Department Of Pediatric Medicine Research Articles

Cardiovascular anomalies in infants born to diabetic mothers: A study at a Tertiary Care Hospital.

Objective: To find out the frequency of cardiovascular anomalies in infants born to diabetic mothers (IDMs). Study Design: Case-control study. Setting: Department of Pediatric Medicine and the Department of Obstetrics & Gynecology, Rai Medical College / Teaching Hospital, Sargodha. Period: January 2022 to December 2022. Material & Methods: A total of 50 term IDMs were enrolled in case group while equal number of healthy infants (n=50) were enrolled as controls. All mothers received prenatal care. Standard diagnostic criteria were followed for labeling diabetes and gestational diabetes. All infants underwent detailed physical and clinical examination. Demographic and maternal characteristics along with perinatal and maternal information were noted. All infants underwent echocardiographic evaluation. Results: In a total of 100 infants, 51 (51.0%) were boys and 49 (49.0%) girls. The mean birth weight, Apgar score (at 5-minutes), maternal age and gestational age were 2.84±1.8 kg, 8.8±0.7, 29.5±3.2 and 37.4±1.8 weeks respectively. Maternal hypertension was observed among 12 (12.0%) subjects. Birth weight (p<0.0001), maternal age (p=0.0129) and gestational age (p=0.0110) were significantly higher among cases while Apgar score was significantly lower among cases in comparison to controls (p=0.0028). Cardiovascular anomalies were diagnosed in 10 (20.0%) cases in comparison to 3 (6.0%) controls and the difference was found to be statistically significant. Among IDMs, hypertrophic cardiomyopathy (HCM) was the most frequent cardiovascular anomaly, noted in 4 (8.0%) cases. Conclusion: The frequency of cardiovascular anomalies was significantly high among IDMs in comparison to infants born to non-diabetic mothers. IDMs should undergo cardiac examination to rule out the possibility of existing cardiovascular anomalies.

Comparative Study on Umbilical Cord Serum Prolactin Levels of Normal Preterm Neonates and Preterm Neonates with Respiratory Distress Syndrome

Introduction: Respiratory distress syndrome (RDS) is the most common cause of respiratory distress, morbidity, and mortality associated with premature delivery. Prolactin is present in very high concentrations in amniotic fluid, and prolactin receptors are present in lung preparations. Prolactin acts as a direct trigger of lecithin synthesis or in a “chain reaction” along the hypothalamic–pituitary–adrenal axis. Thus, prolactin seems to have a role in lung maturation along with many other factors through a complex mechanism. Aim: The aim of this study was to evaluate and compare the umbilical cord serum prolactin levels of preterm infants with and without RDS. Materials and Methods: This was a hospital-based comparative observational study carried out at neonatal units of the department of pediatric medicine in a tertiary care center from April 2019 to May 2020. Out of a total of 80 preterm infants, 40 developed RDS and other 40 served as controls. Umbilical cord blood prolactin levels in neonates were measured in both groups and compared. Chi-square test and an unpaired Student’s t-test were used for statistical analysis. Probability was considered significant if <0.05. Results: The mean weight of babies was 1312.50 ± 134.30 g in the normal preterm group and 1285.80 ± 314.76 g in the preterm RDS group (P = 0.622). The mean gestational age was 32.1 ± 1.39 weeks in the normal preterm group and 31.77 ± 2.10 weeks in the preterm RDS group (P = 0.418). The mean serum prolactin levels were slightly high in the female preterm RDS group (P = 0.533). The mean cord prolactin levels in all the gestational ages were higher in normal preterm as compared to preterm with RDS (P < 0.05). Conclusions: Prolactin level was significantly associated with gestational age and birth weight. Low prolactin levels were significantly associated with the development of RDS in preterm babies. The easily available cord blood can be used to measure prolactin levels at birth to predict RDS.

