Arshad Rafique

Bio: Arshad Rafique is an academic researcher from The Aga Khan University Hospital. The author has contributed to research in topics: Medicine & Pediatrics. The author has an hindex of 2, co-authored 3 publications receiving 15 citations.

Subacute sclerosing panencephalitis: clinical and demographic characteristics

Abstract: Objective To determine the clinical and demographic characteristics of children diagnosed with Subacute sclerosing panencephalitis (SSPE). Study design Case series. Place and duration of study The Aga Khan University Hospital, Karachi, from January 2000 to June 2012. Methodology A retrospective analysis was done, regarding medical charts of 43 children under the age of 16 years with a discharge diagnosis of SSPE. Demographic and clinical characteristics were recorded. RESULTS were expressed as percentages. Results Most of the 43 patients were male (72%). The average age at presentation was 8.7 years with average duration of symptoms being 100.6 days. History of measles was present in 17 patients (39.5%). All children had seizures at presentation and 65% had cognitive impairment. Most patients required poly therapy for control of seizures. Sodium valproate was the most commonly used anti-epileptic agent; Isoprinosine was tried in 22 (51%) patients. CSF for antimeasles antibodies was positive in approximately 86% of the 40 (93%) children. EEG showed burst suppression pattern in 36 (83.7%) cases. Forty-two patients (97.6%) were discharged home in a vegetative state. Conclusion SSPE is progressive neurodegenerative disorder. It can be prevented by timely immunization against measles. Measles antibody in the CSF is diagnostic for SSPE and is helpful in early diagnosis. Most patients experience a gradual but progressive decline in motor and cognitive functions.

Etiology of Congestive Heart Failure in Children

Abstract: Objective: To determine the frequency of common causes of congestive heart failure among children in a tertiary care hospital. Study Design: Cross-sectional study Place and Duration of Study: Department of Paediatrics Medicine, Services Hospital, Lahore from 1st January 2018 to 30th June 2018. Methodology: Ninety children were enrolled. Demographic information like name, age, gender, weight of child was noted. Complete blood count, echocardiography and chest X-ray were done. Children underwent assessment for presence of causes of congestive heart failure. Results: Fifty six (62.22%) were between 2-30 months of age whereas 34 (37.78%) were between 31-60 months of age with mean age 29.4±12.47 months. There were 40 (44.44%) males and 50 (55.56%) females. The causes of CCF were acute myocarditis in 39 (43.33%), congenital heart disease in 31 (34.44%) and severe anemia in 20 (22.33%). Conclusion: Acute myocarditis is one of the common causes of congestive heart failure in children aftersevere anemiaand congenital heart disease. Keywords: Congestive heart failure, Common causes, Acute myocarditis, Congenital heart disease, Severe anemia

Comparison of Hypertonic Saline vs Salbutamol in Normal Saline Nebulization in Children with Bronchiolitis

Abstract: Background: Main stay of treatment of acute Bronchiolitis is general supportive care, such as oxygenation, aspiration of respiratory tract secretions, and hydration therapy. Recent research indicates that breathed hypertonic saline is a potential treatment. Objective: To compare the mean length of hospital stay and clinical bronchiolitis score of salbutamol nebulized in normal saline versus hypertonic saline in children with acute bronchiolitis. Material and methods Study Design: Randomized controlled design Setting: Department of pediatrics, Fatima Memorial Hospital, Lahore. Duration of Study: 6 months after approval of the study i.e. from 12th April 2017 to 12th October 2017. Data Collection Procedure: Relevant parameters were identified, and the CBSS was computed. Using random tables, cases were divided among two groups and given salbutamol or hypertonic saline nebs. The length of stay was determined. The Clinical Bronchiolitis Severity Score (CBSS) was recorded based on various variables. Version 17 of the statistical package for social sciences was used for statistical analysis. Result: Patients in the salbutamol group had a mean age of 13.56.66 months, while those in the hypertonic saline group had a mean age of 12.46.58 months. In the group receiving salbutamol, there were 29 males and 31 females. There were 32 men and 28 women in the hypertonic saline group. After 24 hours, the mean CBSS in the salbutamol group was 6.132.47, whereas in the hypertonic saline group, it was 4.881.75. After 24 hours of treatment, the difference in CBSS was significant between the two groups (P0.05). The mean duration of hospitalization was 3.920.81 days with salbutamol and 3.050.77 days with the hypertonic group. In both groups, there was a marked difference in duration of hospital stay (P0.05). Conclusion: Thus, hypertonic saline was more effective than salbutamol in reducing the CBSS score and duration of hospital stay. Keywords: Hospital Stay, Clinical Bronchiolitis Score, Nebulized Salbutamol, Normal Saline, Hypertonic Saline, Children, Acute Bronchiolitis.

