bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinicolaboratory profile of children with celiac disease in North India
Authors: Singh Princy , Mittal Hema Gupta , Dewan Vivek , Yadav Tribhuvan Pal
Published: June 2020

Background: Prevalence of celiac disease (CD) has increased worldwide, but there are only few studies reporting clinicolaboratory profile of children with CD. Aim: To study the current clinicolaboratory profile of celiac disease in North Indian children. Methods: This retrospective study was done in pediatric gastroenterology clinic of a tertiary care center of North India. The primary objective was to study clinical and laboratory profile in children with CD. Secondary objective was to find correlation between duodenal biopsy Marsh stage and IgA tissue with tissue transglutaminase antibody (tTG) titers and also with serum hemoglobin, serum iron levels, and severity of anemia. A total of the 54 children fulfilling the diagnostic criteria of CD were included, and details were reviewed and analyzed. Results: Average age of onset of symptoms was 4.7±2.5 years, 80% had onset of symptoms after 2 years of age. Chronic diarrhea (70.3%), pain abdomen (62.9%), and abdomen distention (53.7%) were the most common manifestations. Wasting (38.4% - <5 years, 41.4% in >5 years), stunting (46.3%), rickets (22%), and anemia (90.7%) were common. Serum hemoglobin levels and serum iron levels were inversely correlated to the serum tTG levels and Marsh biopsy staging; though, not significant. Correlation of hemoglobin levels between Marsh stage 3A and 3C was statistically significant (p=0.036). There was no correlation between serum tTG levels and Marsh biopsy staging with anemia and its severity. Conclusion: Gastrointestinal symptoms still remain the most common presentation in children with celiac disease. Malnourishment, anemia, and rickets require special attention in these children.
Knowledge, stress and adopted coping strategies of parents of children having congenital adrenal hyperplasia: An exploratory survey
Authors: Joshi Poonam , Yadav Babita , Jain Vandana , Sharma Shilpa
Published: June 2020

Background: Congenital adrenal hyperplasia (CAH) is an inherited disorder of adrenal glands, the most common type being due to a deficiency of the enzyme 21-?-hydroxylase. Girls affected with it are virilized to a variable extent. The taboo associated with ambiguous genitalia in female babies poses an immense societal pressure on parents for keeping the disease a secret. Objective: The aim of the study was to generate the evidence on the knowledge, stress, and coping strategies used by the parents of CAH children. Methodology: In a cross-sectional descriptive survey using mixed methods approach, 30 parents of children with CAH attending the outdoor department of pediatric medicine and surgery in a tertiary care hospital were enrolled. The CAH knowledge questionnaire, parental stress scale (PSS), and COPE inventory were the standardized tools used along with demographic profile sheet to assess the knowledge of parents related to CAH, stress, and coping strategies used by them. Results: Majority of the parents (67%) had poor knowledge (<7) and moderate stress (42-65) scores. Knowledge and stress were negatively correlated (r=?0.39, p=0.035). Coping strategies used by the parents in dealing with stress in moderate amount were mainly problem-focused (active coping [60%] and planning [60%], instrumental social support [53%], suppression of competing activities [50%]), and emotion-focused (positive reinterpretation [60%], emotional social support [67%], acceptance [53%], and religious coping [50%]). Less useful coping strategies such as focus on and venting of emotions, behavioral disengagement, mental disengagement, humor, and substance abuse were not used by the majority parents. Conclusion: Parents of children with CAH had poor knowledge and moderate stress related to the disease condition of their children and were using problem focused and emotion focused coping strategies to reduce their stress.
Toxic epidermal necrolysis: A study of clinical profile and treatment outcome in children
Authors: Sugunan Sheeja , Kumar K K Santhosh , Sreenivasan Priya , Balachandran Neeraja
Published: June 2020

Objectives: The objective of this study is to study the clinical and laboratory profile, risk factors for the development of blood culture positive septicemia and treatment outcome of children admitted with toxic epidermal necrolysis (TEN). Methods: All children admitted with TEN from January 2012 to January 2017 were included in the study. Blood culture, organ functions, and serum electrolytes were sent at admission and repeated as clinically indicated. Children were managed with reverse isolation in workforce limited setting of a Government Medical College Hospital. Outcome measure analyzed were the duration of hospital stay, development of blood culture positive septicemia and death. Children were followed up for a variable period from 2-month to 1-year. Results: A total of 13 children were admitted with TEN in the 5-year study period, aged 7.9±3.2 years. Mean area of skin involvement was 69±19.9%. Drugs were found to be the most common cause of TEN accounting for 12 cases (92%). Evidence of renal injury was seen in 6 cases (46%). Disorders of sodium balance were the most common electrolyte abnormality observed in 11 cases (85%). There was no statistically significant difference in duration of progression of skin lesions in children who received ?2 g/kg of intravenous immunoglobulin (IVIG) and those who received <2 g/kg of IVIG. The mortality rate was 7.6%. At follow-up, all patients had dyspigmentation and none had scarring. 6 children (46%) had ophthalmic complaints at follow-up. Conclusion: Non-steroidal anti-inflammatory drugs were found to be the most common cause of TEN in children. Furthermore, TEN was found to be a disease causing critical kidney disease in children. Multi-organ dysfunction, hyperglycemia, and need for invasive ventilation were found to be associated with increased risk of developing culture positive sepsis. Low-dose IVIG, parenteral steroids and skin care with normal saline washes and sterile liquid paraffin impregnated gauze are the effective and safe treatment options for children with TEN in resource-limited setting.
Role of ultrasound in early prediction of severity of dengue infection
Authors: Malleshappa K , Srinivasa K
Published: June 2020

