderabad, from July 2019 to March 2020. A total of 172 children of either gender from 2 to 60 months of age with confirmed urinary tract infection (UTI) (having positive urine C/S report) were included in the study. The child who received antibiotics 48 hours prior or already on immunosuppressive drugs and steroids from previous health record or by taking clinically relevant history), children with CKD on vitamin-D supplementation, and known case of Vitamin-D deficiency were also excluded from the study. All study participants were evaluated for vitamin-D level by high performance liquid chromatography. Urine sample was collected for C/S and 1 cc venous blood was taken for Vitamin D status (ng/ml). The mean ± standard deviation (SD) and stratification was calculated for age, duration of urinary tract infection and vitamin-D level. Post stratification chi-square test was applied for all categorical variables at 95% confidence interval (CI) and P-value ≤0.05 was considered significant., Results: The average age of the patients was 41.51±18.34 months. There were 130 (75.58%) females and 40 (23.25%) males. Most common complaint of the children was fever 150 (87.21%). Vomiting was present in 31 (18.02%), abdominal pain 22 (12.79%) and dysuria in 15 (8.72%) children. A total of 129 (75%) children had pyelonephritis and 15 (25%) had cystitis. (Frequency of vitamin-D deficiency in children with diagnosed UTI was 45.93% (79/172). Mild vitamin D deficiency was present in 42 (53.16%) children, while moderate deficiency in 55 (69.62%) children. E. Coli was the most common pathogen in both mild and moderate vitamin D deficiency i.e., 20 (47.61) and 31 (56.36%) respectively., Conclusion: The frequency of urinary tract infection is more common in children having vitamin D deficiency., (Copyright: © Pakistan Journal of Medical Sciences.)

Objectives: The primary objective was to determine the association between histopathological and microbiological findings in patients clinically suspected to have tuberculous lymphadenitis. A secondary objective was to assess the diagnostic utility of GeneXpert in lymph node specimens., Method: This was a single-centre prospective cohort study, performed in the Infectious Disease Clinic at The Indus Hospital. Three hundred and forty-one adult patients with chronically enlarged, accessible lymph nodes were enrolled after obtaining verbal consent, between February 2013 and April 2016. Tissue specimens were processed for histopathology, acid-fast bacillus (AFB) microscopy, AFB culture, and GeneXpert. Based on these results, anti-tuberculosis therapy (ATT) was prescribed. Clinical characteristics and treatment outcomes were recorded., Results: There were 297 evaluable patients; 74.4% were diagnosed with tuberculous lymphadenitis (TBLA), 6.7% with a malignancy, and 12.8% with reactive nodes. TBLA was diagnosed on suggestive histopathology in 89.6% of cases, followed by GeneXpert (32.6%), mycobacterial culture (26.6%), and AFB smear positivity (12.5%). The sensitivity of GeneXpert was 65.7% when assessed against AFB culture. Drug resistance was displayed by 8.2% of GeneXpert-positive cases and 11.7% of culture-positive cases. The majority of TBLA patients (88.7%) responded favorably to ATT., Conclusions: In light of laboratory evidence, a quarter of patients suspected of TBLA had an alternative diagnosis, highlighting its importance in avoiding over-treatment and diagnostic delays in malignancy. Although sensitivity is poor, the demonstration of drug resistance by both GeneXpert and AFB culture represents a useful tool to guide treatment., (Copyright © 2018. Published by Elsevier Ltd.)

Objective: To compare the effectiveness of zinc supplementation in tablet form with that of the suspension form in the treatment of acute diarrhoea., Methods: A comparative study was carried out at the Liaquat University Hospital, Hyderabad, Pakistan from October 2008 to April 2009, and comprised children aged6-24 months suffering from acute diarrhoea. The patients were divided into two groups on the basis of even and odd numbers. Group A (even numbers) received dispersible zinc tablets, and group B (odd numbers) received zinc suspension. The patients were admitted for 3 days and improvement was checked at the end of 3rd day in terms of decrease in the frequency of stools/day. SPSS 15 was used for data analysis., Results: The 88 patients were divided into two groups of 44(50%) each. Overall, 49(55.7%) patients were male and 39(44.3%) were female. At the end of the 3rd day 51(58%) patients improved, while 37(42%) did not. In the zinc tablet group, improvement was in 32(72%) patients compared to 19(43%) in the zinc suspension group (p<0.05).diarrhoea., Conclusions: The results of tablets preparation were clinically significant in reducing the duration and severity of diarrhoea.