Association of C-Reactive Protein with Parameters of Early Onset Sepsis and Blood Culture

Background: Blood culture is a gold standard technique to diagnose neonatal sepsis but the C-reactive protein (CRP) is also an important biomarker of acute phase reaction. CRP has a role in humoral immunity against infection, leading to inflammation. Very few of the data is available to conclude the diagnostic accuracy of CRP in association with parameters of early stage neonatal sepsis in pre-term or low birth weight babies. So the aim of current study was to find out the association of C-reactive protein with parameters of early onset sepsis and blood culture in pre-term and low birth weight babies. Methods: A cross-sectional study was conducted at the Pediatric Medicine department of Maternal and Child Health Center (MCH), Shaheed Benazirabad during August 2022 to January 2023. Early onset sepsis was diagnosed on the basis of maternal factors, prenatal history and clinical examination. Blood sample was collected and sent to the pathology laboratory of Peoples University of Medical and Health Sciences for Nawabshah for measurement of C-reactive protein, white blood cell count and culture and sensitivity testing. Data was analyzed by using the Statistical Package for Social Science (SPSS) version-20. p-value less than 0.05 was considered as significant. Results: A total of 120 patients of neonatal sepsis were enrolled in the study out of them 52 were positive for C-reactive protein. The mean age of the study participants was 1.6 ±0.69 days. Male participants were predominant (63.5%) over their female counterpart. Majority cases of septicemia (57.7%) were having birth weight less than 2.5kg. Odd ratio of C-reactive protein was estimated at 95% confidence interval and the results found that age had significant association with positive C-reactive protein. Birth weight less than 2.5kg also showed significant negative association with C-reactive protein but the term of birth found no any significant association. Patients having positive blood culture and those who had WBC count more than 25000/mm3 reported strongly significant association with C-reactive protein. Conclusion: It can be concluded that the C-reactive protein is significantly associated with parameters like age, WBC count more than 25000/mm3 and blood culture but no association has been found with maturity of neonate i.e. term or pre-term babies. The birth weight less than 2.5kg is negatively associated with the C-reactive protein. Keywords: Neonatal sepsis, C-reactive protein, Pre-term

Impact of Maternal Education on Breast Feeding and Complementary Feeding Practices of Infants

Objectives: To determine the impact of maternal education on incidence of breast feeding, duration and infant complementary feeding practices.
 Methodology: A Cross sectional study done in Department of Paediatric medicine, University of Lahore Teaching Hospital ,Lahore from October 2020 to March 2021. Non probability consecutive sampling technique, total 198 mothers having child 6 to 12 months were enrolled in study after approval of hospital ethical committee and informed consent from mother. Data was entered and analyzed using SPPS 22.
 Results: Breast feeding was adopted by 62.8% mothers. Mean duration of breast feeding was 8.52±3.1 months. Regarding initiation of breast feeding 35.1% started immediately after delivery. Regarding introduction of solid feed 27.3% started before 6 months of age. Pre lacteal was given in 35.5% infants. There was no impact of maternal education on frequency of breast feeding, p-value 0.328 but duration of breast-feeding was longer in mother having graduation as compared to mothers having education less than matric i.e. 8.77±2.977 months vs 7.82±3.384 months.
 Conclusion: Mothers with higher education have greater duration of breast-feeding ad compared to mother with less education.

Frequency of vitamin D deficiency in admitted children 6 -36 months of age at Sahiwal Teaching Hospital Sahiwal, Punjab, Pakistan.

Objective: To find out the frequency of vitamin D deficiency (VDD) in healthy children. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, Sahiwal Teaching Hospital, Sahiwal. Period: July 2022 to December 2022. Material & Methods: A total of 80 healthy children of either gender aged 6 to 36 months visiting outpatients department of pediatrics during the study period adopting convenient sampling technique were included. At the time of enrollment, demographic information was recorded and blood sample was obtained and sent for vitamin D analysis. The frequency of VDD was noted. Results: In a total of 80 children, 48 (60.0%) were boys and 32 (40.0%) girls. The mean age was of 14.4±6.2 months. Residential status of 47 (58.3%) children was rural. Evaluation of vitamin D status revealed that 16 (20.0%) children had sufficient levels while deficiency and severe deficiency were noted in 44 (55.0%) and 20 (25.0%) children respectively. Younger age group was having significant linkage with VDD (p=0.0135). Conclusion: The frequency of vitamin D deficiency was very high among healthy children visiting a tertiary care health facility of Punjab, Pakistan. Younger age groups had significant association with the occurrence of vitamin D deficiency.

