Subclinical rickets

The study on sub clinical rickets is unique in the sense that it has not been preplanned conducted anywhere especially in Pakistan. The objective of present study was to explore the prevalence, gender and geographical distribution of sub clinical rickets and their related factors among school students. Out of total participants, 189[90%] students were finally included in the study from rural, urban and suburban high schools of Hazara Division, KPK. The age of boys and girls students was 11 years to 16 years. Anthropometrics data along with daily intakes of meal and availability of sun shine was noted on record form. Sub clinical cases were diagnosed with abnormal biochemical findings without physical indications of rickets. Sub clinical rickets was found in 51[27%] students, out of which 15[8%] were boys and 36[19%] girls. Geographically, 26 cases of sub clinical rickets were from rural schools, 16 of urban and 09 found in suburban school. All sub clinical cases had serum level of sunshine vitamin D in between >/= 18nmol/l to

Subclinical nutritional rickets among adolescents in kaghan valley

To determine the occurrence of subclinical rickets and its causing factors among adolescent students of schools in Kaghan Valley, Pakistan. Observation cross-sectional study. Department of Biochemistry and Health Sciences, Hazara University, Mansehra, Ayub Medical College and Teaching Hospital, Abbottabad, from March to April 2012. Sixty seven students [34 boys and 33 girls] age between 11 - 16 years included in the study from different schools of Kaghan Valley, Pakistan. Characteristic, serum biochemical and nutritional status were measured for all the participants. On the basis of biochemical finding the boys and girls students were divided in to two groups, normal subjects and subclinical rickets [absent symptoms with altered biochemistry]. Twenty six participants, 19 [73%] girls and 07 [27%] boys had biochemical abnormality but no clinical signs and symptoms of rickets. Low vitamin D and high alkaline phosphatase level were observed in 26 [100%], 21 [81%], low calcium in 17 [65%] and low phosphorus 7 [27%] subjects with subclinical rickets. None had high parathormone level above normal range. Nutritional intake of calcium, phosphorus and vitamin D was found less than the recommended daily intake in all the participants. Subclinical rickets is common problem among adolescent students especially in girls which is due to low nutritional intakes and avoidance of sunshine due to environmental and traditional impacts

Aetiology and types of neonatal seizures presenting at ayub teaching hospital Abbottabad

Neonatal seizures [NS] affect approximately 1% of neonates. Clonic, tonic, myoclonic and subtle seizures are the common types. Birth asphyxia, sepsis, metabolic derangements, intracranial bleed, kernicterus, tetanus and 5[th] day fits are the common aetiologies. This study was planned to evaluate the types and causes of neonatal seizures. It was a descriptive case series conducted at Ayub Teaching Hospital, Abbottabad from 12[th] December 2006 to 25[th] September 2007 on eonates having seizures. Serum chemistry, blood counts, cerebrospinal fluid examination and cranial ultrasound were done in all patients. Blood culture, renal and liver function tests, computerised tomography scan, metabolic and septic screening was done in selected patients. Descriptive statistics were applied for analysis. Tonic clonic seizure was the commonest type [28%] followed by multi-focal clonic, and focal tonic seizures [25% each]. Birth asphyxia was found to be the main aetiology [46%].Tonic clonic seizure was the commonest type and birth asphyxia the main aetiology identified in the majority of neonatal seizures.

Prevalence of obesity in school children of Hazara division

Limited data is available in Pakistan regarding prevalence of obesity in school going children. The objective of this study was to find out obesity prevalence in school going children in Hazara division. It was descriptive study. Data of 3200 students was collected over six month period, from Hazara Division. Four schools were selected in each district two for boys and two for females. District Kohistan was excluded from study as female education is not permitted beyond primary education. Children 5-14 year age group were included in the study. Initial 20 students of each class were selected for study. Anthropometric data [weight, height] for each student was collected and entered on Performa structured for this purpose. BMI was calculated and values were compared with standard BMI charts of National Health Centre for health statistics. Prevalence of obesity was 4.78%. Out of 3,200 children enrolled 153 [4.78%] were obese. Male to female ratio was 1:1.2. The prevalence of obesity was high in private school students than government schools [66.66% and 33%]. The prevalence was high in both sexes in 12-14 years and 6-7 years age groups [49% and 20.26%]. Prevalence of obesity in present study is similar to the results from developing countries in the region but prevalence is lower than developed countries. Problem of obesity also exists in developing countries and there is need to create awareness about obesity and related complications

Frequency and clinical presentation of UTI among children of Hazara division, Pakistan

