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Objective: To assess the early complications of surfactant administration in neonates with respiratory distress syndrome. Study Design: Perspective longitudinal study. Place and Duration of Study: Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Jun to Dec 2021. Methodology: A total of 64 neonates admited in ICU with gestational age 27-32 weeks requiring Continuous Positive Airway Pressure and surfactant administration were included. Neonatal complications after 24 hours of administration of surfactant and final outcome was recorded on a predesigned data colection tool. Results: Mean duration of stay on ventilator was 41.12±8.88 hours. Mean duration for Continuous Positive Airway Pressure was 43.59±22.70 hours. Second dose of surfactant was given to 34(53.1%) of neonates. Among neonates 25% suffered from pulmonary hemorrhage and 7.8% from bradycardia, 48(75%) were discharged and 16(25%) died. Conclusion: The mortality rate decreased in neonates after administration of surfactant. In future, we wil implement surfactant in term neonates, diagnosed with Respiratory Distress Syndrome, in order to improve the survival of neonates and reduce complications. [ABSTRACT FROM AUTHOR]

Objective: Any component of the urinary system can get infected with bacteria, which is known as a urinary tract infection (UTI). It is one of the most common bacterial diseases in children. The study's objectives included identifying the clinical symptoms of UTI in children between the ages of one month and fifteen, as well as the bacteria responsible for the illness and their sensitivity to various medicines. Methods: This cross-sectional study was conducted at the CMH Rawalpindi, Pakistan from January to June of 2022. Our analysis comprised 137 strongly suspected instances of UTI in children (1 month to 15 years old). Results: A total of 137 urine samples from paediatric patients suspected of having UTI were obtained in which the 93 samples (67.88%) generated significant bacteria. The two most common clinical symptoms of UTI patients in our research were fever and dysuria. E. coli was the most prevalent isolate in cases with paediatric UTI. Ampicillin, Ciprofloxacin, and cotrimoxazole were the medications that were most effective against E. coli and Klebsiella, respectively. Conclusions: This study highlights the importance of identifying the clinical symptoms, bacteria causing urinary tract infections (UTIs), and their drug sensitivity patterns in children. The findings emphasize the need for early detection through urine culture sensitivity tests and provide valuable insights for clinicians to effectively manage UTI cases in children, including selecting appropriate empirical antibiotic treatment. [ABSTRACT FROM AUTHOR]

Objective: To validate a clinical scoring system for defining the severity of ailment that will assist in developing strategies for management prioritisation. Study Design: Cross-sectional analytical study. Place and Duration of Study: Paediatric Department, Combined Military Hospital Lahore, Pakistan, form Jan 2020 to Jul 2021. Methodology: The paediatric patients who reported to the Medical Reception Centre and were admitted to an Inpatient Facility were enrolled. Demographic profile, temperature, oxygen saturation, pulse, respiratory rate, seizures, and sensorium labelled as "TOPRS" score was recorded with "0 - Normal" and "1 - Abnormal" and scores calculated for each patient with the incorporation of systemic inflammatory response and advanced paediatric life support criteria. Results: A total of 300 paediatric patients with an age range of 1-18 years (mean: 3.86±5.43) were included. Of 300 patients, 237(79%) were discharged after improvement, and the mortality rate was 63(21%). A significant association with the mortality rate was deciphered with temperature, oxygen saturation, and respiratory rate variables. In contrast, pulse rate, sensorium, and seizures were concluded to have an insignificant association. Score "0" mortality was associated with the 4.4% mortality, whereas score "5" enumerated an 80% death rate. Conclusion: The TOPRS clinical scoring system has significant value in the diagnosis of mortality and morbidity of paediatric patients and, hence, can assist in early recognition and triage of patients, consequently aiding in the provision of prioriti sation protocols and management in a befitting manner. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of adjuvant Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) therapy in neonatal sepsis. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Lahore Pakistan, Mar 2019 to Mar 2020. Methodology: Thirty neonates (15 cases and 15 controls) were randomly selected for this study. The Interventional Group was given GM-CSF and standard-of-care treatment; the Control Group only received standard care. Both groups were followed for the primary outcome (i.e., discharge or death). Secondary outcomes included the effects of GM-CSF on haematological parameters of neonatal sepsis. Results: The mean gestational age of the children was 33.46±2.47 weeks. In the Interventional-Group, 56.7% of the neonates were discharged with the resolution of the sepsis. There was no significant difference concerning the secondary outcome, but the mortality was higher in the neonates among the Control-Group (p-value>0.05). Conclusion: Our study showed no difference in mortality between the Interventional and the Control Groups. The GM-CSF therapy could be used as an adjuvant therapy in neonates with neonatal sepsis to increase the total leukocyte and absolute neutrophil counts. Further studies are needed to holistically chart the clinical benefit of GM-CSF adjuvant therapy. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic value of red blood cell distribution width and red cell distribution width index in differentiating iron deficiency anaemia and beta-thalassemia trait. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2021 to Feb 2022. Methodology: A study population of 110 children with an age limit of 1.5-7 years who reported low haemoglobin was subjected to serum iron and ferritin levels with further evaluation of red cell count, blood morphology, and comparison of mean corpuscular volume. Red cell distribution width was taken from the lab report, whereas Red blood cell distribution width index value was computed for the samples. Results: A total of 110 patients were enrolled in the study. Seventy-five (68.18%) participants were diagnosed with IDA, 26(23.63%) participants were the candidate of PTT. Nine participants were suffering from anaemia of variable etiologies such as chronic ailment and sideroblastic, etc. PTT patients presented with higher RBC counts with a mean of 5.71±1.2 x1012 /l (6.8-8.5 x1012 /l) when compared to IDA participants who deciphered values of 3.5±0.5 (2.6-4.3 x1012 /l). Mean MCV in PTT was 52.2±2.7(50.1-56.8) whereas for IDA were 72.5±1.2(61.2-78.3). In IDA low serum ferritin was recorded 4.02±1.1(2.2-9.2) as compared to mean values of PTT patients. Conclusion: Red cell distribution width index and Red blood cell distribution width are authentic variables and inexpensive modalities in differentiating between iron deficiency anaemia and beta-thalassemia trait with reliability. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of low maternal serum vitamin-D levels with serum vitamin-D levels of their term neonates and higher risk of early onset neonatal sepsis (EOS). Study Design: Prospective observational study. Place and Duration of Study: Neonatal intensive care unit (NICU) of Department of Pediatrics; Combined Military Hospital (CMH) Malir Cantt Karachi, from Apr 2016 to Apr 2017. Material and Methods: Ninety three term neonates with EOS formed the "sepsis group" and equal number (93) of healthy term neonates without sepsis were included in the control group selected as per inclusion criteria. Blood samples of mothers and their neonates were drawn during the first 72 hours after delivery for measurement of serum vitamin-D levels. Results: Mean serum vitamin-D levels were 18.16 ± 8.21 ng/ml and 13.93 ± 13.29 ng/ml in the mothers and their neonates respectively in the sepsis group and were significantly lower (p-value <0.001) than the mean serum vitamin-D levels of 33.35 ± 12.70 ng/ml and 27.92 ± 7.58ng/ml in the mothers and their neonates respectively in the control group. Vitamin-D deficiency was found in significantly higher number of cases in mothers (88.17%) and neonates (82.80%) in sepsis group as compared to 52.69% mothers and 39.78% neonates in control group (p-value<0.001). There were 14 (15.05%) cases of culture proven sepsis in the study group as compared to just 01 (1.08%) case of culture proven sepsis in control group which was statistically significant (p-value<0.001). Conclusion: Lower maternal serum vitamin-D levels are associated with lower serum vitamin-D levels and higher risk of EOS in their term neonates. [ABSTRACT FROM AUTHOR]

