Children's Hospital Lahore Research Articles

Utilizing Integrated Lung and Inferior Vena Cava Ultrasound for Dry Weight Assessment - Insights from a Single-Center Experience

ABSTRACT Precise dry weight evaluation holds significant importance for individuals with end-stage renal disease (ESRD) undergoing hemodialysis. Fluid overload is associated with an increased likelihood of mortality and morbidity. Ultrasonography aids in assessing dry weight and modifying dialysis prescription. OBJECTIVE: To assess the following in ESRD Patients by ultrasonography: Dry weight and effectiveness of fluid removal Adjust the dialysis prescription METHODOLOGY: A prospective cross-sectional study was carried out in the Pediatric Hemodialysis unit at The Children's Hospital Lahore, over 6 months from July to December 2022. The study included 30 children aged 5-16 years undergoing maintenance hemodialysis and exhibiting signs of overload. Ultrasound was performed for B-lines and IVC diameter before and after dialysis. Dialysis prescriptions were modified and patients were monitored through sequential scans. Data was analyzed using SPSS version 20. RESULTS: A total of 30 patients were enrolled with 53.3% being males. The average pre-dialysis weight was 25.39 kg, systolic blood pressure was 150.67 mmHg and diastolic blood pressure was 92.6 mmHg. Pre-dialysis pleural and pericardial effusions were observed in 86.7% patients, while B-lines were present in 63.3%. Majority of children (83%) were on twice-weekly dialysis and remaining were prescribed thrice weekly dialysis. A significant reduction in weight, blood pressure, pleural and pericardial effusion, B-lines, and IVC diameter was found after dialysis. Dialysis prescription was adjusted following the first session, with 80% subjects receiving thrice-weekly sessions, 16.7% daily, and 3.3% twice-weekly dialysis. CONCLUSION: Monitoring the appropriate fluid removal and adjustments to the dialysis prescription in hemodialysis patients can be accomplished using ultrasonography. Keywords: Dry weight, Ultrasound, B-lines, IVC, Dialysis frequency.

Outcome Analysis of Transperitoneal Laparoscopic Nephrectomy in Children: Experience from a Developing Country.

To analyse the outcome of laparoscopic nephrectomy among children. An observational study. Place and Duration of the Study: Department of Paediatric Urology, Children's Hospital Lahore, from September 2021 to June 2023. During the study, 100 children aged 5-180 months were included. Data regarding age, gender, cause, side, intraoperative and postoperative outcomes such as number of ports, estimated blood loss, need of transfusion, operative time, hospital stay, analgaesia requirement and complications were recorded. Data were collected through proforma which were entered and analysed through computer software SPSS version 16.0. Among 100 children, 58.0% were males and the mean age was 79.54 ±4.427 months while the major cause of laparoscopic nephrectomy was PUJO (Pelvi-Ureteric Junction Obstruction) for 47.0% of children. The mean blood loss was 19.93±65.556 ml and the majority of the children (96.0%) did not require blood transfusion. The mean operative time was 125.31 ± 43.365 minutes and the mean hospital stay was 2.82 ± 1.258 days. Most of the children (90.0%) had no complications while 3.0% had ileus which was managed conservatively and 3.0% were converted to open surgery while 4.0% had wound infection. Laparoscopic nephrectomy is an effective technique with regard to insignificant blood loss, operative time, hospital stay, and rate of complications. Laparoscopy, Nephrectomy, Children, Operative time, Hospital stay, Complications.

Outcome Analysis of Transperitoneal Laparoscopic Nephrectomy in Children: Experience from a Developing Country.

