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Objective: To determine the neurological consequences and short–term outcome of children with diagnosis of cyanotic congenital heart diseases (CHDs) at a tertiary care cardiac setup of Pakistan. Study Design: Single Center Observational Cohort study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Period: November 2021 to October 2022. Material & Methods: A total of 80 children of both genders, aged between 1 month to 12 years with known cyanotic CHD as per 2D transthoracic echocardiography were admitted in Pediatric Cardiology Department of NICVD, Karachi and were considered. At the time of enrollment, demographic characteristics along with presenting complaints were noted. Necessary baseline laboratory and radiological investigations were ordered and clinical neurological examination was done. Children were discharged and short term outcomes were labeled after 3 months follow up. Results: In a total of 80 children with cyanotic CHDs, most common underlying diagnosis was tetralogy of fallot, found in 41 (51.3%) children. The CT brain revealed ischemic infarct, brain abscess and gross oedema as the most frequent observations revealed in 47 (58.8%), 40 (50.0%) and 37 (46.3%) children. Surgical management of underlying neurological abnormality was advised in 23 (28.8%) children. After 3 months follow-up, complete recovery was observed among 43 (53.8%) children. CT findings at the time of enrollment as haemorrhagic infarct (p

Objective: To determine the clinical features and echocardiographic findings among children presenting with Ebstein’s anomaly (EA). Study Design: Descriptive Case-series. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi Pakistan. Period: July 2021 to June 2022. Material & Methods: Children of both genders aged above 1 month up to 18 years, having echocardiographic confirmed EA were analyzed. Demographic data along with clinical features, presenting symptoms and echocardiographic findings were noted in all case. Results: In a total of 48 cases of EA, 38 (79.2%) were female. The mean age was 8.4±4.21 years. Cyanosis, exertional dyspnea, easy fatigue ability and exercise intolerance were the most frequent symptoms reported in 31 (64.6%), 27 (56.3%), 26 (54.2%) and 24 (50.0%) patients respectively. Arrhythmias and heart failure were the most frequent clinical features noted in 29 (60.4%) patients each. Small atrial septal defect (ASD) was noted in 27 (56.3%) patients while ventricular septal defect in 19 (39.6%) cases. There were 11 (22.9%) patients who presented timely with diagnosis of EA while 37 (77.1%) patients had late diagnosis. Conclusion: Majority of the patients with Ebstein’s anomaly were female. Cyanosis, exertional dyspnea, easy fatigue ability and exercise intolerance were the most frequent symptoms whereas arrhythmias and heart failure were the most frequent clinical features observed. ASD was the most commonly noted associated CHDs observed in almost half of the Ebstein’s anomaly case. Almost 3/4th of the patients had late diagnosis.

Objective: To find out the prevalence of different types of arrhythmias in children with congenital heart defects (CHDs) presenting at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: July 2021 to June 2022. Material & Methods: A total of 120 children of both genders aged 1 day to 16 years and presenting to study setting with confirmed CHDs were evaluated. At the time of enrollment, demographical information and disease history were noted. Necessary laboratory investigations like complete blood count and serum electrolytes were analyzed while standard electrocardiography (ECG) was performed. Prevalence of different types of arrhythmias was noted. Results: In a total of 120 children with CHDs, 64 (53.3%) were boys. Mean age was be 2.7±2.1. Most common electrolyte abnormalities were noted to be hyponatremia and hypermagnesemia found in 39 (32.5%) and 26 (21.7%) children respectively. There were 31 (25.8%) children who were diagnosed to have arrhythmias. Out of these 31 children, first degree A-V block was the most common types of arrhythmias observed in 24 (77.4%) cases while ectopic A-V rhythm were found in 3 (9.7%). Conclusion: The findings of this research revealed that arrhythmias are quite common among children having CHDs. There is a need to routine assessment for the possible presence of arrhythmias among children presenting with CHDs.

