Comparison of risk factors for Methicillin Resistant Staphylococcus aureus (MRSA) colonization in healthy newborns, born to mothers with and without MRSA colonization.

Objective: To compare the risk factors for MRSA colonization in healthy newborns, born of mothers with and without MRSA colonization. Methods: This case control study was conducted in post-natal unit of Lady Willingdon Hospital, affiliated with King Edward Medical University/Mayo Hospital, Lahore from January to June 2017. The vaginal and anterior nares swabs for MRSA culture were collected from mothers within six hours before planned delivery and the neonatal anterior nares swabs for MRSA culture were taken within one hour of birth. All the samples were cultured in Paediatric Microbiology laboratory in Mayo Hospital. Data were analyzed through SPSS 20.0 and logistic regression was applied for risk factors analysis. Results: Out of total 80 mothers and their newborns, 15 (18.75%) mothers and 16 neonates (20%) were MRSA colonized. The frequency of MRSA colonization in mothers' anterior nares and vaginal swab was 17.5% and 1.25% respectively. The significant risk factors were prolonged rupture of membranes for >18 hours (p-value 0.02, odds ratio 11.85, 95% CI 1.41-99.3), birth weight <2500 grams (p-value 0.01, odds ratio 5.39, 95% CI 1.35-21.4), history of presence of meconium (p-value 0.006, odds ratio 7.30, 95% CI 1.78-29.8). The non-significant factors were age of mother (p-value 0.682, odds ratio 0.765, 95% CI 1.0.212-2.76), parity (p-value 0.185, odds ratio 3.82, 95% CI 0.46-31.66) , gestation (p-value 0.615, odds ratio 0.797, 95% CI 0.714-0.89) , mode of delivery (p-value 0.576, odds ratio 0.543, 95% CI 0.062-4.76), sex of baby (p-value 0.546, odds ratio 0.683, 95% CI 0.196-2.37) and presentation of baby at birth (p-value 0.47, odds ratio 0.795, 95% CI 0.71-0.89). Conclusion: The presence of meconium, prolonged rupture of membranes and low birth weight were the significant risk factors for MRSA colonization in healthy new-borns, born to mothers with and without MRSA colonization.

Neuromuscular Training following Anterior Cruciate Ligament reconstruction - Pain, Function, Strength, Power & Quality of Life Perspective: A Randomized Control Trial.

Objectives: To determine the effectiveness of neuromuscular physical Therapy as compared to strength training following anterior cruciate ligament reconstruction in terms of pain, function, quality of life, strength and power of participants. Methods: A randomized clinical trial was conducted at Kanaan Physiotherapy & Spine Clinic, Lahore, Pakistan from July 2020 to December 2020. Seventy-six patients were selected by non-probability convenience sampling technique and randomly divided into either neuromuscular training or strength training group. Sample included 20-40 years aged adults with unilateral anterior cruciate ligament injury who had undergone surgical reconstruction of ACL two months ago using hamstring graft. Patients were assessed using the Cincinnati Knee Score for function, Numeric Pain Rating Scale (NPRS) for pain, SF-36 for quality of life, and Single Leg Hop, Triple Hop, Crossover Hop and 6-meter Hop test for power and strength. Data was analyzed using SPSS Version-21. A t-test was used to assess difference between groups. P<0.05 was considered significant. Results: Results revealed that neuromuscular training is statistically significant in reducing pain (p<0.001) and improving function (p<0.001), power & strength (p<0.001) and quality of life (p=0.001). Conclusion: Study concludes that compared to strength training, neuromuscular training was significantly more effective in reducing pain; improving function, quality of life, strength and power.

Diagnostic accuracy of cerebrospinal fluid lactate in confirmed cases of acute bacterial meningitis in children.

OBJECTIVE: To determine the diagnostic accuracy of cerebrospinal fluid lactate level in confirmed cases of acute bacterial meningitis in children. METHODS: This cross sectional study was conducted in the Department of Paediatrics, King Edward Medical University/ Mayo Hospital, Lahore from January to December 2018. A total of 250 children, between two months - 12 years of age, of both the genders, with suspected acute bacterial meningitis were included by non-probability consecutive sampling. Each child was subjected to lumbar puncture for biochemistry, cytology, culture, and lactate level. CSF lactate level of 1.1-2.4 mmol/L was taken as normal, and >2.4 mmol/L was taken as cut off for acute bacterial meningitis. All collected data was entered and analyzed in SPSS version 22. A 2 x 2 table was made to calculate diagnostic accuracy, sensitivity, specificity, positive and negative predictive value for CSF Lactate. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CSF lactate taking CSF culture as gold standard was 100%, 60.61%, 17.27%, 100% and 63.6% respectively, with kappa of 0.19 and p value of 0.000. CONCLUSION: At a cut off value of 2.4 mmol/L, cerebrospinal fluid lactate level has a high diagnostic accuracy for acute bacterial meningitis.