Inosine Pranobex: A Key Player in the Game Against a Wide Range of Viral Infections and Non-Infectious Diseases

Abstract: Inosine pranobex (IP), commonly known as inosine acedoben dimepranol, isoprinosine and methisoprinol, has been proven to positively impact the host's immune system, by enhancing T-cell lymphocyte proliferation and activity of natural killer cells, increasing levels of pro-inflammatory cytokines, and thereby restoring deficient responses in immunosuppressed patients. At the same time, it has been shown that it can affect viral RNA levels and hence inhibit growth of several viruses. Due to its immunomodulatory and antiviral properties, and its safety profile, it has been widely used since 1971 against viral infections and diseases, among which subacute sclerosis panencephalitis, herpes simplex virus, human papilloma virus, human immunodeficiency virus, influenza and acute respiratory infections, cytomegalovirus and Epstein-Barr virus infections. Following an analysis of almost five decades of scientific literature since its original approval, we here summarize in vivo and in vitro studies manifesting the means in which IP impacts the host's immune system. We also provide a synopsis of therapeutic trials in the majority of which IP was found to have a beneficial effect. Lastly, positive results from limited studies, suggesting the putative future use of IP in new therapeutic indications are briefly described. In order to support use of IP against viral infections apart from those already approved, and to establish its use in clinical practice, further well-designed and executed trials are warranted.Funding: Ewopharma International.

Subacute sclerosing panencephalitis - current perspectives.

Abstract: Subacute sclerosing panencephalitis is a progressive neurodegenerative disease. It usually occurs 7–10 years after measles infection. The clinical course is characterized by progressive cognitive decline and behavior changes followed by focal or generalized seizures as well as myoclonus, ataxia, visual disturbance, and later vegetative state, eventually leading to death. It is diagnosed on the basis of Dyken’s criteria. There is no known cure for subacute sclerosing panencephalitis to date, but it is preventable by ensuring that an effective vaccine program for measles is made compulsory for all children younger than 5 years in endemic countries.

Subacute sclerosing panencephalitis in South African children following the measles outbreak between 2009 and 2011

Abstract: Between 2009 and 2011, there was an outbreak of measles throughout South Africa (SA). The largest age category infected was children<5 years of age. In 2014, four patients, with a median age of 4 years and 5 months (range 4 years 3 months-4.5 years), three males and one female, presented with subacute sclerosing panencephalitis (SSPE). All were infected with measles during the period of the 2009-2011 outbreak in early infancy, at a time when their immune systems were immature and before they were vaccinated against the measles virus. One patient was immunocompromised, with vertically acquired HIV infection. All the children presented with cognitive and behavioural decline, abnormal movements and medically intractable myoclonic and atonic seizures. Outcome was poor in all and no reversibility was evident with standard therapeutic interventions. Optimal seizure control with carbamazepine is reported in patients with SSPE. Three of our patients who received carbamazepine experienced improved seizure control, but their neuroregression continued. Since submission of this case series, patient 1 (see Table 1) has died, and a further child has presented with the same clinical phenotype as described. On the basis of this clustering of patients in the Western Cape Province, SA, it is important to screen children admitted with acute cognitive decline and intractable seizures for SSPE, especially those who were infants during the measles outbreak.

Burden of neurological illnesses in a pediatric intensive care unit of developing country.

Abstract: Objective To assess the burden and spectrum of neurological illness in a pediatric intensive care unit and review the associated mortality. Methods Retrospective review of medical records of children (1 mo-16 years) with acute neurological diagnosis admitted in PICU in Aga Khan University hospital from January 2008 to December 2011 was done. Basic demographic, diagnosis, neuro diagnostic procedures performed, therapies and outcomes were done on a structured datasheet. Results During study period, 231 (19.3%) patients were admitted with acute neurological illnesses in PICU. The mean age was 67 ±50 months, 54% (n=125) was under-five and 138 (59.7%) were males. Out of total, 144 (62.3%) had neurological illness and 87 (37.7%) had neurosurgical diagnosis. In acute neurological illness, 51.5% (n=119) had non-traumatic-coma (NTC) and 10.8% (n=25) had neuromuscular illness. CNS infection (26%, n=60) in structural cause and status epilepticus (10%, n=23) were the most common cause of structural and metabolic type of NTC respectively. Severe traumatic brain injury (21.2%, n=49) and postoperative neurosurgical illness (16.5%, n=38) were common neurosurgical cases in our cohort. The intensive care resources were utilized as mechanical ventilation in 78% (n=180), inotropic support in 29.4% (n=67) and therapeutic hypothermia in 33% (n=76). Fifty children (21.6%) required PICU care for observation only. More than 500 neurodiagnostic tests/procedures were performed in this cohort of children with acute neurological disorders in PICU. The mortality rate in neurological cases was 18% (42/231) as compared to the overall mortality rate was 12% in PICU. Conclusion Acute neurological disorders were common in PICU, and were associated with higher mortality. CNS infections, status epilepticus and severe traumatic brain injuries were the most common acute neurological illnesses in our cohort.