Paediatric external ventricular drains: experience from a tertiary care hospital of a developing country

Abstract The aim of the study was to describe indications and complications of external ventricular drain (EVD) placement in children aged between 1 month and 16 years. This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised all children who underwent EVD placement from January 2007 to December 2014. Of the 177 patients identified, 117(66%) were males 60(34%) were girls. The overall mean age was 5.4±5.2 years. The median Glasgow Coma Scale score on presentation and discharge was 13 (interquartile range [IQR]: 7) and 15 (IQR: 4), respectively. Major diagnosis included intracranial tumour 60(34%), bacterial meningitis 34(19%), tuberculous meningitis 33(18.6%), and haemorrhage 23(13%). Clinical indications for EVD insertion were acute hydrocephalus secondary to infection 64(36.2%), tumour 54(30.5%), and haemorrhage 23(13%) ventriculoperitoneal shunt malfunction or infection 25(14.1%) and traumatic brain injury 11(6.2%). Complications were observed in 47(26%) patients including infections 25(14.1%), malfunction 11(6.2%), haemorrhage 6(3.4%), misplacement 3(1.7%) and obstruction 2(1.1%). Staphylococcus was the main organism isolated. Moreover, 25(14%) patients expired. Acute hydrocephalus was the major indication and EVD infection was the major complication

Laboratory blood testing in paediatric intensive care unit of a university hospital: Are we doing it appropriately?

Retrospective chart review of all children (aged-one month to 16 years) admitted in our paediatric intensive care from June to November 2016 was done to determine the indication of different laboratory tests. LBT indications were defined into: diagnostic/case findings/screening tests to make a diagnosis; haemostatic tests (to monitor function or identify before clinical signs and symptoms) and therapeutic /monitoring tests to get the level of drug directly or getting level of marker as a guide to therapy. Laboratory tests reports which were within normal range more than once were labelled as in-appropriate tests. In total 274 patients, Haemostatic tests were performed for mean of 35.18±56.72 times (range of 0-429), monitoring for mean of 9.38±20 times (range 0-165), and therapeutic tests (3.26±11.25). Most common tests included serum Sodium levels (7.83±12.73), Serum Potassium (8.19±12.80), bicarbonate (7.75±11.9). 13.40±9.11 tests were done on first day and 13.0±8.49/day tests were performed afterwards. Cumulatively 54.31±74.21 tests were performed/ patients out of which 18.5±37.82 were inappropriate

Factors associated with parental refusal for lumber puncture among children and adolescent: A cross sectional survey at a tertiary care hospital

Introduction: The lumbar puncture is frequently used in medical facilities to collect data on the cerebrospinal fluid (CSF). The method aids in the diagnosis of conditions affecting the spine and brain\u27s central nervous system. However, in routine practice out of the many challenges posed by the parents due to lack of education, denial of consent for this procedure is a great challenge at clinical settings.Objectives: To determine the association of various factors with parental refusal for lumbar puncture among pediatric population (age from 1 moth to 18 years).Materials and Methods: A descriptive, cross-sectional study was carried out at the department of pediatrics and child health and department of Emergency at Aga Khan University Hospital, Karachi from June 2017 to May 2018. A total of 178 children 1 month to 18 years old admitted with febrile fits, suspected meningitis or encephalitis who were advised for lumber puncture were included.Results: In the present study, the age of the patients ranged from 1 month to 18 year. Majority of the patients 153 (85.39%) were between 1 month to 6 years of age. There were 115 (64.61%) male patients.. Fever and fits was the most frequent indication (n=151, 84.83%) for lumber puncture in the study. Most of the parents were educated, 68.54% of mothers and 65.17% fathers had graduate level of education, and parents of 47 (26.4%) patients refused for lumber puncture.Conclusion: This study concluded that frequency of parental refusal for lumbar puncture was 26.4% and the most common reason for refusal was fear of complications

Factors affecting accidental toxic ingestion among children younger than 5 years

Introduction: One million children die each year from injuries around the world, with poisoning being the fourth most common cause.Children below five years are at an increased risk because of their exploratory nature and hand to mouth activity, accounting for 15% of accidental poisoning related deaths in this age group.A community oriented study that studiedthe national health survey of Pakistan reported that the incidence of accidental poisoning was 4.3% among children below five years.Objectives: To determine the socio-demographic factors affecting accidental toxic ingestion in children younger than five years at Aga Khan University Hospital, Karachi.Materials & Methods: A descriptive cross-sectional study was carried out at the emergency Deptof the Aga Khan University Hospital in Karachi, Pakistanbetween August 2016 to July 2017. Children with a history of accidental ingestion were included in the study. Descriptive statistics and Chi-square association was used employed using SPSS version 23.Results: A total of 97 children between the age group of 6 months – 5 years were enrolled, amongst 61 (62.88%) male. 74 (76.29%) children had unsafe storage of hazardous chemicals, 34 (35.05%) had large family size, 5 (5.15%), 3 (3.09%), and 3 (3.09%) of participants had lower socioeconomic status, uneducated, and rural residents respectively.Conclusion: Awareness to parents regarding child protective strategies and usage of safe packaging in medicines may avoid accidental toxic ingestion