Abstract: Pancytopenia is decrease in all three cells lines in blood either due to bone marrow failure or peripheral destruction. Aplastic anemia is a rare but concerning cause of pancytopenia in children, which if left untreated can be fatal. Objective: To determine the frequency of aplastic anemia in children presenting with pancytopenia. Study Design: Descriptive Cross-Sectional Study. Place and Duration of Study: Pediatrics Department, Ayub Teaching Hospital, Abbottabad. From January 2020 to June 2020. Methodology: Non- probability consecutive sampling technique is used and ninety-one children from ages 6 months to 15 years of age of either gender with isolated pancytopenia on admission fulfilling the inclusion criteria were enrolled after informed written consent from the parents. The details of the patients were collected on a predesigned proforma. Data was analysed using SPSS version 20.0. Results: Total 91 children with pancytopenia were included in this study. The mean age was 4.78±2.33 years. There were 40 (43.9%) children of age <4years while 51 (56.0%) had age >4 years. There were 49(53.8%) males and 42 (46.1%) females. 12 (13.1%) children had aplastic anaemia while 79 (86.3%) had pancytopenia related to other causes. Conclusion: Aplastic anaemia is a rare but an important treatable cause of pancytopenia in children and by its timely diagnosis and management many lives can be saved and burden on health resources can be minimized.
Abstract Celiac disease is a gluten sensitive enteropathy of small bowel characterized by villous atrophy that leads to malabsorption steatorrhea and weight loss. Broad spectrum of disorders specially auto immune is associated with celiac disease ranging from primary biliary cirrhosis, Sjogren’s syndrome to dermatitis herpetiformis. Celiac disease also shows variety of neurological manifestation including ataxia, epilepsy, neuropathy and myelopathy. The cause of tis association is still not cleared. Celiac crisis is a life-threatening presentation associated with celiac disease leading to electrolyte imbalance. Neurological manifestation of celiac crisis with residual encephalopathy is rare presentation of celiac crisis with apparently no published local data. We are going to document 2.5 years old give case presented to emergency department with status epilepticus and encephalopathy. Patient was in usual state of health prior to illness at home with history of abdominal distension, intermittent diarrhea and failure to thrive. Patient presented to tertiary care at Bahawalpur in emergency with status epilepticus and encephalopathy with probable diagnosis of TBM. And then referred to the Children Hospital and the Institute of Child Health Multan for status epilepticus at emergency department. In the context of this case, it is suggested that celiac crises should be considered in the differentials of seizures and encephalopathy. Key words: Attention deficient hyperactive disorder, Celiac disease, Celiac crises, Encephalopathy Glasgow coma scale, Intracranial pressure, Pakistan Pediatric Association, Signs of meningial irritation, Status epilepticus, Tuberculosis meningitis, The children hospital and institute of children health
Abstract: Vitamin D deficiency is a prevalent global health issue, particularly in children, and is associated with various health complications, including poor bone development, rickets, and immune dysfunction1. This study aims to determine the frequency of vitamin D deficiency in children aged 3 to 12 years who present to a tertiary care hospital. A cross-sectional study design was used, and serum 25-hydroxyvitamin D [25’OH) D] levels were measured in children meeting the inclusion criteria. The findings indicate a high prevalence of vitamin D deficiency, necessitating urgent public health interventions. KEYWORDS: Vitamin D Deficiency, Children, 25-Hydroxyvitamin D, Tertiary Care, Public Health 1.INTRODUCTION: Vitamin D is essential for calcium homeostasis and bone metabolism, and its deficiency in children is associated with growth retardation, rickets, and increased susceptibility to infections (Holick, 2017)2. The deficiency of vitamin D has been recognized as a growing