Urinary tract infections (UTI) have a prevalence of 1% in boys and about 1-3% in girls. It is more common in boys under 1 year of age after which the incidence is higher in girls. Vitamin D is a fat-soluble vitamin that is synthesized in the skin epithelial cells and also obtained from diet. It has an important role in bone formation and deficiency of vitamin D leads to rickets in children. Objective: To determine the mean levels of vitamin D in children with first episode of urinary tract infection. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Study was conducted at Department of pediatrics, Fauji Foundation Hospital Rawalpindi from 16th Nov, 2021 to 16th May, 2022. Materials and Methods: 50 patients fulfilling the criteria for first episode of urinary tract infection included. All patients age, gender, height and weight were noted. Samples were inoculated on culture media and were examined at 24-48hrs for colony counts and bacterial identification. All patients who were tested positive for urinary tract infection had their serum Vitamin D 25(OH) D3 levels done, a deficiency was defined as values of less than 25ng/ml. Data was entered and analysed in SPSS version 22.0 Results: Mean age (6.70+3.9) with ranges from 02 to 12 years and Mean height (cm) and weight (kg) were (121.76+31.58), (25.64+12.36) respectively. There were 12 (24.0) male and 38 (76.0) female patients who were included in the study according to the inclusion criteria. Mean vitamin-D levels in children with first episode of urinary tract infection in the study was (23.46+1.68). Mean vitamin-D levels in children with first episode of urinary tract infection in children ages 02-06 years was (23.36+1.36), whereas mean vitamin-D levels in children ages 7 – 12 years was (23.54+1.91), Mean vitamin-D levels in among male and female children with first episode of urinary tract infection was (22.83+1.26) ( 23.66+1.76) which was statistically not significant (p-value 0.139). Mean vitamin-D levels in children with first episode of urinary tract infection in children have height between 101 – 175 cm, was (23.50+1.18). Mean vitamin-D levels in children with first episode of urinary tract infection in children having weight between 21 – 50 kg was (23.63+1.88). Conclusion: The study concluded that average vitamin D deficiency was substantial among children with urinary tract infection. Keywords: Urinary tract infections. Vitamin D levels, E coli

Objective: Our study's goal is to find out how common stunting and obesity are among Pakistani children aged 2 to 5 years old. Study Design: Descriptive study Place and Duration: Shalamar Medical & Dental College Lahore and Quetta Institute of Medical Sciences. Jan, 2021 to June, 2021. Methods: There were 130 children with age 2-5 years were presented in this study. Detailed demographics of enrolled cases included age, sex; weight and height were recorded after taking informed written consent from the parents of children. Maternal demographics status was also recorded. Frequency of stunting was recorded with respect to weight of included patients. SPSS 24.0 was used to analyze complete data. Results: Among 130 children, there were 80 (61.5%) males and 50 (38.5%) females in this study. The mean age of the included children was 5.9±12.42 years and had mean weight 17.16±12.52 kg. Children had mean height 109.5±11.22 cm. Majority of the patients were underweight 75 (57.7%), 45 (34.6%) children were obese and frequency of severe underweight were 10 (7.7%). As per maternal status, majority were had poor socio economic status. Frequency of stunted children was 19 (14.6%), in which 8 (4.6%) cases were obese while remaining 13 (10%) were underweighted. Among 19 cases of stunted children, 11 (57.9%) were females and 8 (42.1%) were males. Conclusion: We concluded in this study that prevalence of stunting among obese children was 4.6% and majority were females in these cases. Poor-socioeconomic status of mothers was the most common factor of stunting among children. Treatments that can address these issues, such as community-based education and focused nutritional interventions, are thus needed to lessen the impact of malnutrition. Keywords: Children, Obese, Stunt, Underweight, Gender

