Medical Specialties Commons^™

Prognostic Indicators Of Childhood Acute Viral Encephalitis, E Bhutto, M Naim, M Ehtesham, M Rehman, M A. Siddique, I Jehan

Community Health Sciences

Objective: To devise a set of clinical signs and laboratory parameters that would help clinicians assess prognosis in patients and plan appropriate management.Methods: Medical records of 147 paediatric cases (with a discharge diagnosis of acute viral encephalitis) admitted over a ten year period from 1987 to 1997 were reviewed and relevant information collected on a data extraction form.Results: Of 147 patients, 24 (16.3%) died and 48 (32.7%) were left with severe neurological deficits. A GCS (Glasgow Coma Scale) score between 6-10 had an association with poor outcome (OR = 2.62, Chi-square = 5.57, p-value = 0.018) and that a GCS …

Self-Reported Feeding Advice By Physicians For Common Childhood Illnesses, S Q. Nizami, Z A. Bhutta

Department of Paediatrics and Child Health

Background: A nutritious diet is important for recovery during illnesses. Dietary advice by physicians and consumption of food by the patients are often based upon their hot and cold concepts and beliefs about various foods rather than on scientific basis.
Objectives: To look at the food-advising behaviour of physicians during illnesses and to know the maternal concepts about various foods being hot or cold.
Methods: A questionnaire was served to the physicians participating in a continuous medical education session held at the Aga Khan University and Hospital, asking them to write the foods they advise or restrict during different illnesses …

Neurobehavioral And Neuromotor Long-Term Sequelae Of Prenatal Exposure To Cocaine And Other Drugs: An Unresolved Issue, Yvette Blanchard

All PTHMS Faculty Publications

When the cocaine epidemic began, predictions were made that the children of cocaine users would demonstrate devastating negative developmental sequelae. In infants and young children prenatally exposed to cocaine most frequently the neurobehavioral and neuromotor systems have been studied. Although clinically described as irritable, difficult to console, and jittery as infants, research findings have not been able to clearly describe a pattern of long-term developmental sequelae. The mechanisms of action of drug exposure on developmental outcome have shown to be more complex than originally suspected. Many factors, other than the drug use, can influence developmental outcome. In most studies of …

Insulin-Like Growth Factor Ii Signaling In Neoplastic Proliferation Is Blocked By Transgenic Expression Of The Metalloproteinase Inhibitor Timp-1, David C. Martin, John L. Fowlkes, Bojana Babic, Rama Khokha

Pediatrics Faculty Publications

Insulin-like growth factor (IGF) II is overexpressed in many human cancers and is reactivated by, and crucial for viral oncogene (SV40 T antigen, [TAg])-induced tumorigenesis in several tumor models. Using a double transgenic murine hepatic tumor model, we demonstrate that tissue inhibitor of metalloproteinase 1 (TIMP-1) blocks liver hyperplasia during tumor development, despite TAg-mediated reactivation of IGF-II. Because the activity of IGFs is controlled by IGF-binding proteins (IGFBPs), we investigated whether TIMP-1 overexpression altered the IGFBP status in the transgenic liver. Ligand blotting showed that IGFBP-3 protein levels were increased in TIMP-1-overexpressing double transgenic littermates, whereas IGFBP-3 mRNA levels were …

Dysphagia In Hereditary Sensory Autonomic Neuropathy Type Iv, U Shah, M Arshad, T Mozaffar

Department of Paediatrics and Child Health

No abstract provided.

Immunohistochemical Evaluation Of Small Round Cell Tumors Of Childhood, Sajid H. Shah, Irshad N. Soomro, M. Shahid Siddiqui, Shahid Pervez, Sheema H. Hassan

Department of Pathology and Laboratory Medicine

Objective:

This study was done to evaluate the pediatric undifferentiated small round cell tumors with immunohistochemical staining.

Setting:

The present study included consecutive cases of small round cell tumors which were diagnosed in children (<15 years) in the section of Histopathology at the Aga Khan University Hospital, Karachi during the period of two years.