Background: Dengue has become a major international health problem in recent years. As per the World Health Organization, dengue has shown a 30-fold increase globally over the past five decades, and approximately, 50-100 million new infections are estimated to occur annually in more than 100 endemic countries. Objective: To evaluate the sonographic findings in children with dengue fever (DF) and to determine its role in predicting the severity of the disease. Methods: One hundred and twenty dengue serology-positive cases in the age group of 2 months to 18 years were studied. These children were divided into two groups - mild (dengue hemorrhagic fever [DHF] I-II without shock) and severe dengue (DHF III-IV with shock). Sonographic variables of these cases were studied and compared by applying appropriate statistical analysis. Results: Out of 120 cases, gallbladder wall thickness (83.3%) and pericholecystic edema (81.6%) were the most common sonographical findings. When sonographic variables of mild and severe groups compared, significant statistical difference was noted in variables such as ascites, pleural effusion, and perinephric edema with p=0.0015, p=0.0058, p<0.000, respectively. Conclusion: Ultrasound can be used as an adjunct modality in patients with suspected DF to detect early signs suggestive of the disease and also useful tool to predict severity of the disease.
Role of gastric aspirate for bacteriological confirmation of pulmonary tuberculosis in hospitalized pre-school children
Authors: Sharma Pradeep Kumar , Sharma Seema , Sharma Milap , Sharma Ajay
Published: June 2020

Introduction: Tuberculosis (TB) is an infectious disease caused by Mycobacterium TB (MTB). India accounts for one-fourth of the global TB burden, i. e., 2.2 million out of 9.6 million new cases annually. Objectives: The aim of this study was to assess the role of gastric aspirate (GA) for bacteriological confirmation of pulmonary TB (PTB) in hospitalized preschool children. Methods: A total of 66 consecutive preschool children hospitalized for suspected PTB were included in the study. These patients were prospectively evaluated with a detailed medical history, anthropometric assessment, physical examination and relevant investigations, including complete blood count, erythrocyte sedimentation rate, tuberculin skin test (TST), chest radiograph and GA on three consecutive mornings for smear and culture of MTB. Results: Out of 66 TB suspects, 20 (30.3%) cases were discharged on antitubercular treatment (ATT) based on clinical, laboratory, TST radiological and bacteriological criteria while 46 (69.7%) cases were discharged with an alternative diagnosis. Among cases discharged on ATT, 5 (25%) cases were bacteriologically confirmed on GA smear and culture for acid-fast bacilli (confirmed cases), and 15 (75%) cases were smear negative (probable cases). Out of 5 bacteriologically confirmed cases, 4 (80%) were in the age group 0-2 years, and 1 (20%) case was in the age group 4-6 years. Conclusion: GA remains a useful diagnostic technique for bacteriological confirmation in young children suspected to have PTB, especially in the inpatient setting. It is cheap, simple to perform and requires no special equipment.
Study of health status and morbidity pattern in 5-18 years Birhor children: A primitive tribe of Chhattisgarh
Authors: Kurrey Virendra Kumar , Lokesh Sharma , Rakesh Nahrel , Sharja Phuljhele
Published: June 2020

Background: A 5-18 years children constitute about 31.6% of the Indian population. This age group, particularly children of underprivileged class are at higher risk to suffer from malnutrition and health-related condition and needs to be developed and cultivate for the country to progress. Objectives: To study the health status and morbidity pattern in Birhor children (5-18 years) of Dharamjaigarh Block Raigarh, Chhattisgarh. Materials and Methods: This cross-sectional study was conducted among 50 Birhor children (boys and girls of 5-18 years age). Anthropometric indices were used to determine the health status and variants, i.e., socioeconomic condition, cultural feeding practices, and family literacy were studied which could have an influence on thehealth status. Morbidity pattern was also studied by assessing the current illness by clinical examination and history of past illnesses. Results: The prevalence of underweight was 32.5%, while stunting was found in 22% and thinness in 24% children. Prevalence of common morbidities was as follows: Pallor (66%), conjunctival xerosis (38%), caries teeth (32%), skin infections (24%), and lymphadenopathy (22%). History of acute febrile illness (non-malaria) was present in 46% cases, malaria in 16%, jaundice in 16%,envenomation/intoxication/animal bites in 16%, and history of hospitalization was present in 12% cases, and trauma/accidents was there in 12% cases in the past. Conclusion: In this study, we found a high prevalence of morbidities in Birhor tribal; though, the health status of these children when compared with other tribes of different states was not critical.
One minute preceptor as an effective teaching and learning method for pediatric internship: An interventional study
Authors: Iyer Chandrakala R , Nanditha G , Raman Janaki
Published: June 2020

