Empyema thoracis in children: clinical presentation, management and complications

To determine the etiology, clinical manifestation, management [medical and surgical] and complications of children with empyema thoracis in a tertiary care hospital from Karachi, Pakistan. Descriptive, analytical study. Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1996 to December 2010. Medical records of admitted children aged > a month to 15 years with discharge diagnosis of empyema thoracis and data was collected on demographic features, clinical manifestation, management and complications. Children managed medically were compared with those managed surgically by using interquartile range and median comparison. Mann-Whitney U test was used to compare age in months, weight [kg] and length of stay in days and presenting complaint, duration of illness; chi-square test was used to compare thrombocytosis in between groups and p-value was calculated. Among the 112 patients, 59 [53%] were younger than 5 years of age. Males [n=83, 74%] were predominant. Fifty [45%] children were admitted in winter. Thirty [27%] children found unvaccinated and one fourth [n=27; 24%] were severely malnourished. Fever, cough, and dyspnea were the major presenting symptoms. Sixty-six [59%] were on some antibiotics prior to admission. Staphylococcus aureus [n=13] and Streptococcus pneumoniae [n=5] were the commonest organism isolated from blood and pleural fluid cultures. Majority of the children required some surgical intervention [n=86]. Surgically managed children were younger [p=0.01]; had less weight [p=0.01] and prolonged fever [p=0.02]; and stayed longer in hospital [p < 0.001] as compared to medically managed children. Requiring readmission [n=8], subcutaneous emphysema [n=5] and recollection of pus [n=5] were the major complications. Staphylococcus aureus was the major organism associated with paediatric empyema thoracis. Early identification and empiric antibiotic as per local data is essential to prevent short and long-term complications. Younger, lower weight children with prolonged fever required surgical management

Orally and sexually transmitted gonorrhea

Gonorrhea can be transmitted by oral sex and is known as pharyngeal gonorrhea and appears as pharyngitis. Patients with symptomatic gonorrhea infection or other STDs are commonly seen in outpatient departments. Majority of them seek treatment without having adequate understanding regarding the nature of their condition. It is important for a healthy community that the members have information regarding STDs, their spread and preventive measure. The study was conducted during the time period of six months extending from August 2013-January 2014. The data was collected from four tertiary care hospital after obtaining oral and written consent. Patients attending Urology outpatient department with a history of STD were included in the study. Overall 410 patients participated in the study with a response rate of 82%. 315[76.8%] males and 95[23.2%] female participants. 37.8% of females and 36.5 of males with total 36.8% of participants had knowledge that PID is a complication of Gonorrhea. In total 16.3% of the participants knew the correct mode of transmission of Gonorrhea with 22% females and 14.6% males with Odd ratio F/M 1.5. Regarding the best preventive measure for STD, 60.7% considers avoiding multiple sexual partners and engage in spousal relationship [53.7 and 62.8% of females and male respectively, Odds ratio F/M 0.85] is the best way followed by using condoms [20.7% of total participant with an odds F/M of 1.54]. The knowledge in patients regarding Gonorrhea is scant hence it is essential to counter educational needs of the population regarding STD in effective and timely manner

Urinary incontinence- patient's physical, mental and oral health analysis

Urinary incontinence can be distressful and may affect the quality of life to a great extent. Common types of UI are stress incontinence, urge incontinence and mixed incontinence. UI is more prevalent in older people and more frequently diagnosed in females than males. Efforts are made to investigate the primary disorder which causes incontinence, as UI is mostly secondary to an underlying medical condition. This study included patients diagnosed with UI and was conducted during one year period extending from February 2013 to January 2014. The data also constituted of a self-administered questionnaire to access the patient's knowledge regarding their disease. Ethical consent was obtained from the hospital where data were collected and oral and written consents were taken from all the participants prior to their participation. The study included 332 patients with a response rate of 73.7%. Overall, 254 males and 278 females participated. 64.9% of the male participants had urge incontinence followed by 26.6% having stress incontinence, while only 8.44% of the males were diagnosed with mixed incontinence. In females 77.2% had stress incontinence followed by urge incontinence [15.1%] and only 7.3% had Mixed urinary incontinence. 24% of males and 44.3% of females believed that pelvic exercises can prevent or treat UI. 34.6% of the total participants [40% females,27.9% males] had an understanding that weak anatomy contributes to the development of UI. Stress incontinence is more common in women, while the dominant type in men is urge continence. All patients, especially pregnant women should be provided information regarding UI in order to efficiently cope up with the condition if encountered