Frequency of Vitamin-D deficiency in children with Urinary tract infection: A descriptive cross-sectional study.

OBJECTIVE: To determine Vitamin-D status in children with urinary tract infection. METHODS: A Cross-sectional study was done at Pediatric Department, Liaquat University Hospital Hyderabad, from July 2019 to March 2020. A total of 172 children of either gender from 2 to 60 months of age with confirmed urinary tract infection (UTI) (having positive urine C/S report) were included in the study. The child who received antibiotics 48 hours prior or already on immunosuppressive drugs and steroids from previous health record or by taking clinically relevant history), children with CKD on vitamin-D supplementation, and known case of Vitamin-D deficiency were also excluded from the study. All study participants were evaluated for vitamin-D level by high performance liquid chromatography. Urine sample was collected for C/S and 1 cc venous blood was taken for Vitamin D status (ng/ml). The mean ± standard deviation (SD) and stratification was calculated for age, duration of urinary tract infection and vitamin-D level. Post stratification chi-square test was applied for all categorical variables at 95% confidence interval (CI) and P-value ≤0.05 was considered significant. RESULTS: The average age of the patients was 41.51±18.34 months. There were 130 (75.58%) females and 40 (23.25%) males. Most common complaint of the children was fever 150 (87.21%). Vomiting was present in 31 (18.02%), abdominal pain 22 (12.79%) and dysuria in 15 (8.72%) children. A total of 129 (75%) children had pyelonephritis and 15 (25%) had cystitis. (Frequency of vitamin-D deficiency in children with diagnosed UTI was 45.93% (79/172). Mild vitamin D deficiency was present in 42 (53.16%) children, while moderate deficiency in 55 (69.62%) children. E. Coli was the most common pathogen in both mild and moderate vitamin D deficiency i.e., 20 (47.61) and 31 (56.36%) respectively. CONCLUSION: The frequency of urinary tract infection is more common in children having vitamin D deficiency.

Comparison of performance on written and OSCE assessment during end semester pediatric examination.

OBJECTIVE: To compare the scores obtained on written and OSCE examination during pediatrics end semester examination and to find out the reasons for the discrepancies among the scores obtained. METHODS: This co-relational study was carried out in pediatric department, Liaquat University of Medical and Health Sciences (LUMHS). The performance of medical students who were posted in the pediatric department for one semester (November 2016 to October 2017) was compared on the basis of scores obtained in their written and OSCE during end semester examination. To find out the reasons for discrepancies qualitative data was collected by using likert scale on Pre-designed questionnaire distributed among the students at the end of assessment. Frequencies of their responses were calculated. RESULTS: Data of 160 students who participated in study was analyzed by SPSS version 22. The mean and standard deviation of participant's score was 51.25 ± 12.19. Females performed better in written as well as in OSCE. Moderate correlation was seen between MCQ and SAQ scores (r=0.5, p <0.01). Around 60% considered OSCE as their preferred mode of assessment. Deep learning approach and group discussion was found in female students (65%). CONCLUSION: Our study concluded that students performed better in OSCE than in written assessment. However, in OSCE they had shown unsatisfactory performance for some important competencies like clinical examination methods and procedural skills. Female students performed better in both segments of assessment.

Bone mineral density level by dual energy X-ray absorptiometry in rheumatoid arthritis.

OBJECTIVE: To observe the level of bone mineral density by Dual Energy X-ray Absorptiometry in rheumatoid arthritis patients. METHODS: The observational study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan, from January 2011 to December 2014. Bone mineral density was measured from the femoral neck, ward's triangle and lumbar spine, in patients 25-55 years of age, who were diagnosed with rheumatoid arthritis. All the cases were assessed for bone mineral density from appendicular as well as axial skeleton. Data was collected through a designed proforma and analysis was performed using SPSS 21. RESULTS: Of the 229 rheumatoid arthritis patients, 33(14.4%) were males. Five (15.1%) males had normal bone density, 14(42.4%) had osteopenia and 14(42.4%) had osteoporosis. Of the 196(85.5%) females, 45(29.9%) had normal bone density, 72 (37.7%) had osteopenia and 79(40.30%) had osteoporosis. Of the 123(53.7%) patients aged 30-50 years, 38(30.9%) had normal bone density, 59(48.0%) had osteopenia, and 26(21.1%) had osteoporosis. Of the 106(46.3%) patients over 50 years, 12(11.3%) had normal bone density, 27 (25.5%) had osteopenia and 67(63.2%) had osteoporosis. CONCLUSIONS: Osteoporosis and osteopenia were most common among rheumatoid arthritis patients. Assessment of bone mineral density by Dual Energy X-ray Absorptiometry can lead to quick relief in the clinical symptoms with timely therapy.

