Diagnostic accuracy of mid upper arm circumference [MUAC] for screening low birth weight babies

Objective: To determine the diagnostic accuracy of Mid Upper Arm Circumference [MUAC] for screening low birth weight babies

Study Design: Cross-sectional study

Place and Duration of study: This study was conducted at the Pediatric Unit II and Gynecology Unit II at Civil Hospital Karachi, Pakistan, from January to June 2012

Materials and Methods: A hospital base study was carried out on full term, singleton 112 live born babies. Birth weight was taken through digital weighing scale as gold standard against anthropometric measurement of MUAC in centimeters

Correlation between MUAC and low birth weight was calculated with 95 % confidence interval

Sensitivity, specificity, positive and negative predictive values were calculated

Results: Out of 112 newborn babies studied, 44 [39 %] were male and 68 [61%] were female. The mean birth weight was 2.316 +/- 0.563 kgs and 51 [45.5%] newborns were low birth weight [LBW]

The mean MUAC was 8.90 +/- 1.08. In low birth weight mean MUAC was 8.41 +/- 0.87; 95% CI [8.21; 8.61] and in normal birth weight mean MUAC was 9.90 +/- 0.70; 95% CI [9.66; 10.13].Pearson correlation between low birth weight and MUAC was found statistically significant [r= 0.858;P-value <0.001]. A cut-off point of <9.3 cm of MUAC showed 81.1% sensitivity and 78.3% specificity

Conclusion: Mid upper arm circumference was statistically significant anthropometric surrogate of birth weight at cut-off point < 9.3 cm in the study population. Further studies are needed to validate the finding of this study in community setting. MUAC is a simple, practicable, quick and reliable indicator for predicting LBW newborns in the community and can be easily measured by paramedical workers in developing nations

Efficacy and adverse effects of oral chelating therapy [deferasirox] in multi-transfused Pakistani children with -thalassemia major

Objective: To determine the efficacy and adverse effects of oral chelation therapy [deferasirox] in multitransfused -thalassemia major patients visiting pediatric thalassemia clinic in Civil Hospital Karachi. Methods: This prospective study was conducted at pediatric thalassemia clinic of Civil Hospital Karachi. Hundred multi-transfused -thalassemia patients registered in the clinic for oral iron chelation therapy were included in the study. Information regarding clinical and laboratory parameters including abdominal pain, jaundice, serum ferritin, creatinine and serum transaminase levels were recorded on a Performa and data was analyzed through SPSS 16. Results: Hundred patients were stratified into two age groups, 54% were below and 46% were above nine year. Majority were males, 62% and 38% were females. Abdominal pain 41%, nausea 31%, vomiting 15%, jaundice 15% and elevated serum creatinine 11.5% were frequently observed clinical adverse effects in this study. Serum glutamic pyruvic transaminase [SGPT] level was statistically significant compared with initial visit and six months after optimal chelation therapy [p=0.030]. Although Serum ferritin was decreased but it was not statistically significant [p=0.929]. Conclusion: Deferasirox is an effective oral chelation agent for -thalassemia major patients. Most common adverse effects of the drug are abdominal pain, nausea, vomiting, and elevation of liver enzymes

Maternal psychiatric morbidity and childhood malnutrition

To determine maternal psychiatric morbidity and its relation with malnutrition in their children. It was a case control study conducted at Nutrition Rehabilitation Unit of Department of Pediatrics, Civil Hospital Karachi, Pakistan from March to September 2011. Samples included hundred children between 3 to 36 months of age. The number of cases and control were fifty each. Children with moderate and severe malnutrition according to WHO classification were included in the case group whereas controls were children of the same age group and normal weight, coming to the department with common illnesses like acute respiratory infections, diarrhea, during the same time period. Mothers of both groups were screened for a probable psychiatric morbidity using HADS; "The Hospital Anxiety and Depression Scale", a psychiatric screening instrument. The score of more than eleven on either sub scale of HADS was considered significant for presence of psychiatric illness in the mothers. Data was analyzed through SPSS 15. Statistical analysis of data was done by using Odds ratio, stratification and logistic regression for each variable in both case and control groups. Maternal HADS score was significantly high >21 in 50% of cases whereas in controls it was 46% [O.R=0.85 [95%Cl=0.38-1.86]. Of the malnourished 90% and controls, 84% belong to low income status OR=1.71 [95% CI 0.52-5.6] whereas low birth weight was 64% in cases and 56% in controls OR=1.39 [95% Cl 0.62-3.11]. Maternal mental health affects the nutritional status of the children. Anxiety and depression are common psychiatric illnesses found in our society as suggested by significantly high HADS scores of mothers in both cases and control groups. It also shows that it is difficult to establish a straightforward relationship between maternal psychiatric illnesses and poor nutritional status of their children. However increasing age of mothers, low birth weight of child, increasing family size and low income are associated important risk factors for predicting increasing HADS scores in mothers of malnourished children.