public health concern worldwide1, particularly in developing countries, where sunlight exposure and dietary intake are often insufficient (Munns et al., 2016)5. Despite the availability of fortified foods and vitamin D supplements, children remain at risk due to lifestyle changes, reduced outdoor activities, and increased use of sunscreen (Wagner & Greer, 2020)9. Studies have reported a significant prevalence of vitamin D deficiency among children in various regions, but data on its frequency in Tehsil Headquarter Hospital settings remain limited. This study aims to assess the frequency of vitamin D deficiency among children aged 3 to 12 years presenting to TehsilHeadquarter Hospitalhighlighting its magnitude and potential risk factors. 2.METRIAL AND METHODS: 2.1Study Design and Setting. This cross-sectional study was conducted at the pediatric outpatient department of Tehsil Head quarter hospital Dogarbetween July andDecember 2024. The hospital serves as a referral center, catering to a diverse pediatric population. 2.2 Study Population and Inclusion Criteria The study included children aged 3 to 12 years who presented to the hospital for routine check-ups, mild illnesses, or suspected vitamin D deficiency symptoms (e.g., bone pain, muscle weakness, or recurrent infections). Exclusion criteria included children on vitamin D supplements, those with chronic illnesses affecting vitamin D metabolism (e.g., chronic kidney disease, liver disease), and those with malabsorption syndromes. 2.3 Sample Size and Sampling Technique A sample size of 400 children was calculated using OpenEpi software, with a confidence interval of 95% and an expected prevalence of 50% based on previous studies (Misra et al., 2008)4. A consecutive sampling technique was used to recruit participants. 2.4 Data Collection and Biochemical Analysis After obtaining informed consent from parents, demographic and clinical data were collected using a structured questionnaire. Blood samples were drawn to measure serum 25(OH)D levels using chemiluminescent immunoassay (CLIA) methods. Vitamin D status was classified as follows (Holick et al., 2011)3. - Deficient: <20 ng/mL -Insufficient: 20–30 ng/mL - Sufficient:>30 ng/mL
A 12 year old girl not having attained menarche yet, presented with complaints of urinary retention and abdominal pain. Clinical examination and imaging confirmed the presence of hematocolpos secondary to both imperforate hymen and transverse vaginal septum. There was evidence of hydroureteronephrosis along with a septate uterus and vaginal agenesis (ESHRE Type U2b, C0, V4). Following Examination under Anesthesia, excision of the transverse vaginal septum was done along with drainage of menstrual blood and a vaginoplasty to correct the vaginal aplasia. This is a very rare and possibly one of the first reported cases of concurrent imperforate hymen, TVS, septate uterus and vaginal agenesis with hydroureteronephrosis.
Lemierre’s syndrome is a rare head and neck condition that starts as an infection, typically in the ENT, and can progress to septic thrombophlebitis. It may include the jugular vein, facial vein, and respiratory tract. (1) It usually occurs as a complication of a bacterial throat infection The thrombophlebitis is a serious condition and can result in further systemic complications such as bacteremia or septic emboli. Recent evidence indicates that its prognosis is still grim even after a century from its first report, with significant rates of in-hospital complications, mortality, and long-term sequelae. Its management has no specific guidelines except for standard antibiotic stewardship, with an ongoing debate on the role of therapeutic-dose (2). We present the case of a 9-year-old boy with a history of oral cavity and palate, fever and severe respiratory distress, left-sided tension pneumothorax on chest X-ray, emergency intervention, and tomography that showed internal. carotid artery Venous thrombosis extended to the brachiocephalic vein and resulted in bilateral septic embolism with central pleural effusion, left pneumothorax and right abducens nerve palsy. The patient also complained of pain and discharge in the right ear for the last 3 months.
