Iron Deficiency Anaemia As Risk Factor For Simple Febrile Seizures: A Case Control Study.

BACKGROUND: Febrile fits is common problem in children. Among other risk factors, iron deficiency anaemia is considered as aggravating factor for febrile fits. Iron deficiency anaemia is preventable and treatable disease. The objective of the study was to find out iron deficiency anaemia as risk factor for febrile fits. METHODS: It was a case control study. Thirty cases of febrile fits were recorded. Control group of 30 cases was taken at the same time with same variables but without febrile fits. Their temperatures and weights were recorded and laboratory haematological parameters haemoglobin, haematocrit, Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Haemoglobin Concentration (MCHC), Red Blood Count (RBC) and Red Cell Distribution Width values were collected and analysed statistically with SPSS Ver 20.0. RESULTS: In case group 21 had haemoglobin <11.0 gm% while in control group 13 cases had haemoglobin <11.0 gm% (Odd Ratio 3.0513 95% CI 1.0533-8.8390) Mean Haematocrit, RBC, MCV, MCH, MCHC and RDW had statistically significant difference between the two groups (p-value <0.05). CONCLUSIONS: As Iron Deficiency Anaemia is a risk factor for febrile fits, treatment and prevention of iron deficiency anaemia can decrease incidence of febrile fits.

Frequency of nutritional rickets in children admitted with severe pneumonia.

OBJECTIVE: To determine the frequency of nutritional rickets in children hospitalized with severe pneumonia. METHOD: This study was carried out at the department of paediatric medicine at National Institute of Child Health Karachi. It is a case series done over a period of six months from 15th November 2008 to 15th may 2009. Patients admitted (n=137) with severe pneumonia were included in the study and were investigated for presence of rickets with serum calcium, phosphorus and alkaline phosphatase. Those having low to normal calcium low phosphorus and raised alkaline phosphatase were labeled as having rickets. All data collected were entered on Performa. Children with familial, vitamin D dependent/resistant rickets, secondary rickets, and cerebral palsy or on anti convulsant therapy were excluded from this study. RESULTS: Out of 137 patients, with severe pneumonia, 83 were male and 54 female. Frequency of nutritional rickets in children with severe pneumonia was observed in 101(74%) cases. Rickets was more common in 2 to 12 months of age, i.e., 79.8% (67/84) and in those children who were breast fed (85.3% vs. 40%). Frequency was higher in those children who were not exposed to sunlight. CONCLUSION: Pneumonia is a very common presentation of rickets. This study suggests that rickets may be more common in children who are breast fed and those who have less exposure to sunlight.

Randomized controlled trial of standard versus double dose cotrimoxazole for childhood pneumonia in Pakistan.

OBJECTIVE: Increasing concern over bacterial resistance to cotrimoxazole, which is recommended by WHO as a first-line drug for treating non-severe pneumonia, led to the suggestion that this might not be optimal therapy. However, changing to alternative antimicrobial agents, such as amoxicillin, is costly. We compared the clinical efficacy of twice-daily cotrimoxazole in standard versus double dosage for treating non-severe pneumonia in children. METHODS: A randomized controlled multicentre trial was implemented in seven hospital outpatient departments and two community health programmes. A total of 1143 children aged 2-59 months with non-severe pneumonia were randomly allocated to receive 4 mg trimethoprim plus 20 mg sulfamethoxazole/kg of body weight or 8 mg trimethoprim plus 40 mg sulfamethoxazole/kg of body weight orally twice-daily for 5 days Treatment failure occurred when a child required a change of therapy, died or was lost to follow-up. Children required a change of therapy if their condition worsened (they developed chest indrawing or danger signs) or if at 48 hours after enrollment, their clinical condition was the same (defined as having a respiratory rate that was 5 breaths/minute higher or lower than at the time of enrollment). FINDINGS: The results of 1134 children were analysed: 578 were assigned to the standard dose of cotrimoxazole and 556 to the double dose. Treatment failed in 112 children (19.4%) in the standard group and 118 (21.2%) in the double-dose group (relative risk 1.10; 95% confidence interval = 0.87-1.37). Using multivariate analysis we found that treatment was more likely to fail in children who were not given the medicine correctly (P = 0.001), in those younger than 12 months (P = 0.004), those who had used antibiotics previously (P = 0.002), those whose respiratory rate was > or =20 breaths/minute above the age-specific cut-off point (P = 0.006), and those from urban areas (P = 0.042). CONCLUSION: Both standard and double strength cotrimoxazole were equally effective in treating non-severe pneumonia. Close follow-up of patients is essential to prevent worsening of disease. Definitions of clinical failure need to be more specific. Surveillance in both rural and urban areas is essential in the development of treatment policies that are based on clinical outcomes.