-
Outcome of Treatment with Thalidomide in Transfusion Dependent Thalassemia Patients: A Prospective Study in a Thalassemia Center, Dhaka, Bangladesh
Maksuda Begum,
Mir Hasan Md. Moslem,
Nurun Nahar Fatema Begum,
Md. Zobaidur Rahman
Issue:
Volume 6, Issue 3, September 2020
Pages:
168-171
Received:
15 March 2020
Accepted:
27 March 2020
Published:
30 April 2020
Abstract: The aim of the study was to assess the outcome of thalidomide in patients with Thalassemia. Method: We identified the outcome of thalidomide in 51 patients with thalassemia needing blood transfusion. We enlisted thalassemia patients, who received treatment with thalidomide between 01 July 2017 and 29 Feb 2020 in Combined Military Hospital, Dhaka. Thalidomide was used in a reduced dose (2 mg/ kg to 5 mg/kg). Thalidomide had been stopped in those patients who developed complications. The following factors were recorded: age and sex, hemoglobin (Hb) levels, ferritin level, blood transfusion interval before and after treatment with thalidomide. Furthermore, we documented blood transfusion dependence and the complications subsequently. All data were studied using SPSS v 24.0 (SPSS Inc. Chicago, IL, U.S.A.). For patients, a paired sample t-test was used to compare the changes in the mean Hb level, ferritin level and the difference in blood transfusion interval before and after treatment with thalidomide. P < 0.05 was considered statistically significant. Results: The study included 51 patients comprised of 23 females (45.1%) and 28 males (54.9%) with an age ranging from 3 to 24 years (9.75±4.11 years). Amongst them 18% (n=9) were beta-thalassemia and 82% (n=42) were Hb E beta-thalassemia. Data of Hb and ferritin levels before and after treatment were recorded in all 51 patients. Ferritin levels reduced to 20.52% (3258.11±2291.91 ng/ml to 2589.65± 2072.74 ng/ml). Hb level increased by 19.26% (7.04±0.53 g/dL to 8.39±1.44g/dL). We found 18 (35.3%) patients with no requirement of blood transfusion after the treatment. 63% (n=32) of the patients showed no adverse effect of thalidomide after the treatment. 16% (n=8) of the patients showed high ALT (Alaline Aminotransferase) and 6% (n=3) showed excessive sleepiness. Other effects included- high TSH, acute urticaria, restlessness, edema, facial puffiness, palpitation, and vomiting. Conclusion: Treatment with thalidomide considerably improved Hb level, increased blood transfusion interval even resulted to non-dependence on blood transfusion and reduced ferritin levels. More studies are necessary to clarify the possible use of thalidomide in the treatment of thalassemia.
Abstract: The aim of the study was to assess the outcome of thalidomide in patients with Thalassemia. Method: We identified the outcome of thalidomide in 51 patients with thalassemia needing blood transfusion. We enlisted thalassemia patients, who received treatment with thalidomide between 01 July 2017 and 29 Feb 2020 in Combined Military Hospital, Dhaka. T...
Show More
-
Implementation of Educative Boardgame to Improve Knowledge, Attitude and Practice of Complementary Feeding in Stunting Locus at Central Lombok
Titi Pambudi Karuniawaty,
Linda Silvana Sari,
Adnanto Wiweko,
Intan Karmila
Issue:
Volume 6, Issue 3, September 2020
Pages:
172-181
Received:
7 March 2020
Accepted:
8 April 2020
Published:
12 May 2020
Abstract: Complementary feeding practice (CFP) contributes to high incidence of stunting in West Nusa Tenggara especially in Central Lombok. The complementary feeding program for infants and children was launched by government as a strategy to combat stunting in order to realize the Generasi Emas NTB 2025. For this reason, the provision of complementary feeding has been introduced into maternal and child health book (MCH), but has not met all WHO recommendations. This interventional, quasi experimental, pre-post test design study, aimed to develop board game as an educational media about stunting and CFP and to assess its effectiveness to increase parents' knowledge, attitude and practice (KAP) regarding CFP in Central Lombok as stunting locus. This study located at Sukadana village that was selected randomly. Subjects were parents of children aged 6-12 months old whom met inclusion and exclusion criteria. KAP assessment was conducted by using validated questionnaire, which was carried out before and after GiMPASI intervention, educational game. From 42 subjects involved in this study we found significant differences both in knowledge scores about complementary food (CF) feeding pre and post intervention (3.43±1.70 vs 4.83±1.64; p=0.001) and in attitude scores (10.55±2.77 vs. 12.33±2.67; p=0.002). Likewise, there was an increase in CFP score between pretest (25.90±4.75) and post test (26.12±4.74), but didnt different significantly in paired t-test analysis (p=0.79). GiMPASI can be used as an effective educational media to increase parents' knowledge and attitude regarding stunting and CFP. GiMPASI can be developed as part of infant and child complementary feeding against stunting.
Abstract: Complementary feeding practice (CFP) contributes to high incidence of stunting in West Nusa Tenggara especially in Central Lombok. The complementary feeding program for infants and children was launched by government as a strategy to combat stunting in order to realize the Generasi Emas NTB 2025. For this reason, the provision of complementary feed...
Show More
-
Pediatric High Flow Nasal Cannula Experience in a Tertiary Care Hospital in Saudi Arabia
Alayed Tareq,
Skaff Chahdah,
Alabdulsalam Moath,
Alturki Abdullah,
Aljofan Fahad,
Alanzi Fawaz,
Alofaisan Tareq
Issue:
Volume 6, Issue 3, September 2020
Pages:
182-189
Received:
15 March 2020
Accepted:
30 March 2020
Published:
12 May 2020
Abstract: Acute respiratory failure, being a significant problem in Pediatric intensive care units, always requires support, whether via invasive or non-invasive devices. High flow nasal cannula, a relatively new machine, has multiple favorable physiological effects when used for respiratory distressed patients. It is currently widely applied in multiple settings, including PICU. This study describes the experience of HFNC use in a tertiary care hospital in Saudi Arabia. The primary outcome of interest was the intubation rate. The secondary outcomes were mortality rate and length of stay in the pediatric intensive care unit. Moreover, we compared these outcomes between two groups of patients: immunocompromised and immunocompetent patients. Four hundred thirteen patients were included. 45.5% admitted due to pneumonia. 24.6% of patients required intubation with an interval time between the initiation of HFNC and intubation being 40 hours (hrs.). The mortality rate was 17%, and the mean length of stay in PICU was 12 days. One hundred thirty six (35%) patients were immunocompromised. The majority admitted because of pneumonia (70%). There was a significant statistical difference in the rate of intubation (35.5% vs. 25%, P-value 0.03) and mortality (39% vs. 5.5% with a p-value of <0.0001) between the two groups. However, when comparing the mortality rate in the immunocompromised patients only, 81.6% were intubated compared to 14.6% required only HFNC (p < 0.05). HFNC seems to be beneficial and tolerable to pediatric populations. Although the immunocompromised patients showed expected higher mortality and intubation rate compared to the non-immunocompromised, the sub-analysis showed that those who required only HFNC had a better survival rate.
Abstract: Acute respiratory failure, being a significant problem in Pediatric intensive care units, always requires support, whether via invasive or non-invasive devices. High flow nasal cannula, a relatively new machine, has multiple favorable physiological effects when used for respiratory distressed patients. It is currently widely applied in multiple set...
Show More
-
Sickle Cell Anemia and Family Taboo: The Experience of a Sister of a Sick Child in Cameroon
Hassan Njifon Nsangou,
Regine Scelles
Issue:
Volume 6, Issue 3, September 2020
Pages:
190-198
Received:
10 April 2020
Accepted:
26 April 2020
Published:
15 May 2020
Abstract: Sickle cell anemia is the most prevalent genetic disease in the world that is seen as a taboo in African communities where single-child families are rare. However, speaking with a family about a pathology or a disability reduces the harmful effects in the sick child as well as on the members of his family. This research aims to understand the psychological impact of family taboo on sickle cell anemia on a sister of a sick child in Cameroon. This knowledge will enable professionals to further improve support for sick children by taking into account their family and siblings and making them a resource for both the sick child and their siblings. We met a 17-year-old girl without sickle cell anemia who is the second child of a family composed of seven children including five girls and two boys. She is the older sister of the only sick child in the 13-year-old siblings. The meeting took place in Cameroon at the home of her parents who allowed her to participate in the research by signing a consent form. We collected data through an interview about the illness, her relationship with her sick sister and with her family members. Following the interview, we invited her to make a drawing of her family. We analyzed the interview according to the thematic approach. The interview and drawing of the family were two complementary tools to better understand the experience of this girl. The family taboo about the illness causes the girl to feel strange about her sick sister and her illness. It makes her powerless in the face of crises of her sister. This helplessness arouses her feelings of guilt and to have aggressive behavior against her sick sister she thought to be a passive victim of the disease and a child to be protected. The mother's order concerning the protection of the sick child by her siblings gives the girl a feeling of abandonment and non-recognition of her experience as a sister of the sick child by her parents in general and by her mother in particular. This article shows the need to remain extremely sensitive to how the experience of the disease fits into the family dynamics in order to transform it and to make family and siblings a resource for the sick child and for his siblings.
