Superior Mediastinal Syndrome Misdiagnosed as Foreign Body Aspiration: A Case Report.

Superior mediastinal syndrome is a life-threatening pediatric oncological emergency that requires high level of awareness and clinical suspicion to avoid misdiagnosis and devastating outcomes. Early diagnostic evaluation and management of underlying etiology are of utmost significance for optimal results. In children, it is most commonly caused by non-Hodgkin's lymphoma and T-cell lymphoblastic leukemia. We report a case of a six-year-old boy with superior mediastinal syndrome secondary to T-cell acute lymphoblastic leukemia, initially misdiagnosed as foreign body aspiration and underwent a procedure with a life-threatening outcome.

Experience of pediatric rapid response team in a tertiary care hospital in Pakistan.

OBJECTIVE: To report our experience before and after implementation of pediatric rapid response team (RRT) in pediatric wards of a tertiary care hospital in Pakistan. METHODS: An audit of RRT activity from December 2007 to August 2008 was conducted and reviewed patient diagnoses at the time of call placement, interventions done and post-intervention clinical outcomes. Clinical Outcomes in the nine months before RRT implementation were compared with those in the first operational nine months after RRT. RESULTS: Eighty-three calls were generated during the post-intervention study period of 9-month (21 calls/1000 admissions). The median age of patients was 27 months; 37% calls were for infants. The majority of patients were under care of medical services (93% vs 7% under care of surgical services). Greater numbers of calls were made during 0800-1600 hours (45%). Respiratory issues were the most common reason for activation of RRT. Because of early interventions, majority (61%) of patients avoided unnecessary PICU stay and expenditure; only 17% required mechanical ventilation in PICU. The code rate per 1000 admissions decreased from 5.2 (pre-RRT) to 2.7 (post-RRT) (p=0.08; OR 1.88 (95%Cl 0.9-3.93). The mortality rate of patients admitted in PICU from wards decreased from 50% to 15% (p=0.25; OR 1.64 (95%Cl 0.63-4.29). CONCLUSION: Our experience with implementation of RRT was associated with reduction in cardiorespiratory arrest, mortality and saved a lot of PICU resource utilization. It is an excellent patient-safety initiative especially in resource-constrained countries by bringing PICU reflexes outside the PICU.

Endemic dengue fever: a seldom recognized hazard for Pakistani children.

BACKGROUND: Dengue fever (DF) has gained prominence as an epidemic disease in Pakistan in the recent years. However, little data exists to show its likely endemic nature. METHODOLOGY: We retrospectively analyzed blood for dengue IgM on samples obtained during a community-based surveillance for febrile illnesses in two slum areas of Karachi, Pakistan, between June 1999 and December 2001. In this period, no epidemic of DF occurred in the city. Participants were children older than 16 years who had fever >or=38 degrees C for more than 72 hours and in whom other common infections were excluded, based on clinical examination and laboratory tests (blood culture, urinalysis, complete blood count, Typhidot test and peripheral blood film for malaria). RESULTS: One hundred and fourteen blood samples were analyzed for dengue IgM ELISA, out of which 54 (47.4%) tested positive. The incidence of DF in this community was possibly as high as 185 (95% CI: 145 - 242) per hundred thousand population/year. Older children (10 - 15 years) appeared 5.5 times more likely to be affected than their younger (0 - 5 years) counterparts. CONCLUSIONS: DF is probably endemic in children in slums of Karachi, and likely to have high incidence rate. Older children are more susceptible to the disease. Further prospectively designed research is needed to confirm these findings. Until that time, DF may be included in the differential diagnosis of fever without focus in children in Karachi slums even in non-epidemic periods.

Risk factors for typhoid fever in children in squatter settlements of Karachi: a nested case-control study.

Typhoid fever remains a major public health problem in developing countries such as Pakistan. A great majority of cases occur in children living in poor sanitary conditions in squatter settlements in large cities. We conducted a case-control study to identify risk factor for typhoid fever in children under the age of 16 years residing in squatter settlements of Karachi. We enrolled 88 typhoid fever patients, diagnosed by positive blood culture or Typhidot test, between June 1999 and December 2001. Simultaneously, we enrolled 165 age-matched neighborhood controls. Multivariate analysis done through conditional binary logistic regression analysis technique showed that increasing number of persons in the household (odds ratio [OR]=1.9; 95% confidence interval [CI] 1.2-3.1), non-availability of soap near hand washing facility (OR=2.6; 95% CI 1.1-6.3), non-use of medicated soap (OR=11.2; 95% CI 1.3-97.6) and lack of awareness about contact with a known case of typhoid fever (OR=3.7; 95% CI 1.6-8.4) were independent risk factors of the disease. Health education with emphasis on hand washing may help decrease the burden of typhoid fever in developing countries.