ABSTRACT
Background: Frequency of nutritional rickets, its clinicobiochemical profile and its relationship to the lower respiratory tract infections in indoor patients from 2 to 60 months of age.Methods: Children aged 2 to 60 months admitted for the first time were included in the study and divided into two groups i.e. with and without clinical signs of rickets. Disease profile was studied in both groups. Incidence of lower respiratory tract infection was compared between two groups. Children with clinicoradiological signs of rickets were also investigated for biochemical abnormalities.Results: During the one year study period a total of 393 children were admitted, 65 were found to have rickets constituted as study group and 328 were without rickets were included the controls. Rickets incidence was 16.5% of which majority (74.6%) were males and most rachitic children (64.6%) were below six months of age. Acute lower respiratory tract infection (64.6%) was commonest in study group and acute gastroenteritis (24.4%) in the controls. The rate of ALRTI was nearly three times in study group. Frontal bossing (67.7%) was most common sign of rickets and increased alkaline phosphatase (93.8%) was the commonest biochemical abnormality.Conclusions: Nutritional rickets, a multifactorial disease, is easily preventable. The present study has revealed the high incidence of rickets i. e., 16.5% and also show the strong statistically significant association of nutritional rickets with acute lower respiratory tract infections.
ABSTRACT
Background: Pediatric snake bite cases are frequently encountered at health care centers of Himachal Pradesh. It is a medical emergency which require early hospitalisation and immediate medical intervention. This study determines the epidemiological and envenomation details along with clinical profile and management of pediatric snake bite patients in Himachal Pradesh, India.Methods: This prospective clinico-epidemiologic study included 30 paediatric snake bite cases reported at Department of Paediatrics, IGMC, Shimla. Demography, envenomation details, first aid and treatment, antivenom administration and outcome were recorded for all patients.Results: Of the total 30 cases, 56.6% were males and 43.3% were females. All patients were resident of rural areas and most of them belonged to middle socioeconomic status. Most (56.7%) snake bites occurred between 6pm to 12am and peak time was during rainy season. More cases of hemotoxic envenomation were observed as compared to neuroparalytic envenomation. Most common hematologic abnormalities were hematuria (4.8%) and epistaxis (4.8%). Respiratory paralysis, ptosis and opthalmoplegia were the most common presentation in patients with neuroparalytic envenomation. Clinical profile of patients showed thrombocytopenia (26.7%), prolonged PT/INR (76.6%) and 36.7% had prolonged activated partial thromboplastin time. All symptomatic patients were given ASV as primary treatment out of which 79.2% patients required more than 10 vials of ASV. Most common complication observed in neuroparalytic envenomation was respiratory failure (33.3%) and in hemotoxic envenomation was coagulation failure (66.7%). Only 3.3% case fatality was observed in this study.Conclusions: Snake bite in children is a medical emergency in hilly state of Himachal Pradesh where people still follow traditional first aid methods and treatment protocol. A widespread awareness programme is needed to propagate the newly advised first aid methods to prevent mortality by early hospitalization and administration of ASV.