No abstract

Aim: To evaluate peripheral oxygen consumption (VO 2 ) measurements using near infrared spectroscopy (NIRS) with arterial occlusion in healthy term neonates by studying the effect of limb cooling on peripheral and global VO 2 . Subjects and methods: Twenty two healthy term neonates were studied. Peripheral VO 2 was measured by NIRS using arterial occlusion and measurement of the oxyhaemoglobin (HbO 2 ) decrement slope. Global VO 2 was measured by open circuit calorimetry. Global and peripheral VO 2 was measured in each neonate before and after limb cooling. Results: In 10 neonates, a fall in forearm temperature of 2.2°C (mild cooling) decreased forearm VO 2 by 19.6% (p < 0.01). Global VO 2 did not change. In 12 neonates, a fall in forearm temperature of 4°C (moderate cooling) decreased forearm VO 2 by 34.7% (p < 0.01). Global VO 2 increased by 17.6% (p < 0.05). Conclusions: The NIRS arterial occlusion method is able to measure changes in peripheral VO 2 induced by limb cooling. The changes are more pronounced with moderate limb cooling when a concomitant rise in global VO 2 is observed. Change in peripheral temperature must be taken into consideration in the interpretation of peripheral VO 2 measurements in neonates.

Aim: To evaluate the effect of an induced change in global metabolic rate on peripheral oxygen consumption (VO 2 ) in healthy full term neonates. Subjects and methods: Twenty four healthy full term neonates were studied. Peripheral VO 2 was measured by near infrared spectroscopy (NIRS) using arterial occlusion and measurement of the oxyhaemoglobin (HbO 2 ) decrement slope. Global VO 2 was measured by open circuit calorimetry. Global and peripheral VO 2 were measured in each neonate before and after a routine bath. Abdominal and forearm skin temperatures were also recorded. Results: Nineteen neonates completed the study. Global VO 2 increased by 30.7% (p = 0.001), and peripheral VO 2 by 23.1% (p = 0.001). A correlation between the fractional changes in global and peripheral VO 2 was apparent (r = 0.76, p = 0.001). Abdominal skin temperature decreased by 0.8°C (p = 0.001), and forearm skin temperature by 0.6°C (p = 0.04). Conclusions: Measurement of peripheral VO 2 using NIRS with arterial occlusion is responsive to conditions that increase global metabolic rate. Any change in global VO 2 must be taken into consideration during the interpretation of peripheral VO 2 measurements in neonates. E arly in circulatory compromise, compensatory mechanisms maintain oxygen delivery to vital organs, such as the brain and heart, through redistribution of blood flow away from the periphery. This will give rise to reduced peripheral perfusion, thereby limiting oxygen uptake by these areas. Studies during critical care in adults, using invasive oxygen electrodes, suggest that hypoxic changes in skeletal muscle may be observed before there is a significant change in blood pressure.1 Therefore a method for assessment of peripheral oxygen consumption in neonates may give an early warning of the need for circulatory support during critical care.2 Cerebral ischaemic lesions are still an important cause of neurodevelopmental problems in preterm infants. 3 There is evidence that prevention of hypotension is important in the prevention of these lesions, 4-6 and the British Association of Perinatal Medicine guidelines 7 promote the maintenance of mean arterial pressure above predefined limits. Unfortunately this strategy has not been effective in preventing the development of these lesions. The cause of this white matter damage is almost certainly multifactorial, with contributions from antenatal infection (chorioamnionitis) 8 9 and hypocapnia. 10 11 Nevertheless it is possible that improved management of the circulation, particularly in the first 48 hours of life may improve brain perfusion and lead to improved outcomes for these babies.Previously we reported a non-invasive method for measurement of peripheral oxygen consumption (VO 2 ) in neonates using near infrared spectroscopy (NIRS) with arterial occlusion.12 Before assessing this technique during critical care, it was necessary to understand how changes in the external environment may affect the measurements obtained. Changes in environmental temperature may have a profound effect...

