Psittacosis: rare respiratory problem in children

Psittacosis is a rare disease particularly in children with usual presentation of respiratory and constitutional symptoms. The cases may remain undiagnosed or diagnosis may be delayed because of lack of awareness among the paediatricians and physicians. Early diagnosis is very important as this is potentially curable and preventable disease. An interesting case of psittacosis is being reported here, which has been treated successfully with azithromycin

Outcome of pediatric kidney transplant: an experience from Lahore

Objective: to analyze demography, clinical profile, complications and outcome of children after kidney transplant

Methods: eleven patients [6 boys and 5 girls] who underwent kidney transplant from September 2008 till September 2013 were included in the study. Retrospective analysis of their record was done

Results: a significant improvement in growth parameters, hemoglobin level, cardiac function, and blood pressure and bone diseases was noted after kidney transplant

Conclusion: kidney transplant is treatment of choice for patients having irreversible kidney disease progressing toward end stage kidney disease. It is a superior modality offering not only excretory function but also metabolic, endocrine, erythropoitic and acid base and mineral homeostasis

Effectiveness of nebulized N-acetylcysteine solution in children with acute bronchiolitis

Objective: To evaluate the effectiveness of nebulized mucolytic therapy [N-acetylcysteine] in treatment of children with acute bronchiolitis. Study Design: Prospective randomized, controlled study. Place and Duration of Study: Paediatric Medical Unit of the Children's Hospital and the Institute of Child Health, Lahore, from November 2011 to April 2012

Methodology: All the patients aged 2 months to 24 months, with the diagnosis of acute viral bronchiolitis were enrolled in the study. A predesigned proforma was completed after taking parental consent. All eligible patients were randomly assigned to one of the two groups: group-1 received N-acetylcysteine in nebulized form, and group-2 received salbutamol as a nebulized aerosol. Both groups were then compared regarding their clinical improvement and duration of stay in the hospital. The data obtained was analyzed on the statistical software SPSS version 16. Descriptive statistics were obtained by frequencies and percentages. Chi-square test was applied to find p-value

Results: A total of 100 patients met the inclusion criteria. The mean age was 3 months. On the first day of treatment, the mean clinical severity score at baseline were 5.38 +/- 2.62 in group-1 and 4.68 +/- 2.2 in group-2. At day 3 and 5, it was 2.9 +/- 1.48 and 3.30 +/- 1.77 in group-1 and 0.88 +/- 1.08 and 1.90 +/- 1.32 in group-2 respectively. The clinical severity score after N-acetylcysteine inhalation therapy was better in group-1 on the third but more so on fifth day after hospital admission. The mean duration of hospitalization was 4.67 +/- 2.2 days for the whole population and it differed between the 2 groups: 4.36 +/- 1.66 days in group-1 versus 4.98 +/- 2.6 days in group-2

Conclusion: On the basis of improvement in clinical severity score and early discharge from the hospital, N-acetylcysteine was found to be an effective therapy in acute bronchiolitis

Caffey's disease in an infant

Caffey's disease is a self limited disorder of infantile age group. It is synonymous with 'infantile cortical hyperostosis' and 'Caffey's-Silver syndrome'.It is characterized by fever, irritability, bone pain and characteristic bony changes. It has no definite etiology. This report describes a 4 months old infant presenting with fever, irritability and soft tissue swellings. Investigations led to the diagnosis of Caffey's disease. Symptomatic treatment was given to good clinical response

Maternal education and impact on child health care practice in most common 5 admissions in pediatric medicine

1] To determine the frequency of top five diseases among children presenting in pediatric medical unit. 2] To find out the association of maternal education with Feeding practices, immunization and nutritional status in children with these diseases

Materials and Methods: It was a prospective observational study conducted in medical unit of the Children's hospital and the institute of child health Lahore from February 2009 to April 2009. Total 175 patients age betweenl month to 5 years were enrolled in the study. Data was collected after an informed consent from the mother. A predesigned Performa was filled for every patient, which included history and examination

Results: Among 175 patients, there were 64% male and 36% female. Regarding age distribution 92 patients were between 1 month-2 years and 83 were in the age group of 2 - 5 years. The most common cause for hospitalization was acute lower respiratory tract infections like bronchopneumonia/lobar pneumonia and bronchiolitis [30.8%], acute watery diarrhea [18.85%], meningoencephalitis [bacterial/viral/tuberculous] 12%, tuberculosis [pulmonary/Skeletal] [9%] and malaria [4.5%]. Other less common diseases were enteric fever [4%], febrile seizures [4%], urinary tract infections [3.4%], metabolic seizures [3%] and measles [2.28%]. Amongst patients, 18.3% did not receive any vaccination, 39.3% were partially immunized while 74% were fully immunized according to EPI. After inquiry it was found that only 2% of the mothers fulfill the criteria for clean feeding practices and rest of 98% were otherwise. Only 15% of patients were adequately weaned and 28.3% were exclusively breast fed. It was found that 107 patient [61.2%] belonged to low socio-economic class while 65 [37.1%] came from low middle class income group while only 3 patients [1.7%] belonged to upper middle class family

Conclusion: Great emphasis is needed for improvement of primary health care, immunization, and promotion of breast feeding as well as hygienic practices. In resource compromised country like Pakistan strengthening of primary health facilities and education of women appears to be the only way forward if reduction in disease burden and morbidity has to be achieved

Childhood Hodgkin's lymphoma: treatment, outcome and complications of 44 cases

To determine response to different treatment protocols, complications, outcome of cases of Hodgkin lymphoma. Observational descriptive study. Department of Pediatrics, King Edward Medical College/ Mayo Hospital, Lahore. 44 patients who were diagnosed as Hodgkin lymphoma were included in the study. Response to therapy, complications and outcome of disease was recorded on a predesigned proforma. Out of 44 patients of histologically proven Hodgkin's Lymphoma there were 40 boys and 4 girls. The mean age was 7.34 years. Most of the children were in advanced stage [stage III - 50%, stage IV - 20.45%]. Mixed cellularity was the commonest histology subtype [68.19%]. Chemotherapy protocols given to these children were: ABVD - 53%, ChlVPP - 23%, VVAP - 115, ChlVPP-VVAP-9% and ABVD-VVAP- 2%. Involved field radiation was given in 10 cases that had bulky disease. Infections of all grades were the most common complication observed [Staphylococcal sepsis - 5, chicken pox - 3, pulmonary tuberculosis - 3 and upper respiratory tract infection - 8]. Alopecia and leucopenia were the next most common complications. Out of 38 children who completed therapy at the end of the study 29 are in complete remission, 2 have relapsed, one expired and 6 cases were lost to follow up. Overall survival was similar to develop countries. Infections, alopecia and myelosuppression were the commonest complications