Objective: To analyze children of congenital heart defect hospitalized with lower respiratory tract infections (LRTIs). Study Design: Cohort study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: July 2021 to June 2022. Material & Methods: Echocardiography confirmed known CHD cases of both genders aged 1 month to 10 years and hospitalized with LRTI were included. Demographic and clinical data were noted while relevant radiological examination and bacterial culture / respiratory virus panel from nasopharayngeal swabs examined. Types of CHD (acyanotic or cyanotic), types of bacterial causative agents and outcomes in terms of duration of hospitalization (days) and mortality or discharged were noted. Results: In a total of 63 children, 34 (54.0%) were male. The mean age was 1.56±1.42 years while 46 (73.0%) children were aged below 1 year. Assessment of causative agents revealed that 9 (14.3%) had viral involvement, 8 (12.7%) bacterial agents. Majority of the children, 44 (69.8%) had acyanotic CHD while remaining 19 (30.2%) had cyanotic CHD. Need for pediatric intensive care unit (PICU) admission was noted in 22 (34.9%). Although, need for PICU stay was more among children with acyanotic CHD when compared to cyanotic CHD, but the difference did not reach statistical significance (40.9% vs. 21.1%, p=0.1292). Likewise, duration of hospitalization was relatively more among children with acyanotic CHD when compared to children with cyanotic CHD but the difference did not reach statistical significance (17.65±8.21 vs. 14.3±6.84, p=0.1243). Conclusion: Majority of the children with CHD hospitalized with LRTI were below 1 year of age. Acyanotic CHD was the most common CHD type. Mortality was relatively low and most of the children with CHD hospitalized with LRTI were treated and discharged successfully.

Objective: To find out echocardiographic findings in patients with tetralogy of Fallot (TOF) prior to total corrective surgery admitted at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease, Karachi. Period: January 2021 to December 2021. Material & Methods: A total of 197 echocardiography confirmed TOF cases of both genders and age up to any years were included. Physical examination, chest radiography and electrocardiogram were done in each patient prior to transthoracic echocardiography (TTE) using Toshiba Aplio i600 using 5 Hz and 6 Hz transducers. Standard protocols were followed in all TTE procedures. Results: In a total of 197 patients with TOF, there were 121 (61.4%) male. Mean age was 8.36±10.12 years. Hypoplastic pulmonary arteries was the most frequent pulmonary artery abnormality observed in 30 (15.2%) cases. Thickened and domed pulmonic valve was the most common pulmonary valvular anomaly noted in 89 (45.2%). Associated “atrial septal defect (ASD)” was observed in 47 (23.9%) cases while “patent ductus arteriosus (PDA)” was seen in 83 (42.1%) patients. History of past “Blalock and Taussig (BT) Shunt” performed was found in 20 (10.2%) cases, out of which, 15 were functioning. Conclusion: Echocardiography is an inexpensive and safe approach to cardiac evaluation among patients of tetralogy of fallot. Hypoplastic pulmonary arteries was the most frequent pulmonary artery abnormality observed in tetralogy of Fallot patients. PDA was the most frequent associated abnormality followed by associated ASD.

Objective: To find out the prevalence and risk factors of systemic hypertension. Study Design: Cross Sectional study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal. Period: July 2020 to June 2021. Material & Methods: A total of 298 children of both gender aged 4-12 years, visiting pediatric outpatient department of the study institution were enrolled. A child was labeled as normotensive if blood pressure (BP) measurement was below 90th percentile, pre-hypertensive if BP between 90th to 95th percentile and hypertensive if BP more than 95th percentile. The data was analyzed using SPSS version 26.0. Results: In a total of 298 children, 171(57.4%) were male. Overall, mean age was found to be 7.6+2.1 years while 159 (53.4%) were below 7 years of age. Majority of the children, 166 (55.7%) belonged to rural areas of residence. Family history of hypertension was noted in 150 (50.3%) children. Hypertension was found in 56 (18.8%) children, pre-hypertension in 9 (3.0%) while remaining 233 (78.2%) children were normotensive. Age less than 7 years (p=0.0023), overweight/obesity (p=0.0026) or family history of hypertension (p=0.0118) were found to have significant association with hypertension. Conclusion: High prevalence of systemic hypertension was noted in children. Younger age, high body mass index and family history of hypertension were found to be significantly associated with hypertension.

