Objective: To determine the frequency and outcome of electrolyte imbalance in seriously ill children admitted in Paediatric Intensive Care Unit (PICU) of a public sector hospital in Karachi. Methods: All children between the ages of one month to 12 years admitted in PICU from May 2017 to October 2017 were included. Blood samples were drawn to determine the baseline sodium, potassium, calcium, magnesium and phosphorous and followed 24 hourly or earlier, if needed (Those who had imbalance at admission or on subsequent repeat labs as per protocol). Results: A total of 101 children were included in the study. Electrolyte imbalance was seen in 84%. A single electrolyte imbalance was noted in 30.58%. Hypocalcemia was the most frequent abnormality noted in 57.6%. Among the total expiries during the study period 91% had electrolyte imbalance. Mortality within 48 hours and duration of stay was also increased in these patients. Conclusion: Electrolyte imbalance is an important prognostic indicator in critically ill patients. doi: https://doi.org/10.12669/pjms.35.4.286 How to cite this:Naseem F, Saleem A, Mahar IA, Arif F. Electrolyte imbalance in critically ill paediatric patients. Pak J Med Sci. 2019;35(4):---------.  doi: https://doi.org/10.12669/pjms.35.4.286 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective:To study the demographic and clinical features, outcome, complications and treatment cost of tetanus patients admitted in Paediatirc Intensive Care Unit (PICU) of Civil Hospital Karachi (CHK).Methods:It is a descriptive observational study conducted at Civil Hospital Karachi from July 2013 to June 2015. Patients of tetanus admitted in PICU during the study period were enrolled. Data was collected from the file records of patients and included the demographic profile, clinical presentation, grade of severity, length of stay, complications and outcome. It also included the cost of treatment. Descriptive statistics were applied to describe the results.Results:During the study period, 23 cases of tetanus were admitted in P.I.C.U. twelve were male and 11 female. Majority of cases (13) belonged to age group 2-6 years. Seventeen cases were unvaccinated and 6 had received only BCG & OPV. None was appropriately vaccinated for age.There were 9 cases of post injury tetanus, 6 of them were males, 5 cases of otogenic tetanus and 9 cases had no clinically identifiable portal of entry. Eleven cases belonged to grade III severity of Ablett classification and 6 had grade IV severity. Mortality in our case series was 26%. Autonomic instability was seen in 17 patients and all of them needed ionotropic support. The estimated cost of per day treatment of a tetanus patient with mechanical ventilation was approximatly 31, 979/Pak Rs and without mechanical ventilation was 20,000/Pak Rs.Conclusion:Tetanus is an entirely preventable disease with a high mortality. Treatment is very costly as compared to vaccination which is free of cost. Complete vaccination and proper wound care is the only option to reduce the ongoing burden of tetanus.

Background and Objective:Tetanus is a potentially fatal but preventable disease. Mortality is related to severity of the disease, cardiovascular, pulmonary and renal complications. Acute kidney injury (AKI) is a frequent and lethal complication of tetanus. The objective was to determine the frequency of AKI in tetanus patients managed in a public hospital.Methods:Children aged 1-12 years admitted in Paediatric Intensive Care Unit (PICU) with the clinical diagnosis of tetanus over three and half years were recruited for the retrospective study. pRIFLE (Pediatric Risk, Injury, Failure, Loss, End) criteria was applied to all cases of tetanus to categorize them as having AKI or not, on the basis of estimated creatinine clearance (ECCL). Comparison was done between AKI and non-AKI cases, as well as between AKI survivors and AKI non-survivors. The study was conducted at PICU of Dr. Ruth K.M. PFau Civil Hospital Karachi for tetanus cases admitted during July 2013 to December 2016Results:During the study period, 44 patients of tetanus were enrolled. Nearly 32 % of tetanus patients developed acute renal dysfunction according to PRIFLE criteria. There were overall 15 (34.09%) expiries among tetanus patients among which nine (60%) had AKI. Oliguria was observed in five (35.71%) cases. All the AKI non-survivors had ECCL below 50% and all had autonomic instability. AKI developed towards the end of first week in three cases, mid of second week in four cases and third week in seven cases. Renal replacement therapy (RRT) i.e. peritoneal dialysis (PD) was done in four AKI cases but it did not improve the outcome. CRP was more than 50 in 24 (54.54%) cases. Ventilatory support was given to 85.71% with AKI as compared to 66.66% of non AKI patients.Conclusion:Development of AKI in tetanus is multifactorial. Major contributors are severity of the tetanus itself, presence of autonomic instability, ventilator dependency, and sepsis. Presence of AKI worsens the outcome of tetanus in terms of survival, length of stay, hospital cost and ventilator days.

BackgroundIn Pakistan social and ethical bindings are major constraints to launch effective awareness campaign or vaccination trial against HIV transmission. Lack of awareness coupled with high risk behaviour could result in AIDS epidemic among adolescents and street children as in these groups coercive and transactional sex is common. We aimed to examine adolescent's behavioural risks and their knowledge about HIV/AIDS. Sources of information regarding HIV/AIDS were analysed for risk behaviour in relation to social factors.MethodsCross-sectional study was conducted in rural and urban areas of Rawalpindi to gather information from street children (n=148, mean age 17 years). Multivariate analysis was performed to see effect of residential site and gender on AIDS concepts.ResultsAmong surveyed population, 14% had heard of HIV vaccine and 50% believe HIV vaccine could develop infection. About 33% ever had sex and 10% revealed >1 partner per year. 5% had knowledge about HIV status of partner see Abstract P2-S5.04 Table 1. A high degree of risky behaviour activities correlated with those children who lived in rural areas. Urban area street children were found to explore more sources to grasp HIV information. We found limited availability of documented information to compare the present observations.Abstract P2-S5.04 Table 1Multivariate ANOVA for HIV/AIDS knowledgeMain effectInteractionSiteGenderSite × GenderMANOVA test (Pillais F value)2.174.451.43HIV/AIDS transmission route<1<1<1Discussion about HIV/AIDS1.22.211.53Behavior risks<1<12.25ConclusionsBoth the adolescents and street children with poor knowledge about HIV are involved in risky behaviour. Our study propelled the need to consolidate, where relevant, community mobilisation for HIV prevention research throughout the country. Moreover, cross-country documentation must be improved for wider sharing of knowledge. A planned approach with educational sessions seems imperative for developing an effective sexual health safety program.