Children's Hospital Lahore Research Articles

To Assess the Iron Reserves in Blood Donors by Measuring Serum Ferritin and Hemoglobin in the Children Hospital Lahore

Introduction: Frequent contribution of blood can cause iron exhaustion in blood donors along with the problems related to it. Curtailing the proportion of iron reduction among blood donors is a crucial plan for boosting donor’s well-being. Aim & objectives: The aim of this analysis is to determine iron stocks by measuring serum ferritin in pre-donation male blood donors along with their relation with the hemoglobin concentration and frequency of blood donations. Study design: Cross-sectional study. Place and duration: Pathology (immunohematology) department and blood bank of University of Child Health Sciences, The Children Hospital Lahore from Aug 2021 to July 2022 Material and Methods: A total of 350 serum samples were processed to determine hemoglobin and serum ferritin concentrations. The study involved was performed on healthy blood donors. The method used was chemiluminescence for the simultaneous measurement of serum ferritin. Results: An aggregate of 350 serums were collected from the contributors in blood bank. Among them, 154 were the first-time donor and 196 were the frequent donors; the serum ferritin was markedly reduced in constant contributors. The mean value 105ng/mL was found in infrequent donors and 79.35ng/mL was found in frequent donors. There was no notable variance in hemoglobin of newbie and regular blood givers. However, a momentous variation in the pervasiveness of iron depletion between first‑time and regular donors is found. Conclusion: Blood donation has a noteworthy impact on iron stores and is one of the most important factors for iron shortage in contributors, specifically in those who donate blood again and again. Serum ferritin measurement ought to be incorporated in the blood donor preference especially in the evaluation of consistent blood givers to assure enough iron pools in the donor community in order to sustain a pertinent potential donor.

Alloimmunization and Autoimmunization in Multi-Transfused Thalassemic Patients: A Single Center Study

Aim: To determine frequency of alloimmunization and autoimmunization among the patient of thalassemia with history of multiple blood transfusions. Methods: This study was conducted by consecutive sampling in six months duration from September 2020 to August 2021 at the department of Hematology and blood Transfusion Medicine, of University of Child Health Sciences, The Children's Hospital Lahore. Any patient with a positive Direct antiglobulin test (DAT) was labeled as auto-immunized and a positive indirect antiglobulin test (IAT) was labeled as alloimmunized. Results: Total 90 cases were enrolled with 62% male and 38% females with a mean age 6.04 + 3.3 years (range of age: 7 months to 14 years). Antibody screening and auto-antibodies were positive in 4.4% (n= 4) cases each, and allo-antibodies in 6.7% (n=6) cases (anti-E in 2, anti-C in 2, anti-K and anti-e in 1 each). Among all these patients of beta thalassemia, spleen was enlarged in 71% cases; around half of these were <5 years old. Around 96% had first transfusion <2 years. The frequency of patients positive on DAT, IAT and on anti-body screening was significantly related to the frequency of blood transfusion Practical Implications: Autoantibodies produce a positive direct antiglobulin test (DAT), resulting in hyperhemolysis of red cells in thalassemic patients, which exacerbates the existing alloantibodies factor in children who have received several blood transfusions. The gap between transfusions will be shortened. Routinely, greater emphasis is placed on the identification of allo-antibodies, but auto-antibodies should also be evaluated so that this phenomena may be better understood and handled. This study was conducted to examine the link between a greater transfusion demand and the existence of auto or allo antibodies in Thalassemia patients. I Conclusion: We found Alloimmunization and autoimmunization together not very uncommon in transfusion dependent patients of Thalassemia. The frequency of transfusions is affected in co-existing states. Extended matching, as well as early diagnosis and control of Auto and allo-antibodies both can improve the efficacy of blood transfusion. Keywords: Autoantibodies, IAT, DAT, Coomb’s test, Thalassemia, Allo-immunization

Outcome of Pediatric Neuroblastoma at the Children’s Hospital and Institute of Child Health, Lahore

