Clinical Profile Of Pediatric Patients Research Articles

Clinical Profile of Pediatric Patients with Steroid-resistant Nephrotic Syndrome Treated by Cyclophosphamide, Cyclosporin A, Mycophenolate Mofetile and Tacrolimus in Hasan Sadikin General Hospital

BackgroundSteroid-resistant nephrotic syndrome is a major cause of chronic kidney disease in children and adolescents. These diseases require appropriate management, while in some developing countries, the availability of agents recommended by international guidelines is very limited.Research objectivesTo determine and describe the patient profiles of pediatric Steroid Resistant Nephrotic Syndrome (SRNS) that use Cyclophosphamide(CPA), Cyclosporine(CyA), Tacrolimus, and Mycofenolat Mofetil (MMF) in Dr. Hasan Sadikin Hospital (RSHS), Bandung as a tertiary hospital in West Java, Indonesia.Methods and materialsThis research used a retrospective study with cross-sectional study design, total sampling method and medical record of pediatric (1-18 years old) patients from January 1st 2017–September 31st 2019 who were diagnosed as SRNS .Results : From 99 subjects that belonged to inclusion criteria, 35.4% pediatric SRNS patients were in the age group 6-10 years and 60.6% were males. Laboratorium profiles showed among all population, ureum <100 mg/dL were found as high as 97%, creatinine 0.3-1.0 mg/dL (71.7%) albumin >2,5 gr/dL (51.5%), negative hematuria (68.7%) , protein dipstick < 3 (50.5%), and LFG > 90 mL/min/1.73 m2 (79.8%).. The patients generally had use CPA (87.9%) and remission <6 month (51.5%).Conclusion: Profiles of pediatric patients are important to diagnose and prognose SRNS. By using these approaches, it is feasible to access and detect the most effective treatment for SRNS.

Clinical Profile of Paediatric Patients Admitted with Dengue Fever in a Tertiary Care Hospital of North India

Background: Dengue, a viral disease transmitted by mosquitoes, is the fastest spreading mosquito-borne illnessin human history, with its global incidence increasing 30-times over the past fifty years. This is a prospectivestudy with the aim to study clinical manifestation of dengue in children diagnosed admitted in a medical collegeHospital in Jammu, India.Methods: The study was conducted on 300 children admitted as dengue fever in a tertiary care hospital from October2022 to December 2022. Paediatric patients who were admitted with symptoms like fever, headache, myalgia,vomiting etc. were evaluated with other clinical features (warning signs of dengue fever, signs of haemorrhage,signs of plasma leakage and signs of shock) and the other causes of fever other than Dengue were rule out.Results: Sixty three percent (63.3%) of patients were adolescents (age >10 Years) and most common symptom wasfever (83%) while as bleeding manifestations was seen in 9.3% and Dengue Shock Syndrome 7.7% patients.Conclusion: Study emphasizes that being the disease with panic, can be well managed to go beyond just a feverinto haemorrhage and shock by timely identification clinically and laboratory methods and followed by appropriateintervention.

Clinical Presentation of Acute Kidney Injury in Pediatric; Dr Salma Dialysis Center 2022

BACKGROUND: Unlike in developed countries, where AKI typically develops in older patients with systemic diseases, multiple co-morbidities, and multiorgan failure, AKI in developing countries primarily affects young individuals, particularly children and adolescents, and is often caused by a single factor. Although early detection and management can reduce complications, there is limited data available from Africa on this disease. AIM: This study aims to describe the sociodemographic characteristics and clinical profile of pediatric patients with AKI presenting to Salma Dialysis Center from 2017 to 2021. METHODS: A hospital-based descriptive cross-sectional study was conducted at Salma Dialysis Center in Khartoum, Sudan. Patients' hospital records from January 2017 to December 2021 were reviewed to gather information on clinical presentation, investigations, treatment, and patient outcomes. RESULTS: Out of the 76 patients included in the study, 60.5% were males, with a median age of 8.0 years (range 0.09-17). Approximately 39.5% of the patients were from Khartoum state. The most common presenting symptoms were fever, generalized swelling, and changes in urine colour. The mean blood urea and creatinine levels were 1.6 mg/dl (range 0.2-23.8) and 82.0 mg/dl (range 9-416), respectively. The most common causes of AKI were malaria, sepsis, and sickle cell nephropathy. The majority of patients did not require dialysis and recovered without complications (84.2%). CONCLUSION: Malaria was found to be the most common cause of AKI in pediatric patients, with a higher prevalence among male patients. The prognosis for these patients was generally favourable.