To analyse the outcome of laparoscopic nephrectomy among children. An observational study. Place and Duration of the Study: Department of Paediatric Urology, Children's Hospital Lahore, from September 2021 to June 2023. During the study, 100 children aged 5-180 months were included. Data regarding age, gender, cause, side, intraoperative and postoperative outcomes such as number of ports, estimated blood loss, need of transfusion, operative time, hospital stay, analgaesia requirement and complications were recorded. Data were collected through proforma which were entered and analysed through computer software SPSS version 16.0. Among 100 children, 58.0% were males and the mean age was 79.54 ±4.427 months while the major cause of laparoscopic nephrectomy was PUJO (Pelvi-Ureteric Junction Obstruction) for 47.0% of children. The mean blood loss was 19.93±65.556 ml and the majority of the children (96.0%) did not require blood transfusion. The mean operative time was 125.31 ± 43.365 minutes and the mean hospital stay was 2.82 ± 1.258 days. Most of the children (90.0%) had no complications while 3.0% had ileus which was managed conservatively and 3.0% were converted to open surgery while 4.0% had wound infection. Laparoscopic nephrectomy is an effective technique with regard to insignificant blood loss, operative time, hospital stay, and rate of complications. Laparoscopy, Nephrectomy, Children, Operative time, Hospital stay, Complications.

Comparison of Clinical, Etiological and Antibiotic Sensitivity Patterns of UTI in CAKUT and Non CAKUT Children

Background: Urinary tract infections (UTIs) are one of the most common bacterial infections in children. Congenital anomalies of the kidney and urinary tract (CAKUT) are a major cause of UTIs in this population. Objective: To compare clinical, etiological and antibiotic sensitivity patterns of UTIs in CAKUT and non-CAKUT children. Study Design: Prospective comparative study. Place and Duration: The study was conducted at the department of Pediatric Nephrology, The Children's Hospital Lahore from August 2023 to January 2024. Methods: 68 children with and without CAKUT having UTI were evaluated. Data regarding demographics, clinical presentation and antibiotic sensitivity pattern was collected. Susceptibility testing was done according to CLSI recommendations. Results: 34 patients with UTI in CAKUT group (Group A) had male predominance (73.5%) while children without CAKUT (Group B) were predominantly females (55.9%). Mean age in Group A (38.9 months) was less than that in Group B (53.9 months). The common presentations in both the groups were pyelonephritis and cystitis. Vesico-ureteric reflux (32.4%) and posterior urethral valves (29.4%) were the most common CAKUT findings. Majority of patients with CAKUT had Pseudomonas UTI (32.4%) while E. coli (35.3%) was common in children without CAKUT. Fosfomycin, Colistin, Linezolid and Polymyxin B had low resistance amongst both groups. The association between CAKUT and atypical uropathogens was not found to be statistically significant (p = 0.287). Conclusion: Differences exist in clinical presentation, etiology and antibiotic sensitivity patterns specific to UTI in CAKUT and non-CAKUT children. A high resistance pattern was found amongst common antibiotics.

Comparison of Facial Angular Measurements Between Males and Females Presenting at a Tertiary Care Hospital

Background and Objective: The effectiveness of orthodontic diagnosis and treatment planning is dependent on an accurate assessment of the patient's soft tissue profile. The objective of the study was to compare the facial angular measurements between males and females.Methods: The study comprised 100 volunteers (50 males and 50 females) ranging in age from 12 to 16 years. The respondents were chosen through convenience sampling technique from orthodontics department of children hospital Lahore. Cephalometric and photographic profile analysis was used, with angular measurements based on standard cephalometric and photographic records taken in natural head position. The study included four factors in total.Results: The mean cephalometric and photographic naso-frontal angle was 121.050 and 121.030 respectively, where as cephalometric and phographic measurement in females were 122.240 and 122.840 respectively.Conclusion: There was no significant difference in angular measurements between two genders.Keywords: Photographic analysis, Cephalometric analysis, Naso-labial angle, Naso-mental angle, Naso- frontal angle, Naso-facial angle

COMPARISON OF DIFFERENT TREATMENT MODALITIES OF CHELATION THERAPY IN BETA-THALASSEMIA MAJOR PATIENTS.

