Frequency and outcome of hypoglycemia in children having severe protein energy malnutrition presenting with diarrhea

Background: Hypoglycemia in malnourished child with diarrhea is a complicated situation faced by pediatrician in emergency department

Objective: To determine the frequency and outcome of hypoglycemia in severely malnourished children suffering from diarrhea at time of admission

Methodology: Study Design: Cross sectional study. Sampling Technique: Non probability, consecutive sampling. Setting and Duration of Study: This study was conducted in Pediatric Medicine Unit-1, Bahawal Victoria Hospital, Bahawalpur from 16th May to 15th November 2012. Total 184 patients were selected. All were suffering from severe malnutrition and had acute diarrhea at admission. Serum sugar levels of all patients were checked and results were noted on the performa. SPSS version 10 was used for data analysis

Results: Among the 184 children 56 [30.4%] were hypoglycemic and 128 [69.6%] were normoglycemic. 41 [67.21%] out of 56 children from hypoglycemic group while 20 [15.6%] out 128 children from normoglycemic group expired. The mortality was significantly more in hypoglycemic children. [P Value = 0.000]

Conclusion: The frequency of hypoglycemia and mortality in severely malnourished children suffering from diarrhea at the time of admission was significantly higher than normoglycemic children in this study

Risk factors of retinopathy in type 2 diabetes mellitus at a tertiary care hospital, Bahawalpur Pakistan

Objectives: To find out the risk factors of diabetic retinopathy in type 2 diabetes mellitus

Methodology: It was a cross-sectional study involving 300 patients of type 2 diabetes. Clinical history, relevant examination including fundoscopy and lab investigations were done. Data was analysed with SPSS 17.0. T-test and chi square/Fischer exact were applied to determine significance

Results: Mean age of the patients was 49.04 +/- 0.69 years with slight female predominance with male to female ratio of 3:4. Average duration of disease was 7.17 +/- 0.38 years. Diabetic retinopathy was diagnosed in [74, 23.9%]. Mean HbA1c was 8.15% in patients with retinopathy and 8.884% in those who had no retinopathy [p=0.08]. However, duration of DM, age of patients, male gender, high total cholesterol, high LDL and microalbuminuria were significantly associated with the development of retinopathy

Conclusions: Diabetic retinopathy was found in 23.9% of type 2 diabetics. It was associated with duration of disease, age at presentation, male gender, high total cholesterol, high LDL and microalbuminuria. A single high level of HbA1c was not associated with retinopathy

Pulmonary hydatid cyst disease in South of Iraq: short term outcome after surgical intervention

To discuss the clinical presentation, diagnosis, surgical treatment and outcome of 300 patients. A retrospective study of 300 patients with pulmonary hydatid cyst disease was conducted, who were treated surgically at cardiothoracic surgical department in Basra teaching hospital from June2005 to June 2011. The records of all patients were reviewed taking in account the complete clinical history, clinical examination and chest radiology. All the patients were treated surgically. There were 225 [75%] patients of age, 18 years and above, with 149 [66%] males and 76 [34%]females, while 75 [25%] patients were below 18 years of age, including 36 [48%] boys and 39 [52%] girls. The cough was the common presenting symptom [56.6%]. Chest radiology was diagnostic in 95.7% of patients, the right lung was the common site [60%], and 20% presented with associated extrpulmonary hydatid cysts. Only 12.3% have postoperative complications. Surgery is the treatment of choice for pulmonary hydatid cysts, with very low mortality and morbidity

Frequency of hyponatremia in children with acute diarrhea taking low smolar oral rehydration solution

Acute diarrhea is defined as passage of three or more stools in a day, of consistency softer than usual for the child, or one watery stool. Acute diarrhea is the major cause of morbidity and mortality in developing countries. It accounts for approximately 25% of total admissions in children ward and causes mortality of 5-10% in community. As dehydration is the main complication of diarrhea, treatment focuses upon rehydration through fluid replacement. Oral Rehydration solution [ORS] is the recommended treatment in children with acute diarrhea and some dehydration. Now WHO has recommended Low Osmolarity ORS which contains less sodium and glucose than standard ORS. One of the side effect of use of ORS solution with reduced sodium level is the development of hyponatremia [i.e. serum sodium level less than 130 meq/L] in some of children with acute diarrhea and results in adverse clinical events. To determine the frequency of hyponatremia in children taking low osmolarity ORS for management of acute diarrhea with some dehydration. Descriptive case series. Study was conducted in Department of Pediatrics, Children ward-2 Bahawal Victoria Hospital Bahawal Pur and Department of Pathology Quaid-e-Azam medical college Bahawal Pur from 7th August 2010 to 22nd September 2010. Total 32 children with age between 3 months to 60 months with acute diarrhoea and some dehydration with normal initial serum sodium were included. An informed consent was taken from the parents to include their children in the study. Proforma was filled at the time of admission and after 4 hours. Blood sample was taken to measure serum sodium level. Criteria of hyponatreima was serum sodium level below 130 meq/l after giving low osmolarity ORS at a dose of 75 ml/kg to drink. A total of 32 children with acute diarrhea were included in study with age ranging from 3 months to 60 months. Male to female ratio was 1.1:1. Hyponatremia was seen in 2 [6.3%] of patients. The risk of hyponatremia in patients treated with the low osmolarity ORS was minimal