Abstract: Sickle cell anemia is the most prevalent genetic disease in the world that is seen as a taboo in African communities where single-child families are rare. However, speaking with a family about a pathology or a disability reduces the harmful effects in the sick child as well as on the members of his family. This research aims to understand the psych...
Show More
-
Venous Cerebral Infarction Caused by Intake of Hormonal Contraceptives in Adolescents with Congenital Thrombophilia
Putilina Marina,
Teplova Nataliya,
Dvornikov Anton
Issue:
Volume 6, Issue 3, September 2020
Pages:
199-206
Received:
18 April 2020
Accepted:
6 May 2020
Published:
15 May 2020
Abstract: In recent years, an increase in dysmenorrhea among adolescents has been observed worldwide. Oral contraceptives are used in gynaecological practice to correct this condition. However, the prescription of drugs belonging to this group often misses the risk of developing vascular complications, such as cerebral venous thrombosis and cerebral venous infarction. Due to the growing percentage of patients with congenital genetic mutations, it is relevant and reasonable to consider the risk factors and clinical signs of venous infarction in adolescents. First, it is necessary to exclude congenital thrombophilia, factor V Leiden and prothrombin G20210A gene mutations, and deficiency of proteins C, S and antithrombin. Of particular notice are the young patients and adolescents with complaints of a first-time, intense, poorly treatable headache (or headache in anamnesis), changes in the eye fundus (edematous, hyperemic optic disks; dilated, plethoric veins in the fundus of the eye). In such cases, a thorough medical history is extremely important, including, in particular, detection of an infectious process, traumatic brain injury, venous thrombosis of any localization; the use of drugs (especially hormonal ones) that can provoke the development of a hypercoagulable state; and investigation of the family history. These measures will help to prevent development of a cerebral venous circulation disorder (venous infarction).
Abstract: In recent years, an increase in dysmenorrhea among adolescents has been observed worldwide. Oral contraceptives are used in gynaecological practice to correct this condition. However, the prescription of drugs belonging to this group often misses the risk of developing vascular complications, such as cerebral venous thrombosis and cerebral venous i...
Show More
-
Our Four Years Experience of Hemoadsorption, Albumin and Heparin Treatment for Paediatric Sepsis: Let’s Give a Chance in Multifactorial Pathological Conditions
Milella Leonardo,
Cito Fabiana,
Raimondo Pasquale,
Ficarella Maria Teresa,
Moliterni Paola,
Sisto Michele,
Lasorella Maria Luigia,
Lombardi Nadia,
Maldera Milena,
Calabrese Gerolmina
Issue:
Volume 6, Issue 3, September 2020
Pages:
207-217
Received:
3 March 2020
Accepted:
30 March 2020
Published:
28 May 2020
Abstract: Extracorporeal blood purification therapies are increasingly applied in the field of intensive care medicine. These techniques are applied to a relevant number of clinical situations as Sepsis, Trauma, burns, Influenza, surgery, Pancreatitis, ARDS, Life support, Liver failure. Compared to filtration-based methods mainly used for renal replacement therapy, newest adsorptive approaches have shown to specifically target the inflammatory cascade by the effective removal of relevant mediators. In the neonatal and pediatric setting however, the application of these methods brings with it various challenges but also profound technical difficulties. Recently, a promising extracorporeal device for cytokine adsorption (Cytosorb) has been introduced, however data for its application in critically ill pediatric patients remains sparse1. The lack of data and procedure protocols led us to take some aprioristic diagnostic and speculative decisions only from a scientific point of view: “in primis” when we decided for the first time in a pediatric patient to use this "Cytosorb Absorber", a device not registered and delivered for toddlers; second when it was clear that we could extend its use to not conventional disease therapeutic strategies; third when we decided to give to “Cytosorb” use the appellation and indication of “rescue treatment”. These results are interesting for the scientific community, but further research is needed.
Abstract: Extracorporeal blood purification therapies are increasingly applied in the field of intensive care medicine. These techniques are applied to a relevant number of clinical situations as Sepsis, Trauma, burns, Influenza, surgery, Pancreatitis, ARDS, Life support, Liver failure. Compared to filtration-based methods mainly used for renal replacement t...
Show More
-
A Single-Center Evaluation of Mid-Term Results of Ponseti Management for Nonidiopathic Congenital Clubfeet in Vietnam
Nam Quang Dinh Vo,
Giam Minh Trinh,
Khang Trien Truong
Issue:
Volume 6, Issue 3, September 2020
Pages:
218-222
Received:
23 April 2020
Accepted:
18 May 2020
Published:
29 May 2020
Abstract: By comparing initial correction, early relapses, latest follow-up mid-term results between idiopathic and nonidiopathic congenital clubfeet, this study is to define the efficacy of the Ponseti method for the nonidiopathic clubfeet. 32 nonidiopathic congenital clubfeet (group 1) in 21 children and 118 idiopathic congenital clubfeet (group 2) in 82 children (newborn to 12 months) are recruited for this study, following treatment with the Ponseti method with a follow-up period of a minimum of two years. The clubfeet are classified and evaluated during casting, of initial correction, and for early relapse according to Diméglio’s score. The latest follow-up results are evaluated according to Richards’ classification. The initial correction is successfully 81.3% in group 1, and 96.6% in group 2 (p=0.019). The early relapses are 26.9% in group 1, and 7.0% in group 2 (p=0.003); for group 1, 57.1% of early relapses were subjected to medial posterior release and for group 2, all of early relapses were successfully managed by casting (p < 0.001). The latest follow-up results are good 21.9%, fair 46.8%, poor 31.3% in group 1, and good 76.3%, fair 22.0%, poor 1.7% in group 2 (p < 0.001). This study indicates that the Ponseti method is successfully applied to nonidiopathic clubfeet. However, the early relapse rate of nonidiopathic clubfeet is high and most of these relapsing clubfeet need to be managed by posteromedial release. In addition, posteromedial release should be indicated as the initially definite management for very severe clubfeet of arthrogryposis.
Abstract: By comparing initial correction, early relapses, latest follow-up mid-term results between idiopathic and nonidiopathic congenital clubfeet, this study is to define the efficacy of the Ponseti method for the nonidiopathic clubfeet. 32 nonidiopathic congenital clubfeet (group 1) in 21 children and 118 idiopathic congenital clubfeet (group 2) in 82 c...
Show More
-
Factors Associated with Children’s Cognitives in Daycare
Ni Putu Andina Kluniari,
I Gusti Ayu Trisna Windiani,
Putu Siadi Purniti,
I Wayan Dharma Artana,
I Gusti Ngurah Made Suwarba,
Putu Junara Putra
Issue:
Volume 6, Issue 3, September 2020
Pages:
223-227
Received:
12 April 2020
Accepted:
3 May 2020
Published:
4 June 2020
Abstract: Cognitive development is the result of the relationship between nervous system and individual experiences to adapt to its environment. A thorough social and demographic changes lead to increased number of children receiving non-parental care. Some mothers entrust their child care in daycare. The impact of daycare service to the child's development depends on several interrelated factors, including the personality of the child, stimulation, care setting, and family condition. In daycare facilites, the children were cared non-parental or non-familial settings. Factors that may affect the child's development in a daycare are duration of care, caregiver-to-child ratio, the level of caregiver education, and child stimulation during the daycare. The aim of this study is to confirm association between the care duration, caregiver-to-child ratio, caregiver education, and daycare stimulation on child’s cognitive in daycare. This was an observational analytical study with a cross-sectional design. This study was conducted at the daycare in Denpasar since July 2018 to July 2019. The child’s cognitive was measured with Mullen score. A total of 80 children in 6 daycares were included. The mean Mullen score was 91.71 (SD 10.4). The bivariate analysis of caregiver education, caregiver-to-child ratio, and stimulation using independent T test showed significant differences. The level of caregiver education showed a mean difference of 6.3 with a p-value of 0.045 (95% CI 0.129-12.411). The caregiver-to-child ratio showed a mean difference difference of 10.1 with a p-value of <0.001 (95% CI 6.064-14.170). The multivariate analysis demonstrated that caregiver education level have a koef B of 5.9 (95% CI 0.534-11.192) with a p-value of 0.031 and caregiver-to-child ratio have a koef B of 9.5 (95% CI 5.675-13.357) with a p-value of <0.001 which showed significant differences. Conclusion there are significant association between caregiver education and caregiver-to-child ratio with children’s cognitive in day care.
Abstract: Cognitive development is the result of the relationship between nervous system and individual experiences to adapt to its environment. A thorough social and demographic changes lead to increased number of children receiving non-parental care. Some mothers entrust their child care in daycare. The impact of daycare service to the child's development ...
