Colonoscopy in children

To study the safety and diagnostic yield of colonoscopy in children and see the pathological pattern in those who underwent biopsy of the lesion. Retrospective analysis was carried out on paediatric colonoscopies that were carried out at Military Hospital, Rawalpindi over 5 years. All children presenting with lower gastro intestinal bleeding, chronic diarrhea and abdominal pain were subjected to colonoscopic examination. The procedure was done after 72 hours preparation, under Ketamine sedation. Mucosal biopsies were taken where indicated and polypectomies were performed using snare and electrocautery. A total of 190 children [111 boys, 79 girls; mean age 5.7 +/- 3.5 years] were included in the study. A diagnosis could be made in 162 [85.2%] patients which included polyps [138], colitis [18] and miscellaneous causes [6]. On histology, colitis was further defined into nonspecific colitis in 15 cases with 6 showing features suggestive of ulcerative colitis. Eosinophilic colitis was seen in 3 cases. Majority [78%] of polyps were in the rectosigmoid colon and all were juvenile hamartomatous polyps except two which were adenomatous polyps. Mean age for children with colitis and polyps were 6.5 and 5.1 years respectively. There was no procedure-related complication. Rectal bleeding was the major indication for colonoscopy and majority of the cases had polyps. Colonoscopy is a safe procedure in children and can be carried out under conscious sedation. All patients with rectal bleeds should undergo colonoscopy and this instruments should be available in all tertiary care pediatric units

Frequency of hepatitis B and hepatitis C in multi-transfused beta thalassemia major patients

To determine the frequency of hepatitis B and C virus infection among children with beta thalassemia major registered at Military Hospital Rawalpindi. Descriptive Study. The study was carried out at Military Hospital Rawalpindi, from 1st September 2008 to 31st August 2009. Children attending Thalassemia Centre Military Hospital Rawalpindi for regular blood transfusion were registered. They belonged to different ethnic groups and came from different parts of the country. Their demographic data was recorded, detailed history taken and physical examination was carried out. Their serum samples were tested for hepatitis B surface antigen and anti HCV antibody assay with third generation commercial ELISA method. During the study, 141 patients of beta thalassemia major were screened. Out of them 50 patients [35.5%, 95% confidence interval 27.8-43.5] were found hepatitis C virus antibody positive and 1 patient [0.7%] hepatitis B surface antigen positive. One patient [0.7%] had both hepatitis B and C virus infection. Mean age of hepatitis C infected patients was 10.4+3.85years [range 2-16 years]. Mean age of uninfected patients was 6.1+ 3.59 years. [p value 0.000]. In addition, the results indicate that higher prevalence of anti-HCV was significantly associated with longer duration of transfusion [p value <0.003]. In spite of the fact that screened blood is used for transfusions, still a large number of patients have been found infected with hepatitis C. Therefore more accurate techniques are required for screening of blood to prevent transfusion associated transmission

Parenteral iron therapy in malnourished children

To evaluate the safety and efficacy of intravenous iron sucrose complex in the treatment of iron deficiency anemia in malnourished children who are unable to tolerate oral iron supplementation or are unresponsive to oral supplementation because of gastrointestinal dysfunction or iron malabsorption. Prospective interventional study. This study was carried out at Department of Paediatrics Combined Military Hospital Quetta over 24 months of period from 1st November 2002 to 31st October 2004. Each selected patient was given total calculated amount of iron sucrose complex. The iron deficit was calculated by using following formula: Total Iron Deficit [mg] = Body wt [Kg] x [target Hb - Actual Hb] x 0.24 + Depot Iron [mg]. Target Hb is 13 G/dl and depot iron is 15 mg/Kg. Iron sucrose complex was diluted in 0.9% Normal saline and was given intravenously over 3-4 hours. To assess the efficacy of Iron sucrose complex serial samples were analyzed for Hemoglobin [HB], Hematocrit [Hct], Red Blood cell indices, Reticulocyte count and serum Ferritin. Total iron deficit was administered over 2 to 3 weeks time. A total of 17 malnourished children with weight for age below -2SD, completed intravenous iron sucrose infusion. Tolerance of intravenous iron sucrose was good except in one, who had transient episode of lethargy. Mean Hemoglobin at presentation was 6.6G/dl [Range: 4.9G/dl-8.4G/dl]. Six weeks after giving intravenous iron therapy mean Hemoglobin was 10.5 G/dl, with average increase of 3.9G/dl [range 3.0G/dl-5.3G/dl]. Intravenous iron supplementation with Iron sucrose complex is quite safe and efficient way of replenishing iron body stores and significantly increasing the hemoglobin concentration in malnourished iron deficient children