Pakistan Pediatric Journal

Celiac Crisis Presenting as Status Epilepticus and Irreversible Encephalopathy: A Rare Pediatric Case Report

2025-12-20T09:48:54+00:00

Abstract

Celiac disease is a gluten sensitive enteropathy of small bowel characterized by villous atrophy that leads to malabsorption steatorrhea and weight loss. Broad spectrum of disorders specially auto immune is associated with celiac disease ranging from primary biliary cirrhosis, Sjogren’s syndrome to dermatitis herpetiformis. Celiac disease also shows variety of neurological manifestation including ataxia, epilepsy, neuropathy and myelopathy. The cause of tis association is still not cleared.

Celiac crisis is a life-threatening presentation associated with celiac disease leading to electrolyte imbalance. Neurological manifestation of celiac crisis with residual encephalopathy is rare presentation of celiac crisis with apparently no published local data. We are going to document 2.5 years old give case presented to emergency department with status epilepticus and encephalopathy. Patient was in usual state of health prior to illness at home with history of abdominal distension, intermittent diarrhea and failure to thrive. Patient presented to tertiary care at Bahawalpur in emergency with status epilepticus and encephalopathy with probable diagnosis of TBM. And then referred to the Children Hospital and the Institute of Child Health Multan for status epilepticus at emergency department. In the context of this case, it is suggested that celiac crises should be considered in the differentials of seizures and encephalopathy.

Key words: Attention deficient hyperactive disorder, Celiac disease, Celiac crises, Encephalopathy Glasgow coma scale, Intracranial pressure, Pakistan Pediatric Association, Signs of meningial irritation, Status epilepticus, Tuberculosis meningitis, The children hospital and institute of children health

Lemierre syndrome, an overlooked but re-surfacing disease: Case report

2026-01-03T07:02:32+00:00

Lemierre’s syndrome is a rare head and neck condition that starts as an infection, typically in the ENT, and can progress to septic thrombophlebitis. It may include the jugular vein, facial vein, and respiratory tract. (1) It usually occurs as a complication of a bacterial throat infection The thrombophlebitis is a serious condition and can result in further systemic complications such as bacteremia or septic emboli. Recent evidence indicates that its prognosis is still grim even after a century from its first report, with significant rates of in-hospital complications, mortality, and long-term sequelae. Its management has no specific guidelines except for standard antibiotic stewardship, with an ongoing debate on the role of therapeutic-dose (2).

We present the case of a 9-year-old boy with a history of oral cavity and palate, fever and severe respiratory distress, left-sided tension pneumothorax on chest X-ray, emergency intervention, and tomography that showed internal. carotid artery Venous thrombosis extended to the brachiocephalic vein and resulted in bilateral septic embolism with central pleural effusion, left pneumothorax and right abducens nerve palsy. The patient also complained of pain and discharge in the right ear for the last 3 months.

A Nearly Fatal Case of Expanded Dengue Syndrome in an Infant: Complex Challenges of Severe Hemorrhage, DIC and Multi-Organ Involvement

2025-11-19T07:23:46+00:00

A 1-year-old infant with Expanded Dengue Syndrome (EDS)—a severe dengue complication marked by multi-organ dysfunction—exhibited fever, vomiting, diarrhea, petechiae, palpebral edema, and cold extremities, progressing to disseminated intravascular coagulation (DIC), hepatic failure, and severe anemia. Laboratory findings confirmed thrombocytopenia, coagulopathy and acute liver injury. Management involved intensive resuscitation with crystalloids, colloids, packed red blood cells, fresh frozen plasma, and platelet transfusions, alongside vitamin K administration. Despite hemodynamic instability and severe bleeding, timely interventions enabled recovery.

Uncommon manifestations like palpebral edema and limb discoloration expanded the recognized EDS spectrum. This case underscores the critical need for early recognition of atypical symptoms, aggressive fluid optimization, and prompt transfusion strategies in endemic regions. Enhanced clinician awareness of EDS’s diverse presentations is vital to improving outcomes in pediatric dengue, where rapid deterioration necessitates vigilant monitoring and multidisciplinary care.

Medley of Gynecological abnormalities around Hematocolpos

2026-01-29T06:56:25+00:00

A 12 year old girl not having attained menarche yet, presented with complaints of urinary retention and abdominal pain. Clinical examination and imaging confirmed the presence of hematocolpos secondary to both imperforate hymen and transverse vaginal septum. There was evidence of hydroureteronephrosis along with a septate uterus and vaginal agenesis (ESHRE Type U2b, C0, V4). Following Examination under Anesthesia, excision of the transverse vaginal septum was done along with drainage of menstrual blood and a vaginoplasty to correct the vaginal aplasia. This is a very rare and possibly one of the first reported cases of concurrent imperforate hymen, TVS, septate uterus and vaginal agenesis with hydroureteronephrosis.

