Blood Culture and sensitivity pattern in neonotology unit of children hospital Lahore

To identify spectrum of organisms causing neonatal sepsis and the sensitivity pattern against commonly used antibiotics. Prospective descriptive study. Blood samples were taken from all neonates with clinical suspicion of sepsis before start of antibiotics and sent for culture by standard method. The data obtained from January 2004 to June 2004 was analyzed and results were tabulated. A total of 1900 blood samples were taken. Cultures were positive in 524 samples [27.6%]. E Coli was the most common organism found [31.67%] followed by Staph Epidermidis [24.80%], Klebsiella [19.08%] and Pseudomonas [14.69%]. Amikacin was the most effective drug followed by Co-Amoxi Clav, Ciprofloxacin, Imipenem and Ceftazidime in that order. Gram positive and gram negative organisms showed a high degree of resistance against Ampicillin and Gentamycin respectively. Neonatal sepsis is one of the leading causes of morbidity and mortality. Gram negative organ isms are the major cause of neonatal sepsis in NNU of Children Hospital. In this study these organisms showed resistance against commonly used antibiotics [Ampicillin, Gentamycin and Cefotaxime].There is a need to modify already existing protocol in NNU of Children Hospital

Wheezing conditions in early childhood: prevalence and risk factors among preschool children

Using current WHO guidelines, antibiotics are over prescribed in children with wheezing and bronchodilators are under utilized. There are, however, number of causes of wheeze and data on prevalence of wheeze and risk factor among preschool children is lacking in Pakistan. Aim: To determine the prevalence of wheezing in early childhood and identify various risk factors in pre school children. This study was conducted in the out patient department of the Children's Hospital, Lahore, which is a tertiary center. It is a prospective hospital based study performed on the children with aged 1-59 months with acute respiratory symptoms. The researcher filled a questionnaire and patients were assessed in the asthma clinic. The study period was from 1st Jan to 31st December 2004. The prevalence of recent wheeze was 15.8%. It was more common in infants 46.7%. Other risk factors were females 58%, high prevalence with family history of asthma 66%, and other allergic disease like allergic rhinitis 86% eczema 15%, Smoking 73.6% and low level of education 76.6%. With exclusive breastfeeding [33.3%] the prevalence was found to be low. The wheezing is a common symptom in early childhood diseases. Risk factors include age 1-12 months, females, family history of asthma and other allergic disorders. Parents' low education, over crowding and exposure to smoke are other important factors. The breast-feeding seems to have a protective role

Thrombo-embolism in patients with myocarditis

Myocarditis and dilated Cardiomyopathy continues to be an important cause of hospital admission in our part of the world. Systemic embolism due to thrombi in left ventricle is a rare but important complication of these patients. Study objectives: To determine the incidence, course and outcome of thrombo-embolism in children with dilated dysfunctioning heart due to acute myocarditis or dilated Cardiomyopathy. Design: A 5 year analysis [December 1999- Nov 04] of all children under 16 years of age admitted and diagnosed as having myocarditis or dilated Cardiomyopathy in a single tertiary care center. Patients and The charts and echocardiography records of all patients with dilated dysfunctioning heart and systemic thrombo-embolism were reviewed. Data was reviewed for mode of presentation, age, hospital course and outcome. Echocardiography data was reviewed with special reference to the size, function and presence of thrombus in LV. Of all admissions to the paediatric cardiology unit over the study period, myocarditis and dilated Cardiomyopathy was the underlying lesion in 405 patients. The mean age of patients was 2.1 +/- 4 years. Systemic embolism was the presenting feature in 28 [6.9%] patients [Group A]; while another 17 [4.2%] developed it during the hospital stay [Group B]. Another 5 patients had thrombus in the LV but did not develop embolism. All 50 patients showed seriously impaired LV function with mean ejection fraction [EF] for those with vs. those without thrombo-embolism was 17.5 +/- 5.5 vs. 20.0 +/- 6.9 [p = 0.08]. The groups were similar with respect to other baseline characteristics, co morbid illnesses, and drug therapies other than anticoagulants. In group A 26/28 patients presented with a stroke. Only 6 had a thrombus in LV at the time of admission. All 28 patients with or without LV thrombus were treated with heparin and then oral anticoagulant warfarin. There were two deaths. In group B, 3/17 patients had thrombus in the LV on echocardiography at presentation. They were started anticoagulation but still went on to develop a stroke. There were 2 deaths in this group as well. Conclusions: Myocarditis and dilated Cardiomyopathy is an important cause of hospital admission in our set up accounting for 15% of all admissions to a paediatric cardiology unit. These patients are at risk of developing thromboembolism, which may well be the presenting feature. The risk is higher in patients with lower ejection fraction of the LV. All patients with EF below 17% should be treated with prophylactic anticoagulation. A peripheral embolic event adds to morbidity and is related to poor long-term survival in this patient group

Epidemiology and prognosis of acute renal failure in children

One hundred and thirty three children with nonsurgical forms of acute renal failure [ARF] were admitted during a six-month period [January to June, 1991] to the Department of Paediatrics, Mayo Hospital, Lahore; they comprised 1.8% of the hospitalised children. Newborns and infants constituted 69% of the patients. Acute diarrhoea [53%], sepsis [21%], and haemolytic uraemic syndrome [8%] were the leading causes of ARF. The case fatality rate was 23.3%, with septicaemia as the major cause [48%] of death. Four patients [3%] developed chronic renal failure. Good prognosis indicators were prerenal oliguria versus renal oliguria, based on history, and low fractional excretion of sodium [< 1%] and renal failure index [< 1]; oliguria of less than seven days; unclouded sensorium; and early dialysis at the onset of complications