A CLINICAL STUDY OF INTUSSUSCEPTION IN CHILDREN

A CLINICAL STUDY OF INTUSSUSCEPTION IN CHILDREN

Socio-Demographic and Clinical Profile of Pediatric Patients Who Consulted At the Out-Patient Department of A Psychiatric Facility in Southern Philippines from 2015 To 2019

Objective: This study aimed to describe the sociodemographic and clinical profile of pediatric patients who consulted at the Out-Patient Department of a psychiatric facility in Davao City, ie. Southern Philippines Medical Center Institute of Psychiatry and Behavioral Medicine and provide baseline data for future research and program development. Methodology: This is a descriptive chart review that used a purposive sampling method to determine the sociodemographic and clinical profile of patients below nineteen (19) years old, seen at the Out-Patient Department of a psychiatric facility from January 2015 to December 2019. Results: A total of 427 charts were reviewed in this study. Majority (30.2%) of the study population had their first consult in 2019, female (56%), belonged to the 12-18 age group (64%), and had high school education (43%). Most came from Davao Region (89%) with class D social classification (64%). The clinical profile showed that majority consulted due to forensic reasons (54%), with referrals coming from WCPU, courts, or police stations (54%). Sexual abuse (43.9%) was the most common cause for forensic consult. The most common diagnosis was clustered under Adverse Childhood Experiences (30%). Most were advised referral to the psychology unit (59%) and were discharged as Out-patient (97%). Conclusion: The number of child and adolescent consults in the Out-Patient Department of a psychiatric facility steadily increased within the span of five years. Majority of the patients came in for forensic reasons, with sexual abuse as the highest. A third of the consults were diagnosed to have Adverse Childhood Experience.

Parent-Child Connectedness as Predictor of Risky Sexual Behaviour Among Adolescents in The Assin South District, Ghana

Background: Lack of connectedness between adolescents and their parents has been found to affect adolescent development and decision-making negatively. This study investigates the parent-child connectedness (PCC) and risky sexual behaviour using Assin South District as a case study. Methods: A cross-sectional descriptive design was employed with 354 respondents which comprised parents aged 30-59 years and older adolescents aged 15-19 years. Data were analysed using descriptive statistics, Pearson’s chi-squared test of independence and binary logistic regression. Results: The study revealed that offering encouragement to adolescents on their own ideas and respecting their individuality was statistically significant at P<0.022, (OR=7.486, 95%CI[1.331-42.090]). Again, building child’s charisma was statistically significant at p>0.030, (OR=0.319, 95%CI ([0.114-0.894]), while clarifying messages about risky sexual behaviour was also observed as statistically significant at p>0.014, (OR=5.684, 95%CI[1.420-22.755]). Conclusion: The study recommends that parents provide adolescents with the requisite information aimed at reducing any harmful consequences of behaviour when occurs to the adolescents. Also, parents in the Assin South district should endeavour to encourage their children to talk openly with them (parents) about their ideas, needs, and worries for redress.

Clinical Profile of Pediatric Patients with Neural Tube Defects in a Tertiary Hospital in Davao City, Philippines: A Five-Year Retrospective Study