ABSTRACT Objective:To determine the frequency of hypokalemia and evaluate changes in serum potassium levels following nebulized Salbutamol therapy in children presenting with mild asthma exacerbation. Methodology:This cross-sectional study was conducted in the Pediatric Emergency Department of Civil Hospital Karachi over six months. A total of 370 children aged 1–12 years presenting with mild asthma exacerbation and requiring nebulized Salbutamol were included through consecutive sampling. Children with chronic illnesses, potassium-altering medications, or systemic disorders were excluded. Nebulized Salbutamol was administered in three standardized doses (2.5 mg for <20 kg and 5 mg for ≥20 kg). Serum potassium levels were measured before and 30 minutes after therapy. Hypokalemia was defined as serum potassium <3.5 mmol/L. Data were analyzed using appropriate statistical tests, and logistic regression was applied to identify predictors. Results:The mean age was 7.1 ± 2.6 years, and 60.5% were males. The mean baseline serum potassium was 4.18 ± 0.46 mmol/L, which significantly decreased to 3.76 ± 0.49 mmol/L after nebulization (p < 0.001), showing a mean decline of 0.42 mmol/L. Hypokalemia developed in 27.8% (n = 103) of children. Higher frequency was observed among children <5 years (p = 0.01), those receiving 5 mg Salbutamol (p = 0.003), and malnourished children (p < 0.001). Logistic regression confirmed younger age, higher dose, and malnutrition as independent predictors. Conclusion:Nebulized Salbutamol significantly reduces serum potassium levels and may induce hypokalemia even in mild asthma. Younger children, malnourished patients, and those receiving higher doses are at increased risk; therefore, careful dosing and consideration of potassium monitoring in high-risk groups are recommended. Keywords: Salbutamol, Hypokalemia, Asthma, Children, Nebulization, Serum Potassium, Pakistan
Children with Attention Deficit Hyperactivity Disorder (ADHD) in this digital era often spend time playing with gadgets, which has both positive and negative aspects if not accompanied wisely. Excessive gadget use increases the risk of gadget addiction in children with ADHD due to its association with brain dysfunction that affects impulsivity. Studies show a bidirectional relationship between ADHD and gadget addiction, where ADHD patients are more vulnerable to gadget addiction, and excessive use exacerbates ADHD symptoms. The role of parents and teachers is crucial in providing education to prevent and address gadget addiction in children with ADHD.
Amaç: Bu çalışmanın iki amacı vardı: Türkiye'deki ilkokul öğrencileri arasında onikofaji sıklığını belirlemek ve onikofajinin sosyodemografik faktörler ve davranış bozuklukları ile ilişkisini belirlemek. Gereç ve Yöntemler: Tanımlayıcı tipteki çalışmanın örneklemini 5-9 yaş arası çocuğu olan 709 ebeveyn oluşturmuştur. Katılımcılar kolayda örnekleme yöntemiyle seçilmiştir. Veriler sosyodemografik özellikler anketi ve Güç ve Zorluklar Anketi (SDQ) kullanılarak toplandı. Bulgular: Onikofaji, babaları çalışmayan ve eğitim düzeyi düşük olan parçalanmış ailelerden gelen çocuklarda daha yaygındı. Sosyoekonomik durum ile onikofaji arasında negatif bir ilişki vardı. Sonuç: Yetkililerin ebeveynleri ve sağlık çalışanlarını onikofaji konusunda bilinçlendirmesi, onikofajinin erken teşhis edilmesi ve multidisipliner bir bakış açısıyla ele alınması gerekmektedir.
Abstract: Spine dysraphism (SD) refers to a group of congenital spine and spinal cord anomalies that frequently appear with external cutaneous indicators, particularly occult spinal dysraphism (OSD). Early detection of these skin lesions is critical for quick diagnosis and intervention, preventing irreversible neurological consequences. Objectives: The objectives of the study were to identify the pattern and distribution of cutaneous lesions linked to spinal dysraphism in newborns and children with neurological complaints or spinal defects. Material and Methods: This cross-sectional observational study was conducted at the Department of Paediatric Neurology and Paediatric Neurosurgery, Children Hospital & Institute of Child Health, Faisalabad, from January 2023 to December 2024. 230 neonates and children (aged 0-3 years) were enrolled. Inclusion criteria were the presence of evident midline cutaneous lesions as well as neurological or spinal abnormalities. Detailed demographic and clinical data were collected, with emphasis on the number, type, and anatomical location of skin lesions. Results: Among the 230 subjects, 67% were female, and 76% presented within the first month of birth. Lumbosacral lipomas (44%), hypertrichosis (12%), sacral dimples (8%), vascular nevi (7%), and other lesions (9%) were the most common skin markers. There were several cutaneous abnormalities in 64% of children, with the bulk of lesions (93%) located in the lumbosacral region. Conclusion: Spinal dysraphism in early childhood is significantly indicated by cutaneous symptoms, especially in the lumbosacral region. So any child presenting with a cutaneous marker, especially in the lumbosacral region, spinal dysraphism should be ruled out.
