Journal Issue: Volume: 35, No. 2 (2015)
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Issue Date
2015
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ISSN 1990-7974 eISSN 1990-7982
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Articles
Analysis of Co-morbidities in Children with Severe Acute Malnutrition in Eastern Nepal
(Nepal Paediatric Society (JNPS), 2015) Thapa, Anil; Shah, Gauri Shankar; Mishra, Om P
Abstract:
Introduction: Malnutrition is a common problem in developing countries and often associated with co-morbidities. The present study was undertaken with objectives of to find out the comorbidities in children with severe acute malnutrition (SAM).
Materials and Methods: This was a hospital based study carried in 77 children with SAM, diagnosed on the basis of WHO criteria.
Results: The age group of children was 1- 5 years (median age 23 months) with about 39% between 1- 2 years. There were 38 males (49.3%). Low maternal education (60%), overcrowding (60%), lower- middle socioeconomic status (87%) were some of the predisposing factors observed. Pneumonia (51%), acute gastroenteritis (21%) and bacterial meningitis (8%) were common co- morbidities found. Associated abnormal laboratory parameters found were anemia (60%), leucocytosis (38%), hyboalbuminemia (36%) hyponetremia (31%), and hypokalemia (17%).
Conclusion: Presence of infections and biochemical abnormalities require urgent attention in SAM cases and appropriate treatment in a hospital setting to improve their survival.
Childhood Poisoning at a Tertiary Hospital in South West Nigeria
(Nepal Paediatric Society (JNPS), 2015) Olatunya, Oladele Simeon; Isinkaye, Ayodeji Olusola; Ogundare, Ezra Olatunde; Oluwayemi, Isaac Oludare; Akinola, Foluso John
Abstract:
Introduction: Poisoning is a preventable cause of childhood morbidity and mortality. Information on childhood poisoning in the developing world is scanty. This study describes the profile of childhood poisoning in a third world hospital.
Materials and Methods: Children admitted with poisoning over a 48-months period at the Ekiti State University Teaching Hospital Ado-Ekiti, Southwest Nigeria, were reviewed.
Results: It was found that 81 of 5256 admissions representing 1.54% of the total admissions were due to poisoning. Kerosene, Drugs, Alcohol based herbal concoction, pesticides, corrosive agents and carbon monoxide were involved in 37.0%, 22.2%, 19.8%, 8.6%, 6.2% and 6.2% respectively. Accidental and non-accidental intentions were involved in 85.2% and 14.8% cases respectively. Administration of palm oil (oil from Elais guineensis), vomiting induction and herbal concoction were the leading home interventions in 69.1%, 38.3% and 23.5% respectively. One patient required intensive care. There were seven deaths and overall mortality rate was 8.6%.
Conclusion: Poisoning remains a cause of childhood morbidity and mortality in Nigeria. Establishment of poisoning information and control centre is recommended among other strategies to combat its scourge.
Childhood Systemic Lupus Erythematosus: A Tertiary Care Centre Experience
(Nepal Paediatric Society (JNPS), 2015) Bajracharya, Luna; Thapa, Surya Bahadur
Abstract:
Introduction: Systemic lupus erythematosus (SLE) is a chronic immunologic disorder with multisystem manifestations. Even more awareness is required to diagnose the disease at younger age. Objective of this study was to explore clinico-laboratory manifestations and management of SLE in children at Tribhuvan University Teaching Hospital (TUTH).
Materials and Methods: The study was retrospective hospital based study conducted from 15th July, 2008 to 14th July, 2014. Medical charts of all children and adolescent (6- 16years of age) with SLE admitted at TUTH were reviewed for analysis of data.
