Objectives: Hemoglobin & red blood cell indices (mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, red cell distribution width) among adolescent. Study Design: Cross-Sectional study (Descriptive). Setting: Department of Physiology, Baqai Medical University (BMU) Karachi. Period: 6 months from February to August 2017. Material & Methods: A total of 500 students of MBBS, BDS, DPT with having age ranges from 18-25 years were enrolled in this study. The anthropometric measurement [height (m2) and weight (kg)] was recorded for calculation of the Body Mass Index and Complete blood count i-e Hemoglobin (Hb%), Mean Corpuscular Volume (MCV), Mean corpuscular hemoglobin (MCH), Mean corpuscular hemoglobin concentration (MCHC), Red cell distribution width (RDW) was done and calculated. Data analysis was done on Microsoft excel & SPSS version 22.0 was used. Results: It was seen that the comparison of Hb%, MCV & RDW had no significant (p>0.001) association of study participants to different categories of Body Mass Index. Mean corpuscular hemoglobin (MCH) (X²=28.278, p<0.001) and Mean corpuscular hemoglobin concentration (MCHC) (X²=15.659, p=0.016) were statistically significantly association with different categories of Body Mass Index. Conclusion: Mean corpuscular hemoglobin and Mean corpuscular hemoglobin concentration had statistically significant (p<0.001) association with body mass index (BMI).
Background and purpose: Data on the epidemiology of acute kidney injury (ARI) in Asia come primarily from studies conducted in large tertiary hospitals with nephrology departments. Little is known about what happens in primary care settings without nephrology, especially in the paediatric population. The aim of this study is to describe the epidemiology, outcome and risk factors of ARF in children admitted in pediatric department. Place and Duration: In the Pediatric Medicine and Nephrology department of Abbasi Shaheed Hospital for one-year duration from August 2020 to August 2021. Methods: We prospectively examined children aged 2 to 14 whose guardians gave the consent for the study and were admitted in the Pediatric ward. We identified children with risk factors for AKI on admission and then tested them for AKI using the 2012 Creatinine-based Modified General Kidney Disease Improvement (KDIGO) criteria to improve overall outcomes. Participants with AKI were followed up to discharge. The subject of interest was the need and access to dialysis and renal recovery on discharge from the hospital. Results: A total of 74.3% (n = 116) out of the 156 patients admitted during the study period were at risk of ARF. Of the 156 registered participants, 51.9% (n = 81) were males with a mean age of 5 years. Although comorbid conditions were rare, sickle cell anaemia and malnutrition were the most common. Most of the children were hypotensive (n = 89; 57.1%), with mean systolic and diastolic blood pressures of 81 mmHg and 42 mmHg, respectively. The mean urine output was 0.79 ml / kg / hr. Thirteen patients (8.33%) had urine dipstick anomalies. Anaemia was common (n = 72, 46.2%) and 32 (20.5%) had severe anaemia. Leucocytosis was detected in 26.3% of patients, and a platelet count below 100,000 / mm3 in 24 (15.4%) patients. In total, 21 of 156 participants had AKI for an incidence of 13.5%. The only patient with an indication for dialysis (uremic encephalopathy and anuria> 24 hours) died without dialysis due to a delay in transfer to a dialysis centre (due to lack of resources). Of the 20 survivors in the AKI group, 15 (71.4%) had complete improvement in kidney function The median hospitalization time was significantly longer in participants with stage 3 AKI. Conclusions: ARF risk factors are very common in children admitted in the hospitals. At least one in 10 children presenting with AKI risk factors will have AKI. AKI is largely caused by community-acquired diseases that can be prevented, such as diarrheal diseases and malaria. Efforts should be made to educate about risk assessment, prevention, early diagnosis and treatment of AKI in children. Keywords: AKI; epidemiology; risk factors and outcome.
