Medical Specialties Commons^™

Teaching Paediatric Critical Care Medicine To Paediatric Residents, Anwarul Haque, Rizwan Haider, Muhammad Sohail Salat

Department of Paediatrics and Child Health

Critical care training during paediatric residency provides an ideal opportunity to learn and refine the skills needed in the early recognition and prompt treatment of the acutely ill paediatric patients. Paediatric critical care medicine is a relatively young sub-specialty in Pakistan. The aim of this study is to describe our experience of teaching paediatric residents in paediatric critical care medicine during paediatric intensive care unit rotation. Our paediatric critical care teaching curriculum for residents is based on the spectrum of our common critical care problems along with basic principal of critical care. The clinical rotation in our paediatric intensive care …

New Approaches To Preventing, Diagnosing, And Treating Neonatal Sepsis, Karen Edmond, Anita K. M. Zaidi

Department of Paediatrics and Child Health

No abstract provided.

Acute Necrotizing Encephalopathy Of Childhood: A Fatal Complication Of Swine Flu, Muhammad Rehan Khan, Prem Kumar Maheshwari, Syed Asad Ali, Anwarul Haque

Department of Paediatrics and Child Health

Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition characterized by the presence of multifocal symmetrical brain lesions involving mainly thalami, brainstem, cerebellum and white matter. ANEC is a serious and life threatening complication of simple viral infections. We present a case of a young child who developed this condition with classical clinical and radiological findings consistent with ANEC, secondary to swine flu (H1N1). He needed ventilatory support and had profound motor and intellectual deficit on discharge. We report this case with aim of raising awareness about this fatal complication of swine flu which has become a global health …

Efficacy And Safety Of Procedural Sedation And Analgesia By Paediatric Intensivist In Paediatric Oncology Unit, Anwarul Haque, Zahra Fadoo

Department of Paediatrics and Child Health

Children with cancer especially acute leukaemia undergo multiple painful procedures like bone marrow biopsy (BM) and lumber puncture (LP) for intrathecal chemotherapy during their first year of treatment. The purpose of this study is to report safety and efficacy of Procedural Sedation and Analgesia (PSA) by paediatric intensivist for oncology procedures in controlled setting in paediatric oncology unit. During 20 months, 124 children received PSA for 499 procedures. 324 LP alone, 175 BM alone and 40 combined LP and BM were done. The most common diagnosis was acute leukaemia and lymphoma. All procedures were in compliance with American Society of …

Analysis Of The Uk Recommendations On Obesity Based On A Proposed Implementation Framework, Amudha S. Poobalan, Lorna S. Aucott, Sheraz Ahmed, W. Cairns S. Smith

Department of Paediatrics and Child Health

Background: There is considerable expertise in the obesity field in identifying, appraising, and synthesising evidence to develop guidelines and recommendations for policy and practice. The recommendations, while based on evidence, are not formulated in a way that readily leads to implementation. This paper analyses the recent UK recommendations on obesity using a proposed implementation framework. Methods: Two bibliographic databases (Medline and Embase) and various health related and government websites were systematically searched for obesity recommendations published between 1996 and 2007. All the documents published on recommendations for either prevention or treatment of obesity in the UK were assessed. A proposed …

Clinical Profile And Treatment Of Infantile Spasms Using Vigabatrin And Acth - A Developing Country Perspective, S. H. Ibrahim, Shamshad Gulab, Sidra Ishaque, Taimur Saleem

Department of Paediatrics and Child Health

Background: Infantile spasms represent a serious epileptic syndrome that occurs in the early infantile age. ACTH and Vigabatrin are actively investigated drugs in its treatment. This study describes the comparison of their efficacy in a large series of Patients with infantile spasms from Pakistan. Methods: All Patients with infantile spasms who presented to Aga Khan University Hospital, Karachi, Pakistan from January, 2006 to April, 2008 were included in this study. Inclusion criteria were clinical symptoms of infantile spasms, hypsarrythmia or modified hyparrythmia on electroencephalography, at least six months of follow-up period and receipt of any of the two drugs mentioned …

Venoarterial Pco2 Difference: A Marker Of Postoperative Cardiac Output In Children With Congenital Heart Disease, Muhammad Furqan, Fahad Hashmat, Munir Amanullah, Mansoor Khan, Hina K Durani, Anwarul Haque

Department of Paediatrics and Child Health

OBJECTIVE: To determine the relationship between venoarterial carbon dioxide gradient (DeltapCO2) and central venous oxygen saturation (ScvO2) in children after cardiac surgery.

