Complete Kawasaki disease after COVID-19 infection in an infant.

Kawasaki disease is a generalized systemic vasculitis that affects blood vessels throughout the body. The aetiology of Kawasaki disease is still unknown but is thought to be related to the combined effects of the immune response, genetic susceptibility, and infections including COVID-19. In this case report, we present a seven months old male infant who presented to us with fever, swollen lips, ulcers in the mouth, enlarged tonsils, strawberry tongue, conjunctivitis and generalised non-blanchable maculopapular rash. The detailed workup fulfilled the criteria of Kawasaki disease. The COVID-19 IgM antibodies were positive. The patient was treated with IV Immunoglobulins, IV methylprednisolone and Aspirin. The repeat echocardiography on six weeks follow-up turned out normal. In conclusion, there should be a high index of suspicion of Kawasaki disease while evaluating pediatric patients with COVID-19 infection so that timely intervention can be made to prevent complications. Prospective studies are needed to evaluate the relationship between Kawasaki Disease and COVID-19 infection.

Granulocyte to Lymphocyte Ratio among Different Categories of Neonatal Sepsis according to their Vitamin D Status.

The objective of this study was to ascertain whether, among the cases of neonatal sepsis, there is any significant difference between GLR (Granulocyte to Lymphocyte ratio) of different groups of patients according to their vitamin D status. One hundred and nine neonates with odd admission number, admitted in NICU (Neonatal Intensive Care Unit) with clinical manifestations of neonatal sepsis during the study period from December 2017 to December 2018, were included in the study. Vitamin D deficiency was present in 83 (76.1%), normal vitamin D levels were present in 21 (19.3%), and hypervitaminosis D was detected in 5 (4.6%) patients. Kruskal-Wallis test showed that there was no significant difference between GLR of different group of patients, according to their vitamin D status. There was no significant difference between GLR of different groups, according to outcome. Key Words: Granulocyte to Lymphocyte Ratio, Vitamin D, Neonatal sepsis.

Hemoglobin, Ferritin levels and RBC Indices among children entering school and study of their correlation with one another.

OBJECTIVE: To study correlation of various complete blood count variables with one another and to ascertain the values of intercept and slope among those having strong correlation. METHODS: The cross-sectional study was conducted in Marach 2017 in the Rabwah town of Punjab province in Pakistan, and comprised randomly selected one in four children studying under the Nazrat Taleem School System. Serum sample from each subject was used to analyse complete blood count on an automated analyser, and ferritin levels were checked by enzyme-linked immunosorbent assay. SPSS20 was used for data analysis. RESULTS: There were 299 children with a median age of 67 months. Mean haemoglobin level was 12.09±0.82gm/dl. There was a very strong positive correlation between haemoglobin and haematocrit; mean corpuscular volume; and red cell distribution width; mean corpuscular volume and mean corpuscular haemoglobin; red cell distribution width and mean corpuscular haemoglobin (p<0.001).Moderate positive correlation was found between haemoglobin and red blood cell count; haematocrit and red blood cell count; mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration (p<0.05). Moderate negative correlation was present between red blood cell count and mean corpuscular volume; red blood cell count and red cell distribution width; red blood cell count and mean corpuscular haemoglobin (p<0.05). CONCLUSIONS: There were strong to moderate correlation between various complete blood count variables in the studied population. Ferritin level was the only variable which did not have any correlation with any of the other variables.

Frequency of Anemia and Iron Deficiency among Children Starting First Year of School Life and Their Association with Weight and Height.

The objectives of the study were to ascertain frequency of anemia and iron deficiency among children starting first year of school life and test association with height and weight. One in four children starting first year of school life in five schools of Rabwah, Pakistan, was included. Full blood counts and ferritin levels of the children included in the study were checked. Status of their height and weight was determined according to Z-score charts. Chi-square test was used to test association. Two hundred and ninety-five children with median age of 67 months were included in the study. Out of 295, 240 (81.4%) had normal Hb and 55 (18.6%) had anemia. Ferritin levels were found to be below normal level in 242 (82%) children. There was no significant difference between hemoglobin and ferritin levels of children belonging to different categories of height and weight. Spearman test showed that there was very weak correlation between ferritin and hemoglobin levels (rs = .163). Our conclusions were that iron deficiency without anemia is very frequent among children starting first year of school. Regression models show that ferritin levels cannot be predicted by independent variables like status of height and weight on Z-score charts, age, gender, and anemia.