Objective: To demonstrate outcome of pediatric neuroblastoma at The Children’s Hospital and Institute of Child Health, Lahore. Study design: Descriptive observational study Place and duration: The study was conducted in Pediatric Hematology Oncology department, The Children’s Hospital and the Institute of Child Health, Lahore in twelve months from March 2020 to February 2021. Methodology: Study was conducted on total of 60 patients of diagnosed neuroblastoma. Main variables of study were age, parent’s education, socioeconomic status, traveling distance, LTS, and INSS stage, metastatic sites, tumor size and outcome. SPSS version 23.1 was used for data analysis. Test of significance was applied taking p value ≤0.05 as significant value. Results: Regarding histopathology, fifty eight 96% patients had neuroblastoma while 4% patients had ganglioneuroblastoma. Life threatening symptoms were present in 85% patients. Most common primary sites were suprarenal 45%, retroperitoneum 25%, pre/paravertebral 11%, posterior mediastinal 11%, others 6%. Metastasis were present in 40% patients at diagnosis and most common metastatic sites were bone marrow 21%, bone 8% and both 10%. Six(10%) patients with stage 2 showed complete remission ,2(3%) partial remission, 2(3%) patients with stage 3 achieved complete remission ,19(34%) partial remission, 4(7%) patients with stage3 expired, 18(30%) patients with stage 4 were put on palliation initially, 2(3%) patients with stage 4S showed complete remission. Conclusion: The survival outcomes of children with neuroblastoma who were treated at the children hospital lahore between march-2020 and fab-2021are compareable to those in developed and developing countries. A high level of suspicion for neuroblastoma is necessary, especially in children under five years of age with an abdominal mass. This can only be ensured through proper education of health care providers about this aggressive childhood malignancy. Advanced disease presentation is common, high-risk neuroblastoma is considered challenging and has one of the least favourable outcomes among cancers. Late diagnosis due to cultural and socioeconomic barriers and lack of care at primary care level and poor referral to oncology units owing to deficient health care system are still considered the major contributory factors for poor outcome. However, newer treatment strategies are mandated to improve outcomes in pediatric patients who are at high-risk and display relapse. Moreover, multidisciplinary approach with the establishment of infrastructure is the need of time to provide integrated care. Keywords: Neuroblastoma, Outcome, Management, Children

Blood group discrepancies in leukemia children: A cross sectional study.

Objective: To Estimate the frequency of blood group discrepancies among Leukemia Children. Study Design: Cross Sectional study. Setting: University of Child Health Sciences, The Children Hospital Lahore. Period: October to January 2020. Material & Methods: This study was conducted among patients in CH and ICH Lahore, regarding ABO blood group discrepancies in leukemic patients, in the year 2019. A total of 200 samples were processed in order to detect ABO blood group discrepancies by tube method of blood grouping, using antisera-A, antisera-B, antisera-D for forward grouping and A-cells, B-cells and O-cells for reverse grouping. Auto-control was also run by reacting patient’s cell suspension with the patient’s own serum. The collected data were checked for its completeness, consistency and accuracy before analysis. Results: In this study, a total of 200 subjects were included out of which 122 (61%) were male patients and 78 (39 %) were female. Most common age group was 6-10 years. ALL 157(78.5%) and AML 43(21.5%). Blood group discrepancy was found in 5 (2.5%) and all were of Group I. Conclusion: The study found that leukemia (ALL, AML) results in ABO discrepancies that must be resolved by proper serological workup. Both forward and reverse grouping should be performed to investigate the correct ABO blood group in leukemic patients and accurately matched blood must be transfused to these patients.