Urinary tract infection is common in children and result in permanent renal damage and end stage renal failure in significant number of patients. It is imperative to diagnose urinary tract infection early and to treat adequately. We carried out this study to look into frequency and clinical profile of UTI in children admitted in our unit. Three hundred and seventy five patients with UTI, diagnosed by urine culture with age from 0-15 years admitted in pediatric unit during 2003-2006 were included in study. Urine sample for culture was collected by midstream clean catch, urine collecting bag and Suprapubic methods depending upon the age of patient. A proforma was used to record clinical presentation and laboratory findings of these patients. Frequency of Urinary tract infections among children examined by urine culture was 375 out of 1000 [37.5%] out of which 36 [9.6%] were male and 339 [90.4%] were females. Almost half of them 48.5% were less than 3 years old. About 60% of patients belong to Kohistan and Batagram districts and failure to thrive was common presenting feature [56.6%] in patients of these two districts. Fever was common clinical presentation 91% followed by Dysuria [65%] and failure to thrive [40%]. Frequency and clinical profile of urinary tract infection in children in Hazara Division is not significantly different from that of developing and developed countries

Clinical outcome in measles patients hospitalized with complications

Measles is a highly communicable viral illness and is common cause of childhood mortality and morbidity. Keeping in view the high prevalence of measles in the developing world, we carried out this study to look into the complicated measles cases and clinical outcome in patients admitted in children ward of Ayub Teaching Hospital. Detailed history and physical examination of all the hospitalized patients with complication of measles were recorded in a proforma. Immunization and nutritional status of each admitted patient was assessed and the clinical outcome of measles was compared with demographic profile. One hundred thirty six hospitalized patients with complications of measles were studied. There was 60.3% male and 57.3% of patients were vaccinated against measles. Malnourished patients were 71.35% and had longer hospital stay [>5 days]. Pneumonia [39.7%] and diarrhoea [38.2%] were the commonest complications. Seven children died and encephalitis [57.1%] was the commonest cause of death. The most common complications of measles are pneumonia and diarrhoea with dehydration requiring admission. Malnutrition results in more complications and longer hospital stay. Mortality is significantly associated with encephalitis

Frequency of dyslipidaemia in type 2 diabetes mellitus in patients of Hazara division

Diabetes mellitus increases the risk of atherosclerotic vascular disease because of associated dyslipidaemia. Many studies advocate aggressive management of lipid disorders in Type 2 Diabetes to decrease these complications. This study was carried out to know the frequency of dyslipidaemia in our patients and also to determine that whether patients with good glycaemic control [HbA1c /= 8%] emphasizing the importance of good glycaemic control. However none of our patients had a low HDL-Cholesterol as found in some other studies. Hypertriglyceridaemia along with impaired LDL-Cholesterol is present in majority of our patients. Good glycaemic control does affect the lipid profile in Type 2 Diabetes mellitus. However to provide the benefits of lipid lowering therapy to our patients, as confirmed in many studies, we need more awareness and placebo controlled double blind studies

Mushroom poisoning in children: clinical presentation and outcome

A variable clinical picture characterizes mushroom poisoning. The Amatoxin, the main toxic component of these fungi, are responsible for gastrointestinal symptoms as well as hepatic and renal failure. As acute gastroenteritis is extremely common in our set up, so every patient presenting with these symptoms is treated as gastroenteritis of viral aetiology. The authors present the clinical picture of the phalloid syndrome, its treatment and immediate outcome. All children age less than 16 years admitted in Saidu Hospital Swat from January to December 2006 with mushroom poisoning were included in the study. Patients with doubtful history or with associated illness were not included. The diagnosis was based on the clinical picture of the patient, history and the laboratory data. In addition to maintenance of fluid and electrolyte balance and treating sepsis, oral Silymarin and intravenous penicillin was started. Liver function tests, renal functions tests, serum electrolytes and coagulation profile was done in all the patients. The severity of poisoning was graded according to hepatic transaminase elevations and prolongation of prothrombin time. Of the 18 patients, fifteen were above five years of age. Female were twice in number. Fifteen patients developed hepatic failure and three patients developed renal failure. Thirteen patients expired. To start timely management, Mushroom poisoning should be considered in the differential diagnosis in patients presenting with food poisoning particularly coming in groups. Delay in diagnosis is associated with high mortality

