Background 
Despite numerous advances made in improving child health and the clinical management protocols for treating severe acute malnutrition at treatment centers, evidences concerning the treatment outcomes are scarce. Therefore, this study was conducted to assess the recovery rate and associated factors of severely acute malnourished children of age 6 to 59 months admitted to inpatient therapeutic feeding unit at Felege Hiwot Referral Hospital.


Methods 
We conducted a hospital-based cross-sectional study including 401 severely malnourished children who were admitted from September 2012 to January 2016. Bivariable and a Multivariable logistic regression model were fitted to identify factors associated with recovery rate. Adjusted Odds ratio with its 95% CI was reported and P-value less than 0.05 was considered as significant.


Results 
Fifty eight percent (58.4%) (95%CI: 53.1–64.1) of admitted children were recovered with a mean recovery time of 18 (±6.3) days. Being female, children who were fully and partially vaccinated, who had better MUAC measurement, who stayed longer in the hospital, and children who took routine vitamin-A supplementation had better recovery rate. However, children who had co-morbidity at admission, had human immune virus (HIV) and Tuberculosis (TB) infection, and who had edema were less likely to recover.


Interpretation 
Recovery rate was low as compared to international SPHERE cutoff points (> 75% recovery rate). Interventions that could address the outlined factors would be helpful to improve treatment recovery rate of admitted children.

/pdf/recovery-rate-and-associated-factors-of-children-age-6-to-59-4p4nmbrhaj.pdf

Recovery rate and associated factors of children age 6 to 59 months admitted with severe acute malnutrition at inpatient unit of Bahir Dar Felege Hiwot Referral hospital therapeutic feeding unite, northwest Ethiopia.

Objective: The study was intended to document the clinical profile and treatment outcome of severe malaria caused by Plasmodium vivax (P.vivax) in children hospitalized in a tertiary care centre of northern India.Methods: This prospective observational study was performed among children admitted with severe malaria at a tertiary care referral hospital of northern India from January 2012 to December 2012. Information was recorded pertaining to clinical symptoms at presentation, examination findings, biochemical and hematological investigation, and treatment outcome. Presence of malarial parasite on thick and thin smears and/or positive parasite lactate dehydrogenase (p-LDH) based rapid malaria antigen test was considered diagnostic of ‘malaria’. Based on the etiology, children were categorized into three groups: P.vivax, Plasmodium falciparum (P. falciparum) and mixed infection. Children diagnosed with ‘severe malaria’ (World Health Organization, 2000), were started on intravenous artesunate follow...

/pdf/clinical-spectrum-and-treatment-outcome-of-severe-malaria-4ypi7uplz6.pdf

Clinical spectrum and treatment outcome of severe malaria caused by Plasmodium vivax in 18 children from northern India

Severe acute malnutrition affects more than 20 million children. Africa is pointed out as a region where the problem is highly prevalent. There were individual studies on the recovery rate and its determinants among children with severe acute malnutrition in Ethiopia. But, there is no national pooled estimate. Therefore, this systematic review and meta-analysis aimed to estimate the recovery rate and determinants among children with severe acute malnutrition admitted to the therapeutic feeding unit in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed in this study. Studies were accessed through electronic web-based search from PubMed, Cochrane Library, Google Scholar, and EMBASE. The statistical analysis was conducted using STATA version-11 software. The pooled prevalence was estimated with 95% confidence intervals using a random-effects model. A total of 12 studies were included with 2658 participants in the analysis. The overall pooled estimated recovery rate among children with severe acute malnutrition admitted to the inpatient therapeutic feeding unit in Ethiopia was 72.02 % (CI, 64.83, 79.22%). In the subgroup analysis, the highest estimate (80.29%) was observed in studies conducted in Oromia regional state, while 68.63% was observed in studies Southern Nation Nationality of people region 68.63%. Children who had no congestive heart failure were 4.88 times (OR, 4.88; 95% CI, 2.246, 10.586) more likely to recover than their counterparts. The recovery rate among severe acute malnourished children on the therapeutic feeding unit in Ethiopia lied within the international minimum sphere. Hence, health care providers shall strengthen the management of severe acute malnutrition and management other co-morbidities like congestive heart failure. PROSPERO CRD42019119124

