Causes of recurrent pneumoniaamong children

Background: Respiratory tract infections remain the commonest cause of pediatric morbidity and mortality particularly in developing countries. A sub group of these children has recurrent pneumonia which may be the presentation of an underlying more serious systemic or local pathology

Objective: To determine the frequency of underlying causes of recurrent pneumonia, among pediatric patients

Patients and Methods: This descriptive study was conducted in the department of Pediatrics, Sheikh Zayed Hospital/ Medical College, Rahim Yar Khan, from 1[st] January, 2011 to 31[st] December, 2011. All the patients presented to the department and diagnosed as recurrent pneumonia were included in the study

Results: During the study period of one year, recurrent pneumonia was diagnosed in 292 patients. An underlying illness could be identified in 282 [97%] while in 10 [3%] cases the underlying cause could not be diagnosed. Underlying illnesses included neurodevelopmental disability in 183 [63%] cases, recurrent bronchiolitis with aspiration pneumonia 30 [10%], congenital heart disease 23 [8%], bronchiectasis 07 [2.3%], bronchial asthma 07 [2.3%], anomalies of the respiratory system 05 [1.7%], cleft palate 05 [1.7%], gastroesophageal reflux disease 04 [1.3%], down syndrome without CHD 04 [1.3%], severe malnutrition 03[1%], ciliary dyskinesia 03[1%], foreign body 02 [0.6%], thalassemia 02 [0.6%] and nutritional rickets 02 [0.6%]

Conclusion: Recurrent pneumonia is relatively common in our country as are recurrent respiratory tract infections. Common underlying illnesses included neurodevelopmental disability, recurrent bronchiolitis with aspiration pneumonia, congenital heart disease, down syndrome, bronchiectasis, bronchial asthma, anomalies of the respiratory system and cleft palate

Celiac disease and celiac crisis in children

To determine the frequency of clinical features of Celiac disease [CD] and Celiac crisis in children. Case series. Paediatrics Unit, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, from September 2009 to September 2010. Forty children aged between 4 to 13 years of either gender, presenting with complaints of recurrent diarrhea, abdominal distention, severe emaciation and dehydration were included. The information about breast feeding, weaning diets, age of introduction of wheat diets, onset of diarrhea, characteristics and frequency of stools, growth, vaccination status, symptoms in 1st degree relatives, restriction of Gluten diet in the past and anthropometric measures were recorded. Serological tests against anti-Tissue Transglultaminase [anti-tTG] antibodies were obtained in all cases. Upper gastrointestinal endoscopies were performed and multiple biopsies were taken from distal parts of duodenum. Among the forty children, twenty four [60%] were females and 16 were males [40%]. The mean age was 6.35 +/- 2.83 years. Thirty five [87.5%] parents were cousins. Breast feeding was not exclusively given and the Gluten containing weaning diets were given as early as 3.5 months of age. Thirty [75%] children presented with typical sign and symptoms of CD. Celiac crisis presented with profuse diarrhea, severe dehydration; abdominal distention; pedal edema, carpopedal spasm due to tetany; wasted muscles; head drop and inability to stand. The serum TtG antibodies in thirty-eight cases [95%] were above the cut off level of 7u/ml ranging from 35-99 u/ml. The histopathology of specimens from distal duodenum revealed lesions of M3 type in thirteen [32.5%] and M2 type in eighteen cases [45%]. All cases recovered and improved on follow-up after strict adherence to gluten-free diet [GFD]. Majority of children with Celiac disease presented with typical symptom, while Celiac crisis was characterized by severe dehydration, weakness and calcium deficiency signs. Most were the product of consanguineous marriages and were given Gluten - containing weaning foods as early as the 4th month of life