Show More
-
The Prevention of Childhood Dental Caries in China
Xu Zheng,
Chun Yi Cao,
Sheng Ping Cao,
Qiuchi Ran,
Shi Wang Wu,
Zhu Ling Guo
Issue:
Volume 6, Issue 3, September 2020
Pages:
228-233
Received:
16 May 2020
Accepted:
27 May 2020
Published:
4 June 2020
Abstract: Children's oral health is the foundation of a healthy life. Dental caries is a common disease among children, which not only affects children's physical and mental health, but also has a negative impact on their families and the surrounding social environment. The world health organization (WHO) and the international dental union (FDI) have established a 2020 global goal for oral health. At present, the prevalence of dental caries among children in China is high, the awareness rate of oral health knowledge and behavioral development is low, the ability of oral health services at the grassroots level is weak, and the oral health work of children needs to be strengthened. This paper is a review paper and examines the basis of the disease and the recent studies carried out in various parts of The Peoples Republic of China, including the Hong Kong Special Administrative area. It recommended that oral hygiene be included in school curricula as part of children's general education, and called on Chinese teachers and parents to participate. At the same time, it is suggested that oral health care programmes be incorporated into general health education programmes and that children with dental caries be encouraged to take further active treatment in time.
Abstract: Children's oral health is the foundation of a healthy life. Dental caries is a common disease among children, which not only affects children's physical and mental health, but also has a negative impact on their families and the surrounding social environment. The world health organization (WHO) and the international dental union (FDI) have establi...
Show More
-
Factor Associated with Development Disorder in Children
I Gusti Ayu Trisna Windiani,
Vanessa Lini Gunawan,
I Gusti Agung Ngurah Sugitha Adnyana,
Soetjiningsih
Issue:
Volume 6, Issue 3, September 2020
Pages:
234-239
Received:
6 May 2020
Accepted:
25 May 2020
Published:
15 June 2020
Abstract: Early detection of growth and development delay is important so that interventions can be carried out on time. Knowing the factors associated with developmental disorders in children is important in efforts to improve the quality of life of children and reduce the prevalence of these disorders in general. This study aims to determine the factor associated with developmental disorder in the Sanglah General Hospital Growth and Development clinic in 2018. This research is a retrospective cross sectional study. The research data was obtained from the outpatient register at the Growth and developmental clinic, Sanglah General Hospital. The subjects of this study were all patients who visited in RSUP Sanglah Denpasar from January 1st, 2018 to December 31st, 2018. There were 363 patient with developmental disorder in a year, most cases (37.5%) were global developmental delays. The majority of patients with developmental disorder were aged 2-5 years (47.9%), were male (66.7%), had normal birth weight (69.9%) and had vaginal birth 60.4%. The majority of patients were found with comorbidities (50.4%), and epilepsy (12.6%) were the most common comorbidities found among patients. Child’s gender (PR 2.687; 96%CI 1.829-3.945; p=0.001), parents level of education (PR 2.223; 95%CI 1.414-3.497; p=0.001), birth weight (PR 2.066; 95%CI: 1.290-3.310; p=0.001), and nutritional status (PR 2.014; 95%CI 1.312-23.091; p=0.001) was associated with developmental dissorder. This research proved that child’s gender, parents level of education, birth weight, and nutritional status had a significant role in children's development disorders.
Abstract: Early detection of growth and development delay is important so that interventions can be carried out on time. Knowing the factors associated with developmental disorders in children is important in efforts to improve the quality of life of children and reduce the prevalence of these disorders in general. This study aims to determine the factor ass...
Show More
-
Management of Complicated Pneumonia in Children: Evidence Beyond Guidelines
Abdullah Saeed Al-Shamrani
Issue:
Volume 6, Issue 3, September 2020
Pages:
240-252
Received:
20 May 2020
Accepted:
4 June 2020
Published:
16 June 2020
Abstract: What is already known? Complicated pneumonia is an area of debate, and a rapid diagnosis is essential for patient survival. Due to the importance of stage-adapted therapeutic decisions, different classification systems have been established. Depending on the stage of the disease, both antimicrobial and interventional approaches are indicated. Conservative management remains the mainstay for the management of parapneumonic effusion, and continuous pleural fluid drainage is not necessary in some children. However, an established consensus worldwide for the management of complicated pneumonia and thoracic empyema with different therapeutic algorithms lacks clear evidence to evaluate complex cases with minimally invasive intervention versus open decortication. Such controversy concerning the best surgical approach persists, especially for sick patients in intensive care who are not doing well despite chest tube or fibrinolytic agents. This article aimed to review current treatment standards for children with different phases of thoracic empyema and complicated pneumonia, this review article will discuss the usefulness of different diagnostic methods and most recent updates on management. 1. Outline the definition, pathophysiology and common causes 2. Review the diagnosis and current treatment standards for complicated pneumonia 3. Review different surgical approaches and their outcomes 4. Provide an update on the recent utilization of video-assisted thoracoscopy (VATS) 5. Review evidence regarding the best fibrinolytic agent 6. Review evidence concerning when to indicate decortication 7. Provide a simplified pathway for the management of complicated pneumonia (figure 9).
Abstract: What is already known? Complicated pneumonia is an area of debate, and a rapid diagnosis is essential for patient survival. Due to the importance of stage-adapted therapeutic decisions, different classification systems have been established. Depending on the stage of the disease, both antimicrobial and interventional approaches are indicated. Conse...
Show More
-
Flu and Flu Vaccination in Comparison, in the Evaluation of the Health Status of Children
Gaetano Bottaro,
Giuseppe Bottaro,
Filippo Palermo
Issue:
Volume 6, Issue 3, September 2020
Pages:
253-258
Received:
27 May 2020
Accepted:
17 June 2020
Published:
4 July 2020
Abstract: Influence often have severe consequences in the short and long term, and could cause fatal outcomes in some of the sick people. We evaluated the impact of flu vaccines on the health of children in the months following the epidemics, comparing these data with those of children who, on the other hand, caught the flu. The present study was performed between 2014/15 and 2018/19 (5 seasons), focusing on children aged between 6 months and 14 years old, and it compared two group of children, sorted according to whether they received the flu vaccine or contracted flu. We demonstrate, in a statistically significant way, that children who get vaccinated with the seasonal flu vaccine catch fewer diseases in the following months, compared to those who catch the flu, especially with respect to the feared acute otitis media and wheezing. Moreover, vaccinated children receive fewer antibiotic therapies and, consequently, they attend the office of the family pediatrician less. We conclude that flu vaccine protects any child, even if this child is healthy, and does not suffer from any preexisting pathology, during the months after vaccination.
Abstract: Influence often have severe consequences in the short and long term, and could cause fatal outcomes in some of the sick people. We evaluated the impact of flu vaccines on the health of children in the months following the epidemics, comparing these data with those of children who, on the other hand, caught the flu. The present study was performed b...
Show More
-
Tracheoesophageal Fistula Newborn Presentation and Outcome: Case Series
Putu Tarita Susanti,
I Made Kardana,
Kadek Deddy Ariyanta
Issue:
Volume 6, Issue 3, September 2020
Pages:
259-267
Received:
17 June 2020
Accepted:
2 July 2020
Published:
13 July 2020
Abstract: Tracheoesophageal fistula (TEF/TOF) represents one of the most rare congenital anomaly in pediatric centers. Its an abnormal connection (fistula) between esophagus and trachea, characterized by copious salivation associated with choking, coughing, vomiting, cyanosis coincident with the onset of feeding and aspiration. Tracheoesophageal fistula commonly associated with other congenital anomaly, particularly cardiac defects. Diagnose can be established early during antenatal care by ultrasonography and postnatal by babygram and esophagography. Definitive management of TEF is surgical procedure. In this study we want to present outcome of our patients with tracheoesophageal fistula. Three cases were identified as tracheoesophageal fistula type C. The first and second case suffered vomit after feeding, then underwent esophagography examination and got surgical procedure. The third case showed difficult entry of feeding tube and hypersalivation but did not get other supporting examinations due to worsening condition. The first case with stable condition and discharge from hospital, meanwhile the second and third case passed away due to severe comorbid. Tracheoesophageal fistula diagnosis should be done immediately for planning surgery procedure. Supportive management would be needed if there are comorbid diseases. The prognosis of TEF is determined by clinical improvement after surgery and comorbid disease.
Abstract: Tracheoesophageal fistula (TEF/TOF) represents one of the most rare congenital anomaly in pediatric centers. Its an abnormal connection (fistula) between esophagus and trachea, characterized by copious salivation associated with choking, coughing, vomiting, cyanosis coincident with the onset of feeding and aspiration. Tracheoesophageal fistula comm...