/pdf/recovery-rate-and-determinants-of-severe-acute-malnutrition-4siitrv6k5.pdf

Recovery rate and determinants of severe acute malnutrition children treatment in Ethiopia: a systematic review and meta-analysis

Malaria mixed infections are often unrecognized by microscopists in the hospitals, and a delay or failure to treat Plasmodium-mixed infection may lead to aggravated morbidity and increased mortality. The present study aimed to quantify the pooled proportion and risk of malarial recurrences after the treatment of Plasmodium-mixed infection. The results of the study may provide benefits in the management of Plasmodium-mixed infection in co-endemic regions. This systematic review and meta-analysis searched the international Prospective Register of Systematic Reviews (PROSPERO; ID = CRD42020199709), MEDLINE, Web of Science, and Scopus for potentially relevant studies in any language published between January 1, 1936, and July 20, 2020, assessing drug efficacy in patients with Plasmodium-mixed infection. The primary outcome was the pooled prevalence of Plasmodium parasitemia after initiating antimalarial treatment for Plasmodium-mixed infection. The secondary outcome was the pooled risk ratio (RR) of malarial recurrence in Plasmodium-mixed infection compared with those in Plasmodium falciparum and Plasmodium vivax mono-infection. The pooled analyses were calculated by random-effects meta-analysis. After the initial treatment in different days of recurrences (≤ 28 days or > 28 days), the risk of Plasmodium parasitemia was compared in subgroup analysis. Out of 5217 screened studies, 11 were included in the meta-analysis, including 4390 patients from six countries. The pooled prevalence of all recurrences of Plasmodium-mixed parasitemia was 30% (95% confidence interval (CI) 16–43; I2: 99.2%; 11 studies). The RR of malarial recurrence within 28 days after the initial treatment (clinical treatment failure) of Plasmodium-mixed parasitemia compared with the treatment of P. falciparum was 1.22 (p: 0.029; 95% CI 1.02–1.47; Cochran Q: 0.93; I2: 0%; six studies), while there was no significant difference in the risk of recurrence 28 days after initial treatment compared with the treatment of P. falciparum (p: 0.696, RR: 1.14; 95% CI 0.59–2.18; Cochran Q < 0.05; I2: 98.2%; four studies). The subgroup analysis of antimalarial drugs showed that significant malarial recurrence within 28 days was observed in patients treated with artemisinin-based combination therapies (ACTs) with no significant heterogeneity (p: 0.028, RR: 1.31; 95% CI 1.03–1.66; Cochran Q: 0.834; I2: 0%). The present findings showed a high prevalence of malarial recurrence after the initial treatment of Plasmodium-mixed infection. Moreover, significant malaria recurrence of mixed infection occurred within 28 days after treatment with ACTs.

/pdf/the-high-risk-of-malarial-recurrence-in-patients-with-4tnydlzul9.pdf

The high risk of malarial recurrence in patients with Plasmodium-mixed infection after treatment with antimalarial drugs: a systematic review and meta-analysis.

