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Background: Patients with cystic fibrosis (CF) who have recurrent bacterial lung infections eventually develop respiratory incompetency, which increases morbidity and death. It's important to treat these patients promptly to achieve positive results. Objective: To explore the Antimicrobial sensitivity pattern of pediatric cystic fibrosis patients. Methodology: This observational study was conducted form April 2022 to September 2022 at the Department of Paediatric Medicine, Qazi Hussain Ahmad Medical Complex, Nowshera, Pakistan. The health status of the pediatric CF patients, extensive evaluations were conducted as part of the diagnostic evaluation and data gathering procedure for this study. Physical examination and laboratory testing like culture and sensitivity were performed. To evaluate the antimicrobial sensitivity pattern Kirby Bauer modified disc diffusion method was used. Version 26 of the SPSS software was used to carry out the statistical analysis. The p-value level of 0.05 has been defined as a measure of statistical significance. Results: A total of 84 children with CF symptoms were included in the research. Of these patients, there were 28 females (33.3%) and 56 boys (66.6%). Among the respiratory samples taken from pediatric CF patients, the most prevalent isolated bacteria was Pseudomonas aeruginosa (36%) followed by Klebsiella pneumonia (22.9%). Among all bacterial strains, Ciprofloxacin and Levofloxacin had the highest levels of antimicrobial sensitivity, whereas Amoxicillin, Erythromycin, and Rifampicin shown significant resistance. Conclusion: Our study concludes that the P. aeruginosa was the most prevalent isolated bacteria followed by Klebsiella pneumonia in patients with cystic fibrosis. The most effective antimicrobial agents in our study were ciprofloxacin and levofloxacin. [ABSTRACT FROM AUTHOR]

Background: Asthma poses a substantial worldwide health issue, particularly during childhood, where it stands as the most common chronic condition. Pulmonary function tests (PFT) have been designed to assess children's tidal breathing may have limited cooperation due to their age or respiratory condition. Objective: The present study aimed to assess the pulmonary function in pediatric emergency department patients, experiencing acute wheezing/asthma exacerbation. Methodology: This prospective observational study investigated 52 acute wheezing/ asthma exacerbation in Emergency Department of Children Hospital, Lahore from November 2020 to October 2021. All the patients with age range 2-16 years presented with wheezing or asthma exacerbation as a chief compliant were enrolled. Pulmonary function tests were conducted initially, before initiating the standard care treatment (specifically, protocol- driven care for patients with asthma). The primary metrics evaluated included the feasibility of testing, patient compliance, and the tests' ability to predict whether the patient should be admitted to the hospital or discharged. Results: Of the total 52 patients, there were 33 (63.5%) male and 19 (36.5%) females. The overall mean age was 8.8±4.7 years. The incidence of mild, moderate, and severe asthma patients were 53.8% (n=28), 28.8% (n=15), and 17.3% (n=9) respectively. Admitted patients exhibited elevated heart rates, higher phase angle, labored breathing index, and asthma score. Bases on prior history of patients, asthma/wheezing, allergic rhinitis, eczema, and smoke exposure was found in 18 (34.6%), 14 (26.9%), 9 (17.3%), and 4 (7.7%) respectively. Among 52 patients, the admitted and discharged patients were 19 (36.5%) and 33 (63.5%) respectively. Conclusion: The current study endorsed the use of Pulmonary Function Tests (PFTs) as an objective assessment tool for evaluating the asthma/wheezing severity and exacerbation in an Emergency Department. [ABSTRACT FROM AUTHOR]