Background: Compulsory Rotating Residential Internship (CRRI) is an important learning period for medical graduates to become competent registered medical practitioners. Exclusive teaching programs for interns are scarce. During short pediatric CRRI postings, it is difficult to disseminate the necessary knowledge and skills to manage the common pediatric problems seen in the community by traditional teaching methods. We explored innovative teaching techniques to train the interns in a short time to acquire such basic skills. One minute preceptor (OMP) is a five micro skills clinical teaching, tailored to the learner’s needs by motivating them to learn. Objective: To implement OMP in our busy pediatric outpatient department (OPD) to train the interns andto know if it is an effective teaching technique. Methods: The study group included 15 interns who were posted to pediatric OPD on rotation for a month and never had earlier OMP teaching module. Their learning experience with traditional teaching method was gathered by a validated pre-project questionnaire graded on Likert scale. After 3 OMP sessions with a trained faculty, their learning experience was again collected by a post-project questionnaire. The data were compared and analyzed statistically using stata14 version software. p<0.05 was considered as statistically significant. Results: The average scores of questions went up from 1.3 and3.1 in pre-project questionnaire to average scores of 2.3 and 4.1 in post-project questionnaire on a 5-point Likert scale. This shows OMP as an effective teaching method over traditional teaching method for interns at pediatric OPD. Preceptor experienced OMP as simple, individualized and focused teaching method to the interns. Conclusion: OMP should be implemented in pediatric OPD to train the interns on common pediatric problems.
Randomized controlled trial of antenatal magnesium sulfate for short-term neuroprotection in premature neonates
Authors: C Manoj Varanattu , Menon Bindu , Sankar Ajay , M Anand , Manikoth Prakash
Published: June 2020

Objective: To test the hypothesis that antenatal magnesium sulfate (MgSO4) has a short term neuroprotective role in the early neonatal period, when given to women considered at risk for preterm delivery in a developing country. Study Design: Randomized, placebo-controlled, open label, trial. Participants: A total of 126 mothers who delivered at or below 34 weeks gestation were randomized to receive either antenatal MgSO4 (cases) or normal saline as placebo (controls). A total of 108 babies born were observed for the primary and secondary outcomes. Primary Outcome: The composite of the incidence of death and intraventricular hemorrhage (IVH) by cranial ultrasonography in surviving preterm infants. Results: There were 6 deaths in cases and 11 deaths in controls (relative risk [RR]: 0.54; 95% confidence interval [CI]: 0.2173-1.369; p=0.18). A statistically significant reduction in the number of IVH was observed in cases (n=1) compared to controls (n=9) (RR: 0.11; 95% CI: 0.0145-0.897; p=0.016) with a number needed to treat of 7. Conclusion: Antenatal MgSO4 resulted in a significant reduction in the risk of IVH in preterm infants born at or below 34 weeks of gestation.
Variation of body temperature after sponge bath in stable very low birth weight preterm neonates
Authors: Mangalgi Sharanabasavesh , Upadhya Namratha
Published: June 2020

Aim: To observe the variation of the body temperature after routine sponge bath in stable very low birth weight preterm babies. Methods: 74 babies admitted to the neonatal intensive care unit (NICU) of a tertiary care teaching hospital were enrolled. The inclusion criteria were babies with corrected gestational age between 28 and 36 weeks, birth weight <1500 g during postnatal age of 14-28 days who were stable, on full feeds. All babies were in incubator at preset temperature. The babies received sponge bath within the incubator as a part of developmental care by a trained nurse. The axillary temperatures before bath and at 15, 30 and 60 min post bath were measured. The mean differences between the temperature before bath and after bath were analyzed using repeated measures analysis of variance. A p<0.05 was considered significant. Results: None of the babies receiving sponge bath developed hypothermia. There was a drop in the axillary temperature at 15 min post bath as compared to the temperature before bath (p=0.00, mean difference=?0.174°F, 95% confidence interval=0.119-0.229). Subsequently, there was a rise in temperature at 30 min and the temperature normalized by 60 min after bath. The differences in temperature before and 15 min post bath were uniformly significant across all weight groups. Conclusion: Routine sponge bath in stable preterm babies causes a transient drop in temperature but does not lead to hypothermia. As it is a relatively simple technique and incorporates developmental care, it can be used as a part of routine care of stable preterm babies.
Effect of low-cost white reflecting sling application on efficacy of phototherapy in healthy term neonates with non-hemolytic jaundice: A randomized controlled trial
Authors: Devpura Kusum , Swami Ghanshyam , Debbarma Ripan , Udawat Priyanka , Jangid Amit
Published: June 2020

Objective: The objective of this study was to evaluate the efficacy of white reflecting material (slings) hung from the sides of compact fluorescent lamp (CFL) phototherapy equipment in reducing the duration of phototherapy in healthy term neonates with non-hemolytic jaundice. Design: Randomized controlled trial. Setting: Postnatal ward of a tertiary level neonatal unit. Participants and Intervention: Healthy term neonates with non-hemolytic jaundice between 24 h and 14 days of age were randomly assigned to receive single surface phototherapy with (n=50) or without slings (n=50). Outcome Measure: Primary outcome was rate of reduction of serum bilirubin levels and secondary outcome was duration of phototherapy (hour) required. Results: Birth weight (2780±360 vs. 2790±260 g), gestation (38.22±1.0 vs. 38.08±0.90 week), and initial serum total bilirubin (17.36±1.06 vs. 16.96±1.20 mg/dL) were comparable between the two groups. There was a significant difference in the duration of phototherapy (mean ± standard deviation [SD]) between the sling (53.28±21.02 h) and no sling (62.88±20.22 h) groups (p=0.02). The irradiance of phototherapy equipment (?W/cm2/nm, mean±SD) was higher in sling group compared to no sling group (24.17±0.13 vs. 22.11±0.21). Conclusion: Hanging of white reflective sling on sides of CFL phototherapy equipment resulted in marginal increase in irradiance and reduction in the duration of phototherapy.
A retrospective cross-sectional study of nonsurgical management of childhood intussusception in a tertiary care hospital
Authors: Muduli Jayant Kumar , Mitra Meenakshi
Published: June 2020

