Objective: To evaluate and compare the effectiveness of zinc and B-Complex supplementation to prevent the recurrence of nephrotic syndrome in the cases priory responsive to corticosteroid therapy. Methodology It is a randomized controlled trial conducted at OPD Pediatric medicine, Shaheed Zulfiqar Ali Bhutto University, PIMS Children Hospital Islamabad from October 3, 2016 to April 2, 2017. 192 patients (96 in each group) were included in the study after obtaining informed consent from parents or guardians taken before determining the population. Patients were randomly assigned to two groups (Group 1: Zinc and Group 2: B-Complex) to receive oral zinc sulphate (10 mg / day) or B-Complex using a random number table. The patients were followed up after 4 months. All data were collected by the researchers themselves in a structured form. Results: The age of 192 participants of the trial averaged 6.38±3.42 years of age ranging from 1-12 years. There were 88 (45.8%) men and 104 (54.2%) women cases. In group 1, there were 22 (22.9%) and in group 2, there were 47 (49%) cases that had been pardoned. The recurrence of nephrotic syndrome was significantly higher in group 1 than group 2 (p = <0.001). Conclusion: The findings of this study suggest that Zinc supplementation is more preferrable to B-Complex supplementation as the rate of continuous remission was higher in the zinc group, so in the future may be added to the treatment regimen to treat steroid-sensitive nephrotic syndrome.

Tetanus is initiated by the release of neurotoxins. The progressive paralysis of several muscles is due to contamination of the wound by the toxin. The case under discussion was about a patient with the tetanus infection after ear piercing due to unsterilized instruments and lack of awareness of complications. Due to the late presentation to the hospital, leading to a delay in treatment, the child could not survive. Physicians need to have a vigilant eye to have a high suspicion for tetanus at a very early stage and immediate initiation of advanced critical care, which can favour lifesaving interventions. Prophylactic tetanus toxoid should be administered before any body piercing

Objective: To determine accuracy of cord blood bilirubin in identifying significant neonatal hyperbilirubinemia. Methodology: A Cross sectional study was conducted in Pediatric department of Fauji Foundation Hospital Rawalpindi from Jan.2019 to June 2019. Cord blood samples were sent for the blood group and bilirubin levels. Neonates with cord bilirubin level > 2mg/dl and < 5 mg/dl were enrolled and admitted for 3 days and serum bilirubin level were done on 3rd day. Those developing significant hyperbilirubinemia were further investigated for hemoglobin, reticulocyte count, Coomb’s test and other causes. Results: Total 74 newborns at >35 weeks of gestation were included in the study of which 35 (47.3%) were male and 39 (52.7%) were female (male: female: 1:1.1). The data was analyzed using SPSS 17. At 3rd day of life mean ± SD cord blood bilirubin was 8.4 ± 2.7 mg/dl, mean direct bilirubin was 1.6 ± 0.9 mg/dl and mean indirect bilirubin was 6.8 ± 2.3mg/dl. Significant hyperbilirubinemia developed in 16 (21.6%) newborns at >35 weeks of gestation, who had a cord blood bilirubin level of > 2 mg/dl, so that the accuracy of cord blood bilirubin level (true positives) in determining significant hyperbilirubinemia was 21.6%. Conclusion: Cord blood bilirubin level >2mg/dl in all healthy term newborns predicts significant hyperbilirubinemia.

Objective: This study was conducted to compare epinephrine and salbutamol nebulization in emergency management of moderately ill children less than one and a half years old with bronchiolitis in terms of mean change in respiratory distress assessment instrument (RDAI) score. Materials and Methods: Randomized controlled design was selected in this trial at the Department of Pediatrics, KRL Hospital Islamabad, Pakistan from 24th April 2016 to 24th October 2016. Sixty children with acute bronchiolitis, having a moderate degree of illness (RDAI 8-15) were included in this study. Patient were randomly allocated into Group A (epinephrine = 0.1 mL/kg in concentration of 1:10000) and Group B (salbutamol = 0.15 mg/kg combined with 3 mL 0.9% normal saline). It was delivered by a nebulizer and a face mask with a continuous flow of 6 L/min at100% oxygen. Data was collected on a predesigned performa and assessed with reference to mean change in RDAI score. Results: The patients ' mean age in Group A and Group B were 10.57±4.22 and 11.63±3.14 months, respectively. The majority of the patients were males (56%). The mean RDAI score was insignificant between the two groups, both at baseline (11.57±2.21 in epinephrine group vs 11.3±2.14 in salbutamol group, p = 0.63) and 125 minutes (4.77±2.19 in Epinephrine group vs 5.43±1.69 in Salbutamol group, p = 0.19). However, when stratified according to age and gender, the mean RDAI score was found statistically significant among the 2-12 months age group (p = 0.0045) and female gender (p = 0.0052). Conclusion: Epinephrine and salbutamol have similar effects in acute bronchiolitis when compared with regards to mean change in RDAI score.

Objective: To determine the outcome of preterm neonates with the early introduction of bubble continuous positive airway pressure (CPAP). Methodology: This observational study was conducted in NICU of Shifa International Hospital, Islamabad from March 2017 to August 2017. Ninety preterm infants were enrolled with a gestational age of 28 to 37 weeks and with the clinical features of Respiratory Distress Syndrome (RDS). Infant variables that were recorded were birth weight, gestational age, and severity of RDS and Fio2 requirement. Bubble CPAP was started at 5cm of water and FiO2 adjusted to maintain SpO2 of 87 to 95%. The SPSS 26 version was used to analyze data. The Chi square test was used, with a P value of <0.05 considered significant. Results: The study included 90 neonates who were clinically diagnosed with RDS. To treat RDS, CPAP was started at the mean age of 5.27 hours of life with a standard deviation of 2.66 hours. 11 out of 90 (11.22%) babies had chest X-ray findings in favor of severe RDS; while X-rays of the remaining 79 (88.78%) showed mild to moderate RDS. Conclusion: CPAP is of valuable importance in low resource countries with a lack of ventilators and provides an adequate and conservative treatment method of mild to moderate RDS for preterm neonates. However, in cases of severe RDS, intubation and mechanical ventilation are often necessary.