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Article ; Online: Low-field magnetic resonance imaging in a boy with intracranial bolt after severe traumatic brain injury: illustrative case.

Abbas, Awais / Hilal, Kiran / Rasool, Aniqa Abdul / Zahidi, Ume-Farwah / Shamim, Muhammad Shahzad / Abbas, Qalab

Journal of neurosurgery. Case lessons

2023 Volume 6, Issue 1

Abstract: Background: Conventional magnetic resonance imaging (cMRI) is sensitive to motion and ferromagnetic material, leading to suboptimal images and image artifacts. In many patients with neurological injuries, an intracranial bolt (ICB) is placed for ... ...

Abstract	Background: Conventional magnetic resonance imaging (cMRI) is sensitive to motion and ferromagnetic material, leading to suboptimal images and image artifacts. In many patients with neurological injuries, an intracranial bolt (ICB) is placed for monitoring intracranial pressure (ICP). Repeated imaging (computed tomography [CT] or cMRI) is frequently required to guide management. A low-field (0.064-T) portable magnetic resonance imaging (pMRI) machine may provide images in situations that were previously considered contraindications for cMRI. Observations: A 10-year-old boy with severe traumatic brain injury was admitted to the pediatric intensive care unit, and an ICB was placed. Initial head CT showed a left-sided intraparenchymal hemorrhage with intraventricular dissection and cerebral edema with mass effect. Repeated imaging was required to assess the brain structure because of continually fluctuating ICP. Transferring the patient to the radiology suite was risky because of his critical condition and the presence of an ICB; hence, pMRI was performed at the bedside. Images obtained were of excellent quality without any ICB artifact, guiding the decision to continue to manage the patient conservatively. The child later improved and was discharged from the hospital. Lessons: pMRI can be used to obtain excellent images at the bedside in patients with an ICB, providing useful information for better management of patients with neurological injuries.
Language	English
Publishing date	2023-07-03
Publishing country	United States
Document type	Journal Article
ISSN	2694-1902
ISSN (online)	2694-1902
DOI	10.3171/CASE23225
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Article ; Online: Life-threatening complication of retropharyngeal abscess in an infant: a case report.

Rehman, Ayaz Ur / Khan, Salman / Abbas, Awais / Pasha, Hamdan Ahmad / Abbas, Qalab / Siddiqui, Naveed Ur Rehman

Journal of medical case reports

2023 Volume 17, Issue 1, Page(s) 367

Abstract: Background: Deep neck space infections are uncommon in infants. Retropharyngeal abscess (RPA) is a deep space neck infection that can present with subtle signs and symptoms. Delay in diagnosis can lead to life-threatening complications. Here we describe ...

Abstract	Background: Deep neck space infections are uncommon in infants. Retropharyngeal abscess (RPA) is a deep space neck infection that can present with subtle signs and symptoms. Delay in diagnosis can lead to life-threatening complications. Here we describe life-threatening complication of retropharyngeal abscess. Case presentation: We report a life-threatening complication of retropharyngeal abscess in 10-month old Asian infant weighing 8.2 kg. The patient presented with fever, right-sided neck swelling, hoarseness of voice, and respiratory distress. The clinical and radiological findings were suggestive of airway obstruction complicated by retropharyngeal abscess. The patient was urgently taken to the operating room and underwent (grade 3) intubation. After stabilization, the patient underwent endoscopic trans-oral incision and drainage, during which 5 cc pus was aspirated. Antibiotics were prescribed for 2 weeks following the procedure based on the sensitivity result of the pus culture. Conclusion: In retropharyngeal abscess, a delay in diagnosis can result in life-threatening complications. This report highlights the importance of prompt recognition of a threatened airway and the management of retropharyngeal abscess by emergency physicians. If an emergency physician suspects RPA with airway obstructions, the airway should be immediately secured in a secure environment by otolaryngologist and an anesthesiologist.
MeSH term(s)	Humans ; Infant ; Retropharyngeal Abscess/diagnosis ; Retropharyngeal Abscess/diagnostic imaging ; Neck ; Airway Obstruction/diagnostic imaging ; Airway Obstruction/etiology ; Anti-Bacterial Agents/therapeutic use ; Drainage
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-08-27
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2269805-X
ISSN	1752-1947 ; 1752-1947
ISSN (online)	1752-1947
ISSN	1752-1947
DOI	10.1186/s13256-023-04101-x
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Article ; Online: Comparison Of Two Definitions (P-Rifle And Kdigo) For Prevalence Of Acute Kidney Injury And In Hospital Mortality In A Paediatric Intensive Care Unit Of Pakistan.

