Pakistan Pediatric Journal

Knowledge, attitude and practices of physicians in management of asthma according to GINA guidelines.

2024-07-11T10:09:47+00:00

Background of the Study: Asthma is a chronic airway disease that has a significant impact on patients with substantial global socioeconomic burden. Appropriate knowledge by health care practitioners is important in the management of asthma.

Objective: To determine the knowledge about the management of asthma according to GINA guidelines among health care professional working at Tertiary Care Hospitals of Karachi.

Study Design: Cross sectional study.

Place and Duration of Study: Study was conducted at Department of Pediatrics, Abbasi Shaheed Hospital, Karachi in the period of Six months from October, 2021 till April, 2022.

Material & Methods: Data was prospectively collected from 97 HCPs’ after taking a verbal consent. Quantitative data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables was presented as frequency and percentages. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Post stratification chi square test was applied taking p-value of ≤0.05 as significant.

Results: A total of 97 HCPs’ were included in this study. 56 (57.7%) were male and 41 (42.3%) were female. Out of 97 HCPs’, knowledge about management of Asthma according to GINA guidelines showed 45 (46.4%), 25 (25.8%) and 27 (27.8%) had good, moderate and poor knowledge respectively.

Conclusion: There was good knowledge of epidemiology and clinical features of asthma, but a small number of the doctors had knowledge of pathophysiology and treatment of the disease. For best practices in asthma management, there is a need for further education.

EVALUATION OF INPATIENT MORTALITY IN PEDIATRIC NON-HODGKIN LYMPHOMA AND LESSONS LEARN AT A TERTIARY CARE HOSPITAL IN PAKISTAN

2024-05-27T06:03:21+00:00

Background Non-Hodgkin Lymphoma (NHL) is an aggressive pediatric malignancy. Treatment outcomes have improved in developed countries, but prognosis is still dismal in developing countries. Causes of mortality are variable and scarce data is available from developing countries to accurately identify them. Clinical audit was done so as to identify causes of inpatient mortality of children with NHL at a tertiary care hospital in a developing country and to recommend interventions that can help reduce the mortality.

Materials & Methods: Clinical audit conducted in pediatric Hematology Oncology department at The Children’s Hospital, Lahore, Pakistan from 1^st January 2020 till June 2022. Mortality analysis was done of pediatric NHL patients retrospectively in respect to demographics, clinical, epidemiological features, histopathology, stage and causes of death. Mortality cause was categorized as treatment related or disease related mortality.

Results: Total 205 NHL patients were diagnosed during the study period. There were 42 mortalities. Thirty eight percent were between 5 -10 years of age, 81% were boys and 70% were from other cities. Predominant symptoms were Fever (52%), abdominal pain/distension (38%), Respiratory distress (33%) palpable mass (21%) and lymphadenopathy (21%). Histopathology was T Lymphoblastic Lymphoma (22%), Burkitt’s Lymphoma (17%), High grade B cell NHL (17%). Common causes of mortality were sepsis (29%), febrile neutropenia (22%), Acute renal failure (10%), Tumor Lysis syndrome (9%), disease progression (10%), Superior vena cava syndrome (7%) and COVID infection (4%). Twenty-two (52%) patients had treatment related mortality while 20(48%) had disease related mortality.

Conclusion: Treatment and disease related complications still constitute a common cause of inpatient pediatric NHL deaths. Infection is still the biggest cause of mortality. Significant number of children presented with Oncological emergency. There is need for early diagnosis, more pediatric Oncology units, training of pediatricians to deal with oncological emergencies and better supportive care to improve patient outcomes.

Detection of Micronutrients Deficiency in Egyptian Children Using Dietary Diversity Score: A cross-sectional study

2023-12-23T07:01:29+00:00

Objective: To detect malnutrition and micronutrient deficiency using the Dietary Diversity Score (DDS) to improve infants' and children's physical and mental health.

Study design: A descriptive cross-sectional study.

Place and duration: Pediatric outpatient clinic at Suez Canal University hospital for 1 year.

Materials and methods: The study was conducted recruiting 100 children from 6 months to 6 years old attending a tertiary Hospital Pediatric clinic. The study population was divided into three groups based on diversity score: Low score for those who consumed ≤ 3 food groups, medium score who consumed 4-5 food groups, and high score who consumed ≥ 6 food groups.