Thalassemia has a high prevalence and carrier rate of 8-10% in Pakistan, repeated blood transfusions lead to iron deposition in organs. In this Prospective study, we have compared the efficacy of three chelation regimens being used in our country. It has been conducted at PBTS, Fatmid Foundation and Children Hospital Lahore. 60 thalassemia major patients, were divided into 3 groups according to their mode of chelation. Patients in group I were on oral iron chelator deferiprone, 7 days per week. Thalassemics in group II were on parenteral iron chelator deferoxamine given subcutaneously for 4 days a week, and group III patients were on combination therapy, deferiprone for 5 days & deferoxamine given twice weekly. The assessment of chelation was done by measurement of serum ferritin and 24-hour urinary iron excretion at the start of the study and then after six months of follow-up. To assess the hepatic iron, hepatic MRIs were also performed. Ferritin levels were maximally decreased in group II, followed by group III, with no significant reduction in group I. However, a statistically significant difference in mean urinary iron excretion (increased) was seen in group III. The hepatic iron was very high in all three groups as shown by the hepatic MRI. Combination chelation therapy is the most effective chelation therapy in iron-overloaded patients. It helps to improve compliance and increases urinary iron excretion. Patients on DFX had the lowest degree of hepatic siderosis even though it was considerably higher than the normal population.

Effect of Educational Intervention on Neonatal Nurses Practices Regarding Oral Motor Stimulation on Early Transition from Tube to Oral Feeding in Preterm Infants

Nurses working in neonatal nursery units play a crucial role in assessing the preterm infants feeding readiness cues for initiation of oral feeding and implementing the evidence-based intervention to support the development of feeding skills. Objectives: To assess the effect of educational intervention on neonatal nurses’ practices regarding oral Motor stimulation on early transition from to oral oral feeding in preterm infants. Methods: A quasi-experimental single group study conducted in Children Hospital Lahore from May to July 2023. Pre and post intervention data was collected through the observational checklist from 36 nurses working in Neonatology. Nurses were educated through PowerPoint presentation and direct demonstration on infants. Results: Descriptive statistics showed that Majority of nurses were having diploma in nursing, 4-10 years’ experience and belonged to 31-45 years age category. In inferential statistics Paired sample t-test revealed that the majority of nurses (100%, n=36) had incompetent practices before training which were improved (91.6%, n=33) after educational intervention with significant p-value<0.05. Conclusions: The nurses who received training revealed competent practices so we conclude that educational intervention was effective to improve the nurses’ practices.

Effects of Early Mobilization on Pain Among Children Post Appendectomy at Children Hospital Lahore

Early mobilization means interval starting with initial physiologic mobilization and continuing through the hospital stay. Mobilization includes the activities that help critical patients to move, and ambulate with or without assistance using a walker and/or support from staff. Objective: To assess the effect of Early Mobilization on pain and wound healing among children post appendectomy. Methods: A randomized control study was conducted from December 2022 to August 2023 at the Children hospital Lahore. The target population consisted of children undergone appendectomy at Children hospital Lahore. A random sample of n=26 was recruited. Validated tool was used for data collection from participants to assess the pain in the control and interventional group. Initially, Pre-assessment was conducted to obtain pain scores, then the intervention as early mobilization was provided to the interventional group while the control group was observed with usual care. After the intervention in the post assessment, the data were collected from the control and interventional group to compare the effect of intervention. Results: The study results revealed that after the intervention, the assessment at 1st follow-up showed somewhat significant difference in control and interventional group scores of pains. A significant mean difference was found on pain between control and interventional group scores at the 2nd follow up where z (-2.056) =, p value=0.040. Conclusions: Overall, these findings suggest that early mobilization intervention has a positive and statistically significant impact on reducing mean pain scores.

