Background: Self-assembled, bubble continuous positive airway pressure is a low-cost noninvasive respiratory support modality used to manage newborns with respiratory distress. Very few local studies have been conducted regarding its use in the management of neonatal respiratory distress. This study was conducted to evaluate the effectiveness of this device as a primary treatment modality for neonatal respiratory distress. Methods: This cross-sectional study was conducted in the Department of Pediatrics, Ziauddin Hospital, Karachi from 1st February 2018-31st July 2018 on neonates (n=200) admitted with respiratory distress, in whom self-assembled bubble continuous positive airway pressure was used as a primary respiratory support. The effectiveness of its use was determined, based on the absence of associated complications, signs of respiratory distress, and oxygen saturation at room air of 94% or more. Data were analyzed by SPSS version 20. The Chi-square test was used for categorical variables and a p-value <0.05 was considered statistically significant. Results: The mean gestational age was 34.3+2.73 weeks, the mean age at initiation of bubble continuous positive airway pressure was 7.7 4 hours, and the mean duration of hospital stay was 4.2 days. The observed failure rate in the study population was 8.5%, while the mortality was only 2%. The finding of respiratory distress syndrome on chest- X-ray with (FiO2) > 60% was observed. In addition, bubble CPAP after 6 hours of the onset of respiratory distress showed significant results (p<0.001). Conclusion: Self-assembled bubble continuous positive airway pressure is a significant and effective treatment modality (p=0.001) in neonatal respiratory distress. Keywords: Bubble Continuous Positive Airway Pressure; Neonates; Respiratory Distress.

Background: Dengue is the commonest arboviral disease that is endemic in our country. Electrolyte imbalance is commonly encountered in this disease. There had been only a few worldwide research studies investigating at all the metabolic parameters of dengue infection. Therefore, the study aimed to assess the electrolyte imbalance and its correlation with the severity of dengue fever in pediatrics. Methods: This cross-sectional study was carried out in the Pediatric Department of Ziauddin Hospital over 18 months. Diagnosed patients through detection of Dengue NS1 antigen or serology of dengue fever from 6 months to 18 years of age were enrolled and their history, hematological and electrolyte values (sodium, potassium, calcium, magnesium, and phosphate) were analyzed. Data was analyzed by SPSS and a Chi-squared test was used to compare the frequency of electrolyte disturbances between patients. A p -value < 0.05 was considered statistically significant. Results: A higher incidence of dengue fever was observed in the younger age group (81)54 %. The majority of the patients showed mild hyponatremia 82(54.6%), mild hypokalemia 63(42%) and hypocalcemia 96(64 %). Hypophosphatemia 98(65.3 %) ( p -value 0.045) was found more compared to hypomagnesemia 22(14.6%). Fever was observed in 100% of patients along with body aches 90(60%), drowsiness 31(20.7%) and abdominal pain 16(10.7%). We also found leucopenia 48(32%) and thrombocytopenia 127(84.6%), whereas hematocrit 30(20 %) was also raised. Conclusion: Majority of electrolytes (sodium, potassium, calcium and phosphate) were found decreased in dengue patients. However, hyponatremia ( p =0.001) and hypophosphatemia ( p =0.045) were significantly associated to the severity of dengue.

Aim: To determine the bacterial spectrum and the frequency of sepsis in infants and children presenting to a tertiary care hospital, as well as its association with sociodemographic factors. Methods: This retrospective cross-sectional research was performed at the Department of Pediatrics, Ziauddin University Hospital Karachi. A total of 199 children records in the age group from 29 days to 12 years of age with a report of positive blood culture were included in the study. Non-probability consecutive sampling technique was used. Records were reviewed retrospectively and demographic data collected such as gender, age, diagnosis, type of admission (medical or surgical), length of stay in the hospital, and primary diagnosis with associated co-morbidities. SPSS was used for statistical analysis. The findings of quantitative variables were reported in terms of mean and standard deviation and qualitative variables in terms of frequency and percentages. Inferential statistics were analyzed by using Chi-square for comparing positivity of culture with baseline characteristics and a p-value of ≤0.05 was considered significant. Results: The mean age of the study population and the mean duration of hospital stay were 45.95±37.15 months and 7.61±3.61 days respectively. Out of a total of 199 cases with positive blood culture findings for bacterial isolates, coagulase negative staphylococci were found in 95(47.7%), Staphylococci Aureus in 57(28.6%), Streptococci species in 54(27.1%), E. Coli in 24(12.1%), Pseudomonas Aeruginosa in 14(7%), Klebsiella Pneumonia in 13(6.5%), Enterococcus species in 11(5.5%). Practical implication: Sepsis in the pediatric age group is associated with a high mortality and increased length of hospital stay. Early diagnosis and prompt treatment is the key to improve outcome of sepsis. Conclusion: There is a high prevalence of sepsis in children less than 48 months of age, more commonly in children with incomplete vaccination, female gender, decreased maternal educational level and a lower socioeconomic status especially in blood culture positive cases with unusual organisms such as Pseudomonas, Acinetobacter and gram-negative bacilli Keywords: Sepsis, Tertiary care, Pediatric intensive care, gram positive organism

