Background: Diphtheria remains an important cause of paediatric mortality in developing countries. The mortality rate is still ∼10% and has changed little over the past 20 years with particular reference to developed world. The objective of this study is to examine clinical spectrum of diphtheric cardiomyopathy and by using tools (serum markers, ECG, Echocardiography) to predict the cardiomyopathy and role of steroids in these predicted patients. Methods: For this cohort study, 67 patients having diphtheria presenting for the first time in a 3-year period were enrolled after obtaining informed verbal consent from the guardian of each child. Demographical profile, vaccination status, clinical spectrum, ECG interpretation and echocardiographic findings were recorded that predicted the occurrence of diphtheric cardiomyopathy and used intravenous methylprednisolone pulses in these predicted patients to look for their outcome regarding change in severity or the fate in the form of mortality. Results: Among the 67 enrolled children (M: F 2.3:1) with age ranging from 24 to 172 months (median 106 months), 56.7% subjects presented with diphtheria were non-vaccinated. 37.3% had a cardiac involvement in the form of diphtheria cardiomyopathy or arrhythmia.7.5% patient expired on follow up. Presence of septal paradoxes on echo had association with the cardiac involvement (OR 10.1: 95% CI 1.2-84.6; p=0.0005). IV methyl prednisolone was given in all 37.3% (n=25) patients predicted as diphtheric cardiomyopathy (Asymptomatic) and 88 %(n=22) had a favourable outcome with no morbidity and mortality. 12% (n=3) were expired and they presented with shock and VT as their first presentation (symptomatic). Conclusion: Early prediction by alone or in combination of ECG and echocardiographic markers and early use of IV methyl prednisolone in these predicted patients before symptoms, can reduce the mortality related to diphtheric cardiomyopathy and can decrease the burden of the disease in the community. Further randomized controlled trials with a larger sample size are required to unambiguously delineate the prognostic value of steroids in early predicted diphtheric cardiomyopathy.

Introduction: Endotracheal intubation and ventilation is often required to manage acute respiratory failure in critically ill patients. Despite being lifesaving therapy, mechanical ventilation can frequently cause problems with significant hazards, including the nosocomial infection recognized as ventilator associated pneumonia. Objective: To determine the frequency of ventilator associated pneumonia in children > 1 month -15 years of age. Study Design: Cross sectional study. Duration of Study: 06-11-2015 to 05-05-2016. Setting: Department of Pediatric Medicine Unit-1, Allied Hospital, Faisalabad. Sample size: The total sample size was 96 cases. Sampling Technique: Non probability purposive sampling. Methodology: Total of 96 patients, having age range from >1 month to 15 years, on mechanical ventilation due to any reason for more than 48 hours were enrolled in study. Patients already having pneumonia were excluded from the study. All patients underwent detailed medical history and physical examination followed by investigations i.e. complete blood count, C reactive protein and X-ray chest.

Objectives: To determine the relationship of etiology with the type ofcerebral palsy in children. Study Design: Descriptive case series. Setting: Department of Paediatrics, Allied Hospital,Faisalabad. Period: From January 2002 to December 2004. Patients and Methods: 120 children from 1-12 years ofage of either sex who presented in Paediatric Department with abnormalities of tone, posture and movement andsubsequently diagnosed as cerebral palsy on the basis of history, physical examination and investigations, wereincluded. Results: Out of 120 cases the majority had spastic CP, 72% (n = 86) such as quadriplegic, diplegic andhemiplegic types. The spastic quadriplegia was mainly associated with birth asphyxia and meningoencephalitis.Prematurity and low birth weight were the major contributors towards diplegic CP, while spastic hemiplegia althoughless common was caused by meningoencephalitis in 5 cases and intra cranial bleed and asphyxia in 3 cases each.Atonic or hypotonic CP found in 23 cases, were caused by meningoencephalitis, kernicterus, birth asphyxia andprematurity. 10 cases of atonic CP did not have any reason (hence idiopathic). Athetoid CP was mainly due tokernicterus, meningoencephalitis and asphyxia. Ataxic and mixed types of CP were present in 3 cases each and weredue to meningoencephalitis and birth asphyxia.