Effects of position on oxygen saturation in acute respiratory distress in neonates

To determine the effects of prone versus supine positions of the patient on oxygen [O[2]] saturation in neonates with acute respiratory distress. Observational Cross sectional study. Department of Paediatrics Chandka Medical College Hospital Larkana, from December 2011 to June 2012. One hundred neonates were included in this study by non-probability sampling. All the patients with respiratory distress [RD] were kept in supine position for three hours after all necessary resuscitative measures and oxygen saturation was recorded with pulse oximeter. After that they were kept in prone position for six hours. With pulse oximeter oxygen saturation and respiratory rate were measured every two hours interval for six hours. Age ranged from 1 hour - 25 days. There were 77 [77%] term, 19 [19%] preterm and 4 [4%] post term babies with male to female ratio of 1.3:1. There were a total of 200 supineprone cycles. After 6 hour in prone position the PaO[2] of all patients increased by about 7%. In supine position it was 86.4 +/- 5.7 and in prone 93.5 +/- 4.1 with p value of < 0.001 which is statistically highly significant. Prone position improves oxygenation in majority of patients as compared to supine position

Risk factors for severe acute malnutrition in children under the age of five year in Sukkur

Severe acute malnutrition [SAM] affects approximately 13 million children under the age of 5 year and is associated with 1-2 million preventable child deaths per year. To determine the risk factors for severe acute malnutrition in children under the age of five year. Settings and duration: Nutrition stabilization center of Ghulam Muhammad Mahar Medical College Hospital Sukkur from February 2011 to January 2012. This was a prospective descriptive study. All children diagnosed as severe acute malnutrition, defined as weight for height measurement of < 70% of the median or > 3 SD below the mean World Health organization reference values or the presence of bilateral pitting edema of nutritional origin admitted in Nutrition Stabilization Center were included in this study. Two hundred seventy [270] children were admitted during study period. The age ranged from 06 to 59 months. Maternal illiteracy was present in 216[80%] and paternal illiteracy in 180[66.7%] cases. Parent's income was less than 5000/month in 198[73.3%], family size with more than 4 or more children was seen in 180[66.7%] cases. Exclusive breast feeding was present in only 70[25.9%], mixed feeding was seen in 170[62.9%] and only bottle feeding was seen in 30[11.1%] cases. Late weaning was started in 150[55.6%]. Recurrent diarrhoea was seen in 120[44.4%]. The common risk factors associated with severe acute malnutrition were parental illiteracy, large family size, poverty, non exclusive breast feeding and recurrent diarrhoea. Policy message: To decrease childhood malnutrition mothers should be encouraged for exclusive breast feeding. Parent's education can play an important role in improving child health

Experience of malaria at tertiary care hospitals Sukkur

To determine Plasmodium species, clinical features, and hematological changes in Malaria. Prospective Descriptive Study. This study was carried out at the Paediatric Departments of Shaheed Mohtrama Benazir Bhutto Medical University at Ghulam Muhammad Mahar Medical college Hospital sukkur and chandka Medical Collage Larkan, from July 2007 to July 2011. This is prospective descriptive study, including 250 patients with fever and malaria confirmed on microscopy and immunochromatography, at both departments were included. After consent a separate pro- forma was filled for each patient to record demography and data about clinical presentation and laboratory investigations. Out of 250 malaria cases, the classical clinical presentation was found in 198 [79.2%] of patients while 52 [20.8%] had other symptoms. Males were in majority 164 [65.6%] and age range 1 year to 12 years. Splenomegaly was found in 135 [54%] and hepatomegaly in 86 [34.4%] of patients. Microscopy results of malaria patients revealed P. Falciparum in 97 [38.8%], P. Vivax 91 [36.4%] and 62 [24.8%] mixed infection of P. Falciparum and P. Vivax. Anemia was found in most of patients 84% [Hb <10g/dl]. Thrombocytopenia [platelets < 150,000/cmm] was found in 50 [20%] of patients. The classical presentation of Malaria was seen in majority of cases but one should be careful about atypical or very serious complicated clinical presentation of malaria, and early diagnosis of P. falciparum or mixed infection is very essential to save the life of young children

experience of thrombocytopenia in children at Tertiary Care Hospitals Sukkur and Larkana

Thrombocytopenia is the most common cause of bleeding in children. Patients with thrombocytopenia may experience petechiae, epistaxis, gum bleeding, hematuria or gastrointestinal hemorrhage or intracranial bleeding, seizures and unconsciousness. To determine the various causes, and clinical features of thrombocytopenia in children. Prospective descriptive study. This study was conducted at the Paediatric Departments of Shaheed Mohtrama Benazir Bhutto Medical University at Ghulam Muhammad Mahar Medical College Hospital Sukkur and Chandka Medical College Hospital Larkana, from July 2009 to July 2011. This was a prospective descriptive study, include 200 patients1 to 12 year of age, presenting with fever, mucocutaneous bleeding and thrombocytopenia on peripheral smear at both departments. After consent a separate pro-forma was filled for each patient to record demography and data about various causes, clinical presentation and laboratory investigations. Out of 200 thrombocytopenic patients 128 [64%] were males and 72 [36%] females, majority in age group of under 10 years 154 [77%]. The most common cause was the malaria in 50% of cases, followed by ITP 20 [10%], aplastic anemia and thalassemia [hypersplenism] in 7.5% respectively. Dengue fever and Typhoid fever was [5%] of cases. The other minor causes were severe malnutrition, acute leukemia, hemolytic uraemic syndrome 2.5% each. The most common clinical presentation was petechiae and echymosis in 92 [46%], followed by epistaxis and gum bleeding 68 [34%] of cases, subconjuctival hemorrhage in [14%] and hematuria in [08%] of cases. Unconsciousness was present in [9%] of cases. Anemia was found in most of patients [71%]. Splenomegaly was present in 79 [39.5%] and hepatomegaly in 59 [29.5%] of patients. Platelets were less than 50,000/cmm in majority [60%] of patients. The common cause of thrombocytopenia in febrile children was malaria, followed by ITP, Aplastic anemia and thalassemia [hypersplenism], Dengue hemorrhagic fever and enteric fever was less common. The other minor causes were severe malnutrition, acute leukemia, hemolytic uremic syndrome and lymphoma

