Role of probiotics in acute diarrhea in children

Objective: To determine the effect of Bifidobacterium BB12 on mean change in stool frequency and hospital stay in the management of acute diarrhea. Study Design: Randomized controlled trial. Place and duration of study: Study was conducted at department of pediatrics. DHQ hospital, Faisalabad from 1[st] July 2013 to 31[st] December 2013

Patients and methods: Ninety eight patients after fulfilling inclusion criteria were registered and sorted out into group A [study] and Group B [Control] randomly [By lottery method]. Group A patients were given Bifidobacterium BB12 [6 Billion units BD for five days] diluted in ORS while group B patients were given ORS only. The cases were assessed daily for decrease in frequency of stool and total duration of illness at discharge

Results: Mean age at the time of admission was 17.6 +/- 7 months for study group and 14.6 +/- 7.4 months for controls. Duration of hospital admission was 1.88 +/- 0.21 days in the probiotic group compared with 3.38 +/- 0.13 days in the control group [P = 0.02]. Mean reduction in the frequency of stool per day was 5.08 +/- 0.34 times for study group and 2.3 +/- 0.35 times for the control group [P = 0.05]

Conclusion: We conclude that effect of Bifidobacterium bifidum is statistically significant in reducing the mean change in stool frequency and hospital stay in management of acute diarrhea in children

Acute severe asthma in children; role of intravenous magnesium sulfate in treatment

To compare the efficacy of intravenous magnesium sulfate and conventional treatment with conventional treatment alone in acute severe asthma in children of age group 5 to 15 years known cases of bronchial asthma. Randomized control trial. Indoor and outdoor patients of pediatrics department of DHQ hospital, Faisalabad. Six months. In this study, 43.58%[n=17] in Exposed and 53.85% [n=21] in Un-exposed group were male and remaining 56.42%[n=22] and 46.15%[n=18] were females, mean pulse rate in both groups was recorded which shows 97.32 +/- 6.58 in Exposed Group and 103.67 +/- 8.32 in Un-exposed Group, p value was calculated as 0.02, mean FEV1 rate in both groups was recorded which shows 60.32 +/- 7.56 in Exposed Group and 54.07 +/- 6.43 in Un-exposed Group, p value was calculated as 0.03. We concluded that intravenous magnesium sulfate along with conventional treatment is significantly better than conventional treatment alone for the management of acute severe asthma attack

Treatment of Bronchiolitis; role of inhaled beta-agonists in infants and children

Objective: To compare the efficacy of normal saline and inhaled beta-agonist in the treatment of bronchiolitis

Study design: Randomized clinical trial

Settings: The study was conducted in Paediatric Medicine Department, DHQ hospital/Punjab Medical College Faisalabad. Period: 06 months from 1[st] October 2013 to 31[st] march 2014

Results: In this study, 58.33%[n=21] in Group-A and 66.67%[n=24] in Group-B were between 0-9 months of age, mean and sd was calculated as 11.43 + 3.87 months in Group-A and 10.52 +/- 3.32 months in Group-B, 52.78%[n=19] in Group-A and 61.11%[n=22] in Group-B were male while 47.22%[n=17] in Group-A and 38.89%[n=14] were females, mean clinical score in both groups was recorded as 4.11+1.32 in Group-A and 5.65 + 1.89 in Group-B, comparison of efficacy in both groups was recorded which shows 58.33%[n=21] in Group-A and 25%[n=9] in Group-B were treated effectively while rest of 41.67%[n=15] in Group-A and 75%[n=27] in Group-B were not treated effectively, p value was calculated as 0.008, which is statistically significant

Conclusions: The results of this study reveal that inhaled beta-agonists are more effective than normal saline

Radionuclide gastroesophageal reflux scan; an effective screening tool for infants/children with repeated chest infections

Objective: unexplained recurrent chest infections are a cause of failure to thrive in infants and young children. Repeated hospital admissions with respiratory symptoms are an extra economic burden on the health budget along with the morbidity. The aim of this study was to analyze the utility of Nuclear Medicine to screen children with clinically significant gastroesophageal reflux

