RESUMO
Thrombocytopenia is the most common cause of bleeding in children. Patients with thrombocytopenia may experience petechiae, epistaxis, gum bleeding, hematuria or gastrointestinal hemorrhage or intracranial bleeding, seizures and unconsciousness. To determine the various causes, and clinical features of thrombocytopenia in children. Prospective descriptive study. This study was conducted at the Paediatric Departments of Shaheed Mohtrama Benazir Bhutto Medical University at Ghulam Muhammad Mahar Medical College Hospital Sukkur and Chandka Medical College Hospital Larkana, from July 2009 to July 2011. This was a prospective descriptive study, include 200 patients1 to 12 year of age, presenting with fever, mucocutaneous bleeding and thrombocytopenia on peripheral smear at both departments. After consent a separate pro-forma was filled for each patient to record demography and data about various causes, clinical presentation and laboratory investigations. Out of 200 thrombocytopenic patients 128 [64%] were males and 72 [36%] females, majority in age group of under 10 years 154 [77%]. The most common cause was the malaria in 50% of cases, followed by ITP 20 [10%], aplastic anemia and thalassemia [hypersplenism] in 7.5% respectively. Dengue fever and Typhoid fever was [5%] of cases. The other minor causes were severe malnutrition, acute leukemia, hemolytic uraemic syndrome 2.5% each. The most common clinical presentation was petechiae and echymosis in 92 [46%], followed by epistaxis and gum bleeding 68 [34%] of cases, subconjuctival hemorrhage in [14%] and hematuria in [08%] of cases. Unconsciousness was present in [9%] of cases. Anemia was found in most of patients [71%]. Splenomegaly was present in 79 [39.5%] and hepatomegaly in 59 [29.5%] of patients. Platelets were less than 50,000/cmm in majority [60%] of patients. The common cause of thrombocytopenia in febrile children was malaria, followed by ITP, Aplastic anemia and thalassemia [hypersplenism], Dengue hemorrhagic fever and enteric fever was less common. The other minor causes were severe malnutrition, acute leukemia, hemolytic uremic syndrome and lymphoma
RESUMO
Enteric fever [Typhoid fever] is widely recognized as a major public health problem in developing countries. To evaluate the treatment outcome of enteric fever in children. Retrospective descriptive study. This study was conducted at the Paediatric department, Ghulam Muhammad Mahar Medical College Hospital Sukkur from January 2009 to December 2011. This was a retrospective study, included all patients of enteric fever, of both sex and age ranged from 6m to 13 years. All enteric patients were confirmed by serological test Typhidot IgM or IgM and IgG positive. The data was collected from case record for demography and treatment outcome. A total of 360 patients were diagnosed to have enteric fever during this period. Mean age of presentation was 6.47 years and 166 [46.12%] patients were <5 years whereas 194 [53.88%] were > 5 years of age. Male: Female ratio was 2:1. Serological test typhidot IgM was positive in 290 [80.5%] and both [IgM + IgG] were positive in 70 [19.45%] of cases. Raised ALT was seen in 90[25%] of cases. Complications were seen in 52 [14.4%] of cases, hepatitis 10 [2.77%], hepatic abscess 3 [0.83%] intestinal hemorrhage 8 [2.22%], peritonitis 4 [1.11%] intestinal perforation 4 [1.11%], cholecystitis 6 [1.66%], paralytic ileus 3 [0.83%] enteric encephalopathy 3 [0.83%], meningitis 1 [0.27%]. Two patients expired [0.55%], one was enteric encephalopathy and other intestinal perforation with peritonitis. enteric fever remains a major cause of morbidity and mortality in our part of country. Major complications found in our cases were hepatitis, hepatic abscess, intestinal hemorrhage, intestinal perforation, peritonitis, cholecystitis, enteric encephalopathy, meningitis, osteomyelitis, septic arthritis