Clinical spectrum and outcome of accidental poisoning in children

Childhood poisoning is an important health problem which is usually accidental and is responsible for serious morbidity with mortality all over the world. Accidental poisoning is the second most common cause of death in Iran. This descriptive study is designed to assess the clinical spectrum and outcome of poisoning among children. This study was conducted in Liaquat University Hospital Hyderabad over a period of one year from 1[st] January 2007 to 31[st] December 2007. A total of 62 children up to 12 years of age admitted for acute poisoning to children ward were included. The cases were studied to see the clinical spectrum, complication and outcome of the poisoning. In one year period a total of 62 children including 35 [56.45%] boys' and 27 [43.54%] girls presented with acute poisoning. Maximum number of cases with poisoning was seen in the age group 1-5 year. Kerosene oil was the commonest form of ingredient used followed by drugs. The most common systems involved were cultural nervous system [CNS], respiratory and GIT. Over the period 2 [3.22%] children died, one of them was poisoned by lice killer liquid and other by insecticide. Most of the cases of poisoning are due to common household products and drugs. It is therefore necessary to educate the population on preventive measure

Evaluation of breast feeding practices

The best first food for babies is breast milk. This study was conducted to assess the percentage of population having knowledge regarding benefits of breast feeding, exclusive breast feeding and ratio of mothers practicing it. This observational study was carried out from January 2008 to June 2008, in the vicinity of Isra University Hyderabad. A sample of 285 women who attended the Gynaecology antenatal clinics, living in the vicinity of Isra University, also lady doctors working there were enrolled by convenient sampling. A pre-designed questionnaire was filled by interviewing these women. The data collected was statistically analyzed and percentages recorded. Breast feeding was practiced in 278[97.54%] of the study population and only 7[2.45%] women did not practice it. 130[44.56%] of women were knowing about benefits of breast feeding and 155[54.38%] were not aware about the benefits. Among those knowing about the benefits, only 3.2% were fully aware, 67% were feeding for health of babies and 29.8% for prevention from diseases. Information regarding exclusive breast feeding was collected, 198 [68.70%] were practicing it and 87 [31.29%] were not exclusively feeding their babies. Time duration of breast feeding noticed that 28 [9.82%] of mothers feed their child for <6 months but most of women 104 [36.49%] for 2 years and some of them even feed for >2 years. Breast feeding is well practiced in this community but the ratio of exclusive breast feeding is low. Mothers have poor knowledge of benefits of breast feeding

Familial predisposition of dysmenorrhea among the medical students

To evaluate familial predisposition of dysmenorrhea among the medical students of Isra University Hyderabad. An observational study was carried out at Isra University Hyderabad, from June to November 2007 in which a total number of 197 students participated.A pre designed questionnaire was administered to the female medical students in which their age, menarcheal age about menstrual cycle, presence or absence of dysmenorrhea, severity of symptoms and positive family history of dysmenorrhea in mothers and in sisters were asked. Exclusion criteria of the study were amenorrhea, irregular menstrual cycle and whose mothers and sisters had secondary dysmenorrhea as this study basically was concerned with primary dysmenorrhea and to observe familial risk. In this study dysmenorrheal was observed in 76%, the mean age of students was 20.9 SD +/- 1.7, mean age at menarche with dysmenorrhea was 13.2 SD +/- 1.1 and without dysmenorrhea was 12.7 SD +/- 0.9. Positive family history of dysmenorrhea was seen in 33% of mothers and 43% in sisters and there was a group of students who had positive history in both mothers as well as in sisters. We found significant correlation of positive family history with dysmenorrhea in the present study. This suggests that genetic factor is involved in the pathogenesis of primary dysmenorrhea and increases the familial tendency. Therefore positive family history could be the strong predictor for occurrence of dysmenorrhea in offspring and in siblings

