Background: The National Institute of Child Health (NICH) is the largest tertiary care pediatric hospital operating in Karachi, Pakistan. Its emergency department (ED) is always occupied. However, the spectrum of illness in patients presenting to this ED has not been investigated in depth to identify the most common presentations and to develop effective management for treating patients.Methods: This retrospective study included all children visiting the pediatric ED of the NICH from January 2017 through December 2017. Newborns to children 14 years of age were included, for a total cohort of 188,803 patients. Sociodemographic data and clinical information were extracted from the medical record. Univariate analysis was performed to determine the frequency and percentage for all the variables.Results: The cohort consisted of 9% (n=16,952) neonates (0 to 1 month) and 91% (n=171,351) older children (>1 month to 14 years). Among the neonates, 36.6% presented as triage level 1. Sepsis was diagnosed in 23.8% of neonates, low birth weight/preterm in 18.4%, and respiratory distress/pneumonia in 15.2%. In infants and older children, diagnoses related to the respiratory system (37.3%), gastrointestinal system (16.4%), and multisystem involvement (15.9%) were the most common. During the evening shifts, 38.1% of patients were seen, and on weekends, 51.6% of patients were seen. Sunday was the busiest day in the ED.Conclusion: The tertiary care pediatric EDs in Pakistan have witnessed an increasing number of critical emergencies over time. Respiratory and gastrointestinal emergencies form the majority of the ED burden. A surge of patients is seen on the weekends and during the evening shifts. The spectrum of illnesses should be investigated via prospective, longitudinal studies in other pediatric EDs in Pakistan to understand the trends and to provide the foundation for developing nationwide recommendations for improving pediatric emergency care.

Background: To analyse the functional outcome of primary cemented bipolar hemi arthroplasty (PCBH) for unstable osteoporotic intertrochanteric femur fractures in elderly patients. Methods: It was a multicentre prospective study conducted at Institute of Orthopaedics & Surgery, Medicare Cardiac & General Hospital and Dr Ruth K M Pfau Civil Hospital Karachi, Pakistan from February 2015 to July 2020. Thirty-eight patients of 60–90 years of either gender diagnosed as close UIF, severe osteoporosis as per Singh index grade ≤3, time since injury <2 weeks, ASA status II & III and pre-injury independent walking were enrolled in this study. All patients with UIF underwent PCBH. The radiographs were performed before surgery and at intervals postoperatively. All patients were requested to come for follow up visits at 2 weeks, 4 weeks, 3 months, 6 months 1 year and then at 3 years to assess the functional outcome of patients. At first postoperative day check X-rays taken and rehabilitation started as per institutional rehabilitation protocol, at 2-week stiches removed, at 4 weeks’ x-ray was done and all the patients were followed for 3 years. The primary outcomes were noted using Harris Hip Score (HHS) for the functional outcome assessed at the end of 1 year and at final follow up. Results: The mean age of the study participants was 68.29±8.04 years. One male (2.6%) died at 6th month, then 2 females (5.2%) patients died at 1 year and 2 females (5.2%) patients died at the end of 3 years due to multiple comorbid conditions. During 1st year 3 patients (7.4%) developed DVT and 4 patients (10.5%) having diabetes and hypertension developed superficial wound infection. The mean Harris Hip Score between time points which indicated that the mean Harris Hip Score significantly improve over the period of time (p=0.001). Post hoc tests revealed that there were statistically significant differences between each time points (p<0.05). The functional outcome at 3 years, shown, one patient had excellent outcome, 24 patients had good outcome and 8 had fair outcome, respectively. Conclusion: The Primary Cemented Bipolar Hemiarthoplasty is a good choice of treatment in terms of reasonable functional outcome such as early mobilization and associated with less post-operative complications in elderly patients of UIF.

