Yield of suprapubic aspirate versus bag collection in diagnosis of UTI in children 0 to 6 months of age

Objective: To evaluate the accuracy of urine sample collection methods among children suspected of having urinary tract infection

Subjects and Methods: Urine samples were collected in infants 0-3 months of age presenting with features of sepsis. Two methods of collection were used, one was bag attached to perineal skin and the other was suprapubic aspirate. Within 30 minutes of collection, all specimens were sent to the laboratory, refrigerated and processed according to standard hospital microbiological procedures. Urine samples were analyzed using routine culture technique

Setting: This cross sectional study was conducted at Shaikh Zayed hospital Lahore. The duration of study was six months. A total of 100 cases fulfilling the inclusion criteria were included in this study. Results were analyzed according to SPSS 16

Results: Out of 100 patients [n=100] 17 had positive bag culture, only 4 out of 17 had culture positive by SPA, so there were 13 false positives while using bag collection method

Conclusion: Suprapubic aspiration showed the positive yield in 4 SPA which does not indicate contamination and sterile urine bag showed the highest contamination rate among the two methods of urine sample collection. So urine bag leads to unnecessary treatment burden on the child and family. There fore we cannot rely on bag samples for diagnosis of urinary tract infections specially the bag collection method because the specificity of bag collection method is very low

Frequency of gastroesophageal reflux disease in children with chronic cough

Objective: To identify the frequency of gastroesophageal reflux disease in children with chronic cough aged 2 months to 2 years

Methods: This cross sectional survey was conducted in 75 children between 2 months to 2 years in the department of pediatrics, Shaikh Zayed Hospital, Lahore. Children having chronic cough of > 4 weeks duration included in study and were admitted in ward and barium swallow was done in the Radiology Department

Results: Total 75 of chronic cough were included in this study, out of these 75 patients GERD was diagnosed in 29 [39%] on barium study. Out of these 29 patients, 20[27%] were in the age group of 2-9 months, 9[12%] were between 10-17 months. No patients of age group 18-24 months were diagnosed as GERD on barium study. In this 29 patients, 18[24%] patients were male and 11[15%] were female

Conclusion: Gastro esophageal reflux disease is one of the most common reasons for chronic cough seeking consultation of pediatricians. Early diagnosis and management of GERD can lead to decrease morbidity in children

Role of C-reactive protein in the diagnosis of sepsis in early infancy

Objecctives: To assess the role of serial C-reactive protein in the diagnosis of sepsis during the early period of infancy [<90 days]

Materials and Methods: This cross sectional study was conducted in the pediatrics Department of Shaikh Zayed Hospital [SZH], Lahore. The duration of study was 6 months from 1[st] July to 31[st] December 2010. Total 150 cases fulfilling the inclusion criteria were enrolled randomly in the study. Babies were divided in two groups: Group 1 -Healthy babies. Group II- Babies with sign and symptoms of sepsis. The first C-reactive protein and blood cultures were sent in all cases at the time of admission. Antibiotics were started in the suspected cases of sepsis. After 48 hours of admission, second sample of C-reactive protein was again sent in all cases

Results: The study was carried out in babies <90 days admitted in the neonatal and pediatric unit. All the cases were divided into two categories. There were 68 admitted in the neonatal and pediatric unit. All the cases were divided into two categories. There were 68 [45.33%] culture proven cases of sepsis and 82 [54.67%] cases were culture negative. Escherichia coli was the most common organism isolated followed by Staphylococcus aureus. Males [63%] were predominant as compared to females [37%]. 80% were term babies while 20% were preterm. 75% babies were born by lower segment caesarian section, 15% were delivered at home while 10% were born at the private clinics. Early onset sepsis was seen in 39.33% of cases while late onset sepsis was seen in 60.67% cases. Mechanical ventilation was done in 10 babies [6.6%]. 97.4% babies survived and 2.6% babies expired. The sensitivity, specificity, PPV, NPV of C-reactive protein was 91.18%, 53.66%, 62% and 88% respectively at the time of admission. The CRP level was statistically different between the two group [p<0.001], at the time of admission and at 48 hours after admission

