Medical Specialties Commons^™

Omphalocoele, Ten Years Experience At A Tertiary Care Hospital, Anila Haroon, Akhtar Amin Memon, Rehan Ali

Department of Paediatrics and Child Health

Omphalocoele is a rare congenital anterior abdominal wall defect. We present 12 cases of Omphalocoele seen in our hospital. Further, we have discussed the clinical presentation, antenatal diagnosis, associated abnormalities and final outcome of the cases.

Idiopathic Pulmonary Haemosiderosis Presenting As Severe Iron Deficiency Anaemia--A Case From Pakistan, Noureen Afzal, Ammara Mushtaq, Arshalooz Rahman, Sonia Qureshi

Department of Paediatrics and Child Health

Idiopathic pulmonary haemosiderosis is an uncommon disorder, which is characterized by iron deficiency, recurrent haemoptysis and diffuse parenchymal infiltration on chest radiograph. We report an 8 year old child who had past history of multiple blood transfusions with diagnosis of iron deficiency anaemia and recurrent chest infection since the age of 21/2 year. At the age of 8 years, the child presented with fever and severe respiratory distress requiring intubation and ventilation. On Chest X-ray, bilateral white out was found and CT scan lung showed diffuse alveolar involvement. Lung biopsy confirmed haemosiderin-laden macrophages. Child was put on steroids and despite …

Acute Lymphoblastic Leukemia In A Child With Fanconi’S Anemia, Naureen Mushtaq, Rabia Wali, Zehra Fadoo, Ali Faisal Saleem

Department of Paediatrics and Child Health

No abstract provided.

Cardiac Involvement In Kawasaki Disease In Pakistani Children, Saleem Akhtar, Muhammad Matloob Alam, Mehnaz Atiq Ahmed

Department of Paediatrics and Child Health

Introduction: Coronary artery involvement is the most dreaded long-term complication of Kawasaki disease. Our aim was to look at the pattern of cardiovascular involvement in Pakistani children admitted with Kawasaki disease.
Methods: This study included children admitted with Kawasaki disease at the Aga Khan University Hospital Karachi over a period of 14 years from January 1997 to December 2010. Information gathered included patient demographics, clinical features, investigations, echocardiographic findings, treatment and follow-up. Those with coronary artery involvement on initial echocardiogram remained on long-term follow-up with clinical examination and echocardiogram.
Results: A total of 56 patients were admitted. (Mean age at …

Urinary Tract Infection Presenting As Jaundice In Neonates, Noureen Afzal, Maqbool Qadir, Sonia Qureshi, Rehan Ali, Shakeel Ahmed, Khalil Ahmad

Department of Paediatrics and Child Health

Neonatal Hyperbilirubinaemia is a common finding during the first postnatal week. Physiological jaundice occurs in first week of life in 60% of term and 80% of premature neonates. Non physiologic or pathologic jaundice occurs in 5-10% of newborns which require intervention. According to AAP guidelines laboratory investigation for jaundice include total serum bilirubin, blood Type and coombs test and if the baby has an elevation of direct reacting or conjugated bilirubin, there should be a urine analysis and urine culture. Here we are presenting 5 cases that developed indirect hyperbilirubinaemia and routine workup done according to AAP guidelines were normal. …

Elective Tracheostomy In Mechanically Ventilated Children, Prem Kumar Maheshwari, Muhammad Rehan Khan, Anwarul Haque

Department of Paediatrics and Child Health

Tracheostomy is an important procedure in children requiring prolonged mechanical ventilation. We conducted a retrospective study to assess the frequency, indications, postoperative course and short-term outcome of elective tracheostomy in a Paediatric Intensive Care Unit (PICU) of Pakistan. Twenty-five patients underwent tracheostomy in last 5 years (2.2 % of all PICU admissions). Mean age of patients was 6 years and 60% were male. The most common indication for tracheostomy was prolonged mechanical ventilation secondary to neurological disease (60%), followed by upper airway obstruction (40%). Major complications included accidental decannulation (20%) and tube obstruction (20%). Three patients (12%) developed ventilator-associated pneumonia …

