Clinical Efficacy and Safety of Injectable Levetiracetam Versus Phenytoin as Second-Line Therapy in the Management of Generalized Convulsive Status Epilepticus in Children: An Open-Label Randomized Controlled Trial

BACKGROUND AND PURPOSE: There is sparsity of quality evidence for the use of drugs after first-line benzodiazepines in convulsive status epilepticus in children. The aim of the study was to compare the clinical efficacy and safety of intravenous levetiracetam versus intravenous phenytoin as second-line drugs in the management of generalized convulsive status epilepticus in children. METHODS: This open-label randomized controlled trial was conducted in the Emergency Department of The Children's Hospital and The Institute of Child Health, Multan, Pakistan over a period of 4 years and 6 months from January 2014 to June 2018. This study included 600 children with generalized convulsive status epilepticus: 300 in the 40 mg/kg levetiracetam group, and 300 in the 20 mg/kg phenytoin group. Cessation of a clinical seizure (seizure cessation rate) within 30 minutes after the end of drug administration was the primary outcome in this study, and the presence or absence of adverse effects was noted as the secondary outcome. Data were analyzed using SPSS (version 20.0). RESULTS: The children in the levetiracetam and phenytoin were aged 3.5±0.2 and 3.4±0.2 years (mean±SD), respectively, their seizure durations before the start of treatment were 25.1±0.6 and 23.8±0.4 minutes, and their treatment efficacies were 278/300 (92.7%) and 259/300 (83.3%). Levetiracetam was significantly more effective than phenytoin (p=0.012), with no significant difference in safety. Adverse events were observed in eight children in the phenytoin group. CONCLUSIONS: Levetiracetam is significantly more effective than phenytoin for the treatment of convulsive status epilepticus in children who have failed to respond to benzodiazepines.

Malnourished children with diarrhea; to assess the frequency of serum electrolytes [NA[+], K[+] AND CA[+]] disturbances

"To assess the frequency of serum electrolytes [Na[+], K[+] and Ca[+]] disturbances in malnourished children with diarrhea". Cross-sectional. Pediatrics Department Nishtar Hospital Multan. 01-07-2013 to 31-12-2013. Approval from the institutional ethical committee was taken. Malnourished children with diarrhea admitted to Pediatrics Department Nishtar Hospital Multan were registered. Children meeting the inclusion and exclusion criteria enrolled in the study. In this study there were 90 patients which were found to be malnourished and having diarrhea. The average age of patients was 3.28 +/- 1.2 years and the average duration of diarrhea was 4.67 +/- 0.821 days. There were 58[64.4%] males and 32[35.5%] female patients. Hyponatremia was present in 28[31.1%] patients, Hypokalemia was present in 55[61.1%] while Hypocalcemia was present in 12[13.3%]. Serum electrolyte disturbances in malnourished children are obvious during diarrheal illness particularly in those patients with Grade III malnutrition and measurement of these Serum electrolytes is helpful for immediate therapy to avoid serious life threatening situations

Breast feeding; awareness and complementary feeding in mothers of children with severe acute malnutrition at Nutrition Stabilization Centre Children Hospital and Institute Of Child Health Multan

Background: breast feeding is the most natural way of feeding the infants and help to reduce child mortality and morbidity and millions of deaths could be prevented each year if mothers were aware of benefits of exclusive breast feeding for 4 -6 months and early initiation of breast feeding

Objective: to evaluate the awareness regarding breast feeding and complementary feeding in mothers of severely malnourished children

Study Design: this is a descriptive /cross sectional study

Place and duration of study: this study was conducted at the department of preventive pediatrics Children hospital and institute of child health, Multan from March 2013 to September 2013

Materials and Methods: this study included a total of 100 females that were the mothers of malnourished children visiting the follow up room of department of preventive pediatrics Children hospital and institute of child health, Multan. A questionnaire was designed and others were interviewed in detail after taking proper consent

