Clinical efficacy comparison of saccharomyces boulardii and lactic acid as probiotics in acute pediatric diarrhea

Objective: To compare the efficacy of Saccharomyces boulardii and lactic acid producing probiotics in addition to usual treatment regimen to cure diarrhea among children [6 months to 5 years of age]

Study Design: Randomized controlled trial

Place and Duration of Study: Department of Pediatrics, Sheikh Zayed Hospital, Lahore, from February to July 2015

Methodology: Children suffering from acute diarrhea were orally administered Saccharomyces boulardii and lactic acid producing probiotics for 5 days. The efficacy of administered probiotics was monitored. Patients were given Saccharomyces boulardii and lactic acid producing probiotics randomly to remove the bias

Results: Two hundred patients randomly selected for trials; out of which, 100 were treated with Saccharomyces boulardii while the other 100 were supplemented with lactic acid concomitantly along with conventional diarrhea treatment. Results indicated that Saccharomyces boulardii treatment group has significantly higher efficacy rate [45%] compared to lactic acid producing probiotics [26%]

Conclusion: This study concluded that Saccharomyces boulardii has a better efficacy compared to lactic acid and may be adopted as a probiotic of choice

Frequency of thrombocytopenia in Plasmodium vivax Malaria

Background: Plasmodium vivax is the most widely distributed human malarial parasite. Mild thrombocytopenia is a common feature of acute malaria caused by P. vivax regardless of the severity of infection which may progress to severe thrombocytopenia. The aim of our study was to find the frequency of thrombocytopenia in Plasmodium vivax

Materials and Methods: This descriptive cross sectional study was carried out at Peadiatrics unit, Shaikh Zayed Hospital, Lahore from July, 2013 to November, 2014 comprising of 56 children of both gender age 14 years and below who presented with fever of more than 101o F and Plasmodium vivax rings, trophozoites or schizonts on peripheral blood smear [thick and thin smear]. Full blood counts and platelet counts were done along with other routine as well specific investigations where required. The data was entered in standardized proforma and analyzed on SPSS 17

Results: There were 40 [71.43%] males and 16 [28.57%] females with the mean ages of 6.3 +/- 4.4 and 9.4 +/- 3.3 of males and females respectively with an overall mean age of 7.6 +/- 4.2. The frequency of thrombocytopenia was noted in 46 patients [82.14%]. Mild thrombocytopenia was in 15 patients [26.79%] with mean of 119,000.89 +/- 8,000.76SD, moderate in 23 [41.07%] with mean of 89,210.56 +/- 5637.23 and severe thrombocytopenia was in 8 patients [14.29%] with mean of 29,678.98 +/- 2389.54

Conclusion: Thrombocytopenia is common in P. vivax malaria in our set up and all patients with such malaria must be screened for thrombocytopenia

Frequency and etiology of urinary tract infections in neonatal late onset sepsis

Objective: To determine the frequency and etiology of urinary tract infections in neonatal late onset sepsis

Study Design: Cross-sectional study

Place and Duration of Study: The study was carried out in neonatal unit, Shaikh Zayed Hospital, Lahore for six months period from January to June, 2014

Methodology: 175 neonates admitted in Neonatal Unit, Shaikh Zayad Hospital, Lahore through emergency, obstetric unit or outpatient department with late onset sepsis were included. Cases were selected by non-probability sampling technique

Results: Culture proven urinary tract infection [UTI] was present in 21.6% of late onset sepsis. The most common causative organism was Eschericha coli [84.21%] followed by Klebsiella [13.6%]. No male, female predisposition was found in this study

Conclusion: All neonates with late onset sepsis should be investigated for urinary tract infection and most common causative organism is Escherichia coli

Frequency of risk factors for ventilator associated pneumonia in paediatric population

Objective: To determine the frequency of risk factors for Ventilator Associated Pneumonia [VAP] in a pediatric population

Setting and Study Design: It was a cross sectional survey conducted at the Neonatal and Pediatric Intensive Care Unit, [NICU and PICU], Sheikh Zayed Hospital, Lahore from 31-10-2009 till 2010

