Zinc supplement in reduction of relapses in children with steroid sensitive nephrotic syndrome

To determine whether Zinc supplementation could reduce relapse rate in children with nephrotic syndrome. Randomized-controlled trial. National Institute of Child-Health and The Kidney Centre, Karachi, from January 2008 to June 2009. Sixty nephrotic children aged 2 - 15 years were selected. Baseline data including age, number of infections and relapses during pre and post study one year were recorded. Randomization was done to divide into Zinc group [Zg] to receive Zinc versus placebo [Pg] for 6 months. Relapses and infections were treated with standard therapy. T-test and chi-square tests were used to compare the mean values and proportions respectively with significance at p < 0.05. Among 60 children, 54 completed trial [Zg = 25, Pg = 29]. Forty [74%] were males and 14 [26%] females. Mean age, pre study relapses and Zinc level in the two groups were similar. Overall, infections and relapses were observed in 43 [79.62%] and 17 cases [31.48%] respectively. There was no significant difference in frequency of infections and mean infection rate in Zg [20, 80% and 1.92 +/- 1.47] compared to Pg [23, 79.3% and 2 +/- 1.53, p = 0.950]. Relapses occurred in 7 [28%] in Zg compared to 10 [34%] in Pg which was not significant [p = 0.609]. Mean infection and relapse rate per patient per year [PPPY] in Zg was 1.92 +/- 1.47and 1.14 +/- 0.37 compared to 2 +/- 1.53 and1.3 +/- 0.48 in Pg respectively [p=0.846, 0.464]. Pre study relapses in two groups were similar [Zg vs. Pg = 96 vs. 96.6%] whereas post study relapses in Zg were lower [7, 28%] compared to Pg [10, 34.5%]. Post study mean relapse rate in Zg was 1.14 +/- 0.37 PPPY compared to 2.71 +/- 1.11 in pre study [p = 0.005]. In Pg, post study mean relapse rate PPPY was 1.30 +/- 0.48 compared to 1.70 +/- 0.48 in pre study period [p = 0.037]. Relapse rate reduction was 43% after Zinc supplementation compared to 27% reduction in placebo. Metallic taste was observed in 10% of cases. Zinc supplementation was helpful in reducing relapses in nephrotic syndrome

Urinary citrate level in urinary stone formers versus controls

To determine the urinary citrate [UC] level in stone formers [SF] versus controls. Case control study. Department of Pediatric Nephrology, National Institute of Child Health [NICH], Karachi from January- July 2008. Eighty six children of 1-13 years, 43 in each group, stone former [SF] and controls were studied. In both groups, 24-hours UC was measured by citrate lyase method. Hypocitraturia was defined as 24- hours UC-level < 5mg/kg for children under 9 years and <7mg/kg for 9 years and above. Data including age, sex, weight, 24-hours urine volume [UV] and UClevel were analyzed using descriptive statistics on SPSS version 15. Of the 86 children, 59 [68.6%] were males and 27 [31.4%] females. Overall mean age was 5.65 + 3.05 years, while that of SF and controls was 5.61+ 3.1 and 5.70 + 3.04 years respectively. Mean 24-hours UV and UC-level in total of 86 samples was 385.10+130 ml and 88.10 + 62.11mg respectively. Mean + SD 24-hours UC-level [mg] in SF and controls was 69.4 + 53.55 [95%CI 53.39-85.41] and 106.8 + 65 [95%CI 87.37-126.23] respectively. Overall hypocitraturia was found in 42[48.8%] children. Frequency of hypocitraturia was high in SF [n 30, 69.8%] compared to controls [n 12, 27.9%] with a significant difference between the two groups [p<0.001]. Overall hypocitraturia was found in 48.8% of cases. Though hypocitraturia was prevalent in both groups, but was significantly high [69.8%] in SF compared to controls [27.9%]. Hypocitraturia may be an important metabolic risk factor and urinary citrate level should be included in the metabolic evaluation in all stone formers

Anthropometric assessment of nutritional status and socio-demographic characteristics in children up to 2 years of age

