Journal of tropical pediatrics
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To describe the perspectives of pediatricians from a tertiary care center from India on end-of-life (EOL) care issues, a standardized anonymous questionnaire was administered, which included questions regarding attitudes towards withdrawal/withholding of life-sustaining treatment in children and neonates at the EOL, and responses to an EOL case scenario. The questionnaire was administered to 40 pediatricians, of whom 31 (22 males, mean age 34.5 +/- 7.7 years) responded. ⋯ The most common modes of life-support limitation practiced were withholding new treatments (17/31; 54.8%) and 'do-not-resuscitate orders' (14/31; 45.2%). 51.6% respondents believed that withholding treatment and withdrawal of support were ethically the same. There is wide variation in responses and there were significant differences from findings of similar studies from the developed countries, the most important being the complete lack of use of withdrawal of support.
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Demographic and Health Surveys conducted quinquennially in 1996, 2001 and 2006 show that infant, child and under-five mortality in Nepal have declined steadily at least over the past 25 years. Estimates based on exponential-decline regression curves fitted to the 15-year data immediately preceding each survey, aggregated by 5-year period, show the infant, child and under-five mortality rates for the period 1986-1990 to be 106, 58 and 158 per 1000 live births and 52, 17 and 67 per 1000 live births for 2001-2005, respectively. The projected rates, assuming that the policy and program efforts are sustained, for the period 2011-2015 are 32, 7 and 38 per 1000 live births. Nepal is most likely to achieve the Millennium Development Goals (MDG) target of a two-thirds reduction in child mortality by 2015, the end of the MDG countdown.
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Randomized Controlled Trial
Use of probiotics in HIV-infected children: a randomized double-blind controlled study.
HIV/AIDS is an infection characterized by immune cell dysfunction and subsequent immunodeficiency, as well as intestinal disorder. Probiotics are live microbial feed supplements that beneficially affect the host animal by improving intestinal microbial balance and promoting health benefits. The goals of this study were to determine whether the use of probiotics could improve the immune response determined by CD4 cells mm(-3) counts and reduce liquid stool episodes. ⋯ A similar reduction in liquid stool consistency in both the groups (p < 0.06), with a slight enhancement in the probiotics group, was observed, but without significant difference (p < 0.522). The incidence of loose-soft stools showed a small decrease in both groups (p < 0.955) and there was an increase in the incidence of normal stool consistency in both the groups (p < 0.01). Our study showed that probiotics have immunostimulatory properties and might be helpful in the treatment of HIV-infected children.
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There is paucity of data about the predictive values and likelihood ratios of clinical signs of late onset nosocomial sepsis in neonates. A clinical score comprising of seven items had been derived from analysis of individual signs and had been published by this group in the Journal of Tropical Pediatrics in 2003. The current study was done to validate the score in a fresh validation cohort, to evaluate the score at 0 and 24 h after onset of clinical signs of sepsis and to evaluate the sepsis screen in combination with the clinical score. ⋯ The 24-h score had higher specificity (60.6%) but lower sensitivity than the 0-h score. Sepsis screen per se had a sensitivity and NPV of 48.3 and 78.3% but when combined with the 0-h clinical score, the sensitivity and NPV rose to 95 and 90.6%, respectively. The 'clinical score' in combination with sepsis screen result can be used by clinicians to rule out sepsis.
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The aim of this article is to determine the prevalence of celiac disease (CD), Helicobacter pylori (H. pylori) and gastroesophageal reflux (GER) in patients with resistant iron deficiency anemia (IDA). ⋯ CD was positive in 11 out of 25 patients (44%), H. pylori infection in 12 out of 25 patients (48%), while GER was diagnosed in 11 out of 25 patients (44%). Patients with CD had age of presentation < or =2 years in two patients (18.2%) while the remaining nine patients (81.8%) had age of presentation >2 years and it was statistically significant (p = 0.05*). Also patients with H. pylori had age of presentation < or =4 years in five patients (41.7%) and the remaining seven patients (81.8%) had age of presentation >4 years and it was statistically significant (p = 0.03*). Logistic regression analysis demonstrated that the risk factors for severity of anemia were age of patients and duration of anemia. On the other hand, other parameters have no significant influence on the severity of anemia. Also risk factors of short stature were age of presentation of anemia, degree of anemia and H. pylori infection. AGA had the highest sensitivity (100%) followed by antiendomysium antibody (81.8%) while the tTG antibody had the highest specificity (85.7%) for diagnosis of CD. UBT and histopathology had the highest sensitivity (100%) for diagnosis of H. pylori while rapid urease test, culture, H. pylori stool antigen and anti-H. pylori IgG antibody had the highest specificity (100%). In conclusion, refractory IDA may be due to clinically unapparent H. pylori gastritis and CD. CD is one of the most common causes of intestinal malabsorption during childhood which leads to impairment of iron absorption. Apart from offering them gluten-free diet rich in iron, early detection and treatment of IDA and prophylactic iron and folic acid supplementation will go a long way to optimize their mental and psychological functions. Eradication of H. pylori infection with concomitant iron therapy should correct the anemia.