Psychosocial determinants of nutritional neglect in a developing country

To determine the demographic features and psycho-social and economic determinants of nutritional neglect in order to suggest interventional strategies. Cross-sectional, observational study. Department of Paediatrics, Dow University of Health Sciences [DUHS] and Civil Hospital Karachi [CHK], from January 2009 to December 2010. All children suffering from nutritional neglect suggested by weight and height less than the third centile for age, and their mothers were recruited in the study through non-probability consecutive sampling. A team comprising of paediatrician, psychologist, medical social worker and social motivator interviewed the mothers and children suffering from nutritional neglect. Information about demographic, social, economic and psychological factors was obtained. The results were analyzed and described as frequency distribution and percentage. A total of 658 children suffering from nutritional neglect were inducted. Around 75% of children were below 5 years of age, 51% were females. Other determinants of nutritional neglect were, large family size [family of > 5 members [84%] young mother [60%], uneducated parents [67% father and 77% mothers being illiterate], low income [77% earning less than Rs. 7000/month], addiction [23%], tobacco smoking [50%] and non-nutritive substance use [51%]. Psychological indicators identified in mothers were depression [70%], anxiety [73%], helplessness [70%], displaced aggression [50%] and insecurity [36%]. Psychological factors identified in children as a secondary outcome were aggression [80%], rebellious behaviour [75%], lack of confidence [70%], lack of social interaction [70%] and paranoid tendencies [60%]. Psycho-social and economic factors are important determinants of neglect. A holistic approach and intervention at multiple levels is required to address these issues

Implementing WHO feeding guidelines for inpatient management of malnourished children

To evaluate the efficacy of adopting WHO feeding guidelines on weight gain and case fatality rate in malnourished children. Cross-sectional, observational study. Department of Pediatrics, Dow University of Health Sciences, Karachi, from 2009 to 2010. Patients above 6 months and less than 5 years of age with severe malnutrition were included during the study period, acute complications were treated and nutritional rehabilitation by WHO feeding formulae was done. Demographic details, clinical features, reasons for weight gain and risk factors of mortality were analyzed. A total of 131 children were included. Mean age of children was 22 +/- 18 months. There were 78% marasmic, 4% kwashiorkor and marasmic kwashiorkor 18% children. Resolution of edema took 8 +/- 4 days, dermatosis cleared in 11 +/- 3 days. Mean hospital stay was 10 +/- 8 days. Case fatality rate was 13%. Mean weight gain was 5.25 +/- 4.57 g/kg/day. Weight gain of > 5 gm/kg/day was associated with hospital stay of more than 7 days, acceptability and palatability of feed by the children and mothers and early clearance of infections. Implementation of WHO feeding guidelines resulted in adequate weight gain of inpatient malnourished children, however, adequate healthcare services are available at the therapeutic feeding centers

Interferon- alpha treatment of children and young adults with chronic hepatitis delta virus [HDV] infection

To determine the response of one-year interferon-alpha therapy in hepatitis delta virus [HDV] infection in children and young adults at a tertiary care hospital, Karachi, Pakistan. An observational study. Sarwar Zuberi Liver Centre [SZLC], Medical Unit IV, Civil Hospital, Karachi / Dow University of Health Sciences [DUHS], from June 2009 to July 2010. Paediatric patients [< 18 years age] and young adults [18-35 years] presenting were screened for hepatitis B virus [HBV] and HDV sero-markers. HDV anti-body positive by ELISA were further screened for hepatitis D ribonucleic acid [HDV-RNA] by real time PCR. HDV RNA PCR positive patients were treated with INF- alpha [children 6 MIU/m2/day and adults 5 MIU/day] for a period of one year. Patients were assessed monthly. Haematological parameters and ALT were monitored during treatment. Clinical progress [side effects] and negative HDV RNA were used as response criteria. Overall 49 patients were HDV RNA positive [children: n=15, mean age 15 +/- 2.92 years adults: n=34, mean age 27 +/- 4 years]. Eighty percent were male. Treatment was given to 25 patients [children: n=11, adults: n=14]. HBV genotype D was the predominant in all HDV RNA positive patients [73%]. Eighty percent [20/25] were HDV-RNA negative after one year of treatment, and remaining patients are still under treatment. Side effects were tolerated well and children continued regular activity. Haematological parameters were unremarkable. Children maintained their pre-treatment centile for height and weight [growth parameters]. ALT levels were significantly decreased post-treatment. Conventional INF- was safe in children with HDV infection in terms of side effects and growth parameters. Eighty percent were HDV-RNA negative one year after treatment. Further follow-up 2 years post-treatment will give conclusive results

Nutritional rickets: correlation between clinical, biochemical and radiological profile