Results: Children with Low DDS had both Iron and Zinc deficiencies with an incidence of 90.6% and 29.7 %, respectively. Children with medium DDS had Iron deficiency (27.6%) and no Zinc deficiency, while children with high DDS had Iron deficiency (14.3 %) and no Zinc deficiency. Children with Low DDS showed a statistically significant difference (p=0.001) in Ferritin levels compared to children with medium and high DDS.

Conclusion: Dietary diversity score is a valid indicator to evaluate micronutrient inadequacy. Children with Low dietary diversity had 35% zinc deficiency, about 97% iron deficiency, and 48.4 % ferritin deficiency.

MID-UPPER ARM CIRCUMFERENCE (MUAC): AN INDICATOR TO IDENTIFY, WASTING IN INFANTS LESS THAN SIX MONTHS OF AGE.

2024-07-02T07:09:29+00:00

Objective:

Malnutrition under six month of age is one of the major challenging issues and highly prevalent in developing countries. The significance of mid upper arm circumference, and its cutoff value, in less than six months of age is still under research. The present study was done to determine the MUAC cut-off value for severe acute malnutrition, to distinguish between severe moderate malnutrition in infants less than six months of age in a tertiary care hospital.

Study Design: Cross-Sectional Study

Place and Duration of Study: Department of Paediatrics, Dow University of health Sciences, Civil Hospital Karachi, from January to December 2021

Material Methods:

A total of 249 infants of either gender, between the ages of two to six months, were included. In our study. To assess the diagnostic accuracy and to identify optimal MUAC cut-offs for screening, severe and moderate wasting, the receiver operating characteristic curve was used.

Results: The MUAC cutoff value was determined for infants divided in two groups, two months up to four months and infants above four months of age, in males ranging from two up to four months of age it was, 10.26cm. On the other hand, the cut off for females in both the age group was the same 9.25 cm. A combined MUAC cut off value , between two months up to four months age, was calculated to be 10.25 cm whereas it was 9.25 cm, ,above four months of age

Conclusion: The MUAC cutoffs values presented in this study will contribute to assess the severity of malnutrition among infants up to six months of age.

CLINICAL SPECTRUM OF AUTOIMMUNE ENCEPHALITIS IN CHILDREN AT TERTIARY CARE HOSPITAL

2024-09-02T07:24:27+00:00

Background & Objective: To study the clinical spectrum and functional outcome of autoimmune encephalitis (AE) in children.

Methodology: This Cross-Sectional Study was carried out at the Pediatric Neurology Department, University of Child Health Sciences and Children Hospital Lahore (A tertiary care hospital) after taking ethical approval from the Institutional review board via letter no.661. The study participants were asked a validated questionnaire after taking informed consent from the parents of the children.

Results: Majority of the study participants were males presented with encephalopathy. Cerebrospinal fluid NMDA receptor antibodies were negative in almost two third of the patients. As far as clinical spectrum of AE is concerned, disorganized speech, agitation, primary febrile illness, anxiety, paranoia, social withdrawal, change in speech, disorganized speech, insomnia, severe cognitive dysfunction, fluctuation of in blood pressure and increase in seizure frequency were highly prevalent. Response to steroids was good among half of the study participants and remaining showed improved response to intravenous immunoglobulins and rituximab.

Conclusion: AE has shown a very diverse range of symptoms in our study participants and it gives a whole new perspective to the clinical spectrum of AE for the future consultants and researchers.

The Iron Deficiency Anemia: An Undermined Risk Factor in Children Presenting with Febrile Fits

2024-07-24T07:33:31+00:00

ABSTRACT

Background: Febrile fits in children younger than five years pose a significant healthcare concern. The association between iron deficiency anemia (IDA) and these seizures remains unclear in the existing literature. Developing countries including Pakistan, grapple with notable IDA prevalence in this age group. This study seeks potential connection between IDA and febrile fits in pediatric populations.

Objective: Objective was to uncover any hidden association between iron deficiency anemia and febrile fits.

Design: It was a randomized controlled trial.

Study Settings: This study was conducted at Pediatric Department, Ghurki Trust Teaching Hospital, Lahore.

