Current Issue : January - March Volume : 2019 Issue Number : 1 Articles : 5 Articles
Birth weight is associated with cardiovascular disease, with those at both ends of the\nspectrum at increased risk. However, birth weight is a crude surrogate of fetal growth. Measures of\nbody composition may more accurately identify high risk infants. We aimed to determine whether\naortic wall thickening, cardiac autonomic control, and cardiac structure/function differ in newborns\nwith high or low body fatness compared to those with average body fatness. 189 healthy singleton\nterm born neonates were recruited and stratified by body fat percentiles (sex and gestation-specific).\nInfants with low body fat had higher aortic intima-media thickness (43..(95% confidence interval\n(CI) 7, 78),p = 0.02), lower heart rate variability (log total power, ........... and thicker ventricular walls (posterior wall thickness, 3.1 mm (95% CI 1.6, 4.6), p < 0.001) compared\nto infants with average body fatness. Infants with high body fat showed no differences in aortic\nintima-media thickness (.......), ......). The non-linear\nassociation of body fatness with heart rate variability was independent of birth weight. Infants born\nwith low or high body fat have altered markers of cardiovascular health. Assessment of body fatness\nalongside birth weight may assist in identifying high risk individuals....
Background and objective: Infectious diarrhea is one of the most common\ninfections and a significant cause of morbidity and mortality in children under\n5 years of age. Frequent and irrational use of antibiotics has resulted in\nincreased bacterial resistance. The aim of our study was to determine the\nculture and sensitivity patterns of antibiotics used for the treatment of diarrhea\nin children less than 5 years of age in a tertiary care hospital of Karachi,\nPakistan. Methodology: This cross sectional study was conducted for a period\nof six months in the children of ages ranging between 6 months and 5 years.\nStool samples were obtained from the patients presented with signs and\nsymptoms of diarrhea in OPD or being referred to microbiology department\nfor stool C/S (culture and sensitivity). Data were analyzed on SPSS version\n19.0. Results: A total number of 325 stool samples were collected, out of\nwhich 152 samples were positive for pathogens. The most common pathogen\nisolated was E. coli 92 (60%), followed by Klebsiella 56 (37%) and Salmonella\n4 (3%). All 152 isolates were highly resistant to majority of the standard antibiotics.\nConclusion: Infectious diarrhea is highly prevalent among children\nunder 5 years of age. E. coli was found to be the most frequent pathogen isolated\nin stool samples of the patients presenting with diarrhea and was highly\nresistant to many of the commonly used standard antibiotics in our clinical\nset up. Male children were predominantly affected by infectious diarrhea as\ncompared to female children. Therefore, injudicious use of antibiotics should\nbe stopped as well as should not be prescribed empirically for the treatment\nof all cases of pediatric diarrhea....
Background: Pediatric severe sepsis is a public health problem with significant morbidities\nin those who survive. In this article, we aim to present an overview of the important studies\nhighlighting the limited data available pertaining to long-term outcomes of survivors of pediatric\nsevere sepsis. Materials and Methods: A review of literature available was conducted using\nPUBMED/Medline on pediatric severe sepsis outcomes. Long-term outcomes and health-related\nquality of life (HRQL) following severe sepsis was defined as any outcome occurring after discharge\nfrom the hospital following an episode of severe sepsis which affected either the survivor or the\nsurvivorâ??s family members. Results: Many children are discharged with worse clinical and functional\noutcomes, depending on their diagnosis, treatments received, psychological effects, and the impact\nof their illness on their parents. Additionally, they utilize healthcare services more than their peers\nand are often readmitted soon after discharge. However, pediatric HRQL studies with worthwhile\noutcome measures are limited and the current data on pediatric sepsis is mainly retrospective.\nConclusions: There is significant and longstanding morbidity seen in children and their families\nfollowing a severe sepsis illness. Further prospective data are required to study the long-term\noutcomes of sepsis in the pediatric population....
