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Objectives: This cross-sectional study aimed to evaluate the association between the vasoactive-inotropic score (VIS) and post-operative morbidity and mortality in pediatric patients undergoing cardiac surgery for congenital heart diseases (CHDs). Methodology: A cross-sectional study was conducted at the Pediatric Cardiac Intensive Care Unit (PCICU) of the National Institute of Cardiovascular Diseases, Karachi, Pakistan, between October 2021 and March 2022. A total of 101 children up to 18 years of age admitted to the PCICU were included in the analysis. Demographic characteristics and peri-operative variables were recorded, and VIS scores were collected to assess their association with post-surgery outcomes. A score of ≥15 was considered high, while a score <15 was considered low. Results: Among the 101 children included in the study, 49 (48.5%) were male and 52 (51.5%) were female, with a mean age of 7.45±2.81 years. Fifteen (14.9%) patients had a high VIS score during their ICU stay, while 86 patients had a low VIS score. Low cardiac output was the most common post-operative morbidity observed in 9 (8.9%) children, followed by hepatic dysfunction and acute kidney injury, each reported in 8 (7.9%) children. Significant associations were found between high VIS and hepatic dysfunction (p<0.001), acute kidney injury (p<0.001), low cardiac output (p<0.001), neurological dysfunction (p=0.016), and mortality (p<0.001). Conclusion: High VIS scores were significantly associated with poor short-term morbidity and mortality in children undergoing corrective surgery for CHDs. The VIS system can aid in predicting disease progression, severity, and outcomes in pediatric cardiac surgical patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and risk factors for prolonged mechanical ventilation (PMV) in patients with CHDs undergoing cardiac surgery at a tertiary care center of Karachi, Pakistan. Study Design: Cross-sectional study. Setting: Paediatric Cardiac Intensive Care Unit (PCICU) at National Institute of Cardiovascular Diseases, Karachi, Pakistan. Period: July 2022 to June 2023. Material & Methods: We analyzed patients who underwent open or closed heart surgery for CHDs. PMV was defined as duration of mechanical ventilation > 72 hours from the time of arrival to PCICU until extubation after cardiac surgery. Peri-operative factors were noted and their association with PMV was documented. Results: In a total of 184 patients who underwent surgeries for CHD, 105 (57.1%) were male while the overall mean age was 7.23±6.49 years. Post-surgery, PMV was documented in 17 (9.2%) patients. PMV was significantly associated with age (p=0.001), weight (p<0.001), cyanosis (p=0.005), TAPSE (p=0.011), and CPB time (p=0.003). Post-surgery, PMV was linked with metabolic acidosis (p=0.003), lactate (p=0.001), AVDO2 (p<0.001), inotropic score (p=0.002), low cardiac output (p=0.005), LV dysfunction (p<0.001), acute kidney injury (p=0.002), sepsis (p<0.001), pneumonia (p=0.004), mortality (p=0.045), and PCICU stay (p<0.001). Conclusion: PMV was documented in 9.2% patients who underwent CHD repair. Age, weight, cyanosis, TAPSE, CPB time, metabolic acidosis, lactate, AVDO2, inotropic score, low cardiac output, LV dysfunction, acute kidney injury, sepsis, and pneumonia were noted to be significant risk factors for PMV. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence and risk factors associated with acute kidney injury (AKI) in children with congenital heart diseases (CHDs) who underwent cardiac surgery in a tertiary care center. Study Design: Crosssectional study. Setting: Paediatric Cardiac Intensive Care Unit (PCICU) of National Institute of Cardiovascular diseases, Karachi, Pakistan. Period: November 2022 to May 2023. Material & Methods: We included patients of both genders and any age who underwent open or closed heart surgery for congenital heart defects. All patients undergoing CHD repairs were monitored for the total duration of PCICU stay. The development of AKI was labeled as per RIFLE criteria, and management thereafter was performed as per standard institutional protocols. Results: In a total of 93 patients with CHD, there were 50 (53.8%) males and 43 (46.2%) females. The mean age was 9.71±9.14 year ranging between 3 months to 60 years. There were 6 (6.5%) patients who developed AKI post-surgery. Overall, mortality was noted in 7 (7.5%) patients. Cardiopulmonary bypass (CPB) time and aortic cross-clamp (ACC) time were significantly higher among patients who developed post-surgery AKI (<0.001). Moreover, post-surgery AKI was significantly associated with intra-operative hypotension (p<0.001), postoperative hypotension (p<0.001), and post-operative sepsis (p<0.001). It was also found that AKI had significant association with higher post-operative inotropic scores (p<0.001), prolonged duration of mechanical ventilation (p<0.001), and length of PCICU stay (p<0.001). Mortality had significant association with AKI (33.3% vs. 5.7%, p=0.013). Conclusion: We noted the incidence of AKI among patient who underwent cardiac repairs to be 6.5%. CPB time and ACC time were significantly higher among patients who developed post-surgery AKI. Post-surgery AKI was significantly associated with intra-operative hypotension, post-operative hypotension, and post-operative sepsis. Mortality was significant high among cases that had AKI. [ABSTRACT FROM AUTHOR]

