Motivation One of the main challenges in applying graph convolutional neural networks on gene-interaction data is the lack of understanding of the vector space to which they belong, and also the inherent difficulties involved in representing those interactions on a significantly lower dimension, viz Euclidean spaces. The challenge becomes more prevalent when dealing with various types of heterogeneous data. We introduce a systematic, generalized method, called iSOM-GSN, used to transform “multi-omic” data with higher dimensions onto a two-dimensional grid. Afterwards, we apply a convolutional neural network to predict disease states of various types. Based on the idea of Kohonen’s self-organizing map, we generate a two-dimensional grid for each sample for a given set of genes that represent a gene similarity network. Results We have tested the model to predict breast and prostate cancer using gene expression, DNA methylation, and copy number alteration. Prediction accuracies in the 94-98% range were obtained for tumor stages of breast cancer and calculated Gleason scores of prostate cancer with just 14 input genes for both cases. The scheme not only outputs nearly perfect classification accuracy, but also provides an enhanced scheme for representation learning, visualization, dimensionality reduction, and interpretation of multi-omic data. Availability The source code and sample data are available via a Github project at https://github.com/NaziaFatima/iSOM_GSN. Supplementary information Supplementary figures and data availability are in the Supplementary Material file.

Objective:To determine the outcomes in very low birth weight (VLBW) neonates receiving volume advancement versus frequency advancement feeding protocols.Methods:This controlled clinical trial was conducted in Children Hospital Multan within duration of 6 months from February 2017 to August 2017. VLBW neonates having weight < 1500 g at the time of birth were included. The protocol for frequency advancement (FA) group was to give 1 ml/kg human or pre-formula milk after every 8 hours and in volume advancement (VA) group after every 3 hours initially. After three days, in FA group duration of feeds was decreased gradually from 8 to 2 hours and feed volume of 10 ml.kg-1.day-1 until full-recommended dose of feeding i.e. 150 ml.kg-1.day-1 reached. While in VA group, volume of 20 ml.kg-1.day-1 was given until full-recommended dose of feeding reached. Days to achieve full feed, weight gain, and length of hospital stay were primary study outcomes.Results:Baseline weight of neonates was 1148 (111) grams in VA 1179 (106) grams in FA groups (p-value 0.18). In VA group, full feed was achieved in 11.04 (2.38) days versus 15.76 (2.48) days in FA group (P-value <0.001). Duration of IV fluid therapy were 13.5 (8.4) days in FA group versus 9.4 (7.6) in VA group (p-value <0.001). Moreover weight gain at the end of feeding protocol was significantly higher in VA group 1440 (78) grams versus 1284 (99) grams in FA group (P-value <0.001). Necrotizing entero-colitis occurred in only one neonate that was belonging to volume advancement group.Conclusion:Volume advancement (VA) feeding is better as compared to frequency advancement (FA) feeding in very low birth weight neonates.

Objectives: The prevalence of end-stage renal disease is increasing worldwide. It is also one of the main health problems in Pakistan. Currently, hemodialysis represents the main mode of treatment for patients with end-stage renal disease in this country. Despite 24-hour free dialysis at the Sindh Institute of Urology and Transplantation (Karachi, Pakistan), a significant number of patients do not turn up for regular dialysis or miss regular sessions of dialysis. We conducted this study to identify and highlight the factors leading to poor compliance with regular hemodialysis treatment despite free dialysis treatment offered at our center. Results: Despite 24-hour dialysis facilities, the patient drop-out rate (779; 18%) was high. In addition, a significant minority of patients (610; 13.4%) was erratic in adherence to maintenance hemodialysis schedules, with > 2 missed appointments. The mean age of these 610 patients was 33.4 ± 7.4 years, and 345 patients (57%) were males. The main factors leading to poor compliance included cost of travel (33.2%), lack of affordable lodging and boarding facilities near dialysis center (30.9%), long distances from dialysis center (20.1%), and lack of family support (15.6%).Conclusions: This study shows that there is significant drop-out and poor compliance rates for regular dialysis despite free dialysis facilities.

