Children's Hospital Lahore Research Articles

Level of Actual Physical Fitness and its Perception among Students of Physiotherapy in Lahore

OBJECTIVE: To assess estimated and measured the physical fitness level of physiotherapy students.METHODOLOGY: This Cross sectional study carried out at Azra Naheed Medical College and School of Allied Health Sciences, Children Hospital Lahore, with Simple convenient sampling technique. The data was collected from 115 students including 42 male and 73 female, from 3rd year to final year. Self-perceived fitness questionnaire was used for estimation of perceived fitness and actual physical fitness level was measured by common clinical tests. Harvard step was used for fitness index measurement. SPSS version 21.0 was used for analysis and Pearson correlation for the correlation of perceived and measured physical fitness level. RESULTS: It was evident that physiotherapy students have good perception about their BMI. Results of perceived and measured body composition were correlated significantly .004 because they have good perception of body composition. Measured strength was low from the perceived, although some maleswere in average level. The results of strength show significant correlation for upper extremity that was 269 but for lower extremity non-significant. But measured flexibility results were good for lower extremities as compared to the shoulder flexibility for upper extremities, but both variables were differentfrom perceived fitness. Actual fitness index level was very low as compared to the self-estimated. CONCLUSION: Measured fitness was quite different from self-perceived. The students of physiotherapy were not physically fit as they perceived it. They need to improve their physical fitness level as their profession requires.

Risk Factors of Diarrhoea in Malnourished Children under Age of 5 Years

Abstract:
 Background: Acute infectious enteritis remains one of the commonest causes of death among infants and children in developing countries. Acute enteritis is defined as a loss of stool consistency with pasty or liquid stools, and/or an increase in stool frequency to more than three stools in 24 hours with or without fever or vomiting. Human survival depends on the secretion and reabsorption of fluid and electrolytes in the intestinal tract. The objective of the study is to evaluate the risk factors of diarrhoea in children under age of 5 years.
 Methodology: It was an observational study. Study was completed in about six months. Non-probability purposive sampling technique was used. In this study, 270 samples were taken from Diarrheal ward of The Children Hospital Lahore, Pakistan.
 Results: In this study, out of 270 patients, 58.52% were males and 41.48% were females. 90.37% patients were vaccinated. 54.81% had weaning history. 91.85% patients had feeding history. 29.26% had blood in stool. 96.67% patients were dehydrated. 95.56% patients had loose watery diarrhoea. 62.96% patients used boiled water. 58.52% patients consumed less than half litre of water, 30.00% patients consumed 1 litre of water and 11.48% patients consumed > 1 litre of water. 49.18% patients had proper hygiene. 38.15% mothers of patients were well educated. 40.37% patients had model household condition. 57.41% patients lived in rural area and 42.59% patients lived in urban area.
 Conclusion: The variation in the level of diarrheal morbidity was well explained by maternal education, income, personal hygiene, refuse disposal system and the effect of health extension programme.

COMPARISON OF ANTIBIOTICS;

