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Objective: To compare mean platelet volume in neonates with and without sepsis. Study Design: Cross-sectional study. Place and Duration of Study: Neonatal Intensive Care Unit, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2017 to Jan 2018. Methodology: A total of 140 neonates of either gender with ages between 0-28 days, suspected of neonatal sepsis presenting with any two of the signs: a core body temperature of >38.5°C or <36°C at time of presentation, pulse rate beyond the range of 100-200 beats/minute, leukocyte count beyond the range of 4000 to 30,000/mm3 or >10% immature neutrophils on peripheral smear, tachypnea (>60 breaths/minute) and oxygen saturation (<90%) on the pulse oximeter, were included. Three ml of blood was drawn and sent for culture, while another 3ml of blood was sent for peripheral smear and mean platelet volume. Conclusion: Neonates having sepsis were found to have significantly raised mean platelet volume. As a result, mean platelet volume is available in complete blood counts without additional cost to prove cost-effective. [ABSTRACT FROM AUTHOR]

Objective: To determine the epidemiology of coeliac disease in the children presenting at the tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of Study: Department of Paediatrics, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr 2015 to Jul 2016. Methodology: Ninety-five consecutive children presenting with the suspicion of celiac disease were included in this study after taking written informed consent. A pre-designed proforma was used to record the patient's demographic details and the presenting complaints, laboratory, endoscopic and histological findings. Results: The mean age of the patients was 6.48 ± 3.20 years and the majority 53 (55.8%) of the children, were aged between 5 to 10 years. Failure to thrive was the most frequent presenting complaint and was recorded in 53 (55.8%) children, followed by pallor (54.7%), chronic diarrhoea (34.7%), short stature (29.5%), pain abdomen (28.4%) and recurrent vomiting (6.3%). The patients' haemoglobin ranged from 5.3 g/dl to 12.8 g/dl with a mean of 8.81±1.24 g/dl. The serum Anti-tTG level ranged from 8.0 U/ml to 759.0 U/ml with a mean of 298.75 ± 225.51 U/ml. Upon endoscopy, atrophic mucosa was revealed in 60 (63.2%) children, while 24 (25.3%) children had normal mucosa. Partial villous atrophy was the most frequent histological diagnosis (37.9%). Normal duodenal mucosa was reported in 4 (4.2%) children, while 21 (22.1%) children had mild non-specific duodenitis. Frequency of pallor (p=0.025), anaemia (p=0.017) and complete villous atrophy on histology (p=0.004) were significantly higher in patients with higher anti-tTG levels. Conclusion: Celiac disease has a diverse presentation for age, gender and clinical and biochemical markers. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of a wide range of clinical presentations of inherited metabolic disorders diagnosed in infants and children at a tertiary care hospital in Rawalpindi, Pakistan. Study Design: Cross sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Jun 2015 to Jun 2016. Methodology: Sixty four children diagnosed with metabolic disorders, reporting to the Pak Emirates Military Hospital Rawalpindi, were enrolled in the study. History was taken with special reference to family history, consanguineous marriage, sibling’s death and clinical manifestations. Thorough physical examination was done in every patient to find out the clinical signs present. All the data was recorded on a proforma. SPSS-20 version was used to derive the results and p-value of <0.05 was taken as statistically significant. Results: In children with metabolic disorders, gastrointestinal manifestation were more significant 78.1% (p-value 0.022). Neurological signs were present in 60.9% (p-value 0.094) while respiratory manifestations were present in 15.6% children (p-value 0.251). fifty three point one percent were males and 46.9% were females. The positive history of other affected children in family was significant (p-value 0.015), along with hypoglycaemia (p-value 0.001). Conclusion: Pallor, failure to thrive, poor feeding, convulsions, lethargy and hypoglycemia were the most frequent clinical manifestations in children with metabolic disorders. [ABSTRACT FROM AUTHOR]

Objective: To determine the etiology and clinical profile of chronic liver disease in children presenting at Pak Emirates Military Hospital Rawalpindi. Study Design: Cross-sectional study. Place and Duration of Study: This study was conducted at the Department of Pediatrics, Pak Emirates Military Hospital Rawalpindi, from Sep 2015 to Sep 2016. Methodology: After informed written consent, 84 consecutive children diagnosed of chronic liver disease were included in the study and demographic features, presentation and underlying etiology. Results: There were 43 (51.2%) male and 41 (48.8%) female children with a mean age of 46.62 ± 46.89 months. Frequent presenting complaints were jaundice (32.1%) persistent neonatal jaundice (29.8%), abdominal distension (27.4%). Hepatosplenomegaly was the frequent presentation of children with glycogen storage disease while persistent neonatal jaundice was associated with biliary atresia and neonatal hepatitis. Wilson disease presented with neurological symptoms. Glycogen storage disease and biliary atresia were the most frequent underlying etiologies recorded in 15 (17.9%) children. The frequency of Wilsons disease was significantly higher among children aged between 5-10 years. Conclusion: The frequent clinical presentations of children with chronic liver disease were jaundice, abdominal distension and hepatosplenomegaly. Glycogen Storage Disorders, Biliary atresia and Wilsons Disease and were the most frequently encountered etiologies. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of serum IgA anti-tissue transglutaminase antibody in the diagnosis of celiac disease taking histopathology as gold standard. Study Design: Cross-sectional survey. Place and Duration of Study: This study was conducted at the department of Pediatrics, Military Hospital Rawalpindi from April 2015 to July 2016. Patients and Methods: Ninety-five consecutive children presenting with suspicion of celiac disease were included in this study after taking written informed consent. A predesigned proforma was used to record patient's demographic details. Anti-tTG level of =25 U/ml was taken as diagnostic of celiac disease while results of histopathology on endoscopic biopsy were taken as gold standard. Results: The mean age of the patients was 6.48 ± 3.20 years and majority (n=53, 55.8%) of the children were aged between 5 to 10 years. The serum anti-tTG level ranged from 8.0 U/ml to 759.0 U/ml with a mean of 298.75 ± 225.51 U/ml. Taking a cut-off value of =25 U/ml for anti-tTG, 81 (85.3%) children were suspected of celiac disease. Histopathology of endoscopic biopsy confirmed celiac disease in 68 (71.6%) children with 62 true positive, 19 false positive, 6 false negative and 8 true negative cases. It yielded 91.18% sensitivity, 29.63% specificity and 73.68% accuracy for anti-tTG (=25 U/ml) in the diagnosis of celiac disease with positive and negative predictive values of 76.54% and 57.14% respectively. Conclusion: IgA anti-tissue transglutaminase antibody (=25 U/ml) was found to be highly sensitive test for the detection of celiac disease in children. [ABSTRACT FROM AUTHOR]