Objective: To assess the effectiveness of early nasal Continuous Positive Airway Pressure (nCPAP) in preterm neonates with respiratory distress syndrome (RDS). Study Design: Cohort study. Setting: Department of Neonatology, The Children’s Hospital and Institute of Child Health, Multan. Period: September 2018 to June 2020. Material & Methods: A total of 172 neonates admitted to neonatal intensive care unit (NICU), having RDS with gestational age as 28 to 34 weeks were enrolled. All study participants were administered early nCPAP (within 6 hours of onset of RDS). All babies with RDS were evaluated using Silverman–Anderson (SA) score, blood gas analysis and pulse oximetry. Results: Out of a total of 172 neonates, most, 91 (52.9%) were mal, nourished 89 (51.7%) had gestational age between 31 to 32 weeks and 97 (56.4%) with birth-weight between 1000 to 1500 grams. Majority of the neonates, 97 (56.4%) were found to have radiological grading of RDS as moderate. Successful outcome of early nCPAP was observed in 143 (83.1%) neonates. There was no statistical difference in terms of nCPAP outcome among study participants with respect to gender (p=0.4990). Gestational age, birth weight and severity of radiological grading of RDS were significantly associated with outcome of nCPAP (p <0.00001). Arterial blood gas parameters as PO2, PCO2 and HCO3 were also significantly associated with nCPAP outcome among study participants (p<0.0001). Conclusion: Early Nasal CPAP is safe, inexpensive and effective means of respiratory support in neonates with RDS. Early nasal CPAP is useful especially in mild to moderate grade RDS.

Objective: To find out the frequency of hypoglycemia among infants of diabetic mothers (IDMs) and factors affecting it. Study Design: Descriptive Cross Sectional study. Setting: Department of Neonatology, The Children’s Hospital and Institute of Child Health, Multan, Pakistan. Period: September 2019 t0 June 2020. Material & Methods: A total of 186 IDMs admitted to department of neonatology during the study period were enrolled. Bed side blood glucose (BG) was measured using “Accu Chek Performa Blood Glucose Meter” at 0, 2, 4, 6, 8, 12, 18 and 24 hours of life. All IDMs (Infants of Diabetic Mothers) were labeled either gestational diabetes mellitus (GDM) or pre GDM (pre-GDM). IDMs noted to have hypoglycemia during 1st 24 hours of life were described as hypoglycemic and others were labeled as normoglycemic IDMs. Results: Hypoglycemia was noted among 77 (41.4%) IDMs. Duration of disease was significantly more among mothers of hypoglycemic infants (27.62+28.8months vs. 19.69+24.41 months, p=0.0444). Significantly more large for gestational age (LGA) IDMs were found to be hypoglycemic in comparison to normoglycaemic ones (32.5% vs. 16.5%, p=0.0110). Among a total of 77 IDMs noted to have hypoglycemia, 34 (44.1%) were born to mothers who had GDM while remaining 43 (55.9%) were born to pre-GDM mothers. Significantly more IDMs were preterm among pre-GDM mothers when compared to GDM mothers (53.5% vs. 23.5%, p=0.0077). Conclusion: Hypoglycemia is frequent problem among IDMs. Increased duration of diabetes among mothers, LGA as well as preterm IDMs are found to have significantly increased risk of developing hypoglycemia.

ABSTRACT… Introduction:The need for neonatal resuscitation is usually unexpected and approximately 10% infants require some assistance at birth to begin breathing. We conducted a study to know the facilities and practice of neonatal resuscitation among healthcare providers at different healthcare centers of Multan. Study Design: A cross sectional descriptive epidemiological study. Setting: Different Health Care Centers providing Gynecological and Obstetrical Care in different areas of Urban Multan. Period: 15-08-2016 to 30-08-2016. Method: A questionnaire-type survey on neonatal resuscitation was performed at 69 different health care facilities of Multan. Data were analyzed using SPSS version 17.0 for windows. The results are presented using tables. Results: Out of 69 healthcare facilities, 50 (72.5%) were private hospitals. Majority of the center were run by doctors (52.2%). Ambu-bags were present in 83% centers, bulb sucker 68%, foot sucker 62% and electric sucker in 75% of healthcare centers. Routine delivery room care like drying, warmth and wrap were given in 70%, 74% and 48% centers respectively. Most common way of resuscitating the baby was suction 74%. Post resuscitation referrals in cases needing special care to other facility were made by 88% centers. New born resuscitation courses had been attended by only 36% of healthcare providers. Conclusion: Basic neonatal resuscitation facilities were available at most of the health facilities. There is increased need of new born resuscitation courses attended by the healthcare providers. Key words:Neonatal Resuscitation, Ambu-bag, Suction, Bag and Mask ventilation.

