Salmonella Cholecystitis: Atypical Presentation of a Typical Condition

Salmonella cholecystitis is a rare but important complication of Salmonella typhi infection. We are reporting an 11 years old female child who presented with complaints of high-grade fever, jaundice and right sided abdominal pain (Charcot\u27s triad). Her examination showed tender hepatomegaly. Initial blood results revealed high white cell counts with left shift, deranged liver function tests. Abdominal ultrasonography revealed distended gallbladder with minimal layer of sludge seen within its lumen along with streak of pericholecystic fluid. Blood culture grew Salmonella typhi. She was successfully treated with intravenous ceftriaxone

Incomplete Kawaski disease: are we missing it

Kawasaki disease, also known as mucocutaneous lymph node syndrome or infantile polyarteritis nodosa is an acute febrile vasculitis of unknown etiology with a predilection for coronary arteries and potential for aneurysm formation. In Incomplete Kawasaki disease, children with fever lack the sufficient number of criteria to fulfill the epidemiologic case definition and are diagnosed when coronary artery disease is detected. We present a case report of a one and a half years old girl who came with features of incomplete Kawasaki disease, high grade fever, irritability, history of conjunctivitis and cracking of lips. She was investigated and had a platelet count of 902 x 10(9)/L, ESR was 71 mm/hr and CRP was also raised to 12.8 mg/l. Cardiac evaluation and echocardiography was done which showed dilated coronary arteries \u3e3mm on the left side and 4mm on the right side with early aneurysmal changes. She was treated with immunoglobulin and aspirin and improved

Frequency of retinopathy of prematurity in premature neonates with a birth weight below 1500 grams and a gestational age less than 32 weeks: a study from a tertiary care hospital in a lower-middle income country

Introduction: Retinopathy of prematurity (ROP) is a treatable cause of blindness in neonates. In Pakistan, ROP is often not recognized early because screening and treatment programs are not yet in place in most neonatal units, even in tertiary care hospitals. It is hoped that this report will help inform medical professionals of the magnitude of the problem and help to design appropriate management strategies. Objectives: The aim was to determine the frequency of ROP in premature and very low birth weight (BW) neonates (BW(GA)weeks). Study Design: Cross-sectional study. Study Setting : Neonatal intensive care unit (NICU) of a tertiary care hospital in Karachi, Pakistan. Study Duration : From June 2009 to May 2010. Subjects and Methods : Neonates with a Birth weight (BW)(GA)examination, or were referred for a ROP eye examination as an outpatient, were included in the study. GA was estimated from intrauterine ultrasound findings. Neonates with major congenital malformations, syndromes or congenital cataracts or tumors of the eyes, and those that died before the eye examination or did not attend the out patients department for an eye examination, were excluded. The neonatal eye examination was performed by a trained ophthalmologist at 4 or 6 weeks of age. Results : Out of 86 neonates, ROP was identified in nine neonates (10.5%) at the first eye examination. ROP was significantly associated with BW (P = 0.037), GA (P = 0.033), and chronological age (P\u3c0.001). Conclusions : we identified ROP in 10.5% of neonates at first eye examination. Significant associations between ROP and a GABWdiagnosis

The pediatric disease spectrum in emergency departments across Pakistan: data from a pilot surveillance system

Background: There is an increasing number of urgently ill and injured children being seen in emergency departments (ED) of developing countries. The pediatric disease burden in EDs across Pakistan is generally unknown. Our main objective was to determine the spectrum of disease and injury among children seen in EDs in Pakistan through a nationwide ED-based surveillance system. Methods: Through the Pakistan National Emergency Department Surveillance (Pak-NEDS), data were collected from November 2010 to March 2011 in seven major tertiary care centers representing all provinces of Pakistan. These included five public and two private hospitals, with a collective annual census of over one million ED encounters. Results: Of 25,052 children registered in Pak-NEDS (10% of all patients seen): 61% were male, 13% under 5 years,while almost 65% were between 10 to \u3c 16 years. The majority (90%) were seen in public hospital EDs. About half the patients were discharged from the EDs, 9% admitted to hospitals and only 1.3% died in the EDs. Injury (39%) was the most common presenting complaint, followed by fever/malaise (19%) and gastrointestinal symptoms (18%). Injury was more likely in males vs. females (43% vs. 33%; p \u3c 0.001), with a peak presentation in the 5-12 year age group (45%). Conclusions: Pediatric patients constitute a smaller proportion among general ED users in Pakistan. Injury is the most common presenting complaint for children seen in the ED. These data will help in resource allocation for cost effective pediatric ED service delivery systems. Prospective longer duration surveillance is needed in more representative pediatric EDs across Pakistan

Cardiopulmonary resuscitation in low-resource settings: a statement by the International Liaison Committee on Resuscitation, supported by the AFEM, EUSEM, IFEM, and IFRC.

Most recommendations on cardiopulmonary resuscitation were developed from the perspective of high-resource settings with the aim of applying them in these settings. These so-called international guidelines are often not applicable in low-resource settings. Organisations including the International Liaison Committee on Resuscitation (ILCOR) have not sufficiently addressed this problem. We formed a collaborative group of experts from various settings including low-income, middle-income, and high-income countries, and conducted a prospective, multiphase consensus process to formulate this ILCOR Task Force statement. We highlight the discrepancy between current cardiopulmonary resuscitation guidelines and their applicability in low-resource settings. Successful existing initiatives such as the Helping Babies Breathe programme and the WHO Emergency Care Systems Framework are acknowledged. The concept of the chainmail of survival as an adaptive approach towards a framework of resuscitation, the potential enablers of and barriers to this framework, and gaps in the knowledge are discussed, focusing on low-resource settings. Action points are proposed, which might be expanded into future recommendations and suggestions, addressing a large diversity of addressees from caregivers to stakeholders. This statement serves as a stepping-stone to developing a truly global approach to guide resuscitation care and science, including in health-care systems worldwide

Profile and outcomes of in-hospital cardiac arrest in a paediatric emergency department

Objective: To determine the profile and outcome of patients for in-hospital cardiac arrest (IHCA) in an emergency department (ED). Methods: It is a retrospective study of one year from Jan – Dec’ 2017 for patients who suffered cardiac arrest during their stay in emergency department of National Institute of Child Health (NICH), Karachi, Pakistan. Data was seen for IHCA only and their outcomes including rate of ROSC (Return of Spontaneous Circulation). Patients with out of hospital cardiac arrest were excluded. Results: Total number of children landed in critical conditions were 19,385. In-Hospital Cardiac Arrest were noted in 935 (5%) cases during the study period. ROSC was achieved in 568 (61%). Males were 556 (59%). Infants (<12 months of age) were among the top who suffered in-hospital cardiac arrest they were 719 (77%). The outcome of those who suffered cardiac arrest that 505 (54%) of them survived till emergency room management before disposal to the high level of care. Just 140 cases (15%) landed in emergency department through ambulance and the outcomes were better who landed through ambulance. Conclusion: • More than half of the patients achieved ROSC after in-hospital cardiac arrest and half of them stabilized till final disposal from Emergency department. • Utilization of ambulance service seems very low. • Most common age group was infant. Continuous..