Methods:

The group of undifferentiated small round cell tumors were evaluated immunohistochemically by using a panel of antibodies on sections from routinely processed, formalin fixed, paraffin embedded tissue blocks.

Results:

The category of undifferentiated small round cell tumors included rhabdomyosarcoma (23.2%), primitive neuroectodermal tumor (17.9%), non-Hodgkin’s lymphoma (16.1%), neuroblastoma (14.2%), Ewing’s sarcoma (10.7%) in order of frequency. Osteosarcoma (Small cell variant), retinoblastoma and medulloblastoma comprised …

Nebulized Nitroglycerin In Children With Pulmonary Hypertension Secondary To Congenital Heart Disease, Hatim Omar, Fangqi Gong, Mei Y. Sun, Stanley Einzig

Pediatrics Faculty Publications

Pulmonary hypertension continues to be a major cause of morbidity and mortality, despite new treatments. Since inhaled nitric oxide has been reported to be effective in some cases, we investigated using nebulized nitroglycerine to treat pulmonary hypertension in children with congenital heart disease. Four children (ages 6-72 months) with severe pulmonary hypertension secondary to congenital heart disease (all with membranous ventricular septal defect, undergoing cardiac catheterization) were given 3 cc of nebulized normal saline over 10 min as placebo control, followed by nebulized nitroglycerine (20 micrograms/Kg in 3 cc normal saline). Normal saline administration did not elicit any change, but …

Myelofibrosis In Severe Vitamin D Deficiency Rickets, Mehnaz Atiq, Zehra Fadoo, Fouzia Naz, Mohammad Khurshid

Department of Paediatrics and Child Health

Vitamin D deficiency is prevalent in infants and children in the underdeveloped countries¹. Infants with mild deficiency tend to present with complications like hypocalcemic seizures whereas occurrence of pathological features in advanced rickets is well elucidated². Secondary myeloflbrosis has been reported as a complication of severe rickets and in these children anemia, myeloid metaplasia and bone marrow aplasia strongly suggested myelofibrosis. Despite the high prevalence of rickets in the Indo-Pakistan subcontinent, there has been no report on this complication.We present a case of severe clinical rickets who had developed secondary myelofibrosis with hepatosplenomegaly. The purpose of …

The Efficacy Of A Developmental Follow-Up Program For High-Risk Infants, Laurie M. De Jong

Graduate Student Dissertations, Theses, Capstones, and Portfolios

Objective: To assess the efficacy of a developmental follow-up program provided at a local community hospital. Efficacy was measured by the number of children referred to early intervention services and the cost effectiveness of the program. Design: This is a retrospective study of 174 children evaluated during 272 visits in the Follow-up Clinic from the inception of the program on November 22, 1994 through December 31, 1998. The data collected included referral rates and demographic information on all children. Financial information was also obtained on 74 children seen during a one year period to assess the financial implications of the …

The Role Of Gap Junctions In Congenital Diseases Of The Heart, Scott Henry Britz-Cunningham

Loma Linda University Electronic Theses, Dissertations & Projects

Background. Gap junctions are thought to have a crucial role in the synchronized contraction of the heart and in embryonic development. Connexin43, the major protein of gap junctions in the heart, is targeted by several protein kinases that regulate myocardial cell-cell coupling. We hypothesized that mutations altering sites critical to this regulation would lead to functional or developmental abnormalities of the heart.

Methods. Connexin43 DNA from 25 normal subjects and 30 children with a variety of congenital heart diseases was amplified by the polymerase chain reaction and sequenced. Mutant DNA was expressed in cell culture and examined for its effect …

Dobutamine Stress Echocardiography For Assessing Coronary Artery Disease After Transplantation In Children., R L. Larsen, P M. Applegate, D A. Dyar, P A. Ribeiro, S D. Fritzsche, N F. Mulla, Girish S. Shirali, M A. Kuhn, R E. Chinnock, P M. Shah

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: The purpose of this study was to determine the feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography (DSE) for evaluating posttransplant coronary artery disease (TxCAD) in children, and to determine the frequency of selected cardiac events after normal or abnormal DSE.