Risk Factors and Prevalence of Spina Bifida in Children Reported at Children Hospital (Lahore): A Mix Method Analysis

Pakistan is the country with more than 100 million children and spina bifida is a neural tube defect that commonly affects children. Folic acid deficiency during the initial three weeks of pregnancy has been identified as a significant causative factor. However, other factors and their effects vary based on geographic location, maternal pregnancy history, child sex, and race. This cross sectional study aimed to investigate the factors contributing to the incidence rate of spina bifida in Lahore, Pakistan. A total of 200 cases of neural tube defects, including spina bifida, were studied and reported from October 2012 to August 2013 at Children's Hospital Lahore. Various factors were examined, such as the age of mothers, with 50% of babies with neural tube defects born to mothers aged between 26 and 36 years. The incidence of spina bifida was found to be higher in boys (59%) compared to girls (41%). Hydrocephalus, a common complication of spina bifida, was more prevalent in boys (51%) than in girls (14%). Spina bifida cystica, another form of the condition, occurred more frequently in girls (38%) than in boys (33%). In this study group, 161 out of 200 women did not use or properly use folic acid during pregnancy, indicating a lack of awareness regarding its importance. The study also revealed that 119 cases of spina bifida occurred during winter, suggesting a seasonal influence on the condition. In addition to other identified risk factors, this study underscores the critical need for raising awareness about the use of folic acid before conception and during the initial three weeks of pregnancy.

Gender and its association with cardiac defects in down syndrome population at Children Hospital & Institute of Child Health, Lahore, Pakistan.

The objective of this study was to determine the frequency of different congenital cardiac defects co-existing in karyotypically proved Down syndrome population. It also highlighted the association between gender and pattern of congenital cardiac defects and gender as a risk factor. A cross sectional comparative study was done in the Department of Genetics, Children Hospital Lahore in the year 2017. A total of 160 patients were subjected to karyotypic analysis through blood test for determining the type of Down Syndrome and Echocardiography of all established cases was performed for determining presence and types of congenital cardiac defects. Results were evaluated in terms of establishing co-existence of various cardiac phenotypes in Down Syndrome cases. In karyotypically proven 160 cases of Down syndrome, 58.1% of Down Syndrome cases and 88.2% of Down Syndrome with Congenital Cardiac Defects presented in infancy. The odds ratio (OR) suggested that females are 1.72 times more likely to experience a cardiac effect compared to males. Female gender was potentially associated (p-value 0.07) with occurrence of Patent Ductus Arteriosus (47.8%), whereas VSD (Ventricular Septal Defects) was most prevalent (41.1%) in males. Patent Ductus Arteriosus + Atrial Septal Defects (44.4%) was the commonest cardiac defect in female cases. The combined data for pattern of cardiac anomalies showed no significant association with gender, as indicated by a p-value of 0.990. The study concluded that most of Down syndrome cases and Down syndrome with congenital cardiac defects present to the hospital in infancy. Female cases are more prone to develop cardiac defects as compared to males. The manifestation of PDA (Patent Ductus Arteriosus) was significantly associated as an isolated anomaly in females and VSD (Ventricular Septal Defects) as isolated anomaly in males. Patent Ductus Arteriosus tend to co-exist most with ASD (Atrial Septal Defects) in female cases. Gender was not established as a risk factor for affecting the pattern of cardiac defects.

Prevalence of A2 and A2B Subgroups among Blood Groups A and AB in healthy donors.