The Relationship between Onychophagia and Behavioral Disorders in Primary School Students

2025-12-20T09:31:47+00:00

Amaç: Bu çalışmanın iki amacı vardı: Türkiye'deki ilkokul öğrencileri arasında onikofaji sıklığını belirlemek ve onikofajinin sosyodemografik faktörler ve davranış bozuklukları ile ilişkisini belirlemek.

Gereç ve Yöntemler: Tanımlayıcı tipteki çalışmanın örneklemini 5-9 yaş arası çocuğu olan 709 ebeveyn oluşturmuştur. Katılımcılar kolayda örnekleme yöntemiyle seçilmiştir. Veriler sosyodemografik özellikler anketi ve Güç ve Zorluklar Anketi (SDQ) kullanılarak toplandı.

Bulgular: Onikofaji, babaları çalışmayan ve eğitim düzeyi düşük olan parçalanmış ailelerden gelen çocuklarda daha yaygındı. Sosyoekonomik durum ile onikofaji arasında negatif bir ilişki vardı.

Sonuç: Yetkililerin ebeveynleri ve sağlık çalışanlarını onikofaji konusunda bilinçlendirmesi, onikofajinin erken teşhis edilmesi ve multidisipliner bir bakış açısıyla ele alınması gerekmektedir.

Probing The Prognostic Factors of Neonatal Outcomes in Congenital Diaphragmatic Hernia

2025-12-31T06:56:38+00:00

Abstract:

Background: Congenital diaphragmatic hernia or CDH is a complex deformity with a significant death rate, particularly in developing countries. Several prognostic factors affect the outcome of CDH including pre-maturity, low birth weight, ante-natal diagnosis, pulmonary hypertension and associated cardiac anomalies.

Objective: To identify and compare factors affecting the outcome of CDH in neonates among survivors and non-survivors.

Study Design: It was a descriptive case series

Place and Duration of Study: The study was conducted from January 2024 to July 2024 at The University of Child Health Sciences and The Children’s Hospital, Lahore

Methods: Prospective data of 60 neonates presenting to our institution with the diagnosis of CDH was reviewed for its outcome, and associated factors were analyzed.

Results: The survival rate was 51.7%. We identified that early age of presentation, birth weight, prematurity, and pulmonary hypertension were the poor prognostic factors. Factors like gender, prenatal diagnosis, cardiac anomaly, arterial blood gases on admission, side of the defect, and intrathoracic liver did not have any effect on the outcome.

Conclusion: We concluded that we can improve the outcome of CDH in our setup by improving our pre- and post-natal care, aseptic measures and by treating pulmonary hypertension effectively.

Assessment of Nutritional Intake of Essential Minerals in Children Through Milk Consumption

2025-12-30T07:18:46+00:00

Abstract

Objective: Dietary assessment serves as a tool to identify inadequate micronutrient intakes in children. This study aimed to assess the nutritional intake of five essential minerals (Ca, Mg, P, Na, and K) among children aged 1 to 12 through milk consumption.

Study design: A total of 30 milk samples were collected from various dairy farms in the rural areas of Jamshoro, Sindh. All the samples were analyzed using flame atomic absorption spectroscopy (FAAS) to determine mineral concentrations. Nutritional assessments of these minerals for children aged 1-12 years were based on the concentrations of Ca, Mg, P, Na, and K in the milk samples and daily milk intake.

Results: The results revealed that the concentrations of Ca, Mg, P, Na, and K in the milk samples ranged from 798.09-1598.05, 112.35-267.13, 632.06-1098.11, 251.67-501.13, to 1220.32-1701.09 mg/kg.

Discussion: The milk consumption data revealed that the highest daily intake of essential minerals among the selected age groups was found in the order of 1-3 > 4-8 > 9-12 years. Among the essential minerals, K was the most consumed by children, followed by Ca > P > Na > and Mg through milk intake. Furthermore, the regular intake of all selected essential minerals was observed below their recommended ranges.

Therapeutic Plasma exchange as An Emerging Treatment Modality in Neurologic Disorders – An Experience in Pediatric Population.

2025-12-24T07:07:40+00:00

Objective: Therapeutic plasma exchange (TPE) is a modality to treat neurologic diseases like Guillain-Barre syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), inflammatory demyelinating disorders of CNS, autoimmune encephalitis and many others. This study is designed for evaluation of efficacy and safety of TPE either a first line therapy or as an adjunct to other initial treatments in patients with neurologic diseases.

Study Design: It is an observational study of descriptive type.

Study duration and place: This study is the joint venture of Department of Paediatric Neurology, Pediatric intensive care unit and Hematology at The Children’s hospital Lahore from October 2021 till December 2023.