Fever with Thrombocytopenia in the Pediatric Age Group

Introduction: Fever with thrombocytopenia refers to a reduction in platelet count below 150,000/L in association with fever. Although febrile thrombocytopenia may occur due to aplastic anemia, malignancy or megaloblastic anemia, its commonest cause in the pediatric age group is infections like Dengue fever, Malaria and Enteric fever. Since infectious diseases are highly prevalent in our region we decided to determine the frequency of diseases associated with febrile thrombocytopenia in the pediatric age group. Objective: To determine the frequency of diseases associated with febrile thrombocytopenia in the pediatrics age group Study Design: Descriptive Cross-Sectional Study Place and Duration: Department of Paediatric Medicine, Civil Hospital, Karachi, Pakistan from November 22, 2018, to May 21, 2019 Methodology: After obtaining informed consent data related to signs, symptoms, clinical and confirmed diagnosis, and relevant lab results were recorded for children who fulfilled the inclusion criteria. Data were analyzed in terms of frequencies and percentages for qualitative variables like age group, gender and outcome variables. Results: Mean ± SD of age was 4.74±3.28. Out of 89 patients, 45(50.56%) were male and 44(49.44%) were female. In distribution for common causes of thrombocytopenia, 19 (21.3%) had malaria, 8 (9%) had dengue, 25 (28.1%) had an enteric fever, 32 (36%) had sepsis, 2 (2.2%) had malignancy and 3 (3.4%) had megaloblastic anemia. Conclusion: Sepsis, dengue, and malaria were the most frequent causes of thrombocytopenia. Therefore, anytime thrombocytopenia is found, more investigations can usually assist us in making the right diagnosis. Keywords: Febrile Thrombocytopenia, Malaria, Sepsis, Dengue, Enteric.

Complications and Outcome of Children Presenting with Tuberculosis Meningitis

Aim: To determine the frequency of complications and outcome in children with tubercular meningitis. Study design: Descriptive case series. Place and duration of study: Department of Paediatric Medicine, The Children’s Hospital and Institute of Child Health Lahore from 1st July 2021 to 31st December 2021. Methodology: One hundred and forty children of both genders aged between 1-12 years diagnosed of tuberculous meningitis which were treated as per department protocols and were evaluated for various complications of TBM; seizures, tuberculoma, tuberculous brain abscess and hydrocephalus. Outcome of these children was evaluated after 3 months in terms of death and survival with and without sequelae; cognitive impairment, motor deficit, aphasias and seizures. Results: The mean age of the children was 4.9±2.6 years with 88(62.9%) boys and 52 (37.1%) girls. Among the various complications of TBM, tuberculoma was the most frequent and was observed in 73(52.1%) children followed by hydrocephalus 53(37.9%), seizures 20(14.3%) and tubercular brain abscess 11(7.9%). 16(11.4%) children died while 124(88.6%) children survived of TBM. Out of 124 children who survived, 72(58.1%) children had sequelae. Practical implication: Understanding the complication and related outcomes can assist in pre-empting the related issued in cases of tuberculosis meningitis and therefore assist in better treatment by promptly preventing sever complications identified through this research. Conclusion: Tuberculoma and hydrocephalus were observed as the most frequent complications in children presenting with tuberculous meningitis and majority of these children survived with long term disability. Keywords: Extrapulmonary tuberculosis, Tuberculous meningitis, Complications, Outcome