Objective: To determine if granulocyte colony-stimulating factor (G-CSF) withempirical antibiotics therapy accelerates febrile neutropenia resolution compared with antibioticswithout it. Study design: Experimental study. Place and Duration of Study: Study wasconducted for a period of one year from march 2012 to february 2013 in oncology/haematologydepartment Children Hospital Lahore (PAKISTAN). Subject and Methods: A total of 56 childrenwith febrile neutropenia due to chemotherapy were included in the study. Two groups were madeA and B. Twenty eight patients were included in each group. Patients included in the group Awere given granulocyte colony stimulating factor with the dose of 5 microg/kg/day for five daysand the patients included in group B were not given granulocyte colony stimulating factor.Subcutaneous administration was recommended. Patients remained on study until absoluteneutrophil count (ANC) >500/microl and > or =48 hr without fever. Every child in both groupswas given antibiotic treatment in the hospital whenever there is need, antibiotics changedaccording to the blood culture sensitivity. Admitted patients were followed daily for fever andsigns of sepsis. Number of days of admission in hospital and number of days of treatment wascalculated in both groups and compared with each other. Duration of febrile neutropenia andmortality was also analysed for both groups. Results: Out of 56 patients 46 had acutelymphoblastic leukemia (ALL), 06 patients were of wilm tumour and 04 patient were havingrhabdomyosarcoma. Twenty eight patients were given only antibiotics(GROUP B) and 28patients were given G-CSF plus antibiotics(GROUP A). Addition of G-CSF significantly reducedneutropenia and febrile neutropenia recovery times. Median days to febrile neutropeniaresolution was 4.3 days earlier with G-CSF (5.3 vs. 9.6 days) (P < 0.0001). Resolution of fever wasone day earlier in patients who were given G-CSF (GROUP A). Hospitalization was 2.1 daysshorter with G-CSF (6.1 vs. 8.2 days) (P = 0.02). (Table II). There was difference of 2.2 days in theduration of IV and oral antibiotic treatment. Addition of antifungal therapy was done in 4 patientsin group B and only in one patient in group A. All the patients recovered and no death occurred inthe study. Conclusions: It is concluded that addition of G-CSF to empiric antibiotic therapyaccelerates chemothserapy-induced febrile neutropenia resolution by 4.3 days in pediatricpatients with malignancy. It is a significant difference in duration of hospitalization. By bearingexpenses of G-CSF we can decrease the expenses of hospitalization and antibiotics

Burden of Chemotherapy Induced Febrile Neutropenia in Paediatric Oncology in a Low-Income Country: The Children's Hospital Lahore Pakistan Experience

Background: Febrile neutropenia (FN) is one of most common and potentially lethal complications in patients with cancer during chemotherapy. The Oncology Department of the Children's Hospital Lahore Pakistan is a 60 bedded unit providing free treatment to over 1300 new childhood cancer cases each year and over 200 admissions per month with bed occupancy rate around 200%. The department receives childhood cancer cases not only from Pakistan but also from Afghanistan. Therefore it's very challenging to treat cancer and infection parallel with increased burden on the public sector hospital providing free treatment as well as on health professionals managing these patients with advanced stages and frequent infection episodes. Aim: The objective of this study is to evaluate the burden of FN in resource limited settings like a public sector hospital in Pakistan. A prospective review of data of patients treated for febrile neutropenia from October to December 2017 in the Haematology/Oncology Department of The Children's Hospital Lahore after IRB approval. The data were analyzed by using SPSS 20. Results: 250 patients were treated for FN during these three months 59% of them male and mean age 6.27 years. Among diagnoses, 58% had acute lymphoblastic leukaemia, 16% sarcomas, 10% lymphoma and 16% other solid malignancies on different chemotherapy regimens. 53% received their chemo during last 3 days and 35% in the last week prior to FN admission. 84% of them were receiving either induction or intensive phase protocols. 48% had respiratory tract infection followed by AGE 25%, fever alone in 20%, 82% cases had mucositis. 52% cases had symptoms of more than 24 hours before seek treatment of FN. ANC (absolute neutrophil count) was < 100 in 60% and platelets < 50,000 in 56% cases on arrival. 57% cases stayed 1-3 hours drive from the Children´s hospital and only 44% parents had adequate awareness of FN management. Regarding the outcome 81% discharged home, 16% expired (mainly FN and progressive disease) and 3% abandoned treatment. G-CSF (granulocyte-colony stimulating factor) was used in 30% (0.026 for RX cost and 0.043 hospital stay) and blood products in 75%, inotropes used in 16% with mean estimated cost of 15,000 RS/patient (total 3.8 million RS) with 95% staying > 48 hrs. 61 cultures were positive mainly urine, blood, ENT, wound, CSF. 92% were Gram negative with majority Klebsiella followed by Pseudomonas, E. coli and Citrobacter species. There were no central lines used. Conclusion: This study described that FN has been a profound burden in childhood cancer care in public sector hospital in resource limited settings like Pakistan. There is immense need to health educate the parents, nurses and doctors for standard care of febrile neutropenia along with sustainable social support and shared care oncology as being provided in developed countries to share the load of primary treatment centers aiming for decreased morbidity and mortality.

