Non-urgent visits to emergency department and comparison of urgency evaluation between patients and doctors

Objective: To assess the proportion of non urgent patients presenting to the emergency department and to compare urgency evaluation between patients and doctors. Study Design: Descriptive cross sectional study. Place and Duration of Study: Emergency department Combined Military Hospital [CMH] Jhelum, from November 2015 to December 2015

Material and Methods: All the patients presenting to the emergency department after working hours between 4-6 pm were documented for 16 consecutive working days. They were assessed as to the urgency of their condition by the doctor. The patients or guardians in case of children were also required to rate the level of urgency of their medical condition. The level of urgency was graded on visual analog scale from 0-10. A 5 and above score was labeled as urgent while a score of less than 5 was considered non urgent

Results: A total of 205 patients reported in 32 hours over 16 days, to the emergency department. Of these 31 [15.12%] were assessed as emergencies by doctors while 49 [24%] were thought to be emergencies by patients. The p-value for this difference was 0.021. The largest group of patients visiting the emergency department was pediatric and they comprised the largest group of non urgent visits to the hospital as well

Conclusion: Actual emergencies comprise a small proportion of visits to emergency departments while the main bulk consists of non urgent visits

Frequency of causes of chronic liver disease in children

Objective: To determine the etiology of chronic liver disease in children. Study Design: Descriptive cross sectional. Place and Duration of Study: Department of Paediatrics, Combined Military Hospital Lahore, from Jun 2014 to Dec 2014

Material and Methods: This is a descriptive cross sectional study conducted at department of Paediatrics, Combined Military Hospital Lahore from 1[st] June 2014 to 31[st] December 2014. It included 150 consecutive paediatric patients [1-14 years] with chronic liver disease

Results: Out of 150 children 95 [63.33%] were male and 55 [36.66%] were females. The mean age of the children included in the study was 7.2 +/- 4.6 years and the age range was 1 year to 14 years. Viral hepatitis [61, 40.67%] was the commonest cause of the liver disease followed by glycogen storage disease [11, 7.33%] and Wilson's disease in 13 [8.6%]

Conclusion: There are various causes of chronic liver disease in children most common being hepatitis B and C infection. The early identification of etiology of chronic liver disease in children is of cardinal importance for optimal management of these cases

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

Hepatitis A - frequency in children with non-specific abdominal symptoms

To study the frequency of subclinical hepatitis 'A' in children having non-specific abdominal symptoms. Design: A descriptive study. Place and Duration of Study: This study was conducted at Combined Military Hospital [CMH], Peshawar from June to December 2000. Subjects and Three hundred and sixty children of either gender, < 12 years of age, presenting with vague abdominal symptoms and no jaundice were evaluated for hepatitis. Eighty eight [24.4%] children meeting the inclusion criteria of elevated serum alanine aminotransferase [ALT], twice the upper limits of normal [90 IU/L], and normal serum bilirubin were labelled as subclinical hepatitis. A total of 360 children were evaluated for vague abdominal symptoms and 96 [26.7%] of them had hepatitis on laboratory profile. Eight patients developed early jaundice and were excluded from the study. Out of 88 [24.4%] cases of subclinical hepatitis, 82 [93.2%] had hepatitis-A, 03 [3.4%] had hepatitis-B, while no causative agent was found in 03 [3.4%] children. The common presenting symptoms were abdominal pain/discomfort, loss of appetite, nausea, vomiting, malaise, fatigue and fever. Hepatomegaly and splenomegaly was documented in 56% and 43% cases respectively. A history of exposure to a patient with hepatitis was present in 14/88 [15.9%] cases whereas no child was vaccinated against HAV. Serum ALT level declined to normal limits within 4 weeks for 77/88 [87.5%] cases and within 6 weeks for 84/88 [95.4%]. All cases recovered spontaneously with out any complication. Hepatitis-A was rampant in children presenting with vague abdominal symptoms in our series