To determine the frequency of A2 and A2B subgroups among blood groups A and AB in healthy donors. It was a Cross-Sectional study, conducted at the Department of Hematology & Transfusion Medicine, UCHS, The Children's Hospital Lahore and Sundas foundation Lahore from June 2022 to December 2022 including 13,120 healthy blood donors of both genders, after taking informed consent. Venous blood samples of donors were collected in EDTA vials (3ml) and serum gel vial for routine blood grouping which was done by standard tube method. Further testing of donors positive for an antigen (blood Group-A and AB) was performed using anti-A1 lectin by standard tube method as per manufacturer's instruction. The data was analyzed using SPSS version 23. Among 13120 blood donors, 12857 (97.9%) were male and 263 (2.0%) were female with mean age of 36.7 years ± 15.04 years. Majority of them (91.7%) were of Punjabi ethnicity. Donors having blood group phenotype A and AB were 3890 (29.6%). Among blood Group-A donors, A1 was found in 97.8% and A2 in 2.2% donors. While among Blood Group-AB, 96.7% donors belonged to A1B blood group and 3.2% belonged to A2B blood group. Blood group A2 and A2B do exist in blood donors of Punjabi ethnicity. The knowledge of presence of these blood groups' phenotypes in our population can provide a better base for transfusion staff to do troubleshooting in compatibility testing and to avoid any rare but hazardous transfusion outcome.

Frequency of Aplastic Anemia in Children (1-15 years) with New-Onset Pancytopenia

Background: Pancytopenia is a medical disorder in which the usual quantities of red blood cells, white blood cells, and platelets are depleted. This condition can arise from various factors, including diminished production of hematopoietic cells, ineffective hematopoiesis, or the destruction of these cells in the peripheral blood. Objective: To determine the frequency of aplastic anemia in children (1-15 years) with new-onset pancytopenia presenting at Children Hospital Lahore. Study Design: Cross sectional study. Settings: Department of Pediatric Medicine, Children Hospital, Lahore Pakistan. Duration: From August 2022 January 2023. Methods: This research included 250 children, covering both genders, with ages ranging from 1 month to 15 years old. These children had all been diagnosed with pancytopenia within the past month. The primary focus of the study was to determine the prevalence of aplastic anemia within this group of children. This prevalence was then examined in relation to their age, gender, and socioeconomic backgrounds. Results: The patient group had a mean age of 6.74 years, primarily consisting of children aged 1-10 years (86.4%). Gender distribution was fairly balanced, with 55.2% males and 44.8% females. Most patients belonged to the middle class (48.8%), followed by the lower class (35.2%) and high class (16.0%). Pallor was the most common, with 86.36% of patients experiencing it. Fever and bruises/purpura were also frequent, affecting 64.55% and 59.55% of patients, respectively. Aplastic anemia was observed in 33.60% of the children, while 66.4% did not have this condition. Conclusion: In children who had recently developed pancytopenia, the incidence of aplastic anemia was determined to be 33.60%. Interestingly, no noteworthy disparities in the occurrence of aplastic anemia were observed with regard to age, gender, or socioeconomic status.

A Descriptive Study on Management of Neonatal Jaundice in Children Hospital Lahore

A Descriptive Study on Management of Neonatal Jaundice in Children Hospital Lahore

Knowledge and Practice of Healthcare Workers Regarding the Healthcare Waste Management

Background: Healthcare waste management (HWM) issues are getting worse in Pakistan since there are more and more hospitals, clinics, diagnostic labs, etc. One of the major individuals in charge of properly managing healthcare wastes at any healthcare facility is the medical staff. But how well you perform will rely on how much you know and do about waste management. Aim: To ascertain the knowledge and practice of healthcare professionals about the management of healthcare waste. Study design: Cross-sectional descriptive study. Methodology: The Children Hospital Lahore has conducted the current study. The current study included 400 participants. Structured, pre-tested, and self-administered questionnaires were used to collect data. The survey was cleaned, revised, and reviewed for completeness. The analysis of the data was done using SPSS 23. Results: 400 individuals were involved, 174(43.5%) of whom had sufficient understanding of health care waste management, whereas 226(56.5%) had insufficient knowledge. Of the 400 participants, 188(47%) had good practice managing medical waste, whereas the remaining 212(50%) had bad practice. Practical Implication: This study helped researchers investigate the knowledge and practice of health workers. It would help in estimating the practice and knowledge of health waste management by health care workers. Conclusion: It was determined that most workers had inadequate knowledge of waste management and had poor practice on health care waste management. All employees must receive the appropriate training and supervision in HCW management, as well as pertinent and continuous in-service training, to ensure that they have the necessary information, attitudes, and safe practices. Keywords: Health Care Workers, Waste Management, Knowledge, Practices and Training.

