Northern International Medical College Journal

Telemedicine - the virtual healthcare

2023-08-21T04:11:16+00:00

Abstract not available

Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 523-525

COVID-19 In Children

2023-08-21T04:11:23+00:00

Diagnosis of SARS-CoV-2 infection is based on detection of viral RNA by RT-PCR of nasopharyngeal or oropharyngeal swabs. Consider alternative diagnoses in children who are unwell, even in the presence of a positive SARS-CoV-2 PCR result. Children with mild to moderate Covid19 do not routinely need admission or investigations such as blood tests and radiology, unless otherwise clinically indicated. Children with severe or critical disease as a minimum should have the following investigations: Blood cultures, Full Blood Count (FBC), Coagulation profile, D-dimer, Urea and Electrolytes, LFT, CRP, Troponin, Ferritin, Lactate dehydrogenase (LDH) and Blood Gas Analysis. Remdesivir may be considered for children > 12 years and >40kg with COVID-19 requiring supplemental oxygen. Consider chest x-ray in children who do not follow the expected clinical course, for example, those still requiring oxygen on day three of admission, those with worsening hypoxemia or those requiring respiratory support. Decision to escalate respiratory support to Non-Invasive Ventilation (NIV) should be made by a senior member of the pediatric team, in discussion with critical care. For children with clinical findings consistent with the Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS) should be managed as per specialized guidelines.

Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 548-554

Variable presentation of Covid 19 infection

2023-08-21T04:11:24+00:00

Abstract not available

Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 555-557

Presenting clinical features of COVID-19 in neonatal age group

2023-08-21T04:11:16+00:00

Background : In December, 2019 a cluster of pneumonia cases spread in Wuhan City, Hubei Province, China caused by a novel corona virus (named as “2019-nCoV”). Although it is thought to be a disease of adult but it can occur in children and neonates also.

Objective : The aim of this study was to see the incidence of Neonatal COVID-19 and its mode of presentation in neonatal age group.

Methods : This cross sectional study was done in Dhaka Shishu (Children) Hospital from April, 2020 to October, 2020. All suspected neonates for COVID-19, RT PCR were done from nasopharyngeal swab. Suspecting sign were fever, respiratory difficulty, reluctant to feed, neonate not responding to conventional treatment, or referred from endemic area or having any household contact. Routinely RT PCR was done preoperatively who needed surgery. Then all the data were collected and analyzed using Statistical Package of Social Science (SPSS), version 26.

Results : Total 5521 neonates were admitted and 299 neonates were suspected for COVID-19 infection during this study periods and undergone RT PCR, out of which 47 cases were test positive. The incidence of COVID-19 cases was 0.85% among hospitalized neonates. Thirty one were male and 16 were female. Male female ratio was 1.9:1. Thirtythree cases admitted in medicine and 14 cases in surgery division. Twenty three (49%) cases presented symptoms after 7 days of age and 13(28%) cases got admitted within 3 days, among them 2 cases were admitted at 24 hours of age with symptoms. Respiratory difficulty (25.5%), convulsion (19.1%), fever (17%) and reluctant to feed (17%) were common presenting symptoms. The associated diagnosis with COVI-19 cases were mostly perinatal asphyxia, septicemia and pneumonia. Regarding chest X-ray, one neonate had patchy opacities in right lower lobe, another had bilateral ground-glass opacity and in case of third one few patchy opacities was found in the right perihilar region. Out of 47 positive cases 23 patients could discharge after improvement, 14 patients referred to COVID specialized hospital, 2 cases went as LAMA (Leave against medical advice) and 8 patients died at our hospital.

Conclusion : In this Study the incidence of COVID-19 in newborn was 0.85% among hospitalized newborn. The common clinical features were respiratory difficulty, convulsion, fever and reluctant to feed. It could not be differentiated whether these clinical features were due to COVID-19 or associated diseases.

Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 526-529

Breast feeding Status of Infants Born in a Baby Friendly Hospital Up to 180 days of life

2023-08-21T04:11:17+00:00

Background : Initiation of breast-feeding (BF) within 1 hour after birth has been associated with reduced neonatal mortality. Baby Friendly Hospital Initiative has profound effects on appropriate practice of BF and thus helps to reduce infant mortality and morbidity.

Objective : This study was conducted in the Department of Gynae and Obstetrics and Department of Paediatrics of Shaheed Suhrawardy Medical College Hospital (ShMCH), Dhaka, to observe the rate of exclusive breast feeding and home-based compliance.

Methodology : Hundred (100) term babies of normal birth weight irrespective of sex, born in ShSMCH by normal vaginal delivery (NVD) or caesarian section were included. Data was collected from the mother with a pretested questionnaire at the postnatal period, at 6th week, 14th week and 6th month (180 days) of age.

Result : The mean age of studied newborn (100) was 20±19.5 hours. All the infants started breast feeding after birth and among them 56% initiated with in 1 hour. Difficulty in breast feeding was found in 36(36.0%) infants, which was resolved mostly (94%) by nurse. Exclusive breastfeeding (EBF) was found in 100% of infants during discharge from hospital. During 1st and 2nd follow up we found 95 (95.0%) and 89 (89.0%) infants respectively were exclusively breastfed. In 3rd follow up at completed 6th month (180 days) 78 (78.0%) infants were exclusively breast fed. In our study 5 (5%) and 6 (6%) infants received supplementary food in 1st follow up and in 2nd follow up respectively. In the last follow up the number were 11 (11%) and the total number was 22 (22%).

Conclusion : Exclusive breast feeding up to completion of 6 months (180 days) was found in 78.0% of infants. Maternal and relative’s misperception of baby’s crying due to insufficient breast milk and joining to job outside home were the causes of introduction of formula milk in the 1st, 2nd and 3rd visit respectively.

Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 530-534

The Role of Zinc in Acute Bronchiolitis in children less than 2 years old

2023-08-21T04:11:18+00:00

Background: Bronchiolitis is an acute respiratory illness which is the leading cause of respiratory distress in infancy and early childhood with its greatest morbidity in infants. Although zinc supplementation is effective in both preventing and treating pneumonia but its role in acute bronchiolitis has rarely been examined.

Objective: To assess the effect of zinc sulfate to improve the clinical manifestations of acute bronchiolitis (Severe cases) in children less than 2 years of age.

Materials and Methods: This was a double blind randomized clinical trial on 70 patients aged 2 to 23 months admitted in the Pediatric ward of Khwaja Yunus Ali Medical College and Hospital from September 2019 to September 2020 with the diagnosis of acute bronchiolitis. Patients were randomly divided equally into 2 groups: a case group was assigned oral zinc sulfate and the control group received placebo.

Results: Mean age of case group was 174.63±98.7 days and control group 176.86±97.43 days ( p=0.924) with male predominance in both groups. Symptoms and signs of acute bronchiolitis (Severe cases) were compared between the 2 groups during admission and then at 24, 48 and 72 hours after initiation of treatment. No statistically significant differences were observed between the 2 groups in improvement of symptoms and signs including fever, fast breathing, chest indrawing and wheezing on 48 and 72 hours after treatment with zinc sulfate ( p>0.05). The duration of hospitalization was 4.2±2.6 days in the case group and 4.4±2.2 days in the control group and this difference was not significant.

Conclusion: The present study showed that zinc sulfate has no benefit in improving the clinical manifestations of acute bronchiolitis.

Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 535-538

Risk factors of persistent diarrhea in children below 5 years of age

2023-08-21T04:11:20+00:00

Background: Persistent diarrhea is a known cause of mortality, morbidity, and malnutrition in developing countries. With recent improvement of rehydration therapy death due to acute diarrhea has been reduced. Though persistent diarrhea accounts for 2-20% of total diarrhea cases, it accounts for 23-62% of all diarrhea related deaths. Objective: The study was done to identify the risk factors associated with persistent diarrhea in children below 5 years of age.