Does Gender Affect Levels of Hyperbilirubinemia in Term Neonates

Introduction: Hyperbilirubinemia is a common & in most1cases, benign problem in1first month of1life which is often1physiologic & intervention is not1usually1necessary. In the first week of life, about 60.0% of term & 80.0% of preterm infants have jaundice. Jaundice could lead to major side effects like kernicterus and permanent impairment.1One of the most frequent disorders requiring medical1attention in babies is neonatal jaundice. It has high levels of unconjugated1bilirubin, which can occasionally lead to kernicterus. Objective: To determine frequency of hyperbilirubinemia among neonates who present with physiological jaundice and compare the mean levels of hyperbilirubinemia among genders. Methodology: A total of 368 consecutive neonates were included. This cross-sectional study1was conducted at Department of Paediatric Medicine, NICH Karachi during June 2020 to December 2020. All pre-term or term neonates of either gender with physiological jaundice, and get admitted to pediatric medicine department were included in this study. While Neonates who did not survive first 48 hours of life, neonates who were not exclusively breast fed as determined by History were excluded from study. Blood samples1were taken from the patients and concentrations of serum total bilirubin, In the centrifuged venous samples, direct & indirect1bilirubin concentrations were determined. Serum total,1direct& indirect bilirubin was recorded for each patient. Data was analyzed using IBM. SPSS 22 on computer. Results: Mean ±SD age of neonates was 10.6±4.2 days. In distribution of gender, 214 (58.2%) were male while 154 (41.8%) were female. Mean ±SD of birth weight was 3.4±1.8 kg. Mean ±SD of birth weight was 3.4±1.8 kg with min to max 1.5 – 4.5 kg. majority 203 (55.2%) of neonates had birth weight was 1.5 – 3.0 kg. pre term delivery was done in 195 (53%) neonates while 173 (46.7%) were documented in term neonates. Hyperbilirubinemia was found in 156 (42.4%) patients. Mean levels of hyperbilirubinemia in male v/s female was noted as (12.3±3.8) and (11.5±3.4) respectively and P value found to be significant i.e. (P=0.038). Proportion of hyperbilirubinemia was significantly high 92 (52.9%) in neonates with age > 9 days (p=0.00). Advanced maternal age (>30 years) was also significantly associated with hyperbilirubinemia 88 (50.9%), (p=0.002; OR=1.9). C-section was significantly associated with hyperbilirubinemia 99 (49.3%), (p=0.003). Practical Implication: This study aims to provide an answer to the question of whether gender affects the level of hyperbilirubinemia in neonates. The rationale behind this is that because both preterm and term neonates are affected by this condition, if it is determined that one gender is more affected and experiences higher levels of bilirubinemia, neonates of that specific gender can be closely monitored and followed up in the future. Conclusion: It is to be concluded that hyperbilirubinemia is a frequent finding among neonates who present with physiological jaundice. Therefore, to correctly diagnose and treat the disease, both parents and professionals should take precautions. Keywords: 1Hyperbilirubinemia, Neonates, Jaundice, Risk Factors, Etiology, Hemolysis

Does Gender Affect Levels of Hyperbilirubinemia in Term Neonates

Introduction: Hyperbilirubinemia is a common & in most1cases, benign problem in1first month of1life which is often1physiologic & intervention is not1usually1necessary. In the first week of life, about 60.0% of term & 80.0% of preterm infants have jaundice. Jaundice could lead to major side effects like kernicterus and permanent impairment.1One of the most frequent disorders requiring medical1attention in babies is neonatal jaundice. It has high levels of unconjugated1bilirubin, which can occasionally lead to kernicterus. Objective: To determine frequency of hyperbilirubinemia among neonates who present with physiological jaundice and compare the mean levels of hyperbilirubinemia among genders. Methodology: A total of 368 consecutive neonates were included. This cross-sectional study1was conducted at Department of Paediatric Medicine, NICH Karachi during June 2020 to December 2020. All pre-term or term neonates of either gender with physiological jaundice, and get admitted to pediatric medicine department were included in this study. While Neonates who did not survive first 48 hours of life, neonates who were not exclusively breast fed as determined by History were excluded from study. Blood samples1were taken from the patients and concentrations of serum total bilirubin, In the centrifuged venous samples, direct & indirect1bilirubin concentrations were determined. Serum total,1direct& indirect bilirubin was recorded for each patient. Data was analyzed using IBM. SPSS 22 on computer. Results: Mean ±SD age of neonates was 10.6±4.2 days. In distribution of gender, 214 (58.2%) were male while 154 (41.8%) were female. Mean ±SD of birth weight was 3.4±1.8 kg. Mean ±SD of birth weight was 3.4±1.8 kg with min to max 1.5 – 4.5 kg. majority 203 (55.2%) of neonates had birth weight was 1.5 – 3.0 kg. pre term delivery was done in 195 (53%) neonates while 173 (46.7%) were documented in term neonates. Hyperbilirubinemia was found in 156 (42.4%) patients. Mean levels of hyperbilirubinemia in male v/s female was noted as (12.3±3.8) and (11.5±3.4) respectively and P value found to be significant i.e. (P=0.038). Proportion of hyperbilirubinemia was significantly high 92 (52.9%) in neonates with age > 9 days (p=0.00). Advanced maternal age (>30 years) was also significantly associated with hyperbilirubinemia 88 (50.9%), (p=0.002; OR=1.9). C-section was significantly associated with hyperbilirubinemia 99 (49.3%), (p=0.003). Practical Implication: This study aims to provide an answer to the question of whether gender affects the level of hyperbilirubinemia in neonates. The rationale behind this is that because both preterm and term neonates are affected by this condition, if it is determined that one gender is more affected and experiences higher levels of bilirubinemia, neonates of that specific gender can be closely monitored and followed up in the future. Conclusion: It is to be concluded that hyperbilirubinemia is a frequent finding among neonates who present with physiological jaundice. Therefore, to correctly diagnose and treat the disease, both parents and professionals should take precautions. Keywords: 1Hyperbilirubinemia, Neonates, Jaundice, Risk Factors, Etiology, Hemolysis