Foreign body aspiration in children

A case series descriptive study,was carried out from September 2007 to September 20010 at Paediatrics unit Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan. The aim of the study was bronchoscopic evaluation of children suspicious of inhaled foreign body [FB] such as beetlenut, seeds, peanuts, tiny objects and fragments of tooth and presented with persistent cough. Fory [n-40] children [male and female] in age range of 1-3 years [toddlers] presented with persistent cough with no history of foreign body [FB] aspiration were included. The chronic persisting cough was defined as cough lasting for 30 days or >30 days as guided by WHO. They had bouts of cough mimicking pertussis and had clinical findings of decreased air entry with rales and rhonchi. Oxygen saturation was monitored by pulse oxymetry. X-rays chest were obtained. The pulmonary tuberculosis, pertussis and other chronic lung diseases were ruled out by history, clinical examination and investigations available in hospital laboratory. The cases with suspicion of FB inhalation were subjected to bronchoscopy. Rigid broncoscope was an essential tool for investigation and removal of FB in study. The data were processed in soft wear SPSS 16.Male: Female ratio was 2:1 and had height and weight above 10[th] percentile and vaccinated as per EPIschedule. The clinical examination of chest revealed dull or hyper resonant, decreased or no air entry with or without rales and rhonchi on the side of chest where FB lodged the lung. X-rays chest had no radio opaque FB, hyper inflation in cases 15 [n-15] and collapse in 10 cases [n-10] were the main findings. The clinical and radiological findings supported the empirical diagnosis of foreign body aspiration [FBA] and these children underwent rigid bronchoscopy. Bronchoscopically visualized FB were retrieved and the air ways were cleared of inflammatory debris and pus. The oxygen saturation retuned to normal and marked clinical improvement occurred soon after bronchoscopy. The commonest FB in our study was the beetle nut [Chalia/Supari]. The radiological changes were also seen after bronchoscopy. FBA should be considered in children presenting with persisting cough and after thorough clinical and radiological examination the suspected cases be evaluated by rigid bronchoscopy

Congenital hypothyroidism: an underestimated clinical entity

The aim of study was to determine the clinical features of Hypothyroid Children in various age groups residing in Rahim Yar Khan. Prospective, descriptive, study, over a span of one year. This study was conducted in Pediatrics department at Sheikh Zayed Hospital and Medical College Rahim Yar Khan from 1st March 2010 to March 2011. The thirty children of both sexes in age group of 1 day - 12 years presenting with clinical features, suspicion of Hypothyroidism were included in study. Children with subtle as well as full fledged sign and symptoms of hypothyroidism were considered for further evaluation. The clinical history, feeding pattern and clinical examination of these cases were recorded. Their blood was examined for T4, T3 and TSH. The X-rays of chest, X-rays of Skeleton, particularly X-ray wrist and X-ray knee joint were obtained. Serum cholesterol, glucose, electrolytes [Na[+] and K[+] and perchlorate [KC10[4] discharge test were obtained. Thyroid scintigraphy was done for isotope uptake. Ultrasonography for thyroid position, its size and detection of solid and cystic lesions was performed.Cardiac monitoring was gained by E.C.G. The data analysis was done by software SPSS 16. All children with clinical features and investigations in favor of hypothyroidism were kept in four groups according to the age. The sluggish behavior, bradycardia, typical coarse faces and TSH in values above normal range were consistent findings in all thirty [n=30] cases. Congenital Hypothyroidism is usually under diagnosed that leads to mental retardation in a child. Therefore any child having suspicion of hypothyroidism should be evaluated by thyroid functions test [TFT], including new born screening

Iron and zinc levels in blood of children with PICA

The aim of study was to determine the levels of serum iron and plasma zinc in toddlers with pica. Prospective analytic type of study. Over a span of 6 months. The study was conducted in Pediatrics Outpatient department at Sheikh Zayed Hospital Rahim Yar Khan. The thirty children of both sexes in age group of 1-3 years, presented with anemia and pica were included in study. They had no other apparent cause of anemia other than nutritional deficiencies. They were physically and mentally well. The clinical history, feeding pattern and .clinical examination were recorded. Their blood was evaluated for iron and zinc to find relation of pica with these micronutrients. The Hemoglobin [Hb%]; blood smears were examined for RBCs morphology. Stool samples were examined for occult blood and intestinal parasites. All children were anemic; milk was the main source of nutrition till 3years of age and iron rich food like meat was deficit .They were involved in earth eating [geophagia]. They belonged to poor socioeconomic conditions. The laboratory reports of their blood smears detected microcytic hypochromic anemia, low serum iron and normal plasma zinc. Hb% level was < llg/dl, BUN and urine examination was normal. Stool examination detected intestinal parasites. Pica [Geophegia] in our study is strongly associated with iron deficiency anemia [IDA]. The zinc deficiency was not found in these children