Objective: To describe the factors based on which nonsurgical management of acute intussusception may be undertaken. Methodology: A retrospective cross-sectional study was conducted by collecting data of all the children admitted in the pediatric ward of the hospital with radiologically confirmed intussusception between January 2016 and December 2016 from case files. A surgical consultation had been taken, and the children with no hemodynamic instability had been treated with gut rest, intravenous fluids, and sodium phosphate enema. Results: Total 25 cases were studied, and nonsurgical management was successful in 88% of these cases. Statistically significant association was found between younger age (p=0.033), shorter duration of symptoms at presentation (p=0.005), early initiation of treatment (p=0.001) and shorter hospital stay (p=0.002), and successful nonsurgical management of acute intussusception. Conclusion: Younger age, shorter duration of symptoms, and early initiation of management are significantly associated with successful nonsurgical management of acute intussusception. With the above results, risk stratification may be proposed for predicting successful nonsurgical management of acute intussusception.
Valvular heart disease after scorpion sting in a child - A case report
Authors: Prasad Arun , Kumar Sanjeev , Kumar Anil , Kumari Neelam
Published: June 2020

Myocarditis is a life-threatening complication of scorpion sting envenomation, and the victims who survive after this injury have normal cardiac function without any residual valvular lesion unlike acute rheumatic fever which causes residual valvular disease by thickening and scarring. We report here a case of a 9-year-old girl who was detected to have valvular heart disease, 2 months after she had scorpion sting envenomation.
A neonate with perianal cellulitis due to leukocyte adhesion deficiency - A case report
Authors: Jagannathan Muthu Kumaran , Lingaldinna Swapna , Vivek S , Balasubramaniam P
Published: June 2020

Leukocyte adhesion deficiency (LAD) is a rare autosomal recessive disorder characterized by absence or dysfunctional CD18 on the surface of leukocytes due to a mutation in ITGB2 gene. The hallmarks of LAD are defects in leukocyte adhesion and marked leukocytosis. It is characterized by recurrent bacterial infections of the skin and mucosal membrane. Here, we report clinical and flow cytometric immunophenotyping of a baby diagnosed with LAD Type 1.
Effect of central adiposity on lung function tests in adolescents
Authors: Rao Chandrika , Renukappa Varun Bhaktarahalli , Ramu Somashekar Ankanahalli , Srinivas Murthy Nandigudi
Published: June 2020

Objectives: The objectives of the study were to study the relation of total body adiposity and abdominal adiposity markers with forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) in adolescents in Bengaluru. Methods: 125 healthy children from a school and 70 asthmatics from Ramaiah hospital between 10 and 15 years were included in the study. Anthropometry including weight, body mass index (BMI), waist and hip circumference, and abdominal height was done in all study adolescents. The subjects were categorized according to BMI. Pulmonary function tests (PFTs) were done by Knudson methodand FEV1, FVC, and peak expiratory flow (PEF) were measured. The patients were classified by their asthma severity according to GINA guidelines. Results: BMI, weight, waist and hip circumference correlated with abdominal height in male asthmatics and controls where they revealed significant correlations with FEV1/FVC% ratio. In females, abdominal height correlated with BMI, weight, waist and hip circumference in both the groups. PEF correlated with BMI, weight, waist circumference, and abdominal height in healthy females. FEV1/FVC correlated with BMI, abdominal height in female asthmatics, with weight in healthy females.Independent predictors of FEV1/FVC% ratio were hip circumference in males and abdominal height, and waist circumference in females. Conclusion: Increase in obesity is associated with reduced lung volumes and flows. The abdominal adiposity markers (waist and hip circumference, and abdominal height) are significant and effective predictors of obesity and the variations of PFT’s than total adiposity markers (BMI and weight).
Study of cardiac changes in children with malnutrition
Authors: Mannu Alexander , Narayana Ganesh , Ramagopal Ganavi , Vasudevan Jaishree , Nayar Pradeep G
Published: June 2020

Background: Children with malnutrition usually exhibit several alterations in the body composition, one of them being a loss of cardiac muscle and its consequences. Aim: The aim of this study is to detect the incidence of cardiac involvement among malnourished schoolchildren as shown by clinical examination and corresponding investigations. Methodology: This is a prospective case-control study conducted on 15 children between 5 and 15 years of age with malnutrition. Inclusion criteria were children who fall under the definition of moderate malnutrition as per the World Health Organization (WHO) Z-score based on the WHO Child Growth Standards. Children with known congenital/acquired heart diseases were excluded from the study. Thesechildren were assessed by echocardiography and estimation of cardiac troponin T (cTn T) levels for cardiac involvement that was compared with 12 healthy controls. Results: The mean left ventricular mass (LVM) was 16.74 units higher in children with normal nutritional status compared with malnourished children (p=0.092, 95% confidence interval=2.91-36.40).The mean LVM index was 4.76 units higher in children with normal nutritional status compared with kids with malnutrition indicating the reduction of cardiac muscle mass. Conclusion: As cardiac muscle mass is reduced in children with malnutrition leading to various complications, they need early detection, monitoring, and appropriate management.
To study the clinicoetiological profile of children admitted with bleeding diathesis
Authors: Bhalla Kapil , Mehta Poonam , Nanda Sanjiv , Mehra Shuchi
Published: June 2020