Frequency of causes of acute kidney injury at a children tertiary care hospital.

Objective: To determine the frequency of causes of acute kidney injury (AKI) in children at a tertiary care hospital. Study Design: Descriptive, Cross-sectional study. Setting: Department of Pediatric Medicine, The Children’s Hospital & Institute of Child Health, Multan. Period: January 2022 to December 2022. Material & Methods: A total of 268 children presenting with AKI were analyzed. Once registered, 5 ml venous blood sample was drawn and sent to the laboratory of the hospital for serum creatinine level and blood culture reports. All the relevant information like age, gender, residential status, monthly family income, maternal literacy and their relation to causes of AKI were noted. Results: In a total of 268 AKI cases, 164 (61.2%) were boys and 104 (38.8%) girls. The mean age was 4.33±2.57 years. There were 163 (60.8%) children who belonged to rural areas and 105 (39.2%) were from urban areas. Family history of AKI was positive in 61 (22.8%) while mothers of 206 (76.9%) cases were literate. Sepsis was noted in 113 (42.2%) cases, glomerulonephritis in 62 (23.1%) and shock in 65 (24.3%). Sepsis was significantly associated with male gender (p=0.001), younger age (p<0.001), low monthly family income (p=0.002) and family history of AKI (p<0.001). Glomerulonephritis was significantly associated with older age (p<0.001) and maternal illiteracy (p=0.045) while shock was significantly associated with female gender (p=0.013) and family history of AKI (p<0.001). Conclusion: Sepsis was the commonest etiological factor for pediatric acute kidney injury followed by shock and glomerulonephritis.

Frequency of meningitis in children 6-18 months of age presenting with 1st episode of seizure and fever at Sahiwal Teaching Hospital Sahiwal, Punjab, Pakistan.

Objectives: To determine the frequency of meningitis in children 6-18 months of age presenting with 1st episode of febrile seizure (FS). Study Design: Cross-sectional. Setting: Department of Pediatric Medicine, Sahiwal Teaching Hospital, Sahiwal. Period: October 2021 to April 2022. Material & Methods: Children with 1st simple FS of age 6 months to 18 months of either gender were included. After taking informed written consent from the child’s parents, lumbar puncture was done in each patient and cerebrospinal fluid (CSF) analysis and blood sample were sent to the institutional pathology laboratory for presence or absence of meningitis. Results: In a total of 156 children, mean age was 11.24±2.86 months while 94 (60.3%) children were between 6-12 months of age. There were 100 (64.1%) male and 56 (35.9%) female children. The frequency of meningitis was found in 16 (10.3%) patients. Conclusion: The frequency of meningitis in children with 1st episode of febrile seizure was high (10.3%).

Comparison of the frequency of necrotizing enterocolitis in preterm infants with formula feed versus breast feed.

