Despite being prevalent in the cities of Gilgit-Baltistan and Azad Jammu Kashmir in north-eastern Pakistan, diagnosing visceral leishmaniasis for doctors in Pakistan can be an arduous task. We present here, a case of a five-year-old boy, who presented to us with a history of intermittent, high-grade fever, abdominal pain that was localized to the left side and abdominal distention as well as pallor for the past two and a half months. The child also developed measles in the week before presenting to us at Civil Hospital Karachi.On examination, the child looked pale, with several hyperpigmented lesions on the face and nose. There was bilateral pedal edema, which extended upward to the thighs and generalized lymphadenopathy. The examination of the respiratory and cardiovascular system was normal. On examination of the abdomen, there was marked hepatosplenomegaly. A diagnosis of visceral leishmaniasis was made based on the findings of routine blood investigations indicative of pancytopenia, clinical manifestations, and epidemiology and, finally, a bone marrow biopsy report with demonstrable Donovan bodies. The patient's condition improved after five weeks of treatment with intravenous amphotericin B deoxycholate.

The prevalence of anemia in chronic kidney disease (CKD) patients is almost twice that of the normal population and its severity increases exponentially as the disease worsens, dramatically affecting the quality of an individual's life. The advent of erythropoiesis stimulating agents (ESA) in the 1980s saw a revolutionary change in the treatment of anemia in CKD patients, drastically improving quality of life (QoL), overall health and reducing the need for blood transfusions. Numerous ESAs have been developed ever since and are in current use, with the primary routes of administration being intravenous (IV) and subcutaneous (SC) injections. Their use, however, has stirred significant controversy over the last two decades. Additionally, despite numerous studies and trials, the latest international recommendations for their use do not provide clear cut guidance with well-grounded evidence on the recommended route of administration for different sets of patients. Instead, this decision has mainly been left up to the physician's discretion, whilst keeping certain key factors in mind. This review shall summarize, discuss and compare the findings of previous studies on various factors governing the two aforementioned routes of administration and identify areas that need further exploration.

Microcephalic osteodysplastic primordial dwarfism type 2 (MOPD2) is a rare autosomal recessive disorder that presents as a myriad of skeletal abnormalities collectively termed as osteodysplasia, which have their onset during intrauterine life with the fetus exhibiting intrauterine growth restriction. Affected individuals also tend to have a very small head size that is more than three standard deviations (SD) below the mean for a population termed microcephalic. The growth problems progress postnatally, causing stunted growth or short stature. In this report, we present the case of two siblings: a 15-year-old unvaccinated female weighing 8 kg (case one), and a seven-year-old unvaccinated female weighing 6 kg (case two), who presented to the Department of Pediatrics, Unit 2 at the Civil Hospital in Karachi, Pakistan, complaining of short stature since birth.