Show More
-
The Pentalogy of Cantrell: A Case Report
Ni Nyoman Anik Cindi Yuliastini,
I Made Kardana,
Kadek Deddy Ariyanta
Issue:
Volume 6, Issue 3, September 2020
Pages:
268-272
Received:
17 June 2020
Accepted:
2 July 2020
Published:
13 July 2020
Abstract: Pentalogy of Cantrell (PC) is a rare anomaly marked by the coexistence of omphalocele and ectopia cordis. Pentalogy of Cantrell comprises of the following five characteristics: midline, upper abdominal wall disorder (e.g. omphalocele, gastroschisis); defect of lower sternum (i.e. cleft sternum or absent sternum); anterior diaphragmatic defect (i.e. hypoplastic diaphragm, anterior diaphragmatic hernia); pericardial abnormality (e.g. ectopia cordis); congenital abnormalities of the heart (e.g. tetralogy of Fallot, ventricular septal defect, atrial septal defect). Toyama classified this syndrome into: class I – the occurrence of all 5 defects; class – II the occurrence of 4 defects with intracardiac and ventral abdominal wall abnormalities definitely present; class III – an incomplete expression of the disorders showing various combinations of defects, although sternal anomalies are definitely present. The incidence is estimated 5.5 – 7.9 per 1 million live births with male predominance. PC can be diagnosed since antenatal through ultrasonography examination. Unfortunately, the mortality rate is quite high with minimal survival rate even with surgical reconstruction. We present a case of one-day old infant whom was referred from West Nusa Tenggara with suspicion of PC syndrome and neonatal pneumonia. The baby was born through cesarean section with mild asphyxia, birth weight was 3000 gram and body length was 48 cm. There was no family and pregnancy risk factor. The multidisciplinary team consist of neonatologist, pediatric cardiologist and pediatric surgeon was teamed up to handle this case. There were some abnormalities in complete blood counts such as decreasing number of lymphocyte and neutrophil percentage and also increasing basophil percentage. Chest and abdominal X-ray showed a suspicion of pneumonia but this didn’t align with our physical examination. Echocardiography showed the infant had congenital heart defects such as Taussig Bing anomaly, single atrium, mild valvular pulmonary stenosis, mild tricuspid regurgitation and mesocardia. Genetic testing and further radiologic examination other than plain X-ray were not done in this case. There was no further intervention for this patient other than regular echocardiography and antibiotic topical treatment.
Abstract: Pentalogy of Cantrell (PC) is a rare anomaly marked by the coexistence of omphalocele and ectopia cordis. Pentalogy of Cantrell comprises of the following five characteristics: midline, upper abdominal wall disorder (e.g. omphalocele, gastroschisis); defect of lower sternum (i.e. cleft sternum or absent sternum); anterior diaphragmatic defect (i.e....
Show More
-
Combination of Lactobacillus Rhamnosus LGG, Vitamin D3 and Zn in Preventing Atopic Dermatitis in Infancy
Ivana Filipovic,
Olivera Ostojic,
Vesna Vekovic,
Milan Lackovic,
Zorica Zivkovic
Issue:
Volume 6, Issue 3, September 2020
Pages:
273-277
Received:
7 May 2020
Accepted:
8 July 2020
Published:
17 July 2020
Abstract: Introduction: With the prevalence of between 10-20% atopic dermatitis (AD) is one of the most common chronic diseases in infants and children. AD is characterized by itching and recurrent lesion. Mixtures of probiotics, including at the first place Lactobacillus rhamnosus LGG strain strains significantly decreased the risk of AD if given pre- and postnatally. Objective: The aim of the current study was to assess the effect of oral supplementation with LGG in infancy on eczema development and sensitization during the first 2 years of life. Material and methods: The study was a real life controlled observational study that included 96 patients (52 infants were treated with Lactobacillus rhamnosus with vitamin D3 and zinc, while the rest were advised to use only symptomatic treatment). Results: At the baseline the infants in the experiment group had higher values for SCORAD. During the follow up period a significant reduction in SCORAD was observed only in the group of participants who was treated with probiotics. They used also less topical treatments and antihistamines. Conclusions: This study has found that Lactobacillus rhamnosus GG (LGG) formulation with Zn and vitamin D3 supplementation during the postnatal period (in infancy and early childhood) reduce the severity of atopic dermatitis. Based on the findings it is recommended to introduce probiotic supplementation as well as vitamin D3 and zinc in infants and children with atopic dermatitis and positive family history.
Abstract: Introduction: With the prevalence of between 10-20% atopic dermatitis (AD) is one of the most common chronic diseases in infants and children. AD is characterized by itching and recurrent lesion. Mixtures of probiotics, including at the first place Lactobacillus rhamnosus LGG strain strains significantly decreased the risk of AD if given pre- and p...
Show More
-
Pattern of Childhood Renal Diseases in Aba, South East Nigeria
Nneka Chioma Okoronkwo,
Assumpta Udechi Chappjumbo,
Benson Nnamdi Onyire,
Samuel Chidi Ekpemo,
Stella Nnenne Ijeoma
Issue:
Volume 6, Issue 3, September 2020
Pages:
278-284
Received:
19 June 2020
Accepted:
9 July 2020
Published:
17 July 2020
Abstract: Background: Renal diseases are currently posing a great health concern worldwide. Proper documentation, knowledge of renal disease burdens, and established renal registries will provide data to guide stake-holders in future planning and resource allocation. This study aims at documenting the pattern and outcome of childhood renal diseases admitted at our centre. Methods: This was a prospective study of all childhood renal diseases admitted into the pediatrics wards of the Abia State University Teaching Hospital, Aba, from October 2013 to October 2018. The demographic characteristics of the patients, ingestion of herbal concoctions, clinical presentation, laboratory investigations, diagnosis and management outcomes were documented, and analysed. Result: A total of 6108 children were admitted into the paediatric wards during the study period. One hundred and four (104) of them had renal diseases, accounting for 1.7% of paediatric admissions. There was male preponderance (55.8%) with a Male: Female ratio of 1.3:1. Sex had significant association with renal diseases (p-Value=0.025). The age range was 0.5 – 16 years with a mean age of 7.9±4.5 years. Majority (40.4%) of the patients were aged 5-10 years (p-Value 0.021). Nephrotic Syndrome (47.1%), Acute Kidney Injury (10.6%) and Acute Glomerular Nephritis (10.6%) were the commonest causes of admission. Proteinuria (39.4%), Oedema (39.4%) and Oliguria (26.9%) were the most frequent clinical presentations. Progressive increase in yearly diagnosis of renal diseases was observed. More than 90% of the patients took herbal remedies before presentation (p-Value=0.001). Mortality rate was 4.8%. Causes of death were Chronic Kidney Disease (40%), Acute Kidney Injury (20%), Wilms tumour (20%), and HIVAN (20%). Conclusion: The prevalence of childhood renal diseases in Aba is 1.7%. Nephrotic syndrome is the commonest cause of renal admission in our centre. Ingestion of herbal concoctions by our cohort was high. There was an annual increment in the number of renal disorders in our centre. Preventive nephrology should be adopted to curb the morbidity and mortality from renal diseases worldwide.
Abstract: Background: Renal diseases are currently posing a great health concern worldwide. Proper documentation, knowledge of renal disease burdens, and established renal registries will provide data to guide stake-holders in future planning and resource allocation. This study aims at documenting the pattern and outcome of childhood renal diseases admitted ...
Show More
-
Clinical Characteristics of a Group of Cameroonian Neonates with Delayed Breastfeeding Initiation
Georges Pius Kamsu Moyo,
Ngwanou Dany Hermann
Issue:
Volume 6, Issue 3, September 2020
Pages:
285-288
Received:
22 June 2020
Accepted:
4 July 2020
Published:
17 July 2020
Abstract: The timely or Early Initiation of Breastfeeding (EIBF) within the first hour following childbirth is known to be a determining factor for the overall breastfeeding process. Nevertheless, in some cases there may exist a considerable delay in its start. This could be responsible for disorders in neonate infants, with varying severity. The main objective of this survey was to determine particular clinical characteristics of a group of neonates with delayed breastfeeding initiation, compared with that of neonates with early breastfeeding initiation (EBFI), during the first week of life. We did an analytical cross-sectional study with the notion of timely breastfeeding initiation according to the World Health Organization (WHO), used to distinguish neonates. The study was conducted at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital from December 2018 to May 2019. All livebirth infants weighing > 2000g were recruited during the period of study. From an overall sample of 250 neonates, 153 (61.2%) had delayed breastfeeding initiation, while 97 others had EIBF. All neonates with delayed breastfeeding initiation had other characteristics of inadequate breastfeeding practices. Although 144 (94%) were in good health immediately after birth, 38 (24.8%) were hospitalized within 7 days, of which 21 (55.2%) were related to sepsis and 6 (15.7%) due to metabolic disorders. They represented 83.3% (15 out of 18) infants with hypotrophy. Therefore, the late initiation of breastfeeding may induce inadequate breastfeeding practices, with significant repercussions on the neonate’s health condition, including nutritional disorders such as metabolic disturbances, growth retardation, increased susceptibility to neonatal infections and eventually, the rate of hospitalization during the given period of time on. Mothers’ education, medical staff and family encouragements may help promote timely breastfeeding initiation, so as to limit adverse neonatal outcomes.
Abstract: The timely or Early Initiation of Breastfeeding (EIBF) within the first hour following childbirth is known to be a determining factor for the overall breastfeeding process. Nevertheless, in some cases there may exist a considerable delay in its start. This could be responsible for disorders in neonate infants, with varying severity. The main object...