Background: Bleeding complications in children may be caused by disorders of secondary hemostasis or fibrinolysis. A child who presents with bleeding warrants evaluation for a significant bleeding problem. Objectives: The aim is to study the clinicoetiological profile of children admitted with bleeding diathesis. Materials and Methods: Children up to the age of 14 years presenting in the Department of Pediatrics, Pandit B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, with hemorrhagic diathesis, that is, non-traumatic spontaneous bleeding, suspected to be either due to the defective primary hemostatic mechanism (platelet– blood vessel interaction) or defective secondary hemostatic mechanism, were enrolled for this study. Frequency distribution of various bleeding disorders in various age groups was studied. Results: A total of 92 children up to the age of 14 years were taken up for study, of which, maximum cases with bleeding presented with hematemesis (23.9%) followed by melena (22.8%). A total of 73 children (79.34%) presented with skin and joint bleeds. We were able to make diagnosis in 82 children (89.1%). Among 82 patients, 31 (37.8%) had bleeding secondary to infections, 11 (13.4%) had coagulation disorder, 9 (10.97%) had Henoch–Schonlein purpura (HSP) and immune thrombocytopenic purpura (ITP) each, 6 (7.3%) had hypoplastic bone marrow, 2 (2.4%) had chronic malaria, 4 (4.9%) had leukemia, 6 (7.3%) had liver diseases, and 6 (7.3%) had hemorrhagic disease of newborn (HDN). Almost half of the children with bleeding manifestations in each age group had thrombocytopenia. The most common causes of bleeding in <1 year were septicemia with thrombocytopenia and HDN; among 1-7 years were infections, ITP, and coagulation disorders; and in more than 7 years were HSP, ITP, liver disease, and hemolytic-uremic syndrome. Conclusion: Our study foundthat the gastrointestinal tract was the most common site of bleeding in children presenting with non-traumatic spontaneous bleed, and thrombocytopenia was present in 50% of the cases in each age group. We also found that infections were the most common cause of bleeding in younger children, whereas immunological causes and coagulation disorders predominate in older children. Hence, while evaluating any child with bleeding, age at presentation is also an important parameter to find the etiological diagnosis.
Mortality profile and incidence of deaths due to neonatal sepsis in an urban tertiary care center in South India: A retrospective study
Authors: Kumar S Vignesh , Kamalarathnam C N , Kumutha J , Bharathi S Mangala , Lingaldinna Swapna
Published: June 2020

Background: The neonatal mortality rate is a key outcome indicator for newborn care and directly reflects prenatal, intrapartum, and neonatal care. Objective: Primary objective was to assess the neonatal mortality profile, incidence of neonatal sepsis among total neonatal deaths and pattern of antimicrobial resistance. Methodology: This was a retrospective descriptive study done at a tertiary care center. All neonatal deaths from January 2014 to December 2014 were reviewed, and primary causes of mortality, incidence of sepsis among neonatal deaths and pattern of antimicrobial resistance were analyzed. Results: Common causes of neonatal mortality were sepsis, respiratory distress syndrome, congenital malformations, asphyxia, extreme preterm, meconium aspiration syndrome. Case fatality rate was high in extreme preterm neonates (82%), followed by respiratory distress syndrome (29%), congenital malformations (29%), sepsis (25%), asphyxia (25%). In our study incidence of neonatal sepsis among total neonatal deaths was about 20.5%. Staphylococcus aureus (60%) and Klebsiella pneumoniae (23%) were predominant organisms. Highest case fatality rate was associated with K. pneumoniae sepsis about 60%, followed by Escherichia coli sepsis (54%) and Acinetobacter sepsis (50%). Multidrug resistance is an emerging problem, especially in Acinetobacter sepsis. Conclusion: Sepsis still remains the leading cause of death in developing countries. S. aureus was the most common predominant organism; of this, two-thirds were methicillin-resistant S. aureus. About 90% of K. pneumoniae were resistant to extended-spectrum cephalosporins. Multidrug resistance is an emerging problem, especially in Acinetobacter sepsis.
Neurodevelopmental assessment of neonates with congenital hypothyroidism in a tertiary care center
Authors: James Jemila , Nair, P M C , Kailas Lalitha , Narayanan Sreedevi
Published: June 2020

Background: Thyroid hormones play a crucial role in early neurodevelopment so that untreated severe congenital hypothyroidism (CH) results in neurological and psychiatric deficits, including intellectual disability, spasticity, and disturbances of gait and coordination. Objective: The aim of this study is to assess the neuromotor and neurocognitive development of babies at 12 months of age who are diagnosed to have CH and initiated on thyroxine treatment at birth. Furthermore, to estimate the occurrence of CH among babies delivered in our hospital through thyroid screening. Study Design: This was a descriptive study. Setting: The study was conducted in Sree Gokulam Medical College Hospital and Research Foundation, a tertiary care center, located in Trivandrum, Kerala. Participants: All babies delivered in the hospital during the study period and neonatal screening was done for CH. Methods: Cord blood was collected as the direct flow of blood from cord, labeled and sent to laboratory from delivery room for analysis (by chemiluminescent assay) of thyroid-stimulating hormone (TSH). Babies with cord blood TSH level ?20 uIU/ml were repeated at 72 h of age for venous TSH and FT4 level. Venous TSH level ?20 uIU/ml with low FT4 (below normal range for age) was considered as abnormal and initiated on treatment before discharge from the hospital. These babies were followed till 12 months of age for neurodevelopmental assessment. Results: The occurrence of CH among babies delivered in our hospital was 0.6 in 100 live births. Neurodevelopmental assessment of babies with CH on follow-up has shown normal neuromotor and neurocognition at 12 months of age with early detection and prompt initiation of L-thyroxine at a higher dose range within 5 days of age. Conclusion: In our study, early detection and initiation of treatment in infants with CH have shown normal neuromotor and neurocognitive development at 12 months of age.
To study the clinical profile of children with pleural effusion at a Tertiary Care Center in North India: A prospective study
Authors: Mehta Poonam , Rathod Kamleshkumar G , Bhalla Kapil , Nanda Sanjiv
Published: June 2020

