Pediatric Education and Research

 Acute diarrhoeal diseases are among the leading causes of mortality in infants and young children in many developing countries. In most cases, death is caused by dehydration. Dehydration from diarrhoea can be prevented by giving extra fluids at home, or it can be treated simply, effectively, and cheaply in all age-groups and in all but the most severe cases by giving patients by mouth an adequate glucose-electrolyte solution called Oral Rehydration Salts (ORS) solution. Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent or treat dehydration especially that due to diarrhea. It involves drinking water with modest amounts of sugar and salt added (an oral rehydration solution or ORS) while continuing to eat. Routine therapy also includes supplemental zinc. Caretakers are taught the signs of dehydration and/or worsening dehydration. The World Health Organization specify indications, preparations and procedures for ORT.

 Background : Neglected and residual clubfoot deformities in older children is a difficult surgical problem as the foot in these patients is stiff with some amount of pain and almost always had already undergone some surgical intervention. Basic aim of foot surgeries in such cases is to achieve painless functional plantigrade foot. In this study, a percutaneous dorsolateral closing wedge midfoot osteotomy with correction of angulation and translation deformity was done fixed with k-wires or ilizarov frame. Additional procedures like plantar fascia release and Achilles lengthening procedures were done for associated deformities as required. The aim of this study is to evaluate outcome of the proposed surgical procedure in correction of complex clubfoot deformities. Methods: Our centre is a tertiary care orthopaedic hospital. A total of 25 patients [32 feet] were included in this retrospective study done from august 2009 to august 2014. Patient aged 5-12 years were selected for the surgical procedure. All the patients were followed up at least up to 18 months after surgery. Both preoperative and postoperative evaluation of patients done clinically, with help of dimeglio score, and radiologically. Results: Follow up period ranged from 18-30 months. Clinical and radiographic improvement was achieved in all the patients. Dimeglio score improved from 10.63 to 2.93 which denotes good result. All radiographic angles showed correction to near normal values. All the patient showed pain relief and optimal function at 18 month follow-up. Complications in form of pin tract infection, under correction and skin problems were noted in three, three and five patients respectively. Conclusion: A percutaneous dorsolateral closing wedge osteotomy in combination with plantar fascia release and Achilles tenotomy is a good alternative procedure for neglected and recurrent clubfoot deformities with minimal complications. This is a joint sparing surgical technique which preserves ankle and foot flexibility.

 Background: Adolescent period is the critical period of growth and development. Undernutrition during adolescence can impair growth and development and result in long term health consequence. Aims: To study the nutritional status of early adolescents its association with sexual dimorphism. Methods: This cross-sectional community based study has conducted among 355 adolescent (189 boys; 166 girls) aged 11-14 years of the rural areas of Paschim Medinipur district, West Bengal, India. Anthropometric measurements including height, weight, midupper arm circumference were taken following standard technique. Body mass index (BMI) was calculated to determine the nutritional status using international BMI cut-off point for children and adolescence from 2 to 18 years of age. Statistical package SPSS  is employed for one way ANOVA and Student- ‘t’ test of the data. Results: The mean BMI for girls (16.71±3.02 kg/m2) were higher than boys (15.97±2.26 kg/m2) with t=2.631 (P=0.009). There is a significant age difference (P<0.001) existed for weight, height and MUAC. The prevalence of thinness and overweight was 51.83% and 4.51% respectively. The prevalence of thinness was grater among the boys (52.91%) than the girls (50.60%). Conclusion: The present study indicates high prevalence of thinness among adolescent in the area of study. A comprehensive strategy should be implemented in disadvantaged groups to prevent adolescent undernourishment.

 Summary: Nasal cavities foreign bodies are common accidents in children, sometimes leading, in accordance with the literature, to complications such as epistaxis and bronchoaspiration. Diagnosis is often made with anterior rhinoscopy, but  sometimes nasal fibroendoscopy and  imaging may be useful. Aim: To evaluate 420 cases of nasal  foreign bodies removed in ENT Service of Souza Aguiar  Hospital, Rio de Janeiro, as related to sex, age, type of foreign body and complications. Materials and Method: 420 cases of nasal foreign bodies removed in the ENT service of Souza guiar Hospital between December 1992 and December 1998 were evaluated according to the parameters related above. RESULTS: We found higher incidence between  0 and  4 years of age, and the most frequently found foreign bodies were foam fragments, plastic pieces of little toys, beans and paper  fragments. Complications occurred in 9.05% of the cases, epistaxis and vestibulitis being the commonest. Conclusion: Nasal foreign bodies are especially found between the ages of 0 and 4 years. In our study, foam  fragments and small plastic objects were the most frequent foreign bodies found. Complications were found in 9.05% of the cases, headed by epistaxis and nasal vestibulitis.

 Serum electrolyte  abnormalities are quite common in children who need intensive care.  They have a significant contribution to morbidity and mortality.  Electrolyte imbalance occurs frequently and should be looked for in all severely  ill patients. Hyponatremia is of euvolemic type in almost all acute infection except in Diarrhea which can go undiagnosed clinically, presence of hyponatremia significantly  increase the morbidity and mortality.   Early detection and institution of rational therapy for hyponatremia should be done  regardless of underlying disease. Careful correction of sodium level is warrented to avoid fatal neurological sequalae.        In the presence of mixed electrolyte abnormalities, the  risk is even higher. In general, CNS  diseases, respiratory diseases and infectious diseases are more commonly associated with  serum electrolyte abnormalities.  SIADH quite commonly occurs in euvolemic hyponatremia,  in respiratory and CVS disorders.  There are no reliable clinical predictors of electrolyte abnormalities except in cases of  hyponatremia and hypokalemia; and the signs of electrolyte imbalances often merge with  those of the underlying diseases. In addition, electrolyte abnormalities  occur commonly in an  ICU setting.  In view of  these  facts, a routine estimation of serum electrolytes should be  considered in all patients getting admitted to PICU. Thus this study brings out the salient aspects of sodium and potassium abnormalities in severely ill, and  focuses on the importance  and need to recognize the  abnormalities  and acts as good predictor of  morbidity and mortality in PICU.

 Objective: To analyze the spectrum of varied presentation and management of different foreign bodies in Ear presenting in tertiary centre of Ahmednagar district, Maharashtra. Methods: A cross sectional hospital based study was carried in tertiary center of a medical college, Department Of ENT over a period of 2 year. A data form was completed by the otolaryngology resident removing the foreign body. Results: Total of 330 patients were registered. The mean age of presentation was 7 years with max age 18 years and min of 1.5 years. This study comprises 149 (48.4%) males and 151(51.6%) females showing slight female preponderance. 143(43.3%) patients had foreign bodies in right ear, 180(54.5%) in left ear and 7(2.1%) in both ears. Most common foreign body seen was insect. Conclusion: Ear foreign bodies a simple and common ENT emergency may become complicated and so needs to be removed using standard methods which should be carried out by specialist.