Malnutrition is one of the major causes of morbidity and mortality in children. It is important to realize that normal length and weight being attained at 1 year of age, would predict the nutritional status at 3 years of age. To asses the nutritional status and the associated socio-demographic characteristics in supposedly healthy children of up to 2 years of age and highlight the importance of anthropometric measurements in routine child health care. A cross- sectional study using purposive sampling technique was conducted on children attending well baby clinic of National Institute of Child Health, Karachi during the year 2003-2005. Anthropometric measurements i.e. height and weight, were measured and a standard questionnaire was used to interview the mothers regarding sociodemographic back ground information after a verbal informed consent and ensuring confidentiality. Height for age, weight for age and weight for height of the children were compared with the National Centre of Health Statistics [NCHS] reference population of the United States, and Z-score < -2 SD were considered as stunted, under weight and wasted respectively. Data was analyzed using SPSS software package. We observed stunting in 22%, wasting in 15% and under weight in 31.6% children. Majority of children with low weight were between 19 - 24 months of age. Regarding socio-economic status of the households, 53.8% had family income less than Rs6000 /month and almost 50% had a family size of 6-10 persons. Parents' education to the level of illiteracy [father, 27% and mother, 40%] and incomplete immunization [20%] were other associated factors for stunting, wasting and under weight. About 32% of children up to 2 years of age in the selected population were under weight, followed by stunning [22%]. Anthropometric measurement of children is a useful in routine child care settings as it will facilitate early identification and timely interventions for emerging health problems

Histopathological pattern in childhood glomerulonephritis

To determine the histopathological pattern in childhood glomerulonephritis [CGN]. This retrospective analysis of renal biopsies of 118 children with various clinical syndromes of CGN was carried out at the National Institute of Child Health [NICH] and The Kidney Center [TKC], Karachi, from July 2005 to December 2009. The age ranged from 6 months to 16 years. All biopsies were studied under light microscopy [LM] and immunoflourescence [IMF] Histopathological lesions [HPL] were classified as primary and secondary glomerular diseases. Demographic data, indications and HPL were retrieved and analyzed using descriptive statistics. Out of 118 patients, 62 [52.54%] were males and 56[47.45%] females. Mean age was 8.2 +/- 3.9 years. Major indications for biopsy were primary nephrotic syndrome [PNS 86, 72.88%]. secondary GN [SGN, 17, 14.4%] and nephritic-nephrotic syndrome [NNS 13, 11%]. Overall, primary glomerular diseases [PGD] accounted for 84.74% of all biopsies. Minimal change disease [MCD 38, 32.2%] and focal segmental glomerulosclerosis [FSGS 35, 29.66%] were the two most common lesions and accounted for 43% and 33.72% respectively in PNS. Other important lesions were membranous GN [MGN 10, 8.47%], membranoproliferative [MPGN 9, 7.16%], post-infective [PIGN 4, 3.38%] and IgM nephropathy [IgMN 3, 2.54%]. Among secondary glomerular diseases [SGD], lupus nephritis [LN 11, 9.32%] was the most common lesion followed by Henoch-Schonlein nephritis [HSN] and haemolytic uraemic syndrome [HUS] each in 3 [2.52%]. Overall, MCD and FSGS were the two most common HPL in PGD and both dominated in PNS. Lupus nephritis was the leading lesion in SGD. These histopathological pattern of CGN in our study is in conformity with the existing literature from Pakistan

Blood pressure, body mass index and waist circumference of school going children of Karachi

Exposure to cardiovascular risk factors during childhood may be associated with the development of atherosclerosis later in life. To determine blood pressure, body mass index and waist circumference in school going children of Karachi. A descriptive cross sectional study was conducted in schools of Karachi. Children from randomly selected public and private sector schools, aged between 8-14 years were included. Height, weight, body mass index, waist circumference and blood pressure of each child were recorded. All children with raised blood pressure were re-evaluated and their detailed history and physical examination was carried out. Of the total 500 children, 41[8.2%] were over weight, [23[9.2%] boys and 18 [7.2%] girls] and 33[6.6%] were obese [21 [8.4%] boys and 12[4.8%] girls]. Waist percentile > 90 was found in 65[26%] boys and 89[35.6%] girls and all obese [33] children had waist percentile >/= 90. Over all 21[4.2%] and 28[5.6%] children had raised systolic and diastolic blood pressure [>/= 95[th] percentile] respectively. With increasing status of body mass index, there was an increase in both systolic and diastolic blood pressure. Over weight and obese children had significantly [p<0.001] higher blood pressure values than children with healthy weight. In obese category, 3[9%] children were hypertensive [systolic and diastolic blood pressure >/= 95[th] percentile], 2[6.%, systolic] and 4[12.% diastolic] were pre-hypertensive [>=90<95] while over weight was marked by hypertension in 3[7.3%] and pre-hypertension in 5[12.2%]. Present findings are in accordance with the definition that 5% of children in any given population would be classified as having high blood pressure and an increase in body mass index and waist circumference was found associated with raised blood pressure. The study recommends a need for measuring blood pressure in children during health maintenance visits, to identify children at greatest risk of obesity in adolescent and suggest interventions before chronic overweight is established. Education department should introduce healthy life style behaviour in school curricula to improve the health of our younger generation

