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Article ; Online: Clinical and epidemiological features of pediatric population hospitalized with COVID-19

Qalab Abbas / Farah Khalid / Fatima Farrukh Shahbaz / Javeria Khan / Shazia Mohsin / Murtaza Ali Gowa / Abdul Sattar Shaikh / Rai Muhammad Asghar / Javairia Khalid / Sehrish Karim / Fyezah Jehan / Masood Sadiq / Junaid Rashid

The Lancet Regional Health - Southeast Asia, Vol 11, Iss , Pp 100176- (2023)

a multicenter longitudinal study (March 2020–December 2021) from PakistanResearch in context

2023

Abstract: Summary: Background: We aimed to explore the epidemiological, clinical, and phenotypic parameters of pediatric patients hospitalized with COVID-19 in Pakistan. Methods: This longitudinal cohort study was conducted in five tertiary care hospitals in ... ...

Abstract	Summary: Background: We aimed to explore the epidemiological, clinical, and phenotypic parameters of pediatric patients hospitalized with COVID-19 in Pakistan. Methods: This longitudinal cohort study was conducted in five tertiary care hospitals in Pakistan from March 2020 to December 2021. Data on various epidemiological and clinical variables were collected using Case Report Forms (CRFs) adapted from the WHO COVID-19 clinical data platform at baseline and at monthly follow-ups for 3 months. Findings: A total of 1090 children were included. The median age was 5 years (Interquartile range 1–10), and the majority presented due to new signs/symptoms associated with COVID-19 (57.8%; n = 631), the most common being general and respiratory symptoms. Comorbidities were present in 417 (38.3%) children. Acute COVID-19 alone was found in 932 (85.5%) children, 81 (7.4%) had multisystem inflammatory syndrome (MIS-C), 77 (7.0%) had overlapping features of acute COVID-19 and MIS-C, and severe disease was found in 775/1086 (71.4%). Steroids were given to 351 (32.2%) patients while 77 (7.1%) children received intravenous immunoglobulins. Intensive care unit (ICU) care was required in 334 (31.6%) patients, and 203 (18.3%) deaths were reported during the study period. The largest spike in cases and mortality was from July to September 2021 when the Delta variant first emerged. During the first and second follow-ups, 37 and 10 children expired respectively, and medical care after discharge was required in 204 (25.4%), 94 (16.6%), and 70 (13.7%) children respectively during each monthly follow-up. Interpretation: Our study highlights that acute COVID-19 was the major phenotype associated with high severity and mortality in children in Pakistan in contrast to what has been observed globally. Funding: The study was supported by the World Health Organization (WHO), which was involved in the study design but played no role in its analysis, writeup, or publication.
Keywords	Pediatric COVID-19 ; Epidemiology ; SARS-CoV-2 ; Pakistan ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2023-04-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Development and validation of a clinical predictive model for severe and critical pediatric COVID-19 infection.

Judith Ju Ming Wong / Qalab Abbas / Felix Liauw / Ririe Fachrina Malisie / Chin Seng Gan / Muhammad Abid / Pustika Efar / Josephine Gloriana / Soo Lin Chuah / Rehena Sultana / Koh Cheng Thoon / Chee Fu Yung / Jan Hau Lee / PACCOVRA Investigators of the PACCMAN research group

PLoS ONE, Vol 17, Iss 10, p e

2022 Volume 0275761

Abstract: Introduction Children infected with COVID-19 are susceptible to severe manifestations. We aimed to develop and validate a predictive model for severe/ critical pediatric COVID-19 infection utilizing routinely available hospital level data to ascertain ... ...

