Objective: To determine the relationship between serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) with active disease in patients with juvenile rheumatoid arthritis (JRA). Methods: This is a cross-sectional analytical study conducted at the Department of Paediatrics, Abbasi Shaheed Hospital, Karachi for one-year duration from April 2020 to April 2021. All patients who met the MJA’s American College of Rheumatology (ACR) criteria were enrolled in the study. The ACR 20 improvement criteria were used to define the pardon of the disease, and those who met the ACR20 recovery criteria were included in the remission group. Laboratory tests such as PCR and ESR. Statistical analysis was performed using SAS software (version 10.3). Results: The study involved 90 patients, including 28 in the remission group (31.2%) and 62(68.88%) in the active disease group. There were 61.11% (n = 55) of females, and the ratio of males to females was 3: 4. The mean age of the subjects was 10.12 ± 3.39 years (4–17 years). Distribution of the age of admission by different subgroups, 13 patients (14.44%) aged 1-5 years, 31 patients (34.44%) aged 5-10 years, 40 patients (44.44%) aged 10-15 years and 6 patients (6.66%) were over 15 years old. The mean duration of the disease was 2.40 + 2.11 years (range = 0.3–7 years). The onset of the disease in 21 patients (23.33%) lasting one year (22.9%) from the onset of the disease, 48 patients (53.33%) presented one to five years from the onset of the disease, and 21 patients (23.33%) over five years. The most common type of arthritis was polyarthritis in 43 patients (47.77%), followed by oligo-arthritis in 31 patients (34.44%) and systemic onset in 12 patients (13.33%). The mean ESR was 41.03 + 27.80 mm / hour 1. (Range = 07-128 mm / hour 1) And mean CRP 16.1 + 13.80 mg / L (range = 6-47 mg / L). While the ESR was> 30 mm / 1 hour in 50 of the 90 patients (55.55%), 43 of these 50 patients (86%) were in the active disease group. Similarly, positive CRP was found in 58 patients (64.44%), of whom 52 (89.7%) belonged to the group with active disease. Compared with the remission and active disease groups, 33 patients of active diseases were female. In the active disease group, the mean age was 11.01 + 3.30 years, and the duration of the disease began at one year in patients. Polyarthritis was detected in 26/62 (41.9%) of patients in the active disease group. Conclusion: High CRP and ESR parameters are good for predicting active disease in JRA patients. Keywords: C-reactive protein, Juvenile rheumatoid arthritis, JRA and Erythrocyte mentation rate.

Background and purpose: Data on the epidemiology of acute kidney injury (ARI) in Asia come primarily from studies conducted in large tertiary hospitals with nephrology departments. Little is known about what happens in primary care settings without nephrology, especially in the paediatric population. The aim of this study is to describe the epidemiology, outcome and risk factors of ARF in children admitted in pediatric department. Place and Duration: In the Pediatric Medicine and Nephrology department of Abbasi Shaheed Hospital for one-year duration from August 2020 to August 2021. Methods: We prospectively examined children aged 2 to 14 whose guardians gave the consent for the study and were admitted in the Pediatric ward. We identified children with risk factors for AKI on admission and then tested them for AKI using the 2012 Creatinine-based Modified General Kidney Disease Improvement (KDIGO) criteria to improve overall outcomes. Participants with AKI were followed up to discharge. The subject of interest was the need and access to dialysis and renal recovery on discharge from the hospital. Results: A total of 74.3% (n = 116) out of the 156 patients admitted during the study period were at risk of ARF. Of the 156 registered participants, 51.9% (n = 81) were males with a mean age of 5 years. Although comorbid conditions were rare, sickle cell anaemia and malnutrition were the most common. Most of the children were hypotensive (n = 89; 57.1%), with mean systolic and diastolic blood pressures of 81 mmHg and 42 mmHg, respectively. The mean urine output was 0.79 ml / kg / hr. Thirteen patients (8.33%) had urine dipstick anomalies. Anaemia was common (n = 72, 46.2%) and 32 (20.5%) had severe anaemia. Leucocytosis was detected in 26.3% of patients, and a platelet count below 100,000 / mm3 in 24 (15.4%) patients. In total, 21 of 156 participants had AKI for an incidence of 13.5%. The only patient with an indication for dialysis (uremic encephalopathy and anuria> 24 hours) died without dialysis due to a delay in transfer to a dialysis centre (due to lack of resources). Of the 20 survivors in the AKI group, 15 (71.4%) had complete improvement in kidney function The median hospitalization time was significantly longer in participants with stage 3 AKI. Conclusions: ARF risk factors are very common in children admitted in the hospitals. At least one in 10 children presenting with AKI risk factors will have AKI. AKI is largely caused by community-acquired diseases that can be prevented, such as diarrheal diseases and malaria. Efforts should be made to educate about risk assessment, prevention, early diagnosis and treatment of AKI in children. Keywords: AKI; epidemiology; risk factors and outcome.