Outcome of pediatric renal biopsy with monopty gun technique

To determine the outcome of percutaneous renal biopsy [PRB] using Monopty-gun technique [MGT] and to compare the results of sedation with general anesthesia [GA] used for the procedure. Descriptive Study. Department of Pediatrics at National Institute of Child Health [NICH] and the Kidney Center Postgraduate Training Institute [KPTI], Karachi from June 2005 to February 2010. Renal biopsies were performed either under sedation /GA at NICH and KPTI respectively using MGT under ultrasound guidance [USG] after routine tests. A resident/ nurse monitored the procedure. Data including age, sex, indication, vitals monitored, number of attempts per patient, glomeruli per biopsy and complications were recorded. Using statistical-Package-Scientific-Software [SPSS] version- 15, descriptive statistics were applied. Paired test was used to compare pre-and- post procedure vitals. P<0.0 was considered significant. A total of 147 biopsies in 145 children were performed. Boys were 79 [54.58%] and girls 66 [45.51%]. Mean age was 7.31 +/- 4.23 years. Most of the procedures were performed under sedation [n 105, 71.42%]. Indication were nephritic syndrome [NS] in 96[65.3%], secondary glomerulonephritis [SGN] in 17 [11.6%], nephritic-nephrotic syndrome [NNS] in 16 [10.9%], congenital nephritic syndrome [NS] in 15[10.2%] and others 3[2.06%]. The success and adequacy rate was 95.91% and 95.23% respectively. Failure occurred in 5[3.4%] cases. Overall, 26[17.68%] complications were observed in 21[14.28%] patients with 6[4%] being major. Technique related complications [20, 76.92%] were more than sedation/GA related [SGRC-n 6.23%]. The complications were more in sedation but the outcome was better in GA. MGT is a safe for PRB in children. The success, adequacy and complication rates in our study are in uniformity with the current standards

Assessment of nutritional status in children attending attending basic health unit of Shidi Goth

Shidi Goth is a slum area at a distance of 35 km. from Karachi and has a population of 10,000, mostly Sindhi and Balochi speaking inhabitants. The population belongs to low socioeconomic strata with low educational background. Assessment of nutritional status and associated factors in children attending basic health unit of Shidi Goth was a joint program of Bin Qasim and National Institute of Child Health, Karachi for primary health care system and community development. To assess nutritional status of children attending Basic Health Unit [BHU] of Shidi Goth. Cross - sectional study done in Basic Health Unit of, Shidi Goth from January, 2004 -December, 2004 uses simple random method. The sample size 78 at 95% confidence level was calculated using computer package, EPI-Info, version 5.0. Seventy eight children [35 male and 43 female] representing 78 households, suffering from various diseases who attended the Basic Health Unit of Shidi Goth were included in the study. A questionnaire was used to interview the parents of the children after a formal verbal consent, regarding number of family members, their social habits, socioeconomic and educational status, common diseases found in children up to 4 years of age, their vaccination status and information about going to school or otherwise, residing in the same house. Of 78 children 44 [56.4%] were up to 1 year of age. Common diseases in children included acute respiratory infections and gastroenteritis. Majority 67 [88.5%] had complete vaccination and only 9[11.5%] were partially vaccinated. Low weight for age was observed in 61[78%] children while severe stunting was found in 34[43.6%] and 5[6.4%] manifested severe wasting. Regarding socioeconomic status of the households, 45[58%] of the families had income less than Rs5,000/month. Average family size was 10/family. Single room occupancy was seen in 32[41%] households and basic facilities i.e. water, electricity, gas and sanitation were available in 48[61.5%] houses. Educational status of the parents was low as 35[45%] fathers and 58[75%] mothers were illiterate. Cigarette, pan and gutka were commonly consumed by the parents. Malnutrition was a major health problem and low education level of parents, large family size and low family income were the factors, contributing to low nutritional status of the children