Objective: To note the factors linked with delayed diagnosis of congenital heart diseases (CHDs) among children. Study Design: Cross-sectional study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan. Period: September 2022 to February 2023. Material & Methods: We analyzed children aged up to 15 years who presented for the first time with echocardiographic evidence for the diagnosis of CHDs. Socio-demographic data along with clinical information like gender, age, residential status, maternal education status, history of maternal fetal echocardiography and the frequency of delayed diagnosis of CHDs were noted on a specially made proforma. Parent or guardians were asked for possible reasons of delayed diagnosis for CHDs. Results: In a total of 250 children, the mean age was 2.33±3.81 years while 162 (64.8%) children were aged below 2 years. There were 138 (55.2%) boys. Residential status of 159 (63.6%) children was rural while maternal educational status of 99 (39.6%) was illiterate. There were 164 (65.6%) children who were diagnosed to have cyanotic CHDs while 86 (34.4%) had acyanotic CHDs. Frequency of delayed diagnosis was noted among 182 (72.8%) children. In these 182 cases, delayed first consultation was the commonest factor behind delayed diagnosis noted in 78 (42.9%) children while missed diagnosis by the pediatrician was the 2nd most common factors linked with the delayed diagnosis of CHDs as described by 62 (34.1%) parents. Conclusion: Almost 3/4th of the studied children had delayed diagnosis of CHDs while cyanotic CHDs were the most common CHD types. Delayed first consultant and missed diagnosis by the pediatrician were the most common factors linked with delayed diagnosis of CHDs. [ABSTRACT FROM AUTHOR]

Objective: To determine the neurological consequences and short–term outcome of children with diagnosis of cyanotic congenital heart diseases (CHDs) at a tertiary care cardiac setup of Pakistan. Study Design: Single Center Observational Cohort study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Period: November 2021 to October 2022. Material & Methods: A total of 80 children of both genders, aged between 1 month to 12 years with known cyanotic CHD as per 2D transthoracic echocardiography were admitted in Pediatric Cardiology Department of NICVD, Karachi and were considered. At the time of enrollment, demographic characteristics along with presenting complaints were noted. Necessary baseline laboratory and radiological investigations were ordered and clinical neurological examination was done. Children were discharged and short term outcomes were labeled after 3 months follow up. Results: In a total of 80 children with cyanotic CHDs, most common underlying diagnosis was tetralogy of fallot, found in 41 (51.3%) children. The CT brain revealed ischemic infarct, brain abscess and gross oedema as the most frequent observations revealed in 47 (58.8%), 40 (50.0%) and 37 (46.3%) children. Surgical management of underlying neurological abnormality was advised in 23 (28.8%) children. After 3 months follow-up, complete recovery was observed among 43 (53.8%) children. CT findings at the time of enrollment as haemorrhagic infarct (p<0.001), brain abscess (p=0.001) and atrophic changes (p=0.032) were significantly associated with incomplete recovery. Surgery as a mode of treatment for the underlying neurological disease was associated with good recovery outcomes (p<0.001). Conclusion: Most common underlying diagnosis among children with cyanotic CHDs was tetralogy of fallot. CT findings at the time of enrollment as haemorrhagic infarct, brain abscess and atrophic changes, as well as hypotonia, down going plantars and developmental delay at the time of presentation were significantly linked with incomplete recovery. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical features and echocardiographic findings among children presenting with Ebstein's anomaly (EA). Study Design: Descriptive Case-series. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi Pakistan. Period: July 2021 to June 2022. Material & Methods: Children of both genders aged above 1 month up to 18 years, having echocardiographic confirmed EA were analyzed. Demographic data along with clinical features, presenting symptoms and echocardiographic findings were noted in all case. Results: In a total of 48 cases of EA, 38 (79.2%) were female. The mean age was 8.4±4.21 years. Cyanosis, exertional dyspnea, easy fatigue ability and exercise intolerance were the most frequent symptoms reported in 31 (64.6%), 27 (56.3%), 26 (54.2%) and 24 (50.0%) patients respectively. Arrhythmias and heart failure were the most frequent clinical features noted in 29 (60.4%) patients each. Small atrial septal defect (ASD) was noted in 27 (56.3%) patients while ventricular septal defect in 19 (39.6%) cases. There were 11 (22.9%) patients who presented timely with diagnosis of EA while 37 (77.1%) patients had late diagnosis. Conclusion: Majority of the patients with Ebstein's anomaly were female. Cyanosis, exertional dyspnea, easy fatigue ability and exercise intolerance were the most frequent symptoms whereas arrhythmias and heart failure were the most frequent clinical features observed. ASD was the most commonly noted associated CHDs observed in almost half of the Ebstein's anomaly case. Almost 3/4th of the patients had late diagnosis. [ABSTRACT FROM AUTHOR]