Methods: TPE was performed on every alternate day, with total of 3-5 sessions. Vascular access was gained by femoral or jugular double lumen catheter and we used apheresis machine FRESENIUS KABI. FFPs was used as replacement fluid. Patients were assessed before and after TPE procedures for clinical and functional status using GMFCS and MRCS scores and paired t- test was applied to measure it statistically.

Results: 134 procedures were done on 30 patients. The study population has mean age of 7.84 ±3.6years (range is 2-14 years), the males were 56.6% while females were 43.3%. Most common disease was GBS (60%), predominantly axonal variant (60%) followed by NMOSD (16.6%), NMDAR encephalitis (10%) and 6.6% each of MOGAD and CIDP. Mechanical ventilation was required in 56.7 % (n=17) and all these patients developed autonomic dysfunction. Improvement in terms of function and motor power was measured both before and after plasmapheresis using GMFCS and MRCS score and found a very low p-value of 0.000 in both pairs, which is significant statistically.

Conclusion: TPE is an effective and safe therapeutic modality in pediatric population with neurologic disorders especially in resource constraint settings.

Key words: Therapeutic plasma exchange (TPE), Guillain-Barre syndrome (GBS), Neurologic diseases.

Cutaneous markers of spinal dysraphism: A cross-sectional study in 230 children

2026-01-08T10:03:31+00:00

Abstract:

Spine dysraphism (SD) refers to a group of congenital spine and spinal cord anomalies that frequently appear with external cutaneous indicators, particularly occult spinal dysraphism (OSD). Early detection of these skin lesions is critical for quick diagnosis and intervention, preventing irreversible neurological consequences.

Objectives: The objectives of the study were to identify the pattern and distribution of cutaneous lesions linked to spinal dysraphism in newborns and children with neurological complaints or spinal defects.

Material and Methods: This cross-sectional observational study was conducted at the Department of Paediatric Neurology and Paediatric Neurosurgery, Children Hospital & Institute of Child Health, Faisalabad, from January 2023 to December 2024. 230 neonates and children (aged 0-3 years) were enrolled. Inclusion criteria were the presence of evident midline cutaneous lesions as well as neurological or spinal abnormalities. Detailed demographic and clinical data were collected, with emphasis on the number, type, and anatomical location of skin lesions.

Results: Among the 230 subjects, 67% were female, and 76% presented within the first month of birth. Lumbosacral lipomas (44%), hypertrichosis (12%), sacral dimples (8%), vascular nevi (7%), and other lesions (9%) were the most common skin markers. There were several cutaneous abnormalities in 64% of children, with the bulk of lesions (93%) located in the lumbosacral region.

Conclusion: Spinal dysraphism in early childhood is significantly indicated by cutaneous symptoms, especially in the lumbosacral region. So any child presenting with a cutaneous marker, especially in the lumbosacral region, spinal dysraphism should be ruled out.

Aplastic Anemia in Children with Pancytopenia:A Single Center Cross-sectional study from A Tertiary Care Hospital in KPK, Pakistan.

2026-03-03T07:13:15+00:00

Abstract: Pancytopenia is decrease in all three cells lines in blood either due to bone marrow failure or peripheral destruction. Aplastic anemia is a rare but concerning cause of pancytopenia in children, which if left untreated can be fatal.

Objective: To determine the frequency of aplastic anemia in children presenting with pancytopenia.

Study Design: Descriptive Cross-Sectional Study.

Place and Duration of Study: Pediatrics Department, Ayub Teaching Hospital, Abbottabad. From January 2020 to June 2020.

Methodology: Non- probability consecutive sampling technique is used and ninety-one children from ages 6 months to 15 years of age of either gender with isolated pancytopenia on admission fulfilling the inclusion criteria were enrolled after informed written consent from the parents. The details of the patients were collected on a predesigned proforma. Data was analysed using SPSS version 20.0.

Results: Total 91 children with pancytopenia were included in this study. The mean age was 4.78±2.33 years. There were 40 (43.9%) children of age <4years while 51 (56.0%) had age >4 years. There were 49(53.8%) males and 42 (46.1%) females. 12 (13.1%) children had aplastic anaemia while 79 (86.3%) had pancytopenia related to other causes.

Conclusion: Aplastic anaemia is a rare but an important treatable cause of pancytopenia in children and by its timely diagnosis and management many lives can be saved and burden on health resources can be minimized.

Frequency of hypokalemia in patients with salbutamol nebulization

2026-03-07T06:52:51+00:00

ABSTRACT

Objective:
To determine the frequency of hypokalemia and evaluate changes in serum potassium levels following nebulized Salbutamol therapy in children presenting with mild asthma exacerbation.

