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Objectives: In resource limited countries facing a huge burden of multidrug resistant and extensively drug resistant (XDR) enteric fever, treatment is a great challenge on the part of a patient as well as a health care professional. This study was conducted to determine the association of XDR enteric fever with various studied factors among hospitalized culture-positive pediatric patients in a tertiary care hospital setup. Methods: We conducted a descriptive observational study at The Karachi Adventist Hospital from July 01, 2019, to March 31, 2020 on 143 hospitalized children with culture proven enteric fever who were already on empirical antibiotics. Depending on the variability of the course of illness and clinical responses to given antibiotics, the data was gathered on a structured data sheet. Association of various study parameters and their significance in relation to XDR salmonella infection was analyzed and studied. Results: The age group highly affected was 5-7.5 years, with a male preponderance of 61.5%. Majority were from urban slums areas of Karachi (53.8%) and 52% were admitted between 7 to 14 days of fever onset. XDR salmonella infection was observed in 79% of blood culture isolates. None of the XDR patients were consuming boiled water and neither of these infected children were vaccinated against salmonella typhi. Duration of fever before hospitalization, non-consumption of boiled or mineral water, ciprofloxacin use and lack of typhoid vaccination showed statistically strong association with XDR enteric fever (p<0.01). Conclusion: Prehospitalization fever duration, use of boiled/mineral water, ciprofloxacin use and typhoid vaccine status showed strong association with XDR salmonella infection. Prioritizing the focus on healthcare awareness, early access to proper health care facility, discouraging over-the-counter drugs and enforcement of immunization will help decline the dissemination of this dreadful disease.
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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.
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Background:The objective of the study was to determine the pattern of disparities among paediatric hospital admissions according to gender.Methods:This retrospective observational study was done at pediatric ward of Al-Tibri Medical College and Hospital Karachi from June 2018 to May 2019. Pediatric patients below 12 years of age admitted to the pediatric ward of the hospital were included while patients who were admitted for less than 24 hours, refused for consent by parent/guardian, surgical or ICU pediatric patients were excluded. SPSS was used for data analysis. Quantitative data included age, gender, diagnosis and seasonal variation, expressed as frequency in percentages and chi-square test was applied to test for significance.Results:Among 734 pediatric hospital admissions, 423 (58%) were males and 311 (42%) females. Highest percentages of pediatric admission in both genders were infants afterwhich second most patients were from the 1-4 years group in both genders (p=0.01). 215 patients of acute gastroenteritis were male while 142 females. Among patients admitted with respiratory disease, 56 were males while 48 were females. 52 male patients were admitted with viral fever while 34 patients admitted were females (p=0.01).Conclusions:Our study reported a significant difference among gender variances in pediatric hospital admissions. Overall, not only males were predominant in admission to pediatric wards, they were also found to be predominant in disease categorization. Further studies set to determine the reasons behind such gender differences would help in determining plans accordingly to improve outcome of diseases
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Background: Breast milk is an ideal feed for infants, and it is effective in ensuring child health and survival. The study was done to assess the perception regarding breastfeeding among medical students of basic and clinical sciences and to compare knowledge regarding feeding among basic sciences with clinical sciences students.Methods: This cross-sectional survey was done at Al-Tibri Medical College and Hospital over a period of 6 months from February 2019 till July 2109. A self-generated Questionnaire was used to assess the perception of 367 medical students regarding breast feeding from basic and clinical sciences of medical students. Result was statistically analyzed using SPSS version 22. Chi-square test was used to compare qualitative data, p-value <0.05 was considered significant.Results: A total of 367 students participated in the study with 159(43.3%) from basic medical sciences and 208(56.7%) from clinical sciences. Out of respondents, 54.5% were females. Internet was the main source of knowledge (47.3%) as shown in the graph, 74.1% were native. Generally, the majority of students from clinical group had a better perception regarding breastfeeding initiation and continuation along with infant and maternal benefit. Clinical science group had an edge on the basic science group with reference to their perception of breastfeeding in special circumstances.Conclusions: Medical universities are the main platform for future physicians, so knowledge regarding breast feeding promotion and practices should be given from this stage.
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Background: In pediatrics, the season is one of the elements contributing to the etiological factors of community based diseases. Awareness of this variation can help the physicians for prevention and counseling of the patients. A cross-sectional observational study was designed with non-probability convenient sampling technique to determine the frequency of patients admitted to the paediatric ward of the hospital in a whole calendar year and to ascertain which disease presentation is most common. Methods: Study conducted at paediatric ward of Al-Tibri Medical College and Hospital Karachi, Pakistan having patients admitted during May 2018 to April 2019. After ethical approval and informed consent from their parents/ guardian, a total of 734 paediatric patients that were admitted from paediatric OPD/ emergency were selected for the study. Paediatric patients that were referred, in emergency/ ICU and surgical paediatric patients were excluded from the study. Chi-square test was applied to evaluate the statistical variation among the patients.Results: From the 734 patients, 357 (48.6%) patients were of acute gastroenteritis, 104 (14.2%) of respiratory illness, 86 (11.7%) of viral fever, 67 (9.1%) of urinary tract infection, 36 (4.9%) of neurological illness, 29 (4.0%) of protein calorie malnutrition, 25 (3.4%) of enteric fever, 20 (2.7%) of haematological illness and 10 (1.4%) patients were admitted due to sepsis.Conclusion: Our study concluded that majority of the patients admitted were of acute gastroenteritis / admitted due to gastric issues, therefore further studies in the vicinity would help to better understand the issues and help plan a strategy to combat the diseases.