Improvement in Infection Prevention and Control Measures at The Children Hospital, Lahore. A My Child Matters Collaborative Project

Background: Overcrowding, lack of operational funds, and healthcare associated infections are major challenges at the Children Hospital Lahore, a public healthcare facility in Pakistan with 900 new pediatric cancer admissions annually. In 2014, a collaboration between My Child Matters (MCM), St. Jude Global Infectious Diseases Program (SJ-GID), and our institution was established to address these issues. Aim: To describe the effect of a collaborative improvement strategy on the infection prevention and control (IPC) standards in a pediatric oncology unit in a resource-limited setting. Methods: Our study was a prospective before-and-after study. We compare the WHO Hand Hygiene Self-Assessment Framework (HHSAF) and 4 modules of the St. Jude modified Infection Control Assessment Tool (ICAT) scores. Our strategy included: (1) creating a multidisciplinary team of pediatric hematology-oncology, infectious disease physicians, nurses, microbiologist, and a data manager, (2) engaging on monthly online IPC mentoring sessions with the SJ-GID and MCM mentors, (3) performing daily inpatient healthcare associated (HAI) surveillance rounds, and (4) providing regular hand hygiene training and compliance audits. Results: Our hand hygiene facility level per WHO scores increased from “Inadequate” during the baseline assessment to “Intermediate/Consolidation” by the end of 3-year implementation (122 vs 352 HHSAF scores). The sink: bed and hand sanitizer: bed ratios improved to 1:6 and 1:1 respectively. Six washrooms were added to our unit. ICAT general infection control module increased by 40% (45 vs 78 ICAT score) and hygiene compliance improved by 20% from baseline. Identification of HAI increased from baseline (4.07 vs 8.7 infections per 1000 patient days). A 25% of the isolates were multidrug-resistant microorganisms. Conclusion: Implementing a collaborative improvement strategy improved the IPC standards in our pediatric cancer center. The increase of HAI might be a result of a better surveillance and laboratory identification. Further targeted interventions should be develop to decrease HAI rates and infection-related morbidity and mortality in our population.

Demographics and Outome in Paediatric Non-Hodgkin Lymphoma: Single Centre Experience at The Children Hospital Lahore, Pakistan.

To describe the patient demographics and outcome analysis in paediatric non-Hodgkin lymphoma (NHL) patients. An observational study. The Hematology/Oncology Unit of The Children's Hospital and Institute of Child Health, Lahore, from January 2012 till December 2014. Demographics including age, gender, histopathology, stage and outcome data, in biopsy proven NHL patients were analyzed. Burkitts/B Cell and Diffuse Large B Cell lymphoma patients were treated with MCP 842 Protocol while T/B-cell lymphoblastic lymphoma (LL) patients were treated with EURO-LB 02 protocol. Ninety-one patients were treated during the study period at CHL. Data was insufficient in 18 patients, so they were excluded from the study. Patients included were 73. Males were 53 (72.6%). Thirty-seven (50.7%) were 5-10 years of age, and 22 (30.1%) 10-16 years old. Abdominal mass was the commonest presentation seen in 32 (43.8%), lymphadenopathy in 27 (37%), intussusception in 5 (6.8%), while intestinal obstruction, obstructive uropathy, nasopharyngeal mass, gastric mass, primary bone lymphoma, pericardial effusion, jaw swelling, cheek swelling and paraspinal mass present in one (1%) each. Histopathological subtypes consist of Burkitt's lymphoma (BL) in 32 (43.8%), B cell NHL in 10 (13.7%), lymphoblastic lymphoma (LL) in 26 (35.6%), diffuse large B cell lymphoma (DLBCL) in 2 (2.8%), and anaplastic large cell lymphoma (ALCL) in 1 (1.4%). Sixty-seven (91%) presented in stage III, and six (8.4%) in stage IV. Forty-eight (65.8%) patients had completed treatment and are well to date, 16 (21.9%) died, 5 (6.8%) left against medical advice (LAMA), and 4 (5.5%) patients relapsed. Burkitts lymphoma was the commonest type of NHL seen in this cohort that predominantly presented with an abdominal mass. Children usually presented in advanced stage with delayed diagnosis. Better supportive care can improve the prognosis significantly. Training of pediatricians is equally important along with increasing parental/family knowledge about the disease symptoms so that they can seek early medical care, and earlier diagnosis is possible.

