Congenital lobar emphysema.

Congenital lobar emphysema is a rare variety of congenital malformation of lung characterized by over distension of a lobe of the lung due to partial obstruction of the bronchus. It is one of the rare causes of infantile respiratory distress requiring surgical resection of affected lobe. We are reporting the case of an 8-week-old baby who presented with respiratory distress related to CLE affecting the left upper lobe. Lobectomy was performed under general anaesthesia followed by an uneventful recovery.

Vitamin D levels in children with growing pains.

OBJECTIVE: To estimate the serum levels of vitamin D in children with growing pains and determine the relationship between serum vitamin D levels, parathormone and routine biochemical markers. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Paediatrics, Liaquat National Hospital, Karachi, from October 2008 to September 2009. METHODOLOGY: Hundred children, aged 5-12 years presenting in Paediatric Outpatient Department of Liaquat National Hospital, Karachi, with limb pains, fulfilling the diagnostic criteria of growing pains, were included. Children with any systemic illness, organic cause of pain, rheumatologic disorders and signs of rickets were excluded from the study. Children were investigated for serum total calcium, inorganic phosphorus, alkaline phosphatase, vitamin D3 (25-hydroxecholecalciferol) and parathormone levels. On the basis of serum vitamin D3 level, patients were divided into 3 groups; group 1 with normal level of vitamin D3 (> 75 nmol/L), group 2 with vitamin D insufficiency (level between 50-75 nmol/L), and group 3 with vitamin D deficiency (level < 50 nmol/L). Significance of group proportions was determined using chi-square test with significance at p < 0.05. RESULTS: The mean age of the participants was 8.05 years with the majority (59%) being females. Only 6% had normal vitamin D levels. Over 95% of the children with vitamin D insufficiency had normal alkaline phosphatase and parathormone levels. CONCLUSION: Hypovitaminosis D may have a role in pathogenesis of growing pains. All children with unexplained limb pains without identifiable organic pathology should be tested for vitamin D status, and treated, if necessary. Routine biochemical markers alone are not sufficient to detect all cases of hypovitaminosis D.

Moya Moya disease in a child.

The case report describes Moya Moya disease in a 5-year-old child who presented with seizures and signs of bilateral upper motor neuron lesion. Diagnostic workup revealed a primary cerebral vascular pathology, which was confirmed by cerebral angiography.

Effect of weaning period on nutritional status of children.

OBJECTIVE: To determine the effect of age of introduction and the type of weaning foods used, on the nutritional status of children under three years of age. DESIGN: Cross-sectional, community-based study. PLACE AND DURATION OF STUDY: The study was conducted in rural areas of District Malir in Karachi, Pakistan, comprising of 900 villages spread over 1200 square kilometer, from November 2000 to April 2001. PATIENTS AND METHODS: Three hundred and fifty-nine children under 3 years were included in the study. Based on the age of commencement of weaning, the children were categorized as children weaned at appropriate and inappropriate age. For the type of weaning foods, the children were grouped into two categories based on the nature of food items. RESULTS: Children for whom weaning was started at the recommended age of 4-6 months were found to be significantly less malnourished on anthropometric measurements as compared to the other set in which weaning was started at an earlier or later age. Significant statistical difference was noted in the children weaned on nutritious home-made items compared to children having commercial foods. CONCLUSION: Malnutrition is of multi-faceted origin beyond only poverty and food shortage. Inappropriate feeding practices can result in growth faltering as noted in the present study. Programmes should be launched for education of mothers regarding weaning practices.

Management of acute asthma in children using metered dose inhaler and small volume nebulizer.

OBJECTIVE: To determine whether the administration of beta2-agonist by Metered Dose inhaler (MDI) with accessory device (AD) is a as effective as the administration of beta2-agonist by small volume nebulizers (SVN) for the treatment of acute asthma. METHODS: A cross sectional study was conducted at Emergency Room (ER) of National Institute of Child Health (NICH), Karachi, between October 2000 to March 2001. This study included 150 children, 6 months and older with a history of wheeze and presenting with an acute asthma exacerbation. Children were categorized into mild, moderate and severe asthma according to medical scoring system. Children were assigned randomly into group A and B to receive standard dose of beta2-agonist (salbutamol) by MDI/AD (group A) or SVN (group B). Baseline characteristics and asthma severity were recorded. All variables (dyspnoea, use of accessory muscles, cyanosis, respiratory rate, heart rate, blood pressure, oxygen saturation, pulsus paradoxus, and wheeze) and Peak Expiratory Flow Rate (PEFR) in children 5 years and older, were determined at pre and post inhalation therapy. RESULTS: Both groups did not differ in demographic characteristics. There were no significant differences in outcome measures. In children treated with MDI/ADs and SVNs. PEFR increased significantly in both the groups after completion of treatment, but PEFR was not statistically significant when compared in between groups. CONCLUSION: The data suggested that MDI/AD is an effective alternative to nebulizer for the treatment of children with acute asthma exacerbation in the ER.

Determinants of bottle use amongst economically disadvantaged mothers.

BACKGROUND: There is documented evidence of increased risk of infant mortality in formula fed infants versus breast fed babies. The hazards of bottle use for infant feeding, especially in underprivileged communities, are also well known. As the issue of bottle use is directly related to childhood survival and mortality, there is legislation against propagation of bottle-feeding in Pakistan. OBJECTIVES: To obtain information about determinants of bottle use for infant feeding in a low-income periurban community. DESIGN: Community based cross-sectional study. RESULTS: 150 mothers with infants up to one year of age were included in the study period from October 03 to March 04. Out of these 102 mothers were found using bottle for infant with or without breast-feeding. The tendency to use the bottle increased in relation to child's increasing age. Only 17% of the infants under the age of 3 months were offered bottle, it was 69% between 4 to 6 months and it increased to 76% in infants from 7 months to 1 year. The attributes associated with increased bottle use were mother's older age, illiteracy and increased parity. CONCLUSION: Bottle use is a public health issue in poor and illiterate mothers of developing countries. While, in Pakistan, laws are enacted against its propagation, we need community-based strategies to bring about a socio-cultural shift in the growing prevalence of bottle use found in the study.

Weaning practices in peri-urban low socioeconomic groups.

OBJECTIVE: To assess the current weaning practices in infants (children under one year of age) in a low socioeconomic peri-urban area in Karachi. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: 'Well Baby Clinic" in Jinnah Medical College Hospital situated in Korangi Industrial area of Karachi from October 2003 to March 2004. PATIENTS AND METHODS: One hundred and fifty infants were included in the study. Their feeding pattern and weaning practices were studied using a questionnaire. They were grouped in three categories according to their age of commencement of weaning. RESULTS: Ninety (60%) infants were receiving semi-solids/solids (weaning foods) in addition to milk. The recommended age (between 4 to 6 months) was noted in 37 (25%) cases, while early weaning was present in 9 (6%) cases and delayed weaning in 44 (29 %) cases. Even if weaning was started at the correct age, several problems were noted. These included infrequent feeding, use of expensive commercial cereals given in diluted form as compared to home-made foods, and improper food preparation. The quality, type and choice of food was not ideal for adequate growth. CONCLUSION: Incorrect weaning practices is an issue of public health in developing countries. The identification and analysis of weaning practices prevalent in low socioeconomic households can lead to remedial strategies for improving the nutrition status of infants and, thereby, help reduce infant and morbidity rate.