There is always need for the earliest diagnosis of enteric fever to start the appropriate treatment for this life threatening illness. The diagnosis becomes difficult because of inherent limitation due to the long standing vague complaints. Some findings like acalculus cholecystitis, hepato-splenomegaly, enlarged mesenteric lymph nodes (MLN) and free fluid can easily be picked up by ultrasonography (USG). USG is easily available, without any ionizing radiation, non-invasive and economical. Hemoculture and Widal tests are time consuming and the cost is quite high. The study was conducted with 100 paediatric patients aged 1-year to 15-year. All were having enteric fever based on typhi dot-IgM presented to the paediatric department of the hospital. USG was conducted for the evaluation of the various relevant findings. Blood samples for CBC, LFT and blood culture were taken on the same day as that of USG evaluation. USG evaluation of confirmed enteric fever cases revealed that 25% had gall bladder findings, 23% had hepato-splenomegaly, 11% had hepatomegaly, 1% had enlarged mesenteric lymph nodes (MLN) and 3% had thickened caecum wall and ileocaecal junction. USG can diagnose many findings which are related to enteric fever and are helpful in starting the early management. Hemoculture and other investigations may delay the treatment which can lead to various complications.
Introduction: Cleft lip and/ or cleft palate are the most common visible craniofacial anomalies. These patients often have feeding difficulties and recurrent infections leading to an altered immune system which can be assessed by the variations in hematological parameters. We intended to assess the clinical profile and the hematological parameters in patients with cleft lip and palate. Methods: This is a three-year cross-sectional study conducted at SGT Medical College, Gurugram, Haryana, India from January 2017 to December 2019 involving assessment of patients with cleft lip and palate who visited the paediatric unit for complete evaluation before surgery. Syndromic children or those with associated deformities were excluded .A total of 115 patients were enrolled in the study and the following information was recorded: Age, Gender and type of cleft (Cleft lip and alveolus, cleft lip, alveolus and palate, and isolated cleft palate). Hematological parameters including hemoglobin, total leukocyte count, differential leukocyte count, absolute eosinophil count, and red cell indices were evaluated and compared amongst the anatomical subtypes. Results: A total of 115 patients were included in the study, of which 66 (57.4%) were males and 49 (42.6%) were females. 57 (49.6%) had a cleft lip, alveolus, and palate, 36 (31.3%) had a cleft lip and alveolus and 22 (19.1%) had cleft palate only. Anaemia was present in 71.1% of cases. 83.4% cases of cleft lip and alveolus while81.8% of isolated cleft palate were anaemic. Microcytic hypochromic anaemia was present in 63.4% of cases while 36.6% had normocytic normochromic anaemia. The total leukocyte count was elevated in 60 children (52.2%) which was highest in cleft lip and alveolus (66%). Absolute neutrophil count was significantly high in the lip and alveolus groups.(13.9%) Absolute lymphocyte count was highest in lip and alveolus (30.56%). Absolute monocyte count and the absolute eosinophil count was low in the majority of cases. Conclusions: A large number of children with cleft lip and/ or palate are not exclusively breastfed due to anatomical deficits. They need supplemental iron to meet the demands. A standard policy to provide auxillary iron by health care professionals should be made at the first visit to the health centre because nutritional anaemia negatively affects the physical and cognitive development of a child. It also unnecessarily prolongs the date for optimum and safe surgery.
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