Gauri Shankar Shah

Role of zinc in severe pneumonia: a randomized double bind placebo controlled study

BackgroundPneumonia is a leading cause of morbidity and mortality in children.ObjectiveThe aim of study was to evaluate the efficacy of Zinc supplementation in treatment of severe pneumonia in hospitalized children.Design/MethodsA double blind randomized, placebo- controlled clinical trial conducted at a tertiary care centre of a teaching hospital. Children with diagnosis of severe pneumonia were randomly assigned to receive supplementation with either elemental zinc or placebo by mouth at the time of enrollment. From day 2, they received 10 mg of their assigned treatment by mouth twice a day for 7 days along with standard antimicrobial therapy.ResultsThe baseline characteristics like age, sex, weight, weight Z score, height, height Z score, weight for height Z score and hemoglobin were comparable in both study groups. The respiratory rate, chest indrawing, cyanosis, stridor, nasal flaring, wheeze and fever in both groups recorded at enrollment and parameters did not differ significantly between the two groups. The outcome measures like time taken for resolution of severe pneumonia, pneumonia, duration of hospital stay, nil per oral, intravenous fluid, oxygen use, treatment requiring 2nd line of drug and 3rd line drug were evaluated and found to be same.ConclusionThe present study did not show a statistically significant reduction in duration of severe pneumonia, or reduction in hospital stay for children given daily zinc supplementation along with standard antimicrobial therapy. Therefore, zinc supplementation given during the acute episode does not help in short term clinical recovery from severe pneumonia.

Subclinical Hypothyroidism and Elevated Thyroglobulin in Infants with Chronic Excess Iodine Intake

BACKGROUND Acute iodine excess in newborns can cause hypothyroidism, but there are limited data on the effects of iodine excess on thyroid function in older infants. The aim of this study was to measure the effects of chronic excess iodine intake on thyroid function in 6-24-month-old infants. METHODS In this cross-sectional study, infants (n=696) in eastern Nepal were studied. Spot urine samples, venous blood samples, and household salt samples were collected, and urinary iodine concentration (UIC), serum free thyroxine (fT4), thyrotropin (TSH), thyroglobulin (Tg), and titrated household salt iodine concentration (SIC) were measured. Daily iodine intake was calculated from UIC based on estimates of urine volume at this age. RESULTS Median (25th-75th percentile) household SIC was 89 (70-149) ppm, while national legislation stipulates a fortification level of 50 ppm. Median UIC was 407 (312-491) μg/L; 76% of infants had a UIC >300 μg/L, suggesting iodine excess. Calculated mean iodine intake in 12-24-month-old infants was 220 μg/day, exceeding the recommended safe upper limit for iodine at this age (200 μg/day). Among the infants, 15.8% had an elevated Tg, 7.4% had subclinical hypothyroidism, but <1% had overt hypothyroidism. UIC was not a significant predictor of thyroid function, thyroid hormones, or Tg. CONCLUSION In 6-24-month-old infants exposed to excessive iodine intake, ∼7% have subclinical hypothyroidism but <1% have overt hypothyroidism. These findings suggest the thyroid in late infancy is already able to adapt to high iodine intakes and, in most cases, maintain euthyroidism.

Electrocardiographic and enzymatic correlations with outcome in neonates with hypoxic-ischemic encephalopathy

BackgroundPerinatal asphyxia leading to hypoxic-ischemic encephalopathy (HIE) is a common problem causing multi organ dysfunction including myocardial involvement which can affect the outcome.ObjectiveTo evaluate the myocardial dysfunction in neonates having HIE by electrocardiographic(ECG) and cardiac enzymes (CK Total, CK-MB and Troponin I) and find out the relationship with HIE and outcome.Design/MethodsThis was a hospital based prospective study. Sixty term neonates who had suffered perinatal asphyxia and developed HIE were enrolled. Myocardial involvement was assessed by clinical, ECG, and CK Total, CK-MB and Troponin I measurements.ResultsOf 60 cases, 13(21.7%) were in mild, 27(45%) in moderate and 20(33.3%) belonged to severe,HIE. ECG was abnormal in 46 (76.7%); of these 19 (41.3%) had grade I, 13 (28.2%) grades II and III each and 1 (2.1%) with grade IV changes. Serum levels of CK Total, CK- MB and Troponin I were raised in 54 (90%), 52 (86.6%) and 48 (80%) neonates, respectively. ECG changes and enzymatic levels showed increasing abnormalities with severity of HIE, and the differences among different grades were significant (p = 0.002, 0.02, <0.001 and 0.004, respectively). Nineteen (32%) cases died during hospital stay. The non- survivors had high proportion of abnormal ECG (p = 0.024), raised levels of CK-MB (p = 0.018) and Troponin I (p = 0.008) in comparison to survivors.ConclusionsAbnormal ECG and cardiac enzymes levels are found in HIE and can lead to poor outcome due to myocardial damage Early detection can help in better management and survival of these neonates.

Pattern of renal diseases in children: A developing country experience

Spectrum of renal disease varies in different ethnic population, geographical location, and by environmental factors. The purpose of this study was to find out the clinical spectrum and occurrence of different pediatric renal diseases at a teaching hospital in the Eastern part of Nepal. All cases of renal diseases from one month to 15 years of age, attending the pediatric renal outpatient department and/or were admitted to the wards during the period of February 2012 to January 2013, were included in the study. Detailed clinical and laboratory evaluations were performed on all patients. Diseases were categorized as per standard definitions and managed with hospital protocols. Renal diseases accounted to be 206 cases (6.9%) of total annual pediatric admissions, of which (58%) were male and (42%) female. Acute glomerulonephritis (AGN) was the most common disorder (37.7%) followed by nephrotic syndrome (26.1%), urinary tract infection (21.3%), acute kidney injury (AKI) (17.9%), obstructive uropathy (1.9%), chronic kidney disease (CKD) (1.2%), and others. In AGN group, the most common cause was post-infectious glomerulonephritis (PIGN) (32.9%) followed by lupus nephritis (4%) and Henoch-Schonlein purpura nephritis (0.8%). Urine culture was positive in (9.22%) and the most common organism was Escherichia coli (57.9%). The causes of AKI were urosepsis, septicemia, and AGN (18.9%) each, followed by dehydration (13.5%). Mortality was found in 5% of cases and the etiologies were AKI in (72.7%), PIGN (18.1%), and CKD (9%). Renal diseases are a significant problem among children and are one of the common causes of hospital admission. These patients need comprehensive services for early identification and management.

