ABSTRACT
Background and Objective: Infantile spasm [IS] is one of the severe epileptic encephalopathies which affect children in early two years of life. Our objective was to determine the clinical profile, etiology and outcome of treatment in children with infantile spasms attending tertiary care hospital at Karachi, Pakistan
Methods: This is retrospective study of 36 patients out of 94 registered as IS, aged three months to two years, managed and followed up at Aga Khan University Hospital, Karachi, from 2010 to 2015. Data of all children with IS was collected from case record. Details including clinical observations, lab investigations, anti-epileptic medications and treatment outcome was collected and analyzed. Patients who received treatment for six weeks to document response were included. The treatment response was categorized as complete response, partial response [>50% improvement] and no response. Data was analyzed on SPSS using descriptive statistics
Results: Thirty-six patients [38.29%] with IS fulfilled eligibility criteria. The mean +/- SD age at presentation was 4.6 +/- 2.1 months. Male to female ratio was 2:1. Consanguinity and developmental motor delay was observed in 66.6% and 89% respectively. Symptomatic etiology was predominant [61%] and hypoxic ischemic insult [32%] was the commonest underlying cause. EEG and MRI were diagnostic tools whereas metabolic studies were not helpful. Multiple antiepileptic drugs were used for seizure control and vigabatrin was the most frequently used [88%] drug. Short term treatment response was not different in idiopathic or symptomatic infantile spasms
Conclusion: Majority of patients had symptomatic infantile spasms and generalized tonic clonic along with myoclonic jerks were predominant seizure types. EEG and MRI were diagnostic in most of cases. Multiple AEDs were required to control seizures and VGB was most common drug [88%] used. Treatment outcome was not different in idiopathic and symptomatic groups
ABSTRACT
Objectives: First objective was to compare eGFR by Updated Schwartz [US] and Simple Height Independent [SHID] formula with Original Schwartz [OS] in children with Severe Acute Malnutrition [SAM]. The second objective was to compare eGFR in children below and above two years
Methods: This analytic study on estimation of GFR was based on retrospective data collected from 78 children with SAM at Nutritional Rehabilitation Unit from October 2014 - March 2015. Glomerular filtration rate was calculated using serum creatinine [S. Cr] and height in Original Schwartz, US and by age in SHID equation and compared with OS as standard. Data was analyzed using descriptive statistics
Results: There were 78 children in this study. Males were 39[50%]. Mean age of patients was 18+/-15.53 months with 62[79.48%] /=90ml calculated by US compared to OS [0.025] and by SHID with OS [0.04] in children below two years and no difference in children above two years. But there was no difference in other categories of eGFR calculated by either of formula in both age groups
Conclusion: We found a significant difference in eGFR in ranges above 90 ml/min/1.73 m[2] by US compared to OS as well as by SHID with OS in children below two years and no difference in children above two years. Also, there was no difference in GFR categories below 90 ml/min /1.73 m[2] calculated by either of formula in both age groups. So, we may conclude that either of formula can be used in clinical practice for eGFR in mild to severe renal dysfunction in severely malnourished children
ABSTRACT
Background and Objective: Pakistan accounts for the highest stillbirth rate in the world. Therefore, this observational study was planned to determine the prevalence of stillbirths and its associated demographic characteristics in the given context. Hence our objective included: To determine the frequency of stillbirths with reference to parity and gestational age in a tertiary care public hospital, Karachi. To determine the socio-demographic characteristics of families with stillbirths
Methods: All pregnant mothers who delivered stillbirth babies at Gynaecology and Obstetrics ward of Jinnah Postgraduate Medical Center, Karachi a tertiary care facility were prospectively enrolled from October 2012 to September 2013. Deliveries occurred before 28 weeks of gestational age were excluded. Gestational age was confirmed from hospital record and attending physicians. Data was collected on predesigned proforma and analyzed using descriptive statistics
Results: Among 7708 registered deliveries, 137 were stillbirths. A total of 84 mothers were primiparous and 12% of mothers were below 20 years at the time of delivery. Majority of stillbirths were macerated type [80.3%] and 20% were fresh stillbirth. About 55% of still births occurred between 33-37 weeks and 20% between 28-32 weeks. Almost 80%[109] of stillbirths were low birth weight and only 20%[28] were normal birth weight
