Experience of malaria in children of a flood affected area: a field hospital study

To determine the frequency of malaria among children presenting with fever in a flood affected area, and the frequency of Plasmodium vivax and P. falciparum among cases, this cross-sectional study was conducted from 1 September 2010 to 15 January 2011 in the Australian Field Camp and Ehsas Field Hospital, Kot Addu, Muzaffargarh District, Southern Punjab, Pakistan. Each febrile child aged >/= 15 years fulfilling the clinical case definition of suspected uncomplicated malaria was investigated by rapid diagnostic test. Of 20 288 children examined, 3198 [16%] febrile patients fulfilled the clinical case definition and 2406 [75%] cases were positive for malaria. P. vivax, P. falciparum,and co-infection were present in 1562 [65%], 759 [31%] and 85[4%] cases respectively. P. vivaxwas the most prevalent species followed by P. falciparum.Twenty seven [4%] cases of P. falciparumfulfilled the case definition of cerebral malaria. The age group most affected was 5-9 years [41%]

[ efficacy of amlodipine and diltiazem in cyclosporine dose adjustment with respect to trough and 2-hour concentrations in kidney transplant patients]

Hypertension, hyperuricaemia and nephrotoxicity are some common side-effects of Cyclosporine A [CsA] treatment in renal transplant recipients. Previous studies suggest that Calcium Channel Blockers [CCB] can increase serum level of CsA and may improve graft function in patients receiving CsA. The aim of this study was to evaluate the effects of Diltiazem and Amlodipine on cyclosporine dose adjustment with respect to trough and 2-hour concentrations in renal transplant recipients treated with CsA. This observer-blind randomized clinical trial was performed on 120 renal transplant recipients treated with CsA. Patients received either Amlodipine [5-10mg/day] or Diltiazem [90-180mg/day] for 3 months and were compared with control group receiving no CCB. Data were analyzed using ANOVA, Post Hoc and Correlation tests. Diltiazem significantly decreased CsA dosage [20%] from 162.03 +/- 40.6 mg/dl to 128.5 +/- 25.5 mg/dl [P=0.000] and Amlodipine, too, decreased it to 140.5 +/- 22.3 mg/dl [13%] which was significant [P=0.008]. Trough concentration in patients who had received Amlodipine were significantly higher than control group [P=0.019]. Diltiazem significantly decreased Cholesterol Level [P=0.027] but other parameters were not significantly different between Amlodipine / Diltiazem and control groups. Diltiazem and Amlodipine were well tolerated in co-administration with CsA with no adverse effect on graft function and did not affect blood pressure or heart rate. Our findings support that these two CCBs can be used in clinical settings to reduce the administered dose of cyclosporine

Hypocalcemia and nutritional rickets in children: common etiological factors

Hypocalcemia can be defined as a state when serum calcium level is less than 7 mg/dl in preterm neonates and less than 8 mg/dl in term neonates and less than 8.5 mg/dl in older children. Nutritional rickets is commonly associated with rickets in children. To determine the common etiological factors of hypocalcemia and nutritional rickets in children. Cross sectional analytical study. This study was conducted in the department of Pediatrics, King Edward Medical University/Mayo hospital Lahore from March 1998 to January 2001. 120 patients [2 months to 60 months] who presented with tetany, clinical and skeletal manifestations of rickets and seizures were included in the study. Biochemical profile [serum calcium, phosphate and alkaline phosphatase] and radiographs of wrist joint were done. Each child was accessed for age, sex, feeding pattern, exposure to sunlight, number of children in family, maternal age, educational sta tus of mothers, presenting features of the disease, total calcium, phosphate and alkaline phosphatase level in the serum and X-ray wrist. The study group comprised of 120 children [72 boys and 48 girls] ranging from 2 months to 3.5 years. 65% of the children had weight below 5th centile on National Center for Health Statistics charts. 32% of children got sunlight exposure for less than 30 minutes/week and 16% got it for 30-120 minutes/week. Out of total 120, 110 were below 2years among these 110, 9% were exclusive breast fed, 35% got diluted fresh milk, 1% got formula milk and 13% got both breast and bottle feeding. In 45% children weaning was not started. 47.5% couples had 2 or more children. 72% mothers were below 30 years of age, at the time of interview. 31% of the mothers were uneducated. 85% children had seizures at the time of presentation. Out of these 24.51% had upper respiratory tract infection and 51.96% had lower respiratory tract infection 79% had clinical signs of florid rickets. 67.5% of patients were had serum calcium between 6 and 7mg/dl, 69% were had serum phosphate level < 4 mg/dl and 76% had alkaline phosphatase level >1000IU/L. Hypocalcemia represents a major health problem in Pakistani children. Infants under 2 years of age are liable to have vitamin D deficiency rickets particularly if they are exclusively breastfed or received fresh milk with reduced exposure to sunlight. The higher the level of education of mothers, the less likely is the chance that their children become rachitic. Hypocalcemia can present with a wide variety of symptoms, the most important of which are seizures and recurrent chest infections. Rickets must be looked for as an underlying cause of these complaints