To determine the correlation between clinical manifestations, biochemical and radiological profile in children with nutritional rickets. This is a cross-sectional study conducted at paediatric ward of a private sector health facility, Kutyana Memon Hospital Kharadar Karachi. A total of hundred patients aged 2 to 36 months with clinical suspicion of nutritional rickets were included in the study. A detailed history and examination was done and relevant investigations including serum calcium, phosphate, alkaline phosphatase and X-ray wrist joints were done to confirm the diagnosis. Data was analyzed and presented as percentages and frequencies. There were 63% males and 37% females. Majority of children were between 6 to 18 months of age, [49%] followed by 2-6 months [44%] and 18 to 36 months [07%]. Rachitic rosary was the most frequent clinical feature observed in 87% followed by widening of wrist joints in 76% cases. Serum calcium was low in 90% cases and serum alkaline phosphatase was increased in all patients. Serum phosphate was either low or normal in 44% cases each. Radiological findings were suggestive of rickets in 54% cases. Clinical and Biochemical markers are reliable indicators for diagnosis of nutritional rickets, which is more frequent between 2 to 18 months of age

Applicability of scoring chart in the early detection of tuberculosis in children

To test the applicability of scoring chart to detect children suffering from tuberculosis. Case control study. The study was conducted at the Department of Paediatrics Unit-1, Civil Hospital, Karachi. Included in this study were 50 children in whom tuberculosis [TB] was diagnosed on the basis of history, physical signs, investigations and positive response to anti-tuberculous therapy. Also included in the study were 50 controls admitted with diagnosis other than tuberculosis. Modified Kenneth Jones Scoring Chart [KJSC] was applied to both the groups of children. These children were given a score of 0-7 or above according to the chart. The sensitivity of various parameters used in the KJSC was also tested in both the groups. A score of 1-2 [TB unlikely] was found in none of the cases versus 44% in the controls. Score of 5-6 [TB probable] was obtained in 40% of cases and none in the controls. Fifty-six percent cases had a score of 7 or more [TB unquestionable] versus 0% in controls. Contact with an adult suffering from tuberculosis, physical and radiological signs suggestive of tuberculosis and an exaggerated reaction to BCG vaccine emerged as the most important indicators used in the scoring chart to detect children with tuberculosis. The Kenneth Jones Scoring Chart is a simple cost-effective tool, which can easily be applied to improve the case detection rate in children. In the absence of a gold standard for diagnosing tuberculosis in children and in view of logistic and financial constraints faced by resource constraint countries, like ours, this simple screening tool can be utilized at the health care facilities

Percutaneous liver biopsies in children and assessment of its usefullness

Review of 80 percutaneous liver biopsies is done to determine the usefulness of this invasive procedure in the diagnosis of specific liver diseases. The biopsies were performed in children admitted with clinical suspicion of liver disease. Thirtyfive liver biopsies were done in children in whom there was clinical and/or biochemical suspicion of chronic liver disease. Though histopathological confirmation was possible in 82.86% cases, a clue to the underlying aetiology was reported in only 2.5% cases. Twentyeight children presented with unexplained hepatomegaly and/or splenomegaly. Liver function tests and routine haematological investigations were inconclusive. Storage disorders were detected on liver biopsies in 67.8% [19/28] cases. Prolonged recurrent jaundice was the indication for liver biopsy in eleven children. Severe intrahepatic cholestasis was the principal finding on histopathology of liver. The underlying aetiology was not determined on histopathology

Microcytic hypochromic anaemia: an unusual presentation of gaucher's disease in children

Seven cases of Gaucher's disease presented with moderate to severe anaemia and marked splenomegaly. These children were initially suspected of suffering from haemolytic anemia. Preliminary haematological investigations revealed anaemia to be of the microcytic hypochromic type. Bone-marrow aspiration biopsy was characteristically alike in all cases showing changes due to iron deficiency or acute haemolytic process. Gaucher's cells were seen in the bone-marrow in two cases and in the spleen and/or liver in five cases. We did not find any association between microcytic anaemia and Gaucher's disease reported in the reported in the literature. We suggest that Gaucher's disease should be considered in the differential diagnosis of microcytic anaemia with marked splenomegaly

Liver abscess in children: not an uncommon problem

Thirty cases of amoebic liver abscess in children are being presented. Diagnosis was based on clinical presentation, ultrasound examination, detection of E.H. trophozoite in the aspirate and response to therapy. Aspiration of pus alongwith appropriate medication was found more appropriate management than medical therapy alone

Liver abscess in children

Liver abscess is a common condition in our paediatric population. It has high morbidity. There is a difference in management policy in various centres. The present article reviews the condition and updates the subject vis a vis management