Etiological profile of pancytopenia in children: a hospital based study

To determine the etiological profile of pancytopenia in children admitted in a Paediatric department of a tertiary care hospital. This is a cross-sectional study conducted at Department of Paediatrics Dow University of Health Sciences and Civil Hospital Karachi from January 2009 to December 2009. It included all the patients between 1 -12 years of age, presenting with complaints of pallor, fever and bleeding manifestations and their complete blood picture showed decrease in 2 or 3 blood cells lines i.e hemoglobin less than 10g/dl, absolute neutrophil count less than 1.5X10[3]/L and platelet count less than 150X10[9]/L. Relevant investigations such as complete blood count, peripheral smear, reticulocyte count and bone marrow examination were done to confirm the diagnosis. The data was analyzed through SPSS version 15.0. A total of fifty patients were enrolled. There were 48% males and 52% females. Male to female ratio was 0.9:1. Mean age of patients was 7 + 3.35 years with range from 1 to 12 years. Infectious etiology was found in 50% cases followed by aplastic anemia 22%, malignancies 10% and hypersplenism 8%. Common infections found were malaria 22%, enteric fever 12% and megaloblastic anemia secondary to vitamin B12 deficiency was observed in 4% patients. The most frequent etiology of pancytopenia in children was infections followed by aplastic anemia, malignancy and hypersplenism. Malaria and enteric fever were the two most commonly observed infections causing pancytopenia in children

Communication skills of doctors in a paediatric department, their perceptions and practices

To determine the perceptions and practices regarding communication skills of doctors in a paediatric department of a tertiary care hospital. This was a cross-sectional study conducted in the Department of Paediatrics, Dow Medical College and Civil Hospital Karachi from October to December 2008. Fifty four doctors including faculty, consultants, registrars, postgraduates and medical officers of indoor and outdoor departments and wards were enquired regarding their behavior and communication with parents and physicians. Their responses were recorded on a questionnaire based on standards IMNCI/WHO guidelines for good communication skills. The data was later analyzed and given as frequencies and percentages. Sixty five percent doctors were spending less than 10 minutes with patients, seventy percent of the doctors claimed that they were polite and friendly with their patients, thirty seven percent were using simple language, thirty nine percent were listening carefully without interruption whereas eighty percent did not know the appropriate time of follow up. Seventy four percent doctors claimed that lack of parental understanding is one of the important reasons for lack of effective communication. Other reasons reported were large number of patients [56%] lack of adequate time [50%], inadequate numbers of doctors [35%] and other paramedical staff [30%]. Majority of doctors of Paediatric Department are using inadequate communication skills. Large number of patients, lack of adequate number of doctors and paramedical staff and lack of parental understandings were the reasons given by the doctors for inadequate communication practices

Mental health morbidity in children: a hospital based study in child psychiatry clinic

To determine the frequency and pattern of mental health morbidity in children attending "Psychiatry Clinic" in Paediatric OPD of a tertiary care hospital. This was a cross-sectional study conducted at psychiatric clinic of Paediatric OPD at civil hospital Karachi. Two hundred children upto the age of 14 years were included in the study. These children were assessed by a semi-structured interview based on P-CHIPS [Child Interview for Psychiatric Syndrome] and diagnosis of various psychiatric illnesses was further confirmed by DSMIV diagnostic criteria. Psychiatric disorders were more frequent in males 126 [63%] compared to females 74 [37%]. Majority of patients affected were between 5-10 years of age [62.5%]. Among the psychiatric disorders, oppositional defiant disorders were [20%], ADHD were [17%], elimination disorders and anxiety disorders were [11%] each. Other less frequent psychiatric problems were mood disorder, somatoform disorders, specific developmental disorders, emotional and habit disorders. Mental health morbidity is an important issue in children attending the psychiatry clinic in the Paediatric OPD. Sensitization of parents, teachers and physicians is required, so that timely referral for psychiatric consultation is ensured before a critical illness develops

Neurological cases admitted into a general pediatrics ward

To see presentation of neurological cases admitted into a general pediatrics ward and review the findings, investigations, complications and treatment provided. This is a retrospective analysis of patients admitted during the year 2006 in Pediatrics ward of Civil Hospital Karachi. All patients older than one month of age with a final diagnosis of a neurological problem were included. Patients with metabolic fits and neonates were excluded from the study. A considerable proportion of all patients admitted into the pediatrics ward are neurological illnesses [67/687 or 8.9%]. Commonest neurological problems were CNS infections [42/67 or 62.5%]. Other causes of hospitalization were cerebral palsy with complications [7/67, 10.4%], febrile fit [5/67 or 7.5%] and epilepsy [7/67;10.4%] etc. Commonest symptom was fever with or without seizures [59; 87.9%]. All patients suspected of a CNS infection were treated with intravenous antibiotics. Patients with cerebral malaria were treated with intravenous quinine. Neurological problems in children less than five years of age are an important reason for hospital admission, infections being most frequent. Bacterial infections of the nervous system are more common than viral or protozoal infections. This study results will help in better planning regarding management of such patients in wards and in emergency. Children, Childhood, Encephalitis, Meningitis, Cerebral malaria, Tuberculous meningitis, Neurological complications, Neurological deficits