Objectives : The study aimed to describe the clinical profile of pediatric patients with Neural Tube Defects (NTDs) in a tertiary hospital in Davao City from January 2014 – January 2019. Methodology: The study used retrospective descriptive research design through chart review in the Medical Records Section of a tertiary hospital in Davao City. Pediatric patients 0 to < 19 years old with final diagnosis of neural tube defects and/or its types admitted from January 2014 to January 2019 were included. Results: The main outcome measures of the study were demographic profile of NTD, maternal risk factors, associated congenital anomalies and its outcome. Majority (41%) of NTDs seen from January 2014 to January 2019 were newborns 0-day old presenting with open type of NTDs, 68% of them died before 24 hours of life. The median maternal age upon delivery is between 19 to 34 years old. Its occurrence in both sexes were equally distributed. Maternal infection (24%) followed by poor prenatal check – up (20%) were the identified maternal risk factors for the defect. Teenage mothers have a significant increased risk of having a child with NTD. Cases seen were mostly located in the cranium. Seventy-four percent (74%) of cases reviewed had open type NTDs with myelomeningocoele as the most common subtype. Sixty percent (60%) of the cases were discharged alive but suffered from complications, of which hydrocephalus is the most common. Among the 49 mothers sub-grouped based on history of prenatal intake of folic acid, it revealed that none to poor intake of folic acid is proportional to mothers with poor prenatal check – up. These non - takers of folic acid also have five times chance of bearing anencephalic child. Conclusion: This study supported the government’s mandate on maternal health and nutrition during pregnancy. With NTDs’ high mortality rate and debilitating complications, multidisciplinary management approach and intensification of health prevention strategies are needed to improve the quality of life of every child. Keywords: Neural Tube Defects, Congenital Anomalies, Folic Acid DOI: 10.7176/JHMN/106-04 Publication date: March 31 st 2023

Primary eye care in pediatric population-I study (PREPP-I study): Demographic and clinical profile of pediatric patients treated in six major vision centers of a tertiary eye care facility in South India.

The study intends to evaluate the demographic and clinical profile of pediatric patients (0-18 years) attending six vision centers (VCs) of a tertiary eye care facility in south India. This is a cross-sectional observation study conducted at six major peripheral VCs of a tertiary eye care facility in South India from June 20 to Dec 20. All children presenting at the VCs under a base hospital (BH) in Pondicherry, whose parents gave consent were included. Data were entered by the ophthalmic assistants in the VC and cross checked by the principal investigator at the BH. A total of 250 pediatric patients were brought to the VCs during the study period, predominantly males (60.8%), with a mean age of 8.2 ± 4.5 years (0-18 years). Half of them were staying within 5 km from the VCs. Most children were escorted by their parents (88%), and the expenditure of travel to the VC was affordable for most of the parents (75%). Also, 53.6% of patients were in their primary school, while schooling had not started for 28% of children. Visual acuity (VA) could be assessed only for school-going children and older children due to lack of age-matched VA assessment tools. Most children (91.3%) had uncorrected VA better than or equal to 6/18 in the better eye, and approximately 3% had VA worse than 6/60. All patients had best corrected VA of 6/6-6/18 after cycloplegic refraction. Most children reported to the VC for allergic conjunctivitis (25%), followed by refractive error (13%) and squint (10.4%). Urgent referral to the BH was made for 47 children. Primary eye care in pediatric population-I (PREPP-I) showed that most children can be treated at the VCs and only one-fifth of the children require active intervention at higher referral centers. Further study on satisfaction of services provided for pediatric patients in these VCs and barriers of not reporting to the BH when referred are considered for the PREPP-II study.

Analysis of clinical profile and role of various prognostic factors in early bone marrow response in children with acute lymphoblastic leukemia treated by Modified Multicenter Protocol (MCP) 841 protocol: Experience from a tertiary care center in North India.

It is important to study the clinical profile of pediatric patients with acute lymphoblastic leukemia (ALL) and assess various prognostic factors implicated in response to induction chemotherapy for optimal treatment outcomes in India. The present study was done to evaluate the clinical profile and to find the correlation of day 7 and day 28 marrow blast response with already established prognostic factors in children with ALL in the region of North India using MCP 841 protocol for all patients. A total of 60 children up to ages 14 years with ALL were given treatment in the form of induction remission (MCP-841 protocol) I1 cycle (induction 1) therapy for 29 days. Complete hemogram for blast cells and bone marrow examination (bone marrow aspiration and, if required, bone marrow biopsy) was done on days 7 and 28 (completion of I1 cycle) to see early bone marrow response. Early response to induction therapy was compared in patients with and without high-risk factors, and results were analyzed statistically. Out of 60 enrolled children, 56 (93.4%) patients were in complete remission at the end of induction 1 cycle. Various risk factors were found to be of prognostic significance in first remission and early response to induction therapy were initial total leukocyte count (TLC) at presentation, immunophenotype of ALL; while other factors including age and sex was not found to be significant. Prevalence and significance of various prognostic factors implicated in pediatric ALL tend to be different in various populations. A better understanding of such factors in these populations will help in the tailoring of risk-adapted treatment protocols to local needs.

