Comparison of Lateral Arm Flap and Split Thickness Skin Graft for Soft Tissue Reconstruction of Elbow in Post Burn Contractures
Asma Ishtiaq, Faisal Akhlaq Ali Khan, Maryam Noor, Waqas Sami, Hiba Khan, Kinza Imam
Department of Plastic & Reconstructive Surgery, Dr. Ruth K.M. Pfau, Civil Hospital, Karachi, Pakistan.
Abstract: Background: Elbow contracture ranks as the second most frequent post-burn contracture following the shoulder, with reported incidence rates ranging from 21% to 40%. Surgical intervention is typically necessary to address the functional restrictions caused by scarred tissue and joint contractures.
Objective: To compare outcomes of lateral forearm flap and split thickness skin graft for soft tissue reconstruction of elbow contractures in post-burn patients.
Materials and Methods: This prospective cohort study was carried out by Plastic & Reconstructive Surgery Department, Dr. Ruth K.M. Pfau Civil Hospital, Dow University of Health Sciences, Karachi, Pakistan, during 1st November, 2024 to 31st May, 2025. The study followed the Declaration of Helsinki, was approved by the Institutional Review Board (IRB -3460/DOHS/Approval/2024/272, dated 28th September, 2024), and all participants provided written informed consent. Patients were evaluated at sixth week and three months for assessing study outcome variables. Study outcomes included range of motion, post-operative complication and recurrence of contracture.
Result: A total of 50 patients were studied per group. Operative time (in minutes) was significantly higher in LAF group than STSG group (166.8 ±28.5 versus 89.4 ± 33.3, p<0.001). ROM at sixth week (30.6° ± 3.8 versus 18.4° ± 5.8) and third month (112.9° ± 22.20 versus 54.3° ± 15.6, p<0.001) was significantly higher in LAF than STSG. Complication at sixth week (0 versus 8%, p=0.117) and third month (0 versus 10%, p=0.056) was not significantly different. Recurrence rate was significantly lower in LAF group than STSG group at sixth week (0 versus 12%, p=0.027) and third month (4% versus 20%, p=0.014).
Conclusion: The present study demonstrates lateral arm flap had better outcomes than the split thickness skin grafts in terms of reconstruction of elbow contractures, showing rapid improvement in functional recovery with lesser complication and recurrence rate in pediatric population.
Keywords: Burn, Elbow contracture, Local flap, Skin graft, Soft tissue reconstruction, Reconstructive surgery.
doi.org/10.21089/njhs.112. 0077
Received: October 23, 2025
Revised: November 27, 2025
Accepted: December 03, 2025
Stretched Penile Length and Penile Circumference in Pediatric Population of Pakistan: A Cross-Sectional Single-Center Study
Babar Shahzad, Batool Fatima, Muhammad Kashif Bashir, Muhammad Rehman Waheed, Zuha Zafar, Syed Salman Hussain Zaidi
Department of Pediatric Surgery, Mayo Hospital Lahore, King Edward Medical University, Lahore, Pakistan.
Abstract: Introduction: Evaluation of pediatric male external genitalia in Pakistan often relies on reference standards of foreign populations due to lack of standard local reference data, which may not accurately represent the local population. This study aims to establish the first standard nomogram of male external genitalia of pre-pubertal males in Pakistan.
Materials and Methods: A single-center cross-sectional study was conducted from 1st April 2025 to 1st December 2025 at pediatric surgery department, Mayo hospital Lahore affiliated with King Edward Medical University, Lahore. The study included 403 healthy boys aged 0–13 years to establish age-specific normative values for stretched penile length, penile circumference, glans diameter, and testicular volume in a Pakistani pediatric population. Standardized clinical measurement techniques were applied, and data were analyzed descriptively with results expressed as mean and standard deviation across predefined age groups.
Result: Stretched penile length increased from 2.85 ± 0.51 cm in infants aged 0–1 year to 7.28 ± 0.63 cm in those aged 11–13 years, while testicular volume increased from 1.78 ± 0.63 cm³ to 7.47 ± 1.86 cm³ across the same age range. Penile circumference and glans diameter demonstrated consistent age-related increases, with greater variability observed in older children.
Conclusion: The proposed age-specific nomogram provides locally relevant reference standards that may support more accurate clinical assessment of Pakistani pediatric male external genital development and reduce dependence on foreign datasets.
