Septic arthritis, osteomyelitis, and cellulitis in a neonate: A case report and discussion of diagnosis and management.

INTRODUCTION: Septic arthritis, osteomyelitis, and cellulitis are rare but life-threatening conditions in neonates. This case report emphasizes the significance of early diagnosis and intervention in such cases. PRESENTATION OF CASE: We present a case of a male neonate, who developed septic arthritis, osteomyelitis, and cellulitis following trauma from a fall. The patient presented with fever, swelling, and limited joint movement. Diagnosis was based on clinical evaluation, laboratory investigations, and imaging studies. Treatment involved intravenous antibiotics for three weeks, followed by oral antibiotics for two weeks, resulting in complete recovery. DISCUSSION: Neonatal septic arthritis and osteomyelitis are challenging to diagnose due to nonspecific symptoms. Early initiation of antibiotics is crucial to prevent long-term complications. Surgical intervention may be required in cases of inadequate antibiotic response or significant joint effusion. This case underscores the importance of prompt recognition and tailored management. CONCLUSION: Septic arthritis, osteomyelitis, and cellulitis pose serious threats to neonates. Timely diagnosis, appropriate antibiotics, and, if needed, surgical intervention are vital for favorable outcomes. Individualized treatment plans should consider clinical condition and local protocols.

Effectiveness of modified Valsalva maneuver by using wide bore syringe for emergency treatment of supraventricular tachycardias: Findings from Pakistan.

Background and Objectives: The Valsalva maneuver (VM) is the most effective measure that can be carried out to treat supraventricular tachycardia (SVT). Our objective was to compare the efficacy of postural modified VM with 20 ml syringe to standard VM for the emergency treatment of SVT. Methods: This randomized control trial study was conducted at the Accident and Emergency Department, Pakistan ordinance factories hospital, Wah Cantt from July 2019 to September 2020. In the standard Valsalva group, fifty patients were placed at an angle of 45 with continuous monitoring of vitals and electrocardiogram. Patients blew into a 20ml syringe to generate 40 mmHg pressure for 15 seconds and remained in the same position for 45 seconds before a reassessment of cardiac rhythm at one-minute and three-minute intervals. In the modified Valsalva group same procedure was repeated with the other fifty patients, but immediately at the end of the strain, they were laid flat with their legs raised to 45° for 15 seconds. Participants returned to semi-recumbent position and cardiac rhythm was reassessed after 45 seconds and then at one and three minutes. Results: In the standard Valsalva maneuver (SVM)20.0% of participants versus 58% of participants in the modified Valsalva maneuvers group(MVM) reverted to sinus rhythm at one min (odds ratio or 5.52, 95% CI 2.26-13.47; p<0.001) and time of stay in the emergency room was (odds ratio or 2.39, 95% CI 1.45- 3.93; p<0.0001). Conclusion: Modified Valsalva by using a wide-bore syringe is more effective method than standard Valsalva in terminating SVT.

Burnout prevalence and associated factors in medical students in integrated modular curriculum: A cross-sectional study.

Objectives: The present study aimed to explore the prevalence of burnout syndrome and to find the association of burnout symptoms with sociodemographic factors in medical students. Methods: A cross-sectional study was conducted between September 2019 to January 2021 at Shifa College of Medicine, Islamabad. A total of 284 medical students from the first year to the fifth year participated in this cross-sectional study. After taking informed consent, students were asked to record responses on the Burnout Clinical Subtype Questionnaire BCSQ-12. In addition, a structured questionnaire was developed to obtain information about the sociodemographic status. Results: Prevalence of burnout was observed among day scholars, females, and students having a relatively sedentary lifestyle. Low family income showed a significant association of burnout in medical students (p=0.025). A significant association was found in the mean scores of neglect subtype of burnout with low family household income (p = 0.010). The mean scores of the overload subtype of burnout and daily duration of sleep also showed a significant association (p = 0.039). Conclusion: The prevalence of burnout was associated with low household income and sleep deprivation. Gender, academic year and physical activity did not have a significant association with burnout syndrome. The high prevalence of burnout syndrome necessitates appropriate interventions to identify and reduce the prevalence of burnout in medical students.

Management zone delineation and spatial distribution of micronutrients in cold-arid region of India.

The plant health is governed by many factors: soil playing a central role which exhibits huge variability in its characteristics. Micronutrients even though needed in small quantities by plants play an indispensable role in affecting the crop growth and development. The assessment of spatial variability of different soil parameters is incumbent for tackling the loss of crop productivity on account of non-receipt of desirable inputs. The present investigation centered on the spatial distribution of soil parameters and micronutrients was conducted to delineate management zones (MZs) in cold arid region (Kargil) of India for proficient micronutrient management. Overall 454 georeferenced representative soil samples at the depths of 0-15 cm were garnered. The soil samples were processed and analyzed for different soil parameters encompassing pH, EC (electrical conductivity), SOC (soil organic carbon), and available micro-nutrient (iron, manganese, zinc, copper and nickel) concentrations. The distinct variation in the soil properties including micronutrients was identified with coefficient of variation ranging as low as 5.62% to moderate (21.16 to 42.49%) and as high as 159.63%. Semivariogram analysis and ordinary kriging of soil variables under study revealed diverse spatial distribution exhibiting medium to high spatial dependence in the region. PCA (principal component analysis) and K-means clustering were expended for the delineation of MZs. Four principal components (PCs) having eigen values > 1 and accounting for 70% of the total variation were subjected to further analysis. The five potential MZs were demarcated on the basis of K-means cluster performance index, and heterogeneity in parameters was discerned. The results of study corroborate that the spatial variability analysis of different soil parameters for delineation/identification of MZs might be effectually employed for site-specific micronutrient management.