Socio-demographic and clinical profile of pediatric patients with cerebral palsy in Gujarat, India

PurposeCerebral palsy is a common childhood neurodevelopmental disorder. The estimated prevalence of cerebral palsy in India ranges from 2.1 to 3 per 1000 live births as per published literature. The present study was aimed to study socio-demographic and clinical profiles of cerebral palsy children in the Gujarat state of India.Materials and methodsA total of 481 cerebral palsy children were included from various physiotherapy, rehabilitation, and neurological setups across Gujarat between May 2018 and April 2019. Information regarding gender, age, city of residence, family details, types of cerebral palsy, and gross motor function classification system was collected using a simple survey form designed for the study.ResultThe study showed that 67.57% of children were male and 32.22% were in the age group of 48–96 months. When classified 77.34% had a spastic type of cerebral palsy, out of which diplegic cerebral palsy was reported to be the most common (42.83%). When assessed for functional levels, most of the children were classified in gross motor function classification system levels 3 and 4 (76.30%).ConclusionThe findings of this study support the published data and emphasize the need for a robust and authentic official database of cerebral palsy in Gujarat and India to help in the estimation of the current disease burden and implementation policies for the prevention and management of cerebral palsy.

Pediatric patch testing in a multi‐ethnic Asian population: A retrospective review

Pediatric allergic contact dermatitis (ACD) is increasingly prevalent. Patch testing is the gold-standard diagnostic investigation. The aims of our study were to describe the clinical profile of pediatric patients with ACD in a multi-ethnic Asian population and identify the common contact allergens. This was a retrospective study involving children and adolescents aged 16years or younger with clinically suspected ACD who underwent patch testing between January 2007 and March 2020 at two institutions in Singapore. Information pertaining to their demographics, atopy history, clinical presentation, and patch test results was analyzed. A total of 252 patients were included. The mean age was 10.9years (1.0-16.7years). The majority were Chinese (79.8%) and girls (57.5%). Many (66.3%) had atopic dermatitis (AD), which was mild. The most common presentation was an acral eczematous rash. The sensitization rate was 50.0%. The most frequent reactions were to nickel sulfate (49.2%) and fragrance mix (19.1%). The overall rate of relevant positive patch tests was 72.5%. Patients with AD were less likely to have a reaction to fragrance mix (p=.019) and more likely to have a reaction to disperse blue (p=.041). Compared to younger children, adolescents were less likely to have a positive patch test (p=.008). Indians were also less likely to have a positive reaction (p=.004). Metals and fragrances were the most common allergens causing childhood ACD in Singapore. Patients with AD were less likely to be sensitized to fragrances and more likely to be sensitized to disperse blue dye.

Effects of Rapid Influenza Antigen Test on Antimicrobial Management of Pediatric Patients with Influenza-Like Illness in the Emergency Room

Background: Influenza is a commonly encountered respiratory tract infection and diagnosis remains to be a challenge. Use of a rapid antigen test may influence decisions on treatment in the emergency room (ER). Objectives: This research aims to determine the effects of rapid influenza antigen test (RIAT) on antimicrobial management of influenza-like illness (ILI) in the ER, determine the clinical profile of pediatric patients with ILI and look into the relationship between RIAT result, symptomatology, and immunization status. Methods: This is a cross-sectional study which involved review of charts of 195 pediatric patients with ILI who underwent RIAT (KlintecTM) through a nasopharyngeal swab in the ER of a tertiary hospital from September 2019 to February 2020. Chi-square, Fischer exact test and likelihood ratio were used for data analysis. Results: Most pediatric patients were 7–12 years old males. Majority presented with fever, cough, and colds and underwent RIAT at 2–4 days from onset of illness. About 73.33% of study participants did not receive their yearly influenza vaccine and 70.7% of patients with positive RIAT had no influenza vaccine. There is a lower percentage of vaccinated children who developed cough (86.5% vs. 89.5%) and colds (80.8% vs. 83.2%) when compared with unvaccinated children. RIAT result significantly affected management in terms of antimicrobial prescribing to patients with ILI. Conclusion: Influenza presents with non-specific symptoms and vaccination remains a major preventive measure against the disease. The result of RIAT facilitates targeted treatment for influenza and decreases unnecessary antibacterial use, but this should be done with careful thought and interpretation.

