Subacute sclerosing panencephalitis (SSPE) is a rare disorder in the developed world. However, an upsurge has been seen lately in our part of the world owing to inadequate measles immunization coverage. At the midst of our struggle against polio, we are struggling with the war against other vaccine-preventable childhood illnesses like measles. The increasing numbers of SSPE that we reported over the past half decade suggest an underlying periodic measles epidemic in Pakistan. In addition, children are now presenting with SSPE in early childhood, warranting a relook, reinforcement and strengthening of primary immunization and mandatory two-dose measles vaccination for all children nationwide. Previously undertaken Measles Supplementary Immunization Activity were a failure in terms of providing the expected cover against measles in young children. Intensive surveillance and establishment of SSPE registers at the district level is essential for eradication of this easily preventable disorder. Unless timely efforts are made to achieve global immunization, SSPE is bound to add to the national disability burden.

Background: Main stay of treatment of acute Bronchiolitis is general supportive care, such as oxygenation, aspiration of respiratory tract secretions, and hydration therapy. Recent research indicates that breathed hypertonic saline is a potential treatment. Objective: To compare the mean length of hospital stay and clinical bronchiolitis score of salbutamol nebulized in normal saline versus hypertonic saline in children with acute bronchiolitis. Material and methods Study Design: Randomized controlled design Setting: Department of pediatrics, Fatima Memorial Hospital, Lahore. Duration of Study: 6 months after approval of the study i.e. from 12th April 2017 to 12th October 2017. Data Collection Procedure: Relevant parameters were identified, and the CBSS was computed. Using random tables, cases were divided among two groups and given salbutamol or hypertonic saline nebs. The length of stay was determined. The Clinical Bronchiolitis Severity Score (CBSS) was recorded based on various variables. Version 17 of the statistical package for social sciences was used for statistical analysis. Result: Patients in the salbutamol group had a mean age of 13.56.66 months, while those in the hypertonic saline group had a mean age of 12.46.58 months. In the group receiving salbutamol, there were 29 males and 31 females. There were 32 men and 28 women in the hypertonic saline group. After 24 hours, the mean CBSS in the salbutamol group was 6.132.47, whereas in the hypertonic saline group, it was 4.881.75. After 24 hours of treatment, the difference in CBSS was significant between the two groups (P0.05). The mean duration of hospitalization was 3.920.81 days with salbutamol and 3.050.77 days with the hypertonic group. In both groups, there was a marked difference in duration of hospital stay (P0.05). Conclusion: Thus, hypertonic saline was more effective than salbutamol in reducing the CBSS score and duration of hospital stay. Keywords: Hospital Stay, Clinical Bronchiolitis Score, Nebulized Salbutamol, Normal Saline, Hypertonic Saline, Children, Acute Bronchiolitis.

Aim: To assess the nutritional status for identifying nutritional rickets in children less than five years of age. Study design: Prospective study Place and duration of study: Department of Medicine Paediatrics, Arif Memorial Teaching Hospital Lahore from 1st April 2021 30th September 2021. Methodology: Sixty children suffering from rickets were enrolled. Blood sample 3cc was taken from each child and serum was separated by centrifugation. The serum was stored at -20°C until analysis. Biochemical tests including 25-OH vitamin D3, serum calcium and alanine phosphatase were done. The radiological imaging (X-ray) pictures completely demonstrated the rickets status. Demographical information, age, body mass index of each child was documented on a well-structured questionnaire. Food frequency charts related to vitamin D rich foods as well as calcium rich diet was used for assessing the nutritional status of children. Results: The mean age of the children was 3.5±1.9 years. The clinical symptoms of the enrolled children showed that sweating was most common symptoms in all sixty children suffering from rickets. Forty-eight percent cases were under weight and stunting was presented in 73% while wasting was observed in 23% of the cases. The radiological x ray imaging showed Cupping of the bones was presented in 51% of the cases followed by wrist widening in 24%. The food frequency results also presented similar findings in which serum calcium was observed inadequate in 86.6% of cases while ALP and vitamin D3 was inadequate in 90% and 100% of cases respectively. Conclusion: Vitamin D status of Pakistan children was very alarming as 100% of the cases was vitamin D deficient. Calcium deficiency was also significantly associated with nutritional rickets. Keywords: Nutritional rickets, Vitamin D deficiency, Geological location, Bone deformities

Aim: To compare the predictive accuracy of Glasgow coma Scale (GCS) versus full outline of unresponsiveness score (FOUR score) for poor out-come prediction in children admitted in paediatric ICU. Study design: Descriptive cross-sectional study. Place and duration of study: Department of Pediatrics, Services Hospital Lahore from 29th June 2017 to 29th December 2017. Methodology: One hundred and seventy children were enrolled. Both GCS and FOUR scale scores were recorded in paediatric intensive care unit (ICU) by clinical examination within 30 minutes of arrival in ICU. Both GCS and FOUR score were calculated on each and every patient. Responses were noted by clinically examining the eye, motor, verbal and brain stem reflexes. Patients were followed upto 7 days and poor outcome was noted. Results: The frequency of pediatric mortality was 52 (30.59%). Predictive accuracy of Full Outline of Unresponsiveness Score (FOUR score) for poor outcome prediction in children admitted in paediatrics ICU showed 63.46% for sensitivity, 86.44% for specificity, 67.35% for PPV, 84.30% for NPV and 79.41% for accuracy rate, whereas predictive accuracy of GCS Score for prediction of poor outcome in children admitted in paediatrics ICU shows 55.76% for sensitivity, 83.89% for specificity, 60.42% for PPV, 81.15% for NPV and 75.29% for accuracy rate. Conclusion: The FOUR and GCS both showed good results in terms of mortality after one week of admission in pediatric ICU. Key words: Children, poor outcome, FOUR score, Glasgow coma scale, predictive accuracy

Aim: To determine predictive accuracy of CRIB II score in predicting mortality among premature with low birth weight neonates. Study design: Cross-sectional study. Place and duration of study: Paediatric NICU, Services Hospital Lahore from 2nd June 2017 to 2nd December 2017. Methodology: Two hundred and forty preterm new-born born before 32 weeks and birth weight from 600-1500grams were enrolled. Temperature was measured using rectal thermometer. Arterial blood gas sample was taken using standard sampling technique for base excess. Premature infants were evaluated for CRIB-II Score within 1 hour of arrival. Neonates were followed for 28 days to assess for their survival status. Results: The mean CRIB-II score was 10.95±2.79, mean gestational age was 29.16±1.58 weeks and mean weight was 1111.13±202.28 grams. There were 123(51.25%) males and 117(48.75%) were females. Actual neonatal mortality was 82(34.17%). Predictive accuracy of CRIB II score in predicting mortality among premature and very low birth weight neonates admitted to NICU was 92.68% for sensitivity, 94.94% specificity, 90.48% positive predictive value and 96.15% had negative predictive value. Conclusion: The predictive accuracy of CRIB II score is higher in prediction of mortality among premature and very low birth weight neonates. Keywords: Neonates, Premature, Very low birth weight, Mortality, CRIB II score, Prediction