Show More
-
Neonatal Profile and Outcome in Neonatal Intensive Care Unit Sanglah Hospital
Kirana Dyah Larasati Budhiarta,
I Made Kardana
Issue:
Volume 6, Issue 3, September 2020
Pages:
289-294
Received:
27 June 2020
Accepted:
9 July 2020
Published:
23 July 2020
Abstract: Children face the highest risk of dying in their first month of life, at an average global rate of 2.5 million deaths in 2018. The highest neonatal mortality rate in 2018 occurred in Sub-Saharan Africa which reached 28 deaths per 1000 live births, followed by East Mediaterania with 25 deaths per 1000 live births. Meanwhile, based on Central Bureau of Statistics, the neonatal mortality rate in Indonesia were 15 deaths per 1000 live births in 2017. More than 80% death in neonates caused by 3 preventable factors such as complication of prematurity, complication of birth like asphyxia and neonatal infection (such as sepsis and pneumonia). Furthermore intensive care unit play crucial role in critically ill neonate. In this study we aimed to determine profile and outcome of neonates treated in Neonatal Intensive Care Unit (NICU) of Sanglah Hospital. This was a descriptive cross sectional study and data was taken retrospectively from medical record of neonates treated in NICU during 2019. We got 393 neonates admitted in NICU, but forty patients were excluded due to readmission and insufficient data. Finally there were 208 (62.1%) male neonates and 127 (37.9%) female neonates, with 208 subjects were premature neonates (<37 weeks). Their median length of stay was 7 days. Most cases were treated due to respiratory distress (84.1%). In 2019, we found 111 neonates passed away with sepsis as the most common cause of neonatal death. Neonates treated in NICU were dominated by premature neonates, male and low birth weight (<2500 gram). There was 28.2% neonatal death in 2019.
Abstract: Children face the highest risk of dying in their first month of life, at an average global rate of 2.5 million deaths in 2018. The highest neonatal mortality rate in 2018 occurred in Sub-Saharan Africa which reached 28 deaths per 1000 live births, followed by East Mediaterania with 25 deaths per 1000 live births. Meanwhile, based on Central Bureau ...
Show More
-
Antimicrobial Stewardship in a Tertiary Neonatal Intensive Care Unit with Limited Resources
Fouzia Naeem,
Ashley Thomas,
Brenik Kuzmic,
Indira Chandrasekar
Issue:
Volume 6, Issue 3, September 2020
Pages:
295-299
Received:
25 June 2020
Accepted:
16 July 2020
Published:
28 July 2020
Abstract: Background: Antimicrobial stewardship programs (ASP) have been recognized nationally as an effective way to combat antimicrobial resistance. Using data from the Pediatric Health Information System (PHIS) database, we noticed high utilization of antimicrobials in our hospital particularly in our tertiary level neonatal intensive care unit (NICU). This prompted focused efforts in the NICU consisting of development of management guidelines and prospective audit with intervention and feedback. Method: Using the PHIS database, we retrospectively measured days of therapy per 1000 patient days (DOT/1000 PD) in the NICU during the pre-implementation, implementation and post-implementation phases to determine the change in antimicrobial utilization. All antimicrobials administered between 01/01/14 to 12/31/19 were included in this review. Secondary outcomes including late-onset sepsis (LOS), necrotizing enterocolitis (NEC), mortality rates and hospital-wide antimicrobial utilization were also evaluated. Comparison of means among groups was performed by analysis of variance (ANOVA). Results: Overall, mean DOT/1000 PD for the NICU decreased 32% from the pre-implementation to the post-implementation phase (656.86 vs 480.81 vs 431.90 DOT/1000 PD, P < 0.01). NICU LOS rates decreased from 2.4% to 1.5%. NEC and mortality rates remained unchanged from 4.2% to 4.9% and 3.4% to 4.4%, respectively. Mean DOT/1000 PD for the entire hospital decreased 22% overall (857.09 vs 739.71 vs 667.76 DOT/1000 PD, P < 0.01). Conclusions: Implementation of a NICU ASP helped reduce antimicrobial utilization in the NICU without increasing morbidity and mortality. Hospitals with limited resources may consider targeted unit-based stewardship to help reduce antimicrobial utilization.
Abstract: Background: Antimicrobial stewardship programs (ASP) have been recognized nationally as an effective way to combat antimicrobial resistance. Using data from the Pediatric Health Information System (PHIS) database, we noticed high utilization of antimicrobials in our hospital particularly in our tertiary level neonatal intensive care unit (NICU). Th...
Show More
-
Case Report: One Case of Coronavirus Disease 2019 (COVID-19) in Child with Thrombocytopenia and Skin Lesion
Masoumeh Abedini,
Borhan Moradveisi,
Mohammad Ghaderi,
Avat Karimi,
Farima Zakaryaei
Issue:
Volume 6, Issue 3, September 2020
Pages:
300-302
Received:
5 June 2020
Accepted:
29 June 2020
Published:
4 August 2020
Abstract: COVID-19 disease characterized by a wide range of clinical manifestations of respiratory and gastrointestinal symptoms, like diarrhea and vomiting, in children and adults; also, some laboratory findings like thrombocytopenia and lymphopenia are reported in some cases, but Skin lesions are uncommon symptoms. In this study, we report a 7-year-old girl admitted to an emergency department of Besat hospital in Sanandaj, Iran, with erythematous maculopapular skin lesions manifestation. Our patients had other symptoms including fever, gastrointestinal symptoms (vomiting, loss of appetite, and diarrhea) severe systemic symptoms include respiratory distress and cardiomyopathy, and also she had abnormal laboratory findings like thrombocytopenia, leukocytosis, and lymphopenia. First of some differential diagnosis like gastrointestinal infection and Kawasaki disease was consider and but after rule outing these disease, COVID-19 infection was diagnosed for the patient by PCR testing of the nasopharyngeal sample. She treated with chloroquine and Kaletra for five days and Meropenem and Clindamycin. So we introduce thrombocytopenia and skin lesion as the clinical manifestation of COVID-19 disease in children. Also, according to this study, we recommend doing diagnostic tests to rule out COVID-19 disease in children with skin manifestation or thrombocytopenia. Also, it is necessary to understand the clinical features of COVID-19 in children.
Abstract: COVID-19 disease characterized by a wide range of clinical manifestations of respiratory and gastrointestinal symptoms, like diarrhea and vomiting, in children and adults; also, some laboratory findings like thrombocytopenia and lymphopenia are reported in some cases, but Skin lesions are uncommon symptoms. In this study, we report a 7-year-old gir...
Show More
-
Clinical Characteristics and Report of Seven Iranian Neonates Born to Mothers with Covid-19
Farhad Abolhasan Choobdar,
Maral Ghassemzadeh,
Ezzat Abbariki,
Mohammad Attarian
Issue:
Volume 6, Issue 3, September 2020
Pages:
303-311
Received:
17 June 2020
Accepted:
14 July 2020
Published:
4 August 2020
Abstract: The outbreak of Covid-19 infection is an actual public health challenge. Iran is fighting hard against the virus outbreak. Although at first it seemed that the disease does not affect infants and the neonates, But the population of affected infants and neonates appears to be increasing. This article is written to share some of the experiences about encountering with neonates born to mothers with covid-19. It describes the maternal, perinatal and neonatal aspects of the disease in seven Iranian cases. It also explains the outcome of delivery and follow up of mothers and their neonates after they discharged from hospital. According to our vague and incomplete knowledge about this novel disease and also hazardous side effects of its specific drugs which are not fully evaluated in neonatal population, in this article we just emphasize on routine and supportive care and avoiding unconventional therapy. In this case series we manage our patients according to their disease such as pneumonia, transient tachypnea of neonates or respiratory distress syndrome by using antibiotics, total parenteral nutrition and supplementary oxygen therapy with the preference of non-invasive methods. We didn’t use any novel treatment for Covid-19 disease. We also carefully considered isolation and personal protection issues.
Abstract: The outbreak of Covid-19 infection is an actual public health challenge. Iran is fighting hard against the virus outbreak. Although at first it seemed that the disease does not affect infants and the neonates, But the population of affected infants and neonates appears to be increasing. This article is written to share some of the experiences about...
Show More
-
A 17-year-old Girl with Crohn’s Disease: A Case Report
Ida Ayu Putu Purnamawati,
I Putu Gede Karyana,
I Gusti Ngurah Sanjaya Putra,
Ni Nyoman Metriani Nesa,
I Gusti Lanang Sidiartha
Issue:
Volume 6, Issue 3, September 2020
Pages:
312-316
Received:
1 July 2020
Accepted:
13 July 2020
Published:
4 August 2020
Abstract: The prevalence of inflammatory bowel disease (IBD) in worldwide exceeded 0.3%. The highest prevalence of Crohn’s disease is reported in Germany (322 per 100.000). The incidence and prevalence of IBD relatively low in Asia. In Indonesia, the case of IBD are rarely found. Reported a 5.2% of cases of Crohn’s disease and from the rest of the total cases colonoscopy at Cipto Mangunkusumo Hospital. In majority population, patients with Crohn’s disease usually diagnosed in their 20s and 30s. However 5-10% of all cases occur early in paediatric. The aim of our case report was to describe clinical presentation, laboratory, imaging study and histopathology finding of Crohn’s disease. A 17-year-old girl had reccurent bloody stool, recurrent diarrhea, recurrent stomatitis, pale, abdominal pain, weight loss, and did not have her period since 16-year-old. Physical examination showed cachexia appearance, old man face, prominent costae, tenderness at abdominal palpation, muscle wasting, severe malnutrition, and abnormal puberty stage. The laboratory findings revealed micrositic hypochromic mild anemia, positive fecal test, faecal calprotectin >2.100 ug/g, and hypoalbuminemia. The abdominal Computerized Tomography (CT) scan showed suspect inflamation process in the intestine. The colonoscopy and Esophago Gastro Duodenoscopy (EGD) finding revealed multiple colon ulcers with skip lesions and pangastritis superficialis. The histopathologic finding revealed an active chronic gastritis and colitis. Patient was diagnosed as Crohn’s disease, urinary tract infection, mild microcytic hypochromic anemia due to chronic dissease, secondary amenorrhea, severe marasmic malnutrition condition III rehabilitation phase. Patient got enteral nutrition with 6 weeks, corticosteroid to induce remission for 10 weeks (include tapering dose), omeprazole, antibiotic for urinary tract infection, albumin, vitamin and micronutrient for malnutrition management. After 10 weeks of treatment she had remission. Diagnosis of Crohn disease in adolescent girl is not easy to establish. However, some symptom of upper and lower gastrointestinal tract, extraintestinal manifestation like secondary amenorhea, faecal calprotectin level >2.100 ug/g, along with support finding from colonoscopy and EGD which revealed multiple ulcers in colon with skip lesions, pangastritis superficialis and histopathology result which showed an active chronic gastritis and colitis can be helpful to diagnose the case.