Usman, Parveen / Qaisar, Habib / Haque, Anwar Ul / Abbas, Qalab

Journal of Ayub Medical College, Abbottabad : JAMC

2022 Volume 34, Issue 1, Page(s) 112–117

Abstract: Background: To compare the Paediatric RIFLE (p-RIFLE) and Kidney Disease Improving Global Outcomes (KDIGO) definitions of acute kidney injury (AKI) for frequency of (AKI) and in-hospital mortality in critically ill children.: Methods: Retrospective ... ...

Abstract	Background: To compare the Paediatric RIFLE (p-RIFLE) and Kidney Disease Improving Global Outcomes (KDIGO) definitions of acute kidney injury (AKI) for frequency of (AKI) and in-hospital mortality in critically ill children. Methods: Retrospective review of medical records of all patients (aged 1 month - 16 years) admitted in Paediatric Intensive Care Unit from January 2015-December 2016, with length of stay >48 hours, was done. Patients with chronic kidney disease were excluded. Receiver operating characteristic (ROC) curves were used to evaluate the performance of the p-RIFLE and KDIGO criteria to predict the AKI related mortality. Logistic regression analysis was done to determine the association of different variables with mortality in AKI patient based on p-RIFLE, KDIGO. A p-value of <0.05 was considered significant. Results: Out of total 823 patients admitted during the study period, 562 patients were included in the study. Median age was 2 years (Interquartile range 8 years). Acute kidney injury frequency according to p-RIFLE and KDIGO were 391 (70%), and 372 (66%) respectively. Overall, 106/823 (12.8%) children died during study period, 78 (19.9%) in AKI by p-RIFLE and 76 (20.4%) in AKI by KDIGO died. The area-under- curve for in-hospital mortality for p-RIFLE and KDIGO criteria were 0.525 (p=0.427), and 0.534 (p=0.276), respectively. Conclusions: P-RIFLE is more sensitive compared to KDIGO in diagnosing AKI in critically ill children; identifying a greater number of moderate staged AKI cases. Greater AKI severity is associated with higher mortality in critically ill children.
MeSH term(s)	Acute Kidney Injury/diagnosis ; Acute Kidney Injury/epidemiology ; Child ; Critical Illness ; Female ; Hospital Mortality ; Humans ; Intensive Care Units ; Intensive Care Units, Pediatric ; Male ; Pakistan/epidemiology ; Prevalence ; Retrospective Studies
Language	English
Publishing date	2022-04-07
Publishing country	Pakistan
Document type	Journal Article
ZDB-ID	2192473-9
ISSN	1819-2718 ; 1025-9589
ISSN (online)	1819-2718
ISSN	1025-9589
DOI	10.55519/JAMC-01-9147
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Article: Safety huddles in paediatric intensive care unit: Implementation and staff perception in a resource limited setting.

Zeeshan, Arsheen / Hashwani, Yasmin / Jawwad, Muhammad / Yousafzai, Muhammad Tahir / Rehman, Naveed / Abbas, Qalab

JPMA. The Journal of the Pakistan Medical Association

2023 Volume 73, Issue 2, Page(s) 258–263

Abstract: Objective: To evaluate the perception, knowledge, empowerment and comfort level of critical care staff in relation to the implementation of safety huddles in paediatric intensive care unit of a tertiary care hospital.: Methods: The descriptive cross- ... ...

Abstract	Objective: To evaluate the perception, knowledge, empowerment and comfort level of critical care staff in relation to the implementation of safety huddles in paediatric intensive care unit of a tertiary care hospital. Methods: The descriptive cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from September 2020 to February 2021, and comprised physicians, nurses and paramedics who were part of the safety huddle. Staff perception regarding this activity was evaluated using open-ended questions that were scored on a Likert scale. Data was analysed using STATA 15. Results: Of the 50 participants, 27(54%) were females and 23(46%) were males. Overall, 26(52%) subjects were aged 20-30 years age, while 24(48%) were aged 31-50 years. Of the total, 37(74%) subjects strongly agreed that safety huddle had been routinely held in the unit since initiation; 42(84%) felt comfortable sharing their concerns about patient safety; and 37(74%) considered the huddles worthwhile. Majority 42(84%) felt more empowered through huddle participation. Moreover, 45(90%) participants strongly agreed that daily huddle helped them in becoming clearer about their responsibilities. For safety risk assessment, 41(82%) participants acknowledged that safety risks had been assessed and modified in routine huddles. Conclusion: Safety huddle was found to be a powerful tool to create a safe environment in a paediatric intensive care unit where all team members can speak up freely about patient safety.
MeSH term(s)	Female ; Male ; Child ; Humans ; Adult ; Middle Aged ; Resource-Limited Settings ; Cross-Sectional Studies ; Cognition ; Intensive Care Units, Pediatric ; Perception
Language	English
Publishing date	2023-02-17
Publishing country	Pakistan
Document type	Journal Article
ZDB-ID	603873-6
ISSN	0030-9982
ISSN	0030-9982
DOI	10.47391/JPMA.5308
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Article ; Online: High Flow Nasal Cannula Therapy in Children with Acute Respiratory Insufficiency in the Pediatric Intensive Care Unit of a Resource-limited Country: A Preliminary Experience.

