Assessment of coverage levels of single dose measles vaccine

To study the consequences of low coverage levels of a single dose of measles vaccine. Design: Case series. Place and Duration of Study: The study was conducted in the Department of Paediatrics, Rawalpindi General Hospital [RGH] from January 2001 to August 2001. Patients and Information about 68 admitted cases of measles was collected on a structured proforma with reference to epidemiological profile, vaccination history and comorbidities. Mean age observed in measles cases was 2 years and 8 months with a range from 3 months to 8 years. Maximum number of cases reported were <1 year of age [n=22,32%]. Fifty% of cases were seen among vaccinated children. Seventy-five% [n=51] had history of contact with a measles case. Pneumonia was the commonest complication followed by acute gastroenteritis, encephalitis, febrile convulsions, oral ulcers, oral thrush, eye changes of vitamin-A deficiency and pulmonary tuberculosis [T.B.] in descending order of frequency. Fifty-four cases were successfully treated for complications of measles and discharged. Nine cases left against medical advice. Five patients died ' all of them had encephalitis either alone [n=1] or in combination with pneumonia and acute gastroenteritis [n=4]. There is a dire need to increase the immunization coverage to reduce the rate of vaccine failure and achieve effective control of measles

Neurofibromatosis with ganglioneuroblastoma in a child

A nine years old male child with neurofibromatosis type I and Ganglioneuroblastoma of right adrenal is reported. At presentation, imaging studies, bone marrow examination and biopsy revealed stage III tumour. In view of the large size which was 15 x 10 cms on abdominal ultrasound, 6 cycles of chemotherapy were given. This considerably reduced the size to 8.6x7 cms. At this stage surgical excision was decided. Due to extensive local invasion around inferior vena cava and aorta, approximately 90% of tumour could be excised. One hour following surgery the child went into shock with sudden gush of 500 ml of fresh blood into the drainage bag. Intensive resuscitative measures were carried out with infusion of 2 pints of blood. Plan was to reopen the child after stabilization but he could not be revived and expired. Histopathology of tumour tissue confirmed ganglioneuroblastoma

Mediastinal enteric cyst

A 4-week-old female baby admitted with respiratory distress in Neonatal unit was found to have a mediastinal cyst on radiologic examination. It was successfully excised and turned out to be an enteric cyst. This emphasises the need for proper radiologic evaluation in newborn infants with respiratory distress

Foreign body aspiration in children - a persistent problem

OBJECTIVE: Cough and respiratory distress due to foreign body inhalation in children is a common problem in our society. This study was planned to identify the criteria for early diagnosis and management in suspected cases of foreign body inhalation. SETTING: The study was carried out on indoor patients of Paediatrics Department, Rawalpindi General Hospital [RGH] affiliated with Rawalpindi Medical College [RMC], from January, 1995 to December, 1996. Paediatrics Department has 50-bedded general paediatrics ward, 20-bedded neonatal unit [NNU] and 150-200 daily attendance of outpatient department [OPD]. It offers primary to tertiary level care to its patients from whole of Rawalpindi Division. METHODS: This prospective study encompasses profile and immediate outcome of 20 suspected cases of foreign body inhalation. Selection of study subjects and subjection to bronchoscopy was based on symptomatology, clinical and radiological findings and response to treatment. The data with outcome was recorded on a proforma. In 18 cases foreign body was removed successfully by rigid bronchoscope with immediate relief of symptoms and normal chest roentgenograms. Most susceptable age for foreign body inhalation was 1-3 years [n = 14] and male children were at higher risk than females [13 vs 7]. Valuable clinical features were sudden onset with respiratory distress, cough, choking, localized poor air entry, crepitations or rhonchi in descending order of frequency. Most common finding in chest roentgenogram was consolidation-collapse and/or emphysema in 50% cases. 30% cases [n = 6] with persistent respiratory tract infection inspite of adequate treatment of recurrent episodes of respiratory distress with wheeze turned out as foreign body inhalation and therefore, such cases need re-evaluation. Betelnut was the most common foreign body removed [n = 7] followed by peanut [n = 6]. Most frequent site involved was right main bronchus [n = 7] followed by left main bronchus [n = 5]. Public awareness through mass media needs attention to prevent foreign body inhalation. High index of clinical suspicion is mandatory for early diagnosis and management to prevent fatal outcome and long term morbidity

Determinants of neonatal mortality

To identify the common causes and contributory factors for high neonatal mortality in Pakistan and propose effective strategies to safeguard against it. METHODS: This retrospective study was carried out in Neonatal Unit [NNU] of Rawalpindi General Hospital [RGH] from January 1995 to December 1996. Relevant prenatal information obtained from referral forms, admission files or attendants was recorded on a proforma at the time of death of a newborn. This included obstetric and medical management of the mother, neonatal resuscitation and care, birth weight [wt] and gestational age. Cause of death was based on available clinical and laboratory data. During the study period, there were 3005 admissions and 268 deaths, resulting in 9% neonatal mortality. Eighty-eight% of this mortality was due to early neonatal deaths. More than 50% of deaths were unavoidable due to their critical condition at admission and occurred within first 24 hours of hospitalization. Neonatal infections and birth asphyxia were two major causes of neonatal mortality [37% and 31% respectively], followed by idiopathic respiratory distress syndromes [IRDS], Meconium aspiration syndrome [MAS] and congenital malformations. Sixty-eight% of mortality was contributed by low birth weight [LBW], 74% of them being preterm suggesting high mortality among LBW-preterm infants. Other less common contributory factors were maternal medical disease, complicated deliveries and multiple gestation. These causes and contributory factors of neonatal mortality reflect poor prenatal health services in this country. Hence there is a need for coordinated efforts to organise and regionalize MCH and prenatal health services with the help of a neonatal task force

Association of diarrhoea and malnutrition in infants

A hospital based cross-sectional study was conducted on 401 infants to address the hypothesis that positive relationship exists between diarrhoea and malnutrition. Malnutrition was significantly more common among infants with diarrhoea compared to controls [P<0.001]. Risk of malnutrition among acute diarrhoea cases was 1.6 times and among chronic diarrhoea cases 2.6 times that of controls. This association between malnutrition and diarrhoea remained significant after adjusting for significant confounders and substituting weight [Wt] for, age by height [Ht] for age and Wt for Ht

Spectrum and pathogenesis of congenital malformations; a hospital based study

The study was undertaken to find out the magnitude, pattern and pathogenesis of congenital malformations. The baby births at Rawalpindi General Hospital accuring between June 1993 to June 1995 were scanned. Out of 4860 deliveries, 4400 were live-birth whilst 460 were still births. Fifty five new borns had congentital malfermations. Frequency of congenital malformations was 1.1% among total birth, 1% among live births and 1.7% among still births. Amoug malformed, 47% were male and 53% were females. These malformations were further subgrouped to find out specific defects and the remedial measures. Early detection of clinically suspected malformations in high risk cases by abdominal ultrasound and appropriate fetal management will help reducing the incidence of congenital malformations and the perinatal mortality

Antimicrobial activity of some new species of medicinal plants of Karachi region

An antimicrobial study of some medicinal plants of Karachi region has been carried out. Their crude extracts [acetone soluble and water soluble] were tested for their antibacterial activity against twenty-five different pathogenic and non-pathogenic bacteria. Antimicrobial activity of the crude extracts of different parts of plants belonging to five different families were carried out. It was found that the activity was solvent dependent i.e., acetone extract part was found to be more active as compared to water soluble part. Ageratum houstonianum Mill. and Salsola nudiflora were found to be more active as compared to other plants