Methodology:
This cross-sectional study was conducted in the Pediatric Emergency Department of Civil Hospital Karachi over six months. A total of 370 children aged 1–12 years presenting with mild asthma exacerbation and requiring nebulized Salbutamol were included through consecutive sampling. Children with chronic illnesses, potassium-altering medications, or systemic disorders were excluded. Nebulized Salbutamol was administered in three standardized doses (2.5 mg for <20 kg and 5 mg for ≥20 kg). Serum potassium levels were measured before and 30 minutes after therapy. Hypokalemia was defined as serum potassium <3.5 mmol/L. Data were analyzed using appropriate statistical tests, and logistic regression was applied to identify predictors.

Results:
The mean age was 7.1 ± 2.6 years, and 60.5% were males. The mean baseline serum potassium was 4.18 ± 0.46 mmol/L, which significantly decreased to 3.76 ± 0.49 mmol/L after nebulization (p < 0.001), showing a mean decline of 0.42 mmol/L. Hypokalemia developed in 27.8% (n = 103) of children. Higher frequency was observed among children <5 years (p = 0.01), those receiving 5 mg Salbutamol (p = 0.003), and malnourished children (p < 0.001). Logistic regression confirmed younger age, higher dose, and malnutrition as independent predictors.

Conclusion:
Nebulized Salbutamol significantly reduces serum potassium levels and may induce hypokalemia even in mild asthma. Younger children, malnourished patients, and those receiving higher doses are at increased risk; therefore, careful dosing and consideration of potassium monitoring in high-risk groups are recommended.

Keywords: Salbutamol, Hypokalemia, Asthma, Children, Nebulization, Serum Potassium, Pakistan

FREQUENCY OF VITAMIN D DEFICIENCY IN CHILDREN AGED 3 TO 12 YEARS PRESENTED TO A TEHSIL HEAD QUARTER HOSPITAL DOGAR

2025-08-21T07:30:26+00:00

Abstract:

Vitamin D deficiency is a prevalent global health issue, particularly in children, and is associated with various health complications, including poor bone development, rickets, and immune dysfunction¹. This study aims to determine the frequency of vitamin D deficiency in children aged 3 to 12 years who present to a tertiary care hospital. A cross-sectional study design was used, and serum 25-hydroxyvitamin D [25’OH) D] levels were measured in children meeting the inclusion criteria. The findings indicate a high prevalence of vitamin D deficiency, necessitating urgent public health interventions.

KEYWORDS:

Vitamin D Deficiency, Children, 25-Hydroxyvitamin D, Tertiary Care, Public Health

1.INTRODUCTION:

Vitamin D is essential for calcium homeostasis and bone metabolism, and its deficiency in children is associated with growth retardation, rickets, and increased susceptibility to infections (Holick, 2017)². The deficiency of vitamin D has been recognized as a growing public health concern worldwide¹, particularly in developing countries, where sunlight exposure and dietary intake are often insufficient (Munns et al., 2016)⁵. Despite the availability of fortified foods and vitamin D supplements, children remain at risk due to lifestyle changes, reduced outdoor activities, and increased use of sunscreen (Wagner & Greer, 2020)⁹.

Studies have reported a significant prevalence of vitamin D deficiency among children in various regions, but data on its frequency in Tehsil Headquarter Hospital settings remain limited. This study aims to assess the frequency of vitamin D deficiency among children aged 3 to 12 years presenting to TehsilHeadquarter Hospitalhighlighting its magnitude and potential risk factors.

2.METRIAL AND METHODS:

2.1Study Design and Setting.

This cross-sectional study was conducted at the pediatric outpatient department of Tehsil Head quarter hospital Dogarbetween July andDecember 2024. The hospital serves as a referral center, catering to a diverse pediatric population.

2.2 Study Population and Inclusion Criteria

The study included children aged 3 to 12 years who presented to the hospital for routine check-ups, mild illnesses, or suspected vitamin D deficiency symptoms (e.g., bone pain, muscle weakness, or recurrent infections). Exclusion criteria included children on vitamin D supplements, those with chronic illnesses affecting vitamin D metabolism (e.g., chronic kidney disease, liver disease), and those with malabsorption syndromes.

2.3 Sample Size and Sampling Technique

A sample size of 400 children was calculated using OpenEpi software, with a confidence interval of 95% and an expected prevalence of 50% based on previous studies (Misra et al., 2008)⁴. A consecutive sampling technique was used to recruit participants.

2.4 Data Collection and Biochemical Analysis

After obtaining informed consent from parents, demographic and clinical data were collected using a structured questionnaire. Blood samples were drawn to measure serum 25(OH)D levels using chemiluminescent immunoassay (CLIA) methods. Vitamin D status was classified as follows (Holick et al., 2011)³.

- Deficient: <20 ng/mL

-Insufficient: 20–30 ng/mL

- Sufficient:>30 ng/mL