Impact of an IEC (Information, Education and Communication) intervention on key family practices of mothers related to child health in Jamshoro, Sindh.

OBJECTIVE: To determine change in practice of mothers having children less than five years of age in five key areas related to child health, growth and development including immunization, feeding during illness, appropriate home treatment for infections and care seeking behavior. METHODS: This was a community based interventional study of Information, Education and Communication (IEC) intervention in the UC Jamshoro, Taluka Kotri, district Jamshoro of 15 months duration from March 2011 to June 2012. Ninety five mothers having children less than five years of age were selected by systematic random sampling for house hold based survey by questionnaire designed by EPP evaluation and health section of UNICEF during baseline and post-intervention phases. Base line data was collected from the interventional area then health education messages were given through written and pictorial material by LHWs for 9 months. To measure the impact helath education messages, data was again collected by same questionnaire are from the same union council during post-intervention phase. RESULTS: During baseline survey except immunization all other key family practices were poor. After 9 months of intervention of repeated heath education sessions through LHW during their routine visits all practices were improved with statistically significant difference. Regarding the comparison of the results between baseline and post-intervention surveys we found that except immunization which was already better, all those practices which requires mother's knowledge and practice were improved after our intervention with significant P-values. CONCLUSIONS: Improving the mother's education level is very important, to empower the first care provider of child in the community. However, in the mean time, health educational messages related to the limited number of key family practices should be disseminated.

Role of rapid diagnostic tests for guiding outpatient treatment of febrile illness in Liaquat University Hospital.

OBJECTIVES: To assess the validity /strength of clinical diagnosis of Malaria on the basis of IMNCI algorithm by slide microscopy (gold standard) and to compare the effectiveness of Rapid Diagnostic Test (RDT )against slide microscopy. Methods : It is a descriptive cross sectional study of 6 month duration conducted at Pediatric Outpatient Department LUH Hyderabad from June-Dec. 2010. Sample of 400{the minimum required sample was 385 with malaria prevalence 5% (0.05) with margin of error of 3% (0.03, frequency vary from 2-8 % among different studies)} febrile children under 5 years classified as Suspected Clinical Malaria according to algorithm of IMNCI were included; The operational definition for Suspected Clinical Malaria was; fever for more than 2 days with no runny nose, no measel rash and no other cause of fever. Hyderabad was considered as low risk area. Rapid diagnostic test (RDT) and slide microscopy were done, and only confirmed cases were treated according to current guidelines given by National Malaria Program/updated IMNCI. RESULTS: Total 2000 patients under 5 years presented with fever and were evaluated. From 2000 cases 20% (400) were diagnosed as suspected clinical Malaria according to IMNCI algorithm; and only 40 cases (10%) have shown positive results for malaria parasite on slide microscopy and 38 cases on RDT. Regarding the plasmodium species 70% were vivax and 30% were falciparum. As regards the effectiveness, RDT has shown 95% sensitivity for the detection of plasmodium antigens in the febrile clinically suspected cases of malaria. CONCLUSION: Prompt and accurate diagnosis of malaria is needed for implementation of appropriate treatment to reduce unnecessary anti-malarial prescription. RDT is as effective as slide microscopy for the diagnosis of malaria especially in resource poor countries.

To compare the outcome (early) of neonates with birth asphyxia in-relation to place of delivery and age at time of admission.

OBJECTIVE: To determine the frequency of birth asphyxia and short-term (early) outcome in relation to age at admission and place of delivery. METHODS: A descriptive cross-sectional study was conducted in the Paediatric Department, Neonatal Ward of Liaquat University Hospital (LUH) Hyderabad from January to December 2009. All babies were received at our nursery or delivered in LUH with birth asphyxia were included, while babies having major congenital abnormalities, with birth weight < 1800 gm or preterm were excluded. After consent and enrollment their detailed history including peri-natal history, Apgar score, resuscitation measures, problems and outcome were recorded on a pre-designed study proforma. Short-term outcome was measured after 7 hours as clinically improved, developed neurological disability (Hypoxic Ischaemic Encephalopathy stage II or III) or death. RESULTS: The frequency was (n = 600; 25%) of LUMHS born and (n = 310; 61.63%) were received within 6 hours, (n = 272 45% were LUMHS born and n = 7 7% were out born), (n = 37; 38.95%) within 24 hours and (n = 9; 10.3%) after 24 hours. On initial neurological evaluation (n = 90; 15%) were normal while clinical signs of HIE were present in 85%, with (n = 180; 30%) in stage I, (n = 210; 35%) in Stage II and (n = 120; 20%) in stage III of HIE. Outcome was measured after 72 hours, around 53.3% (320) were normal, 31.6% (190) developed neurological disability, while 15% (90) babies expired. Outcome was better in Liaquat University of Medical Health Sciences (LUMHS) born than out-born with statistically significant difference in terms of disability (Chi-square test P-value < 0.0001) but no difference was noted in terms of disability to death. There was a statistically improved outcome for babies received within 6 hours than those after 6 hours of birth (Chi-square test P-value < 0.0255). CONCLUSION: Early recognition of birth asphyxia and timely referral to tertiary center can reduce morbidity and mortality.