Spinal Muscular Atrophy:Clinical Spectrum And Genetic Mutations In Pakistani Children, S. H. Ibrahim, Tariq Moatter, Ali Faisal Saleem

Department of Paediatrics and Child Health

Background: In Pakistan the rate of consanguineous marriages is high, thus, the chance of incidence of autosomal recessive disorders is likely to be high. The aim of this study is to investigate the clinical characteristics and genetics of spinal muscular atrophy (SMA) in children who presented to Aga Khan University, Karachi.
Materials and Methods: This study was a retrospective review of the medical charts of children (neonate: 15 years) with discharge diagnosis of SMA during last 10 years. Demographic features, consanguinity, and diagnostic analysis (including genetic analysis) were noted.
Results: During the study period 67 children had a discharge diagnosis …

Acute Myeloid Leukaemia In Children: Experience At A Tertiary Care Facility Of Pakistan, Zehra Fadoo, Naureen Mushtaq, Saima Alvi, Muhammad Ali

Department of Paediatrics and Child Health

Objective: To document the demographics and outcome of children with Acute Myeloid Leukemia (AML) treated at a tertiary care facility of Pakistan.

Methods: A retrospective study was conducted at Aga Khan University on children (less than 15 years) diagnosed to have AML between January 2000 to May 2007.Total 40 cases were diagnosed out of which 37 charts were available for review.

Results: The average age of presentation was 8.5±4.5 years and 75% were males. The most common presenting feature was fever in 83% followed by bleeding in 41% and pallor in 39%. Initial WBC of > 100,000 was seen in 19% …

Schools As Potential Vaccination Venue For Vaccines Outside Regular Epi Schedule: Results From A School Census In Pakistan., Sajid Bashir Soofi, Inam-Ul Haq, M. Imran Khan, Muhammad Bilal Siddiqui, Mushtaq Mirani, Rehman Tahir, Imtiaz Hussain, Mahesh K Puri, Zamir Hussain Suhag, Asif R Khowaja, Abdul Razzaq Lasi, John D Clemens, Michael Favorov, R. Leon Ochiai, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Vaccines are the most effective public health intervention. Expanded Program on Immunization (EPI) provides routine vaccination in developing countries. However, vaccines that cannot be given in EPI schedule such as typhoid fever vaccine need alternative venues. In areas where school enrolment is high, schools provide a cost effective opportunity for vaccination. Prior to start of a school-based typhoid vaccination program, interviews were conducted with staff of educational institutions in two townships of Karachi, Pakistan to collect baseline information about the school system and to plan a typhoid vaccination program. Data collection teams administered a structured questionnaire to all schools …

Pseudomonas Necrotizing Fasciitis In An Otherwise Healthy Infant, Shakeel Ahmed, Syed Rehan Ali, Zahra Aziz Samani

Department of Paediatrics and Child Health

Necrotizing fasciitis is an uncommon rapidly progressing infection of soft tissue characterized by a severe inflammation of the fascia and soft tissue. The disease is associated with necrosis and subcutaneous gangrene of the inflamed tissue with systemic toxicity that carries a significant mortality unless timely diagnosed and aggressively treated. Monomicrobial necrotizing fasciitis caused by Pseudomonas aeruginosa is an exceptionally uncommon condition with only few cases reported in the literature so far. We are reporting a six-month-old female infant who was previously healthy and who presented with necrotizing fasciitis and isolates Pseudomonas aeruginosa both from the blood and tissue. The child …

Clinical Profile And Outcomes Of Paediatric Patients With Diabetic Ketoacidosis At A Tertiary Care Hospital In Pakistan, Madiha Syed, Fariha Batool Khawaja, Taimur Saleem, Umair Khalid, Abdul Rashid, Khadija Nuzhat Humayun

Department of Paediatrics and Child Health

OBJECTIVES: This study aims to present an experience in the management and clinical features of 88 children presenting with diabetic ketoacidosis (DKA) from Pakistan.

