Seasonal variation of childhood acute poisoning

Acute poisoning is a common medical emergency in paediatric unit. This was a retrospective study to see the seasonal variation of acute poisoning in children in a tertiary hospital. The study was done in Khulna Medical College Hospital from January 2004 to December 2005. The cases were studied to see the seasonal variations and other epidemiological and clinical parameters. One hundred ninety three patients enrolled in the study were divided in four groups. Prevalence and type of poisoning was observed in winter, spring, summer and rainy seasons respectively. A total of 193[4.7%] cases of childhood acute poisoning were admitted. Out of them 107[55.4%] cases were male and rest 86[44.6%] were female. 1-3 years was the most vulnerable age group to be affected [P<.005]. Kerosene was the commonest form of ingredient used. Poisoning cases were more common during summer season [P<.005]. Overall mortality rate was 4.66%. Poisoning was common during the summer season and kerosene was found to be most common ingredient. It was possibly due to easy availability of kerosene and during the summer months thirsty children took this substance which was sometimes kept in the discarded container of soft drinks and mineral water bottles etc. People should be warned not to keep these toxic ingredients in such containers and within reach of the children

Leukemia mimicking juvenile rheumatoid arthritis

Leukemia is the most common childhood cancer and acute lymphoblastic leukemia [ALL] represent about 75% of all cases. All patients who present with arthritis should have thorough investigations otherwise early diagnosis may be missed. This study describes four patients which presented with arthritis but later on they were diagnosed to be suffering from leukemia

Clinical course and outcome of intraventricular haemorrhage in high risk neonate

To ascertain the clinical course of intracranial haemorrhage and to determine the short-term outcome of the affected baby. Design: This is a cross sectional prospective study. Setting: Neonatal Ward of Khulna Medical College Hospital for a period of 15 months from January 2002 to March 2003. Subjects: All the high-risk newborns admitted in Khulna Medical College Hospital were enrolled for this study. Low birth weight and perinatal asphyxia were regarded as the high risk factors. Main outcome variables: Clinical features in relation to severity of haemorrhage and short term outcome. Twenty-one children [17.8%] out of 118 high-risk newborn developed intraventricular haemorrhage. Among 81 low birth weight babies 19 [23.5%] suffered from intraventricular haemorrhage. The commonest symptoms were refusal to suck; lethargy and signs were poor reflex and convulsion. Ten babies [47.6%] died within first two weeks of life and five recovered fully. The remaining 6 [28.6%] babies developed neurological sequleae. The natural course and prognosis of babies with intraventricular haemorrhage can be monitored with clinical feature along with the aid of cranial ultrasound

Use of misoprostol for induction of labour in unfavorable cervix in eclampsia

To find out safety and efficacy of Misoprostol in cervical ripening and induction of labour to achieve vaginal delivery Design: Prospective observational study Setting: Dept. of Obstetrics and Gynecology, Khulna Medical College, Bangladesh Patients Et From January 2002 to December 2003, 5197 obstetric patients were received for delivery. This included 251 eclampsia patients. Out of the 251 Eclampsia patients, 81 patients [Primigravida 49 and multigravida 32] with unripe cervix were selected for induction of labour using Misoprostol tablet 1/4 th mixed with K-Y Jelly. Misoprostol application was stopped after third dose if there was no progress in cervical dilatation or effective uterine contractions and patients were taken for caesarean operation. From Misoprostol insertion to delivery time was 4-24 hours. Vaginal delivery was achieved in 80.2%, which included spontaneous, forceps and vacuum extraction. Caesarean section rate was 19.7%. Indications for C. Section included Misoprostol unresponsiveness 11% and fetal distress in 8.6%. Oxytocin augmentation was required in 32% of cases. Term babies were 58%. Intrauterine death and neonatal deaths were 9.8% and 8.6% respectively. Hyper stimulation and postpartum haemorrhage was seen in 2.4% and 3.7% of patients respectively Conclusions: Intravaginal Misoprostol is well tolerated and is very effective for the induction of labour in eclampsia. It helps vaginal delivery in toxemic patients, reduces maternal morbidity, mortality and hospital stay

Salbutamol Versus Theophylline for Wheezy Infant

OBJECTIVE: To compare the tolerability and efficacy of salbutamol and theophylline in treating wheezy infant. DESIGN: This was a prospective parallel group study. SETTING AND SUBJECTS: Wheezy infants admitted in paediatric ward of Khulna Medical College Hospital from January 1998 to March 1999. MAIN OUTCOME VARIABLES: Palatability of drugs, clinical efficacy of drugs and adverse events during treatment. Ninety-five patients had undergone this study. Forty eight were was in salbutamol group and 47 in theophylline group. Clinical problem at the beginning was recurrent wheeze [46.3%], wheeze with fever [32.6%] and spasmodic cough [21.1%]. Salbutamol was more palatable [P < 0.001] than theophylline. However efficacy of both the drugs were nearly equal [P > 0.1]. Adverse effect was more frequent in theophylline treated children [47.4%] than in salbutamol group [24.4%]. Salbutamol is better tolerated than theophylline whereas both the drugs were equally effective for bronchodilation in infancy

Quinolone induced arthropathy in adolescents and adults

To ascertain the incidence, clinical pattern and outcome of arthropathy in adolescents and adults induced by different quinolones. Cases of enteric fever treated with different quinolones having no previous history of joint disorders who developed arthropathy and improved well with conservative treatment were labelled as quinolone induced arthropathy. In-patients of Rajshahi and Khulna Medical College Hospitals and private clinics of the authors. Four hundred and three cases of enteric fever were treated with various quinolones during the period January 1995 to June 1999. Main outcome measures: Clinical characteristics, incidence, relation with quinolones used and outcome of quinolone induced arthropathy. The age of the 403 [males 260 and females 143] patient ranged from 13-60 years. They were treated with either ciprofloxacin, pefloxacin or ofloxacin. Out of them 31 [7.7%] patients developed arthropathy. It was highest with pefloxacin [12.5%]. The arthropathy was maximum [11.8%] in the age group of 11-20 years. Patterns of arthropathy were oligoarthropathy [23], polyarthropathy [7] and monoarthropathy [1]. Although quinolones use is not advocated in children for development of arthropathy, it also occurs in adolescents and adults in considerable number of cases. It improves well with conservative treatment without residual effect

Cerebral palsy and the role of physiotherapy

To find out the clinical pattern of cerebral palsy and role of physiotherapy in its management. Design: A prospective study of 35 cases over a period on one year [July, 95-June, 96] Setting: Physiotherapy department of Rajshahi Medical College Hospital, Rajshahi. Subjects: Thirty five cases under five years of age attending the physiotherapy department. Main outcome measures: Clinical variants, associated problem, progress in motor function and the determinant of progress. Majority [77.1%] of cases were spastic in nature. Mental Retardation [51.4%] was the most frequent association followed by epilepsy [34.2%]. Significant improvement were noticed in 71% cases although motor function progressed in 25% children. The prognosis of disease were directly related with age of insult to the brain. Delay in starting the therapy resulted in poor chance of recovery. Physiotherapy can contribute substantial improvement to the cerebral palsy cases. Early diagnosis and physiotherapy increase the chance of improvement