The objective of this study was to find any association of extrahepatic biliary atresia (EHBA) with a possible infectious etiology. Infants diagnosed to have EHBA were tested by blood PCR for cytomegalovirus (CMV), Ebstein-Barr virus, HBsAg, anti-HCV and IgM antibodies for CMV, toxoplasma, rubella, and herpes infections. Thirty-three infants of EHBA were included in the study, male 22, median age when diagnosed 2.5 months (range 1.0-5.0 months). On examination pallor, oedema and hepatosplenomegaly were seen in all and ascites and microcephaly in 19 (57.6%). Centile height and weight were 50th in 23 and 25th in 10. Persistent CMV infection documented by PCR was present in 14 (42%) patients. Eleven of these also had positive CMV IgM antibodies. No other above mentioned infections could be detected in our patients of EHBA. Our data suggests that CMV infection may play a role in the pathogenesis and progression of EHBA.

Objective: To assess the practice and knowledge of mothers regarding breast feeding, complimentary feeding, and to find out socio-economic correlates of feeding practices., Methods: A cross sectional survey conducted at paediatric department of Liaquat University Hospital (LUH) from Jan-Dec 2008. During that period 500 mothers with children less than 24 months were included. Infant feeding patterns were assessed in relation to recommendations and household socio-economic factors by an Interview Technique., Results: Out of 500 mothers, 8.4% started exclusive breast feeding (EBF) while Pre-lacteal use was seen in 31.6%. Regarding the duration 52.2% mothers continued breast feeding for 2 years. Median duration of EBF was 3.5 months. It was seen that 60% of the 0-5 month-old infants breastfed 8 or more times per day. However, exclusiveness of breast feeding decreased from 60% at (0-2 months) to 40% (3-5 months). Majority 64.2% were poor and 61.5% had no education. There is a statistically significant difference in feeding practices of educated and uneducated (P < 0.0001) and also in poor and middle class mothers (P < 0.0003). Regarding, age of their last born babies, 180 babies were under 6 months, and 320 were 6 to 23 months of age. The knowledge about complimentary feeding (CF) was inadequate. Around 21% of 2-3 months old babies received complementary food and 19% of 6-8 month-olds were only breastfed. In 78% mothers CF was advised by family members while in 23% mothers by doctors., Conclusion: Exclusive breastfeeding was not maintained upto recommended age of 6 months. Knowledge about CF was lacking in the mothers. Regarding, mothers' education and socioeconomic conditions, a positive correlation was noted with feeding practices.

Background: Birth asphyxia is a serious clinical problem worldwide. There are many reasons a baby may not be able to take in enough oxygen before, during, or just after birth. Damage to brain tissues is a serious complication of low oxygen that can cause seizures and other neurological problems. This study was designed to asses the risk factors of birth asphyxia in neonates., Methods: This descriptive, prospective study was conducted in the Department of Paediatrics, Isra University Hospital, Hyderabad, from April 2005 to April 2006. 125 newborn (75 males and 50 females) admitted to the neonatal care unit, who were delivered with delayed cry or low apgar score (< 7) were included. Detailed maternal history was taken, regarding their age, gestational age, and complications, if any., Results: Out of 125 neonatal encephalopathy cases, 28% were diagnosed as suffering with moderate or severe encephalopathy, whereas 36% had mild encephalopathy. Risk of neonatal encephalopathy increased with increasing or decreasing maternal age. Antepartum risk factors included non-attendance for antenatal care (64%). Multiple births increased risk in 4.8%. Intrapartum risk factors included non-cephalic presentation (20%), prolonged rupture of membranes (24%) and various other complications. Particulate meconium was associated with encephalopathy in 9.6%. 60% mothers were anemic. Vaginal bleeding was strongly associated with birth asphyxia in 34.44% of neonates. 56% of mothers delivered at home, while 28% delivered at a private hospital or maternity home. Only 12% delivered at a tertiary care hospital., Conclusion: Lack of antenatal care, poor nutritional status, antepartum hemorrhage and maternal toxaemia were associated with higher incidence of asphyxia. Improvements in the public health of women with associated gains in female growth and nutrition must remain a longer-term goal. Early identification of high-risk cases with improved antenatal and perinatal care can decrease such high mortality. Safe motherhood policy is recommended.

At its inception in 1987, the Aga Khan University introduced the idea of community-based medical education in Pakistan, at a time when this model was being introduced and adapted internationally. Human resource development has been a major objective in the Department of Community Health Sciences (CHS). CHS has contributed to developing a medical curriculum that addresses the health needs of the community at large. This paper narrates the department's experience in working directly with under-served communities, leading to the development of specialized courses and degree programs. CHS emphasizes operational research and development of managerial skills among front-line public health professionals, in both the public and private sectors. Training is provided by people from diverse backgrounds, such as public health, community development, social sciences, law, epidemiology, economy, biostatistics, demography, theater, and film. The lessons we have learned show that the mode of training depends on the overall objectives of the program, the clients and the setting. However, in the spirit of the participatory approach, the recipients of the training must be involved during all stages so as to ensure the sustainability of the training program. Training must focus on the communities at the grass roots level or community based organizations, where the communities identify their own capacity and needs. Wide dissemination of training materials, courses and manuals is also useful to replicate successful experience.