National Institute of Child Health

Karachi, Pakistan

National Institute of Child Health

Karachi, Pakistan
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Katz Y.,Allergy and Immunology Institute | Katz Y.,Tel Aviv University | Gutierrez-Castrellon P.,Hospital General | Gonzalez M.G.,University lle | And 4 more authors.
Clinical Reviews in Allergy and Immunology | Year: 2014

Since 1943, cases of sensitization or allergy to soy-based formulas (SBFs) have been described without any consensus on their real prevalence. We identified the adjusted prevalence of IgE-mediated soy allergies in children and performed a secondary analysis of the impact of age (less than and more than 6 months). We performed a systematic review with meta-analysis of studies published from 1909 to 2013 in PubMed, Embase, LILACS, ARTEMISA, Cochrane, Bandolier, DARE and the GRADE system for grading quality. Results are presented in tables and graphs using a forest plot. The 40 studies identified established weighted prevalence of soy allergies of 0 to 0.5 % (0.27) for the general population, 0.4 to 3.1 % (1.9) for the referred population, and 0 to 12.9 % (2.7) for allergic children. Prevalence of sensitization after the use of SBFs is 8.7 and 8.8 %, depending on the method used. The prevalence of allergies to soy and IgE sensitization to the use of SBFs is less than reported. Not enough evidence exists to show a higher risk of allergy in infants younger than 6 months. The concern about soy allergy is no reason to postpone the use of SBFs in IgE-mediated cow's milk allergy infants until the age of 6 months. © 2014 Springer Science+Business Media.

Ramet J.,University of Antwerp | Ramet J.,Universitair Ziekenhuis Antwerpen | Van Esso D.,CAP Serraparera | Meszner Z.,National Institute of Child Health
European Journal of Pediatrics | Year: 2011

A large proportion of sexually active adults are infected with the human papillomaviruses (HPVs). Although largely asymptomatic, some types of HPVs (HPV-16, HPV-18) which infect the genitalia are known to cause cancers, including cervical cancer. Cervical cancer is an important public health concern and is the second most clinically important cancer to breast cancer in women aged 15-44 years. Until recently, cervical cancer strategies focussed on screening. However, as adolescents become sexually active at a much younger age, the focus is on the use of vaccination as an effective measure to prevent progression of HPV infection to cancer. HPV is also involved in the aetiology of cancers of the anus, vagina, vulva and penis as well as genital warts and laryngeal papillomatosis in young children. Primary prevention through vaccination is now possible in Europe using either the quadrivalent HPV vaccine, Gardasil® (Sanofi Pasteur MSD), or the bivalent HPV vaccine, Cervarix® (GSK), which are both highly immunogenic, with their effects persisting for at least 5 years. HPV vaccines are well tolerated, with serious vaccine-related events occurring in less than 0.1% of patients for both vaccines. Here, we review the possibilities for utilising vaccination programmes alongside current cervical cancer screening in comprehensive cervical cancer prevention programmes. The European Academy of Paediatrics Scientific Working Group on Vaccination concluded that the use of HPV vaccines will have a significant impact in primary prevention of cancers and other HPV-related disease. © 2010 Springer-Verlag.

Habib M.I.,Child Life Foundation | Khan K.M.,National Institute of Child Health
Journal of the Pakistan Medical Association | Year: 2017

Objective: To quantify the extent of emergency department overcrowding in a tertiary care hospital and to identify possible solutions. Methods: This retrospective study was conducted at the National Institute of Child Health, Karachi, and comprised data of all patients presenting to the emergency department from November 2014 to January 2015. Data was collected through the health management information system which generates daily report of patients. Patients who stayed at the emergency department for 4 or more hours were included. Results: Of the 6,505 patients, 2,757(42.38%) were discharged straightaway while 2,555(39.27%) were admitted to different wards and subspecialties. Besides, 934(14.35%) patients left the department against medical advice, 147(2.25%) expired, 89(1.36%) were referred to other hospitals, 20(0.30%) were dead on arrival and 3(0.04%) left without being seen by a physician. Of those who were admitted, 1,049(41%) patients stayed for more than 10 hours before getting the main hospital bed. Mostly, the delays observed were due to delay in getting lab reports, already preoccupied ventilators and incubators in paediatric and neonatal intensive care units, not using checklist for proper re-assessment of patients and early discharge, overburdened by patients coming in just for nebulisation and intravenous or intramuscular medications, the admitting residents detain the unstable patient longer in emergency department before admission to wards. Conclusion: The emergency department of the hospital faced significant overcrowding which overwhelmed efficient standard care. © 2017, Pakistan Medical Association. All rights reserved.