Abstract	Introduction Children infected with COVID-19 are susceptible to severe manifestations. We aimed to develop and validate a predictive model for severe/ critical pediatric COVID-19 infection utilizing routinely available hospital level data to ascertain the likelihood of developing severe manifestations. Methods The predictive model was based on an analysis of registry data from COVID-19 positive patients admitted to five tertiary pediatric hospitals across Asia [Singapore, Malaysia, Indonesia (two centers) and Pakistan]. Independent predictors of severe/critical COVID-19 infection were determined using multivariable logistic regression. A training cohort (n = 802, 70%) was used to develop the prediction model which was then validated in a test cohort (n = 345, 30%). The discriminative ability and performance of this model was assessed by calculating the Area Under the Curve (AUC) and 95% confidence interval (CI) from final Receiver Operating Characteristics Curve (ROC). Results A total of 1147 patients were included in this analysis. In the multivariable model, infant age group, presence of comorbidities, fever, vomiting, seizures and higher absolute neutrophil count were associated with an increased risk of developing severe/critical COVID-19 infection. The presence of coryza at presentation, higher hemoglobin and platelet count were associated with a decreased risk of severe/critical COVID-19 infection. The AUC (95%CI) generated for this model from the training and validation cohort were 0.96 (0.94, 0.98) and 0.92 (0.86, 0.97), respectively. Conclusion This predictive model using clinical history and commonly used laboratory values was valuable in estimating the risk of developing a severe/critical COVID-19 infection in hospitalized children. Further validation is needed to provide more insights into its utility in clinical practice.
Keywords	Medicine ; R ; Science ; Q
Subject code	310
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Multisystem inflammatory syndrome (MIS-C) in Pakistani children

Shazia S Mohsin / Qalab Abbas / Devyani Chowdhary / Farah Khalid / Abdul Sattar Sheikh / Zuviya Ghazala Ali Khan / Nadeem Aslam / Omaima Anis Bhatti / Maha Inam / Ali Faisal Saleem / Adnan T Bhutta

PLoS ONE, Vol 16, Iss 6, p e

A description of the phenotypes and comparison with historical cohorts of children with Kawasaki disease and myocarditis.

2021 Volume 0253625

Abstract: Objectives To determine clinical, laboratory features and outcomes of Multisystem Inflammatory Syndrome in children (MIS-C) and its comparison with historic Kawasaki Disease (KD) and Viral Myocarditis (VM) cohorts. Methods All children (1 month- 18 years) ...

Abstract	Objectives To determine clinical, laboratory features and outcomes of Multisystem Inflammatory Syndrome in children (MIS-C) and its comparison with historic Kawasaki Disease (KD) and Viral Myocarditis (VM) cohorts. Methods All children (1 month- 18 years) who fulfilled the World Health Organization criteria of MIS-C presenting to two tertiary care centers in Karachi from May 2020 till August 31st were included. KD and VM admitted to one of the study centers in the last five years prior to this pandemic, was compared to MIS-C. Results Thirty children with median age of 24 (interquartile range (IQR)1-192) months met the criteria for MIS-C. Three phenotypes were identified, 12 patients (40%) with KD, ten (33%) VM and eight (26%) had features of TSS. Echocardiography showed coronary involvement in 10 (33%), and moderate to severe Left Ventricular dysfunction in 10 (33%) patients. Steroids and intravenous immunoglobulins (IVIG) were administered to 24 (80%) and 12 (41%) patients respectively while 7 (23%) received both. Overall, 20% children expired. During the last five years, 30 and 47 children were diagnosed with KD and VM, respectively. Their comparison with MIS-C group showed lymphopenia, thrombocytosis, and higher CRP as well as more frequent atypical presentation in MIS-C KD group with less coronary involvement. The MIS-C VM was more likely to present with fulminant myocarditis. Conclusions Our MIS-C cohort is younger with higher mortality compared to previous reports. MIS-C is distinct from historic cohorts of KD and VM in both in clinical features and outcomes.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Evaluation of antibiotic use in Pediatric Intensive Care Unit of a developing country

Qalab Abbas / Anwar Ul Haq / Raman Kumar / Syed Asad Ali / Kashif Hussain / Sadia Shakoor

Indian Journal of Critical Care Medicine, Vol 20, Iss 5, Pp 291-

2016 Volume 294

Abstract: Background: Pediatric Intensive Care Unit (PICU) patients are often prescribed antibiotics with a low threshold in comparison to patients elsewhere. Irrational antibiotics use can lead to rapid emergence of drug resistance, so surveillance of their use ... ...

