RESUMO
Background: Considered as a rare clinical entity in immediate post-vaccination era, diphtheria has now started gaining surface in India for last few years, with an epidemiological shift involving older children owing to poor immunization coverage and waning immunity. Thus, it is imperative to quantify disease burden, analyses the clinical profile and factors affecting the outcome of diphtheria in children.Methods: A prospective observational study conducted in the Pediatric department of a teaching hospital where all children admitted with clinical diagnosis of diphtheria during the study period were included. Demographic data and clinically relevant information along with complications and outcome were recorded. Cases were managed as per standard treatment protocol providing intensive care support wherever required. Complications and factors affecting the outcome in all diphtheria cases were analysed.Results: Total 53 children were enrolled into study, and the mean age of study population was 7.55'2 years. Fever, pseudo membrane and throat pain were observed in all the cases. Palatal palsy was the earliest and the commonest complication (60.4%) followed by myocarditis (55%). Case fatality rate was 33.9% and myocarditis (77%) was the commonest complication attributing to it. Poor immunization status, late presentation and delayed ADS administration were associated with increased complication rate and unfavorable outcome.Conclusions: Robust immunization activity coupled with improved case-based surveillance would go a long way in preventing further diphtheria outbreaks in community. Sensitization about this re-emerging disease and high index of suspicion in diagnosing it, amongst primary care physicians and peripheral health workers would promote early referral and prompt management thereby reducing morbidity and high mortality associated with diphtheria.
RESUMO
Background: Peripheral cytopenia with its ramifications as pancytopenia and bicytopenia is a common hematological phenomenon in children. Its etiology ranging from benign self-limiting illness to severe life-threatening conditions decide the management and prognosis in these children. This study aims to describe the clinical, haematological and etiological profile of peripheral blood cytopenia in children of Rohilkhand region.Methods: A hospital based prospective observational study conducted in the Pediatric ward of a teaching hospital over a period of 30 months. All children between age 6 months to 14 years with bicytopenia and pancytopenia on hemogram were included. Detailed history, clinical examination, haematological tests followed by bone marrow aspiration wherever indicated was performed. Additional tests like parasitological and sepsis work up was undertaken on case to case basis, to ascertain the cause of cytopenia.Results: Bicytopenia was more common than pancytopenia (61.2% vs. 38.8%) The most common age group observed was 10-14 years. Normocytic normochromic blood picture was seen in all cases of cytopenia while macrocytic normochromic blood picture had statistically significant association with pancytopenia. Fever was the commonest symptom, while pallor was the commonest sign followed by hepatosplenomegaly. Most common etiology in bicytopenia was infective (68%) while pancytopenia reported equal incidence of infective (50%) and non-infective causes. Malaria was the commonest infective cause of bicytopenia (46.3%) and pancytopenia (27%). Children with bicytopenia had higher incidence of malignancy (22% vs. 7.7%) and lesser incidence of nutritional causes (7.3% vs. 27%), and aplastic anemia (2.4% vs. 15.4%) as compared to pancytopenia.Conclusions: Clinical assessment coupled with haematological tests plays a pivotal role in ascertaining the cause of cytopenia in children. As the etiologies are varied, their knowledge and distribution unique to a particular region may help in better management and outcome.