Association of long term sodium valproate monotherapy and vitamin D3 levels in epileptic children

Objective: To determine the association of long term sodium valproate monotherapy and vitamin D3 levels in epileptic children Methods: This cross-sectional study was conducted in the Department of Pediatrics, Children Hospital, Pakistan Institute of Medical Sciences, Islamabad for six months from 15th February 2019 to 14th August 2019. A total of one hundred and thirty (n=130) children and adolescents of either gender between age 3-18 years who had a history of two seizures at least 24 hours apart in their life and were on sodium valproate monotherapy for more than one year were enrolled in this study through non-probability, consecutive sampling. Serum vitamin D3 (25-hydroxy vitamin D) levels were measured in all the patients at the time of enrolment into the study. All the demographic data and laboratory investigations were entered on the predesigned proforma and analyzed through SPSS version 17. Results: Vitamin D3 deficiency was found in 47 (36.2%) children which were significantly higher among patients with older age and longer duration of treatment (P<0.05) while gender and BMI of the patients did not show any significant difference (P>0.05). Conclusion: Significant percentage of epileptic children on sodium valproate monotherapy was found to have vitamin D3 deficiency. Therefore we recommend routine screening of vitamin D3 deficiency in all the epileptic children on long-term sodium valproate therapy followed by vitamin D supplementation in deficient patients. &nbsp

Hearing Loss Due to Cyclosporine In Children

ABSTRACT A 13-year-old boy known for steroid-resistant nephrotic syndrome taking cyclosporine for the last four years was referred from one private hospital for non-response to treatment and decreased hearing. On detailed history, it was revealed that hearing loss started after initiation of treatment with cyclosporine during the first year, and the patient was not properly followed for hearing issues. Rather cyclosporine was continued despite no response to treatment. The patient raised alanine transaminase (ALT) and uric acid levels. The drug was discontinued, and ALT and uric acid were normalized on follow-up. Hearing on follow-up improved clinically. It was concluded that children taking calcineurin inhibitors should be screened for hearing when taking them long

Paraquat Poisoning In Children – A Case Report

OBJECTIVES Accidental poisoning in children is a serious public health problem in developing countries, especially where chemicals used in agriculture are ingested. Paraquat is a herbicide which is still used in Pakistan. We report a case of fatal unintentional paraquat ingestion by 3 years old child who could not survive. Lack of care in the storage of paraquat lead to the poisoning but initial inappropriate management was also one factor in the fatal outcome. Detailed history and provision of poison containers are important in the proper management of patients with poisoning

Fetal Warfarin Syndrome – a case report

A two-month-old male infant presented with history of respiratory difficulty and got admitted with provisional diagnosis of pneumonia. On examination patient was having unilateral nasal hypoplasia and cyanosis with echocardiography showing truncus arteriosus. Detail history revealed that mother had valve replacement and she was taking warfarin during pregnancy. After initial management patient was referred to pediatric cardiac surgery and plastic surgery for further management. Parents were counseled regarding contraception and family planning.

Ivermectin Poisoning with Neurological Manifestations in 10 Years Old Girl – A Case Report

In developing countries, accidental poisoning is a serious public health problem in children. But unintentional poisoning by parents in the form of medication is very rare. Ivermectin belongs to the group of Avermectins and is used in veterinary medicine and in use for human parasitic diseases. We report the case of 10 years old girl given ivermectin by her mother for an unspecified amount. The patient presented to the hospital with seizures and remained in a coma for five days. The patient was managed symptomatically and discharged home in stable condition with parents' counselling regarding child safety

Frequency of malignant solid tumors in children

Objective: To find out the frequency of malignant solid tumors in children (cTl5 years). Setting: All cases of pediatric malignant solid tumors which were diagnosed in the section of histopathology at the Aga Khan University Hospital, Karachi during the period of two years. Methods: These tumors were initially evaluated on H&E stained sections and special stains were also performed whenever indicated. The undifferentiated tumors were evaluated immunohistochemically by using a panel of antibodies on sections from routinely processed, fornialin fixed, paraffin embedded tissu.e blocks. Results: Of two hundred and fifty three (253) consecutive cases of paediatric malignant solid tumors, lyinphorna (26.1 %) was the most common tumor followed by central nervous system tumors (16,6%), osteosarcoma (7.5%), rhabdomyosarcoma (6.7%), neuroblastoma (5.1%), Wilm\\u27s tumor (5.1% %), Ewing’s sarcoma (4.7%), retinoblastoma (4.7%), germ cell tumor (4.4%) and primitive neuroectodermal tumor (4%) in order of frequency. In seven cases (2.8%), the nature of lesion remained undetermined even after immunohistochemical staining. Rest of malignant tumors (12.3%) included the rare entities like synovial sarcoma, nasopharyngeal carcinoma, leiomyosarcoma, malignant schwannoma and thyroid carcinoma, etc. Conclusion: Lymphoma was the most frequent Paediatric tumor. The frequency of childhood central nervous to the other series from different regions of Pakistan system tumors was quite high as compared

