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

Impact of 3G and 4G Technology Performance on Customer Satisfaction in the Telecommunication Industry

This study investigates the impact of factors (network coverage, customer service, video calls, and downloading Speed) of 3G and 4G telecommunication services performance on customer satisfaction in the Punjab region of Pakistan. This research indicates how to make strong relations with customers and what factors of the 3G and 4G networks need to be improved to enhance the revenue of telecom operator companies. The study has recognized the four main hypotheses responsible for checking the level of customer satisfaction in the telecommunication industry of Pakistan in the Punjab region. The study depends on essential insights gathered on the arbitrary premise from 300 clients of significant telecom administrators in the Punjab area. The respondents have selected on irregular premises and were welcomed to express their sentiments through an organized survey. A complete questionnaire has been utilized for statistics collection and exists based on the analysis of descriptive measurement, correlation, and regression analysis and analyzed through SmartPLS software. They indicate that the independent variables network coverage, customer service, video calls, and downloading speed are key driving factors of customer satisfaction. Among all independent variables “Internet downloading speed” highly impacts the dependent variable “customer satisfaction” based on 3G and 4G network performance. There are a limited number of studies that focus on customer satisfaction in the telecommunication sector in Pakistan. The study will fill the gap in the literature and help service providers to increase the satisfaction level of their customers and captivate new customers