Objective: To find out the frequency of necrotizing enterocolitis (NEC) in preterm infants and to compare the frequency of NEC in preterm infants with formula feed versus breast feed. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, Ghazi Khan Medical College, Dera Ghazi Khan, Pakistan. Period: January 2022 to June 2022. Material & Methods: A total of 174 preterm infants were enrolled. The NEC was diagnosed as abdominal distention or intolerance to nasogastric feed with pneumatosis intestinalis / portal venous gas or free intraperitoneal air which was confirmed by abdomen X-ray. At the time of enrollment, gestational age and weight were recorded. All preterm neonates were called for follow up every week for 4 weeks to diagnose NEC. Results: Of these 174 study cases, 101 (58.0 %) were male patients while 73 (42.0 %) were female patients. Mean gestational age of our study cases was 30.48 ± 3.24 weeks. Of these 174 study cases, 102 (58.6%) mothers were illiterate. Breastfeeding was noted in 74 (42.5%) infants while formula feeding was recorded among 100 (57.5%) infants. The NEC was reported among 61 (35.1%) cases whereas NEC in breastfeeding cases was found in 14 (18.9%) and 47 (47.0%) infants with formula feeding. Conclusion: High frequency of NEC was observed among preterm infants given formula feeding in comparison to breastfed preterm infants. Significant linkage of NEC was noted with gender, maternal literacy, birth weight and pattern of feeding.

TO EVALUATE CARDIAC BIOMARKERS AND ECG CHANGES IN ASSESSING CARDIAC DYSFUNCTION IN CHILDREN WITH ACUTE SEVERE BRONCHIAL ASTHMA

Introduction:Asthma is a chronic inammatory disease of the airways, characterized by recurrent episodes of airow obstruction resulting from edema, bronchospasm, and increased mucus production. There are an estimated 300 million people who have asthma worldwide, with a signicant geographic variation of prevalence, severity, and mortality. The exact etiology of asthma remains unclear and appears to be multifactorial. Both genetic and environmental factors seem to contribute. Aim and Objective: To evaluate role of cardiac biomarkers and ECG changes in assessing the cardiac dysfunction in children with acute severe bronchial asthma. Material and Methods: This was Prospective, observational, Hospital based study at department of pediatric medicine, SPINPH (JK Lone hospital), SMS Medical College, Jaipur, Rajasthan. The study includes 51 patients admitted during study period of 18 months. Sample size was calculated of 95% condence level, α error of 0.05 expecting 15% abnormal CK-MB levels as one of the biomarker in children with acute severe bronchial asthma. Result: The study included Sample size of 51 Patients in each group. In our study, mean age of study participants was 8.8±2.5 years. Out of the 51 participants, 37 were in age of 5-10 years and 14 in age above 10 years. Male participants were 32 and female were 19. Mean FEV1 of study participants was 77.7±5.7%. Conclusion: Our study concluded that at the time of admission, children with acute severe bronchial asthma exhibited abnormal CPK-MB in 21.6%, abnormal trop-I in 58.8%, and abnormal BNPin 11.6%. The most common ECG nding in these patients was sinus tachycardia

The Short Term Outcome of Therapeutic Hypothermia Compared with Standard Treatment among Asphyxiated Newborns Presenting after 6 hours of Life

Objectives: To compare the short term outcome of therapeutic hypothermia in asphyxiated newborn with standard treatment presenting after 6 hours of life. Methodology: It was Randomized controlled trial conducted in the department of Pediatric Medicine, Bahawal Victoria Hospital, Bahawalpur from December 2018 to June 2019 after taking ethical approval from institutional ethical review committee and informed written consent from parents of patients. Confidentiality of the data was maintained and it was assured that no harm to study participants is done. A total of 108 term neonates with moderate to severe HIE presenting >6 hours of life were included. Preterm infants, major congenital anomaly and overt bleeding were excluded. Then selected patients were placed randomly into Group A (hypothermia group) & Group B (conservative group), by using lottery method. Outcome variable like mortality within 1st week was noted. There was no conflict of interest in the study and funding was done by the authors. Results: The mean age of patients in group A was 17.69 ± 6.68 hours and in group B was 17.60 ± 6.65 hours. Out of 108 patients, 62 (57.41%) were males and 46 (42.59%) were females with male to female ration of 1.3:1. There was mortality within one week (short term outcome) in 07 (12.96%) patients in Group A (hypothermia group) while in Group B (conservative group), it was seen in 16 (29.63%) patients. Conclusion: This study concluded that there is benefit of therapeutic hypothermia in asphyxiated newborns after 6 hours of life and short term outcome is better after therapeutic hypothermia in asphyxiated newborns. Keywords: Asphyxia, Encephalopathy, Mortality, Cooling.