Risk factors for candidaemia in neonates with sepsis in a tertiary care hospital in Pakistan.

OBJECTIVE: To determine the risk factors for candidaemia in babies admitted to a tertiary care hospital with neonatal sepsis. METHODS: This nested case control study was conducted in the Neonatal Unit of the department of Paediatrics, King Edward Medical University/Mayo Hospital, Lahore, from January 2017 to June 2018. A total of 350 neonates having sepsis according to the clinical case definition were enrolled in this study by non-probability convenient sampling. Blood culture for bacteria on first day and for candida on fifth day was sent. Patients were started antimicrobial therapy as per institutional policy on admission. All patients were followed for risk factors for development of candidaemia. Data was analyzed by SPSS 22.0, Odds ratio and logistic regression was used to determine the magnitude of risk factors. RESULTS: Among 350 septic neonates, 36 isolates were positive for Candida spp, constituting 10.2% of candidaemia among septic neonates. Necrotizing enterocolitis was found to be the significantly associated risk factor for development of candidaemia. CONCLUSIONS: Necrotizing enterocolitis was found to be an important risk factor for development of candidaemia among hospitalized septic neonates.

Performance of Pediatrics' residents as clinical teachers: A student-based assessment.

OBJECTIVE: To assess the clinical teaching skills of Pediatrics' residents as rated by final year MBBS students by using augmented Stanford Faculty Development Program questionnaire (SFDPQ) in a teaching hospital, Lahore. METHODS: This cross- sectional survey was conducted in the Department of Pediatrics, King Edward Medical University, Lahore in six months in 2016.Total of 265 students of final year MBBS, attending the teaching sessions organized by residents during their four weeks rotation in Pediatrics were included by non-probability purposive sampling. The augmented SFDPQ was emailed to the study participants after the completion of the clinical rotation, following several encounters with the resident. The data was entered in SPSS 22 for statistical analysis. Scores for each domain (learning climate, control of session, communication of goals, promoting understanding and retention, evaluation, promoting self-directed learning, teacher's knowledge and teacher's attitude) were also presented as mean and standard deviation. One-sample Kolmogorov-Smirnov test was applied to observe the normality of data. Where normality of data was observed, independent sample t-test was applied and where normality of data was not observed, Mann-Whitney U test was applied to compare the score between genders. Score of four was considered as cut off score for satisfactory results. RESULTS: Out of 265 students, 250 responded with response rate of 94.3%. Out of 250 medical students, 105 (42.0%) were male and 145(58.0%) were female. The internal consistency (Cronbach's alpha) of this score was excellent (0.973). The mean score for all SFDPQ domains was also sub-optimal (2.90±0.611). The mean total score was sub-optimal for learning climate (3.39±0.69), control of session (3.25±0.77), communication of goals (3.26±0.86), promoting understanding and retention (3.26±0.77), evaluation (2.25±0.67), promoting self-directed learning (3.17±0.90), teacher's knowledge (3.14±0.93) and teacher's attitude (3.31±0.89), while it was good only for feedback (4.03±0.11). The mean total score for all SFDPQ domains in males and females was 3.05±0.54 and 2.79±0.64 respectively. Although sub-optimal in both the genders, the score was significantly higher in males with p-value 0.001. CONCLUSION: We found suboptimal clinical teaching skills of Pediatrics' residents as rated by final year MBBS medical students.

Educational intervention to improve the knowledge of hand hygiene in pediatric residents and nurses.

OBJECTIVES: To assess the improvement in the knowledge of hand hygiene in Pediatric residents and nurses after theoretical and hands-on educational intervention. METHODS: This study was a questionnaire-based cross-sectional survey carried out in the department of Pediatrics, King Edward Medical University/ Mayo hospital Lahore in two weeks period. Total 41 Pediatrics residents and nurses, participated in the study. Initially a pretest questionnaire was given to each participant, followed by an educational intervention: a day's worth of didactic lectures and practical training of practices for infection control. After two weeks, an identical post-test questionnaire was sent to the participants via email. Data were statistically analyzed through SPSS 22. Z test was applied to see the normality of data while paired t test was applied to compare the pretest score with posttest score. RESULTS: Of 41 participants who attended the workshop, 34 participants responded to post-test giving an overall response rate of 83%. Out of 34, there were 27(80%) doctors and 7(20%) nurses, who participated in workshop. Each item of the questionnaire was analyzed, showing that pretest score for questions related to indication for hand washing, minimum timings required for hand rub, and spread of infection from unclean hands was quite low, as compared to post-test score, indicating statistically significant increment (p value 0.000, 0.001and 0.046 respectively). Mean pre-test score for doctors was 3.22 while for nurses, it was 3.14, whereas post-test score was 4.51 and 4.00 for doctors and nurses respectively. Overall, there was statistically significant increase in knowledge after educational intervention. CONCLUSION: There is statistically significant impact of educational intervention on improving the knowledge of Pediatric residents and nurses with respect to hand hygiene practices.

