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Objective: To determine the diagnostic accuracy of IgA anti-tissue transglutaminase antibody in the diagnosis of celiac disease taking histopathology as gold standard. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Pediatrics, Pak Emirates Military Hospital Rawalpindi, from Apr 2015 to Jul 2016. Methodology: Ninety five consecutive children presenting with suspicion of celiac disease were included into 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 53 (55.8%) of the children were aged between 5-10 years. There were 47 (49.5%) male and 48 (50.5%) female children in the study group. 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 91.18% sensitive, 29.63% specific and 73.68% accurate in the diagnosis of celiac disease taking histopathology as gold standard with positive and negative predictive values of 76.54% and 57.14% respectively. [ABSTRACT FROM AUTHOR]

Background: Thalassemia major is the severe form of β thalassemia characterized by severe anaemia, hepatosplenomegaly and facioskeletal changes due to increased haemolysis of defective red blood cells. In iron overload states, high levels of iron exceed the iron-carrying capacity of transferrin within the plasma, leading to the formation of nontransferrin-bound iron form. These nontransferrin-bound iron forms can be taken up into cells, including liver, heart, and endocrine cells leading to organ damage. To prevent complications associated with hemosiderosis, iron chelation therapy remains one of the main objectives of clinical management of the patients affected by Thalassemia Major. Methods: Thirty-seven patients were enrolled using non randomized convenience sampling technique after the written consent from patients. Patients age 2--30 years were enrolled in this study. Serum Ferritin, ALT, Serum Creatinine were checked at the start of the study, 3 months, 6months and then at the end of the study, i.e., at 9 months of the commencement of the study. They were also assessed for other side effects pertaining to oral tolerability of the drug like vomiting, nausea, GI upset, diarrhoea, urinary complaints or any other subjective complaint. Results: Of the 37 patients, 20 were male (54.1%) and 17 were female (45.9%). Mean age of the patients was 10.2 years (Min. 3 years, Max 21 years). The average serum Ferritin at baseline was noted as 3440 which increased after a period of 3 months, 6 months and 9 months with average of 3359, 3677 and 4394 respectively. After the period of 9 months largest 95% confidence interval of serum Ferritin levels was observed in the range of 3420.17 to 5368.63. In our study, 17 patients required alternative chelation (46%). These patients needed IV Deferioxamine because of the rising trend of Serum Ferritin after the study. Conclusion: From the results of our study, we infer that oral Deferasirox is not an effective iron chelator. If the patients are taking oral deferasirox, their Serum Ferritin should be checked 3 monthlies. The drug is effective only in maintaining Serum Ferritin levels with levels less than 1500ng/ml. Intravenous Deferioxamine still should be preferred over oral iron chelators for effective control of iron overload and its complications. [ABSTRACT FROM AUTHOR]

Objective: To compare frequency of short term (first 7 days of life) neonatal morbidities in late preterm vs term infants. Study Design: Prospective cohort study. Place and Duration of Study: Study was carried out over a period of six months from Jan 2016 to Jun 2016. Methodology: A total of 130 patients (65 in each group) were included in this study. All infants enrolled in study were followed till first 7 days of life for any morbidity by clinical evaluation. Infants who were discharged before 7 days were called for mandatory follow up evaluation in the outpatient clinic on 7th day of life. Results: Mean age of the babies was 3.28 ± 1.45 and 1.58 ± 0.65 in group-A and B, respectively. Mean gestational age in group-A was 35.18 ± 0.73 weeks and in group-B was 38.38 ± 11.07 weeks. Mean weight (kg) of neonates was 2.53 ± 0.33 in group-A and 3.24 ± 0.49 in group-B. Morbidities were found as follows: Probable sepsis was seen in 17 cases (26.2%) of group-A and 7 cases (10.8%) of group-B with p-value of 0.024. Respiratory morbidity observed in 15 cases (23%) of group-A and 3 cases (4.6%) of group-B with p-value of 0.002. Hyperbilirubinemia developed in 33 cases (50.8%) of group-A and in 15 cases of group-B with p-value of 0.001. Conclusion: The frequency of sepsis, respiratory morbidity and hyperbilirubinemia was more in late preterm as compared to term infants. [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 compare ringer's lactate and normal saline fluid replacement in pediatric patients with acute watery diarrhoea in terms of mean serum bicarbonate, potassium and pH. Study Design: Quasi experimental study. Place and Duration of Study: This study was conducted at the department of Pediatrics, Pak Emirates Military Hospital, Rawalpindi from Feb 2015 to Jul 2015. Methodology: This study involved 206 children of both genders aged between 1-5 years with watery diarrhoea and severe dehydration. These patients were randomly divided into two treatment groups each comprising of 103 patients. Patients in group-A received ringer's lactate while group-B patients were given normal saline as replacement fluids. Results: The mean age of the patients was 3.34 ± 1.19 years and there were 112 (54.4%) male and 94 (45.6%) female patients. Both the groups were comparable in terms of mean age (p=0.861) and gender distribution (p=0.576). After 6 hours of initiating fluid therapy, mean serum bicarbonate (13.61 ± 2.41 vs. 9.72 ± 2.07 meq/l; p<0.001) and mean blood pH (7.46 ± 0.02 vs. 7.38 ± 0.03; p<0.001) were significantly higher in children treated with ringer's lactate as compared to normal saline. While there was no significant difference between the two groups (4.35 ± 0.61 vs. 4.27 ± 0.58 meq/l; p=0.319) in terms of mean serum potassium level. Conclusion: Fluid replacement with ringer's lactate was superior to normal saline in terms of significantly higher mean serum bicarbonate and mean blood pH after 6 hours of initiating therapy while it was equally safe and only caused insignificant increase in mean serum potassium level. [ABSTRACT FROM AUTHOR]

