Brain Abscess in children

To find out the clinical presentation, radiological characteristics, various underlying predisposing conditions and causative organisms of brain abscess in children in our setup. Descriptive study. The Children's Hospital and the Institute of Child Health, Lahore, over two years from September 2001 to August 2003. All children [<16 years] presenting with brain abscess were included to study demographic, clinical and radiological features. In addition, attempts were made to find out underlying predisposing conditions and causative organisms. Twenty-five children with brain abscess were managed over 2 years. The mean age was 7.8 years [range 9 months to 16 years]. Male to female ratio was 2.1:1. Most patients [43%] presented with 4 weeks history of illness, with mean duration of illness at presentation of 29.3 days. Main presenting complaints were fever [72%], vomiting [48%], headache [44%] and convulsions [32%]. Five patients [20%] had papilledema at presentation, another 4 [16%] had paresis/paralysis and 3 [12%] had cranial nerve palsies. Majority [64%] had solitary abscess, located in parietal, temporal, frontal and occipital lobes in order of frequency. No underlying predisposing condition was identified in 8 [32%] cases; while 8 [32%] had cyanotic congenital heart disease, 5 [20%] patients had otic infection [mastoiditis], 2 [8%] were postoperative cases and one each developed brain abscess secondary to ventriculo-peritoneal [VP] shunt infection and pulmonary tuberculosis. Causative organisms were isolated in 40% cases, which included Staphylococcus aureus, Staphylococcus epidermidis, Streptococcal species, Klebsiella, E.coli and Proteus. Awareness of predisposing factors, early recognition of clinical features and understanding of the prevalent microbial profile is imperative for better management of children with brain abscess

etiology of neonatal sepsis and patterns of antibiotic esistance

To study the patterns of causative bacteria and antibiotic resistance in neonatal sepsis. Design: Descriptive study. Place and Duration of Study: Department of Neonatology, The Children's Hospital and the Institute of Child Health, Lahore from July 2000 to December 2000. Subjects and Two hundred and twenty-eight neonates [age 0-28 days] with clinical sepsis and positive blood cultures were selected. Blood cultures were taken before antibiotics [intravenous cefotaxime and amikacin] administration. The clinical and birth records were thoroughly analyzed. Blood culture reports [n=233] were analyzed for bacterial isolates and pattern of resistance to cefotaxime, ceftazidime, amikacin and ciprofloxacin were compared as percentage of reports showing resistance to the above antibiotics. Among 228 cases included in the study, the male to female ratio was 2.1 to 1. The gestational age was less than 36 weeks in 68 [30%] cases and low birth weight babies were 143 [62.6%]. History of birth asphyxia was present in 103 [45%] cases. There were 142 [62.3%] cases of early onset [< 7 days] sepsis and 86 [37.7%] cases of late onset [>7 days]. Out of 233 positive blood cultures Escherichia coli was found to be commonest [47.8%, n=111, p <0.05] both in early onset [47.8%, n=68, p <0.05] and late onset sepsis [47.3%, n=43, p<0.05]. Staphylococcus aureus was the most common among gram positive organism. Resistance to cefotaxime, ceftazidime and amikacin was 34% to 80% and to ciprofloxacin 13% to 72%. A total of 64 cases [28%] died. Mortality was four times higher in early onset sepsis [n=53 vs 11, 47% vs 12%]. Gram negative bacteria are the commonest cause of neonatal sepsis. The resistance to the commonly used antibiotics is alarmingly high. Mortality is four times higher in early onset sepsis

Haematological screening in diagnosis of neonatal sepsis

Neonatal sepsis is a clinical syndrome haracterized by bacteremia and clinical symptoms caused micro-organisms or their toxic products Diagnosis is confirmed by growth of micro-organisms in body fluid cultures. When available, blood culture positivity is approximately 40% and takes as long as 48-72 hours. In order to determine the predictive value of simple to performs hematological tests for neonatal sepsis, a prospective randomized study was carried out in 100 neonates who had strong clinical suspicion of sepsis. Thirty normal neonates served as controls Role of TLC, DLC, Absolute Neutrophil Count ANC, I:T ratio, platelet counts and degenerative morphological changes was determined. Out of 100 clinically suspected cases, 40 neonates were proved to be septic by blood culture and 60 neonates were of probable sepsis [strong clinical suspicion despite negative culture]. An abnormal ANC was found to be the most sensitive [67%], single parameter for prediction of neonatal sepsis followed by elevated LT ratio and thrombocytopenia Derangement of either ANC or I:T ratio had sensitivity of 80% higher sensitivity was found in cases of late onset sepsis. Combination of abnormal ANC and elevated I:T ratio scents reasonable as a surrogate parameter for neonatal sepsis especially in the late onset type