Clinical Profile of Pediatric Patients with Leptospirosis admitted at a Tertiary Government Hospital

Background: In the Philippines, Leptospirosis is a seasonal but common and prevalent disease with an average of 680 cases and 40 deaths annually. Cases result from exposure to contaminated flood, water, or soil. Several studies showed that males are more commonly affected, who are believed to be more exposed to the outdoor environment. In terms of pediatric population, early diagnosis is based mainly on clinical and epidemiological factors. Objective: This study was conducted to determine the clinical features and outcomes of pediatric leptospirosis, as well as determine the prognostic factors associated with mortality. Methodology: A descriptive retrospective study was done in a tertiary hospital from January 2007 – December 2019. Review of all cases that satisfy the diagnosis of Leptospirosis by WHO Criteria (2003) was done. The data extracted from the chart were encoded using Microsoft Excel; processed and analyzed using STATA SE 15 to generate the required output. Results & Conclusion: In this 12-year study, a total of 85 cases of leptospirosis in children, aged 0-18 years, were reported. Leptospirosis predominates in males in the adolescent age group. It is noted all year round but noted mostly during the rainy months which increases the risk to exposure to contaminated water through wading, especially in the cities of Navotas, Malabon and Tondo. The mean duration of symptoms was 3.6 days. The most common clinical findings noted in this study were fever, gastrointestinal symptoms, conjunctival suffusion, oliguria, calf tenderness and headache. Abnormal laboratory findings were leukocytosis, neutrophilia, thrombocytosis, elevated BUN and creatinine, hypokalemia and hyponatremia. Significant correlation with poor outcome was found in patients who have had pulmonary hemorrhage.

Demographic and Clinical Profile of Pediatric patients with Multiple Sclerosis Infected with SARS-Cov2 (4351)

Demographic and Clinical Profile of Pediatric patients with Multiple Sclerosis Infected with SARS-Cov2 (4351)

#1: The Clinico-Epidemiologic Profile and the Correlation of Nutrition and Immunization Status With Outcome of Measles Patients During an Outbreak

Abstract Background Measles is a highly contagious disease that leads to substantial morbidity among pediatric patients. Vaccination has already been implemented in the Philippines, but still measles outbreak is resurgent. This study will be of importance because it can be utilized to establish the factors that lead to the recent measles outbreak. Objectives To describe the demographic and clinical profile of pediatric patients diagnosed with measles during the recent measles outbreak in a tertiary hospital in Central Luzon, Philippines; and to investigate the relationship of nutrition and measles immunization status with the outcomes of measles. Methods Cross-sectional analytic study, conducted in Tertiary training government hospital. Included in the study were less than 19 years old, admitted between January and April 2019, and manifested the following criteria for suspected measles:fever, generalized maculopapular rash, cough, coryza, conjunctivitis. Descriptive statistics was used to present data for the clinico-demographic profile of patients. A correlation study was done by determining the statistical significance of the relationship of nutrition and vaccination status with measles complications and outcomes; and the relationship of complications with outcomes of patients. Results In total, 373 patients were included in this study, 60% (224) were males; 40% (149) were females. The majority was under 0–6 months, 40% (149). Most cases came from Pampanga, 333 (89.2%). A total of 355 (95%) patients were classified as clinically compatible measles, seven (2%) were laboratory confirmed, and all seven had measles IgM antibodies, four (1%) were epidemiologically linked cases. Most of the cases manifested the classic symptoms of measles: fever 100%, rashes 99%, cough 96%, colds 84%, conjunctivitis 55%, and Koplik’s spots was seen in only 13%. As to exposure, those with exposure (49%) and without exposure (51%) are almost the same. The majority of the patients (285, 76%) had no measles vaccine and the top reason for non-immunization is the issue of the patients being too young for vaccination. The majority had normal nutritional status (72.4%). Three hundred and twelve patients reported the occurrence of clinical complications in patients with measles. Pneumonia was seen in 75% of cases and 9.3% had diarrhea. The occurrence of diarrhea is not directly correlated (P = 0.823) with the outcome of measles while Pneumonia shows a significant correlation (P < 0.001) with the outcome of measles. Death among patients was seen in cases with pneumonia. The occurrence of pneumonia is not significantly correlated with nutritional status (P = 0.083) while diarrhea is significantly correlated with nutritional status(P = 0.027). Two hundred and forty-eight patients with normal nutritional status did not develop diarrhea. Vaccination status shows a significant correlation with the occurrence of pneumonia(P =0.001). Out of the 285 non-vaccinated cases, 223 developed pneumonia. Vaccination status did not show a significant correlation with the occurrence of diarrhea (P = 0.946). Nutritional status and vaccination status was not significantly correlated with measles outcome(P = 0.605 and 0.120).In terms of outcome, 90% of the patients were discharged while 10% died. Conclusion Most were males, aged 0 to 6 months. There was a clustering of cases in Pampanga. The majority was classified as clinically compatible measles. The most common complication was pneumonia. Half had exposure to measles. The majority had no vaccine. The presence of diarrhea is significantly related to nutritional status. Pneumonia is significantly correlated with vaccination status and the outcome of measles. Most of the patients were discharged.