Objective: To compare clinical effectiveness of azithromycin versus ceftriaxone in terms of mean time taken in number of days for defervesence in children with enteric fever. Study Design: Quasi experimental study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Oct 2015 to Apr 2016. Methodology: The study involved 212 children of both genders aged between 2 to 12 years diagnosed with enteric fever. Patients were divided randomly into two treatment groups. All patients in group A were treated with oral azithromycin suspension/capsule (20mg/kilogram/day; max dose, 500mg/day) once daily for 7 days and group B with Intravenous (I/V) ceftriaxone (75mg/kg/day; max dose, 2.5 grams/day) twice daily for 10 days. Results: No statistically significant difference was noted in the mean defervesence time in patients treated with azithromycin and ceftriaxone (4.48 ± 1.13 days vs. 4.32 ± 1.23 days; p=325). When stratified, there wasn't any significant difference in mean defervesence time in patients given azithromycin and ceftriaxone across age groups and genders. Conclusion: There was no significant difference in mean defervesence time in patients given treatment for enteric fever with azithromycin versus ceftriaxone. A drug that was less invasive and has similar clinical effectiveness may be used as treatment alternative in pediatric patients with enteric fever. [ABSTRACT FROM AUTHOR]

Objective: To find out the association between iron deficiency anemia and febrile seizures in children. Study Design: Analytical: case-control study. Place and Duration of Study: The study was conducted at Paediatrics department, Pak Emirates Military Hospital Rawalpindi, from May 2013 till Oct 2013. Material and Methods: Two Hundred patients were selected through non probability consecutive sampling, one hundred in each group i.e. patients with febrile seizures and patients without febrile seizures. The blood sample of cases and controls were taken at the time of admission and was sent for assessment of hemoglobin (Hb), serum ferritin level, mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular volume (MCV). The samples were analyzed for iron deficiency anemia and compared in both groups (patients with febrile seizures and those without febrile seizures). Results: In the febrile seizures group 58 (58%) were anemic with a hemoglobin level less than 10gm/dL and 59 (59%) had a low plasma ferritin of less than 10ng/dL. In the control group 39 (39%) were anemic with a hemoglobin level less than 10gm/dL and 26 (26%) had a plasma ferritin of less than 10ng/dL. The frequency of anemia with low MCV, MCHC and serum ferritin was more in the febrile seizure group 38% as compared to 20% in controls (p-value = 0.002). Conclusion: The children with febrile seizures have lower hemoglobin, MCV, MCHC and serum ferritin level as compared to the control groups suggesting that iron deficiency anemia has a positive role in the pathogenesis of febrile seizures. [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 determine the status of thyroid functions in patients of β Thalassemia Major, reporting to OPD of Military Hospital, Rawalpindi. Study Design: Descriptive cross sectional study. Place and Duration of Study: Paediatric Outpatients Department of Military Hospital, Rawalpindi from 1st Jan to 30th Jun 2012. Material and Methods: After taking informed consent from the parents of all the children fulfilling the inclusion criteria, detailed history was taken and blood samples were drawn by strict aseptic means. Samples taken from these patients included complete blood and thyroid profile (serum thyroxine T4, triiodothyronine T3 and thyroid stimulating hormone TSH). These blood samples were labeled and sent to Armed Forces Institute of Pathology (AFIP), Rawalpindi for analysis by enzyme-linked immunosorbent assay (ELISA). Primary hypothyroidism was defined by TSH levels >4IU/ml. Statistical analysis was done at the end of study using SPSS version 10. Significance for association was calculated using student t-test. Results: Sixty patients fulfilled the inclusion criteria out of these sixty four patients lost the follow up while 56 patients completed the study. Out of 56 patients, 21 (37.5%) had biochemical evidence of hypothyroidism. Mean Ferritin level was 3924 ± 1247ng/ml in hypothyroid and 3136 ± 1387ng/ml in euthyroid patients indicating a significant difference in mean serum ferritin levels between hypothyroid patients and others. Conclusion: The study demonstrates hypothyroidism in a significant number of hyper transfused β-thalassemic patients, emphasizing the importance of monitoring thyroid functions in thalassemic patients, particularly in those receiving suboptimal chelation. [ABSTRACT FROM AUTHOR]

Objective: To determine the immunization status of children between 1-3 years of age, reported at children OPD; Military Hospital, Rawalpindi. Study Design: Descriptive cross sectional study. Place and Duration of Study: Paediatric outpatients department of Military Hospital, Rawalpindi from January to June 2010. Material and Methods: Vaccination data of 2200 children of 1-3 years of age coming to outpatients department, regarding seven EPI target diseases was collected using a standard proforma. Statistical analysis was done at the end of study using SPSS version 14.0. Results: Out of 2200 children, 1256 (57.1%) were completely immunized, 740 (33.6%) were partially immunized and 204 (9.3%) were unimmunized. Conclusions: This study concludes that immunization indicators have not met the expected benchmarks and achievements are inadequate as compared to the regional and global immunization level. [ABSTRACT FROM AUTHOR]

Neonates with congenital malaria may present with non-specific signs and symptoms which may be mistaken for neonatal sepsis and inborn error of metabolism resulting in delay of diagnosis.and significant mortality and morbidity. Here we present a unique case of 25 days old premature female baby who was diagnosed to have mixed malarial infection. Despite standard treatment the patient was not responding well and was also diagnosed to have congenital adrenal hyperplasia.