The National Commission on the Rights of Child (NCRC) and Pakistan Pediatric Association (PPA) affirms that, in accordance with the UN Convention on the Rights of the Child (UNCRC), every individual below 18 years of age is a child and entitled to age-appropriate, safe, and developmentally suitable healthcare. However, in many health facilities across Pakistan, adolescents—particularly boys aged 14–17—are routinely admitted to adult wards rather than pediatric units. This practice arises largely from concerns about privacy and safety of female patients and accompanying mothers in pediatric wards.NCRC and PPA recognizes that this long-standing approach is clinically inappropriate, detrimental to adolescent well-being and aligned with child rights principals including best interest of the child.
A 1-year-old infant with Expanded Dengue Syndrome (EDS)—a severe dengue complication marked by multi-organ dysfunction—exhibited fever, vomiting, diarrhea, petechiae, palpebral edema, and cold extremities, progressing to disseminated intravascular coagulation (DIC), hepatic failure, and severe anemia. Laboratory findings confirmed thrombocytopenia, coagulopathy and acute liver injury. Management involved intensive resuscitation with crystalloids, colloids, packed red blood cells, fresh frozen plasma, and platelet transfusions, alongside vitamin K administration. Despite hemodynamic instability and severe bleeding, timely interventions enabled recovery. Uncommon manifestations like palpebral edema and limb discoloration expanded the recognized EDS spectrum. This case underscores the critical need for early recognition of atypical symptoms, aggressive fluid optimization, and prompt transfusion strategies in endemic regions. Enhanced clinician awareness of EDS’s diverse presentations is vital to improving outcomes in pediatric dengue, where rapid deterioration necessitates vigilant monitoring and multidisciplinary care.
Few feeding practices are as warmly perceived by families as giving milk to a young child. Milk is associated with growth, comfort, strength, and parental reassurance. In infancy, that association is justified: milk is nutritionally central and developmentally appropriate. In toddlerhood, however, the picture changes. What was once essential can, when continued in excess and often through prolonged bottle feeding, become a barrier to healthy nutrition and development. The paradox is striking: the very food regarded as the hallmark of nourishment may, in excess, contribute to iron deficiency, poor dietary diversity, constipation, dental caries, and missed opportunities for normal feeding maturation. ¹–³ This pattern is common in pediatric practice. Parents often report with pride that their toddler “drinks milk very well,” even when the same child refuses family foods, eats very little at meals, or remains dependent on a bottle well into the second or third year of life. The child may appear full, calm, and even thriving. Yet satiety is not the same as nutritional adequacy, and fullness should not be mistaken for healthy feeding. Toddlerhood is not simply an extension of infancy; it is a developmental transition during which the child must gradually move from a milk-dominant intake to a varied, balanced, family-based diet. ¹˒⁸ When that transition is delayed, milk ceases to be a supplement to the diet and instead becomes its main competitor.
Abstract Objective: Dietary assessment serves as a tool to identify inadequate micronutrient intakes in children. This study aimed to assess the nutritional intake of five essential minerals (Ca, Mg, P, Na, and K) among children aged 1 to 12 through milk consumption. Study design: A total of 30 milk samples were collected from various dairy farms in the rural areas of Jamshoro, Sindh. All the samples were analyzed using flame atomic absorption spectroscopy (FAAS) to determine mineral concentrations. Nutritional assessments of these minerals for children aged 1-12 years were based on the concentrations of Ca, Mg, P, Na, and K in the milk samples and daily milk intake. Results: The results revealed that the concentrations of Ca, Mg, P, Na, and K in the milk samples ranged from 798.09-1598.05, 112.35-267.13, 632.06-1098.11, 251.67-501.13, to 1220.32-1701.09 mg/kg. Discussion: The milk consumption data revealed that the highest daily intake of essential minerals among the selected age groups was found in the order of 1-3 > 4-8 > 9-12 years. Among the essential minerals, K was the most consumed by children, followed by Ca > P > Na > and Mg through milk intake. Furthermore, the regular intake of all selected essential minerals was observed below their recommended ranges.