Keywords: Pediatric anthropometry, Stretched penile length, Testicular volume, Glans width, Normative reference values, Hypogonadism, Micropenis.
doi.org/10.21089/njhs.112.0084
Received: April 06, 2026
Revised: May 07, 2026
Accepted: May 11, 2026
Frequency of Pneumonia and its Associated Factors among Children Presenting at Tertiary Care Hospital, Karachi
Jamshaid Ahmed1, Anila Haroon2, Warisha Kiran Khan3, Aqsa Rafique3, Fariya Iqbal1
1Department of Pediatric Medicine, Medical Institute Hospital, Karachi, Pakistan.
2Department of Pediatric Medicine, Memon Medical Institute Hospital, Karachi, Pakistan.
3Department of Pediatric Medicine, Jinnah Postgraduate Medical Center, Karachi, Pakistan.
Abstract: Background: Pneumonia is the major cause of morbidity and mortality among under-five children. Several risk factors have been identified. Because of rising prevalence of pneumonia, it is necessary to refresh insights about the contributing factors.
Objective: To determine the frequency and factors associated with pneumonia among children presenting at a tertiary care hospital.
Materials and Methods: This cross-sectional study was carried out at the paediatrics departments of Memon Medical Institute Hospital, Karachi, Pakistan, from October 2025 to February 2026. A total of 177 children aged 1 month to 14 years presenting with fever (>37.50C) and cough for more than 48 hours were analyzed. Demographic and clinical history was noted and their association with the frequency of pneumonia were analyzed. The statistical analysis was performed using IBM-SPSS Statistics, version 26.0.
Result: In a total of 177 children, the median age was 30.0 months and 101 (57.1%) were males. Pneumonia was diagnosed in 58 (32.8%) children. Incomplete vaccination (aOR=2.6, 95% CI:1.3-4.4; p=0.014), no vitamin A supplementation (aOR=2.2, 95% CI:1.4-3.7; p=0.042) and previous pneumonia history (aOR=2.3, 95% CI:1.1-1.4; p=0.049), duration of symptoms (aOR=1.3, 95% CI:1.1-1.4; p=0.002) and MUAC ( (aOR=1.2, 95% CI:1.1-1.8; p=0.008) were independently associated with pneumonia.
Conclusion: Pneumonia burden was higher at a tertiary care hospital and remained common among children presenting with fever and cough at this tertiary care hospital. Relatively younger children, incomplete vaccination, poor nutritional status, lack of vitamin A supplementation, recurrent respiratory vulnerability, and delayed presentation were significant predictors of pneumonia among children.
Keywords: Cough, Fever, Malnutrition, Pneumonia, Radiology.
doi.org/10.21089/njhs.112.0092
Received: April 22, 2026
Revised: June 03, 2026
Accepted: June 04, 2026
Strengthening Pediatric Oncology Capacity Through Online Learning: Insights from an Inaugural Course for Physicians in a Low-Resource Setting
Anushe Mohsin Feroze1,, Naeem Jabbar1 Shafaq Sultana2, Sadia Muhammad1, Syed Ahmer Hamid3
1Department of Pediatric Oncology, Indus Hospital and Health Network, Karachi, Pakistan.
2Department of Health Professions Education, Indus University of Health Sciences, Indus Hospital and Health Network, Karachi, Pakistan.
3Department of Hematology and Oncology, Indus Hospital and Health Network, Karachi, Pakistan.
Abstract: Background: In low-and-middle income countries (LMIC), childhood cancer outcomes are poor because of multiple factors including delayed diagnosis, which may be due to limited healthcare professional training and ineffective referral systems.
Objective: To evaluate the impact of a newly developed blended-learning pediatric oncology course designed for physicians in Pakistan.
Materials and Methods: A pre-and-post interventional study was conducted at Indus Hospital and Health Network to evaluate the effectiveness of a pilot pediatric oncology course from 2nd September till 29th November, 2024. The study was reviewed by the Institutional Ethical Review Committee (IHHN_IRB_2025_08_004) (18-Aug-25) and was granted exemption. Twenty doctors were enrolled in the course that included recorded lectures, case-based discussions, and live interactive sessions. A 5-point Likert scale was used to assess knowledge of pre- and post-module. Participants’ performance was assessed by end-of-module exam scores, and course content and delivery satisfaction by online questionnaire.
