Unintentional injuries In children: are our homes safe?

Abstract Unintentional injuries are a leading cause of death in childhood globally. Injuries lead to emotional trauma and financial burden for children, parents, and society. Here are the frequencies of unintentional injuries in children presented to the emergency and paediatric surgery clinics of the Aga Khan University Hospital, Karachi, Pakistan, from January to December 2012. Aretrospective chart review of children aged 0 day to 14 years presented with falls, burns, foreign body ingestion or inhalation, poisoning, fingers caught in doors, electrocution injuries and drowning, was conducted. Atotal of 165 children were included. Domestic injuries were frequently occurring injuries in our set-up which could be prevented by doing small adjustments to make the home safe for childre

Implantable port devices in paediatric oncology patients: A clinical experience from a tertiary care hospital

Objective: To assess the frequency of infection of portacath in children having malignant tumours and undergoing chemotherapy, and to assess the association of the infection with already known risk factors.Methods: The retrospective review was conducted at Aga Khan University Hospital, Karachi, and involved patient data related to the period between January 2005 to December 2010. A questionnaire was designed to collect the required data. A total of 67 children were included having portacath inserted for chemotherapy. Children in which portacath was inserted under local anaesthesia in Radiology department, reinserted or inserted because of a reason other than childhood malignancy were excluded. SPSS 19 was used for statistical analysis.Results: Of the total, 46 (67%) patients were males and a majority of the total (n = 31; 46%) was between 6-10 years of age. Besides, 42 (63%) patients had leukaemia, 7 (11%) had lymphoma and 18 (26%) had various solid tumours. Six (8.95%) ports were removed due to infection. There was significant difference between infection and non-infection groups with respect to absolute neutrophilic count levels (p \u3c 0.001). Positive association was found between low absoulute neutrophilic count level (\u3c or = 500) and the occurrence of port infection.Conclusions: Port infection rate is higher in children with low absoulute neutrophilic count. The issue needs to be addressed and one may have to alter the timings of port insertion. It is recommended to insert port when absolute neutrophilic count is normal. To further evaluate the subject, a multicentre trial must be conducted

Congenital prepubic sinus: An aborted dorsal urethral duplication or a cloacal remnant?

Background: Congenital Prepubic Sinus (CPS) is an uncommon urogenital anomaly characterized by a blind tract between the skin over the pubis to anterior of the urinary bladder, Urethra or umbilicus. We report four such cases to emphasize varied clinical presentation and embryological conundrum. Methods: Following Ethical Review Committee (ERC) approval, medical records of pediatric patients (\u3c16 \u3eyears) presenting with CPS (identified through operating room records and Hospital Information Management System (HIMS) between 1994 and 2018 were reviewed for demographics, clinical presentation, investigations including histopathology, management and outcome. Results: Four cases of CPS, 3 females and 1 male, age range 9 months to 13 years were managed over 25-years. Clinical presentation includes a discharging sinus and recurrent episodes of cellulitis and abscess formation in pubic area and labia majora. Urological investigations were mostly normal. Insertion of lacrimal probe or plastic sheath of intravenous cannula through the sinus opening was useful to determine the course of sinus and aid its excision. Histology of excised sinus highlights the possible embryological origin. Concluions: CPS is a rare anomaly with varied clinical presentation. It seems CPS is an aborted urethral duplication (Stephen Type 3) or a Cloacal remnant. Complete excision of the tract in the reported cases was curative

Sensitivity and specificity of CT scan in small bowel obstruction among children

Objective: To determine the sensitivity and specificity of computed tomography scan for diagnosing small bowel obstruction among children.Methods: The retrospective diagnostic test accuracy study was carried out at the Aga Khan University Hospital, Karachi, and comprised data of all patients aged 2-16 years who presented with clinical features of small bowel obstruction and underwent computed tomography scan of abdomen from January 2001 to December 2015Data was analyzed using SPSS19.Results: Of the 98 subjects, 65(66.0%) were males and 33(34.0%) were females. Overall mean age of the patients was 7.67±4.33 years and mean duration of symptoms was 2.84±1.17 days. Sensitivity, specificity, positive and negative predictive values as well as accuracy of computed tomography scan was 97.4%, 81.8%, 94.9%, 90.0% and 93.9% respectively.Conclusions: CT scan was found to have a high sensitivity, fairly good specificity and accuracy in revealing small bowel obstruction. However, the scan is known to have its limitations in sub-acute intestinal obstruction and primary peritoniti

