Objectives: To determine the diagnostic accuracy of C-reactive protein in the diagnosis of neonatal sepsis keeping blood cultures as gold standard. Study Design: Descriptive cross-sectional study. Setting: Pediatric Unit of Lady Reading Hospital Peshawar Pakistan. Duration: Six months from 09-06-2012 to 08-12-2012. Methodology: Total of 196 patients meeting the required inclusion criteria with clinical suspicion of sepsis. Those neonates were subjected to investigations. C.R.P. was tested using the Quantitative method according to the instructions provided with the kit. By keeping blood culture as gold standard, patients with both positive and negative cultures were taken and the results compared to the results of C.R.P. in these subjects being positive or negative. Results: Among the 196, majority of the neonates included were less than a week old having a mean age of 4.5 days. There were 57 (29%) females and 139 (71%) males, with male to female ratio of 2.4:1. Blood cultures were positive in 85 (43%) and negative in 111 (57%) cases, while C.R.P. was positive in 95 (48%) and negative in 101 (52%) cases. Sensitivity, specificity, and positive and predictive values of C-reactive protein were calculated using formulas, and they turned out to be 77.6%, 73.8%, 69.4%, and 81.2% respectively with accuracy being 0.41%. Conclusion: An accurate and timely diagnosis of early onset neonatal sepsis remains challenging to the clinician as well as laboratory. Physicians can prevent unnecessary antibiotic use by performing the qualitative estimation CRP as a single, rapid and inexpensive test with a negative predictive value of 81.2%.
To evaluate the successful management of intussusception through ultrasound guided hydrostatic reduction with respect to duration of symptoms in children up to 6 years of age. METHODS: Retrospective analysis was done for 68 paediatric patients in the age range from 2.5 months to 6 years at Radiology & Paediatrics departments, Medical Teaching Institution Lady Reading Hospital, Peshawar. Children primarily diagnosed as intussusception, based on ultrasound ndings & managed conservatively with ultrasound guided hydrostatic reduction from January 2014 to December 2017 were included in the study. Their management was analyzed with respect to duration of symptoms. Children who were primarily managed surgically were excluded from study. RESULTS: A total of 68 patients in the age range from 2.5 months to 6 years were included in the study. Male to female ratio was 3.25/1 with 52 males (≤1 year=45 & >1year=7) and 16 females (≤1 year=11 & >1 year=5). Abdominal pain was reported in all (100%) cases, followed by bleeding per rectum in 35.2% and abdominal mass in 13.2% cases. Classic triad of abdominal pain, abdominal mass and bleeding per rectum was reported only in 8.8% of cases. Overall rate of success of hydrostatic reduction was 89.70% (n=61/68). Success rate in cases presented ≤48 hours was 97.56% and in cases presented >48 hours was 77.77% (p<0.05). CONCLUSION: Hydrostatic reduction for intussusception in paediatric patients under ultrasound guidance has a good outcome. Success rate for patients presenting presented ≤48 hours was better than patients presenting presented ≥48 hours.
Introduction: Extension Type III supracondyla fractures of the humerus is most common fractures around the elbow in children. Closed reduction and percutaneous pinning under image intensifier guide has been the gold standard method of treatment. However, image intensifier is not readily available in most part of our country. Closed reduction and percutaneous pinning is possible even without image intensifier. we report our case series of 51 cases who underwent closed reduction and percutaneous pinning without image intensifier. Methods: Between November 2009 and April 2011 a total of 51 children with a displaced supracondylar fractures of the humerus were managed by close reduction and percuteneus k-wire fixation without using image intensifier. They were followed for a period of minimum 6 months up to one and a half years (average one year) and the final outcome was assessed using functional and cosmetic criteria used by Flynn and associates. Results: Of these 51 patients, 46 (90%) patients showed an excellent results. Satisfactory results were achieved in 4 (8%) patients, poor in 1(2%) patients. Conclusion: Close reduction and percutaneous K-wire fixation without using image intensifier is radiation free, cost effective and relatively safe method of management of displaced supracondylar fractures of humerus in children. It can be used in a remote hospital where the facilities of image intensifier or portable x-ray are not available. DOI: http://dx.doi.org/10.3126/noaj.v3i1.9321 Nepal Orthopedic Association Journal 2013 Vol.3(1): 19-22
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