Results: in this study, the mean age of the sample was25years +/- 3 years. 70% females [70/100] were from urban areas while 30% [30/100] were from rural areas. Of the 100 respondents 54% [54/100] of mothers were illiterate and this study showed that 99% [99/100] considered breast milk safe and effective than other feeds but practically only 23% [23/100] babies were breast fed while 77% [77/100] were bottle fed. Pre-lacteal feed was given by 82% [82/100]. According to 58% [58/100] mothers there should be a early initiation of breast feeding, while 57% [57/100] were un aware of the facts that clostrum should be given while 43% [43/100]of then considered it unhealthy and non effective, 82% [82/100] considered 4 months a period of exclusive breast feeding,61% [61/100] were counseled by doctors regarding the benefits of breast feeding, 50% [50/100] were aware of the use of exclusive breast feeding as a contraceptive tool and 34% [34/100] were aware of its importance for the prevention of breast cancer

Conclusion: the findings of the study indicated the various important policy implications for the intervention of breastfeeding. Strategies to encourage mothers to follow breastfeeding recommendations should concentrate on improving their knowledge

Efficacy of intravenous iron sucrose infusion in children with iron deficiency anemia: experience at children hospital and ICH Multan

To describe the efficacy of intravenous iron sucrose in children with iron deficiency anemia who did not respond to /tolerate oral iron therapy. Quasi experimental interventional study. A prospective study was performed in 100 children, aged between 08 months and 15 years, 66% male and 33% female, diagnosed as iron deficiency anemia with predefined criteriaexcluding other causes. The children who did not respond to /tolerate oral iron therapy were treated with injectable ironin a day care hematology center. Dose of iron sucrose was calculated by a formula. Total dose was divided in three equal aliquots, each one was diluted in 0.9% normal saline and infused over a period of 120 minutes onthree consecutive days. The efficacy of iron sucrose was analyzed by comparing baseline mean hemoglobin at initiation of therapy and mean hemoglobin level two weeks after iron infusion. Mean age was 4.18 +/- 3.68 years.At start of treatment,baseline meanHb was 6.09 +/- 1.37 g/dl, mean MCV 51.5 +/- 9.03 fl and mean ferritin 7.76 +/- 7.6232 ng/ml. At day 14, mean Hb was 9.21 +/- 1.134 g/dl [P < 0.05], mean MCV 66.5 +/- 7.19 fl and mean ferritin 52.47 +/- 29.6828 ng/ml . Mean hemoglobin rise was 3.12 +/- 1.081 gm/dl [P < 0.05]. During infusion, only one patient had hypotensionwho was treated. Iron sucrose infusion is a safe and effective way of raising hemoglobin in iron deficiency anemia in pediatric age group in special set up with minimal side effects

Comparison of duration of hospitalization and clinical outcome in children infected with methicillin resistant staphylococcus aureus and methicillin sensitive staphylococcus aureus