Status epilepticus: aetiology and outcome in children

Convulsing Status Epilepticus [CSE] is a common paediatric emergency especially under 24 months age group. Present study was done to know causes of Status Epilepticus [SE] and outcome during admission and at the time of discharge. A descriptive study in children 2 months to 15 years of age, admitted in Department of Paediatrics, Ayub Medical College, Abbottabad with first status epilepticus, was done to evaluate aetiology, complications and immediate outcome after relevant history, examination, laboratory tests. All information was recorded on Performa designed especially for this purpose. Study was conducted over 2 year period from November 2005 to November 2007. Total number of children admitted with SE was 125. Majority of SE episodes were related to acute febrile illnesses. Acute viral encephalitis was the common cause of SE especially in children younger than 24 months followed by febrile convulsions. Fifteen [12%] patients expired while neurological complications secondary to brain injury developed in 10[8%] cases. Mean seizure duration was 4.92 +/- 9.18 hours in children with normal outcome, 5.93 +/- 5.76 hours in children who died, and 12.85 +/- 12.91 hours in children with abnormal neurological outcome at discharge [p > 0.05]. Correlation between age and duration of seizure was not significant [p > 0.05]. SE is a common paediatric emergency associated with high mortality and morbidity. In young children SE is commonly associated with acute viral encephalitis. Antiviral treatment should be started earlier in this group of young children after history, examination, laboratory tests along with appropriate management of SE

Estimation of foetal weight in third trimester using thigh measurements

Estimation of foetal weight is essential in daily obstetric practice particularly close to term. It guides clinicians to finalize important obstetrical decisions. Low birth weight and excessive foetal weight at delivery both are associated with an increased risk of neonatal complications during labour and the puerperium. The objectives of this cross sectional study were to estimate the foetal weight using only two thigh parameters and its comparison with birth weight. This study was conducted in Radiology Department PNS Shifa during 1st June, 2007 to 30 Nov, 2007. All pregnant females coming to Radiology Department for Ultrasound examinations in 3rd trimester were the Subjects of study. All infants were delivered with in 48 hour of ultrasound examination. 100 patients were included in this study. Thigh measurements were made by conventional two dimensional ultrasonography. The Isobe formula was compared with already established Aoki's formula and actual birth weight using paired sample t-test. Isobe's formula showed a significant correlation with the actual birth weight. In 90% of cases estimated foetal weight was within 10% of the actual birth weight The Isobe's formula was found to be convenient among all the established formulas for estimated foetal body weight. Measurement of head circumference was not necessary near term

Etiology of strokes and hemiplegia in children presenting at Ayub Teaching Hospital, Abbottabad

Strokes in pediatric age group are not common. However diagnosing the cause of stroke will help in providing preventive and curative treatment. Present study was conducted to find etiology of strokes/hemiplegia in children. This study was conducted in Department of Pediatrics, Ayub Teaching Hospital Abbottabad from December 2002 to December 2005.All children from two months to fifteen years of age were included in the study. Children with weakness due to acute poliomyelitis and Guillan barre syndrome were excluded. Investigations were based on findings on history and clinical examination and included full blood count, PT, APTT, Platelets count, ECG, Echocardiography, hematocrit, lumber puncture with CSF analysis and culture and CT-scan skull. Data of all the patients presenting with strokes/hemiplegia was entered on prepared proforma. The main etiology of strokes was intracranial infection causing strokes in 23[56.09%] children and majority of children [78.26%] in this group were below five years. Etiology was un-known in 7[17.07%] children after necessary available investigations. Intracranial infection Infections that is meningitis and encephalitis are commonest etiology of strokes and hemiplegia in paediatrics patients presenting at Ayub Teaching Hospital, Abbottabad

Febrile convulsions in children: Relationship of family history to type of convulsions and age at presentation

Febrile Convulsions are the commonest cause of convulsions in children under five years of age. Present study was conducted to know relationship of positive family history of convulsions to the type of febrile convulsions and age of presentation. This study was carried out in the Department of Paediatrics, Hayat Shaheed Teaching Hospital Peshawar from June 1999 to June 2000. Data of all children with febrile convulsions were recorded on special proforma. Convulsions were labelled as febrile by excluding infections of central nervous system in developmentally normal children on the basis of history, examination and relevant laboratory investigations. In 30% children there was positive family history of febrile convulsions and febrile convulsions occurred at earlier age in these children. Febrile convulsions were complex in 35% of cases and out of these there was positive family history of convulsions in 29% of children. As a whole 44% of children had first febrile convulsions below 12 months of age and 56% above 12 months of age. Majority of febrile convulsions occurred in first two years of life. Initial febrile convulsions of simple type are more common in children with positive family history of convulsions, in whom first febrile convulsions tend to occur at earlier age. Further, complex febrile convulsions are more common when age at presentation is less than 12 months