Introduction The prevalence of persistent pulmonary hypertension of newborn (PPHN) has been estimated 1.9/1000 live births. Although the efficacy of inhaled nitric oxide and extracorporeal membrane oxygenation in PPHN is well established but it is difficult to administer and monitor in resource limited countries. Owing to this, other treatment options need to be evaluated. Method This is a prospective observational study conducted in the Pediatric Cardiology Department, NICVD, Karachi, from February 2020 to October 2020 after the approval from the Institutional Ethical Review Committee. All the neonates referred to our Unit were screened by echocardiography (echo) and those who fulfilled the inclusion criteria were included. Echo were done before starting sildenafil and after 72 h to assess the pressure gradient across tricuspid valve and right to left or bidirectional shunt across patent ductus arteriosus, patent foramen ovale, or both. Sildenafil was started with a dose of 1 mg/kg/dose thrice a day and increased to 2 mg/kg/dose after 48 h if partial pressure of oxygen (PO1] did not increase. In neonates who did not respond to increased dose of Sildenafil were added on oral Bosentan 1 mg/kg/dose twice a day. Results Total 82 newborns were enrolled. Fifty-two patients improved after 48 h so were continued on same treatment. Sildenafil dose was increased in 30 (37.9%) patients whose PO2 did not increase to at least 10% from baseline after 48 h of starting treatment. Three patients expired within 48–72 h. Out of 27 remaining patients, only four responded whereas 23 patients did not show any improvement. In these patients, Bosentan was supplemented along with sildenafil. Conclusion The results of our study show effectiveness of oral Sildenafil in treating PPHN. The overall improvement observed in the patients was overwhelming. Combination of Sildenafil with Bosentan is beneficial in patients who did not respond on Sildenafil alone. [ABSTRACT FROM AUTHOR]

Objective: To find out echocardiographic findings in patients with tetralogy of Fallot (TOF) prior to total corrective surgery admitted at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease, Karachi. Period: January 2021 to December 2021. Material & Methods: A total of 197 echocardiography confirmed TOF cases of both genders and age up to any years were included. Physical examination, chest radiography and electrocardiogram were done in each patient prior to transthoracic echocardiography (TTE) using Toshiba Aplio i600 using 5 Hz and 6 Hz transducers. Standard protocols were followed in all TTE procedures. Results: In a total of 197 patients with TOF, there were 121 (61.4%) male. Mean age was 8.36±10.12 years. Hypoplastic pulmonary arteries was the most frequent pulmonary artery abnormality observed in 30 (15.2%) cases. Thickened and domed pulmonic valve was the most common pulmonary valvular anomaly noted in 89 (45.2%). Associated "atrial septal defect (ASD)" was observed in 47 (23.9%) cases while "patent ductus arteriosus (PDA)" was seen in 83 (42.1%) patients. History of past "Blalock and Taussig (BT) Shunt" performed was found in 20 (10.2%) cases, out of which, 15 were functioning. Conclusion: Echocardiography is an inexpensive and safe approach to cardiac evaluation among patients of tetralogy of fallot. Hypoplastic pulmonary arteries was the most frequent pulmonary artery abnormality observed in tetralogy of Fallot patients. PDA was the most frequent associated abnormality followed by associated ASD. [ABSTRACT FROM AUTHOR]

