Fulminant hepatic failure with typhoid fever in childhood

Although hepatic dysfunction has been described among adults with typhoid, there are few reports of significant hepatic functional impairment in children with typhoid. Of 355 children with culture proven typhoid seen at the Aga Khan University Hospital, hepatomegaly was noted in 118 (33%) and isolated right hypochondrial tenderness in 30 (8.5%). The liver function tests were normal in 78% and 47% of these children respectively and significant hepatic dysfunction was seen only in 26 (7.3%). However, children with typhoid and significant hepatic dysfunction had higher mortality (P less than 0.001) and two patients presented with a picture of fulminant hepatic failure with fatal outcome

Necrotizing enterocolitis in infants weighing less than 2000 G

Over a 4 year period, nine of 180 (5%) infants weighing less than 2000 G, admitted to the Aga Khan University Hospital (AKUH) developed necrotizing enterocolitis (NEC). An outbreak of NEC occurred in 1989, during which six infants developed the clinical illness. Overall incidence was 1.1%. Thirty-one birth weight and gestation matched controls were selected for comparison. Risk factors usually considered as predisposing factors, i.e., low 5 min Apgar score, rate of maternal complications, respiratory distress syndrome, mechanical ventilation, umbilical catheterisation, patient ductus arteriosus, use of antibiotics and feeding practices were found with equal frequency in both cases and controls. Six infants had positive blood and/or peritoneal fluid cultures (66%) compared to only five (16%) in the control group (P less than 0.01). Our data suggests that prematurity and sepsis are important predisposing factors for development of NEC

Transcutaneous bilirubinometry in Pakistani newborns: a preliminary report

Neonatal hyperbilirubinemia is a frequently encountered problem in the neonatal period and carries a potential risk of encephalopathy. Early detection and quantification is important, and transcutaneous bilirubinometry (TcB) has been recommended as a non-invasive method for rapid screening. We prospectively compared the efficacy of TcB in 65 normal Pakistani jaundiced newborns undergoing simultaneous serum bilirubin measurements. Although the correlation between the two methods was significant (r = 0.66, P less than 0.01), the scatter was wide and the specificity only 53%. Although the technique offers the potential for non-invasive early screening of neonatal hyperbilirubinemia, it requires further validation in a larger study in our population

Lactose intolerance in persistent diarrhoea during childhood: The role of a traditional rice-lentil (Khitchri) and yogurt diet in nutritional management

Lactose intolerance is frequently encountered in children with persistent diarrhoea (PD). Selection of an appropriate milk-based formulation is a major management problem in the developing world. In a consecutive series of studies, we evaluated the role of feeding a traditional rice-lentil (khitchri) diet alone (KY) or in combination with either soy formula (KY-Soy) a dilute buffalo milk (KY-B), in children (age 6 months-3 years) with PD. Serial observations of stool output, caloric intake and weight gain of these children over a 14 day period indicated satisfactory tolerance of the KY diet with adequate weight gain. The weight gain and stool output was however higher in lactose intolerant children, with the worst results seen with K-Y and buffalo milk combination. While lactose intolerant children with PD do have higher. rates of therapeutic failure, our data indicates that a traditional diet and yogurt combination can be used satisfactorily for nutritional rehabilitation in over 80% of such children

Ciprofloxacin in multi-resistant infections in childhood: An audit

Ciprofloxacin is a new orally administrable fluoroquinolones, with considerable efficacy against multiresistant organisms. Its use in the paediatric age group however, is controversial because of the risk of potential articular toxicity. We retrospectively reviewed ciprofloxacin usage over a 32 week periods (June, 1991-September, 1993) in paediatric inpatients at The Aga Khan University Hospital. Ciprofloxacin was used in 21 cases, singly in 11 (52%) and in combination with other antibiotics in a further 10 (48%). The response to therapy was adjudged as \u27good\u27 or \u27fair\u27 in 13 (62%) cases. Ciprofloxacin was the only sensitive antibiotic in 4 (19%) and resistance to it was detected in another 4 (19%) cases. Despite all efforts, adequate follow-up could only be achieved in a third of the patients. Although no toxic or side effects were detected, in view of poor follow-up and emergence of ciprofloxacin resistant strains, our experience highlights the need to regulate ciprofloxacin use in the paediatric age group

Self-reported feeding advice by physicians for common childhood illnesses

Background: A nutritious diet is important for recovery during illnesses. Dietary advice by physicians and consumption of food by the patients are often based upon their hot and cold concepts and beliefs about various foods rather than on scientific basis.Objectives: To look at the food-advising behaviour of physicians during illnesses and to know the maternal concepts about various foods being hot or cold.Methods: A questionnaire was served to the physicians participating in a continuous medical education session held at the Aga Khan University and Hospital, asking them to write the foods they advise or restrict during different illnesses such as fever, jaundice etc. Mothers of sick children suffering from diarrhea and other illnesses were also interviewed to know their concepts about various foods.Results: Six (10%) out of sixty physicians believed in hot and cold concepts of the food. A variety of common foods were either restricted or strongly recommended by 10% to 50% of these physicians without any scientific basis, 23% physicians restricted fatty foods in jaundice, 17% physicians restricted in cough and cold. Although the interviewed mothers believed in hot-cold concepts of food but 55-63% of them were not sure what is meant by hot or cold food. In spite of that 70-80% of these mothers classified chicken, meat, egg, brinjal, masoor and mangoes are hot foods and rice, yogurt, moong, banana and orange as cold foods.Conclusion: Hot-Cold concept of food exists not only in mothers but also in physicians. Proper education regarding food intake is mandatory for both mothers and physicians to ascertain adequate intake of calories during sickness