FREQUENCY OF HOSPITAL ACQUIRED HYPONATREMIA IN A PEDIATRIC TERTIARY CARE SETTING.

BACKGROUND: Hyponatremia is the most commonly encountered electrolyte disorder in children. In our country the epidemiology of hospital acquired hyponatremia has hardly ever been explored whereas the administration of hypotonic IV fluids is widely practiced here. Therefore we pioneered to conduct this study to determine the frequency of hospital acquired hyponatremia. METHODS: This was a cross sectional study carried out at Aga Khan University Hospital, Karachi in paediatric ward and ICU over a period of 12 months. All children (>1 month and <15 years of age) admitted in paediatric units and on maintenance IV fluids who had serum sodium level measured on admission were included in the study and followed to identify patients who had a drop in serum sodium during hospitalization. Informed consent was taken from parents and collected data was recorded on a pro forma. RESULTS: A total of 865 patients were enrolled in the study. Hyponatremia was recorded in 405 patients on admission (46.8%) while hospital acquired hyponatremia was documented in 240. children (27.7%). Out of these 142 (59.2%) were male and 98 (40.8%) were female. Mean age of children in hospital acquired hyponatremia group was 60.67 months. Severity of hospital acquired hyponatremia was recorded as mild in 191 (79.6%), moderate in 35 (14.6%) and severe in 14 (5.8%) children. Major disease categories included gastrointestinal disorder (30.4 %), respiratory illness (12.5%), oncological disease (16.3%), cardiovascular disease (11.7%), infectious disease (9.2%) and neurological illness (8.3%). CONCLUSION: Hospital acquired hyponatremia is frequently encountered in our hospitalized children with majority of them receiving hypotonic IV solutions.

Aetiological profile of acquired anaemia in a paediatric tertiary care setting.

BACKGROUND: Anaemia is the commonest haematological disorder frequently faced by clinicians worldwide. The multi-factorial aetiology of the disorder warrants a comprehensive search for the different causes as management plans differ for different disorders. The objective of this study was to identify the different acquired causes of anaemia in our paediatric population. METHODS: The study was conducted at the Department of Paediatrics, Ayub Teaching Hospital from April 2009 to April 2010. It was a cross-sectional study. A total of 110 patients were included in the study who presented with anaemia secondary to acquired aetiologies and were assessed clinically using general physical and systemic examination. The salient clinical and laboratory data was retrieved in designed protocol. RESULTS: Out of a total of 110 patients, 61 (55.5%) were male and 49 (44.5%) were female. Mean age of the participants was 48 months. Nutritional anaemia comprising iron deficiency anaemia and megaloblastic anaemia was the leading cause being present in 49 (44.5%) patients followed by Visceral Leishmaniasis in 28 (25.5%) patients. Mean haemoglobin was 4.36 g/dl. CONCLUSION: Anaemia secondary to acquired causes is a disorder with grave consequences ranging from cognitive and psychomotor dysfunction to mortality in severe cases. Identification of the different acquired causes is important in preventing the disorder by guiding appropriate interventions.

Childhood strokes: epidemiology, clinical features and risk factors.

BACKGROUND: Stroke constitutes a significant health problem in paediatric population. The impact of childhood stroke can easily be realised in terms of economic, social and psychological burden related to disability of the affected children. The objective of study was to outline the epidemiology and clinical features of stroke in a cohort of Pakistani children and also ascertain the causes and potential risk factors in these patients. METHODS: The study was conducted at the Department of Paediatrics, Ayub Teaching Hospital from January 2008 to October 2010. It was a cross sectional study. A total of 46 patients were included in the study who presented with cerebrovascular disease and were assessed clinically using general physical and systemic examination. The salient epidemiological, clinical, neuro-imaging and laboratory data was retrieved in designed protocol. RESULTS: Out of a total of 46 patients, 50% were from either gender. Mean age of presentation was 39 months. Limb weakness was the commonest presenting feature being present in 37 (80.43%) patients. Infectious disorders was the most prevalent risk factor present in 31 (67.39%) patients followed by microcytic hypochromic anaemia in 28 (60.86%) patients. CONCLUSION: A Childhood stroke is a disorder with long term morbidity. Identification of risk factors is important in preventing the disorder by guiding appropriate interventions.