Objective: The aim of the current study was to examine the frequency of meningitis in infants having late onset sepsis (LOS). Bacterial sepsis and meningitis endure being leading causes of illness and mortality in neonates around the world, predominantly in preterm neonates. They must be discovered and cured as soon as possible to avoid death or disability. Study Design: The Cross-Sectional method was used to conduct a study. Duration and Place of Study: The study period was from July to December 2021. Data was collected from Pak Emirates Military Hospital (PEMH) NICU Rawalpindi. Material and Method: The study comprised a total of 110 individuals, both male, and female. All of them were older than 3 days and had been hospitalized and diagnosed with late-onset sepsis. A neonate was diagnosed with meningitis if his or her cerebrospinal fluid (CSF) had > 30 leukocytes/mm3 and any of these two: >200 mg/dl protein or 40 mg/dl glucose. Results: Out of 110 infants having LOS 38 were diagnosed with meningitis of which 21(55.2%) were male and 17(44.8%) were female. The overall mean weight of neonates was 2.38±1.72. A total of 24(63.1%) having low body weight and 22(57.8%) were premature. Meningitis was found to have a significant association with low bod weight and pre-term birth (p value<0.05). Conclusion: Meningitis was considerably high in neonates with (LOS). Low body weight and pre-term birth had significant associations with meningitis (LOS). [ABSTRACT FROM AUTHOR]

Background: Thalassemia is a set of inherited hematological illnesses caused by mutations in the genes that code for globin. Regular blood transfusions extend the lives of thalassemia patients, but they also increase the danger of blood-borne illness infections. Objective: The current study was conducted to check the frequency and risk factors of hepatitis B virus (HBV) infections among β thalassemia major patients. Methods: The study was conducted over a period of 3 months that is from November 2021 to February 2022 in the department of Thalassemia center CMH Rawalpindi. The study consists of thalassemia patients aged 6 months to 15 years including both male and female patients. Their venous blood was taken and transmitted to the laboratory, Armed force institute of pathology CMH Rawalpindi, for a hepatitis B surface antigen test (HbsAg). Their demographic information was gathered, including their age, gender, number of blood transfusions received each year and Hepatitis B virus (HBV) vaccination status. Results: Out of 100 patients there were 45 patients were male and 55 patients were female. The patients' ages span from 6 months to 15 years, with a mean age difference of 11.20 years and a standard deviation of 5.56. In three months, the mean difference in the number of blood transfusions received by patients was 22.7 6.6 SD. Patients under the age of ten were 50 percent of the time, and patients beyond ten were also 50 percent of the time (50 percent). Five (5%) of the total 100 patients tested positive for hepatitis B. In three months, the mean difference in the number of blood transfusions received by patients was 18.2 5.6 SD. Thirty (30%) patients out of a total of 100 were not immunized. Conclusion: The frequency of hepatitis B in beta-thalassemia major patients is minimal (less than 5 per 100) is seen in our study. To reduce the future risk of TTI, the development of strong national and regional policies on safe blood transfusion procedures, VNRD-based transfusions, and universal quality-assured donor screening are recommended. [ABSTRACT FROM AUTHOR]