Q ANGLE VARIATIONS IN PREADOLESCENT CHILDREN WITH HEMIPLEGIC CEREBRAL PALSY

Background and Aim: Hemiplegic cerebral palsy children presented with wide variations of lower limb kinematics. The normal limb in children with spastic hemiplegic cerebral palsy shows variations in Q angle. So, this study aimed to determine the different values of Q angle from both legs among hemiplegic cerebral palsy children having age between the 7 to 12 years. Methodology: An observational cross-sectional study was conducted by using non-probability convenience sampling technique. 71 diagnosed cases with unilateral cerebral palsy in Mobility Quest clinic Lahore and Children Hospital Lahore were enrolled in the study during the duration of six months from September 2019 to March 2020. The consent was taken from those subjects who fulfill the inclusion criteria (n=71) and assessed by the Goniometer that is used to measure the Q angle in hemiplegic Cerebral palsy. Data entry and analysis was done by using SPSS version 25. Descriptive measures of mean and standard deviation were used to summarize data collection. Results: The study included 71 children diagnosed with unilateral cerebral palsy. The Mean Q angle for hemiplegic CP children in right leg is 14.65 ± 2.8 (Normal Range: 11.71-16.98) and in left leg it is 15.09 ± 3.4(Normal Range: 11.47 -18.33) but it differs with the distribution pattern of hemiplegia. Out of 71 children 39 kids were experienced with right sided weakness while 32 were with left sided weakness. Conclusion: Mean Q angles are higher in the affected leg as compared with the unaffected leg in hemiplegic CP. Q angle increase with age and more in female subjects as compared to male subjects.

HEALTH PROFESSIONAL’S PERCEPTION OF DOMINANT PERSONALITY TRAITS OF STAMMERERS

Background and Aim: Allied health professionals play an important role in therapy of stammering. So, this study was to assess the perception of health professionals regarding different dominant personality traits of stammerers as they devise the therapy and counselling techniques accordingly. Methodology: This observational study was conducted at the department of Developmental and Behavioral Pediatrics; Children Hospital Lahore. The 25 bipolar semantic differential scales developed by Woods and William, was used in this study. A total of 100 health professionals were given the questionnaire. The health professionals involved in this study were Speech and Language Pathologists, Dev. Pediatricians, Occupational Therapists, Physiotherapists, Clinical Psychologists, Special Educationist and Nurses. Results: Sample size of this study was 100. Percentage of females was greater than males (88% vs 12%). Results showed that majority of the participants perceive stammerers as nervous, shy, cooperative, friendly, talkative, sensitive, anxious, fearful, perfectionist, intelligent, emotional, aggressive, self-conscious, self-pitying, guarded, introvert. Conclusion: In this study many health professionals considered that there are many negative personality traits that are dominant among stammerers that had to be addressed seriously. Along with negative traits, there are some positive dominant traits of stammerers according health professionals’ perception.

Analysis of pattern of ABO Blood groups in pediatric diabetic patients – An observational study

Diabetes Mellitus (DM) is the most frequently occurring metabolic disorder, caused by inadequacy in secretion of insulin or malfunction leading to chronic hyperglycemia. Well-established corroborations have been reported in the literature suggesting association of ABO blood group with DM. The available literature focuses on adult population, with limited information of said association in children. Thus this study was aimed to determine the association of ABO blood group with Diabetes in pediatric patients having confirmed diagnosis. This was a comparative cross sectional study conducted from October 2021-January 2022 at Endocrinology Ward, Children Hospital Lahore (CHL), Pakistan. The study was approved by the local research ethics committee of CHL and conducted according to the declaration of Helsinki 2000. Blood grouping was done by forward and reverse methods. A total of 25 patients, including 18 males and 7 females were included. Frequency of blood group B (n=10;40%) was highest followed by blood group O (n=4;16%), A blood group (n=3;12%), and AB (n=1;4%) in males. In females, the blood group AB (n=3;12%) has the highest frequency followed by O (n=2;8%). Blood group A (n=1;4%) and B (n=1;4%) had the same frequency among female diabetic patients

Evaluation of Anemia as a Risk Factor for Lower Respiratory Tract Infection in Children

