Towards Rabies Elimination in Pakistan: Barriers, Facilitators, and the Role of One Health.

Background: Rabies is a neglected zoonotic disease with an estimated 59,000 deaths annually, disproportionately affecting low- and middle-income countries. Pakistan remains a high-burden setting due to weak surveillance, poor intersectoral coordination, and limited public awareness. Therefore, this study aimed to examine the barriers and facilitators to rabies control in Pakistan through the One Health approach, integrating perspectives from both community members and institutional stakeholders.

Aflatoxin exposure and mortality in acutely ill children: results from the CHAIN network cohort.

Background: Chronic exposure to aflatoxins is associated with liver cancer, impaired child growth, and compromised immune function. The Childhood Acute Illness and Nutrition (CHAIN) Network cohort was established to identify risk factors for mortality in acutely ill children admitted to nine hospitals in four African and two South Asian countries. We examined the role of aflatoxin exposure in inpatient and post-discharge mortality.

Post-vaccination campaign evaluation of systemic and mucosal immunity of trivalent oral poliovirus vaccine in Karachi, Pakistan (2020-2021): a cross-sectional study.

Background: The transmission of wild poliovirus (WPV1) and circulating vaccine-derived poliovirus (cVDPV) continues to be a major Public Health Emergency of International Concern. Currently, only Afghanistan and Pakistan remain polio-endemic for WPV1. In response to the co-circulation of VDPV2 with WPV1, the Technical Advisory Group of WHO had recommended two nationwide campaigns of trivalent oral poliovirus vaccine (tOPV) for children aged <5 years in Pakistan in 2020.

Association of iron deficiency anemia with dental caries in the permanent first molars of children aged 7-12 years in Karachi, Sindh, Pakistan: protocol for an analytical cross-sectional study.

Introduction: Iron deficiency anaemia (IDA) and dental caries are prevalent diseases among Pakistani children. Limited research has been done to explore their association with permanent teeth. Given the caries susceptibility of permanent first molars and their role in the development of ideal occlusion, this study aimed to estimate caries frequency in these molars and assess its association with IDA in 7-12 year-old children.

Exploring the quality of life of pediatric trainees: Mixed-method explanatory design.

Objective: Healthcare workers are at a higher risk of burnout. The aim of the study was to explore the professional quality of life (QOL) i.e.

Burden of Respiratory Disease in Pediatric Intensive Care Unit: Experience from a PICU of a Tertiary Care Center in Pakistan.

Introduction: We aimed to determine the burden of respiratory disease by examining clinical profiles and associated predictors of morbidity and mortality of patients admitted to a Pediatric Intensive Care Unit (PICU) in Pakistan, a resource limited country. We also stratified the respiratory diseases as defined by the Pediatric Advanced Life Support (PALS) Classification.

Methods: A retrospective study was conducted on children aged 1 month to 18 years who were diagnosed with respiratory illness at the PICU in a tertiary hospital in Karachi, Pakistan.

Childhood growth during recovery from acute illness in Africa and South Asia: a secondary analysis of the childhood acute illness and nutrition (CHAIN) prospective cohort.

Background: Growth faltering is well-recognized during acute childhood illness and growth acceleration during convalescence, with or without nutritional therapy, may occur. However, there are limited recent data on growth after hospitalization in low- and middle-income countries.

Methods: We evaluated growth following hospitalization among children aged 2-23 months in sub-Saharan Africa and South Asia.

Mutational analysis in different genes underlying severe combined immunodeficiency in seven consanguineous Pakistani families.

Background: Severe Combined Immunodeficiency (SCID) is an autosomal recessive inborn error of immunity (IEI) characterized by recurrent chest and gastrointestinal (GI) infections and in some cases associated with life-threatening disorders.

Methodology And Results: This current study aims to unwind the molecular etiology of SCID and also extended the patients' phenotype associated with identified particular variants. Herein, we present 06 disease-causing variants identified in 07 SCID-patients in three different SCID related genes.

Mucosal Immunity to Poliovirus in Children 0-15 Years of Age: A Community-Based Study in Karachi, Pakistan in 2019.

This study assesses poliovirus type 1 (PV1) immunity in children to inform the contribution of mucosal immunity in and prevention of poliovirus circulation. A community-based study was conducted in periurban Karachi, Pakistan. Randomly selected children (0-15 years of age) received oral poliovirus vaccine (OPV) challenge dose.

Impact of COVID-19 on feto-maternal and neonatal health in Karachi, Pakistan, A retrospective cohort study.

Scientific literature suggests that pregnant women are at greater risk of acquiring a more severe form of COVID-19 exposing both mother and child to a higher risk of obstetric and neonatal complications. These include increased hospitalization rates, ICU admissions, or ventilatory support among pregnant women when compared to COVID-19 negative pregnant womenA case-control study was conducted at the Aga Khan University Hospital, Karachi, Pakistan with the objective of evaluating the clinical presentation of COVID-19 in pregnancy and its effect on maternal and neonatal outcomes. Data was retrospectively collected from April 2020 till January 2022 of obstetric patients with COVID-19 positive cases and were compared with COVID-19 negative cases from the same time.

Complementary Feeding Pattern and Nutritional Status of Children.

Objective: To determine the complementary feeding patterns and their association with malnutrition.