To compare the duration of hospitalization and clinical outcome in children infected with methicilline-sensitive staphylococcus aureus and methicillin-resistant Staphylococcus aureus. [MRSA and MSSA] comparative cross sectional This Study was carried out at the Paediatrics Department, Nishtar hospital Multan from 14.01.2012 to 13.07.2012 Children meeting the inclusion criteria were selected. Clinical samples were collected before starting antibiotics and sent to microbiology lab for culture. Colony morphology, gram straining and production of catalase and coagulase. confirmed growth of S. aureus. Methicillin resistance was determined by disk diffusion method according to CLSI guidelines. S.aureus with inhibition zone more than 18 mm were taken as methicillin-sensitive and those inhibition zone of less than 18 mm were taken as methicillin-resistant. Adequate information regarding identification of patient, clinical diagnosis, duration of hospital stay and clinical outcome were entered. Aftertaking consent from parents. Lab results were entered in the proforma. Children of all age groups up to 12 years of age and both sexes were included to avoid any bias. All patients clinically diagnosed to be suffering from staphylococcal infection [septicemia, pneumonia, skeletal infection, skin and soft tissue infection, meningitis] who were admitted in pediatric ward were included. Sixty patients with S. aureus infection were included in the study. Thirty patients were of MRSA and 30 were of MSSA. In MRSA group 12 [40%] patients remained in the hospital for less than a week and 18 [60%] patients stayed for more than a week but less than 3 weeks. In MSSA group 23[76.6%] patients were hospitalized for less than one week duration and 7[23.4%] patients were admitted for more than 1 week but less than 3 weeks duration. In MRSA group, 15[50%] patients recovered, 4[13.4%] patients improved, 2[6.6%] patients didn't improved and 9[30%] patients expired. In MSSA group, 22[73.4%] patients recovered completely, 4[13.4%] patients improved, 2[6.6%] patients didn't improved and 2[6.6%] patients expired. Children suffering from MRSA infection have more severe illness as compared to those suffering from MSSA infection. Duration of hospitalization of children suffering from MRSA infection is prolonged as compared to MSSA infection while clinical outcome is better in children suffering from MSSA infection as compared to MRSA infection

Immune response of tuberculin test and diagnostic BCG test in children suffering from tuberculosis

To compare the immunological response of tuberculin test and diagnostic BCG test inoculation given simultaneously to children suffering from tuberculosis. Comparative - Cross sectional. This study was carried out at the Department of Paediatric Medicine, Nishtar Hospital Multan from 6 April 2011 to 5 Oct 2011. Fifty patients with tuberculosis were selected. Relevant data of cases including personal data, presenting complaints, physical examination finding and results of all the relevant investigations were collected. We injected 0.1 ml tuberculin intradermally on ulnar surface of right forearm and 0.1 ml BCG vaccine intradermally on deltoid muscle of left side. Both the BCG and tuberculin tests were performed at the same time by the same doctor. All information was recorded in a specifically designed proforma. 26 patients were male and 24 female. Out of 50 patients; BCG test was positive 36 patients and was negative in 14 patients. Mantoux test was positive in 26 patients and was negative in 24 patients. Both BCG and mantoux tests were positive in 26 patients. Ten patients had a positive BCG test where Mantoux test showed negative results. Both tests were negative in 14 patients. BCG skin test is more superior to Mantoux test as a diagnostic tool in paediatric age group patients suffering from various types of tuberculosis

Hepatitis-B virus infection; to describe the clinical presentation in children

To describe the clinical presentations of hepatitis B virus infection in children. Children presenting with symptoms of liver diseases and other diseases who were found to be HBsAg positive by screening or ELISA method were enrolled. Children suffering from thalassemia, hemophilia and hemolytic anemia, which need multiple transfusions, were excluded. On the basis of history, examination and investigations the clinical presentation of the patient was categorized. Basic demographic data, relevant clinical history, physical examination, lab investigations and clinical presentations category were entered in the predesigned proforma. As this is the descriptive study, no hypothesis were required. Descriptive case series. Paediatric unit-2 Nishtar Hospital Multan. 16[th] May 2012 to 15th November 2012. Study results consist of relative frequencies of different clinical presentations of HBsAg positive patients. Fifty children who were HBsAg positive were enrolled in a six month period. Out of 50 patients, 21 [42%] were of hepatic encephalopathy, 14 [28%] were with acute hepatitis, 12 [24%] were cirrhosis, 2 [4%] were asymptomatic carrier and 1 [2%] was presented with chronic hepatitis B. There were 40 [80%] males and 10 [20%] females. The overall male to female ratio was 4:1. Most common presentation was hepatic encephalopathy which has a very bad prognosis, next comes the acute hepatitis and then cirrhosis. There is another inference that males are more and severely affected by hepatitis-B virus infection