BACKGROUND: Posttransplant coronary artery disease is the most common cause of graft loss (late death or retransplantation) after cardiac transplantation (CTx) in children. Coronary angiography, routinely performed to screen for TxCAD, is an invasive procedure with limited sensitivity. The efficacy of DSE for detecting atherosclerotic coronary artery disease is established, but is unknown in children after CTx. …

Posttransplant Recoarctation Of The Aorta: A Twelve Year Experience., Girish S. Shirali, C E. Cephus, M A. Kuhn, K K. Ogata, L K. Vander Dussen, R E. Chinnock, N F. Mulla, J K. Johnston, L L. Bailey, S R. Gundry, A J. Razzouk, R L. Larsen

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: This study was undertaken to investigate the incidence of posttransplant recoarctation of the aorta, delineate the mode of presentation, identify risk factors that predict recoarctation and examine the results of intervention for posttransplant recoarctation.

BACKGROUND: Patients with aortic arch hypoplasia require extended arch reconstruction at transplant, with an inherent possibility of subsequent recoarctation of the aorta.

METHODS: This was a retrospective review of all children (ageyears) who underwent cardiac transplantation over a 10-year period. Collected data included pretransplant diagnosis, details of the transplant procedure and posttransplant data including development of recoarctation of the aorta, interventions for recoarctation and the …

Cholera In Children In Karachi From 1990 Through 1995: A Study Of Cases Admitted To A Tertiary Care Hospital, S Q. Nizami, B J. Farooqui

Department of Paediatrics and Child Health

Although cholera is an endemic disease in Bangladesh, India and other countries, it was never a significant cause of gastroenteritis in Pakistan before 1988. Since then, cases of cholera are identified each year, both in adults and children in Pakistan. In order to see the contribution of Vibrio cholerae as a cause of gastroenteritis in children, we reviewed the cases of cholera admitted in the pediatric ward of the Aga Khan University Hospital, Karachi, Pakistan. Of 4346 children hospitalized with gastroenteritis during 1990 through 1995, 348 children (8%) were confirmed to have cholera. The youngest child with cholera was seven …

Haemolytic Uraemic Syndrome In Childhood: An Experience Of 7 Years At The Aga Khan University, S H. Ibrahim, Z A. Bhutta, I A. Khan

Department of Paediatrics and Child Health

We reviewed the case records of all children admitted to the Aga Khan University Hospital (AKUH) with a diagnosis of Haemolytic Uremic Syndrome (HUS) over a 7 year period (July, 1988-June, 1995). A total of 33 patients were admitted to the Pediatric ward at (AKUH) with a median age of 16 months (range 4 months-9 years). 97% cases identified were of the classic variety and no familial case was identified. The mean duration of illness was 27 days, 39% had an illness > 28 days. Diarrhoea and prior antibiotic used was in 97% patients. Oliguria at admission was seen in 52.5% …

Effects Of Prenatal Drug Exposure On Neurobehavioral Functioning In Young Infants, Yvette Blanchard, Patricia E. Suess, Marjorie Beeghly

All PTHMS Faculty Publications

In the newborn period, infants prenatally exposed to cocaine and other drugs show low scores on the Neonatal Behavioral Assessment Scale. Beyond that period, research is limited on the effects of prenatal drug exposure on neurobehavioral functioning. In this study we compared infants exposed to cocaine and other drugs and control infants from low socioeconomic backgrounds on measures of neurobehavioral functioning during neuromotor assessment at 1, 4 and 7 months of life. None of the measures of neurobehavioral functioning showed any significant group differences. This study did not support the hypothesis of disrupted neurobehavioral functioning beyond the neonatal period in …

Predicting Red Blood Cell Transfusions In Very Low Birth Weight Infants Based On Clinical Risk Factors., David A. Paul, Stephen A. Pearlman, Kathleen H. Leef, John L. Stefano

Department of Pediatrics Faculty Papers

OBJECTIVE: To describe the clinical factors most predictive of red blood cell transfusion in very low birth weight (VLBW) infants.

