Hypocalcemia and nutritional rickets in children: common etiological factors

Hypocalcemia can be defined as a state when serum calcium level is less than 7 mg/dl in preterm neonates and less than 8 mg/dl in term neonates and less than 8.5 mg/dl in older children. Nutritional rickets is commonly associated with rickets in children. To determine the common etiological factors of hypocalcemia and nutritional rickets in children. Cross sectional analytical study. This study was conducted in the department of Pediatrics, King Edward Medical University/Mayo hospital Lahore from March 1998 to January 2001. 120 patients [2 months to 60 months] who presented with tetany, clinical and skeletal manifestations of rickets and seizures were included in the study. Biochemical profile [serum calcium, phosphate and alkaline phosphatase] and radiographs of wrist joint were done. Each child was accessed for age, sex, feeding pattern, exposure to sunlight, number of children in family, maternal age, educational sta tus of mothers, presenting features of the disease, total calcium, phosphate and alkaline phosphatase level in the serum and X-ray wrist. The study group comprised of 120 children [72 boys and 48 girls] ranging from 2 months to 3.5 years. 65% of the children had weight below 5th centile on National Center for Health Statistics charts. 32% of children got sunlight exposure for less than 30 minutes/week and 16% got it for 30-120 minutes/week. Out of total 120, 110 were below 2years among these 110, 9% were exclusive breast fed, 35% got diluted fresh milk, 1% got formula milk and 13% got both breast and bottle feeding. In 45% children weaning was not started. 47.5% couples had 2 or more children. 72% mothers were below 30 years of age, at the time of interview. 31% of the mothers were uneducated. 85% children had seizures at the time of presentation. Out of these 24.51% had upper respiratory tract infection and 51.96% had lower respiratory tract infection 79% had clinical signs of florid rickets. 67.5% of patients were had serum calcium between 6 and 7mg/dl, 69% were had serum phosphate level < 4 mg/dl and 76% had alkaline phosphatase level >1000IU/L. Hypocalcemia represents a major health problem in Pakistani children. Infants under 2 years of age are liable to have vitamin D deficiency rickets particularly if they are exclusively breastfed or received fresh milk with reduced exposure to sunlight. The higher the level of education of mothers, the less likely is the chance that their children become rachitic. Hypocalcemia can present with a wide variety of symptoms, the most important of which are seizures and recurrent chest infections. Rickets must be looked for as an underlying cause of these complaints

Level of satisfaction of parents attending pediatric emergency

Patient satisfaction is an important indicator of quality of health care. Without appreciable levels of patient satisfaction, health plans may not get full accreditation and will lack competitive edge enjoyed by full accredited plans. To study the level of satisfaction of the parents visiting Pediatric emergency of Mayo Hospital Lahore for medical care of their children and to formulate suggestions to further improve the quality of care. Descriptive qualitative cross sectional study. This study was conducted in emergency section of the department of Pediatrics King Edward Medical University/Mayo Hospital Lahore in 45 days [July 01, 2005 to Aug 15, 2005]. During the study period, a total of 100 parents were selected by non-probability convenient sampling. Consent was taken and confidentiality was assured. They were interviewed by using a structured proforma. Out of 100 parents, 60 were of male children and 40 wer e of female children. The questionnaire was scored for 14 core topics. Majority [71%] took less than 5 minutes for their first encounter from hospital door to the medical personnel. 47% were attended by casualty medical officer within 5 minutes and 40% were attended within 10 minutes. Out of total, 51% were attended by emergency doctors within 5 minutes. Overall attitude of "purchi clerk" was found to be satisfactory. Attitude of casualty medical officer, attending doctors, nursing staff was very good while that of paramedics was found to be good. Cleanliness in emergency was fair while comfort and environment of emergency was satisfactory. Availability of medicines in emergency was found to be excellent [82%]. Overall, 22% of parents were fully satisfied while 11% were not satisfied at all. Mean level of satisfaction was 69.57%. It is concluded that majority of parents were satisfied with the services offered in Pediatric emergency of Mayo Hospital Lahore