Abstract: The prevalence of inflammatory bowel disease (IBD) in worldwide exceeded 0.3%. The highest prevalence of Crohn’s disease is reported in Germany (322 per 100.000). The incidence and prevalence of IBD relatively low in Asia. In Indonesia, the case of IBD are rarely found. Reported a 5.2% of cases of Crohn’s disease and from the rest of the total case...
Show More
-
Gaucher’s Disease in a 2 Years Old Child: A Case Report
Sri Satya Mahayani,
I Gusti Lanang Sidiartha,
I Gusti Ayu Eka Pratiwi
Issue:
Volume 6, Issue 3, September 2020
Pages:
317-321
Received:
11 July 2020
Accepted:
23 July 2020
Published:
13 August 2020
Abstract: Gaucher’s Disease (GD) is an autosomal recessive systemic lysosomal storage disorder, characterized by glucocerebroside deposition in cells of macrophage-monocyte system as result of deficiency in lysosomal β-glycosidase (glucocerebrosidase). GD is a rare genetic disorder. It is the most common among the lysosomal storage disorders. Hereby we report a 2-year-old male presented with weakness, pallor and gradually enlarge belly. In the beginning the diagnosis was suspected acute leukemia, an abnormality in hematooncology due to bisitopenia and organomegaly. Therefore patient was gone through Bone Marrow Aspiration (BMA) to confirm the diagnosis, however the results of 3 times BMA were not align with acute leukemia. Moreover the history and clinical examination pointed to be a lipid storage disease. Finally patient was diagnosed as GD after the smear of BMA showed foam cell. In addition the confirmation of Gaucher’s disease was performed by measurement of glucocerebrosidase level, which resulted low in β-Glukosidase 0.97 uM/hr (normal level > 1.8 uM/hr). Therefore we emphasize the importance of early recognition by clinical manifestation and histological findings. GD should be considered as differential diagnosis of children with unexplained hepatosplenomegaly. Patients suspected with acute leukemia should be examined for possibility of GD from bone marrow smear. Furthermore, early recognition of GD would lead to safe and effective treatment with enzyme replacement which can decrease morbidity.
Abstract: Gaucher’s Disease (GD) is an autosomal recessive systemic lysosomal storage disorder, characterized by glucocerebroside deposition in cells of macrophage-monocyte system as result of deficiency in lysosomal β-glycosidase (glucocerebrosidase). GD is a rare genetic disorder. It is the most common among the lysosomal storage disorders. Hereby we repor...
Show More
-
Leucopenia, Neutropenia, Lymphopenia and Monocytopenia in a 15 year Old Girl with Iron Deficiency Anemia Responding to Iron Therapy: A Case Report
Sam Hassan,
Tessy Augustine,
Nidal Mahgoub
Issue:
Volume 6, Issue 3, September 2020
Pages:
322-326
Received:
8 July 2020
Accepted:
27 July 2020
Published:
18 August 2020
Abstract: Despite the high prevalence of iron deficiency anemia (IDA) in children, extensive information about its impact on growth and cognitive functions, less is known about how it affects the non-erythrocytes cell lines and its implications. High erythropoietin levels in severe iron deficiency anemia may down regulate the production of non- erythroid precursors resulting in various cytopenia, however, the mechanism of this is not fully understood. Reports depicting the association of iron deficiency anemia with cytopenia is quite scarce in pediatric population. We report a case of a 15 year old girl presented with severe iron deficiency anemia and leucopenia, lymphopenia, neutropenia and monocytopenia who has no other evidence of bone marrow dysfunction. The patient responded to iron therapy with prompt reversal of all cell counts. It is therefore recommended to include iron study and plasma erythropoietin concentration in the evaluation of otherwise healthy children presenting with cytopenia. Likewise, to consider iron deficiency in the causative list of non-erythroid cytopenia such as neutropenia.
Abstract: Despite the high prevalence of iron deficiency anemia (IDA) in children, extensive information about its impact on growth and cognitive functions, less is known about how it affects the non-erythrocytes cell lines and its implications. High erythropoietin levels in severe iron deficiency anemia may down regulate the production of non- erythroid pre...
Show More
-
Retrospective Survey of Pediatric Diabetics at a Tertiary Healthcare Center in Uyo, South-South Nigeria
Olufisayo Gabriel Ayoade,
Collins Amadi,
Sunday Babatunde Adesina,
Sarah Ifreke Essien,
Enobong Nkereuwem Udoh,
Ofonmbuk Okon Umoh
Issue:
Volume 6, Issue 3, September 2020
Pages:
327-333
Received:
10 July 2020
Accepted:
29 July 2020
Published:
18 August 2020
Abstract: Purpose: Despite the high prevalence of diabetes mellitus (DM) reported among adult Uyo inhabitants in south-south Nigeria, no data exist on pediatric DM (PDM) to date. Hence, the current study aimed to evaluate pediatric subjects diagnosed with DM in Uyo, South-south Nigeria. Methods: This was a retrospective survey of incident/newly diagnosed PDM subjects diagnosed/managed over 15 years (2003-2018) at the University of Uyo Teaching Hospital (UUTH), South-south Nigeria. Patients’ demographic, clinical, and laboratory variables at PDM diagnosis were retrieved from medical records and analyzed using descriptive statistics. Results: 45,551 pediatric cases were managed during the studied period among them 9 PDM cases, all of type 1 DM, giving PDM prevalence of 0.20/1000. Age at diagnosis was 7.00±4.82 years (range 2-16) with a predominance of ≤5-year-olds (44.4%) and females (66.6%). Most (77.8%) presented via the pediatric outpatient clinic, during the rainy season (55.6%), were urban-dwellers (55.6%), of Ibibio ethnicity (55.6%), and lower socioeconomic status (44.4%). Three (33.3%) had DM family history, mostly in first-degree (n=2) relatives. Predominant symptoms were polyuria (100%), polydipsia (100%), weight loss (88.9%), and weakness (77.8%); polyuria being the most prolonged symptom. Three (33.3%) were underweight/stunted, and 2 (22.2%) were overweight. DKA complicated with AKI and dehydration-induced AKI was recorded in 2 respective cases. The default rate to follow-up was discouragingly high following diagnosis. Conclusion: The prevalence rate of PDM was relatively low, occurred mostly among the ≤5-year-olds, with a high rate of default to follow-up. These findings could serve as health policy targets by various stakeholders within the studied region.
Abstract: Purpose: Despite the high prevalence of diabetes mellitus (DM) reported among adult Uyo inhabitants in south-south Nigeria, no data exist on pediatric DM (PDM) to date. Hence, the current study aimed to evaluate pediatric subjects diagnosed with DM in Uyo, South-south Nigeria. Methods: This was a retrospective survey of incident/newly diagnosed PDM...
Show More
-
Examination of Intrauterine Inflammation and Immature Platelet Fraction at Birth in Extremely Low Birth Weight Infants
Yuko Sakurai,
Motoichiro Sakurai
Issue:
Volume 6, Issue 3, September 2020
Pages:
334-340
Received:
27 July 2020
Accepted:
10 August 2020
Published:
18 August 2020
Abstract: IL-6 is thought to be involved in the prognosis of extremely low birth weight infants, in whom it leads to newborn organopathy. IL-6 also influences various processes in vivo, including thrombocytopoiesis. In the present study, we investigated whether the influence of IL-6 in the fetal period could be evaluated using the actual number of infant platelets, which is an index of thrombocytopoiesis. We retrospectively examined the perinatal information of extremely low birth weight infants, IL-6, the number of platelets (Plt), and the number of immature platelets fraction (IPF). The study population included 81 infants. The mean gestational age of the infants was 26.1±2.5 weeks and the mean birth weight was 729±161 g. The immature platelet count (Plt×IPF) was positively correlated with the IgM level (R=0.45, p<0.01) and the membrane rupture time (R=0.095, p<0.01). In addition, the Plt×IPF in the group in which the cord blood IL-6 level was ≥11 pg/mL was significantly higher than that in the group in which the cord blood IL-6 was <11 pg/mL (p<0.01). The Plt×IPF value at birth was associated with the IL-6 level in extremely low birth weight infants, which suggests the possibility that it may be used to evaluate fetal inflammation.