Study Design: Prospective observational study. Place and Duration of the Study: Outpatient clinics of Aga Khan University Hospital, Pakistan, from June to November 2019.

Two-Year Duration of Immunity of Inactivated Poliovirus Vaccine: A Follow-up Study in Pakistan in 2020.

This was a follow-up study conducted in 2020 assessing changes in levels of type 2 poliovirus-neutralizing antibodies 2 years postimmunization in children who received inactivated poliovirus vaccine (IPV) in Karachi, Pakistan. Unexpectedly, the findings revealed an increase in seroprevalence of type 2 antibodies from 73.1% to 81.

Biomarker-Based Risk Stratification in Pediatric Sepsis From a Low-Middle Income Country.

Objectives: Most biomarker studies of sepsis originate from high-income countries, whereas mortality risk is higher in low- and middle-income countries. The second version of the Pediatric Sepsis Biomarker Risk Model (PERSEVERE-II) has been validated in multiple North American PICUs for prognosis. Given differences in epidemiology, we assessed the performance of PERSEVERE-II in septic children from Pakistan, a low-middle income country.

Neurodevelopment and Recovery From Wasting.

Background And Objectives: Acute illness with malnutrition is a common indication for hospitalization among children in low- and middle-income countries. We investigated the association between wasting recovery trajectories and neurodevelopmental outcomes in young children 6 months after hospitalization for an acute illness.

Methods: Children aged 2 to 23 months were enrolled in a prospective observational cohort of the Childhood Acute Illness & Nutrition Network, in Uganda, Malawi, and Pakistan between January 2017 and January 2019.

Epidemiological, clinical, and radiological comparison of adult and pediatric features in COVID-19: A scoping review.

Objective: To assess epidemiological, clinical, and radiological characteristics of the coronavirus disease in children and adults.

Methods: The scoping review comprised search on PubMed and Scopus Cochrane databases from January 2020 to April 2021 for English-language articles dealing with clinical and radiological manifestations amongst children and adults affected by coronavirus disease. Two reviewers independently screened the titles and abstracts.

Poliovirus excretion among children with primary immune deficiency in Pakistan: a pilot surveillance study protocol.

Introduction: Children with primary immunodeficiency disorders (PID) are more susceptible to developing viral infections and are at a substantially increased risk of developing paralytic poliomyelitis. Such children, if given oral polio vaccines tend to excrete poliovirus chronically that may lead to the propagation of highly divergent vaccine-derived poliovirus (VDPV). Consequently, they may act as a reservoir for the community by introducing an altered virus potentially imposing a risk to global polio eradication.

Multisystem inflammatory syndrome (MIS-C) in Pakistani children: A description of the phenotypes and comparison with historical cohorts of children with Kawasaki disease and myocarditis.

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.

Serial population-based serosurveys for COVID-19 in two neighbourhoods of Karachi, Pakistan.

Objective: To determine population-based estimates of coronavirus disease 2019 (COVID-19) in a densely populated urban community of Karachi, Pakistan.

Methods: Three cross-sectional surveys were conducted in April, June and August 2020 in low- and high-transmission neighbourhoods. Participants were selected at random to provide blood for Elecsys immunoassay for detection of anti-severe acute respiratory syndrome coronavirus-2 antibodies.

Surgical-site infections in emergency abdominal paediatric surgeries at a tertiary-care hospital in Pakistan.

A retrospective chart review was carried out in children (neonates to 18 years) who underwent acute surgical abdominal exploration during 2012-2016 at the Aga Khan University Hospital, Karachi, to evaluate the postoperative surgical site infection rates in emergency paediatric abdominal surgery. Incidence of surgical site infection (SSI) was estimated. P-value was calculated, chisquare and non-parametric tests were performed by comparing pre-surgical and post-surgical procedure pathogen occurrence and pre-procedure wound status.

Antimicrobial Stewardship - Do we need it in Pakistan?

In order to identify the literature and research available on development and implementation of Antimicrobial Stewardship Programme (ASP) in Pakistan, a systematic search of various electronic databases such as PubMed, Cochrane, CINAHL and PakMedinet from January 1, 2008 till November 2018 was conducted. Studies were included if they were focused around the development and implementation of the ASP within Pakistan. The search revealed that a significant knowledge gap exists regarding antimicrobial/antibiotic stewardship within Pakistan and not much is known about the current status of the development and implementation of antimicrobial stewardship programme.

One-Year Decline of Poliovirus Antibodies Following Fractional-Dose Inactivated Poliovirus Vaccine.

Background: Fractional dose (one-fifth of full intramuscular dose) of inactivated poliovirus vaccine (fIPV) administered intradermally is used as IPV dose-sparing strategy. We compared the rate of decline of poliovirus antibodies (PVA) in recipients of 2 doses of fIPV or IPV.

Methods: A community-based randomized controlled trial was conducted in Karachi, Pakistan.

Paediatric respiratory isolation: A challenge for a secondary care hospital! A service innovation project.

Objective: The aim of this project was to broaden the secondary care hospital's scope of services and provide safe, effective and quality care for the patient presenting with measles.

Methods: Six Sigma DMAIC [define measure, analyze, improve, and control (DMAIC)] methodology was used in this quality improvement project. The quality project was started in October 2015 using a Gantt chart quality tool.