Background: Acute lower respiratory tract infection being a leading cause of death n children less than five years of age and anemia is the commonest cofactor in these patients seeking medical advice, particularly in developing countries. Aim: To determine the association of anemia with lower respiratory tract infection in children by evaluating the frequency of anemia in children with and without LRTI. Methods: A Case Control Study was carried out at department of Pediatrics, Children hospital Lahore, Institute of child health from 20-1-18 to 20-7-19. Blood was drawn by phlebotomist from each patient included in this study by using disposable and sterile syringes and accurate tubes. Blood samples were used to estimate hemoglobin level by using automatic blood cell counter. Anemia was defined as per operational definition. Children were managed as per standard protocol. Results: In this study risk of anemia was significantly higher among cases i.e. Cases: 54% & Controls: 22%, OR= 4.162, p-value=0.001. Although in all age groups frequency as well as risk of anemia was higher in cases. But children among cases in the elder age group showed statistically significant risk for anemia as compared to children in control group i.e. 31-45 Months. OR= 14.00, p-value=0.013 & 46-60 months: 5.60, p-value=0.027. Conclusion: Children presenting with LRTI possesses significant risk for anemia. Thus, early and accurate diagnosis of anemia in children and treatment of anemia will have a positive effect decreasing pneumonia in children. Keywords: Anemia, Lower respiratory tract infection, Children, association, odds ratio

MEAN LEVEL OF PROTEIN C, PROTEIN S AND ANTITHROMBIN III IN PEDIATRIC NEPHROPATHIC SYNDROME

The triad of clinical symptoms linked with proteinuria of nephrotic range, including hypoalbuminemia and edema, is known as nephrotic syndrome. When body excrete more than40 mg/m2/hr of protein or a first morning protein: creatinine ratio of more than 2-3: 1 then we call it proteinuria of nephrotic range.(1)It is estimated that the vast majority of children with nephrotic syndrome have some form of primary or idiopathic sickness, with minimal change disease being the most prevalent.Thromboembolic consequences are more common in people who have nephrotic syndrome. (2) This study tends to shed light if there is increase or decrease in level of protein C, S or antithrombin III in nephrotic syndrome. OBJECTIVE: To determine the mean level of protein C, protein S and AT Ill in children with nephrotic syndrome. SETTING: The research was conducted at Department of Haematology at Children Hospital Lahore. STUDY DESIGN: Cross sectional study. DURATION OF STUDY: The study was completed in six months from 25-08-2017 to 29-02-2018. DATA COLLECTION PROCEDURE: Patients fulfilling the inclusion criteria were taken for Protein C, Protein S and Antithrombin III assays Collect blood 3ml (9 vol) in 0.109M (3.2%) anticoagulant (1 Vol) and Centrifuge. All centrifuge specimens were run in DIAGNOSTIC STAGO. Results: A total of 100 children with nephrotic syndrome were enrolled after fulfilling inclusion criteria. The mean age of the children was 6.26±2.72 month. 69(69%) were male children. Protein C level was 95.31±16.02, Protein S level 84.05±13.31 and antithrombin III level was 86.50±16.36. Conclusion: Protein C, S and Antithrombin III level were within normal range. Further studies are needed to delineate the exact pathogenesis behind thromboembolic phenomenon in nephrotic syndrome children.