Abstract: IL-6 is thought to be involved in the prognosis of extremely low birth weight infants, in whom it leads to newborn organopathy. IL-6 also influences various processes in vivo, including thrombocytopoiesis. In the present study, we investigated whether the influence of IL-6 in the fetal period could be evaluated using the actual number of infant pla...
Show More
-
A Retrospective Study of Clinical Presentation of Child with Febrile Seizure and Its Duration
Nipun Shrestha,
Dhruba Shrestha,
Ashish Shrestha,
Mala Shrestha
Issue:
Volume 6, Issue 3, September 2020
Pages:
341-345
Received:
4 May 2020
Accepted:
22 July 2020
Published:
20 August 2020
Abstract: Background: Febrile Seizure is defined as seizure occurring during febrile episode (body temperature > 100.4°F or 38°C) in a child between 6 to 60 months, in absence of CNS infection, metabolic abnormalities, neurological condition and a history of prior afebrile seizure. Some of the major concerns regarding febrile seizure are its duration and recurrence. Risk factors associated with its duration are poorly understood. Method: A retrospective study was conducted from January to December 2018 among children admitted to Siddhi Memorial Hospital (for Women and Children), Bhaktapur (Nepal) with a diagnosis of febrile seizure. Information on those children, including gender, age of onset, type of seizure, duration of seizure etc., were collected from patient records. Children meeting the standard definition of febrile seizure were included in the study. Data analysis was done using Microsoft Excel and STATA, version 15. A p value <0.05 was considered statistically significant. Result: A total of 1389 children had been admitted to pediatric department during the study period. Among them, 124 children (i.e. 8.9% of total admission) met the criteria of febrile seizure and were hence included in the study. Majority of the cases had Simple febrile Seizure (77%) and the remaining had Complex febrile seizure (23%). The study population was of mixed gender (60% male and 40% female). Mean age of presentation was 23.7 (±11.7) months. The highest prevalence was seen in children < 2 years of age. Mean duration of seizure was 5.11 (±4.84) minutes. URTI and AGE were the leading cause of febrile seizure, with prevalence of 45% and 42% respectively. 10% of children were stunted and 5% of children were wasted. Mean height for age was -0.43 (±1.5) SD and mean weight for height was -0.31 (±1.02) SD. Mean serum sodium, potassium and calcium level were 133 (±2.81) meq/l, 4.4 (±3.0) meq/l and 8.14 (±0.99) mg/dl respectively and mean random blood sugar was 108.4 (±24.17) mg/dl. No association was found between serum sodium level and duration of seizure (correlation=-0.19, p=0.832), serum potassium level and duration seizure (correlation=-0.03, p=0.7). Positive correlation were found between serum calcium level and duration of seizure (correlation=+0.25, p=0.03), as well as blood sugar level and duration of seizure (correlation=+0.19, p=0.027). Conclusion: Since blood sugar and serum calcium levels tended to be high among our study subjects, their impact on duration of febrile seizure should be investigated further. Serum sodium and potassium level had no effect on seizure duration.
Abstract: Background: Febrile Seizure is defined as seizure occurring during febrile episode (body temperature > 100.4°F or 38°C) in a child between 6 to 60 months, in absence of CNS infection, metabolic abnormalities, neurological condition and a history of prior afebrile seizure. Some of the major concerns regarding febrile seizure are its duration and rec...
Show More
-
Newborn Transport Practices: Influence on Newborn Survival in Benin City, Nigeria
Ikechukwu Richard Okonkwo,
Blessing Imuetinyan Abhulimhen-Iyoha,
Angela Anene Okolo
Issue:
Volume 6, Issue 3, September 2020
Pages:
346-352
Received:
11 July 2020
Accepted:
27 July 2020
Published:
20 August 2020
Abstract: Objective: To assess the transfer process, modes of transportation, distances covered to access care, condition on arrival, and outcomes of newborns admitted to hospital in Benin City, Nigeria. Methods: This was a cross sectional survey of all consecutively presenting neonates to the children’s emergency unit over a 12-month period. Their demographic information, antepartum and perinatal antecedents, clinical information, main complaint, and co-morbidities were noted on a structured questionnaire. Other information gathered included transfer process, mode of transport, distance covered to reach facility, interventions during transport, condition on arrival, and outcome. Data were analyzed using descriptive statistics, frequencies, and chi-square comparisons; significance was set at P<0.05. Results: Responsible persons for 115 babies—73 males and 42 females—completed the questionnaire. Of the newborns, 62 (53.9%) were of normal birth weight and 43 (37.3%) of low birth weight; of these 37 (32.2%) were preterm. Most cases arrived from peripheral hospitals without referral notes or prior contact with the receiving hospitals. There was no organized pre- or intra-transfer stabilization or medical interventions. Patients came mainly with relatives (89%) or healthcare workers (10%). They arrived in private cars (81%), and were not kept in warm clothes. Distance covered was 10-20 km for more than 50% and over 100 km for less than 8%. Perinatal asphyxia was the commonest reason for transfer (14%). Lower gestational age and cyanosis on presentation significantly affected survival, as only 13 of 25 (52%) with cyanosis and 23 of 37 (62.2%) preterm babies survived. Overall mortality was 30/ 115 (26.1%), and preterm mortality was significantly higher at 14/37 (37.8%). Conclusions: The neonatal transfer process is poorly developed. Prior contact with receiving hospitals is infrequent. Staffing, monitoring, and stabilizing interventions during transfer of sick newborns are inadequate. Transfer mode might have affected survival of preterm infants in particular.
Abstract: Objective: To assess the transfer process, modes of transportation, distances covered to access care, condition on arrival, and outcomes of newborns admitted to hospital in Benin City, Nigeria. Methods: This was a cross sectional survey of all consecutively presenting neonates to the children’s emergency unit over a 12-month period. Their demograph...
Show More
-
Correlation Between Frequency of Seizure and Cognitive Development Levels in Children with Drug Resistant Epilepsy
Ni Luh Sukma Pratiwi Murti,
Gusti Ngurah Suwarba,
Gusti Ayu Trisna Windiani
Issue:
Volume 6, Issue 3, September 2020
Pages:
353-356
Received:
15 July 2020
Accepted:
29 July 2020
Published:
25 August 2020
Abstract: Epilepsy, if not treated properly, can develop into refractory epilepsy or drug-resistant epilepsy. This type of epilepsy does not respond perfectly to the anti-epileptic drugs given. Drug-resistant epilepsy causes ischemia in neuron cells in the brain. Drug resistant epilepsy can cause impaired cognitive function, especially in children who are in the golden age. Epilepsy prevalence from various studies ranged from 1.5 to 31/1000 population. Epilepsy cases in Indonesia are predicted to range from 0.7 to 1% of the population in Indonesia or range from 1.5 to 2 million people. To determine correlation between the frequency of seizures with the level of cognitive development in children with drug resistant epilepsy. A cross sectional correlation study was carried out in 41 children with drug resistant epilepsy to determine cognitive values in drug resistant epileptic children. The sample was chosen from an affordable population by non-random sampling or consecutive sampling. The research hypothesis is there is a level of cognitive development in children aged 6 to 68 months with drug resistant epilepsy. Calculation of research subjects used the formula for correlative research. Data analysis was performed by Saphiro-Wilk data normality test, correlation analysis used Coefficient Lambda. Results were significant if the value of p<0.05. The results of this study found female subject 26 (63.4%). There were 16 subjects (39%) well nourished. diagnosis age of epilepsy<1 year 15 (37%). Number of seizure periods < 10 times 12 (29%). The number of anti-seizure medication were 2 drugs 27 subject (65%). Abnormal 1 EEG results were 8 subjects (19.5%). The Mullen Scale test results are below average 38 subject (97.2%). Strong correlation of seizure frequency ≥ 10 times was statistically significant to the level of cognitive development in children with epilepsy with r 0.783 with a p value was 0.00. Frequency of seizure 43.3% influenced cognitive development level. Conclusion, the frequency of seizures has a positive strong correlation to the level of cognitive development.
Abstract: Epilepsy, if not treated properly, can develop into refractory epilepsy or drug-resistant epilepsy. This type of epilepsy does not respond perfectly to the anti-epileptic drugs given. Drug-resistant epilepsy causes ischemia in neuron cells in the brain. Drug resistant epilepsy can cause impaired cognitive function, especially in children who are in...
