OBJECTIVE: To determine cut off value of procalciton (PCT) in aseptic end stage renal disease patients undergoing haemodialysis. BACKGROUND: Haemodialysisis considered as a proinflammatory state and therefore associated with release of inflammatory cytokines and acute phase reactant proteins. The conventional laboratory markers (C-reactive protein, erythrocyte sedimentation rate) are efficient tools for the diagnosis of infection in patients with normal kidney functions. However they can be nonspecifically elevated in patients on haemodialysis and only reflect inflammatory response not associated with infection. PCT is considered a very important biomarker in differentiating infections from inflammation. The study was undertaken to evaluate normal serum levels of PCT in patients undergoing HD.PATIENTS AND METHOD: The study included 82 end-stage renal failure patients without evidence of systemic or localized infection undergoing maintenance haemodialysis. RESULTS: In our study, the PCT concentrations showed a mean of .622ng/ml in patients on maintenance hemodialysis without signs of infection. CONCLUSION:The study suggests that serum PCT at a cutoff value of .62ng/ml should be considered normal in aseptic haemodialysis patients. KEYWORDS: Procalcitonin, haemodialysis, sepsis

Objective: To determine the frequency of Urinary tract infections in children presenting with fever without a focus -a tertiary care hospital experience. Material and Methods:It is a descriptive cross sectional study to find out the frequency of UTI conducted from 26th April to 25th October 2013. Patients of either gender, 1 month to 36 months of age, presenting with the complaints of fever without focus were included. History and physical examination were done; urine sample was collected for analysis and culture. Data was recorded on a pre designed Proforma. Mean and standard deviation for quantitative, frequencies and percentages for qualitative variables were computed. Stratification was done to observe the effects of modifiers on outcome. Post stratification chi square test was applied and p value ≤ 0.05 was considered as significant.Results: Among total 126 study subjects 62 patients were male. The mean age was 13.96 ± 8.56 months. Mean age of patients was 13.88 ± 6.50 months and 13.97 ± 8.86 months for patients with and without UTI respectively. Among patients with urinary tract infection, 9(52.9%) were male and 8(47.1%) were female patients. Age of 9(52.9%) patients was ≤13 months and age of 8(47.1%) patients was >13 months. There was no significant association of UTI observed with gender (p = 0.741) and age (p = 0.794). Conclusion:UTI is a common infection that can be easily missed in young children. Screening patients at risk can lead to proper diagnosis and a reduction in morbidity.

BACKGROUND Adequate nutrition is critical to child development especially from birth to two years of age. In India, about 65 percent of under five children suffer from varying degrees of malnutrition. The health indicators of Kerala are higher compared to other states in India, there are certain backward pockets mostly in slums, coastal and tribal settlements. The objective is to study the nutritional profile of children less than 2 years from a rural area in Kerala. MATERIALS AND METHODS Children of 1 to 24 months of age were included from Talikulam Panchayath, a rural area in the district of Thrissur, Kerala. Weight, height and mid arm circumference were analysed by using WHO Z scores & IAP classification. The degree of stunting and wasting were categorized as per Waterlow's classification. Relation of low birth weight and exclusive breast feeding with malnutrition were also studied. RESULTS Out of 376 children 19.9 % came under mild PEM, 6.1% moderate and 1.3 % with severe malnutrition and 72.7% had no malnutrition according to IAP classification. 33.5% had first degree stunting, and 3.2% had second degree stunting and no stunting in 62.5%. 20.5 % had grade 1 wasting. Measurement of Mid Arm Circumference showed 37.6% moderate PEM and 7 % severe PEM. 88.5% had birth weight ≥ 2.5 kg and 11.5% had low birth weight. In the normal birth weight category, 74.8 % had normal weight for age, while within low birth weight, only 53.5% were normal. Only 40.8% were exclusively breastfed for 6 months and received appropriate complementary feeding. In <6 months age group, the prevalence of PEM was higher using WHO standards than using IAP. CONCLUSION The prevalence of under nutrition in 1-24 months of age is 27.7% as per IAP standards and 22.4 % by WHO-Z score. More stunting in females. Low birth weight has statistically significant association with PEM. Only 41 % of children are exclusively breast fed for six months. 37.5 % of children are stunted indicating greater degree of chronic malnutrition.

Total 106 study subjects were included in the study with non probability consecutive sampling technique. WHO software for sample size determination was used considering 12 P=13.33% , d=6.5%, with 95% confidence level. Inclusion criteria were age between 2 to 12 years of either sex with symptoms of airflow obstruction characterized by recurrent cough, difficulty in breathing and wheeze. Children having known or suspected immunodeficiency, congenital heart disease, neurologically impaired children (as they are at risk for recurrent aspiration), lung diseases like tuberculosis, bronchiectasis, cystic adenomatoid malformation of lung and cystic fibrosis were excluded from study. Children having the history of allergic rhinitis, allergic dermatitis, autoimmune diseases and parasitic infections were also METHODS ORIGINAL ARTICLE

Objective: To determine the frequency and clinical spectrum of common congenital heart disease (CHD) in preterm newborns attending public sector tertiary care hospital. Methods: A descriptive cross-sectional study was conducted at Neonatal Intensive Care Unit (NICU) of Liaquat National Hospital Karachi from October 2016 to March 2017. Record of preterm newborns having gestational age ≤37 weeks admitted to NICU were included. Cardiovascular examination and echocardiography were performed. If a defect was discovered on echocardiography, the type of CHD was also documented. CHD was labeled as positive based on the presence of anyone of the following: visual septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA) and tetralogy of fallot (TAF). Results: Of 106 patients, CHD was observed in 21 (19.8%) cases. Of these, VSD was found in 8 (38.1%), ASD in 5 (23.8%), while PDA and TOF in 4 (19%) each. A significant association of CHD was observed with birth weight (pvalue <0.001), history of CHD in siblings (p-value <0.001), consanguinity (p-value 0.005), and history of unexplained deaths in siblings (p-value 0.011). The mean birth weight was found significantly higher among neonates without CHD as compared to the neonates with CHD i.e., 2.83 ± 0.61 kg vs. 2.05 ± 0.56 kg (p-value <0.001). Conclusion:The current study findings revealed that twenty percent of the preterm neonates admitted in NICU had CHD. Furthermore, an increased risk of CHD was observed in premature low birth weight neonates, those with history of CHD in siblings, history of unexplained deaths in siblings, and consanguineous marriage.