Awareness regarding breast feeding and complementary feeding in mothers of children with severe acute malnutrition at stabilization centre Multan

Breast feeding is the most natural way of feeding the infants and help to reduce child mortality and morbidity and millions of deaths could be prevented each year if mothers were aware of benefits of exclusive breast feeding for 4 -6 months and early initiation of breast feeding. In current study, awareness regarding breast feeding and complementary feeding in mothers of severely malnourished children was evaluated. The results showed that 99% mothers considered breast milk safe and effective but practically only 23% babies were breast fed while 77% were bottle fed. According to 58% mothers, there should be a early initiation of breast feeding, while 57% were un aware of the facts that clostrum should be given while 43% (43/100) of then considered it unhealthy and non effective. The current awareness reveals that most of the mothers prefer to give commercially available foods for their infants instead of breast feeding. This situation is alarming regarding child health and there is need to educate the mothers especially about the beneficial and health curing effects of breast feeding

A descriptive study of double burden of malnutrition in mothers of children with severe acute malnutrition admitted in children hospital and institute of child health, Multan

Objective: To assess the nutritional status of mothers of severely malnourished children, and to evaluate the factors associated with inadequate caloric intake of children with severe acute malnutrition versus sufficient caloric intake by mothers.Methods: The cross-sectional descriptive study was conducted from January to June 2016 at Children Hospital and Institute of Child Health, Multan, Pakistan, and comprised mothers of severely malnourished children admitted for treatment. Data was collected using a questionnaire administered through interviews. Elements noted included body mass index, 24-hour recall, dietary restriction during pregnancy, lactation and complimentary feeding patterns of the children. The mothers were also examined for clinical signs of iron deficiency anaemia.Results: Of the 100 women, 20(20%) were malnourished, 42(42%) were of normal weight, and 38(38%) were either overweight, pre-obese or obese. The caloric intake of 26(26%) mothers was less than 1500 kcal per day, while 42(42%) were taking between 2000-2500 kcal per day and 32(32%) were taking \u3e2500 kcal daily. Also, 67(67%) women were suffering from anaemia and 80(80%) women had some myths related with dietary restrictions during pregnancy, lactation and complimentary feeding of children. Overall, 23(23%) women breastfed their babies

Awareness regarding breast feeding and complementary feeding in mothers of children with severe acute malnutrition at stabilization centre Multan

Breast feeding is the most natural way of feeding the infants and help to reduce child mortality and morbidity and millions of deaths could be prevented each year if mothers were aware of benefits of exclusive breast feeding for 4 -6 months and early initiation of breast feeding. In current study, awareness regarding breast feeding and complementary feeding in mothers of severely malnourished children was evaluated. The results showed that 99% mothers considered breast milk safe and effective but practically only 23% babies were breast fed while 77% were bottle fed. According to 58% mothers, there should be a early initiation of breast feeding, while 57% were un aware of the facts that clostrum should be given while 43% (43/100) of then considered it unhealthy and non effective. The current awareness reveals that most of the mothers prefer to give commercially available foods for their infants instead of breast feeding. This situation is alarming regarding child health and there is need to educate the mothers especially about the beneficial and health curing effects of breast feeding

Serum Phosphate Level in Patients with Severe Acute Malnutrition at Nutrition Stabilization Centre, Children Hospital, and Institute of Child Health Multan