Risk factors associated with childhood asthma

To identify the risk factors associated with childhood asthma, in children attending Isra University Hospital, Hyderabad. Case-control study. Isra University Hospital between September 2005 to August 2006. The study included 398 age-matched children [200 asthmatic and 198 non-asthmatic]. Information was collected concerning their familial history of atopy, birth weight, environment, breastfeeding, disease and treatment history. Odds ratio was calculated for determining the risk. The children were aged between 12 months and 8 years and 60% were male. The asthmatic children were hospitalized more frequently than the non-asthmatic children [p < 0.0001]. Most of the asthmatic children lived in the urban areas of Hyderabad [odd ratio [OR] = 16.7, 95% CI = 3.1-14.6, p < 0.0001], had a parental history of asthma [OR = 26.8, 95% CI = 10.8-68.2, p < 0.0001] or allergic rhinitis [OR = 4, 95% CI = 1.2-13.4, p= 0.01], 38.5% had at least one person who smoked, and were weaned earlier than the non-asthmatic children [OR =12.4, 95% CI = 1.3-4.4, p < 0.01]. Childhood asthma was strongly associated with a family history of asthma and allergic rhinitis, the urban place of residence, having smokers as parents and early weaning from maternal breast milk. The results highlight the need to educate the parents about the risk of smoking and early weaning in the development of asthma

Clinical presentation of late haemorrhagic disease of newborn

To observe the clinical presentation of late haemorrhagic disease of the newborn [LHDNB], and clinical improvement after the administration of vitamin K1. This is a prospective descriptive study. All the children older than seven days who presented with bleeding were admitted in pediatrics ward of Isra University Hyderabad from April 2006 to April 2007 were included. Data collection was done by means of detailed proforma. Analysis was done on SPSS version 11. Thirty five cases were included. Commonest site of bleeding was subcutaneous followed by oral and injection site. Mean age of late haemorrhagic disease of newborn was 109 days and minimum age of presentation was 28 days. Common clinical presentations were irritability, convulsions, poor reflexes and poor feeding. Mostly recovery was within 24 hours after vit K. Late HDN results in severe hemorrhage especially hemorrhage in the central nervous system. Administration of Vitamin K [1mg, IM] at birth can present these severe complications

Efficacy of aloe vera gel in the treatment of vulval lichen planus

To compare the efficacy of aloe vera gel and placebo in the topical management of vulval lichen planus. Randomized, double-blind, placebo-controlled trial. Department of Dermatology, Isra University Hospital, Hyderabad, from January 2007 to January 2008. Thirty-four female patients were randomized into two groups to receive aloe vera gel or placebo for local application for 8 weeks. Clinical data and treatment response was graded according to Thongprasom criteria. Z-test was used for comparing response between the groups. Thirty-four consecutive patients participated in the study. We found erosive and ulcerative lesions in 83% and 17%, respectively. The most common site of vulval lichen planus was the labia minora. Fourteen [82%] out of 17 patients treated with aloe vera had a good response i.e. clinically improved by at least 50% after 8 weeks of treatment, while one [5%] of 17 placebo-treated patients had a similar response [p < 0.001]. Furthermore, one patient [5%] treated with aloe vera had a complete clinical remission. No side-effects were found in both groups. Aloe vera gel was a safe and effective treatment for patients with vulval lichen planus

Frequency of vaginal candidiasis in pregnant women attending routine antenatal clinic

To determine the frequency of vaginal candidiasis in clinically symptomatic and asymptomatic cases of pregnant women attending routine antenatal clinic. A descriptive cross-sectional study. The antenatal clinic of Gynaecology and Obstetric Department at Isra University Hospital, Hyderabad, from April to October 2005. A total of 110 pregnant women were nonrandomly recruited by convenient sampling. The studied variables included the demographic data information on parity, trimester of pregnancy, presence of vaginal discharge and the presence or absence of diabetes. Vulva and vagina were inspected for signs of inflammation and discharge with sterile speculum and vaginal specimens were collected with sterile cotton tipped swabs. Swabs were subjected to Gram staining and examined microscopically for the diagnosis of candidiasis. The frequency of vaginal candidiasis during pregnancy was found to be 38%, in which 27% were symptomatic and 11% were asymptomatic group. Increased ratio of infection was observed in multigravida and diabetic women. There was no marked differences in results with respect to age and trimester of pregnancy. Although there is generally a high frequency of vaginal candidiasis, an increased ratio of vaginal candidiasis in multigravida and diabetic pregnant women requires these women to be routinely screened for vaginal candidiasis regardless of symptomatic status