Introduction: Pleural effusion is the most common manifestation of pleural disorders and is mostly secondary to bacterial infections in children. Aims and Objectives: The primary objective was to study the clinical presentation of pleural effusion in hospitalized children. The secondary objective was to establish the etiology. Methods: A prospective observational study conducted from April 2014 to September 2015. Children >1 month and <14 years diagnosed to have pleural effusion on clinical and radiological examination were included in the study. Data regarding demographic profile, presenting complaints, immunization history, anthropometry, biochemical and radiological investigations, and the outcome of the patients were collected. Results: Seventy-five patients were included in this study. The mean age of the patients was 69.97±48.23 months. Regarding etiology of pleural effusion, it was parapneumonic in 35 (46.6%), empyema in 18 (24%), transudative in 12 (16%), tubercular in 9 (12%), and malignant (non-Hodgkin’s lymphoma) in 1 (1.3%) case. The presenting complaints were fever (82.6%), cough (78.7%), respiratory distress (69.3%), chest pain (36%), and abdominal pain (9.3%). There was no sex predominance. About 16% patients were severely malnourished. Severe anemia was present in 5 (6.7%) patients. None of them required decortication surgery, and none of the patients expired during hospitalization. Conclusion: Pleural effusion is a major health problem with parapneumonic effusion still beingthe most common etiology. Our study also confirmed that fever, cough, and respiratory distress were the most common presenting complaints and most of the children were malnourished. A high index of suspicion is required to avoid delays in diagnosis that may influence treatment and outcome.
Duodenal perforation with Ascaris lumbricoides in a child: A case report
Authors: Agrawal Archana , Aggarwal Bindu , Maletha Madhukar , Gupta Sourabh
Published: June 2020

Gastrointestinal infestation with Ascaris lumbricoides is common in temperate and tropical countries. Although heavy worm infestation produces wide range of acute abdominal complications, duodenal perforation in association with ascariasis, especially in children, is rarely reported. We report a case of 5-year-old girl with duodenal perforation secondary to ascariasis.
Miliary tuberculosis in an immunocompetent adolescent
Authors: Pal Swasti , Gupta Alpa , Dhasmana Renu , Saini Manju , Khanduri Rakhee , Bhat N K
Published: June 2020

Miliary tuberculosis (TB) is a rare form of TB, seen in approximately 1-2% of all the patients with TB. It represents hematogenous dissemination of uncontrolled TB. Human immunodeficiency virus (HIV) pandemic has led to resurgence of TB in both developed and developing countries. Without treatment, the mortality is near 100%. With early and appropriate treatment; however, mortality can be reduced to <10%. Early diagnosis increases the likelihood of a positive outcome. A 15-year-old boy presented to the outpatient department with complaints of dry cough and fever for 2 months, along with the history of anorexia and weight loss. Clinical workup showed mild pallor, hepatosplenomegaly, and choroid tubercles. Screening for HIV antibodies was negative. X-ray chest showed miliary opacities in the bilateral lung fields. Contrast enhanced computed tomography thorax showed multiple military nodules in both lung fields, tree in bud appearance, and multiple enlarged lymph nodes. The patient was treated with 4 drugs antitubercular treatment along with oral steroids. Follow-up after 1 month showed clinical improvement.
Infant feeding practices in an urban tertiary care hospital: A descriptive longitudinal study
Authors: Hegde Jayashree , Manjula L , Venkatesha K R
Published: June 2020

Background: Infant and young child feeding are the corner stone for child development. More than a third of the world’s undernourished children reside in India. Inadequate infant and young child feeding practices with inadequate care and management of common illnesses contributes to malnutrition. Objective: To study the prevailing infant feeding practices and determine influence of factors on infant feeding in a tertiary care hospital. Materials and Methods: A descriptive longitudinal follow-up study was conducted in a tertiary care hospital between November 2010 and April 2012. Maternal and baby’s profiles were obtained using oral questionnaire after birth by personal one-to-one interview. These cases were followed up for their infant feeding practices till 1 year of age in outpatient department and also by telephonic conversation. Continous variables were analysed by mean and SD. For categorical variable frequency and percentage were determined. Results: 61.25% mothers had initiated breastfeeding within 1 h. Prelacteal feed was given to 28.6% babies. 61.5% had initiated complementary feed at 6 months. Bottle feeding was preferred mode of feeding. There was a statistically significant association between initiation of breastfeeding and parity (p=0.022) and type ofdelivery (p<0.0001), religion and complementary feeding introduction (p<0.001), religion and duration of exclusive breastfeeding (EBF) (p=0.003), occupation and EBF duration (p=0.005), education (p=0.015), and religion (p=0.001) were associated with prelacteal feeds. Conclusions: Infant feeding practices observed from the study include early initiation of breastfeeding, appropriate duration of EBF, and timely introduction of complementary feed. Practice of prelacteal and bottle feeding was seen. Infant feeding practices are found to be influenced by several socio-demographic factors.
Prevalence of childhood asthma and its immediate outcome - At tertiary care rural hospital
Authors: Muley Prasad , Dave Hemal , Patel Maitrey , Shah Unnati , Dosi Jigar , Mehta Ankur
Published: June 2020

