ABSTRACT
Objective: To determine the correlation between serum folic acid, vitamin B12 and ferritin of mother and child and to study various neonatal risk factors as a cause of anemia in children
Methods: One hundred eighty children two months to two years of age admitted in the department of Pediatric Medicine of The Children's Hospital and The Institute of Child Health Lahore from January 2013 to January 2015 with common medical conditions having anemia were included. Complete blood count [CBC], serum ferritin level, folic acid and Vitamin [Vit] B12 level were sent of children and their mothers. Data was analyzed using SPSS version 20
Results: Out of 180 children with anemia, 66.7% were males. Mean age of children was 7.3months. Fifty-five percent children were malnourished according to z scoring. The mean Hemoglobin [Hb] of children was 8 g/dl. Only 4% children had low ferritin level while 60% had low folic acid and 45% had decreased VitB12. There was significant correlation between Hb of mother and child [p =0.02], Vit B12 deficiency [p=0.008] and iron deficiency [p<0.001]. Premature children had lower folic acid levels [p =0.02], while prematurity, IUGR, previous admission and history of sepsis showed no association with anemia in our study. Both breast-feeding and top feeding showed significant association with anemia with p-value of 0.042 and 0.003 respectively while dilution showed no impact on anemia
Conclusion: Maternal anemia has a significant impact on child's hemoglobin. As compared to previous concept of increased iron deficiency in children we found increased occurrence of folic acid and VitB12 deficiency in children and their mothers
ABSTRACT
Objective: To describe bacteriological profile, morbidity and mortality of acute bacterial meningitis [ABM] in children and to compare these parameters before and after the introduction of Pneumococcal vaccine in Pakistan National Immunization Program
Methods: The present descriptive study was conducted at the Department of Paediatric Medicine of The Children's Hospital Lahore from January 2012 to December 2015. A total of 503 children one month to five years of age admitted with diagnosis of meningitis were included. Complete blood count, CSF cytology, biochemistry, culture sensitivity and blood culture sensitivity were performed
Results: Frequency of meningitis decreased by 50% in 2013-2015 [199 [2012] vs 304 [2013-2015]. Most children in both groups were under one year of age. More neurological complications were seen in the group 2, 20% vs 17%. CSF culture positivity decreased from 12% to 6.6%. Streptococcus pneumoniae isolation decreased from 5 [2.5%] in 2012 to 4 [1.3%] in 2013-2015. Refusal to take feed [p=0.002], impaired sensorium [p=<0.001], severe malnutrition [p=0.001], prolonged duration of symptoms [p=<0.001] and incomplete vaccination status [0.005] were associated with mortality. Mortality rate decreased from 20 [10%] in 2012 to 17 [5.6%] in 2013-2015 but more children developed neurological sequelae 2.7% versus 1%
Conclusion: Acute bacterial meningitis mostly affected children <1 year. Frequency of Streptococcus pneumoniae and mortality of meningitis decreased significantly after PCV but more neurological complications developed in those children who were unvaccinated in 2013-2015 compared to 2012
ABSTRACT
Objective: The present study aimed to determine the frequency and antimicrobial profile of ESBL-producing isolates of f. coli in different environments
Methods: This cross-sectional study was conducted at The Children's Hospital and The Institute of Child Health, Lahore from July to December 2015. The faecal specimens from healthy individuals, patients, sewage sludge, cattle, chickens and raw meat [n = 122] were processed for microbiological analysis using MacConkey agar supplemented with cefotaxime. The identification of organisms was confirmed by API 10S and antimicrobial resistance profile was recorded by Kirby-Bauer disc diffusion method
Results: On the basis of screening, 77 [63.0%] specimens were found to be positive for ESBL production
The confirmation of 74 [60.0%] ESBL producing f. coli was done using double disc synergy test [DDST]