Clinical Profile of Pediatric Patients with Acyanotic Congenital Heart Disease in Dr. Soetomo General Hospital Surabaya

Congenital Heart Diseases (CHD) are classified as Acyanotic or Cyanotic CHD. Prevalence of CHDaccording to various studies is 8-10 per 1000 live births worldwide, 10% of cases became infant mortalityin developing countries. This research aims to study the characteristics and clinical presentations in childrenwith acyanotic CHD in Dr. Soetomo General Hospital. A retrospective observational study from children withacyanotic type of CHD from medical record outpatient clinic in the Division of Neonatology and PediatricWard at Dr. Soetomo General Hospital from June to December 2016. Age, sex, heart defect, comorbid andnutritional status were taken from the medical record. The most dominant clinical profile was female witha mean age of 4 years. Atrial Septal Defect was the most common type of left-to-right shunt, followed byVentricular Septal Defect, and Patent Ductus Arteriosus. Pulmonary Stenosis was the most common typeof obstructive lesion, followed by Aortic Stenosis. Complications of acyanotic CHD were dominated byrecurrent respiratory tract infections followed by growth and developmental disorder, and heart failure. Themost common nutritional status was moderate malnutrition.

Clinical profile of pediatric patients with tuberculosis in a tertiary care centre in India

Background: India has one of the highest TB burden globally. Children contribute a significant proportion of TB burden, in whom the diagnosis can be challenging because many childhood diseases mimic TB. Therefore, a high index of suspicion is required for early diagnosis of childhood tuberculosis to prevent poor outcome. Objectives was to evaluate the prevalence and profile of childhood tuberculosis cases and to determine the risk factorsMethods: An observational cross-sectional study was conducted over a period of 6 months at a hospital in north India and the prevalence and profile of the children admitted with the clinical suspicion of tuberculosis was studied. Case specific diagnostic approach was used for diagnosis and the appropriate treatment was instituted.Results: The prevalence of childhood TB was 2.3% among hospitalized children. Of these, 66.5% were males and 33.49% were females. The majority of cases were more than 8 years. The history of contact was present only in 31.1%. Tuberculin skin test was positive in 53.11%. Pulmonary tuberculosis was the most common type of childhood tuberculosis (45.45%) followed by neurological tuberculosis (42.8%), abdominal tuberculosis (6.45%), tuberculous lymphadenitis (2.63%), others (2.61%). Malnutrition was a potent contributing factor present in 91.86%. The mortality rate observed in the study was 9.56%.Conclusions: Owing to the high burden of tuberculosis among pediatric population in India, there is an alarming need to develop more economical and advanced diagnostic methods for better patient management and above all there is urgent need of the hour to educate the masses about the transmission and risk factors for this disease.

