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Background and Objectives: Neonatal septicemia is responsible for 1.5 to 2.0 million deaths/year in the under developed countries of the world. Pakistan is number three among these countries and accounts for 7% of global neonatal deaths. The objective of the study was to determine the role of simple hematological parameter, immature to total neutrophil ratio [I/T ratio] in diagnosing early onset neonatal bacterial infection
Methods: A descriptive cross-sectional study was conducted in Neonatal Intensive Care Unit of Liaquat College of Medicine and Dentistry [LCMD] Hospital from January 2016 to January 2017. A total 85 neonates were admitted with clinical suspicion of presumed early onset sepsis or who had potential risk factors for sepsis like prematurity, prolonged rupture of membranes was carried out. After taking informed consent from parents of admitted neonates, data was collected in a structured questionnaire. Laboratory workup included White blood cell count, CRP, absolute neutrophil count, immature neutrophil count while blood C/S was kept as gold standard. Empirical antibiotics started after sample collection for workup. Manual differential count and immature neutrophil count of the peripheral blood smear was performed by a senior technician masked to clinical information. I/T ratio was calculated from WBC, neutrophils and immature neutrophil count by a simple formula
Results: Out of 85 neonates, 13 had positive blood cultures [15.29%]. The mean white blood count was 18761.18 +/- 8570.75 and mean I/T ratio was 0.1622 +/- 0.0419.About 50% of proven sepsis cases had WBC higher than 26000 as compared to 50% of cases for negative diagnoses that had WBC <15500 . The mean I/T in positive CRP 0.204 +/- 0.04 was non-significantly higher as compared to negative CRP 0.151 +/- 0.034 [p =0.084]. Point biserial correlation revealed that I/T ratio was significant strong correlation [rpb = 0.721, p < 0.001] and overall I/T ratio was a good indicator of a positive and negative blood culture result. The sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] of I/T ratio were 76.47%, 83.82%, 54.16% and 93.44% respectively. Similarly majority of neonates having high I/T ratio also depicts positive C-reactive protein [CRP] [NPV 91.23%]. Therefore, both I/T and CRP showed a high negative predictive value [I/T = 93.44% and CRP = 91.23%] in this study
Conclusion: I/T ratio is a useful tool for early onset sepsis [EOS] with reasonable specificity but cannot be relied upon as sole indicator. Combination of normal immature to total neutrophil Ratio with negative CRP values in neonates with presumed sepsis is an indicator of non-infected neonate which comprised 78.8% of our study population
RESUMO
Objective: to assess knowledge, attitude and practices of mothers on routine immunization and to study factors for unsatisfactory Polio campaigns
Methods: this cross-sectional study was conducted in the Department of Paediatrics, Darul Sehat hospital from 1st March 2015 to 31st May 2015. Sampling type was non probability convenience and sample size was 210. Mothers who brought their children for routine immunization or any other illness of their own or their children, and accompanying women with children below the age of five years were included in the study. Women from other than the local areas, those unable to perceive the questions due to any illness or language problem and those who were accompanying a critically ill child, were excluded
Results: "Mandatory for child health" [95%] was the most common reason for complete vaccination while missing vaccination card was the main reason for incomplete vaccination [33%]. Most common reason of polio vaccination refusal was misconception about campaigns [22%]. Two hundred and two [98%] participants indicated that vaccine provided protection from major killer diseases. One hundred and ninety [94%] were in favor of routine immunization. Two hundred and eight [99%] brought a child regularly for routine immunization. Routine polio vaccination coverage was 99.58% while that for National Immunization Days [NID] polio was 87%
Conclusion: majority of participants thought that routine immunization protects children from major killer diseases and Polio campaigns are necessary for eradicating Polio. Majority was in favor of routine immunization and brought children regularly for routine immunization. Misconception about Polio campaigns is the main hurdle in Polio eradication and that is the reason why NID Polio coverage is lacking behind
RESUMO
Objective: To assess Knowledge, Attitude and Practices of mothers on ARI [Acute Respiratory Tract Infection] in children less than five years of age
Methods: This cross-sectional survey was conducted in the Department of Pediatrics, Darul Sehat hospital from 1st December 2014 to 28th February 2015. Mothers[n=335] who were local residents, had at least one child below the age of five years and coming to the hospital for any medical problem along with accompanying women were included. Foreign mothers and/or those having difficulty in perceiving questions were excluded. Language used in the Questionnaire was English which was translated to Urdu for better understanding. Questionnaire was interviewer administered. Researchers and two house physicians took part in questioning the mothers
Results: Total 335 children were studied. Out of 335 children 228[68%] had ARI. Mean age of the children was 20 months +/- 17 SD while mean Birth weight was 2.7 kg +/- 1.8 SD. The most common symptom perceived was cough [n=303, 40%], mostly worsening during winter season [n=255,87%], commonest aggravating factor was dust [n=174,81%], most common complication was Pneumonia [n=135, 83%], and most mothers opted for medical practitioner [n=268,89%] for treatment. Self-medication was practiced by 192[58%] and paracetamol was frequently used medication [n=117,42%]
Conclusion: The study reveals good knowledge of mothers on ARI symptoms, worsening environmental conditions, aggravating factors and complications. Their attitude towards ARI was appropriate with early consultation with qualified medical practitioner. Better literacy rate, has a positive influence on the Knowledge, Attitude and Practices of mothers
RESUMO
Objective: To assess knowledge, attitude and practices of mothers on the use of ORS in diarrhoea in children
Methods: This cross-sectional KAP study was conducted in the Department of Paediatrics, Dar-ul-Sehat hospital, Karachi from February 2015 to 30 April 2015. Sampling type was non-probability convenience and the sample size was 200. Mothers who were local residents, opted for participation in the study, accompanying children in OPD and ward and also accompanying women having children were included in the study. Mothers unable to understand the language and/or perceive the questions were excluded
Results: The mean age of the mothers was 28.7 +/- 3.7 years. Mean age of the children was 20 +/- 16 months. Socioeconomically 170 [85%] families were earning >Rs. 20,000/month. Most of the fathers and mothers [n=170, 85% and n=128, 64%] had completed graduation. Significant majority of fathers [n=167, 84%] were on job. Regarding mothers 180 [90%] were house wives. Ninety four [47%] of the mothers had correct understanding of diarrhoea while one hundred one [51%] knew about ORS. Significant majority [n=180,90%] thought ORS was good in diarrhoea while one hundred forty one [71%] consulted a doctor. Family members [n=114, 57%] contributed most to the information given on ORS
Conclusion: Majority of the mothers had a correct understanding of diarrhoea, knew about ORS and sought a doctors' advice when the child had diarrhoea. More than eighty percent of the mothers knew how to prepare ORS and thought that ORS was beneficial for diarrhea
RESUMO
Continuing medical education providers' [academia] and industrial relationship is drawing attention all over the world. To date, there are no national commercial support guidelines available in Pakistan to properly regulate cooperation between the two distinct entities. However, the fact is that the future of all continuing medical education depends on pharmaceutical support and the providers are heavily dependent on the pharmaceutical industry to remain in action. It should always be remembered that medical education and profession is regarded as a moral of enterprise based on a blind faith between the physician and the patient. The funding support by the industry should not bind or influence physician's prescription for any reason. To be trusted, medicine must be free of all such dependency; it should be accountable only to the society it serves and to its own professional standards