RESUMO
Objectives: The association of malnutrition and systemic diseases like chronic kidney disease [CKD] is well known. Various urinary tract abnormalities may be associated with malnutrition. So objective of current study was to determine the frequency of functional and structural urinary tract abnormalities in severely malnourished children admitted in Nutritional Rehabilitation Unit [NRU] of a tertiary care facility, Karachi
Methods: This descriptive cases series of 78 children was conducted in NRU from October 2014 - March 2015. All newly admitted children aged 2-60 months, diagnosed as Severe Acute Malnutrition [SAM] were studied and children with known kidney and urinary tract disorders were excluded. Detailed history, examination and investigations like serum creatinine, ultrasound kidney and urinary tract in addition to routine tests for SAM, were done. A proforma was used to collect demographic data, clinical history, physical findings, and radio-imaging and biochemical investigations. Glomerular filtration rate [GFR] was calculated using Schwartz equation. Data was analyzed using descriptive statistics
Results: Among 78 children, male to female ratio was equal. Mean age was 18+/-15.53 months and majority [79.48%] of children were below 24 months. Majority [82%] of children with SAM had marasmus whereas 18% had edematous malnutrition. Out of 78, 57 [73%] children had either functional [80.7%] and or structural [19.3%] abnormalities whereas 21[36.84%] had normal functional and structural status. Most common functional abnormality was subnormal GFR [<90ml/min/1.73 m[2]] found in all 46 children. Functional abnormities were more common in children below 24 months. Other functional disorders were Bartter syndrome, renal tubular acidosis and urinary tract infection [UTI] found in two cases each. Common structural abnormalities were echogenic kidneys [n=4, 36%], hydronephrosis [n=3, 27%], hypoplastic kidneys [n=3, 27%] and calculi [n=1, 9%]. Subnormal GFR was also found in all cases with structural abnormalities. UTI was observed exclusively in two children among 11 with structural abnormalities
Conclusion: A high frequency of functional abnormalities and noticeable proportion of structural abnormalities of urinary tract were detected in children with SAM. Current finding suggest that multicenter study at national level may be undertaken to generate better data about prevalence of renal diseases in SAM
RESUMO
Background and Objective: Pakistan accounts for the highest stillbirth rate in the world. Therefore, this observational study was planned to determine the prevalence of stillbirths and its associated demographic characteristics in the given context. Hence our objective included: To determine the frequency of stillbirths with reference to parity and gestational age in a tertiary care public hospital, Karachi. To determine the socio-demographic characteristics of families with stillbirths
Methods: All pregnant mothers who delivered stillbirth babies at Gynaecology and Obstetrics ward of Jinnah Postgraduate Medical Center, Karachi a tertiary care facility were prospectively enrolled from October 2012 to September 2013. Deliveries occurred before 28 weeks of gestational age were excluded. Gestational age was confirmed from hospital record and attending physicians. Data was collected on predesigned proforma and analyzed using descriptive statistics
Results: Among 7708 registered deliveries, 137 were stillbirths. A total of 84 mothers were primiparous and 12% of mothers were below 20 years at the time of delivery. Majority of stillbirths were macerated type [80.3%] and 20% were fresh stillbirth. About 55% of still births occurred between 33-37 weeks and 20% between 28-32 weeks. Almost 80%[109] of stillbirths were low birth weight and only 20%[28] were normal birth weight
Conclusion: This study shows that stillbirths are more common in primiparous mothers in a given context. Conducting awareness sessions with special focus on antenatal and obstetrical care of primiparous may be helpful to reduce still births