Conclusion: This study shows that stillbirths are more common in primiparous mothers in a given context. Conducting awareness sessions with special focus on antenatal and obstetrical care of primiparous may be helpful to reduce still births
ABSTRACT
Objectives: The association of malnutrition and systemic diseases like chronic kidney disease [CKD] is well known. Various urinary tract abnormalities may be associated with malnutrition. So objective of current study was to determine the frequency of functional and structural urinary tract abnormalities in severely malnourished children admitted in Nutritional Rehabilitation Unit [NRU] of a tertiary care facility, Karachi
Methods: This descriptive cases series of 78 children was conducted in NRU from October 2014 - March 2015. All newly admitted children aged 2-60 months, diagnosed as Severe Acute Malnutrition [SAM] were studied and children with known kidney and urinary tract disorders were excluded. Detailed history, examination and investigations like serum creatinine, ultrasound kidney and urinary tract in addition to routine tests for SAM, were done. A proforma was used to collect demographic data, clinical history, physical findings, and radio-imaging and biochemical investigations. Glomerular filtration rate [GFR] was calculated using Schwartz equation. Data was analyzed using descriptive statistics
Results: Among 78 children, male to female ratio was equal. Mean age was 18+/-15.53 months and majority [79.48%] of children were below 24 months. Majority [82%] of children with SAM had marasmus whereas 18% had edematous malnutrition. Out of 78, 57 [73%] children had either functional [80.7%] and or structural [19.3%] abnormalities whereas 21[36.84%] had normal functional and structural status. Most common functional abnormality was subnormal GFR [<90ml/min/1.73 m[2]] found in all 46 children. Functional abnormities were more common in children below 24 months. Other functional disorders were Bartter syndrome, renal tubular acidosis and urinary tract infection [UTI] found in two cases each. Common structural abnormalities were echogenic kidneys [n=4, 36%], hydronephrosis [n=3, 27%], hypoplastic kidneys [n=3, 27%] and calculi [n=1, 9%]. Subnormal GFR was also found in all cases with structural abnormalities. UTI was observed exclusively in two children among 11 with structural abnormalities
Conclusion: A high frequency of functional abnormalities and noticeable proportion of structural abnormalities of urinary tract were detected in children with SAM. Current finding suggest that multicenter study at national level may be undertaken to generate better data about prevalence of renal diseases in SAM
ABSTRACT
To determine the spectrum of presentation, treatment outcome and prognostic factors of splenic abscess in a tertiary care hospital. Study Design: Case-series. Place and Duration of Study: Department of General Surgery, the Aga Khan University Hospital, Karachi, from July 1988 to July 2007. Methodology: The records of 27 patients with splenic abscess, diagnosed from 1988 to 2007, were retrieved through ICD-10 coding system. The demographic data, physical and radiological findings, treatment modalities, bacteriology reports, morbidity and mortality were collected on a proforma. There were 12 males and 15 females with a mean age of 43.52 +/- 17.49 years. Common symptoms were fever [92.6%], abdominal pain [55.6%] and malaise [29.6%]. Majority of patients [89%] had leukocytosis and 63% patients had associated diseases with which they were admitted. The most common pathogenic organism was Staphylococcus species and gram-negative rods. Ultrasound was used as a preliminary diagnostic modality, which was often followed by CT scan. Thirteen patients were treated with intravenous antibiotics, 8 underwent percutaneous drainage and 6 patients required splenectomy with respective survival rates of 84%, 87.5% and 83%. Mortality rate was 14.81% but no statistically significant difference between 3 treatment groups was manifested. There was significant difference between treatment groups regarding the size of the abscess [p=0.01] and hospital stay [p=0.04]. Splenectomy was done when abscess size was >10 cm and hospital stay were increased in the radiological drainage group. Splenic abscess is an uncommon surgical entity. High index of suspicion and liberal use of radiological studies is essential for timely diagnosis. Most of the patients could be cured with non-operative treatment. Splenectomy is a safe procedure for patients with abscess size more than 10 cm and patients not responding to non-operative treatment