STUDY DESIGN: A cohort study.

PLACE AND DURATION OF STUDY: The Paediatric cardiac intensive care unit of the Aga Khan University Hospital, Karachi, from June 2006 to May 2007.

METHODOLOGY: All children admitted in the paediatric cardiac intensive care after complete repair of congenital heart defect using cardiopulmonary bypass were included in the study. Simultaneous arterial and central venous blood gas samples were obtained from a catheter placed in the artery (either radial or femoral) and superior vena …

Foreign Body Or Foreign From Body--Congenital Unilateral Lobar Hypoplasia Of Lung, Heeramani Lohana, Syed Rehan Ali, Shakeel Ahmed

Department of Paediatrics and Child Health

We report a rare case of congenital unilateral hypoplasia of the lung without any other anomaly at Aga Khan University Hospital. A 7-month-old male infant presented in emergency room with respiratory distress. There was no history of cough and wheeze. X-ray revealed left sided non homogenous opacity along with right sided hyperinflation. A suspicion of foreign body was made on chest X-ray but bronchoscopy was deferred in view of bilateral equal air entry and absence of wheeze. CT scan showed left upper lobe hypoplasia. Child recovered with supportive therapy and was discharged home. To the best of our knowledge unilateral …

Incomplete, Atypical Kawasaki Disease Or Evolving Systemic Juvenile Idiopathic Arthritis: A Case Report., Shakeel Shaikh, Sidra Ishaque, Taimur Saleem

Department of Paediatrics and Child Health

Kawasaki disease is an acute febrile condition seen in children. However, it is also well recognized that some Patients do not fulfill the classic diagnostic criteria for the diagnosis of kawasaki disease. The incomplete form of kawasaki disease is termed as 'Incomplete KD' or 'Atypical KD'. We present a case of a 6 year old child with a history of prolonged fever, periorbital, oral and lip changes, changes in the extremities and an erythamatous, maculopapular rash. Based on the physical exam and her echocardiogram that showed right coronary artery dilatation, Intravenous immune globulin was administered in this Patient. This Patient …

Clinical Profile And Outcome In A Paediatric Intensive Care Unit In Pakistan, Anwarul Haque, Surraiya Bano

Department of Paediatrics and Child Health

Paediatric critical care medicine is a relatively new subspecialty in Pakistan. The clinical profile and outcomes of children admitted in the PICU (paediatric intensive care unit) were retrospectively reviewed from January to December 2007. Mean age of the studied 314 patients was 24 months; 37% were less than one-year-old and 66% was male. Mean PRISM score was 13.2. There were almost equal distribution of medical (46%) and surgical (54%) cases. Ninety percent of patients received mechanical ventilation, while more than 50% received vasoactive drugs. The rate of nosocomial infection was 4.7%. The average length of PICU stay was 3.2 (1-49) …

Comparison Of Oral Versus Injectable Vitamin-D For The Treatment Of Nutritional Vitamin-D Deficiency Rickets, Abdul Gaffar Billoo, Ghulam Murtaza, M. Ashraf Memon, Sultan Ahmed Khaskheli, Khalid Iqbal, Masood Hussain Rao

Department of Paediatrics and Child Health

OBJECTIVE: To assess the safety and acceptability of a single dose of vitamin-D versus the efficacy of injectable Vitamin-D versus oral vitamin-D.

STUDY DESIGN: Case control.

PLACE AND DURATION OF STUDY: It was carried out at the Department of Paediatrics, Kharadar General Hospital, Karachi, from August 2003 to April 2004.

METHODOLOGY: Children of the age of 6 months to 3 years with clinical, biochemical and radiological evidence of vitamin- D deficiency rickets were included. The history, clinical examination, complete blood picture, serum calcium. Phosphorus, alkaline phosphatase and X-ray of wrist joint were done. The children were divided into two groups …

Multiple Major Artery Compression By An Idiopathic Aortic Aneurysm: An Unusual Cause Of Hypertensive Encephalopathy, Shakeel Ahmed, Syed Rehan Ali, Husen Yousuf

Department of Paediatrics and Child Health

Multiple major artery compression by an aortic aneurysm is extremely rare in the paediatric population. Most arterial aneurysms in children are secondary to infections mainly mycotic, connective tissue disorder, vasculitis, collagen vascular diseases, and other causes. True idiopathic aneurysms are the least common and a few reports in children have been published. We describe an 8 year old boy who presented with hypertensive encephalopathy and later was found to have an idiopathic, symptomatic suprarenal aortic aneurysm compressing multiple major arteries of the abdomen. The child was subsequently managed on multiple antihypertensive medication and later required engraftment of the renal and …

Incomplete Kawaski Disease: Are We Missing It, Abdul Gaffar Billoo, Saira Waqar Lone, Salman Siddiqui, Huba Atiq

Department of Paediatrics and Child Health

Kawasaki disease, also known as mucocutaneous lymph node syndrome or infantile polyarteritis nodosa is an acute febrile vasculitis of unknown etiology with a predilection for coronary arteries and potential for aneurysm formation. In Incomplete Kawasaki disease, children with fever lack the sufficient number of criteria to fulfill the epidemiologic case definition and are diagnosed when coronary artery disease is detected. We present a case report of a one and a half years old girl who came with features of incomplete Kawasaki disease, high grade fever, irritability, history of conjunctivitis and cracking of lips. She was investigated and had a platelet …

Controlled Evaluation Of Bactec Peds Plus/F And Bactec Lytic/10 Anaerobic/F Media For Isolation Of Salmonella Enterica Serovars Typhi And Paratyphi A From Blood, Megan E. Reller, Anita K. M. Zaidi, Shazia Sultana, Shazia Azeem, Beenish Hanif, Shahida Qureshi, Rumina Hasan, Zulfiqar Ahmed Bhutta, Rehana Akhter, Donald A. Goldmann

Department of Paediatrics and Child Health

We compared anaerobic lytic (AL) and pediatric aerobic resin-containing (Peds Plus/F) blood culture media for the isolation of Salmonella enterica serotype Typhi or Paratyphi A from children. The yields from AL and Peds Plus/F media were the same with equal volumes of blood, but recovery was faster from AL medium than Peds Plus/F medium (10.7 and 16.4 h, respectively) (P < 0.001).

A Comparison Of Treatments Offered To Patients With Nonalcoholic Steatohepatitis, Saleem Perwaiz Iqbal, Sadia Mahmud, Saeed Hamid, Omrana Pasha, Khabir Ahmad

Department of Paediatrics and Child Health

OBJECTIVE: To compare various treatment options provided to patients with Nonalcoholic Steatohepatitis (NASH) and assess improvement in liver status via reduction in serum Alanine Aminotransferase (ALT) levels.

STUDY DESIGN: Retrospective cohort study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from April 2000 to April 2007.

METHODOLOGY: All available records of patients aged between 20-70 years, fatty liver on ultrasound, elevated serum ALT and having at least one follow-up, after a baseline visit were included. The patients had variable number of follow-ups and a maximum of 3 follow-ups were considered. Information was collected on demographic and clinical …

Fluoroquinolones For Treating Typhoid And Paratyphoid Fever (Enteric Fever), Durrane Thaver, Anita K. M. Zaidi, Julia A. Critchley, Asma Azmatullah, Syed Ali Madni, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Fluoroquinolones are recommended as first-line therapy for typhoid and paratyphoid fever (enteric fever), but how they compare with other antibiotics and different fluoroquinolones is unclear.
Objectives: To evaluate fluoroquinolone antibiotics for treating enteric fever in children and adults compared with other antibiotics, different fluoroquinolones, and different durations of fluoroquinolone treatment.
Search strategy: In November 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE, EMBASE, LILACS, mRCT, conference proceedings, and reference lists.
Selection criteria: Randomized controlled trials of fluoroquinolones in people with blood or bone marrow culture-confirmed enteric fever.
Data collection …