Agricultural soils a trigger to nitrous oxide: a persuasive greenhouse gas and its management.

Agricultural soils form the backbone of the country's economic development. The increased population has not only reduced this treasure but also has affected the global climate at an alarming rate. Among the GHGs, emission of N2O due to agricultural activities is nowadays a global concern. Agricultural industries have increased N2O and CH4 by 17% in the atmosphere since 1990, with an average emanation rate of around 60 MT CO2 equivalents per year. Crop production accounts for approximately 50% of N2O emissions stemming from the farming community and discharges of fertilizer-induced N2O, for the time being estimated by IPCC at 1.24% of the N used ranging from 0.76% (rice) to 2.77% (maize). The concentration of atmospheric N2O has increased (60 ppb) after the industrial revolution, at the pace of 0.73 ppb year-1. Besides, soil structure, temperature, moisture, denitrifying microbial population, pH, C:N ratio, and relief are the factors which significantly enhance the N2O levels into the atmosphere. N2O as a GHG has more potential towards global warming than CO2 and has a very long residence period (115 years) in the atmosphere. N2O emission is nowadays a core issue which needs to be mitigated so as to decline the levels of its production in agricultural soils. However, priority should be given to the organic farming, management of soil chemistry, and phytoremediation to reduce the addition of N2O into the ambient air. Furthermore, deployment of N2O reductase in agricultural soils increases the efficiency of converting N2O to inert N2 which is a valuable strategy to reduce N2O production.

Effects of Recombinant Irisin on Body Mass Index, Serum Insulin, Luteinizing Hormone and Testosterone Levels in Obese Female BALB/c Mice.

OBJECTIVE: To determine the effects of recombinant irisin on body mass index (BMI), serum insulin, luteinizing hormone (LH) and testosterone levels, and to correlate the serum insulin levels with serum luteinizing hormone and testosterone levels and to correlate the body mass index with serum insulin levels in obese female BALB/c mice. STUDY DESIGN: Laboratory-based experimental study. PLACE AND DURATION OF STUDY: Department of Physiology, Shifa College of Medicine, Islamabad in collaboration with Research Laboratory of Shifa College of Medicine, National Institute of Health (NIH) and Reproductive Physiology Laboratory, Quaid-e-Azam University, Islamabad, from March 2015 to September 2016. METHODOLOGY: Ninety female BALB/c mice were divided into three equal groups. Group A which was the control group was fed with normal chow diet. Group B and Group C were fed with high fat-high sucrose (HF-HS) diet for five weeks to induce obesity. After four weeks group C was divided into two subgroups. Group C-low dose (LD) was injected with low dose irisin and group C-High dose (HD) was injected with high dose irisin for one week. After five weeks, the BMI, serum insulin, LH and testosterone levels were measured in all the groups. Data was analysed by SPSS version 21. P-value of <0.05 was considered significant. RESULTS: Group B showed statistically significant elevation in BMI, serum insulin, LH and testosterone levels as compared to Group A (p <0.001, <0.001, 0.007 and 0.014, respectively). Group C-HD showed statistically significant decrease in BMI, serum insulin, and LH as compared to Group B (p <0.001, 0.013 and 0.028, respectively). Serum testosterone level was also decreased in group C-HD as compared to Group B, however the difference was not significant. CONCLUSION: Obesity increases the serum insulin, LH and testosterone and irisin significantly lowers the elevated BMI, serum insulin and LH levels in female BALB/c mice. It also lowers the elevated testosterone levels, but not significantly.

Effect of Kisspeptin on Serum Prolactin and Gonadotropins Levels in Balb-c Mice with Induced Chronic Stress.

OBJECTIVE: To determine and compare effects of kisspeptin on serum prolactin, luteinizing hormone and follicle stimulating hormone levels in Balb-c mice with and without exposure to chronic restraint stress. STUDY DESIGN: An animal experimental study. PLACE AND DURATION OF STUDY: Shifa College of Medicine / Shifa International Hospital Islamabad, in collaboration with National Institute of Health, Islamabad and Centre for Research in Experimental and Applied Medicine Laboratory, Army Medical College, Rawalpindi, from April 2014 to June 2015. METHODOLOGY: Mice divided into three groups, each containing 30 mice. Control group (group A) received intraperitoneal injection of saline, group B was administered with intraperitoneal injection of saline and restrained stress, and group C was administered with both stress and kisspeptin 100 ng daily for four weeks. Restraint stress was applied to groups B and C for three hours per day by immobilising individual mice in wire-mesh restrainers. At the end of four weeks blood sampling was done. Serum luteinizing hormones (LH), serum follicular stimulating hormone (FSH) and serum prolactin (PRL) were analysed by ELISA. RESULTS: Serum prolactin level increased in group B (stressed) and group C (stressed + kisspeptin treated) as compared to control group; and decreased in group C as compared to group B. Serum LH and FSH in group B was decreased as compared to control, and it was increased in group C as compared to control and group B. CONCLUSION: Administration of kisspeptin increases level of gonadotropins and reduces stress-induced hyperprolactinemia, which may improve fertility despite stress in animal.