Outcome and Prognostic factors of stroke in children presenting at an Army hospital in Pakistan

Objective: To determine the outcome and prognostic factors of stroke in children presenting at Military Hospital Rawalpindi

Study Design: Cross-sectional study

Place and Duration of Study: This study was conducted at the department of Pediatrics, Military Hospital Rawalpindi, from Oct 2012 to Mar 2014

Patients and Methods: Sixty consecutive children presenting with stroke were included in this study after taking written informed consent from the guardians/parents. A predesigned proforma was used to record patient's demographic details along with the presenting complaints, type of stroke, underlying cause and outcome

Results: The mean age of the patients was 3.49 +/- 3.29 [Mean +/- SD] years. There were 35 [58.3 percent] male and 25 [41.7 percent] female children. Ischemic stroke was the most frequent and was observed in 37 [61.7 percent] patients followed by hemorrhagic [16.7 percent], sinovenous thrombosis [8.3 percent] and ischemia with hemorrhagic findings [6.7 percent]. Mixed lesions and transient ischemic attacks were reported in 2 [3.3 percent] patient each. Mean length of hospital stay was 9 +/- 6 [Mean +/- SD] days. Sixteen [26.7 percent] children recovered completely while 41 [68.3 percent] children had some neurological deficit at discharge. Mild to moderate deficit was recorded in 21 [35.0 percent] children while 20 [33.3 percent] children had severe deficit. Three [5.0 percent] patients expired during hospital stay

Conclusion: Ischemic stroke was the most common cause of paediatric stroke. Important risk factors of peadiatric stroke included congenital heart diseases and intracranial infections. Poor prognostic factors included male gender, age less 5 years and congenital heart disease

Croup not always a benign condition

A 16 month old male baby was brought to emergency department with stridor and low grade fever. He was diagnosed with croup. Tracheostomy was done in emergency due to his worsening condition. Tracheostomy ended up with multiple complications. These were addressed promptly and the patient recovered quickly

Diagnosis and outcome of birth asphyxia in resource constrained health care set up

Objective: To determine morbidity and mortality of neonates with low APGAR score in a resource constrained health care set up

Study Design: Prospective descriptive study

Place and Duration of Study: The study was carried out in combined military hospital Attock, from Jan 2013 to Jan 2015

Material and Methods: All term neonates with 37 completed weeks of gestation and APGAR score less than 7 were included in the study. APGAR score was calculated by an attending pediatrician, gynecologist or trained female nurse at 0 and 5 minutes. In Neonatal Intensive Care Unit [NICU] the babies were daily examined by pediatrician. Outcome was documented in term of morbidity i.e. fits and mortality i.e. death of babies

Results: Total number of neonates included in the study were 85 of which 55 [65%] were males and 30 [35%] were females. Of the total neonates 65 [76%] were discharged in satisfactory conditions and 20 [24%] expired during stay in the hospital. The mean APGAR score of newborns was 4.98 +/- 0.98 at 5 minutes. During stay in hospital 46 [54%] were diagnosed to have hypoxic ischemic encephalopathy 2 [HIE2], those diagnosed with HIE3 were 5 [6%] and the rest 14 [16%] with HIE1

Conclusion: Low APGAR score is an important cause of admission to NICU. Low APGAR score was found associated with increased risk of fits in neonates and one of the most important cause of mortality in our set up

Need for notifying and prevention of congenital anomalies

Objective: To determine the frequency of different systems involved in congenital anomalies to prevention and notifying strategies

Study Design: Descriptive observational study

Place and Duration of Study: The study was carried out at Military Hospital, Rawalpindi, from Jan 2011 to Aug 2013

Material and Methods: The study was carried out at Military Hospital, Rawalpindi. The data of all the neonates with congenital anomalies was analyzed in term of sex and various system involved. Various type of tests were used for the diagnosis of different defects like, barium studies, computed topography, magnetic resonance imaging, echocardiography, x-rays, ultrasound

Results: Total number of admissions during the study period were 4201 out of which 371 [8.83%] were diagnosed cases of congenital anomalies. Of these babies 220 [59.30%] were male, 142 [38.27%] were females and the remaining 9 [2.43%] were with ambiguous genitalia 215 [57.95%] were delivered by normal vaginal delivery and rest 156 [42.05%] by lower segment caesarian section. The most common system involved was central nervous system [CNS] 89 [23.99%], followed by gastro intestinal tract 74 [19.95%], cardiovascular system 61 [16.44%], respiratory system 35 [9.43%] and genito urinary system 18 [4.85%]. Babies with dysmorphic features were 48 [12.94%] and with cleft lip and palate 17 [4.58%]. The remaining 29 [7.82%] were grouped in miscellaneous category

Conclusion: Congenital anomalies are an important cause of admission to NICU. The prevalence of congenital anomalies was found more in males than in females. In our set up the most common system involved in congenital anomalies is central nervous system followed by gastrointestinal tract and cardiovascular systems