Latif N.,Civil Hospital | Mehmood K.,National Institute of Child Health
Journal of the Pakistan Medical Association | Year: 2010

Objective: To identify the risk factors for fulminant hepatic failure (FHF) and their relation with the outcome in children. Methods: Descriptive case study was conducted at National Institute Of Child Health. Fifty patients having clinical and biochemical markers suggestive of FHF were included in this study and data was extracted from files, retrospectively. Their outcome was noted as expiry or recovery during hospital stay. Results: The most common etiology found was viral in origin present in thirty-seven (74%) cases. Out of them twenty-eight (56%) had HAV and nine (18%) had HBV. Thirteen (26%) patients were negative for acute serology of hepatrophic viruses, out of them four (8%) had Wilson's disease and one (2%) had autoimmune hepatitis. Etiology could not be established in eight (16%) cases. Thirty (60%) patients expired and twenty (40%) patients recovered. Conclusion: FHF is not uncommon in children. Hepatitis A is most common cause in paediatric age group. Age less than 4 years, higher degree of encephalopathy, INR >4, higher serum bilirubin with lower SGPT has poor outcome and mortality is high without liver transplantation.

Shams S.,National Institute of Child Health
Pakistan Paediatric Journal | Year: 2012

Objective: to find frequency of low birth weight (LBW) and maternal factors associated with it. Place of Study Department of Obstetrics and Gynaecology, Sir Syed Hospital (Private Teaching Hospital) of Sir Syed College of Medical and Dental Sciences for Girls, Karachi. Methods and materials: A cross-sectional hospital based study, was undertaken in the department of Obstetrics and Gynaecology of a private teaching hospital in Karachi (PK) over a period of 2 years on 832 singleton live births. Data of 832 mothers and their newborns was collected at the time of delivery either from mothers or their close attendants Results: Of 832 babies, 95.3% were term, 4.7% preterm and mean birth weight was 2900 ± 500 gm. There were 52.5% males and 47.5% females. 99 were LBW having frequency of rate 11.98%. In LBW babies, 60 were term and 39 preterm (52 males and 47 females). Statistics revealed, lack of antenatal care (p value = 0.0139), parity more than 1, anaemia (Haemoglobin less than 10gm %), Pregnancy induced hypertension (maternal BP systolic > 140mm of Hg and diastolic > 90mm of Hg), antepartum haemorrhage Urinary Tract Infection in mothers were significant risk factors (p value(s) = 0.0000) while sex of baby and maternal age were not significant risk factors for LBW. Conclusion: Our findings indicate that parity, anaemia (Haemoglobin less than 10 gm %), PIH, APH, UTI and lack of antenatal care in mothers were highly significant factors for LBW.

Nordahl H.,Copenhagen University | Krolner R.,University of Southern Denmark | Pall G.,National Institute of Child Health | Currie C.,University of Edinburgh | Andersen A.,University of Southern Denmark
Journal of Adolescent Health | Year: 2011

Purpose: Indicators such as country of birth and language spoken at home have been used as proxy measures for ethnic background, but the validity of these indicators in surveys among school children remains unclear. This study aimed at comparing item response and studentparent agreement on four questions about country of birth and language spoken at home in three European countries. Methods: We analyzed data from the Health Behaviour in School-aged Children (HBSC) ChildParent Validation Study 2005, including 486 matched studentparent pairs from Denmark, Hungary, and Scotland. Selected items from the internationally standardized HBSC questionnaire were completed by 11-year-old students and their parents. We examined item response and studentparent agreement on the four HBSC Ethnic Background Indicators: the student's country of birth, mother's country of birth, father's country of birth, and language usually spoken at home. Results: All item response rates were high for both students (>92%) and parents (>96%). The percent studentparent agreement was high on all four items (>97%). The strength of agreement ranged from good to excellent for all items indicated by the kappa value (between.60 and 1.00). Results were robust across countries. Conclusions: Our findings suggest that students as young as 11 years are able to provide valid responses to four simple questions about country of birth and language spoken at home. The four HBSC Ethnic Background Indicators can be useful in epidemiologic studies on identification of subgroups that may receive unequal prevention services or in assessment of how risk factors, symptoms, and diseases may differ by ethnic background among school children. © 2011 Society for Adolescent Health and Medicine. All rights reserved.

Vandenplas Y.,Vrije Universiteit Brussel | Alarcon P.,National Institute of Child Health
Beneficial Microbes | Year: 2015

Regurgitation, constipation, excessive crying/fussiness, infantile colic and gassiness are frequent GI manifestations in young infants and result in numerous visits to paediatricians and in many cases in unnecessary change of formulas. The aim of this study was to offer paediatricians consensus based and simple algorithms for the management of the most frequent GI symptoms in infants. Paediatric gastroenterologists processed practical algorithms to assist general practitioners and general paediatricians. Four such practice recommendations were developed, based on the in 2013 published algorithms after an updated literature review. These algorithms cannot be considered as an 'evidence based guideline'. To date, these algorithms are the result of a consensus based on the available literature and the algorithms published in 2013. © 2014 Wageningen Academic Publishers.