Material & Methods: A total of 60 children presenting with febrile seizures and meeting inclusion criteria were enrolled after taking informed consents from parents and demographics were noted. A 3ml blood sample was taken as per standard procedure for investigation and findings were recorded. The data was entered in SPSS version 25.0 for analysis. Confounding variables were controlled through exclusion.

Results: The mean age of children presenting with febrile fits was 2.26±1.26 years. Gender-based analysis revealed higher prevalence of male participants (n=37) (61.7%), with male-to-female ratio of 1.61:1. The study found mean Hb of 10.1 ± 1.5 g/dl and mean serum iron level of 46.68±25.01 µg/L. Stratifying mean iron levels by age and gender further showed insignificant differences, with p-value > 0.05.

Conclusion: In conclusion, our study substantiates that iron deficiency anemia is a significant and potentially undermined risk factor in children with febrile fits, emphasizing the importance of targeted interventions and further exploration.

Socio-developmental outcomes among children in relation to their activities: A Cross-sectional descriptive study

2024-07-09T08:22:45+00:00

Background: A child’s socio-developmental skills such as speech and behavioural changes in regards to their social interaction is an important phenomenon to be studied for. Due to technological advances these skills are

Objective: To compare ability to speak and behavioral changes in children in relation with their physical activity and screen time.

Study Design: This was a cross-sectional survey.

Place and Duration of the Study: Study was conducted at BMY Health in a period of nine months from January 1^st, 2023 to September 5, 2023.

Methodology: 249 participants out of 401 were used for data analysis. Data was collected via Google Forms having informed consent form and self-constructed questionnaire with a total of 27 questions about social behavior and speech delay among children with high screen time and physical activity. All statistical analysis was done in SPSS 22 software.

Results:

Conclusion: Screen time and physical healthy activity have variable effects on child development. Children with high usage of electronic devices were found to have nightmares and aggressive behavior. They had, indeed, teen personalities with good concentration level. On the other hand, those with physical activity had lesser mood changes and better speech comprehension with healthy social interaction.

Handwriting evaluation in school aged ( 7-14 years) children

2024-08-29T08:14:49+00:00

Objective:

To evaluate handwriting performance in school going children ranges from 7- 14 years old and to explore the association between illegible handwriting and complaints of pain.

Material and Methods

Cross sectional study design and convenience sampling technique were used in this study. 200 healthy students with age range of 7-14 years (girls = 94 and boys = 106) were included in this study. 185 participants were right handed and 15 students were left handed. Students with no physical and mental impairment were a part of this study. Students who had received any special education classes were excluded from the study. The participants were taken from Gulab Devi Girls High School and Gulab Devi Primary School. Informed consent was obtained from class teachers of the students. HPSQ used to evaluate handwriting problems faced by school going children. All students were tested in department of Audiology, Gulab Devi teaching hospital under same condition from the month of February to October 2023.

Results

Total sample size was 200, out of which 94 were female and 106 were male. Out of 200 students, we had larger number of children with the age lies between 7 and 8 years old, were 51.5 %, then smaller number (19.5%) were 12 and 13 years old and smallest number (3.5 %) was 14 years. With the average age of students was about 9 years (SD=1.9). It also showed that 20.25 % had illegible issues and 32 % students had poor performance time and wellbeing. The association between illegible handwriting and pain complaints was highly significant as p value was 0.000

Conclusion

Handwriting difficulty in children are frequently underestimated or not adequately addressed, despite their considerable impact on academic achievement and self-confidence. So, HPSQ can be used to identify any handwriting deficits in school going children as it can predict all the main components of handwriting. It can be used for clinical or academic evaluation in order to highlight the problems that children faced during academic performance and thus easily refer to Occupational Therapy for better performance in their life.

Key words: Handwriting problems, evaluation, Handwriting Proficiency Screening Questionnaire

ROLE OF INTRA-ARTICULAR CORTICOSTEROID INJECTION IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

2024-07-13T07:53:20+00:00

ABSTRACT:

OBJECTIVE: To determine the role of intra-articular corticosteroid injection (IACI) in inducing remission of synovitis in children with Juvenile idiopathic arthritis.