Saeed, Bushra / Azim, Asim / Haque, Anwar Ul / Abbas, Qalab

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP

2021 Volume 31, Issue 1, Page(s) 110–112

Abstract: A retrospective study was performed in children (aged one month - 16 years) receiving HFNC to determine the frequency, efficacy and adverse effects of high flow nasal cannula (HFNC) therapy in the pediatric intensive care unit (PICU), from January to ... ...

Abstract	A retrospective study was performed in children (aged one month - 16 years) receiving HFNC to determine the frequency, efficacy and adverse effects of high flow nasal cannula (HFNC) therapy in the pediatric intensive care unit (PICU), from January to December 2017. Treatment failure was defined as clinical deterioration on HFNC therapy such that mechanical ventilation (MV) was required. Clinical parameters before and after HFNC were assessed using repeated measures analysis of variance. A total of 120 patients received HFNC therapy (21% of total admissions). Primary diagnosis were respiratory disease (50%), central nervous system diseases (14.2%), sepsis (10.8%), and postoperative care (10%). Mean duration of HFNC was 27.5 ±19.7 hours and mean PICU length of stay was 6 ± 6 days. Pneumothorax developed in four patients. MV was required in 28 patients, and subsequently, 15 deaths occurred in that group. HFNC is a frequently used, safe and effective therapy for children requiring respiratory support in PICU. Key Words: Respiratory insufficiency, Non-invasive ventilation, Paediatric intensive care unit.
MeSH term(s)	Cannula ; Child ; Humans ; Intensive Care Units, Pediatric ; Length of Stay ; Oxygen Inhalation Therapy ; Respiratory Insufficiency/therapy ; Retrospective Studies
Language	English
Publishing date	2021-01-30
Publishing country	Pakistan
Document type	Journal Article
ZDB-ID	2276646-7
ISSN	1681-7168 ; 1022-386X
ISSN (online)	1681-7168
ISSN	1022-386X
DOI	10.29271/jcpsp.2021.01.110
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Article: Acute Symptomatic Seizures in Critically Ill Children: Frequency, Etiology and Outcomes.

Rajper, Sanam B / Moazzam, Mujtaba / Zeeshan, Arsheen / Abbas, Qalab

Journal of pediatric neurosciences

2021 Volume 15, Issue 4, Page(s) 375–378

Abstract: Background: Critically ill individuals have an increased risk of acute symptomatic seizures secondary to systemic illnesses; unrecognized or untreated seizures can quickly convert into status epilepticus, which is associated with high morbidity and ... ...

Abstract	Background: Critically ill individuals have an increased risk of acute symptomatic seizures secondary to systemic illnesses; unrecognized or untreated seizures can quickly convert into status epilepticus, which is associated with high morbidity and mortality. Objective: The aim of this study was to determine frequency, etiology, and outcome of seizures in critical ill children admitted in intensive care unit of a tertiary care hospital. Materials and methods: Retrospective review of medical records of all children admitted in pediatric intensive care unit (PICU) of the Aga Khan University from January 2016 to December 2018 and who had a new-onset seizure irrespective of underlying diagnosis was carried out after ethical review committee approval. Data were collected on a structured proforma; it included demographic information as well as relevant clinical and outcome information. The data were analyzed on Statistical Package for the Social Sciences (SPSS) software program, version 19.0. The descriptive statistics frequency and percentage was computed for qualitative variable. Mean and standard deviation were computed for quantitative variable, and univariate analysis was performed. Results: During the study period, a total 2053 patients were admitted in the PICU. One hundred six (5%) had seizure. Sixty-three (59.5%) were males. Meningitis 21 (20%), sepsis 21 (20%), complicated pneumonia 18 (17%) were the major primary diagnosis in these children. Mean age of the study population was 75 months (standard deviation [SD] ± 54.4) and 72 (68%) were <5 years of age, whereas 63 (59.5%) were males. The seizures lasted >10min in 10 (10%) and were associated with high had neurological deficit ( Conclusion: Infection was the most common etiology associated with a new-onset seizure in children admitted in our PICU. Seizures lasting for >10min were observed with high neurological deficit. We did not find any association of mortality with seizure duration.
Language	English
Publishing date	2021-01-19
Publishing country	India
Document type	Journal Article
ISSN	1817-1745
ISSN	1817-1745
DOI	10.4103/jpn.JPN_140_19
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Article ; Online: Critical illness related to community acquired pneumonia, its epidemiology and outcomes in a pediatric intensive care unit of Pakistan.

