Prevalence of tuberculosis in pediatric patients undergoing chest intubation

This is a prospective cross sectional descriptive observational study. This is designed to see indications and complications of chest intubation and to see prevalence of tuberculosis in chest intubation patients. This study was carried out in the Department of Pediatrics, DHQ Teaching Hospital, Gomal Medical College, Dera Ismail Khan. In a period of two years [Jan 2007 to Dec 2008]. All those patients who underwent chest intubation during the study period were included in the study analysis. After admission, a detailed history was taken and a thorough examination was performed. Investigations included X-ray chest, full blood count, ESR, analysis and culture of pleural fluid, Mantoux test and ultrasonography of chest and abdomen. Later a chest tube was placed in the relevant pleural space under local anaesthesia. Chest tube was removed when pus/fluid drainage was stopped for at least 24-48 hrs. Diagnosis of tuberculosis was based on prolonged illness, history of contact, history of measles, raised ESR, positive Mantoux test [>10mm] and poor response to appropriate antibiotics and chest intubation beyond 10-14 days, all or some in various combinations. Data was analysed for age, sex, duration of illness, investigations, diagnosis, duration/complications of chest intubation, mortality during the study period and prevalence of tuberculosis in these patients. A total of 40 patients [n=40] underwent chest intubation during the study period. Twenty six [65%] patients were male and 14 [35%] were female. Four patients [10%] were less than 1 yr of age, 25 [60%] were 1-5 yr of age and 12 [30%] were above 5 yrs of age. Indications for chest intubation included pyothorax in 27 [67.5%], pneumothorax in 11 [27.5%] and pyopneumothorax in 2 [5%] patients. Seventeen patients [42.5%] were suffering from tuberculosis. The criteria for the diagnosis were positive Mantoux test [more than 10mm] in 12 patients, suggestive pleural fluid analysis in 9 patients, history of contact in 8 patients, slow response to standard antibiotic therapy and closed tube thoracostomy in 5 patients, history of measles in preceding weeks in 2 patients and suggested CT scan in 2 patients. Complications included local wound infection in 5 [12.5%], tube blockage in 2 [5%], surgical emphysema in 2 [5%] and no response to conservative measures due to pleural thickening and fibrosis in 1 [2.5%] patients. Mean duration of chest drainage was 8.1 +/- 2.4 days. Tuberculosis is a common cause of pleural diseases and it must be considered in the differential diagnosis of pleural infections, particularly pyopneumothorax

Prevalence of megaloblastic anaemia in a paediatric unit

Megaloblastic anaemia is common in paediatric population of developing countries. The objective of this study was to find out the prevalence of megaloblastic anaemia in Paediatric Unit of District Headquarter Teaching Hospital, Dera Ismail Khan. A retrospective analysis of forty bone marrow aspirates was performed to find out the prevalence of megaloblastic anaemia in Paediatric unit of District Headquarter Teaching Hospital Dera Ismail Khan, from January 2007 to December 2008. Both male and female indoor patients up to 12 years of age were included in the study. Blood count and peripheral smear findings revealed anaemia in 40[100%], leukopenia in 17 [42.5%] and thrombocytopenia in 36 [90%] patients. Bicytopenia was present in 18 [45%] and pancytopenia in 17 [42.5%] patients. Analysis of the bone marrow findings showed megaloblastic anaemia in 23 [57.5%], bone marrow hypoplasia /aplasia in 8[20%] and Leukaemia in 6 [15%] patients. So megaloblastic anaemia was the most prevalent finding in this study. Next was bone marrow hypoplasia /aplasia, followed by leukaemia. Megaloblastic anaemia is the most prevalent diagnosis and the major cause of bicytopenia and pancytopenia in the bone marrow aspirates performed in the Paediatric unit of District Headquarter Teaching Hospital District Dera Ismail Khan

Essential newborn care practice in hospital versus home deliveries

Newborn mortality is one of the most neglected health problems in the developing world. In Pakistan it also remains very high. Most of these deaths could be prevented through cost-effective interventions. A large proportion of births continue to occur at homes. The study was undertaken to describe newborn care practices in the hospital and at homes, as an initiative to focus this alarming problem. This comparative cross-sectional study was carried out during the months of June and July 2005 in District Mardan, Pakistan. Data was collected and compared in hospital-based and community based deliveries. Gynae labour suite in District Headquarter Hospital Mardan was chosen as hospital-based facility. Irum colony in Mardan city was taken as community-based population. Information from 30 delivery cases was gathered; half the cases were hospital-based and half at homes. Sampling method was convenient. Descriptive statistical analysis was performed. The result of this study showed that among hospital deliveries 80% were conducted by nurses, 20% by skilled dais and none by doctor. Among these cleanliness was kept in 33%, cord care 100%, thermal protection 83.3%, breast feeding initiation within an hour was noted in 66.6%, spontaneous breathing was 100%. All of the home based deliveries were conducted by unskilled birth attendants. Among these; cleanliness 16.6%, cord care 80%, thermal protection 100%, breast feeding within an hour 14%, spontaneous breathing 100%. In both of these groups eye care was 0%, and immunization was 100%. This small scale study highlighted the deficiencies in the newborn care. Both hospital practices and traditional ones neglected the basic principles of newborn cleanliness, early breast feeding, eye care and cord care. A community based essential newborn care strategy is recommended

Frequency of heart failure in patients with beta thalassemia major

Estimated prevalence of beta thalassemia is 3-8% in Pakistan. Over the past three decades, regular blood transfusions have significantly increased the survival of these patients. There has been an increase in the frequency of complications, mainly caused by iron overload. The aim of this study was to determine the frequency of heart failure in patients with beta thalassemia major in this region. It was a descriptive audit of ward record, carried out in the Department of Paediatrics, District Headquarter Teaching Hospital, D.I.Khan, Pakistan, from January 2004 to December 2005. Case records of all beta thalassemia major patients admitted during this period were analyzed for heart failure. Clinical data recorded was age, sex and cardiac status of patients. Investigations including ECG, chest x-ray and echocardiography were evaluated. Two hundred and twelve patients of beta thalassemia were admitted during the study period. Clinical congestive cardiac failure was observed in 33 [15.6%] patients with the age range of 8-21 years. Fifty four patients [25.5%] had cardiomegaly on chest x-ray but were not having clinical heart failure. Age range of these patients was 5-12 years. As a whole heart failure and cardiomegaly on chest x-ray was observed in 87 [41.1%] patients. All these patients were above the age of 5 years. Heart failure is not uncommon in patients with beta thalassemia major in our setup. Regular transfusions and chelation therapy are recommended to reduce this complication

Study of patients presenting with acute flacid paralysis in Dera Ismail Khan, NWFP - Pakistan

A descriptive study was designed to analyse patients of acute flacid paralysis [AFP] in paediatric deptt of DHQ teaching hospital D. I. Khan during 2002. A total of 36 cases of AFP were reported during this period. They were clinically examined. History was taken with special reference to IM injection and OP vaccination. Stool samples were sent to NIH Islamabad for viral detection. Out of total of 36 patients, 15 were confirmed as polio, 5 were labelled as compatible with polio and 16 were non-polio cases. Out of 15 confirmed cases of polio, 12 [80%] had received IM injections and all had some residual paralysis / weekness after two months follow-up, while 3 of the non polio cases had received I.M. injections and non had residual paralysis / weekness on follow-up. Main cause of high polio prevalence seems to be due to low vaccination rate, particularly routine as compared to supplemental vaccination. It was concluded that supplemental polio vaccination should be continued in an improved and strengthened fession through NIDs and EPI