MATERIALS AND METHODS: This quasi-experimental study was directed at the Pediatric Medicine/ Rheumatology Department at The University of Child Health Sciences Lahore from July 2021 to July 2022. All patients, regardless of gender, who met the JIA with synovitis criteria set forth by the International League of Associations for Rheumatology were enrolled and given IACIs (single or multiple). Data from pre- and post-IACI (after 6 months of IACI) were recorded, including synovitis symptoms and signs, erythrocyte sedimentation rate (ESR), and patients' and doctors' visual analogue pain scale (VAS). SPSS version 23 was used for the statistical analysis. For qualitative variables, frequency and percentages were computed. For the quantitative variables, a mean and standard deviation were computed. The post-IACI response for quantitative variables was ascertained using a paired sample t-test. A significant P-value was defined as < 0.05.

RESULTS: A total of 45 joints from 27 individuals were injected. There were 16/27 (60%) males and a 1.5:1 M:F ratio. At IACIs, the average age was 9.1 + 3.5 years. The most common joint implicated in 33/45 (73.3%) cases was the knee joint, which was followed in frequency by the wrist in 5/45 (11.1%), ankle in 4/45 (8.9%), and proximal interphalangeal joint in 3/45 (7%) cases. Movement restriction was one of the indications of a synovitis flare, along with warmth, edema, and pain in 21 joints (46.7%). Three months following IACI, 34 joints (76%) had established remission. Regarding joint synovitis (p=0.005), ESR (p=0.005), VAS physicians (p=0.006), and VAS parents/patient (p=0.009), there was a statistically significant improvement after IACI.

CONCLUSION:

IACI is a type of local therapy used to treat juvenile idiopathic arthritis. They assist patients avoid systemic steroids and their harmful side effects by reversing joint synovitis and improving ESR and VAS (patient, parent, and physician).

Oro-dental manifestations of pediatric celiac disease

2024-07-09T10:19:13+00:00

ABSTRACT

Objective: To document oro-dental manifestations of pediatric celiac disease in our population.

Study Design: Prospective, descriptive, cross sectional study.

Place and Duration of Study: Department of Pediatrics, Post Graduate Medical Institute/Ameer ud Din Medical College/Lahore General Hospital, Lahore, from 01-01-2023 to 15-02-2024.

Material and Methods: 45 pediatric patients, 2-18 years old, diagnosed as having celiac disease on the basis of small bowel biopsy were examined by a single consultant dental surgeon. Oro-dental findings were recorded through a predesigned proforma.

Results: Out of 45 patients, 19(42.2%) were male, 26(57.8%) were female with mean age of 8.16±2.87 years. Dental lesions were most commonly located on incisors and molars combined. Defect in enamel color (35.6%) was the most common finding in our study. Among oral lesions, RAS (24.4%) was most common followed by atrophic glossitis (20%).

Conclusion: Oro-dental lesions are common in pediatric CD and must be screened for by early referral to dentist.

Key Words: Pediatric celiac disease, enamel defects, recurrent atrophic stomatitis.

CLINICAL CHARACTERISTICS, TYPES OF EPILEPSY, ELECTROPHYSIOLOGICAL PROFILE AND NEUROIMAGING FEATURES OF NEUROCUTANEOUS SYNDROME: EXPERIENCE IN A TERTIARY CARE HOSPITAL

2024-07-11T07:42:41+00:00

Introduction: Neurocutaneous syndromes encompass a collection of disorders in which distinctive alterations in the skin are observed, alongside abnormalities in the central nervous system, and by consequences ae at risk of epilepsy and other accompanying conditions in future.

Methodology: The study was conducted at Department of Pediatric Neurology, Children’s Hospital Lahore, Pakistan from March, 2022 to September 2022. Children from either gender, from 1 month to 15 years with neurocutaneous syndrome, diagnosed on the basis of diagnostic standard criteria for different neurocutaneous syndromes, were enrolled. A comprehensive clinical history, examination, neuroimaging, electroencephalography (EEG) were taken into account.

Results: Out of 33 children with neurocutaneous syndrome, 51.5% (17) were females with mean age of 46±42.59 months. The majority of age group belongs to 1 to 5 years, represents 45.5% of the total entitled patients. According to neurocutaneous findings distribution, 60.6% (20) had tuberous sclerosis, while 18.2% (6) Sturge-Weber syndrome and Neurofibromatosis type-1 equally observed and 3% (1) had ataxia telangiectasia. The clinical features include seizures in 90.9% (30), predominantly generalized tonic clonic seizures in 51.5% (17). While the hypopigmented patches 33.3% (11) was the most common cutaneous finding. Most common EEG recordings were Generalized epileptiform discharges 51.5% (17), while the frequently observed Neuroimaging findings were Subependymal nodules in 30.3% (10).