Design and Place of Study: this study was descriptive case series and was conducted at Punjab Institute of Nuclear Medicine in collaboration with the department of pediatrics Allied Hospital Faisalabad

Patients and Methods: seventy clinically symptomatic patients underwent Gastroesophageal Reflux [GER] Scan with effective fasting of one to three hours. Four to thirty seven MBq of [99m]Tc labeled Colloid was diluted in milk for oral intake. Thirty minutes dynamic study with frame rate of 3 second per frame was acquired in either anterior or posterior projection. Both qualitative and quantitative analysis was done using cine review, time active curves [TAC] and percentage reflux index [%RI]. Patients with high grades of reflux were also reviewed after 08 weeks of conventional antireflux treatment

Results: sixty three percent of the patients [44/70] were declared as reflux positive of varying grades on GER scan. Most of the refluxing subjects [26/44] were in grade I/II category while [13/44] of the patient showed moderate degree reflux and only [2/44] of the patients fell into severe reflux category. Chest infection was the chief clinical presentation in each grade of reflux [57%]. Of all the refluxing individuals, [9/44] were having no refluxing spikes on TACs while when reflux index [%RI] were calculated [4/44] of the patients showed value below 4%. Eighty percent of selected patients [8/10] showed improvement with conventional antireflux treatment but complete improvement was evident only in [3/10] patients

Conclusion: GER scan is a non-invasive and effective way of screening clinically symptomatic babies for reflux of the gastric contents interfering with the respiratory tract. Quantitative assessment of improvement after conventional antireflux treatment offer cost-effective follows up of GERD

Serum magnesium level; comparison between healthy and malnourished children

To evaluate serum magnesium level in children with 3rd degree malnutrition and to compare these values with healthy children. Cross sectional comparative study. Pediatric Department of Allied Hospital Faisalabad from Oct. 2003 to Nov. 2004. Cases: 60 children of age six month to five year having weight < 60% of that for age. Control: 60 healthy children of age six month to five year having weight > 80% of that for age. Both cases and controls were selected from indoor and outdoor through simple random sampling. Detailed history and examination was done and S/Mg level were measured by atomic absorption spectrophotometer. Data was analyzed with the help of SPSS by applying T test and was presented by frequency tables. The cases showed decreased S/Mg level [1.11 +/- 0.24 mg/dl] as compared to controls [2.01 +/- 0.78mg/dl].S/Mg levels were also decreased in cases with height < 80% of that for age [0.98 +/- 0.5mg/dl] as compared to controls having height > 90% of that for age. S/Mg levels were markedly low in cases who had low albumin level [0.98 +/- 0.05 mg/dl] and those children who presented with persistent diarrhea [0.96 +/- 0.12mg/dl]. S/Mg levels were decreased in children with PEM as compared to those with age and sex matched control. This decrease in S/Mg levels was marked in those cases who had decrease serum albumin level and persistent diarrhea

Relationship of type of cerebral palsy with the etiology

To determine the relationship of etiology with the type of cerebral palsy in children. Descriptive case series. Department of Paediatrics, Allied Hospital, Faisalabad. From January 2002 to December 2004. 120 children from 1-12 years of age of either sex who presented in Paediatric Department with abnormalities of tone, posture and movement and subsequently diagnosed as cerebral palsy on the basis of history, physical examination and investigations, were included. Out of 120 cases the majority had spastic CP, 72% [n = 86] such as quadriplegic, diplegic and hemiplegic types. The spastic quadriplegia was mainly associated with birth asphyxia and meningoencephalitis. Prematurity and low birth weight were the major contributors towards diplegic CP, while spastic hemiplegia although less common was caused by meningoencephalitis in 5 cases and infra cranial bleed and asphyxia in 3 cases each. Atonic or hypotonic CP found in 23 cases, were caused by meningoencephalitis, kemicterus, birth asphyxia and prematurity. 10 cases of atonic CP did not have any reason [hence idiopathic]. Athetoid CP was mainly due to kemicterus, meningoencephalitis and asphyxia. Ataxic and mixed types of CP were present in 3 cases each and were due to meningoencephalitis and birth asphyxia