METHODS: A retrospective medical chart review of all patients, < or = 15 years of age, who presented to the Aga Khan University Hospital, Karachi, Pakistan in the last ten years with a diagnosis of diabetic ketoacidosis was carried out. Severity of DKA was defined as mild (venous pH < 7.30 or bicarbonate=15mEq/l), moderate (venous pH < 7.2 or bicarbonate = 10 mEq/l) and severe (venous pH < 7 or bicarbonate < 5 mEq/l). These classes correspond to 1st, 2nd and 3rd degrees of diabetic ketoacidosis severity respectively. Cases in which diabetic ketoacidosis had occurred at onset of diabetic diagnosis were not included in the study.

RESULTS: Mean age was 7.5 +/- 3.6 years; 58 (66%) patients were male. Twenty six patients had mild diabetic ketoacidosis, 44 had moderate while 18 had severe diabetic ketoacidosis at the time of presentation. Severity of diabetic ketoacidosis was significantly associated with the presence of infection, history of omission of insulin, poor compliance, presence of shock at time of presentation, length of stay in the hospital, final …

Foetus-In-Foetu, Syed Rehan Ali, Maqbool Qadir, Shakeel Ahmed, Prem Kumar

Department of Paediatrics and Child Health

Foetus-in-foetu is a rare malformation in which a monozygotic diamniotic parasitic twin is incorporated into the body of its fellow twin and grows inside it. Less than 100 cases have been reported in literature. One day old newborn male was admitted with antenatal diagnosis of abdominal mass. It was cystic/solid in nature with pressure effects on left ureter and urinary bladder, most likely to be a germ cell tumour. Birth history was uneventful. Exploratory laparotomy was performed and the mass was excised. Physical examination confirmed the diagnosis of foetus-in-foetu. Although it is a rare condition, imaging may play an important …

Setting Research Priorities To Reduce Global Mortality From Childhood Pneumonia By 2015, Igor Rudan, Shams El Arifeen, Zulfiqar Ahmed Bhutta, Robert E. Black, Abdullah Brooks, Kit Yee Chan, Mickey Chopra, Trevor Duke, David Marsh, Antonio Pio, Eric A. F. Simoes, Giorgio Tamburlini, Evropi Theodoratou, Martin W. Weber, Cynthia G. Whitney, Harry Campbell, Shamim A. Qazi

Department of Paediatrics and Child Health

No abstract provided.

Real-World Comparison Of Two Molecular Methods For Detection Of Respiratory Viruses, Syed Asad Ali, James E. Gern, Tina V. Hartert, Kathryn M. Edwards, Marie R. Griffin, E Kathryn Mille, Tebeb Gebretsadik, Tressa Pappas, Wai Ming Lee, John V. Williams

Department of Paediatrics and Child Health

Background: Molecular polymerase chain reaction (PCR) based assays are increasingly used to diagnose viral respiratory infections and conduct epidemiology studies. Molecular assays have generally been evaluated by comparing them to conventional direct fluorescent antibody (DFA) or viral culture techniques, with few published direct comparisons between molecular methods or between institutions. We sought to perform a real-world comparison of two molecular respiratory viral diagnostic methods between two experienced respiratory virus research laboratories.
Methods: We tested nasal and throat swab specimens obtained from 225 infants with respiratory illness for 11 common respiratory viruses using both a multiplex assay (Respiratory MultiCode-PLx Assay [RMA]) …

Does Improving Maternal Knowledge Of Vaccines Impact Infant Immunization Rates? A Community-Based Randomized-Controlled Trial In Karachi, Pakistan, Aatekah Owais, Beenish Hanif, Amna R. Siddiqui, Ajmal Agha, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Background: In Pakistan, only 59-73% of children 12-23 months of age are fully immunized. This randomized, controlled trial was conducted to assess the impact of a low-literacy immunization promotion educational intervention for mothers living in low-income communities of Karachi on infant immunization completion rates. Methods: Three hundred and sixty-six mother-infant pairs, with infants aged Results: Baseline characteristics among the two groups were similar. At 4 month assessment, among 179 mother-infant pairs in the intervention group, 129 (72.1%) had received all 3 doses of DPT/Hepatitis B vaccine, whereas in the control group 92/178 (51.7%) had received all 3 doses. Multivariable analysis …