Objective: To evaluate the serum phosphate level of children with severe acute malnutrition and effect of therapeutic feeds (F75 and F100) on serum phosphate levels. Study Design: Prospective Observational Study. Place and Duration of Study : The study was conducted at Stabilization center of Children's Hospital and Institute of Child Health Multan from 1 March 2018 to 30 March 2019. Materials and Methods: The total 270 children with severe acute malnutrition, who were under 5 years of age and admitted to the stabilization center for complicated SAM during study duration were included in the study. Initial management of the patients were started by following WHO protocols for Severe Acute Malnutrition management and the baseline labs along with serum phosphate levels were sent for evaluation. Patients were admitted at Stabilization Centre for the management plan as per guidelines. Once the patients were stabilized in one week approximately the transition towards rehabilitation phase of severe acute management started. Serum phosphate levels were assessed at admission, at stabilization (day 7 of admission) and at the time of discharge. Data was analyzed using SPSS version 21. Results: The mean age of our patients was 22 ± 2 months. The male to female ratio were 1:2. Hypophosphatemia was documented in 180 (66%) patients with mean 0.96 ± 0.40 mmol/ltr < (1.45 –1.78mmol/ltr) serum phosphate levels at the time of admission. During transition phase the phosphate levels were 1.1± 0.45 mmol/l and after rehabilitation phase 1.45 ± 0.45 mmol/l on average of 15 days of management. After using F75 and F100 therapeutic feeds in stabilization, transition, and rehabilitation phase 178 (98.9%) children were treated and had normal serum phosphate level at the time of discharge. Conclusion: Hypophosphatemia is commonly present in SAM children. Introduction of therapeutic feeds F75 and F-100 during stabilization phase and rehabilitation phase significantly improves phosphate levels in SAM children with low phosphate levels

Treatment Outcome of Kwashiorkor in Children as Per World Health Organization Guideline at Nutrition Stabilization Center Multan, Pakistan

Objective: To assess the treatment outcomes and associated factors among children with kwashiorkor (Edematous Severe Acute Malnutrition) at Nutrition Rehabilitation Centre the Children Hospital and The Institute of Child Health, Multan. Study Design: Retrospective Descriptive research. Place and Duration of Study: This study was planned at the nutritional rehabilitation center of The Children Hospital and The Institute of Child Health, Multan from 01 January 2012 till 30 December 2020. Materials and Methods: The record register of stabilization center was utilized to gather the required information for the study. Baseline statistics and medical signs and symptoms of kwashiorkor, complications and treatment outcome of children were recorded. Patients of age 1 month to 60 months with kwashiorkor (weight/height less than -3SD with edema) were included who were treated according to WHO guidelines for Severe Acute Malnutrition (SAM). Results: during the year 2012-2020, a total of 2393 children were admitted with severe acute malnutrition out of which 222 (9.4%) were edematous SAM (Kwashiorkor). 222 kwashiorkor patients 25 (11.2%) were less than 6 months while 197(88.7%) were more than 6 months old. 120 (54%) were males and 102 (46%) were females. Out of total kwashiorkor patients, 40% presented with diarrhea, about 30% had pneumonia, hypoglycemia was recorded in 10% children, Urinary Tract Infection 15% and other diseases like celiac disease nephrotic syndrome and complication included the 5% of total. Almost 90% of patients recovered and got discharged and 8% passed away, only (2%) patients left against medical advice (LAMA). Conclusions: Kwashiorkor is the second most prevalent form of severe acute malnutrition in south Punjab and usually difficult to diagnose due to masking effects of edema. Kwashiorkor can be successfully managed by using the WHO guidelines for sever acute malnutrition. WHO guidelines also show treated patients discharged mostly with a lower percentage of mortality and comorbidities

APPLICATION OF L-METHIONINE CONFERS SALINITY TOLERANCE IN MAIZE THROUGH MODULATION OF METABOLITES AND ANTIOXIDATIVE DEFENSE

&lt;p&gt;&lt;strong&gt;Abstract&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;The world's arid and semi-arid regions are frequently subjected to significant abiotic stresses, particularly salt stress, which threaten crop yield and production. In light of this, the current study aimed to assess the mitigating effects of salinity stress through different doses of L-methionine (0, 50, and 100 mg L-1), with the goal of promoting sustainable production of Dekalb maize hybrids (Dk-6317 and Dk-9108). The experiment was carried out during spring 2020 in a pot setup, where salt stress was induced by applying two levels of sodium chloride (0 and 120 mM). Exogenous L-methionine at 50 mg L-1 and 100 mg L-1 significantly improved maize growth, yield, photosynthetic pigments, and antioxidant defence characteristics. Salt stress significantly (p ≤0.05) reduced plant height (17.89% and 21.40%), shoot fresh weight (17.13% and 17.42%), shoot dry weight (18.03% and 29.98%), root fresh weight (21.56% and 31.02%), root dry weight (33.37% and 30.51%), and leaf area (16.28% and 21.18%) of Dk-6317 and DK-9108, respectively, when compared to L-methionine treatments. Furthermore, correlation analysis revealed a significant (p ≤0.05) correlation between various studied traits, including enzymatic and stress-related antioxidants, as well as yield attributes. As a result, antioxidant enzyme activity such as superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), and ascorbate peroxidase (APX) promotes plant growth by positively correlating with photosynthetic pigments, resulting in higher yield attributes. It appears that L-methionine improves maize crop development when subjected to salt exposure, a novel aspect of L-methionine's beneficial role. A beneficial interaction between L-methionine and photosynthetic pigments suggests its potential to mitigate salt toxicity effects and enhance sustainable maize production.&lt;/p&gt

