Two cases of ambigious genitalia

The term "Ambiguous genitalia" applies to confusing appearance of the external genitalia. Sex assignment becomes essential for the parent's peace of mind, and in turn depends on anatomy and functional endocrinology rather than karyotype. Two cases with all different genetic sex, gonadal sex and phenotypic sex are described. First case is that of congenital adrenal hyperplasia [CAH] in a month old baby whose genotype was female with laboratory investigations exposing her diagnosis. She is doing well with oral hydrocortisone and fludrocortisone. Second case is that of probable 5-alpha reductase deficiency who would probably need future surgery

Recurrent abdominal pain in children

To determine the causes of recurrent abdominal pain [RAP] in children and suggest general management guidelines. It is a descriptive observational study conducted from August 2000 to July 2003.One hundred fifty two children of 2- 15-Years age with recurrent abdominal pain were enrolled in this study. A pre-designed proforma was filled and investigations like Complete Blood Count [CBC], urine and fresh stool analysis was performed in all cases. Patients presenting with upper abdominal pain with or without dyspeptic symptoms were evaluated for H. Pylon by serology. Helicobacter pylon antibody serology [value >50 i.u Elisa method] positive patients were offered endoscopy examination and endoscopic antral biopsies were done. Other tests like x-ray chest and or abdomen, barium meal study, ultrasonography of abdomen, EEG examination and tuberculin test were done as indicated. Patients were followed at 2-week interval for three months and specific treatment prescribed as per etiology identified. Out of 152 children, a female to male ratio was 2:1, age range was 2-15 years and mean age was 8.9 years. Mean duration of symptoms was 16 months. Patients presented with epigastric localization of pain 65%, 25% presented with 'whole' abdominal pain while 5% patients presented with pain in loins and 5% had pain in tower abdomen. Protozoal infections which included giardiasis and amoebiasis [33%] were the commonest association followed by Helicobacter pylon [31%]. Endoscopy was performed in 15 cases; biopsy was positive for H.Pylori in all [100%] cases. Thirteen percent had worms in addition to giardia and entamoeba histolytica and 10% had gastro-esophageal reflux. Among other causes urinary tract infection was 5%, constipation was 3% a peptic ulcer diseases was 02%. Abdominal epilepsy, abdominal migraine, cholilithiasis, ovarian cyst, ulcerative colitis and gastnic-trichobizoar all were less than 1%. Recurrent abdominal pain is frequent and challenging pediatric problem. High index of suspicion and careful thorough clinical evaluation supported by stepwise laboratory work-up according to it's clinical presentation and consideration of common treatable causes will be a cost effective approach. Balanced diet with higher fiber content, environmental cleanliness, better quality of water and good personal hygiene practices can reduce common infections with causative factors

Progressive familial intrahepatic cholestasis

A case of progressive familial intrahepatic cholestasis [PFIC] is described in a 7 years old girl who presented with pruritis and progressive jaundice alongwith failure to thrive. Laboratory indicated PFIC type 1 or 2 along with cirrhosis. Patient is responding to supportive therapy while liver transplantation is being awaited

Scleredema of Buschke in pediatric age group

Two cases of scleredema of Buschke are described, which occurred in pediatric age group - an uncommon occurrence after febrile illness. Both cases were self-limiting. Characteristic features are described

Helicobacter pylori - A correlation between symptomatology and endoscopy in children

Helicobacter pylori is a well known cause of peptic ulcer disease in adults, but its role in gastrointestinal diseases in children is not fully established. This is a retrospective study conducted in the Department of Pediatrics, Civil Hospital, Karachi from February 1995 to February 1997. The endoscopies record was reviewed to find out the correlation between symptomatology and endoscopic findings of 70 children tested for presence of H. pylori by urease, histopathology and/or culture of biopsy specimens. Among these children, 29 were found to be positive for H. pylori. The most frequent symptoms found in these children were, pain in epigastrium [17], followed by vomiting [10] and heartburn [9]. Other symptoms observed were, abdominal distention [3] hemetamesis [4] malena [2], diarrhea [2] and failure to thrive [1] children. Abnormal findings on endoscopy were found in 19 children: These included duodenal ulcer in majority of children 11[57%], gastritis in 3, gastric ulcer, duodenitis and gastric erosions were present in 2 children each. It was concluded that a significant correlation exists between symptomatology and endoscopy finding in peptic ulcer disease of Helicobacter pylori positive children

Acute otitis media in children

This is an observational hospital based prospective study of 6 months [Feb-Julyl 998] duration done to find out the frequency of acute otitis media [AOM] in children less than 2 years of age, to observe age specific symptomatology and to assess risk factors in children <15 years of age. Out of 7125 children coming to the OPD, 113 had evidence of AOM giving a frequency of 1.6 percent. These cases mainly concentrated in the less than 2 year old group [frequency 4.4 percent]. General symptoms were more frequent in the younger age group [<2 years] in contrast to the older age group [2-15 years] where more local symptoms were obvious. Out of the 113 cases many had multiple risk factors namely, bottle feeding, use of pacifiers, passive smoking, allergy, cleft palate, etc

Dominant malarial parasite species in hospitalized children in Nawabshah and chloroquine resistance

To observe dominant species causing malarial infection and to evaluate the incidence of Chloroquine resistant malaria in Children. Material and Clinically diagnosed cases of malaria admitted to Paediatric Unit at Nawabshah Medical College Hospital [NMCH] [N=144] and confirmed by detection of malarial parasite in peripheral smear during three year period i.e. January 1987 to December 1989. All patients received parenterally 50mg/ kg/course of Chloroquine over five days. Resistance was defined as persistence of clinical picture and malarial parasite in blood smear 48 hours or more after institution of specific therapy. Resistant cases were then treated with other available options. Seventy% cases of diagnosed malaria in children was caused by Plasmodium Falciparum species and Chloroquine Resistance [RIII] was found in twenty three% cases. Conclusions: Paediatricians and Practitioners should be sensitized to change in dominant species [Falciparum instead of Vivax] and high incidence of Chloroquine Resistant Malaria in Nawabshah Region and treatment strategies modified accordingly