Background: Empyema thoracis is an accumulation of pus in the pleural space. It is estimated that 0.6% of childhood pneumonias progress to empyema, affecting 3.3/1,00,000 children. Various treatment options available include antibiotics alone or with chest tube drainage, intrapleural fibrinolytics, video-assisted thoracoscopic surgery, and open decortications. Aims and Objectives: (1) The objective of the study was to study clinico-epidemiological and lab profile of pediatric patients with pleural effusion of infective etiology and (2) to study outcome and short term follow-up. Materials and Methods: Prospective observational study conducted from June 2020 to May 2021 at the pediatric department of a tertiary care hospital, central India. Inclusion criteria: Children between 6 months and 14 years diagnosed with pleural effusion clinically and radiologically. Exclusion criteria: Effusion of traumatic or malignant origin. Detailed history, examination, and relevant investigations were recorded. Data were compiled and analyzed. Patients were treated with intercostal drainage, antibiotics and were referred for surgical intervention wherever necessary. Results: Thirty-five patients were included in this study. The mean age of the patients was 4.4 years. Fever (100%), cough (88.5%) and breathlessness (65.7%) were the most common symptoms found at admission. Staphylococcus aureus was the most common organism isolated from pleural fluid. In the present study, 77% (27) patients were treated with ICD and antibiotics, 11.5% patients required surgical intervention, and 11.5% patients responded to antibiotics alone. The mortality rate in our study was 5.7% and the rest of the patients were successfully discharged and followed up. Conclusion: Antibiotics and tube thoracostomy are effective methods of treating pyogenic empyema thoracis in children in resource poor settings.
Background: Acute encephalitis syndrome (AES) is defined as the acute onset of fever and a change in mental status and/or new onset of seizures (excluding simple febrile seizures) in a person of any age at any time of the year. Aims and Objectives: The objectives of the study were as follows: (a) To study clinicoepidemiological profile and outcome among children with AES admitted at M.Y.H. Hospital and MGM Medical College, Indore, M.P., and (b) to study prognostic factors associated with bad outcomes. Materials and Methods: This prospective observational study was conducted over 12 months (July 2019–August 2020) at the pediatric department of our hospital. Inclusion criteria: Inpatient children aged 6 months–14 years meeting the case definitions of acute encephalitis syndrome. Exclusion criteria: Simple febrile seizures. Results: Out of 50 AES cases, majority were between 1 and 5 years of age (40%). There were more males 31 (62%) than 19 (38%) females. Most of the cases were reported during the monsoon period 29 (58%) followed by post-monsoon 13 (26%) and pre-monsoon 8 (16%). Out of 50 cases, all had fever and altered sensorium, 37 (74%) had convulsions, 14 (28%) had vomiting, and 9 (18%) had headache. Out of 50 cases, 42 (84%) had viral etiology including 7 (14%) of dengue encephalitis and 1 (2%) of case of human immunodeficiency virus encephalitis. Only 5 (10%) cases had bacterial etiology. Those who needed inotropes and mechanical ventilation showed significant mortality. Conclusion: The peak of AES cases occurred during the monsoon period. A higher proportion of such cases had viral etiology on cerebrospinal fluid analysis. Use of inotropes and mechanical ventilation was identified to be associated with significant mortality.
Introduction: Sickle Cell Disease (SCD) is one of the most common hereditary haemoglobinopathies globally. Patients with SCD are at a high risk of pulmonary complications. However, there have been very few studies in literature regarding the spectrum of pulmonary involvement and its association with clinicotherapeutic parameters in Indian patients. Aim: To study the incidence of acute and chronic pulmonary complications in children with SCD and to estimate the association of various risk factors with pulmonary complications. Materials and Methods: The present observational crosssectional study was conducted in the Department of Paediatrics, Mahatma Gandhi Memorial Medical College (tertiary care hospital) and Maharaja Yeshwantrao (MY) Hospital, Indore, Madhya Pradesh, India, from June 2021 to July 2022. A total of 100 patients with SCD below the age of 18 years attending sickle-thalassaemia Outpatient Department (OPD) and Inpatient Department (IPD) with pulmonary symptoms admitted were enrolled in the study. Clinical history, physical examination and laboratory findings were noted as per the preconstructed proforma. Data were statistically analysed with unpaired t-test and Pearson’s Chi- square test. Results: A total of 100 patients with SCD were enrolled and the mean age of the study subjects was 9.27±3.39 years. Nearly equal distribution of males (n=52) and females (n=48) were seen with male to female ratio of 1:1.08. Incidence of complications was seen very high in homozygous sickle disease (63%) followed by only 40% in Haemoglobin S (HbS) beta thalassaemia. Most common complication noted in our patients was Acute Chest Syndrome (ACS) (57.7%), followed pneumonia (20%), sympneumonic effusion (15.6%) while only 6.7% had pulmonary hypertension. A statistically significant association (p-value<0.05) was found between compliance to Hydroxyurea therapy and frequency of Vaso-occlusive Crisis (VOC) episodes with pulmonary complications status. Conclusion: In the present study, most frequent acute pulmonary complication noted was ACS followed by pneumonia and sympneumonic effusion. Frequency of VOCs episodes was significantly associated with increased risk of developing pulmonary complications.
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