ABSTRACT
Background: Diarrhoea still continues to be a major cause of hospitalization and death in under fives. Electrolyte disturbances play an important role in the associated morbidity and mortality. Acute renal failure is one of the important complications of acute gastroenteritis (AGE) in children. Early intervention and proper fluid replacement may lessen this risk. This study was designed to find out the incidence of acute gastroenteritis and the status of associated electrolyte derangements and renal involvement.Methods: This was a cross sectional study conducted at KIMS, Bengaluru in which 117 children from the age of 1 month to 5 years with acute diarrhea were included based on a predefined inclusion and exclusion criteria. Demographic profile of the patients, details of diarrhea, clinical examination and accompanying degree of dehydration (defined as per WHO criteria) were recorded. Serum electrolytes along with renal parameters were investigated.Results: Total 117 children with acute gastroenteritis were enrolled in the study as per the inclusion criteria which constituted 5% of total paediatric admissions. Children aged 1-12 months had the highest incidence of diarrhea (50%). Male to female ratio is 1.3:1. 65% had some dehydration, 19% no dehydration and 16% had severe dehydration. Isonatremia was seen in 58% followed by hyponatremia in 35% and hypernatremia in only 7%. 83% had isokalemia, hypokalemia in 12%, hyperkalemia in 5%. Levels of serum sodium and potassium decreased with the severity of dehydration. Serum urea and creatinine were significantly high in severe dehydration (p value 0.001). Out of 28 children who were given diluted ORS before admission, majority had hyponatremia (39%) and all of them who received concentrated ORS had hypernatremia.Conclusions: Hyponatremic dehydration is the second most common type of dehydration next to isonatremic dehydration, but it is more common in children who took diluted ORS. Increased awareness regarding ORS preparation may help in preventing electrolyte imbalance in AGE. The levels of serum sodium and potassium decreased and urea and creatinine increased with severity of dehydration. Measurements of serum electrolytes and renal parameters early can help to predict the complications due to AGE and may help in the prevention of diarrhea related complications in children.
ABSTRACT
Background: Dengue, an endemic disease in most subtropical and tropical regions of the world is causing severe epidemics in India. An alarming rise of dengue has also been seen in India during the recent years. Majority of dengue viral infections are self-limiting, but complications may cause high morbidity and mortality. Present study was undertaken with an objective of describing various clinical presentations as noted in our cohort of dengue patients and to evaluate the outcome of dengue fever.Methods: This retrospective study included all confirmed dengue cases below 18 years age admitted to Paediatric department of KIMS, Bengaluru over a period of 1 year in 2019. Medical records were reviewed and analysed. Those diagnosed to be positive for dengue serology (NS1 or IgM) were included in our study. Dengue was classified according to the WHO guidelines into 2 groups, Dengue fever (without/with warning signs) and Severe Dengue. Clinical features, haematological, biochemical, radiological parameters, management and the outcome were assessed.Results: Out of 441 patients enrolled, 79% had non-severe dengue and 21% severe dengue. The commonest age of presentation was above 10 years with mean age of 8.68±5.25 years. Male to female ratio was 1.7:1. 60% presented within 4 to 7 days of illness (mean 4.26±1.72 days). Majority presented with fever (88%). 47% had vomiting and 31% abdominal pain. Bleeding manifestations were seen in 18%. Dengue serology was positive for NS1Ag (58%), IgM (21%), mixed (21%). Thrombocytopenia and leukopenia seen in 82% and 39.45% respectively. The association between dengue serology and platelet count was statistically significant (p value 0.001). 46% had raised SGPT. 31% had evidence of plasma leakage. The case fatality rate was 0.2%.Conclusions: High grade fever, vomiting, abdominal pain and bleeding manifestations with normal or low platelet count were the presenting features. Early diagnosis, monitoring and prompt supportive management can reduce mortality.
ABSTRACT
Background: Febrile seizure is the most common type of seizure disorder that occurs in children aged 6-60 months. Recurrences are common. This study was conducted to evaluate the epidemiology, clinical profile and laboratory parameters of children presenting with febrile seizure in a teaching hospital.Methods: This was a descriptive retrospective study among children presenting with febrile seizure admitted to KIMS, Bengaluru from March (2018-2019). Children between six months to five years were included in the study while patients with prior episodes of afebrile seizures, abnormal neurodevelopment and not meeting the age criteria were excluded. Patient’s demographic and clinical data were collected from the in-patient records and analysed.Results: Among 60 children with febrile seizures were enrolled in our study with highest prevalence in males (58%) and amongst 13-24 months age group (37%). Majority (20%) presented in the monsoon season (June) and in the morning hours (43%). Simple febrile seizures and complex febrile seizures were observed in 60% and 40% respectively. Majority (73%) who developed first episode of seizure were below 24 months ago with mean age of 18.71±11.50 months. 42% had recurrence and was significantly associated with first episode of febrile seizures at age ≤1 year and family history of seizures. Upper respiratory tract infections were the commonest cause of fever. Anaemia and leucocytosis were seen in 72% and 70% cases respectively.Conclusions: Febrile seizure was observed predominantly in children below two years, simple febrile seizure being the commonest. Recurrence was common and significantly associated with the first episode of febrile seizure at the age one year or below and family history. Majority had anaemia which showed that iron deficiency anaemia could be a risk factor. Leucocytosis was present in most which could be either due to underlying infection or due to the stress of seizure itself.
ABSTRACT
Background: The changing pattern of antimicrobial susceptibility of bacterial pathogens causing acute UTI is a growing problem. Hence, the knowledge of the local pattern of urinary pathogens and their susceptibility to various antimicrobials is of atmost importance for selection of the appropriate empiric therapy for children with acute UTI.Methods: This retrospective cross-sectional study was conducted in 208 children of 1-18 years age group with suspected UTI infection who were admitted in KIMS hospital, Bangalore from January to December 2018. The data of all samples were collected from medical record.Results: Overall 208 children between 1-18 years with suspected UTI were screened. Out of which 48 were culture positive, with a prevalence of 23%. Culture positive UTI was predominantly found in males in 1-5 years age group as against female predominance in 6-18 years age group. E. coli (45.83%) was the commonest organism isolated in our study, followed by Enterococcus (31.25%), Klebsiella (16.67%), Proteus (4.17%) and Acinetobacter (4.17%). Antibiotics with highest sensitivity to E-coli are Amikacin (91%) and Gentamicin (77%). Klebsiella is most sensitive to Gentamicin (87.5%) and piperacillin (75%). Enterococcus has highest sensitivity to Vancomycin (67%) and Linezolid (60%).Conclusions: It requires regular monitoring to determine the current status of resistance against antimicrobial agents. The use of antimicrobials must be restricted in order to decline the resistance and we suggest that empirical antibiotic selection should be based on the knowledge of local pattern of bacterial organisms and their susceptibility to various antimicrobials rather than on universal guidelines.