Result: Seventeen physicians successfully completed the course and were included in the analysis. Overall performance in the end-of-module assessments demonstrated good knowledge acquisition across all modules, with the highest scores observed in the palliative care module and comparatively lower scores in solid tumor module. Participants also showed substantial improvement in their self-perceived knowledge across all learning objectives following completion of course. Despite issues related to technology, participants reported high satisfaction, which was reflected in positive ratings for course organization, clarity, and relevance.
Conclusion: The inaugural e-learning pediatric oncology course was associated with improvements in participant’s perceived knowledge and confidence, highlighting the role of structured online training in strengthening capacity in LMICs. Development of improved version of similar multidisciplinary training programs could further contribute to improving early diagnosis and management of childhood cancers by enhancing physician’s knowledge and awareness of pediatric oncology.
Keywords: Pediatric oncology, E-learning, Capacity building, Physician training.
doi.org/10.21089/njhs.112.0099
Received: March 30, 2026
Revised: June 03, 2026
Accepted: June 04, 2026
Quality of Life in Parents of Children with Developmental Disabilities
Shumaila Waseem, Heena Rais, Tayyaba Anwar, Muhammad Abid Sharif, Saba Safdar
Department of Paediatrics, Ziauddin Hospital, Karachi, Pakistan..
Abstract: Background: Caregiving and its related burden are considered important aspects in determining the quality of life (QOL) among parents.
Objective: To evaluate the QoL as per the WHO QoL-BREF questionnaire in parents of children with developmental disabilities.
Materials and Methods: This comparative cross-sectional study was conducted at the Outpatient Department of Paediatrics, Ziauddin Hospital, Karachi, from 1st January to 30th June 2025. A total of 268 parents were enrolled (134 cases and 134 controls). Cases were parents of children aged 5–18 years, with confirmed diagnoses of developmental disabilities, and absence of developmental, behavioural, or psychiatric disorders for controls. Demographic data were collected, and quality of life was assessed using the Urdu version of the WHOQOL-BREF. Data were analyzed in SPSS v26, applying appropriate statistical tests taking p<0.05 as significant.
Result: Among 268 parents, 115 (42.9%) were male and 153 (57.1%) were female, with a median age of 37.5 years (interquartile range, IQR, 32.8–43.0). Children included 159 (59.3%) males and 109 (40.7%) females, median age 9.1 years (IQR 7.0–12.3). Parental education was significantly lower in cases (p=0.013), and monthly income <50,000 PKR was more frequent in cases 68 (50.7%) than controls 34 (25.4%) (p<0.001). Parents of affected children reported significantly lower WHOQOL-BREF scores in physical health 60.2 vs 68.4, psychological health 58.1 vs 66.7, social relationships 55.3 vs 62.8, environment 57.6 vs 64.3, overall QoL 3.1 vs 4.0, and general health 3.0 vs 4.1 (all p<0.001).
Conclusion: Parents of children with developmental disabilities experience significantly lower QoL across physical, psychological, social, and environmental domains, as well as in overall life satisfaction and general health.
Keywords: Children, Developmental disabilities, Parent, Quality of life, WHO QOL-BREF.
doi.org/10.21089/njhs.112.0108
Received: April 27, 2026
Revised: June 08, 2026
Accepted: June 08, 2026
Anatomical Effectiveness of Endoscopic Dilatation in Plummer–Vinson Syndrome: A Prospective Observational Study from a Tertiary Care Hospital in Pakistan
Mahnoor Iftikhar, Sayyad Nusrat Raza, Sadia Faisal, Kiran Bukhari
ENT Department, Fauji Foundation Hospital Rawalpindi, Pakistan.
Abstract: Background: Plummer–Vinson syndrome (PVS) is a rare triad of dysphagia, iron deficiency anemia, and esophageal webs. Endoscopic dilatation is the primary mechanical intervention for relieving web-related obstruction. Evaluating its anatomical effectiveness, alongside hematological changes attributable to combined treatment, can help guide patient management.
Objective: To evaluate the effectiveness of endoscopic dilatation in patients with Plummer-Vinson Syndrome PVS treated at a tertiary care hospital.
Materials and Methods: This Prospective observational study, was conducted at Fauji Foundation Hospital, Rawalpindi, from 14th March 2025 to 30th December 2025. Ethical approval was granted by the Ethical Review Committee of Fauji Foundation Hospital (Ref# 935/RC/FFH/RWP; approval date: 13th March 2025). All consecutive patients aged 30–70 years with PVS were enrolled. All patients received oral ferrous sulphate 200 mg daily and underwent endoscopic dilatation with Savary–Gilliard bougie dilators to achieve a luminal diameter of 15 mm under general anesthesia. Dysphagia was assessed using a standardized 5-point ordinal scale at baseline and follow-up. Hemoglobin, serum ferritin, and esophageal web status were assessed at three months. Anatomical resolution of the esophageal web, along with hematological changes and improvement in dysphagia, were noted as outcome.
