In this study, residual concentration of organochlorine pesticides (OCPs) in the sediments, prey, and eggs of Bubulcus ibis were measured from three breeding heronries from the Punjab province of Pakistan. Pattern of contamination in eggs followed the order: DDTs>HCHs>heptachlor>aldrin. Overall, pesticide residual concentrations were greater in eggs of cattle egrets collected from heronry on the River Ravi. Among HCHs, γ-HCH was more prevalent in eggs, whereas DDTs followed the order: DDD>DDE>p,p'-DDT>o,p'-DDT. Eggshell thinning was detected which showed negative relationship with residual concentration of DDE. In prey samples, residual concentration of POPs followed the order: DDTs>HCHs>dicofol>heptachlor; however, contamination pattern in sediments followed a slightly different order: DDTs>heptachlor>dicofol>HCHs>dieldrin>aldrin. Concentration of β-HCH was more prevalent in sediments and comparatively greater concentrations of POPs were measured in sediments collected from the River Ravi. Dicofol was found for the very first time in the biological samples from Pakistan, and its concentration was measured as relatively high in eggs from heronry from the River Chenab. Residual concentrations measured in eggs were below the levels that could affect egret populations. Biomagnification of the total OCPs through the food chain was evident in three breeding heronries. The concentration of DDE measured in eggs of the cattle egret suggests the need for monitoring this contaminant in other bird species at different trophic levels.

Objective: To analyze the association of various biochemical changes with different grades of hepatic encephalopathy among patients of hepatitis C-related decompensated liver disease presenting at Pak Emirates Military Hospital. Rawalpindi, Pakistan. Study Design: Comparative cross-sectional study. Place and Duration of Study: Medicine and Gastroenterology Department of Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Mar 2020 to Feb 2021. Methodology: This study was conducted on 100 patients with hepatitis C-related decompensated liver. A consultant medical specialist or gastroenterologist graded hepatic encephalopathy according to the West Haven criteria. Serum urea, creatinine, albumin and international normalized ratio were performed in all the patients at the time of grading of encephalopathy and derangement in the level of these parameters was analyzed with Grades of encephalopathy. Results: Out of 100 patients, in the final analysis, 66 were males, and 44 were females. The commonest aetiology of hepatic encephalopathy was Infection (33%) followed by Constipation (29%). 15 patients had Grade-1 encephalopathy, 43 had Grade-2, 26 had Grade-3 while 16 had Grade-4 encephalopathy. Deranged serum creatinine, international normalized ratio and albumin levels were significantly associated with a higher grade of hepatic encephalopathy (p-value<0.05) in our study participants. Conclusion: Biochemical markers studied in patients with hepatic encephalopathy secondary to hepatitis C-related decompensated chronic liver disease were deranged. In addition, creatinine, albumin and International normalized ratio were found to be more deranged in higher grades of encephalopathy.

No abstract

No abstract

Background: Vici syndrome is a rare, autosomal recessive multisystem disorder, first described in 1988 by Dionisi-Vici. This syndrome is characterized by corpus callosum agenesis, oculocutaneous hypopigmentation, cataracts, immunodeficiency, and cardiomyopathy with additional variable multisystem manifestations. Case Presentation: We present a case of a 2-month-old infant, born preterm via Spontaneous vaginal delivery (SVD). He presented with fever, fits, and developmental delay. His weight and head circumference were below the third percentile for age and sex. In addition, he had hypopigmented skin and hair, a long philtrum, micrognathia, and high-arched palate. He had generalized hypotonia and hyporeflexia and his eyes showed horizontal nystagmus. His brain magnetic resonance imaging showed agenesis of corpus callosum, colpocephaly, and periventricular necrosis of white matter. He was admitted as a case of Vici syndrome and was treated for infections and seizures. He presented to emergency afterward as well for sepsis and eventually died of cardiopulmonary arrest at an age of 6 months. Conclusion: Vici syndrome is a rare disease and around 80 cases have been reported so far. This is a first reported case in Pakistan. It has variable presentation but agenesis of corpus callosum, recurrent infections, microcephaly, cardiomyopathy, cataracts, seizures, developmental delay, and hypopigmentation remain the most common features.

Retained surgical sponge (Gossypiboma) in the abdominal cavity following surgery is a serious complication that can be avoided. The incidence is variable and underreported, because of medico-legal consequences, but also patient remains aymptomatic. Retained sponge can erode the bowel leading to partial or complete bowel obstruction. Transmural migration of the surgical sponge is a rare entity. We present a case of intraluminal migration of gossypiboma that spontaneously expulsed through rectum with favorable recovery.

Mycotic aortic aneurysm is an infective disease of the aorta with high mortality rate despite surgical repair. Recombinant activated factor VIIa (rFVIIa) is approved for the treatment of bleeding in hemophilia and used (off-labeled) in acute bleeding related to the trauma, cardiac surgery, and intracranial bleed. A 38-year female was admitted with abdominal pain, and was subsequently diagnosed with bleeding mycotic aneurysm of the abdominal aorta. She was given rFVIIa and the bleeding stopped successfully. We recommend further evaluation of the role of rFVIIa in bleeding mycotic abdominal aortic aneurysm, as it can bring a novel change in the management of this devastating disease.