Outcome of neonates ventilated in NICU of a tertiary care hospital and factors associated with poor outcome

Objective: To ascertain the outcome of neonates who are ventilated for various reasons in our Neonatal Intensive Care Unit [NICU] and determine the risk factors associated with increased incidence of adverse outcome. Study Design: Retrospective study. Place and Duration of Study: Neonatal Intensive Care Unit of Combined Military Hospital Rawalpindi from Jul 2016 to Dec 2016

Material and Methods: All neonates who received mechanical ventilation during the study period were included in the study

Results: Total sixty seven [35.8% females and 64.15% males] neonates were ventilated during the study period for various reasons. Of these 67 neonates who were ventilated, 35 [52.23%] died and 32 [47.76%] survived to be discharged home. 10 babies were born less than 28+ 0weeks gestation and all [100%] expired. Of 7 babies born between 28+1-31+6 weeks gestation, only 01 [14.28%] survived. Of 50 newborns between 32+0-36+6 weeks, 20 [40%] died and 30 [60%] survived to be discharged home. In our cohort of ventilated babies, 7 weighed less than 1000 gm of which 6 [85.71%] died and only 01 [14.28%] survived. Of 18 babies born 1000-1499 gm, 14 [77.77%] died and 4 [22.22%] survived. Of 14 babies born between 1500-2499 gm, 6 [42.85%] died and 8 [57.14%] survived. Of all ventilated babies, 28 weighed more than 2500 gm, of which 10 [35.71%] died and 18 [64.28%] survived. Out of our cohort of 67 babies, 14 were diagnosed with hypoxic ischemic encephalopathy grade 3, of which 11 [78.57%] died and 3 [21.42%] were discharged. Twenty three had RDS, of which 11 [47.82%] died and 12 [52.17%] survived. Ten babies were ventilated due to sepsis, of which 6 [60%] died and 4 [40%] survived

Conclusion: We conclude that gestational age less than 32+0 weeks, birth weight less than 1500 gm, Hypoxic Ischemic Encephalopathy grade 3 and sepsis are associated with a poor outcome in babies who are mechanically ventilated

Role of corticosteroids in reducing respiratory morbidity in neonates delivered by elective cesarean section before 39 weeks

Objective: to determine the effect of dexamethasone administration to women between 37 to 39 weeks of gestation on neonatal outcome in terms of respiratory morbidity and the need for NICU admission

Study Design: an experimental study

Place and Duration of Study: department of Obstetrics and Department of Neonatology, Military Hospital, Rawalpindi, Pakistan, from February to July 2017

Methodology: women with singleton pregnancies, undergoing elective cesarean section between 37-39 weeks. Neonates were evaluated for any respiratory morbidity and need for NICU admission as well as need of mechanical ventilation, length of hospital stay and final outcome

Results: out of 535 patients, 240 [44.8%] patients received steroid cover before their elective cesarean section [group 1]. Two hundred and ninety-five [55.2%] patients who did not receive steroid cover, were allocated group 2. Mean age of mother's in-group 1 was 29.20 +4.50 years and in-group 2, it was 29.34 +4.50 years. The mean gestational ages were 37.56 +0.66 weeks and 38.11 +0.79 weeks in groups 1 and 2, respectively. In-group 2, 14 [4.74%] newborns developed transient tachypnea of newborn [TTN], which was higher than the newborns in-group 1 [04 [1.66%], p = 0.049]. Also the number of neonates being admitted to NICU was greater in group 2 than in group 1 [23 [7.79%] vs. 06 [2.5%] respectively, p = 0.007].However, there was no statistically significant difference between the two groups with regard to final outcome, requirement for mechanical ventilation, length of hospital stay and APGAR scores at one and five minutes

Conclusion: steroid cover significantly reduced the risk of respiratory morbidity in babies delivered by elective cesarean section between 37-39 weeks

Neonatal Sepsis in a tertiary care hospital: Bacteriological profile and Its Antibicrobial sensitivity

Objective: To study the spectrum and antimicrobial sensitivity of bacterial pathogens causing neonatal sepsis, in neonatal intensive care unit [NICU] of Pak Emirates Military Hospital, Rawalpindi

Study Design: Prospective cross sectional study

Place and Duration of Study: This was a prospective cross sectional study, conducted at NICU of Military Hospital, Rawalpindi, from Jul 2017 to Dec 2017

Material and Methods: All neonates admitted to our department who underwent evaluation for sepsis, from Jul 2017 to Dec 2017

Results: Out of 2,480 admitted neonates, 733 were suspected with sepsis, making an incidence of suspected neonatal sepsis to be 29.5 percent. 421 [57.4 percent] babies were suspected with early onset sepsis [EOS] and 312 [42.6 percent] with late onset sepsis [LOS]. Majority of the babies [70.3 percent] were preterm. In 281 [11.3 percent] neonates, blood culture came out to be positive. 73/281 neonates with culture proven sepsis died making a mortality rate of 25.9 percent. Gram negative bacilli were most predominant among isolated bacteria. Most of the organisms showed resistance to the first line antibiotics