Objective: To compare the mean post-treatment bilirubin level with light emitting diode (LED) phototherapy versus compact fluorescent lamp (CFL) phototherapy in neonates presenting with hyperbilirubinemia Study Design: Comparative prospective study Place and Duration of Study: Department of Paediatrics, Pakistan Railway Hospital, Rawalpindi Pakistan, from Jan to Dec 2019. Methodology: Hundred children fulfilling the inclusion criteria were recuited in the study from Emergency Department. Then neonates were divided into two groups. In Group-A, neonates underwent phototherapy with LED; in Group-B, neonates underwent phototherapy with conventional phototherapy. Then neonates were followed up in the neonatal intensive care unit for 24 hours. Pre and post-treatment reports were assessed, and bilirubin level was noted. Results: In Group-A, the mean age of neonates was 49.12±23.42 hours, while in Group-B was 38.70±15.42 hours. In Group-A, the mean Bilirubin level at baseline was 13.64±5.98 gm/dl and in Group-B was 15.88±5.44 gm/dl. In Group-A, the mean Bilirubin level after 24 hours was 8.47±4.96 gm/dl and in Group-B was 9.538±5.35 gm/dl. In both groups, no significant difference in the mean bilirubin level was observed after 24 hours (p-value=0.30). Conclusion: Light-emitting diode phototherapy and compact fluorescent lamp phototherapy are equally effective in a mean reduction in the total serum bilirubin after 24 hours. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To determine the frequency and pattern of various congenital heart diseases in a tertiary care hospital neonatal unit. Study Design: Prospective longitudinal study. Place and Duration of Study: Neonatal Unit of Pak Emirates Military Hospital, Rawalpindi Pakistan from Jul 2015 to Jun 2018. Methodology: All neonates admitted to the Neonatal Unit of Pak Emirates Military Hospital, Rawalpindi Pakistan, suspected of having congenital heart disease were included in the study. Suspicion for CHD was based on the presence of murmur, cyanosis with or without feeding difficulty, signs of congestive heart failure, and variation in pre and postductal SpO2 reading. Echocardiography was performed on all neonates by a Paediatric cardiologist to determine diagnosis and type of lesion. Results: One hundred and thirty-one neonates were found to have congenital heart disease with male predominance, with 79(60.3%) males and 52(39.7%) females. Ventricular Septal Defect (VSD) was the most common lesion occurring in 44(33.6%) neonates, followed by PDA in 28(21.37%) neonates. CHD occurred more frequently in term neonates (62.0%) than preterm neonates (38.0%). Conclusion: Congenital heart disease is the most common congenital malformation, with Asia having the highest prevalence worldwide. Lack of specialized antenatal and neonatal health services and paucity of diagnostic facilities lead to delays in diagnosis, increasing morbidity and mortality of CHD cases. Therefore, drastic measures are required to improve neonatal health and transport facilities in our country to mitigate the impact of this disease. [ABSTRACT FROM AUTHOR]

Objective: To compare mean platelet volume in neonates with and without sepsis. Study Design: Cross-sectional study. Place and Duration of Study: Neonatal Intensive Care Unit, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2017 to Jan 2018. Methodology: A total of 140 neonates of either gender with ages between 0-28 days, suspected of neonatal sepsis presenting with any two of the signs: a core body temperature of >38.5°C or <36°C at time of presentation, pulse rate beyond the range of 100-200 beats/minute, leukocyte count beyond the range of 4000 to 30,000/mm3 or >10% immature neutrophils on peripheral smear, tachypnea (>60 breaths/minute) and oxygen saturation (<90%) on the pulse oximeter, were included. Three ml of blood was drawn and sent for culture, while another 3ml of blood was sent for peripheral smear and mean platelet volume. Results: There were 31 (22.14%) neonates who were culture positive for neonatal sepsis. The age distribution of the neonates showed that 43 (30.71%) were between 0-7 days, whereas 97 (69.29%) were between 8-28 days. The mean gestational age was noted to be 37.04±1.76 weeks. The mean neonatal birth weight was 2344.28±.49 grams. The mean platelet volume (fl) was 7.31±0.92 (fl). Mean platelet volume was 8.52±0.51 (fl) in septic neonates and 6.97±0.70 (fl) in neonates without sepsis (p<0.001). Conclusion: Neonates having sepsis were found to have significantly raised mean platelet volume. As a result, mean platelet volume is available in complete blood counts without additional cost to prove cost-effective. [ABSTRACT FROM AUTHOR]