Burnout among pediatric residents and junior consultants working at a tertiary care hospital

Objective: To determine the burnout among postgraduate residents' and junior consultants in a tertiary care hospital

Methods: This cross-sectional study was conducted among the postgraduate residents [PGR] and junior consultants [JC] working at The Children's Hospital Lahore in 2018. Participants were asked to complete Copenhagen Burnout Inventory questionnaire about burnout on 5 point Likert scale. '100 [always], 75 [often], 50 [sometimes], 25 [seldom] and 0 [never/almost never or according to intensity ranging from 'a very low degree' to 'to a very high degree'. Data was analyzed using SPSS version 22. Three questions were added related to hospital factors but scored separately. Students t-test and chi square test were used to compare the burnout

Results: A total of 227 participants including 177 PGR and 50 JC completed the questionnaire with a response rate of 84% and 86% respectively. There was a female predominance, 140 participants [61.7%] were female. Majority was from pediatric medicine 173 [76.2%]. The mean personal and work related-burnout was high among PGRs as compared to JCs [18.68+/-5.01 vs 16.62+/-4.57] [p=0.008] and [21.14+/-5.57 vs. 18.56+/-5.52] [p=0.004] respectively. Similarly, there was significantly more burnout among pediatric medicine study participants as compared to surgery and diagnostic in all domains [personal BO; p=0.030, work-related BO; p=0.021, patient related BO; 0.033 and hospital related BO; 0.001]. No difference was noted based on gender and year of training

Conclusion: Tertiary care hospital postgraduate residents and junior consultants face moderate burnout. Postgraduate residents had significantly more burnout as compared to junior consultants and majority were from pediatric medicine

rare case of Kikuchi-Fujimoto Disease associated with systemic lupus erythematosus

Kikuchi-Fujimoto Disease [KFD], also known as histiocytic necrotizing lymphadenitis, is a self-remitting, immune-mediated rare disorder having unique histopathological characteristics which is commonly seen in young Asian females, but can occur in all ethnicities. There is a strong association between KFD and Systemic Lupus Erythematosus [SLE]. We present a case of a young Pakistani boy who presented with cervical lymphadenopathy, fever, blackish discoloration of finger tips, and Raynaud's phenomenon. His lymph node biopsy was suggestive of KFD. The American Rheumatology Association diagnostic criteria were not met as no other features of SLE were present. His autoimmune workup including Anti-Nuclear Antibodies [ANA] and Anti-Double Stranded DNA [Anti-Ds DNA] antibodies were positive and supported the diagnosis of SLE. He improved clinically with steroid therapy and nifedipine with resolution of symptoms

Spectrum of complications in childhood Enteric Fever as reported in a Tertiary Care Hospital

Objective: To find out frequency of various complications in children admitted with Enteric Fever at a tertiary care hospital

Methods: This was prospective cross sectional study, carried out in the Pediatric Medicine department of The Children's Hospital Lahore from Dec 2014 to March 2017. Children of both genders with age range of 6 months to 16 years diagnosed as enteric fever on the basis of clinical features and positive Typhidot, or blood culture were included in the study. All 180 patients were scrutinized for all possible complications. Where ever required and feasible appropriate and relevant investigations were done to document complications. Data was analyzed by SPSS version 20

Results: Mean age of children was 7.2+/-3.38, majority 94 [52.2 percent] were 5-10 years old. Out of 180 patients, complications were noted in 58 [32.2 percent]. Neurological complications 30.7 percent encompassed maximum complications followed by hepatobiliary 24.61 percent, abdominal 16.92 percent hematological 9.23 percent, bone and joints 7.69 percent, respiratory system 6.1 percent and cardiovascular system 4.41 percent. Mortality rate was 1.6 percent. Thrombocytopenia and leucopenia were significantly associated with complications with p value of 0.002 and 0.003 respectively

Conclusion: Enteric fever is causing our children to suffer by its numerous perplexing and fatal complications. The most vulnerable age for enteric fever and its complication is 5-10 years. To combat these issues large scale vaccination remains promising option at least in most susceptible age group

Impact of maternal education, employment and family size on nutritional status of children

Objective: To determine the impact of maternal education, employment, and family size on nutritional status of children