Conclusion: Sepsis has a high mortality rate in neonates admitted to our department. Gram negative organisms are the most common cause. Most of the isolated organisms are resistant to empirical antibiotics

Efficacy of trichloro-acetic acid peel alone versus combined topical magnesium ascorbyl phosphate for epidermal melasma

Objective: To compare the efficacy in terms of reduction in melasma area and severity index [MASI] score by more than 10 of a combination of 20% trichloro-acetic acid peel plus 5% topical magnesium ascorbyl phosphate versus 20% trichloro- acetic acid peel alone in the treatment of epidermal melasma

Study Design: Randomized controlled trial

Place and Duration of Study: Department of Dermatology, Lady Reading Hospital [LRH], Peshawar, from May 2012 to May 2013

Methodology: Patients aged 18-65 years, with Fitzpatrick skin type III-V were divided into two equal groups having 74 patients each. Detailed history was taken and Wood's lamp examination done to rule out mixed and dermal melasma

Melasma area and severity index [MASI] score was calculated for every patient. Priming was done for all patients with tretinoin cream applied once daily at night for 2 weeks, and to use a broad spectrum sun block cream before sun exposure

Patients in group A were subjected to combined treatment, i.e. trichloro-acetic acid peel 20% [weekly] plus magnesium ascorbyl phosphate cream [applied once daily], while patients in group B were subjected to trichloro-acetic acid peel 20% [weekly] alone. Treatment was continued for 6 weeks. After completion of treatment, MASI score was recalculated

Proportion of patients with significant MASI score reduction was compared using chi-square test with significance at p < 0.05

Results: Male and female patients were 11 [14.9%] and 63 [85.1%], respectively in group A, whereas 13 [17.6%] and 61 [82.4%] in group B. The mean age in group A was 30.28 +/- 8.08 years, and 29.36 +/- 6.84 years in group B. Significant MASI score reduction in group A was seen in 60 [81.1%] patients and in group B 49 [66.2%, p= 0.040]

Conclusion: Combination of trichloro-acetic acid peel and topical magnesium ascorbyl phosphate cream was significantly more effective than trichloro-acetic acid peel alone in treatment of melasma

Histopathological findings of biopsy specimen in children presenting with lower gastrointestinal bleeding

Objective: The aim of this study was to determine the frequency of different histopathological findings of biopsy specimens obtained through colonoscopy in children presenting with lower gastrointestinal bleeding

Methodology: It was a descriptive cross sectional study which was carried out at the department of Pediatrics Military Hospital, Rawalpindi, and Armed Forces Institute of Pathology [AFIP] Rawalpindi from June 2010 to 19 February 2012. 80 biopsy specimen obtained through fibre-optic colonscopy were included in the study and the histopthological findings reported by consultant Pathologist were recorded. Data was analysed using SPSS version 10

Results: A total of 80 biopsy specimens were included in the study. Out of these, 47 [58.75%] patients had polyps in colon. Histopathological examination revealed juvenile polyp to be the most common finding; all 47 patients revealed juvenile polyps.13 patients had chronic non specific colitis.11 cases were found to be normal .Only 03 had evidence of ulcerative colitis while 06 specimens revealed no specific findings

Conclusion: Histopathologically, juvenile polyp is the major cause of LGIB in children in our set up which is also found in other national and international studies

Nutritional status of pre-school children - a cross-sectional study in Mingora, Swat

Objective: The main aim of the study was to assess the nutritional status of pre-school children in Mingora city of Swat

Methodology: A community based, cross-sectional study was conducted in Mingora city - an urban area of Swat valley, from April to December 2013, to determine the current nutritional status of pre-school children [2-5years age group]. A total of 550 children were selected by convenience sampling method. Anthropometric data was collected about height and weight. It was compared against National Center for Health Statistics [NCHS] standards. It was analysed using SPSS version 16 and Microsoft Excel 2010

Results: Out of total of 550 children, 46% [n=253] were males while 54% [297] were females. Mean weights of the children ranged from 11.6 to 19.3 kg [+/-1.9kg] and mean heights of different age groups ranged from 85.7 to 111.6 cm [+/-3.99 cm]. Height for age parameter shows that 88% [n=484] of children are within normal range. Weight for Age parameter shows that 82% [n=451] of children had normal weight for age; 14% [n=77] were underweight; 8% [n=44] of the children were wasted; while 8% [n=44] were stunted

Conclusion: The prevalence of childhood malnutrition was very low in the geographic area studied. Similar studies in other geographic areas are indicated to establish a complete regional nutritional profile

Etiology of lower gastrointestinal bleeding in paediatric patients, a colonoscopic surgery