Echocardiographic based cardiac evaluation in children with severe acute malnutrition

Objective: To identify echocardiography-based myocardial changes in children with severe acute malnutrition. Method: The prospective study was conducted from January to November 2020 at a territory care paediatric hospital in Multan, Pakistan, and comprised severe acute malnutrition patients of either gender aged 1-60 months and an equal number of matching healthy controls. Malnutrition was categorised using the World Health Organisation criteria. Echocardiographic evaluation was done by expert cardiologists. Values for ejection fraction shortening, left ventricular mass, E/A wave ratio as well as mitral and tricuspid annular plane systolic excursions were noted. Data was analysed using SPSS 21. Result: Of the 150 subjects, 75(50%) each were cases and controls. Age and gender were not significant different between the groups (p>0.05). Left ventricular mass and left ventricular mass index with body surface area were significantly reduced in the cases compared to the controls, and the same was the case with left ventricular ejection fractional shortening (p0.05). Among the cases, cardiac evaluation showed 26(34.6%) were kwashiorkor and 49(65.3%) were marasmic patients. Conclusion: Left ventricular parameters in malnourished children were found to be reduced. As such, the assessment of these parameters may appear to be a significant indicator for timely identification of cardiac malfunction in severe acute malnutrition cases. Key Words: Severe acute malnutrition, Myocardial performance index, Ejection fraction, Fractional shortening, Cardiac function

Parental Iron Therapy to Treat Iron Deficiency Anemia in Malnourished Children

Objective: To evaluate the safety and efficacy of parental iron therapy to treat iron deficiency anemia in malnourished children. Study Design: Quasi experimental design. Place and Duration of Study: Stabilization Centre, Children Hospital and the Institute of Child Health, Multan from 1 December 2014 to 31 December 2020. Materials and Methods: A total of 250 malnourished children with iron deficiency were included in the study. The laboratory parameters i.e., Hemoglobin, Hematocrit, Red Blood Cells Count, mean corpuscular hemoglobin, mean corpuscular volume, and Serum ferritin of all patients were done. Using the iron deficit formula, all participants were given the measured iron sucrose complex. The iron sucrose complex was diluted with 0.9% normal saline and administered steadily for 3-4 hours. After 6 weeks of therapy, hemoglobin, RBC count , ferritin was measured. Comparison of mean ±SD of baseline laboratory parameters and after 6 weeks of iron supplementation was analyzed by using t-test. Results: A total of 250 participants were registered, male patients (57.2%) were more than female patients (42.8 %). Most of the 92(36.8%) participants were 12-24 months old. The key cause of anemia among 102(40.8%) admitted patients was inadequate diet or excessive milk consumption. The mean ±SD value of the Hb level at admission was 7.5±1.9 and it increased to 11±1.15g/dL after 6 weeks of active supplementation which is statistically significant (P-value < 0.05). Six weeks after giving intravenous iron therapy mean serum Ferritin increased from 11.5ml to 21.61 ng/ml. Conclusion: Current study concluded that controlled administration of IV iron sucrose for treatment of iron deficiency anemia among inpatients is efficacious and safe. IV iron sucrose should be considered for patient with severe IDA, those who are not compliant with oral formulations, and patients with malabsorption

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally