Pediatrics Commons^™

Machine Learning From Fetal Flow Waveforms To Predict Adverse Perinatal Outcomes: A Study Protocol, Zahra Hoodbhoy, Babar Hasan, Fyezah Jehan, Bart Bijnens, Devyani Chowdhury

Department of Paediatrics and Child Health

Background: In Pakistan, stillbirth rates and early neonatal mortality rates are amongst the highest in the world. The aim of this study is to provide proof of concept for using a computational model of fetal haemodynamics, combined with machine learning. This model will be based on Doppler patterns of the fetal cardiovascular, cerebral and placental flows with the goal to identify those fetuses at increased risk of adverse perinatal outcomes such as stillbirth, perinatal mortality and other neonatal morbidities.
Methods: This will be prospective one group cohort study which will be conducted in Ibrahim Hyderi, a peri-urban settlement in south …

Rapid Intravenous Rehydration Of Children With Acute Gastroenteritis And Dehydration: A Systematic Review And Meta-Analysis, M. A. Iro, T. Sell, N. Brown, K. Maitland

Department of Paediatrics and Child Health

Background: The World Health Organization (WHO) recommends rapid intravenous rehydration, using fluid volumes of 70-100mls/kg over 3–6 h, with some of the initial volume given rapidly as initial fluid boluses to treat hypovolaemic shock for children with acute gastroenteritis (AGE) and severe dehydration. The evidence supporting the safety and efficacy of rapid versus slower rehydration remains uncertain.
Methods: We conducted a systematic review of randomised controlled trials (RCTs) on 11th of May 2017 comparing different rates of intravenous fluid therapy in children with AGE and moderate or severe dehydration, using standard search terms. Two authors independently assessed trial quality and …

Association Between Environmental Tobacco Smoke And Dental Caries Amongst 5-14 Years Old Children In Karachi, Pakistan., Anna Ali Nayani, Romaina Iqbal, Syed Iqbal Azam, Farhan Raza Khan, Aysha Habib Khan, Naveed Janjua, Azmina Hussain

Community Health Sciences

Objective:To determine the association between environmental tobacco smoke and dental caries.
Methods:This cross-sectional study was conducted in peri-urban and urban areas of Karachi, from February to August 2014, and comprised children aged 5-14 years. A pre-coded questionnaire for environmental tobacco smoke and food frequency questionnaire for dietary habits were used. Dental examination of children was done to detect caries. Cox-proportional hazard algorithm was used to measure the association of environmental tobacco smoke with dental caries at multivariable level. STATA version 12.0 was used for statistical analysis.
Result:Of the 500 children, 250(50%) each were from peri-urban and urban …

Quality Of Care Of Treatment For Uncomplicated Severe Acute Malnutrition Provided By Lady Health Workers In Pakistan, Eleanor Rogers, Muhammad Ali, Shahid Fazal, Deepak Kumar, Saul Guerrero, Imtiaz Hussain, Sajid Bashir Soofi, Jose Luis Alvarez Morán

Department of Paediatrics and Child Health

Objective: To assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community.
Design: Cross-sectional quality-of-care study.
Setting: The feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model.
Subjects: LHW implementing treatment for uncomplicated SAM in the community.
Results: Oedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for …

High Smad7 And P-Smad2,3 Expression Is Associated With Environmental Enteropathy In Children, Sana Syed, Vincenzo Dinallo, Najeeha Talat Iqbal, Laura Di Iorio, Davide Di Fusco, Shan Guleria, Beatrice C. Amadi, Kamran Sadiq, Christopher Moskaluk, Syed Asad Ali

Department of Paediatrics and Child Health

Enteropathies such as Crohn's disease are associated with enteric inflammation characterized by impaired TGF-β signaling, decreased expression of phosphorylated (p)-SMAD2,3 and increased expression of SMAD7 (an inhibitor of SMAD3 phosphorylation). Environmental enteropathy (EE) is an acquired inflammatory disease of the small intestine (SI), which is associated with linear growth disruption, cognitive deficits, and reduced oral vaccine responsiveness in childrenp-SMAD2,3 levels (using Western blotting) in EE duodenal biopsies (N = 19 children, 7 from Pakistan, 12 from Zambia) and comparing these with healthy controls (Ctl) and celiac disease (CD) patients from Italy. Densitometric analysis of immunoblots showed that EE SI biopsies …

Direct Detection Of Shigella In Stool Specimens By Use Of A Metagenomic Approach, Jie Liu, Mathieu Almeida, Furqan Kabir, Sadia Shakoor, Shahida Qureshi, Anita K. M. Zaidi, Shan Li, Boubou Tamboura, Samba O. Sow, Inacio Mandomando

Department of Paediatrics and Child Health

The underestimation of Shigella species as a cause of childhood diarrhea disease has become increasingly apparent with quantitative PCR (qPCR)-based diagnostic methods versus culture. We sought to confirm qPCR-based detection of Shigella via a metagenomics approach. Three groups of samples were selected from diarrheal cases from the Global Enteric Multicenter Study: nine Shigella culture-positive and qPCR-positive (culture⁺ qPCR⁺) samples, nine culture-negative but qPCR-positive (culture^- qPCR⁺) samples, and nine culture-negative and qPCR-negative (culture^- qPCR^-) samples. Fecal DNA was sequenced using paired-end Illumina HiSeq, whereby 3.26 × 10⁸ ± 5.6 × 10 …

Partnerships For Child Health: Capitalising On Links Between The Sustainable Development Goals, Yulia Blomstedt, Zulfiqar Ahmed Bhutta, Johan Dahlstrand, Peter Friberg, Lawrence O. Gostin, Måns Nilsson, Nelson K. Sewankambo, Göran Tomson, Tobias Alfvén

Department of Paediatrics and Child Health

No abstract provided.

Congenital Prepubic Sinus: An Aborted Dorsal Urethral Duplication Or A Cloacal Remnant?, Zafar Nazir, Muhammad Arif Mateen Khan, Javaria Qamar

Section of Paediatric Surgery

Background: Congenital Prepubic Sinus (CPS) is an uncommon urogenital anomaly characterized by a blind tract between the skin over the pubis to anterior of the urinary bladder, Urethra or umbilicus. We report four such cases to emphasize varied clinical presentation and embryological conundrum.
Methods: Following Ethical Review Committee (ERC) approval, medical records of pediatric patients (<16 >years) presenting with CPS (identified through operating room records and Hospital Information Management System (HIMS) between 1994 and 2018 were reviewed for demographics, clinical presentation, investigations including histopathology, management and outcome.
Results: Four cases of CPS, 3 females and 1 male, age range …

Pre-Albumin As A Marker For Predicting Weight Loss In Hospitalised Children, Del-Rossi Sean Quadros, Rose Kamenwa, Samuel Akech, William Macharia

Paediatrics and Child Health, East Africa

Objectives: This study sought to determine the diagnostic utility of serum pre-albumin in predicting weight loss in hospitalised children.

Design: A hospital-based longitudinal survey was carried out between December 2013 and February 2014.

Setting: Aga Khan University Hospital, Nairobi, Kenya, a tertiary care hospital.

Subjects: A total of 170 children aged 29 days to 15 years who met the inclusion criteria were included in the study.

Outcome measures: Serum pre-albumin levels and weight were measured at admission and repeated after 48–96 h. Sensitivity, specificity, and positive and negative predictive values were calculated to determine the diagnostic utility of serum pre-albumin …

Teaching Children Road Safety Through Storybooks: An Approach To Child Health Literacy In Pakistan, Haris Ahmad, Rubaba Naeem, Nukhba Zia, Asher Feroze, Amarah Shakoor, Uzma R. Khan, Asad Mian

Department of Emergency Medicine

Background: Road traffic injuries (RTIs) commonly affect the younger population in low- and-middle-income countries. School children may be educated about road safety using storybooks with colorful pictures, which tends to increase the child’s interest in the text. Therefore, this study assessed the use of bilingual pictorial storybooks to improve RTI prevention knowledge among school children.
Methods: This pretest-posttest study was conducted in eight public and nine private schools of Karachi, Pakistan, between February to May 2015. Children in grades four and five were enrolled at baseline (n = 410). The intervention was an interactive discussion about RTI prevention using a …

Hospital-Acquired Malnutrition In Children At A Tertiary Care Hospital, Del-Rossi Sean, Rose Kamenwa, Samuel Akech, William Macharia

Paediatrics and Child Health, East Africa

Objectives: This study sought to investigate the incidence and factors associated with hospital-acquired malnutrition in children.

Design: A hospital-based longitudinal survey carried out between December 2013 and February 2014.

Setting: Aga Khan University Hospital, Nairobi, Kenya, a tertiary care hospital.

Subjects: One hundred and seventy children who met the inclusion criteria were included in the study.

Outcome measures: Anthropometry was done at admission and discharge. Incidence of hospital-acquired malnutrition was estimated from the total number of children showing a decrease in weight-for-height/length (WFH) or Body Mass Index (BMI) z-scores from the time of admission to discharge. Logistic regression analysis was …

Children’S Oxygen Administration Strategies Trial (Coast): A Randomised Controlled Trial Of High Flow Versus Oxygen Versus Control In African Children With Severe Pneumonia, Kathryn Maitland, Sarah Kiguli, Robert Opoka, Peter Olupot-Olupot, Charles Engoru, Patricia Njuguna, Victor Bandika, Ayub Mpoya, Andrew Bush, Thomas Williams

Paediatrics and Child Health, East Africa

Background: In Africa, the clinical syndrome of pneumonia remains the leading cause of morbidity and mortality in children in the post-neonatal period. This represents a significant burden on in-patient services. The targeted use of oxygen and simple, non-invasive methods of respiratory support may be a highly cost-effective means of improving outcome, but the optimal oxygen saturation threshold that results in benefit and the best strategy for delivery are yet to be tested in adequately powered randomised controlled trials. There is, however, an accumulating literature about the harms of oxygen therapy across a range of acute and emergency situations that …

Fmic Annual Report 2018 | Dari (دری), French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Fmic Annual Report 2018 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

The Global Impact Of The Dracma Guidelines Cow’S Milk Allergy Clinical Practice, Alessandro Fiocchi, Holger Schunemann, Ignacio Ansotegui, Amal Assa’Ad, Sami Bahna, Roberto Berni Canani, Martin Bozzola, Lamia Dahdah, Christophe Dupont, Motohiro Ebisawa, Elena Galli, Haiqi Li, Rose Kamenwa, Gideon Lack, Alberto Martelli, Ruby Pawankar, Maria Said, Mario Sánchez-Borges, Hugh Sampson, Raanan Shamir, Jonathan Spergel, Luigi Terracciano, Yvan Vandenplas, Carina Venter, Susan Waserman, Gary Wong, Jan Brozek

Paediatrics and Child Health, East Africa

Background: The 2010 Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) guidelines are the only Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines for cow’s milk allergy (CMA). They indicate oral food challenge (OFC) as the reference test for diagnosis, and suggest the choice of specific alternative formula in different clinical conditions. Their recommendations are flexible, both in diagnosis and in treatment.

Objectives & methods: Using the Scopus citation records, we evaluated the influence of the DRACMA guidelines on milk allergy literature. We also reviewed their impact on successive food allergy and CMA guidelines at national and …

Hemimegalencephaly: Seizure Outcome In An Infant After Hemispherectomy, Prem Chand, Pooja Manglani, Qalab Abbas

Department of Paediatrics and Child Health

Isolated hemimegalencephaly (iHME) is a rare form of congenital malformation of cortical development characterized by enlargement of all or part of one cerebral hemisphere. It typically presents with intractable seizures, developmental delay, contralateral hemiparesis, and hemianopia. We report a case of an 18-month-old girl who presented first with focal seizures at tenth day of life, with no other physical or behavioral abnormality. Initial EEG showed excessive sharp EEG transients more over the right hemisphere; repeated EEG showed spikes, polyspikes, sharps, and slow wave discharges predominately over the right hemisphere. MRI of the brain showed asymmetric enlargement of the right cerebral …

Factors Influencing Choice Of Skilled Birth Attendance At Anc: Evidence From The Kenya Demographic Health Survey, Caroline Nyongesa, Xiaoyue Xu, John J. Hall, William Macharia, Faith Yego, Brigid Hall

Paediatrics and Child Health, East Africa

Background: In Kenya, skilled attendance at delivery is well below the international target of 90% and the maternal mortality ratio is high at 362 (CI 254–471) per 100,000 live births despite various interventions. The preventative role of skilled attendance at delivery makes it a benchmark indicator for safe motherhood.

Methods: Maternal health data from the Service Provision Assessment Survey, a subset of the 2010 Kenya Demographic Health Survey was analyzed. Logistic regression models were employed using likelihood ratio test to explore association between choice of skilled attendance and predictor variables.

Results: Overall, 94.8% of women are likely to seek …

Mabry Syndrome In A Child Of South Asian Descent, Amir Humza Sohail, Muhammad Younus Khan Durrani, Shahnaz Hamid Ibrahim, Khadija Nuzhat Humayun

Section of Paediatric Surgery

Mabry syndrome is the triad of seizures, hyperphosphatasia, and mental disability. It usually manifests in first year of life and has an autosomal recessive mode of inheritance. Besides the usual triad, other manifestations of Mabry syndrome include hypoplasia of distal phalanges, brachytelencepahly, gastrointestinal malformations and constipation, hypertelorism, short nose with a broad nasal bridge and dip, and thin upper lip with down turned corners of the mouth. More than 20 cases of Mabry syndrome have been reported in medical literature. Herein, we report the case of a six-month child with Mabry syndrome that presented with decreased neck holding, hypotonia and …

Accelerating Kenya’S Progress To 2030: Understanding The Determinants Of Under-Five Mortality From 1990 To 2015, Emily C. Keats, William Macharia, Neha S. Singh, Nadia Akseer, Nirmala Ravishankar, Anthony Ngugi, Arjumand Rizvi, Emma Nelima Khaemba, John Tole, Zulfiqar Ahmed Bhutta

Paediatrics and Child Health, East Africa

Introduction: Despite recent gains, Kenya did not achieve its Millennium Development Goal (MDG) target for reducing under-five mortality. To accelerate progress to 2030, we must understand what impacted mortality throughout the MDG period.

Methods: Trends in the under-five mortality rate (U5MR) were analysed using data from nationally representative Demographic and Health Surveys (1989–2014). Comprehensive, mixed-methods analyses of health policies and systems, workforce and health financing were conducted using relevant surveys, government documents and key informant interviews with country experts. A hierarchical multivariable linear regression analysis was undertaken to better understand the proximal determinants of change in U5MR over the MDG …

Nasopharyngeal Carriage Of Streptococcus Pneumoniae In Children Under 5 Years Of Age Before Introduction Of Pneumococcal Vaccine (Pcv10) In Urban And Rural Districts In Pakistan, Muhammad Imran Nisar, Kanwal Nayani, Tauseef Akhund, Atif Riaz, Omer Irfan, Sadia Shakoor, Sehrish Muneer, Sana Muslim, Aneeta Hotwani, Furqan Kabir, Cynthia Whitney, Lindsay Kim, Velusamy Srinivasan, Syed Asad Ali, Anita K. M. Zaidi, Fyezah Jehan

Department of Paediatrics and Child Health

Background: Benefits of pneumococcal conjugate vaccine programs have been linked to the vaccine’s ability to disrupt nasopharyngeal carriage and transmission. The 10-valent pneumococcal vaccine (PCV10) was included in the Expanded Program on Immunization (EPI) in Sindh, Pakistan in February 2013. This study was carried out immediately before PCV10 introduction to establish baseline pneumococcal carriage and prevalent serotypes in young children and to determine if carriage differed in urban and rural communities.
Methods: Nasopharyngeal specimens were collected from a random sample of children 3-11 and 12-59 months of age in an urban community (Karachi) and children 3-11 months of age in …

Spectrum Of Complications Of Severe Dka In Children In Pediatric Intensive Care Unit, Qalab Abbas, Saba Arbab, Anwarul Haque, Khadija Nuzhat Humayun

Department of Paediatrics and Child Health

Objectives: To describe the spectrum of complications of Diabetic Ketoacidosis (DKA) observed in children admitted with severe DKA.
Methods: Retrospective review of the medical records of all children admitted with the diagnosis of severe DKA in Pediatric Intensive Care Unit (PICU) of the Aga Khan University Hospital, from January 2010 to December 2015 was done. Data was collected on a structured proforma and descriptive statistics were applied.
Results: Total 37 children were admitted with complicated DKA (1.9% of total PICU admission with 1.8% in 2010 and 3.4% in 2015). Mean age of study population was 8.1±4.6 years and 70% were …

A Comparison Of Three Diagnostic Platforms For The Detection Of Influenza A And B In Children, Furqan Kabir, Marvi Tariq, Fatima Aziz, Syed Imran Rizvi, Shahida Qureshi, Syed Asad Ali, Najeeha Talat Iqbal

Department of Paediatrics and Child Health

Background: Viral flu is the predominant cause of hospitalization in young children, which invariably leads to enhanced morbidity and mortality in children in developing countries. Initial treatment of viral flu is based on presumptive diagnosis. Bedside testing is not common in clinical settings because of variable sensitivity and specificity of rapid tests in different settings.
Methods: To address this issue, we evaluated the performance of Binax influenza A/B rapid testing kit against two robust molecular platforms (quantitative real-time polymerase chain reaction [qRT-PCR] and TaqMan array card [TAC]) in 24 nasopharyngeal (NP) swabs, collected from children under 5 years of age. …

Impact Of Pre-Eclampsia On The Cardiovascular Health Of The Offspring: A Cohort Study Protocol, Zahra Hoodbhoy, Babar Hasan, Nuruddin Badruddin Mohammed, Devyani Chowdhury

Department of Paediatrics and Child Health

Introduction: Pre-eclampsia is a common disorder associated with serious maternal and fetal complications. It is associated with abnormal placentation, which significantly reduces flow, resulting in a relative hypoxic state. These pathophysiological changes lead to subtle macrovascular and cardiac structural and functional changes in the fetus. This can predispose the child with maternal history of pre-eclampsia to risk of premature cardiovascular disease.
Methods and analysis: The children will be identified from a cohort of women with pre-eclampsia. The study will be conducted at The Aga Khan University Hospital, Karachi. Inclusion criteria will be children who are between 2 and 5 years …

What’S Coming For Health Science And Policy In 2018? Global Experts Look Ahead In Their Field, Soumya Swaminathan, Robin S. Room, Louise C. Ivers, Graham Hillis, Rebecca F. Grais, Zulfiqar Ahmed Bhutta, Peter Byass

Department of Paediatrics and Child Health

No abstract provided.

What’S Coming For Health Science And Policy In 2018? Global Experts Look Ahead In Their Field, Soumya Swaminathan, Robin S. Room, Louise C. Ivers, Graham Hillis, Rebecca F. Grais, Zulfiqar Ahmed Bhutta, Peter Byass

Department of Paediatrics and Child Health

No abstract provided.

Outcome Of Traumatic Brain Injury In Children By Using Rotterdam Score On Computed Tomography, Anwarul Haque, Zehra Dhanani, Amin Ali, Basit Salam, Qalab Abbas, Gohar Javed, Humaira Jurair

Department of Paediatrics and Child Health

Background: The Rotterdam Score (RS) on CT head is a new evolving clinical tool as a predictor of mortality in Traumatic Brain Injury (TBI). The objective of this study is to assess the outcome of children with TBI admitted in paediatric intensive care unit (PICU) of a tertiary-care, university hospital by using RS.
Methods: This was a prospective observational study conducted on children (age: 1mo -16yr) with TBI admitted in PICU of Aga Khan University Hospital from 2013 to 2016. RS on CT was calculated by a radiologist. All patients were managed according to according to Paediatric Brain Trauma Foundation …

High Heterotrophic Counts In Potable Water And Antimicrobial Resistance Among Indicator Organisms In Two Peri-Urban Communities Of Karachi, Pakistan, Sadia Shakoor, Imran Ahmed, Saima Mukhtiar, Israr Ahmed, Farzeen Hirani, Shazia Sultana, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objective: Fecal contamination of potable water leads to unsafe water supply. Although many urban areas of large metropolitan cities receive safe water, peri-urban areas are often not monitored by public health authorities and water supply and quality remain unknown. We assessed microbiological quality and rates of antimicrobial resistance in viable indicator bacteria in two peri-urban communities of Karachi, Pakistan. Water samples were collected over 5 months (October 2015 to February 2016) from these peri-urban communities and samples were processed for microbiological quality as per Standing Committee of Analysts, United Kingdom and World Health Organization guidelines and criteria for drinking water. …

Prevalence And Possible Factors Associated With Anaemia, And Vitamin B 12 And Folate Deficiencies In Women Of Reproductive Age In Pakistan: Analysis Of National-Level Secondary Survey Data, Sajid Bashir Soofi, Gul Nawaz Khan, Kamran Sadiq, Shabina Ariff, Atif Habib, Sumra Kureishy, Imtiaz Hussain, Muhammad Umer, Zamir Suhag, Arjumand Rizvi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Objective: To determine the prevalence and possible factors associated with anaemia, and vitamin B12 and folate deficiencies in women of reproductive age (WRA) in Pakistan.
Methods: A secondary analysis was conducted on data collected through the large-scale National Nutrition Survey in Pakistan in 2011. Anaemia was defined as haemoglobin levels <12 g/dL, vitamin B12 deficiency as serum vitamin B12 levels of <203 pg/mL (150 pmol/L) and folate deficiency as serum folate levels <4 ng/mL (10 nmol/L).
Results: A total of 11751 blood samples were collected and analysed. The prevalence of anaemia, vitamin B12 deficiency and folate deficiency was 50.4%, 52.4% and 50.8%, respectively. After adjustment, the following factors were positively associated with anaemia: living in Sindh province (RR 1.07; 95%CI 1.04 to 1.09)P<0.00, food insecure with moderate hunger (RR 1.03; 95%CI 1.00 to 1.06)P=0.02, four or more pregnancies (RR 1.03; 95%CI 1.01 to 1.05)P<0.00, being underweight (RR 1.03; 95%CI 1.00 to 1.05)P=0.02, being overweight or obese (RR 0.95; 95%CI 0.93 to 0.97)P<0.00 and weekly intake of leafy green vegetables (RR 0.98; 95%CI 0.95 to 1.00)P=0.04. For vitamin B12 deficiency, a positive association was observed with rural population (RR 0.81; 95%CI 0.66 to 1.00)P=0.04, living in Khyber Pakhtunkhwa province (RR 1.25; 95%CI 1.11 to 1.43)P<0.00 and living in Azad Jammu and Kashmir (RR 1.50; 95%CI 1.08 to 2.08)P=0.01. Folate deficiency was negatively associated with daily and weekly intake of eggs (RR 0.89; 95%CI 0.81 to 0.98)P=0.02 and (RR 0.88; 95%CI 0.78 to 0.99)P=0.03.
Conclusions: In Pakistan, …

Small For Gestational Age: Case Definition & Guidelines For Data Collection, Analysis, And Presentation Of Maternal Immunisation Safety Data, Elizabeth P. Schlaudecker, Flor M. Munoz, Azucena Bardají, Nansi S. Boghossian, Asma Khalil, Hatem Mousa, Mirjana Nesin, Muhammad Imran Nisar, Vitali Pool, Hans M.L. Spiegel

Department of Paediatrics and Child Health

No abstract provided.

Low Birth Weight: Case Definition & Guidelines For Data Collection, Analysis, And Presentation Of Maternal Immunization Safety Data, Clare L. Cutland, Eve M. Lackritz, Tamala Mallett-Moore, Azucena Bardají, Ravichandran Chandrasekaran, Chandrakant Lahariya, Muhammad Imran Nisar, Milagritos D. Tapia, Jayani Pathirana, Sonali Kochhar

Department of Paediatrics and Child Health

No abstract provided.