Status of hepatitis B vaccination amongst health care workers and their knowledge about prevention strategies

To assess the status Of Hepatitis B Vaccination Amongst Health Care Workers [HCW] and Their Knowledge About Prevention Strategies. A questionnaire based report. National Institute of Child Health, Karachi from January 2006 to April 2006. Three hundred and eighteen health care workers [age range 20-59 years] filled the questionnaire. Amongst them 186 [58.49 percent] were male. The study showed that 159 [50 percent] were completely vaccinated, 59 [18.55 percent] partially vaccinated and 100 [31.44 percent] were unvaccinated. The study also showed that among vaccinated HCW, 21 [13.20 percent] had their antibody titer done. Only 25 [15.72 percent] had booster dose. Needle stick injury was reported by 174 [54.71 percent] health care workers. Out of this only 56.60 percent had complete vaccination. Only 181 [56.91 percent] health care workers wear gloves while handling blood and blood products. Awareness among health care workers about getting them vaccinated is present but it did not materialize in actuality. The reasons mentioned are not forthcoming with, when one calculates the life long complications that may result from not getting vaccinated. The careless attitude in their clinical practice expose them to the risk of getting infected with contaminated materials

experiment of renal replacement therapy in children

To determine the prevalence of renal failure in children requiring renal replacement therapy [RRT], the types of RRT being performed, problems encountered during the procedure and the outcome of the RRT in pediatric age group. Design: It was a retrospective study on pediatric patients with renal failure undergoing RRT. Place and Duration of Study: The study was carried out at National Institute of Child Health [N.I.C.H] covering a period of four years. Subjects and The study included all pediatric patients of acute renal failure, chronic renal failure and end stage renal disease who underwent RRT at N.I.C.H. 17% of the patients with renal disease came in renal failure. A total of 65.04% patients received RRT. Out of these, 84.7% underwent peritoneal dialysis [PD] while 15.3% required hemodialysis and 2 were successfully transplanted. High cost of the RRT was the most commonly encountered problem during the procedure. Peritonitis was the commonest complication faced during the peritoneal dialysis while hypotention and complications related to vascular access were commonest during hemodialysis. About 50% of the patients undergoing peritoneal dialysis were left with persistent renal impairment while hemodialysis revealed a mortality of 37%. The two transplanted patients were doing well. The study showed that renal failure was a fairly common problem in pediatric age group and the prospects of successful RRT in Pakistan were quite high with a little effort on the part of medical professionals along with some financial assistance from the affluents of the country

Vesicoureteric reflux in children

A prospective study was carried out on 65 patients with vesicoureteric reflux [VUR]. Twenty-four patients were in primary [group A] and 41 patients in secondary VUR [group B]. Male to female ratio in group A was 1.6:1 and in group B 4:1. Nine [37 percent] patients in group A and 17 [42 percent] in group B presented after 3 years of age. Main clinical presentations of group A were failure to thrive, anaemia, U.T.I and renal failure. Main clinical presentations of group B were urinary complaints, anaemia, failure to thrive, U.T.I and renal failure. Bilateral grade IV VUR was found in 11/24 [46 percent] in group A and 23/41 [55 percent] in group B. The causes of secondary VUR were PUV [32] prune belly syndrome [6] and meningomyelocele [3]. Early diagnosis and prompt management is required to prevent irreversible renal impairment

Childhood asthma, response to oral prophylaxis

The value and efficacy of ketotifen as a prophylactic drug for childhood asthma was assessed for 1 year in 45 children. Sixty seven percent showed good response, 15.5% moderate and 17.7% poor response to ketotifen therapy. The side effects [sedation, dizziness, headache] were seen in 20% children which resolved without interruption of therapy. Ketotifen appeared to be an effective and safe oral prophylactic drug for childhood asthma