Evaluation of Recent Medication Therapies of Asthma in Different Hospitals of Lahore City, Pakistan

Asthma is the episodic and most chronic disease that exists worldwide. Factors that trigger asthma are allergens, pollens, cigarette smoke, dust, mites, and animal dander, cockroaches and food. A increased knowledge of asthma, its causes and prevention influence the researchers to find out new and improved medication therapies for future to serve asthma patients is a great opportunity for ambulatory care pharmacists. A questionnaire based, cross-sectional study was planned for this research. Questionnaires were standardized based on common research or they can be customized to meet the specific data gathering need. The study was conducted at five different hospitals of Lahore, Children hospital Lahore, Jinnah hospital Lahore, General hospital Lahore, Social security hospital Lahore and Chaudhary Muhammad Akram teaching and research hospital Lahore. The results indicated that 85% of population is suffering from asthma. 91.5% of population is any taking medication for asthma. Most recently used medication for asthma are inhalers i.e. 80% and inhaled corticosteroids i.e. 82%.Patients are taking medication therapies for asthma but most commonly used are inhalers and steroids. Education provided by pharmacist about asthma was an integral part of health maintenance services its management to control or prevent further attacks because of his knowledge in pathophysiology pharmacology and medication techniques of asthma. Pharmacist driven medication therapy management services were economically stabilized.

Factors contributing to the lack of interest in research activities among postgraduate medical students.

Objective:To determine the factors contributing to lack of interest in research activities among postgraduate residents in pediatric medicine.Methods:This cross-sectional survey was conducted at The Children’s Hospital Lahore, Pakistan in August 2017. The questionnaire was distributed to 105 postgraduate residents working in pediatric medicine department and 90 of them returned the completed proforma (response rate; 86%). Data was analyzed by SPSS version 22.Results:Out of 90 residents’ females were predominant (n=58/90; 64.4%). Mean age of the participants was 28.22 ± 2.092 years. Majority were unmarried (n=57; 63.3%). The highest mean score (2.31±0.697) was regarding “Lack of proper training for research”, followed by “lack of previous exposure” (2.26±0.728) and “over loaded curriculum” (2.13±0.753). “Uncooperative faculty” and “funding issues” as a barrier towards research (p=0.016 and 0.014 respectively) was mentioned by males more than females. “Social and family commitment” was a significant perceived barrier in married residents as compared to unmarried residents (p=0.001). The residents in the younger age group were more reluctant to do research due to “over loaded curriculum” (p=0.038).Conclusion:Lack of proper training of research, lack of previous exposure and time management are the major factors affecting resident’s research work, whereas married residents face more social/family constraints as compare to unmarried residents.