Background: Puberty and changes resulting from it are one of the most important events of everybody’s life. Mothers play a central role in raising the level of knowledge, managing family health and improving hygienic behaviors of their daughters. Objectives: The current study aimed to compare the effects of educating mothers and their daughters on the knowledge and practices toward puberty hygiene in adolescent girls in Tabriz, Iran, 2014. Patients and Methods: This randomized controlled trial was conducted on 364 adolescent students of 12 randomly selected high schools who had experienced menstruation. The students were first matched by the practice scores they received in the pretest and then divided randomly and equally into three groups: educating the mothers, educating the girls, and the non-intervention group. The questionnaires regarding knowledge and practices in the pre- and post-intervention stages (with an interval of two months between them) were completed. The general linear model, in which the baseline values were controlled, was employed to compare the scores of the three groups after the intervention. Results: There were no significant differences between the three groups concerning the scores received on knowledge and practice prior to the intervention (P > 0.05). After the intervention, by controlling the scores received before the intervention, the mean score on knowledge in the two groups of educating the mothers (adjusted difference: 0.7; confidence interval (CI) 95%: 0.0 - 1.3) and educating the girls (0.8; 0.2 - 1.5) were significantly higher compared to those of the control group. With respect to improvement in the scores received on practice, no significant differences were found between the three groups. Conclusions: Results of the current study indicate that it is possible to use the method of educating the mothers and transferring knowledge from them to their daughters as a substitute for direct education of the girls in order to raise the level of their knowledge on puberty hygiene.

Educating Mothers and Girls about Knowledge and Practices toward Puberty Hygiene in Tabriz, Iran: A Randomized Controlled Clinical Trial

OBJECTIVE To identify clinical features of severe malaria and their association with adverse outcomes according to recently proposed WHO guidelines and observe treatment failure to Quinine. METHODS This descriptive study was performed at Civil Hospital Karachi from September 2007 to January 2008. Various clinical features and laboratory parameters were analyzed according to t WHO guidelines and treatment failure to anti-malarial drugs was recorded. Mean, frequencies, percentages and chi-square test were used for analysis. Statistical significance was defined as p-value < 0.05. RESULTS Total of 81 patients were enrolled in the study. Mean age of children was 5.5 +/- 3.4 years. Type of malaria infections that were seen included falciparum 46 (57%), mixed infection 26 (32%) and vivax 9 (11%). Frequent clinical features included splenomegaly (74%), multiple organ dysfunction (MOD) (70%), cerebral malaria (31%) and malnutrition (27%). Thrombocytopenia (86%) and severe anaemia (42%) were the common laboratory findings. Shock (p < 0.001), renal failure (p < 0.001), hepatic involvement (p < 0.002) and cerebral malaria (p < 0.002) emerged as strong predictors of complications. Fourteen out of 81 cases showed early treatment failure to Quinine. CONCLUSION Shock, renal failure, hepatic involvement and cerebral malaria are strongly associated with complications in severe malaria. MOD and malnutrition were identified as significant new clinical features present in severe malaria in this study.

Severe malaria in children: factors predictive of outcome and response to Quinine.

Objective: To evaluate the efficacy of adopting WHO feeding guidelines on weight gain and case fatality rate in malnourished children. Study Design: Cross-sectional, observational study. Place and Duration of Study: Department of Pediatrics, Dow University of Health Sciences, Karachi, from 2009 to 2010. Methodology: Patients above 6 months and less than 5 years of age with severe malnutrition were included during the study period, acute complications were treated and nutritional rehabilitation by WHO feeding formulae was done. Demographic details, clinical features, reasons for weight gain and risk factors of mortality were analyzed. Results: A total of 131 children were included. Mean age of children was 22 ± 18 months. There were 78% marasmic, 4% kwashiorkor and marasmic kwashiorkor 18% children. Resolution of edema took 8 ± 4 days, dermatosis cleared in 11 ± 3 days. Mean hospital stay was 10 ± 8 days. Case fatality rate was 13%. Mean weight gain was 5.25 ± 4.57 g/kg/day. Weight gain of > 5 gm/kg/day was associated with hospital stay of more than 7 days, acceptability and palatability of feed by the children and mothers and early clearance of infections. Conclusion: Implementation of WHO feeding guidelines resulted in adequate weight gain of inpatient malnourished children, however, adequate healthcare services are available at the therapeutic feeding centers.

https://applications.emro.who.int/imemrf/J_Coll_Physicians_Surg_Pak/J_Coll_Physicians_Surg_Pak_2014_24_7_493_497.pdf

Implementing WHO feeding guidelines for inpatient management of malnourished children.

