Background:Genetic and environmental factors are important determinants of disease distribution. Several disorders associated with ataxia are known to occur more commonly in certain ethnic groups; for example, the disequilibrium syndrome in the Hutterites. The aim of this study was to determine the ethnic and geographic distribution of pediatric patients with chronic ataxia in Manitoba, Canada.Methods:We identified 184 patients less than 17 years-of-age with chronic ataxia during 1991-2008 from multiple sources. Their diagnosis, ethnicity and place of residence were determined following a chart review.Results:Most patients resided in Manitoba (N=177) and the majority in Winnipeg, the provincial capital. Thirty five Aboriginal, 29 Mennonite and 11 Hutterite patients resided in Manitoba. The latter two groups were significantly overrepresented in our cohort. Ataxia telangiectasia, mitochondrial disorders, and non-progressive ataxia of unknown etiology associated with pyramidal tracts signs and developmental delay were significantly more common in Mennonite patients. Four of five patients with neuronal migration disorders associated with chronic ataxia were Aboriginal. Few isolated disorders with chronic ataxia occurred in the 11 Hutterite patients including a Joubert syndrome related disorder.Conclusions:Three disorders associated with chronic ataxia were more prevalent than expected in Mennonites in Manitoba. Few rare disorders were more prevalent in the Hutterite and Aboriginal population. Further research is needed to determine the risk factors underlying these variations in prevalence within different ethnic groups. The unique risk factor profiles of each ethnic group need to be considered in health promotion endeavors.

Background: Malnutrition has become quite common among children especially in rural areas of Pakistan. The nutritional status of children under the age of five was assessed and the degree of malnutrition and its associated factors were studied. The socioeconomic status, delayed weaning and lack of education of parents are some of the key reasons of malnutrition in case of children. Objectives: This study aimed to analyze the nutritional status of children under the age of five years in Pakistan Study design: This is a cross-sectional study conducted on 250 children that visited the tertiary care center Shaikh Zayed Hospital, Rahim Yar Khan and Abbasi Shaheed Hospital, Karachi from May 2021 to April 2022.The study duration was one year. Materials and methods: The data was taken from 250 children, among these there were 147 boys and 103 girls. Written consent was taken from the parents, and they were fully aware of the study. The children were selected as per Non-probability convenient sample method. The physical growth and nutritional condition was evaluated by making use of basic anthropometric technique. A semi-structured questionnaire was prepared and face to face interview was carried out with the mothers of the children. SPSS version 16 was used for calculations and statistical analysis was done by using the same software. Results: Out of 250 children that were included in the study, 147 were boys and 103 were girls. By using the Gomez classification, the degree of malnutrition was analyzed among the children. It was observed that 150 children were facing malnutrition. 28% of the cases had first degree malnutrition, 14% and 17% had second and third degree condition. Stunted growth was observed in 130 children. There were 285 children with mild stunted growth; however 8% and 11% had moderate and severe form of stunted growth problem. Lack of education of mothers was seen to be directly linked with malnutrition in this study. Conclusion: Health education about proper breast feeding and immunization of children should be provided to the parents to prevent malnutrition among children. Keywords: Nutritional status, Risk factors, Child, Malnutrition

Background: Chest pain is the communal complaint among pediatric age groups. Chest pain due to heart disease is rare in children and adolescents, with an incidence of less than 6%. History and physical examination may be sufficient to identify the most important etiologies. Aim: The aim of the study is to review various causes of chest pain in young patients admitted to a pediatric cardiology clinic. Method: We retrospectively analyzed the clinical data of our patients visited to emergency or outpatient clinics in our hospital with chest pain from March 2022 to October 2022. A total of 56 patients (36 females and 20 males), aged 5-15 years were included in this study. Follow-up of the patients was carried out by calling all relatives of the patient and asking about the child's condition and chest pain. Clinical history and physical examination were performed. Results: A total of 56 patients between the ages of 5 and 15 were enrolled in the study, with a mean age of 11.78 ± 2.95 years. Six cases (10.7%) were identified to have a cardiac cause. 16 individuals (28.6%) had a respiratory cause identified. 3(5.4%) of patients referred to a gastroenterology clinic with gastrointestinal causes. The diagnosis of idiopathic chest pain was made in 6 individuals (10.7%) after a negative history, physical examination, and testing. Conclusion: Chest pain in children is usually mild. However, thorough physical examination and detailed history should be performed to detect any signs of disease. Keywords: Chest pain, Pediatric patients, Echocardiography.

