Journal of tropical pediatrics
-
Comparative Study Historical Article
Late presentation of tracheobronchial foreign body aspiration in children.
The diagnosis of tracheobronchial foreign body (FB) aspiration in children is often delayed or overlooked. The aim of this study is to examine the causes of delay (>1 month) in the diagnosis and to study the complications of late presentation and their management. During the period between July 1993 and August 2002, 128 patients with suspected FB aspiration were admitted to KKUH, Riyadh, Saudi Arabia. ⋯ Follow-up ranged from 6 to 48 months. Diagnostic delay of tracheobronchial FB aspiration has significant morbidity in children. A high index of suspicion and early referral are essential in preventing such complications.
-
Case Reports
Paradoxical appearance of intracranial tuberculoma in a child with tuberculous meningitis.
Intracranial tuberculomas are known to develop during treatment of tuberculous meningitis (TBM). However, they usually develop within weeks or a couple of months after the start of antituberculous therapy (ATT). We present a case of an 18-month-old boy who developed tuberculomas after 9 months of ATT, which subsequently responded to the reintroduction of steroids. Thus, one must keep a watch for neurological deterioration in a child of TBM and if it is due to tuberculomas, one may have to continue steroids and ATT for a long time.
-
Malnutrition is the fourth commonest reason for hospital admission to the paediatric department of the Central Hospital, Maputo and has the second highest death rate (20 per cent). A study from 1995 into mortality at this paediatric department, suggested an increase in severe malnutrition. Recent studies have shown that the global burden of undernutrition in the world is declining; however, data for Eastern Africa shows a deterioration. ⋯ Clinical malnutrition at a referral hospital level, in spite of the remarkable Mozambican economic growth, shows signs of following the depressing pattern for much of Eastern Africa. A prospective study including HIV tests and anthropometric data for this and the city's other hospitals is warranted. Discussion needs to be prompted on a local level about malnutrition and the use of guidelines.
-
Mustard oil massage of newborns is an integral component of traditional care practices in many communities. Recent evidence suggests that this practice may have detrimental effects, particularly for preterm infants or for those whose skin barrier function is otherwise sub-optimal. Other natural oils such as sunflower, sesame or safflower seed oil may have a beneficial impact on newborn health and survival. ⋯ Focus group discussion participants noted that smell, oiliness, mode of pre-massage preparation, and perceived absorptive potential on the skin are important contextual factors involved in the practice. Caretakers are willing to consider adaptation of established traditions for the promotion of positive health outcomes if essential contextual criteria are met. An understanding of cultural, social, and economic factors that shape the context of traditional healthcare practices is essential to the design and implementation of intervention trials examining the relative efficacy of application of oils in reducing neonatal mortality and morbidity.
-
Randomized Controlled Trial Clinical Trial
A randomized open label clinical trial to compare the efficacy and safety of intravenous quinine followed by oral malarone vs. intravenous quinine followed by oral quinine in the treatment of severe malaria.
The treatment of patients with severe malaria in sub-Saharan Africa has become a challenge to clinicians due to poor compliance to quinine and the increasing multidrug resistance to antimalarials by the P. falciparum parasite. The aim of this study was to compare the efficacy and safety profile of two truncated antimalarial regimens of intravenous quinine followed by oral Malarone (Malarone arm) with intravenous quinine followed by oral quinine (quinine arm) in the treatment of severe P. falciparum malaria. The outcome measures were parasite clearance time, fever clearance time, efficacy, and adverse events profile. ⋯ The mean parasite clearance time was 120 h and 108 h for the quinine and Malarone arms of the study, respectively, and the mean fever clearance times were 84 h and 72 h for the quinine and Malarone arms, respectively (p=0.1). Truncated therapeutic regimen using malarone after intravenous quinine is safer and as effective as conventional intravenous quinine followed by oral quinine in the treatment of severe malaria. The P. falciparum recrudescence rate was lower with the use of Malarone than for quinine.