Functional outcome of anorectal malformations and associated anomalies in era of krickenbeck classification

Abstract OBJECTIVE: To describe the management and functional outcome of anorectal malformations and associated anomalies according to Krickenbeck classification. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 2002 to December 2012. METHODOLOGY: Anorectal anomalies were classified according to Krickenbeck classification. Data was collected and proforma used regarding the primary disease associated anomalies, its management and functional outcome, according to Krickenbeck classification. Cases included were: all those children with imperforate anus managed during the study period. Qualitative variables like gender and functional outcome were reported as frequencies and percentages. Quantitative variables like age were reported as medians with interquartile ranges. RESULTS: There were 84 children in study group. Most common associated anomaly was cardiac (38%), followed by urological anomaly (33%). All children were treated by Posterior Sagittal Anorectoplasty (PSARP). Fistula was present in 64 out of 84 (76%) cases. The most common fistula was rectourethral (33%), followed by recto vestibular (31%). According to Krickenbeck classification, continence was achieved in 62% children; however 27% children were constipated, followed by 12% children having fecal soiling. CONCLUSION: Functional outcome of anorectal malformation depends upon severity of disease. A thorough evaluation of all infants with ARM should be done with particular focus on cardiovascular (38%) and genitourinary abnormalities (33%)

Focused abdominal sonography for trauma (FAST) in blunt paediatric abdominal trauma

Objective: To evaluate the role of focussed abdominal sonography for trauma in blunt paediatric abdominal trauma patients, and to see if the role of computed tomography scan could be limited to only those cases in which sonography was positive.Methods: The retrospective study covered 10 years, from January 1,2000 to December 31,2009, and was conducted at the Department of Radiology and Department of Emergency Medicine, Aga Khan University Hospital, Karachi. It comprised cases of 174 children from birth to 14 years who had presented with blunt abdominal trauma and had focussed abdominal sonography for trauma done at the hospital. The findings were correlated with computed tomography scan of the abdomen and clinical follow-up. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of focussed abdominal sonography for trauma were calculated for blunt abdominal trauma. SPSS 17 was used for statistical analysis.Results: Of the total 174 cases, 31 (17.81%) were later confirmed by abdominal scan. Of these 31 children, sonography had been positive in 29 (93.54%) children. In 21 (67.74%) of the 31 children, sonograpy had been true positive; 8 (25%) (8/31) were false positive; and 2 (6%) (2/31) were false negative. There were 6 (19.3%) children in which sonography was positive and converted to laparotomy. There was no significant difference on account of gender (p\u3e0.356). Focussed abdominal sonography for trauma in the study had sensitivity of 91%, specificity of 95%, positive predictive value of 73%, and negative predictive value of 73% with accuracy of 94%. All patients who had negative sonography were discharged later, and had no complication on clinical follow-up.Conclusions: Focussed abdominal sonography for trauma is a fairly reliable mode to assess blunt abdominal trauma in children. It is a useful tool to pick high-grade solid and hollow viscous injury. The results suggest that the role of computed tomography scan can be limited to those cases in which focussed sonography is positive

Infantile haemangioendothelioma of the parotid gland: Case report and review of literature

Haemangioendotheliomas (HAE), although rare but are the most common parotid gland tumours in children. We report a 4-month-old girl who presented with a progressively enlarging right sided facial swelling overlying the angle of the mandible. An Ultrasound of the lesion and a computed tomography (CT) scan of the head and neck was carried out which revealed a large lesion within the right parotid gland. CT scan further demonstrated a direct communication with the right external carotid artery and external jugular vein. Considering the clinical course and radiological findings, there was sufficient evidence to avoid any invasive testing. Due to the self-limiting nature of the disease, patient was managed expectantly

Empyema thoracis in children: clinical presentation, management and complications