Result: Of 27 patients, complete anatomical resolution of esophageal webs was observed in all patients (100.0%; 95% CI:87.2%–100.0%). Dysphagia improvement was reported in 25 patients (92.6%; 95% CI:75.7%–99.1%). Median hemoglobin increased from 8.7g/dL (IQR:8.1–9.3) to 12.8g/dL (IQR:9.2–14.0), and median serum ferritin from 9.0ng/mL (IQR:7.8–10.7) to 19.8ng/mL (IQR:10.6–26.9) (p<0.001 for both). Iron deficiency anemia persisted in 17 patients (63.0%; 95% CI:44.2%–78.5%).
Conclusion: Endoscopic dilatation achieved complete anatomical resolution of esophageal webs and dysphagia in most PVS patients.
Keywords: Plummer-Vinson syndrome, Esophageal web, Endoscopic dilatation, Iron-deficiency anemia, Dysphagia.
doi.org/10.21089/njhs.112.0115
Received: February 24, 2026
Revised: June 10, 2026
Accepted: June 12, 2026
Knowledge Status among Mothers Regarding Childhood Immunization and Causes of its Failure
Komal Bhatti1,, Asma Noreen2, Mehrozia Nuzhat3, Nadeem Noor3, Mehtab Hussain4, Jalal Uddin Akbar1
1Department of Pediatrics, Baqai Medical Hospital, Karachi, Pakistan.
2Department of Pediatrics, Jinnah Medical & Dental Hospital, Karachi, Pakistan.
3Department of Pediatrics, Jinnah Medical College/ Sohail Trust Hospital, Karachi, Pakistan.
4Department of Pediatrics, Liaquat National Hospital and Medical College, Karachi, Pakistan.
Abstract: Background: Mothers are a fundamental component of child health care services; therefore, their level of awareness and involvement is critical for the successful implementation of immunization programs.
Objective: To assess the knowledge status among mothers regarding childhood immunization and causes of its failure.
Materials and Methods: This cross-sectional study was done at the Department of Pediatric Medicine, Baqai Medical Hospital, Karachi, Pakistan during a period of 1st July 2025 to 31st December 2025, after the approval of Institutional Ethical and Review committee (Ref: BMU-IREB/15-2025/035/(FRREC-FM/05-2025/14, dated: June 04, 2025). A total of 147 mothers of children aged birth to 5 years were analyzed after consecutive sampling technique. Demographical information along with immunization status were documented. Maternal knowledge was evaluated adopting a 20-item self-designed questionnaire (Cronbach’s α=0.82). Mothers who scored 12 or above (≥60% of total score) were classified as having adequate knowledge, while those who received a score <12 would be categorized as having inadequate knowledge. Data were analyzed using SPSS version 26.0, applying Chi-square and Fisher’s exact tests with p<0.05 considered significant.
Result: In a total of 147 mothers, the mean age was 28.7±5.4 years. The mean of children was 4.2±0.6 years. Immunization status was found to be complete, partial and unimmunized in 108 (73.5%), 20 (13.6%) and 19 (12.9%) respectively. The mean maternal knowledge score was 12.6±2.4, with 83 (56.5%) having adequate knowledge. Significant association was found between knowledge and maternal education (p<0.001), residence (p<0.001), birth order (p<0.001), child’s gender (p=0.003) and immunization status (p<0.001). Common causes of immunization failure included postponement 31 (48.4%) and fear of side effects 14 (21.9%).
Conclusion: Maternal knowledge shows important role in child immunization practices. The association of knowledge with maternal education, residence, and immunization status emphasizes the multifaceted nature of vaccine uptake.
Keywords: Knowledge, Immunization, Mothers, Failures, Barriers.
doi.org/10.21089/njhs.112.0123
Received: May 05, 2026
Revised: June 11, 2026
Accepted: June 14, 2026
Kite-Bridge Native Tissue Repair versus Conventional Anterior Colporrhaphy: Functional and Anatomic Outcomes in Cystocele Patients
Shakila Yasmin1, Shams-un-Nisa1, Khiaynat Sarwar Hashmi2,
1Department of Obstetrics and Gynaecology, Bahawal Victoria Hospital/ Quaid-e-Azam Medical College, Bahawalpur, Pakistan.