Prevalence and Risk Factors of Primary Malnutrition in Children Below 5 Years of Age

Objective: To find out the prevalence and risk factors of primary malnutrition among children below 5 years of age visiting outpatient department of a tertiary care hospital. Study Design: A cross-sectional study. Place and duration: Department of Pediatric Medicine, Ibn-e-Siena Hospital, Multan from 1st January 2022 to 30th June 2022. Methodology: A total of 151 children of either gender aged below 5 years visiting outpatient department of pediatrics. At the time of enrollment, socio-demographic as well as anthropometric characteristics were noted. Z-score were calculated to label malnutrition considering weight for height criteria according to “World Health Organization (WHO)” charts as: mild, -1.0 to -1.9, moderate, -2.0 to 2.9, and severe, ≤ -3.0. Results: In a total of 151 children, 78 (51.7%) were girls. The mean age, weight and height were 2.67±1.56 years, 10.18±3.55 kg and 82.99±16.39 cm. The mean birth weight was 2.44±0.21 kg. Exclusive breast-feeding for the first 6 months was reported in 69 (45.7%) children while cow’s mild before 1 year of age was reported by 101 (66.9%). The mean height for weight Z-score was calculated to be -1.40±2.20. Distribution of nutritional status revealed that 61 (40.4%) were normal while mild, moderate and severe malnutrition were observed among 37 (24.5%), 11 (7.3%) and 42 (27.8%) children respectively. Malnutrition status had significant association with increasing age (p<0.001), poor maternal educational status (p=0.034) and use of cow’s milk before 1 year of age (p=0.004). Practical Implications: There is a massive need to identify causes behind factors linked with primary malnutrition among children below 5 years of age so that targeted interventions could be planned. Conclusion: The prevalence of primary malnutrition was very high among children below 5 years of age. Age, poor maternal educational status and use of cow’s milk before 1 year of age had significant association with malnutrition. Keywords: Breastfeeding, maternal education, malnutrition, socio-economic status, Z-score

Association of iron deficiency anemia with febrile seizures: A case control study.

Objective: To determine the association of iron deficiency anemia (IDA) with febrile seizures (FS). Study Design: Case Control study. Setting: Department of Pediatric Medicine, Bahawal Victoria Hospital, Bahawalpur. Period: January 2022 to July 2022. Material & Methods: A total of 30 children of both genders of age 1 to 5 years with febrile seizure and 30 children in control group (febrile without seizures) were included. Three ml blood sample of each patient was taken as sent to the institutional laboratory for assessment of iron deficiency anemia (hemoglobin < 11.5 g/dl). Association of IDA with FS was calculated. Results: Out of 60 patients, 28 (46.7%) were boys and 32 (53.3%) girls with boy to girl ratio of 1:1.1. The mean age in case group was 2.93 ± 1.23 years and in control group was 3.0 ± 1.31 years. Majority of the patients 39 (65.0%) were between 1 to 3 years of age. Frequency of IDA in case group (febrile seizure group) was found in 11 (36.7%) while in control group (febrile disease without seizures) it was found in 4 (13.3%) children (p=0.037, odds ratio=3.76).

Frequency of Hepatitis a Virus as a Cause of Anicteric Hepatitis in Children Under 5 Years