Common neurologic disorders seen in child neurology clinic in a teaching hospital in Pakistan

Resource utilization especially in underdeveloped countries require information regarding the nature of chronic diseases and their prevalence. This impacts utilization of available resources. Our initial experience in starting referral based child neurology clinic in a tertiary teaching postgraduate hospital is summarized. Case load for a period of two years from January 1994 to December 1995 were analyzed. Total outpatients paediatrics visits were 30, 126 in the same period out of which paediatric consultations were 19, 315. Total visits over the two years were 964 out of which 638 were in 1994 and 326 in 1995. There were 588 male patients and 376 female patients. Total number of new patients in the neurology clinic over this period were 356 in 1994 and 137 in 1995 thus suggesting repeat visits for chronic problems in some patients. Six main complaints identified were seizures [n=416] cerebral palsy [n=106] mental retardation [n=47] postencephalitic brain damage [n=54] degenerative brain diseases [n=27] and muscular dystrophy [n=32]. Seizures resulted in new patients visits of 156 [97 in 1994 and 59 in 1995]. Total visits of patients with seizures were 416 [254 in 1994 and 171 in 1995]. Thus patients with seizures remained a major patients load approximately 43% of the new patient load and also 32% of the repeat visits. Keeping this into account this study suggested further resource mobilization of outpatient department to provide further facilities for patients with seizures for monitoring and diagnostic services. It also necessitates improvement in social services, education liaison services and providing education and support to families of these patients

Comparison of conventional bacteriological methods with latex agglutination technique for the diagnosis of pyogenic meningitis in children

A total of 41 cases of pyogenic meningitis were studied to compare the Gram-staining method with latex agglutination technique by taking the culture as a "Gold standard test. Gram-staining was positive in 26 [63.41%], culture in 19 [46.34%] and latex agglutination in 27 [65.85%] cases. The commonest aetiological agent was Streptococcus pneumoniae, identified from 15 [36.5%] cases. In 3 [7.5%] cases, no aetiological agent was identified. Forty six percent of the patients had received antibiotic therapy before their admission. The comparison was done for sensitivity, specificity and efficiency of the tests. The sensitivity, specificity and efficiency of Gram-staining was 84.2, 54.5 and 68.2 percent, and latex agglutination was 100, 13.6, 36.6 percent, respectively

Pyogenic meningitis in children

I order to identify aetiological agents of pyogenic meningitis in children, admitted to the Department of Paediatrics, Shaikh Zayed Hospital, Lahore, a prospective study from October 93 to March 94 in 1609 cases was carried out. Of these, 26 [1.6%] were diagnosed as pyogenic meningitis. The causative micro-organisms were identified by Gram smear or culture in 16 of 26 [61.5%] children. Those identified were Streptococcus pneumonia [5=31], Staphylococcus aureus [4=25%], Neisseria meningitides [2=12%], Escherichia coli [1=6%] and others [4=26%] In 10 of the 26 [38%] children, causative pathogens could not be identified, although the clinical rataon, signs and cerebrospinal fluid findings were compatible with the diagnosis of pyogenic meningitis. mr R2 percent of the patients had a history of antibiotic treatment prior to the admission in the hospital

Screening for inherited metabolic disorders at Shaikh Zayed hospital

Intermarriages within the families are prevalent in the Pakistani society which may cause spread of genetic disorders. To assess the magnitude of the problem a preliminary screening program was started. Out of the 116 screened, 54 [or 49.5%] were those whose relatives were affected. Family history was available in only 109 cases. Among them the parents of 64 were first, second or distant counsins

Haemolytic uraemic syndrome in children

Of the 4070 children admitted in the department of paediatrics, 830 [24%] presented with diarrhoea. Eleven of these had haemolytic ureamic syndrome [HUS] characterised by microangiopathic haemolytic anaemia, thrombocytopenia and acute renal failure. Only 3 had positive stool cultures [E.Coli 2, shigella dysenteriae 1]. Two children expired while the rest recovered with conservative management and peritoneal dialysis. Thus HUS should be remembered as a complication of diarrhoea and a cause of acute renal failure in children

case of meconium aspiration

A case of meconium aspiration is described. After an uneventful pregnancy a full term baby was delivered vaginally. Meconiurn staining was noted and the neonate developed respiratory distress prompting artificial ventilation with satisfactory outcome. The pathogenesis and management techniques have been discussed