2Department of Obstetrics and Gynaecology, Tertiary Care Hospital Nishtar-II, Multan, Pakistan.
Abstract: Background: A cystocele is the most widespread anterior compartment defect in women with symptomatic pelvic floor disorders (POP) and contributes to a poor quality of life both in physical and psychological aspect. Most of the women who reported with symptomatic pelvic floor disorders have an increased risk of anterior vaginal wall prolapse. Risk Factors seen in these women are multiparity, increasing age, connective tissue frailty, and repetitive vaginal childbirth trauma.
Objective: To compare the anatomical and functional results of a modified Kite Bridge native tissue repair against conventional anterior Colporrhaphy in patients who had a cystocele repair.
Materials and Methods: A prospective and comparative cohort study that was carried out across 18 months in the Department of Obstetrics and Gynaecology, Bahawal Victoria Hospital, Bahawalpur, between 23rd January 2024 and 30th June 2025. Sixty women with symptomatic anterior vaginal wall prolapse were assigned to the Kite-Bridge (n=30) or conventional anterior colporrhaphy (n=30). Outcomes included anatomic success (POP-Q Ba ≤ –1 at 6 months), functional improvement, perioperative complications, dyspareunia, and patient satisfaction.
Result: Both techniques showed marked anatomic success at 6 months. Functional improvement and patient satisfaction were numerically higher in the Kite-Bridge group, with a lesser dyspareunia; however, these differences weren’t statistically significant. Operative time was slightly longer in the Kite-Bridge group. Minimal perioperative complications were seen in both groups.
Conclusion: Kite-Bridge native tissue repair was as anatomically successful in women with anterior vaginal wall prolapse as traditional anterior colporrhaphy. However the two techniques differed in the number of functional outcomes of the techniques, dyspareunia rates and patient satisfaction. The Kite-Bridge technique is a procedure that is good and non-aggressive native tissue solution particularly in the sections that the mesh is used sparingly.
Keywords: Anterior vaginal wall prolapse, Native tissue repair, Kite-Bridge technique, Anterior colporrhaphy, Pelvic floor reconstruction, Functional outcomes.
doi.org/10.21089/njhs.112.0131
Received: January 08, 2026
Revised: June 06, 2026
Accepted: June 11, 2026
The Frequency of Aspiration Pneumonia with Thick Liquid Diet among Stroke Patients having Dysphagia
Muhammad Mohsan Amin 1, Umair Arif2, Javeria Afzal2, Muhammad Ahsan Amin1, Ali Imran2
1Department of Medicine, Bahawal Victoria Hospital, Bahawalpur, Pakistan.
2Department of Medicine, Quaid-e-Azam Medical College, Bahawal Victoria Hospital, Bahawalpur, Pakistan.
Abstract: Background: Oropharyngeal dysphagia is frequently encountered in clinical practice. When it is not recognized and managed properly, it can lead to serious consequences such as aspiration pneumonia.
Objective: To determine the frequency of aspiration pneumonia with thick liquid diet among stroke patients having dysphagia.
Materials and Methods: This prospective longitudinal study was conducted in Unit-4 of the Department of Medicine, Bahawal-Victoria Hospital, Bahawalpur, from 1st September 2025 to 27th February 2026. Patients aged 30–70 years with post-stroke dysphagia and receiving a thick liquid diet were enrolled through consecutive sampling. Baseline demographic and clinical variables were recorded. Patients were followed at two-week intervals for aspiration pneumonia, diagnosed based on clinical features and chest X-ray findings. Data were analyzed using SPSS 26.0, with appropriate statistical tests applied.
Result: Among 189 patients, the median age was 57.0 (IQR=48.0–64.0) years, with 112 (59.3%) males. Ischemic stroke was present in 134 (70.9%) patients. Diabetes mellitus was present in 82 (43.4%) patients, smoking in 64 (33.9%), and anemia in 91 (48.1%). Median duration of stroke, dysphagia, and hospitalization was 9.0 (5.0–16.0) days, 6.0 (IQR=3.0–10.0) days, and 8.0 (IQR=5.0–13.0) days, respectively. Aspiration pneumonia developed in 46 (24.3%) patients. On multivariable analysis, anemia (aOR 2.4, 95% CI: 1.3–5.2; p=0.032) and dysphagia duration >7 days (aOR 2.7, 95% CI: 1.5–4.9; p=0.014) remained independent predictors of aspiration pneumonia.
