Background: Seizures are the most common neurologic emergency in pediatrics and can be terrifying for patients and families. They occur in approximately 4-10% of children and account for 1% of all emergency department visits. There are a variety of potential causes for seizures; however, they have a final common pathway which includes abnormal electrical discharges of neurons. The extent of this abnormal discharges and their location in the brain leads to a variety of clinical presentation which range from subtle, non-convulsive events to dramatic generalized convulsions. Most common biochemical abnormality causing seizures is hypocalcemia, which in children may manifest astetany, seizures, muscle cramp, and paresthesia. Objectives: The objective of the study was to: determine the frequency of hypocalcaemia in children presenting with afebrile seizures from age 2 months to 2 years. Study Design: Descriptive cross sectional study. Settings: Pediatric emergency and outpatient department of Pediatric Medicine Unit 1, Independent University Faisalabad. Period: Six months from 01.01.2018 to 30.06.2018. Methodology: After Approval from Ethical committee, 86 children presenting in pediatric emergency of Independent Hospital Faisalabad who meet the inclusion criteria were enrolled in this study. Detailed history and informed consent was obtained from parents of each patient presenting with first episode of afebrile seizure. Blood serum sample was sent to the hospital pathology laboratory for assessment of serum calcium. Routine investigations to rule out other causes of seizures were also done. All the data was recorded on a predesigned performa. Inclusion and exclusion criteria were strictly followed. Results: In this study, out of 86 cases, 55%(n=47) were between 2-12 months of age and 45%(n=39) were between 13-24 months of age, mean+sd was calculated as 12.33+5.27 months, maternal age shows that 72.24%(n=58) were between 18-30years of age and 30.76%(n=29) were between 31-45years of age, mean+sd was calculated as 29.52+3.70 years, 52.38%(n=44) were male and 47.62%(n=42) were females, frequency of hypocalcaemia in children presenting with afebrile seizures from age 2 months to 2 years was recorded in 66.48%(n=56) cases. Conclusion: We concluded that the frequency of hypocalcaemia is higher in children presenting with afebrile seizures from age 2 months to 2 years, and by controlling hypocalcemia, we may reduce the risk of seizures.

Background and Objective: The long QT syndrome (LQTS) is a repolarization defect of heart involving potassium linked channels and it usually manifests clinically as seizures, syncope, or sudden cardiac death syndrome in children secondary to its characteristic ventricular tachy-arrhythmia like torsades de pointes. The reason behind epilepsy or seizures like activity in this disease is the sequelae of prolonged cerebral hypoperfusion secondary to the cardiac dysrhythmia. The aim of study is to look for clinical spectrum and risk factors associated with LQTS among children presenting with epilepsy, which can predict the early diagnosis of LQTS. Materials and Methods: For this observational study, 422 patients having epilepsy presenting for the first time in a 3-year period were enrolled. Demographical profile, LQTS measures, and various factors under observation were recorded. Results: Among the 422 enrolled children (M: F 1.8:1) with age ranging from 4 to 87 months (median 23 months), 8 (1.9%) children who presented with epilepsy had LQTS. Among those, mean QTc on electrocardiogram was 454 ± 31 msec and mean Schwartz score >3. Half of the patients with LQTS had deafness (P = 0.002) and 37.5% had a positive family history (P = 0.0045). Nearly a third (37.5%) presented with syncope and 87.5% patients with LQTS had no postictal drowsiness or sleep (P ≤ 0.004). Conclusions: LQTS is underestimated in children presenting with epilepsy and LQTS should be considered as an alternate diagnosis in children with recurrent seizures or syncopal attacks. The brief period of seizures with no postictal drowsiness, syncope, and strong family history are the features which may help in segregating LQTS from epilepsy.

Combined congenital aortic and pulmonary valvular stenosis is a rare congenital heart defect. Prevalence of severe combined valvular stenosis of aortic and pulmonary valve accounts about 0.01% and also has association with many syndromes.  This combination presents unusual diagnostic as well as management problems. Apart from a few case reports, there is little in the literature on the combined stenosis of both semilunar valves and its management. We present this rare combination in a 9 year old boy which was promptly managed with the balloon valvoplasty without any complications in the same setting under local anesthesia with sedation.