Objectives: To determine the frequency of sensorineural hearing loss (SNHL) in children with bacterial meningitis. Study Design: Cross Sectional study. Setting: Department of Paediatric Medicine Nishtar Hospital, Multan. Period: October 2019 to March 2020. Material & Methods: The study was conducted after permission from ethical committee. A total of 151 patients admitted with bacterial meningitis were enrolled. Apart from the presenting complaints, necessary information like the age and gender were noted. Examination of the child was done to assess the condition of child. Brainstem evoked response audiometry (BERA) test was performed before discharge of the patient from the hospital. The outcome variable that is SNHL in bacterial meningitis assessed by BERA test was noted in a specifically designed Performa. Results: Out of total of 151 patients, males were 83 (55%) while females 68 (45%). Overall mean age was 11.85+6.12 months. SNHL was found in 26 (17.2%) children. There was no significant effect of age or gender on the frequencies of SNHL. Conclusion: SNHL is a frequently encountered complication in our population of children with bacterial meningitis. SNHL should be carefully sought out and properly diagnosed in all the patients presenting with bacterial meningitis.

Objective: To correlate the immunofluorescence (IF) findings on renal biopsies of patients of glomerulonephritis (GN) with the clinical course of the disease. Methods: This retrospective descriptive study was done at the Department of Pediatrics Medicine Unit-I, Nishtar Hospital Multan, from January 2008 to January 2019. A total of 387 cases of both gender, aged up to 16 years, diagnosed having GN on the basis of renal biopsies by light microscopy (LM) and IF findings, were included. Outcome as remission, partial remission, no remission with stable kidney disease, no remission with progressive kidney disease and end-stage kidney disease (ESKD) were computed. Chi square test was applied to see the correlation of IF findings and outcome by taking p value less than 0.05 as statistically significant. Results: Focal segmental glomerulosclerosis (FSGS) was found to be the commonest histopathology finding noted in 158 (40.8%) followed by mesangioproliferative GN 74 (19.1%) and membranous nephropathy 42 (10.9%). Complete remission was observed in 145 (37.5%) cases whereas ESKD was seen in 26 (6.7%). Distinct pattern of IF findings were shown when distribution of IF findings were seen with respect to all study variables (p value < 0.001). For outcome, 134 (51.3%) IF negative cases had complete remission while 93 (35.6%) negative IF findings also had partial remission. ESKD was seen among 14 (25.9%) IgM positive and three (33.3%) IgA positive cases. Conclusion: Immunofluorescence proved an important diagnostic tool in reaching the exact diagnosis in various types of GN. Distinct correlation between IF findings and clinical course of various types of GN was observed. IF negative cases had better outcome and was not having progressive course of disease so prognosis remained better than IF positive cases in this study. doi: https://doi.org/10.12669/pjms.37.1.2497 How to cite this:Zafar F, Mehar MF, Khan AA, Safdar RS. Clinical correlation and prognostic significance of immunofluorescence in renal biopsies of patients having Glomerulonephritis. Pak J Med Sci. 2021;37(1):76-80. doi: https://doi.org/10.12669/pjms.37.1.2497 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.

Objectives: To find out frequency, clinicopathological features, response of treatment and outcome among children with primary focal segmental glomerulosclerosis (FSGS). Methods: This retrospective, non-interventional medical charts review study was conducted from a period of January 2011 to January 2020 at Pediatric Department of Nishtar Medical University Hospital, Multan, Pakistan. During the nine years study period, children of both genders, aged less than 16 years, with renal biopsies proven FSGS were included. Patient’s demographic along with clinical and laboratory data, urine dipstick for proteinuria, renal functions, 24 hours urinary protein and ultrasonography findings of kidneys, ureters and bladder (KUB) were noted from case records. Response rates of various treatment options and their outcome like remission, partial remission, no remission with stable kidney disease & no remission with progression of kidney disease were noted. Results: During the study duration, out of 307 renal biopsies performed in glomerulonephritis cases, 124 (40.4%) had primary FSGS. In 124 primary FSGS cases, mean age was 8.83±3.05 years while most of the children, 70 (56.5%) were above 10 years of age. Majority of the cases, 64 (51.6%) were male. Mean follow up duration was noted to be 28.35+18.47 months. Most of the cases, 68 (54.8%) were found to have complete remission, 22 (17.7%) partial remission while 11 (8.9%) progressed to ESKD. Conclusions: Among children, frequency of primary FSGS was high at our setting. Most of the cases achieved sustained remission rates with the help of immunosuppressive drugs. Cyclosporine and tacrolimus were found to be the most effective drugs. doi: https://doi.org/10.12669/pjms.37.2.3535 How to cite this:Safdar RS, Mehar MF, Khan AA, Buzdar N. Focal Segmental Glomerulosclerosis in Paediatric Population of South Punjab Pakistan: A Tertiary Care Hospital Experience. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3535 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.