Objective: The aim behind this study was to determine the frequency of visual field and visual acuity disturbances before resection and improvement after resection of pituitary tumors in patients. Study Design: Observational study. Setting: Neurosurgery Department of Jinnah Post Graduate Medical Center, Karachi. Period: August 2015 to August 2016. Material & Methods: A total of 30 patients presented with headache and visual deterioration and diagnosed as pituitary adenoma at neurosurgery OPD, ward and ER were included through a consecutive purposive sampling technique. The detailed visual and ocular analysis (visual acuity, visual field, and extra ocular movements) carried out at time of admission and postoperatively. Tumor was removed by consultant neurosurgeon through trans-sphenoidal approach. SPSS version 17.0 was used to analyze the collected data. Results: A total of 30 cases of pituitary adenoma were included. The average age of the patients was 34.5 ± 10.8 years and among them 17 (56.7%) were males and 13 (43.3%) were females. Pre-operative assessment of the mean deviation of visual function was -8.21 ± 6.10 dB which is significantly improved to -4.6 ± 3.9 dB post-operatively (P < 0.0001). While pre-operative Visual Acuity (logMAR) was 0.3 ± 0.26 and post-operative 0.21 ± 0.2 (P <0.0001). Conclusion: Scientific observation from our study has shown that more than 90% of the patients suffering from pituitary adenomas experience visual impairment which can be improved to significant extent if treated with trans-sphenoidal surgical resection of the tumor. [ABSTRACT FROM AUTHOR]

Pakistan is a patriarchal culture in which men have the most power and women are seen as second-class citizens. This has major ramifications for both women and men's lives. The goal was to investigate contemporary gender roles in urban Pakistan, as well as how they are reproduced and perpetuated, and how they affect men's and women's lives. It was also said that the younger age was more supportive of gender norms being modernised than the older generation. In Pakistani society, there are substantial gender inequities and human rights abuses against women, according to this report. The uneven gender roles were seen as permanent and imposed by societal systems. Women were frequently subjected to severe restrictions and constraints on their liberty. Higher levels of education, on the other hand, were seen as a catalyst for change, not only for women but also for males. Furthermore, the media was seen to play a good role in promoting women's empowerment. COVID-19 has a negative influence on employee performance and increases the risk of making a mistake. It's all about figuring out if there's a link between employee support and corporate success on a large scale. Let's look at the differences between workplace justice and job fairness. For this study, a convenience poll of 100 gender based employees was defined and chosen. The surveys were kept open-ended to stimulate responses. A Pseudo-Differential Templating Method was employed to analyse a subset of the replies. Employee morale rises during periods of high cash flow, since COVID-19 views this as delivering additional resources to employees rather than laying the groundwork for their positions. [ABSTRACT FROM AUTHOR]

Objective: To find out the mode of presentation and severity of cardiac involvement in children presented with established rheumatic heart diseases (RHD) at first presentation at a tertiary care setup. Study Design: Cross-sectional study. Place and Duration of the Study: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease, Karachi Pakistan, from Jul 2020 to Jun 2021. Methodology: One hundred seven children of genders aged 3 to 18 with a confirmed diagnosis of RHD were included. Demographic features, chief presenting complaints, possible reasons for late presentation, and echocardiographic findings were noted. Results: In 107 patients with RHD, 63(58.9%) were male. The sensation of the rapid pounding of heartbeat (palpitation) was observed among 72(67.3%) children, while a similar number of cases, 72(67.3%), presented with breathlessness. There were 33(30.8%) children who were diagnosed for the first time with RHD. The most common reason for late diagnosis was socio-economic factors in children (18, 26.1%). Primary prophylaxis for acute rheumatic fever (ARF)/RHD was noted to be given in 11(10.3%) patients. Mitral regurgitation was the most common echocardiographic finding in 103(96.3%), followed by aortic regurgitation in 99(92.5%). Conclusion: The majority of children with RHD are diagnosed late, which exposes them to an increased risk of undiagnosed valvular disorders. Palpitation, orthopnea and breathlessness were RHD most frequent presenting clinical features. Mitral regurgitation and aortic regurgitation were the most common echocardiographic findings. [ABSTRACT FROM AUTHOR]