Intrathecal anti-tetanus human immunoglobulin in the treatment of neonatal tetanus

To determine the outcome of tetanus in neonates treated with intrathecal tetanus immunoglobulin in terms of mortality and hospital stay. Experimental study. Paediatric Unit I, Bahawal Victoria Hospital, Bahawalpur, from April 2004 to December 2007. Seventy neonates with diagnosis of neonatal tetanus were included in the study. The neonates with fits due to causes other than tetanus were excluded. Thirty five patients received intrathecal immunoglobulin in addition to standard treatment [group A] while, the other 35 patients received only standard treatment [group B]. The mortality and duration of hospital stay in 2 groups were recorded. In group A, mean duration of hospital stay was 10 days while, in group B it was 13 days [p<0.001]. One patient from group A and 8 patients from group B expired [p=0.026]. The occurrence of refractory fits, repeated apnoeic episodes and high grade fever did not show any statistically significant difference in the 2 groups. Intrathecal anti-tetanus immunoglobulin in addition to the standard improved the outcome of neonatal tetanus in terms of mortality and hospital stay

Status of hepatitis c virus [HCV] infection; children admitted in paediatric ward of Bahawal Victoria hospital Bahawalpur

To know the status of hepatitis C virus [HCV] infection in children admitted in Pediatric ward of Bahawal Victoria Hospital Bahawalpur. Cross-sectional descriptive study. Pediatric unit-1 Bahawal Victoria Hospital Bahawalpur over a period of 2 months and 15 days. This study was conducted over 500 children admitted in children ward-1 of Bahawal Victoria Hospital Bahawalpur. Children of 1-15 years of age were included in the study. The blood samples of these children were taken at the time of admission and serum was tested for HCV with ICT method and later on confirmed by ELISA. Children having HCV infection were tested for SGPT level. Different risk factors for transmission of HCV infection were also studied. Out of 500 children 43 were HCV positive by ICT method. Out of these 43 ICT positive children 38 were confirmed by ELISA. In this way 7.6% children were found positive for HCV. In 23 cases [60.5%] SGPT was raised [>40]. Statistically significant risk factors for transmission of HCV infection found in this study were past history of blood transfusion and history of injections in past. HCV infection is quite common in children. Safe blood transfusions and use of disposable and sterilized syringes is important for prevention of this infection

Modified kenneth jones criteria for diagnosing tuberculous meningitis in children

To evaluate accuracy of modified Kenneth Jones scoring criteria [MKJSC] as a screening tool to diagnose tuberculous meningitis in children. Cross-sectional study. Paediatric Medicine, Unit-1, Bahawal Victoria Hospital, Bahawalpur, from May 2006 to March 2007. A total of 100 children admitted through emergency in Paediatric Medicine, Unit-l, were included who were having fever and features suggestive of central nervous system [CNS] infection. Lumbar puncture was done in all patients after written consent. Findings of lumbar puncture were taken as gold standard for the diagnosis of IBM. MKJSC was applied on each patient and accuracy determined against the gold standard. Out of 100 children, 47 were diagnosed as IBM on the basis of CSF results. All children had scored 0-7 or above according to MKJSC. A score 1-2, 3-4, 5-6 and 7 or more was obtained in 23, 25, 30 and 22 children respectively. Children who had scored 5 or more received ATT. Accuracy of MKJSC was calculated to be 91%. MKJSC is a simple and accurate tool to improve tuberculous meningitis case detection rate in children

Farber disease: a rare neurodegenerative disorder

This is the case report of a two-and-a-half-year old male infant with Farber disease, which is a rare neurodegenerative mucolipidosis. The child presented with regression of milestones, laryngeal involvement and painful joints with swellings around the joints. Neuroimaging findings and the biopsy of the soft tissue swellings helped to reach the diagnosis

One year surveillance data of acute flaccid paralysis at bahwal victoria hospital Bahawalpur