Many perinatal deaths follow birth asphyxia that occurs in babies of women who are referred on developing life-threatening obstetric complications. Objectives: To determine the antenatal and intrapartum risk factors for perinatal asphyxia among babies delivered by women admitted as emergency obstetric referrals. Study Design: Cross-sectional study. Setting: Pediatric Unit 1, Nishtar Hospital Multan, Pakistan. Period: From May 2017 to April 2018. Material & Methods: A total of 150 newborn term babies (and their mothers) with a 1, 5, & 10-minutes Apgar score 4 or less (perinatal asphyxia) were considered for the study. Antepartum and intraparturn risk factors were noted among newborn babies (and their mothers) from socio-demographic characteristics, obstetric complications or labour management. Results: Out of150 neonates, 57(38%) were presented with perinatal asphyxia at the age of 1 minute, 62(41.3%) at the age of 5 minutes and 31(20.1%) neonates were presented at the age of 10 minutes. In these cases, 45(30%) were related to maternal causes, 71(47.3%) to placental causes and 34(22.7%) to fetal cause. Conclusions: Early recognition of antepartum and intraparturn risk factors for perinatal axphyxiaamong emergency obstetric referrals, followed by prompt and appropriate management, may reduce the perinatal deaths from perinatal asphyxia.

Background: Urinary tract infection (UTI) is a common clinical issue among pediatric population and might progress into renal scaring, hypertension as well as end stage kidney disease. This study was aimed at finding clino-pathological features of UTI and antibiotic sensitivity against most common causative agents involved at a tertiary care hospital of South Punjab, Pakistan.Methods: This descriptive case series study was conducted at department of Paediatric Medicine, Nishtar University Hospital Multan from July to December 2019. A total of 100 children fulfilling the inclusion criteria, presenting in outpatient department or emergency section of paediatric medicine department, having positive urine culture and sensitivity were selected. Their detailed history, clinical examination and relevant investigations were done.Results: Out of the 100 children, 73 (73.0%) were female and 27 (27.0%) were male. There were 57 (57.0%) children from 1 year to 4 years age group and 43 (43.0%) were of more than 4 years. Most common clinical presentations were fever 83 (83.0%), urinary symptoms, vomiting 52 (52.0%) and pain abdomen 48 (48.0%). Most common aetiological agents were Escherichia coli 74 (74.0%) and Klebsiella pneumoniae 9 (9.0%).Conclusions: UTI is more common in female children. Most common presentation observed was fever and/or urinary symptoms while most common aetiological agent was E. coli.

Objective: To evaluate the clinic-pathological characteristics and their association with biopsy-proven glomerulonephritis in pediatric patients. Study Design: Prospective longitudinal study. Place and Duration of Study: Pediatric Department Nishtar Medical University, Multan Pakistan, from Jan 2014 to Dec 2019. Methodology: During the study, a total of 211 renal biopsy reports of different age groups were studied and analyzed for clinic-pathological features and patterns of direct immunofluorescence. Results: The mean age of 8.6±3.25 years was observed. The most common pathology was focal segmental glomerulo-sclerosis in 86 (40.76) of the patients, followed by mesangio-proliferative glomerulonephritis in 41 (19.43) of the patients. Minimal change disease was seen in 26 (12.32) cases. It was observed that the majority of the patients with diffuse proliferative glomerulonephritis were younger than 11 years old, whereas; 10 (11.2), patients with lupus nephritis, 11 (15.1) and membranous nephropathy, 10 (12.2) were comparatively older. Conclusion: Glomerulonephritis presents a diversified group of diseases with overlapping clinic-pathological features. The present study has reported many significant characteristics which could help diagnose a particular disorder among the pediatric population.

Background: Urinary tract infections (UTIs) are the 2nd commonest bacterial infections, after respiratory tract infections (RTIs), and may go on to progress into chronic kidney disease among paediatric population. The objective of this study was to determine frequency of sensitivity of ciprofloxacin and ceftriaxone in children with urinary tract infections (UTIs).Methods: This descriptive, cross-sectional study was done at the department of pediatric medicine, Nishtar Hospital, Multan, from 10th August 2019 to 9th January 2020. A total of 165 patients presenting with UTI and aged 2 to 12 years of either gender were included. Urine sample was taken in sterilized container and sent immediately for urine culture and sensitivity tests.Results: In a total of 165 cases, mean age was 5.15±2.50 years while most cases, 113 (68.48%) were between 2 to 6 years of age. Out of the 165 patients, 112 (67.87%) were female representing female to male ratio of 2.1:1. Sensitivity of ciprofloxacin in 53 (32.12%) and ceftriaxone in 107 (64.85%) patients was found.Conclusions: This study showed the sensitivity of ciprofloxacin in 32.12% and ceftriaxone in 64.9% children with UTIs.

Objectives: To know the frequency of hypertension among children having acute kidney injury (AKI) at a tertiary care hospital. Study Design: Descriptive, cross-sectional study. Setting: Department of Pediatric Medicine, Nishtar Hospital, Multan, Period: 1st January to 31 December 2019. Material & Methods: A total of 718 children with AKI were included from department of Pediatric medicine, Nishtar Hospital, Multan. Once registered, study variables were noted along with systolic and diastolic blood pressure. Results: Of these 718 study cases, majority, 439 (61.1%) were male, 435 (61.0%) belonged to rural areas, 443 (61.7%) from poor socioeconomic status and 551 (76.7%) mothers were illiterate. Mean age was 4.33±2.56 years whereas mean body mass index was 23.58±3.17 kg/m2. Overall, family history of AKI was noted in 165 (23.0%) children. Hypertension was noted in 228 (31.8%) cases. Conclusion: Very high frequency of hypertension was seen in children presenting with AKI.