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Background: In Severe Acute Malnutrition (SAM) clinical and biochemical abnormalities are commonly observed. In this institute author observed that many children of complicated SAM had bleeding manifestations but there is no defined prevalence of vitamin K deficiency in SAM that's why author have planned this study.Methods: This was the hospital based prospective study conducted in 150 complicated SAM children. All children were treated according to WHO protocol for SAM management. Prothrombin Time (PT), International Normalized Ratio (INR), activated Partial Thromboplastin Time (aPTT) along with routine investigations were done on admission. All the collected data was managed and analyzed with standard software Biostatics (SPSS Version 20).Results: Total 150 complicated SAM children were studied for prevalence and clinical manifestations of vitamin K deficiency. Mean age of children was 17.03'11.0 months, 52.0% were male and 48.0% were female children. Average weight was 5.92'1.57 kg. Average height/length was 70.66'8.38 cm and mean MUAC was 10.47'1.31 cm. Out of 150, 42(28%) children had abnormal INR and 28(18.7%) had abnormal aPTT with abnormal INR. The mean INR was 2.11'1.1 and mean aPTT was 45.30'9.59 in children those had abnormal INR. Twelve out of 42(28.6%) had various bleeding manifestations and majority (66.6%) had gastrointestinal bleeding.Conclusions: More than one fourth children (28%) of complicated SAM children are having vitamin K deficiency and majority of children present with gastrointestinal bleeding.
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Purpose: The purpose of this study was to compare the short-term functional and radiological outcome between Joshi’s externalstabilization systems (JESSs) with volar locking compression plate (LCP) in treatment of unstable distal end radius fractures.Materials and Methods: A prospective study was conducted which included a total of 50 patients between the age group of20–60 years with fresh closed unstable distal end radius fractures and was randomized into two groups of 25 patients eachand their outcomes were compared.Results: The average period of follow-up was 2 years after which range of motion of the two groups was compared and clinicaland radiological evaluation was done. The functional result according to modified Gartland and Werley scoring was excellent in8%, good in 40%, fair in 48%, and poor in 4% in JESS group while it was excellent in 8%, good in 84%, fair in 4%, and poor in4% in volar LCP group. According to Stewart scoring system, the result was excellent in 8%, good in 40%, fair in 48% cases,and poor in 4% cases in JESS group while it was excellent-good in 88%, fair in 8%, and poor in 4% in the LCP group.Conclusions: The mean time to union was 5.71 months in volar LCP group and 3.75 months in JESS group. The functional andanatomical evaluation of both the groups showed that fixation by volar LCP group had better result in comparison to externalfixation by JESS with accurate maintenance of articular margin. Better functional results can be expected in the early postoperative period in association with open reduction and internal fixation, and this form of treatment should be considered forpatients requiring a faster return to function after the injury, but in the long run, this is comparable with JESS fixation.
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Background: Diagnosis of celiac disease in children suffering from severe acute malnutrition without duodenal biopsy or HLA typing is a dilemma. The objective of this study was to study the response to gluten free diet in sero-positive Celiac Disease children suffering from severe acute malnutrition in age group 1-5 years.Methods: This prospective, observational, hospital-based study was conducted at MTC of tertiary care medical college hospital of southern Rajasthan from Dec. 2017 to Nov. 2018. Total 110 children with SAM were enrolled and screened for celiac disease on the basis of tissue tTg-IgA/IgG serology. Seropositive cases were kept on gluten free diet for short period of time and observed for the resolution of symptoms and improvement in growth, monitored by anthropometry on discharge and follow up visit.Results: Mean weight gain (gm/kg/day) on follow up was 3.87'3.49 in seropositive and 1.88'3.79 in seronegative cases (P-value<0.05). Mean weight gain was 6.43'3.28gm/kg/day in only tTg-IgA positive and 3.04'2.95 gm/kg/day in only tTg-IgG positive cases (P-value-<0.05). The mean weight gain in strictly gluten free adherent sero-positive cases was 4.89'2.97 gm/kg/day while in gluten free non-adherent patients it was -0.49'1.70 (P-value <0.001). Mean weight gain in probable (tTg-Ig-A <10 times ULN) and presumptive (tTg-IgA >10 times ULN) Celiac disease were 3.44'3.73 and 5.44'3.78, respectively without statically significant difference (P-value >0.05).Conclusions: In situations where facility of duodenal biopsy and or HLA DQ2/DQ8 typing is not available, resolution of symptoms and improvement in growth on gluten free diet confirms the diagnosis of celiac disease.