Objective: To study the efficacy of platelet-rich plasma with Methylprednisolone in patients with tennis elbow. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Orthopedics, Jinnah Postgraduate Medical Centre, Karachi, Feb 2019 to Sep 2020. Methodology: All the patients with chronic lateral epicondylitis with the onset of symptoms of greater than three months were grouped into two groups. Seventy-six patients in each group were treated. Group-A received an injection of 5ml Platelet-rich plasma. Group-B was administered 1 ml of Methylprednisolone (dosage; 4-30 mg). The severity of pain using the visual analogue scale was evaluated at baseline. Results: In the PRP group, significant changes in pain perception were observed. The mean baseline VAS score in the PRP group was 6.9 ± 1.7, which decreased to 3.4 ± 2.9, 1.7 ± 0.3, and 1.2 ± 1.4 at four weeks, 12 weeks, and 52 weeks follow-up visit, respectively. Similarly, in group-B (Methylprednisolone), there was a significant change from baseline to 52 weeks postprocedure (p<0.001). It was found that the efficacy of Platelet free plasma was significantly higher than methylprednisolone (77.6% versus 48.7%, <0.005). Conclusions: The study concluded that Plasma rich platelet therapy was significantly more effective in relieving the pain and improving the functional outcomes in patients with elbow epicondylitis than Methylprednisolone.

Measles is highly contagious infection with person-to-person transmission through droplet infection in developing countries, which can lead to death in complicated cases. Bronchopneumonia, encephalitis, gastroenteritis with renal failure and electrolyte imbalance are common complications in pediatric age group. Objective: To determine complications of measles in hospitalized children at Tertiary Care Children Hospital. Methods: This cross-sectional study conducted at inpatient medical wards of National Institute of Child Health from July-Dec 2022. All patients hospitalized in study duration with the diagnosis of measles from 6 months till 12 years of age were enrolled. History, examination, laboratory tests, treatment and outcome were recorded and analyzed. Results: Children enrolled were 185, the mean age ± SD of presentation was 26.7 ± 27.1 months, with 56.8% males. Mean weight of patients was 10.48 ± 9.7kg. Common measles complications were bronchopneumonia 160(86.5%), acute diarrhea 64(34.6%) encephalitis 24(13%), myocarditis 16(8.6%), acute kidney injury 11(5.9%), and otitis media 18(9.7%). Conclusions: Most common clinical features were fever, maculopapular rash, cough and coryza.  Bronchopneumonia was the main reason of hospitalization in majority of patients and leading cause of death in 13.5% of patients along with encephalitis and myocarditis. Additional strategies are required by government for elimination of vaccine preventable measles from Pakistan.

Background: Analyzing a blood film is the most accurate approach to determine the number of parasites present. People question which blood film and counting method is the most accurate and can be used again and over again. Objective: To see if thin peripheral blood smear films may identify malaria with little parasitaemia, thick peripheral blood smear films were used as the gold standard. Material and Methods: The study was conducted by the National Institute of Child Health in Karachi's Department of Paediatric Medicine and was a cross-sectional one. 177 people were admitted to the hospital. A vein yielded about 5 milliliters of blood for the experiment. As long as there was a single control band and two testing bands, the test result was positive for both P. falciparum and P. viridans. When the control band and the test band were found to be present, the test verified the presence of P. falciparum. Results were deemed negative if neither the test nor control bands appeared. Comparison of thin peripheral blood smear accuracy to the gold standard of thick peripheral blood smear accuracy was used to assess the thin blood smear diagnostic accuracy. Results: Sixty-one percent of the patients were men, and only 39 percent were women. The average age was 30 years and 15 months. The P.falciparum was 66.0%, the P.vivax was 22.7%, and the P.ovale was 11.3%. With a thick peripheral blood smear film, 52.5 percent were found to have scanty parasitaemia malaria, and 48 percent were found to have it with a thin peripheral blood smear film. The accuracy, specificity, and sensitivity were 95.3%, 87.5%, and 90.9%, respectively. Conclusion: The results of the study showed that thin blood smear films are accurate diagnostic tools 90.9% of the time. It could be used as a second way to confirm a diagnosis of malaria. Keywords: Diagnostic Accuracy, Thin Peripheral Blood Smear Film, Parasitaemia Malaria, Thick Peripheral Blood Smear Film