Burden of chemotherapy-induced febrile neutropenia in paediatric oncology in developing countries: The Children's Hospital Lahore Pakistan experience.

e22021 Background: The Oncology Department Of The Children’s Hospital Lahore is a 60 bedded unit providing free treatment to over 1000 new childhood cancer cases each year.The aim of this prospective study was to analyze the burden of chemotherapy induced FN and to assess the leading risk factors . Methods: Prospective review of 100 patients with FN admitted in July to August 2016 was done. Data regarding their age, sex, and clinical features, baseline CBC, course of therapy, hospital stay and understanding of caregivers regarding FN analyzed. Results: Total 100 patients with age ranging from < 1 to 15 years (67% < 5 yrs) were included.M: F Ratio was 1.7:1, 72% of cases had ALL and 28% with solid tumors. 28% had last chemotherapy received in 72 hours, 30% in last week and rest in more than a week time 36% had respiratory tract infections, 18% gastrointestinal infections, 20% mucositis, 10% no focus found and rest 16% had other manifestations Only 2 % presented in < one hour of start of symptoms, 27% < 24 Hours, 61% in < 5 Days and 10% > 5 days duration of symptoms. 45% had Hb < 8 gm%, 33% had platelets < 50000, and 54% had WBC < 1000 and 63% had ANC <100 (p-Value = 0.003- Hospital Stay). 29% presented with first episode while 51 % had 3 or more FN episodes.28% cases stayed 1 hour distance from CHL while 72% had to travel > 1-5 hrs to reach the primary treatment center. 66% received paracetamol at home, 17 had oral antibiotics while 17% had no treatment before reached PTC. Only19% caregivers had adequate awareness regarding FN, 72% had some understanding while 9% had no knowledge about FN (p-value = 0.000). 40% had social issues, 41% were unaware while 13% showed negligence in seeking treatment .46% stayed for 5 days and 48% for more than 5 days. 21% patients had increased doses of oral chemotherapy not adjusted timely according to CBC. Conclusions: Health educationof caregivers and health professionals is of utmost importance to prevent and manage FN effectively. Need of capacity building in pediatric oncology in low income countries along with sustainable social support is essential for provision of standard childhood cancer care and implementation of effective infection control measures.

1408 - Burden of chemotherapy induced febrile neutropenia in paediatric oncology in developing countries: the Children's Hospital Lahore Pakistan experience

1408 - Burden of chemotherapy induced febrile neutropenia in paediatric oncology in developing countries: the Children's Hospital Lahore Pakistan experience

Acute bacterial meningitis in children presenting to The Children's Hospital Lahore before and after pneumococcal vaccine in Pakistan National Immunization Program; A comparison.

Objective:To describe bacteriological profile, morbidity and mortality of acute bacterial meningitis (ABM) in children and to compare these parameters before and after the introduction of Pneumococcal vaccine in Pakistan National Immunization Program.Methods:The present descriptive study was conducted at the Department of Paediatric Medicine of The Children’s Hospital Lahore from January 2012 to December 2015. A total of 503 children one month to five years of age admitted with diagnosis of meningitis were included. Complete blood count, CSF cytology, biochemistry, culture sensitivity and blood culture sensitivity were performed.Results:Frequency of meningitis decreased by 50% in 2013-2015 (199 [2012] vs 304 [2013-2015). Most children in both groups were under one year of age. More neurological complications were seen in the group 2, 20% vs 17%. CSF culture positivity decreased from 12% to 6.6%. Streptococcus pneumoniae isolation decreased from 5 (2.5%) in 2012 to 4 (1.3%) in 2013-2015. Refusal to take feed (p=0.002), impaired sensorium (p=<0.001), severe malnutrition (p=0.001), prolonged duration of symptoms (p=<0.001) and incomplete vaccination status (0.005) were associated with mortality. Mortality rate decreased from 20 (10%) in 2012 to 17 (5.6%) in 2013-2015 but more children developed neurological sequelae 2.7% versus 1%.Conclusion:Acute bacterial meningitis mostly affected children <1 year. Frequency of Streptococcus pneumoniae and mortality of meningitis decreased significantly after PCV but more neurological complications developed in those children who were unvaccinated in 2013-2015 compared to 2012.