A study of Microorganisms causing wound infections after Elective laparotomy

Any purulent discharge from a closed surgical incision, after surgery, together with signs of inflammation of the surrounding tissue should be considered as Post operative (post-op) wound infection. There are two types of wounds in elective laparotomy: clean and contaminated wound Objective: To find out most causative microorganism involved in post-op wound infection in elective laparotomy cases at the Children Hospital and The Institute of Child Health Sciences, Lahore Pakistan. Methods: It was a prospective observational study conducted on patients who developed wound infection after elective laparotomy. This study was conducted in the surgical Units I and II of Children Hospital Lahore, Lahore, Pakistan. The duration of the study was 11 months from January 2019 to November 2019. 150 patients were included in this study. Data was collected by convenient sampling technique. It was a hospital-based study in which patients from both genders were included. Data was obtained by a questionnaire. Patients were asked for wound condition and surgery details were taken to find out the reasons of wound infection. The data selected was analyzed using SPSS version 21.0. Results: Out of total 150 patients who underwent elective laparotomy, 40% patients were identified with Escherichia Coli, 13.3% patients identified with Pseudomonas species, 13.3% patients had klebsiella, 6.7% patients had Pseudomonas Florescence, 6.7% people had Acinetobacter, 6.7% had Staphylococcus aureus, 13.3% did not show any growth. Conclusions: It was concluded that most abundant microorganism isolated from patients who underwent elective laparotomy was Escherichia coli. The most common reasons for wound infection were increase in number of surgeons and increase in duration of illness.

Reflection as a Learning Tool in Postgraduate Medical Education.

To explore the reflective capacity as a learning tool in pediatric residents. Survey. The Children's Hospital Lahore, Pakistan from 20th March to 30th March 2021. In this cross sectional online survey, the participants were postgraduate residents and registrars of Paediatric Medicine, Paediatric Surgery, and Paediatric Diagnostics, working at The Children's Hospital, Lahore, Pakistan. Reflective practices questionnaire (RPQ) was used for measuring the reflective practices and SPSS-24 for data analysis. Out of a total of 175 study participants, 144 (82.3%) were paediatric medicine residents followed by paediatric surgery 18 (10.3%) and paediatric diagnostic 13 (7.4%) with a slight female preponderance 91 (52%). All years of trainees participated; majority was 4th year trainees 58 (33.1%), and 1st year the lowest 17 (9.7%). The overall mean score of the questionnaire was 69.97 ± 10.79 (95% CI: 68.36 ± 71.58) out of 96 total score. The highest score was of critical appraisal 18.52 ± 3.16 (95% CI: 18.04 ± 18.99) out of 24. There was no difference in mean score of different sub-domains and mean scores based on gender, specialty or year of training (p=>0.05). The overall reflective capacity of paediatric postgraduate residents is good irrespective of specialty, gender or year of training. Critical appraisal of interaction in the reflection is the highest scored domain. Key Words: Postgraduate, Residents, Medical education, Reflection, Practice, Learning tool.

Current Status of Paediatric Cardiac Surgery in Pakistan

This study is aimed to assess current status of paediatric cardiac surgery in Pakistan regarding the available procedures, hospitals and number of patients being treated. Data was collected through related published articles on PubMed, Google Scholar, ResearchGate and hospital websites. Pakistan has a prevalence of approximately 60,000 births with Congenital Heart Diseases (CHD) each year. With a population of 200 million and only 17 paediatric cardiac surgeons in Pakistan, the current ratio is 0.08 surgeons / million for Pakistan. 3000-4000 paediatric cardiac surgical procedures are performed each year in Punjab, 1400-1500 surgeries per year in Sindh, some surgeries being performed in Khyber Pakhtunkhwa (KPK) while there is no such facility in Baluchistan, Azad Jammu & Kashmir (AJK) and Gilgit Baltistan. Children's Hospital Lahore performs about 1100 surgeries per year, Ittefaq Hospital (IHL) about 950, Armed Forces Institute of Cardiology Rawalpindi (AFIC) conducts about 900, University of Lahore Teaching Hospital Lahore (UOLTH) about 200 cases, National Institute of Cardiovascular Disease (NICVD) about 1500 and Agha Khan University Hospital (AKUH) about 400 cases per year. There is a huge patient load but a lack of resources as well as trained staff and infrastructure. Methods: Publications were systematically searched on PubMed, Google Scholar and ResearchGate using the key words ‘paediatric cardiac surgery’, ‘quality measures for paediatric cardiac surgery’, ‘paediatric cardiac surgery current status in Pakistan’. 31 articles were found related to our topic and were included. More over data was also collected from official websites of NICVD, Children Hospital Lahore and Pakistan Children’s Heart Foundation (PCHF).

