ABSTRACT
To determine the pattern of referrals, socio-demographic factors, frequency of psychiatric diagnosis, and help offered to children presenting in Child Psychiatry Department outpatient clinic of a tertiary care hospital in Lahore. A cross sectional study of children attending child psychiatry outdoor in a tertiary care hospital in Lahore was conducted. Following informed consent from the parent/ legal guardian, 1000 consecutive new referral to the department were assessed by interviewing the parent and the child. A Structured proforma was used for data collection. ICD-10 criteria were used for the diagnosis of psychiatric illness. Record was made of the interventions offered to the child and family.Total sample size was 1000 children with predominant male gender [65%] and mean age of 8.46 [S.D 4.51].More than half [54.5%] of the children in our sample were not enrolled in school and 19% had family history of psychiatric illness. Among the various sources of referral, self-referral was the highest [84.7%] followed by referral from Pediatrics [8.4%]. Psychiatric diagnosis observed were Speech Related Difficulties [including speech delay, articulation problems and specific developmental delays of speech and language [46.5%], Learning Disability [43.3%], Behavior Problems [26.3], Epilepsy [12.6%], Dissociative Disorders [10.1%], Attention Deficit Hyperactivity Disorder [4.5%], Autism [3.2%], Depression[2.4%], Anxiety[1.7%], Psychosis [1%] and Tics [1%]. Co-morbidities were found in 44.7 percent of the children. The various interventions offered included medications, referral to psychologist [for family therapy and individual work], play therapist and speech therapist. Majority of children presenting to the child psychiatry clinic have multiple and complex needs due to high frequency of learning disabilities and co morbidities. The findings illustrate the importance of multidisciplinary approach and to assess the different dimensions of psychopathology in children for future service planning
ABSTRACT
Background: Renal stone disease is a significant and worldwide health problem. Recent advances in stone management have allowed kidney stones to be treated using extracorporeal shock wave lithotripsy [ESWL], uretero-renoscopy [URS], and percutaneous nephrostolithotomy [PCNL]. Recently, medical expulsion therapy [MET] has been investigated as a supplement to observation in an effort to improve spontaneous stone passage rates. Patients and Methods: This study was a randomized, controlled, prospective study to determine whether the administration of Alpha-1- adrenergic receptor antagonists as an adjunctive medical therapy, increases the efficacy of ESWL to treat renal stones. Sixty patients with renal stones of 0.51.5 Cm in size [average size 1.2 Cm] were included in this study underwent ESWL followed by administration of Alpha-1-adrenergic receptor antagonists at department of Urology Liaquat National Hospital Karachi from Feb 2008 to Sept 2008. This was a comparative study and patients were divided into two groups. In group A patients received conventional treatment Diclofenac sodium, Anti Spasmodic [Drotverine HCl] as required and Proton Pump inhibitor [Omeprazole 20 mg] once daily after shock wave lithotripsy. In group B patients received alpha-1 blocker, Alfuzosin HCl 5 mg twice daily in addition to conventional treatment. All patients were instructed to drink a minimum of 2 litres water daily. Ultrasound guided Dornier Alpha Impact Lithotripter was utilised for shock wave lithotripsy. Results: Of the 60 patients, 76.7% of those receiving Alfuzosin and 46.7% of controls had achieved clinical success at 1 month [p=0.01]. The mean cumulative diclofenac dose was 485 mg per patient in the Alfuzosin group and 768 mg per patient in the control group [p=0.002]. This difference was statistically significant. Conclusion: Alfuzosin therapy as an adjunctive medical therapy after ESWL is more effective than lithotripsy alone for the treatment of patients with large renal stones and is equally safe. It increases the expulsion rates of stones, decreases time to expulsion, and decreases need for analgesia during stone passage. Keywords: Alpha-blockers, Ureteral stones, Kidney stones, ESWL
ABSTRACT
To determine the prevalence of obesity among the school- going children [6[th] and 7[th] grade] of Lahore and ascertain the associated factors. A descriptive study with sample size of 293 children conducted over a period of four months in two private sector schools of Lahore. Information was gathered by the help of a pre designed questionnaire after getting formal consent from parents. Children included in the study were healthy with no reported chronic illness. Body weight was measured in minimal clothing using a weight scale; body height was measured in erect posture without shoes using a stadiometer. Obesity, underweight and overweight were defined by plotting BMI against age [in months and years] on WHO BMI-for-age [5-19 years [percentiles]] charts. Out of 293 children 11.9% were obese [more than 97[th] percentile] while 21.8% were overweight [85[th]-97[th] percentile]. Among obese children 74.3% were found to watch TV for 1-2 hours daily while 25.7% watch TV for 3-4 hours. 48.6% of obese children did not participate in any field sports while 34.3% have less than 3 hours participation in field sports. Among parents of obese children, 60% were found to have little or no influence on their children's food intake at school whereas 22.9% parents of obese children never advise them against eating junk food. Parents think that ban on advertisements promoting unhealthy foods [75.1%] and use of popular media characters in promoting healthy foods [83.6%] and exercise can help in preventing obesity in children. This study shows that high prevalence of obesity and overweight among children in private schools has direct relationship with decreased physical activity and other factors like watching TV, role of media and lack of diet control by parents