Methods: It was case control study conducted at OPD of children Hospital Lahore, from September 2015 to April 2017. Total 340 children [170 cases and 170 controls] with age range of six months to five years along with their mothers were included. Anthropometric measurements were plotted against WHO growth Charts. 170 wasted [<-2 SD] were matched with 170 controls [>/= -2 SD]. Maternal education, employment and family size were compared between the cases and control. Confounding variables noted and dichotomized. Univariate analysis was carried out for factors under consideration i.e.; Maternal Education, employment and family size to study the association of each factor. Logistic regression analysis was applied to study the independent association

Results: Maternal education had significant association with growth parameters; OR of 1.32 with confidence interval of [CI= 1.1 to 1.623]. Employment status of mothers had OR of 1.132 with insignificant confidence interval of [CI=0.725 to 1.768]. Family size had OR of one with insignificant confidence interval [CI=0.8 -1.21]. Association remained same after applying bivariate logistic regression analysis

Conclusion: Maternal education has definite and significant effect on nutritional status of children. This is the key factor to be addressed for prevention or improvement of childhood malnutrition. For this it is imperative to launch sustainable programs at national and regional level to uplift women educational status to combat this ever increasing burden of malnutrition

Patient safety awareness among postgraduate students and nurses in a tertiary health care facility

Objective: To determine the knowledge of patient safety among postgraduate residents [PGR] and nurses in a tertiary care hospital

Methods: This casual comparative study was conducted among the postgraduate residents and nurses working at The Children's Hospital Lahore in the month of July, August 2017. Both PGR and nurses were asked to complete APSQ-IV questionnaire about patient safety on 7 point Likert scale. Data was analyzed using SPSS version 20 and t-test was used to compare the mean score between two groups. The names of the participants were kept confidential

Results: A total of 150 residents and 150 nurses were included. The scores of both postgraduate residents and nurses were similar in all domains having positively worded questions with insignificant difference in mean score [p=0.141]. In the reverse coded questions the nurses showed positive perception with higher mean score as compared to postgraduate residents [p=0.004]. The postgraduate residents in the early years of residency had higher mean score in positively worded question as compared to residents who were in last years of training [p=0.006]

There was no difference in the mean score of nurses as regard to their years of experience [p=0.733]. Medical error disclosure domain was reported lowest by both postgraduate residents and nurses

Conclusion: Both postgraduate residents and nurses showed positive attitude with good knowledge and perception towards patient safety. Lowest rated scores were from error disclosure confidence domain

Socioeconomic risk factors for asthma in child

The purpose of the study was to explore and explain different socioeconomic conditions and factors related to childhood asthma, Cross sectional descriptive study, This study was conducted at the Children's Hospital and the Institute of Child Health, Lahore for a period of three month. This is a descriptive study done at the asthma clinic of the Children's Hospital and the Institute of Child Health, Lahore. Total 110 patients were included in the study between 2-16 years, An objectively designed structured questionnaire was used and data was collected after taking consent from the parents. Out of 110 patients, the commonest age was 2-8 years for both males and females. The disease was most common in boys [63.6%] and urban area [57.3%] had higher frequency than patients from semi urban [24.5%] or rural areas [18.2%]. Asthma was more common in lower and middle class than upper. Different socioeconomic risk factors involved in the increased frequency of asthma were smoking, animals at home and environmental dust. Allergic reactions to food, change in weather and preceding upper respiratory tract infections also play an important role. Poor socioeconomic class, uneducated families, urban life and environmental allergen exposure are responsible for increase frequency of asthma and by investing resources in to community based education and support services we can provide a better control of asthma to our community

Non compliance of drug therapy in diabetics - experience at Lahore

Diabetes is becoming a major health problem in Pakistan. However, there is no data about noncompliance of drug therapy in diabetics in Pakistan. To assess drug compliance in diabetic patients and their reasons for noncompliance. Setting: Lahore General Hospital, Lahore having a catchment area of poor population. Methods: Using a standard questionnaire administered by a doctor to diabetic adults over the age of 20 years, the degree of drug compliance and the reasons for noncompliance were assessed. Of 163 diabetics studied, only 40% of the patients had good compliance with others having various degrees of noncompliance. Main reasons for stopping the drugs in 97 non-compliant patients were carelessness [51.6%/, misbelief that diabetes is cured when there are no symptoms or when blood glucose becomes normal [50.5%], not being told about the chronic nature of the disease by the treating doctor [28.9%] and cost of treatment [25.8%]. This study underscores the need for health education of the diabetic patients by general practitioners about the disease and the need for continuous treatment by the patients to avoid the manifold cost of treatment of complication of uncontrolled diabetes