Association of body mass index with fitness index among male and female physical therapy students in Lahore

Background: Body Mass Index is an important predictor of physical fitness that needs to be addressed in job-related work in physical therapy profession. Objectives: To determine the association of BMI with fitness Index among physical therapy students. Methods: This was a cross-sectional associational study. The Sample of 156 undergraduate students between the ages of 20 to 30 years was included. By using a convenient sampling technique, data was collected from Azra Naheed Medical College and the Institute of Child Health and Children Hospital Lahore after ethical approval on 30th January 2018 from Azra Naheed Medical College. Harvard Step Index was used for measuring Fitness Index and Body Mass Index was measured using height and weight. SPSS 22 version was used for the analysis of outcomes of interest. Results: In our study 85 (54.4%) females and 71 (45.51%) males students with mean age of 25.4+4.6 participated. In male physiotherapy students, 11 (17.18%) out of 64 were excellent in physical fitness, 12 (18.75%) were good, 4 (6.25%) were average, 4 (6.25%) were low average and 54 (57.44%) were poor. While in female physiotherapy students only 6 (6.59%) out of 91 were excellent, 18 (19.78%) were good, 5 (5.49%) above average, 2 (2.19%) were low average and 40 (43.95%) were poor. Regarding BMI and Fitness Index, 47 (30.12%) had poor, while 28 (17.94%) had good and 14 (8.94%) had excellent fitness level. Conclusion: The study concluded that Physical therapy students were not having good fitness level. The male students were found fit compared to females, but they were also not to optimum required level of fitness. P value calculated through chi square test was 0.00 showed BMI and physical fitness was associated to each other.

Socio-Economic Challenges in Childhood Cancer Care in a Low-Middle-Income Country

Background: Each year, it is estimated that over 200 000 children and adolescents are diagnosed with cancer, and 80% of these reside in low-middle-income countries, with 90% mortality. There are enormous psychosocial needs of these patients, families, and care-givers, which are primarily affected by the communities' social, economic, cultural, and religious factors. Aim: To elucidate the significant psychosocial and socio-economic issues faced by the caregivers of children suffering from different types of cancer at the Children's Hospital Lahore. Study design: Prospective cohort study Place and duration of study: Department of Paediatric Hematology and Oncology, Children's Hospital Lahore Pakistan from 1st January 2018 to 30th June 2018 Methodology: Two hundred family members/caregivers of the patients were enrolled with ages ranging from <1 to 15 years (43% <5 years and 57% >5years old). Results: Male to female ratio was 1.2:1. 52% belonged to hematological malignancies and 48% from solid tumor groups. Most of these children had malnutrition with anemia (81% with Hb <10g%) and small weight forage in 63% cases at presentation. 80% of families had more than three children, with the youngest child being less than five years in 75%. 95% of families relied on public transport, with 65% of them traveling 100-500Km with 2-10 hours duration to reach the primary treatment center. 80% had a monthly income of less than USD150. 68% of these families had to borrow money for trip to hospital (p-Value=0.003), and 58% took a loan for treatment course. Conclusion: The significant socio-economic challenges faced by these families and caregivers included large family size with low incomes increasing their financial difficulties, logistic burden like traveling long distances to access health care, and parental employment and family dynamics disruptions. Keywords: Socioeconomic Challenges, Childhood Cancer, Low-Middle-Income Countries

Coordination Difficulties in the Management of Operation Theatre in Children Hospital Lahore.

