Journal Issue: Volume: 32, No. 2 (2012)
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2012
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ISSN 1990-7974 eISSN 1990-7982
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Articles
Clinopathological Profile of Acute Leukemia in Children
(Nepal Paediatric Society (JNPS), 2012) Harpani, PT; Parmar, BJ; Makwana, AM
Abstract:
Introduction: Acute leukemia is the most common malignancy in children of which acute lymphoblastic leukemia accounts for majority of the cases. The objective of this study was to see the clinical profile, hematological parameters and assessment of response to chemotherapeutic agents in acute leukemia. This was an observational prospective study involving 58 children conducted over a period of two years from September 2005 to August 2007 at the department of paediatrics, B.J. Medical College, Ahmedabad.
Materials and Methods: Leukemia was suspected in children presenting with history of prolonged fever, pallor, hepatosplenomegaly, lymphadenopathy, abnormal bleeding or history of repeated blood transfusion. A complete history, clinical examination and relevant investigations were done to diagnose leukemia. After confirmation of diagnosis, patients were treated, followed up to first remission after receiving chemotherapy. Follow up bone marrow examination was done after induction phase to confirm remission. Complete blood count and CSF cytology were done periodically during intrathecal chemotherapy.
Results: Out of total 58 patients, 49 (84.5%) were ALL and 9 (15.5%) were AML. Pallor (87.9%), fever (82.7%) and fatigue (86.2%) were most common presenting symptoms. Pallor (86.2%), splenomegaly (89.6%) and hepatomegaly (84.5%) were the most common clinical signs. Forty two patients (74.2%) presented with moderate anemia. Remission was achieved in 51 cases (87.9%) after intrathecal chemotherapy.
Conclusion: ALL is more common than AML in children. With detailed history and clinical examination, timely diagnosis and initiation of appropriate chemotherapy commonly leads to remission in childhood acute leukemias.
Comparison of Pain Response to Venepuncture Versus Heel Lance Blood Sampling in Term Neonates
(Nepal Paediatric Society (JNPS), 2012) Shrestha, M; Adhikari, RK
Abstract:
Introduction: Pain in neonates is largely underestimated and neglected. Pain experience can alter clinical outcome, brain development and subsequent behavior in newborns. Numerous newborns undergo blood sampling routinely in nurseries/NICUs and these procedures are often done without pain relieving measures. Heel lancing and venepuncture are two common procedures for blood sampling in neonates. The objective of this study was to compare pain response to venepuncture versus heel lance in full term neonates.
Materials and Methods: A comparative observational study was conducted among 200 term neonates who were undergoing blood sampling for bilirubin or glucose estimation. Neonates were randomly assigned to heel lance (HL) and venepuncture (VP) groups with 100 babies in each group. During the procedure, pain was assessed by Neonatal/Infant pain Scale (NIPS). Heart rate (HR) and oxygen saturation (SpO2) were continuously monitored 5 minutes prior to procedure and upto 5 minutes after the procedure.
Results: The median NIPS score in HL and VP were 7 and 3.5 respectively which showed statistically significant (p= 0.0001) higher level of pain experience in HL than in VP. During the procedure, both the groups (HL and VP) showed significant changes in heart rate and oxygen saturation i.e., increase in HR (p= 0.0001) and decrease in SpO2 (p= 0.0001), however the increase in heart rate and decrease in oxygen saturation were significantly more in HL than in VP (p= 0.0001).
Conclusion: Neonates perceive pain as demonstrated by Neonatal Pain Scale and venepuncture is the less painful procedure than heel lancing for blood sampling in neonates.
Congenital Anomalies at Birth: A Hospital Based Study in UAE
(Nepal Paediatric Society (JNPS), 2012) Aryasinghe, L; Moezzi, D; Ansari, TA; Mathew, E; Sharbatti, SA; Shaikh, RB
Abstract:
Introduction: It is widely acknowledged that congenital anomalies heavily contribute to infant morbidity and mortality worldwide, with an estimated 9 million infants (7% of all births) born annually having a serious congenital anomaly that result in death or lifelong disability. The objective of our study was to estimate the frequency of congenital anomalies at the Gulf Medical College Hospital and Research Center, Ajman and to estimate the proportion of births with congenital anomalies per 1,000 live births.