Conclusion: Babies during the early infancy period are susceptible of developing sepsis that may lead to potential consequences if not treated in proper time. Also babies may be over-treated and may have prolonged stay in the hospital if not properly investigated, which may itself be a burden to the family members and have a financial instability also. So keeping in mind all these factors, were performed a serial CRP test at admission and after 48 hours for treatment monitoring and observing the response. Sensitivity of C-reactive protein and negative predictive value was high in this study at the time of admission. So, serial monitoring of C-reactive protein is recommended for the monitoring treatment response

Qualitative analysis of sputum specimens submitted for acit fast bacilli [AFB] microscopy to a teaching hospital at Rawalpindi

To find out the quality of sputum specimens submitted for AFB microscopy, to categorize these specimens on the basis of their quality and to compare the frequency of AFB positive smears in each category of these specimens. Five hundred and seventy convenient sputum samples from patients referred for AFB microscopy of sputum were examine after Ziehi Neelsen staining. Based on Heinman and Radano's criteria for sputum, all the sputa under study were divided into sputum and non-sputum categories. The non-sputum category was sub-divided into saliva and mixed samples based on the ratio of pus cells and epithelial cells. All the smears for qualitative categorization and for AFB were examined by the qualified microbiologist. The frequency of AFB positive smears in each category was calculated. Out of 570 specimens submitted, only 110 [19%] were found to be sputum specimens, while 324 [57%] were saliva and 136 [24%] were declared as mixed. The frequency of AFB positive smears was the highest in samples categorized as sputum, 23.6% [26 out of 110] followed by mixed samples 7.35% [10 out of 136], and saliva 0.31% [1 out of 324]. The overall frequency of AFB positive smears was 6.49% [37 out of 570]. Quality of sputum specimen plays a major role in the detection of AFB from the sputum smears. As evident from this study, the frequency of AFB positive smears in the sputum was found to be much higher as compared to saliva and mixed samples

Presenting features of urinary tract infection [UTI] in children: a hospital based study

Urinary tract infection [UTI] is one of the most common disorders seen in children world wide but not as frequently as in adults. Because of high incidence of urinary tract infection and its associated morbidity and mortality, early diagnosis and treatment of this condition is essential. This study was carried out to see the common clinical presentations of UTI especially presenting with fever but no urinary symptoms, in children admitted in Department of Pediatrics at Sheikh Zayed Hospital, Lahore. 57 Children diagnosed as UTI, upto 15 years of age, admitted during years 2004 and 2005 in department of Pediatrics Sheikh Zayed Hospital, Lahore, were included in this observational descriptive study. Fever was the commonest clinical presentation [78%] followed by pain abdomen [54%] and dysuria [40%] Failure to thrive was observed in [12%] of patients. Fever was the main clinical feature observed in our study. Children who present with fever without focus should be investigated for UTI. so that early diagnosis and prompt management can reduce the risk of complications associated with UTI

Using Systematized Nomenclature of Medicine clinical term codes to assign histological findings for prostate biopsies in the Gauteng province, South Africa: Lessons learnt

Background: Prostate cancer (PCa) is a leading male neoplasm in South Africa.Objective: The aim of our study was to describe PCa using Systemized Nomenclature of Medicine (SNOMED) clinical terms codes, which have the potential to generate more timely data.Methods: The retrospective study design was used to analyse prostate biopsy data from our laboratories using SNOMED morphology (M) and topography (T) codes where the term 'prostate' was captured in the narrative report. Using M code descriptions, the diagnosis, sub-diagnosis, sub-result and International Classification of Diseases for Oncology (ICD-O-3) codes were assigned using a lookup table. Topography code descriptions identified biopsies of prostatic origin. Lookup tables were prepared using Microsoft Excel and combined with the data extracts using Access. Contingency tables reported M and T codes, diagnosis and sub-diagnosis frequencies.Results: An M and T code was reported for 88% (n = 22 009) of biopsies. Of these, 20 551 (93.37%) were of prostatic origin. A benign diagnosis (ICD-O-3:8000/0) was reported for 10 441 biopsies (50.81%) and 45.26% had a malignant diagnosis (n = 9302). An adenocarcinoma (8140/3) sub-diagnosis was reported for 88.16% of malignant biopsies (n = 8201). An atypia diagnosis was reported for 760 biopsies (3.7%). Inflammation (39.03%) and hyperplasia (20.82%) were the predominant benign sub-diagnoses.Conclusion: Our study demonstrated the feasibility of generating PCa data using SNOMED codes from national laboratory data. This highlights the need for extending the results of our study to a national level to deliver timeous monitoring of PCa trends