Objective: To determine etiology and outcome of children with lower gastrointestinal bleeding (LGIB). Methods: This was a prospective study conducted at the Department of Pediatric Gastroenterology and Hepatology, Children’s Hospital and The Institute of Child’s Heath, Multan, Pakistan, from July 2019 to March 2020. A total of 148 cases presented with bleeding per rectum and underwent colonoscopy, were included. Children of both genders and aged three month to 15 years were included. Detailed history, clinical examination, laboratory studies, colonoscopy and histopathology were done in all cases. Study information like demographics, complaints, general clinical examination, colonoscopy and histopathological findings were recorded. Results: Overall, mean age was noted to be 7.20±1.83 years. Abdominal pain was reported in 41 (27.7%), diarrhea 36 (24.3%), fever 12 (8.1%) and constipation in 4 (2.7%). Pallor was noted among 68 (45.9%), weight loss 39 (26.3%) and tachycardia 31 (20.9%). Colonoscopy revealed juvenile colonic / rectal polyps, infectious colitis and solitary rectal ulcer (SRU) as the most common etiologies found among 58 (39.2%), 20 (13.5%) and 19 (12.8%) cases respectively. Juvenile polyps and non-specific colitis were the commonest histopathological findings seen in 55 (37.2%) and 20 (13.5%) cases respectively. Colonoscopic polypectomy was used to remove all juvenile polyps. Conclusion: LGIB is presentation of various underlying causes. Children with LGIB commonly present with abdominal pain. Juvenile polyps were the most frequent cause of LGIB among children flowed by non-specific colitis. Most of the children having LGIB were diagnosed and treated successfully, few are in remission and very few were found resistant to treatment. doi: https://doi.org/10.12669/pjms.37.2.2676 How to cite this:Talib MA, Aziz MT, Suleman H, Khosa GK, Joya SJ, Hussain I. Etiologies and outcome of lower gastrointestinal bleeding in patients presenting to a tertiary care Children’s Hospital. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.2676 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objectives: To compare the mean hemoglobin level before and six weeks after giving intravenous iron sucrose therapy in malnourished children having iron deficiency anemia. Study Design: Quasi Experimental Study. Setting: Nutritional Stabilization Centre, Children Hospital and Institute of Child Health, Multan. Period: From July 2018 to December 2018. Material & Methods: A total of 80 patients were enrolled in the study. Hemoglobin level at baseline was recorded. IV iron sucrose therapy was divided into 3 equal doses and administered on 3 consecutive days. After 6 weeks of administration of iron sucrose, hemoglobin level was noted. Independent sample T-test was applied to compare Hb level before and after therapy with p-value≤0.05 as significant. Results: Overall, mean age was 13.39±6.11months. There were 54 (67.5%) males and 28 (32.5%) females. The mean weight of patients was 5.06±1.45kg and mean height was 64.59±8.72cm. The weight for height ratio was <-3SD in all patients (100%). The mean hemoglobin level of patients at baseline was 7.37±0.44g/dl, which was improved to 9.47±0.47g/dl after 6 weeks treatment. This was significant improvement (p<0.05). Conclusion: Thus intravenous iron sucrose therapy can significantly improve the condition of child and rectify the IDA.

Objectives: The anemia of chronic kidney disease (CKD) is commonly normocytic and normochromic. The objective of current study was to see the effectiveness of erythropoietin in correcting anemia in children with CKD. Study Design: Descriptive case series. Setting: Department of Nephrology, at The Children’s hospital and the institute of child health, Multan. Period: From March 2018 to September 2018. Material & Methods: A total of 79 children with CKD were enrolled in this study. A standard dose of erythropoietin 100 IU/kg was given s/c biweekly and after 4 weeks patients were assessed for improvement in Hemoglobin (Hb) level. Data were entered and analyzed using SPSS-18. Results: Of the 79 cases, 48 (60.8%) were boys and 31 (39.2 %) girls. Mean age amongst cases was 9.92 ± 2.60 years and mean weight 19.65 ± 4.71 Kilograms. Mean baseline hemoglobin level of our study cases was 7.88 ± 1.09 gm/dl. Mean hemoglobin level after 4 weeks of therapy with Erythropoietin was 9.22 ± 1.04 gm/dl. Majority of our study cases i.e. 56 (70.88 %) were having stage 1 and 2 of CKD. Correction of anemia (effectiveness) was seen in 72 (91.1%) of our study cases. Conclusion: Recombinant human erythropoietin aid major improvement / correction of anemia in children with CKD. This drug can be safely used in children with CKD disease without any side effects such as hypertension.

Background and Objective: Parathormone (PTH) and serum Vitamin D3 (VD3) share a complex interplay where increased VD3 leads to a negative response on parathormone level. Our objective was to determine the correlation of parathormone (PTH) and Vitamin D3 (VD3) levels in nursing mothers and infants 1-6 months’ age from South Punjab, Pakistan. Methods: This study is a secondary data analysis of previously conducted cross sectional study which was conducted at the Department of Pediatric Medicine, Nishtar Medical University, Multan, during August 2010 to June 2011. Study included 67 infants 1-6 months of age and 60 nursing mothers. A venous blood sample was drawn for estimation of VD3, calcium, phosphate, alkaline phosphatase, parathormone and albumin. Spearman correlation coefficient was calculated to determine the inverse correlation between PTH and VD3 levels. Results: Mean age (in days) of the infants was 83±53.7 days whereas maternal mean age was 25.53 ± 4.12 years. Median VD3 level in infants was 20.90 ng/ml (IQR – 49.5). Median serum PTH levels were 20.90 pg/ml (IQR – 26.17). Median VD3 level in nursing mothers was 21.0 ng/ml (IQR 7.2– 43.8). Median maternal serum PTH levels were 20.89 pg/ml (IQR 2.9 – 232.4). Substantial negative relation between VD3 and parathormone in infants and mothers was not evident (r = - 0.027, p-value 0.83) and (r = 0.156, p-value 0.23) respectively. A significant positive association between infant and maternal VD3 was observed (rs –0.55, p-value < 0.001). Conclusion: Our study affirms that the customary negative correlation between VD3 and parathormone levels does not exist. doi: https://doi.org/10.12669/pjms.36.5.2150 How to cite this:Mustafa G, Khalid M, Ahmed I, Talib MA. Correlation of serum levels of Vitamin D3 with serum parathormone in nursing mothers and infants 1-6 months’ age from South Punjab, Pakistan. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.2150 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The subject of nutrition in intensive care is being discussed among the pediatric intensivists since long. The nutritional supplementation plays a vital role in treatment of pediatric intensive care patients. In recent past, due to technological advances the pathophysiology of critical diseases is being better understood so better nutritional strategies are being implemented in critical care units. As a result the prognosis of intensive care patients is improving resulting in decreased length of stay and less number of deaths of these patients. The metabolic stress in sick patients is an important factor to be considered while calculating the nutritional requirements of patients. The body’s physiological mechanisms in the event of stress due to critical illness, need to be understood to make nutritional assessment of pediatric critical patients. The purpose of the current review is to recognize the recent nutritional supplementation guidelines of pediatric critical patients and to discuss any controversial issues. A meticulous study of the published literature regarding supplemental nutrition, energy calculation and algorithmic protocols for nutritional targets in pediatric critical population was done and areas in need of future research were identified.