Zeeshan, Arsheen / Abbas, Qalab / Siddiqui, Arsalan / Khalid, Farah / Jehan, Fyezah

Pediatric pulmonology

2021 Volume 56, Issue 12, Page(s) 3916–3923

Abstract: Background: To determine the epidemiology and outcomes in critically ill children admitted with severe community acquired pneumonia (CAP) and to identify risk factors associated with mortality in a pediatric intensive care unit (PICU) METHODS: ... ...

Abstract	Background: To determine the epidemiology and outcomes in critically ill children admitted with severe community acquired pneumonia (CAP) and to identify risk factors associated with mortality in a pediatric intensive care unit (PICU) METHODS: Retrospective review of medical records of all children (age 1 month to 18 years) admitted to PICU with CAP from January 2013 to March 2018 was done. Patients admitted in last 2 weeks before current illness and those with bronchiolitis (based on clinical diagnosis) were excluded. Data were collected on a structured proforma and included demographic, clinical data, comorbidities, therapeutic information, laboratory data, and outcome data. Results were presented as mean with SD and frequency with percentages. Factors associated with mortality were analyzed, using logistic regression for both univariate and multivariate analyses. Results: A total of 187 children with severe CAP were identified, 53.5% (n = 100) were <1 year of age and 65.2% (n = 122) were male, 32.6% (n = 61) were underweight, and 24.6% (n = 46) were stunted. A total of 94% (175) required mechanical ventilation. Mortality among the cohort was 20.3% (n = 38) with median length of mechanical ventilation 4 (2-8) days, and median length of PICU stay was 6 (4-12) days. PRISM score >10 on admission, presence of systemic illness, empyema, and length of PICU stay 14 (±2) days were associated with increased mortality among critically ill children admitted with CAP (p < .05). Conclusions: Severe illness on presentation, presence of systemic illness and empyema are associated with increased mortality in children admitted to the PICU with severe CAP.
MeSH term(s)	Aged ; Child ; Critical Illness ; Humans ; Infant ; Intensive Care Units, Pediatric ; Length of Stay ; Male ; Pakistan/epidemiology ; Pneumonia/epidemiology ; Retrospective Studies ; Severity of Illness Index
Language	English
Publishing date	2021-09-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	632784-9
ISSN	1099-0496 ; 8755-6863
ISSN (online)	1099-0496
ISSN	8755-6863
DOI	10.1002/ppul.25668
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Article: Performance of a Risk Analytic Tool (Index of Tissue Oxygen Delivery "IDO2") in Pediatric Cardiac Intensive Care Unit of a Developing Country.

Abbas, Qalab / Hussain, Muhammad Zaid H / Shahbaz, Fatima Farrukh / Siddiqui, Naveed Ur Rehman / Hasan, Babar S

Frontiers in pediatrics

2022 Volume 10, Page(s) 846074

Abstract: Objective: To determine the performance of a commercially available risk analytic tool (IDO2) to estimate the risk for SVO2 < 40% in patients admitted in cardiac intensive care unit (CICU).: Methods: Medical and T3 records of all patients (aged 1 day ...