Electrolyte Abnormalities in Neonates with Probable and Culture-Proven Sepsis and its Association with Neonatal Mortality.

OBJECTIVE: To ascertain the frequency of electrolyte abnormalities in patients of probable and culture-proven sepsis on admission and assess any association of electrolyte disorders with mortality. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: NICU, Fazle-Omar Hospital, Rabwah, from October 2015 to September 2016. METHODOLOGY: All neonates with the diagnosis of probable and culture-proven sepsis during the study period admitted in NICU, Fazle-Omar Hospital, were included in the study. Electrolyte levels were categorised as normal, high or low and recorded in the data form, with age and outcome. Fisher exact test was used to test association. SPSS 20 was used for data analysis. RESULTS: One hundred and fifty-one neonates were included in the study. Ten (6.6%) died. Among these, 114 (75.49%) had one or more electrolyte abnormalities. Median (IQR [interquartile range]) levels of sodium and chloride were, 140 (7.1), and 100.2 (7.4) mmol/L, respectively. Mean levels of potassium and calcium were 5.07 ±0.76 mmol/L and 2.35 ±0.338 mmol/L, respectively. Hyperkalemia was the commonest electrolyte disorder present in 60 (39.7%) neonates, followed by hypercalcemia in 50 (33.1%) and hypocalcemia in 20 (13.2%). None of the neonates without any electrolyte abnormality died (p=0.053). CONCLUSION: Majority cases of neonatal sepsis have got electrolyte abnormalities. Hyperkalemia was the commonest electrolyte imbalance followed by hypercalcemia and hypocalcemia.

Frequency of underweight and stunting among children entering school in a small urban locality and their association with academic performance.

OBJECTIVE: To determine the frequency of underweight and stunting among the children entering first year of school and to assess its associated factors. METHODS: This descriptive, analytical study was conducted at 5 schools of Rabwah, Pakistan, from August to September 2015, and comprised all students who got admission in the selected schools during the study period. Name, father's name, gender, weight, height, status of height, and weight on Z-score charts, and marks obtained in the test were recorded. SPSS 20 was used for statistical analysis. RESULTS: Of the 478 participants, 212(44.4%) were boys and 266(55.6%) were girls. The overall mean age was 66.6±5.966 months (range: 41-129 months). Overall, 53(11.1%) were underweight, 22(4.6%) were severely underweight, 55(11.5%) had stunting and 12(2.5%) had severe stunting. Median marks (Interquartile Range [IQR]) in admission test for obese, overweight, normal, underweight and severely underweight children were 76.3%(37.2-84.7), 65.9%, 66.7%(56.4-72.3), 64.6%(47-71), and 67%(55.3-78), respectively. Median marks (IQR) in admission test for tall, normal height, stunted and severe stunted children were 24.1%, 67%(57.3-73), 57%(31.1-67.8), and 62.6%(49.7-68.3), respectively. Children with stunting scored significantly fewer marks compared to children of normal height (p<0.05). CONCLUSIONS: Stunting and underweight were common problems among children starting school. Stunting was found to be associated with lower marks in admission test.

Temperature on admission among cases of neonatal sepsis and its association with mortality.