Analyzing communication skills of Pediatric Postgraduate Residents in Clinical Encounter by using video recordings

Objective:To analyze communication skills of pediatric postgraduate residents in clinical encounter by using video recordings.Methods:This qualitative exploratory research was conducted through video recording at The Children’s Hospital Lahore, Pakistan. Residents who had attended the mandatory communication skills workshop offered by CPSP were included. The video recording of clinical encounter was done by a trained audiovisual person while the resident was interacting with the patient in the clinical encounter. Data was analyzed by thematic analysis.Results:Initially on open coding 36 codes emerged and then through axial and selective coding these were condensed to 17 subthemes. Out of these four main themes emerged: (1) Courteous and polite attitude, (2) Marginal nonverbal communication skills, (3) Power game/Ignoring child participation and (4) Patient as medical object/Instrumental behaviour. All residents treated the patient as a medical object to reach a right diagnosis and ignored them as a human being. There was dominant role of doctors and marginal nonverbal communication skills were displayed by the residents in the form of lack of social touch, and appropriate eye contact due to documenting notes. A brief non-medical interaction for rapport building at the beginning of interaction was missing and there was lack of child involvement.Conclusion:Paediatric postgraduate residents were polite while communicating with parents and child but lacking in good nonverbal communication skills. Communication pattern in our study was mostly one-way showing doctor’s instrumental behaviour and ignoring the child participation.

Prevalence of Common Infectious Diseases in Paediatric Age Group Admitted in Children's Hospital Lahore, Pakistan

Prevalence of Common Infectious Diseases in Paediatric Age Group Admitted in Children's Hospital Lahore, Pakistan

Impact of maternal education, employment and family size on nutritional status of children.

Objective:To determine the impact of maternal education, employment, and family size on nutritional status of children.Methods:It was case control study conducted at OPD of children Hospital Lahore, from September 2015 to April 2017. Total 340 children (170 cases and 170 controls) with age range of six months to five years along with their mothers were included. Anthropometric measurements were plotted against WHO growth Charts. 170 wasted (<-2 SD) were matched with 170 controls (≥ -2 SD). Maternal education, employment and family size were compared between the cases and control. Confounding variables noted and dichotomized. Univariate analysis was carried out for factors under consideration i.e.; Maternal Education, employment and family size to study the association of each factor. Logistic regression analysis was applied to study the independent association.Results:Maternal education had significant association with growth parameters; OR of 1.32 with confidence interval of (CI= 1.1 to 1.623). Employment status of mothers had OR of 1.132 with insignificant confidence interval of (CI=0.725 to 1.768). Family size had OR of one with insignificant confidence interval (CI=0.8 -1.21). Association remained same after applying bivariate logistic regression analysis.Conclusion:Maternal education has definite and significant effect on nutritional status of children. This is the key factor to be addressed for prevention or improvement of childhood malnutrition. For this it is imperative to launch sustainable programs at national and regional level to uplift women educational status to combat this ever increasing burden of malnutrition.

Blood culture and sensitivity pattern in Neonotology unit of Children Hospital Lahore

Objectives: To identify spectrum of organisms causing neonatal sepsis and the sensitivity pattern against commonly used antibiotics. Study design: Prospective descriptive study. Material and method: Blood samples were taken from all neonates with clinical suspicion of sepsis before start of antibiotics and sent for culture by standard method. The data obtained from January 2004 to June 2004 was analyzed and results were tabulated. Results: A total of 1900 blood samples were taken. Cultures were positive in 524 samples (27.6%). E Coli was the most common organism found (31.67%) followed by Staph Epidermidis (24.80%), Klebsiella (19.08%) and Pseudomonas (14.69%). Amikacin was the most effective drug followed by Co-Amoxi Clav, Ciprofloxacin, Imipenem and Ceftazidime in that order. Gram positive and gram negative organisms showed a high degree of resistance against Ampicillin and Gentamycin respectively. Conclusion: Neonatal sepsis is one of the leading causes of morbidity and mortality. Gram negative organ isms are the major cause of neonatal sepsis in NNU of Children Hospital. In this study these organisms showed resistance against commonly used antibiotics (Ampicillin, Gentamycin and Cefotaxime). There is a need to modify already existing protocol in NNU of Children Hospital.

