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

Correlation between maternal and childhood VitB12, folic acid and ferritin levels

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

Acute bacterial meningitis in children presenting to the children's hospital Lahore before and after pneumococcal vaccine in Pakistan national immunization program; a comparison

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

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

Analyzing communication skills of pediatric postgraduate residents in clinical encounter by using video recordings

Objective: To analyze communication skills of pediatric postgraduate residents in clinical encounter by using video recordings

Methods: This qualitative exploratory research was conducted through video recording at The Children's Hospital Lahore, Pakistan. Residents who had attended the mandatory communication skills workshop offered by CPSP were included. The video recording of clinical encounter was done by a trained audiovisual person while the resident was interacting with the patient in the clinical encounter. Data was analyzed by thematic analysis

Results: Initially on open coding 36 codes emerged and then through axial and selective coding these were condensed to 17 subthemes. Out of these four main themes emerged: [1] Courteous and polite attitude, [2] Marginal nonverbal communication skills, [3] Power game/Ignoring child participation and [4] Patient as medical object/Instrumental behaviour. All residents treated the patient as a medical object to reach a right diagnosis and ignored them as a human being. There was dominant role of doctors and marginal nonverbal communication skills were displayed by the residents in the form of lack of social touch, and appropriate eye contact due to documenting notes. A brief non-medical interaction for rapport building at the beginning of interaction was missing and there was lack of child involvement

Conclusion: Paediatric postgraduate residents were polite while communicating with parents and child but lacking in good nonverbal communication skills. Communication pattern in our study was mostly one-way showing doctor's instrumental behaviour and ignoring the child participation