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.
