Objective: To find out the most common organisms involved in neonatal sepsis origination and observe the pattern of antibiotic sensitivity and resistance of bacterial isolates. Materials and Methods: This descriptive cross-sectional study was conducted at the Department of Paediatrics Izzat Ali Shah Hospital, Wah Cantt. Out of 420 patients admitted with sepsis in NICU, 19.5% of patients with positive blood cultures were included in the study. A consecutive, non-probability sampling technique was used. Results: Out of 82 positive blood cultures gram-positive bacteria were observed in 19 patients (23.2%) and gram-negative bacteria were seen in 63 patients (76.8%). The most common gram-negative pathogens isolated were Acinetobacter (29.3%) and Klebsiella (24.4%). Staphylococcus aureus (12.2%) was the commonest gram-positive organism isolated. Gram-negative organisms showed maximum sensitivity to Tigecycline and Colistin and were resistant to Cefixime, Aztreonam, Amoxicillin, and Ceftriaxone. Gram-positive bacteria were sensitive to Teicoplanin, Linezolid, and Vancomycin while resistance was shown to penicillin and amoxicillin.Conclusion: The current study showed that gram-negative bacteria were the major contributors to sepsis in the respective setup and showed resistance to first-line antibiotics such as Penicillins and Cephalosporins. Strict infection control measures need to be implemented to avoid the emergence of resistant strains of pathogens in NICUs. This will help to reduce the incidence of neonatal sepsis leading to mortality.

Objectives: This study has been performed to observe the efficacy & safety of Topiramate in refractory epilepsies in children in Pakistan.Materials and Methods: A cross-sectional prospective consecutive series of children age between (1-14 years) with refractory epilepsy were recruited from the Paediatric Neurology clinic of Izzat Ali Shah Hospital. Epilepsy was classified into Generalized, Focal, and Unknown based on ILAE Classification. Topiramate was added in patients who were refractory to at least two anti-epileptic drugs. The outcome was recorded in four categories i.e total remission, >50% seizure reduction, <50% seizure reduction, and no improvement.Results: Fifty-eight patients were enrolled in the study, but 5 patients were dropped out due to significant side effects. Most of the children were in the age group ranging from 5 to 10 years with predominant boys (n=32). The major type of epilepsy was 53% (n=28) was Unknown, while 36% (n=19) children had Generalized epilepsy and 11% (n=6) had Focal epilepsy. 25% children had total remission, 38% had >50% seizure reduction, 28% had < 50% seizure reduction and 9% had no improvement. Total remission was mostly seen in Focal epilepsy (50%) and least shown in Unknown type (14%) and the difference was significant (Chi-Square test p=0.039). Adverse effects to Topiramate were found in 33 (62%) of the total enrolled patients. Common adverse effects were weight loss in 14(26%), poor appetite in 13(24.5%), and behavioral issues in 6(22.5%) children.Conclusion: Topiramate is an effective anti-epileptic drug (AED) in refractory epilepsy especially with Focal and Generalized onset but is not as effective in other types of Refractory epilepsy. Weight loss and poor appetite were the commonest adverse effects that were reversible after dose reduction.

Objective: To determine the frequency of various Inherited Metabolic Diseases (IMDs) in clinically suspected neonates and children in relation to age, gender, and distribution in rural and urban areas.Materials and Methods: A total of 275 symptomatic neonates and children were enrolled for IMDs. A complete medical history, baseline biochemical tests, cerebrospinal fluid analysis, arterial blood gases, anion gap, serum ammonia, lactate, and urinary ketones were assessed. Any significant microbiological cause for the presenting symptom was excluded. For screening of Inborn Metabolic Error simple Heel prick test was done on PerkinElmer 226 filter paper in newborns and infants. Samples were sent to Jordan for analysis. High-performance liquid chromatography combined with tandem mass spectrometry (LC-MS/MS) was the technique used in the screening of a variety of IMDs. The frequency of Inherited Metabolic Diseases and their relation with age, gender, and location was determined using the chi-square goodness of fit test. A p-value ≤ of 0.05 was considered statistically significant. Results: Of the 275 subjects screened, 47(17%) had an inherited metabolic disorder, of which 27 were male and 20 were female with a Male to Female ratio of 1.35:1. The difference in metabolic disorders was significantly different between age (p=0.01) and gender (p=0.04). Of the diagnosed cases G6PD disorder was found to be the most frequent disorder 14 (29.79%) of the total diagnosed cases, followed by Aminoaciduria in 9 (19.15%) and Carnitine Uptake Defect in 7 (14.8). Conclusion: The cases detected to have IMDs revealed a significant prevalence. G6PD was detected as the most frequent disorder. A simple Heel prick test on PerkinElmer 226 filter paper is a useful method to detect IMDs, though confirmation is usually required by other tests.