Background: Bronchopulmonary dysplasia (BPD) continues to be an important\nproblem in neonates especially premature infants despite improved facilities\nof care, monitoring and treatment. Pulmonary hypertension (PH) is a\nmajor complicating factor and key cause of mortality in this population. Altered\nvascular and alveolar growth particularly in canalicular and early saccular\nstages of lung development following mechanical ventilation and oxygen\ntherapy result in arrest of the lung development leading to BPD with PH.\nEarly recognition of PH in infants with these risk factors is important for optimal\nmanagement. We tested the hypothesis that asymmetric dimethylarginine,\nwould be greater in infants with bronchopulmonary dysplasia associated\npulmonary hypertension than in infants with BPD alone. The Aim:\nThe aim of the current study was to measure the Asymmetric dimethylarginine\n(ADMA) levels, arginine levels & the plasma arginine-to-ADMA ratio in\nnewborn infants with broncho-pulmonary dysplasia, to evaluate echocardiographic\nparameters among neonates with bronchopulmonary dysplasia, to\ncorrelate between plasma ADMA & arginine-to-ADMA ratio and echocardiographic\n(ECHO) parameters in those patients and to compare full term &\npreterm neonates with bronchopulmonary dysplasia as regard to plasma\nADMA level. Methods: A case-control study was carried out of ninety (90)\nnewborns selected from those admitted to Neonatal Intensive Care Unit at\nMaternity & Children Hospital and Alzhraa University hospital during the\nperiod from October 2015 to March 2018. Neonates were divided into 2\ngroups: Patient with BPD with PH (cases group): It included 45 neonates with\nBPD & PH, 35 preterm neonates and 10 full term neonates. Patient with BPD\nonly (Control group): It included 45 neonates with BPD without PH. These\n45 neonates were divided as 22 preterm neonates and 23 full term neonates. Laboratory work was done in Alzhraa University hospital. Asymmetric dimethylarginine\n(ADMA) levels & arginine levels were measured using competitive\nenzyme linked immune-assay (ELISA). Results: Patients with both\nBPD and PH had greater plasma levels of ADMA than patients with BPD\nalone (P value 0.000). ADMA level > 186 ng/dl can predict development of\nPH in patient with BPD with sensitivity 100% and specify 100%. Preterm\nneonates with BPD had greater level of ADMA than full term neonates (P\nvalue 0.002). There was no statically significance difference between level of\nADMA if withdrawn before or after 28 days of age (range of age at time of\nsampling in our study was 23 - 40 days) (P value 0.878), even ADMA level\nincreased above the cut point early in the disease before we screened some\ncases by ECHO. There was no statically significance difference between level\nof arginine in cases and control groups with P value 0.530. The plasma arginine-\nto-ADMA ratio was lower in cases than in controls suggesting a greater\nlikelihood of inhibition of nitric oxide production in patients with both BPD\nand PH than in patients with BPD alone (P value 0.000). ADMA level can\npredict severity of pulmonary hypertension in patient with BPD, as it was positively\ncorrelated with the grade of pulmonary hypertension (P value 0.006).\nADMA level is higher in neonates with BPD and PH who died than those\nwho survived; it can predict death in neonates with BPD &PH; at cut off\npoint > 643 ng/dl. Conclusion: ADMA increased in newborn infants with\nBPD, who developed PH. ADMA may have diagnostic and prognostic values.\nADMA level was higher in preterm neonates than full term neonates and its\nlevel was correlated positively with severity of PH. ADMA levels were significant\nhigher in infants with BPD with PH who died later than those who survived.\nThere was no statically significance difference between levels of\nADMA, whether it was drawn before or after 28 days of age (range 23 - 40\ndays). Echocardiographic screening and ADMA measurement could help in\nprevention of PH, diagnosis and early treatment of newborn infants suffering\nfrom BPD....
Introduction: Meningitis remains a common and serious problem in children\nworldwide. One million instances of meningitis are assessed to happen\nin children worldwide each year. In Africa, where outbreaks are common\n70% of meningitis cases are diagnosed in children under the age of five (5)\nyears. Though in most cases, doctors diagnose early and adequate treatment\nstarted, 5% to 10% of patients still succumb during the 24 - 48 hours after\nonset of clinical features. In 2009, the mortality rate in Africa was four thousand\ndeaths. Study Objective: This study describes the predictors of bacterial\nmeningitis among children aged 0 - 5 years admitted at Kenyatta National\nHospital (K.N.H.) paediatric wards. Methodology: The study adopted a descriptive\ncross-sectional design. It was carried out in K.N.H. paediatric wards.\nData were obtained from consenting parent or guardian and healthcare workers\n(nurses and registrars). Study participants were selected by convenient sampling\nmethod. A total of 104 study participants were included in the study\nsample. In-depth interviews of key informants were conducted on 7 health\nworkers; 5 nurses from the paediatric wards and paediatric emergency unit\nand 2 paediatric registrars. Ethical consideration included full disclosure to\nparticipants, confidentiality, security of health records and informed consent.\nData were collected by use of researcher administered semi-structured questionnaire\nand desk reviews of patientsâ?? files were also used. Qualitative data\nfrom the interviews were audio-taped. Logistic regression analysis was used\nfor data analysis. Quantitative data were cleaned, entered and analysed using\nStatistical Package for Social Sciences (SPSS) version 23. Results were displayed\nby utilization of tables, pie charts. Qualitative data were transcribed,\ngrouped in themes and analysed manually. Study Results: The majority of\nthe children (55.8%) were female. The highest percentage of the children\n(53.8%) was aged less than one year. The highest proportion of the parents (39.4%) was within the age group of 26 - 30 years. Neonatal sepsis (37.5%),\nneonatal jaundice (25.0%) and for observation (25.0%) were the common\nreasons for admission to NBU. Children admitted and managed in the nursery\nunit were significantly 2.7 times more likely to have bacterial meningitis\ncompared to those children never admitted to the nursery [OR = 2.75; 95%\nCI = 1.08 - 7.00; P = 0.031]. Streptococcus pneumonia was the main (51.2%)\ncausative agent of bacterial meningitis among the children. Children who\nwere taken to hospital in delay after illness were 1.740 times more likely to\nexhibit meningitis than those taken to hospital immediately. Children whose\nparents had higher levels of income were two times less likely to exhibit\nmeningitis than those with lower. Majority (62.5%) resided in mid urban and\nslum areas. Most lived in a one (1) bed-roomed house and most houses\n(60.6%) had more than five people living in it. The main co-existing illnesses\namong the children were pneumonia (53.8%) and heart disease (22.9%).\nConclusions: Streptococcus pneumoniae was the common causative agent of\nmeningitis among the study population. The enviromnetal factors such as\nliving in overcrowded areas, inadequate exposure to health education\ncontributed to contracting and developing meningitis. Financial contraints\namong caregivers posed a hindrance to the participants in seeking medical\nattention early. A previous upper respiratory tract infection more often led to\ncontracting meningitis....
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