Background and purpose: Data on the epidemiology of acute kidney injury (ARI) in Asia come primarily from studies conducted in large tertiary hospitals with nephrology departments. Little is known about what happens in primary care settings without nephrology, especially in the paediatric population. The aim of this study is to describe the epidemiology, outcome and risk factors of ARF in children admitted in pediatric department. Place and Duration: In the Pediatric Medicine and Nephrology department of Abbasi Shaheed Hospital for one-year duration from August 2020 to August 2021. Methods: We prospectively examined children aged 2 to 14 whose guardians gave the consent for the study and were admitted in the Pediatric ward. We identified children with risk factors for AKI on admission and then tested them for AKI using the 2012 Creatinine-based Modified General Kidney Disease Improvement (KDIGO) criteria to improve overall outcomes. Participants with AKI were followed up to discharge. The subject of interest was the need and access to dialysis and renal recovery on discharge from the hospital. Results: A total of 74.3% (n = 116) out of the 156 patients admitted during the study period were at risk of ARF. Of the 156 registered participants, 51.9% (n = 81) were males with a mean age of 5 years. Although comorbid conditions were rare, sickle cell anaemia and malnutrition were the most common. Most of the children were hypotensive (n = 89; 57.1%), with mean systolic and diastolic blood pressures of 81 mmHg and 42 mmHg, respectively. The mean urine output was 0.79 ml / kg / hr. Thirteen patients (8.33%) had urine dipstick anomalies. Anaemia was common (n = 72, 46.2%) and 32 (20.5%) had severe anaemia. Leucocytosis was detected in 26.3% of patients, and a platelet count below 100,000 / mm3 in 24 (15.4%) patients. In total, 21 of 156 participants had AKI for an incidence of 13.5%. The only patient with an indication for dialysis (uremic encephalopathy and anuria> 24 hours) died without dialysis due to a delay in transfer to a dialysis centre (due to lack of resources). Of the 20 survivors in the AKI group, 15 (71.4%) had complete improvement in kidney function The median hospitalization time was significantly longer in participants with stage 3 AKI. Conclusions: ARF risk factors are very common in children admitted in the hospitals. At least one in 10 children presenting with AKI risk factors will have AKI. AKI is largely caused by community-acquired diseases that can be prevented, such as diarrheal diseases and malaria. Efforts should be made to educate about risk assessment, prevention, early diagnosis and treatment of AKI in children. Keywords: AKI; epidemiology; risk factors and outcome.

Background: Assisted ventilation has turn out to be an essential part of the neonatal intensive care unit (NICU). It is one of the main methods of support in the ICU and undoubtedly influences the survival of sick newborns. Aims: 1. To investigate common indications for mechanical ventilation in newborns 2. To investigate factors influencing the outcome. Method: It is a descriptive study of 60 infants admitted to the Department of Pediatric Medicine in the ICU over a one-year period in the department of Paediatrics, Abbasi Shaheed Hospital. The information was gathered and analysed in a pre-designed format. Results: Of a total of 60 infants, 46 survived, 14 died, and one infant was discharged despite medical advice. 36 children were born vaginally, 20 were born via LSCS, and 4 via assisted delivery. Postnatal asphyxia was the most common ventilation indication in full-term newborns, while HMD was present in preterm infants. The best results were obtained in ventilated infants with MAS, with 100% survival, followed by apnoea in premature infants, perinatal asphyxia, and HMD. Pulmonary haemorrhage (48.3%) was the most common complication among deceased infants, followed by sepsis (28.3%) and shock (23.4%) with a significant p <0.05. There were no complications in 76.7% of the surviving infants. Conclusions: Among the many widely available variables studied in this study, maximum and mean peak inspiratory pressure (PIP or (PEEP), maximum respiratory rate, maximum mean airway pressure (MAP) and average ventilation demand was much greater among non-survivals in comparison to the survivors. Bicarbonate, PH and excess base have been found to be important determinants of mortality in ventilated newborns. Keywords: Indications, mechanical ventilation and Results