A high prevalence of multidrug-resistant (MDR) pathogens has been reported in adult and pediatric populations of Pakistan. However, data describing the effect of MDR microbes on the gut microbiota is scarce. We designed a cross-sectional pediatric study to investigate the effect of MDR microbes' infection on the gut microbiome and its resistome of children using high-throughput next-generation sequencing (NGS). A cross-sectional study was conducted at a tertiary health care hospital in Peshawar Pakistan, between 5 September 2019 to 15 February 2020. Pediatric patients with acute gastroenteritis (n = 200) were enrolled. All the enrolled pediatric patients underwent initial antimicrobial resistance (AMR) screening using the disk diffusion method. Children with MDR infections were identified and selected for gut microbiome and its resistome profiling using NGS. Out of 200 enrolled pediatric patients, 80 (40%) were found infected with MDR diarrheagenic Enterobacteriaceae consisting of 50 (62.5%) infections caused by extended-spectrum beta-lactamase (ESBL) producing E. coli while 30 (37.5%) by MDR Enterobacter specie. A total of 63 and 17 antibiotic-resistant genes (ARGs) conferring resistance to 7 and 5 classes of antibiotics were identified in the resistomes of MDR diarrheagenic Enterobacteriaceae infected and healthy children, respectively. NGS-based gut microbial profiling of MDR Enterobacter spp., ESBL producing E. coli infected pediatric patients and healthy controls revealed the predominance of Proteobacteria and Actinobacteria, respectively. An increased abundance of several pathogenic gram-negative bacteria namely E. coli, Enterobacter cloacae, and Salmonella enterica was observed in the gut microbiota of children infected with MDR bacterial infections than that of the healthy controls. This work indicates that children with MDR infections have reduced microbial diversity and enriched ARGs than healthy controls. The emergence of MDR bacterial strains and their association with gut dysbiosis needs immediate attention to regulate antibiotics usage in Pakistani children. [ABSTRACT FROM AUTHOR]

Background: The rise of Multidrug-resistant organisms (MDROs) poses a considerable burden on the healthcare systems, particularly in low-middle income countries like Pakistan. There is a scarcity of data on the carriage of MDRO particularly in the pediatrics population therefore, we aimed to determine MDRO carriage in pediatric patients at the time of admission to a tertiary care hospital in Karachi, Pakistan, and to identify the risk factors associated with it.Methods: A cross-sectional study conducted at the pediatric department of Aga Khan University Hospital (AKUH) from May to September 2019 on 347 children aged 1-18 years. For identification of MDRO (i.e., Extended Spectrum Beta-Lactamase (ESBL) producers, Carbapenem Resistant Enterobacteriaceae (CRE), Vancomycin Resistant Enterococci (VRE), Methicillin Resistant Staphylococcus aureus (MRSA), Multidrug-resistant (MDR) Acinetobacter species and MDR Pseudomonas aeruginosa), nasal swabs and rectal swabs or stool samples were cultured on specific media within 72 h of hospitalization. Data was collected on a predesigned structured questionnaire on demographics, prior use of antibiotics for > 48 h in the last 6 months, history of vaccination in last 6 months, exposure to health care facility regardless of the time of exposure, ICU stay for > 72 h, and about the prior use of medical devices (urinary catheter, central venous lines etc.) in last 1 year. Statistical analysis was performed by Standard statistical software.Results: Out of 347 participants, 237 (68.3%) were found to be MDRO carriers. Forty nine nasal swabs from 346 children (14.2%) showed growth of MRSA. The majority of the stool/rectal swabs (n = 222 of 322; 69%) collected were positive for MDRO. The most isolated species were ESBL Escherichia coli 174/222 (78.3%) followed by ESBL Enterobacter species 37/222 (16.7%) and ESBL Klebsiella pneumoniae 35/222 (15.8%). On univariate analysis, none of the risk factors showed statistically significant association with MDRO carriage.Conclusion: Overall, a high prevalence of MDRO carriage was identified among admitted pediatric patients. Implementation of systematic screening may help to identify true burden of MDROs carriage in the health care settings. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the levels of N-terminal pro-B-type Natriuretic Peptide in infants and children with non-cardiac diseases especially respiratory diseases. Study Design: Cross-sectional study. Place and Duration of Study: Department of Chemical Pathology/Biochemistry Laboratory Services of Liaquat National Hospital Karachi Pakistan, from Dec 2018 to Nov 2019. Methodology: Infants and children admitted to the Pediatric department with non-cardiac diseases were included in the study. Non-probability consecutive sampling was done. Blood was taken and analyzed for N- terminal pro-B-type Natriuretic Peptide, Troponin I, urea, creatinine, Lactate dehydrogenase, Creatinine Kinase, lactate and sodium analysis. Results: Out of the 93 patients, 74 (80%) were diagnosed with respiratory disorders, with bronchopneumonia making up 54 (59%) Bronchiolitis 15 (17%) and 4% had miscellaneous respiratory diseases. Out of the remaining 20%, 8 (9%) patients were diagnosed with sepsis, and the remaining 11% were diagnosed with miscellaneous diseases. There was a positive correlation of N- terminal pro-B-type Natriuretic Peptide with Troponin I, urea, creatinine, Creatinine Kinase and Lactate dehydrogenase levels (p<0.05). Conclusion: N- terminal pro-B-type Natriuretic Peptide levels were found to be raised in pediatric patients with non-cardiac diseases especially broncho-pneumonia and in future it may be used as a marker of bronchopneumonia in children. [ABSTRACT FROM AUTHOR]