Familial Chylomicronemia In A Nine Months Old Infant, Saira Waqar Lone, Aamer Imdad, Abdul Gaffar Billoo

Department of Paediatrics and Child Health

Familial chylomicronemia syndrome is a rare disorder of lipoprotein metabolism due to familial lipoprotein lipase or apolipoprotein C-II deficiency or the presence of inhibitors to lipoprotein lipase. It manifests as eruptive xanthomas, acute pancreatitis, and lipaemic plasma due to marked elevation of triglyceride and chylomicrons levels. We report a rare case of familial chylomicronemia in a 9-month-old infant, who was diagnosed after his plasma was incidentally found to be milky. Lipid profile showed familial chylomicronemia (Type 1 Hyperlipidemia). The infant was started on a low fat diet and advised a regular follow-up.

Alma-Ata: Rebirth And Revision 8 - Primary Health Care: Making Alma-Ata A Reality, John Walley, Joy E. Lawn, Anne Tinker, Andres De Francisco, Mickey Chopra, Igor Rudan, Zulfiqar Ahmed Bhutta, Robert E. Black

Department of Paediatrics and Child Health

The principles agreed at Alma-Ata 30 years ago apply just as much now as they did then. "Health for all" by the year 2000 was not achieved, and the Millennium Development Goals (MDGs) for 2015 will not be met in most low-income countries without substantial acceleration of primary health care. Factors have included insufficient political prioritisation of health, structural adjustment policies, poor governance, population growth, inadequate health systems, and scarce research and assessment on primary health care. We propose the following priorities for revitalising primary health care. Health-service infrastructure, including human resources and essential drugs, needs strengthening, and user fees …

Factor Xiii Deficiency In Children--Clinical Presentation And Outcome, Zehra Fadoo, Ali Faisal Saleem

Department of Paediatrics and Child Health

OBJECTIVE: To determine the demographic features and clinical outcome of children with Factor XIII deficiency.

STUDY DESIGN: Observational case series.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 1996 to December 2006.

METHODOLOGY: Records of all hospitalized pediatric patients with discharge diagnosis of FXIII D, on the basis of factor XIII assay 5 mol/L urea test were retrospectively reviewed and abstracted on a pre-specified proforma. Demographic features, coagulation profile, family history and outcomes were noted.

RESULTS: A total of 10 charts were reviewed. There were 5 boys and 5 girls. Almost all the children (9/10) …

Perinatal Arterial Ischaemic Stroke: An Update With Literature Review, S. H. Ibrahim, Zafar Abdul Mueed

Department of Paediatrics and Child Health

Perinatal arterial ischaemic strokes are a major cause of morbidity in the neonatal period and leads to significant neurological morbidity. It is however under recognized as an entity and usually missed till the baby is 3-4 months of age when they first present with hemiplegia. Perinatal arterial ischaemic strokes are not reported from our country and this may be due to the fact that neurodiagnostic modalities were not available until the last few years. Even now this is not available in the smaller cities of our country. In this review we will discuss the common issues related to etiology and …

Clinical Profile And Outcome Of Cyanotic Congenital Heart Disease In Neonates, Khadija N Humayun, Mehnaz Atiq

Department of Paediatrics and Child Health

OBJECTIVE: To determine the clinical profile and assess the outcome of all neonates diagnosed with cyanotic congenital heart disease.

STUDY DESIGN: A case series.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital from January 1998 to December 2000.

PATIENTS AND METHODS: Neonates admitted with diagnosis of cyanotic congenital heart disease were evaluated for clinical diagnosis, survival and mortality.