Sepsis in newborns is a serious medical condition having a high mortality. Pakistan and other developing countries have a high burden of neonatal sepsis. Objectives: To determine the bacterial spectrum and antibiotic activity pattern in neonatal sepsis. Methods: This retrospective cross-sectional research was performed at the Pediatrics Unit of Ziauddin University Hospital Karachi from 1st June 2022 till 1st December 2022. A total of 120 medical records of neonates admitted with the clinical suspicion of sepsis were reviewed. Non-probability convenience sampling technique was used. Data regarding clinical characteristics of neonates, type of bacteria isolated and antibiotic susceptibility results were recorded. SPSS version 20 was used for statistical analysis. The results were written as frequencies / percentages. Results: Neonatal sepsis was suspected in 120 newborns but blood culture-proven infection was present in 32 (13.3%) neonates with 23(71.8%) having early -onset sepsis. The mean age on admission was 7.61±3.61 days. Acinetobacter was the commonest bacteria implicated in sepsis followed by Klebsiella ,Burkholderia and Serratia. The mortality rate in study population was 8.3%. Mortality was highest in Klebsiella sepsis. None of the bacterial species were sensitive to ampicillin while Acinetobacter and Burkholderia species responded to colistin, polymyxin and meropenem but showed resistance to imipenem. Conclusion: Early-onset neonatal sepsis has a high prevalence especially with gram -negative bacteria. Antimicrobial resistance to first line empiric therapy is common

Necrotizing Enterocolitis (NEC) contributes significantly to a high neonatal death rate in Pakistan and other developing countries. A number of elements related to its development are modifiable and can be addressed. Objectives: To evaluate the frequency of NEC, its associated factors and outcome in preterm babies. Methods: This retrospective, cross-sectional study was conducted at Ziauddin University Hospital, Karachi. Medical records of admitted preterm newborns from 1st December 2020 till 1st December 2022 were reviewed and neonates meeting the modified Bell’s diagnostic criteria ,with NEC stage II and III were included. Data pertaining to antenatal period, delivery and postnatal course of the disease were recorded . Data analysis were done using SPSS version-20 and results expressed as frequencies and percentages. Chi square test was applied with p-value statistical significance set at <0.05. Results: The prevalence of NEC was observed to be 7.1%. Male to female ratio was 1.6:1 with 84.5% of the neonates being low birth weight and culture-proven sepsis present in 44.8%. The mortality rate was 32.7%. Thrombocytopenia, hypotension, formula feeds, a positive blood culture and invasive ventilation were significant risk factors for mortality (p-value 0.01) Conclusions: Necrotizing enterocolitis has a high prevalence and mortality in preemies. Sepsis, formula feeding and a low birth weight adversely affect outcome. Early diagnosis and timely intervention can improve survival

Recently the use of radiography is growing significantly due to technology advancements and overdependence for diagnosis that's the reason everyone is exposed to radiation and there is a linear relationship exists between radiation exposure and adverse effects on the body. Objectives: To compare the radiation hazards and protection protocols knowledge among the final year medical and dental students of private university. Methods: It was an analytical cross-sectional study conducted on final year students of Medical and Dental College of private university at Karachi Pakistan in year 2022. All students in final year MBBS and BDS irrespective of age and gender were the source population. The study populations (n=85) were those students who were randomly chosen to fill the questionnaire. The study tool in this research included a structured questionnaire. Each correct answer was scored as 1 point. Percentages and frequencies will be recorded for qualitative variables. The total knowledge scores between medical and dental students were compared using the independent t-test. Results: The data were analyzed on a total of (n=85) students. The mean ages were 22.91±0.71 and 59 (69%) were girls and 26 (31) % were boys. There were (n=45) students from the final year MBBS and (n=40) students from BDS referred as group I and II respectively. There was significant difference (t (83) = -3.052, P=0.003) in the knowledge scores group I (8.95±3.30) and group II (11.40±4.07). Conclusion: Majority of Dental students have high knowledge scores as compare to medical students

