Objectives: To determine the etiology of Fever of Unknown Origin (FUO) in children. Study Design: Prospective Observational study. Setting: Department of Pediatric Medicine, The Children's Hospital, Lahore. Period: August 2019 to January 2020. Material & Methods: A total of 45 children aged between 01 to 180 months (15 years), having FUO were included. FUO was defined as a temperature of greater than 100.4ºF documented by a health care provider, persisting over a period of three weeks and for which no cause could be identified after at least 8 days of evaluation. All the study information was analyzed by using standard software SPSS 20. The quantitative variables like age and duration of fever before hospital admission were presented as mean and standard deviation. Qualitative variables like sex, antibiotic therapy use before definitive diagnosis and various diagnoses made were presented as frequencies and percentages. Results: The patient’s age range was from 01 to 180 months with mean of 80±45.12 months and male to female ratio was 2.2:1. Definitive diagnosis was made in 37(82.2%) patients. Infections were the predominant cause of FUO (44.4%) followed by malignancy (24.4%). Tuberculosis was the most common infection while Acute Lymphoblastic leukemia dominated the malignancy. Systemic lupus erythematosus was the most commonly diagnosed connective tissue disorder.  There was a significant association between duration of fever and the ultimate diagnosis (p=0.01). Conclusion: Infectious diseases were the most common cause of FUO followed by malignancy, connective tissue disorders and miscellaneous causes.

Objectives: Community acquired pneumonia (CAP) is considered to be the commonest reason for hospitalization among children. Pneumonia is the leading cause of mortality among children in Pakistan in children, causing 33% of all deaths in infants and 37% of all deaths in children 1 to 4 years. The aim of current study was to compare efficacy of amoxicillin-clavulanic acid versus ceftriaxone among children under 5 years of age, hospitalized having uncomplicated CAP. Study Design: Randomized Controlled trial (RCT). Setting: Department of Pediatric Medicine, The Children Hospital and Institute of Child Health, Lahore. Period: 01/01/2019 to 30/06/2019. Material & Methods: A total of 210 (105 in each group) children aged between 2 to 60 months, diagnosed having CAP were randomly allocated into either Group-A (received IV amoxicillin-clavulanic acid) or Group B (received IV ceftriaxone). Efficacy in terms of response of both treatment groups was noted after 5 days treatment. Results: Overall, mean age was noted as 14.68±15.7 months. Majority (n=131, 32.4%) were male and aged between 1 to 12 months (n=135, 64.3%). Mean duration of symptoms was noted as 3.60±1.69 days. Efficacy was significantly higher in children treated with ceftriaxone as compared to those treated with Amoxicillin/Clavulanic acid (96.2% vs. 76.2%; p<0.001). This difference was significant across all age, gender and duration of symptom groups (p<0.05). Conclusion: The efficacy was significantly higher in children treated with ceftriaxone as compared to Amoxicillin/Clavulanic acid.

Objective: To determine the types, clinical spectrum and outcome of Extra-Pulmonary Tuberculosis (EPTB) in children admitted at a tertiary care hospital. Study Design: Cross Sectional study. Setting: The Children's Hospital and The Institute of Child Health, Lahore. Period: May to December 2019. Material & Methods: A total of 63 patients diagnosed with EPTB aged 1 month to 16 years were included. All patients with lung involvement were excluded from the study. Anti-tuberculous therapy (ATT) was started in all patients and outcome was monitored during the hospital stay. Results: In a total of 63 patients, mean age was 9.03+3.1 years. There were 35 (55.5%) male and 28 (44.4%) female. The mean duration of symptoms at the time of presentation was 5.93+2.4 months. The common sites of EPTB were meninges noted in 17(26.9%), pleural in 13 (20.6%), abdominal in 12 (19.04%), lymph nodes in 11 (17.4%), disseminated in 6 (9.52%) and bone and joints in 4 (6.34%) patients. The most common systemic complaints were fever in 58 (92.06%), weight loss in 48 (76.1%) and anorexia in 45 (71.4%). After treatment, fifty-four patients improved and discharged while 9 (14.2%) patients died. Conclusion: The commonest sites of EPTB were meninges, pleural, abdomen and lymph nodes. Fever, weight loss and anorexia were the most frequent systemic complaints. Most of the patients recovered while the most common cause of mortality was tuberculous meningitis.