ABSTRACT
Background: Acute respiratory infections constitute one of the principal causes of morbidity and mortality in children less than five years of age in developing countries. For logistic reasons, WHO recommended case management is structured towards treatment as pneumonia in preference to acute asthma. It is warned that wheezing can occur during pneumonia and therefore, care must be taken when treating wheezing not to miss treating pneumonia with an antibiotic. Current WHO ARI CASE MANAGEMENT guidelines, in a child presenting with cough and rapid breathing, there is a predilection for over -treatment of pneumonia and under treatment of asthma.Methods: Totally 245 children were included in the study. They were classified into asthmatic and LRI prone with the help of simple predictors.Results: The combination of fever, chest indrawing and persistent tachypnoea after bronchodilator has an excellent specificity of 96.12% in predicting the presence of pulmonary infiltrate. The presence of more than two episodes of similar respiratory distress, previous H/O of nebulization and family H/O asthma, either alone or in combination may point more towards asthma as a cause of cough and respiratory distress.Conclusions: In a child presenting with cough and fast breathing with a previous similar episode, trial nebulization can be given before investigating further for pneumonia.
ABSTRACT
Background: Phototherapy is safe and effective in neonatal hyperbilirubinemia. Despite its worldwide application, questions regarding methods of optimizing efficacy remain unanswered, turning the infant is believed to be one of the methods to improve. Severe neonatal hyperbilirubinemia is associated with kernicterus, condition characterized by athetoid spasticity, gaze and visual abnormalities, and sensory-neural hearing loss. It may also be associated with mental retardation. Aim of this study was conducted to compare the efficacy of intermittent with continuous phototherapy.Methods: Study was conducted in 100 neonates from February 2018 to July 2018 in Sree Balaji medical college and hospital. Inclusion criteria were weight >2000 grams, absence of other concomitant diseases, and hyperbilirubinemia not requiring exchange transfusion. The neonates were randomly divided into two groups. Continuous phototherapy group received phototherapy on and off for 2 hours and half an hour respectively and the intermittent phototherapy group on and then off for one hour. Serum total bilirubin levels were measured in every 36 hours.Results: Mean age of the patients was 3.89'1.83(p=.91) days, mean baseline bilirubin was 17.56mg/dl'1.42 (p=0.36), while the mean follow-up bilirubin was 12.85mg/dl'1.65 (p=.95), and the mean difference between the baseline and follow-up bilirubin was 4.7 mg/dl'1.19 (p=.32). For group A and B babies, the mean difference between the baseline and follow-up bilirubin was 4.78 mg/dl'1.20 (p=.32) and 4.63mg/dl'1.18(p=0.32) respectively. The difference between the mean age, mean baseline bilirubin, mean follow-up bilirubin, and the mean decrease in bilirubin for both the groups was statistically not significant.Conclusions: Intermittent and continuous phototherapies were found to be equally effective for reducing neonatal hyperbilirubinemia.