An operation theatre is any facility within a hospital domain where the surgical procedures are carried out in a strict sterile cosmos. Management of the operation theatre requires the coordination of humane and material resources in such a way that surgery can be performed safely, efficiently and cost effectively.Objective: To identify the difficulties in coordination of operating room management and find out their solutions for better patient outcomes.
 Methods: This descriptive study was conducted in Main Operation Theatre of Children Hospital and Institute of Child Health Lahore. Data was collected by using Convenient Sampling Technique. This was a hospital-based study in which staff members of both genders were included. The study population divided into four strata; doctors (surgeons and anesthetists), nurses, operation theatre technicians and anesthesia technicians. A total of 51 cases were observed and checked by a checklist about coordination diffculties in the management of operation theatre.
 Results: A total of 51 cases were studied to determine the difficulties in management of operation theatre. 25.22% cases showed difficulty in proper management of Operation Theater. This result showed that there are still some difficulties like insufficient and old equipments, absence of proper sterilization, lack of proper leadership, work overload, no quality check of equipments, no teaching program, and unpunctuality of staff, improper timing and organization in the operation theater.
 Conclusions: There are many difficulties in management of operation theatre regarding staff members, equipments, timings and sterilization. A proper leadership and organization can sort out these problems.

Assessment of Awareness About Biomedical Waste Among Doctors and Nurses of Children Hospital Lahore

Bio Medical waste refers to any type of waste which is generated during the diagnosis, treatment or immunization of human beings or animals or in research purposes pertaining to or in the fabrication or testing of biologicals.
 Objective: To assess the awareness about bio-medical waste management among Doctors and Nurses of Children Hospital. 
 Methods: Descriptive study was conducted in Children's Hospital and Institute of Child Health Lahore. Convenient Sampling Technique was applied to gather data. This was a hospital-based study in which staff members of both genders were included. The study population divided into two strata and these strata consisted of doctors and nurses. A total of 139 staff members were involved out of which there were 77 doctors, 62 nurses. Their responses checked by a Performa about problems in the management of biomedical waste.
 Results: The result showed that majority (62%) staff members had knowledge about bio-medical waste. The remaining staff had very basic knowledge about bio-medical waste.
 Conclusions: The awareness about BMW management among Children's Hospital Operation theater staff is satisfactory. But still, they need to improve their knowledge to ensure more patient safety by organizing seminars, workshops.

Frequency of hearing impairment in children between the ages of 2 and 10 years with middle ear infection.

This study was conducted on children between 2 and 10 years age to determine the frequency of hearing impairment in middle ear infection. It was a cross-sectional survey, done at Riphah International University from August 2018 to January 2019. Data was collected from the ENT Department of Children's Hospital Lahore through convenience sampling technique and included 52 patients with middle ear infection. Measurements for the level of hearing impairment were taken, and data was analysed using statistical package for social sciences, SPSS 20.0. Of the total 52 patients, 15 (28.8%) had ear infection once a month and 37 (71.2%) had it off and on. Mild hearing loss was determined in 35 (67.3%) patients,13 (25%) had moderate, 2 (3.8%) severe and 2 (3.8%) had normal hearing. It was concluded that most of the children with middle ear infections developed hearing loss.

PLATELET FUNCTION ASSESSMENT AMONG CHILDREN WITH CONGENITAL CYANOTIC HEART DISEASE PRESENTING IN TERTIARY CARE HOSPITAL LAHORE

Objective: The objective of this study was to determine the frequency of platelet dysfunction in congenital cyanotic heart diseases patients presenting to a tertiary care hospital in Lahore. Methodology: A cross sectional survey was carried out from March 2018 to February 2019 in children hospital Lahore. Patients of congenital cyanotic heart disease who fulfilled the inclusion were selected after taking informed consent. Aggregation ability of platelet rich plasma was tested by collagen (1.25μg/ml), ristocetin (1.2mg), epinephrine (5μM) and ADP (2.5μM). Results: There were one hundred and eighty-seven patients of congenital cyanotic heart disease in our study. The minimum age was 1 year and maximum age was 15 years with a mean age 8.02 ± 4.31 years. Platelet dysfunction was diagnosed in 60.4% patients. Conclusion: Platelet dysfunction was found to be high among patients of congenital cyanotic heart diseases.

