Anti-Tuberculosis therapy induced Liver injury in children

Introduction: Tuberculosis has remained and is one of the major issues of the under developed world including Pakistan. About 10-11 percent cases of tuberculosis are from pediatric population. Isoniazid, rifampicin and pyrazinamide constitutes generally used therapeutic regime. Directly observed treatment short course [DOTS] is now much popular strategy. Ant tuberculosis drug-induced liver injury creates obstacles in treatment and also exerts socioeconomic strain on resources

Objective: To determine the frequency, severity and pattern of the Anti-tuberculosis Drug-Induced Liver Injury in children under 14 years of age

Study Design: Case series study

Duration of Study: 02-10-2015 to 03-10-2016

Setting: Department of Pediatric Medicine Unit-1, Allied Hospital, Faisalabad. Sample size: The total sample size is 100 cases. Sampling Technique: Non-probability purposive sampling. Methodology: Total of 100 patients with either sex from 1 to 15 years of age, on anti-tuberculosis therapy due to any variety of tuberculosis having normal liver anatomy and function initially were studied. Patients already having hepatobiliary disease regardless of etiology were not enrolled in study. Initial diagnosis was confirmed using set criteria. All patients underwent detailed medical history and physical examination followed by investigations. Data comprising age, sex, type of tuberculosis, treatment interval, and hepatotoxicity etc. was collected using designed Performa by the researcher. The data was analyzed through SPSS-20 by means of descriptive statistic

Results: In our study, out of 100 children, minimum age was 6 months and maximum age was 156 months and Mean + SD was calculated as 38.07+/-37.368 months, 51 [53.1 percent] were male and 45 [46.9 percent] were females, ventilator associated pneumonia was recorded in 19 [19.8 percent] while 77[80.2 percent] had no findings of the ventilator associated pneumonia

Conclusion: The frequency of TB DILI was 14.0 percent in this study, indicating the importance of keeping index of suspicion high for the development of hepatotoxicity with anti-tuberculosis therapy in children being treated for any variety of tuberculosis

Efficacy of lactobacillus acidophilus dds-1, lactobacillus bulgaricus, bifidobacterium infantis in the prevention of necrotizing enterocolitis in preterm neonates

Objectives: To compare the efficacy of combination of lactobacillus acidophilus DDS-1, lactobacillus bulgaricus, bifidobacterium infantis in the prevention of necrotizing enterocolitis in preterm neonates with placebo. Study Design: Randomized controlled trial. Duration of Study: May 2012 to October 2012. Setting: Department of Pediatric Medicine, Allied Hospital, Faisalabad

Methodology: Over 6 months, 220 preterm neonates meeting the inclusion criteria were selected and were assigned randomly to two groups after parental informed consent was obtained. The neonates in study group received probiotic with breast milk or preterm formula milk and neonates in control group received breast milk or preterm formula milk. Both groups were observed for the development of clinical evidence of NEC. The Data was statistically analyzed; Chi square test and Fischer's exact test was applied to compare both groups for presence of NEC

Results: The number of days required to reach full enteral feeding [study group 8.73 +/- 3.87 days vs control group 10.72 +/- 5.43 days; p-value 0.002] and duration of hospital stay was [study group 11.35 +/- 6.74 vs control group 15.35 +/- 10.29; p-value 0.001] significantly low in the probiotic-exposed group compared with the control. The incidence of NEC [study group 10.0% vs control group 22.72%; p-value 0.011] was significantly low in the probiotic-exposed group when compared with non-exposed group

Conclusion: Alteration of microbial florae following oral supplementation of probiotics along with human milk have beneficial effects in reducing the incidence of NEC especially in pre-term neonates

Recurrent meningitis - a case report

Recurrent meningitis is an uncommon but serious condition. A 13 year old girl presented with recurrent meningitis, was admitted and investigated for the cause of meningitis. She had frontal bone fracture due to trauma 5 years back. We present a pediatric patient with recurrent meningitis without CSF rhinorrea or otorrhea

Poland syndrome: a case report

Poland Syndrome is a rare birth anomaly commonly found in males characterized by partial or complete absence of pectoralis major muscle on one side of the body [mostly right side], along with some other associated anomalies like asymmetry of upper limb, hypo-plastic nipple and syndactyly of the effected side. A 4-month old male baby presented with complaint of fever and respiratory distress, was admitted and treated as case of bronchopneumonia. The patient was ultimately diagnosed as a case of Poland syndrome

Bilateral developmental dysplasia of hip joints [DDH]