RESULTS: Forty four neonates met the inclusion criteria. Eleven babies (25%) had Tetralogy of Fallot or its variants. Other malformations were d-transposition of great arteries, tricuspid valve anomalies (tricuspid atresia and Ebstein's anomaly), hypoplastic left heart syndrome, truncus arteriosus, total …

A Family With Acute Intermittent Porphyria, Abdul Gaffar Billoo, Saira Waqar Lone

Department of Paediatrics and Child Health

Porphyrias are inherited defects in heme metabolism that result in excessive secretion of porphyrins and porphyrin precursors. Porphyrias can be classified into acute, (neuropsychiatric), cutaneous and mixed forms. There are seven main types of porphyrias; acute intermittent porphyria and plumboporphyria are predominantly neuropsychiatric; congenital erythropoietic porphyria, porphyria cutanea tarda and erythropoietic protoporphyria have predominantly cutaneous manifestations and hereditary coproporphyria and variegate porphyria are classified as mixed as they both have neuropsychiatric and cutaneous features. They cause life-threatening attacks of neurovisceral symptoms that mimic many other acute medical and psychiatric conditions. Lack of clinical recognition often delays effective treatment, and inappropriate …

Drug Resistant Infections In Poor Countries: A Major Burden On Children, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Making A Difference - Drug Resistant Infections In Poor Countries - A Major Burden On Children, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Short-Course Versus Long-Course Antibiotic Therapy For Non-Severe Community-Acquired Pneumonia In Children Aged 2 Months To 59 Months, Batool A. Haider, Muhammad Ammad Saeed, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Pneumonia is the leading cause of mortality in children under five years of age. Treatment of pneumonia requires an effective antibiotic used in adequate doses for an appropriate duration. Recommended duration of treatment ranges between 7 and 14 days, but this is not based on any empirical evidence. Shorter duration of therapy, if found to be effective, could be particularly important in resource-poor settings where there is a high risk of death, poor access to medicines and health care, and limited budgets for medicines.
Objectives: To evaluate the efficacy of short- course versus long-course therapy with the same antibiotic …

Managing Severe Pneumonia In Children In Developing Countries - Increasing Resistance To First Line Antibiotics Means Recommendations Need Changing, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Cerebral Venous Sinus Thrombosis In Neonates, Shahnaz Ibrahim

Department of Paediatrics and Child Health

Neonatal Cerebrovenous sinus thrombosis(CVST) is extremely rare, however it is a devastating condition and one needs to be aware of this condition to diagnose it. The risk factors for CVST are still not properly understood. The largest registry for stroke and for neonatal CVST is from the Canadian registry which quotes an incidence of 0.6per 100,000 population per year. No data is present for the neonatal CVST in this region.
One needs to be aware of this devastating condition to manage it timely and appropriately. To date there is no consensus on the role of anticoagulant therapy and therefore therapy …

Child Health And Survival In The Eastern Mediterranean Region, Zulfiqar A. Bhutta, Asim Belgaumi, Rab Mohammad Abdur, Zein Karrar, Mohamed Khashaba, Nezha Mouane

Department of Paediatrics and Child Health

No abstract provided.

Role Of A Probiotic (Saccharomyces Boulardii) In Management And Prevention Of Diarrhoea, A G. Billoo, M A. Memon, S A. Khaskheli, G Murtaza, Khalid Iqbal, M Saeed Shekhani, Ahson Q. Siddiqi

Department of Paediatrics and Child Health

AIM: To assess the efficacy and safety of Saccharomyces boulardii (S. boulardii) in acute watery diarrhoea and its role in reducing the frequency of episodes of diarrhoea in subsequent two months.
Methods: Children from 2 mo to 12 years of age, with acute diarrhoea were selected according to inclusion criteria and randomised in S. boulardii group (treated with ORS, nutritional support and S. boulardii, 250 mg bid) and in control group (treated with ORS and nutritional support only). Active treatment phase was 5 d and each child was followed for two months afterwards. Frequency and consistency of stools as well …

Current Concepts In The Diagnosis And Treatment Of Typhoid Fever, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

No abstract provided.