Objective: To find out prevalence, risk factors, severity and outcome of neonatal thrombocytopenia (TCP). Study Design: Prospective Observational study. Setting: Neonatal Intensive Care Unit (NICU) of Children Hospital Complex Multan. Period: January 2020 to January 2021. Material & Methods: A total of 191 neonates admitted to NICU during the study period were enrolled. A special proforma was designed to record all study information while SPSS version 26.0 was utilized for data analysis. Prevalence of TCP was noted among neonates admitted in NICU during the study period. Maternal risk factors, neonatal risk factors, severity of TCP and outcome were recorded. Results: In a total of 191 neonates, 110 (57.6%) were male while overall mean age was recorded to be 2.98+2.46 days. The prevalence of TCP was recorded to be 47.1% (90/191). Pregnancy induced hypertension (p=0.0003), premature rupture of membrane (p=0.0105) and eclampsia (0.0215) were found to have significant association with the presence of TCP. Preterm neonates (p<0.0001), small for gestational age (p<0.0001), sepsis (p<0.0001) and nectrozing enterocolitis (p=0.0014) were found to have significant association with TCP. A total of 13 (6.8%) neonates died, out of which, 5 (38.5%) were having severe TCP. Conclusion: Prevalence of neonatal thrombocytopenia at neonatal intensive care unit was found to be high (47.1%). Pregnancy induced hypertension, premature rupture of membrane and eclampsia were found to have significant association with neonatal thrombocytopenia. Preterm, small for gestational age, sepsis and necrotizing enterocolitis were noted to be significantly associated with neonatal thrombocytopenia. Severe thrombocytopenia was noted to be a significant predictor of poor outcomes.

Objectives: To find out the burden of cardiovascular dysfunction and outcome among term newborns having birth asphyxia. Methods: This prospective observational study was conducted at The Department of Neonatology, Children’s Hospital and The Institute of Child Health, Multan from August 2020 to March 2021.A total of 171 term newborns having asphyxia were enrolled. Detailed history along with clinical and physical examination were done at the time of admission at Neonatal Intensive Care Unit (NICU). All neonates were followed up for duration of 14 days following birth. Echocardiographic patterns as well as electrocardiography grading were described among neonates with cardiovascular abnormalities. Results: Out of a total of 171 neonates, there were 94 (55.0%) male and 77 (45.0%) female. Lowe segment cesarean section was the mode of delivery in 72 (42.1%) while normal vaginal delivery was noted in 99 (57.9%). Mean gestational age was noted to be 38.3±1.8 weeks. Mean birth weight was calculated to be 2574.10±122.30 grams. Cardiovascular dysfunction was noted among 60 (35.1%) neonates as exhibited by the use of inotropes while abnormal ECHO was observed in 52 (30.4%), abnormal ECG in 27 (15.8%) and elevated CK-MB in 31 (18.1%). A total of 29 (17.0%) asphyxiated neonates died while among 60 asphyxiated neonates with cardiovascular dysfunction, 23 (38.3%) died and all remaining survived and discharged (p<0.0001). Conclusion: Cardiovascular dysfunction among asphyxiated neonates was found to be in high proportion of cases. Cardiovascular dysfunction was noted to have significant association with poor outcome. doi: https://doi.org/10.12669/pjms.38.4.5160 How to cite this:Shakir W, Abdur-Rehman, Arshad MS, Fatima N. Burden of cardiovascular dysfunction and outcome among term newborns having birth asphyxia. Pak J Med Sci. 2022;38(4):---------. doi: https://doi.org/10.12669/pjms.38.4.5160 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.