Histopathological patterns in childhood steroid resistant nephrotic syndrome

To determine the frequency of various histopathological lesions in children with steroid resistant nephrotic syndrome [SRNS] presenting to the Children's Hospital and the Institute of Child Health, Multan. Retrospective observational study. This study was conducted at the Department of Paediatric Nephrology, The Children's Hospital and The Institute of Child Health, Multan, Pakistan from October 2005 to December 2012. Medical record of 152 children with SRNS, who were biopsied was reviewed all SRNS patients, both initial steroid resistant and late non-responders were included in the study out of the total 152 patients, 98[64.5%] were males and 54[35.5%] females, with a male to female ratio of +/- 1.8: 1. Mean age and standard deviation of patients was micro 8.11 +/- 3.58 years with age range of 1 to 15 years. Histopathological spectrum showed focal segmental glomerulosclerosis [FSGS] as the commonest [59; 38.81%] lesion followed by mesangioproliferative glomerulonephritis [MesPGN] [40; 26.31%], minimal change disease [MCD] [35; 23.02%] and mesangiocapillary glomerulonephritis [MCGN] [13; 08.55%]. Four [2.63%] patients had membranous nephropathy. One patient of renal amyoidosis was also diagnosed on renal biopsy. Overall FSGS was the commonest lesion followed by MesPGN, MCD, and MCGN. IgMN was an associated finding in 25% cases of MesPGN. FSGS was significantly more common among children >10 years. MCD was significantly more common among children 1-5 years. MesPGN and MCGN were significantly more common among children >5 years

Knowledge and practices of mothers regarding acute respiratory infection in children under 5 years of age in Urban Slums of Multan

Acute Respiratory Infection [ARI] is the leading cause of morbidity and mortality in children under 5 years of age in developing countries. The knowledge of mothers regarding ARI is inadequate which leads to delayed care seeking and other factors contributing to high mortality. To determine the Knowledge and Practices of mothers regarding Acute Respiratory Infection. Cross-sectional descriptive study. Urban slums of Multan, from April 2010 to March 2011. A semi-structured questionnaire proforma was used to interview 500 mothers selected by stratified random sampling technique from urban slums of Multan. SPSS software was used to analyze the data. Mother's description of the causes of ARI in children was mostly exposures to "Thand" [cold], after bathing, sour and cold foods. Mothers also had inadequate knowledge of severity of symptoms of ARI including pneumonia. About 44% showed prompt care seeking response within 24 hours of ARI and rest [55.8%] showed delayed response to health care seeking. Thirty three percent mothers preferred private doctors to get treatment, 27.2% favored to go to the public sector, and the rest did home remedy i.e. Tea, Honey, Vicks rub and Warm wrapping. The reasonable majority of mothers [58%] did self medication in their children suffering from ARI. Mothers living in urban slums in Multan have insufficient knowledge and inappropriate health care seeking practices regarding management of ARI in their children

Risk factors, presentations and outcome of the haemorrhagic disease of newborn

To determine the presentations, associated factors and acute outcome in the haemorrhagic disease of newborn. Cross-sectional analytical study. Paediatric Medicine Unit II, Nishtar Hospital, Multan, from June 2004 to May 2006. Fifty patients with haemorrhagic disease of newborn were studied. Age at onset of symptoms, gender, feeding pattern, place of delivery, site of bleeding and acute outcome of patients were noted. Chi-square test was applied to determine the significance of differences and relationship between variables and outcome. P-value of less than 0.05 was considered significant. The mean age at onset of symptoms was 51.65 +/- 39.49 days. Male to female ratio was 2.1:1 [p=0.047]. Late onset disease [8 days to 6 months of life] was noted in 32 [72%] babies [p=0.094]. Exclusive breastfeeding was noted in 45 [90%] babies [p <0.001]. Thirty babies [60%] were delivered at homes [p=0.025], 13 [26%] at private clinics and 7 [14%] at government hospitals. Intracranial haemorrhage was noted in 26 [52%] babies, skin bleeding in 09 [18%] babies, gastrointestinal in 08 [16%], bleeding from injection site in 04 [8%], hematuria in 02 [4%] and bleeding from umbilicus in 01 [2%] baby. Forty babies recovered, whereas death occurred in 10 babies. The cause of death was intracranial haemorrhage in all babies [p=0.059] and all were of late onset disease [p=0.088]. Haemorrhagic disease of newborn was common in male gender, breast-fed infants and spontaneous vaginal deliveries. Intracranial haemorrhage and late onset disease were the causes of mortality in all cases