Introduction: Asthma is a chronic inflammatory disorder of the airways resulting in episodic airway obstruction. Globally, childhood asthma is increasing in the prevalence, despite improvements in investigation and treatment. Childhood asthma seemed more prevalent in urban population and now even in rural areas of India. Objectives: To know the prevalence, assess the risk factors, severity, and immediate outcome of the treatment offered to asthmatic children in a tertiary rural hospital. Materials and Methods: All the diagnosed asthmatic children up to 18 years were enrolled in the study. All the patients of pulmonary Koch’s, congenital heart disease and chronic lung disease were excluded from the study. Clinical profile was noted in recruited patients. Results: The prevalence of childhood asthma among children visiting to our department was 3.93%. 58 (48.33%) had age of onset before the age of 6 years. Asthma was more prevalent in boys. 116 (96.66%) children presented with complain of cough, and 118 (98.33%) children had associated breathlessness. Common precipitating factors were change in season (71.66%), pollen allergy (58.33%), air pollutieon (45.00%), and passive smoking (23.33%). Exercise-induced asthma was seen in 55% cases, diurnal variation in 60% and 28.33% children had family history of atopic disease. Majority of the patient was undernourished. The average duration of stay in persistent asthma is 1.8 times more than in intermittent asthma. Conclusion: Significant number of patient becomes symptomatic before the 6 years of age. Prevention of child from exposure to passive smoking, environmental improvement, and allergen avoidance are major aspects for prevention of asthma exacerbations.
Mean platelet volume as short-term follow-up biomarker in children with celiac disease
Authors: Ramachandran Mohanaraj , Agarwal Anurag , Ravi R N Mandal , Rajeshwari K , Lomash Avinash , Kapoor Seema
Published: June 2020

Objective: To assess the mean platelet volume (MPV) as a short-term follow-up biomarker in celiac disease (CD) and to compare it with anti-tissue transglutaminase antibody (TTGA) assay in Indian children. Material and Methods: Newly diagnosed 35 children aged <12 years who were positive for TTGA and further confirmed by intestinal biopsy with histological Grade 2 and 3 based on modified Marsh Classification were enrolled. TTGA, MPV, and clinical parameters were assessed at enrollment and after 3 months of gluten free diet (GFD). Results: Short stature (94.3%) and diarrhea (80%) were the most common presenting features. 33 (94.3%) children were found to have anemia. MPV reduced significantly from 9.28±1.88 fl to 8.55±1.10 fl after 3 months of GFD, (p<0.001). The mean TTG level reduced from 166.80±59.23 U/ml to 86.45±39.67 U/ml (p<0.001) after 3 months of GFD. Conclusion: MPV is one of the biomarkers that can be used to monitor dietary transgressions in CD in short term.
Feeding practices among tribal mothers of malnutrition prevalent region of Amravati District in India
Authors: Mahure Pankaj , Gurjar Yashashree , Sawkar Jitendra
Published: June 2020

Introduction: Due to lack of intra- and post-natal care, the feeding practices can lead to a number of morbidities in the infancy period. Infant care in the community is influenced by cultural practices prevalent in the specific area apart from medical and economic reasons. Objectives: The objectives of this study were to understand prevalent feeding practices among tribal mothers having children <3 years of age and to explore reasons behind these practices. Methods: This community-based cross-sectional descriptive study was done in the northern tribal region of Amravati district. A total of 312 mothers were selected randomly for the study. Data were collected through face-to-face interviews of mothers who had a child of age <3 years using the structured interview. Results: Nearly 35% of mothers gave colostrum to the baby after 1 h of birth. While 39% of mothers were not found to be feed colostrum to the baby due to family tradition or advice of the elders, and 68% rejected colostrum feeding because they thought it was not clean. As high as 90% of the mothers initiated complementary feeding to the baby between 6 and 8 months of age, whereas 59% of children suffered from illness during 6 months immediately preceding the study. Conclusion: Inappropriate feeding practices need to be corrected to ameliorate the nutritional and health status of infants in a tribal region in India.
Correlation of amplitude electroencephalography in first 24 h after birth in perinatal asphyxiated neonates with short-term clinical outcome
Authors: Goyal Himanshu , Sharma Gopikishan , Gulati R K
Published: June 2020