The frequency of ESBL producing E. coli was found to be 17 [57.0%] in healthy individuals, 15 [53.0%] in patients, 10 [66.0%] in cattle faeces, 5 [71.0%] in sewage sludge, 14 [70.0%] in raw meat and 13 [59.0%] in chicken faeces. All of these isolates were resistant to cephalosporins and some of these were resistant to fluoroquinolones and meropenem. None of the isolates showed resistance to cefoperazone-sulbactam, imipenem, piperacillin-tazobactam and amikacin
Conclusion: The prevalence of ESBL-producing E. coli was recorded in all the environments, suggesting a global expansion of these enzymes
Subject(s)
Animals , beta-Lactamases , Sewage , Chickens , Cattle , Raw Foods , Meat , Cross-Sectional StudiesABSTRACT
Objective: To determine the causes of medical errors, the emotional and behavioral response of pediatric medicine residents to their medical errors and to determine their behavior change affecting their future training
Methods: One hundred thirty postgraduate residents were included in the study. Residents were asked to complete questionnaire about their errors and responses to their errors in three domains: emotional response, learning behavior and disclosure of the error. The names of the participants were kept confidential. Data was analyzed using SPSS version 20
Results: A total of 130 residents were included. Majority 128[98.5%] of these described some form of error. Serious errors that occurred were 24[19%], 63[48%] minor, 24[19%] near misses, 2[2%] never encountered an error and 17[12%] did not mention type of error but mentioned causes and consequences. Only 73[57%] residents disclosed medical errors to their senior physician but disclosure to patient's family was negligible 15[11%]. Fatigue due to long duty hours 85[65%], inadequate experience 66[52%], inadequate supervision 58[48%] and complex case 58[45%] were common causes of medical errors. Negative emotions were common and were significantly associated with lack of knowledge [p=0.001], missing warning signs [p=<0.001], not seeking advice [p=0.003] and procedural complications [p=0.001]. Medical errors had significant impact on resident's behavior; 119[93%] residents became more careful, increased advice seeking from seniors 109[86%] and 109[86%] started paying more attention to details. Intrinsic causes of errors were significantly associated with increased information seeking behavior and vigilance [p=0.003] and [p=0.01] respectively
Conclusion: Medical errors committed by residents have inadequate disclosure to senior physicians and result in negative emotions but there was positive change in their behavior, which resulted in improvement in their future training and patient care
ABSTRACT
Objective: To determine the disease pattern, etiological agents and outcome of childhood acute bacterial meningitis. Study Design: A descriptive study. Place and Duration of Study: Department of Paediatric Medicine. The Children's Hospital. Lahore, from January to December 2012
Methodology: A total of 199 children between the ages of 1 month and 5 years, admitted with the diagnosis of meningitis on the basis of clinical findings and positive cerebrospinal fluid [CSF], were included. In all patients, complete blood count [CBC], CSF culture sensitivity, and blood culture sensitivity were performed. Data was analysed using SPSS version 20
Results: Out of 199 children. 127 [63.8%] were males with M:F ratio of 1.7:1. Mean age was 11.33 +/-12 months. Maximum numbers of children were < 1 year of age, 136 [68.3%]. Only 90 [45.2%] children were fully vaccinated according to Expanded Program of Immunisation [EPI] schedule. Presentations with refusal to take feed [p=0.008] and with impaired conscious state were independent predictors of death [p=0002]. Complications were noted in 34 [17%] and were significantly associated with severe malnutrition [p=0.006] and altered conscious level at presentation [p<0.001]. The common pathogens identified on CSF culture were coagulase negative staphylococci [CoNS] in 11 [5.5%] and streptococcus pneumoniae in 5 [2 5%]. Overall mortality was 10.1%. The commonest pathogen isolated from children who died was streptococcus pneumoniae [p=0.039]
Conclusion: Acute bacterial meningitis mostly affected children under the age of 1 year. CSF culture revealed both Gram- positive and Gram-negative bacteria. The most common pathogen in children who died was streptococcus pneumoniae