Effectiveness of Ready-to-Use Therapeutic Food Among Children With Protein-Calorie Malnutrition.

Background Malnutrition develops when there is an inadequacy of one or more than one macronutrient for optimum body functioning. This study was designed to determine the effectiveness of ready-to-use therapeutic food (RUTF) in children with protein-calorie malnutrition (PCM) in terms of weight gain and mid-upper arm circumference (MUAC) improvement. Methodology This prospective observational study was done at The Department of Pediatrics, National Institute of Child Health, Karachi, Pakistan from 1st January 2021 to 31st December 2021. A total of 159 children of either gender between six and 59 months of age and diagnosed with PCM were included. All children participating in the study were asked to come back for a follow-up every two weeks until they are 12 weeks old. Outcomes were measured in terms of comparison of weight gain and MUAC at baseline and after 12 weeks of RUTF. Results Of the 159 children, 94 (59.1%) were female. The mean age was 16.8±9.2 months, and 88 (55.3%) children were aged between six to 12 months. The mean body weight was 6.8±9.7 kg. The mean MUAC was calculated to be 116±9.1 mm. There were 121 (76.1%) children who had severe acute malnutrition. One hundred and thirty-one children completed the planned 12-week of follow-up using RUTF in this study, so they were included in the final analysis. Body weight increased significantly from baseline to 12-weeks after RUTF (6.8±1.7 kg vs. 7.6±1.2kg, p<0.0001). Likewise, MUAC also increased from baseline to 12 weeks after RUTF (116.0±9.1 mm vs. 127.2±8.2 mm, p<0.0001). Conclusion The RUTF was found to significantly improve weight gain and MUAC among children aged between six to 60 months with PCM during a period of 12-weeks. Early diagnosis and timely intervention can improve outcomes among children with PCM. Community-based interventions can be aimed to improve the nutritional status of children in a developing country like Pakistan.

Trends in Weight Gain Among Breastfed Infants Versus Bottle-Fed Infants at a Tertiary Care Hospital in Karachi, Pakistan.

Background Infants need to be exclusively breastfed up to six months of age, and breastfeeding should be continued up to two years of age along with complementary food. In Pakistan, the majority of newborns are not exclusively breastfed. This study was done to compare weight gain between breastfed infants and non-breastfed infants at a tertiary care hospital in Karachi, Pakistan. Methodology This observational cohort study was conducted at the well-baby clinic and vaccination center of the National Institute of Child Health, Karachi, Pakistan, from January 2021 to December 2021. A total of 360 normal term babies (180 in each group) with age below 11 months on either exclusively breastfeeding or other milk feed were included. Data were collected by the duty senior staff nurse of the well-baby clinic and monitored on daily basis by the researchers. The sociodemographic characteristics of mothers of breastfed and non-breastfed babies and birth weight, length, and BMI Z scores of babies in both groups were compared. Results In a total of 360 babies, there were 192 (53.3%) boys and 168 (46.7%) girls. Overall, the mean maternal age was calculated to be 28.1±6.2 years, ranging between 18 and 37 years. The employment status of mothers (p=0.0117) and monthly income of parents (p=0.0388) were significantly different between groups. The mean weight gain in the exclusively breastfeeding group was 4.0±0.5 kg between the first and fifth visit (final visit) in comparison with 4.5±0.5 kg in the non-breastfeeding group (p<0.0001). Conclusion Non-breastfed babies gained significantly more weight in comparison with exclusively breastfed babies. More multicenter trials involving a large proportion of populations are needed to further verify the findings of the present study.

Chickenpox: presentation and complications in adults.

OBJECTIVE: To describe the clinical manifestations laboratory findings and frequency of complications in adult chickenpox patients admitted in the hospital. METHODS: This was a hospital based descriptive study, conducted at the Infectious Diseases Unit, Rashid Hospital Dubai, UAE, from March 2005 to February 2008. The study was designed to include demographics (age, sex, nationality); clinical information, radiological and biochemical changes observed in each patient and data was entered into the proforma separately. Full blood count, urea, electrolytes and blood sugar were done for all the patients, whereas, other tests were carried out when and where it was indicated. Patients were treated according to the standard protocol for the management of Chickenpox and its complications. RESULTS: A total of 102 adult patients were entered into the study. The main presenting symptoms were itchy skin rash, fever, cough, sputum, breathlessness, throat pain, vomiting, abdominal pain, confusion and headache. Whereas, the most common complications observed were raised Alanine aminotransferases (ALT) levels (51.9%) and the levels were greater than 10-folds of normal value in 4.9%, thrombocytopenia (42.1%), varicella pneumonia (28.4%), skin infection (25.4%), septicaemia (10.7%), Encephalitis/Meningitis (8.8%), Acute Respiratory Distress Syndrome (ARDS) (6.8%), acute renal failure (2.9%) and acute hepatic failure (1.9%). The frequency of varicella pneumonia was noted to be higher in males, older age group (p < .005), smokers (p < .002) and patients with respiratory symptoms (p < .0001). Total five (4.9%) patients expired, whereas, mortality rate was 17.2% in varicella pneumonia patients and 45.5% in mechanically ventilated patients. CONCLUSION: Chickenpox in adults causes severe systemic manifestations leading to high frequency of complications with increased mortality rate, particularly in the older age group and in smokers who develops varicella pneumonia and require mechanical ventilation.

Comparative analysis of disease activity in patients of chronic hepatitis B virus, with and without superinfection with hepatitis D virus; an experience at tertiary care centre.

BACKGROUND: The hepatitis D virus super-infection contributes significantly to the morbidity and mortality of hepatitis B virus infection. The objectives were to describe the incidence of Hepatitis D virus and comparative analysis of disease activity in patients of chronic hepatitis B virus, with and without super-infection of hepatitis D virus. METHODS: This Cross-sectional comparative study was conducted at Department of Medicine and Gastroenterology Clinic Jinnah Postgraduate Medical Centre, Karachi, Pakistan from February 2007 to July 2007. HBsAg positive patients who attended our Gastroenterology clinic were selected for the study. After screening for Anti-HDV these patients were segregated in to Anti-HDV positive and negative groups. Data was analyzed on SPSS 12. RESULTS: Eighty-four patients were selected. Seventy-three patients who fulfilled the inclusion criteria were enrolled in to the study. Anti-HDV was positive in 23 (31.5%) patients. Among these 23 anti-HDV positive, HDV-RNA was detected in 15 (75%) patients. The differences of age, gender, marital status and area of residence whether rural or urban were not significant between the two groups. HBV-DNA was significantly suppressed in majority of anti-HDV positive patients (p = 0.019). Mean serum ALT levels were significantly higher in patients who had HDV infection (p = 0.014). CONCLUSION: HDV infection was common in this series of patients with a frequency of 31.5%. All patients of chronic HBV should be screened for HDV whether they are asymptomatic HBV carriers or have chronic active hepatitis particularly when they have raised serum ALT.