Objectives: To determine the frequency of neurological manifestations of vitamin B12deficiency and to observe the reversibility of the symptoms after the therapy. Study Design: Descriptivestudy. Study Design: Descriptive study. Setting: Medicine Department of Bolan Medical Complex HospitalQuetta. Period: One year that is from January 2012 to December 2012. Methodology: 46 patients presentedto various OPDS of B.M.C.H.. The inclusion criteria for the patients to be studied were: Anemia, Neurologicalcomplaints. Results: Out of 46 patients 26(56%) were males and 20(43%) were the females with a meanage of (40) years.32 (69%) belonged to the rural areas. 45(97%) had mixed diets whereas only one 1(2.1%)young non Muslim was found to be pure vegetarian.32 (69%) patients presented with hematological aswell as neurological complaints. 23(30%) had pancytopenia and 9(19.5%) had bicytopenia. 14(30%)presented with neurological complaints only as sacd 6 (13%), ataxia 8 (17%), sensorimotor neuropathies36 (78%) and dementia 2 (4.3%). In signs glossitis was found in 6(13%), jaundice in 22 (47%), pallor in32 (69%) proximal myopathy in 12 (26%) out of which 6 (13%) had shoulder girdle and 8 (17%) pelvicgirdle myopathy. Impaired position sense was found in 18 (39%) patients and vibration sense in 21(45%)patients. other signs were pigmentation 2(4.3%) hypotonia in 6(13%) Spasticity in 2(4.3%) and Upgoingplantars in 6(13%) patients. Lhermittes sign could be elicited in only 2(4.3%) patients Optic neuritis andoptic atrophy was found in 4(8.6%) patients who came with paraplegia and marked anemia. Rhombergssign was positive in 8(17.3%) who came with clumsiness of gait. Hemoglobin (Hb %) was found to be lowin 32(69%) with a mean of 7.2gm%.pancytopenia (anemia+leucopenia+thrombocytopenia) was found in23(50%) of patients whereas bicytopenia was found only in 9(19.5%) of patients. Hypersegmented W.B.Cwere very carefully looked for and were found in 20(43%) of cases. ovalomegaloblasts were found in 32(69%) of cases .both findings of ovalomegaloblasts and hypersegmented w.b.cs were found in 20 (43%).in the rest 14 (30%) the blood investigations were found to be normal. The next investigation in all patientswas serum B12 estimation, It was found that levels below 200pg/ml were found in 95% cases where only2(4.3%) patients came with levels slightly above 205pg/ml and 210pg/ml. the response to therapy wasrecorded as reversible and irreversible. the irreversible features were sacd in 6 (13%), optic atrophy in2 (4.3%), and dementia in 2 (4.3%) patients. the partially reversible features were myelopathy 10 (21%)numbness and paraesthesias 30 (65%) optic neuritis inn 2 (4.3%) patients were assessed on a durationof 24 weeks. partially reversible features were ataxia, in 6 (13%) patients myelopathy in 2 (4.3%) patientsdementia in 2 (4.3%) patients and paraesthesias and numbness in 6 (13%) patients over a period of 24weeks. Conclusion: It is concluded from my study that the neuropsychiatric manifestations of vitamin B12deficiency are common among the elderly age group, either with or with out the evidence of anemia.

Objectives: To evaluate the frequency of different risk profiles and associated clinical parameters in patients with nonalcoholic fatty liver disease (NAFLD). Methodology: This cross-sectional study was conducted at the Gambat Institute Of Medical Sciences,Gambat District, Khairpur, between March 2019 to January 2020. A total of 345 patients participated in the study. Demographics, clinical features, investigations, and causative agents of NAFLD were noted in a document. Patients with raised ALT, fatty liver on imaging, aged between 18-75 years were a part of the study. Exclusion criteria included patients with overconsumption of alcohol, positive HBsAg, positive anti-HCV, and other underlying liver diseases with known origin. Patients’ blood samples were also tested for fasting blood sugar, random blood sugar, fasting cholesterol and fasting triglyceride levels.Levels of glucose, triglycerides and cholesterol were measured with an autoanalyzer; Photometer 4010; Beohrnger Mannheim; using the enzymatic-calorimetric methods. All data was analyzed using SPSS version 24. Results: The mean age of the patient was 48.4 ± 12.2 years and a mean body mass index of 30.2 The mean cholesterol was 199.4 ± 54.3 mg/dl. The majority i.e. > 60 percent were women with only 128 (37.1%) males (Table 1). The body mass index (BMI) was significantly higher in female patients as compared to males (p<0.001). The males had a significantly greater frequency of traits for metabolic syndrome as compared to women i.e. 111 (86.7%) vs. 145 (66.8%) (p=0.02). Obesity in patients was also significantly associated with female gender. We found a significant relationship of hypercholesterolemia in patients with DMT2 (p=0.04). Similarly, the majority of the patients i.e. 55 (47%) with DMT2 also had hypertriglyceridemia (p=0.002). Conclusion: The present study indicated that female gender, obesity, and diabetes mellitus were significantly associated with NAFLD. NAFLD places a significant burden on the healthcare system and is associated with poor quality of life of patients. Metabolic syndrome is another leading association that needs to be explored in further detail. Recognition of high-risk profile patients can help establish early diagnosis and hence treatment plans can be implemented at an early stage of disease. Keywords: fatty liver, chronic liver disease, non-alcoholic liver disease, NAFLD, obesity, diabetes mellitus, dyslipidemia