Immune Response And Anamnestic Immune Response In Children After A 3-Dose Primary Hepatitis B Vaccination.

BACKGROUND: Diseases caused by Hepatitis B virus (HBV) have a worldwide distribution. Pakistan adopted the recommendations of World Health Organization (WHO) for routine universal infant vaccination against hepatitis B in 2002, currently being administered at 6, 10, and 14 weeks of age in a combination vaccine. This study was conducted to determine the immune response & anamnestic immune response in children, 9 months-10 years of age, after a 3dose primary Hepatitis B vaccination. METHODS: This cross sectional study was conducted in the Department of Paediatrics, King Edward Medical University/Mayo Hospital, Lahore, Pakistan, from January to June, 2014. A total of 200 children of either sex between the ages of 9 months to 10 years, documented to have received 3 doses of hepatitis B vaccines according to Expanded Program of Immunization (6,10,14 weeks) schedule in infancy, were recruited by consecutive sampling. The level of serum antiHBsAb by ELIZA was measured. Children with antiHBs titers ≥10 mIU/mL were considered to be immune. Those with anti HBsAb levels <10 mIU/mL were offered a booster dose of infant recombinant hepatitis B vaccine. The second serum sample was obtained 21-28 days following the administration of the booster dose and the anamnestic immune response was measured. Data was analysed using SPSS 17 to determine the relation between time interval since last vaccination and antibody titer. Chi square test was applied. RESULTS: Of the 200 children, protective antibody response was found in 58%. Median serological response was 18.60 (range 2.82 - 65.15). Antibody levels were found to have a statistically significant ( pvalue 0.019) negative correlation with the time since last administration of vaccine. A booster dose of Hepatitis B vacci ne was administered to all nonresponders, with each registering a statistically significant (pvalue 0.00) anamnestic response. CONCLUSIONS: The vaccination schedule with short dosage interval was unable to provide protection to 42% of the study population. Introduction of birth dose of Hepatitis B vaccine to the existing schedule is recommended.

Knowledge Of Maintenance Intravenous Fluid Therapy In Acutely Ill Hospitalized Children Among Residents.

BACKGROUND: Isotonic saline is recommended as maintenance intravenous fluid therapy (MIVFT) for most of the acutely ill hospitalized children. The aim of this study is to assess the current knowledge of paediatric residents regarding the selection of MIVFT in hospitalized children. METHODS: We conducted a paper-based questionnaire survey to paediatric residents from ten centres asking selection of MIVFT in four common clinical scenarios in 6-month and 10-year old patients as well as monitoring of fluid balance and electrolyte. RESULTS: 445 responses were collected (>90% response rate). Majority [78.3% (n=348)] of them were FCPS-trainees. The 0.9%, 0.45% and 0.2% solution were selected by 45.8%, 43.98% and 10.92% respectively. The isotonic and hypotonic solution was prescribed in 6- mo (35.22% vs. 64.76% [p<0.001]) and 10-year (54.49% vs. 44.98%) in four different clinical scenarios respectively. 0.45% solution was most commonly prescribed MIVFT in pneumonia (50.22%) and meningitis (45.39%) and 0.9% solution was most commonly selected in acute gastroenteritis (55.05%) and post-operative patients (51.23%). Fluid balance and electrolyte monitoring were selected by 96.9% and 55.7% respondents respectively. CONCLUSIONS: Our survey reports that more than fifty percent of paediatric residents have inadequate knowledge about maintenance intravenous fluid therapy in acutely ill hospitalized children.

Congenital hypothyroidism in neonates.

CONTEXT: Congenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation in children and it occurs in approximately 1:2,000-1:4,000 newborns. AIMS AND OBJECTIVES: The aim of this study is to determine the frequency of CH in neonates. SETTINGS AND DESIGN: This cross-sectional study was conducted in neonatal units of the Department of Pediatrics Unit-I, King Edward Medical University/Mayo Hospital, Lahore and Lady Willington Hospital Lahore in 6 months (January-June 2011). MATERIALS AND METHODS: Sample was collected by non-probability purposive sampling. After consent, 550 newborn were registered for the study. Demographic data and relevant history was recorded. After aseptic measures, 2-3 ml venous blood analyzed for thyroid-stimulating hormone (TSH) level by immunoradiometric assay. Treatment was started according to the individual merit as per protocol. STATISTICAL ANALYSIS USED: Data was analyzed by SPSS 17 and Chi-square test was applied to find out the association of CH with different variables. RESULTS: The study population consisted of 550 newborns. Among 550 newborns, 4 (0.8%) newborns had elevated TSH level. CH had statistically significant association with mother's hypothyroidism (P value 0.000) and mother's drug intake during the pregnancy period (P value 0.013). CONCLUSION: CH is 0.8% in neonates. It has statistically significant association with mother's hypothyroidism and mother's drug intake during pregnancy.