Parenteral nutrition in the initial treatment of protein energy malnutrition [PEM]

The study included 30 severely malnourished infants [11 marasmus, 13 kwashiorkor and 6 marasmic kwashiorkor] who could not tolerate a sufficient amount of calories enterally. Mortality rate was reduced to 13% by the use of parenteral nutrition via a peripheral vein in the initial therapy of PEM. The general condition and tolerance to oral intake were markedly improved after a mean duration of 7 days. Marasmic patients showed a steady and significant increase of the anthropometric measurements between day 1 and day 30. Kwashiorkor and marasmic kwashiorkor patients showed a significant decrease of these measurements during the first two weeks. Later, a significant increase was observed between day 15 and day 30. Plasma proteins increased steadily and significantly in all patients. No major complications were encountered during the administration of parenteral nutrition

Tuberculin skin testing for evaluation of the efficacy of BCG vaccines used in Egypt

The efficacy of the liquid compared to the freeze-dried BCG vaccines used in Egypt was evaluated by studying the tuberculin conversion. Two hundred and eleven apparently healthy infants and children between four months and four years of age were studied. They were divided into two groups, the first included 104 infants and children 4 months to 2.5 years old [vaccinated with the freeze-dried BCG vaccine] and the second included 107 children aged 2.5 to 4 years [vaccinated with the liquid preparation]. Tuberculin test "Mantoux" was done for every child using PPD [2Tu]. The results were read after 48 hours; negative reactors [less than 10 mm] were subjected to a repeat test two weeks later. Tuberculin test was positive in 83.65% of children vaccinated with the freeze-dried preparation and in 56.07% of those vaccinated with the liquid one. The difference between the two groups was highly significant. A significant difference was also observed between the induration diameter of both groups [13.4 mm and 11.4 mm respectively]. Several possibilities were discussed to explain our results

Fluid therapy in paediatric surgical emergencies a simplified scheme and its clinical application

A scheme is presented for fluid and electrolyte therapy in paediatric surgical patients. It was applied on 31 infants and children undergoing various surgical procedures. During application of the scheme frequent clinical assessment as well as laboratory estimation of serum electrolytes were undertaken. The clinical response was satisfactory in the majority of cases. The scheme could be applied safely to children and infants requiring emergency operation without the help of laboratory estimation except in few complicated cases. The response to intravenous fluid therapy in 31 newly born infants and children undergoing major surgery has been studied. The plan of treatment was designed to provide for correlation of dehydration if present and for maintenance of normal fluid and electrolyte levels. Solutions of glucose and of sodium chloride in varying concentrations were used to relief the dehydration, resume urinary flow and restore tissue fluids. Potassium salts were added to these solutions at the proper time. The scheme included an initial phase of 40-80 ml/kgm body weight, a maintenance quantity of 100-150 ml/kgm body weight and a replacement therapy for losses of 20 ml or more per kgm body weight. Cases with marked distension and low sodium levels and those with low potassium serum levels were given special attention. Laboratory estimations of sodium and potassium serum levels were undertaken on admission, and on the first and second post-operative days. Clinical progress in response to intravenous fluid therapy was satisfactory in the majority of cases. Since confidence in the present plan of treatment has increased, it can now be applied to children and infants requiring emergency operation without the help of laboratory estimation except in some complicated cases