STUDY DESIGN: Retrospective review of VLBW infants cared for at a single level III NICU during a two year period, n = 199.

RESULTS: Overall transfusion requirement was 4.6 +/- 6.2 transfusions/infant/hospital course. Length of hospital stay, days of mechanical ventilation, requirement for dopamine support, birth weight, initial hematocrit, periventricular leukomalacia and necrotizing enterocolitis all independently correlated with number of transfusions and donors. Bronchopulmonary dysplasia and patent ductus arteriosus were associated with donor but not transfusion number.

CONCLUSIONS: Our data …

The Optimal Fontan Connection: A Growing Extracardiac Lateral Tunnel With Pedicled Pericardium., S R. Gundry, A J. Razzouk, M J. Del Rio, Girish S. Shirali, L L. Bailey

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: The concept of a lateral tunnel for the Fontan operation is now widely accepted. Most lateral tunnels are constructed intraatrially with the use of aortic crossclamping. Construction of extracardiac lateral tunnels with the use of homografts or other nonviable tubes eliminates aortic crossclamping but lacks growth potential in length or width. The native pericardium, which is "sealed" posteriorly along the pulmonary artery, atrium, and inferior vena cava, could be turned down onto the right atrium to form a viable extracardiac lateral tunnel.

METHODS: We designed and successfully constructed extracardiac lateral tunnels using viable autologous pericardium, pedicled on its lateral …

Profile And Risk Factors For Congenital Heart Disease, I Hassan, A A. Haleem, Z A. Bhutta

Department of Paediatrics and Child Health

Congenital heart disease is an important cause of infant mortality and disability. The frequency, spectrum and contributory risk factors for significant cardiovascular malformations among live-births was retrospectively evaluated at the Aga Khan University Hospital. Of a total of 8331 live births between July, 1987 and December, 1992 34 babies were diagnosed to have congenital heart disease in the neonatal period giving a prevalence of 4 per 1000 live births. Ventricular septal defects was the most common (n = 10, 29%) abnormality. Eight cases had associated chromosomal abnormality, the most common being Trisomy 21. Maternal abortions, still-births, consanguinity and diabetes mellitus …

The Role Of Zinc In Health And Disease: Relevance To Child Health In Developing Countries, Z A. Bhutta

Department of Paediatrics and Child Health

No abstract provided.

A Randomized Clinical Trial To Compare Selective Posterior Rhizotomy Plus Physiotherapy With Physiotherapy Alone In Children With Spastic Diplegic Cerebral Palsy, Paul Steinbok, Ann M. Reiner, Richard Beauchamp, Robert Armstrong, Douglas Cochrane

Paediatrics and Child Health, East Africa

A randomized controlled single-blind trial was performed to compare lumbo-sacral selective posterior rhizotomy (SPR) followed by intensive physiotherapy, with intensive physiotherapy alone in improving motor function in children with spastic diplegic cerebral palsy. Fifteen patients were randomly assigned to each treatment modality. Patients in the SPR group had rhizotomy within 1 month, followed by intensive outpatient physiotherapy for 9 months. Patients assigned to physiotherapy alone had identical intensive physiotherapy. There was a statistically significant and clinically important difference in improvement in motor function in favor of the SPR group, with a mean increase in total Gross Motor Function Measure (GMFM) …

Lactose Intolerance In Persistent Diarrhoea During Childhood: The Role Of A Traditional Rice-Lentil (Khitchri) And Yogurt Diet In Nutritional Management, Z A. Bhutta, S Q. Nizami, Z Isani

Department of Paediatrics and Child Health

Lactose intolerance is frequently encountered in children with persistent diarrhoea (PD). Selection of an appropriate milk-based formulation is a major management problem in the developing world. In a consecutive series of studies, we evaluated the role of feeding a traditional rice-lentil (khitchri) diet alone (KY) or in combination with either soy formula (KY-Soy) a dilute buffalo milk (KY-B), in children (age 6 months-3 years) with PD. Serial observations of stool output, caloric intake and weight gain of these children over a 14 day period indicated satisfactory tolerance of the KY diet with adequate weight gain. The weight gain and stool …