Molecular Genetics Analysis of Von Williebrand Disease: Studies in Cohort Pakistani Patients

Introduction: Von Willebrand disease (VWD) type III is the second most common inherited bleeding disorder in Pakistan. It is caused by severe quantitative deficiency of plasma Von Willebrand factor (VWF). Absence of VWF increases the severity of disease and is caused by homozygous/ compound heterozygous mutations in Von Willebrand factor gene.Objective: The aim of study is to characterize molecular genetics of Von Willebrand type III in Pakistani population.Setting: NIBD & BMT Karachi, Chughtais lab, Children's Hospital Lahore, PAEC Islamabad and HMC Peshawar.Material And Method: In this cohort study of Von Willebrand disease (VWD) type III, Blood samples of 48 unrelated patients of type III VWD were collected in National Institute Of Blood Disease & Bone Marrow Transplant (NIBD) Karachi, Chughtais lab, Children's Hospital Lahore, PAEC Islamabad and HMC Peshawar. Genomic DNA was extracted from peripheral blood by QIAamp DNA Blood mini kit (Qiagen) and Exon specific PCR was done for VWF gene and Direct gene sequenced on automated ABI-3130 Genetic Analyzer (Applied Biosystems). Sequence Variations in VWF were checked on ISTH-SSC VWD homepage (http://www.vwf.group.shef.ac.uk/), Ensemble genome browser (http://www.ensembl.org/), VWFdb hemobase and biobase biological database (http://www.hgmd.cf.ac.uk/ac/index.php). We have adopted the nomenclature for numbering amino acids of Human genome variation society (HGVS). Statistics analysis was done SPSSv17.Results: Sequence analysis detected mutations in 46 (95.83%) out of 48 samples. VWD type III has led to identification of 28 cases (60.8%) homozygous and 18 (39.1%) were compound heterozygous. We have indentified total 31 Mutations distributed as 17 missense mutations (54%), 7 nonsense mutations (22%) 2 small deletions (6%) , 2 insertion mutations (6%) and 3 splice site mutations (9%).19 of these were newly mutations in this cohort study.. Further method multiplex ligation dependent probe amplification (MLPA) is needed for detection of large deletions in two patients. Nonsense c.3931C>T, p.Q1311*was founder mutation in Pakistani patients.Conclusion: In cohort study, missense mutations are detected as common in among patients and most of the mutations identified in this cohort were homozygous due to Consanguinity in the family of the patients. DisclosuresOldenburg:SOBI: Consultancy.

PERCENTAGE OF PATIENTS WHO SHOW AGREEMENT BETWEEN EMG AND CSF FINDINGS FOR THE DIAGNOSIS OF GBS

Objective: to determine the percentage of patients who show agreement between EMG and CSF findings for the diagnosis of GBS.&#x0D; Study Design: Cross sectional survey.&#x0D; Setting: This study was conducted in the Department of Neurology and Medical ICU, The Children Hospital Lahore, from 01-10-2011 to 31-03-2012.&#x0D; Methodology: 120 patients fulfilled the inclusion criteria were enrolled in the study. EMG was conducted and conduction velocities of motor and sensory nerves of lower and upper limbs and amplitude of compound motor action potential (CMAP’s) were checked. After ten days of start of disease lumbar puncture was done with aseptic measures by the researcher and was sent to the central laboratory of the hospital for analysis of CSF.&#x0D; Results: The mean age of the patients was 5.6±2.8 years. There were 72 (60.0%) male patients and 48 (40.0%) female patients. 116 (96.7%) patients had positive EMG findings and 4 (3.3%) patients had negative EMG findings. 66 (55%) patients had positive CSF findings and 54 (45%) patients had negative CSF findings. Thus at least 64 (53.3%) patients had an agreement between CSF and EMG findings.&#x0D; Conclusion: It is concluded from this study that there is strong agreement between EMG findings and CSF findings for the diagnosis of Guillain Barre Syndrome in children.