Objective: Therapeutic plasma exchange (TPE) is a modality to treat neurologic diseases like Guillain-Barre syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), inflammatory demyelinating disorders of CNS, autoimmune encephalitis and many others. This study is designed for evaluation of efficacy and safety of TPE either a first line therapy or as an adjunct to other initial treatments in patients with neurologic diseases. Study Design: It is an observational study of descriptive type. Study duration and place: This study is the joint venture of Department of Paediatric Neurology, Pediatric intensive care unit and Hematology at The Children’s hospital Lahore from October 2021 till December 2023. Methods: TPE was performed on every alternate day, with total of 3-5 sessions. Vascular access was gained by femoral or jugular double lumen catheter and we used apheresis machine FRESENIUS KABI. FFPs was used as replacement fluid. Patients were assessed before and after TPE procedures for clinical and functional status using GMFCS and MRCS scores and paired t- test was applied to measure it statistically. Results: 134 procedures were done on 30 patients. The study population has mean age of 7.84 ±3.6years (range is 2-14 years), the males were 56.6% while females were 43.3%. Most common disease was GBS (60%), predominantly axonal variant (60%) followed by NMOSD (16.6%), NMDAR encephalitis (10%) and 6.6% each of MOGAD and CIDP. Mechanical ventilation was required in 56.7 % (n=17) and all these patients developed autonomic dysfunction. Improvement in terms of function and motor power was measured both before and after plasmapheresis using GMFCS and MRCS score and found a very low p-value of 0.000 in both pairs, which is significant statistically. Conclusion: TPE is an effective and safe therapeutic modality in pediatric population with neurologic disorders especially in resource constraint settings. Key words: Therapeutic plasma exchange (TPE), Guillain-Barre syndrome (GBS), Neurologic diseases.
Abstract: Background: Congenital diaphragmatic hernia or CDH is a complex deformity with a significant death rate, particularly in developing countries. Several prognostic factors affect the outcome of CDH including pre-maturity, low birth weight, ante-natal diagnosis, pulmonary hypertension and associated cardiac anomalies. Objective: To identify and compare factors affecting the outcome of CDH in neonates among survivors and non-survivors. Study Design: It was a descriptive case series Place and Duration of Study: The study was conducted from January 2024 to July 2024 at The University of Child Health Sciences and The Children’s Hospital, Lahore Methods: Prospective data of 60 neonates presenting to our institution with the diagnosis of CDH was reviewed for its outcome, and associated factors were analyzed. Results: The survival rate was 51.7%. We identified that early age of presentation, birth weight, prematurity, and pulmonary hypertension were the poor prognostic factors. Factors like gender, prenatal diagnosis, cardiac anomaly, arterial blood gases on admission, side of the defect, and intrathoracic liver did not have any effect on the outcome. Conclusion: We concluded that we can improve the outcome of CDH in our setup by improving our pre- and post-natal care, aseptic measures and by treating pulmonary hypertension effectively.
