Background: Childhood SLE is a severe autoimmune disease involving multiple systems that effect peoples globally. Aim: To delineate the spectrum of clinical manifestations of childhood SLE at the Government Children’s Hospital Lahore. Study design: Descriptive observational study. Methodology: Study was carried out at department of Pediatric medicine, unit 1, Children’s hospital Lahore from January 2016 to December 2019. Applying a nonprobability convenience sampling technique, children between 1-16 years of age with childhood systemic lupus erythematosus attending rheumatology outpatient clinic or admitted through emergency were included in study. Written and verbal informed consent was obtained after explanation of study purpose. Results: There were 59 (78.70%) female and 16 (28.3%) male patients enrolled in the study. Mean age at diagnosis was 10.89±3.4% years. Female predominance was noticeable. Amongst the clinical features fever (96%) was the commonest, followed by oral ulcers (74.70%), alopecia (72%), renal manifestations (69.30%), rash (61.30%), arthritis (56%), and hematological abnormalities (48%), photosensitivity (44%), neurological features (36%) in 24% of patients. Conclusion: It was concluded that disease was prevalent among all races around the world but in South Asia there are few studies available on its prevalence. Timely diagnosis by a detailed history, physical examination and laboratory evaluation can improve the chances of prolonged disease-free periods and better survival of children. Keywords: Childhood SLE, ACR and SLICC.

Objective: to determine the frequency of hypomagnesaemia in severe acute malnutrition, aged 6 – 59 months. Methodology: Patients admitted in Pediatric Medical Unit of Children Hospital, Lahore fulfilling the inclusion criteria were enrolled in the study. Their MUAC along with weight for height/length was taken and also examined for bilateral pitting edema. Venous sample was taken for serum magnesium level and studied in labs of CHL. Hypomagnesaemia was labeled as per operational definition. Treatment given in form of magnesium sulfate after confirming hypomagnesaemia. Results: Of 200 cases, 58%(n=116) were between 6-36 months of age whereas 42%(n=84) were between 37-59 months. mean +sd was calculated as 34.9+11.36 months. 50.5%(n=101) were male while 49.5%(n=99) were female, mean magnesium level was calculated as 1.94+0.30 mg/dL. Frequency of hypomagnesemia in severe acute malnutrition, aged 6 – 59 months was recorded in 31.5%(n=63) of the cases. Conclusion: frequency of hypomagnesemia is significantly higher in cases with malnutrition, however, a larger study is required to record the rate of this morbidity in our region. Keywords: Malnutrition, hypomagnesemia, 6-59 months of age

Wilms tumour is the most common renal malignancy in children, with two-thirds of cases diagnosed before five years and 95 percent before 10 years of age. Over the last decade, the five-year survival rate has improved dramatically and now approaches 90 %. Tumour lysis syndrome, commonly seen in association with haematological malignancies, is rarely seen in Wilms tumour. We present two cases of Wilms tumour developing tumour lysis syndrome in the first week of initiation of chemotherapy. Both patients presented with huge abdominal masses causing mass effect on surrounding structures. Chemotherapy was administered as per International Society of Pediatric Oncology guidelines (SIOP). Both patients developed laboratory and clinical tumour lysis syndrome (TLS) after the first cycle of chemotherapy requiring continuous renal replacement therapy (CRRT). However, both died because of multiorgan failure. Key Words: tumour lysis syndrome, Wilms tumour, chemotherapy, continuous renal replacement therapy, case report.

Background: Culture from various infected body fluids is one of the commonly used investigations to establish the etiology of infections and helps clinicians to select appropriate antimicrobial therapy. This study is aimed to determine the culture and sensitivity patterns of bacteriological agents grown in children admitted to a tertiary care center. Patients and methods: This descriptive cross-sectional study was conducted at the Department of Pediatric Medicine, The Children’s Hospital and the Institute of Child Health, Lahore from April 2019 to December 2019. All admitted children of age £ 15 years who fulfilled the criteria of systemic inflammatory response syndrome and sepsis were enrolled in the study. Blood and other body fluids were cultured in appropriate medium as indicated. Profile of microorganisms grown and their sensitivity patterns were noted and recorded on a predesigned data sheet. Statistical analysis was performed by SPSS v.22. Results: A total of 500 patients were enrolled in the study. Eighty-three of them (16.6%) had growth of different microorganisms on culture and were further analyzed. Total 58 of these 83 (69.87%) were <5 years of age, Male to female ratio was 1.2:1. Blood culture was positive in 36 patients (43.37%). Cultures from throat swabs, sputum and tracheal secretions showed growth of organisms in 15 (18.10%), while cerebrospinal fluid culture was positive in 14 (16.87%) and urine culture in 11 (13.25%). Microorganism isolated were: Klebsiella spp. (15.66%), Salmonella spp. (14.45%), Escherichia coli (13.25%), Staphylococcus aureus (12.04%), Acinetobacter (12.04%), Streptococcus pyogenes (10.84%), Pseudomonas aeruginosa (10.84%), Enterobacter spp. (7.23%) and Stenotrophomonas maltophilia (3.61%). Klebsiella spp. and E. coli showed resistant to various antibiotics including penicillin, co-amoxiclav, cephalosporin, fluoroquinolones and nalidixic acid. Salmonella spp. was mostly sensitive to meropenem and azithromycin. Staphylococcus aureus was sensitive to cephalosporin, amikacin, vancomycin and linezolid. Conclusion: Commonest micro-organism isolated were Klebsiella spp., Salmonella spp., Escherichia coli, Staphylococcus aureus and Streptococcus pyogenes. Resistance to commonly used antibiotics was observed in most cultures, which is a whistle blower against inappropriate use of these drugs.

<p><strong>Background and Objective:</strong> Pandemics like COVID-19 adversely affect children&rsquo;s behavior and psychological development by disrupting routine life activities. Children of healthcare workers are exposed additionally due to the fear of parental exposure to the virus. The objective of this study was to assess the perception of frontline healthcare workers (HCWs) regarding the psychological impact of the COVID-19 pandemic on their children. We also sought to identify the difference of the psychological impact on children of the male and female healthcare workers.<br /><strong>Methods:</strong> A survey questionnaire was developed comprising 10 questions about the perception of HCWs regarding the psychological impact of COVID-19 on their children. It was distributed both online and face to face among 150 healthcare professionals, working in training and non-training posts in 4 public and 5 nongovernment hospitals of Pakistan. The mean and standard deviation were calculated for each survey item using Statistical Package for the Social Sciences 26.0. Results: The response rate was 71.3% and majority (64.2%) of the healthcare professionals were &ge;30 years of age. Ninety-two HCWs (85.98%) either agreed or strongly agreed that the parental separation from their kids for long hours during the pandemic had a negative<br />psychological impact on their children. There was a significant difference in perceived psychological impact of COVID-19 on the children of male and female HCWs, with a mean survey score of 2.29 &plusmn; 1.82 and 1.69 &plusmn; 0.79, respectively (t = 2.29, p-value = 0.024).<br /><strong>Conclusion:</strong> Children of the healthcare workers experience more stress and anxiety because of long duty hours and working in high-risk settings. Continuous psychological support and counseling services may be adopted formally to prevent unforeseen adverse events or any long-term negative impact on their physical and mental health.</p>