Objective: To find out efficacy of sildenafil for the treatment of persistent pulmonary hypertension of the newborn (PPHN). Study Design: Observational study. Setting: Department of Neonatology, Sughra Shafi Medical Complex, Sahara Medical College, Narowal. Period: May 2020 to April 2021. Material & Methods: A total of 22 neonates of both genders with diagnosis of PPHN were enrolled during the study period. Demographic characteristic along with information about perinatal and postnatal characteristics were recorded among all neonates at the time of admission. X-ray chest were asked. Oral sildenafil was administered as 2mg/kg per dose thrice a day to all study cases and continued till extubation. Outcome was recorded on the basis of difference in FiO2 need after initiating sildenafil, time required to get ventilator off or mortality. Results: Out of a total of 22 neonates, 13 (59.1%) were male. Majority of the neonates, 15 (68.2%) were term newborns. Mode of delivery was lower segment cesarean section in 17 (77.3%) cases. APGAR score at 5 minutes was between 7 to 10 in 13 (59.1%) newborns. There were 13 (59.1%) newborns who required immediate resuscitation following birth. Meconium aspiration syndrome was the commonest associated condition found among 8 (36.4%) neonates. As per echocardiographic findings, 13 (59.1%) neonates had severe PPHN, 5 (22.7%) moderate and 4 (18.2%) mild. Mean oxygenation index at the time of admission was noted to be 46+14. Inotropic support was administered to 19 (86.4%) cases. Mean length of neonatal intensive care unit was 15+5 days. Mortality was reported among 10 (45.4%) neonates. Conclusion: Oral sildenafil was found to be a promising option for the treatment of neonates having PPHN. Oral sildenafil was found to successfully improve oxygenation among neonates having PPHN.

Objective: To find out the effectiveness of prophylactic parenteral paracetamol to minimize rates of ductus patency among preterm infants. Study Design: Case-control study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal, Pakistan. Period: March 2020 to February 2021. Material & Methods: A total of 70 neonates (35 cases and 35 controls) having gestational age less than or equal to 34 weeks were enrolled. All 35 cases were administered prophylactic parenteral paracetamol as 20 mg per kg stat and 7.5 mg per kg 6 hourly for 1st 3 days of life while all controls were given no drugs. Echocardiography was performed in all 70 neonates after 1st three post-natal days to identify PDA. Data was analyzed using SPSS 26.0. Results: In a total of 70 neonates, 37 (52.9%) were male and 33 (47.1%) female. Overall, mean gestational age was noted to be 32.1+1.47 weeks while mean body weight was recorded to be 1424.6+229.7 grams. There were 6 neonates (17.1%) among cases who were found to have PDA in comparison to 23 (65.7%) in controls (p

Objective: To find out characteristics and clinical features of children presenting with acute myocarditis at a tertiary care hospital. Study Design: Observational Study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal, Pakistan. Period: February 2020 to February 2021. Material & Methods: A total of 71 children aged 1 month to 15 years admitted with acute myocarditis were enrolled. Acute myocarditis was labeled as short history of illness in otherwise healthy child, echocardiography evident of left ventricular dysfunctioning, cardiac biomarkers showing cardiac damage as well as electrocardiography showing acute myocarditis. Age was represented as mean and standard deviation whereas qualitative variables like gender, area of residence and clinical features were shown as frequency and percentages. Results: Out of a total of 71 children, there were 38 (53.5%) were male. Median age was recorded to be 16.6 months. Majority of the cases, 42 (59.2%) belonged to rural areas of residence. Tachycardia was the commonest clinical feature noted in 65 (91.5%) children, irritability was seen in 50 (70.4%), tachypnea in 48 (67.6%) while poor feeding was noted 44 (62.0%) children. Hepatomegaly was noted in 39 (54.9%) children. Hypotension was recorded in 35 (49.3%) children. Conclusion: Male predominance was seen among children presenting with acute myocarditis. Tachycardia, irritability, tachypnea and poor feeding were the commonest clinical features observed.