Evaluation of zinc status of preschool children as assessed by hair zinc level in Punjab province

To determine status of zinc in healthy children in some parts of Punjab province by estimation of hair zinc levels. Descriptive study [cross sectional survey] The study was organized at KRL Hospital from August 2004 to January 2005. Study samples were selected randomly from a larger study [To evaluate vitamin A status] carried out in 6 districts of Punjab. This community-based study was done in 6 districts of Punjab including Mianwali, Jhang, Attock, Multan, Pak Pattan and Faisalabad. The population selected was 1-5 yr old healthy children. Both male and female healthy children were included. Malnourished children with mid arm circumference <12 cm, children with skin and hair disorders, liver disease and prolonged illness were excluded from the study. After parental consent and filling up of questionnaire data, hair samples were collected. Relevant features like age, sex, dietary history and previous illnesses were recorded. Hair samples were taken, sealed in dry plastic bags and dispatched to Dr A Q Khan Research Laboratories [KRL] Kahuta where they were analyzed using atomic absorption spectrophotometery. Data analysis was performed through SPSS-10.0. Mean age of study population was 37.5 +/- 13.39 months and male to female ratio was 1:1.32. Hair zinc levels ranged from 69 to 227 micro gm/gm of hair. Mean hair zinc level was 164.79 +/- 53.7 micro gm/gm of hair. Majority of children [62] had an adequate zinc level, while 13 were identified with low zinc status [<100 micro gm/gm]. Hair zinc was not significantly higher in children with adequate dietary habits, similarly there was no association with age and gender. Majority of healthy pre-school children in the sampled districts of Punjab did not have zinc deficiency as assessed by hair zinc level. However about 1 in 10 children was deficient in zinc even in the healthy population

Comparison of diagnostic accuracy of non-invasive tests for helicobacter pylori infection in children

To compare urea breath and stool antigen in children, with hisotological diagnosis for helicobacter pylori [H.pylori] infection. Cross-sectional study. From June 2005 to December 2005 carried out at KRL Hospital, Islamabad and Children Hospital, PIMS, Islamabad. Children between 3 and 15 years of age reporting in pediatric outpatient department with upper gastrointestinal symptoms were included. All the participating children underwent an upper gastrointestinal endoscopy and 3 tests namely: histopathological identification of H.pylori [the traditional gold standard], urea breath test and stool antigen test were carried out on each child. The sensitivity, specificity, and positive predictive values were calculated for each noninvasive test used in the study. A total of 54 patients completed the study with a mean age of 8.2 years. On histological examination, 725 [39] were positive for H.pylori infection. On gross endoscopic examination, only 9 patients had signs of gastritis as compared to 39 histological positives. The sensitivity, specificity and positive predictive value of stool antigen test were: 77%, 73% and 89% respectively whereas the same for urea breath test: 79%, 80% and 91% respectively. Both the noninvasive tests were found to be sensitive and specific as compared with histological identification, for the diagnosis of H.pylori in our pediatric population. The accuracy of urea breath test was better than the stool antigen test but later was easier to perform and could fulfill the criteria for a rapid bedside diagnostic test

Serum zinc levels and effects of oral supplementation in pregnant women

To evalmicroate the effects of oral zinc smicropplementation on the sermicrom zinc levels of pregnant women. Experimental [domicroble blinded randomized controlled trial]. PIMS and KRL Hospital, Islamabad, and commmicronity in tehsil Kahmicrota from April 2003 to April 2004. Pregnant women of 10 to 16 weeks gestation were invited to enter the stmicrody on their booking visit. A sample size of 125 in each gromicrop was calcmicrolated. After taking an informed consent, they were assigned to control or test gromicrop by simple random sampling techniqmicroe. A detailed qmicroestionnaire was filled-microp by trained staff and initial evalmicroation along with sermicrom zinc samples was collected. The smicrobjects were given either zinc smicrolphate powder, eqmicroivalent to 20 mg elemental zinc, or were given placebo treatment along with romicrotine smicropplements. These patients were followed microp thromicroghomicrot the pregnancy by health care providers and their compliance was monitored. At delivery, sermicrom samples were again collected for zinc estimation. The data was entered on compmicroter, cleaned and analyzed. Paired t-test was microsed for comparison of means. The data of 242 smicrobjects was analyzed at the end of the stmicrody. The mean age of the stmicrody participants was 25.7 +/- 4.8 years [range 16 to 40]. Both the gromicrops were similar in other demographic variables as socioeconomic statmicros, edmicrocation, BMI, height and weight. One-third of the patients had sermicrom zinc levels below 64microg/dl at the start of the stmicrody. A 128 pairs of pre and post-sermicrom zinc levels were analyzed in the two gromicrops [64 pairs in each gromicrop] to compare the means. The zinc smicropplemented women showed a mean increase of 14.7 microg/dl [95% CI 5-23] [P=0.002]. On the other hand the non-smicropplemented gromicrop showed an actmicroal decrease in the sermicrom zinc level which, however, did not reach statistical significance [P=0.47]. Oral zinc smicropplementation of pregnant women with 20 mg elemental zinc was effective in raising the sermicrom levels of zinc. It is smicroggested that smicropplementation trials with larger dose of zinc shomicrold be carried omicrot