Parent reported wheeze in school children of South Punjab, Pakistan

To find the prevalence of wheeze as reported by the parents in school children of Southern Punjab Pakistan. It was a cross sectional, questionnaire based survey of the children aged 3-18 years, in randomly selected primary and secondary schools, from October 2002 to March 2003. The data was analyzed using Statistical Analysis System. Of 6120 questionnaire sent to the parents/guardians, we received 3180 back [52%]. Of the 3180 respondents, 1767[56%] were for boys and 1413[44%] were for girls. The median age was 8.25 years. Around 71% of children were between 4 to 11 years of age. The parents reported wheeze in 222[7%] of their children with a slight predominance in boys 120[4%] than in girls 102[3%]. The wheeze was not reported in 14-18 years age group. Childhood wheeze was reported in children by 7% parents. Most of the time wheeze is not reported or disclosed rather denied. An extensive educational media campaign is required for creating awareness in masses regarding wheeze

Nocturnal asthma in school children of South Punjab, Pakistan

At the present time, the epidemiology of the childhood asthma is of considerable interest. There is an understandable concern that changes in the geographical area, lifestyle, and environment. This study was conducted to find the prevalence of nocturnal asthma, in school children of south Punjab, Pakistan. It was a cross sectional, questionnaire based, descriptive survey of the children aged 3-18 years, in randomly selected primary and secondary schools, from October 2002 to March 2003. The data was analyzed with Statistical Analysis System [SAS]. Of 6120 questionnaire sent to the parents/guardians, we received 3180 back [52%]. Of the 3180 respondents, 1767 [56%] were for boys and 1413 [44%] were for girls. The median age was 8.25 years. Around 71% of children were between 4 to 11 years of age. The parents reported nocturnal asthma in 177 [6%] of their children with an equal prevalence in boys and girls, i.e., [3% each, rounded off to nearest whole number]. Of these 177 children with nocturnal asthma, 99 [56%] were boys and 78 [44%] were girls. Of the 1767 boys and 1413 girls, the nocturnal asthma reported by parents was 6% each [99 and 78 respectively]. The nocturnal asthma was not reported in 14-18 years age group of females. The asthma is taken as a stigma in our society and as such is not reported or disclosed rather denied. An extensive educational media campaign is required for awareness of the masses

Physician diagnosed asthma as reported by the parents in school children of South Punjab, Pakistan

To find the prevalence of doctor diagnosed asthma, as reported by the parents, in school children of South Punjab, Pakistan. It was a cross sectional, questionnaire based, descriptive survey of the children aged 3-18 years, in randomly selected primary and secondary schools, from October 2002 to March 2003. The data then was analyzed by the coauthor with Statistical Analysis System [SAS]. Of 6120 questionnaire sent to the parents/guardians, we received 3180 back [52%]. Of the 3180 respondents, 1767[56%] were for boys and 1413[44%] were for girls. The median age was 8.25 years. Around 71% of children were between 4 to 11 years of age. The parents reported asthma only in 129 [4%] of their children as was told to them by their doctor with almost equal distribution in boys [60] and girls [69] of 2%, respectively. Of these 129 children with doctor diagnosed asthma, 60 [47%] were boys and 69 [53%] were girls. Of the 1767 boys, the doctor diagnosed asthma as reported by parents was 3% [60]. Of the 1413 girls, the doctor diagnosed asthma as reported by parents was 5% [69]. The asthma was not reported in 14-18 years age. The asthma is taken as a stigma in our society and as such is not reported or disclosed rather denied. An extensive educational media campaign is required for awareness of the masses