Etiological profile of pancytopenia in children: a hospital based study

To determine the etiological profile of pancytopenia in children admitted in a Paediatric department of a tertiary care hospital. This is a cross-sectional study conducted at Department of Paediatrics Dow University of Health Sciences and Civil Hospital Karachi from January 2009 to December 2009. It included all the patients between 1 -12 years of age, presenting with complaints of pallor, fever and bleeding manifestations and their complete blood picture showed decrease in 2 or 3 blood cells lines i.e hemoglobin less than 10g/dl, absolute neutrophil count less than 1.5X10[3]/L and platelet count less than 150X10[9]/L. Relevant investigations such as complete blood count, peripheral smear, reticulocyte count and bone marrow examination were done to confirm the diagnosis. The data was analyzed through SPSS version 15.0. A total of fifty patients were enrolled. There were 48% males and 52% females. Male to female ratio was 0.9:1. Mean age of patients was 7 + 3.35 years with range from 1 to 12 years. Infectious etiology was found in 50% cases followed by aplastic anemia 22%, malignancies 10% and hypersplenism 8%. Common infections found were malaria 22%, enteric fever 12% and megaloblastic anemia secondary to vitamin B12 deficiency was observed in 4% patients. The most frequent etiology of pancytopenia in children was infections followed by aplastic anemia, malignancy and hypersplenism. Malaria and enteric fever were the two most commonly observed infections causing pancytopenia in children

Nutritional rickets: correlation between clinical, biochemical and radiological profile

To determine the correlation between clinical manifestations, biochemical and radiological profile in children with nutritional rickets. This is a cross-sectional study conducted at paediatric ward of a private sector health facility, Kutyana Memon Hospital Kharadar Karachi. A total of hundred patients aged 2 to 36 months with clinical suspicion of nutritional rickets were included in the study. A detailed history and examination was done and relevant investigations including serum calcium, phosphate, alkaline phosphatase and X-ray wrist joints were done to confirm the diagnosis. Data was analyzed and presented as percentages and frequencies. There were 63% males and 37% females. Majority of children were between 6 to 18 months of age, [49%] followed by 2-6 months [44%] and 18 to 36 months [07%]. Rachitic rosary was the most frequent clinical feature observed in 87% followed by widening of wrist joints in 76% cases. Serum calcium was low in 90% cases and serum alkaline phosphatase was increased in all patients. Serum phosphate was either low or normal in 44% cases each. Radiological findings were suggestive of rickets in 54% cases. Clinical and Biochemical markers are reliable indicators for diagnosis of nutritional rickets, which is more frequent between 2 to 18 months of age

Communication skills of doctors in a paediatric department, their perceptions and practices

To determine the perceptions and practices regarding communication skills of doctors in a paediatric department of a tertiary care hospital. This was a cross-sectional study conducted in the Department of Paediatrics, Dow Medical College and Civil Hospital Karachi from October to December 2008. Fifty four doctors including faculty, consultants, registrars, postgraduates and medical officers of indoor and outdoor departments and wards were enquired regarding their behavior and communication with parents and physicians. Their responses were recorded on a questionnaire based on standards IMNCI/WHO guidelines for good communication skills. The data was later analyzed and given as frequencies and percentages. Sixty five percent doctors were spending less than 10 minutes with patients, seventy percent of the doctors claimed that they were polite and friendly with their patients, thirty seven percent were using simple language, thirty nine percent were listening carefully without interruption whereas eighty percent did not know the appropriate time of follow up. Seventy four percent doctors claimed that lack of parental understanding is one of the important reasons for lack of effective communication. Other reasons reported were large number of patients [56%] lack of adequate time [50%], inadequate numbers of doctors [35%] and other paramedical staff [30%]. Majority of doctors of Paediatric Department are using inadequate communication skills. Large number of patients, lack of adequate number of doctors and paramedical staff and lack of parental understandings were the reasons given by the doctors for inadequate communication practices

Mental health morbidity in children: a hospital based study in child psychiatry clinic

To determine the frequency and pattern of mental health morbidity in children attending "Psychiatry Clinic" in Paediatric OPD of a tertiary care hospital. This was a cross-sectional study conducted at psychiatric clinic of Paediatric OPD at civil hospital Karachi. Two hundred children upto the age of 14 years were included in the study. These children were assessed by a semi-structured interview based on P-CHIPS [Child Interview for Psychiatric Syndrome] and diagnosis of various psychiatric illnesses was further confirmed by DSMIV diagnostic criteria. Psychiatric disorders were more frequent in males 126 [63%] compared to females 74 [37%]. Majority of patients affected were between 5-10 years of age [62.5%]. Among the psychiatric disorders, oppositional defiant disorders were [20%], ADHD were [17%], elimination disorders and anxiety disorders were [11%] each. Other less frequent psychiatric problems were mood disorder, somatoform disorders, specific developmental disorders, emotional and habit disorders. Mental health morbidity is an important issue in children attending the psychiatry clinic in the Paediatric OPD. Sensitization of parents, teachers and physicians is required, so that timely referral for psychiatric consultation is ensured before a critical illness develops