Frequency, clinical characteristics, biochemical findings and outcomes of DKA at the onset of type-1 DM in young children and adolescents living in a developing country - an experience from a pediatric emergency department.

Background As per the International Society for Pediatrics and Adolescent Diabetes (ISPAD) census, diabetic ketoacidosis (DKA) is the most frequent cause of diabetes-related death. In developing countries, DKA-related mortality rate ranges from 6% to 24% (Onyiriuka AN, Ifebi E. Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents: frequency and clinical characteristics. J Diabetes Metab Disord 2013;12:47) in contrast to 0.15%-0.31% in the Western world (Poovazhagi V. Risk factors for mortality in children with diabetic ketoacidosis from developing countries. World J Diabetes 2014;5:932-93.). In developing countries like Pakistan, the situation is more perplexing owing to uncertain or under-reported statistics about the spectrum of the disease and its prevalence, coupled with limited access to medical care and experts as well as less awareness. These limitations restrict our ability to develop interventions that are patient-centered. Our main objective was to determine the severity, clinical features, bio-chemical findings and outcomes of DKA in children aged 1 month to 16 years. Subjects and methods This retrospective study included the analysis of medical and laboratory records from patients' medical charts and the electronic database of all children aged 1 month to 16 years with newly diagnosed type-1 diabetes mellitus (T1DM) complicated with ketoacidosis, who presented to the emergency department (ED) at the Aga Khan University Hospital (AKUH), between January 2009 and December 2014. Results Diabetes mellitus complicated with DKA was the predominant diagnosis (n=113 [75.83%]) among endocrine diseases in children visiting the ED. Our study witnessed an increase in the incidence of DKA particularly after 5 years of age, with more severity in females. In our study, the mortality rate was 3.4%. Conclusions Considering the high incidence and mortality rate, it is emphasized that DKA should be considered in differential diagnosis. An awareness campaign for both general pediatricians and physicians as well as for the public is needed for better outcomes.

Ruptured Baker's Cyst in a 15-Year Boy.

Baker's cysts or popliteal cysts are common cystic lesions surrounding the knee joint. These are prevalent among the adult population but rare in children. These are asymptomatic in majority of cases, and are identified incidentally by the parent or physician. We report a case of 15-year boy who presented to the emergency room with symptoms of calf pain and swelling for two weeks. He was in good health previously, and had no underlying knee pathology. Prior to presenting in emergency department (ED), he was suspected as deep vein thrombosis (DVT), and referred for evaluation and management. During his evaluation for DVT, the diagnosis of ruptured Baker's cyst was made on ultrasound. This was further confirmed with magnetic resonance imaging (MRI) of knee joint. He responded to conservative management and was discharged home after reassurance.

Frequency and Outcome of Meningitis in Pediatric Intensive Care Unit of Pakistan.

Meningitis is a leading cause of morbidity and mortality worldwide in intensive care settings. The aim of this study was to assess the frequency and outcome in children with meningitis through a retrospective chart review done in pediatric intensive care unit of a tertiary care hospital from January 2000 to December 2014. During these 14 years, 64 patients were admitted with meningitis in pediatric intensive care unit. Out of 64, 36 were diagnosed with pyogenic meningitis, 18 patients with viral meningitis, and 10 with tuberculous meningitis. Most complications were observed in the initial 48 hours. Most common presentation was altered level of consciouness in 50 (78.1%), seizure in 38 (59.4%), and shock in 23 (35.9%) patients. Ventilatory support was required in 30 (46.9%) patients and inotropic support in 26 (40.6%). During stay in pediatric intensive care unit, there was 7.8% mortality. Although meningitis was an infrequent cause of hospitalization at the study centre, but it was an important infectious cause of mortality and morbidity in pediatric age group and associated with high neurological sequelae.

Haematological causes of thrombocytopenia in children at Aga Khan University Hospital, Karachi.

OBJECTIVE: To identify the haematological causes of thrombocytopenia in children admitted at a tertiary care hospital. METHODS: The prospective, descriptive study was carried out at the Aga Khan University Hospital, Karachi, from September 3, 2009 to March 3, 2010, and comprised children between one month and 14 years of age with platelet count less than15000. After reviewing the record, a questionnaire was filled and data was analysed using SPSS 15. RESULTS: Out of 108 patients in the study, 69(64%) were male and 39(36%) were female. The overall mean age was 69±46.54 months (range: 12-168 months). The mean platelet count was 59.8±46.1/µl (range: 1,000-149,000/µl). Besides, 24 (22.2%) children had mild thrombocytopenia, 34(31.5%) had moderate and 50(46.3 %) had severe thrombocytopenia. The causes of haematological thrombocytopenia in descending order of frequency was acute lymphoblastic leukaemia 17(15.7%), idiopathic thrombocytopenic purpura 10(8.3%) and aplastic anaemia 5(4.6%). CONCLUSIONS: Acute lymphoblastic leukaemia was the commonest cause of haematological thrombocytopenia followed by idiopathic thrombocytopenic purpura and aplastic anaemia.