Simple repair is sufficient for most injuries to the duodenum - a case series of 23 patients

Duodenal injury is the most important hollow viscus injury in the abdomen. The study analysed the outcome of duodenal injuries at the unit. Prospectively collected data on a case series involving 23 patients over 3 years. It involved demographic details, part of duodenum injured, injury severity according to the AAST, injury-operation time lag, mode of repair, and the extent of significant associated injuries. M:F ratio was 4.75:1. Mean age 33yrs. Patients with non-perforating injury were excluded. All were operated by a senior registrar or senior. 7/23 were blunt, 13/23 firearm and 3/23 stab injuries. D2 was involved in 87%. Injury severity was graded according to AAST [American Association for Surgery of Trauma]. 17/23 were Grade II/III, 3 Grade IV and 3 Grade V injuries. Four had injury-operation lag of >18hrs. Two injuries were missed. All injuries up to Grade IV had simple repair. Two of them had T-tube duodenostomy. None had pyloric exclusion. Complex repairs wer e required for 3/23 patients. Five patients died, as a result of associated insults. One delayed repair developed duodenal fistula. Intra-abdominal abscess, septicaemia and wound dehiscence were seen in two patients each. Duodenum-related mortality was zero. Adverse prognostic factors towards morbidity were injury severity >GIII and injury-operation lag >18hrs. The mortality was related to associated injuries. Primary repair is sufficient for most non-resectional duodenal injuries

clinical audit of management of peripheral vascular injuries

This is a retrospective analysis of the management of 21 cases with vascular injuries who presented in the Casualty Department of Mayo Hospital in the period from September 1993 to September 1995. Evaluation of results and comparison with other studies is presented. The mean age of the patients was 26 years with a male to female ratio of 20:1. Femoral vessels were the most frequently involved and gun shot was the commonest mode of injury. Ligation of vessel was done in six where as 15 cases underwent repair. Disruption of repair occurred in 4 cases out of which two underwent amputation. There is one mortality in 21 cases. Successful management depends on meticulous surgical technique, team work and prompt repair

Mandatory exploration in the management of penetrating neck trauma

A retrospective analysis of 16 cases of penetrating trauma to the neck admitted in a surgical unit of a teaching hospital, is done to determine the role of mandatory exploration in penetrating trauma and to define measures that improve the outcome. Nine cases had zone I injury and five cases had Zone II injury and all of them underwent exploration. Two cases had Zone III injury and were successfully managed conservatively. There is a negative exploration rate of 7%, and a mortality rate of 6.1%. In all cases who had neck exploration vascular injury was present in all three cases who presented with shock. Laryngotracheal injury was the commonest visceral injury whereas, surgical emphysema was present in 25% of the cases followed by infection of chest and the tracheostomy site [6.1%]. Haemodynamically stable patients with Zone III injury can be managed conservatively but definite exploration should be done in all Zone II injury