Objective: To determine the effectiveness of negative pressure dressing with silver alginate hydro-fibre dressings in managing chronic wounds compared to negative pressure dressing without silver alginate hydro-fibre dressings. 
Study Design: Cross-sectional analytical study. 
Place and Duration of the Study: Department of Plastic and Reconstructive Surgery at Dr Ruth K.M. Pfau Civil Hospital Karachi, from Jan to Jul 2021. 
Methodology: All patients above 18 years of age of either gender presented with more than six weeks of wound duration, hemoglobin levels more than 10 g/dl, platelet count above 150 x 10E9/L, and size of the wound more than 10*10cm were consecutively enrolled. Negative pressure dressings with and without hydro-fibre dressings were applied. A team of plastic surgeons monitored the wound site to assess granulation tissue by noting the size of the wound and pain severity. The outcome was assessed at four weeks. 
Results: Of 62 patients, the median age was 43 (32.5-56.7) years. There were 37 (59.67%) males and 25 (40.32%) females. The outcome assessment at four weeks showed that overall pain was observed in 34 (54.83%) patients. Pain severity (p-value <0.001) and low granulation score (p-value 0.025) were found significantly higher in patients who received negative pressure dressing without silver alginate as compared to the patients who received negative pressure dressing with silver alginate. A significant median difference in granulation days was observed between groups (p-value <0.001). 
Conclusion: Combining negative pressure dressings with silver alginate dressing has positive effect on the chronic wound compared to using negative pressure dressings alone.

A Comparative Study of Negative Pressure Dressing with and without Silver Alginate to Promote Faster Wound Healing in Chronic Wounds

OBJECTIVE: To compare the bleeding control of skin graft donor site between normal saline soaked gauze with adrenaline and conventional technique having no adrenaline. 
METHODS: This open-label randomized control trial was conducted at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan from October 2020 to March 2021. Seventy-five patients were randomized to interventional (n=36, 48%) and control group (n=39, 52%) through sealed envelopes. Diluted solution was prepared by adding 30cc of Ringer’s lactate and 10cc of lignocaine 2%, with 1cc of adrenaline of 1:200000 with 200 ml of normal saline solution. Solution for control group was containing only normal saline. Following the skin harvesting at donor site, a gauze piece soaked with tumescent solution was applied at the donor site wound. Bleeding severity and epithelialization were assessed. Data was recorded in a pre-designed performa and analyzed through SPSS version-25. 
RESULTS: There was no significant differences in baseline characteristics like age (p=0.823), gender (p=0.984) and nature of injury (p=0.936) among two groups. Severe, moderate and mild bleeding was noted in 20/39 (51.3%), 15/39 (38.5%) and 4/39 (10.3%) cases in control group as compared to 0/36 (0%); 2/36 (5.6%) and 25/36 (69.4%) cases in interventional group respectively (**<0.001). No bleeding was noted in 9/36 (25%) cases of interventional group. Complete epithelialization was observed in 24/36 (66.7%) & 17/39 (43.6%) cases in adrenaline and control groups respectively (p=0.045). 
CONCLUSION: Application of adrenaline was more effective in bleeding control and early epithelialization at donor site following the skin harvesting as compared to conventional technique.

/pdf/comparison-between-adrenaline-and-without-adrenaline-1narp75j.pdf

Comparison between adrenaline and without adrenaline solution on bleeding control of skin graft donor site: a randomized controlled trial

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Papers

Severe malaria in children: factors predictive of outcome and response to Quinine.

Implementing WHO feeding guidelines for inpatient management of malnourished children.

A Comparative Study of Negative Pressure Dressing with and without Silver Alginate to Promote Faster Wound Healing in Chronic Wounds

Comparison between adrenaline and without adrenaline solution on bleeding control of skin graft donor site: a randomized controlled trial