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Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition mainly affecting children with a distinct clinico-radiologic pattern. Initially thought to be secondary to respiratory viral infections, there have been more insights to the pathogenesis of ANEC including genetics. We present a case of a girl who developed this condition with classical clinico-radiologic findings of ANEC secondary to severe dengue infection and could not survive. We report this case with the aim to raise awareness about this fatal complication of dengue infection as dengue has become a global health-care problem.

ObjectiveThe aim of this study was to describe the outcome of the use of interventional radiological procedures (IRP) (angioembolization) in critically injured children.MethodsA retrospective review of medical records of all children who underwent an IRP from January 2010 to December 2015 was done. Data were collected on a structured proforma and results are presented as mean with standard deviation and frequency with percentages.ResultEighteen patients were identified who underwent IRP during the study period. The mean age was 10.4 ± 4.3 years and 10 (55%) were males. Ten patients had a road traffic accident, four had a history of fall, one patient had glass cut pelvic injury, and two patients had blunt abdominal trauma, while one patient had bleeding secondary to hemipelvectomy. The genitourinary system was involved in five patients, liver in four, and spleen in two and pancreas in one patient. Bleeding was from branches of internal iliac artery in seven patients, hepatic artery in three patients, splenic artery in two patients, and middle colic artery in one patient, while one patient had blood oozing from the bone after hemi-pelvictomy. Four French vascular access sheath was placed under ultrasound guidance; this was followed by the placement of C1 catheter (Cordis, Miami, FL). After vessel identification, a 2.7F Progreat microcatheter (Terumo, Tokyo) was used for super-selective cannulation of the bleeding vessel. Intravascular coil, polyvinyl alcohol (PVA) particles, or gel foam was used for the embolization of bleeding vessels. No procedural complications were observed except minor oozing in one patient. One patient expired due to multiorgan dysfunction.ConclusionAngioembolization is a useful and relatively safe procedure in the management of vitally stable children with hemorrhagic abdominopelvic injuries. However, further studies may be needed to evaluate the efficacy and cost-effectiveness of this practice, especially in resource-constrained settings.

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To determine the relationship of hyperchloremia on development of Acute Kidney Injury (AKI), hyperchloremic metabolic acidosis, PICU length of stay and mortality in critically ill children. We did retrospective review of medical records of all children (aged 1 month to 16 years) admitted in our PICU from January to December 2015. Study population was divided into groups based on Chloride (Cl) level. Children with Cl level >110 meq/L were labelled as hyperchloremic groups and those with <110 as normochloremic group. Patients having acute kidney injury on admission and length of PICU stay <24 hours were excluded. A total 200 patients were identified, 100 in each group. Mean age was 55.59 ± 57.77 months with no difference between the two groups (p 0.66). 63% were males. Mechanical ventilation was needed in 50% patients, inotropes in 21.6 and renal replacement therapy in 14%. There was no significant difference between the two groups in development of AKI, length of PICU stay or survival (p value >0.05).

OBJECTIVES: To evaluate nationwide pediatric critical care facilities and resources in Pakistan. DESIGN: Cross-sectional observational study. SETTING: Accredited pediatric training facilities in Pakistan. PATIENTS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A survey was conducted using the Partners in Health 4S (space, staff, stuff, systems) framework, via email or telephone correspondence. We used a scoring system in which each item in our checklist was given a score of 1, if available. Total scores were added up for each component. Additionally, we stratified and analyzed the data between the public and private healthcare sectors. Out of 114 hospitals (accredited for pediatric training), 76 (67%) responded. Fifty-three (70%) of these hospitals had a PICU, with a total of 667 specialized beds and 217 mechanical ventilators. There were 38 (72%) public hospitals and 15 (28%) private hospitals. There were 20 trained intensivists in 16 of 53 PICUs (30%), while 25 of 53 PICUs (47%) had a nurse-patient ratio less than 1:3. Overall, private hospitals were better resourced in many domains of our four Partners in Health framework. The Stuff component scored more than the other three components using analysis of variance testing (p = 0.003). On cluster analysis, private hospitals ranked higher in Space and Stuff, along with the overall scoring. CONCLUSIONS: There is a general lack of resources, seen disproportionately in the public sector. The scarcity of qualified intensivists and nursing staff poses a challenge to Pakistan’s PICU infrastructure.

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Background and Aim Procedural sedation and analgesia is the standard of care for painful procedures in children that require immobility. Children with cancer are subjected to many procedures for their treatment which are painful and cause anxiety in them. Our aim was to assess the safety and efficacy of procedural sedation and analgesia in pediatric oncological patients in a large tertiary care hospital in Karachi. Methods A retrospective study was done and records were reviewed of children receiving PSA (procedural sedation and analgesia) for pediatric oncological procedures. This included patients for oncology procedures (lumber puncture, intrathecal chemotherapy and/or bone marrow aspiration ± trephine). PSA was provided by non-anesthesiologists. These patients were assessed according to PSA protocol guidelines by American Society of Anesthesiology (ASA). Low dose Ketamine (0.5 mg/kg) and Propofol (2 mg/kg) were used. Results A total of 1216 oncological procedures were performed out of which lumber puncture was the commonest procedure performed (n=956; 78.6%) followed by bone marrow aspirate only (n=137, 11.3%) and both (n=123, 10.1%). A total of 565 children were enrolled in the study out of which majority (65.1%) were males and 34.9% were females (Table 1). Only eight (0.7%) of the patients were found to have hypoxia as an adverse effect of propofol-ketamine drug with 50% procedures utilizing propofol 1 mg/kg for sedation. Conclusion This study concludes that the combination of Ketamine and Propofol is safe for procedures. There were no major complications. None of the patients required CPR or endotracheal intubation.