Assessment of episodes of pneumonia and diarrhea in vaccinated and unvaccinated children under 60 months of age.

OBJECTIVE: To assess the episodes of pneumonia and diarrhea in vaccinated and unvaccinated children under 60 months of age. METHODS: This descriptive cross-sectional study was carried out at Darul Sehat Hospital and SESSI, Karachi in the Department of Pediatrics from 1st November 2018 to 3rd February 2019. An interview based questionnaire was administered and selection of participants was done by convenience sampling. Total of 196 participants were selected for interview. RESULTS: Total 196 participants were interviewed which included mothers of children between the age group of 1- 60 months. The questions were entered on the questionnaire after taking consent from the mothers. Among them, males were 98 (52.7%) and females were 88(47.3%). One hundred seventy two (88.7%) children were vaccinated for pneumococcal and rotavirus whereas unvaccinated children were 22(11.3%). There was an incidence of 66(63.5%) for loose watery diarrhea. In vaccinated children, grading of diarrhea was found to be severe cases as 30 (34.9%), moderate cases as 27 (31.4%) and mild cases as 29(33.7%). For unvaccinated children, severe cases were 12 (66.7%) and for mild and moderate cases were (11.1%) and 04(22.2%) respectively with p value of 0.035. As compared to their unvaccinated counterparts, the frequency of severe pneumonia was far less than cough and cold in vaccinated children (p<0.001). CONCLUSION: There is significant reduction in cases of severe pneumonia in children receiving pneumococcal vaccine as compared to children receiving Rota vaccine there is moderate reduction in cases of severe diarrhea. The overall coverage of Pneumococcal and Rota vaccines was higher in our sample population. Efforts should be made to increase the awareness of Rotavirus vaccination in order to have better coverage in future.

Morphometric features of Linea aspera on dry femur bones.

OBJECTIVE: To observe and describe the features of line a aspera in dry femurs. METHODS: The prospective observational study was conducted from October to December 2017 at Darul Sehat Hospital, Karachi, and comprised dry femurs. Data was collected by trained medical students. Observations of landmarks of linea aspera were taken using classical measuring techniques. Data was analysed using SPSS 21. RESULTS: There were 48 dry femurs with mean maximum length of linea aspera 133.4±22.4 mm, and mean minimum length 188±79 mm. The mean diameter of antero posterior thickness was 2.7±1.1 mm. Linea aspera was widest at its lower one third 30(62.5%) and narrowest at its middle one-third 5 (10.4%). The most common pattern on linea aspera was three ridges 26 (54.2%). Majority of bones had at least one uninterrupted ridge 32(66.7%). The most prominent ridge on linea aspera was lateral in 20 (41.7%) bones. The largest nutrient foramen in 19 (42.2%) bones was located at the level of proximal one-third of linea aspera.. CONCLUSIONS: linea aspera was widest at its lower one-third. In majority of bones the lateral ridge was the most prominent, and the largest nutrient foramen of femur was most commonly located at the level of proximal one-third of linea aspera.

Immature to total neutrophil ratio as an early indicator of early neonatal sepsis.

BACKGROUND & OBJECTIVES: Neonatal septicemia is responsible for 1.5 to 2.0 million deaths/year in the under developed countries of the world. Pakistan is number three among these countries and accounts for 7% of global neonatal deaths. The objective of the study was to determine the role of simple hematological parameter, immature to total neutrophil ratio (I/T ratio) in diagnosing early onset neonatal bacterial infection. METHODS: A descriptive cross-sectional study was conducted in Neonatal Intensive Care Unit of Liaquat College of Medicine & Dentistry (LCMD) Hospital from January 2016 to January 2017. A total 85 neonates were admitted with clinical suspicion of presumed early onset sepsis or who had potential risk factors for sepsis like prematurity, prolonged rupture of membranes was carried out. After taking informed consent from parents of admitted neonates, data was collected in a structured questionnaire. Laboratory workup included White blood cell count, CRP, absolute neutrophil count, immature neutrophil count while blood C/S was kept as gold standard. Empirical antibiotics started after sample collection for workup. Manual differential count and immature neutrophil count of the peripheral blood smear was performed by a senior technician masked to clinical information. I/T ratio was calculated from WBC, neutrophils and immature neutrophil count by a simple formula. RESULTS: Out of 85 neonates, 13 had positive blood cultures (15.29%). The mean white blood count was 18761.18 ± 8570.75 and mean I/T ratio was 0.1622 ± 0.0419. About 50% of proven sepsis cases had WBC higher than 26000 as compared to 50% of cases for negative diagnoses that had WBC <15500. The mean I/T in positive CRP 0.204 ± 0.04 was non-significantly higher as compared to negative CRP 0.151 ± 0.034 (p =0.084). Point biserial correlation revealed that I/T ratio was significant strong correlation (rpb = 0.721, p < 0.001) and overall I/T ratio was a good indicator of a positive and negative blood culture result. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of I/T ratio were 76.47%, 83.82%, 54.16% and 93.44% respectively. Similarly majority of neonates having high I/T ratio also depicts positive C-reactive protein (CRP) (NPV 91.23%). Therefore, both I/T and CRP showed a high negative predictive value (I/T = 93.44% and CRP = 91.23%) in this study. CONCLUSION: I/T ratio is a useful tool for early onset sepsis (EOS) with reasonable specificity but cannot be relied upon as sole indicator. Combination of normal immature to total neutrophil Ratio with negative CRP values in neonates with presumed sepsis is an indicator of non-infected neonate which comprised 78.8% of our study population.