Abstract	Background: Pediatric Intensive Care Unit (PICU) patients are often prescribed antibiotics with a low threshold in comparison to patients elsewhere. Irrational antibiotics use can lead to rapid emergence of drug resistance, so surveillance of their use is important. Objectives: To evaluate the use of antibiotics in relation to bacteriological findings in PICU of a Tertiary Hospital. Methods: Retrospective review of medical records of all children (age 1 month–16 years) admitted in our closed multidisciplinary-cardiothoracic PICU from January to June 2013 was performed, after approval from Ethical Review Committee. For each antibiotic, indication (prophylactic, empiric, therapeutic) and duration of use were recorded. All diagnoses of infections were recorded according to diagnostic criteria of IPSCC 2005. Results are presented as frequency and percentages and median with inter quartile range using SPSS version 19. Results: All of the total 240 patients admitted in PICU during the study period received antibiotics: 43% (n = 104) prophylactically, 42% (n = 102) empirically, and 15% (n = 15) therapeutically. Median number of antibiotic use per patient in PICU was 3, with range of 1–7. 25% received 1 antibiotic, 23% received 2 antibiotics, 29% received 3 antibiotics, and rest received ≥4 antibiotics. Most commonly used antibiotics were cefazolin, meropenem, vancomycin and ceftriaxone, and most frequently used combination was meropenem and vancomycin. In majority of the cases, (70%) empiric antibiotic combinations were stopped in 72 h. Conclusion: This is the first report of antibiotics use in PICU from our country, which shows that antibiotics are prescribed universally in our PICU. Strategies to assess the need for antibiotic use are needed.
Keywords	Antibiotic use ; developing country ; infection ; Pediatric Intensive Care Unit ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9 ; Internal medicine ; RC31-1245 ; Medicine ; R
Subject code	610
Language	English
Publishing date	2016-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Paediatric External Ventricular Drains: Experience from a tertiary care hospital of a Developing Country.

Qalab, Abbas / Asad, Rayaan / Hakeem, Mahnaz / Ahmed, Maria / Anwar, Haque / Darbar, Aneela

JPMA. The Journal of the Pakistan Medical Association

2016 Volume 66Suppl 3, Issue 10, Page(s) S72–S74

Abstract: The aim of the study was to describe indications and complications of external ventricular drain (EVD) placement in children aged between 1 month and 16 years. This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, ... ...

Abstract	The aim of the study was to describe indications and complications of external ventricular drain (EVD) placement in children aged between 1 month and 16 years. This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised all children who underwent EVD placement from January 2007 to December 2014. Of the 177 patients identified, 117(66%) were males 60(34%) were girls. The overall mean age was 5.4±5.2 years. The median Glasgow Coma Scale score on presentation and discharge was 13 (interquartile range [IQR]: 7) and 15 (IQR: 4), respectively. Major diagnosis included intracranial tumour 60(34%), bacterial meningitis 34(19%), tuberculous meningitis 33(18.6%), and haemorrhage 23(13%). Clinical indications for EVD insertion were acute hydrocephalus secondary to infection 64(36.2%), tumour 54(30.5%), and haemorrhage 23(13%) ventriculoperitoneal shunt malfunction or infection 25(14.1%) and traumatic brain injury 11(6.2%). Complications were observed in 47(26%) patients including infections 25(14.1%), malfunction 11(6.2%), haemorrhage 6(3.4%), misplacement 3(1.7%) and obstruction 2(1.1%). Staphylococcus was the main organism isolated. Moreover, 25(14%) patients expired. Acute hydrocephalus was the major indication and EVD infection was the major complication.
MeSH term(s)	Adolescent ; Child ; Child, Preschool ; Developing Countries ; Drainage ; Female ; Humans ; Hydrocephalus/therapy ; Infant ; Male ; Retrospective Studies ; Tertiary Care Centers ; Ventriculoperitoneal Shunt
Language	English
Publishing date	2016-11-29
Publishing country	Pakistan
Document type	Journal Article
ZDB-ID	603873-6
ISSN	0030-9982
ISSN	0030-9982
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Spectrum of Intracerebral Hemorrhage in Children

Qalab Abbas / Qurat ul Ain Merchant / Bushra Nasir / Anwar ul Haque / Basit Salam / Gohar Javed

Critical Care Research and Practice, Vol

A Report from PICU of a Resource Limited Country

2016 Volume 2016

Abstract: Intracerebral hemorrhage (ICH) in children is a rare but disabling disease that accounts for almost half cases of stroke. We report our experience of ICH in children. Retrospective review of medical records of children (1 month-16 years) admitted in ... ...