Background: Assisted ventilation has turn out to be an essential part of the neonatal intensive care unit (NICU). It is one of the main methods of support in the ICU and undoubtedly influences the survival of sick newborns. Aims: 1. To investigate common indications for mechanical ventilation in newborns 2. To investigate factors influencing the outcome. Method: It is a descriptive study of 60 infants admitted to the Department of Pediatric Medicine in the ICU over a one-year period in the department of Paediatrics, Abbasi Shaheed Hospital. The information was gathered and analysed in a pre-designed format. Results: Of a total of 60 infants, 46 survived, 14 died, and one infant was discharged despite medical advice. 36 children were born vaginally, 20 were born via LSCS, and 4 via assisted delivery. Postnatal asphyxia was the most common ventilation indication in full-term newborns, while HMD was present in preterm infants. The best results were obtained in ventilated infants with MAS, with 100% survival, followed by apnoea in premature infants, perinatal asphyxia, and HMD. Pulmonary haemorrhage (48.3%) was the most common complication among deceased infants, followed by sepsis (28.3%) and shock (23.4%) with a significant p <0.05. There were no complications in 76.7% of the surviving infants. Conclusions: Among the many widely available variables studied in this study, maximum and mean peak inspiratory pressure (PIP or (PEEP), maximum respiratory rate, maximum mean airway pressure (MAP) and average ventilation demand was much greater among non-survivals in comparison to the survivors. Bicarbonate, PH and excess base have been found to be important determinants of mortality in ventilated newborns. Keywords: Indications, mechanical ventilation and Results
Ventilator Associated Pneumonia (VAP) is defined as pneumonia that occurs 48 hours or more after endotracheal intubation or tracheostomy, caused by infectious agents not present or incubating at the time mechanical ventilation started. While critically ill patients experience a life-threatening illness, they commonly contract ventilator-associated pneumonia. This nosocomial infection increases morbidity and likely mortality as well as the cost of health care. This study aims to find out the bacterial profile of VAP in geriatric patients and the antibiotic susceptibility pattern of the isolated pathogen including detection of MRSA, ESBLs and MBLs. This study was conducted in the Department of Microbiology at ESIC MC and PGIMSR, Rajajinagar, Bengaluru from January 2017 to June 2018. A total of 38 isolates from 35 VAP patients were collected during the study. They were processed following standard laboratory protocol. Antibiogram was done using appropriate antibiotics by Kirby-Bauer disc diffusion method and the occurrence of MRSA, ESBLs and MBLs was seen. Males were most common male to female ratio of 2:1.Acinetobacter spp. (45.5%) was most common organism isolated followed by Pseudomonas aeruginosa (24.2%), Klebsiella pneumoniae (21.2%), Staphylococcus aureus (15.2%) and Escherichia coli (9%). Enterobacteriaceae isolated were found to be highly sensitive to Amikacin (30%) followed by Gentamicin (20%) and Piperacillin-tazobactam (10%) and Highest resistance (100%) was seen with Cefotaxime, Cefoperazone, Cotrimaxazole, Piperacillin and Amoxiclav. Non-fermenters showed highest sensitivity to Cefperazone-sulbactum (73.9%), followed by Amikacin (60.9%) and Meropenem (52.2%), Highest resistance was seen with Cefotaxime (86.9%) followed by Cefperazone (78.3%) and Ceftazidime (73.9%). Overall MDR among Gram negative isolates were 31.6% and common mechanism of resistance was found to be Carbapenamase (57.6%), followed by AmpC (18.2%), and ESBL (3.03%). Among Carbapenamase Metallo-betalactamase production was seen in 18.2% of isolates. MRSA was detected to be 40% and were sensitive to Linezolid, Tetracycline and Teicoplanin. Diabetes mellitus (54.3%) was most common risk factor, followed by smoking (51.4%), and alcohol (45.7%). 88% of patients had leucocytosis with mean total leucocytosis count (TLC) of 17,348 cells/mm3 and 17% of patients were anaemic with mean Hb of 10.02g/dl and 45.7% of patients had pneumonic changes (consolidation) and 51.4% of patients had BL/UL alveolar or interstitial infiltration. Periodic analysis of Sputum culture and their antibiotic sensitivity report should be made to identify the changing trends in etiological and sensitivity patterns.
Background: Magnesium deficiency is common in serious diseases and is often associated with mechanical ventilation, mortality, and long-term intensive care. Awareness of hypomagnesaemia is essential because little data is available and may have prognostic and therapeutic implications. Aim: This study was conducted to calculate the incidence of hypomagnesaemia at PICU admission and to relate it to length of PICU stay, duration of mechanical ventilation, and outcome of hospital stay or discharge. Place and Duration: In the Pediatric Intensive Care Unit (PICU), Abbasi Shaheed Hospital, Karachi for one-year duration from April 2020 to April 2021. Methods: This is a prospective observational study involving 200 children aged 1 month to 12 years admitted to the PICU. All qualified children underwent an interview and clinical examination. Blood was collected during admission to calculate serum magnesium level. The patients were grouped into three groups: normomagnesemia, hypomagnesaemia and hypermagnesemia, and the data were analyzed. Results: 200 children were included in the inclusion study. Males constituted 57.0%and females 43.0%. The ratio of men to women was 1.2: 1. Most of the respondents were 5 years old. Most of the respondents were in the ICU with neurological symptoms (36.5%), followed by respiratory diseases (27%). Of the 200 patients, 138 (69%) had a mean magnesium level of 1.9 mg / dL. 51(25.5%) patients had hypomagnesaemia. The average magnesium level was 1.3 mg / dL. 11 (5.5%) patients had hypermagnesemia with a mean magnesium content of 2.7 mg / dl. The lowest measured magnesium level was 1 mg / dl and the highest was 4.2 mg / dl. There was no statistically significant association between hypomagnesaemia and gender, age, disease acceptance category, and sepsis. ≤ 27.4% of children under 5 years of age had severe acute malnutrition in the hypomagnesaemia group. Among those with normal magnesium levels, 24% had severe acute malnutrition and 27.3% had severe acute malnutrition among those with hypermagnesemia. In the study, overall mortality was 25% (50 out of 200). Mortality among people with hypomagnesaemia was 29.40%. Among those with normal magnesium levels, 21.2% died and 18.2% in the hypermagnesemia group. Conclusion: Patients with hypomagnesaemia have prolonged PICU stay, other related electrolyte disturbances and increased mortality. Therefore, in severe ill patients, magnesium levels are monitored. Keywords: Children, Hypomagnesaemia, Intensive Care Unit, Mortality, Outcome, ICU
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