Objectives: To determine clinical, laboratory features and outcomes of Multisystem Inflammatory Syndrome in children (MIS-C) and its comparison with historic Kawasaki Disease (KD) and Viral Myocarditis (VM) cohorts. Methods: All children (1 month– 18 years) who fulfilled the World Health Organization criteria of MIS-C presenting to two tertiary care centers in Karachi from May 2020 till August 31st were included. KD and VM admitted to one of the study centers in the last five years prior to this pandemic, was compared to MIS-C. Results: Thirty children with median age of 24 (interquartile range (IQR)1–192) months met the criteria for MIS-C. Three phenotypes were identified, 12 patients (40%) with KD, ten (33%) VM and eight (26%) had features of TSS. Echocardiography showed coronary involvement in 10 (33%), and moderate to severe Left Ventricular dysfunction in 10 (33%) patients. Steroids and intravenous immunoglobulins (IVIG) were administered to 24 (80%) and 12 (41%) patients respectively while 7 (23%) received both. Overall, 20% children expired. During the last five years, 30 and 47 children were diagnosed with KD and VM, respectively. Their comparison with MIS-C group showed lymphopenia, thrombocytosis, and higher CRP as well as more frequent atypical presentation in MIS-C KD group with less coronary involvement. The MIS-C VM was more likely to present with fulminant myocarditis. Conclusions: Our MIS-C cohort is younger with higher mortality compared to previous reports. MIS-C is distinct from historic cohorts of KD and VM in both in clinical features and outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This was conducted to determine frequency of various refractive errors with types of strabismus among the age group of 5-15 years children visited in the tertiary eye care hospital Gadap town, Karachi. Study Design: Cross Sectional Analytical Study. Setting: Al-Ibrahim Eye Hospital. Period: May 2019 to November 2019. Material & Methods: This study was conducted on 300 strabismic subjects with a mean age of 5 to 15 years by non-probability convenience sampling. All respondents underwent visual acuity assessment by Snellen chart with and without correction, pinhole method, and fundus examination by retinoscope, Cardiff card, cover/uncover test, cycloplegic refraction by cyclopentolate 1%, and ocular movement examination. Results: Out of 300 patients, 43(14.3%) subjects were diagnosed as strabismus with refractive error. 20(46.5%) were boys, while 23(53.5%) were girls with a mean age of 9.62 ± 3.1. The hyperopic 20(46.5 %), 17(39.6 %) myopic, and 6(13.9%) had astigmatism. Conclusion: Strabismus was more frequently observed in females than in males. Hyperopia was in Strabismic respondents than myopic and astigmatism. The esotropia was commonly seen in hypermetropia, Exotropia, in Myopia. The vertical and alternate not frequently seen are these respondents. Hence it is necessary to diagnose the children as early as possible to prevent them from other ocular manifestations. [ABSTRACT FROM AUTHOR]

BACKGROUND & OBJECTIVE: To assess the results of pallidotomy in Parkinson's disease, and its effect on improving the lifestyle of the patients and cost-effectiveness. METHODOLOGY: A descriptive study was conducted at Neuro-Spinal & Cancer Care Institute, Karachi from June 2014 to January 2020. Patients who were known case of Parkinson's disease refractory to medication and developed side effects to medication were included in the study and patients withprevious brain surgery, associated brain disorders like Alzheimer's disease, basal ganglia lesion, brain trauma were excluded. All patients were treated by pallidotomy on the contralateral side. The significance of the difference between groups to compare between the pre-op or post-op treatments was calculated through non-parametric assessment Kruskal-Wallis tests. RESULTS: The mean age of the patients was around 57 years. There were 34(81%) male and 8(19%) female patients' Maximum number of patients who were more than 45 years, were having a left-sided proportion. More male patients were having a left-sided proportion as compared to female patients. The majority of patients (57.5%) were having dyskinesia as q primary symptom. A significant difference (p-value<0.001) existed in pre & post-operative UPDRS-III scores. A significant difference (p-value<0.001) also existed between on & off medications UPDRS-III (pre-op/post-op) scores. CONCLUSION: The result of pallidotomy is promising especially for unilateral pallidotomy to minimize the risk of cognition and speech disorder and long-term follow-up is needed to prove the statement further. Currently, pallidotomy is associated with minimal complications, more effective, and improving the quality of life of Parkinsonian patients. [ABSTRACT FROM AUTHOR]