Abstract	Intracerebral hemorrhage (ICH) in children is a rare but disabling disease that accounts for almost half cases of stroke. We report our experience of ICH in children. Retrospective review of medical records of children (1 month-16 years) admitted in Pediatric Intensive Care Unit between January 2007 and December 2014 was done. Data collected included age, gender, presentation, examination findings, neuroimaging done (CT, MRI, and angiography) management (conservative/intervention), and outcome. Results are presented as frequency and percentages. Of the total 50 patients, 58% were male and 26% were <1 year. On presentation 44% had vomiting, 42% had seizures, and GCS < 8 while 40% had altered level of consciousness. Single bleed was present in 88%, 94% had supratentorial bleed, and 32% had intraventricular extension. 72% had bleed volume of <30 mL and 8% had >60 mL. CT scan was done in 98% patients and MRI in 34%, while 6% underwent conventional angiography. 60% patients were managed conservatively, 36% underwent neurosurgical intervention, and 6% underwent radiological vascular intervention. Hematologic causes were identified in 52% patients and vascular malformations in 14% and in 26% no cause could be identified. 26% of patients expired.
Keywords	Internal medicine ; RC31-1245
Subject code	610
Language	English
Publishing date	2016-01-01T00:00:00Z
Publisher	Hindawi Publishing Corporation
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Risk Factors Associated with Anthracycline Induced Cardiac Dysfunction in Pediatric Patients

Abdul Sattar Shaikh / Muhammad Matloob Alam / Shazia Samad Mohsin / Qalab Abbas / Zehra Fadoo / Mehnaz Atiq

World Journal of Cardiovascular Diseases , Vol 04, Iss 07, Pp 377-

2014 Volume 383

Abstract: Anthracyclines ( i.e. , doxorubicin, daunorubicin) have significant impact on outcome in many pediatric chemotherapy protocols and therefore remain the mainstay of treatment. The objective of this study was to identify the risk factors for anthracycline ... ...

Abstract	Anthracyclines ( i.e. , doxorubicin, daunorubicin) have significant impact on outcome in many pediatric chemotherapy protocols and therefore remain the mainstay of treatment. The objective of this study was to identify the risk factors for anthracycline induced cardiac dysfunction in pediatric patients. Multiple logistic regression model was applied to assess the risk factors for development of cardiac dysfunction. 110 pediatric oncology patients were available for final analysis. 75 (66%) children were males and mean age was 74 ± 44 months. ALL ( n = 70, 64%) was the most common primary diagnosis followed by lymphoma ( n = 19; 17%) and AML ( n = 12, 11%). Daunorubicin alone or in combination with doxorubicin was used in ( n = 94, 85%) patients and cumulative dose < 300 mg was used in ( n = 95; 86%) children. 24 (22%) children received radiation therapy as per protocol and sepsis were observed in 47 (43%) cases. Post anthracycline, 15 (14%) children had cardiac dysfunction within a month; out of them 10/15 (67%) had isolated diastolic dysfunction, while 28 (25%) developed dysfunction within a year. 19 (17%) had pericardial effusion. 11 expired and out of them, 7 had significant cardiac dysfunction. Cumulative dose > 300 mg/m 2 ( p < 0.001; AOR 2.3), radiation therapy ( p = 0.009; AOR 3.5) and sepsis ( p = 0.002; AOR 2.6) were found to be independent risk factors associated anthracycline induced cardiac dysfunction. At univariant level use of daunorubicin alone or in combination therapy ( p < 0.001, OR 7) and mode of delivery ( p 0.048, OR 9.7) were also found statistically significant. In conclusion anthracycline induced cardiac dysfunction is mostly related to cumulative dose > 300 mg/m 2 , use of Daunorubicin alone or in combination with doxorubicin, mode of delivery, radiation therapy and sepsis. Regular long term follow-up with cardiologist is the key point for early diagnosis and therapy for a long term survival.
Keywords	Anthracycline ; Cardiac Dysfunction ; Risk Factors ; Pediatric Oncology ; Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R
Subject code	610 ; 616
Language	English
Publishing date	2014-06-01T00:00:00Z
Publisher	Scientific Research Publishing
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018