Background and Aim: Globally, Acute viral hepatitis A is the widespread type of hepatitis particularly in developing countries. Children under 5 year of age are at greater risk of asymptomatic infections, and if they do develop symptoms, they are likely to experience anicteric illnesses. The present study aimed to determine the incidence of hepatitis A virus as anicteric hepatitis cause among children under 5 years. Methodology: A cross-sectional study was carried out on 380 children (<5 years) in the Pediatric Medicine Department of Qazi Hussain Ahmad Medical Complex Nowshera for the duration from 1st July 2021 to 30th June 2022. Study protocol was approved by the institute ethical committee. Children with normal-colored urine, diarrhea, abdominal pain, vomiting, malaise, nausea, and low-grade fever (< 38.5 °C) were investigated. Demographic details and physical examination were recorded from children with elevated transaminase levels (ALT). Children with elevated transaminases were only enrolled and categorized into two groups: Group-I HAV-positive and Group-II HAV negative groups. Children with transaminases were the only ones who had IgM antibodies against HAV virus. ELISA was used to test for anti-HAV IgM. Results: Of the total 380 children, the incidence of elevated transaminases (ALT, AST) were 42.6% (n=162). The frequency of HAV positive and HAV negative was 13.6% (n=22) and 86.4% (n=140) respectively. Out of 162 children, there 84 (51.9%) male and 78 (48.1%) females. Age-wise distribution of patients were as follows: Age≥3 years 92 (56.8%) and age≤ 70 (43.2%). HAV infection rates were significantly higher among children over 2 years old (p <0.05). Abdominal pain, vomiting, diarrhea, nausea, Right hypochondrial tenderness, Arthralgia, and Hepatomegaly were different clinical manifestation of HAV negative and HAV positive found in 20.7% (n=29) versus 13.6% (n=3), 97.1% (n=136) versus 81.8% (n=18), 87.1% (n=122) vs 81.8% (n=18), 81.4% (n=114) versus 95.5% (n=21), 32.9% (n=46) versus 86.4% (n=19), 38.6% (n=54) versus 59.1% (n=13), 4.3% (n=6) versus 18.2% (n=4) respectively. Conclusion: Children with anicteric hepatitis under the age of 5 years were found to have 13.6% HAV infection. Diarrhea and vomiting were the most prevalent clinical manifestation of children < 5 years. A higher level of maternal education, older age, and poor sanitary conditions were various risk factors related to HAV infection. Keywords: Hepatitis A, Anicteric hepatitis, Children

Spectrum of Rare and Novel Indel Mutations Responsible for β Thalassemia in Eastern India.

The online version contains supplementary material available at 10.1007/s12291-022-01098-w.

The Comparison of the Efficacy of Probiotic (Bacillus Clausii)with Yoghurt in the Management of Acute Watery Diarrhoea

Objective: To compare the efficacy of Probiotics with the yoghurt in the management of children with acute diarrhoea in terms of frequency and consistency of stools.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Department of Paediatric Medicine, Combined Military Hospital, Peshawar Pakistan, from Jun to Dec 2020.
 Methodology: Patients were allotted into three Groups A, B, or C. Group-A received a Probiotic (Bacillus Clausii), Group-B received plain yoghurt, and Group-C did not receive yoghurt or Probiotic. The outcome was an improvement in stool consistency at 72 hours. Stool consistency was assessed via Bristol stool chart along with frequency. Data were collected 72 hours after initiation of treatment.
 Result: The total number of patients enrolled was 159(53 in each Group). Among these, 85(53.5%) were males, and 74(46.5%) were females. There was a statistically significant association in terms of consistency (p=0.001) and term of frequency (p<0.001) in the Probiotic and Yoghurt-Group.
 Conclusion: The outcome in terms of consistency is almost equal in the Probiotic and Yoghurt-Group. However, Probiotic is superior to yoghurt in terms of frequency.

Screening of Iron Deficiency Anemia in Children Using Mentzer Index in Pakistan: A Cross Sectional Study.

The objective of the study was to determine the diagnostic accuracy of Mentzer Index in children with hypochromic microcytic anemia by taking serum ferritin levels as a gold standard. This cross-sectional study was conducted in the Department of Pediatric Medicine, Liaquat National Hospital Karachi, from 1st January to 30th June 2022. Children age 1 to 5 years and both genders were included in this study. Children who have had a history of blood transfusion in the past 3 months or Thalassemia or blood disorders, chronic liver disease or kidney diseases, and children with malignancy and congenital abnormalities were excluded. Eligible children were enrolled after taking written informed consent. Complete blood count (CBC) and serum ferritin were sent to the laboratory. Sensitivity, specificity, diagnostic accuracy, and likelihood ratio were calculated taking serum ferritin levels as a gold standard. A total of 347 subjects were enrolled. The median age was 26 (IQR-18) months and 42.9% were males. The most common symptom was fatigue 40.9%. The sensitivity of the Mentzer index was 80.7% while the specificity was 77.7%. Similarly, the positive predictive value (PPV) was 56.8% while the negative predictive value (NPV) was 91.6%. Finally, the accuracy of the Mentzer index in determining iron deficiency anemia was 78.4%. Diagnostic accuracy was 78.4% and the likelihood ratio was 3.6. Mentzer index is a valuable tool in the early detection of IDA in children. It has got high sensitivity, specificity diagnostic accuracy, and likelihood ratio.