Objectives: To compare the efficacy of Duloxetine with Amitriptyline in Terms of Reduction in Frequency of Pain in The Management of Patients of Diabetic Neuropathy. Study Design: Randomized Control Trial. Setting: Medical OPD of ABWA Medical College Hospital Faisalabad. Period: Six Months from 01-01-2019 to 30-06-2019. Material & Methods: A total of 200 cases (100 in each group) between the age 20-65 years of any gender, ≥ 5 years history of diabetes, symptoms of peripheral neuropathy for at least six months, having HbA1c >7.5% were included. Two groups were formed Group A was given 60mg Duloxetine each day and Group B was given 75mg amitriptyline in a single dose. After 3 weeks, an additional three weeks supply of medication was dispensed and patient were scheduled to return at week 6 for the final evaluation that recorded by me in terms of reduction in pain score and also assessed for 50% reduction in pain score from base line that was labeled as reduced. Results: 62%(n=62) in Group-A and 35%(n=35) in Group-B were treated effectively, which shows a significant difference between the two groups. Conclusion: The duloxetine was more effective than amitriptyline in terms of reduction of pain in diabetic neuropathy.

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Objective: To compare outcome of hypertonic saline (HS) versus normal saline (NS) among children aged 2 to 24 months with acute bronchiolitis. Study design: An open label randomized controlled trial. Place and Duration of the Study: Department of Pediatric Medicine, Ibn-e-Siena Hospital, Multan from 1st September 2021 to 31st March 2022. Methodology: A total of 220 children (110 in each group) of both genders aged 2 to 24 months reporting to emergency department with acute bronchiolitis with a disease spanning less than 5 days were included. In HS group, children were nebulized with 4 ml of 3% HS while in NS groups, all children were nebulized with 4ml 0.9% saline solution. In both groups, children were given respective treatment with interval gap of 4 hours. Clinical severity score and need for hospitalization after 24 hours was noted. Results: In a total of 220 children, 126 (57.3%) were males and 94 (42.7%) females. Overall, mean age was 7.9±5.3 months while 170 (77.3%) children were aged between 2 to 12 months. Residential status of 132 (60.0%) children was rural. Monthly family income of 165 (75.0%) children was below 25,000 Pakistani Rupees (PKR). Maternal educational status of 91 (41.4%) children was illiterate. Mean baseline clinical severity score was calculated to 7.28 ± 1.47. HS group, post-treatment mean clinical severity score was 4.29±2.83 in comparison to 5.99±2.64 in NS groups. There were 28 (25.5%) children in HS group who required hospitalization in comparison to 56 (50.9%) in NS group (p=0.0001) Conclusion: In comparison to nebulization with normal saline, nebulization with hypertonic saline solution was found to be significantly more effective in reducing clinical severity score and need for hospitalization among children aged up to 2 years with acute bronchiolitis. Keywords: Hypertonic saline, normal saline, acute bronchiolitis, clinical severity score.

Objective: To find out the prevalence and risk factors of primary malnutrition among children below 5 years of age visiting outpatient department of a tertiary care hospital. Study Design: A cross-sectional study. Place and duration: Department of Pediatric Medicine, Ibn-e-Siena Hospital, Multan from 1st January 2022 to 30th June 2022. Methodology: A total of 151 children of either gender aged below 5 years visiting outpatient department of pediatrics. At the time of enrollment, socio-demographic as well as anthropometric characteristics were noted. Z-score were calculated to label malnutrition considering weight for height criteria according to “World Health Organization (WHO)” charts as: mild, -1.0 to -1.9, moderate, -2.0 to 2.9, and severe, ≤ -3.0. Results: In a total of 151 children, 78 (51.7%) were girls. The mean age, weight and height were 2.67±1.56 years, 10.18±3.55 kg and 82.99±16.39 cm. The mean birth weight was 2.44±0.21 kg. Exclusive breast-feeding for the first 6 months was reported in 69 (45.7%) children while cow’s mild before 1 year of age was reported by 101 (66.9%). The mean height for weight Z-score was calculated to be -1.40±2.20. Distribution of nutritional status revealed that 61 (40.4%) were normal while mild, moderate and severe malnutrition were observed among 37 (24.5%), 11 (7.3%) and 42 (27.8%) children respectively. Malnutrition status had significant association with increasing age (p<0.001), poor maternal educational status (p=0.034) and use of cow’s milk before 1 year of age (p=0.004). Practical Implications: There is a massive need to identify causes behind factors linked with primary malnutrition among children below 5 years of age so that targeted interventions could be planned. Conclusion: The prevalence of primary malnutrition was very high among children below 5 years of age. Age, poor maternal educational status and use of cow’s milk before 1 year of age had significant association with malnutrition. Keywords: Breastfeeding, maternal education, malnutrition, socio-economic status, Z-score