Admission patterns and outcome in a pediatric intensive care unit in Nepal.

Aims: To study the admission patterns and outcome of children in a Pediatric Intensive Care Unit (PICU) in Nepal. Methods: Demographic profile, diagnosis, treatment, supportive measures and outcome of children admitted to the PICU of B P Koirala Institute of Health Sciences from April 2011 to March 2012 were reviewed. Results: 230 children were admitted to the PICU with male to female ratio of 1.7:1. Diagnoses included respiratory diseases (n=76, 33%), central nervous system diseases (n=43, 18.6%), infectious diseases (n=26, 11.3%), surgical problems (n=18, 7.8%), gastrointestinal diseases (n=17, 7.4%), cardiovascular diseases (n=15, 6.5%), poisonings (n=11, 4.8%), renal (n=9, 3.9%), hematological (n=3, 1.3%) and others (n=12, 5.4%). Out of 230 admitted children, 29 (12.6%) died, 19 (8.2%) left against medical advice and 5 (2%) were referred to other centers. Forty-one (17.8%) children received mechanical ventilation, among which 23 (56%) improved, 14 (34.1%) died and 4 (9.7%) children were taken away by caretakers against medical advice. Conclusion: Respiratory, central nervous system and infectious disease were the

Sturge Weber Syndrome with Bilateral Port-Wine Nevus

Sturge-Weber syndrome is a rare neurocutaneous syndrome characterized by port -wine stain, seizures and intracranial calcifications.The present case had bilateral port-wine nevus, generalised tonic-clonic seizures and right sided intracranial calcifications involving right temporo-parieto-occipital lobe regions with prominent choroid plexus.

Idiopathic Pulmonary Hemosiderosis: A Case Report with Review of Related Literature

Pulmonary hemosiderosis is an uncommon disorder in pediatric population in developing countries. It may affect the lung in an isolated form of Idiopathic Pulmonary Hemosiderosis (IPH) or as a manifestation of systemic disorders. The present patient belonging to Mongolian race presented with history of fever, cough, respiratory distress and previous episode of hemoptysis. The child had anemia, negative tuberculin test and no acid-fast bacilli in sputum and presence of bilateral pulmonary infiltrates in X-ray chest. Sputum examination showed iron-laden macrophages and no secondary cause could be ascertained. The patient responded well to prednisolone treatment alone. Idiopathic pulmonary hemosiderosis can be diagnosed based on the clinical features and sputum examination. Lung biopsy and high resolution CT thorax may not be undertaken in setting where facilities are not available.

Clinical profile and outcome of neonates admitted to the Neonatal Intensive Care Unit (NICU) at BPKIHS: A need for advanced neonatal care

Background: One of the Millennium Development Goals is to reduce childhood mortality by two-thirds by 2015 (www.un.org/millenniumgoals). This study was conducted to identify the clinical profile and pattern of disease, and to find out the commonest cause of mortality and morbidity of neonatal ICU patients in a Nepali teaching hospital. Methods: A retrospective study was conducted at a grade IIIA NICU in the Neonatal Intensive Care Unit of a tertiary care teaching hospital in the eastern part of Nepal to identify the clinical profile, pattern of disease, and outcome of patients. The data of all neonates were analyzed retrospectively from January 2012 to December 2012. IRB approval was exempted. Results: A total of 361 neonates were admitted in NICU during the study period, 65.6% were male and 34.4% were female. Of these neonates, 86 (23.8%) were admitted with a diagnosis of prematurity and 73 (20.2%) were admitted with a diagnosis of birth asphyxia. One of the commonest causes for birth asphyxia is the meconium aspiration syndrome. Among the neonates with birth asphyxia, 40 (54.8%) were in hypoxic ischemic encephalopathy (HIE) III, 20 (27.4%) in HIE II, and 13 (17.8%) in HIE I. The common causes for admission in NICU were sepsis (n = 118, 32.6%), prematurity (n = 86, 23.8%), and birth asphyxia (n = 73, 20.2%). The overall mortality was 20.2%. Among the ventilated cases, the mortality was 36.1%. In the non-ventilated cases, it was 13.25%. If two-thirds of the cases requiring ventilation would have survived thanks to a different treatment approach, we could have reduced our overall mortality to 15.7%. Conclusions: The neonatal phase is a very vulnerable period with a high risk of mortality and morbidity, most of which are preventable with good obstetric and subsequent neonatal care1–2. Most of the NICU patients under mechanical ventilation may need advanced ventilation to reduce mortality further. There is a need for timely referral to a tertiary care hospital from peripheral and non-tertiary set-ups to prevent and control neonatal mortality and morbidity. The mortality rate can be reduced by giving advanced care such as extracorporeal membrane oxygenation (ECMO) to patients who fail to improve from conventional mechanical ventilation.3

Mechanical Ventilation in Neonates: Experience at a Tertiary Care Center in Eastern Nepal.

Aims: To study the diagnoses and survival of neonates receiving mechanical ventilation. Study Design: Prospective observational study.