Methods: This prospective observational study was conducted in the department of Pediatric Gastroenterology, Hepatology and Nutrition of Dhaka Shishu hospital from July 2019 to June 2020. It included 50 children with persistent diarrhea age between 1 month to <5 years. Detailed history, examination and appropriate investigations were done for all children. Crude odd ratio was calculated for each risk factor by univariate analysis and adjusted odds ratio was calculated by multivariate logistic regression.

Results: Most of the children (52%) were under the age of 6 months to 1 year. Male (84%) were more affected than female (16%). Acute malnutrition was observed in 44% cases; among them severe acute malnutrition was in 40% cases. Unsafe drinking water, severe acute malnutrition, diarrhea within past 2 months, bottle feeding, persistent of dehydration more than 24 hours, feeding of cow’s milk, lack of exclusive breast feeding, prior antibiotic used, UTI, LRTI were statistically significant risk factors by univariate analysis. Unsafe drinking water (OR-1.6; 95% CI- 0.27- 2.78), severe acute malnutrition (OR-1.92; 95% CI-0.64 - 5.72), Feeding of cow’s milk (OR-3.90; 95% CI- 1.21- 12.49), lack of exclusive breastfeeding (OR-5.77; 95% CI- 1.44- 23.10), irrational use of antibiotics (OR-3.37; 95% CI- 1.01- 11.38), LRTI (OR-1.16; 95% CI- 0.49- 1.53) were found to be independent risk factors by multivariate logistic regression analysis.

Conclusions: The results of this study concluded that use of unsafe drinking water, severe acute malnutrition, feeding of cow’s milk, lack of exclusive breastfeeding, irrational use of antibiotics are significant risk factors for the incidence of diarrhea in the present study population.

Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 539-543

Clinical Spectrum of Major Infection in Hospitalized Children with Nephrotic Syndrome at a Tertiary Care Hospital

2023-08-21T04:11:22+00:00

Background : Children with Nephrotic Syndrome (NS) are exposed to multiple infections resulting in significant morbidity and mortality. Besides being a common cause of mortality, infections may also be responsible for a poor response to steroid therapy or induce relapse in a child with Nephrotic Syndrome.

Aims: To assess the clinical spectrum of major infection in hospitalized children with Nephrotic Syndrome.

Materials and Methods: This hospital based cross-sectional study was done in the Department of Paediatrics, Sylhet M A G Osmani Medical College Hospital, Sylhet, Bangladesh. In this study, sample size was 44 diagnosed cases of Nephrotic Syndrome with infection. After taking consent, detailed history and thorough physical examination were done in each patient. All data were collected in a preformed questioner and finally collected data were expressed in tabulated form.

Results: In our study total 44 children with Nephrotic Syndrome were enrolled with the mean age of 5.98 ± 2.93 years and most of the childhood Nephrotic Syndrome was aged between 2 to 8 years (75.0%); 23 (52.3%) patients were male, and 21 (47.7%) patients were female with a ratio of male to female of 1.1:1. The common clinical symptoms of major infection were fever (79.5%) and cough (70.5%). Other clinical presentations were throat pain (18.2%), abdominal pain (15.9%), runny nose (11.4%), burning micturition (9.1%), respiratory distress (6.8%), vomiting (4.5%) and leg pain (4.5%). Relapse of Nephrotic Syndrome was found in 33 (75.0%) cases. The most common major infection was pneumonia (50.0%), followed by urinary tract infection (20.5%), Upper respiratory tract infection (15.9%), pneumonia with UTI (6.8%), cellulitis (4.5%) and pneumonia with UTI with spontaneous bacterial peritonitis (2.3%). The most common isolated organisms in urine were Escherichia coli (27.3%), followed by Klebsiella pneumoniae (2.3%).

Conclusion: The common symptoms of major infection in Nephrotic Syndrome are fever and cough. The most common major infection was pneumonia and urinary tract infection.

Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 544-547