Paediatric Prescribing In Karachi, S Q. Nizami, I A. Khan, Z A. Bhutta

Department of Paediatrics and Child Health

To assess amount of drug overuse we studied drug prescribing for common childhood problems by 65 general practitioners (GPs) and 29 paediatricians. A total of 2433 encounters between GPs or paediatricians and children under five years of age were observed. The presenting complaints were fever in 18%, cough in 9%, both fever and cough in 21%, vomiting in 20% and diarrhoea in 41% of encounters. Antibacterials were prescribed in 49% of encounters, analgesics and antipyretics in 29%, antiemetics in 8% and injectables in 15%. Antidiarrhoeals were prescribed in 41% encounters with children reported to have diarrhoea. Ampicillin and cotrimoxazole were …

Pneumococcal Sepsis In The Newborn--An Emerging Problem?, Z A. Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Uwomj Volume 66, No 1, Winter 1996-97, Western University

University of Western Ontario Medical Journal

An interdisciplinary medical science publication, established in 1930.

Moyamoya Disease Of Childhood As A Cause Of Recurrent Cerebral Ischemic Attacks--A Case Report, S Ibrahim, S S. Hyder

Department of Paediatrics and Child Health

No abstract provided.

Ventricular Remodeling Following Infant-Pediatric Cardiac Transplantation. Does Age At Transplantation Or Size Disparity Matter?, Girish S. Shirali, F Lombano, W L. Beeson, D A. Dyar, N F. Mulla, A Khan, J K. Johnston, R E. Chinnock, S R. Gundry, A J. Razzouk

Manuscripts, Articles, Book Chapters and Other Papers

Early left ventricular (LV) remodeling following pediatric cardiac transplantation has not been described. To identify patterns and determinants of change in left ventricular mass and volume posttransplant, we studied 125 consecutive children who underwent cardiac transplantation between January 1, 1989 and July 31, 1993. Two-dimensional imaging-directed M-mode echocardiograms were studied weekly until 26 weeks post-transplant. LV mass and volume (indexed to BSA1.5) were measured. LV mass index increased until 3 weeks post-transplant, and then decreased. The mean decrement in LV mass index after 8 weeks post-transplant (relative to baseline) was significantly larger in patients with donor-recipient weight ratio > 1.5 compared …

The Fourth Circuit's Baby K Decision: Plain Language Does Not Make Good Law, David Zell Myerberg M.D.

West Virginia Law Review

No abstract provided.

A Call To Action: The Institute Of Medicine Report On Emergency Medical Services For Children., J F. Knapp

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Ciprofloxacin In Multi-Resistant Infections In Childhood: An Audit, D M. Khan, Z A. Bhutta

Department of Paediatrics and Child Health

Ciprofloxacin is a new orally administrable fluoroquinolones, with considerable efficacy against multiresistant organisms. Its use in the paediatric age group however, is controversial because of the risk of potential articular toxicity. We retrospectively reviewed ciprofloxacin usage over a 32 week periods (June, 1991-September, 1993) in paediatric inpatients at The Aga Khan University Hospital. Ciprofloxacin was used in 21 cases, singly in 11 (52%) and in combination with other antibiotics in a further 10 (48%). The response to therapy was adjudged as 'good' or 'fair' in 13 (62%) cases. Ciprofloxacin was the only sensitive antibiotic in 4 (19%) and resistance to …

The Importance Of Religion For Parents Coping With A Chronically Ill Child, Carolyn M. Rutledge, Jeffrey S. Levin, David B. Larson, John S. Lyons

Ellmer School of Nursing Faculty Publications

This study examines differences in the stability and consequences of religious coping among parents (N = 102) of chronically ill children. Analyses revealed that changes in religious patterns due to a child's illness were reflected in changes in other, non-religious coping resources. Specifically, parents whose pre-illness religious patterns were satisfactory did not alter their use of other coping resources, whereas parents who reported changes in their religious patterns also made changes in their use of familial financial and social support systems.