Background: Arthrogryposis multiplex congenita (AMC) is a rare syndrome with multiple joint contractures. The number of studies which have been previously done on Pakistani population to investigate patients with arthrogryposis is limited. Aim: This study presents our experience with evaluation and management of children with AMC at The Children Hospital & the Institute of Child Health, Lahore. Method: During the period from January 2018 to December 2018, we evaluated 25 children with AMC. The mean age at the time of evaluation was 20.56 months (range, 5 days to 9 years). All of the included patients were evaluated in terms of their clinical state according to selected subjective and objective criteria. Result: Our results indicate that shoulders were internally rotated (20%), the elbows were extended (36%), and the wrists (76%) and digits (56%) were flexed. Thumb was adducted (36%), hands were clawed (52%) and palmar crease was absent (28%). Hips were found to be dislocated (16%) and adducted (16%). Knees having extension contracture (32%); feet were in equinocavovarus (72%). Calf muscles were atrophic (56%). Conclusion: Our experience shows that the clinical findings are highly variable between families and also within families with AMC. Joint manipulation and casting during the first few months of life may produce considerable improvement. Orthotics may help. Surgery may be needed later, but mobility is rarely enhanced. Muscle transfers may improve function. Many children do remarkably well; two thirds are ambulatory after treatment. A multidisciplinary team evaluation of the child with AMC is recommended for specific diagnosis and planning of treatment. Keywords: Arthrogryposis multiplex congenita (AMC), clinical evaluation

Objective : Urinary tract infection is one of the commonest infections in the pediatric age group. The emergence of resistance to various antibiotics has posed many difficulties in treating such patients. This study has been done to compare the efficacy of fosfomycin & ciprofloxacin in pediatric Urinary tract infection (UTI). Study Design: Randomized Control study Place and Duration: Akhtar Saeed Medical College/ Farooq Hospital. July, 2021 to Dec, 2021 Methodology: This randomized controlled clinical trial is done at the Department of Pediatrics, Akhtar Saeed Medical College/ Farooq Hospital. One hundred and thirty individuals who met the criteria for UTI were recruited. The patients were split into two groups at random. Patients in Group A received 15–20mg/kg of oral Ciprofloxacin twice daily (BD) for 7 days, whereas those in Group B received 150–300mg/kg of oral fosfomycin all at once. Results: One-hundred and ten patients included in this trial. In group A mean age of the paties was 6.4±2.8 years and in group B patients had mean age 7.7±3.0 years. There were 35 males (63.6%) and 20 females (36.4%) in group A and in group B 33 males (60%) and 22 females (40%). As per effectiveness we found that fosfomycin was effective in 42 patients (76.4%) and ciprofloxacin was efficacious in 30 patients (54.5%) with p-value 0.016. Conclusion: When comparing the treatment of children with acute uncomplicated urinary tract infections, the results showed that a single oral dosage of fosfomycin was substantially more effective than ciprofloxacin. Keywords: Antibiotics, Resistance, uropathogens, paediatrics, UTI, gram-negative,

Aim: To determine the nutritional status of children under five-years of age, the factors related to it and the degree of malnutrition. Study Design: A cross-sectional study. Place and Duration: In the department of Paediatrics, Hayatabad Medical Complex, Peshawar for the duration of six months from July, 2021 to Dec, 2021. Methods: Using a non-probability-based convenient sampling technique, approximately 130 children under the age of five were selected. The nutritional status and physical development of children was assessed with simple anthropometric technique. A partially pre-tested organised survey form was given to collect the data by face-to-face interviews with the mothers of the children. SPSS version 22.0 was applied for data collection and to estimate percentages and numbers. Results: Of 130 children, 80(61.5%) were male and 50(38.5%) were female. According to the classification of Gómez's, 102 children had Malnutrition out of 130 children; 55 (42.3%) had grade I, and 24 (18.5%) had grade II and 23 (17.7%) had grade III malnutrition. Of 80 children, 32.3% had mild stunned growth, 16.9% moderate stunned growth, and 12.3% severe stunned growth. When status of immunization was calculated, 32 (24.6%) were nonimmunized, partially immunization was seen in 65 (50%) children and fully immunization in 33 (25.4%) cases. Of the 98 uneducated mothers, 60(63.2%) had malnourished children, 70(71.4%) had Kwashiorkor, and 28(28.6) had marasmus. Of 130 children, 90 were breastfed and children on bottle-fed were 40. Conclusions: The malnutrition rate was augmented among children <5 years of age (78.6%) due to inadequate eating habits. Accompanying influences were insufficient immunization and illiterate mothers. The education regarding health counting adequate weaning, exclusive breastfeeding, family planning and routine immunization via schedule of EPI should be encouraged. Keywords: Nutritional status, Child, Risk factors, Protein and Energy malnutrition.