Challenges in Treating Hodgkin Lymphoma in a Developing Country: Children Hospital Lahore Experience

Purpose: The Children's Hospital Lahore is a tertiary government centre with 45 paediatric Oncology beds. It receives over 500 new cancer patients per year. The purpose of this study was to analyze treatment and outcome of children with biopsy proven Hodgkin Lymphoma and discuss various factors causing poor outcome as compared to developed countries.

A Survey Report on Measles in Pakistan

Abstract Objective: To study the epidemic condition and to know the cause of the epidemic, treatment being provided and cause of increasing deaths due to measles. Study Design: Survey report Place and Duration of Study: Admitted Measles patients in peads department of Jinnah Hospital Lahore, Services Hospital Lahore, General Hospital Lahore, Children Hospital Lahore, Mayo Hospital Lahore, Sir Gangaram Hospital Lahore and Social Security Hospital Lahore during January 2013 to March 2013. Methodology: Admitted patients in peads department of hospitals were visited patients affected with proper signs and symptoms such as High fever, Generalized Maculo pappular rashes, Conjunctivitis and spots on body were studied. Their prescriptions were studied, the medicines given to reduce severity of the symptoms of the disease including Antipyretics, Antibiotics and Oral Antifungals were studied. They were asked whether they were vaccinated for measles or not and their socio economic status including patients' residing conditions were also studied. Results: Most of the patients studied in hospitals had post measles complications and some patients were solely affected by measles. Most of the patients studied were vaccinated according to the EPI schedule and rests were partially vaccinated, non-vaccinated, vaccine was not available to them, they did not have awareness and some parents were careless regarding vaccination. Most patients belonged to the poor class making 61.90 %, rest of the patients belonged to middle and lower middle class. Conclusion: Pneumonia was found to be the most common complication of measles. Most children belonged to poor socio-economic status. Key words: Epidemic, Measles, Vaccination, Immunization, Children.

“Correlation of Magnetic Resonance Patterns of Lumbar Disc Disease with Clinical Symptomatology of Patientsâ€

Objective: To describe the patterns of degenerative changes in lumbar spine discs in correlation with cli-nical symptomatology of patients. Patients and Methods: This cross sectional analy-tical study was carried out in Radiology Department of Children Hospital Lahore, from October 2006 to Octo-ber 2007. The study included 170 patients who presen-ted with low back and leg pain. All patients underwent lumbar MRI using 1.5 T - scanner. MRI scans were evaluated for magnitude and location of nerve com-pression, disc bulge or disc herniation and the nature of nerve and thecal sac deformation and association of these findings with age, sex and clinical symptomato-logy of patients was evaluated. Results: The study included 170 patients, the age range was 20 to 79 years (mean 47 years). Disc bulge was most frequent finding seen in 128 patients (74%), disc herniation was seen in 42 patients (25%) and was common in patient with acute history of backache, while disc bulge was common in patients with chronic symptoms. Overall 131 patients (76%) had MRI evi-dence of nerve or thecal sac compression. There was no significant association between segmental distribu-tion of symptoms and presence of anatomic impair-ment. However, severe nerve compression and disc herniation were significantly associated with pain dis-tal to the knees. Conclusion: The presence of disc herniation or ipsi-lateral severe nerve compression at one or multiple sites is strongly associated with distal leg pain and sen-sory symptoms in that leg. Mild to moderate nerve compression, disc degeneration or bulging, and non disc degenerative changes are not significantly associ-ated with specific pain patterns.