Contributing factors of rickets among children at hyderabad

To determine the factors contributing to nutritional rickets among the children presenting at Isra University Hospital Hyderabad, Sindh - Pakistan. A case control study. The Pediatrics Department of Isra University Hospital Hyderabad from August 2004 to August 2005. Children less than 5 years of age of both sexes were included in study. Sixty children with rickets and 60 control children matched for age and social characteristics over study period were studied. Diagnosis was made on clinical, radiological and biochemical parameters. A specially designed questionnaire was administered, for patients and mothers of control subjects to assess the role of social, nutritional and other related factors in the pathogenesis of nutritional rickets. Biochemical investigations included estimation of serum calcium, serum phosphorus and alkaline phosphates. At the time of diagnosis, mean bodyweights of the patients and controls were 9.30 and 10.17kg respectively. Mean heights at the time of diagnosis were 60.08 and 62.38 cm for the patients and the controls respectively. Mean serum calcium and serum phosphate were significantly lower in the patients compared with the controls. Alkaline phosphates were higher among the patients. The weaning diet was started at the age of 6 months only in 30% of cases of rickets, compared with 52% of controls who started at the 6 months of age. Only 41% of mothers of children with rickets had normal nutritional status and 75% of control mothers had normal nutritional status. Most of the children with rickets 75% were completely wrap during infancy compared to controls; only 20% wrapped. There are a lot of contributing factors for nutritional rickets. However, several factors seem to make more important contribution. Among these, lack of exposure to sunlight, prolonged breast-feeding without supplementation and inadequate complementary feeding practices are important. Maternal health and education is important as it can influence all of the above factors

Pattern of congenital heart disease at Liaquat university hospital Hyderabad

Objective: to find out the frequency of various congenital heart disease among affected children from birth to 12 years of age at Liaquat University Hospital Hyderabad

Setting: Study was conducted in pediatric Department of Liaquat University Hospital Hyderabad

Study design: This descriptive study was conducted over a period of one year from April 2006 to March 2007

Patients and Method: eighty Children up to 12 year of age with clinical suspicion of congenital heart disease were evaluated for type of lesion, gender and age at presentation. They were subjected to chest X-ray, ECG and detailed echocardiography which confirmed the final diagnosis .The results was analyzed on SPSS window version 10

Results: out of eighty cases fifty were male [62.5%] and thirty were female [37.5%].Fifty eight [72.5%] children were having cyanotic heart disease. Among A cyanotic lesion VSD was present in 42 patients [52.5%], ASD were 7 [8.75%] 6 have secondo types. PDA was present in 6 [7.50%] patients. A total of 7 [8.75%] patients had the TOF and 3 [3.75%] had TGA in association with VSD in one and ASD in 2 patients .Severe pulmonary stenosis was seen in 3 [3.75%] patients 2 were in association with ASD. Single ventricle and dextrocardia were seen in 3 [3.75%] patients each. Complex cardiac lesion was seen in 2 [2.5%] patients

Conclusion: majority of Congenital heart disease in children at Tertiary care Hospital are acidotic, VSD is the commonest acidotic lesion while TOF is the commonest cyanotic lesion. Early detection of this defect is important for proper management

Risk factors of birth asphyxia

Birth asphyxia is a serious clinical problem worldwide. There are many reasons a baby may not be able to take in enough oxygen before, during, or just after birth. Damage to brain tissues is a serious complication of low oxygen that can cause seizures and other neurological problems. This study was designed to asses the risk factors of birth asphyxia in neonates. This descriptive, prospective study was conducted in the Department of Paediatrics, from April 2005 to April 2006. 125 newborn [75 males and 50 females] admitted to the neonatal care unit, who were delivered with delayed cry or low apgar score [<7] were included. Detailed maternal history was taken, regarding their age, gestational age, and complications, if any. Out of 125 neonatal encephalopathy cases, 28% were diagnosed as suffering with moderate or severe encephalopathy, whereas 36% had mild encephalopathy. Risk of neonatal encephalopathy increased with increasing or decreasing maternal age. Antepartum risk factors included non-attendance for antenatal care [64%]. Multiple births increased risk in 4.8%. Intrapartum risk factors included non-cephalic presentation [20%], prolonged rupture of membranes [24%] and various other complications. Particulate meconium was associated with encephalopathy in 9.6%. 60% mothers were anemic. Vaginal bleeding was strongly associated with birth asphyxia in 34.44% of neonates. 56% of mothers delivered at home, while 28% delivered at a private hospital or maternity home. Only 12% delivered at a tertiary care hospital. Lack of antenatal care, poor nutritional status, antepartum hemorrhage and maternal toxaemia were associated with higher incidence of asphyxia. Improvements in the public health of women with associated gains in female growth and nutrition must remain a longer-term goal. Early identification of high-risk cases with improved antenatal and perinatal care can decrease such high mortality. Safe motherhood policy is recommended

