Background. There is insufficient data in Pakistan and in South Asia regarding paediatric COVID-19 demographics and related parameters. The main aim of this study was to assess the paediatric population exposed to SARS-CoV-2 infection, their clinical parameters, risk factors, and outcome. Methods. This was a descriptive retrospective study conducted at the Pakistan Institute of Medical Sciences and Federal General Hospital Islamabad from 23rd July 2020 to 22nd August 2020. All paediatric contacts (≤13 years) of one hundred adult COVID-19 patients were included. Data of the index cases was taken from the medical records. Paediatric data was collected on the phone using a predesigned proforma. Results. There were 137 paediatric contacts of 100 adult COVID-19 index cases. The index cases were predominantly males (67%) and belonged to the middle socioeconomic class (89%), and 14% succumbed to the disease. Females had more paediatric contacts. The mean age of contacts was 6.6 years, and the majority (80%) developed no symptoms. Among the symptomatic contacts, fever and cough were the most common symptoms. None of the contacts developed dyspnoea or required hospitalization. Majority of the contacts had been vaccinated with the BCG vaccine. Testing for COVID-19 was done in only 77 (56%) contacts, 25 (32%) by the government team, and 52 (67%) privately. A higher number of symptomatic contacts were positive (15/17 (88%)) as compared to that of the asymptomatic contacts (6/60 (10%)) ( p = 0.002 ). Development of symptoms in the contacts was associated with the history of respiratory illnesses, recurrent infections, use of hematinics, a positive COVID-test result, and health professionals being index cases ( p ≤ 0.01 ). Parents with higher education and in the health profession and the families of symptomatic contacts reported better compliance with quarantine regulations. Conclusion. A significant number of children were exposed to adult COVID-19 patients. Most paediatric contacts remained asymptomatic. Children with preexisting medical conditions and with parents in health profession were susceptible to infection.
Objective: to recognize an alternate method for screening neonatal sepsis in patients while considering the sensitivity and accuracy of the diagnosis. Study Design: Cross sectional study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Jun to Dec 2021. Methodology: Patients admitted to the Neonatal Intensive Care Unit of the Combined Military Hospital were included in the study. Demographic data, including age, weight, gender, and gestational age, were recorded. In addition, a statistical comparison of total leucocyte count, absolute neutrophil and lymphocyte counts, neutrophil-lymphocyte ratio, and C-reactive protein test was carried out for the cases and controls. Results: It was evident from the results that a significant correlation between the neutrophil-lymphocyte ratio and neonatal sepsis exists. The mean NLR in non-septic individuals was (1.8±1.3) and in septic individuals, it was (2.9±1.9). The p-value was 0.001. Furthermore, ROC showed that at an NLR value of 1.6, sensitivity was 0.594 and 1-specificity 0.295. Conclusion: Neutrophil lymphocyte ratio was an efficient screening tool for determining sepsis in neonates, with comparable results to the C-reactive protein test.
Background: Down syndrome is present in every 1 in 700 births, associated with developmental disability and comorbidities, like obesity which significantly contributes to morbidity and mortality in these children. Aim: To identify the trends in body mass index and prevalence of obesity in school going down syndromes. Methodology: A descriptive cross-sectional survey conducted at special children’s schools in Islamabad and Rawalpindi. A questionnaire was designed after literature search and was filled by the parents of the selected candidates according to inclusion criteria i.e., school going down syndromes and residents of Islamabad and Rawalpindi, in an interactive counselling session conducted by authors in collaboration with pediatrician, with parents at respective schools of their child, keeping the questionnaire anonymous. After data collection it was entered in SPSS v25 for statistical analysis in terms of frequencies and percentages. Results: Our survey included 44 candidates in which majority was between the age group 11 years to 20 years i.e., 23(52%) and 12(27%) were below 10 years. This survey showed that 42(95%) of our selected candidates have Normal BMI while 2(4.5%) of our candidates fall in Overweight (High BMI) category. Conclusion: Most of our selected Down syndrome individuals are protected from obesity as they indulge in different sports, physical activities, physiotherapy and maintain a balanced diet. It is therefore recommended to emphasize the importance of physical activities, active participation in sports, gymnastics, regular exercises and maintaining a healthy diet plan to avoid obesity in these individuals so that further complications of obesity can be prevented thus improving the quality of life of these individuals. Keywords: Body Mass Index, Down Syndrome, Obesity
Background: Down syndrome are slow learners having mild to moderate intellectual disability with co-morbidities, we need to pay special attention on conservative management techniques like early intervention programs, speech therapies, physiotherapies, exercises, sports, schooling and education etc. to make these children intellectual compatible for a normal life. Aim: To identify the conservative management techniques for improving the quality of life for down syndromes. Methodology: A descriptive cross-sectional survey (designed after literature search) was conducted from the parents of Down Syndromes at special children’s schools in Islamabad and Rawalpindi according to inclusion criteria i.e., school going down syndromes and residents of Islamabad and Rawalpindi, in an interactive counselling session conducted by authors in collaboration with pediatrician, keeping the questionnaire anonymous. Results: For the management of Down Syndromes, out of 44 parents, 36(81.8%) agreed on home based teaching, 34(77.3%) agreed on exercise, gym and sports for down syndromes. Around 38(86.4%) agreed on speech therapy and social interactions, 31(70.5%) parents agreed on controlled and healthy diet and 34(77.3%) parents said brain storming and learning new things should be in practice for down syndromes. Conclusion: Down syndrome is a complex condition requiring a multi-disciplinary team of professionals to manage the myriad of problems faced by the patients. Aside from these, a vital role is played by parents, teachers & the community itself in taking care of these special individuals. Also, Down syndrome is characterized by learning disabilities as its hallmark feature but their learning abilities can be improved through certain conservative management techniques. Keywords: Down Syndrome, School, Exercise
Background. There is limited published literature on the feasibility of WHO 2009 guidelines for the management of dengue fever (DF) in Pakistani children. This study aimed to assess the outcome of children with DF who received outpatient treatment according to these guidelines during a DF epidemic. Method. This was a prospective cohort study conducted at Federal General Hospital, a secondary care hospital, Islamabad, Pakistan, from 1st August to 31st October 2019. Using WHO DF 2009 guidelines, children ≤13 years, diagnosed as confirmed DF (NS1 Ag +), were classified into the outpatient (DF) or the inpatient group (DF with warning signs or severe dengue (SD)). The inpatient group was admitted to the Pakistan Institute of Medical Sciences, a tertiary care hospital, and discharged on recovery. These children were followed for the primary outcome, i.e., recovery or hospitalization by day 14 of enrollment. Additionally, clinical and laboratory features (Hb, HCT, TLC, PLT, and ALT) of the patients in the outpatient who remained stable with those who progressed to inpatient care during follow-up were compared; also, time of recovery of blood counts was assessed. Results. Of 93 children with DF, 87 (93.5%) received outpatient care at enrollment. Of these, 6 (7.8%) deteriorated by day 7 and were admitted to inpatient care. SD was present in 6/93 (6.4%) patients at presentation and were admitted. All children showed signs of recovery until day 14. Male gender ( p = 0.049 ), lower normal mean platelet ( p = 0.02 ), and high mean hematocrit ( p = 0.001 ) were associated with disease progression. Conclusion. The majority of children with confirmed DF who received outpatient treatment according to WHO 2009 guidelines were successfully managed. Additionally, confirmed DF with warning signs or SD were admitted and recovered. Regular follow-ups according to the guidelines are pertinent. Thrombocytopenia and high HCT were associated with disease progression.
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