Pattern of electrolyte imbalance in Type 2 diabetes patients: Experience from a tertiary care hospital.

OBJECTIVE: To determine frequency of electrolyte imbalance including sodium, chloride, potassium and magnesium levels present in patients with uncontrolled diabetes at a tertiary care hospital in Karachi. METHODS: This was a descriptive cross sectional study conducted at Medicine Department, Darul Sehat Hospital, Karachi, Pakistan from March 2017 to October 2017. A total of one hundred and eighty one admitted and OPD patients with uncontrolled diabetes (HbA1c more than 7%) were included and their demographics, comorbidities, microvascular complications, drug history, fasting and random blood glucose and serum electrolyte levels were recorded. RESULTS: In uncontrolled diabetes mellitus, decrease in serum sodium and chloride levels were observed to be statistically highly significant (p-value less than or equal to 0.05) while that of potassium and magnesium showed insignificant alterations. Sodium level was also observed to decline with increasing pattern of urine for microalbumin. CONCLUSION: Electrolyte imbalance is markedly present in patients with uncontrolled blood sugars therefore serum electrolytes should be routinely measured in patients with type 2 diabetes mellitus. Serum fasting blood glucose can be used as a predictor for electrolytes.

Frequency of Metabolic Syndrome in Chronic Hepatitis C Patients: Findings From a Lower Middle Income Country.

Introduction The world over, hepatitis C virus (HCV) engenders the risk of developing chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC). It has many extrahepatic manifestations, among which diabetes and metabolic syndrome (MetS) has been increasingly recognized and has become an active research field. The current study aimed to ascertain the frequency of MetS in chronic hepatitis C patients and to curb its long-term adverse outcomes. Methods  In our cross-sectional analysis, a total of 331 subjects diagnosed with chronic HCV were registered from June 2017 to November 2018 in two tertiary care hospitals of Karachi, Pakistan. Metabolic syndrome (MetS) was delineated following the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III). Categorical variables were compared by using the Chi-square test, and a significant P value was at the value of < 0.05. Results We found that adults of 40 - 49 years of age were the worst sufferers of hepatitis C. Out of the total 331 patients of hepatitis C, 97 (29.3%) cases were suffering from metabolic syndrome.  Conclusion Prevalence of MetS is substantial among HCV-infected individuals Therefore estimation of MetS in individuals with HCV infection is imperative and patients should be educated for lifestyle modification, diet, and weight control. However, we cannot generalized the results of our study as it was done in some tertiary care centres, so additional surveys are warranted to know the actual prevalence of MetS in our entire population.

Osteomalacia in a Case of Adult-Onset Bartter Syndrome.

Bartter syndrome is a rare heterogeneous disease characterised by a deficiency in sodium and chloride absorption. Gain-of-function mutations in the CASR gene have been described in some patients with Bartter syndrome associated with hypocalcaemia and hypercalciuria. We describe a case of adult-onset Bartter syndrome with hypocalcaemia severe enough to cause osteomalacia. LEARNING POINTS: Bartter syndrome is one of the rare heterogenous diseases that present with electrolyte disturbances.Bartter syndrome type 5 also causes hypercalciuria which is not severe enough to cause osteomalacia.Patients with adult-onset Bartter syndrome should be screened promptly for osteomalacia to prevent pathological fractures and consequent complications.

Factors determining outcome of acute renal failure patients.

OBJECTIVE: Acute Renal Failure (ARF) is a common medical problem. Delay in diagnosis is associated with increased mortality. Variety of conditions can lead to ARF. Many factors can influence the outcome of ARF. This study was done to find the predictive factors related to outcome of ARF. METHODS: One hundred adult patients of acute renal failure admitted to Ziauddin Hospital were studied. Certain factors related to outcome of ARF were identified and analyzed. RESULTS: Among such factors oliguria, levels of urea, creatinine and potassium were found significant poor prognostic predictors on univariate analysis as far as outcome of treatment modality is concerned. The multivariate analysis revealed that the presence of oliguria is the only significant independent predictor (P<0.001) for good outcome with dialysis. CONCLUSION: Oliguria was found to be the major predictor of non recovery of renal function.