Objective: To find out the prevalence of different types of arrhythmias in children with congenital heart defects (CHDs) presenting at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: July 2021 to June 2022. Material & Methods: A total of 120 children of both genders aged 1 day to 16 years and presenting to study setting with confirmed CHDs were evaluated. At the time of enrollment, demographical information and disease history were noted. Necessary laboratory investigations like complete blood count and serum electrolytes were analyzed while standard electrocardiography (ECG) was performed. Prevalence of different types of arrhythmias was noted. Results: In a total of 120 children with CHDs, 64 (53.3%) were boys. Mean age was be 2.7±2.1. Most common electrolyte abnormalities were noted to be hyponatremia and hypermagnesemia found in 39 (32.5%) and 26 (21.7%) children respectively. There were 31 (25.8%) children who were diagnosed to have arrhythmias. Out of these 31 children, first degree A-V block was the most common types of arrhythmias observed in 24 (77.4%) cases while ectopic A-V rhythm were found in 3 (9.7%). Conclusion: The findings of this research revealed that arrhythmias are quite common among children having CHDs. There is a need to routine assessment for the possible presence of arrhythmias among children presenting with CHDs.

Objective: To find out the prevalence and pattern of congenital heart diseases (CHDs) in children with Down syndrome (DS). Study Design: Cross-sectional study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha, Pakistan. Period: January 2021 to December 2022. Material & Methods: A total of 165 children of either gender, aged 1 month to 12 years with DS diagnosed with the help of typical clinical features and confirmation by cytogenetic studies were analyzed. Children diagnosed with DS were further evaluated for cardiac assessment as per 2-D echocardiographic and Doppler examinations. The prevalence of CHDs was noted among children with DS. Results: In a total of 165 children with DS, 86 (52.1%) were male. The mean age was noted to be 1.8±1.2 years while 106 (64.2%) children were aged below 1 year. The existence of CHDs was found to be in 56 (33.9%). Among 56 children with CHDs, ventricular septal defect (VSD), atrial septal defect (ASD) and tetralogy of fallot (TOF) were the commonest forms of CHDs noted in 16 (28.6%), 12 (21.4%) and 9 (16.1%) children respectively. Conclusion: High prevalence of CHDs in children with Down syndrome was noted. The VSD and ASD were the most common forms of CHDs among children with Down syndrome.

Objective: To find out the frequency of cardiovascular anomalies in infants born to diabetic mothers (IDMs). Study Design: Case-control study. Setting: Department of Pediatric Medicine and the Department of Obstetrics & Gynecology, Rai Medical College / Teaching Hospital, Sargodha. Period: January 2022 to December 2022. Material & Methods: A total of 50 term IDMs were enrolled in case group while equal number of healthy infants (n=50) were enrolled as controls. All mothers received prenatal care. Standard diagnostic criteria were followed for labeling diabetes and gestational diabetes. All infants underwent detailed physical and clinical examination. Demographic and maternal characteristics along with perinatal and maternal information were noted. All infants underwent echocardiographic evaluation. Results: In a total of 100 infants, 51 (51.0%) were boys and 49 (49.0%) girls. The mean birth weight, Apgar score (at 5-minutes), maternal age and gestational age were 2.84±1.8 kg, 8.8±0.7, 29.5±3.2 and 37.4±1.8 weeks respectively. Maternal hypertension was observed among 12 (12.0%) subjects. Birth weight (p<0.0001), maternal age (p=0.0129) and gestational age (p=0.0110) were significantly higher among cases while Apgar score was significantly lower among cases in comparison to controls (p=0.0028). Cardiovascular anomalies were diagnosed in 10 (20.0%) cases in comparison to 3 (6.0%) controls and the difference was found to be statistically significant. Among IDMs, hypertrophic cardiomyopathy (HCM) was the most frequent cardiovascular anomaly, noted in 4 (8.0%) cases. Conclusion: The frequency of cardiovascular anomalies was significantly high among IDMs in comparison to infants born to non-diabetic mothers. IDMs should undergo cardiac examination to rule out the possibility of existing cardiovascular anomalies.

Objective: To analyze children of congenital heart defect hospitalized with lower respiratory tract infections (LRTIs). Study Design: Cohort study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: July 2021 to June 2022. Material & Methods: Echocardiography confirmed known CHD cases of both genders aged 1 month to 10 years and hospitalized with LRTI were included. Demographic and clinical data were noted while relevant radiological examination and bacterial culture / respiratory virus panel from nasopharayngeal swabs examined. Types of CHD (acyanotic or cyanotic), types of bacterial causative agents and outcomes in terms of duration of hospitalization (days) and mortality or discharged were noted. Results: In a total of 63 children, 34 (54.0%) were male. The mean age was 1.56±1.42 years while 46 (73.0%) children were aged below 1 year. Assessment of causative agents revealed that 9 (14.3%) had viral involvement, 8 (12.7%) bacterial agents. Majority of the children, 44 (69.8%) had acyanotic CHD while remaining 19 (30.2%) had cyanotic CHD. Need for pediatric intensive care unit (PICU) admission was noted in 22 (34.9%). Although, need for PICU stay was more among children with acyanotic CHD when compared to cyanotic CHD, but the difference did not reach statistical significance (40.9% vs. 21.1%, p=0.1292). Likewise, duration of hospitalization was relatively more among children with acyanotic CHD when compared to children with cyanotic CHD but the difference did not reach statistical significance (17.65±8.21 vs. 14.3±6.84, p=0.1243). Conclusion: Majority of the children with CHD hospitalized with LRTI were below 1 year of age. Acyanotic CHD was the most common CHD type. Mortality was relatively low and most of the children with CHD hospitalized with LRTI were treated and discharged successfully.

Objective: To determine the clinical profile of children presenting with acute rheumatic fever (ARF) at a tertiary care healthcare facility. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: January 2021 to December 2022. Material & Methods: We analyzed children of both genders aged between 1 month to 18 years and presenting with ARF. At the time of enrollment, medical history was obtained and physical as well as clinical examinations were performed. The demographical and clinical information were recorded. ARF was labeled as per “Modified Jones Criteria”. A special proforma was formed to record study data. Results: In a total of 154 children, 96 (62.3%) were female while the mean age was 9.3±4.6 years. Forty four (28.6%) patients were having first episode of ARF while 110 (71.4%) had recurrence of ARF. Fever was noted to be the most common presentation noted in 121 (78.6%) patients of ARF. Arthritis was significantly more common among patients with first episode of ARF when compared to recurrence of ARF (70.5% vs. 29.1%, p<0.0001). Degree of carditis was significantly more severe among patients with recurrence of ARF (p<0.0001). Conclusion: Majority of the acute rheumatic fever patients present with recurrence of acute rheumatic fever. Fever was the commonest clinical presentation while arthritis was significantly more prevalent among patients with first episode of acute rheumatic fever.