Bone marrow examination in ITP in children: mandatory?

To determine the need of bone marrow examination in children with idiopathic thrombocytopenic purpura [ITP] at initial presentation. Descriptive study. Pediatric Units of Children Hospital, Islamabad, from January 1 999 to December 2003. All children, clinically suspected to have ITP, who underwent bone marrow examination, were included After reviewing the file records of these patients for history, examination and investigations, a predesigned proforma was filled and data was analyzed, using SPSS version 10 for statistical analysis. The results were reported in the form of frequencies, percentages and mean. A majority of the children were between 48 to 96 months, with a mean age of 54.43 months. Male to female ratio was 1.45:1. Mean platelet count was 33861/mm3. None of the bone marrow results showed the presence of abnormal cells consistent with hematological malignancy. ITP was the final diagnosis in 52 patients. One patient was diagnosed to have megakaryocytic hypoplasia. Bone marrow aspiration in one patient was hypoplastic, and subsequently, he was diagnosed to have aplastic anemia on trephine biopsy. Bone marrow aspiration should not be a part of routine work-up for diagnosing ITP in children and should be reserved for those children having atypical clinical and laboratory features

Clinical outcome in children hospitalized with complicated measles

To determine the association of clinical outcome of measles in children with demographic profile and complications. A cross-sectional analytical study. Isolation ward, The Children's Hospital, Pakistan Institute of Medical Sciences [PIMS], from January 2003 to August 2004. Detailed history and physical examination of all the hospitalized patients with complications of measles was filled in case report form. Immunization cards were assessed for measles vaccination status. Data was analyzed by using SPSS version 10 software. The clinical outcome of measles was compared with demographic profile and complications by using Chi-square test and p-values were obtained. Two hundred and five hospitalized patients with complications of measles were studied. There were 61.5% males. Mean age was 46.1 months and 57% patients were vaccinated against measles. Malnourished patients were 71.2% and had a longer hospital stay [p=0.010]. Pneumonia [40.0%] and diarrhoea [38.5%] were the commonest complications. Seven children died. Mortality was significantly associated with younger age [p=0.04], unvaccinated status [p=0.04] and presence of encephalitis [p=0.00001]. The most common complications of measles are pneumonia and diarrhoea with dehydration requiring hospitalization. Malnourished children experience more complications and have longer hospital stay. Mortality is significantly associated with infancy, unvaccinated status and encephalitis. A second dose of measles should be introduced at 15 months of age

open non-comparative study of the efficacy and safety of three day azithromycin treatment of pneumonia in children under five years of age

Acute respiratory tract infections [ARI] are a leading cause of morbidity and mortality in developing countries. In order to reduce mortality due to respiratory tract infections WHO has developed ARI case management guidelines which recommend co-trimoxazole and amoxicillin for the treatment of childhood pneumonia. These antibiotics are safe, economical and effective in the majority of cases of pneumonia. However. situations do arise when treatment fails due to the presence of resistant organisms. Two of the major reasons for the growing problem of resistance are indiscriminate use of antibiotics and poor patient compliance. Shorter duration of treatment and single daily dosing is associated with better patient compliance. Azithromycin, an azalide, has been shown to be effective in the treatment of respiratory tract infections in a single daily dosing regimen of three days duration. An open non-comparative trial was carried out at the Children Hospital. Islamabad to assess the safety and efficacy of short couse of azithromycin in the treatment of childhood pneumonia. Our results. show a cure rate of 86% at the 14th day of follow-up. No adverse events were reported by any of the care takers in our study patients

Rheumatoid arthritis in children: a comparative study

Ten children with rheumatoid arthritis were admitted in children hospital over of 2 years. Since Juvenile Rheumatoid Arthritis is an uncommon disease throughout the world, it was considered a good apportunity to study these patients in detail, classify them into various sub types on clinical grounds and utilize available laboratory facilities to compare our findings with available statistics from North America to assess any differences in clinical presentation, course of the disease and complications. The results were consistent with Western statistics, though some differences were noted