Xin Wang, MSc / You Li, PhD / Katherine L O'Brien, ProfMD / Shabir A Madhi, ProfPhD / Marc-Alain Widdowson, VetMB / Peter Byass, ProfPhD / Saad B Omer, ProfPhD / Qalab Abbas, MBBS / Asad Ali, MD / Alberta Amu, MD / Eduardo Azziz-Baumgartner, MD / Quique Bassat, ProfMD / W Abdullah Brooks, MD / Sandra S Chaves, MD / Alexandria Chung, BMedSci(H) / Cheryl Cohen, MD / Marcela Echavarria, PhD / Rodrigo A Fasce, BSc / Angela Gentile, ProfMD /

Aubree Gordon, PhD / Michelle Groome, PhD / Terho Heikkinen, ProfMD / Siddhivinayak Hirve, PhD / Jorge H Jara, MD / Mark A Katz, MD / Najwa Khuri-Bulos, ProfMD / Anand Krishnan, ProfMD / Oscar de Leon, BSc / Marilla G Lucero, MD / John P McCracken, ScD / Ainara Mira-Iglesias, MSc / Jennifer C Moïsi, PhD / Patrick K Munywoki, PhD / Millogo Ourohiré, MD / Fernando P Polack, ProfMD / Manveer Rahi, MBChB / Zeba A Rasmussen, MD / Barbara A Rath, ProfMD / Samir K Saha, ProfPhD / Eric AF Simões, ProfMD / Viviana Sotomayor, MPH / Somsak Thamthitiwat, MD / Florette K Treurnicht, PhD / Marylene Wamukoya, MPH / Lay-Myint Yoshida, ProfPhD / Heather J Zar, ProfPhD / Harry Campbell, ProfMD / Harish Nair, ProfPhD

The Lancet Global Health, Vol 8, Iss 4, Pp e497-e

a systematic review and modelling study

2020 Volume 510

Abstract: Summary: Background: Seasonal influenza virus is a common cause of acute lower respiratory infection (ALRI) in young children. In 2008, we estimated that 20 million influenza-virus-associated ALRI and 1 million influenza-virus-associated severe ALRI ... ...

Abstract	Summary: Background: Seasonal influenza virus is a common cause of acute lower respiratory infection (ALRI) in young children. In 2008, we estimated that 20 million influenza-virus-associated ALRI and 1 million influenza-virus-associated severe ALRI occurred in children under 5 years globally. Despite this substantial burden, only a few low-income and middle-income countries have adopted routine influenza vaccination policies for children and, where present, these have achieved only low or unknown levels of vaccine uptake. Moreover, the influenza burden might have changed due to the emergence and circulation of influenza A/H1N1pdm09. We aimed to incorporate new data to update estimates of the global number of cases, hospital admissions, and mortality from influenza-virus-associated respiratory infections in children under 5 years in 2018. Methods: We estimated the regional and global burden of influenza-associated respiratory infections in children under 5 years from a systematic review of 100 studies published between Jan 1, 1995, and Dec 31, 2018, and a further 57 high-quality unpublished studies. We adapted the Newcastle-Ottawa Scale to assess the risk of bias. We estimated incidence and hospitalisation rates of influenza-virus-associated respiratory infections by severity, case ascertainment, region, and age. We estimated in-hospital deaths from influenza virus ALRI by combining hospital admissions and in-hospital case-fatality ratios of influenza virus ALRI. We estimated the upper bound of influenza virus-associated ALRI deaths based on the number of in-hospital deaths, US paediatric influenza-associated death data, and population-based childhood all-cause pneumonia mortality data in six sites in low-income and lower-middle-income countries. Findings: In 2018, among children under 5 years globally, there were an estimated 109·5 million influenza virus episodes (uncertainty range [UR] 63·1–190·6), 10·1 million influenza-virus-associated ALRI cases (6·8–15·1); 870 000 influenza-virus-associated ALRI hospital ...
Keywords	Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2020-04-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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