Conclusion: Aspiration pneumonia is a frequent complication among stroke patients with dysphagia. Anemia and prolonged dysphagia are key determinants of risk, underscoring the need for comprehensive clinical management beyond dietary modification.
Keywords: Anemia, Aspiration pneumonia, Dysphagia, Smoking, Stroke.
doi.org/10.21089/njhs.112.0138
Received: April 22, 2026
Revised: June 15, 2026
Accepted: June 16, 2026
Pediatric Appendectomy Outcomes: A Prospective Cohort Study for Comparison of Laparoscopic and Open Techniques
Farhan Ali Qureshi 1 , Ali, Raza Brohi1, Sadia Sarwar2, Habibullah Maitlo3, Masoom Ali Shah1, Ishaque Cader1
1Department of Pediatric Surgery, Institute of Mother and Child Health, Nawabshah, Sindh, Pakistan.
2Department of General Surgery, Benazir Institute of Urology & Transplantation, Nawabshah, Sindh, Pakistan.
3Department of Pediatric Surgery, Dr. Zeenat Essani Institute of Medical Sciences, Shikarpur, Sindh, Pakistan.
Abstract: Background: Acute appendicitis (AA) is a universal surgical emergency. The established standard of care for appendicitis is surgical removal of the infected appendix with two approaches; laparoscopic and open procedure. The variation in reported outcomes creates clinical uncertainty regarding the optimal surgical approach for appendicitis in children.
Objective: To compare postoperative outcomes between laparoscopic and open appendectomy in children with acute appendicitis.
Materials and Method: This prospective cohort study was conducted in Pediatric Surgery Department, at institute of maternal and child health, Nawabshah, from 1st January 2025 to 30th June 2025. Children were allocated to laparoscopic (LA) or open appendectomy (OA) group based on surgeon’s decision.
Result: A total of 140 patients were studied with 1:1 group ratio. Operative time was longer (65±23 vs 49.5±22 minutes). On postoperative day 2 (4.2 ± 1.1 versus 5.5 ± 1.8, p < 0.001) and day 7 (2.7 ± 1.4 versus 4.6 ± 2.1) mean pain score for LA was significantly lower than OA (4.2 ± 1.1 versus 5.5 ± 1.8, p < 0.001). Hospital stay was shorter in the LA group (3.0±2.0 vs 5.0±2.0 median days), p values for both were <0.001). Wound infection rates were lower in the LA group compared to OA group (1.4% vs 11.4%, p=0.039). Other postoperative complications were infrequent and comparable between the groups.
Conclusion: LA demonstrates postoperative advantages over OA in terms of early pain control, a lower surgical site infection and a shorter hospital stay. However, its successful implementation in low-resource settings depends on the availability of adequately trained surgical personnel and infrastructures.
Keywords: Pediatric, Acute appendicitis, Open appendectomy, Laparoscopic appendectomy, Postoperative outcomes.
doi.org/10.21089/njhs.112.0145
Received: April 17, 2026
Revised: June 05, 2026
Accepted: June 05, 2026
Echocardiographic Findings in Children with Different Stages of Chronic Kidney Disease
Maheen Khan, Mashal Khan
National Institute of Child Health (NICH), Rafiqui H.J. Shaheed Road, Karachi, Pakistan.
Abstract: Background: The burden of CKD during childhood extends beyond the early years, as both the underlying disease and its cardiovascular consequences may continue to affect health well into adult life.
Objective: To assess the echocardiogrphic findings in children with chronic kidney disease (CKD).
Materials and Methods: This cross-sectional study was carried out at the Department of Pediatric Medicine, National Institute of Child Health, Karachi, Pakistan, from 3rd September 2025 to 20th February 2026, after obtaining approval from the institution (letter: IERB-57/2023, dated: 21st August, 2025). 3rd September 2025 to 20th February 2026. Children of age bracket 1 month to 18 years with CKD (> 3 months duration) were enrolled by non-probability consecutive sampling. Demographic and clinical data were logged. Two-dimensional echocardiography was performed to assess heart functions. Data were analyzed using SPSS 25.
