Diagnosis and outcome of birth asphyxia in resource constrained health care set up

Objective: To determine morbidity and mortality of neonates with low APGAR score in a resource constrained health care set up

Study Design: Prospective descriptive study

Place and Duration of Study: The study was carried out in combined military hospital Attock, from Jan 2013 to Jan 2015

Material and Methods: All term neonates with 37 completed weeks of gestation and APGAR score less than 7 were included in the study. APGAR score was calculated by an attending pediatrician, gynecologist or trained female nurse at 0 and 5 minutes. In Neonatal Intensive Care Unit [NICU] the babies were daily examined by pediatrician. Outcome was documented in term of morbidity i.e. fits and mortality i.e. death of babies

Results: Total number of neonates included in the study were 85 of which 55 [65%] were males and 30 [35%] were females. Of the total neonates 65 [76%] were discharged in satisfactory conditions and 20 [24%] expired during stay in the hospital. The mean APGAR score of newborns was 4.98 +/- 0.98 at 5 minutes. During stay in hospital 46 [54%] were diagnosed to have hypoxic ischemic encephalopathy 2 [HIE2], those diagnosed with HIE3 were 5 [6%] and the rest 14 [16%] with HIE1

Conclusion: Low APGAR score is an important cause of admission to NICU. Low APGAR score was found associated with increased risk of fits in neonates and one of the most important cause of mortality in our set up

Rates of caesarean section and trials and success of vaginal birth after caesarean sections in secondary care hospital

We planned to investigate the rates of Caesarean Section [CS], potential Vaginal Births After previous Caesarean Section [VBAC], and successful VBAC in a secondary care hospital. We conducted an analytical retrospective study at Aga Khan Hospital for Women, Karimabad, Karachi, from October 2011 to September 2012. Data related to total deliveries, Lower Segment CS [LSCS], attempted VBAC and successful VBAC was retrieved from medical records. Total number of deliveries were 3266. Of these, 1021[31.26%] deliveries were conducted by CS. A total of 365[11.1%] had a previous history of one CS and VBAC trial was given to 33[9%] of these pregnancies. The success rate of VBAC was 21[63.6%]. Our results highlight that despite having limited resources, our rates of CS, VBAC trials and successful VBACs were within reasonable limits when compared with international rates

Use of corticosteroids in the management of idiopathic pulmonary haemosiderosis: do we have enough evidence

Idiopathic Pulmonary Haemosiderosis [IPH] is a rare disease commonly affecting the paediatric population with approximately 500 globally reported cases in the literature. The disease usually presentswith a symptom triad consisting of ferropenic anaemia, cough with haemoptysis and diffuse bilateral alveolar infiltrates. Therapeutic options for this disorder are not only limited but also not fully effective. Moreover, corticosteroids remain the mainstay of IPH treatment. This communication reviews the available evidence in support of corticosteriod usage in the treatment of IPH. We conclude that the use of corticosteroid in IPH treatment is unfathomed and demands further investigation

Current efficacy of antibiotics against Klebsiella isolates from urine samples - A multi-centric experience in Karachi

Due to emergence of bacterial resistant strains, the effectiveness of current antibiotic treatment without culture/sensitivity testing is questionable. Our study aims to assess the present sensitivity profiles of Klebsiella isolates from urine samples and provide options for empiric prescription in critically ill patients. Klebsiella pneumoniae isolates collected over a period of 28 months till January 2011 from 1, 617 urine samples of subjects presenting with Urinary Tract Infections were identified at a local diagnostic lab using standard protocol and subjected to Kirby-Bauer disk diffusion sensitivity testing. MICs were also estimated by E-nephelometry. Among 20 drugs used, low sensitivity was found to amoxicillin [0.1%], doxycycline [11.5%], nitrofurantoin [15.5%], amoxiclav [18.2%], gentamicin [35.4%], pipemidic acid, cephradine [40.3%] and cotrimoxazole [43.1%]. The isolates were more sensitive to cefuroxime [55.9%], cefixime [57.7%], ciprofloxacin [62.5%], ofloxacin [63%], ceftriaxone [66.2%], ceftazidime [66.4%], cefotaxime [66.6%], fosfomycin [77.5%] and amikacin [89.4]. Most effective were cefroperazone.sulbactam [95.8%], piperacillin.tazobactam [95.7%] and imipenem [97.7%]. Self-medication, lack of awareness, and the misuse of antibiotics by doctors has exacerbated the menace of microbial resistance. The study warrants the prudent choice of drugs in adherence with prevailing sensitivity profiles

Meckel gruber syndrome: second trimester diagnosis of a case in a non-consanguineous marriage

Meckel-Gruber Syndrome [MKS] is a rare, autosomal recessive genetic disorder, incompatible with life. It is characterized by enlarged polycystic kidneys and post axial polydactyly. Foetal or neonatal death is caused by pulmonary hypoplasia. We report a case of a 35 year old woman who presented at 7 weeks of gestation of her sixth pregnancy. A transabdominal anomaly ultrasound performed for her current pregnancy at 18 weeks of gestation showed features consistent with MKS. The termination of pregnancy was declined and a live newborn female was delivered via an emergency caeserean section at 34 weeks of gestation due to previous history of lower segment caesarean section [LSCS] and leaking. Physical examination of the neonate confirmed the features of MKS. The neonate died within 4-5 hours of birth. This case represented a second trimester diagnosis of a recurrent case of MKS in a non-consanguineous marriage

Gastroschisis

We report a case of gastroschisis which was not diagnosed antenatally and was delivered through lower segment caesarean section due to non-reassuring cardiotocograph and small for gestational age fetus in a 21-year old mother. It was associated with oligohydramnios and partial extension of wrist joint in the neonate. After delivery, baby was referred to tertiary care for specialized care by paediatric surgeon and neonatologist where he had silo reduction and surgical repair. Postnatally, the baby is in healthy condition till now

Frequency of HBsAg positivity: a laboratory data analysis

The objective of the study was to evaluate the current frequency ratio of HBsAg seropositivity in a laboratory-based setting. It was a retrospective study, conducted during September 2009 and November 2010 at Dr. Essa's Diagnostic Laboratory and its branches in Karachi, Pakistan. Blood samples of 8,648 individuals were screened for HBsAg using the BioRad EVOLIS EIA method. Pertinent questionnaires filled in by 50 practicing physicians were also evaluated. The 551 subjects [6.4%] that tested positive for HBsAg included 360 males [65.3%] and 191 females [34.6%]. The highest frequency of HBsAg was noted in those aged 16-29 years [43.9%]. HBsAg rate in the studied population has steadily increased and is more common in the sexually active age group, with males tending to be more often seropositive than females