Asthma is a serious medical condition in the pediatric age group and can have a high mortality, therefore it should be managed effectively. Patients not responding adequately to first line therapy need additional treatment. A few research studies have evaluated the use of intravenous magnesium sulfate in improving respiratory scores in severe acute pediatric asthma but the results have been conflicting. Objectives: To determine the benefit of intravenous magnesium sulfate in treating children presenting with worsening of asthma symptoms. Methods: A cross-sectional prospective study carried out at the Pediatrics Unit of Zia Uddin University Hospital, Karachi from 1st March 2021 to 1st March 2022. On the whole, 280 children in the age group 2-12 years with acute worsening of asthma of were selected by non-probability purposive sampling technique, however, children in need of invasive ventilation and those having asthma related complications on radiological investigations were omitted. Chi-square was applied for categorical variables and a p-value <0.05 was considered statistically significant. Results: Out of 280 patients who came to the Pediatric Emergency Department with acute severe asthma, 236 (84.3%) patients responded to a single dose of intravenous magnesium sulfate manifested by an improvement in clinical asthma score, while 44 patients (15.7%) did not show improvement. The admission rate to the pediatric intensive care unit was only 12.8%. Conclusion: Magnesium sulfate infusion helps improve respiratory symptoms in acute worsening of pediatric asthma.

Objective: To determine the predisposing factors contributing to unintentional home injuries in children under 5 years of age presenting to Emergency department of Ziauddin medical university and hospital, Karachi Place and duration of study: The study is conducted at Department of Emergency, Ziauddin Medical University and Hospital, Karachi And the duration of study is 13th October 2019 To 12th April 2020. It is a cross-sectional study design having having 200 patients, in which non-probability consecutive sampling technique is used. Material and Method: There were 200 patients in total with Injuries that happened at home environment. Mothers participated in an interview. After each child received the recommended care, data were gathered.Calculated descriptive statistics were used. Stratification was used to manage effect modifiers. The chi-square test was used after stratification. P-values lower than 0.05 were regarded as significant. Results: There were 46% male and 54% female patients. Mean age was 35.02±13.79 months. Most of the children were injured >3 times in last one month. 57% patients were found with injury due to falling down while most of the injuries (32.5%) were occurred at stairs. In our study, 39% of children caused injury due to lack of care, 11.5% due to availability of hazardous material and 49.5% due to unsafe home environment. Practical implications: From the standpoint of injury prevention, this study suggests that the risk of non-fatal injury in children under the age of five is complicated and multidimensional, and that effective prevention measures must target numerous components. To effectively increase children's comprehension of the safety issue and lower their risk of hazard, health care providers, parents, or both should design alternative strategic teaching methods. Conclusion: Most prevalent cause of injury was falling down. 39% children injured due to lack of care, 11.5% due to availability of hazardous material and 49.5% due to unsafe home environment. Keywords: Unintentional Home injuries, Children, predisposing factors, falling down, Injuries

Coronary artery dilatation has been observed with coronavirus disease 2019 (COVID-19)-associated multisystem inflammatory syndrome in children (MIS-C), which is more common in those with Kawasakilike disease.MIS-C is a clinical syndrome in children and adolescents; its signs and symptoms, as well as cardiac manifestations, are similar to Kawasaki diseases, such as coronary artery dilation, coronary aneurysms, and ventricular dysfunction.The occurrence of coronary artery dilatation in asymptomatic pediatric patients following COVID-19 infection has not been well documented in the literature.Thus, in this article, we present four cases of coronary artery dilation in children with a past history of COVID-19 infection who had very few or no symptoms and were referred to us for vague chest pain and palpitation.As a result, a high index of suspicion is required, and any patient complaining of chest pain and palpitation with a history of COVID-19 exposure should not be ignored and be given proper coronary artery evaluation.This article also raises the question of whether every child infected with COVID-19 should have an echocardiogram.

Background: The aim of the study was to determine the frequency of asthma and allergic diseases and to identify the associated risk factors in school-aged children of Karachi.Methods: This prospective, cross-sectional study was conducted from August 2019 to January 2020 on school-aged children (4-15 years) of Karachi. Non-probability purposive sampling technique was used, data was analyzed using SPSS version 20.Results: The prevalence of allergic rhinitis and eczema in the study population was 22.1%, asthma 14% and 34% had a history of wheezing in the last 12 months. Food allergy was present in 15.5% of the study population. The predisposing factors were exposure to dust in 32.6%, passive smoking in 30.8%, perfume smell in 27.3% and the presence of pets in the house in 23.2%. Male gender and maternal asthma were significantly associated with the development of these allergic disorders in children (p=0.033).Conclusions: There is a high prevalence of allergic disorders and asthma amongst the school children of Karachi. Environmental factors such as exposure to dust and passive smoking are significant predisposing factors. There is an urgent need to conduct further epidemiological studies to identify high-risk groups and key modifiable factors.