Moorani K.N.,National Institute of Child Health | Sherali A.R.,The Kidney Center Postgraduate Training Institute
Journal of the Pakistan Medical Association | Year: 2010

Objectives: To determine the histopathological pattern in childhood glomerulonephritis (CGN). Methods: This retrospective analysis of renal biopsies of 118 children with various clinical syndromes of CGN was carried out at the National Institute of Child Health (NICH) and The Kidney Center (TKC), Karachi, from July 2005 to December 2009. The age ranged from 6 months to 16 years. All biopsies were studied under light microscopy (LM) and immunoflourescence (IMF). Histopathological lesions (HPL) were classified as primary and secondary glomerular diseases. Demographic data, indications and HPL were retrieved and analyzed using descriptive statistics. Results: Out of 118 patients, 62 (52.54%) were males and 56(47.45%) females. Mean age was 8.2 ± 3.9 years. Major indications for biopsy were primary nephrotic syndrome (PNS 86, 72.88%). secondary GN (SGN, 17, 14.4%) and nephritic-nephrotic syndrome (NNS 13, 11%). Overall, primary glomerular diseases (PGD) accounted for 84.74% of all biopsies. Minimal change disease (MCD 38, 32.2%) and focal segmental glomerulosclerosis (FSGS 35, 29.66%) were the two most common lesions and accounted for 43% and 33.72% respectively in PNS. Other important lesions were membranous GN (MGN 10, 8.47%), membranoproliferative (MPGN 9, 7.16%), post-infective (PIGN 4, 3.38%) and IgM nephropathy (IgMN 3, 2.54%). Among secondary glomerular diseases (SGD), lupus nephritis (LN 11, 9.32%) was the most common lesion followed by Henoch- Schonlein nephritis (HSN) and haemolytic uraemic syndrome (HUS) each in 3 (2.52%). Conclusion: Overall, MCD and FSGS were the two most common HPL in PGD and both dominated in PNS. Lupus nephritis was the leading lesion in SGD. These histopathological pattern of CGN in our study is in conformity with the existing literature from Pakistan.

Raza J.,National Institute of Child Health | Mazen I.,National Research Center of Egypt
Endocrine Development | Year: 2014

Disorders of sex development are complex disorders with atypical chromosomal, gonadal or anatomical sex. Decision making in relation to sex assignment has been perceived as extremely disturbing and difficult for families and healthcare professionals. This is mainly due to a general paucity of information about the condition, lack of advanced diagnostic settings, and an exaggerated feeling of stigma and shame associated with genital abnormalities. Lack of accurate healthcare information and reporting results in poor knowledge about the exact incidence and impact of these disorders in resource-poor countries. Lack of neonatal screening facilities for congenital adrenal hyperplasia often results in delayed diagnosis of these disorders and perhaps a higher number of deaths, especially in male children who lack ambiguity of genitalia. Technically more sophisticated investigations are often not available or affordable, posing further difficulties in establishing a diagnosis. Limited resources also include the lack of availability of adequately trained personal. Thus, the establishment of the recommended and necessary multidisciplinary team is often hard to accomplish in these countries. This seriously compromises the ability to manage these children properly. Finally, countries in places like Southeast and Far East Asia and sub-Saharan Africa are often accompanied with their unique cultural and social issues, filled with myths and misconceptions, which worsens the already complex situation. Thus, a huge limitation exists in dealing with these children with disorders that are complex to diagnose and manage, even in countries with advanced and well-equipped medical facilities. © 2014 S. Karger AG, Basel.

Haider N.,National Institute of Child Health | Nagi A.G.,National Institute of Child Health | Khan K.M.A.,National Institute of Child Health
Journal of the Pakistan Medical Association | Year: 2010

Objective: To determine the frequency of nutritional rickets in children hospitalized with severe pneumonia. Method: This study was carried out at the department of paediatric medicine at National Institute of Child Health Karachi. It is a case series done over a period of six months from 15th November 2008 to 15th may 2009. Patients admitted (n=137) with severe pneumonia were included in the study and were investigated for presence of rickets with serum calcium, phosphorus and alkaline phosphatase. Those having low to normal calcium low phosphorus and raised alkaline phosphatase were labeled as having rickets. All data collected were entered on Performa. Children with familial, vitamin D dependent/resistant rickets, secondary rickets, and cerebral palsy or on anti convulsant therapy were excluded from this study. Results: Out of 137 patients, with severe pneumonia, 83 were male and 54 female. Frequency of nutritional rickets in children with severe pneumonia was observed in 101(74%) cases. Rickets was more common in 2 to 12 months of age i.e. 79.8% (67/84) and in those children who were breast fed (85.3% vs. 40%). Frequency was higher in those children who were not exposed to sunlight. Conclusion: Pneumonia is a very common presentation of rickets. This study suggests that rickets may be more common in children who are breast fed and those who have less exposure to sunlight.

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