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Objective: To determine the clinical profile, selected antepartum and intrapartum risk factor for adverse shortterm outcomes of hypoxic ischemic encephalopathy in babies with birth asphyxia. Study Design: Cross sectional study. Place and Duration of Study: Neonatal Intensive Care Unit of Pak Emirates Military Hospital, Rawalpindi, fromJan to Dec 2018. Methodology: This study including all birth asphyxiated babies born who fulfilled the inclusion criteria.Following data was collected prospectively regarding gender, gestational age, birth weight and mode of delivery, maternal age, antenatal follow up, history of premature rupture of membranes and meconium stained liquor. Babies were categorized into different stages of hypoxic ischemic encephalopathy according to Sarnat and Sarnat staging. Selected antepartum and intrapartum risk factors leading to hypoxic insult at birth were studied and short-term outcome was recorded in the form of need of mechanical ventilation, mortality and discharge from the hospital.Results: The frequency of birth asphyxia turned out to be 122/5986 (2.03%) at our center. Thirty four (27.87%)required mechanical ventilation, mortality was recorded at 20/122 (16.39%). While 61 (50%) babies suffered from stage I hypoxic ischemic encephalopathy, 13/20 (65%) of newborn who expired were suffering from grade III hypoxic ischemic encephalopathy. Conclusion: The severity of hypoxic ischemic encephalopathy affects the outcome of newborns having birthasphyxia with hypoxic ischemic encephalopathy grade III associated with maximum mortality. Early identifycation of pregnancies at risk for asphyxia, with appropriate intervention in selected cases is the key to prevent birth asphyxia and its ensuing neonatal complications.

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Objective: To study the serum sodium levels in patients of lower respiratory tract infections admitted in the paediatric intensive care unit with their prognosis. Study Design: Prospective observational study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jan to Jun 2018. Methodology: Eighty patients suffering from lower respiratory tract infections who were admitted to the paediatric intensive care unit were selected at consecutive sampling. The outcome was recorded in the form of discharge or mortality. Serum sodium was done at the time of admission and then periodically after every 24-48 hours. The Association of patients’ serum sodium with their prognosis was studied using chi-square test and p-value was calculated. Results: A total of 80 patients were enrolled in our study out of which 50 (62.50%) were males and 30 (37.50%) were females. Out of the total, 48 patients suffered from hyponatremia. These 48 patients had a mean serum sodium concentration of 131.24 ± 3.31 mEq/L. The mean age of patients suffering from hyponatremia was 5.78 ± 3.4 years. Mortality occurred in 5 (80.12%) of patients suffering from severe hyponatremia. Conclusion: There was a significant association of hyponatremia with mortality in children admitted in paediatric intensive care settings with lower respiratory tract infections. Therefore, proper management hence correction of serum sodium levels can improve survival in, particularly children admitted in a pediatric intensive care setting.

Objective: To find out the electrocardiographic changes among beta thalassemia major patients as the marker of cardiac complications at later stages of life. Study Design: Prospective observational study. Place and Duration of Study: Department of Pediatrics and Neonatology, Pak Emirates Military Hospital Rawalpindi from Jul 2018 to Dec 2018. Methodology: One hundred and thirty patients of age 5-20 years with beta thalassemia major were included in the study. Patients were attending the thalassemia centre regularly. Results: Out of total 130 patients, 70 (53.84%) were males and 60 (46.15%) were females. Out of 81 (56.92%) patients showed at least one electrocardiographic change while 49 (37.69%) patients showed normal electrocardiography. Remarkable electrocardiographic changes were sinus tachycardia, arrhythmias, T-wave inversions, long QTc interval and sinus bradycardia. There was statistically significant association in the increased serum ferritin levels, electrocardiographic changes, number of blood transfusions and occurrence of ECG changes (p<0.05). Conclusion: Regular electrocardiographic monitoring has significant role in cardiac evaluation of beta thalassemia major patients as an indicator of evolving cardiac complications that can arise from iron overload secondary to multiple blood transfusions.

Objective: To study clinical outcome of early versus late caffeine therapy in preterm infants. Study Design: Prospective comparative study. Place and Duration of Study: Neonatal Intensive Care Unit, Pak Emirates Military Hospital, Rawalpindi, from Jan to Jul 2018. Methodology: A total of 40 preterm infants with gestational age <32 weeks and birth weight <1500 grams were randomly divided into two groups on the basis of initiation of caffeine therapy i.e. group A (early caffeine group) and group B (late caffeine group). Infant’s demographic data and clinical outcomes were compared between both groups using SPSS IBM software. Results: Mean gestational age was 29.9 ± 1.19 weeks with male to female ratio of 1.5:1 Mean birth weight was 1165.3 ± 316 grams. Half (50%) of the infants were delivered by cesarean section while surfactant was given in 29 (72.5%) infants. While comparing both groups we observed that early caffeine shortens duration of Neonatal Intensive Care Unit stay (p<0.05) whereas caffeine therapy initiation timings didn’t influence the risk of development of Respiratory Distress Syndrome or need of mechanical ventilation. Conclusion: Early caffeine therapy in preterm infants is associated with decrease duration of Neonatal Intensive Care Unit stay. However further work is needed in this regards to establish its efficacy and safety.

Background:Lupus nephritis (LN) is one of the most critical complications of systemic lupus erythematosus (SLE). Approximately 30–50% of SLE patients develop LN with 5-year survival rate of about 70-80%. Thus, finding reliable non-invasive biomarkers at the early stages of SLE is of great interest (1). Many studies focused on the association between microRNAs and the risk of LN. miRNA-146a (miR-146a) was one of the most promising circulating markers which was suggested recently for early diagnosis of SLE but its diagnostic relevancies regarding LN have not been extensively investigated.Objectives:This study aims to test the expression of miR-146a in patients with LN in relation to Kallikrein-1 as another widely investigated diagnostic marker for LN along with other conventional measures.Methods:One hundred and thirty subjects were enrolled in this study. They were divided into forty six patients with LN, forty four patients with SLE but without nephritis and forty healthy controls. The expression levels of miR-146a in peripheral blood mononuclear cells (PBMCs) were detected via RT-qPCR analysis. Besides, serum Kallikrein-1 levels were determined by ELISA. The diagnostic role of miR-146a and Kallikrein-1 in LN was evaluated by Receiver operating curve (ROC). The impact of miR-146a and Kallikrein-1 on renal disease was compared to albumin creatinine ratio, renal biopsy findings as well as renal SLEDAI.Results:Levels of miR-146a were significantly lower in the plasma of LN patients than both patients of SLE without LN and normal controls (p < 0.05). However, serum levels of Kallikrein-1 were significantly higher in LN patients when compared to SLE patients and normal population (p < 0.05). ROCs were conducted to assess the diagnostic values of both miR-146a and kallikrein-1. They revealed good diagnostic values with AUC of 0.888 and 0.913 respectively. Also, plasma miR-146a was observed to be negatively associated with serum creatinine, proteinuria as well as SLEDAI score (p < 0.01) while serum Kallikrein-1 was positively correlated with them (p < 0.05) and inversely correlated with miR-146a (p < 0.01).Conclusion:The expression levels of miR-146a are reduced in SLE patients with more reduction with LN. Therefore, miR-146a could be considered as potential biomarker for detecting LN either alone or in combination with Kallikrein-1. However, more studies are required.References:[1]Soliman S. And Mohan C. Lupus nephritis Biomarkers.Clin Immunol.2017 Dec; 185: 10-20.Disclosure of Interests:None declared