RESUMO
Background and Objective: Infantile spasm [IS] is one of the severe epileptic encephalopathies which affect children in early two years of life. Our objective was to determine the clinical profile, etiology and outcome of treatment in children with infantile spasms attending tertiary care hospital at Karachi, Pakistan
Methods: This is retrospective study of 36 patients out of 94 registered as IS, aged three months to two years, managed and followed up at Aga Khan University Hospital, Karachi, from 2010 to 2015. Data of all children with IS was collected from case record. Details including clinical observations, lab investigations, anti-epileptic medications and treatment outcome was collected and analyzed. Patients who received treatment for six weeks to document response were included. The treatment response was categorized as complete response, partial response [>50% improvement] and no response. Data was analyzed on SPSS using descriptive statistics
Results: Thirty-six patients [38.29%] with IS fulfilled eligibility criteria. The mean +/- SD age at presentation was 4.6 +/- 2.1 months. Male to female ratio was 2:1. Consanguinity and developmental motor delay was observed in 66.6% and 89% respectively. Symptomatic etiology was predominant [61%] and hypoxic ischemic insult [32%] was the commonest underlying cause. EEG and MRI were diagnostic tools whereas metabolic studies were not helpful. Multiple antiepileptic drugs were used for seizure control and vigabatrin was the most frequently used [88%] drug. Short term treatment response was not different in idiopathic or symptomatic infantile spasms
Conclusion: Majority of patients had symptomatic infantile spasms and generalized tonic clonic along with myoclonic jerks were predominant seizure types. EEG and MRI were diagnostic in most of cases. Multiple AEDs were required to control seizures and VGB was most common drug [88%] used. Treatment outcome was not different in idiopathic and symptomatic groups
RESUMO
Background: acute kidney injury [AKI] is rapid decrease of renal function. AKI has been resulted in significant morbidity and mortality. The term RIFLE consist of risk, injury, failure, loss, and end-stage renal disease. A modified version of this criteria pRIFLE is used in pediatric population with AKI, for the severity assessment and its outcome. Therefore early intervention can be made. This study helps to make recommendations based on pRIFLE criteria for severity and outcome
Objectives: to determine severity and outcome of AKI in pediatric population using pediatric RIFLE criteria
Study design, settings and duration: it was a descriptive case series carried out in departments of Pediatric ICU and pediatric nephrology unit at National Institute of Child Health [NICH], Karachi from August 2010 to March 2011
Patients and Methods: total ninety seven children with acute kidney injury [AKI] were included in this study. Schwartz equation was applied for calculation of estimated glomerular filtration rate [eGFR] and severity of AKI was assessed using pRIFLE criteria at presentation andt then on daily basis till discharge. Outcome was labeled as death or alive. Data entered and analyzed by using SPSS version 19.0
Results: the pediatric RIFLE identified those at risk, injury, and failure in 16 [16.5%], 25 [25.8%], and 56 [57.7%] patients respectively. Outcome in term of mortality was observed in 11.3% cases. There was 6.3% death in those at risk, 17.9% [10/56] in those with failure and no significant in injury
Conclusion: there are significant number of patients in renal failure due to AKI, this implies lack of early detection of AKI and delayed referral to the pediatric tertiary care hospital so "pRIFLE criteria" can be widely used by all pediatricians for early detection of children with AKI in risk category so that early interventions may halt the progression of AKI to failure
RESUMO
Objectives: First objective was to compare eGFR by Updated Schwartz [US] and Simple Height Independent [SHID] formula with Original Schwartz [OS] in children with Severe Acute Malnutrition [SAM]. The second objective was to compare eGFR in children below and above two years
Methods: This analytic study on estimation of GFR was based on retrospective data collected from 78 children with SAM at Nutritional Rehabilitation Unit from October 2014 - March 2015. Glomerular filtration rate was calculated using serum creatinine [S. Cr] and height in Original Schwartz, US and by age in SHID equation and compared with OS as standard. Data was analyzed using descriptive statistics
Results: There were 78 children in this study. Males were 39[50%]. Mean age of patients was 18+/-15.53 months with 62[79.48%] /=90ml calculated by US compared to OS [0.025] and by SHID with OS [0.04] in children below two years and no difference in children above two years. But there was no difference in other categories of eGFR calculated by either of formula in both age groups
Conclusion: We found a significant difference in eGFR in ranges above 90 ml/min/1.73 m[2] by US compared to OS as well as by SHID with OS in children below two years and no difference in children above two years. Also, there was no difference in GFR categories below 90 ml/min /1.73 m[2] calculated by either of formula in both age groups. So, we may conclude that either of formula can be used in clinical practice for eGFR in mild to severe renal dysfunction in severely malnourished children
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