Comparison of gene expert and tuberculin test for the diagnosis of childhood tuberculosis

Background: Tuberculosis is a lethal communicable disease, and at times its diagnosis is difficult to establish

Objective: To compare the results of Gene Expert to that of tuberculin test for the diagnosis of childhood tuberculosis

Patients and Methods: Study design: Cross-Sectional Analytical study. Place and duration of study: Department of Pediatrics, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan from 1[st] November, 2012 to 31[st] July, 2013. 92 patients of tuberculosis were included strictly, following the inclusion and exclusion criteria. Diagnosis of tuberculosis was on the basis of Kenneth Jones criteria. Beside other investigations Gene Expert and Tuberculin test were done and their results were compared. The data was entered and analyzed by SPSS version 15

Results: Out of 92 patients, 80 [86.9%] were reported positive by Gene Expert whereas 56 [60.8%] were reported positive by Tuberculin test. Overall 52 [56.5%] were found positive by both Gene Expert and Tuberculin test, whereas 8 [8.6%] were found negative by both Gene Expert and Tuberculin test. Out of 80 who were found positive by Gene Expert, 28[35%] were reported negative by Tuberculin test while out of 12 who were reported negative by Gene Expert, 4 [33.3%] were positive by Tuberculin test

Conclusion: In our study, we found that both Gene Expert and Tuberculin test are effective diagnostic tools for tuberculosis. However, in several cases Gene Expert is more effective than Tuberculin test

Comparison of gene expert and tuberculin test for the diagnosis of childhood tuberculosis

Background: Tuberculosis is a lethal communicable disease, and at times its diagnosis is difficult to establish

Objective: To compare the results of Gene Expert to that of tuberculin test for the diagnosis of childhood tuberculosis

Patients and Methods: Study design: Cross-Sectional Analytical study. Place and duration of study: Department of Pediatrics, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan from 1[st] November, 2012 to 31[st] July, 2013.92 patients of tuberculosis were included strictly, following the inclusion and exclusion criteria. Diagnosis of tuberculosis was on the basis of Kenneth Jones criteria. Beside other investigations Gene Expert® and Tuberculin test were done and their results were compared. The data was entered and analyzed by SPSS version 15

Results: Out of 92 patients, 80 [86.9%] were reported positive by Gene Expert whereas 56 [60.8%] were reported positive by Tuberculin test. Overall 52 [56.5%] were found positive by both Gene Expert and Tuberculin test, whereas 8 [8.6%] were found negative by both Gene Expert and Tuberculin test. Out of 80 who were found positive by Gene Expert, 28 [35%] were reported negative by Tuberculin test while out of 12 who were reported negative by Gene Expert, 4 [33.3%] were positive by Tuberculin test

Conclusion: In our study, we found that both Gene Expert and Tuberculin test are effective diagnostic tools for tuberculosis. However, in several cases Gene Expert is more effective than Tuberculin test

Scurvy

Scurvy is a condition caused by a lack of vitamin C [ascorbic acid] in the diet. It is extremely rare in industrialized societies but still exists in higher risk groups including economically disadvantaged populations with poor nutrition. We are reporting a case of 4 year old Asad who presented to our department with this condition

Dengue hemorrhagic fever/ dengue shock syndrome

To study the clinical spectrum of Dengue Hemorrhagic Fever [DHF] and Dengue Shock Syndrome [DSS] in children admitted in a tertiary care center during 2011 dengue epidemic in Lahore. This study was conducted in department of Pediatrics Lahore General Hospital [LGH] / Postgraduate Medical Institute [PGMI] Lahore, Pakistan. Retrospective descriptive study. 1st August to 31st October 2011. All the children [<18 years] with clinical features of Dengue Hemorrhagic Fever and Dengue shock Syndrome [DHF/DSS] admitted to the Pediatric ward Lahore General Hospital, Lahore during the period of 1st August to 31st October 2011 were enrolled in the study. The clinical manifestation were recorded on a standard questionnaire form. Clinically DHF/DSS cases were confirmed in the laboratory by different investigations. All the patient were diagnosed, managed and discharged according to WHO protocol. A total of 254 patients were admitted in the ward labeled as dengue fever [DF] clinically. Out of these 142[55.9%] were confirmed by serology. Of 254 DF cases 37[14.57%] were labeled as DHF and 02[0.79%] as DSS on their clinical manifestations and fulfilling the WHO criteria. 55% were male and 45%females. Common symptoms were fever seen in 100%, headache 71.79% and vomiting seen in 58.97% of the cases. The most common bleeding manifestations were epistaxis seen in 69.23% of the cases. Positive IgM was noted in 53.9% and IgG in 36.6% cases. A decrease in platelet count and increase in Heamatocrit [Hct] during stay in ward was noted. Out of 39 patients only one patient expired [2.56%]

Renal failure in asphyxiated term babies frequency and severity associated with apgar scoring and HIE grading

