Significance of pyuria in the diagnosis of urinary tract infections in neonates

OBJECTIVES: To determine the significance of pyuria as a predictor of culture proven urinary tract infections (UTI) in neonates and to assess the frequency of urinary tract anomalies in neonates with pyuria. METHODS: Prospective study conducted at the neonatal intensive care unit of a tertiary care hospital; (Liaquat National Hospital Karachi) for a period of 4 months from April 2008 to August 2008. One hundred and ten consecutive infants \u3c or = 28 days of age admitted to the NICU of Liaquat National Hospital for medical reasons were included in the study. Information regarding age, gender, antenatal history, birth weight, clinical examination, laboratory findings and outcome were recorded on a questionnaire. Septic work up was performed and urine samples were collected using urethral catheterization. Patients showing any number of white blood cells on microscopy were included and their urine sent for culture. All patients had Ultrasound done during their hospital stay and those patients with any renal abnormality were further investigated with Micturating cyestoretherogram (MCUG) at 6 weeks. RESULTS: Out of one hundred and ten patients admitted, thirty five patients showed the presence of pus cells in urine and were included in the study. Of the 35 neonates with pyuria, 71.4% had no growth in urine cultures and 38.2 % neonates with insignificant pyuria (\u3c or = 9 cells in urine) showed a positive culture. The renal ultrasound was normal in 51.4% neonates with pyuria although it was abnormal in 100% of the subjects with higher number of pus cells in urine (\u3e 20 pus cells). CONCLUSION: Pyuria is not a useful marker for the diagnosis of culture proven UTI in neonates it cannot be used as an indicator of underlying renal abnormality, though it may have some utility in neonates with \u3e 20 /numerous pus cells

Unusual Presentation of Dengue Fever : A child with acute myocarditis

Dengue fever (DF) is an acute febrile illness that follows a self-limiting course. However, some patients suffer from complications, including myocarditis, due to the involvement of other organs. A child presented at the Aga Khan University Hospital in Karachi, Pakistan, in June 2013 with a high-grade fever, malaise and epigastric pain radiating to the chest. Positive DF antigen and immunoglobulin M assays confirmed the diagnosis of DF. Persistent bradycardia with low blood pressure led to further cardiac investigations which showed a decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage. With supportive care and use of inotropes, the spontaneous normalisation of cardiac enzyme levels and ejection fraction was observed. The child was discharged five days after admission. This case highlights the importance of identifying myocarditis in DF patients suffering from cardiac symptoms that are not explained by other potential aetiologies. Awareness, early suspicion and supportive care are essential to ensure favourable outcomes

Mumps myocarditis: a forgotten disease?

Mumps is an acute viral illness that follows a self-limiting course but up to 10% of cases have a complicated course with the involvement of other organ systems. Myocarditis is reported as a complication but the incidence has greatly fallen ever since the development of the mumps vaccine. A child presented to our department with parotid swelling and fever. Persistent tachycardia with irregular pulse led to further cardiac work up which showed decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage. With ionotropic agents and supportive care, there was complete normalization of ejection fraction and serum cardiac enzyme levels. He was discharged within a week of admission. This case highlights the importance of suspecting myocarditis in the setting of mumps, a diagnosis that precludes early suspicion in mumps patients suffering from cardiac symptoms not explained by other potential aetiologies. Early suspicion and timely supportive care are essential to ensure favourable outcomes

UNDERLYING PSYCHIATRIC DISORDER AMONG CHILDREN WITH SOMATIC COMPLAINTS PRESENTED AT PEDIATRIC UNIT OF A TERTIARY CARE HOSPITAL IN KARACHI, PAKISTAN

Objective: Children with functional somatic symptoms (FSS) often present with chronic symptoms severe enough to result in decreased quality of life, healthcare seeking behavior and skepticism in general pediatricians due to timely non-diagnosis is a major issue. Neurobiological alterations and adverse psychosocial factors contribute to FSS. This research aims to study the presence of undiagnosed psychiatric disorder and adverse psychosocial factors contributing to somatization. Methods: Retrospective approach was adapted and pre-recorded patient-centered data of five years (2008-2012) of the pediatric ward of Aga Khan University Hospital in Karachi, Pakistan was utilized.  Medical records of patients admitted with complaints of bodily symptoms and diagnosed with a psychiatric disorder were identified and retrieved, manually. Data was entered and analyzed using SPSS v.23. Results: Of 20,608 admissions, 67 (0.63%) of all ward admissions had somatic complaints and after an evaluation, they were diagnosed with a psychiatric or conversion disorder (CD). Most frequent clinical presentations were pseudoseizure (n=15, 22.3%) and headache (n=11, 16.4%). The most common psychiatric diagnoses were Conversion Disorder (CD) (n=38, 56.7%) and Major Depressive Disorder (MDD) (n=10, 14.9%). History of physical/verbal abuse and parental marital discord were significant stressors for CD. 17.9% (n=12) children had suicidal ideation which included 50% (n=5) children with MDD. Conclusion: This retrospective analysis concludes that somatization with underlying undiagnosed psychiatric disorders such as Conversion and Major Depressive disorder are commonly seen in the pediatric general practice. Somatization and comorbid psychiatric disorder roots back to emotional trauma or distress such as physical abuse and parental marital discord

Unusual Presentation of Dengue Fever: A child with acute myocarditis

Dengue fever (DF) is an acute febrile illness that follows a self-limiting course. However, some patients suffer from complications, including myocarditis, due to the involvement of other organs. A child presented at the Aga Khan University Hospital in Karachi, Pakistan, in June 2013 with a high-grade fever, malaise and epigastric pain radiating to the chest. Positive DF antigen and immunoglobulin M assays confirmed the diagnosis of DF. Persistent bradycardia with low blood pressure led to further cardiac investigations which showed a decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage. With supportive care and use of inotropes, the spontaneous normalisation of cardiac enzyme levels and ejection fraction was observed. The child was discharged five days after admission. This case highlights the importance of identifying myocarditis in DF patients suffering from cardiac symptoms that are not explained by other potential aetiologies. Awareness, early suspicion and supportive care are essential to ensure favourable outcomes