Assessment of infant feeding practices at a tertiary care hospital.

OBJECTIVE: To assess the practice and knowledge of mothers regarding breast feeding, complimentary feeding, and to find out socio-economic correlates of feeding practices. METHODS: A cross sectional survey conducted at paediatric department of Liaquat University Hospital (LUH) from Jan-Dec 2008. During that period 500 mothers with children less than 24 months were included. Infant feeding patterns were assessed in relation to recommendations and household socio-economic factors by an Interview Technique. RESULTS: Out of 500 mothers, 8.4% started exclusive breast feeding (EBF) while Pre-lacteal use was seen in 31.6%. Regarding the duration 52.2% mothers continued breast feeding for 2 years. Median duration of EBF was 3.5 months. It was seen that 60% of the 0-5 month-old infants breastfed 8 or more times per day. However, exclusiveness of breast feeding decreased from 60% at (0-2 months) to 40% (3-5 months). Majority 64.2% were poor and 61.5% had no education. There is a statistically significant difference in feeding practices of educated and uneducated (P < 0.0001) and also in poor and middle class mothers (P < 0.0003). Regarding, age of their last born babies, 180 babies were under 6 months, and 320 were 6 to 23 months of age. The knowledge about complimentary feeding (CF) was inadequate. Around 21% of 2-3 months old babies received complementary food and 19% of 6-8 month-olds were only breastfed. In 78% mothers CF was advised by family members while in 23% mothers by doctors. CONCLUSION: Exclusive breastfeeding was not maintained upto recommended age of 6 months. Knowledge about CF was lacking in the mothers. Regarding, mothers' education and socioeconomic conditions, a positive correlation was noted with feeding practices.

Etiological spectrum of pancytopenia based on bone marrow examination in children.

OBJECTIVE: To determine the spectrum of pancytopenia with its frequency, common clinical presentation and etiology on the basis of bone marrow examination in children from 2 months to 15 years. DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Paediatrics, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, from October 2005 to March 2007. PATIENTS AND METHODS: All patients aged 2 months to 15 years having pancytopenia were included. Patients beyond this age limits, already diagnosed cases of aplastic anemia and leukemia, clinical suspicion of genetic or constitutional pancytopenia, history of blood transfusion in recent past, and those not willing for either admission or bone marrow examination were excluded. History, physical and systemic examination and hematological parameters at presentation were recorded. Hematological profile included hemoglobin, total and differential leucocyte count, platelet count, reticulocyte count, peripheral smear and bone marrow aspiration/biopsy. RESULTS: During the study period, out of the 7000 admissions in paediatric ward, 250 patients had pancytopenia on their peripheral blood smear (3.57%). Out of those, 230 patients were finally studied. Cause of pancytopenia was identified in 220 cases on the basis of bone marrow and other supportive investigations, while 10 cases remained undiagnosed. Most common was aplastic anemia (23.9%), megaloblastic anemia (13.04%), leukemia (13.05%), enteric fever (10.8%), malaria (8.69%) and sepsis (8.69%). Common clinical presentations were pallor, fever, petechial hemorrhages, visceromegaly and bleeding from nose and gastrointestinal tract. CONCLUSION: Pancytopenia is a common occurrence in paediatric patients. Though acute leukemia and bone marrow failure were the usual causes of pancytopenia, infections and megaloblastic anemia are easily treatable and reversible.

Spectrum and immediate outcome of seizures in neonates.