This case report describes a two year old child with bilateral developmental dysplasia [DDH] of the hip joint, presented with waddling gate and lordotic posture. Treatment with open reduction led to recovery from symptoms

Comparison of serum zinc levels between healthy and malnourished children

To compare serum zinc levels of healthy and malnourished children. Prospective study. Department of Pediatrics and Dermatology Allied/DHQ Hospital Punjab Medical College Faisalabad between July 2006 to September 2006. Serum zinc levels of 150 children between the ages of 2 months to 14 years of either sex were studied, out of which 75 hospitalized children were suffering from malnutrition while 75 healthy children were taken as control from the outdoor. Both groups were further divided into three age groups 2 months to 4 years, 5-10 years and 11-14 years. Verbal consent was taken from all the parents. All the details of children were enrolled on a specific proforma designed for the study. No ethical issue was involved. Malnourished children were classified and sub-grouped according to modified Gomez classification. Serum zinc levels were measured at HiTech Laboratory, Agriculture University, Faisalabad by Atomic Absorption Spectrophotometry, the most widely used and reliable method. The mean serum zinc level of 75 healthy children was found to be 99.97 micro g/dl [Standard Error +/- 10.2] while mean serum zinc level of 75 malnourished children was 51.2 micro g/dl [ +/- 1.14]. The children suffering from 1st, 2nd and 3rd degree malnutrition were 22, 27 and 26 in number with a mean level of 56.36 micro g/dl [ +/- 2.26], 51.56 micro g/dl [ +/- 1.89] and 46.46 micro g/dl [ +/- 1.36] respectively. Statistical analysis of data was done by calculating P-value with analysis of variance of serum zinc level for degree of malnutrition, age and sex. It showed that serum zinc level of malnourished children is significantly low [P-value = 0.001]. There is a significant difference of serum zinc levels between healthy and malnourished children especially in children with diarrhea and respiratory tract infection. This signifies a proper replacement of zinc as part of management of malnutrition and also during disease process

Relationship of type of cerebral palsy with the etiology

To determine the relationship of etiology with the type of cerebral palsy in children. Descriptive case series. Department of Paediatrics, Allied Hospital, Faisalabad. From January 2002 to December 2004. 120 children from 1-12 years of age of either sex who presented in Paediatric Department with abnormalities of tone, posture and movement and subsequently diagnosed as cerebral palsy on the basis of history, physical examination and investigations, were included. Out of 120 cases the majority had spastic CP, 72% [n = 86] such as quadriplegic, diplegic and hemiplegic types. The spastic quadriplegia was mainly associated with birth asphyxia and meningoencephalitis. Prematurity and low birth weight were the major contributors towards diplegic CP, while spastic hemiplegia although less common was caused by meningoencephalitis in 5 cases and infra cranial bleed and asphyxia in 3 cases each. Atonic or hypotonic CP found in 23 cases, were caused by meningoencephalitis, kemicterus, birth asphyxia and prematurity. 10 cases of atonic CP did not have any reason [hence idiopathic]. Athetoid CP was mainly due to kemicterus, meningoencephalitis and asphyxia. Ataxic and mixed types of CP were present in 3 cases each and were due to meningoencephalitis and birth asphyxia

Neonatal lupus

The case presented here is of a newborn having cutaneous lesion which were noticed soon after birth. Cutaneous lesion included well demarcated macular erythematous rash over face. The cutaneous lesion was associated with positive anti Ro Ab in the newborn as well as in the mother. There was no evidence of hepatic, cardiac and hematological involvement in this newborn

Infections in pre-term babies; role of intravenous immunoglobulins

Objective: To determine the effectiveness of I/V immunoglobulins for prophylaxis against sepsis in preterm newborn. Design of study: Prospective study Setting: Department of Pediatrics at Allied Hospital, Faisalabad. Period: From October 1999 to August 2001

Material and Methods: Seventy newborns of either sex, weighing 1000 gms to 2000 gms [mean 1450 gms] with gestational age 28 to 35 weeks [mean 31 weeks] were included and assigned into 2 groups [35 babies in each group]. On alternate basis one group [study group] was given I/V immunoglobulins 500 mg/kg on day 1, 3 and 10 and the other was not [control group]. The serum level of Immunoglobulins was not determined

Results: Maternal and neonatal risk factors for infection did not differ between the two groups. There was a significant difference in development of sepsis [both culture positive and negative] as well as mortality in the study group as compared to control group. The drug was well tolerated without any significant adverse reactions

Conclusion: It is recommended to give intravenous immunoglobulins to preterm babies, for prophylaxis against infections especially in high risk group