Show More
-
Parental Perceptions of COVID-19 Pandemic: Adherence to Laid Down Containment Measures
Ezeonwu Bertilla,
Joseph Ajanwaenyi Uzoma,
Uwadia Omozele,
Osim Chinemerem,
Ofudu Prince,
Opara Hyginus,
Adeniran Kayode,
Onyeka-Okite Ezinne,
Okike Clifford,
Okolo Angela
Issue:
Volume 6, Issue 3, September 2020
Pages:
357-361
Received:
30 July 2020
Accepted:
21 August 2020
Published:
27 August 2020
Abstract: Objectives: To ascertain, the perceptions of caregivers of children on covid-19 containment measures, the need for adherence to the measures to understand the reasons for poor compliance. Design: Qualitative prospective cross sectional survey of representative sub strata of the community’s population. Analysis according to these themes was conducted using standard Centre for Disease Control, Atlanta Georgia package called CDC EZ TEXT. Setting: The Focus Group discussions (FGDs) and the key informant (KIIs) interviews were held in the hospital at the respective units of the Pediatrics department at the Federal Medical Center (FMC), Asaba. The FGDs and KIIs examined fifteen thematic areas. These focused on Knowledge of the cause of COVID-19, method of spread, implications of observance of the government imposed lockdown and other measures of disease containment. Participants: Consecutively recruited caregivers of children admitted to the various units of the Pediatrics department at the Federal Medical Center. Results: We consecutively recruited 61 consenting participants in FMC: 50 participants for the focused group discussion (FGD) and 11 for key informant interview (KII). They had fair knowledge of the causative organism of this pandemic, its method of spread and the implications of the disease containment measures were fully understood. Rather, the interviewees expressed their difficulties and frustrations in maintaining the rigors of application of these measures but would that government should expedite action towards the discovery of Protective vaccines because of the effect these measures had on their economic means of livelihoods. Conclusion: There is low personal and community engagement in implementation of containment measures. Further efforts should target community engagement.
Abstract: Objectives: To ascertain, the perceptions of caregivers of children on covid-19 containment measures, the need for adherence to the measures to understand the reasons for poor compliance. Design: Qualitative prospective cross sectional survey of representative sub strata of the community’s population. Analysis according to these themes was conducte...
Show More
-
Bonding, Resilience and Their Promotion by the Pediatrician Taking into Account the Covid-19-Challenge
Issue:
Volume 6, Issue 3, September 2020
Pages:
362-367
Received:
12 August 2020
Accepted:
28 August 2020
Published:
3 September 2020
Abstract: The history of childhood is also a history of endangerment and abuse of children. In addition to biological conditions, the experience of basic trust is essential. Based on her sociological field research for successful survival, the developmental psychologist Emmy Werner used the term resilience (elasticity), which originates from technology and considers this to be learnable. In developmental psychology emotional security, curiosity, recognition, boundaries, and community have been described as essential prerequisites that can be divided into child-related, family, and social resilience factors. Although stable mother-child attachment is undoubtedly an essential foundation for healthy development, there are fundamental discussions in the practical implementation, e.g. the beginning of the non-domestic occupation of the mother and nursery care. Today, the autonomy of the infant, its empathic observation, and its imitation of role models are recognized as the essential foundation of development. In the field of psychology and neurophysiology, above all impulse control and the training of empathy and self-will have been identified as important factors for successful personality development. Resilience is hampered by family conflicts, ambivalent, and psychologically abnormal behavior of close associates, as well as poverty and traumatic experiences after the first year of life. There is evidence that a child’s spirituality encourages its resilience. Diverse social-political achievements and pediatric offers in the first years of life can promote resilience but they must be used as early as possible and developed further. In the actual worldwide Covid-19-pandemia the promotion of a resilient behavior is of very great importance.
Abstract: The history of childhood is also a history of endangerment and abuse of children. In addition to biological conditions, the experience of basic trust is essential. Based on her sociological field research for successful survival, the developmental psychologist Emmy Werner used the term resilience (elasticity), which originates from technology and c...
Show More
-
Attitude Towards Infant Feeding Among Health Workers in Calabar, Nigeria
Ikobah Joanah Moses,
Omoronyia Ogban,
Ikpeme Offiong,
Ekpeyong Nnete,
Utsu Caleb
Issue:
Volume 6, Issue 3, September 2020
Pages:
368-372
Received:
16 August 2020
Accepted:
26 August 2020
Published:
7 September 2020
Abstract: Background: Effective practice of recommended infant feeding methods is key to child survival strategy in sub-Saharan Africa. Attitude towards infant feeding has been shown to be a significant determinant of practice. For health workers, attitude may determine the propensity to counsel mothers towards adoption and adherence to recommended infant feeding practices. This study aimed at assessing health workers’ attitude towards infant feeding. Methods: This was a cross-sectional descriptive study carried out in April 2019. Leslie Kish formula was used to recruit 225 health workers in Calabar to participate in the study. Ethical approval was obtained from the Cross River State Research and Health Ethics Committee. A validated self-administered IOWA infant feeding attitude scale was utilized in this study. Using the scale, attitude was categorized as positive for breastfeeding, neutral, and positive for formula feeding. Data was analysed using SPSS version 21.0, and p-value was set at 0.05. Result: Two hundred and twenty-five respondents completed the questionnaire. Female: male ratio was 1:0.24, the commonest age group (43.1%) was 31 to 40 years old, and 60% of respondents were nurses. Most respondents (52.9%) had neutral attitude, while 44.0% had positive attitude for breastfeeding, and 3.1% had positive attitude towards formula feeding. Age group, religion, profession, and ethnicity did not significantly influence attitude towards breastfeeding (p>0.05). Conclusion: Neutral attitude towards breastfeeding was common among health workers. This has implications for successful implementation of the recommended breastfeeding initiative towards improvement in child survival especially in resource-poor settings. Regular re-training of health workers is needed, especially through continuing educational effort by the various health professional bodies.
Abstract: Background: Effective practice of recommended infant feeding methods is key to child survival strategy in sub-Saharan Africa. Attitude towards infant feeding has been shown to be a significant determinant of practice. For health workers, attitude may determine the propensity to counsel mothers towards adoption and adherence to recommended infant fe...
Show More
-
Skeletal and Neurological Features of Seckel Syndrome and Microcephalic Osteodysplastic Primodrial Dwarfism – A Review of the Literature
Abd-Alla Mona,
Koenigs Ingo,
Fritzsche Sophie Friederike,
Kloth Katja,
Singer Dominique,
Reinshagen Konrad,
Trah Julian
Issue:
Volume 6, Issue 3, September 2020
Pages:
373-380
Received:
6 July 2020
Accepted:
3 August 2020
Published:
10 September 2020
Abstract: Backround: Primordial dwarfism is a rare disease pattern that is notable due to its clinical appearance. The first description was made in 1960 and created the initial image of the "bird-like" face with severe growth retardation. The condition then was called Seckel syndrome. However, not every child with primordial dwarfism met the criteria of Seckel syndrome; hence a sub-classification of microcephalic osteodysplastic primordial dwarfism (MOPD) was introduced. This in turn caused far-reaching confusion because many of the mentioned manifestations overlapped. Objectives: By this study the authors try to identify syndrome specific features for the respective clinical pictures with focus on skeletal changes and the associated neurological risks. Method: Medical Databases search was done for the Keywords: Seckel Syndrome, MOPD and Microcephalic Osteoplastic Primordial Dwarfism. All Articles until 2020 were included with special attention to case and case control studies. Results: Some clinical features or the common appearance of features appear to make a clear differentiation of Seckel syndrome, MOPD I/III and MOPD II possible. Conclusion: This review aims to highlight the differences in the morphological and skeletal appearances and to represent possible associated neurological co-morbidities that require special observation. Although for detailed differentiation genetic analyses of associated mutations might be the only.
Abstract: Backround: Primordial dwarfism is a rare disease pattern that is notable due to its clinical appearance. The first description was made in 1960 and created the initial image of the "bird-like" face with severe growth retardation. The condition then was called Seckel syndrome. However, not every child with primordial dwarfism met the criteria of Sec...
Show More
-
Comorbid Diseases Is a Predictor Length of Stay in Children with Severe Acute Malnutrition
Made Laksmi Dewi Adnyana,
I Gusti Lanang Sidiartha,
I Gusti Ayu Eka Pratiwi
Issue:
Volume 6, Issue 3, September 2020
Pages:
381-385
Received:
27 August 2020
Accepted:
16 September 2020
Published:
23 September 2020
Abstract: Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in children in developing countries. Patient with SAM mostly hospitalized with comorbidity that reduce the time of recovery and longer the length of stay (LOS). The aim of this study is to determine the association between comorbid with longer LOS among children with SAM. This was a retrospective cohort study from 2017-2018 on children with SAM conducted in the pediatric care ward of Sanglah Denpasar General Hospital. Inclusion criteria was children aged 1 months to 18 years diagnosed with SAM and had complete data at the start of admission. Exclusion criteria was patient discharged against medical advice. 134 children with SAM were included and analyzed with appropriate statistical analysis. The median of LOS was 18 days, comorbid at admission found were infection (31.3%), non-infection (56.0%), both infection and non-infection (12.7%). HIV found as the most comorbid in SAM patient (21.3%) followed by malignancy (17.3%), congenital heart disease (14%), and pneumonia (12.7%). Multivariate analysis found that comorbid was a risk factor for longer LOS in hospitalized SAM patients. Comorbid increases the LOS by 3.23 times (95% CI 1.563-6.709) p value 0.002. Bivariate analysis found that infection as comorbid increase the LOS by 1.72 times (95% CI 1.171-2.524) p value 0.011. Conclusion that comorbid at admission was associated with longer LOS in hospitalized patient with SAM.
Abstract: Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in children in developing countries. Patient with SAM mostly hospitalized with comorbidity that reduce the time of recovery and longer the length of stay (LOS). The aim of this study is to determine the association between comorbid with longer LOS among children...
Show More