Clinical profile of pediatric patients with cerebral palsy

Background and Aim: Cerebral Palsy (CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that is attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. Hence the present study was planned with the sole objective to study the clinical profile of patients of cerebral palsy and to assess the spectrum of functional disability. Materials and Methods: A total of 100 consecutive children diagnosed as cerebral palsy attending the pediatric department and Rehabilitation center were included in the study. Participants were examined forbehavioral problems like Pervasive Developmental Disorders (PDD) and ADHD. Complete evaluation of a child with CP included an assessment of associated deficits like vision, speech and hearing, oromotor evaluation, epilepsy, and cognitive functioning. Results:Out of 1000 cases studied, spastic cerebral palsy was the commonest physiological type of cerebral palsy (82%). atonic, athetoid, and dystonic types formed the rest of the 18% of cases. Among the spastic group, quadriplegia was the commonest topographical type (48%) followed by diplegia (24%). The study showed 96% of patients were mentally retarded. In the study, 48% ofchildren with CP had a seizure disorder. Conclusion: Spastic cerebral palsy was the commonest clinical type of cerebral palsy withquadriplegia being the most common topographical type of spastic cerebral palsyfollowed by diplegia as observed in this study. The prevalenceof behavioral problems like autism spectrum disorder and ADHD in the clinical sampleof children with CP was found to be 10%.PDD is not rare in CP and should be considered in patients with other comorbid conditions.

Pediatric Abdominal Tuberculosis in Singapore: A 10-Year Retrospective Series.

Background. Tuberculosis (TB) remains a major cause of mortality and morbidity globally. Pediatric patients are more likely to develop severe disease. Abdominal TB is a rare manifestation of pediatric TB and can present with chronic and nonspecific abdominal symptoms. This study examines the clinical profile of pediatric patients with abdominal TB and treatment outcomes. Method. A retrospective study of patients admitted to a tertiary pediatric hospital in Singapore over 10 years. Clinical characteristics and outcomes were examined. Results. There were 3 male and 3 female patients with mean age of 11.3 years. Household contacts were traced in 3 cases. The most common presenting symptoms were fever, weight loss, and abdominal symptoms such as diarrhea, vomiting, and loss of appetite. Inflammatory markers were raised with mean C-reactive protein (CRP) and erythrocyte sedimentation (ESR) rate at 70.9 mg/L and 90 mm/h respectively. Abdominal imaging showed abnormalities such as splenic foci and thickened bowel wall with significant intraabdominal lymphadenopathy. Mycobacterium tuberculosis was isolated from stool, rectal swabs and intra-adominal specimens. Two patients underwent excisional biopsy of lymph node to obtain diagnosis. Two patients required emergency laparotomy and 1 patient received esophagogastroduodenoscopy and colonoscopy. Four out of the 6 patients had pulmonary involvement. Conclusion. Abdominal TB should be a differential diagnosis in children with chronic abdominal symptoms for at least 8 weeks with anemia, raised ESR and CRP. The gold standard for diagnosis still remains as positive microbiological culture. However, abdominal imaging studies are also vital in obtaining further supportive evidence for chronic infection.

Acute Necrotizing Encephalopathy.

To describe the clinical profile of pediatric patients with acute necrotizing encephalopathy (ANE). Case series. Aga Khan University Hospital, Karachi, Pakistan, from January 2014 to October 2017. Retrospective review of medical records of all children aged 1 month to 16 years admitted with diagnosis of ANE was done. Diagnosis was based on the criteria of ANE described by Mizuguchi et al. the clinical profile, management and outcome were recorded. There were 17 patients. The mean age at presentation was 55.47 ± 59.13 months. The most common presentation was fever with altered consciousness and seizures. The mean length of stay was 11.7 ± 5.6 days. Viral etiology was established in three children. The managements of the patients were symptomatic and supportive; the combination of antibiotics, antivirals and anticonvulsants was the most frequently used regimen. Eleven out of seventeen (65%) patients required intensive care unit admission and mechanical ventilation; while others were managed in the special care unit. Three (17.6%) children died during the stay; while 10 (58.8%) children developed severe morbidity in the form of neurodevelopmental sequelae. The devastating outcome of ANE seemed to occur with increasing severity at the time of initial presentation; and the use of antivirals and immunomodulation did not alter the course of disease.