To find out the demographic characteristics and analyze the stool culture results of the Acute Flaccid Paralysis [AFP] cases presenting at Bahawal Victoria Hospital Bahawalpur during the year 2005. It is a simple observational study conducted at Department of Pediatrics and EPI centre in Pediatric outpatient Department Bahawal Victoria Hospital Bahawalpur. Study was conducted from January 2005 to December 2005. All the AFP cases presenting at Bahawal Victoria Hospital Bahawalpur during the year 2005 were included. The data of these cases was analyzed regarding the demographic characteristics and stool culture results. In 73 cases of AFP presenting during the year 2005 male to female ratio was 1:1 while rural to urban ratio was 2.9:1. In 71[97%] of the cases stool samples were sent for poliovirus isolation. In 64[90%] stool samples no virus was isolated. Enterovirus was isolated in 6[8.5%] stool samples. In one stool sample, vaccine poliovirus was isolated. In two cases stools could not be sent; one out of these two expired while the other one was already notified from another district. Active surveillance of all AFP cases is mandatory to get the Polio eradicated. In this way all the cases of Poliomyelitis can be picked up and necessary measures can be taken

Liver biopsy as a diagnostic tool in undiagnosed chronic hepatic problems in children

To determine the diagnostic yield and safety of liver biopsy in undiagnosed cases of chronic hepatic problems in children. Retrospective review of 50 pediatric patients who underwent closed needle liver biopsy. Paediatric unit 2, Quaid-e-Azam Medical College/ Bahawal Victoria Hospital Bahawalpur, from Feb 2004 to March 2005 for a period of 14 months. In this study, 50 cases of liver biopsies in children were included. The patients included children who were having chronic hepatic problems i.e., hepatomegaly, hepatosplenomegaly with or without jaundice or deranged liver function tests for more than 3 months duration. In these cases, etiology could not be determined by routine non-invasive laboratory investigation and liver biopsy was carried out. The record of these patients was evaluated for the histopathological findings of biopsy and post-biopsy complications. Liver biopsy led to a definitive diagnosis in 90% of cases of chronic liver disorders in children. Glycogen storage diseases are the commonest disorders present in 40% of the cases, followed by histopathological changes of fatty liver in 18%, and cirrhosis in 10% of the cases. Only 7 [14%] children complained of pain at the local site during stay in the ward in the first six hours after biopsy. The percutaneous liver biopsy provides a good diagnostic yield with an acceptable failure rate. The approach to the management of various liver ailments can be tailored according to the histological diagnosis furnished by the liver biopsy. It is very safe with minimal complications

Demographic characteristics of admitted patients of measles and their association with mortality

To see the demographic characteristics of the admitted patients of measles and find their association with mortality. Retrospective analytic. Children ward-2, Bahawal Victoria Hospital Bahawalpur, over a period of one year from May, 2005, to April, 2006. This retrospective analytic hospital based study was carried out on the patients of measles who were admitted with complications in the Pediatric unit 2 of the Bahawal Victoria Hospital, Bahawalpur, which is a tertiary care hospital attached to Quaid-e-Azam Medical College Bahawalpur. The complications were recognized clinically and relevant investigations were performed where needed. The data was analyzed for various risk factors which may lead to death. These risk factors were age, sex, nutritional status, vaccination status against measles, history of contact with measles patients and the type of complication. In the 192 patients studied, male to female ratio was 2:1 and majority was in the age range of 1-5 years. In 87.5% of the patients' history of contact with a case of measles was present. 58.3% of the patients were vaccinated against measles. Pneumonia was the most common complication followed by encephalitis and gastroententeritis. Severe malnutrition was the only risk factor associated with increased mortality. Measles is a common viral infection in children. These patients can develop severe complications which can lead to significant mortality. Vaccination program against measles may be reviewed for its eradication

Assessment of level of awareness and utilization of treatment options in thalassemic children

To assess the level of awareness and utilization of treatment options in thalassemic children. Cross-sectional study. Thalassemia centre of Bahawal Victoria Hospital Bahawalpur over a period of 2 months from March 2006-April 2006. This study was performed on 90 diagnosed patients of thalassemia. All of these patients came for routine blood transfusion in the thalassemia unit of Bahawal Victoria Hospital Bahawalpur. The parents of the patients were interviewed regarding their level of awareness and utilization of treatment options of thalassemia. Data was analyzed with SSPS 10.0 computer program. There were 48 [53%] male patients and 42 [47%] female patients with male to female ratio of 1:1.4. The mean age for diagnosis and first blood transfusion was 6.5 months.. All patients were receiving blood transfusions with mean of 60 transfusions per patient. Fifty five [61%] of the parents had knowledge about the chelation therapy. Only 16 [17.5%] of the patients were receiving the oral chelation therapy. Fifty one [56%] parents knew about the bone marrow transplantation as a treatment of thalassemia. Seventy one [79%] parents knew about the prenatal diagnosis of thalassemia. The management of thalassemia major in a developing country poses a major challenge to the health services. Impetus on prevention and development of more centers for curative treatment should be stressed