Methods: 175 cases of VAP were enrolled by non-probability, purposive sampling technique Patients from birth to 12 years [144 months], admitted in NICU and PICU, who received mechanical ventilation for >48 hours, were analyzed retrospectively for the presence of risk factors such as reintubation, nosogastric tube feeding and thoracostomy tube and eventual development of Ventilator Associated Pneumonia

Results: Out of total 175 patients, 55.3% were < 1 month [neonates] admitted in NICU while 44.7% were between 1 month and 12 years [144 months] and admitted in PICU. Mean +/- S.D age for NICU and PICU patients was 3.76 +/- 1.10 days and 39.88 +/- 33.78 months respectively. In both NICU [male 53.2% Vs female 46.8%] and PICU [71.1% males Vs 28.96% female], there was male predominance. Regarding frequency of risk factors, in both NICU and PICU, reintubation was the most frequent risk factor [85.1% NICU, 73.1% PICU] followed by nasogastric tube feeding [17% NICU, 36.8% PICU] and tube thoracostomy [6.4% NICU, 10.5% PICU]

Conclusions: VAP is a common infection associated with process of patient care and certain interventions [such as reintubation, nasogastric tube placement and tube thoracostomy] might affect the incidence of VAP. ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk of VAP and thus modifying patient's care to minimize the risk of VAP

Intraventricular haemorrhage amongst preterm babies-preventive role of dexamethasone

Objective: to determine the antenatal use of dexamethasone in preventing intraventricular haemorrhage [IVH] in preterm newborns

Setting and Study Design: descriptive case series study done in a prospective fashion at the Neonatal Unit [NNU] of the Department of Paediatrics in collaboration with the Department of Obstetrics and Gynecology, Sheikh Zayed Hospital, Lahore

Patients and Methods: 210 women from the Obstetrics and Gynecology Department, who gave bii1h to preterm babies from 0 1-05-2009 till 30-04- 2010 were included in this study; they received dexamethasone, 1/M, 6mg, in 4 doses, 12 hourly, antenatal. Deliveries were. Attended by trained pediatricians and new barns were followed up for any physical stress and birth asphyxia. The newborns were brought to ·NNU for postnatal care. Cranial ultrasonography [USG] was performed on these babies at 72 hours after delivery, at I week and then at 2 weeks of life. Outcome was recorded regarding presence or absence of IVH on cranial ultrasound at the end of 2 weeks

Results: the mean age of the mothers was 28.1+/- 4.3 years. The mean gestational age of the patients was 33.6+/-1.6 weeks. In 191 [91%] neonates IVH was not present while IVH was present amongst 19 [9%] neonates. There were 6 [3%] patients of IVH Grade I, 10 [5%] patients of IVH Grade II and 2 [1%] patient or IVH Grade III

Conclusion: dexamethasone is useful in prevention of IVH in preterm babies when it is used in the antenatal period

Frequency of meningitis among children 6-18 months of age with first episode of fever and fit

Objective: to determine the frequency of meningitis in children, 6 to 18 months of age, presenting with first episode of fit and fever

Study Design and Setting: this was a descriptive case series performed as a cross sectional survey carried out in the Department of Paediatrics, Sheikh Zayed Hospital Lahore

Patients and Methods: this study was; carried out from 1-04-2009 to 30-03-2010. 423 patients, who fulfilled the inclusion criteria, were selected for this study. Blood glucose was recorded before lumbar puncture to compare with CSF glucose. CSF was sent for analysis of protein, glucose and white blood cell count to assess the presence of meningitis

Results: mean age of the patients was 11.9+/-3.5 months with age range of6 to 18 months. There were 262 [62%] males and 161 [38%] female patients. The mean blood sugar at the time of lumbar puncture was 104.8+/-10.9 mg/di. There were 9 [2%] patients who had raised CSF leucocyte count, 9[2%] patients h11d raised CSF protein and 9 [2%] patients had reduced CSF Glucose There were 9 [2%] patients who had meningitis so frequency of meningitis was 2% in our population under study

Conclusion: frequency of meningitis in children presenting with first episode of fit and fever in the absence of any other symptoms is very low. Majority of children are, therefore, cases of simple febrile seizures rather than meningitis. It is suggested that unuecessary lumbar puncture can be avoided as this invasive procedure has its own complications