Severe acute malnutrition (SAM) is an established contributor of under-five mortality and morbidity. Achieving desired treatment outcome has proven to be challenging. There is limited data concluding the success of treatments in the study area. Objective: This study was aimed to compare the recovery from severe acute malnutrition with identified medical complications where presence or absence of edema denotes a major predictor among children aged 0-59 months of age. Methods: This was a retrospective observational study on facility based management which was conducted in SAM block of Chattogram Medical College hospital, Chattogram, Bangladesh. Here a total of 485 patients were admitted during the period of 2013-2017 and among them, 266 patients were successfully discharged from the hospital. Based on WHO & National guidelines for management of severely malnourished children in Bangladesh, treatment protocol, admission and discharge criteria were followed. A structured and prescribed data format was prepared and data were collected from the hospital records. Daily observation, monitoring and follow-up notes of the patients were also recorded. After data collection, they were cleaned, edited and stored into excel, EPI-INFO and analyzed by SPSS. Results: More than half of the admitted patients were cured and routinely discharged. 8.04% patients died during this period. 39.7% (193) children recovered according to the set discharge criteria as per guidelines. Mean age of the observed patients was 22.35±15.8607 months. More than half of the admitted patients showed moderate to good weight gain during hospital stay. Mean weight gain was higher in non-edematous patients. 50% of non -edematous patients started to gain weight in 3-5 days while 76% of edematous patients required 6-10 days to start weight gain. 4.3% patients did not gain weight during hospital stay. Both descriptive and analytic analyses were executed. P value<0.05 was considered as statistically significant Conclusions: The mean duration of hospital stay (in days) of the patients with oedema (15.64±SD 7.133 days) was higher than that of the patients without oedema (9.47±SD 5.881 days). But greater portion of patients with edema were cured. Independent-Sample T Test revealed the difference statistically significant, where t=(438,485)=-9.878, p=0.002.
Background: Mild or subclinical hypothyroidism may coexist with NephroticSyndrome (NS). But persistence of this hypothyroidism is related with remission ofproteinuria. Objectives of the study is to compare thyroid function status (FT4 andTSH) in the atypical and typical NS before and 4 weeks after steroid therapy. Materials and methods: This was a hospital based comparative observational studywith prospective follow up of study subjects. It was carried out in the Department ofPediatrics and in the Department of Nephrology, Chattogram Medical CollegeHospital (CMCH) Chattogram, Bangladesh from January to December’ 2017. A total83 diagnosed admitted cases of initial attack idiopathic NS, aged 1-18 years ofeither sex divided into 2 groups were included. Typically presented NS were in groupA and atypically presented NS were in group B. FT4 and TSH were estimated in allpatients on 2 occasions before and 4 weeks after initiation of steroid therapy andcomparison was done between 2 groups. Results: FT4 level was normal before and after steroid therapy in both typically andatypically presented nephrotic syndrome. Before steroid therapy, mean TSH valuewas found significantly raised in both groups (9.28±5.17 vs 7.26±3.67 μIU/ml).Proportion of subclinical hypothyroidism was statistically similar. After treatmentwith steroid, number of subclinical hypothyroid cases reduced in both groups withreduction of TSH value (3.13±1.14 vs 5.38±2.52 μIU/ml). But significant difference inTSH value was observed in between two groups. There was persistence of subclinicalhypothyroidism after treatment with steroid among 16.6 % (14.2% grade II and2.3% grade I) children with atypically presented NS and which is statisticallysignificant (p=0.006). Conclusion: Subclinical hypothyroidism persists in atypically presented nephroticsyndrome even after treatment with steroid. Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 28-32
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