RESUMEN
Background & Objective: Posterior Urethral Valves (PUV) are common cause of congenital obstructive uropathy in boys and may be associated with urinary tract infection(UTI) and chronic kidney disease(CKD) if not managed timely. The objective of our study was to determine the clinical profile of children with PUV. Methods: This is a descriptive case series comprising of 30 children aged 1-5 years, diagnosed and managed as PUV over six months, conducted at the Department of Pediatric Nephrology, National Institute of Child Health, Karachi. Patients were followed for 12 weeks and the outcome was assessed in terms of recovery, UTI, urinary incontinence and CKD. Descriptive statics were used for data analysis. Results: Thirty cases of PUV were managed during study period. Clinical presentations were poor urinary stream (83%), fever (73%), signs and symptom suggesting UTI (96.6%), pallor (73.3%), acute kidney injury (37%)and urinary retention (13%). UTI was confirmed in 73.3 % and E.Coli was the most common pathogen. Ultrasonography showed bilateral hydronephrosis/hydroureter in 80% and micturating cystourethrogram demonstrated vesicoureteral reflux in 86.66% cases. All patients received intravenous hydration (97%), urinary decompression, and antibiotics. Meropenem was the most commonly used. Packed cell transfusion and peritoneal dialysis was done in 73.33% and 13.3% respectively. Cystoscopic valve fulguration was done in 86.66% and vesicostomy in 13.3%. On short-term follow-up, 60% recovered,16.66% experienced UTI and remained incontinent whereas 23.33% had CKD. Conclusion: Our study showed a high frequency of UTI and AKI. E. coli was most common pathogen. Despite valve fulgration, significant patients had CKD.
RESUMEN
BACKGROUND: Acute kidney injury (AKI) is known to complicate one-third of cases in pediatric intensive care units (PICU), and almost one-fourth of these are due to nephrotoxic drugs (NTDs). Although stopping NTDs seems the most obvious option, it is not practically applicable. Many NTDs are the only existing option, and their potential benefits outweigh the risk of drug-induced AKI. OBJECTIVES: To assess the proportion of children receiving NTDs in the PICU and highlight the children who developed AKI. METHODS: A prospective observational study was conducted in the PICU of the National Institute of Child Health, Karachi. All children admitted to the PICU for at least 72 hours not diagnosed with any acute or chronic kidney disease were included. Serum creatinine (SCr) was done at admission and then after 72 hours. Data was entered and analyzed using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. RESULTS: Of 99 children, 53 (53.5%) were male. NTD exposure was positive in 97 (97.9%), and 72 (72.7%) had high exposure (≥3 NTDs). Drug-induced AKI was diagnosed in 46 (46.5%). It was significantly related to high SCr even at admission and high NTDs exposure. The mortality rate in the AKI group was 17% compared to 4% in the non-AKI (p=0.02). CONCLUSION: Almost half of all PICU admissions were infants. Almost all patients were exposed to NTDs, and three-fourth experienced high exposure. AKI developed in 46% of patients and may be predicted by raised creatinine at the time of admission. Children exposed to ≥3 NTDs had a higher chance of drug-induced AKI.
RESUMEN
Community-acquired pneumonia (CAP) is among the most commonly prevailing acute infections in children that may require hospitalization. Inconsistencies among suggested care and actual management practices are usually observed, which raises the need to assess local clinical practices. The current study was conducted to evaluate pediatricians' compliance with the standard clinical practice guidelines and their antibiotic-prescribing behavior for the management of CAP in children. Methods: A descriptive cross-sectional study was conducted using a self-administered questionnaire; which was provided to pediatricians by the researchers. Statistical analysis was performed with SPSS 25 Statistics; χ2 tests (or Fisher-exact tests) with the p-value set at < 0.05 as the threshold for statistical significance. Results: The overall response rate was 59.2%. Male respondents were (n = 101; 42.6%), and the respondents (n = 163; 68.7%) were under 30 years of age. Amoxicillin (n = 122; 51.5%) was considered as the most commonly used first-line treatment for non-severe pneumonia, whereas a smaller proportion (n = 81; 34.2%) of respondents selected amoxicillin-clavulanate. Likewise, amoxicillin (n = 100; 42.2%) was the most popular choice for non-severe pneumonia in hospitalized children; however, if children had used antibiotics earlier to admission, respondents showed an inclination to prescribe a macrolide (n = 95; 40.0%) or second-generation cephalosporin (n = 90; 37.9%). More than 90% responded that children <6 months old with suspected bacterial CAP will probably receive better therapeutic care by hospitalization. Restricting exposure to the antibiotic as much as possible (n = 71; 29.9%), improving antibiotic prescribing (n = 59; 24.8%), and using the appropriate dose of antimicrobials (n = 29; 12.2%) were considered the major factors by the respondents to reduce antimicrobials resistance. Conclusions: The selection of antibiotics and diagnostic approach was as per the recommendations, but indication, duration of treatment, and hospitalization still can be further improved.