Functional outcome of Hirschsprung's disease in children: A single center study at The Children's Hospital Lahore.

Hirschsprung's disease (HD) is a congenital bowel disorder resulting in functional dysmotility. Advancement in surgical techniques has improved outcomes, but recent studies have identified problems having significant impact on patient's quality of life. The aim of this study is to analyze postoperative functional outcome after definitive surgery for Hirschsprung's disease. A retrospective study was conducted at the Department of Pediatric Surgery, The Children's Hospital Lahore. The record of 64 patients was reviewed from the year 2009 to 2019. Parents were interviewed on phone calls and a predesigned questionnaire was filled. Degree of constipation, incontinence and voluntary bowel movements was analyzed according to Krickenbeck classification. Median age at initial presentation was 11days, with male to female ratio of 3.9:1. Most common presentation was delayed passage of meconium (38%). Diagnosis was made on biopsy in 70.3%, but contrast enema and biopsy in 29.7%. Aganglionosis was limited to short segment in 81.3% and long segment in 14.5%. Decompressing enterostomy was made in 63% at a mean age of 191days. Definitive surgery included Duhamel pull-through in 89.1%. Mean age at follow-up was 10.6 ± 4.19years and alive patients were 95.4%. Postoperative enterocolitis was reported by 27%, while 35.5% reported fecal incontinence and 16.1% complained of constipation.80% could voluntarilyhold bowel movement, among which 5% had a feeling of urge and 15% had the capacity to verbalize. In 25% of thepatients, fecal incontinence was a constant social problem and in 25% of these patients constipation was resistant to diet and laxatives. On long-term follow-up, fecal incontinence was more worrisome, affecting quality of life and requiring help of the bowel management program. Such patients need close follow-up after definitive procedure, so that they have normal stooling habits in their adulthood and lead a normal life.

REASONS OF DONOR DEFERRAL FOR A SINGLE DONOR PLATELETPHERESIS IN A PUBLIC SECTOR BLOOD TRANSFUSION CENTRE OF LAHORE: A CROSS-SECTIONAL STUDY

Background and Objective: Plateletpheresis is a process by which platelets are extracted from the donor. Donor selection is critical since donors are the sole supply of blood available to satisfy demand. The goal of this study is to investigate the causes behind plateletpheresis donor deferral in order to ensure safe blood donation. Materials and Methods: The research was carried out at the department of Haematology and Transfusion Medicine University of Child Health Sciences, The Children Hospital Lahore. 50 plateletpheresis donors who voluntarily came for donation were considered for the procedure as per guidelines and departmental standard operating procedure. The details of the procedure of plateletpheresis were explained to each donor. Donor questionnaire was filled including brief history, general physical examination, Haematological parameters such as haemoglobin and the donor blood screening was done to be considered fit for procedure. The reasons for deferral of donors were noted after all work up was done. Informed consent was taken before the procedure. Plateletpheresis was done using COM.TEC Cell Separator instrument. Results: In this study 50 donors were included. Out of 50 donors 34 were approved for procedure and 16 were deferred due to different temporary and permanent reasons. The age of the donors were in between 18 to 50 years. Major reason for temporary deferral was poor venous access (n=7, 14%) followed by the low haemoglobin value (n=4, 8%). Other reasons for temporary deferral were history of medication (n=3, 6%), low platelet count (n=4,8%), history of blood transfusion (n=1, 2%), history of vaccination n=2, 4%), leucocytosis (n=1, 2%), underweight (n=4, 8%), fever (n=1, 2%), refusal after questionnaire (n=1, 2%), seropositive for malaria and VDRL (n=3, 6%), high blood pressure (n=1, 2%), and anxiety (n=1, 2%). Permanent reasons for deferral were seropositive for HbsAg (n=2, 4%), seropositive for HCV (n=4, 8%) and tattoo (n=1, 2%). Conclusion: This study found a pattern of donor deferral in single donor platelet apheresis that was our experience in single centre. In conclusion during the selection of donors, Transfusion services should be very careful related to donor safety measures and these causes of deferral should be kept in mind.