Objective: To correlate amplitude electroencephalography (aEEG) (in first 24 h after birth) in perinatal asphyxiated neonates with clinical outcome. Materials and Methods: This prospective cohort study was conducted in Jay Kay Lon Mother and Child Hospital, Government Medical College, Kota. All term asphyxiated neonates born with Apgar score of ?7 at 5 min, admitted within 24 h of birth were included in this study. In each case, aEEG was recorded, and neurological examination was done at the time of admission and discharge. Results: Out of 72 cases, 39 neonates of hypoxic-ischemic encephalopathy (HIE) I had normal aEEG. Out of 24 neonates of HIE II, aEEG was normal in 7 and moderately abnormal in 17 neonates. All 9 neonates with HIE III had abnormal aEEG. Sensitivity of aEEG to identify seizures was 76.67%, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 92.86%, 88.46%, and 84.78%, respectively. There were 41 neonates, who were neurologically normal at the time of discharge had normal aEEG. Out of 22 neonates, who were neurologically abnormal at discharge, aEEG was normal in 5 neonates and moderately abnormal in rest 17 neonates. Out of 9 neonates whose death occurred during treatment, aEEG was moderately abnormal in 2 neonates and severely abnormal in 7 neonates. Sensitivity of aEEG (normal pattern) for good outcome was 100% and specificity, PPV, and NPV were 83.87%, 89.13%, and 100%, respectively. Sensitivity of aEEG (abnormal pattern) for poor outcome was 83.87% and specificity, PPV, and NPV were 100%, 100%, and 89.13%, respectively. Conclusion: It is concluded that if aEEG is done within 24 h of birth in asphyxiated neonates, we can predict outcome of the baby. If early aEEG is normal then outcome tends to be favorable. On the other hand, if early aEEG is abnormal, then outcome tends to be unfavorable.
Neonatal Jaundice: Knowledge, attitude beliefs, and practices of postnatal mothers in a tertiary care hospital in Uttarakhand, India
Authors: Aggarwal Bindu , Agrawal Archana , Chaudhary Piyush , Gupta Girish , Rana Sudhir , Gupta Sourabh
Published: June 2020

Background: Neonatal jaundice (NNJ), a preventable cause of brain damage, is the most common cause of admission in the 1st week of life in neonatal intensive care unit. Objective: To determine the knowledge attitude and practices of postnatal mothers toward NNJ in tertiary care hospital. Materials and Methods: In this descriptive analytical study, 350 mothers who underwent delivery in our institute were interviewed within first 72 h of delivery using a structured questionnaire. Data were entered in Microsoft Excel 13 and analyzed with SPSS 23. Results: Mean knowledge score was 6.48±3.93 (0-21). 73% of the mothers knew the site of recognition in NNJ. However, inadequate knowledge regarding causes, danger signs of severity, complications and treatment were seen among respondents. At least one correct answer for cause, danger sign and complication of NNJ was reported by 28%, 54%, and 33% mothers, respectively. Only 8% mothers attributed it as a risk factor for death in the baby. Phototherapy and exchange transfusion as treatment modality was answered by 15% mothers only. Their knowledge score was significantly associated with parity, education level, residence, religion and previously affected babies but not with age. Regarding attitude, 20% mothers were willing to take the baby to the hospital within 24 h on recognition of jaundice, and almost 91% of those seeking medical advice were ready to follow it. Conclusion: Although awareness of NNJ was seen in the majority of mothers, there was a paucity of knowledge regarding causes, danger signs, and effective treatment available. Cultural beliefs and traditional infant care practices do have a significant impact on mothers. Special educational programs and involvement of electronic media are needed to increase the awareness of mothers regarding NNJ.
Dyke-Davidoff-Masson syndrome: A case report
Authors: Chaudhary Piyush , Agrawal Archana , Malhotra Ankur , Bangari Akhil
Published: June 2020

A 7 years girl presented with seizures, intellectual disability, right sided spastic cerebral palsy, and strabismus of right eye. Magnetic resonance imaging (MRI) brain was suggestive of severe volume loss of brain parenchyma with dilatation of ipsilateral lateral ventricle, and other MRI features diagnostic of infantile type Dyke-Davidoff-Masson syndrome also termed as cerebral hemiatrophy. Seizures can be refractory to medical treatment and surgical treatment may become necessary. Greater awareness about the disease is required to diagnose the condition timely and refer to neurosurgery in the case of refractory seizures as hemispherectomy is thetreatment of choice with high success rate.
Naphthalene induced hemolysis in a glucose 6 phosphate dehydrogenase deficient neonate - A case report
Authors: Kamal Murtaza , Arya Sugandha , Shriyan Rhea , Chellani Harish
Published: June 2020

Glucose-6-phosphate dehydrogenase (G6PD), a critical enzyme in the hexose monophosphate pathway, is a key component in the antioxidant mechanism of all cells, particularly erythrocytes. Its deficiency may manifest in the neonatal period in the form of severe hyperbilirubinemia. Hemolysis in neonate may occur de novo or be precipitated by stressors such as oxidant drugs or naphthalene. We report a case of 3 days old, G6PD deficient neonate, with naphthalene induced hemolysis, requiring exchange transfusion.
Macrosomia due to maternal obesity: A case report
Authors: Meshram Rajkumar M , Thakur Poonam , Bhise Balaji , Phatak Amruta
Published: June 2020

Macrosomia, birth weight >4000 g is said to occur in <10% of the pregnancies and is associated with morbidity and mortality in both mother and baby. Although it is more common in diabetic mother, it is also associated with maternal obesity and high-body mass index. We describe the case of near-term male neonate who was delivered by cesarean section and birth weight was 5000 g who developed hypoglycemia and hyperbilirubinemia which was treated successfully.
A case of Canavan disease with normocephaly - A rare entity
Authors: Hassan Shamsuddin , Bajaj Srilatha , Meena Sangeeta , Mina Shyam Sundar
Published: June 2020

Canavan disease (CD) is an autosomal recessive disorder with spongy degeneration of white matter of the brain. It typically presents with developmental delay, visual problems, and macrocephaly. Our patient presented with these features along with normocephaly. Brain magnetic resonance spectroscopy showed typical findings for CD (peaks of N-acetylaspartic acid). This case illustrates the fact that the presence of normocephaly should not be used in isolation to rule out the possibility of CD.