Treatment outcome of enteric fever in children at tertiary care hospital Sukkur Pakistan

Enteric fever [Typhoid fever] is widely recognized as a major public health problem in developing countries. To evaluate the treatment outcome of enteric fever in children. Retrospective descriptive study. This study was conducted at the Paediatric department, Ghulam Muhammad Mahar Medical College Hospital Sukkur from January 2009 to December 2011. This was a retrospective study, included all patients of enteric fever, of both sex and age ranged from 6m to 13 years. All enteric patients were confirmed by serological test Typhidot IgM or IgM and IgG positive. The data was collected from case record for demography and treatment outcome. A total of 360 patients were diagnosed to have enteric fever during this period. Mean age of presentation was 6.47 years and 166 [46.12%] patients were <5 years whereas 194 [53.88%] were > 5 years of age. Male: Female ratio was 2:1. Serological test typhidot IgM was positive in 290 [80.5%] and both [IgM + IgG] were positive in 70 [19.45%] of cases. Raised ALT was seen in 90[25%] of cases. Complications were seen in 52 [14.4%] of cases, hepatitis 10 [2.77%], hepatic abscess 3 [0.83%] intestinal hemorrhage 8 [2.22%], peritonitis 4 [1.11%] intestinal perforation 4 [1.11%], cholecystitis 6 [1.66%], paralytic ileus 3 [0.83%] enteric encephalopathy 3 [0.83%], meningitis 1 [0.27%]. Two patients expired [0.55%], one was enteric encephalopathy and other intestinal perforation with peritonitis. enteric fever remains a major cause of morbidity and mortality in our part of country. Major complications found in our cases were hepatitis, hepatic abscess, intestinal hemorrhage, intestinal perforation, peritonitis, cholecystitis, enteric encephalopathy, meningitis, osteomyelitis, septic arthritis

Response of primary torticollis to physiotherapy

To determine the response of torticollis including sternocleidomastoid tumor to physiotherapy and positioning. Descriptive case series. Department of Paediatric Medicine at Chandka Medical College [CMC], Shaheed Muhatarma Benazir Bhutto University, Larkana, from January 2007 to June 2008. All children with swelling at the side of neck, difficulty in head movement, not feeding on one side of breast and with the history of prolonged or difficult labor, were included. Diagnosis of torticollis and /or sternocleidomastoid tumor was based on history and physical examination of the swelling in the neck. They were advised physiotherapy and proper position as per protocol for 4 weeks to 24 weeks. Patients were reviewed at 4 weeks interval for response to physiotherapy. The data were analyzed by SPSS version 10.0. A total of 170 patients of torticollis were enrolled during the study period. Most of the cases were below four weeks of age [n 61- 35.9%] with overall male to female ratio of 1.4:1. The common presentation of torticollis were excessive cry with neck movement [n105, 61.7%], followed by sternocleidomastiod tumor or swelling on side of neck [n 95, 55.09%], history of prolonged/difficult labor [n 84, 49.04%] and not feeding from one side of breast [n 75, 44.11%]. Major physical signs were head tilt on one side in all cases and swelling in right side of neck in 95[55.09%] cases. 154 [90.60%] patients improved completely within 4 weeks to 4 month of physiotherapy while 15 [8.80%] cases showed partial improvement. Majority of cases completely improved on physiotherapy and rest showed considerable improvement

Experience of cefotaxime as first line antibiotic in acute bacterial meningitis

To find out efficacy safety and tolerability of cefotaxime sodium [Cefotax] as first line antibiotic. An Observational analytic study. Child Medicare Center Larkana for the period of 18 months from July 2003 to December 2004. fifty six patients having cerebrospinal fluid favoring acute bacterial meningitis between 2 months to 12 years of age with set inclusion criteria were included in the study. CSF aspiration was per formed under strict aseptic technique and sent .for routine examination and culture in every case to detect the organisms and see the pattern of sensitivity. CSF was repeated in all cases to confirm the clearance. The data were recorded and than statistically analyzed. Total male 37/56 and female 19/56 with male to female ratio were 2:1. Culture-was positive in 28.57% patients [16/56], while 71.42% [40/56] cases revealed no organism. The most cases were below 6 years of age. The maximum sensitivity seen with cefotaxime [100%] and higher proportion of resistant to gentamycin [75%]. The Predominant Organisms were below 6 year of age were S. Pneumoniae and H. Influenzae. Neurological morbility was more in patients < 6 years of age [8.92%] while above this age were [1.78%]. The case fatality was [1/56] [2%] and with S. Pneumoniae organism. Culture was positive in 28.57% patients. The most common organism were S.pnenmoniae. H. influenzae and Meningococcus. Mostly the organisms are sensitive to cefotaxime and ceftriaxone, as first line antibiotic in acute bacterial meningitis, cefotaxime is safe, effective and reliable