Surgical Smoke Inhalation, Its Hazards And Prevention Among Paediatric Surgery Residents In Pakistan.

For thousands of years human beings have been using heat as a source of ligature and to treat the wound either it's from the trauma or fought in the wars. In 1854 an imminent surgeon Albrecht Theodor Middendorf published a paper on the application of electrocautery in surgical operations. The objective of the present study was to analyze the hazards of surgical smoke inhalation in Paediatric Surgery residents and to create awareness of its signs and symptoms, risk factors and utilizing preventive measures. A Cross-sectional study was conducted involving all the Paediatric Surgery residents enrolled on a supervised training program in Pakistan between 1st July 2022 to 30th June 2023 at all the tertiary care hospitals in Pakistan. Their socio-demographic, academic data, signs and symptoms and risk factors were calculated. Data was analyzed with descriptive and comparative analysis using SPSS. A Pearson contingency coefficient is used to determine the association between categorical variables. Our study included all the Paediatric Surgery residents in Pakistan n=155 over one year starting from July 1st 2022 to June 30th 2023. N=75 (48.4%) were males and n=80 (52.6%) were female residents. Their mean age was 29.5 years±4 (SD). 41% of the residents were from Khyber Teaching Hospital Peshawar, 32% from The Children's Hospital Lahore, 14% from National Institute of Child Health Karachi, 9.8% from The Children's Hospital Islamabad (PIMS) and 5.2% from Lady Reading Hospital Peshawar. N=135 (87.1%) of the residents used electrocautery while performing the surgery (p=0.006). N=121 (78.1%) were aware of its hazards (p=0.341). 90% think they are at an increased risk (p=0.032). Most of them (84.6%) wear a surgical mask while only (64%) wear protective equipment (p=0.321). Think they are at an increased risk of cancers (83.9%) (p=0.002) and should be screened (93.7%) (p=0.343). Paediatric Surgery residents are at an increased risk of surgical smoke inhalation, pointing to the emerging need to adopt protective measures by creating awareness, and utilizing health safety checklists and smoke evacuation mechanisms in operation rooms. All residents should seek knowledge on the subject and use personal protective equipment for less harmful effects on their health.

SPECTRUM OF CYTOGENETIC ABNORMALITIES IN PEDIATRIC PATIENTS WITH ACUTE MYELOID LEUKEMIA

Objective: To determine the frequency and types of cytogenetic abnormalities in pediatric Acute Myeloid Leukemia. Material and Methods: This cross-sectional study was conducted from January 2021 to October 2021 in Hematology department of the CHUGHTAI Institute of Pathology in Lahore Pakistan. Total 60 patients who were newly diagnosed with Acute myeloid leukemia in CHUGHTAI Institute of Pathology and were also referred from Children Hospital Lahore were included. Patients under the age of 16 years and from both gender were included. Informed consent was taken from patient’s guardian/parents. Patients had their bone marrow aspirates processed for standard G-banding and their karyotypes were examined using a cyto-vision system, where the number of chromosomes was counted and examined for any changes, such as damaged, missing, rearranged, or additional copies of chromosomes. Morphology, immunophenotyping of aspirate, and trephine biopsy are used to make the diagnosis of AML. Data was entered in SPSS version 23.0. Result: There were total 60 patients included in the study. The mean age was 10.2+ 3.2 years. There were n=32(53.3%) males and n=28(46.6%) female. Normal karyotype was observed in n=36(60%) patients, abnormal were seen in n=14(23.3%) and unsuccessful was shown in n=10(16.6%) patients. Favorable cytogenetic results were seen in n=6 (10%), intermediate in n=41 (68.3%), and unfavorable in n=4 (6.6%) cases. t(8;21) (q22:q22) and t(15;17)(q24;q21) were found in 8.3% and 1.6% of our study population respectively which have favorable prognosis . One of our patients had complex cytogenetic abnormalities, including [del5p, del7q, del11q-17+] which shows poor prognosis. Conclusion: The study discovered that 14 (23.3%) of the total pediatric patients with acute myeloid leukemia showed aberrant cytogenetic abnormalities. Chromosomal abnormalities should be identified as early as possible since they can be used for AML risk stratification and prediction of prognosis. Keywords: Acute myeloid leukemia, Complex cytogenetic, Cyto-vision, Karyotype, Morphology, Pediatric

