No abstract

BACKGROUND Foreign body aspiration (FBA) in children is one of the major causes of death in developing countries, the diagnosis of which can be missed due to varied presentation. It is one of the causes of choking among children which, if not recognized early may lead to fatal consequences. Early recognition and prompt intervention may reduce the mortality and morbidity. In this study, we wanted to assess the clinical profile of children with foreign body aspiration/ingestion, determine the nature and location of foreign body and also determine the outcome among children with foreign body aspiration at a tertiary care centre. METHODS This cross-sectional study was taken up to analyse the clinical profile, to study the types, location and the outcome of children with foreign body aspiration. All children in the age group of 2 months to 12 years admitted to Niloufer hospital, Hyderabad from January 2018 to December 2019 with either history of FBA or clinical features suggestive of FBA even in the absence of history were included in the study. Age, sex, clinical features (C/F), duration of illness were noted. A chest X-ray was done in all cases, whereas a computed tomography (CT) scan was done in children where clinical features & chest X-rays were inconclusive. All children fulfilling the inclusion criteria were subjected to bronchoscopy under general anaesthesia by ENT surgeons. The findings like type and location of the foreign bodies were noted. Statistical analysis was done by statistical package for social sciences (SPSS) software version 10.0. RESULTS Of 108 children studied, 60 % of cases were males and 40 % were females. 55 % of cases were below the age of 3 years. Common symptoms were rapid breathing (68 %) and cough (38.8 %). Nuts & seeds were the common foreign bodies seen in 47.30 %, out of which groundnuts were the most common. Organic foreign bodies accounted for 58.11 % while inorganic was 41.89 %. The common site of lodgement of foreign body was right main bronchus (35.59 %), followed by left main bronchus (27.11 %) and sub-glottis (8.47 %). CONCLUSIONS Foreign body aspiration is difficult to diagnose in children and a delay in diagnosis can lead to mortality and morbidity. Early intervention by bronchoscopy goes a long way in improving survival. Clinical suspicion is the key to the diagnosis. KEYWORDS Foreign Body, Bronchoscopy, Children

BACKGROUND Fever with thrombocytopenia is a common clinical problem in paediatric wards. Significant number of acute febrile illnesses have an infectious aetiology and are often associated with thrombocytopenia. The objective of the study was to determine the clinico-etiological profile and outcome of children admitted with febrile thrombocytopenia, especially in those with infective aetiology. METHODS The study design is a prospective observational study. It was conducted from September 2017 to August 2019 in the Department of Paediatrics, Niloufer Institute of Women and Child Health, Hyderabad. A total of hundred (100) children in the age group of 1 year to 12 years presented with fever, and thrombocytopenia were included in the study. Newborns, infants, children with febrile thrombocytopenia, known ITP (idiopathic thrombocytopenic purpura), already diagnosed haematological malignancy and children on antiplatelet drugs like aspirin were excluded from the study. After informed written consent, detailed history was elicited, clinical examination and necessary laboratory investigations were carried out, and the data was captured in a pre-structured proforma. Study parameters were analysed using Statistical Package for Social Sciences (SPSS) version 16 software. RESULTS The study included 100 children. A ratio of 1.4 : 1 was observed in male to female ratio. As of the clinical features, gastrointestinal (GI) symptoms such as nausea, vomiting and pain abdomen were more common, followed by headache and myalgia. On examination, two-thirds of the children had hepatomegaly, and onethird had splenomegaly. Among 100 children with febrile thrombocytopenia, 38 children had bleeding manifestations (cutaneous bleeds > GI bleeds > other bleeds) in those with moderate to severe thrombocytopenia. In the etiological profile, dengue fever was more common, followed by undiagnosed fever, enteric fever, ALL (acute lymphoblastic leukemia), scrub typhus, malaria and leptospira, respectively. Out of 100 children, 94 were discharged, and 6 children with ALL were referred to the haemato-oncology center for further management. CONCLUSIONS Clinical presentation of cases with febrile thrombocytopenia is varied. Common causes of febrile thrombocytopenia observed in this study were dengue fever followed by un diagnosed fever and enteric fever. KEYWORDS Fever, Thrombocytopenia, Platelet count, Bleeding