Nutritional status and micronutrient levels of children with celiac disease before and after gluten free diet

Celiac disease is an autoimmune inflammatory disorder of small intestine precipitated by ingestion of gluten. Clinical and histological improvement occurs on withdrawal of gluten from the diet. The present study were to identify the trace mineral deficiency in diagnosed celiac children and to assess how far these deficiencies are corrected after strict gluten free diet. The study also assessed the nutritional status of celiac children compared to the healthy controls before and after Gluten Free Diet. Department of Pediatrics Punjab Medical College Faisalabad. January 2004 to March 2005. Interventional case control study. 22 children aged 2 to 14 years diagnosed as Celiac disease on the basis of typical intestinal biopsy findings were included. 15 healthy children served as controls. Anthropometric measurements and serum Zinc Copper Magnesium and Iron along with albumin were done for both patients and controls initially and repeated after 6 months while patients were receiving strict GFD and controls receiving normal diet. The general linear model was used for the analysis of variance using SPSS [2004]. Serum Zinc was below the reference range in 68%. Serum copper and Magnesium in 31%, Iron in 95%and albumin in 59% of the patients. There was a statistically significant increase in serum zinc, iron and magnesium levels [p value, < 0 05] while serum copper and albumin did not show any significant rise after Gluten free diet. Control group did not show any significant change in their trace mineral levels .Celiac patients gained more weight [mean 4.47 versus 2.91 cm] and height [3.34cm versus 1 .022 cm] as compared to the control group. Celiac children receiving strict Gluten free diet and showing good clinical response probably do not need mineral supplementation

Nutritional status of pre-schooling children of different socio-econornic statuses as influence by various diseases

The study was carried out on 100 children [85 malnourished and 15 apparently healthy] of pre-schooling age [0-4 years]. The malnourished children were randomly selected from those admitted to Pediatrics wards of Allied and National Hospitals at Faisalabad [Punjab]. The test patients were divided into four age groups [up to 12, 13-23, 24-35 and 36-48 months], three socio-economic statuses, i.e. lower class [maximum earning of Rs. 5000 per month], middle class [Rs. 5000 - 15000 per month] and upper class [minimum earning of Rs. 15000 per month], sex and on the basis of area of living, i.e. industrial or non-industrial. Parameters of study included anthropometrics [BMI, mid-arm circumference and percent weight]. The obtained results revealed that diarrhoea, fever and malnutrition were the major complaints. Mid-arm circumference, percent of weight and body mass index were low in malnourished children. They were also low among malnourished children of 3rd degree. In each socio-economic status, age and sex groups, serum iron and copper were higher in malnourished children and in females than in males. Malnutrition was more prevalent in children of up to 12 months of age, in males, in children of low socio-economic status and of non-industrial area. Several types of milk were more frequently offered to males and breast-feeding was more often offered by uneducated and under-matriculate mothers

Infections in pre-term babies; role of intravenous immunoglobulins

Objective: To determine the effectiveness of I/V immunoglobulins for prophylaxis against sepsis in preterm newborn. Design of study: Prospective study Setting: Department of Pediatrics at Allied Hospital, Faisalabad. Period: From October 1999 to August 2001

Material and Methods: Seventy newborns of either sex, weighing 1000 gms to 2000 gms [mean 1450 gms] with gestational age 28 to 35 weeks [mean 31 weeks] were included and assigned into 2 groups [35 babies in each group]. On alternate basis one group [study group] was given I/V immunoglobulins 500 mg/kg on day 1, 3 and 10 and the other was not [control group]. The serum level of Immunoglobulins was not determined

Results: Maternal and neonatal risk factors for infection did not differ between the two groups. There was a significant difference in development of sepsis [both culture positive and negative] as well as mortality in the study group as compared to control group. The drug was well tolerated without any significant adverse reactions

Conclusion: It is recommended to give intravenous immunoglobulins to preterm babies, for prophylaxis against infections especially in high risk group