Background: Ventricular septal defects (VSDs) are malformations in the septum separating the heart's ventricles. VSDs may present as a single anomaly (isolated/nonsyndromic VSD) or as part of a group of phenotypes (syndromic VSD). The exact location of the defect is crucial in linking the defect to the underlying genetic cause. The number of children visiting cardiac surgery units is constantly increasing. However, there are no representative data available on the genetics of VSDs in Pakistani children. Methods: Two hundred forty-two subjects (121 VSD children and 121 healthy controls) were recruited from pediatric cardiac units of Lahore. The clinical and demographic data of the subjects were collected. A total of four SNPs, one each from MTRR, GATA4, VEGF, and ISL1 genes were genotyped by PCR-RFLP. Results: The results showed that the minor allele (T) frequency (MAFs) for the MTRR gene variant rs1532268 (c.524C > T) was 0.20 and 0.41 in the controls and the cases, respectively, with the genotype frequencies 3, 35, 62% in the controls and 12, 59 and 29% in the cases for TT, CT, CC genotypes, respectively (allelic OR: 5.73, CI: 3.82–8.61, p-value: 5.11 × 10− 7). For the GATA4 variant rs104894073 (c.886G > A), the MAF for the controls and the cases was 0.16 and 0.37, respectively, the frequencies of AA, GA and GG genotypes were 2, 28, and 70% in the controls and 5, 64 and 31% of the cases (allelic OR: 3.08, CI: 2.00–4.74, p-value: 8.36 × 10− 8). The rs699947 (c.-2578C > A) of VEGF gene showed MAF 0.36 and 0.53 for the controls and cases, respectively, with the genotype frequencies 13, 42, and 45% in the controls and 22, 15, and 63% in the cases for the AA, CA, CC (allelic OR: 2.03, CI: 1.41–2.92, p-value: 0.0001). The ISL1 gene variant rs6867206 (g.51356860 T > C), the MAFs were 0.26 and 0.31 in the controls and cases, respectively. The genotype frequencies were 48, 52, 0% in the controls and 39, 61, 0% in the cases for TT, TC, CC genotypes (allelic OR: 0.27, CI: 0.85–1.89, p-value: 0.227). The MTRR, GATA4 and VEGF variants showed association while ISL1 variant did not appear to be associated with the VSD in the recruited cohort. Conclusion: This first report in Pakistani children demonstrates that single nucleotide polymorphisms in genes encoding transcription factors, signaling molecules and structural heart genes involved in fetal heart development are associated with developmental heart defects., however further work is needed to validate the results of the current investigation. [ABSTRACT FROM AUTHOR]

Objective: To compare the post-operative pain relief with Bupivacaine and Ropivacaine for caudal block in children in terms of mean duration of analgesia. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anaesthesia, Combined Military Hospital, Rawlakot Pakistan, from Jul 2021 to Jun 2022. Methodology: Hundred patients undergoing infra-umbilical surgery, such as circumcision, herniotomy, and orchidopexy of age 1-10 years, were included. After induction of general anaesthesia, a caudal block was given. Group-B patients were given 1 ml/kg of 0.25% Bupivacaine, whereas Group-R patients were given 1ml/kg of 0.25% Ropivacaine. Modified Hnnallah Pain Score was used to observe the post-operative analgesic effects of the block. The score was noted every 30 minutes. The painfree duration was considered from the time of the caudal block till the modified Hannallah pain score of 4 or more. Injectable Paracetamol 10mg/kg was given as rescue analgesia as required. Results: Demographic data was comparable in both groups with no statistical significance. In our study, we have found the duration of analgesia as 219.78±35.42 minutes in the Bupivacaine-Group compared with 198.24±34.5 minutes in patients in the Ropivacaine-Group (p-value of 0.54). Conclusion: Ropivacaine is as effective as Bupivacaine regarding post-operative pain relief for caudal block in children. [ABSTRACT FROM AUTHOR]