Background: Assisted ventilation has turn out to be an essential part of the neonatal intensive care unit (NICU). It is one of the main methods of support in the ICU and undoubtedly influences the survival of sick newborns. Aims: 1. To investigate common indications for mechanical ventilation in newborns 2. To investigate factors influencing the outcome. Method: It is a descriptive study of 60 infants admitted to the Department of Pediatric Medicine in the ICU over a one-year period in the department of Paediatrics, Abbasi Shaheed Hospital. The information was gathered and analysed in a pre-designed format. Results: Of a total of 60 infants, 46 survived, 14 died, and one infant was discharged despite medical advice. 36 children were born vaginally, 20 were born via LSCS, and 4 via assisted delivery. Postnatal asphyxia was the most common ventilation indication in full-term newborns, while HMD was present in preterm infants. The best results were obtained in ventilated infants with MAS, with 100% survival, followed by apnoea in premature infants, perinatal asphyxia, and HMD. Pulmonary haemorrhage (48.3%) was the most common complication among deceased infants, followed by sepsis (28.3%) and shock (23.4%) with a significant p <0.05. There were no complications in 76.7% of the surviving infants. Conclusions: Among the many widely available variables studied in this study, maximum and mean peak inspiratory pressure (PIP or (PEEP), maximum respiratory rate, maximum mean airway pressure (MAP) and average ventilation demand was much greater among non-survivals in comparison to the survivors. Bicarbonate, PH and excess base have been found to be important determinants of mortality in ventilated newborns. Keywords: Indications, mechanical ventilation and Results

The Culture of numerous contaminated fluids of the body are commonly used to determine the aetiology of infection and to help medicine specialists and pediatricians to select the suitable antimicrobial treatment. The objective of this analysis is to govern the culture and sensitivity patterns to bacteriological agents’ grownup in children. Methods: This descriptive cross-sectional study was held at the Paediatric Medicine department of Abbasi Shaheed Hospital Karachi, for one-year duration from November 2020 to November 2021. All ≤15-year-old children who met the criteria for sepsis and systemic inflammatory response syndrome were included in the study. Any body fluids or blood were cultivated in the suitable medium as specified. The sensitivity pattern and profile of the cultured microorganisms were recorded and documented in a pre-designed data sheet. SPSS v.22 was applied for data analysis. Results: Of the 300 patients enrolled, 51 (17%) developed multiple organisms in culture and these have been described in more detail. Of these 51 patients with positive culture, 47.1% were male with a M:F ratio of 1.3: 1. Of the 51 patients, 21 (41.2%) were less than one- year old, and 14 (27.5%) were one to five years old, 9 (17.6%) was between 5 and 10 years old and 7 (13.7%) were 10 to 15 years of age. Twenty-three patients (45.1%) showed an increase in microorganisms in the blood smear. Throat swab, tracheal secretions and sputum cultures were positive in 11 patients (21.6%), CSF cultures were positive in 13 (25.5%), and urine cultures in 10 (19.6%), Swabs (ear and skin) cultures were positive in 7 (13.7%) and 3 (5.9%) have positive pleural fluid cultures. The most frequently isolated microorganism is Salmonella spp. (17.6%), Klebsiella spp. (15.7%), Escherichia coli (11.8%), Acinetobacter (9.8%), Staphylococcus aureus (7.8%), Pseudomonas aeruginosa (13.7%), Streptococcus pyogenes (7.8%), Stenotrophomonas maltophilia (3.9%) and Enterobacter spp. (7.23%). Conclusions: The most frequently isolated microorganisms were Salmonella spp., Staphylococcus aureus, Klebsiella spp., E coli and Streptococcus pyogenes. The antibiotics resistance in various cultures is a warning in contradiction of overuse of antibiotics.

Background: Respiratory tract infection is a disease that can result in high mortality and morbidity. Factors related with severe respiratory infections in children comprise the age of young children, male sex, malnutrition, incomplete vaccination status and breastfeeding only children. This analysis targets the Role of multi-strain probiotics as supportive therapy in reducing the frequency and severity of respiratory infections among children. Place and Duration: In the Pediatric Medicine department of Abbasi Shaheed Hospital, Karachi for six months duration from January 2021 to June 2021. Methods: This was a randomized controlled study in 74 children aged 2 months to 5 years with respiratory infections receiving standard therapy and multi strains probiotics versus standard therapy and placebo. The assessment regarding treatment was done in both groups. Results following 7 days of adjuvant treatment alienated into group I (n = 37) (standard therapy and multi strains probiotics) and II Group (n = 37) (placebo and standard therapy). The factors evaluated in this analysis included subject characteristics, duration of stay, duration of fever, dyspnea, withdrawal, C-reactive protein, rales, breast history and probiotics use. The analysis of data was accomplished using SPSS version 20.0. Results: The males were 51.4% and females were 49.6%), breastfeeding (83.8% in Group-I vs 67.6% in Group-II), children who were not malnourished (81.1% in Group-I vs 86.5% in Group-II), and children who completed vaccination history (91.9% in Group-I versus 78.4% in Group-II). As shown in Table 1 in groups I and II, correspondingly, the mean concentration of CRP in subjects diagnosed with respiratory infections was not statistically significant in 1st group (30.10 (20.01-44.60 mg / l), relative to Group II (28.23 (19.20-46.12 mg / l), respectively (P = 0.39).Multivariate analysis with Ancova showed that probiotics can significantly decrease the time of Rale by 5.84 hours (p = 0.021, CI 95% -10.90 - (- 0.87). Conclusions: In this study, it was found that multi strains probiotic therapy significantly reduced the duration of Rale among children with infections of the upper respiratory tract. Keywords: Respiratory tract infections, children, multi strain probiotics, efficiency.