Infection Prevention and Control Measures at the Children Hospital Lahore: A My Child Matters Collaborative Project.

PURPOSEInfection prevention among children with cancer is a major challenge at Children Hospital Lahore (CHL), a public health care facility in Pakistan with 1,000 new pediatric cancer admissions annually. The objective has been to reduce infections through collaboration between CHL and the St Jude Children’s Hospital Global Infectious Disease program via a grant by the Sanofi Espoir foundation through the My Child Matters program. The aim of the current study was to describe the effect of the collaborative improvement strategy on existing infection prevention and control (IPC) standards at CHL.MATERIALS AND METHODSOur work was a prospective before-and-after study to improve IPC standards. We compared the WHO Hand Hygiene Self-Assessment Framework and four modules of the St Jude modified Infection Control Assessment Tool (ICAT) scores over a 3-year period. Our strategy included creating a multidisciplinary team of pediatric oncologists, infectious disease physicians, nurses, a microbiologist, and a data manager; engaging in monthly online IPC mentoring sessions with St Jude Children’s Hospital Global Infectious Disease program and My Child Matters mentors; performing daily inpatient health care–associated infection surveillance rounds; and performing regular hand hygiene training and compliance audits.RESULTSBaseline needs assessment showed health care–associated infections identified by positive blood cultures as 8.7 infections per 1,000 patient-days. Deficient hand hygiene supplies, health education measures, and bed sharing of neutropenic patients were identified as major challenges. Our hand hygiene facility level, per WHO scores, increased from Inadequate to Intermediate/Consolidation by the end of the 3-year implementation (122 v 352 WHO Hand Hygiene Self-Assessment Framework scores). The sink:bed and hand sanitizer:bed ratios improved to 1:6 and 1:1, respectively. The ICAT general infection control module increased by 40% (45 v 78 ICAT scores) and hygiene compliance improved by 20%.CONCLUSIONImplementing a collaborative improvement strategy improved IPC standards in our center, which can be easily replicated in other pediatric oncology centers in lower- and middle-income countries.

The Quality of Life amongst Caregivers of Cancer Patients at Tertiary Care Centers in Lahore, Pakistan

<p><strong>Background and Objective:</strong> Cancer is a leading cause of death worldwide and is initiating an overburden in developing countries. A grave illness, such as cancer, not only affects lives of patients, but also the lives of their caregivers. A caregiver nurtures continuous support, responsibility, concern and care hence,undergoes immense psychological distress because of the fear of losing their loved one, thus affecting their own quality of life (QOL). The study aims to assess the QOL of caregivers of cancer patients by using the World Health Organization Quality of Life Instrument (WHOQOL BREF) Questionnaire.<br /><strong>Methods: </strong>This cross-sectional study of caregivers of cancer patient’s was carried out at INMOL, MayoHospital, Jinnah Hospital and Children Hospital Lahore within 6 months in 2017. Interviews of 267 caregivers of diagnosed cancer patients were taken using WHOQOL BREF Questionnaire. Information was collected regarding QOL of caregivers and socio-demographic variables. Statistical Package for the Social Sciences (SPSS) software was used for data compilation and analysis hence taking P-value ≤0.05 as significant.<br /><strong>Results: </strong>The study results suggest that several conditions obtain an impact on the QOL of caregivers. For all measures the higher the score calculated the better the QOL. The caregivers of cancer patients reported the lowest mean score (6.89 ± 1.56) in general health and QOL. Caregiver’s low educational status, marriedstature, along-with their own current illness and health problems described lowest mean scores in QOL.<br /><strong>Conclusion:</strong> The results of this study provided information that caregivers revealed a low QOL. Therefore understanding of several aspects affecting the QOL of caregivers may assist in improving their ability to care for patients and themselves. Initiation of patient care training programs for caregivers would be helpful.</p>