Cholestatic jaundice is a well recognised complication of late sepsis. However, cholestatic liver injury preceding sepsis is less well known and appreciated. This leads to delays in diagnosis in clinical practice and may result in significant morbidity and mortality. The development of a cholestatic blood picture should be considered as an early warning sign of an underlying infection, even in the absence of signs or symptoms of sepsis. This report describes the case of a previously healthy patient who presented with cholestatic jaundice. Staphylococcal osteomyelitis involving the left sacroiliac joint was diagnosed. Literature relating to cholestatic jaundice in sepsis is reviewed.

Introduction: The lumbar puncture is frequently used in medical facilities to collect data on the cerebrospinal fluid (CSF). The method aids in the diagnosis of conditions affecting the spine and brain's central nervous system. However, in routine practice out of the many challenges posed by the parents due to lack of education, denial of consent for this procedure is a great challenge at clinical settings. Objectives: To determine the association of various factors with parental refusal for lumbar puncture among pediatric population (age from 1 moth to 18 years). Materials and Methods: A descriptive, cross-sectional study was carried out at the department of pediatrics and child health and department of Emergency at Aga Khan University Hospital, Karachi from June 2017 to May 2018. A total of 178 children 1 month to 18 years old admitted with febrile fits, suspected meningitis or encephalitis who were advised for lumber puncture were included. Results: In the present study, the age of the patients ranged from 1 month to 18 year. Majority of the patients 153 (85.39%) were between 1 month to 6 years of age. There were 115 (64.61%) male patients.. Fever and fits was the most frequent indication (n=151, 84.83%) for lumber puncture in the study. Most of the parents were educated, 68.54% of mothers and 65.17% fathers had graduate level of education, and parents of 47 (26.4%) patients refused for lumber puncture. Conclusion: This study concluded that frequency of parental refusal for lumbar puncture was 26.4% and the most common reason for refusal was fear of complications. Keywords: lumbar puncture, febrile seizures, parental refusal.

Bezoars are an undigested mass causing an intraluminal obstruction in children.  Pharmacobezoars are formed from medicines or their vehicle, considered as a less frequent type observed in children. Our objective is to report a relatively rare entity as a potential cause of intestinal obstruction in children.  Here we report a case of 13-year-old girl with a history of herbal medicine intake who presented with persistent vomiting and abdominal distension. She was diagnosed with acute intestinal obstruction and managed conservatively without any complications. The patient became stable within two days so was discharged home. We found that ineffective history could lead to a delay in diagnosis and management. Clinicians should have a high index of suspicion for pica and psychiatric disorders, especially in adolescent children.

Introduction:One million children die each year from injuries around the world, with poisoning being the fourth most common cause.Children below five years are at an increased risk because of their exploratory nature and hand to mouth activity, accounting for 15% of accidental poisoning related deaths in this age group.A community oriented study that studiedthe national health survey of Pakistan reported that the incidence of accidental poisoning was 4.3% among children below five years. Objectives: To determine the socio-demographic factors affecting accidental toxic ingestion in children younger than five years at Aga Khan University Hospital, Karachi. Materials & Methods:A descriptive cross-sectional study was carried out at the emergency Deptof the Aga Khan University Hospital in Karachi, Pakistanbetween August 2016 to July 2017. Children with a history of accidental ingestion were included in the study. Descriptive statistics and Chi-square association was used employed using SPSS version 23. Results: A total of 97 children between the age group of 6 months – 5 years were enrolled, amongst 61 (62.88%) male. 74 (76.29%) children had unsafe storage of hazardous chemicals, 34 (35.05%) had large family size, 5 (5.15%), 3 (3.09%), and 3 (3.09%) of participants had lower socioeconomic status, uneducated, and rural residents respectively. Practical implication Conclusion: Awareness to parents regarding child protective strategies and usage of safe packaging in medicines may avoid accidental toxic ingestion. Keywords: Accidental poisoning, Socioeconomic Status, Education.

Bezoars are an undigested mass causing an intraluminal obstruction in children.  Pharmacobezoars are formed from medicines or their vehicle, considered as a less frequent type observed in children. Our objective is to report a relatively rare entity as a potential cause of intestinal obstruction in children.  Here we report a case of 13-year-old girl with a history of herbal medicine intake who presented with persistent vomiting and abdominal distension. She was diagnosed with acute intestinal obstruction and managed conservatively without any complications. The patient became stable within two days so was discharged home. We found that ineffective history could lead to a delay in diagnosis and management. Clinicians should have a high index of suspicion for pica and psychiatric disorders, especially in adolescent children.