To determine the frequency of various etiologies of painless lower gastrointestinal bleeding [LGIB] in pediatric patients using colonoscopy. Cross sectional descriptive study. This study was carried out at the department of Pediatrics, Military Hospital, Rawalpindi, from June 2010 to February 2012. A total of 80 patients [2-18 years of age] presenting with painless lower gastrointestinal bleeding were subjected to fiber-optic colonoscopy and findings were recorded. Data was analyzed with the help of SPSS version 10. Descriptive statistics were used to determine the mean +/- SD of numerical data, e.g., for age. Categorical data like gender and colonoscopic findings were analyzed by their frequencies and percentages. The study included 80 children out of which 53 were boys and 27 girls [male: female ratio was 1.96: 1]. The majority of children, n=54 [67.5%] were between two and six years of age. The most common colonoscopic findings were polyps. In 47 [58.75%] patients, polyps were found in the colon and were resected. In 9 [11.25%] patients, gross appearance of colon was normal. Evidence of colitis was found in 17 [21.25%] patients. Patients with hemangiomas were 2 [2.5%]. A total of 5 [6.25%] patients had non specific ulcerative lesions. Polyps of the colorectal area are the most common cause of rectal bleeding in children in our set up. Thorough physical examination which includes a digital rectal examination and colonoscopy leads to rapid and accurate diagnosis and appropriate therapeutic measures

Degree of thrombocytopeniaand malaria parasite species

Background: Malaria is a common health issue of our country and has shown variable prevalence in different regions of the world. It has a vast array of clinical presentation including, high grade fever with rigors and chills, headache, dizziness, acute renal failure, hepatopathy, joint pains and congenital malaria. It has various abnormalities on laboratory indices like thrombocytopenia, anemia, and leucopenia

Objective: This study was conducted to find out the degree of thrombocytopenia and types of the parasites among malaria patients from upper Punjab

Patients and Methods: This descriptive case series was conducted in CMH, Kharian, from 1[st] September, 2011 to 30[th] September, 2012. All the suspected malaria patients were included on the basis of history, physical examination and diagnosed on laboratory parameters [thick and thin films]

The data was entered and analyzed in SPSS version 16

Results: Out of the 273 enrolled cases in our study, 190 [69.6%] had malaria. 145 [76.3%] were infected by Plasmodium vivax and 45 [23.7%] had falciparum malaria. Out of these 190 patients 151 [79.5%] had thrombocytopenia, and among these patients having thrombocytopenia, 118 [78.1%] were infected by vivax species and 33 [21.8%] were infected by Falciparum species

Conclusion: It is concluded from our study that majority of the patients in this region of country, are suffering from Vivax and Falciparum malaria and present with varying degree of thrombocytopenia

Jervell and Lange-Nielsen Syndrome in deaf school children population

To identify the patients of Jervell and Lange-Nielsen syndrome [JLNS] amongst congenitally deaf children. This was a cross-sectional study, conducted at Hamza Foundation Academy for the Deaf, and Combined Military Hospital Lahore over a period of 4 months from February to May 2012. A total of 379 children with congenital sensorineural hearing loss were included in this study. Echocardiographs of all children [ages 4-18 years] were obtained. The corrected QT [QTc] intervals of all 379 ECGs were calculated using the Bazett's formula. Using the Schwartz's criteria, patients with long QTc intervals were further evaluated for Jervell and Lange-Nielsen Syndrome. Out of 379 children, 84 [22.1%] were found to have QTc intervals equal to or longer than 0.44 seconds. As per Schwartz's criteria, 31 [36.9%] out of 84 children with Long QTc [8.17% in sample population], scored high points [4.0 to 6.0], proving presence of JLNS. A sizable proportion of congenitally deaf children had Jervell and Lange-Nielsen Syndrome in our study

Needle stick injuries in nurses at a tertiary health care facility

This study was aimed to assess the frequency and factors associated with Needle Stick Injuries[NSI] in nurses of a tertiary health care facility. This cross-sectional descriptive study was conducted in Combined Military Hospital Lahore in June-July 2012. Responses were obtained via a self-administered questionnaire with close-ended questions about the knowledge of the nurses regarding hazards of NSI, their frequency, and methods they practice to prevent them. The data was analyzed using SPSS-16. Chi-square test was applied and p-value was fixed at 0.05 to be statistically significant. Out of 118 nurses who participated, all were aware of the occupational hazards of their profession when they joined nursing. Sixty Five [55%] got NSI and 38[58%] of those were injured at the time of recapping the syringe. Sixty Nine [58.5%] did not use gloves while administering injections. After getting stuck by a contaminated needle, 100% squeezed out the blood from the area and 45[69%] out of 65 nurses cleaned the wound with a spirit swab. Only 13[20%] out of 65 consulted a physician regarding safety measures after NSI and 35[53%] had screening for Hepatitis-B Virus [HBV]. Seventy Eight [66%] of the total 118 nurses were immunized against HBV. Needle-stick injuries are highly prevalent among nurses, and prevention is the most effective way to protect nurses from infectious diseases which these injuries can transmit. Mandatory reporting to the concerned authorities, proper follow up, screening of nurses after NSI and promotion of safety measures against it should be greatly encouraged