To determine the frequency and severity of renal failure in asphyxiated neonates and to correlate it with Apgar score and Hypoxic ischemic encephalopathy [HIE] grading. Analytic study. This study was conducted in Department of Pediatrics, Lahore General Hospital [LGH]/Postgraduate Medical Institute [PGMI] Lahore for a period from Feb 2010 to Jan 2011. All the deliveries taking place in LGH during the working hours of 8 am to 2 pm were attended by senior doctors on call and asphyxiated babies [apgar 7 or less at 5 mins] were enrolled for the study. After every one week one non asphyxiated baby with no know confounding factor believed to alter renal function was randomly picked up to serve as a control. Gestational age, birth weight, relevant perinatal history, findings on physical evaluation and systemic sings were entered in predesigned proforma. Investigations like urine complete, real functions test [RFTs] and serum electrolytes were monitored initially within 24 hours of birth, day 3rd of life and repeated when required. Data were analyzed and relation of frequency and severity of renal failure with apgar scoring and HIE was noted. Of 150 asphyxiated babies, 60 [40%] had renal failure. 29 [19.33%] had proteinuria ++ or more and 17 [11.33%] developed hematuria. Of 40 non-asphyxiated babies no neonate had abnormal renal function. Sonography was abnormal in 55 cases, all were those having renal failure. Renal parameters normalized in all neonates by two months of age. 11 [7.33%] babies expired. All of them were of oliguric renal failure

Childhood Hodgkin's lymphoma: treatment, outcome and complications of 44 cases

To determine response to different treatment protocols, complications, outcome of cases of Hodgkin lymphoma. Observational descriptive study. Department of Pediatrics, King Edward Medical College/ Mayo Hospital, Lahore. 44 patients who were diagnosed as Hodgkin lymphoma were included in the study. Response to therapy, complications and outcome of disease was recorded on a predesigned proforma. Out of 44 patients of histologically proven Hodgkin's Lymphoma there were 40 boys and 4 girls. The mean age was 7.34 years. Most of the children were in advanced stage [stage III - 50%, stage IV - 20.45%]. Mixed cellularity was the commonest histology subtype [68.19%]. Chemotherapy protocols given to these children were: ABVD - 53%, ChlVPP - 23%, VVAP - 115, ChlVPP-VVAP-9% and ABVD-VVAP- 2%. Involved field radiation was given in 10 cases that had bulky disease. Infections of all grades were the most common complication observed [Staphylococcal sepsis - 5, chicken pox - 3, pulmonary tuberculosis - 3 and upper respiratory tract infection - 8]. Alopecia and leucopenia were the next most common complications. Out of 38 children who completed therapy at the end of the study 29 are in complete remission, 2 have relapsed, one expired and 6 cases were lost to follow up. Overall survival was similar to develop countries. Infections, alopecia and myelosuppression were the commonest complications

Presentation of neurotuberculosis in children

A study of 50 cases of tuberculous meningitis was carried out in the Department of Paediatrics, Mayo Hospital, Lahore. 56% of the total patients were below the age of 3 years, 54% presented with fever and fit, in 90% duration of fever was more than 15 days s. Majority 54% were in stage II at the time of presentation, only 6% presented in stage I and 40% in stage III. Cranial nerve palsies were found in 38%, motor deficits in [26%], altered level of consciousness in [46%], muscle tone abnormalities [70%]. Signs of meningeal irritation were positive in 68% patients. 74% patients were not immunized for tuberculosis and 74% had positive history of contact with tuberculous patients. ESR was raised in 60% cases and positive MX test was positive only in 30% cases. Chest X- Ray findings were suggestive of tuberculosis in 40% cases. C. T Scan brain revealed positive findings in 62%. Outcome of the patients revealed that 70% were discharged alive, out of these 40% had sequele at the time of discharge. 10% patients expired during the stay in the hospital, 6% were discharged on request and 14% left against medical advice

Penicillin resistance in pneumococcal meningitis

Streptococcus pneumoniae is an important cause of bacterial meningitis in children. This prospective study was conducted in the department of paediatrics Mayo Hospital Lahore from 1st march 1997 to 30th November 1997 to evaluate the prevalence of penicillin resistance in S. pneumoniae causing acute meningitis. Cerebrospinal fluid was obtained from children of all ages admitted with diagnosis of acute bacterial meningitis. Gram staining and culture was done on these samples. Samples showing gram positive diplococci on smear and growth of S. pneumoniae on culture were tested for penicillin sensitivity by disk diffusion. Out of 135 samples organisms could be isolated from 73 cases. Forty nine out of 73 samples showed growth of S. pneumoinae. Twenty six samples which had a growth of S. pneumoniae were tested for Penicillin sensitivity. Penicillin resistance was seen in 42.3% cases. There is high prevalence of penicillin resistance in S. pneumoniae causing meningitis. Antibiotics other than penicillin should be considered for intial therapy of suspected cases of acute bacterial meningitis before obtaining the report of CSF culture

Aplastic anaemia in children

Aplastic anaemia is a hematological disorder characterized by pancytopenia resulting from early stem cell deficiency. Chemical exposure, medicines, viral infections and immunodeficiency are the aetiological factors responsible. This study was conducted in the Department of Pediatrics, Mayo Hospital, Lahore from January 1994 to December 1995. Out of 40 children 26 were boys and 14 were girls with median age of 8 years. An association with history of drug intake was present in 32/40 patients The most common relationship was seen with chloramphenicol [40%]. Pallor [47%], bleeding tendency [62%] and prolonged fever [42%] were the most common symptoms and anemia [100%], mucosal bleed [50%] and ecchymoses [37%] commonest signs. All patients had pancytopenia, reduced reticulocyte count and prolonged bleeding time. In this study secondary aplastic anemia was seen more commonly than idiopathic variety and the most common agent responsible was chloramphenicol