OBJECTIVE: To determine the frequency, etiology, the clinical types, and outcome of seizures in neonates during the course of stay in the neonatal unit. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION: Pediatric Department, LMCH, from February 2000 to April 2001. PATIENTS AND METHODS: All neonates (1-28 days) presented with seizures during that period were included in the study. Their detailed history, physical examination, and appropriate investigations were recorded on a study proforma. RESULTS: Out of a total 680 patients, 100 patients presented with the seizures; this comprises the frequency of 14.7%. Male to female ratio was 2.1:1. Regarding gestational age, 65% were full-term, 31% were pre-term, and 4% were post-term. Regarding etiology, 40% patients had birth asphyxia; 14% had hypoglycemia; 12% were due to hypocalcaemia, 5% were due to intracranial hemorrhage (ICH), 4% had malformation, 10 % had infection /neonatal sepsis, and in 12%, the etiology was kernicterus. Among the patients with seizures, 45% were completely recovered and discharged and 15% patients had neurological deficit at the time of discharge. From the hospitalized 100 patients, 22% expired. The critical factors for the outcome were etiology, gestational age, birth weight, APGAR score, and clinical characteristics. Generally, birth asphyxia had poor, while metabolic causes had good prognosis. CONCLUSION: Frequency of seizures was higher in full term (65%) neonates than pre-term (31%). Among the etiological factors birth asphyxia was found to be the most common cause, and showed unfavorable outcome in this series. Common risk factors were low birth weight, pre-maturity, home delivery, pregnancy-induced hypertension and premature rupture of membranes.

Spectrum of heart disease in children under 5 years of age at Liaquat University Hospital, Hyderabad, Pakistan.

OBJECTIVE & METHODOLOGY: This was a descriptive cross sectional study of one year duration conducted in Pediatric department of Liaquat University Hospital, Hyderabad. The objective was to assess the clinical pattern, age distribution and type of heart diseases in children under 5 years of age. In this study 150 children with suspicion of cardiac problem were enrolled. RESULT: Among 150 cardiac patients 55.3% were male and 44.7% were female. Congenital heart diseases (CHD) seen in 89.3% and 10.7% had acquired heart disease. Among CHD 74.6% were Acyanotic lesions while cyanotic lesions were seen in 23.9% and 1.5% were cases of dextrocardia. Ventricular septal defect was the commonest Acyanotic lesion (29.9%) followed by atrial septal defect (25.4%). Among cyanotic heart diseases tetralogy of Fallot was the commonest lesion seen in 11.2% followed by transposition of great arteries and complex heart defect 5.2% and 3% respectively. Among acquired heart disease myocarditis was the commonest disease accounts 94% and pericardial effusion was seen in 6%. CONCLUSION: Regarding the type of congenital heart defect acyanotic defect was more common than cyanotic with ventricular septal defect commonest lesion. Tetralogy of Fallot's was commonest in cyanotic group. Availability of expertise locally will lead to more patients getting surgical treatment at an earlier age thereby reducing morbidity and mortality and improving quality of life for these children.

Severe acute maternal morbidity (SAMM) in postpartum period requiring tertiary Hospital care.

BACKGROUND: Postpartum period is the critically important part of obstetric care but most neglected period for majority of Pakistani women. Only life threatening complications compel them to seek for tertiary hospital care. We describe the nature of these obstetric morbidities in order to help policymakers in improving prevailing situation. OBJECTIVE: To find out the frequency and causes of severe post-partum maternal morbidity requiring tertiary hospital care and to identify the demographic and obstetrical risk factors and adverse fetal outcome in women suffering from obstetric morbidities. MATERIALS AND METHODS: This prospective cross-sectional study was carried out in the Department of Gynecology and Obstetrics, Liaquat University Hospital Hyderabad, between April 2008-July 2009. The subjects comprised of all those women who required admission and treatment for various obstetrical reasons during their postpartum period. Women admitted for non-obstetrical reasons were excluded. A structured proforma was used to collect data including demographics, clinical diagnosis, obstetrical history and feto-maternal outcome of index pregnancy, which was then entered and analyzed with SPSS version 11. RESULTS: The frequency of severe postpartum maternal morbidity requiring tertiary hospital care was 4% (125/3292 obstetrical admissions). The majority of them were young, illiterate, multiparous and half of them were referred from rural areas. Nearly two third of the study population had antenatal visits from health care providers and delivered vaginally at hospital facility by skilled birth attendants. The most common conditions responsible for life threatening complications were postpartum hemorrhage (PPH) (50%), preeclampsia and eclampsia (30%) and puerperal pyrexia 14%. Anemia was associated problem in 100% of cases. Perinatal death rate was 27.2% (34) and maternal mortality rate was 4.8%. CONCLUSION: PPH, Preeclampsia, sepsis and anemia were important causes of maternal ill health in our population. Perinatal mortality was high.