Structured physiotherapy protocols for pediatric acute disseminated encephalomyelitis (ADEM) remain inadequately described in the literature, despite persistent neurological deficits occurring in approximately 20% of cases. We report a 13-year-old MOG-antibody-positive male with ADEM who presented with severe bilateral weakness (Manual Muscle Testing 1-3/5), ataxic gait, bladder dysfunction, and complete functional dependence (Functional Independence Measure [FIM]: 55/126). Following medical stabilisation, an 8-phase, 16-week intensive physiotherapy protocol was implemented alongside immunomodulatory therapy, incorporating progressive strengthening, proprioceptive training, balance activities, and task-specific gait rehabilitation based on neuroplasticity and motor learning principles. Outcomes were quantified using 6 validated measures. Walking speed increased by 316% (0.18-0.75 m/s); FIM improved by 60 points (55-115/126); Berg Balance Scale increased by 30 points (18-48/56); Functional Ambulation Category progressed from level 1 (non-functional) to level 5 (independent community ambulation); Pediatric Quality of Life Inventory increased by 40 points (45-85/100); and bladder dysfunction completely resolved. As spontaneous recovery occurs in up to 80% of pediatric ADEM cases and a control condition was absent, functional gains cannot be attributed to the physiotherapy programme alone; however, the breadth and pace of documented recovery across 6 validated domains within 16 weeks provides the first detailed, replicable phased physiotherapy framework for pediatric ADEM with quantified benchmarks that may guide clinical practice and inform future controlled trials.
Background: Neurodevelopmental disorders (NDDs) are major contributors to cognitive, behavioral, communication, and motor impairments arising from abnormal brain development. Pakistan lacks comprehensive epidemiological data on NDDs, limiting evidence-based health planning and targeted interventions. Objectives: To determine the prevalence patterns and bio-demographic correlates of neurological disorders (ND) and neuromuscular disorders (NMD) in the population of the Potohar plateau, Pakistan. Design and methods: A cross-sectional study (2019-2023) was conducted using a mixed recruitment approach involving district hospitals, community settings, and door-to-door surveys. Standardized classification was performed using OMIM and ICD-10 databases. Descriptive statistics and multivariable logistic regression analyses were applied. Results: A total of 1169 independent patients were enrolled; 62% were males. Most participants belonged to rural, low-income, and nuclear-family backgrounds. ND accounted for 63% of cases and NMD for 37%, further classified into 70 minor entities. The most prevalent ND was intellectual disability (ID, 36%), followed by Down syndrome (8%) and microcephaly (7%). Among NMD, cerebral palsy (CP, 35%) and muscular dystrophies (8%) predominated. Parental consanguinity was 76% overall, highest in ID (81%) and lowest in epilepsy (59%). Sixty-five percent of anomalies were sporadic, while 35% were familial. More than 30 rare disorders were also identified. Age showed strong associations, with older participants more likely to present with ND, and younger children with NMD, particularly CP. Socioeconomic status demonstrated a protective effect against CP but not against ID. Conclusions: This study documents a substantial burden of neurological and neuromuscular disorders in the Potohar region, dominated by ID and CP and characterized by high consanguinity and a significant number of rare disorders. The findings highlight the urgent need for improved antenatal care, early diagnosis, health education, and strengthened molecular diagnostic services to reduce the burden and improve outcomes for affected populations.
Paediatric medication errors remain a major and preventable cause of patient harm worldwide. Children are particularly vulnerable to medication-related adverse events because of weight-based dosing requirements, age-dependent pharmacokinetics, off-label medication use, communication limitations, and the need for complex drug preparation and administration processes. High-risk settings such as neonatal intensive care units, emergency departments, oncology services, and transitions of care are associated with particularly high rates of prescribing and administration errors. This narrative review examines the epidemiology, causes, and prevention of paediatric medication errors, with a focus on system-level contributors and evidence-based safety strategies. Common sources of error include dosing miscalculations, interruptions during medication administration, inadequate communication, insufficient paediatric-specific decision support, and caregiver-related challenges such as low health literacy and language barriers. The review highlights the role of technological interventions, including computerised physician order entry, clinical decision support systems, barcode medication administration, and smart infusion pumps in reducing prescribing and administration errors. Additional effective strategies include standardised dosing protocols, structured communication tools, pharmacist integration into multidisciplinary teams, independent double-checking processes, and family-centred education using teach-back methods and pictorial instructions. Although significant progress has been made in high-resource settings, important gaps remain in low- and middle-income countries where access to paediatric formulations, trained personnel, and electronic safety systems may be limited. Emerging technologies such as artificial intelligence-based dosing support may offer future benefits but also introduce ethical and governance challenges. Improving paediatric medication safety requires coordinated system-level approaches that combine technology, standardisation, workforce training, human-factors design, and active caregiver engagement to achieve sustained reductions in preventable harm.
Deliberate self-poisoning (DSP) among children and adolescents has been steadily increasing over the past decade worldwide with paracetamol and ibuprofen the most common medications used. Assessment and management often fall to Emergency Department (ED) staff with varied psychiatric experience. We outline an easy-to-use psychiatry framework for ED clinicians to guide them in assessing and managing young people who present with DSP with Ibuprofen. A “what, when and why” framework derived from the authors’ clinical experience in child and adolescent liaison psychiatry and emergency care, is outlined. This may guide ED clinicians in the assessment of what medication is ingested, when DSP occurred on as well as when to initiate treatment and how to explore why the DSP episode took place. DSP with Ibuprofen has the potential to cause severe physical sequelae ranging from renal and liver impairment to severe gastro-intestinal bleeds and thrombocytopaenia. Establishing what was used in the DSP episode and when it occurred is therefore crucial to allow for timely treatment and management. Establishing reasons why the young person took the overdose, along with thorough risk assessment is crucial in aiding safe discharge planning. Given the importance of timely intervention, the suggested framework provides an easy-to-remember method for assessment, informing management and discharge planning.
Background:Acute Lymphoblastic Leukemia (ALL) is the most common pediatric cancer with a 5-year survival rate of 90% in High Income Countries (HICs), but in lower-to-middle-income countries (LMICs) survival rates fall below 60%. This is influenced by many factors; one of the major ones being malnutrition. Objectives:To ascertain the changes in and association of nutritional status in the treatment of pediatric ALL patients. Design:This article investigated the association between nutritional status in patients receiving ALL treatment, and morbidity and mortality. This is a retrospective study for the period of May 2022 to April 2023 including a total of 332 patients. Methods:The study used WHO defined weight-for-age and height-for-age for patients from 1 year of age up till the age of 5 years old, and BMI for age for patients over the age of 5 to assess nutritional status. Various disease and treatment variables were analyzed with patients' nutritional statuses. Results:From the sample, more than one-third of patients (38.5%) were malnourished with the majority of them being underweight or severely underweight. Wilcoxon signed-rank test for paired values showed a P-value of .0177 (z = 2.373) when used to compare patient weight at initial assessment and weight after intensive phase of treatment, indicating a significant change in weight between both timepoints. Nutritional status was significantly associated with the number of patients with positive bacterial cultures (P = .01) and multiple hospital admissions (P = .004), but was not significantly associated with mortality (P > .05). Conclusion:Nutritional status changed significantly after intensive phase of treatment. Malnutrition in ALL patients was significantly associated with bacterial infections, however, it was not significantly correlated to patient mortality. Future prospective studies with a longer study period should be planned to follow patients compromised nutrition to assess long term survival. Registration:Not applicable.