Determinants of Vaccine Hesitancy and Refusal in Children of District Swabi Khyber Pakhtunkhwa, Pakistan

OBJECTIVES: The objective of the study was to evaluate factors associated with vaccine hesitancy and refusal at District Swabi, Khyber Pakhtunkhwa. METHODOLOGY: This cross-sectional study was conducted at a teaching hospital of Khyber Pakhtunkhwa District Swabi over a period of four months. Children between the ages of 9 months to 10 years from the local population admitted to the children ward/daycare centre were included in the study. Parents were inquired about vaccination status and in case of no vaccination or partial vaccination; then the reason was inquired after proper informed consent. Data were collected by using a structured proforma and analyzed using SPSS-24. RESULTS: A total of 828 children were included in this study. Out of these 492 (59.4%) were male and 336 (40.6%) were females. Of the total 828 children, 753 (90.9%) were vaccinated up to date, 48 (5.8%) were not vaccinated and 27 (3.3%) were partially vaccinated. Under vaccinated were 75 patients, 52% were left out due to misconception/beliefs, 6% patients were having issues due to living far away, 2.7% patients could not be vaccinated due to presence of other diseases and 37.3% due to lack of knowledge regarding vaccination. A significant correlation was found between the vaccination status of children and aforementioned reasons (p-value ≤0.001). CONCLUSION: The most common cause of not vaccinating children with polio vaccines was misconceptions/beliefs and lack of knowledge of the parents

Risk Factors for Bronchiolitis in Infants of Hazara Division - A Cross Sectional Study

OBJECTIVES Bronchiolitis is one of the major causes of hospitalization in the infants. Higher rate of hospitalization and mortality can be reduced by recognizing and control of risk factors for bronchiolitis. The objective of this study is to ascertain risk factors of bronchiolitis in infants, in local population of Hazara Division. METHODOLOGY This cross-sectional study was done in Ayub teaching hospital form January, 2020 till June 2020. Infants of both gender from age of 3 months to 12 months were included with diagnosis of bronchiolitis. Patients with croup, pneumonia, cystic fibrosis and bronchomalasia are excluded. Demographic variables, clinical characteristics and risk factors of bronchiolitis related to infant, mother and family were documented on specific proforma. The data was analyzed by SPSS 21. RESULTS There were 101 infants. Mean age was 5±3.5 months. Male to female ratio was 2.8. 77.2% infant had de livery through surgical procedure and 82% are term. 45% infants were exclusively breast fed. 34% patients room were carpeted, 35% exposed to molds and 81% had history of contact with infected person.28% infants are exposed to passive smoke, 49% had history of allergies and 60% mothers uses perfume to their child’s. 31% infants have more than 10 family members and are living in 2 rooms (p=0.000). Infant weaned at 6month have late onset of bronchiolitis as compare to infants weaned before 6 months (p=0.000). CONCLUSION Perfume/powder use, family history of allergies, history of contact with respiratory infection, delivery with surgical procedure as major new risk factors. Carpets, mold, passive smoking, overcrowding, are also contributing risk factors

Childhood non-Hodgkin\u27s Lymphoma: An immunophenotypic analysis.

Objective: To observe the frequency of histological subtypes of childhood non-Hodgkin`s lymphoma and its immunohistochemical profile. Setting: All cases of non-Hodgkin’s lymphoma diagnosed in children (\u3c15 years) in the section of histopithology at the Aga Khan University Hospital Karachi during the period of three years. Methods: These consecutive cases were evaluated on H&E stained sections and then immunohistochemistry analysis of these tumors was performed by employing Peroxidase Anti-Peroxidase (PAP) technique. Results: The present series included 61 cases of non-Hodgkin’s lymphoma. NHL was more common in males as compared to females with male to female ratio of 5.8:1. High grade NHL comprised 87% of childhood lymphoma. The mode of presentation in majority of NHL (57%) was extranodal. Burkitt’s lymphonia (33%) was the most prevalent histological subtypes, followed by lymphoblastic (28%), diffuse large cell (15%), diffuse mix small and large cell (13%), small non cleaved Non-Burkitts (7%) and immunoblastic (4%). Immunophenotypic analysis of the childhood Non-Hodgkin’s lymphoma revealed that 67% of the Non-Hodgkin’s Iy mphoma are cell type while 33% are those of T-cell lineage. Conclusion: NHL was more common in males. Majority of NHL in children were high grade tumors. Burkitt’s lymphoma was the most frequent histological subtype. T-cell NUL comprised a significant portion of childhood lymphoma