Objective: The study aimed to ascertain different causes and outcomes of convulsive status epilepticus in children. Methods: From January 2018 to June 2018, seventy three patients who presented with status epilepticus were studied. Data were recorded with the help of a pre-formed performa. Etiological factors and outcomes in terms of recovery, morbidity and mortality were studied. Results: Out of 73 children, forty one (56%) were males and 32(44%) were females with median age of 1.09±0.27 years. Etiologies were acute symptomatic 25(34%), febrile 19(26%), progressive encephalopathy 10(14%), remote symptomatic 10(14%) and idiopathic 7 (9%) with p-value 0.005. Status epilepticus was controlled within one hour in 42(57%), within 1-6 hours in 21(29%) and more than 6 hours in 10(14%) patients with p-value 0.027. During hospitals stay, twenty one (29%) patients recovered completely, seizure recurred in 12(16%), Twelve (16%) became mentally retarded, Twelve (16%) developed mental retardation along with seizures and 16(22%) died. Eight (10.9%) deaths were attributed to acute symptomatic etiology with p-value less than 0.001. Conclusion: This study concluded that acute symptomatic etiology was more common cause of status epilepticus as compared to other etiologies and it is associated with poorer outcomes as compared to other etiologies. doi: https://doi.org/10.12669/pjms.35.3.120 How to cite this:Uzair M, Ibrahim A, Zafar F, Sultan T. Etiology and outcomes of convulsive status epilepticus in children. Pak J Med Sci. 2019;35(3):---------. doi: https://doi.org/10.12669/pjms.35.3.120 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction: Typhoid fever is a major health problem in developing countries. Extensively drug-resistant (XDR) typhoid is an emerging threat to world health. The objectives of this study were to report our blood culture proven patients having XDR typhoid and compare the rate of gastrointestinal (GI) and hepatobiliary manifestations and complications of antimicrobial sensitive and resistant strains. Materials and methods: This prospective observational study was carried out at a tertiary care hospital in Pakistan, from January 2019 till August 2020 on all consecutive blood culture proven patients of Salmonella typhi. A total of 57 cases of Salmonella were identified, of which 10 were nonresistant, seven multi drugresistant (MDR), 39 extensively drug-resistant (XDR), and one was extended-spectrum beta lactamase (ESBL) positive. Alarmingly, one of the S. typhi isolate in addition to the first line drugs, was also resistant to azithromycin. Patients were treated with antibiotics according to antimicrobial susceptibility of the Salmonella in accordance with the World Health Organization (WHO) and Medical Microbiology and Infectious Diseases Society of Pakistan (MMIDSP) guidelines and GI and hepatobiliary complications were recorded. Results: Overall rate of complications was low. Some 10% (1/10) with nonresistant typhoid, 14% (1/7) with MDR, and 15% (6/39) of our patients with XDR typhoid fever had abdominal tenderness (p=0.95). None of the patients had GI bleeding, abdominal abscess, or peritonitis. Some 20% (2/10) patients with nonresistant typhoid, 29% (2/7) with MDR, and 18% (7/39) with XDR typhoid developed acute hepatitis, with greater than three times elevation of liver transaminases. There was no statistically significant difference in the occurrence of hepatitis between these groups (p=0.98). Interestingly, one of our patients with XDR typhoid also developed cholestatic hepatitis. Conclusion: There is no significant difference in GI and hepatobiliary complications amongst antimicrobial sensitive and resistant strains of typhoid. However, emergence of resistant strains calls for focus on prevention and judicious use of antimicrobials.

Background: Treatment of melasma is a challenging job for dematologists. Different modalities are in practice with variable results. Superficial chemical peeling is a newly introduced way of treatment in this regard, in which a chemical solution is applied to the skin that causes exfoliation and peeling. Methods: Sixty patients of either sex, with melasma of any type having Fitzpatrick skin type 4 to 6 were enroled from outpatient department. Patients in group A were treated with 20% salicylic acid solution and in group B were treated with Jessener’s solution. Baseline melasma area and severity index (MASI) scoring was done. Result: Both the peeling agents produced a drop in MASI score, but the mean reduction compared in both the groups was not statistically significant (p>0.05). Conclusion: Both salicylic acid and Jessner’s solution are effective and safe peeling agents in treatment of melasma in Asian skin types, giving comparable results

At least 10 million TBIs serious enough to result in death or hospitalization occur annually. The mortality associated with acute subdural hematoma has been reported to range from 36-79%. Epidural hematoma occurs in approximately 2% of patients with head injuries and 5-15% of patients with fatal head injuries. Both can be caused by fall, motor vehicle crashes, assaults, blasts and sports activities. CT is best modality for diagnosis of brain injury. Objective:To measure the frequency of subdural and epidural hematoma in brain injury via computed tomography in trauma center of DHQ Teaching Hospital Sargodha.Methodology:In this descriptive study, among 137 patients of traumatic brain injury (TBIs) were selected with age and gender discrimination by convenient sampling, at Department of Radiology, DHQ Teaching Hospital Sargodha. Single slice Computed Tomography Toshiba asteion machine was used.Results:Out of 137 patients collected, 35 were females and 102 were males who visited emergency department due to brain Injury. It shows 25.5% were females and males were 74.5%.Out of 137 patients, 63.5% were injured with RTA and 35.8% came with the history of fall. 67.2% patients present with loss of consciousness, 67.9% patients with skull fractures and 73% with swelling. Out of 137 patients 85.4% develop SDH and 14.6% develop EDH. Conclusion:In this study we conclude that male develop larger number of brain injuries than females. Most patients with history of RTA had epidural hematoma. Females most likely develop subdural hematoma. Most patients with brain injury later develop subdural hematoma.

Background: Pyelonephritis is a renal inflammatory condition diagnosed with patient’s history, physical examination and imaging studies. Although laboratory finding, clinical sign and symptoms are considered for the diagnosis and treatment. Aim: To compare the sonographic findings of pyelonephritis with urine complete examination Methodology: A Cross sectional analytical study was conduct at Gilani Ultrasound Center, Ferozepur Road, Lahore and routine urine examination was performed in the Sanabil Health Services Hospital, Khayaban-e-Quaid, Lahore. Entirely comprised patients were queried concerning variables such as gender, age, clinical history, grey scale ultrasound findings, Doppler ultrasound findings and lab findings. Patients were enquired to lie down as well as depiction Abdomen. Results: Out of 138 patients, 77 were males and 61 were females, maximum age of patients was 77 years and minimum was 18 years, 75 (54.3%) patients with clinical history of pyelonephritis, 67 patients were with lab findings that support pyelonephritis and 71 patients had no lab findings. Out of 138 patients, 67(48.6%) patients had right kidney acute pyelonephritis and 65(47.1%) had left kidney acute pyelonephritis. Conclusion: The study concluded that there was an important association among the Urine complete examination as well as sonographic findings in the evaluation of acute pyelonephritis. However, the clinical and ultrasound findings in acute Pyelonephritis do not play a significant role but these findings can be helpful in chronic cases of Pyelonephritis. Key words: Acute pyelonephritis, Ultrasonography, Urine complete analysis, Routine urine examination