Frequency of Vitamin B12 Deficiency in patients of Pancytopenia

Background: Vitamin B12 insufficiency is prevalent in developing nations. It often causes megaloblasticanemia, but it may also impact the other two cell lines, i.e. platelets and leukocytes (pancytopenia), and may be misdiagnosed as cancer or bone marrow failure. A therapeutic test may be performed, providing a prompt diagnosis and preventing a high death rate. Aim To find frequency of vitamin B12 deficiency in children having pancytopenia. Methodology: This cross sectional study was done at Children's Hospital &The Institute of Child Health Lahore in 6 months. This study involved 242 children of 6 months to 14 years age of both genders admitted in Children Hospital Lahore and had pancytopenia on their CBC. Results: The age of the patients ranged from 6 months to 14 years with a mean of 6.4±2.8 years. There were 111(45.9%) male and 131 (54.9%) female patients with a male to female ratio of 1:1.2. A total of 6.2% patients were found to have B12 deficiency. Conclusion: It is concluded that, 6.2% of patients with pancytopenia had a deficiency of B12; thus, patients may be routinely evaluated for pancytopenia and its reasons, since many of them are entirely curable and others are managed. Keywords: Vitamin B12 deficiency, cobalamin, Pancytopenia, Megaloblastic

Assessment of Depression in Mothers of Children with Cerebral Palsy

Background: Mothers of children with various degrees of impairment may bear a high amount of stress. Children with chronic medical disorders lead their moms to experience sadness, mental distress, and behavior problems. Aim: To determine the frequency of depression in mothers of children with cerebral palsy. Methodology: This cross sectional study was conducted in OPD of Neurology and Development Department, Children's Hospital Lahore in six months after the approval of synopsis August 20, 2020 till Feb 20, 2020. After taking written informed consent, 196 CP children's mothers were enrolled. Demographic information (including name, age) was also recorded. After admission to hospital detailed history and thorough clinical examinations were carried out to reach the provisional diagnosis. Results: The mean age of children was 6.65±2.23 years with age range of 3 and 10 years. There were 109(55.6%) male and 87(44.4%) female cases with higher male to female ratio. The mean age of mothers was 37.92±7.69 years with age range of 25 and 50 years. There were 115(58.7%) mothers who had depression and 81(41.3%) mothers did not have depression. There were 81(41.3%) mothers who had normal, 33(16.8%) had mild mood disturbance, 24(12.2%) mothers had borderline clinical depression, 23(11.7%) mothers had moderate depression and 35(17.9%) mother had severe depression. Practical implication: This study identifies a greater risk of depression in mothers of CP children, so by the help of this study we can identify such mothers at follow up of CP children and can give them psychiatric attention which can decrease mental health issues in them and would be beneficial for both the mother and their CP children. Conclusion: Depression among mothers of CP child was higher in this study, so these mothers must be given attention through psychiatric education and mental health programs to reduce their depression at the time of their CP children follow up. Keywords: Depression, care taker, disability, cerebral palsy, mental health