In Sri Lanka, tetanus is a notifiable disease and all cases are personally investigated by the Ministry of Health. Between 1967-1978, government hospitals' staff treated on average 2000 cases of all types of tetanus/year of which a mean of 765 (37.7%) cases/year were neonatal. Within this time period, the incidence of neonatal tetanus ranged from 123.9-248/100,000. 2 years after the initiation of the Expanded Program on Immunization (EPI) in Sri Lanka, the incidence rate fell below 100/100,000. Data for the 1st 6 months of 1981 showed a further decline to 44.4/100,000. The case fatality rate (CFR) for hospital admissions for neonatal tetanus was about 42%. Between 1975-1980, hospital physicians treated 10,809 cases of tetanus. 423 (52.2%) of the cases were neonatal. 254 cases (60.1%) were males and 144 (34%) were females with 25 (5.9%) not specified. The CFR for those cases where the outcome was known decreased from 84.4% in 1975 to 53% in 1979, only to increase to 60% in 1980. The mean incubation period was 6.2 days, while the incubation period was 2 weeks for 90.3% of the cases. In terms of immunization status, the CFR stood at 78.6% for the unimmunized group, 64.9% for those who received 1 dose of the tetanus toxoid (TT), and 57.1% for those who received 2 doses. An increase in coverage of pregnant women who received TT occurred after the EPI program was initiated. For example, in 1974, 7.6% of pregnant women received 1 TT dose and 4.3% received 2 TT doses, by 1980, these percentages rose to 70.5% and 48.5% respectively. Both these percentages exceeded the EPI 1980 target of immunizing 35% of all pregnant women. Based on an assessment survey of 3 provinces EPI has further increased its target to 80%.
Researchers conducted a survey study of 59,598 households in 3 major socioeconomic groups (urban slums, rural agricultural areas, and rural cattle and horse raising areas) in the Punjab province of Pakistan to estimate mortality from neonatal tetanus and to develop a strategy for its control. The investigators learned of 13,831 live births. 724 of these died in the 1st month of life with 432 (60%) dying from neonatal tetanus. Village untrained "dai" or trained midwives delivered all infants in all 3 areas. Often these deliverers placed cow dung on the stump of the severed umbilical cord and used a dirty cloth for cleaning the infant. In addition, the trained midwives would use unclean unsterilized tools to assist in delivery. In rural areas, animals sleep inside with the family and they are always with the family. Since Clostridium tetani is found in intestines of animals, especially horses, the neonatal tetanus rates as a percentage of all neonatal deaths for the rural agricultural and rural cattle and horse raising areas were higher (60% and 73%) than for the urban slums (45%). The village barber circumcises male infants on or before the 7th day of life. Since he stuffs the wound with ash or cow dung or rubs it with a dirty cloth, the chances of infecting the wound with C1. tetani increases. Therefore the total ratio of male deaths to female deaths was 1.61:1. Most males died during the last 3 weeks of the 1st month which can be attributed to circumcision. Overall most deaths occurred between 4-19 days. None of the mothers interviewed had been vaccinated with a tetanus toxoid during pregnancy which greatly contributed to the neonatal tetanus mortality rate.
In 1980 sample surveys were collected to provide reliable baseline data on neonatal tetanus and poliomyelitis in India. Surveys were prepared by the Directorate General of Health Services, along with the Indian Council of Medical Research and WHO. Each state consisting of populations with more than 20,000,000 were surveyed separately; union territories were surveyed along with neighboring states. States with less than 20,000,000 were grouped together, forming one unit. Rural and urban areas were surveyed separately, 16 urban, 15 rural. A sample of 2,000 live births were collected with 67 live births recorded at each of the 30 birth sites throughout wards and villages. House to house visits by health workers recorded the survey's findings. Estimates based on the mortality rates of neonatal tetanus in 12 states in the survey suggest 90,657 to 115,935 neonatal deaths occur annually. Annually 159,818 to 204,380 children die within the 1st months of life due to tetanus. Total number of cases of tetanus deaths reported is, however 48,651 on an annual average. Neonatal tetanus can be prevented by safe delivery services and successfully immunizing pregnant women. Neonatal tetanus mortality rates were lower in urban areas than rural, in some states where deliveries were performed in hospitals with trained personnel, and mothers were protected by tetanus toxoid immunization. Tetanus toxoid vaccination is included in the expanded program on immunization (EPI), and during the year covered 8,000,000 pregnant women, 35% of the eligible populations with 2 doses of TT vaccine. By 1990, 100% of the pregnant women will be provided with vaccination services. Children have been given TT vaccinations since 1980, these in the last classes of secondary schools. Girls were given only a booster shot during subsequent pregnancies. Overall, both maternal and child health services are being significantly improved and upgraded to include antenatal, natal, and postnatal care with an inclusion of dias training.