Result: Among 112 children, the median age was 10.0 years (IQR=6.0-13.0), 68 were males (60.7%), and the median illness duration was 16.0 months (IQR=10.0-24.0). CKD stages 1 to 5 were present in 9 (8.0%), 15 (13.4%), 28 (25.0%), 27 (24.1%), and 33 (29.5%) children. Hypertension was present in 46 (41.1%) and dialysis history in 38 (33.9%) children, both increasing significantly (p< 0.001). Overall, 73 (65.2%) had at least one echocardiographic abnormality which increased significantly with CKD severity (p<0.001). LVH (p=0.007), diastolic dysfunction (p<0.001) and systolic dysfunction (p=0.003) were present in 49 (43.8%), 36 (32.1%), and 19 (17.0%), respectively, and worsening with increase in CKD severity. Left ventricular ejection fraction declined (p<0.001), and wall thickness increased (p<0.001) with increase in CKD staging.
Conclusion: Echocardiographic abnormalities were highly prevalent in children with CKD and became more prominent with advancing CKD stage. LVH, diastolic dysfunction, and declining systolic performance formed the dominant pattern with structural and functional changes becoming increasingly apparent with increase in CKD severity.
Keywords: Children, Chronic kidney disease, Echocardiography, Ventricular dysfunction, Ventricular hypertrophy.
doi.org/10.21089/njhs.112.0154
Received: April 23, 2026
Revised: June 16, 2026
Accepted: June 18, 2026
Frequency of Spontaneous Bacterial Peritonitis in Cirrhotic Patients Presenting with Ascites in Tertiary-Care Hospitals in Karachi
Usman Rehman1,, Syed Masroor Ahmed1, Shabnam Naveed1, Maryam Fatima Waqar1,2
1Department of Medicine, Jinnah Postgraduate Medical Center (JPMC), Karachi, Pakistan.
2Department of Medicine, Jinnah Sindh Medical University (JSMU), Karachi, Pakistan.
Abstract: Background: Spontaneous bacterial peritonitis (SBP) is regarded as being related to the translocation of bacteria from the intestinal lumen into the peritoneum. Early recognition and empirical antimicrobial treatment are extremely effective in decreasing death rates.
Objective: To find out the prevalence of SBP in patients with cirrhosis and ascites admitted in the tertiary care hospitals in Karachi and to describe the demographic, clinical, biochemical and microbiological features of the patients.
Materials and Methods: The analytical cross sectional study was conducted at Jinnah Post Graduate Medical Centre (JPMC), Civil Hospital Karachi and Dow University Hospital (OJHA Campus) from 6th October 2025 till 6th January 2026. A total of 385 adult patients (20–70 years) with cirrhosis, Child-Pugh class B or C, and clinical ascites were selected. Patients with secondary peritonitis, tuberculous peritonitis, malignancy-related ascites and renal disease were excluded. All patients had a diagnostic paracentesis performed. SBP was defined as a PMN count of 250 cells/µL or higher in ascitic fluid indicates SBP. in the absence of any known intra-abdominal source of infection. Demographic, clinical and laboratory information was collected. The data obtained was analyzed statistically using IBM SPSS software, version 22.
Result: 107 out of 385 patients (27.8%) had been diagnosed with SBP.The average age of the study population was 49.7 ± 9.8 years, having a male-to-female ratio of 2.1:1. The most prevalent underlying cause of cirrhosis was hepatitis C virus infection (57.9%), followed by hepatitis B virus infection (23.9%). The predominant clinical symptoms of SBP were fever (63.6%), stomach discomfort (52.3%), and hepatic encephalopathy (40.1%). In 44 (41.1%) patients with SBP, ascitic fluid cultures yielded positive results, with Escherichia coli as the main strain (61.3%), next to Klebsiella pneumoniae (20.4%). SBP had a strong correlation with Child-Pugh class C illness (p < 0.001), decreased blood albumin levels, and elevated serum bilirubin concentrations.
Conclusion: SBP was common in cirrhotic patients admitted to hospitals in Karachi (27.8%), especially in those with severe liver disease resulting from chronic viral hepatitis. Regular diagnostic paracentesis and early empirical antibiotic treatment should be considered for hospitalized cirrhotic patients suffering from ascites to mitigate morbidity and death.
Keywords: Spontaneous bacterial peritonitis, Cirrhosis, Ascites, Hepatitis C, Diagnostic paracentesis.
doi.org/10.21089/njhs.112.0161
Received: January 27, 2026
Revised: June 12, 2026
Accepted: June 12, 2026
