INTRODUCTION: Vitamin D deficiency (VDD) is exceedingly predominant in children leading to dysregulation of the immune system and inflammation. Data on the prevalence of VDD in children with sepsis and its association with sepsis severity are limited from our part of the world. The primary aim of this study was to identify the burden of VDD in children with sepsis. MATERIAL AND METHODS: One hundred and five children (< 15 years) with sepsis were enrolled from April 15, 2017 to April 14, 2018 from a tertiary care center in Eastern Nepal. Demographic data including BMI, sequential organ failure assessment (SOFA) scores were recorded at the time of admission. Plasma 25-hydroxy vitamin D [25(OH)D] levels were measured by chemiluminescence immunoassay technique (CLIA) (MAGLUMI 25-OH Vitamin D; CLIA) within 24 hours of admission. Vitamin D concentrations of <20 ng/mL (50 nmol/L) were considered as deficient. RESULTS: Of the 105 children enrolled, the majority 74 (70.55%) had vitamin D deficiency. Vitamin D was deficient in 77, 65, and 66% of children in 1-5, 5-10, and 10-15 years of age group respectively. Vitamin D deficiency was maximum (80%) in underweight children. In the VDD group, 60% had severe sepsis, whereas only 32% had severe sepsis in vitamin D sufficient group with significant statistical association with sepsis severity and vitamin D deficiency. CONCLUSION: A high burden of VDD is present in children with sepsis which was found to be associated with greater severity of illness.
Background: Sepsis is one of the most common causes of morbidity and mortality in young children. Zinc supplementation has a preventive effect against diarrhoeal diseases and respiratory infections, but little is known about its effect on the treatment of sepsis. Objectives: To evaluate the benefit of oral Zinc supplementation along with standard antimicrobial therapy in childhood sepsis. Methods: A randomised, double-blind controlled trial was conducted on 164 septic children between 1-15 years of age from 15th April 2017 to 14th April 2018 in a eastern Nepal tertiary care centre. Block randomisation was done with four participants in each block. There were 21 and 20 blocks in the intervention and in the placebo group respectively. Each child received oral zinc (20 mg elemental zinc/day) or a placebo once a day for 14 days. Percentage was calculated for descriptive statistics and Chi-square for inferential statistics with 95% CI and p <0.05 for data analysis using SPSS v.16. Results: Of the participants, 84 (51.21%) received Zinc and 80 (48.79%) received a placebo in adjunct to the standard antimicrobial therapy. Most of the children 76 (46.34%) were under five years and were male 98 (59.75%), and 69 (42.07%) were underweight. Those receiving zinc and placebo had similar improvements at discharge; there was no reduction in the need for higher-order antibiotics or in the length of PICU/ hospital stay. Zinc supplementation in childhood sepsis had no benefit on decreasing mortality or decreasing severity (p >0.05). Conclusion: Zinc supplementation during childhood sepsis does not help in short-term clinical recovery.
Introduction: Complicated community-acquired pneumonia resulting in empyema thoracis remains the largest single cause of morbidity and mortality worldwide in children. This study was carried out to evaluate the clinical profile, associated complications and outcome of empyema thoracis in children. Methods: A retrospective study was conducted in the Department of Paediatrics at a tertiary care center in Eastern Nepal. A total of 106 children were managed with the diagnosis of complicated pneumonia with effusion or empyema thoracis from March 2017 to February 2021 (Five years). Only those patients who had clinico-radiological evidence of pleural effusion or empyema thoracis and received treatment with or without intercostal chest tube drainage (ICD) as the initial procedure were enrolled in the study. Besides supportive treatments and antibiotics; streptokinase was instilled intrapleurally in all the patients for three days. Patients who did not respond underwent VATS / decortication. Results: Majority of the children (60.19%) were below five years of age and were males (73.58%). Majority (55.67%) had a right-sided pleural effusion and fever was the predominant symptom (55.66%) at presentation. The pleural fluid culture was sterile in more than half (55.66%) of the patients with Staphylococcus aureus grown in 33.96%. The three most common complications were subcutaneous emphysema, thickened pleura, and pyo-pneumothorax. The success rate of medical management was 83.96% and the mortality was low (2.84%). Conclusions: The success rate of conservative management with antimicrobial therapy, intercostal drainage and fibrinolytics in this study was high (83.96%) with no major adverse effects of fibrinolytic therapy in empyema thoracis.
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