Search

Background: Critical illness is one of the most common causes of delirium in children which can be associated with increased morbidity and mortality. Delirium continues to be an overlooked aspect of the management of critically ill children. This study was conducted with the objective of determining the frequency and risk factors of delirium in critically ill children. Subjects and Methods: This prospective observational study included patients admitted for at least a period of 24 h of teaching in the pediatric intensive care unit (PICU) of a medical college of Pakistan from March 2022 to September 2022. Each patient was screened for developing delirium twice a day using the Cornell Assessment of Pediatric Delirium. Results: The median age of the patients was 19.5 months (interquartile range: 10.7–72). There were 64.6% (n = 106) of male children, and 97.2% (n = 143) were admitted due to medical conditions. Delirium was identified in 97 (59.1%) patients. Mortality was observed in 3 (1.8%) cases. The average length of stay and frequency of hypoxia was higher among the pediatric delirium group (P = 0.002 and P = 0.022, respectively). Independent predictors of delirium in PICU patients were length of stay (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.39–4.20), use of inotropes (OR, 3.32; 95% CI, 1.0.4–10.64), use of narcotics (OR, 8.78; 95% CI, 0.96–80.51), and hypoxia (OR, 3.02; 95% CI, 1.17–7.81). Conclusion: Delirium is common in children admitted to PICU. Length of PICU stay, use of narcotics, inotropes, and hypoxia were found as independent risk factors for delirium.

Objective: The aim of this study was to determine the impact of chorioamnionitis on neonatal outcome. Methods: This cross-section descriptive study was conducted in the neonatal intensive care unit (NICU) of the Department of Pediatrics, Liaquat National Hospital Karachi from June 1st, 2016 to December 31st, 2016. Neonates (infants < 28 days of age) with maternal risk factors indicative of chorioamnionitis (maternal febrile illness in last trimester, high WBC count in maternal blood, lower abdominal pain or tenderness, and foul-smelling discharge) were included in the study. The neonates with an inborn error of metabolism and congenital anomalies were excluded from this study. The neonates were further categorized by gestational age as a term (gestational age >37 weeks) and preterm (gestational age

Objective: To determine the diagnostic accuracy of serum procalcitonin levels (PCT) by taking blood culture as gold standard. Methods: This was a cross-sectional study conducted in neonatal intensive care unit (NICU) of Liaquat National Hospital, Karachi over a period of six months from June 2017 to December 2017. A total of 141 babies were enrolled in the study that had evidence of neonatal sepsis. Non-probability consecutive sampling was the technique used in our study for sample collection. Later on, after completion of data of required sample, a data base was developed on SPSS for windows version 22.0 for data analysis. Mean, median and standard deviation were calculated for continuous while fre- quency along with percentages was drawn for qualitative variables. Pearson Chi-square test (c2) was applied on all qualitative variables by taking p-value

There is very little information in the literature on the treatment and prognosis of primary focal segmental glomerulosclerosis (FSGS) among children in Pakistan. This is a review of 94 children (≤16 years) with a diagnosis of primary FSGS who presented to the Sindh Institute of Urology and Transplantation between 1995 and 2008. The clinical records and original renal biopsy reports were reviewed to determine demographic, clinical, laboratory and pathologic features. Renal biopsies were studied by light microscopy, immunofluoroscence and electron microscopy. Thera-peutic regimens and response to therapy were analyzed. Majority of the children (60, 63.8%) had steroid-dependant nephrotic syndrome (SDNS) and 33 (35%) had steroid-resistant nephrotic syndrome (SRNS). Cyclosphosphamide was used in SDNS, and this produced complete remission (CR) in 25/36 (69.4%), partial response (PR) in 4/36 (11%) and no response in 7/36 (19.4%) cases. Cyclosporine was used in SRNS and some SDNS children, and showed a CR in 30 (52.6%), PR in 20 (35%) and no response in seven (12.2%) cases. Tacrolimus was used in seven (7.44%) children. CR was obtained in two (28.5%) and PR in five (71.4%) cases. Renal insufficiency developed in 12 (12.7%) children. Results from this study show that majority of the children with primary FSGS at our center could achieve high rates of sustained remission with second- and third-line immunosuppressive therapies with fairly good prognosis.

Key Clinical Message This case emphasizes the significance of COVID‐19 in pediatric patients presenting with unusual hepatic manifestations, urging clinicians to broaden their diagnostic lens. The unexpected elevation of SARS‐CoV‐2 antibodies and the effective use of N‐acetyl cysteine highlight the importance of adaptability in treatment strategies. Abstract This case report presents a unique manifestation of severe hepatic involvement in a 4‐year‐old girl with thalassemia minor and COVID‐19. Despite the absence of prominent respiratory symptoms, the patient exhibited jaundice, elevated liver enzymes, and coagulopathy. Initial suspicion of viral hepatitis was replaced by the discovery of significantly elevated SARS‐CoV‐2 antibodies. A multidisciplinary approach, including gastroenterology consultation and an extensive workup, was pivotal in ruling out alternative etiologies. Unconventional use of N‐acetyl cysteine contributed to clinical improvement, highlighting the need for adaptable treatment strategies. This case underscores the importance of heightened awareness in recognizing atypical presentations of COVID‐19 in pediatric patients, especially those with underlying health conditions. Further exploration into nuanced manifestations and treatment approaches is warranted for comprehensive clinical management.

The objective of the study was to determine the diagnostic accuracy of Mentzer Index in children with hypochromic microcytic anemia by taking serum ferritin levels as a gold standard. This cross-sectional study was conducted in the Department of Pediatric Medicine, Liaquat National Hospital Karachi, from 1st January to 30th June 2022. Children age 1 to 5 years and both genders were included in this study. Children who have had a history of blood transfusion in the past 3 months or Thalassemia or blood disorders, chronic liver disease or kidney diseases, and children with malignancy and congenital abnormalities were excluded. Eligible children were enrolled after taking written informed consent. Complete blood count (CBC) and serum ferritin were sent to the laboratory. Sensitivity, specificity, diagnostic accuracy, and likelihood ratio were calculated taking serum ferritin levels as a gold standard. A total of 347 subjects were enrolled. The median age was 26 (IQR-18) months and 42.9% were males. The most common symptom was fatigue 40.9%. The sensitivity of the Mentzer index was 80.7% while the specificity was 77.7%. Similarly, the positive predictive value (PPV) was 56.8% while the negative predictive value (NPV) was 91.6%. Finally, the accuracy of the Mentzer index in determining iron deficiency anemia was 78.4%. Diagnostic accuracy was 78.4% and the likelihood ratio was 3.6. Mentzer index is a valuable tool in the early detection of IDA in children. It has got high sensitivity, specificity diagnostic accuracy, and likelihood ratio.