COVID-19 vaccination associated severe immune thrombocytopenia.

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has emerged as a deadliest global pandemic after its identification in December 2019 in Wuhan, China resulting in more than three million deaths worldwide. Recently FDA issued emergency authorization for three vaccines for prevention of COVID-19. Here in, we report three cases of severe immune thrombocytopenia (ITP) following COVID-19 vaccination and their clinical course. CASE PRESENTATIONS: Case #1: 53 year old male with past medical history of Crohn's disease was admitted for myalgias and diffuse petechial rash 8 days after receiving second dose of Pfizer-BioNTech COVID-19 vaccine. A complete blood test showed a platelet count of 2 × 109/L. Patient did not have a prior history of thrombocytopenia and other causes of thrombocytopenia were ruled out by history and pertinent lab data. He received two doses of intravenous immunoglobulin and oral dexamethasone for 4 days resulting in normalization of platelet counts. Case #2: 67 year male with past medical history of chronic ITP in remission was admitted for melena 2 days after receiving his first dose of Pfizer-BioNTech COVID-19 vaccine. A complete blood test showed a platelet count of 2 × 109/L. Physical exam showed generalized petechiae. There was no history of recent flares of ITP and patient had normal platelet counts following his splenectomy 4 years ago. He received two doses of IVIG and oral dexamethasone for 4 days with gradual improvement in platelet counts. Case #3: 59 year old female with past medical history of chronic ITP secondary to SLE was admitted for bloody diarrhea 2 days after receiving her first dose of Johnson and Johnson COVID-19 vaccine. Physical exam was unremarkable. A complete blood test showed platelet count of 64 × 109/L which dropped to 27 × 109/L during hospital course. She received oral dexamethasone for 4 days with improvement in platelet counts. CONCLUSION: COVID-19 vaccination induced ITP has been recently acknowledged. However, given very few cases and limited data, currently there are no guidelines for management of ITP caused by COVID-19 vaccine as well as vaccination of people with predisposing conditions.

Gender differences of dyslipidemia in type 2 diabetics.

BACKGROUND: Type II diabetic patients are at an increased risk of coronary artery disease and cerebrovascular disease because of deranged lipid metabolism. Female diabetic patients are predominantly at risk. The objective of this cross-sectional study was to determine effects of gender on dyslipidemia of type II diabetic patients. METHODS: This study was carried out at Out-Patients Department, Medical A Unit, Ayub Teaching Hospital Abbottabad from 27th May to 27th November 2009. All type II diabetic patients who were above 40 and gave consent were included in the study. Data was collected through a structured proforma. Pattern of dyslipidemia in type II diabetic patients were estimated by computing all the four types of dyslipidemia like hypertriglyceridemia, low HDL, increased serum total cholesterol and increased serum LDL. RESULTS: There were 150 patients with mean age 65.67 +/- 11.29 years. There were 80 (53.33%) male and 70 (46.7%) female patients. Mean BMI was 28.45 +/- 3.30 Kg/m2. Mean serum cholesterol level was 3.9 +/- 1.31 mmol/L, triglyceride level was 2.98 +/- 1.14 mmol/L, LDL level was 3.28 +/- 0.85 mmol/L and HDL was 0.95 +/- 0.02 mmol/L. Women were more frequent to have low level HDL as compare to men (p < 0.05), while no significant difference was found regarding serum cholesterol, serum triglyceride and serum LDL (p > 0.05). CONCLUSION: Female diabetic patients have increased frequency of low level of serum HDL as compared to males.