Clinical outcome in children hospitalized with complicated measles

To determine the association of clinical outcome of measles in children with demographic profile and complications. A cross-sectional analytical study. Isolation ward, The Children's Hospital, Pakistan Institute of Medical Sciences [PIMS], from January 2003 to August 2004. Detailed history and physical examination of all the hospitalized patients with complications of measles was filled in case report form. Immunization cards were assessed for measles vaccination status. Data was analyzed by using SPSS version 10 software. The clinical outcome of measles was compared with demographic profile and complications by using Chi-square test and p-values were obtained. Two hundred and five hospitalized patients with complications of measles were studied. There were 61.5% males. Mean age was 46.1 months and 57% patients were vaccinated against measles. Malnourished patients were 71.2% and had a longer hospital stay [p=0.010]. Pneumonia [40.0%] and diarrhoea [38.5%] were the commonest complications. Seven children died. Mortality was significantly associated with younger age [p=0.04], unvaccinated status [p=0.04] and presence of encephalitis [p=0.00001]. The most common complications of measles are pneumonia and diarrhoea with dehydration requiring hospitalization. Malnourished children experience more complications and have longer hospital stay. Mortality is significantly associated with infancy, unvaccinated status and encephalitis. A second dose of measles should be introduced at 15 months of age

Neonatal sepsis in hospital-born babies: bacterial isolates and antibiotic susceptibility patterns

To determine the frequency of bacterial isolates from neonatal blood cultures and their susceptibility patterns in hospital-born babies having sepsis. Design: An observational study. Place and Duration of Study: Obstetrics Unit and Special Care Baby Unit of Khyber Teaching Hospital, Peshawar from 1st January to 31st December 2001. Subjects and This study was carried out on the neonates born and admitted in hospital with positive blood culture reports. Early onset neonatal sepsis [EONNS] and late onset neonatal sepsis [LONNS] were defined as illness appearing from birth to seven days and from eight to twenty-eight days postnatal age respectively. The blood culture reports were analyzed by SPSS package and cross tabulation was done. One hundred and twelve hospital-born babies presented with sepsis. Sixty-seven neonates had positive cultures. Escherichia coli [E.coli] was the commonest organism causing EONNS [35;77.1%] followed by Pseudomonas [4; 8.9%], Klebsiella [4; 8.9%] and Staphylococcus aureus [2;4.4%] respectively. In the LONNS E. coli [19; 77.3%] was the commonest followed by Staphylococcus and Pseudomonas [2; 9% each] and Klebsiella [1; 4.5%]. The gram-negative organisms showed high degree of resistance to commonly used antibiotics, ampicillin [79.3%], amoxicillin [74.6%] and ceftazidime [71.6%], cefotaxime [55.2%] and comparatively low resistance to gentamicin [43.2%], tobramycin [34.3%], imipinem [23.6%], amikacin [22.3%], ofloxacin and ciprofloxacin [11.9%] respectively. Staphylococcus aureus showed almost the same resistance to ampicillin, 75%, and comparatively low resistance to the rest of the antibiotics as compared to the gram negative organisms. Neonatal sepsis is mainly caused by gram-negative organisms, which are developing resistance to commonly used antibiotics

Comparative efficacy of amoxicillin, cefuroxime and clarithromycin in the treament of community - acquired pneumonia in children

To compare the clinical response to amoxicillin, cefuroxime and clarithromycin in the treatment of community-acquired pneumonia in children and to see the cost effectiveness of each treatment. Design: Randomized clinical control trial. Place and Duration of Study: Department of Pediatrics, Khyber Teaching Hospital, Peshawar, from October 2001 to February 2002. Subjects and Patients between 3 to 72 months of age, admitted in the hospital with community acquired pneumonia, were randomly divided into three groups,1,2,3. They were started on amoxicillin, cefuroxime and clarithromycin respectively. The patients were assessed daily. If there was no clinical improvement at 48 hours the antibiotic was changed. ANOVA statistical test was applied to see the clinical response to the treatment in the three groups. Cost effectiveness of the treatment was compared. There was no statistical difference in the clinical response at 48 hours of initiating treatment and at discharge [p > 0.01 each]. The mean hospital stay in group 1 and 2 was 3.3 days and group 3 was 3.2 days respectively [p > 0.01]. Ninety-seven% patients in group 1 and 3, and 95% patients in group 2 showed clinical improvement. The cost of treatment of community acquired pneumonia for 8 days was Rs 496/-, 730/-, 1018/- for amoxicillin, clarithromycin and cefuroxime respectively. Amoxicillin was found the most cost effective followed by clarithromycin and cefuroxime respectively in the treatment of non-severe and severe community-acquired pneumonia

Nosocomial infections as a major cause of sepsis in admitted neonates

To determine the causes of nosocomial infection in admitted neonates having clinical or bacteriological proven sepsis.A retrospective analysis of 100 neonates admitted to neonatology unit of a teaching hospital, having clinical or bacteriological evidence of sepsis. History and laboratory data was scrutinized to collect relevant information. Out of 100 neonates, 58 were females and 42 were males. 63 patients were preterm and 37 were term infants. 68 patients were delivered at home and 32 were delivered in hospital. In 15 patients, mother had some perinatal infections and in 28 cases mothers had prolonged rupture of membranes. In 57 cases, no maternal or neonatal cause of infection was found and these babies acquired nosocomial or hospital acquired infection. Nosocomial infections are very common in our setup. Stringent methods are recommended to improve the basic hygiene of our neonatal units