Effect Of Case Management On Neonatal Mortality Due To Sepsis And Pneumonia, Anita K. M. Zaidi, Hammad A. Ganatra, Sana Syed, Simon Cousens, Anne C. C. Lee, Robert Black, Zulfiqar A. Bhutta, Joy E. Lawn

Department of Paediatrics and Child Health

Background: Each year almost one million newborns die from infections, mostly in low-income countries. Timely case management would save many lives but the relative mortality effect of varying strategies is unknown. We have estimated the effect of providing oral, or injectable antibiotics at home or in first-level facilities, and of in-Patient hospital care on neonatal mortality from pneumonia and sepsis for use in the Lives Saved Tool (LiST). Methods: We conducted systematic searches of multiple databases to identify relevant studies with mortality data. Standardized abstraction tables were used and study quality assessed by adapted GRADE criteria. Meta-analyses were undertaken where …

Seeing The Unseen:Targeting Neonatal Mortality In Rural Vietnam., Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Safety Of Insulin Tolerance Test For The Assessment Of Growth Hormone Deficiency In Children, Saira Waqar Lone, Yasir Naqi Khan, Farah Qamar, Irum Atta, Mohsina Noor Ibrahim, Jamal Raza

Department of Paediatrics and Child Health

OBJECTIVE: To determine the safety of insulin tolerance test (ITT) for assessing growth hormone (GH) deficiency in children.

METHODS: This hospital based study was conducted at the National Institute of Child Health, Karachi from 1st November 2008 till 30th October 2009. All children suspected of growth hormone deficiency, were included after excluding all other causes of short stature. Verbal informed consent was taken from the parents. Children less than 2 years of age, weighing less than 10 kg, untreated/inadequately treated hypothyroidism or Addison's disease, epilepsy, having history of hypoglycaemic fits or cardiac disease were excluded. All children were subjected to …

Continuous Ambulatory Peritoneal Dialysis (Capd) Associated Peritonitis In A Child: A Rare Case Of Peritonitis Caused By Sphingomonous Paucimobilis, Arwa Quresh Tambawala, Sadaf Hamid, Iqtidar Khan, Asad Ali

Department of Paediatrics and Child Health

First identified in 1977, Sphingomonous Paucimobilis has emerged as an opportunistic human pathogen. It is primarily known to cause a range of mostly nosocomial, non-life-threatening infections that typically are easily treated by antibiotic therapy. Sources of its isolation linked to clinical disease include blood, spinal fluid and leg ulcers. It has also been reported as a rare cause of peritonitis in patients on continuous ambulatory peritoneal dialysis. We present a case of a child with peritonitis due to this organism. Clinical features, bacteriology and treatment option and response have been discussed.

Availability And Affordability Of Essential Medicines: Exploring The Health Seeking Behaviours And Health Service Utilisation For Children Under-5 Years Living In Squatter Settlement Of Karachi, Pakistan, Yasir Shafiq, Babar Tasneem Shaikh, Ramesh Kumar

Department of Paediatrics and Child Health

Background: Child health outcomes in the poor communities are largely affected by the non-availability of essential medicines at government health facilities and non-affordability of prescribed medicines at private retail pharmacies. This phenomenon largely defines health seeking behaviours and health service utilisation patterns of the families of the children.
Methods: Using observational visits, we examined the shelf-availability of medicines for children less than 5 years of age at a rural health centre and conducted focus group discussions with the mothers to explore the effects of non-availability and non-affordability of medicines. We also validated all information by interviewing the health care providers …

Perception And Practices Of Breastfeeding Of Infants 0-6 Months In An Urban And A Semi-Urban Community In Pakistan: A Cross-Sectional Study, Sumera Ali, Syed Faizan Ali, Ayesha Mallick Imam, Samia Ayub, Abdul Gaffar Billoo

Department of Paediatrics and Child Health

OBJECTIVE: To investigate mother's perception and practices about breastfeeding and their socio-demographic correlate in infants equal to or less than 6 months.