Objective: To determine the etiology, clinical manifestation, management (medical and surgical) and complications of children with empyema thoracis in a tertiary care hospital from Karachi, Pakistan. Study Design: Descriptive, analytical study. Place and Duration of Study: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1996 to December 2010. Methodology: Medical records of admitted children aged \u3e a month to 15 years with discharge diagnosis of empyema thoracis and data was collected on demographic features, clinical manifestation, management and complications. Children managed medically were compared with those managed surgically by using interquartile range and median comparison. Mann-Whitney U test was used to compare age in months, weight (kg) and length of stay in days and presenting complaint, duration of illness; chi-square test was used to compare thrombocytosis in between groups and p-value was calculated. Results: Among the 112 patients, 59 (53%) were younger than 5 years of age. Males (n=83, 74%) were predominant. Fifty (45%) children were admitted in winter. Thirty (27%) children found unvaccinated and one fourth (n=27; 24%) were severely malnourished. Fever, cough, and dyspnea were the major presenting symptoms. Sixty-six (59%) were on some antibiotics prior to admission. Staphylococcus aureus (n=13) and Streptococcus pneumoniae (n=5) were the commonest organism isolated from blood and pleural fluid cultures. Majority of the children required some surgical intervention (n=86). Surgically managed children were younger (p=0.01); had less weight (p=0.01) and prolonged fever (p=0.02); and stayed longer in hospital (p \u3c 0.001) as compared to medically managed children. Requiring readmission (n=8), subcutaneous emphysema (n=5) and recollection of pus (n=5) were the major complications. Conclusion: Staphylococcus aureus was the major organism associated with paediatric empyema thoracis. Early identification and empiric antibiotic as per local data is essential to prevent short and long-term complications. Younger, lower weight children with prolonged fever required surgical management

Adaptive Multi-Cost Routing Protocol to Enhance Lifetime for Wireless Body Area Network

Wireless Body Area Network (WBAN) technologies are emerging with extensive applications in several domains. Health is a fascinating domain of WBAN for smart monitoring of a patient's condition. An important factor to consider in WBAN is a node's lifetime. Improving the lifetime of nodes is critical to address many issues, such as utility and reliability. Existing routing protocols have addressed the energy conservation problem but considered only a few parameters, thus affecting their performance. Moreover, most of the existing schemes did not consider traffic prioritization which is critical in WBANs. In this paper, an adaptive multi-cost routing protocol is proposed with a multi-objective cost function considering minimum distance from sink, temperature of sensor nodes, priority of sensed data, and maximum residual energy on sensor nodes. The performance of the proposed protocol is compared with the existing schemes for the parameters: network lifetime, stability period, throughput, energy consumption, and path loss. It is evident from the obtained results that the proposed protocol improves network lifetime and stability period by 30% and 15%, respectively, as well as outperforms the existing protocols in terms of throughput, energy consumption, and path loss

Feedback in a clinical setting: A way forward to enhance student\u27s learning through constructive feedback

Feedback is considered as a dynamic process in which information about the observed performance is used to promote the desirable behaviour and correct the negative ones. The importance of feedback is widely acknowledged, but still there seems to be inconsistency in the amount, type and timing of feedback received from the clinical faculty. No significant effort has been put forward from the educator end to empower the learners with the skills of receiving and using the feedback effectively. Some institutions conduct faculty development workshops and courses to facilitate the clinicians on how best to deliver constructive feedback to the learners. Despite of all these struggles learners are not fully satisfied with the quality of feedback received from their busy clinicians. The aim of this paper is to highlight what actually feedback is, type and structure of feedback, the essential components of a constructive feedback, benefits of providing feedback, barriers affecting the provision of timely feedback and different models used for providing feedback. The ultimate purpose of this paper is to provide sufficient information to the clinical directors that there is a need to establish a robust system for giving feedback to learners and to inform all the clinical educators with the skills required to provide constructive feedback to their learners. For the literature review, we had used the key words glossary as: Feedback, constructive feedback, barriers to feedback, principles of constructive feedback, Models of feedback, reflection, self-assessment and clinical practice etc. The data bases for the search include: Cardiff University library catalogue, Pub Med, Google Scholar, Web of Knowledge and Science direct