Abstract	Objective: To determine the performance of a commercially available risk analytic tool (IDO2) to estimate the risk for SVO2 < 40% in patients admitted in cardiac intensive care unit (CICU). Methods: Medical and T3 records of all patients (aged 1 day to 12 years, weight >2 kg) who received care in the CICU between October 1st, 2019 and October 1st, 2020, had SvO2 lab(s) drawn during CICU course and whose data was transmitted to T3, were included. The average IDO2 Index was computed in the 30-min period immediately prior to each SvO2 measurement and used as a predictor score for SvO2 < 40%. Results: A total of 69 CICU admissions from 65 patients, median age 9.3 months (interquartile range 20.8) were identified. Surgical and medical patients were 61 (88%) and 8 (12%) respectively; 4 (5.7%) patients had single ventricle physiology. Tetralogy of Fallot Conclusion: IDO2 performed well in estimating low SvO2 (<40%) in pediatric patients presenting to a CICU in a low resource setting. Future work is needed to determine the effect of this risk analytic tool on clinical outcomes in such a setting.
Language	English
Publishing date	2022-06-03
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2022.846074
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Article: Safety of Vasopressor Medications through Peripheral Line in Pediatric Patients in PICU in a Resource-Limited Setting.

Abrar, Saira / Abbas, Qalab / Inam, Maha / Khan, Iraj / Khalid, Farah / Raza, Syed

Critical care research and practice

2022 Volume 2022, Page(s) 6160563

Abstract: Objective: Central venous catheter (CVC) placement in children in resource-limited settings (RLSs) can be a difficult task. Timely administration of vasopressor medications (VMs) through peripheral intravenous line (PIV) can help overcome this ... ...

Abstract	Objective: Central venous catheter (CVC) placement in children in resource-limited settings (RLSs) can be a difficult task. Timely administration of vasopressor medications (VMs) through peripheral intravenous line (PIV) can help overcome this limitation. We aim to determine the safety of administration of vasopressor medications through PIVs in children admitted to pediatric intensive care unit (PICU) in a RLS. Design: Prospective observational study. Conclusion: Vasopressor medication through PIV line is a safe option in patients admitted to the PICU.
Language	English
Publishing date	2022-03-31
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2573849-5
ISSN	2090-1313 ; 2090-1305
ISSN (online)	2090-1313
ISSN	2090-1305
DOI	10.1155/2022/6160563
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Article ; Online: Impact of Nutrition Support Team in Achieving Target Calories in Children Admitted in Pediatric Intensive Care Unit.

Zeeshan, Arsheen / Nairn, Qurat Ul Ain / Jawwad, Muhammad / Saeed, Amna Afzal / Abbas, Qalab / Hague, Anwar Ul

Journal of pediatric gastroenterology and nutrition

2022 Volume 74, Issue 6, Page(s) 830–836

Abstract: Objective: To determine the impact of nutrition support team (NST) on achieving an early target caloric goal in mechanically ventilated children admitted in pediatric intensive care unit (PICU).: Methods: An early enteral nutrition protocol (EENP) ... ...

Abstract	Objective: To determine the impact of nutrition support team (NST) on achieving an early target caloric goal in mechanically ventilated children admitted in pediatric intensive care unit (PICU). Methods: An early enteral nutrition protocol (EENP) was implemented by NST to ensure early and adequate nutrition provision to PICU patients. All children (1 month- 18 years) that were admitted in PICU for >2days and received mechanical ventilation, with no contraindications to enteral feed, were included and data was compared with those of pre-intervention. The adequacy of energy intake was defined as 70% achievement of target energy intake on the third day of admission. Chi-square/t-test was used to determine the difference between different variables pre and post intervention. Results: Total 180 patients (99 and 81 in pre- and post-intervention group, respectively) were included. Overall, 115 (63.9%) received adequate calories (70%) on third day of admission. Of which 69 (85.2%) were from post intervention (P < 0.001; odds ratio [OR] 6.6, 95% confidence interval [CI] 3.195-13.73). Moreover, NST intervention also promoted adequate protein intake in 62 (76.5%) children compared to 37 (37.4%) in pre-intervention group (P < 0.001, OR 5.468, 95% CI 2.838- 10.534). The median (interquartile range) length of PiCU stay in pre-NST group was 6 (4-9) days and in NST supported group was 4 (3-4) days (OR 0.580, CI 0.473-0.712, P < 0.001). Age, severity of illness, multiorgan dysfunction syndrome, sepsis, need of organ support had no effect in achievement of caloric target in both the groups (P > 0.05). Conclusion: Introduction of EENP with NST helped in the achievement of better and quicker target caloric intake.
MeSH term(s)	Child ; Critical Illness/therapy ; Energy Intake ; Humans ; Intensive Care Units, Pediatric ; Length of Stay ; Nutritional Support ; Respiration, Artificial ; Retrospective Studies
Language	English
Publishing date	2022-03-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1097/MPG.0000000000003438
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