Clinical outcome in children hospitalized with complicated measles

To determine the association of clinical outcome of measles in children with demographic profile and complications. A cross-sectional analytical study. Isolation ward, The Children's Hospital, Pakistan Institute of Medical Sciences [PIMS], from January 2003 to August 2004. Detailed history and physical examination of all the hospitalized patients with complications of measles was filled in case report form. Immunization cards were assessed for measles vaccination status. Data was analyzed by using SPSS version 10 software. The clinical outcome of measles was compared with demographic profile and complications by using Chi-square test and p-values were obtained. Two hundred and five hospitalized patients with complications of measles were studied. There were 61.5% males. Mean age was 46.1 months and 57% patients were vaccinated against measles. Malnourished patients were 71.2% and had a longer hospital stay [p=0.010]. Pneumonia [40.0%] and diarrhoea [38.5%] were the commonest complications. Seven children died. Mortality was significantly associated with younger age [p=0.04], unvaccinated status [p=0.04] and presence of encephalitis [p=0.00001]. The most common complications of measles are pneumonia and diarrhoea with dehydration requiring hospitalization. Malnourished children experience more complications and have longer hospital stay. Mortality is significantly associated with infancy, unvaccinated status and encephalitis. A second dose of measles should be introduced at 15 months of age

audit of pediatric upper gastrointestinal endoscopies

One hundred upper gastrointestinal endoscopies were performed in 90 children [age ranging from 2 months to 12 years, Mean: 7 years 2 months] over a period of 18 months, by the pediatricians, at the adult endoscopy unit of KRL Hospital, Islamabad. We used an Olympus GIF N30 fibreoptic endoscope with an external diameter of 5mm. Fifty-four% of our patients were female where as the major indications were recurrent upper abdominal pain [n=36], chronic diarrhoea [n=28], short stature/failure to thrive [n=13], portal hypertension [n=5], and GI bleeding [n=3] and other [n=12]. Sixty-three endoscopies were carried out under general anaesthesia, 9 patients needed mild sedation and the rest of the 28 children did not need any sedation or anaesthesia. No complications were observed during or after the procedure. In total 67 antral biopsies, 60 duodenal biopsies and 5 sclerotherapies were performed. The histological diagnosis were gastritis [64%] of antral biopsies, coeliac disease [55%] and duodenitis [16.6%] incase of duodenal biopsies. Pediatric GI endoscopy is invaluable and can be successfully. Performed by pediatricians, in an adult endoscopy unit, at centers where separate pediatric setups are not available

Congenital heart disease in children admitted to children's hospital at Pakistan institute of medical sciences [PIMS]

The exact incidence and prevalence of congenital heart disease in children is not known in Pakistan, as most of reported studies are hospital based. Considering increased consanginous marriages in our societies, risk is certainly more than other developed countries. This study was planned to look at the incidence of congenital heart disease in hospitalised patients to look at type of lesions usually seen, age of presentation and prognosis. High ventriculo-septal defects are commonest acyanotic lesion and Tetrology of Fallots is common amongst cyanotic lesions. These are similar to lesions seen in the developed countries. Multiple factors affect the prognosis in children with congenital heart disease in Pakistan, some have been highlighted in this study. Data and analysis of 206 patients is presented here

new breakthrough in treatment of visceral leishmaniasis in children

Fifty cases of visceral leishmaniasis were admitted in Children's Hospital, Islamabad. Common clinical features were fever [100%], splenomegaly [100%], hepatomegaly [100%], anaemia [96%], abdominal distension [40%], bronchopneumonia [26%] and bleeding diathesis [22%]. Hb was below 7.0 G/dl in 80%, white cell count below 4x10[9]/c[mm] in 88% and platelet count below 100x10[9]/c[4mm] in 86%. All the patients showed leishmania donovani bodies in the marrow smears. Fourteen patients were treated with aminosidine [15 mg/kg], intramuscularly daily for 4 weeks. All responded dramatically and none of them went into relapse in a year's follow-up. No side-effects were observed. Aminosidine can therefore, be recommended as a treatment of choice for visceral leishmaniasis in children

Neonatal tetanus in Pakistan

Tetanus is caused by the spore forming gram positive, anaerobic organism clostridium tetani. It is a well known killer in neonates. In Islamabad this disease is especially seen in its Katchi Abadis. Over the past three years 88 patients of neonatal tetanus were admitted to the Children's Hospital, PIMS, out of which we were able to save sixty eight. Advanced and sophisticated techniques like intermittent positive pressure ventilation and endotracheal intubation helped to save patients who would probably have died if these facilities were not available. These measures are not available in most of the hospitals in a poor country like Pakistan. It is felt that, under the circumstances, a preventive programme consisting of immunization of women of child bearing age would be a more practicable and cost effective solution

Patent ductus arteriosus: our experience at PIMS

A series of 68 patients of patent ductus arteriosus is presented from the paediatric cardiology service of the Islamabad children hospital. Out of these, 12 patients did not respond to the medical therapy and underwent successful ligation of the ductus. There were no complications. Medical treatment of the rest of the children is also discussed

Antenatal bullet injury: an unusual cause of pneumothorax in a new born

Mrs. Ghulam Sughra 20 years of age was married to a policeman eleven months back. One day while her husband was cleaning his revolver, she was accidentally hit by a bullet in her abdomen. Intitiall she was managed by a general prectitoner who referred her to District Headquarter Hospital, Rawalpindi. She was in shock. Her pulse and BP were not recordable. A few pints of blood was immediately arranged and transfusion was started. On history and Physical examination she was found 38 weeks pregnant and was examined by the Obstetrician. The fetus was in diastress. Fetal heart beast were irregular and rate was more than 160 per minute. An emergency cesarean section was carried out about 18 hours after the injury and male baby was delivered. The bullet was found impacted in R[t] paravertebral muscles