METHODS: A cross-sectional study was carried out on 200 mother-infant pairs who visited the health care centers, Bilal Colony (semi-urban) and the Aga Khan University (urban), for their well baby follow-ups and vaccination using convenient sampling. Frequencies and percentages were computed and Chi-square was used to find associations between socio-demographics of mothers and their perception and practices about breastfeeding.

RESULTS: Exclusive breastfeeding was reported by about 54% of the mothers. Thirty-five percent of the mothers gave prelacteal feed, …

Significance Of Pyuria In The Diagnosis Of Urinary Tract Infections In Neonates, Arshalooz J Rahman, Farah Naz, Sohail Ashraf

Department of Paediatrics and Child Health

OBJECTIVES: To determine the significance of pyuria as a predictor of culture proven urinary tract infections (UTI) in neonates and to assess the frequency of urinary tract anomalies in neonates with pyuria.

METHODS: Prospective study conducted at the neonatal intensive care unit of a tertiary care hospital; (Liaquat National Hospital Karachi) for a period of 4 months from April 2008 to August 2008. One hundred and ten consecutive infants < or = 28 days of age admitted to the NICU of Liaquat National Hospital for medical reasons were included in the study. Information regarding age, gender, antenatal history, birth weight, clinical examination, laboratory findings and outcome were recorded on a questionnaire. Septic work up was performed and urine samples were collected using urethral catheterization. Patients showing any number of white blood cells on microscopy were included and their urine sent for culture. All patients had Ultrasound done during their hospital stay and those patients with any renal abnormality were further investigated with Micturating cyestoretherogram (MCUG) at 6 weeks.

RESULTS: Out of one hundred and ten patients admitted, thirty five patients showed the presence of pus cells in urine and were included in the study. Of the 35 neonates with …

Effect Of Zinc In Tablet And Suspension Formulations In The Treatment Of Acute Diarrhoea Among Young Children In An Emergency Setting Of Earthquake Affected Region Of Pakistan, Muhammad Atif Habib, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

A longitudinal cohort study was conducted at Camp Hospital Batagram in August 2006 to ascertain the effect of Zinc utilization in tablet and suspension formulations on the frequency and recovery rates of diarrhoea among young children in the emergency settings of earthquake affected region of Pakistan. Two hundred patients were recruited and followed up, the patients were allocated either of the 2 groups i.e. A (zinc in tablets form) and B (zinc in suspension form). Both groups also received WHO recommended treatment for diarrhoea. Most of the cases recovered from the illness within 3 days after presentation. Significant p-values were …

Evaluation Of Health Workforce Competence In Maternal And Neonatal Issues In Public Health Sector Of Pakistan: An Assessment Of Their Training Needs, Shabina Ariff, Sajid B. Soofi, Kamran Sadiq, Asher B. Feroze, Shuaib Khan, Sadiqua N. Jafarey, Nabeela Ali, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

Background: More than 450 newborns die every hour worldwide, before they reach the age of four weeks (neonatal period) and over 500,000 women die from complications related to childbirth. The major direct causes of neonatal death are infections (36%), Prematurity (28%) and Asphyxia (23%). Pakistan has one of the highest perinatal and neonatal mortality rates in the region and contributes significantly to global neonatal mortality. The high mortality rates are partially attributable to scarcity of trained skilled birth attendants and paucity of resources. Empowerment of health care providers with adequate knowledge and skills can serve as instrument of change. Methods: …

Successful Management Of Invasive Aspergillosis With Voriconazole And Amphoteracin B Therapy In A Patient With Acute Mycloid Leukemia (Aml-M2), Nauman Fazal Manzoor, Sidra Azim, Zehra Fadoo

Department of Paediatrics and Child Health

An eleven-year-old boy presented with one month's history of fever and weight loss. He was diagnosed with Acute Mycloid Leukemia (AML-M2). During treatment he developed recurrent infections with neutropenia requiring prolonged antibiotics and subsequently developed invasive aspergillosis. He was treated with amphotericin B and Voriconazole. This case shows the efficacy and safety of combined antifungal therapy, including voriconazole, for invasive aspergillosis complicating AML.