Objective: to find out the impact of cardiopulmonary bypass time (CPBT) and aortic cross-clamp time (ACCT) on immediate post-operative outcomes in patients with congenital heart disease (CHD) undergoing open heart surgery at a tertiary care centre. Study Design: Prospective longitudinal study. Place and Duration of the Study: Department of Paediatric, Cardiac Intensive Care Unit, National Institute of Cardiovascular Diseases (NICVD), Karachi Pakistan, from Jul to Dec 2021. Methodology: We enrolled 104 patients of both genders up to any age with CHD undergoing open heart surgeries. At the time of admission, age, gender, body weight, presence of cyanosis and types of CHDs were noted. Duration of mechanical ventilation, pediatric cardiac intensive care unit (PCICU) stay, and mortality was recorded. Baseline characteristics and pos t-surgery parameters were compared about CPBT and ACCT. Results: Of 104 patients, 58(55.8%) were males. Overall, the mean age was 7.9±5.1 years. Cyanosis was noted in 34(32.7%) cases. Mean CPBT was 74.6±42.9 minutes, while the mean ACCT was 43.5±29.5 minutes. Most types of CHDs were noted to be tetralogy of Fallot (ToF) 28(26.9%). An increase in the duration of CPBT and ACCT was found to have a significant association with post-surgical morbidity (p<0.001). Conclusion: Increased cardiopulmonary bypass time and aortic cross-clamp time were found to have a significant association with post-surgical morbidity and outcomes among cases undergoing open heart surgeries for congenital heart diseases. [ABSTRACT FROM AUTHOR]

Introduction: Prolonged rupture of membrane (PROM) is an important risk factor for early onset neonatal sepsis (EONS), which is associated with increased neonatal morbidity and mortality. We reported the incidence and associated risk factors of PROM for culture-proven EONS. Methodology:The medical records of all neonates born at Aga Khan University, Karachi over a period of five years (2007-2011) with PROM (> 18 hours) were reviewed. Data about maternal and neonatal risk factors for EONS was collected and adjusted logistic regression (AOR) analysis was applied. Results:Incidence of PROM in this neonatal birth cohort was 27/1,000 live births. A total of 17 (4%) cases with blood-culture proven bacterial sepsis were identified within 72 hours of birth. Klebsiella pneumonia (n = 5; 29%) and Pseudomonas aeruginosa (n = 4; 24%) were the commonest isolates followed by group B Streptococcus (n = 3; 18%) and Escherichia coli (n = 2; 12%). Maternal fever (p = <0.001; AOR, 36.6), chorioamnionitis (p < 0.001; AOR, 4.1), PROM > 48 hr. (p < 0.001; AOR, 8.2), neonatal prematurity < 34 weeks (p < 0.001; AOR, 4.1) and low birth weight < 1,500 grams (p 0.001; AOR, 9.8) along with neonatal thrombocytopenia and raised CRP were found to be independent risk factors associated with culture-proven EONS in PROM. Conclusions: Preventive measures should focus on recognition of these high-risk infants with prompt laboratory screening for sepsis and early institution of empirical antibiotic based on local data. Such approaches would be a safe and cost-effective strategy, especially in developing countries. [ABSTRACT FROM AUTHOR]

Introduction: Multidrug-resistant strains of Acinetobacter pose a serious therapeutic dilemma in hospital practice, particularly when they cause meningitis, as the few antimicrobial agents to which these isolates are susceptible have poor central nervous system (CNS) penetration. Methodology: We retrospectively reviewed the clinical course and outcome of eight consecutive cases of meningitis due to Acinetobacter spp. in children ages 15 years or less, seen in a tertiary care medical center in Karachi, Pakistan. Results: Of the eight cases of Acinetobacter meningitis, isolates from five patients were pan-resistant, and two were multidrug-resistant. A neurosurgical procedure was performed in five of eight patients followed by external ventricular drain insertion prior to the development of infection. Seven received intravenous (IV) polymyxin (mean; 12.8 days), while 5/8 also received intrathecal (IT) polymyxin (mean; 12.0 days). The mean length of hospitalization was 38.7 ± 19 days. All patients achieved cerebrospinal fluid (CSF) culture negativity by the end of treatment (mean; 5.4 days). Two patients died: one with pan-resistant Acinetobacter, and the second with a multi-drug resistant isolate. Conclusion: Post-neurosurgical multidrug-resistant and pan-resistant Acinetobacter meningitis can be successfully treated if appropriate antimicrobial therapy is instituted early. The role of IT polymyxin B administration alone versus combination therapy (IV and IT) needs further study. [ABSTRACT FROM AUTHOR]