Results: The total number of patients was 33, with 28(84.8%) girls and 5 (15.2%) boys. The mean age of diagnosis was 12.12 (SD 1.89). Facial puffiness (27.3%) and arthralgia (24.2%) were the commonest presentations at disease onset. The most frequent clinical features during the entire course of illness were edema (78.9%), anemia (69.7%) and fever (66.7%). Twenty three (69.6%) patients underwent renal biopsy in which class IV was the commonest lupus nephritis. The commonly used drugs after prednisolone were intravenous cyclophosphamide, intravenouse methylprednisolone and mycophenolate mofetil. Total 17 (51.5%) patients went into remission. Two patients died due to active lupus and four due to sepsis.
Conclusion: Lupus nephritis was the commonest feature at disease onset, at the time of diagnosis and throughout the disease course among Nepalese children with SLE. The most frequently used medications were prednisolone and iv cyclophosphamide. Infection and active lupus were the leading causes of complications and death.
Comparison of Intranasal Midazolam and Rectal Diazepam as Anticonvulsant in Children
(Nepal Paediatric Society (JNPS), 2015) Gunawan, Prastiya Indra; Rulian, Fadil; Saharso, Darto
Abstract:
Introduction: Rectal diazepam is reputed as the gold-standard management of childhood seizures. Otherwise, intranasal (IN) midazolam has no first-pass metabolism and faster onset of action. The effectiveness and easier route of these drugs are important choices for faster seizure cessation. The aim of this study was to clarify the effectiveness of intranasal midazolam compared with rectal diazepam for seizure termination.
Material and Methods: The children, one month until 18 years of age, presented with acute seizures. Patients were randomly classified into two groups with either received intranasal midazolam or rectal diazepam for seizure termination. Interval time of drug administration to cease seizure was compared. The log-rank analysis was used for statistical analysis. Side effect of both drugs were evaluated.
Results: There were 60 patients enrolled the study, 30 in each group. The median time interval for seizures cessation with intranasal midazolam was 42 seconds, otherwise in rectal diazepam group was 180 seconds. There was statistically significant difference interval time between two groups (p<0.01). None of the both groups had any significant side effects statistically.
Conclusion: Intranasal midazolam is effective to terminate a seizure in children. It can be used as an alternative treatment for seizures in patients with intravenous or rectal route difficulties.
Findings of Paediatric Upper Gastrointestinal Endoscopy at a Tertiary Care Centre
(Nepal Paediatric Society (JNPS), 2015) Thapa, Surya Bahadur; Sharma, Arun Kumar
Abstract:
Introduction: Endoscopy is an important diagnostic tool for gastrointestinal disorders in children. Practitioners still debate the need and utility of endoscopy in children and this important evaluation is potentially underutilized. There is a paucity of paediatric endoscopy data in Nepal. This report describes an initial three-year experience on profile of upper gastrointestinal endoscopy at Tribhuvan University Teaching Hospital (TUTH).
Material and Methods: This retrospective study was conducted by reviewing hospital records for children undergoing endoscopy for various indications at TUTH during November 2011 to October 2014 (3 years).
Results: We performed 362 endoscopies during this period. Mean age of patients was 9.49 years (range 2 months to 18 years) and 199 (54.9%) patients were under 10 years of age. Common indications were upper gastrointestinal bleeding (27.6%), recurrent abdominal pain (26.2%), acute abdominal pain (24.6%), recurrent vomiting (5.2%), and caustic ingestion (3.6%). An abnormality was detected in 159 (42.2%) patients. Varices (16.6%), gastritis/duodenitis (14.9%), ulcer (3.3%), oesophagitis (1.9%) were common diagnoses. Etiology of upper gastrointestinal bleed was identified in 65% of patients. Majority of patients with recurrent abdominal pain had negative results (80%). Failure to thrive constituted a very small proportion of children (0.2%) evaluated. All children received sedation/ analgesia and tolerated the procedure well.
Conclusion: Paediatric upper gastrointestinal endoscopy can be safely performed across wide age range with proper sedation/ analgesia. Endoscopic diagnosis may improve management and children requiring such evaluation should be timely referred. Paediatricians should be encouraged to refer patients with growth failure early to ensure proper management.