Exercise induced asthma in school children of south Punjab, Pakistan

To find the prevalence of exercise induced asthma, in school children of South Punjab, Pakistan. It was a cross sectional, questionnaire based, descriptive survey of the children aged 3-18 years, in randomly selected primary and secondary schools, from October 2002 to March 2003. The data then was analyzed by the statistician with Statistical Analysis System [SAS]. Of 6120 questionnaire sent to the parents/guardians, we received 3180 back [52%]. Of the 3180 respondents, 1767[56%] were for boys and 1413[44%] were for girls. The median age was 8.25 years. Around 71% of children were between 4 to 11 years of age. The parents reported exercise induced asthma in 306[10%] of their children with an equal prevalence in boys and girls i.e. [5% each, when figures were rounded off to the nearest whole number]. Of this 306 children with exercise induced asthma, 159 [51%] were boys and 147[49%] were girls. Of the 1767 boys and 1413 girls, the exercise induced asthma reported by parents was 9% in boys and 10% in girls, [159 and 147 respectively]. The exercise induced asthma was not reported in 14-18 years age group of males. The asthma is taken as a stigma in our society and as such is not reported or disclosed rather denied. An extensive educational media campaign is required for awareness of the masses

Diagnostic value of CT scan in paediatric neurological disorders

Computerised tomography [CT] is now an established and widely available neuroimaging teachnique. Data regarding 80 children undergoing CT scan at the Nishtar Hospital. Multan were analyzed. Indications for ordering a CT scan included complicated cases of meningitis, seizure disorders, developmental delay, cerebro-vascular lesions and children with suspected space occupying lesions [SOL]. CT scan provided significant help in diagnosis or management in 100 percent cases of acute hemiparesis and suspected SOL and in 80 percent cases of complicated meningitis. Diagnostic help was provided by CT in 66 percent of children with seizures and in 40 percent with developmental delay. However, in only a very small percentage of children with these disorders, scan findings helped in deciding the course of management. CT scan has been a very significant advance in cranial imaging; however, physicians need to carefully consider relevant clinical findings in children with neurological disorders before considering them a candidate for this costly investigation

Diagnostic value of CT scan in paediatric neurological disorders

Computerised tomography [CT] is now an established and widely available neuroimaging technique. Data regarding 80 children undergoing CT scan at the Nishtar Hospital, Multan were analyzed. Indications for ordering a CT scan included complicated cases of meningitis, seizure disorders, developmental delay, cerebro-vascular lesions and children with suspected space occupying lesions [SOL]. CT scan provided significant help in diagnosis or management in 100% cases of acute hemiparesis and suspected SOL and in 80% cases of complicated meningitis. Diagnostic help was provided by CT in 66% of children with seizures and in 40% with developmental delay. However, in only a very small percentage of children with these disorders, scan findings helped in deciding the course of management. CT scan has been a very significant advance in cranial imaging, however, physicians need to carefully consider relevant clinical findings in children with neurological disorders before considering them a candidate for this costly investigation

clinical study of asthma in children

Fifty children with bronchial asthma were studied. Male female ratio was 2:1 and age of onset was above 2 years in 70%. The disease presented as an acute attack in 74% cases. Commonest precipitating factors were exercise, cold air, cold drinks and rice. Symptoms were more prominent during the night and in winters in 56%. Chest deformity was noted in 24% and eosinophilia in 71%. PEFR was lower than 80% of predicted in 67%, spirometry showed obstructive pattern in all those tested. Disease was mild in 48%, moderate in 40% and severe in 12%. Severity of the disease was statistically unrelated to known risk factors. Expected weight of the patients was significantly affected by the severity of the disease but height remained unaffected