Conclusion: Neurocutaneous syndromes encompass a multitude of different clinical presentations, with epilepsy being the most common manifestation. Skin lesions can serve as an early detectable indicator to ascertain the cause of epilepsy aiding in reaching a definitive diagnosis.

Outcome of management of intussusception in children presenting to a tertiary care hospital

2024-06-23T19:23:46+00:00

Abstract

Background: Intussusception is a common cause of intestinal obstruction in children, posing significant risks of morbidity and mortality if not treated promptly. The standard treatment involves hydrostatic or pneumatic reduction, though open surgery remains prevalent in developing countries. This research examines the clinical presentation, management strategies, and early outcomes at our tertiary care center, highlighting the challenges encountered in managing this condition.

Methods: A prospective cohort study was done at the Department of Pediatric Surgery, The Children’s Hospital, Lahore, from October 2023 to June 2024. The study included patients of both genders aged up to 12 years with intussusception. Ethical approval was obtained prior to the study. Data were analyzed using SPSS version 29.

Results: A total of 80 patients with intussusception were included. The male-to-female ratio was 1.3:1. The median age of presentation was 9 months. The median duration of presentation was 3 days (mean 3.13 days ± 1.23). Idiopathic intussusception was found in 66 patients (82.5%), and pathological lead points (PLP) were identified in the remaining cases. The diagnoses were made clinically and radiologically by abdominal ultrasound. All patients underwent surgical treatment. Ileo-colic intussusception was encountered in the majority (71.3%). About half of the intussusceptions (42; 52,6%) could be reduced manually. Bowel resection was required in 38 (47.6%) patients. The complication rate was 17.5%, including surgical site infection (5%), anastomotic leakage (3.8%), and stoma complications (1.3%). The median length of stay was 4 days (mean 4.5 days ± 2.03). One patient expired after redo surgery for postoperative gut necrotizing enterocolitis.

Conclusion: Most of our patients presented late, leading to bowel necrosis in about half of the cases. Although half of the patients underwent manual reduction of intussusception, hydrostatic reduction could not be performed due to late presentations. Furthermore, secondary complications complicated the postoperative recovery of a few patients.

CASE REPORT: Inherited Factor XIII Deficiency ; Significance of Diagnosis

2024-06-01T07:17:39+00:00

Abstract: Factor XIII deficiency is a rare disorder characterized by difficult to control bleeding following trauma or occurring spontaneously. The defect is either inherited or acquired. Autosomal recessive inherited deficiency of Factor XIII is more common in Pediatrics. The condition is diagnosed on high index of suspicion in the presence of a typical history and a normal coagulation profile. Incidence of this rare condition is 1 in 2-3 million live births. A case of an eight year old boy is presented here, admitted in our hospital with a history of difficult to control scalp bleeding following trivial trauma.

Key words: Factor XIII deficiency, umbilical stump bleeding (omphalorrhagia), intracranial bleed

A Case Report Efficacy of non-pharmacological intervention in children with Attention-Deficit/Hyperactive Disorder (ADHD) and conduct disorders comorbidities

2024-02-13T09:52:49+00:00

Attention-Deficit/Hyperactive Disorder (ADHD) is the most common pediatric psychological disorder. Although pharmacotherapy is effective, parents often hesitate to initiate this form of therapy and prefer non-pharmacological treatments. This is a case report of an 8-year-old boy with complaints of hyperactivity, restless behavior, struggles with focusing and often behaving carelessly and dangerously. The child's hyperactivity and impulsivity, accompanied by resistance to authority, anger, and cruelty towards animals, exaggerated in the last 8 months. The parents' inconsistent parenting styles and domestic conflicts contribute to the child's worsening behavior. Despite a diagnosis of ADHD comorbid with conduct disorder (CD), parents refused pharmacotherapy and only accepted behavioral therapy, but no significant improvement. ADHD children with comorbid CD can have altered treatment responses. Isolated behavioral interventions did not appear to provide substantial benefits. Addressing parental concerns and involvement, and tailoring interventions to individual needs are essential.