OBJECTIVE: To ascertain the prevalence of hyperthermia and different categories of hypothermia among the cases of probable and culture-proven neonatal sepsis, and to evaluate association of mortality rate with axillary temperature at admission. METHODS: This analytical study was conducted at Fazl-e-Omar Hospital, Rabwah, Pakistan, from January to December 2013, and comprised all cases of culture-proven and probable neonatal sepsis admitted in the neonatal intensive-care unit of the hospital. Using World Health Organisation classification, cases were categorised according to their temperature on admission, and outcome was recorded. SPSS 20 was used for data analysis. RESULTS: Of the 374 patients, 47(12.6%) died. Besides, 217(58%) cases had normal temperature, 49(13.1%) had hyperthermia, 50(13.4%) had mild hypothermia, and 58(15.5%) had moderate hypothermia. Mortality rate was high among cases with mild and moderate hypothermia i.e. 15(32.6%) and 15(33%), compared with the mortality rate in cases with normal temperature i.e. 12(6.1%). Mortality rate among cases with hyperthermia was 5(11.6%). In early onset cases, 33(16.2%) had mild and 45(22.1%) had moderate hypothermia. In late onset cases, 37(21.8%) had hyperthermia. CONCLUSIONS: Most cases with neonatal sepsis had normal temperature. Mild and moderate hypothermia were found to be associated with higher mortality rate.

Prevalence of Electrolyte Disorders Among Cases of Diarrhea with Severe Dehydration and Correlation of Electrolyte Levels with Age of the Patients.

OBJECTIVE: To find out the prevalence of electrolyte disorders among children with severe dehydration, and to study correlation between age and electrolyte, urea and creatinine levels. STUDY DESIGN: Prospective, analytical study. PLACE AND DURATION OF STUDY: Outdoor and indoor of Fazle-Omar Hospital, Rabwah, Pakistan, from January to December 2012. METHODOLOGY: All patients from birth to 18 years age, presenting with diarrhea and severe dehydration were included in the study. Urea, creatinine and electrolyte levels of all patients included in the study were checked and recorded in the data form with name, age and outcome. The prevalence of electrolyte disorders were ascertained and correlation with age was determined by Pearson's coefficient. RESULTS: At total of 104 patients were included in the study. None of the patients died. Hyperchloremia was the commonest electrolyte disorder (53.8%), followed by hyperkalemia (26.9%) and hypernatremia (17.3%). Hyponatremia, hypokalemia and hypochloremia were present in 10.6%, 7.7%, and 10.6% cases, respectively. Weak negative correlation was found between age and chloride and potassium levels. CONCLUSION: Different electrolyte disorders are common in children with diarrhea-related severe dehydration.

Platelet counts, MPV and PDW in culture proven and probable neonatal sepsis and association of platelet counts with mortality rate.

OBJECTIVE: To determine frequency of thrombocytopenia and thrombocytosis, the MPV (mean platelet volume) and PDW (platelet distribution width) in patients with probable and culture proven neonatal sepsis and determine any association between platelet counts and mortality rate. STUDY DESIGN: Descriptive analytical study. PLACE AND DURATION OF STUDY: NICU, Fazle Omar Hospital, from January 2011 to December 2012. METHODOLOGY: Cases of culture proven and probable neonatal sepsis, admitted in Fazle Omar Hospital, Rabwah, were included in the study. Platelet counts, MPV and PDW of the cases were recorded. Mortality was documented. Frequencies of thrombocytopenia (< 150000/mm3) and thrombocytosis (> 450000/mm3) were ascertained. Mortality rates in different groups according to platelet counts were calculated and compared by chi-square test to check association. RESULTS: Four hundred and sixty nine patients were included; 68 (14.5%) of them died. One hundred and thirty six (29%) had culture proven sepsis, and 333 (71%) were categorized as probable sepsis. Thrombocytopenia was present in 116 (24.7%), and thrombocytosis was present in 36 (7.7%) cases. Median platelet count was 213.0/mm3. Twenty eight (27.7%) patients with thrombocytopenia, and 40 (12.1%) cases with normal or raised platelet counts died (p < 0.001). Median MPV was 9.30, and median PDW was 12.30. MPV and PDW of the patients who died and who were discharged were not significantly different from each other. CONCLUSION: Thrombocytopenia is a common complication of neonatal sepsis. Those with thrombocytopenia have higher mortality rate. No significant difference was present between PDW and MPV of the cases who survived and died.