Serum electrolytes changes in malnourished children with diarrhea

To determine the frequency of electrolyte disturbances in malnourished children with and without diarrhea and whether these findings have therapeutic value or not. It is a descriptive study conducted at pediatric Unit-II LUH Hyderabad, from1st August to 31st September 2004. One hundred children of protein-calorie-malnutrition between 6 months to 5 year of age of either sex who were admitted due to diarrhoea, failure to thrive, acute respiratory infection, malaria, anemia, cardiac failure and feeding problems were included in the study. On the basis of history, physical examination and anthropometrics measurement they were divided into Group A patients [n=64] who were malnourished but had diarrhoea and Group B patients [n=36] who were also malnourished and had no diarrhoea. Serum electrolytes were done in patients of both groups and the results were analyzed statistically. Analysis of serum electrolyte in both groups revealed that hypokalemia, hyponatremia and low serum bicarbonate were seen more frequently in patients of group A as compared to group B. In group A hypokalemia was seen in 40 patients[62.5%] while it was observed in 8 patients[22.22%] in group B [p<0.001], hyponatremia was seen in 17 patients [26.56%] in group A and in 5 patients [13.88%] in group B [p<0.001]. In group A 41 patients [64%] had low serum bicarbonate while in group B only 15 patients [41.66%] had low serum bicarbonate value [p<0.001] Electrolyte changes were commonly seen in grade II and III malnourished patients particularly who presented with diarrhoeal episode of variable duration. If these changes are diagnosed in time and treated appropriately the morbidity and mortality could be decreased

Clinical manifestations of hypokalemia

To observe the clinical manifestations of hypokalemia resulting from acute watery diarrhoea. A descriptive study. Paediatrics department, Isra University Hospital Hyderabad, Sindh from April 2004 to April 2005. Children less than 5 years of age with acute watery diarrhoea and vomiting who were found to have hypokalemia were included in this study. Children with chronic diarrhoea [more than 14 days duration] or hypokalemia of any other cause such as Bartter's syndrome etc. were excluded. Children with paralytic ileus due to other causes such as anti-diarrhoeal drugs etc. were also excluded. Serum potassium levels were checked at Isra University research laboratory by the standard ion selective electrode method. Hypokalemia was defined as serum potassium level of less than 3.5 mEq/l. The clinical presentations of children with hypokalemia were recorded and statistically analysed. During study period, 350 children with acute watery diarrhoea were admitted. Of these, 130 [37.14%] were hypokalemic and were included in this study, whereas 220 [62.85%] children were normokalemic [normal serum potassium level] and therefore were excluded from study. Abdominal distention was the commonest manifestation in 110[84.61%] children followed by head flop in 90[69.23%] cases, diminished bowel sounds in 55[42.30%], paralytic ileus in 30 [23.07%], inability to sit, stand or walk in 45[34.61%] and aphonia or dysphonia in 15[11.53%] children. Five children [3.84%] with hypokalemia had no clinical manifestation. Examination revealed weakness of limbs in 35 children, out of which 30 children had quadriparesis and 5 had paraparesis. Hypokalemia is an important electrolyte disturbance with acute diarrhoea. It may have serious clinical manifestations like abdominal distention, paralytic ileus, and can even lead to cardiac arrhythmias and arrest. Although, it can have fatal morbidities, timely intervention yields encouraging results