Materials and Methods: It was a Hospital-Record based descriptive study of the 1,222 consecutive live births from December 2007 to June 2008.
Results: There were 84 cases of congenital anomalies among the 1,222 live births; the rate of anomalous births was 68.7 per 1,000 live births or 6.9%. Anomalies of the genitourinary system (40.5%) were the most common, followed by musculoskeletal (28.6%) and cardiovascular (10.7%). Gastrointestinal, chromosomal and multiple system anomalies accounted for 3.6% each and miscellaneous anomalies were seen in 7.1%. Central Nervous system (2.4%) anomalies were the least. Congenital hydrocele (19.0%) was seen to have the highest frequency amongst all recorded anomalies, followed by Talipes or Clubfoot (14.3%). 9.3% of the male and 4.3% of the female population of live births had a congenital anomaly. Birth Weight (p=0.005) and Gender (p=0.001) were found to have significant association with the frequency of birth defects. Maternal Age, gravidity, parity, previous abortions, VDRL and Hepatitis B status, Gestational Diabetes, Pregnancy Induced Hypertension, gestational age, maternal and infant blood group, nationality and consanguinity showed no statistically significant association with congenital anomalies.
Conclusion: The proportion of congenital anomalies found in our study is alarmingly high and emphasizes the need for more accessible nationwide screening, counseling and surveillance systems.
Evaluation of Nutritional Status by Mid-Upper Arm Circumference Amongst Affluent Children
(Nepal Paediatric Society (JNPS), 2012) Maiti, S; De, D; Ali, KM; Ghosh, A; Ghosh, Debidas; Paul, S
Abstract:
Introduction: Anthropometry is widely accepted as low-cost technique for defining the nutritional status of children. The mid upper arm circumference (MUAC) is a fast screening method in detecting acute malnutrition and it is also a predictor of childhood mortality.
Materials and Methods: This is the retrospective study to evaluate the nutritional status based on mid upper arm circumference (MUAC) among urban, pre-school age children. A total of 1060 children, aged 1 to 3 years, attending the vaccination clinic of the Indian Red Cross Society Paschim Medinipur Hospital over a two years period, were enrolled in the study. The measurement of MUAC (in centimetres) was taken by the standard technique. Undernutrition was defined based on age and sex-specific MUAC cut-off values as recommended by the World Health Organization (WHO).
Results: Boys were higher level of mean MUAC than girls at all ages and there was no significant sex differences. The age-combined rate of overall undernutrition was 18.96% and it was slightly higher among the boys (19.38%) than girls (18.46%). The age-combined moderate undernutrition was higher among the boys (16.08% vs 14.11%) but girls’ value was higher in case of severe undernutrition (3.28% vs 4.35%).
Conclusion: The present study showed that a remarkable number of pre-schooler was undernourished based on MUAC.
Evaluation of physical growth and sexual maturation rating of Adolescent boys
(Nepal Paediatric Society (JNPS), 2012) Gedam, DS; Waseem, M; Chansoria, M
Abstract:
Introduction: The present study is an attempt to evaluate the incidence of malnutrition as well as obesity. We have evaluated physical growth and sexual maturity rating of 10-18 years adolescent boys–overweight Vs Normal Vs Underweight.
Material and Methods: A random sample of 530 adolescent boys (one private English Medium and one Govt. Hindi Medium School) between the ages of 10-18 years during the period of August 2008 to August 2009 constituted the material for this study. Weight, Height and BMI and Sexual maturation rating (SMR) were calculated.
Results: Nearly 39% of the adolescent boys studied were either underweight (31%) or overweight (8%). All overweight adolescent boys have their mean weight more as compared to WHO 50th centile. Normal weight and underweight adolescent boys have lesser mean weight as compared to WHO 50th centile. All overweight and normal weight adolescent boys have their mean height lesser as compared to WHO 50th centile. All underweight adolescent boys except for age group of 12 yr have their mean height lesser as compared to WHO 50th centile. Underweight boys achieved different stages of genital growth prior to normal weight and overweight boys but lag behind as compared to Tanner. It was obvious that underweight boys achieved different stages of pubic hair growth prior to normal weight and overweight boys.
Conclusion: Present study indicates that incidence of overweight children is also increasing significantly. Adolescent psychological need should be assessed and they should be given knowledge regarding their normal sexual growth pattern to decrease their anxiety.