Investment In Paediatric Tuberculosis Prevention In Pakistan: Loss Or Gain, Emad Uddin Siddiqui, Kiran Ejaz, Saira Lone, Syed Jamal Raza

Department of Paediatrics and Child Health

OBJECTIVE: To assess the effectiveness of paediatric tuberculosis prevention, by reevaluation factors in children exposed to tuberculosis from less privileged strata of Pakistan.

METHODS: This cross sectional descriptive study was conducted at National Institute of Child Health, from January 2004 to December 2005. Paediatric patients under 15 years of either gender, diagnosed with active tuberculosis were enrolled. Interviews were conducted with parents regarding common preventive measures and factors advocating tuberculosis spread. Later factors leading to non-compliance to safety recommendations were also evaluated.

RESULTS: Fifty five (70%) children younger than 5 years, had index cases in direct contact within their own …

Congenital Bilateral Choanal Atresi, Ali Faisal Saleem, Shabina Ariff, Nadeem Aslam, Mubasher Ikram

Department of Paediatrics and Child Health

Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral cases because this is a life-threatening situation in newborns. This is a case report of a full-term, healthy newborn baby presenting with intermittent attacks of cyanosis and respiratory distress soon after birth. On examination, alternating cyanosis and normal colour was observed in the infant. The insertion of nasal catheters in both the nares revealed the diagnosis of bilateral CCA. For this rare condition, conservative management was followed with elective transnasal endoscopic repair …

Klebsiella Osteomyelitis Of The Right Humerus Involving The Right Shoulder Joint In An Infant, Maqbool Qadir, Syed Rehan Ali, Mumtaz Lakhani, Pervaiz Hashmi, Ahsen Amirali

Department of Paediatrics and Child Health

Osteomyelitis in newborn infants is a rare infection. Lower extremity joints are commonly affected. Most of the cases have a haematogenous spread. Aerobes are the common group of organism involved, of which Staphylococcus aureus is the commonest. Klebsiella osteomyelitis has been reported as a cause of Osteomyelitis. However, to the best of our knowledge, this is the first case report of Klebsiella pneumoniae associated osteomyelitis in an infant from Pakistan.

Use Of Miltefosine In The Treatment Of Visceral Leishmaniasis In Children At A Tertiary Care Hospital Of Karachi, Khadija Nuzhat Humayun, Taimur Saleem, Umair Khalid, Fyezah Jehan, Sajid Soofi

Department of Paediatrics and Child Health

Existing standard treatment options for visceral leishmaniasis are less than optimal. We report here the use of oral miltefosine in the treatment of two paediatric cases of visceral leishmaniasis at a tertiary care hospital in Karachi, Pakistan. One patient came from Balochistan while the second patient was from Northern Pakistan. Both presented with a prolonged history of fever, massive hepatosplenomegaly, anaemia and thrombocytopenia. Visceral leishmaniasis was diagnosed with bone marrow studies. Amphotericin B was first started in the first patient; however severe hypokalaemia and allergic reaction occurred. Oral miltefosine was then administered. The child showed clinical improvement with regards to …

Dyssegemental Dyspalsia; Rolland-Desbuquois Type--A Case Report From Pakistan, Bushra Afroze

Department of Paediatrics and Child Health

Two different forms of dyssegmental dysplasia can be distinguished; the lethal Silverman-Handmaker type and less severe Rolland-Desbuquois type. Patients with Rolland-Desbuquois type often survive beyond neonatal period. The purpose of this paper is to report a rare case of Dyssegmental dysplasia, Rolland-Desbuquois type from Pakistan.